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+Project Gutenberg's The Home Medical Library, Volume II (of VI), by Various
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Home Medical Library, Volume II (of VI)
+
+Author: Various
+
+Editor: Kenelm Winslow
+
+Release Date: January 31, 2009 [EBook #27944]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK THE HOME MEDICAL LIBRARY ***
+
+
+
+
+Produced by Juliet Sutherland, Chris Logan and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+
+
+                           The Home Medical
+                               Library
+
+                                  By
+
+                     KENELM WINSLOW, B.A.S., M.D.
+
+   _Formerly Assistant Professor Comparative Therapeutics, Harvard
+           University; Late Surgeon to the Newton Hospital;
+          Fellow of the Massachusetts Medical Society, etc._
+
+                 With the Coöperation of Many Medical
+              Advising Editors and Special Contributors
+
+                            IN SIX VOLUMES
+
+        _First Aid :: Family Medicines :: Nose, Throat, Lungs,
+           Eye, and Ear :: Stomach and Bowels :: Tumors and
+             Skin Diseases :: Rheumatism :: Germ Diseases
+            Nervous Diseases :: Insanity :: Sexual Hygiene
+            Woman and Child :: Heart, Blood, and Digestion
+                 Personal Hygiene :: Indoor Exercise
+             Diet and Conduct for Long Life :: Practical
+                    Kitchen Science :: Nervousness
+                and Outdoor Life :: Nurse and Patient
+                    Camping Comfort :: Sanitation
+                       of the Household :: Pure
+                      Water Supply :: Pure Food
+                          Stable and Kennel_
+
+                               NEW YORK
+
+                    The Review of Reviews Company
+
+                                 1907
+
+
+
+
+Medical Advising Editors
+
+
+Managing Editor
+
+ALBERT WARREN FERRIS, A.M., M.D.
+
+_Former Assistant in Neurology, Columbia University; Former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, New International Encyclopedia._
+
+
+Nervous Diseases
+
+CHARLES E. ATWOOD, M.D.
+
+_Assistant in Neurology, Columbia University; Former Physician, Utica
+State Hospital and Bloomingdale Hospital for Insane Patients; Former
+Clinical Assistant to Sir William Gowers, National Hospital, London._
+
+
+Pregnancy
+
+RUSSELL BELLAMY, M.D.
+
+_Assistant in Obstetrics and Gynecology, Cornell University Medical
+College Dispensary; Captain and Assistant Surgeon (in charge),
+Squadron A, New York Cavalry; Assistant in Surgery, New York
+Polyclinic._
+
+
+Germ Diseases
+
+HERMANN MICHAEL BIGGS, M.D.
+
+_General Medical Officer and Director of Bacteriological Laboratories,
+New York City Department of Health; Professor of Clinical Medicine in
+University and Bellevue Hospital Medical College; Visiting Physician
+to Bellevue, St. Vincent's, Willard Parker, and Riverside Hospitals._
+
+
+The Eye and Ear
+
+J. HERBERT CLAIBORNE, M.D.
+
+_Clinical Instructor in Ophthalmology, Cornell University Medical
+College; Former Adjunct Professor of Ophthalmology, New York
+Polyclinic; Former Instructor in Ophthalmology in Columbia University;
+Surgeon, New Amsterdam Eye and Ear Hospital._
+
+
+Sanitation
+
+THOMAS DARLINGTON, M.D.
+
+_Health Commissioner of New York City; Former President Medical Board,
+New York Foundling Hospital; Consulting Physician, French Hospital;
+Attending Physician, St. John's Riverside Hospital, Yonkers; Surgeon
+to New Croton Aqueduct and other Public Works, to Copper Queen
+Consolidated Mining Company of Arizona, and Arizona and Southeastern
+Railroad Hospital; Author of Medical and Climatological Works._
+
+
+Menstruation
+
+AUSTIN FLINT, JR., M.D.
+
+_Professor of Obstetrics and Clinical Gynecology, New York University
+and Bellevue Hospital Medical College; Visiting Physician, Bellevue
+Hospital; Consulting Obstetrician, New York Maternity Hospital;
+Attending Physician, Hospital for Ruptured and Crippled, Manhattan
+Maternity and Emergency Hospitals._
+
+
+Heart and Blood
+
+JOHN BESSNER HUBER, A.M., M.D.
+
+_Assistant in Medicine, University and Bellevue Hospital Medical
+College; Visiting Physician to St. Joseph's Home for Consumptives;
+Author of "Consumption: Its Relation to Man and His Civilization; Its
+Prevention and Cure."_
+
+
+Skin Diseases
+
+JAMES C. JOHNSTON, A.B., M.D.
+
+_Instructor in Pathology and Chief of Clinic, Department of
+Dermatology, Cornell University Medical College._
+
+
+Diseases of Children
+
+CHARLES GILMORE KERLEY, M.D.
+
+_Professor of Pediatrics, New York Polyclinic Medical School and
+Hospital; Attending Physician, New York Infant Asylum, Children's
+Department of Sydenham Hospital, and Babies' Hospital, N. Y.;
+Consulting Physician, Home for Crippled Children._
+
+
+Bites and Stings
+
+GEORGE GIBIER RAMBAUD, M.D.
+
+_President, New York Pasteur Institute._
+
+
+Headache
+
+ALONZO D. ROCKWELL, A.M., M.D.
+
+_Former Professor Electro-Therapeutics and Neurology at New York
+Post-Graduate Medical School; Neurologist and Electro-Therapeutist to
+the Flushing Hospital; Former Electro-Therapeutist to the Woman's
+Hospital in the State of New York; Author of Works on Medical and
+Surgical Uses of Electricity, Nervous Exhaustion (Neurasthenia), etc._
+
+
+Poisons
+
+E. ELLSWORTH SMITH, M.D.
+
+_Pathologist, St. John's Hospital, Yonkers; Somerset Hospital,
+Somerville, N. J.; Trinity Hospital, St. Bartholomew's Clinic, and the
+New York West Side German Dispensary._
+
+
+Catarrh
+
+SAMUEL WOOD THURBER, M.D.
+
+_Chief of Clinic and Instructor in Laryngology, Columbia University;
+Laryngologist to the Orphan's Home and Hospital._
+
+
+Care of Infants
+
+HERBERT B. WILCOX, M.D.
+
+_Assistant in Diseases of Children, Columbia University._
+
+
+
+
+Special Contributors
+
+
+Food Adulteration
+
+S. JOSEPHINE BAKER, M.D.
+
+_Medical Inspector, New York City Department of Health._
+
+
+Pure Water Supply
+
+WILLIAM PAUL GERHARD, C.E.
+
+_Consulting Engineer for Sanitary Works; Member of American Public
+Health Association; Member, American Society Mechanical Engineers;
+Corresponding Member of American Institute of Architects, etc.; Author
+of "House Drainage," etc._
+
+
+Care of Food
+
+JANET MCKENZIE HILL
+
+_Editor, Boston Cooking School Magazine._
+
+
+Nerves and Outdoor Life
+
+S. WEIR MITCHELL, M.D., LL.D.
+
+_LL.D. (Harvard, Edinburgh, Princeton); Former President, Philadelphia
+College of Physicians; Member, National Academy of Sciences,
+Association of American Physicians, etc.; Author of essays: "Injuries
+to Nerves," "Doctor and Patient," "Fat and Blood," etc.; of scientific
+works: "Researches Upon the Venom of the Rattlesnake," etc.; of
+novels: "Hugh Wynne," "Characteristics," "Constance Trescott," "The
+Adventures of François," etc._
+
+
+Sanitation
+
+GEORGE M. PRICE, M.D.
+
+_Former Medical Sanitary Inspector, Department of Health, New York
+City; Inspector, New York Sanitary Aid Society of the 10th Ward, 1885;
+Manager, Model Tenement-houses of the New York Tenement-house Building
+Co., 1888; Inspector, New York State Tenement-house Commission, 1895;
+Author of "Tenement-house Inspection," "Handbook on Sanitation," etc._
+
+
+Indoor Exercise
+
+DUDLEY ALLEN SARGENT, M.D.
+
+_Director of Hemenway Gymnasium, Harvard University; Former President,
+American Physical Culture Society; Director, Normal School of Physical
+Training, Cambridge, Mass.; President, American Association for
+Promotion of Physical Education; Author of "Universal Test for
+Strength," "Health, Strength and Power," etc._
+
+
+Long Life
+
+SIR HENRY THOMPSON, Bart., F.R.C.S., M.B. (Lond.)
+
+_Surgeon Extraordinary to His Majesty the King of the Belgians;
+Consulting Surgeon to University College Hospital, London; Emeritus
+Professor of Clinical Surgery to University College, London, etc._
+
+
+Camp Comfort
+
+STEWART EDWARD WHITE
+
+_Author of "The Forest," "The Mountains," "The Silent Places," "The
+Blazed Trail," etc._
+
+
+
+
+[Illustration: HARVEY WASHINGTON WILEY, Ph.D., LL.D.
+
+The researches of Dr. Wiley, Chief of the Bureau of Chemistry in the
+United States Department of Agriculture, were important factors in
+hastening the enactment of the present pure food law. He analyzed the
+various food products and made public the deceptions practiced by
+unscrupulous manufacturers. He aroused attention throughout the
+country by pointing out the necessity of a campaign of education, in
+order, as stated in Volume V, Part II, that the housekeeper might be
+able to determine the purity of every article of food offered for
+sale. As an example of his methods, he organized a "poison squad" of
+government employees who restricted themselves to special diets,
+consisting of food preparations containing drugs commonly used as
+adulterants. In this way he actually demonstrated the effect of these
+substances upon the human system.]
+
+
+
+
+The Home Medical
+Library
+
+
+Volume II
+
+
+THE EYE AND EAR
+THE NOSE, THROAT AND LUNGS
+SKIN DISEASES
+TUMORS :: RHEUMATISM
+HEADACHE :: SEXUAL HYGIENE
+
+By KENELM WINSLOW, B.A.S., M.D. (Harv.)
+
+_Formerly Assistant Professor Comparative Therapeutics, Harvard
+University; Late Surgeon to the Newton Hospital; Fellow of the
+Massachusetts Medical Society, etc._
+
+
+INSANITY
+
+By ALBERT WARREN FERRIS, A.M., M.D.
+
+_Former Assistant in Neurology, Columbia University; former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, "New International Encyclopedia"_
+
+
+NEW YORK
+
+The Review of Reviews Company
+
+1907
+
+
+
+
+Copyright, 1907, by
+
+THE REVIEW OF REVIEWS COMPANY
+
+
+THE TROW PRESS, NEW YORK
+
+
+
+
+_Contents_
+
+
+    PART I
+
+    CHAPTER                                                       PAGE
+
+    I.    THE EYE AND EAR                                           13
+
+            Foreign Bodies in the Eye--Black Eye--Twitching of
+            the Eyelids--Wounds and Burns--Congestion--
+            Conjunctivitis--"Pink Eye"--Strain--Astigmatism--
+            Deafness--Foreign Bodies in the Ear--Earache--Simple
+            Remedies.
+
+    II.   THE NOSE AND THROAT                                       51
+
+            Nosebleed--Foreign Bodies in the Nose--Cold in the
+            Head--Toothache--Mouth-Breathing--Sore Mouth--
+            Pharyngitis--How to Treat Tonsilitis--Quinsy--
+            Diphtheria--Croup--Laryngitis.
+
+    III.  THE LUNGS AND BRONCHIAL TUBES                             87
+
+            Acute and Chronic Bronchitis--Coughs in Children--
+            Liniments and Poultices--Cough Mixtures--Treatment
+            of Pneumonia--Consumption--Asthma--Influenza, its
+            Symptoms and Cure.
+
+    IV.   HEADACHES                                                113
+
+            Causes of Sick Headache--Symptoms and Treatment--
+            Headaches Caused by Indigestion--Organic Disease a
+            Frequent Source--Nervous and Neuralgic Headaches--
+            Effect of Poison--Heat-Stroke.
+
+
+    PART II
+
+    I.    GROWTHS AND ENLARGEMENTS                                 123
+
+            Cancers--Fatty Tumors--Use of Patent Preparations
+            Dangerous--Symptoms and Cure of Rupture--The Best
+            Kind of Truss--Varicose Veins--Varicocele--External
+            and Internal Piles--Operations the Most Certain
+            Cure.
+
+    II.   SKIN DISEASES AND RELATED DISORDERS                      139
+
+            Itching, Chafing, and Chapping--Treatment of
+            Hives--Nettlerash--Pimples--Fever Blisters--Prickly
+            Heat--Cause of Ringworm--Freckles and Other Skin
+            Discolorations--Ivy Poison--Warts and Corns--
+            Boils--Carbuncles.
+
+    III.  RHEUMATISM AND KINDRED DISEASES                          169
+
+            Inflammatory Rheumatism--Symptoms and Treatment--
+            Muscular Rheumatism--Lumbago--Stiff Neck--Rheumatism
+            of the Chest--Chronic Rheumatism--Rheumatic Gout--
+            Scurvy in Adults and Infants--Gout, its Causes and
+            Remedies.
+
+
+    PART III
+
+    I.    HEALTH AND PURITY                                        191
+
+            Duties of Parents--Sexual Abuse--Dangers to
+            Health--Physical Examination of Infants--Necessary
+            Knowledge of Sex Functions Natural--The Critical Age
+            of Puberty--Marriage Relations.
+
+    II.   GENITO-URINARY DISEASES                                  199
+
+            Gonorrhea in Men and Women--Dangers of Infection--
+            Syphilis, its Causes, Symptoms, and Treatment--
+            Incontinence and Suppression of Urine--Bed-wetting--
+            Inflammation of the Bladder--Acute and Chronic
+            Bright's Disease.
+
+
+    PART IV
+
+    I.    INSANITY                                                 229
+
+            Mental Disorder Not Insanity--Illusions of the
+            Insane--Hallucinations and Delusions--Signs and
+            Causes of Insanity--Paranoia--How the Physician
+            Should Be Aided--The Best Preventive.
+
+    _Appendix._ PATENT MEDICINES                                   245
+
+            Advice Regarding the Use of Patent Medicines--Laws
+            Regulating the Sale of Drugs--Proprietary
+            Medicines--Good Remedies--Dangers of So-called
+            "Cures"--Headache Powders--The Great American Fraud.
+
+
+
+
+Part I
+
+THE EYE AND EAR, THE NOSE
+AND THROAT, THE LUNGS
+AND BRONCHIAL TUBES,
+HEADACHES
+
+BY
+
+KENELM WINSLOW
+
+
+
+
+CHAPTER I
+
+=The Eye and Ear=
+
+_Injuries to the Eye--Inflammatory Conditions--"Pink
+Eye"--Nearsightedness and Farsightedness--Deafness--Remedies for
+Earache._
+
+
+=CINDERS AND OTHER FOREIGN BODIES IN THE EYE.=--Foreign bodies are
+most frequently lodged on the under surface of the upper lid, although
+the surface of the eyeball and the inner aspect of the lower lid
+should also be carefully inspected. A drop of a two-per-cent solution
+of cocaine will render painless the manipulations. The patient should
+be directed to continue looking downward, and the lashes and edge of
+the lid are grasped by the forefinger and thumb of the right hand,
+while a very small pencil is gently pressed against the upper part of
+the lid, and the lower part is lifted outward and upward against the
+pencil so that it is turned inside out. The lid may be kept in this
+position by a little pressure on the lashes, while the cinder, or
+whatever foreign body it may be, is removed by gently sweeping it off
+the mucous membrane with a fold of a soft, clean handkerchief.
+
+Hot cinders and pieces of metal may become so deeply lodged in the
+surface of the eye that it is necessary to dig them out with a needle
+(which has been passed through a flame to kill the germs on it) after
+cocaine solution has been dropped into the eye twice at a minute
+interval. Such a procedure is, of course, appropriate for an oculist,
+but when it is impossible to secure medical aid for days it can be
+attempted without much fear, if done carefully, as more harm will
+result if the offending body is left in place. It is surprising to see
+what a hole in the surface of the eye will fill up in a few days. If
+the foreign body has caused a good deal of irritation before its
+removal, it is best to drop into the eye a solution of boric acid (ten
+grains to the ounce of water) four times daily.
+
+
+"=BLACK EYE.="--To relieve this condition it is first necessary to
+reduce the swelling. This can be done by applying to the closed lids,
+every three minutes, little squares of white cotton or linen, four
+fold and about as large as a silver dollar, which have laid on a cake
+of ice until thoroughly cold. This treatment is most effective when
+pursued almost continuously for twenty-four hours. The cold compresses
+should not be permitted to overlap the nose, or a violent cold in the
+head may ensue. The swelling having subsided, the discoloration next
+occupies our attention. This may be removed speedily by applying, more
+or less constantly below the lower lid, little pieces of flannel
+dipped in water as hot as can be borne. The cloths must be changed as
+often as they cool. Repeat this treatment for a half hour every two
+hours or so during the day.
+
+
+=STYE.=--A stye is a boil on the eyelid; it begins at the root of a
+hair as a hard swelling which may extend to the whole lid. The tip of
+the swelling takes on a yellowish color, breaks down and discharges
+"matter" or pus. There are pain and a feeling of tension in the lid,
+and, very rarely, some fever. When one stye follows another it is well
+to have the eyes examined by an oculist, as eye-strain is often an
+inviting cause of the trouble, and this can be corrected by the use of
+glasses. Otherwise the patient is probably "run down" from chronic
+constipation and anæmia (poverty of the blood) and other causes, and
+needs a change of air, tonics, and exercise out of doors. In a
+depreciated condition, rubbing the lids causes introduction of disease
+germs.
+
+The immediate treatment, which may cut short the trouble, consists in
+bathing the eyelid for fifteen minutes at a time, every hour, with a
+hot solution of boric acid (half a teaspoonful to the cup of water).
+Then at night the swelling should be painted with collodion, several
+coats, being careful not to get it in the eye, as it would cause much
+smarting. If the stye persists in progressing, bathing it in hot water
+will cause it to discharge pus and terminate much sooner.
+
+
+=TWITCHING OF THE EYELIDS.=--This condition may be due to eye-strain,
+and can be relieved if the eyes are fitted to glasses by an oculist
+(not an optician). It is frequently an accompaniment of inflammation
+of the eyes, and when this is cured the twitching of the lids
+disappears. When the eyes are otherwise normal the twitching is
+frequently one of the signs of nerve fag and overwork.
+
+
+=WOUNDS AND BURNS ABOUT THE EYES.=--Slight wounds of the inner surface
+of the eyelids close readily without stitching if the boric-acid
+solution (ten grains to the ounce of water) is dropped into the eye
+four times daily. Burns of the inner surface of the lids follow the
+entrance of hot water, hot ashes, lime, acids, and molten metals.
+Burns produced by lime are treated by dropping a solution of vinegar
+(one part of vinegar to four of water) into the eye, while those
+caused by acids are relieved by similar treatment with limewater or
+solution of baking soda (half a teaspoonful to the glass of water). If
+these remedies are not at hand, the essential object is attained by
+washing the eye with a strong current of water, as from a hose or
+faucet. If there is much swelling of the lids, and inflammation after
+the accident, drop boric-acid solution into the eye four times daily.
+Treatment by cold compresses, as recommended for "black eye," will do
+much also to quiet the irritation, and the patient should wear dark
+glasses.
+
+
+=SORE EYES; CONJUNCTIVITIS.=--The mucous membrane lining the inner
+surface of the eyelids also covers the front of the eyeball, although
+so transparent here that it is not apparent to the observer.
+Inflammation of this membrane is more commonly limited to that portion
+covering the inner surfaces of the lids, but may extend to the
+eyeball when the eye becomes "bloodshot" and the condition more
+serious. For the sake of convenience we may speak of a mild form of
+sore eye, as _congestion of the eyelids_, and the more severe type, as
+true _conjunctivitis_ (see p. 18).
+
+
+=CONGESTION OF THE EYELIDS.=--This may be caused by smoke or dust in
+the atmosphere, by other foreign bodies in the eye; frequently by
+eye-strain, due to far- or near-sightedness, astigmatism, or muscular
+weakness, which may be corrected by an oculist's (never an optician's)
+prescription for glasses. Exposure to an excessive glare of light, as
+in the case of firemen, or, on the other hand, reading constantly and
+often in a poor light, will induce irritation of the lids. The germs
+which cause "cold in the head" often find their way into the eyes
+through the tear ducts, which connect the inner corner of the eyes
+with the nose, and thus may set up similar trouble in the eyes.
+
+=Symptoms.=--The eyes feel weary and "as if there were sand in them."
+There may be also smarting, burning, or itching of the lids, and there
+is disinclination for any prolonged use of the eyes. The lids, when
+examined, are found to be much deeper red than usual, and slightly
+swollen, but there is no discharge from the eye, and this fact serves
+to distinguish this mild type of inflammation from the more severe
+form.
+
+=Treatment.=--The use of dark glasses and a few drops of zinc-sulphate
+solution (one grain to the ounce of water) in the eye, three times
+daily, will often cure the trouble. If this does not do so within a
+few days then an oculist should be consulted, and it will frequently
+be found that glasses are needed to secure freedom from irritation of
+the eyes. In using "eye-drops" the head should be held back, and
+several drops be squeezed from a medicine dropper into the inner
+corner of the eye.
+
+
+=CONJUNCTIVITIS; CATARRHAL INFLAMMATION OF THE EYES.=--In this
+disorder there is discharge which sticks the lids together during the
+night. The inner surface of the lids is much reddened, the blood
+vessels in the lining membrane are much enlarged, and the lids are
+slightly swollen. The redness may extend to the eyeball and give it a
+bloodshot appearance. There is no interference with sight other than
+momentary blurring caused by the discharge, and occasionally there is
+very severe pain, as if a cinder had suddenly fallen in the eye. This
+symptom may occur at night and awaken the patient, and may be the
+reason for his first consulting a physician.
+
+One eye is commonly attacked twenty-four to thirty-six hours before
+the other, and even if it is thought that the cause is a cinder, in
+case of one eye, it can hardly be possible to sustain this belief in
+the case of the involvement of both eyes. There is a feeling of
+discomfort about the eyes, and often a burning, and constant watering,
+the tears containing flakes of white discharge.
+
+When the discharge is a copious, creamy pus or "matter," associated
+with great swelling of the lids and pain on exposure to light, the
+cause is usually a germ of a special disease, and the eyesight will
+very probably be lost unless a skillful physician be immediately
+secured. Early treatment is, however, of great service, and, until a
+physician can be obtained, the treatment recommended below should be
+followed conscientiously; by this means the sight may be saved. This
+dangerous variety of inflammation of the eyes is not rare in the
+newborn, and infants having red eyes within a few days of birth should
+immediately receive proper attention, or blindness for life will be
+the issue. This is the usual source of that form of blindness with
+which babies are commonly said to have been born.
+
+All forms of severe inflammation of the lids are contagious,
+especially the variety last considered, and can be conveyed, by means
+of the discharge, through the agency of towels, handkerchiefs, soap,
+wash basins, etc., and produce the same or sometimes different types
+of inflammation in healthy eyes. Therefore, if the severe form of
+conjunctivitis breaks out among any large number of people, as in
+schools, prisons, asylums, and almshouses, isolation of the patients
+should be enforced.
+
+
+"=PINK EYE.="--This is a severe epidemic form of catarrh of the eye,
+which is caused by a special germ known as the "Koch-Weeks bacillus."
+The treatment of this is the same as that outlined below. The germ of
+pneumonia and that of grippe also often cause conjunctivitis, and
+"catching cold," chronic nasal catarrh, exposure to foul vapors and
+gases, or tobacco smoke, and the other causes enumerated, as leading
+to congestion of the lids, are also responsible for catarrhal
+inflammation of the eye.
+
+=Treatment.=--In the milder attacks of conjunctivitis the treatment
+should be that recommended above for congestion of the lids. The
+swelling and inflammation, in the severer types, are greatly relieved
+by the application of the cold-water compresses, advised under the
+section on "black eye," for an hour at a time, thrice daily.
+Confinement in a dark room, or the use of dark glasses, and drops of
+zinc sulphate (one grain in an ounce of water) three times a day, with
+hourly dropping of boric acid (ten grains to the ounce of water)
+constitute the ordinary treatment.
+
+In inflammations with copious discharge of creamy pus, and great
+swelling of the lids, the eyes should be washed out with the
+boric-acid solution every half hour, and a solution of silver nitrate
+(two grains to the ounce of water) dropped into the eye, once daily,
+followed immediately by a weak solution of common salt in water to
+neutralize the nitrate of silver, after its action has been secured.
+The constant use of ice cloths, already mentioned, forms a necessary
+adjunct to treatment. The sound eye must be protected from the chance
+of contagion, arising from a possible infection from the pus
+discharging from its mate. This may be secured by bandaging the well
+eye, or, better, by covering it with a watch crystal kept in place by
+surgeon's plaster.
+
+In treating sore eyes with discharge, in babies, the infant should be
+held in the lap with its head backward and inclined toward the side of
+the sore eye, so that in washing the eye no discharge will flow into
+the sound eye. The boric acid may then be dropped from a medicine
+dropper, or applied upon a little wad of absorbent cotton, to the
+inner corner of the eye, while the eyelids are held apart.
+
+Hemorrhages occurring under the conjunctiva (or membrane lining the
+inner surface of the lids and covering the front surface of the
+eyeball) may be caused by blows or other injury to the eye, by violent
+coughing, by straining, etc. Dark-red spots may appear in the white of
+the eyeball, slightly raised above the surface, which are little blood
+clots under the conjunctival membrane. No special trouble results and
+there is nothing to be done except to wait till the blood is absorbed,
+which will happen in time. If the eyes water, solution of zinc
+sulphate (one grain to the ounce of water) may be dropped into the
+eye, twice daily. Hot applications are beneficial here to promote
+absorption of the clot.
+
+
+=EYE-STRAIN.=--Eye-strain is commonly due to either astigmatism,
+nearsightedness, farsightedness, or weakness of the eye muscles. The
+farsighted eye is one in which parallel rays entering the eye, as from
+a distance, come to a focus behind the retina. The retina is the
+sensitive area for receiving light impressions in the back of the
+eyeball. Sight is really a brain function; one sees with the brain,
+since the optic nerve endings in the back of the eye merely carry
+light impressions to the brain where they are properly interpreted.
+
+In order that vision be clear and perfect, it is essential that the
+rays of light entering the eye be bent so that they strike the retina
+as a single point. In the farsighted or hyperopic eye, the eyeball is
+usually too short for the rays to be properly focused on the sensitive
+nerve area in the back of the eye.
+
+This defect in vision is, however, overcome by the act of
+"accommodation." There is a beautiful transparent, double-convex body,
+about one-third of an inch thick, which looks very much like an
+ordinary glass lens, and is situated in the eye just back of the
+pupil. This is what is known as the crystalline lens, and the rays of
+light are bent in passing through it so as to be properly focused on
+the retina.
+
+The foregoing statements have been made as though objects were always
+at a distance from the eye, so that the rays of light coming from them
+were almost parallel. Yet when one is looking at an object within a
+few inches of the eye the rays diverge or spread out, and these the
+normal eye (if rigid) could not focus on the retina--much less the
+farsighted eye. But the eye is adaptable to change of focus through
+the action of a certain muscle, situated within the eyeball about the
+lens, which controls to a considerable extent the shape of the lens.
+When the muscle contracts it allows the lens to bulge forward by
+virtue of its elasticity, and, therefore, become more convex. This is
+what happens when one looks at near objects, the increased convexity
+of the lens bending the rays of light so that they will focus as a
+point on the retina. (See Plate I, p. 30.)
+
+Now in the farsighted eye this muscular control or "accommodative
+action" must be continually exercised even in looking at distant
+objects, and it is this constant attempt of nature to cure an optical
+defect of the eye which frequently leads to nervous exhaustion or
+eye-strain. The nerve centers, which animate and control the nerves
+supplying the eye muscles to which we have just alluded, are in close
+proximity to other most important nerve centers in the brain, so
+irritation of the eye centers will produce sympathetic irritation of
+these other centers, leading to manifold and complex symptoms which we
+will describe under this head. But these symptoms do not necessarily
+develop in everyone having farsightedness or astigmatism, since both
+are often present at birth.
+
+The power of accommodation is sufficient to overcome the optical
+defect of the eye, providing that the general health is good and the
+eye is not used much for near work. If, on the other hand, excessive
+use of the eyes in reading, writing, figuring, sewing, or other fine
+work is required, and especially if the health becomes impaired, it
+happens that the constant drain on the eye center in the brain will
+result in a group of symptoms which we will consider later. Failure of
+accommodation comes on at about forty, and gradually increases until
+all accommodation is lost at the age of seventy-five.
+
+For this reason it is necessary for persons over forty-five years of
+age, having normal or farsighted eyes, to wear convex glasses in
+reading or doing near work, and these should be changed for stronger
+ones every year or two. These convex glasses save the eyes in their
+attempt to make the lens more convex when looking at near objects in
+farsightedness, and also prove serviceable in the same manner when
+accommodation begins to fail in the case of what is called "old
+sight." The neglect to provide proper glasses for reading any time
+after the age of forty-five, and the failure to replace them by
+stronger lenses when required, distinctly favor the occurrence of
+cataract in later life.
+
+In the act of accommodation, in addition to the muscular action by
+which the lens is made more convex, there is the tendency for the
+action of another group of muscles outside the eyeball, which turn the
+eyes inward when they are directed toward a near object. Here then is
+another source of trouble resulting from farsightedness, i. e., the
+not infrequent occurrence of inward "squint" occasioned by the
+constant use of the muscles pulling the eyes inward during
+accommodation for near objects. Again, inflammation of the eyelids,
+and sometimes of deeper parts of the eyeball, follows untreated
+hyperopia. Early distaste for reading is often acquired by farsighted
+persons, owing to the strain on the accommodative apparatus. The
+convex lens is that used to correct farsightedness.
+
+
+=NEARSIGHTED EYE.=--In the nearsighted eye the eyeball is too long for
+parallel rays entering the eye to be focused upon the retina; they are
+bent, instead, to a point in front of the retina, and then diverge
+making the vision blurred. (Plate I, p. 30.) The act of accommodation
+in making the lens more convex will not aid this condition, but only
+make it worse, so that it is not attempted.
+
+Eye-strain in this optical defect is brought on by constant use of the
+eye muscles (attached to the outside of the eyeball) in directing both
+eyes inward so that they will both center on near objects; the only
+ones which can be seen. Outward squint frequently results, because the
+muscular efforts required to direct both eyes equally inward to see
+near objects are so great that the use of both eyes together is given
+up, and the poorer eye is not used and squints outward, while the
+better eye is turned inward in the endeavor to see. Nearsighted
+persons are apt to stoop, owing to the habitual necessity for coming
+close to the object looked at. Their facial expression is also likely
+to be rather vacant, since they do not distinctly see, and do not
+respond to the facial movements of others.
+
+Nearsightedness, or myopia, is not a congenital defect, but is usually
+acquired owing to excessive near work which requires that the eye
+muscles constantly direct both eyes inward to see near objects. In so
+acting the muscles compress the sides of the eyeballs and tend to
+increase their length, interfere with their nutrition, and aggravate
+the condition when it is once begun. (See Diagram.) Concave lenses are
+used to correct myopia, and they must be worn all the time.
+
+
+=ASTIGMATISM.=--This is a condition caused by inequality of the outer
+surface of the front of the eyeball, and rarely by a similar defect in
+the surfaces of the lens. The curvature of the eyeball in the
+astigmatic eye is greater in one meridian than in the opposite. In
+other words, the front of the eyeball is not regularly spherical, but
+bulges out along a certain line or meridian, while the curvature is
+flattened or normal in the other meridian. For instance, if two
+imaginary lines were drawn, one vertically, and the other horizontally
+across the front of the eyeball intersecting in the center of the
+pupil, they would represent the principal meridians, the vertical and
+the horizontal. As a rule the meridian of greatest curvature is
+approximately vertical, and that of least curvature is at right angles
+to it, or horizontal.
+
+Rays of light in passing through the different meridians of the
+astigmatic eye are differently bent, so that in one of the principal
+meridians rays may focus perfectly on the retina, while in the other
+the rays may focus on a point behind the retinal field. In this case
+the eye is made farsighted or hyperopic in one meridian, and is
+normal in the other. Or again, the rays may be focused in front of the
+retina in one meridian, and directly on the retina in the other; this
+would be an example of nearsighted or myopic astigmatism.
+Farsightedness and nearsightedness are then both caused by
+astigmatism, although in this case not by the length of the eyeball,
+but by inequality in the curvature of the front part (cornea) of the
+eyeball. For example, in simple astigmatism one of the principal
+meridians is hyperopic (turning the rays so that they focus behind the
+retina) or myopic (bending the rays so that they focus in front of the
+retina), while the other meridian is normal. In mixed astigmatism, one
+of the principal meridians is myopic, the other hyperopic; in compound
+astigmatism the principal meridians are both myopic, or both
+hyperopic, but differ in degree; while in irregular astigmatism, rays
+of light passing through different parts of the outer surface of the
+eyeball are turned in so many various directions that they can never
+be brought to a perfect focus by glasses.
+
+It is not by any means possible for a layman to be able always to
+inform himself that he is astigmatic, unless the defect is
+considerable. If a card, on which are heavy black lines of equal size
+and radiating from a common center like the spokes of a wheel, be
+placed on a wall in good light, it will appear to the astigmatic eye
+as if certain lines (which are in the faulty meridian of the eyeball)
+are much blurred, while the lines at right angles to these are clear
+and distinct. Each eye should be tested separately, the other being
+closed. The chart should be viewed from a distance as great as any
+part of it can be seen distinctly. All the lines on the test card
+should look equally black and clear to the normal eye.
+
+Astigmatism is corrected by a cylindrical lens, which is in fact a
+segment of a solid cylinder of glass. The axis of the cylindrical lens
+should be at right angles to the defective meridian of the eye, in
+order to correct the astigmatism. Eye-strain is caused by astigmatism
+in the same manner that it is brought about in the simple farsighted
+eye, i. e., by constant strain on the ciliary muscle, which regulates
+the convexity of the crystalline lens. For it is possible for the
+inequalities of the front surface of the eyeball or of the lens to be
+offset or counterbalanced by change in the convexity of the lens
+produced by the action of this muscle, and it is conceivable that the
+axis of the lens may be tilted one way or another by the same agency,
+and for the same purpose. But, as we have already pointed out, this
+continual muscular action entails great strain on the nerve centers
+which animate the muscle, and if constant near work is requisite, or
+the health is impaired, the nervous exhaustion becomes apparent. The
+lesser degrees of astigmatism often give more trouble than the
+greater.
+
+
+[Illustration: PLATE I
+
+=Plate I=
+
+=ANATOMY OF THE EYE=
+
+The upper illustration shows the six muscles attached to the eye. The
+=Superior Rectus Muscle= pulls and directs the eye upward; the
+=Inferior Rectus=, downward; the =External= and =Internal Rectus
+Muscles= pull the eye to the right and left; the =Oblique Muscles=
+move the eye slantwise in any direction.
+
+Lack of balance of these muscles, and especially inability to focus
+both eyes on a near object without effort, constitute "eye-strain."
+
+The lower cut illustrates the relation of the crystalline lens to
+sight. =Lens Nearsight Focus= shows the lens bulging forward and very
+convex; =Lens Farsight Focus= shows it flat and less convex.
+
+This adjustment of the shape of the crystalline lens is called
+"accommodation"; it is effected by a small muscle in the eyeball.
+
+In the normal eye, the rays of light from an object pass through the
+lens, adjusted for the proper distance, and focus on the retina.
+
+In the nearsighted eye, these rays focus at a point in front of the
+retina; while in the farsighted eye these rays focus behind the
+retina; the nearsighted eye being elongated, and the farsighted eye
+being shortened.]
+
+
+=WEAKNESS OF THE EYE MUSCLES.=--There are six muscles attached to the
+outside of the eyeball which pull it in various directions, and so
+enable each eye to be directed upon a common point, otherwise objects
+will appear double. Weakness of these muscles or insufficiency,
+especially of those required to direct the eyes inward for near work,
+may lead to symptoms of eye-strain. When reading, for example, the
+muscles which pull the eye inward soon grow tired and relax, allowing
+the opposing muscles to pull the eye outward so that the eyes are no
+longer directed toward a common point, and two images may be perceived
+or, more frequently, they become fused together producing a general
+blurring on the page. Then by a new effort of will the internal
+muscles pull the eyes into line again, only to have the performance
+repeated, all of which entails a great strain upon the nervous system,
+and may lead to permanent squint, as has been pointed out. In addition
+to these symptoms caused by weakness of the eye muscles--seeing
+double, blurred vision, and want of endurance for close work--there
+are others which are common to eye-strain in general, as headache,
+nausea, etc., described in the following paragraph.
+
+=Symptoms of Eye-strain.=--Headache is the most frequent symptom. It
+may be about the eyes, but there is no special characteristic which
+will positively enable one to know an eye headache from that arising
+from other sources, although eye-strain is probably the most common
+cause of headache. The headache resulting from eye-strain may then be
+in the forehead, temples, top or the back of the head, or limited
+to one side. It frequently takes the form of "sick headache" (p. 113).
+It is perhaps more apt to appear after any unusual use of the eyes in
+reading, writing, sewing, riding, shopping, or sight-seeing, and going
+to theaters and picture galleries, but this is not by any means
+invariably the case, as eye headache may appear without apparent
+cause.
+
+Nausea and vomiting, with or without headache, nervousness,
+sleeplessness, and dizziness often accompany eye-strain. Sometimes
+there is weakness of the eyes, i. e., lack of endurance for eye work,
+twitching of the eyelids, weeping, styes, and inflammation of the
+lids. In view of the extreme frequency of eye-disorders which lead to
+eye-strain, it behooves people, in the words of an eminent medical
+writer, to recognize that "the subtle influence of eye-strain upon
+character is of enormous importance" inasmuch as "the disposition may
+be warped, injured, and wrecked," especially in the young. Some of the
+more serious nervous diseases, as nervous exhaustion, convulsions,
+hysteria, and St. Vitus's dance may be caused by the reflex irritation
+of the central nervous system following eye-strain.
+
+=Treatment of Eye-strain.=--The essential treatment of eye-strain
+consists in the wearing of proper glasses. It should be a rule,
+without any exception, to consult only a regular and competent
+oculist, and never an optician, for the selection of glasses. It is as
+egregious a piece of folly to employ an optician to choose the
+glasses as it would be to seek an apothecary's advice in a general
+illness. Considerably more damage would probably accrue from following
+the optician's prescription than that of the apothecary, because
+nature would soon offset the effects of an inappropriate drug; but the
+damage to the eyes from wearing improper glasses would be lasting.
+
+Properly to determine the optical error in astigmatic and farsighted
+eyes it is essential to place drops in the eye, which dilate the pupil
+and paralyze the muscles that control the convexity of the crystalline
+lens, and to use instruments and methods of examination, which can
+only be properly undertaken and interpreted by one with the general
+and special medical training possessed by an oculist.
+
+The statement has been emphasized that farsighted and astigmatic
+persons, up to the age of forty-five or fifty, can sometimes overcome
+the optical defects in their eyes by exercise of the ciliary muscle
+which alters the shape of the lens, and, therefore, it would be
+impossible for an examiner to discover the fault without putting drops
+in the eye, which temporarily paralyze the ciliary muscles for from
+thirty-six to forty-eight hours, but otherwise do no harm. After the
+age of fifty it may be unnecessary to use drops, as the muscular power
+to alter the convexity of the lens is greatly diminished. Opticians
+are incompetent to employ these drops, as they may do great damage in
+certain conditions of the eye which can only be detected by a medical
+man specially trained for such work. Opticians are thus sure to be
+caught on one of the horns of a dilemma; either they do not use drops
+to paralyze the ciliary muscle, or, if they do employ the drops, they
+may do irreparable damage to the eye. Any abnormality connected with
+the vision, especially in children, should be a warning to consult an
+oculist. Squint, "cross-eye" (_Strabismus_), as has been stated, may
+often result from near- or far-sightedness, and it may be possible in
+young children to cure the squint by the use of glasses or even drops
+in the eye, whereas in later life it may be necessary to cut some of
+the muscles of the eyeball to correct the condition. It is a wise rule
+to subject every child to an oculist's examination before entering
+upon school life.
+
+
+=DEAFNESS.=--Sudden deafness without apparent reason is more apt to
+result from an accumulation of wax than from any other cause. It is a
+very common ear disorder. The opening into the ear is about an inch
+long, or a little more, and is separated from that part of the ear
+within, which is known as the middle ear, by the eardrum membrane. The
+drum membrane is a thin, skinlike membrane stretched tightly across
+the bottom of the external opening in the ear or auditory canal, and
+shuts it off completely from the middle ear within, and in this way
+protects the middle ear from the entrance of germs, dust, and water,
+but only secondarily aids hearing. The obstruction caused by wax
+usually exists in about the middle of the auditory canal or opening in
+the ear, and only causes deafness when it completely blocks this
+passage.
+
+The deafness is sudden because, owing to the accidental entrance of
+water, the wax quickly swells and chokes the canal; or, in attempts to
+relieve irritation in the ear, the finger or some other object is
+thrust into the opening in the ear (auditory canal) and presses the
+wax down on the ear drum. The obstruction in the ear is usually a
+mixture of waxy secretion from the canal, and little scales of dead
+skin which become matted together in unwise efforts at cleansing the
+ear by introducing a twisted towel or some other object into the ear
+passage and there turning it about; or it may occur owing to disease
+of the ear altering the character of the natural secretion. In the
+normal state, the purpose of the wax is, apparently, to repel insects
+and to glue together the little flakes of cast-off skin in the
+auditory canal, and these, catching on the hairs lining the canal, are
+thrown out of the ears upon the shoulders by the motion of the jaws in
+eating.
+
+Nothing should be introduced into the ear with the idea of cleansing
+it, as the skin growing more rapidly from within tends naturally to
+push the dead portions out as required, and so the canal is
+self-cleansing.
+
+=Symptoms.=--Sudden deafness in one ear usually calls the attention of
+the patient to an accumulation of wax. There is apt to be more or less
+wax in the other ear as well. Noises in the deaf ear and a feeling of
+pressure are also common. Among rarer symptoms are nausea and
+dizziness. But the only way to be sure that deafness is due to choking
+of the ear passage with wax is to see it. This is usually accomplished
+by a physician in the following way: he throws a good light from a
+mirror into a small tube introduced into the ear passage. This is, of
+course, impossible for laymen to do, but if the ear is drawn upward,
+backward, and outward, so as to straighten the canal, it may be
+possible for anyone to see a mass of yellowish-brown or blackish
+material filling the passage. And in any event, if the wax cannot be
+seen, one is justified in treating the case as if it were present, if
+sudden deafness has occurred and competent medical aid is
+unobtainable, since no harm will be done if wax is absent, and, if it
+is present, the escape of wax will usually give immediate relief from
+the deafness and other symptoms.
+
+=Treatment.=--The wax is to be removed with a syringe and water as hot
+as can be comfortably borne. A hard-rubber syringe having a piston,
+and holding from two teaspoonfuls to two tablespoonfuls, is to be
+employed--the larger ones are better. The clothing should be protected
+from water by towels placed over the shoulder, and a basin is held
+under the ear to catch the water flowing out of the canal. The tip of
+the syringe is introduced just within the entrance of the ear, which
+is to be pulled backward and upward, and the stream of water directed
+with some force against the upper and back wall of the passage rather
+than directly down upon the wax. The water which is first returned is
+discolored, and then, on repeated syringing, little flakes of dry
+skin, with perhaps some wax adhering, may be seen floating on the top
+of the water which flows from the ear, and finally, after a longer or
+shorter period, a plug of wax becomes dislodged, and the whole trouble
+is over.
+
+This is the rule, but sometimes the process is very long and tedious,
+only a little coming away at a time, and, rarely, dizziness and
+faintness will require the patient to lie down for a while. The water
+should always be removed from the ear after syringing by twisting a
+small wisp of absorbent cotton about the end of a small stick, as a
+toothpick, which has been dipped into water to make the cotton adhere.
+The tip of the toothpick, thus being thoroughly protected by dry
+cotton applied so tightly that there is no danger of it slipping off,
+while the ear is pulled backward and upward to straighten the canal,
+is gently pushed into the bottom of the canal and removed, and the
+process repeated with fresh cotton until it no longer returns moist.
+Finally a pledget of dry cotton should be loosely packed into the ear
+passage, and worn by the patient for twelve or twenty-four hours.
+
+
+=PERSISTENT AND CHRONIC DEAFNESS.=--A consideration of deafness
+requires some understanding of the structure and relations of the ear
+with other parts of the body, notably the throat. It has been pointed
+out that the external ear--comprising the fleshy portion of the ear,
+or auricle, and the opening, or canal, about an inch long--is
+separated from that portion of the ear within (or middle ear) by the
+drum membrane. The middle ear, while protected from the outer air by
+the drum, is really a part of the upper air passages, and participates
+in disorders affecting them. It is the important part of the ear as it
+is the seat of most ear troubles, and disease of the middle ear not
+only endangers the hearing, but threatens life through proximity to
+the brain.
+
+In the middle ear we have an air space connected with the throat by
+the Eustachian tube, a tube about an inch long running downward and
+forward to join the upper air passage at the junction of the back of
+the nose and upper part of the throat. If one should run the finger
+along the roof of the mouth and then hook it up behind and above the
+soft palate one could feel the openings of these tubes (one for each
+ear) on either side of the top of the throat or back of the nose,
+according to the view we take of it.
+
+Then the middle ear is also connected with a cavity in the bone back
+of the ear (mastoid cavity or cells), and the outer and lower wall is
+formed by the drum membrane. Vibrations started by sound waves which
+strike the ear are connected by means of a chain of three little bones
+from the drum through the middle ear to the nervous apparatus in the
+internal ear. The head of one of these little bones may be seen by an
+expert, looking into the ear, pressing against the inside of the drum
+membrane. Stiffening or immovability of the joints between these
+little bones, from catarrh of the middle ear, is most important in
+producing permanent deafness. The middle ear space is lined with
+mucous membrane continuous with that of the throat through the
+Eustachian tube. This serves to drain mucus from the middle ear, and
+also to equalize the air pressure on the eardrum so that the pressure
+within the middle ear shall be the same as that without.
+
+When there is catarrh or inflammation of the throat or nose it is apt
+to extend up the Eustachian tubes and involve the middle ear. In this
+way the tubes become choked and obstructed with the oversecretion or
+by swelling. The air in the middle ear then becomes absorbed in part,
+and a species of vacuum is produced with increased pressure from
+without on the eardrum. The drum membrane will be pressed in, and
+through the little bones pressure will be made against the sensitive
+nervous apparatus, irritating it and giving rise to deafness,
+dizziness, and the sensation of noises in the ear. Noises from without
+will also be intensified in passing through the middle ear when it is
+converted into a closed cavity through the blocking of the Eustachian
+tube.
+
+A very important feature following obstruction of the Eustachian
+tubes, and rarefaction of the air in the middle ear, is that
+congestion of the blood vessels ensues and increased secretion,
+because the usual pressure of the air on the blood vessels within the
+middle ear is taken away.
+
+This then is the cause of most permanent deafness, to which is given
+the name catarrhal deafness, because every fresh cold in the head, or
+sore throat, tends to start up trouble in the ear such as we have just
+described. Repeated attacks leave vestiges behind until permanent
+deafness remains. In normal conditions every act of swallowing opens
+the apertures of the Eustachian tubes in the throat, and allows of
+equalization of the air pressure within and without the eardrum, but
+if the nose is stopped up by a cold in the head, or enlargement of the
+tonsil at the back of the nose (as from adenoids, see p. 61), the
+process is reversed and air is exhausted from the Eustachian tubes
+with each swallowing motion.
+
+The moral to be drawn from all the foregoing is to treat colds
+properly when they are present, keeping the nose and throat clean and
+clear of mucus, and to have any abnormal obstruction in the nose or
+throat and source of chronic catarrh removed, as enlarged tonsils,
+adenoids, and nasal outgrowths.
+
+
+=FOREIGN BODIES IN THE EAR.=--Foreign bodies, as buttons, pebbles,
+beans, cherry stones, coffee, etc., are frequently placed in the ear
+by children, and insects sometimes find their way into the ear passage
+and create tremendous distress by their struggles. Smooth,
+nonirritating bodies, as buttons, pebbles, etc., do no particular harm
+for a long time, and may remain unnoticed for years. But the most
+serious damage not infrequently results from unskillful attempts at
+their removal by persons (even physicians unused to instrumental work
+on the ear) who are driven to immediate and violent action on the
+false supposition that instant interference is called for. Insects, it
+is true, should be killed without delay by dropping into the ear sweet
+oil, castor, linseed, or machine oil or glycerin, or even water, if
+the others are not at hand, and then the insect should be removed in
+half an hour by syringing as recommended for wax (p. 35).
+
+To remove solid bodies, turn the ear containing the body, downward,
+pull it outward and backward, and rub the skin just in front of the
+opening into the ear with the other hand, and the object may fall out.
+
+Failing in this, syringing with warm water, as for removal of wax,
+while the patient is sitting, may prove successful. The essentials of
+treatment then consist, first, in keeping cool; then in killing
+insects by dropping oil or water into the ear, and, if syringing
+proves ineffective, in using no instrumental methods in an attempt to
+remove the foreign body, but in awaiting such time as skilled medical
+services can be obtained. If beans or seeds are not washed out by
+syringing, the water may cause them to swell and produce pain. To
+obviate this, drop glycerin in the ear which absorbs water, and will
+thus shrivel the seed.
+
+
+=EARACHE.=--Earache is due usually not to neuralgia of the ear, but to
+a true inflammation of the middle ear, which either subsides or
+results in the accumulation of inflammatory products until the drum is
+ruptured and discharge occurs from the external canal. The trouble
+commonly originates from an extension of catarrhal disease of the nose
+or throat; the germs which are responsible for these disorders finding
+their way into the Eustachian tubes, and thus into the middle ear. Any
+source of chronic catarrh of the nose or throat, as enlarged and
+diseased tonsils, adenoids in children, or nasal obstruction, favor
+the growth of germs and the occurrence of frequent attacks of acute
+catarrh or "colds." The grippe has been the most fruitful cause of
+middle-ear inflammation and earache in recent years. Any act which
+forces up fluid or secretions from the back of the nose into the
+Eustachian tubes (see section on Deafness) and thus into the middle
+ear, is apt to set up inflammation there, either through the
+introduction of germs, or owing to the mechanical injury sustained.
+Thus the use of the nasal douche, the act of sniffing water into the
+nose, or blowing the nose violently when there is secretion or fluid
+in the back of the nose, or the employment of the post-nasal syringe
+are one and all attended with this danger. Swimming on the back,
+diving, or surf bathing also endangers the ear, as cold water is
+forcibly driven not only into the external auditory canal, but, what
+is more frequently a source of damage, into the Eustachian tubes
+through the medium of the nose or throat. In this case the plugging
+of the nose with cotton would be of more value than the external
+canal, as is commonly practiced. If water has entered the Eustachian
+tube, blowing the nose and choking merely aggravate the trouble. The
+wiser plan is to do nothing but trust that the water will drain out,
+and if pain ensues treat it as recommended below for earache.
+
+Water in the ears is sometimes removed by jumping about on one foot
+with the troublesome ear held downward, and if it is in the external
+canal it may be wiped out gently with cotton on the end of a match, as
+recommended in the article on treating wax in the ear (see p. 35). In
+the treatment of catarrh in the nose or throat only a spray from an
+atomizer should be used, as Dobell's or Seiler's solutions followed by
+menthol and camphor, twenty grains of each to the ounce of alboline or
+liquid vaseline.[1]
+
+Exposure to cold and the common eruptive diseases of children, as
+scarlet fever, measles, and also diphtheria, are common causes of
+middle-ear inflammation. In the latter disorders the protection
+afforded by a nightcap which comes down over the ears, and worn
+constantly during the illness, is frequently sufficient to ward off
+ear complications.
+
+Although earache or middle-ear inflammation is common, its dangers are
+not fully appreciated, since the various complications are likely to
+arise, and the result is not rarely serious. Extension of the
+inflammation to the bone behind the ear may necessitate chiseling
+away a part of the skull to liberate pus or dead bone in this
+locality, and the occurrence of abscess of the brain will necessitate
+operation.
+
+The use of leeches in the beginning of the attack is of great value,
+and though unpleasant are not difficult or painful in their
+application. One should be applied just in front of the opening into
+the ear (which should be previously closed with cotton to prevent the
+entrance of the leech), and the other behind the ear in the crease
+where it joins the side of the head and at a point a little below the
+level of the external opening into the ear. A drop of milk on these
+spots will often start the leeches immediately at work, or a drop of
+blood obtained with a pin prick. When the leeches are gorged with
+blood and cease to suck, they should be removed and bleeding
+encouraged for half an hour with applications of absorbent cotton
+dipped in hot water. Then clean, dry absorbent cotton is applied, and
+pressure made on the wounds if bleeding does not soon stop or is
+excessive.
+
+The after treatment of the bites consists in cleanliness and the use
+of vaseline. The patient must stay in bed, and the hot-water bag be
+constantly kept on the ear till all pain ceases. If the drum
+perforates, a discharge will usually appear from the external ear.
+Then the canal must be cleansed, once or more daily, by injecting very
+gently into the ear a solution of boric acid (as much of boric acid
+as the water will dissolve), following this by wiping the water out of
+the canal with sterilized cotton, as directed for the treatment of wax
+in the ear (p. 35).
+
+The syringing is permissible only once daily, unless the discharge is
+copious, but the canal may be wiped out in this manner several times a
+day with dry cotton. It is well to keep the opening into the ear
+greased with vaseline, and a plug of clean absorbent cotton loosely
+packed into the canal to keep out the cold. Excessive or too forcible
+syringing may bring about that complication most to be feared,
+although it may appear through no fault in care, i. e., an implication
+of the cavity in the bone back of the ear (mastoid disease). Germs
+find their way through the connecting passage by which this cavity is
+in touch with the middle ear, or may be forced in by violent
+syringing. When this happens, earache, or pain just back of the ear,
+commonly returns during the first or second week after the first
+attack, and tenderness may be observed on pressing on the bone just
+back of the ear close to the canal. Fever, and local redness and
+swelling of the parts over the bone in this region may also occur.
+Confinement to bed, and constant application of a rubber bag
+containing cracked ice, to the painful parts must be enforced. If the
+tenderness on pressure over the bone and pain do not subside within
+twenty-four to forty-eight hours, surgical assistance must be obtained
+at any cost, or a fatal result may ensue. The opening in the drum
+membrane, caused by escape of discharge in the course of middle-ear
+inflammation, usually closes, but even if it does not deafness is not
+a necessary sequence.
+
+The eardrum is not absolutely essential to hearing, but it is of great
+importance to exclude sources of irritation, dust, water, and germs
+which are likely to set up middle-ear trouble. More ordinary
+after-effects are chronic discharge from the ear following acute
+inflammation and perforation of the eardrum, which may mean at any
+time a sudden return of pain with the occurrence of the more dangerous
+conditions just recited, together with deafness. Bearing all this in
+mind it is advisable never to neglect a severe or persistent earache,
+but to call in expert attention. When this is not obtainable the
+treatment outlined below should be carefully followed.
+
+=Symptoms.=--Pain is severe and often excruciating in adults. It may
+be felt over the temple, side and back of the head and neck, and even
+in the lower teeth, as well as in the ear itself. The pain is
+increased by blowing the nose, sneezing, coughing, and stooping. There
+is considerable tenderness usually on pressing on the skin in front of
+the ear passage. In infants there may be little evidence of pain in
+the ear. They are apt to be very fretful, refuse food, cry out in
+sleep, often lie with the affected ear resting on the hand, and show
+tenderness on pressure immediately in front or behind the ear
+passage.
+
+Dullness, fever, chills, and convulsions are not uncommon in children,
+but, on the other hand, after some slight illness it is not infrequent
+for discharge from the ear to be the first sign which calls the
+attention of parent or medical attendant to the source of the trouble.
+For this reason the careful physician always examines the ear in
+doubtful cases of children's diseases. Unless the inflammation
+subsides with treatment, either a thin, watery fluid (serum) is formed
+in the middle ear, or pus, when we have an "abscess of the ear." The
+drum if left to itself breaks down in three to five days, or much
+sooner in children who possess a thinner membrane. A discharge then
+appears in the canal of the external ear, and the pain is relieved. It
+may occasionally happen that the Eustachian tube drains away the
+discharge, or that the discharge from the drum is so slight that it is
+not perceived, and recovery ensues. Discharge from the ear continues
+for a few weeks, and then the hole in the drum closes and the trouble
+ceases. This is the history in favorable cases, but unfortunately, as
+we have indicated, the opposite state of affairs results not
+infrequently, especially in neglected patients.
+
+=Treatment.=--The patient with severe earache should go to bed and
+take a cathartic to move the bowels. He should lie all the time with
+the painful ear on a rubber bag containing water as hot as can be
+comfortably borne. Every two hours a jet of hot water, which has been
+boiled and cooled just sufficiently to permit of its use, is allowed
+to flow gently from a fountain syringe into the ear for ten minutes,
+and then the ear is dried with cotton, as described under the
+treatment of wax in the ear (p. 35). No other "drops" of any kind are
+admissible for use in the ear, and even this treatment is of less
+importance than the dry heat from the hot-water bag, and may be
+omitted altogether if the appliances and skill to dry the ear are
+lacking. Ten drops of laudanum[2] for an adult, or a teaspoonful of
+paregoric for a child six years old, may be given by the mouth to
+relieve the pain. The temperature of the room should be even and the
+food soft.
+
+If the pain continues it is wiser to have an aurist lance the drum, to
+avoid complications, than to wait for the drum membrane to break open
+spontaneously in his absence. Loss or damage of the eardrums may call
+for "artificial eardrums." They do not act at all like the drumhead of
+the musical instrument by their vibrations, but only are of service in
+putting on the stretch the little bones in the middle ear which convey
+sound. Some of those advertised do harm by setting up a mechanical
+irritation in the ear after a time, and a better result is often
+obtained with a ball of cotton or a paper disc introduced into the ear
+by an aurist.
+
+
+[Illustration: PLATE II
+
+=Plate II=
+
+=ANATOMY OF THE EAR=
+
+The illustration on the opposite page shows the interior structure of
+the ear. The concha and =Meatus=, or canal, comprise the external ear,
+which is separated from the middle ear by the =Drum Membrane=. Wax is
+secreted by glands located in the lining of the meatus, and should be
+detached by the motion of the jaws during talking and eating. If it
+adheres to the drum membrane it causes partial deafness.
+
+The internal ear, or labyrinth, a cavity in the bone, back of the
+middle ear, consists of three parts: the =Cochlea=, the =Semicircular
+Canals=, and a middle portion, the =Vestibule=. The middle ear is
+connected with the throat by the =Eustachian Tube=.
+
+Sound vibrations, which strike the drum membrane, are conveyed by
+means of a chain of three small bones through the middle ear to the
+nervous apparatus of the internal ear. The Eustachian tube and middle
+ear are lined throughout with mucous membrane, and any severe
+inflammation of the throat may extend to and involve the tube and the
+middle ear, causing deafness.]
+
+
+=MODERATE OR SLIGHT EARACHE.=--A slight or moderate earache, which
+may, however, be very persistent, not sufficient to incapacitate the
+patient or prevent sleep, is often caused by some obstruction in the
+Eustachian tube, either by swelling or mucous discharge. This
+condition gives rise to the train of effects noted in the section on
+deafness. The air in the middle ear is absorbed to some extent, and
+therefore the pressure within the ear is less than that outside the
+drum, so that the latter is pressed inward with the result that pain,
+and perhaps noises and deafness ensue, and, if the condition is not
+relieved, inflammation of the middle ear as described above.
+
+=Treatment.=--Treatment is directed toward cleaning the back of the
+nose and reducing swelling at the openings of the Eustachian tubes in
+this locality, and inflating the tubes with air. A spray of Seiler's
+solution[3] is thrown from an atomizer through the nostrils, with the
+head tipped backward, until it is felt in the back of the throat, and
+after the water has drained away the process is repeated a number of
+times. This treatment is pursued twice daily, and one hour after the
+fluid in the nose is well cleared away the Eustachian tubes may be
+inflated by the patient. To accomplish this the lips are closed
+tightly, and the nostrils also, by holding the nose; then an effort is
+made to blow the cheeks out till air is forced into the tubes and is
+felt entering both ears. This act is attended with danger of carrying
+up fluid into the tubes and greatly aggravating the condition, unless
+the water from the spray has had time to drain away.
+
+Blowing the nose, as has been pointed out, is unwise, but the water
+may be removed to some extent by "clearing the throat." The reduction
+of swelling at the entrance of the Eustachian tube in the back of the
+nose can be properly treated only by an expert, as some astringent
+(glycerite of tannin) must be applied on cotton wound on a curved
+applicator, and the instrument passed above and behind the roof of the
+mouth into the region back of the nose.
+
+Rubbing the parts just in front of the external opening into the ear
+with the tip of one finger for a period of a few minutes several times
+a day will also favor recovery in this trouble.
+
+
+FOOTNOTES:
+
+[1] See p. 49.
+
+[2] Caution. Ask the doctor first.
+
+[3] Tablets for the preparation of Seiler's solution are to be found
+at most druggists.
+
+
+
+
+CHAPTER II
+
+=The Nose and Throat=
+
+_Cold in the Head--Mouth-Breathing--Toothache--Sore Mouth--Treatment
+of Tonsilitis--Quinsy--Diphtheria._
+
+
+=NOSEBLEED.=--Nosebleed is caused by blows or falls, or more
+frequently by picking and violently blowing the nose. The cartilage of
+the nasal septum, or partition which divides the two nostrils, very
+often becomes sore in spots, owing to irritation of dust-laden air,
+and these crust over and lead to itching. Then "picking the nose"
+removes the crusts, and frequent nosebleed results. Nosebleed also is
+common in both full-blooded and anæmic persons; in the former because
+of the high pressure within the blood vessels, in the latter owing to
+the thin walls of the arteries and capillaries which readily rupture.
+
+Nosebleed is again an accompaniment of certain general disorders, as
+heart disease and typhoid fever. The bleeding comes usually from one
+nostril only, and is a general oozing from the mucous membrane, or
+more commonly flows from one spot on the septum near the nostril, the
+cause of which we have just noted. The blood may spout forth in a
+stream, as after a blow, or trickle away drop by drop, but is rarely
+dangerous except in infants and aged persons with weak blood vessels.
+In the case of the latter the occurrence of bleeding from the nose is
+thought to indicate brittle vessels and a tendency to apoplexy, which
+may be averted by the nosebleed. This is uncertain. If nosebleed comes
+on at night during sleep, the blood may flow into the stomach without
+the patient's knowledge, and on being vomited may suggest bleeding
+from the stomach.
+
+=Treatment.=--The avoidance of excitement and of blowing the nose,
+hawking, and coughing will assist recovery. The patient should sit
+quietly with head erect, unless there is pallor and faintness, when he
+may lie down on the side with the head held forward so that the blood
+will flow out of the nose. There is no cause for alarm in most cases,
+because the more blood lost the more readily does the remainder clot
+and stop bleeding. As the blood generally comes from the lower part of
+the partition separating the nostrils, the finger should be introduced
+into the bleeding nostril and pressure made against this point, or the
+whole lower part of the nose may be simply compressed between the
+thumb and forefinger. If this does not suffice a lump of ice may be
+held against the side of the bleeding nostril, and another placed in
+the mouth. The injection into the nostril of ice water containing a
+little salt is sometimes very serviceable in stopping nosebleed.
+Blowing the nose must be avoided for some time after the bleeding
+ceases.
+
+If none of these methods arrest the bleeding the nostril must be
+plugged. A piece of clean cotton cloth, about five inches square,
+should be pushed gently but firmly into the nostril with a slender
+cylinder of wood about as large as a slate pencil and blunt on the
+end. This substitute for a probe is pressed against the center of the
+cloth, which folds about the stick like a closed umbrella, and the
+cotton is pressed into the nostril in a backward and slightly downward
+direction, for two or three inches, while the head is held erect. Then
+pledgets of cotton wool are packed into the bag formed by the cotton
+cloth after the stick is withdrawn. The mouth of the bag is left
+projecting slightly from the nostril, so that the whole can be
+withdrawn in twenty-four hours.
+
+The bleeding nostril may be more readily plugged by simply pressing
+into it little pledgets of cotton with a slender stick, but it would
+be impossible for an unskilled person to get them out again, and a
+physician should withdraw them inside of forty-eight hours.
+
+
+=FOREIGN BODIES IN THE NOSE.=--Children often put foreign bodies in
+their nose, as shoe buttons, beans, and pebbles. They may not tell of
+it, and the most conspicuous symptoms are the appearance of a thick
+discharge from one nostril, having a bad odor, and some obstruction to
+breathing on the same side. If the foreign body can be seen, the
+nostril on the unobstructed side should be closed and the child made
+to blow out of the other one. If blowing does not remove the body
+it is best to secure medical aid very speedily.
+
+
+[Illustration: PLATE III
+
+=Plate III=
+
+=THE NASAL CAVITY=
+
+In the illustration on the opposite page, the =Red Portion= indicates
+the =Septum= of the nose, the partition which separates the nostrils.
+
+Inflammation of the membrane lining the nasal cavity is the condition
+peculiar to catarrh or "cold in the head." Deformity of the septum may
+obstruct the entrance of air into the nose and create suction on the
+walls of the nasal cavity, causing an overfilling of the blood
+vessels, or "congestion," with subsequent thickening of the mucous
+membrane.
+
+Polypi, small growths which form in the nose, or enlargement of the
+glands in the upper part of the throat (just beyond dotted line at
+inner edge of red portion) also block the air passages and give rise
+to mouth-breathing and its attendant disorders.
+
+Another cause of mouth-breathing is extreme swelling of the membrane
+which covers the turbinated bones of the nose.]
+
+
+=COLD IN THE HEAD FROM OVERHEATING.=--Chilling of the surface of the
+body favors the occurrence of colds, in which lowered bodily vitality
+allows the growth of certain germs always present upon the mucous
+membrane lining the cavities of the nose. Dust and irritating vapors
+also predispose to colds. Overwarm clothing makes a person susceptible
+to colds, while the daily use of cold baths is an effective
+preventive. There is no sufficient reason for dressing more warmly in
+a heated house in winter than one would dress in summer. It is,
+moreover, unwise to cover the chest more heavily than the rest of the
+body. Some one has wisely said: "The best place for a chest protector
+is on the soles of the feet." The rule should always be to keep the
+feet dry and warm, and adapt the clothing to the surrounding
+temperature. Among the germs which cause colds in the head, that of
+pneumonia is the one commonly found in the discharge from the nose.
+When pneumonia is epidemic it is therefore wise to take extra
+precautions to avoid colds, and care for them when they occur.
+
+The presence of chronic trouble in the throat and nose, such as
+described under Mouth-Breathing, Adenoids, etc. (p. 60), is perhaps
+the most frequent cause of colds, because the natural resistance of
+the healthy mucous membrane to the attack of germs is diminished
+thereby, and the catarrhal secretions form a source of food for the
+germs to grow upon. It should also be kept in mind that cold in the
+head is the first sign of measles and of _grippe_. Colds are more
+common in the spring and fall.
+
+=Symptoms.=--Colds begin with chilliness and sneezing, and, if severe,
+there may be also headache, fever, and pain in the back and limbs, as
+in _grippe_. The nose at first feels dry, but soon becomes more or
+less stopped with secretion. The catarrh may extend from the back of
+the nose through the Eustachian tube to the ear, causing earache,
+noises in the ear, and deafness (see p. 41). This unfortunate result
+may be averted by proper spraying of the nose, and avoidance of
+blowing the nose violently.
+
+=Treatment.=--Treatment must be begun at the first suspicion of an
+attack to be of much service. The bowels should be opened with calomel
+or other cathartic; two-fifths of a grain for an adult, half a grain
+for a child. Rest in bed for a day or two, after taking a hot bath and
+a glass of hot lemonade containing a tablespoonful or two of whisky,
+is the most valuable treatment. The Turkish bath is also very
+efficacious in cutting short colds, but involves great risk of
+increasing the trouble unless the patient can return home in a closed
+carriage directly from the bath. Of the numerous remedies which are
+commonly used to arrest colds in the first stages are two which
+possess special virtue; namely, quinine and Dover's powder, given in
+single dose of ten grains of each for an adult. Both of these
+remedies may be taken, but while the Dover's powder is most effective
+it is often necessary for the patient to remain in bed twelve to
+eighteen hours after taking it on account of nausea and faintness
+which would be produced if the patient were up and moving about.
+Rhinitis tablets should never be used. They are generally abused, and,
+indeed, some fatal cases are on record in which they caused death.
+Drugs are of little value except in the beginning of a cold, when they
+are given with the hope of cutting short an attack.
+
+The local applications of remedies to the inflamed region is of
+service. At the onset of the cold, Seiler's solution (conveniently
+made from tablets which are sold in the shops) or Dobell's solution
+should be sprayed from an atomizer, into the nostrils, every half
+hour, and, when the discharge becomes thick and copious, this is to be
+discarded for a spray consisting of alboline (four ounces) and camphor
+and menthol (each thirty grains), used in the same manner as long as
+the cold lasts. Containing bottles should be stood in hot water, in
+order that all sprays for the nostrils may be used warm.
+
+It is well to give babies a teaspoonful of castor oil and a warm bath,
+and keep them in bed. If there is fever with the cold, five drops of
+sweet spirit of niter may be given in a teaspoonful of sweetened water
+every two hours. Liquid vaseline, or the alboline mixture advised for
+adults, may be dropped into the nostrils with a medicine dropper more
+conveniently than applied by spray.
+
+
+=TOOTHACHE.=--When there is a cavity in an aching tooth it should be
+cleaned of food, and a little pledget of cotton wool wrapped on a
+toothpick may be used to wipe the cavity dry. Then the cavity should
+be loosely packed, by means of a toothpick or one prong of a hairpin,
+with a small piece of absorbent cotton rolled between the fingers and
+saturated with one of the following substances, preferably the first:
+oil of cloves, wood creosote or chloroform.
+
+If wood creosote is used the cotton must be well squeezed to get rid
+of the excess of fluid, as it is poisonous if swallowed, and will burn
+the gum and mouth if allowed to overflow from the tooth.
+
+
+=ALVEOLAR ABSCESS= (_improperly called "Ulcerated Tooth"_).--An
+"ulcerated tooth" begins as an inflammation in the socket of a tooth,
+and, if near its deepest part, causes great pain, owing to the fact
+that the pus formed can neither escape nor expand the unyielding bony
+wall of the socket.
+
+This explains why an abscess near the tooth is so much more painful
+than a similar one of soft parts. There may be no cavity in the tooth,
+but the tooth is commonly dead, or its nerve is dying, and the tooth
+is frequently darker in color. It often happens that threatened
+abscess at the root of a tooth, which has been filled, can be averted
+by a dentist's boring down into the root of the tooth, or removing the
+filling. It is not always possible to locate the troublesome tooth,
+from the pain, but by tapping on the various teeth in turn with a
+knife, or other metal instrument, special soreness will be discovered
+in the "ulcerated" tooth. The ulcerated tooth frequently projects
+beyond its fellows, and so gives pain when the jaws are brought
+together in biting.
+
+=Treatment.=--The treatment for threatened abscess near a tooth
+consists in painting tincture of iodine, with a camel's hair brush,
+upon the gum at the root of the painful tooth, and applying, every
+hour or so, over the same spot a toothache plaster (sold by all
+druggists). The gum must be wiped dry before applying the moistened
+toothache plaster. Water, as hot as can be borne, should be held in
+the mouth, and the process repeated for as long a time as possible.
+Then the patient should lie with the painful side of the face upon a
+hot-water bag or bottle. The trouble may subside under this treatment,
+owing to disappearance of the inflammation, or to the unnoticed escape
+of a small amount of pus through a minute opening in the gum. If the
+inflammation continues the pain becomes intense and throbbing; there
+is often entire loss of sleep and rest, fever, and even chills, owing
+to a certain degree of blood poisoning. The gum and face swell on the
+painful side, and the patient often suffers more than with many more
+serious diseases.
+
+After several days of distress, the bony socket of the tooth gives
+way, and the pus makes its exit, and, bulging out the gum, finally
+escapes through this also, to the immediate relief of the patient. But
+serious results sometimes follow letting nature alone in such a case,
+as the pus from an eyetooth may burrow its way into the internal parts
+of the upper jaw, or into the chambers of the nose, while that from a
+back tooth often breaks through the skin on the face, leaving an ugly
+scar, or, if in the lower jaw, the pus may find its way between the
+muscles of the neck, and not come to the surface till it escapes
+through the skin above the collar bone. Pulling the tooth is the most
+effective way of relieving the condition, the only objection being the
+loss of the tooth, which is to be avoided if possible.
+
+If the pain is bearable and there are no chills and fever, the patient
+may save the tooth by remaining in bed with a hot-water bottle
+continually on the face, and taking ten drops of laudanum to relieve
+the pain at intervals of several hours. Then many hours of suffering
+may be prevented if the gum is lanced with a sharp knife (previously
+boiled for five minutes) as soon as the gum becomes swollen, to allow
+of the escape of pus. The dentist is, of course, the proper person to
+consult in all cases of toothache, and the means herein suggested are
+to be followed only when it is impossible to obtain his services.
+
+
+=MOUTH-BREATHING= (_including Adenoids, Chronic Tonsilitis, Deviation
+of the Nasal Septum, Enlarged Turbinates, and Polypi_).--Any
+obstruction in the nose causes mouth-breathing and gives rise to one
+or more of a long train of unfortunate results. Among the disorders
+producing mouth-breathing, enlargement of the glandular tissue in the
+back of the nose and in the throat of children is most important.
+Glandular growths in the upper part of the throat opposite the back of
+the nasal cavities are known as "adenoids"; they often completely
+block the air passage at this point, so that breathing through the
+nose becomes difficult. Associated with this condition we usually see
+enlargement of the tonsils, two projecting bodies, one on either side
+of the entrance to the throat at the back of the mouth. In healthy
+adult throats the tonsils should be hardly visible; in children they
+are active glands and easily visible.
+
+We are unable to see adenoids because of their position, but can be
+reasonably sure of their presence in children where we find symptoms
+resulting from mouth-breathing as described below. The surgeon assures
+himself positively of the existence of adenoids by inserting a finger
+into the mouth of the patient and hooking it up back of the roof of
+the mouth, when they may be felt as a soft mass filling the back of
+the nose passages.
+
+Other less common causes of mouth-breathing, seen in adults as well as
+children, are deviation of the nasal septum, swelling of the mucous
+membrane covering certain bones in the nose (turbinates), and polypi.
+
+Deviation of the nasal septum means displacement of the partition
+dividing the two nostrils, so that more or less obstruction exists.
+This condition may be occasioned by blows on the nose received in the
+accidents common to childhood. The deformity which results leads in
+time to further obstruction in the nose, because when air is drawn in
+through the narrowed passages a certain degree of vacuum is produced
+and suction on the walls of the nose, as would occur if we drew in air
+from a large pair of bellows through a small thin rubber tube. This
+induces an overfilling of the blood vessels in the walls of the
+passages of the nose, and the continued congestion is followed by
+increased thickness of the lining mucous membrane, thus still further
+obstructing the entrance of air. A one-sided nasal obstruction in a
+child with discharge from that side leads one to suspect that a
+foreign body, as a shoe button, has been put in by the child.
+
+Polypi are small pear-shaped growths which form on the membrane lining
+the nasal passages and sometimes completely block them. They resemble
+small grapes without skins.
+
+These, then, are the usual causes of mouth-breathing, but of most
+importance, on account of their frequency and bearing on the health
+and development, are adenoids and enlarged throat tonsils in children.
+Adenoids and enlarged tonsils are often due to inflammation of these
+glands during the course of the contagious eruptive disorders, as
+scarlet fever, measles, or diphtheria; probably, also, to constant
+exposure to a germ-laden atmosphere, as in the case of children
+herded together in tenements.
+
+=Symptoms.=--The mouth-breathing is more noticeable during sleep;
+snoring is common, and the breathing is of a snorting character with
+prolonged pauses. Children suffering from enlarged tonsils and
+adenoids are often backward in their studies, look dull, stupid, and
+even idiotic, and are often cross and sullen; the mouth remains open,
+and the lower lip is rolled down and prominent; the nose has a pinched
+aspect, and the roof of the mouth is high. Air drawn into the lungs
+should be first warmed and moistened by passing through the nose, but
+when inspired through the mouth, produces so much irritation of the
+throat and air passages that constant "colds," chronic catarrh of the
+throat, laryngitis, and bronchitis ensue.
+
+The constant irritation of the throat occurring in mouth-breathers
+weakens the natural resistance against such diseases as acute
+tonsilitis, scarlet fever, and diphtheria, so that they are especially
+subject to these diseases. But these are not the only ailments to
+which the mouth-breather is liable, for earache and deafness naturally
+follow the catarrh, owing to obstruction of the Eustachian tubes (see
+Earache, p. 40, and Deafness, p. 38). Deformity of the chest is
+another result of obstruction to nose-breathing, the common form being
+the "pigeon breast," where the breastbone is unduly prominent. The
+voice is altered so that the patient, as the saying goes, "talks
+through the nose," although, in reality, nasal resonance is reduced
+and difficulty is experienced in pronouncing N and M correctly, while
+stuttering is not uncommon. Nasal obstruction leads to poor nutrition,
+and hence children with adenoids and enlarged tonsils are apt to be
+puny and weakly specimens.
+
+=Treatment.=--The treatment is purely surgical in all cases of nasal
+obstruction: removal of the adenoid growths, enlarged tonsils, and
+polypi, straightening the displaced nasal septum, and burning the
+thickened mucous lining obstructing the air passages in the nose. None
+of the operations are dangerous if skillfully performed, and should be
+generally done, even in the case of delicate children, as the very
+means of overcoming this delicacy. The after treatment is not
+unimportant, consisting in the use of simple generous diet, as plenty
+of milk, bread and butter, green vegetables and fresh meat, and the
+avoidance of pastries, sweets, fried food, pork, salt fish and salt
+meats, also the roots, as parsnips, turnips, carrots and beets, and
+tea and coffee. Life in the open air, emulsion of cod-liver oil, daily
+sponging with cold water while the patient stands in warm water,
+followed by vigorous rubbing, will all assist the return to health.
+
+
+=SORE MOUTH; INFLAMMATION OF THE MOUTH.=--There are various forms of
+inflammation of the mouth, generally dependent upon the entrance of
+germs, associated with indigestion or general weakness following some
+fever or other disease. Unclean nipples of the mother or of the
+bottle, or unclean bottles, allow entrance of germs, and are frequent
+causes. Irritation of a sharp tooth, or from rubbing the gum, or from
+too vigorous cleansing of the mouth, may start the disease. Some
+chemicals, especially mercury improperly prescribed, produce the
+disease. The germs may gain admission in impure milk in some cases.
+Inflammation of the mouth is essentially a children's disease, only
+the ulcerated form being common in adults.
+
+=Symptoms.=--In general, the mouth is hot, very red, dry, and tender;
+the child is fretful and has difficulty in nursing, often dropping the
+nipple and crying; the tongue is coated, and there may be fever and
+symptoms of indigestion, as vomiting; sometimes the disease occurs
+during the course of fevers; later in the course of the disorder the
+saliva often runs freely from the mouth.
+
+=Simple Form.=--In this there are only redness, swelling, and
+tenderness of the inside of the mouth. The tongue is at first dry and
+white, but the white coating comes off, leaving it red in patches.
+After a while the saliva becomes profuse. The treatment consists in
+washing the mouth often in ice water containing about one-half drachm
+of boric acid to four ounces of water by means of cotton tied on a
+stick, and holding lumps of ice in the mouth wrapped in the corner of
+a handkerchief. It is well also to give a teaspoonful of castor oil.
+
+=Aphthous Form.=--In this there are yellow-white spots, resulting in
+little shallow depressions or ulcers, on the inside of the cheeks and
+lips, and on the tongue and roof of the mouth. These occur in crops
+and last from ten to fourteen days. The disease is often preceded by
+vomiting, constipation, and fever, with pain in the mouth and throat,
+and is accompanied by lumps or swelling of the glands under the jaw
+and in the neck. The treatment consists in the use of castor oil, and
+swabbing the mouth, several times a day, after each feeding, with
+boric-acid solution, as advised before, or better with permanganate of
+potash solution, using ten grains to the cup of water.
+
+=Thrush= (_Sprue_).--This form is due to the growth of a special
+fungus in the mouth, causing the appearance of white spots on the
+inside of the cheeks, lips, tongue, and roof of the mouth, looking
+like flakes of curdled milk, but not easily removed. There are also
+symptoms of indigestion, as vomiting, diarrhea, and colic. The disease
+is contagious, and is due to some uncleanliness, often of the bottles,
+nipples, or milk. Sometimes ulcers or sore depressions are left in the
+mouth, and in weak children, in which the disease is apt to occur, the
+result may be serious, and a physician's services are demanded. The
+treatment consists in applying saleratus and water (one teaspoonful in
+a cup of water) to the whole inside of the mouth, between feedings,
+with a camel's-hair brush or with a soft cloth. A dose of castor oil
+is also desirable, and great care as regards cleanliness of the
+bottles and nipples should be exercised.
+
+=Ulcerous Form.=--This does not occur in children under five, but may
+attack persons of all greater ages. It is often seen following measles
+and scarlet fever, and in the poor and ill nourished, and after the
+unwise use of calomel. There are redness and swelling of the gum about
+the base of the lower front teeth, and the gums bleed easily. Matter,
+or pus, forms between the teeth and the gum, and the mouth has a foul
+odor. The gum on the whole lower jaw may become inflamed, and a yellow
+band of ulceration may appear along the gums. The glands under the jaw
+and in the neck are enlarged, feeling like tender lumps, and saliva
+flows freely. In severe cases the gums may become destroyed and eaten
+away by the ulceration, and the bone of the jaw be diseased and
+exposed. As in the graver cases it may become necessary to remove dead
+bone and teeth, and the very dangerous form next described may
+sometimes follow it, it will be seen that it is a disease requiring
+skilled medical attention. The treatment consists in using, as a mouth
+wash and gargle, a solution of chlorate of potash (fifteen grains to
+the ounce) every two hours. Cases usually last at least a week.
+
+=Gangrenous Form.=--This is a rare and fatal form of inflammation of
+the mouth and occurs in children weak and debilitated from other
+diseases, as from the contagious eruptive fevers, chronic diarrhea,
+and scurvy. It is seen more often in hospitals and is contagious. A
+foul odor is noticed about the mouth, in which will be seen an ulcer
+on the gum or inside of the cheek. The cheek swells tremendously, with
+or without pain, and becomes variously discolored--red, purple, black.
+The larger proportion of patients die of exhaustion and blood
+poisoning within one to three weeks, and the only hope is through
+surgical interference at the earliest possible moment.
+
+
+=CANKER.=--A small, shallow, yellow ulcer, appearing on the inside of
+the lips or beneath the tongue during some disorder of the digestion.
+It is very tender when touched and renders chewing or talking somewhat
+painful. Treatment consists of touching the ulcer carefully with the
+point of a wooden toothpick which has been dipped in pure carbolic
+acid (a poison) and then rinsing the resulting white spot and the
+whole mouth very carefully, so as not to swallow any of the acid.
+
+Inflammation of the mouth occurs in two other general diseases, in
+syphilis and rarely in diphtheria. In children born of syphilitic
+parents, deep cracks often appear at either side of the mouth and do
+not heal as readily as ordinary sores, but continue a long time, and
+eventually leave deep scars. In diphtheria the membrane which covers
+the tonsils sometimes spreads to the cheeks, tongue, and lips, but in
+either case the general symptoms will serve to distinguish the
+diseases, and neither can be treated by the layman.
+
+
+=MILD SORE THROAT= (_Acute Pharyngitis_).--The milder sore throat is
+commonly the beginning of an ordinary cold, although sometimes it is
+caused by digestive disorders. Exposure to cold and wet is, however,
+the most frequent source of this form of sore throat. Soreness,
+dryness, and tickling first call attention to the trouble, together
+with a feeling of chilliness and, perhaps, slight fever. There may be
+some stiffness and soreness about the neck, owing to swelling of the
+glands. If the back of the tongue is held down by a spoon handle, the
+throat will be seen to be generally reddened, including the back, the
+bands at the side forming the entrance to the throat at the back of
+the mouth, and the uvula or small, soft body hanging down from the
+middle of the soft palate at the very back of the roof of the mouth.
+The tonsils are not large and red nor covered with white dots, as in
+tonsilitis. Neither is there much pain in swallowing. The surface of
+the throat is first dry, glistening, and streaked with stringy, sticky
+mucus.
+
+=Treatment.=--The disorder rarely lasts more than a few days. The
+bowels should be moved in the beginning of the attack by some purge,
+as two compound cathartic pills or three grains of calomel, and the
+throat gargled, six times daily, with potassium chlorate solution
+(one-quarter teaspoonful to the cup of water), or with Dobell's
+solution. In gargling, simply throw back the head and allow the
+fluid to flow back as far as possible into the throat without
+swallowing it. The frequent use of one of these fluids in an atomizer
+is even preferable to gargling. As an additional treatment, the
+employment of a soothing and pleasant substance, as peppermints,
+hoarhound or lemon drops, or marshmallows or gelatin lozenges, is
+efficacious, and will prove an agreeable remedy to the patient in sad
+contrast with many of our prescriptions. The use of tobacco must be
+stopped while the throat is sore.
+
+
+[Illustration: PLATE IV
+
+=Plate IV=
+
+=THE LARYNX=
+
+The illustration on the opposite page shows the upper part of the
+larynx and the base of the tongue.
+
+During the inspiration of a full breath, or when singing a low note,
+the =Epiglottis= lies forward and points upward, as shown in the cut,
+with the glottis (the passage leading into the windpipe between the
+vocal cords) wide open.
+
+During the act of swallowing, the epiglottis is turned downward and
+backward until it touches the =Cricoid Cartilage=, thus closing the
+glottis. The cricoid cartilage, which forms the upper part of the
+framework of the larynx, rests on the "Adam's apple."
+
+The =False Vocal Cords= are bands of ligament, and take no part in the
+production of sound.
+
+The =True Vocal Cords= move during talking or singing, and relax or
+contract when sounding, respectively, a low or high note. Hoarseness
+and cough occurring during laryngitis, diphtheria, and croup, are the
+result of inflammation of the mucous membrane lining the larynx.]
+
+
+=TONSILITIS= (_Follicular Tonsilitis_).--Tonsilitis is a germ disease
+and is contagious. Exposure to cold and wet and to germ-laden air
+renders persons more liable to attacks. It is more likely to occur in
+young people, especially those who have already suffered from the
+disease and whose tonsils are chronically enlarged, and is most
+prevalent in this country in spring. The disease appears to be often
+associated with rheumatism. Tonsilitis begins much like _grippe_, with
+fever, headache, backache and pain in the limbs, sore throat, and pain
+in swallowing. On inspecting the throat (with the tongue held down
+firmly by a spoon handle and the mouth widely open in a good light,
+preferably sunlight) the tonsils will be seen to be swollen, much
+reddened, and dotted over with pearl-white spots.
+
+Sometimes only one tonsil is so affected, but the other is likely to
+become inflamed also. Occasionally there may be only one spot of
+white on the tonsil. The swelling differs in degree; in some cases the
+tonsils may be so swollen as almost to meet together, but there is no
+danger of suffocation from obstruction of the throat, as occurs in
+diphtheria and very rarely in quinsy. The characteristic appearance
+then consists in large, red tonsils covered with white spots. The
+spots represent discharge which fills in the depressions in the
+tonsil. The fever lasts three days to a week, generally, and then
+subsides together with the other symptoms.
+
+With apparent tonsilitis there must always be kept in mind the
+possibility of diphtheria, and, unfortunately, it is at times
+impossible for the most acute physician to distinguish between these
+two diseases by the appearances of the throat alone. In order to do so
+it is necessary to rub off some of the discharge from the tonsils, and
+examine, microscopically, the kind of germs contained therein. The
+general points of difference are: in diphtheria the tonsils are
+usually completely covered with a gray membrane. In the early stage,
+or in mild cases of diphtheria, there may be only a spot on one
+tonsil, but it is apt to be yellow in color, and is thicker than the
+white spots in tonsilitis. These are the difficult cases. Ordinarily,
+in diphtheria, not only are the tonsils covered with a grayish
+membrane, but this soon extends to the surrounding parts of the
+throat, whereas in tonsilitis the spots are always found on the tonsil
+alone. The white spot can be readily wiped off with a little
+absorbent cotton wound on a stick, in the case of tonsilitis, but in
+diphtheria the membrane can be removed in this way only with
+difficulty, and leaves underneath a rough, bleeding surface. The
+breath is apt to have a bad odor in diphtheria, and the temperature is
+lower (not much over 100° F.) than in tonsilitis, when it is
+frequently 101° to 103° F. Notwithstanding these points, it is never
+safe for a layman to undertake the diagnosis when a physician's
+services are obtainable. On the other hand, when this is not possible
+and the patient's tonsils present the white, dotted appearance
+described, especially if subject to similar attacks, one may be
+reasonably sure that the case is tonsilitis.
+
+=Treatment.=--The patient should be put to bed and kept apart from
+children and young persons, and, if living among large numbers of
+people, should be strictly quarantined. For, although the disease is
+not dangerous, it quickly spreads in institutions, boarding schools,
+etc. If the tonsils are painted with a solution of silver nitrate (one
+drachm to the ounce of water), applied carefully with a camel's-hair
+brush, at the beginning of the attack, and making two applications
+twelve hours apart, the disease may sometimes be arrested. It is well
+also at the start to open the bowels with calomel, giving three grains
+in a single dose, or divided doses of one-half grain each until three
+grains have been taken. Pain is relieved by phenacetin in three- to
+five-grain doses as required, but not taken oftener than once in three
+hours, while at night five to ten grains of Dover's powder (for an
+adult) will secure sleep. For children one-half drop doses of the
+(poisonous) tincture of aconite is preferable to phenacetin. The
+outside of the throat should be kept covered with wet flannel wrung
+out in cold water and covered with oil silk, or an ice bag may be
+conveniently used in its place. A half teaspoonful of the following
+prescription is beneficial unless it disagrees with the stomach. It
+must not be taken within half an hour of a meal, and is not to be
+diluted with water, as it acts, partly through its local effect, on
+the tonsils when allowed to flow from a spoon on the back of the
+tongue.
+
+    [Rx] Glycerin                                4 ounces
+         Tincture of chloride of iron          1/2 ounce
+
+    Mix. Directions, half teaspoonful every half hour.
+
+A mixture of hydrogen dioxide, equal parts, with water can also be
+used to advantage as a spray in an atomizer every two hours. The
+phenacetin and Dover's powder must be discontinued as soon as the pain
+and sleeplessness cease, but the iron preparation and spray should be
+continued until the throat regains its usual condition. A liquid diet
+is desirable during the first part of the attack, consisting of milk,
+cocoa, eggnog (made of the white of egg), soups, and gruels; orange
+juice may be allowed, also grapes. The bowels must be kept regular
+with mild remedies, as a Seidlitz powder in a glass of water in the
+morning, or one or two two-grain tablets of extract of cascara
+sagrada at night.
+
+
+=QUINSY.=--Quinsy is a peritonsilitis; that is, it is an inflammatory
+disease of the tissues in which the tonsil is imbedded, an
+inflammation around the tonsil. The swelling of these tissues thrusts
+the tonsil out into the throat; but the tonsil is little affected.
+Quinsy involves the surrounding structures of the throat, and usually
+results in abscess. The disease is said to be frequently hereditary,
+and often occurs in those subject to rheumatism and gout. It is seen
+more often in spring and autumn and in those living an out-of-door
+existence, and having once had quinsy the victim is liable to frequent
+recurrences of the disease. Quinsy is characterized by much greater
+pain in the throat and in swallowing than is the case in tonsilitis,
+and the temperature is often higher--sometimes 104° to 105° F. When
+the throat is inspected, one or both tonsils are seen to be enlarged
+and crowded into its cavity from the swelling of the neighboring
+parts. The tonsils may almost block the entrance to the throat. The
+voice is thick and indistinct, the glands in the side of the neck
+become swollen, and the neck is sore and stiff in consequence, while
+the mouth can be only partially opened on account of pain. For the
+same reason the patient can swallow neither solid nor liquid food, and
+sits bent forward, with saliva running out of the mouth. The secretion
+of saliva is increased, but is not swallowed on account of the pain
+produced by the act. Sleep is also impossible, and altogether a more
+piteous spectacle of pain and distress is rarely seen. Having reached
+this stage the inflammation usually goes on to abscess (formation
+behind or above or below the tonsil), and, after five to ten days from
+the beginning of the attack, the pus finds its way to the surface of
+the tonsil, and breaks into the mouth to the inexpressible relief of
+the patient. This event is followed by quick subsidence of the
+symptoms. Quinsy is rarely a dangerous disease, yet, occasionally, it
+leads to so much obstruction in the throat that death from suffocation
+ensues unless a surgeon opens the throat and inserts a tube.
+Occasionally the pus from the ruptured abscess enters the larynx and
+causes suffocation.
+
+Quinsy differs from tonsilitis in the following respects: the swelling
+affects the immediate surrounding area of the throat; there are no
+white spots to be seen on the tonsil unless the trouble begins as an
+ordinary tonsilitis; there is great pain on swallowing, and finally
+abscess near the tonsil in most cases.
+
+=Treatment.=--A thorough painting of the tonsils at the onset of a
+threatened attack of quinsy with the silver-nitrate solution, as
+recommended under tonsilitis, may cut short the disorder. A single
+dose of calomel (three to five grains) is also useful for the same
+purpose. The tincture of aconite should be taken hourly in three-drop
+doses until five such have been swallowed, when the drug is to be no
+longer used. The constant use of a hot flaxseed poultice (as large as
+the whole hand and an inch thick, spread between thin layers of cotton
+and applied as hot as can be borne, and changed every half hour) gives
+more relief than anything else, and may possibly lead to disappearance
+of the trouble if employed early enough. The use of the poultices is
+to be kept up until recovery, although they need not be applied so
+frequently as at first. A surgeon's services are especially desirable
+in this disorder, as early puncture of the peritonsillar tissue may
+save days of suffering in affording exit for pus as soon as it forms.
+
+
+=DIPHTHERIA.=--The consideration of diphtheria will be limited to
+emphasizing the importance of calling in expert medical advice at the
+earliest possible moment in suspicious cases of throat trouble. For,
+as we noted under tonsilitis, it is impossible in some cases to
+decide, from the appearance of the throat, whether the disease is
+diphtheria or tonsilitis. A specimen of secretion removed from the
+throat for microscopical examination by a bacteriologist as to the
+presence of diphtheria germs alone will determine the point. When such
+an examination is impossible, it is always best to isolate the
+patient, especially if a child, and treat the case as if it were
+diphtheria. Diphtheria may invade the nose and be discoverable in the
+nostrils. A chronic membranous rhinitis should be treated as a case of
+walking diphtheria.
+
+Antitoxin is the treatment above all other remedies. It has so
+altered the outlook in diphtheria that, formerly regarded by
+physicians with alarm and dismay, it is now rendered comparatively
+harmless. The death rate has been reduced from an average of about
+forty per cent, before the introduction of antitoxin, to only ten per
+cent since its use, and, when it is used at the onset of the disease,
+the results are much more favorable still. This latter fact is the
+reason for obtaining medical advice at the earliest opportunity in all
+doubtful cases of throat ailments; and, we might add, that the
+diagnosis of any case of sore throat is doubtful, particularly in
+children, whenever there is seen a whitish, yellowish-white, or gray
+deposit on the throat. Antitoxin is an absolutely safe remedy, its ill
+effects being sometimes the production of a nettlerash or some mild
+form of joint pains. In small doses, it will prevent the occurrence of
+diphtheria in those exposed, or liable to exposure, to the disease.
+The proper dose and method of employing antitoxin it is impossible to
+impart in a book of this kind. Paralysis of throat, of vocal cords, or
+of arms or legs--partial or entire--is a frequent sequel of
+diphtheria. It is not caused by antitoxin.
+
+The points which it is desirable for everyone to know are, that any
+sore throat--with only a single white spot on the tonsil--may be
+diphtheria, but that when the white spot or deposit not only covers
+the tonsil or tonsils (see Tonsilitis) but creeps up on to the
+surrounding parts, as the palate (the soft curtain which shuts off
+the back of the roof of mouth from the throat), the uvula (the little
+body hanging from the middle of the palate in the back of the mouth),
+and the bands on either side of the back of the mouth at its junction
+with the throat, then the case is probably one of diphtheria. But it
+is often a day or two before the white deposit forms, the throat at
+first being simply reddened. The fever in diphtheria is usually not
+high (often not over 100° to 102° F.), and the headache, backache, and
+pains in the limbs are not so marked as in tonsilitis.
+
+
+=MEMBRANOUS CROUP.=--Membranous croup is diphtheria of the lower part
+of the throat (larynx), in the region of the Adam's apple. If in a
+case of what appears to be ordinary croup (p. 83) the symptoms are not
+soon relieved by treatment, or if any membrane is coughed up, or if,
+on inspection of the throat, it is possible to see any evidence of
+white spots or membrane, then a physician's services are imperative.
+
+It is not very uncommon for patients with mild forms of diphtheria to
+walk about and attend to their usual duties and, if children, to go to
+school, and in that inviting field to spread the disease. These cases
+may present a white spot on one tonsil, or in other cases have what
+looks to be an ordinary sore throat with a simple redness of the
+mucous membrane. Sore throats in persons who have been in any way
+exposed to diphtheria, and especially sore throats in children under
+such circumstances, should always be subjected to microscopical
+examination in the way we have alluded to before, for the safety of
+both the patient and the public.
+
+There is still another point perhaps not generally known and that is
+the fact that the germs of diphtheria may remain in the throat of a
+patient for weeks, and even months, after all signs in the throat have
+disappeared and the patient seems well. In such cases, however, the
+disease can still be communicated in its most severe form to others.
+Therefore, in all cases of diphtheria, examination of the secretion in
+the throat must show the absence of diphtheria germs before the
+patient can rightfully mix with other people.
+
+Gargling and swabbing the throat with the (poisonous) solution of
+bichloride of mercury, 1 part to 10,000 parts of water (none of which
+must be swallowed), should be employed every three or four hours each
+day till the germs are no longer found in the mucus of the tonsils.
+
+
+=HOARSENESS= (_Acute Laryngitis_).--This is an acute inflammation of
+the mucous membrane of the larynx. The larynx is that part of the
+throat, in the region of the Adam's apple, which incloses the vocal
+cords and other structures used in speaking. Hoarseness is commonly
+due to extension of catarrh from the nose in cold in the head and
+_grippe_. It also follows overuse of the voice in public speakers and
+singers, and is seen after exposure to dust, tobacco, or other smoke,
+and very commonly in those addicted to alcohol.
+
+=Symptoms.=--Hoarseness is the first symptom noticed, and perhaps
+slight chilliness, together with a prickling or tickling sensation in
+the throat. There is a hacking cough and expectoration of a small
+amount of thick secretion. There may be slight difficulty in breathing
+and some pain in swallowing. The patient feels generally pretty well,
+and is troubled chiefly by impairment of the voice, which is either
+husky, reduced to a mere whisper, or entirely lost. This condition
+lasts for some days or, rarely, even weeks. There may be a mild degree
+of fever at the outset (100° to 101° F.). Very uncommonly the
+breathing becomes hurried and embarrassed, and swallowing painful,
+owing to excessive swelling and inflammation of the throat, so much so
+that a surgeon's services become imperative to intube the throat or to
+open the windpipe, in order to avoid suffocation. This serious form of
+laryngitis may follow colds, but more often is brought about by
+swallowing very hot or irritating liquids, or through exposure to fire
+or steam. In children, after slight hoarseness for a day or two, if
+the breathing becomes difficult and is accompanied by a crowing or
+whistling sound, with blueness of the lips and signs of impending
+suffocation, the condition is very suggestive of membranous croup (a
+form of diphtheria), which certainly is the case if any white,
+membranous deposit can be either seen in the throat or is coughed up.
+Whenever there is difficulty of breathing and continuous hoarseness,
+in children or adults, the services of a competent physician are
+urgently demanded.
+
+=Treatment.=--The use of cold is of advantage. Cracked ice may be held
+in the mouth, ice cream can be employed as part of the diet, and an
+ice bag may be applied to the outside of the throat. The application
+of a linen or flannel cloth to the throat wrung out of cold water and
+covered with oil silk or waterproof material, is also beneficial, and
+often more convenient than an ice bag. The patient must absolutely
+stop talking and smoking. If the attack is at all severe, he should
+remain in bed. If not so, he must stay indoors. At the beginning of
+the disorder a teaspoonful of paregoric and twenty grains of sodium
+bromide are to be taken in water every three hours, by an adult, until
+three doses are swallowed.
+
+Inhalation of steam from a pitcher containing boiling water is to be
+recommended. Fifteen drops of compound tincture of benzoin poured on
+the surface of a cup of boiling water increases the efficacy of the
+steam inhalation. The head is held above the pitcher, a towel covering
+both the head and pitcher to retain the vapor.
+
+The employment, every two hours, of a spray containing menthol and
+camphor (of each, ten grains) dissolved in alboline (two ounces)
+should be continued throughout the disease. If the hoarseness persists
+and tends to become chronic, it is most advisable for the patient to
+consult a physician skilled in such diseases for local examination and
+special treatment.
+
+
+=CROUP.=--Croup is an acute laryngitis of childhood, usually occurring
+between the ages of two and six years. The nervous element is more
+marked than in adults, so that the symptoms appear more alarming. The
+trouble frequently arises as part of a cold, or as a forerunner of a
+cold, and often is heralded by some hoarseness during the day,
+increasing toward night. The child may then be slightly feverish
+(temperature not over 102° F., usually). The child goes to bed and to
+sleep, but awakens, generally between 9 and 12 P.M., with a hard,
+harsh, barking cough (croupy cough) and difficulty in breathing. The
+breathing is noisy, and when the air is drawn into the chest there is
+often a crowing or whistling sound produced from obstruction in the
+throat, due to spasm of the muscles and to dried mucus coating the
+lining membrane, or to swelling in the larynx. It is impossible to
+separate these causes. The child is frightened, as well as his
+parents, and cries and struggles, which only aggravates the trouble.
+The worst part of the attack is, commonly, soon over, so that as a
+rule the doctor arrives after it is past. While it does last, however,
+the household is more alarmed than, perhaps, by any other common
+ailment.
+
+Death from an attack of croup, pure and simple, has probably never
+occurred. The condition described may continue in a less urgent form
+for two or three hours, and very rarely reappears on following nights
+or days. The child falls asleep and awakens next morning with
+evidences of a cold and cough, which may last several days or a week
+or two.
+
+The only other disease with which croup is likely to be confused is
+membranous croup (diphtheria of the larynx), and in the latter
+disorder the trouble comes on slowly, with hoarseness for two or three
+days and gradually increasing fever (103° to 105° F.) and great
+restlessness and difficulty in breathing, not shortly relieved by
+treatment, as in simple croup. In fifty per cent of the cases of
+membranous croup it is possible to see a white, membranous deposit on
+the upper part of the throat by holding the tongue down with a spoon
+handle and inspecting the parts with a good light.
+
+Croup is more likely to occur in children suffering from adenoids,
+enlarged tonsils, indigestion, and decayed teeth, and is favored by
+dry, furnace heat, by exposure to cold, and by screaming and shouting
+out of doors.
+
+=Treatment.=--Place the child in a warm bath (101° F.) and hold a
+sponge soaked in hot water over the Adam's apple of the throat,
+changing it as frequently as it cools. Hot camphorated oil rubbed over
+the neck and chest aids recovery. If the bowels are not loose, give a
+teaspoonful of castor oil or one or two grains of calomel. The most
+successful remedies are ipecac and paregoric. It is wise to keep both
+on hand with children in the house. A single dose of paregoric
+(fifteen drops for child of two years; one teaspoonful for child of
+seven years) and repeated doses of syrup of ipecac (one-quarter to
+one-half teaspoonful) should be given every hour till the child vomits
+and the cough loosens, and every two hours afterwards. The generation
+of steam near the child also is exceedingly helpful in relieving the
+symptoms. A kettle of water may be heated over a lamp. A rubber or tin
+tube may be attached to the spout of the kettle and carried under a
+sort of sheet tent, covering the child in bed. The tent must be
+arranged so as to allow the entrance of plenty of fresh air. Very
+rarely the character of the inflammation in croup changes, and the
+difficulty in breathing, caused by swelling within the throat,
+increases so that it is necessary to employ a surgeon to pass a tube
+down the throat into the larynx, or to open the child's windpipe and
+introduce a tube through the neck to prevent suffocation.
+
+The patient recovering from croup should generally be kept in a warm,
+well-ventilated room for a number of days after the attack, and
+receive syrup of ipecac three or four times daily, until the cough is
+loosened. If ipecac causes nausea or vomiting, the dose must be
+reduced. The disease is prevented by a simple diet, especially at
+night; by the removal of enlarged tonsils and adenoids; by daily
+sponging, before breakfast, with water as cold as it comes from the
+faucet, while the child stands, ankle deep, in hot water; and by an
+out-of-door existence with moderate school hours; also by evaporating
+water in the room during the winter when furnace heat is used. When
+children show signs of an approaching attack of croup, give three
+doses of sodium bromide (five grains for child two years old; ten
+grains for one eight years old) during the day at two-hour intervals
+and give a warm bath before bedtime, and rub chest and neck with hot
+camphorated oil.
+
+
+
+
+CHAPTER III
+
+=The Lungs and Bronchial Tubes=
+
+_Meaning of Bronchitis--Symptoms and Treatment--Remedies for
+Infants--Pneumonia--Consumption the Great Destroyer--Asthma--La
+Grippe._
+
+
+=COUGH= (_occurring in Bronchitis, Pneumonia, Consumption or
+Tuberculosis, Asthma, and Influenza or Grippe_).--Cough is a symptom
+of many disorders. It may be caused by irritation of any part of the
+breathing apparatus, as the nose, throat, windpipe, bronchial tubes,
+and (in pleurisy and pneumonia) covering membrane of the lung. The
+irritation which produces cough is commonly due either to congestion
+of the mucous membrane lining the air passages (in early stage of
+inflammation of these tissues), or to secretion of mucus or pus
+blocking them, which occurs in the later stages.
+
+Cough is caused by a sudden, violent expulsion of air from the chest
+following the drawing in of a deep breath. A loose cough is to be
+encouraged, as by its means mucus and other discharge is expelled from
+the air passages.
+
+A dry cough is seen in the early stages of various respiratory
+diseases, as bronchitis, pneumonia, pleurisy, consumption, whooping
+cough, and with irritation from enlarged tonsils and adenoids (see p.
+61) occurring in children.
+
+Irritation produced by inhaling dust, or any irritation existing in
+the nose, ear, or throat may lead to this variety of cough. The dry
+cough accomplishes no good, and if continuous and excessive may do
+harm, and demands medicinal relief.
+
+=Bronchitis.=--Cough following or accompanying cold in the head and
+sore throat generally means bronchitis.
+
+The larynx or lower part of the throat ends just below the "Adam's
+apple" in the windpipe. The windpipe is about four and a half inches
+long and three-quarters to an inch in diameter, and terminates by
+dividing into the two bronchial tubes in the upper part of the chest.
+Each bronchial tube divides and subdivides in turn like the branches
+of a tree, the branches growing more numerous and smaller and smaller
+until they finally end in the microscopic air sacs or air cells of the
+lungs. The bronchial tubes convey air to the air cells, and in the
+latter the oxygen is absorbed into the blood, and carbonic acid is
+given up. Bronchitis is an inflammation of the mucous membrane lining
+these tubes. In cough of an ordinary cold only the mucous membrane of
+the windpipe and, perhaps, of the larger tubes is inflamed. This is a
+very mild disorder compared to inflammation of the smaller and more
+numerous tubes.
+
+In bronchitis, besides the ordinary symptoms of a severe cold in the
+head, as sneezing, running of mucus from the nose, sore throat and
+some hoarseness perhaps, and languor and soreness in the muscles,
+there is at first a feeling of tightness, pressure, and rawness in the
+region of the breastbone, with a harsh, dry cough. The coughing causes
+a strain of the diaphragm (the muscle which forms the floor of the
+chest), so that there are often pain and soreness along the lower
+borders of the chest where the diaphragm is attached to the inside of
+the ribs. After a few days the cough becomes looser, greatly to the
+patient's comfort, and a mixture of mucus and pus is expectorated. In
+a healthy adult such a cough is usually not in itself a serious
+affair, and apart from the discomfort of the first day or two, there
+is not sufficient disturbance of the general health to interfere with
+the ordinary pursuits. The temperature is the best guide in such
+cases; if it is above normal (98-3/5° F.) the patient should stay
+indoors. In infants, young children, enfeebled or elderly people,
+bronchitis may be a serious matter, and may be followed by pneumonia
+by extension of the inflammation from the small bronchial tubes into
+the air sacs of the lungs, and infection with the pneumonia germ. The
+principal signs of severe attacks of bronchitis are rapid breathing,
+fever, and rapid pulse.
+
+The normal rate of breathing in adults is seventeen a minute, that is,
+seventeen inbreaths and seventeen outbreaths. In children of one to
+five years the normal rate is about twenty-six breathing movements a
+minute. In serious cases of bronchitis the rate may be twenty-five to
+forty in adults, or forty to sixty in children, per minute.
+
+Of course the only exact way of learning the nature of a chest trouble
+is thorough, careful examination by a physician, for cough, fever,
+rapid breathing and rapid pulse occur in many other diseases besides
+bronchitis, particularly pneumonia.
+
+Pneumonia begins suddenly, often with a severe chill, headache, and
+general pains like _grippe_. In a few hours cough begins, short and
+dry, with violent, stabbing pain in one side of the chest, generally
+near the nipple. The breathing is rapid, with expanding nostrils, the
+face is anxious and often flushed. The matter coughed up at first is
+often streaked with blood, and is thick and like jelly. The
+temperature is often 104°-105° F.
+
+If the disease proceeds favorably, at the end of five, seven, or ten
+days the temperature, breathing, and pulse become normal suddenly, and
+the patient rapidly emerges from a state of danger and distress to one
+of comfort and safety. The sudden onset of pneumonia with chill,
+agonizing pain in side, rapid breathing, and often delirium with later
+bloody or rusty-colored, gelatinous expectoration, will then usually
+serve to distinguish it from bronchitis, but not always.
+
+Whenever, with cough, rapid and difficult breathing occur with rise of
+temperature (as shown by the thermometer) and rapid pulse, the case
+is serious, and medical advice is urgently demanded.
+
+=Treatment of Acute Cough and Bronchitis.=--In the case of healthy
+adults with a cough accompanying an ordinary cold, the treatment is
+very simple, when there is little fever or disturbance of the general
+health. The remedies recommended for cold in the head (p. 55) should
+be taken at first. It is also particularly desirable for the patient
+to stay in the house, or better in bed, for the first day or two, or
+until the temperature is normal.
+
+The feeling of tightness and distress in the chest may be relieved by
+applying a mild mustard paper over the breastbone, or a poultice
+containing mustard, one part, and flour, three parts, mixed with warm
+water into a paste and spread between two single thicknesses of cotton
+cloth about eight inches square. The tincture of iodine painted twice
+over a similar area forms another convenient application instead of
+the mustard. If the cough is excessive and troublesome at night the
+tablets of "ammonium chloride compound with codeine" are convenient.
+One may be taken every hour or two by an adult, till relieved.
+
+Children suffering from a recent cough and fever should be kept in bed
+while the temperature is above normal. It is well to give infants at
+the start a grain of calomel or half a teaspoonful of castor oil, and
+to children of five to eight years double the dose.
+
+The chest should be rubbed with a liniment composed of one part of
+turpentine and two parts of camphorated oil. It is well also to apply
+a jacket made of sheet cotton over the whole chest. It is essential to
+keep the room at a temperature of about 70° F. and well ventilated,
+not permitting babies to crawl on the floor when able to be up, or to
+pass from a warm to a cold room. Sweet spirit of niter is a
+serviceable remedy to use at the beginning: five to fifteen drops
+every two hours in water for a child from one to ten years of age, for
+the first day or two.
+
+If the cough is harsh, hard, or croupy (see p. 83), give syrup of
+ipecac every two hours: ten drops to an infant of one year or under,
+thirty drops to a child of ten years, unless it causes nausea or
+vomiting, when the dose may be reduced one-half. If children become
+"stuffed up" with secretion so that the breathing is difficult and
+noisy, give a teaspoonful of the syrup of ipecac to make them vomit,
+for until they are six or seven years old children cannot expectorate,
+and mucus which is coughed up into the mouth is swallowed by them.
+Vomiting not only gets rid of that secretion which has been swallowed,
+but expels it from the bronchial tubes. This treatment may be repeated
+if the condition recurs.
+
+In infants under a year of age medicine is to be avoided as much as
+possible. A teaspoonful of sweet oil and molasses, equal parts, may be
+given occasionally to loosen the cough in mild cases. In other cases
+use the cough tablet for infants described on p. 91. A paste
+consisting of mustard, one part, and flour, twenty parts, is very
+useful when spread on a cloth and applied all about the chest, front
+and back. The diet should be only milk for young children during the
+first day or two, and older patients should not have much more than
+this, except toast and soups. In feeble babies with bronchitis it is
+wise to give five or ten drops of brandy or whisky in water every two
+hours, to relieve difficulty in breathing.
+
+Children who are subject to frequent colds, or those in whom cough is
+persistent, should receive Peter Möller's cod-liver oil, one-half to
+one teaspoonful, according to age, three times daily after eating. One
+of the emulsions may be used instead if the pure oil is unpalatable.
+Adenoids and enlarged tonsils are a fruitful source of constant colds
+and sore throat, and their removal is advisable (see p. 61). Hardening
+of the skin by daily sponge baths with cold salt water, while the
+child stands or sits in warm water, is effective as a preventive of
+colds, as is also an out-of-door life with proper attention to
+clothing and foot gear.
+
+=Treatment of Pneumonia.=--Patients developing the symptoms described
+as suggestive of pneumonia need the immediate attention of a
+physician. If a person is unfortunate enough to have the care of such
+a case, when it is impossible to secure a physician, it may afford
+some comfort to know that good nursing is really the prime requisite
+in aiding recovery, while skillful treatment is of most value if
+complications arise.
+
+One in every ten cases of pneumonia in ordinarily healthy people
+proves fatal. In specially selected young men, as soldiers, the death
+rate from pneumonia is only one in twenty-five cases. On the other
+hand, pneumonia is the common cause of death in old age; about seventy
+out of every hundred patients who die from pneumonia are between sixty
+and eighty years of age. Infants under a year old, and persons
+enfeebled with disease or suffering from excesses, particularly
+alcoholism, are also likely to die if stricken with the disease.
+
+The patient should go to bed in a large, well-ventilated, and sunny
+room. The temperature of the room should be about 70° F., and the
+patient must not be covered so warmly with clothing as to cause
+perspiration. A flannel jacket may be made to surround the chest, and
+should open down the whole front. The nightshirt is worn over this;
+nothing more. Daily sponging of the patient with tepid water (85° to
+90° F.) should be practiced. The body is not to be all exposed at
+once, but each limb and the trunk are to be separately sponged and
+dried. If the fever is high (104° F.) the water should be cold (77° to
+72° F.), and the sponging done every three hours in the case of a
+strong patient. Visitors must be absolutely forbidden. No more than
+one or two persons are to be allowed in the sick room at once.
+
+The diet should consist chiefly of milk, a glass every two hours,
+varied with milk mixed with thin cooked cereal or eggnog. It is wise
+to give at the beginning of the disease a cathartic, such as five
+grains of calomel followed in twelve hours by a Seidlitz powder, if
+the bowels do not act freely before that time. To relieve the pain in
+the side, if excruciating, give one-quarter grain morphine
+sulphate,[4] and repeat once, if necessary, in two hours. The
+application of an ice bag to the painful side frequently stops the
+pain, and, moreover, is excellent treatment throughout the course of
+the disease. The seat of pain usually indicates that the lung on that
+side is the inflamed one, so that the ice bag should be allowed to
+rest against that portion of the chest. Water should be freely
+supplied, and should be given as well as milk even if the patient is
+delirious.
+
+The bowels are to be moved daily by glycerin suppositories or
+injection of warm water. Dover's powder in doses of five grains is
+useful to assuage cough. It may be repeated once, after two hours'
+interval if desirable, but must not be employed at the same time as
+morphine. After the first two or three days are passed, or sooner in
+weak subjects, give strychnine sulphate, one-thirtieth grain, every
+six hours in pill or tablet form. The strychnine is to be continued
+until the temperature becomes normal, and then reduced about one-half
+in amount for a week or ten days while the patient remains in bed, as
+he must for some time after the temperature, pulse, and breathing have
+become normal.
+
+
+=CONSUMPTION; TUBERCULOSIS OF THE LUNGS; PHTHISIS.=--This disease
+demands especial attention, not only because it is above all others
+the great destroyer of human life, causing one-seventh of all deaths,
+but because, so far from being a surely fatal disease as popularly
+believed, it is an eminently curable disorder if recognized in its
+earliest stage. The most careful laboratory examinations of bodies
+dead from other causes, show that very many people have had
+tuberculosis at some time, and to some extent, during life. The reason
+why the disease fails to progress in most persons is that the system
+is strong enough to resist the inroads of the disease. The process
+becomes arrested by the germs being surrounded by a barrier of healthy
+tissue, and so perishing in their walled-in position. These facts
+prove that so far from being incurable, recovery from consumption
+frequently occurs without even our knowledge of the disease. It is
+only those cases which become so far advanced as to be easily
+recognized that are likely to result fatally. Many more cases of
+consumption are now cured than formerly, because exact methods have
+been discovered which enable us to determine the existence of the
+disease at an early stage of its development.
+
+Consumption is due to the growth of a special germ in the lungs. The
+disease is contagious, that is, it is capable of being communicated
+from a consumptive to a healthy person by means of the germs present
+in the sputum (expectoration) of the patient. The danger of thus
+acquiring the disease directly from a consumptive is slight, if one
+take simple precautions which will be mentioned later, except in the
+case of a husband, wife, or child of the patient who come in close
+personal contact, as in kissing, etc. This is proved by the fact that
+attendants in hospitals for consumptives, who devote their lives to
+the care of these patients, are rarely affected with consumption. The
+chief source of danger to persons at large is dust containing the
+germs derived from the expectoration of human patients, and thus
+finding entrance into the lungs.
+
+Consumption is said to be inherited. This is not the case, as only
+most rarely is an infant born actually bearing the living germs of the
+disease in its body. A tendency to the disease is seen in certain
+families, and this tendency may be inherited in the sense that the
+lung tissue of these persons possesses less resistance to the growth
+of the germ of consumption. It may well be, however, that the children
+of consumptive parents, as has been suggested, are more resistant to
+the disease through inherited immunity (as is seen in the offspring of
+parents who have had other contagious diseases), and that the reason
+that they more often acquire tuberculosis is because they are
+constantly exposed to contact with the germ of consumption in their
+everyday home life.
+
+It is known that there are certain occupations and diseases which
+render the individual more susceptible to consumption. Thus, stone
+cutters, knife grinders and polishers, on account of inhaling the
+irritating dust, are more liable to the disease than any other class.
+Plasterers, cigar makers, and upholsterers are next in order of
+susceptibility for the same reason; while out-of-door workers, as
+farmers, are less likely to contract consumption than any other body
+of workers except bankers and brokers. Among diseases predisposing to
+consumption, ordinary colds and bronchitis, influenza, pneumonia,
+measles, nasal obstruction causing mouth-breathing, and scarlet fever
+are the most important.
+
+No age is exempt, from the cradle to the grave, although the liability
+to the disease diminishes markedly after the age of forty.
+
+About one-third more women than men recover from consumption, probably
+because it is more practicable for them to alter their mode of life to
+suit the requirements of treatment.
+
+It is, then, the neglected cold and cough (bronchitis) which offers a
+field most commonly favorable for the growth of the germs in the lungs
+which cause consumption. And it is essential to discover the existence
+of the disease at its beginning, what is called the incipient stage,
+in order to have the best chance of recovery. It becomes important,
+therefore, that each individual know the signs and symptoms which
+suggest beginning consumption.
+
+Cough is the most constant early symptom, dry and hacking at first,
+and most troublesome at night and in the early morning. Expectoration
+comes later. Loss of weight, of strength, and of appetite are also
+important early symptoms. Dyspepsia with cough and loss of weight and
+strength form a common group of symptoms. The patient is pale, has
+nausea, vomiting, or heartburn, and there is rise of temperature in
+the afternoon, together with general weakness; and, in women, absence
+of monthly periods. Slight daily rise of temperature, usually as much
+as a half to one degree, is a very suspicious feature in connection
+with chronic cough and loss of weight. To test the condition, the
+temperature should be taken once in two hours, and will commonly be
+found at its highest about 4 P.M., daily. The pulse is also increased
+in frequency. Night sweats are common in consumption, but not as a
+rule in the first stage; they occur more often in the early morning
+hours.
+
+Chills, fever, and sweating are sometimes the first symptoms of
+consumption, and in a malarial region would very probably lead to
+error, since these symptoms may appear at about the same intervals as
+in ague. But the chills and fever are not arrested by quinine, as in
+malaria, and there are also present cough and loss of weight, not
+commonly prominent in malaria. Persistently enlarged glands, which may
+be felt as lumps beneath the skin along the sides of the neck, or in
+the armpits, should be looked upon with suspicion as generally
+tuberculous, containing the germ of consumption. They certainly demand
+the attention of early removal by a surgeon.
+
+The spitting of bright-red blood is one of the most certain signs of
+consumption, and occurs in about eighty per cent of all cases, but
+rarely appears as an early warning. The pupils of the eyes may be
+constantly large at the onset of the disease, but this is a sign of
+general weakness. Pain is also a frequent but not constant early
+symptom in the form of "stitch in the side," or pain between or
+beneath the shoulder blades, or in the region of the breastbone. This
+pain is due to pleurisy accompanying the tuberculosis. Shortness of
+breath on exertion is present when consumption is well established,
+but is not so common as an early symptom. The voice is often somewhat
+hoarse or husky at the onset of consumption, owing to tuberculous
+laryngitis.
+
+To sum up then, one should always suspect tuberculosis in a person
+afflicted with chronic cough who is losing weight and strength,
+especially if there is fever at some time during the day and any
+additional symptoms, such as those described. Such a one should
+immediately apply to a physician for examination of the chest, lungs,
+and sputum (expectoration). If the germs of tuberculosis are found on
+microscopical inspection of the sputum, the existence of consumption
+is absolutely established. Failure to find the germs in this way does
+not on the other hand prove that the patient is free from the
+disease, except after repeated examinations at different times,
+together with the inability to discover any signs by examination of
+the chest. This examination in some instances produces no positive
+results, and it may be impossible for the physician to discover
+anything wrong in the lungs at the commencement of consumption. But,
+generally, examination either of the lungs or of the sputum will
+decide the matter, one or both giving positive information.
+
+The use of the X-rays in the hands of some experts sometimes reveals
+the presence of consumption before it is possible to detect it by any
+other method. There is also a substance called tuberculin, which, when
+injected under the skin in suspected cases of consumption causes a
+rise of temperature in persons suffering from the disease, but has no
+effect on the healthy. This method is that commonly applied in testing
+cattle for tuberculosis. As the results of tuberculin injection in the
+consumptive are something like an attack of _grippe_, and as
+tuberculin is not wholly devoid of danger to these patients, this test
+should be reserved to the last, and is only to be used by a physician.
+
+=Treatment.=--There is no special remedy at our disposal which will
+destroy or even hinder the growth of the germs of tuberculosis in the
+lungs. Our endeavors must consist in improving the patient's strength,
+weight, and vital resistance to the germs by proper feeding, and by
+means of a constant out-of-door life. The ideal conditions for
+out-of-door existence are pure air and the largest number of sunshiny
+days in the year. Dryness and an even temperature, and an elevation of
+from 2,000 to 3,000 feet, are often serviceable, but not necessarily
+successful.
+
+When it is impossible for the patient to leave his home he should
+remain out of doors all hours of bright days, ten to twelve hours
+daily in summer, six to eight hours in winter without regard to
+temperature, and should sleep on a porch or on the roof, if possible.
+In the Adirondacks, patients sit on verandas with perfect comfort
+while the thermometer is at ten degrees below zero. A patient (a
+physician) in a Massachusetts sanitarium has arranged a shelf,
+protected at the sides, along the outside of a window, on which his
+pillow rests at night, while he sleeps with his head out of doors and
+his body in bed in a room inside. If it becomes stormy he retires
+within and closes the window. If the temperature ranges above 100° F.
+patients should rest in bed or on a couch in the open air, but, if
+below this, patients may exercise. A steamer chair set inside of a
+padded, wicker bath chair, from which the seat has been removed, makes
+a convenient protected arrangement in which a consumptive can pass his
+time out of doors. If the patient is quite weak and feverish he may
+remain in bed, or on a couch, placed on a veranda or balcony during
+the day, and in a room in which all the windows are open at night.
+Screens may be used to protect from direct draughts.
+
+No degree of cold, nor any of the common symptoms, as night sweats,
+fever, cough, or spitting of blood, should be allowed to interfere
+with this fresh-air treatment. The treatment may seem heroic, but is
+most successful. The patient must be warmly clothed or covered with
+blankets, and protected from strong winds, rain, and snow. During
+clear weather patients may sleep out of doors on piazzas, balconies,
+or in tents.
+
+Nutritious food is of equal value with the open-air life. A liberal
+diet of milk and cream, eggs, meat and vegetables is indicated. Raw
+eggs swallowed whole with a little sherry, or pepper and salt on them,
+may be taken between meals, beginning with one and increasing the
+number till three are taken at a time, or nine daily. If the appetite
+is very poor it is best that a glass of milk be taken every two hours,
+varied by white of egg and water and meat juice. Drug treatment
+depends on individual symptoms, and can, therefore, only be given
+under a physician's care. Sanitarium treatment is the most successful,
+because patients are under the absolute control of experts and usually
+in an ideal climate. Change of climate is often useful, but patients
+should not leave their homes without the advice of a competent
+physician, as there are many questions to consider in taking such a
+step.[5] There is a growing tendency among physicians to give
+consumptives out-of-door treatment at their homes, if living out of
+cities, as careful personal supervision gives much better results than
+a random life in a popular climatic resort.
+
+=Prevention.=--Weakly children and those born of consumptives must
+receive a generous diet of milk, eggs, meat, and vegetables, and spend
+most of their time in the open air. Their milk should be heated for
+fifteen minutes to a temperature of 160° F., in order to kill any
+germs of tuberculosis, unless the cows have been tested for this
+disease. The patient must have a separate sleeping room, and refrain
+from kissing or caressing other members of the family.
+
+The care of the sputum (expectoration) is, however, the essential
+means of preventing contagion. Out of doors, it should be deposited in
+a bottle which is cleaned by rinsing in boiling water. Indoors, paper
+bags or paper boxes made for the purpose are used to receive the
+sputum, and burned before they become dry. The use of rags,
+handkerchiefs, and paper napkins is dirty, and apt to cause soiling of
+the hands and clothes and lead to contagion. Plenty of sunlight in the
+sick room will cause destruction of the germs of consumption, besides
+proving beneficial to the patient. No dusting is to be done in the
+invalid's room; only moist cleansing. All dishes used by a consumptive
+must be boiled before they are again employed.
+
+
+=ASTHMA.=--This is a disorder caused by sudden narrowing of the
+smaller air tubes in the lungs. This narrowing is produced by
+swelling of the mucous membrane lining them, or is due to contraction
+of the tubes through reflex nervous influences. It may accompany
+bronchitis, or may be uncomplicated. It may be a manifestation of
+gout.
+
+The sufferers from asthma are usually apparently well in the period
+between the attacks. The attack often comes on suddenly in the night;
+the patient wakening with a feeling of suffocation. The difficulty in
+breathing soon becomes so great that he has to sit up, and often goes
+to a window and throws it open in the attempt to get his breath. The
+breathing is very labored and panting. There is little difficulty in
+drawing the breath, but expiration is very difficult, and usually
+accompanied by wheezing or whistling sounds. The patient appears to be
+on the brink of suffocation; the eyeballs protrude; the face is
+anxious and pale; the muscles of the neck stand out; the lips may be
+blue; a cold sweat covers the body; the hands and feet are cold, and
+talking becomes impossible. Altogether, a case of asthma presents a
+most alarming appearance to the bystander, and the patient seems to be
+on the verge of dying, yet death has probably never occurred during an
+attack of this disease. The attacks last from one-half to one or
+several hours, if not stopped by treatment, and they often return on
+several successive nights, and then disappear, not to recur for months
+or years.
+
+Attacks are brought on by the most curious and diverse means.
+Atmospheric conditions are most important. Emanations from plants, or
+animals, are common exciting agencies. Fright or emotion of any kind;
+certain articles of diet; dust and nasal obstruction are also frequent
+causes. Patients may be free from the disease in cities and attacked
+on going into the country. Men are subject to asthma more than women,
+and the victims belong to families subject to nervous troubles of
+various kinds. The attack frequently subsides suddenly, just when the
+patient seems to be on the point of suffocation. There is often
+coughing and spitting of little yellowish, semitransparent balls of
+mucus floating in a thinner secretion.
+
+Asthma is not likely to be mistaken for other diseases. The
+temperature is normal during an attack, and this will enable us to
+exclude other chest disorders, as bronchitis and pneumonia.
+Occasionally asthma is a symptom of heart and kidney disease. In the
+former it occurs after exercise; in the latter the attack continues
+for a considerable time without relief. But, as in all other serious
+diseases, a physician's services are essential, and it is our object
+to supply only such information as would be desirable in emergencies
+when it is impossible to obtain one.
+
+=Treatment.=--An attack of asthma is most successfully cut short by
+means of one-quarter of a grain of morphine sulphate[6] with 1/20 of a
+grain of atropine sulphate, taken in a glass of hot water containing a
+tablespoonful of whisky or brandy. Ten drops of laudanum,[7] or a
+tablespoonful of paregoric, may be used instead of the morphine if the
+latter is not at hand. Sometimes the inhalation of tobacco smoke from
+a cigar or pipe will stop an attack in those unaccustomed to its use.
+In the absence of morphine, or opium in the form of laudanum or
+paregoric, fifteen drops of chloroform or half a teaspoonful of ether
+may be swallowed on sugar.
+
+A useful application for use on the outside of the chest consists of
+mustard, one part, and flour, three parts, mixed into a paste with
+warm water and placed between single thicknesses of cotton cloth.
+Various cigarettes and pastilles, usually containing stramonium and
+saltpeter, are sold by druggists for the use of asthmatic patients.
+They are often efficient in arresting an attack of asthma, but it is
+impossible to recommend any one kind, as one brand may agree with one
+patient better than another. Amyl nitrite is sold in "pearls" or
+small, glass bulbs, each containing three or four drops, one of which
+is to be broken in and inhaled from a handkerchief during an attack of
+asthma. This often affords temporary relief.
+
+To avoid the continuance of the disease it is emphatically advisable
+to consult a physician who may be able to discover and remove the
+cause. The diet should consist chiefly of eggs, fish, milk, and
+vegetables (with the exception of beans, large quantities of potatoes,
+and roots, as parsnips, beets, turnips, etc.). Meat should be eaten
+but sparingly, and also pastries, sugar, and starches (as cereals,
+potato, and bread). The evening meal ought to be light, dinner being
+served at midday. Any change of climate may stop asthmatic seizures
+for a time, but the relief is apt to be temporary. Climatic conditions
+affect different patients differently. Warm, moist air in places
+destitute of much vegetation (as Florida, Southern California, and the
+shore of Cape Cod and the Island of Nantucket, in summer) enjoy
+popularity with many asthmatics, while a dry, high altitude influences
+others much more favorably.
+
+
+=INFLUENZA; LA GRIPPE.=--Influenza is an acute, highly contagious
+disease due to a special germ, and tending to spread with amazing
+rapidity over vast areas. It has occurred as a world-wide epidemic at
+various times in history, and during four periods in the last century.
+A pandemic of influenza began in the winter of 1889-90, and continued
+in the form of local epidemics till 1904, the disease suddenly
+appearing in a community and, after a prevalence of about six weeks,
+disappearing again. One attack, it is, perhaps, unnecessary to state,
+does not protect against another. The mortality is about 1 death to
+400 cases. The feeble and aged are those who are apt to succumb.
+Fatalities usually result from complications or sequels, such as
+pneumonia or tuberculosis; neurasthenia or insanity may follow.
+
+=Symptoms.=--There are commonly four important symptoms characteristic
+of _grippe_: fever; pain, catarrh; and depression, mental and
+physical. _Grippe_ attacks the patient with great suddenness. While in
+perfect health and engaged in ordinary work, one is often seized with
+a severe chill followed by general depression, pain in the head, back,
+and limbs, soreness of the muscles, and fever. The temperature varies
+from 100° to 104° F. The catarrh attacks the eyes, nose, throat, and
+larger tubes in the lungs. The eyes become reddened and sensitive to
+light, and movements of the eyeballs cause pain. Sneezing comes on
+early, and, after a day or two, is followed by discharge from the
+nose. The throat is often sore and reddened. There may be a feeling of
+weight and tightness in the chest accompanied by a harsh, dry cough,
+which, after a few days, becomes looser and expectoration occurs.
+Bodily weakness and depression of spirits are usually prominent and
+form often the most persistent and distressing symptoms.
+
+After three or four days the pains decrease, the temperature falls,
+and the cough and oppression in the chest lessen, and recovery usually
+takes place within a week, or ten days, in serious cases. The patient
+should go to bed at once, and should not leave it until the
+temperature is normal (98-3/5° F.). For some time afterwards general
+weakness, associated with heart weakness, causes the patient to sweat
+easily, and to get out of breath and have a rapid pulse on slight
+exertion.
+
+Such is the picture of a typical case, but it often happens that some
+of the symptoms are absent, while others are exaggerated so that
+different types of _grippe_ are often described. Thus the pain in the
+back and head may be so intense as to resemble that of meningitis.
+Occasionally the stomach and bowels are attacked so that violent
+vomiting and diarrhea occur, while other members of the same family
+present the ordinary form of influenza. There is a form that attacks
+principally the nervous system, the nasal and bronchial tracts
+escaping altogether. Continual fever is the only symptom in some
+cases. _Grippe_ may last for weeks. Whenever doubt exists as to the
+nature of the disorder, a microscopic examination of the expectoration
+or of the mucus from the throat by a competent physician will
+definitely determine the existence of influenza, if the special germs
+of that disease are found. It is the prevailing and erroneous fashion
+for a person to call any cold in the head the _grippe_; and there are,
+indeed, many cases in which it becomes difficult for a physician to
+distinguish between _grippe_ and a severe cold with muscular soreness
+and fever, except by the microscopic test. Influenza becomes dangerous
+chiefly through its complications, as pneumonia, inflammation of the
+middle ear, of the eyes, or of the kidneys, and through its
+depressing effect upon the heart.
+
+These complications can often be prevented by avoiding the slightest
+imprudence or exposure during convalescence. Elderly and feeble
+persons should be protected from contact with the disease in every
+way. Whole prisons have been exempt from _grippe_ during epidemics,
+owing to the enforced seclusion of the inmates. The one absolutely
+essential feature in treatment is that the patient stay in bed while
+the fever lasts and in the house afterwards, except as his strength
+will permit him to go out of doors for a time each sunny day until
+recovery is fully established.
+
+=Treatment.=--The medicinal treatment consists at first in combating
+the toxin of the disease and assuaging pain, and later in promoting
+strength. Hot lemonade and whisky may be given during the chilly
+period and a single six- to ten-grain dose of quinine. Pain is
+combated by phenacetin,[8] three grains repeated every three hours
+till relieved. At night a most useful medicine to afford comfort when
+pain and sleeplessness are troublesome, is Dover's powder, ten grains
+(or codeine, one grain), with thirty grains of sodium bromide
+dissolved in water. After the first day it is usually advisable to
+give a two-grain quinine pill together with a tablet containing
+one-thirtieth of a grain of strychnine three times a day after meals
+for a week or two as a tonic (adult). Only mild cathartics are
+suitable to keep the bowels regular as a Seidlitz powder in the
+morning before breakfast. The diet should be liquid while the fever
+lasts--as milk, cocoa, soups, eggnog, one of these each two hours. A
+tablespoonful of whisky, rum, or brandy may be added to the milk three
+times daily if there is much weakness.
+
+The germ causing _grippe_ lives only two days, but successive crops of
+spores are raised in a proper medium. Neglected mucus in nose or
+throat affords an inviting field for the germ. Therefore it is
+essential to keep the nostrils free and open by means of spraying with
+the Seiler's tablet solution (p. 49), and then always breathing
+through the nostrils.
+
+
+FOOTNOTES:
+
+[4] Caution. Dangerous. Use only on physician's order.
+
+[5] Arizona, New Mexico, Colorado, and the Adirondacks contain the
+most favorable climatic resorts in this country.
+
+[6] Caution. Dangerous. Use only on physician's order.
+
+[7] This dose is only suitable for strong, healthy adults of average
+weight and those who are not affected peculiarly by opium. Delicate
+women and others not coming under the above head should take but half
+the dose and repeat in an hour if necessary.
+
+[8] Caution. A powerful medicine.
+
+
+
+
+CHAPTER IV
+
+=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 anæmia, 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 anæmia 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 anæmia.
+
+=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 (_papillæ_) 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 _papillæ_ 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° to 104° 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° or 101° 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, anæmia, 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° to 102° 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° to 103° 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._
+
+
+Every individual should know how to care for the sexual organs as well
+as those of any other part of the body, providing that the instruction
+be given by the proper person and at the proper time and place. Such
+information should be imparted to children by parents, guardians, or
+physicians at an early age and, if this is neglected through ignorance
+or false modesty, erroneous ideas of the nature and purpose of the
+sexual function will very surely be supplied later by ignorant and
+probably evil-minded persons with correspondingly bad results. There
+is no other responsibility in the whole range of parental duties which
+is so commonly shirked and with such deplorable consequences. When the
+subject is shorn of the morbid and seductive mystery with which custom
+has foolishly surrounded it in the past, and considered in the same
+spirit with which we study the hygiene of the digestion and other
+natural functions, it will be found possible to give instruction about
+the sexual function in a natural way and without exciting unhealthy
+and morbid curiosity.
+
+A word in the beginning as to the harm produced by abuse of the sexual
+function. The injury thus received is purposely magnified tenfold for
+reasons of gain by quacks who work upon the fears of their victims for
+their own selfish purposes. The voluntary exercise of the sexual
+function--unlike that of any other important organs--is not necessary
+to health until maturity has been reached; on the contrary, continence
+is conducive to health, both physical and mental. Even after maturity,
+unless marriage occurs, or by improper living the sexual desires are
+unnaturally stimulated, it is quite possible to maintain perfect
+health through life without exercising the sexual function at all.
+Undue irritation of the sexual organs causes disorder of the nervous
+system, and if continued it will result ultimately in overfatigue and
+failure of the nervous activities which control the normal functions
+of every organ in the body. In other words, it will result in nervous
+exhaustion.
+
+Damage is also wrought by exciting local irritation, congestion, and
+inflammation of the sexual organs which result in impairment of the
+proper functions of these parts and in local disorders and distress.
+It is unnecessary further to particularize other than to state that
+abuse of the sexual organs in the young is usually owing to the almost
+criminal neglect or ignorance of the child's parents. But so far from
+increasing alarm in the patient it is almost always possible to enable
+the child to be rid of the habit by kindly instruction and judicious
+oversight in the future, and no serious permanent local damage to the
+sexual organs or general injury to the nervous system will be likely
+to persist. The opposite teaching is that peculiar to the quack who
+prophesies every imaginable evil, from complete loss of sexual
+function to insanity. Any real or fancied disorder of the sexual
+function is extremely apt to lead to much mental anxiety and
+depression, so that a cheerful outlook is essential in inspiring
+effort to correct bad habits and is wholly warranted in view of the
+entire recovery in most cases of the young who have abused their
+sexual organs. Insanity or imbecility are seldom the result but more
+often the cause of such habits. It is a sad fact, however, that, under
+the prevailing custom of failure of the parents to exercise proper
+supervision over the sexual function of their children, self-abuse is
+generally practiced in youth, at least by boys.
+
+This often leads to temporary physical and mental suffering and is
+very prejudicial to the morals, but does not commonly result in
+permanent injury except in the degenerate. Children at an early
+age--three to four years--should be taught not to touch, handle, rub,
+or irritate their sexual organs in any way whatsoever except so far as
+is necessary in urination or in the course of the daily cleansing. If
+there seems to be any inclination to do so it will usually be found
+that it is due to some local trouble to which a physician's attention
+should be called and which may generally be readily remedied by him.
+It is always advisable to ask the medical adviser to examine babies
+for any existing trouble and abnormality of the sexual organs, as a
+tight, adherent, or elongated foreskin in boys--and rarely a
+corresponding condition in girls--may give rise to much local
+irritation and remote nervous disturbances. The presence of worms may
+lead to irritation in the bowel, which excites masturbation in
+children. Girl babies should be watched to prevent them from
+irritating the external sexual parts by rubbing them between the inner
+surfaces of the thighs. As the child begins to play with other
+children he or she should be cautioned to avoid those who in any way
+try to thwart the parents' advice, and be instructed to report all
+such occurrences. It is wise also to try and gratify the child's
+natural curiosity about the sexual function so far as may be judicious
+by explanations as to the purpose of the sexual organs, when the child
+is old enough to comprehend such matters.
+
+The reticence and disinclination of parents to instruct their children
+in matters relating to sex cannot be too strongly condemned. It is
+perfectly natural that the youth should wish to know something of the
+origin of life and how human beings come into the world. The mystery
+and concealment thrown around these matters only serve to stimulate
+his curiosity. It is a habit of most parents to rebuke any questions
+relating to this subject as improper and immodest, and the first
+lesson the child learns is to associate the idea of shame with the
+sexual organs; and, since he is not enlightened by his natural
+instructors, he picks up his knowledge of the sex function in a
+haphazard way from older and often depraved companions.
+
+Evasive replies with the intent of staving off the dreaded explanation
+do no good and may result in unexpected evil. By securing the child's
+confidence at the start, one may not only keep informed of his actions
+but protect him from seeking or even listening to bad counsels. At the
+age of ten or twelve it is well that the family physician or parent
+should give instruction as to the special harm which results from
+unnaturally exciting the sexual nature by handling and stimulating the
+sexual organs and also warning the child against filthy literature and
+improper companions. At the age of puberty he should be warned against
+the moral and physical dangers of sexual intercourse with lewd women.
+The physical dangers refer to the great possibility of infection with
+one or both of the common diseases--syphilis and gonorrhea--acquired
+by sexual contact with one suffering from these terrible disorders (p.
+199). It is usually quite impossible for a layman to detect the
+presence of these diseases in others, or rather, to be sure of their
+absence, and the permanent damage which may be wrought to the sufferer
+and to others with whom he may have sexual relations is incalculable.
+It is generally known that syphilis is a disease to be dreaded, but
+not perhaps that it not only endangers the life and happiness of the
+patient, but the future generation of his descendants. Gonorrhea--the
+much more common disease--while often treated lightly by youth,
+frequently leads to long, chronic, local disease and may even result
+fatally in death; later in life it may cause infection of a wife
+resulting in chronic invalidism and necessitating surgical removal of
+her maternal organs. These possibilities often occur long after the
+patient thinks he is wholly free from the disease. Gonorrhea in women
+is the most frequent cause of their sterility, and also is a common
+source of abortion and premature birth. It is the cause in most cases
+of blindness in infants (p. 205) and also of vulvo-vaginitis in girl
+babies. Furthermore, gonorrhea is so alarmingly prevalent that it is
+stated on good authority that the disease occurs in eighty per cent of
+all males some time during their lives. The disease is not confined to
+prostitutes, but is common, much more frequently than is suspected, in
+all walks and classes of life and at all ages. Even among boys
+attending boarding schools and similar institutions the disease is
+only too frequent. It is particularly important that the true
+situation be explained to boys about to enter college or a business
+career, for it is at this period of life that their temptations become
+greatest. Alcohol is the most dangerous foe--next to bad
+companions--with which they must contend in this matter, for, weakened
+by its influence and associated with persuasive friends, their will
+gives way and the advice and warning, which they may have received,
+are forgotten. Idleness is also another influential factor in
+indirectly causing sexual disease; hard physical and mental work are
+powerful correctives of the passions.
+
+It may be of interest to readers to know that but recently an
+association of American physicians, alarmed by the fearful prevalence
+of sexual diseases in this country, has been taking measures to inform
+youths and adults and the general public, through special instruction
+in schools, and by means of pamphlets and lectures to teachers and
+others, of the prevalence and great danger of this evil.
+
+When young adult life has been attained it is also desirable for the
+parent, or the family physician, to inform the young man or
+woman--especially if either is about to enter a marriage
+engagement--that close and frequent personal contact with the opposite
+sex, especially when the affections are involved, will necessarily,
+though involuntarily, excite local stimulation of the sexual organs
+and general irritability and exhaustion of the entire nervous system.
+Long engagements--when the participants are frequent companions--are
+thus peculiarly unfortunate. It is only when the sexual functions are
+normally exercised in adult life, as in sexual intercourse, that
+sexual excitement is not harmful.
+
+Young women about to marry should receive instruction from their
+mothers as to the sexual relations which will exist after marriage.
+Most girls are allowed to grow up ignorant of such matters and in
+consequence may become greatly shocked and even disgusted by the
+sexual relations in marriage--fancying that there must be something
+unnatural and wrong about them because the subject was avoided by
+those responsible for their welfare.
+
+Any excess in frequency of sexual intercourse after marriage is
+followed by feelings of depression and debility of some sort which may
+be readily attributed to the cause and so corrected. Any deviation
+from the natural mode of intercourse is pretty certain to lead to
+physical disaster; thus, unnatural prolongation of the act, or
+withdrawal on the part of the man before the natural completion of the
+act in order to prevent conception, often results in deplorable
+nervous disorders.
+
+In conclusion, it may be said that parents must take upon themselves
+the burden of instructing their children in sexual hygiene or shift it
+upon the shoulders of the family physician, who can undertake it with
+much less mental perturbation and with more intelligence. Otherwise
+they subject their offspring to the possibility of incalculable
+suffering, disease, and even death--largely through their own
+inexcusable neglect.
+
+
+
+
+CHAPTER II
+
+=Genito-Urinary Diseases=
+
+_Contagious Disorders--Common Troubles of Children--Inflammation of
+the Bladder--Stoppage and Suppression of Urine--Causes and Treatment
+of Bright's Disease._
+
+
+=GONORRHEA.=--Gonorrhea is a contagious inflammation of the urethra,
+accompanied by a white or yellowish discharge. It is caused by a
+specific germ, the _gonococcus_, and is acquired through sexual
+intercourse with a person suffering from this disease. Exceptionally
+the disease may be conveyed by objects soiled with the discharge, as
+basins, towels, and, in children, diapers, so that in institutions for
+infants it may be thus transferred from one to the other, causing an
+epidemic. The mucous membrane of the lower part of the bowel and the
+eyes are also subject to the disease through contamination with the
+discharge. The disease begins usually three to seven days after sexual
+intercourse, with symptoms of burning, smarting, and pain on
+urination, and a watery discharge from the passage, soon followed by a
+yellowish or white secretion. Swelling of the penis, frequent
+urination, and painful erections are also common symptoms. The
+disease, if uncomplicated and running a favorable course, may end in
+recovery within six weeks or earlier, with proper treatment. On the
+other hand, complications are exceedingly frequent, and the disorder
+often terminates in a chronic inflammation which may persist for
+years--even without the knowledge of the patient--and may result in
+the infection of others after all visible signs have ceased to appear.
+
+=Treatment.=--Rest is the most important requisite; at first, best in
+bed; if not, the patient should keep as quiet as possible for several
+days. The diet should consist of large quantities of water or
+milk, or milk and vichy, with bread, cereals, potatoes, and
+vegetables--absolutely avoiding alcohol in any form. Sexual
+intercourse is harmful at any stage in the disease and will
+communicate the infection. Aperient salts should be taken to keep the
+bowels loose. The penis should be soaked in hot water three times
+daily to reduce the inflammation and cleanse the organ. A small wad of
+absorbent cotton may be held in place by drawing the foreskin over it
+to absorb the discharge, or may be held in place by means of a bag
+fitting over the penis. All cloths, cotton, etc., which have become
+soiled with the discharge, should be burned, and the hands should be
+washed after contact with the discharge; otherwise the contagion may
+be conveyed to the eyes, producing blindness. It is advisable for the
+patient to take one-half teaspoonful of baking soda in water three
+times daily between meals for the first four or five days, or, better,
+fifteen grains of potassium citrate and fifteen drops of sweet spirit
+of nitre in the same way. Painful erections may be relieved by bathing
+the penis in cold water, urinating every three hours, and taking
+twenty grains of sodium bromide at night in water. After all swelling
+and pain have subsided, local treatment may be begun.
+
+Injections or irrigations with various medicated fluids constitute the
+best and most efficient measures of local treatment. They should be
+used only under the advice and management of the physician. No greater
+mistake can be made than to resort to the advertising quack, the
+druggist's clerk, or the prescription furnished by an obliging friend.
+Skillful treatment, resulting in a complete radical cure, may save him
+much suffering from avoidable complications and months or years of
+chronic trouble.
+
+At the same time the first medicines advised are stopped and oleoresin
+of cubebs, five grains, or copaiba balsam, ten grains--or both
+together--are to be taken three times daily after meals, in capsules,
+for several weeks, unless they disturb the digestion too much. A
+suspensory bandage should be worn throughout the continuance of the
+disease. The approach of the cure of the disease is marked by a
+diminution in the quantity and a change in the character of the
+discharge, which becomes thinner and less purulent and reduced to
+merely a drop in the passage in the early morning, but this may
+continue for a great while. Chronic discharge of this kind and the
+complications cannot be treated properly by the patient, but require
+skilled medical care.
+
+In this connection it may be said that most patients have an idea that
+the subsidence or disappearance of the discharge is an evidence of the
+cure of the disease. Experience shows that the disease may lapse into
+a latent or chronic form and remain quiescent, without visible
+symptoms, during a prolonged period, while susceptible of being
+revived under the influence of alcoholic drinks or sexual intercourse.
+It is important that treatment should be continued until all disease
+germs are destroyed, which can only be determined by an examination of
+the secretions from the urethra under the microscope.
+
+The more common complications of gonorrhea are inflammation of the
+glands in the groin (bubo), acute inflammation of the prostate glands
+and bladder, of the seminal vesicles, or of the testicles. The latter
+complication is a most common cause of sterility in men. Formerly it
+was thought that gonorrhea was a local inflammation confined to the
+urinary canal and neighboring parts, but advances in our knowledge
+have shown that the germs may be taken up into the general circulation
+and affect any part of the body, such as the muscles, joints, heart,
+lungs, liver, spleen, kidneys, etc., with results always serious and
+often fatal to life. One of the most common complications is
+gonorrheal arthritis, which may affect one or several joints and
+result in stiffness or complete loss of movement of the affected
+joint, with more or less deformity and permanent disability. Another
+complication is gonorrheal inflammation of the eye, from direct
+transference of the pus by the fingers or otherwise, and resulting in
+partial or complete blindness.
+
+
+=GONORRHEA IN WOMEN.=--Gonorrhea in women is a much more frequent and
+serious disease than was formerly supposed. The general impression
+among the laity is that gonorrhea in women is limited to the
+prostitute and vicious classes who indulge in licentious relations.
+Unfortunately, this is not the case. There is perhaps more gonorrhea,
+in the aggregate, among virtuous and respectable wives than among
+professional prostitutes, and the explanation is the following: A
+large proportion of men contract the disease at or before the marrying
+age. The great majority are not cured, and the disease simply lapses
+into a latent form. Many of them marry, believing themselves cured,
+and ignorant of the fact that they are bearers of contagion. They
+transmit the disease to the women they marry, many of whom, from
+motives of modesty and an unwillingness to undergo an examination do
+not consult a physician, and they remain ignorant of the existence of
+the disease until the health is seriously involved. In women,
+gonorrhea is not usually so acute and painful as in men, unless it
+involves the urethra. It usually begins with smarting and painful
+urination, with frequent desire to urinate and with a more or less
+abundant discharge from the front passage. In the majority of cases
+the infection takes place in the deeper parts, that is, in the neck or
+body of the womb. In this location it may not give rise at first to
+painful symptoms, and the patient often attributes the increased
+discharge to an aggravation of leucorrhea from which she may have
+suffered. The special danger to women from gonorrhea is that the
+inflammation is apt to be aggravated during the menstrual period and
+the germs of the disease ascend to the cavity of the womb, the tubes,
+and ovaries, and invade the peritoneal covering, causing peritonitis.
+Pregnancy and childbirth afford favorable opportunities for the upward
+ascension of the germs to the peritoneal cavity. The changes caused by
+gonorrheal inflammation in the maternal organs are the most common
+cause of sterility in women. It is estimated that about fifty per cent
+of all sterility in women proceeds from this cause. In addition to its
+effects upon the child-bearing function, the danger to the health of
+such women is always serious. In the large proportion of cases they
+are made permanent invalids, no longer able to walk freely, but
+compelled to pass their lives in a reclining position until worn out
+by suffering, which can only be relieved by the surgical removal of
+their maternal organs. It is estimated that from fifty to sixty per
+cent of all operations performed on the maternal organs of women are
+due to disease caused by gonorrheal inflammation.
+
+=Treatment.=--Rest in bed, the use of injections of hot water,
+medicated with various astringents, by means of a fountain syringe in
+the front passage three times daily, and the same remedies and bath
+recommended above, with hot sitz baths, will usually relieve the
+distress. In view of the serious character of this affection in women
+and its unfortunate results when not properly treated, it is important
+that they should have the benefit of prompt and skillful treatment by
+a physician. Otherwise, the health and life of the patient may be
+seriously compromised.
+
+The social danger of gonorrhea introduced after marriage is not
+limited to the risks to the health of the woman. When a woman thus
+infected bears a child the contagion of the disease may be conveyed to
+the eyes of the child in the process of birth. Gonorrheal pus is the
+most virulent of all poisons. A single drop of the pus transferred to
+the eye may destroy this organ in from twenty-four to forty-eight
+hours. It is estimated that from seventy-five to eighty per cent of
+all babies blinded at birth have suffered from this cause, while from
+twenty to thirty per cent of blindness from all causes is due to
+gonorrhea. While the horrors of this disease in the newborn have been
+mitigated by what is called the Crédé method (instillation of nitrate
+of silver solution in the eye immediately after birth), it still
+remains one of the most common factors in the causation of blindness.
+Another social danger is caused by the pus being conveyed to the
+genital parts of female children, either at birth or by some object
+upon which it has been accidentally deposited, such as clothes,
+sponges, diapers, etc. These cases are very common in babies'
+hospitals and institutions for the care of children. Quite a number of
+epidemics have been traced to this cause. The disease occurring in
+children is exceedingly difficult of cure and is often followed by
+impairment in the development of their maternal organs. Much of the
+ill health of young girls from disordered menstruation and other
+uterine diseases may be traced to this cause. Another serious
+infection in babies and young children is gonorrheal inflammation of
+the joints, with more or less permanent crippling.
+
+
+=SYPHILIS; THE POX; LUES.=--Syphilis is a contagious germ disease
+affecting the entire system. While commonly acquired through sexual
+intercourse with a person affected with the disorder, it may be
+inherited from the parents, one or both. It is often acquired through
+accidental contact with sources of contagion. Syphilis and
+tuberculosis are the two great destroyers of health and happiness, but
+syphilis is the more common.
+
+=Symptoms.=--Acquired syphilis may be divided into three stages: the
+primary, secondary, and tertiary. The first stage is characterized by
+the appearance of a pimple or sore on the surface of the sexual organ
+not usually earlier than two, nor later than five to seven, weeks
+after sexual intercourse. The appearance of this first sore is subject
+to such variations that it is not always possible for even the most
+skillful physician to determine positively the presence of syphilis
+in any individual until the symptoms characteristic of the second
+stage develop. Following the pimple on the surface of the penis comes
+a raw sore with hard deposit beneath, as of a coin under the skin. It
+may be so slight as to pass unnoticed or become a large ulcer, and may
+last from a few weeks to several months. There are several other kinds
+of sores which have no connection with syphilis and yet may resemble
+the syphilitic sore so closely that it becomes impossible to
+distinguish between them except by the later symptoms to be described.
+Along with this sore, lumps usually occur in one or both groins, due
+to enlarged glands.
+
+The second stage appears in six to seven weeks after the initial sore,
+and is characterized by the occurrence of a copper-colored rash over
+the body, but not often on the face, which resembles measles
+considerably. Sometimes a pimply or scaly eruption is seen following
+this or in place of the red rash. At about, or preceding, this period
+other symptoms may develop, as fever, headache, nausea, loss of
+appetite, and sleeplessness, but these may not be prominent. Moist
+patches may appear on the skin, in the armpits, between the toes, and
+about the rectum; or warty outgrowths in the latter region. There is
+sore throat, with frequently grayish patches on the inside of the
+cheeks, lips, and tongue. The hair falls out in patches or, less
+often, is all lost. Inflammation of the eye is sometimes a symptom.
+These symptoms do not always occur at the same time, and some may be
+absent or less noticeable than others.
+
+The third stage comes on after months or years, or in those subjected
+to treatment may not occur at all. This stage is characterized by
+sores and ulcerations on the skin and deeper tissues, and the
+occurrence of disease of different organs of the body, including the
+muscles, bones, nervous system, and blood vessels; every internal
+organ is susceptible to syphilitic change.
+
+A great many affections of the internal organs--the heart, lungs,
+liver, kidneys, brain, and cord--which were formerly attributed to
+other causes, are now recognized as the product of syphilis. The
+central nervous system is peculiarly susceptible to the action of the
+syphilitic poison, and when affected may show the fact through
+paralysis, crippling, disabling, and disfiguring disorders.
+
+Years after cure has apparently resulted, patients are more liable to
+certain nervous disorders, as locomotor ataxia, which attacks
+practically only syphilitics; and general paresis, of which
+seventy-five per cent of the cases occur in those who have had
+syphilis.
+
+=Inherited Syphilis.=--Children born with syphilis of syphilitic
+parents show the disease at birth or usually within one or two months.
+They present a gaunt, wasted appearance, suffer continually from
+snuffles or nasal catarrh, have sores and cracks about the lips, loss
+of hair, and troublesome skin eruptions. The syphilitic child has been
+described as a "little old man with a cold in his head." The internal
+organs are almost invariably diseased, and sixty to eighty per cent of
+the cases fortunately die. Those who live to grow up are puny and
+poorly developed, so that at twenty they look not older than twelve,
+and are always delicate.
+
+It is to be noted that syphilis is not necessarily a venereal disease,
+that is, acquired through sexual relations. It may be communicated by
+kissing, by accidental contact with a sore on a patient's body, by the
+use of pipes, cups, spoons, or other eating or drinking utensils, or
+contact with any object upon which the virus of the disease has been
+deposited.
+
+Any part of the surface of the body or mucous membrane is susceptible
+of being inoculated with the virus of syphilis, followed by a sore
+similar to what has been described as occurring upon the genital parts
+and later the development of constitutional symptoms. The
+contagiousness of the disease is supposed to last during the first
+three years of its existence, but there are many authentic cases of
+contagion occurring after four or five years of syphilis.
+
+=Diagnosis.=--The positive determination of the existence of syphilis
+at the earliest moment is of the utmost importance in order to set at
+rest doubt and that treatment may be begun. It is necessary to wait,
+however, until the appearance of the eruption, sore throat,
+enlargement of glands, falling out of hair, etc., before it is safe to
+be positive.
+
+=Treatment.=--The treatment should be begun as soon as the diagnosis
+is made, and must be continuously and conscientiously pursued for
+three years or longer. If treatment is instituted before the secondary
+symptoms, it may prevent their appearance so that the patient may
+remain in doubt whether he had the disease or not, for it is
+impossible for the most skilled specialist absolutely to distinguish
+the disease before the eruption, no matter how probable its existence
+may seem. This happens because there are several kinds of sores which
+attack the sexual organs and which may closely simulate syphilis. The
+treatment is chiefly carried out with various forms of mercury and
+iodides, but so much knowledge and experience are required in adapting
+these to the individual needs and peculiarities of the patient that it
+is impossible to describe their use. Patients should not marry until
+four or five years have elapsed since the appearance of syphilis in
+their persons, and at least twelve months after all manifestations of
+the disease have ceased. If these conditions have been complied with,
+there is little danger of communicating the disease to their wives or
+transmitting it to their offspring. They must moreover, have been
+under the treatment during all this period. Abstinence from alcohol,
+tobacco, dissipation, and especial care of the teeth are necessary
+during treatment.
+
+=Results.=--The majority of syphilitics recover wholly under treatment
+and neither have a return of the disease nor communicate it to their
+wives or children. It is, however, possible for a man, who has
+apparently wholly recovered for five or six years or more, to impart
+the disease. Without proper treatment or without treatment for the
+proper time, recurrence of the disease is frequent with the occurrence
+of the destructive and often serious symptoms characteristic of the
+third stage of the disease. While syphilis is not so fatal to life as
+tuberculosis, it is capable of causing more suffering and unhappiness,
+and is directly transmitted from father to child, which is not the
+case with consumption. Syphilis is also wholly preventable, which is
+not true of tuberculosis at present. It is not probable that syphilis
+is ever transmitted to the third generation directly, but deformities,
+general debility, small and poor teeth, thin, scanty growth of hair,
+nervous disorders, and a general miserable physique are seen in
+children whose parents were the victims of inherited syphilis. In
+married life syphilis may be communicated to the wife directly from
+the primary sore on the penis of the husband during sexual
+intercourse, but contamination of the wife more often happens from the
+later manifestations of the disease in the husband, as from secretion
+from open sores on the body or from the mouth, when the moist patches
+exist there.
+
+It is possible for a child to inherit syphilis from the father--when
+the germs of syphilis are transmitted through the semen of the father
+at the time of conception--and yet the mother escape the disease. On
+the other hand, it is not uncommon for the child to become thus
+infected and infect its mother while in her womb; or the mother may
+receive syphilis from the husband after conception, and the child
+become infected in the womb.
+
+The chief social danger of syphilis comes from its introduction into
+marriage and its morbid radiations through family and social life.
+Probably one in every five cases of syphilis in women is communicated
+by the husband in the marriage relation. There are so many sources and
+modes of its contagion that it is spread from one person to another in
+the ordinary relations of family and social life--from husband to wife
+and child, from child to nurse, and to other members of the family, so
+that small epidemics of syphilis may be traced to its introduction
+into a family. Syphilis is the only disease which is transmitted in
+full virulence to the offspring, and its effect is simply murderous.
+As seen above, from sixty to eighty per cent of all children die
+before or soon after birth. One-third of those born alive die within
+the next six months, and those that finally survive are blighted in
+their development, both physical and mental, and affected with various
+organic defects and deformities which unfit them for the battle of
+life. Syphilis has come to be recognized as one of the most powerful
+factors in the depopulation and degeneration of the race.
+
+
+=INVOLUNTARY PASSAGE OF URINE--BED-WETTING IN
+CHILDREN.=--(_Incontinence of Urine_).--This refers to an escape of
+urine from the bladder uncontrolled by the will. It naturally occurs
+in infants under thirty months, or thereabouts, and in the very old,
+and in connection with various diseases. It may be due to disease of
+the brain, as in idiocy or insanity, apoplexy, or unconscious states.
+Injuries or disorders of the spinal cord, which controls the action of
+the bladder (subject to the brain), also cause incontinence. Local
+disorders of the urinary organs are more frequent causes of the
+trouble, as inflammation of any part of the urinary tract, diabetes,
+nephritis, stone in the bladder, tumors, and malformations. The
+involuntary passage of urine may arise from irritability of
+bladder--the most frequent cause--or from weakness of the muscles
+which restrain the escape of urine, or from obstruction to flow of
+urine from the bladder, with overflow when it becomes distended.
+
+It is a very common disorder of children and young persons, and in
+some cases no cause can be found; but in many instances it is due to
+masturbation (p. 193), to a narrow foreskin and small aperture at the
+exit of the urinary passage, to worms in the bowels or disease of the
+lower end of the bowels, such as fissure or eczema, to digestive
+disorders, to retaining the urine overlong, to fright, to dream
+impressions (dreaming of the act of urination), and to great weakness
+brought on by fevers or other diseases. In old men it is often due to
+an enlargement of a gland at the neck of the bladder which prevents
+the bladder from closing properly. A concentrated and irritating
+urine, from excessive acidity or alkalinity, may induce incontinence.
+
+Children may recover from it as they approach adult life, but they
+should not be punished, as it is a disease and not a fault. Exception
+should be made in case children wet their clothing during play,
+through failure to take the time and trouble to pass water naturally.
+It is more common among children at night, leading to wetting of the
+bed, but may occur in the day, and often improves in the spring and
+summer, only to return with the cold weather. Children who sleep very
+soundly are more apt to be subject to this disorder.
+
+=Treatment.=--In the case of a disorder depending upon one of so many
+conditions it will be realized that it would be folly for the layman
+to attempt to treat it. Children who are weak need building up in
+every possible way, as by an outdoor life, cold sponging daily, etc.
+If there is in boys a long foreskin, or tight foreskin, hindering the
+escape of urine and natural secretions of this part, circumcision may
+be performed to advantage by the surgeon, even in the infant a few
+months old. Sometimes a simpler operation, consisting of stretching or
+overdistending the foreskin, can be done.
+
+A somewhat corresponding condition in girls occasionally causes
+bed-wetting and other troubles. It can be discovered by a physician.
+Children who wet their beds, or clothes, should not drink liquid
+after five in the afternoon, and should be taken up frequently during
+the night to pass water. The bed covering must be light, and they
+should be prevented from lying on the back while asleep by wearing a
+towel knotted in the small part of the back. Elevation of the foot of
+the bed a few inches is recommended as having a corrective influence.
+Masturbation, if present, must be corrected.
+
+It is a very difficult disorder to treat, and physicians must be
+excused for failures even after every attempt has been made to
+discover and remove the cause. Even when cure seems assured, the
+disorder may recur.
+
+
+=INFLAMMATION OF THE BLADDER= (_Cystitis_).--The condition which we
+describe under this head commonly causes frequent painful urination.
+Primarily there is usually some agency which mechanically or
+chemically irritates the bladder, and if the irritation does not
+subside, inflammation follows owing to the entrance of germs in some
+manner. The introduction into the bladder of unboiled, and therefore
+unclean, instruments is a cause; another cause is failure to pass
+urine for a long period, from a feeling of delicacy in some persons
+when in unfavorable surroundings. Nervous spasm of the urinary passage
+from pain, injuries, and surgical operations constitutes another
+cause. Inflammation may extend from neighboring parts and attack the
+bladder, as in gonorrhea, and in various inflammations of the sexual
+organs of women, as in childbed infection. Certain foods, waters, and
+drinks, as alcohol in large amounts, and drugs, as turpentine or
+cantharides applied externally or given internally, may lead to
+irritation of the bladder. Exposure to cold in susceptible persons is
+frequently a source of cystitis, as well as external blows and
+injuries. The foregoing causes are apt to bring on sudden or acute
+attacks of bladder trouble, but often the disease comes on slowly and
+is continuous or chronic.
+
+Among the causes of chronic cystitis, in men over fifty, is
+obstruction to the outflow of urine from enlargement of the prostate
+gland, which blocks the exit from the bladder. In young men, narrowing
+of the urethra, a sequel to gonorrhea, may also cause cystitis; also
+stone in the bladder or foreign bodies, tumors growing in the bladder,
+tuberculosis of the organ. Paralysis of the bladder, which renders the
+organ incapable of emptying itself, thus retaining some fermenting
+urine, is another cause of bladder inflammation.
+
+=Symptoms.=--The combination of frequency of and pain during
+urination, with the appearance of blood or white cloudiness and
+sediment in the urine, are evidences of the existence of inflammation
+of the bladder. The trouble is aggravated by standing, jolting, or
+active exercise. The pain may be felt either at the beginning or end
+of urination. There is also generally a feeling of weight and
+heaviness low down in the belly, or about the lower part of the bowel.
+Blood is not frequently present, but the urine is not clear, if there
+is much inflammation, but deposits a white and often slimy sediment
+on standing. In chronic inflammation of the bladder the urine often
+has a foul odor and smells of ammonia.
+
+=Treatment.=--The treatment of acute cystitis consists in
+rest--preferably on the back, with the legs drawn up, in bed. The diet
+should be chiefly fluid, as milk and pure water, flaxseed tea, or
+mineral waters. Potassium citrate, fifteen grains, and sweet spirit of
+nitre, fifteen drops, may be given in water to advantage three times
+daily. Hot full baths or sitz baths two or three times a day, and in
+women hot vaginal douches (that is, injections into the front
+passage), with hot poultices or the hot-water bag over the lower part
+of the abdomen, will serve to relieve the suffering. If, however, the
+pain and frequency attending urination is considerable, nothing is so
+efficient as a suppository containing one-quarter grain each of
+morphine sulphate and belladonna extract, which should be introduced
+into the bowel and repeated once in three hours if necessary. This
+treatment should be employed only under the advice of a physician. In
+chronic cystitis, urotropin in five-grain doses dissolved in a glass
+of water and taken four times daily often affords great relief, but
+these cases demand careful study by a physician to determine their
+cause, and often local treatment. Avoidance of all source of
+irritation is also essential in these cases, as sexual excitement and
+the use of alcohol and spices. The diet should consist chiefly of
+cereals and vegetables, with an abundance of milk and water. The
+bowels should be kept loose by means of hot rectal injections in acute
+cystitis.
+
+
+=RETENTION, STOPPAGE, OR SUPPRESSION OF URINE.=--Retention refers to
+that condition where the urine has been accumulating in the bladder
+for a considerable time--over twelve hours--and cannot be passed. It
+may follow an obstruction from disease, to which is added temporary
+swelling and nervous contraction of some part of the urinary passage;
+or it may be due to spasm and closure of the outlet from nervous
+irritation, as in the cases of injuries and surgical operations in the
+vicinity of the sexual organs, the rectum, or in other parts of the
+body. Overdistention of the bladder from failure to pass water for a
+long time may lead to a condition where urination becomes an
+impossibility. Various general diseases, as severe fevers, and
+conditions of unconsciousness, and other disorders of the nervous
+system, are frequently accompanied by retention of urine. In retention
+of urine there is often an escape of a little urine from time to time,
+and not necessarily entire absence of outflow.
+
+=Treatment.=--Retention of urine is a serious condition. If not
+relieved, it may end in death from toxæmia, caused by back pressure on
+the kidneys, or from rupture of the bladder. Therefore surgical
+assistance is demanded as soon as it can be obtained. Failing this,
+begin with the simpler methods. A hot sitz bath, or, if the patient
+cannot move, hot applications, as a hot poultice or hot cloths
+applied over the lower part of the belly, may afford relief.
+Injections of hot water into the bowel are often more efficient still.
+A single full dose of opium in some form, as fifteen drops of
+laudanum[10] or two teaspoonfuls of paregoric[10] or one-quarter grain
+of morphine,[10] will frequently allow of a free passage of urine. The
+introduction of a suppository into the bowel, containing one-quarter
+grain each of morphine sulphate,[10] and belladonna extract, is often
+preferable to giving the drug by the mouth. These measures proving of
+no avail, the next endeavor should be to pass a catheter. If a soft
+rubber or elastic catheter is used with reasonable care, little damage
+can be done, even by a novice. The catheter should be boiled in water
+for ten minutes, and after washing his hands thoroughly the attendant
+should anoint the catheter with sweet oil (which has been boiled) or
+clean vaseline and proceed to introduce the catheter slowly into the
+urinary passage until the urine begins to flow out through the
+instrument.
+
+A medium-sized catheter is most generally suitable, as a No. 16 of the
+French scale, or a No. 8-1/2 of the English scale.
+
+
+=BRIGHTS DISEASE OF THE KIDNEYS.=--Bright's disease of the kidneys is
+acute or chronic, and its presence can be definitely determined only
+by chemical and microscopical examination of the urine. Acute Bright's
+disease coming on in persons previously well may often, however,
+present certain symptoms by which its existence may be suspected even
+by the layman.
+
+
+=ACUTE BRIGHT'S DISEASE; ACUTE INFLAMMATION OF THE KIDNEYS.=--Acute
+Bright's disease is often the result of exposure to cold and wet.
+Inflammation of the kidneys may be produced by swallowing turpentine,
+many of the cheap flavoring extracts in large amounts, carbolic acid,
+and Spanish flies; the external use of large quantities of turpentine,
+carbolic acid, or Spanish flies may also lead to acute inflammation of
+the kidneys. It occurs occasionally in pregnant women. The contagious
+germ diseases are very frequently the source of acute Bright's disease
+either as a complication or sequel. Thus scarlet fever is the most
+frequent cause, but measles, smallpox, chickenpox, yellow fever,
+typhoid fever, erysipelas, diphtheria, cholera, and malaria are also
+causative factors.
+
+=Symptoms.=--Acute Bright's disease may develop suddenly with pallor
+and puffiness of the face owing to dropsy. The eyelids, ankles, legs,
+and lower part of the belly are apt to show the dropsy most. There may
+be nausea, vomiting, pain and lameness in the small part of the back,
+chills and fever, loss of appetite, and often constipation. In
+children convulsions sometimes appear. The urine is small in amount,
+perhaps not more than a cupful in twenty-four hours, instead of the
+normal daily excretion of three pints. Occasionally complete
+suppression of urine occurs. It is high-colored, either smoky or of a
+porter color, or sometimes a dark or even bright red, from the
+pressure of blood. Stupor and unconsciousness may supervene in severe
+cases. Recovery usually occurs, in favorable cases, within a few
+weeks, with gradually diminishing dropsy and increasing secretion of
+urine, or the disease may end in a chronic disorder of the kidneys. If
+acute Bright's disease is caused by, or complicated with, other
+diseases, the probable result becomes much more difficult to predict.
+
+=Treatment.=--The failure of the kidneys to perform their usual
+function of eliminating waste matter from the blood makes it necessary
+for the skin and bowels to do double duty. The patient should remain
+in bed and be kept very warm with flannel night clothes and blankets
+next the body. The diet should consist wholly of milk, a glass every
+two hours, in those with whom it agrees, and in others gruels may be
+substituted to some extent. The addition to milk of mineral waters,
+limewater, small amounts of tea, coffee, or salt often makes it more
+palatable to those otherwise disliking it. As the patient improves,
+bread and butter, green and juicy vegetables, and fruits may be
+permitted. An abundance of pure water is always desirable. The bowels
+should be kept loose from the outset by salts given in as little water
+as possible and immediately followed by a glass of pure water. A
+teaspoonful may be given hourly till the bowels move. Epsom or
+Glauber's salts are efficient, but the compound jalap powder is the
+best purgative. Children, or those to whom these remedies are
+repugnant, may take the solution of citrate of magnesia, of which the
+dose is one-half to a whole bottle for adults. The skin is stimulated
+by the patient's lying in a hot bath for twenty minutes each day or,
+if this is not possible, by wrapping the patient in a blanket wrung
+out of hot water and covered by a dry blanket, and then by a rubber or
+waterproof sheet, and he is allowed to remain in it for an hour with a
+cold cloth to the head. If the patient takes the hot bath he should be
+immediately wrapped in warmed blankets on leaving it, and receive a
+hot drink of lemonade to stimulate sweating.
+
+For treatment of convulsions, see Vol. I, p. 188.
+
+Vomiting is allayed by swallowing cracked ice, single doses of bismuth
+subnitrate (one-quarter teaspoonful) once in three hours, and by heat
+applied externally over the stomach. Recovery is hastened by avoiding
+cold and damp, and persisting with a liquid diet for a considerable
+period. A course of iron is usually desirable after a few weeks have
+elapsed to improve the quality of the blood; ten drops of the tincture
+of the chloride of iron taken in water through a glass tube by adults;
+for children five to ten drops of the syrup of the iodide of iron. In
+either case the medicine should be taken three times daily after
+meals.
+
+
+=CHRONIC BRIGHT'S DISEASE.=--This includes several forms of kidney
+disease. The symptoms are often very obscure, and the condition may
+not be discovered or suspected by the physician until an examination
+of the urine is made, which should always be done in any case of
+serious or obscure disorder. Accidental discovery of Bright's disease
+during examination for life insurance is not rare. The disease may
+exist for years without serious impairment resulting.
+
+=Causes.=--Chronic Bright's disease often follows and is the result of
+fevers and acute inflammation of the kidneys. It is more common in
+adults. Overeating, more especially of meat, and overdrinking of
+alcohol are frequent causes. Gout is a frequent factor in its
+causation. The disease has in the past been regarded as a local
+disease of the kidneys, but recent research makes it probable that
+there is a general disorder of the system due to some faulty
+assimilation of food--especially when the diet itself is faulty--with
+the production of chemical products which damage various organs in the
+body as well as the kidneys, notably the heart and blood vessels.
+
+=Symptoms.=--The symptoms are most diverse and varied and it is not
+possible to be sure of the existence of the disease without a careful
+physical examination, together with a complete examination of the
+urine, both made by a competent physician. Patients may be afflicted
+with the disease for long periods without any symptoms until some
+sudden complication calls attention to the underlying trouble.
+Symptoms suggesting chronic Bright's disease are among the following:
+indigestion, diarrhea and vomiting, frequent headache, shortness of
+breath, weakness, paleness, puffiness of the eyelids, swelling of the
+feet in the morning, dropsy, failure of eyesight, and nosebleed, and
+sometimes apoplexy. As the disease comes on slowly the patient has
+usually time to apply for medical aid, and attention is called to the
+foregoing symptoms merely to emphasize the importance of attending to
+such in due season.
+
+=Outcome.=--While the outlook as to complete recovery is very
+discouraging, yet persons may live and be able to work for years in
+comparative comfort in many cases. When a physician pronounces the
+verdict of chronic Bright's disease, it is not by any means equivalent
+to a death warrant, but the condition is often compatible with many
+years of usefulness and freedom from serious suffering.
+
+=Treatment.=--Medicines will no more cure Bright's disease than old
+age. Out-of-door life in a dry, warm, and equable climate has the most
+favorable influence upon the cause of chronic Bright's disease, and
+should always be recommended as a remedial agent when available.
+Proper diet is of great importance. Cereals, vegetables, an abundance
+of fat in the form of butter and cream--to the amount of a pint or so
+a day of the latter, and the avoidance of alcohol and meat, fish and
+eggs constitute the ideal regimen when this can be carried out. Tea
+and coffee in much moderation are usually allowable and water in
+abundance. The underclothing should be of wool the year round, and
+especial care is essential to avoid chilling of the surface. Medicines
+have their usefulness to relieve special conditions, but should only
+be taken at the advice of a physician, whose services should always be
+secured when available.
+
+
+
+
+Part IV
+
+DISEASE AND DISORDER OF THE
+MIND
+
+BY
+
+ALBERT WARREN FERRIS
+
+
+
+
+CHAPTER I
+
+=Insanity=
+
+
+Insanity is the name given to a collection of symptoms of disease of
+the brain or disorder of brain nutrition or circulation. The principal
+test of insanity lies in the adjustment of the patient to his
+surroundings, as evidenced in conduct and speech. Yet one must not
+include within the field of insanity the improper conduct and speech
+of the vicious, nor of the mentally defective. Crime is not insanity,
+though there are undoubtedly some insane people confined in prisons
+who have been arrested because of the commission of crime.
+
+Then, too, while mental defect may exist in the insane, there is a
+certain class of mental defectives whose condition is due not to
+disease of the brain, but to arrest of development of the brain during
+childhood or youth, and these we call idiots or imbeciles; but they
+are not classed with the insane.
+
+
+_Mental Disorder Not Insanity_
+
+We frequently hear repeated the assertion, "Everybody is a little
+insane," and the quotation is reported as coming from an expert in
+insanity. This quotation is untrue. The fact is that anyone is liable
+to mental disorder; but mental disorder is not insanity. To
+illustrate: a green glove is shown to a certain man and he asserts
+that its color is brown, and you cannot prove to him that he is wrong,
+because he is color-blind. Green and brown appear alike to him. This
+is mental disorder, but not insanity. Again, a friend will explain to
+you how he can make a large profit by investing his money in a certain
+way. He does so invest it and loses it, because he has overlooked
+certain factors, has not given proper weight to certain influences,
+and has ignored probable occurrences, all of which were apparent to
+you. He was a victim of his mental disorder, his judgment, reason, and
+conception being faulty; yet he was not insane. Again, you answer a
+letter from a correspondent, copying on the envelope the address you
+read at the head of his letter. A few days later your answer is
+returned to you undelivered. In astonishment, you refer to his letter
+and find that you have misread the address he gave, mistaking the
+number of his house. This was an instance of mental disorder in your
+not reading the figure aright; but it was not insanity.
+
+
+_What Autopsies of the Brain Reveal_
+
+The changes in the brain accompanying or resulting from disease, as
+found in some chronic cases of insanity in which autopsies are made,
+consist largely in alteration of the nerve cells of the brain. The
+cells are smaller and fewer than they should be, they are altered in
+shape, and their threads of communication with other cells are
+broken. Nerve cells and often large areas of gray matter are replaced
+by connective tissue (resembling scar tissue), which grows and
+increases in what would otherwise be vacant spaces. All areas which
+contain this connective tissue, this filling which has no function, of
+course, cease to join with other parts of the brain in concerted
+action, and so the power of the brain is diminished, and certain of
+its activities are restricted or abolished.
+
+
+_Curious Illusions of the Insane_
+
+In the normal brain certain impressions are received from the special
+senses: impressions of sight or of hearing, for example. These
+impressions are called conscious perceptions, and the healthy brain
+groups them together and forms concepts. For instance, you see
+something which is flat and shiny with square-cut edges. You touch it,
+and learn that it is cold, smooth, and hard. Lift it and you find it
+heavy. Grouping together your sense perceptions you form the concept,
+and decide that the object is a piece of marble. Again, you enter a
+dimly lighted room and see a figure in a corner the height of a woman,
+with a gown like a woman's. You approach it, speak to it and get no
+reply, and you find you can walk directly through it, for it is a
+shadow. Perhaps you were frightened. Perhaps you imagined she was a
+thief. Your first judgment was wrong and you correct it. The insane
+person, however, has defective mental processes. He cannot group
+together his perceptions and form proper conceptions. His imagination
+runs riot. His emotions of fear or anger are not easily limited. He
+has to some extent lost the control over his mental actions that you
+and other people possess if your brains are normal. The insane man
+will insist that there is a woman there, and not a shadow, and to his
+mind it is not absurd to walk directly through this person. He cannot
+correct the wrong idea. Such a wrongly interpreted sense perception is
+called an illusion. Another example of illusion is the mistaking the
+whistle of a locomotive for the shriek of a pursuing assassin.
+
+
+_What Hallucinations Are_
+
+The insane man may also suffer from hallucinations. A hallucination is
+a false perception arising without external sensory experience. In a
+hallucination of sight, the disease in the brain causes irritation to
+be carried to the sight-centers of the brain, with a result that is
+similar to the impression carried to the same centers by the optic
+nerves when light is reflected into the eyes from some object. An
+insane man may be deluded with the belief that he sees a face against
+the wall where there is nothing at all. When the air is pure and sweet
+and no odor is discoverable, he may smell feathers burning, and thus
+reveal his hallucination of smell.
+
+
+_Delusions Common to Insanity_
+
+The insane man may have wrong ideas without logical reason for them.
+Thus, an insane man may declare that a beautiful actress is in love
+with him, when there is absolutely no foundation for such an idea. Or,
+he may believe that he can lift 500 pounds and run faster than a
+locomotive can go, while in reality he is so feeble as scarcely to be
+able to walk, and unable to dress himself. Such ideas are delusions.
+Sane people may be mistaken; they may have hallucinations, illusions
+and delusions; but they abandon their mistaken notions and correct
+their judgment at once, on being shown their errors. Sane people see
+the force of logical argument, and act upon it, abandoning all
+irrational ideas. The insane person, on the other hand, cannot see the
+force of logical argument; cannot realize the absurdity or
+impossibility of error. He clings to his own beliefs, for the evidence
+of his perverted senses or the deductions from his disease-irritation
+are very real to him. When we find this to be the fact we know he is
+insane.
+
+Yet we must not confound delirium of fever with insanity. A patient
+suffering from typhoid fever may have a delusion that there is a pail
+by his bed into which he persists in throwing articles. Or he may have
+the hallucination that he is being called into the next room, and try
+to obey the supposed voice.
+
+Certain delusions are commonly found in certain types of insanity.
+Depressed patients frequently manifest the delusion that they have
+committed a great sin, and are unfit to associate with anyone.
+Excited and maniacal patients often believe they are important
+personages--kings or queens, old historical celebrities, etc.
+Paranoiacs commonly have delusions of persecution and of a conspiracy
+among their relatives or their associates or rivals. Victims of
+alcoholic insanity have delusions regarding sexual matters, and
+generally charge with infidelity those to whom they are married.
+General paretics in most cases have delusions of grandeur; that is,
+false ideas of great strength, wealth, political power, beauty, etc.
+
+The emotion which accompanies mental activity is generally exaggerated
+in all insane people except the demented. One sees extreme depression,
+or undue elation and exaltation, or silly glee and absurd joy.
+Intensity of emotion is frequent.
+
+
+_Crimes Impulsively Committed by the Insane_
+
+An interesting mental feature of many insane patients is the
+imperative conception, or imperative impulse. This is a strong urging
+felt by the patient to commit a certain act. He may know the act is
+wrong and dread the punishment which he expects will follow its
+commission. But so constantly and strongly is he impelled that he
+finally yields and commits the act. Crimes are thus perpetrated by the
+insane, with a full knowledge of their enormity. The fact that such
+impulses undoubtedly exist should modify the common test, as to an
+insane person's responsibility before the law. The statute in many
+countries regards an insane criminal as responsible for his act, if he
+knows the difference between right and wrong. This decision is unjust
+and the basis is wrong; for an impulse may be overwhelming, and the
+patient utterly helpless during its continuance. However, a patient
+who has committed a crime under stress of such an irresistible impulse
+should be put under permanent custodial care.
+
+
+_Physical Signs of Insanity_
+
+The physician who is skilled in psychiatry finds in very many insane
+patients marked physical signs. There are pains, insensitive areas,
+hypersensitive areas, changes in the pupils of the eyes, unrestrained
+reflex action, and partial loss of muscular control, as shown in
+talking, walking, and writing. Constipation and insomnia are very
+early symptoms of disease in a very large proportion of the insane.
+
+It is productive of no good result for a layman to try to classify the
+insane. The matter of classification will be for several years in a
+condition of developmental change. It is enough to speak of the
+patient as depressed or excited, agitated or stupid, talkative or
+mute, homicidal, suicidal, neglectful, uncleanly in personal habits,
+etc.
+
+
+_Illustrations of Various Types_
+
+There are very interesting features connected with typical instances
+of several varieties of insanity, as they were noted in certain cases
+under the writer's care. A depressed patient with suicidal tendencies
+cherished the delusion that war with Great Britain was imminent, and
+that in such an event British troops would be landed on Long Island
+between New York City and the spot where he conceived the cattle to be
+kept. This, he argued, would cut off the beef and milk supply from the
+city. He therefore decided to do his part toward husbanding the
+present supply of food by refusing to eat; an act which necessitated
+feeding him through a rubber tube for many weeks. He also attempted
+suicide by drowning, throwing himself face downward in a shallow
+swamp, whence he was rescued. This young man was an expert chess
+player even during his attack.
+
+A maniacal patient wore on her head a tent of newspaper to keep the
+devil from coming through the ceiling and attacking her. She
+frequently heard her husband running about the upper floor with the
+devil on his back. As a further precaution she stained her gray hair
+red with pickled beet juice, and would occasionally hurl loose
+furniture at the walls and ceilings of her rooms and assault all who
+approached her.
+
+A man who presented a case of dementia pulled the hairs from his beard
+and planted them in rows in the garden, watering them daily, and
+showing much astonishment that they did not grow. He spent hours each
+day in spelling words backward and forward, and also by repeating
+their letters in the order in which they appear in the alphabet. When
+he wanted funds he signed yellow fallen leaves with a needle, and they
+turned into money.
+
+A case of general paresis (commonly though improperly called
+"softening of the brain") passed into the second stage as a delusion
+was uppermost to the effect that there was opium everywhere; opium in
+his hat, opium in his newspaper, opium in his bath sponge, opium in
+his food. He thereupon refused to eat, and was fed with a tube for two
+years, at the end of which time he resumed natural methods of
+nutrition and ate voraciously. Another general paretic promised to his
+physician such gifts as an ivory vest with diamond buttons, boasted of
+his great strength while scarcely able to walk alone, and declared he
+was a celebrated vocalist, while his lips and tongue were so tremulous
+he could scarcely articulate.
+
+
+_Fixed Delusions of Paranoia_
+
+Paranoia is an infrequent variety of insanity in which the patient is
+dominated by certain fixed delusions, while for a long time his
+intellect is but slightly impaired. The delusions are usually
+persecutory, and the patient alleges a conspiracy. He is generally
+deluded with the belief that he is a prominent person in history, or
+an Old Testament worthy, and there is usually a religious tinge to his
+delusions. A patient of the writer believed himself to be the
+reincarnation of Christ, appearing as "the Christ of the Jews and the
+Christ of the Christians" in one. Over the head of his landlord, who
+requested overdue rent, the patient fired a revolver, "to show that
+the reign of peace had begun in the world." He wrote a new bible for
+his followers, and arranged for a triumphal procession headed by his
+brother and himself on horseback, wearing white stars.
+
+
+_How the Physician Should Be Aided_
+
+When there is a suspicion of irrationality in a person's conduct, and
+certain acts or speeches suggest insanity, the whole surroundings and
+the past life must be considered. Frequently when the eyes are once
+opened to the fact of insanity, a whole chapter of corroborating
+peculiarities can be recalled. It is wise to recall as many of these
+circumstances as possible and note them in order as they occurred, for
+the use of the physician. Strikingly eccentric letters should be
+saved. Odd arrangement of clothes, or the collecting of useless
+articles, should be noted in writing. Changes in character, alteration
+in ideas of propriety, changes in disposition, business or social
+habits, and great variation in the bodily health should be noted in
+writing. Delusions, hallucinations, and illusions should be reported
+in full. It conveys nothing to anyone's mind to say that the patient
+is queer; tell what he does or says that leads you to think he is
+queer, and let the physician draw his own inferences from the deeds or
+speeches. Write down, for example, that the patient talks as if
+answering voices that are imaginary; or that the patient brought an ax
+into the dining room and stood it against the table during the meal;
+or that he paraded up and down the lawn with a wreath of willow
+branches about his neck; in each case stating the actual fact. It is
+important to ascertain exactly what the patient's habits are, as to
+the use of alcoholic beverages, tobacco, and drugs (such as opium),
+and also as to sexual matters. To secure such information is extremely
+difficult, and the help of a close friend or companion will be
+necessary. After the mind begins to waver many a patient plunges into
+dissipation, though formerly a model of propriety.
+
+
+_The Causes of Insanity_
+
+The two great causes of insanity are heredity and stress or strain.
+Lunacy is not infrequent in children of epileptic, alcoholic, or
+insane parents, and those born of parents suffering from nervous
+disease frequently are in such condition that shock, intense emotion,
+dissipation, or exhausting diseases render them insane. Drinking
+alcoholic beverages is the most potent factor in the production of
+insanity. Mental strain, overwork, and worry come next. Adverse
+conditions, bereavement, business troubles, etc., rank third, equally
+with heredity. The arterial diseases of old age, epilepsy, childbirth
+(generally in the neurotic), change of life, fright and nervous shock,
+venereal diseases, sexual excesses or irregularities follow in the
+order named.
+
+
+_A Temperate, Virtuous Life the Best Preventive_
+
+To avoid insanity, therefore, one should lead a righteous,
+industrious, sensible life, preserve as much equanimity as possible,
+and be content with moderate pleasure and moderate success. In many
+cases, people who are neurotic from early youth are so placed that
+unusual demands are made upon them. Adversity brings necessity for
+overwork, duties are manifold, and responsibilities are heavy. In
+ignorance of the fact that they are on dangerous ground and driven by
+circumstances, they overwork, cut short their sleep, and,
+conscientiously pressing on, finally lose their mental balance and
+insanity is the result, a great calamity which is really no fault of
+theirs. Undoubtedly such is frequently the sad history; and for this
+reason, as well as for the general reason that the insane are simply
+ill, all insane should be cared for sympathetically. To consider the
+insane as constantly malevolent is a relic of the old-time, absurd
+belief that insane people were "possessed of the devil." It is no
+disgrace to be insane, and the feeling of chagrin at discovering
+disease of the brain in a relative is another absurdity. Avoidance of
+insanity should be studied with as much devotion as avoidance of
+tuberculosis. Yet there should be no detraction from the fact that the
+heredity is strong. No one should be allowed to marry who has been
+insane, for the offspring of the insane are defective.
+
+The tendency of the times is toward nervous and mental disorder. In
+the large cities the strain is too constant, the struggle is too keen,
+the pace is too swift. Haste to be rich, desire to appear rich, or
+ambition for social distinction has wrecked many a bright, strong
+intellect. This is the age of the greatest luxury the world has ever
+seen, and a large proportion of people in cities are living beyond
+their means, in the gratification of luxurious desires or the effort
+to appear as well as others. Stress and strain are voluntarily
+invited. Children are pushed in their studies and overloaded with too
+many subjects. Genius and insanity, worry and dementia, proceed among
+us hand in hand; the overwrought brain finally totters.
+
+
+_False Ideas Regarding Insanity_
+
+Curious ideas regarding insanity are common, and are apparently
+fostered by the reportorial writers of the daily papers. We read of
+people who are "insane on a subject." This is an impossibility. Many
+people can be drawn out and led into a betrayal of their mental
+condition only when a certain topic or idea is discussed. But although
+exhibiting their insane condition only when this topic is broached,
+they are in no respect sane. Not every act of an insane man is an
+insane act, we must remember. Forgetfulness of this fact leads to
+errors in the superficial. You will hear people say that a certain
+person must be sane, because during a half day's companionship nothing
+astray was noticed. True, there may be a long period of self-control,
+or of absence of test; but occasional conduct will establish the fact
+of constant insanity. Again, we hear the expression: "He cannot be
+insane; there is too much method in such madness." The answer to this
+silly remark is that there is method in all madness except some
+epileptic insanity and terminal dementia. Insane people prepare
+careful plans, with all the details thoroughly considered, and perfect
+methods to escape from hospitals with the greatest cunning. One must
+never take it for granted that the insane person is so demented
+mentally as to be unable to appreciate what is said and done. One
+should never talk about the insane man in his presence, but should
+include him in the conversation as if sane, as a general rule,
+allaying his suspicions and avoiding antagonism. Do not agree with the
+delusions of an insane person, except so far as may be necessary to
+draw them out. Yet avoid argument over them. Simply do not agree, and
+do not strengthen them by appearing to share them. His food should be
+prepared for him, and his medicines administered to him as to any
+other sick person. His baths should be regularly taken.
+
+A depressed patient should be very carefully watched. If the slightest
+suspicion of a suicidal impulse be present, the patient should never
+be left alone. Many a valuable life has been saved through the moral
+support of constant companionship; while we read very frequently of
+the death of an insane patient who sprang from a window during a brief
+period of relaxation of watchful care. Some people think it a
+protection to one insane to elicit from him a promise not to be
+depressed, and not to do anything wrong. One might as well secure a
+promise not to have a rise of temperature. The gloom of despondency
+and the suicidal impulse are as powerful as they are unwelcome and
+unsought; and the wretchedly unhappy patient cannot alone meet the
+issue and resist.
+
+It is unreasonable to be offended by acts or speeches of an insane
+patient, to bear a grudge or expect an apology. Very frequently such a
+patient will turn savagely upon the nearest and dearest, and make
+cutting remarks and accusations or exhibit baseless contempt. All this
+conduct must be ignored and forgotten; for the unkind words of an
+unaccountable and really ill person should not be taken at all
+seriously.
+
+Should a patient escape from home, it is the duty of the one in charge
+without hesitation to overtake him, and then accompany him or at least
+follow at a short distance. The nurse should go with and stay with the
+patient, telephoning or telegraphing home when opportunity offers, and
+finally securing aid; he should know where the patient is at all
+times, foregoing sleep if necessary to protect his charge, and should
+avoid as long as prudence permits the publicity of an arrest; though
+the latter may finally be essential to safety, and to the prevention
+of embarking on a voyage, or taking a train to a distance, or
+purchasing weapons.
+
+=Diversions.=--Music favorably affects many patients, so the pleasure
+of listening to it should be afforded at frequent intervals. Patients
+should be encouraged to absorb themselves in it. It is often possible
+to take insane people to opera, musical comedy, or concert. Vocal and
+instrumental practice at suitable intervals is of great value in
+fixing the attention, filling the mind with desirable thoughts and
+memories, and allaying irritability. Drawing and painting are of
+service when within the number of the patient's accomplishments.
+Intellectual pastimes, as authors, anagrams, billiards, chess, and
+many games with playing cards, are generally helpful. Gardening,
+croquet, and tennis are very desirable. Golf, rowing, swimming, and
+skating are excellent, but are within the reach of very few insane
+patients. All regular occupation that necessitates attention and
+concentration is of supreme value; in fact, insane patients not
+infrequently ask for occupation and find relief in the accomplishment
+of something useful, as well as in the healthful sleep and increased
+appetite that attend judicious physical fatigue.
+
+
+_The Beneficial Atmosphere of Sanitariums_
+
+After caring for an insane patient for a time at home, the question
+arises as to the desirability of sending him away to a sanitarium.
+Generally this is a wise course to pursue. The constant association
+with an insane person is undermining; the responsibility is often too
+heavy; children, often inheriting the same neurotic tendency and
+always impressionable, should not be exposed to the perverting
+influence; it may not be safe to keep a patient with suicidal or
+homicidal impulses in his home; the surroundings amid which the insane
+ideas first started may tend to continue a suggestion of these ideas.
+Removal to strange locality and new scenes, the influence of
+strangers, the abandonment of all responsibilities and duties, and the
+atmosphere of obedience, routine, and discipline are all beneficial.
+An insane person will generally make a greater effort for a stranger
+than for a familiar relative. Discipline, in the form of orders of the
+physicians, and exact obedience is very often very salutary. There is
+a feeling with some that all discipline is cruel. This is not so, for
+the conduct of an insane person is not all insane, but frequently
+needs correction. Many cases of mental alienation improve promptly
+under custodial care, many need it all their lives. A great many cases
+of insanity are never obliged to go away from home, and there is a
+considerable number who carry on a business while still insane, rear a
+family, and take care of themselves. In general, a depressed patient
+should be kept at home as long as there is absolute safety in so
+doing. Most other forms of mental disease progress more rapidly toward
+recovery in sanitariums or hospitals equipped for such patients.
+Prospects of recovery are never jeopardized by confinement in a proper
+institution. Mental and physical rest, quiet, regularity of eating,
+exercising, and sleeping are the essentials which underlie all
+successful treatment of these cases. Dietetics, diversion by means of
+games, music, etc., regular occupation of any practicable sort,
+together with the association with the hopeful, tactful, and reasoning
+minds of physicians and nurses trained for this purpose are of great
+value. It must be remembered that in wholly civilized localities
+madhouses have been replaced by hospitals, keepers have been replaced
+by nurses and attendants, and the old methods of punishment and
+coercion have been long since abandoned, in the light of modern
+compassionate custody.
+
+Certain forms of insanity are hopeless from the start. Few recover
+after two years of mental aberration. Omitting the hopeless cases,
+over forty per cent of the cases of insanity recover. About sixty per
+cent recover of the cases classed as melancholia and mania. Most
+recoveries occur during the first year of the disease; but depressed
+patients may emerge and recover after several years' treatment.
+
+
+FOOTNOTES:
+
+[10] Caution. Dangerous. Use only on physician's order.
+
+
+
+
+APPENDIX
+
+=Patent Medicines=[11]
+
+
+The term "patent medicine" is loosely used to designate all remedies
+of a secret, non-secret, or proprietary character, which are widely
+advertised to the public. This use of the name is erroneous, and it is
+better first to understand the exact difference between the different
+classes of medicines generally comprised under this heading. Only in
+this way can one comprehend their right and wrong use.
+
+=A Patent Medicine= is a remedy which is patented. In order to secure
+this patent, an exact statement of the ingredients and the mode of
+manufacture must be filed with the government. These true "patent
+medicines" are generally artificial products of chemical manufacture,
+such as phenacetin. The very fact of their being patented makes them
+non-secret, and if an intelligent idea is held of their nature and
+mode of action, they may be properly used. Physicians with a full
+knowledge of their uses, limitations, and dangers often, and
+legitimately, prescribe them, and thus used they are the safest and
+most useful of all drugs and compounds of this class.
+
+=A Nostrum.=--The Century Dictionary defines a nostrum as "a medicine
+the ingredients of which, and the methods of compounding them, are
+kept secret for the purpose of restricting the profits of sale to the
+inventor or proprietor." Some nostrums have stated, on their label,
+the names of their ingredients, but not the amount. There has been no
+restriction upon their manufacture or sale in this country, therefore
+the user has only the manufacturer's statement as to the nature of the
+medicine and its uses, and these statements, in many instances, have
+been proved utterly false and unreliable.
+
+=A Proprietary Medicine= is a non-secret compound which is marketed
+under the maker's name. This is usually done because the manufacturer
+claims some particular merit in his product and its mode of
+preparation, and as these drugs are perfectly ethical and largely used
+by physicians, it is to the maker's interest to maintain his
+reputation for the purity and accuracy of the drug. Familiar instances
+of this class are: Squibb's Ether and Chloroform, and Powers &
+Weightman's Quinine.
+
+From the above definition it may be seen that the only unreliable
+medicines are those which are, in reality, nostrums. In regard to all
+of these medicines the following rules should be observed:
+
+_First._--Don't use any remedy that does not show its formula on the
+label.
+
+_Second._--No matter what your confidence in the medicine, or how
+highly recommended it is, consult a physician before using very much
+of it.
+
+_Third._--Take no medicine internally without a physician's advice.
+
+Throughout this chapter the word "patent medicine" will be used in its
+widely accepted form, in the everyday sense, without regard to its
+legal definition, and will be held to include any of the
+above-mentioned classes, unless a direct statement is made to the
+contrary.
+
+In Germany the contents of patent medicines are commonly published,
+and in this country, notably in Massachusetts, the State Boards of
+Health are analyzing these preparations, and making public their
+findings. In North Dakota a law has been passed which requires that a
+proprietary medicine containing over five per cent of alcohol, or any
+one of a number of specified drugs, be labeled accordingly.
+
+
+=PURE FOOD BILL.=--A far-reaching and important step, in the movement
+for reform of patent medicines and for the protection of the public,
+has now been taken by the United States Government. On June 30, 1906,
+an act was approved forbidding the manufacture, sale, or
+transportation of adulterated, misbranded, or poisonous or deleterious
+foods, drugs, medicines, or liquors. This act regulates interstate
+commerce in these articles, and went into effect January 1, 1907.
+Section 7 of this act states:
+
+    "That for the purposes of this Act an article shall be deemed to
+    be adulterated: in case of drugs:
+
+    "_First._ If, when a drug is sold under or by a name recognized in
+    the United States Pharmacopoeia or National Formulary, it differs
+    from the standard of strength, quality, or purity, as determined
+    by the test laid down in the United States Pharmacopoeia or
+    National Formulary official at the time of investigation;
+    _Provided_, that no drug defined in the United States
+    Pharmacopoeia or National Formulary shall be deemed to be
+    adulterated under this provision if the standard of strength,
+    quality, or purity be plainly stated upon the bottle, box or other
+    container thereof although the standard may differ from that
+    determined by the test laid down in the United States
+    Pharmacopoeia or National Formulary.
+
+    "_Second._ If its strength or purity fall below the professed
+    standard or quality under which it is sold."
+
+Section 8 states that a drug shall be deemed misbranded:
+
+    "_First._ If it be an imitation of or offered for sale under the
+    name of another article.
+
+    "_Second._ If it (the package, bottle or box) fails to bear a
+    statement on the label of the quantity or proportion of any
+    alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine,
+    chloroform, cannabis indica, chloral hydrate, or acetanilid, or
+    any derivative or preparation of any such substances contained
+    therein."
+
+What are the motives which impel persons to buy and use patent
+medicines? The history of medicine offers a partial explanation. In
+somewhat remote times we find that the medicines in use by regular
+physicians were of the most vile, nauseating, and powerful nature. We
+read of "purging gently" with a teaspoonful of calomel. Then during
+the wonderful progress of scientific medicine, beginning a little more
+than a half century ago, the most illustrious and useful workers were
+so busily engaged in finding the causes of disease and the changes
+wrought in the various organs, in observing the noticeable symptoms
+and in classifying and diagnosticating them, that treatment was given
+but scant attention. This was nowhere more noticeable than in Germany,
+the birthplace, home, and world-center of scientific medicine, to
+which all the medical profession flocked. Patients became simply
+material which could be watched and studied. This was an exemplary
+spirit, but did not suit the patients who wanted to be treated and
+cured. This fact, together with the peculiar wording of the laws
+regulating the practice of medicine, which allow anyone with the
+exception of graduates to treat patients, but not to prescribe or
+operate upon them, accounts for the number of quacks in Germany.
+
+Dr. Jacobi states that "there is one quack doctor to every two regular
+physicians in Saxony and Bavaria."[12]
+
+Another cause for the use of patent medicines is mysticism. Ignorance
+is the mother of credulity. It is reported[13] that Cato, the elder,
+recommended cabbages as a panacea for all sorts of ills, that he
+treated dislocations of the limbs by incantations, and ordered the
+Greek physicians out of Rome. The ignorant are greatly influenced by
+things that they cannot understand. Therefore, as the mass of people
+are utterly ignorant of the changes in structure and function of the
+body caused by disease, and also the limitations of medicines in their
+power of healing such alterations, their belief in the mysterious
+power said to attach to patent medicines is not surprising. When
+testimonials of the efficacy of patent medicines purporting to come
+from respectable divines, merchants, and statesmen are offered, the
+proof of their power seems incontestable.
+
+Economy and convenience are added incentives to the employment of
+patent medicines. This method of saving the doctor's fee is engendered
+by those physicians who themselves write prescriptions for nostrums.
+"Why not, indeed, eliminate this middleman (the doctor) and buy the
+nostrums direct?" So say the unthinking. But what doctor worthy of the
+name would prescribe a medicine the composition of which he was
+ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it,
+what would be thought of a banker or financial adviser who recommended
+his client to buy a security simply on the recommendation of the
+exploiter of the security? Yet that is exactly the position of a
+doctor who recommends a nostrum.
+
+In view of the fact, therefore, that persons of undoubted intelligence
+are in the habit of purchasing and using remedies of this character
+and since many of the most widely advertised preparations are
+extremely harmful, even poisonous, we have taken the liberty of
+pointing out a few "danger signals," in the guise of extravagant
+assertions and impossible claims, which are characteristic signs of
+the patent medicines to be avoided.
+
+
+=DANGER SIGNALS.=--There are many picturesque and easily grasped
+features in the literature, labels, and advertising of patent
+medicines that spell danger. When these features are seen, the
+medicine should be abandoned immediately, no matter what your friends
+tell you about it, or how highly recommended it may have been by
+others than your physician.
+
+=Claiming a Great Variety of Cures.=--Perhaps of all features of
+patent medicine advertising, this is the most alluring. No one drug or
+combination of drugs, with possibly one or two exceptions, can or does
+"cure" any disease. Patients recover only when the resistance of the
+body is greater than the strength of the disease. This body resistance
+varies in different persons, and is never just alike in any two
+individuals or illnesses. The patient must be treated and not the
+disease, so it is the aim of every conscientious physician to conserve
+and strengthen the vital forces and, at the same time, guard against
+further encroachment of the disease. There is no cure-all, and even if
+a drug or combination of drugs were helpful in any single case, they
+might easily be totally unsuited, or even harmful, in another case,
+with apparently similar symptoms. When a maker claims that his
+particular concoction will cure a long list of diseases, the assertion
+bears on its face evidence of its falsity.
+
+One of the most widely advertised and largely sold catarrh remedies
+claims to cure pneumonia, consumption, dyspepsia, enteritis,
+appendicitis, Bright's disease, heart disease, canker sores, and
+measles. _This is absolute fraud._ No matter what virtues this
+medicine might have in the treatment of one or two ailments, no one
+remedy could possibly be of service in such a varied list of diseases,
+and it could not "cure" one of them.
+
+Another remedy bases its assertion of "cures" on the fact that it
+claims to be a germ killer, and assumes that all disease is caused by
+germs. To quote from its advertising literature, it claims to cure
+thirty-seven diseases which are mentioned by name, and then follows
+the assertion that it cures "all diseases that begin with fever, all
+inflammations, all catarrhal contagious diseases, all the results of
+impure or poisoned blood. In nervous diseases--acts as a vitalizer,
+accomplishing what no drugs can do." It would seem that an intellect
+of any pretensions would recognize the fraudulent nature of this
+claim, yet thousands of bottles of this stuff are annually sold to a
+gullible public. These wide and unjustifiable claims are real danger
+signals, and any medicine making them should be avoided. There are
+many other remedies for which just as great claims are made; the two
+instances cited are merely representative of a large class. It is a
+waste of time, money, and health to buy them with any idea that they
+can fulfill their pretensions.
+
+=Claiming to Cure Headaches.=--The use of any "headache powders" or
+"tablets" should be avoided, except on the advice of a physician. The
+presence of pain in the head, or in any other part of the body, may be
+a symptom of a serious and deep-seated disorder, and it may often be a
+serious matter to temporize with it. At the best, these "pain
+relievers" can give only temporary relief, and their use may prove to
+be dangerous in the extreme. Their action is dependent upon one of the
+modern coal-tar products, usually acetanilid, because it is the
+cheapest. But, unfortunately, acetanilid is also the one with the most
+depressant action on the heart. The danger of headache powders lies in
+the habit which they induce, because of their quick pain-relieving
+qualities and their easy procurability, and from overdosage. If a
+person is otherwise in good health, the use of one headache powder
+will in all probability do no harm, but the dose should not be
+repeated without a doctor's authority. Many deaths have occurred from
+their continued use, or because of an idiosyncrasy on the part of the
+taker, but it is their abuse more than their use which has brought
+upon them such almost universal condemnation. Therefore, while the
+physician may advocate their use, do not take them without his advice
+and specific directions as to kind and dosage.
+
+=Claiming Exhilaration.=--These medicines, by their insidious
+character, constitute a particularly dangerous variety. They depend,
+for their effect, upon the amount of alcohol that they contain. Many
+conscientious temperance workers have not only unsuspectingly taken
+them, but have actually indorsed them. Recently the published analyses
+of several State Boards of Health and the investigations made by
+Samuel Hopkins Adams, and published in his series on "The Great
+American Fraud" have shown that a majority of the "tonics,"
+"vitalizers," and "reconstructors" depend for their exhilarating
+effect upon the fact that they contain from seventeen to fifty per
+cent of alcohol; while beer contains only five per cent, claret eight
+per cent, and champagne nine per cent. Pure whisky contains only fifty
+per cent of alcohol, yet few people would drink "three wineglassfuls
+in forty-five minutes"[14] as a medicine pure and simple. The United
+States Government has prohibited the sale of one of these medicines to
+the Indians, simply on account of the fact that as an intoxicant it
+was found too tempting and effective.[15]
+
+If one must have a stimulant it is better to be assured of its purity.
+These medicines are not only costly, but contain cheap, and often
+adulterated, spirits.
+
+Their worst feature is that they often induce the alcoholic habit in
+otherwise upright people. Commencing with a small dose, the amount is
+gradually increased until the user becomes a slave to drink. Could the
+true history of these widely used medicines be written, it would
+undoubtedly show that many drunkards were started on their downward
+career by medicinal doses of these "tonics" and "bracers."
+
+=Claiming Pain-relieving or Soothing Qualities.=--The properties of
+this class of remedies depend generally upon the presence of cocaine,
+opium, or some equally subtle and allied substance. It should be
+needless to state that such powerful drugs should be taken only upon a
+physician's prescription. Habit-forming and insidious in character,
+they are an actual menace. When present in cough syrups, they give by
+their soothing qualities a false sense of security, and when present
+in "soothing syrups" or "colic cures" for babies, they may be given
+with fatal result. Never take a medicine containing these drugs
+without a full understanding of their dangerous character, and a
+realization of the possible consequences.
+
+=Testimonials.=--These may mean anything or nothing; generally the
+latter. They are usually genuine, but, as Mr. Adams observes, "they
+represent, not the average evidence, but the most glowing opinions
+which the nostrum-vender can obtain, and generally they are the
+expression of a low order of intelligence."[16] It is a sad commentary
+on many men and women, prominent in public life, that they lend their
+names and the weight of their "testimony" to further the ends of such
+questionable ventures. Political and newspaper interests are
+responsible for the collection of this class of testimonials. An
+investigation of some men, who permitted the use of their names for
+this purpose, revealed that many of them had never tasted the
+compound, but that they were willing to sign the testimonials for the
+joy of appearing in print as "prominent citizens."[17] "Prominent
+ministers" and "distinguished temperance workers" are often cited as
+bearing testimony to the virtues of some patent medicine. It has been
+shown that, while the testimonials were real, the people who signed
+them had little right of credence, and were possessed of characters
+and attributes which would show their opinions to be of little value.
+Money and energy can be productive of any number of testimonials for
+any remedy. While some of them may be authentic, yet the fact that a
+medicine "cured" any one of the signers is no evidence that it will
+cure or even help anyone else. Many people recover from diseases with
+no medicine at all, and isolated "cures" can never be taken as a
+criterion of the value of any remedy or method.
+
+=Offering "Money Back Unless Cured."=--Careful reading of this clause
+in most advertising literature will show that there is "a string
+attached." The manufacturers are usually safe in making this
+proposition. In the first place, the average person will not put the
+matter to a test. The second reason why this is a safe proposition for
+the maker is, that if the medicine does not cure, the patient may die,
+and dead men are hardly possible claimants.
+
+=Claiming to Cure Diseases Incurable by Medicine Alone.=--Probably no
+class of people are greater users of patent medicines than those
+unfortunates afflicted with the so-called incurable diseases. The very
+fact of the serious nature of their complaint, and the dread of
+surgical intervention, makes them easy victims to the allurement of
+"sure cures."
+
+The committee on the prevention of tuberculosis of the Charity
+Organization Society of New York City has announced in decided terms
+that there is no specific medication for consumption. Cancer,
+likewise, cannot be cured by the use of internal medicine alone.
+Surgery holds out the greatest hope in this dread disease. The
+medicines claiming to cure these diseases are, therefore, of the most
+fraudulent nature. Their use is positively harmful, for in taking them
+priceless time is lost.
+
+Never temporize if there is any suspicion of the existence of such
+diseases as consumption or cancer. Self-treatment with patent
+medicines in such cases is worse than useless--it is actually
+dangerous to life itself. Consult a physician at the earliest possible
+moment, and put no faith in patent medicines.
+
+There are, however, as has been pointed out, certain patent and
+proprietary medicines which may properly be employed by the physician.
+These include the newly discovered, manufactured chemicals of known
+composition and action; and single substances or combinations of known
+drugs in known proportions, which can only be made to best advantage
+by those having the adequate facilities. The habit of prescribing
+proprietary mixtures of several substances for special diseases is,
+however, generally a matter of laziness, carelessness, or ignorance on
+the doctor's part. This follows because no disease is alike in any two
+patients; because any one disease has many phases and stages; and
+because a doctor should always treat the patient and not the disease.
+Thus a doctor, after carefully questioning and examining the patient,
+should adjust the remedy to the peculiarities of the patient and
+disease. It is impossible to make a given combination of drugs fit all
+patients with the same disease.
+
+The quantity of patent medicine sold in the United States is enormous.
+A series of articles by Samuel Hopkins Adams appeared in _Collier's
+Weekly_ during 1905 and 1906, in which he not only showed the
+fraudulent character of many of the best-known patent medicines,
+giving their names and most minute details concerning them, but
+furnished much reliable information in an interesting and convincing
+manner. In the course of these articles he pointed out that about one
+hundred millions of dollars are paid annually for patent medicines in
+the United States. As explaining this, in part, he affirmed that as
+many as five companies each expended over one million dollars annually
+in advertising patent medicines.
+
+_What Are the Good Ones Good For?_--In any great movement, when a
+dormant public suddenly awakens to the fact that a fraud has been
+perpetrated or a wrong committed, the instinctive and overwhelming
+desire is for far-reaching reform. In efforts to obtain needed and
+radical improvement, and with the impetus of a sense of wrong dealing,
+the pendulum of public opinion is apt to swing too far in an opposite
+direction. There are bad patent medicines--the proof of their
+fraudulent character is clear and overwhelming; but there are good
+ones whose merits have been obscured by the cloud of wholesale and
+popular condemnation. It is true that the manufacturers of even some
+of the valuable ones have an absurd habit of claiming the impossible.
+This attitude is to be regretted, for the makers have thus often
+caused us to lose faith in the really helpful uses to which their
+products might be put.
+
+However, it is well in condemning the bad not to overlook the good.
+The mere fact that a medicine is patented, or that it is a so-called
+proprietary remedy, does not mean that it is valueless or actually
+harmful. The safety line is knowledge of the medicine's real nature,
+its uses and its dangers; the rules given above should be rigorously
+followed.
+
+It is far easier to give general indications for the guidance of those
+wishing to shun unworthy patent medicines than to enable the reader to
+recognize the worthy article. It is safe to assume, however, that
+there are certain simple remedies, particularly those for external
+application, which have a definite use and are dependable. In justice
+it must be said that great improvement has taken place, and is now
+taking place in the ethical character of patent medicines, owing to
+recent agitation, and what is true concerning them to-day may not be
+true to-morrow.
+
+The only proper, ethical patent medicine is the one showing its exact
+composition, and refraining from promise of a cure in any disease.
+Such a one might, nevertheless, advertise its purity, reliability,
+advantageous mode of manufacture, and the excellence of its
+ingredients with more modest and truthful claims as to its use.
+
+The purchaser of a patent medicine pays not only for the ingredients,
+the cost of combining them, and the maker's just profit, but he also
+pays the exploiter's bills for advertising and distributing the
+finished product. With such standard remedies as those mentioned
+above, this added cost is usually a good investment for the purchaser,
+because trade-marked remedies which have "made good" possess two
+advantages over those less advertised, and over their prototypes in
+crude form: procurability and integrity.
+
+Even at remote cross-roads stores, it is possible to obtain a popular
+remedy, one which has been well pushed commercially. And an article
+sold in packages sealed by the makers gets to the consumer just as
+pure as when it left the laboratory. This is not always true of
+ingredients held in bulk by the retailer; witness the evidence
+brought forward in recent prosecutions for drug adulteration.
+
+It is not the purpose of this chapter, in any sense, to advertise or
+place the seal of its unrestricted approval upon any one article of a
+class. Its position in the matter is absolutely impartial. But in
+order that it may be as helpful as possible, it definitely mentions
+the most widely known, and therefore the most easily obtainable,
+remedies. There are other equally good remedies in each case, but as
+it would be almost impossible to mention each individual remedy with
+similar virtues now on the market, the ones discussed must be taken as
+representative of their class in each instance.
+
+Do not forget that the use of these simple remedies does not justify
+their abuse. They may make great claims while their use is really
+limited. Do not rely upon them to do the impossible.
+
+=Vaseline.=--This is pure and refined petroleum, and will be found of
+much service in many forms of skin irritation. It is useful in the
+prevention of "chapping," for softening rough skin, for preventing and
+healing bleeding and cracked lips, as a protective dressing in burns,
+cuts, or any acute inflammation of the skin where the cuticle has been
+injured or destroyed, or where it is desirable that a wound should be
+protected and kept closed from the air. Rubbed over the surface of the
+body when a patient is desquamating or "peeling" after scarlet fever
+or measles, it keeps the skin smooth, soothes the itching, and
+prevents the scales from being carried about in the air and so
+infecting others. Vaseline is a soothing, nonirritating, and bland
+protective ointment for external use. It is perfectly harmless, but
+should not be used for severe skin disease or for internal use, unless
+recommended by a physician in conjunction with other means of healing.
+
+=Pond's Extract.=--Although the makers have claimed special virtues
+for this remedy, it is in reality an extract of hamamelis or
+witch-hazel, and probably differs little in its application or results
+from the ordinary marketed extract made by the average druggist. It is
+mild and bland, harmless when used externally, but should not be used
+internally unless ordered by a physician. It is soothing and healing
+when applied to wounds, sprains, and bruises; diluted with water it is
+a pleasant gargle for a sore throat, and may be applied externally on
+the throat by means of a flannel wrung out in a solution of it in hot
+water. For nosebleed it is often efficient when snuffed up the nose,
+or when pledgets of cotton are soaked in it and placed in the
+nostrils. It may be used as an application in ulcers or varicose
+veins, and from two to four teaspoonfuls with an equal amount of water
+injected into the rectum two or three times daily will often prove of
+great help in piles, particularly if bleeding. It gives relief when
+used for sore or inflamed eyes or eyelids, but in this, as in all
+other serious inflammations, it is not a "cure all," and the physician
+should be consulted if the relief is not prompt.
+
+=Listerine.=--Of the many mild liquid antiseptics "Listerine" is
+probably the best known. The remarks and recommendations concerning
+it, however, are equally applicable to many other remedies of a
+somewhat similar nature, such as glycothymoline, borolyptol, lythol,
+alkalol, formalid, etc.
+
+Listerine is a solution of antiseptic substances with the addition of
+thymol and menthol in quantities sufficient to give it a pleasant odor
+and taste. It has a very strong hold on the public, and is a
+deservedly useful remedy.
+
+Listerine has many helpful uses. It is potent enough to kill many
+germs, and is excellent for this purpose when used as a mouth wash,
+particularly during illness. In acute cold in the head it is soothing
+to the mucous membrane of the nose, if used diluted with warm water as
+a nasal douche. It serves a similar purpose when used as a gargle in
+mild sore throat.
+
+If there is any reason to suspect that dirt or other foreign matter
+has come in contact with a sore or cut, the wound may be freely washed
+with a solution of listerine in order to clean it and render it as
+nearly aseptic as possible. When there are distinct signs of
+inflammation it should not be relied upon. Do not use it internally
+without a physician's advice.
+
+=Scott's Emulsion.=--This is a good emulsion of cod-liver oil, widely
+prescribed by physicians for the many patients who are too
+delicate-stomached to retain the pure oil. For those who can take the
+refined oil straight, Peter Möller's brand is in a class by itself.
+
+In certain conditions cod-liver oil is one of the most valuable
+remedies known. As a concentrated and reconstructive food in many
+wasting diseases it is of great service. Weak and puny children, and
+all suffering from malnutrition may take it with benefit. It does help
+produce flesh, increase strength, and add to the body's resisting
+powers. It does not contain any medicinal properties, and its virtue
+is largely in its fat or oil, but as an aid to other remedies, or
+alone, when increased nutrition is desired, it is a reliable and
+helpful remedy.
+
+=Antiphlogistine.=--There are many clay poultices on the market:
+antiphlogistine, antithermoline, cretamethyl, sedol, unguentum,
+yorkelin, and the Emplastrum Kaolini of the U. S. Pharmacopoeia.
+Antiphlogistine, being probably the most widely known, is here
+discussed. It is of value when a poultice is indicated. It is
+preferable to the homemade varieties in that it retains heat for a
+longer period of time and is antiseptic.
+
+It should never be used in deep-seated inflammations, such as
+peritonitis, appendicitis, deep abscesses of any part of the body, or
+other serious conditions, unless recommended by a physician; for such
+ailments need more thorough treatment than can be afforded by any
+poultice. It is perfectly harmless, and may be used with decided
+benefit in aborting or preventing many inflammatory diseases. Applied
+in the early stages of a boil, felon, or carbuncle it may either
+abort the trouble or, if the disease has already progressed too far,
+it will hasten suppuration and shorten the course of the disease. When
+a poultice is indicated in bronchitis or pleurisy it is an excellent
+one to use; it will afford much comfort, and often hasten recovery. In
+nursing mothers, when the breasts become full and tender and signs of
+beginning inflammation are present, antiphlogistine spread in a warm
+and thick coat over the breasts will often afford relief.
+
+=Platt's Chlorides.=--When it is desirable to use a liquid
+disinfectant Platt's Chlorides will be found a useful article, as will
+lysol and other marketed products. The source of a foul smell or
+dangerous infection should never be overlooked. No disinfectant can
+offer a safeguard if plumbing is defective, or other unsanitary
+conditions exist; in fact, disinfectants are often deprecated, since
+they afford a false sense of security. If a contagious disease exists
+in a household, other means than the use of a disinfectant must be
+taken in order to prevent the spread of the contagion. Disinfectants
+do have their uses, however, and are often essential. In case of an
+illness of a contagious or infectious nature, a solution of Platt's
+Chlorides or a similar disinfectant should be kept in all vessels
+containing or receiving discharges from the body. Pails containing
+such a solution should be in readiness to receive all cloths, bedding,
+or washable clothes which have come, in any way, in contact with the
+patient.
+
+
+FOOTNOTES:
+
+[11] The publishers announce this chapter as prepared independent of
+Dr. Winslow or any of the Advising Editors. Considered as an effort to
+give helpful information, free of advertising on the one hand and
+sensational exposures on the other, the article meets with the
+approval of conservative physicians. But the problems dealt with are
+too involved at present for discussion direct from the profession to
+the public.
+
+[12] Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.
+
+[13] Ibid.
+
+[14] S. H. Adams, "The Great American Fraud."
+
+[15] Ibid.
+
+[16] S. H. Adams, "The Great American Fraud."
+
+[17] S. H. Adams, "The Great American Fraud."
+
+
+
+
++--------------------------------------------------------------------+
+| TRANSCRIBER'S NOTE.                                                |
+| ===================                                                |
+|                                                                    |
+| The prescription symbol has been transcribed as [Rx].              |
+|                                                                    |
++--------------------------------------------------------------------+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Home Medical Library, Volume II
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+
+Project Gutenberg's The Home Medical Library, Volume II (of VI), by Various
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Home Medical Library, Volume II (of VI)
+
+Author: Various
+
+Editor: Kenelm Winslow
+
+Release Date: January 31, 2009 [EBook #27944]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK THE HOME MEDICAL LIBRARY ***
+
+
+
+
+Produced by Juliet Sutherland, Chris Logan and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+
+</pre>
+
+
+
+<div id="title_page">
+<h1>The Home Medical<br />
+Library</h1>
+
+<p class="by">By</p>
+
+<p class="kenelm">Kenelm Winslow, B.A.S., M.D.</p>
+
+<p class="assistant"><em>Formerly Assistant Professor Comparative Therapeutics, Harvard<br />
+University; Late Surgeon to the Newton Hospital;<br />
+Fellow of the Massachusetts Medical Society, etc.</em></p>
+
+<p>With the Coöperation of Many Medical<br />
+Advising Editors and Special Contributors</p>
+
+<p class="volumes">IN SIX VOLUMES</p>
+
+<p><em>First Aid :: Family Medicines :: Nose, Throat, Lungs,<br />
+Eye, and Ear :: Stomach and Bowels :: Tumors and<br />
+Skin Diseases :: Rheumatism :: Germ Diseases<br />
+Nervous Diseases :: Insanity :: Sexual Hygiene<br />
+Woman and Child :: Heart, Blood, and Digestion<br />
+Personal Hygiene :: Indoor Exercise<br />
+Diet and Conduct for Long Life :: Practical<br />
+Kitchen Science :: Nervousness<br />
+and Outdoor Life :: Nurse and Patient<br />
+Camping Comfort :: Sanitation<br />
+of the Household :: Pure<br />
+Water Supply :: Pure Food<br />
+Stable and Kennel</em></p>
+
+<p class="published"><span class="ny">New York</span><br />
+The Review of Reviews Company<br />
+1907</p>
+</div>
+
+
+
+<div class="section_break"></div>
+<div class="contributors">
+<h2>Medical Advising Editors</h2>
+
+<div class="thought_break"></div>
+
+<p class="managing">Managing Editor</p>
+
+<p class="name">Albert Warren Ferris, A.M., M.D.</p>
+
+<p><em>Former Assistant in Neurology, Columbia University; Former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, New International Encyclopedia.</em></p>
+
+
+<p class="subject">Nervous Diseases</p>
+
+<p class="name">Charles E. Atwood, M.D.</p>
+
+<p><em>Assistant in Neurology, Columbia University; Former Physician, Utica
+State Hospital and Bloomingdale Hospital for Insane Patients; Former
+Clinical Assistant to Sir William Gowers, National Hospital, London.</em></p>
+
+
+<p class="subject">Pregnancy</p>
+
+<p class="name">Russell Bellamy, M.D.</p>
+
+<p><em>Assistant in Obstetrics and Gynecology, Cornell University Medical
+College Dispensary; Captain and Assistant Surgeon (in charge),
+Squadron A, New York Cavalry; Assistant in Surgery, New York
+Polyclinic.</em></p>
+
+
+<p class="subject">Germ Diseases</p>
+
+<p class="name">Hermann Michael Biggs, M.D.</p>
+
+<p><em>General Medical Officer and Director of Bacteriological Laboratories,
+New York City Department of Health; Professor of Clinical Medicine in
+University and Bellevue Hospital Medical College; Visiting Physician
+to Bellevue, St. Vincent's, Willard Parker, and Riverside Hospitals.</em></p>
+
+
+<p class="subject">The Eye and Ear</p>
+
+<p class="name">J. Herbert Claiborne, M.D.</p>
+
+<p><em>Clinical Instructor in Ophthalmology, Cornell University Medical
+College; Former Adjunct Professor of Ophthalmology, New York
+Polyclinic; Former Instructor in Ophthalmology in Columbia University;
+Surgeon, New Amsterdam Eye and Ear Hospital.</em></p>
+
+
+<p class="subject">Sanitation</p>
+
+<p class="name">Thomas Darlington, M.D.</p>
+
+<p><em>Health Commissioner of New York City; Former President Medical Board,
+New York Foundling Hospital; Consulting Physician, French Hospital;
+Attending Physician, St. John's Riverside Hospital, Yonkers; Surgeon
+to New Croton Aqueduct and other Public Works, to Copper Queen
+Consolidated Mining Company of Arizona, and Arizona and Southeastern
+Railroad Hospital; Author of Medical and Climatological Works.</em></p>
+
+
+<p class="subject">Menstruation</p>
+
+<p class="name">Austin Flint, Jr., M.D.</p>
+
+<p><em>Professor of Obstetrics and Clinical Gynecology, New York University
+and Bellevue Hospital Medical College; Visiting Physician, Bellevue
+Hospital; Consulting Obstetrician, New York Maternity Hospital;
+Attending Physician, Hospital for Ruptured and Crippled, Manhattan
+Maternity and Emergency Hospitals.</em></p>
+
+
+<p class="subject">Heart and Blood</p>
+
+<p class="name">John Bessner Huber, A.M., M.D.</p>
+
+<p><em>Assistant in Medicine, University and Bellevue Hospital Medical
+College; Visiting Physician to St. Joseph's Home for Consumptives;
+Author of "Consumption: Its Relation to Man and His Civilization; Its
+Prevention and Cure."</em></p>
+
+
+<p class="subject">Skin Diseases</p>
+
+<p class="name">James C. Johnston, A.B., M.D.</p>
+
+<p><em>Instructor in Pathology and Chief of Clinic, Department of
+Dermatology, Cornell University Medical College.</em></p>
+
+
+<p class="subject">Diseases of Children</p>
+
+<p class="name">Charles Gilmore Kerley, M.D.</p>
+
+<p><em>Professor of Pediatrics, New York Polyclinic Medical School and
+Hospital; Attending Physician, New York Infant Asylum, Children's
+Department of Sydenham Hospital, and Babies' Hospital, N. Y.;
+Consulting Physician, Home for Crippled Children.</em></p>
+
+
+<p class="subject">Bites and Stings</p>
+
+<p class="name">George Gibier Rambaud, M.D.</p>
+
+<p><em>President, New York Pasteur Institute.</em></p>
+
+
+<p class="subject">Headache</p>
+
+<p class="name">Alonzo D. Rockwell, A.M., M.D.</p>
+
+<p><em>Former Professor Electro-Therapeutics and Neurology at New York
+Post-Graduate Medical School; Neurologist and Electro-Therapeutist to
+the Flushing Hospital; Former Electro-Therapeutist to the Woman's
+Hospital in the State of New York; Author of Works on Medical and
+Surgical Uses of Electricity, Nervous Exhaustion (Neurasthenia), etc.</em></p>
+
+
+<p class="subject">Poisons</p>
+
+<p class="name">E. Ellsworth Smith, M.D.</p>
+
+<p><em>Pathologist, St. John's Hospital, Yonkers; Somerset Hospital,
+Somerville, N. J.; Trinity Hospital, St. Bartholomew's Clinic, and the
+New York West Side German Dispensary.</em></p>
+
+
+<p class="subject">Catarrh</p>
+
+<p class="name">Samuel Wood Thurber, M.D.</p>
+
+<p><em>Chief of Clinic and Instructor in Laryngology, Columbia University;
+Laryngologist to the Orphan's Home and Hospital.</em></p>
+
+
+<p class="subject">Care of Infants</p>
+
+<p class="name">Herbert B. Wilcox, M.D.</p>
+
+<p><em>Assistant in Diseases of Children, Columbia University.</em></p>
+</div>
+
+
+
+<div class="section_break"></div>
+<div class="contributors">
+<h2>Special Contributors</h2>
+
+<div class="thought_break"></div>
+
+<p class="subject">Food Adulteration</p>
+
+<p class="name">S. Josephine Baker, M.D.</p>
+
+<p><em>Medical Inspector, New York City Department of Health.</em></p>
+
+
+<p class="subject">Pure Water Supply</p>
+
+<p class="name">William Paul Gerhard, C.E.</p>
+
+<p><em>Consulting Engineer for Sanitary Works; Member of American Public
+Health Association; Member, American Society Mechanical Engineers;
+Corresponding Member of American Institute of Architects, etc.; Author
+of "House Drainage," etc.</em></p>
+
+
+<p class="subject">Care of Food</p>
+
+<p><span class="name">Janet McKenzie Hill</span></p>
+
+<p><em>Editor, Boston Cooking School Magazine.</em></p>
+
+
+<p class="subject">Nerves and Outdoor Life</p>
+
+<p class="name">S. Weir Mitchell, M.D., LL.D.</p>
+
+<p><em>LL.D. (Harvard, Edinburgh, Princeton); Former President, Philadelphia
+College of Physicians; Member, National Academy of Sciences,
+Association of American Physicians, etc.; Author of essays: "Injuries
+to Nerves," "Doctor and Patient," "Fat and Blood," etc.; of scientific
+works: "Researches Upon the Venom of the Rattlesnake," etc.; of
+novels: "Hugh Wynne," "Characteristics," "Constance Trescott," "The
+Adventures of François," etc.</em></p>
+
+
+<p class="subject">Sanitation</p>
+
+<p class="name">George M. Price, M.D.</p>
+
+<p><em>Former Medical Sanitary Inspector, Department of Health, New York
+City; Inspector, New York Sanitary Aid Society of the 10th Ward, 1885;
+Manager, Model Tenement-houses of the New York Tenement-house Building
+Co., 1888; Inspector, New York State Tenement-house Commission, 1895;
+Author of "Tenement-house Inspection," "Handbook on Sanitation," etc.</em></p>
+
+
+<p class="subject">Indoor Exercise</p>
+
+<p class="name">Dudley Allen Sargent, M.D.</p>
+
+<p><em>Director of Hemenway Gymnasium, Harvard University; Former President,
+American Physical Culture Society; Director, Normal School of Physical
+Training, Cambridge, Mass.; President, American Association for
+Promotion of Physical Education; Author of "Universal Test for
+Strength," "Health, Strength and Power," etc.</em></p>
+
+
+<p class="subject">Long Life</p>
+
+<p><span class="name">Sir Henry Thompson, Bart., F.R.C.S., M.B.</span> (Lond.)</p>
+
+<p><em>Surgeon Extraordinary to His Majesty the King of the Belgians;
+Consulting Surgeon to University College Hospital, London; Emeritus
+Professor of Clinical Surgery to University College, London, etc.</em></p>
+
+
+<p class="subject">Camp Comfort</p>
+
+<p class="name">Stewart Edward White</p>
+
+<p><em>Author of "The Forest," "The Mountains," "The Silent Places," "The
+Blazed Trail," etc.</em></p>
+</div>
+
+<div class="section_break"></div>
+<div class="figcenter" style="width: 482px;">
+<img src="images/frontis.jpg" width="482" height="500" alt="HARVEY WASHINGTON WILEY, Ph.D., LL.D." title="HARVEY WASHINGTON WILEY, Ph.D., LL.D." />
+<span class="caption">HARVEY WASHINGTON WILEY, Ph.D., LL.D.</span>
+
+<p>The researches of Dr. Wiley, Chief of the Bureau of Chemistry in the
+United States Department of Agriculture, were important factors in
+hastening the enactment of the present pure food law. He analyzed the
+various food products and made public the deceptions practiced by
+unscrupulous manufacturers. He aroused attention throughout the
+country by pointing out the necessity of a campaign of education, in
+order, as stated in Volume V, Part II, that the housekeeper might be
+able to determine the purity of every article of food offered for
+sale. As an example of his methods, he organized a "poison squad" of
+government employees who restricted themselves to special diets,
+consisting of food preparations containing drugs commonly used as
+adulterants. In this way he actually demonstrated the effect of these
+substances upon the human system.</p>
+</div>
+
+
+
+
+<div class="section_break"></div>
+<div id="volume_title">
+<h2>The Home Medical<br />
+Library</h2>
+
+<div class="section_break"></div>
+
+<p class="volume">Volume II</p>
+
+<div class="section_break"></div>
+
+<p class="title">THE EYE AND EAR<br />
+THE NOSE, THROAT AND LUNGS<br />
+SKIN DISEASES<br />
+TUMORS :: RHEUMATISM<br />
+HEADACHE :: SEXUAL HYGIENE</p>
+
+<p class="name">By KENELM WINSLOW, B.A.S., M.D. (Harv.)</p>
+
+<p><em>Formerly Assistant Professor Comparative Therapeutics, Harvard University;<br />
+Late Surgeon to the Newton Hospital; Fellow of<br />
+the Massachusetts Medical Society, etc.</em></p>
+
+<div class="section_break"></div>
+
+<p class="title">INSANITY</p>
+
+<p class="name">By ALBERT WARREN FERRIS, A.M., M.D.</p>
+
+<p><em>Former Assistant in Neurology, Columbia University; former Chairman,<br />
+Section on Neurology and Psychiatry, New York Academy<br />
+of Medicine; Assistant in Medicine, University and Bellevue<br />
+Hospital Medical College; Medical Editor,<br />
+"New International Encyclopedia"</em></p>
+
+<div class="section_break"></div>
+
+<p class="published"><span class="ny">New York</span><br />
+The Review of Reviews Company<br />
+1907</p>
+</div>
+
+
+
+<div class="section_break"></div>
+<div id="copyright">
+<p>Copyright, 1907, by</p>
+
+<p class="company">The Review of Reviews Company</p>
+
+
+<p class="press">THE TROW PRESS, NEW YORK</p>
+</div>
+
+
+
+<div class="section_break"></div>
+<div id="toc">
+<p><span class="pagenum"><a name="Page_7" id="Page_7">[Pg 7]</a></span></p>
+<h2><em>Contents</em></h2>
+
+
+<h3>PART I</h3>
+
+<table summary="Table of contents - Part 1">
+<thead>
+<tr>
+  <th>CHAPTER</th>
+  <th>&nbsp;</th>
+  <th>PAGE</th>
+</tr>
+</thead>
+<tbody>
+<tr>
+  <td class="toc_chapter_number">I.</td>
+  <td class="toc_chapter">The Eye and Ear</td>
+  <td class="toc_page"><a href="#Page_13">13</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Foreign Bodies in the Eye&mdash;Black Eye&mdash;Twitching of the Eyelids&mdash;Wounds and
+Burns&mdash;Congestion&mdash;Conjunctivitis&mdash;"Pink Eye"&mdash;Strain&mdash;Astigmatism&mdash;Deafness&mdash;Foreign Bodies in the Ear&mdash;Earache&mdash;Simple Remedies.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number">II.</td>
+  <td class="toc_chapter">The Nose and Throat</td>
+  <td class="toc_page"><a href="#Page_51">51</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Nosebleed&mdash;Foreign Bodies in the Nose&mdash;Cold in the Head&mdash;Toothache&mdash;Mouth-Breathing&mdash;Sore Mouth&mdash;Pharyngitis&mdash;How to Treat Tonsilitis&mdash;Quinsy&mdash;Diphtheria&mdash;Croup&mdash;Laryngitis.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number">III.</td>
+  <td class="toc_chapter">The Lungs and Bronchial Tubes</td>
+  <td class="toc_page"><a href="#Page_87">87</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Acute and Chronic Bronchitis&mdash;Coughs in Children&mdash;Liniments and Poultices&mdash;Cough Mixtures&mdash;Treatment of Pneumonia&mdash;Consumption&mdash;Asthma&mdash;Influenza, its Symptoms and Cure.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number"><span class="pagenum"><a name="Page_8" id="Page_8">[Pg 8]</a></span>IV.</td>
+  <td class="toc_chapter">Headaches</td>
+  <td class="toc_page"><a href="#Page_113">113</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Causes of Sick Headache&mdash;Symptoms and Treatment&mdash;Headaches Caused by Indigestion&mdash;Organic Disease a Frequent Source&mdash;Nervous and Neuralgic Headaches&mdash;Effect of Poison&mdash;Heat-Stroke.</td>
+  <td>&nbsp;</td>
+</tr>
+</tbody>
+</table>
+
+
+<h3>PART II</h3>
+
+<table summary="Table of contents - Part 2">
+<thead>
+<tr>
+  <th>CHAPTER</th>
+  <th>&nbsp;</th>
+  <th>PAGE</th>
+</tr>
+</thead>
+<tbody>
+<tr>
+  <td class="toc_chapter_number">I.</td>
+  <td class="toc_chapter">Growths and Enlargements</td>
+  <td class="toc_page"><a href="#Page_123">123</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Cancers&mdash;Fatty Tumors&mdash;Use of Patent Preparations Dangerous&mdash;Symptoms and
+Cure of Rupture&mdash;The Best Kind of Truss&mdash;Varicose Veins&mdash;Varicocele&mdash;External and Internal Piles&mdash;Operations the Most Certain Cure.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number">II.</td>
+  <td class="toc_chapter">Skin Diseases and Related Disorders</td>
+  <td class="toc_page"><a href="#Page_139">139</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Itching, Chafing, and Chapping&mdash;Treatment of Hives&mdash;Nettlerash&mdash;Pimples&mdash;Fever Blisters&mdash;Prickly Heat&mdash;Cause of Ringworm&mdash;Freckles and Other Skin Discolorations&mdash;Ivy Poison&mdash;Warts and Corns&mdash;Boils&mdash;Carbuncles.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number">III.</td>
+  <td class="toc_chapter">Rheumatism and Kindred Diseases</td>
+  <td class="toc_page"><a href="#Page_169">169</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Inflammatory Rheumatism&mdash;Symptoms and Treatment&mdash;Muscular Rheumatism&mdash;Lumbago&mdash;Stiff Neck&mdash;Rheumatism of<span class="pagenum"><a name="Page_9" id="Page_9">[Pg 9]</a></span>
+the Chest&mdash;Chronic Rheumatism&mdash;Rheumatic Gout&mdash;Scurvy in Adults and Infants&mdash;Gout, its Causes and Remedies.</td>
+  <td>&nbsp;</td>
+</tr>
+</tbody>
+</table>
+
+
+<h3>PART III</h3>
+
+<table summary="Table of contents - Part 3">
+<thead>
+<tr>
+  <th>CHAPTER</th>
+  <th>&nbsp;</th>
+  <th>PAGE</th>
+</tr>
+</thead>
+<tbody>
+<tr>
+  <td class="toc_chapter_number">I.</td>
+  <td class="toc_chapter">Health and Purity</td>
+  <td class="toc_page"><a href="#Page_191">191</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Duties of Parents&mdash;Sexual Abuse&mdash;Dangers to Health&mdash;Physical Examination of Infants&mdash;Necessary Knowledge of Sex Functions Natural&mdash;The Critical Age of Puberty&mdash;Marriage Relations.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number">II.</td>
+  <td class="toc_chapter">Genito-urinary Diseases</td>
+  <td class="toc_page"><a href="#Page_199">199</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Gonorrhea in Men and Women&mdash;Dangers of Infection&mdash;Syphilis, its Causes, Symptoms, and Treatment&mdash;Incontinence and Suppression of Urine&mdash;Bed-wetting&mdash;Inflammation of the Bladder&mdash;Acute and Chronic Bright's Disease.</td>
+  <td>&nbsp;</td>
+</tr>
+</tbody>
+</table>
+
+
+<h3>PART IV</h3>
+
+<table summary="Table of contents - Part 1">
+<thead>
+<tr>
+  <th>CHAPTER</th>
+  <th>&nbsp;</th>
+  <th>PAGE</th>
+</tr>
+</thead>
+<tbody>
+<tr>
+  <td class="toc_chapter_number">I.</td>
+  <td class="toc_chapter">Insanity</td>
+  <td class="toc_page"><a href="#Page_229">229</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Mental Disorder Not Insanity&mdash;Illusions of the Insane&mdash;Hallucinations and Delusions&mdash;Signs and Causes of Insanity&mdash;Paranoia&mdash;How the Physician Should Be Aided&mdash;The Best Preventive.</td>
+  <td>&nbsp;</td>
+</tr>
+<tr>
+  <td class="toc_chapter_number"><span class="pagenum"><a name="Page_10" id="Page_10">[Pg 10]</a></span><em>Appendix.</em></td>
+  <td class="toc_chapter">Patent Medicines</td>
+  <td class="toc_page"><a href="#Page_245">245</a></td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td class="toc_chapter_summary">Advice Regarding the Use of Patent Medicines&mdash;Laws Regulating the Sale of
+Drugs&mdash;Proprietary Medicines&mdash;Good Remedies&mdash;Dangers of So-called "Cures"&mdash;Headache Powders&mdash;The Great American Fraud.</td>
+  <td>&nbsp;</td>
+</tr>
+</tbody>
+</table>
+</div>
+
+
+
+<div class="section_break"></div>
+<div class="part_head">
+<p><span class="pagenum"><a name="Page_11" id="Page_11">[Pg 11]</a></span></p>
+
+<h2>Part I</h2>
+
+<p class="title">THE EYE AND EAR, THE NOSE<br />
+AND THROAT, THE LUNGS<br />
+AND BRONCHIAL TUBES,<br />
+HEADACHES</p>
+
+<p class="by">BY</p>
+
+<p>KENELM WINSLOW</p>
+</div>
+
+
+
+<p><span class="pagenum"><a name="Page_12" id="Page_12">[Pg 12]</a></span></p>
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_13" id="Page_13">[Pg 13]</a></span></p>
+<h3>CHAPTER I</h3>
+
+<p class="chapter_head"><strong>The Eye and Ear</strong></p>
+
+<p class="chapter_head"><em>Injuries to the Eye&mdash;Inflammatory Conditions&mdash;"Pink
+Eye"&mdash;Nearsightedness and Farsightedness&mdash;Deafness&mdash;Remedies for
+Earache.</em></p>
+
+
+<p class="section"><strong>CINDERS AND OTHER FOREIGN BODIES IN THE EYE.</strong>&mdash;Foreign bodies are most
+frequently lodged on the under surface of the upper lid, although the
+surface of the eyeball and the inner aspect of the lower lid should
+also be carefully inspected. A drop of a two-per-cent solution of
+cocaine will render painless the manipulations. The patient should be
+directed to continue looking downward, and the lashes and edge of the
+lid are grasped by the forefinger and thumb of the right hand, while a
+very small pencil is gently pressed against the upper part of the lid,
+and the lower part is lifted outward and upward against the pencil so
+that it is turned inside out. The lid may be kept in this position by
+a little pressure on the lashes, while the cinder, or whatever foreign
+body it may be, is removed by gently sweeping it off the mucous
+membrane with a fold of a soft, clean handkerchief.</p>
+
+<p>Hot cinders and pieces of metal may become so deeply lodged in the
+surface of the eye that it is necessary to dig them out with a needle
+(which has been<span class="pagenum"><a name="Page_14" id="Page_14">[Pg 14]</a></span> passed through a flame to kill the germs on it) after
+cocaine solution has been dropped into the eye twice at a minute
+interval. Such a procedure is, of course, appropriate for an oculist,
+but when it is impossible to secure medical aid for days it can be
+attempted without much fear, if done carefully, as more harm will
+result if the offending body is left in place. It is surprising to see
+what a hole in the surface of the eye will fill up in a few days. If
+the foreign body has caused a good deal of irritation before its
+removal, it is best to drop into the eye a solution of boric acid (ten
+grains to the ounce of water) four times daily.</p>
+
+
+<p class="section"><a name="SECTION_BLACK_EYE" id="SECTION_BLACK_EYE"></a>"<strong>BLACK EYE.</strong>"&mdash;To relieve this condition it is first necessary to
+reduce the swelling. This can be done by applying to the closed lids,
+every three minutes, little squares of white cotton or linen, four
+fold and about as large as a silver dollar, which have laid on a cake
+of ice until thoroughly cold. This treatment is most effective when
+pursued almost continuously for twenty-four hours. The cold compresses
+should not be permitted to overlap the nose, or a violent cold in the
+head may ensue. The swelling having subsided, the discoloration next
+occupies our attention. This may be removed speedily by applying, more
+or less constantly below the lower lid, little pieces of flannel
+dipped in water as hot as can be borne. The cloths must be changed as
+often as they cool. Repeat this treatment for a half hour every two
+hours or so during the day.</p>
+
+
+<p class="section"><span class="pagenum"><a name="Page_15" id="Page_15">[Pg 15]</a></span><strong>STYE.</strong>&mdash;A stye is a boil on the eyelid; it begins at the root of a hair
+as a hard swelling which may extend to the whole lid. The tip of the
+swelling takes on a yellowish color, breaks down and discharges
+"matter" or pus. There are pain and a feeling of tension in the lid,
+and, very rarely, some fever. When one stye follows another it is well
+to have the eyes examined by an oculist, as eye-strain is often an
+inviting cause of the trouble, and this can be corrected by the use of
+glasses. Otherwise the patient is probably "run down" from chronic
+constipation and anæmia (poverty of the blood) and other causes, and
+needs a change of air, tonics, and exercise out of doors. In a
+depreciated condition, rubbing the lids causes introduction of disease
+germs.</p>
+
+<p>The immediate treatment, which may cut short the trouble, consists in
+bathing the eyelid for fifteen minutes at a time, every hour, with a
+hot solution of boric acid (half a teaspoonful to the cup of water).
+Then at night the swelling should be painted with collodion, several
+coats, being careful not to get it in the eye, as it would cause much
+smarting. If the stye persists in progressing, bathing it in hot water
+will cause it to discharge pus and terminate much sooner.</p>
+
+
+<p class="section"><strong>TWITCHING OF THE EYELIDS.</strong>&mdash;This condition may be due to eye-strain,
+and can be relieved if the eyes are fitted to glasses by an oculist
+(not an optician). It is frequently an accompaniment of inflammation
+of the eyes, and when this is cured the<span class="pagenum"><a name="Page_16" id="Page_16">[Pg 16]</a></span> twitching of the lids
+disappears. When the eyes are otherwise normal the twitching is
+frequently one of the signs of nerve fag and overwork.</p>
+
+
+<p class="section"><strong>WOUNDS AND BURNS ABOUT THE EYES.</strong>&mdash;Slight wounds of the inner surface
+of the eyelids close readily without stitching if the boric-acid
+solution (ten grains to the ounce of water) is dropped into the eye
+four times daily. Burns of the inner surface of the lids follow the
+entrance of hot water, hot ashes, lime, acids, and molten metals.
+Burns produced by lime are treated by dropping a solution of vinegar
+(one part of vinegar to four of water) into the eye, while those
+caused by acids are relieved by similar treatment with limewater or
+solution of baking soda (half a teaspoonful to the glass of water). If
+these remedies are not at hand, the essential object is attained by
+washing the eye with a strong current of water, as from a hose or
+faucet. If there is much swelling of the lids, and inflammation after
+the accident, drop boric-acid solution into the eye four times daily.
+Treatment by cold compresses, as recommended for "black eye," will do
+much also to quiet the irritation, and the patient should wear dark
+glasses.</p>
+
+
+<p class="section"><strong>SORE EYES; CONJUNCTIVITIS.</strong>&mdash;The mucous membrane lining the inner
+surface of the eyelids also covers the front of the eyeball, although
+so transparent here that it is not apparent to the observer.
+Inflammation of this membrane is more commonly limited to that portion
+covering the inner surfaces of the<span class="pagenum"><a name="Page_17" id="Page_17">[Pg 17]</a></span> lids, but may extend to the
+eyeball when the eye becomes "bloodshot" and the condition more
+serious. For the sake of convenience we may speak of a mild form of
+sore eye, as <em>congestion of the eyelids</em>, and the more severe type, as
+true <em>conjunctivitis</em> (see p. <a href="#Page_18">18</a>).</p>
+
+
+<p class="section"><strong>CONGESTION OF THE EYELIDS.</strong>&mdash;This may be caused by smoke or dust in the
+atmosphere, by other foreign bodies in the eye; frequently by
+eye-strain, due to far- or near-sightedness, astigmatism, or muscular
+weakness, which may be corrected by an oculist's (never an optician's)
+prescription for glasses. Exposure to an excessive glare of light, as
+in the case of firemen, or, on the other hand, reading constantly and
+often in a poor light, will induce irritation of the lids. The germs
+which cause "cold in the head" often find their way into the eyes
+through the tear ducts, which connect the inner corner of the eyes
+with the nose, and thus may set up similar trouble in the eyes.</p>
+
+<p><strong>Symptoms.</strong>&mdash;The eyes feel weary and "as if there were sand in them."
+There may be also smarting, burning, or itching of the lids, and there
+is disinclination for any prolonged use of the eyes. The lids, when
+examined, are found to be much deeper red than usual, and slightly
+swollen, but there is no discharge from the eye, and this fact serves
+to distinguish this mild type of inflammation from the more severe
+form.</p>
+
+<p><strong>Treatment.</strong>&mdash;The use of dark glasses and a few drops of zinc-sulphate
+solution (one grain to the ounce of water) in the eye, three times
+daily, will often cure<span class="pagenum"><a name="Page_18" id="Page_18">[Pg 18]</a></span> the trouble. If this does not do so within a
+few days then an oculist should be consulted, and it will frequently
+be found that glasses are needed to secure freedom from irritation of
+the eyes. In using "eye-drops" the head should be held back, and
+several drops be squeezed from a medicine dropper into the inner
+corner of the eye.</p>
+
+
+<p class="section"><strong>CONJUNCTIVITIS; CATARRHAL INFLAMMATION OF THE EYES.</strong>&mdash;In this disorder
+there is discharge which sticks the lids together during the night.
+The inner surface of the lids is much reddened, the blood vessels in
+the lining membrane are much enlarged, and the lids are slightly
+swollen. The redness may extend to the eyeball and give it a bloodshot
+appearance. There is no interference with sight other than momentary
+blurring caused by the discharge, and occasionally there is very
+severe pain, as if a cinder had suddenly fallen in the eye. This
+symptom may occur at night and awaken the patient, and may be the
+reason for his first consulting a physician.</p>
+
+<p>One eye is commonly attacked twenty-four to thirty-six hours before
+the other, and even if it is thought that the cause is a cinder, in
+case of one eye, it can hardly be possible to sustain this belief in
+the case of the involvement of both eyes. There is a feeling of
+discomfort about the eyes, and often a burning, and constant watering,
+the tears containing flakes of white discharge.</p>
+
+<p>When the discharge is a copious, creamy pus or<span class="pagenum"><a name="Page_19" id="Page_19">[Pg 19]</a></span> "matter," associated
+with great swelling of the lids and pain on exposure to light, the
+cause is usually a germ of a special disease, and the eyesight will
+very probably be lost unless a skillful physician be immediately
+secured. Early treatment is, however, of great service, and, until a
+physician can be obtained, the treatment recommended below should be
+followed conscientiously; by this means the sight may be saved. This
+dangerous variety of inflammation of the eyes is not rare in the
+newborn, and infants having red eyes within a few days of birth should
+immediately receive proper attention, or blindness for life will be
+the issue. This is the usual source of that form of blindness with
+which babies are commonly said to have been born.</p>
+
+<p>All forms of severe inflammation of the lids are contagious,
+especially the variety last considered, and can be conveyed, by means
+of the discharge, through the agency of towels, handkerchiefs, soap,
+wash basins, etc., and produce the same or sometimes different types
+of inflammation in healthy eyes. Therefore, if the severe form of
+conjunctivitis breaks out among any large number of people, as in
+schools, prisons, asylums, and almshouses, isolation of the patients
+should be enforced.</p>
+
+
+<p class="section">"<strong>PINK EYE.</strong>"&mdash;This is a severe epidemic form of catarrh of the eye,
+which is caused by a special germ known as the "Koch-Weeks bacillus."
+The treatment of this is the same as that outlined below. The germ of
+pneumonia and that of grippe also often cause con<span class="pagenum"><a name="Page_20" id="Page_20">[Pg 20]</a></span>junctivitis, and
+"catching cold," chronic nasal catarrh, exposure to foul vapors and
+gases, or tobacco smoke, and the other causes enumerated, as leading
+to congestion of the lids, are also responsible for catarrhal
+inflammation of the eye.</p>
+
+<p><strong>Treatment.</strong>&mdash;In the milder attacks of conjunctivitis the treatment
+should be that recommended above for congestion of the lids. The
+swelling and inflammation, in the severer types, are greatly relieved
+by the application of the cold-water compresses, advised under the
+section on "<a href="#SECTION_BLACK_EYE">black eye</a>," for an hour at a time, thrice daily.
+Confinement in a dark room, or the use of dark glasses, and drops of
+zinc sulphate (one grain in an ounce of water) three times a day, with
+hourly dropping of boric acid (ten grains to the ounce of water)
+constitute the ordinary treatment.</p>
+
+<p>In inflammations with copious discharge of creamy pus, and great
+swelling of the lids, the eyes should be washed out with the
+boric-acid solution every half hour, and a solution of silver nitrate
+(two grains to the ounce of water) dropped into the eye, once daily,
+followed immediately by a weak solution of common salt in water to
+neutralize the nitrate of silver, after its action has been secured.
+The constant use of ice cloths, already mentioned, forms a necessary
+adjunct to treatment. The sound eye must be protected from the chance
+of contagion, arising from a possible infection from the pus
+discharging from its mate. This may be secured by bandaging the well
+eye, or, better,<span class="pagenum"><a name="Page_21" id="Page_21">[Pg 21]</a></span> by covering it with a watch crystal kept in place by
+surgeon's plaster.</p>
+
+<p>In treating sore eyes with discharge, in babies, the infant should be
+held in the lap with its head backward and inclined toward the side of
+the sore eye, so that in washing the eye no discharge will flow into
+the sound eye. The boric acid may then be dropped from a medicine
+dropper, or applied upon a little wad of absorbent cotton, to the
+inner corner of the eye, while the eyelids are held apart.</p>
+
+<p>Hemorrhages occurring under the conjunctiva (or membrane lining the
+inner surface of the lids and covering the front surface of the
+eyeball) may be caused by blows or other injury to the eye, by violent
+coughing, by straining, etc. Dark-red spots may appear in the white of
+the eyeball, slightly raised above the surface, which are little blood
+clots under the conjunctival membrane. No special trouble results and
+there is nothing to be done except to wait till the blood is absorbed,
+which will happen in time. If the eyes water, solution of zinc
+sulphate (one grain to the ounce of water) may be dropped into the
+eye, twice daily. Hot applications are beneficial here to promote
+absorption of the clot.</p>
+
+
+<p class="section"><strong>EYE-STRAIN.</strong>&mdash;Eye-strain is commonly due to either astigmatism,
+nearsightedness, farsightedness, or weakness of the eye muscles. The
+farsighted eye is one in which parallel rays entering the eye, as from
+a distance, come to a focus behind the retina. The<span class="pagenum"><a name="Page_22" id="Page_22">[Pg 22]</a></span> retina is the
+sensitive area for receiving light impressions in the back of the
+eyeball. Sight is really a brain function; one sees with the brain,
+since the optic nerve endings in the back of the eye merely carry
+light impressions to the brain where they are properly interpreted.</p>
+
+<p>In order that vision be clear and perfect, it is essential that the
+rays of light entering the eye be bent so that they strike the retina
+as a single point. In the farsighted or hyperopic eye, the eyeball is
+usually too short for the rays to be properly focused on the sensitive
+nerve area in the back of the eye.</p>
+
+<p>This defect in vision is, however, overcome by the act of
+"accommodation." There is a beautiful transparent, double-convex body,
+about one-third of an inch thick, which looks very much like an
+ordinary glass lens, and is situated in the eye just back of the
+pupil. This is what is known as the crystalline lens, and the rays of
+light are bent in passing through it so as to be properly focused on
+the retina.</p>
+
+<p>The foregoing statements have been made as though objects were always
+at a distance from the eye, so that the rays of light coming from them
+were almost parallel. Yet when one is looking at an object within a
+few inches of the eye the rays diverge or spread out, and these the
+normal eye (if rigid) could not focus on the retina&mdash;much less the
+farsighted eye. But the eye is adaptable to change of focus through
+the action of a certain muscle, situated within the eyeball about the<span class="pagenum"><a name="Page_23" id="Page_23">[Pg 23]</a></span>
+lens, which controls to a considerable extent the shape of the lens.
+When the muscle contracts it allows the lens to bulge forward by
+virtue of its elasticity, and, therefore, become more convex. This is
+what happens when one looks at near objects, the increased convexity
+of the lens bending the rays of light so that they will focus as a
+point on the retina. (See <a href="#Plate_I">Plate I</a>, p. 30.)</p>
+
+<p>Now in the farsighted eye this muscular control or "accommodative
+action" must be continually exercised even in looking at distant
+objects, and it is this constant attempt of nature to cure an optical
+defect of the eye which frequently leads to nervous exhaustion or
+eye-strain. The nerve centers, which animate and control the nerves
+supplying the eye muscles to which we have just alluded, are in close
+proximity to other most important nerve centers in the brain, so
+irritation of the eye centers will produce sympathetic irritation of
+these other centers, leading to manifold and complex symptoms which we
+will describe under this head. But these symptoms do not necessarily
+develop in everyone having farsightedness or astigmatism, since both
+are often present at birth.</p>
+
+<p>The power of accommodation is sufficient to overcome the optical
+defect of the eye, providing that the general health is good and the
+eye is not used much for near work. If, on the other hand, excessive
+use of the eyes in reading, writing, figuring, sewing, or other fine
+work is required, and especially if the health becomes impaired, it
+happens that the constant drain on<span class="pagenum"><a name="Page_24" id="Page_24">[Pg 24]</a></span> the eye center in the brain will
+result in a group of symptoms which we will consider later. Failure of
+accommodation comes on at about forty, and gradually increases until
+all accommodation is lost at the age of seventy-five.</p>
+
+<p>For this reason it is necessary for persons over forty-five years of
+age, having normal or farsighted eyes, to wear convex glasses in
+reading or doing near work, and these should be changed for stronger
+ones every year or two. These convex glasses save the eyes in their
+attempt to make the lens more convex when looking at near objects in
+farsightedness, and also prove serviceable in the same manner when
+accommodation begins to fail in the case of what is called "old
+sight." The neglect to provide proper glasses for reading any time
+after the age of forty-five, and the failure to replace them by
+stronger lenses when required, distinctly favor the occurrence of
+cataract in later life.</p>
+
+<p>In the act of accommodation, in addition to the muscular action by
+which the lens is made more convex, there is the tendency for the
+action of another group of muscles outside the eyeball, which turn the
+eyes inward when they are directed toward a near object. Here then is
+another source of trouble resulting from farsightedness, i. e., the
+not infrequent occurrence of inward "squint" occasioned by the
+constant use of the muscles pulling the eyes inward during
+accommodation for near objects. Again, inflammation of the eyelids,
+and sometimes of deeper parts of the<span class="pagenum"><a name="Page_25" id="Page_25">[Pg 25]</a></span> eyeball, follows untreated
+hyperopia. Early distaste for reading is often acquired by farsighted
+persons, owing to the strain on the accommodative apparatus. The
+convex lens is that used to correct farsightedness.</p>
+
+
+<p class="section"><strong>NEARSIGHTED EYE.</strong>&mdash;In the nearsighted eye the eyeball is too long for
+parallel rays entering the eye to be focused upon the retina; they are
+bent, instead, to a point in front of the retina, and then diverge
+making the vision blurred. (<a href="#Plate_I">Plate I</a>, p. 30.) The act of accommodation
+in making the lens more convex will not aid this condition, but only
+make it worse, so that it is not attempted.</p>
+
+<p>Eye-strain in this optical defect is brought on by constant use of the
+eye muscles (attached to the outside of the eyeball) in directing both
+eyes inward so that they will both center on near objects; the only
+ones which can be seen. Outward squint frequently results, because the
+muscular efforts required to direct both eyes equally inward to see
+near objects are so great that the use of both eyes together is given
+up, and the poorer eye is not used and squints outward, while the
+better eye is turned inward in the endeavor to see. Nearsighted
+persons are apt to stoop, owing to the habitual necessity for coming
+close to the object looked at. Their facial expression is also likely
+to be rather vacant, since they do not distinctly see, and do not
+respond to the facial movements of others.</p>
+
+<p>Nearsightedness, or myopia, is not a congenital defect, but is usually
+acquired owing to excessive near<span class="pagenum"><a name="Page_26" id="Page_26">[Pg 26]</a></span> work which requires that the eye
+muscles constantly direct both eyes inward to see near objects. In so
+acting the muscles compress the sides of the eyeballs and tend to
+increase their length, interfere with their nutrition, and aggravate
+the condition when it is once begun. (See <a href="#Plate_I">Diagram</a>.) Concave lenses are
+used to correct myopia, and they must be worn all the time.</p>
+
+
+<p class="section"><strong>ASTIGMATISM.</strong>&mdash;This is a condition caused by inequality of the outer
+surface of the front of the eyeball, and rarely by a similar defect in
+the surfaces of the lens. The curvature of the eyeball in the
+astigmatic eye is greater in one meridian than in the opposite. In
+other words, the front of the eyeball is not regularly spherical, but
+bulges out along a certain line or meridian, while the curvature is
+flattened or normal in the other meridian. For instance, if two
+imaginary lines were drawn, one vertically, and the other horizontally
+across the front of the eyeball intersecting in the center of the
+pupil, they would represent the principal meridians, the vertical and
+the horizontal. As a rule the meridian of greatest curvature is
+approximately vertical, and that of least curvature is at right angles
+to it, or horizontal.</p>
+
+<p>Rays of light in passing through the different meridians of the
+astigmatic eye are differently bent, so that in one of the principal
+meridians rays may focus perfectly on the retina, while in the other
+the rays may focus on a point behind the retinal field. In this case
+the eye is made farsighted or hyperopic<span class="pagenum"><a name="Page_27" id="Page_27">[Pg 27]</a></span> in one meridian, and is
+normal in the other. Or again, the rays may be focused in front of the
+retina in one meridian, and directly on the retina in the other; this
+would be an example of nearsighted or myopic astigmatism.
+Farsightedness and nearsightedness are then both caused by
+astigmatism, although in this case not by the length of the eyeball,
+but by inequality in the curvature of the front part (cornea) of the
+eyeball. For example, in simple astigmatism one of the principal
+meridians is hyperopic (turning the rays so that they focus behind the
+retina) or myopic (bending the rays so that they focus in front of the
+retina), while the other meridian is normal. In mixed astigmatism, one
+of the principal meridians is myopic, the other hyperopic; in compound
+astigmatism the principal meridians are both myopic, or both
+hyperopic, but differ in degree; while in irregular astigmatism, rays
+of light passing through different parts of the outer surface of the
+eyeball are turned in so many various directions that they can never
+be brought to a perfect focus by glasses.</p>
+
+<p>It is not by any means possible for a layman to be able always to
+inform himself that he is astigmatic, unless the defect is
+considerable. If a card, on which are heavy black lines of equal size
+and radiating from a common center like the spokes of a wheel, be
+placed on a wall in good light, it will appear to the astigmatic eye
+as if certain lines (which are in the faulty meridian of the eyeball)
+are much blurred, while the lines at<span class="pagenum"><a name="Page_28" id="Page_28">[Pg 28]</a></span> right angles to these are clear
+and distinct. Each eye should be tested separately, the other being
+closed. The chart should be viewed from a distance as great as any
+part of it can be seen distinctly. All the lines on the test card
+should look equally black and clear to the normal eye.</p>
+
+<p>Astigmatism is corrected by a cylindrical lens, which is in fact a
+segment of a solid cylinder of glass. The axis of the cylindrical lens
+should be at right angles to the defective meridian of the eye, in
+order to correct the astigmatism. Eye-strain is caused by astigmatism
+in the same manner that it is brought about in the simple farsighted
+eye, i. e., by constant strain on the ciliary muscle, which regulates
+the convexity of the crystalline lens. For it is possible for the
+inequalities of the front surface of the eyeball or of the lens to be
+offset or counterbalanced by change in the convexity of the lens
+produced by the action of this muscle, and it is conceivable that the
+axis of the lens may be tilted one way or another by the same agency,
+and for the same purpose. But, as we have already pointed out, this
+continual muscular action entails great strain on the nerve centers
+which animate the muscle, and if constant near work is requisite, or
+the health is impaired, the nervous exhaustion becomes apparent. The
+lesser degrees of astigmatism often give more trouble than the
+greater.</p>
+
+<div class="plate">
+<a name="Plate_I" id="Plate_I"></a>
+<h4><strong>Plate I</strong></h4>
+
+<p class="plate_head"><strong>ANATOMY OF THE EYE</strong></p>
+
+<p>The upper illustration shows the six muscles attached to the eye. The
+<strong>Superior Rectus Muscle</strong> pulls and directs the eye upward; the <strong>Inferior
+Rectus</strong>, downward; the <strong>External</strong> and <strong>Internal Rectus Muscles</strong> pull the
+eye to the right and left; the <strong>Oblique Muscles</strong> move the eye slantwise
+in any direction.</p>
+
+<p>Lack of balance of these muscles, and especially inability to focus
+both eyes on a near object without effort, constitute "eye-strain."</p>
+
+<p>The lower cut illustrates the relation of the crystalline lens to
+sight. <strong>Lens Nearsight Focus</strong> shows the lens bulging forward and very
+convex; <strong>Lens Farsight Focus</strong> shows it flat and less convex.</p>
+
+<p>This adjustment of the shape of the crystalline lens is called
+"accommodation"; it is effected by a small muscle in the eyeball.</p>
+
+<p>In the normal eye, the rays of light from an object pass through the
+lens, adjusted for the proper distance, and focus on the retina.</p>
+
+<p>In the nearsighted eye, these rays focus at a point in front of the
+retina; while in the farsighted eye these rays focus behind the
+retina; the nearsighted eye being elongated, and the farsighted eye
+being shortened.</p>
+<div class="figcenter" style="width: 390px;">
+<img src="images/plate1.jpg" width="390" height="500" alt="PLATE I" title="PLATE I" />
+<span class="caption">PLATE I</span>
+</div>
+</div>
+
+
+<p class="section"><strong>WEAKNESS OF THE EYE MUSCLES.</strong>&mdash;There are six muscles attached to the
+outside of the<span class="pagenum"><a name="Page_29" id="Page_29">[Pg 29]</a></span> eyeball which pull it in various directions, and so
+enable each eye to be directed upon a common point, otherwise objects
+will appear double. Weakness of these muscles or insufficiency,
+especially of those required to direct the eyes inward for near work,
+may lead to symptoms of eye-strain. When reading, for example, the
+muscles which pull the eye inward soon grow tired and relax, allowing
+the opposing muscles to pull the eye outward so that the eyes are no
+longer directed toward a common point, and two images may be perceived
+or, more frequently, they become fused together producing a general
+blurring on the page. Then by a new effort of will the internal
+muscles pull the eyes into line again, only to have the performance
+repeated, all of which entails a great strain upon the nervous system,
+and may lead to permanent squint, as has been pointed out. In addition
+to these symptoms caused by weakness of the eye muscles&mdash;seeing
+double, blurred vision, and want of endurance for close work&mdash;there
+are others which are common to eye-strain in general, as headache,
+nausea, etc., described in the following paragraph.</p>
+
+<p><strong>Symptoms of Eye-strain.</strong>&mdash;Headache is the most frequent symptom. It may
+be about the eyes, but there is no special characteristic which will
+positively enable one to know an eye headache from that arising from
+other sources, although eye-strain is probably the most common cause
+of headache. The headache resulting from eye-strain may then be in the
+forehead, temples,<span class="pagenum"><a name="Page_31" id="Page_31">[Pg 30]<br />[Pg 31]</a></span> top or the back of the head, or limited to one
+side. It frequently takes the form of "sick headache" (p. <a href="#Page_113">113</a>). It is
+perhaps more apt to appear after any unusual use of the eyes in
+reading, writing, sewing, riding, shopping, or sight-seeing, and going
+to theaters and picture galleries, but this is not by any means
+invariably the case, as eye headache may appear without apparent
+cause.</p>
+
+<p>Nausea and vomiting, with or without headache, nervousness,
+sleeplessness, and dizziness often accompany eye-strain. Sometimes
+there is weakness of the eyes, i. e., lack of endurance for eye work,
+twitching of the eyelids, weeping, styes, and inflammation of the
+lids. In view of the extreme frequency of eye-disorders which lead to
+eye-strain, it behooves people, in the words of an eminent medical
+writer, to recognize that "the subtle influence of eye-strain upon
+character is of enormous importance" inasmuch as "the disposition may
+be warped, injured, and wrecked," especially in the young. Some of the
+more serious nervous diseases, as nervous exhaustion, convulsions,
+hysteria, and St. Vitus's dance may be caused by the reflex irritation
+of the central nervous system following eye-strain.</p>
+
+<p><strong>Treatment of Eye-strain.</strong>&mdash;The essential treatment of eye-strain
+consists in the wearing of proper glasses. It should be a rule,
+without any exception, to consult only a regular and competent
+oculist, and never an optician, for the selection of glasses. It is as
+egregious<span class="pagenum"><a name="Page_32" id="Page_32">[Pg 32]</a></span> a piece of folly to employ an optician to choose the
+glasses as it would be to seek an apothecary's advice in a general
+illness. Considerably more damage would probably accrue from following
+the optician's prescription than that of the apothecary, because
+nature would soon offset the effects of an inappropriate drug; but the
+damage to the eyes from wearing improper glasses would be lasting.</p>
+
+<p>Properly to determine the optical error in astigmatic and farsighted
+eyes it is essential to place drops in the eye, which dilate the pupil
+and paralyze the muscles that control the convexity of the crystalline
+lens, and to use instruments and methods of examination, which can
+only be properly undertaken and interpreted by one with the general
+and special medical training possessed by an oculist.</p>
+
+<p>The statement has been emphasized that farsighted and astigmatic
+persons, up to the age of forty-five or fifty, can sometimes overcome
+the optical defects in their eyes by exercise of the ciliary muscle
+which alters the shape of the lens, and, therefore, it would be
+impossible for an examiner to discover the fault without putting drops
+in the eye, which temporarily paralyze the ciliary muscles for from
+thirty-six to forty-eight hours, but otherwise do no harm. After the
+age of fifty it may be unnecessary to use drops, as the muscular power
+to alter the convexity of the lens is greatly diminished. Opticians
+are incompetent to employ these drops, as they may do great damage in
+certain con<span class="pagenum"><a name="Page_33" id="Page_33">[Pg 33]</a></span>ditions of the eye which can only be detected by a medical
+man specially trained for such work. Opticians are thus sure to be
+caught on one of the horns of a dilemma; either they do not use drops
+to paralyze the ciliary muscle, or, if they do employ the drops, they
+may do irreparable damage to the eye. Any abnormality connected with
+the vision, especially in children, should be a warning to consult an
+oculist. Squint, "cross-eye" (<em>Strabismus</em>), as has been stated, may
+often result from near- or far-sightedness, and it may be possible in
+young children to cure the squint by the use of glasses or even drops
+in the eye, whereas in later life it may be necessary to cut some of
+the muscles of the eyeball to correct the condition. It is a wise rule
+to subject every child to an oculist's examination before entering
+upon school life.</p>
+
+
+<p class="section"><a name="SECTION_DEAFNESS" id="SECTION_DEAFNESS"></a><strong>DEAFNESS.</strong>&mdash;Sudden deafness without apparent reason is more apt to
+result from an accumulation of wax than from any other cause. It is a
+very common ear disorder. The opening into the ear is about an inch
+long, or a little more, and is separated from that part of the ear
+within, which is known as the middle ear, by the eardrum membrane. The
+drum membrane is a thin, skinlike membrane stretched tightly across
+the bottom of the external opening in the ear or auditory canal, and
+shuts it off completely from the middle ear within, and in this way
+protects the middle ear from the entrance of germs, dust, and water,
+but only secondarily aids hearing. The obstruction caused by<span class="pagenum"><a name="Page_34" id="Page_34">[Pg 34]</a></span> wax
+usually exists in about the middle of the auditory canal or opening in
+the ear, and only causes deafness when it completely blocks this
+passage.</p>
+
+<p>The deafness is sudden because, owing to the accidental entrance of
+water, the wax quickly swells and chokes the canal; or, in attempts to
+relieve irritation in the ear, the finger or some other object is
+thrust into the opening in the ear (auditory canal) and presses the
+wax down on the ear drum. The obstruction in the ear is usually a
+mixture of waxy secretion from the canal, and little scales of dead
+skin which become matted together in unwise efforts at cleansing the
+ear by introducing a twisted towel or some other object into the ear
+passage and there turning it about; or it may occur owing to disease
+of the ear altering the character of the natural secretion. In the
+normal state, the purpose of the wax is, apparently, to repel insects
+and to glue together the little flakes of cast-off skin in the
+auditory canal, and these, catching on the hairs lining the canal, are
+thrown out of the ears upon the shoulders by the motion of the jaws in
+eating.</p>
+
+<p>Nothing should be introduced into the ear with the idea of cleansing
+it, as the skin growing more rapidly from within tends naturally to
+push the dead portions out as required, and so the canal is
+self-cleansing.</p>
+
+<p><strong>Symptoms.</strong>&mdash;Sudden deafness in one ear usually calls the attention of
+the patient to an accumulation of wax. There is apt to be more or less
+wax in the other ear as well. Noises in the deaf ear and a feeling of<span class="pagenum"><a name="Page_35" id="Page_35">[Pg 35]</a></span>
+pressure are also common. Among rarer symptoms are nausea and
+dizziness. But the only way to be sure that deafness is due to choking
+of the ear passage with wax is to see it. This is usually accomplished
+by a physician in the following way: he throws a good light from a
+mirror into a small tube introduced into the ear passage. This is, of
+course, impossible for laymen to do, but if the ear is drawn upward,
+backward, and outward, so as to straighten the canal, it may be
+possible for anyone to see a mass of yellowish-brown or blackish
+material filling the passage. And in any event, if the wax cannot be
+seen, one is justified in treating the case as if it were present, if
+sudden deafness has occurred and competent medical aid is
+unobtainable, since no harm will be done if wax is absent, and, if it
+is present, the escape of wax will usually give immediate relief from
+the deafness and other symptoms.</p>
+
+<p><strong>Treatment.</strong>&mdash;The wax is to be removed with a syringe and water as hot
+as can be comfortably borne. A hard-rubber syringe having a piston,
+and holding from two teaspoonfuls to two tablespoonfuls, is to be
+employed&mdash;the larger ones are better. The clothing should be protected
+from water by towels placed over the shoulder, and a basin is held
+under the ear to catch the water flowing out of the canal. The tip of
+the syringe is introduced just within the entrance of the ear, which
+is to be pulled backward and upward, and the stream of water directed
+with some force against<span class="pagenum"><a name="Page_36" id="Page_36">[Pg 36]</a></span> the upper and back wall of the passage rather
+than directly down upon the wax. The water which is first returned is
+discolored, and then, on repeated syringing, little flakes of dry
+skin, with perhaps some wax adhering, may be seen floating on the top
+of the water which flows from the ear, and finally, after a longer or
+shorter period, a plug of wax becomes dislodged, and the whole trouble
+is over.</p>
+
+<p>This is the rule, but sometimes the process is very long and tedious,
+only a little coming away at a time, and, rarely, dizziness and
+faintness will require the patient to lie down for a while. The water
+should always be removed from the ear after syringing by twisting a
+small wisp of absorbent cotton about the end of a small stick, as a
+toothpick, which has been dipped into water to make the cotton adhere.
+The tip of the toothpick, thus being thoroughly protected by dry
+cotton applied so tightly that there is no danger of it slipping off,
+while the ear is pulled backward and upward to straighten the canal,
+is gently pushed into the bottom of the canal and removed, and the
+process repeated with fresh cotton until it no longer returns moist.
+Finally a pledget of dry cotton should be loosely packed into the ear
+passage, and worn by the patient for twelve or twenty-four hours.</p>
+
+
+<p class="section"><strong>PERSISTENT AND CHRONIC DEAFNESS.</strong>&mdash;A consideration of deafness requires
+some understanding of the structure and relations of the ear with
+other parts of the body, notably the throat. It has been<span class="pagenum"><a name="Page_37" id="Page_37">[Pg 37]</a></span> pointed out
+that the external ear&mdash;comprising the fleshy portion of the ear, or
+auricle, and the opening, or canal, about an inch long&mdash;is separated
+from that portion of the ear within (or middle ear) by the drum
+membrane. The middle ear, while protected from the outer air by the
+drum, is really a part of the upper air passages, and participates in
+disorders affecting them. It is the important part of the ear as it is
+the seat of most ear troubles, and disease of the middle ear not only
+endangers the hearing, but threatens life through proximity to the
+brain.</p>
+
+<p>In the middle ear we have an air space connected with the throat by
+the Eustachian tube, a tube about an inch long running downward and
+forward to join the upper air passage at the junction of the back of
+the nose and upper part of the throat. If one should run the finger
+along the roof of the mouth and then hook it up behind and above the
+soft palate one could feel the openings of these tubes (one for each
+ear) on either side of the top of the throat or back of the nose,
+according to the view we take of it.</p>
+
+<p>Then the middle ear is also connected with a cavity in the bone back
+of the ear (mastoid cavity or cells), and the outer and lower wall is
+formed by the drum membrane. Vibrations started by sound waves which
+strike the ear are connected by means of a chain of three little bones
+from the drum through the middle ear to the nervous apparatus in the
+internal ear. The head of one of these little bones may be seen by an<span class="pagenum"><a name="Page_38" id="Page_38">[Pg 38]</a></span>
+expert, looking into the ear, pressing against the inside of the drum
+membrane. Stiffening or immovability of the joints between these
+little bones, from catarrh of the middle ear, is most important in
+producing permanent deafness. The middle ear space is lined with
+mucous membrane continuous with that of the throat through the
+Eustachian tube. This serves to drain mucus from the middle ear, and
+also to equalize the air pressure on the eardrum so that the pressure
+within the middle ear shall be the same as that without.</p>
+
+<p>When there is catarrh or inflammation of the throat or nose it is apt
+to extend up the Eustachian tubes and involve the middle ear. In this
+way the tubes become choked and obstructed with the oversecretion or
+by swelling. The air in the middle ear then becomes absorbed in part,
+and a species of vacuum is produced with increased pressure from
+without on the eardrum. The drum membrane will be pressed in, and
+through the little bones pressure will be made against the sensitive
+nervous apparatus, irritating it and giving rise to deafness,
+dizziness, and the sensation of noises in the ear. Noises from without
+will also be intensified in passing through the middle ear when it is
+converted into a closed cavity through the blocking of the Eustachian
+tube.</p>
+
+<p>A very important feature following obstruction of the Eustachian
+tubes, and rarefaction of the air in the middle ear, is that
+congestion of the blood vessels ensues and increased secretion,
+because the usual pres<span class="pagenum"><a name="Page_39" id="Page_39">[Pg 39]</a></span>sure of the air on the blood vessels within the
+middle ear is taken away.</p>
+
+<p>This then is the cause of most permanent deafness, to which is given
+the name catarrhal deafness, because every fresh cold in the head, or
+sore throat, tends to start up trouble in the ear such as we have just
+described. Repeated attacks leave vestiges behind until permanent
+deafness remains. In normal conditions every act of swallowing opens
+the apertures of the Eustachian tubes in the throat, and allows of
+equalization of the air pressure within and without the eardrum, but
+if the nose is stopped up by a cold in the head, or enlargement of the
+tonsil at the back of the nose (as from adenoids, see p. <a href="#Page_61">61</a>), the
+process is reversed and air is exhausted from the Eustachian tubes
+with each swallowing motion.</p>
+
+<p>The moral to be drawn from all the foregoing is to treat colds
+properly when they are present, keeping the nose and throat clean and
+clear of mucus, and to have any abnormal obstruction in the nose or
+throat and source of chronic catarrh removed, as enlarged tonsils,
+adenoids, and nasal outgrowths.</p>
+
+
+<p class="section"><strong>FOREIGN BODIES IN THE EAR.</strong>&mdash;Foreign bodies, as buttons, pebbles,
+beans, cherry stones, coffee, etc., are frequently placed in the ear
+by children, and insects sometimes find their way into the ear passage
+and create tremendous distress by their struggles. Smooth,
+nonirritating bodies, as buttons, pebbles, etc., do no particular harm
+for a long time, and may remain<span class="pagenum"><a name="Page_40" id="Page_40">[Pg 40]</a></span> unnoticed for years. But the most
+serious damage not infrequently results from unskillful attempts at
+their removal by persons (even physicians unused to instrumental work
+on the ear) who are driven to immediate and violent action on the
+false supposition that instant interference is called for. Insects, it
+is true, should be killed without delay by dropping into the ear sweet
+oil, castor, linseed, or machine oil or glycerin, or even water, if
+the others are not at hand, and then the insect should be removed in
+half an hour by syringing as recommended for wax (p. <a href="#Page_35">35</a>).</p>
+
+<p>To remove solid bodies, turn the ear containing the body, downward,
+pull it outward and backward, and rub the skin just in front of the
+opening into the ear with the other hand, and the object may fall out.</p>
+
+<p>Failing in this, syringing with warm water, as for removal of wax,
+while the patient is sitting, may prove successful. The essentials of
+treatment then consist, first, in keeping cool; then in killing
+insects by dropping oil or water into the ear, and, if syringing
+proves ineffective, in using no instrumental methods in an attempt to
+remove the foreign body, but in awaiting such time as skilled medical
+services can be obtained. If beans or seeds are not washed out by
+syringing, the water may cause them to swell and produce pain. To
+obviate this, drop glycerin in the ear which absorbs water, and will
+thus shrivel the seed.</p>
+
+
+<p class="section"><strong>EARACHE.</strong>&mdash;Earache is due usually not to neuralgia of the ear, but to a
+true inflammation of the<span class="pagenum"><a name="Page_41" id="Page_41">[Pg 41]</a></span> middle ear, which either subsides or results
+in the accumulation of inflammatory products until the drum is
+ruptured and discharge occurs from the external canal. The trouble
+commonly originates from an extension of catarrhal disease of the nose
+or throat; the germs which are responsible for these disorders finding
+their way into the Eustachian tubes, and thus into the middle ear. Any
+source of chronic catarrh of the nose or throat, as enlarged and
+diseased tonsils, adenoids in children, or nasal obstruction, favor
+the growth of germs and the occurrence of frequent attacks of acute
+catarrh or "colds." The grippe has been the most fruitful cause of
+middle-ear inflammation and earache in recent years. Any act which
+forces up fluid or secretions from the back of the nose into the
+Eustachian tubes (see section on <a href="#SECTION_DEAFNESS">Deafness</a>) and thus into the middle
+ear, is apt to set up inflammation there, either through the
+introduction of germs, or owing to the mechanical injury sustained.
+Thus the use of the nasal douche, the act of sniffing water into the
+nose, or blowing the nose violently when there is secretion or fluid
+in the back of the nose, or the employment of the post-nasal syringe
+are one and all attended with this danger. Swimming on the back,
+diving, or surf bathing also endangers the ear, as cold water is
+forcibly driven not only into the external auditory canal, but, what
+is more frequently a source of damage, into the Eustachian tubes
+through the medium of the nose or throat. In this case the plugging<span class="pagenum"><a name="Page_42" id="Page_42">[Pg 42]</a></span>
+of the nose with cotton would be of more value than the external
+canal, as is commonly practiced. If water has entered the Eustachian
+tube, blowing the nose and choking merely aggravate the trouble. The
+wiser plan is to do nothing but trust that the water will drain out,
+and if pain ensues treat it as recommended below for earache.</p>
+
+<p>Water in the ears is sometimes removed by jumping about on one foot
+with the troublesome ear held downward, and if it is in the external
+canal it may be wiped out gently with cotton on the end of a match, as
+recommended in the article on treating wax in the ear (see p. <a href="#Page_35">35</a>). In
+the treatment of catarrh in the nose or throat only a spray from an
+atomizer should be used, as Dobell's or Seiler's solutions followed by
+menthol and camphor, twenty grains of each to the ounce of alboline or
+liquid vaseline.<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a></p>
+
+<p>Exposure to cold and the common eruptive diseases of children, as
+scarlet fever, measles, and also diphtheria, are common causes of
+middle-ear inflammation. In the latter disorders the protection
+afforded by a nightcap which comes down over the ears, and worn
+constantly during the illness, is frequently sufficient to ward off
+ear complications.</p>
+
+<p>Although earache or middle-ear inflammation is common, its dangers are
+not fully appreciated, since the various complications are likely to
+arise, and the result is not rarely serious. Extension of the
+in<span class="pagenum"><a name="Page_43" id="Page_43">[Pg 43]</a></span>flammation to the bone behind the ear may necessitate chiseling
+away a part of the skull to liberate pus or dead bone in this
+locality, and the occurrence of abscess of the brain will necessitate
+operation.</p>
+
+<p>The use of leeches in the beginning of the attack is of great value,
+and though unpleasant are not difficult or painful in their
+application. One should be applied just in front of the opening into
+the ear (which should be previously closed with cotton to prevent the
+entrance of the leech), and the other behind the ear in the crease
+where it joins the side of the head and at a point a little below the
+level of the external opening into the ear. A drop of milk on these
+spots will often start the leeches immediately at work, or a drop of
+blood obtained with a pin prick. When the leeches are gorged with
+blood and cease to suck, they should be removed and bleeding
+encouraged for half an hour with applications of absorbent cotton
+dipped in hot water. Then clean, dry absorbent cotton is applied, and
+pressure made on the wounds if bleeding does not soon stop or is
+excessive.</p>
+
+<p>The after treatment of the bites consists in cleanliness and the use
+of vaseline. The patient must stay in bed, and the hot-water bag be
+constantly kept on the ear till all pain ceases. If the drum
+perforates, a discharge will usually appear from the external ear.
+Then the canal must be cleansed, once or more daily, by injecting very
+gently into the ear a solution of boric<span class="pagenum"><a name="Page_44" id="Page_44">[Pg 44]</a></span> acid (as much of boric acid
+as the water will dissolve), following this by wiping the water out of
+the canal with sterilized cotton, as directed for the treatment of wax
+in the ear (p. <a href="#Page_35">35</a>).</p>
+
+<p>The syringing is permissible only once daily, unless the discharge is
+copious, but the canal may be wiped out in this manner several times a
+day with dry cotton. It is well to keep the opening into the ear
+greased with vaseline, and a plug of clean absorbent cotton loosely
+packed into the canal to keep out the cold. Excessive or too forcible
+syringing may bring about that complication most to be feared,
+although it may appear through no fault in care, i. e., an implication
+of the cavity in the bone back of the ear (mastoid disease). Germs
+find their way through the connecting passage by which this cavity is
+in touch with the middle ear, or may be forced in by violent
+syringing. When this happens, earache, or pain just back of the ear,
+commonly returns during the first or second week after the first
+attack, and tenderness may be observed on pressing on the bone just
+back of the ear close to the canal. Fever, and local redness and
+swelling of the parts over the bone in this region may also occur.
+Confinement to bed, and constant application of a rubber bag
+containing cracked ice, to the painful parts must be enforced. If the
+tenderness on pressure over the bone and pain do not subside within
+twenty-four to forty-eight hours, surgical assistance must be obtained
+at any cost, or a fatal result may ensue. The<span class="pagenum"><a name="Page_45" id="Page_45">[Pg 45]</a></span> opening in the drum
+membrane, caused by escape of discharge in the course of middle-ear
+inflammation, usually closes, but even if it does not deafness is not
+a necessary sequence.</p>
+
+<p>The eardrum is not absolutely essential to hearing, but it is of great
+importance to exclude sources of irritation, dust, water, and germs
+which are likely to set up middle-ear trouble. More ordinary
+after-effects are chronic discharge from the ear following acute
+inflammation and perforation of the eardrum, which may mean at any
+time a sudden return of pain with the occurrence of the more dangerous
+conditions just recited, together with deafness. Bearing all this in
+mind it is advisable never to neglect a severe or persistent earache,
+but to call in expert attention. When this is not obtainable the
+treatment outlined below should be carefully followed.</p>
+
+<p><strong>Symptoms.</strong>&mdash;Pain is severe and often excruciating in adults. It may be
+felt over the temple, side and back of the head and neck, and even in
+the lower teeth, as well as in the ear itself. The pain is increased
+by blowing the nose, sneezing, coughing, and stooping. There is
+considerable tenderness usually on pressing on the skin in front of
+the ear passage. In infants there may be little evidence of pain in
+the ear. They are apt to be very fretful, refuse food, cry out in
+sleep, often lie with the affected ear resting on the hand, and show
+tenderness on pressure immediately in front or behind the ear
+passage.</p>
+
+<p><span class="pagenum"><a name="Page_46" id="Page_46">[Pg 46]<br />[Pg 47]</a></span>Dullness, fever, chills, and convulsions are not uncommon in children,
+but, on the other hand, after some slight illness it is not infrequent
+for discharge from the ear to be the first sign which calls the
+attention of parent or medical attendant to the source of the trouble.
+For this reason the careful physician always examines the ear in
+doubtful cases of children's diseases. Unless the inflammation
+subsides with treatment, either a thin, watery fluid (serum) is formed
+in the middle ear, or pus, when we have an "abscess of the ear." The
+drum if left to itself breaks down in three to five days, or much
+sooner in children who possess a thinner membrane. A discharge then
+appears in the canal of the external ear, and the pain is relieved. It
+may occasionally happen that the Eustachian tube drains away the
+discharge, or that the discharge from the drum is so slight that it is
+not perceived, and recovery ensues. Discharge from the ear continues
+for a few weeks, and then the hole in the drum closes and the trouble
+ceases. This is the history in favorable cases, but unfortunately, as
+we have indicated, the opposite state of affairs results not
+infrequently, especially in neglected patients.</p>
+
+<p><strong>Treatment.</strong>&mdash;The patient with severe earache should go to bed and take
+a cathartic to move the bowels. He should lie all the time with the
+painful ear on a rubber bag containing water as hot as can be
+comfortably borne. Every two hours a jet of hot water, which has been
+boiled and cooled just suffi<span class="pagenum"><a name="Page_48" id="Page_48">[Pg 48]</a></span>ciently to permit of its use, is allowed
+to flow gently from a fountain syringe into the ear for ten minutes,
+and then the ear is dried with cotton, as described under the
+treatment of wax in the ear (p. <a href="#Page_35">35</a>). No other "drops" of any kind are
+admissible for use in the ear, and even this treatment is of less
+importance than the dry heat from the hot-water bag, and may be
+omitted altogether if the appliances and skill to dry the ear are
+lacking. Ten drops of laudanum<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a> for an adult, or a teaspoonful of
+paregoric for a child six years old, may be given by the mouth to
+relieve the pain. The temperature of the room should be even and the
+food soft.</p>
+
+<p>If the pain continues it is wiser to have an aurist lance the drum, to
+avoid complications, than to wait for the drum membrane to break open
+spontaneously in his absence. Loss or damage of the eardrums may call
+for "artificial eardrums." They do not act at all like the drumhead of
+the musical instrument by their vibrations, but only are of service in
+putting on the stretch the little bones in the middle ear which convey
+sound. Some of those advertised do harm by setting up a mechanical
+irritation in the ear after a time, and a better result is often
+obtained with a ball of cotton or a paper disc introduced into the ear
+by an aurist.</p>
+
+
+<div class="plate">
+<h4><strong>Plate II</strong></h4>
+
+<p class="plate_head"><strong>ANATOMY OF THE EAR</strong></p>
+
+<p>The illustration on the opposite page shows the interior structure of
+the ear. The concha and <strong>Meatus</strong>, or canal, comprise the external ear,
+which is separated from the middle ear by the <strong>Drum Membrane</strong>. Wax is
+secreted by glands located in the lining of the meatus, and should be
+detached by the motion of the jaws during talking and eating. If it
+adheres to the drum membrane it causes partial deafness.</p>
+
+<p>The internal ear, or labyrinth, a cavity in the bone, back of the
+middle ear, consists of three parts: the <strong>Cochlea</strong>, the <strong>Semicircular
+Canals</strong>, and a middle portion, the <strong>Vestibule</strong>. The middle ear is
+connected with the throat by the <strong>Eustachian Tube</strong>.</p>
+
+<p>Sound vibrations, which strike the drum membrane, are conveyed by
+means of a chain of three small bones through the middle ear to the
+nervous apparatus of the internal ear. The Eustachian tube and middle
+ear are lined throughout with mucous membrane, and any severe
+inflammation of the throat may extend to and involve the tube and the
+middle ear, causing deafness.</p>
+
+<div class="figcenter" style="width: 447px;">
+<img src="images/plate2.jpg" width="447" height="500" alt="PLATE II" title="PLATE II" />
+<span class="caption">PLATE II</span>
+</div>
+</div>
+
+
+<p class="section"><strong>MODERATE OR SLIGHT EARACHE.</strong>&mdash;A slight or moderate earache, which may,
+however, be<span class="pagenum"><a name="Page_49" id="Page_49">[Pg 49]</a></span> very persistent, not sufficient to incapacitate the
+patient or prevent sleep, is often caused by some obstruction in the
+Eustachian tube, either by swelling or mucous discharge. This
+condition gives rise to the train of effects noted in the section on
+<a href="#SECTION_DEAFNESS">deafness</a>. The air in the middle ear is absorbed to some extent, and
+therefore the pressure within the ear is less than that outside the
+drum, so that the latter is pressed inward with the result that pain,
+and perhaps noises and deafness ensue, and, if the condition is not
+relieved, inflammation of the middle ear as described above.</p>
+
+<p><strong>Treatment.</strong>&mdash;Treatment is directed toward cleaning the back of the nose
+and reducing swelling at the openings of the Eustachian tubes in this
+locality, and inflating the tubes with air. A spray of Seiler's
+solution<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a> is thrown from an atomizer through the nostrils, with the
+head tipped backward, until it is felt in the back of the throat, and
+after the water has drained away the process is repeated a number of
+times. This treatment is pursued twice daily, and one hour after the
+fluid in the nose is well cleared away the Eustachian tubes may be
+inflated by the patient. To accomplish this the lips are closed
+tightly, and the nostrils also, by holding the nose; then an effort is
+made to blow the cheeks out till air is forced into the tubes and is
+felt entering both ears. This act is attended with danger of carrying
+up fluid into the tubes and greatly<span class="pagenum"><a name="Page_50" id="Page_50">[Pg 50]</a></span> aggravating the condition, unless
+the water from the spray has had time to drain away.</p>
+
+<p>Blowing the nose, as has been pointed out, is unwise, but the water
+may be removed to some extent by "clearing the throat." The reduction
+of swelling at the entrance of the Eustachian tube in the back of the
+nose can be properly treated only by an expert, as some astringent
+(glycerite of tannin) must be applied on cotton wound on a curved
+applicator, and the instrument passed above and behind the roof of the
+mouth into the region back of the nose.</p>
+
+<p>Rubbing the parts just in front of the external opening into the ear
+with the tip of one finger for a period of a few minutes several times
+a day will also favor recovery in this trouble.</p>
+
+
+<div class="footnotes"><h4>FOOTNOTES:</h4>
+
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> See p. <a href="#Page_49">49</a>.</p></div>
+
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Caution. Ask the doctor first.</p></div>
+
+<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> Tablets for the preparation of Seiler's solution are to
+be found at most druggists.</p></div>
+</div>
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_51" id="Page_51">[Pg 51]</a></span></p>
+<h3>CHAPTER II</h3>
+
+<p class="chapter_head"><strong>The Nose and Throat</strong></p>
+
+<p class="chapter_head"><em>Cold in the Head&mdash;Mouth-Breathing&mdash;Toothache&mdash;Sore Mouth&mdash;Treatment
+of Tonsilitis&mdash;Quinsy&mdash;Diphtheria.</em></p>
+
+
+<p class="section"><strong>NOSEBLEED.</strong>&mdash;Nosebleed is caused by blows or falls, or more frequently
+by picking and violently blowing the nose. The cartilage of the nasal
+septum, or partition which divides the two nostrils, very often
+becomes sore in spots, owing to irritation of dust-laden air, and
+these crust over and lead to itching. Then "picking the nose" removes
+the crusts, and frequent nosebleed results. Nosebleed also is common
+in both full-blooded and anæmic persons; in the former because of the
+high pressure within the blood vessels, in the latter owing to the
+thin walls of the arteries and capillaries which readily rupture.</p>
+
+<p>Nosebleed is again an accompaniment of certain general disorders, as
+heart disease and typhoid fever. The bleeding comes usually from one
+nostril only, and is a general oozing from the mucous membrane, or
+more commonly flows from one spot on the septum near the nostril, the
+cause of which we have just noted. The blood may spout forth in a
+stream, as after a blow, or trickle away drop by drop, but is rarely
+dangerous<span class="pagenum"><a name="Page_52" id="Page_52">[Pg 52]</a></span> except in infants and aged persons with weak blood vessels.
+In the case of the latter the occurrence of bleeding from the nose is
+thought to indicate brittle vessels and a tendency to apoplexy, which
+may be averted by the nosebleed. This is uncertain. If nosebleed comes
+on at night during sleep, the blood may flow into the stomach without
+the patient's knowledge, and on being vomited may suggest bleeding
+from the stomach.</p>
+
+<p><strong>Treatment.</strong>&mdash;The avoidance of excitement and of blowing the nose,
+hawking, and coughing will assist recovery. The patient should sit
+quietly with head erect, unless there is pallor and faintness, when he
+may lie down on the side with the head held forward so that the blood
+will flow out of the nose. There is no cause for alarm in most cases,
+because the more blood lost the more readily does the remainder clot
+and stop bleeding. As the blood generally comes from the lower part of
+the partition separating the nostrils, the finger should be introduced
+into the bleeding nostril and pressure made against this point, or the
+whole lower part of the nose may be simply compressed between the
+thumb and forefinger. If this does not suffice a lump of ice may be
+held against the side of the bleeding nostril, and another placed in
+the mouth. The injection into the nostril of ice water containing a
+little salt is sometimes very serviceable in stopping nosebleed.
+Blowing the nose must be avoided for some time after the bleeding
+ceases.</p>
+
+<p><span class="pagenum"><a name="Page_53" id="Page_53">[Pg 53]</a></span>If none of these methods arrest the bleeding the nostril must be
+plugged. A piece of clean cotton cloth, about five inches square,
+should be pushed gently but firmly into the nostril with a slender
+cylinder of wood about as large as a slate pencil and blunt on the
+end. This substitute for a probe is pressed against the center of the
+cloth, which folds about the stick like a closed umbrella, and the
+cotton is pressed into the nostril in a backward and slightly downward
+direction, for two or three inches, while the head is held erect. Then
+pledgets of cotton wool are packed into the bag formed by the cotton
+cloth after the stick is withdrawn. The mouth of the bag is left
+projecting slightly from the nostril, so that the whole can be
+withdrawn in twenty-four hours.</p>
+
+<p>The bleeding nostril may be more readily plugged by simply pressing
+into it little pledgets of cotton with a slender stick, but it would
+be impossible for an unskilled person to get them out again, and a
+physician should withdraw them inside of forty-eight hours.</p>
+
+
+<p class="section"><strong>FOREIGN BODIES IN THE NOSE.</strong>&mdash;Children often put foreign bodies in
+their nose, as shoe buttons, beans, and pebbles. They may not tell of
+it, and the most conspicuous symptoms are the appearance of a thick
+discharge from one nostril, having a bad odor, and some obstruction to
+breathing on the same side. If the foreign body can be seen, the
+nostril on the unobstructed side should be closed and the child made
+to blow out of the other one. If blowing does not remove<span class="pagenum"><a name="Page_55" id="Page_55">[Pg 54]<br />[Pg 55]</a></span> the body
+it is best to secure medical aid very speedily.</p>
+
+
+<div class="plate">
+<h4><strong>Plate III</strong></h4>
+
+<p class="plate_head"><strong>THE NASAL CAVITY</strong></p>
+
+<p>In the illustration on the opposite page, the <strong>Red Portion</strong> indicates
+the <strong>Septum</strong> of the nose, the partition which separates the nostrils.</p>
+
+<p>Inflammation of the membrane lining the nasal cavity is the condition
+peculiar to catarrh or "cold in the head." Deformity of the septum may
+obstruct the entrance of air into the nose and create suction on the
+walls of the nasal cavity, causing an overfilling of the blood
+vessels, or "congestion," with subsequent thickening of the mucous
+membrane.</p>
+
+<p>Polypi, small growths which form in the nose, or enlargement of the
+glands in the upper part of the throat (just beyond dotted line at
+inner edge of red portion) also block the air passages and give rise
+to mouth-breathing and its attendant disorders.</p>
+
+<p>Another cause of mouth-breathing is extreme swelling of the membrane
+which covers the turbinated bones of the nose.</p>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/plate3.jpg" width="500" height="484" alt="PLATE III" title="PLATE III" />
+<span class="caption">PLATE III</span>
+</div>
+</div>
+
+
+<p class="section"><strong>COLD IN THE HEAD FROM OVERHEATING.</strong>&mdash;Chilling of the surface of the
+body favors the occurrence of colds, in which lowered bodily vitality
+allows the growth of certain germs always present upon the mucous
+membrane lining the cavities of the nose. Dust and irritating vapors
+also predispose to colds. Overwarm clothing makes a person susceptible
+to colds, while the daily use of cold baths is an effective
+preventive. There is no sufficient reason for dressing more warmly in
+a heated house in winter than one would dress in summer. It is,
+moreover, unwise to cover the chest more heavily than the rest of the
+body. Some one has wisely said: "The best place for a chest protector
+is on the soles of the feet." The rule should always be to keep the
+feet dry and warm, and adapt the clothing to the surrounding
+temperature. Among the germs which cause colds in the head, that of
+pneumonia is the one commonly found in the discharge from the nose.
+When pneumonia is epidemic it is therefore wise to take extra
+precautions to avoid colds, and care for them when they occur.</p>
+
+<p>The presence of chronic trouble in the throat and nose, such as
+described under Mouth-Breathing, Adenoids, etc. (p. <a href="#Page_60">60</a>), is perhaps
+the most frequent cause of colds, because the natural resistance of
+the healthy mucous membrane to the attack of germs is diminished
+thereby, and the catarrhal secretions form a source of<span class="pagenum"><a name="Page_56" id="Page_56">[Pg 56]</a></span> food for the
+germs to grow upon. It should also be kept in mind that cold in the
+head is the first sign of measles and of <em>grippe</em>. Colds are more
+common in the spring and fall.</p>
+
+<p><strong>Symptoms.</strong>&mdash;Colds begin with chilliness and sneezing, and, if severe,
+there may be also headache, fever, and pain in the back and limbs, as
+in <em>grippe</em>. The nose at first feels dry, but soon becomes more or
+less stopped with secretion. The catarrh may extend from the back of
+the nose through the Eustachian tube to the ear, causing earache,
+noises in the ear, and deafness (see p. <a href="#Page_41">41</a>). This unfortunate result
+may be averted by proper spraying of the nose, and avoidance of
+blowing the nose violently.</p>
+
+<p><strong>Treatment.</strong>&mdash;Treatment must be begun at the first suspicion of an
+attack to be of much service. The bowels should be opened with calomel
+or other cathartic; two-fifths of a grain for an adult, half a grain
+for a child. Rest in bed for a day or two, after taking a hot bath and
+a glass of hot lemonade containing a tablespoonful or two of whisky,
+is the most valuable treatment. The Turkish bath is also very
+efficacious in cutting short colds, but involves great risk of
+increasing the trouble unless the patient can return home in a closed
+carriage directly from the bath. Of the numerous remedies which are
+commonly used to arrest colds in the first stages are two which
+possess special virtue; namely, quinine and Dover's powder, given in
+single dose of ten grains of each for an adult.<span class="pagenum"><a name="Page_57" id="Page_57">[Pg 57]</a></span> Both of these
+remedies may be taken, but while the Dover's powder is most effective
+it is often necessary for the patient to remain in bed twelve to
+eighteen hours after taking it on account of nausea and faintness
+which would be produced if the patient were up and moving about.
+Rhinitis tablets should never be used. They are generally abused, and,
+indeed, some fatal cases are on record in which they caused death.
+Drugs are of little value except in the beginning of a cold, when they
+are given with the hope of cutting short an attack.</p>
+
+<p>The local applications of remedies to the inflamed region is of
+service. At the onset of the cold, Seiler's solution (conveniently
+made from tablets which are sold in the shops) or Dobell's solution
+should be sprayed from an atomizer, into the nostrils, every half
+hour, and, when the discharge becomes thick and copious, this is to be
+discarded for a spray consisting of alboline (four ounces) and camphor
+and menthol (each thirty grains), used in the same manner as long as
+the cold lasts. Containing bottles should be stood in hot water, in
+order that all sprays for the nostrils may be used warm.</p>
+
+<p>It is well to give babies a teaspoonful of castor oil and a warm bath,
+and keep them in bed. If there is fever with the cold, five drops of
+sweet spirit of niter may be given in a teaspoonful of sweetened water
+every two hours. Liquid vaseline, or the alboline mixture advised for
+adults, may be dropped into the nostrils<span class="pagenum"><a name="Page_58" id="Page_58">[Pg 58]</a></span> with a medicine dropper more
+conveniently than applied by spray.</p>
+
+
+<p class="section"><strong>TOOTHACHE.</strong>&mdash;When there is a cavity in an aching tooth it should be
+cleaned of food, and a little pledget of cotton wool wrapped on a
+toothpick may be used to wipe the cavity dry. Then the cavity should
+be loosely packed, by means of a toothpick or one prong of a hairpin,
+with a small piece of absorbent cotton rolled between the fingers and
+saturated with one of the following substances, preferably the first:
+oil of cloves, wood creosote or chloroform.</p>
+
+<p>If wood creosote is used the cotton must be well squeezed to get rid
+of the excess of fluid, as it is poisonous if swallowed, and will burn
+the gum and mouth if allowed to overflow from the tooth.</p>
+
+
+<p class="section"><strong>ALVEOLAR ABSCESS</strong> (<em>improperly called "Ulcerated Tooth"</em>).&mdash;An
+"ulcerated tooth" begins as an inflammation in the socket of a tooth,
+and, if near its deepest part, causes great pain, owing to the fact
+that the pus formed can neither escape nor expand the unyielding bony
+wall of the socket.</p>
+
+<p>This explains why an abscess near the tooth is so much more painful
+than a similar one of soft parts. There may be no cavity in the tooth,
+but the tooth is commonly dead, or its nerve is dying, and the tooth
+is frequently darker in color. It often happens that threatened
+abscess at the root of a tooth, which has been filled, can be averted
+by a dentist's boring down into the root of the tooth, or removing the
+filling. It is<span class="pagenum"><a name="Page_59" id="Page_59">[Pg 59]</a></span> not always possible to locate the troublesome tooth,
+from the pain, but by tapping on the various teeth in turn with a
+knife, or other metal instrument, special soreness will be discovered
+in the "ulcerated" tooth. The ulcerated tooth frequently projects
+beyond its fellows, and so gives pain when the jaws are brought
+together in biting.</p>
+
+<p><strong>Treatment.</strong>&mdash;The treatment for threatened abscess near a tooth consists
+in painting tincture of iodine, with a camel's hair brush, upon the
+gum at the root of the painful tooth, and applying, every hour or so,
+over the same spot a toothache plaster (sold by all druggists). The
+gum must be wiped dry before applying the moistened toothache plaster.
+Water, as hot as can be borne, should be held in the mouth, and the
+process repeated for as long a time as possible. Then the patient
+should lie with the painful side of the face upon a hot-water bag or
+bottle. The trouble may subside under this treatment, owing to
+disappearance of the inflammation, or to the unnoticed escape of a
+small amount of pus through a minute opening in the gum. If the
+inflammation continues the pain becomes intense and throbbing; there
+is often entire loss of sleep and rest, fever, and even chills, owing
+to a certain degree of blood poisoning. The gum and face swell on the
+painful side, and the patient often suffers more than with many more
+serious diseases.</p>
+
+<p>After several days of distress, the bony socket of the tooth gives
+way, and the pus makes its exit, and,<span class="pagenum"><a name="Page_60" id="Page_60">[Pg 60]</a></span> bulging out the gum, finally
+escapes through this also, to the immediate relief of the patient. But
+serious results sometimes follow letting nature alone in such a case,
+as the pus from an eyetooth may burrow its way into the internal parts
+of the upper jaw, or into the chambers of the nose, while that from a
+back tooth often breaks through the skin on the face, leaving an ugly
+scar, or, if in the lower jaw, the pus may find its way between the
+muscles of the neck, and not come to the surface till it escapes
+through the skin above the collar bone. Pulling the tooth is the most
+effective way of relieving the condition, the only objection being the
+loss of the tooth, which is to be avoided if possible.</p>
+
+<p>If the pain is bearable and there are no chills and fever, the patient
+may save the tooth by remaining in bed with a hot-water bottle
+continually on the face, and taking ten drops of laudanum to relieve
+the pain at intervals of several hours. Then many hours of suffering
+may be prevented if the gum is lanced with a sharp knife (previously
+boiled for five minutes) as soon as the gum becomes swollen, to allow
+of the escape of pus. The dentist is, of course, the proper person to
+consult in all cases of toothache, and the means herein suggested are
+to be followed only when it is impossible to obtain his services.</p>
+
+
+<p class="section"><strong>MOUTH-BREATHING</strong> (<em>including Adenoids, Chronic Tonsilitis, Deviation of
+the Nasal Septum, Enlarged Turbinates, and Polypi</em>).&mdash;Any obstruction<span class="pagenum"><a name="Page_61" id="Page_61">[Pg 61]</a></span>
+in the nose causes mouth-breathing and gives rise to one or more of a
+long train of unfortunate results. Among the disorders producing
+mouth-breathing, enlargement of the glandular tissue in the back of
+the nose and in the throat of children is most important. Glandular
+growths in the upper part of the throat opposite the back of the nasal
+cavities are known as "adenoids"; they often completely block the air
+passage at this point, so that breathing through the nose becomes
+difficult. Associated with this condition we usually see enlargement
+of the tonsils, two projecting bodies, one on either side of the
+entrance to the throat at the back of the mouth. In healthy adult
+throats the tonsils should be hardly visible; in children they are
+active glands and easily visible.</p>
+
+<p>We are unable to see adenoids because of their position, but can be
+reasonably sure of their presence in children where we find symptoms
+resulting from mouth-breathing as described below. The surgeon assures
+himself positively of the existence of adenoids by inserting a finger
+into the mouth of the patient and hooking it up back of the roof of
+the mouth, when they may be felt as a soft mass filling the back of
+the nose passages.</p>
+
+<p>Other less common causes of mouth-breathing, seen in adults as well as
+children, are deviation of the nasal septum, swelling of the mucous
+membrane covering certain bones in the nose (turbinates), and polypi.</p>
+
+<p>Deviation of the nasal septum means displacement<span class="pagenum"><a name="Page_62" id="Page_62">[Pg 62]</a></span> of the partition
+dividing the two nostrils, so that more or less obstruction exists.
+This condition may be occasioned by blows on the nose received in the
+accidents common to childhood. The deformity which results leads in
+time to further obstruction in the nose, because when air is drawn in
+through the narrowed passages a certain degree of vacuum is produced
+and suction on the walls of the nose, as would occur if we drew in air
+from a large pair of bellows through a small thin rubber tube. This
+induces an overfilling of the blood vessels in the walls of the
+passages of the nose, and the continued congestion is followed by
+increased thickness of the lining mucous membrane, thus still further
+obstructing the entrance of air. A one-sided nasal obstruction in a
+child with discharge from that side leads one to suspect that a
+foreign body, as a shoe button, has been put in by the child.</p>
+
+<p>Polypi are small pear-shaped growths which form on the membrane lining
+the nasal passages and sometimes completely block them. They resemble
+small grapes without skins.</p>
+
+<p>These, then, are the usual causes of mouth-breathing, but of most
+importance, on account of their frequency and bearing on the health
+and development, are adenoids and enlarged throat tonsils in children.
+Adenoids and enlarged tonsils are often due to inflammation of these
+glands during the course of the contagious eruptive disorders, as
+scarlet fever, measles, or diphtheria; probably, also, to constant
+exposure to a germ-<span class="pagenum"><a name="Page_63" id="Page_63">[Pg 63]</a></span>laden atmosphere, as in the case of children
+herded together in tenements.</p>
+
+<p><strong>Symptoms.</strong>&mdash;The mouth-breathing is more noticeable during sleep;
+snoring is common, and the breathing is of a snorting character with
+prolonged pauses. Children suffering from enlarged tonsils and
+adenoids are often backward in their studies, look dull, stupid, and
+even idiotic, and are often cross and sullen; the mouth remains open,
+and the lower lip is rolled down and prominent; the nose has a pinched
+aspect, and the roof of the mouth is high. Air drawn into the lungs
+should be first warmed and moistened by passing through the nose, but
+when inspired through the mouth, produces so much irritation of the
+throat and air passages that constant "colds," chronic catarrh of the
+throat, laryngitis, and bronchitis ensue.</p>
+
+<p>The constant irritation of the throat occurring in mouth-breathers
+weakens the natural resistance against such diseases as acute
+tonsilitis, scarlet fever, and diphtheria, so that they are especially
+subject to these diseases. But these are not the only ailments to
+which the mouth-breather is liable, for earache and deafness naturally
+follow the catarrh, owing to obstruction of the Eustachian tubes (see
+Earache, p. <a href="#Page_40">40</a>, and Deafness, p. <a href="#Page_38">38</a>). Deformity of the chest is
+another result of obstruction to nose-breathing, the common form being
+the "pigeon breast," where the breastbone is unduly prominent. The
+voice is altered so that the patient, as the saying goes, "talks
+through the nose," although, in<span class="pagenum"><a name="Page_64" id="Page_64">[Pg 64]</a></span> reality, nasal resonance is reduced
+and difficulty is experienced in pronouncing N and M correctly, while
+stuttering is not uncommon. Nasal obstruction leads to poor nutrition,
+and hence children with adenoids and enlarged tonsils are apt to be
+puny and weakly specimens.</p>
+
+<p><strong>Treatment.</strong>&mdash;The treatment is purely surgical in all cases of nasal
+obstruction: removal of the adenoid growths, enlarged tonsils, and
+polypi, straightening the displaced nasal septum, and burning the
+thickened mucous lining obstructing the air passages in the nose. None
+of the operations are dangerous if skillfully performed, and should be
+generally done, even in the case of delicate children, as the very
+means of overcoming this delicacy. The after treatment is not
+unimportant, consisting in the use of simple generous diet, as plenty
+of milk, bread and butter, green vegetables and fresh meat, and the
+avoidance of pastries, sweets, fried food, pork, salt fish and salt
+meats, also the roots, as parsnips, turnips, carrots and beets, and
+tea and coffee. Life in the open air, emulsion of cod-liver oil, daily
+sponging with cold water while the patient stands in warm water,
+followed by vigorous rubbing, will all assist the return to health.</p>
+
+
+<p class="section"><strong>SORE MOUTH; INFLAMMATION OF THE MOUTH.</strong>&mdash;There are various forms of
+inflammation of the mouth, generally dependent upon the entrance of
+germs, associated with indigestion or general weakness following some
+fever or other disease. Unclean<span class="pagenum"><a name="Page_65" id="Page_65">[Pg 65]</a></span> nipples of the mother or of the
+bottle, or unclean bottles, allow entrance of germs, and are frequent
+causes. Irritation of a sharp tooth, or from rubbing the gum, or from
+too vigorous cleansing of the mouth, may start the disease. Some
+chemicals, especially mercury improperly prescribed, produce the
+disease. The germs may gain admission in impure milk in some cases.
+Inflammation of the mouth is essentially a children's disease, only
+the ulcerated form being common in adults.</p>
+
+<p><strong>Symptoms.</strong>&mdash;In general, the mouth is hot, very red, dry, and tender;
+the child is fretful and has difficulty in nursing, often dropping the
+nipple and crying; the tongue is coated, and there may be fever and
+symptoms of indigestion, as vomiting; sometimes the disease occurs
+during the course of fevers; later in the course of the disorder the
+saliva often runs freely from the mouth.</p>
+
+<p><strong>Simple Form.</strong>&mdash;In this there are only redness, swelling, and tenderness
+of the inside of the mouth. The tongue is at first dry and white, but
+the white coating comes off, leaving it red in patches. After a while
+the saliva becomes profuse. The treatment consists in washing the
+mouth often in ice water containing about one-half drachm of boric
+acid to four ounces of water by means of cotton tied on a stick, and
+holding lumps of ice in the mouth wrapped in the corner of a
+handkerchief. It is well also to give a teaspoonful of castor oil.</p>
+
+<p><span class="pagenum"><a name="Page_66" id="Page_66">[Pg 66]</a></span><strong>Aphthous Form.</strong>&mdash;In this there are yellow-white spots, resulting in
+little shallow depressions or ulcers, on the inside of the cheeks and
+lips, and on the tongue and roof of the mouth. These occur in crops
+and last from ten to fourteen days. The disease is often preceded by
+vomiting, constipation, and fever, with pain in the mouth and throat,
+and is accompanied by lumps or swelling of the glands under the jaw
+and in the neck. The treatment consists in the use of castor oil, and
+swabbing the mouth, several times a day, after each feeding, with
+boric-acid solution, as advised before, or better with permanganate of
+potash solution, using ten grains to the cup of water.</p>
+
+<p><strong>Thrush</strong> (<em>Sprue</em>).&mdash;This form is due to the growth of a special fungus
+in the mouth, causing the appearance of white spots on the inside of
+the cheeks, lips, tongue, and roof of the mouth, looking like flakes
+of curdled milk, but not easily removed. There are also symptoms of
+indigestion, as vomiting, diarrhea, and colic. The disease is
+contagious, and is due to some uncleanliness, often of the bottles,
+nipples, or milk. Sometimes ulcers or sore depressions are left in the
+mouth, and in weak children, in which the disease is apt to occur, the
+result may be serious, and a physician's services are demanded. The
+treatment consists in applying saleratus and water (one teaspoonful in
+a cup of water) to the whole inside of the mouth, between feedings,
+with a camel's-hair brush or with a soft cloth. A dose of castor oil
+is also desirable, and<span class="pagenum"><a name="Page_67" id="Page_67">[Pg 67]</a></span> great care as regards cleanliness of the
+bottles and nipples should be exercised.</p>
+
+<p><strong>Ulcerous Form.</strong>&mdash;This does not occur in children under five, but may
+attack persons of all greater ages. It is often seen following measles
+and scarlet fever, and in the poor and ill nourished, and after the
+unwise use of calomel. There are redness and swelling of the gum about
+the base of the lower front teeth, and the gums bleed easily. Matter,
+or pus, forms between the teeth and the gum, and the mouth has a foul
+odor. The gum on the whole lower jaw may become inflamed, and a yellow
+band of ulceration may appear along the gums. The glands under the jaw
+and in the neck are enlarged, feeling like tender lumps, and saliva
+flows freely. In severe cases the gums may become destroyed and eaten
+away by the ulceration, and the bone of the jaw be diseased and
+exposed. As in the graver cases it may become necessary to remove dead
+bone and teeth, and the very dangerous form next described may
+sometimes follow it, it will be seen that it is a disease requiring
+skilled medical attention. The treatment consists in using, as a mouth
+wash and gargle, a solution of chlorate of potash (fifteen grains to
+the ounce) every two hours. Cases usually last at least a week.</p>
+
+<p><strong>Gangrenous Form.</strong>&mdash;This is a rare and fatal form of inflammation of the
+mouth and occurs in children weak and debilitated from other diseases,
+as from<span class="pagenum"><a name="Page_68" id="Page_68">[Pg 68]</a></span> the contagious eruptive fevers, chronic diarrhea, and scurvy.
+It is seen more often in hospitals and is contagious. A foul odor is
+noticed about the mouth, in which will be seen an ulcer on the gum or
+inside of the cheek. The cheek swells tremendously, with or without
+pain, and becomes variously discolored&mdash;red, purple, black. The larger
+proportion of patients die of exhaustion and blood poisoning within
+one to three weeks, and the only hope is through surgical interference
+at the earliest possible moment.</p>
+
+
+<p class="section"><strong>CANKER.</strong>&mdash;A small, shallow, yellow ulcer, appearing on the inside of
+the lips or beneath the tongue during some disorder of the digestion.
+It is very tender when touched and renders chewing or talking somewhat
+painful. Treatment consists of touching the ulcer carefully with the
+point of a wooden toothpick which has been dipped in pure carbolic
+acid (a poison) and then rinsing the resulting white spot and the
+whole mouth very carefully, so as not to swallow any of the acid.</p>
+
+<p>Inflammation of the mouth occurs in two other general diseases, in
+syphilis and rarely in diphtheria. In children born of syphilitic
+parents, deep cracks often appear at either side of the mouth and do
+not heal as readily as ordinary sores, but continue a long time, and
+eventually leave deep scars. In diphtheria the membrane which covers
+the tonsils sometimes spreads to the cheeks, tongue, and lips, but in
+either case the general symptoms will serve to dis<span class="pagenum"><a name="Page_69" id="Page_69">[Pg 69]</a></span>tinguish the
+diseases, and neither can be treated by the layman.</p>
+
+
+<p class="section"><strong>MILD SORE THROAT</strong> (<em>Acute Pharyngitis</em>).&mdash;The milder sore throat is
+commonly the beginning of an ordinary cold, although sometimes it is
+caused by digestive disorders. Exposure to cold and wet is, however,
+the most frequent source of this form of sore throat. Soreness,
+dryness, and tickling first call attention to the trouble, together
+with a feeling of chilliness and, perhaps, slight fever. There may be
+some stiffness and soreness about the neck, owing to swelling of the
+glands. If the back of the tongue is held down by a spoon handle, the
+throat will be seen to be generally reddened, including the back, the
+bands at the side forming the entrance to the throat at the back of
+the mouth, and the uvula or small, soft body hanging down from the
+middle of the soft palate at the very back of the roof of the mouth.
+The tonsils are not large and red nor covered with white dots, as in
+tonsilitis. Neither is there much pain in swallowing. The surface of
+the throat is first dry, glistening, and streaked with stringy, sticky
+mucus.</p>
+
+<p><strong>Treatment.</strong>&mdash;The disorder rarely lasts more than a few days. The bowels
+should be moved in the beginning of the attack by some purge, as two
+compound cathartic pills or three grains of calomel, and the throat
+gargled, six times daily, with potassium chlorate solution
+(one-quarter teaspoonful to the cup of water), or with Dobell's
+solution. In gargling,<span class="pagenum"><a name="Page_71" id="Page_71">[Pg 70]<br />[Pg 71]</a></span> simply throw back the head and allow the
+fluid to flow back as far as possible into the throat without
+swallowing it. The frequent use of one of these fluids in an atomizer
+is even preferable to gargling. As an additional treatment, the
+employment of a soothing and pleasant substance, as peppermints,
+hoarhound or lemon drops, or marshmallows or gelatin lozenges, is
+efficacious, and will prove an agreeable remedy to the patient in sad
+contrast with many of our prescriptions. The use of tobacco must be
+stopped while the throat is sore.</p>
+
+
+<div class="plate">
+<h4><strong>Plate IV</strong></h4>
+
+<p class="plate_head"><strong>THE LARYNX</strong></p>
+
+<p>The illustration on the opposite page shows the upper part of the
+larynx and the base of the tongue.</p>
+
+<p>During the inspiration of a full breath, or when singing a low note,
+the <strong>Epiglottis</strong> lies forward and points upward, as shown in the cut,
+with the glottis (the passage leading into the windpipe between the
+vocal cords) wide open.</p>
+
+<p>During the act of swallowing, the epiglottis is turned downward and
+backward until it touches the <strong>Cricoid Cartilage</strong>, thus closing the
+glottis. The cricoid cartilage, which forms the upper part of the
+framework of the larynx, rests on the "Adam's apple."</p>
+
+<p>The <strong>False Vocal Cords</strong> are bands of ligament, and take no part in the
+production of sound.</p>
+
+<p>The <strong>True Vocal Cords</strong> move during talking or singing, and relax or
+contract when sounding, respectively, a low or high note. Hoarseness
+and cough occurring during laryngitis, diphtheria, and croup, are the
+result of inflammation of the mucous membrane lining the larynx.</p>
+
+<div class="figcenter" style="width: 500px;">
+<img src="images/plate4.jpg" width="500" height="379" alt="PLATE IV" title="PLATE IV" />
+<span class="caption">PLATE IV</span>
+</div>
+</div>
+
+
+<p class="section"><a name="SECTION_TONSILITIS" id="SECTION_TONSILITIS"></a><strong>TONSILITIS</strong> (<em>Follicular Tonsilitis</em>).&mdash;Tonsilitis is a germ disease
+and is contagious. Exposure to cold and wet and to germ-laden air
+renders persons more liable to attacks. It is more likely to occur in
+young people, especially those who have already suffered from the
+disease and whose tonsils are chronically enlarged, and is most
+prevalent in this country in spring. The disease appears to be often
+associated with rheumatism. Tonsilitis begins much like <em>grippe</em>, with
+fever, headache, backache and pain in the limbs, sore throat, and pain
+in swallowing. On inspecting the throat (with the tongue held down
+firmly by a spoon handle and the mouth widely open in a good light,
+preferably sunlight) the tonsils will be seen to be swollen, much
+reddened, and dotted over with pearl-white spots.</p>
+
+<p>Sometimes only one tonsil is so affected, but the other is likely to
+become inflamed also. Occasionally<span class="pagenum"><a name="Page_72" id="Page_72">[Pg 72]</a></span> there may be only one spot of
+white on the tonsil. The swelling differs in degree; in some cases the
+tonsils may be so swollen as almost to meet together, but there is no
+danger of suffocation from obstruction of the throat, as occurs in
+diphtheria and very rarely in quinsy. The characteristic appearance
+then consists in large, red tonsils covered with white spots. The
+spots represent discharge which fills in the depressions in the
+tonsil. The fever lasts three days to a week, generally, and then
+subsides together with the other symptoms.</p>
+
+<p>With apparent tonsilitis there must always be kept in mind the
+possibility of diphtheria, and, unfortunately, it is at times
+impossible for the most acute physician to distinguish between these
+two diseases by the appearances of the throat alone. In order to do so
+it is necessary to rub off some of the discharge from the tonsils, and
+examine, microscopically, the kind of germs contained therein. The
+general points of difference are: in diphtheria the tonsils are
+usually completely covered with a gray membrane. In the early stage,
+or in mild cases of diphtheria, there may be only a spot on one
+tonsil, but it is apt to be yellow in color, and is thicker than the
+white spots in tonsilitis. These are the difficult cases. Ordinarily,
+in diphtheria, not only are the tonsils covered with a grayish
+membrane, but this soon extends to the surrounding parts of the
+throat, whereas in tonsilitis the spots are always found on the tonsil
+alone. The white<span class="pagenum"><a name="Page_73" id="Page_73">[Pg 73]</a></span> spot can be readily wiped off with a little
+absorbent cotton wound on a stick, in the case of tonsilitis, but in
+diphtheria the membrane can be removed in this way only with
+difficulty, and leaves underneath a rough, bleeding surface. The
+breath is apt to have a bad odor in diphtheria, and the temperature is
+lower (not much over 100° F.) than in tonsilitis, when it is
+frequently 101° to 103° F. Notwithstanding these points, it is never
+safe for a layman to undertake the diagnosis when a physician's
+services are obtainable. On the other hand, when this is not possible
+and the patient's tonsils present the white, dotted appearance
+described, especially if subject to similar attacks, one may be
+reasonably sure that the case is tonsilitis.</p>
+
+<p><strong>Treatment.</strong>&mdash;The patient should be put to bed and kept apart from
+children and young persons, and, if living among large numbers of
+people, should be strictly quarantined. For, although the disease is
+not dangerous, it quickly spreads in institutions, boarding schools,
+etc. If the tonsils are painted with a solution of silver nitrate (one
+drachm to the ounce of water), applied carefully with a camel's-hair
+brush, at the beginning of the attack, and making two applications
+twelve hours apart, the disease may sometimes be arrested. It is well
+also at the start to open the bowels with calomel, giving three grains
+in a single dose, or divided doses of one-half grain each until three
+grains have been taken. Pain is relieved by phenacetin in <span class="pagenum"><a name="Page_74" id="Page_74">[Pg 74]</a></span>three- to
+five-grain doses as required, but not taken oftener than once in three
+hours, while at night five to ten grains of Dover's powder (for an
+adult) will secure sleep. For children one-half drop doses of the
+(poisonous) tincture of aconite is preferable to phenacetin. The
+outside of the throat should be kept covered with wet flannel wrung
+out in cold water and covered with oil silk, or an ice bag may be
+conveniently used in its place. A half teaspoonful of the following
+prescription is beneficial unless it disagrees with the stomach. It
+must not be taken within half an hour of a meal, and is not to be
+diluted with water, as it acts, partly through its local effect, on
+the tonsils when allowed to flow from a spoon on the back of the
+tongue.</p>
+
+<table summary="Prescription">
+<tbody>
+<tr>
+  <td>R<sub>x</sub></td>
+  <td>Glycerin</td>
+  <td>4 ounces</td>
+</tr>
+<tr>
+  <td>&nbsp;</td>
+  <td>Tincture of chloride of iron</td>
+  <td><span class="frac_top">1</span>/<span class="frac_bottom">2</span> ounce</td>
+</tr>
+</tbody>
+</table>
+
+<p class="directions">Mix. Directions, half teaspoonful every half hour.</p>
+
+<p>A mixture of hydrogen dioxide, equal parts, with water can also be
+used to advantage as a spray in an atomizer every two hours. The
+phenacetin and Dover's powder must be discontinued as soon as the pain
+and sleeplessness cease, but the iron preparation and spray should be
+continued until the throat regains its usual condition. A liquid diet
+is desirable during the first part of the attack, consisting of milk,
+cocoa, eggnog (made of the white of egg), soups, and gruels; orange
+juice may be allowed, also grapes. The bowels must be kept regular
+with mild remedies, as a Seidlitz powder in a glass of water in the
+morning, or one<span class="pagenum"><a name="Page_75" id="Page_75">[Pg 75]</a></span> or two two-grain tablets of extract of cascara
+sagrada at night.</p>
+
+
+<p class="section"><strong>QUINSY.</strong>&mdash;Quinsy is a peritonsilitis; that is, it is an inflammatory
+disease of the tissues in which the tonsil is imbedded, an
+inflammation around the tonsil. The swelling of these tissues thrusts
+the tonsil out into the throat; but the tonsil is little affected.
+Quinsy involves the surrounding structures of the throat, and usually
+results in abscess. The disease is said to be frequently hereditary,
+and often occurs in those subject to rheumatism and gout. It is seen
+more often in spring and autumn and in those living an out-of-door
+existence, and having once had quinsy the victim is liable to frequent
+recurrences of the disease. Quinsy is characterized by much greater
+pain in the throat and in swallowing than is the case in tonsilitis,
+and the temperature is often higher&mdash;sometimes 104° to 105° F. When
+the throat is inspected, one or both tonsils are seen to be enlarged
+and crowded into its cavity from the swelling of the neighboring
+parts. The tonsils may almost block the entrance to the throat. The
+voice is thick and indistinct, the glands in the side of the neck
+become swollen, and the neck is sore and stiff in consequence, while
+the mouth can be only partially opened on account of pain. For the
+same reason the patient can swallow neither solid nor liquid food, and
+sits bent forward, with saliva running out of the mouth. The secretion
+of saliva is increased, but is not swallowed on account of the pain
+produced<span class="pagenum"><a name="Page_76" id="Page_76">[Pg 76]</a></span> by the act. Sleep is also impossible, and altogether a more
+piteous spectacle of pain and distress is rarely seen. Having reached
+this stage the inflammation usually goes on to abscess (formation
+behind or above or below the tonsil), and, after five to ten days from
+the beginning of the attack, the pus finds its way to the surface of
+the tonsil, and breaks into the mouth to the inexpressible relief of
+the patient. This event is followed by quick subsidence of the
+symptoms. Quinsy is rarely a dangerous disease, yet, occasionally, it
+leads to so much obstruction in the throat that death from suffocation
+ensues unless a surgeon opens the throat and inserts a tube.
+Occasionally the pus from the ruptured abscess enters the larynx and
+causes suffocation.</p>
+
+<p>Quinsy differs from tonsilitis in the following respects: the swelling
+affects the immediate surrounding area of the throat; there are no
+white spots to be seen on the tonsil unless the trouble begins as an
+ordinary tonsilitis; there is great pain on swallowing, and finally
+abscess near the tonsil in most cases.</p>
+
+<p><strong>Treatment.</strong>&mdash;A thorough painting of the tonsils at the onset of a
+threatened attack of quinsy with the silver-nitrate solution, as
+recommended under tonsilitis, may cut short the disorder. A single
+dose of calomel (three to five grains) is also useful for the same
+purpose. The tincture of aconite should be taken hourly in three-drop
+doses until five such have been swallowed, when the drug is to be no
+longer used.<span class="pagenum"><a name="Page_77" id="Page_77">[Pg 77]</a></span> The constant use of a hot flaxseed poultice (as large as
+the whole hand and an inch thick, spread between thin layers of cotton
+and applied as hot as can be borne, and changed every half hour) gives
+more relief than anything else, and may possibly lead to disappearance
+of the trouble if employed early enough. The use of the poultices is
+to be kept up until recovery, although they need not be applied so
+frequently as at first. A surgeon's services are especially desirable
+in this disorder, as early puncture of the peritonsillar tissue may
+save days of suffering in affording exit for pus as soon as it forms.</p>
+
+
+<p class="section"><strong>DIPHTHERIA.</strong>&mdash;The consideration of diphtheria will be limited to
+emphasizing the importance of calling in expert medical advice at the
+earliest possible moment in suspicious cases of throat trouble. For,
+as we noted under tonsilitis, it is impossible in some cases to
+decide, from the appearance of the throat, whether the disease is
+diphtheria or tonsilitis. A specimen of secretion removed from the
+throat for microscopical examination by a bacteriologist as to the
+presence of diphtheria germs alone will determine the point. When such
+an examination is impossible, it is always best to isolate the
+patient, especially if a child, and treat the case as if it were
+diphtheria. Diphtheria may invade the nose and be discoverable in the
+nostrils. A chronic membranous rhinitis should be treated as a case of
+walking diphtheria.</p>
+
+<p>Antitoxin is the treatment above all other reme<span class="pagenum"><a name="Page_78" id="Page_78">[Pg 78]</a></span>dies. It has so
+altered the outlook in diphtheria that, formerly regarded by
+physicians with alarm and dismay, it is now rendered comparatively
+harmless. The death rate has been reduced from an average of about
+forty per cent, before the introduction of antitoxin, to only ten per
+cent since its use, and, when it is used at the onset of the disease,
+the results are much more favorable still. This latter fact is the
+reason for obtaining medical advice at the earliest opportunity in all
+doubtful cases of throat ailments; and, we might add, that the
+diagnosis of any case of sore throat is doubtful, particularly in
+children, whenever there is seen a whitish, yellowish-white, or gray
+deposit on the throat. Antitoxin is an absolutely safe remedy, its ill
+effects being sometimes the production of a nettlerash or some mild
+form of joint pains. In small doses, it will prevent the occurrence of
+diphtheria in those exposed, or liable to exposure, to the disease.
+The proper dose and method of employing antitoxin it is impossible to
+impart in a book of this kind. Paralysis of throat, of vocal cords, or
+of arms or legs&mdash;partial or entire&mdash;is a frequent sequel of
+diphtheria. It is not caused by antitoxin.</p>
+
+<p>The points which it is desirable for everyone to know are, that any
+sore throat&mdash;with only a single white spot on the tonsil&mdash;may be
+diphtheria, but that when the white spot or deposit not only covers
+the tonsil or tonsils (see <a href="#SECTION_TONSILITIS">Tonsilitis</a>) but creeps up on to the
+surrounding parts, as the palate (the soft cur<span class="pagenum"><a name="Page_79" id="Page_79">[Pg 79]</a></span>tain which shuts off
+the back of the roof of mouth from the throat), the uvula (the little
+body hanging from the middle of the palate in the back of the mouth),
+and the bands on either side of the back of the mouth at its junction
+with the throat, then the case is probably one of diphtheria. But it
+is often a day or two before the white deposit forms, the throat at
+first being simply reddened. The fever in diphtheria is usually not
+high (often not over 100° to 102° F.), and the headache, backache, and
+pains in the limbs are not so marked as in tonsilitis.</p>
+
+
+<p class="section"><strong>MEMBRANOUS CROUP.</strong>&mdash;Membranous croup is diphtheria of the lower part of
+the throat (larynx), in the region of the Adam's apple. If in a case
+of what appears to be ordinary croup (p. <a href="#Page_83">83</a>) the symptoms are not soon
+relieved by treatment, or if any membrane is coughed up, or if, on
+inspection of the throat, it is possible to see any evidence of white
+spots or membrane, then a physician's services are imperative.</p>
+
+<p>It is not very uncommon for patients with mild forms of diphtheria to
+walk about and attend to their usual duties and, if children, to go to
+school, and in that inviting field to spread the disease. These cases
+may present a white spot on one tonsil, or in other cases have what
+looks to be an ordinary sore throat with a simple redness of the
+mucous membrane. Sore throats in persons who have been in any way
+exposed to diphtheria, and especially sore throats in children<span class="pagenum"><a name="Page_80" id="Page_80">[Pg 80]</a></span> under
+such circumstances, should always be subjected to microscopical
+examination in the way we have alluded to before, for the safety of
+both the patient and the public.</p>
+
+<p>There is still another point perhaps not generally known and that is
+the fact that the germs of diphtheria may remain in the throat of a
+patient for weeks, and even months, after all signs in the throat have
+disappeared and the patient seems well. In such cases, however, the
+disease can still be communicated in its most severe form to others.
+Therefore, in all cases of diphtheria, examination of the secretion in
+the throat must show the absence of diphtheria germs before the
+patient can rightfully mix with other people.</p>
+
+<p>Gargling and swabbing the throat with the (poisonous) solution of
+bichloride of mercury, 1 part to 10,000 parts of water (none of which
+must be swallowed), should be employed every three or four hours each
+day till the germs are no longer found in the mucus of the tonsils.</p>
+
+
+<p class="section"><strong>HOARSENESS</strong> (<em>Acute Laryngitis</em>).&mdash;This is an acute inflammation of the
+mucous membrane of the larynx. The larynx is that part of the throat,
+in the region of the Adam's apple, which incloses the vocal cords and
+other structures used in speaking. Hoarseness is commonly due to
+extension of catarrh from the nose in cold in the head and <em>grippe</em>.
+It also follows overuse of the voice in public speakers and singers,
+and is seen after exposure to dust, tobacco, or<span class="pagenum"><a name="Page_81" id="Page_81">[Pg 81]</a></span> other smoke, and very
+commonly in those addicted to alcohol.</p>
+
+<p><strong>Symptoms.</strong>&mdash;Hoarseness is the first symptom noticed, and perhaps slight
+chilliness, together with a prickling or tickling sensation in the
+throat. There is a hacking cough and expectoration of a small amount
+of thick secretion. There may be slight difficulty in breathing and
+some pain in swallowing. The patient feels generally pretty well, and
+is troubled chiefly by impairment of the voice, which is either husky,
+reduced to a mere whisper, or entirely lost. This condition lasts for
+some days or, rarely, even weeks. There may be a mild degree of fever
+at the outset (100° to 101° F.). Very uncommonly the breathing becomes
+hurried and embarrassed, and swallowing painful, owing to excessive
+swelling and inflammation of the throat, so much so that a surgeon's
+services become imperative to intube the throat or to open the
+windpipe, in order to avoid suffocation. This serious form of
+laryngitis may follow colds, but more often is brought about by
+swallowing very hot or irritating liquids, or through exposure to fire
+or steam. In children, after slight hoarseness for a day or two, if
+the breathing becomes difficult and is accompanied by a crowing or
+whistling sound, with blueness of the lips and signs of impending
+suffocation, the condition is very suggestive of membranous croup (a
+form of diphtheria), which certainly is the case if any white,
+membranous deposit can be either seen in the throat or is<span class="pagenum"><a name="Page_82" id="Page_82">[Pg 82]</a></span> coughed up.
+Whenever there is difficulty of breathing and continuous hoarseness,
+in children or adults, the services of a competent physician are
+urgently demanded.</p>
+
+<p><strong>Treatment.</strong>&mdash;The use of cold is of advantage. Cracked ice may be held
+in the mouth, ice cream can be employed as part of the diet, and an
+ice bag may be applied to the outside of the throat. The application
+of a linen or flannel cloth to the throat wrung out of cold water and
+covered with oil silk or waterproof material, is also beneficial, and
+often more convenient than an ice bag. The patient must absolutely
+stop talking and smoking. If the attack is at all severe, he should
+remain in bed. If not so, he must stay indoors. At the beginning of
+the disorder a teaspoonful of paregoric and twenty grains of sodium
+bromide are to be taken in water every three hours, by an adult, until
+three doses are swallowed.</p>
+
+<p>Inhalation of steam from a pitcher containing boiling water is to be
+recommended. Fifteen drops of compound tincture of benzoin poured on
+the surface of a cup of boiling water increases the efficacy of the
+steam inhalation. The head is held above the pitcher, a towel covering
+both the head and pitcher to retain the vapor.</p>
+
+<p>The employment, every two hours, of a spray containing menthol and
+camphor (of each, ten grains) dissolved in alboline (two ounces)
+should be continued throughout the disease. If the hoarseness persists
+and<span class="pagenum"><a name="Page_83" id="Page_83">[Pg 83]</a></span> tends to become chronic, it is most advisable for the patient to
+consult a physician skilled in such diseases for local examination and
+special treatment.</p>
+
+
+<p class="section"><strong>CROUP.</strong>&mdash;Croup is an acute laryngitis of childhood, usually occurring
+between the ages of two and six years. The nervous element is more
+marked than in adults, so that the symptoms appear more alarming. The
+trouble frequently arises as part of a cold, or as a forerunner of a
+cold, and often is heralded by some hoarseness during the day,
+increasing toward night. The child may then be slightly feverish
+(temperature not over 102° F., usually). The child goes to bed and to
+sleep, but awakens, generally between 9 and 12 <span class="ampm">P.M.</span>, with a hard,
+harsh, barking cough (croupy cough) and difficulty in breathing. The
+breathing is noisy, and when the air is drawn into the chest there is
+often a crowing or whistling sound produced from obstruction in the
+throat, due to spasm of the muscles and to dried mucus coating the
+lining membrane, or to swelling in the larynx. It is impossible to
+separate these causes. The child is frightened, as well as his
+parents, and cries and struggles, which only aggravates the trouble.
+The worst part of the attack is, commonly, soon over, so that as a
+rule the doctor arrives after it is past. While it does last, however,
+the household is more alarmed than, perhaps, by any other common
+ailment.</p>
+
+<p>Death from an attack of croup, pure and simple, has probably never
+occurred. The condition described<span class="pagenum"><a name="Page_84" id="Page_84">[Pg 84]</a></span> may continue in a less urgent form
+for two or three hours, and very rarely reappears on following nights
+or days. The child falls asleep and awakens next morning with
+evidences of a cold and cough, which may last several days or a week
+or two.</p>
+
+<p>The only other disease with which croup is likely to be confused is
+membranous croup (diphtheria of the larynx), and in the latter
+disorder the trouble comes on slowly, with hoarseness for two or three
+days and gradually increasing fever (103° to 105° F.) and great
+restlessness and difficulty in breathing, not shortly relieved by
+treatment, as in simple croup. In fifty per cent of the cases of
+membranous croup it is possible to see a white, membranous deposit on
+the upper part of the throat by holding the tongue down with a spoon
+handle and inspecting the parts with a good light.</p>
+
+<p>Croup is more likely to occur in children suffering from adenoids,
+enlarged tonsils, indigestion, and decayed teeth, and is favored by
+dry, furnace heat, by exposure to cold, and by screaming and shouting
+out of doors.</p>
+
+<p><strong>Treatment.</strong>&mdash;Place the child in a warm bath (101° F.) and hold a sponge
+soaked in hot water over the Adam's apple of the throat, changing it
+as frequently as it cools. Hot camphorated oil rubbed over the neck
+and chest aids recovery. If the bowels are not loose, give a
+teaspoonful of castor oil or one or two grains of calomel. The most
+successful remedies<span class="pagenum"><a name="Page_85" id="Page_85">[Pg 85]</a></span> are ipecac and paregoric. It is wise to keep both
+on hand with children in the house. A single dose of paregoric
+(fifteen drops for child of two years; one teaspoonful for child of
+seven years) and repeated doses of syrup of ipecac (one-quarter to
+one-half teaspoonful) should be given every hour till the child vomits
+and the cough loosens, and every two hours afterwards. The generation
+of steam near the child also is exceedingly helpful in relieving the
+symptoms. A kettle of water may be heated over a lamp. A rubber or tin
+tube may be attached to the spout of the kettle and carried under a
+sort of sheet tent, covering the child in bed. The tent must be
+arranged so as to allow the entrance of plenty of fresh air. Very
+rarely the character of the inflammation in croup changes, and the
+difficulty in breathing, caused by swelling within the throat,
+increases so that it is necessary to employ a surgeon to pass a tube
+down the throat into the larynx, or to open the child's windpipe and
+introduce a tube through the neck to prevent suffocation.</p>
+
+<p>The patient recovering from croup should generally be kept in a warm,
+well-ventilated room for a number of days after the attack, and
+receive syrup of ipecac three or four times daily, until the cough is
+loosened. If ipecac causes nausea or vomiting, the dose must be
+reduced. The disease is prevented by a simple diet, especially at
+night; by the removal of enlarged tonsils and adenoids; by daily
+sponging, before breakfast, with water as cold as it comes from the<span class="pagenum"><a name="Page_86" id="Page_86">[Pg 86]</a></span>
+faucet, while the child stands, ankle deep, in hot water; and by an
+out-of-door existence with moderate school hours; also by evaporating
+water in the room during the winter when furnace heat is used. When
+children show signs of an approaching attack of croup, give three
+doses of sodium bromide (five grains for child two years old; ten
+grains for one eight years old) during the day at two-hour intervals
+and give a warm bath before bedtime, and rub chest and neck with hot
+camphorated oil.</p>
+
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_87" id="Page_87">[Pg 87]</a></span></p>
+<h3>CHAPTER III</h3>
+
+<p class="chapter_head"><strong>The Lungs and Bronchial Tubes</strong></p>
+
+<p class="chapter_head"><em>Meaning of Bronchitis&mdash;Symptoms and Treatment&mdash;Remedies for
+Infants&mdash;Pneumonia&mdash;Consumption the Great Destroyer&mdash;Asthma&mdash;La
+Grippe.</em></p>
+
+
+<p class="section"><strong>COUGH</strong> (<em>occurring in Bronchitis, Pneumonia, Consumption or
+Tuberculosis, Asthma, and Influenza or Grippe</em>).&mdash;Cough is a symptom
+of many disorders. It may be caused by irritation of any part of the
+breathing apparatus, as the nose, throat, windpipe, bronchial tubes,
+and (in pleurisy and pneumonia) covering membrane of the lung. The
+irritation which produces cough is commonly due either to congestion
+of the mucous membrane lining the air passages (in early stage of
+inflammation of these tissues), or to secretion of mucus or pus
+blocking them, which occurs in the later stages.</p>
+
+<p>Cough is caused by a sudden, violent expulsion of air from the chest
+following the drawing in of a deep breath. A loose cough is to be
+encouraged, as by its means mucus and other discharge is expelled from
+the air passages.</p>
+
+<p>A dry cough is seen in the early stages of various respiratory
+diseases, as bronchitis, pneumonia, pleurisy, consumption, whooping
+cough, and with irritation<span class="pagenum"><a name="Page_88" id="Page_88">[Pg 88]</a></span> from enlarged tonsils and adenoids (see p.
+<a href="#Page_61">61</a>) occurring in children.</p>
+
+<p>Irritation produced by inhaling dust, or any irritation existing in
+the nose, ear, or throat may lead to this variety of cough. The dry
+cough accomplishes no good, and if continuous and excessive may do
+harm, and demands medicinal relief.</p>
+
+<p><strong>Bronchitis.</strong>&mdash;Cough following or accompanying cold in the head and sore
+throat generally means bronchitis.</p>
+
+<p>The larynx or lower part of the throat ends just below the "Adam's
+apple" in the windpipe. The windpipe is about four and a half inches
+long and three-quarters to an inch in diameter, and terminates by
+dividing into the two bronchial tubes in the upper part of the chest.
+Each bronchial tube divides and subdivides in turn like the branches
+of a tree, the branches growing more numerous and smaller and smaller
+until they finally end in the microscopic air sacs or air cells of the
+lungs. The bronchial tubes convey air to the air cells, and in the
+latter the oxygen is absorbed into the blood, and carbonic acid is
+given up. Bronchitis is an inflammation of the mucous membrane lining
+these tubes. In cough of an ordinary cold only the mucous membrane of
+the windpipe and, perhaps, of the larger tubes is inflamed. This is a
+very mild disorder compared to inflammation of the smaller and more
+numerous tubes.</p>
+
+<p>In bronchitis, besides the ordinary symptoms of a<span class="pagenum"><a name="Page_89" id="Page_89">[Pg 89]</a></span> severe cold in the
+head, as sneezing, running of mucus from the nose, sore throat and
+some hoarseness perhaps, and languor and soreness in the muscles,
+there is at first a feeling of tightness, pressure, and rawness in the
+region of the breastbone, with a harsh, dry cough. The coughing causes
+a strain of the diaphragm (the muscle which forms the floor of the
+chest), so that there are often pain and soreness along the lower
+borders of the chest where the diaphragm is attached to the inside of
+the ribs. After a few days the cough becomes looser, greatly to the
+patient's comfort, and a mixture of mucus and pus is expectorated. In
+a healthy adult such a cough is usually not in itself a serious
+affair, and apart from the discomfort of the first day or two, there
+is not sufficient disturbance of the general health to interfere with
+the ordinary pursuits. The temperature is the best guide in such
+cases; if it is above normal (98<span class="frac_top">3</span>/<span class="frac_bottom">5</span>° F.) the patient should stay
+indoors. In infants, young children, enfeebled or elderly people,
+bronchitis may be a serious matter, and may be followed by pneumonia
+by extension of the inflammation from the small bronchial tubes into
+the air sacs of the lungs, and infection with the pneumonia germ. The
+principal signs of severe attacks of bronchitis are rapid breathing,
+fever, and rapid pulse.</p>
+
+<p>The normal rate of breathing in adults is seventeen a minute, that is,
+seventeen inbreaths and seventeen outbreaths. In children of one to
+five years the normal<span class="pagenum"><a name="Page_90" id="Page_90">[Pg 90]</a></span> rate is about twenty-six breathing movements a
+minute. In serious cases of bronchitis the rate may be twenty-five to
+forty in adults, or forty to sixty in children, per minute.</p>
+
+<p>Of course the only exact way of learning the nature of a chest trouble
+is thorough, careful examination by a physician, for cough, fever,
+rapid breathing and rapid pulse occur in many other diseases besides
+bronchitis, particularly pneumonia.</p>
+
+<p>Pneumonia begins suddenly, often with a severe chill, headache, and
+general pains like <em>grippe</em>. In a few hours cough begins, short and
+dry, with violent, stabbing pain in one side of the chest, generally
+near the nipple. The breathing is rapid, with expanding nostrils, the
+face is anxious and often flushed. The matter coughed up at first is
+often streaked with blood, and is thick and like jelly. The
+temperature is often 104°&ndash;105° F.</p>
+
+<p>If the disease proceeds favorably, at the end of five, seven, or ten
+days the temperature, breathing, and pulse become normal suddenly, and
+the patient rapidly emerges from a state of danger and distress to one
+of comfort and safety. The sudden onset of pneumonia with chill,
+agonizing pain in side, rapid breathing, and often delirium with later
+bloody or rusty-colored, gelatinous expectoration, will then usually
+serve to distinguish it from bronchitis, but not always.</p>
+
+<p>Whenever, with cough, rapid and difficult breathing occur with rise of
+temperature (as shown by the ther<span class="pagenum"><a name="Page_91" id="Page_91">[Pg 91]</a></span>mometer) and rapid pulse, the case
+is serious, and medical advice is urgently demanded.</p>
+
+<p><strong>Treatment of Acute Cough and Bronchitis.</strong>&mdash;In the case of healthy
+adults with a cough accompanying an ordinary cold, the treatment is
+very simple, when there is little fever or disturbance of the general
+health. The remedies recommended for cold in the head (p. <a href="#Page_55">55</a>) should
+be taken at first. It is also particularly desirable for the patient
+to stay in the house, or better in bed, for the first day or two, or
+until the temperature is normal.</p>
+
+<p>The feeling of tightness and distress in the chest may be relieved by
+applying a mild mustard paper over the breastbone, or a poultice
+containing mustard, one part, and flour, three parts, mixed with warm
+water into a paste and spread between two single thicknesses of cotton
+cloth about eight inches square. The tincture of iodine painted twice
+over a similar area forms another convenient application instead of
+the mustard. If the cough is excessive and troublesome at night the
+tablets of "ammonium chloride compound with codeine" are convenient.
+One may be taken every hour or two by an adult, till relieved.</p>
+
+<p>Children suffering from a recent cough and fever should be kept in bed
+while the temperature is above normal. It is well to give infants at
+the start a grain of calomel or half a teaspoonful of castor oil, and
+to children of five to eight years double the dose.</p>
+
+<p>The chest should be rubbed with a liniment com<span class="pagenum"><a name="Page_92" id="Page_92">[Pg 92]</a></span>posed of one part of
+turpentine and two parts of camphorated oil. It is well also to apply
+a jacket made of sheet cotton over the whole chest. It is essential to
+keep the room at a temperature of about 70° F. and well ventilated,
+not permitting babies to crawl on the floor when able to be up, or to
+pass from a warm to a cold room. Sweet spirit of niter is a
+serviceable remedy to use at the beginning: five to fifteen drops
+every two hours in water for a child from one to ten years of age, for
+the first day or two.</p>
+
+<p>If the cough is harsh, hard, or croupy (see p. <a href="#Page_83">83</a>), give syrup of
+ipecac every two hours: ten drops to an infant of one year or under,
+thirty drops to a child of ten years, unless it causes nausea or
+vomiting, when the dose may be reduced one-half. If children become
+"stuffed up" with secretion so that the breathing is difficult and
+noisy, give a teaspoonful of the syrup of ipecac to make them vomit,
+for until they are six or seven years old children cannot expectorate,
+and mucus which is coughed up into the mouth is swallowed by them.
+Vomiting not only gets rid of that secretion which has been swallowed,
+but expels it from the bronchial tubes. This treatment may be repeated
+if the condition recurs.</p>
+
+<p>In infants under a year of age medicine is to be avoided as much as
+possible. A teaspoonful of sweet oil and molasses, equal parts, may be
+given occasionally to loosen the cough in mild cases. In other cases
+use the cough tablet for infants described on p. <a href="#Page_91">91</a>. A<span class="pagenum"><a name="Page_93" id="Page_93">[Pg 93]</a></span> paste
+consisting of mustard, one part, and flour, twenty parts, is very
+useful when spread on a cloth and applied all about the chest, front
+and back. The diet should be only milk for young children during the
+first day or two, and older patients should not have much more than
+this, except toast and soups. In feeble babies with bronchitis it is
+wise to give five or ten drops of brandy or whisky in water every two
+hours, to relieve difficulty in breathing.</p>
+
+<p>Children who are subject to frequent colds, or those in whom cough is
+persistent, should receive Peter Möller's cod-liver oil, one-half to
+one teaspoonful, according to age, three times daily after eating. One
+of the emulsions may be used instead if the pure oil is unpalatable.
+Adenoids and enlarged tonsils are a fruitful source of constant colds
+and sore throat, and their removal is advisable (see p. <a href="#Page_61">61</a>). Hardening
+of the skin by daily sponge baths with cold salt water, while the
+child stands or sits in warm water, is effective as a preventive of
+colds, as is also an out-of-door life with proper attention to
+clothing and foot gear.</p>
+
+<p><strong>Treatment of Pneumonia.</strong>&mdash;Patients developing the symptoms described as
+suggestive of pneumonia need the immediate attention of a physician.
+If a person is unfortunate enough to have the care of such a case,
+when it is impossible to secure a physician, it may afford some
+comfort to know that good nursing is really the prime requisite in
+aiding recovery, while<span class="pagenum"><a name="Page_94" id="Page_94">[Pg 94]</a></span> skillful treatment is of most value if
+complications arise.</p>
+
+<p>One in every ten cases of pneumonia in ordinarily healthy people
+proves fatal. In specially selected young men, as soldiers, the death
+rate from pneumonia is only one in twenty-five cases. On the other
+hand, pneumonia is the common cause of death in old age; about seventy
+out of every hundred patients who die from pneumonia are between sixty
+and eighty years of age. Infants under a year old, and persons
+enfeebled with disease or suffering from excesses, particularly
+alcoholism, are also likely to die if stricken with the disease.</p>
+
+<p>The patient should go to bed in a large, well-ventilated, and sunny
+room. The temperature of the room should be about 70° F., and the
+patient must not be covered so warmly with clothing as to cause
+perspiration. A flannel jacket may be made to surround the chest, and
+should open down the whole front. The nightshirt is worn over this;
+nothing more. Daily sponging of the patient with tepid water (85° to
+90° F.) should be practiced. The body is not to be all exposed at
+once, but each limb and the trunk are to be separately sponged and
+dried. If the fever is high (104° F.) the water should be cold (77° to
+72° F.), and the sponging done every three hours in the case of a
+strong patient. Visitors must be absolutely forbidden. No more than
+one or two persons are to be allowed in the sick room at once.</p>
+
+<p><span class="pagenum"><a name="Page_95" id="Page_95">[Pg 95]</a></span>The diet should consist chiefly of milk, a glass every two hours,
+varied with milk mixed with thin cooked cereal or eggnog. It is wise
+to give at the beginning of the disease a cathartic, such as five
+grains of calomel followed in twelve hours by a Seidlitz powder, if
+the bowels do not act freely before that time. To relieve the pain in
+the side, if excruciating, give one-quarter grain morphine
+sulphate,<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a> and repeat once, if necessary, in two hours. The
+application of an ice bag to the painful side frequently stops the
+pain, and, moreover, is excellent treatment throughout the course of
+the disease. The seat of pain usually indicates that the lung on that
+side is the inflamed one, so that the ice bag should be allowed to
+rest against that portion of the chest. Water should be freely
+supplied, and should be given as well as milk even if the patient is
+delirious.</p>
+
+<p>The bowels are to be moved daily by glycerin suppositories or
+injection of warm water. Dover's powder in doses of five grains is
+useful to assuage cough. It may be repeated once, after two hours'
+interval if desirable, but must not be employed at the same time as
+morphine. After the first two or three days are passed, or sooner in
+weak subjects, give strychnine sulphate, one-thirtieth grain, every
+six hours in pill or tablet form. The strychnine is to be continued
+until the temperature becomes normal, and then reduced about one-half
+in amount for a week or ten days<span class="pagenum"><a name="Page_96" id="Page_96">[Pg 96]</a></span> while the patient remains in bed, as
+he must for some time after the temperature, pulse, and breathing have
+become normal.</p>
+
+
+<p class="section"><strong>CONSUMPTION; TUBERCULOSIS OF THE LUNGS; PHTHISIS.</strong>&mdash;This disease
+demands especial attention, not only because it is above all others
+the great destroyer of human life, causing one-seventh of all deaths,
+but because, so far from being a surely fatal disease as popularly
+believed, it is an eminently curable disorder if recognized in its
+earliest stage. The most careful laboratory examinations of bodies
+dead from other causes, show that very many people have had
+tuberculosis at some time, and to some extent, during life. The reason
+why the disease fails to progress in most persons is that the system
+is strong enough to resist the inroads of the disease. The process
+becomes arrested by the germs being surrounded by a barrier of healthy
+tissue, and so perishing in their walled-in position. These facts
+prove that so far from being incurable, recovery from consumption
+frequently occurs without even our knowledge of the disease. It is
+only those cases which become so far advanced as to be easily
+recognized that are likely to result fatally. Many more cases of
+consumption are now cured than formerly, because exact methods have
+been discovered which enable us to determine the existence of the
+disease at an early stage of its development.</p>
+
+<p>Consumption is due to the growth of a special germ in the lungs. The
+disease is contagious, that is, it is<span class="pagenum"><a name="Page_97" id="Page_97">[Pg 97]</a></span> capable of being communicated
+from a consumptive to a healthy person by means of the germs present
+in the sputum (expectoration) of the patient. The danger of thus
+acquiring the disease directly from a consumptive is slight, if one
+take simple precautions which will be mentioned later, except in the
+case of a husband, wife, or child of the patient who come in close
+personal contact, as in kissing, etc. This is proved by the fact that
+attendants in hospitals for consumptives, who devote their lives to
+the care of these patients, are rarely affected with consumption. The
+chief source of danger to persons at large is dust containing the
+germs derived from the expectoration of human patients, and thus
+finding entrance into the lungs.</p>
+
+<p>Consumption is said to be inherited. This is not the case, as only
+most rarely is an infant born actually bearing the living germs of the
+disease in its body. A tendency to the disease is seen in certain
+families, and this tendency may be inherited in the sense that the
+lung tissue of these persons possesses less resistance to the growth
+of the germ of consumption. It may well be, however, that the children
+of consumptive parents, as has been suggested, are more resistant to
+the disease through inherited immunity (as is seen in the offspring of
+parents who have had other contagious diseases), and that the reason
+that they more often acquire tuberculosis is because they are
+constantly exposed to contact with the germ of consumption in their
+everyday home life.</p>
+
+<p><span class="pagenum"><a name="Page_98" id="Page_98">[Pg 98]</a></span>It is known that there are certain occupations and diseases which
+render the individual more susceptible to consumption. Thus, stone
+cutters, knife grinders and polishers, on account of inhaling the
+irritating dust, are more liable to the disease than any other class.
+Plasterers, cigar makers, and upholsterers are next in order of
+susceptibility for the same reason; while out-of-door workers, as
+farmers, are less likely to contract consumption than any other body
+of workers except bankers and brokers. Among diseases predisposing to
+consumption, ordinary colds and bronchitis, influenza, pneumonia,
+measles, nasal obstruction causing mouth-breathing, and scarlet fever
+are the most important.</p>
+
+<p>No age is exempt, from the cradle to the grave, although the liability
+to the disease diminishes markedly after the age of forty.</p>
+
+<p>About one-third more women than men recover from consumption, probably
+because it is more practicable for them to alter their mode of life to
+suit the requirements of treatment.</p>
+
+<p>It is, then, the neglected cold and cough (bronchitis) which offers a
+field most commonly favorable for the growth of the germs in the lungs
+which cause consumption. And it is essential to discover the existence
+of the disease at its beginning, what is called the incipient stage,
+in order to have the best chance of recovery. It becomes important,
+therefore, that each individual know the signs and symptoms which
+suggest beginning consumption.</p>
+
+<p><span class="pagenum"><a name="Page_99" id="Page_99">[Pg 99]</a></span>Cough is the most constant early symptom, dry and hacking at first,
+and most troublesome at night and in the early morning. Expectoration
+comes later. Loss of weight, of strength, and of appetite are also
+important early symptoms. Dyspepsia with cough and loss of weight and
+strength form a common group of symptoms. The patient is pale, has
+nausea, vomiting, or heartburn, and there is rise of temperature in
+the afternoon, together with general weakness; and, in women, absence
+of monthly periods. Slight daily rise of temperature, usually as much
+as a half to one degree, is a very suspicious feature in connection
+with chronic cough and loss of weight. To test the condition, the
+temperature should be taken once in two hours, and will commonly be
+found at its highest about 4 <span class="ampm">P.M.</span>, daily. The pulse is also increased
+in frequency. Night sweats are common in consumption, but not as a
+rule in the first stage; they occur more often in the early morning
+hours.</p>
+
+<p>Chills, fever, and sweating are sometimes the first symptoms of
+consumption, and in a malarial region would very probably lead to
+error, since these symptoms may appear at about the same intervals as
+in ague. But the chills and fever are not arrested by quinine, as in
+malaria, and there are also present cough and loss of weight, not
+commonly prominent in malaria. Persistently enlarged glands, which may
+be felt as lumps beneath the skin along the sides of the neck, or in
+the armpits, should be looked upon with sus<span class="pagenum"><a name="Page_100" id="Page_100">[Pg 100]</a></span>picion as generally
+tuberculous, containing the germ of consumption. They certainly demand
+the attention of early removal by a surgeon.</p>
+
+<p>The spitting of bright-red blood is one of the most certain signs of
+consumption, and occurs in about eighty per cent of all cases, but
+rarely appears as an early warning. The pupils of the eyes may be
+constantly large at the onset of the disease, but this is a sign of
+general weakness. Pain is also a frequent but not constant early
+symptom in the form of "stitch in the side," or pain between or
+beneath the shoulder blades, or in the region of the breastbone. This
+pain is due to pleurisy accompanying the tuberculosis. Shortness of
+breath on exertion is present when consumption is well established,
+but is not so common as an early symptom. The voice is often somewhat
+hoarse or husky at the onset of consumption, owing to tuberculous
+laryngitis.</p>
+
+<p>To sum up then, one should always suspect tuberculosis in a person
+afflicted with chronic cough who is losing weight and strength,
+especially if there is fever at some time during the day and any
+additional symptoms, such as those described. Such a one should
+immediately apply to a physician for examination of the chest, lungs,
+and sputum (expectoration). If the germs of tuberculosis are found on
+microscopical inspection of the sputum, the existence of consumption
+is absolutely established. Failure to find the germs in this way does
+not on the other hand prove that the<span class="pagenum"><a name="Page_101" id="Page_101">[Pg 101]</a></span> patient is free from the
+disease, except after repeated examinations at different times,
+together with the inability to discover any signs by examination of
+the chest. This examination in some instances produces no positive
+results, and it may be impossible for the physician to discover
+anything wrong in the lungs at the commencement of consumption. But,
+generally, examination either of the lungs or of the sputum will
+decide the matter, one or both giving positive information.</p>
+
+<p>The use of the X-rays in the hands of some experts sometimes reveals
+the presence of consumption before it is possible to detect it by any
+other method. There is also a substance called tuberculin, which, when
+injected under the skin in suspected cases of consumption causes a
+rise of temperature in persons suffering from the disease, but has no
+effect on the healthy. This method is that commonly applied in testing
+cattle for tuberculosis. As the results of tuberculin injection in the
+consumptive are something like an attack of <em>grippe</em>, and as
+tuberculin is not wholly devoid of danger to these patients, this test
+should be reserved to the last, and is only to be used by a physician.</p>
+
+<p><strong>Treatment.</strong>&mdash;There is no special remedy at our disposal which will
+destroy or even hinder the growth of the germs of tuberculosis in the
+lungs. Our endeavors must consist in improving the patient's strength,
+weight, and vital resistance to the germs by proper feeding, and by
+means of a constant out-of-door life.<span class="pagenum"><a name="Page_102" id="Page_102">[Pg 102]</a></span> The ideal conditions for
+out-of-door existence are pure air and the largest number of sunshiny
+days in the year. Dryness and an even temperature, and an elevation of
+from 2,000 to 3,000 feet, are often serviceable, but not necessarily
+successful.</p>
+
+<p>When it is impossible for the patient to leave his home he should
+remain out of doors all hours of bright days, ten to twelve hours
+daily in summer, six to eight hours in winter without regard to
+temperature, and should sleep on a porch or on the roof, if possible.
+In the Adirondacks, patients sit on verandas with perfect comfort
+while the thermometer is at ten degrees below zero. A patient (a
+physician) in a Massachusetts sanitarium has arranged a shelf,
+protected at the sides, along the outside of a window, on which his
+pillow rests at night, while he sleeps with his head out of doors and
+his body in bed in a room inside. If it becomes stormy he retires
+within and closes the window. If the temperature ranges above 100° F.
+patients should rest in bed or on a couch in the open air, but, if
+below this, patients may exercise. A steamer chair set inside of a
+padded, wicker bath chair, from which the seat has been removed, makes
+a convenient protected arrangement in which a consumptive can pass his
+time out of doors. If the patient is quite weak and feverish he may
+remain in bed, or on a couch, placed on a veranda or balcony during
+the day, and in a room in which all the windows are open at night.
+Screens may be used to protect from direct draughts.</p>
+
+<p><span class="pagenum"><a name="Page_103" id="Page_103">[Pg 103]</a></span>No degree of cold, nor any of the common symptoms, as night sweats,
+fever, cough, or spitting of blood, should be allowed to interfere
+with this fresh-air treatment. The treatment may seem heroic, but is
+most successful. The patient must be warmly clothed or covered with
+blankets, and protected from strong winds, rain, and snow. During
+clear weather patients may sleep out of doors on piazzas, balconies,
+or in tents.</p>
+
+<p>Nutritious food is of equal value with the open-air life. A liberal
+diet of milk and cream, eggs, meat and vegetables is indicated. Raw
+eggs swallowed whole with a little sherry, or pepper and salt on them,
+may be taken between meals, beginning with one and increasing the
+number till three are taken at a time, or nine daily. If the appetite
+is very poor it is best that a glass of milk be taken every two hours,
+varied by white of egg and water and meat juice. Drug treatment
+depends on individual symptoms, and can, therefore, only be given
+under a physician's care. Sanitarium treatment is the most successful,
+because patients are under the absolute control of experts and usually
+in an ideal climate. Change of climate is often useful, but patients
+should not leave their homes without the advice of a competent
+physician, as there are many questions to consider in taking such a
+step.<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a> There is a growing tendency among physicians to give<span class="pagenum"><a name="Page_104" id="Page_104">[Pg 104]</a></span>
+consumptives out-of-door treatment at their homes, if living out of
+cities, as careful personal supervision gives much better results than
+a random life in a popular climatic resort.</p>
+
+<p><strong>Prevention.</strong>&mdash;Weakly children and those born of consumptives must
+receive a generous diet of milk, eggs, meat, and vegetables, and spend
+most of their time in the open air. Their milk should be heated for
+fifteen minutes to a temperature of 160° F., in order to kill any
+germs of tuberculosis, unless the cows have been tested for this
+disease. The patient must have a separate sleeping room, and refrain
+from kissing or caressing other members of the family.</p>
+
+<p>The care of the sputum (expectoration) is, however, the essential
+means of preventing contagion. Out of doors, it should be deposited in
+a bottle which is cleaned by rinsing in boiling water. Indoors, paper
+bags or paper boxes made for the purpose are used to receive the
+sputum, and burned before they become dry. The use of rags,
+handkerchiefs, and paper napkins is dirty, and apt to cause soiling of
+the hands and clothes and lead to contagion. Plenty of sunlight in the
+sick room will cause destruction of the germs of consumption, besides
+proving beneficial to the patient. No dusting is to be done in the
+invalid's room; only moist cleansing. All dishes used by a consumptive
+must be boiled before they are again employed.</p>
+
+
+<p class="section"><strong>ASTHMA.</strong>&mdash;This is a disorder caused by sudden narrowing of the smaller
+air tubes in the lungs. This<span class="pagenum"><a name="Page_105" id="Page_105">[Pg 105]</a></span> narrowing is produced by swelling of the
+mucous membrane lining them, or is due to contraction of the tubes
+through reflex nervous influences. It may accompany bronchitis, or may
+be uncomplicated. It may be a manifestation of gout.</p>
+
+<p>The sufferers from asthma are usually apparently well in the period
+between the attacks. The attack often comes on suddenly in the night;
+the patient wakening with a feeling of suffocation. The difficulty in
+breathing soon becomes so great that he has to sit up, and often goes
+to a window and throws it open in the attempt to get his breath. The
+breathing is very labored and panting. There is little difficulty in
+drawing the breath, but expiration is very difficult, and usually
+accompanied by wheezing or whistling sounds. The patient appears to be
+on the brink of suffocation; the eyeballs protrude; the face is
+anxious and pale; the muscles of the neck stand out; the lips may be
+blue; a cold sweat covers the body; the hands and feet are cold, and
+talking becomes impossible. Altogether, a case of asthma presents a
+most alarming appearance to the bystander, and the patient seems to be
+on the verge of dying, yet death has probably never occurred during an
+attack of this disease. The attacks last from one-half to one or
+several hours, if not stopped by treatment, and they often return on
+several successive nights, and then disappear, not to recur for months
+or years.</p>
+
+<p>Attacks are brought on by the most curious and<span class="pagenum"><a name="Page_106" id="Page_106">[Pg 106]</a></span> diverse means.
+Atmospheric conditions are most important. Emanations from plants, or
+animals, are common exciting agencies. Fright or emotion of any kind;
+certain articles of diet; dust and nasal obstruction are also frequent
+causes. Patients may be free from the disease in cities and attacked
+on going into the country. Men are subject to asthma more than women,
+and the victims belong to families subject to nervous troubles of
+various kinds. The attack frequently subsides suddenly, just when the
+patient seems to be on the point of suffocation. There is often
+coughing and spitting of little yellowish, semitransparent balls of
+mucus floating in a thinner secretion.</p>
+
+<p>Asthma is not likely to be mistaken for other diseases. The
+temperature is normal during an attack, and this will enable us to
+exclude other chest disorders, as bronchitis and pneumonia.
+Occasionally asthma is a symptom of heart and kidney disease. In the
+former it occurs after exercise; in the latter the attack continues
+for a considerable time without relief. But, as in all other serious
+diseases, a physician's services are essential, and it is our object
+to supply only such information as would be desirable in emergencies
+when it is impossible to obtain one.</p>
+
+<p><strong>Treatment.</strong>&mdash;An attack of asthma is most successfully cut short by
+means of one-quarter of a grain of morphine sulphate<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a> with <span class="frac_top">1</span>/<span class="frac_bottom">20</span> of a
+grain of atropine sulphate, taken in a glass of hot water containing a
+ta<span class="pagenum"><a name="Page_107" id="Page_107">[Pg 107]</a></span>blespoonful of whisky or brandy. Ten drops of laudanum,<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a> or a
+tablespoonful of paregoric, may be used instead of the morphine if the
+latter is not at hand. Sometimes the inhalation of tobacco smoke from
+a cigar or pipe will stop an attack in those unaccustomed to its use.
+In the absence of morphine, or opium in the form of laudanum or
+paregoric, fifteen drops of chloroform or half a teaspoonful of ether
+may be swallowed on sugar.</p>
+
+<p>A useful application for use on the outside of the chest consists of
+mustard, one part, and flour, three parts, mixed into a paste with
+warm water and placed between single thicknesses of cotton cloth.
+Various cigarettes and pastilles, usually containing stramonium and
+saltpeter, are sold by druggists for the use of asthmatic patients.
+They are often efficient in arresting an attack of asthma, but it is
+impossible to recommend any one kind, as one brand may agree with one
+patient better than another. Amyl nitrite is sold in "pearls" or
+small, glass bulbs, each containing three or four drops, one of which
+is to be broken in and inhaled from a handkerchief during an attack of
+asthma. This often affords temporary relief.</p>
+
+<p>To avoid the continuance of the disease it is emphatically advisable
+to consult a physician who may be<span class="pagenum"><a name="Page_108" id="Page_108">[Pg 108]</a></span> able to discover and remove the
+cause. The diet should consist chiefly of eggs, fish, milk, and
+vegetables (with the exception of beans, large quantities of potatoes,
+and roots, as parsnips, beets, turnips, etc.). Meat should be eaten
+but sparingly, and also pastries, sugar, and starches (as cereals,
+potato, and bread). The evening meal ought to be light, dinner being
+served at midday. Any change of climate may stop asthmatic seizures
+for a time, but the relief is apt to be temporary. Climatic conditions
+affect different patients differently. Warm, moist air in places
+destitute of much vegetation (as Florida, Southern California, and the
+shore of Cape Cod and the Island of Nantucket, in summer) enjoy
+popularity with many asthmatics, while a dry, high altitude influences
+others much more favorably.</p>
+
+
+<p class="section"><strong>INFLUENZA; LA GRIPPE.</strong>&mdash;Influenza is an acute, highly contagious
+disease due to a special germ, and tending to spread with amazing
+rapidity over vast areas. It has occurred as a world-wide epidemic at
+various times in history, and during four periods in the last century.
+A pandemic of influenza began in the winter of 1889&ndash;90, and continued
+in the form of local epidemics till 1904, the disease suddenly
+appearing in a community and, after a prevalence of about six weeks,
+disappearing again. One attack, it is, perhaps, unnecessary to state,
+does not protect against another. The mortality is about 1 death to
+400 cases. The feeble and aged are those who are apt<span class="pagenum"><a name="Page_109" id="Page_109">[Pg 109]</a></span> to succumb.
+Fatalities usually result from complications or sequels, such as
+pneumonia or tuberculosis; neurasthenia or insanity may follow.</p>
+
+<p><strong>Symptoms.</strong>&mdash;There are commonly four important symptoms characteristic
+of <em>grippe</em>: fever; pain, catarrh; and depression, mental and
+physical. <em>Grippe</em> attacks the patient with great suddenness. While in
+perfect health and engaged in ordinary work, one is often seized with
+a severe chill followed by general depression, pain in the head, back,
+and limbs, soreness of the muscles, and fever. The temperature varies
+from 100° to 104° F. The catarrh attacks the eyes, nose, throat, and
+larger tubes in the lungs. The eyes become reddened and sensitive to
+light, and movements of the eyeballs cause pain. Sneezing comes on
+early, and, after a day or two, is followed by discharge from the
+nose. The throat is often sore and reddened. There may be a feeling of
+weight and tightness in the chest accompanied by a harsh, dry cough,
+which, after a few days, becomes looser and expectoration occurs.
+Bodily weakness and depression of spirits are usually prominent and
+form often the most persistent and distressing symptoms.</p>
+
+<p>After three or four days the pains decrease, the temperature falls,
+and the cough and oppression in the chest lessen, and recovery usually
+takes place within a week, or ten days, in serious cases. The patient
+should go to bed at once, and should not leave it until the
+temperature is normal (98<span class="frac_top">3</span>/<span class="frac_bottom">5</span>° F.). For some time<span class="pagenum"><a name="Page_110" id="Page_110">[Pg 110]</a></span> afterwards general
+weakness, associated with heart weakness, causes the patient to sweat
+easily, and to get out of breath and have a rapid pulse on slight
+exertion.</p>
+
+<p>Such is the picture of a typical case, but it often happens that some
+of the symptoms are absent, while others are exaggerated so that
+different types of <em>grippe</em> are often described. Thus the pain in the
+back and head may be so intense as to resemble that of meningitis.
+Occasionally the stomach and bowels are attacked so that violent
+vomiting and diarrhea occur, while other members of the same family
+present the ordinary form of influenza. There is a form that attacks
+principally the nervous system, the nasal and bronchial tracts
+escaping altogether. Continual fever is the only symptom in some
+cases. <em>Grippe</em> may last for weeks. Whenever doubt exists as to the
+nature of the disorder, a microscopic examination of the expectoration
+or of the mucus from the throat by a competent physician will
+definitely determine the existence of influenza, if the special germs
+of that disease are found. It is the prevailing and erroneous fashion
+for a person to call any cold in the head the <em>grippe</em>; and there are,
+indeed, many cases in which it becomes difficult for a physician to
+distinguish between <em>grippe</em> and a severe cold with muscular soreness
+and fever, except by the microscopic test. Influenza becomes dangerous
+chiefly through its complications, as pneumonia, inflammation of the
+middle ear, of the eyes, or of the<span class="pagenum"><a name="Page_111" id="Page_111">[Pg 111]</a></span> kidneys, and through its
+depressing effect upon the heart.</p>
+
+<p>These complications can often be prevented by avoiding the slightest
+imprudence or exposure during convalescence. Elderly and feeble
+persons should be protected from contact with the disease in every
+way. Whole prisons have been exempt from <em>grippe</em> during epidemics,
+owing to the enforced seclusion of the inmates. The one absolutely
+essential feature in treatment is that the patient stay in bed while
+the fever lasts and in the house afterwards, except as his strength
+will permit him to go out of doors for a time each sunny day until
+recovery is fully established.</p>
+
+<p><strong>Treatment.</strong>&mdash;The medicinal treatment consists at first in combating the
+toxin of the disease and assuaging pain, and later in promoting
+strength. Hot lemonade and whisky may be given during the chilly
+period and a single six- to ten-grain dose of quinine. Pain is
+combated by phenacetin,<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a> three grains repeated every three hours
+till relieved. At night a most useful medicine to afford comfort when
+pain and sleeplessness are troublesome, is Dover's powder, ten grains
+(or codeine, one grain), with thirty grains of sodium bromide
+dissolved in water. After the first day it is usually advisable to
+give a two-grain quinine pill together with a tablet containing
+one-thirtieth of a grain of strychnine three times a day after meals
+for a week or two as a tonic (adult). Only mild cathartics are<span class="pagenum"><a name="Page_112" id="Page_112">[Pg 112]</a></span>
+suitable to keep the bowels regular as a Seidlitz powder in the
+morning before breakfast. The diet should be liquid while the fever
+lasts&mdash;as milk, cocoa, soups, eggnog, one of these each two hours. A
+tablespoonful of whisky, rum, or brandy may be added to the milk three
+times daily if there is much weakness.</p>
+
+<p>The germ causing <em>grippe</em> lives only two days, but successive crops of
+spores are raised in a proper medium. Neglected mucus in nose or
+throat affords an inviting field for the germ. Therefore it is
+essential to keep the nostrils free and open by means of spraying with
+the Seiler's tablet solution (p. <a href="#Page_49">49</a>), and then always breathing
+through the nostrils.</p>
+
+
+<div class="footnotes"><h4>FOOTNOTES:</h4>
+
+<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Caution. Dangerous. Use only on physician's order.</p></div>
+
+<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> Arizona, New Mexico, Colorado, and the Adirondacks
+contain the most favorable climatic resorts in this country.</p></div>
+
+<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> Caution. Dangerous. Use only on physician's order.</p></div>
+
+<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> This dose is only suitable for strong, healthy adults of
+average weight and those who are not affected peculiarly by opium.
+Delicate women and others not coming under the above head should take
+but half the dose and repeat in an hour if necessary.</p></div>
+
+<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Caution. A powerful medicine.</p></div>
+</div>
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_113" id="Page_113">[Pg 113]</a></span></p>
+<h3>CHAPTER IV</h3>
+
+<p class="chapter_head"><strong>Headaches</strong></p>
+
+<p class="chapter_head"><em>Treatment of Sick Headache&mdash;Effects of
+Indigestion&mdash;Neuralgia&mdash;Headaches Occasioned by Disease&mdash;Other
+Causes&mdash;Poisoning&mdash;Heat Stroke.</em></p>
+
+
+<p>Headache varies according to its nature and causes. The first variety
+to be considered is "sick headache" or migraine.</p>
+
+
+<p class="section"><strong>SICK HEADACHE.</strong>&mdash;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.</p>
+
+<p><span class="pagenum"><a name="Page_114" id="Page_114">[Pg 114]</a></span>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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;Any article of diet which experience has shown to provoke
+an attack should naturally be<span class="pagenum"><a name="Page_115" id="Page_115">[Pg 115]</a></span> 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 <em>one</em> 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.</p>
+
+
+<p class="section"><strong>HEADACHE FROM VARIOUS CAUSES.</strong>&mdash;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.</p>
+
+<p><strong>Headache from Indigestion.</strong>&mdash;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.</p>
+
+<p><span class="pagenum"><a name="Page_116" id="Page_116">[Pg 116]</a></span>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.</p>
+
+<p><strong>Sympathetic Headaches.</strong>&mdash;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.
+<a href="#Page_29">29</a>). 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.</p>
+
+<p><strong>Decayed Teeth.</strong>&mdash;These not uncommonly give rise to headache.</p>
+
+<p><span class="pagenum"><a name="Page_117" id="Page_117">[Pg 117]</a></span><strong>Disorders of the Nose and Throat.</strong>&mdash;Such troubles, especially adenoids
+and enlarged tonsils in children, enlarged turbinates, and polypi (see
+Nose Disorders, p. <a href="#Page_60">60</a>) 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.</p>
+
+<p><strong>Diseases of the Maternal Organs.</strong>&mdash;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.</p>
+
+<p><strong>Nervous Headaches.</strong>&mdash;These occur in brain exhaustion and anæmia, 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 anæmia 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).</p>
+
+<p><strong>Neuralgic Headaches.</strong>&mdash;The pain is usually of a shooting character, and
+the scalp is often exceedingly tender to pressure. They may be caused
+by exposure<span class="pagenum"><a name="Page_118" id="Page_118">[Pg 118]</a></span> to cold, or by decayed teeth, or sometimes by
+inflammation of the middle ear (see Earache, p. <a href="#Page_40">40</a>).</p>
+
+<p><strong>Headache from Poisoning.</strong>&mdash;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.</p>
+
+<p>Many drugs occasion headache, as quinine, salicylates, nitroglycerin,
+and some forms of iron.</p>
+
+<p>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.<span class="pagenum"><a name="Page_119" id="Page_119">[Pg 119]</a></span> Headache owing to germ poisons is also one of the most
+distressing accompaniments of <em>grippe</em>, measles, and smallpox, and
+sometimes of pneumonia.</p>
+
+<p>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. <a href="#Page_169">169</a>).</p>
+
+<p>The poison of gout circulating in the blood is sometimes a source of
+intense headache.</p>
+
+<p>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.</p>
+
+<p>The headaches of indigestion are also of poisonous origin, the
+products of imperfectly digested food being absorbed into the blood
+and acting as poisons.</p>
+
+<p>Another variety of headache due to poisoning is seen in children
+crowded together in ill-ventilated<span class="pagenum"><a name="Page_120" id="Page_120">[Pg 120]</a></span> schoolrooms and overworked. Still
+another kind is due to inhalation of illuminating gas escaping from
+leaky fixtures.</p>
+
+<p><strong>Headache from Heat Stroke.</strong>&mdash;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.</p>
+
+<p><strong>Constant Headache.</strong>&mdash;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.</p>
+
+
+
+
+<div class="section_break"></div>
+<div class="part_head">
+<p><span class="pagenum"><a name="Page_121" id="Page_121">[Pg 121]</a></span></p>
+
+<h2>Part II</h2>
+
+<p class="title">TUMORS<br />
+SKIN DISEASES<br />
+RHEUMATISM</p>
+
+<p class="by">BY</p>
+
+<p>KENELM WINSLOW</p>
+
+<p class="and">AND</p>
+
+<p>ALBERT WARREN FERRIS</p>
+</div>
+
+
+
+<p><span class="pagenum"><a name="Page_122" id="Page_122">[Pg 122]</a></span></p>
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_123" id="Page_123">[Pg 123]</a></span></p>
+<h3>CHAPTER I</h3>
+
+<p class="chapter_head"><strong>Growths and Enlargements</strong></p>
+
+<p class="chapter_head"><em>Benign and Malignant Tumors&mdash;Treatment of Rupture&mdash;Hernia in
+Children&mdash;Varicocele&mdash;Causes of Varicose Veins&mdash;External and Internal
+Piles.</em></p>
+
+
+<p class="section"><strong>TUMORS.</strong>&mdash;A tumor&mdash;in its original meaning&mdash;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<span class="pagenum"><a name="Page_124" id="Page_124">[Pg 124]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p>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 inflam<span class="pagenum"><a name="Page_125" id="Page_125">[Pg 125]</a></span>mation 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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum"><a name="Page_126" id="Page_126">[Pg 126]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Causes.</strong>&mdash;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<span class="pagenum"><a name="Page_127" id="Page_127">[Pg 127]</a></span> 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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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&mdash;that is, return of the
+disease&mdash;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.</p>
+
+<p>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<span class="pagenum"><a name="Page_128" id="Page_128">[Pg 128]</a></span> 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.</p>
+
+
+<p class="section"><strong>RUPTURE.</strong>&mdash;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.</p>
+
+<p><strong>Causes.</strong>&mdash;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, fat<span class="pagenum"><a name="Page_129" id="Page_129">[Pg 129]</a></span>ness, chronic coughing, constipation, diarrhea,
+sudden strain, or blows on the abdomen.</p>
+
+<p><strong>Symptoms.</strong>&mdash;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<span class="pagenum"><a name="Page_130" id="Page_130">[Pg 130]</a></span>
+some cases, where the obstruction is not complete, the symptoms are
+comparatively milder, as occasional vomiting and slight pain and
+partial constipation.</p>
+
+<p>If the patient cannot return the protrusion speedily, a surgeon should
+be secured at all costs&mdash;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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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<span class="pagenum"><a name="Page_131" id="Page_131">[Pg 131]</a></span> 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&mdash;if it
+can be done by a skillful surgeon and in a hospital with all
+facilities&mdash;is usually to be recommended<span class="pagenum"><a name="Page_132" id="Page_132">[Pg 132]</a></span> 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&mdash;thirty-five cures out of thirty-six
+operations for umbilical rupture, and one death, by Mayo, of
+Rochester, Minn.&mdash;and they are usually the very worst patients, of
+middle age, or older, and very stout.</p>
+
+<p>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.</p>
+
+
+<p class="section"><strong>VARICOSE VEINS.</strong>&mdash;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<span class="pagenum"><a name="Page_133" id="Page_133">[Pg 133]</a></span> 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&mdash;if not
+extensive&mdash;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.</p>
+
+<p><strong>Causes.</strong>&mdash;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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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<span class="pagenum"><a name="Page_134" id="Page_134">[Pg 134]</a></span> 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.</p>
+
+
+<p class="section"><strong>VARICOCELE.</strong>&mdash;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.</p>
+
+<p><strong>Causes.</strong>&mdash;Varicocele occurs usually in young, unmarried men and often
+disappears of itself in later life. Undue sexual excitement may
+produce the condition.</p>
+
+<p><span class="pagenum"><a name="Page_135" id="Page_135">[Pg 135]</a></span><strong>Treatment.</strong>&mdash;When any treatment is necessary, the application of a
+snugly fitting suspensory bandage&mdash;which can be procured at any good
+drug shop&mdash;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.</p>
+
+
+<p class="section"><strong>PILES&mdash;HEMORRHOIDS.</strong>&mdash;Piles consist of enlarged, and often inflamed,
+veins in the rectum, or lower part of the bowel.</p>
+
+<p><strong>External Piles.</strong>&mdash;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&mdash;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,<span class="pagenum"><a name="Page_136" id="Page_136">[Pg 136]</a></span> 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.</p>
+
+<p><strong>Internal Piles.</strong>&mdash;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<span class="pagenum"><a name="Page_137" id="Page_137">[Pg 137]</a></span> 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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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<span class="pagenum"><a name="Page_138" id="Page_138">[Pg 138]</a></span> 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.</p>
+
+<p><strong>Causes.</strong>&mdash;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.</p>
+
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_139" id="Page_139">[Pg 139]</a></span></p>
+<h3>CHAPTER II</h3>
+
+<p class="chapter_head"><strong>Skin Diseases and Related Disorders</strong></p>
+
+<p class="chapter_head"><em>Household Remedies for Itching&mdash;Chafing and Chapping&mdash;Hives, Cold
+Sores and Pimples&mdash;Ringworms, Warts and Corns&mdash;Eczema and other
+Inflammatory Disorders.</em></p>
+
+
+<p>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.</p>
+
+
+<p class="section"><strong>ITCHING</strong> (<em>Pruritus</em>).&mdash;Itching is not a distinct disease by itself,
+but a symptom or sign of other skin<span class="pagenum"><a name="Page_140" id="Page_140">[Pg 140]</a></span> 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 (<em>anus</em>), or to the
+external female sexual parts (<em>vulva</em>), 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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum"><a name="Page_141" id="Page_141">[Pg 141]</a></span> 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.</p>
+
+<p>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. <a href="#Page_145">145</a>) is also a serviceable preparation when there
+is redness and swelling of the skin.<span class="pagenum"><a name="Page_142" id="Page_142">[Pg 142]</a></span> 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.</p>
+
+
+<p class="section"><strong>CHAFING AND CHAPPING.</strong>&mdash;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.</p>
+
+<p>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<span class="pagenum"><a name="Page_143" id="Page_143">[Pg 143]</a></span> seen in chapping of the face and lips, and
+cracking of the lips is frequent.</p>
+
+<p>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.</p>
+
+
+<p class="section"><strong>HIVES; NETTLERASH</strong> (<em>Urticaria</em>).&mdash;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.</p>
+
+<p><span class="pagenum"><a name="Page_144" id="Page_144">[Pg 144]</a></span>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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;Remove any source of irritation in the digestive canal, or
+externally, and employ a simple diet for a few days, as bread and
+milk.</p>
+
+<p>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. <a href="#Page_141">141</a>) is the most
+useful treatment when the<span class="pagenum"><a name="Page_145" id="Page_145">[Pg 145]</a></span> 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.</p>
+
+<p class="medicine">Calamine Lotion</p>
+
+<table summary="Calamine lotion">
+<tbody>
+<tr>
+  <td>Zinc oxide</td>
+  <td><span class="frac_top">1</span>/<span class="frac_bottom">4</span> ounce</td>
+</tr>
+<tr>
+  <td>Powdered calamine</td>
+  <td><span class="frac_top">1</span>/<span class="frac_bottom">4</span>&nbsp;&nbsp;&nbsp;&nbsp;"</td>
+</tr>
+<tr>
+  <td>Limewater</td>
+  <td>6 ounces</td>
+</tr>
+</tbody>
+</table>
+
+<p class="directions">Mix and shake before applying to the skin.</p>
+
+<p>If choking is threatened, give an emetic of mustard, one teaspoonful,
+and warm water, half a pint.</p>
+
+
+<p class="section"><strong>PIMPLES; BLACKHEADS</strong> (<em>Acne</em>).&mdash;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.</p>
+
+<p>"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<span class="pagenum"><a name="Page_146" id="Page_146">[Pg 146]</a></span> 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 anæmia.</p>
+
+<p><strong>Treatment.</strong>&mdash;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. <a href="#Page_145">145</a>) 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<span class="pagenum"><a name="Page_147" id="Page_147">[Pg 147]</a></span> hot water used on the face three
+times daily are also efficacious. Sulphur lotion is better than
+sulphur ointment.</p>
+
+
+<p class="section"><strong>COLD SORE; FEVER BLISTER.</strong>&mdash;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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.<span class="pagenum"><a name="Page_148" id="Page_148">[Pg 148]</a></span> Better
+use spirits of camphor, and afterwards, if there is much itching or
+burning, sopping the eruption with calamine lotion (p. <a href="#Page_145">145</a>) will
+relieve the discomfort.</p>
+
+
+<p class="section"><strong>PRICKLY HEAT</strong> (<em>Miliaria</em>).&mdash;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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.</p>
+
+
+<p class="section"><span class="pagenum"><a name="Page_149" id="Page_149">[Pg 149]</a></span><strong>RINGWORM OF THE BODY; RINGWORM OF THE SCALP.</strong>&mdash;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.</p>
+
+<p><strong>Symptoms.</strong>&mdash;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.</p>
+
+<p><span class="pagenum"><a name="Page_150" id="Page_150">[Pg 150]</a></span><strong>Treatment.</strong>&mdash;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.</p>
+
+
+<p class="section"><strong>FRECKLES, TAN, AND OTHER DISCOLORATIONS OF THE SKIN.</strong>&mdash;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<span class="pagenum"><a name="Page_151" id="Page_151">[Pg 151]</a></span> 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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.</p>
+
+<p>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:</p>
+
+<p class="medicine">Poisonous Sublimate Solution</p>
+
+<table summary="Poisonous sublimate solution">
+<tbody>
+<tr>
+  <td>Corrosive sublimate</td>
+  <td>7 grains</td>
+</tr>
+<tr>
+  <td>Alcohol</td>
+  <td>1<span class="frac_top">1</span>/<span class="frac_bottom">2</span> ounces</td>
+</tr>
+<tr>
+  <td>Glycerin</td>
+  <td>1<span class="frac_top">1</span>/<span class="frac_bottom">2</span>&nbsp;&nbsp;&nbsp;&nbsp;"</td>
+</tr>
+<tr>
+  <td>Oil of lavender</td>
+  <td>10 drops</td>
+</tr>
+</tbody>
+</table>
+
+<p class="directions">Mix.</p>
+
+<p><span class="pagenum"><a name="Page_152" id="Page_152">[Pg 152]</a></span>The following lotion is also efficacious:</p>
+
+<table summary="Lotion">
+<tbody>
+<tr>
+  <td>Zinc oxide</td>
+  <td>30 grains</td>
+</tr>
+<tr>
+  <td>Powdered starch</td>
+  <td>30&nbsp;&nbsp;&nbsp;&nbsp;"</td>
+</tr>
+<tr>
+  <td>Kaolin</td>
+  <td>60&nbsp;&nbsp;&nbsp;&nbsp;"</td>
+</tr>
+<tr>
+  <td>Glycerin</td>
+  <td>2 drams</td>
+</tr>
+<tr>
+  <td>Rose water</td>
+  <td>2 ounces</td>
+</tr>
+</tbody>
+</table>
+
+<p class="directions">Mix.</p>
+
+<p class="directions"><span class="smcap">Directions.</span>&mdash;Shake and paint on spots, and allow the preparation
+to dry; wash it off before each fresh application.</p>
+
+<p>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.</p>
+
+
+<p class="section"><strong>IVY POISON.</strong>&mdash;The poison ivy (<em>Rhus toxicodendron</em>), poison sumach
+(<em>Rhus venenata</em>), and poison oak (<em>Rhus diversiloba</em> 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.</p>
+
+<p>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<span class="pagenum"><a name="Page_153" id="Page_153">[Pg 153]</a></span> 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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a> 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.</p>
+
+
+<p class="section"><strong>WARTS.</strong>&mdash;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.</p>
+
+<p><em>Seed Warts.</em>&mdash;These have numerous, little, fleshy projections over
+their surface, which are enlarged normal structures (<em>papillæ</em>) of the
+middle layer of the skin, together with the thickened, outer, horny
+layer.</p>
+
+<p><em>Threadlike Warts.</em>&mdash;These are seen along the edge of the nails, on
+the face, neck, eyelids, and ears.<span class="pagenum"><a name="Page_154" id="Page_154">[Pg 154]</a></span> They are formed by the great
+prolongation and growth of the projections, or <em>papillæ</em> of the middle
+layer of the skin just described.</p>
+
+<p><em>Flat Warts</em>, raised but slightly above the surface are more common in
+old people.</p>
+
+<p><em>Moist Warts</em> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.</p>
+
+
+<p class="section"><strong>CORNS.</strong>&mdash;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<span class="pagenum"><a name="Page_155" id="Page_155">[Pg 155]</a></span> 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."</p>
+
+<p><strong>Treatment.</strong>&mdash;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:</p>
+
+<table summary="Corns treatment">
+<tbody>
+<tr>
+  <td>Salicylic acid</td>
+  <td>30 grains</td>
+</tr>
+<tr>
+  <td>Tincture of iodine</td>
+  <td>10 drops</td>
+</tr>
+<tr>
+  <td>Extract of Cannabis Indica</td>
+  <td>10 grains</td>
+</tr>
+<tr>
+  <td>Collodion</td>
+  <td>4 drams</td>
+</tr>
+</tbody>
+</table>
+
+<p class="directions">Mix.</p>
+
+<p>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<span class="pagenum"><a name="Page_156" id="Page_156">[Pg 156]</a></span> 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.</p>
+
+<p>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.</p>
+
+
+<p class="section"><strong>CALLUS AND CRACKS OF THE SKIN.</strong>&mdash;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.</p>
+
+<p><strong>Treatment.</strong>&mdash;The hands and feet should be soaked continuously in hot
+baths containing washing soda,<span class="pagenum"><a name="Page_157" id="Page_157">[Pg 157]</a></span> 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.</p>
+
+
+<p class="section"><strong>BOILS.</strong>&mdash;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<span class="pagenum"><a name="Page_158" id="Page_158">[Pg 158]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Causes.</strong>&mdash;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<span class="pagenum"><a name="Page_159" id="Page_159">[Pg 159]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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-<span class="pagenum"><a name="Page_160" id="Page_160">[Pg 160]</a></span>tenth grain) are
+commonly prescribed by physicians, every three hours.</p>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>The poultices should be stopped as soon as the pain ceases, and the
+boil dressed as recommended above,<span class="pagenum"><a name="Page_161" id="Page_161">[Pg 161]</a></span> 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.</p>
+
+
+<p class="section"><strong>CARBUNCLE.</strong>&mdash;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.</p>
+
+<p>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<span class="pagenum"><a name="Page_162" id="Page_162">[Pg 162]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.</p>
+
+<p><span class="pagenum"><a name="Page_163" id="Page_163">[Pg 163]</a></span>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. <a href="#Page_161">161</a>) 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.</p>
+
+
+<p class="section"><strong>ECZEMA; SALT RHEUM; TETTER.</strong>&mdash;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:</p>
+
+<p>(1) Eczema of internal origin, including cases due to morbid agencies
+produced within the body, cases due to drugs, and possibly reflex
+cases.</p>
+
+<p>(2) Eczema of external origin, including cases caused by occupation,
+by climate, or by seborrhea.</p>
+
+<p>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<span class="pagenum"><a name="Page_164" id="Page_164">[Pg 164]</a></span> 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.</p>
+
+<p>Occupation eczema occurs first on exposed parts, as the hands, arms,
+face, and neck, in those who handle irritant dyes, sugar, formalin,
+etc.</p>
+
+<p>Climatic eczema includes the "winter itch," common in this latitude,
+appearing on wrists and ankles in the form of clean, scaly patches,
+often ringed.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.</p>
+
+<p>The outlook is always good; and even in the case of weak and
+debilitated patients, there is excellent chance of cure.</p>
+
+<p>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,<span class="pagenum"><a name="Page_165" id="Page_165">[Pg 165]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p>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
+resor<span class="pagenum"><a name="Page_166" id="Page_166">[Pg 166]</a></span>cin 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:</p>
+
+<table summary="Eczema lotion 1">
+<tbody>
+<tr>
+  <td>Salicylic acid</td>
+  <td>5 to 15 grains</td>
+</tr>
+<tr>
+  <td>Zinc oxide</td>
+  <td>2 drams</td>
+</tr>
+<tr>
+  <td>Powdered starch</td>
+  <td>2 drams</td>
+</tr>
+<tr>
+  <td>Vaseline</td>
+  <td>1 ounce</td>
+</tr>
+</tbody>
+</table>
+
+<p>If weeping returns, stop the ointment and resume the powder treatment,
+or use the following lotion:</p>
+
+<table summary="Eczema lotion 2">
+<tbody>
+<tr>
+  <td>Zinc oleate</td>
+  <td>1 dram</td>
+</tr>
+<tr>
+  <td>Magnesium carbonate</td>
+  <td>1 dram</td>
+</tr>
+<tr>
+  <td>Ichthyol</td>
+  <td><span class="frac_top">1</span>/<span class="frac_bottom">2</span> ounce</td>
+</tr>
+<tr>
+  <td>Lime water</td>
+  <td>4 ounces</td>
+</tr>
+</tbody>
+</table>
+
+<p>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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum"><a name="Page_167" id="Page_167">[Pg 167]</a></span> 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&mdash;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.</p>
+
+<p>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.</p>
+
+
+<p class="section"><strong>BALDNESS AND DANDRUFF.</strong>&mdash;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<span class="pagenum"><a name="Page_168" id="Page_168">[Pg 168]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p>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. <a href="#Page_210">210</a>).</p>
+
+
+<div class="footnotes"><h4>FOOTNOTES:</h4>
+
+<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> Caution. Poisonous.</p></div>
+</div>
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_169" id="Page_169">[Pg 169]</a></span></p>
+<h3>CHAPTER III</h3>
+
+<p class="chapter_head"><strong>Rheumatism and Kindred Diseases</strong></p>
+
+<p class="chapter_head"><em>Causes of Rheumatic Fever&mdash;Relief of Pain in the
+Joints&mdash;Lumbago&mdash;Stiff Neck&mdash;Gout&mdash;Symptoms and Cure of Scurvy.</em></p>
+
+
+<p class="section"><strong>RHEUMATIC FEVER; INFLAMMATORY RHEUMATISM; ACUTE RHEUMATISM.</strong>&mdash;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&mdash;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. <a href="#Page_180">180</a>), 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.</p>
+
+<p><strong>Symptoms.</strong>&mdash;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<span class="pagenum"><a name="Page_170" id="Page_170">[Pg 170]</a></span> high (the temperature ranging from 102° to 104° 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.</p>
+
+<p>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&mdash;more often when the fever runs high.</p>
+
+<p>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&mdash;more particularly in young persons. Acute
+rheumatism frequently takes a milder form, with slight fever (the
+temperature running not over 100° or 101° F.) and slight pain, and
+swelling of the joints. In children this is<span class="pagenum"><a name="Page_171" id="Page_171">[Pg 171]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;It appears extremely doubtful whether rheumatic fever can
+be cut short by any form of treat<span class="pagenum"><a name="Page_172" id="Page_172">[Pg 172]</a></span>ment. 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.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum"><a name="Page_173" id="Page_173">[Pg 173]</a></span> 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.</p>
+
+
+<p class="section"><strong>MUSCULAR RHEUMATISM</strong> (<em>Myalgia</em>).&mdash;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:</p>
+
+
+<p class="section"><strong>LUMBAGO.</strong>&mdash;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.</p>
+
+
+<p class="section"><span class="pagenum"><a name="Page_174" id="Page_174">[Pg 174]</a></span><strong>STIFF NECK.</strong>&mdash;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.</p>
+
+
+<p class="section"><strong>RHEUMATISM OF THE CHEST.</strong>&mdash;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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;Rest, heat, and rubbing are the most satisfactory
+remedies. In stiff neck, rub well with<span class="pagenum"><a name="Page_175" id="Page_175">[Pg 175]</a></span> 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.</p>
+
+
+<p class="section"><strong>CHRONIC RHEUMATISM.</strong>&mdash;Chronic rheumatism is a disease attacking persons
+of middle age, or after, and is seen more commonly in poor,
+hard-work<span class="pagenum"><a name="Page_176" id="Page_176">[Pg 176]</a></span>ing 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.</p>
+
+<p><strong>Treatment.</strong>&mdash;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,<span class="pagenum"><a name="Page_177" id="Page_177">[Pg 177]</a></span> 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.</p>
+
+
+<p class="section"><strong>RHEUMATIC GOUT</strong> (<em>Arthritis</em>).&mdash;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 cor<span class="pagenum"><a name="Page_178" id="Page_178">[Pg 178]</a></span>responding 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.</p>
+
+<p><strong>General Form.</strong>&mdash;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,<span class="pagenum"><a name="Page_179" id="Page_179">[Pg 179]</a></span> 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.</p>
+
+<p>The general health suffers, and weakness, anæmia, 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.</p>
+
+<p>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.</p>
+
+<p><strong>Outlook.</strong>&mdash;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<span class="pagenum"><a name="Page_180" id="Page_180">[Pg 180]</a></span> the
+disease. The deformity and crippling are permanent.</p>
+
+<p><strong>Treatment.</strong>&mdash;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.</p>
+
+
+<p class="section"><strong>SCURVY.</strong>&mdash;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,<span class="pagenum"><a name="Page_181" id="Page_181">[Pg 181]</a></span> 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.</p>
+
+<p><strong>Symptoms.</strong>&mdash;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.</p>
+
+<p><strong>Treatment.</strong>&mdash;Recovery is usually rapid and complete, unless the disease
+is far advanced. Soups, fresh<span class="pagenum"><a name="Page_182" id="Page_182">[Pg 182]</a></span> 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.</p>
+
+
+<p class="section"><strong>INFANTILE SCURVY.</strong>&mdash;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.</p>
+
+<p>Scurvy is frequently mistaken for either rheumatism or paralysis in
+babies.</p>
+
+<p><strong>Symptoms.</strong>&mdash;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<span class="pagenum"><a name="Page_183" id="Page_183">[Pg 183]</a></span> 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° to 102° F. The babies are exceedingly pale, and lose
+all strength.</p>
+
+<p><strong>Treatment.</strong>&mdash;The treatment is very simple, and recovery rapidly takes
+place as soon as it is carried out. The feeding of all patent baby
+foods&mdash;condensed or sterilized milk&mdash;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.</p>
+
+
+<p class="section"><strong>GOUT.</strong>&mdash;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.</p>
+
+<p>We are still ignorant of the exact changes in the bodily condition
+which lead to gout, but may say in<span class="pagenum"><a name="Page_184" id="Page_184">[Pg 184]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Symptoms.</strong>&mdash;There is often a set of preliminary symptoms varying in
+different persons, and giving warning of an approaching attack of
+gout, such as<span class="pagenum"><a name="Page_185" id="Page_185">[Pg 185]</a></span> 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° to 103° 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 <em>vice versa</em>.</p>
+
+<p>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.</p>
+
+<p>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<span class="pagenum"><a name="Page_186" id="Page_186">[Pg 186]</a></span> 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.</p>
+
+<p>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.</p>
+
+<p><strong>Treatment.</strong>&mdash;One of the most popular remedies is colchicum&mdash;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.</p>
+
+<p>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<span class="pagenum"><a name="Page_187" id="Page_187">[Pg 187]</a></span> 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&mdash;at least three pints daily. Mineral
+waters offer no particular advantage.</p>
+
+
+
+<p><span class="pagenum"><a name="Page_188" id="Page_188">[Pg 188]</a></span></p>
+<div class="section_break"></div>
+<div class="part_head">
+<p><span class="pagenum"><a name="Page_189" id="Page_189">[Pg 189]</a></span></p>
+
+<h2>Part III</h2>
+
+<p class="title">SEXUAL HYGIENE</p>
+
+<p class="by">BY</p>
+
+<p>KENELM WINSLOW</p>
+</div>
+
+
+<p><span class="pagenum"><a name="Page_190" id="Page_190">[Pg 190]</a></span></p>
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_191" id="Page_191">[Pg 191]</a></span></p>
+<h3>CHAPTER I</h3>
+
+<p class="chapter_head"><strong>Health and Purity</strong></p>
+
+<p class="chapter_head"><em>Duties of Parents&mdash;Abuse of the Sexual Function&mdash;False
+Teachings&mdash;Criminal Neglect&mdash;Secure the Child's Confidence&mdash;The Best
+Corrections&mdash;Marriage Relations.</em></p>
+
+
+<p>Every individual should know how to care for the sexual organs as well
+as those of any other part of the body, providing that the instruction
+be given by the proper person and at the proper time and place. Such
+information should be imparted to children by parents, guardians, or
+physicians at an early age and, if this is neglected through ignorance
+or false modesty, erroneous ideas of the nature and purpose of the
+sexual function will very surely be supplied later by ignorant and
+probably evil-minded persons with correspondingly bad results. There
+is no other responsibility in the whole range of parental duties which
+is so commonly shirked and with such deplorable consequences. When the
+subject is shorn of the morbid and seductive mystery with which custom
+has foolishly surrounded it in the past, and considered in the same
+spirit with which we study the hygiene of the digestion and other
+natural functions, it will be found possible to give instruction about
+the sexual function in a natural way and without exciting unhealthy
+and morbid curiosity.</p>
+
+<p><span class="pagenum"><a name="Page_192" id="Page_192">[Pg 192]</a></span>A word in the beginning as to the harm produced by abuse of the sexual
+function. The injury thus received is purposely magnified tenfold for
+reasons of gain by quacks who work upon the fears of their victims for
+their own selfish purposes. The voluntary exercise of the sexual
+function&mdash;unlike that of any other important organs&mdash;is not necessary
+to health until maturity has been reached; on the contrary, continence
+is conducive to health, both physical and mental. Even after maturity,
+unless marriage occurs, or by improper living the sexual desires are
+unnaturally stimulated, it is quite possible to maintain perfect
+health through life without exercising the sexual function at all.
+Undue irritation of the sexual organs causes disorder of the nervous
+system, and if continued it will result ultimately in overfatigue and
+failure of the nervous activities which control the normal functions
+of every organ in the body. In other words, it will result in nervous
+exhaustion.</p>
+
+<p>Damage is also wrought by exciting local irritation, congestion, and
+inflammation of the sexual organs which result in impairment of the
+proper functions of these parts and in local disorders and distress.
+It is unnecessary further to particularize other than to state that
+abuse of the sexual organs in the young is usually owing to the almost
+criminal neglect or ignorance of the child's parents. But so far from
+increasing alarm in the patient it is almost always possible to enable
+the child to be rid of the habit by<span class="pagenum"><a name="Page_193" id="Page_193">[Pg 193]</a></span> kindly instruction and judicious
+oversight in the future, and no serious permanent local damage to the
+sexual organs or general injury to the nervous system will be likely
+to persist. The opposite teaching is that peculiar to the quack who
+prophesies every imaginable evil, from complete loss of sexual
+function to insanity. Any real or fancied disorder of the sexual
+function is extremely apt to lead to much mental anxiety and
+depression, so that a cheerful outlook is essential in inspiring
+effort to correct bad habits and is wholly warranted in view of the
+entire recovery in most cases of the young who have abused their
+sexual organs. Insanity or imbecility are seldom the result but more
+often the cause of such habits. It is a sad fact, however, that, under
+the prevailing custom of failure of the parents to exercise proper
+supervision over the sexual function of their children, self-abuse is
+generally practiced in youth, at least by boys.</p>
+
+<p>This often leads to temporary physical and mental suffering and is
+very prejudicial to the morals, but does not commonly result in
+permanent injury except in the degenerate. Children at an early
+age&mdash;three to four years&mdash;should be taught not to touch, handle, rub,
+or irritate their sexual organs in any way whatsoever except so far as
+is necessary in urination or in the course of the daily cleansing. If
+there seems to be any inclination to do so it will usually be found
+that it is due to some local trouble to which a physician's attention
+should be called and which may generally<span class="pagenum"><a name="Page_194" id="Page_194">[Pg 194]</a></span> be readily remedied by him.
+It is always advisable to ask the medical adviser to examine babies
+for any existing trouble and abnormality of the sexual organs, as a
+tight, adherent, or elongated foreskin in boys&mdash;and rarely a
+corresponding condition in girls&mdash;may give rise to much local
+irritation and remote nervous disturbances. The presence of worms may
+lead to irritation in the bowel, which excites masturbation in
+children. Girl babies should be watched to prevent them from
+irritating the external sexual parts by rubbing them between the inner
+surfaces of the thighs. As the child begins to play with other
+children he or she should be cautioned to avoid those who in any way
+try to thwart the parents' advice, and be instructed to report all
+such occurrences. It is wise also to try and gratify the child's
+natural curiosity about the sexual function so far as may be judicious
+by explanations as to the purpose of the sexual organs, when the child
+is old enough to comprehend such matters.</p>
+
+<p>The reticence and disinclination of parents to instruct their children
+in matters relating to sex cannot be too strongly condemned. It is
+perfectly natural that the youth should wish to know something of the
+origin of life and how human beings come into the world. The mystery
+and concealment thrown around these matters only serve to stimulate
+his curiosity. It is a habit of most parents to rebuke any questions
+relating to this subject as improper and immodest, and the first
+lesson the child learns is to associate the idea<span class="pagenum"><a name="Page_195" id="Page_195">[Pg 195]</a></span> of shame with the
+sexual organs; and, since he is not enlightened by his natural
+instructors, he picks up his knowledge of the sex function in a
+haphazard way from older and often depraved companions.</p>
+
+<p>Evasive replies with the intent of staving off the dreaded explanation
+do no good and may result in unexpected evil. By securing the child's
+confidence at the start, one may not only keep informed of his actions
+but protect him from seeking or even listening to bad counsels. At the
+age of ten or twelve it is well that the family physician or parent
+should give instruction as to the special harm which results from
+unnaturally exciting the sexual nature by handling and stimulating the
+sexual organs and also warning the child against filthy literature and
+improper companions. At the age of puberty he should be warned against
+the moral and physical dangers of sexual intercourse with lewd women.
+The physical dangers refer to the great possibility of infection with
+one or both of the common diseases&mdash;syphilis and gonorrhea&mdash;acquired
+by sexual contact with one suffering from these terrible disorders (p.
+<a href="#Page_199">199</a>). It is usually quite impossible for a layman to detect the
+presence of these diseases in others, or rather, to be sure of their
+absence, and the permanent damage which may be wrought to the sufferer
+and to others with whom he may have sexual relations is incalculable.
+It is generally known that syphilis is a disease to be dreaded, but
+not perhaps that it not only endangers the life<span class="pagenum"><a name="Page_196" id="Page_196">[Pg 196]</a></span> and happiness of the
+patient, but the future generation of his descendants. Gonorrhea&mdash;the
+much more common disease&mdash;while often treated lightly by youth,
+frequently leads to long, chronic, local disease and may even result
+fatally in death; later in life it may cause infection of a wife
+resulting in chronic invalidism and necessitating surgical removal of
+her maternal organs. These possibilities often occur long after the
+patient thinks he is wholly free from the disease. Gonorrhea in women
+is the most frequent cause of their sterility, and also is a common
+source of abortion and premature birth. It is the cause in most cases
+of blindness in infants (p. <a href="#Page_205">205</a>) and also of vulvo-vaginitis in girl
+babies. Furthermore, gonorrhea is so alarmingly prevalent that it is
+stated on good authority that the disease occurs in eighty per cent of
+all males some time during their lives. The disease is not confined to
+prostitutes, but is common, much more frequently than is suspected, in
+all walks and classes of life and at all ages. Even among boys
+attending boarding schools and similar institutions the disease is
+only too frequent. It is particularly important that the true
+situation be explained to boys about to enter college or a business
+career, for it is at this period of life that their temptations become
+greatest. Alcohol is the most dangerous foe&mdash;next to bad
+companions&mdash;with which they must contend in this matter, for, weakened
+by its influence and associated with persuasive friends, their will
+gives way and the advice and<span class="pagenum"><a name="Page_197" id="Page_197">[Pg 197]</a></span> warning, which they may have received,
+are forgotten. Idleness is also another influential factor in
+indirectly causing sexual disease; hard physical and mental work are
+powerful correctives of the passions.</p>
+
+<p>It may be of interest to readers to know that but recently an
+association of American physicians, alarmed by the fearful prevalence
+of sexual diseases in this country, has been taking measures to inform
+youths and adults and the general public, through special instruction
+in schools, and by means of pamphlets and lectures to teachers and
+others, of the prevalence and great danger of this evil.</p>
+
+<p>When young adult life has been attained it is also desirable for the
+parent, or the family physician, to inform the young man or
+woman&mdash;especially if either is about to enter a marriage
+engagement&mdash;that close and frequent personal contact with the opposite
+sex, especially when the affections are involved, will necessarily,
+though involuntarily, excite local stimulation of the sexual organs
+and general irritability and exhaustion of the entire nervous system.
+Long engagements&mdash;when the participants are frequent companions&mdash;are
+thus peculiarly unfortunate. It is only when the sexual functions are
+normally exercised in adult life, as in sexual intercourse, that
+sexual excitement is not harmful.</p>
+
+<p>Young women about to marry should receive instruction from their
+mothers as to the sexual relations which will exist after marriage.
+Most girls are al<span class="pagenum"><a name="Page_198" id="Page_198">[Pg 198]</a></span>lowed to grow up ignorant of such matters and in
+consequence may become greatly shocked and even disgusted by the
+sexual relations in marriage&mdash;fancying that there must be something
+unnatural and wrong about them because the subject was avoided by
+those responsible for their welfare.</p>
+
+<p>Any excess in frequency of sexual intercourse after marriage is
+followed by feelings of depression and debility of some sort which may
+be readily attributed to the cause and so corrected. Any deviation
+from the natural mode of intercourse is pretty certain to lead to
+physical disaster; thus, unnatural prolongation of the act, or
+withdrawal on the part of the man before the natural completion of the
+act in order to prevent conception, often results in deplorable
+nervous disorders.</p>
+
+<p>In conclusion, it may be said that parents must take upon themselves
+the burden of instructing their children in sexual hygiene or shift it
+upon the shoulders of the family physician, who can undertake it with
+much less mental perturbation and with more intelligence. Otherwise
+they subject their offspring to the possibility of incalculable
+suffering, disease, and even death&mdash;largely through their own
+inexcusable neglect.</p>
+
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_199" id="Page_199">[Pg 199]</a></span></p>
+<h3>CHAPTER II</h3>
+
+<p class="chapter_head"><strong>Genito-Urinary Diseases</strong></p>
+
+<p class="chapter_head"><em>Contagious Disorders&mdash;Common Troubles of Children&mdash;Inflammation of
+the Bladder&mdash;Stoppage and Suppression of Urine&mdash;Causes and Treatment
+of Bright's Disease.</em></p>
+
+
+<p class="section"><strong>GONORRHEA.</strong>&mdash;Gonorrhea is a contagious inflammation of the urethra,
+accompanied by a white or yellowish discharge. It is caused by a
+specific germ, the <em>gonococcus</em>, and is acquired through sexual
+intercourse with a person suffering from this disease. Exceptionally
+the disease may be conveyed by objects soiled with the discharge, as
+basins, towels, and, in children, diapers, so that in institutions for
+infants it may be thus transferred from one to the other, causing an
+epidemic. The mucous membrane of the lower part of the bowel and the
+eyes are also subject to the disease through contamination with the
+discharge. The disease begins usually three to seven days after sexual
+intercourse, with symptoms of burning, smarting, and pain on
+urination, and a watery discharge from the passage, soon followed by a
+yellowish or white secretion. Swelling of the penis, frequent
+urination, and painful erections are also common symptoms. The
+disease, if uncomplicated and running a favorable<span class="pagenum"><a name="Page_200" id="Page_200">[Pg 200]</a></span> course, may end in
+recovery within six weeks or earlier, with proper treatment. On the
+other hand, complications are exceedingly frequent, and the disorder
+often terminates in a chronic inflammation which may persist for
+years&mdash;even without the knowledge of the patient&mdash;and may result in
+the infection of others after all visible signs have ceased to appear.</p>
+
+<p><strong>Treatment.</strong>&mdash;Rest is the most important requisite; at first, best in
+bed; if not, the patient should keep as quiet as possible for several
+days. The diet should consist of large quantities of water or milk, or
+milk and vichy, with bread, cereals, potatoes, and
+vegetables&mdash;absolutely avoiding alcohol in any form. Sexual
+intercourse is harmful at any stage in the disease and will
+communicate the infection. Aperient salts should be taken to keep the
+bowels loose. The penis should be soaked in hot water three times
+daily to reduce the inflammation and cleanse the organ. A small wad of
+absorbent cotton may be held in place by drawing the foreskin over it
+to absorb the discharge, or may be held in place by means of a bag
+fitting over the penis. All cloths, cotton, etc., which have become
+soiled with the discharge, should be burned, and the hands should be
+washed after contact with the discharge; otherwise the contagion may
+be conveyed to the eyes, producing blindness. It is advisable for the
+patient to take one-half teaspoonful of baking soda in water three
+times daily between meals for the first four or five days, or, better,
+fifteen grains of potassium citrate and fifteen<span class="pagenum"><a name="Page_201" id="Page_201">[Pg 201]</a></span> drops of sweet spirit
+of nitre in the same way. Painful erections may be relieved by bathing
+the penis in cold water, urinating every three hours, and taking
+twenty grains of sodium bromide at night in water. After all swelling
+and pain have subsided, local treatment may be begun.</p>
+
+<p>Injections or irrigations with various medicated fluids constitute the
+best and most efficient measures of local treatment. They should be
+used only under the advice and management of the physician. No greater
+mistake can be made than to resort to the advertising quack, the
+druggist's clerk, or the prescription furnished by an obliging friend.
+Skillful treatment, resulting in a complete radical cure, may save him
+much suffering from avoidable complications and months or years of
+chronic trouble.</p>
+
+<p>At the same time the first medicines advised are stopped and oleoresin
+of cubebs, five grains, or copaiba balsam, ten grains&mdash;or both
+together&mdash;are to be taken three times daily after meals, in capsules,
+for several weeks, unless they disturb the digestion too much. A
+suspensory bandage should be worn throughout the continuance of the
+disease. The approach of the cure of the disease is marked by a
+diminution in the quantity and a change in the character of the
+discharge, which becomes thinner and less purulent and reduced to
+merely a drop in the passage in the early morning, but this may
+continue for a great while. Chronic discharge of this kind and the
+complications cannot be<span class="pagenum"><a name="Page_202" id="Page_202">[Pg 202]</a></span> treated properly by the patient, but require
+skilled medical care.</p>
+
+<p>In this connection it may be said that most patients have an idea that
+the subsidence or disappearance of the discharge is an evidence of the
+cure of the disease. Experience shows that the disease may lapse into
+a latent or chronic form and remain quiescent, without visible
+symptoms, during a prolonged period, while susceptible of being
+revived under the influence of alcoholic drinks or sexual intercourse.
+It is important that treatment should be continued until all disease
+germs are destroyed, which can only be determined by an examination of
+the secretions from the urethra under the microscope.</p>
+
+<p>The more common complications of gonorrhea are inflammation of the
+glands in the groin (bubo), acute inflammation of the prostate glands
+and bladder, of the seminal vesicles, or of the testicles. The latter
+complication is a most common cause of sterility in men. Formerly it
+was thought that gonorrhea was a local inflammation confined to the
+urinary canal and neighboring parts, but advances in our knowledge
+have shown that the germs may be taken up into the general circulation
+and affect any part of the body, such as the muscles, joints, heart,
+lungs, liver, spleen, kidneys, etc., with results always serious and
+often fatal to life. One of the most common complications is
+gonorrheal arthritis, which may affect one or several joints and
+result in stiffness or complete loss of move<span class="pagenum"><a name="Page_203" id="Page_203">[Pg 203]</a></span>ment of the affected
+joint, with more or less deformity and permanent disability. Another
+complication is gonorrheal inflammation of the eye, from direct
+transference of the pus by the fingers or otherwise, and resulting in
+partial or complete blindness.</p>
+
+
+<p class="section"><strong>GONORRHEA IN WOMEN.</strong>&mdash;Gonorrhea in women is a much more frequent and
+serious disease than was formerly supposed. The general impression
+among the laity is that gonorrhea in women is limited to the
+prostitute and vicious classes who indulge in licentious relations.
+Unfortunately, this is not the case. There is perhaps more gonorrhea,
+in the aggregate, among virtuous and respectable wives than among
+professional prostitutes, and the explanation is the following: A
+large proportion of men contract the disease at or before the marrying
+age. The great majority are not cured, and the disease simply lapses
+into a latent form. Many of them marry, believing themselves cured,
+and ignorant of the fact that they are bearers of contagion. They
+transmit the disease to the women they marry, many of whom, from
+motives of modesty and an unwillingness to undergo an examination do
+not consult a physician, and they remain ignorant of the existence of
+the disease until the health is seriously involved. In women,
+gonorrhea is not usually so acute and painful as in men, unless it
+involves the urethra. It usually begins with smarting and painful
+urination, with frequent desire to urinate and with a more or less
+abundant discharge from the front passage. In the majority of<span class="pagenum"><a name="Page_204" id="Page_204">[Pg 204]</a></span> cases
+the infection takes place in the deeper parts, that is, in the neck or
+body of the womb. In this location it may not give rise at first to
+painful symptoms, and the patient often attributes the increased
+discharge to an aggravation of leucorrhea from which she may have
+suffered. The special danger to women from gonorrhea is that the
+inflammation is apt to be aggravated during the menstrual period and
+the germs of the disease ascend to the cavity of the womb, the tubes,
+and ovaries, and invade the peritoneal covering, causing peritonitis.
+Pregnancy and childbirth afford favorable opportunities for the upward
+ascension of the germs to the peritoneal cavity. The changes caused by
+gonorrheal inflammation in the maternal organs are the most common
+cause of sterility in women. It is estimated that about fifty per cent
+of all sterility in women proceeds from this cause. In addition to its
+effects upon the child-bearing function, the danger to the health of
+such women is always serious. In the large proportion of cases they
+are made permanent invalids, no longer able to walk freely, but
+compelled to pass their lives in a reclining position until worn out
+by suffering, which can only be relieved by the surgical removal of
+their maternal organs. It is estimated that from fifty to sixty per
+cent of all operations performed on the maternal organs of women are
+due to disease caused by gonorrheal inflammation.</p>
+
+<p><strong>Treatment.</strong>&mdash;Rest in bed, the use of injections of hot water, medicated
+with various astringents, by<span class="pagenum"><a name="Page_205" id="Page_205">[Pg 205]</a></span> means of a fountain syringe in the front
+passage three times daily, and the same remedies and bath recommended
+above, with hot sitz baths, will usually relieve the distress. In view
+of the serious character of this affection in women and its
+unfortunate results when not properly treated, it is important that
+they should have the benefit of prompt and skillful treatment by a
+physician. Otherwise, the health and life of the patient may be
+seriously compromised.</p>
+
+<p>The social danger of gonorrhea introduced after marriage is not
+limited to the risks to the health of the woman. When a woman thus
+infected bears a child the contagion of the disease may be conveyed to
+the eyes of the child in the process of birth. Gonorrheal pus is the
+most virulent of all poisons. A single drop of the pus transferred to
+the eye may destroy this organ in from twenty-four to forty-eight
+hours. It is estimated that from seventy-five to eighty per cent of
+all babies blinded at birth have suffered from this cause, while from
+twenty to thirty per cent of blindness from all causes is due to
+gonorrhea. While the horrors of this disease in the newborn have been
+mitigated by what is called the Crédé method (instillation of nitrate
+of silver solution in the eye immediately after birth), it still
+remains one of the most common factors in the causation of blindness.
+Another social danger is caused by the pus being conveyed to the
+genital parts of female children, either at birth or by some object
+upon which it has been<span class="pagenum"><a name="Page_206" id="Page_206">[Pg 206]</a></span> accidentally deposited, such as clothes,
+sponges, diapers, etc. These cases are very common in babies'
+hospitals and institutions for the care of children. Quite a number of
+epidemics have been traced to this cause. The disease occurring in
+children is exceedingly difficult of cure and is often followed by
+impairment in the development of their maternal organs. Much of the
+ill health of young girls from disordered menstruation and other
+uterine diseases may be traced to this cause. Another serious
+infection in babies and young children is gonorrheal inflammation of
+the joints, with more or less permanent crippling.</p>
+
+
+<p class="section"><strong>SYPHILIS; THE POX; LUES.</strong>&mdash;Syphilis is a contagious germ disease
+affecting the entire system. While commonly acquired through sexual
+intercourse with a person affected with the disorder, it may be
+inherited from the parents, one or both. It is often acquired through
+accidental contact with sources of contagion. Syphilis and
+tuberculosis are the two great destroyers of health and happiness, but
+syphilis is the more common.</p>
+
+<p><strong>Symptoms.</strong>&mdash;Acquired syphilis may be divided into three stages: the
+primary, secondary, and tertiary. The first stage is characterized by
+the appearance of a pimple or sore on the surface of the sexual organ
+not usually earlier than two, nor later than five to seven, weeks
+after sexual intercourse. The appearance of this first sore is subject
+to such variations that it is not always possible for even the most
+skillful physician<span class="pagenum"><a name="Page_207" id="Page_207">[Pg 207]</a></span> to determine positively the presence of syphilis
+in any individual until the symptoms characteristic of the second
+stage develop. Following the pimple on the surface of the penis comes
+a raw sore with hard deposit beneath, as of a coin under the skin. It
+may be so slight as to pass unnoticed or become a large ulcer, and may
+last from a few weeks to several months. There are several other kinds
+of sores which have no connection with syphilis and yet may resemble
+the syphilitic sore so closely that it becomes impossible to
+distinguish between them except by the later symptoms to be described.
+Along with this sore, lumps usually occur in one or both groins, due
+to enlarged glands.</p>
+
+<p>The second stage appears in six to seven weeks after the initial sore,
+and is characterized by the occurrence of a copper-colored rash over
+the body, but not often on the face, which resembles measles
+considerably. Sometimes a pimply or scaly eruption is seen following
+this or in place of the red rash. At about, or preceding, this period
+other symptoms may develop, as fever, headache, nausea, loss of
+appetite, and sleeplessness, but these may not be prominent. Moist
+patches may appear on the skin, in the armpits, between the toes, and
+about the rectum; or warty outgrowths in the latter region. There is
+sore throat, with frequently grayish patches on the inside of the
+cheeks, lips, and tongue. The hair falls out in patches or, less
+often, is all lost. Inflammation of the eye is sometimes a symptom.
+These symptoms do not always<span class="pagenum"><a name="Page_208" id="Page_208">[Pg 208]</a></span> occur at the same time, and some may be
+absent or less noticeable than others.</p>
+
+<p>The third stage comes on after months or years, or in those subjected
+to treatment may not occur at all. This stage is characterized by
+sores and ulcerations on the skin and deeper tissues, and the
+occurrence of disease of different organs of the body, including the
+muscles, bones, nervous system, and blood vessels; every internal
+organ is susceptible to syphilitic change.</p>
+
+<p>A great many affections of the internal organs&mdash;the heart, lungs,
+liver, kidneys, brain, and cord&mdash;which were formerly attributed to
+other causes, are now recognized as the product of syphilis. The
+central nervous system is peculiarly susceptible to the action of the
+syphilitic poison, and when affected may show the fact through
+paralysis, crippling, disabling, and disfiguring disorders.</p>
+
+<p>Years after cure has apparently resulted, patients are more liable to
+certain nervous disorders, as locomotor ataxia, which attacks
+practically only syphilitics; and general paresis, of which
+seventy-five per cent of the cases occur in those who have had
+syphilis.</p>
+
+<p><strong>Inherited Syphilis.</strong>&mdash;Children born with syphilis of syphilitic parents
+show the disease at birth or usually within one or two months. They
+present a gaunt, wasted appearance, suffer continually from snuffles
+or nasal catarrh, have sores and cracks about the lips, loss of hair,
+and troublesome skin eruptions. The syphilitic child has been
+described as a "little old man<span class="pagenum"><a name="Page_209" id="Page_209">[Pg 209]</a></span> with a cold in his head." The internal
+organs are almost invariably diseased, and sixty to eighty per cent of
+the cases fortunately die. Those who live to grow up are puny and
+poorly developed, so that at twenty they look not older than twelve,
+and are always delicate.</p>
+
+<p>It is to be noted that syphilis is not necessarily a venereal disease,
+that is, acquired through sexual relations. It may be communicated by
+kissing, by accidental contact with a sore on a patient's body, by the
+use of pipes, cups, spoons, or other eating or drinking utensils, or
+contact with any object upon which the virus of the disease has been
+deposited.</p>
+
+<p>Any part of the surface of the body or mucous membrane is susceptible
+of being inoculated with the virus of syphilis, followed by a sore
+similar to what has been described as occurring upon the genital parts
+and later the development of constitutional symptoms. The
+contagiousness of the disease is supposed to last during the first
+three years of its existence, but there are many authentic cases of
+contagion occurring after four or five years of syphilis.</p>
+
+<p><strong>Diagnosis.</strong>&mdash;The positive determination of the existence of syphilis at
+the earliest moment is of the utmost importance in order to set at
+rest doubt and that treatment may be begun. It is necessary to wait,
+however, until the appearance of the eruption, sore throat,
+enlargement of glands, falling out of hair, etc., before it is safe to
+be positive.</p>
+
+<p><span class="pagenum"><a name="Page_210" id="Page_210">[Pg 210]</a></span><strong>Treatment.</strong>&mdash;The treatment should be begun as soon as the diagnosis is
+made, and must be continuously and conscientiously pursued for three
+years or longer. If treatment is instituted before the secondary
+symptoms, it may prevent their appearance so that the patient may
+remain in doubt whether he had the disease or not, for it is
+impossible for the most skilled specialist absolutely to distinguish
+the disease before the eruption, no matter how probable its existence
+may seem. This happens because there are several kinds of sores which
+attack the sexual organs and which may closely simulate syphilis. The
+treatment is chiefly carried out with various forms of mercury and
+iodides, but so much knowledge and experience are required in adapting
+these to the individual needs and peculiarities of the patient that it
+is impossible to describe their use. Patients should not marry until
+four or five years have elapsed since the appearance of syphilis in
+their persons, and at least twelve months after all manifestations of
+the disease have ceased. If these conditions have been complied with,
+there is little danger of communicating the disease to their wives or
+transmitting it to their offspring. They must moreover, have been
+under the treatment during all this period. Abstinence from alcohol,
+tobacco, dissipation, and especial care of the teeth are necessary
+during treatment.</p>
+
+<p><strong>Results.</strong>&mdash;The majority of syphilitics recover wholly under treatment
+and neither have a return of<span class="pagenum"><a name="Page_211" id="Page_211">[Pg 211]</a></span> the disease nor communicate it to their
+wives or children. It is, however, possible for a man, who has
+apparently wholly recovered for five or six years or more, to impart
+the disease. Without proper treatment or without treatment for the
+proper time, recurrence of the disease is frequent with the occurrence
+of the destructive and often serious symptoms characteristic of the
+third stage of the disease. While syphilis is not so fatal to life as
+tuberculosis, it is capable of causing more suffering and unhappiness,
+and is directly transmitted from father to child, which is not the
+case with consumption. Syphilis is also wholly preventable, which is
+not true of tuberculosis at present. It is not probable that syphilis
+is ever transmitted to the third generation directly, but deformities,
+general debility, small and poor teeth, thin, scanty growth of hair,
+nervous disorders, and a general miserable physique are seen in
+children whose parents were the victims of inherited syphilis. In
+married life syphilis may be communicated to the wife directly from
+the primary sore on the penis of the husband during sexual
+intercourse, but contamination of the wife more often happens from the
+later manifestations of the disease in the husband, as from secretion
+from open sores on the body or from the mouth, when the moist patches
+exist there.</p>
+
+<p>It is possible for a child to inherit syphilis from the father&mdash;when
+the germs of syphilis are transmitted through the semen of the father
+at the time of<span class="pagenum"><a name="Page_212" id="Page_212">[Pg 212]</a></span> conception&mdash;and yet the mother escape the disease. On
+the other hand, it is not uncommon for the child to become thus
+infected and infect its mother while in her womb; or the mother may
+receive syphilis from the husband after conception, and the child
+become infected in the womb.</p>
+
+<p>The chief social danger of syphilis comes from its introduction into
+marriage and its morbid radiations through family and social life.
+Probably one in every five cases of syphilis in women is communicated
+by the husband in the marriage relation. There are so many sources and
+modes of its contagion that it is spread from one person to another in
+the ordinary relations of family and social life&mdash;from husband to wife
+and child, from child to nurse, and to other members of the family, so
+that small epidemics of syphilis may be traced to its introduction
+into a family. Syphilis is the only disease which is transmitted in
+full virulence to the offspring, and its effect is simply murderous.
+As seen above, from sixty to eighty per cent of all children die
+before or soon after birth. One-third of those born alive die within
+the next six months, and those that finally survive are blighted in
+their development, both physical and mental, and affected with various
+organic defects and deformities which unfit them for the battle of
+life. Syphilis has come to be recognized as one of the most powerful
+factors in the depopulation and degeneration of the race.</p>
+
+
+<p class="section"><span class="pagenum"><a name="Page_213" id="Page_213">[Pg 213]</a></span><strong>INVOLUNTARY PASSAGE OF URINE&mdash;BED-WETTING IN CHILDREN.</strong>&mdash;(<em>Incontinence
+of Urine</em>).&mdash;This refers to an escape of urine from the bladder
+uncontrolled by the will. It naturally occurs in infants under thirty
+months, or thereabouts, and in the very old, and in connection with
+various diseases. It may be due to disease of the brain, as in idiocy
+or insanity, apoplexy, or unconscious states. Injuries or disorders of
+the spinal cord, which controls the action of the bladder (subject to
+the brain), also cause incontinence. Local disorders of the urinary
+organs are more frequent causes of the trouble, as inflammation of any
+part of the urinary tract, diabetes, nephritis, stone in the bladder,
+tumors, and malformations. The involuntary passage of urine may arise
+from irritability of bladder&mdash;the most frequent cause&mdash;or from
+weakness of the muscles which restrain the escape of urine, or from
+obstruction to flow of urine from the bladder, with overflow when it
+becomes distended.</p>
+
+<p>It is a very common disorder of children and young persons, and in
+some cases no cause can be found; but in many instances it is due to
+masturbation (p. <a href="#Page_193">193</a>), to a narrow foreskin and small aperture at the
+exit of the urinary passage, to worms in the bowels or disease of the
+lower end of the bowels, such as fissure or eczema, to digestive
+disorders, to retaining the urine overlong, to fright, to dream
+impressions (dreaming of the act of urination), and to great weakness
+brought on by fevers or other diseases. In old men it is often<span class="pagenum"><a name="Page_214" id="Page_214">[Pg 214]</a></span> due to
+an enlargement of a gland at the neck of the bladder which prevents
+the bladder from closing properly. A concentrated and irritating
+urine, from excessive acidity or alkalinity, may induce incontinence.</p>
+
+<p>Children may recover from it as they approach adult life, but they
+should not be punished, as it is a disease and not a fault. Exception
+should be made in case children wet their clothing during play,
+through failure to take the time and trouble to pass water naturally.
+It is more common among children at night, leading to wetting of the
+bed, but may occur in the day, and often improves in the spring and
+summer, only to return with the cold weather. Children who sleep very
+soundly are more apt to be subject to this disorder.</p>
+
+<p><strong>Treatment.</strong>&mdash;In the case of a disorder depending upon one of so many
+conditions it will be realized that it would be folly for the layman
+to attempt to treat it. Children who are weak need building up in
+every possible way, as by an outdoor life, cold sponging daily, etc.
+If there is in boys a long foreskin, or tight foreskin, hindering the
+escape of urine and natural secretions of this part, circumcision may
+be performed to advantage by the surgeon, even in the infant a few
+months old. Sometimes a simpler operation, consisting of stretching or
+overdistending the foreskin, can be done.</p>
+
+<p>A somewhat corresponding condition in girls occasionally causes
+bed-wetting and other troubles. It can be discovered by a physician.
+Children who wet their<span class="pagenum"><a name="Page_215" id="Page_215">[Pg 215]</a></span> beds, or clothes, should not drink liquid
+after five in the afternoon, and should be taken up frequently during
+the night to pass water. The bed covering must be light, and they
+should be prevented from lying on the back while asleep by wearing a
+towel knotted in the small part of the back. Elevation of the foot of
+the bed a few inches is recommended as having a corrective influence.
+Masturbation, if present, must be corrected.</p>
+
+<p>It is a very difficult disorder to treat, and physicians must be
+excused for failures even after every attempt has been made to
+discover and remove the cause. Even when cure seems assured, the
+disorder may recur.</p>
+
+
+<p class="section"><strong>INFLAMMATION OF THE BLADDER</strong> (<em>Cystitis</em>).&mdash;The condition which we
+describe under this head commonly causes frequent painful urination.
+Primarily there is usually some agency which mechanically or
+chemically irritates the bladder, and if the irritation does not
+subside, inflammation follows owing to the entrance of germs in some
+manner. The introduction into the bladder of unboiled, and therefore
+unclean, instruments is a cause; another cause is failure to pass
+urine for a long period, from a feeling of delicacy in some persons
+when in unfavorable surroundings. Nervous spasm of the urinary passage
+from pain, injuries, and surgical operations constitutes another
+cause. Inflammation may extend from neighboring parts and attack the
+bladder, as in gonorrhea, and in various inflammations of the sexual
+organs of women, as in childbed infection. Certain foods, waters, and<span class="pagenum"><a name="Page_216" id="Page_216">[Pg 216]</a></span>
+drinks, as alcohol in large amounts, and drugs, as turpentine or
+cantharides applied externally or given internally, may lead to
+irritation of the bladder. Exposure to cold in susceptible persons is
+frequently a source of cystitis, as well as external blows and
+injuries. The foregoing causes are apt to bring on sudden or acute
+attacks of bladder trouble, but often the disease comes on slowly and
+is continuous or chronic.</p>
+
+<p>Among the causes of chronic cystitis, in men over fifty, is
+obstruction to the outflow of urine from enlargement of the prostate
+gland, which blocks the exit from the bladder. In young men, narrowing
+of the urethra, a sequel to gonorrhea, may also cause cystitis; also
+stone in the bladder or foreign bodies, tumors growing in the bladder,
+tuberculosis of the organ. Paralysis of the bladder, which renders the
+organ incapable of emptying itself, thus retaining some fermenting
+urine, is another cause of bladder inflammation.</p>
+
+<p><strong>Symptoms.</strong>&mdash;The combination of frequency of and pain during urination,
+with the appearance of blood or white cloudiness and sediment in the
+urine, are evidences of the existence of inflammation of the bladder.
+The trouble is aggravated by standing, jolting, or active exercise.
+The pain may be felt either at the beginning or end of urination.
+There is also generally a feeling of weight and heaviness low down in
+the belly, or about the lower part of the bowel. Blood is not
+frequently present, but the urine is not clear, if there is much
+inflammation, but deposits a white and<span class="pagenum"><a name="Page_217" id="Page_217">[Pg 217]</a></span> often slimy sediment on
+standing. In chronic inflammation of the bladder the urine often has a
+foul odor and smells of ammonia.</p>
+
+<p><strong>Treatment.</strong>&mdash;The treatment of acute cystitis consists in
+rest&mdash;preferably on the back, with the legs drawn up, in bed. The diet
+should be chiefly fluid, as milk and pure water, flaxseed tea, or
+mineral waters. Potassium citrate, fifteen grains, and sweet spirit of
+nitre, fifteen drops, may be given in water to advantage three times
+daily. Hot full baths or sitz baths two or three times a day, and in
+women hot vaginal douches (that is, injections into the front
+passage), with hot poultices or the hot-water bag over the lower part
+of the abdomen, will serve to relieve the suffering. If, however, the
+pain and frequency attending urination is considerable, nothing is so
+efficient as a suppository containing one-quarter grain each of
+morphine sulphate and belladonna extract, which should be introduced
+into the bowel and repeated once in three hours if necessary. This
+treatment should be employed only under the advice of a physician. In
+chronic cystitis, urotropin in five-grain doses dissolved in a glass
+of water and taken four times daily often affords great relief, but
+these cases demand careful study by a physician to determine their
+cause, and often local treatment. Avoidance of all source of
+irritation is also essential in these cases, as sexual excitement and
+the use of alcohol and spices. The diet should consist chiefly of
+cereals and vegetables, with an abundance of<span class="pagenum"><a name="Page_218" id="Page_218">[Pg 218]</a></span> milk and water. The
+bowels should be kept loose by means of hot rectal injections in acute
+cystitis.</p>
+
+
+<p class="section"><strong>RETENTION, STOPPAGE, OR SUPPRESSION OF URINE.</strong>&mdash;Retention refers to
+that condition where the urine has been accumulating in the bladder
+for a considerable time&mdash;over twelve hours&mdash;and cannot be passed. It
+may follow an obstruction from disease, to which is added temporary
+swelling and nervous contraction of some part of the urinary passage;
+or it may be due to spasm and closure of the outlet from nervous
+irritation, as in the cases of injuries and surgical operations in the
+vicinity of the sexual organs, the rectum, or in other parts of the
+body. Overdistention of the bladder from failure to pass water for a
+long time may lead to a condition where urination becomes an
+impossibility. Various general diseases, as severe fevers, and
+conditions of unconsciousness, and other disorders of the nervous
+system, are frequently accompanied by retention of urine. In retention
+of urine there is often an escape of a little urine from time to time,
+and not necessarily entire absence of outflow.</p>
+
+<p><strong>Treatment.</strong>&mdash;Retention of urine is a serious condition. If not
+relieved, it may end in death from toxæmia, caused by back pressure on
+the kidneys, or from rupture of the bladder. Therefore surgical
+assistance is demanded as soon as it can be obtained. Failing this,
+begin with the simpler methods. A hot sitz bath, or, if the patient
+cannot move, hot applications, as<span class="pagenum"><a name="Page_219" id="Page_219">[Pg 219]</a></span> a hot poultice or hot cloths
+applied over the lower part of the belly, may afford relief.
+Injections of hot water into the bowel are often more efficient still.
+A single full dose of opium in some form, as fifteen drops of
+laudanum<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a> or two teaspoonfuls of paregoric<a href="#Footnote_10_10" class="fnanchor">[10]</a> or one-quarter grain
+of morphine,<a href="#Footnote_10_10" class="fnanchor">[10]</a> will frequently allow of a free passage of urine. The
+introduction of a suppository into the bowel, containing one-quarter
+grain each of morphine sulphate,<a href="#Footnote_10_10" class="fnanchor">[10]</a> and belladonna extract, is often
+preferable to giving the drug by the mouth. These measures proving of
+no avail, the next endeavor should be to pass a catheter. If a soft
+rubber or elastic catheter is used with reasonable care, little damage
+can be done, even by a novice. The catheter should be boiled in water
+for ten minutes, and after washing his hands thoroughly the attendant
+should anoint the catheter with sweet oil (which has been boiled) or
+clean vaseline and proceed to introduce the catheter slowly into the
+urinary passage until the urine begins to flow out through the
+instrument.</p>
+
+<p>A medium-sized catheter is most generally suitable, as a No. 16 of the
+French scale, or a No. 8<span class="frac_top">1</span>/<span class="frac_bottom">2</span> of the English scale.</p>
+
+
+<p class="section"><strong>BRIGHTS DISEASE OF THE KIDNEYS.</strong>&mdash;Bright's disease of the kidneys is
+acute or chronic, and its presence can be definitely determined only
+by chemical and microscopical examination of the urine. Acute Bright's
+disease coming on in persons previ<span class="pagenum"><a name="Page_220" id="Page_220">[Pg 220]</a></span>ously well may often, however,
+present certain symptoms by which its existence may be suspected even
+by the layman.</p>
+
+
+<p class="section"><strong>ACUTE BRIGHT'S DISEASE; ACUTE INFLAMMATION OF THE KIDNEYS.</strong>&mdash;Acute
+Bright's disease is often the result of exposure to cold and wet.
+Inflammation of the kidneys may be produced by swallowing turpentine,
+many of the cheap flavoring extracts in large amounts, carbolic acid,
+and Spanish flies; the external use of large quantities of turpentine,
+carbolic acid, or Spanish flies may also lead to acute inflammation of
+the kidneys. It occurs occasionally in pregnant women. The contagious
+germ diseases are very frequently the source of acute Bright's disease
+either as a complication or sequel. Thus scarlet fever is the most
+frequent cause, but measles, smallpox, chickenpox, yellow fever,
+typhoid fever, erysipelas, diphtheria, cholera, and malaria are also
+causative factors.</p>
+
+<p><strong>Symptoms.</strong>&mdash;Acute Bright's disease may develop suddenly with pallor and
+puffiness of the face owing to dropsy. The eyelids, ankles, legs, and
+lower part of the belly are apt to show the dropsy most. There may be
+nausea, vomiting, pain and lameness in the small part of the back,
+chills and fever, loss of appetite, and often constipation. In
+children convulsions sometimes appear. The urine is small in amount,
+perhaps not more than a cupful in twenty-four hours, instead of the
+normal daily excretion of three pints. Occasionally<span class="pagenum"><a name="Page_221" id="Page_221">[Pg 221]</a></span> complete
+suppression of urine occurs. It is high-colored, either smoky or of a
+porter color, or sometimes a dark or even bright red, from the
+pressure of blood. Stupor and unconsciousness may supervene in severe
+cases. Recovery usually occurs, in favorable cases, within a few
+weeks, with gradually diminishing dropsy and increasing secretion of
+urine, or the disease may end in a chronic disorder of the kidneys. If
+acute Bright's disease is caused by, or complicated with, other
+diseases, the probable result becomes much more difficult to predict.</p>
+
+<p><strong>Treatment.</strong>&mdash;The failure of the kidneys to perform their usual function
+of eliminating waste matter from the blood makes it necessary for the
+skin and bowels to do double duty. The patient should remain in bed
+and be kept very warm with flannel night clothes and blankets next the
+body. The diet should consist wholly of milk, a glass every two hours,
+in those with whom it agrees, and in others gruels may be substituted
+to some extent. The addition to milk of mineral waters, limewater,
+small amounts of tea, coffee, or salt often makes it more palatable to
+those otherwise disliking it. As the patient improves, bread and
+butter, green and juicy vegetables, and fruits may be permitted. An
+abundance of pure water is always desirable. The bowels should be kept
+loose from the outset by salts given in as little water as possible
+and immediately followed by a glass of pure water. A teaspoonful may
+be given hourly till the bowels move.<span class="pagenum"><a name="Page_222" id="Page_222">[Pg 222]</a></span> Epsom or Glauber's salts are
+efficient, but the compound jalap powder is the best purgative.
+Children, or those to whom these remedies are repugnant, may take the
+solution of citrate of magnesia, of which the dose is one-half to a
+whole bottle for adults. The skin is stimulated by the patient's lying
+in a hot bath for twenty minutes each day or, if this is not possible,
+by wrapping the patient in a blanket wrung out of hot water and
+covered by a dry blanket, and then by a rubber or waterproof sheet,
+and he is allowed to remain in it for an hour with a cold cloth to the
+head. If the patient takes the hot bath he should be immediately
+wrapped in warmed blankets on leaving it, and receive a hot drink of
+lemonade to stimulate sweating.</p>
+
+<p>For treatment of convulsions, see Vol. I, p. 188.</p>
+
+<p>Vomiting is allayed by swallowing cracked ice, single doses of bismuth
+subnitrate (one-quarter teaspoonful) once in three hours, and by heat
+applied externally over the stomach. Recovery is hastened by avoiding
+cold and damp, and persisting with a liquid diet for a considerable
+period. A course of iron is usually desirable after a few weeks have
+elapsed to improve the quality of the blood; ten drops of the tincture
+of the chloride of iron taken in water through a glass tube by adults;
+for children five to ten drops of the syrup of the iodide of iron. In
+either case the medicine should be taken three times daily after
+meals.</p>
+
+
+<p class="section"><strong>CHRONIC BRIGHT'S DISEASE.</strong>&mdash;This includes several forms of kidney
+disease. The symptoms<span class="pagenum"><a name="Page_223" id="Page_223">[Pg 223]</a></span> are often very obscure, and the condition may
+not be discovered or suspected by the physician until an examination
+of the urine is made, which should always be done in any case of
+serious or obscure disorder. Accidental discovery of Bright's disease
+during examination for life insurance is not rare. The disease may
+exist for years without serious impairment resulting.</p>
+
+<p><strong>Causes.</strong>&mdash;Chronic Bright's disease often follows and is the result of
+fevers and acute inflammation of the kidneys. It is more common in
+adults. Overeating, more especially of meat, and overdrinking of
+alcohol are frequent causes. Gout is a frequent factor in its
+causation. The disease has in the past been regarded as a local
+disease of the kidneys, but recent research makes it probable that
+there is a general disorder of the system due to some faulty
+assimilation of food&mdash;especially when the diet itself is faulty&mdash;with
+the production of chemical products which damage various organs in the
+body as well as the kidneys, notably the heart and blood vessels.</p>
+
+<p><strong>Symptoms.</strong>&mdash;The symptoms are most diverse and varied and it is not
+possible to be sure of the existence of the disease without a careful
+physical examination, together with a complete examination of the
+urine, both made by a competent physician. Patients may be afflicted
+with the disease for long periods without any symptoms until some
+sudden complication calls attention to the underlying trouble.
+Symptoms sug<span class="pagenum"><a name="Page_224" id="Page_224">[Pg 224]</a></span>gesting chronic Bright's disease are among the following:
+indigestion, diarrhea and vomiting, frequent headache, shortness of
+breath, weakness, paleness, puffiness of the eyelids, swelling of the
+feet in the morning, dropsy, failure of eyesight, and nosebleed, and
+sometimes apoplexy. As the disease comes on slowly the patient has
+usually time to apply for medical aid, and attention is called to the
+foregoing symptoms merely to emphasize the importance of attending to
+such in due season.</p>
+
+<p><strong>Outcome.</strong>&mdash;While the outlook as to complete recovery is very
+discouraging, yet persons may live and be able to work for years in
+comparative comfort in many cases. When a physician pronounces the
+verdict of chronic Bright's disease, it is not by any means equivalent
+to a death warrant, but the condition is often compatible with many
+years of usefulness and freedom from serious suffering.</p>
+
+<p><strong>Treatment.</strong>&mdash;Medicines will no more cure Bright's disease than old age.
+Out-of-door life in a dry, warm, and equable climate has the most
+favorable influence upon the cause of chronic Bright's disease, and
+should always be recommended as a remedial agent when available.
+Proper diet is of great importance. Cereals, vegetables, an abundance
+of fat in the form of butter and cream&mdash;to the amount of a pint or so
+a day of the latter, and the avoidance of alcohol and meat, fish and
+eggs constitute the ideal regimen when this can be carried out. Tea
+and coffee in much modera<span class="pagenum"><a name="Page_225" id="Page_225">[Pg 225]</a></span>tion are usually allowable and water in
+abundance. The underclothing should be of wool the year round, and
+especial care is essential to avoid chilling of the surface. Medicines
+have their usefulness to relieve special conditions, but should only
+be taken at the advice of a physician, whose services should always be
+secured when available.</p>
+
+
+
+<p><span class="pagenum"><a name="Page_226" id="Page_226">[Pg 226]</a></span></p>
+<div class="section_break"></div>
+<div class="part_head">
+<p><span class="pagenum"><a name="Page_227" id="Page_227">[Pg 227]</a></span></p>
+
+<h2>Part IV</h2>
+
+<p class="title">DISEASE AND DISORDER OF THE<br />
+MIND</p>
+
+<p class="by">BY</p>
+
+<p>ALBERT WARREN FERRIS</p>
+</div>
+
+
+<p><span class="pagenum"><a name="Page_228" id="Page_228">[Pg 228]</a></span></p>
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_229" id="Page_229">[Pg 229]</a></span></p>
+<h3>CHAPTER I</h3>
+
+<p class="chapter_head"><strong>Insanity</strong></p>
+
+
+<p>Insanity is the name given to a collection of symptoms of disease of
+the brain or disorder of brain nutrition or circulation. The principal
+test of insanity lies in the adjustment of the patient to his
+surroundings, as evidenced in conduct and speech. Yet one must not
+include within the field of insanity the improper conduct and speech
+of the vicious, nor of the mentally defective. Crime is not insanity,
+though there are undoubtedly some insane people confined in prisons
+who have been arrested because of the commission of crime.</p>
+
+<p>Then, too, while mental defect may exist in the insane, there is a
+certain class of mental defectives whose condition is due not to
+disease of the brain, but to arrest of development of the brain during
+childhood or youth, and these we call idiots or imbeciles; but they
+are not classed with the insane.</p>
+
+
+<h4><em>Mental Disorder Not Insanity</em></h4>
+
+<p>We frequently hear repeated the assertion, "Everybody is a little
+insane," and the quotation is reported as coming from an expert in
+insanity. This quotation is untrue. The fact is that anyone is liable
+to mental<span class="pagenum"><a name="Page_230" id="Page_230">[Pg 230]</a></span> disorder; but mental disorder is not insanity. To
+illustrate: a green glove is shown to a certain man and he asserts
+that its color is brown, and you cannot prove to him that he is wrong,
+because he is color-blind. Green and brown appear alike to him. This
+is mental disorder, but not insanity. Again, a friend will explain to
+you how he can make a large profit by investing his money in a certain
+way. He does so invest it and loses it, because he has overlooked
+certain factors, has not given proper weight to certain influences,
+and has ignored probable occurrences, all of which were apparent to
+you. He was a victim of his mental disorder, his judgment, reason, and
+conception being faulty; yet he was not insane. Again, you answer a
+letter from a correspondent, copying on the envelope the address you
+read at the head of his letter. A few days later your answer is
+returned to you undelivered. In astonishment, you refer to his letter
+and find that you have misread the address he gave, mistaking the
+number of his house. This was an instance of mental disorder in your
+not reading the figure aright; but it was not insanity.</p>
+
+
+<h4><em>What Autopsies of the Brain Reveal</em></h4>
+
+<p>The changes in the brain accompanying or resulting from disease, as
+found in some chronic cases of insanity in which autopsies are made,
+consist largely in alteration of the nerve cells of the brain. The
+cells are smaller and fewer than they should be, they are altered in
+shape,<span class="pagenum"><a name="Page_231" id="Page_231">[Pg 231]</a></span> and their threads of communication with other cells are
+broken. Nerve cells and often large areas of gray matter are replaced
+by connective tissue (resembling scar tissue), which grows and
+increases in what would otherwise be vacant spaces. All areas which
+contain this connective tissue, this filling which has no function, of
+course, cease to join with other parts of the brain in concerted
+action, and so the power of the brain is diminished, and certain of
+its activities are restricted or abolished.</p>
+
+
+<h4><em>Curious Illusions of the Insane</em></h4>
+
+<p>In the normal brain certain impressions are received from the special
+senses: impressions of sight or of hearing, for example. These
+impressions are called conscious perceptions, and the healthy brain
+groups them together and forms concepts. For instance, you see
+something which is flat and shiny with square-cut edges. You touch it,
+and learn that it is cold, smooth, and hard. Lift it and you find it
+heavy. Grouping together your sense perceptions you form the concept,
+and decide that the object is a piece of marble. Again, you enter a
+dimly lighted room and see a figure in a corner the height of a woman,
+with a gown like a woman's. You approach it, speak to it and get no
+reply, and you find you can walk directly through it, for it is a
+shadow. Perhaps you were frightened. Perhaps you imagined she was a
+thief. Your first judgment was wrong and you correct it. The insane
+person,<span class="pagenum"><a name="Page_232" id="Page_232">[Pg 232]</a></span> however, has defective mental processes. He cannot group
+together his perceptions and form proper conceptions. His imagination
+runs riot. His emotions of fear or anger are not easily limited. He
+has to some extent lost the control over his mental actions that you
+and other people possess if your brains are normal. The insane man
+will insist that there is a woman there, and not a shadow, and to his
+mind it is not absurd to walk directly through this person. He cannot
+correct the wrong idea. Such a wrongly interpreted sense perception is
+called an illusion. Another example of illusion is the mistaking the
+whistle of a locomotive for the shriek of a pursuing assassin.</p>
+
+
+<h4><em>What Hallucinations Are</em></h4>
+
+<p>The insane man may also suffer from hallucinations. A hallucination is
+a false perception arising without external sensory experience. In a
+hallucination of sight, the disease in the brain causes irritation to
+be carried to the sight-centers of the brain, with a result that is
+similar to the impression carried to the same centers by the optic
+nerves when light is reflected into the eyes from some object. An
+insane man may be deluded with the belief that he sees a face against
+the wall where there is nothing at all. When the air is pure and sweet
+and no odor is discoverable, he may smell feathers burning, and thus
+reveal his hallucination of smell.</p>
+
+
+<p><span class="pagenum"><a name="Page_233" id="Page_233">[Pg 233]</a></span></p>
+<h4><em>Delusions Common to Insanity</em></h4>
+
+<p>The insane man may have wrong ideas without logical reason for them.
+Thus, an insane man may declare that a beautiful actress is in love
+with him, when there is absolutely no foundation for such an idea. Or,
+he may believe that he can lift 500 pounds and run faster than a
+locomotive can go, while in reality he is so feeble as scarcely to be
+able to walk, and unable to dress himself. Such ideas are delusions.
+Sane people may be mistaken; they may have hallucinations, illusions
+and delusions; but they abandon their mistaken notions and correct
+their judgment at once, on being shown their errors. Sane people see
+the force of logical argument, and act upon it, abandoning all
+irrational ideas. The insane person, on the other hand, cannot see the
+force of logical argument; cannot realize the absurdity or
+impossibility of error. He clings to his own beliefs, for the evidence
+of his perverted senses or the deductions from his disease-irritation
+are very real to him. When we find this to be the fact we know he is
+insane.</p>
+
+<p>Yet we must not confound delirium of fever with insanity. A patient
+suffering from typhoid fever may have a delusion that there is a pail
+by his bed into which he persists in throwing articles. Or he may have
+the hallucination that he is being called into the next room, and try
+to obey the supposed voice.</p>
+
+<p>Certain delusions are commonly found in certain<span class="pagenum"><a name="Page_234" id="Page_234">[Pg 234]</a></span> types of insanity.
+Depressed patients frequently manifest the delusion that they have
+committed a great sin, and are unfit to associate with anyone. Excited
+and maniacal patients often believe they are important
+personages&mdash;kings or queens, old historical celebrities, etc.
+Paranoiacs commonly have delusions of persecution and of a conspiracy
+among their relatives or their associates or rivals. Victims of
+alcoholic insanity have delusions regarding sexual matters, and
+generally charge with infidelity those to whom they are married.
+General paretics in most cases have delusions of grandeur; that is,
+false ideas of great strength, wealth, political power, beauty, etc.</p>
+
+<p>The emotion which accompanies mental activity is generally exaggerated
+in all insane people except the demented. One sees extreme depression,
+or undue elation and exaltation, or silly glee and absurd joy.
+Intensity of emotion is frequent.</p>
+
+
+<h4><em>Crimes Impulsively Committed by the Insane</em></h4>
+
+<p>An interesting mental feature of many insane patients is the
+imperative conception, or imperative impulse. This is a strong urging
+felt by the patient to commit a certain act. He may know the act is
+wrong and dread the punishment which he expects will follow its
+commission. But so constantly and strongly is he impelled that he
+finally yields and commits the act. Crimes are thus perpetrated by the
+insane, with a full<span class="pagenum"><a name="Page_235" id="Page_235">[Pg 235]</a></span> knowledge of their enormity. The fact that such
+impulses undoubtedly exist should modify the common test, as to an
+insane person's responsibility before the law. The statute in many
+countries regards an insane criminal as responsible for his act, if he
+knows the difference between right and wrong. This decision is unjust
+and the basis is wrong; for an impulse may be overwhelming, and the
+patient utterly helpless during its continuance. However, a patient
+who has committed a crime under stress of such an irresistible impulse
+should be put under permanent custodial care.</p>
+
+
+<h4><em>Physical Signs of Insanity</em></h4>
+
+<p>The physician who is skilled in psychiatry finds in very many insane
+patients marked physical signs. There are pains, insensitive areas,
+hypersensitive areas, changes in the pupils of the eyes, unrestrained
+reflex action, and partial loss of muscular control, as shown in
+talking, walking, and writing. Constipation and insomnia are very
+early symptoms of disease in a very large proportion of the insane.</p>
+
+<p>It is productive of no good result for a layman to try to classify the
+insane. The matter of classification will be for several years in a
+condition of developmental change. It is enough to speak of the
+patient as depressed or excited, agitated or stupid, talkative or
+mute, homicidal, suicidal, neglectful, uncleanly in personal habits,
+etc.</p>
+
+
+<p><span class="pagenum"><a name="Page_236" id="Page_236">[Pg 236]</a></span></p>
+<h4><em>Illustrations of Various Types</em></h4>
+
+<p>There are very interesting features connected with typical instances
+of several varieties of insanity, as they were noted in certain cases
+under the writer's care. A depressed patient with suicidal tendencies
+cherished the delusion that war with Great Britain was imminent, and
+that in such an event British troops would be landed on Long Island
+between New York City and the spot where he conceived the cattle to be
+kept. This, he argued, would cut off the beef and milk supply from the
+city. He therefore decided to do his part toward husbanding the
+present supply of food by refusing to eat; an act which necessitated
+feeding him through a rubber tube for many weeks. He also attempted
+suicide by drowning, throwing himself face downward in a shallow
+swamp, whence he was rescued. This young man was an expert chess
+player even during his attack.</p>
+
+<p>A maniacal patient wore on her head a tent of newspaper to keep the
+devil from coming through the ceiling and attacking her. She
+frequently heard her husband running about the upper floor with the
+devil on his back. As a further precaution she stained her gray hair
+red with pickled beet juice, and would occasionally hurl loose
+furniture at the walls and ceilings of her rooms and assault all who
+approached her.</p>
+
+<p>A man who presented a case of dementia pulled the hairs from his beard
+and planted them in rows in the garden, watering them daily, and
+showing much aston<span class="pagenum"><a name="Page_237" id="Page_237">[Pg 237]</a></span>ishment that they did not grow. He spent hours each
+day in spelling words backward and forward, and also by repeating
+their letters in the order in which they appear in the alphabet. When
+he wanted funds he signed yellow fallen leaves with a needle, and they
+turned into money.</p>
+
+<p>A case of general paresis (commonly though improperly called
+"softening of the brain") passed into the second stage as a delusion
+was uppermost to the effect that there was opium everywhere; opium in
+his hat, opium in his newspaper, opium in his bath sponge, opium in
+his food. He thereupon refused to eat, and was fed with a tube for two
+years, at the end of which time he resumed natural methods of
+nutrition and ate voraciously. Another general paretic promised to his
+physician such gifts as an ivory vest with diamond buttons, boasted of
+his great strength while scarcely able to walk alone, and declared he
+was a celebrated vocalist, while his lips and tongue were so tremulous
+he could scarcely articulate.</p>
+
+
+<h4><em>Fixed Delusions of Paranoia</em></h4>
+
+<p>Paranoia is an infrequent variety of insanity in which the patient is
+dominated by certain fixed delusions, while for a long time his
+intellect is but slightly impaired. The delusions are usually
+persecutory, and the patient alleges a conspiracy. He is generally
+deluded with the belief that he is a prominent person in<span class="pagenum"><a name="Page_238" id="Page_238">[Pg 238]</a></span> history, or
+an Old Testament worthy, and there is usually a religious tinge to his
+delusions. A patient of the writer believed himself to be the
+reincarnation of Christ, appearing as "the Christ of the Jews and the
+Christ of the Christians" in one. Over the head of his landlord, who
+requested overdue rent, the patient fired a revolver, "to show that
+the reign of peace had begun in the world." He wrote a new bible for
+his followers, and arranged for a triumphal procession headed by his
+brother and himself on horseback, wearing white stars.</p>
+
+
+<h4><em>How the Physician Should Be Aided</em></h4>
+
+<p>When there is a suspicion of irrationality in a person's conduct, and
+certain acts or speeches suggest insanity, the whole surroundings and
+the past life must be considered. Frequently when the eyes are once
+opened to the fact of insanity, a whole chapter of corroborating
+peculiarities can be recalled. It is wise to recall as many of these
+circumstances as possible and note them in order as they occurred, for
+the use of the physician. Strikingly eccentric letters should be
+saved. Odd arrangement of clothes, or the collecting of useless
+articles, should be noted in writing. Changes in character, alteration
+in ideas of propriety, changes in disposition, business or social
+habits, and great variation in the bodily health should be noted in
+writing. Delusions, hallucinations, and illusions should be reported
+in full.<span class="pagenum"><a name="Page_239" id="Page_239">[Pg 239]</a></span> It conveys nothing to anyone's mind to say that the patient
+is queer; tell what he does or says that leads you to think he is
+queer, and let the physician draw his own inferences from the deeds or
+speeches. Write down, for example, that the patient talks as if
+answering voices that are imaginary; or that the patient brought an ax
+into the dining room and stood it against the table during the meal;
+or that he paraded up and down the lawn with a wreath of willow
+branches about his neck; in each case stating the actual fact. It is
+important to ascertain exactly what the patient's habits are, as to
+the use of alcoholic beverages, tobacco, and drugs (such as opium),
+and also as to sexual matters. To secure such information is extremely
+difficult, and the help of a close friend or companion will be
+necessary. After the mind begins to waver many a patient plunges into
+dissipation, though formerly a model of propriety.</p>
+
+
+<h4><em>The Causes of Insanity</em></h4>
+
+<p>The two great causes of insanity are heredity and stress or strain.
+Lunacy is not infrequent in children of epileptic, alcoholic, or
+insane parents, and those born of parents suffering from nervous
+disease frequently are in such condition that shock, intense emotion,
+dissipation, or exhausting diseases render them insane. Drinking
+alcoholic beverages is the most potent factor in the production of
+insanity. Mental strain, overwork, and worry come next. Adverse
+conditions, bereave<span class="pagenum"><a name="Page_240" id="Page_240">[Pg 240]</a></span>ment, business troubles, etc., rank third, equally
+with heredity. The arterial diseases of old age, epilepsy, childbirth
+(generally in the neurotic), change of life, fright and nervous shock,
+venereal diseases, sexual excesses or irregularities follow in the
+order named.</p>
+
+
+<h4><em>A Temperate, Virtuous Life the Best Preventive</em></h4>
+
+<p>To avoid insanity, therefore, one should lead a righteous,
+industrious, sensible life, preserve as much equanimity as possible,
+and be content with moderate pleasure and moderate success. In many
+cases, people who are neurotic from early youth are so placed that
+unusual demands are made upon them. Adversity brings necessity for
+overwork, duties are manifold, and responsibilities are heavy. In
+ignorance of the fact that they are on dangerous ground and driven by
+circumstances, they overwork, cut short their sleep, and,
+conscientiously pressing on, finally lose their mental balance and
+insanity is the result, a great calamity which is really no fault of
+theirs. Undoubtedly such is frequently the sad history; and for this
+reason, as well as for the general reason that the insane are simply
+ill, all insane should be cared for sympathetically. To consider the
+insane as constantly malevolent is a relic of the old-time, absurd
+belief that insane people were "possessed of the devil." It is no
+disgrace to be insane, and the feeling of chagrin at discovering
+disease of the brain in a relative is another absurdity. Avoid<span class="pagenum"><a name="Page_241" id="Page_241">[Pg 241]</a></span>ance of
+insanity should be studied with as much devotion as avoidance of
+tuberculosis. Yet there should be no detraction from the fact that the
+heredity is strong. No one should be allowed to marry who has been
+insane, for the offspring of the insane are defective.</p>
+
+<p>The tendency of the times is toward nervous and mental disorder. In
+the large cities the strain is too constant, the struggle is too keen,
+the pace is too swift. Haste to be rich, desire to appear rich, or
+ambition for social distinction has wrecked many a bright, strong
+intellect. This is the age of the greatest luxury the world has ever
+seen, and a large proportion of people in cities are living beyond
+their means, in the gratification of luxurious desires or the effort
+to appear as well as others. Stress and strain are voluntarily
+invited. Children are pushed in their studies and overloaded with too
+many subjects. Genius and insanity, worry and dementia, proceed among
+us hand in hand; the overwrought brain finally totters.</p>
+
+
+<h4><em>False Ideas Regarding Insanity</em></h4>
+
+<p>Curious ideas regarding insanity are common, and are apparently
+fostered by the reportorial writers of the daily papers. We read of
+people who are "insane on a subject." This is an impossibility. Many
+people can be drawn out and led into a betrayal of their mental
+condition only when a certain topic or idea is discussed. But although
+exhibiting their insane condition only<span class="pagenum"><a name="Page_242" id="Page_242">[Pg 242]</a></span> when this topic is broached,
+they are in no respect sane. Not every act of an insane man is an
+insane act, we must remember. Forgetfulness of this fact leads to
+errors in the superficial. You will hear people say that a certain
+person must be sane, because during a half day's companionship nothing
+astray was noticed. True, there may be a long period of self-control,
+or of absence of test; but occasional conduct will establish the fact
+of constant insanity. Again, we hear the expression: "He cannot be
+insane; there is too much method in such madness." The answer to this
+silly remark is that there is method in all madness except some
+epileptic insanity and terminal dementia. Insane people prepare
+careful plans, with all the details thoroughly considered, and perfect
+methods to escape from hospitals with the greatest cunning. One must
+never take it for granted that the insane person is so demented
+mentally as to be unable to appreciate what is said and done. One
+should never talk about the insane man in his presence, but should
+include him in the conversation as if sane, as a general rule,
+allaying his suspicions and avoiding antagonism. Do not agree with the
+delusions of an insane person, except so far as may be necessary to
+draw them out. Yet avoid argument over them. Simply do not agree, and
+do not strengthen them by appearing to share them. His food should be
+prepared for him, and his medicines administered to him as to any
+other sick person. His baths should be regularly taken.</p>
+
+<p><span class="pagenum"><a name="Page_243" id="Page_243">[Pg 243]</a></span>A depressed patient should be very carefully watched. If the slightest
+suspicion of a suicidal impulse be present, the patient should never
+be left alone. Many a valuable life has been saved through the moral
+support of constant companionship; while we read very frequently of
+the death of an insane patient who sprang from a window during a brief
+period of relaxation of watchful care. Some people think it a
+protection to one insane to elicit from him a promise not to be
+depressed, and not to do anything wrong. One might as well secure a
+promise not to have a rise of temperature. The gloom of despondency
+and the suicidal impulse are as powerful as they are unwelcome and
+unsought; and the wretchedly unhappy patient cannot alone meet the
+issue and resist.</p>
+
+<p>It is unreasonable to be offended by acts or speeches of an insane
+patient, to bear a grudge or expect an apology. Very frequently such a
+patient will turn savagely upon the nearest and dearest, and make
+cutting remarks and accusations or exhibit baseless contempt. All this
+conduct must be ignored and forgotten; for the unkind words of an
+unaccountable and really ill person should not be taken at all
+seriously.</p>
+
+<p>Should a patient escape from home, it is the duty of the one in charge
+without hesitation to overtake him, and then accompany him or at least
+follow at a short distance. The nurse should go with and stay with the
+patient, telephoning or telegraphing home when opportunity offers, and
+finally securing aid; he<span class="pagenum"><a name="Page_244" id="Page_244">[Pg 244]</a></span> should know where the patient is at all
+times, foregoing sleep if necessary to protect his charge, and should
+avoid as long as prudence permits the publicity of an arrest; though
+the latter may finally be essential to safety, and to the prevention
+of embarking on a voyage, or taking a train to a distance, or
+purchasing weapons.</p>
+
+<p><strong>Diversions.</strong>&mdash;Music favorably affects many patients, so the pleasure of
+listening to it should be afforded at frequent intervals. Patients
+should be encouraged to absorb themselves in it. It is often possible
+to take insane people to opera, musical comedy, or concert. Vocal and
+instrumental practice at suitable intervals is of great value in
+fixing the attention, filling the mind with desirable thoughts and
+memories, and allaying irritability. Drawing and painting are of
+service when within the number of the patient's accomplishments.
+Intellectual pastimes, as authors, anagrams, billiards, chess, and
+many games with playing cards, are generally helpful. Gardening,
+croquet, and tennis are very desirable. Golf, rowing, swimming, and
+skating are excellent, but are within the reach of very few insane
+patients. All regular occupation that necessitates attention and
+concentration is of supreme value; in fact, insane patients not
+infrequently ask for occupation and find relief in the accomplishment
+of something useful, as well as in the healthful sleep and increased
+appetite that attend judicious physical fatigue.</p>
+
+
+<p><span class="pagenum"><a name="Page_245" id="Page_245">[Pg 245]</a></span></p>
+<h4><em>The Beneficial Atmosphere of Sanitariums</em></h4>
+
+<p>After caring for an insane patient for a time at home, the question
+arises as to the desirability of sending him away to a sanitarium.
+Generally this is a wise course to pursue. The constant association
+with an insane person is undermining; the responsibility is often too
+heavy; children, often inheriting the same neurotic tendency and
+always impressionable, should not be exposed to the perverting
+influence; it may not be safe to keep a patient with suicidal or
+homicidal impulses in his home; the surroundings amid which the insane
+ideas first started may tend to continue a suggestion of these ideas.
+Removal to strange locality and new scenes, the influence of
+strangers, the abandonment of all responsibilities and duties, and the
+atmosphere of obedience, routine, and discipline are all beneficial.
+An insane person will generally make a greater effort for a stranger
+than for a familiar relative. Discipline, in the form of orders of the
+physicians, and exact obedience is very often very salutary. There is
+a feeling with some that all discipline is cruel. This is not so, for
+the conduct of an insane person is not all insane, but frequently
+needs correction. Many cases of mental alienation improve promptly
+under custodial care, many need it all their lives. A great many cases
+of insanity are never obliged to go away from home, and there is a
+considerable number who carry on a business while still insane, rear a
+family, and take care of<span class="pagenum"><a name="Page_246" id="Page_246">[Pg 246]</a></span> themselves. In general, a depressed patient
+should be kept at home as long as there is absolute safety in so
+doing. Most other forms of mental disease progress more rapidly toward
+recovery in sanitariums or hospitals equipped for such patients.
+Prospects of recovery are never jeopardized by confinement in a proper
+institution. Mental and physical rest, quiet, regularity of eating,
+exercising, and sleeping are the essentials which underlie all
+successful treatment of these cases. Dietetics, diversion by means of
+games, music, etc., regular occupation of any practicable sort,
+together with the association with the hopeful, tactful, and reasoning
+minds of physicians and nurses trained for this purpose are of great
+value. It must be remembered that in wholly civilized localities
+madhouses have been replaced by hospitals, keepers have been replaced
+by nurses and attendants, and the old methods of punishment and
+coercion have been long since abandoned, in the light of modern
+compassionate custody.</p>
+
+<p>Certain forms of insanity are hopeless from the start. Few recover
+after two years of mental aberration. Omitting the hopeless cases,
+over forty per cent of the cases of insanity recover. About sixty per
+cent recover of the cases classed as melancholia and mania. Most
+recoveries occur during the first year of the disease; but depressed
+patients may emerge and recover after several years' treatment.</p>
+
+
+<div class="footnotes"><h4>FOOTNOTES:</h4>
+
+<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> Caution. Dangerous. Use only on physician's order.</p></div>
+</div>
+
+
+<div class="section_break"></div>
+<p><span class="pagenum"><a name="Page_247" id="Page_247">[Pg 247]</a></span></p>
+<h3>APPENDIX</h3>
+
+<p class="chapter_head"><strong>Patent Medicines</strong><a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a></p>
+
+
+<p>The term "patent medicine" is loosely used to designate all remedies
+of a secret, non-secret, or proprietary character, which are widely
+advertised to the public. This use of the name is erroneous, and it is
+better first to understand the exact difference between the different
+classes of medicines generally comprised under this heading. Only in
+this way can one comprehend their right and wrong use.</p>
+
+<p><strong>A Patent Medicine</strong> is a remedy which is patented. In order to secure
+this patent, an exact statement of the ingredients and the mode of
+manufacture must be filed with the government. These true "patent
+medicines" are generally artificial products of chemical manufacture,
+such as phenacetin. The very fact of their being patented makes them
+non-secret, and if an intelligent idea is held of their nature and
+mode of action, they may be properly used. Physicians with a full
+knowledge of their uses, limitations, and dangers often, and
+legitimately, prescribe them, and thus used they are<span class="pagenum"><a name="Page_248" id="Page_248">[Pg 248]</a></span> the safest and
+most useful of all drugs and compounds of this class.</p>
+
+<p><strong>A Nostrum.</strong>&mdash;The Century Dictionary defines a nostrum as "a medicine
+the ingredients of which, and the methods of compounding them, are
+kept secret for the purpose of restricting the profits of sale to the
+inventor or proprietor." Some nostrums have stated, on their label,
+the names of their ingredients, but not the amount. There has been no
+restriction upon their manufacture or sale in this country, therefore
+the user has only the manufacturer's statement as to the nature of the
+medicine and its uses, and these statements, in many instances, have
+been proved utterly false and unreliable.</p>
+
+<p><strong>A Proprietary Medicine</strong> is a non-secret compound which is marketed
+under the maker's name. This is usually done because the manufacturer
+claims some particular merit in his product and its mode of
+preparation, and as these drugs are perfectly ethical and largely used
+by physicians, it is to the maker's interest to maintain his
+reputation for the purity and accuracy of the drug. Familiar instances
+of this class are: Squibb's Ether and Chloroform, and Powers &amp;
+Weightman's Quinine.</p>
+
+<p>From the above definition it may be seen that the only unreliable
+medicines are those which are, in reality, nostrums. In regard to all
+of these medicines the following rules should be observed:</p>
+
+<p><em>First.</em>&mdash;Don't use any remedy that does not show its formula on the
+label.</p>
+
+<p><span class="pagenum"><a name="Page_249" id="Page_249">[Pg 249]</a></span><em>Second.</em>&mdash;No matter what your confidence in the medicine, or how
+highly recommended it is, consult a physician before using very much
+of it.</p>
+
+<p><em>Third.</em>&mdash;Take no medicine internally without a physician's advice.</p>
+
+<p>Throughout this chapter the word "patent medicine" will be used in its
+widely accepted form, in the everyday sense, without regard to its
+legal definition, and will be held to include any of the
+above-mentioned classes, unless a direct statement is made to the
+contrary.</p>
+
+<p>In Germany the contents of patent medicines are commonly published,
+and in this country, notably in Massachusetts, the State Boards of
+Health are analyzing these preparations, and making public their
+findings. In North Dakota a law has been passed which requires that a
+proprietary medicine containing over five per cent of alcohol, or any
+one of a number of specified drugs, be labeled accordingly.</p>
+
+
+<p class="section"><strong>PURE FOOD BILL.</strong>&mdash;A far-reaching and important step, in the movement
+for reform of patent medicines and for the protection of the public,
+has now been taken by the United States Government. On June 30, 1906,
+an act was approved forbidding the manufacture, sale, or
+transportation of adulterated, misbranded, or poisonous or deleterious
+foods, drugs, medicines, or liquors. This act regulates interstate
+commerce in these articles, and went into effect January 1, 1907.
+Section 7 of this act states:</p>
+
+<div class="blockquot"><p><span class="pagenum"><a name="Page_250" id="Page_250">[Pg 250]</a></span>"That for the purposes of this Act an article shall be deemed to
+be adulterated: in case of drugs:</p>
+
+<p>"<em>First.</em> If, when a drug is sold under or by a name recognized in
+the United States Pharmacop&oelig;ia or National Formulary, it
+differs from the standard of strength, quality, or purity, as
+determined by the test laid down in the United States
+Pharmacop&oelig;ia or National Formulary official at the time of
+investigation; <em>Provided</em>, that no drug defined in the United
+States Pharmacop&oelig;ia or National Formulary shall be deemed to be
+adulterated under this provision if the standard of strength,
+quality, or purity be plainly stated upon the bottle, box or other
+container thereof although the standard may differ from that
+determined by the test laid down in the United States
+Pharmacop&oelig;ia or National Formulary.</p>
+
+<p>"<em>Second.</em> If its strength or purity fall below the professed
+standard or quality under which it is sold." </p></div>
+
+<p>Section 8 states that a drug shall be deemed misbranded:</p>
+
+<div class="blockquot"><p>"<em>First.</em> If it be an imitation of or offered for sale under the
+name of another article.</p>
+
+<p>"<em>Second.</em> If it (the package, bottle or box) fails to bear a
+statement on the label of the quantity or proportion of any
+alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine,
+chloroform, cannabis indica, chloral hydrate, or acetanilid, or
+any derivative or preparation of any such substances contained
+therein." </p></div>
+
+<p>What are the motives which impel persons to buy and use patent
+medicines? The history of medicine offers a partial explanation. In
+somewhat remote times we find that the medicines in use by regular
+physicians were of the most vile, nauseating, and powerful nature. We
+read of "purging gently" with a teaspoonful of calomel. Then during
+the wonderful progress of scientific medicine, beginning a little more
+than a half century ago, the most illustrious and use<span class="pagenum"><a name="Page_251" id="Page_251">[Pg 251]</a></span>ful workers were
+so busily engaged in finding the causes of disease and the changes
+wrought in the various organs, in observing the noticeable symptoms
+and in classifying and diagnosticating them, that treatment was given
+but scant attention. This was nowhere more noticeable than in Germany,
+the birthplace, home, and world-center of scientific medicine, to
+which all the medical profession flocked. Patients became simply
+material which could be watched and studied. This was an exemplary
+spirit, but did not suit the patients who wanted to be treated and
+cured. This fact, together with the peculiar wording of the laws
+regulating the practice of medicine, which allow anyone with the
+exception of graduates to treat patients, but not to prescribe or
+operate upon them, accounts for the number of quacks in Germany.</p>
+
+<p>Dr. Jacobi states that "there is one quack doctor to every two regular
+physicians in Saxony and Bavaria."<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a></p>
+
+<p>Another cause for the use of patent medicines is mysticism. Ignorance
+is the mother of credulity. It is reported<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a> that Cato, the elder,
+recommended cabbages as a panacea for all sorts of ills, that he
+treated dislocations of the limbs by incantations, and ordered the
+Greek physicians out of Rome. The ignorant are greatly influenced by
+things that they cannot understand. Therefore, as the mass of people
+are utterly ignorant of the changes in structure and function of<span class="pagenum"><a name="Page_252" id="Page_252">[Pg 252]</a></span> the
+body caused by disease, and also the limitations of medicines in their
+power of healing such alterations, their belief in the mysterious
+power said to attach to patent medicines is not surprising. When
+testimonials of the efficacy of patent medicines purporting to come
+from respectable divines, merchants, and statesmen are offered, the
+proof of their power seems incontestable.</p>
+
+<p>Economy and convenience are added incentives to the employment of
+patent medicines. This method of saving the doctor's fee is engendered
+by those physicians who themselves write prescriptions for nostrums.
+"Why not, indeed, eliminate this middleman (the doctor) and buy the
+nostrums direct?" So say the unthinking. But what doctor worthy of the
+name would prescribe a medicine the composition of which he was
+ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it,
+what would be thought of a banker or financial adviser who recommended
+his client to buy a security simply on the recommendation of the
+exploiter of the security? Yet that is exactly the position of a
+doctor who recommends a nostrum.</p>
+
+<p>In view of the fact, therefore, that persons of undoubted intelligence
+are in the habit of purchasing and using remedies of this character
+and since many of the most widely advertised preparations are
+extremely harmful, even poisonous, we have taken the liberty of
+pointing out a few "danger signals," in the guise of extravagant
+assertions and impossible claims, which<span class="pagenum"><a name="Page_253" id="Page_253">[Pg 253]</a></span> are characteristic signs of
+the patent medicines to be avoided.</p>
+
+
+<p class="section"><strong>DANGER SIGNALS.</strong>&mdash;There are many picturesque and easily grasped
+features in the literature, labels, and advertising of patent
+medicines that spell danger. When these features are seen, the
+medicine should be abandoned immediately, no matter what your friends
+tell you about it, or how highly recommended it may have been by
+others than your physician.</p>
+
+<p><strong>Claiming a Great Variety of Cures.</strong>&mdash;Perhaps of all features of patent
+medicine advertising, this is the most alluring. No one drug or
+combination of drugs, with possibly one or two exceptions, can or does
+"cure" any disease. Patients recover only when the resistance of the
+body is greater than the strength of the disease. This body resistance
+varies in different persons, and is never just alike in any two
+individuals or illnesses. The patient must be treated and not the
+disease, so it is the aim of every conscientious physician to conserve
+and strengthen the vital forces and, at the same time, guard against
+further encroachment of the disease. There is no cure-all, and even if
+a drug or combination of drugs were helpful in any single case, they
+might easily be totally unsuited, or even harmful, in another case,
+with apparently similar symptoms. When a maker claims that his
+particular concoction will cure a long list of diseases, the assertion
+bears on its face evidence of its falsity.</p>
+
+<p><span class="pagenum"><a name="Page_254" id="Page_254">[Pg 254]</a></span>One of the most widely advertised and largely sold catarrh remedies
+claims to cure pneumonia, consumption, dyspepsia, enteritis,
+appendicitis, Bright's disease, heart disease, canker sores, and
+measles. <em>This is absolute fraud.</em> No matter what virtues this
+medicine might have in the treatment of one or two ailments, no one
+remedy could possibly be of service in such a varied list of diseases,
+and it could not "cure" one of them.</p>
+
+<p>Another remedy bases its assertion of "cures" on the fact that it
+claims to be a germ killer, and assumes that all disease is caused by
+germs. To quote from its advertising literature, it claims to cure
+thirty-seven diseases which are mentioned by name, and then follows
+the assertion that it cures "all diseases that begin with fever, all
+inflammations, all catarrhal contagious diseases, all the results of
+impure or poisoned blood. In nervous diseases&mdash;acts as a vitalizer,
+accomplishing what no drugs can do." It would seem that an intellect
+of any pretensions would recognize the fraudulent nature of this
+claim, yet thousands of bottles of this stuff are annually sold to a
+gullible public. These wide and unjustifiable claims are real danger
+signals, and any medicine making them should be avoided. There are
+many other remedies for which just as great claims are made; the two
+instances cited are merely representative of a large class. It is a
+waste of time, money, and health to buy them with any idea that they
+can fulfill their pretensions.</p>
+
+<p><span class="pagenum"><a name="Page_255" id="Page_255">[Pg 255]</a></span><strong>Claiming to Cure Headaches.</strong>&mdash;The use of any "headache powders" or
+"tablets" should be avoided, except on the advice of a physician. The
+presence of pain in the head, or in any other part of the body, may be
+a symptom of a serious and deep-seated disorder, and it may often be a
+serious matter to temporize with it. At the best, these "pain
+relievers" can give only temporary relief, and their use may prove to
+be dangerous in the extreme. Their action is dependent upon one of the
+modern coal-tar products, usually acetanilid, because it is the
+cheapest. But, unfortunately, acetanilid is also the one with the most
+depressant action on the heart. The danger of headache powders lies in
+the habit which they induce, because of their quick pain-relieving
+qualities and their easy procurability, and from overdosage. If a
+person is otherwise in good health, the use of one headache powder
+will in all probability do no harm, but the dose should not be
+repeated without a doctor's authority. Many deaths have occurred from
+their continued use, or because of an idiosyncrasy on the part of the
+taker, but it is their abuse more than their use which has brought
+upon them such almost universal condemnation. Therefore, while the
+physician may advocate their use, do not take them without his advice
+and specific directions as to kind and dosage.</p>
+
+<p><strong>Claiming Exhilaration.</strong>&mdash;These medicines, by their insidious character,
+constitute a particularly dangerous variety. They depend, for their
+effect, upon the<span class="pagenum"><a name="Page_256" id="Page_256">[Pg 256]</a></span> amount of alcohol that they contain. Many
+conscientious temperance workers have not only unsuspectingly taken
+them, but have actually indorsed them. Recently the published analyses
+of several State Boards of Health and the investigations made by
+Samuel Hopkins Adams, and published in his series on "The Great
+American Fraud" have shown that a majority of the "tonics,"
+"vitalizers," and "reconstructors" depend for their exhilarating
+effect upon the fact that they contain from seventeen to fifty per
+cent of alcohol; while beer contains only five per cent, claret eight
+per cent, and champagne nine per cent. Pure whisky contains only fifty
+per cent of alcohol, yet few people would drink "three wineglassfuls
+in forty-five minutes"<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a> as a medicine pure and simple. The United
+States Government has prohibited the sale of one of these medicines to
+the Indians, simply on account of the fact that as an intoxicant it
+was found too tempting and effective.<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a></p>
+
+<p>If one must have a stimulant it is better to be assured of its purity.
+These medicines are not only costly, but contain cheap, and often
+adulterated, spirits.</p>
+
+<p>Their worst feature is that they often induce the alcoholic habit in
+otherwise upright people. Commencing with a small dose, the amount is
+gradually increased until the user becomes a slave to drink. Could the
+true history of these widely used medicines be written, it would
+undoubtedly show that many<span class="pagenum"><a name="Page_257" id="Page_257">[Pg 257]</a></span> drunkards were started on their downward
+career by medicinal doses of these "tonics" and "bracers."</p>
+
+<p><strong>Claiming Pain-relieving or Soothing Qualities.</strong>&mdash;The properties of this
+class of remedies depend generally upon the presence of cocaine,
+opium, or some equally subtle and allied substance. It should be
+needless to state that such powerful drugs should be taken only upon a
+physician's prescription. Habit-forming and insidious in character,
+they are an actual menace. When present in cough syrups, they give by
+their soothing qualities a false sense of security, and when present
+in "soothing syrups" or "colic cures" for babies, they may be given
+with fatal result. Never take a medicine containing these drugs
+without a full understanding of their dangerous character, and a
+realization of the possible consequences.</p>
+
+<p><strong>Testimonials.</strong>&mdash;These may mean anything or nothing; generally the
+latter. They are usually genuine, but, as Mr. Adams observes, "they
+represent, not the average evidence, but the most glowing opinions
+which the nostrum-vender can obtain, and generally they are the
+expression of a low order of intelligence."<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a> It is a sad commentary
+on many men and women, prominent in public life, that they lend their
+names and the weight of their "testimony" to further the ends of such
+questionable ventures. Political and newspaper interests are
+responsible for the collection of this class of testimonials. An
+investigation of some men,<span class="pagenum"><a name="Page_258" id="Page_258">[Pg 258]</a></span> who permitted the use of their names for
+this purpose, revealed that many of them had never tasted the
+compound, but that they were willing to sign the testimonials for the
+joy of appearing in print as "prominent citizens."<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a> "Prominent
+ministers" and "distinguished temperance workers" are often cited as
+bearing testimony to the virtues of some patent medicine. It has been
+shown that, while the testimonials were real, the people who signed
+them had little right of credence, and were possessed of characters
+and attributes which would show their opinions to be of little value.
+Money and energy can be productive of any number of testimonials for
+any remedy. While some of them may be authentic, yet the fact that a
+medicine "cured" any one of the signers is no evidence that it will
+cure or even help anyone else. Many people recover from diseases with
+no medicine at all, and isolated "cures" can never be taken as a
+criterion of the value of any remedy or method.</p>
+
+<p><strong>Offering "Money Back Unless Cured."</strong>&mdash;Careful reading of this clause in
+most advertising literature will show that there is "a string
+attached." The manufacturers are usually safe in making this
+proposition. In the first place, the average person will not put the
+matter to a test. The second reason why this is a safe proposition for
+the maker is, that if the medicine does not cure, the patient may die,
+and dead men are hardly possible claimants.</p>
+
+<p><span class="pagenum"><a name="Page_259" id="Page_259">[Pg 259]</a></span><strong>Claiming to Cure Diseases Incurable by Medicine Alone.</strong>&mdash;Probably no
+class of people are greater users of patent medicines than those
+unfortunates afflicted with the so-called incurable diseases. The very
+fact of the serious nature of their complaint, and the dread of
+surgical intervention, makes them easy victims to the allurement of
+"sure cures."</p>
+
+<p>The committee on the prevention of tuberculosis of the Charity
+Organization Society of New York City has announced in decided terms
+that there is no specific medication for consumption. Cancer,
+likewise, cannot be cured by the use of internal medicine alone.
+Surgery holds out the greatest hope in this dread disease. The
+medicines claiming to cure these diseases are, therefore, of the most
+fraudulent nature. Their use is positively harmful, for in taking them
+priceless time is lost.</p>
+
+<p>Never temporize if there is any suspicion of the existence of such
+diseases as consumption or cancer. Self-treatment with patent
+medicines in such cases is worse than useless&mdash;it is actually
+dangerous to life itself. Consult a physician at the earliest possible
+moment, and put no faith in patent medicines.</p>
+
+<p>There are, however, as has been pointed out, certain patent and
+proprietary medicines which may properly be employed by the physician.
+These include the newly discovered, manufactured chemicals of known
+composition and action; and single substances or combinations of known
+drugs in known proportions, which<span class="pagenum"><a name="Page_260" id="Page_260">[Pg 260]</a></span> can only be made to best advantage
+by those having the adequate facilities. The habit of prescribing
+proprietary mixtures of several substances for special diseases is,
+however, generally a matter of laziness, carelessness, or ignorance on
+the doctor's part. This follows because no disease is alike in any two
+patients; because any one disease has many phases and stages; and
+because a doctor should always treat the patient and not the disease.
+Thus a doctor, after carefully questioning and examining the patient,
+should adjust the remedy to the peculiarities of the patient and
+disease. It is impossible to make a given combination of drugs fit all
+patients with the same disease.</p>
+
+<p>The quantity of patent medicine sold in the United States is enormous.
+A series of articles by Samuel Hopkins Adams appeared in <em>Collier's
+Weekly</em> during 1905 and 1906, in which he not only showed the
+fraudulent character of many of the best-known patent medicines,
+giving their names and most minute details concerning them, but
+furnished much reliable information in an interesting and convincing
+manner. In the course of these articles he pointed out that about one
+hundred millions of dollars are paid annually for patent medicines in
+the United States. As explaining this, in part, he affirmed that as
+many as five companies each expended over one million dollars annually
+in advertising patent medicines.</p>
+
+<p><em>What Are the Good Ones Good For?</em>&mdash;In any<span class="pagenum"><a name="Page_261" id="Page_261">[Pg 261]</a></span> great movement, when a
+dormant public suddenly awakens to the fact that a fraud has been
+perpetrated or a wrong committed, the instinctive and overwhelming
+desire is for far-reaching reform. In efforts to obtain needed and
+radical improvement, and with the impetus of a sense of wrong dealing,
+the pendulum of public opinion is apt to swing too far in an opposite
+direction. There are bad patent medicines&mdash;the proof of their
+fraudulent character is clear and overwhelming; but there are good
+ones whose merits have been obscured by the cloud of wholesale and
+popular condemnation. It is true that the manufacturers of even some
+of the valuable ones have an absurd habit of claiming the impossible.
+This attitude is to be regretted, for the makers have thus often
+caused us to lose faith in the really helpful uses to which their
+products might be put.</p>
+
+<p>However, it is well in condemning the bad not to overlook the good.
+The mere fact that a medicine is patented, or that it is a so-called
+proprietary remedy, does not mean that it is valueless or actually
+harmful. The safety line is knowledge of the medicine's real nature,
+its uses and its dangers; the rules given above should be rigorously
+followed.</p>
+
+<p>It is far easier to give general indications for the guidance of those
+wishing to shun unworthy patent medicines than to enable the reader to
+recognize the worthy article. It is safe to assume, however, that
+there are certain simple remedies, particularly those<span class="pagenum"><a name="Page_262" id="Page_262">[Pg 262]</a></span> for external
+application, which have a definite use and are dependable. In justice
+it must be said that great improvement has taken place, and is now
+taking place in the ethical character of patent medicines, owing to
+recent agitation, and what is true concerning them to-day may not be
+true to-morrow.</p>
+
+<p>The only proper, ethical patent medicine is the one showing its exact
+composition, and refraining from promise of a cure in any disease.
+Such a one might, nevertheless, advertise its purity, reliability,
+advantageous mode of manufacture, and the excellence of its
+ingredients with more modest and truthful claims as to its use.</p>
+
+<p>The purchaser of a patent medicine pays not only for the ingredients,
+the cost of combining them, and the maker's just profit, but he also
+pays the exploiter's bills for advertising and distributing the
+finished product. With such standard remedies as those mentioned
+above, this added cost is usually a good investment for the purchaser,
+because trade-marked remedies which have "made good" possess two
+advantages over those less advertised, and over their prototypes in
+crude form: procurability and integrity.</p>
+
+<p>Even at remote cross-roads stores, it is possible to obtain a popular
+remedy, one which has been well pushed commercially. And an article
+sold in packages sealed by the makers gets to the consumer just as
+pure as when it left the laboratory. This is not always true of
+ingredients held in bulk by the retailer; witness the<span class="pagenum"><a name="Page_263" id="Page_263">[Pg 263]</a></span> evidence
+brought forward in recent prosecutions for drug adulteration.</p>
+
+<p>It is not the purpose of this chapter, in any sense, to advertise or
+place the seal of its unrestricted approval upon any one article of a
+class. Its position in the matter is absolutely impartial. But in
+order that it may be as helpful as possible, it definitely mentions
+the most widely known, and therefore the most easily obtainable,
+remedies. There are other equally good remedies in each case, but as
+it would be almost impossible to mention each individual remedy with
+similar virtues now on the market, the ones discussed must be taken as
+representative of their class in each instance.</p>
+
+<p>Do not forget that the use of these simple remedies does not justify
+their abuse. They may make great claims while their use is really
+limited. Do not rely upon them to do the impossible.</p>
+
+<p><strong>Vaseline.</strong>&mdash;This is pure and refined petroleum, and will be found of
+much service in many forms of skin irritation. It is useful in the
+prevention of "chapping," for softening rough skin, for preventing and
+healing bleeding and cracked lips, as a protective dressing in burns,
+cuts, or any acute inflammation of the skin where the cuticle has been
+injured or destroyed, or where it is desirable that a wound should be
+protected and kept closed from the air. Rubbed over the surface of the
+body when a patient is desquamating or "peeling" after scarlet fever
+or measles, it keeps the skin smooth, soothes the itching, and
+prevents the<span class="pagenum"><a name="Page_264" id="Page_264">[Pg 264]</a></span> scales from being carried about in the air and so
+infecting others. Vaseline is a soothing, nonirritating, and bland
+protective ointment for external use. It is perfectly harmless, but
+should not be used for severe skin disease or for internal use, unless
+recommended by a physician in conjunction with other means of healing.</p>
+
+<p><strong>Pond's Extract.</strong>&mdash;Although the makers have claimed special virtues for
+this remedy, it is in reality an extract of hamamelis or witch-hazel,
+and probably differs little in its application or results from the
+ordinary marketed extract made by the average druggist. It is mild and
+bland, harmless when used externally, but should not be used
+internally unless ordered by a physician. It is soothing and healing
+when applied to wounds, sprains, and bruises; diluted with water it is
+a pleasant gargle for a sore throat, and may be applied externally on
+the throat by means of a flannel wrung out in a solution of it in hot
+water. For nosebleed it is often efficient when snuffed up the nose,
+or when pledgets of cotton are soaked in it and placed in the
+nostrils. It may be used as an application in ulcers or varicose
+veins, and from two to four teaspoonfuls with an equal amount of water
+injected into the rectum two or three times daily will often prove of
+great help in piles, particularly if bleeding. It gives relief when
+used for sore or inflamed eyes or eyelids, but in this, as in all
+other serious inflammations, it is not a "cure all," and the physician
+should be consulted if the relief is not prompt.</p>
+
+<p><span class="pagenum"><a name="Page_265" id="Page_265">[Pg 265]</a></span><strong>Listerine.</strong>&mdash;Of the many mild liquid antiseptics "Listerine" is
+probably the best known. The remarks and recommendations concerning
+it, however, are equally applicable to many other remedies of a
+somewhat similar nature, such as glycothymoline, borolyptol, lythol,
+alkalol, formalid, etc.</p>
+
+<p>Listerine is a solution of antiseptic substances with the addition of
+thymol and menthol in quantities sufficient to give it a pleasant odor
+and taste. It has a very strong hold on the public, and is a
+deservedly useful remedy.</p>
+
+<p>Listerine has many helpful uses. It is potent enough to kill many
+germs, and is excellent for this purpose when used as a mouth wash,
+particularly during illness. In acute cold in the head it is soothing
+to the mucous membrane of the nose, if used diluted with warm water as
+a nasal douche. It serves a similar purpose when used as a gargle in
+mild sore throat.</p>
+
+<p>If there is any reason to suspect that dirt or other foreign matter
+has come in contact with a sore or cut, the wound may be freely washed
+with a solution of listerine in order to clean it and render it as
+nearly aseptic as possible. When there are distinct signs of
+inflammation it should not be relied upon. Do not use it internally
+without a physician's advice.</p>
+
+<p><strong>Scott's Emulsion.</strong>&mdash;This is a good emulsion of cod-liver oil, widely
+prescribed by physicians for the many patients who are too
+delicate-stomached to retain the<span class="pagenum"><a name="Page_266" id="Page_266">[Pg 266]</a></span> pure oil. For those who can take the
+refined oil straight, Peter Möller's brand is in a class by itself.</p>
+
+<p>In certain conditions cod-liver oil is one of the most valuable
+remedies known. As a concentrated and reconstructive food in many
+wasting diseases it is of great service. Weak and puny children, and
+all suffering from malnutrition may take it with benefit. It does help
+produce flesh, increase strength, and add to the body's resisting
+powers. It does not contain any medicinal properties, and its virtue
+is largely in its fat or oil, but as an aid to other remedies, or
+alone, when increased nutrition is desired, it is a reliable and
+helpful remedy.</p>
+
+<p><strong>Antiphlogistine.</strong>&mdash;There are many clay poultices on the market:
+antiphlogistine, antithermoline, cretamethyl, sedol, unguentum,
+yorkelin, and the Emplastrum Kaolini of the U. S. Pharmacop&oelig;ia.
+Antiphlogistine, being probably the most widely known, is here
+discussed. It is of value when a poultice is indicated. It is
+preferable to the homemade varieties in that it retains heat for a
+longer period of time and is antiseptic.</p>
+
+<p>It should never be used in deep-seated inflammations, such as
+peritonitis, appendicitis, deep abscesses of any part of the body, or
+other serious conditions, unless recommended by a physician; for such
+ailments need more thorough treatment than can be afforded by any
+poultice. It is perfectly harmless, and may be used with decided
+benefit in aborting or preventing many inflammatory diseases. Applied
+in the early<span class="pagenum"><a name="Page_267" id="Page_267">[Pg 267]</a></span> stages of a boil, felon, or carbuncle it may either
+abort the trouble or, if the disease has already progressed too far,
+it will hasten suppuration and shorten the course of the disease. When
+a poultice is indicated in bronchitis or pleurisy it is an excellent
+one to use; it will afford much comfort, and often hasten recovery. In
+nursing mothers, when the breasts become full and tender and signs of
+beginning inflammation are present, antiphlogistine spread in a warm
+and thick coat over the breasts will often afford relief.</p>
+
+<p><strong>Platt's Chlorides.</strong>&mdash;When it is desirable to use a liquid disinfectant
+Platt's Chlorides will be found a useful article, as will lysol and
+other marketed products. The source of a foul smell or dangerous
+infection should never be overlooked. No disinfectant can offer a
+safeguard if plumbing is defective, or other unsanitary conditions
+exist; in fact, disinfectants are often deprecated, since they afford
+a false sense of security. If a contagious disease exists in a
+household, other means than the use of a disinfectant must be taken in
+order to prevent the spread of the contagion. Disinfectants do have
+their uses, however, and are often essential. In case of an illness of
+a contagious or infectious nature, a solution of Platt's Chlorides or
+a similar disinfectant should be kept in all vessels containing or
+receiving discharges from the body. Pails containing such a solution
+should be in readiness to receive all cloths, bedding, or washable
+clothes which have come, in any way, in contact with the patient.</p>
+
+
+<div class="footnotes"><h4>FOOTNOTES:</h4>
+
+<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> The publishers announce this chapter as prepared
+independent of Dr. Winslow or any of the Advising Editors. Considered
+as an effort to give helpful information, free of advertising on the
+one hand and sensational exposures on the other, the article meets
+with the approval of conservative physicians. But the problems dealt
+with are too involved at present for discussion direct from the
+profession to the public.</p></div>
+
+<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.</p></div>
+
+<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Ibid.</p></div>
+
+<div class="footnote"><p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> S. H. Adams, "The Great American Fraud."</p></div>
+
+<div class="footnote"><p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> Ibid.</p></div>
+
+<div class="footnote"><p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> S. H. Adams, "The Great American Fraud."</p></div>
+
+<div class="footnote"><p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> S. H. Adams, "The Great American Fraud."</p></div>
+</div>
+
+
+<div class="section_break"></div>
+<div id="trannote">
+<h2>TRANSCRIBER'S NOTE.</h2>
+
+<p>The prescription symbol has been transcribed as R<sub>x</sub>.</p>
+</div>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of The Home Medical Library, Volume II
+(of VI), by Various
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@@ -0,0 +1,7158 @@
+Project Gutenberg's The Home Medical Library, Volume II (of VI), by Various
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Home Medical Library, Volume II (of VI)
+
+Author: Various
+
+Editor: Kenelm Winslow
+
+Release Date: January 31, 2009 [EBook #27944]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK THE HOME MEDICAL LIBRARY ***
+
+
+
+
+Produced by Juliet Sutherland, Chris Logan and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+
+
+                           The Home Medical
+                               Library
+
+                                  By
+
+                     KENELM WINSLOW, B.A.S., M.D.
+
+   _Formerly Assistant Professor Comparative Therapeutics, Harvard
+           University; Late Surgeon to the Newton Hospital;
+          Fellow of the Massachusetts Medical Society, etc._
+
+                 With the Cooperation of Many Medical
+              Advising Editors and Special Contributors
+
+                            IN SIX VOLUMES
+
+        _First Aid :: Family Medicines :: Nose, Throat, Lungs,
+           Eye, and Ear :: Stomach and Bowels :: Tumors and
+             Skin Diseases :: Rheumatism :: Germ Diseases
+            Nervous Diseases :: Insanity :: Sexual Hygiene
+            Woman and Child :: Heart, Blood, and Digestion
+                 Personal Hygiene :: Indoor Exercise
+             Diet and Conduct for Long Life :: Practical
+                    Kitchen Science :: Nervousness
+                and Outdoor Life :: Nurse and Patient
+                    Camping Comfort :: Sanitation
+                       of the Household :: Pure
+                      Water Supply :: Pure Food
+                          Stable and Kennel_
+
+                               NEW YORK
+
+                    The Review of Reviews Company
+
+                                 1907
+
+
+
+
+Medical Advising Editors
+
+
+Managing Editor
+
+ALBERT WARREN FERRIS, A.M., M.D.
+
+_Former Assistant in Neurology, Columbia University; Former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, New International Encyclopedia._
+
+
+Nervous Diseases
+
+CHARLES E. ATWOOD, M.D.
+
+_Assistant in Neurology, Columbia University; Former Physician, Utica
+State Hospital and Bloomingdale Hospital for Insane Patients; Former
+Clinical Assistant to Sir William Gowers, National Hospital, London._
+
+
+Pregnancy
+
+RUSSELL BELLAMY, M.D.
+
+_Assistant in Obstetrics and Gynecology, Cornell University Medical
+College Dispensary; Captain and Assistant Surgeon (in charge),
+Squadron A, New York Cavalry; Assistant in Surgery, New York
+Polyclinic._
+
+
+Germ Diseases
+
+HERMANN MICHAEL BIGGS, M.D.
+
+_General Medical Officer and Director of Bacteriological Laboratories,
+New York City Department of Health; Professor of Clinical Medicine in
+University and Bellevue Hospital Medical College; Visiting Physician
+to Bellevue, St. Vincent's, Willard Parker, and Riverside Hospitals._
+
+
+The Eye and Ear
+
+J. HERBERT CLAIBORNE, M.D.
+
+_Clinical Instructor in Ophthalmology, Cornell University Medical
+College; Former Adjunct Professor of Ophthalmology, New York
+Polyclinic; Former Instructor in Ophthalmology in Columbia University;
+Surgeon, New Amsterdam Eye and Ear Hospital._
+
+
+Sanitation
+
+THOMAS DARLINGTON, M.D.
+
+_Health Commissioner of New York City; Former President Medical Board,
+New York Foundling Hospital; Consulting Physician, French Hospital;
+Attending Physician, St. John's Riverside Hospital, Yonkers; Surgeon
+to New Croton Aqueduct and other Public Works, to Copper Queen
+Consolidated Mining Company of Arizona, and Arizona and Southeastern
+Railroad Hospital; Author of Medical and Climatological Works._
+
+
+Menstruation
+
+AUSTIN FLINT, JR., M.D.
+
+_Professor of Obstetrics and Clinical Gynecology, New York University
+and Bellevue Hospital Medical College; Visiting Physician, Bellevue
+Hospital; Consulting Obstetrician, New York Maternity Hospital;
+Attending Physician, Hospital for Ruptured and Crippled, Manhattan
+Maternity and Emergency Hospitals._
+
+
+Heart and Blood
+
+JOHN BESSNER HUBER, A.M., M.D.
+
+_Assistant in Medicine, University and Bellevue Hospital Medical
+College; Visiting Physician to St. Joseph's Home for Consumptives;
+Author of "Consumption: Its Relation to Man and His Civilization; Its
+Prevention and Cure."_
+
+
+Skin Diseases
+
+JAMES C. JOHNSTON, A.B., M.D.
+
+_Instructor in Pathology and Chief of Clinic, Department of
+Dermatology, Cornell University Medical College._
+
+
+Diseases of Children
+
+CHARLES GILMORE KERLEY, M.D.
+
+_Professor of Pediatrics, New York Polyclinic Medical School and
+Hospital; Attending Physician, New York Infant Asylum, Children's
+Department of Sydenham Hospital, and Babies' Hospital, N. Y.;
+Consulting Physician, Home for Crippled Children._
+
+
+Bites and Stings
+
+GEORGE GIBIER RAMBAUD, M.D.
+
+_President, New York Pasteur Institute._
+
+
+Headache
+
+ALONZO D. ROCKWELL, A.M., M.D.
+
+_Former Professor Electro-Therapeutics and Neurology at New York
+Post-Graduate Medical School; Neurologist and Electro-Therapeutist to
+the Flushing Hospital; Former Electro-Therapeutist to the Woman's
+Hospital in the State of New York; Author of Works on Medical and
+Surgical Uses of Electricity, Nervous Exhaustion (Neurasthenia), etc._
+
+
+Poisons
+
+E. ELLSWORTH SMITH, M.D.
+
+_Pathologist, St. John's Hospital, Yonkers; Somerset Hospital,
+Somerville, N. J.; Trinity Hospital, St. Bartholomew's Clinic, and the
+New York West Side German Dispensary._
+
+
+Catarrh
+
+SAMUEL WOOD THURBER, M.D.
+
+_Chief of Clinic and Instructor in Laryngology, Columbia University;
+Laryngologist to the Orphan's Home and Hospital._
+
+
+Care of Infants
+
+HERBERT B. WILCOX, M.D.
+
+_Assistant in Diseases of Children, Columbia University._
+
+
+
+
+Special Contributors
+
+
+Food Adulteration
+
+S. JOSEPHINE BAKER, M.D.
+
+_Medical Inspector, New York City Department of Health._
+
+
+Pure Water Supply
+
+WILLIAM PAUL GERHARD, C.E.
+
+_Consulting Engineer for Sanitary Works; Member of American Public
+Health Association; Member, American Society Mechanical Engineers;
+Corresponding Member of American Institute of Architects, etc.; Author
+of "House Drainage," etc._
+
+
+Care of Food
+
+JANET MCKENZIE HILL
+
+_Editor, Boston Cooking School Magazine._
+
+
+Nerves and Outdoor Life
+
+S. WEIR MITCHELL, M.D., LL.D.
+
+_LL.D. (Harvard, Edinburgh, Princeton); Former President, Philadelphia
+College of Physicians; Member, National Academy of Sciences,
+Association of American Physicians, etc.; Author of essays: "Injuries
+to Nerves," "Doctor and Patient," "Fat and Blood," etc.; of scientific
+works: "Researches Upon the Venom of the Rattlesnake," etc.; of
+novels: "Hugh Wynne," "Characteristics," "Constance Trescott," "The
+Adventures of Francois," etc._
+
+
+Sanitation
+
+GEORGE M. PRICE, M.D.
+
+_Former Medical Sanitary Inspector, Department of Health, New York
+City; Inspector, New York Sanitary Aid Society of the 10th Ward, 1885;
+Manager, Model Tenement-houses of the New York Tenement-house Building
+Co., 1888; Inspector, New York State Tenement-house Commission, 1895;
+Author of "Tenement-house Inspection," "Handbook on Sanitation," etc._
+
+
+Indoor Exercise
+
+DUDLEY ALLEN SARGENT, M.D.
+
+_Director of Hemenway Gymnasium, Harvard University; Former President,
+American Physical Culture Society; Director, Normal School of Physical
+Training, Cambridge, Mass.; President, American Association for
+Promotion of Physical Education; Author of "Universal Test for
+Strength," "Health, Strength and Power," etc._
+
+
+Long Life
+
+SIR HENRY THOMPSON, Bart., F.R.C.S., M.B. (Lond.)
+
+_Surgeon Extraordinary to His Majesty the King of the Belgians;
+Consulting Surgeon to University College Hospital, London; Emeritus
+Professor of Clinical Surgery to University College, London, etc._
+
+
+Camp Comfort
+
+STEWART EDWARD WHITE
+
+_Author of "The Forest," "The Mountains," "The Silent Places," "The
+Blazed Trail," etc._
+
+
+
+
+[Illustration: HARVEY WASHINGTON WILEY, Ph.D., LL.D.
+
+The researches of Dr. Wiley, Chief of the Bureau of Chemistry in the
+United States Department of Agriculture, were important factors in
+hastening the enactment of the present pure food law. He analyzed the
+various food products and made public the deceptions practiced by
+unscrupulous manufacturers. He aroused attention throughout the
+country by pointing out the necessity of a campaign of education, in
+order, as stated in Volume V, Part II, that the housekeeper might be
+able to determine the purity of every article of food offered for
+sale. As an example of his methods, he organized a "poison squad" of
+government employees who restricted themselves to special diets,
+consisting of food preparations containing drugs commonly used as
+adulterants. In this way he actually demonstrated the effect of these
+substances upon the human system.]
+
+
+
+
+The Home Medical
+Library
+
+
+Volume II
+
+
+THE EYE AND EAR
+THE NOSE, THROAT AND LUNGS
+SKIN DISEASES
+TUMORS :: RHEUMATISM
+HEADACHE :: SEXUAL HYGIENE
+
+By KENELM WINSLOW, B.A.S., M.D. (Harv.)
+
+_Formerly Assistant Professor Comparative Therapeutics, Harvard
+University; Late Surgeon to the Newton Hospital; Fellow of the
+Massachusetts Medical Society, etc._
+
+
+INSANITY
+
+By ALBERT WARREN FERRIS, A.M., M.D.
+
+_Former Assistant in Neurology, Columbia University; former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, "New International Encyclopedia"_
+
+
+NEW YORK
+
+The Review of Reviews Company
+
+1907
+
+
+
+
+Copyright, 1907, by
+
+THE REVIEW OF REVIEWS COMPANY
+
+
+THE TROW PRESS, NEW YORK
+
+
+
+
+_Contents_
+
+
+    PART I
+
+    CHAPTER                                                       PAGE
+
+    I.    THE EYE AND EAR                                           13
+
+            Foreign Bodies in the Eye--Black Eye--Twitching of
+            the Eyelids--Wounds and Burns--Congestion--
+            Conjunctivitis--"Pink Eye"--Strain--Astigmatism--
+            Deafness--Foreign Bodies in the Ear--Earache--Simple
+            Remedies.
+
+    II.   THE NOSE AND THROAT                                       51
+
+            Nosebleed--Foreign Bodies in the Nose--Cold in the
+            Head--Toothache--Mouth-Breathing--Sore Mouth--
+            Pharyngitis--How to Treat Tonsilitis--Quinsy--
+            Diphtheria--Croup--Laryngitis.
+
+    III.  THE LUNGS AND BRONCHIAL TUBES                             87
+
+            Acute and Chronic Bronchitis--Coughs in Children--
+            Liniments and Poultices--Cough Mixtures--Treatment
+            of Pneumonia--Consumption--Asthma--Influenza, its
+            Symptoms and Cure.
+
+    IV.   HEADACHES                                                113
+
+            Causes of Sick Headache--Symptoms and Treatment--
+            Headaches Caused by Indigestion--Organic Disease a
+            Frequent Source--Nervous and Neuralgic Headaches--
+            Effect of Poison--Heat-Stroke.
+
+
+    PART II
+
+    I.    GROWTHS AND ENLARGEMENTS                                 123
+
+            Cancers--Fatty Tumors--Use of Patent Preparations
+            Dangerous--Symptoms and Cure of Rupture--The Best
+            Kind of Truss--Varicose Veins--Varicocele--External
+            and Internal Piles--Operations the Most Certain
+            Cure.
+
+    II.   SKIN DISEASES AND RELATED DISORDERS                      139
+
+            Itching, Chafing, and Chapping--Treatment of
+            Hives--Nettlerash--Pimples--Fever Blisters--Prickly
+            Heat--Cause of Ringworm--Freckles and Other Skin
+            Discolorations--Ivy Poison--Warts and Corns--
+            Boils--Carbuncles.
+
+    III.  RHEUMATISM AND KINDRED DISEASES                          169
+
+            Inflammatory Rheumatism--Symptoms and Treatment--
+            Muscular Rheumatism--Lumbago--Stiff Neck--Rheumatism
+            of the Chest--Chronic Rheumatism--Rheumatic Gout--
+            Scurvy in Adults and Infants--Gout, its Causes and
+            Remedies.
+
+
+    PART III
+
+    I.    HEALTH AND PURITY                                        191
+
+            Duties of Parents--Sexual Abuse--Dangers to
+            Health--Physical Examination of Infants--Necessary
+            Knowledge of Sex Functions Natural--The Critical Age
+            of Puberty--Marriage Relations.
+
+    II.   GENITO-URINARY DISEASES                                  199
+
+            Gonorrhea in Men and Women--Dangers of Infection--
+            Syphilis, its Causes, Symptoms, and Treatment--
+            Incontinence and Suppression of Urine--Bed-wetting--
+            Inflammation of the Bladder--Acute and Chronic
+            Bright's Disease.
+
+
+    PART IV
+
+    I.    INSANITY                                                 229
+
+            Mental Disorder Not Insanity--Illusions of the
+            Insane--Hallucinations and Delusions--Signs and
+            Causes of Insanity--Paranoia--How the Physician
+            Should Be Aided--The Best Preventive.
+
+    _Appendix._ PATENT MEDICINES                                   245
+
+            Advice Regarding the Use of Patent Medicines--Laws
+            Regulating the Sale of Drugs--Proprietary
+            Medicines--Good Remedies--Dangers of So-called
+            "Cures"--Headache Powders--The Great American Fraud.
+
+
+
+
+Part I
+
+THE EYE AND EAR, THE NOSE
+AND THROAT, THE LUNGS
+AND BRONCHIAL TUBES,
+HEADACHES
+
+BY
+
+KENELM WINSLOW
+
+
+
+
+CHAPTER I
+
+=The Eye and Ear=
+
+_Injuries to the Eye--Inflammatory Conditions--"Pink
+Eye"--Nearsightedness and Farsightedness--Deafness--Remedies for
+Earache._
+
+
+=CINDERS AND OTHER FOREIGN BODIES IN THE EYE.=--Foreign bodies are
+most frequently lodged on the under surface of the upper lid, although
+the surface of the eyeball and the inner aspect of the lower lid
+should also be carefully inspected. A drop of a two-per-cent solution
+of cocaine will render painless the manipulations. The patient should
+be directed to continue looking downward, and the lashes and edge of
+the lid are grasped by the forefinger and thumb of the right hand,
+while a very small pencil is gently pressed against the upper part of
+the lid, and the lower part is lifted outward and upward against the
+pencil so that it is turned inside out. The lid may be kept in this
+position by a little pressure on the lashes, while the cinder, or
+whatever foreign body it may be, is removed by gently sweeping it off
+the mucous membrane with a fold of a soft, clean handkerchief.
+
+Hot cinders and pieces of metal may become so deeply lodged in the
+surface of the eye that it is necessary to dig them out with a needle
+(which has been passed through a flame to kill the germs on it) after
+cocaine solution has been dropped into the eye twice at a minute
+interval. Such a procedure is, of course, appropriate for an oculist,
+but when it is impossible to secure medical aid for days it can be
+attempted without much fear, if done carefully, as more harm will
+result if the offending body is left in place. It is surprising to see
+what a hole in the surface of the eye will fill up in a few days. If
+the foreign body has caused a good deal of irritation before its
+removal, it is best to drop into the eye a solution of boric acid (ten
+grains to the ounce of water) four times daily.
+
+
+"=BLACK EYE.="--To relieve this condition it is first necessary to
+reduce the swelling. This can be done by applying to the closed lids,
+every three minutes, little squares of white cotton or linen, four
+fold and about as large as a silver dollar, which have laid on a cake
+of ice until thoroughly cold. This treatment is most effective when
+pursued almost continuously for twenty-four hours. The cold compresses
+should not be permitted to overlap the nose, or a violent cold in the
+head may ensue. The swelling having subsided, the discoloration next
+occupies our attention. This may be removed speedily by applying, more
+or less constantly below the lower lid, little pieces of flannel
+dipped in water as hot as can be borne. The cloths must be changed as
+often as they cool. Repeat this treatment for a half hour every two
+hours or so during the day.
+
+
+=STYE.=--A stye is a boil on the eyelid; it begins at the root of a
+hair as a hard swelling which may extend to the whole lid. The tip of
+the swelling takes on a yellowish color, breaks down and discharges
+"matter" or pus. There are pain and a feeling of tension in the lid,
+and, very rarely, some fever. When one stye follows another it is well
+to have the eyes examined by an oculist, as eye-strain is often an
+inviting cause of the trouble, and this can be corrected by the use of
+glasses. Otherwise the patient is probably "run down" from chronic
+constipation and anaemia (poverty of the blood) and other causes, and
+needs a change of air, tonics, and exercise out of doors. In a
+depreciated condition, rubbing the lids causes introduction of disease
+germs.
+
+The immediate treatment, which may cut short the trouble, consists in
+bathing the eyelid for fifteen minutes at a time, every hour, with a
+hot solution of boric acid (half a teaspoonful to the cup of water).
+Then at night the swelling should be painted with collodion, several
+coats, being careful not to get it in the eye, as it would cause much
+smarting. If the stye persists in progressing, bathing it in hot water
+will cause it to discharge pus and terminate much sooner.
+
+
+=TWITCHING OF THE EYELIDS.=--This condition may be due to eye-strain,
+and can be relieved if the eyes are fitted to glasses by an oculist
+(not an optician). It is frequently an accompaniment of inflammation
+of the eyes, and when this is cured the twitching of the lids
+disappears. When the eyes are otherwise normal the twitching is
+frequently one of the signs of nerve fag and overwork.
+
+
+=WOUNDS AND BURNS ABOUT THE EYES.=--Slight wounds of the inner surface
+of the eyelids close readily without stitching if the boric-acid
+solution (ten grains to the ounce of water) is dropped into the eye
+four times daily. Burns of the inner surface of the lids follow the
+entrance of hot water, hot ashes, lime, acids, and molten metals.
+Burns produced by lime are treated by dropping a solution of vinegar
+(one part of vinegar to four of water) into the eye, while those
+caused by acids are relieved by similar treatment with limewater or
+solution of baking soda (half a teaspoonful to the glass of water). If
+these remedies are not at hand, the essential object is attained by
+washing the eye with a strong current of water, as from a hose or
+faucet. If there is much swelling of the lids, and inflammation after
+the accident, drop boric-acid solution into the eye four times daily.
+Treatment by cold compresses, as recommended for "black eye," will do
+much also to quiet the irritation, and the patient should wear dark
+glasses.
+
+
+=SORE EYES; CONJUNCTIVITIS.=--The mucous membrane lining the inner
+surface of the eyelids also covers the front of the eyeball, although
+so transparent here that it is not apparent to the observer.
+Inflammation of this membrane is more commonly limited to that portion
+covering the inner surfaces of the lids, but may extend to the
+eyeball when the eye becomes "bloodshot" and the condition more
+serious. For the sake of convenience we may speak of a mild form of
+sore eye, as _congestion of the eyelids_, and the more severe type, as
+true _conjunctivitis_ (see p. 18).
+
+
+=CONGESTION OF THE EYELIDS.=--This may be caused by smoke or dust in
+the atmosphere, by other foreign bodies in the eye; frequently by
+eye-strain, due to far- or near-sightedness, astigmatism, or muscular
+weakness, which may be corrected by an oculist's (never an optician's)
+prescription for glasses. Exposure to an excessive glare of light, as
+in the case of firemen, or, on the other hand, reading constantly and
+often in a poor light, will induce irritation of the lids. The germs
+which cause "cold in the head" often find their way into the eyes
+through the tear ducts, which connect the inner corner of the eyes
+with the nose, and thus may set up similar trouble in the eyes.
+
+=Symptoms.=--The eyes feel weary and "as if there were sand in them."
+There may be also smarting, burning, or itching of the lids, and there
+is disinclination for any prolonged use of the eyes. The lids, when
+examined, are found to be much deeper red than usual, and slightly
+swollen, but there is no discharge from the eye, and this fact serves
+to distinguish this mild type of inflammation from the more severe
+form.
+
+=Treatment.=--The use of dark glasses and a few drops of zinc-sulphate
+solution (one grain to the ounce of water) in the eye, three times
+daily, will often cure the trouble. If this does not do so within a
+few days then an oculist should be consulted, and it will frequently
+be found that glasses are needed to secure freedom from irritation of
+the eyes. In using "eye-drops" the head should be held back, and
+several drops be squeezed from a medicine dropper into the inner
+corner of the eye.
+
+
+=CONJUNCTIVITIS; CATARRHAL INFLAMMATION OF THE EYES.=--In this
+disorder there is discharge which sticks the lids together during the
+night. The inner surface of the lids is much reddened, the blood
+vessels in the lining membrane are much enlarged, and the lids are
+slightly swollen. The redness may extend to the eyeball and give it a
+bloodshot appearance. There is no interference with sight other than
+momentary blurring caused by the discharge, and occasionally there is
+very severe pain, as if a cinder had suddenly fallen in the eye. This
+symptom may occur at night and awaken the patient, and may be the
+reason for his first consulting a physician.
+
+One eye is commonly attacked twenty-four to thirty-six hours before
+the other, and even if it is thought that the cause is a cinder, in
+case of one eye, it can hardly be possible to sustain this belief in
+the case of the involvement of both eyes. There is a feeling of
+discomfort about the eyes, and often a burning, and constant watering,
+the tears containing flakes of white discharge.
+
+When the discharge is a copious, creamy pus or "matter," associated
+with great swelling of the lids and pain on exposure to light, the
+cause is usually a germ of a special disease, and the eyesight will
+very probably be lost unless a skillful physician be immediately
+secured. Early treatment is, however, of great service, and, until a
+physician can be obtained, the treatment recommended below should be
+followed conscientiously; by this means the sight may be saved. This
+dangerous variety of inflammation of the eyes is not rare in the
+newborn, and infants having red eyes within a few days of birth should
+immediately receive proper attention, or blindness for life will be
+the issue. This is the usual source of that form of blindness with
+which babies are commonly said to have been born.
+
+All forms of severe inflammation of the lids are contagious,
+especially the variety last considered, and can be conveyed, by means
+of the discharge, through the agency of towels, handkerchiefs, soap,
+wash basins, etc., and produce the same or sometimes different types
+of inflammation in healthy eyes. Therefore, if the severe form of
+conjunctivitis breaks out among any large number of people, as in
+schools, prisons, asylums, and almshouses, isolation of the patients
+should be enforced.
+
+
+"=PINK EYE.="--This is a severe epidemic form of catarrh of the eye,
+which is caused by a special germ known as the "Koch-Weeks bacillus."
+The treatment of this is the same as that outlined below. The germ of
+pneumonia and that of grippe also often cause conjunctivitis, and
+"catching cold," chronic nasal catarrh, exposure to foul vapors and
+gases, or tobacco smoke, and the other causes enumerated, as leading
+to congestion of the lids, are also responsible for catarrhal
+inflammation of the eye.
+
+=Treatment.=--In the milder attacks of conjunctivitis the treatment
+should be that recommended above for congestion of the lids. The
+swelling and inflammation, in the severer types, are greatly relieved
+by the application of the cold-water compresses, advised under the
+section on "black eye," for an hour at a time, thrice daily.
+Confinement in a dark room, or the use of dark glasses, and drops of
+zinc sulphate (one grain in an ounce of water) three times a day, with
+hourly dropping of boric acid (ten grains to the ounce of water)
+constitute the ordinary treatment.
+
+In inflammations with copious discharge of creamy pus, and great
+swelling of the lids, the eyes should be washed out with the
+boric-acid solution every half hour, and a solution of silver nitrate
+(two grains to the ounce of water) dropped into the eye, once daily,
+followed immediately by a weak solution of common salt in water to
+neutralize the nitrate of silver, after its action has been secured.
+The constant use of ice cloths, already mentioned, forms a necessary
+adjunct to treatment. The sound eye must be protected from the chance
+of contagion, arising from a possible infection from the pus
+discharging from its mate. This may be secured by bandaging the well
+eye, or, better, by covering it with a watch crystal kept in place by
+surgeon's plaster.
+
+In treating sore eyes with discharge, in babies, the infant should be
+held in the lap with its head backward and inclined toward the side of
+the sore eye, so that in washing the eye no discharge will flow into
+the sound eye. The boric acid may then be dropped from a medicine
+dropper, or applied upon a little wad of absorbent cotton, to the
+inner corner of the eye, while the eyelids are held apart.
+
+Hemorrhages occurring under the conjunctiva (or membrane lining the
+inner surface of the lids and covering the front surface of the
+eyeball) may be caused by blows or other injury to the eye, by violent
+coughing, by straining, etc. Dark-red spots may appear in the white of
+the eyeball, slightly raised above the surface, which are little blood
+clots under the conjunctival membrane. No special trouble results and
+there is nothing to be done except to wait till the blood is absorbed,
+which will happen in time. If the eyes water, solution of zinc
+sulphate (one grain to the ounce of water) may be dropped into the
+eye, twice daily. Hot applications are beneficial here to promote
+absorption of the clot.
+
+
+=EYE-STRAIN.=--Eye-strain is commonly due to either astigmatism,
+nearsightedness, farsightedness, or weakness of the eye muscles. The
+farsighted eye is one in which parallel rays entering the eye, as from
+a distance, come to a focus behind the retina. The retina is the
+sensitive area for receiving light impressions in the back of the
+eyeball. Sight is really a brain function; one sees with the brain,
+since the optic nerve endings in the back of the eye merely carry
+light impressions to the brain where they are properly interpreted.
+
+In order that vision be clear and perfect, it is essential that the
+rays of light entering the eye be bent so that they strike the retina
+as a single point. In the farsighted or hyperopic eye, the eyeball is
+usually too short for the rays to be properly focused on the sensitive
+nerve area in the back of the eye.
+
+This defect in vision is, however, overcome by the act of
+"accommodation." There is a beautiful transparent, double-convex body,
+about one-third of an inch thick, which looks very much like an
+ordinary glass lens, and is situated in the eye just back of the
+pupil. This is what is known as the crystalline lens, and the rays of
+light are bent in passing through it so as to be properly focused on
+the retina.
+
+The foregoing statements have been made as though objects were always
+at a distance from the eye, so that the rays of light coming from them
+were almost parallel. Yet when one is looking at an object within a
+few inches of the eye the rays diverge or spread out, and these the
+normal eye (if rigid) could not focus on the retina--much less the
+farsighted eye. But the eye is adaptable to change of focus through
+the action of a certain muscle, situated within the eyeball about the
+lens, which controls to a considerable extent the shape of the lens.
+When the muscle contracts it allows the lens to bulge forward by
+virtue of its elasticity, and, therefore, become more convex. This is
+what happens when one looks at near objects, the increased convexity
+of the lens bending the rays of light so that they will focus as a
+point on the retina. (See Plate I, p. 30.)
+
+Now in the farsighted eye this muscular control or "accommodative
+action" must be continually exercised even in looking at distant
+objects, and it is this constant attempt of nature to cure an optical
+defect of the eye which frequently leads to nervous exhaustion or
+eye-strain. The nerve centers, which animate and control the nerves
+supplying the eye muscles to which we have just alluded, are in close
+proximity to other most important nerve centers in the brain, so
+irritation of the eye centers will produce sympathetic irritation of
+these other centers, leading to manifold and complex symptoms which we
+will describe under this head. But these symptoms do not necessarily
+develop in everyone having farsightedness or astigmatism, since both
+are often present at birth.
+
+The power of accommodation is sufficient to overcome the optical
+defect of the eye, providing that the general health is good and the
+eye is not used much for near work. If, on the other hand, excessive
+use of the eyes in reading, writing, figuring, sewing, or other fine
+work is required, and especially if the health becomes impaired, it
+happens that the constant drain on the eye center in the brain will
+result in a group of symptoms which we will consider later. Failure of
+accommodation comes on at about forty, and gradually increases until
+all accommodation is lost at the age of seventy-five.
+
+For this reason it is necessary for persons over forty-five years of
+age, having normal or farsighted eyes, to wear convex glasses in
+reading or doing near work, and these should be changed for stronger
+ones every year or two. These convex glasses save the eyes in their
+attempt to make the lens more convex when looking at near objects in
+farsightedness, and also prove serviceable in the same manner when
+accommodation begins to fail in the case of what is called "old
+sight." The neglect to provide proper glasses for reading any time
+after the age of forty-five, and the failure to replace them by
+stronger lenses when required, distinctly favor the occurrence of
+cataract in later life.
+
+In the act of accommodation, in addition to the muscular action by
+which the lens is made more convex, there is the tendency for the
+action of another group of muscles outside the eyeball, which turn the
+eyes inward when they are directed toward a near object. Here then is
+another source of trouble resulting from farsightedness, i. e., the
+not infrequent occurrence of inward "squint" occasioned by the
+constant use of the muscles pulling the eyes inward during
+accommodation for near objects. Again, inflammation of the eyelids,
+and sometimes of deeper parts of the eyeball, follows untreated
+hyperopia. Early distaste for reading is often acquired by farsighted
+persons, owing to the strain on the accommodative apparatus. The
+convex lens is that used to correct farsightedness.
+
+
+=NEARSIGHTED EYE.=--In the nearsighted eye the eyeball is too long for
+parallel rays entering the eye to be focused upon the retina; they are
+bent, instead, to a point in front of the retina, and then diverge
+making the vision blurred. (Plate I, p. 30.) The act of accommodation
+in making the lens more convex will not aid this condition, but only
+make it worse, so that it is not attempted.
+
+Eye-strain in this optical defect is brought on by constant use of the
+eye muscles (attached to the outside of the eyeball) in directing both
+eyes inward so that they will both center on near objects; the only
+ones which can be seen. Outward squint frequently results, because the
+muscular efforts required to direct both eyes equally inward to see
+near objects are so great that the use of both eyes together is given
+up, and the poorer eye is not used and squints outward, while the
+better eye is turned inward in the endeavor to see. Nearsighted
+persons are apt to stoop, owing to the habitual necessity for coming
+close to the object looked at. Their facial expression is also likely
+to be rather vacant, since they do not distinctly see, and do not
+respond to the facial movements of others.
+
+Nearsightedness, or myopia, is not a congenital defect, but is usually
+acquired owing to excessive near work which requires that the eye
+muscles constantly direct both eyes inward to see near objects. In so
+acting the muscles compress the sides of the eyeballs and tend to
+increase their length, interfere with their nutrition, and aggravate
+the condition when it is once begun. (See Diagram.) Concave lenses are
+used to correct myopia, and they must be worn all the time.
+
+
+=ASTIGMATISM.=--This is a condition caused by inequality of the outer
+surface of the front of the eyeball, and rarely by a similar defect in
+the surfaces of the lens. The curvature of the eyeball in the
+astigmatic eye is greater in one meridian than in the opposite. In
+other words, the front of the eyeball is not regularly spherical, but
+bulges out along a certain line or meridian, while the curvature is
+flattened or normal in the other meridian. For instance, if two
+imaginary lines were drawn, one vertically, and the other horizontally
+across the front of the eyeball intersecting in the center of the
+pupil, they would represent the principal meridians, the vertical and
+the horizontal. As a rule the meridian of greatest curvature is
+approximately vertical, and that of least curvature is at right angles
+to it, or horizontal.
+
+Rays of light in passing through the different meridians of the
+astigmatic eye are differently bent, so that in one of the principal
+meridians rays may focus perfectly on the retina, while in the other
+the rays may focus on a point behind the retinal field. In this case
+the eye is made farsighted or hyperopic in one meridian, and is
+normal in the other. Or again, the rays may be focused in front of the
+retina in one meridian, and directly on the retina in the other; this
+would be an example of nearsighted or myopic astigmatism.
+Farsightedness and nearsightedness are then both caused by
+astigmatism, although in this case not by the length of the eyeball,
+but by inequality in the curvature of the front part (cornea) of the
+eyeball. For example, in simple astigmatism one of the principal
+meridians is hyperopic (turning the rays so that they focus behind the
+retina) or myopic (bending the rays so that they focus in front of the
+retina), while the other meridian is normal. In mixed astigmatism, one
+of the principal meridians is myopic, the other hyperopic; in compound
+astigmatism the principal meridians are both myopic, or both
+hyperopic, but differ in degree; while in irregular astigmatism, rays
+of light passing through different parts of the outer surface of the
+eyeball are turned in so many various directions that they can never
+be brought to a perfect focus by glasses.
+
+It is not by any means possible for a layman to be able always to
+inform himself that he is astigmatic, unless the defect is
+considerable. If a card, on which are heavy black lines of equal size
+and radiating from a common center like the spokes of a wheel, be
+placed on a wall in good light, it will appear to the astigmatic eye
+as if certain lines (which are in the faulty meridian of the eyeball)
+are much blurred, while the lines at right angles to these are clear
+and distinct. Each eye should be tested separately, the other being
+closed. The chart should be viewed from a distance as great as any
+part of it can be seen distinctly. All the lines on the test card
+should look equally black and clear to the normal eye.
+
+Astigmatism is corrected by a cylindrical lens, which is in fact a
+segment of a solid cylinder of glass. The axis of the cylindrical lens
+should be at right angles to the defective meridian of the eye, in
+order to correct the astigmatism. Eye-strain is caused by astigmatism
+in the same manner that it is brought about in the simple farsighted
+eye, i. e., by constant strain on the ciliary muscle, which regulates
+the convexity of the crystalline lens. For it is possible for the
+inequalities of the front surface of the eyeball or of the lens to be
+offset or counterbalanced by change in the convexity of the lens
+produced by the action of this muscle, and it is conceivable that the
+axis of the lens may be tilted one way or another by the same agency,
+and for the same purpose. But, as we have already pointed out, this
+continual muscular action entails great strain on the nerve centers
+which animate the muscle, and if constant near work is requisite, or
+the health is impaired, the nervous exhaustion becomes apparent. The
+lesser degrees of astigmatism often give more trouble than the
+greater.
+
+
+[Illustration: PLATE I
+
+=Plate I=
+
+=ANATOMY OF THE EYE=
+
+The upper illustration shows the six muscles attached to the eye. The
+=Superior Rectus Muscle= pulls and directs the eye upward; the
+=Inferior Rectus=, downward; the =External= and =Internal Rectus
+Muscles= pull the eye to the right and left; the =Oblique Muscles=
+move the eye slantwise in any direction.
+
+Lack of balance of these muscles, and especially inability to focus
+both eyes on a near object without effort, constitute "eye-strain."
+
+The lower cut illustrates the relation of the crystalline lens to
+sight. =Lens Nearsight Focus= shows the lens bulging forward and very
+convex; =Lens Farsight Focus= shows it flat and less convex.
+
+This adjustment of the shape of the crystalline lens is called
+"accommodation"; it is effected by a small muscle in the eyeball.
+
+In the normal eye, the rays of light from an object pass through the
+lens, adjusted for the proper distance, and focus on the retina.
+
+In the nearsighted eye, these rays focus at a point in front of the
+retina; while in the farsighted eye these rays focus behind the
+retina; the nearsighted eye being elongated, and the farsighted eye
+being shortened.]
+
+
+=WEAKNESS OF THE EYE MUSCLES.=--There are six muscles attached to the
+outside of the eyeball which pull it in various directions, and so
+enable each eye to be directed upon a common point, otherwise objects
+will appear double. Weakness of these muscles or insufficiency,
+especially of those required to direct the eyes inward for near work,
+may lead to symptoms of eye-strain. When reading, for example, the
+muscles which pull the eye inward soon grow tired and relax, allowing
+the opposing muscles to pull the eye outward so that the eyes are no
+longer directed toward a common point, and two images may be perceived
+or, more frequently, they become fused together producing a general
+blurring on the page. Then by a new effort of will the internal
+muscles pull the eyes into line again, only to have the performance
+repeated, all of which entails a great strain upon the nervous system,
+and may lead to permanent squint, as has been pointed out. In addition
+to these symptoms caused by weakness of the eye muscles--seeing
+double, blurred vision, and want of endurance for close work--there
+are others which are common to eye-strain in general, as headache,
+nausea, etc., described in the following paragraph.
+
+=Symptoms of Eye-strain.=--Headache is the most frequent symptom. It
+may be about the eyes, but there is no special characteristic which
+will positively enable one to know an eye headache from that arising
+from other sources, although eye-strain is probably the most common
+cause of headache. The headache resulting from eye-strain may then be
+in the forehead, temples, top or the back of the head, or limited
+to one side. It frequently takes the form of "sick headache" (p. 113).
+It is perhaps more apt to appear after any unusual use of the eyes in
+reading, writing, sewing, riding, shopping, or sight-seeing, and going
+to theaters and picture galleries, but this is not by any means
+invariably the case, as eye headache may appear without apparent
+cause.
+
+Nausea and vomiting, with or without headache, nervousness,
+sleeplessness, and dizziness often accompany eye-strain. Sometimes
+there is weakness of the eyes, i. e., lack of endurance for eye work,
+twitching of the eyelids, weeping, styes, and inflammation of the
+lids. In view of the extreme frequency of eye-disorders which lead to
+eye-strain, it behooves people, in the words of an eminent medical
+writer, to recognize that "the subtle influence of eye-strain upon
+character is of enormous importance" inasmuch as "the disposition may
+be warped, injured, and wrecked," especially in the young. Some of the
+more serious nervous diseases, as nervous exhaustion, convulsions,
+hysteria, and St. Vitus's dance may be caused by the reflex irritation
+of the central nervous system following eye-strain.
+
+=Treatment of Eye-strain.=--The essential treatment of eye-strain
+consists in the wearing of proper glasses. It should be a rule,
+without any exception, to consult only a regular and competent
+oculist, and never an optician, for the selection of glasses. It is as
+egregious a piece of folly to employ an optician to choose the
+glasses as it would be to seek an apothecary's advice in a general
+illness. Considerably more damage would probably accrue from following
+the optician's prescription than that of the apothecary, because
+nature would soon offset the effects of an inappropriate drug; but the
+damage to the eyes from wearing improper glasses would be lasting.
+
+Properly to determine the optical error in astigmatic and farsighted
+eyes it is essential to place drops in the eye, which dilate the pupil
+and paralyze the muscles that control the convexity of the crystalline
+lens, and to use instruments and methods of examination, which can
+only be properly undertaken and interpreted by one with the general
+and special medical training possessed by an oculist.
+
+The statement has been emphasized that farsighted and astigmatic
+persons, up to the age of forty-five or fifty, can sometimes overcome
+the optical defects in their eyes by exercise of the ciliary muscle
+which alters the shape of the lens, and, therefore, it would be
+impossible for an examiner to discover the fault without putting drops
+in the eye, which temporarily paralyze the ciliary muscles for from
+thirty-six to forty-eight hours, but otherwise do no harm. After the
+age of fifty it may be unnecessary to use drops, as the muscular power
+to alter the convexity of the lens is greatly diminished. Opticians
+are incompetent to employ these drops, as they may do great damage in
+certain conditions of the eye which can only be detected by a medical
+man specially trained for such work. Opticians are thus sure to be
+caught on one of the horns of a dilemma; either they do not use drops
+to paralyze the ciliary muscle, or, if they do employ the drops, they
+may do irreparable damage to the eye. Any abnormality connected with
+the vision, especially in children, should be a warning to consult an
+oculist. Squint, "cross-eye" (_Strabismus_), as has been stated, may
+often result from near- or far-sightedness, and it may be possible in
+young children to cure the squint by the use of glasses or even drops
+in the eye, whereas in later life it may be necessary to cut some of
+the muscles of the eyeball to correct the condition. It is a wise rule
+to subject every child to an oculist's examination before entering
+upon school life.
+
+
+=DEAFNESS.=--Sudden deafness without apparent reason is more apt to
+result from an accumulation of wax than from any other cause. It is a
+very common ear disorder. The opening into the ear is about an inch
+long, or a little more, and is separated from that part of the ear
+within, which is known as the middle ear, by the eardrum membrane. The
+drum membrane is a thin, skinlike membrane stretched tightly across
+the bottom of the external opening in the ear or auditory canal, and
+shuts it off completely from the middle ear within, and in this way
+protects the middle ear from the entrance of germs, dust, and water,
+but only secondarily aids hearing. The obstruction caused by wax
+usually exists in about the middle of the auditory canal or opening in
+the ear, and only causes deafness when it completely blocks this
+passage.
+
+The deafness is sudden because, owing to the accidental entrance of
+water, the wax quickly swells and chokes the canal; or, in attempts to
+relieve irritation in the ear, the finger or some other object is
+thrust into the opening in the ear (auditory canal) and presses the
+wax down on the ear drum. The obstruction in the ear is usually a
+mixture of waxy secretion from the canal, and little scales of dead
+skin which become matted together in unwise efforts at cleansing the
+ear by introducing a twisted towel or some other object into the ear
+passage and there turning it about; or it may occur owing to disease
+of the ear altering the character of the natural secretion. In the
+normal state, the purpose of the wax is, apparently, to repel insects
+and to glue together the little flakes of cast-off skin in the
+auditory canal, and these, catching on the hairs lining the canal, are
+thrown out of the ears upon the shoulders by the motion of the jaws in
+eating.
+
+Nothing should be introduced into the ear with the idea of cleansing
+it, as the skin growing more rapidly from within tends naturally to
+push the dead portions out as required, and so the canal is
+self-cleansing.
+
+=Symptoms.=--Sudden deafness in one ear usually calls the attention of
+the patient to an accumulation of wax. There is apt to be more or less
+wax in the other ear as well. Noises in the deaf ear and a feeling of
+pressure are also common. Among rarer symptoms are nausea and
+dizziness. But the only way to be sure that deafness is due to choking
+of the ear passage with wax is to see it. This is usually accomplished
+by a physician in the following way: he throws a good light from a
+mirror into a small tube introduced into the ear passage. This is, of
+course, impossible for laymen to do, but if the ear is drawn upward,
+backward, and outward, so as to straighten the canal, it may be
+possible for anyone to see a mass of yellowish-brown or blackish
+material filling the passage. And in any event, if the wax cannot be
+seen, one is justified in treating the case as if it were present, if
+sudden deafness has occurred and competent medical aid is
+unobtainable, since no harm will be done if wax is absent, and, if it
+is present, the escape of wax will usually give immediate relief from
+the deafness and other symptoms.
+
+=Treatment.=--The wax is to be removed with a syringe and water as hot
+as can be comfortably borne. A hard-rubber syringe having a piston,
+and holding from two teaspoonfuls to two tablespoonfuls, is to be
+employed--the larger ones are better. The clothing should be protected
+from water by towels placed over the shoulder, and a basin is held
+under the ear to catch the water flowing out of the canal. The tip of
+the syringe is introduced just within the entrance of the ear, which
+is to be pulled backward and upward, and the stream of water directed
+with some force against the upper and back wall of the passage rather
+than directly down upon the wax. The water which is first returned is
+discolored, and then, on repeated syringing, little flakes of dry
+skin, with perhaps some wax adhering, may be seen floating on the top
+of the water which flows from the ear, and finally, after a longer or
+shorter period, a plug of wax becomes dislodged, and the whole trouble
+is over.
+
+This is the rule, but sometimes the process is very long and tedious,
+only a little coming away at a time, and, rarely, dizziness and
+faintness will require the patient to lie down for a while. The water
+should always be removed from the ear after syringing by twisting a
+small wisp of absorbent cotton about the end of a small stick, as a
+toothpick, which has been dipped into water to make the cotton adhere.
+The tip of the toothpick, thus being thoroughly protected by dry
+cotton applied so tightly that there is no danger of it slipping off,
+while the ear is pulled backward and upward to straighten the canal,
+is gently pushed into the bottom of the canal and removed, and the
+process repeated with fresh cotton until it no longer returns moist.
+Finally a pledget of dry cotton should be loosely packed into the ear
+passage, and worn by the patient for twelve or twenty-four hours.
+
+
+=PERSISTENT AND CHRONIC DEAFNESS.=--A consideration of deafness
+requires some understanding of the structure and relations of the ear
+with other parts of the body, notably the throat. It has been pointed
+out that the external ear--comprising the fleshy portion of the ear,
+or auricle, and the opening, or canal, about an inch long--is
+separated from that portion of the ear within (or middle ear) by the
+drum membrane. The middle ear, while protected from the outer air by
+the drum, is really a part of the upper air passages, and participates
+in disorders affecting them. It is the important part of the ear as it
+is the seat of most ear troubles, and disease of the middle ear not
+only endangers the hearing, but threatens life through proximity to
+the brain.
+
+In the middle ear we have an air space connected with the throat by
+the Eustachian tube, a tube about an inch long running downward and
+forward to join the upper air passage at the junction of the back of
+the nose and upper part of the throat. If one should run the finger
+along the roof of the mouth and then hook it up behind and above the
+soft palate one could feel the openings of these tubes (one for each
+ear) on either side of the top of the throat or back of the nose,
+according to the view we take of it.
+
+Then the middle ear is also connected with a cavity in the bone back
+of the ear (mastoid cavity or cells), and the outer and lower wall is
+formed by the drum membrane. Vibrations started by sound waves which
+strike the ear are connected by means of a chain of three little bones
+from the drum through the middle ear to the nervous apparatus in the
+internal ear. The head of one of these little bones may be seen by an
+expert, looking into the ear, pressing against the inside of the drum
+membrane. Stiffening or immovability of the joints between these
+little bones, from catarrh of the middle ear, is most important in
+producing permanent deafness. The middle ear space is lined with
+mucous membrane continuous with that of the throat through the
+Eustachian tube. This serves to drain mucus from the middle ear, and
+also to equalize the air pressure on the eardrum so that the pressure
+within the middle ear shall be the same as that without.
+
+When there is catarrh or inflammation of the throat or nose it is apt
+to extend up the Eustachian tubes and involve the middle ear. In this
+way the tubes become choked and obstructed with the oversecretion or
+by swelling. The air in the middle ear then becomes absorbed in part,
+and a species of vacuum is produced with increased pressure from
+without on the eardrum. The drum membrane will be pressed in, and
+through the little bones pressure will be made against the sensitive
+nervous apparatus, irritating it and giving rise to deafness,
+dizziness, and the sensation of noises in the ear. Noises from without
+will also be intensified in passing through the middle ear when it is
+converted into a closed cavity through the blocking of the Eustachian
+tube.
+
+A very important feature following obstruction of the Eustachian
+tubes, and rarefaction of the air in the middle ear, is that
+congestion of the blood vessels ensues and increased secretion,
+because the usual pressure of the air on the blood vessels within the
+middle ear is taken away.
+
+This then is the cause of most permanent deafness, to which is given
+the name catarrhal deafness, because every fresh cold in the head, or
+sore throat, tends to start up trouble in the ear such as we have just
+described. Repeated attacks leave vestiges behind until permanent
+deafness remains. In normal conditions every act of swallowing opens
+the apertures of the Eustachian tubes in the throat, and allows of
+equalization of the air pressure within and without the eardrum, but
+if the nose is stopped up by a cold in the head, or enlargement of the
+tonsil at the back of the nose (as from adenoids, see p. 61), the
+process is reversed and air is exhausted from the Eustachian tubes
+with each swallowing motion.
+
+The moral to be drawn from all the foregoing is to treat colds
+properly when they are present, keeping the nose and throat clean and
+clear of mucus, and to have any abnormal obstruction in the nose or
+throat and source of chronic catarrh removed, as enlarged tonsils,
+adenoids, and nasal outgrowths.
+
+
+=FOREIGN BODIES IN THE EAR.=--Foreign bodies, as buttons, pebbles,
+beans, cherry stones, coffee, etc., are frequently placed in the ear
+by children, and insects sometimes find their way into the ear passage
+and create tremendous distress by their struggles. Smooth,
+nonirritating bodies, as buttons, pebbles, etc., do no particular harm
+for a long time, and may remain unnoticed for years. But the most
+serious damage not infrequently results from unskillful attempts at
+their removal by persons (even physicians unused to instrumental work
+on the ear) who are driven to immediate and violent action on the
+false supposition that instant interference is called for. Insects, it
+is true, should be killed without delay by dropping into the ear sweet
+oil, castor, linseed, or machine oil or glycerin, or even water, if
+the others are not at hand, and then the insect should be removed in
+half an hour by syringing as recommended for wax (p. 35).
+
+To remove solid bodies, turn the ear containing the body, downward,
+pull it outward and backward, and rub the skin just in front of the
+opening into the ear with the other hand, and the object may fall out.
+
+Failing in this, syringing with warm water, as for removal of wax,
+while the patient is sitting, may prove successful. The essentials of
+treatment then consist, first, in keeping cool; then in killing
+insects by dropping oil or water into the ear, and, if syringing
+proves ineffective, in using no instrumental methods in an attempt to
+remove the foreign body, but in awaiting such time as skilled medical
+services can be obtained. If beans or seeds are not washed out by
+syringing, the water may cause them to swell and produce pain. To
+obviate this, drop glycerin in the ear which absorbs water, and will
+thus shrivel the seed.
+
+
+=EARACHE.=--Earache is due usually not to neuralgia of the ear, but to
+a true inflammation of the middle ear, which either subsides or
+results in the accumulation of inflammatory products until the drum is
+ruptured and discharge occurs from the external canal. The trouble
+commonly originates from an extension of catarrhal disease of the nose
+or throat; the germs which are responsible for these disorders finding
+their way into the Eustachian tubes, and thus into the middle ear. Any
+source of chronic catarrh of the nose or throat, as enlarged and
+diseased tonsils, adenoids in children, or nasal obstruction, favor
+the growth of germs and the occurrence of frequent attacks of acute
+catarrh or "colds." The grippe has been the most fruitful cause of
+middle-ear inflammation and earache in recent years. Any act which
+forces up fluid or secretions from the back of the nose into the
+Eustachian tubes (see section on Deafness) and thus into the middle
+ear, is apt to set up inflammation there, either through the
+introduction of germs, or owing to the mechanical injury sustained.
+Thus the use of the nasal douche, the act of sniffing water into the
+nose, or blowing the nose violently when there is secretion or fluid
+in the back of the nose, or the employment of the post-nasal syringe
+are one and all attended with this danger. Swimming on the back,
+diving, or surf bathing also endangers the ear, as cold water is
+forcibly driven not only into the external auditory canal, but, what
+is more frequently a source of damage, into the Eustachian tubes
+through the medium of the nose or throat. In this case the plugging
+of the nose with cotton would be of more value than the external
+canal, as is commonly practiced. If water has entered the Eustachian
+tube, blowing the nose and choking merely aggravate the trouble. The
+wiser plan is to do nothing but trust that the water will drain out,
+and if pain ensues treat it as recommended below for earache.
+
+Water in the ears is sometimes removed by jumping about on one foot
+with the troublesome ear held downward, and if it is in the external
+canal it may be wiped out gently with cotton on the end of a match, as
+recommended in the article on treating wax in the ear (see p. 35). In
+the treatment of catarrh in the nose or throat only a spray from an
+atomizer should be used, as Dobell's or Seiler's solutions followed by
+menthol and camphor, twenty grains of each to the ounce of alboline or
+liquid vaseline.[1]
+
+Exposure to cold and the common eruptive diseases of children, as
+scarlet fever, measles, and also diphtheria, are common causes of
+middle-ear inflammation. In the latter disorders the protection
+afforded by a nightcap which comes down over the ears, and worn
+constantly during the illness, is frequently sufficient to ward off
+ear complications.
+
+Although earache or middle-ear inflammation is common, its dangers are
+not fully appreciated, since the various complications are likely to
+arise, and the result is not rarely serious. Extension of the
+inflammation to the bone behind the ear may necessitate chiseling
+away a part of the skull to liberate pus or dead bone in this
+locality, and the occurrence of abscess of the brain will necessitate
+operation.
+
+The use of leeches in the beginning of the attack is of great value,
+and though unpleasant are not difficult or painful in their
+application. One should be applied just in front of the opening into
+the ear (which should be previously closed with cotton to prevent the
+entrance of the leech), and the other behind the ear in the crease
+where it joins the side of the head and at a point a little below the
+level of the external opening into the ear. A drop of milk on these
+spots will often start the leeches immediately at work, or a drop of
+blood obtained with a pin prick. When the leeches are gorged with
+blood and cease to suck, they should be removed and bleeding
+encouraged for half an hour with applications of absorbent cotton
+dipped in hot water. Then clean, dry absorbent cotton is applied, and
+pressure made on the wounds if bleeding does not soon stop or is
+excessive.
+
+The after treatment of the bites consists in cleanliness and the use
+of vaseline. The patient must stay in bed, and the hot-water bag be
+constantly kept on the ear till all pain ceases. If the drum
+perforates, a discharge will usually appear from the external ear.
+Then the canal must be cleansed, once or more daily, by injecting very
+gently into the ear a solution of boric acid (as much of boric acid
+as the water will dissolve), following this by wiping the water out of
+the canal with sterilized cotton, as directed for the treatment of wax
+in the ear (p. 35).
+
+The syringing is permissible only once daily, unless the discharge is
+copious, but the canal may be wiped out in this manner several times a
+day with dry cotton. It is well to keep the opening into the ear
+greased with vaseline, and a plug of clean absorbent cotton loosely
+packed into the canal to keep out the cold. Excessive or too forcible
+syringing may bring about that complication most to be feared,
+although it may appear through no fault in care, i. e., an implication
+of the cavity in the bone back of the ear (mastoid disease). Germs
+find their way through the connecting passage by which this cavity is
+in touch with the middle ear, or may be forced in by violent
+syringing. When this happens, earache, or pain just back of the ear,
+commonly returns during the first or second week after the first
+attack, and tenderness may be observed on pressing on the bone just
+back of the ear close to the canal. Fever, and local redness and
+swelling of the parts over the bone in this region may also occur.
+Confinement to bed, and constant application of a rubber bag
+containing cracked ice, to the painful parts must be enforced. If the
+tenderness on pressure over the bone and pain do not subside within
+twenty-four to forty-eight hours, surgical assistance must be obtained
+at any cost, or a fatal result may ensue. The opening in the drum
+membrane, caused by escape of discharge in the course of middle-ear
+inflammation, usually closes, but even if it does not deafness is not
+a necessary sequence.
+
+The eardrum is not absolutely essential to hearing, but it is of great
+importance to exclude sources of irritation, dust, water, and germs
+which are likely to set up middle-ear trouble. More ordinary
+after-effects are chronic discharge from the ear following acute
+inflammation and perforation of the eardrum, which may mean at any
+time a sudden return of pain with the occurrence of the more dangerous
+conditions just recited, together with deafness. Bearing all this in
+mind it is advisable never to neglect a severe or persistent earache,
+but to call in expert attention. When this is not obtainable the
+treatment outlined below should be carefully followed.
+
+=Symptoms.=--Pain is severe and often excruciating in adults. It may
+be felt over the temple, side and back of the head and neck, and even
+in the lower teeth, as well as in the ear itself. The pain is
+increased by blowing the nose, sneezing, coughing, and stooping. There
+is considerable tenderness usually on pressing on the skin in front of
+the ear passage. In infants there may be little evidence of pain in
+the ear. They are apt to be very fretful, refuse food, cry out in
+sleep, often lie with the affected ear resting on the hand, and show
+tenderness on pressure immediately in front or behind the ear
+passage.
+
+Dullness, fever, chills, and convulsions are not uncommon in children,
+but, on the other hand, after some slight illness it is not infrequent
+for discharge from the ear to be the first sign which calls the
+attention of parent or medical attendant to the source of the trouble.
+For this reason the careful physician always examines the ear in
+doubtful cases of children's diseases. Unless the inflammation
+subsides with treatment, either a thin, watery fluid (serum) is formed
+in the middle ear, or pus, when we have an "abscess of the ear." The
+drum if left to itself breaks down in three to five days, or much
+sooner in children who possess a thinner membrane. A discharge then
+appears in the canal of the external ear, and the pain is relieved. It
+may occasionally happen that the Eustachian tube drains away the
+discharge, or that the discharge from the drum is so slight that it is
+not perceived, and recovery ensues. Discharge from the ear continues
+for a few weeks, and then the hole in the drum closes and the trouble
+ceases. This is the history in favorable cases, but unfortunately, as
+we have indicated, the opposite state of affairs results not
+infrequently, especially in neglected patients.
+
+=Treatment.=--The patient with severe earache should go to bed and
+take a cathartic to move the bowels. He should lie all the time with
+the painful ear on a rubber bag containing water as hot as can be
+comfortably borne. Every two hours a jet of hot water, which has been
+boiled and cooled just sufficiently to permit of its use, is allowed
+to flow gently from a fountain syringe into the ear for ten minutes,
+and then the ear is dried with cotton, as described under the
+treatment of wax in the ear (p. 35). No other "drops" of any kind are
+admissible for use in the ear, and even this treatment is of less
+importance than the dry heat from the hot-water bag, and may be
+omitted altogether if the appliances and skill to dry the ear are
+lacking. Ten drops of laudanum[2] for an adult, or a teaspoonful of
+paregoric for a child six years old, may be given by the mouth to
+relieve the pain. The temperature of the room should be even and the
+food soft.
+
+If the pain continues it is wiser to have an aurist lance the drum, to
+avoid complications, than to wait for the drum membrane to break open
+spontaneously in his absence. Loss or damage of the eardrums may call
+for "artificial eardrums." They do not act at all like the drumhead of
+the musical instrument by their vibrations, but only are of service in
+putting on the stretch the little bones in the middle ear which convey
+sound. Some of those advertised do harm by setting up a mechanical
+irritation in the ear after a time, and a better result is often
+obtained with a ball of cotton or a paper disc introduced into the ear
+by an aurist.
+
+
+[Illustration: PLATE II
+
+=Plate II=
+
+=ANATOMY OF THE EAR=
+
+The illustration on the opposite page shows the interior structure of
+the ear. The concha and =Meatus=, or canal, comprise the external ear,
+which is separated from the middle ear by the =Drum Membrane=. Wax is
+secreted by glands located in the lining of the meatus, and should be
+detached by the motion of the jaws during talking and eating. If it
+adheres to the drum membrane it causes partial deafness.
+
+The internal ear, or labyrinth, a cavity in the bone, back of the
+middle ear, consists of three parts: the =Cochlea=, the =Semicircular
+Canals=, and a middle portion, the =Vestibule=. The middle ear is
+connected with the throat by the =Eustachian Tube=.
+
+Sound vibrations, which strike the drum membrane, are conveyed by
+means of a chain of three small bones through the middle ear to the
+nervous apparatus of the internal ear. The Eustachian tube and middle
+ear are lined throughout with mucous membrane, and any severe
+inflammation of the throat may extend to and involve the tube and the
+middle ear, causing deafness.]
+
+
+=MODERATE OR SLIGHT EARACHE.=--A slight or moderate earache, which
+may, however, be very persistent, not sufficient to incapacitate the
+patient or prevent sleep, is often caused by some obstruction in the
+Eustachian tube, either by swelling or mucous discharge. This
+condition gives rise to the train of effects noted in the section on
+deafness. The air in the middle ear is absorbed to some extent, and
+therefore the pressure within the ear is less than that outside the
+drum, so that the latter is pressed inward with the result that pain,
+and perhaps noises and deafness ensue, and, if the condition is not
+relieved, inflammation of the middle ear as described above.
+
+=Treatment.=--Treatment is directed toward cleaning the back of the
+nose and reducing swelling at the openings of the Eustachian tubes in
+this locality, and inflating the tubes with air. A spray of Seiler's
+solution[3] is thrown from an atomizer through the nostrils, with the
+head tipped backward, until it is felt in the back of the throat, and
+after the water has drained away the process is repeated a number of
+times. This treatment is pursued twice daily, and one hour after the
+fluid in the nose is well cleared away the Eustachian tubes may be
+inflated by the patient. To accomplish this the lips are closed
+tightly, and the nostrils also, by holding the nose; then an effort is
+made to blow the cheeks out till air is forced into the tubes and is
+felt entering both ears. This act is attended with danger of carrying
+up fluid into the tubes and greatly aggravating the condition, unless
+the water from the spray has had time to drain away.
+
+Blowing the nose, as has been pointed out, is unwise, but the water
+may be removed to some extent by "clearing the throat." The reduction
+of swelling at the entrance of the Eustachian tube in the back of the
+nose can be properly treated only by an expert, as some astringent
+(glycerite of tannin) must be applied on cotton wound on a curved
+applicator, and the instrument passed above and behind the roof of the
+mouth into the region back of the nose.
+
+Rubbing the parts just in front of the external opening into the ear
+with the tip of one finger for a period of a few minutes several times
+a day will also favor recovery in this trouble.
+
+
+FOOTNOTES:
+
+[1] See p. 49.
+
+[2] Caution. Ask the doctor first.
+
+[3] Tablets for the preparation of Seiler's solution are to be found
+at most druggists.
+
+
+
+
+CHAPTER II
+
+=The Nose and Throat=
+
+_Cold in the Head--Mouth-Breathing--Toothache--Sore Mouth--Treatment
+of Tonsilitis--Quinsy--Diphtheria._
+
+
+=NOSEBLEED.=--Nosebleed is caused by blows or falls, or more
+frequently by picking and violently blowing the nose. The cartilage of
+the nasal septum, or partition which divides the two nostrils, very
+often becomes sore in spots, owing to irritation of dust-laden air,
+and these crust over and lead to itching. Then "picking the nose"
+removes the crusts, and frequent nosebleed results. Nosebleed also is
+common in both full-blooded and anaemic persons; in the former because
+of the high pressure within the blood vessels, in the latter owing to
+the thin walls of the arteries and capillaries which readily rupture.
+
+Nosebleed is again an accompaniment of certain general disorders, as
+heart disease and typhoid fever. The bleeding comes usually from one
+nostril only, and is a general oozing from the mucous membrane, or
+more commonly flows from one spot on the septum near the nostril, the
+cause of which we have just noted. The blood may spout forth in a
+stream, as after a blow, or trickle away drop by drop, but is rarely
+dangerous except in infants and aged persons with weak blood vessels.
+In the case of the latter the occurrence of bleeding from the nose is
+thought to indicate brittle vessels and a tendency to apoplexy, which
+may be averted by the nosebleed. This is uncertain. If nosebleed comes
+on at night during sleep, the blood may flow into the stomach without
+the patient's knowledge, and on being vomited may suggest bleeding
+from the stomach.
+
+=Treatment.=--The avoidance of excitement and of blowing the nose,
+hawking, and coughing will assist recovery. The patient should sit
+quietly with head erect, unless there is pallor and faintness, when he
+may lie down on the side with the head held forward so that the blood
+will flow out of the nose. There is no cause for alarm in most cases,
+because the more blood lost the more readily does the remainder clot
+and stop bleeding. As the blood generally comes from the lower part of
+the partition separating the nostrils, the finger should be introduced
+into the bleeding nostril and pressure made against this point, or the
+whole lower part of the nose may be simply compressed between the
+thumb and forefinger. If this does not suffice a lump of ice may be
+held against the side of the bleeding nostril, and another placed in
+the mouth. The injection into the nostril of ice water containing a
+little salt is sometimes very serviceable in stopping nosebleed.
+Blowing the nose must be avoided for some time after the bleeding
+ceases.
+
+If none of these methods arrest the bleeding the nostril must be
+plugged. A piece of clean cotton cloth, about five inches square,
+should be pushed gently but firmly into the nostril with a slender
+cylinder of wood about as large as a slate pencil and blunt on the
+end. This substitute for a probe is pressed against the center of the
+cloth, which folds about the stick like a closed umbrella, and the
+cotton is pressed into the nostril in a backward and slightly downward
+direction, for two or three inches, while the head is held erect. Then
+pledgets of cotton wool are packed into the bag formed by the cotton
+cloth after the stick is withdrawn. The mouth of the bag is left
+projecting slightly from the nostril, so that the whole can be
+withdrawn in twenty-four hours.
+
+The bleeding nostril may be more readily plugged by simply pressing
+into it little pledgets of cotton with a slender stick, but it would
+be impossible for an unskilled person to get them out again, and a
+physician should withdraw them inside of forty-eight hours.
+
+
+=FOREIGN BODIES IN THE NOSE.=--Children often put foreign bodies in
+their nose, as shoe buttons, beans, and pebbles. They may not tell of
+it, and the most conspicuous symptoms are the appearance of a thick
+discharge from one nostril, having a bad odor, and some obstruction to
+breathing on the same side. If the foreign body can be seen, the
+nostril on the unobstructed side should be closed and the child made
+to blow out of the other one. If blowing does not remove the body
+it is best to secure medical aid very speedily.
+
+
+[Illustration: PLATE III
+
+=Plate III=
+
+=THE NASAL CAVITY=
+
+In the illustration on the opposite page, the =Red Portion= indicates
+the =Septum= of the nose, the partition which separates the nostrils.
+
+Inflammation of the membrane lining the nasal cavity is the condition
+peculiar to catarrh or "cold in the head." Deformity of the septum may
+obstruct the entrance of air into the nose and create suction on the
+walls of the nasal cavity, causing an overfilling of the blood
+vessels, or "congestion," with subsequent thickening of the mucous
+membrane.
+
+Polypi, small growths which form in the nose, or enlargement of the
+glands in the upper part of the throat (just beyond dotted line at
+inner edge of red portion) also block the air passages and give rise
+to mouth-breathing and its attendant disorders.
+
+Another cause of mouth-breathing is extreme swelling of the membrane
+which covers the turbinated bones of the nose.]
+
+
+=COLD IN THE HEAD FROM OVERHEATING.=--Chilling of the surface of the
+body favors the occurrence of colds, in which lowered bodily vitality
+allows the growth of certain germs always present upon the mucous
+membrane lining the cavities of the nose. Dust and irritating vapors
+also predispose to colds. Overwarm clothing makes a person susceptible
+to colds, while the daily use of cold baths is an effective
+preventive. There is no sufficient reason for dressing more warmly in
+a heated house in winter than one would dress in summer. It is,
+moreover, unwise to cover the chest more heavily than the rest of the
+body. Some one has wisely said: "The best place for a chest protector
+is on the soles of the feet." The rule should always be to keep the
+feet dry and warm, and adapt the clothing to the surrounding
+temperature. Among the germs which cause colds in the head, that of
+pneumonia is the one commonly found in the discharge from the nose.
+When pneumonia is epidemic it is therefore wise to take extra
+precautions to avoid colds, and care for them when they occur.
+
+The presence of chronic trouble in the throat and nose, such as
+described under Mouth-Breathing, Adenoids, etc. (p. 60), is perhaps
+the most frequent cause of colds, because the natural resistance of
+the healthy mucous membrane to the attack of germs is diminished
+thereby, and the catarrhal secretions form a source of food for the
+germs to grow upon. It should also be kept in mind that cold in the
+head is the first sign of measles and of _grippe_. Colds are more
+common in the spring and fall.
+
+=Symptoms.=--Colds begin with chilliness and sneezing, and, if severe,
+there may be also headache, fever, and pain in the back and limbs, as
+in _grippe_. The nose at first feels dry, but soon becomes more or
+less stopped with secretion. The catarrh may extend from the back of
+the nose through the Eustachian tube to the ear, causing earache,
+noises in the ear, and deafness (see p. 41). This unfortunate result
+may be averted by proper spraying of the nose, and avoidance of
+blowing the nose violently.
+
+=Treatment.=--Treatment must be begun at the first suspicion of an
+attack to be of much service. The bowels should be opened with calomel
+or other cathartic; two-fifths of a grain for an adult, half a grain
+for a child. Rest in bed for a day or two, after taking a hot bath and
+a glass of hot lemonade containing a tablespoonful or two of whisky,
+is the most valuable treatment. The Turkish bath is also very
+efficacious in cutting short colds, but involves great risk of
+increasing the trouble unless the patient can return home in a closed
+carriage directly from the bath. Of the numerous remedies which are
+commonly used to arrest colds in the first stages are two which
+possess special virtue; namely, quinine and Dover's powder, given in
+single dose of ten grains of each for an adult. Both of these
+remedies may be taken, but while the Dover's powder is most effective
+it is often necessary for the patient to remain in bed twelve to
+eighteen hours after taking it on account of nausea and faintness
+which would be produced if the patient were up and moving about.
+Rhinitis tablets should never be used. They are generally abused, and,
+indeed, some fatal cases are on record in which they caused death.
+Drugs are of little value except in the beginning of a cold, when they
+are given with the hope of cutting short an attack.
+
+The local applications of remedies to the inflamed region is of
+service. At the onset of the cold, Seiler's solution (conveniently
+made from tablets which are sold in the shops) or Dobell's solution
+should be sprayed from an atomizer, into the nostrils, every half
+hour, and, when the discharge becomes thick and copious, this is to be
+discarded for a spray consisting of alboline (four ounces) and camphor
+and menthol (each thirty grains), used in the same manner as long as
+the cold lasts. Containing bottles should be stood in hot water, in
+order that all sprays for the nostrils may be used warm.
+
+It is well to give babies a teaspoonful of castor oil and a warm bath,
+and keep them in bed. If there is fever with the cold, five drops of
+sweet spirit of niter may be given in a teaspoonful of sweetened water
+every two hours. Liquid vaseline, or the alboline mixture advised for
+adults, may be dropped into the nostrils with a medicine dropper more
+conveniently than applied by spray.
+
+
+=TOOTHACHE.=--When there is a cavity in an aching tooth it should be
+cleaned of food, and a little pledget of cotton wool wrapped on a
+toothpick may be used to wipe the cavity dry. Then the cavity should
+be loosely packed, by means of a toothpick or one prong of a hairpin,
+with a small piece of absorbent cotton rolled between the fingers and
+saturated with one of the following substances, preferably the first:
+oil of cloves, wood creosote or chloroform.
+
+If wood creosote is used the cotton must be well squeezed to get rid
+of the excess of fluid, as it is poisonous if swallowed, and will burn
+the gum and mouth if allowed to overflow from the tooth.
+
+
+=ALVEOLAR ABSCESS= (_improperly called "Ulcerated Tooth"_).--An
+"ulcerated tooth" begins as an inflammation in the socket of a tooth,
+and, if near its deepest part, causes great pain, owing to the fact
+that the pus formed can neither escape nor expand the unyielding bony
+wall of the socket.
+
+This explains why an abscess near the tooth is so much more painful
+than a similar one of soft parts. There may be no cavity in the tooth,
+but the tooth is commonly dead, or its nerve is dying, and the tooth
+is frequently darker in color. It often happens that threatened
+abscess at the root of a tooth, which has been filled, can be averted
+by a dentist's boring down into the root of the tooth, or removing the
+filling. It is not always possible to locate the troublesome tooth,
+from the pain, but by tapping on the various teeth in turn with a
+knife, or other metal instrument, special soreness will be discovered
+in the "ulcerated" tooth. The ulcerated tooth frequently projects
+beyond its fellows, and so gives pain when the jaws are brought
+together in biting.
+
+=Treatment.=--The treatment for threatened abscess near a tooth
+consists in painting tincture of iodine, with a camel's hair brush,
+upon the gum at the root of the painful tooth, and applying, every
+hour or so, over the same spot a toothache plaster (sold by all
+druggists). The gum must be wiped dry before applying the moistened
+toothache plaster. Water, as hot as can be borne, should be held in
+the mouth, and the process repeated for as long a time as possible.
+Then the patient should lie with the painful side of the face upon a
+hot-water bag or bottle. The trouble may subside under this treatment,
+owing to disappearance of the inflammation, or to the unnoticed escape
+of a small amount of pus through a minute opening in the gum. If the
+inflammation continues the pain becomes intense and throbbing; there
+is often entire loss of sleep and rest, fever, and even chills, owing
+to a certain degree of blood poisoning. The gum and face swell on the
+painful side, and the patient often suffers more than with many more
+serious diseases.
+
+After several days of distress, the bony socket of the tooth gives
+way, and the pus makes its exit, and, bulging out the gum, finally
+escapes through this also, to the immediate relief of the patient. But
+serious results sometimes follow letting nature alone in such a case,
+as the pus from an eyetooth may burrow its way into the internal parts
+of the upper jaw, or into the chambers of the nose, while that from a
+back tooth often breaks through the skin on the face, leaving an ugly
+scar, or, if in the lower jaw, the pus may find its way between the
+muscles of the neck, and not come to the surface till it escapes
+through the skin above the collar bone. Pulling the tooth is the most
+effective way of relieving the condition, the only objection being the
+loss of the tooth, which is to be avoided if possible.
+
+If the pain is bearable and there are no chills and fever, the patient
+may save the tooth by remaining in bed with a hot-water bottle
+continually on the face, and taking ten drops of laudanum to relieve
+the pain at intervals of several hours. Then many hours of suffering
+may be prevented if the gum is lanced with a sharp knife (previously
+boiled for five minutes) as soon as the gum becomes swollen, to allow
+of the escape of pus. The dentist is, of course, the proper person to
+consult in all cases of toothache, and the means herein suggested are
+to be followed only when it is impossible to obtain his services.
+
+
+=MOUTH-BREATHING= (_including Adenoids, Chronic Tonsilitis, Deviation
+of the Nasal Septum, Enlarged Turbinates, and Polypi_).--Any
+obstruction in the nose causes mouth-breathing and gives rise to one
+or more of a long train of unfortunate results. Among the disorders
+producing mouth-breathing, enlargement of the glandular tissue in the
+back of the nose and in the throat of children is most important.
+Glandular growths in the upper part of the throat opposite the back of
+the nasal cavities are known as "adenoids"; they often completely
+block the air passage at this point, so that breathing through the
+nose becomes difficult. Associated with this condition we usually see
+enlargement of the tonsils, two projecting bodies, one on either side
+of the entrance to the throat at the back of the mouth. In healthy
+adult throats the tonsils should be hardly visible; in children they
+are active glands and easily visible.
+
+We are unable to see adenoids because of their position, but can be
+reasonably sure of their presence in children where we find symptoms
+resulting from mouth-breathing as described below. The surgeon assures
+himself positively of the existence of adenoids by inserting a finger
+into the mouth of the patient and hooking it up back of the roof of
+the mouth, when they may be felt as a soft mass filling the back of
+the nose passages.
+
+Other less common causes of mouth-breathing, seen in adults as well as
+children, are deviation of the nasal septum, swelling of the mucous
+membrane covering certain bones in the nose (turbinates), and polypi.
+
+Deviation of the nasal septum means displacement of the partition
+dividing the two nostrils, so that more or less obstruction exists.
+This condition may be occasioned by blows on the nose received in the
+accidents common to childhood. The deformity which results leads in
+time to further obstruction in the nose, because when air is drawn in
+through the narrowed passages a certain degree of vacuum is produced
+and suction on the walls of the nose, as would occur if we drew in air
+from a large pair of bellows through a small thin rubber tube. This
+induces an overfilling of the blood vessels in the walls of the
+passages of the nose, and the continued congestion is followed by
+increased thickness of the lining mucous membrane, thus still further
+obstructing the entrance of air. A one-sided nasal obstruction in a
+child with discharge from that side leads one to suspect that a
+foreign body, as a shoe button, has been put in by the child.
+
+Polypi are small pear-shaped growths which form on the membrane lining
+the nasal passages and sometimes completely block them. They resemble
+small grapes without skins.
+
+These, then, are the usual causes of mouth-breathing, but of most
+importance, on account of their frequency and bearing on the health
+and development, are adenoids and enlarged throat tonsils in children.
+Adenoids and enlarged tonsils are often due to inflammation of these
+glands during the course of the contagious eruptive disorders, as
+scarlet fever, measles, or diphtheria; probably, also, to constant
+exposure to a germ-laden atmosphere, as in the case of children
+herded together in tenements.
+
+=Symptoms.=--The mouth-breathing is more noticeable during sleep;
+snoring is common, and the breathing is of a snorting character with
+prolonged pauses. Children suffering from enlarged tonsils and
+adenoids are often backward in their studies, look dull, stupid, and
+even idiotic, and are often cross and sullen; the mouth remains open,
+and the lower lip is rolled down and prominent; the nose has a pinched
+aspect, and the roof of the mouth is high. Air drawn into the lungs
+should be first warmed and moistened by passing through the nose, but
+when inspired through the mouth, produces so much irritation of the
+throat and air passages that constant "colds," chronic catarrh of the
+throat, laryngitis, and bronchitis ensue.
+
+The constant irritation of the throat occurring in mouth-breathers
+weakens the natural resistance against such diseases as acute
+tonsilitis, scarlet fever, and diphtheria, so that they are especially
+subject to these diseases. But these are not the only ailments to
+which the mouth-breather is liable, for earache and deafness naturally
+follow the catarrh, owing to obstruction of the Eustachian tubes (see
+Earache, p. 40, and Deafness, p. 38). Deformity of the chest is
+another result of obstruction to nose-breathing, the common form being
+the "pigeon breast," where the breastbone is unduly prominent. The
+voice is altered so that the patient, as the saying goes, "talks
+through the nose," although, in reality, nasal resonance is reduced
+and difficulty is experienced in pronouncing N and M correctly, while
+stuttering is not uncommon. Nasal obstruction leads to poor nutrition,
+and hence children with adenoids and enlarged tonsils are apt to be
+puny and weakly specimens.
+
+=Treatment.=--The treatment is purely surgical in all cases of nasal
+obstruction: removal of the adenoid growths, enlarged tonsils, and
+polypi, straightening the displaced nasal septum, and burning the
+thickened mucous lining obstructing the air passages in the nose. None
+of the operations are dangerous if skillfully performed, and should be
+generally done, even in the case of delicate children, as the very
+means of overcoming this delicacy. The after treatment is not
+unimportant, consisting in the use of simple generous diet, as plenty
+of milk, bread and butter, green vegetables and fresh meat, and the
+avoidance of pastries, sweets, fried food, pork, salt fish and salt
+meats, also the roots, as parsnips, turnips, carrots and beets, and
+tea and coffee. Life in the open air, emulsion of cod-liver oil, daily
+sponging with cold water while the patient stands in warm water,
+followed by vigorous rubbing, will all assist the return to health.
+
+
+=SORE MOUTH; INFLAMMATION OF THE MOUTH.=--There are various forms of
+inflammation of the mouth, generally dependent upon the entrance of
+germs, associated with indigestion or general weakness following some
+fever or other disease. Unclean nipples of the mother or of the
+bottle, or unclean bottles, allow entrance of germs, and are frequent
+causes. Irritation of a sharp tooth, or from rubbing the gum, or from
+too vigorous cleansing of the mouth, may start the disease. Some
+chemicals, especially mercury improperly prescribed, produce the
+disease. The germs may gain admission in impure milk in some cases.
+Inflammation of the mouth is essentially a children's disease, only
+the ulcerated form being common in adults.
+
+=Symptoms.=--In general, the mouth is hot, very red, dry, and tender;
+the child is fretful and has difficulty in nursing, often dropping the
+nipple and crying; the tongue is coated, and there may be fever and
+symptoms of indigestion, as vomiting; sometimes the disease occurs
+during the course of fevers; later in the course of the disorder the
+saliva often runs freely from the mouth.
+
+=Simple Form.=--In this there are only redness, swelling, and
+tenderness of the inside of the mouth. The tongue is at first dry and
+white, but the white coating comes off, leaving it red in patches.
+After a while the saliva becomes profuse. The treatment consists in
+washing the mouth often in ice water containing about one-half drachm
+of boric acid to four ounces of water by means of cotton tied on a
+stick, and holding lumps of ice in the mouth wrapped in the corner of
+a handkerchief. It is well also to give a teaspoonful of castor oil.
+
+=Aphthous Form.=--In this there are yellow-white spots, resulting in
+little shallow depressions or ulcers, on the inside of the cheeks and
+lips, and on the tongue and roof of the mouth. These occur in crops
+and last from ten to fourteen days. The disease is often preceded by
+vomiting, constipation, and fever, with pain in the mouth and throat,
+and is accompanied by lumps or swelling of the glands under the jaw
+and in the neck. The treatment consists in the use of castor oil, and
+swabbing the mouth, several times a day, after each feeding, with
+boric-acid solution, as advised before, or better with permanganate of
+potash solution, using ten grains to the cup of water.
+
+=Thrush= (_Sprue_).--This form is due to the growth of a special
+fungus in the mouth, causing the appearance of white spots on the
+inside of the cheeks, lips, tongue, and roof of the mouth, looking
+like flakes of curdled milk, but not easily removed. There are also
+symptoms of indigestion, as vomiting, diarrhea, and colic. The disease
+is contagious, and is due to some uncleanliness, often of the bottles,
+nipples, or milk. Sometimes ulcers or sore depressions are left in the
+mouth, and in weak children, in which the disease is apt to occur, the
+result may be serious, and a physician's services are demanded. The
+treatment consists in applying saleratus and water (one teaspoonful in
+a cup of water) to the whole inside of the mouth, between feedings,
+with a camel's-hair brush or with a soft cloth. A dose of castor oil
+is also desirable, and great care as regards cleanliness of the
+bottles and nipples should be exercised.
+
+=Ulcerous Form.=--This does not occur in children under five, but may
+attack persons of all greater ages. It is often seen following measles
+and scarlet fever, and in the poor and ill nourished, and after the
+unwise use of calomel. There are redness and swelling of the gum about
+the base of the lower front teeth, and the gums bleed easily. Matter,
+or pus, forms between the teeth and the gum, and the mouth has a foul
+odor. The gum on the whole lower jaw may become inflamed, and a yellow
+band of ulceration may appear along the gums. The glands under the jaw
+and in the neck are enlarged, feeling like tender lumps, and saliva
+flows freely. In severe cases the gums may become destroyed and eaten
+away by the ulceration, and the bone of the jaw be diseased and
+exposed. As in the graver cases it may become necessary to remove dead
+bone and teeth, and the very dangerous form next described may
+sometimes follow it, it will be seen that it is a disease requiring
+skilled medical attention. The treatment consists in using, as a mouth
+wash and gargle, a solution of chlorate of potash (fifteen grains to
+the ounce) every two hours. Cases usually last at least a week.
+
+=Gangrenous Form.=--This is a rare and fatal form of inflammation of
+the mouth and occurs in children weak and debilitated from other
+diseases, as from the contagious eruptive fevers, chronic diarrhea,
+and scurvy. It is seen more often in hospitals and is contagious. A
+foul odor is noticed about the mouth, in which will be seen an ulcer
+on the gum or inside of the cheek. The cheek swells tremendously, with
+or without pain, and becomes variously discolored--red, purple, black.
+The larger proportion of patients die of exhaustion and blood
+poisoning within one to three weeks, and the only hope is through
+surgical interference at the earliest possible moment.
+
+
+=CANKER.=--A small, shallow, yellow ulcer, appearing on the inside of
+the lips or beneath the tongue during some disorder of the digestion.
+It is very tender when touched and renders chewing or talking somewhat
+painful. Treatment consists of touching the ulcer carefully with the
+point of a wooden toothpick which has been dipped in pure carbolic
+acid (a poison) and then rinsing the resulting white spot and the
+whole mouth very carefully, so as not to swallow any of the acid.
+
+Inflammation of the mouth occurs in two other general diseases, in
+syphilis and rarely in diphtheria. In children born of syphilitic
+parents, deep cracks often appear at either side of the mouth and do
+not heal as readily as ordinary sores, but continue a long time, and
+eventually leave deep scars. In diphtheria the membrane which covers
+the tonsils sometimes spreads to the cheeks, tongue, and lips, but in
+either case the general symptoms will serve to distinguish the
+diseases, and neither can be treated by the layman.
+
+
+=MILD SORE THROAT= (_Acute Pharyngitis_).--The milder sore throat is
+commonly the beginning of an ordinary cold, although sometimes it is
+caused by digestive disorders. Exposure to cold and wet is, however,
+the most frequent source of this form of sore throat. Soreness,
+dryness, and tickling first call attention to the trouble, together
+with a feeling of chilliness and, perhaps, slight fever. There may be
+some stiffness and soreness about the neck, owing to swelling of the
+glands. If the back of the tongue is held down by a spoon handle, the
+throat will be seen to be generally reddened, including the back, the
+bands at the side forming the entrance to the throat at the back of
+the mouth, and the uvula or small, soft body hanging down from the
+middle of the soft palate at the very back of the roof of the mouth.
+The tonsils are not large and red nor covered with white dots, as in
+tonsilitis. Neither is there much pain in swallowing. The surface of
+the throat is first dry, glistening, and streaked with stringy, sticky
+mucus.
+
+=Treatment.=--The disorder rarely lasts more than a few days. The
+bowels should be moved in the beginning of the attack by some purge,
+as two compound cathartic pills or three grains of calomel, and the
+throat gargled, six times daily, with potassium chlorate solution
+(one-quarter teaspoonful to the cup of water), or with Dobell's
+solution. In gargling, simply throw back the head and allow the
+fluid to flow back as far as possible into the throat without
+swallowing it. The frequent use of one of these fluids in an atomizer
+is even preferable to gargling. As an additional treatment, the
+employment of a soothing and pleasant substance, as peppermints,
+hoarhound or lemon drops, or marshmallows or gelatin lozenges, is
+efficacious, and will prove an agreeable remedy to the patient in sad
+contrast with many of our prescriptions. The use of tobacco must be
+stopped while the throat is sore.
+
+
+[Illustration: PLATE IV
+
+=Plate IV=
+
+=THE LARYNX=
+
+The illustration on the opposite page shows the upper part of the
+larynx and the base of the tongue.
+
+During the inspiration of a full breath, or when singing a low note,
+the =Epiglottis= lies forward and points upward, as shown in the cut,
+with the glottis (the passage leading into the windpipe between the
+vocal cords) wide open.
+
+During the act of swallowing, the epiglottis is turned downward and
+backward until it touches the =Cricoid Cartilage=, thus closing the
+glottis. The cricoid cartilage, which forms the upper part of the
+framework of the larynx, rests on the "Adam's apple."
+
+The =False Vocal Cords= are bands of ligament, and take no part in the
+production of sound.
+
+The =True Vocal Cords= move during talking or singing, and relax or
+contract when sounding, respectively, a low or high note. Hoarseness
+and cough occurring during laryngitis, diphtheria, and croup, are the
+result of inflammation of the mucous membrane lining the larynx.]
+
+
+=TONSILITIS= (_Follicular Tonsilitis_).--Tonsilitis is a germ disease
+and is contagious. Exposure to cold and wet and to germ-laden air
+renders persons more liable to attacks. It is more likely to occur in
+young people, especially those who have already suffered from the
+disease and whose tonsils are chronically enlarged, and is most
+prevalent in this country in spring. The disease appears to be often
+associated with rheumatism. Tonsilitis begins much like _grippe_, with
+fever, headache, backache and pain in the limbs, sore throat, and pain
+in swallowing. On inspecting the throat (with the tongue held down
+firmly by a spoon handle and the mouth widely open in a good light,
+preferably sunlight) the tonsils will be seen to be swollen, much
+reddened, and dotted over with pearl-white spots.
+
+Sometimes only one tonsil is so affected, but the other is likely to
+become inflamed also. Occasionally there may be only one spot of
+white on the tonsil. The swelling differs in degree; in some cases the
+tonsils may be so swollen as almost to meet together, but there is no
+danger of suffocation from obstruction of the throat, as occurs in
+diphtheria and very rarely in quinsy. The characteristic appearance
+then consists in large, red tonsils covered with white spots. The
+spots represent discharge which fills in the depressions in the
+tonsil. The fever lasts three days to a week, generally, and then
+subsides together with the other symptoms.
+
+With apparent tonsilitis there must always be kept in mind the
+possibility of diphtheria, and, unfortunately, it is at times
+impossible for the most acute physician to distinguish between these
+two diseases by the appearances of the throat alone. In order to do so
+it is necessary to rub off some of the discharge from the tonsils, and
+examine, microscopically, the kind of germs contained therein. The
+general points of difference are: in diphtheria the tonsils are
+usually completely covered with a gray membrane. In the early stage,
+or in mild cases of diphtheria, there may be only a spot on one
+tonsil, but it is apt to be yellow in color, and is thicker than the
+white spots in tonsilitis. These are the difficult cases. Ordinarily,
+in diphtheria, not only are the tonsils covered with a grayish
+membrane, but this soon extends to the surrounding parts of the
+throat, whereas in tonsilitis the spots are always found on the tonsil
+alone. The white spot can be readily wiped off with a little
+absorbent cotton wound on a stick, in the case of tonsilitis, but in
+diphtheria the membrane can be removed in this way only with
+difficulty, and leaves underneath a rough, bleeding surface. The
+breath is apt to have a bad odor in diphtheria, and the temperature is
+lower (not much over 100 deg. F.) than in tonsilitis, when it is
+frequently 101 deg. to 103 deg. F. Notwithstanding these points, it is never
+safe for a layman to undertake the diagnosis when a physician's
+services are obtainable. On the other hand, when this is not possible
+and the patient's tonsils present the white, dotted appearance
+described, especially if subject to similar attacks, one may be
+reasonably sure that the case is tonsilitis.
+
+=Treatment.=--The patient should be put to bed and kept apart from
+children and young persons, and, if living among large numbers of
+people, should be strictly quarantined. For, although the disease is
+not dangerous, it quickly spreads in institutions, boarding schools,
+etc. If the tonsils are painted with a solution of silver nitrate (one
+drachm to the ounce of water), applied carefully with a camel's-hair
+brush, at the beginning of the attack, and making two applications
+twelve hours apart, the disease may sometimes be arrested. It is well
+also at the start to open the bowels with calomel, giving three grains
+in a single dose, or divided doses of one-half grain each until three
+grains have been taken. Pain is relieved by phenacetin in three- to
+five-grain doses as required, but not taken oftener than once in three
+hours, while at night five to ten grains of Dover's powder (for an
+adult) will secure sleep. For children one-half drop doses of the
+(poisonous) tincture of aconite is preferable to phenacetin. The
+outside of the throat should be kept covered with wet flannel wrung
+out in cold water and covered with oil silk, or an ice bag may be
+conveniently used in its place. A half teaspoonful of the following
+prescription is beneficial unless it disagrees with the stomach. It
+must not be taken within half an hour of a meal, and is not to be
+diluted with water, as it acts, partly through its local effect, on
+the tonsils when allowed to flow from a spoon on the back of the
+tongue.
+
+    [Rx] Glycerin                                4 ounces
+         Tincture of chloride of iron          1/2 ounce
+
+    Mix. Directions, half teaspoonful every half hour.
+
+A mixture of hydrogen dioxide, equal parts, with water can also be
+used to advantage as a spray in an atomizer every two hours. The
+phenacetin and Dover's powder must be discontinued as soon as the pain
+and sleeplessness cease, but the iron preparation and spray should be
+continued until the throat regains its usual condition. A liquid diet
+is desirable during the first part of the attack, consisting of milk,
+cocoa, eggnog (made of the white of egg), soups, and gruels; orange
+juice may be allowed, also grapes. The bowels must be kept regular
+with mild remedies, as a Seidlitz powder in a glass of water in the
+morning, or one or two two-grain tablets of extract of cascara
+sagrada at night.
+
+
+=QUINSY.=--Quinsy is a peritonsilitis; that is, it is an inflammatory
+disease of the tissues in which the tonsil is imbedded, an
+inflammation around the tonsil. The swelling of these tissues thrusts
+the tonsil out into the throat; but the tonsil is little affected.
+Quinsy involves the surrounding structures of the throat, and usually
+results in abscess. The disease is said to be frequently hereditary,
+and often occurs in those subject to rheumatism and gout. It is seen
+more often in spring and autumn and in those living an out-of-door
+existence, and having once had quinsy the victim is liable to frequent
+recurrences of the disease. Quinsy is characterized by much greater
+pain in the throat and in swallowing than is the case in tonsilitis,
+and the temperature is often higher--sometimes 104 deg. to 105 deg. F. When
+the throat is inspected, one or both tonsils are seen to be enlarged
+and crowded into its cavity from the swelling of the neighboring
+parts. The tonsils may almost block the entrance to the throat. The
+voice is thick and indistinct, the glands in the side of the neck
+become swollen, and the neck is sore and stiff in consequence, while
+the mouth can be only partially opened on account of pain. For the
+same reason the patient can swallow neither solid nor liquid food, and
+sits bent forward, with saliva running out of the mouth. The secretion
+of saliva is increased, but is not swallowed on account of the pain
+produced by the act. Sleep is also impossible, and altogether a more
+piteous spectacle of pain and distress is rarely seen. Having reached
+this stage the inflammation usually goes on to abscess (formation
+behind or above or below the tonsil), and, after five to ten days from
+the beginning of the attack, the pus finds its way to the surface of
+the tonsil, and breaks into the mouth to the inexpressible relief of
+the patient. This event is followed by quick subsidence of the
+symptoms. Quinsy is rarely a dangerous disease, yet, occasionally, it
+leads to so much obstruction in the throat that death from suffocation
+ensues unless a surgeon opens the throat and inserts a tube.
+Occasionally the pus from the ruptured abscess enters the larynx and
+causes suffocation.
+
+Quinsy differs from tonsilitis in the following respects: the swelling
+affects the immediate surrounding area of the throat; there are no
+white spots to be seen on the tonsil unless the trouble begins as an
+ordinary tonsilitis; there is great pain on swallowing, and finally
+abscess near the tonsil in most cases.
+
+=Treatment.=--A thorough painting of the tonsils at the onset of a
+threatened attack of quinsy with the silver-nitrate solution, as
+recommended under tonsilitis, may cut short the disorder. A single
+dose of calomel (three to five grains) is also useful for the same
+purpose. The tincture of aconite should be taken hourly in three-drop
+doses until five such have been swallowed, when the drug is to be no
+longer used. The constant use of a hot flaxseed poultice (as large as
+the whole hand and an inch thick, spread between thin layers of cotton
+and applied as hot as can be borne, and changed every half hour) gives
+more relief than anything else, and may possibly lead to disappearance
+of the trouble if employed early enough. The use of the poultices is
+to be kept up until recovery, although they need not be applied so
+frequently as at first. A surgeon's services are especially desirable
+in this disorder, as early puncture of the peritonsillar tissue may
+save days of suffering in affording exit for pus as soon as it forms.
+
+
+=DIPHTHERIA.=--The consideration of diphtheria will be limited to
+emphasizing the importance of calling in expert medical advice at the
+earliest possible moment in suspicious cases of throat trouble. For,
+as we noted under tonsilitis, it is impossible in some cases to
+decide, from the appearance of the throat, whether the disease is
+diphtheria or tonsilitis. A specimen of secretion removed from the
+throat for microscopical examination by a bacteriologist as to the
+presence of diphtheria germs alone will determine the point. When such
+an examination is impossible, it is always best to isolate the
+patient, especially if a child, and treat the case as if it were
+diphtheria. Diphtheria may invade the nose and be discoverable in the
+nostrils. A chronic membranous rhinitis should be treated as a case of
+walking diphtheria.
+
+Antitoxin is the treatment above all other remedies. It has so
+altered the outlook in diphtheria that, formerly regarded by
+physicians with alarm and dismay, it is now rendered comparatively
+harmless. The death rate has been reduced from an average of about
+forty per cent, before the introduction of antitoxin, to only ten per
+cent since its use, and, when it is used at the onset of the disease,
+the results are much more favorable still. This latter fact is the
+reason for obtaining medical advice at the earliest opportunity in all
+doubtful cases of throat ailments; and, we might add, that the
+diagnosis of any case of sore throat is doubtful, particularly in
+children, whenever there is seen a whitish, yellowish-white, or gray
+deposit on the throat. Antitoxin is an absolutely safe remedy, its ill
+effects being sometimes the production of a nettlerash or some mild
+form of joint pains. In small doses, it will prevent the occurrence of
+diphtheria in those exposed, or liable to exposure, to the disease.
+The proper dose and method of employing antitoxin it is impossible to
+impart in a book of this kind. Paralysis of throat, of vocal cords, or
+of arms or legs--partial or entire--is a frequent sequel of
+diphtheria. It is not caused by antitoxin.
+
+The points which it is desirable for everyone to know are, that any
+sore throat--with only a single white spot on the tonsil--may be
+diphtheria, but that when the white spot or deposit not only covers
+the tonsil or tonsils (see Tonsilitis) but creeps up on to the
+surrounding parts, as the palate (the soft curtain which shuts off
+the back of the roof of mouth from the throat), the uvula (the little
+body hanging from the middle of the palate in the back of the mouth),
+and the bands on either side of the back of the mouth at its junction
+with the throat, then the case is probably one of diphtheria. But it
+is often a day or two before the white deposit forms, the throat at
+first being simply reddened. The fever in diphtheria is usually not
+high (often not over 100 deg. to 102 deg. F.), and the headache, backache, and
+pains in the limbs are not so marked as in tonsilitis.
+
+
+=MEMBRANOUS CROUP.=--Membranous croup is diphtheria of the lower part
+of the throat (larynx), in the region of the Adam's apple. If in a
+case of what appears to be ordinary croup (p. 83) the symptoms are not
+soon relieved by treatment, or if any membrane is coughed up, or if,
+on inspection of the throat, it is possible to see any evidence of
+white spots or membrane, then a physician's services are imperative.
+
+It is not very uncommon for patients with mild forms of diphtheria to
+walk about and attend to their usual duties and, if children, to go to
+school, and in that inviting field to spread the disease. These cases
+may present a white spot on one tonsil, or in other cases have what
+looks to be an ordinary sore throat with a simple redness of the
+mucous membrane. Sore throats in persons who have been in any way
+exposed to diphtheria, and especially sore throats in children under
+such circumstances, should always be subjected to microscopical
+examination in the way we have alluded to before, for the safety of
+both the patient and the public.
+
+There is still another point perhaps not generally known and that is
+the fact that the germs of diphtheria may remain in the throat of a
+patient for weeks, and even months, after all signs in the throat have
+disappeared and the patient seems well. In such cases, however, the
+disease can still be communicated in its most severe form to others.
+Therefore, in all cases of diphtheria, examination of the secretion in
+the throat must show the absence of diphtheria germs before the
+patient can rightfully mix with other people.
+
+Gargling and swabbing the throat with the (poisonous) solution of
+bichloride of mercury, 1 part to 10,000 parts of water (none of which
+must be swallowed), should be employed every three or four hours each
+day till the germs are no longer found in the mucus of the tonsils.
+
+
+=HOARSENESS= (_Acute Laryngitis_).--This is an acute inflammation of
+the mucous membrane of the larynx. The larynx is that part of the
+throat, in the region of the Adam's apple, which incloses the vocal
+cords and other structures used in speaking. Hoarseness is commonly
+due to extension of catarrh from the nose in cold in the head and
+_grippe_. It also follows overuse of the voice in public speakers and
+singers, and is seen after exposure to dust, tobacco, or other smoke,
+and very commonly in those addicted to alcohol.
+
+=Symptoms.=--Hoarseness is the first symptom noticed, and perhaps
+slight chilliness, together with a prickling or tickling sensation in
+the throat. There is a hacking cough and expectoration of a small
+amount of thick secretion. There may be slight difficulty in breathing
+and some pain in swallowing. The patient feels generally pretty well,
+and is troubled chiefly by impairment of the voice, which is either
+husky, reduced to a mere whisper, or entirely lost. This condition
+lasts for some days or, rarely, even weeks. There may be a mild degree
+of fever at the outset (100 deg. to 101 deg. F.). Very uncommonly the
+breathing becomes hurried and embarrassed, and swallowing painful,
+owing to excessive swelling and inflammation of the throat, so much so
+that a surgeon's services become imperative to intube the throat or to
+open the windpipe, in order to avoid suffocation. This serious form of
+laryngitis may follow colds, but more often is brought about by
+swallowing very hot or irritating liquids, or through exposure to fire
+or steam. In children, after slight hoarseness for a day or two, if
+the breathing becomes difficult and is accompanied by a crowing or
+whistling sound, with blueness of the lips and signs of impending
+suffocation, the condition is very suggestive of membranous croup (a
+form of diphtheria), which certainly is the case if any white,
+membranous deposit can be either seen in the throat or is coughed up.
+Whenever there is difficulty of breathing and continuous hoarseness,
+in children or adults, the services of a competent physician are
+urgently demanded.
+
+=Treatment.=--The use of cold is of advantage. Cracked ice may be held
+in the mouth, ice cream can be employed as part of the diet, and an
+ice bag may be applied to the outside of the throat. The application
+of a linen or flannel cloth to the throat wrung out of cold water and
+covered with oil silk or waterproof material, is also beneficial, and
+often more convenient than an ice bag. The patient must absolutely
+stop talking and smoking. If the attack is at all severe, he should
+remain in bed. If not so, he must stay indoors. At the beginning of
+the disorder a teaspoonful of paregoric and twenty grains of sodium
+bromide are to be taken in water every three hours, by an adult, until
+three doses are swallowed.
+
+Inhalation of steam from a pitcher containing boiling water is to be
+recommended. Fifteen drops of compound tincture of benzoin poured on
+the surface of a cup of boiling water increases the efficacy of the
+steam inhalation. The head is held above the pitcher, a towel covering
+both the head and pitcher to retain the vapor.
+
+The employment, every two hours, of a spray containing menthol and
+camphor (of each, ten grains) dissolved in alboline (two ounces)
+should be continued throughout the disease. If the hoarseness persists
+and tends to become chronic, it is most advisable for the patient to
+consult a physician skilled in such diseases for local examination and
+special treatment.
+
+
+=CROUP.=--Croup is an acute laryngitis of childhood, usually occurring
+between the ages of two and six years. The nervous element is more
+marked than in adults, so that the symptoms appear more alarming. The
+trouble frequently arises as part of a cold, or as a forerunner of a
+cold, and often is heralded by some hoarseness during the day,
+increasing toward night. The child may then be slightly feverish
+(temperature not over 102 deg. F., usually). The child goes to bed and to
+sleep, but awakens, generally between 9 and 12 P.M., with a hard,
+harsh, barking cough (croupy cough) and difficulty in breathing. The
+breathing is noisy, and when the air is drawn into the chest there is
+often a crowing or whistling sound produced from obstruction in the
+throat, due to spasm of the muscles and to dried mucus coating the
+lining membrane, or to swelling in the larynx. It is impossible to
+separate these causes. The child is frightened, as well as his
+parents, and cries and struggles, which only aggravates the trouble.
+The worst part of the attack is, commonly, soon over, so that as a
+rule the doctor arrives after it is past. While it does last, however,
+the household is more alarmed than, perhaps, by any other common
+ailment.
+
+Death from an attack of croup, pure and simple, has probably never
+occurred. The condition described may continue in a less urgent form
+for two or three hours, and very rarely reappears on following nights
+or days. The child falls asleep and awakens next morning with
+evidences of a cold and cough, which may last several days or a week
+or two.
+
+The only other disease with which croup is likely to be confused is
+membranous croup (diphtheria of the larynx), and in the latter
+disorder the trouble comes on slowly, with hoarseness for two or three
+days and gradually increasing fever (103 deg. to 105 deg. F.) and great
+restlessness and difficulty in breathing, not shortly relieved by
+treatment, as in simple croup. In fifty per cent of the cases of
+membranous croup it is possible to see a white, membranous deposit on
+the upper part of the throat by holding the tongue down with a spoon
+handle and inspecting the parts with a good light.
+
+Croup is more likely to occur in children suffering from adenoids,
+enlarged tonsils, indigestion, and decayed teeth, and is favored by
+dry, furnace heat, by exposure to cold, and by screaming and shouting
+out of doors.
+
+=Treatment.=--Place the child in a warm bath (101 deg. F.) and hold a
+sponge soaked in hot water over the Adam's apple of the throat,
+changing it as frequently as it cools. Hot camphorated oil rubbed over
+the neck and chest aids recovery. If the bowels are not loose, give a
+teaspoonful of castor oil or one or two grains of calomel. The most
+successful remedies are ipecac and paregoric. It is wise to keep both
+on hand with children in the house. A single dose of paregoric
+(fifteen drops for child of two years; one teaspoonful for child of
+seven years) and repeated doses of syrup of ipecac (one-quarter to
+one-half teaspoonful) should be given every hour till the child vomits
+and the cough loosens, and every two hours afterwards. The generation
+of steam near the child also is exceedingly helpful in relieving the
+symptoms. A kettle of water may be heated over a lamp. A rubber or tin
+tube may be attached to the spout of the kettle and carried under a
+sort of sheet tent, covering the child in bed. The tent must be
+arranged so as to allow the entrance of plenty of fresh air. Very
+rarely the character of the inflammation in croup changes, and the
+difficulty in breathing, caused by swelling within the throat,
+increases so that it is necessary to employ a surgeon to pass a tube
+down the throat into the larynx, or to open the child's windpipe and
+introduce a tube through the neck to prevent suffocation.
+
+The patient recovering from croup should generally be kept in a warm,
+well-ventilated room for a number of days after the attack, and
+receive syrup of ipecac three or four times daily, until the cough is
+loosened. If ipecac causes nausea or vomiting, the dose must be
+reduced. The disease is prevented by a simple diet, especially at
+night; by the removal of enlarged tonsils and adenoids; by daily
+sponging, before breakfast, with water as cold as it comes from the
+faucet, while the child stands, ankle deep, in hot water; and by an
+out-of-door existence with moderate school hours; also by evaporating
+water in the room during the winter when furnace heat is used. When
+children show signs of an approaching attack of croup, give three
+doses of sodium bromide (five grains for child two years old; ten
+grains for one eight years old) during the day at two-hour intervals
+and give a warm bath before bedtime, and rub chest and neck with hot
+camphorated oil.
+
+
+
+
+CHAPTER III
+
+=The Lungs and Bronchial Tubes=
+
+_Meaning of Bronchitis--Symptoms and Treatment--Remedies for
+Infants--Pneumonia--Consumption the Great Destroyer--Asthma--La
+Grippe._
+
+
+=COUGH= (_occurring in Bronchitis, Pneumonia, Consumption or
+Tuberculosis, Asthma, and Influenza or Grippe_).--Cough is a symptom
+of many disorders. It may be caused by irritation of any part of the
+breathing apparatus, as the nose, throat, windpipe, bronchial tubes,
+and (in pleurisy and pneumonia) covering membrane of the lung. The
+irritation which produces cough is commonly due either to congestion
+of the mucous membrane lining the air passages (in early stage of
+inflammation of these tissues), or to secretion of mucus or pus
+blocking them, which occurs in the later stages.
+
+Cough is caused by a sudden, violent expulsion of air from the chest
+following the drawing in of a deep breath. A loose cough is to be
+encouraged, as by its means mucus and other discharge is expelled from
+the air passages.
+
+A dry cough is seen in the early stages of various respiratory
+diseases, as bronchitis, pneumonia, pleurisy, consumption, whooping
+cough, and with irritation from enlarged tonsils and adenoids (see p.
+61) occurring in children.
+
+Irritation produced by inhaling dust, or any irritation existing in
+the nose, ear, or throat may lead to this variety of cough. The dry
+cough accomplishes no good, and if continuous and excessive may do
+harm, and demands medicinal relief.
+
+=Bronchitis.=--Cough following or accompanying cold in the head and
+sore throat generally means bronchitis.
+
+The larynx or lower part of the throat ends just below the "Adam's
+apple" in the windpipe. The windpipe is about four and a half inches
+long and three-quarters to an inch in diameter, and terminates by
+dividing into the two bronchial tubes in the upper part of the chest.
+Each bronchial tube divides and subdivides in turn like the branches
+of a tree, the branches growing more numerous and smaller and smaller
+until they finally end in the microscopic air sacs or air cells of the
+lungs. The bronchial tubes convey air to the air cells, and in the
+latter the oxygen is absorbed into the blood, and carbonic acid is
+given up. Bronchitis is an inflammation of the mucous membrane lining
+these tubes. In cough of an ordinary cold only the mucous membrane of
+the windpipe and, perhaps, of the larger tubes is inflamed. This is a
+very mild disorder compared to inflammation of the smaller and more
+numerous tubes.
+
+In bronchitis, besides the ordinary symptoms of a severe cold in the
+head, as sneezing, running of mucus from the nose, sore throat and
+some hoarseness perhaps, and languor and soreness in the muscles,
+there is at first a feeling of tightness, pressure, and rawness in the
+region of the breastbone, with a harsh, dry cough. The coughing causes
+a strain of the diaphragm (the muscle which forms the floor of the
+chest), so that there are often pain and soreness along the lower
+borders of the chest where the diaphragm is attached to the inside of
+the ribs. After a few days the cough becomes looser, greatly to the
+patient's comfort, and a mixture of mucus and pus is expectorated. In
+a healthy adult such a cough is usually not in itself a serious
+affair, and apart from the discomfort of the first day or two, there
+is not sufficient disturbance of the general health to interfere with
+the ordinary pursuits. The temperature is the best guide in such
+cases; if it is above normal (98-3/5 deg. F.) the patient should stay
+indoors. In infants, young children, enfeebled or elderly people,
+bronchitis may be a serious matter, and may be followed by pneumonia
+by extension of the inflammation from the small bronchial tubes into
+the air sacs of the lungs, and infection with the pneumonia germ. The
+principal signs of severe attacks of bronchitis are rapid breathing,
+fever, and rapid pulse.
+
+The normal rate of breathing in adults is seventeen a minute, that is,
+seventeen inbreaths and seventeen outbreaths. In children of one to
+five years the normal rate is about twenty-six breathing movements a
+minute. In serious cases of bronchitis the rate may be twenty-five to
+forty in adults, or forty to sixty in children, per minute.
+
+Of course the only exact way of learning the nature of a chest trouble
+is thorough, careful examination by a physician, for cough, fever,
+rapid breathing and rapid pulse occur in many other diseases besides
+bronchitis, particularly pneumonia.
+
+Pneumonia begins suddenly, often with a severe chill, headache, and
+general pains like _grippe_. In a few hours cough begins, short and
+dry, with violent, stabbing pain in one side of the chest, generally
+near the nipple. The breathing is rapid, with expanding nostrils, the
+face is anxious and often flushed. The matter coughed up at first is
+often streaked with blood, and is thick and like jelly. The
+temperature is often 104 deg.-105 deg. F.
+
+If the disease proceeds favorably, at the end of five, seven, or ten
+days the temperature, breathing, and pulse become normal suddenly, and
+the patient rapidly emerges from a state of danger and distress to one
+of comfort and safety. The sudden onset of pneumonia with chill,
+agonizing pain in side, rapid breathing, and often delirium with later
+bloody or rusty-colored, gelatinous expectoration, will then usually
+serve to distinguish it from bronchitis, but not always.
+
+Whenever, with cough, rapid and difficult breathing occur with rise of
+temperature (as shown by the thermometer) and rapid pulse, the case
+is serious, and medical advice is urgently demanded.
+
+=Treatment of Acute Cough and Bronchitis.=--In the case of healthy
+adults with a cough accompanying an ordinary cold, the treatment is
+very simple, when there is little fever or disturbance of the general
+health. The remedies recommended for cold in the head (p. 55) should
+be taken at first. It is also particularly desirable for the patient
+to stay in the house, or better in bed, for the first day or two, or
+until the temperature is normal.
+
+The feeling of tightness and distress in the chest may be relieved by
+applying a mild mustard paper over the breastbone, or a poultice
+containing mustard, one part, and flour, three parts, mixed with warm
+water into a paste and spread between two single thicknesses of cotton
+cloth about eight inches square. The tincture of iodine painted twice
+over a similar area forms another convenient application instead of
+the mustard. If the cough is excessive and troublesome at night the
+tablets of "ammonium chloride compound with codeine" are convenient.
+One may be taken every hour or two by an adult, till relieved.
+
+Children suffering from a recent cough and fever should be kept in bed
+while the temperature is above normal. It is well to give infants at
+the start a grain of calomel or half a teaspoonful of castor oil, and
+to children of five to eight years double the dose.
+
+The chest should be rubbed with a liniment composed of one part of
+turpentine and two parts of camphorated oil. It is well also to apply
+a jacket made of sheet cotton over the whole chest. It is essential to
+keep the room at a temperature of about 70 deg. F. and well ventilated,
+not permitting babies to crawl on the floor when able to be up, or to
+pass from a warm to a cold room. Sweet spirit of niter is a
+serviceable remedy to use at the beginning: five to fifteen drops
+every two hours in water for a child from one to ten years of age, for
+the first day or two.
+
+If the cough is harsh, hard, or croupy (see p. 83), give syrup of
+ipecac every two hours: ten drops to an infant of one year or under,
+thirty drops to a child of ten years, unless it causes nausea or
+vomiting, when the dose may be reduced one-half. If children become
+"stuffed up" with secretion so that the breathing is difficult and
+noisy, give a teaspoonful of the syrup of ipecac to make them vomit,
+for until they are six or seven years old children cannot expectorate,
+and mucus which is coughed up into the mouth is swallowed by them.
+Vomiting not only gets rid of that secretion which has been swallowed,
+but expels it from the bronchial tubes. This treatment may be repeated
+if the condition recurs.
+
+In infants under a year of age medicine is to be avoided as much as
+possible. A teaspoonful of sweet oil and molasses, equal parts, may be
+given occasionally to loosen the cough in mild cases. In other cases
+use the cough tablet for infants described on p. 91. A paste
+consisting of mustard, one part, and flour, twenty parts, is very
+useful when spread on a cloth and applied all about the chest, front
+and back. The diet should be only milk for young children during the
+first day or two, and older patients should not have much more than
+this, except toast and soups. In feeble babies with bronchitis it is
+wise to give five or ten drops of brandy or whisky in water every two
+hours, to relieve difficulty in breathing.
+
+Children who are subject to frequent colds, or those in whom cough is
+persistent, should receive Peter Moeller's cod-liver oil, one-half to
+one teaspoonful, according to age, three times daily after eating. One
+of the emulsions may be used instead if the pure oil is unpalatable.
+Adenoids and enlarged tonsils are a fruitful source of constant colds
+and sore throat, and their removal is advisable (see p. 61). Hardening
+of the skin by daily sponge baths with cold salt water, while the
+child stands or sits in warm water, is effective as a preventive of
+colds, as is also an out-of-door life with proper attention to
+clothing and foot gear.
+
+=Treatment of Pneumonia.=--Patients developing the symptoms described
+as suggestive of pneumonia need the immediate attention of a
+physician. If a person is unfortunate enough to have the care of such
+a case, when it is impossible to secure a physician, it may afford
+some comfort to know that good nursing is really the prime requisite
+in aiding recovery, while skillful treatment is of most value if
+complications arise.
+
+One in every ten cases of pneumonia in ordinarily healthy people
+proves fatal. In specially selected young men, as soldiers, the death
+rate from pneumonia is only one in twenty-five cases. On the other
+hand, pneumonia is the common cause of death in old age; about seventy
+out of every hundred patients who die from pneumonia are between sixty
+and eighty years of age. Infants under a year old, and persons
+enfeebled with disease or suffering from excesses, particularly
+alcoholism, are also likely to die if stricken with the disease.
+
+The patient should go to bed in a large, well-ventilated, and sunny
+room. The temperature of the room should be about 70 deg. F., and the
+patient must not be covered so warmly with clothing as to cause
+perspiration. A flannel jacket may be made to surround the chest, and
+should open down the whole front. The nightshirt is worn over this;
+nothing more. Daily sponging of the patient with tepid water (85 deg. to
+90 deg. F.) should be practiced. The body is not to be all exposed at
+once, but each limb and the trunk are to be separately sponged and
+dried. If the fever is high (104 deg. F.) the water should be cold (77 deg. to
+72 deg. F.), and the sponging done every three hours in the case of a
+strong patient. Visitors must be absolutely forbidden. No more than
+one or two persons are to be allowed in the sick room at once.
+
+The diet should consist chiefly of milk, a glass every two hours,
+varied with milk mixed with thin cooked cereal or eggnog. It is wise
+to give at the beginning of the disease a cathartic, such as five
+grains of calomel followed in twelve hours by a Seidlitz powder, if
+the bowels do not act freely before that time. To relieve the pain in
+the side, if excruciating, give one-quarter grain morphine
+sulphate,[4] and repeat once, if necessary, in two hours. The
+application of an ice bag to the painful side frequently stops the
+pain, and, moreover, is excellent treatment throughout the course of
+the disease. The seat of pain usually indicates that the lung on that
+side is the inflamed one, so that the ice bag should be allowed to
+rest against that portion of the chest. Water should be freely
+supplied, and should be given as well as milk even if the patient is
+delirious.
+
+The bowels are to be moved daily by glycerin suppositories or
+injection of warm water. Dover's powder in doses of five grains is
+useful to assuage cough. It may be repeated once, after two hours'
+interval if desirable, but must not be employed at the same time as
+morphine. After the first two or three days are passed, or sooner in
+weak subjects, give strychnine sulphate, one-thirtieth grain, every
+six hours in pill or tablet form. The strychnine is to be continued
+until the temperature becomes normal, and then reduced about one-half
+in amount for a week or ten days while the patient remains in bed, as
+he must for some time after the temperature, pulse, and breathing have
+become normal.
+
+
+=CONSUMPTION; TUBERCULOSIS OF THE LUNGS; PHTHISIS.=--This disease
+demands especial attention, not only because it is above all others
+the great destroyer of human life, causing one-seventh of all deaths,
+but because, so far from being a surely fatal disease as popularly
+believed, it is an eminently curable disorder if recognized in its
+earliest stage. The most careful laboratory examinations of bodies
+dead from other causes, show that very many people have had
+tuberculosis at some time, and to some extent, during life. The reason
+why the disease fails to progress in most persons is that the system
+is strong enough to resist the inroads of the disease. The process
+becomes arrested by the germs being surrounded by a barrier of healthy
+tissue, and so perishing in their walled-in position. These facts
+prove that so far from being incurable, recovery from consumption
+frequently occurs without even our knowledge of the disease. It is
+only those cases which become so far advanced as to be easily
+recognized that are likely to result fatally. Many more cases of
+consumption are now cured than formerly, because exact methods have
+been discovered which enable us to determine the existence of the
+disease at an early stage of its development.
+
+Consumption is due to the growth of a special germ in the lungs. The
+disease is contagious, that is, it is capable of being communicated
+from a consumptive to a healthy person by means of the germs present
+in the sputum (expectoration) of the patient. The danger of thus
+acquiring the disease directly from a consumptive is slight, if one
+take simple precautions which will be mentioned later, except in the
+case of a husband, wife, or child of the patient who come in close
+personal contact, as in kissing, etc. This is proved by the fact that
+attendants in hospitals for consumptives, who devote their lives to
+the care of these patients, are rarely affected with consumption. The
+chief source of danger to persons at large is dust containing the
+germs derived from the expectoration of human patients, and thus
+finding entrance into the lungs.
+
+Consumption is said to be inherited. This is not the case, as only
+most rarely is an infant born actually bearing the living germs of the
+disease in its body. A tendency to the disease is seen in certain
+families, and this tendency may be inherited in the sense that the
+lung tissue of these persons possesses less resistance to the growth
+of the germ of consumption. It may well be, however, that the children
+of consumptive parents, as has been suggested, are more resistant to
+the disease through inherited immunity (as is seen in the offspring of
+parents who have had other contagious diseases), and that the reason
+that they more often acquire tuberculosis is because they are
+constantly exposed to contact with the germ of consumption in their
+everyday home life.
+
+It is known that there are certain occupations and diseases which
+render the individual more susceptible to consumption. Thus, stone
+cutters, knife grinders and polishers, on account of inhaling the
+irritating dust, are more liable to the disease than any other class.
+Plasterers, cigar makers, and upholsterers are next in order of
+susceptibility for the same reason; while out-of-door workers, as
+farmers, are less likely to contract consumption than any other body
+of workers except bankers and brokers. Among diseases predisposing to
+consumption, ordinary colds and bronchitis, influenza, pneumonia,
+measles, nasal obstruction causing mouth-breathing, and scarlet fever
+are the most important.
+
+No age is exempt, from the cradle to the grave, although the liability
+to the disease diminishes markedly after the age of forty.
+
+About one-third more women than men recover from consumption, probably
+because it is more practicable for them to alter their mode of life to
+suit the requirements of treatment.
+
+It is, then, the neglected cold and cough (bronchitis) which offers a
+field most commonly favorable for the growth of the germs in the lungs
+which cause consumption. And it is essential to discover the existence
+of the disease at its beginning, what is called the incipient stage,
+in order to have the best chance of recovery. It becomes important,
+therefore, that each individual know the signs and symptoms which
+suggest beginning consumption.
+
+Cough is the most constant early symptom, dry and hacking at first,
+and most troublesome at night and in the early morning. Expectoration
+comes later. Loss of weight, of strength, and of appetite are also
+important early symptoms. Dyspepsia with cough and loss of weight and
+strength form a common group of symptoms. The patient is pale, has
+nausea, vomiting, or heartburn, and there is rise of temperature in
+the afternoon, together with general weakness; and, in women, absence
+of monthly periods. Slight daily rise of temperature, usually as much
+as a half to one degree, is a very suspicious feature in connection
+with chronic cough and loss of weight. To test the condition, the
+temperature should be taken once in two hours, and will commonly be
+found at its highest about 4 P.M., daily. The pulse is also increased
+in frequency. Night sweats are common in consumption, but not as a
+rule in the first stage; they occur more often in the early morning
+hours.
+
+Chills, fever, and sweating are sometimes the first symptoms of
+consumption, and in a malarial region would very probably lead to
+error, since these symptoms may appear at about the same intervals as
+in ague. But the chills and fever are not arrested by quinine, as in
+malaria, and there are also present cough and loss of weight, not
+commonly prominent in malaria. Persistently enlarged glands, which may
+be felt as lumps beneath the skin along the sides of the neck, or in
+the armpits, should be looked upon with suspicion as generally
+tuberculous, containing the germ of consumption. They certainly demand
+the attention of early removal by a surgeon.
+
+The spitting of bright-red blood is one of the most certain signs of
+consumption, and occurs in about eighty per cent of all cases, but
+rarely appears as an early warning. The pupils of the eyes may be
+constantly large at the onset of the disease, but this is a sign of
+general weakness. Pain is also a frequent but not constant early
+symptom in the form of "stitch in the side," or pain between or
+beneath the shoulder blades, or in the region of the breastbone. This
+pain is due to pleurisy accompanying the tuberculosis. Shortness of
+breath on exertion is present when consumption is well established,
+but is not so common as an early symptom. The voice is often somewhat
+hoarse or husky at the onset of consumption, owing to tuberculous
+laryngitis.
+
+To sum up then, one should always suspect tuberculosis in a person
+afflicted with chronic cough who is losing weight and strength,
+especially if there is fever at some time during the day and any
+additional symptoms, such as those described. Such a one should
+immediately apply to a physician for examination of the chest, lungs,
+and sputum (expectoration). If the germs of tuberculosis are found on
+microscopical inspection of the sputum, the existence of consumption
+is absolutely established. Failure to find the germs in this way does
+not on the other hand prove that the patient is free from the
+disease, except after repeated examinations at different times,
+together with the inability to discover any signs by examination of
+the chest. This examination in some instances produces no positive
+results, and it may be impossible for the physician to discover
+anything wrong in the lungs at the commencement of consumption. But,
+generally, examination either of the lungs or of the sputum will
+decide the matter, one or both giving positive information.
+
+The use of the X-rays in the hands of some experts sometimes reveals
+the presence of consumption before it is possible to detect it by any
+other method. There is also a substance called tuberculin, which, when
+injected under the skin in suspected cases of consumption causes a
+rise of temperature in persons suffering from the disease, but has no
+effect on the healthy. This method is that commonly applied in testing
+cattle for tuberculosis. As the results of tuberculin injection in the
+consumptive are something like an attack of _grippe_, and as
+tuberculin is not wholly devoid of danger to these patients, this test
+should be reserved to the last, and is only to be used by a physician.
+
+=Treatment.=--There is no special remedy at our disposal which will
+destroy or even hinder the growth of the germs of tuberculosis in the
+lungs. Our endeavors must consist in improving the patient's strength,
+weight, and vital resistance to the germs by proper feeding, and by
+means of a constant out-of-door life. The ideal conditions for
+out-of-door existence are pure air and the largest number of sunshiny
+days in the year. Dryness and an even temperature, and an elevation of
+from 2,000 to 3,000 feet, are often serviceable, but not necessarily
+successful.
+
+When it is impossible for the patient to leave his home he should
+remain out of doors all hours of bright days, ten to twelve hours
+daily in summer, six to eight hours in winter without regard to
+temperature, and should sleep on a porch or on the roof, if possible.
+In the Adirondacks, patients sit on verandas with perfect comfort
+while the thermometer is at ten degrees below zero. A patient (a
+physician) in a Massachusetts sanitarium has arranged a shelf,
+protected at the sides, along the outside of a window, on which his
+pillow rests at night, while he sleeps with his head out of doors and
+his body in bed in a room inside. If it becomes stormy he retires
+within and closes the window. If the temperature ranges above 100 deg. F.
+patients should rest in bed or on a couch in the open air, but, if
+below this, patients may exercise. A steamer chair set inside of a
+padded, wicker bath chair, from which the seat has been removed, makes
+a convenient protected arrangement in which a consumptive can pass his
+time out of doors. If the patient is quite weak and feverish he may
+remain in bed, or on a couch, placed on a veranda or balcony during
+the day, and in a room in which all the windows are open at night.
+Screens may be used to protect from direct draughts.
+
+No degree of cold, nor any of the common symptoms, as night sweats,
+fever, cough, or spitting of blood, should be allowed to interfere
+with this fresh-air treatment. The treatment may seem heroic, but is
+most successful. The patient must be warmly clothed or covered with
+blankets, and protected from strong winds, rain, and snow. During
+clear weather patients may sleep out of doors on piazzas, balconies,
+or in tents.
+
+Nutritious food is of equal value with the open-air life. A liberal
+diet of milk and cream, eggs, meat and vegetables is indicated. Raw
+eggs swallowed whole with a little sherry, or pepper and salt on them,
+may be taken between meals, beginning with one and increasing the
+number till three are taken at a time, or nine daily. If the appetite
+is very poor it is best that a glass of milk be taken every two hours,
+varied by white of egg and water and meat juice. Drug treatment
+depends on individual symptoms, and can, therefore, only be given
+under a physician's care. Sanitarium treatment is the most successful,
+because patients are under the absolute control of experts and usually
+in an ideal climate. Change of climate is often useful, but patients
+should not leave their homes without the advice of a competent
+physician, as there are many questions to consider in taking such a
+step.[5] There is a growing tendency among physicians to give
+consumptives out-of-door treatment at their homes, if living out of
+cities, as careful personal supervision gives much better results than
+a random life in a popular climatic resort.
+
+=Prevention.=--Weakly children and those born of consumptives must
+receive a generous diet of milk, eggs, meat, and vegetables, and spend
+most of their time in the open air. Their milk should be heated for
+fifteen minutes to a temperature of 160 deg. F., in order to kill any
+germs of tuberculosis, unless the cows have been tested for this
+disease. The patient must have a separate sleeping room, and refrain
+from kissing or caressing other members of the family.
+
+The care of the sputum (expectoration) is, however, the essential
+means of preventing contagion. Out of doors, it should be deposited in
+a bottle which is cleaned by rinsing in boiling water. Indoors, paper
+bags or paper boxes made for the purpose are used to receive the
+sputum, and burned before they become dry. The use of rags,
+handkerchiefs, and paper napkins is dirty, and apt to cause soiling of
+the hands and clothes and lead to contagion. Plenty of sunlight in the
+sick room will cause destruction of the germs of consumption, besides
+proving beneficial to the patient. No dusting is to be done in the
+invalid's room; only moist cleansing. All dishes used by a consumptive
+must be boiled before they are again employed.
+
+
+=ASTHMA.=--This is a disorder caused by sudden narrowing of the
+smaller air tubes in the lungs. This narrowing is produced by
+swelling of the mucous membrane lining them, or is due to contraction
+of the tubes through reflex nervous influences. It may accompany
+bronchitis, or may be uncomplicated. It may be a manifestation of
+gout.
+
+The sufferers from asthma are usually apparently well in the period
+between the attacks. The attack often comes on suddenly in the night;
+the patient wakening with a feeling of suffocation. The difficulty in
+breathing soon becomes so great that he has to sit up, and often goes
+to a window and throws it open in the attempt to get his breath. The
+breathing is very labored and panting. There is little difficulty in
+drawing the breath, but expiration is very difficult, and usually
+accompanied by wheezing or whistling sounds. The patient appears to be
+on the brink of suffocation; the eyeballs protrude; the face is
+anxious and pale; the muscles of the neck stand out; the lips may be
+blue; a cold sweat covers the body; the hands and feet are cold, and
+talking becomes impossible. Altogether, a case of asthma presents a
+most alarming appearance to the bystander, and the patient seems to be
+on the verge of dying, yet death has probably never occurred during an
+attack of this disease. The attacks last from one-half to one or
+several hours, if not stopped by treatment, and they often return on
+several successive nights, and then disappear, not to recur for months
+or years.
+
+Attacks are brought on by the most curious and diverse means.
+Atmospheric conditions are most important. Emanations from plants, or
+animals, are common exciting agencies. Fright or emotion of any kind;
+certain articles of diet; dust and nasal obstruction are also frequent
+causes. Patients may be free from the disease in cities and attacked
+on going into the country. Men are subject to asthma more than women,
+and the victims belong to families subject to nervous troubles of
+various kinds. The attack frequently subsides suddenly, just when the
+patient seems to be on the point of suffocation. There is often
+coughing and spitting of little yellowish, semitransparent balls of
+mucus floating in a thinner secretion.
+
+Asthma is not likely to be mistaken for other diseases. The
+temperature is normal during an attack, and this will enable us to
+exclude other chest disorders, as bronchitis and pneumonia.
+Occasionally asthma is a symptom of heart and kidney disease. In the
+former it occurs after exercise; in the latter the attack continues
+for a considerable time without relief. But, as in all other serious
+diseases, a physician's services are essential, and it is our object
+to supply only such information as would be desirable in emergencies
+when it is impossible to obtain one.
+
+=Treatment.=--An attack of asthma is most successfully cut short by
+means of one-quarter of a grain of morphine sulphate[6] with 1/20 of a
+grain of atropine sulphate, taken in a glass of hot water containing a
+tablespoonful of whisky or brandy. Ten drops of laudanum,[7] or a
+tablespoonful of paregoric, may be used instead of the morphine if the
+latter is not at hand. Sometimes the inhalation of tobacco smoke from
+a cigar or pipe will stop an attack in those unaccustomed to its use.
+In the absence of morphine, or opium in the form of laudanum or
+paregoric, fifteen drops of chloroform or half a teaspoonful of ether
+may be swallowed on sugar.
+
+A useful application for use on the outside of the chest consists of
+mustard, one part, and flour, three parts, mixed into a paste with
+warm water and placed between single thicknesses of cotton cloth.
+Various cigarettes and pastilles, usually containing stramonium and
+saltpeter, are sold by druggists for the use of asthmatic patients.
+They are often efficient in arresting an attack of asthma, but it is
+impossible to recommend any one kind, as one brand may agree with one
+patient better than another. Amyl nitrite is sold in "pearls" or
+small, glass bulbs, each containing three or four drops, one of which
+is to be broken in and inhaled from a handkerchief during an attack of
+asthma. This often affords temporary relief.
+
+To avoid the continuance of the disease it is emphatically advisable
+to consult a physician who may be able to discover and remove the
+cause. The diet should consist chiefly of eggs, fish, milk, and
+vegetables (with the exception of beans, large quantities of potatoes,
+and roots, as parsnips, beets, turnips, etc.). Meat should be eaten
+but sparingly, and also pastries, sugar, and starches (as cereals,
+potato, and bread). The evening meal ought to be light, dinner being
+served at midday. Any change of climate may stop asthmatic seizures
+for a time, but the relief is apt to be temporary. Climatic conditions
+affect different patients differently. Warm, moist air in places
+destitute of much vegetation (as Florida, Southern California, and the
+shore of Cape Cod and the Island of Nantucket, in summer) enjoy
+popularity with many asthmatics, while a dry, high altitude influences
+others much more favorably.
+
+
+=INFLUENZA; LA GRIPPE.=--Influenza is an acute, highly contagious
+disease due to a special germ, and tending to spread with amazing
+rapidity over vast areas. It has occurred as a world-wide epidemic at
+various times in history, and during four periods in the last century.
+A pandemic of influenza began in the winter of 1889-90, and continued
+in the form of local epidemics till 1904, the disease suddenly
+appearing in a community and, after a prevalence of about six weeks,
+disappearing again. One attack, it is, perhaps, unnecessary to state,
+does not protect against another. The mortality is about 1 death to
+400 cases. The feeble and aged are those who are apt to succumb.
+Fatalities usually result from complications or sequels, such as
+pneumonia or tuberculosis; neurasthenia or insanity may follow.
+
+=Symptoms.=--There are commonly four important symptoms characteristic
+of _grippe_: fever; pain, catarrh; and depression, mental and
+physical. _Grippe_ attacks the patient with great suddenness. While in
+perfect health and engaged in ordinary work, one is often seized with
+a severe chill followed by general depression, pain in the head, back,
+and limbs, soreness of the muscles, and fever. The temperature varies
+from 100 deg. to 104 deg. F. The catarrh attacks the eyes, nose, throat, and
+larger tubes in the lungs. The eyes become reddened and sensitive to
+light, and movements of the eyeballs cause pain. Sneezing comes on
+early, and, after a day or two, is followed by discharge from the
+nose. The throat is often sore and reddened. There may be a feeling of
+weight and tightness in the chest accompanied by a harsh, dry cough,
+which, after a few days, becomes looser and expectoration occurs.
+Bodily weakness and depression of spirits are usually prominent and
+form often the most persistent and distressing symptoms.
+
+After three or four days the pains decrease, the temperature falls,
+and the cough and oppression in the chest lessen, and recovery usually
+takes place within a week, or ten days, in serious cases. The patient
+should go to bed at once, and should not leave it until the
+temperature is normal (98-3/5 deg. F.). For some time afterwards general
+weakness, associated with heart weakness, causes the patient to sweat
+easily, and to get out of breath and have a rapid pulse on slight
+exertion.
+
+Such is the picture of a typical case, but it often happens that some
+of the symptoms are absent, while others are exaggerated so that
+different types of _grippe_ are often described. Thus the pain in the
+back and head may be so intense as to resemble that of meningitis.
+Occasionally the stomach and bowels are attacked so that violent
+vomiting and diarrhea occur, while other members of the same family
+present the ordinary form of influenza. There is a form that attacks
+principally the nervous system, the nasal and bronchial tracts
+escaping altogether. Continual fever is the only symptom in some
+cases. _Grippe_ may last for weeks. Whenever doubt exists as to the
+nature of the disorder, a microscopic examination of the expectoration
+or of the mucus from the throat by a competent physician will
+definitely determine the existence of influenza, if the special germs
+of that disease are found. It is the prevailing and erroneous fashion
+for a person to call any cold in the head the _grippe_; and there are,
+indeed, many cases in which it becomes difficult for a physician to
+distinguish between _grippe_ and a severe cold with muscular soreness
+and fever, except by the microscopic test. Influenza becomes dangerous
+chiefly through its complications, as pneumonia, inflammation of the
+middle ear, of the eyes, or of the kidneys, and through its
+depressing effect upon the heart.
+
+These complications can often be prevented by avoiding the slightest
+imprudence or exposure during convalescence. Elderly and feeble
+persons should be protected from contact with the disease in every
+way. Whole prisons have been exempt from _grippe_ during epidemics,
+owing to the enforced seclusion of the inmates. The one absolutely
+essential feature in treatment is that the patient stay in bed while
+the fever lasts and in the house afterwards, except as his strength
+will permit him to go out of doors for a time each sunny day until
+recovery is fully established.
+
+=Treatment.=--The medicinal treatment consists at first in combating
+the toxin of the disease and assuaging pain, and later in promoting
+strength. Hot lemonade and whisky may be given during the chilly
+period and a single six- to ten-grain dose of quinine. Pain is
+combated by phenacetin,[8] three grains repeated every three hours
+till relieved. At night a most useful medicine to afford comfort when
+pain and sleeplessness are troublesome, is Dover's powder, ten grains
+(or codeine, one grain), with thirty grains of sodium bromide
+dissolved in water. After the first day it is usually advisable to
+give a two-grain quinine pill together with a tablet containing
+one-thirtieth of a grain of strychnine three times a day after meals
+for a week or two as a tonic (adult). Only mild cathartics are
+suitable to keep the bowels regular as a Seidlitz powder in the
+morning before breakfast. The diet should be liquid while the fever
+lasts--as milk, cocoa, soups, eggnog, one of these each two hours. A
+tablespoonful of whisky, rum, or brandy may be added to the milk three
+times daily if there is much weakness.
+
+The germ causing _grippe_ lives only two days, but successive crops of
+spores are raised in a proper medium. Neglected mucus in nose or
+throat affords an inviting field for the germ. Therefore it is
+essential to keep the nostrils free and open by means of spraying with
+the Seiler's tablet solution (p. 49), and then always breathing
+through the nostrils.
+
+
+FOOTNOTES:
+
+[4] Caution. Dangerous. Use only on physician's order.
+
+[5] Arizona, New Mexico, Colorado, and the Adirondacks contain the
+most favorable climatic resorts in this country.
+
+[6] Caution. Dangerous. Use only on physician's order.
+
+[7] This dose is only suitable for strong, healthy adults of average
+weight and those who are not affected peculiarly by opium. Delicate
+women and others not coming under the above head should take but half
+the dose and repeat in an hour if necessary.
+
+[8] Caution. A powerful medicine.
+
+
+
+
+CHAPTER IV
+
+=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._
+
+
+Every individual should know how to care for the sexual organs as well
+as those of any other part of the body, providing that the instruction
+be given by the proper person and at the proper time and place. Such
+information should be imparted to children by parents, guardians, or
+physicians at an early age and, if this is neglected through ignorance
+or false modesty, erroneous ideas of the nature and purpose of the
+sexual function will very surely be supplied later by ignorant and
+probably evil-minded persons with correspondingly bad results. There
+is no other responsibility in the whole range of parental duties which
+is so commonly shirked and with such deplorable consequences. When the
+subject is shorn of the morbid and seductive mystery with which custom
+has foolishly surrounded it in the past, and considered in the same
+spirit with which we study the hygiene of the digestion and other
+natural functions, it will be found possible to give instruction about
+the sexual function in a natural way and without exciting unhealthy
+and morbid curiosity.
+
+A word in the beginning as to the harm produced by abuse of the sexual
+function. The injury thus received is purposely magnified tenfold for
+reasons of gain by quacks who work upon the fears of their victims for
+their own selfish purposes. The voluntary exercise of the sexual
+function--unlike that of any other important organs--is not necessary
+to health until maturity has been reached; on the contrary, continence
+is conducive to health, both physical and mental. Even after maturity,
+unless marriage occurs, or by improper living the sexual desires are
+unnaturally stimulated, it is quite possible to maintain perfect
+health through life without exercising the sexual function at all.
+Undue irritation of the sexual organs causes disorder of the nervous
+system, and if continued it will result ultimately in overfatigue and
+failure of the nervous activities which control the normal functions
+of every organ in the body. In other words, it will result in nervous
+exhaustion.
+
+Damage is also wrought by exciting local irritation, congestion, and
+inflammation of the sexual organs which result in impairment of the
+proper functions of these parts and in local disorders and distress.
+It is unnecessary further to particularize other than to state that
+abuse of the sexual organs in the young is usually owing to the almost
+criminal neglect or ignorance of the child's parents. But so far from
+increasing alarm in the patient it is almost always possible to enable
+the child to be rid of the habit by kindly instruction and judicious
+oversight in the future, and no serious permanent local damage to the
+sexual organs or general injury to the nervous system will be likely
+to persist. The opposite teaching is that peculiar to the quack who
+prophesies every imaginable evil, from complete loss of sexual
+function to insanity. Any real or fancied disorder of the sexual
+function is extremely apt to lead to much mental anxiety and
+depression, so that a cheerful outlook is essential in inspiring
+effort to correct bad habits and is wholly warranted in view of the
+entire recovery in most cases of the young who have abused their
+sexual organs. Insanity or imbecility are seldom the result but more
+often the cause of such habits. It is a sad fact, however, that, under
+the prevailing custom of failure of the parents to exercise proper
+supervision over the sexual function of their children, self-abuse is
+generally practiced in youth, at least by boys.
+
+This often leads to temporary physical and mental suffering and is
+very prejudicial to the morals, but does not commonly result in
+permanent injury except in the degenerate. Children at an early
+age--three to four years--should be taught not to touch, handle, rub,
+or irritate their sexual organs in any way whatsoever except so far as
+is necessary in urination or in the course of the daily cleansing. If
+there seems to be any inclination to do so it will usually be found
+that it is due to some local trouble to which a physician's attention
+should be called and which may generally be readily remedied by him.
+It is always advisable to ask the medical adviser to examine babies
+for any existing trouble and abnormality of the sexual organs, as a
+tight, adherent, or elongated foreskin in boys--and rarely a
+corresponding condition in girls--may give rise to much local
+irritation and remote nervous disturbances. The presence of worms may
+lead to irritation in the bowel, which excites masturbation in
+children. Girl babies should be watched to prevent them from
+irritating the external sexual parts by rubbing them between the inner
+surfaces of the thighs. As the child begins to play with other
+children he or she should be cautioned to avoid those who in any way
+try to thwart the parents' advice, and be instructed to report all
+such occurrences. It is wise also to try and gratify the child's
+natural curiosity about the sexual function so far as may be judicious
+by explanations as to the purpose of the sexual organs, when the child
+is old enough to comprehend such matters.
+
+The reticence and disinclination of parents to instruct their children
+in matters relating to sex cannot be too strongly condemned. It is
+perfectly natural that the youth should wish to know something of the
+origin of life and how human beings come into the world. The mystery
+and concealment thrown around these matters only serve to stimulate
+his curiosity. It is a habit of most parents to rebuke any questions
+relating to this subject as improper and immodest, and the first
+lesson the child learns is to associate the idea of shame with the
+sexual organs; and, since he is not enlightened by his natural
+instructors, he picks up his knowledge of the sex function in a
+haphazard way from older and often depraved companions.
+
+Evasive replies with the intent of staving off the dreaded explanation
+do no good and may result in unexpected evil. By securing the child's
+confidence at the start, one may not only keep informed of his actions
+but protect him from seeking or even listening to bad counsels. At the
+age of ten or twelve it is well that the family physician or parent
+should give instruction as to the special harm which results from
+unnaturally exciting the sexual nature by handling and stimulating the
+sexual organs and also warning the child against filthy literature and
+improper companions. At the age of puberty he should be warned against
+the moral and physical dangers of sexual intercourse with lewd women.
+The physical dangers refer to the great possibility of infection with
+one or both of the common diseases--syphilis and gonorrhea--acquired
+by sexual contact with one suffering from these terrible disorders (p.
+199). It is usually quite impossible for a layman to detect the
+presence of these diseases in others, or rather, to be sure of their
+absence, and the permanent damage which may be wrought to the sufferer
+and to others with whom he may have sexual relations is incalculable.
+It is generally known that syphilis is a disease to be dreaded, but
+not perhaps that it not only endangers the life and happiness of the
+patient, but the future generation of his descendants. Gonorrhea--the
+much more common disease--while often treated lightly by youth,
+frequently leads to long, chronic, local disease and may even result
+fatally in death; later in life it may cause infection of a wife
+resulting in chronic invalidism and necessitating surgical removal of
+her maternal organs. These possibilities often occur long after the
+patient thinks he is wholly free from the disease. Gonorrhea in women
+is the most frequent cause of their sterility, and also is a common
+source of abortion and premature birth. It is the cause in most cases
+of blindness in infants (p. 205) and also of vulvo-vaginitis in girl
+babies. Furthermore, gonorrhea is so alarmingly prevalent that it is
+stated on good authority that the disease occurs in eighty per cent of
+all males some time during their lives. The disease is not confined to
+prostitutes, but is common, much more frequently than is suspected, in
+all walks and classes of life and at all ages. Even among boys
+attending boarding schools and similar institutions the disease is
+only too frequent. It is particularly important that the true
+situation be explained to boys about to enter college or a business
+career, for it is at this period of life that their temptations become
+greatest. Alcohol is the most dangerous foe--next to bad
+companions--with which they must contend in this matter, for, weakened
+by its influence and associated with persuasive friends, their will
+gives way and the advice and warning, which they may have received,
+are forgotten. Idleness is also another influential factor in
+indirectly causing sexual disease; hard physical and mental work are
+powerful correctives of the passions.
+
+It may be of interest to readers to know that but recently an
+association of American physicians, alarmed by the fearful prevalence
+of sexual diseases in this country, has been taking measures to inform
+youths and adults and the general public, through special instruction
+in schools, and by means of pamphlets and lectures to teachers and
+others, of the prevalence and great danger of this evil.
+
+When young adult life has been attained it is also desirable for the
+parent, or the family physician, to inform the young man or
+woman--especially if either is about to enter a marriage
+engagement--that close and frequent personal contact with the opposite
+sex, especially when the affections are involved, will necessarily,
+though involuntarily, excite local stimulation of the sexual organs
+and general irritability and exhaustion of the entire nervous system.
+Long engagements--when the participants are frequent companions--are
+thus peculiarly unfortunate. It is only when the sexual functions are
+normally exercised in adult life, as in sexual intercourse, that
+sexual excitement is not harmful.
+
+Young women about to marry should receive instruction from their
+mothers as to the sexual relations which will exist after marriage.
+Most girls are allowed to grow up ignorant of such matters and in
+consequence may become greatly shocked and even disgusted by the
+sexual relations in marriage--fancying that there must be something
+unnatural and wrong about them because the subject was avoided by
+those responsible for their welfare.
+
+Any excess in frequency of sexual intercourse after marriage is
+followed by feelings of depression and debility of some sort which may
+be readily attributed to the cause and so corrected. Any deviation
+from the natural mode of intercourse is pretty certain to lead to
+physical disaster; thus, unnatural prolongation of the act, or
+withdrawal on the part of the man before the natural completion of the
+act in order to prevent conception, often results in deplorable
+nervous disorders.
+
+In conclusion, it may be said that parents must take upon themselves
+the burden of instructing their children in sexual hygiene or shift it
+upon the shoulders of the family physician, who can undertake it with
+much less mental perturbation and with more intelligence. Otherwise
+they subject their offspring to the possibility of incalculable
+suffering, disease, and even death--largely through their own
+inexcusable neglect.
+
+
+
+
+CHAPTER II
+
+=Genito-Urinary Diseases=
+
+_Contagious Disorders--Common Troubles of Children--Inflammation of
+the Bladder--Stoppage and Suppression of Urine--Causes and Treatment
+of Bright's Disease._
+
+
+=GONORRHEA.=--Gonorrhea is a contagious inflammation of the urethra,
+accompanied by a white or yellowish discharge. It is caused by a
+specific germ, the _gonococcus_, and is acquired through sexual
+intercourse with a person suffering from this disease. Exceptionally
+the disease may be conveyed by objects soiled with the discharge, as
+basins, towels, and, in children, diapers, so that in institutions for
+infants it may be thus transferred from one to the other, causing an
+epidemic. The mucous membrane of the lower part of the bowel and the
+eyes are also subject to the disease through contamination with the
+discharge. The disease begins usually three to seven days after sexual
+intercourse, with symptoms of burning, smarting, and pain on
+urination, and a watery discharge from the passage, soon followed by a
+yellowish or white secretion. Swelling of the penis, frequent
+urination, and painful erections are also common symptoms. The
+disease, if uncomplicated and running a favorable course, may end in
+recovery within six weeks or earlier, with proper treatment. On the
+other hand, complications are exceedingly frequent, and the disorder
+often terminates in a chronic inflammation which may persist for
+years--even without the knowledge of the patient--and may result in
+the infection of others after all visible signs have ceased to appear.
+
+=Treatment.=--Rest is the most important requisite; at first, best in
+bed; if not, the patient should keep as quiet as possible for several
+days. The diet should consist of large quantities of water or
+milk, or milk and vichy, with bread, cereals, potatoes, and
+vegetables--absolutely avoiding alcohol in any form. Sexual
+intercourse is harmful at any stage in the disease and will
+communicate the infection. Aperient salts should be taken to keep the
+bowels loose. The penis should be soaked in hot water three times
+daily to reduce the inflammation and cleanse the organ. A small wad of
+absorbent cotton may be held in place by drawing the foreskin over it
+to absorb the discharge, or may be held in place by means of a bag
+fitting over the penis. All cloths, cotton, etc., which have become
+soiled with the discharge, should be burned, and the hands should be
+washed after contact with the discharge; otherwise the contagion may
+be conveyed to the eyes, producing blindness. It is advisable for the
+patient to take one-half teaspoonful of baking soda in water three
+times daily between meals for the first four or five days, or, better,
+fifteen grains of potassium citrate and fifteen drops of sweet spirit
+of nitre in the same way. Painful erections may be relieved by bathing
+the penis in cold water, urinating every three hours, and taking
+twenty grains of sodium bromide at night in water. After all swelling
+and pain have subsided, local treatment may be begun.
+
+Injections or irrigations with various medicated fluids constitute the
+best and most efficient measures of local treatment. They should be
+used only under the advice and management of the physician. No greater
+mistake can be made than to resort to the advertising quack, the
+druggist's clerk, or the prescription furnished by an obliging friend.
+Skillful treatment, resulting in a complete radical cure, may save him
+much suffering from avoidable complications and months or years of
+chronic trouble.
+
+At the same time the first medicines advised are stopped and oleoresin
+of cubebs, five grains, or copaiba balsam, ten grains--or both
+together--are to be taken three times daily after meals, in capsules,
+for several weeks, unless they disturb the digestion too much. A
+suspensory bandage should be worn throughout the continuance of the
+disease. The approach of the cure of the disease is marked by a
+diminution in the quantity and a change in the character of the
+discharge, which becomes thinner and less purulent and reduced to
+merely a drop in the passage in the early morning, but this may
+continue for a great while. Chronic discharge of this kind and the
+complications cannot be treated properly by the patient, but require
+skilled medical care.
+
+In this connection it may be said that most patients have an idea that
+the subsidence or disappearance of the discharge is an evidence of the
+cure of the disease. Experience shows that the disease may lapse into
+a latent or chronic form and remain quiescent, without visible
+symptoms, during a prolonged period, while susceptible of being
+revived under the influence of alcoholic drinks or sexual intercourse.
+It is important that treatment should be continued until all disease
+germs are destroyed, which can only be determined by an examination of
+the secretions from the urethra under the microscope.
+
+The more common complications of gonorrhea are inflammation of the
+glands in the groin (bubo), acute inflammation of the prostate glands
+and bladder, of the seminal vesicles, or of the testicles. The latter
+complication is a most common cause of sterility in men. Formerly it
+was thought that gonorrhea was a local inflammation confined to the
+urinary canal and neighboring parts, but advances in our knowledge
+have shown that the germs may be taken up into the general circulation
+and affect any part of the body, such as the muscles, joints, heart,
+lungs, liver, spleen, kidneys, etc., with results always serious and
+often fatal to life. One of the most common complications is
+gonorrheal arthritis, which may affect one or several joints and
+result in stiffness or complete loss of movement of the affected
+joint, with more or less deformity and permanent disability. Another
+complication is gonorrheal inflammation of the eye, from direct
+transference of the pus by the fingers or otherwise, and resulting in
+partial or complete blindness.
+
+
+=GONORRHEA IN WOMEN.=--Gonorrhea in women is a much more frequent and
+serious disease than was formerly supposed. The general impression
+among the laity is that gonorrhea in women is limited to the
+prostitute and vicious classes who indulge in licentious relations.
+Unfortunately, this is not the case. There is perhaps more gonorrhea,
+in the aggregate, among virtuous and respectable wives than among
+professional prostitutes, and the explanation is the following: A
+large proportion of men contract the disease at or before the marrying
+age. The great majority are not cured, and the disease simply lapses
+into a latent form. Many of them marry, believing themselves cured,
+and ignorant of the fact that they are bearers of contagion. They
+transmit the disease to the women they marry, many of whom, from
+motives of modesty and an unwillingness to undergo an examination do
+not consult a physician, and they remain ignorant of the existence of
+the disease until the health is seriously involved. In women,
+gonorrhea is not usually so acute and painful as in men, unless it
+involves the urethra. It usually begins with smarting and painful
+urination, with frequent desire to urinate and with a more or less
+abundant discharge from the front passage. In the majority of cases
+the infection takes place in the deeper parts, that is, in the neck or
+body of the womb. In this location it may not give rise at first to
+painful symptoms, and the patient often attributes the increased
+discharge to an aggravation of leucorrhea from which she may have
+suffered. The special danger to women from gonorrhea is that the
+inflammation is apt to be aggravated during the menstrual period and
+the germs of the disease ascend to the cavity of the womb, the tubes,
+and ovaries, and invade the peritoneal covering, causing peritonitis.
+Pregnancy and childbirth afford favorable opportunities for the upward
+ascension of the germs to the peritoneal cavity. The changes caused by
+gonorrheal inflammation in the maternal organs are the most common
+cause of sterility in women. It is estimated that about fifty per cent
+of all sterility in women proceeds from this cause. In addition to its
+effects upon the child-bearing function, the danger to the health of
+such women is always serious. In the large proportion of cases they
+are made permanent invalids, no longer able to walk freely, but
+compelled to pass their lives in a reclining position until worn out
+by suffering, which can only be relieved by the surgical removal of
+their maternal organs. It is estimated that from fifty to sixty per
+cent of all operations performed on the maternal organs of women are
+due to disease caused by gonorrheal inflammation.
+
+=Treatment.=--Rest in bed, the use of injections of hot water,
+medicated with various astringents, by means of a fountain syringe in
+the front passage three times daily, and the same remedies and bath
+recommended above, with hot sitz baths, will usually relieve the
+distress. In view of the serious character of this affection in women
+and its unfortunate results when not properly treated, it is important
+that they should have the benefit of prompt and skillful treatment by
+a physician. Otherwise, the health and life of the patient may be
+seriously compromised.
+
+The social danger of gonorrhea introduced after marriage is not
+limited to the risks to the health of the woman. When a woman thus
+infected bears a child the contagion of the disease may be conveyed to
+the eyes of the child in the process of birth. Gonorrheal pus is the
+most virulent of all poisons. A single drop of the pus transferred to
+the eye may destroy this organ in from twenty-four to forty-eight
+hours. It is estimated that from seventy-five to eighty per cent of
+all babies blinded at birth have suffered from this cause, while from
+twenty to thirty per cent of blindness from all causes is due to
+gonorrhea. While the horrors of this disease in the newborn have been
+mitigated by what is called the Crede method (instillation of nitrate
+of silver solution in the eye immediately after birth), it still
+remains one of the most common factors in the causation of blindness.
+Another social danger is caused by the pus being conveyed to the
+genital parts of female children, either at birth or by some object
+upon which it has been accidentally deposited, such as clothes,
+sponges, diapers, etc. These cases are very common in babies'
+hospitals and institutions for the care of children. Quite a number of
+epidemics have been traced to this cause. The disease occurring in
+children is exceedingly difficult of cure and is often followed by
+impairment in the development of their maternal organs. Much of the
+ill health of young girls from disordered menstruation and other
+uterine diseases may be traced to this cause. Another serious
+infection in babies and young children is gonorrheal inflammation of
+the joints, with more or less permanent crippling.
+
+
+=SYPHILIS; THE POX; LUES.=--Syphilis is a contagious germ disease
+affecting the entire system. While commonly acquired through sexual
+intercourse with a person affected with the disorder, it may be
+inherited from the parents, one or both. It is often acquired through
+accidental contact with sources of contagion. Syphilis and
+tuberculosis are the two great destroyers of health and happiness, but
+syphilis is the more common.
+
+=Symptoms.=--Acquired syphilis may be divided into three stages: the
+primary, secondary, and tertiary. The first stage is characterized by
+the appearance of a pimple or sore on the surface of the sexual organ
+not usually earlier than two, nor later than five to seven, weeks
+after sexual intercourse. The appearance of this first sore is subject
+to such variations that it is not always possible for even the most
+skillful physician to determine positively the presence of syphilis
+in any individual until the symptoms characteristic of the second
+stage develop. Following the pimple on the surface of the penis comes
+a raw sore with hard deposit beneath, as of a coin under the skin. It
+may be so slight as to pass unnoticed or become a large ulcer, and may
+last from a few weeks to several months. There are several other kinds
+of sores which have no connection with syphilis and yet may resemble
+the syphilitic sore so closely that it becomes impossible to
+distinguish between them except by the later symptoms to be described.
+Along with this sore, lumps usually occur in one or both groins, due
+to enlarged glands.
+
+The second stage appears in six to seven weeks after the initial sore,
+and is characterized by the occurrence of a copper-colored rash over
+the body, but not often on the face, which resembles measles
+considerably. Sometimes a pimply or scaly eruption is seen following
+this or in place of the red rash. At about, or preceding, this period
+other symptoms may develop, as fever, headache, nausea, loss of
+appetite, and sleeplessness, but these may not be prominent. Moist
+patches may appear on the skin, in the armpits, between the toes, and
+about the rectum; or warty outgrowths in the latter region. There is
+sore throat, with frequently grayish patches on the inside of the
+cheeks, lips, and tongue. The hair falls out in patches or, less
+often, is all lost. Inflammation of the eye is sometimes a symptom.
+These symptoms do not always occur at the same time, and some may be
+absent or less noticeable than others.
+
+The third stage comes on after months or years, or in those subjected
+to treatment may not occur at all. This stage is characterized by
+sores and ulcerations on the skin and deeper tissues, and the
+occurrence of disease of different organs of the body, including the
+muscles, bones, nervous system, and blood vessels; every internal
+organ is susceptible to syphilitic change.
+
+A great many affections of the internal organs--the heart, lungs,
+liver, kidneys, brain, and cord--which were formerly attributed to
+other causes, are now recognized as the product of syphilis. The
+central nervous system is peculiarly susceptible to the action of the
+syphilitic poison, and when affected may show the fact through
+paralysis, crippling, disabling, and disfiguring disorders.
+
+Years after cure has apparently resulted, patients are more liable to
+certain nervous disorders, as locomotor ataxia, which attacks
+practically only syphilitics; and general paresis, of which
+seventy-five per cent of the cases occur in those who have had
+syphilis.
+
+=Inherited Syphilis.=--Children born with syphilis of syphilitic
+parents show the disease at birth or usually within one or two months.
+They present a gaunt, wasted appearance, suffer continually from
+snuffles or nasal catarrh, have sores and cracks about the lips, loss
+of hair, and troublesome skin eruptions. The syphilitic child has been
+described as a "little old man with a cold in his head." The internal
+organs are almost invariably diseased, and sixty to eighty per cent of
+the cases fortunately die. Those who live to grow up are puny and
+poorly developed, so that at twenty they look not older than twelve,
+and are always delicate.
+
+It is to be noted that syphilis is not necessarily a venereal disease,
+that is, acquired through sexual relations. It may be communicated by
+kissing, by accidental contact with a sore on a patient's body, by the
+use of pipes, cups, spoons, or other eating or drinking utensils, or
+contact with any object upon which the virus of the disease has been
+deposited.
+
+Any part of the surface of the body or mucous membrane is susceptible
+of being inoculated with the virus of syphilis, followed by a sore
+similar to what has been described as occurring upon the genital parts
+and later the development of constitutional symptoms. The
+contagiousness of the disease is supposed to last during the first
+three years of its existence, but there are many authentic cases of
+contagion occurring after four or five years of syphilis.
+
+=Diagnosis.=--The positive determination of the existence of syphilis
+at the earliest moment is of the utmost importance in order to set at
+rest doubt and that treatment may be begun. It is necessary to wait,
+however, until the appearance of the eruption, sore throat,
+enlargement of glands, falling out of hair, etc., before it is safe to
+be positive.
+
+=Treatment.=--The treatment should be begun as soon as the diagnosis
+is made, and must be continuously and conscientiously pursued for
+three years or longer. If treatment is instituted before the secondary
+symptoms, it may prevent their appearance so that the patient may
+remain in doubt whether he had the disease or not, for it is
+impossible for the most skilled specialist absolutely to distinguish
+the disease before the eruption, no matter how probable its existence
+may seem. This happens because there are several kinds of sores which
+attack the sexual organs and which may closely simulate syphilis. The
+treatment is chiefly carried out with various forms of mercury and
+iodides, but so much knowledge and experience are required in adapting
+these to the individual needs and peculiarities of the patient that it
+is impossible to describe their use. Patients should not marry until
+four or five years have elapsed since the appearance of syphilis in
+their persons, and at least twelve months after all manifestations of
+the disease have ceased. If these conditions have been complied with,
+there is little danger of communicating the disease to their wives or
+transmitting it to their offspring. They must moreover, have been
+under the treatment during all this period. Abstinence from alcohol,
+tobacco, dissipation, and especial care of the teeth are necessary
+during treatment.
+
+=Results.=--The majority of syphilitics recover wholly under treatment
+and neither have a return of the disease nor communicate it to their
+wives or children. It is, however, possible for a man, who has
+apparently wholly recovered for five or six years or more, to impart
+the disease. Without proper treatment or without treatment for the
+proper time, recurrence of the disease is frequent with the occurrence
+of the destructive and often serious symptoms characteristic of the
+third stage of the disease. While syphilis is not so fatal to life as
+tuberculosis, it is capable of causing more suffering and unhappiness,
+and is directly transmitted from father to child, which is not the
+case with consumption. Syphilis is also wholly preventable, which is
+not true of tuberculosis at present. It is not probable that syphilis
+is ever transmitted to the third generation directly, but deformities,
+general debility, small and poor teeth, thin, scanty growth of hair,
+nervous disorders, and a general miserable physique are seen in
+children whose parents were the victims of inherited syphilis. In
+married life syphilis may be communicated to the wife directly from
+the primary sore on the penis of the husband during sexual
+intercourse, but contamination of the wife more often happens from the
+later manifestations of the disease in the husband, as from secretion
+from open sores on the body or from the mouth, when the moist patches
+exist there.
+
+It is possible for a child to inherit syphilis from the father--when
+the germs of syphilis are transmitted through the semen of the father
+at the time of conception--and yet the mother escape the disease. On
+the other hand, it is not uncommon for the child to become thus
+infected and infect its mother while in her womb; or the mother may
+receive syphilis from the husband after conception, and the child
+become infected in the womb.
+
+The chief social danger of syphilis comes from its introduction into
+marriage and its morbid radiations through family and social life.
+Probably one in every five cases of syphilis in women is communicated
+by the husband in the marriage relation. There are so many sources and
+modes of its contagion that it is spread from one person to another in
+the ordinary relations of family and social life--from husband to wife
+and child, from child to nurse, and to other members of the family, so
+that small epidemics of syphilis may be traced to its introduction
+into a family. Syphilis is the only disease which is transmitted in
+full virulence to the offspring, and its effect is simply murderous.
+As seen above, from sixty to eighty per cent of all children die
+before or soon after birth. One-third of those born alive die within
+the next six months, and those that finally survive are blighted in
+their development, both physical and mental, and affected with various
+organic defects and deformities which unfit them for the battle of
+life. Syphilis has come to be recognized as one of the most powerful
+factors in the depopulation and degeneration of the race.
+
+
+=INVOLUNTARY PASSAGE OF URINE--BED-WETTING IN
+CHILDREN.=--(_Incontinence of Urine_).--This refers to an escape of
+urine from the bladder uncontrolled by the will. It naturally occurs
+in infants under thirty months, or thereabouts, and in the very old,
+and in connection with various diseases. It may be due to disease of
+the brain, as in idiocy or insanity, apoplexy, or unconscious states.
+Injuries or disorders of the spinal cord, which controls the action of
+the bladder (subject to the brain), also cause incontinence. Local
+disorders of the urinary organs are more frequent causes of the
+trouble, as inflammation of any part of the urinary tract, diabetes,
+nephritis, stone in the bladder, tumors, and malformations. The
+involuntary passage of urine may arise from irritability of
+bladder--the most frequent cause--or from weakness of the muscles
+which restrain the escape of urine, or from obstruction to flow of
+urine from the bladder, with overflow when it becomes distended.
+
+It is a very common disorder of children and young persons, and in
+some cases no cause can be found; but in many instances it is due to
+masturbation (p. 193), to a narrow foreskin and small aperture at the
+exit of the urinary passage, to worms in the bowels or disease of the
+lower end of the bowels, such as fissure or eczema, to digestive
+disorders, to retaining the urine overlong, to fright, to dream
+impressions (dreaming of the act of urination), and to great weakness
+brought on by fevers or other diseases. In old men it is often due to
+an enlargement of a gland at the neck of the bladder which prevents
+the bladder from closing properly. A concentrated and irritating
+urine, from excessive acidity or alkalinity, may induce incontinence.
+
+Children may recover from it as they approach adult life, but they
+should not be punished, as it is a disease and not a fault. Exception
+should be made in case children wet their clothing during play,
+through failure to take the time and trouble to pass water naturally.
+It is more common among children at night, leading to wetting of the
+bed, but may occur in the day, and often improves in the spring and
+summer, only to return with the cold weather. Children who sleep very
+soundly are more apt to be subject to this disorder.
+
+=Treatment.=--In the case of a disorder depending upon one of so many
+conditions it will be realized that it would be folly for the layman
+to attempt to treat it. Children who are weak need building up in
+every possible way, as by an outdoor life, cold sponging daily, etc.
+If there is in boys a long foreskin, or tight foreskin, hindering the
+escape of urine and natural secretions of this part, circumcision may
+be performed to advantage by the surgeon, even in the infant a few
+months old. Sometimes a simpler operation, consisting of stretching or
+overdistending the foreskin, can be done.
+
+A somewhat corresponding condition in girls occasionally causes
+bed-wetting and other troubles. It can be discovered by a physician.
+Children who wet their beds, or clothes, should not drink liquid
+after five in the afternoon, and should be taken up frequently during
+the night to pass water. The bed covering must be light, and they
+should be prevented from lying on the back while asleep by wearing a
+towel knotted in the small part of the back. Elevation of the foot of
+the bed a few inches is recommended as having a corrective influence.
+Masturbation, if present, must be corrected.
+
+It is a very difficult disorder to treat, and physicians must be
+excused for failures even after every attempt has been made to
+discover and remove the cause. Even when cure seems assured, the
+disorder may recur.
+
+
+=INFLAMMATION OF THE BLADDER= (_Cystitis_).--The condition which we
+describe under this head commonly causes frequent painful urination.
+Primarily there is usually some agency which mechanically or
+chemically irritates the bladder, and if the irritation does not
+subside, inflammation follows owing to the entrance of germs in some
+manner. The introduction into the bladder of unboiled, and therefore
+unclean, instruments is a cause; another cause is failure to pass
+urine for a long period, from a feeling of delicacy in some persons
+when in unfavorable surroundings. Nervous spasm of the urinary passage
+from pain, injuries, and surgical operations constitutes another
+cause. Inflammation may extend from neighboring parts and attack the
+bladder, as in gonorrhea, and in various inflammations of the sexual
+organs of women, as in childbed infection. Certain foods, waters, and
+drinks, as alcohol in large amounts, and drugs, as turpentine or
+cantharides applied externally or given internally, may lead to
+irritation of the bladder. Exposure to cold in susceptible persons is
+frequently a source of cystitis, as well as external blows and
+injuries. The foregoing causes are apt to bring on sudden or acute
+attacks of bladder trouble, but often the disease comes on slowly and
+is continuous or chronic.
+
+Among the causes of chronic cystitis, in men over fifty, is
+obstruction to the outflow of urine from enlargement of the prostate
+gland, which blocks the exit from the bladder. In young men, narrowing
+of the urethra, a sequel to gonorrhea, may also cause cystitis; also
+stone in the bladder or foreign bodies, tumors growing in the bladder,
+tuberculosis of the organ. Paralysis of the bladder, which renders the
+organ incapable of emptying itself, thus retaining some fermenting
+urine, is another cause of bladder inflammation.
+
+=Symptoms.=--The combination of frequency of and pain during
+urination, with the appearance of blood or white cloudiness and
+sediment in the urine, are evidences of the existence of inflammation
+of the bladder. The trouble is aggravated by standing, jolting, or
+active exercise. The pain may be felt either at the beginning or end
+of urination. There is also generally a feeling of weight and
+heaviness low down in the belly, or about the lower part of the bowel.
+Blood is not frequently present, but the urine is not clear, if there
+is much inflammation, but deposits a white and often slimy sediment
+on standing. In chronic inflammation of the bladder the urine often
+has a foul odor and smells of ammonia.
+
+=Treatment.=--The treatment of acute cystitis consists in
+rest--preferably on the back, with the legs drawn up, in bed. The diet
+should be chiefly fluid, as milk and pure water, flaxseed tea, or
+mineral waters. Potassium citrate, fifteen grains, and sweet spirit of
+nitre, fifteen drops, may be given in water to advantage three times
+daily. Hot full baths or sitz baths two or three times a day, and in
+women hot vaginal douches (that is, injections into the front
+passage), with hot poultices or the hot-water bag over the lower part
+of the abdomen, will serve to relieve the suffering. If, however, the
+pain and frequency attending urination is considerable, nothing is so
+efficient as a suppository containing one-quarter grain each of
+morphine sulphate and belladonna extract, which should be introduced
+into the bowel and repeated once in three hours if necessary. This
+treatment should be employed only under the advice of a physician. In
+chronic cystitis, urotropin in five-grain doses dissolved in a glass
+of water and taken four times daily often affords great relief, but
+these cases demand careful study by a physician to determine their
+cause, and often local treatment. Avoidance of all source of
+irritation is also essential in these cases, as sexual excitement and
+the use of alcohol and spices. The diet should consist chiefly of
+cereals and vegetables, with an abundance of milk and water. The
+bowels should be kept loose by means of hot rectal injections in acute
+cystitis.
+
+
+=RETENTION, STOPPAGE, OR SUPPRESSION OF URINE.=--Retention refers to
+that condition where the urine has been accumulating in the bladder
+for a considerable time--over twelve hours--and cannot be passed. It
+may follow an obstruction from disease, to which is added temporary
+swelling and nervous contraction of some part of the urinary passage;
+or it may be due to spasm and closure of the outlet from nervous
+irritation, as in the cases of injuries and surgical operations in the
+vicinity of the sexual organs, the rectum, or in other parts of the
+body. Overdistention of the bladder from failure to pass water for a
+long time may lead to a condition where urination becomes an
+impossibility. Various general diseases, as severe fevers, and
+conditions of unconsciousness, and other disorders of the nervous
+system, are frequently accompanied by retention of urine. In retention
+of urine there is often an escape of a little urine from time to time,
+and not necessarily entire absence of outflow.
+
+=Treatment.=--Retention of urine is a serious condition. If not
+relieved, it may end in death from toxaemia, caused by back pressure on
+the kidneys, or from rupture of the bladder. Therefore surgical
+assistance is demanded as soon as it can be obtained. Failing this,
+begin with the simpler methods. A hot sitz bath, or, if the patient
+cannot move, hot applications, as a hot poultice or hot cloths
+applied over the lower part of the belly, may afford relief.
+Injections of hot water into the bowel are often more efficient still.
+A single full dose of opium in some form, as fifteen drops of
+laudanum[10] or two teaspoonfuls of paregoric[10] or one-quarter grain
+of morphine,[10] will frequently allow of a free passage of urine. The
+introduction of a suppository into the bowel, containing one-quarter
+grain each of morphine sulphate,[10] and belladonna extract, is often
+preferable to giving the drug by the mouth. These measures proving of
+no avail, the next endeavor should be to pass a catheter. If a soft
+rubber or elastic catheter is used with reasonable care, little damage
+can be done, even by a novice. The catheter should be boiled in water
+for ten minutes, and after washing his hands thoroughly the attendant
+should anoint the catheter with sweet oil (which has been boiled) or
+clean vaseline and proceed to introduce the catheter slowly into the
+urinary passage until the urine begins to flow out through the
+instrument.
+
+A medium-sized catheter is most generally suitable, as a No. 16 of the
+French scale, or a No. 8-1/2 of the English scale.
+
+
+=BRIGHTS DISEASE OF THE KIDNEYS.=--Bright's disease of the kidneys is
+acute or chronic, and its presence can be definitely determined only
+by chemical and microscopical examination of the urine. Acute Bright's
+disease coming on in persons previously well may often, however,
+present certain symptoms by which its existence may be suspected even
+by the layman.
+
+
+=ACUTE BRIGHT'S DISEASE; ACUTE INFLAMMATION OF THE KIDNEYS.=--Acute
+Bright's disease is often the result of exposure to cold and wet.
+Inflammation of the kidneys may be produced by swallowing turpentine,
+many of the cheap flavoring extracts in large amounts, carbolic acid,
+and Spanish flies; the external use of large quantities of turpentine,
+carbolic acid, or Spanish flies may also lead to acute inflammation of
+the kidneys. It occurs occasionally in pregnant women. The contagious
+germ diseases are very frequently the source of acute Bright's disease
+either as a complication or sequel. Thus scarlet fever is the most
+frequent cause, but measles, smallpox, chickenpox, yellow fever,
+typhoid fever, erysipelas, diphtheria, cholera, and malaria are also
+causative factors.
+
+=Symptoms.=--Acute Bright's disease may develop suddenly with pallor
+and puffiness of the face owing to dropsy. The eyelids, ankles, legs,
+and lower part of the belly are apt to show the dropsy most. There may
+be nausea, vomiting, pain and lameness in the small part of the back,
+chills and fever, loss of appetite, and often constipation. In
+children convulsions sometimes appear. The urine is small in amount,
+perhaps not more than a cupful in twenty-four hours, instead of the
+normal daily excretion of three pints. Occasionally complete
+suppression of urine occurs. It is high-colored, either smoky or of a
+porter color, or sometimes a dark or even bright red, from the
+pressure of blood. Stupor and unconsciousness may supervene in severe
+cases. Recovery usually occurs, in favorable cases, within a few
+weeks, with gradually diminishing dropsy and increasing secretion of
+urine, or the disease may end in a chronic disorder of the kidneys. If
+acute Bright's disease is caused by, or complicated with, other
+diseases, the probable result becomes much more difficult to predict.
+
+=Treatment.=--The failure of the kidneys to perform their usual
+function of eliminating waste matter from the blood makes it necessary
+for the skin and bowels to do double duty. The patient should remain
+in bed and be kept very warm with flannel night clothes and blankets
+next the body. The diet should consist wholly of milk, a glass every
+two hours, in those with whom it agrees, and in others gruels may be
+substituted to some extent. The addition to milk of mineral waters,
+limewater, small amounts of tea, coffee, or salt often makes it more
+palatable to those otherwise disliking it. As the patient improves,
+bread and butter, green and juicy vegetables, and fruits may be
+permitted. An abundance of pure water is always desirable. The bowels
+should be kept loose from the outset by salts given in as little water
+as possible and immediately followed by a glass of pure water. A
+teaspoonful may be given hourly till the bowels move. Epsom or
+Glauber's salts are efficient, but the compound jalap powder is the
+best purgative. Children, or those to whom these remedies are
+repugnant, may take the solution of citrate of magnesia, of which the
+dose is one-half to a whole bottle for adults. The skin is stimulated
+by the patient's lying in a hot bath for twenty minutes each day or,
+if this is not possible, by wrapping the patient in a blanket wrung
+out of hot water and covered by a dry blanket, and then by a rubber or
+waterproof sheet, and he is allowed to remain in it for an hour with a
+cold cloth to the head. If the patient takes the hot bath he should be
+immediately wrapped in warmed blankets on leaving it, and receive a
+hot drink of lemonade to stimulate sweating.
+
+For treatment of convulsions, see Vol. I, p. 188.
+
+Vomiting is allayed by swallowing cracked ice, single doses of bismuth
+subnitrate (one-quarter teaspoonful) once in three hours, and by heat
+applied externally over the stomach. Recovery is hastened by avoiding
+cold and damp, and persisting with a liquid diet for a considerable
+period. A course of iron is usually desirable after a few weeks have
+elapsed to improve the quality of the blood; ten drops of the tincture
+of the chloride of iron taken in water through a glass tube by adults;
+for children five to ten drops of the syrup of the iodide of iron. In
+either case the medicine should be taken three times daily after
+meals.
+
+
+=CHRONIC BRIGHT'S DISEASE.=--This includes several forms of kidney
+disease. The symptoms are often very obscure, and the condition may
+not be discovered or suspected by the physician until an examination
+of the urine is made, which should always be done in any case of
+serious or obscure disorder. Accidental discovery of Bright's disease
+during examination for life insurance is not rare. The disease may
+exist for years without serious impairment resulting.
+
+=Causes.=--Chronic Bright's disease often follows and is the result of
+fevers and acute inflammation of the kidneys. It is more common in
+adults. Overeating, more especially of meat, and overdrinking of
+alcohol are frequent causes. Gout is a frequent factor in its
+causation. The disease has in the past been regarded as a local
+disease of the kidneys, but recent research makes it probable that
+there is a general disorder of the system due to some faulty
+assimilation of food--especially when the diet itself is faulty--with
+the production of chemical products which damage various organs in the
+body as well as the kidneys, notably the heart and blood vessels.
+
+=Symptoms.=--The symptoms are most diverse and varied and it is not
+possible to be sure of the existence of the disease without a careful
+physical examination, together with a complete examination of the
+urine, both made by a competent physician. Patients may be afflicted
+with the disease for long periods without any symptoms until some
+sudden complication calls attention to the underlying trouble.
+Symptoms suggesting chronic Bright's disease are among the following:
+indigestion, diarrhea and vomiting, frequent headache, shortness of
+breath, weakness, paleness, puffiness of the eyelids, swelling of the
+feet in the morning, dropsy, failure of eyesight, and nosebleed, and
+sometimes apoplexy. As the disease comes on slowly the patient has
+usually time to apply for medical aid, and attention is called to the
+foregoing symptoms merely to emphasize the importance of attending to
+such in due season.
+
+=Outcome.=--While the outlook as to complete recovery is very
+discouraging, yet persons may live and be able to work for years in
+comparative comfort in many cases. When a physician pronounces the
+verdict of chronic Bright's disease, it is not by any means equivalent
+to a death warrant, but the condition is often compatible with many
+years of usefulness and freedom from serious suffering.
+
+=Treatment.=--Medicines will no more cure Bright's disease than old
+age. Out-of-door life in a dry, warm, and equable climate has the most
+favorable influence upon the cause of chronic Bright's disease, and
+should always be recommended as a remedial agent when available.
+Proper diet is of great importance. Cereals, vegetables, an abundance
+of fat in the form of butter and cream--to the amount of a pint or so
+a day of the latter, and the avoidance of alcohol and meat, fish and
+eggs constitute the ideal regimen when this can be carried out. Tea
+and coffee in much moderation are usually allowable and water in
+abundance. The underclothing should be of wool the year round, and
+especial care is essential to avoid chilling of the surface. Medicines
+have their usefulness to relieve special conditions, but should only
+be taken at the advice of a physician, whose services should always be
+secured when available.
+
+
+
+
+Part IV
+
+DISEASE AND DISORDER OF THE
+MIND
+
+BY
+
+ALBERT WARREN FERRIS
+
+
+
+
+CHAPTER I
+
+=Insanity=
+
+
+Insanity is the name given to a collection of symptoms of disease of
+the brain or disorder of brain nutrition or circulation. The principal
+test of insanity lies in the adjustment of the patient to his
+surroundings, as evidenced in conduct and speech. Yet one must not
+include within the field of insanity the improper conduct and speech
+of the vicious, nor of the mentally defective. Crime is not insanity,
+though there are undoubtedly some insane people confined in prisons
+who have been arrested because of the commission of crime.
+
+Then, too, while mental defect may exist in the insane, there is a
+certain class of mental defectives whose condition is due not to
+disease of the brain, but to arrest of development of the brain during
+childhood or youth, and these we call idiots or imbeciles; but they
+are not classed with the insane.
+
+
+_Mental Disorder Not Insanity_
+
+We frequently hear repeated the assertion, "Everybody is a little
+insane," and the quotation is reported as coming from an expert in
+insanity. This quotation is untrue. The fact is that anyone is liable
+to mental disorder; but mental disorder is not insanity. To
+illustrate: a green glove is shown to a certain man and he asserts
+that its color is brown, and you cannot prove to him that he is wrong,
+because he is color-blind. Green and brown appear alike to him. This
+is mental disorder, but not insanity. Again, a friend will explain to
+you how he can make a large profit by investing his money in a certain
+way. He does so invest it and loses it, because he has overlooked
+certain factors, has not given proper weight to certain influences,
+and has ignored probable occurrences, all of which were apparent to
+you. He was a victim of his mental disorder, his judgment, reason, and
+conception being faulty; yet he was not insane. Again, you answer a
+letter from a correspondent, copying on the envelope the address you
+read at the head of his letter. A few days later your answer is
+returned to you undelivered. In astonishment, you refer to his letter
+and find that you have misread the address he gave, mistaking the
+number of his house. This was an instance of mental disorder in your
+not reading the figure aright; but it was not insanity.
+
+
+_What Autopsies of the Brain Reveal_
+
+The changes in the brain accompanying or resulting from disease, as
+found in some chronic cases of insanity in which autopsies are made,
+consist largely in alteration of the nerve cells of the brain. The
+cells are smaller and fewer than they should be, they are altered in
+shape, and their threads of communication with other cells are
+broken. Nerve cells and often large areas of gray matter are replaced
+by connective tissue (resembling scar tissue), which grows and
+increases in what would otherwise be vacant spaces. All areas which
+contain this connective tissue, this filling which has no function, of
+course, cease to join with other parts of the brain in concerted
+action, and so the power of the brain is diminished, and certain of
+its activities are restricted or abolished.
+
+
+_Curious Illusions of the Insane_
+
+In the normal brain certain impressions are received from the special
+senses: impressions of sight or of hearing, for example. These
+impressions are called conscious perceptions, and the healthy brain
+groups them together and forms concepts. For instance, you see
+something which is flat and shiny with square-cut edges. You touch it,
+and learn that it is cold, smooth, and hard. Lift it and you find it
+heavy. Grouping together your sense perceptions you form the concept,
+and decide that the object is a piece of marble. Again, you enter a
+dimly lighted room and see a figure in a corner the height of a woman,
+with a gown like a woman's. You approach it, speak to it and get no
+reply, and you find you can walk directly through it, for it is a
+shadow. Perhaps you were frightened. Perhaps you imagined she was a
+thief. Your first judgment was wrong and you correct it. The insane
+person, however, has defective mental processes. He cannot group
+together his perceptions and form proper conceptions. His imagination
+runs riot. His emotions of fear or anger are not easily limited. He
+has to some extent lost the control over his mental actions that you
+and other people possess if your brains are normal. The insane man
+will insist that there is a woman there, and not a shadow, and to his
+mind it is not absurd to walk directly through this person. He cannot
+correct the wrong idea. Such a wrongly interpreted sense perception is
+called an illusion. Another example of illusion is the mistaking the
+whistle of a locomotive for the shriek of a pursuing assassin.
+
+
+_What Hallucinations Are_
+
+The insane man may also suffer from hallucinations. A hallucination is
+a false perception arising without external sensory experience. In a
+hallucination of sight, the disease in the brain causes irritation to
+be carried to the sight-centers of the brain, with a result that is
+similar to the impression carried to the same centers by the optic
+nerves when light is reflected into the eyes from some object. An
+insane man may be deluded with the belief that he sees a face against
+the wall where there is nothing at all. When the air is pure and sweet
+and no odor is discoverable, he may smell feathers burning, and thus
+reveal his hallucination of smell.
+
+
+_Delusions Common to Insanity_
+
+The insane man may have wrong ideas without logical reason for them.
+Thus, an insane man may declare that a beautiful actress is in love
+with him, when there is absolutely no foundation for such an idea. Or,
+he may believe that he can lift 500 pounds and run faster than a
+locomotive can go, while in reality he is so feeble as scarcely to be
+able to walk, and unable to dress himself. Such ideas are delusions.
+Sane people may be mistaken; they may have hallucinations, illusions
+and delusions; but they abandon their mistaken notions and correct
+their judgment at once, on being shown their errors. Sane people see
+the force of logical argument, and act upon it, abandoning all
+irrational ideas. The insane person, on the other hand, cannot see the
+force of logical argument; cannot realize the absurdity or
+impossibility of error. He clings to his own beliefs, for the evidence
+of his perverted senses or the deductions from his disease-irritation
+are very real to him. When we find this to be the fact we know he is
+insane.
+
+Yet we must not confound delirium of fever with insanity. A patient
+suffering from typhoid fever may have a delusion that there is a pail
+by his bed into which he persists in throwing articles. Or he may have
+the hallucination that he is being called into the next room, and try
+to obey the supposed voice.
+
+Certain delusions are commonly found in certain types of insanity.
+Depressed patients frequently manifest the delusion that they have
+committed a great sin, and are unfit to associate with anyone.
+Excited and maniacal patients often believe they are important
+personages--kings or queens, old historical celebrities, etc.
+Paranoiacs commonly have delusions of persecution and of a conspiracy
+among their relatives or their associates or rivals. Victims of
+alcoholic insanity have delusions regarding sexual matters, and
+generally charge with infidelity those to whom they are married.
+General paretics in most cases have delusions of grandeur; that is,
+false ideas of great strength, wealth, political power, beauty, etc.
+
+The emotion which accompanies mental activity is generally exaggerated
+in all insane people except the demented. One sees extreme depression,
+or undue elation and exaltation, or silly glee and absurd joy.
+Intensity of emotion is frequent.
+
+
+_Crimes Impulsively Committed by the Insane_
+
+An interesting mental feature of many insane patients is the
+imperative conception, or imperative impulse. This is a strong urging
+felt by the patient to commit a certain act. He may know the act is
+wrong and dread the punishment which he expects will follow its
+commission. But so constantly and strongly is he impelled that he
+finally yields and commits the act. Crimes are thus perpetrated by the
+insane, with a full knowledge of their enormity. The fact that such
+impulses undoubtedly exist should modify the common test, as to an
+insane person's responsibility before the law. The statute in many
+countries regards an insane criminal as responsible for his act, if he
+knows the difference between right and wrong. This decision is unjust
+and the basis is wrong; for an impulse may be overwhelming, and the
+patient utterly helpless during its continuance. However, a patient
+who has committed a crime under stress of such an irresistible impulse
+should be put under permanent custodial care.
+
+
+_Physical Signs of Insanity_
+
+The physician who is skilled in psychiatry finds in very many insane
+patients marked physical signs. There are pains, insensitive areas,
+hypersensitive areas, changes in the pupils of the eyes, unrestrained
+reflex action, and partial loss of muscular control, as shown in
+talking, walking, and writing. Constipation and insomnia are very
+early symptoms of disease in a very large proportion of the insane.
+
+It is productive of no good result for a layman to try to classify the
+insane. The matter of classification will be for several years in a
+condition of developmental change. It is enough to speak of the
+patient as depressed or excited, agitated or stupid, talkative or
+mute, homicidal, suicidal, neglectful, uncleanly in personal habits,
+etc.
+
+
+_Illustrations of Various Types_
+
+There are very interesting features connected with typical instances
+of several varieties of insanity, as they were noted in certain cases
+under the writer's care. A depressed patient with suicidal tendencies
+cherished the delusion that war with Great Britain was imminent, and
+that in such an event British troops would be landed on Long Island
+between New York City and the spot where he conceived the cattle to be
+kept. This, he argued, would cut off the beef and milk supply from the
+city. He therefore decided to do his part toward husbanding the
+present supply of food by refusing to eat; an act which necessitated
+feeding him through a rubber tube for many weeks. He also attempted
+suicide by drowning, throwing himself face downward in a shallow
+swamp, whence he was rescued. This young man was an expert chess
+player even during his attack.
+
+A maniacal patient wore on her head a tent of newspaper to keep the
+devil from coming through the ceiling and attacking her. She
+frequently heard her husband running about the upper floor with the
+devil on his back. As a further precaution she stained her gray hair
+red with pickled beet juice, and would occasionally hurl loose
+furniture at the walls and ceilings of her rooms and assault all who
+approached her.
+
+A man who presented a case of dementia pulled the hairs from his beard
+and planted them in rows in the garden, watering them daily, and
+showing much astonishment that they did not grow. He spent hours each
+day in spelling words backward and forward, and also by repeating
+their letters in the order in which they appear in the alphabet. When
+he wanted funds he signed yellow fallen leaves with a needle, and they
+turned into money.
+
+A case of general paresis (commonly though improperly called
+"softening of the brain") passed into the second stage as a delusion
+was uppermost to the effect that there was opium everywhere; opium in
+his hat, opium in his newspaper, opium in his bath sponge, opium in
+his food. He thereupon refused to eat, and was fed with a tube for two
+years, at the end of which time he resumed natural methods of
+nutrition and ate voraciously. Another general paretic promised to his
+physician such gifts as an ivory vest with diamond buttons, boasted of
+his great strength while scarcely able to walk alone, and declared he
+was a celebrated vocalist, while his lips and tongue were so tremulous
+he could scarcely articulate.
+
+
+_Fixed Delusions of Paranoia_
+
+Paranoia is an infrequent variety of insanity in which the patient is
+dominated by certain fixed delusions, while for a long time his
+intellect is but slightly impaired. The delusions are usually
+persecutory, and the patient alleges a conspiracy. He is generally
+deluded with the belief that he is a prominent person in history, or
+an Old Testament worthy, and there is usually a religious tinge to his
+delusions. A patient of the writer believed himself to be the
+reincarnation of Christ, appearing as "the Christ of the Jews and the
+Christ of the Christians" in one. Over the head of his landlord, who
+requested overdue rent, the patient fired a revolver, "to show that
+the reign of peace had begun in the world." He wrote a new bible for
+his followers, and arranged for a triumphal procession headed by his
+brother and himself on horseback, wearing white stars.
+
+
+_How the Physician Should Be Aided_
+
+When there is a suspicion of irrationality in a person's conduct, and
+certain acts or speeches suggest insanity, the whole surroundings and
+the past life must be considered. Frequently when the eyes are once
+opened to the fact of insanity, a whole chapter of corroborating
+peculiarities can be recalled. It is wise to recall as many of these
+circumstances as possible and note them in order as they occurred, for
+the use of the physician. Strikingly eccentric letters should be
+saved. Odd arrangement of clothes, or the collecting of useless
+articles, should be noted in writing. Changes in character, alteration
+in ideas of propriety, changes in disposition, business or social
+habits, and great variation in the bodily health should be noted in
+writing. Delusions, hallucinations, and illusions should be reported
+in full. It conveys nothing to anyone's mind to say that the patient
+is queer; tell what he does or says that leads you to think he is
+queer, and let the physician draw his own inferences from the deeds or
+speeches. Write down, for example, that the patient talks as if
+answering voices that are imaginary; or that the patient brought an ax
+into the dining room and stood it against the table during the meal;
+or that he paraded up and down the lawn with a wreath of willow
+branches about his neck; in each case stating the actual fact. It is
+important to ascertain exactly what the patient's habits are, as to
+the use of alcoholic beverages, tobacco, and drugs (such as opium),
+and also as to sexual matters. To secure such information is extremely
+difficult, and the help of a close friend or companion will be
+necessary. After the mind begins to waver many a patient plunges into
+dissipation, though formerly a model of propriety.
+
+
+_The Causes of Insanity_
+
+The two great causes of insanity are heredity and stress or strain.
+Lunacy is not infrequent in children of epileptic, alcoholic, or
+insane parents, and those born of parents suffering from nervous
+disease frequently are in such condition that shock, intense emotion,
+dissipation, or exhausting diseases render them insane. Drinking
+alcoholic beverages is the most potent factor in the production of
+insanity. Mental strain, overwork, and worry come next. Adverse
+conditions, bereavement, business troubles, etc., rank third, equally
+with heredity. The arterial diseases of old age, epilepsy, childbirth
+(generally in the neurotic), change of life, fright and nervous shock,
+venereal diseases, sexual excesses or irregularities follow in the
+order named.
+
+
+_A Temperate, Virtuous Life the Best Preventive_
+
+To avoid insanity, therefore, one should lead a righteous,
+industrious, sensible life, preserve as much equanimity as possible,
+and be content with moderate pleasure and moderate success. In many
+cases, people who are neurotic from early youth are so placed that
+unusual demands are made upon them. Adversity brings necessity for
+overwork, duties are manifold, and responsibilities are heavy. In
+ignorance of the fact that they are on dangerous ground and driven by
+circumstances, they overwork, cut short their sleep, and,
+conscientiously pressing on, finally lose their mental balance and
+insanity is the result, a great calamity which is really no fault of
+theirs. Undoubtedly such is frequently the sad history; and for this
+reason, as well as for the general reason that the insane are simply
+ill, all insane should be cared for sympathetically. To consider the
+insane as constantly malevolent is a relic of the old-time, absurd
+belief that insane people were "possessed of the devil." It is no
+disgrace to be insane, and the feeling of chagrin at discovering
+disease of the brain in a relative is another absurdity. Avoidance of
+insanity should be studied with as much devotion as avoidance of
+tuberculosis. Yet there should be no detraction from the fact that the
+heredity is strong. No one should be allowed to marry who has been
+insane, for the offspring of the insane are defective.
+
+The tendency of the times is toward nervous and mental disorder. In
+the large cities the strain is too constant, the struggle is too keen,
+the pace is too swift. Haste to be rich, desire to appear rich, or
+ambition for social distinction has wrecked many a bright, strong
+intellect. This is the age of the greatest luxury the world has ever
+seen, and a large proportion of people in cities are living beyond
+their means, in the gratification of luxurious desires or the effort
+to appear as well as others. Stress and strain are voluntarily
+invited. Children are pushed in their studies and overloaded with too
+many subjects. Genius and insanity, worry and dementia, proceed among
+us hand in hand; the overwrought brain finally totters.
+
+
+_False Ideas Regarding Insanity_
+
+Curious ideas regarding insanity are common, and are apparently
+fostered by the reportorial writers of the daily papers. We read of
+people who are "insane on a subject." This is an impossibility. Many
+people can be drawn out and led into a betrayal of their mental
+condition only when a certain topic or idea is discussed. But although
+exhibiting their insane condition only when this topic is broached,
+they are in no respect sane. Not every act of an insane man is an
+insane act, we must remember. Forgetfulness of this fact leads to
+errors in the superficial. You will hear people say that a certain
+person must be sane, because during a half day's companionship nothing
+astray was noticed. True, there may be a long period of self-control,
+or of absence of test; but occasional conduct will establish the fact
+of constant insanity. Again, we hear the expression: "He cannot be
+insane; there is too much method in such madness." The answer to this
+silly remark is that there is method in all madness except some
+epileptic insanity and terminal dementia. Insane people prepare
+careful plans, with all the details thoroughly considered, and perfect
+methods to escape from hospitals with the greatest cunning. One must
+never take it for granted that the insane person is so demented
+mentally as to be unable to appreciate what is said and done. One
+should never talk about the insane man in his presence, but should
+include him in the conversation as if sane, as a general rule,
+allaying his suspicions and avoiding antagonism. Do not agree with the
+delusions of an insane person, except so far as may be necessary to
+draw them out. Yet avoid argument over them. Simply do not agree, and
+do not strengthen them by appearing to share them. His food should be
+prepared for him, and his medicines administered to him as to any
+other sick person. His baths should be regularly taken.
+
+A depressed patient should be very carefully watched. If the slightest
+suspicion of a suicidal impulse be present, the patient should never
+be left alone. Many a valuable life has been saved through the moral
+support of constant companionship; while we read very frequently of
+the death of an insane patient who sprang from a window during a brief
+period of relaxation of watchful care. Some people think it a
+protection to one insane to elicit from him a promise not to be
+depressed, and not to do anything wrong. One might as well secure a
+promise not to have a rise of temperature. The gloom of despondency
+and the suicidal impulse are as powerful as they are unwelcome and
+unsought; and the wretchedly unhappy patient cannot alone meet the
+issue and resist.
+
+It is unreasonable to be offended by acts or speeches of an insane
+patient, to bear a grudge or expect an apology. Very frequently such a
+patient will turn savagely upon the nearest and dearest, and make
+cutting remarks and accusations or exhibit baseless contempt. All this
+conduct must be ignored and forgotten; for the unkind words of an
+unaccountable and really ill person should not be taken at all
+seriously.
+
+Should a patient escape from home, it is the duty of the one in charge
+without hesitation to overtake him, and then accompany him or at least
+follow at a short distance. The nurse should go with and stay with the
+patient, telephoning or telegraphing home when opportunity offers, and
+finally securing aid; he should know where the patient is at all
+times, foregoing sleep if necessary to protect his charge, and should
+avoid as long as prudence permits the publicity of an arrest; though
+the latter may finally be essential to safety, and to the prevention
+of embarking on a voyage, or taking a train to a distance, or
+purchasing weapons.
+
+=Diversions.=--Music favorably affects many patients, so the pleasure
+of listening to it should be afforded at frequent intervals. Patients
+should be encouraged to absorb themselves in it. It is often possible
+to take insane people to opera, musical comedy, or concert. Vocal and
+instrumental practice at suitable intervals is of great value in
+fixing the attention, filling the mind with desirable thoughts and
+memories, and allaying irritability. Drawing and painting are of
+service when within the number of the patient's accomplishments.
+Intellectual pastimes, as authors, anagrams, billiards, chess, and
+many games with playing cards, are generally helpful. Gardening,
+croquet, and tennis are very desirable. Golf, rowing, swimming, and
+skating are excellent, but are within the reach of very few insane
+patients. All regular occupation that necessitates attention and
+concentration is of supreme value; in fact, insane patients not
+infrequently ask for occupation and find relief in the accomplishment
+of something useful, as well as in the healthful sleep and increased
+appetite that attend judicious physical fatigue.
+
+
+_The Beneficial Atmosphere of Sanitariums_
+
+After caring for an insane patient for a time at home, the question
+arises as to the desirability of sending him away to a sanitarium.
+Generally this is a wise course to pursue. The constant association
+with an insane person is undermining; the responsibility is often too
+heavy; children, often inheriting the same neurotic tendency and
+always impressionable, should not be exposed to the perverting
+influence; it may not be safe to keep a patient with suicidal or
+homicidal impulses in his home; the surroundings amid which the insane
+ideas first started may tend to continue a suggestion of these ideas.
+Removal to strange locality and new scenes, the influence of
+strangers, the abandonment of all responsibilities and duties, and the
+atmosphere of obedience, routine, and discipline are all beneficial.
+An insane person will generally make a greater effort for a stranger
+than for a familiar relative. Discipline, in the form of orders of the
+physicians, and exact obedience is very often very salutary. There is
+a feeling with some that all discipline is cruel. This is not so, for
+the conduct of an insane person is not all insane, but frequently
+needs correction. Many cases of mental alienation improve promptly
+under custodial care, many need it all their lives. A great many cases
+of insanity are never obliged to go away from home, and there is a
+considerable number who carry on a business while still insane, rear a
+family, and take care of themselves. In general, a depressed patient
+should be kept at home as long as there is absolute safety in so
+doing. Most other forms of mental disease progress more rapidly toward
+recovery in sanitariums or hospitals equipped for such patients.
+Prospects of recovery are never jeopardized by confinement in a proper
+institution. Mental and physical rest, quiet, regularity of eating,
+exercising, and sleeping are the essentials which underlie all
+successful treatment of these cases. Dietetics, diversion by means of
+games, music, etc., regular occupation of any practicable sort,
+together with the association with the hopeful, tactful, and reasoning
+minds of physicians and nurses trained for this purpose are of great
+value. It must be remembered that in wholly civilized localities
+madhouses have been replaced by hospitals, keepers have been replaced
+by nurses and attendants, and the old methods of punishment and
+coercion have been long since abandoned, in the light of modern
+compassionate custody.
+
+Certain forms of insanity are hopeless from the start. Few recover
+after two years of mental aberration. Omitting the hopeless cases,
+over forty per cent of the cases of insanity recover. About sixty per
+cent recover of the cases classed as melancholia and mania. Most
+recoveries occur during the first year of the disease; but depressed
+patients may emerge and recover after several years' treatment.
+
+
+FOOTNOTES:
+
+[10] Caution. Dangerous. Use only on physician's order.
+
+
+
+
+APPENDIX
+
+=Patent Medicines=[11]
+
+
+The term "patent medicine" is loosely used to designate all remedies
+of a secret, non-secret, or proprietary character, which are widely
+advertised to the public. This use of the name is erroneous, and it is
+better first to understand the exact difference between the different
+classes of medicines generally comprised under this heading. Only in
+this way can one comprehend their right and wrong use.
+
+=A Patent Medicine= is a remedy which is patented. In order to secure
+this patent, an exact statement of the ingredients and the mode of
+manufacture must be filed with the government. These true "patent
+medicines" are generally artificial products of chemical manufacture,
+such as phenacetin. The very fact of their being patented makes them
+non-secret, and if an intelligent idea is held of their nature and
+mode of action, they may be properly used. Physicians with a full
+knowledge of their uses, limitations, and dangers often, and
+legitimately, prescribe them, and thus used they are the safest and
+most useful of all drugs and compounds of this class.
+
+=A Nostrum.=--The Century Dictionary defines a nostrum as "a medicine
+the ingredients of which, and the methods of compounding them, are
+kept secret for the purpose of restricting the profits of sale to the
+inventor or proprietor." Some nostrums have stated, on their label,
+the names of their ingredients, but not the amount. There has been no
+restriction upon their manufacture or sale in this country, therefore
+the user has only the manufacturer's statement as to the nature of the
+medicine and its uses, and these statements, in many instances, have
+been proved utterly false and unreliable.
+
+=A Proprietary Medicine= is a non-secret compound which is marketed
+under the maker's name. This is usually done because the manufacturer
+claims some particular merit in his product and its mode of
+preparation, and as these drugs are perfectly ethical and largely used
+by physicians, it is to the maker's interest to maintain his
+reputation for the purity and accuracy of the drug. Familiar instances
+of this class are: Squibb's Ether and Chloroform, and Powers &
+Weightman's Quinine.
+
+From the above definition it may be seen that the only unreliable
+medicines are those which are, in reality, nostrums. In regard to all
+of these medicines the following rules should be observed:
+
+_First._--Don't use any remedy that does not show its formula on the
+label.
+
+_Second._--No matter what your confidence in the medicine, or how
+highly recommended it is, consult a physician before using very much
+of it.
+
+_Third._--Take no medicine internally without a physician's advice.
+
+Throughout this chapter the word "patent medicine" will be used in its
+widely accepted form, in the everyday sense, without regard to its
+legal definition, and will be held to include any of the
+above-mentioned classes, unless a direct statement is made to the
+contrary.
+
+In Germany the contents of patent medicines are commonly published,
+and in this country, notably in Massachusetts, the State Boards of
+Health are analyzing these preparations, and making public their
+findings. In North Dakota a law has been passed which requires that a
+proprietary medicine containing over five per cent of alcohol, or any
+one of a number of specified drugs, be labeled accordingly.
+
+
+=PURE FOOD BILL.=--A far-reaching and important step, in the movement
+for reform of patent medicines and for the protection of the public,
+has now been taken by the United States Government. On June 30, 1906,
+an act was approved forbidding the manufacture, sale, or
+transportation of adulterated, misbranded, or poisonous or deleterious
+foods, drugs, medicines, or liquors. This act regulates interstate
+commerce in these articles, and went into effect January 1, 1907.
+Section 7 of this act states:
+
+    "That for the purposes of this Act an article shall be deemed to
+    be adulterated: in case of drugs:
+
+    "_First._ If, when a drug is sold under or by a name recognized in
+    the United States Pharmacopoeia or National Formulary, it differs
+    from the standard of strength, quality, or purity, as determined
+    by the test laid down in the United States Pharmacopoeia or
+    National Formulary official at the time of investigation;
+    _Provided_, that no drug defined in the United States
+    Pharmacopoeia or National Formulary shall be deemed to be
+    adulterated under this provision if the standard of strength,
+    quality, or purity be plainly stated upon the bottle, box or other
+    container thereof although the standard may differ from that
+    determined by the test laid down in the United States
+    Pharmacopoeia or National Formulary.
+
+    "_Second._ If its strength or purity fall below the professed
+    standard or quality under which it is sold."
+
+Section 8 states that a drug shall be deemed misbranded:
+
+    "_First._ If it be an imitation of or offered for sale under the
+    name of another article.
+
+    "_Second._ If it (the package, bottle or box) fails to bear a
+    statement on the label of the quantity or proportion of any
+    alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine,
+    chloroform, cannabis indica, chloral hydrate, or acetanilid, or
+    any derivative or preparation of any such substances contained
+    therein."
+
+What are the motives which impel persons to buy and use patent
+medicines? The history of medicine offers a partial explanation. In
+somewhat remote times we find that the medicines in use by regular
+physicians were of the most vile, nauseating, and powerful nature. We
+read of "purging gently" with a teaspoonful of calomel. Then during
+the wonderful progress of scientific medicine, beginning a little more
+than a half century ago, the most illustrious and useful workers were
+so busily engaged in finding the causes of disease and the changes
+wrought in the various organs, in observing the noticeable symptoms
+and in classifying and diagnosticating them, that treatment was given
+but scant attention. This was nowhere more noticeable than in Germany,
+the birthplace, home, and world-center of scientific medicine, to
+which all the medical profession flocked. Patients became simply
+material which could be watched and studied. This was an exemplary
+spirit, but did not suit the patients who wanted to be treated and
+cured. This fact, together with the peculiar wording of the laws
+regulating the practice of medicine, which allow anyone with the
+exception of graduates to treat patients, but not to prescribe or
+operate upon them, accounts for the number of quacks in Germany.
+
+Dr. Jacobi states that "there is one quack doctor to every two regular
+physicians in Saxony and Bavaria."[12]
+
+Another cause for the use of patent medicines is mysticism. Ignorance
+is the mother of credulity. It is reported[13] that Cato, the elder,
+recommended cabbages as a panacea for all sorts of ills, that he
+treated dislocations of the limbs by incantations, and ordered the
+Greek physicians out of Rome. The ignorant are greatly influenced by
+things that they cannot understand. Therefore, as the mass of people
+are utterly ignorant of the changes in structure and function of the
+body caused by disease, and also the limitations of medicines in their
+power of healing such alterations, their belief in the mysterious
+power said to attach to patent medicines is not surprising. When
+testimonials of the efficacy of patent medicines purporting to come
+from respectable divines, merchants, and statesmen are offered, the
+proof of their power seems incontestable.
+
+Economy and convenience are added incentives to the employment of
+patent medicines. This method of saving the doctor's fee is engendered
+by those physicians who themselves write prescriptions for nostrums.
+"Why not, indeed, eliminate this middleman (the doctor) and buy the
+nostrums direct?" So say the unthinking. But what doctor worthy of the
+name would prescribe a medicine the composition of which he was
+ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it,
+what would be thought of a banker or financial adviser who recommended
+his client to buy a security simply on the recommendation of the
+exploiter of the security? Yet that is exactly the position of a
+doctor who recommends a nostrum.
+
+In view of the fact, therefore, that persons of undoubted intelligence
+are in the habit of purchasing and using remedies of this character
+and since many of the most widely advertised preparations are
+extremely harmful, even poisonous, we have taken the liberty of
+pointing out a few "danger signals," in the guise of extravagant
+assertions and impossible claims, which are characteristic signs of
+the patent medicines to be avoided.
+
+
+=DANGER SIGNALS.=--There are many picturesque and easily grasped
+features in the literature, labels, and advertising of patent
+medicines that spell danger. When these features are seen, the
+medicine should be abandoned immediately, no matter what your friends
+tell you about it, or how highly recommended it may have been by
+others than your physician.
+
+=Claiming a Great Variety of Cures.=--Perhaps of all features of
+patent medicine advertising, this is the most alluring. No one drug or
+combination of drugs, with possibly one or two exceptions, can or does
+"cure" any disease. Patients recover only when the resistance of the
+body is greater than the strength of the disease. This body resistance
+varies in different persons, and is never just alike in any two
+individuals or illnesses. The patient must be treated and not the
+disease, so it is the aim of every conscientious physician to conserve
+and strengthen the vital forces and, at the same time, guard against
+further encroachment of the disease. There is no cure-all, and even if
+a drug or combination of drugs were helpful in any single case, they
+might easily be totally unsuited, or even harmful, in another case,
+with apparently similar symptoms. When a maker claims that his
+particular concoction will cure a long list of diseases, the assertion
+bears on its face evidence of its falsity.
+
+One of the most widely advertised and largely sold catarrh remedies
+claims to cure pneumonia, consumption, dyspepsia, enteritis,
+appendicitis, Bright's disease, heart disease, canker sores, and
+measles. _This is absolute fraud._ No matter what virtues this
+medicine might have in the treatment of one or two ailments, no one
+remedy could possibly be of service in such a varied list of diseases,
+and it could not "cure" one of them.
+
+Another remedy bases its assertion of "cures" on the fact that it
+claims to be a germ killer, and assumes that all disease is caused by
+germs. To quote from its advertising literature, it claims to cure
+thirty-seven diseases which are mentioned by name, and then follows
+the assertion that it cures "all diseases that begin with fever, all
+inflammations, all catarrhal contagious diseases, all the results of
+impure or poisoned blood. In nervous diseases--acts as a vitalizer,
+accomplishing what no drugs can do." It would seem that an intellect
+of any pretensions would recognize the fraudulent nature of this
+claim, yet thousands of bottles of this stuff are annually sold to a
+gullible public. These wide and unjustifiable claims are real danger
+signals, and any medicine making them should be avoided. There are
+many other remedies for which just as great claims are made; the two
+instances cited are merely representative of a large class. It is a
+waste of time, money, and health to buy them with any idea that they
+can fulfill their pretensions.
+
+=Claiming to Cure Headaches.=--The use of any "headache powders" or
+"tablets" should be avoided, except on the advice of a physician. The
+presence of pain in the head, or in any other part of the body, may be
+a symptom of a serious and deep-seated disorder, and it may often be a
+serious matter to temporize with it. At the best, these "pain
+relievers" can give only temporary relief, and their use may prove to
+be dangerous in the extreme. Their action is dependent upon one of the
+modern coal-tar products, usually acetanilid, because it is the
+cheapest. But, unfortunately, acetanilid is also the one with the most
+depressant action on the heart. The danger of headache powders lies in
+the habit which they induce, because of their quick pain-relieving
+qualities and their easy procurability, and from overdosage. If a
+person is otherwise in good health, the use of one headache powder
+will in all probability do no harm, but the dose should not be
+repeated without a doctor's authority. Many deaths have occurred from
+their continued use, or because of an idiosyncrasy on the part of the
+taker, but it is their abuse more than their use which has brought
+upon them such almost universal condemnation. Therefore, while the
+physician may advocate their use, do not take them without his advice
+and specific directions as to kind and dosage.
+
+=Claiming Exhilaration.=--These medicines, by their insidious
+character, constitute a particularly dangerous variety. They depend,
+for their effect, upon the amount of alcohol that they contain. Many
+conscientious temperance workers have not only unsuspectingly taken
+them, but have actually indorsed them. Recently the published analyses
+of several State Boards of Health and the investigations made by
+Samuel Hopkins Adams, and published in his series on "The Great
+American Fraud" have shown that a majority of the "tonics,"
+"vitalizers," and "reconstructors" depend for their exhilarating
+effect upon the fact that they contain from seventeen to fifty per
+cent of alcohol; while beer contains only five per cent, claret eight
+per cent, and champagne nine per cent. Pure whisky contains only fifty
+per cent of alcohol, yet few people would drink "three wineglassfuls
+in forty-five minutes"[14] as a medicine pure and simple. The United
+States Government has prohibited the sale of one of these medicines to
+the Indians, simply on account of the fact that as an intoxicant it
+was found too tempting and effective.[15]
+
+If one must have a stimulant it is better to be assured of its purity.
+These medicines are not only costly, but contain cheap, and often
+adulterated, spirits.
+
+Their worst feature is that they often induce the alcoholic habit in
+otherwise upright people. Commencing with a small dose, the amount is
+gradually increased until the user becomes a slave to drink. Could the
+true history of these widely used medicines be written, it would
+undoubtedly show that many drunkards were started on their downward
+career by medicinal doses of these "tonics" and "bracers."
+
+=Claiming Pain-relieving or Soothing Qualities.=--The properties of
+this class of remedies depend generally upon the presence of cocaine,
+opium, or some equally subtle and allied substance. It should be
+needless to state that such powerful drugs should be taken only upon a
+physician's prescription. Habit-forming and insidious in character,
+they are an actual menace. When present in cough syrups, they give by
+their soothing qualities a false sense of security, and when present
+in "soothing syrups" or "colic cures" for babies, they may be given
+with fatal result. Never take a medicine containing these drugs
+without a full understanding of their dangerous character, and a
+realization of the possible consequences.
+
+=Testimonials.=--These may mean anything or nothing; generally the
+latter. They are usually genuine, but, as Mr. Adams observes, "they
+represent, not the average evidence, but the most glowing opinions
+which the nostrum-vender can obtain, and generally they are the
+expression of a low order of intelligence."[16] It is a sad commentary
+on many men and women, prominent in public life, that they lend their
+names and the weight of their "testimony" to further the ends of such
+questionable ventures. Political and newspaper interests are
+responsible for the collection of this class of testimonials. An
+investigation of some men, who permitted the use of their names for
+this purpose, revealed that many of them had never tasted the
+compound, but that they were willing to sign the testimonials for the
+joy of appearing in print as "prominent citizens."[17] "Prominent
+ministers" and "distinguished temperance workers" are often cited as
+bearing testimony to the virtues of some patent medicine. It has been
+shown that, while the testimonials were real, the people who signed
+them had little right of credence, and were possessed of characters
+and attributes which would show their opinions to be of little value.
+Money and energy can be productive of any number of testimonials for
+any remedy. While some of them may be authentic, yet the fact that a
+medicine "cured" any one of the signers is no evidence that it will
+cure or even help anyone else. Many people recover from diseases with
+no medicine at all, and isolated "cures" can never be taken as a
+criterion of the value of any remedy or method.
+
+=Offering "Money Back Unless Cured."=--Careful reading of this clause
+in most advertising literature will show that there is "a string
+attached." The manufacturers are usually safe in making this
+proposition. In the first place, the average person will not put the
+matter to a test. The second reason why this is a safe proposition for
+the maker is, that if the medicine does not cure, the patient may die,
+and dead men are hardly possible claimants.
+
+=Claiming to Cure Diseases Incurable by Medicine Alone.=--Probably no
+class of people are greater users of patent medicines than those
+unfortunates afflicted with the so-called incurable diseases. The very
+fact of the serious nature of their complaint, and the dread of
+surgical intervention, makes them easy victims to the allurement of
+"sure cures."
+
+The committee on the prevention of tuberculosis of the Charity
+Organization Society of New York City has announced in decided terms
+that there is no specific medication for consumption. Cancer,
+likewise, cannot be cured by the use of internal medicine alone.
+Surgery holds out the greatest hope in this dread disease. The
+medicines claiming to cure these diseases are, therefore, of the most
+fraudulent nature. Their use is positively harmful, for in taking them
+priceless time is lost.
+
+Never temporize if there is any suspicion of the existence of such
+diseases as consumption or cancer. Self-treatment with patent
+medicines in such cases is worse than useless--it is actually
+dangerous to life itself. Consult a physician at the earliest possible
+moment, and put no faith in patent medicines.
+
+There are, however, as has been pointed out, certain patent and
+proprietary medicines which may properly be employed by the physician.
+These include the newly discovered, manufactured chemicals of known
+composition and action; and single substances or combinations of known
+drugs in known proportions, which can only be made to best advantage
+by those having the adequate facilities. The habit of prescribing
+proprietary mixtures of several substances for special diseases is,
+however, generally a matter of laziness, carelessness, or ignorance on
+the doctor's part. This follows because no disease is alike in any two
+patients; because any one disease has many phases and stages; and
+because a doctor should always treat the patient and not the disease.
+Thus a doctor, after carefully questioning and examining the patient,
+should adjust the remedy to the peculiarities of the patient and
+disease. It is impossible to make a given combination of drugs fit all
+patients with the same disease.
+
+The quantity of patent medicine sold in the United States is enormous.
+A series of articles by Samuel Hopkins Adams appeared in _Collier's
+Weekly_ during 1905 and 1906, in which he not only showed the
+fraudulent character of many of the best-known patent medicines,
+giving their names and most minute details concerning them, but
+furnished much reliable information in an interesting and convincing
+manner. In the course of these articles he pointed out that about one
+hundred millions of dollars are paid annually for patent medicines in
+the United States. As explaining this, in part, he affirmed that as
+many as five companies each expended over one million dollars annually
+in advertising patent medicines.
+
+_What Are the Good Ones Good For?_--In any great movement, when a
+dormant public suddenly awakens to the fact that a fraud has been
+perpetrated or a wrong committed, the instinctive and overwhelming
+desire is for far-reaching reform. In efforts to obtain needed and
+radical improvement, and with the impetus of a sense of wrong dealing,
+the pendulum of public opinion is apt to swing too far in an opposite
+direction. There are bad patent medicines--the proof of their
+fraudulent character is clear and overwhelming; but there are good
+ones whose merits have been obscured by the cloud of wholesale and
+popular condemnation. It is true that the manufacturers of even some
+of the valuable ones have an absurd habit of claiming the impossible.
+This attitude is to be regretted, for the makers have thus often
+caused us to lose faith in the really helpful uses to which their
+products might be put.
+
+However, it is well in condemning the bad not to overlook the good.
+The mere fact that a medicine is patented, or that it is a so-called
+proprietary remedy, does not mean that it is valueless or actually
+harmful. The safety line is knowledge of the medicine's real nature,
+its uses and its dangers; the rules given above should be rigorously
+followed.
+
+It is far easier to give general indications for the guidance of those
+wishing to shun unworthy patent medicines than to enable the reader to
+recognize the worthy article. It is safe to assume, however, that
+there are certain simple remedies, particularly those for external
+application, which have a definite use and are dependable. In justice
+it must be said that great improvement has taken place, and is now
+taking place in the ethical character of patent medicines, owing to
+recent agitation, and what is true concerning them to-day may not be
+true to-morrow.
+
+The only proper, ethical patent medicine is the one showing its exact
+composition, and refraining from promise of a cure in any disease.
+Such a one might, nevertheless, advertise its purity, reliability,
+advantageous mode of manufacture, and the excellence of its
+ingredients with more modest and truthful claims as to its use.
+
+The purchaser of a patent medicine pays not only for the ingredients,
+the cost of combining them, and the maker's just profit, but he also
+pays the exploiter's bills for advertising and distributing the
+finished product. With such standard remedies as those mentioned
+above, this added cost is usually a good investment for the purchaser,
+because trade-marked remedies which have "made good" possess two
+advantages over those less advertised, and over their prototypes in
+crude form: procurability and integrity.
+
+Even at remote cross-roads stores, it is possible to obtain a popular
+remedy, one which has been well pushed commercially. And an article
+sold in packages sealed by the makers gets to the consumer just as
+pure as when it left the laboratory. This is not always true of
+ingredients held in bulk by the retailer; witness the evidence
+brought forward in recent prosecutions for drug adulteration.
+
+It is not the purpose of this chapter, in any sense, to advertise or
+place the seal of its unrestricted approval upon any one article of a
+class. Its position in the matter is absolutely impartial. But in
+order that it may be as helpful as possible, it definitely mentions
+the most widely known, and therefore the most easily obtainable,
+remedies. There are other equally good remedies in each case, but as
+it would be almost impossible to mention each individual remedy with
+similar virtues now on the market, the ones discussed must be taken as
+representative of their class in each instance.
+
+Do not forget that the use of these simple remedies does not justify
+their abuse. They may make great claims while their use is really
+limited. Do not rely upon them to do the impossible.
+
+=Vaseline.=--This is pure and refined petroleum, and will be found of
+much service in many forms of skin irritation. It is useful in the
+prevention of "chapping," for softening rough skin, for preventing and
+healing bleeding and cracked lips, as a protective dressing in burns,
+cuts, or any acute inflammation of the skin where the cuticle has been
+injured or destroyed, or where it is desirable that a wound should be
+protected and kept closed from the air. Rubbed over the surface of the
+body when a patient is desquamating or "peeling" after scarlet fever
+or measles, it keeps the skin smooth, soothes the itching, and
+prevents the scales from being carried about in the air and so
+infecting others. Vaseline is a soothing, nonirritating, and bland
+protective ointment for external use. It is perfectly harmless, but
+should not be used for severe skin disease or for internal use, unless
+recommended by a physician in conjunction with other means of healing.
+
+=Pond's Extract.=--Although the makers have claimed special virtues
+for this remedy, it is in reality an extract of hamamelis or
+witch-hazel, and probably differs little in its application or results
+from the ordinary marketed extract made by the average druggist. It is
+mild and bland, harmless when used externally, but should not be used
+internally unless ordered by a physician. It is soothing and healing
+when applied to wounds, sprains, and bruises; diluted with water it is
+a pleasant gargle for a sore throat, and may be applied externally on
+the throat by means of a flannel wrung out in a solution of it in hot
+water. For nosebleed it is often efficient when snuffed up the nose,
+or when pledgets of cotton are soaked in it and placed in the
+nostrils. It may be used as an application in ulcers or varicose
+veins, and from two to four teaspoonfuls with an equal amount of water
+injected into the rectum two or three times daily will often prove of
+great help in piles, particularly if bleeding. It gives relief when
+used for sore or inflamed eyes or eyelids, but in this, as in all
+other serious inflammations, it is not a "cure all," and the physician
+should be consulted if the relief is not prompt.
+
+=Listerine.=--Of the many mild liquid antiseptics "Listerine" is
+probably the best known. The remarks and recommendations concerning
+it, however, are equally applicable to many other remedies of a
+somewhat similar nature, such as glycothymoline, borolyptol, lythol,
+alkalol, formalid, etc.
+
+Listerine is a solution of antiseptic substances with the addition of
+thymol and menthol in quantities sufficient to give it a pleasant odor
+and taste. It has a very strong hold on the public, and is a
+deservedly useful remedy.
+
+Listerine has many helpful uses. It is potent enough to kill many
+germs, and is excellent for this purpose when used as a mouth wash,
+particularly during illness. In acute cold in the head it is soothing
+to the mucous membrane of the nose, if used diluted with warm water as
+a nasal douche. It serves a similar purpose when used as a gargle in
+mild sore throat.
+
+If there is any reason to suspect that dirt or other foreign matter
+has come in contact with a sore or cut, the wound may be freely washed
+with a solution of listerine in order to clean it and render it as
+nearly aseptic as possible. When there are distinct signs of
+inflammation it should not be relied upon. Do not use it internally
+without a physician's advice.
+
+=Scott's Emulsion.=--This is a good emulsion of cod-liver oil, widely
+prescribed by physicians for the many patients who are too
+delicate-stomached to retain the pure oil. For those who can take the
+refined oil straight, Peter Moeller's brand is in a class by itself.
+
+In certain conditions cod-liver oil is one of the most valuable
+remedies known. As a concentrated and reconstructive food in many
+wasting diseases it is of great service. Weak and puny children, and
+all suffering from malnutrition may take it with benefit. It does help
+produce flesh, increase strength, and add to the body's resisting
+powers. It does not contain any medicinal properties, and its virtue
+is largely in its fat or oil, but as an aid to other remedies, or
+alone, when increased nutrition is desired, it is a reliable and
+helpful remedy.
+
+=Antiphlogistine.=--There are many clay poultices on the market:
+antiphlogistine, antithermoline, cretamethyl, sedol, unguentum,
+yorkelin, and the Emplastrum Kaolini of the U. S. Pharmacopoeia.
+Antiphlogistine, being probably the most widely known, is here
+discussed. It is of value when a poultice is indicated. It is
+preferable to the homemade varieties in that it retains heat for a
+longer period of time and is antiseptic.
+
+It should never be used in deep-seated inflammations, such as
+peritonitis, appendicitis, deep abscesses of any part of the body, or
+other serious conditions, unless recommended by a physician; for such
+ailments need more thorough treatment than can be afforded by any
+poultice. It is perfectly harmless, and may be used with decided
+benefit in aborting or preventing many inflammatory diseases. Applied
+in the early stages of a boil, felon, or carbuncle it may either
+abort the trouble or, if the disease has already progressed too far,
+it will hasten suppuration and shorten the course of the disease. When
+a poultice is indicated in bronchitis or pleurisy it is an excellent
+one to use; it will afford much comfort, and often hasten recovery. In
+nursing mothers, when the breasts become full and tender and signs of
+beginning inflammation are present, antiphlogistine spread in a warm
+and thick coat over the breasts will often afford relief.
+
+=Platt's Chlorides.=--When it is desirable to use a liquid
+disinfectant Platt's Chlorides will be found a useful article, as will
+lysol and other marketed products. The source of a foul smell or
+dangerous infection should never be overlooked. No disinfectant can
+offer a safeguard if plumbing is defective, or other unsanitary
+conditions exist; in fact, disinfectants are often deprecated, since
+they afford a false sense of security. If a contagious disease exists
+in a household, other means than the use of a disinfectant must be
+taken in order to prevent the spread of the contagion. Disinfectants
+do have their uses, however, and are often essential. In case of an
+illness of a contagious or infectious nature, a solution of Platt's
+Chlorides or a similar disinfectant should be kept in all vessels
+containing or receiving discharges from the body. Pails containing
+such a solution should be in readiness to receive all cloths, bedding,
+or washable clothes which have come, in any way, in contact with the
+patient.
+
+
+FOOTNOTES:
+
+[11] The publishers announce this chapter as prepared independent of
+Dr. Winslow or any of the Advising Editors. Considered as an effort to
+give helpful information, free of advertising on the one hand and
+sensational exposures on the other, the article meets with the
+approval of conservative physicians. But the problems dealt with are
+too involved at present for discussion direct from the profession to
+the public.
+
+[12] Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.
+
+[13] Ibid.
+
+[14] S. H. Adams, "The Great American Fraud."
+
+[15] Ibid.
+
+[16] S. H. Adams, "The Great American Fraud."
+
+[17] S. H. Adams, "The Great American Fraud."
+
+
+
+
++--------------------------------------------------------------------+
+| TRANSCRIBER'S NOTE.                                                |
+| ===================                                                |
+|                                                                    |
+| The prescription symbol has been transcribed as [Rx].              |
+|                                                                    |
++--------------------------------------------------------------------+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Home Medical Library, Volume II
+(of VI), by Various
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