' Century Book of Health THE MAINTENANCE OF HEALTH PREVENTION AND CURE OF DIS- EASE ■ MOTHERHOOD ■ CARE FEEDING AND DISEASES OF CHILDREN • MODERN HOME NURSING • ACCIDENTS AND EMER- GENCIES-INJURIOUS HABITS A COMPLETE PRACTICAL GUIDE BASED UPON THE LATEST MEDICAL PRACTICE RECENT DISCOVERIES IN SCIENCE AND U. S. PHARMACOPOEIA REVISION OF 1905 J. H. McCORMICK, M.D., Editor-in-Chief Member: American Therapeutical Society, Medical Society of the District of Columbia, Medical Association of the District of Columbia, Medical and Surgical Society, Wash- ington, D. C, Anthropological Society, Biological Society Maryland Public Health Association The King-Richardson Company SPRINGFIELD, MASS. BUFFALO, N. Y. CHICAGO, ILL. .Hi*s COPYRIGHT BY THE KING-RICHARDSON COMPANY 1906 COPYRIGHT BY THE KING-RICHARDSON COMPANY 1907 COPYRIGHT BY THE KING-RICHARDSON COMPANY 1908 COPYRIGHT BY THE KING-RICHARDSON COMPANY 1909 COPYRIGHT BY THE KING-RICHARDSON COMPANY 1912 gCU3l24*3 Kin i EDITOR IN CHIEF. john h. Mccormick, m.d. Member : American Therapeutical Society, Medical Society of the District of Columbia Medical Association of the District of Columbia, Medical and Surgical Society Washington, D.C., Anthropological Society, Biological Society Maryland Public Health Association ASSOCIATE EDITORS. i GEORGE R. DEVITT, A.B. Member : Anthropological Society : National Geographical Society Literary and Managing Editor James Freed Wark, D.D.S. Western Reserve University, Superintendent of Dental Clinic " Hygiene and Care of the Teeth' ' G. Frederic Wheeler Mills Training School for Nurses, Expert Nurse and Masseur "Nursing" and "Massage" J. W. Woods, M.D. Medical College of University of New York Sometime Attending Physician Midwifery City of New York, Attending Physician Diseases of Children, Northwestern Hospital " Care, Feeding, and Diseases of Children" J. W. Hofsess, M.D.,D.O. Sometime Dean S.S. Still College of Osteopathy " Principles of Osteopathy" Gordon Lindsay, Ph.G.,B.S.,M.D. Bellevue Medical College, New York Staff of Bellevue and Allied Medical Hospitals " Causation and Prevention of Disease" Emil Buehler, Ph.G. New York College of Pharmacy Dispensing Pharmacist Northwestern Hospital New York City "Materia Medica" and "Useful Medical Knowledge" R. W. Conant, A.B.,M.D. Yale University, Chicago Homcepathic College "Domestic Hygiene" "Alcoholism" "Injurious Habits and Their Effects' "Drug Frauds" etc. R. J. McDonnell, M.D. Rush Medical College " Accidents and Emergencies" A. Goltman, M.D. McGill Medical University L.R.C.P. and L.R.C.S., Edinburgh L.F.P., Glasgow Consulting Oculist, New York City " Hygiene of the Eye and Ear" Charles H. Clemmer, M.A. State Institute Conductor of Teachers' Institutes "Anatomy and Physiology" INTRODUCTION. By JOHN H. McCORMICK, M.D. The study of medicine, not as an accomplishment, but as a subject of the first importance to the individual, should be taken up by every one. The care of our bodies is our first duty to ourselves. " Self-preservation is the first law of Nature." In obedience to that law all should learn from undoubted authorities how to preserve a healthful condition of body, to ward off disease, to care for and to feed the sick, as well as to render aid to the injured in emergencies. The need of this study is all the more emphasized by the statement upon the highest medical author- ity that nearly all of our ailments are produced and propagated by either our own ignorance or our own carelessness. At no period of the world's history have the people been so well quali- fied to take up the study of health as they are now. Physiology and other science subjects, taken up of late years in the schools of the country, have given a solid foundation upon which a sound knowledge of the human body and its needs may rest. This fact and the wonderful advances in medical science require that the subject be approached in a very different way from that which satisfied our immediate ancestors. Ten years have made a wonderful change in our knowledge of health and disease. Treatises that were excellent in their day now fail to meet the new conditions in so many respects that new and revised editions no longer satisfy. The study of medicine is not limited, as so many think, to the heal- ing of the sick. It is a many-sided science; in fact, it levies tribute upon all sciences, and, like the honeybee, takes what it needs from all of the flowers in the garden of knowledge. One of its most important aspects is the prevention of disease, which every one can practise to his own and his family's great welfare. This means much more than to io INTRODUCTION. merely abide by the laws and regulations of boards of health and city ordinances. A parent who can train the sons and daughters of the family to right habits of life and the practice of daily personal hygiene, confers upon them the inestimable blessing of a magnificent start in life. When by these means the predisposing causes of disease are removed, or at least modified, the children are passed safely through the numerous evils incident to childhood and youth. The mother who performs the highest act of life — the conferring of life itself upon her child — needs much more than mere maternal instinct to guide her in the rearing of her child. However much we may be tempted to admire that unerring quality in the lower animals, we know that safe rules and guides are necessary to secure to a child its first right of being well born and, second, of being properly developed. Mothers cannot "know too much. They go forward into an undis- covered country, and may at any moment meet with strange conditions of health and disease with which they are compelled to deal, and the most loving and conscientious mother must pay the same penalty for her ignorance that others pay for willful neglect. In seasons of epidemic or of ordinary exposure to contagious disease, every one should know the proper preventive measures to be taken to ward off an attack. Sitting in quiet ignorance on such occasions is more than an error ; it is a crime. For not only is the individual himself likely to suffer, but he is a means of passing the disease along and of commu- nicating it to others. Only those whose knowledge of nursing and of cooking for the sick qualifies them to minister to the comfort of their loved ones when they are ill, know the joy of efficient personal attention and the flood of sympathetic care which often works magic in the cure of a disease. What a sense of disappointment and loss of self-confidence is felt when on such occasions we realize our ignorance of the right thing to be "These hard, well-meaning hands we thrust Among the heartstrings of a friend." And yet how comparatively easy this knowledge is of acquisition and INTRODUCTION. II what a power for good it makes of its possessor. How we are forced to admire the calm, direct effort of the one who knows just what to do in emergencies and accidents; while the ignorance of helpful measures causes panic and helpless confusion in others. "Knowledge is power" undoubtedly on such occasions, and very often it has been the power of saving life when out of reach of a doctor's aid. Why do not people generally know as much about these things as they do about some others? Why do they not know more about medi- cine than they do? Ignorance of the subject not only exposes them to the ravages of disease; and deprives them of the joy of caring for their loved ones when ill ; but, worst of all, it exposes them to the cruelty and robbery of the quack and charlatan, because they have not the power of knowing the impostor and incompetent from the trustworthy and skilled. The medical fraternity are not to be expected to teach people this knowledge. Theirs is a profession and one of hard work. They have not the time to give such instruction to their patrons, and it is not to be expected from them. It must be derived from other sources. The labor attached to the gathering together of matter from so many sources; of subjecting it to modern criticism; of arranging to the best advantage what would prove most helpful, — has been a task of no slight magnitude. That, however, has been forgotten when it is remembered that we have the honor of presenting a work that is at once reliable in its recommendations, trustworthy in its advice, and clear and plain in its instructions and explanations. There are many new features incorporated in this work which we feel are of especial value. Not the least of these is the Materia Medica, where the drugs and medicines alluded to in the body of the work are explained as to their origin, effects, and doses. It has been insisted upon on the ground that the reader of this book is an intelligent person, and should know exactly what is being done when medicine is given. The copious topical index, and the emergency index for consulta- tion in accidents and sudden illness, have been prepared with especial regard for quick reference. We have no apology to make for the explanation of the treatment 12 INTRODUCTION. of disease by the homeopathic methods, nor by the methods of the older school. Nor have we any to make to either of these schools for the explanation of the principles of osteopathy and other special systems. Our aim has been to give to the reader an intelligent idea of what all are doing, with a view to the treatment of disease and the alleviation of the sufferings of mankind. The work is mainly educative. For both general reading and study, the subjects of the book have been arranged in the order in which each should be taken up. The study proceeds from the known to the unknown in the order in which it will prove most helpful to those who take it up. There are some chapters which are to be carefully studied in detail for the information which will be of service in emergency and illness. The work is not alone for consultation in times of distress and danger. It is for reading and study by all of the members of the family in health that they may wisely avoid the errors of daily life; and in cases of illness, that each may contribute something, according to his ability, to relieve the suffering. TABLE OF CONTENTS Page Introduction 20 BOOK I. THE MAINTENANCE OF GOOD HEALTH. Personal Hygiene 25 Hygiene and General Care of the Digestive Apparatus, 26 — Food, 26 — Selection of Food, 27 — Rapid Eating, 27 — Irregular Meals, 27 — Moderation in Eating, 28 — Overeating, 28 — Deficiency of Food, 29 — Classification of Food, 29 — Nitrogenous Food, 29 — Fats, 30 — Carbonaceous Foods, 30 — Min- eral Matter, 30 — General Principles of Diet, 30 — Milk an Ideal Food for Children, 31— Need of Well Balanced Diet, 31— Value of Foods, 32— Table of Food Values, 32 — Digestibility of Food, 32 — Table of Digestibility of Food, 33 — Arranging a Diet, 34 — Diet Governed by Climate, 34 — Diet Gov- erned by Age, 35 — Diet Governed by Occupation, 35 — Change of Conditions, 35 — Pure Food, 36 — How to Detect Impure Food, 36 — Unripe Fruit, 40 — Constitution and Temperament, 40 — Good Cooking, 41 — Abstinence, 41 — ■ Concentrated Foods, 41 — Daily Ration in Health, 42 — The Water We Drink and Its Effects, 42 — Impurities of Drinking Water, 43 — Effects of Impurities in Water, 44 — Tests for Drinking Water, 44 — To Purify Water, 45 — Mastication and Insalivation, 46 — Care of the Teeth, 47 — Struc- ture of Teeth, 48 — Causes of Decay, 49 — Cleaning the Teeth, 49 — Dead Teeth, 50^ Filling Teeth, 50. Care of the Skin, Complexion, Hair, and Nails 50 The Skin and Its Functions, 50— Baths and Bathing, 51— Cold Bath, 51— Warm Bath, 52— Sea Bathing, 52— Turkish Bath, 53— Hot Bath, 53— Shower Bath, 53 — How to Make a Homemade Shower Bath, 53 — Bath Thermometer, 54 — Russian Bath, 55 — Sponge Bath, 55 — Bath Room Accessories, 55 — Soap, 56 — Face Cloths, 56 — Flesh Brush, 56 — Face Brush, 56. The Complexion, 56 — Cream for Pimples, 57 — Summer Rash, 57 — Freckles, 57 — Permanent Freckles, 58 — Chapping, 58 — Tan and Sunburn, 59 — Black- heads, 59— Wrinkles, 60— Warts, 61. Clothing, 61 — Tight Neckwear, 64 — Hardening Children, 64 — Too Much Cloth- ing, 65 — Exercise and Food, 65 — Tight Waist Clothing, 65. Care of the Hair, 65 — Color of the Hair, 66 — Cleanliness, 66 — Dandruff, 67 — Ventilation of the Hair, 68 — Friction and Massage of the Scalp, 69 — Itching of the Scalp, 70— Falling Hair, 70— Gray Hair, 72— Bleaching the Hair, 73— Superfluous Hair, 73. 14 TABLE OF CONTENTS. Care of the Nails, 74 — Manicuring, 75 — Rose Paste for the Nails, 77 — Powder for Polishing the Nails, 77. Hygiene and General Care of the Organs of Respiration and of the Voice 77 Protection Against Cold, 77 — Vocal Cords, 78 — Nose Breathing, 79 — Dan- gerous Occupations, 79 — Cold Water Application, 79 — Bad Sitting Position, 80 — Bad Sleeping Position, 81 — Correct Standing Position, 81 — Flat Chests and Round Shoulders, 82 — Exercises to Correct and Prevent Deformities, 82 — Importance of Fresh Air and Ventilation, 85 — Diseases Caused by Impurities in the Air, 86 — Effects of Some Impurities in the Air, 86 — Amount of Fresh Air Required, 86 — Testing the Purity of the Air, 87 — Effects of Breathing Bad Air, 87— How to Ventilate, 88— How to Breathe Properly, 89. Care of the Nose 91 Cleanliness, 91 — Cold in the Head, 92 — Mouth Breathing, 92 — Polypus of the Nose, 92 — Hairs of the Nose, 93 — Blowing the Nose, 93 — Atomizers and Douches, 93 — Foreign Substances in the Nose, 93. Care of the Ear 94 Cold in the Ear, 94 — Wax of the Ear, 94 — Hardened Wax in the Ear, 95— Noises in the Ear, 95 — Deafness in Children, 95 — Boxing a Child's Ear, 96 — Foreign Bodies in the Ear, 96 — Tests of Hearing, 96 — Helps to Hear- ing, 98. Care of the Eyes 99 Children's Eyes, 99— Need of an Oculist, 99— Defects of Vision, 99— Test- ing the Eyesight, 101 — Protection of the Eyes, 102 — Poor Light, 103 — Strong Light in the Eyes, 103 — Care During Convalescence, 103 — Fine Print, 104 — Reading on Trains, 104 — Fine Work, 104 — Floating Specks, 104 — Need of Resting the Eyes, 105 — Bathing the Eyes, 105— Foreign Substances in the Eyes, 105. Care of the Bones 106 Curvature of the Spine, 107 — Bones of the Feet, 107 — Cracking the Knuckles, 107— The Bones During Old Age, 108— Ligaments, . 108— Diseases and Injuries of the Bones, 108. Care of the Muscles 109 Exercise, 109— Special Value of Exercise, 110— Quantity of Exercise, 113 — Form of Exercise, 113— Walking, 114 — Running, 116— Physical Exercise for Young Persons, 116 — Bicycling, 121. The Nervous System I 2 * Sleep, 121 — Neurasthenia or Nervous Prostration, 122 — Overwork, 123— Anger and Passion, 124 — A Stock of Energy, 125. TABLE OF CONTENTS. 15 Domestic Hygiene and Healthful Homes 126 Location, 126 — The Suburbs, 126 — Flats versus Houses, 127 — Skin Flats, 127— The Best Way, 127— The Country House, 128— Soil, 129— The Cellar Walls, 129— The House Walls, 130— The Roof, 130— Water Near the House, 130— Sewage, 130— Dry Earth Closet, 131— The Rubbish Pile, 131 — Water Supply, 132 — The Grounds, 132 — The Interior, 133 — Stairways and Halls, 133— The Roof Garden, 133— Every Room Bright, 134— Hard Oiled Floors, 13-1 — House Cleaning, 134 — Prevention of Dust, 134 — The Playhouse, 135 — The Kitchen, 135 — Cleanliness, 135 — The Bath Room, 136 — Ventila- tion, 136 — Impurities of Air, 137 — Tests of Air, 137 — Ventilation Problems, 137 — Carbon Monoxide, 138 — Moisture, 138 — Heating, 138 — Furnaces, 138 — Early Fires, 139 — Fireplaces and Grates, 139 — Regulation of Temperature, 140 — Automatic Regulation, 140 — Lighting, 141 — Gas, 141 — Incandescent Gas Light, 142 — Acetylene Light, 142 — Gasoline Generators, 142 — Position of Lights, 143 — Acclimitization, 144 — Diseases Due to Climate, 144. BOOK II. THE CAUSATION AND PREVENTION OF DISEASE. Causation of Disease in General 145 Predisposing Causes to Disease, 146 — Age, 146 — Sex, 147 — Heredity, 147 — Hygienic Conditions, 148. Exciting Causes of Disease, 148 — Mechanical Causes, 148 — Physical Exciting Causes, 149 — Chemical Exciting Causes, 149 — Vital Exciting Causes, 149. Contagion, 149 — Nature of the Contagia, 150 — Bacteria, 150 — Mode of Entrance into the Body, 151 — Action within the Body, 151 — Exit from the Body, 152 — Existence Outside of the Body, 152 — Modes of Transmission, 152. General Rules for the Prevention of Infectious Diseases 15.2 Special Preventive Measures Against Infectious Diseases, 15-! — Smallpox, 154 — Chicken Pox, 15-1 — Measles, 154 — German Measles, 15-1 — Scarlet Fever, 15-4 — Typhus Fever, 155 — Influenza or Epidemic Catarrh, 155 — Whooping Cough, 155 — Mumps, 155 — Diphtheria, 155 — Typhoid Fever, 155 — Yellow Fever, 156 — Cholera, 156 — Dysentery, 156 — Malarial Fevers, 156 — Erysip- elas, 157 — Septicaemia or Blood Poisoning, 157 — Tetanus or Lockjaw, 157 — Hydrophobia or Rabies, 157. Disinfection, 158 — Fresh Air, 158 — Heat, 158 — Sterilization and Pasteurization of Milk, 159. Chemical Disinfectants, 160 — Corrosive Sublimate, 160 — Carbolic Acid, 161 — Formalin, 161 — Formaldehyde, 161 — Chlorine, 162 — Sulphurous Acid, 162— Quicklime, 162 — Permanganate of Potash, 162. i6 TABLE OF CONTENTS. Practical Disinfection, 163 — Discharges from the Mouth and Nose, 163 — Dis- charges through the Skin, 163. Disinfection of Clothing and Bedding 164 Disinfection of Rooms and Furniture 164 Modern Methods of Preventing and Curing Consumption 165 Ravages of Consumption, 166 — What Consumption is Now Known to Be, 166 — How Consumption is Spread, 167 — Persons Most Likely to be Attacked, 169 — How Consumption May Be Prevented, 171 — How Consumption Begins : Early Symptoms, 173 — Modern Methods of Curing Consumption, 178 — Diet, 181— Exercise, 182— How to Live Out of Doors, 183— Shelter, 183— Cloth- ing, 184 — Sleeping Out of Doors, 186. Detection and Recognition of Disease 187 Prodromal Symptoms or Warnings of Disease, 189 — General Appearance, 189 — The Face, 190 — The Tongue, 191 — The Gums and Lips, 191 — The Eye, 192— The Pulse, 192— Diseases of the Heart, 193— Breathing, 194— Coughs, 195— Expectoration, 196— The Skin, 197— The Stomach, 198— Vomit, 198— The Bowels, 198 — The Faeces, 199 — The Urine, 200 — Congestion of the Kidney, 201— Dropsy, 202— Fluctuation, 202— Seat of Pain, 202— Some Common Diseases and Their Symptoms, 203 — Fevers, 203 — Typhoid, 203 — Pneumonia, 204— Measles, 204— Scarlet Fever, 204— Tonsilitis, 205— Diph- theria, 205 — Jaundice, 205 — Appendicitis, 205. List of Symptoms Arranged for Ready Reference 206 Table of Symptoms of Eruptive Fevers 223 BOOK III. MODERN NURSING AND CARE OF THE SICK. Home Nursing 225 How to Prepare the Bed, 226 — How to Pin the Sheet, 226 — How to Change the Sheet with the Patient in Bed, 227 — Bedsores, Prevention and Manage- ment, 228— How to Turn a Patient in Bed, 229— Packs, Hot and Cold, 230— Brand's Bath for Typhoid Fever, 231 — Bandages, 232 — Stupes, 234 — Ene- mata, 234 — Hypodermic Injections, 236 — Counter-Irritation, 236 — Blisters, 237— Cupping, 238 — Leeches, 238 — Cataplasms or Poultices, 239 — Swabs and Mouth Washing, 241 — Ice Bag, 241 — Embrocations or Liniments, 241 — Endermic Medication, 242 — Nasal Douche or Spray, 242 — Necessary Uten- sils, 243— The Chart and How to Keep It, 244— Clinical Thermometer, 248— The Pulse, 248— The Respiration, 249— Medication, 249— The Urine, 251— Faeces, 251 — Baths, 251 — Cleanliness, 254 — Applications of Heat and Cold, 256 — Fever Nursing, 257 — Surgical Nursing, 260 — Care of Children, 261 — Visitors, Flowers, etc., 262 — What Not to Do in the Sick Room, 263— Convalescence, 265, TABLE OF CONTENTS. 17 Massage 266 Introduction, 266 — Its Uses and Benefits, 267 — When to Give Massage, 267 — Importance of a System, 269 — How to Give Massage, 270 — Massage for Sprains and Bruises, 272 — Beauty Massage, 272 — To Massage the Face, 274 — How to Develop the Neck and Chest, 276 — To Make the Hands and Arms Beautiful, 277. Food for the Sick : How to Prepare and Serve It 277 Dietetics, 277 — Service of Food to the Sick, 279 — Time of Feeding, 280 — Assistance to a Patient While Eating, 280 — Fever Diet, 281 — Dyspepsia Diet, 281 — Constipation Diet, 282 — Diarrhoea, 282 — Liver Troubles, 283 — ■ Diabetes, 283— Bright's Disease, 284— Debility, 284— Obesity, 285— Rheu- matism, 286 — Gout, 286 — Consumption, 287. Dishes for the Sick 287 Peptonized Foods, 287 — Soups, 293 — Farinaceous Foods, 295 — Eggs, 299 — Desserts, 301. BOOK IV. DISEASES OF ADULTS. Local Diseases of Adults 303 Diseases of the Head, 303 — Dandruff or Seborrhcea, 303 — Baldness or Alo- pecia, 304 — Partial Baldness or Alopecia Areata, 306 — Neuralgic Headache or Tic Douloureux, 306 — Migraine or Sick Headache, Bilious Headache, or Blind Headache, 307 — Rheumatic Headache, 308 — Congestive Headache, 309 — Periodic Headache, Brow Ache or Brow Ague, 309 — Organic Head- ache, 310 — Headache of Neurasthenia or of Nervous Debility, 310 — Head- ache of Eye-Strain, 310 — Anaemic Headache, 310 — -Headache Due to Diseases of the Kidney, 310 — Ringworm of the Scalp or Tinea Tonsurans, 311 — Barber's Itch or Ringworm of the Beard, 312. Diseases of the Eyes, 313 — Granular Lids or Trachoma, 313 — Stye or Horde- olum, 314 — Watery Eye, 315 — Blear Eye, 315 — Weakness of the Eyes, 316 — Inflammation of the Eyes or Conjunctivitis, 316 — Gonorrhceal Inflammation of the Eye, 317 — Aborted Stye or Chalazion, 317 — Inflammation of the Edge of the Eyelids or Blepharitis, 318 — Cataracts, 318 — Eye Bruises or Black Eye, 319 — Protrusion of the Eyeball or Exophthalmos, 320 — Sinking of the Eyeball, 320 — Squint or Strabismus, 320. Diseases of the Ear, 322 — Earache or Otalgia, 322 — Inflammation of the Ear or Otitis, 323 — Eczema of the Ear or Tetter, 324 — Wax in the Ear, 325— Foreign Bodies in the Ear, 325 — Polypus of the Ear, 326 — Noises in the Ear, 327. Diseases of the Nose, 327 — Cold in the Head or Coryza, 327 — Chronic Nasal Catarrh, 328 — Inflamed and Ulcerated Nose, 329 — Nosebleed or Epistaxis, 330 — Polypus of the Nose, 331 — Foreign Substances in the Nose, 331 — Cold Sore, Fever Sore or Herpes, 332. i8 TABLE OF CONTENTS. Diseases of the Mouth, 332 — Chapped or Cracked Lips, 332 — Salivation or Mercurial Stomatitis, 333 — Gumboil, 333 — Stammering, 333 — Sore Tongue, 33-1 — Inflammation of the Tongue or Glossitis, 334. Diseases of the Throat, 335 — Sore Throat or Acute Pharyngitis, 335 — Clergy- man's Sore Throat or Chronic Pharyngitis, 335 — Inflammation of the Tonsils or Tonsilitis, 336 — Quinsy or Peritonsilar Abscess, 338 — Hoarseness or Laryngitis, 338 — Enlargement or Swelling of the Uvula, 339 — Dropsical Inflammation of the Larynx or Oedematous Laryngitis, 340. Diseases of the Lungs, 340 — Cold in the Chest or Acute Catarrhal Bronchitis, 340 — Chronic Bronchitis, 342 — Pleurisy or Pleuritis, 343 — Dropsy of the Pleura or Hydrothorax, 344 — Asthma, 345 — Hay Asthma or Hay Fever or The Rose, 347 — Bleeding from the Lungs or Hemoptysis, 348 — Lobar Pneu- monia or Lung Fever or Winter Fever, 349 — Consumption, 351. Diseases of the Heart, 355 — Dilatation of the Heart, 355 — Inflammation of the Pericardium or Pericarditis, 355 — Palpitation of the Heart, 357 — Irregular Pulse or Arhythmia, 357 — Rapid Heart or Tachycardia, 358 — Slow Heart or Brachycardia, 359 — Neuralgia of the Heart or Angina Pectoris, 359 — Enlargement of the Ventricles of the Heart, 360 — Shrinking or Atrophy of the Heart, 361 — Fainting or Syncope, 361. Diseases of the Stomach, 362 — Inflammation of the Stomach or Acute Gas- tritis, 362 — Milk Sickness, 363 — Water Brash, 363 — Nausea and Vomiting, 36-1 — Cramp or Spasm of the Stomach or Gastralgia, 365 — Dyspepsia or Indigestion, 365 — Gastric Ulcer or Ulcer of the Stomach, 368 — Gastric Can- cer or Cancer of the Stomach, 369. Diseases of the Bowels, 370 — Constipation, 370 — Intestinal Indigestion, 371 — Diarrhoea, 372 — Dysentery, 375 — Cholera Morbus, 376 — Colic, 378 — Painter's Colic, 378 — Wind Colic, 379 — Bilious Colic, 379 — Piles or Hemorrhoids, 381 — Falling of the Bowel, 382 — Inflammation of the Peritoneum or Peri- tonitis, 382 — Fistula, 383 — Obstruction of the Bowel, 383 — Appendicitis or Inflammation of the Appendix, 384. Diseases of the Liver and Spleen, 385 — Jaundice or Icterus, 385 — Gallstones, 386 — Congestion of the Liver, 387 — Gin-Drinker's Liver, 388 — Cancer of the Liver, 388 — Inflammation of the Spleen, 389. Diseases of the Kidneys, 389 — Diabetes Insipidus or Excessive Flow of Urine, 389 — Diabetes Mellitus or Sugar Diabetes, 390 — Congestion of the Kidneys or Renal Congestion, 391 — Acute Bright's Disease, 391 — Chronic Bright's Disease, 392 — Uraemia, 393 — Suppression of L'rine, 394 — Incontinency of Urine, 395 — Gravel or Renal Calculi, 396 — Inflammation of the Bladder or Cystitis, 398. Infectious Diseases of Adults 400 Dengue or Breakbone Fever, 400 — Erysipelas, 401 — Hydrophobia or Rabies. 402 — Influenza or La Grippe, 404 — Lockjaw or Tetanus, 405 — Malaria or TABLE OF CONTENTS. 19 Intermittent or Remittent Fever, 406 — Glanders or Farcy, 408 — Smallpox or Variola, 408 — Typhoid or Enteric Fever, 410 — Typhus Fever, 413 — Asiatic Cholera, 415. General Diseases of Adults 417 Aneurism, 417 — Apoplexy, Cerebral Hemorrhage, Embolism or Thrombosis, 417 — Epilepsy, 420 — Concussion or Inflammation of the Brain, 423 — Inflam- mation of the Outer Covering of the Brain or Pachymeningitis, 42-1 — Acute Meningitis, Cerebral or Brain Fever, 425 — Nervous Prostration or Neurasthenia, 426 — Locomotor Ataxia, 427 — Palsy or Paralysis, 428 — Anchylosis, 432 — Rheumatic Fever or Acute Articular Rheumatism, 432 — Muscular Rheumatism, 435 — Neuralgia, 436 — Anaemia, 439 — Cerebral Anae- mia, 440 — Congestion of the Brain, 441 — Dizziness or Vertigo, 443 — Abscess, 444 — Abscess in the Ear, 445 — Ulcers, 445 — Corns, 446 — Ingrowing Nails, 447— Chilblains, 448 — Rashes, 450— Rose Rash, 450— Hives or Nettle Rash, 450 — Disorders of the Sweat Glands, 452 — Disorders of the Oil Glands, 452 — Prickly Heat or Lichen, 453 — Irritation, Itching or Prurigo, 453 — Eczema, Herpes or Tetter, 455 — Moist Eczema, 455 — Milk Crust Eczema, 456 — Ringworms, 456 — Carbuncle or Anthrax Benigna, 457 — Boil or Furun- culus, 458 — Excessive Perspiration or Hyperidrosis, 459 — Lice, 460. BOOK V. WOMANHOOD AND MOTHERHOOD. Menstruation, 461 — Delayed or Obstructed Menstruation or Amenorrhcea, 463— Suppressed Menstruation or Amenorrhcea, 46-1 — Painful Menstruation or Dysmenorrhcea, 466 — Profuse Menstruation, 466 — Falling of the Womb, 468 — Cancer of the Womb, 468 — Inflammation of the Ovaries or Ovaritis, 470 — Inflammation of the Womb, 470 — Whites or Leucorrhcea, 470 — Pruritis Vulvae, 471. Motherhood 472 Pregnancy, 472 — Obstetrical Table, 473 — Signs of Pregnancy, 47-1 — Conduct During Pregnancy, 475 — Diet During Pregnancy, 475 — Dress and Exercise, 476 — Moral Influences, 476 — The Breasts, 476 — Care of the Teeth During Pregnancy, 477. Diseases of Pregnancy, 481 — Morning Sickness, 481 — Constipation, 481 — Heart- burn, 482 — Incontinence of Urine, 482 — Coughs and Shortness of Breath, 482 — Pruritis Vulvae or Itching, 483 — Insomnia or Sleeplessness, 483 — Melancholy or Despondency, 483 — Varicose Veins, 484 — Hemorrhoids or Piles, 48-1 — False Pregnancy, 484 — Abortion or Miscarriage, 485 — Prema- ture Birth, 487 — Confinement or Parturition, 487 — Preparation of Bed and Patient, 488 — The Breast, 490— Inflammation of the Breast, 490— Sore 20 TABLE OF CONTEXTS. Nipples, 491 — ^lilk Fever, 491— The Lochia, 492— Afterpains, 492— Con- stipation After Deliver}-, 492 — Retention of Urine, 493 — Diet after Labor, 493 — Puerperal Mania or Nervousness, 493 — Childbed Fever or Septicaemia, 494. BOOK VI. CARE, FEEDING, AND DISEASES OF CHILDREN. Care of the Newborn Child, 495— First Suckling of the Child, 496— The Meconium, 496 — Urine, 496. Diseases of Newborn Children 496 Apparent Death or Asphyxia, 496 — Jaundice of Newborn Infants, 498 — Inflammation of the Breasts of Infants, 499 — Erysipelas of Newborn Infants, 499 — Lockjaw of the Newborn or Tetanus, 500 — Sore Eyes or Ophthalmia of the Newborn, 500 — Inflammation of the Navel or Omphalitis, 501 — Rupture of the Navel or Umbilical Hernia, 502. Care of Prematurely Born or Delicate Children 503 The Nursery, 50-1 — Sleep, 506 — Airing, 506 — Exercise, 507 — Clothing, 507 — Bathing, 508— Growth and Development, 508 — Weight, 508 — Height, 509— Table of Weight and Height of Children, 510 — Development of the Muscles, 511 — Development of Sight. 511 — Development of Hearing, 511 — Develop- ment of Taste and Smell, 511 — Development of Speech, 511. Feeding of Children 511 Breast Feeding, 511 — Mothers Who Should Not Nurse, 512 — The Wet Nurse, 512 — Mixed Feeding, 512 — Care of the Breasts During Nursing, 513 — Training the Child to Nurse, 513 — Time for Feeding During the First Year, 513 — Weaning, 51-1 — Sterilizing Milk, 515 — Pasteurization of Milk, 516 — Peptonizing Milk, 516 — Condensed Milk, 517 — Infant Foods, 517 — Cow's Milk, 518 — Modification of Cow's Milk, 518 — Why it is Necessary to Modify Milk, 519— How is Cow's Milk Modified? 520— Formulas for Modified Milk, 522 — Formula for the Second Day, 522 — Formula for the Fourth Day, 522 — Formula for the Tenth Day, 522 — Formula for the Fifth Week, 522 — Formula for the Seventh to Ninth Week, 523 — Formula for the Third or Fourth Month, 523 — Formula for the Fifth and Sixth Months, 523 — Formula for the Seventh, Eighth, and Ninth Months, 52-1 — Formula for the Tenth and Eleventh Months, 524. Diet for a Child of One Year, 525— Diet for a Child Fifteen Months Old, 525— Diet for a Child Two Years Old. 526— Diet During the Third Year, 526. Diseases of Children Caused by Improper Feeding, 529 — Rickets, 529 — Simple Wasting or Marasmus, 530 — Scurvy or Scorbutus, 531. Diseases of the Digestive Organs 533 TABLE OF CONTENTS. 21 Malformation of the Mouth, 533 — Harelip, 533 — Cleft Palate, 533 — Tongue- tie, 533. Teeth and Teething, 534 — Thumb Sucking, 536 — Lancing the Gums, 538 — The Toothbrush, 540— Filling a Child's Teeth, 541— Catarrh of the Mouth or Catarrhal Stomatitis, 542 — Canker or Follicular or Aphthous Stomatitis, 543 — Putrid Sore Mouth or Ulcerative Stomatitis, 544 — Soor, Muguet, Sprue, White Mouth, Thrush or Parasitic Stomatitis, 544 — Inflammation of the Tonsils or Tonsilitis, 545 — Quinsy or Peritonsilar Abscess, 547 — Vomit- ing, 548 — Colic, 549 — Cramp in the Stomach or Gastralgia, 550 — Acute Stomach Indigestion, 550 — Diarrhoea, 552 — Summer Complaint or Cholera Infantum, 553 — Croup, 555 — Worms, 557 — Spasm of the Glottis or Child Crowing, 558 — Snuffles or Cold in the Head, 558 — Convulsions, Fits, and Spasms, 559. Infectious Diseases of Children 559 Cerebro-Spinal Fever or Cerebro-Spinal Meningitis, 559 — Whooping Cough or Pertussis, 560 — Mumps or Parotiditis, 562 — Scarlet Fever or Scarlatina, 563 — Measles or Rubeola, 565 — German Measles or Rubella, 56(5 — Diphthe- ria or Putrid Sore Throat, 567 — Chicken Pox or Varicella, 570. BOOK VII. ACCIDENTS AND EMERGENCIES. POISONS AND THEIR ANTIDOTES. Accidents and Emergencies 571 Carrying Injured Persons, 571 — Bandages and Bandaging, 572 — How to Bandage, 575 — Bandaging the Leg, 575 — Bandaging the Arm, 575 — Many- tailed Bandage, 576 — Cross Bandage, 576 — Bandage for a Sprained Ankle, 576 — Bandage for a Sprained Wrist, 577 — Bandage for a Cut Finger, 577 — Bandage for the Eyes, 577 — Bandage for Fractured Ribs, 577 — The T Bandage, 577. Hemorrhage, 580 — Arterial Hemorrhage, 580 — Venous Hemorrhage, 580 — Capillary Hemorrhage, 580 — Primary Hemorrhage, 583 — Secondary Hem- orrhage, 583 — Punctured Wounds, 583 — Contused Wounds, 583 — Lacerated Wounds, 583 — Gunshot Wounds, 583 — Incised Wounds, 584 — Bleeding from the Nose, 585 — Bleeding from the Lungs, 585 — Bleeding from the Stomach, 585 — Bleeding from the Bowels, 585 — Bleeding from the Teeth, 585 — Hem- orrhage through the Vagina, 586. Wounds : Railway and Machinery Accidents 586 Crushed Fingers or Toes, 586 — Crushed Feet or Hands, 586 — Crushed Arms or Legs, 586 — Crushed Chest or Lower Part of Body, 586 — Parts Torn Off, 586 — Bruises or Contusions, 586 — Contused Wounds, 587 — Cuts or Incised Wounds, 587 — Torn or Lacerated Wounds, 587 — Punctured Wounds, 587— Healing of Wounds, 589. 22 TABLE OF CONTENTS. Fractures, 589 — Fracture of Leg, 590 — Fracture of Arm, 590— Fracture of Skull, 591 — Fracture of Jaw, 591 — Fracture of Spine, 591 — Fracture of Ribs, 591 — Fracture of Collar Bone, 591 — Fracture of Finger, 592 — Fracture of Kneecap, 592. Sprains, 592 — Sprained Wrist, 592 — Sprained Ankle, 592 — Dislocation of the Elbow, 593 — Dislocation of the Lower Jaw, 593 — Dislocation of the Shoul- der, 594 — Dislocation of the Fingers, 594 — Dislocation of the Thumb, 594. Domestic Emergencies 595 Infantile Spasms, 595 — Colic, 595 — Diarrhoea, 596 — Dysentery, 596 — Croup, 59(5 — Whooping Cough, 596 — Toothache, 596 — Earache, 596 — Neuralgia, 596 — Vomiting, 596 — Cholera Morbus, 596 — Pneumonia, 596 — Fever, 59(5 — Asthma, 59(5 — Burns and Scalds, 597 — Clothes Catching Fire, 597 — Burns with Acids, 598 — Burns with Lye and Alkalies, 598 — Bites and Stings of Insects, 598 — Snake Bites, 599 — Hydrophobia, 601 — Scratches or Bites of Cat, Bite of Rat, 601— Sunstroke, 601— Lightning Stroke, 602— Frostbite, 602— Vertigo, 603— Injuries of the Head, 604. Apparent Death from Drowning, Strangulation or Suffocation, 606 — Artificial Respiration, 607— Sylvester's Method, 607— Method When the Arm is Broken or Injured, 609. Poisons and Their Antidotes 611 Irritant Poisons, 611 — Narcotic Poisons, 611 — Emetics to be Used in Cases of Poisoning, 612 — Heart Stimulants, 612 — Respiratory Stimulants, 612 — Emollients and Demulcents, 612. Poisonous Plants of Wood, Field, and Garden 618 Common Causes of Poisoning by Plants, 619 — Protective Measures, 620 — Fly Amanita, 620 — Death Cup, 621 — American False Hellebore, 622 — Lady's Slippers, 623 — Aconite, 624 — Larkspurs, 624 — Black Cherry, 625 — Kentucky Coffee Tree, 626— Woolly Loco Weed, 626— Rattlebox, 628— Spurges, 628— Poison Ivy, 631 — Poison Oak, 631 — Poison Sumac, 631 — Lily of the Valley, 632 — Corn Cockle, 633 — Red Buckeye, 635 — Water Hemlock, 636 — Poison Hemlock, 637 — Broad-leaf Laurel, 638 — False Jessamine, 639 — Jimson Weed, 640 — Black Nightshade, 641 — Bittersweet, 642 — Spreading Nightshade, 643 — Sneezeweed, 643 — Bloodroot, 644 — Indian Tobacco, 645. BOOK VIII. INJURIOUS HABITS AND THEIR EFFECTS. Alcoholism 646 Proprietary Medicines, 646 — The First Steps, 646 — Who Pays the Drink Bill? 647 — To the Third and Fourth Generations, 647 — Marry a Drinking Man? 648— The Nursery of Crime, 648— Heroic Efforts, 648— The Good Old Times, 648— The Dangers of Alcoholism To-day, 648— The Three- TABLE OF CONTENTS. 23 Headed Monster, 649 — Remedies, 649 — Alcoholism and Its Treatment, 650 — Causes, 650 — Effects of Alcohol, 650 — Symptoms of Acute Alcoholism, 651 — Delirium Tremens, 652 — Cigarettes, 656 — "Coffin Nails," 656 — Secret of Its Power, 656 — No Cigarette Fiend Need Apply, 657 — Birds of a Feather, 658 — Popular Fallacies, 658 — The Real Reason, 658 — Tobacco Smoke, 658 — Guard the Children, 659. Drug Frauds 659 Free Samples, 660 — Soothing Syrup, 661 — Cocaine Frauds, 661 — Morphine and the Drug Habit and Its Treatment, 662. Insanity 663 Modern Scientific View, 663 — Emotional Insanity, 664 — Duty of Every One, 664 — Who is Insane? 665 — Kinds of Insanity, 665 — The Test Question, 666 — Causes, 666 — The Rush for Wealth, 666 — Rural Insanity, 667 — Solu- tion of a Great Problem, 668 — Treatment of the Insane, 668 — Safeguards of the Insane, 668 — Safeguards of the Sane, 669 — Responsibility of Experts, 669 — Judge and Jury, 670. Suicide 670 Causes, 670— Never Justifiable, 671— Moral, 671— Best Cure, 672— The Ancients, 672 — Punishment, 673 — Statistics of Suicide, 673. BOOK IX. SPECIAL SYSTEMS OF TREATING DISEASE. Homeopathy, 674 — Homeopathy in the United States, 674 — Provings, 675 — Homeopathic Statistics, 675 — Homeopathic Treatment of Disease, 676. Osteopathy 687 How Malpositions Cause Disease, 687 — Other Lesions than Bony Ones, 688 — Practical Therapeutics of Osteopathy, 689 — A Proper Examination, 689 — How to Remove Conditions Found, 690 — General Manipulative Meas- ures, 691 — The Nerves of the Body, 691 — The Blood Supply, 692 — Specific Manipulation, 692 — Corrective Treatment, 692 — Diseases of Women, 693 — Fevers, 694. Radiotherapy 695 X-Rays in Medicine and Surgery, 695 — Risk to Patients in X-Ray Exami- nation, 695 — The Fluoroscope, 696 — Foreign Bodies in the (Esophagus, 697 — Foreign Bodies in the Eyeball, 700 — Examination of the Brain, 700 — X-Rays in Dentistry, 700 — Detection of Incipient Consumption, 701 — Detection of Aneurism, 701 — Detection of Stone in the Kidney, Renal Calculi, 701 — Stone in the Bladder, 701 — Examination of Fractures, 701 — Location of Foreign Bodies, 702 — Measurement and Examination of the Pelvis, 703 — Curvature of the Spine, 703. 24 TABLE OF CONTENTS. Orthopaedic Surgery 1 703 Antitoxin in Diphtheria and the Use of Other Serum 703 Vaccination, 705 — Mode of Vaccination, 705. Hydrotherapy 706 Electrotherapy 709 Multiple Neuritis, 709 — Facial Paralysis, 709 — Paralysis Agitans or Shaking Palsy, 710 — Hysteria, 710 — Neurasthenia or Nervous Prostration, 710 — Loco- motor Ataxia, 710 — Infantile Spinal Paralysis, 710 — Neuritis, 710. Phototherapy 710 Hypnotism in Surgery 712 BOOK X. ANATOMY AND PHYSIOLOGY. Anatomy and Physiology 715 BOOK XI. MATERIA MEDICA. Materia Medica 775 Description of all drugs recognized by the United States Pharmacopoeia, latest revision. Therapeutical and physiological effects, doses, and prepara- tions of official drugs. BOOK XII. USEFUL MEDICAL KNOWLEDGE. Family Medicine Chest 827 Medical Dictionary » 829 Useful Hints and Information ; 836 INDEXES. Topical Index 841 Emergency Index for Consulting in Accidents and Emergencies 871 BOOK I. THE MAINTENANCE OF HEALTH PERSONAL HYGIENE. We are prodigal and wasteful of good health, and what we learn about the care of our bodies is often the result of bitter experience. There is a true saying that "We do not know the value of health until we have lost it." If it were possible for us to live our lives over, the greatest change and improvement that we would make would probably be in the direction of leading correct and hygienic lives. The word "hygiene" has a vague and somewhat meaningless force to the minds of many, who at best regard it as having something to do with medicine. We have only to remember that the word is derived from a Greek adjective meaning healthy. So highly was this branch of knowl- edge esteemed by the Greeks that they made Hygeia, the daughter of Esculapius, the goddess of health ; and the highest ideal of Greek citizen- ship was the possession of "a sound mind in a sound body." But probably the only successful attempt to connect the laws of health with the people's mode of life was that made by Moses in his wonderful association of hygiene and religion. In his system he minutely set down the laws of personal and tribal life to be carefully followed by his people. These laws impress us as being most intelligently adapted to the mode of living and the social conditions of his day. But the modern world has approached the question from another side, and instead of making the sanitary conditions depend almost wholly upon the efforts of the individual, there have been incorporated systems of sewerage, drainage, and water supply that secure results with less and less individual effort and responsibility. Health is that condition of mind and body in which all of the func- tions of the organs and parts are performed without pain or disease. Dis- ease may be regarded as the result of accident or of willful violation of Nature's laws. Nature knows absolutely no forgiveness. She is the most exacting, relentless, and impartial judge that ever presided over a court and inflicted punishment. Ignorance of the law is no excuse ; and there is no delay in the execution of sentence. We are not always conscious of the punishment and may at times congratulate ourselves that we have 26 THE MAINTENANCE OF HEALTH. escaped the penalty of our hygienic transgressions. But when the day of reckoning comes, as it inevitably does, the folly of this attitude is very manifest. We must regard the observance of laws of right living as being of prime importance to those who are in good health. It is the means of maintaining good health. Hygiene is not a hobby or a fad. The prin- ciples are very simple and should form a large and early part of every child's education. Good health is the greatest heritage with which a person can be endowed. The first responsibility of parents is the enforce- ment of the laws of health, not only by precept but by example. Right living may easily be made a habit, so that any unhealthy conditions soon become a positive discomfort against which one turns instinctively. HYGIENE AND GENERAL CARE OF THE DIGESTIVE APPARATUS. The chief organs included in this group are the mouth, teeth, throat, stomach, and bowels. They need protection against cold and chills, for the diseases which attack them from this cause are very severe and dangerous. This is provided by suitable clothing, which is discussed in another section. The care of the skin has also a very important bearing upon these organs, and that has been taken up under the head of baths and bathing. Both of these points are very essential to the healthy condition of these organs. But the most important features in the hygiene of the very complex digestive system are food and exercise. Food. — An exhaustive consideration of the influence of food upon digestion calls for a discussion of the chemical nature of the several articles upon which man lives; the relative values of these articles as nourishment to the body; the digestibility of all the kinds of food; and the art of cooking. Obviously such a critical and exhaustive treatment of the subject is impossible at this time. But there are many generaliza- tions deduced from the array of facts gleaned by scientists which are of prime importance to assist us in the care of these important parts of our bodies. The evils which arise from disregard of the hygienic principles of food and digestion are largely due to the fact that the process of diges- tion, compared with other processes such as respiration and circulation, is tremendously complex. All complicated machines and systems are RAPID EATING. 27 very easily put out of order with very serious consequences. Derange- ment of the digestive organs with the attendant train of evils is largely the result of a long period of slight but continued habits of abuse; and, as they are usually a long time in developing, they are a correspondingly long time in being removed, either by the correction of bad habits or by medical prescription. Selection of Food. — Except in the case of children, who are too young to make a wise selection of food, little attempt is made to prescribe a diet for healthy persons, who usually follow the dictates of the palate or the teachings of experience. Beyond certain broad principles, no hard and fast rules are possible for personal guidance in the choice of food ; for it has been wisely said that "what is one man's food is another man's poison." One soon learns what foods do not agree with one, and so knows what food to avoid. This is purely a matter of personal expe- rience. But old persons are often heard to say regretfully that as soon as one has learned from his own experience how to live right, it is time to die. Rapid Eating. — One of the greatest indiscretions is rapid eating, — a fault for which Americans, as a nation, are notorious. The evils inci- dent to this injurious habit are numerous and far-reaching. Not suffi- cient saliva is mixed with the food to digest it. The food is not chewed small enough to allow the digestive fluids to act upon it. The food, instead of being well chewed and mixed with saliva so that it may be easily swallowed, is forced down the throat in bulk by drinks which dilute and weaken the gastric juice. The food is forced into the stomach so rapidly and in such quantities that the stomach is overloaded before one knows it. The full taste of the food is not received by the palate, and hot sauces and condiments are used in too large and irritating quantities. So important and beneficial is the habit of slow eating that Fletcherism, so called from the sufferer from dyspepsia who discovered his own method of cure, advocates the chewing of all solids until they assume the consistency of cream, and that every substance, both solid and liquid, except water, be thoroughly chewed, — even tea and coffee passed back- wards and forwards in the mouth until intimately mixed with saliva before swallowing. This practice surpasses even Gladstone's famous advice to bite every mouthful of meat thirty times before swallowing. Irregular Meals. — Allowing too long a time to elapse between meals keeps the stomach idle for a period during which it secretes an oversupply of mucus which interferes with its efficiency. This applies to the habit 28 THE MAINTENANCE OF HEALTH. of eating a very light breakfast or of doing without lunch, and, as a consequence, the indulgence of an abnormal appetite and the overloading of the stomach at the next meal. The work of the stomach must be equalized so that its powers may not be overtaxed at any time. It is equally injurious to follow one meal too quickly by another, which has the same effect as the pernicious habit of eating between meals. When food is taken into the stomach, the blood flows freely to that part where work is to be done. If a person has been engaged in mental work, study or business, the blood has been most abundant in the brain, which was the part most actively engaged. It is therefore well to allow a little interval to elapse between work and a meal, during which time the circu- lation of the blood may become equalized ; and for the same reason to let at least half an hour intervene between a meal and the resumption of work. The habit of eating heartily just before retiring is undoubtedly injurious. For sleep is a period of rest intended to refresh the whole body, not merely for the limbs and brain. The stomach is as much entitled to its period of rest as are the other members of the body. Slight wonder that it rebels when much is demanded of it while the other mem- bers are resting. Still, one must not risk going to bed hungry, for that state brings wakefulness and unrest. Light food, sufficient to appease the hunger, should be taken, but not a heavy meal of such food as is hard to digest. Moderation. — There is no doubt that as a rule we eat too much. The habits of overeating, especially at Thanksgiving and Christmas, have much to do with stomach derangements. It is not alone in the quantity of food that excesses are committed, but in the quality as well. Rich meats and gravies, highly flavored with piquant sauces to tempt jaded appetites; rich pastries, cakes, wines, and puddings; cold drinks, ices, dishes frappe and glace to stop the flow of gastric juice at a time it is most needed ; all of these imperfectly masticated and washed down with quantities of liquid to dilute the digestive fluids must inevitably cause the offender to suffer the penalty which inexorable Nature exacts — dys- pepsia, biliousness, gastritis, malnutrition, constipation, diarrhoea, obesity, and gout. Overeating. — If larger quantities of food are forced upon the stomach than it is capable of caring for, the first point to be noted is that the organs of digestion cannot cause the absorption of it all into the blood. Some of it must remain unacted upon. There is an impor- tant guard or watchman located at the lower end of the stomach, at CLASSIFICATION OF FOOD. 29 the opening into the bowel, whose duty it is to see that no food passes that point until it has been acted upon by the juices in the stomach and has been thoroughly subjected to all of those processes of digestion which it is the duty of the stomach to perform well. This organ of watchful- ness is called the pylorus, from a Greek word meaning a gate. So long as the stomach is not overtaxed this guardian's work is well done. But when more food is taken into the stomach than can be properly cared for by it, or if food that is too difficult of digestion be presented to it, the pylorus seems to realize the futility of its objections, and offers but feeble resistance to the passage of a part of the undigested food into the bowel. The condition of affairs, then, is that a part of the undigested food remains in the stomach and a part of it passes into the intestine along with such food as has been digested. That which remains in the stomach putrefies and ferments. The results from this are disordered stomach, acidity of the stomach, fetid breath, sore throat, flatulency or wind on the stomach, wind "around the heart," a sense of fullness, and all the ills of dyspepsia quickly develop. That portion of the undigested food which passes into the intestine cannot be absorbed into the blood, and it, too, putrefies and ferments. From that follows wind in the intes- tines, accumulation of gases, pain in the bowels, torpor and heaviness, constipation, piles, absorption of faecal matter, and consequent blood- poisoning. And this condition is repeated from time to time by some persons almost daily, for the mere gratification of the palate at the expense of health, — perhaps of life itself. Deficiency of Food. — This term, in its usual significance, denotes that not enough nourishing food is taken into the system. This may be caused by a perverted appetite, which selects the wrong sorts of food, as is very often the case with children; or, even when no perversion of appetite exists, proper care is not taken that a right proportion of a particular sort of food demanded by the body is supplied. There may also be such an impaired condition of the organs of digestion that, even when good food is supplied, it cannot be properly acted upon so as tc afford nutrition. This is a form of dyspepsia which brings about malnutrition. Classification of Food. — In order to build up the several organs and to keep every part of the body in the best possible condition, four kinds or classes of foods are needed : — I. Nitrogenous Food. — Such foods, as the name signifies, are very rich in the gas called nitrogen. This is so important a constituent of 3 o THE MAINTENANCE OF HEALTH. food that only such matter as contains it can produce flesh or repair wasted tissue, and it is, consequently, the basis of all flesh-forming foods. Nitrogenous foods also go by the name of albuminous foods, as the type of the class is the white of an egg, which is nearly pure albumen. They are also called proteids. Other common forms of this class are casein, the chief constituent of cheese; lean meat; and gluten, which gives the tough consistence to dough. 2. Fats. — The fats are, chiefly, of animal origin, and are repre- sented by fat meat, butter, lard, and the several kinds of oils. Their chief use in the nourishment of the body is the storing up of food in the form of fat; and in maintaining the heat of the body. For the latter reason they are regarded as heat-producing foods. j. Carbonaceous Foods. — This group contains the starches and sugars. They are mainly of vegetable origin, and consist of cereals, peas, beans, potatoes, beets, fruits, sugar cane, etc. This class is a heat- producing group of foods, but they also aid in assimilation and in the production of fat. They contain from 40 to 45 per cent of carbon. 4. Mineral Matter. — This group includes water, which is chemically regarded as a mineral, lime, phosphoric acid, potash, soda, chlorine, sulphur, iron, etc. Nearly three pints of water are needed daily by an adult to dissolve the food, to carry it through the circulation, to dissolve out waste matter, to moisten the tissues, and in evaporation from the body. The body of an adult weighing one hundred and fifty pounds contains over one hundred pounds of water, or about twelve gallons. The iron in such food enriches the blood and forms a constituent of the red blood corpuscles. Lime, phosphoric acid, and carbonic acid con- tribute to the strength of the teeth and the bones. Absence of these food elements in a child's diet brings about the enfeebled condition known as rickets. Salt is found in the liquids and secretions of the body, such as the tears, perspiration, etc. General Principles of Diet. — For the proper support of the body, the choice of food or the selection of menus must be based upon these broad principles : — 1. There must be a proteid constituent — a food containing nitro- gen, — because nitrogenous or albuminous foods are needed to build up the essential framework of the body, which is every instant being worn out. 2. There must be salts and mineral matter, for these are present in all of the tissues and fluids of the body. 3. There must be either a fat or some article of carbonaceous food. A WELL BALANCED DIET. 31 Although fat may be obtained from the proteids, such is not the usual source, nor could the requisite amount of fat be derived from the quan- tity of proteids consumed at a meal. As to the choice between fats and carbonaceous foods, it may be said that the carbonaceous foods are more easily digested than are the fats, but that the fats contain much more energy and force in a given quantity than do the carbonaceous foods. These laws are pretty generally observed unconsciously in every meal, for we eat bread and butter, a combination of a starch and a fat; rice and milk ; cheese and macaroni ; and pork and beans. Milk an Ideal Food for Children. — An appreciation of the needs of the body in these directions and a glance at the chemical composition of milk will at once make clear why it has come to be so highly esteemed as an article of food for children, and also why it is in itself a sufficiently nutritious diet during the early years. Milk is composed of : — Water, 87.00 per cent. Albumen, etc., 4.00 per cent. Sugar, 4.25 per cent. Fat, 4.00 per cent. Salts, 75 per cent. 100.00 per cent. It is a nitrogenous food, since it contains albumen; the starch and sugar make it a carbonaceous food; fat is present as cream; and also a percentage of mineral matter as salts. It would serve admirably as an adult food were it not for the large percentage of water which it con- tains. This would necessitate the taking of larger quantities than the stomach can accommodate, and so the adult takes his nourishment in more concentrated form. The analysis of the composition of milk as given also serves to show that more than one of the four classes of food elements are to be found in a single article of diet. Food products may be at the same time both nitrogenous and carbonaceous ; or both fatty and rich in mineral matter. Need of Well Balanced Diet. — The necessity of the correct bal- ancing of diet according to the principles stated above cannot be too strongly impressed. A violation of the laws of diet is attended not only with imperfect nutrition and a loss of bodily energy and sustenance, but it provokes a number of ills and diseases. If too much nitrogenous food, such as lean meat, eggs, cheese, gluten, etc., be taken, the liver and kid- neys are overworked in their efforts to throw off the excess, and gout, 32 THE MAINTENANCE OF HEALTH. rheumatism, and other kidney and liver troubles result. Much proteid matter and too little starch and sugar cause a loss of flesh and weight because the supply of fat-forming food is deficient. If too much starch and sugar are taken, there result dyspepsia, flatulence, acidity of the stomach, corpulence, and obesity. Value of Foods. — There is a very great difference in the nutritive qualities of the several articles of food usually consumed. The low degree of nutrition represented, by the table given below, as being sup- plied by milk, which has just been spoken of as an ideal food, and of turnips, and some others, is due to the relatively large amount of water which they contain. This of course reduces the value of a pound of milk when compared with a pound of olive oil, or of wheat bread. In the list here given, the common food articles are arranged in the order of their relative nutritive properties, beginning with the most nutritious. A perfect food, if such existed, would be marked ioo: — TABLE OF FOOD VALUES. Olive oil, 96 Blood, 22 Wheat bread, baked, 95 Sole, fried, 21 Peas, dry, boiled, 93 Pork, roast, 21 Barley, boiled 92 Flour, bolted, in bread, 21 Rice, boiled, 88 Codfish, boiled, 21 Beans, dry, boiled, 87 Peaches, raw, 20 Bread, baked, 80 Soup, barley, boiled, 20 Rye flour, baked, 79 Gooseberries, raw, 19 Oatmeal, 74 Haddock, boiled, 18 Almonds, raw, 66 Potatoes, boiled, 13 Flour, unbolted in bread, 35 Eggs, whipped, 13 Mutton, roast, 30 Strawberries, raw, 12 Plums, raw, 29 Apples, raw 10 Chickens, fricasseed, 27 Carrots, boiled, 10 Grapes, raw, 27 Pears, raw, 10 Apricots, raw, 26 Cabbage, boiled, 7 Beef, roast 26 Milk, 7 Cherries, raw, 25 Turnips, boiled, 4 Veal, fried, 25 Melons, raw, 3 Venison, broiled, 22 Cucumbers, raw, 2 Digestibility of Food. — The following table of the digestibility of the several articles commonly used as food, beginning with the easiest, is based upon the judgment and experience of the most eminent authori- ties. It will prove helpful in arranging a diet in sickness and in health : — - DIGESTIBILITY OF FOOD. 33 TABLE OF DIGESTIBILITY OF FOOD. Food. Time Required for Digestion. Rice, boiled, 1 hour Pig's feet, soused, boiled, 1 hour Tripe, soused, boiled, 1 hour Eggs, whipped, raw, 1 hour 30 minutes Trout, salmon, fresh, boiled or fried, 1 hour 30 minutes Soup, barley, boiled, 1 hour 30 minutes Apples, sweet, raw, 1 hour 30 minutes Venison steak, broiled, 1 hour 35 minutes Sago, boiled, 1 hour 45 minutes Tapioca, boiled, 2 hours Barley, boiled, 2 hours Milk, boiled, 2 hours Liver, beef's, broiled, 2 hours Eggs, fresh, raw, 2 hours Codfish, cured, boiled, 2 hours Apples, sour, raw, 2 hours Cabbage, with vinegar, raw, 2 hours Milk, raw, 2 hours 15 minutes Turkey, wild, roasted, 2 hours 20 minutes Turkey, domestic, boiled, 2 hours 25 minutes Gelatine, boiled, 2 hours 25 minutes Turkey, domestic, roasted, 2 hours 30 minutes Goose, wild, roasted, 2 hours 30 minutes Fig, sucking, roasted, 2 hours 30 minutes Hash, meat and vegetables, warmed, 2 hours 30 minutes Beans, string, boiled, , . . . 2 hours 30 minutes Cake, sponge, baked, .2 hours 30 minutes Parsnips, boiled, 2 hours 30 minutes Potatoes, Irish, roasted, 2 hours 30 minutes Chicken, fricasseed, 2 hours 45 minutes Custard, baked, 2 hours 45 minutes Beef, plain boiled, 2 hours 45 minutes Apples, sour, hard, raw, 2 hours 50 minutes Oysters, fresh, raw, 2 hours 55 minutes Eggs, fresh, soft-boiled, 3 hours Bass, fresh, striped, broiled, 3 hours Beef, fresh, lean, rare, roast, 3 hours Pork, newly salted, stewed, 3 hours Mutton, fresh, broiled, 3 hours Soup, boiled, 3 hours Chicken soup, boiled, 3 hours Dumpling, apple, boiled, 3 hours 34 THE MAINTENANCE OF HEALTH. TABLE OF DIGESTIBILITY OF FOOD— Continued. Food. Time Required for Digestion. Corn cake, baked, 3 hours Oysters, fresh, roasted, 3 hours Pork steak, broiled, 3 hours 1 5 minutes Mutton, fresh, roasted, 3 hours 1 5 minutes Corn bread, baked, 3 hours 1 5 minutes Carrot, boiled, . . . 3 hours 15 minutes Sausage, fresh, broiled, 3 hours 30 minutes Oysters, fresh, stewed, 3 hours 30 minutes Butter, 3 hours 30 minutes Cheese, old, strong, 3 hours 30 minutes Soup, mutton, boiled, 3 hours 30 minutes Oyster soup, boiled, 3 hours 30 minutes Wheat bread, fresh, baked, 3 hours 30 minutes Turnips, boiled, 3 hours 30 minutes Potatoes, Irish, boiled, 3 hours 30 minutes Eggs, fresh, hard-boiled, 3 hours 30 minutes Green corn and beans, boiled, 3 hours 45 minutes Beets, boiled, 3 hours 45 minutes Salmon, salted, boiled, 4 hours Beef, fried, 4 hours Veal, fresh, broiled, 4 hours Arranging a Diet. — By reference to the foregoing tables of nutritive values and of the digestibility of foods, the selection of a suitable diet for special cases will be greatly facilitated. These tables should be read together in making a choice of food. For it is plain that a food may be highly nutritive and yet very difficult to digest. Such a condition is worse than a food of medium nutritive quality and of easy digestion. No table of the digestibility of food can be arranged which will be true for every individual. Personal peculiari- ties, idiosyncrasies, and more or less impairment of the digestive organs, all operate as factors which are hardly capable of being accurately estimated. One's own experience must be a modifying element in all selection. There are, however, other considerations, besides nutritive and diges- tible qualities of food, to influence a careful and competent selection. Diet Governed by Climate. — The influence of climate and the sea- sons, in deciding the sorts of food which should be chosen, is of prime importance. In cold climates and in the winter season there is great need of the heat-producing foods, the fats and the carbonaceous foods. SELECTION OF A DIET. 35 Almost incredible quantities of oil, blubber, and fat meat are reported to be consumed in the diet of the Esquimaux and other arctic inhabitants. Dr. Hayes, the arctic explorer, says that the daily ration of the Esqui- maux with whom he came in contact was from twelve to fifteen pounds of meat, one-third of it fat, to each person. He saw one man eat ten pounds of walrus meat and blubber at a single meal. Such instances must not, however, be regarded as gluttony on the part of these people, but as the requirements of the body for fortification against the rigors of the climate. On the other hand the inhabitant of the tropics subsists almost wholly upon a diet of juicy, watery, cooling fruits. Our diet, then, in winter should be largely carbonaceous food, com- prising meats, fats, and oils, in abundance. In summer it should consist of a liberal allowance of fresh vegetables and fruits. Fortunately Nature contributes to make such an arrangement easy, as the summer season is one of abundance of the very foods most desirable at that time. Diet Governed by Age. — In youth, during the growing period, the repair or upbuilding of the tissues is greater than the waste; in middle life the repair and waste are about equal; and in old age the waste is greater than the repair. Therefore, it may be briefly concluded that the diet of young persons should be largely of a vegetable nature and of a more nourishing kind than the diet of old age. Diet Governed by Occupation. — Occupation is intended to repre- sent the amount of manual work performed or the amount of exercise taken; which must be provided for in the selection of a suitable diet. When great muscular exertion is required, nitrogenous foods are to pre- dominate in the diet, for they are the foods that rebuild the muscles that are worn down by use. In sedentary occupations carbonaceous foods are to abound. The appetite is a great regulator in such cases. If the wrong sort of food is presented, according to the needs of the body, or of a particular case, that food will be partaken of in large quantities in the effort to get a sufficient quantity of the required nourishment. This unsatisfied need of the body, in a measure, explains the possibility of a person eating heartily of food with apparent good appetite, and yet com- plaining of feeling hungry. This is an almost sure sign that a change of diet is needed. It will also be realized that the excessive amount taken in the effort to satisfy the natural craving of the appetite entails a lot of unnecessary work upon the digestive organs. Change of Conditions. — One should be always watchful to adjust the diet to a change of occupation or of climate. Where one has been 36 THE MAINTENANCE OF HEALTH. leading an active life of manual labor or of much exercise, and then changes to a sedentary occupation, one must not expect to maintain the same dietary supply as formerly, but must endeavor to adapt the diet to one's new needs as quickly as possible. It may be that even with one's best efforts in this direction there will be a period of greater or less dis- turbance in the endeavor to meet the new requirements. Pure Food. — An important duty in connection with the supply of food is the exercise of that care in its selection which is necessary to procure articles of good quality and of insured purity. Government inspection of meats, and of food generally, does much in the way of regulating the sale and the supply of food. But even the best efforts of inspectors do not prevent goods of poor quality and even of impurity from being offered for sale. Ptomaine poisoning results from eating tainted meat or poultry. Tapeworm is transferred from the flesh of the pig and ox to the human body, and the well known disease of trichi- niasis is communicated to man from a parasite in pork. Parasites in meat, capable of communicating disease to man, are certainly destroyed by thorough cooking. At least it is the requisite degree of heat through- out the entire portion of the meat that kills the germs. But tainted meat, poultry, and fish are not rendered harmless by cooking; and oysters and other shellfish eaten raw have often been the means of communicating dangerous diseases. Milk is recognized as a means of spreading disease ; and, as a precaution, all milk is, or should be, pasteurized. In this process the milk is heated to 160 Fahrenheit, at which temperature the germs of disease which it may contain are killed. Many cases of fatal poisoning have resulted from the careless habit of opening canned goods, using a part of the contents, and leaving the remnant in the opened tin for future use. This is lead poisoning caused by the fruit acid acting on the solder of the tin in the presence of oxygen in the air. As soon as a can of goods is opened, the contents should be at once removed to another vessel, if it is not intended for immediate use or cooking. The same effects have resulted from eating ice cream which has become affected in a similar way. How to Detect Impure Food. — Adulteration of food is quite com- mon. The methods of detecting some of these cheap and harmful compounds are extremely simple and can be performed by anyone. It is a great satisfaction to know something of the purity of the articles of food which one is using. It is a well understood fact that when it is generally known that one has a pair of scales in the house, one is very TESTS OF THE PURITY OF FOOD. 37 likely always to get full weight. So when one has even a slight reputa- tion as a domestic analyst, there is small likelihood that an inferior article of food will be offered. To examine a specimen of coffee, take the whole bean. Many believe that it is only the unground coffee that is free from adulteration, and that by having a mill at home they will insure a purer article. It may surprise such to know that the coffee bean is adulterated with artificial coffee beans or pellets which are made from wheat bran roasted and from chicory. To detect these, take a cup of water and put into it a few of the whole beans. The genuine coffee beans will float on the top of the water while the adulterants will sink to the bottom. Then take some of the ground coffee and try it in the same way in another cup of water. The grains of pure coffee will float and will not color the water for some minutes. The grains of chicory and cereals will sink to the bottom and will leave a colored trail behind them as they fall. There is another test for "ground coffee, which depends simply upon examination by the unaided eye. Spread some of the grains upon a piece of writing paper and examine them closely. Genuine coffee grains are of a dull color. They also have the coffee taste. Chicory grains are dark colored and have an appearance like that of gum. When tasted they are found to be very soft and bitter. Grains of cereal have a smooth and polished surface and are devoid of taste. Honey, jams, jellies, syrups, and similar preparations often depend for their sweet taste upon the presence of glucose. This is a very cheap substitute for sugar, and is made by treating cornstarch with an acid. To detect the presence of glucose in any preparation a very strong alcohol is required. Pour a small quantity of 95 per cent alcohol into a tumbler. Then take a spoonful of the substance to be tested and slowly pour it into the alcohol. If glucose is present the alcohol will show a milky color, and a thick substance like gum will settle on the bottom of the glass. The milky appearance of the alcohol will remain for a long time. But if no glucose is present a white flaky sediment will settle to the bottom of the glass, and in a few minutes the alcohol will be quite clear. Many jams, jellies, syrups, tomato ketchup, and the like, owe their brilliant color to the use of a dye, generally an aniline dye. The test in such cases is simply to learn whether or not- the suspected substance will dye a piece of woolen goods. Take a small quantity — two or three spoonfuls — of the suspected substance and stir it into rather less than a pint of water. Place this in a stewpan. Take a small piece of all-wool 3 8 THE MAINTENANCE OF HEALTH. white goods such as nun's veiling, and pour boiling water over it until it is thoroughly saturated. Then place it in the solution and boil it for about ten minutes, stirring it meanwhile. If there is any dye present it will impart a bright, vivid color to the piece of goods. Natural juices from fruit are of a dull or dead color. If there is any doubt of the char- acter of the stain on the cloth, boil the dyed cloth with a tablespoonful of ordinary ammonia in a pint of water for five minutes. Then remove the cloth; add a few tablespoonfuls of vinegar to the ammonia; put in a new or clean piece of cloth, and boil again for five or ten minutes. If the new piece of cloth is colored there is aniline or other dye present. The explanation is that the color was extracted from the first piece of cloth by the ammonia, and when the vinegar was added and the clean piece of cloth boiled in the discolored ammonia, the dye was imparted to the cloth. If the coloring matter in the first piece of cloth were only the natural juice of the fruit, it would not have been removed from it by the ammonia. This experiment will prove the pres- ence of a dye in any article of food. The presence of coloring matter in milk may be detected by allowing the cream to rise and then comparing the color of the cream with that of the milk. In natural colored milk the cream is always more yellow than the milk from which it rises. If the milk is as yellow or more so than the cream, there is little doubt that a yellow coloring matter has been added to make up for some deficiency in the quality of the milk. To test the purity of butter, take a piece as large as the end of one's thumb. Place this in a spoon and heat it over the flame of an alcohol lamp or a candle. After it has melted, lower it into the flame so that it will boil. Stir it well during the boiling. If the sample is butter, the boiling will be attended with very little noise, and there will be a great deal of foam ; oleomargarine or artificial butter will boil very noisily and there will be very little foam. Another test is applied by taking a tin cupful of sweet milk and placing in it a small lump of the butter. Heat the milk and stir while the butter is melting. Then place the cup in broken ice so as to cause it to cool rapidly. Now observe the action of the sample while cooling. If it is butter the mass will form small grains as it does in the churn, and cannot be gathered together in a lump. Oleo- margarine or artificial butter will gather in a mass. To test vanilla flavoring extract, place some in a small bowl and set it in the top of the teakettle. Allow it to boil or evaporate until there is only one-third of the original volume. Then add water enough to TESTS OF PURE FOOD. 39 make up the original quantity. If there is a red, flaky sediment in the bottom of the bowl it is vanilla of good quality. If there is no sediment, the article is artificial. To test the purity of lemon flavoring extract, take a tumblerful of water and add a teaspoonful of the lemon extract to it. If there is a cloudy appearance communicated to the water, the extract is artificial and there is no pure lemon oil present. If there is reason to suspect that the liquid is colored artificially, and not by the rind of lemon peel, the dyeing test given above may be used. To test for the presence of alum in baking powder, get a few chips of logwood and pour water upon them and boil. Pour off the liquid and add more water and boil again. Repeat this so as to get the fourth water. Add a teaspoonful or two of the baking powder to a half tumbler- ful of water. Then add two tablespoonfuls of vinegar and pour in two or three drops of the extract of logwood. If alum is present the solution will turn reddish blue. If there is no alum the solution will be yellow. The first quality which milk should possess is that of cleanliness, not only as a direct essential to health but in order that the milk will keep. Cleanliness is the best preservative, and, indeed, the only one that is really permissible outside of temperature. It is a difficult matter to detect an impure condition of milk resulting from this necessary lack of care. The senses of sight, smell, and taste are reliable guides so far as they go; but a sample of milk may easily pass these guards and yet be wholly unfit for use. The reputation of the dealer is about all that one can go on in that case. The commonest form of adulteration, if it can be regarded as adulteration, is the reducing of the strength of the milk by (1) the addition of water, (2) the addition of skim milk, or (3) the removal of cream. This dilution can easily be detected by the use of the lactometer, which is a simple, inexpensive instrument for ascertaining the density or specific gravity of milk. It will tell whether the cream has been removed. A simpler test is to pour some fresh milk into a glass and set it aside to allow the cream to rise. The amount of cream which forms is an indication of the strength of the milk. By using samples from several sources, one can easily select the richest. If milk spoils without souring, a preservative has been used. It is safe to say that all preservatives are injurious. The commonest in use are borax or boric acid, salicylic acid, and formaldehyde. These are all preventives of the growth of the germ which causes milk to sour, and are undesirable constituents of food, especially for young children. 4 o THE MAINTENANCE OF HEALTH. The safest way to guard against injurious canned goods is to make it a rule to accept no cans which do not bear the name of the packer. The greatest danger arises from the too common custom of cleaning up old stock and putting on a new fresh wrapper in bright colors, attractively printed, but bearing no name of the person upon whom responsibility can be placed. A man who is ashamed to have his name appear upon his product is unworthy of patronage. Unripe Fruit. — Eating unripe fruit, a common practice with chil- dren, is often the direct cause of diseases of the digestive organs. Much disturbance of these organs is also caused by eating too heartily of new fruits and vegetables. When such first come in season the system is not prepared for them, and they should be used moderately and with caution. The dangers seem to be lessened considerably in these days of cold storage, which not only insures a riper grade of fruit than was possible formerly, but the season for all fruits and vegetables has been vastly extended by its use. Constitution and Temperament. — In all families the diet should be arranged so as to suit the constitution and temperament of each one of its members. If, as is too often the case, the menu is prescribed to suit the taste, occupation, and age of the father of the family, it is unrea- sonable to expect the anaemic girl or the nervous boy to be properly nour- ished or satisfied with it. When such is the case, the unreasonableness of it all is increased by a, perhaps, well-intentioned effort to force the children to partake of some of the dishes for which they have expressed a distaste. It is not merely a matter of kindness to prepare a special dish for one or more of the younger members of the family, but it really is imperative that such be done. No thoughtful mother will allow considerations of extra work and cooking to prevent this attention to the needs of her children. Those of a sanguine temperament require a moderate quantity of simple food. They should avoid the use of sauces and condiments, pepper, and highly seasoned food. Stimulating drinks are also to be excluded from their diet. Those of a lymphatic or phlegmatic temperament require an abun- dance of nourishing food, with a good supply of animal food, fresh vege- tables and fruits. Those of a bilious temperament are so subject to derangements of the digestive organs that the question of their diet is often perplexing. Easily digested, well cooked food of high nourishing quality is essential. CONCENTRATED FOODS. 41 Those of a nervous temperament are also extremely difficult to pro- vide for. If the food is not rich enough, impure blood is sent to the brain, the seat of the nervous system, and nervous derangements will surely be aggravated. If the food is too stimulating, or if too substan- tial a diet be supplied, the blood becomes too much enriched, and therefore too stimulating and exciting, which is the very condition sought to be avoided in these cases. Good Cooking. — A great advance has been made in recent years in the art of cooking. There is now little truth in the assertion that much good food is spoiled by bad cooking. It is more nearly correct to say that inferior food is often improved by good cooking. Every year shows a decided advance in the science and art of preparing food. This is to be regarded as a great improvement in hygiene and health. It is possible, however, that great skill in the preparation of appetizing and savory dishes may be responsible for many cases of excesses in eating. Abstinence. — There are times when it would be vastly better to miss a meal than to eat one. When one approaches a meal hour without a desire for food, one should not let habit force one to partake of the food. Judicious abstinence on occasions is one of Nature's own means of self-defense. Highly seasoned dishes with savory sauces are often a spur to a jaded appetite caused by surfeit and over-indulgence. Concentrated Foods. — There are a great many concentrated foods on the market for which great claims are made by the manufacturers. It must be remembered that there is a limit to concentration, beyond which the value of the article as nourishing food is more than doubtful. The common statement that a lozenge of concentrated food contains as much nourishment as a beefsteak is not only untrue but absurd. Some go so far as to claim that a few lozenges contain all the nourishment which an adult will require for an entire day's sustenance. This claim is equally absurd and untrue. For the weight of chemically dry, water- free food which an adult requires in a day while in a state of perfect rest is 16 ounces; while engaged in ordinary work, 22^ ounces. When highly concentrated, predigested food is presented to the stom- ach in a state of health, that organ seems to resent the premature inter- ference with its duties, There results a loss of appetite and either diarrhcea or constipation. It is also clearly established that the digestive 'juices require something undigested to work upon; and considerable bulk of food is also required for the proper distention of the stomach and bowels, in order that these organs may properly discharge their several 42 THE MAINTENANCE OF HEALTH. functions. The fact that some of these concentrated foods may be not only highly beneficial but absolutely indispensable in some forms of disease is no proof that they are a fit food in a state of health. Their greatest recommendation is the fact that they are easily carried by those who are obliged to transport quantities of food in small space to remote parts of the world. Daily Ration in Health. — The distribution of the food elements, the quantity of food required by an adult in a state of health, and the variety of the food, may, perhaps, be best illustrated by the daily ration served to each soldier in the United States army. On comparison with the daily ration of soldiers of the armies of other countries, this is said to be the most generous allowance to any : — Bread or flour, 22 ounces. Fresh or salt beef, 20 ounces. Or pork or bacon, 12 ounces. Potatoes, three times a week, 16 ounces. Rice, 1.6 ounces. Coffee, 1.6 ounces. Or tea, 0.24 ounces. Sugar, 2.4 ounces. Beans, 0.64 gill. Vinegar, 0.32 gill. Salt, o. 16 gill. THE WATER WE DRINK AND ITS EFFECTS. Absolutely pure water has no color, taste, or odor, and is composed of two parts of hydrogen gas and sixteen parts of oxygen gas by weight. Natural water is classified as follows : Rain water, spring water, river water, lake water, and sea water. These, however, are never found chemically pure; only distilled water is such. The impurities found in water are either solid or gaseous; and are either suspended in it or are dissolved in it. Rain water is the purest of all natural waters. It always contains gases dissolved in it, especially nitrogen, oxygen, carbon dioxide, and ammonia gas. These are washed out of the atmosphere as the rain falls through the air. Ice water in the form of melted ice is purer than rain ^ater, for, in the process of freezing, the solids and gases are expelled. IMPURITIES OF DRINKING WATER. 43 Spring water is rain water which, in its passage through the earth, dissolves out of the soil, and unites chemically with certain substances which produce the mineral ingredients found in spring water. There are common springs which yield fresh water, mineral springs which supply mineral water, and thermal and medicinal springs. Well water, when obtained from a deep well, is much the same as spring water. But surface or shallow springs and wells yield, usually, polluted or contami- nated water by reason of the surface drainage into them and the imper- fect filtration, as the water does not pass through deep layers of soil in reaching them. If there is much mineral matter contained in water it is said to be "hard" ; if only a slight quantity, it is called "soft." Hard waters do not make a good lather with soap; and sea water none at all. River water partakes very largely of the nature of the soil over which it flows. There is always a large percentage of organic matter contained in river water, which is washed into it from the surface of the ground. Lake water varies greatly in mineral matter, and includes salt lakes, like that of Utah and the Dead Sea, and all the modifications of these down to the freshest and clearest of waters. As the water in a lake is not so much subject to agitation as it is when flowing in a river, much of the suspended organic matter of the river water subsides and falls as a sediment to the bottom of the lake, leaving the water clearer and less turbid. Lakes, therefore, are natural reservoirs and are among the best sources of a good water supply. Impurities of Drinking Water. — The gases and minerals dissolved in water are not all harmful or disagreeable. Indeed, many of them remove the insipid taste of distilled water. Besides the gases and dis- solved mineral matter we find certain solids suspended in the water or falling to the bottom as a sediment when at rest. These are minute particles of clay, sand, etc. ; vegetable and animal matter ; and living organisms. Micro-organisms, or bacteria, are found in large numbers in all water, except spring water, which has passed through a deep layer of fine soil, by which means the bacteria are filtered out. These micro- organisms vary in number from two in a cubic centimeter of water drawn from an artesian well to thirty-eight million in a cubic centimeter of sewer water. There are more bacteria in water during hot than during cold weather. These germs find their way into the water from both the air and the soil. Under favorable conditions they multiply very rapidly in water. The fact that micro-organisms are found in water does not mean anything, for they are found in all water; nor is it important 44 THE MAINTENANCE OF HEALTH. that there are few or many; but it is of the utmost importance to ascer- tain whether or not they are the bacteria of any specific disease, and whether or not they are characteristic sewage or surface drainage germs. The determination of these points decides the purity or impurity of the water. The refuse from some mills and certain manufactures, when allowed to escape into rivers, are also frequent sources of pollution and contami- nation of water. The pipes by which water is conveyed sometimes yield such impuri- ties as lead, zinc, or iron; and wooden pipes, in the process of decay, impregnate it with dead organic matter. Leaking sewer and gas pipes, and the drainage from cesspools, are common causes of impurity of water. A curious instance is known where a sudden diminution of the water pressure in water pipes created a partial vacuum within the pipe and sewer air or water was sucked into the water pipes, resulting in an epidemic of typhoid fever. Effects of Impurities in Water. — Sewer gases, when dissolved in water, are known to produce diarrhoea, as does also hydrogen sulphide gas, a constituent of illuminating gas. Some of the "hard" waters pro- duce calculus, or stone in the bladder. Lime salts in water produce dyspepsia, as does iron, with the additional effect of. constipation. Dis- solved vegetable and organic matter produces fevers and diarrhoea. Turbid water, containing particles of clay, vegetable matter, and the like, causes diarrhoea, dysentery, and, sometimes, fevers and cholera. Tests for Drinking Water. — The chemical, microscopical, and bacteriological tests for drinking water are, of course, a matter for the trained specialist. But there are a few physical tests which anyone may easily apply. The points to be noted are : — I. Color. — The water under examination should be allowed to remain at rest for a time in order that any sediment may settle to the bottom of the vessel. The clear water above is then to be poured into a clean glass vessel, and a sheet of white paper is placed behind or below it. In this way the color is noted. To do this properly the glass vessel should have a diameter of at least eighteen inches. If a glass vessel containing distilled water be placed beside it for comparison a better result will be reached. A bluish tinge characterizes perfectly pure water ; a grayish tinge is not objectionable; a greenish tinge may result from harmless algae, or water plants; yellowish or brownish hues result from iron salts, peat, animal matter, or sewage. TO PURIFY WATER. 45 2. Clearness or Turbidity. — The water should then be well shaken up so as to distribute the sediment, and a printed page should be placed behind or below the glass vessel so as to estimate the depth of water through which the page may be read. If the turbidity does not subside after the water has stood at rest for some time, it is caused by finely divided particles of clay. j. Sediment. — This may be classified approximately, as : absent, minute, slight, large, or very large. Some idea may also be given of its nature, as : sandy, clayey, reddish ; and the presence of any large particles of organic matter, as chips, minute fragments of leaves, grass, etc., may be noted. 4. Luster. — If highly aerated, the water sparkles. Polluted river or well water, or stagnant water, has no luster. 5. Taste.— A good tasting water may be impure ; but a bad tasting water should be unhesitatingly condemned. 6. Smell. — Slightly heat the water and then observe the odor, or the absence of it. When water is heated, the gases are liberated and the odor is much more pronounced than when cold. A bad odor is another cause for the immediate rejection of a water. But the absence of odor is not in itself a proof of its purity. Generally speaking, a water that is colorless, clear, free from sediment, sparkling, and devoid of taste or odor may be regarded as safe to drink. To Purify Water. — The safest and most convenient methods of insuring good water in the home are filtration and boiling. The process of filtration most generally employed is that of some mechanical method where the filter employed contains either sand, porcelain, asbestos, or some form of carbon or charcoal. The great objection to the most effective methods of filtering is the slow delivery of the filtered water; and, while the water delivered may be clear and apparently fit for use, there is no assurance that the germs of disease which the water may have contained are removed. The great safeguard, then, is to boil the water. While this is an effective means of killing all disease germs in the water, it has the objectionable effect of driving off the gases dis- solved in the water and thereby rendering the water insipid and unpal- atable. In cases of suspected impurity of water, and during seasons of epidemic, it is very largely the custom to procure a table water of known purity and free from all taint. These are usually of certified chemical constitution, and are often both palatable and medicinal. After water has been boiled and the gases driven off, it is possible to aerate it again 46 THE MAINTENANCE OF HEALTH. by pouring it backwards and forwards through a fine sieve so as to divide it into many small streams, and while thus exposed to the air it will absorb oxygen. If the water is only turbid, it may be allowed to settle, and the clear water carefully poured off. Hard water may be improved for drinking purposes by the addition of a little limewater. Mastication and Insalivation. — That the mouth by local care be kept in a normal, healthy condition is by no means of purely aesthetic interest. It is of vital importance to our general health, as indeed in many cases of severe and even serious dyspepsia the cause lies no deeper than the mouth, and the patient needs not pills for his stomach, but pellets for his decaying teeth. And while the field of medicine of to-day is broad enough without specializing in dentistry, every man who busies himself with the treatment of alimentary diseases should know enough about the teeth to be able to tell when the patient has mistaken the doctor's door for the dentist's. Among the various functions which are performed in the mouth, such as taste and the articulating of speech, we have one very important adjunct to the process of digestion. By the use of our teeth, cheeks, and tongue we chew our food and mix it with saliva, performing the functions of mastication and insalivation, constituting the first two steps in the process of digestion. And only after these two are thoroughly carried out should deglutition or swallowing occur. These three vol- untary acts are the only parts of digestion and nutrition over which we have any control, and it is ours to see that they are carried out in the most perfect manner, for here is the starting point of good digestion or of a dyspeptic constitution, as we choose to make it. Failure in this causes the whole body to suffer, for the stomach will receive food too coarse to act upon it. If it is not properly insalivated by the action of the saliva, it will pass it on to the intestines in such a condition that they in turn will be overworked, causing a general derangement of the various organs of assimilation and excretion, bringing about such maladies as are of grave constitutional importance by producing a condition of what is known as malnutrition. This is in the case of a large number of diseases a predisposing cause which can be traced to improper chewing and insalivation of our food. And while the serpent bolts his fly, the bird its grain, and the fish its brother without the ceremony of chewing, Nature has imposed upon us the work of mastication to meet the requirement of our higher organ- ization, and in no other particular is the perfection of creation more CARE OF THE TEETH. 47 beautifully illustrated than it is in the adaptation of the various forms of teeth for the various purposes for which they were designed. Thus in the carnivora or flesh-eating animals, which spend but a short time in mastication, their teeth are in general adapted rather for tearing and cutting than for grinding, while in ruminating animals, whose teeth work all day long, most of them are especially adapted for grinding. But where the diet is partly animal and partly vegetable, as in man, the teeth are fitted for performing all kinds of work, — the front teeth being designed to cut, as they are sharp, and, in overlapping the lower teeth in closing, as the normal meeting of the teeth provides, they perform the work of a pair of shears, from which the name incisor (to cut) has been applied to them. Their immediate associates, the cuspids, commonly called eye and stomach teeth, being pointed, are adapted to the work of tearing, leaving the work of grinding to be done by our molars and bicuspids, whose broad, but uneven surfaces are so well adapted to complete this important function of mastication. In man there are two sets of teeth : the deciduous (from de and cado, to fall) or temporary teeth, sometimes called milk teeth, and the perma- nent teeth. The deciduous teeth are twenty in ^ number — ten in the upper and ten in _ /"'* ^N ,b the lower jaw — and consist on each ^^It^^S^^^iili^'^ side of four incisors (from incido, I cf ^^^iM^l^iX '^ cut), two canines or tearing teeth vMnlff ^^^m (from canis, a dog), so called because p^-^. ^^/^J they are well developed in the dog. *■' They are scientifically called cuspid „ FlG * lm . . Temporary or Deciduous Teeth. teeth (from the Latin cuspis, a spear), A Incisors> B CaninesorCuspid , CMolars . and four molars or grinding teeth (from the Latin mola, a mill), so called because they are for grinding purposes. Each of the deciduous teeth is, in the course of time, replaced by a permanent tooth, but not of the same denomination throughout, for the baby molars are succeeded by teeth which are now called pre-molars (from the Latin prae, before), meaning before molars, so applied because in the dental arch they come in rotation before the permanent molars as regards their position, but they are more commonly called bicuspids, having two cusps. And, in addition, the vacant portion of the gum back of the baby teeth is now filled up by twelve teeth, six on each side, three 4 8 THE MAINTENANCE OF HEALTH. Fig. 2. Permanent Teeth. A. Incisors. B. Canines. C. Bicuspids. D. Molars. above and three below these twelve permanent molars; they raise the number of the permanent teeth to thirty-two. And from before backward on each side, above and below, they are given the names of the first, second, and third molars. The -A i as t or third molar is more commonly called the wisdom tooth. Structure of Teeth. — Each tooth contains four structural substances : the enamel ; the dentine; the cementum; and the pulp. The enamel, which forms the outside shell of the crown, is the hardest substance within the body, being com- posed almost entirely of earthy or mineral (about 97 per cent), is made up of rod-like structure called enamel prisms, which radiate out- ward from the surface of the dentine at all points, being thickest at the grinding or cutting edges, and becoming thinner as it approaches the necks. The dentine represents the interior or middle portion of the tooth throughout its entire length. Its structure is similar to that of bone, but is harder and more dense. Dentine contains about 72 per cent of mineral matter, but is not nearly so hard as enamel. The cementum is the external covering of the root, completely envel- oping it as the enamel does the crown, and in structure it very much resembles the dentine. The pulp is the formative organ of the dentine. It occupies the central portion of the crown and root at about their junction, narrowing down gradually into a few nerve fibers and blood vessels, which pass out through the end of the root to connect with the large nerve trunk and blood vessels, of which it is a tributary part. This tissue is of much importance to the tooth because it is from this structure that it receives its blood supply and nerve vitality — its nourishment. The pulp tissue represents the incalcified portion of the original tooth germ. It is a highly organized, consequently an extremely sensitive tissue, and, when exposed by decay to the action of foreign bodies and to heat and cold, it is the source of excruciating pain. CARE OF THE TEETH. 49 Causes of Decay. — It has been claimed upon very good reasoning that if it were possible to keep our teeth absolutely clean upon all sur- faces and at all times, there would be no decay of the teeth. Discussions at length have been held regarding the theory of decay of teeth, but present-day scientists seem to agree that it can be laid to the chemical and bacteriological theories alone, these two never working independ- ently. There is always an abundance of bacteria in the mouth, and in their presence there can always be found left an acid condition as their waste product, which, by its action to dissolve bone structure, penetrates the enamel, leaving a new surface with fresh organic matter for food for bacteria, which work together for the destruction of our teeth. The enamel, as above stated, contains only 3 per cent of organic matter, which is not enough to support bacterial life in itself, but when once the dentine is penetrated there is 28 per cent of organic matter in it, presenting a feeding ground for the millions of bacteria which inhabit the mouth. Under these most favorable conditions of heat and moisture they will multiply and thrive, still burrowing deeper until the pulp, being exposed, gives the possessor a gentle hint of the presence of a diseased tooth, which, when examined by the dentist, will probably require the removal of a nerve, causing the tooth to lose its transparency, as well as to make it brittle. Teeth should not be neglected until Nature warns us by pain, and the sooner people become educated to this fact the better will be the service they will receive from their dentists. Decay begins on the surfaces of the teeth and not on the inside or at the roots, as so many people erroneously believe. It begins, first, in crevices within the surface due to improper union of the enamel, which, being developed in segments, sometimes fails to form a proper and thorough union; second, it commences on surfaces which rest against other teeth where particles of food, principally of a starchy nature, lodge, and their inacessibility to a brush or other means of cleansing causes them to undergo a process of fermentation and decomposition and con- sequent disaster which follows. The usual point at which this condition is found is just above their contact points. Cleaning the Teeth. — Our teeth should be cleansed after each meal, and at least once a year by the dentist, who at this time can examine them thoroughly. Sometimes people flatter themselves with the thought that a tooth in which the nerve has become exposed by decay and has subsequently died of its own accord, will ache no more; but here begins the founda- 50 THE MAINTENANCE OF HEALTH. tion for some of the most serious complications I have ever seen, as it is the starting point for a developing abscess of the jaw, which some- times proves very disastrous. I have in mind now a case of this kind which came to a public clinic with which I was connected at the time, and which was the direct cause of the patient having the entire lower jaw removed, defacing her expression in a most ghastly manner for life. Dead Teeth should either be extracted or thoroughly filled to be in a safe condition to keep in the mouth, and should be considered as dan- gerous organs to be retained in the mouth, both by reason of their poison- ous influence to digestion and of the danger of an alveolar abscess, which is liable, under favorable conditions, to develop at any time. Filling Teeth. — Teeth should be filled for their preservation so long as fillings can be retained in them, for crowning teeth must be resorted to as a last attempt to save them, as crowned teeth have a fixed and almost uniformly definite period of usefulness, which is ordinarily about fifteen to twenty years, oftener a much shorter time, when they become loosened by absorption and fall out, to be replaced by an entirely artificial substitute, and, as a wooden leg is better than no leg, so artificial teeth are better than no teeth, likewise a glass eye, a wig, a rubber nose, but the loss of the organ is none the less deplorable. THE CARE OF THE SKIN. The Skin and its Functions. — Because it is so actrve in throwing off refuse matter from the body, the skin has been described as the third lung. Its further uses are protective and absorbent. There are two layers of skin : the outer or scarf skin, sometimes called the cuticle ; and an inner skin, known as the true skin. The outer skin scarfs off in the form of dandruff and small scales. This explains why stains, such as that of iodine, so soon disappear. The skin is provided with two sets of glands : oil glands, which secrete a sort of oil to keep the hair oily and the skin soft and pliable; and perspiration glands, or pores, through which the perspiration passes and by which liquids are absorbed. The oil glands secrete a sebaceous matter which sometimes clogs up the glands and collects dirt, forming the unsightly blackheads. They are not found in those parts of the body which are devoid of hair, such as the soles of the feet and the palms of the hands. The perspiration glands BATHS AND BATHING. 51 are extremely fine tubes, over two and a half millions in number, dis- tributed over all parts of the body. They are most numerous on the palms of the hands, and least so on the back of the neck and of the body. Perspiration, called insensible when it cannot be seen, and sensible when it forms drops, is constantly passing off from the body at the rate of about two pounds of liquid every day. If it is suddenly and temporarily checked, painful and dangerous results ensue; if permanently checked, death quickly follows. Actual breathing of oxygen gas and expulsion of carbon dioxide is carried on through the pores of the skin in the same manner as by the lungs. If all of the pores be closed so as to stop this process, death by suffocation will follow. This actually occurred in the case of a little child in a festival celebration at Rome, whose body was completely covered with gold leaf to represent the golden glory of an angel. Death followed in a few hours from suffocation by stopping the exhalations of the skin. Painter's colic is caused by the absorption of lead from the paint through the pores in the palms of the hand. The use of liniments containing opium is very dangerous, as the poison is absorbed by the skin, 'especially by raw surfaces. This absorbing power is active when the chest is rubbed with oil, or when skin food is applied to the body. The only way in which the pores of the body can be kept open and the activity of the skin insured is by frequent bathing. Baths and Bathing. — A state of good health cannot be maintained or secured unless the skin properly performs its several functions. This is impossible unless the skin is kept scrupulously clean. The cleansing process includes the removal of not only the accidental dirt but of the accumulated excretions of the skin itself. Part of the excretions are volatile, and either pass off into the air or are absorbed by the -clothing; and another part is non-volatile and can be removed from the skin only by washing. As this non-volatile part is very largely fatty in its nature, it cannot be thoroughly and effectively removed without the use of soap. As fatty matter is more soluble at a high temperature than at a medium or low temperature, warm water is more cleansing than is cold water. Friction by means of a flesh brush or by a rough towel is a great aid in the cleansing process. Cold Bath. — A cold bath is one in which the water is below 6o° Fahrenheit. Such baths abstract heat from the body, but, except in cases of very high fever, not to an extent appreciable by a thermometer, because the loss of heat by the body is made up by the increased heat production. This heat production is caused by, or produces, increased waste of tissue. 52 THE MAINTENANCE OF HEALTH. or change of tissue. More carbonic acid is given off by the lungs; the pores of the skin are closed; the heart's action is at first quickened and then diminished ; and breathing is more rapid. The vigorous rubbing with a rough towel, which should instantly follow a cold bath, dilates or opens the pores of the skin, and a general stimulating and invigorating sensa- tion follows. The cold bath regularly taken, opens and closes the pores of the skin, and the power which the pores acquire in this respect render cold bathers little liable to take cold. Such are the good effects of a cold bath that is neither too cold nor too long continued, and upon the person of one who has sufficient vitality to react from the shock. Cold baths should not be taken by the very young, the very old, by those weakened by illness or disease, or by those already suffering from congestion. Those who suffer from disease of the heart should take only temperate baths. To those who can stand a cold bath, it should be the rule of their lives to take one daily, partly to cleanse the skin, and partly for the tonic effect upon the skin in particular, and to the whole body gen- erally. The best time of day for the full wash is on rising in the morn- ing. The body is then warm and better able to stand cold water than at any other time of the day; the muscles are relaxed by sleeping and the cold bath is bracing. Warm Bath. — A warm bath is one in which the temperature of the water is over 6o° and under 90 Fahrenheit. It dilates the pores of the skin and causes more rapid breathing. On leaving a warm bath the pores are still open and the perspiration is increased. There is then great need of care lest a chill be taken. The blood is withdrawn from the internal organs, and a sedative effect upon the whole body, with a feeling of sleepiness, is noticeable, so that a warm bath at bedtime is advisable in cases of insomnia or sleeplessness. Too frequently indulged in, warm baths are enervating, and the danger of taking cold is very great; but a warm bath is more cleansing than a cold bath, and after excessive exer- tion is useful to relieve the sensation of fatigue. It is best taken at night before retiring. Sea Bathing. — Sea bathing has all of the virtues of a cold bath with the added benefits of the moving water and the probable slight stimulating effect of the salt. The best time for a sea bath is about two hours after breakfast, and the bath should last not more than five minutes for those who cannot swim, and about ten minutes for those who can; in no case for more than fifteen minutes. The feeling of chilliness should be the signal for instant retirement from the water. The bather should then BATHS AND BATHING. 53 dry himself and dress quickly. After cold or sea bathing, a little exercise immediately indulged in, is not only beneficial but essential. Turkish Bath. — The Turkish bath is intended to produce extreme perspiration with cleansing effect, to remove fatty matter from the skin, with attendant loss of weight. These baths must not be taken under any circumstances by those who suffer from valvular disease of the heart, aneurism, fatty degeneration of the heart, or by very old persons. There is very great danger of taking cold by going out into the cold air too soon after taking a Turkish bath. The establishments where these baths are given are usually provided with abundant means for resting and for allowing a sufficient time — certainly an hour at least — to elapse before exposing one's self to the dangers of cold air. Apart from any medicinal effect, the Turkish bath is a form of cleansing to be most highly recom- mended. The sweating in the hot room brings the dirt and fatty matter to the surface, and the subsequent thorough scrubbing with flesh brush and soap, and the flooding with w r ater, cleanses the skin and opens the pores. Hot Bath. — In a hot bath, the temperature of the water varies from 90 to 112 Fahrenheit. It is not taken by persons in good health. Its effects are powerfully stimulating upon the vital processes, and, if sus- tained for more than ten or fifteen minutes, the hot bath is very weaken- ing. Its chief use is to induce perspiration with a view to alleviating a fevered condition. It is also beneficial in extreme cases of nervousness. The hot bath is generally administered by placing the patient in tepid water, the temperature of which is gradually increased. On the com- pletion of the bath, the patient is warmly wrapped in blankets. Shower Bath. — The cold shower bath is a greater shock to the system than is the cold all-over or plunge bath. The shock is greatly intensified by a large volume of cold water falling from a considerable height. The effects of this form of bath are very quickly felt, and are more far- reaching than are those of immersion. Such baths are usually arranged so that the temperature of the water may be varied and regulated as desired. When the shower is used as an adjunct of the Turkish bath, and is employed to reduce the temperature of the body gradually, warm water is first turned on and the temperature slowly lowered as the subject can stand it. Under no circumstances should the shower be long con- tinued. Its duration, when the water is cold, is not to be measured by minutes but by seconds. How to Make a Homemade Shower Bath. — Even in houses other- wise well provided with bathing facilities there is often no provision 54 THE MAINTENANCE OF HEALTH. made for the shower bath. The preparation of a shower bath is a very inexpensive matter. One must first choose a satisfactory place for it. Any place where provision can be made for catching the falling water is all that is required. A large tub in which the bather can stand while taking his bath will answer very well. Take a small-sized tub, one that Fig. 3. Details of Parts for Homemade Shower Bath. Ftg. 4. Parts of Shower Bath Put Together. will hold two or three buckets of water — a large-sized butter or lard tub is of a suitable size — and bore a hole in the bottom, near one side, large enough to contain the end of the pipe. Procure two pieces of iron pipe, one and one-half inches in diameter, and from ten to twelve inches in length, and an elbow to match. Fit the pieces of pipe into the elbow. Plug one end of the pipe with a piece of soft wood. Bore a hole through the plug of wood large enough to admit the end of an ordinary brass faucet. Cut a piece of tin to fit the end of a good-sized funnel. Per- forate this piece of tin with a number of holes. Solder the top thus made on the end of the funnel. Solder the small end of the funnel to the faucet. Insert the free end of the pipe into the hole in the bottom of the tub, and your shower bath is completed. The apparatus is to be placed at a convenient height, upon a beam, or a shelf. The ease of filling the tub must be considered in such arrangements as are adopted. Bath Thermometer. — The hand is a poor and unreliable test for the temperature of water for bathing, except in cases where there has been education and experience from long practice. For the hand is one of the most exposed parts of the body, and is not so sensitive to heat and cold as are those parts which are warmly clad. A most useful acces- BATHS AND BATHING. 55 sory to the bath of both children and adults, therefore, is a bath thermom- eter. This is an ordinary thermometer encased in wood on three sides so that it floats easily in the bath and is protected from breaking against Fig. 5. Bath Thermometer. the metal sides of the tub. It is placed in the water and allowed to float for five minutes, when it is read in the ordinary way. The temperature of the water for the several sorts of bath is as follows : — Hot Bath, Over 98 Fahrenheit. Warm Bath, Between 90 and 98 Fahrenheit. Tepid Bath, Between 8o° and 90 Fahrenheit. Cool Bath, Between 65 ° and 8o° Fahrenheit. Cold Bath, Below 65 Fahrenheit. Russian Baths. — Russian baths are mainly vapor baths. The sub- ject is placed in a small room completely filled with hot steam, where he remains until a copious perspiration is induced. The body is then thor- oughly scrubbed and the temperature gradually lowered, the bath ending with a cold bath or shower. Sponge Bath. — Owing to a lack of conveniences, this is the only form of daily bath that can be taken by many persons. The requisites are a large basin full of good, soft water, a mild soap, a piece of face cloth or a sponge, one soft towel and one rough one. Use cold water in summer and tepid water in winter. The entire body is to be quickly rubbed over with the soaped sponge or face cloth. If the temperature of the room is low, a part of the body is to be washed and dried at a time, the rest being protected from the cold by clothing. After washing, the skin is first wiped dry with the soft towel, and then the rough towel is used briskly for four or five minutes, until the flesh is all aglow. The chest and the abdomen require the most attention in the rubbing, but the tenderness of the skin will determine the rigor of this treatment. Bath Room Accessories. — The water used in bathing is to be prefer- ably soft water. Hard water does not mix well with soap, is a poor cleanser, and is injurious to the skin. Usually, however, no choice can be exercised in this matter, as the bather is entirely dependent upon the water supply; but the addition of a little powdered borax will render 56 THE MAINTENANCE OF HEALTH. hard water less disagreeable; and a very little pearline will greatly increase the cleansing power of all water. Soap. — No very cheap soap can be good soap. That which is to be used on the face especially should be of the best quality obtainable. The chief quality that all soap should possess is that it contains no free alkali. In the manufacture of soap an alkali is mixed with oil or grease. If more alkali than is needed is used to mix with the oil or grease, some of it will be free, and in that form it has a caustic, burning effect upon the skin. Good, pure soap is one of the little luxuries of life that all should try to afford. A simple test of free alkali in soap is to hold the soap for a moment to the tip of the tongue ; if free alkali is present a burning sensation will quickly be felt in the tongue. Highly scented soaps, espe- cially those of a cheap grade, should be looked upon with suspicion, as the heavy, cheap perfumes used in their manufacture admit of the use of an inferior and objectionable grade of oil or grease. Face Cloths. — Face cloths are preferable to sponges, as they are much more easily cleansed and dried after use. The chief use of the face cloth or sponge in bathing is to insure a complete removal of the soap from the skin after bathing. Flesh Brush. — This is indispensable to a good cleansing bath. Friction is needed to remove obstructions of fatty matter and secretions which choke up the pores of the skin, and which, if permitted to remain, produce pimples and blackheads. No properly performed bath is pos- sible without this aid. Face Brush. — A softer form of flesh brush, made of camel's-hair, is of great service in bathing the face. A vigorous rubbing of the face with this, and the use of hot water and good soap, will do vastly more than cosmetics to produce a fine complexion. The regular use of the face brush produces a satin-like bloom that no art can supply. The Complexion. — The great cause of a lack of beauty lies not so much in irregular contour of the features, or in lack of expression, as in the bad condition of the skin. This, so far as the face is concerned, is called the complexion. Too often, neglect to care properly for the skin of the body brings eruptions and blemishes upon the face. Of course a woman is abundantly justified in temporarily concealing the eruption or blemish by all the means in her power; but she is not justified in neglecting to instantly and intelligently attack and remove the cause of such blemishes. That cause is most likely to be found in some irregular- ity of diet, especially in the consumption of large quantities of pastry. FRECKLES. 57 Abstinence from this, in its several seductive forms, and attention to the condition of the blood, will work wonders in this direction. A good fruit diet, green vegetables, and hot water, to take the place of sweets, tea, coffee, fats, and the like, is a sure cure. Saline purgatives, Rochelle salts, cream of tartar, sulphur soap and ointments, tar ointment, persist- ently used for a time, will abundantly repay all trouble and self-denial. Cream for Pimples. Lanolin, 8 ounces. Sweet Almond Oil, 8 ounces. Precipitated Sulphur, 8 ounces. Oxide of Zinc, 4 ounces. Extract of Violet, 15 drops. A very little of this ointment carefully applied to the pimples at even- ing will be found very effective. Refrain from the use of the face brush and other irritations until cured. Summer Rash. — There is an annoying form of pimple accompanied by a redness or rash, which usually comes upon the face and neck in summer. It is prevented by attention to the diet, as it is caused by irregularities in eating. Starchy foods, much meat, and heating foods of all sorts are to be avoided. Freckles. — There are two sorts of freckles, — temporary and per- manent. Temporary freckles appear after exposure to winds and strong sunlight; they usually disappear with shade and protection. Bathing the face frequently with soft water and pure soap, with liberal and ener- getic use of the face brush, will so stimulate the circulation of the blood that these freckles will soon disappear. Their removal may be hastened by the application of the cream and lotion given below. The cream is to be applied at night on retiring and the lotion several times, during the day : — Cream for Freckles. Ointment of Elder Flower, 1 ounce. Sulphate of Zinc, 20 grains. Lotion for Freckles. Infusion of Roses, 8 ounces. Citric Acid, 30 grains. This lotion is to be kept in a close stoppered bottle. If it irritates the skin, relief will be afforded by the use of the following : — 58 THE MAINTENANCE OF HEALTH. Healing Lotion. Boracic Acid, i dram. Witch Hazel Extract, 2 ounces. Rose Water, 2 ounces. Permanent Freckles. — The permanent freckle usually appears in winter and the cool weather. It can be removed only by the removal of the outer skin. This can be done without pain, although the applications will cause redness of the skin and some irritation while they are being used. When this occurs, the condition will be at once relieved by the use of the healing lotion given. Wash for Permanent Freckles. Lactic Acid, 4 ounces. Glycerine, 2 ounces. Rose Water, 1 ounce. This is to be applied carefully to each freckle so as not to involve the surrounding clear skin. The irritation which this will most likely cause may be allayed by using the following : — Ointment. Oil of Almonds, 4 ounces. Vaseline, . .3 ounces. Spermaceti, 1 ounce. Melt and add Tincture of Benzoin, 15 drops. Chapping. — Chapping of the skin of the face is prevented by the use of a veil as a protection against cold winds. The following cream is delightfully soothing for chapped face and hands : — Cream for Chapped Face and Hands. Spermaceti, J4 ounce. White Wax J4 ounce. Almond Oil, ]/\ pound. Cocoa Butter, Y\ pound. Lanolin, 2 ounces. Melt and add Balsam of Peru, 1 dram. Let it settle. Pour of! the clear liquid and add Orange Flower Water, 2 drams. Stir until it solidifies. Apply two or three times a day with a piece of soft cotton cloth or BLACKHEADS. 59 flannel. The face may be bathed in tepid water, with a little soap, an hour after each application. Tan and Sunburn. — Tan and sunburn may be removed by this lotion : — Lotion for Tan and Sunburn. Borax, 10 grains. Limewater, 2 ounces. Oil of Sweet Almonds, 2 ounces. If the skin is inclined to "peel" from the effects of the sunburn, after using this wash twice a day, the following wash, used every morning after washing, will relieve the condition : — Lotion for Peeling Skin. Sal Ammoniac, 2 drams. Alcohol, 2 ounces. Rose Water, 1 pint. Venetian Talc, 1 ounce. Yellow or Liver Spots. — Large yellow spots that form on the skin are produced by inactivity or irregularities of the liver. Small doses of calomel and the application of either of these lotions will soon cause them to disappear : — Wash for Liver Spots. Kaolin, 1 ounce. Lanolin, 1 J4 ounces. Glycerine, 1 ounce. Carbonate of Magnesia, y 2 ounce. Oxide of Zinc, J^ ounce. Apply at night on retiring and allow it to remain all night. Wash for Liver Spots. Oleate of Copper, 15 grains. Oxide of Zinc Ointment, y 2 ounce. Apply every night and morning. Blackheads. — Blackheads are formed in the obstructed pores of the skin, and consist of fatty matter surmounted by black accumulations of dirt. They are best removed by treating the skin for two or three weeks with the following cream, to soften the skin : — Cream for Softening the Skin. Lanolin, 1 ounce. Almond Oil, 1 ounce Tincture of Benzoin, V2. ounce. 60 THE MAINTENANCE OF HEALTH. Mix and rub well into the skin night and morning. This applica- tion is intended to so soften the skin that the blackheads may be squeezed out without danger of rupturing the delicate tissues or of leaving small scars. Wash the face well with good soap and hot water before apply- ing the cream. If after two or three weeks' treatment, the skin is not sufficiently softened to permit of squeezing the blackheads out by gentle pressure, recourse must then be had to green soap. The face is first to be bathed in water as hot as can be borne. Cloths wrung out of hot water are then to be applied and frequently renewed. This is to be con- tinued for fifteen minutes. The green soap is then applied by rubbing it well into the pores of the skin. It is a soft, jelly-like substance, pro- curable at all drug stores. The soap is then well rinsed from the face by several waters and with a free use of the face brush. This not only removes the soap from the pores but brings many of the blackheads away at the same time. The cream mentioned above is then applied to the skin, and the operation is repeated each night until all the blackheads have disappeared. Wrinkles. — A wrinkle is usually caused by the falling away of the adipose or fatty tissue between the skin and the muscles through weak- ness, disease or age. Age has been spoken of as that period of life when the waste of tissues is greater than the repair. Consequently wrinkles are to be expected after sixty. Prior to that they may be regarded as pre- mature. Then we must look for other causes which are capable of being removed. Those wrinkles that are an indication of character and temperament, if characteristic of undesirable qualities, can be removed only by the exercise of the opposite benevolent trait, which simply means a decided change in character and disposition. Those that are charac- teristic or indicative of good qualities are by no means to be considered as blemishes. A countenance devoid of lines is expressionless and un- attractive. Besides the wrinkles which are to be considered as the character lines of the face, there are lines and wrinkles formed by little habits and tricks of manner, which can be removed permanently only by stopping the objectionable practices. Then there are those wrinkles which come from illness, anxiety, care, and fretfulness. The great principle underlying, the removal of wrinkles is the improve- ment of the general health and observance of the laws of hygiene. By such means the layer of adipose tissue which gives roundness and fullness to the face and body, and which has disappeared, is to be restored with CLOTHING. 61 a view to filling out the hollows and vacancies between overlying muscles. Supplement these means with careful and skillful massage, the applica- tion of a good skin food, physical culture, and the cultivation of a happy disposition, and, probably, all of the available and requisite means are enumerated. Skin Food for Wrinkles. White Wax, i ounce. Spermaceti, i ounce. Lanolin, 2 ounces. Sweet Almond Oil, 4 ounces. Cocoanut Oil, 2 ounces. Tincture of Benzoin, 3 drops. Orange Flower Water, 2 ounces. Melt together the solids and the oils; beat until nearly cold; mix the benzoin and the orange flower water and add it a little at a time while beating. This is a valuable tissue builder to be used with massage when the skin is dry and wrinkled. There are many mechanical appliances for admin- istering massage but none of them is comparable to the manual method. Warts. — These are to be removed by tying a string around them when they are pendulous, or hanging by a stalk ; the string is to be worn until the wart falls off by reason of the stoppage of the supply of nour- ishment upon which it feeds ; or, when flat, the wart may be treated with nitrate of silver or lunar caustic. This comes in the form of a white pencil. The end of it is dipped in water and rubbed over the surface of the wart. On exposure to light the nitrate of silver turns jet black. Care must therefore be taken that the treatment is confined to the wart, and that the surrounding tissues are not touched. As the caustic burns the wart away, the surface of the wart is to be pared with a sharp knife and the treatment applied anew to the fresh surface. Care must be taken that the paring does not cause the wart to bleed. Other strong escharotics, such as strong or glacial acetic acid, nitric acid, caustic potash, tincture of iron, and hydrochloric acid, may be used by those who know something about their properties. But, as they are extremely dangerous in their effects if wrongly used, the caustic treatment is to be preferred. CLOTHING. As it is a part of the office of the clothing worn next to the skin to take up the perspiration and exhalations of the body, it follows that 62 THE MAINTENANCE OF HEALTH. frequent change of this is not only advisable on the score of comfort, but is absolutely necessary to health. The exhalations from the bodies of some persons, are quite profuse and offensive in odor. Especially is this true of the emanations from the feet even in spite of all attempts at cleanliness. Frequent changing of the garments, then, becomes im- perative. If the feet perspire copiously this may be checked by bathing the feet daily in water in which a small piece of alum has been dissolved. This has the effect of closing the pores by the astringent or puckering power of alum. The offensive odor may be gotten rid of by shaking talcum powder into the socks or stockings and shoes each day. The shoes should be dried out frequently, as the perspiration accumulates in them sometimes to an offensive degree. The underclothing in winter should be of wool ; and even in summer, wool or a mixture of wool and cotton known as merino, should be worn. Some skins are so tender that they will not bear wool next to it. Silk is ideally comfortable in summer, but, unfortunately, is debarred by its expensiveness. Woolen clothing worn next to the skin is almost a sure guarantee against chills after overheating or in cold weather. The danger of a chill is one of the greatest risks to which we are exposed, as it nearly always means at least a cold, and sometimes pneumonia or inflammation. Cotton garments when damp from perspiration become cold and uncomfortable; but, as was rather paradoxically said of a woolen undergarment, "It is always dry and warm no matter how cold and wet it is." The chief objection to woolen garments is that, even though great care be taken in washing them to prevent shrinking, they, in time, become stiff and hard, losing the absorbent properties which make them so comfortable and healthful. In cold weather woolen clothing is warm by reason of the pores or cavities in the fabric in which the air lodges; and air is one of the best non-conductors of heat. For, in addition to the necessity of keeping the cold out, much of one's comfort in winter depends upon keeping the warmth of the body in. A tightly fitting coat buttoned up is warmer than a loose fitting garment, as the former keeps a layer of non-conducting air next to the body. For the same reason two thin woolen garments are warmer than one thick one. In summer, light-colored clothing of cotton or linen is much cooler than dark-colored or woolen clothing. The great danger of taking cold lies in sudden changes of temperature where the climate is so variable that one does not know quite how to dress CLOTHING. 63 for the day. But in such cases it is rather better to err by providing clothing which is uncomfortably warm than to risk exposure in clothing that is too thin. Many attempts have been made from time to time to introduce sani- tary and hygienic clothing, but these efforts have been attended with but slight success. Not that the suggestions were not practical or meritorious from a sanitary and hygienic standpoint, but that the shapes and styles proposed were so much at variance with the prevailing fashions that no one had the desire or temerity to adopt them. It is generally true that women are not nearly so warmly clad as are men. This is, perhaps, because of the fact that they are not exposed to the rigors of climate and to the inclemency of the weather so much nor for so long a time as men are ; and also for the reason that it is a physio- logical fact that they have a much thicker deposit of subcutaneous fat than men have. At all events the dictates of fashion and the social demands appear to make them run very great risks on occasion. Cer- tainly the thin-soled slippers, thin stockings, low-necked and short-sleeved gowns in which they are so often seen in bad weather justify the fears that they do expose themselves injudiciously in compliance with the con- ventionalities of life and the customs of society. For protection against rain, the best material is one that will keep out the wet, and, at the same time, allow the perspiration and exhalations from the skin to pass off. The clothing must not be of such a nature as to permit rapid drying by evaporation while on the body ; for evaporation absorbs heat and causes a chill, which must always be avoided. So far as the perspiration is concerned, there should be rapid absorption and slow evaporation; and, regarding the rain, slow absorption and slow evaporation. Wool meets these requirements better than any other fabric. The wool is porous and therefore absorbs a great deal of water; being thick the water does not evaporate too quickly. In addition, the wool is warm. When woolen garments are treated with the well known water- proofing process, their efficiency as a protection against rain is increased. Waterproof materials of the rubber variety are objectionable because they are not porous and do not allow the perspiration either to be absorbed or to pass off. It is essential that the feet be kept dry. Snow water is more pene- trating than rain water. Under no conditions should one sit with either damp or cold feet. Dry, warm woolen socks or stockings should be put on at once. In the case of women, very often the edges of the skirts 64 THE MAINTENANCE OF HEALTH. become wet from rain or snow. The skirt should be changed, if possible, but certainly should be dried at once. No one should sit for any length of time with rubber overshoes on. These exert an uncomfortable drawing effect upon the feet, and are weakening. By reason of their being air tight, they interfere with the necessary ventilation of the feet. Bad effects are produced when chil- dren are permitted to wear rubber overshoes during school sessions. Tight Neckwear. — A great deal of eye trouble and headache is directly traceable to the wearing of tight collars and other neckwear. These have the effect of constricting the throat and of interfering with the circulation of the blood. The neck is provided with large and impor- tant blood vessels which supply the brain and some organs of special sense. If this fresh supply is prevented from reaching the brain, or if the return of the impure blood from the brain is impeded, as is often the case when bending or stooping over a tight collar, the effects are neces- sarily injurious. The effect is quite the same as when a string or rubber band is tightly tied around the finger. The constriction of the blood and its retention and congestion in the head produce many eye troubles and headaches. Changing Underclothing. — It is the habit of many people to change the underclothing for a lighter or heavier weight at the change of seasons. There are some, however, who wear the same weight all the year around, and who regulate their health and comfort by the weight and number of the outer garments. Where the change is made, especially from a heavy to a lighter weight, it must be done with care and judgment. It is best to make the change in the morning on rising, and to select a fine, mild day for the purpose. These conditions are most favorable and least dangerous. Hardening Children. — The habit of dressing children rather lightly for the purpose of hardening them and of inuring them to cold, very often falls little short of cruelty and inhumanity. If immediate bad results from this practice are not noticeable, parents are often inclined to think well of it and do not take into consideration that they are plant- ing the seed of future disease and are undermining the child's health. It is most reasonable that the use of short stockings and the exposure of several inches of bare legs to cold winds in chill weather must be not only uncomfortable but decidedly dangerous. It is a safe rule in the dressing of children for protection against cold to clothe them as far as possible in woolen garments throughout. CARE OF THE HAIR. 65 Too Much Clothing. — On the other hand, there is a possibility of overclothing* one's self. The proper protection in a variable climate requires care, judgment, and observation. The greatest safety lies in uniformity under like conditions. Wrapping and bundling up the throat and neck is dangerous, not so much from doing it, as from the neglect to do it on a cold day after the organs have become accustomed to the protec- tion. One's own comfort is a safe guide to follow in the matter of clothing. Exercise and Food. — It is by exercise and proper food that the body is invigorated and not by insufficient clothing and exposure. Nor should weight of clothing be mistaken for warmth. Laboring under this mis- taken notion, feeble persons are often seen exhausted and weakened by an incredible weight of clothing. Especially is this mistake prevalent in the matter of bed clothing. One is more likely to be deceived in this connection by cotton clothing and fabrics than by woolen goods. Tight Waist Clothing. — Much has been written and spoken against wearing tight garments and supports around the waist. A general tirade and an energetic crusade have been conducted with little effect against the corset. Corsets have always been worn by civilized races, probably always will be worn; fashion dictates their use, and women require the support which they give. But all of this does not lessen or justify the injury of excessively tight lacing by women, or the tight belt which the summer or negligee dress of men has so much encouraged. In these cases the constriction of the waist and abdomen displaces the organs and pre- vents deep abdominal breathing. The breathing of women differs essen- tially from that of men. Woman's breathing is largely chest breathing. Few of them know the pleasure and value of deep, hearty breaths, and on this account the regular practice of breathing and chest expansion exercises, night and morning, are strongly recommended. CARE OF THE HAIR. The hair is designed as a protection against heat, cold, and injury from blows. It is a modified or changed form of the cuticle or skin. It is found on all parts of the body except the palms of the hands and the soles of the feet. The luxuriance of growth varies greatly in dif- ferent persons and is largely influenced by heredity, temperament, and constitution. Each hair is tubular in shape, and is composed of hard, colorless scales, which overlap one another like shingles on a roof. The interior of the hair is hollow or porous. Buried well down in the true 66 THE MAINTENANCE OF HEALTH. skin is a bulb, the papilla, where the growth of the hair proceeds at the rate of from five to seven inches a year by the constant formation of numerous cells. When a hair is pulled out, this bulb is seldom injured, but produces a new hair. If the papilla is in any way injured or de- stroyed, the hair can never giow again. The lower part of the bulb is supplied with small nerve and blood-vessel connections for both sensa- tion and nourishment. The space around the bulb is the true seat of growth and of life, and is known as the follicle. A little above these parts is a small muscle interlaced among the fibers of the skin. These small muscles contract with cold and under other influences. This con- traction puckers the skin and causes the hair "to stand on end." Above this are the two oil or sebaceous glands which secrete an oil to keep the hair soft. Baldness is due to the death of the follicle, and the peculiar shiny appearance of the scalp is a sign that this stage has been reached. No effort will then produce a new growth of hair. When baldness begins there is necessity of arresting the process and of taking good care of the hair that is left. Color of the Hair. — The color of the hair is due to the presence of a mineral ingredient in the pigment, or coloring matter, in the cells. It is said that the various colors of the human hair have all been caused by the mixture of three primary colors : red, yellow, and black. Yellow hair has the yellow coloring matter alcne; browns, reds, and dark hair are composed of varying mixtures of all three; and the blackest of all hair has some red coloring matter mixed with the black. Chemical analysis shows that yellow or very light hair is colored by salts of mag- nesia; the browns and dark hair owe their color to the presence of sulphur; and black hair is so colored by iron. These mineral coloring matters are affected by both age and health in this order : iron, sulphur, magnesia. Accordingly it is observed that black hair usually turns gray first, and blond hair retains its original color much later in life than the other shades. Cleanliness. — There is a prevalent prejudice against washing the hair on the ground that washing removes the oil from the hair and tends to make the hair dry, brittle, and liable to split. If the washing is done in such a way as to bring about these results, it certainly is injurious. But it is the method that must be changed rather than the practice stopped. Absolute cleanliness of the scalp is necessary to the healthy growth of the hair. The scalp is a part of the skin. It has its exudations of per- WASHING THE HAIR. 67 spiration and of fatty matter just as the rest of the body has. The accumulation of this matter and the clogging of the pores is quite as inju- rious in the scalp as in any other part of the body, and the removal of the matter is just as necessary. There is also an accumulation of acci- dental dirt on the scalp and the adherence of particles of dust and dirt to the hair which must be removed. It is not by the practice of washing the hair once a week that the injury is done, but by the use of much soap and ammonia and other harmful ingredients of shampoos that this condition of the hair is often brought about. Some consider that the use of the brush and comb is sufficient to keep the hair clean. The object of the comb is to straighten the hair and to prevent matting and tangling. It also produces some slight electrical stimulation at times. The comb should not be used to violently scratch the scalp, as this sets up inflammation and causes a heavy growth of dandruff as well as an annoying irritation. The brush is intended to evenly distribute the natural oil of the hair throughout its length, and, while the brush should be fairly stiff to perform this work, it should not have wire bristles, as these are more harmful than the harshest possible use of the comb. The natural oil of the hair is quite as well able to withstand the application of water as are the feathers on the back of ducks and other aquatic birds. Water without soap will not affect the oil of the hair, for oil and water do not mix. If a lather is desirable in washing the hair, it can be produced most abundantly by using the white or the yolk of an egg. After the hair has been thor- oughly wet with the water the egg is applied and well rubbed in. The lather which results has great cleansing power on both the scalp and the hair without disturbing the oil of the hair. When the lather is well washed out, the hair and scalp are both in splendid condition. The albumen of the egg has also some effect in soothing any irritation which may exist, for it is a good emollient application to inflamed surfaces. Dandruff. — This is a natural formation on the scalp and is not a disease. But if the deposit is excessive so that it cannot be removed by ordinary cleansing methods this indicates an unhealthy condition of the scalp. In obstinate cases either of the following applications will be found helpful and efficient :— For Dandruff. Yolk of one egg. Hot Rain Water, 1 pint. Spirit of Rosemary, 1 ounce. 68 THE MAINTENANCE OF HEALTH. Beat the mixture together thoroughly, and, while warm, rub it well into the scalp. Rinse well in several waters. To Prevent Dandruff. Oil of Rosemary, i dram. Liquor Ammonia, 2 drams. Glycerine, . . . 1 ounce. Oil of Thyme, 1 dram. Tincture of Cantharides, 2 ounces. Mix with 12 ounces of rose water. Apply this well to the scalp, rubbing it in vigorously. Continue its use until the dandruff disappears. Dandruff Lotion. Tincture of Cantharides, ■ T / 2 dram. Solution of Carbonate of Potassium, iy 2 drams. Extract of Rosemary, 1 dram. Distilled Water, 4 ounces. This is to be applied and well rubbed into the scalp after the hair has been thoroughly washed. Ventilation. — The hair like other parts of the body requires to be well ventilated. Fresh air must have access to the scalp, and the ema- nations from the pores of the scalp must be permitted to escape. This is true of all parts of the body, but the penalty exacted for its violation in regard to the scalp is greater by the weakening of the hair and its ultimate loss if persisted in. Consequently heavy headgear, wearing the hat in the house and office, and the tight coiling of the hair by women are injurious to the hair. The removal of the hat on occasions, to which good manners obligates men, is, therefore, beneficial to them. It is claimed by many scientists that ill ventilation of the scalp is one of the most fruitful causes of baldness. The necessity of keeping the head cool at all times has passed into a proverb; but experience shows that too often a proverb slips glibly from the tongue without making much impression on the mind. Friction and Massage. — The point at which friction of the scalp, or scalp massage, is directed is the circulation of the blood in the scalp. The indications of imperfect circulation are : dryness of the hair, brittle- ness and consequent breaking and splitting of the hair, excessive oiliness, and persistent dampness at the roots of the hair from perspiration. When it is remembered that the circulation of the blood through the scalp is the CARE OF THE HAIR. 69 means by which the tissues are fed and nourished, it will be easily seen that, if the circulation is imperfect, the whole tissue and all of its de- pendents will suffer; and that if the circulation is restored to its normal condition, growth will be stimulated and decline and decay will be ar- rested. Scalp massage, if properly performed, will do that very thing. Fig. 6. Massage of the Hair. First Movement. The stimulation of the blood vessels in the scalp by massage is compara- tively easy, since there is a strongly resisting surface of bone throughout against which gentle pressure is ex- erted. It is not nearly so hard as to treat by massage those deep-seated vessels which are surrounded by soft yielding tissues in other parts of the body. Fig. 7. Massage of the Hair. Second Movement. Fig. Massage of the Hair. Third Movement. Ill administering scalp massage, the hair, if long, should be loosened and parted in the middle. The fin- gers are placed close together, with the tips upon the scalp, and gently forced into and upon the scalp from the crown towards the forehead. The en- tire surface of the scalp is gone over in this manner. Next the tips of the slightly sepa- rated fingers of both hands are pressed into the scalp with a rotating motion. This treatment is applied to the entire surface of the scalp. The fingers are then separated, and yo THE MAINTENANCE OF HEALTH. the head is struck gently with a sidewise action of the hand, the little finger of both hands striking the scalp first. At the moment of striking, the other fingers loosely held, strike against the little fingers only. This has the effect of a series of blows, gentle at first, but cumulative in their effects when rapidly performed. This treatment is given to the entire scalp. Itching. — The itching of the scalp, which usually accompanies the excessive formation of dandruff, is extremely annoying and uncomfort- able. There is strong probability that it is occasioned by a parasite. If this be the cause, it will quickly respond to a few washings with bichloride of mercury soap, or, as it is often called, sublimate soap. This is a good agent for killing parasites and also for relieving itching of the skin in other parts of the body from other causes. Falling Hair. — This is to be regarded as a sign of general debility and of failing health, but only when it is persistent. It does not apply to the occasional falling of the old hair which is displaced at times by a new growth. There need be no alarm over the matter unless the fall of hair continues. It frequently follows fevers and other weakening diseases. It must be, first of all, attacked by building up the system with a good course of tonic medicines taken internally. Sometimes the cutting of the hair is necessary, and, in the case of men, this should be done fre- quently. Cleanliness is to be faithfully observed, and one of the follow- ing lotions may be applied with advantage : — For Falling Hair. Eau de Cologne, . . . 2 ounces. Tincture of Cantharides, .2 drams. Oil of Lavender, 10 drops. Oil of Rosemary, 10 drops. Mix thoroughly and rub a little into the scalp night and morning. For Falling Hair. Beef Marrow, 6 ounces. Nervine Balsam, 2 ounces. Peruvian Balsam, 2 ounces. Oil of Almonds, 1 J / 2 ounces. Extract of Cantharides, 16 grains. Melt the marrow and the nervine balsam in the oil; strain and add the Peruvian balsam, and, lastly, the extract of cantharides dissolved in one dram of rectified spirits, CARE OF THE HAIR. 71 Rub the pomade into the scalp night and morning for a week. Too frequent, or too liberal, application will cause soreness. In that event use less and apply only once a day. For Falling Hair. Fresh Lemon Juice, 1 dram. Extract of Peruvian Bark, 2 drams. Beef Marrow, 2 ounces. Tincture of Cantharides, 1 dram. Oil of Lemon, 20 drops. Oil of Bergamot, 10 drops. Mix by melting and stirring. Wash the head and dry thoroughly at night. Next morning apply a little of the pomade and rub well in. Continue the application for four or five weeks. For Falling Hair. Burnt Alum, iy 2 drams. Biborate of Soda, iy 2 drams. Beef Marrow, 1 ounce. Essence of Bergamot, 6 drops. Mix by melting and stirring. Rub well into the scalp night and morning. For Falling Hair. Oil of Mace, iy 2 ounces. Olive Oil, . .- 2 drams. Aqua Ammonia, 1 y 2 drams. Spirits of Rosemary 1 ounce. Rose Water, 2^ ounces. Mix and rub well into the scalp night and morning. For Falling Hair. Bay Leaves, 2 ounces. Whole Cloves, y± ounce. Spirit of Lavender, 4 ounces. Spirit of Thyme, 4 ounces. Mix and allow to stand for six days, shaking the mixture well once a day. Filter, or strain through very fine cloth. Add half an ounce of ether. Apply a little night and morning, rubbing well into the scalp. J2 THE MAINTENANCE OF HEALTH. For Falling Hair. Hydrochlorate of Jaborandi, 6 grains. Tincture of Jaborandi, 4 drams. Spirit of Rosemary, 2 drams. Vaseline, 4 ounces. Alcohol, 4 ounces. Apply every night. Rub well into the scalp. For Falling Hair. Eau de Cologne, 8 ounces. Tincture of Cantharides, 1 ounce. Oil of Lavender, Y 2 dram. Oil of Rosemary, y 2 dram. Mix. Shake well. Rub into the scalp twice a day. For Falling Hair. Castor Oil, . 1 ounce. Bay Rum, 1 ounce. Tincture of Cantharides, 1 dram. Mix. Shake well. Rub into the scalp night and morning. Gray Hair. — Heredity has much to do with prematurely gray hair. Although, after the tricks of heredity, the inheritance may skip a genera- tion, and the fact that one's father or mother was not gray is no proof that heredity has nothing to do with this special case. One must look farther back before deciding. Well authenticated cases are on record of the sudden changing of the hair under the influence of fright, grief, illness, and anxiety. Sometimes the change is gradual and the beginning of it may date from one of these influences. Some people object to the intervening stages of yellowish gray color through which the hair gen- erally passes and seek to change the color to white at once. There is no way known by which this can be done without injury to the hair. Gray Jiair may be slightly darkened by the use of one of the following applica- tions, but they are in no sense of the word hair dyes : — For Darkening the Hair. Glycerine, . . 1 ounce. Rose Water, 1 ounce. Mix and rub well into the roots of the hair each morning. This is not at all injurious, and is sometimes used for darkening hair which has not turned gray. CARE OF THE HAIR. 73 For Darkening the Hair. Green Tea, i ounce. Freshly Dried Sage, i ounce. Rain Water, I pint. These are to be boiled in an iron \*essel and allowed to stand in it for 24 hours. Rub well into the roots of the hair night and morning. Homemade hair dyes are rarely a success. The changes of the com- plexion and of the skin keep pace with the changes of the hair. When the latter is dyed, ever so successfully, there is at once such a subtle, per- ceptible lack of harmony between the complexion and the dyed hair that no one is deceived by the practice. Gray hair, when well kept, is becom- ing, and is regarded with more and more esteem every year. When a dye is not well applied, the hair streaks, and if the hair is not regularly treated, the gray roots of the hair are sure to be most conspicuous. The dyes which contain lead are positively injurious and should never be used. Bleaching the Hair. — The woman who yields to the desire for golden hair when Xature decreed another color, assumes a terrible burden of discomfort and anxiety. The difficulties of the bleach by the peroxide of hydrogen are a tremendous price to pay for an adornment that seldom deceives any one but the wearer. The roots of the hair, being rich in natural coloring matter, are always darker for an inch or two next to the head than the rest of the hair; and the tips of the hair are always much lighter, to say nothing of the variegated streaks of natural color which will persist in showing, even after a whole day has been spent on the operation of bleaching. Hair that has been bleached may be returned to its original color only by the use of a dye until it changes ; or one may heroically stop the use of the bleach and let the color return openly. The tips of the hair, however, will never resume the original color. They will always remain tow white, and must either be dyed or sacrificed by cutting. Apart from this, peroxide used alone, if chemically pure, will not injure either the constitution or texture of the hair. The great harm is done by the admixture of ammonia, which hairdressers sometimes use to hasten the process. Superfluous Hair. — Probably nothing entails so much mortification and suffering upon a sensitive woman as a growth of hair on the face and arms. As far as the face is concerned, there is only one certain method for the permanent removal of such a growth, and that is by the electric needle. Yet this method is slow, painful, and expensive. It is necessary that the needle be inserted into the root of the hair with accuracy and pre- 74 THE MAINTENANCE OF HEALTH. cision in order to kill the hair at the root. Even by the most expert operators this is done only about ten times in a hundred. If he is not skilled, the face is likely to be further disfigured by scars and eruptions. If persevered in, with this ratio of failure of the hairs treated at a sitting, it will, after much suffering and great expense, prove successful. Those who cannot afford this method or who dare not face it, then turn to chemical hair removers known as depilatories. Many are on the market, and the most absurd claims are made as to their efficacy. But let it be said that there is not yet a single preparation discovered which will perma- nently remove the hair. Most of these preparations remove the growth temporarily ; it returns more luxuriantly and abundant than ever. Hair on the arms may be removed by the use of pumice stone. This wears the hair down to the surface of the skin so that it cannot be seen. Some resort to the heroic means of pulling the hairs out by the aid of tweezers. It is needless to say that in all of these cases the hair comes in again stronger than ever. CARE OF THE NAILS. Like the hair, the nails are regarded as modifications of the skin. Their uses are to protect the tips of the fingers, where the sense of touch is extremely delicate, and the toes; also to enable us to pick up small objects easily. The nail is inserted in a groove of the skin, known as the matrix, and is attached to the flesh by what is popularly known as the quick. The growth takes place from a multitude of cells at the root of the nail. The growth of the nail has been measured by making a mark at the base of the nail and then observing the length of time elapsing before the mark has moved or grown up to the tip or end. It has been found that the thumb nail grows from its root to the free end in five months ; the great toe nail in ten months. There are several marks which can be observed on the nails. Ridges running up and down the nail are caused by scraping the surface of the nail either with a knife or file. This practice causes an uneven growth or roughness on the surface in which dust accumulates and destroys the polish. The treatment for this condition is to stop the practice, and to polish the nails with the nailbrush. The same effect is also produced by the habit of scraping the inner surface of the tip of the nail with a knife or sharp steel tool when cleaning the nails. White spots or flecks on the nails are due to an interruption in the circulation of the blood MANICURING. 75 under the nail, and often result from blows, scraping, or slight cuts of the nail surface. Heavy blows on the nails cause black and blue discolor- ation by escaping blood from the -ruptured blood vessels. The loss of the nail nearly always follows this condition. The moon-shaped, light-colored parts at the base of the nails are caused by a difference of the circulation of the blood at that part. These are regarded as elements of beauty in the nails and are to be preserved. Ridges sometimes run across the nails. These are caused by severe illness or periods of great weakness, during which time the growth of the nail is not so active as before and after the attack. One can tell, often, by these ridges that a person has had a severe illness, and by estimating the location of the ridges on the nail can form some idea of the date of it. This is one of the mysterious observings of palmistry. Hygiene of the nails requires that the tips or free ends of the nails be kept scrupulously clean. The accumulation of dirt under the nails, besides being uncleanly, is often of a poisonous nature; it is the direct cause of serious consequences when children pick a sore. This accumu- lation of material under the nails is also a common means of communi- cating disease. It is most conveniently removed just after washing the hands, and by using the nailbrush over the extremities of the fingers. The nail is nearly surrounded, except at the free extremities, by a pro- tective sheath, which should not be allowed to adhere to the nail, as it grows with, or is drawn along by, the growing nail. After a time it breaks or splits, forming the painful agnail, commonly called hangnail. This can be prevented by pushing the sheath back from the nail gently while the hands are still moist from washing. A sharp edge should never be used for this purpose ; the towel is much better. If these sheaths become ragged from neglect of this simple means, they may be snipped off with scissors to prevent more serious tearing. It is, perhaps, unnec- essary to say that good breeding and a proper regard for the comfort of others require that all of this attention to the nails is to be performed in private with the rest of one's toilet. Manicuring. — The proper and systematic care of the nail is known as manicuring. It is an act which any and all can perform, as it is extremely simple. Professional manicurists surround themselves with almost as many tools as a dentist. But these are not at all necessary. A satisfactory and complete outfit is extremely simple and inexpensive. 1. Nippers for cutting the nails are much more convenient and effective for personal use than are either curved or straight scissors, or ~: THE MAINTENANCE OF HEALTH. a knife. In fact a knife should never be used for treating the nails; for, while there are a very few little attentions which it can give well :; :he rails rhere is su:h rrea: :err::ar:r :: r:ake inrrrre: arc inju- rious use of it. 2. A nle for smooth- ir.g- iv. i sharirr the eires of the nails after cutting with the nippers. It should Nau. Nippers. ** of me finely cut variety known as the velvet file. J. A bur. lie :: zrarrre ~rz>:-i sticks ::: :learir.r :he exrre:ri:ies ::r rushirz; ":a:k :he shear: :r:r: rhe base arb sibes :: rhe rails 4. A piece of chamois leather or a buff er for polishing the nails. 5. A box of rose-cokir^ ;b ;as:e. 6. A box of nail powder. 7. A piece of pumice to remove spots or roughness. 8. A jar of Amandine. With this equipment anyone may keep the nails in excellent condition by the expenditure of a little time and trouble. The regular operation of manicuring need not be performed oftener than once a week. The tips of the fingers of one hand at a time are covered lightly with Amandine. This is a preparation of gum arabic. honey, almond cream, almond oil, and perfumed with bitter almonds or attar of roses. It is too difficult to be made borne, and r a be bought ready prepared. The white variety is :vt purer. The effect of Amandine is cleansing s :::tr ::r arb heakrg\ The harb is r:er s:akei ::r several rrirures ir warm water, after which it is to be carefully dried. Xext. the sheath around the nails is gently pressed back from the naiL This may be done, if it is free, with a towel or soft napkin. If it adheres in the rail use rhe :rarre : : : s:i:k :: free i: :u: re e: use :-. l-r:i:e :: a i:t:^ instrument. The nails are then cut with the nippers. The object to be sought in cutting is to secure a perfectly oval form, and to have the nails as nearly as possible all of the same shape. This may take time to effect by reasrr :f previous bai habits. Tbt i::uurula:i ::: :: rarer :,: r;e :ir 5 of the nails is to be removed by means of the orange wood stick. Xever use knife or steel in doing this work. The orange wood stick is whittled to a flat chisel-like point for this purpose. The soft file is then used on the edges of the tips of the nails to give smoothness and evenness to the edge. Remove roughness and ink spots with pumice stone. Dis- CARE OF THE NAILS. 77 colorations of the nails may be removed by the use of a little vinegar or lemon juice. A little rose paste is then placed upon the nail surface. It is made as follows : — Rose Paste for the Nails. Spermaceti, iy 2 ounces. White Wax, 9 drams. Oil of Almonds, 12 ounces. Alkanet Root, 2 ounces. Attar of Roses, 1 dram. The first four ingredients are melted together and strained; beaten well until nearly cold; and the attar of roses is then added. A fairly thick coating of powder is then dusted over the paste and the nails are polished with the chamois skin or the buffer. The rubbing or polishing is always to be across the nail, never /up and down. The nail powder is made as follows : — Powder for Polishing the Nails. Silicon, 8 ounces. Oxide of Zinc, 2 ounces. Pulverized Pumice, y 2 ounce. Rose coloring matter. These are ground fine in a mortar and passed through a very fine sieve. The preparations which are given may all be procured ready com- pounded at drug and department stores. Homemade remedies, while they are guarantees of the purity of the preparations, are usually difficult to manufacture. During the rest of the week, vigorous scrubbing with the nailbrush and careful pressing back of the sheath around the nail is all the care required to keep the nails in good order, with, of course, regular daily cleansing of the extremities with the orange wood stick. CARE OF THE ORGANS OF RESPIRATION AND OF THE VOICE. Protection Against Cold. — The effects of cold are, perhaps, most commonly and severely felt in the organs of respiration and of the voice. They are : the larynx, the trachea, and the lungs. These organs require 78 THE MAINTENANCE OF HEALTH. constant and watchful care and protection against cold. The principal and best methods of protection are : frequent bathing of the chest and throat in cold water and subsequent vigorous rubbing; and by proper clothing. For those who are susceptible to cold in these organs, more than ordinary warmth of clothing is required. A woolen undervest or chamois jacket, or a few folds of newspaper, are effective means of pro- tection against cold and winds, especially when driving. But such pro- tection must not be worn one day and discarded the next. With some persons it is customary, after a fever square or mustard plaster has been applied to the chest, to wear for a time a protective covering of cotton wool upon which a little dry mustard has been sprinkled. Great care must be observed in leaving this off; and equally great care be taken that it is not worn too long. For these protective coverings owe their efficacy to the fact that they are nearly impervious to air, and, conse- quently, do not allow the emanations of the body to pass off freely. Cold in these parts manifests itself, as in other parts, by inflamma- tion, more copious secretions, and in efforts to allay irritation or to expel accumulated secretions by coughing. The condition of inflamma- tion and the part affected are usually indicated in the name of the disease, by attaching the termination "itis" to the name of the part or organ so affected. Laryngitis is inflammation of the larynx; tracheitis is inflammation of the trachea; and so on. All of these diseases are dealt with in detail elsewhere. It is here desired to make clear the care that must be taken to avoid cold, chills, draughts, and exposure, which are certain to bring these diseases on. Vocal Cords. — As the vocal cords are situated in the larynx, affec- tions of these parts are generally accompanied by hoarseness or partial loss of voice. There is a form of inflammation of the larynx, which is caused by long, loud, and continued speaking. It is known sometimes as "Clergyman's Sore Throat." The vocal cords are not cords at all, but thin, delicate, muscular membranes stretched across the glottis. When they are used too long, or too vigorously, they become inflamed and cause pain and irritation of the throat. They are more in repose in speaking than in singing ; and more in repose when there is slight modu- lation of the voice than when there is considerable range to the speaker's tone. It is a great art, and one which all speakers and singers should strive to cultivate, to save the voice as much as possible. It is said that the admirable art of reading aloud pleasantly, easily, and for a length of CARE OF THE LUNGS. 79 time, is passing away. The cultivation of the pure tone in reading and the habit of reading aloud for an hour at a time is a splendid vocal and throat exercise, if it is done properly. A pleasant speaking voice is a desirable possession ; and it is something that every one may gain by proper practice and training. The cultivation of the voice is not con- fined to speakers and singers, but should be striven for by all, as one of the requisites of a good conversationalist. Nose Breathing. — One great protection against cold and other affec- tions of the throat and lungs is properly conducted nose breathing. Espe- cially is this true in winter cold and in damp weather. The habit of taking the cold air through the mouth and into the throat and lungs without the slight but necessary warming that it gets in passing over the surface of the inner nose, is responsible for much disease. Dangerous Occupations. — There are many occupations in which the workmen who carry on the several processes are obliged to inhale poisonous and injurious matter. The dust of coal mines; the particles in iron, lead, tin, and copper mines ; the clay particles in pottery making ; the dust from steel in grinding and polishing; the poisonous gases, and vapors in chemical works and paper mills ; the fire damp of mines ; the chlorine and sulphur fumes in bleaching mills; the carbon bisulphide in rubber works ; and the phosphorus in match factories, all exert a poison- ous and injurious effect upon the workmen, despite the best preventive efforts and sanitary methods. All the forms of throat and lung trouble result from these occupations, and they materially shorten the lives of those engaged in them. Cold Water Application. — The method of taking the cold water applications recommended to those who have delicate throats and lungs, and who are susceptible to cold in these organs, is not by gentle applica- tions with a cloth or sponge, as in a sponge bath. More vigorous treat- ment than that is required. One must strip to the waist and splash the cold water repeatedly upon the chest and throat — at least a dozen times, more if it can be borne, — and follow it quickly by a vigorous rubbing with a coarse towel. It is a nerve treatment, and the involuntary gasp that is evoked by the splashed water is proof of both its efficacy and need. The glow and the after effects will abundantly compensate for the momen- tary discomfort. If cold water cannot be borne at first, let the taking of it be a matter of education, and begin with water as cold as can be borne, and gradually reduce the temperature of it. It is recognized by all medical authorities as the most effective means of invigorating the 8o THE MAINTENANCE OF HEALTH. parts and of rendering one able to withstand the cold and rigors of a northern climate. It is an infinitely better and safer treatment than the habit of burdening the throat and neck with wrappings. Bad Sitting Position. — Incorrect habits of sitting are both a means of producing bad effects upon the organs of respiration and also an indi- Fig. 10. Correct Sitting Position. Fig. Incorrect Sitting Position. cation of weakness in these organs. Any position of body which does not allow free play to the lungs and the unrestricted ingress and egress of sufficient quantities of air into them, is at once characterized as a bad one and should be corrected as speedily as possible. The outward signs of weakness and the effects of bad position are stooped shoulders, Fig. 12. Desk Too High. Fig. 13. Desk Too Low. fiat or hollow chest and listless movements. Bending over the work at desk or table is the most prolific cause of these ; and the results are more pronounced when the subject is afflicted with near-sightedness, which necessitates a more cramped position. One of the first points to which CORRECT POSTURE. 81 attention should be directed is the proper height of the chair. It must not be too long in the legs, as that causes the sitter to keep the feet dangling a few inches from the floor, which interferes with the circula- tion or compels him to sit on the front edge of the chair in the effort to have the feet rest upon the floor. This latter position throws the upper part of the body forward over the desk or table. Where high stools are used, there must be an adequate and properly adjusted foot rest. There must also be a properly proportioned height of both chair and desk or table to insure comfort. If the desk is too low, the subject is sure to bend over; if the desk is too high, the work is brought too close to the eyes. Little children ought to be supplied not only with a high chair, but also with a small chair and a low table adapted to their size. This inexpensive recognition of their needs will go far towards preventing the evils of flat chests and round shoulders. The habit of crossing the legs while sitting is injurious, as it interferes w T ith the circu- lation, even to the extent of putting the foot "to sleep." Sometimes the sharp edge of a chair presses too tightly upon the blood vessels of the legs and stops the circulation. Bad Sleeping Position. — An unhealthy and injurious position in bed is the result of using too many pillows. For those whose chest development is not all that is to be desired, or for those who are flat- chested or round-shouldered, one small, flat pillow is sufficient. The pillow may properly be as thick as the distance from the neck to the out- side point of the shoulder, which is sufficient to keep the head in the proper position when a person lies on the side. Lying propped up with several pillows after a day spent over a desk or table is certain to be the cause of the defects mentioned. Such a pillow as suggested and a not uncomfortably hard bed will insure a proper position or body for at least eight hours out of the twenty-four. Correct Standing Position. — To insure a correct standing position that in use in the army may well be followed, for it is the result of years of experience and the survival of the fittest of all suggestions. Stand squarely on both feet, heels in line, toes turned out, legs straight, hips slightly drawn in, body erect, chest expanded, shoulders square, head erect, chin slightly drawn in, and eyes looking straight to the front. The habit of taking this correct position and of maintaining it for several minutes at frequent intervals during the day will prove very beneficial. In order that one may realize how far one's ordinary, customary carriage deviates from this ideal, it is a good plan to stand 82 THE MAINTENANCE OF HEALTH. with the back against the wall or a door and align the body with it by forcing back the shoulders and head so as to touch it in all possible parts of the back of the body, and then allow the body to relapse into the cus- tomary attitude. The per- ceptible difference of posi- tion will guide one as to one's need of this exercise. The bad fit of clothing at the neck and shoulders is often caused by the unconscious assumption of a more than usual erect position of body at the time of fitting, and the subsequent relapse into the habitual position. Flat Chests and Round Shoulders. — For flat chests and round shoulders, the breathing exercise is an invaluable means of improvement. It is capable of many variations and modifications which, regularly performed, will undoubtedly be of great benefit. Fig. 14. Correct Standing Position. Fig. 15. Incorrect Standing Position. Exercise No. i. Stand erect, exhale deeply, bring the arms out straight in front of the body at full length, the palms touching. Slowly inhale as deeply as possible, and at the same time gradually bring the arms, with a per- fectly horizontal sweep, out at right angles to the side of the body, and as far back as pos- sible, at the same time rising upon the toes. Maintain this position for a moment. Then slowly exhale as deeply as possible and bring the arms back gradually to the former position in front of the body, and sink to the flat of the foot again. Fig. 16. Position i. Fig. 17. Position 2. EXERCISES TO CORRECT DEFORMITIES. 83 Light wooden dumb-bells, not exceeding a half pound in weight, may be used to advantage in this exercise. (See Figs. 16 and 17.) Exercise No. 2. Drop the arms to the sides at full length. Exhale deeply. Slowly raise the arms at full length above the head, palms touching, at the same time taking a full, deep breath, and raise the body upon the toes. Maintain the position for a moment. Then slowly exhale as deeply as possible, let the arms fall back to the former position at the sides, at the same time exhaling deeply, and sink to the flat of the foot again. Dumb-bells may be used to advantage in this exercise. Fig. 18. Exercise No. 3. Take a step forward with the right foot, slightly bend the right leg at the knee, keep the left leg straight. Bend the arms at the elbow and place the clenched fists on the chest. Exhale deeply and thrust out the arms alternately straight out to full extent, with as much force and in the same manner as in striking a punching bag. Inhale deeply and slowly. Reverse the position by throwing forward the left leg and repeat as before. Figs. 19 and 20. Dumb-bells may be used to advantage in this exercise. Exercise No. 4. With dumb-bells. Let the dumb-bells rest lightly upon the shoulders. Bend the arms with the elbows close to the sides. The arms are then thrown out straight in front of the body. These movements may be performed both simultaneously and alternately. Fig. 21. Exercise No. 5. With or without dumb-bells. Place the hands on the chest. Arms bent at the elbows. Exhale deeply. Throw the arms backwards at full length and inhale deeply. The effect of this movement is the forcible expansion of the chest. Fig. 19. Position 8 4 THE MAINTENANCE OF HEALTH. Fig. 20. Position 2. Exercise No. 6. With dumb-bells. Let the dumb-bells rest lightly upon the shoulders. Arms bent and upper arm at right angles to the body. Alternately extend the hands as high as possible with a reaching motion above the head. Exhale and inhale deeply and slowly. Fig. 22. Practise all of these exercises moderately at first; gently increase both speed and length of time as fast as it can be borne. Perform with loose clothing in a well ventilated room, preferably on rising and before retiring. Several of the exercises are to be taken at one practice to vary the monotony. Two or three months of faithful practice will work wonders in devel- oping a full chest, and in straight- ening the shoulders. Keep up the splash bath of cold water upon the chest and follow it with vigorous rubbing. Let the bath precede the practice rather than follow it. If you are wearied or fatigued with work or other exercise, do not take your practice. Never take it just after eating. For the rest of the day make up your mind that cer- tain and positive means must be taken to remedy these defects. The will power must be exercised to break the bad habits, and the exercises which are taken must be faithfully followed up. It is comparatively easy to correct the faults and to incul- cate good habits and an erect carriage in young people ; this can also be very successfully conducted in the case of middle-aged persons; and even old persons need not despair. But forgetfulness, inattention, and irreg- ular practice of the exercises will not do. Persistence and determination are required, and beneficial results are sure to accrue. Running and skipping the rope are also excellent exercises for developing the chest in the case of young people who are flat-chested. But both exercises must be practised in moderation. Fig. 21. Position 2. Fig. 22. Position AIR AND VENTILATION. 85 Singing and voice culture are strongly recommended in all cases of weak organs of respiration. Much care must be taken, however, in the case of young girls about the age of fourteen. With them it is a very easy matter to overdo and to defeat the very object for which these exer- cises are prescribed. IMPORTANCE OF FRESH AIR AND VENTI- LATION. As it has been said that a man can live three weeks without food, three days without water, and three minutes without air, it seems fitting that a consideration of the laws of healthy living should deal fully with the subject of air as being most essential and important. The active, life-giving constituent of the air is oxygen gas, which forms about one-fifth of the volume of the atmosphere. It is this oxygen in the air which, in the process of breathing, is taken into the lungs and there purifies the blood. The other constituents of the air are nitrogen gas, which forms nearly all of the remaining four-fifths of the volume of the air and is an inactive, harmless gas ; and several gaseous and solid impurities which are present in only very small proportions. Among these impurities are : — Ammonia gas and its compounds, which are given of! from the decay of animal and vegetable matter. Carbon compounds, especially carbonic acid gas or carbon dioxide, which are given off during the breathing of man and other animals ; by the burning of coal, wood, and gas; and by the decay of animal and vegetable matter. Sulphur compounds, from the decay of animal and vegetable matter, and the burning of gas. Dust, mineral, animal, and vegetable particles, which may be seen floating in a ray of sunlight. Bacteria, which are living forms of animals, microscopic in size, and present in the air in all localities. The purest air and the freest from bacteria is found in mid-ocean, and at the highest elevations. The impurities found in buildings and crowded localities are : — 1. Impurities from breathing. 2. Impurities from perspiration. 3. Impurities from burning coal, wood, and gas. 4. Impurities from the walls, floors, ceilings, and ■ furniture. 86 THE MAINTENANCE OF HEALTH. Diseases Caused by Impurities in the Air. — Smallpox, measles, chicken pox, German measles, typhus fever, influenza, whooping cough, and mumps are undoubtedly spread by infective particles floating in the air and clinging to the walls and furniture of houses, as well as to the clothing of the occupants. Scarlet fever and diphtheria are generally so spread. Enteric fever, cholera, diarrhcea, dysentery, and yellow fever may be communicated in this way; and cerebro-spinal meningitis is apparently so spread. Hay fever is caused by inhaling pollen dust in the air. Bronchitis, pneumonia, phthisis, and asthma are caused some- times by irritant gases and solid particles in the air. Sore throat, ton- silitis, and some forms of colic, may be contracted from more or less severe poisonous impurities. Effects of Some Impurities in the Air. — Carbon dioxide, or car- bonic acid gas, when breathed in full strength, kills instantly by a spasm or contraction of the glottis. When present in the proportion of only thirty parts in 1,000 parts of air, it produces slowness and feebleness of the heart's action and great difficulty in breathing ; and fifteen parts have produced severe headache. It is breathed out during respiration and is the chief impurity in overcrowded and poorly ventilated buildings. As it is much heavier than ordinary air, it accumulates in old wells, cellars, mines, and other low places. When present in dangerous quantities, it may be detected by lowering a lighted candle into suspected places, where three per cent of the gas will extinguish the flame. If limewater be exposed in a saucer in a room, a white scum will form upon the surface of the liquid if this gas be present even in very small quantities. Carbon monoxide is a more powerful poison than carbon dioxide. An extremely minute quantity causes headache, giddiness, and insensi- bility. This is the poisonous gas given off when the fumes of burning charcoal escape into a room, and it is thus, very frequently, the cause of death, both accidental and suicidal. Dust from mechanical and metallic trades and manufactures produces, when inhaled by the workmen, asthma, bronchitis, consumption, blood- spitting, and poisoning. Amount of Fresh Air Required. — It is estimated that an average adult consumes at each breath about thirty cubic inches of air. At the rate of seventeen breaths per minute, each adult will consume 425 cubic feet of air in each twenty-four hours. In order to insure getting rid of the used air, and of furnishing a sufficient supply of fresh air, it is necessary that an adult in repose have 3,000 cubic feet of fresh air every TESTS FOR THE PURITY OF AIR. 87 hour; under moderate exertion, 4,500 cubic feet; and when engaged in hard work, 9,000 cubic feet per hour. As living rooms never approach a size of even 3,000 cubic feet, it follows that, in order to supply the needed amount, the air in an ordinary room must be changed several times in an hour, which number will depend upon the size of the room. In order, therefore, to ventilate properly, one must know the amount of air required by all of the inmates, and the space per head. Then one must know something of the quality and purity of the air that is to replace the foul air; for great care must be taken that it does not come from a contaminated source. Further, it must be admitted imperceptibly, so that a draught is not created. And especially must this care be taken when the temperature of the outer air is lower than that of the rooms. One of the hardest problems of ventilation is to see that the air does not merely come through a window and pass out by a door, but that the fresh supply is equally and fully distributed throughout the entire space. Testing the Purity of the Air. — Under ordinary circumstances, tests of the purity of the air must be made by the senses and not by exhaustive chemical analysis, except in special cases. To investigate the purity of air in a room, one should enter immediately from the outside fresh air. Careful note should be made of whether the inside air smells fresh and sweet, rather close, close, or very close. In damp weather the odors, if any, will be more pronounced than in fair, dry weather. The sense of smell will also detect the presence of organic matter, the escape of gas, leakage of sewer gas, dampness or mustiness, and the presence of dust. This is as far as an examination by the senses can go ; but it is far enough to tell whether the atmosphere of the house is conducive to health or not. A thorough examination will require a chemical, micro- scopical, and a biological investigation, by which means deleterious gases, dust, solid impurities, and bacteria may be certainly and accurately deter- mined. Effects of Breathing Bad Air. — If the air is extremely vitiated, as in the case of the famous Black Hole of Calcutta, or in overcrowded vessels with battened down hatches in stormy weather, death will result from the lack of oxygen and the presence of organic matter in the re- breathed air. In slighter vitiation, when foul air is breathed for a long time, the results are anaemia, weakness, depression of the vital forces, and interference with nutrition. Indirectly or directly, lung diseases develop in time; and headache, loss of energy and want of appetite are among the most marked results. So it follows that light and oxygen 88 THE MAINTENANCE OF HEALTH. are the most powerful agents iri the eradication or the arrest of many such diseases as phthisis, typhoid, and other contagious diseases. The foul air of crowded theaters, churches, and assemblies, especially at night when much gas is burned, causes anaemia, headache, and even stomach derangement when the air is breathed for only a few hours. It is bad enough to breathe the air contaminated by the emanations from the lungs and bodies of healthy persons ; but the effects are intensi- fied and the danger increased when the impurities proceed from the bodies and the lungs of the sick and diseased. Not only is consumption spread in this way, and the other contagious diseases proper, but also erysipelas and gangrene. The air of sewers has been known to directly and instantly produce death by asphyxiation, sewer gas poisoning, and to develop fatal cases of pneumonia. In smaller quantity, sewer gas, when breathed, pro- duces lassitude, loss of appetite, vomiting, diarrhoea, prostration, and fever. Well authenticated instances have been recorded where food which had been impregnated by sewer gas was eaten with fatal poisoning results. Marshes, in which much decay of vegetable matter always takes place, give off poisonous gases, such as marsh gas. Residents of such localities are always subject to malarial diseases and even to acute fevers and dysentery. How to Ventilate. — Good ventilation requires that each occupant of a room shall have 600 cubic feet of space, and that the air in this space be changed five times every hour, so that he gets 3,000 cubic feet of fresh air during that time. It is a simple matter to estimate the number of occupants any room will accommodate comfortably. Multiply together in feet the length, breadth, and height of the room, and divide the product by 600. On this principle a sleeping room should be 1 1 feet long, 11 feet wide, and 10 feet high to accommodate two persons. Pro- vision must be made for changing the air in such a room five times every hour. And this makes no allowance for lights. A single light in a room will vitiate as much air in a given time as ten persons will, for the light uses up the oxygen from the air. This is not true of incan- descent electric lights, which use no oxygen. In ordinary cases, the easiest and best way to ventilate is to open the window a little at the top and bottom. This allows the warm, foul air of the room to pass out at the top, and the cooler, fresh air from outside to enter at the bottom, in obedience to the well known law of HOW TO VENTILATE. 89 physics. In sleeping apartments, an additional supply of bedding can be used in cold weather to make sleeping comfortable in the lowered temperature caused by ventilating. The effect of slight openings at top and bottom of windows may be realized when it is known that a wind traveling at the rate of two miles an hour, which is barely, if at all, perceptible, will sweep across a room twenty feet wide with sufficient rapidity to change the air in that room 548 times in an hour. There is always some air finding its way in and out of a room through the loose fitting window frames, by the opening and closing of doors, and through the chimneys. In houses heated by furnace, with cold air shafts communicating with the outer air, some also finds its way in by that means. But all of this ingress and egress of air is by no means sufficient. Regular and systematic methods of ven- tilation must be adopted in every home to so frequently change the air throughout the house that that within may be as pure as that outside, — which is the ideal ventilation. Those who are careful about the air they breathe are often commis- erated by others, or are ridiculed about their "hobby" by those who have never stopped to think of that stupendous, marvelous process which we are accustomed to speak so lighjtly of as "breathing." Let such persons carefully consider these facts : — 1. Each human being takes at least seven million breaths a year. 2. He inhales one hundred thousand cubic feel; of air annually. 3. He purifies over three thousand five hundred tons of blood in that time. All of this is done without worry, weariness, or even conscious atten- tion on his part. How to Breathe Properly. — Respiration, or breathing, consists of two more or less unconscious or involuntary acts : inspiration, the taking of air into the lungs; and expiration, the act of breathing out. The fact that these acts require no attention on our part is the chief reason why they are not performed properly. The lungs, as previously stated, consist of a collection of six hundred million little air cells, or bladders, into which the air is drawn by inspiration. When little short, catchy breaths are taken, some of these cells in the deeper parts of the lungs are neither emptied of the used air nor filled with fresh air. It is only in the deep panting after violent exercise, in involuntary sighing, or, best of all, in the deep, deliberate, voluntary inhalations that all should practice every day, that they are brought into use. When we consider 90 THE MAINTENANCE OF HEALTH. that most persons use only about one-half the full lung power, and at the same time fill that space with impure air, is it remarkable that so many suffer from the long train of impure blood diseases and an anaemic or bloodless condition? Children should be early taught to breathe through the nose and not through the mouth. If a child develops the habit of "mouth breathing" a physician should examine it for adenoid growths, which close up the back passages of the nose. The removal of these growths is a very simple surgical operation, and it is not only advisable but absolutely necessary to the health of the child that they be removed as early as possible. Nose breathing is the natural method, and to this end the nose is lined with hairs to catch particles of dust and to prevent them from entering the lungs. When cold air is breathed through the nose, it passes over a large surface, which warms it slightly before it enters the lungs. When very hot air is breathed, such as the air near furnaces of rolling mills and other factories, as well as that of hot, sandy deserts, it is slightly but sufficiently cooled by passing over the extensive surfaces of the nasal passages. It also passes over the surface covered by the nerve of smell, — the olfactory nerve, — by which bad odors, escaping gas, and other im- purities are detected in time to warn one of their presence. There is no better form of exercise for the development of the chest, and for the improvement of the general health, than the fixed habit of two or three times every day taking a number of deep breaths. This can be best done during a walk. Some begin by inhaling during four or five steps, and exhaling during the next four or five. In a very short time the act of inhaling or exhaling may be made to endure for six, seven, and even ten steps. By this simple exercise the chest muscles, and the inter- costal muscles between the ribs, are exercised; the diaphragm is pushed down and the abdominal muscles are brought into action ; the size and elasticity of the chest are increased ; the shoulders are raised and squared ; the lungs expand, and all of the six hundred million air cells are filled with fresh air and emptied of the impure air and the poisonous carbonic acid gas ; but, above all, the oxygen is brought into contact with the impure blood and freshens and revivifies it, so that it goes coursing, under the heart's action, through the body and limbs, carrying new life and vigor and health to every part. When one begins this exercise, the measurement of the chest should be taken at forced expiration, and again at forced inspiration. The difference of these measurements is called the mobility of the chest or CARE OF THE NOSE. 9i the chest expansion. It is the measure of the chest capacity. Gymnasium records show that those whose mobility at the beginning of this exercise was barely one inch, have, by reg- ular practice, developed an expansion of three and even four inches and more. This breathing exercise may be taken in a well ventilated room with open windows, both on rising and before retiring, as well as during one's walks, with immense physical advantage. During the breathing exercise taken in the morning or at night before retiring, a beneficial modification may be adopted. With the hands at the sides, exhale as deeply as possible. On slowly inhaling raise the hands to the full ex- tent above the head, as in the illustration given. This form of exercise is to be repeated slowly ten times. C Fig. 23. Position 2. CARE OF THE NOSE. Cleanliness. — The first essential in the care of the nose is cleanliness, and this is one of the lessons which should be taught as early as possible to children. Many an hour of wakefulness or of restlessness is passed by reason of obstructions in the nose caused by children's inability to remove the natural secretions. These latter are more profuse during a cold in the head, and the difficulty of breathing is greatly augmented. If these accumulations are moistened with a little warm vaseline care- fully inserted into the nostril by means of a soft camel's-hair brush, and the bridge of the nose be rubbed with a little vaseline or camphorated oil on retiring, much of the inconvenience will be removed and the breathing be greatly assisted. It is necessary that the nasal passages be kept free and unobstructed at all times, but especially in the case of a child who has contracted the unhealthy and pernicious habit of mouth breathing, which, once developed, may persist during life. Then, on the score of cleanliness, the habit of using the handkerchief should be taught to children. Some parents, in following up this lesson, pin a handkerchief by one corner to the child's shoulder, where it is both out of the way and close at hand when needed. The frequent removal of the secretion by the handkerchief will prevent the substance from hard- ening and thus obstructing the passages; and will also prevent a child from contracting the offensive habit of picking the nose; although the 92 THE MAINTENANCE OF HEALTH. itching of the nose in children is regarded as an indication or symptom of stomach irritation or of worms. Cold in the Head. — The most serious affection of the nose is cold in the head, which frequently develops into catarrh. The precautions to be taken against catarrh consist not so much, if at all, in the care of the nose, as in the care of the body and the prevention of exposure to draughts and dampness. Still, the manifestations of the disease center in this organ and the adjacent parts. The delicate mucous membrane of the nose and of its connections are very sensitive, and, being well supplied with blood vessels, is soon the seat of painful inflammation, and the natural secretions of the nose are very much increased thereby. This inflammation and the increased flow of the nasal secretion are to be regarded as the curative force of Nature upon the cold. Fig. 24. Deformity Caused by Mouth Breathing. Mouth Breathing. — Mouth breathing is usually developed in children by an obstruction of the nasal passages. The commonest of these in childhood are the adenoid growths. These spongy growths form at the back of the nasal passages and are easily reached through the mouth. Their removal is not attended by much pain or inconvenience. If a child display a tendency to mouth breathing, accompanied by a dullness of facial expression, he should be at once examined by a physician. Adenoid growths usually develop around the third or fourth year. Polypus of the Nose. — Another growth develops later in life in the nose, and it also obstructs the passages and causes mouth breathing in adults. It is called polypus, from two Greek words meaning many feet. It was erroneously believed to have many roots or branches. It is an enlargement of the mucous membrane, and is attached to it by a small stem like that of a mushroom or toadstool. Its removal is a very simple CARE OF THE NOSE. 93 surgical operation, consisting of burning it out with caustic, just as a wart is treated. Hairs of the Nose. — The hairs of the nose are designed to keep out much of the dust and the solid impurities of the air. These hairs often grow so long as to cause them to protrude from the nostril. The habit of pulling them out by the roots is very dangerous and differs from pulling hairs out of the outer skin. The hairs of the nose grow from the delicate mucous membrane, and violence to this is attended with the great danger of setting up an inflammation, which may be the direct cause of exciting a malignant growth. The fact that the pulling out of the hairs from the nose is nearly always attended by a sneeze, or at least by a desire to sneeze, is a proof that Nature resents such treatment, and that the act is an irritating one. It is much better to cut the long hairs off, if they are annoying, as this is sufficient to remove the unsightly appearance. Blowing the Nose. — Medical experts are calling the attention of the public to the importance of performing the nose blowing operation in a scientific and hygienic manner. First one nostril and then the other should be blown without undue violence. Doctors state that the two nasal passages should never be closed at the same time. If they are obstructed, as in the case of a cold, the back of the throat is filled with compressed air, and this, together with the discharge and the microbes which it contains, may be driven through the eustachian tube into the middle ear and lead to serious results. A great authority on the subject used to forbid his patients to blow their noses when suffering from a cold; but this course is hardly one which will commend itself to those who are in the habit of catching colds. The best advice would seem to be that when it is necessary to blow the nose, the blowing should be done gently. Atomizers and Douches. — It is frequently necessary to administer washes or lotions to the deeper recesses of the nose. This may be done either by means of an atomizer, the tube being placed well up in the nostril, and the liquid sprayed into the nose, the patient meanwhile assist- ing the process by snuffing the liquid up or extending its range by strong nasal inhalations; or the nasal douche is used. In this application, the passage from the mouth to the nose is closed and the liquid impelled by some force flows in at one nostril and out at the other. Such applications and douches are of great value in cases of chronic catarrh. Foreign Substances in the Nose. — When foreign substances lodge 94 THE MAINTENANCE OF HEALTH. in the nose and cannot be extricated by simple means, the services of a physician would better be procured. He will probably remove the object with a small flattish probe having a bent end. This he slips up the nostril past the object and draws it out. Beans and similar objects, which are likely to swell after lodgment, are difficult to remove. Some- times the object may be forcibly driven out by closing the free nostril and energetically forcing the breath out. CARE OF THE EAR. A. GOLTMAN, M.D. McGill Medical University ; L.R.CP.and L.R.C.S., Edinburgh; L.F.P., Glasgow ; Consulting Oculist, New York City. Cold in the Ear. — The ear is an organ of great complexity and of extreme delicacy. The most delicate parts of it are placed well within the skull, and are both abundantly protected and difficult of access. Under no conditions should cold water ever be allowed to enter the outer ear. Not only excruciating earaches but permanent deafness has resulted from sleet and snow beating against the exposed ear. When- ever water is permitted to reach the inner portion of the ear, it should be at least tepid. So, in sea bathing, it is a wise precaution to protect the ear, with pieces of cotton wool, against the entrance of cold sea water. Cold draughts are always to be avoided, as they are the most fruitful cause of earache, and may lead to inflammation of the ear, with accom- panying discharges and abscesses. Even the hair around this organ should not be allowed to remain wet after bathing lest a chill reach the delicate membranes of the ear. Wax of the Ear. — The ear secretes a peculiar wax, which, so long as the secretion is normal in quantity, and is not increased by inflamma- tion, is Nature's own way of cleaning the inner tube of the outer ear. The only assistance expected from us in the way of cleansing the ear is to keep the outer shell of the ear and the entrance into the ear tube clean. This wax in the ear, when Nature is ready to dispense with it, peels off in tiny flakes, which, on dropping off, leave the tube perfectly clean. Attempts to clean the tube of the ear by such means as the corner of a towel or cloth screwed up and pushed into the ear, are only a cause of irritation and inflammation, and of an increased and abnormal supply of wax to be secreted. These attempts also serve to solidify the wax and to cause it to press unduly against the drum of the ear, with painful and dangerous results. Cold in the head, inflammation in the throat, and of the ear tube, also cause an increased secretion of wax in the ear. The inflammation WAX IN THE EAR. 95 of the throat, caused by the inhalation of smoke by cigarette smokers, also produces similar effects. When this inflammation of the ear tube takes place, it causes a tickling in the ear, and one of the first sought-for means of relief is a pin, hairpin, match, pencil, or similar article which will remove the wax and thus stop the uncomfortable sensation. All of these means are attended by very great danger; for there is not only a certainty of hardening and solidifying the wax in the ear, but very great danger of injuring or even breaking the drum of the ear, which is a very thin and delicate membrane stretched tightly across the tube. The hardening of the wax is one of the chief causes of temporary or partial deafness. The wax should never be removed; the proper treatment consists in stopping the cause of the inflammation in the ear tube that excites the secretion of the abnormal amount of wax. Relieve the cold ; cure the inflammation in the throat ; stop the smoking ; but do not remove the wax from the ear. Hardened Wax in the Ear. — When from any improper treatment of the ear, or from disease, the wax has hardened so that Nature cannot remove it in her own way, it is to be softened by washing with warm water and castile soap applied with a syringe. When thoroughly dried, a few drops of good oil are to be poured into the ear. With this assist- ance it will be removed in a short time by natural means. This hard- ened wax in the ear produces difficulty in hearing. Noises in the Ear. — Colds are responsible for partial deafness, and also for some of the noises in the ear. The circulation of the blood under abnormal or diseased conditions produces many of the sounds and ring- ing in the ears. Some medicines, such as quinine, cause a roaring in the ears. There is a curious connection of the inner ear with the mouth by means of the eustachian tube, which opens into the upper part of the throat. Its office is to equalize the air pressure on the drum of the ear. In inflammation of the throat, this tube becomes involved and communi- cates the disturbance to the ear ; this is another cause of noises in the ear. But the familiar ringing in the ears is caused by interruptions in the circulation of the blood. Deafness in Children. — Many young persons are suspected of mental dullness, when the real trouble is partial deafness. They seem bright enough when anticipating a word or some direction, but when taken unawares they do not respond quickly. It is only right that, before such are regarded as mentally deficient, they be subjected to careful tests 96 THE MAINTENANCE OF HEALTH. of both ears. It will be found, in many cases, that the hearing of one or of both ears is impaired. The sequelae., or after effects, of scarlatina, measles, and scarlet fever, often cause deafness or some affection of the ear. Boxing a Child's Ear. — Permanent and serious injury has fre- quently resulted from the criminal habit of boxing a child's ears. In some cases the drum of the ear has been ruptured, causing permanent and total deafness : abscesses have been induced, with running at the ears, which have caused the destruction of the drum of the ear : and fatal results have sometimes followed this brutally careless punishment. When there are so many other effective forms of punishment offered to those who believe in that sort of discipline, it positively assumes the magnitude of a criminal act to adopt so dangerous a means. Foreign Bodies in the Ear. — Foreign substances that become lodged in the ear usually require the attention of the physician. Attempts at removal by inexperienced persons who are not well acquainted with the anatomy of the part are very likely to produce serious effects. Sometimes insects enter the tube of the ear and cause extreme fright and alarm, even to the extent of convulsions in young children. The insect should first be killed by pouring into the ear about a teaspoonful of warm oil ; and it may then be washed or floated out by tepid or warm water. Tests of Hearing. — The sense of hearing is one of the latest senses to be developed in infants. This tardy development often occasions unnecessary alarm on the part of parents. Preyer says that if at the age of four months a child does not turn the head in attention when a loud noise is made behind its back, such as clapping the hands, or by speaking in a louder tone than usual, justifiable fears for the child's hearing may be entertained. Lack of response or of attention on the part of an older child when it is spoken to is not always caused by defective hearing. It may arise from concentration of attention or from absorption in work or play. This is a power that will prove too valuable in after life to warrant any attempts in the way of distraction. But where fears or suspicions of impaired powers of hearing appear to be well founded, a few very simple tests will soon decide the question. A few words or sentences spoken at a fair distance in a moderate tone, at a time when the child is not expecting them, may reveal the existence of the defect. When a person is expecting to be called or spoken to. or when his attention is fixed upon the face of the speaker, he is often enabled to TEST FOR HEARING. 97 anticipate the speech, and the test will fail. The ringing of a distant bell, or the playing of music in another part of the house, may be made use of to test in some measure the imperfection of the sense. But in all tests, care must be taken that an absence of attention be not mistaken for defective hearing. The human voice is the best and most practical of all the tests of hearing, for that sense is most used in interpreting voice sounds. The tests should be conducted by both full voice and by whispers. If. how- ever, the space in which the tests are made is limited, whispered words and sentences are to be used. Distances should be marked off on the floor so that a fairly accurate note may be made of the distance at which sounds are heard by the patient. The subject is placed in a chair at one end of the room or hall, and is directed to keep his eyes closed during the tests. He is instructed to repeat such words and sentences as are audible to him immediately upon hearing them. The person conducting the test is to preserve the same degree of loudness during the test at each repetition of the word. He advances slowly toward the subject, repeat- ing the word or sentence selected, until he comes within the range of hearing. It is to be remembered in applying the test that some words, because of the preponderance of vowel and consonant sounds, are more audible at a certain fixed distance than are others. So that when the subject has heard one word at a distance of, say 25 feet, it does not hold that all subsequent tests must be made at the same distance. The person conducting the tests is to return to the former distance and select another word — the numerals are very good for this purpose — and note the distance at which each particular word is heard. Faithful records must be kept in order to observe, at another time, any improvement of the hearing power. The normal ear hears a whisper at a distance of from 10 to 40 feet; the names of the numerals are heard at from 8 to 40 feet. The ticking of a watch may also be used as a test, the subject being directed to raise his hand as soon as he hears the sound. There is no fixed distance at which a watch may be heard, as the sound varies so much in different watches. The same watch, however, must be used in subsequent tests in order to make a comparison at different periods of any value. There are many other methods of testing, such as using a series of tuning forks of different pitch; as some persons hear high-pitched tones better than lower ones. AYhistles, and an instrument known as the 98 THE MAINTENANCE OF HEALTH. acoumeter, are used, but chiefly to assist the specialist in locating the cause of partial deafness. Rods, held in contact with the bones of the skull in the vicinity of the mastoid process, are also used for the same purpose. But their use and the deductions made from such tests are technical. By the voice and watch tests any person may easily learn whether the services of an aurist are required in any case of impaired hearing. Helps to Hearing. — The mechanical aids to hearing are chiefly of two kinds : the ear trumpet, and the artificial eardrum. The former is a horn-like contrivance, which serves to collect the sound waves and to present them to the eardrum with greater directness, force, and con- centration. The collection of the sound waves is the office of the enlarged cartilage, commonly called the shell of the ear. From its shape and position, it collects the air waves, upon which the transmission of all sounds depends, and causes them to enter the orifice of the ear, where they strike upon the tympanum or eardrum. "When this organ is ordi- narily sensitive, the hearing is good. Not infrequently, persons whose hearing is defective, are seen to place the hand behind the ear in the form of a shell in order to catch more of the sound waves, and thus to Fig. 25. Fig. 26. Ear Trumpet. Ear Tube. improve the hearing. The ear trumpet is only a modification of this service, and, where any degree of vibratory power exists in the eardrum, is an efficient aid. Artificial eardrums aim to provide a vibratory membrane as an aid to an impaired natural one. They are not always as efficacious as they are claimed to be. Further aids to hearing have taken the form of telephones placed in the rear chairs in churches and assembly rooms, whereby those who, either from defective hearing or from a too remote location, are precluded from hearing the speaker, are materially benefited. These telephones are connected with a sounding board or with receivers close to the speaker. As yet the microphone, designed to intensify very low or inaudible sounds, such as the walking of a fly, has not been adapted to the relief of the afflicted. The mega- CARE OF THE EYES. 99 phone and speaking trumpet, inasmuch as they intensify sounds and supply some control by the speaker over the direction of the sound waves, also serve to make sounds audible. CARE OF THE EYES. If one has passed middle age without trouble with the eyes, or with- out impaired vision and the necessity of wearing eyeglasses or spectacles, one is tolerably safe. But when one considers the great army of spec- tacled school children and young persons, one feels that they are not so much the victims of faulty school conditions as of the carelessness of their parents and ancestors, and pity is evoked for the handicapping legacy which they have inherited. Children's Eyes. — It is one of the first duties of parents and teachers of young children to ascertain whether or not a child is suffering from any impairment of sight, or from a weak condition of the eyes. Where such exists, it is the duty of the parent and the teacher to see that such a child is placed in a good position in the schoolroom so that it can see the blackboards easily, and share in the school exercises with comfort and convenience. Many a child has unjustly been considered stupid or of slow mental development when the trouble consisted of some form of poor sight, which, from a back seat, prevented the child from clearly seeing the lesson on the board, or the teacher. We all know how intently we observe a person in whose conversation we are interested or whose discourse we are trying to follow. The removal of such a child to a more advantageous position has often resulted in rapid school progress. Need of an Oculist. — Where eye or sight trouble is suspected in either a child or an adult, no time should be lost in consulting a good oculist or optician. He will make a thorough and reliable examination, and will prescribe the proper treatment or the sort of glasses the patient should wear. To such perfection and reliability has this art been brought that good and trustworthy service is within reach of all. Irreparable injury has resulted from the haphazard choice of glasses and spectacles, and from the purchase of such from irresponsible persons. Blindness, even in degree, is such a serious deprivation that instant and proper care must be exercised to save the sight as much as possible. Defects of Vision. — It must be remembered that the eye does not see. It is the organ by which the rays of light are received, and an ioo THE MAINTENANCE OF HEALTH. image of the object or objects within the range of vision is received upon the black curtain (the retina) at the back of the eye. This sensation is communicated to the brain by the optic nerve. The cognizance of that image by the brain is what we call sight. Now, the perfection of sight depends very largely upon how that image is received upon the retina. If the rays of light from the object focus exactly upon the retina, the sight is good; it is normal. That condition of exact focus is called by opticians, emmetropia, and such an eye is said to be emmetropic. If the rays of light do not exactly focus on the retina, the condition is called ametropia; and it is with this condition that we are concerned in trying to understand defects of vision. Emmetropia does not much concern us, because that is the normal condition of the eye. But the condition of ametropia is the irregular condition upon which three common defects of sight depend. If the rays of light from an object do not focus exactly upon the retina, but fall upon it in such a way as to focus at some point behind it, if they focus at all, the condition of far-sightedness, or of hyperopia, as the optician calls it, results. The effect of this condition is that the image, instead of being clear and distinct as it is in the emme- tropic eye, is blurred and indistinct. The person sees well the distant objects but cannot see those distinctly which are close at hand. The optician prescribes for this condition a double convex lens, that is, one which bulges on both sides. As the rays of light pass through this they are brought to a focus at a point on the retina instead of behind it. When the rays of light, instead of focusing on the retina, as in the emmetropic eye, or focusing at a point behind it, as in the hyperopic eye, focus at a point a little distance in front of the retina, the condition is one of near-sightedness, or of myopia, as the optician calls it. The result of this is that the person is near-sighted. The optician corrects this con- dition by prescribing a double concave lens, that is, one which is hollowed out on both sides. This causes the rays of light which pass through the lens to come to a focus farther back than when they pass through the unaided eye. So the rays are made to focus on the retina instead of in front of it, and a clear image results. There is a third condition which is in some respects a com- bination of two of the conditions already mentioned. It is a con- dition where some of the rays of light received by the eye from an object focus exactly on the retina and others do not. That condition is known as simple astigmatism. Or some of the rays may focus behind the retina and others in front of it, when the condition ASTIGMATISM. 101 is known as mixed astigmatism. The effect of this .condition is a blurred image instead of a distinct one. The optician corrects this condition by prescribing a lens which bulges out on the side nearest to the eye and is straight up and down on the outer side, defect of vision, and may exist in only one eye without a person being conscious of it until it has advanced to a serious stage. The illustration here given is a form of astigmatic chart. It consists of a number of parallel lines radiating from a cen- ter. On looking at these lines, one eye at a time, if the sight is astig- matic, some of the lines in the de- fective meridian will appear much blurred while others remain clear and distinct. If the eye is normal, and no astigmatism exists, all of the lines are sharp and clear. But it is Astigmatism is a very common ^^ Fig. 27. Astigmatic Chart. E Feet 70 C B DLXT P T S Rso FZBDS; O F L C T G 30 AFEOSPSZ 20 sntvsiBriie 15 Fig. 28. Greatly reduced form of Chart for Testing Sharpness of Sight. found on examination that the very great majority of eyes are more or less astigmatic. The tests for sharpness of sight, or acuity of vision, as the optician calls it, is conducted by means of a chart containing letters of different sizes which the patient is directed to read at a distance. Upon the ability to do this is based the decision of normal or of defective vision. This chart is shown in reduced size in the illus- tration. The figures to the right of the letters indicate the distance at which the letter should be seen by one with normal sight. The card is hung upon the wall in a well-lighted position, and the subject is seated as far from it as the accommoda- tions will permit, but at some known distance, say 20 feet. The subject is then asked to read the letters in the line of smallest sized type which he can see plainly at that distance. His sharpness of vision is then expressed in the form of a fraction having 20, the number of feet that he is distant 102 THE MAINTENANCE OF HEALTH. from the card, as a numerator, and the figures on the right of the line of type that he has just read, as the denominator. This fraction expresses his visual fraction. For instance, suppose he is 20 feet away from the card and can read the line marked 20. The visual fraction is f a and the patient has stood the test. But suppose, at the dis- tance of 20 feet, he can read no smaller sized type than the line marked 30. Then the fraction becomes U, and, as this is a less fraction than U, his sight is pronounced defective. Each eye is tested separately. The fact that the patient successfully passes this test is no assurance, however, that his vision is perfect. It is, in that one respect, but there are other tests to which he must be subjected. There is a small type test card, such as is here given : — It is the duty of parents and of teachers to see that all of the conditions to which the children are exposed in school are such as will best promote their physical as well as mental growth and comfort. A patient less than 2 1 years of age should read this with ease when held at a distance of from 5 to 7 inches from the eye. If he cannot do so, but is obliged to hold it at a greater distance in order to see it clearly, there are indications of far-sightedness or of hyperopia, and his eyes should be examined carefully. If a middle-aged person cannot see it easily at a distance of from 10 to 12 inches, the same condition exists, and. reading glasses are necessary. Protection of the Eyes. — Nor is it alone in the direction of the remedy and the improvement that great care must be exercised. There are the strongest obligations upon all to protect and care for the eyes at all times. The first rule to be observed in reading and writing by either natural or artificial light is to see that the light falls over the left shoulder upon the book or paper. When one is choosing the location for a desk in an office, of a writing table in a room, or a seat for reading, this point is to be carefully observed. Ascertain the source and direction of the light from windows, then place one's self accordingly. By so doing the glare and brilliancy of the light does not shine into the eyes, but the paper or book is well lighted. When the eyes get both the direct light as well as the reflected light from the book or paper, there is an undue and unneces- sary strain upon them. The eyes themselves may be in deep shade so PROTECTION OF THE EYES. 103 long as the page is sufficiently lighted ; and this is why green shades for the eyes, shades for student's and other lamps are used. The light is thrown on the book or paper but the eyes are shielded from the glare by the shade. Poor Light. — Reading by twilight or by fire light, not as a habit, but only on occasions when one has been caught in the most interesting part of a book, is far too great a strain for even good eyes to endure. When children offend unconsciously in this respect, it is better to quietly provide a suitable light as the quickest and easiest remedy, instead of ordering the book to be put away at such a climax, though a word of admonition and the pointing out of the certain injury which will result, should not be neglected. Strong Light in the Eyes. — Some, when in deep thought or in reminiscence, have a habit of looking long and steadily into a fire or at other bright lights. This constant glare of light is very trying to the eyes. It is true that there is a marvelous provision in the eye itself for pro- tection against the admission of too much light into the eye, by a won- derfully contrived shutter controlled by the "nerve of accommodation," as it is called; and this automatic contracting and dilating of the shutter under the varying power of light is a certain protection against the admission of too strong a light, yet it is not sufficient to counteract the effect or to prevent the injury which the habit just mentioned is sure to cause. Most emphatic protest must be made against the carelessness of some mothers and nurses in this regard with the eyes of helpless infants. Metaphysicians all agree that the first object which a young infant sees clearly is a light; and that it naturally manifests great interest in it, and is attracted by it. But that fact, however true, will by no means pardon the thoughtlessness which permits a young helpless child to be placed for hours on its back in its carriage with the full glare of the sun shining upon its blinking and unprotected eyes. Observation will show that this is a very common offense on the part of young and inexperienced nurse girls into whose care young children are so frequently and for so long a time intrusted. It is at this period, while the sense of sight is slowly developing, that the greatest protection is needed; but, unfortu- nately, it is at this very time that the child's well-being in this regard is so often disregarded. Care During Convalescence. — During convalescence from such diseases as measles, scarlatina, and typhoid fever, there is very special io4 THE MAINTENANCE OF HEALTH. need of all possible protection of the eyes. The sequelae, or after effects, of these diseases are sometimes more serious than the disease itself. It is well if the patient escape without some serious affliction which usually falls upon a weak or impaired organ. These diseases are extremely debili- tating, and the eyes, in common with the other organs, share in that debility, and are the last of the organs to recover from it. The light must be softened during the early days of convalescence. Later, a green shade or smoked glasses should be worn until the power and tone of the eyes are restored. Fine Print. — The caution against reading very fine print at any time, but especially in a dim light, while quite as important as ever, is not so necessary in this day of beautiful printing, clear, large type, and good book-making. Reading on Trains. — There is a very great temptation to while away the tedious hours of a long railroad trip with an interesting book. But this habit of reading on a train is one of the most fruitful sources of injury to the eyes. The shaking of the book by the motion of the car causes the distance of the book from the eye to constantly vary. The effort of the eye to adjust itself to this ever-varying distance is intensely tiring. The up and down motion of the page also causes the eye to follow the line with difficulty. ^With this there is also the ordinary right and left motion of the eye. So that when we stop to analyze the amount of work which the eye is obliged to perform by these three motions under trying circumstances in an hour of such reading, we realize the great tax upon it. Fine Work. — Close and continuous application to art needlework, embroidery, lace making, and fine sewing generally, is also trying to the eyes by reason of the fine stitches, the necessity of counting stitches and spaces, and very often the delicacy of pattern and trying, dazzling colors. In such occupation there is also the bending of the head over the work, with the attendant discomfort and injury of tight neckwear to impede the circulation of the blood. Positive and lasting injury to the eyes results from such strain and abuse. Floating Specks. — Nearly every one suffers at some time from little black, floating or falling specks which come within the range of vision and dance over the page when reading. These are called muscqe volitantes, or dancing flies. They are an indication of a debilitated and weakened system, and of a need of tonic and upbuilding treatment. They are caused by a lack of uniformity in the consistence of the liquid CARE OF THE EYES. 105 contained in the eye, which is produced by lack of nutrition or by a weak condition of the body. Need of Resting the Eyes. — The great sign that the eyes are being overtaxed is the aching of the eyes and pain in the eyeball. This warn- ing must not be disregarded. Rest of the eyes is then the great need. All, perhaps, have known the great relief to tired, watching, aching eyes that comes from looking out into the black, inky darkness of night, where no object is seen to occupy the eye. Frequent rest of the eyes, especially at night, is positively requisite whenever the eyes show the slightest signs of fatigue. Bathing the Eyes. — There are a few simple, harmless substances which may be used with benefit to bathe the eyes when they are tired or slightly inflamed from too steady use or from the action of the wind. Among them, are : cold water, hot water, a weak solution of salt and water. When the eyes are much inflamed, a cold, weak solution, or infusion, of green tea; or a teaspoonful of Epsom salts in a quart of warm water; or the addition of a little rose water to the bath will prove helpful and beneficial. But under no circumstances should any other lotion or eyewash be applied without a physician's advice. Foreign Substances in the Eyje. — When dust, cinders, eyelashes, and other substances lodge in the eye, do not rub it, for that only irritates the eye, inflames it, and increases the pain. Winking the eye also has the same effect. Keep the eye quietly closed, and, as the irritation increases the flow of tears, the chances are very great that they will wash the irritating body out of the eye. If they do not, one may take the upper lid at the middle part by the lashes and draw it gently down over the lashes of the lower lid, and allow it to slip back over them on its way back to place. This Fig. 29. First Step in Act of Everting or Turning Outward the Upper Eyelid. Fig. 30. Upper Eyelid Turned Out- ward. A. The Foreign Body. 106 THE MAINTENANCE OF HEALTH. will often brush the foreign body out if it is lodged on the inner upper lid. If the offending substance is under the lower lid, that can be easily pulled down and the body removed. If it adheres to the ball of the eye under the upper lid, the latter may be rolled back over a lead pencil and the substance brushed off with a earner s-hair brush. The finger nail should never be used for this purpose, as it usually contains poisonous, irritating matter which only increases the injury. Eyestones are supposed to possess marvelous and mysterious power to extract substances from the eye. Their only use, however, is to raise the lid from the eye and to allow the tears to wash out the foreign body. Flaxseed will accomplish the same result. If the body is a sharp splinter of metal or similar object, which clings to or becomes embedded in the eyeball, the services of a physician are to be at once procured. Particles of lime in the eye are painful, not only by reason of their sharp corners, but chiefly on account of the burning and caustic effect upon the delicate membranes. Wash the eye at once with a little dilute vinegar, which, being a weak form of acetic acid, neutralizes the caustic effect of the alkaline lime, and, uniting with it, forms a harmless salt. The most effective means of administering a bath, lotion, or wash to the eye is by means of a specially made eye cup, which fits the hollow of the eye and insures long and steady application. CARE OF BONES. Bone undergoes a remarkable change from infancy to old age. In infants there is an excess of cartilaginous matter in the bones, which renders them very soft and little liable to fracture. It is during this early period that malformation of the bones is likely to occur. Bow- legs may be easily caused by permitting heavy children to stand or walk at too early an age. There is a great desire on the part of some parents to have a child walk or stand as soon as possible, and to this end they encourage it to support itself by a chair when the bones are soft, pliable, and unable to bear the weight of the child's body. Rickets, which some- times affect children, is caused by a deficiency of mineral matter in the bones, as a result of which they bend under the weight of the body. This condition is a manifestation of a weak constitution, and the disease is often aggravated by living in damp and ill-ventilated homes. Such chil- dren demand the best hygienic care; fresh air, sunlight, good, nourish- DEFORMITIES OF THE BOXES. 107 ing food, such as abounds in phosphates, cereals especially, and comfort- able clothing. Curvature of the Spine. — Curvature of the spine is the result of bad positions in sitting and sleeping, whereby the spine is bent from its nat- -■mm Fig. 31. Bowlegs. Fig. 32. Knock Knees. ural shape. The cartilage which separates the vertebrae, or individual members of the backbone, become compressed on one side and renders the distortion permanent. Bones of the Feet. — Mal- formation of the bones of the feet is likely to result from the bad habit of sitting on the feet, which is a common practice with some children. Malformation is also frequently caused by ill-fitting shoes. The toes are pinched to such an extent that they override one another, and the joints some- times become enlarged. The nar- row sole compresses the arch of the foot, and the high heels strain the ankle and thrust the weight of the body forward. Cracking the Knuckles. — The Fig. 33. Curvature of Spine. disagreeable habit of cracking the knuckles by pulling and pressing them causes an unsightly enlargement of the joints. io8 THE MAINTENANCE OF HEALTH, The Bones During Old Age. — In old age there is an excessive deposit of earthy matter in the bones, in consequence of which they become very brittle, and much more liable to fracture than at earlier periods of life. Not only that, but, when fractured, the bones of old persons knit more slowly and with greater difficulty. This in conjunc- tion with the failing sight, and other infirmities of age, enjoins the great- est care on the part of old people. Ligaments. — The bones are united, and in some cases held together, by bands of tough cartilaginous matter known as ligaments. Sudden wrenches and twists, often caused by slight accidents and by small objects, result in the stretching, straining, or sundering, of these ligaments, which produces a sprain or a dislocation. Usually the tendon or the ligament, when broken or torn away from its fastening at the end, heals or grows fast again. In such cases, the full use of the member is restored. But very often the lacerated or disengaged end does not attach itself again, and the use of the joint is impaired. The pain of a sprain, which is often more severe than that of a fracture, is caused by a wrenching of both the ligaments and the muscles. The swelling which ensues is caused by the escape of blood into the tissues, which also causes the discoloration. In a dislocation the force of the twist, fall, or blow is sufficient to cause a displacement of the bones of the joint, rendering any movement or use of the joint impossible. Diseases and Injuries to the Bones. — Sprains, dislocations, and fractures are the most familiar results of injuries to the bones. It is hard to tell which is the more to be wondered at, the slight accidents which often produce the most grievous consequences, or the marvelous escapes from serious injury. Children escape certain injuries by reason of the softness of the bones ; old persons are more liable to such injuries because of the greater brittleness of the bones. Intoxicated persons make no effort to save themselves when falling, and the bones are not rigidly fixed by the tenseness of the muscles with which sober persons attempt to break the force of a fall. Sleepwalkers, sleeping children, and others, have bad falls with no serious effect, as they, too, are uncon- scious of danger, and make no effort to save themselves. A bone is subject to death even while in the body. Such a state is known as necrosis of the bone. Death of a bone is caused by anything which interferes with the circulation of the blood in the bone. Such interference may be a severe injury, the separation of the covering of the bone (the periosteum), inflammation of the bone, of the marrow, CARE OF THE MUSCLES. 109 or of the periosteum. Death of the inflamed bone always causes a secre- tion of pus, which finds its way to the surface. The most serious con- dition in which death of the bone results is that commonly known as hip-joint disease. In this the upper part of the long bone of the thigh dies., and its removal by surgical means is required. Inflammation of the kneejoint is often produced by very slight knocks or blows, so slight that they are forgotten until the pain in the joint sets the patient think- ing. A stiff kneejoint is very often the result. CARE OF THE MUSCLES. The proper care of the muscles of the body is largely a matter of good, nourishing food (for which see page 26) and of exercise. Exercise. — The direct effects of exercise upon the muscles are an increase in their size, density, and compactness, and a marked darkening of the color of the flesh. With insufficient exercise, the muscles decrease in size and become pale, flabby, and soft. The dark color of an exercised muscle is due to the larger supply of blood which it acquires through use. For this reason we do not choose dark-colored beef, as this darker color is an indication of much exercise and consequent toughness. The increase of a muscle in size by use is well illustrated by the great development of the breast muscles of pigeons, which are so constantly brought into use in long flights. The flesh becomes discolored and dark from the freer circulation of blood in the parts. The breast of a chicken is smaller in comparison, and is light-colored from lack of use, while the legs and parts most exercised supply the dark meat. Violent and long-continued exercise is injurious because there is greater waste and destruction of tissue than food and bodily functions can repair in the same time. There is a great difference between exercise for health and the systematic training of a professional athlete. A man who trains all of the time, and keeps himself always "in condition," be- comes prematurely old and usually breaks down in middle life. One of the most important laws of health is aimed directly at the man who leads a sedentary life : A sedentary life needs daily, moderate exer- cise, never carried to the point of fatigue. "No organ of the body, no set of organs, nor the body itself, can be maintained in a normal and healthy condition unless its parts are fully exercised.'' The exercise of the muscles is not limited in beneficial effects to the muscles themselves ; but regular no THE MAINTENANCE OF HEALTH. and systematic exercise is of the utmost importance to the full develop- ment and the well-being of the body as a whole. Special Value of Exercise. — The muscles of the body, as has been stated, cannot be strong, and cannot perform their functions well, without regular and intelligently planned exercise. This is true of both the invol- untary and the voluntary muscles. By involuntary muscles are meant those which act regularly, without requiring any effort of the will power or the attention. The lungs are benefited by exercise chiefly in the direction of throw- ing off the carbonic acid gas more liberally and completely. The neces- sity of drawing long breaths which exercise entails is the means by which this is done. The statement that a healthy body is an impossi- bility without proper breathing and a sufficiency of good, fresh air, will bear repetition, so important is this point as a preliminary in the acqui- sition and retaining of good health. The purity of the blood depends upon plenty of oxygen, and the health of the several organs and the parts of the body depends upon the purity of the blood. Deep, efficient breathing of fresh air is the first rule of good health to all, but espe- cially to those who follow sedentary occupations. The circulation of the blood is benefited by the increased action of the heart which is induced while exercise is being taken. The heart beats more rapidly, the pulse is stronger and fuller. The blood is sent coursing to the extremities, the brain is well supplied with fresh, rich blood, and the whole system, both physical and intellectual, responds to the exhilaration. The lawyer, the student, the business man, who have wrestled with perplexities and problems in the office and the study, find great clearness of mental perception in the refreshing walk. Many a knotty problem or difficult question finds easy solution on the golf links, by the seashore, or in the country lane. If the exercise has been violent or carried to the point of fatigue, it will be observed that the heart and the pulse rate rapidly fall below the normal. It is then that the care of the body in the way of clothing and rest is most needed. Excessive exertion may cause palpitation and valvular disease of the heart as a direct consequence of the great demands that are then made upon that organ and of its effort to quickly repair the waste which goes on so rapidly. If disease of the heart is known to exist, it is suicidal to indulge in violent exercise. Even the act of running for a train or car, or of walking rapidly uphill, may be the cause of a rupture of some weakened or diseased organ or part of the heart ; and this explains EFFECTS OF EXERCISE. in some of the cases of sudden death which follow such indiscretions. But this danger should not lead to the other extreme, the neglect of all exercise. There are many forms of gentle, moderate exercise which are perfectly safe for those with "heart trouble" to practise with benefit ; for a deficiency of exercise is often the direct cause of a weakened heart and, in some temperaments, of fatty degeneration of the heart. The skin during exercise becomes red because with increased circu- lation the blood is forced with unusual vigor to the surface capillaries, or minute blood vessels, in all parts of the body. As the temperature of the body increases, the perspiration glands begin their work of cool- ing the body. At this stage another very important law of health must be observed. These pores must be allowed to close gradually. To effect this, as soon as the exercise is completed, heavier, protective cloth- ing must be thrown around the body and a gentle walk should be taken in order, as it is often said, to let the body cool off slowly. Really it is to prevent the pores of the skin from closing too rapidly and thus checking the perspiration too soon. Sudden cold, or cooling, sitting in a draught, or similar exposure closes the pores suddenly. The per- spiration is then checked and has no escape except through the kidneys. This sudden interruption of one of the body's spontaneous efforts to adjust the temperature to new demands and unusual conditions results inevitably in a cold in one or more of its dangerous forms. The same result is brought about by throwing one's self after heating exertion on damp grass or on the cold ground, or by taking a cold bath, or swim- ming when overheated, or indulging in similar indiscretions. Young people who are not informed of the danger of such practices are inclined to think that those who advise against them are treating them with a coddling, unmanly care. But the horse trainer knows better than to neglect to exercise his horse under a blanket after a race, and never thinks of turning him at once into the stable or of letting him drink cold water after a hard drive. A dog, however, may swim and lie in the water as much as he pleases when suffering from the heat, for he has no pores on his body to close ; he does all of his perspiring by means of his mouth, and this accounts for his deep panting, open mouth, and protruding tongue, on hot days and after violent running. The nervous system is benefited mainly by the flow of blood to the brain. Whatever improvement of the nerves, whether motor, sensory, or sympathetic, results from exercise, or, indeed, from any cause, must come from the brain ; for that organ controls the entire nervous system. ii2 THE MAINTENANCE OF HEALTH. That which improves the brain, improves the nerves'; and that which injures the brain, injures the nerves. Moderate exercise renders the mind clear and active. Change of scene, of occupation, and of associates, have a most beneficial effect along the lines of rest, for mental rest may proceed simultaneously with bodily activity. Deficient exercise dis- plays its effects upon the nervous system by morbid excitement, ennui, melancholy, and mental hallucinations, especially in the case of persons of a highly-sensitive nervous organization. Exercise in the fresh air and sunlight are large and important factors in the treatment of nervous diseases. The digestive system is much benefited by judicious exercise. The appetite increases because there is a waste of tissue to be repaired, which does not occur to such an extent in a state of rest or of inactivity. The food digests better; and its absorption into the blood after digestion is both greater and easier. The circulation of the blood in the liver and in the abdomen is improved, and this is attended by a better perform- ance of the functions of these important organs. On the other hand a deficiency of exercise lessens the appetite and diminishes the digestive power. The food which is taken into the body is not fully acted upon and it remains in the stomach, where, to a greater of less extent, it decays rather than digests. This means an impairment of the bodily health and a long train of disorders of which constipation and poison- ing by the absorption of faecal matter are not the least. A great and mischievous error is committed by many at this stage in seeking a remedy in the free use of purgatives and aperients. Not only do people bring this deplorable condition upon themselves by neglect of the simple and natural means of exercise to prevent it, but they then seek to use force to compel the bodily organs and functions to conform to these unnatural and unhealthful habits of living. Such unreasonable forms of relief are often called a means of assisting nature. There is practi- cally no case of constipation brought on by an indolent habit of life or by sedentary occupation that will not, in time, yield to the treatment of moderate exercise, regularly performed, aided by a liberal, fresh fruit diet. Perhaps the most noticeable effect of exercise upon the bowels is the relatively small amount of refuse or waste matter that is thrown off by them as excreta. This is a convincing proof of the benefits of exercise upon digestion. By its means more of the nutritious matter is extracted from the food and is absorbed into the system. There can be no true QUANTITY OF EXERCISE. 113 condition of health when a certain amount of nourishment supplied to the body is, through neglect and carelessness, to a large extent thrown away unused. It is one of the first principles of commercial economics to get the largest possible returns of manufactures from a given quan- tity of raw ^product; and so it is one of the first principles of physiolog- ical economy to derive as much nourishment as possible from a given quantity of nutritious food. Quantity of Exercise. — Attempts to prescribe the amount of exer- cise a healthy adult should take in a day are based upon as accurate, as possible, an estimate of the work done in a day by a man engaged in manual labor in the open air. Such is regarded as the most healthful life possible. A man so engaged will put forth in a day as much strength or force as will suffice to raise from 250 to 350 tons one foot. It would seem then that the minimum of daily exercise to be taken by an average man should be not less than the expenditure of sufficient force to lift about 150 tons one foot. This force is expended in a walk of about nine miles. Taking into consideration the fact that every one in the pursuits of daily life puts forth considerable exertion, this amount is to be reduced according to the amount of force so expended. No rule can be laid down which will cover all cases, but it is possible, from the facts stated above, to fix the amount required in any case with tolerable accuracy. Form of Exercise. — Much has been said and written about this and that series of "movements" ; and many ingenious forms of physical exercises have been devised, with and without elaborate apparatus and contrivances. But it would appear that many of these new forms have been made interesting and attractive in order to coax us to give up a small part of our time each day to such exercise as is really necessary to the healthful development and proper nourishment of our bodies. It is not sufficient that an intelligent person be told that if he move his arms or his body in this or that direction, so many times each day, that this or that result wijl be reached. Knowing only so much of one or more of the many forms of physical culture so strongly advocated, and so speedily superseded, it is no wonder that thinking, reasoning persons tire of them and so soon neglect them. With the full and plain descrip- tion of anatomy and physiology given in another portion of this work, anyone who desires to improve the general condition of the body, or to supply any special deficiency, may do so with intelligent effort and per- sistence in the very simple forms of exercise here recommended. Unless ii 4 THE MAINTENANCE OF HEALTH. one knows the end one is trying to reach, and the means one is employ- ing to reach that end, there is small likelihood of either intelligent or persistent effort, without which practically nothing of lasting benefit can be accomplished. Walking. — For general development, vigor of body, and the full maintenance of health, no form of exercise can compare with walking. This exercise, so much demanded in business and domestic life, is, when properly conducted, one of the most beneficial forms, and the most easily practised. Care must be taken that when performed, whether in the office, the home, the street, or the country, every step be taken correctly. For, apart from the great physical benefits which it confers, one must not forget the charm of an easy and graceful carriage. There are those who most conscientiously take a formal walk for exercise every day, during which they carefully practise all the correct observ- ances which they wantonly neglect all the rest of the day. So awkwardly and inefficiently is this commonest of all acts per- formed by the average man, that the first thing taught to one joining the army is how to walk, and, incidentally, how to stand, correctly. All recruits are obliged to go through the drill of attention and the ''goose- step" to insure that erectness of carriage and that ease and grace of motion for which a well set-up soldier is noted. A good walker carries the head erect with the chin slightly drawn in or down ; shoulders square ; chest raised ; hips drawn in ; toes pointing slightly out; heels striking the ground first, afterward the ball of the foot, evenly; the walker finally springs from the toe after the manner of the square heel-and-toe of the pedestrian. The exaggeration of any of these points is, perhaps, more ludicrous and ungraceful than the disregard of them. One is not always conscious of faults of gait which are apparent to others. These can be corrected by soliciting kindly criticism from one in whose judgment we have confidence, and, in this way, learning our shortcomings. Walking and the mode of carrying the body constitute an indispen- sable part of one's appearance in public, and one owes it to one's self that this be, as far as any personal effort and painstaking can make it, graceful, easy, healthful, and calculated to create a favorable impression. It is, perhaps, hardly necessary to say that no one can walk well or gracefully in uncomfortable and ill-fitting shoes. It is to be remarked in this connection that as much, or more, actual discomfort may be suffered from wearing a shoe that is too large as from one that is too WALKING. 115 small, to say nothing of the added ungainly appearance. Too much care cannot be paid to the proper fitting of the foot; nor too little attention to the dealer's assurance that some detail of poor fit will be all right after the shoe has been worn a few days, when the shoe will take the form of the foot. Too often, under such circumstances, the foot takes the form of the shoe. Slow walking, or sauntering, is really more tiring than is a brisk steady gait. In walking uphill the body should be inclined forward and the steps taken should be short. The habit of starting out to walk to a certain point with the fixed purpose of walking just so far for the sake of exercise and with no other thought than that of performing a duty, is not generally beneficial. Nor is it well to go alone when it is possible to have congenial compan- ionship. In the solitary walk the mind is less likely to be freed from the cares of business or domestic duties or from study or worry. But be sure that the companion is congenial ; an uncongenial companion may render an otherwise beneficial walk quite harmful. One should try to walk in places where there is something interesting to engage one's attention. It would seem worse than idle to recommend this form of exercise purely as a means of developing the muscles to those who in the dis- charge of their duties are obliged to walk a great deal. If a walk is devoid of recreation, pleasure, change, or the benefits of fresh air, by all means let some other exercise be chosen. Still, there remains to such persons, in common with all who walk, the need of observing that each step be taken with marked attention to correctness of gait and grace of bearing, which is so essential to both health and charm. After a comparatively short time, if strict attention be paid to these points, the habit of correct and graceful walking will be so confirmed that it will be well-nigh impossible to fall back into a slouchy or ungainly gait or faulty and ungraceful carriage. Under no circumstances should walking, or, indeed, any form of exercise, be carried to the point of extreme fatigue. There is such a thing, however, as a healthy weariness which insures all the pleasure of rest and of sound sleep, which makes walking and similar forms of exercise Nature's remedy for insomnia. By all means let the walk be taken as a recreation, not as a perfunctory or disagreeable duty to be performed. It is the basis of golf which, after all, is but a game of a long- walk with pleasant companions and the recreative adjunct of skill n6 THE MAINTENANCE OF HEALTH. and the correct estimate of distance. The camera, the botanical tin for collecting specimens, the sketchbook, or the paint box may be the form of recreation added to the walk. To the observant mind and the lover of nature, there is a rich fund of enjoyment and food for rational con- templation in a walk by field and stream. Nor is the exercise to be confined to fine weather alone. A good bracing walk in stormy weather has its charms and pleasures for one who is properly clad and protected against all inclemency. But one must be sure that there is no exposure. Running. — This form of exercise is largely restricted by custom to the young of both sexes and to men. As it is more violent than walk- ing it produces more marked results. The circulation of the blood is greatly increased and, with it, the temperature of the body and the number of respirations per minute. It is possible with regular practice to develop in a very short time the power of keeping up an easy dog- trot for several miles. While the entire body is greatly benefited by running, the special development is in the legs. But the gentle, regu- larly sustained back and forward motion of the arms in a long run is one of the best possible preliminary exercises for arm improvement. The arms are bent at the elbow and are carried at the sides of the chest with a very slight motion. Violent motion of the arms in running is a useless expenditure of strength, which is better conserved for legitimate use. Fast running for a short distance, or sprinting, consists in the power of taking long steps very rapidly. But long distance running at a moderate pace is much the better form of exercise, although, as a sport, it spoils one for short distance running. The behavior of the breathing in long distance running is very peculiar, in that the runner's "wind" fails him after a short distance has been covered; then, after a short period of rather labored breathing, the "second wind" comes and, usually, stays with him. It is conceded by runners that the use of tobacco very materially injures the "wind" of runners and athletes gen- erally. Sometimes running is attended with pain in the side; upon the occurrence of this the runner should instantly cease exercising until such pain passes off". The great danger to be avoided is in exposure on cooling off after a run. A wrap should be thrown around the body and a walk should be kept up until the temperature of the body is re- duced. Drinking cold water and throwing one's self on the ground when overheated are often followed by very serious consequences. Physical Exercise for Young Persons. — No formal physical exer- cise or gymnastics should be encouraged before the fifth year. From PHYSICAL CULTURE. 117 that up to the eighth year such exercises as are employed must be very simple. The child is growing fast and the muscles in their imperfectly developed state cannot perform double or intricate movements. The games that children play, and play so poorly compared with an older person, are both a sufficient exercise and at the same time a proof of their inability to bring several sets of muscles into efficient use at the same time. From the eighth to the twenty-first year is the time for formal physical development. That is the period of life when the body will most easily respond to right efforts towards carriage and development. The youth is well able to take part in those games which call forth a variety of complex movements of both body and mind. The exercises which are given below are designed for general mus- cular and physical culture. The following points should be observed in the practice of them : — 1. They are best practised in the morning on rising. 2. Let the clothing be light and loose. 3. Drink plentifully of water both before and during the practice. 4. Lower the windows from the top and raise them from the bottom. Have plenty of air but no draughts. 5. Do not perform the motions in a listless manner. Act as though you were meeting resistance in the motions. Play one muscle against another. This does not mean a jerking motion, but a steady pull or strain of the muscle. If the exercise is taken in this way the use of weights or dumb-bells is not advised. The artificial resistance is better than the weight. 6. Perform with accuracy and pre- cision and with a determination to get the most possible good out of them. 7. Rest for about a half minute be- tween each movement. Exercise I. Bending and Stretch- ing. — Raise the hands to the full extent above the head, palms to the front. Stretch as high as possible. Keep the body erect and the upper part of the body raised as high as possible with a reaching motion. Bend the body at the hips and try to touch the floor with the tips of the Fig. 34. Position i. Fig. 35. Position 2. n8 THE MAINTENANCE OF HEALTH. Fig. 36. Position 2. fingers without bending the knees. This may be impossible, but come as near doing so as you can. Straighten up, restoring the hands to the former position. Repeat slowly ten times. Exercise II. Bending the Body Forward and Back. — Place the hands on the hips, with the fingers towards the front, and thumbs back. Bend the body forward until it is at right angles with the legs. Keep the back straight. Then bend backward, supporting the back with the hands still upon the hips. Begin with ten times and gradually increase to thirty. This is an excellent exercise for a weak back or for reducing excessive fat on the abdomen. Exercise III. Rotating the Body on the Hips. — Place the hands on the hips, arms bent at the elbows, thumbs to the rear, fingers to the front. Turn the head so that the chin is over the right shoulder, eyes looking to the right. Slowly and with resistance to an imagined opposing force, turn the body on the hips so that the right shoulder comes to the front. Reverse the exercise by letting the right shoulder go back and the left shoulder come to the front. If this exercise is performed rapidly and with a swing, the rotation of the body on the hips will be greater in extent but not so beneficial as when performed slowly and with resistance. Repeat ten times at first with a gradual increase in the number of times and in the vigor of the exercise. The muscles of the back and of the abdomen are greatly bene- fited by this motion. Exercise IV. Bending the Body Sideways and Back. — Raise the hands above the head; bend the body at the hips toward the right side, head and chin raised so as not to interfere with the circulation and the breathing. Straighten up and carry the body as far backward as you can, with the head thrown back. Repeat the move- ment ten times at first ; gradually increase in vigor. This strengthens the muscles of the abdomen and the back. Exercise V. Bending the Body to the Side. — Stand with the arms hanging naturally at the sides, body erect. Bend the body to the right, at the same time reaching down as far as possible with the right hand, and raise the left arm straight up and in line with the right hand. The eyes are to be directed downward. Straighten up and bend Fig. 37. Position i PHYSICAL CULTURE. 119 Fig. 38. Position i. Fig. 39. Position 2. down as far as possible to the left, reaching downward to the full extent with the left hand and raising the right hand above the head, with the eyes directed downwards. Do not let the body incline backward or for- ward in this practice. It is a beneficial exercise for the muscles of the abdomen and the back. Repeat it ten times, gradually increasing. Exercise VI. Abdominal Ex- ercise. — Lie at full length on the floor upon the back. Place the hands upon the hips. Imagine that a weight rests upon the feet. Slowly raise the feet, without bending the knees, so that the legs are at right angles with the body. Gradually and slowly drop the feet and legs to the original position. Repeat ten times and gradually increase. When rightly performed this is a test of the strength of the abdominal mus- cles. Do not overdo it. Exercise VII. Arm and Body Exercise. — Lie full length on the face on the floor. Place the hands, palms downward, on the floor under the shoulders. Slowly raise the body from the floor to the full extent of the arms, keeping the tips of the toes on the floor. Very slowly lower the body to the floor without resting it upon the floor, and repeat the exer- cise only five times at first, gradually increasing it. Exercise VIII. Development of the Calf of the Leg. — Place the hands upon the hips. Raise the body on the toes. By bending the knees, slowly lower the body to a sitting position still resting on the toes. Resume the first position. Begin with ten times and gradually increase to thirty. Exercise IX. Going Upstairs. — This exercise can be put into practice as the occasion requires. There is no more beneficial treatment of the legs than this when properly done. We have been doing it so regularly and from such an early age that we do not realize that the act is a very nice and difficult balancing feat. II we stop to think of the number of falls a child receives while he is learning the art of going up and down stairs, or if we think of the Fig. 40. Position i. 120 THE MAINTENANCE OF HEALTH. trouble we nearly all experience on strange stairs in the dark, we shall begin to appreciate its difficulties. So great is the difficulty of preserving the balance of a body, the center of gravity of which is constantly chang- ing, that when the first Japanese embassy visited Europe several years ago, there was not one of its mem- bers could go up and down stairs without clinging to the hand-rails. And yet those people had gone up Position i. and down ladders at home in their houses with agility. In going up- stairs incline the body forward. Many do this incorrectly by simply dropping the chin upon the chest, which interferes with the breathing and the circulation. Take the first stair with the left foot, raising the body at the same time on the toe of the right foot. This is important, as it exercises the large muscle of the calf of the leg. Do not place the flat of the foot on the stair. Come down on the toe and carry the weight of the body on it. Ability to go up a flight of stairs on the toes is an indication of vigor and freshness. The flat foot on the stairs is an indi- Fig. 42. Fig. 43. Position i. Position 2. cation of illness or of weariness. On going downstairs, carry the body erect, not inclined forward in the act of looking at the steps ; let the eyes do that while the body is erect. Let the weight be carried on the toes. The muscles that are employed in this are the walking muscles, but there is the added weight of the body. In going up one flight of stairs the subject is not only going forward, but is raising the weight of the body a height of ten or twelve feet. It is like climbing up a very steep hill with a good footing. Of course a woman is at a great disadvantage in going upstairs with one hand full of skirts and a few things in the other hand, and few of them perform the act well or gracefully. But there are many who so appreciate the great benefit of the exercise that they seldom use an elevator except in long trips. THE NERVOUS SYSTEM. 121 Bicycling. — It must be remembered that the set of muscles which are brought into play in bicycling are not the same as those used in walk- ing. The bicycle muscles are the same as the skating muscles. And we all know that, no matter how well developed the walking muscles may be, we feel keenly the soreness and stiffness which fol- low the first day's hard skating. The large muscle of the calf of the leg is a walking muscle, but does not come into use to an appreciable extent in either bicycling or skating. This is largely be- cause there is slight need in the latter acts of raising j^, the weight of the body upon the toes. So that both Position 2. bicycling and skating are good supplemental exer- cises to that of walking and running. THE NERVOUS SYSTEM. There is such close and intimate relation between the mind and the body, between the nervous system and the bodily functions, that what- ever injures or impairs the one, in similar measure injures or impairs the other. This was fully appreciated by the ancients, who regarded "a sound mind in a sound body" as the ideal of the perfect development of mankind. Good food, fresh air, and proper proportions of exercise and rest, of work and recreation, are as necessary to the development of the brain as to the growth and sustenance of the body. Sleep, natural, regular, and profound, is the first duty we owe to the nervous system. It is during that period that Nature is building up again what has been lost during the waking hours. The safe rule is to sleep until one wakens naturally. No fixed number of hours can be set. Much depends upon the occupation; — brain workers and children re- quire more hours of sleep than do hand workers and old persons. The best sleep is that induced by Nature and unattended by dreams. Sleep obtained by drugs or medicines is not so beneficial as is natural sleep. It is supposed that the medicine by reaction disturbs the nervous system and neutralizes the value of sleep. Under no circumstances should drugs be used without the sanction of a physician. To those suffering from the fearful affliction of insomnia and driven almost to desperation by their terrible condition such advice may seem unsympathetic and 122 THE MAINTENANCE OF HEALTH. trite. But rather a thousand times the ills of insomnia than the fear- ful thraldom of the drug habit. One suffering from insomnia should be very careful of his every act, but especially of those within six hours of the usual time of retiring. No tea or coffee, no study, no more worry than possible, no excitement during that time, and as much resig- nation and calm, deliberate fighting the demon of unrest as can be sum- moned, will go far towards a conquest; — not, perhaps, the first night, or the second, or the third; but persistence must orevail. Let all of this be accompanied by a hot bath, as hot as can be comfortably borne, to allay nervousness. Many are the suggestions for a remedy, some very ridiculous, but nearly all pointing to the direction of concentrating the mind upon something other than upon one's unfortunate condition and of striving to forget one's sufferings. Insomnia, or sleeplessness, is a symptom or sequel of other conditions. Permanent relief can be found only by the removal of the cause. Temporary relief is afforded by such treatment as will draw the blood, from the brain and so prevent its activity; for the brain cannot act without blood. Such means are the hot bath, a brisk walk before bedtime, moderate diet, and outdoor exercise. Indiscretions in eating and drinking are always accompanied by sleeplessness. The consequent disordered stomach and more or less acute indigestion are the causes to be removed. Whatever the cause it must not be ignored or temporized with; for sleeplessness is one of the most alarming symptoms of a nervous or mental collapse. Neurasthenia, or Nervous Prostration, is the breakdown of the nerv- ous system after a period of nervous excitement or strain. It is Nature's rebellion against bad treatment, — either enforced or willful. It is the almost general custom to ascribe it to overwork. The human body is so protected and safeguarded by bountiful provisions and adap- tation of parts to their uses, that no taxing of its powers beyond its strength is possible by legitimate means. There is no such thing possible as prosecuting work along legitimate lines to injurious lengths. No amount of healthy work can be held responsible for nervous collapse. There are always other reasons for a breakdown. If, during the hours which should be properly devoted to rest and sleep, there are social and intemperate excesses, irregular hours and late suppers; or if there be worry in any of its many phases; undue excitement; mental agony or distress; any of these, alone or in combination, may in time produce this condition. Invariably it is one of Nature's last warnings that all NERVOUS PROSTRATION. 123 of her plain and simple laws of health are being ruthlessly disregarded, that all of her rights are being persistently invaded ; and that it has gone on until she most positively protests against a continuance of it. That this nervous collapse is far too prevalent is attested by the number of sanitariums and health resorts established throughout the country. It has come to be considered as one of the inevitable results of present day conditions of life, both domestic and business. There are, however, indications of a protest being gradually but steadily entered against life and its hard conditions and exactions. Business men are showing an inclination to go slow; to observe shorter hours; and to take more recreation and regular vacations. The unwisdom of inordi- nate ambition and its fierce struggle is gradually being borne in upon the minds of all classes; and moderation, the keynote to all permanent and enjoyable success, is still recognized as the safest course to pursue. It is not the struggle for existence that brings such a state of health to the business man so much as the struggle for high place. To the student with mediocre ability, to the business man of limited capital and few connections, to the professional man with slight popularity, to the social aspirant with small income, the spur of unreasonable ambition and of too lofty aspiration brings the worry, the struggle, and the dis- appointment that kill. In face of such penalties and sufferings the resignation and contentment which make one satisfied to walk in that state of life to which it has pleased God to call one, is almost envi- able. The treatment of neurasthenia consists chiefly of rest, sleep, change of air and scene, and removal from the customary surroundings and associations. Sympathetic and cheerful companions, good diet and nursing, proper medical treatment, and, above all, the necessary disci- pline of regular hours, baths, medicine, and complete change of the manner of living, will, in time, restore much of the former good health. But even then, great care in the mode of life, observance of the laws of health, and moderation and much self-denial will be needed to pre- vent a recurrence which will in the second case be more easily provoked than at first. Overwork. — As previously stated, this term is much misused. There is, however, a form of overwork concerning which parents should be very careful; that is the overtaxing of the young mind before the mental powers are fully developed. There is a great temptation, especially when a young child shows an unusual degree of precocity, to i2 4 THE MAINTENANCE OF HEALTH. encourage a too rapid mental growth. There is more than ordinary danger of this in the case of an only child who is brought up in the company of his elders and is denied the companionship of young chil- dren of near his own age. The more nearly equal mental attainments of such companions is a safeguard against such severe mental strain as the intercourse with grown people too often excites. Such a child is usually sent to school at too early an age and so the process of forcing is continued, to his great detriment. Remembering the very intimate relationship existing between the mind and body, it must appear that such a child's intellectual development is being hastened at the expense of his physical growth. The only encouragement that such a child should receive is along the lines of observation. He should be encour- aged to gather his knowledge of his environment and of the things near- est to him by the senses of touch, sight, and hearing. AYhen the brain is developed and the mental processes are active, there is slight danger of a boy or girl suffering from overstudy. Given a good physical development a parent need have little concern with the possibilities of a child injuring himself by a too close application to study. In the case of children of weak constitution and of a nervous temperament, care must be taken that such a one devotes as much attention as possible to physical culture and outdoor life. If the body is built up and kept up, the brain will grow strong at the same time. A great deal has been said of the injury of "cram" for examinations. Now, the ability to master a subject, or to gain a good knowledge of its principles in a short time and under pressure, is an accomplishment that should not be despised. The lawyer does just such work on every case he takes up. He must get a grip upon a subject within a very short time which will enable him to intelligently conduct his case and even to examine and to cross-examine experts in the interests of his client. This knowledge is put aside when the case is through and a new subject is taken up in the same way. The medical man and other professional men are often called upon to do the same thing. In the case of chil- dren the great objection is that the method is not pedagogically sound and is at variance with the proper principles of education. There is slight danger of any injury, either physical or mental, resulting from it. Anger and Passion. — The nervous system is so delicately balanced and so intimately connected in its control of the functions of the bodily organs, that violence of temper and manifestation of extreme passion and motion are constitutional in their disturbing effects. History is A STOCK OF ENERGY. 125 full of even fatal results from an outburst of anger. Sylla, Valentinian, Nerva, Wenceslas, and Isabeau of Bavaria all fell a prey to a sudden access of passion. The numerous instances in all ages of temporary insanity with attendant crimes of murder, and self-destruction induced by violence of passion, all attest the utter derangement of the brain under their influences. It is a complex metaphysical and physiolog- ical question which confronts one in an attempt to fully explain all of the reasons why the body, its organs, functions, and the general health are so shocked and disturbed by anger, hate, and the painful affections of the soul, and even by intense joy. Certain it is that the blood is suddenly and violently congested in the lungs and brain. The nerve centers of the brain and spinal column are paralyzed, the heart beat and the breathing are interrupted and decline. The liver is so affected that the bile is increased and is absorbed into the system so that jaun- dice sometimes results. Apoplexy results from the congestion of blood in the brain. In repeated indulgences the effects are cumulative and in- duce loss of appetite, indigestion, and affections of the brain. The log- ical hygienic conclusions from these facts are that one must avoid all strong emotions and intense pleasures; and meet the sorrows and agonies of life with philosophical resignation and equanimity. In such conditions work and occupation to employ and divert the mind and to render one proof against the temptations of idleness is one of the greatest blessings of life. A Stock of Energy. — We are often struck by the wonderful display of physical and nervous energy by persons of fragile appearance at critical times. The storing up of nerve force and of supplies to with- stand sudden and severe demands is well provided for in the physical economy. Nature always looks ahead in the most prudent way. She stores her surplus force in reservoirs all over the body in varied forms to guard against both the irregular supply of food and unexpected drafts upon her resources. If this were not so, man could not go, as he often does, for long periods without food or sleep. He lives during such periods upon the stock of energy which Nature has laid up for him. Especially is this remarkable in the case of brain work. The worker may arouse himself with stimulants at such times, but he only drugs the guards of pain, hunger, anxiety, and weariness which warn him of approaching exhaustion and fatigue. Physical and nervous collapse come on him unawares and almost before he knows it he is in the clutches of nervous prostration. This violation of a very simple 126 THE MAINTENANCE OF HEALTH. principle is so often seen among good business men who would smile at the statement of so self-evident a fact that it is impossible to main- tain a bank balance by continually writing checks and never making a- deposit. Yet such is the unreasonable and erroneous attitude which many of these assume towards the highly necessary physical and nerv- ous stock of energy. DOMESTIC HYGIENE. R. W. CON ANT, A.B., M.D. Among the physical needs of man, a healthful and convenient dwelling place stands next in importance to food and clothing. The first essen- tials of a dwelling should be plenty of pure air and sunlight. Neither appearance, convenience, nor expense should be allowed to interfere with these essentials, and yet they often do. Location. — This problem is much simpler in the country than in the city. The more thickly people dwell together, the more difficult it becomes to secure plenty of air and sunlight, to say nothing of freedom from dust, noise, and smells. In the city it is a great temptation to sacrifice these good things to considerations of accessibility, cheapness, or mere gregarious- ness. The very poor, especially, manifest an almost invincible propensity to crowd into the slums, where they pay as much for one or two noisome rooms in a tumble-down rookery on a filthy street as it would cost to rent a pretty little cottage in a suburb, with plenty of air, sunshine, and outlook. This soul and body destroying choice they persist in making, in the face of all advice, partly from ignorance and prejudice, mainly from the herding-together instinct, stronger even than in animals. And so the slums spread and fester like great plague-spots in the large cities — hot- beds of crime, misery, and infant mortality. Even in the better residence districts of a large city the conditions are none too good, especially for children. Where house is joined to house in solid rows, there is necessarily much room space which can never receive direct ventilation and sunshine. Worst of all, these dark rooms are usually the bedrooms, which most of all need abundant sun and air. So long as people will persist in packing into these unhygienic and often unsanitary dwellings,, the only thing which can be advised is to make the best of a bad case. This will be considered in detail under the subject of "Ventilation." The Suburbs. — If possible, own your own home, with a bit of ground FLATS VERSUS HOUSES. 127 for a garden. In any case, live where there is open ground all around the house, so that no room shall be destitute of direct access to light and air. If you are obliged to rent, have a separate house or cottage if pos- sible. It is only a question of going out far enough, and if you are near good, rapid transportation, you are really as near to business as there is any need of being. On the lines of railway radiating from all our cities there are beautiful, healthful suburbs which can be reached in from twenty to forty minutes ; and what are a few minutes more in transit compared with the advantage of exchanging the noise and filth of the city every evening for the beautiful, peaceful country, especially in summer ? It is a strange perversion of taste which prefers staring solid blocks of houses and hot pavements to trees and lawns. Flats vs. Houses. — Much can be said in favor of each. Other things being equal, flats are usually cheaper, and if on the first or second floor, they save much stair-climbing — an important consideration for women or invalids. But the better air, view, and more sunshine are usually found on the top floors. On the other hand, they are poor places for rearing children, for reasons too obvious to need enumerating. But if a flat is to be rented, it should be one which has a maximum of wide courts, with good-sized rooms, well cleaned halls and alley, with prompt and sanitary disposal of ashes and garbage. Of course the plumbing, drainage, ventilation, heating, thickness of the walls and floors, wood- work, and cellar should be carefully inspected. It is also well to make some judicious inquiries of the tenants and neighbors. Especially critical should the inspection be if the building stands on "made land." Find out whether the land was "made" of garbage and refuse or of good soil. Skin Flats. — In some localities there has been a great deal of real estate speculation in "skin" flats and apartment buildings. A "skin" building is one which is put up as cheaply as possible, with a view to filling it with tenants and then selling quickly at a big profit before the building falls down. The judicious renter will be on the lookout for this class of flats and houses. Sometimes they are quite difficult of detection, the skimping and falsifying being confined to the parts of the buildings which are out of sight; but usually such buildings have a family resemblance instantly recognizable by the experienced renter. Almost always they present a tawdry prettiness, an excess of cheap col- ored glass and imitation woodwork, calculated to catch the eye of those who choose a dwelling place because of such adornments. The Best Way. — But by all odds the best way, when it is possible, 128 THE MAINTENANCE OF HEALTH. is to decide first on your location and the rent you can afford to pay. Then watch the flats and houses being built in that locality, so that you may get an intimate knowledge of their construction, which will be impossible after they are finished. In fact, that is the only way in which you can be sure that any dwelling has a real drainpipe, actually connect- ing with the sewer through a perfectly sealed trap, and with ventilation to the roof. And yet that one thing is essential to the healthfulness of your home. Always rent a new flat, if possible, so as not to inherit other people's dirt or bugs. Of course you select your location with due regard to your family needs. If you are a business man, transportation must be reasonably quick, prompt, frequent, well lighted and heated; the station within easy walking distance, over good sidewalks, well lighted. If you have chil- dren of school age, a good school must be reasonably accessible. Fire and police protection must be adequate, which includes a fire plug and alarm box near your house, and a street which an engine can get through in any weather. You should investigate the range of prices at the neigh- boring groceries and markets, to learn if they are exorbitant ; also prices of gas, coal, and wood. If your wife must have domestic help, of course the matter of the local supply of assistants must be inquired into. The necessity of these precautions seems quite self-evident, and yet it is the neglect of them which often entails months of annoyance and loss, perhaps sickness and death. Either you or your wife must look after these things ; don't take the agent's word for it. He is there to rent the property and get his commission. Likewise, do not accept any verbal promises of changes or repairs to be made on the premises — have everything of any importance put in the lease. That document, by the way, should be read very carefully before you sign it. Some of them are tricky and outrageously unfair. The Country House. — Much of what has been said above applies equally to the choice of a house in the country, especially as regards sun- shine and air. But there are other features that are decidedly different. While you could scarcely avoid plenty of sun and air if you tried, you must plan very wisely for good water and effective drainage. If you are so fortunate as to be able to build your own house, there is no end of conveniences for you to plan. Of course the first thing is the selection of the site. The ideal site will be on ground somewhat elevated, in order to secure perfect drain- age and wide view, but that may not be possible. If obliged to build CELLAR WALLS. 129 on the flat prairie, do not dig for a cellar more than three feet at most, and take every precaution to make it dry. Soil. — You cannot pay enough attention to the soil upon which the house is built. Most people think that if they avoid a marsh that they have a dry soil. Others are deceived by a sandy soil, and tell you that sand is one of the best drainage soils to be found. Yes; provided it is deep enough. But a foot or two of sand on a clay or rock base through which the water cannot drain is the most dangerous of all. If you are unfortunate enough to live on a damp soil, you would better move; for here is a list of the diseases which are connected with a cold or damp soil : all catarrhal affections of the lungs ; rheumatism ; neuralgia ; con- sumption; malarial fevers; typhoid; cholera; diphtheria; diarrhoea; and dysentery. If you have selected a site on the side of a hill, do not dig your cellar out so as to leave a cliff behind and the ground sloping to the front. But build a terrace in front so that you will have the same depth of earth all around the house. Dry the soil out as much as possible by effective drains. Put a cement floor over the bottom of the cellar, except where the drainpipes run. Put a board covering over the latter flush with the floor, so that you can get at them when necessary without tearing up the cement. See that no foul matter drains down from around the house; some people drain the surrounding land through their cellars. The effect of that is obviously bad. These points properly carried out will give you a dry cellar; one that can withstand perfectly the rainy or spring season. The Cellar Walls should be double to promote dryness. This may be accomplished in various ways — by building the cellar walls with hollow tiles, perforated brick, or artificial stone. The latter is especially good, since the internal cavities are so large that they connect freely; for the same reason, a house built entirely of artificial stone is best pro- tected against both cold and dampness. Of course the cavities should connect with the cellar and also with the open air at the roof, so that the heat of the furnace shall cause a free circulation of warm air through- out the walls. That will both dry and warm the house. On the outside the earth should be well banked up against the cellar walls at least two feet high, and to the same height the outside surface of the wall should be so well coated with tar, asphalt, or Portland cement as to be wholly impervious to water. Cellar windows should be put in with hinges and bolts so as to be opened easily for ventilation in dry 130 THE MAINTENANCE OF HEALTH. weather. Nothing should be kept there which moulds or makes a musty smell. The House Walls may be of wood, brick or stone, natural or arti- ficial. Wood is usually the cheapest material, the coldest in winter and the hottest in summer. But whatever the material is, one thing is of prime importance — plenty of free air space all around the house between walls and plastering — and this space should communicate freely with the cellar. A furnace in the cellar, as usually managed, is one of the most wasteful ways of heating a house, for the reason that half of the heat is retained in the cellar, which becomes the warmest part. By making house walls practically double and connecting the middle space freely with the cellar, this wasted heat will circulate throughout the walls and add greatly to their warmth. The Roof. — Of course the roof should be water-tight — the object of a roof is to keep out moisture. There are several advantages of the sloping roof compared with the flat. Rain and snow run off rapidly, and the sun's heat in summer strikes only half the roof at a time except at midday. By opening the attic windows a circulation of air is secured which relieves the excessive heat of the upper rooms, and by closing them in bad weather an ideal playroom Is secured for the children. Also a large attic is a very convenient dry storeroom, or it may be partitioned off for extra rooms if needed later. Water Near the House is to be avoided. Stagnant water should never be allowed in any form or under any excuse. The chief objection is that stagnant water is the breeding place of mosquitoes and other insects, and. mosquitoes are not only an intolerable nuisance, but also the conveyors of dangerous disease germs. The disposal of drainage and sewage is the most difficult problem of all, especially if the ground is flat. One thing is sure, it must not be allowed to collect in pools of any kind to decompose into noxious gases, unless you want sickness in your home. Neither should it be run into the streams, making open sewers of them. Sewage. — The method adopted must depend a good deal upon cir- cumstances. If you have land under cultivation, all sewage should in some way be conveyed upon that land to act as a fertilizer, and especially all human excreta. The old-fashioned privy, as usually found in the country, is an abomination from every point of view and smell. By exercising a little intelligent care all that refuse, mixed promptly with clear soil, can be converted into a valuable fertilizer instead of a nuisance. THE RUBBISH PILE. 131 But in winter the privy should be put out of commission entirely, and the earth house closet substituted. That will save a good deal of pneu- monia and rheumatism. Dry Earth Closet. — This is an application of the principle that the earth is the natural deodorizer of decomposing organic matter, to which class the human excrement belongs. If dry earth be added to manure it immediately becomes inoffensive. There are special forms of dry earth closet manufactured for sale. But where the use of them is neces- sary, a little care and ingenuity can make the necessary simple arrange- ment to apply one or two essentials. The earth must be dry, for the value of it depends upon its absorbent power, and wet earth has already absorbed about all that it can contain. Either dry clay or dry garden loam answers best. Sand is of no use whatever, as it is quartz, and that is not absorbent. The second essential is that a sufficient quantity of this good, dry earth be applied immediately after every use of the closet. No water or liquid must be poured into the receptacle, as this will make it offensive. The smaller the receptacle the better, as that will necessitate more frequent removal of the contents. For the destruction of any germs that may be in the faecal matter, a small quantity of quicklime will prove effective in a few minutes. The great difficulty in carrying out this prin- ciple is to get the right kind of earth and to dry it. Rain Water from the roof should not be allowed to run into the ground near the house, nor should it be allowed to stand even a few hours in any receptacle which can be entered by insects for the purpose of depositing their eggs. Looking out for this will save you much trouble later. Kitchen slops should not be thrown out to draw flies, but should go to fertilize the garden. By all means have a garden — two of them, vegetable and flower, one for you to dig and hoe in, and the other for your wife and children to raise beautiful flowers in. The Rubbish Pile. — Paper and all refuse which will burn should be so disposed of regularly in some remote corner, out of sight if possible. To the same rubbish pile should be conveyed all the ashes and litter of every kind, and the duty of keeping the premises thoroughly "picked up" is easy work for the children. It should not be made a task, but a matter of pride with them ; it should be understood to be their department, and any spending money they are to receive should depend upon the efficiency which they "show in that department. In this way ideas of industry, orderliness, of earning what they get, and of appreciating the value of money will be inculcated effectively from the start. 1 32 THE MAINTENANCE OF HEALTH. Water Supply. — Next to the importance of getting all tainted water out of the house is the importance of bringing none in. This is almost as difficult, and is a point frequently overlooked. How many families take all their drinking water from a well in the center of a filthy barn- yard, toward which the ground slopes from all sides ! Generally speaking, the best water supply is a driven well of at least one hundred feet. But even that must be considered carefully with reference to the geological dip, for water will travel a long way under- ground between strata. Therefore, the well, however deep, should be located as far as possible from any privy, drain, sewer or barnyard, and should be on the "up" side of it. If the supply is taken from a spring, lake or river, that and all its tributaries and surroundings should be inspected with great care to make sure that there is no possibility of contamination by organic matter. If there is reason to doubt the purity of the drinking water, or if any epidemic breaks out in that neighborhood, see to it promptly that all the water drunk in your house is boiled half an hour and then allowed to drip through a gravity stone filter. After filtering, the water may be sealed up in Mason jars and set in the ice box to cool. That is not as poetic as the old oaken bucket that hung in the well, but it will cost less in doctor's bills. The dweller in the country has this great advantage over city people, that he can investigate and choose the source of his water supply. Although vast sums are spent on waterworks by all great cities, it is notorious that their supply is impure, often dangerously so. But the city dweller also holds his health in his own hands, for it is always within his power to boil the water and then filter it. Of the many filters on the market the simplest of all and also the most effective consists of two earthen jars, of which the upper one has a porous stone bottom through which the boiled water filters drop by drop. No family should be with- out one, for the germs of typhoid, cholera, and dysentery find an entrance into the body through impure water. The Grounds about the house should be judiciously variegated with trees and shrubbery. But neither should be allowed so near the house as to promote dampness or shut out sunshine and air. The house should have one or more wide verandas, screened in summer ; and with movable roofs which can be taken off in winter to let in the sunlight freely. Both city and country dwellings should face south, if possible, for that throws the kitchen, which needs the sun least, to the north side. For a like INTERIOR OF THE HOUSE. 133 reason it is highly objectionable to have the kitchen on the west side of the house, for in summer the afternoon sun, added to the heat of the kitchen stove, makes the room a very inferno in which the suffering wife or domestic must prepare the evening meal. If there are any natural woods on your grounds, it is well to con- sider them in selecting the site. If the house is situated in the right direction from the woods, it will be protected from the worst blasts of winter; while in summer you will get the music of the leaves and the sweet scents of the forest. The Interior. — Even more than the exterior of the house, the inte- rior will be affected by considerations of expense, individual taste and special uses. But certain general principles may be laid down which should apply to all. Rooms should be large, light, and cheery, especially bedrooms. There is a too prevalent notion that the parlor must be a handsome room, while any dark closet will do for a bedroom. If pos- sible, every room should have two windows and on opposite sides, and a large closet. The minimum size of a room should be 1,000 cubic feet, say 12x9x9. Windows should be large, and both sashes easily moved, so that the upper may be lowered in warm weather to let out the hot air. Con- sequently the wire screens should be full length. Of course every door should be screened, with a spring to keep the screen door always closed. Every outside door should have a chain bolt, for safety at night and by day when the men are away. The front door should either be all plate glass, or should contain a glass window through which the person outside can be seen plainly. An electric light just outside the door, which can be turned on before opening, is also an excellent arrangement. A small wicket in the outer door, for speaking without opening, is wise. Stairways and Halls. — These should be wide, of easy tread, and as straight as can be. There should be two stairways at least, front and back. In the country, where land is comparatively cheap, no dwelling ought to be more than two stories high, for there is scarcely anything more injurious to women than frequent stair-climbing. For the same reason let there be an abundance of electric bells and speaking tubes and a dumb waiter. The Roof Garden. — The stairways to the attic and roof should be as easy as any in the house, not like ladders, as is usually the case. On the roof, even if it is a sloping roof, it is an excellent idea to have a platform to which the family can bring easy chairs and sit under an i 3 4 THE MAINTENANCE OF HEALTH. awning by day, or under the stars by night, whenever the weather is exceptionally sultry. That is about the only thing to be said in favor of a flat roof, that it can be turned into a veritable roof garden, far above heat, dust, noise, miasms, and insects; on a hot night when bedrooms are ovens, the roof will permit of refreshing, healthful slumber. The roof is appreciated by Orientals but neglected by Occidentals. Every Room in the house should be bright and cheery, no dark holes or catch-alls. If you have a flat roof and no attic, set aside one large, bright room as a storeroom for everything not in use which is worth saving. Don't concentrate all your efforts on beautifying the entrance and parlor at the expense of everything else. Let every room be good enough for the neighbors to see, and no room too good for the family to use. Of course all bedsteads and springs should be of metal throughout. Your domestic's room should be as pretty and attractive as your own, and she should be required to keep it just as neat. That is one of the secrets of inducing a domestic to stay with you, which is peculiarly difficult in the country. Hard Oiled Floors. If possible, have hardwood floors throughout the house, and never allow a carpet in your home, for both sanitary and financial reasons. House Cleaning. — This bugbear of housekeeping is immensely sim- plified by having no carpets to pull up and tack down. All that is neces- sary is to have all the rugs taken well away from the house to be beaten and swept, while the hardwood floors are gone over with a weak solution of green oil soap. First, however, the furniture should be cleaned with a brush, and the curtains taken down if it is time to have them laun- dered. Plush covered furniture and unnecessary draperies are highly objectionable on account of the dust which they hold. Painted walls are easiest cleaned, and are especially suitable therefore for the bath room and kitchen. Good paper on walls can be cleaned, but it is a tedious and not altogether satisfactory process; the best way is to repaper after stripping off the old. Calcimining cannot be cleaned, but must be done over. Tapestried walls offer the advantage of being easily cleaned, but of course they collect dust very quickly. Simplest and most sanitary of all is wood or metal paneling or enameled brick, which can be gone over easily and quickly with a damp cloth; or with an antiseptic, if there has been any contagious disease in the house. Prevention of Dust. — It is astonishing how much dust and fuzz will THE KITCHEN. 135 accumulate in a house even in a single day. Much of it is unavoidable, but much can be avoided. Clothing worn in the street is brushed in the house, if brushed at all. This practice is both filthy and dangerous. Of course all outer garments should be thoroughly shaken and brushed outside the house every time they have been worn outdoors; otherwise they soon become perfect nests of every breed of germ life. Another prolific source of dust is the hot air pipes. They should be taken down every fall and cleaned. The Playhouse. — The best way to prevent dust in a house where there are children is to give them an entirely separate playroom. If your means and grounds will permit, build a playhouse for them in the yard, where they may be turned loose in bad weather with perfect safety, and allowed to raise all the noise and dust they want to. In pleasant weather the same little house may supply a welcome retreat from inter- ruption to an adult who wishes to read, write, or smoke. The Kitchen. — In these days of improvements the kitchen should be a veritable workshop of labor-saving devices, each in its place. # Fore- most of all, there should be a substitute for the coal range for summer use; the best is a gas range. If you cannot get gas, have one of the best gasoline cook stoves. The latter are made now so as to be perfectly safe and very convenient. Over either should be an ample hood connect- ing with the chimney, to carry off the odors of cooking. Then there is the ice box or refrigerator, which may be in the kitchen, or better, just outside, to escape the heat of the stove. There is much to be said in favor of each. But if there is much milk, cream, and butter to be cared for, neither should be used; instead there should be a dairy with running water in which everything of the kind can stand. A small imitation of this can be obtained by taking an ice box large enough to hold two or three hundredweight of ice, and plugging the outlet with a large spool. This will keep a few inches of ice water continually in the box, in which jars of milk and cream may stand. The ice should rest on crates, which will keep it out of the water. The ice box or refrigerator should be scrubbed thoroughly with hot water, or boiling water and borax, and then allowed to air for half an hour, "every time new ice is to be put in. Cleanliness. — Of course the kitchen should be spotlessly clean. As little grease as possible should be allowed to run down the sink drain, which should be flushed frequently with hot lye water. All bread, cake, and other food not in the ice box should be kept in close tin boxes out of reach of flies, ants, roaches, and mice. 136 THE MAINTENANCE OF HEALTH. The Bath Room should be the best ventilated and best heated room in the house. All the plumbing should be open; a porcelain-lined iron tub of good length is the best and most durable. Have no wooden rim around it, and have it well tipped toward the outlet. Clean it with gasoline. Enameled brick in colors is the most sanitary, the handsomest, and most expensive covering for the floor, and for the walls to a height of at least five feet. If they are too expensive, substitute some hard finish which will wash, as cement or paint, and wash it frequently. All the outlet pipes in the bath room or elsewhere should be flushed with a solu- tion of copper sulphate, mercuric chloride, or some other good disin- fectant, at least once a month; in hot weather oftener. Every waste pipe in the bath room, and throughout the house, should be well trapped; and, so far as possible, all traps should be easily acces- sible and detachable for cleaning purposes. Not only should plumbing be open, but pipes of all kinds in the walls should not be plastered over but inclosed in channels with covers screwed on, permitting inspection and repair without damage to the surrounding walls, floors, etc. Usually the bath room is the coldest room in the house, being incon- veniently located at the end of some hall. That is a great mistake. In cold weather it should be so well warmed that those of low vitality can strip for a bath without danger of a chill. That will save sickness and promote cleanliness at the same time. Of course there should be every convenience in the bath room, including sprinkler and rough towels which will really scratch — no imitation. Ventilation. — The breathing of impure air, especially that which is deficient in oxygen, involves a rapid deterioration of the blood, the red corpuscles being impoverished, and the life current loaded with poison- ous matter which should be eliminated promptly. Therefore thorough ventilation, particularly in cold weather, is a matter of prime importance. Evidently, also, it is closely connected with the problem of heating. It would seem superfluous, in these times of general education, to urge the importance of ventilation, and yet how often the newspapers record deaths by asphyxiation during sleep. Either the gas jet goes out or the damper in the stovepipe is shut, and then the bedroom fills with gas because all windows are shut tight. Such deaths would be impossible if people ventilated their sleeping rooms at night as good health demands. This lack of ventilation is the chief cause of that much dreaded IMPURE AIR. 137 disease, consumption, which is responsible for one-seventh of all deaths by disease. Consumption is almost wholly an impure air disease. If it has not reached a too advanced stage, it can always be cured by sleep- ing in the open air. Impurities of Air. — When a tightly closed room of ordinary size has been occupied for any length of time the air becomes loaded with impurities, partly from bodily exhalation and partly from the heat and the artificial light, besides the dust which may be stirred up by moving about. Of these impurities the most objectionable is carbon dioxide, a product of combustion, whether through the lungs, the pores, or the stove. It is not directly poisonous, for three to five hundredths of one per cent of outdoor air is usually carbon dioxide ; but in a close and occupied room this small amount is rapidly increased, taking the place of the vital oxygen and so becoming highly injurious. Inasmuch as oxygen is the only part of the air which we really use in respiration, as it is absolutely and continually essential to life, and as it constitutes only one-fifth of the volume of the purest air, it is evident that it takes very little impurity to impair the air seriously for breathing purposes. Tests. — There are several ways of proving chemically the presence of carbon dioxide, but it is hardly worth while to bother with them. You know well enough, without chemical test to prove it, that the air of a tightly closed and occupied room is sure to be foul. The nose test is ordinarily sufficient, for anyone of fairly good nasal perceptions, com- ing into such a room from outdoors, will immediately detect the impurity of the inside air. Yet people will crowd into theaters, concert halls, and other public rooms, where the air is, to a person of fine perceptions, simply horrible. And there they will sit from one to three hours, breath- ing each other's breath and exhalations ! The Problem of ventilating a public hall properly is extremely com- plex and expensive, but in the home there is no excuse for having bad air. The ideal method is to have some device for drawing off the impure air as fast as fresh warm air is introduced, or of introducing fresh cold air gradually from outdoors. There are several such methods which can be built into the house at the beginning. For ordinary purposes, how- ever, the natural leakage of air around windows and doors in very cold weather will be sufficient to keep the air of a house healthfully pure. As soon, however, as it gets milder outside, or as soon as a single room is shut off from the rest of the house, or as soon as an extra number of people are assembled in the house, it will become necessary to renew the 138 THE MAINTENANCE OF HEALTH. air more rapidly. The difficulty is to do this without causing draughts, which are extremely dangerous to people who are sitting still. One of the best and simplest ways to raise the window a few inches and insert a board below, which shall exactly fill the space through which the sash has been raised. This will allow fresh air to work in gradually between the upper and lower sashes. At night the whole house, and particularly the bedrooms, should be well ventilated. If every bedroom door has either a transom or a chain-bolt, this can be done without danger of being surprised by burglars. Carbon Monoxide. — In all the above it is assumed that the heating apparatus is properly constructed and managed, so that it shall not add any carbon monoxide to the other impurities of the inside air. This chemical compound is a product of imperfect combustion, and is deadly poison. It is likely to be present whenever stoves or furnaces are im- properly fired, or when gas or oil stoves are burned in the room without a chimney to carry off the products of combustion. The latter, at the best, eat the oxygen out of the air at an alarming rate. Moisture is another troublesome constituent of air. If there is too little, the air passages become dry and subject to catarrh; if there is too much, the necessary exhalation through the pores is retarded. Modern dwellings are apt to err on the side of being too hot and dry. Dryness of the air in a room is easily remedied by setting a pan of water in a warm place, and all good furnaces have a receptacle for that purpose, which should be kept full. Heating. — It is hardly worth while to discuss the old-fashioned method of heating by stoves — the objectionable features are so evident that stoves have, for the most part, long since been discarded in favor of furnaces of various kinds. Wherever they are still in use, however, great care must be exercised to prevent any chance of their pouring forth the deadly carbon monoxide, especially at night when the family is asleep. The only thing to be said in their favor is that little of the heat produced is lost. Furnaces, on the other hand, are usually wasteful because a large part of their heat is radiated into the cellar, which is the warmest part of the house. This can be obviated considerably by having the furnace and warm air pipes thickly covered with asbestos to check radiation; also by having the cellar connect freely with the air space between double walls all around the house — as explained under "Construction." Also, furnaces make a good deal of dust, which flies up the flues unless care is taken to open the dust damper before shaking down. FIREPLACES AND GRATES. 139 The furnace may be used — with a hot fire and all the drafts open — as a crematory for garbage which cannot be disposed of otherwise. Of course the same loss of heat occurs in furnaces which heat boilers for hot water or steam heating, but they have the advantage of not carrying dust directly into the rooms. On the other hand, they lack the advantage of introducing warm air fresh from outdoors, as the warm air furnace does ; and it takes longer to get up steam or hot water than warm air, which is a consideration in bitter cold mornings. Besides that, unless you have a double system of steam pipes, to bring and carry off steam, you are likely to be annoyed by cold radiators and by the banging of the steam in the pipes. Hot water heat is more quickly obtained but less intense. These objections may be overcome by having the steam radiators in the cellar instead of in each room, and passing air over and through them directly from outdoors, and then through pipes to each room. Sometimes the air is strained of dust by being passed through coarse cloth. This combination of steam and warm air is frequently used in large buildings, and has the advantages of both systems, of both direct and indirect radiation. But any system of heating should be combined with a system of effective ventilation, to carry off the impure air. Whatever method of heating is employed, it will be found that in time the heat will shrink the woodwork badly, unless the latter had been very thoroughly seasoned before building. So far as possible, the cracks and crevices thus formed should be filled up, either with putty or cement or slivers of wood; otherwise they become permanent dust holes and germ nests. Start Early. — But whatever the mode of heating there should be no neglect of one thing. In cold weather it should be the duty of some one who is reliable to start the furnace so early that the house will be com- fortably warm when it is time for the family to rise. Much sickness, discomfort, and lying abed are due to the foolish practice of having an ice cold house just at the time when warmth is most needed. If the dampers are so arranged as to be worked by chains from the first or second floor, it is a slight matter for some one to attend to them very early and then go back to bed for another nap. Fireplaces and Grates. — The first is the real thing, the second is only a feeble imitation. Still, a grate full of glowing coals on a cold night is much better than a blank wall. Both, however, are sanitary and ^esthetic, rather than practical heating- devices. . What can be finer when i 4 o THE MAINTENANCE OF HEALTH. the wind is howling outside like a banshee, and the snow drifting against the windows, than to sit snug before a roaring fireplace, either in solitary meditation, or with the family grouped around, looking for pictures in the glowing embers ? Of course the fireplace is the most wasteful method of all for heating a room, but its advantages quite justify the extrava- gance for those who can afford it. Regulation of Temperature. — Few people can agree exactly as to the most desirable indoor temperature in winter. In the first place, a tempera- ture which seems just right to a person sitting still and working with his brain seems suffocating to one who is moving about and doing manual work. Seventy degrees Fahrenheit is generally the lowest which the former can bear without risk, and that does not mean 70 degrees at his head but at his feet. People differ also in respect to vitality, either from difference in age or constitution, and what is just right for one is just wrong for another. Therefore no rule can be laid down except the very general one, that the temperature of the house should be kept as low as the members of the family can stand it without taking cold. If there is anyone in the house who, for any reason, must have a higher tempera- ture, that person should have a warm room shut off from the rest. The temperature of the house should not be continually fluctuating between hot and cold, according as some one impulsively booms the furnace or throws open a window. Individual feelings are a poor guide. The temperature should be kept as near as possible to some fixed point on the thermometer — usually 70 degrees is best — by some one whose regular duty it shall be to attend to it. Automatic Regulation. — Better still is it to have automatic regu- lators such as are installed now in many schools, hotels, and some private houses. These work by electric contact, so that when the temperature reaches the degree for which the regulator has been set, the heat supply for that room is diminished automatically until the temperature falls below that point. In hot weather the opposite problem needs to be solved. It is not very creditable to our inventive geniuses that they have not yet devised any practical method of cooling houses cheaply in summer. Some day, doubtless, it will be done. It would not seem that the difficulties were insurmountable in the way of passing ice cold water through the pipes and radiators through which steam is forced in winter. Even now that is done in larger cooling plants, but for private dwellings the expense is prohibitive. LIGHTING. 141 As matters stand now, little can be done toward cooling the interior of most private houses besides keeping the windows down. The sense- less modern custom, especially in cities, of building houses with no pro j tection from the glare of the midsummer sun beyond a scant roller shade, leaves the inhabitants at the mercy of the heat. But there is an excellent device in an outside shutter which is so hinged that it can be opened either sideways in the usual manner or vertically, i. e., open at the bottom with a hinge at the top. In the latter position it is equivalent to an awning, only better, for the slats may be opened for either view or breeze. If the heat becomes dangerously intense, resort to the Hindu device of wringing out towels and sheets in cold water and hanging them in the windows and doorways. The evaporation will lower the stifling temperature a little when a little means a good deal. Lighting. — The best light is that from the sun, which tries the eyes least and is deadly to all disease germs. Therefore every building and dwelling should have a maximum of window surface, especially in the city ; and, when possible, two windows opposite each other in each room. Neither should these be rendered valueless by piling shades, curtains, and draperies over them, as is sometimes done to the extent of three layers. The sunlight should enter every room in the house which it can reach, and the bedrooms especially should be thrown open to it at the right time every day. But modern life peculiarly requires artificial light, and many are so unfortunate as to be obliged to use it all day at their work. Of all the artificial kinds the worst is the arc light, with its intense white glare and frequent jumping. A good kerosene lamp with round or duplex wick and well cared for gives the mellowest and cheapest light. If the oil is bought in five gallon lots or by the barrel the cost per hour is a small fraction of a cent. Lamps, however, give out a great deal of heat, and are therefore unsuitable for warm weather. Gas is good or bad, according as it is used. In the first place, it is the easiest thing in the world to run up enormous gas bills, especially in a large house where several people are careless about allowing it to burn. But if each room is provided with a "by-pass" on the gas fixture, and if each person will be careful to pull the by-pass as soon as the light is no longer needed, the bills can be kept within bounds. There are two places, at least, where a light should burn low all night — the hall and the bath room. 142 THE MAINTENANCE OF HEALTH. The ordinary gas jet is wasteful, heating, insanitary, and unclean. A large part of the gas is not consumed at all, but is deposited as soot on the ceiling, or floats in the air until deposited elsewhere. Not only is the oxygen burned out of the air rapidly, but also the air is filled with impurities, so that the effect is soon apparent to the senses, and later appears in drowsiness and headache. Incandescent Gas Light. — But great improvements have been made in gas lighting, especially by the use of mantles and various forms of the Bunsen burner. These devices are now brought to such a point of perfecti6n that a beautiful, steady light, flooding the room with a mellow radiance, may be obtained from a jet of gas so fine that it issues through a mere pinhole. Of course every part of it is consumed. The by-pass can be attached to these also, so that the mere pulling of a small chain shuts the light almost off or turns it on full strength. This variety of gas light is extremely cheap and satisfactory. The only objection which can be urged against it is that it heats up the room in warm weather. The Incandescent Electric. — One argument in- favor of the electric bulb is that it does not heat the air appreciably and does not vitiate it. Also, the light is easily turned on and off, and on an insulated wire cord the bulb may be hung anywhere in the room. It is still the most expen- sive light, but it is being cheapened and perfected all the time. One of the latest improvements has obviated a decided objection — that there was no choice between darkness and brilliant illumination. Now the "Hylo" device enables one, by a turn of the wrist, to reduce the light to a one candle power. The so-called 16 candle power bulb is usually a third less, so that several are needed to make a good reading light. Defective insulation and crossing of wires have been the cause of many destructive fires. Acetylene Light. — This is familiar to the public in the form of the acetylene bicycle lamp. The light is intensely brilliant, casting very black shadows, with great evolution of heat. The chief point in its favor is that it is one of the cheapest illuminants, but there is a public prejudice against using it on account of its bad record of explosions. The manufacturers insist, however, that they have now brought it to such a point of perfection that it is absolutely safe. Gasoline Generators. — The most familiar form of these are the flare lights suspended over hucksters' stalls, but the evolution of heat by the blue hydrogen flame is out of all proportion to the light. This may be obviated by using gasoline with an incandescent mantle, as is done POSITION OF LIGHT. 143 in street lamps where gas is not obtainable. The light thus produced is very bright, about the same as from the best gas mantles. Of course gasoline must always be handled with care, and never exposed in the same room with a light or fire of any kind. For household use it is better not to depend on any one illuminant exclusively, lest it may fail unexpectedly and leave you in the dark. Position of Light. — Inasmuch as artificial light must be used largely, it is of the highest importance that the light should be so placed as to have the least injurious effect on the eyes. This may be accomplished in different ways, and each has its merits. In case the light is strong and brilliant, as incandescent gas or electricity, it should be up near the ceiling, and the direct rays should be softened by ground glass or porce- lain globes. Then the room will be filled with a diffused radiance much like sunshine. But even this may be trying to weak eyes, in which case a feebler light should be used, set on a table near the book or work and covered with an opaque reflector which will throw all the light on a circumscribed area, leaving the rest of the room in dim light. If a lamp is used it should be well shaded, or else the reader's sight should be protected by an eye shade or by turning his back to the light. The latter is preferable, when possible, for the reason that it compels him to hold up his head and receive the light over one shoulder. Chil- dren, especially, are prone to hang over their books, which interferes with the free circulation of blood through the neck and brain, and, worst of all, congests the eyes. The eyesight of school children in general grows alarmingly worse, and every care should be taken to prevent any congestion or strain in that part. EFFECTS OF CLIMATE ON HEALTH. The functions of the liver and of the skin are particularly active in warm climates; the digestive processes are not vigorous; in the dry season the nervous system is excited, and in the wet season, depressed. In cold climates the digestion is vigorous; the nervous system sluggish; the muscular development is great, and life is generally more prolonged than in any other climate. Temperate climates, on the whole, are most healthful; there is no strain on the liver, the digestive organs, or the skin, as is seen in warm climates; nor upon the lungs and kidneys, as 144 THE MAINTENANCE OF HEALTH. is the case in cold and damp climates. The cool, temperate climates are the most healthful of all. Acclimatization. — This is the process by which man adapts himself to new climatic conditions. He undergoes certain changes by which he can thrive and maintain health in a climate to which he is not indige- nous. The great reason why inhabitants of a colder clime who move to the tropics suffer so severely is because they are not so careful of their health as are the natives. It does not appear clearly proven that one can become so adapted to a climate as to become immune to disease. There is no length of residence that will prevent one from taking malaria in regions where that poison exists. Even the natives cannot successfully withstand it. While the natives of the tropics are able to bear the intense heat of the sun to an almost incredible degree, a stranger can never, even after years of residence, become inured to its effects. Much of the unhealthful state of tropical regions is due more to a lack of sanitary conditions than from the effects of the climate proper. Diseases Due to Climate. — There are certain diseases which may be justly regarded as climatic. Malaria, yellow fever, inflammation of the liver, and dysentery certainly may be so considered. Pulmonary affections, such as bronchitis, pneumonia, consumption, are unknown in some regions and are very prevalent in the temperate climates. Sunstroke and frostbite are, of course, due to exposure to the extremes of temperature. Generally it may be said that the majority of the infectious diseases, such as cholera, yellow fever, etc., are to be found most frequently in hot climates; malaria and its chain of attendant diseases are due to a poisonous soil. Liver troubles, dysentery, and certain forms of anaemia are characteristically tropical diseases, while lung affections are most frequent in damp climates. BOOK II. THE CAUSATION AND PREVENTION OF DISEASE. GORDON LINDSAY, Ph.G., B.S., M.D. Bellevue Medical College, New York ; Staff of Bellevue and Allied Medical Hospitals. It might be supposed, on first thought, that the "Preservation of Health" and the "Prevention of Disease" are synonymous terms; but a glance at the topics which are discussed in this and the preceding articles is the surest and speediest means of realizing that, while they are inti- mately connected in results, they are widely different in methods. They are co-equal divisions of the great branch of Hygiene. In the one case we conform to those rules of hygiene by which the body and the mind are brought into a more vigorous state of health ; in the other case we endeavor to ascertain the causes of disease and to remove or overcome them. It is now proposed to gather up the different conditions and causes which bring about disease, and to consider how they may be successfully attacked in our daily living. Causation of Disease in General. — The two great classes into which the causes of disease are divided are: the predisposing causes and the exciting causes. By predisposing causes to disease are meant all of those conditions which so change the state of health of a person as to make him subject to, or predisposed to, contract a certain disease to the influ- ence of which he happens at that particular time to be exposed. The exciting causes to disease are those which immediately excite or impart a disease. Suppose, for illustration, that twenty people are breathing the same air, which is laden, as nearly all air is, more or less, with germs of disease. One of the number is stricken with disease and the other nine- teen are not at all infected. It is ascertained on inquiry that the one who contracts the disease has been suffering severe privation of food and clothing. This privation has so deranged the health and weakened the vitality, that the system became a suitable soil, as it were, for the growth of the disease as soon as its germs were implanted therein. The privation endured is clearly the predisposing cause; and the germs are the exciting cause. Those who were not affected, although they had breathed these same germs of disease at the same time, had by regular 146 CAUSATION AND PREVENTION OF DISEASE. living and observation of the laws of hygiene so fortified themselves against the attacks that there were no predisposing causes to the disease. There are some families that are remarkable for "catching" all the dis- eases to which they are exposed. The predisposing causes to disease, as hereinafter considered in detail, are the points for such to consider, for along those lines lie their avenues of escape. One of the most marked peculiarities of predisposition to disease is the fact that a number of persons in the same place, at the same time, and under exactly the same conditions, may be exposed to the effect of cold, to the extent of con- tracting a chill. Now, so far as the immediate effect of the cold is con- cerned, it acts on all of them alike. That is, it chills the surface of the body, the pores of the skin contract and close up, and internal congestion takes place. But some of the number experience no ill effects, one of them is attacked by bronchitis, another with pneumonia, another with inflammation of the bowels, and a fourth with apoplexy. Those who were not affected were not predisposed to disease. The others were attacked according to the part of the body that was most affected by the congestion. To more clearly understand these and similar instances, it is necessary to take up the predisposing causes in detail. Predisposing Causes to Disease. — The chief of these are : age, sex, heredity, hygienic conditions, and climate. Age. — The influence of age is very considerable. Childhood and youth, being the period of growth and excessive repair, and old age, the period of decay and excessive waste, are the stages of life most sus- ceptible to disease. Maturity, or middle life, the period of equality of waste and repair, is comparatively free from disease. Then, the diseases of childhood are very different from those which affect declining years. The first and second teething periods and puberty are the critical times of childhood and youth. Among the diseases of these periods are acute catarrhal inflammation, especially of the alimentary tract, convulsions, acute tuberculosis, rickets, measles, scarlatina, whooping cough. To these may be added those diseases resulting from unsanitary conditions of living, such as overcrowding, bad water and air, privation, etc., con- tracted chiefly because their powers of resistance are very low at this age. At puberty the mental, moral, and physical conditions are easily dis- turbed and hysteria, epilepsy, lung affections, chorea, or St. Vitus's dance, and rheumatic and scrofulous diseases are common. Adults rarely suffer from the diseases peculiar to childhood, because the attack in their earlier years renders them insusceptible, more or less, in later years. PREDISPOSING CAUSES OF DISEASE. 147 Practically the only diseases to which persons of mature age may be said to be liable are those of occupation. During decline, those diseases which are dependent upon the degen- eration of tissues are common. It is difficult to say, however, when old age sets in, for many a man at forty is older than another at sixty, so far as decline and waste are concerned. Characteristic diseases of this period are : diseases of large organs, loss of power of the stomach, liver, kidneys, and degeneration of the brain, nervous system, and its functions. Sex. — Apart from those diseases which are obviously peculiar to the sexes, it is a matter of observation and record that women are more subject to hysteria and allied diseases, ulceration of the stomach, neu- ralgia, and goitre, than are men; and that men are more susceptible to epilepsy, tetanus or lockjaw, goat, diabetes, locomotor ataxia, vesical or bladder trouble, and acute affections of the lungs. Heredity. — Heredity, as a predisposing cause of disease, manifests itself in the variations of robustness, or of constitutional strength to resist unfavorable influences. It is usually observable as a family trait, although a marked difference in these respects may be noticeable between the children, according as this one favors the father and that one the mother. It is in this connection that family history plays such an impor- tant part in matters of hygiene. It must be remembered that a sound constitution does not mean great physical size and muscular strength. We often find under the "goodly outside" a weak constitution, ill-fitted to withstand the attacks of disease; and, on the other hand, in those of delicate, clear skin and slender build, are frequently stored up veritable surprises of large vitality and abundant force to cope with disease. Very erroneous ideas prevail concerning the transmission of disease from parent to children. It was, until very recently, firmly believed that if one of the parents died from consumption, cancer, or a similar disease, the children were marked, and that the same, fate awaited them in spite of all that could be done for them. In the reaction that has set in against that belief, there are some extremists who quite as firmly believe that heredity has absolutely nothing of influence in these matters. The safe and sane belief is that if a parent has been afflicted in that way, the children, while carrying no actual taint of the disease, are predisposed to the disease and that it is necessary that they especially observe a careful mode of life in order to fortify themselves in that particular direction. It is not only arrant folly but positively suicidal for a man or woman to allow the knowledge of the existence of such so-called hereditary diseases 148 CAUSATION AXD PREVENTION OF DISEASE. in the family to cause the relinquishing of hope, or of interest in life. There are some who are haunted by such knowledge, and who seem to be standing on the brink of the grave, in momentary expectation of the appearance of the well-studied symptoms. Many a life has been de- stroyed by such anticipation. Every pain or slight ache is construed by them as being the manifestation of the long-expected infirmity, and they thus drag out a life devoid of pleasure or of purpose. It is not necessary for such persons to go beyond the facts and figures of insurance com- panies for assurance. It is clearly proved by years of record that of those persons who have been refused as being unsatisfactory risks on account of the death of one or both parents by such diseases, not ten per cent are ever affected by them. Those are cold figures, made with- out favor or prejudice, and as such should be clear and convincing proof that their fears are groundless. A rigid observance of the laws of health will remove them beyond the influence of these predisposing causes. Hygienic Conditions. — Insanitary conditions of living are the direct cause of many persons, otherwise well started in life, acquiring a marked predisposition to disease. Among these conditions are overcrowding, privation, and fatigue, which, unfortunately, too often are the ills borne by the poorer classes. Overcrowding, with its lack of fresh air, and its poor ventilation to remove the foul air, works out its slow poisonous effects upon the body. Privation lowers the strength and tone of the system. Fatigue wastes the tissues beyond the bodily power of repair and is a constant drain upon the vitality. Intemperance in food and in the use of alcohol are not only in themselves predisposing but exciting causes to disease. Impure drinking water leads to a special predisposi- tion to diarrhoea, cholera, and fevers. Insufficient clothing exposes to the chill and so predisposes to that exciting cause of so many ills. Occu- pation, whether by overcrowding in ill-ventilated workrooms or by the breathing of irritant gases, is often both a predisposing and exciting cause of lung and other affections. Climate, with all of its variations and extremes, is both predisposing and exciting. Exciting Causes cf Disease. — The exciting causes to disease are divided into four classes : mechanical, physical, chemical, and vital. They admit also of a broad division into external and internal causes. Mechanical Causes. — These produce results that chiefly concern the surgeon. Among them are external violence, which produces bruises, cuts, wounds, fractures, shock, and mutilation. The internal exciting CONTAGION. 149 causes to disease include the stopping of passages by gallstones, by stone in the bladder, by abscess, inflammation, and by foreign growth. These, perhaps, may be considered as lying beyond the domain of hygiene, as they are usually the result of morbid conditions. Physical Exciting Causes. — These include extremes of heat and cold, which produce respectively sunstroke and frostbite; but they do not include climatic effect of the more moderate temperatures. Chemical Exciting Causes. — Under this head are grouped the poisons, whether the mineral and vegetable poisons introduced into the body, or the internal poisons which form in the body. There are also snakebite, alcohol, putrid and decayed food poisons, commonly known as ptomaines, all of which may be regarded as being introduced into the body, and come under the head of the external poisons. In addition there is the poisoning by accumulations of effete matter in the system. The com- monest of these is the poisoning by the absorption of faecal matter, which is the great ill effect of constipation, and -the absorption of uric acid from the kidneys causing rheumatism and uraemia. Uncleanliness of the skin prevents the elimination of matter by that channel, and the consequent driving back of these poisons into the system. Vital Exciting Causes. — Among these are the parasites that cause parasitic diseases, contagia of other specific diseases, and malarial poison. They are known as vital causes because most of these media for con- veying disease are living forms ; the very great probability is that all are. Contagion. — The distinction which was formerly made between contagion and infection is responsible for many erroneous notions as to the way in which dangerous diseases are communicated. It was held that contagious diseases could be contracted only by actual touching of the person affected; and that infectious diseases were communicated without actual contact. This distinction lost sight of the carrying power of clothing and other similar means of conveying disease. In this way much greater risk of exposure to disease was taken and the spread of disease increased. Contagion is properly the property or the process by which disease is communicated from one part of a diseased body to another part of the same or to another body. The Latin name of contagium (plural contagia) has been given to whatever does this. The means of conta- gion is contact; and this contact may be immediate, by actual touch, or it may be by mediate contact, as through clothing, discharges from the body or by germs of disease. 150 CAUSATION AND PREVENTION OF DISEASE. Nature of the Contagia. — Modern scientific research is tending to show with more and more certainty that all contagia of disease must con- tain in itself, or be included in, some form of living organism capable of multiplying itself rapidly. This is the basis of the germ theory of dis- ease, and the living forms go by the name of micro-organisms, or gen- erally of bacteria. Very valuable contributions to this phase of the spread of disease have been made by Koch, the German scientist. He has laid down the following conditions as being necessary to demonstrate that a particular form of micro-organism is beyond doubt the cause of a certain disease: — 1. The organism must be found in the tissues or fluids of the person suffering from the disease. 2. It must be taken from the body and recognized with absolute certainty by a series of experiments and examination by cultivation. 3. It must be injected by inoculation into the bodies of animals to clearly prove that it is capable of producing the same disease in them. 4. The organisms must be proved to be present in the last named case as laid down in the first condition mentioned. Mace, the scientist, suggests that two more conditions be laid down as necessary to indisputable proof, viz. : — 5. That the organism be not found in other diseased conditions. 6. That the organism be not one of the known harmless forms which are found in the skin and the intestines both in health and disease. These conditions have been met in so many diseases that the theory is accepted as true in all cases, and additional research is constantly con- tributing more proof. The facts regarding the nature of the contagia, so far as known, may be briefly laid down in the following points, to be borne in mind : — The contagium of any one specific disease, on entering the system, produces that disease and none other; the virus of diphtheria produces diphtheria and not smallpox. When the contagium has entered the body it multiplies in the body indefinitely. Bacteria. — The bacteria which produce disease are divided into two classes : first, those which live on dead animal or vegetable matter, which cause decay or fermentation, and are not able to enter the tissues of living plants or animals, and are called Saprophytes; second, those which live within or upon the tissues of living plants and animals, some without harmful effects, and others producing disease. These are called Parasites. BACTERIA. 151 The great group of bacteria is divided, on the basis of their shape, into two large families. The first family includes all those which are spherical, cube-shaped, united in chains, and those which occur in irreg- ular masses. To this family the name of Coccaceae is given. The second family includes those which are in the form of rods or cylinders, and grouped into genera according as the rods are straight or nearly so, curved or spiral of several turns, those with a gelatine covering, and those which are long and thread-like. Cholera. — The bacterium which produces cholera {Spirillum chol- erae) is commonly known by the name of the "comma bacillus," as it resembles the comma in shape. Diphtheria. — It is generally conceded that the germ which produces diphtheria is the Bacillus diphtheriae, although several forms of bacteria are found in the false membrane in the throat. Mode of Entrance into the Body. — The poison of disease enters the body in one of the following four ways : — 1. By coming in contact with the broken surface of the skin or mucous membrane. 2. By coming in contact with the unbroken surface of the skin or mucous membrane. 3. By inhalation of the air. 4. By food and water taken in the acts of eating and drinking. Action within the Body. — Immediately after the poison has entered the body, there follows a period of longer or shorter duration during which the poison is inactive. This is known as the period of incubation, when the symptoms of the disease develop. Then follows the period of invasion, during which the symptoms manifest themselves. The period of eruption comes next, and lastly the period of decline. The period of incubation varies greatly, not only in different diseases but in different cases of the same disease. It may vary from not less than a month or even a year, as in the case of hydrophobia, to a very few hours. During the periods of invasion and eruption, the poison is diffused throughout the organs of the whole body; the lymphatic glands throw the poison into the blood in constitutional diseases and into the organs in local diseases, and the contagium multiplies itself to an enormous degree. In the stage of decline of the disease, or recovery, there are indica- tions that the poison has run itself out, either by reason of there being no more material favorable to its growth upon which it may act, or by 152 CAUSATION AND PREVENTION OF DISEASE. the formation of chemical substances in the body which prevent it from doing so; or because the stamina, or resisting power of the body, has been great enough to overcome the attacks of the poison. The effect, generally, of an attack of a disease is to render the person immune to future attacks of the same disease. Exit from the Body. — During the course of a disease, the contagium has increased and is present in the body in enormous quantities. Its mode of exit largely depends upon the part affected. In typhoid and cholera, where the seat of the disease is the intestine, the contagium is voided in the stool and urine. In smallpox, the seat of the disease is in the pustules on the surface of the body, so the poison passes off in the scales of skin and matter which falls from the body of the patient. In scarlatina, the passage is in the same way as in smallpox, and the process of peeling of the skin is known as desquamation. Contagious throat and lung diseases void the poison in the discharges of sputum and phlegm. Existence Outside of the Body. — The behavior of the poison on reach- ing the outer air is very different in different diseases. Some of the poison, as that of typhus, loses its power of infection in the presence of air; probably the oxygen of the air destroys it. The poison of other diseases, such as smallpox and scarlatina, lives for a long time, is carried about in clothing, and remains in a dormant condition for a long period, ready to break out into virulent activity as soon as the conditions of its development are favorable. This difference of behavior of the poisons of different diseases is of the utmost importance to remember in the prevention of disease. Modes of Transmission. — If the poison has been passed from the body in the faeces, it is most likely that these will eventually contaminate the water supply or food supply, and thus food and water become one of the most frequent modes of transmission of such poison. Other poisons which pass off into the air are inhaled. So that the most common means of transmitting disease is by water, food, and the air. GENERAL RULES FOR THE PREVENTION OF INFECTIOUS DISEASES. i. Place the patient as far as possible away from the other mem- bers of the family. If it is possible, give him the top floor and keep that for him and his attendant exclusively. If the home does not afford this accommodation with comfort, remove the patient to a hospital. This PREVENTION OE INFECTIOUS DISEASES. 153 is a duty to the other members of the family and also to the public health. No sentimental or other feelings should be permitted to interfere with this plain and clear duty to the family and the patient, as well as to the community. 2. Those who nurse the patient must be persons who have already had the disease, if such can be procured. They should remain with the patient and not come in contact with the other members of the family. Should they do so they should first wash in water in which some disin- fectant has been placed, such as carbolic soap or Condy's Fluid. They must avoid breathing the patient's breath. Nurses must have exercise in the open air regularly, first washing and changing the clothing. The latter should be of cotton, which does not afford a lodging place for germs and contagion, as do woolen materials. 3. Keep visitors out of the rooms. Those that are admitted should conform to the sections of the second rule applying to nurses. 4. The contents of wardrobes, closets, etc., in the sick room must be removed at the time of occupancy. No bed hangings, lace curtains, carpets or rugs, and similar lodging places for poisons and infection should be permitted to remain in the room. Only such furniture as is absolutely necessary, and that is very little, should be retained. 5. Ventilate the room by partly open windows, by opening the chimney draft, and, in cold weather, by keeping a grate fire going, if possible, even though the house is otherwise heated. The open fire is the best ventilator in the house. 6. Keep the door closed, and hang over it a sheet dipped frequently in a disinfectant solution such as Condy's Fluid, chloride of lime, carbolic acid, or corrosive sublimate. 7. All the discharges from the patient, the sputum, vomit, faeces, and urine, should be received in a disinfected vessel, and another quantity of the disinfectant be added to the vessel before carrying the contents to be emptied into the closet, or to be burned or buried. 8. All pieces of cotton or linen used for wiping the nose or mouth, or for receiving the sputum, should be at once burned. They must not be allowed to accumulate or lie around. 9. "When the sheets or the sleeping garments of the patient are changed, each article, before being taken from the room, should be dipped in a disinfecting solution; let them remain in this for an hour and then boil them at once. 10. Keep the patient and his bed scrupulously clean. 154 CAUSATION AND PREVENTION OF DISEASE. ii. Let the patient have one set of dishes, spoons, and drinking glasses, for his exclusive use. See that his dishes are used only by himself and not by others, and that he does not use the dishes of others. All dishes used by the patient should be placed in a disinfecting solution before removal from the room, and then washed in boiling water. 12. All scraps, and unfinished or untasted food, should be treated in the same manner as are the discharges from his body — disinfected and thrown at once into the sewer, burned, or deeply buried. No other member of the family should eat them. 13. After recovery, the bedding, the clothes of the patient and all of the furniture and entire contents of the room are to be instantly and thoroughly disinfected by the methods and according to the directions given on page 163. SPECIAL PREVENTIVE MEASURES FOR INFECTIOUS DISEASES. Smallpox. — Isolate the patient. Smear the surface of the skin with oil, vaseline, or glycerine, slightly carbolized, to prevent the infectious matter of the disease from diffusing into the air and so spreading. Re- ceive the discharges from the body in disinfected vessels. Burn the cloths used on nose and mouth. Disinfect the bedding, clothing, and furniture. Vaccination is the great preventive. Chicken Pox. — No preventive means are needed, as the disease is a mild one, always resulting in recovery. Measles. — Isolate the patient. Smear the skin with oil, vaseline, or glycerine, as advised in smallpox. Disinfect discharges from the body. Burn rags used as handkerchiefs and napkins. Disinfection of clothing, bedding, and furniture, generally neglected, under the impres- sion that the disease is not serious, ought to be done very thoroughly. German Measles (Rubella). — No preventive measures are needed, as the disease is a mild one. Scarlet Fever. — Isolate the patient. Promote the shedding of the skin (desquamation), by which the infection is dispersed, by sponging the body twice daily with tepid water to which a small quantity of Condy's Fluid is added, and by applying carbolated oil or cream of carbolic acid (1 in 40). After the fever is over, wash with flesh brush and carbolic soap, and apply the carbolic cream or oil (1 in 20). Dress the hair with carbolic oil. Syringe the throat and nose with a very weak solution of SPECIAL PREVENTIVE MEASURES. 155 Condy's Fluid or other antiseptic wash. Disinfect the clothing, bedding, and furniture. Boil all milk used by the family during an epidemic of this disease. Typhus. — The most preventable of all diseases; but the means must be seriously applied and persistently carried out. Danger of contagion is great only near the body of the patient, as the contagium soon dies in the air. Isolate. Ventilate thoroughly, even to the extent of outdoor tent treatment of the patient. Free use of disinfectants about the room. Exclusion of visitors and thorough disinfection of clothing, bedding, and furniture. Ventilation is a powerful prophylactic. Influenza, or Epidemic Catarrh. — The general mildness of the dis- ease does not call for further isolation than the avoidance of mingling in gatherings of people. The sputum, of course, should be disinfected and destroyed. Whooping Cough. — Isolation. Disinfection of the discharges from the throat and lungs. Freshening the air by sprays of disinfectant. Dis- infection of clothing, bedding, and furniture. Mumps. — Isolation and hygienic means. Not sufficiently serious to call for stringent means. Diphtheria. — Isolation, which must be kept up as long as the pres- ence of infectious matter is found in the throat. Sometimes this remains for a very long time after the membrane has disappeared. Three weeks after the disease has gone 16 the minimum period of isolation. Expecto- ration, throat and mouth and nose discharges, are to be received in a disinfected vessel and treated with a further application of the disin- fectant before destroying. Rags are to be burned, and clothing, bedding, and furniture must be thoroughly disinfected. No disease calls for more stringent disinfection. The general rules must be thoroughly enforced and observed. For prevention, all dampness and accumulations of dirt must be removed. Careful inquiry must be made of other children in the family as to the condition of the throat. Schools ought to be closed during an outbreak of diphtheria ; at all events, teachers should make frequent and regular inquiry among the children for the appearance of sore throat. Typhoid Fever. — Disinfection of the stools in a 1 in 20 solution of carbolic acid or in a 1 in 1,000 solution of perchloride of mercury; add a further quantity of the disinfecting fluid to the vessel before carrying it out. Keep the vessel covered. If the drainage of the premises is not efficient, so that the matter will be thoroughly removed, it is safer to 156 CAUSATION AND PREVENTION OF DISEASE. burn it. All of this care must be paid to the discharge because it is the principal medium through which the disease is conveyed. Disinfection of the clothing, bedding, furniture, etc. Strict isolation is not imperative. Yellow Fever. — The general measures for the prevention of an attack necessitate the recollection that yellow fever is born in filth. Good sew- erage, in order that all excreta may be carried off safely, free ventila- tion, no overcrowding, cleanliness, and pure water, are essential. After the disease has broken out, isolation; disinfection of vomit and stools, with a i in 1,000 perchloride of mercury solution, or a I in 20 carbolic acid solution; ventilate the room well, screen the windows to keep out flies and mosquitoes, and thoroughly disinfect clothing, bedding, and furniture. Cholera. — This is another disease that cannot thrive in clean and sanitary surroundings. Isolation, rigid attention to the disinfection of all discharges, which must be received in a vessel containing from 6 to 8 ounces of a disinfecting solution ; add the same quantity before remov- ing from the room. All discharges should be buried. Dysentery. — Avoid exposure and malnutrition, drink only good water, and breathe only pure air. Disinfect all discharges, treating them with a 1 in 20 carbolic solution or a 1 in 1,000 perchloride of mercury solution. Malarial Fevers. — Among the predisposing causes of these diseases are fatigue, a depressed condition of the body, lack of nourishment, a chill, the fact that one has previously had an attack of the fever, and recent arrival in a malarial district. The exciting cause is a micro-organism known to scientists by the name of Plasmodium malariac. It is found in the blood of sufferers from this disease. The disease is communicated by the poison entering the body through the bite of certain mosquitoes, by drinking water, and possibly by inhalation. While it is not contagious, it is more than likely that it is transferred from one to another by the mosquito. So far as is known, that is the only way in which the poison leaves the body. After the plasmodium has entered the body, efforts must be directed "toward preventing its multiplication. This is done by 5 to 10 grain doses of quinine. All malarial patients should be protected by mosquito netting to prevent the mosquitoes from transferring the poison to healthy persons by inoculation. To prevent the larvae of the plasmodium from breeding or hatching, it has been suggested that the marshes and pools SPECIAL PREVENTIVE MEASURES. 157 be drained, or the pools filled up with earth. The fact that a pool on the Gold Coast of Africa near the petroleum wells contained no mosqui- toes, and consequently no malaria, led to experiments by which it was found that the use of one ounce of kerosene to every ten feet of surface of the breeding pools of mosquitoes in malarial districts will prevent the disease. The adequate protection from mosquitoes by window and door screens is a sure preventive. Erysipelas. — Predisposing causes are the existence of a wound, dis- ease of the bowels, poor food, intemperate habits, and having suffered from the disease before. The exciting cause is a micro-organism known as Micrococcus pyogenes. It enters the body through a broken surface or through an intact mucous membrane. The poison is carried through the air exclusively. The preventive measures are good hygiene, food, ventilation, and cleanliness, and antiseptic treatment of wounds. Septicaemia or Blood Poisoning. — This is a similar disease to erysipelas, and requires the same precautions and preventive measures. It is caused by bacteria known as Micrococcus pyogenes aureus and Micro- coccus pyogenes albus and Micrococcus pyogenes citreus. In addition to these are the Streptococcus pyogenes of erysipelas. The disease is very generally propagated by soiled instruments, sponges, fingers, linen, cloth- ing, etc. In addition to the precautions suggested as preventive of erysipelas, there are some special antiseptic measures to be adopted in childbirth, when this disease so frequently occurs. The antiseptics recom- mended comprise washings of perchloride of mercury 1 in. 1,000, car- bolized oil 1 in 8, and Condy's Fluid. These are for use by nurse, medi- cal attendant, and for washing the patient. Sponges, instruments, bed- pans, and everything of that nature which may come in contact with the patient are to be so treated. Soiled linen and bedding must be at once removed from the room. Tetanus or Lockjaw. — This is caused by the Bacillus tetani enter- ing the body through a broken skin. It is widely distributed in the soil, street dust, and floor sweepings. The preventive measures are clean linens, and the precaution that no dirt or dust reach a wound. The dirt on rusty nails and under the finger nails are direct sources of these germs. Tubercle. — See article on Phthisis or Consumption, page 165. Hydrophobia or Rabies. — The poison enters the body directly by inoculation by a bite. The incubation period is never less than a month and sometimes as long as a year. The efficacy of the Pasteur protective inoculation cannot be doubted. In the past history of this disease the 158 CAUSATION AND PREVENTION OF DISEASE. mortality was ioo per cent. No cures were known. The actual number of persons who develop rabies after a bite by a rabid animal is not known, but the percentage of deaths among those bitten is over 20 per cent. Out of over 1,500 cases treated in one year in the Pasteur Institute there were only three deaths. DISINFECTION. There must be no halfway measures in disinfection, for disinfection means, in the newer application of the word, the actual destruction of every particle of poison given off by a patient during illness from an infectious disease. This work must be regularly and persistently done. It is not sufficient to do it in five cases and omit doing it in the sixth. It is not enough to remove the discharges from a typhoid patient and to throw them out so that they will linger in the soil and find their way into water, where they will multiply and be ready to attack and to spread the disease. That is only temporizing with disease. If proper precau- tions were always taken by those in charge of patients, there would be no such thing as epidemics. There will be a few isolated cases just so long as people do not observe hygienic laws of living and use ordinary protection against disease. One single neglected discharge from the body of a typhoid case may be the means of creating an epidemic. Disinfectants are physical and chemical. The chief physical disin- fectants are : fresh air, sunlight, heat, moist heat, dry heat, boiling, and sterilization. Fresh Air. — The antiseptic action of fresh air is due partly to the union of its oxygen with decaying matter upon which the bacteria thrive and in which they multiply. This union of oxygen with other matter is known as the process of oxidation. It has the effect of breaking up the noxious matter into other harmless substances and of forming with them compounds of oxygen that are not favorable to the increase of the bacteria. So that, while it does not absolutely kill the germs, it sus- pends animation and restrains growth. The effects of sunlight are very much the same, so that these two great purifiers of the air are not to be considered as germicides nor as substitutes for disinfectants. They are not sufficient in themselves to prevent the spread of disease, but are sup- plemental to the action of true disinfectants and germicides. Heat. — The vegetative forms of most bacteria are killed by a tem- perature of 140 Fahrenheit. But destruction of the vegetative form does not effect perfect disinfection. For many of the bacteria increase DISINFECTION. 159 by means of parts known as spores, which act as seeds or eggs. If these spores are not destroyed along with the parent forms, they will grow and increase. A heat of 180 Fahrenheit is needed to kill them, which it will be remembered is within 32 ° of the boiling point. As moist heat in the form of hot water or of steam is a more destructive means of killing bacteria and their spores than is dry heat of a higher temperature, it will be seen that boiling Avater is a sure agency to use in killing these forms of contagia. But it is found that simply to pour boiling water upon them is not sufficient; it is necessary to expose them to its action for a length of time varying with the species. Consequently it is necessary to coA*er the vessel in which they are being treated for an hour or two before throwing them out. If treated for too short a time they will revive again under favorable conditions. Ineffective means of disin- fecting are worse than none. Xot only is a sufficient length of exposure to the disinfecting agent necessary, but care must be taken that every part of the matter which is under treatment must be exposed to the action of the disinfectant. In no other way can one be sure that all of the contagia are destroyed. The survival of even one of the bacteria is full of tremendous possibilities in the way of a future epidemic. Boiling is therefore one of the most effective means of sterilizing, as this method and its effects are called. All clothing, bedding, and similar articles that can be boiled for an hour will be thoroughly sterilized or disinfected. While it is found that in some cases a lower temperature than the boiling point and a shorter period of treatment will accomplish the purpose sought, it is better to err on the right side than to find out too late that the process has not been effective. Sterilization and Pasteurization of Milk. — There are four diseases, typhoid, scarlatina, diphtheria, and tuberculosis, in the spread of which it is tolerably certain that milk plays an important part. While the extent and the manner in which diseases are spread by milk are more or less open questions, frequently debated, the known facts are such as to warrant the employment of preventive measures by all who use milk. It has been shown in the preceding paragraph that boiling is a most effective method of killing disease germs. We accordingly apply that treatment to water which is suspected of containing impurities. It would be the safest course to boil milk. But when milk is boiled it undergoes certain changes not only in taste and smell, but in the digestibility of the casein, the condition of the fat and the coagulation of the albumen which 160 CAUSATION AND PREVENTION OF DISEASE. injure it as a food. Therefore the process of sterilization stops just short of the boiling point. It is found that an exposure to a temperature of from 150 to 160 degrees Fahrenheit for half an hour will kill all of the disease germs found in it except that which is supposed to be respon- sible for infantile diarrhcea. There are many sterilizers expressly made for this purpose and they are all fairly effective. The ordinary method of caring for milk in this way is both effective and easily applied in any household. The milk is best placed in a glass bottle, the mouth of which is loosely plugged with absorbent cotton, which permits the entrance of air but filters it in its passage. The bottle is placed in a pan. of water on the stove and care- fully watched so that it does not boil or become too hot. As the matter is one of experience, it is safer at first to watch the heat of the water in the outer vessel for a time with a thermometer, so that one will be able to successfully gauge the temperature by the judgment alone. The milk is stirred or shaken from time to time to insure all of the contents of the bottle being equally heated, and to prevent the cream from coming to the top on cooling. It is important that the milk be quickly cooled at the close of the process. The advantage of pasteurized milk over untreated milk is that 99 per cent of all the disease germs which it con- tains are destroyed, the exception being the germ of cholera infantum; and its advantages over boiled milk are, that it is more digestible and more palatable while its condition as a food is unchanged. The difference between sterilized and pasteurized milk is that ster- ilized milk may be boiled milk but pasteurized milk never is. CHEMICAL DISINFECTANTS. Out of the great mass of chemical disinfectants which have come forward during recent years, it is necessary to mention only a few. These are the disinfectants which have under all circumstances met the. require- ments of quick action, efficiency, and ease of application. Corrosive Sublimate. — This is the common name given to the per- chloride of mercury. In a 1 in 1,000 solution, it kills the germs of typhoid, diphtheria, and erysipelas in eight seconds ; and the spores of the bacilli of these diseases in a few minutes. It has two important disadvantages for general use : it is expensive and it is poisonous. In a colorless solution of the latter, the danger is increased, consequently it is often colored, so that a solution of it will not be mistaken for water. CHEMICAL DISINFECTANTS. 161 To make a solution of corrosive sublimate of the strength of i in 1,000, it is necessary to take — Corrosive Sublimate, y 2 ounce. Hydrochloric Acid, i ounce. Water, 3 gallons. If this proportion is observed, the proper strength will be secured. For convenience the disinfectant is also sold in tablet form, which enables one to make a solution of the requisite strength, in any quantity, with ease and certainty. While corrosive sublimate is a powerful disinfectant and germicide, it is to be noted that it does not destroy the tubercle bacilli in the sputum of consumptives. This is explained by the fact that it coagulates the exterior of the sputum so that it cannot affect the inner parts of it, and so cannot reach the tubercle. This, so far as is known, is its only limitation. Carbolic Acid. — In the proportion of 3 per cent, carbolic acid kills the germs of typhoid, diphtheria, and erysipelas in eight seconds, but the spores withstand even a 5 per cent solution for several days. It there- fore is inferior to the corrosive sublimate as a spore killer, and conse- quently as a germicide. But a 5 per cent solution of carbolic acid will kill the tubercle bacilli in thirty seconds and the spores of it in one hour. Its prompt and effective action on germs, and its ease of application, make it a good antiseptic. Formalin. — This is the vapor formaldehyde dissolved to the extent of 35 to 40 per cent in water. Neither the vapor, formaldehyde, nor the solution of it, formalin, is poisonous, although both have a very pungent and irritating odor. In both of these forms it is a very powerful disin- fectant. It kills, in the form of a 3 per cent solution of formalin, all forms of disease germs in from one to fifteen minutes. Even in the weak preparation of 1 in 10,000 parts, formalin prevents the growth of cholera, typhoid, and diphtheria germs. The ordinary strength of formalin is obtained by dissolving or mixing four ounces of formalin in one gallon of water, to which is added five ounces of glycerine, which has the effect of preventing change in the solution and also causes it to dry more slowly. Formaldehyde. — The gaseous form of formalin is regarded as one of the most effective gaseous disinfectants in use. It is little likely to dam- age objects upon which other and more powerful disinfectants have an injurious effect. 162 CAUSATION AND PREVENTION OF DISEASE. Chlorine. — This gas is one of the best disinfectants in use. It does its work much better in the presence of dampness than in dry atmos- pheres. The change which it brings about in objectionable and unhealthy matter is a real chemical change; it has such an ease of union with the gas hydrogen, which is present in all vegetable and animal matter, that it unites very quickly with it. In this union it breaks up the matter which originally contained the hydrogen and forms entirely new and harmless compounds with it. It is liberated when water is poured upon chloride of lime. The amount liberated by the action of water is comparatively small and slow. But if hydrochloric acid be poured on the chloride of lime, the supply is greatly increased. The gas also bleaches and destroys foul odors. Three pounds of chloride of lime and three pounds of commercial hydrochloric acid for every 1,000 cubic feet of space will kill all of the disease germs in eight hours. The walls and ceiling should be moistened to get the best results, and the vessels in which the generation of the chlorine gas is being conducted should be placed high, as chlorine gas is heavier than the air and therefore sinks toward the floor. Sulphurous Acid. — This is a gas that is given off when sulphur is burned in the air. It has had for a long time a great household reputa- tion as a strong and efficient disinfectant; and it seems hardly possible that germs of disease can withstand the powerful pungency of its fumes. But recent experiments have served to show that its value for this pur- pose is overestimated. It appears that the slightest covering is a suffi- cient protection for germs against its effects. Its efficacy is greatest in the presence of moisture, and it is employed in the proportion of three pounds of roll sulphur to every 1,000 cubic feet of space acted upon. Quicklime. — This is a powerful germicide, and a i-io per cent solu- tion of it will kill typhoid and cholera germs in five hours. It is also used to disinfect damp places and dry or earth closets. Permanganate of Potash. — While this is a good disinfectant and a valuable antiseptic and deodorant, it is useless in practice, as its force is expended in attacking the organic matter in which germs are found. So much of its energy is used in this direction that enormous quantities would be required to accomplish the desired end. It must be conceded that corrosive sublimate and carbolic acid are by far the best agents known to science for disinfection and germicide uses. PRACTICAL DISINFECTION. 163 PRACTICAL DISINFECTION. One of the first subjects in the practical disinfection in the sick room during infectious disease is the disinfection of the discharges from the body. It is in these that a great danger of the spread of the disease lurks, and prompt and persistent efforts must be made in this direction. In considering the special diseases in a previous section, reference was made to the special means of accomplishing this object in particular cases. These directions may now be summed up. The faecal and urinary discharges must be received into a bedpan, or other vessel, in which are placed from six to eight ounces, about half a pint, of either corrosive sublimate solution, 1 in 1,000, or a carbolic acid solution, 1 in 20. The corrosive sublimate solution of the required strength may be made by taking — Corrosive Sublimate, y 2 ounce. Hydrochloric Acid, 1 ounce. Water, .3 gallons. The carbolic acid solution of this strength, 1 in 20, is made by taking — Carbolic Acid, 8 ounces. Water, 2j^ gallons. Immediately after the discharge is received into the vessel, a further quantity of the disinfecting fluid is to be poured in. If the discharges are fluid and copious, this after addition must be very liberal. The diseases to which this procedure especially applies are : typhoid fever, cholera, dysentery, consumption of the bowels, and yellow "fever. In any of these diseases the vomit is to be treated in the same way. Discharges from the Mouth and Nose. — These discharges are to be received either into vessels, as in the previous mentioned cases, and treated in the same way, or are to be collected in rags used as handker- chiefs or napkins, and afterward burned. The diseases in which this is to be done with special care are : diphtheria, whooping cough, scarlet fever, smallpox, measles, and consumption. In the latter case, the sputa will best be treated with a solution of carbolic acid, 1 in 20. In scarlet fever and diphtheria it is well also to spray the throat with some disinfectant. Discharges Through the Skin. — Smallpox, measles, and scarlet fever are the chief diseases in which the poison of the disease leaves the 164 CAUSATION AND PREVENTION OF DISEASE. patient's body through the skin. It is in the crusts of the pustules of smallpox, in the scales of skin (the epithelia) of measles, and the peeling skin of scarlet fever that the poison abounds; and by it the infection is spread as it passes into the air. It is well on this account to apply oil, vaseline, glycerine, either plain or carbolized, to the skin, with a view to preventing these particles from floating promiscuously through the air. By confining them to some such agent as an oil they are retained until removed by the bath. The bath should for this reason be of a mild dis- infecting nature, and the water of the bath after bathing should be dis- infected with the carbolic or corrosive sublimate solution. Typhus fever discharges the contagia of that disease through the pores of the skin. This contagium loses much of its infectious power when reaching the air. Therefore free ventilation is necessary to carry off this infectious exhalation from the body. By passing out of the room into the larger space of the air its power is greatly weakened by dilution, and the danger of infection by it is destroyed. While confined to the small space of the sick room, it is concentrated and therefore virulent and dangerous. The greatest danger from infection in typhus and relapsing fevers lies close to the body of the patient. Disinfection of Clothing and Bedding. — The systematic and really efficacious method of disinfecting very large and bulky articles is by means of moist or dry heat, and as the apparatus for this purpose is out of reach of houses and homes generally, other means must be employed which, if not so good, are the best obtainable. Such clothing and articles of bedding as blankets, sheets, pillowcases, and all washable articles as can be soaked or boiled, can be thoroughly disinfected. There are several good solutions which will do this work perfectly. A carbolic acid 5 per cent solution is the i in 20 solution previously mentioned on page 163. A chloride of zinc, 1 in 240, or chloride of lime solution of two ounces to the gallon, or the corrosive sublimate, 1 in 1,000 solution, will answer admirably. The articles must be soaked for from twelve to twenty-four hours, after which they are to be boiled and washed. Disinfection of Rooms and Furniture. — A room cannot be disin- fected and occupied at the same time, for the process renders the air entirely unfit for breathing. All articles that can be otherwise treated as before mentioned are of course removed. Closets are opened so as to get full effects of the disinfectant. The windows, doors, and all other openings are to be closed. The room is then to be fumigated for three hours with either chloride of lime, formaldehyde or sulphurous acid. PREVENTION AND CURE OF CONSUMPTION. 165 The proper quantities and proportions of these are given on page 162. After the fumigation has lasted for three hours, the doors and windows are opened to insure thorough ventilation for from twenty- four to thirty- six hours. If the house is otherwise occupied, it will be impossible to have the doors communicating with the living apartments open. But all other possible means of ventilation must be made use of. Those who are employing the disinfecting means must be careful not to expose them- selves to the fumes, for there is great danger of being overcome by them. The paint and woodwork must now be scrubbed thoroughly with a 1 in 1,000 corrosive sublimate solution, or with soft soap, or with both. If the walls are papered, all of the paper, including every layer of paper, must be taken off, and the walls washed with hot lime before being repapered. The ceiling is also washed with the same. The wooden furni- ture is to be washed with a 1 in 20 carbolic acid solution or the formalin spray of 1 in 40, or the 1 in 1,000 corrosive sublimate solution. It is of infinitely greater importance that the walls, ceiling, and woodwork of a room, and the articles of furniture in it, receive a thorough treatment than that the air of the room alone be so treated, for the air in the room may be easily changed and a fresh supply procured. The other parts of the room afford lurking and hiding places for the germs, and the room is unsafe for occupancy until these have been thoroughly disinfected. MODERN METHODS OF PREVENTING AND CURING CONSUMPTION. The message which Robert Koch, a physician in an obscure German village, gave to the world in 1882, is by far the most valuable contribu- tion to the public welfare that has been made in modern times. In this message he announced that consumption is spread like other contagious diseases; that this greatest of all scourges can be prevented; and, most important of all, that those who are afflicted by this "great white plague" may be cured if they take the necessary precautions in time. The direct result of Koch's discoveries is that the work of stamping out this fright- ful menace to public and personal health and life is placed, not upon the physicians of the country, but upon every individual in the community. As it is upon the intelligent and united action of every man, woman, and child in this country that the prevention and cure of consumption depend 1 66 CONSUMPTION. there is no hope that this result can be achieved, even in a slight degree, unless the means and the principles of their application are thoroughly understood. Ravages of Consumption. — It is the most widespread of all diseases. Every nation in the world suffers from it. Every year, in the United States, a part of the population equal to the entire population of a city the size of Indianapolis, Kansas City, St. Paul, or Rochester, N. Y., dies from it. That means 160,000 persons a year, or about 438 every day in the year. Every hour, in this country, eighteen persons die from the effects of a disease which can be prevented. The public is appalled by the death of four or five hundred persons in a burning theater, or on a burn- ing steamer, or in a great earthquake. But every day an equal or greater loss of life occurs, in isolated cases, with an awful train of sorrow and suffering, to say nothing of commercial and economic loss. We have learned to look upon diphtheria, scarlet fever, and cholera as diseases which cause a great many deaths. Yet all of the deaths from cholera, diseases of the bowels, diphtheria, scarlet fever, and measles, combined, do not equal one-half the deaths from consumption. Generally speaking, one out of every ten inhabitants dies of consumption ; in cities, one out of every seven. Out of all of the deaths of persons between the ages of fifteen and twenty-four years, consumption kills one out of four; between twenty-five and thirty-four, one out of three ; between thirty-five and forty-four, one out of four. Pneumonia is the only disease that approaches consumption in point of fatality. What Consumption is Now Known to Be. — Consumption is a con- tagious or infectious disease. Koch demonstrated conclusively that it is caused by a microbe which enters the body and multiplies there enor- mously, even to the extent of 16.000, coo in 24 hours. This microbe is called the Bacillus tuberculosis. Bacillus is the Latin word for a little rod or stick; and the creature is so named because that is what it looks like when seen under a very high power microscope, which is the only way it can be seen, and then only when stained red. In this condition the bacilli most resemble a lot of very small cuttings of fine red silk thread. It takes three thousand of them, end to end, to measure an inch in length, and there may be 200,000,000 of them in a spoonful of milk without one realizing that there is anything but milk in the spoon. These bacilli were found by Koch in the bodies of every one suffering from consumption; but that fact alone was not sufficient to prove that their presence was the cause of the disease. A few of the bacilli were taken HOW CONSUMPTION IS SPREAD. 167 and put into a small glass tube containing a jelly or a bouillon, and the open end of the tube was plugged with absorbent cotton to keep other bacteria out. The tube was then left undisturbed in a warm place for some time. This is what is called a culture, for the bacilli grow and increase in numbers under these favorable conditions. Some of the matter was then injected into rabbits and guinea pigs. Guinea pigs are chosen for such experiments because the behavior of the disease germs in their bodies is most like that in the human body. After a lapse of time, some of the animals were examined and were found to be suffering from consumption. Others were allowed to die from the disease, and, on examination, like conditions were met as are found in human sufferers. Some of this matter was in turn used upon other healthy animals, and the poisonous nature of the bacilli proved beyond a doubt. The disease is called tuberculosis, for in the progress of it, and after the germs have begun to multiply in the lungs, there are formed a number of tubercles. Tubercles are little tubers, and tubers are such root-like parts of plants as the potato. The tubercles in the lung are small roundish bodies about one-sixteenth of an inch in diameter. They are formed out of the healthy tissues in which the bacilli lodge and are of a grayish, semi- transparent appearance. They first become of a substance like cheese, and this later turns to pus. Little by little the germs multiply, change the tissues in which they live into tubercles, and break down all of the structure of the organ and scatter their poison through the body. The body tries to throw that poison off by fever, known as hectic fever in this case; the parts are slowly consumed, and the patient eventually dies of consumption. These tubercles are found in many other parts of the body besides the lungs. There are tubercular joints, hip joint disease, consumption of the bowels, and other parts are similarly affected by the bacillus, and in all of these affections tubercles are formed. How Consumption is Spread. — The Bacillus tuberculosis, the cause of all infection, enters the body by several pathways. The most common of these is by the nose, mouth, and throat, in the process of breathing. Some also enter with the food and are taken into the stomach and the digestive organs. They leave the body of a consumptive person chiefly in the sputum, the matter which is coughed up during the progress of the disease. It has been estimated that a person suffering from con- sumption discharges into the air in the sputum from 200,000,000 to 23,000,000,000 of bacilli every twenty-four hours. If this sputum with its immense number of bacilli is spit out upon the sidewalk or on car 1 68 CONSUMPTION. floors, and in similar places, there are several ways in which it may be scattered abroad to become infectious. The sputum may dry and be ground as fine under foot as dust to be whirled by the wind into the air. It is then one of the solid impurities of the air, and in that form is breathed in by those who come within its range. Or it may be tramped on by passers-by and attach itself to their shoes, or gathered up by sweeping skirts and be carried into the homes. Here it finds a lodgment and becomes dried upon the carpets. On sweeping the floors it is raised upward in the dust of that process to be breathed in by the occupants of the home. In such ways it invades the homes of all classes, and bacilli are present in rooms where there has never been a case of the disease and where it is least expected. That this is no alarm- ing theory or a mere possibility was abundantly proved by Cornet, the Berlin scientist. He scattered a small quantity of sputum on the carpet of a room and allowed it to dry for only two days. He placed about fifty guinea pigs on the floor of the room. Then the carpet was vigor- ously swept. The guinea pigs were allowed to breathe the dust in the ordinary way. All but two of them died from consumption thus con- tracted. In the overcrowded and ill-ventilated clothing factories and workrooms in large cities there are present many conditions favorable to consumption; and the sputum carelessly discharged upon the floor is dried quickly by the steam heat of the buildings, and bacilli in great numbers are not only breathed in by the workmen but infest the clothing that is being made and which is sold all over the country. Even in the acts of sneezing and coughing by a consumptive, when no perceptible amount of sputum is discharged, a perfect shower of bacilli is violently forced into the air in the fine particles of sputum which always accom- pany these acts. Patients often smother a sneeze or a cough in the bed- clothes, and so the bacilli are received into them. The mustache and the beard of a consumptive become perfect hives of infection, especially as so many men allow the beard to grow long, either for comfort or as a protection to the throat in ccld weather. The walls of rooms in which a consumptive has lived and died have been known to retain the bacilli in an active state for over two years after the termination of the case. These are some of the ways in which bacilli are spread through the air and carried from place to place. No man lives long enough to be able to count, during his entire lifetime, the number of bacilli which a con- sumptive carelessly and needlessly discharges into the air in a few hours. HOW CONSUMPTION IS SPREAD. 169 These myriads of bacilli are breathed into the air and are taken into the lungs by all who come in their way. Every one breathes them, and they lodge on the teeth, the tonsils, in the throat, and in the lungs of all, healthy and unhealthy alike. Dr. Cornet examined a very great number of healthy persons who were accustomed to frequent public places, and he found bacilli in the mouths of over 75 per cent of them. They lie there in wait with infinite patience, for upon the healthy, right living man their attacks are useless. But let him neglect his hygienic mode of life, let him be guilty of continued indiscretions, let him become weak- ened and enfeebled by disease, hunger, privation, and exposure, then he succumbs. And the patience and relentless attack of the invisible little microbe kill one out of every four persons. And yet even the healthiest in appearance must not be too sure that they have never been caught by this ever present and watchful enemy. The post-mortem examinations have shown repeatedly that persons who had never been suspected of having consumption have had an attack, and the scars on the lungs ■ prove that they had vitality enough or adopted right modes of living in time to overcome the attack, in other words, to be- come cured. These are not isolated cases. These revelations are of almost daily occur- rence, and are the most convincing proof of the curability of the disease. No man can say positively either that he has not had consumption or that he is not now attacked by it. Were this possible, the stamping out of this insidious disease would be only a question of a very few years. Persons Most Likely to Be Attacked. — There is great difference of opinion among scientists regarding the transmission of consumption from parents to children. Medical journals are filled with articles affirm- Fig. 45- Cot and Bedding Arrangement for Porch Sleeping. 170 CONSUMPTION. ing and denying the possibility of the communication of the disease in this way. But upon one point all are agreed, that there is no doubt that children of consumptive parents, one or both, inherit such a weak con- stitution and so enfeebled a state of health, that they start life with a marked predisposition to the disease. These, then, form a large propor- tion of those who are liable to be attacked by consumption. But that does not by any means imply that they will take it. For facts prove that the very large majority of them do not take it. A statistician of a large insurance company gave -facts before the Tuberculosis Congress in Eng- land that should set that point at rest forever. Forty thousand applica- tions for insurance were refused because there was a family history of consumption. These cases were followed up, and it was found that less than nine per cent of that large number took consumption. Less than one out of ten took it. And this is the class which in popular opinion is doomed from birth because it is in the blood. If those figures prove anything they certainly prove that the inherited predisposition to the disease is no greater a predisposition than are those from other causes. For one out of ten the world over is the average mortality among all classes of people. Right here let us drive home to the members of that class all the hope that this fact gives them. You are under no ban because your father died of consumption. You are not doomed to the disease. You are not going to die of it unless you are willing to. Your chances of escaping it are as great as anyone's, if you do your part. To this class are to be added all those who have inherited a weak state of health and a poor constitution from their ancestors. There is in fact no good reason why the two classes should be separated. The bacilli will find a favorable field for operations in both, in one just as good as the other. It is impossible to tell anything about a person's vitality or constitution, or power of withstanding disease, with absolute certainty from his appearance. Every one can cite case after case from his own observation, no matter how limited, of those who were apparently sound, splendid specimens who succumbed quickly to an attack. They can supplement this with other cases of those who were apparently not at all endowed with powers of resistance who have seemingly more than once come back from the gates of death. It is a fact that men of flesh and men of muscle have, in the great majority of instances, proved but t oo easy a prey to the bacillus of consumption, perhaps because too much was expected from their apparent vigor. Nearly every doctor has at HOW CONSUMPTION MAY BE PREVENTED. 171 least a mental note of more than one instance where a whole generation of the same family of heavy, powerfully built persons succumbed to this disease, although they gave every promise of escaping all danger from it. The vital resistance to the disease was poor, although the physique appeared excellent. There are two types of build which are particularly prone to the disease. The one is represented by those who have inherited a poor chest development, so poor that the lower portions of the lungs seldom if ever are filled with air. These have a light build, small bones, delicate features, thin skin, and blue veins about the temples. The second type is a remarkable contrast to these. It includes those whose bones are large, muscles powerful, of that build known as "lanky." Fig. 46. Sleeping Quarters at the Sanitarium for Consumptives at Liberty, N. Y. A Winter Scene. In these two types, especially the latter, consumption usually runs a rapid course. The last class of which we have to speak is the largest of all. It is larger than all others combined. It is those persons who do not live hygienic lives. The indiscretions, the carelessness, the ignorance, and the willfulness of men and women, together with the poverty of the lives of many of them, are the great predisposing causes to the deaths by consumption. How Consumption May Be Prevented. — The first step in the pre- vention of consumption is to destroy the bacillus as soon as it leaves the body of the patient. As it passes off in the sputum, this means that the sputum from one suffering from the disease must be thoroughly and 172 CONSUMPTION. effectively destroyed. There are several good ways of doing this. A regular sputum cup may be provided, in which a small quantity of the disinfectant and germicide, the perchloride of mercury, is placed. The perchloride solution is the regular i in 1,000 solution made by dissolving one-half an ounce of mercury perchloride (corrosive sublimate), and one ounce of hydrochloric acid in three gallons of water. This kills the germs or bacilli, and the destruction is complete. If there are facilities for burning the sputum, a paper cup, moist rags, old newspapers made into books, may be used to spit in, but they must be promptly and regu- larly burned. This care in the disposal of the sputum must be rigidly performed. There should be absolutely no spitting in public places, on the sidewalks, in cars, on floors anywhere, nor on carpets. As pointed out before, this is the most prolific means of infection. The bacilli are carried about on clothing, dry up and form dust, which is blown about and inhaled, and escape from infection is impossible. Not only should spitting in public places by consumptives be stopped, but the practice should be prohibited to every one. If a spitter have not consumption, and no one can be sure that he himself has not, he is only passing along such bacilli as he has inhaled and which have attached themselves to his throat and tonsils. The enforcement of the ordinance in some cities is not alone on the grounds of cleanliness but to prevent the spread of this disease. If a person must spit, let him be both sanitary and decent about it. Let him spit off the curb into the roadway; that is bad enough, and is also a means of infection, but it is not so bad as the risk of it being carried about on the clothing of passers-by into their homes. The danger of spitting on carpets as a means of infection has already been demon- strated. It is an easy matter to spit in spittoons which have water in them, to spit into a sewer grating, and generally to use a little precaution in disposing of the dangerous and offensive excreta from the mouth and lungs. It is not right that this matter should be swallowed,, as there is very great possibility of carrying the infection into the stomach and bowels, both of which are extremely subject to tubercular infection. A consumptive should also never cough or sneeze without covering the mouth and nose with a wet cloth. He should always have at hand for use a supply of such material, which may be burned after use. The acts of coughing and sneezing being both explosive in nature and intended to force matter from the lungs, throat, and nose, violently expel much of this infectious matter into the air. A consumptive person should never kiss another on the mouth. In HOW CONSUMPTION BEGINS. 173 spite of the comic paragrapher's humor on this point of infection, there is positive danger of communicating disease by this means. He should sleep alone and occupy a separate room. These points on the disposal of the sputum and other preventive measures have to do principally with the prevention of the spread of the disease to others. It is the dissemination of the bacilli that increases the possibility of infection by those who are disposed to the disease. A person who is predisposed to consumption should avoid infection as far as possible. He should live outdoors all that he can. Many have changed their occupations to secure the sunlight and fresh air, with most favorable results. The mortality is greatest among those whose occupations cause the breathing of particles of metal, stone, etc., and among those who are most confined. The glass- workers, stoneworkers, hatters, bookkeepers, cigarmakers, printers, sup- ply a very large proportion of deaths. Predispositions of all kinds are to be closely watched in the early years of life. If a child display a tendency in family history, build, constitution, or if he has been enfeebled by weakening disease, let him be given all of the outdoor life possible. Let him drop school for. a time. Never mind if he does not keep up with his class; give him a chance to keep up with life. The rivalry of school classes and the fear of not making a school year with his classmates are sometimes very pernicious. The choice of a profession or of a career in life must be largely influenced by his physique. Dangerous occupations and those which entail confine- ment are not for children or young men and women with any predispo- sition to disease. An outdoor life is not only advisable but imperative in all such cases. Fresh air and sunlight are not only in themselves a means of destroying the bacillus and its poison, but are powerful agents in increasing the vital resistance to the disease. That is what all of the preventive means should aim at doing. Kill the bacillus, and build up a weakened constitution so as to withstand its attacks. The curative agencies, which will be taken up later for consideration, are to be employed to a degree in the prevention where a possibility of contracting the disease is feared. How Consumption Begins: Early Symptoms. — Consumption begins by the admission, under circumstances favorable to its growth, of the bacillus into the lungs through the organs of respiration. What it will do after it gets in depends entirely upon the virulence of the bacillus, the state of health of the person, the condition of the organ or part affected, and the power of resistance of the individual attacked. If 174 CONSUMPTION. there is no predisposition to the disease ; if the person is in good health and is living a careful, hygienic life ; if he is not weakened by an enfeebling disease, such as pneumonia, typhoid, measles, whooping cough, etc. ; if his health and strength are sufficient to resist the invasion; then the bacillus can do nothing, but is expelled in time by coughing and spitting. Fig. 47. Temporary and Perma- nent Porch Arrangements for Bad Weather. But if any of these conditions are present, in a greater or less degree, then the bacillus begins to act. It first sets up an accumulation of cells in the immediate neighborhood. These cells vary in size and in the nature of their contents. They form a tubercle. In cases of cure, these tubercles, which contain the bacillus, are walled up by a tissue so that the bacillus cannot get out to attack other tissues, and can work no further harm. This is accomplished by a healing process, and when it occurs a scar is left on the lungs just as a scar always marks the place of a wound. This happens in hundreds of thousands of cases, and usually without the individual knowing that he has had the disease. This is important to be remembered, for there is no clearer and more convincing proof of the possibility of a cure of consumption than the fact that this cure takes place in so many cases, and often without any direct effort on the part of the individual. Certainly much more success can be hoped for when well directed efforts are made to bring about these very conditions. PROGRESS OF THE DISEASE. 175 But if the disease does not terminate in this way at this stage, the next step is the death of the tissues which have been affected by the bacillus, which passes on to attack other parts in the vicinity, the bacillus meanwhile increasing enormously and rapidly. If these tubercles are quite small they are called miliary tubercles, as they are said to be about the size of a millet seed; but when a number of these miliary tubercles unite to form one large tubercle, the latter is called a nodule, a word derived from the Latin and which means "a little knot." Inflammation sets up in the part affected, and, as is always the case when inflammation occurs, there is a secretion which surrounds the tubercle and confines or limits the operation of the bacillus to that particular area, and so pre- vents the spread of the disease for a time. This matter secreted by the inflammation surrounds the tubercle with the bacilli, and, in a very great number of cases, grows in- to a tough envelope or covering so strong that the bacilli are walled up inside of it, cannot escape, and are either prevented from getting out as stated or are destroyed. The part of the lung inside of the envelope dies or becomes useless for breathing purposes ; the scar is left and the disease is stopped. This, then, is a cure at a later stage of the disease. If, however, the wall or envelope is absorbed while the bacilli are alive and active, or if it breaks down and allows the bacilli to escape, the attack is at once made upon the lung tissue, and the operations are extended. Sometimes a disease like pneumonia, typhoid fever, or influ- enza works a change in the envelope or covering of these walled up sections of the lungs, and an attack is made by the liberated bacilli upon the neighboring tissues. This is the condition popularly known as "rapid decline," which often follows these and other diseases. This stage of the consumption may have existed unsuspected for some time, Fig. 48. Sleeping out of doors on an Open Porch in Fine Weather. 176 CONSUMPTION. and it took the other inflammatory disease to break down the sealed up barriers and to give the disease full sway with a speedy termination. The formation of this envelope or barrier to the further progress of the disease does not always take place. Where there is little or no resistance to the attacks of the bacilli, a general spreading of the poison- ous matter takes place through the tissues, and, as there is nothing to impede its advance, the course of the disease is very rapid. Early Symptoms. — In the cure of consumption so much depends upon its speedy detection that it is well to have in mind the early symp- toms of the approach of the disease. It is not supposed that these are always within the power of the ordinary person to detect. There must always be the assistance or direction of the physician. No one is capable of diagnosing his own complaint. Even physicians do not attempt this in their own cases when ill, but every one should know the warnings of the approach of consumption so as to be able to tell when a thorough examination by a skilled physician is needed. The neglect to do this upon reasonable grounds for suspecting the existence of incipient con- sumption is criminal negligence. It is a common belief that an attack of consumption is heralded by a cough. This is not true of a very great many cases. Sometimes the first symptom is a rise of temperature in the evening. This rise may be very slight and be preceded by a chilly sensation. A clinical ther- mometer will tell whether this rise is real or fancied and the extent of it. The average normal temperature is 98.4 , and the temperature should be taken during the day and at evening for comparison. In other cases the first symptom is persistent hoarseness. That is when the effects are first shown in the larynx. When this huskiness of voice does not quickly yield to ordinary treatment, an examination for consumption must be made. "Only a slight cold" works a lot of damage at this stage of the disease. Again, the earliest symptom may be the spitting of blood. This does not always mean consumption, but in the great majority of cases it does. It may mean acute pneumonia or some form of heart trouble, with rup- ture of the blood vessels, but both of these conditions will soon be deter- mined by examination. The symptoms of consumption do not develop in the same order or in the same degree in all cases. If they did the task of deciding accu- rately would be much simplified. There are two symptoms which come some time or other in all cases. They are fever and loss of weight. EARLY SYMPTOMS. 177 The fever of consumption does not usually run to very high tem- perature. It is generally moderate, and runs from ioo° to 102 and rarely to 103 °. If it runs higher than this it may be caused by some complication such as blood poisoning. It is high in the evening and low in the morning. It is easy to relieve it but only temporarily. Loss of weight is caused by loss of appetite, \ Y Fig. 49. A Sheltered Cot for an Infant TO SLEEP IN OUT OF DOORS. cough, and consequent loss of sleep, and by ex- haustion, indigestion, anaemia, and the absorp- tion of poisons generated by the disease. Sometimes the loss of flesh proceeds at the rate of four or five pounds a week. This is a sign that the disease is making rapid progress. Gain in weight, on the other hand, indicates that the disease is making slow headway, or that its progress has been stopped, and that the healing, walling-up process has begun. Night sweats, as so many suppose, do not aggravate the disease; but on the contrary, are the natural means of relieving conditions. They are to be regarded as an effort to reduce the effects of the absorption of poison into the system. For it is by the perspiration of night sweat that the poison of the disease is carried off. The cough is a very generally constant symptom of the disease. It is usually worse at night and in the morning on rising. As it is a reme- dial means of clearing out the accumulations in the lungs, it is not to be stopped. At first it is a dry hacking cough, and is not accompanied by much discharge, for the simple reason that the disease has not progressed far enough to form matter in the lungs to be discharged. It is the method by which the lungs are kept clear. Later, when there is much discharge, it is sometimes so severe as to cause loss of sleep, exhaustion, and even vomiting. When sputum is present it, too, is a symptom, for it is capable of microscopical examination which will disclose the presence of the bacilli. i 7 8 CONSUMPTION. The Board of Health in the city of New York is equipped to make a free examination of sputum, and give a report on its condition, and the pres- ence or absence of bacilli in it. Still, it must be remembered that the absence of bacilli in sputum is no proof that the disease is not present at that time. Bacilli may be present in the lungs but in the walled-up condition already mentioned. Modern Methods of Curing Consumption. — It is well to start with the clearly stated announcement that there is no medicine known which will cure consumption. Those who rest their hopes upon this or that medicine Which they have read about, or been told about, are lean- ing upon the worst sort of a broken reed. They are not only not going to be cured by any of them, but they are wasting valuable time and are allowing the bacilli to get such a start upon them that they will probably never overtake the disease or head it off. This plain statement is made without reserve. There are some medicines which will help him in the complica- tions which so often attend this disease. There are some medicines which, in the hands of the proper person, will relieve him of pain and incon- venience. But there are positively no medicines which will cure con- sumption. Those which will help him will be considered in the proper places as they come up. The things which do cure consumption, and are curing lots of cases every year the world over, do not come from drug stores or out of bottles. They are abundant, and yet are, in some cases, hard to get. The first is fresh air — not a little bit of fresh air through a half inch of raised window once in a while, but a regular supply of it got by living out of doors, sleeping out of doors, if possible ; at any rate, by being out of doors as much as possible. Fresh air will not only kill the bacilli but will give the patient a vital power to resist the disease Fig. so. Arrangement of Awnings on a Lower Porch for Shelter in Bad Weather. The Head of the Bed is seen through the Opened Door. CLIMATE. 179 and to seal the germ up in a sac whence it cannot escape and so destroy it. There are places where a consumptive can live out of doors, and there are other places where he cannot. The thing, then, to do is to find out where he can live out of doors and to get there as soon as possible. The one great thing is to get where it is dry. Humidity is above all things to be avoided, for it is the life of bacilli. The old much-vaunted effi- cacy of the sea voyage on a sailing ship is all over and forgotten. There are no more good old sailing vessels, and even if there were, the air at sea is not dry, but damp. There are seasickness, personal discomfort, and being shut up in stuffy places during bad weather. All of which will not do. In the out-of-door life the temperature makes no difference. Dress accordingly. People get well in the cold, dry air of Canada and the northern states just as well as in Florida and on the Pacific coast. The old theories of not going out before 9 a. m. or after 4 p. m. are exploded. Not only go out but sleep out if you can. Of course you can in summer, and, with proper ar- rangement, you can in winter too. Hundreds are doing it to- day and are getting well too. Draughts? They are better for- gotten. The fear of them and the precaution to avoid draughts that never existed, or never came near a patient, have killed more consumptives than direct draughts ever did. If you can, sleep in a tent out in the open where there is plenty of good, fresh air. The tent is sheltered from direct winds ; and it is made of thick canvas that the air does not blow through. The air is admitted in ventilators in the sides and passes out of the top. There is no draught. Night air? That is another bugbear. As Florence Nightingale said, when told that one must not breathe the night air: "Why, doctor, what kind of air must one breathe at night if one cannot breathe night air?" Where tents are impossible, and they are for 90 per cent of con- sumptives, a back porch, a sheltered place outside in summer and under an open window in winter, can easily be secured, and they will work Fig. 51. Tent with Ventilator at the Top, for permanent out of door living. i8o CONSUMPTION. wonders. It is not the tent that cures; it is being out in the best air, the purest air than can be procured. It is possible to protect against all sorts of low temperature by having enough bedding. A consumptive must get the best air all of the time, not part of the time, but all of the time. Good fresh air in the daytime and vitiated bad air of the house at night is not half treatment; for the germs make more headway at night than the patient did in the daytime. There is no doubt that sanitarium treatment is best for those who can afford it. Because there is discipline there, and things must be done. There is no interference with the ar- rangements of a home or with the comforts of others. The treatment is continuous and is thorough. But the patient should not go alone if inclined to worry or to homesickness. That will interfere with his rest of mind, which is absolutely necessary to a cure. In the ordinary out-of-door life of a patient during the day, it is easy to provide a sheltering wall or shield from the wind. It should be thorough- ly exposed to the sun and have the direct rays of the sun shine upon the patient. Sunlight and fresh air will do more towards effecting a cure, even in a locality that is theoretically bad, than the absence of them in the best climate in the world will do unaided. This is to be borne in mind with relation to those cases where a patient cannot avail himself of good climatic conditions. Where it is possible to secure alti- tude in addition to dryness of climate, a height of from 3,000 to 6,000 feet is desirable. This is helpful because the rarity or thinness of the atmosphere at that elevation obliges the patient to breathe with all of the available lung machinery in order to get enough air. That keeps the lungs well exercised and exposed to the action of the air. But weak heart and high pulse indicate that a high location be not chosen. There are scattered now all over the country numerous good sanitariums which are doing splendid work in curing patients and in stopping the spread of the disease. Where such results can be shown by the methods herein advocated, cures of 72 per cent in incipient cases and 46.11 per cent in advanced cases, there is much to be hoped for even in home treatment. Fig. 52. Clothing and Bed Ar- rangement for a Child to Sleep in, on a Porch. DIET. 181 Fig. 53. Suggestions for the Care of a Child in any way pre- disposed to Consumption. Diet. — The matter of diet is to see that the patient eats plenty of nourishing food. This is not so much a matter of appetite as of seeing that he eats enough. There are at least six meals a day. Not much food is to be taken at a time; but be sure that there is plenty of it. If the weight of the patient can be kept increasing, that is a sure sign that the ravages of the bacilli are being checked. Milk, eggs, fat meat, and hard bread are the chief articles of diet. The aim is to have the patient eat six meals a day and to drink three quarts of milk and to eat a dozen raw eggs besides. All of the food is to be well chewed, even the milk is to be sipped and moved back and forth in the mouth so that it is practically digested before it is swallowed. In this way it will not curdle nor will it make the patient bilious. Such are the principles of diet. But a more extended course with greater variety may be given. The patient's digestion must be moderately good to follow such a diet as is here suggested : — Before rising he may sip a cupful of hot milk. Sipping is essential to good digestion of milk. Rest for fifteen minutes. Then bathe and dress. Breakfast : Oatmeal or other nourishing cereal, to be well chewed. A chop or small steak. Dry toast. Tea or coffee if vised to it and it does not make him irritable. An orange or other fruit. Light luncheon between breakfast and midday meal : Cup of broth. Piece of toast. A glass of koumyss. A scraped beef sandwich. Eggs raw or cooked. Sherry or red wine; or a glass of good Scotch or rye whisky if desired. Midday dinner: Soup, preferably a thin soup. Really fresh fish. Roast or broiled meat. Vegetables : potatoes, string beans, macaroni, spinach, asparagus. Sherry or whisky and water. Cornstarch or rice pudding. Light luncheon in middle of afternoon: Similar to mid-morning luncheon. Supper: Arrowroot. Eggs. Stewed oysters and toast. 182 CONSUMPTION. Evening luncheon before going to bed : Cup of broth. A glass of koumyss. Cup of hot milk. Curds and whey. This or any diet must be supplemented by all possible aids to diges- tion, such as pepsin, pancreatin, taka-diastase. The bowels must move regularly. The size of the meals must be regulated according to the patient's condition. If he has spent a restless night he has not much nervous energy left. Therefore the meal must be a light one. If it has been restful he can digest a heartier meal. If the tongue is coated or foul, the amount must be lessened. It is upon such matters as these that the physician's advice must be sought and rigidly followed. Fig. 54. Arrangement of the Bed in a Room with Two Windows — both wide open. Exercise. — If the area involved is small and the general and mus- cular health of the patient is good, he may take gentle exercise, but under no conditions become fatigued. If the lung- area affected is large or if the patient's health is below the average, he does not want exercise. Exercise causes heavy breathing. The lungs of a consumptive are wounded. No one thinks of working a sore hand or foot to make it heal. They let it rest. That is what must be done by the consumptive. He must let his lungs heal. It is infinitely better for such to sit around in the sunshine and fresh air conserving all of the energy they have and devoting it to the digestion of as much nourishing food as possible. If such feel the need of exercise it is best given in the form of massage. In cases where the ambition of a patient exceeds his discretion, and he wants LIVING OUT OF DOORS. 183 Fig. 55. Securing a Supply of Fresh Air by opening all of the Windows. to walk miles, and play golf over long links as he used to do, that is where the discipline of a good friend or doctor comes in. Every time a patient gets tired he undoes all that has been done towards gaining resistance to the ravages of the disease. One indiscretion in that direction puts him back several weeks. Rest for the body and rest for the mind; freedom from worry and the cares of business, will be absolutely neces- sary to a cure. Everything should be dropped and the attention con- centrated upon the cure. How to Live Out of Doors. — It is presumed that the patient has selected the driest possible climate for outdoor life. To those who can afford to go to a sanitarium, there is little to be said further than to go there is quickly as possible. It is to those who cannot, as well as to those who are curious to know what is the modern practice of curing consumption, that these directions are given. There is first a tremen- dous prejudice to be overcome about taking cold. That is the great bugbear in the way of the ready and universal adoption of the methods here advocated. Let it be said as convincingly as possible at the outset that you will not take cold as readily or as frequently if you adopt the outdoor life as you will if you follow the indoor life. Besides if you have consumption and continue to live indoors, with a little outdoor life in the warm part of the day, you will die. If you live outdoors summer and winter, night and day, fine weather and bad weather, you will get well. Forget all that you have ever heard about draughts, chills, and night air, and do as thousands are doing while you are reading this, and get well. You are not to suffer the least discomfort in following the outdoor living. If you do, you are not doing it right. In fact, if you do not feel better out of doors than you do indoors, there is something wrong in the way you are trying to do it. Shelter. — You are not to sit out exposed to the wind in winter or to the intense heat of the sun in summer. You are to be made as com- fortable as possible. While you are to be out of the wind you are not 184- CONSUMPTION. Fig. 56. How to Dress for Out of Door living in Cold Weather. to be away from the direct influence of the fresh air and of the sun. The fresh air and the sunshine are what you are outside to get, and if you do not get all that you can, you are only half doing your share. First of all, get a comfortable chair. Remember that you are going to sit many hours a day in that chair, and it must be as restful and snug as it can be made. A rolling chair or a wheel chair is very desirable, because it is so easy to move about as the wind changes, or as the sun changes, or when you desire to change the scene. Besides, with such an easy chair to move, you can often wait upon yourself when it is not con- venient for others to do so on the moment. An adjustable reclining chair is very good, as it places one at the comfortable angle and will take a larger and softer cushion. Or a canvas chair, which fits it- self so well to the shape of the body, is restful. The cushions of the chair are to be as soft and thick as can be provided; a mattress is often desirable, and can be adapted to a large chair very effectively. A table or book rest is indispensable for reading and writing; for writing is indulged in even when the thermometer is at or below zero, and when the ink freezes at the point of the fountain pen. If the house has broad porches or verandas, one can always find a sheltered spot in any weather on the lee of the house. But even there a screen, such as must be provided in the absence of porch room, is con- venient. If this is of glass, so much the better, as it will not cut off the sunshine. This does not mean the complete walling-in by glass, but is only a small shield against the wind. In a shut-in porch, with glass all about, one is little better than when in a room. If glass is not pro- curable, any form of shield will answer. It should be easily movable, not too heavy, and yet not light enough to blow down in the wind. Clothing. — Again the rule is : be comfortable. It is not intended in the outdoor cure that the body shall be cold. That is not what cures. Cold air is good not because it is cold but because it is dry. Dry air is just as curative in summer as it is in winter. Remember that you are living where you can get the freshest of air all of the time. As long as that fresh air gets free and abundant access to your lungs that is all CLOTHING. 185 that is needed. Comfortable clothing is easily enough secured in the summer and while it is warm ; but the comfort on cold stormy days is a matter of experience. It is not right to go out for a little while improp- erly or insufficiently clad, get chilled, and then come in to a warm fire to get warm and then to go out again. That means that you sit beside a warm stove until the pores of the skin open; then when you go out to the cold air again, the pores are suddenly closed, and the result is a chill and a cold. You are not taking much exercise while you are out, so it is necessary to be well clad. Right here you must be careful to remem- ber that weight of clothing and warmth of clothing are not to be confused. Do not rely upon heavy underclothing, but upon warm out- side wraps. It is from them that the protection will best come. The material of which they are made is of little importance; but it is of the greatest importance that they be warm enough. That is the only test of their fitness. A loose fitting outer garment is not so warm as a rather tight fitting one. It should fit close at the wrists so as not to allow the cold air to affect that particularly sensitive part of the body. A high collar, or, better still, a cape will be found of great service in keeping the neck warm. Women will find a small shawl a sufficient covering for the head. Men should have a cap with flaps to pull down over the ears and a peak to keep the sun from the eyes is desirable. The hands are best protected by mittens. Gloves separate the fingers and are not nearly so warm. A pair of cotton gloves of large size may be worn under warm woolen mittens. This is found to be a very com- fortable arrangement. The feet should be protected by loose-fitting, comfortable shoes. Two pairs of woolen socks or stockings are warmer than one thick pair. The very great value of newspapers as a means of keeping out cold and of keeping in the warmth of the body must not be forgotten. These can Fig. 57. Sleeping in a Room with only One Window. The Head of the Bed is placed outside of the Room, in the Open Air. 1 86 CONSUMPTION. be placed over the chest, the back, and around the feet, with great advan- tage. Sleeping Out of Doors. — The most satisfactory results are secured from sleeping in a tent. This is pretty generally the methods of the best sanitariums. Perfect shelter and protection against all kinds of weather is secured by its use. The ventilation is provided by the pas- sage of the used air out at the top. Such a form as that shown in Fig. 51 is a standard. But shape has little to do with it. A porch may easily be fitted up with pro- tective awnings so as to form an ideal sleeping place, free from exposure to weather and to the curious. Many houses have upstair porches or bal- conies, which afford abundant shelter with a little added sense of security. Where such conveniences cannot be obtain- ed, one must fall back upon indoor sleeping with full ventilation. If there are more than one window in the room, close the door, so as not to affect the rest of the household, and open all of the windows. The arrangement of the room under such conditions is shown in Fig. 54. Where there is only one window available, there are several ways of arranging. One is nothing more nor less than putting the head of the bed out of the window. Where shelter against observation is desired, an umbrella may be raised, but awnings or screens will be better. Care must be taken that not more than one-third of the length of the bed is permitted to project, as there would be danger of the bed tipping if more were used. A weight may be attached to the lower part for additional security. A convenient sort of platform is arranged outside of the window upon which the mattress is placed. The inner part is built up to the required height so that the bed is on a level with the shelf. As a last resort, when no other accommodations are at hand, raise the window to the full height and place the bed directly under the window. Fig. 58. A Shelf or Sup- port OUTSIDE OF THE Window upon which the Head of the Mat- tress MAY REST. DETECTION OF DISEASE 187 DETECTION AND RECOGNITION OF DISEASE. The first step in the detection and recognition of disease is a care- ful and thorough study of the patient. Do this in all cases before looking for the symptoms under the head of any disease. There is a very decided suggestion of symptoms which do not exist when one reads a printed list of them. Writers of patent medicine advertisements know this effect full well, and take advantage of it to the utmost in preparing their matter. Jerome K. Jerome, the English humorist, gives a ludicrous description of his own sensations when he studied a medical encyclopedia from A to Z and found that he was suffering acutely from every disease but one mentioned in it. Let the mind be perfectly free from all suggestion or prejudice and write down a list of such conditions as seem to be most marked. Do this leisurely and carefully from your own observation and the assistance of the patient's complainings. Then, but not till then, consult the list of symptoms arranged for ready reference on page 206. Suppose, for illustration, there is a fever of 102 degrees shown by the thermometer; bad breath; breathing through the mouth; difficulty in swallowing; and a chill has preceded the fever, On looking up these in the list of symp- toms beginning on page 206, it will be found that tonsilitis or inflamma- tion of the tonsils is the only disease which appears in every list of diseases under all the symptoms mentioned. By referring to that disease on pages 336, 337, and 338, one's suspicions are confirmed. In order to facilitate the search for symptoms, one must be familiar with the details given in the following pages, where the appearance of the several parts of the body under disease is clearly given. Such aids as the thermometer and the ability to use it should always be at hand. A casual glance at symptoms of diseases will show the very great number of cases in which an increase in temperature is an early indication of disturbance. The taking of the temperature is one of the first things to be attended to in cases of illness. If fever is present, one can easily determine the severity of it by the degree indicated on the thermometer. The condition of the pulse, the presence of pain, the appearance of the tongue and eyes, the presence of any eruption, the condition of the skin, the nature of a cough, are a few of the subjects which should receive attention. The necessity of a careful study of all of these conditions cannot be too deeply impressed. For this is the starting point of the application 1 88 DETECTION OF DISEASE. of intelligent assistance. As an accomplishment, there is nothing to equal it in other lines of education, for nothing else brings so fully into play the exercise of the benevolent affections for the relief of the suffering. One must not be deterred from approaching the subject of detecting and recognizing disease on account of the proverbial difficulty of making a correct diagnosis. Because there are certain aspects of the study that are beyond the skill of experienced physicians, is no reason why one should decline to go as far on the road as one's opportunities and ability will permit. It is a very decided step in advance to be able to distinguish between states of severe illness and simple indisposition ; to know whether or not a patient requires the services of a skilled physician ; to be able to detect the onset of dangerous and infectious diseases ; and to minister to the wants upon such general lines as may abort a threatened attack. All of this is quite within the range of possibility for persons of ordinary intelligence to do with a fair measure of success. WARNINGS OF DISEASE. 189 PRODROMAL SYMPTOMS OR WARNINGS OF DISEASE. Disease is any deviation from a state of health, and is always preceded or accompanied by certain well-marked symptoms of its approach or presence. Those which precede it are called "Prodromal Symptoms/' because they are forerunners to warn us of an impending attack. They come as warnings to us, often very timely, and we may ward off an attack or succumb to it, according as we heed or ignore them. Some of these symptoms are very plain and can be detected by us all ; others require not only a practised eye to observe, but a mind trained by long experience to recognize the diseased condition which they indicate. It is one thing to read the sign and another to understand it. There are, then, a number of symptoms which are beyond us to interpret correctly; but there are a great many that we can all see and understand. It is the latter that we should learn in the interests of the comfort, well-being, and even the life of ourselves and others. There are two broad classes of symptoms. First, those which the sufferer alone knows about, called "Subjective Symptoms" ; and, second, those that another person can see, called "Objective Symptoms." The first class is the one about which the physician asks his patient so many questions. Upon correct and exact answers to those questions much depends, and care should always be taken to give the doctor a clear under- standing of the nature of the pain, its location, and other details. Do not withhold any information from him. The more you can tell him about this class of symptoms the better for you. Very young children, of course, are unable to help in this way, and it is necessary to work upon the second class of symptoms, or to be aided by the child's sign language, which is often helpful. The second class of symptoms, the Objective, are really signs of disease because they are visible and can easily be read correctly by an observing person. General Appearance. — There is a certain indefinable something in the appearance of one who is threatened with disease which suggests that he "is not well." Closer observation and attention to detail will inform us that this general appearance of ill-health is made up of a number of separate indications which can be noticed individually, and which, put together properly, will lead to what the doctor calls a correct "diagnosis" or reading of the disease. An intelligent understanding of these warning 190 WARNINGS OF DISEASE. signs will prevent us from committing one of two serious mistakes : either magnifying every slight ailment, and thereby needlessly alarming both the patient and ourselves, or neglecting to summon medical assist- ance in time. In studying the details of the case, we endea\~or to find out in what way the changed appearance has come about. We are so familiar with the normal and usual appearance of those in our own families that we should be able to detect any change that may come to one of its members. The Face. — Sudden paleness may be a sign of fainting, or of an internal or external hemorrhage. Constant paleness is a sign of anaemia, insufficient blood. A flushed face is a sign of feverishness, and calls for the use of the thermometer. A livid or bluish appearance of the face and lips indicates a disturb- ance in the breathing or in the circulation of the blood. There is also a possibility of congestion of the brain. It is also present in choking. suffocation, whooping cough, and in the presence of a foreign substance in the throat. Distortions of the face are caused by pain in any part of the body, and vary with the intensity of the pain. Very marked distortion of the features is an indication of convulsions, epilepsy, hysteria, St. Vitus's dance, and paralysis. A peculiar dark blush is noticeable in pneumonia. Eruptions, appearing first upon the face, may be measles, German measles, or other eruptive fevers. The lips are drawn and surrounded with a white ring or zone, the ears are cold, the eyes hollow, and sometimes the muscles of the face set, in the severe pains of peritonitis, inflammation of the bowel (peri- toneum) . In cases of hysteria one is struck by the peculiar woe-begone expres- sion of the patient's face when the symptoms are under discussion, and by the rapidity with which the expression changes when the mind is diverted into a different line of thought. There is the brightness of the eye, which is seemingly on the alert to catch any sign of hope of recovery, to be remarked in patients suffering from advanced phthisis, and the pale, emaciated face is in marked con- trast to the deep hectic flush over the cheek bones. Again, in people suffering from kidney disturbances, one notices the peculiar doughy appearance of the face and the puffiness under the eyes; OBJECTIVE SYMPTOMS. 191 a physician will often make several examinations of the urine before he finally is able to confirm his suspicions which were aroused by these same symptoms. When a patient is seemingly indifferent to all surroundings, or mut- ters in delirium, the face being expressionless, we find the case one of low running fever. The Tongue. — We all know that almost the first thing a physician does is to ask to see the tongue. Florid redness is a sign of dyspepsia ; a livid or purple tongue shows that there is obstruction of the circulation, or of respiration; a pale or white tongue denotes a weak and impov- erished state of the blood; a furred tongue is common to some people even when in health, but, when there are bright red points beneath the fur, scarlet fever may be present ; a tongue with red edges and furred in the middle is a sign of intemperance or indicates brain disorder. In feverish conditions of the system, the tongue becomes very dry and hot, or parched ; when the tongue is clammy and viscid, there is usually derange- ment of the digestive functions; a yellow tinge on the coating of the tongue indicates a biliary or liver disorder ; a thin, creamy white coating, inflammatory disease in the abdomen. In sore throat we often find the tongue of a dingy, whitish color; in scarlatina, we have elongated papillae, appearing as bright red spots ; and in some forms of intestinal irritation and hemorrhage, and after acute disease, it is clean and bright red. In anaemic patients, we find this organ partaking of the general condition of the system, being pale and flaccid ; in paralysis, it is drawn on one side ; in delirium tremens and nervous affections, it is tremulous ; and in some stages of typhoid fever it becomes almost black and cannot be protruded. The Gums and Lips are also indicative of certain conditions of the system : — When the gums are swollen, and bleed at the slightest touch, there is reason to believe that the system is generally out of order, in a state commonly called scorbutic (scurvy). Swollen or spongy gums are also a sign of disorders of digestion, of certain types of anaemia, and of diabetes. In ulcerative stomatitis, we have ulceration along the gum line. Anaemic patients have pale gums. Different poisons produce dis- coloration of the gums. Lack of cleanliness is not an uncommon cause of redness along the edge of the gums. Copper poisoning causes the gums to have a greenish-blue line at the edges, while a pale bluish-red gum, with a marked line of blue at 192 WARNINGS OF DISEASE. the edge, is a sign that lead has been taken into the system in some way. In mercurial stomatitis a blue or red margin is found, and scurvy pro- duces a purple coloration. The Lips. — When the lips are parched and cracked, with fetid breath, there is reason to suppose that fever is present in a typhoid form, though this is by no means a certain sign in itself. Pale lips often suggest anaemia and other diseases in which the skin is pallid, and often the first symptoms of cardiac (heart) disease is detected from their blue color. Trembling or twitching of the lips may be caused by paralysis, severe pain, or emotion. A common symptom of epilepsy is a foam on the lips. The Eye. — The eye is a valuable indication of nervous condition and affections of the brain. Contraction of the pupil of the eye occurs in paresis (slight paralysis), locomotor ataxia, meningitis, tumor of the brain, etc. Dilation of the pupil occurs in epilepsy, hysteria, paralysis of the third nerve, paresis, and locomotor ataxia. Unequal size of the pupils is also noticed in paresis, locomotor ataxia, and nervous diseases of the iris. The filling of the eyes with tears and the accompanying inflamma- tion, which precede influenza or "cold in the head," and measles, are familiar. Excess of bile in the system is indicated by the greenish-yellow color of the "white" of the eye. Trembling eyelids indicate extreme nervousness. Rolling of the eyes accompanies convulsions and other spasms. The Pulse is one of the chief indications of disease. When the pulse is large, rapid, and soft, it indicates the early stage of fever or of acute inflammation, as in scarlatina, erysipelas, inflammation of the lungs, etc. When very frequent, large, and hard, it accompanies the full onset of fever, of an inflammatory kind, such as rheumatic fever, smallpox, etc. A moderately frequent, large, and hard pulse may be that of mere fullness of blood. When frequent, hard, large, and thrilling, there is generally some disease of the artery, or in its close neighborhood, such as aneurism or tumor. A frequent and small pulse is often met with in consump- tion, in which the quantity of blood is diminished, and is equally im- paired. A slow, laboring, large, and hard pulse is often attendant upon apoplexy or other forms of pressure on the brain. Fever is indicated by a rise in temperature above normal (98. 2°) and DISEASES OF THE HEART. *93 can be ascertained only by use of the clinical thermometer. The degrees of fever are: — Feverishness, .99° to ioo° Slight Fever, ioo° to 101 Moderate Fever, 101 ° to 103 High Fever, 104 to 105 ° Intense Fever, 105 to 106 Highest Fever, 106 and over. Diseases of the Heart. — The heart, from the important part it plays in the animal economy, is subject to various serious, and often fatal, diseases. The ear is the principal means of obtaining a knowledge of the state of the heart, and by auscultation and percussion we are enabled to detect the existence of various diseases. The heart gives out two sounds, known as the first and second, which are distinguished from each other. The first sound is longer than the second, and the interval between the first and second sound is shorter than that between the second and first. They have been compared to the two syllables, lupp, ditpp. Any manifest alteration in these sounds is indicative of the existence of disease. They may be high or low, clear or dull, muffled, rough, inter- mittent, etc. Murmurs or regurgitant sounds may arise from disease of the valves. The power of distinguishing between the normal and abnor- mal sounds of the heart, and of the causes producing the latter, can only be obtained by lengthened experience. Diseases of the heart are usually divided into two classes : first, functional or nervous : and, second, struc- tural or organic. Chief among the former are palpitations, syncope or fainting, and angina pectoris. They are chiefly to be met with in per- sons of a naturally nervous temperament, more especially women suffer- ing from hysteria, or other like complaints, and may be induced by great mental excitement. In such cases great attention should be paid to the general health, using tonics, sea bathing, and gentle open air exercise, to strengthen the system. Violent exertion, and strong mental excite- ment, are particularly to be avoided. Among the principal organic dis- eases to which the heart is subject are pericarditis, carditis, endocarditis, atrophy, hypertrophy, dilation, and valvular diseases. 1 Disease of the valves so commonly follows endocarditis, if of long continuance, that it may almost be considered as a chronic form of that disease. It is a thickening of the internal lining of the heart, especially at the valves. It becomes not merely thickened uniformly, but is the seat of warty excrescences, and even cartilaginous and osseous formations 194 WARNINGS OF DISEASE. of considerable size, extending into the cavities of the heart. In old persons, and especially those addicted to a generous mode of living, we most frequently meet with ossification, the effects of which are congestion, difficulty of breathing, apoplectic seizures, and other symptoms of embar- rassed circulation. Breathing. — The normal rate of breathing is about eighteen respira- tions per minute for men, slightly more for women, and still more for children. Difficulty in breathing may result from obstruction of the air passages, pressure upon the lungs, diseases of the lungs, swelling of the abdomen, heart disease, asthma, anaemia, hemorrhage, or paralysis of the muscles of the chest and thorax. If difficulty occurs while breath- ing in, there may be a foreign substance in the larynx or trachea. If it occurs on breathing out, there is probably loss of elasticity and tone of the air vesicles in the disease known as emphysema. It is most com- mon in a combination of the outward and inward acts of breathing. If difficulty in breathing takes the form of shortness of breath, not due to exertion, it indicates severe heart or lung disease. If it is due to exertion it is not serious, but may indicate weakness, anaemia, or stoutness. Slow difficult breathing occurs in the coma or insensibility of diabetes. Rapid difficult breathing is noted in inflammation of the lungs, pleu- risy, pain in the chest muscles, fever, heart disease, anaemia, and diseases of the base of the brain. Irregular difficult breathing, now fast, now slow, is serious, and occurs in apoplexy, meningitis, tumor in the brain, fatty degeneration of the heart, and other similar diseases. In labored breathing, such as is seen in diphtheria and croup, it seems as though every muscle of the chest was brought into play. Interrupted, wavy, or cog-wheel breathing is a broken or inter- rupted breathing inward, caused by nervousness, unequal or irregular contraction of the muscles of the chest; or irregular expansion of the lungs from disease. Suppressed breathing is the entire absence of the breathing sounds. It occurs when the lungs are filled with the water or effusions in pleurisy, or in other solid conditions of the lungs. Mouth breathing indicates a stoppage in the nasal passages, usually by adenoid growths. The irregularities of breathing and the condition of the lungs are indicated to the physician by use of an instrument called a stethoscope, COUGHS. 195 which he places against the walls of the chest, front and back, with the ear-pieces to his ear. The breathing sounds are magnified or intensified, and reveal the condition of the lungs. Very often the examination by auscultation, as it is called, is conducted by placing the ear against the chest walls, by which means the sounds can be heard. The examination is still further assisted by tapping the fingers placed upon the chest so that a sound is made over the lungs which tells the state of the lungs. A hollow sound is given by those parts of the lungs that are filled with air and consequently are in good condition, while those parts which give a dead, dull sound are filled with water, pus, sputum, tuberculous, or other matter, and are, consequently, inactive and diseased. The tapping exam- ination is known as percussion. Coughs. — A cough may be the result of various conditions, but one of the most common causes is a severe cold upon the lungs. The air passages are lined by a thin, delicate mucous membrane which contains secreting glands, that in health secrete a small amount of fluid mucus to assist the air in passing in and out of the alveoli of the lungs without annoyance or friction. If, for any reason, as taking a sudden cold, this secretion is checked, the air passages become dry and inflamed, and pro- duce a disagreeable sensation which patients sometimes call a smarting of the lungs. This state of dryness lasts usually but a short time, and is followed by a secretion many times more abundant than natural. This increased secretion, owing to inflammation of the mucous glands, is catarrhal in character, and acts as a constant irritation. It is often thick, yellowish in color, and raised with difficulty. A persistent cough is Nature's desperate remedy to expel the hardened, thick, offending mucus, just as if a bread crumb or some other foreign substance was in the wind- pipe. By fits of coughing Nature endeavors to obtain relief. This offending substance must be removed, and Nature has only two methods, one to throw it up by coughing, the other to absorb it into the circulation ; the former method is much more desirable than the latter. When a catarrhal cold is yielding to treatment, the mucus becomes loose, is easily detached and readily expelled, all the symptoms become more favorable, and the cough less racking and severe. As the secretion is gradually reduced to the normal, the inflammation and irritation subside, the cough more and more disappears. Great harm may be done by suppressing a cough when Nature is striving to free the air passages from an overload of mucous secretions. Giving opium or morphine, cough drops, troches, or any anodyne reme- 196 WARNINGS OF DISEASE. dies to a young child whose air passages are loaded with catarrhal debris is bad practice, and has cost many a little sufferer his life. In no instance must the cough be quieted in an infant suffering from catarrhal diseases, no matter how much the mother and others are annoyed by the persistent coughing. In capillary bronchitis the cough is the child's safety, and must not be suppressed, else the lungs will fill up and the child will die. Coughs due to irritation and a dry inflammation of the bronchi may be safely quieted, and this can be done with positive benefit to the patient. There is a great deal of character about a cough, and to the prac- tised ear much information as to the cause and location of disease is conveyed. The barking, ringing cough of spasmodic croup is readily recog- nized by any who have heard it once. The dry, hacking cough occurs in the early stages of inflammatory disease and is a sign of obstruction in the respiratory region. The stomach cough is caused by reflex action from a diseased or dis- ordered stomach, and is not accompanied by expectoration. The short, teasing cough denotes irritation of the throat. The dis- ease is seldom deep seated. The hoarse, smothered cough is indicative of obstruction in the larynx and is a serious symptom. The cough of influenza is dry, irritative, persistent, and annoying. The short, harsh, ringing cough of pneumonia is tight, and is sup- pressed by reason of the pain which accompanies it. The spasmodic, paroxysmal, short, rapid cough of whooping cough, terminating in the deep, loud, crowing inspiration, from the sound of which the disease takes its name, is familiar. Vomiting frequently attends the violent and exhausting effort. Three such attacks form one series. Expectoration. — The act of discharging mucus or other matter from the throat, lungs, or trachea, and the substances so discharged, are called the expectoration. The term in its first meaning is synonymous with coughing, and need not further occupy our attention; but, in its second sense, we find so many important considerations connected with the diagnosis of disease, that we must pause awhile to consider it. It is by the nature of the expectoration that the physician is enabled to judge of the character and progress of the malady with which he has to con- tend. If such expectoration is frothy, it indicates active bronchitis, catarrh, or influenza ; if stringy, and of a whitish or yellowish color, the EXPECTORATION. 197 bronchitis has become chronic, or spasmodic, or there may be whooping cough present, or impending ; if purulent it may indicate the latter stages of catarrh or influenza, especially if the sputum, or matter expectorated, is mixed more or less with a tenacious mucus; genuine pus, capable of being poured from one vessel to another, indicates the bursting of an abscess in the lungs, or of pus from empyema, which has found its way into the bronchial passages; the yellow matter often expectorated in humid asthma is not truly purulent, but to a large extent mucous. If lumpy, there can be no mistake as to the nature of the disease; pulmo- nary consumption has fairly set in and made considerable advances; there is sure to be a softening and breaking up of tubercles, where there are small yellowish or whitish lumps expectorated along with a clearer fluid on which they float, perfectly distinct. If membranous, the sputum indicates inflammatory action of a chronic, most likely of a croupy, character. If stringy, and rusty colored, there is certainly pneumonia ; if bloody, there is hemoptysis, — either a blood vessel of the lungs has broken, or blood has oozed through the bronchial membrane, both of which are symptoms indicative of great danger to the patient. If offensive and putrid, there may be gangrene of the lungs, but this is only a single sign of such condition and not to be relied on alone. These are the distinctive characters which expectoration assumes; its increase or decrease in bulk or density, its varieties of tint, and other particular changes, tell to the experienced eye of the doctor how the case is progressing, and whether it is likely to terminate in convales- cence or death. The Skin. — The condition of the skin is indicative not only of the several diseases of the skin, but of eruptive, and other functional and constitutional diseases. Symptoms of skin diseases are : heat, pain, smarting, tingling, burning, and itching. Redness, heat, and burning are indications of ordinary chafing, such as occurs in infants and in very stout persons, on those parts of the body which rub against one another. Very small puffy elevations of the skin accompanied by itching, burning, and prickling sensation denote hives. Heat, swelling, redness, discharge, and crusting denote eczema. German measles appears as an eruption of rose-colored spots of pinhead size, seen generally on the face at first, though it is often noticed earlier on the roof of the mouth. The eruption appears 198 WARNINGS OF DISEASE. from the first to the fourth day of attack and disappears within a week. Measles shows itself as an eruption on the third or fourth day of attack, in the form of dark-red or purplish spots, of small size, first upon the face and then spreading over the body. Clear patches of skin are visible between the collections of spots. The eruption lasts about nine days. Behind the ears, on the forehead, and face are the first places to look for them. Scarlet fever eruptions take the form of a bright scarlet rash which first appears on the chest and neck, and spreads rapidly over the entire body. The eruption is not raised, but is quite flat or even with the surface of the skin. It disappears on pressure and seldom lasts more than five days or a week. Chicken pox shows distinct, scattered, slightly raised, flat spots some of which change to blisters. They come in successive crops and disappear in from three to five days. The eruption is accompanied by intense itching. Erysipelas appears in the form of red spots which quickly run together and form a crimson or violet colored section, with a distinct border. There is swelling, tingling, heat, and tenderness. The skin shows increased sensitiveness (hyperesthesia), decreased or absent sensitiveness (anesthesia), and perverted sensitiveness (pares- thesia), in nervous diseases. The Stomach. — The symptoms affecting the stomach are vomiting or nausea, flatulence, pain after eating, and, in some cases, eructations of a watery fluid, in large quantities. Vomit. — Bilious vomit is of a greenish-yellow color owing to the presence of bile. Black Vomit is characteristic of cholera and is composed of blood and the contents of the stomach. Coffee ground vomit is composed of blood from the stomach mixed with the contents of the stomach, and occurs in forms of cancer of this organ. Continuous vomiting is very serious by reason of its violence and long continuance. It often occurs in pregnancy. Stercoraceous vomiting is that form in which some faecal matter appears. It is a symptom of intestinal obstruction. The Bowels present the following symptoms when disordered: — Constipation may arise from torpor of the bowels, owing to long F7ECAL MATTER. 199 continued neglect, or to the absence of suitable articles of diet, or from deficient secretion of the natural stimulus, the bile. Diarrhoea consists in an increased discharge of liquid faeces, and may be caused by the irritation of food or medicine, or by the presence of hardened faeces ; or sometimes from a poison disease, such as cholera. The Faeces. — The faeces are the rejected residue of the food after it has served the purposes of nutrition. According to Berzelius, the normal constituents of the human faeces are as follows : — Water 73.3 Vegetable and Animal Remains 7.0 Bile 0.9 Albumen 0.9 Peculiar Extractive Matter 2.7 Salts 1.2 Slimy Matter, consisting of Picromel, peculiar Animal Matter and Insoluble Residue 14.0 This is the composition of the faeces when the health is perfect, and there is nothing very peculiar in the diet to render it otherwise. In disease great changes take place, not only in the proportions, but even in the ingredients of which the faeces a v re composed. By the peculiarity of smell and color, the medical man is enabled to judge of the nature and progress of certain diseases; therefore it is of importance that the faeces should be preserved for his inspection. The following are a few of their most obvious indications : — ■ Natural faeces are of a gingerbread color, slightly varying in tint and hue, and of tolerable consistency, although perfectly impressible. The smell is offensive, but has not that peculiar fetidity observed in some diseased conditions of the system. The evacuations should be daily, and at, or near, a certain hour; but a deviation from this rule is no proof of ill health. Cases are known of perfectly healthy persons, who went to stool only once in two, three, or four days, or even in a week. It depends greatly upon habit, but the habit of infrequency is not good. Children should be taught to attend to this matter at a certain hour every day, and the habit of a daily evacuation of the bowels once fixed, will probably remain through life, except when it is interfered with by sickness, or the failing powers which are often con- sequent upon old age. Mucous evacuations have a semi-transparent, jelly-like appearance. They may be tinged with brown, green, or yellow, all indicating the 200 WARNINGS OF DISEASE. presence of bile; or red with blood, when there is inflammation or con- gestion of the mucous membrane, as in mucous diarrhoea and dysentery. Evacuations may have a rough, shreddy, or spotty appearance. There may be little irregular round specks, like dirty white of egg, scattered through the faeces, or long pieces like shreds of lymph or dingy colored parchment. In such cases there may be acute inflammation of the mucous membrane of the intestines, situated in any part of the bowels or rectum. Pus in the faeces indicates either ulceration of the bowels, or the breaking of an abcess into the alimentary canal. If there is much of it, the latter is most likely the case. This is a symptom of danger. Bile in the faeces indicates excessive action of the liver, the cause of which may be irritation or active congestion,— in which case the color is generally of a yellowish brown, but sometimes, especially in children, it is of a decided green color. This, too, is often the case with grown persons, when the liver is just recovering from a torpid state and beginning to act somewhat violently. This is commonly the case, too, in hydrocephalus, when the color is a peculiarly deep green. Bilious motions may or may not be loose, although they are generally so, from the bile acting as an irritant to the lining of the bowels. Absence of bile in the faeces is shown by absence of color. The motions are clayey, sometimes as pale as pipe clay, and ranging from that shade up to the natural hue, occasionally assuming a grayish tint. They vary in substance, and when liquid are usually frothy, and float upon water on account of the quantity of gas which they contain. Loose bowels result from so many causes that we cannot take them as clear indications of any particular diseases. An irritated or inflamed state of the mucous membrane causes diarrhoea, in some stages of which the stools are fluid. If, in this state, there are rice water stools, it indicates Asiatic cholera, or the too powerful action of saline or drastic purgatives. Hard, solid faeces, at unequal intervals, indicate constipation. Offensive stools occur in some forms of dyspepsia. The fcetor is excessive in low fevers, when the poison introduced into the system seems to render the whole of the solids and fluids thereof peculiarly liable to decomposition. The Urine. — The urine in a state of health is of an amber color, with a faint odor, slightly acid reaction, and a specific gravity of 1.018. CONGESTION OF THE KIDNEY. 201 The average quantity voided in 24 hours is from 40 to 50 ounces, or from 2^2 to 3 pints. A greater quantity than this is passed just after the crises of fevers, when the pores of the skin are closed by cold or a chill, in diabetes, and in other kidney diseases. A less quantity is passed after excessive perspiration, in diarrhoea, congestion and inflammation of the kidneys, fever, and stricture and obstruction. Color. — If the quantity is increased, the color is usually very light. If the amount is diminished, it is usually darker. A clouded appearance comes to nearly all normal urine on standing for a time. It is due to mucus. Blood in the urine is a sign of congestion, inflammation, tumors, or injuries in the bladder or urethra. If it flows in the early part of the micturition, the urethra is affected; if at the latter part of the act, the bladder is involved. If mixed throughout, the kidneys are probably involved. Pus in the urine indicates suppuration at some point in the urethra or bladder. Its occurrence during the early or late parts of micturi- tion indicates the urethra or the bladder as the seat of the affection. Brick-dust deposits in the urine indicate an excess of the urates which are increased in wasting diseases, gout, fever, malaria, scurvy, indigestion, etc. Odor. — The odor of urine is changed by articles of food, such as asparagus, garlic, etc., and by such medicines as santonin. Congestion of the Kidney. — The attention of the patient is called to this disorder by pain over the kidney running into the genital organs and by a constant desire to urinate; by headache and nausea. The urine is scanty and high colored. In acute Bright's disease, dropsy is an early symptom; pufriness of eyelids and swelling of lower extremi- ties; the urine is reduced in quantity and looks like beef washings ow- ing to the presence of blood in the urine. In one form of chronic Bright's disease, increasing general debility, pallor of the countenance, a puffy, doughy face, and frequent passing of water call attention to the disease. In another type of Bright's disease, disturbances of digestion and vision ; decline of body-weight ; the skin becoming hard and dry, and of a yellow-white color; nosebleed, headache, thirst, and frequent passing of water, indicate a disease of the kidneys, occurring commonly about middle life. 202 WARNINGS OF DISEASE. Dropsy. — The dropsy of heart disease begins about the ankles and feet and extends upward. Dropsy due to kidney trouble begins in the face with puffiness of the lower eyelids, and extends downwards. Dropsy due to liver trouble, or obstruction of circulation of blood in the liver region, begins in the abdomen. Fluctuation. — This is an indication of the presence of pus in a swelling. It is produced by pressing on opposite sides or parts of the swelling with two or more fingers of each hand. If pus is present, there will be felt a flowing or fluctuating motion of pus under the touch. Flatulency is a system of disordered stomach of a chronic character, as dyspepsia. Pain after eating is also a sign of indigestion or dis- ordered stomach, but there is. generally inflammation accompanying it. The odor of the breath enables us in many instances to determine the presence of disease; and certain poisons impart a peculiar odor to the breath. A sour breath indicates disturbances of digestion. A sweetish breath is found in the later stages of diabetes. The odor of ammonia is frequently noticed in serious kidney disturbances, and in all fevers the breath has the characteristic feverish odor. In tonsilitis and in diseases of the mouth the breath is quite foul. Phosphorus poisoning imparts to the breath the odor of garlic. Carbolic acid poisoning — if the poison has been administered by the mouth — imparts its well-known characteristic odor to the breath. The odors of alcohol and tobacco on the breath are well known. Seat of Pain. — The location of pain is often a guiding sign of the disease, though not infallible. For not infrequently the pain is felt in a region remote from that affected. Pain in the ear, for instance, may be caused by throat trouble, or an affection of the brain, quite as often as by a disease of the ear itself. The eye is often affected by nervous and brain troubles. It also swells and becomes puffed from dropsy, dependent upon kidney disease. The swelling of the ankles is often an indication of heart affections. Still there is no mistaking many of the diseases accompanied by pain when they are of a local nature. Headache plays an important part in diagnosis for it is symptom- atic of many diseases. Pain in the angle of the jaw indicates tonsilitis. Higher up, at the hinge near the temple, when accompanied by swelling, it leads one to suggest mumps. SYMPTOMS OF COMMON DISEASES. 203 Soreness and difficulty in swallowing indicate throat affections. Pain around the heart may be caused by heart disease, neuralgia, pleurisy, or abscess in that region. The pain of neuralgia is sharp, stabbing, and comes in paroxysms. There is usually great tenderness felt all along the path of the nerve affected. Neuralgic pains in the joints and muscles are symptoms of influ- enza. Pain and tenderness over the stomach suggest gastric affections; over the bowels, increasing with pressure, indicate peritonitis, Pains in the joints and limbs, increasing on motion and pressure, are signs of rheumatic diseases. SOME COMMON DISEASES AND THEIR SYMPTOMS. It is necessary for every mother, at least, to recognize some of the symptoms of the common diseases. It is not expected that the layman will be able each time to diagnose every disease correctly, but we all know that our mothers had a way of telling measles from whooping cough and biliousness from diphtheria. Mothers of large families often have an extensive experience in hospital work at home, and keen, observ- ing, intelligent mothers often prove of valuable assistance to physicians by being able to early diagnose disease or locate cause of functional disturbances. We shall attempt in this article to give only a few of the common, early symptoms of the most common diseases. Their treat- ment will be left for another section. Fevers. — A fever is the most general disease of the human race. It attacks all ages, sexes, and constitutions. Fevers may be divided into three classes, viz., continual, remitting, and intermitting. A continual fever is that which never leaves the patient during the whole course of the disease. Fever is called acute when its progress is quick and symptoms are violent ; but, when these are more gentle, it is called slow. A remitting fever differs from a continual only in degree; it has fre- quent increases and decreases, but never wholly leaves the patient dur- ing the course of the disease. Intermitting fevers (agues) are those which, during the time the patient may be said to be ill, have evident intervals and abatements of the various symptoms. Typhoid. — The early symptoms of typhoid are usually headache, 204 WARNINGS OF DISEASE. with general aching of the whole body, frequently chills and fever, accompanied by nervousness, even in people who appear to have no nerves. Often there will be slight hemorrhages from the nose or these may be copious and frequent. There is a loss of appetite with a desire to drink large quantities of water, the bowels move frequently and be- come tender to the touch, the tongue coated, and the eyes shiny. When such symptoms appear a physician should be consulted at once. It is sometimes difficult from clinical diagnosis to determine whether the case is typhoid or not, but the physician's test of the blood will usually prove the suspicion. Pneumonia. — In case of sudden colds, attended by chills and followed by high temperature with flushed cheeks, pain in the chest, and a general tired feeling, watch out for pneumonia. Grip sometimes exhibits something of the same symptoms, and it, too, with its multitude of after complications, needs careful attention. Measles are usually epidemic, and when in the vicinity one is on the lookout for symptoms to appear. Adults rarely have measles; if they have been fortunate enough to escape them in childhood or adolescence they are not likely to have them. However, escaping them in early life by no means makes one entirely immune, and when one is afflicted with this child's disease after reaching manhood or womanhood it is no simple matter. The early symptoms are like those of a sudden cold with headache and weariness. The eyes become red and the conjunc- tiva becomes blotched and inflamed. Usually a rash appears early, appearing first in the hollow of the arm, about the elbow, and around the waist. It is sometimes difficult to tell the rash of measles from the rash of other diseases. Roseola in children much resembles measles to the inexperienced. This rash comes from indigestion or from fruit poison- ing. The germs of measles form in crescent shaped colonies, which are clearly discernible when the rash first appears. Later when the features become swollen and the disease is at the height of its intensity, it is hard to decide whether it is measles, scarlet fever, or smallpox. Scarlet Fever or canker rash is much like measles in form, and the early symptoms are very similar. Usually the temperature runs higher and the throat and mouth show patches of canker. Scarlet fever is a more serious disease, however, being almost sure to be followed by some complication and being more severe in its intensity. Among the complications we find bladder and kidney troubles, abscesses of the ear DIPHTHERIA. 205 which may destroy the hearing, inflammation of the eyes causing de- fective vision or blindness, and many others. This disease needs most careful nursing, skillful attention, and a closely watched convalescence. Tonsilitis is a common disease in cold, damp climates, and is not given sufficient attention by most people. It is considered highly trans- missible and every precaution should be taken to guard against infect- ing other members of the family. Towels, napkins, glasses, spoons, forks, etc., should be thoroughly scalded after being used by the patient, and care taken not to get the breath, which is of a foul nature. The early symptoms of tonsilitis are not readily recognized by people in general, especially in small children. There is a general expression of lassitude and a desire to sleep. The flesh is dry and hot, the face flushed and a tendency to peevishness. The eyes show dark rings and there is a general look of illness. Upon examination of the throat the condition is found to be dark red in color with perhaps a few white patches. This condition increases, the pulse becomes full and decided as the poison is absorbed. Diphtheria is one of the most dreaded diseases and comes from a specific germ finding lodgment in a throat of delicate condition, fit field for its cultivation. The early symptoms are very like tonsilitis with an early appearance of the diphtheritic membrane on the tonsils and in the throat. Whenever diphtheria is even suspected, isolate the suspect till a physician has been consulted. This disease is too virulent in character to take any chances in spreading infection. In all cases where frequent sore throats are noticed in the family, careful inspection and disinfection should be made of the drains, closets, lavatories, cellars, cisterns, wells, cesspools, outhouses, or any place where disease germs are likely to be thriving. Do not wait till some member of the family is striken down with diphtheria or typhoid before these places are looked after. Take them in time. (See modes of disinfecting. Page 154O Jaundice is caused by a disarrangement of the liver or bile ducts, causing the skin to try to do their work by disposing of the bile through the pores, thus giving to the patient a yellow or lemon color. Appendicitis is an acute inflammation of the appendix, which is situ- ated below the liver in the right side of the abdomen, about 2]/ 2 inches below the short ribs. The pain is a griping, coiling, incisive one, which usually makes the patient writhe in intense agony. 206 WARNINGS OF DISEASE. LIST OF SYMPTOMS ARRANGED FOR READY REFERENCE. Abdomen, Distended. — Chronic Catarrh of the Stomach. Chronic Dys- pepsia. Drunkard's Dyspepsia. Chronic Alcoholism. Abdomen, Distended and painful under pressure. — Poisoning by an irri- tating mineral acid. Abdomen, Feeling of soreness and weight on the right side above the hip bone. — Appendicitis. Abdomen, Hard and tense, — Colic or Gripes. Abdomen, Hard and somewhat distended. — Intestinal Colic. Abdomen, Pain in the. — Gallstones. Lead or Phosphorus Poisoning. Abdomen, Burning and tearing pain in the. — Cholera Morbus. Abdomen, Tense, hard, bloated, and severe cutting and boring pain in the. — Peritonitis. Abdomen, Purled out or drawn in. — Stomach Ache or Neuralgia of the Stomach. Gastralgia. Abdomen, Sunken. — Cholera Infantum. Summer Diarrhoea. Abdomen, Considerably swollen. — Dropsy. Abdomen, Swollen and gives out a hollow sound when struck. — Perito- nitis. Inflammation of the Bowels. Abdomen, Tender. — Typhoid Fever. Appetite, Capricious. — Dyspepsia. Indigestion, Heartburn. Diabetes Mellitus. Appetite, Loss of. — Dysentery. Bronchitis. Pneumonia. Catarrh of the Stomach. Acute Indigestion. Ulcerated Stomach. Inflamma- tion of the Stomach. Peritonitis. Jaundice. Congestion of the Liver. Biliousness. Catarrh of the Bladder. Inflammatory Rheu- matism. Rheumatic Fever. Worms. Scarlet Fever. Influenza. Belching. — Dyspepsia. Indigestion. Heartburn. Blood Vessels, Hard, tortuous and sometimes bony. — Arterio-Sclerosis. Blood Vessels, Stand out on face and forehead while coughing. — Whooping Cough. Bowels, Desire to evacuate constantly. — Dysentery Bowels, Desire to move but usually constipated. — Colic or Gripes. Bowels, Irregularity of. — Dysentery. Bowels, Gas in the. — Intestinal Indigestion. Colic. Bram, Rupture of vessels. — Arterio-Sclerosis. SYMPTOMS OF DISEASES. 207 Breath, Bad. — Chronic Bronchitis. Acute Indigestion. Acute Catarrh of the Stomach. Scurvy in Children. Enlargement of the Tonsils. Intestinal Indigestion. Catarrh of the Head and Throat. Breathing, Difficult. — Hay Fever or Hay Asthma. Heart Disease, Endo- carditis. Dropsy. Chronic Bright's Disease. Poisoning by Am- monia. Poisoning by Iodine. Breathing, Difficult and wheezing. — Asthma. Breathing, Difficult and noisy. — Spasmodic Croup. Diphtheria. Breathing, Difficult while coughing. — Whooping Cough. Breathing, Irregular and rapid. — Hysteria. Malnutrition of Infants. Cholera Infantum or Summer Piarrhcea. Poisoning by Tainted Food. Breathing, Irregular and slow. — Apoplexy or Hemorrhage of the Brain. Cerebro-Spinal Meningitis. Spotted Fever. Breathing, Through the mouth. — Adenoid Growths. Tonsilitis. Quinsy. Enlargement of the Tonsils. Breathing, Rapid. — Pneumonia. Neuralgia of the Heart or Angina Pectoris. Heat Stroke or Sunstroke. Acute Bronchitis. Breathing, Rapid and shallow. — Pneumonia. Pleurisy. Peritonitis, or Inflammation of the Bowels. Breathing, Slow and shallow. — Acute Inflammation of the Stomach. Convulsions. Chest, Distress in the. — Congestion of the Lungs. Chest, Fixed and immovable. — Neuralgia of the Heart or Angina Pectoris. Chest, Fluid between lungs and chest-walls. — Pleurisy. Chest, Irritation in the. — Asthma. Chest, Lower part sunken in. — Pneumonia. Chest, Movements decreased over affected parts. — Pleurisy. Chest, Pain in the. — Bronchitis. Chest, Sharp pain in one spot. — Pleurisy. Chest, Crackling or squeaking sounds in the. — Pleurisy. Chest, Crackling sounds in the, which cough does not change. — Pleurisy. Chest, Dull sounds in the, which changes with the position. — Pleurisy. Chest, Moist and bubbling sounds in the. — Acute Bronchitis. Chest, Slight crackling or rattling sound in the. — Pneumonia. Chest, Small and great bubbling sounds in the. — Pneumonia. Chest. Rattling sound in the. — Bronchitis. Pneumonia. Chest, Rough, rasping sound in the. — Membranous Croup. 208 WARNINGS OF DISEASE. Chest, Soreness in the. — Bronchitis. Chest, Tenderness on pressure. — Pleurisy. Chill. — Erysipelas. Malarial Fever. Consumption. Pleurisy. Inflam- mation of the Bowels. Cholera Morbus. Appendicitis. Tonsil- itis. Quinsy. Scarlet Fever. Diphtheria. Influenza or La Grippe. Chill, Followed by fever. — Typhoid Fever. Inflammatory Rheumatism. Rheumatic Fever. Peritonitis or Inflammation of the Bowels. Chill, Slight. — Inflammation of the Bowels. Cholera Morbus. Chill, Violent. — Smallpox. Pneumonia. Circulation of the Blood, Poor. — Inanition of Infants. Malnutrition of Infants. Intestinal Indigestion. Cold, Bad.— Measles. Cold, Moderate. — Whooping Cough. Cold in Nose and Head. — Acute Bronchitis. Cold in Nose and Throat. — Acute Bronchitis. Colic. — Poisoning with Sewer Gas. Cholera Morbus. Gallstones. Improper Feeding of Infants. Intestinal Colic. Chronic Con- stipation. Worms. Lead Poisoning. Copper Poisoning. Tainted Food Poisoning. Colic, During digestion of food. — Peritonitis or Inflammation of the Bowels. Colic. — Gallstones. Biliary Calculi. Constipation. — Acute Bronchitis. Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunkard's Dyspepsia. Chronic Alcoholism. Dyspepsia. Indigestion. Heartburn. Colic or Gripes. Habit- ual or Chronic Constipation. Dropsy. Congestion of the Liver or Biliousness. Inflammatory Rheumatism. Rheumatic Fever. Diabetes Mellitus. Diabetes Insipidus. Rickets. Intestinal Indigestion. Appendicitis. Cerebro-Spinal Meningitis. Convulsions. — Tumors of the Brain. Epilepsy. Cerebro-Spinal Men- ingitis. Whooping Cough. Poisoning. Convulsions, Slight twitching. — Convulsions. Convulsions, Violent. — Strychnine Poisoning. Cough. — Hay Fever or Hay Asthma. Congestion of the Lungs. Pneumonia. Inflammation of the Throat. Typhoid Fever, Poisoning by Ammonia. Acute Pharyngitis. Acute Laryngitis. Cough, Dry and hard. — Bronchitis. Cough, Explosive. — Whooping Cough. Cough, Hacking. — Congestion of the Lungs. Pleurisy. Consumption. SYMPTOMS OF DISEASES. 209 Cough, Hoarse and croupy. — Congestion of the Lungs. Spasmodic Croup. Membranous Croup. Cough, Paroxysmal. — "Whooping Cough. Cough, Short. — Heart Disease. Endocarditis. Cough, Tight. — Acute and Chronic Bronchitis. Cough, with rust-colored expectoration. — Pneumonia. Cramps in the Muscles. — Muscular Rheumatism. Cramps in Thighs, Calves, Fingers, and Toes. — Cholera Morbus. Cry, Low, distressed moan. — Cerebro- Spinal Meningitis. Cry, Sharp and piercing. — Colic in Infants. Cry, Single, peculiar. — Epilepsy. Deafness. — Apoplexy. Congestion of the Brain. Typhoid Fever. Deafness, Defect in hearing. — Tumors of the Brain. Delirium. — Smallpox. Pneumonia. Diphtheria. Lead and Copper Poisoning, Tainted Meat Poisoning. Delirium, with snakes, horrors, etc. — Delirium Tremens. Alcoholism. Erysipelas. Delirium, with throwing hands and arms about the head. — Cerebro- spinal Meningitis. Typhoid Fever. Influenza or La Grippe. Depression. — Neuralgia of the Heart or Angina Pectoris. Acute Gastritis. Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunkard's Dyspepsia. Cystitis. Catarrh of the Bladder. Scurvy. Typhoid Fever. Depression, Easily emotional and whimsical. — Hysteria. Diarrhoea. — Erysipelas. Inflammation of the Bowels. Tonsilitis. Quinsy. Diarrhoea. Cholera Morbus. Summer Diarrhoea. Scarlet Fever. Typhoid Fever. Copper Poisoning. Mercury Poisoning. Poisonous Mushrooms. Tainted Food. Diarrhoea, with purging. — Acute Inflammation of the Stomach or Gastritis. Inflammation of the Bowels. Diarrhoea, Moderate. — Dysentery or Bloody Flux. Pneumonia. Jaun- dice. Acute Bright's Disease. Inanition in Infants. Inflam- mation of the Mouth in Infants. Diarrhoea, Severe. — Dysentery or Bloody Flux. Digestion, Disturbance of. — Erysipelas. Asthma. Pneumonia. Con- sumption. Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunkard's Dyspepsia. Alcoholism. Ulcer of the Stomach. Locomotor Ataxia. Tabes Dorsalis. Consumption of the Spinal Cord. Imperfect Nutrition of Infants. 210 WARNINGS OF DISEASE. Digestion, Indigestion. — Cancer of the Stomach. Dyspepsia. Indi- gestion. Heartburn. Hysteria. Typhoid Fever. Dizziness, with faintness. — Stomach Ache. Gastralgia. Neuralgia of the Stomach. Congestion of the Brain. Apoplexy. Hemorrhage of the Brain. Tumors of the Brain. Hysteria. Nervous Pros- tration or Neurasthenia. Chronic Bright's Disease. Typhoid Fever. Poisoning by Carbolic Acid, by Copper, by Arsenic, by Illuminating Gas, by Coal Stove Gas, and by Belladonna. . Dropsy. — Dropsy. Acute Bright's Disease. Chronic Bright's Disease. Drowsiness. — Dyspepsia. Indigestion. Heartburn. Measles. Influ- enza or La Grippe. Poisoning by Morphine, Opium, etc. Ears, Pain in. — Earache. Ears, Inflammation in. — Scarlet Fever. Ears, Noises in the. — Congestion of the Brain. Delirium Tremens. Poisoning from Phosphorus. Ears, Running from the. — Measles. Eruptions, Blisters form on pimples and pus in blisters about the eighth day. — Smallpox. Eruptions, Bright scarlet, tiny points; passing finger over rash leaves white line. — Scarlet Fever. Eruptions, Coarse red spots appearing on the third day first on fore- head and lips. — Smallpox. Eruptions, Dark red spots appearing first on the ears and gradually spreading over the entire body. — Measles. Eruptions, Small red pimples on a restricted part of the body, running together, containing a thick watery fluid, then crusting over. — Eczema. Eruptions, Large irregular patches on face, from the size of a pinhead to that of a small pea, giving a feeling like small shot. — German Measles. Eruptions, Pimples on scalp or face which spread slowly ; become larger ; have little blisters in them; blisters dry and form pits or hollow scars. — Chicken Pox. Eruptions, Pus forms in pimples and fever is high. — Smallpox. Eruptions, Red spots which run together, spread, and follow a chill. — Erysipelas. Eruptions, Red spots form along the spine. — Cerebro-Spinal Meningitis or Spotted Fever. SYMPTOMS OF DISEASES. 211 Eruptions, Like flea-bites upon the abdomen, chest, and back. — Typhoid Fever. Eruptions, Rose-colored on skin. — Poisoning by Iodine. Eruptions on Face and Neck of Infants. — Sweat Rash. Eruptions, Tiny bright red pimples very close together in hot weather, with tiny sac of watery fluid. — Prickly Heat. Eruptions, Tiny eruption, intolerable itching. — Poison Ivy. Expectoration, Bloody. — Inflammation of the Throat. Follicular Pharyngitis. Expectoration, Brownish-red and yellow. — Pneumonia. Expectoration, Cheesy. — Enlargement of the Tonsils. Expectoration, Glairy mucus. — Consumption. Expectoration, Rust-colored. — Pneumonia. Expectoration, Slightly streaked with blood. — Congestion of the Lungs. Expectoration, Thick, stringy, and yellowish. — Chronic Bronchitis. Eyes, Bloodshot. — Smallpox. Congestion of the Lungs. Congestion of the Brain. Heat Stroke. Sunstroke. Inflammation of the Eyes of Newborn Infants. Nasal Catarrh. Measles. Poison- ing by Iodine. Inflammation of the Conjunctiva. Pink Eye. Granulated Lids. Eyes, Fixed stare for a moment. — Convulsions. Eyes, Swollen lids. — Granulated Lids. Kidney Complaint. Eyes, Sensitive to light. — Measles. Influenza or La Grippe. Eyes, Pain in and around. — Pregnancy. Conjunctivitis. Granulated Lids. Neuralgia. Eye-strain. Eyes, Pupils small. — Congestion of the Brain. Poisoning by Car- bolic Acid, and by Morphine, Opium, etc. Eyes, Pupils large. — Cerebro-Spinal Meningitis or Spotted Fever. Poisoning by Belladonna. Eyes, Sunken. — Scurvy. Cholera Infantum or Summer Diarrhoea. Eyes, Thick, creamy discharge with swollen lids. — Conjunctivitis. Inflammation of the Eyes of Newborn Infants. Pink Eye. Eyes, Watery. — Asthma. Hay Fever or Hay Asthma. Measles. Influenza or La Grippe. Eyes, Whites turned yellow. — Jaundice. Congestion of the Liver. Biliousness. Poisoning by Phosphorus. Face, Anxious look. — Pleurisy. Face, Rash or eruption on. — Eczema. Measles. Face, Dark circles under eyes. — Scurvy. Intestinal Indigestion. 212 WARNINGS OF DISEASE. Face, Dull and stupid expression. — Adenoid Growths. Face, Flushed and bathed in perspiration. — Asthma. Face, Light yellow color. — Jaundice of Newborn Infants. Face, Very pale. — Heat Stroke. Sunstroke. Chronic Bright's Disease. Scurvy. Membranous Croup. Convulsions. Epilepsy. Face, Pinched features and sunken eyes. — Peritonitis. Face, Pinched features, sunken eyes, evidence of pain. — Gallstones. Face, Pinched look. — Dysentery. Bloody Flux. Acute Inflammation of the Stomach or Gastritis. Stomach Ache. Neuralgia of the Stomach, or Gastralgia. Colic or Gripes. Diabetes Mellitus. Cholera Infantum. Colic. Peritonitis, or Inflammation of the Bowels. Face, Puffiness under the eyes. — Acute Bright's Disease. Face, Puffy and swollen. — Acute Bright's Disease. Scurvy. Face, Red and purple while coughing. — Whooping Cough. Face, Red. — Smallpox. Pneumonia. Congestion of the Brain. Apoplexy. Hemorrhage of the Brain. Faintness. — Stomach Ache, or Gastralgia, or Neuralgia of the Stom- ach. Congestion of the Brain. Apoplexy or Hemorrhage of the Brain. Tumors of the Brain. Hysteria. Nervous Prostration or Neurasthenia. Chronic Bright's Disease. Typhoid Fever. Poisoning by Carbolic Acid. Copper Poisoning. Arsenic Poison- ing. Feet and Legs, Swollen ankles. — Cancer of the Stomach. Dropsy. Feet and Legs, Cold. — Stomach Ache, Gastralgia, or Neuralgia of the Stomach. Nervous Prostration or Neurasthenia. Inanition of Infants. Imperfect Nutrition. Cholera Infantum. Intestinal Indigestion. Peritonitis or Inflammation of the Bowels. Scarlet Fever. Feet, Gangrene of. — Arterio-Sclerosis. Feet and Legs, Numbness. — Locomotor Ataxia. Paralysis. Infantile Paralysis. Feet, Legs, and Arms. Deformed. — Rickets. Feet and Legs, Pain and soreness in the. — Congestion of the Liver or Biliousness. Locomotor Ataxia. Diabetes Mellitus. Feet, Limbs jerk. — Congestion of the Brain. Fever, Slight. — Smallpox. Dysentery. Malarial Fever. Fever and Ague. Intermittent Fever. Bronchitis. Pneumonia. Consump- tion. Acute Catarrh of the Stomach. Acute Indigestion. In- SYMPTOMS OF DISEASES. 213 flammation of the Bowels. Appendicitis. Peritonitis. Jaundice. Congestion of the Liver. Biliousness. Acute Bright' s Disease. Catarrh of the Bladder. Pleurisy. Measles. Chicken Pox. Mumps. Diphtheria. Fever, High. — Smallpox. Erysipelas. Malarial Fever. Intermittent Fever. Fever and Ague. Pneumonia. Inflammation of the Throat. Tonsilitis. Quinsy. Cholera Infantum. Peritonitis. Cerebro-Spinal Meningitis. Scarlet Fever. Measles. Typhoid Fever. Influenza or La Grippe. Fever, Secondary. — Smallpox. Gas in Intestines and Bowels. — Intestinal Indigestion. Colic. Worms. Typhoid Fever. Indigestion. Gums, Swollen and bleed easily. — Scurvy. Inflammation of the Mouth. Stomatitis. Ulcerated Sore Mouth. Hands, Cold. — Stomach Ache. Gastralgia. Neuralgia of the Stomach. Nervous Prostration or Neurasthenia. Inanition of Infants. Im- perfect Nutrition. Cholera Infantum. Intestinal Indigestion. Peritonitis. Scarlet Fever. Hands and Arms, Deformed. — Rickets. Rheumatism of the Joints. Hands, Imperfect ■ use of. — Locomotor Ataxia. Paralysis. Hands and Arms, Thrown about the head. — Cerebro-Spinal Meningitis. Spotted Fever. Typhoid Fever. Hard Palate covered with red spots. — Scarlet Fever. Measles. Head, Rush of blood to the. — Congestion of the Brain. Apoplexy. Headache. — Smallpox. Malarial Fever. Intermittent Fever. Fever and Ague. Pneumonia. Acute Catarrh of the Stomach. Acute Indigestion. Dyspepsia. Heartburn. Congestion of the Liver. Biliousness. Neuralgia. Sick Headache. Chronic Headache. Congestion of the Brain. Apoplexy. Nervous Prostration. Neurasthenia. Bright's Disease. Diabetes Insipidus. Pneumonia. Pleurisy. Eye-strain. Constipation. Nervousness. Rheumatism. Cerebro-Spinal Meningitis. Measles. Mumps. Diphtheria. Typhoid Fever. Influenza or La Grippe. Poisoning by Carbolic Acid. Poisoning by Iodine. Poisoning by Arsenic. Poisoning by Belladonna. Poisoning by Morphine or Opium. Poisoning by Tainted Food, Poisonous Mushrooms, etc. Headache, Constant and gradually growing worse. — Tumors of the Brain. 2i 4 WARNINGS OF DISEASE. Heart, Disturbance of action of. — Consumption. Dropsy. Pleurisy. Tobacco Poisoning. Heart, Distress around the. — Inflammation of the Membrane of the Heart. Endocarditis. Heart, Palpitation of the. — Asthma. Dyspepsia. Indigestion. Heart- burn. Hysteria. Nervous Prostration or Neurasthenia. Chronic Bright's Disease. Scurvy. Heart, Severe pain in the. — Neuralgia of the Heart or Angina Pectoris. Heart, Weak action of the. — Poisoning by Arsenic. Heartburn. — Acute Catarrh of the Stomach. Acute Indigestion. Dyspepsia. Indigestion. Heartburn. Heat, Flashes of. — Acute Catarrh of the Stomach. Acute Indigestion. Hemorrhage from Bowels. — Hemorrhoids or Piles. Scurvy. Habitual Constipation. Dysentery or Bloody Flux. Hemorrhage from Lungs. — Consumption. Hemoptysis or Bleeding from the Lungs. Hemorrhage from the Nose. — Epistaxis or Nosebleed. Whooping Cough. Diphtheria. Typhoid Fever. Dry Catarrh. Hemorrhage from the Mouth. — Scurvy. Hemorrhage from the Stomach. — Scurvy. Hematemesis or Vomiting of Blood. Hemorrhage of the Uterus. — Uterine Hemorrhage. Labor. Hiccough. — Peritonitis. Hysteria. Inflammation around the Anus. — Hemorrhoids or Piles. Inflammation of the Bowels. — Peritonitis. Inflammation of the Covering of the Lungs. — Pleurisy. Inflammation of the Ears. — Scarlet Fever. Inflammation of the Mouth and Throat. — Influenza or La Grippe. Poisoning by Ammonia. Inflammation of the Tonsils. — Tonsilitis. Quinsy. Joints, Pain and stiffness in. — Inflammatory Rheumatism. Joints, Swelling around the. — Scurvy. Rickets. Cerebro-Spinal Meningitis. Kidneys and Bladder, Pain near. — Locomotor Ataxia. Acute Bright's Disease. Diabetes Mellitus. Spasm of the Bladder. Stone in the Bladder. Scarlet Fever. Lassitude. — Poisoning by Sewer Gas. Bad Ventilation. Malarial Fever. Intermittent Fever. Acute Bronchitis. Inflammation of the Bowels. Congestion of the Liver. Biliousness. Nervous • SYMPTOMS OF DISEASES. 215 Prostration or Neurasthenia. Scurvy. Diabetes Mellitus. Measles. Lips, Blue. — Malarial Fever. Intermittent Fever. Spasmodic Croup. Convulsions. Lips, Pale. — Scurvy. Worms. Lips, Dry. — Eczema. Pneumonia. Influenza or La Grippe. Lips, Sore and cracked. — Pneumonia. Diphtheria. Liver, Pain in region of. — Gallstones. Congestion of the Liver. Biliousness. Poisoning by Phosphorus. Lungs, Bleeding from. — Hemoptysis. Lungs, Congested. — Acute Endocarditis. Memory, Confused. — Epilepsy. Memory, Poor. — Dyspepsia. Indigestion. Heartburn. Locomotor Ataxia. Nervous Prostration or Neurasthenia. Diabetes Insip- idus. Mind, Confused. — Epilepsy. Mind, Disturbed by fancies. — Poisoning by Belladonna. Delirium. Mind, Irritable and weak. — Nervous Prostration. Mouth, Bad taste in. — Acute Catarrh of the Stomach. Acute Indiges- tion. Mouth, Breathing through. — Tonsilitis. Quinsy. Adenoids. Mouth, Dry. — Mumps. Poisoning by Tainted Food. Mouth, Discharge from. — Diphtheria. Mouth, Inflamed. — Inflammation of the Mouth. Stomatitis. Poison- ing. Mouth, Taste of copper or metal in. — Mercury and Copper Poisoning. Muscles, Shrinking of. — Paralysis. Muscles, Flabby. — Scurvy. Rickets. Intestinal Indigestion. Muscles, Twitching of. — Convulsions. Epilefpsy. St. Vitus's Dance. Poisoning by Strychnine or by Aconite. Muscles, Pain in. — Muscular Rheumatism. Muscles, Weak. — Diphtheria. Typhoid Fever. Nails, Blue. — Malarial Fever. Intermittent Fever. Fever and Ague. Nausea, Slight. — Dysentery or Bloody Flux. Malarial Fever. Inter- mittent Fever. Fever and Ague. Inflammation of the Bowels. Peritonitis. Jaundice. Congestion of the Liver. Biliousness. Tumors of the Brain. Bright's Disease. Typhoid Fever. Nausea, Severe. — Acute Catarrh of the Stomach. Acute Gastritis. Inflammation of the Stomach. 216 WARNINGS OF DISEASE. Nervousness. — Hysteria. Nervous Prostration. Neurasthenia. Dia- betes Mellitus. Intestinal Indigestion. Typhoid Fever. Night Sweats. — Consumption. Typhoid Fever. Nose, Discharge from the. — Asthma. Hay Fever or May Asthma. Abscess in the Throat. Adenoid Growths. Nasal Catarrh. Spas- modic Croup. Measles. Diphtheria. Influenza or La Grippe. Nosebleed. — Erysipelas. Pneumonia. Whooping Cough. Diphtheria. Typhoid Fever. Epistaxis. Dry Catarrh. Nose, Talking through the. — Adenoid Growths. Nose, Stoppage in the. — Nasal Catarrh. Numbness. — Hysteria. Poisoning by Copper. Numbness of the Feet. — Locomotor Ataxia. Numbness of Finger Tips. — Poisoning by Oxalic Acid. Odor to Breath. — Acute Catarrh of the Stomach. Acute Indigestion. Cancer of the Stomach, Scurvy, Indigestion in the Intestines. Odor to Stools, Disagreeable. — Cholera Infantum. Summer Diarrhoea. Indigestion in the Intestines. Typhoid Fever. Odor to Urine, Sweetish. — Diabetes Mellitus. Odor, Peculiar about sick person. — Smallpox. Pain in the Bladder. — Catarrh of the Bladder. Pain in the Joints. — Rheumatism. Pain in the Course of the Nerves. — Neuralgia. Pain in the Rectum with Burning. — Dysentery. Piles or Hemorrhoids. Pain in the Pit of the Stomach. — Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunkard's Dyspepsia. Pain, Cutting, tearing, twisting, and pinching, over the abdomen. — Colic or Gripes. Pain, Colicky. — Dysentery. Stomach Ache or Gastralgia. Colic or Gripes. Pain, Dull, in back and over kidneys. — Acute Bri^ht's Disease. Pain in the Abdomen. — Smallpox. Jaundice. Peritonitis or Inflam- mation of the Bowels. Lead Poisoning. Phosphorus Poisoning. Poisonous Food. Pain in the Back. — Smallpox. Ulcer of the Stomach. Diabetes Mellitus. Inflammation of the Tonsils. Quinsy. Cerebro-Spinal Menin- gitis. Spotted Fever. Measles. Mumps. Pain in the Bowels. — Dysentery. Pain in the entire Body. — Acute Bronchitis. Pneumonia. Influenza. Pain in the Chest. — Acute Bronchitis. SYMPTOMS OF DISEASES. 217 Pain in the Ears. — Earache. Scarlet Fever. Pain in and about the Eyes. — Hyeropia. Far-sightedness. Pain in the Limbs. — Locomotor Ataxia. Pain in the Heart, Intense, sickening. — Neuralgia of the Heart or Angina Pectoris. Pain in the Lungs. — Pleurisy. Pain in the Muscles. — Inflammation of the Tonsils. Quinsy. Muscu- lar Rheumatism. Pain in the Side. — Pleurisy. Appendicitis. Pain, Sudden. Piercing in the region of the liver. — Gallstones. Pain upon Swallowing. — Diseases of the Upper Part of the Throat. Paralysis. — Infantile Paralysis. Apoplexy. Hemorrhage of the Brain. Locomotor Ataxia. Tabes Dorsalis. Consumption of the Spinal Cord. Copper, Blue Vitriol, Verdigris Poisoning. Paralysis of the Vocal Cords. — Tumors of the Brain. Paralysis, Sudden, of any part of the body. — Hysteria. Paralysis, Sensations blunted. — Infantile Paralysis. Perspiration, Clammy. — Cholera Morbus. Perspiration, Gentle, soft. — Gastralgia. Stomach Ache. Perspiration on Head. — Rickets. Perspiration, Profuse at night. — Typhoid Fever. Pits. — Smallpox. Pot-belly. — Rickets. Prostration, Marked. — Lobar Pneumonia. Tuberculosis. Consumption. Heat Stroke. Sunstroke. Pulse, Strong and rapid. — Smallpox. Acute Bronchitis. Malarial Fever. Intermittent Fever. Fever and Ague. Swamp Fever. Congestion of the Lungs. Lobar Pneumonia. Acute Bright's Disease. Membranous Croup. Pneumonia. Lung" Fever. Pulse, Weak and rapid. — Dysentery. Bloody Flux. Broncho-Pneu- monia. Acute Gastritis. Heat Stroke. Sunstroke. Cholera In- fantum. Summer Diarrhoea. Peritonitis. Inflammation of the Bowels. Scarlet Fever. Diphtheria. Influenza or La Grippe. Sulphuric Acid Poisoning. Hydrochloric Acid or Nitric Acid Poisoning. Saltpeter Poisoning. Phosphorus Poisoning. Strych- nine, Morphine, and Opium Poisoning. Pulse, Slow. — Apoplexy. Nicotine (Tobacco) Poisoning. Pulse, Hard and tense. — Arterio-Sclerosis. Colic. Gripes. Perito- nitis. 218 WARNINGS OF DISEASE. Pulse, Irregular. — Arterio-Sclerosis. Gastralgia. Stomach Ache. Purging. — Cholera Morbus. Restlessness. — Erysipelas. St. Anthony's Fire. Rickets. Peritonitis. Inflammation of the Bowels. Restlessness, at night. — Rickets. Cerebro-Spinal Meningitis. Spotted Fever. Restlessness and Fretfulness. — Cholera Infantum. Summer Diarrhoea. Indigestion in the Intestines. Peritonitis. Inflammation of the Bowels. Scabs and Crusts. — Smallpox. Eczema. Seborrhea. Prickly Heat. Chicken Pox. Sight, Interfered with. — Locomotor Ataxia. Tabes Dorsalis. Con- sumption of the Spinal Cord. Congestion of the Brain. Tumors of the Brain. Delirium Tremens. Heat Stroke. Sunstroke. Chronic Bright's Disease. Influenza or La Grippe. Nicotine (Tobacco) Poisoning. Sight, Flashes of light. — Congestion of the Brain. Sight, Floating spots before the eyes. — Illuminating Gas Poisoning. Skin, Blue. — Iodine Poisoning. Arsenic Poisoning. Illuminating Gas and Coal Stove Gas Poisoning. Skin, Cold and clammy. — Acute Gastritis. Colic. Gripes. Cholera Morbus. Heat Stroke. Sunstroke. Diseases dependent upon Food and Feeding. Cholera Infantum. Summer Diarrhoea. Membranous Croup. Skin, Cold. — Colic. Gripes. Peritonitis. Gallstones. Heat Stroke. Sunstroke. Saltpeter Poisoning. Skin, Cool and rough. — Dysentery. Bloody Flux. Skin, Covered with rash. — Scarlet Fever. Measles. Chicken Pox. Belladonna (Atropine — Nightshade) Poisoning. Tainted Meat Poisoning. Fish, Mussels, Cheese, and Milk Poisoning. Skin, Dry, harsh, and itchy. — Jaundice. Measles. Skin, Goose-flesh appearance. — Malarial Fever. Intermittent Fever. Fever and Ague. Swamp Fever. Skin, Hot and dry. — Acute Bronchitis. Sunstroke. Acute Bright's Disease. Diabetes Insipidus. Pneumonia. Lung Fever. Skin, Irregular about blood vessels. — Arterio-Sclerosis. Skin, Muddy color. — Congestion of the Liver. Biliousness. Scurvy. Indigestion in the Intestines. Skin, Pale. — Malarial Fever. Intermittent Fever. Fever and Ague. SYMPTOMS OF DISEASES. 219 Swamp Fever. Tuberculosis. Consumption. Cancer of the Stom- ach. Diseases dependent upon Food and Feeding. Scurvy. Chronic Enlargement of the Tonsils. Cholera Infantum. Sum- mer Diarrhoea. Indigestion in the Intestines. Typhoid Fever. Skin, Red, irritated and swollen. — Poison Ivy. Skin, Scales off. — Erysipelas. St. Anthony's Fire. Measles. Skin, Sensitive. — Neuralgia. Skin, Yellow color. — Jaundice in Diseases of the Newborn Child. Sleeplessness. — Smallpox. Erysipelas. St. Anthony's Fire. Lobar Pneumonia. Chronic Catarrh of the Stomach. Chronic Dyspep- sia. Drunkard's Dyspepsia. Dyspepsia. Indigestion. Heart- burn. Delirium Tremens. Alcoholism. Nervous Prostration. Cystitis. Catarrh of the Bladder. Imperfect Nutrition. Difficult Teething. Indigestion in the Intestines. Colic. Sleeplessness. — Typhoid Fever. Nicotine (Tobacco) Poisoning. Sneezing. — Hay Fever. Nasal Catarrh. Measles. Snoring. — Chronic Enlargement of the Tonsils. Stomach, Bleeding from. — Hematemesis. Vomiting of Blood. Stomach, Bloated. — Gastralgia. Stomach Ache. Acute Indigestion in the Stomach. Stomach, Burning- feeling in the. — Acute Gastritis. Ulcer of the Stomach. Stomach, Distress in and about the. — Erysipelas. St. Anthony's Fire. Acute Catarrh of the Stomach. Acute Indigestion. Ulcer of the Stomach. Cancer of the Stomach. Dyspepsia. Indigestion. Heartburn. Cholera Morbus. Jaundice. Acute Indigestion in the Stomach. Phosphorus Poisoning. Arsenic Poisoning. Tainted Sausages Poisoning. Stomach, Gas in. — Acute Catarrh of the Stomach. Acute Indigestion. Dyspepsia. Indigestion. Heartburn. Stomach, Heaviness. — Acute Catarrh of the Stomach. Acute Indiges- tion. Cancer of the Stomach. Acute Indigestion in the Stomach. Stomach, Sour. — Cancer of the Stomach. Stools, Bloody. — Dysentery. Bloody Flux. Hemorrhoids. Piles. Chronic Constipation. Copper, Blue Vitrol, Verdigris Poisoning. Stools, Dry. — Diabetes Mellitus. Stools, Disagreeable odor. — Cholera Infantum. Summer Diarrhoea. Indigestion in the Intestines. Typhoid Fever. Stools, Frequent. — Cholera Infantum. Summer Diarrhoea. Typhoid Fever. 220 WARNINGS OF DISEASE. Stools, Pale. — Diabetes Mellitus. Indigestion in the Intestines. Stools, Undigested food in. — Acute Indigestion in the Stomach. Stools, Watery. — Inflammation of the Bowels. Cholera Morbus. Cholera Infantum. Summer Diarrhoea. Swallowing, Difficulty in. — Thrush. Diseases of the Upper Part of the Throat. Inflammation of Tonsils. Quinsy. Measles. Swelling of Ankles, Legs, or Abdomen. — Tuberculosis. Consumption. Gastralgia. Stomach Ache. Dropsy. Acute Bright' s Disease. Swelling of the Eyelids. — Trachoma. Granulated Lids. Swelling of the Face. — Smallpox. Acute Bright's Disease. Mumps. Swelling of the Jaw. — Mumps. Swelling of the Joints. — Appendicitis. Muscular Rheumatism. Scurvy. Cerebro-Spinal [Meningitis. Spotted Fever. Swelling of the Skin. — Erysipelas. St. Anthony's Fire. Poison Ivy. Teeth become loose. — Scurvy. Teeth. Chatter. — Malarial Fever. Intermittent Fever. Fever and Ague. Swamp Fever. Teeth, Grind. — Indigestion in the Intestines. Round Worm. Thirst, Intense. — Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunkard's Dyspepsia. Cholera Morbus. Inflammatory Rheu- matism. Acute Articular Rheumatism. Diabetes Mellitus. Cholera Infantum. Summer Diarrhoea. Belladonna (Atropine — Xightshade) Poisoning. Malarial Fever. Swamp Fever. Fever and Ague. Thirst, Moderate. — Acute Bronchitis. Throat, Dryness of the. — Acute Gastritis. Diseases of the Tapper Part of the Throat. Belladonna (Atropine — Xightshade) Poisoning. Throat, Deposit in the. — Diphtheria. Chronic Catarrh of the Throat. Chronic Pharyngitis. Throat, Foreign bodies in the. — Foreign Bodies in the Air Passages. Throat, Feeling, as of ball in. — Hysteria. Throat, Hoarseness. — Acute Laryngitis. Chronic Laryngitis. Throat, Inflamed. — Scarlet Fever. Diphtheria. Influenza or La Grippe. Sulphuric Acid and Mercury. Corrosive Sublimate Poison- ing. Acute Catarrh of the Throat. Acute Pharyngitis. Chronic Catarrh of Throat. Chronic Pharyngitis. Throat, Raw. — Chronic Catarrh of the Throat. Chronic Pharyngitis. Throat, Rattling in the. — Epilepsy. Throat, Spasms in the. — Membranous Croup. SYMPTOMS OF DISEASES. 221 Throat, Sore. — Scarlet Fever. Measles. Diphtheria. Iodine Poison- ing. Acute Catarrh of the Throat. Acute Pharyngitis. Throat, Tonsils swollen. — Diseases of the Upper Part of the Throat. Inflammation of the Tonsils. Quinsy. Throat, White and looks burned. — Carbolic Acid Poisoning. Tongue, Coated. — Erysipelas. St. Anthony's Fire. Dysentery. Bloody Flux. Acute Catarrh of th Stomach. Acute Indigestion. Jaundice. Congestion of the Liver. Biliousness. Inflammation of the Mouth. Thrush. Acute Indigestion in the Stomach. Cholera Infantum. Summer Diarrhoea. Indigestion in the Intes- tines. Cerebro-Spinal Meningitis. Spotted Fever. Typhoid Fever. Influenza or La Grippe. Tongue covered with small white spots. — Thrush. Tongue, Dry. — Diphtheria. Tongue, Edges red. — Inflammation of the Mouth. Tongue, Swollen. — Inflammation of the Mouth. Tumors in Abdomen on Right Side over Hip. — Appendicitis. Tumors of Brain. — Delirium Tremens. Alcoholism. Tumors, Protruding from Anus. — Hemorrhoids. Piles. Ulcers. — Inflammation of the Mouth. Ulcers in Stomach. — Ulcers of the Stomach. Unconsciousness. — Heat Stroke. Sunstroke. Convulsions. Illumin- ating Gas. Coal Stove Gas Poisoning. Urine, Blood in the. — Hematuria. Blood in the Urine. Poisonous Mushrooms. Urine, Frequent desire. — Acute Bright's Disease. Cystitis. Catarrh of the Bladder. Diabetes Mellitus. Diabetes Insipidus. Urine, Heavy and dark color. — Jaundice. Acute Bright's Disease. Cystitis. Catarrh of the Bladder. Carbolic Acid Poisoning. Urine, Lack of control of. — Enuresis. Bed Wetting. Urine, Large amount of. — Diabetes Mellitus. Diabetes Insipidus. Urine, Pale and watery. — Diabetes Mellitus. Diabetes Insipidus. Urine, Scanty. — Malarial Fever. Intermittent Fever. Fever and Ague. Swamp Fever. Acute Catarrh of the Stomach. Acute Indiges- tion. Dropsy. Urine, Scanty and highly colored. — Dysentery. Bloody Flux. Lobar Pneumonia. Broncho-Pneumonia. Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunkard's Dyspepsia. Dyspep- sia. Indigestion. Heartburn. Congestion of the Liver. Bilious- '222 WARNINGS OF DISEASE. ness. Acute Bright's Disease. Chronic Bright'' s Disease. In- flammatory Rheumatism. Acute Articular Rheumatism. Scurvy. Pneumonia. Lung Fever. Veins, Stand out clearly. — Acute Endocarditis. Voice, Affected. — Heat Stroke. Sunstroke. Chronic Enlargement of the Tonsils. Chronic Laryngitis. Voice, Hoarse. — Dysentery. Bloody Flux. Membranous Croup. Acute Laryngitis. Chronic Laryngitis. Voice, Loss of. — Diphtheria. Voice, Nasal. — Abscesses and Adenoids. Nasal Catarrh. Vomiting. — Smallpox. Chronic Bronchitis. Lobar Pneumonia. Chronic Catarrh of the Stomach. Chronic Dyspepsia. Drunk- ard's Dyspepsia. Cancer of the Stomach. Colic. Gripes. Chol- era Morbus. Peritonitis. Jaundice. Gallstones. Biliary Calculi. Apoplexy. Hemorrhage of the Brain. Tumors of the Brain. Acute Bright's Disease. Chronic Bright's Disease. Diseases of the Upper Part of the Throat. Diseases of the Stomach. Acute Indigestion in the Stomach. Indigestion in the Intestines. Appen- dicitis. Peritonitis. Inflammation of the Bowels. Cerebro- spinal Meningitis. Spotted Fever. Scarlet Fever. Mumps. Diphtheria. Influenza or La Grippe. Carbolic Acid Poisoning. Saltpeter Poisoning. Iodine Poisoning. Lead Poisoning. Cop- per, Blue Vitriol, Verdigris Poisoning. Mercury, Corrosive Subli- mate Poisoning. Poisonous Mushrooms. Tainted Sausages, Tainted Meat, Fish, Mussels, Cheese, and Milk Poisoning. Poison Ivy. Vomiting, Acid and bitter. — Acute Catarrh of the Stomach. Acute Indigestion. Vomiting after Coughing. — Whooping Cough. Vomiting, Black lumps. — Sulphuric Acid Poisoning. Vomiting, "Coffee ground." — Fleer of the Stomach. Vomiting, Greenish matter. — Cholera Infantum. Summer Diarrhoea. Copper, Blue Vitriol, Verdigris Poisoning. Vomiting of Blood. — Acute Gastritis. Ulcer of the Stomach. Vomiting of Curds. — Artificial Feeding. Vomiting caused by any sort of Liquid. — Cholera Morbus. Vomit smells of Phosphorus. — Phosphorus Poisoning. ERUPTIVE FEVERS. 223 How Long Contagious so long as desqua- mation, ear dis- charge or abscess present ; danger i n d e fi n i t e 1 y in clothing, etc., not well disinfected o> u £3 n *-■ *3 O ™ 1 s C so- long as scabs re-form ; indefi- nitely in fomites, etc. so long as crusts re-form ; indefi- nitely in fomites etc. b/) • fH 75 T3 en •a S 05 U ^3T3 75 .05 3*S 71 71 05 O 75 O .S § § 43^ Ui < M W in rt > — i i— s >i <3 05 g g«£ Q* a; 75 ,3 ••> a S 05 75 c £ , 75 ^=§ *%$ oT C 75 +J 05 3 ctt j-i ^ b "trt U 03 » X o, tn C44 05 .-tt 0) « a •plol U • 05 5- 05 IOTD 75 1 *J •Si tn •« c >>£ 03 ••- 9- fi .3 75 'u 03 > * w 2 H h U Cu < £ w u •a # s ^ 6 ri 0> 05 3 05 o3 .~~£ B'Z « X3-t3-3 y 05 0;^ +j C X! ■4-J iftl c 05 'Z3 XJ 75 75 0) 75 C 05 05 i« y 75" 75 05 .s a. 03 "3 03 (j "3 S 75 05 75 05 75 O 05 05 a> 3 .§^ Cu.S rt ^4 1 75 3 »-' a, .3 05 M-l a. 5 in ^ i G.J4 3 O u M t3 O 75 +j __ b/D o> 75 c .£ u. 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O o n ^-i O >»"£ c 2 d > rtl ^ & g^ „_ ^ bJD : >> 3 , « Q X c Jr: i.l -a S a 3 C O >> o,^ ^> ^ ^ u OJ q; > > a; ^ 3 O.S ■M ^ ' X ':/. .^ 2 O 3-3 &J 3 b/3 u £3 j-> 3 3 o U 60 S2 u -§ 3 lo X P jo — x _ CD CD CJ >> y — > •~ ., T3 a; 3 £ X. CD tu 6/J x Tl! -a 5 X > CD o ~ >, a; X 2 X 3 15X2 S X — 3^ s^ SJ 'x 5-i 3 1) w 5 a3 53 bJO a l 3 u ! § 1 O X tT X TJ X X i cd u a u 3 •s. o ,2 rt 3 5- 5 X 5-, u [/I O 'x 3 bJO .2 .2 u b£ .2 X g '0 X .2 3 < 1^ O u S Q H Q u 1U BOOK III. MODERN NURSING AND CARE OF THE SICK. HOME NURSING. G. FREDERIC WHEELER. Mills Training School for Nurses, Expert Nurse and Masseur. The time has arrived when the value of skillful nursing is appre- ciated in every home. We no longer dare trust our sick ones in the hands of incompetent, unskilled, although well-meaning, attendants. The self-instituted nurse, with no knowledge of her calling, has been sup- planted by an intelligent class of men and women who have especially prepared themselves for the work. In this class the medical profession realize a valuable adjunct to the fraternity, and are beginning to feel that their assistance and cooperation are indispensable, and almost essen- tial, to the recovery of the patient. At best the physican can spend but a few moments each day in a single sick room, and the remaining hours must be given over to the care and superintendence of some other person. It is not always an easy matter to secure a trained nurse, and many families cannot afford to engage one, for skilled service is expensive. This, however, should not prevent the sick from having excellent atten- tion. It is to this end that these articles on "Home Nursing" are written, trusting that, with careful study and intelligent application of the prin- ciples set forth, the sick may enjoy better care in their helpless suffering. Every family should have some member whom it can call nurse, one who will study the requirements of a sick room and strive to become proficient in this noble work. The entire care of the family illness should not devolve upon the already overworked mother. There must be some son or daughter in every family who will be able and willing to share this work or take the entire charge of the home hospital, one who is willing to prepare to discharge the duties in an efficient manner. No profession is more ennobling, and there is no way in which one can do more good in the world than to make himself proficiently able to take a watch at the bedside, and do it in such a way as to demand trust from both family and physician. The latter can treat a case with greater certainty and success if he but knows the hourly condition of the patient in his absence. 226 MODERN NURSING. HOW TO PREPARE THE BED. With a good mattress to start with, we have the most comfortable foundation that can be found. Cover with a light soft pad, so that the buttons on the mattress will not irritate the patient. Pin the pad securely at the four corners with stout safety pins, this being necessary to pre- vent wrinkling. Next cover the pad with a strip of rubber sheeting or oilcloth a yard wide, which should be drawn smooth and pinned to the edge of the mattress. In case there is no rubber sheeting or oilcloth at hand, several layers of paper under the pad will answer the purpose. Now cover the bed with a soft, white sheet, drawing it smooth and pin- ning securely to the underside of the mattress. HOW TO PIN THE SHEET. The sheet should be drawn tight, the ends folded under, the sides drawn down and the corners mitered, much the same as a paper cover would be placed over a book. These corners should be accurately pinned to the underside of the mattress with large, stiff safety pins, which will hold it in place until it is necessary to remove it. One pin for each corner will be sufficient. It will not be necessary to pin the sides of this sheet down, as it will be held by the "draw-sheet," when the latter is pinned in its place. In pinning the sheets to the bed always turn the point of the pin away from the center; this lessens the strain at the point, and gives a more secure fastening. In bed-making, pin the sheet temporarily first at the foot, then draw it smooth, folding carefully, miter the corners, and pin it securely at the head. When this is done, it will be an easy matter to arrange the corners at the foot of the bed after drawing the sheet smooth and tight. Do not use more pins than are necessary, as the sheet can be removed with less trouble when a small number is used. If the directions are carefully followed, a firm foundation will be completed, which will not wrinkle under the patient, will be comfortable, and lessen the danger of contracting bedsores. Fold a sheet smoothly to about a yard in width — an old soft sheet is better for the purpose — and pin across the middle of the bed. This is known as the "draw-sheet" ; it can easily be removed without disturbing the patient. Safety pins only should be used about the bed, as common, short pins will work loose or may injure the patient. MAKING THE BED. 227 Place the top sheet over the bed, tucking it well under the foot of the mattress. A warm, light-weight blanket, folded to fit the bed prop- erly, will be sufficient cover for the day. An extra blanket should be kept in readiness for night use or whenever it is required. Usually patients are allowed more covers than are necessary or comfortable. It is better to keep them just comfortably warm than to load them down with too many blankets. Do not use a heavy coverlet or spread on the sick bed. A clean, white sheet is much to be preferred, as it is of lighter weight and can be changed every day if necessary. A small feather pillow, and a large one, always kept fresh and clean, will finish the bed-making. Too much care cannot be given to the details of this part of the work, as so much of the comfort and ease of the patient depends upon a properly con- structed bed. A clean, smooth bed is a joy to a person in health, and much more so to an invalid. But aim to keep the bed clean and tidy without continually picking and pulling at it, and thus annoying the patient. Insist that the covers be kept straight, and there will be little trouble in keeping it in order. Always have a good supply of clean linen — sheets, pillow slips, and towels— on hand, and do not use soiled ones. In fever cases change all the linens frequently to prevent reinfection. HOW TO CHANGE THE SHEET WITH THE PATIENT IN BED. To change the draw-sheet with the patient in bed, unfasten the safety pins, have the patient lie flat on his back and draw his knees up. Pass one hand under the small of the back, and gently raise him enough to draw the sheet out. Always have a fresh one rolled ready to slip under while he is in the raised position. This clean sheet should be folded the proper width, and rolled tightly. Raise the end of the draw-sheet to be removed, and place the fresh one in proper position to be quickly rolled under the patient. The end should be pinned properly to the mattress on the side from which the nurse is working before the soiled linen is drawn out. This will make it much easier to straighten out, and prevent wrinkling. After the patient has been lowered to the bed again the opposite side can be drawn as smooth as possible and pinned to the underside or lower edge of the mattress. The object in having the patient draw the knees well up is to allow him to assist in raising himself, while the hand under the back relieves 228 MODERN NURSING. the strain. If the patient is unable to help raise himself, it is better to call some one in to withdraw the soiled sheet and roll the other under, while the nurse raises the patient with one hand under the small of the back and the other under the thighs. To change the lower sheet, remove the pins from the corners, also from the draw-sheet. Roll the soiled linen toward the patient, tucking it well under him after turning him on his side, if his condition will admit. Have ready a clean, well-aired sheet and a draw-sheet. Roll the draw- sheet as before directed, and roll the other sheet lengthwise. Pin it at the two corners from which you are working, unroll it toward the patient, tucking it under the sheets to be removed. Pin the draw-sheet in place, and tuck this also under the patient as directed. Now the patient can be gently turned back, the soiled sheets removed, and the fresh ones drawn smooth and securely pinned. In removing these sheets, the pillows should first be removed from the bed, allowing the patient to lie flat and thus aid the nurse. With a little practice the bed can be quickly changed with little annoyance to the patient and little strain on the nurse. It is the faculty of getting at it properly and having even-thing ready at hand that makes it easy. There need be no great bustle nor house cleaning aspect, if things are rightly managed. Be quiet and systematic in this, as in other sick room work. BEDSORES, PREVENTION AND MANAGEMENT. Patients who are long confined to the bed are subject to ''bedsores. " Such sores occur very rarely under the vigilance of a careful nurse, but neglect and uncleanliness will be most sure to cause them, and, once started, we have a serious annoyance to contend with. To prevent bedsores, do not allow the patient to lie in one position hour after hour. In case of fracture of the hip, etc., the patient cannot be moved much, but, by using rings and air cushions, the point of severe contact can be relieved. Whenever possible, turn the patient a little every three or four hours to allow the blood to circulate freely through the part congested by the weight resting upon it. Bathe the back, hips, shoulder, or any part that becomes red from contact with the bed, thor- oughly, at least once a day, with warm water and castile soap, and rub well with alcohol and zinc stearate ; a solution of alum and alcoholic tannic acid powdered over the parts will also toughen the skin and prevent abrasion. TO TURN A PATIENT IN BED. 229 Watch the heels, ankles, knee joints, and elbows. They are some- times neglected and become sore, especially in patients who are greatly emaciated. Keep the bed linens dry and smooth. Use old, soft sheets for draw-sheets, and if the elbows or heels begin to show signs of irri- tation, pad them with absorbent cotton, the pads held in place with strips of adhesive plaster or bandages. Massage the back, hips, and shoulders frequently to prevent the blood settling in any place. The greatest dangers in bedsores are caused by wet beds. The skin may become parboiled and abrased, the cells become inflamed, suppura- tion take place and gangrene follow. In these cases, every energy must be bent to keep the bed and patient clean and dry. Use astringents such as alum and tannin in bathing, and a rubber ring to keep the hips ele- vated. Never use a feather bed under a patient. The increased heat on the back will be greatly conducive to the early formation of sores. Should bedsores develop after every care and precaution have been taken, it remains only to endeavor to heal them as soon as possible. Again, thorough cleanliness is necessary. Cleanse the sores with warm water and castile soap ; disinfect with a solution of creolin, one teaspoon- f ul to the pint of warm water ; dress with lanolin, oxide of zinc, balsam of Peru, or zinc stearate and boracic acid, as the physician may advise. Use only sterilized cotton and bandages or strips of adhesive plaster for dressing. Linen lint is not so much used since the absorbent cotton has been placed on the market. The cotton is much less expensive. Poul- tices may be used to remove gangrenous tissue, but not longer. Dress at least once a day. Remove all pressure from the part by use of rings, and promote circulation in every possible way. If bedsores are neglected they become serious through the drain from discharge, and by blood poisoning from absorption. HOW TO TURN A PATIENT IN BED. Some patients will constantly slide down in bed when unable to help themselves back. It then becomes necessary to draw them back upon the pillow. To do this easily, have the patient clasp his hands behind your neck, place your arms around his shoulders under his arms, raise him gently, and draw him up to the desired position. To lift a patient out of bed, raise him in a sitting position, swing the feet over the side of the bed, reach around his back with one arm, place 230 MODERN NURSING. the hands under his arms, and lift him gently. Have the chair or couch close by the bedside before he is disturbed. If the patient, for any reason, must be lifted bodily from the bed, two can do it very easily. One should place an arm under his knees, the other arm under the hips, while the nurse should place an arm under his head and the other under his shoulders. Do not allow the patient to strain or try to assist, as it will make it much more difficult to lift him. Explain to him that he is to lie in a supine condition. To turn a patient in bed, place one hand under the hip and one under the shoulder. Have him turn his head toward the side to which he wishes to be moved, and gently roll the body. Do not stand on the side toward which he is to be turned and draw him toward you. It can be done with more comfort and less annoyance to the patient to turn him from you. A practical way to move rheumatic patients is to have three assistants, one at each corner of the bed. Grasp the corner of the lower sheet firmly and pull away from the center, all gently raising it at the same time. This is not only hard on the poor sufferer, but also on the ones who do the lifting; but it is the easiest way to do it. Have mercy on one who is suffering from rheumatism or rheumatic fever and work as gently as possible. Fresh linens should be in readiness to be immediately slipped under the patient and pinned in place, and the soiled ones can be removed after the patient has been lowered to the bed and rested awhile. Removing the soiled bedding in these cases is a delicate task and must be done with gentleness. If a patient is to be raised in bed for the physician to examine the lungs from the back, have the patient cross his arms and extend the hands. The nurse will then stand at the foot of the bed, grasp the hands and draw the patient into a sitting posture leaving the back free for examination. By crossing the arms much of the strain and sagging of the body is prevented. PACKS— HOT AND COLD, Hot Packs. — In using any wet packs, the bed must first be protected by rubber sheets, oil silk, or oilcloth. In rheumatism, sciatica, neuralgia, and localized pains the hot pack is frequently given. After protecting the bed, prepare several large squares of flannel; old blankets or undervests will answer the purpose. It is better to fold HOT AND COLD PACKS. 231 them into squares of several thicknesses and baste them together, as they will be easier to manage, and hold the heat longer. Hot packs are sometimes given with saline solution, alcohol (diluted), or hot water. Occasionally some volatile oil is used. In rheumatism oil of wintergreen or oil of menthol is used. To use the pack be careful that the surface is sufficiently cool to avoid burning the patient. Place several thicknesses of the pack around the affected part and cover with a rubber or oilcloth blanket to keep the heat and steam in. Change frequently, never allowing the pack to get too cool. When the heat seems to make the patient nervous or faint, apply cold cloths to the head and back of the neck and it will relieve him. Excessive sweating will reduce the strength rapidly and hasten emacia- tion. Cold Packs. — Cold packs are much used at the present time in fever cases and pneumonia. They are also used directly over localized pains, sprains, and on the neck and skull to prevent delirium. Unless rubber water bottles are used it will be necessary to protect the bed, as in giv- ing a hot pack. In case it is desired to place a pneumonia patient in a cold pack, or ice jacket, first cover the chest both front and back with a thin layer of absorbent cotton. Pack finely chopped ice around him and cover with another layer of cotton, which will help to absorb the water from the melting ice. In case it is desired that ice should not be used directly, a cold pack can be used like the hot pack, substituting ice water for the hot. This answers very well if constantly changed, and in all cases, save pneumonia, may prove more desirable. However, one must be governed by the physician. Whenever practicable, we advise the use of water bottles, since they protect the bed from water, and thus lessen annoyance and reduce liability to bedsores. BRAND'S BATH FOR TYPHOID (MODIFIED). The American rule for giving Brand's bath for typhoid differs very little from the German save in the temperature of the water. In cases where the heart is a little weak or the patient hypersensitive, half an ounce of brandy or whisky should be given a few minutes before the patient is put into the tub. Place a portable bath tub beside the bed, fill it about half full of water, 232 MODERN NURSING. and put into it sufficient ice to lower the temperature of the water to whatever point the physicians may prescribe for the bath. Have a pail of chopped ice at hand to put into the tub after the patient has been submerged, in quantity sufficient to bring the temperature down five degrees lower. A bath thermometer is an absolute necessity in giving tub baths. Prepare the patient by removing the clothing and giving him a brisk friction rub from head to foot until the skin is very red. Be careful not to use any weight over the bowels. A towel should be pinned about the loins, an ice cap applied to the head and neck, and, with some one to assist, he should be gently but quickly lifted from the bed and as quickly sub- merged to the neck in the bath. The shock is greater to some people than to others, and the pulse must be closely watched, and if it becomes hard or depressed the patient should be removed from the tub at once, and another half ounce of whisky given. While the patient is in the tub, keep up the friction constantly, from head to feet. This brings the blood to the surface and gives it a chance to be cooled. Keep the patient in the bath from 12 to 20 minutes if he stands it well, then gently lift him back into bed and roll him in a warm blanket. He will likely shiver for a few minutes, his lips will be purple, but he will soon get warm and probably go to sleep. The tem- perature should be taken an hour after the bath and be recorded. The rule for administering the ice tub bath is generally, "When the tempera- ture reaches 103.6 degrees F., it is an indication that the Brand bath is required." These are never given more frequently than every three hours, and should not be attempted by non-professionals, except in the presence of a physician, as there is more or less danger of collapse from the shock. BANDAGES. Every home should have on hand a stock of bandages and cloths for emergencies. Bandages, lint, and absorbent cotton can be obtained from almost every drug store now, and are not very expensive, but old sheets torn into strips from one to four inches wide and the ravelings pulled from the edge make good bandages. Cheese cloth or gauze make the best, however. When the bandages have been cut or torn into proper widths, they should be wound tightly and evenly over a lead pencil, wrapped in a clean piece of paper and tied separately and placed in a hot oven until . BANDAGES. 233 thoroughly heated through. The paper should not be removed until the bandages are required for use. The head is perhaps the most difficult part to bandage. This is done in. what we term a "re-cur." First wind the bandage around the head over the forehead and above the ears about two or three times. Hold the bandage in front with the thumb, let it extend up over the head and down to the bandage in the back, where it should be held in place with the middle finger. Next, put it up over the head again and hold this second end with the thumb; back again in re-cur and put it around the forehead once or twice, until these ends are held in place. Repeat the process until the scalp is covered. In bandaging always unroll the bandages from you. Do not wind the bandage around, but cross and recross, keeping it firm and tight. In case of bandaging a taper, as in the forearm or leg, it is necessary to frequently tighten the bandage by making a half turn of the roll, thus crossing the bandage upon itself at an angle. This tends to draw the opposite edge down. Large dressings like laparotomy, or spica bandaging, require the service of an experienced person. The physician can give the young nurse a practical demonstration, which will greatly aid her in bandaging. In bandaging a hand or finger, let it go around the wrist several times. This will help hold it in place. A "T" bandage is made with two strips of cloth, one long enough to go around the waist and the other sewed to the middle of the waist bandage and long enough to go over the dressings between the thighs and pin to the waist bandage. A "four-tail" is any bandage with the ends stripped into tails for tying. They are named according to the number of strips into which the ends are torn, and may be four, six, or eight tail bandages. They are used to tie other bandages on, instead of sewing them or using pins, and are very convenient. (See "Emergencies," page 572. See illustrations.) Rubber Bandages. — Rubber bandages are very little used, save in preparing for operation by Esmarch's plan, or to prevent swelling, as in varicose veins in the legs, and for support, as of a hernia. When used, care should be taken that they are not doubled at right angles with them- serves, or the elastic freedom will be lost. Silk or elastic stockings and supports have replaced the rubber bandages, and are in every way to be preferred. 234 MODERN NURSING. STUPES. Stupes are hot applications used for their counter-irritating effects, to allay pain, and remove gases. Turpentine, chloroform, laudanum, oil of wintergreen (ol. Gaultheria), tincture of capsicum, menthol, and many other agents are used. Prepare flannels as for a hot pack, wring them as dry as possible from very hot water, and sprinkle over one side a few drops of whichever agent the physician may prescribe. Be careful that the patient is not blistered. Never apply chloroform directly to the skin. Hold the hot flannel an inch or two away from the part to be treated. Turpentine is much used in tympanites of typhoid or other intestinal disturbances where large quantities collect and cause distention of the abdomen. It is also used internally by enema. Laudanum is used where excessive pain demands something to quiet the nerves and deaden the sensation, as in abscesses, boils, carbuncles, and fractures. Wring the cloth out as hot as possible, sprinkle it well with laudanum and apply directly over the localized pain. As soon as the pain begins to be less, remove the cloth, replacing it with a dry, warm flannel. ENEMATA. Enemata or injections are used to relieve the colon of fecal matter in constipation, or to cause a quick, ready movement of the bowels. Enemata are usually divided into two classes for convenience : viz., simple and nutritive. In giving injections to very small children, the hard rubber syringe and a Xo. 14 male catheter, or a small rectal tube are necessary. For adults, a bag, or Davidson syringe, and a long rubber rectal tube are indispensable. To administer a simple enema, place the patient on his left side, with hips slightly raised. Protect the bed with rubber sheet or bath towel. Prepare the solution according to direction below. Have the tempera- ture of the solution about 108 degrees, as the syringe will cool it to some extent. If a Davidson syringe is to be used, place the rectal tube over the end and press the bulb until the solution passes through freely without being accompanied by air. Keep the suction end in the solution, never allowing it to come to the surface, or air will get into the syringe. Oil the rectal tube with olive oil or vaseline, and insert gently into the ENEMATA. 235 rectum. As soon as it passes the sphincter muscle it will pass readily into the descending colon, unless it be obstructed by hard fecal matter. Care should be taken that the tube does not double on itself. This can be obviated to a certain degree by beginning to press the bulb gently as soon as the end of the tube passes through the sphincter muscle. When the tube has been inserted its full length, raise the bowl about a foot and allow the solution to slowly siphon out. By giving it slowly much better results will be obtained. The chief objection to the use of the bag or douche syringe is that the general inclination is to allow the solution to run too fast, causing pain for the patient and poor results from the enema. The amount of solution given depends largely upon the patient's ability to retain it for a few minutes. Small children may take half a pint, while, an adult will take from three pints to two quarts. Do not let the patient think about what is going on. Lead his mind from it by con- versation, and it will be found that a larger quantity can easily be given. Insist that he keep his mouth open, as there will be less strain. In preparing solution for rectal injection, always use water that has been boiled. Do not use salt, if soap is to be used, or a gummy substance will form, filling the syringe. When a simple enema is called for it usually means three pints of warm water, to which has been added white castile soap until it is smooth and a suds easily formed. Sometimes a cup of sweet milk is added. For obstinate cases use one quart water, no degrees, two ounces olive oil, and one ounce of glycerine. Be sure that the syringe is thoroughly cleaned after using olive oil, as it will quickly rot the rubber, and the syringe will leak. In cases of impacted faeces with little peristaltic action, one quart to two ounces of Epsom salts, dissolved in a quart of warm water, slowly given and retained for a few minutes, will usually prove effective. In some cases it is necessary to resort to ox gall one ounce to water one pint for quick results. In cases of chronic constipation, glycerine suppositories are invaluable. They can be used with little inconvenience, and often prevent hemor- rhoids, or the reappearance of same. Xutritive enemata are only given upon advice and direction of the physician in cases physically incapable of taking food into the stomach, or of digesting the same. There are predigested foods on the market 236 MODERN NURSING. which are now much used, and are to be preferred. However, if they are not at hand, the white of eggs (some physicians use the yolks), milk or cream, beef tea, and strong, black coffee, with a little brandy, can be used. A nutrient enema should never be larger than can be easily retained. Small children will retain from one to two ounces, while an adult will retain from four to six ounces, and it should not be given more frequently than once in five hours. In case of exhaustion, nausea, and continued vomiting, shock. from surgical operation, and depression after an anesthetic a few ounces of strong, black coffee will prove very useful when given per rectum. Pep- sin is often added to the nutrient enema to digest the food. HYPODERMIC INJECTIONS. The use of the hypodermic needle has become quite common, and quick results from stimulants are obtained by injecting them under the skin. Triturates and tablets are now provided so that physicians feel quite safe in prescribing. To the inexperienced the needle looks horrible. There need be no horror or pain from its use. Prepare the solution as directed, clean the needle with alcohol or carbolic acid, rub the spot on the arm, or whatever part the needle is to pierce, with alcohol and a bit of gauze or cotton to bring the blood to the surface, pinch the flesh up between the thumb and index finger and insert the needle with a quick motion. The patient will scarcely feel it. Press the piston slowly, allow- ing the solution to diffuse, withdraw the needle quickly, and again rub the place with alcohol. If these directions are carefully followed, there need be no pain or infection. The hypodermic should never be used, save by the direction of the physician. COUNTER-IRRITATION. Counter-irritants are usually applied over the seat of the disorder, but are not infrequently placed on some remote part to obtain the so- called revulsive action. As, for instance, mustard footbath and draughts on the feet relieve the head. Mustard is more frequently used than any other rubefacient, although liniments, camphorated oils, ammonia, tur- pentine, etc., are often used. To make a mustard plaster, or sinapism, use one part powdered mustard to from two to five parts of flour, according to strength desired, BLISTERS. 237 Mix the paste with tepid water, and spread on a thin cloth. Cover with a piece of muslin and apply to part desired. It will likely feel cool at first, but will soon get warm. Do not use hot water or vinegar, as the full action of the mustard is desired. They destroy much of the volatile action. Do not leave the plaster on the patient long enough to blister, for a sore thus produced is painful and slow to heal. When the mustard has caused a good irritation, remove the plaster. If it burns too much, sponge the skin with vinegar to counteract the mustard. In preparing mustard paste for children, mix with glycerine, and the action will be less severe. To make a cayenne pepper plaster, mix the same as mustard, using a tablespoonful of cayenne in a thin paste with flour. Or the pepper may be stitched into a flannel bag, and this wrung out in warm water and applied. Mustard paper and capsicum vaseline are good substitutes and easy to use. BLISTERS. The agent most generally employed in blistering is cantharides, and should never be applied where the skin is broken or tender. A piece of oiled tissue paper between the plaster and the skin will not only protect the skin but accelerate the action of the blister. In preparing to blister, wash the part thoroughly with castile soap and water, and dry it well. Shave the part if there be any growth of hair upon it. Secure the cantharides in place by a bandage instead of strips of adhesive plaster, thus lessening the danger of tearing the skin in removing it. Blistering should take place in from 6 to 8 hours. If not within 12 hours remove the blister and apply a poultice, when the desired effect will usually be produced. In removing the plaster, be careful not to tear the skin. Remove all particles of the cantharides with a bit of oil. When the blister is full of serum, a small incision may be made at the lowest point to allow it to drain out, or it may be left to be reabsorbed. Blisters are rarely used now, and only upon direction of a physician. If it is desired to raise a blister quickly, it can be done by moistening a bit of gauze or cotton with chloroform or ammonia and applying to the part to be blistered. These blisters are more in the nature of a burn, and if the applications are left long on the part they will burn deeply into the tissue. : 3 8 MODERN NURSING, CUPPING. The process known as cupping is frequently used to relieve pain and congestion. It requires skill, and especially wet cupping is never given except in the presence of a physician. Cupping glasses are required for this operation, though small tumblers or wineglasses with smooth edges can be used in the absence of any regular apparatus. Have at hand a lighted taper or candle, a little alcohol in a glass, and a small swab or camel's-hair brush. See that the glasses are clean and dry. Prepare the patient by exposing the part to be cupped, dip the swab or brush into the alcohol and squeeze the greater part of the spirits out of it. Rub the inside of the glass with the brush, keeping it well away from the edge, and not allowing any of the alcohol to trickle down the side of the glass upon turning it down. Pass the glass over the flame of the taper, when a blue flame will immediately appear, but will last only three or four seconds; hence the necessity of working lively. Place the cup over the part to be cupped, when it will be seen that the oxygen having been burned out of the glass there will be sufficient suction to draw the flesh well up. Prepare another glass in like manner, always being careful not to use alcohol enough to heat the edge of the glass or drop on the patient, for there is no excuse for burning him. Do not let the glasses remain long enough to cause discoloration. Grasp the glass by the top and with the fingers of the other hand press the flesh away from the edge. As soon as a bit of air enters, the glasses will be released. Do not place a second glass within the ring formed by another. Glasses furnished with rubber bulbs for exhausting the air can be had instead of using alcohol. In wet cupping the same apparatus is used, in addition to which there must be a scarificator, absorbent cotton, and adhesive straps. After cupping, the scarificator will be applied, making a series of little cuts, and the cups replaced until sufficient blood has been extracted. A dry dress- ing will usually suffice, though sometimes it is better to dress in some ointment like lanolin or carbo-vaseline. Wet cupping is seldom used, except to relieve inflammation of the kidneys. LEECHES. Leeches are not so much used now as they were formerly. Those used are of two kinds, the American and the foreign. The latter are to POULTICES. 239 be preferred in most cases, since they are more voracious, and will draw four or five times their own weight of blood. Leeches will draw more blood from a child than from an adult, owing to the thinness and greater vascularity of the skin. For this reason domestic leeches are chosen for children. Leeches should never be applied over large blood vessels, but over a bony surface upon which pressure can be made in case it is necessary to check a hemorrhage. Sometimes it is difficult to make leeches bite. Fumes of sulphur, vinegar, strong odors, or tobacco will affect them. The leech also objects to certain drugs, which may have been taken internally. A slight scratch, just enough to give them a taste of blood, is usually sufficient inducement. The part to which the leech is to be applied should be thoroughly washed and dried before the leeches are applied. The leeches should also be washed and dried in the folds of a towel, and never handled. If they are to be used in the mouth or nose it is well to put a silk thread through the tail to prevent them from being swallowed. In case one should be swallowed, it will become harmless by drinking a quantity of salt and water. When they are full they will drop off. Never attempt to pull them off by force, or the teeth will be left in the wound and abscesses may form, or erysipelas result from it. The bite leaves a permanent star-shaped scar. If it is desired to remove them before they are full, sprinkle a little salt over their heads, when they will release themselves and drop off. If the hemorrhage continues, it can be checked by hot or cold applications, or by touching with nitrate of silver. CATAPLASMS (POULTICES). Cataplasms or poultices are a convenient form of applying warmth and moisture. Their effect is to soften the tissues and dilate the capil- laries, relaxing tension of inflamed parts, and relieving pain. Early application oftentimes checks the progress of inflammation. When suppuration begins, they facilitate the passage of pus to the surface and limit the spread of induration. Poultices should be applied as hot as can be borne, and covered with an oilcloth or rubber to keep the heat and moisture in. Poulticing should not be continued too long, as it renders the flesh sodden and irritable, ?nd may cause sloughing. 2 4 o MODERN NURSING. Gauze, muslin, spongiopilin, which is made of sponge and wool felted together and one surface coated with a preparation of rubber, are used in preparing poultices, which may be made of a variety of ingredi- ents. Linseed meal is very generally used, and when of good quality makes excellent material. It should be well cooked. It is very glutinous, and should be of the consistency of dough. Spread about half an inch thick upon a piece of muslin of the required size, leaving a margin of an inch on all sides. It is better to cover it with a coarse, net like mosquito netting or tulle, though it may be applied directly to the skin. If it dries and adheres to the skin, a little oil will remove it. Keep the poultice warm by the use of hot water bottle or hot flannels. Poultice jackets are sometimes ordered for the chest. They should be made of two pieces, one for the front and one for the back. These can be tied over the shoulders with tapes to prevent them from slipping down. Bread poultices are more bland than linseed, but cool quickly and hold less moisture. They dry and fill the bed with crumbs. Milk should not be used in these poultices, as it soon sours. Weak carbolic solution may be used when a disinfectant is desired. Yeast poultice is often used to hasten sloughing in gangrene. Mix six ounces of yeast with an equal amount of warm water, and stir into it fourteen ounces of flour. Let it stand near the fire until it rises. Apply while fermenting. Starch makes a mild poultice and retains heat well. It is much used in irritating skin diseases. Mix as for laundry use. Slippery elm, Indian and oat meal, rye, and other flours are used, and are cooked the same as linseed meal. Scraped carrots, boiled or raw, are thought to have a peculiar cleans- ing effect. Hops, when sewed into a bag and wrung out in hot water, have a soothing effect. Laudanum is used for its sedative effect. Pow- dered hemlock leaves, one part to three of linseed meal, have something of the same nature. Constitutional effects from the drugs must be watched out for when they are used. There are many other kinds, such as horse- radish or onion poultices, which are used for their stimulating properties, but for ordinary purposes the linseed meal is preferred. Poultices should be renewed whenever they get cold or hard. If there is a large discharge of pus or purulent matter, they should also be frequently changed. ICE BAG. 241 SWABS AND MOUTH WASHING. To keep a patient's mouth clean in fever cases is very important. After taking milk or gruel the patient should cleanse the mouth with fresh water, or a mild salt solution. The teeth should be cleaned, and the sordes removed once or twice a day. This can be done with a piece of gauze over the index finger, or by using a swab made by winding the end of a stick or lead pencil with absorbent cotton or gauze and carefully sponging the mouth. Tincture of myrrh is excellent for cleaning the teeth, and good for the gums, acting as an astringent. A wash made of lemon juice, glycerine, and ice water, equal parts of each, is excellent and agreeable. Washing the mouth with boracic acid solution also helps to keep it fresh, and is very soothing and healing. If the tongue and lips are dry and inclined to crack, use cocoa butter to soften them. Do not use vaseline or glycerine for this purpose. ICE BAG. The ice bag is a rubber cap or helmet that is used for applying ice to the head, and is more convenient than the rubber water bottle for this purpose, since the mouth or opening is larger. To use the ice cap, fill it full of finely chopped ice, mixed with a small quantity of table salt. It is always well to place a sponge or some absorbent cotton in the mouth of the bag before closing it, as it will absorb some of the water and prevent it from leaking. Place a moist cloth or moist cotton over the head and apply the ice cap, tying it in place with bandages if necessary. The moist cloth will aid in keeping the head cool and prevent contact of rubber with the IG * CE AG * flesh. Sometimes, when the cap is not nicely adjusted, there is danger from frost bite. In fever cases, delirium, or injury to the skull the ice cap or helmet is indispensable. An improvised bag can be made of oil silk, rubber, or other material, but it will generally leak and prove unsatisfactory. EMBROCATIONS— LINIMENTS. When any remedy in liquid form is applied to a part by rubbing it in, it is called a liniment, and may be either soothing or stimulating, or a 242 MODERN NURSING. counter-irritant. Liniments usually contain poisonous ingredients, and care should be taken that they are not left where they will be taken internally by mistake. The hands should be well washed after using. For rubbing in liniments see article on "Massage" (local), page 272. ENDERMIC MEDICATION. Endermic medication, or feeding through the agency of the skin, is now used only in rare cases. Some constitutional diseases are still treated with mercurial inunction, and consumptives are given hot baths with massage and cod-liver oil applied to the skin. In either instance the physician should prescribe the treatment. FOMENTATION. See "Hot Pack," page 230. CLYSTERS. See "Enemata," page 234. SINAPISM. See "Counter-irritation," page 236. Fig. 60. Nasal Douche. ATOMIZERS AND SPRAYS. See "Nasal Douche." NASAL DOUCHE OR SPRAY. The nasal douche is now rarely prescribed because of the danger which attends it. It is more or less likely to affect the eustachian tube and cause deafness. Pain in the ear should be a sign of discontinuance of any nasal treatment. The nasal douche has been super- seded by the post-nasal spray, which is far less dangerous and more effec- tive. Atomizers for spraying the nose and throat, with full directions as to their use and management, can be found in any drug store, and are inexpensive. SICK ROOM UTENSILS. 243 Gargles for the throat are not so effective as the spray of the atomizer, and, by spraying, the teeth are protected from injury so likely to occur from the use of iron and acids in gargles. The mouth should always be well rinsed with an alkaline solution like soda or limewater whenever acids are used near the teeth. NECESSARY UTENSILS. There are a few utensils indispensable to the sick room. These are inexpensive and any family cannot afford to be without them. One or more 2-quart rubber water bottles for either hot or cold applications as desired seem almost necessary. Cloth covered ones can now be had and are much to be pre- ferred, since it lessens the danger of burning or blistering when hot water is used. In case the bag is not cloth covered, a cover should be made to slip over it before using near the patient. Do not risk wrap- ping in a towel. They will some- times slip out and accidents occur. In using hot water, never fill more than half full, then lay the bottle flat until the water comes up to the nozzle before putting in the stopper. This excludes the air and steam, lessens the danger of explosion, and also keeps the water hot for a greater length of time. In absence of rubber bottles, or when a greater number is needed than is at hand, quart glass bottles that can be tightly corked, wrapped in towels and securely pinned with safety pins, will prove useful. Care should be exercised in filling, not to use water hot enough to break bottles and scald the patient. To burn a patient is unpardonable, and a nurse who is careless enough to do so should not be trusted in a sick room. In selecting a bedpan, the modern, square, porce- lain pan is preferred, as it is lighter, can be quickly Medicine Glass. warmed, and is more comfortable and more durable. Fig. 61. Atomizer or Spray. 244 MODERN NURSING. In absence of a urinal, wide-mouthed or large-necked pickle bottles prove very satisfactory and convenient. A bag syringe or douche is indispensable. A bulb or Davidson syringe and a glass or hard rubber syringe should also be found among the utensils. A graduated medicine glass for liquids, a glass tube for taking iron, administering liquids to patients unable to be raised, and a china feeding cup can all be had for a few cents and prove most valuable in sickness. A bath bowl, some pure, not strongly-scented toilet soap, talcum powder, etc., should always be provided. A medium-sized, fine sponge, and several yards of bleached gauze or old linen, should be found among the bath perquisites. A covered slop jar, either porcelain or china, one that will stand chloride of lime or other disinfectants, will complete the utensils which seem absolutely necessary. A sputum cup is a necessary 'article in every sick room. China or porcelain ones with covers can be found at any china store. A bit of chloride of lime or some other Fig. 63. Nose Syringe. disinfectant should be placed in the cup each time after it is cleaned. Old cloths, gauze, etc., should be always kept on hand to be used for sputum. It is better to burn such cloths than to wash them. For disinfecting see pages 158 to 162. THE CHART. A carefully and accurately kept chart is a most valuable aid to the physician. It has been remarked before that the physician can spend but a few minutes each day with the patient, and that, usually, at about the same hour each morning or afternoon. Consequently, he has no means of knowing just what takes place in his absence save through a careful report by sone one who has watched the patient, taken his tem- perature, and counted his pulse at regular intervals. A nurse cannot trust details to memory, hence another necessity for having a daily record. Chart sheets can be found at almost any apothecaries', or can be drawn up by the nurse when not at hand. A most convenient form, one that is simple and easy to keep, is given on pages 246 and 247. THE THERMOMETER. 245 Write the name of the patient and number the sheet. Write name of attending physician and his diagnosis of the disease. In their proper spaces fill in the month, day of month, day of week, and hour when the temperature, pulse, and respiration (T. P. R.) are taken, and record them in the spaces marked T. P. R. Use the decimal system in record- ing fractions of a degree of temperature, as it will not then conflict with the small lines, which divide the degrees on the chart into fifths or two- tenths. The dotted line running across the page at 98. 6° is the normal tem- perature line. Any temperature above or below this point shows an irregularity in the system, and the farther the temperature stands from this point the greater the danger, usually. After recording the figures as per direction, place a dot on the proper line showing the maximum height of temperature at the time the record was made. Connect this dot with the one denoting the previous record by a heavy line. It is better to use red ink for night records when it is pos- sible, for it then gives the physician a correct knowledge of the state of af- fairs at a glance, and greatly assists him in deciding what steps are neces- sary to be taken. When baths are given to reduce the temperature, connect the dots which show the point the temperature has reached before and after the bath, by dots instead of the heavy lines. This will show the effect of the bath. On the reverse side of the sheet a record should be kept of the medi- cines administered, baths given, enemata, and cathartics and their results and any irregular symptoms that are noted by the nurse. In fact, any- thing that the physician should know that is not kept on the other side. The importance of a well-kept chart cannot be overestimated. In- accurate reports are not only useless, but are often dangerous. Every physician recognizes and appreciates a true record — and every patient benefits thereby. (See Diagram.) Fig. 64. Oil Atomizer. 246 MODERN NURSING. NAME DISEASE ID5 104 103 102 101 100 99 98 97 96 CQ UJ CO UJ uJ 4 D. *•> »■. / / ," **> k / f \ \ > ' ,/ / \ V / / ' • \ / ' N ^ J t — -- 02 eg CO CNJ O CM 2 2 00 -. — » cm CXI CNl CNJ CXI CM OJ. CM CM CM CX S OJ CNJ ^0 CNl ex CO CNl 00 CM 0. O CO 00 O CD CO C\J CO -*- cO CO cO CO CD J 2 § CNJ § g OO CNJ cx" 3 H O O § CO CO CO CO CD O 2 s 2 CD O § § fe to CO CNJ O § § § < Q. LO CO < lO CO CL LO CO < * — 1 LO CD Q. LO OD < iO CD CL £ Ll. <0 hi 2 iO vD r- Q tO ^ LO nO Specimen Chart Showing Crisis of Pneumonia. Figures in left-hand column mark the Temperature in Degrees. T — Temperature. P— Pulse. R— -Number of Respirations per Minute. SPECIMEN CHART. 247 PNEUMONIA PHYSICIAN X 00 0: DO Cfc^ cO ■ 'N • V CO O •3 3 \ 1— \ • < uO to i0 1- 0' 3> Li I --' 1 — 1 £- >- -1/ r £ *•;; — > ■1 O > _•.> ►___ -- -- -- -- -- <0 H \ W ' ■ CO CN1 OO CM rO §3 C%J CM O CNJ CM CNJ CNJ oO CO oO CO cO CO a I § i2 s 3 3 — ' CD S3 si- 00 S6 i CO oC i s s CD O CO CD en CD CD CD 'en co CO CD od 00 CD CO CD 00 CO CO CO 00 CD 10 < lO CD Q. LO CO < uO CD < r 1 lO CD < CO ^ h- 00 2 O CM r- cO CD Specimen Chart Showing Crisis of Pneumonia. Dotted line across page is Normal Temperature of 98.4* F. Observations are recorded ever)' four hours during day and night. 2 4 8 MODERN NURSING. CLINICAL THERMOMETER. Every family should possess a clinical thermometer and everybody should know how to read one. Many times a person feels indisposed when really nothing is the matter with him. By trying" the temperature one can quickly tell if there is likely to be any serious trouble by the reading of the thermometer. If there is considerable rise in the tem- perature above the normal point, it is better to consult a physician. To use the thermometer, shake the mercury down below the normal point, being very careful not to shake the thermometer out of the hand. Place it under the tongue of the patient, except in cases of small children, and have him close his lips tightly over it. Let him hold it there for a full minute. Removing it, hold it so that the light will fall on it. If it be a triangular affair turn one side of the triangle up, and move from side to side gently till the mercury can be seen. Note to what degree and fraction it has risen, remembering the thermometer is graduated by fifths, — each step equals two-fifths of a degree. The twist in the tube above the bulb prevents the mercury from again falling till it has been shaken down. In children and delirious patients the thermometer may be placed in the armpit and held for four or five minutes. To clean the thermometer use a soft napkin or cloth moistened with water, or, in infectious or contagious diseases, some disinfecting liquid should be used. Do not use hot water, or the bulb will break. Do not use alcohol, or the figures will be removed. Clean thoroughly each time immediately after using, and shake the mercury down ready for use again. Always take and record temperatures at regular intervals, say every three or four hours, and always at the same time each day. Fig. 65. Cloth Covered Hot Water Bag. THE PULSE. The pulse indicates the action and condition of the heart, and is a lifetime study. That the pulsations are about 70 per minute and regular in force and intervals is about all we can say to you in regard to the normal pulse. Any change from this is an indication that there is trouble. RESPIRATION. 249 To feel the pulse, place the tip of the middle finger on the palmar side of the wrist, about three-fourths of an inch from the inner edge. Do not use the thumb or index finger in taking the pulse, as there is a slight pulsation in those fingers that makes the true pulse feel uncertain. Count each pulsation for a full minute and record. Each time note if the pulse feels the same. In fever cases, and other cases where there is toxic poisoning, the lift of the pulse will be quick and decided, with. perhaps, no increase in frequency. Such a pulse calls for expert attend- ance, as does one which beats so lightly it can scarcely be felt. An intermittent pulse is one that pulsates regularly for a few times, then skips a beat, repeating at intervals. This should be reported to the physician. Inexperienced or untrained nurses should not administer heart stimu- lants except under the direction of the physician. One can learn a great deal about the pulse by noting the quality or feeling of the pulse each time it is counted. Always let the arm rest comfortably when counting the pulse, and do not count for record immediately after the patient has been sitting up or is excited in any way. THE RESPIRATION. The number of respirations per minute should be counted when the patient is unaware of it. This can be done by watching the rise and fall of the chest. The normal respiration in an adult is from 14 to 18 per minute. In a child it is more, varying according to age. The quality of the respiration is also a study. In pneumonia and other pulmonary diseases there will be a marked increase of respirations. In case of worms in children, or any bowel trouble in infants, there is a marked increase. Any trouble with the heart, pleurisy, etc., causes short- ness, gasping, or catching of the breath. In counting for record, always count for a full minute. Do not record the respirations of a sleeping patient, unless it is done every time when he is sleeping. MEDICATION. It is never advisable to keep medicines in the sick room. The sight is annoying to the patient, and gives the room a drug store odor. They should be kept well covered in a cool, clean place. Remember cool drinks are appreciated by the sick, and tepid liquids are always distasteful. 250 MODERN NURSING. Hence, if the medicines are disagreeable to the taste, much of the annoy- ance will be removed by keeping them cold. Several large-necked bottles, carefully labeled for holding tablets, are indispensable. Poisons and disinfectants should be marked as such, and kept where danger from mistakes will be impossible. All cups, spoons, and glasses used about the patient should be kept clean and polished. This means a great deal to the sick. It is a bad practice to feed medicines from a spoon. Small, graduated glasses can be obtained from any glassware or drug store, and are indis- pensable in dispensing liquids. One swallow from a glass is much more easily taken than two or three from a spoon, especially if the medicine is bitter, or unpleasant in any way. All medicines containing iron should be taken through a straw, or glass tube, to keep the liquid away from the teeth. Milk and other liquids may be easily taken this way by patients unable to sit up, or to be raised comfortably. Dry powders given on the tongue often choke the patient. It is better to moisten with a little water or glycerine before administering. In giving powders, or tablets, have the patient extend the tongue for- ward, thus giving opportunity to drop them well back, and preventing them from getting under the tongue, or in the teeth. Oils are obnoxious to most people. They should be given in capsules when possible. A little strong, black coffee, taken before and after the oil, will remove the taste. A teaspoonful of sherry, or the juice of an orange, are also pleasant agents for covering the taste of oils. In administering bitter medicines, bear in mind it is the roof of the mouth and back of the tongue that sense bitter, and a straw- or glass tube can be used to advantage by those who object to it. Much care should be used in administering the anodynes, or any astringent medicines, since there is more or less danger of strangulation. A little knowledge of medicine will aid the nurse in devising simple, ingenious ways of covering the taste, greatly to the relief and comfort of the patient. There are other ways of administering medicines than by the mouth. Sometimes it is necessary to administer by rectum, by the hypodermic needle, or through skin absorption. Usually, however, these modes will be given under the direct supervision of the physician. A word on the giving of injections or enemata may prove useful. Usually the patient should be placed on his left side, with hips slightly URINE— FAECES— BATHS. 25 1 raised. A bulb, or Davidson syringe, is best, especially in the hands of the inexperienced. Prepare the solution, which may consist of from one to three pints of warm water into which white castile soap has been rubbed till a smooth suds has been formed, or it may be made of milk and water with oils, or in any other way the physician may prescribe. Place a bath towel under the hips of the patient to prevent soiling the bed. Oil the tip of the syringe and insert gently, not allowing the patient to hold his breath, which tightens the muscles. The end of the syringe should not be taken from the solution to allow air to get into the bulb. Press the bulb gently, and, when the solution is started, raise the bowl about a foot and allow the contents to slowly syphon out. This usually brings good results. URINE. From time to time the physician will wish to see a specimen of the patient's urine, and possibly want to make a chemical examination of it. Clean two or three four-ounce bottles and have ready for saving samples when called for. Always save the morning discharge for the doctor. Measure the quantity passed in twenty-four hours and record same on chart. Learn to observe whether the color is light or dark, straw color or amber, clear or cloudy, if there is a vegetable or ammoniacal odor. In fact, to keep posted as to every detail so that information of a valuable nature can be given if the physician should ask for it. In cases with high temperature the quantity will be small and very dark, almost wine color. Certain drugs will increase the quantity. Niter, Rochelle salts, etc., act in this direction. FAECES. What is said of watching the character of the urine applies also to watching the stools. Observe the color, condition, whether formed or liquid, if the food is digested or in chunks, etc. Report diarrhoea or constipation, and keep record of number of movements of bowels each day. For disinfecting urine and stools in contagious and infectious diseases see page 163. BATHS. How and When to Bathe — Baths are now extensively used in treatment of disease as well as for cleanliness. It is to be assumed that 252 MODERN NURSING. every person has a full bath at least once a week, otherwise the pores of the skin become clogged and cannot perform their proper function. Cleanliness is a prime requisite to the health of the body, and to the social status in all civilized countries. Baths as a therapeutic agent are very valuable when judiciously employed. They should be given only by order of the physician, but when ordered cannot be given too faithfully. The German rule for baths is modified in this country. According to Brand's idea, a cold bath should be given whenever the temperature reaches 103 ° F. The Germans, too, use a much colder bath than is com- monly used in this country. In preparing a patient for any cold bath, apply friction, either by using a coarse towel or the hands, to the entire surface of the body, to increase circulation. Place a cold compress on the head and back of the neck. If a tub bath is ordered it will be given only in the presence of a physician in the absence of a trained nurse, but bed baths, sprinkle, evaporation, and sponge baths can be successfully given by anyone with average common sense and a little practice. In fever cases, especially typhoid, when the patient needs bed baths, it will be necessary to know how to prepare the bed. In cases of extreme temperature a cold sprinkle-bath is often advised. To prepare for this use a large rubber blanket or oilcloth. Lay it flat on the floor and cover it with a sheet. Roll lengthwise. Place it on the bed, unroll toward the patient, tucking it carefully under him, when, with very little trouble, it can be reached from the opposite side, and the bed thus covered. Then roll two blankets lengthwise, putting one on either side under the rubber sheet. A pillow now placed at the head and foot, under the rubber, will form a very serviceable bath tub. After the patient has had friction applied as per direction above, wet a sheet in tepid water, wring- fairly dry, and wrap the patient from his neck to his feet, keeping the hands under the cover. The cold compress is already on the head. Take an ordinary whisk broom and a large bowl of water, first without ice, then gradually adding ice till the bath is finished. Dip the whisk broom in the water and quickly sprinkle the patient from head to foot. Continue this from ten to fifteen minutes, according to the physician's direction, absorb the water with a large sponge or bath towel, remove the wet linen and rubber sheet quickly, but gently, and wrap the patient in a soft blanket. Take the temperature a half hour later and you will usually find that it has dropped from one-half to a whole degree. A little experience with BATHS. 253 this bath and it will do very well instead of an ice water tub in typhoid cases. An evaporation bath is given by sponging the patient with tepid water, leaving the body moist, and gently fanning till the moisture evaporates. Repeat for fifteen or twenty minutes. Care should be exer- cised to prevent a draught reaching the patient when he is uncovered. This can be accomplished by improvised screens. In sponging, a piece of gauze or bleached cheese cloth is preferable to a sponge. The gauze can be shaken a few times and gets very cool. This laid on the patient for a moment, shaken again and repeated, serves to cool the skin, and feels very grateful. An alcohol sponge is given by exposing but small portions of the patient at a time, giving friction to the exposed parts until the blood circulates freely, then sponging with alcohol and water, equal parts. Pure alcohol should not be used for bathing, as it acts as an astringent on the pores. If alcohol is not at hand, a teaspoonful of salt to a quart of water will serve as a very good substitute. Vapor baths are sometimes desired in the home where there is no bath cabinet. A simple and convenient way to arrange one is by running a tape or string along the edge of a bed blanket, and gathering it about the patient's neck. Place a basin of hot water under a chair, seat the patient, protecting his feet and legs from danger of being scalded. Draw the blanket around the chair. Have ready a few, pieces of brick or small stones, which should be placed in the fire until very hot. Drop them, one at a time, into the basin. Keep the steam inside the blanket, and a profuse perspiration will soon take place. In cases of severe colds, grip, or asthma a tablespoonful of tincture of benzoate added to the water will prove beneficial. Much care should be taken that the patient does not take ccld after a vapor bath. Roll him in a dry blanket and cover well, letting him cool gradually. An improvised Sitz bath can be arranged by the use of a small washtub in the absence of a Sitz bath tub. Fill the tub one-third full of water, about warm enough for a bath. Have the patient sit in the tub with feet on the floor, using a folded bath towel to protect his back from the edge of the tub. Pour into the tub warmer water gradually till the bath gets hot as he can endure, having sufficient water to cover the hips. This bath is valuable in sciatica, kidney, and bladder troubles. Cold sponge bathing, in the absence of an opportunity to take a cold plunge in the morning, is most valuable to every one. It helps to 254 MODERN NURSING. ward off colds, reduces susceptibility of tonsilitis from draughts, and refreshes the bather at the same time. A cold sponge and a brisk rub down immediately upon rising in the morning starts the blood bounding through the veins and helps keep the doctor farther away. CLEANLINESS. Much care should be given to cleanliness in and about the sick room. That uncleanliness is sure to spread contagion has been proven times without number. Where due care has been exercised, even virulent infectious diseases have been confined to a single member of a house- hold. On the other hand, where soiled linen and clothing have been allowed to stand without disinfecting, where cleanliness of the patient and the nurse, or those in charge, has been neglected, whole families, and even communities, have had to suffer with such diseases as typhoid and diphtheria. One nursing or caring for the sick should bathe frequently. He owes it to his own health, and also to the sensitive feelings of the patient. People will no longer tolerate the "Sairy Gamp" nursing of Charles Dickens's creation. A nurse should be dressed plainly, preferably in some wash material, hair kept nicely in order, hands and nails immacu- lately clean. This condition will act as a tonic to a patient, while an untidy, unkempt person will be so disgusting that the mere presence will act as a check to all good agents. It behooves the nurse, then, to first look after her own person. Many patients will think that they are too ill to be bathed. This, however, is simply an erratic idea. Every morning and evening the face and hands at least should be carefully bathed, the mouth and teeth care- fully cleaned, and the hair brushed. Even in cases of unconsciousness, there can be no excuse for not bathing the patient. It is refreshing, beside being necessary to the health. We would earnestly impress upon the nurse the importance of the care of the teeth, tongue, and roof of the mouth of fever patients. Unless carefully watched and frequently cleaned they will become filled with sordes, hardening, cracking, giving the patient no end of annoyance, and the breath a foul odor. Have the patient rinse the mouth well with boracic acid solution, or a mild salt solution. Do not use soda, as it dries the membrane, and will cause the tongue and lips to crack. With CLEANLINESS. 255 a piece of gauze the mouth can be freed from all impurities, and the grate- fulness of the patient alone will be sufficient reward. Oil the lips with cocoa butter or cold cream. The nose of fever cases, especially typhoid and pneumonia, should be carefully watched, as the excretions become hardened and soon obstruct the nasal passages. When necessary, the nostrils should be oiled with a bit of olive oil. Do not allow the patient to pick at his nose, as a per- forated septum, or even worse results, may follow. A thoughtful nurse will watch out for all these little things, which amount to much in the long run. It is in just these minor details that the trained nurse proves valu- able, and those who have had no training cannot afford to ignore them. Always keep things free from dust in the sick room. This can best be done by going over everything lightly with a cloth dampened with a weak carbolic solution, or some other disinfectant. The dust should be removed at least once a day, as it will do much to prevent the dangers from disease germs floating about the house. All bed clothes, including the patient's bed robe, towels, etc., in con- tagious or infectious diseases, should be immersed in a carbolic solution. This will not injure nor stain the linen, and is a good germicide. They can be put in a boiler and quickly heated to the boiling point, but under no circumstances should they be allowed to stand without thorough dis- infecting. (For other modes of disinfecting see page 164.) In typhoid the bed utensils must each time be thoroughly cleansed and disinfected, for, be it remembered, that it is from the urine and stools that the disease is spread. Watch the bed linens carefully, and allow no spots to remain after the urinal or bedpan has been used. If small stains are found they can be disinfected with a solution of bichloride, without removing. Always bathe the hands of the patient after the bowels or kidneys have acted. To purify the air in the sick room, joss sticks, ground cloves dropped on a heated shovel or stove cover, or burned coffee, will prove agreeable. The better way to change the air is to close the sick room door, open the windows in the adjoining room for a few minutes, close them and open the doors of the sick room again, when pure, fresh air will take the place of the foul. Chloride of lime used in sick room utensils will aid in preventing the spread of the disease. Plenty of boiling hot water is another good agent. Vapo-cresoline, burned in the halls or at the entrance of a sick room, 256 MODERN NURSING. is an aid in keeping the disease confined to one room. In cases of diphtheria, it is well to vaporize formalin or formaldehyde, in the kitchen and other living rooms after the family has retired. All sinks, drains, closets, and lavatories should be kept scrupulously clean and disinfected. The nurse owes it to her own health, as well as to others, that no detail be overlooked where care and cleanliness are con- cerned. APPLICATIONS OF HEAT AND COLD. The use of hot and cold applications in relieving pain dates back as far as history can take us. Their many uses, or therapeutic values, were then little realized, and it is practically only a few years since an intelli- gent use of these important agents was reduced to a science. Formerly all pains, inflammations, and congestions were treated with a hot pack, regardless of cause, location, or consequence. Hot applications to the head to cool a fevered brain, hot applications to the chest to reduce con- gestion in pneumonia ; in fact it was thought anything cold meant death to the patient. It is only a few years that typhoid patients, burning with fever and dying with thirst, have been allowed ice and cold water, the one great factor used to-day for their recovery. It stands to reason that cold, sensibly applied, will tend to reduce temperature, prove more grateful to the patient, and gain the end desired, where heat would but aggravate the disease. The question is when and where to apply heat, and when and where to apply cold. Should they both be applied at the same time ? Common sense and a scientific knowl- edge of their effect will help us to decide. First, in applying both heat and cold to the body, rubber water bottles are indispensable. They keep the bed and patient dry, and hold the heat or cold longer than the pack, and are in every way to be preferred, except where some medicinal agent, as turpentine, mustard, or ginger, is desired to act as a counter-irritant. In cases of injury to the head or spine, a bottle of ice water placed against the back of the head and neck will tend to reduce delirium, or brain fever. At the same time use a hot water bottle at the feet; also for the hands, if they are cold. In an attack of appendicitis, or any inflammation of the bowels, cold applications are to be preferred. They will allay the pain, reduce the temperature, and quiet the patient. An ice water coil is the proper HOT AND COLD APPLICATIONS. 257 apparatus for applying cold to the abdomen, it being light, and the con- stant stream of ice water running through keeps it cool. In pneumonia, where the physician desires cold applications to the lungs, it is not usually convenient to apply an ice jacket in the average home. Several water bottles half filled with ice water and frequently changed, if packed around the patient's chest, will do very well. When hot packs are ordered, or desired, the same mode of treatment may be followed with the use of hot water, eA*ery care being exercised to prevent burning the patient. When hot packs or fomentations are ordered old flannels folded into large squares are to be preferred. By sewing the ends together and in- serting a stick at each end they can be wrung out very hot, without injury to the hands. One surface should be cooled before applying to the patient. Abdominal packs are frequently used to reduce gases, etc. When the patient seems excited and nervous from the hot applications, a cold water bottle on the back of the neck, or a cloth wrung out in ice water placed on the forehead, proves soothing and quieting". Poultices should always be applied warm or hot, as the chief object in using them is to hasten the decomposition of the tissue. Extremely hot baths in cases of languor, fatigue, depression, or a general aching of the body will prove a great relief. Fill the bath with water as warm as one can get into, then allow the hot water to continue running in till the bath is as hot as the patient can stand. A few ounces of sea salt added to this bath will increase its value. A brisk rub down with a coarse towel, and a good night's rest, will often prevent a serious illness. People in general do not use enough hot and cold water, either inter- nally or externally. A large quantity should be drunk every day to increase the sewerage of the system, and copious quantities used in bath- ing to keep the sewer gates open and the body in a healthy condition. FEVER NURSING. Probably the most important division of nursing is fever nursing. It is then, if ever, the patient's life depends on the eternal vigilance of the nurse, and it is then that the nurse from the first owes herself proper food, rest, and exercise in order to endure the fatigues which naturally attend a long illness. Self-sacrifice is not always unselfishness. The nurse who best cares for her own health takes best care of her patient. 258 MODERN NURSING. Fevers do not necessarily mean high temperatures. People may run high temperatures and still not have a fever. A sudden chill, a slight cold, or an attack of indigestion may send the mercury up two or three degrees, but, if it is nothing more serious, a second reading of the thermometer a few hours later will find the temperature fallen back nearly to normal condition. In fevers the temperature goes up and goes down again, but is sure to rise, probably a little higher each time during a certain period. For instance, typhoid fever is caused by the poisons produced by colonies of microscopic germs in the bowels, which, strange as it may seem, live their lives in a series of sevens. This is called an "expectant fever," it being expected that the germs will have spent their force in fourteen, twenty-one, or twenty-eight days. This fever does not usually run more than four weeks, unless the patient becomes reinfected, and a new colony of germs begins work. The old idea of "breaking up" typhoid fever has long since exploded. Now, where we feel confident we have a case of real typhoid we settle down to work, hoping for the crisis in fourteen or twenty-one days, and in the meantime bending our energies to keep the unnatural fire from consuming the patient, by natural and artificial means of feeding it, and radiating the heat by means of baths, etc. In cases of this nature, where trained service is not available, it is of vital importance to make the next best choice, by selecting one whose personality will adapt him to the work, and to this one give right of precedence. In order to make a success in the sick room one must have a kind nature, at the same time be firm and decisive where necessity demands. One should be ready to obey the physician's orders implicitly, no matter what theory or reason he or she may have in regard to the matter, assuming from the beginning that the physician worthy of your employment has a superior knowledge in all matters pertaining to the disease and its treatment. There can be no liberties safely taken in fever nursing. It is far better to unflinchingly carry out the orders as nearly as possible in the manner prescribed. It is in these cases that the chart, baths, etc., already described, play an important part. Accurate, intelligent reports enlighten the physician as to the true condition of the patient ; they are the index to complications which are almost sure to arise in one form or another. Continued or expectant fevers are usually attended with more or less delirium, especially when attended by high temperatures, or the patient is of a nervous nature. In these cases there is usually low mut- FEVER PATIENTS. 259 terings when the patient is in a restless sleep, and on waking they fancy they see people or objects which greatly excite them. It is better never to leave patients in this condition alone, even for a moment, as they may leave the bed, jump from the window, or do themselves serious injury almost in an instant. It is better to agree with them, even see things with them at times, soothe them by bathing the forehead, and gain their confidence in every way. This will soon dispel all fears, and your very presence will drive all disturbing visions from the bewildered brain. It is vastly important that the patient be fed. but the diet will doubt- less be milk, or some prepared liquid food, for many days. Until the crisis the patient will be satisfied with this restricted diet, but once the temperature drops and the fever turns, the craving for food is usually so great as to make the patient's appeals almost heart rending. Xow is the time when gentleness must be combined with unquestionable firmness. Five to seven days must usually elapse before the first morsel of solid food can safely be taken, and then in such insufficient quantity at first as to be only aggravating to the starving convalescent. However, to dis- obey the physician now will likely undo the good work already done, and most undoubtedly cause the death of the patient. It is better to withstand the pathetic appeals than to let your tender heart be touched to the extent of yielding. Practically, the most important part is played after the fever has abated. During a continued fever many complications are likely to arise, among them hyperstatic pneumonia, which comes from lying in one position too long ; pleurisy, caused by a slight cold, indigestion, or it may arise from lameness of chest caused by patient raising himself in bed. Hiccough is one of the worst complications, and fortunately does not frequently occur. Of course, in typhoid there is always danger from perforation of the intestines and from peritonitis. Much attention should be given to the condition of the bowels. Xurses are indirectly responsible for much of the trouble caused by the inaction of a patient's bowels and kidneys. That they move freely is of grave importance, and if they are allowed to become constipated and inactive, the great sewer through which the substance of the poisonous matter must pass be clogged, there will be no end of trouble : a rise in temperature, a toxaemia from intestinal absorption, and a greater liability to perforation. Such conditions should be reported to the physician, who will look to the matter at once. A careful watch should be kept of the stools to see if the food is being properly assimilated. 2<5o MODERN NURSING. The importance of cooling" baths is in every way evident. By proper friction to bring the overheat; 1 blood bounding to the surface and cold water applied to cool the surface, it can be readily seen that the intensity of the fire will be reduced for a time. Hence, as has elsewhere been urged, baths cannot be too faithfully given. In the lesser fevers much the same line of nursing and attention is necessary. A frequent change of well-aired linen, thorough cleanliness about the patient and the house, systematic methods of "doing things" for the patient, all play an important part. In all cases of severe illness, rest and quiet are absolutely necessary. A fever patient is in no condition to receive visitors ; even the members of the family, not strictly obliged to assist in giving necessary care, should be excluded from the sick room for the patient's good. Where there is no trained nurse in the house this rule is likely to be overlooked, but in every case should be rigidly enforced. General principles, only, can be laid down for general nursing, since cases and circumstances will not admit of fixed rules. Helpful sug- gestions — suggestions born of a long and varied experience — can only be offered, and the rest is left to the thoughtfulness and intelligent obser- vation of whoever undertakes this most important work, whether from force, duty, or love. With the appearance of new symptoms we must look for complications. Quick wit. keen observation, and experi- ence will do much to check many of them before they get settled. For instance, common sense will teach us that to prevent hyperstatic pneumonia a patient should be occasionally turned in bed so that he does not rest continuously on his back or either side. That every caution should be used to prevent a patient from taking a direct draught, and in case of pleurisy that absolute quiet is necessary. If pains are extremely severe bind the chest tightly with a towel or laced jacket, which will diminish the chest action and reduce the pain. Thus will one need to be ready for any emergency. To be cool, col- lected, resourceful, is primarily essential to every one entering a sick room. Nervous, irritable, helpless attendants are worse than useless and should keep within their proper sphere. SURGICAL NURSING. It seems practically unnecessary to say much on the subject of sur- gical nursing. Most cases of major importance will be taken to the SURGICAL NURSING. 261 hospital, or a proficient, trained nurse will be necessary if the operation is done at home. Minor cases, however, may be treated in the home, and a general idea of what to do and what not to do may prove of value. Since all disease is based on a germ theory and all cures on an elimi- nation of the cause, we must then admit it is necessary to destroy all germs or prevent them from coming in contact with clean wounds. A surgically clean wound will heal by primary intention; but should disease germs enter we shall find that complications will soon arise in the form of pus, decomposition or gangrene, and blood poisoning. Hence, the im- portance of keeping all cuts, bruises, etc., from infection. A simple cut or bruise on the finger is practically in more clanger from infection than the wound from the amputation of an arm or leg simply because less precaution is taken. We have seen most serious cases of blood poisoning from a simple bruise of a finger nail, which was thought to be of too little consequence to have proper treatment. In cases of cuts and bruises be sure that the basin or bowl in which the part is to be bathed has been thoroughly scalded with boiling water. For bathing wounds use only w^ater that has been boiled, to which has been added a ^mall quantity of carbolic acid, creolin, or some other germicide. In case there is no germicide at hand a spoonful of salt will answer very well. Only clean bandages that have been baked or soaked in an antiseptic solution should be used as dressing. People often remark that severe wounds are sometimes dressed with soiled hand- kerchiefs or other linen and do not become infected. True, they do not always become infected. Nature provides an antiseptic fluid in the blood, which goes a long ways to exclude germs. But surgical cleanli- ness, so far as is possible, is always advised. In case of important surgical dressings, of course, a surgeon will do the work, or directly supervise it. In cases of accidents or emergen- cies it simply remains for those at hand to see that due caution is used to prevent infection before the surgeon arrives. (For Accidents, etc., see page 571.) CARE OF CHILDREN. It is a lamentable fact that small children do not always receive the careful attention in sickness that their elders demand. Because a child is young and unable to talk or make itself understood there is all the more reason that the mother, or those into whose care the infant falls, should make a study to discern its wants and requirements. 262 MODERN NURSING. We believe that most small children suffer from thirst and especially when they are ill. How can one who is nursing a child which is run- ning a temperature or burning with fever so far forget the delightful sensation of cool drinks as to fail to give the little sufferer a spoonful of water every now and then? Will it not prove as refreshing to the tiny mortal as to a man? And again we have often found that no thought is given to quiet for the sick baby. Doors are allowed to bang, the family bustle about and talk in loud voices, when if the little face be watched shadows of pain will be seen to pass over it with every sound. Yet, it can make no intelligent outcry against it. Babies need quiet, careful, thoughtful nursing even more than an adult. They need liquids in small quantities, but frequently. Their tiny brain needs the consideration that older people demand, and it is our duty to see that they have it. At the time children are teething they are usually fretful and peev- ish. The little gums are swollen, the stomach gets bad, and the child is ill. Many times convulsions occur at this period. In that case place the child in a very warm bath, chafe the hands and feet, massage the body quickly and roll in a warm blanket. A physician should be called at once, who may find it necessary to lance the child's gums, or, at least, will leave something for local application to alleviate the pain. When- ever the child gets fretful and tired a warm bath will be grateful and a refreshing sleep will naturally follow. If all babies and small children should be given a general massage at bedtime there would be less sickness, fewer pale, weak ones, and a marked decrease in the number of deformed boys and girls in the world. Ten or fifteen minutes given to the little one at bedtime is time valuably spent, for it will give health, strength, and a fine physique to the child and prevent many of the petty illnesses. Many mothers keep babies in a room that is too warm, or covered so heavily that the tiny creatures cannot move. This should be avoided as it will be likely to deform the little limbs, cause curvature of spine and general weakness. Place two or three water bottles partly filled with warm water about the child and cover lightly and give the little one fresh air. VISITORS, FLOWERS, ETC. One of the worst features of home nursing is the lack of discipline in the sick room. Patients are allowed to talk at night, often spending VISITORS AND FLOWERS. 263 the entire night in sleeplessness, and then sleeping nearly all day. Have it understood that the night is designed for rest, not only for sick people but also for the other members of the household, and that it is a duty we owe to the family to be as quiet as possible. This will soon have its effect, and, save on rare occasions, there will be no more trouble in this direction. Another thoughtlessness on the part of those intrusted with home nursing is allowing visitors in the sick room. A patient will strive to be gracious and cheerful, appreciating the good intention of the caller, while at the same time his nerves are keyed up to a high pitch and there must necessarily be a reaction. Probably a sleepless night will follow, a depression of spirits and a rise in temperature, all of which will cause uneasiness. It is far better to exclude every one from the sick room save those in attendance. A careful nurse will not ply a patient with a multitude of questions nor allow him to carry on long conversations. All these things are a mighty help toward the desired end and cannot well be overlooked. Do not ask a patient if he will have this or that thing done. If it is the proper thing to do go at it without troubling him. It is a matter of business and should be treated as such. Do not encourage a patient in wanting constant attention. There is quite as much danger from over- doing as there is from doing too little. Sick people need rest and quiet. They are Nature's great restorers. Flowers should not stand in a sick room. Roses, violets, and lilies all have a heavy odor, which soon becomes nauseating. Flowers are beautiful and very few patients are unable to appreciate the sight of them. When flowers are sent by anxious friends they should be taken to the patient for a few minutes, if his condition will admit, otherwise even the knowledge of their having been received should remain a secret with the cards or names of callers, until convalescence is established, when the joy of knowing that friends have been thoughtful will be sufficient and no risks taken. It is always better to conceal things from patients that cannot benefit them. What they do not know cannot harm them and to keep them posted on trivial matters gives them material for anxiety and unnecessary concern. WHAT NOT TO DO IN THE SICK ROOM. Do not revolutionize conventional customs in a moment. Make changes gradually without annoyance to the patient. 264 MODERN NURSING. Do not annoy the patient with useless questions nor carry on long conversations. Keep the sick room quiet and restful. Do not allow visitors or other disturbing influences to enter the sick room. Keep out all news of exciting nature, business matters, or anything likely to worry or annoy the patient. Do not allow soiled towels, glasses, or other utensils to remain in a sick room. Do not neglect to bathe the patient every morning and evening. Do not get excited in emergency cases. Be calm and collected and use your knowledge to good advantage. Do not give alcoholic stimulants to people with bleeding wounds or hemorrhages. Alcohol causes an increase in muscular action of the heart and consequently a greater flow of blood. Do not lose your dignity or temper before a patient. Be pleasant and forceful, sympathetic, but unflinching in duty. It is the only way to be successful. Do not try to deceive the patient or the physician. You will but deceive yourself and lose the confidence of both. Be willing to admit a fault or a mistake and do your best to make amends for it. Do not sing, whistle, hum, chew gum, rock your chair, or rattle the pages of a book or paper. Sick people's nerves are sensitive, and, though they may try to bear it rather than object, it is very trying and exhausting. Do not make the patient feel under obligation to you, yet at the same time do not let him get the idea you are his slave. Friendly rela- tions will prove a great help in the work. Do not neglect little things. Details count in long illnesses. Do not bustle in and out of the room more times than necessary. Make every step count. Do not always sit in the room or watch the patient unless he is delirious or for other reasons requires constant watching. It makes most patients nervous to be watched like a convict. Sit just outside where a low call or a slight movement will attract you. Do not neglect your own meals, rest, and recreation. Remember the best nurse is the one who takes best care of herself and thus fits herself to give best care to a patient. Do not think a little knowledge of nursing sufficient. Study and become competent to do the work well CONVALESCENCE. 265 CONVALESCENCE. Most people do not realize the necessity of a complete recuperation from even a light sickness. The convalescence period should be watched and the patient carefully nursed and nourished that no serious complica- tions may arise and the result be impaired health for life or an un- timely grave. Convalescents are generally weak and emaciated, with ambition far exceeding their strength and judgment. Such should be carefully curbed in their desires and an ever watchful eye kept on them to be sure they do not take undue advantage during the absence of the attendant. Xow is the season when a careful, nourishing diet becomes a study. The stomach must not be overloaded, nor filled with indigestible foods, for it must be remembered the whole system is weak and cannot be over- worked. Small quantities served regularly and daintily, pure, fresh milk, carefully selected fruits will soon bring back strength and color. Bathing should not now be neglected. A tepid bath and brisk rub with a turkish bath towel, every morning, will freshen the skin and send the blood bounding along for the day. And this is the time when massage plays an important part. A thorough, scientific treatment be- fore retiring for the night will rejuvenate the nervous system, enliven the muscles, rest the patient, and give the entire body exercise which it so much needs and which at this time it can get in no other way. If the weather permits, a ride or walk in the open air and sunshine is of inestimable value. Let Nature do all she can toward the restora- tion of health. The trees and flowers, the hills and streams, present views which are a tonic for the heart and mind, and the fresh air, the smell of the earth, and the glow of nature give new hopes, new ambitions, and desires to get well. Do not let the convalescent get overtired. It is such a relief to leave the bed he often wishes to sit up too long at first. This should not be allowed. It is better to rest for a while than to tire the nerves and muscles, and risk a relapse. Again, be careful of draughts. Do not allow the patient to sit before an open window with a door or an- other window ajar in the room. Give him all the sunshine possible and make his surroundings so cheerful that he does not become depressed. Visitors may now prove their good will, few being admitted at first, and at no time a regular reception to be given. Use tact, judgment, 266 MODERN NURSING. and common sense now as during the illness. Do not think the dan- ger is all past till the recovery is complete. A thorough and proper convalescence is slow. To hurry it beyond reason is to undermine the health, and nothing will be gained. Make haste slowly. An extra week or two in which to recuperate may mean a long life of happiness, while injudicious treatment may mean impaired health and years of misery. MASSAGE. Introduction. — That there is an unjust prejudice against massage and those who practise it is realized and lamented by all legitimate masseurs. That the treatment has been abused and the profession scandalized by unscrupulous impostors must be admitted, but it does not lessen the value of the treatment. All professions have quacks, who, for a time, injure those who do an honest business, but in the end they are themselves the injured. That massage is used the world over in the treatment of disease and to preserve physical health should be sufficient indorsement. The world's best physicians and surgeons rec- ognize in it a vast benefit to a large class of patients and are each year recommending it to greater numbers. It is only those who are ignorant of the treatment and its benefits that are ready to condemn it. Every one who has been confined to a sick bed remembers how comforted and rested he felt after having his aching back rubbed for a while, or how soothing and refreshing it was to have the feet and hands chafed when he felt tired and sleepless. That was a crude form of massage which proved an agreeable agent. How much more beneficial, then, would be a knowledge of how to do the work in a practical, scientific way ! Massage is a treatment whereby the muscles, nerves, and blood ves- sels are scientifically manipulated by the means of systematic rubbing, rolling, kneading, moulding, thumping, squeezing, slapping, and whip- ping until the body has received the necessary exercise and the blood is hastened along its course, thus rejuvenating the entire system. Space will not admit of a long discussion of its uses and abuses, nor is this article intended as a text-book on Massage. It is written with the idea of giving to the layman a fair idea of the treatment, that when professional service is not available he may be able to render practical service where it is required. SYSTEMS OF MASSAGE. 267 Its Uses and Benefits. — As has already been stated, massage is bene- ficial in restoring and preserving health. Certain diseases require an enervating exercise which the patient's lack of strength will not permit. People, like lawyers, bookkeepers, stenographers, and others who lead sedentary lives and do not have time or energy to take proper exercise, require the treatment to keep themselves in good physical condition. For that tired, lifeless feeling, nervousness, sleeplessness, constipation, sciatica, contraction of cords and muscles, paralysis, stiff joints, and many other diseases and complications to which the flesh is heir, there is no greater or better remedy than thorough massage, given by one who is intelligently capable of administering the treatment. We cannot go into detail in describing the differences and similar- ities of different systems. A general description will suffice since they all tend to the one great end, exercise, rejuvenation, and development. The Swedish system is vigorous, bracing, and in its true form can be given only to strong, muscular, hardy people like athletes. It exer- cises the muscles to the bone, giving to the subject at each treatment the benefit of an eight mile walk without the fatigue. The German system is less vigorous and is usually given in connec- tion with baths. This treatment is suitable for the average patient who has not been reduced to a weakened condition by a long illness. This treatment can also be given to fracture cases with gratifying results after the bones have become firmly knitted together. Practically speak- ing, German treatment is a modification of the Swedish system, omit- ting Swedish movements and substituting the baths The French system is also called the Beauty treatment, and is a deli- cate manipulation, designed especially to keep the skin free from wrin- kles and blemishes. It is given mostly to the face, neck, arms, and hands, and is a wonderful developer and producer of beauty. The fact that so many Parisian ladies remain beautiful even to old age is greatly due to beauty treatment and the excellent care they give to the skin. French massage is not particularly beneficial to invalids, save as it gives a re- freshed feeling to the skin. When to Give Massage. — In giving massage treatment there are several things to be thought of and considered. First, the room should be warm and free from draughts. Second, the patient should be in a condition to receive the treatment. Owing to the tender condition of the bowels in typhoid it is extremely dangerous to give general massage. In case of a very weak heart the increase of circulation from vigorous 268 MODERN NURSING. massage would be disastrous. Hence, it is necessary to have some practical knowledge of diseases or consult a physician. In case a subject perspires freely give a cooling sponge bath and use a little toilet powder. Do not massage a moist skin. Where the patient is covered with a heavy growth of hair, as on the arms and legs, it will be necessary to use extra precaution or repeated treatments will cause irritation at the roots and abscesses will form. Do not rub these parts in the opposite direction from which the hair grows. Do not massage over the breasts or navel (umbilicus), use a circular motion from left to right in these sections. Do not be afraid of getting too near the bone in deep muscles, nor use too much force over the bowels and vital organs. The old idea that in rubbing a patient one should always rub toward the end of the fingers and toes is quite wrong. The fact that the veins lie near the surface and carry impure blood back to the heart and thence to the lungs to be freed from its impurities, is sufficient reason for rub- bing or massaging toward the heart, thus hastening it back with all its poisonous load. Hence, in giving massage treatment, always work to- ward the heart in circular movements from left to right. To produce or induce sleep begin with the head, then massage the arms, the body, the legs, and finish with the feet. This brings the last great rush of blood away from the head and leaves the brain cool and quiet. Downward strokes in massage, as in hypnotism, have a sleep- producing effect, while upward strokes, bringing the rush of blood to the head, have the effect of making the patient wakeful. Massage should not be given immediately after a hearty meal nor on an empty stomach. It is better to wait at least an hour after a full meal, and if massage is given in the morning it is better that the patient take a glass of milk, an eggnog, or something light before the treat- ment is given. Usually the patient will wish to remain quiet for half an hour or so after having massage. This is to be encouraged as it les- sens the danger of contracting cold and the subject will feel more re- freshed for the rest. Expose only the part being treated and cover this surface before beginning a new section. We do not advise the use of creams or so-called skin foods in the general treatment. Oils grease the surface, prevent the friction and transmission of vitality of the masseur, clog the pores, and are use- less save in cases where they are advised by physicians for throat and pulmonary troubles. Then the part should be first thoroughly treated HOW TO MASSAGE. 269 without the oil, which may later be applied and massaged in. A clean, fresh skin treated with the clean, bare hand of the operator will prove of greater benefit than any applications. The question is often asked. "Is it necessary to expose the body? Cannot the treatment be successfully given through thin clothing?'' To this we would say that treatment can be given with value to the subject through clothing, but the mere fact that the hand of a strong, robust, healthy manipulator transmits more or less of his vital energy is sufficient reason that clothing should be discarded. It is never nec- essary to expose a patient enough so that the most sensitive need object to the treatment from a first-class masseur. But. if one is to have treatment through clothing or a blanket, why not resort to purely mechanical massage? Some masseurs with an enviable reputation re- fuse to give treatment with the bare hand, claiming too great a loss of vitality through transmission by contact. Such operators wear rubber gloves. Importance of a System. — From the foregoing statements of facts it will be readily seen that it is essential that there be a system for giv- ing massage treatment if one would have beneficial results. It has been our experience that no one system will apply to all cases ; that it is necessary to modify any system or perhaps combine the several as the case at different stages demands. We would not give to a patient, emaciated and weak from a fever or long illness, a vigorous Swedish treatment at the beginning of his convalescence. Such a treatment to a well, strong man, if he were not accustomed to massage, would bruise his muscles and make him so lame and sore that he would think he was the victim of a prize fight. On the other hand a gentle, easy treatment would be of no great benefit to a football player or athlete. One must exercise reason in the case. Begin lightly with delicate cases, increase the pressure from day to day until the muscles become accustomed to the treatment. Later, as the muscles become hardened, rounded, and full, it will require a great deal of strength to give a treatment that will be beneficial or satisfactory to the subject. Always begin the treatment in the same manner and take each manip- ulation in its turn. A raised couch or table, narrow enough to enable one to work handily from either side and high enough to relieve strain from the operator, is necessary. Have patient lie fiat on the back with muscles all relaxed. In treating the abdomen have patient draw knees up as it relaxes the abdominal muscles. When one side has been treated *70 MODERN NURSING. the patient will lie face downward while the muscles of the back and buttocks receive treatment. How to Give a Massage. — Beginning with the head, rub the scalp with the finger tips in a brisk, energetic manner to start circulation there. With a rotary motion massage the face, beginning with the chin and working upward and outward toward the ears, till a healthy glow appears. This is not intended for a beauty treatment and five minutes is sufficient for the head and neck. Next raise the arm and from the tips of the fingers stroke to the shoulder a few times, to start surface circulation and prevent chilliness. This should be done in exposing any part of the body. Beginning with the tips of the fingers rub each joint separately with a circular move- ment much as you would in putting on a new glove. Working toward the palm, massage each joint, following the palmar bones to the wrist. It is here that the long muscles and real work begins, (i) With the arm grasped with the two hands use the thumb side in a parting motion, as if the muscles were being divided or parted from the bone. This should be done the entire length of the arm, or in any long muscles. (2) Next, wring or twist the muscles much as you would wring a wet sheet, the hands acting in opposite directions. This movement drives the blood with force from the muscles and arouses the nerves to a keen sense of being. (3) Knead the muscles next, by placing one hand on the underside and with the ball of the thumb and a grasp of the hand roll the muscles with a slow rotary motion from left to right. This should be thoroughly done on every muscle, following the general direction of same. (4) Next, begin with the end of the fingers, with quick, firm grasp squeeze the muscles, hastening the blood on toward the heart. By this time the skin should be in a healthy, pink glow; if not repeat the treatment. Massage the elbow joint carefully, leaving no spot unexercised. To increase the glow and bring the blood to the surface whip with the fingers by giving them a quick, sharp shake, like the snapping of a whip, flaying the patient not too severely. On deeper or larger muscles this should be preceded by a hacking motion. Open the hand, extending the fingers, and use the outer side of both in a quick chopping or hacking motion. The shoulder and hip joints should receive careful attention, work- ing deeply, getting near and around the joint until it is thoroughly treated. In treating the chest lay the hand flat, giving greater weight to the HOW TO MASSAGE. 271 thumb side; use a twisting motion from left to right, avoiding pres- sure over the nipples. Next, grasp the flesh between the thumb and index finger near the short ribs, and with a creeping movement roll the muscles upward. Repeat the treatment several times. A healthy red will usually quickly appear on the chest. To treat the abdomen have the patient draw the knees well up, re- laxing the muscles. Place the hands flat on the bowels near the hips, and with weight from the wrist roll the hands forward to the tips of the fingers. This must be done firmly and gently so as not to injure the patient. Continue the rotary motion here as in other sections. Work well over the liver on the right side. By a little experience the bowels can be most thoroughly and deeply treated without causing the patient annoyance, and with great benefit in cases of torpid liver, con- stipation, etc. Treat the legs in the same manner as the arms, using greater force in case of deeper muscles, and going over these parts several times with the same treatment. This is necessary on account of the greater depth of muscular tissue, larger blood vessels, etc. Large, deep muscles will stand a great deal of thumping with the fist, hacking, and slapping with the open palm. In treating the back, always begin with the back of the head and neck, massaging thoroughly at the base of the brain and along the spinal column. Here lie the nerve centers and it is necessary to give them a good stirring up, to put new life into them. Treat the back much as the chest is treated, rolling the muscles well between the thumb and finger, and with a circular motion. Flay the spine till it gets decidedly rosy. When the entire body has received treatment some simple Swedish movements will be beneficial and refreshing. Beginning with the hands rotate each finger from right to left four times, then in the opposite direction four times. Treat the wrist in the same manner, raise and straighten the forearm, the patient using a little resistance. Extend the arm, grasping the wrist and elbow. Move it in a large circle four times one way and reverse the order. The feet and legs may be treated in the same way. This makes a very satisfactory finish to the massage treatment and will prove very grateful to the patient. In treating special cases a general knowledge of massage is neces- sary. The better one understands anatomy and is able to follow the direction of the muscles, the better treatment he will be able to give. 272 MODERN NURSING. Forty-five minutes is required for a general massage, and will usually be as long as the subject or masseur cares to put into a treatment. In giving local treatment follow general rules for that section of the body. In cases of localized fluid, synovitis, local inflammation, etc., massage away from localized point. In fracture cases do not massage directly over the fracture. Massage on both sides to increase circula- tion and nutrition, thus adding strength to the union. In cases where patient is confined to the bed and unable to be moved, a general, gentle treatment of all parts that can be conveniently reached will greatly rest the patient. Instead of "rubbing" a patient in the old fashioned way, treat him with genuine massage movements, which will prove more grateful and beneficial.. MASSAGE FOR SPRAINS, BRUISES, ETC. In case of sprains, as for example when the cords of the ankle are strained or lacerated, the condition will very soon become painful, swollen, and black. Ascertain if the bones are all in proper place; if so, raise the ankle high, and massage evenly and lightly the affected part for half an hour or more, rapidly driving the blood away from the spot where it will be likely to settle because of the torn condition of the capillary cells. By faithfully massaging the joint much of the cedema will be prevented and the pain will be reduced, Bathe the joint with a hot salt solution and bandage tightly. In massaging sprains use the circular motion with the ball of the thumb, the "parting" movement to increase venous circulation away from the joint, and the tips of the fingers directly over the affected part to encourage circulation through the injured cells. To prevent blood from settling in a bruise, massage thoroughly, driving the blood through the bruised part until a new circulation is established. Hot fomentations will assist in the removal of discolora- tion. After treating in this way, bind a thin piece of well pounded raw beef over the part for a few hours and there will be little annoy- ance from discoloration. The massaging should be done as soon as possible after injury, before the part gets sensitive to the touch. BEAUTY MASSAGE. It is safe to say that the majority of people do not enjoy the approach of old age and decay, and desire to prolong youthfulness in BEAUTY MASSAGE. 273 every way as long as possible. Gray hairs are no longer considered a harbinger of old age nor do they usually detract from a person's comeliness. Wrinkles, a parched, withered, lifeless skin, flabbiness of the muscles, puffs under the eyes, sagging of the corners of the mouth and a general heaviness of the lower part of the face are the noticeable signs of years. Intemperate habits, late hours, worry, churlishness, and overwork encourage decay. Sluggishness, torpidity of the liver, and illness promote sagging of the muscles, sourness of expression, and general ugliness. If one would retain the youthful look, one must first consider the health and habits. Nature will do her part to make all things beautiful, and while old age when sweetly attained is the glory of a life, ugly wrinkles and blemishes are unsightly to everybody. Outside the savages, who delight in making themselves hideous, there is no man or woman of intelligence who does not wish to look well. One can be proud of his person and yet not vain. Artificial beauty through cosmetics and accessories may be vanity, but to preserve the youthful, healthful vigor of the skin, the delightful contour of the face, to eradicate the signs of dissipation, fretfulness, and severity, cannot be considered vanity. In order to do this one must have a purpose and this purpose an ideal; and since ideals usually lead to loftier sentiments and aspirations, the desire to retain the beauty of youth must be most highly commended. A haggard, seamed, distorted face is not only repulsive, but elicits little sympathy from the world. No matter how the heart may have been wrrtng to cause the unsightly furrows on the brow or about the eyes, the world is looking for beautiful and fresh faces and will not stop to inquire if the wrinkles have come from honorable old age, or have been cultivated by a life of dissipation, ribaldry, and unhappiness. True, the lack of happiness in certain classes produces premature signs of decay, even on the faces of innocent children. The more the pity, and the more the necessity of knowing how to cultivate beauty. Perfect health, cheerful surroundings, pure manhood or womanhood will keep the ravages of time at a long distance. This we all wish to do. In order to keep the skin fresh, the pores must be kept open and the face frequently bathed to free it from impurities. Hot water should rarely be applied. It is better to use a tepid bath, with some pure, carefully selected toilet soap, in moderate quantity, when the skin is 274 MODERN NURSING. oily or necessity requires. Great care should be exercised in bathing and drying the face not to injure the epiderm or outer layer of skin, leaving it rough and scaly. Under exposure to the heat of the sun's rays, the rough winds and storms will injure this delicate skin unless it is carefully treated. People who live in a cool, dry climate have the best and most easily kept complexions. We do not recommend the general use of creams, skin foods, and cosmetics so much advertised. More or less of them are harmless and quite useless, while some are injurious. Purity of the skin by steam- ing and bathing is better than artificial means of opening and clogging the pores. Sometimes a cream may prove of value, as in the case of sunburn, dry or parched skin, blackheads that cannot be easily removed by steaming and bathing, etc., but generally, a clean, healthy skin will be its own scavenger. To aid in eradicating wrinkles, rejuvenating the features, develop- ing the muscles, assist in removing decomposed tissue and in hasten- ing the up-building of new, a light, firm, scientific massage will prove of immense value. In order to have it prove of greatest value it will be necessary to understand the reasons for the treatment. First, massage hastens circulation, and, since nutrition depends largely upon circulation, the building of new tissue is accelerated. Secondly, the manipulation of the muscles causes development, thus the parts most exercised will develop or fill in; hence the necessity of great care in massaging for eradication of displeasing features, such as wrinkles, double chin, suspended or flabby muscles, etc., not to increase them. The reason for massaging the face before wrinkles appear is clearly evident. To keep the skin fresh, the circulation perfect, the impurities removed, the muscles from sagging, and undesirable features from developing is reason sufficient. Anyone can keep the face fresh by giving it a few minutes of daily attention. It is always better for a second person to massage the face, since it is easier and possibly the results are more satisfactory, though this is not absolutely necessary. A good way to do where professional service is not available, is for one to massage another's face, and in return receive a treatment. This can be most successfully done where both parties are careful and interested. TO MASSAGE THE FACE. Seat the subject in a high back chair with the head thrown back and the face up-turned. Wring a napkin in very warm water and TO MASSAGE THE FACE. 275 cover the face for a few minutes, repeating two or three times. Dry the face gently and the skin will he in a fresh, susceptible condition for good work. Stand at the back of the chair working from the lower part of the face always toward yourself. This will have a tendency to bring the muscles up, relieving the heavy look about the lower jaw. In massaging one's own face this should be borne in mind, that the stroke should be upward and outward toward the hair. Begin with the chin, and, with the tips of the fingers and a light gentle stroke, draw the muscles back and up over the ear. With the fourth finger (counting the thumb as the first finger) supported by the thumb, used as a brace, massage the wrinkle across the chin length- wise with a smooth, light, circular motion. All wrinkles should be massaged lengthwise instead of crosswise. Massage the lower lip in the same manner drawing the motion well up past the corners of the mouth. The entire face should be massaged with this same gliding circular movement, working the wrinkles of the forehead and about the eyes well out into the scalp. Massage the upper eyelid by carefully pinch- ing the entire surface to enliven the skin. If the eyes have rings or puffs beneath them do not massage the rings or puffs, but give special attention to the adjacent surface, getting up a free circulation away from the localized parts. To massage the long wrinkles extending each side of the nose, hold the muscles of the cheek back until the wrinkles are smooth and then massage the seam lengthwise. Give the eyebrows a treatment follow- ing the natural curve with a circular motion upward. In case the subject has a double chin this can be removed by draw- ing the fingers with slight pressure from the middle of the chin and throat outward and upward behind the ear. The exercise given for developing the neck will also greatly assist in removing a double chin. After finishing the treatment bathe the face gently and dry carefully. In case of hollow cheeks, sunken eyes, etc., a pinching of the muscles and drawing them out with the five fingers is beneficial. Suc- tion cups, which are recommended for this purpose, can also be had at a drug store. They are inexpensive glass cups with rubber bulbs and are excellent for developing a thin lower face. Place the cup firmly on the middle of the chin, when the edges will attach themselves to the skin. Work the cup upward and outward, then press the bulb and release the glass. Repeat several times. Make sure that hollow cheeks do not come from loss of teeth. This is a most 276 MODERN NURSING. common cause of this unsightly feature. Have the space caused by the loss of teeth fitted with porcelain or other material and thus present the round contour. After using creams or skin foods, be sure they are thoroughly washed from the skin. Do not allow the pores to become clogged. Do not apply cream to a moist skin unless you would have an unsightly growth of hair on the face. Do not use yellow or red vaseline on the face as it leaves an ugly, yellow stain and is also drying to the skin. Do not use alum, tannin, or other astringents on the face if you would have a soft, delicate, fair complexion. HOW TO DEVELOP NECK AND CHEST. There is little excuse for having a long, slim, undeveloped neck if one will give it proper exercise and attention. The same might also be said of a short, fat neck, with an unsightly double chin. If the neck be too long, to develop it well at the base and fill it out at the shoulders and around the clavicle will tend to give the idea of shortening. This can be done by carefully and vigorously massaging the base, across the collar bone, and out to the shoulder, drawing the muscles well out of the hollows and rolling them between the thumb and finger. A suction cup or the five finger massage that is used on a hollow face will prove of great value. To assist in the development, inflate the lungs, elevating the chest and shoulders, throw the head back and roll it around the chest three or four times in one direction and reverse the order. This exercise is very beneficial and should be care- fully practised. In cases of large, short, and fat necks it will greatly reduce adipose tissue, make the muscles firm and compact, and assist in removing the double chin. To make a full, round, healthy chest, place the hands on the hips and inhale a full breath. Expel it gradually, whispering the syllable "huh." Again inhale and swing each arm in wide circle four times in one direction and reverse the order. Expel the breath forcibly after each exercise. Swing both arms as a final exercise. This, together with the massage treatment of the chest as given under general mas- sage, will develop a thin, hollow chest into a full, round, robust one, adding not only beauty but health to its possessor. BEAUTY MASSAGE. 277 TO MAKE THE HANDS AND ARMS BEAUTIFUL. Nature does much toward giving every one symmetrical proportions, but through disease or lack of exercise, certain muscles are undeveloped, while muscles that are constantly worked are over-developed. This should be borne in mind in developing any part of the body. The first care of the hands is to keep them clean and the nails properly manicured. Grimy hands and badly kept nails are enough to spoil every other beautiful feature one may possess. The hands are an index to the inner man and their care speaks in glowing though silent words of his habits. Care of the skin must be regarded as the care of the face. The hands are subject to all sorts of hardships and it is not easy to keep the average hand always in good condition. By thorough bathing, using a soft brush and best grade of toilet soap, by the use of a cream or lotion to keep the hands from chapping or cracking where it is neces- sary, and daily giving them a little extra care, they need never be unsightly. To massage the hand and forearm for development and taper, place the elbow on a table with the hand elevated. Massage each finger separately, much after the fashion of working on a new glove. Con- tinue this to the wrist. Place the forearm between the two palms and rapidly roll the muscles working from the wrist to the elbow several times. This will round and taper the arm to the elbow. Treat the elbow to a thorough massage and roll the upper arm as you did the forearm. To massage one's own arm hold the hand in the same position and stroke the arm from the hand toward the elbow. This is not so satis- factory as the other method, yet in time will make a marked improve- ment and give it a graceful taper. Patience and time are required for all developments, but are sure to bring reward. FOOD FOR THE SICK. HOW TO PREPARE AND SERVE IT. Dietetics, or the science of diet and of its regulation, plays an important part in sickness and in health. It is the prime duty of all who care for the sick in whatever capacity to see that the patient 278 MODERN NURSING. receives proper food, properly prepared and served in an appetizing way. It is equally important, if not more so, to see that no injurious or improperly prepared food is served to the patient. There are many who are actuated by the kindest motives in offering articles of food to an invalid when they are guided by their own likes rather than by any thought of whether it will be beneficial to the sufferer or whether his enfeebled digestive capacity can bear it. Others again commit dangerous and even fatal indiscretions by their inability to withstand a patient's pleading for food which is beyond his power to digest or to retain. It is after a crisis in a disease has been reached that especial care must be taken to proceed carefully in the matter of diet. During the period of extreme suffering there is usually little appetite or demand for food, but in early convalescence a craving for improper food sets in and sympathetic friends are very prone to satisfy the desires, with very serious consequences. Diet for the sick is often specified according to the article of food which prevails in or composes such a diet. Accordingly there is a Milk diet, a Meat diet, a Fish diet, a Vegetable diet, a Broth diet, a Mixed diet, a Liquid or Spoon diet. It is often specified by the amount of food to be given at a time. In this classification there is a Full diet, a Generous diet, a Common diet, a Subsistence diet, or one upon which a person can barely live, a Half diet, and a Low diet. There is another mode of designating a diet, which is by stating the particular disease or condition which it is intended to meet. A Fever diet is one made up of milk, broths, toast waters, and jellies. There is no solid food whatever, or vegetables, or fruits. A Gouty diet prohibits meats, wines, and beer. A Diabetic diet allows no sugars, starches, bread, rice, potatoes, fruits, or sweet wines. A Banting diet is designed to reduce flesh and does not permit the eating of fats, cream, starchy or sweet foods, sweet wines and stout or porter. A Convalescent diet is a light, easily digested, simple solid or liquid diet. A Subsistence diet, such as would be given in aneurism for instance, is composed of: Breakfast, two ounces of bread with butter and two ounces of milk; Dinner, two or three ounces of bread, two or three ounces of meat, and two to four ounces of milk or of claret wine; Supper, two ounces of bread with butter and two ounces of milk. SERVICE OF FOOD. 279 It must not be forgotten that the original meaning of the term to nurse is "to nourish." In no way can the offices of a good attendant of the sick be so well directed as in the providing of nourishing food, well cooked, and served in an enticing, attractive way. While this attention always supplements the efforts of the physician, there are many cases in which it supersedes his attentions. Very often the good nourishment that a patient gets is of more benefit than the medicine which the doctor supplies. One of the most pathetic sights during illness, next to the sufferings of the patient, is the utter helplessness of loving friends and relatives, who are impelled by affection and sympathy to do something to minister to the needs and comfort of the sick one. They either sit by and do nothing or make pitiable, blundering attempts which only add to the discomfort. It is not so much what is done as how it is done that counts in the sick room. And- the art of waiting on the sick in an efficient way can be cultivated by anyone, to the degree of making one's attentions appre- ciated and helpful. Service of Food to the Sick. — Let the patient have a set of dishes for his exclusive use. This is imperative in cases of contagious diseases; but let it be so in every case. They should be the daintiest and most attractive that the china closet contains. It goes without saying that the napkin must be clean — provide a fresh one with every meal, if necessary. The china must be spotless, the silver polished, and the glass sparkling. When putting the food into the dishes, take care that cups and saucers are not so full that the contents will spill or slop over when carried. Not alone for that reason but also because the service of a large portion of food at a time not only does not attract a capricious appetite, but may lead to over-indulgence. A small service may lead the patient to ask for a second portion. There is also danger of large portions becoming cold during the slow eating of the patient. For it is important that food which is intended to be served hot, should really be hot; and that which is to be cold, must be so. The seasoning of the food is an important detail. Where the nurse knows the wishes of the patient in this respect it is easy to accord with it. Probably more salt will be desired than when in health, and less sugar. Pepper and high seasoning are not desirable. The freshness of food must be beyond all possible doubt. If eggs are served let them be broken out of the room, so that their purity may be unquestioned. The milk and cream must also be sweet, a point that 280 MODERN NURSING. is liable to be overlooked in summer. If there is the slightest doubt about the condition or quality of an article of food do not serve it. The only safe guide for the condition of food when prepared is by tasting it; but don't under any condition do so in the presence of the patient. Do that in the kitchen so that anything necessary may be supplied before the patient sees it. In planning a meal for the patient, the first thing to do is to know very definitely and exactly what foods he can eat and what must not be given. Make yourself very thoroughly acquainted with the articles to be supplied. Have plenty on your list so that you will be able to supply a variety from time to time, to take advantage of the market, and to consult the patient's tastes. But don't consult the patient too freely about what he will or will not like. Especially don't do so just after he has partaken of food. None of us, even in health, care much about the next meal when we have just finished one. Besides, a little surprise in the way of something which he is known to like and does not expect will often prove most agreeable to him. Get a good list, either from the doctor or from the following pages, and then prepare and serve them in the most attractive manner possible. Time of Feeding. — See that the patient gets his food right on the minute. This is not only important in so far as the supply of food is concerned, but more especially to promote digestion. The stomach expects a certain amount of work at certain definite intervals, and, in cases of illness, this gives rise to feelings of discomfort if the intervals are not regular. Feeding at night is a matter to be decided by cir- cumstances. It is only in very exceptional cases that a patient is to be awakened to partake of food. If a glass of hot milk is given just before time for sleeping it will in many cases bring a sense of sleepi- ness and ward off possible insomnia. If a patient asks for food in the night he should get it, and it will be better if a supply is prepared, or partly so, in case of such emergencies. If too long time is taken the patient may get over the desire for it. But as it will naturally be of a very light and digestible nature it will not take much time to get it ready. Assistance to a Patient While Eating. — When a patient is help- less it will be necessary for the nurse to render all possible assistance while food is being taken. The head must be raised, and it is important to see that the head is not turned to either side. Even a very slight turn will be sufficient to cause the food to run out of the corner of the DIET FOR VARIOUS DISEASES. 281 mouth. His clothing must be protected with a clean, fresh napkin or towel, lest the food be spilled upon it. If he is very weak he will better use a bent glass feeding tube, rather than attempt to drink from a glass. Much more food will probably be taken by this means, and the supply can be better regulated. Only small mouthfuls are to be given and care must be taken that all food is properly masticated before another mouthful is given. See that the mouth is properly cleansed after food, for when the food lodges in the corners of the mouth there is great danger of sores occurring. When the patient is feverish the thirst will be correspondingly great. In giving cooling drinks it is well to use a small glass filled with the liquid, rather than a larger glass only partly filled. There seems to be more in the smaller glass- ful, and the patient will generally be better satisfied with it. Diets for various diseases : — FEVERS. The patient may take : — Foods. — Soups, clear or thickened with some well cooked farinaceous substance, mutton, clam or chicken broth, beef tea, peptonized milk. Drinks. — Pure cold water, toast water, lemon or orange juice in cold water, cold whey, all in small quantities, sipped slowly. The patient must not take : — Any solid or vegetable food or fruit, until so directed by the physician in charge. DYSPEPSIA. The patient may take : — Soups. — Clear, thin soups of beef, mutton, or oysters. Fish. — Oysters raw, shad, cod, perch, bass, fresh mackerel. Meats. — Beef, mutton, chicken, lamb, tripe, tongue, calf's head, broiled chopped meat, sweetbread, game, tender steak. Eggs. — Boiled, poached, raw. Farinaceous. — Cracked wheat, hominy, rolled oats, rice, sago, tapioca, crackers, dry toast, stale bread, corn bread, whole wheat bread, graham bread, rice cakes. Vegetables. — Spinach, sweet corn, string beans, green peas, lettuce, cresses, celery, chicory, asparagus. Desserts. — Rice, tapioca or farina pudding, junket, custards, baked apples, apple snow, apple tapioca, ripe fruits — raw or stewed. 282 MODERN NURSING. Drinks.— One cup of weak tea, coffee, cocoa, milk and hot water equal parts, or one glass of pure, cool water, sipped. The patient must not take: — Rich soups or chowders, veal, pork, hashes, stews, turkey, potatoes, gravies, fried foods, liver, kidney; pickled, potted, corned, or cured meats; salted, smoked, or preserved fish; goose, duck, sausage, crabs, lobster, salmon, pies, pastry, candies, ice cream, cheese, nuts, ice water, malt or spirituous liquors. CONSTIPATION. The patient may take : — ■ Soups. — Meat broths, oyster soup. Fish. — Boiled fresh fish of all kinds, raw oysters. Meats. — Almost any fresh, tender meat, poultry, game. Farinaceous. — Oatmeal, wheaten grits, mush, hominy, whole wheat bread, corn bread, brown bread, rye bread. Vegetables. — Boiled onions, brussels sprouts, spinach, cauliflower, potatoes, asparagus, green corn, green peas, string beans, salads with oil. Desserts. — Stewed prunes, figs, baked apples with cream, ripe peaches, pears, oranges, apples, melons, grapes, huckleberries (the blue seedless kind), cherries, raisins, honey, plain puddings, fig puddings, apple charlotte. Drinks. — Plenty of pure water, cold or hot, black coffee, cocoa, new cider, buttermilk, orange juice, unfermented grape juice. The patient must not take : — Salt, smoked, potted or preserved fish or meats, pork, liver, eggs, new bread, puddings of rice or sago, pastry, milk, sweets, tea, nuts, cheese, pineapple, spirituous liquors. DIARRHOEA. The patient may take: — Soups. — Milk soup well boiled, clam juice, beef tea. Meats. — Scraped fresh beef or mutton well broiled, sweetbread, beef juice from freshly broiled steak (all sparingly). Eggs. — Lightly boiled or poached on dry toast. Farinaceous. — Rice, sago, macaroni, tapioca, arrowroot, dry toast, milk toast, toasted crackers. DIET FOR VARIOUS DISEASES. 283 Desserts. — Milk puddings, plain, with sago, rice, tapioca or arrow- root (no sugar). Drinks. — Tea, toast water, boiled peptonized milk. The patient must not take : — Oatmeal, wheaten grits, fresh breads, rich soups, vegetables, fried foods, fish, salt meats, lamb, veal, pork, brown or graham bread, fruits, nuts, pies, pastry, ice cream, ice water, sugars, sweets, custards, malt liquors, sweet wines. LIVER TROUBLES. The patient may take: — Soups. — Vegetable soups with a little bread or cracker, light broths. Fish. — Boiled fresh cod, bass, sole or whiting, raw oysters. Meats. — Tender lean mutton, lamb, chicken, game (all sparingly). Farinaceous. — Oatmeal, hominy, tapioca, sago, arrowroot (well cooked), whole wheat bread, dry toast, crackers. Vegetables. — Mashed potato, almost all fresh vegetables (well boiled), plain salad of lettuce, water cress, dandelions. Desserts. — Plain milk pudding of tapioca, sago, arrowroot or stewed fresh fruit (all without sugar or cream), raw ripe fruits. Drinks. — Weak tea or coffee (without sugar or cream), hot water, pure, plain, or aerated water. The patient must not take : — ■ Strong soups, rich made dishes of any kind, hot bread or biscuits, preserved fish or meats, curries, red meats, eggs, fat, butter, sugar, herrings, eels, salmon, mackerel, sweets, creams, cheese, dried fruits, nuts, pies, pastry, cakes, malt liquors, sweet wines, champagne. DIABETES. The patient may take: — ■ Soups. — Soup or broth of beef, chicken, mutton, veal, oysters, clams, terrapin or turtle (not thickened with any farinaceous sub- stances), beef tea. Fish. — Shellfish and all kinds of fish, fresh, salted, dried, pickled, or otherwise preserved (no dressing containing flour). Eggs. — In any way most acceptable. Meats. — Fat beef, mutton, ham or bacon, poultry, sweetbreads, calf's head, sausage, kidneys, pig's feet, tongue, tripe, game (all cooked free of flour, potatoes, bread or crackers). 284 MODERN NURSING. Farinaceous. — Gluten porridge, gluten bread, gluten gems, gluten biscuits, gluten wafers, gluten griddle cakes, almond bread or cakes, bran bread or cakes. Vegetables. — String beans, spinach, beet tops, chicory, lettuce, plain or dressed with oil and vinegar, cucumbers, onions, tomatoes, mush- rooms, asparagus, oyster plant, celery, dandelions, cresses, radishes, pickles, olives. Desserts. — Custards, jellies, creams (without sugar), walnuts, almonds, filberts, Brazil nuts, cocoanuts, pecans. Drinks. — Tea or coffee (without sugar), pure water, peptonized milk. The patient must not take: — Liver, sugar, sweets or starches of any kind, Avheaten bread or biscuits, corn bread, oatmeal, barley, rice, rye bread, arrowroot, sago, macaroni, tapioca, vermicelli, potatoes, parsnips, beets, turnips, peas, carrots, melons, fruits, puddings, pastry, pies, ices, honey, jams, sweet or sparkling wines, cordials, cider, porter, lager, chestnuts, peanuts. BRIGHT'S DISEASE. The patient may take: — Soups. — Broths with rice or barley, vegetable or fish soup. Fish. — Boiled or broiled fresh fish, raw oysters, raw clams. Meats. — Chicken, game, fat bacon, fat ham (sparingly). Farinaceous. — Hominy, oatmeal, wheaten grits, rice, stale bread, whole wheat bread, toast, milk toast, biscuits, macaroni. Vegetables. — Cabbage, spinach, celery, water cresses, lettuce, mush- rooms, mashed potatoes, cauliflower, onions. Desserts. — Rice and milk puddings, stewed fruits, raw ripe fruits. Drinks. — Pure water, peptonized milk, fresh buttermilk, milk with hot water (equal parts), whey, weak tea, toast water. The patient must not take : — Fried fish, pork, corned beef, veal, heavy bread, hashes, stews, batter cakes, lamb, beef, mutton, gravies, peas, beans, pastry, ice cream, cakes, coffee, tobacco, malt or spirituous liquors. DEBILITY. The patient may take : — Soups. — Any broth thickened with farinaceous material, chicken DIET IN VARIOUS DISEASES. 285 or beef soup containing chopped meat, rich vegetable soup, whole beef tea. Fish. — All fresh fish, boiled or broiled, raw oysters. Meats. — Beef, mutton, chicken, game, boiled ham, lamb chops or cutlet, broiled bacon, tender, juicy steak, hamburger steak. Eggs. — Soft boiled, poached, scrambled, raw with sherry wine. Farinaceous. — Cracked wheat, rolled oats, mush, sago, tapioca, hominy, barley, macaroni, vermicelli, rolls, biscuits, cakes, whole wheat bread, corn bread, milk toast, dry toast, brown bread. Vegetables. — Nearly all, perfectly fresh and well cooked. Desserts. — Custards, egg and milk, rice or apple pudding, baked apples, fruit jams, jellies, cocoa junket, marmalade, sweet fruits, calf's foot jelly. Drinks.- — Cocoa, chocolate, milk, hot, cold, or peptonized, pure water, plain or aerated. The patient must not take : — Hashes, stews, cooked oysters or clams, pork, veal, thin soups, turkey, salt meats (except ham and bacon), cabbage, cucumbers, turnips, carrots, squash, spices, pickles, vinegar, pies, pastry, bananas, pineapples, OBESITY. The patient may take : — Fish. — Nearly all fresh fish, boiled. Meats. — Lean beef, mutton or lamb, chicken, game (sparingly). Eggs. — Boiled or poached on toast. Farinaceous. — Stale bread, dry toast or crusts (sparingly). Vegetables. — Spinach, lettuce, celery, cresses, asparagus, cauliflower, onions, white cabbage, tomatoes, radishes, olives. Desserts. — Ripe fruits only — acid varieties preferable. Drinks. — One cup of tea or coffee, without milk, cream, or sugar, or one glass of pure water, sipped at the end of the meal. The patient must not take : — Soups, salmon, bluefish, eels, salt fish, pork, veal, sausage, made dishes, fats, potatoes, macaroni, oatmeal, hominy, spices, rice, beets, carrots, turnips, parsnips, puddings, pie, pastry, cake, sugars, sweets, milk, cream, malt or spirituous liquors, beers, sweet wines, champagne. 286 MODERN NURSING. RHEUMATISM. The patient may take : — Soups. — Mutton broth, chicken or beef tea, in small quantities. Fish. — Raw clams or oysters, fresh fish (whiter kinds), boiled. Meats. — Chicken, calf's head, sweetbread, tripe, broiled fat bacon or boiled ham (all sparingly). Farinaceous. — Whole wheat, corn or brown bread, arrowroot, rice. dry toast, milk toast. Vegetables. — Spinach, green peas or cabbage (well boiled), celery, lettuce, cresses, radishes. Desserts. — Milk, rice or arrowroot pudding (all without sugar), junket. Drinks. — Tea (without sugar), buttermilk, pure water, plain, with lemon or lime juice (no sugar). The patient must not take: — Pork, veal, turkey, goose, duck, fried fish or meats, cooked oysters or clams, salted, dried, potted, or preserved fish or meats (except fat bacon or ham), crabs, salmon, lobster, eggs, rich made dishes, gravies, potatoes, tomatoes, beans, asparagus, mushrooms, candies, rich pud- dings, pies, pastry, nuts, cheese, coffee, cider, malt liquors, wines. GOUT. The patient may take : — Soups. — Fresh fish soups, vegetable broths, clear. Fish. — Raw oysters, fresh fish, boiled. Meats. — Fat bacon, boiled or broiled chicken, game (all sparingly). Farinaceous. — Cracked wheat, oatmeal, rice, sago, hominy, whole wheat bread or biscuits, rye bread, graham bread or rolls, crackers, dry toast, milk toast, macaroni. Vegetables. — Mashed potato, green peas, string beans, spinach, cabbage, cucumbers, cresses, lettuce, celery. Desserts. — Plain milk pudding, junket, rice and milk, stewed fruits (all without sugar). Drinks. — Weak tea (no sugar), milk, buttermilk, toast water, pure water, cold or hot. The patient must not take: — Veal, pork, goose, duck, turkey, salted, dried, potted, or preserved fish or meat (except fat bacon), eels, mackerel, crabs, salmon, lobster, eggs, rich soups, gravies, patties, tomatoes, sweet potatoes, asparagus, mushrooms, rhubarb, lemons, pickles, vinegar, fried or made dishes, DISHES FOR THE SICK. 287 rich puddings, spices, pies, pastry, sweets, cheese, nuts, dried fruits, tobacco, coffee, cider, malt liquors, sweet wines, champagne. PHTHISIS (CONSUMPTION). The patient may take : — Soups. — Turtle or oyster soup, mutton, clam, or chicken broth, puree of barley, rice, peas, beans, cream of celery or tomatoes, whole beef tea, peptonized milk gruel. Fish. — All kinds of fresh fish, boiled or broiled, oysters or clams, raw, roasted, or broiled. Meats. — Rare roast beef or mutton, lamb chops, ham, fat bacon, sweetbreads, poultry, game, tender steaks, hamburger steak, rare. Eggs. — Every way except fried. Farinaceous. — Oatmeal, wheaten grits, mush, hominy, rice, whole wheat bread, corn bread, milk toast, biscuits, muffins, gems. Vegetables. — Potatoes, baked, boiled, or creamed, string beans, spinach, onions, asparagus, tomatoes, green peas (all well cooked), lettuce, cresses, celery. Desserts. — Farina, sago, tapioca, apple or milk pudding, floating island, custards, baked or stewed apples with fresh cream, cooked fruits, rice with fresh cream. Drinks. — Fresh milk, cool, warm, or peptonized, cocoa, chocolate, buttermilk, pure water, tea, coffee. The patient must not take: — Fried foods, salt fish, hashes, gravies, veal, pork, carrots, parsnips, cabbage, beets, turnips, cucumbers, macaroni, spaghetti, sweets, pies, pastry, sweet wines. DISHES FOR THE SICK. PEPTONIZED FOODS. For peptonizing milk and other foods either the tubes or essence of pepsin or tablets may be used. Junket tablets are convenient for use. These preparations are to be procured from any drug store, as they are in constant demand. Immediate Process. Put two tablespoonfuls (1 ounce) of cold water in a goblet or glass; dissolve in this one quarter the contents of a peptonizing tube; 288 MODERN NURSING. add eight tablespoonfuls (4 ounces) of warm milk; drink immediately, sipping slowly. If half a pint of milk is desired, double the proportions of water, peptonizing powder, and milk. By the Cold Process. Into a clean, quart bottle put the powder contained in one of the Fairchild peptonizing tubes and a teacup ful (gill) of cold water; shake, then add a pint of fresh, cold milk, shake the mixture again and immediately place the bottle on ice, without subjecting it to the water- bath or any heat. Place the bottle' directly in contact with the ice. When needed, shake the bottle, pour out the required portion, and use in the same manner as ordinary milk. Partially Peptonized Milk. Put into a clean agate ware or porcelain-lined saucepan the powder contained in one of the peptonizing tubes, and a teacupful (gill) of cold water; stir well; then add a pint of cold, fresh milk. Heat with constant stirring until the mixture boils. The heat should be so applied that the milk will come to a boil in ten minutes. When cool, strain into a clean bottle, cork well, and keep in a cold place. When needed, shake the bottle, shake out the required portion, and serve cold or hot, as directed by the physician in charge. N. B. — Milk so prepared will not become bitter. Peptonized Milk. Into a clean, quart bottle put the powder contained in one of the peptonizing tubes, and a teacupful (gill) of cold water; shake, then add a pint of fresh, cold milk, and shake the mixture again. Place the bottle in water so hot that the whole hand can be held in it without discomfort (about 115 F.). Keep the bottle there five or ten minutes as directed. At the end of that time put the bottle on ice at once to check further digestion and keep the milk from spoiling. Place the bottle directly in contact with the ice. The degree of digestion is very simply regulated by the length of time in which the milk is kept warm. Peptonized Milk Gruel. Thick, well boiled, hot gruel, one-half pint. Milk, fresh, cold, one-half pint. DISHES FOR THE SICK. 289 Mix and strain into a small pitcher or jar, and immediately add the contents of one peptonizing tube; mix well. Let it stand in the hot water bath, or warm place, for five minutes, then put in a clean bottle and place on ice. Serve hot or cold. Gruel made from arrowroot, flour, barley, oatmeal, etc., will serve for the purpose. In each instance the farinaceous material should be boiled with water until the starch granules have been thoroughly swollen, broken up, and incorporated with the water. To Make Junket and Whey, Using Essence of Pepsin. Junket. — Into a clean saucepan put one-half pint of fresh, cool milk, heat it lukewarm (not over ioo° F.) ; then add one teaspoonful of essence of pepsin, and stir just enough to mix; divide quickly into small cups or glasses and let stand until firmly jellied, when the junket is ready for use, just as it is, or with sugar; it may be placed on ice and taken cold. Whey. — Into a clean saucepan put one pint of fresh, cool milk, heat it lukewarm (not over ioo° F.); then add two teaspoonfuls of essence of pepsin, and stir just enough to mix; let it stand until firmly jellied, then beat with a fork until it is finely divided; now strain and the whey (liquid part) is ready for use ; keep in a bottle near ice. Whey is a highly nutritious fluid food, containing in solution the sugar and the salts (the mineral constituents) of the milk, and holding also in suspension a considerable portion of caseine and fat (cream), which pass through the strainer. It is peculiarly useful in many ailments, and always valuable as a means of variety in diet for the sick. It is frequently resorted to as a food for infants to tide over periods of indigestion, summer complaints, etc. General Directions for Making Junket with Junket Tablets. — Junket tablets contain nothing but pure rennet ferment and a little pure table salt; they contain no chemicals, cornstarch, or gelatine. The results they produce in milk may seem marvelous, yet you will remember that from pure milk and cream such palatable and solid foods as butter and cheese are made. If you will follow a few plain, easy directions, you can, with the aid of junket tablets, combine all the nourishing, health- ful properties of butter and cheese contained in pure' milk into a milk jelly, exquisitely delicious, smooth, and velvety. You cannot use milk or cream that has been scalded or overheated and then cooled, or milk 290 MODERN NURSING. treated with preservatives, or watered, evaporated, condensed, pasteur- ized, or sterilized milk. Milk must be just warm — that means lukewarm, blood warm, or 98 F. Temper it just so that it does not taste hot or cold, or feel hot or cold to the finger. While the milk is warming, which may be done over the fire in a pan of hot water, stir in the sugar and add flavors or colors to suit the taste. When the milk is just lukewarm remove it at once from the fire, or it will overheat. Have the junket tablet dissolved, ready for use, in a tablespoonful of cold water. Do not dissolve it in warm or hot water or in milk. Eight junket or sherbet glasses hold one quart of junket. Have them all ready in a warm room where they will not be disturbed. In cold weather warm the dish before using. Stir the dissolved junket tablet quickly into the warmed, sweet- ened, and flavored milk (one quick stir of the spoon is enough), then pour at once into the cups, filling them two-thirds full. If you prefer, pour the whole quart into one large dish, but in serving from the large dish the junket is broken, whey forms quickly, and the dainty appearance of the dessert is destroyed. t Therefore individual dishes are preferable. Every housekeeper knows that in baking cake or custard it must not be shaken or roughly handled, or it will fall. Be just as careful with junket while it is jellying, or it will break loose from the dish and become watery. Therefore do not move, jar, or disturb it for ten minutes. When firm remove carefully to a cool place or the ice chest until ready to serve. Devonshire Junket. Stand rich, twelve-hours-old milk where it will come very slowly to scald, and let it remain at that temperature ten or fifteen minutes; then set away to get cold. Make a plain junket, and when ready to serve lift the cream from the scalded milk, place it on top of the junket and serve ; or it may be served in the good old English style with clotted cream and port wine. Coffee Junket. Make a half-cup of strong coffee by pouring a half-cup of freshly boiling water over two tablespoonfuls of pulverized coffee. Heat one and three-quarters pints of milk until lukewarm, add the coffee and a half- DISHES FOR THE SICK. 291 cup of sugar. Stir until dissolved. Add the dissolved tablet and finish as in plain junket. Serve with whipped cream heaped on top. Whey. The junket tablet may be used conveniently in the preparation of whey, a refreshing and slightly stimulating beverage, very useful in the sick room, especially in febrile conditions. As in the coagulation of milk the curd takes w T ith it the caseine and most of the fat, the whey contains only the milk-sugar and salts dis- solved in the water, with a very small portion of nitrogenous substance. It may be considered mildly nutritive and very wholesome ; if fresh, it is readily assimilated by the stomach, requiring no labor to fit it for absorp- tion, and contains in a degree every element of nutrition. Whey is strongly recommended as a most satisfactory food in cholera infantum, and is far more suitable than any other food preparation as a temporary substitute for milk. For adult invalids whey is a most pleasing and nutritious drink. To Prepare Whey. Have the required quantity of milk just lukewarm to ioo° F. and add the dissolved tablet — one to each quart of milk. Allow it to jelly in a warm place. Then break up the curd and strain through two thicknesses of cheese cloth, being careful to remove all the caseine. Whey should be used cold, with or without sweetening, and flavored with any desired flavoring. Junket from Cream. This may be made the same as that made with milk, using cream in the place of milk and in the same proportions. When ready to use turn out on to a dish and heap round the base some tart jelly, and serve at once. Custard Junket. Put over the fire to scald a half-pint of milk. Beat together two eggs and a quarter cup of sugar until light, stir into the scalding milk, and stir constantly until it thickens ; take at once from the fire. Have a pint and a half of milk in which is dissolved another quarter cup of sugar, add the cooled custard slowly, and mix evenly. When lukewarm add a teaspoonful of vanilla and the dissolved tablet, and finish as the plain junket. 292 MODERN NURSING. Junket with Raw Egg. Separate two eggs, beat the whites until perfectly dry ; beat the yolks until thick. Add them to the whites gradually, beating constantly. Heat one pint of milk until lukewarm, dissolve in it two tablespoonfuls of sugar, add a half teaspoonful of flavoring. Pour this over the beaten eggs, stir in a half junket tablet dissolved in a dessert-spoonful of cold water and turn quickly into glasses. Stand in warm place for half an hour until firm, then put in cold place. Wine Junket. Dissolve two tablespoonfuls of sugar (granulated) in three table- spoonfuls of wine or brandy; add one teaspoonful of lemon juice and a little grated nutmeg. Heat one pint of fresh milk, just warm, as for plain junket. Take it from the fire ; stir in the wine, then the dissolved tablet (one-half a tablet to the pint), and proceed as for plain junket. If required, as a medium for administering wine, brandy, or whisky in sickness, as much as four tablespoonfuls may be used. Junket Eggnog. Beat the yolks of two eggs and a teaspoonful of sugar to a light cream, whip the white of the eggs to a stiff froth, mix them together gradually, beating constantly. Dissolve four tablespoonfuls of sugar in three tablespoonfuls of Jamaica rum and mix with the beaten egg. Have one quart of milk or cream just lukewarm, stir in the mixture of egg, sugar, and rum, then stir in quickly one junket tablet, already dissolved in one tablespoonful of cold water, and pour immediately into warm jun- ket glasses, sprinkle grated nutmeg over the top of each. Stand in warm room a half hour. When firm, put in a cool place. This is very nourishing and strengthening for invalids, and can readily be retained by the most delicate stomach. Any other liquor may be used in place of the rum. Whipped Cream. Take half a cup of heavy cream, add one cup of rich milk, two tablespoonfuls of powdered sugar, and two tablespoonfuls of wine or brandy, or half a tablespoonful of other flavoring. Serve the junket with *.he whip above it. Champagne Junket. Dissolve one-fourth cup of granulated sugar in three tablespoonfuls of champagne; add one teaspoonful of Chr. Hansen's lemon flavor. DISHES FOR THE SICK. 293 Dissolve half a junket tablet in a dessert-spoonful of cold water. Heat one pint of milk lukewarm. Take from the fire; stir in the wine, then the dissolved half tablet, and pour into champagne glasses. Koumyss. This is a preparation of milk which is very useful for children and adults during convalescence from acute or subacute, or exhausting diseases. Even young children of three or four years will take a fancy to it if it is not made too sour by continuing the fermentation process too long. The liquid is prepared as follows : Add to one pint clear, perfectly fresh milk two teaspoonfuls of sugar and place it, after shack- ing thoroughly in a clean beer or claret bottle. Then add one-sixth cake Fleischmann's yeast and tightly cork the bottle, standing it in a warm place, or a water bath at 99 to ioo° F. for from eight to ten hours. Then place in a cool place or on the ice and use as needed. It must be re- membered that the development of carbonic acid gas is very great in this liquid, and if an ordinary cork is inserted it must be tied in before heat is applied. Further than this, the cork must be pulled very gently or the liquid will spurt all over the room. The best thing to use to open a bottle of koumyss is a "champagne tap,'' by means of which the liquid may be drawn off as needed. — Dr. Hare, in Practical Therapeutics. SOUPS. Beef Tea. Cut up a pound of rump steak into small pieces, and put it into a bottle (wide-mouthed fruit jar), putting a very small quantity of luke- warm water into the bottle with it, cork tightly and put the bottle into a kettle of warm water; the water should be allowed to boil for a con- siderable time; the bottle should then be removed and the juice drained off. The tea may be salted a little, and a teaspoonful given at a time. Another Beef Tea. The latest and most approved method of making beef tea, is to take a half pound of good steak, broil slightly over hot coals; then lay in a shallow dish, and, with a sharp knife, gash it on both sides until it is cut into mere shreds; then pour half a pint of boiling water over it, and scrape hard for a few moments, when all the nutriment of the beef will be extracted. This is the easiest, quickest, and, by many, thought to be the best method. 294 MODERN NURSING. Chicken Tea. Take off the skin and all the fat of the fowl, and boil it till very tender, with just enough water to cover it, and add a little salt. Take the chicken out of the liquor when boiled, and let the liquor remain until cold to let all the fat rise to the surface, which should then be skimmed off. The tea should be heated when given to the patient. It is a very delicate, nourishing food, and will set well on the stomach when so weak as to be able to retain but little food. Chicken Broth. Take half a chicken, remove all the fat, cut the meat in small pieces and break the bones ; put into a vessel with three pints of boiling water ; boil for an hour, season with salt and strain. Lamb Broth. Stew a lamb chop in a quart of water until it comes to shreds, add a teaspoonful of barley or rice, and a little salt and onion, if desired. Strain, and add a little parsley. Oyster Soup. Take of oysters, a half dozen; milk, a teacupful, with enough liquor of the oysters to make a bowl; a few allspice and cloves, a nice lump of butter, pepper, and salt. Bring to a boil and skim. Then throw in the oysters and simmer. Add a few toasted crackers before removing from the fire. Mutton Tea. Take one pound of mutton, remove the fat and cut the meat in small pieces ; pour half a pint of boiling water over it, and let it stand near a fire for half an hour, and then boil for one hour, strain through a sieve or cloth, add salt to suit the taste. A very nourishing diet. Vegetable Soup. Take two Irish potatoes, one onion, and a piece of bread ; place them in a quart of water ; add a little celery or parsley toward the close of the boil- ing. Salt and pepper may be employed at pleasure. Peptonized Beef. Take one pound minced lean beef, cold water one-half pint; mix in a saucepan. Cook over a gentle fire, stirring constantly until it has boiled a few minutes. Then pour off the liquor for future use; DISHES FOR THE SICK. 295 beat the meat to a paste, put it into a clean fruit jar with one-half pint of cold water and the liquor poured over the meat and add : — Extract of Pancreas, 20 grains. Sodium Bicarbonate (Baking Soda), 15 grains. Shake well together; set aside in a warm place, at about no° or 115 F. for three hours, stirring or shaking occasionally; then boil quickly. The liquid may be strained or clarified by the white of an egg in the usual manner ; season to taste, with salt and pepper. In the great majority of cases it is not necessary to strain the peptonized liquor, for the portion of meat remaining undissolved will have been so softened and acted upon by the pancreatic extract that it will be in very fine particles, and dif- fused in an almost impalpable condition, and is therefore ready for assimi- lation in the body. — Dr. Hare, in Practical Therapeutics. Peptonized Oysters. Peptonized oysters are prepared by mincing six or twelve large oysters and adding to them, when mixed with a moderate amount of their liquid, five grains of pancreatin, or peptonizing powder, and twenty grains of sodium bicarbonate. The cup containing this mixture is now placed in warm water at ioo° F. and allowed to remain there from ten to twenty minutes, according to the degree of digestion desired. After this the liquid mass is quickly brought to a boil to cook the oysters and stop digestion, and is served with pepper and salt as required. Any condiment or flavoring substance may be used. — Dr. Hare, in Practical Therapeutics. FARINACEOUS FOODS. Panada. Break into a bowl three good-sized crackers (arrowroot or oatmeal are nice) broken into small pieces; pour upon them boiling water and cover close for a minute, then add a tablespoonful of white sugar and a little pure milk. It is an excellent breakfast or supper for a child or an invalid. Instead of the milk the juice of a lemon may be squeezed in and another teaspoonful of sugar added, if there is fever. Indian or Oat Meal Gruel. This simple refreshment is invaluable in sickness, and is made with little trouble and less expense, yet it is very seldom prepared exactly right. One tablespoonful of fine Indian or oat meal, mixed smooth with cold 296 MODERN NURSING. water and a little salt; pour upon this a pint of boiling water, and turn into a saucepan to boil gently for half an hour ; thin it with boiling water if it thickens too much, and stir frequently; when it is done a tablespoon- ful of cream or a little new milk may be put in to cool it after straining, but if the patient's stomach is weak it is best without either. Some persons like it sweetened and a little nutmeg added, but to many it is more pala- table plain. Arrowroot Gruel. Add a teaspoonf ul of arrowroot to half a pint of boiling water ; mix well, add half a pint of milk and boil together for two or three minutes ; sweeten to the taste. A little lemon juice or wine may be added. Water Gruel. Corn or oat meal, two tablespoonfuls ; water, one quart. Boil for ten or fifteen minutes, and add sugar or salt, if desired by the patient. Ground Rice Gruel. Ground rice, one heaping tablespoonf ul ; ground cinnamon, half a teaspoonf ul ; water, one quart. Boil slowly for fifteen or twenty minutes, add the cinnamon when it is nearly done boiling, strain and sweeten. Sago Gruel. Sago, two tablespoonfuls; water, one pint. Boil until it thickens, frequently stirring. Wine, sugar, and nutmeg may be used if desirable. Thickened Milk. With a little milk, mix smooth a tablespoonful of flour and a pinch of salt. Pour upon it a quart of boiling milk, and when it is thoroughly mixed, put all back into the saucepan and boil up at once, being careful not to burn, and stirring all the time, to keep it perfectly smooth and free from lumps. Serve with slices of dry toast. It is excellent for diarrhoea; this alone will often cure it by scorching the flour before mixing with the milk. Wheat Balls. Tie half a pound of wheat flour in thick cotton and boil it three or four hours ; then dry the lump, and grate it when you use it. Prepare a gruel of it by making a thin paste, and pouring into boiling milk and water, and flavor with salt. This is good for teething children. DISHES FOR THE SICK. 297 Suet Boiled in Rice. Take some rice milk (boiled rice and milk), and boil it. When nearly boiled enough, add a dessert-spoonful of beef suet, already minced as small as bread crumbs. Boil slowly for a few minutes, and take off the scum as it rises. Or the suet may be inclosed in a muslin bag. It must be eaten hot. Oatmeal. Take half a teacup of oatmeal, add one pint of cold water; put into a tin dish in a kettle of water and boil slowly for two hours, adding more hot water if necessary. Another excellent way to cook oatmeal is to steam it. Oatmeal Jelly. One cup oatmeal, one and one-half pints water, and a little salt. Bake in the oven until it thickens to a starchy substance. Serve warm, with sugar and cream. Tapioca Jelly. One-half cup tapioca, two cups water, one-half cup sugar, juice and rind of one lemon. Cook the tapioca in the water one hour, using a double boiler. At the end of that time add lemon and sugar and three teaspoonfuls of brandy. Strain and serve cold with milk. This is one of the few things for the sick of which enough can be prepared for several meals. Parched Rice. Cook in a custard kettle one-half cup parched rice in one pint salted boiling water. Serve with cream and sugar. Mush. The water must be fresh, salted, and boiling when the corn meal is sprinkled in, so that the starch cells may burst. It is best to use a porce- lain lined or agate kettle. Stir constantly with one hand and sprinkle the meal with the other. Take any amount of water and sprinkle in meal until the mixture is quite thick, when a few sprinklings of flour will seem to make it more palatable. Cover closely and let stand on back of stove for an hour or two, or even half a day. Do not stir after remov- ing from the fire, as this permits the flavor to escape with the steam. Dry Toast. Cut your slices of bread even and not too thick. Toast before a clear 2 9 B • MODERN NURSING. fire, a nice light brown. Cover with a napkin and serve quickly, while it is hot. Dry toast is not always good for invalids, especially when the bowels are confined and it is desirable to keep them open. In this case graham bread, not toasted, is much better. Milk Toast. This is a favorite dish with nearly all sick people, when they are get- ting well. Cut stale bread in rather thin slices, toast a fine brown, and lay them in a deep dish. Meanwhile boil a quart of new milk in a lined saucepan, in which you have first put a very little cold water, to prevent burning. As soon as it boils pour it over the toast, cover and serve quickly. For an invalid no butter should be put in the milk. Some people put in a thickening of flour, but this spoils it for many. "Soft" Toast. Some invalids like this very much indeed, and nearly all do when it is nicely made. Toast well, but not too brown, a couple of thin slices of bread, put them on a warm plate and pour over boiling water; cover quickly with another plate of the same size and drain the water off ; remove the upper plate, butter the toast, put in the oven one minute and then cover again with a hot plate and serve at once. Watered Toast. Toast, several pieces of bread and carefully butter, so that the butter is equally distributed. Salt and pepper to taste, and finally pour as much boiling water on the edges of the crust as is necessary to thoroughly soften, and serve to the patient. This is a much more agreeable dish than might be imagined, and is useful when milk toast is distasteful. Almond Bread for Diabetics. Take of blanched sweet almonds one-quarter pound; beat them as fine as possible in a stone mortar ; remove the sugar contained in this meal by putting it into a linen bag and steeping it for a quarter of an hour in boiling water, acidulated with vinegar; mix this paste thoroughly with three ounces of butter and two eggs. Next add the yolks of three eggs and a little salt, and stir well for some time. Whip up the whites of DISHES FOR THE SICK. 299 three eggs and stir in. Put the dough thus obtained into greased molds and dry by a slow lire. — Dr. Hare, in Practical Therapeutics. Bran Bread for Diabetics. Take a sufficient quantity (say one quart) of wheat bran; boil it in two successive waters for one-quarter hour each time, straining it through a sieve. Then wash it in cold water (on the sieve) until the water runs off perfectly clear. Squeeze the bran in a cloth as dry as possible, then spread it thinly on a dish and place it in a slow oven. If put in at night, let it remain until morning, when, if perfectly dry and crisp, it will be fit for grinding. The bran thus prepared must be ground in a fine mill and sifted through a wire sieve of such fineness as to require the use of a brush to pass it through; that which remains in the sieve must be ground again until it becomes quite fine. Take of this bran powder three ounces (some patients use four ounces) and other ingredients as follows: Three newly laid eggs, one and one-half ounces (or two ounces if desired) butter, and about one- half pint milk; mix the eggs with a little of the milk and warm the but- ter with the other portion; then stir the whole well together, adding a little nutmeg or ginger, or any other agreeable spice. Bake in several patty tins, which must be well buttered, in a rather quick oven for about one-half hour. The cakes, when baked, should be a little thicker than a ship's biscuit ; they may be eaten w T ith meat or cheese at breakfast, dinner, and supper ; at tea they require rather a free allowance of butter, or they may be eaten with curd or other soft cheese. It is important that the above directions as to washing and drying the bran should be exactly followed, in order that it may be freed from starch and rendered friable. The bran in its common state is soft, and not easily reduced to a fine powder. In some seasons of the year, or if the cake has not been well prepared, it changes more rapidly than is convenient, owing to moisture. This may be prevented by placing the cake before the fire for five or ten minutes every day. — Dr. Hare, in Practical Therapeutics. EGGS. Eggnog. Beat an egg until it foams, put it into a glass and fill the glass with cool, rich milk; add from a teaspoonful to a tablespoonful of brandy, and sweeten to taste. 300 MODERN NURSING. Milk and Eggs. Beat up a fresh egg with a grain of salt, pour upon it a pint of boiling milk, stirring all the time. Serve hot, with or without toast. It is good in case of weakness, for an early breakfast, or for a traveler before start- ing on a journey. Soft Boiled Eggs. Fresh eggs for invalids who like them cooked soft should be put in a pan of boiling water, and set on a part of the stove where they will not boil, for several minutes. At the end of that time they will be like jelly, perfectly soft, but beautifully done and quite digestible by even weak stomachs. Soft Custard. Milk, a pint. Place it to boil; while boiling, take of eggs, three; separate them, and beat up the yolks with sugar enough to sweeten to the taste, and with cornstarch, a teaspoonful, rubbed in smoothly. Then pour this egg and cornstarch mixture into the pint of boiling milk; boil for a few minutes, and stir constantly to prevent lumping and burning. When the whole becomes a thick, creamy mass, remove. Have ready, in a dish, some stale sponge cake, slightly wet with brandy or wine. Pour the custard over it, and cover all with the white of the three eggs whipped stiff, with a half teacup ful of pulverized sugar, and flavored with vanilla. Egg Toast. Make a soft toast and have ready one or more fresh eggs, which have been boiled twenty minutes; remove the shells, cut them in slices and place upon the toast, with a little butter, pepper, and salt; without the butter they may be eaten with impunity by the most delicate invalid, as an egg cooked for twenty minutes is really more easy of digestion than one that is termed "soft boiled." Poached Eggs. Into boiling milk which has been seasoned with butter and salt drop fresh eggs, cover, and let simmer for three minutes, when they may be removed to a piece of buttered toast. The toast may or may not have been softened with the hot milk, as desired. DISHES FOR THE SICK. 301 DESSERTS. Tapioca Cup Pudding. This is very light and delicate for invalids. An even tablespoonful of tapioca, soaked for two hours in nearly a cup of new milk. Stir into this the yolk of a fresh egg, a little sugar, a grain of salt, and bake in a cup for fifteen minutes. A little jelly may be eaten with it, or a few fresh strawberries. Invalid Cup Pudding. One tablespoonful of flour, one egg; mix with cold milk and a pinch of salt, to a batter. Boil fifteen minutes in a buttered cup. Eat with sauce, fruits, or plain sugar. Invalid Apple Pie. Slice up one or more nice, tart apples in a saucer, sweeten with white sugar and cover with a moderately thick slice of bread, buttered slightly on the underside. When the bread is nicely browned, the apples, if of a tender kind and thinly sliced, will be done. Roast Apples. These can nearly always be eaten with safety, when they are eaten with relish. Choose good sized, fair apples of a tart and juicy, but not of a sour, kind. Rub them off clean, and put them in rather a slow oven, which may increase in warmth, so that they shall be thoroughly done in an hour. When so soft that the savory pulp breaks through the browned skin in every direction, take them out, sift white sugar over them, and carry one at a time on a saucer to the patient Stewed Prunes. These are extremely good in smallpox, measles, scarlet fever, and the like, both as food and medicine. Get the box prunes, as they will not need washing, and because they are generally of a much better quality than the open sort. Soak them for an hour in cold water, then put them in a porcelain lined saucepan, with a little more water if necessary, and a little water and crushed sugar. Cover and let them stew slowly an hour, or until they are swollen large and quite soft. They are excellent as an accompaniment to breakfast for a sick woman. 3 02 MODERN NURSING. Grange Gelatixe. Soak one teaspoonful granulated gelatine in one tablespoonful cold water one-half hour, add one tablespoonful boiling water and dissolve. Add two tablespoonfuls sugar, three tablespoonfuls orange juice, and two teaspoonfuls lemon juice ; strain through cloth and strainer into cold, wet molds, and set away to harden. Cut orange in half, crosswise : remove pulp and strain. Fill with the jelly, and when firm cut into thirds, leaving the rim filled with the jelly. Place on a plate and serve with whipped cream in the center. (Individual recipe.) Oraxge Charlotte. Soak two teaspoonfuls gelatine in one tablespoonful cold water one-half hour: add one-third cup boiling water and dissolve. Add one-third cup sugar, three tablespoonfuls orange juice, and one tablespoonful lemon juice, and set on ice to cool, stirring frequently. When hardened, fold in the stiffly-beaten whites of two e^s: mix thoroughly and pour into cold, wet molds, and set away to harden. Remove by dipping mold in warm water. Serve with soft custard. (Individual recipe.) Sxow Pudding. Soak two teaspoonfuls granulated gelatine in three tablespoon- fuls cold water, and add one-third cup boiling water and dissolve. Add three tablespoonfuls sugar and one and a half tablespoonfuls lemon juice. When sugar is dissolved, set on ice to cool, stirring occasionally. When jelly is firm, fold in the stiffly-beaten white of one Qgg and pour into cold, wet molds, and place on ice to cool. When solidified, remove and serve with soft custard. (Individual recipe.) Strawberry Mousse. Soften one-quarter box shredded gelatine, or one tablespoonful granulated gelatine in one-quarter cup cold water: add one-quarter cup boiling water and dissolve. Whip one pint cream until stiff, and add one-half cup powdered sugar. Add one cup strawberry juice to the gelatine, fold the cream in carefully, turn into a wet mold, and pack in salt and ice for two hours. Before serving, turn out of mold on to a glass dish and garnish with fresh strawberries and whipped cream. BOOK IV. LOCAL DISEASES OF ADULTS. john h. Mccormick, Editor-in-Chief. DISEASES OF THE HEAD. DANDRUFF OR SEBORRHOEA. A diseased condition of the sebaceous glands of the skin. When it affects the head it is commonly known as Dandruff and it takes the form of very small flakes or scales or crusts. It appears on the forehead and nose in the form of an oily coating. Scales or flakes also appear in any part of the body. These latter forms are known as Seborrhcea. Causes. — While there is no doubt that anaemia (deficiency of blood) contributes to the condition, the cause of the disease is not well under- stood. Women are more subject to it than men; and brunettes than blondes. It is this same condition of the sebaceous glands that causes the body of a newborn infant to be covered with a sebaceous secretion producing the condition known as vernix caseosa. Symptoms. — The well-known dry, more or less greasy, gray, brown, or yellow flakes or crusts adhere to the scalp and sometimes itch annoy- ingly. It appears on the face in the form of a greasy, oily coating on the forehead or nose. It cannot be mistaken for eczema, because dandruff scales are always dry, while eczema at some stage is moist with a watery secretion ; dandruff scales are pale in color and very abundant ; eczema scales are few in number and are very red in color. Prognosis. — While it is an obstinate disease, it will yield to persistent treatment. Its termination is usually favorable, but the danger of bald- ness caused by it must not be overlooked. Treatment. — As the healthy condition of the sebaceous glands of the skin depends upon the general health, a radical cure requires that a course of tonics be given. For this purpose use : — Fowler's Solution of Arsenic, I dram. Bitter Wine of Iron, 4 ounces. One teaspoonful of this solution in a wineglass of water after each meal. 3 04 DISEASES OF ADULTS. Or:— Wine of Iron, ij^ ounces. Simple Syrup, 2 drams. Solution of Potassium Arsenite, 2 drams. Water, , 2 ounces. Take a teaspoonful after each meal in a wine glass of water. For local treatment, which is of the utmost importance, the following will prove efficacious : — The scalp should be thoroughly anointed with olive oil to soften the crusts and then washed with warm water and tincture of green soap every second day for a week, and afterward washed with tincture of green soap once a week until the condition disappears. Apply daily as a hair dressing : — Oil of Bergamot, 2 drops. Ointment of Red Oxide of Mercury, 4 drams. Benzoinated Lard, 1^2 ounces. Or:— Precipitated Sulphur, 1 dram. Salicylic Acid, 10 grains. Vaseline, 1 ounce. Apply directly to the hair, rubbing well into the scalp every night. Or:— Boroglycerin, 2 drams. Rose Water, 8 ounces. Apply every night, rubbing well into the scalp. Or:— Tincture of Cantharides, 3 drams. Tincture of Capsicum, 3 drams. Oil of Lemon, 1 dram. Castor Oil, 2 drams. Alcohol, 2 ounces. Spirits of Rosemary, . . , 1 ounce. Apply every night and morning, rubbing well into the scalp. BALDNESS OR ALOPECIA. The partial or complete loss of hair. Causes. — The disease may be inherited or acquired. If acquired, it occurs both in age and in early life. It may be a symptom of such other diseases as: syphilis, fevers, dandruff, itch, eczema, and parasitic skin diseases. DANDRUFF OR SEBORRHCEA. 305 Prognosis. — The seriousness of the disease depends entirely upon the cause. When it proceeds from old age, the hair can never be restored. If from other causes which can be speedily and completely removed the probability of the return of the hair is considerable. Treatment. — This is to be adapted to the probable cause. If due to dandruff, the treatment of that condition should be followed. If due to anaemia (bloodlessness), general tonic treatment must be instituted. (See "Anaemia," page 439.) If due to syphilis, the treatment will be the treatment of that disease, and in all such cases a physician should be consulted. In all forms of baldness the following will be found of benefit : — Gallic Acid, 1 dram. Cologne Water, 2 drams. Tincture of Cantharides, 1 dram. Vaseline, 2 ounces. Mix and rub well into the scalp once daily. Or, the following may be used : — Mix well together — Liquor of Ammonia, 1 ounce. Camphorated Alcohol, iy> drams. Bay Salt, y 2 ounce. Water, , 1 pint. With this mixture bathe the head three times a day. Afterwards, rub well into the scalp a pomatum made of fresh lard, four parts, and camphor, one part. The action of the sedative water restores the capillary circulation which forms the bulb of the hair, and imparts new life to the organ. The pomatum assists and favors the growth. Or, use either of the following : — Castor Oil, iy 2 ounces. Tincture of Cantharides, y> ounce. Mix well together, and rub the bald part with it night and morning. Or, lard, made to a thin consistence with bay rum, rubbed in night and morning. One of the most successful remedies ever used is prepared as fol- lows : — 306 DISEASES OF ADULTS. Glycerine, 4 ounces. Tannin, 1 dram. Tincture of Cantharides 2 drams. Oil of Capsicum,. . . 10 drops. Apply to the bald spots morning and evening. PARTIAL BALDNESS OR ALOPECIA AREATA. Patches or small areas of baldness on the scalp and beard. Causes. — In some cases this seems to be caused by a parasite; in others, by a disturbance of the nervous system. Symptoms. — The scalp, beard, and eyebrows are affected by one or more round, smooth, white patches or spots of baldness. These differ from the spots in ringworm by the absence of broken off hairs or of any signs of the follicles. There may be at first some redness of inflamma- tion, but the spots very soon turn white. They may appear gradually or suddenly. Prognosis. — Recovery is very slow ; faster in children than in adults. The older the person the more doubtful the recovery. When the hair does begin to return it appears as a fine, white down; after which the stronger natural hair follows. Treatment. — The tonic preparations recommended for baldness are very satisfactory ; as are also the local applications. The following tonic taken internally proves valuable in some cases : — Fluid Extract of Jaborandi, 1 ounce. Take 10 drops in water three times a day. For local applications follow the treatment for baldness as there given. NEURALGIC HEADACHE OR TIC DOULOUREUX. Sudden pain of a sharp and darting character. Causes. — Anaemia; cold; eye-strain; affections of the teeth; anxiety; mental exertion; rheumatism; syphilis; such tendency as occurs in families almost proves that it is heredity. Symptoms. — Sharp, lightning-like, shooting, stabbing pains, most common at points just above and below the eye; sometimes twitching of the muscles and pain along the course of the nerve. It is often most severe along the left side of the head and face, and is accompanied by a profuse flow of tears. SICK, BILIOUS, OR BLIND HEADACHE. 307 Treatment. — Attention to the general health must be given during the intervals of the attack. Nutritious diet and treatment of the cause as directed in anaemia, rheumatism, malaria, etc., which see. MIGRAINE OR SICK HEADACHE, BILIOUS HEADACHE, OR BLIND HEADACHE. Pain in the head, limited more or less to one side of the head, with more or less disturbance and prostration. Causes. — Heredity; overwork; worry; anxiety; insufficient sleep; mental labor; eye-strain; dyspepsia; irritation of the ovaries or uterus; and many other undetermined causes. Prognosis. — Seldom permanently cured; but free from danger to life. Susceptibility to this form of headache increases with age. Symptoms. — Preceded for a day or two by digestive disturbance and feeling of weariness and exhaustion, and heaviness over the eyes. Sensa- tion of chilliness; nausea, sometimes vomiting; soreness in the muscles over the body ; sensitiveness to light ; pain of a sharp, shooting, pulsating character; face pale or flushed; pain on the left side, in front, on the temple, or at the back of the head; not often the pain is on the right side or on both sides. Moving, sound, and light become intolerable. These sensations of pain and discomfort are followed by intervals of rest and freedom from pain. Treatment. — The attack may sometimes be aborted by : — Antipyrine, 10 grains. Or:— Phenacetine, 10 grains. If due to eye trouble, a competent oculist should be consulted. For the attack, the following will be found of benefit : — Bromo-Caffeine ; a dessert-spoonful in half a glass of water every half hour for four or five doses, and Bismuth Subnitrate, 80 grains. Dilute Hydrocyanic Acid,. . 8 drops. Cinnamon Water, 1 ounce. Mix and take one teaspoonful every two hours until nausea and vomiting subside. If due to anaemia, see "Anaemia," page 439. If due to cold, warm 308 DISEASES OF ADULTS. applications, hot drinks, a brisk cathartic, preferably a dose of salts, and the following to relieve pain: — Dover's Powder, 5 grains. Sweet Spirits of Niter, 15 drops. Every three hours until relieved. Or:— Antifebrine, 10 grains. Caffeine, 4 grains. Potassium Bromide, 4 grains. Divide into four powders. Take one every half hour until relieved. Or:— Phenacetine, 10 grains. Citrate of Caffeine, 5 grains. Monobromated Camphor, 20 grains. Make 10 such capsules and take one every two hours until relieved. Menthol pencils applied locally to the- seat of pain and the inhalation of camphor are often beneficial. The diet must be carefully watched during the interval, for indis- cretions in eating are often the direct cause of an attack. The use of tea, coffee, tobacco, and alcohol must be stopped or limited in quantity. When due to malaria, treat the cause. (See "Malaria," page 406.) RHEUMATIC HEADACHE. Pain in the back and front of the head. Causes. — Exposure to cold and draughts ; dampness ; lowered vitality ; heredity. Symptoms. — Pain in the back and front of the head ; distinguished from neuralgia by being on both sides of the head, made worse by moving the muscles, and by the absence of any point of especial tenderness. The pain is most often felt at night when the patient is warm in bed. The pains shoot from point to point and, when they follow the jaw downward, mastication causes intense pain. Treatment. — Use light diet and abstain from animal food; give attention to the clothing ; keep the body and feet warm and dry. When the pain is great, use hot fomentations or mustard plaster on the back of the neck, and give a gentle purgative at night. The following liniment is found very beneficial : — CONGESTIVE HEADACHE. 309 Soap Liniment, 2^ ounces. Liquor Ammonia, y 2 dram. Laudanum, y 2 ounce. Mix and apply to the part. Or:— Oil of Wintergreen, \]/ 2 drams. Alcohol, 2 ounces. Rub thoroughly into the parts affected. Internally administer Sodium Salicylate, 10 to 15 grains Take in half a glass of water, every hour until relieved, or for six doses. CONGESTIVE HEADACHE. Cause. — This proceeds from a congested state of the vessels of the brain, an overfulness of blood or a weakness of the nerve forces, or from an excessive nervous irritability, which frequently affects circulation. Symptoms. — Whichever of these may be the cause, there is nearly always a dull pain over the whole of the head. When it arises from an overloaded condition of the vessels, there is usually a flushed countenance with bloodshot eyes and a flushed expression; we find, on inquiry, also a sluggish liver, congested brain, and a tendency to apoplexy or paralysis. A very effectual remedy for removing pain is : — Acetanilid, 3 to 5 grains. Or:— A tablet containing Acetanilid, Camphor, and Caffeine; known as Migraine Tablet. Or:— Bromide of Potash in 15 grain doses. Repeat only once after two hours. PERIODIC HEADACHE OR BROW ACHE, BROW AGUE, As it is variously called, is an intermitting pain, which comes on at periods more or less regular, and is confined to the brow. It will nearly always yield to full doses of quinine, especially if due to malaria. Fre- quently brow ache or frontal headache, as it is sometimes called, is due to 3 io DISEASES OF ADULTS. constipation and prompt relief follows purgation with castor oil or Epsom salts. ORGANIC HEADACHE, Resulting from actual disease of the brain, is rare, and when it does occur, only a palliative mode of treatment can be adopted. Sedatives, such as opium and bromides, may, for a time, relieve the most intolerable anguish, but they will not touch the disease itself. Citric acid, or lemon juice, is often of great service in easing pain. Put a teaspoonful or two in a glass of cold water and drink it. THE HEADACHE OF NEURASTHENIA OR OF NERVOUS DEBILITY Is a very common type of headache in which the patient feels as though a constricting band were about the head, or experiences a sense of pressure on top of the head, or dull pain at nape of neck. It is usually most severe in the morning, disappearing as the day advances. For treatment, see Neurasthenia, page 426. HEADACHE OF EYE-STRAIN May be of the type described under Migraine, or it may take the form of pain all over the forehead and a sense of pressure at the nape of the neck. For treatment the patient should consult an oculist. ANAEMIC HEADACHE. This is due to an impoverished state of the blood. The pain may be felt immediately over each eyebrow with a sense of weight or pressure on top of the head and at the base of the brain. For treatment of this type, see Anaemia, page 439. HEADACHE DUE TO DISEASES OF THE KIDNEY. The pain may be felt anywhere in the head and may be of a shifting, pulsating, or wave-like character, and is accompanied by ringing in the RINGWORM OF THE SCALP OR TINEA TONSURANS. 311 ears and dizziness. The complexion is doughy or pasty. Puffiness of the lower eyelids may be apparent. For this condition a physician should be consulted without delay. RINGWORM OF THE SCALP OR TINEA TONSURANS. A contagions disease of the scalp of a parasitic nature, in which bald spots ringed around with minute water blisters appear. Cause. — It is produced by a fungus or vegetable organism which is known as trichophyton. This burrows into the follicles of the hair and the skin of the scalp, and the disease is highly contagious. It may be con- tracted from ringworm in other parts of the body. It is almost wholly confined to young persons before the age of puberty. Symptoms. — It appears in small patches upon which minute water blisters form, and from which at a later period the skin or crusts peel or scale off. The hair becomes brittle in the parts affected and is broken off close to the skin, leaving a circumscribed area covered by a short stubby growth or a bald spot with very much the appearance of the flesh of a plucked fowl. The color of the parts involved becomes red or greenish yellow, and unless the disease is checked the skin becomes raised, puffy, and presents raw, inflamed points which discharge a sticky yellowish secretion. Itching is always a prominent symptom. Prognosis. — Without treatment it may persist for years, or until the age of puberty, when it seems to exhaust itself and to gradually subside. Even under treatment it is liable to recur up to that age. Treatment. — The hair should be cut close to the skin and the parts thoroughly cleansed with tincture of green soap and hot water. After drying well (the patient's towel should not be used by another until thoroughly boiled), the parts may be anointed with blue ointment once daily; or the following : — ■ Peruvian Balsam, ]A. ounce. Salicylic Acid, 20 grains. Resorcin, 20 grains. Vaseline, 3 ounces. Mix and apply twice daily. In addition the scalp should be rubbed every morning with the following : — Oil of Turpentine, 2 drams. Spirits of Camphor, 3 ounces. Ammonia Water, 1 dram. 312 DISEASES OF ADULTS. On- Boric Acid, 20 grains. Flowers of Sulphur, 20 grains. Vaseline, 1 y 2 ounces. Mix and apply night and morning. Cases which do not yield to this treatment should then be treated with : — Caustic Potash, 9 grains. Carbolic Acid, 24 grains. Hydrous Wool-fat, y 2 ounce. Oil of Theobroma, y 2 ounce. Rub only a small amount of this into the scalp night and morning. It is better not to shave the parts when this is applied, as it is retained more completely by the hairs. Or:— Ointment of Boric Acid, 2 ounces. Ointment of Eucalyptol, 2 ounces. Oil of Cloves, y 2 dram. Glycerine, Sufficient to make an ointment. Rub well into the scalp night and morning. BARBER'S ITCH OR RINGWORM OF THE BEARD. A disease which affects the hairy portion of the face and neck in the adult male. The hair, follicles, and skin tissues are affected by a fungous growth so as to produce pustules or conical elevations. Cause. — It is produced by the same fungous growth (the trichophy- ton) as produces ringworm. It is usually contracted in barber shops from an unclean razor or brush. Symptoms. — It begins with one or more reddish scaly patches. They soon show little conical elevations, which mature at the top, and surround a single hair. They are at first of a pale yellowish color. After a few days they burst, and the matter, as it runs out, forms hard brownish crusts. The crusts fall off in a week or two, leaving purplish sluggish pimples behind, which are usually a long time in disappearing. Prognosis. — The disease is extremely chronic and is very likely to return unless completely cured. Treatment. — Soak the crusts of the pustules with olive oil or almond oil to soften them. Then wash them with green soap and water and GRANULAR LIDS OR TRACHOMA. 313 remove them. The face is then carefully and fully shaved. This will be a painful operation the first time. The face is then bathed in water as hot as can be borne. Each mature pustule is opened with a fine needle. Sponge the face and neck with the following wash : — Hyposulphite of Soda, 1 dram. Water, 1 ounce. The face is again washed in hot water and thoroughly dried. Anoint the face with the following ointment : — Sulphur Ointment, 1 y 2 drams to the ounce. Allow this ointment to remain on the parts all night. In the morning wash off the ointment thoroughly with soap and water. Then apply the solution of hyposulphite of soda and dust on an ordinary face powder. Treat the face in this way every night and morning, shaving when the beard is long enough. The razor must be in good condition. The contagious nature of the disease must be remembered and all possible cleanliness observed. DISEASES OF THE EYES. GRANULAR LIDS OR TRACHOMA. An infectious inflammation of the mucous membrane covering the inner surface of the eyelid (the conjunctiva). Causes. — It is probably caused by a germ, the growth of which is encouraged by uncleanliness. Symptoms. — The mucous membrane is covered with small granula- tions (minute rounded bodies like grain). These are at first quite distinct, but, as the disease progresses, they run together forming hard masses which irritate the eyeball and cause inflammation and ulceration. There is redness and swelling of the mucous membrane and a flow of matter which causes the lids to stick together. There is the sensation of the presence of a foreign body in the eye; more or less severe pain; sensitiveness to light ; and copious flow of tears. Prognosis. — The disease is very serious, as it often causes loss of sight or necessitates prolonged treatment. Treatment. — Cleanliness and reduction of the swelling and inflam- mation are the ends sought in the treatment. If only one eye is infected 314 DISEASES OE ADULTS. the patient must use all possible precautions to prevent the disease spread- ing to the other. Other persons may also contract the disease from him. So the greatest care in the matter of towels, etc., must be enjoined. Bathe the eyes frequently with hot boric acid solution (a teaspoonful of boric acid to a pint of water), invert the lid and gently rub it with a smooth piece of dry sulphate of copper. The lid should be kept open after the application until the eyeball is syringed with warm water, to remove from it any of the solution caused by the flow of tears acting on the sulphate. There will probably be great smarting of the eye, and increased redness of the white portion, which must be suffered to subside before the application is repeated. Or the following excellent ointment may be used : — Sulphate of Copper, 8 grains. Salicylic Acid, 8 grains. Cocaine Muriate, 8 grains. Vaseline, io drams. Mix, and rub into the inverted eyelid three times daily. STYE OR HORDEOLUM. A suppurating inflammation of the glands of the eyelid. Causes. — A stye is frequently associated with a condition of debility. Scrofulous and anaemic young people are very subject to this disease. Blepharitis, inflammation of the eyelids, may cause a stye by reason of the uncleanly accumulation of scales and crusts which become favorable sites for germs. Symptoms. — Swelling and redness occur over the gland for a few days, then a red pimple appears which itches intensely and soon fills with matter. Prognosis. — An internal stye is more painful and of longer duration than an external stye. The course, however, is short. More than one stye may be present at the same time. Treatment. — The following ointment, if used early, will abort styes : — Red Oxide of Mercury, 4 grains. Olive Oil, 4 drops. Vaseline, Yz ounce. Mix and rub in twice daily. If the stye is fully formed a few of the winkers should be pulled out WATERY EYE. 315 to allow the pus to escape and the lids should be bathed frequently with very hot boracic acid solution (one teaspoonful to a pint of hot water). Peroxide of hydrogen, full strength, may be applied on a piece of absorbent cotton. After having thus cleaned the lid, the above ointment should be used. As the condition is frequently associated with debility the treatment laid down for anaemia should be employed. (See Anaemia, page 439.) WATERY EYE. If we look closely at the inner corner of the eyelids, we may perceive a little point at each, which is the opening of a duct that runs into the nose. These openings convey the tears from the eye ; every time the eye is shut in winking the fluid is forced into those pipes. Now, when either or both become so thickened as to be stopped up, the tears, of necessity, fall over the cheek ; this is called a watery eye. Cause. — Usually caused by taking cold. Treatment. — As the cause of this disease is most commonly inflam- mation, it may be relieved in its early stages by a plan directed toward the lessening of that inflammation, and the best is as follows : — Pure Water, 2 ounces. Sulphate of Zinc, 4 grains. Laudanum, y 2 dram. Mix and apply frequently. Cold must be strictly avoided. If the trouble does not yield to this remedy consult a physician or oculist. BLEAR EYE. A term given to an inflammatory appearance of the eyelids and corner of the eye itself. Causes. — Advancing age, cold, or temporary weakness. It is also caused by hereditary taint, and resolves itself into a constitutional defect. Treatment. — Where it is not constitutional, use the following lotion : — Sulphate of Zinc, 5 grains. Water, 2 tablespoonf uls. Mix. Moisten the eye frequently with a linen cloth. Another good remedy is to take an active aperient of calomel and rhubarb, and to bathe the eye with poppy-water. If the eye should feel 3 i6 DISEASES OF ADULTS. weak after the inflammation has subsided, bathe it frequently during the day with a lotion composed of sugar of lead, one grain, to a large table- spoonful of water. WEAKNESS OF THE EYES. These excellent washes for ordinary weakness of the eyes will prove very beneficial : — Sulphate of Copper, 15 grains. Camphor, 4 grains. Boiling Water, 4 ounces. Mix, strain, and when cold make up to four pints with water. Bathe the eye night and morning with a portion of the mixture. Or the following : — Spirit of Mindererus. 1 ounce. Rose Water, 7 ounces. Mix and use as an eye-wash occasionally. Or this : — White Vitriol, 10 grains. Elder Flower Water, 8 ounces. Mix and apply as occasion may demand. INFLAMMATION OF THE EYE OR CONJUNCTIVITIS. Inflammation of the mucous membrane which covers the front portion of the ball of the eye and also lines the lids and margins of the latter. It varies in severity according to the extent of the part involved. Causes. — The most common cause is exposure to cold. The disease appears to be epidemic in the spring of the year, and there is every indication that it is of infectious origin by bacilli. Symptoms. — In the simpler form, known popularly as "pink-eye," there is redness, smarting, and sensitiveness to light. There is also the sensation of a foreign body in the eye, which is probably due to the accumulation of mucus into strings. Burning and itching of the lids are present. The secretions which accumulate on the lids during the night dry and glue the lids together. Treatment. — Simple cases are to be bathed with warm water or in : — Boric Acid, 1 teaspoonful. Warm Water, 1 pint. GOXORRHCEAL INFLAMMATION OF THE EYE. 317 Bathe the eyes with this every two hours. Severe cases with discharge of mucus and pus, swollen membrane of the eyelids and eyeball, sometimes subside in from three to ten days under the treatment given above. GONORRHOEAL INFLAMMATION OF THE EYE. A form of conjunctivitis due to the presence of the germ of gonor- rhoea, the gonococcus. Cause. — The presence of the gonococcus, the germ of infection of gonorrhoea. Symptoms. — The lids are swollen, red, and stuck together with a thick, creamy, or greenish-yellow discharge, which escapes from the lids and runs down on the face. There is much pain and heat until the discharge flows freely. The disease occurs in newborn children through infection from the vaginal cavity in birth. Prognosis. — The severity depends on the general health of the patient and the extent to which the cornea is involved. The great danger is perforation of the cornea and loss of sight. The eye is very subject to complications even after an apparent recovery from the attack. Treatment. — The disease is too severe and dangerous to permit of any but professional attention. There is, however, the greatest need of cleanliness and all means to prevent contagion. The saturated solution of boric acid, previously mentioned, will be very helpful in keeping the eye free from the discharge and in allaying the inflammation. Every effort must be made to prevent contagion to the other eye if only one is involved. ABORTED STYE OR CHALAZION. A tumor of the eyelids resulting from retained secretion in the gland. Cause. — Infection of the glands of the eyelids. Symptoms. — A small growth about one eighth of an inch from the edge of the lid. It is marked by absence of pain and causes no incon- venience. There may be a single tumor or several together. They do not inflame or suppurate as true styes do. If small they may remain; but, if large, they may cause irritation by friction in winking. 318 DISEASES OF ADULTS. Treatment. — Small chalazia call for no treatment; large ones are cut into and the contents removed. INFLAMMATION OF THE EDGE OF THE EYELIDS OR BLEPHARITIS. Inflammation of the follicles or ducts along the margin of the lid. Causes. — Xeglect of cleanliness ; exposure to irritating agencies, dust, heat, winds; anaemia; scrofula; eruptive fevers; and overflow of tears. Symptoms. — Redness of the lids and crusts at the root of the eve- lashes caused by dried secretions. Prognosis. — The lashes which fall or are pulled out during this disease will grow in again in the form of the disease known as Blepharitis squamosa, but in Blepharitis ulcerosa they do not return. Chronic catarrhal conjunctivitis, a stye, loss of the lashes, and overflow of tears may result. Treatment. — Strict cleanliness ; bathe parts with solution of boric acid (one teaspoonful to a pint of hot water). After having removed the crusts in this way, the following ointment should be rubbed well into the edge of the lid each night on retiring : — Yellow Oxide of Mercury 4 grains. Vaseline, 1 ounce. Or:— A little red precipitate ointment rubbed into the roots of the lashes, when the lids are closed on retiring to rest. This may be repeated every night until no longer required. Sometimes the hairs on the lids grow inward and cause great irritation of the balls. Collodion brushed over the lids will, as it dries, cause contraction of the skin and so draw the hairs outward, but this is only a temporary relief, and the application must be frequently repeated. Surgical aid must be sought. CATARACTS. An opacity of the lens of the eye or of its capsule or of both. Cataracts are either partial or complete, and either stationary or pro- gressive. As to their origin they are classified as : Congenital or inherited; Infantile, the result of rickets; Senile, due to old age; Diabetic, accompanying diabetes; Traumatic, the result of injury: Complicated, EYE BRUISES OR BLACK EYE. 319 due to disease in other parts of the eye ; and Secondary, when they return after operation. They are also closely classified according to location or to the part affected. There is also a division into Hard and Soft cataracts. Causes. — The name cataract was given to the disease under the impression that some semi-solid matter was exuded from the eye and fell down over the parts in the form of a waterfall. The causes, so far as known, are indicated in the names given to the several forms. Senile cataract is caused by an actual change which old age brings about in the eye. Diabetic cataract is the result of that disease. Traumatic cataracts are caused by an injury to the eye. These injuries are of various sorts and natures : blows, stroke of lightning, wounds of the eye tissues, and the entrance of foreign bodies. Infantile cataract seems to be the result of malnutrition in rickets. The time of development of a cataract varies from a few hours to twenty years. In some cases the changes are so slow that they seem to be stationary. Treatment. — The removal of the growth is the only relief when there is danger of loss of sight. This operation is either by cutting or plucking the growth out. It is usually successful. EYE BRUISES OR BLACK EYE. Causes. — A contused wound caused by some injuring agency such as the fist, or by coming in violent contact with some object, is attended by the rupture of vessels and the escape of blood into the loose cellular tissue of the eyelids. The swelling is sometimes very marked and may be sufficient to completely close the eye. The tissues are at first stained a reddish purple color, changing as the swelling subsides to a darker green- ish hue, through yellow to the natural tint as recovery takes place. Sometimes suppuration takes place and the bruised tissue has to be opened and dressed with strict antiseptic care. Treatment. — The following lotion will quickly promote resolution : — Dilute Acetic Acid, 5 ounces. Tincture of Arnica, 1 ounce. Ammonium Chloride, 1 ounce. Boiled or Distilled Water, 5 ounces. Mix and apply locally by means of compresses wet with this solution. The reduction of the swelling and prevention of the discoloration may be accomplished by immediate and constant use of either hot or cold applications. 320 DISEASES OF ADULTS. PROTRUSION OF THE EYEBALL OR EXOPHTHALMOS. Causes. — This may result from a variety of causes. One or both eyes may be protruded from hemorrhage within the orbital cavity. Tumors, cancer, outgrowths of bone and enlargement of the lachrymal glands may cause the eye to bulge outward. The most common cause, however, is a disease of the nervous system associated with enlarged thyroid gland (goitre). This condition is known as exophthalmic goitre or Graves' disease. SINKING OF THE EYEBALL. Causes. — One or both eyes may sink into the orbital cavity by reason of absorption of the fatty tissue behind the eyeball. This occurs in certain wasting diseases, fevers, and imperfect circulation of blood in the vicinity of the eye. Treatment. — The treatment of this condition is that of its cause, but in general it may be stated that rest and nutritious diet combined with such medicinal treatment as quinine, strychnine, iron, arsenic, etc., will be of great benefit. These remedies may be administered in the form of pill or capsule as follows : — Strychnine Sulphate, Yi grain. Iron Arsenate, 2 grains. Quinine, 24 grains. Extract of Licorice, 24 grains. Mix and make into twenty-four pills or capsules and take one after each meal. SQUINT OR STRABISMUS. A deviation of one of the eyes from the right direction so that both of the eyes are not directed towards the same object at the same time. The varying amount and direction of this deviation from the proper direction gives rise to several sorts of squint. They are classified as follows : — Paralytic Squint is due to the paralysis of the muscles which control the movement of the eye. SQUINT OR STRABISMUS. 321 Spastic Squint is that form which is produced by spasms or sudden contractions of the muscles of the eye. Constant Squint is that form which is always noticeable. Periodic Squint is noticeable only at times such as when looking at near-by objects. Intermittent Squint occurs at more or less regular intervals. Unilateral Squint affects but one eye. Alternating Squint affects both eyes alternately. Convergent Squint is the turning of one eye inwards towards the nose. Divergent Squint is the outward turning of the eye towards the temple. Treatment. — This is adapted to the cause and consists of correcting the refraction of the eye by the use of proper mechanical devices; by absorbents and other medicinal agents in cases of paralysis and of spasms ; and by a surgical operation. The operation is called both strabotomy and tenotomy. It consists of cutting the muscles which control the movements of the eyes so as to secure uniformity of motion. This is not performed in the case of children until they are six years old. This is the age at which they begin to use the eyes in school and in near work. Prior to that age the treatment is corrective and preparatory to the operation. If the sight of both eyes is equally good, all of the objects are seen double ; but if the sight of one is much better than that of the other, the mind attends to only the clearer impression and disregards the other. This disregard may lead to dimness of vision (amblyopia) in that eye. To correct this, or to prevent it, a bandage is worn in childhood over the stronger eye to enforce the use and development of the latter. It is customary to operate on the poorer eye first, and, after this has improved, the stronger eye is then treated. This method gives the patient the use of one eye nearly all of the time. As it is a matter of nice adjustment, sometimes a second operation is necessary. The treatment of strabismus due to paralysis of the muscles of the eye will depend upon the cause. If it is caused by rheumatism it will respond to the treatment of that disease by salicylates and diaphoretics (medicines which produce perspiration). Consumption, diphtheria, dis- eases of the base of the brain, diabetes, injuries, and exposure to cold are among the other causes of this form. The trouble usually responds sooner or later to the successful treatment of the disease. 322 DISEASES OF ADULTS. DISEASES OF THE EAR. EARACHE OR OTALGIA. Causes. — This may be of neuralgic origin, or it may be due to acute or chronic inflammation of the middle ear, a condition which frequently complicates scarlet fever, measles, diphtheria, tonsilitis, and influenza. It is often brought on by exposure to colds or draughts. It is not uncom- mon during the period of teething in children and is especially severe while cutting their permanent teeth. Grown persons sometimes suffer from it while cutting their wisdom teeth. There is not often much con- stitutional derangement, though the pain may be sufficiently severe to render the patient unable to attend to his daily affairs. Treatment. — When of neuralgic origin, the following will be helpful in relieving pain : — Tincture of Belladonna, 2 drams. Laudanum, 2 drams. Mix and put five drops in the ear several times a day. Or:— Chloroform, 3 drops. Expressed Oil of Almonds, 4 drams. Mix, warm, and fill the ear canal ; hold until it feels warm, when the ear should be syringed with warm water. When due to inflammation, the ear should be syringed and cleansed with peroxide of hydrogen, one part, and warm water, three parts. Then a piece of cotton saturated in this solution should be placed in the ear canal. The ear may be syringed continuously with several quarts of very hot salt solution (one teaspoonful of table salt to a pint of hot water), and great relief experienced. When earache is caused by an abscess, and is attended with much swelling and severe pain, hot fomentations may be used, syringing the external passage with warm water; and, after the abscess has discharged, syringe with a solution of sulphate of zinc, in the proportion of eight grains to the ounce of plain or rose water, attention being paid to the bowels. Sometimes the drum must be punctured to allow the escape of pus. With some persons any derangement of the general health will cause the formation of these abscesses, and in such cases the treatment must be general rather than local. Earache, no doubt, often proceeds INFLAMMATION OF THE EAR OR OTITIS. 323 from derangement of the digestive organs, and may be relieved by active purgatives and emetics. When a tonic is required, the following will be found very good : — Citrate of Iron, 1 dram. Strychnine, 1 grain. Syrup of Orange Peel, 2 ounces. Soft Water, y 2 pint. Mix. Dose, one teaspoonful three times a day. In children, during dentition, lancing the swollen gums will often afford relief, especially if an aperient be given, such as rhubarb and magnesia combined with a little ginger. Older children may have three or four drops of warm olive or almond oil, with one or two drops of laudanum dropped into the ear; and take compound senna mixture, repeated until the bowels are freely opened. Should these remedies not prove effectual, a fomentation of camomiles and poppies should be applied. The heart of a roasted onion applied warm to the external orifice will sometimes afford relief. If the case is very obstinate, two or three leeches behind the ear may be tried, with the following anodyne saline aperient : — Acetate of Morphine, ]/ 2 grain. Solution of Acetate of Ammonia, 3 ounces. Sulphate of Magnesia, 1 ounce. Water of Camphor Mixture, 5 ounces. Mix, and take two tablespoonfuls every four hours. INFLAMMATION OF THE EAR OR OTITIS. This is characterized by an acute and increasing pain, with tender- ness on pressure or moving the jaw, accompanied by fever. Sometimes the external ear is the seat of the disease, sometimes the internal, or both may be involved. There is frequently impaired or confused hearing, and often the pain is so acute as to produce delirium. On examination, the meatus is observed to be more or less red, swollen, tender, and dry. After a time, if the disease progresses, suppuration takes place, and pus is discharged. If this happens in the inner ear, frequently the tympanum ulcerates and bursts, unless such injury is prevented by timely aid of a surgeon. If this disease is neglected it may result in loss of hearing. An obstinate discharge may remain after the other symptoms have disappeared. 324 DISEASES OF ADULTS. Causes. — It is usually caused by cold, or exposure to currents of cold air; injudicious bathing; violent syringing or probing; scrofula; and acute diseases like scarlet fever. Treatment. — It is to be treated with fomentations, and the repeated application of leeches. At the same time active purgatives are to be administered. The ear should also be frequently syringed with warm water, and dusted with pulverized boric acid. Or:— The ear may be syringed twice daily with creoline solution (a tea- spoonful of creoline to a quart of water) and, after drying, this powder blown into the ear canal : — Salicylic Acid, 8 grains. Powdered Boric Acid, 4 drams. On- After syringing wtih the creoline solution, five to ten drops of the following may be allowed to run into the ear : — Ichthyol, 2 drams. Boiled or Distilled Water 2 drams. Glycerine, 2 drams. Tonic treatment internally will be of service such as, cod liver oil, syrup of hypophosphites, or syrup of the iodine of iron. The last is given in doses of from 1 5 to 30 drops in water three times daily. If there is any catarrhal disease of the nose or throat the same should be treated as advised under Xasal Catarrh, page 329. For chronic cases the following is highly recommended : — Cleanse the ear thoroughly by syringing with hot water ; dry well and paint on lightly : — : Carbolic Acid Crystals, 15 to 75 grains. Pure Glycerine, 2^ drams. When the discharge lessens the following application is to be used : — Pure Glycerine, 2^ drams. Mercury Perchloride, 3 grains. ECZEMA OF THE EAR OR TETTER. Symptoms. — An inflammation of the skin around or within the mouth of the ear canal accompanied by more or less itching and a watery discharge with the formation of crusts, or small scales. WAX IN THE EAR. 325 Treatment. — The treatment of the condition is as follows : — Vaseline, 2^ drams. Oil of Cade, 15 drops. Or:— Vaseline, 5 drams. Starch, 2 y 2 drams. Zinc Oxide, 2j^ drams. Salicylic Acid, J 1 /? grains. Wet applications should not be employed under any circumstances. WAX IN THE EAR. Symptoms. — When this substance becomes too hard or abundant, there will be cracking or hissing noises in the ear, and generally deafness to a considerable extent. Treatment. — In this case the ear should be syringed with warm soap- suds. If this does not soften the wax put two or three drops of glycerine in the ear at night and syringe again in the morning. Repeat until the wax is removed. Or:— Fill the canal with olive oil. After an hour or so syringe with warm water. Then the ear may be cleansed with solution of peroxide of hydrogen, one part to three of water. FOREIGN BODIES IN THE EAR. First: Insects occasionally make their way into the external ear, particularly of children, when lying on the grass. They sometimes pro- duce horrible torture by irritating the drum of the ear. Second : A disease that may be acute or chronic is due to the presence of vegetable parasites which, acting as foreign bodies in the ear, cause considerable itching, pain, vertigo (dizziness), and deafness. These parasites appear as yellowish or black spots on the walls of the ear canal. Treatment. — To Remove Insects: Let the child recline with the opposite ear upon a pillow, and fill the affected one with sweet oil. There is no insect that will not perish, or make good its retreat, when this method is pursued. 326 DISEASES OF ADULTS. Solid substances are frequently pushed into the ear by children, where, if large, they sometimes occasion much inflammation and become firmly wedged by the swelling. Great danger of destruction to the drum and small bones of the ear results from awkward attempts at removing such substances, by which they are driven still deeper into the canal. If the foreign body have any visible projecting point, of which a firm hold can be taken, this may be seized by forceps, or pincers, and the body removed directly; but'when the substance is rounded, or formed with many faces, or extremely smooth and cylindrical, it is very wrong even to attempt its removal by any such means. Cherry stones, apple seeds, common beads, garnets, bugle beads, and pieces of red coral, furnish many cases in point. If we attempt to seize them in front, they instantly slip farther in, and endanger the drum. We must get behind them and hook them out, always with great caution. Sudden and severe pain warns us when we touch the drum of the ear, and then all considerable pressure inward must cease. When the foreign body is small in proportion to the size of the canal, it may generally be removed by means of the little steel ear-picker on the handle of the common pocket tweezers ; but, when larger, the eye of a fine bodkin, or silver probe, should be gently curved and inserted beyond the body to draw it forward. A few drops of sweet oil, pre- viously dropped into the ear, will very much facilitate the operation. As children sometimes fancy things have got into the ear when they really have not, it is best to institute an examination before attempting their removal. This may be done by drawing the upper lobe of the ear upward and backward, which will have the effect of straightening the curved passage so that the eye can discern the drum at the bottom, unless there is an interposing object. To Remove Vegetable Parasites : Syringe the ear with warm water, after which fill the canal with alcohol and dry thoroughly. This treat- ment should be continued every two or three days until the growth disappears. POLYPUS OF THE EAR. Polypus of the ear is by no means an uncommon form of the fungoid growth, which sometimes occurs in several of the internal tissues. Symptoms. — It is of a jelly-like consistency, and a whitish yellow color, and is attached to the membranous lining of the ear. There are NOISES IN THE EAR. 327 also granulations of fungus which sometimes shoot up from the mem- brane, and are distinguished by their reddish hue from polypi. Treatment. — These may generally be removed by being held firmly with a pair of forceps, and then gently twisted and pulled at the same time. This should only be done by a properly qualified person, as much mischief may result from the unskillful application of the forceps to so delicate a part. Sometimes, when the polypus is in the external passage, and not far up, it may be destroyed by application of chromic acid, or burnt alum, applied with a camel's-hair brush. NOISES IN THE EAR. Noises in the ear, like the distant sound of bells, roaring of the sea, hissing, singing, etc., are often indicative of a determination of blood to the head. With some, mere derangement of the digestive organs will cause these noises. When accompanied by a certain degree of deafness, they are generally occasioned by an accumulation of wax in the external passage, or a partial stoppage of the Eustachian tube by cold. When the noises become chronic, or long continued, bathing the head regularly every morning with cold water will sometimes remove them. If cold be the cause, or disordered stomach, they will pass away with the temporary ailments which occasioned them. DISEASES OF THE NOSE. COLD IN THE HEAD OR CORYZA Is an inflammation of the lining membrane of the nose and cavities in the head which communicate with the nose. It is attended by a sense of fullness in the head, sneezing and a discharge which at first is watery, later is mixed with mucus, which eventually becomes thick and yellowish. Causes. — Exposure to cold, dampness, and irritating vapors. Symptoms. — The attack is usually preceded by feeling of general malaise (tired feeling), and some brow ache; chilliness and fever; sneez- ing and a watery discharge from the nose. The catarrhal inflammation causes the tear tube to be stopped up so that the tears flow over the cheeks and the eyes become red and watery. If the inflammation extends into 328 DISEASES OF ADULTS. the Eustachian tube, which communicates from the throat to the ear, there may be more or less deafness. If the condition involves the throat there may be some cough. The condition usually lasts from one to two or three weeks. Treatment. — A hot mustard foot-bath, hot drinks such as hot lemon- ade, ginger tea or plain tea with cayenne pepper, a prompt purge, prefer- ably Epsom salts, Dover's powders in 4 to 8 grain doses every two or three hours to cause sweating and dry up the secretion, and the follow- ing inhalation: — Compound Tincture of Benzoin, 1 ounce. A teaspoonful of the tincture to a pint of boiling water, and inhale through a paper cone every half hour until the fullness in the head is relieved. Or the following powder snuffed into the nostrils three times daily is of benefit : — Sulphate of Quinine, 8 grains. Salicylate of Bismuth, 8 grains. Boric Acid, 15 grains. Powdered Starch, 3 drams. Or:— Menthol, 7 grains. Boric Acid, . • • • • 5 drams. Vaseline, 3 J4 ounces. Mix and apply as an ointment to the nostrils two or three times daily. CHRONIC NASAL CATARRH. A chronic inflammation of the lining membrane of the nose associated with dropping of mucus into the throat with impairment of sense of smell and hearing. Causes. — May follow cold in the head when the same has been of frequent occurrence ; breathing irritating dust and vapors ; syphilis ; and scrofula. Symptoms. — Sense of fullness and swelling in the nose, swelling of the soft palate, dropping of mucus into the throat. The patient awakens in the morning with a plug of mucus in the throat which is dislodged by hawking and coughing. The voice has a peculiar nasal twang; brow ache is quite common; and there may be disagreeable sense of smell in the nose more or less constant. If the tear ducts are closed, the tears flow over the cheeks. INFLAMED AND ULCERATED NOSE. 329 A cure is seldom effected except by change to a warmer and dryer climate. Treatment. — The nasal cavities should be syringed or sprayed with a solution made by dissolving one Setter's tablet in two ounces of warm water. This solution should be made fresh each time used. After hav- ing cleansed the nasal cavities with this solution or with glyco-thymoline, one part to three parts warm water, the following oil should be used in an oil atomizer : — Menthol, 8 grains. Camphor, 5 grains. Olive Oil, 1 ounce. . DobelPs cleansing solution is composed of : — Carbolic Acid, 1 grain. Bicarbonate of Soda, 5 grains. Biborate of Soda, 5 grains. Glycerine, 1 dram. Water, 1 ounce. Spray this into the nostrils. After these cleansing solutions one of these snuffs may be used : — ■ Boric Acid, 30 grains. Subnitrate of Bismuth, 2 drams. Hydrochlorate of Morphine, 1 grain. Or:— Powdered Bloodroot, 1 dram. Tannic Acid, 5 grains. Powdered Camphor, 1 dram. Subnitrate of Bismuth, 2 drams. Use either of the above as snuff every three hours. The following is a very agreeable application : — Tincture of Benzoin, 4 drams. Tincture of Guaiacum, 1 dram. Chloroform, 10 minims. Tincture of Myrrh, ]/ 2 dram. Oil of Almonds, 5 minims. Apply a few drops to each nostril once a day with a camel's-hair brush. INFLAMED AND ULCERATED NOSE. When the lining membrane of the nose is inflamed and ulcerated, a solution of carbonate of soda in warm water thrown up by a syringe will 330 DISEASES OF ADULTS. be of service. If the purulent discharge be offensive, a few drops of the solution of chloride of soda or lime should be added to this. NOSEBLEED OR EPISTAXIS. Persons of a sanguine temperament and full habit of body are often subject to this disease. It ought to be regarded as beneficial, unless from a fullness of the veins and a tendency of blood to the head, are often excessive. Those who are troubled with vertigo and headache, arising relieved by bleeding from the nose ; and there can be no doubt that many a fit of apoplexy has been averted by it, and many an attack of inflamma- tory fever, or congestion of the brain, thus relieved. It is sometimes due to injury as from direct violence. Causes. — Violent exercise, great heat, blows on the nose, the long continuance of a stooping posture, and disease of the vessels conveying blood to the brain which renders them liable to rupture. It may come on without any previous warning, or be preceded by headache and a sense of heaviness, singing noises in the ears, heat and itching of the nostrils, throbbing of the temporal artery, and accelerated pulse. It may be due to presence of polypus ; chronic nasal catarrh ; disease of the nasal bones ; or the presence of a foreign body in the nose ; disease of the heart; mountain climbing. It is also one of the early symptoms of typhoid fever. Treatment. — When it comes on frequently and continues long, so as to cause faintness, and especially if the person subject to it be weak or advanced in years, it should be stopped as soon as possible. This may sometimes be effected by immersing the head in cold water, free exposure to cool air, and drinking cool acidulous liquids. The body of the patient should maintain an erect position, with the head thrown somewhat back, a cold piece of metal or ice applied to the neck over the spinal cord, vinegar or lemon juice snuffed up the nostrils, or an astringent wash injected into them with a syringe. It may be composed as follows : — Alum, 2 drams. Acetic Acid, 2 drams. Water, 6 ounces. Or, three drams of the tincture of chloride of iron in the same quantity of water. Or, if these fail, the nostrils may be plugged with lint dipped in a strong solution of the sulphate of copper. When the bleeding has POLYPUS OF THE NOSE. 331 stopped there should be no haste to remove the clotted blood from the nostrils. Do not blow the nose violently, nor take stimulants, unless there be excessive faintness, in which case a little cold brandy and water may be taken. When there is a full habit of body, cooling medicines and light diet may be safely advised. A hot foot-bath to draw the blood to the lower extremities and ice applied to the nose are beneficial, or the following powder blown up the nostrils is a very certain remedy: — Tannic Acid, 20 grains. Antipyrine, 20 grains. Powdered Starch, 20 grains. POLYPUS OF THE NOSE. Polypus is a name given to a tumor generally occurring in me nose, but sometimes in the womb, or the ear, and so named from an erroneous idea that it had many roots or feet. It is the result of an excessive growth of the mucous membrane, and sometimes assumes a malignant character. It may be either of a soft texture so as easily to tear and bleed, or firm and fibrous, or even almost cartilaginous. The color is commonly a yellowish gray, and it has little or no sensibility, although it causes much pain by its pressure upon the surrounding parts, stoppage of secretions, etc. It is attached to the surface from which it springs by a narrow neck like a footstalk. When in the nose it interferes with the breathing, so that the patient sleeps with the mouth open. In this situation it may be destroyed by the use of such applications as chromic acid applied with a camel's-hair brush, or a little burnt alum taken like snuff, but the only safe treatment is the removal and for this a nose and throat specialist should be consulted. FOREIGN SUBSTANCES IN THE NOSE. Sometimes foreign bodies, such as pieces of tobacco pipe, etc., get pushed up the nose by children. If this is a bean, or anything which swells by absorption of moisture, the extraction is a matter of great difficulty. This should not be attempted by other than a professional sur- geon ; yet if the assistance of such cannot be readily obtained, the effort may be made by means of the fiat end of a probe or a silver bodkin, bent 332 DISEASES OF ADULTS. in about the eighth of an inch at the end, and the instrument then introduced and passed beyond the object, so as to draw it out as with a hook, when the foreign body has not penetrated far. If the opposite nostril is closed, and the child is made to blow the nose violently, it may sometimes be driven out. COLD SORE, FEVER SORE, OR HERPES LABIALIS. An acute inflammatory affection of the skin around the mouth and nose. Causes. — They may be due to fever, to digestive disturbance, or to local congestion. Symptoms. — Clusters of small areas of raised vesicles containing a clear or opaque fluid. These vary in size from a pin-point size to that of a pea. They are often preceded by heat and swelling in the locality. After a short time they crust over and disappear without leaving a scar. Treatment. — They seldom require serious treatment, though they are often painful and always unsightly. The application of a good toilet powder dusted upon them, or cold cream, or a solution of boric acid, a teaspoonful to a pint of water, will lessen the itching and prevent contagion. DISEASES OF THE MOUTH, CHAPPED OR CRACKED LIPS. The lips are often chapped and cracked by exposure to cold, and it is sometimes a difficult matter to heal them. The following is a good form for lip-salve to be used in such a case : — White Wax, 2^ ounces. Spermaceti, y 2 ounce. Almond Oil, 3 ounces. Melt together, stir well, and put by to cool. Apply to the lips on going to bed at night. It may be made of a pretty pink color first by tinting the oil with a small piece of alkanet root, which should be taken out before the other ingredients are introduced. When the lips heat and burn much, a little cold cream will be found a pleasant and service- able application. SORE MOUTH. 333 SALIVATION OR MERCURIAL STOMATITIS. Causes. — Occurs in those poisoned by mercury when working with the same, or from overdosing. Symptoms. — The secretions of the mouth are increased; the breath is foul ; there is a bad taste in the mouth ; the gums swell ; are inflamed, soft; and the teeth are sensitive and may become loose. There is usu- ally loss of appetite and diarrhoea. Treatment. — Creolin, 30 drops in four ounces of water. Use as a mouth wash every three hours. Or:— A small piece of alum dissolved in a little water and applied on a swab to the gums to pucker them and prevent further softening. Or:— Tincture of Myrrh, 3 drams. Chlorate of Potash, 30 grains. Chloride of Soda, 2 drams. Distilled Water, to make 8 ounces. Mix and use as mouth wash every two hours. Internally, use iodide of potash, five to ten grains in half a glass of water three times daily to eliminate the poison. GUMBOIL. Causes. — This sometimes arises from exposure to cold, but is caused in the majority of cases by the irritation of a decayed tooth. Treatment. — Inflammation of the gum generally goes on to suppura- tion, to promote which warm fomentations and poultices may be applied externally. As soon as the matter is formed the abscess may be cut or lanced. Afterwards the mouth should be washed occasionally with an astringent lotion composed of tincture of myrrh and water, or of twenty or twenty-five grains of sulphate of zinc, dissolved in half a pint of rose water. STAMMERING. This defect of speech sometimes proceeds from functional disorder, sometimes from nervousness, sometimes it is the result of irritation. 334 DISEASES OF ADULTS. From whatever cause it originates, it is in the majority of cases to be cured by an exertion of the will. Treatment. — Stammerers, although they cannot speak a single sentence without hesitation, can sing a song of many verses as fluently as any person. It is to be recommended that those who stammer should begin with a set of exercises of commonplace sentences, chant to the first bars of the simplest melody, such as "My Country," and, from that, practise those sentences upon one note ending a note lower or higher, slowly at first, but gradually increased to rapidity. SORE TONGUE. The tongue is liable to become sore or ulcerated, most commonly along the edges ; and there are frequently seen small pimples and cracks. Treatment. — Take mild and cooling aperients, particularly calcined magnesia, either alone or in a Seidlitz powder. Let the drink consist chiefly of soda water, and the diet be light and cooling. Touch the sores with burnt alum and wash the mouth frequently with borax and honey dissolved in water. INFLAMMATION OF THE TONGUE OR GLOSSITIS. Causes. — Mechanical injury, very hot fluids, corrosive poisons, sharp edges of teeth, and irritation from tobacco pipe stems. Symptoms. — The tongue becomes greatly swollen and is painful. There is fever, rapid pulse, and increased flow of saliva. Respiration and deglutition (swallowing) are much interfered with, and the voice is muffled. Prognosis. — The chief dangers are suffocation and abscess formation. Treatment. — Ice held in the mouth and the use of purgatives together with small doses of tincture of aconite, two to four drops every hour, until fever subsides or sweating is produced. If these measures fail, the tongue must be scarified deeply to afford relief. Abscesses must be opened. In chronic cases apply with a camel's-hair brush silver nitrate, ten grains to an ounce of distilled water, to the ulcerations, and administer tonics. A good mouth wash, such as listerine or boric acid solution, should be constantly used. PHARYNGITIS. 335 DISEASES OF THE THROAT. SORE THROAT OR ACUTE PHARYNGITIS. Inflammation of the throat or pharynx. Causes. — Exposure to cold ; insufficient clothing ; too much clothing ; a too rich diet with hot drinks; obstructions in the nose and pharynx; scrofulous or gouty tendency. Symptoms. — Pain in swallowing; persistent clearing the throat; impaired hearing ; loss of taste ; and mouth breathing. Prognosis. — Nearly always very favorable when treated. Treatment. — Sucking of ice; cold sprays; application to the throat by oil atomizer of : — Guaiacol, i ounce. Sweet Oil i ounce. Or:— Menthol, y 2 ounce. Olive Oil, 2 ounces. Apply by spray. Or:— Chlorate of Potash, 15 grains. Water, 1 ounce. Gargle frequently. If there is reason to believe that the stomach is disordered, J4 grain doses of calomel every two hours for four doses, followed in six hours by a full dose of Epsom salts, will be of much benefit. "CLERGYMAN'S SORE THROAT" OR CHRONIC PHARYNGITIS. An inflammation of the back part of the throat easily visible when the mouth is opened wide. The vocal cords and the larynx are usually affected. Causes. — Over-exertion and improper use of the voice; inhaling irritating vapors ; digestive disturbances ; and excessive smoking. Symptoms. — At first the mucous membrane is red and inflamed, and is studded with glandular follicles and lymphatic little glands. The 336 DISEASES OF ADULTS. voice is husky and the throat is dry. There is increased difficulty in using the voice with constant clearing of the throat. There is also difficulty in swallowing. Treatment. — This should be first directed against the underlying causes. The voice must be saved, and whatever practices cause or aggravate the complaint must be stopped. Tonic medicine, fresh air, and good diet must be observed. For local treatment use antiseptic washes in the pharynx and nose, such as Dobell's solution : — Bicarbonate of Soda, i dram. Carbolic Acid, 30 grains. Glycerine, 1 ounce. Boiled Water, 2 pints. Or:- Zinc Sulphate, 5 grains. Water, 1 ounce. Use as a gargle. Or:— Silver Nitrate, 15 grains. Water, 1 ounce. Use as a gargle. A very beneficial and agreeable spray is : — Menthol, 2 grains. Eucalyptol, 1 grain. Liquid Vaseline, 1 ounce. Use with an oil atomizer. INFLAMMATION OF THE TONSILS OR TONSILITIS. Redness and swelling of the tonsils due to inflammation of the soft tissues. Causes. — Exposure to wet and cold ; sudden changes of temperature ; imperfect protection of the feet in damp weather ; rheumatic or scrofulous tendencies; and previous attacks. It usually occurs in childhood and early adult life. Symptoms. — In the simple form there is swelling, redness, difficulty in swallowing. There is usually a warning chill followed by fever from 102 to 104 ° ; headache ; and pain at the angle of the jaw. The breathing is difficult ; hearing impaired ; and the voice sounds distant and indistinct. TONSILITIS. 337 Earache sometimes appears early. The tonsils are covered with light yellow colored spots which may be hastily taken to be the membrane of diphtheria. Usually the breath is fetid. Prognosis. — The disease usually terminates favorably; although suffocation may occur in cases of delicate children. Treatment. — The disease may frequently be aborted during the first 24 hours of the attack by 4-minim hourly doses of tincture of aconite. This must be discontinued as soon as there is tingling in the ends of the fingers or a tickling in the throat. If a rheumatic tendency is ascertained, 3-grain hourly doses of the salicylate of soda may be given. This may be continued until there is a decided improvement. The patient is put to bed at once and a liquid diet is provided. Administer at once a powder of : — Calomel, 3 grains. Bicarbonate of Soda, 5 grains. Follow it in six or eight hours with a dose of Epsom or Rochelle salts or of Hunyadi water. The tonsils may be touched carefully with a solution : — Nitrate of Silver, 40 grains. Water, 1 ounce. Use a camel' s-hair brush or swab of absorbent cotton, taking care not to touch the surrounding parts. This may be done three times a day. Or:— Tincture of Chloride of Iron, 1 dram. Chlorate of Potash, y 2 dram. Water, to make 2 ounces. Mix. Use as a gargle every two hours, plain or diluted. In children who cannot gargle : — Tincture of Chloride of Iron, 3 drams. Glycerine, 3 ounces. Mix. Give one teaspoonful every two hours plain. Should the tonsilitis become chronic, excision of the tonsils may be necessary. When there are white patches on the tonsil, as in ulcerated sore throat, a gargle of peroxide of hydrogen, plain or diluted, is very efficient. When the attack has subsided the tonsils may be contracted by touch- ing them with : — 2>& DISEASES OF ADULTS. Copper Sulphate, 20 grains. Water, 1 ounce. Or:— Monsel's Solution or Solution of Iron Sub- sulphate, 1 dram. Water, 1 ounce. QUINSY OR PERITONSILAR ABSCESS. An abscess of the tissues surrounding the tonsils. Cause. — This disease sometimes accompanies or terminates tonsilitis. It is inflammatory and is thought to be of the same origin. Symptoms. — The loose connecting tissues surrounding the tonsils are inflamed, and the movements of the jaw are painful; nasal breathing is impaired; the soft palate and the uvula are swollen and inflamed. The countenance of the patient appears anxious; the mouth hangs open and saliva escapes from it. Prognosis. — The termination of the disease is favorable. Treatment. — The disease may often be aborted in the first twenty- four hours by use of 4-minim hourly doses of tincture of aconite. If it is not aborted, hot poultices are applied to the neck in order to pro- mote suppuration and hasten the termination of the disease. As soon as the abscess has formed, incision is made at the side of the root of the uvula and the pus allowed to escape. Sometimes the abscess breaks of its own accord. The parts soon heal ; but it is not well to wait for the spontaneous bursting of the abscess, as the deep muscles of the neck may become involved and more serious consequences develop. Warm bran or flaxseed poultices are used to promote suppuration. Acid drinks, or pieces of ice retained in the mouth, are often grateful to the hot and dry throat. Relief from pain may be procured by inhaling the steam of hot water through a teapot or an inverted funnel. After the pus has discharged, a generous diet and tonic treatment is desirable. HOARSENESS OR LARYNGITIS. Inflammation of the larynx. Causes. — Improper use of the voice; insufficient clothing; poor ENLARGEMENT OF THE UVULA. 339 ventilation; breathing irritating particles and gases; digestive disturb- ance ; abuse of alcohol ; excessive smoking. Symptoms. — Dry cough ; hoarseness ; swelling and sometimes hemorrhage; mucous membrane is evenly red and swollen. Prognosis. — If taken early and well treated, and the causes removed, the cure will in time be assured. If not, the disease will run three or four weeks and will leave the patient very susceptible to future attacks. Treatment. — Refrain absolutely from using the voice even in a whisper. The patient should remain in one room of an even tempera- ture of about 65 ° or 70 , the atmosphere of which is laden with moisture from boiling water. A bandage of cotton cloth wrung out of cold water every five hours is to be worn around the neck and held in place by a band of flannel. The compress is to be further moistened with the following solution : — Glycerine, 1 ounce. Tincture of Iodine, 1 dram. Water, to make 8 ounces. Moisten the compress twice daily. The throat may be thoroughly rubbed with camphorated oil. . % grain doses of calomel may be given every two hours until four doses have been taken; then follow in six hours with a full dose of Epsom salts. ENLARGEMENT OR SWELLING OF THE UVULA. The lengthening and enlarging of the uvula, which hangs downward at the back of the mouth from the palate over the base of the tongue. Causes. — A weakening or sometimes an absence of muscular fibers in the uvula. This may result from a partial paralysis of the muscles by diphtheria, scarlet fever, influenza, and similar diseases. It occurs at all ages and among speakers and singers especially. Symptoms. — Fits of coughing at evening and in the morning; tickling in the throat with pain and discomfort; deterioration of the singing voice; hoarseness; and sometimes blood-spitting. Treatment. — Astringent applications to shorten the uvula and to restore it to its place. Burnt alum blown against the uvula; a simple gargle of alum water; and washing with tannic acid or nitrate of silver with a camel's-hair brush will often suffice. If this is not efficacious 340 DISEASES OF ADULTS. the uvula must be amputated. This is a simple operation in the hands of a competent surgeon. DROPSICAL INFLAMMATION OF THE LARYNX OR OEDEMATOUS LARYNGITIS. Inflammation of the mucous membrane of the larynx, glottis, and epiglottis, with an outpouring of blood serum into the tissues producing a dropsical condition. Causes. — Colds; eruptive fevers; breathing irritating vapors and particles; foreign bodies; tubercular and syphilitic affections. Symptoms. — Chill; fever; difficulty in breathing; extreme anxiety of expression; breathing inward is most difficult at first; wheezing; difficulty in swallowing; pain seems to be located at the "Adam's apple"; capillaries (minute blood vessels) in the throat very red; parts swollen. Prognosis. — If not relieved the patient dies of strangulation in from a few hours to five days. Treatment. — Prompt and vigorous treatment is demanded to overcome the tendency to suffocation. This is done by a physician, who scarifies the surface five or six times a day to allow the serum and fluids to run out and thus reduce the swelling. Steam inhalations and pieces of ice dissolving in the throat afford some relief. Ice bag on the neck over the seat of disease is beneficial. If pus is present it must be removed. Tracheotomy (cutting an opening into the throat from outside and the insertion of a silver breathing tube) is often necessary to save life. DISEASES OF THE LUNGS. COLD IN THE CHEST OR ACUTE CATARRHAL BRONCHITIS. Inflammation of the lining membrane of the bronchial tubes. Causes. — Sudden changes in temperature; cold winds; inhaling irritant vapors and dust; infection by micro-organisms; acute infectious diseases, such as typhoid fever, measles, etc. ; heart or kidney disease ; dentition in young children. ACUTE BRONCHITIS. 341 Symptoms. — Chill; a short, dry, annoying cough; soreness under the sternum (breastbone) ; sense of weight or oppression on the chest; slightly quickened breathing; slight rise in temperature; and a rather higher than normal pulse. These are accompanied during the first day or two by fatigue ; furred tongue ; constipation ; and, in very young children, convulsions may be among the earliest symptoms. In a few days the pain in the chest increases and becomes tearing or burning in sensation and is aggravated by a deep breath or by coughing. The cough becomes loose and is followed by free expectoration. The sputum may be slightly stained with blood and soon becomes more abundant, of a greenish-yellow color. Prognosis. — There are a few deaths from acute bronchitis among the very young and the very old or those who are greatly enfeebled from other causes ; but the disease usually terminates favorably in about two weeks. Other cases may drag along and become chronic. Treatment. — The treatment during the first stage of the disease consists in an attempt to allay the inflammation. Hot foot-baths, hot drinks, and the following may be taken : — Dover's Powder, 2 grains. Make five such powders and take one every three or four hours. After which: — Wine of Ipecac, 1 dram. Solution of Potassium Citrate, 3 ounces. Solution of Ammonium Acetate, 3 ounces. Take a tablespoonful every two or three hours. If the cough and pain are severe a mustard plaster may be applied front and back and the chest and back afterwards well rubbed with either ammonia liniment or chloroform liniment. If the passages are very dry and the atmosphere of the room is also dry, much benefit results from allowing the steam from a kettle of boiling water to moisten the air. The boiling water may be beneficially medicated by putting into the water in the kettle from one to two grains of menthol every three or four hours. Or:— Compound Tincture of Benzoin, 1 ounce. Oil of Eucalyptus, 1 ounce. Oil of Pine, 1 ounce. Put a tablespoonful of this mixture into the kettle of boiling water every three or four hours. 342 DISEASES OF ADULTS. If the case is persistent and does not yield to this treatment such cases require the following: — Terebene, 2 drams. Creosote, 24 drops. Mucilage of Acacia enough to mix. Chloroform Water, to make 3 ounces. Take one teaspoonful in water every four hours. CHRONIC BRONCHITIS. Winter coughs, catarrh, and asthma are very common forms of this disease. For the cough give : — Paregoric, ]/ 2 ounce. Syrup of Ipecac, 1 ounce. Syrup of Tolu, 2 ounces. Anise Water, 1 ounce. Mix and give one teaspoonful every two or four hours. If there is fever give : — Sweet Spirits of Niter, 15 drops. One such dose every two or four hours. It is during the spring months with an east wind that bronchitis attacks young and old with greatest frequency. With old persons, in such cases, there is commonly a great accumulation of mucus in the bronchial tubes, which causes continued and violent coughing in the efforts to expel it. Breathing is difficult ; the blood, from lack of proper oxygenation, becomes unfit for vital purposes and death is often a sudden termination of such cases. This form must be carefully treated ; no debilitating measures will do ; a warm, generous diet must be main- tained; warm flannel worn next to the skin; and inhalation of steam — if medicated with turpentine or balsam of Peru so much the better. The following mixture is of much benefit in these cases : — Creosote, 24 drops. Glycerine, 1 ounce. Wine of Burgundy, to make 3 ounces. A teaspoonful every two hours. PLEURISY. 343 PLEURISY OR PLEURITIS. Inflammation of the membranes which line the thorax (chest) and which cover and protect the lungs, called the pleura. There are three varieties with reference to the duration of the disease : acute, sub- acute, and chronic ; and two varieties with reference to the presence or absence of liquid : dry pleurisy and pleurisy with effusion. When there is pus effused the disease is called empyema. Causes. — The presence of a micro-organism; cold; exposure; mus- cular exertion; injuries to the chest walls; a secondary result of pneumonia, tuberculosis, Bright's disease, inflammation of the heart membrane (pericarditis), rheumatism, scarlatina, smallpox, and measles. Tuberculosis, cancer, Bright' s disease, and alcoholism may cause chronic pleurisy. Symptoms. — Chill; pain or ''stitch" in the side; some fever; pain over the nipple is increased by breathing; patient "catches his breath" to ease the pain; breathing is short, rapid, shallow, from 30 to 35 respirations a minute; a short, dry, hacking cough, and a pulse from 90 to 120 per minute. When effusion of liquid occurs the pain is usually less severe. The patient lies on the paining side and rather crouches to get relief. The breathing may be one-sided for the same reason; this form of breathing may sometimes be seen. After the absorption of the liquid the condition is much improved and the con- valescence is rapid. In the chronic form there is a longer duration ; night sweats ; palpitation; greater difficulty in breathing; disturbed circulation; and some prostration. Prognosis. — Usually the disease terminates in recovery in about three weeks. Complications often make the disease a very serious one. Empyema (pleurisy with suffusion of pus) is almost uniformly favor- able in prognosis. There is in pleurisy with effusion some danger of death if the amount of suffused liquid is very large. Treatment. — Rest and a semi-solid or liquid diet are to be first secured. The pain, if great, may be controlled by 3-grain doses of Dover's powder every two or three hours ; and also by binding the thorax with strips of adhesive plaster on the painful side from the middle of the back to the breastbone. This prevents the motion of the chest in breathing and coughing. If the disease is recognized very early the seriousness may be modified bv ; — 344 DISEASES OF ADULTS. Salicylate of Soda, 15 grains. Take one such powder in a wineglass of water every three or four hours. After effusion of liquids has taken place the following should be given : — Acetate of Potassium, 30 grains. Infusion of Digitalis, 2 drams. Take one such dose every three or four hours. The use of poultices and of hot applications is of rather doubtful value on account of the very great risk which the patient runs of taking cold. Attempts to promote infusion by strong purgatives, sweating and similar means are also seldom of benefit; besides they have a weakening effect upon the patient. If the liquids do not disappear by absorption they are withdrawn by use of a needle-like tube (an aspirator). This and the withdrawal of pus in empyema are matters for the attention of the surgeon. DROPSY OF THE PLEURA OR HYDROTHORAX. The presence of a liquid in the pleura. Causes. — Heart disease; kidney disease; inflammation of the liver; and consumption. Symptoms. — The symptoms of pleurisy generally. The fact that it is generally found on both sides of the chest; that there is a history of other diseases mentioned in the causes of the disease, and that there is no fever or pain distinguishes it from pleurisy. Prognosis. — The termination depends upon the other diseases of which this is an accompaniment. Treatment. — The fluid may be absorbed by the use of saline purgatives and hydrogogue cathartics such as : — Epsom Salts, y 2 ounce. Take one such dose every morning before breakfast. At the same time take : — Solution of Iron and Ammonia Acetate, ... 2 ounces. Take one tablespoon ful every four hours. The application of dry cups over the chest frequently affords relief. It may be necessary to withdraw the fluid by surgical means. ASTHMA. 345 When air is present in the cavity of the chest, the disease is known as pneumothorax. Its treatment is along the same lines as in pleurisy. Air and water together in the cavity produces hydropneumothorax ; and pus and air together, pyopneumothorax. ASTHMA. This is a disease of the lungs, whose main characteristic is laborious breathing, which comes in paroxysms, and is accompanied by a wheezing noise. Humid asthma is that in which the attack terminates in expectoration; when it does not, this is called dry asthma. Persons so afflicted have generally disease of the heart or lungs; but, if not, it is called spasmodic asthma. Causes. — Hereditary predisposition ; dwelling in a cold or moist atmosphere, or being subject to sudden changes of temperature; gout; intense study; great mental anxiety; suppression of perspiration; irritation of the air-cells and lungs by atmospheric impurities; irritation of the stomach, uterus, or other viscera. Symptoms. — The attack commonly occurs in the night, the patient having gone to bed in a listless, drowsy state, with a troublesome cough, oppression at the chest, and symptoms of flatulence. Towards mid- night the breathing becomes more labored, the wheezing sounds louder, and the patient is obliged to assume an erect posture to prevent suffocation. Sometimes he starts out of bed, and rushes to the window for air, or he sits with his body bent forward, his arms resting on his knees, with a flushed or livid face, or deadly pale, gasping and struggling for breath, in a condition painful to behold. The pulse is weak and intermittent, with palpitation of the heart; sometimes there is vomiting, with involuntary emission of the urine, which is of a pale color, and relaxed bowels. The attack will probably last for two hours or more, when the severe symptoms will gradually remit, with an expectoration of frothy mucus, and a tranquil sleep follows. For some days there will be felt a tightness of the chest, and the slightest exertion brings on a difficulty of breathing; there will be slighter paroxysms, and after a longer or shorter period another severe one. Prognosis. — Asthma is never fatal by itself; but there are complications which often terminate so. The disease is essentially chronic and can never be said to be cured. 346 DISEASES OF ADULTS. Treatment. — The objects to be attained in this are, first, to moderate the violence of the paroxysm ; second, to prevent its recurrence. Gentle aperients should be administered, and anti-spasmodic mixtures ; a mustard plaster on the chest will often afford much relief. Castor oil, given in peppermint, or weak brandy and water, is a suitable aperient. Where there is reason to suppose the stomach is overloaded, an emetic should be given. Tincture of lobelia inflata is good in obstinate cases, dose one dram. Inhaling the fumes of stramonium is sometimes of service, and the good effect will be assisted by a cup of hot coffee, putting the feet in warm water, or using the warm bath. For bronchial asthma, Gardner's syrup of hydriodic acid, a half- teaspoonful every four hours, is very efficient, together with the following : — Stramonium Powder, i ounce. Belladonna Powder, i ounce. Hyoscyamus Powder, i ounce. Nitrate of Potash Powder, i ounce. Mix and burn on a shovel and let the patient inhale the fumes. In asthma due to heart trouble use : — Fluid Extract of Apocynum Cannabin, 2 drams. Fluid Extract Cactus Grandiflora, 2 drams. Gardner's Syrup of Hydriodic Acid, enough to make 3 ounces. Mix. One teaspoonful every four or five hours. To prevent the return of a paroxysm of asthma, avoid the exciting causes, keep the bowels open with some mild aperient, and strengthen the system by bitter infusions, such as camomile or gentian. If there is tightness of the chest, put on a poultice, and take an expectorant now and then to clear out the phlegm from the bronchial passages. Take a light nourishing diet, avoiding everything difficult of digestion; wear warm clothing, as flannel next to the skin; take regular and moderate exercise; change of climate if possible, should the situation occupied be damp, or bleak and exposed. Do not indulge in sensual or intemperate habits. Eclectic Treatment for Asthma. When the symptoms appear, at once place the feet in warm water, and take a decoction of catnip or pennyroyal, to produce a gentle HAY ASTHMA. 347 perspiration. If the attack still continues, take a tablespoonful of the tincture of lobelia in a cup of warm tea, every half hour. The following remedy has produced marked results in severe cases : Take a half ounce of well-bruised seneca snakeroot; immerse in one pint of water, and boil over a slow fire till reduced to a half pint. Dose, a table- spoonful every ten or fifteen minutes. A teaspoonful of mustard-seed, taken in tea or soup, morning and evening, has cured many severe cases. Damp houses and damp air must be carefully avoided. Let the food be light and nutritious; sleep on a hard mattress; and frequently take the country air. HAY ASTHMA OR HAY FEVER, THE ROSE. This is a catarrhal inflammation of the respiratory tract occurring most frequently in the spring and fall. Causes. — It is caused by the inhalation of certain vapors, the pollen of plants, and odors emanating from some animals. Symptoms. — Those of a severe cold in the head; sneezing; watery discharge from the nose; more or less deafness; irritation of throat and nose; wheezing cough; and difficult breathing. The condition may last for a period of weeks each year, disappearing for a few days, then beginning again. Treatment. — When disease of the nasal turbinated bones exists, their removal usually causes a cure. In other cases there is no treat- ment that is positively curative. A change of residence to a higher, dryer climate, or a sea voyage will sometimes overcome the condition. The medical treatment is varied. Quinine sulphate, five grains three times daily, taken for a month or so before an expected attack, has been recommended. During the attack the same treatment three times daily and an ointment containing thirty grains of quinine to the ounce applied to the nostrils is often beneficial, as is also the following : — Extract of Hyoscyamus, 12 grains. Iodide of Potash, 60 grains. Bicarbonate of Potash, 2 drams. Extract of Licorice, 4 drams. Anise Water, to make 5 ounces. Mix. Two teaspoonfuls every four hours until relieved. 348 DISEASES OF ADULTS. BLEEDING FROM THE LUNGS OR HEMOPTYSIS. This denotes in general the spitting of blood, and is commonly used by pathologists to signify the expectoration of blood from the lungs and air tubes. It is important to ascertain the source of the blood which escapes from the mouth, and, if determined to be from the lungs, to ascertain whether it is symptomatic of disease of these organs, or merely vicarious in its character. It is not so much dangerous in itself as it is rather an indication of some other dangerous disease, being most frequently connected with tubercular consumption. Causes. — Bleeding from the lungs may occur without organic disease, in the plethoric and robust who live a life of excitement and excess, and in nervous, irritable individuals, weakened by mental or bodily fatigue, and leading sedentary lives. It is often hereditary, and may be brought on by violent muscular effort, paroxysms of cough, blows or pressure on the chest, inspiration of irritating vapors, or of rarefied air on high mountains. The blood may be exuded from the tracheal or bronchial membranes, or it may proceed from capillaries communicating with the air passages in any part of their extent. The amount varies from a dram to a pint at a time, and is generally florid, and more or less mixed with air, differing from the dark, coagulated blood which comes from the stomach. Prognosis. — This is rarely a fatal disease, but death may occur from complications. If the causes is consumption or aneurism death may follow. Symptoms. — An attack is frequently announced by a feeling of heat and oppression in the chest behind the sternum, followed by a cough which brings up the blood. When the quantity is very great it pours forth without a cough, and almost by an act of vomiting, with considerable spasmodic effort. Treatment. — Elevating the breast and shoulders, admitting plenty of fresh air, with spare diet and perfect quiet, are among the most useful measures to be adopted. The chest should be sponged with vinegar and cold water, and a dessertspoonful of the former in half a wineglassful of the latter will be a useful accompaniment to any other medicines which may be thought necessary. The oil of turpentine, ten to thirty drops in a glass of water; or gallic acid, in doses of ten to fifteen grains, every three or four hours, have been found of great PNEUMONIA. 349 value. Cold liquids, and the sucking of pieces of ice, will be of service. Nauseating medicines, as tartar emetic and ipecacuanha, are also frequently employed. A teaspoonful of common salt, taken frequently, is an excellent popular remedy. In all cases, calmness of mind, rest, silence, erect position, cool air, and freeness of the bowels should be enjoined. When the attack proceeds from congestion, blood-letting is recommended in certain cases. If cough be present, it should be allayed by narcotics. After the attack, astringent tonics, as iron and quinine, may be given; and the return of the bleeding is to be guarded against by avoiding the exciting causes, and attending to the general health. LOBAR PNEUMONIA OR LUNG FEVER— WINTER FEVER. Pneumonia is an acute infectious inflammation of the lung struc- ture, involving not only the vascular tissues but also the air cells, which are rendered impervious to air by the disease. Causes. — The germ of pneumonia (diplococcus pneumoniae of Fraenkel). Whatever debilitates the system may act as a predisposing cause. Persons suffering from malarial poison, the grip, and acute diseases are liable to attacks of pneumonia. Age, intemperance, climatic changes, impure air, and other similar factors may be regarded as agents in its production. Symptoms. — The onset of pneumonia is sudden and the first notable symptom is usually a chill perhaps accompanied by headache and pain in the back or limbs. In a short time the chill is followed by fever, pain in the chest, shallow, rapid, and painful breathing and a short, hacking, and suppressed cough. If the ear is placed over the chest a crackling sound is heard which can be imitated by rolling a hair between the thumb and ringers. The portion of lung involved is congested with blood in the first stage, which causes a serious obstruction to the circulation; the heart is thus embarrassed in doing its work. The products of inflammation are pressed out into the air cells. In about two days after the onset of the disease, the disabled portion of the lung solidifies and percussion gives a dull sound. The temperature is much elevated, the urine is scanty and high colored. The patient wears an expression of anxiety and distress. The cough is more painful and brings up a rust colored sputum known as the prune juice expectoration. The breathing is labored and painful. The 350 DISEASES OF ADULTS. respiration, which in health averages about seventeen a minute, runs up to forty, or in extreme cases to sixty, which indicates that the functions of the lung are greatly disturbed. In about five or six days, if the case goes on favorably, the morbid material in the air cells begins to soften and is absorbed into the circulation and removed from the system. The temperature declines, the fever abates, moisture appears upon the surface of the body, the patient feels relieved and shows marked signs of improvement. This is known as the stage of resolution and occupies from two to six days. The disease does not always follow the ordinary course. The process of inflammation may advance from one portion of the lung to another, and having traversed one lung may invade the other. Where both lungs are involved the case is one of double pneumonia, where a single lobe of one lung is invaded it is called lobar pneumonia. If the pulse is weak and rapid, above one hundred and twenty a minute, and the temperature continues above one hundred and four degrees, the disease is severe and liable to terminate unfavorably. When the case is severe, with a brown, dry tongue, it is sometimes called typhoid pneumonia. If the patient complains of a sharp stitch in the side, the compli- cation with pleurisy must be considered. Abscess of the lung sometimes follows pneumonia and recovery is tedious. Treatment. — The treatment must be prompt and meet the symptoms as they develop. Careful attention to the symptoms, and prompt medical aid in the early stages, will generally gain the mastery of the disease. In the onset a full dose of quinine will often reduce the temperature, produce perspiration, antagonize the poison depressing the nerve centers, and afford marked relief or even abort the disease. A mustard poultice over the chest acts as a powerful stimulant to the cutaneous nerves, and may help to abort the diesase if used early. In robust persons where there is no weakness and depression, one one-hundredth of a grain of tartarized antimony may be given every two hours advantageously, but should only be given in the first stages. In the second stage carbonate of ammonia is a remedy of great use. It stimulates the lungs, and aids the respiration and circulation. Five or ten grains in fluid extract of licorice every two or four hours is a proper dose. CONSUMPTION. 351 Acetanilid is a valuable remedy in experienced hands to lower the temperature. Its use is not devoid of danger, however. A tendency to heart failure must be met by giving digitalis and suitable stimulants. These can be used safely and satisfactorily only by skilled persons. Pneumonia in children above two years of age does not often prove fatal if properly and promptly treated. Camphor liniment, flaxseed poultices, and the cotton jacket padded to oil silk are well known and serviceable remedies. Tincture of aconite in the early febrile stage is serviceable, especially in cases of children; ten drops in one-half tumbler of water, and of this mixture give one teaspoonful every half hour till it moistens the surface of the skin. Demulcent drinks of slippery elm and flaxseed are soothing and serviceable. Lemonade, in which is dissolved one teaspoonful of cream of tartar to a half pint, makes a cooling and refreshing drink; it also favors the secretion of urine and slightly relaxes the bowels. The patient should have pure air, the sick room being reasonably ventilated. No one but an experienced physician should attempt to treat a case of this kind. CONSUMPTION. Phthisis, or consumption, is a disease which, unfortunately, is but too prevalent and fatal in this country, as in most others. It spares neither age nor sex, and its attacks, at first so insidious as almost to escape notice, too frequently lead to a fatal issue. It is the result of the formation and development of tubercles in the lungs. These first appear in the form of small, gray, semi-transparent granulations, which gradually enlarge and become opaque, and after a time empty them- selves into the bronchial tubes, and thus the substance of the lung is gradually destroyed. Causes. — The tubercle bacillus; heredity; debility and chronic diseases, like Bright's disease and syphilis ; acute affections sometimes terminate in phthisis. Other exciting factors are unhealthy sanitation and certain occupations — mining, milling, etc. Symptoms. — The disease begins insidiously with loss of appetite, dyspepsia, and more or less gastric pain after meals. The subject 352 DISEASES OF ADULTS. becomes pale and bloodless and complains of general weakness. Later, there develops a short, dry cough, exciting no particular attention, being attributed to a slight cold. It, however, continues, and after a time increases in frequency. The breathing is more easily hurried by bodily motion, and the pulse becomes more frequent, particularly after meals and towards evening. Towards evening there is also frequently experienced a slight degree of chilliness, followed by heat and nocturnal perspirations. This is commonly called night sweats. The patient becomes languid and indolent, and gradually loses strength. After a time the cough becomes more frequent, and is particularly troublesome during the night, accompanied by an expectoration of a clear, frothy substance, which .afterwards becomes more copious, viscid, and opaque, and is most abundant in the morning; the sputum is often tinged with blood; or hemoptysis occurs in a more marked form, and to a greater extent. As the disease advances, the breathing and pulse become more hurried; the fever is greater, and the perspirations more regular and profuse. The emaciation and weakness go on increasing; pain is felt in some part of the thorax, which is increased by coughing, and sometimes becomes so acute as to prevent the patient from lying on the affected side. All the symptoms increase toward evening: the face is flushed; the palms of the hands and soles of the feet are affected with a burning heat; the feet and ankles begin to swell, and, in the last stage of consumption, there is nearly always profuse diarrhoea. The emaciation is extreme; the countenance assumes a cadaverous appear- ance, the cheekbones are prominent, the eyes hollow and languid. "The emanation, pallor, and weakness become extreme." Failing circulation, toward the end, is indicated by more or less puffiness about the ankles. "The mind remains clear and hopeful to the last." Sea voyages, and residence at the seaside, are generally found to be very beneficial ; and, as a general rule, those places that are least subject to variations of temperature are recommended. The practice, however, of sending patients in the last stage of consumption away from home — to California, Florida, or elsewhere — cannot be too strongly reprobated. No one should be allowed to sleep with a con- sumptive patient after the disease has fully manifested itself. The contagious principle is found not in the breath, but in the sputum which is raised from the lungs ; this should be destroyed. The acute variety runs a rapid course, terminating fatally in a few months. Sub-acute and chronic types, under careful treatment and CONSUMPTION. - 353 the proper hygienic surroundings, may be arrested, and the patient restored to a state of health; and, even where this is not the case, the progress of the disease will at least be retarded. Tonic medicines, such as bark, sarsaparilla, iron, and iodine, are also very beneficial in the treatment of phthisis; at least in those cases where inflammation or much febrile excitement does not exist. The treatment comprises a proper attention to the digestive organs, with wholesome diet, exercise in the open air, regular habits, attention to the skin, and, if necessary, change of air. The diet should be nutritious, but not stimulating, and the exercise not violent nor too prolonged. When the stomach symptoms are so severe that they interfere with the patient's nutrition, the following is often beneficial : — Fowler's Solution of Arsenic, i dram. Tincture of Nux Vomica, 2 drams. Chloroform Water, to make 4 ounces. Mix. Give one teaspoonful in a wineglass of water before meals. Sometimes it may be necessary to use a sedative mixture such as : — Bismuth Subnitrate, 160 grains. Dilute Hydrocyanic Acid, 32 drops. Cinnamon Water, enough to make 2 ounces. Mix. Give one teaspoonful every two hours until vomiting or nausea ceases. Constipation is relieved by attention to the diet and administration of fruit or fruit juices, by soap and water or olive oil injections, avoiding so far as possible the use of cathartics. Diarrhoea commonly subsides by a strict regulation of the diet, and the avoidance of all stimulating food and medicine; otherwise, small doses of chalk and opium, or rhubarb and opium, may be administered. When the pulse is very frequent and the palpitation distressing, digitalis may be used. But little can be done for the reducing of fever. The patient while feverish should be in bed or on a couch and given a sponge bath with tepid water and alcohol, and in addition either of the following com- binations used to reduce the temperature : — Antipyrine, 1 dram. Syrup of Orange, 1 ounce. Water, • to make 3 ounces. Mix. Give two teaspoonfuls three times daily when required. 354 DISEASES OF ADULTS. Or a capsule containing: — Sulphate of Quinine, 5 grains. Dover's Powder, iy 2 grains. May be given from three to five hours before the expected rise of temperature. For night sweats : — Peruvian Balsam, 15 minims. Formic Acid 1 dram. Chloral Hydrate, .75 grains. Alcohol, 4 ounces. Sponge the body with this at bedtime. And internally : — Camphoric Acid, 4 drams. Sugar of Milk, 2 drams. Mix. Divide into sixteen powders. Use one on retiring and another two hours later if needed. For the cough : — Dionin, J /g to %. grain. Dilute Hydrocyanic Acid, 2 drops. Syrup of Tolu, to make 1 dram. Mix. Administer this every three hours until relieved. When the cough is excessive and there is but little secretion the following will be found efficient : — Terebene, 80 drops. Spirits of Chloroform 160 drops. Dilute Hydrocyanic Acid, 20 drops. Syrup of Acacia, to make 2 ounces. Mix. Give one teaspoonful in a little water every three hours. For hemorrhages from the kings (Hemoptysis) : — Stypticin, 8 grains. Peppermint Water, 1 ounce. Mix. Give one teaspoonful every hour until relieved and apply an ice bag to the chest. As so much depends in the treatment of consumption upon the full assimilation of as large quantities of good nourishing food as possible, any digestive disturbances are to receive immediate attention. These are sometimes brought about by drugs given to relieve other conditions. In this event the use of such offending medicines is to be discontinued. The general principles of treatment for dyspepsia will then obtain. (See "Modern Methods of Treating and Curing Consumption," page 165.) HEART DISEASE. 355 DISEASES OF THE HEART. DILATATION OF THE HEART. Increase in size due to the enlargement of one or more of the cavities of the heart. Causes. — Chronic disease of the valves of the heart; effusion of fluids; chronic bronchitis; Bright's disease; alcoholism; and syphilis. Over-exertion frequently causes it in delicate persons. Symptoms. — Poor circulation; feeble pulse; headache, increased by standing or sitting upright; fainting; cough; difficulty in breathing; dizziness; bleeding at the nose; dyspepsia; constipation; dropsy; and mental dullness. Prognosis. — This is unfavorable. Death results either suddenly from paralysis of the heart caused by over-excitement, or gradually from exhaustion. Treatment. — The disease is incurable and all that can be done is to afford relief. The first point to attend to is the nourishment of the patient by generous diet, moderate exercise, and the making of good blood by the use of red wines, iron preparations, etc. A very rigid hygiene must be observed. Heart tonics, such as digitalis, may be administered in some such form as: — Tincture of Nux Vomica, •• . . J4 ounce. Tincture of Digitalis, J4 ounce. Take fifteen drops in water after each meal. Or:— Tincture of Digitalis, 1 J^ drams. Tincture of Cereus Grandifloris, 1 ounce. Citrate of Caffeine, 1 dram. Compound Tincture of Cardamom, to make 4 ounces. Take a teaspoonful in water three or four times a day. During the intervals of attacks, rest, diet, and the removal of exciting causes are to be attended to. Great care must be taken that there is no constipation or the formation of gas in the stomach. Tonics such as arsenic, iron, strychnine, etc., are of value. They are used to fortify the system against later attacks. Cold baths must not be given under any circumstances during this condition. 356 DISEASES OE ADULTS. INFLAMMATION OF THE PERICARDIUM OR PERICARDITIS. Inflammation of the membrane which envelops the heart. Causes. — That form which results directly from cold and exposure is seldom seen, for it is most frequently of secondary nature and origin. It either follows or is connected with rheumatism, scarlet fever, influenza, smallpox, tuberculosis, blood poisoning, Bright's disease, diabetes, and pneumonia of alcoholics. Symptoms. — Chills; remittent fever, sometimes nausea and vomit- ing; distress and tenderness over the heart; sharp, shooting pains; dry, suppressed cough which increases the pain; and often severe palpitation. After a few days there is effusion of liquid with oppression around the heart much increased; fainting; extreme difficulty in breathing, so that the patient cannot lie down; vomiting; and, sometimes, delirium. Prognosis. — Usually favorable; but when pus is present in effusion the termination is usually fatal. Relapses are to be guarded against. Treatment. — Rest; mental quiet; milk diet; dry cups applied to the region of the heart ; poultices ; blisters ; or cold applications, ice bags, etc., are often preferable. Hypodermic injections of morphine are often needed to allay the severe pain. The following is useful in lessening the inflammation and in relieving stomach and intestine disturbances : — ■ Calomel, i grain. Bicarbonate of Soda, 2 grains. Sugar of Milk, 2 grains. Make six such powders and take one dry on the tongue every two hours until the bowels move freely. The liquid diet should be maintained during the period of effusion, and the use of stimulants and tonics should be free. Inflammation of the heart (Carditis) itself sometimes occurs, but it is usually accompanied with inflammation of the pericardium. The symptoms in both cases are the same, and the treatment will, conse- quently, be similar. In inflammation of the interior lining membrane of the heart (Endocarditis) there is more or less of fever and anxiety, and a peculiar sound of the heart may be heard. A disease so dangerous as pericarditis should always have the prompt attention of a physician. PALPITATION. 357 PALPITATION OF THE HEART. Functional disturbance i >t the heart marked by increased frequency of its action with lack of rhythm of its movements. Causes. — Over-exertion, anaemia, exhaustion, puberty, female sex, menstrual disorders, emotion, hysteria, heart-strain, abuse of tea. coffee, tobacco, and alcohol. Symptoms. — The attack is usually sudden, with some pain in the region of the heart. The beating of the heart is often so violent and rapid as to be visible through the clothing. The breathing is difficult and there is a choking sensation in the throat so that the patient is obliged to sit upright. There are vertigo: f aintness : face flushed or pale; anxiety and fear. The attacks last for a few minutes, a few hours, or for a day. After the attack the patient shows a great desire to sleep. Prognosis. — With early and effective treatment the termination is favorable. Treatment. — First, endeavor to remove the cause, whatever it may be. Then give : — Hoffman's Anodyne, I dram. Give one such dose every three hours. Or:— Aromatic Spirits of Ammonia, I dram. Give one such dose every three hours. If there is anaemia, the elixir of quinine, iron, and strychnine is beneficial. IRREGULAR PULSE OR ARHYTHMIA. A lack of rhythm or of regularity of heart beats, as shown in the pulse. It is a symptom rather than a separate disease. Causes. — It is caused by affections of the heart and arteries due to neurasthenia (nervous debility), hysteria, dyspepsia, and the abuse of tea, tobacco, and coffee. Symptoms. — The heart beats are irregular both in point of time and in force. The pulse may skip a beat now and then. There are always attendant symptoms of heart disease, either organic or functional. 358 DISEASES OF ADULTS. Prognosis. — Entirely dependent upon the cause. If the disease is functional, the prognosis is favorable ; if organic, unfavorable. Treatment. — In* cases not due to organic heart trouble: — Bromide of Potash, 10 to 15 grains. Take one such dose three times a day. Or:— Bromide of Soda, 10 to 15 grains. Take one such dose three times a day. The diet must be well regulated; attention given to the bowels; and complete rest for both body and mind secured. In other cases bitter tonics and treatment directed to the causal heart trouble. In such cases a physician should be consulted. RAPID HEART OR TACHYCARDIA. Rapid heart action as indicated by the pulse. Causes. — Brain or spinal diseases ; change of life ; neurasthenia : irregularities of habit; excesses of any kind; chronic heart affections; excessive use of tobacco; high fever; etc. Symptoms. — The attack may come on suddenly with or without such warnings as dizziness or ringing in the ears. The pulse is increased to 150, 175, 200, or in very rare cases to 250 beats per minute. There is oppression over the heart and sometimes a sensation of smothering. The attack may last from a period of a few minutes to hours and days. Prognosis. — This is good, when the attack is caused by some removable affection. In cases of organic heart disease, it is sometimes terminated by sudden death. Treatment. — The patient must rest in bed; ice is to be applied over the heart. To quiet the nervous element of the attack use: — Bromide of Soda, 15 grains. Or:— Bromide of Potash, 15 grains. Take of either of these one such dose every four hours. Attention must be paid to the diet during the intervals between attacks. The food must be nourishing; and bitter tonics may be given. ANGINA PECTORIS. 359 Fowler's Solution of Arsenic, 1 dram. Strychnia Sulphate, y 2 to 1 grain. Bitter Wine of Iron, enough to make 4 ounces. Take one teaspoonful in a wineglass of water after each meal. SLOW HEART OR BRACHYCARDIA. Either a sudden or permanent slowness of the heart action as indicated by the pulse. Causes. — It is present in some nervous diseases, fatty degeneration of the heart, and in the hardening of some of the muscles which supply the heart. Also in convalescence from diphtheria, pneumonia, typhoid fever, rheumatism, and erysipelas. It is found in epileptics, drunkards, anaemic persons, and in cases of lead poisoning. Symptoms. — The pulse beats from 40 down as low as 8 beats per minute. It is weak, low, and small. There are dizziness; disturbance of the hearing ; and fainting. Sometimes convulsions attend the attack. There may or may not be warning signs of its approach. Prognosis. — Like all heart cases, this depends upon the cause. When organic heart disease is the cause, death sometimes suddenly terminates the case. Treatment. — If the heart is beating fast enough to supply the needs of the body, no treatment is needed. If not, rest in bed; hot applica- tions of mustard over the region of the heart; and the employment of heart tonics. In cases of emergency these latter must be administered by hypodermic injection. Between attacks, nutritious diet and bitter tonics to improve the general condition of the patient must be used. NEURALGIA OF THE HEART OR ANGINA PECTORIS. Severe paroxysms of sharp pains in the region of the heart. Causes. — Lack of nutrition of the heart, either by diseased condi- tions or obstructions of the arteries which supply it; pressure of a tumor; very great dilatation or enlargement of the heart; great excess in the use of tobacco and narcotics; or disease of the valves. It is also present through heredity, syphilis, epilepsy; and the attacks are often precipitated by over-exertion, mental excitement, or acute indigestion. 360 DISEASES OF ADULTS. Symptoms. — Excruciating pains around the heart, up to the neck, and down the left arm; difficulty in breathing; feeling of oppression over the heart ; weak heart action ; pale face ; fear of death ; perspiration in large drops over the body ; cold sweat ; extreme prostration. The attack lasts only a few seconds or minutes. It is usually followed by excessive flow of urine or by vomiting. It is very liable to recur for years. Prognosis. — Recovery from the first attack occurs in 75 per cent, of cases; but death usually ensues in later attacks. Treatment. — As the attack is of such short duration, prompt treat- ment is required to relieve the intense pain. If a physician is at hand he will do this by hypodermic injections of morphine, atropine, or nitro-glycerine. The inhalation of chloroform or of amyl nitrite is also beneficial. Or:— Chlorodyne, 10 to 15 minims. This dose repeated at intervals will afford relief. Hot mustard plaster or similar form of counter-irritation over the region of the heart is also useful. ENLARGEMENT OF THE VENTRICLES OF THE HEART. This is the result of overaction causing an excess of nutrition, the nutritive process appearing to go on more rapidly on account of the extra work which the heart is called upon to perform. In this way the heart is often greatly enlarged in bulk, and its operations seriously interfered with. Three kinds are classified : first, simple, when the walls of the heart or its divisions are thickened, without any diminution in the capacity of the cavities ; second, eccentric, or aneurismal, when the walls are thickened, and the cavities likewise enlarged; and, third, concentric, when the cavities are diminished in proportion to the thick- ening of the walls. The second of these is the most frequent; and any of them may affect a single cavity or the whole heart. The pulsations are frequently regular, but strong, sometimes even visibly raising the bedclothes, and the chest is bulged out over the part. Treatment. — Rest and freedom from exertions and emotions are proper means to be employed in such a case ; and usually, with care and FAINTING OR SYNCOPE. 361 perseverance, the symptoms will be much alleviated. Stimulants must be avoided; coffee and tobacco are usually detrimental in such cases. SHRINKING OR ATROPHY OF THE HEART. A wasting of the heart's substance, arising from a deficiency in the supply of blood (nutrition). It is usually accompanied by general emaciation, and terminates in death. When the heart is examined after death, the tissues are found to have undergone a change. This is called "fatty degeneration." The treatment is to strengthen the system by tonics, especially iron and mix vomica, wholesome and nutritious diet, open air, exercise, sea bathing, etc. FAINTING OR SYNCOPE. This is a state of total or partial unconsciousness, occasioned by diminished action of the heart, causing less rapid circulation of blood through the brain. Causes. — The causes of it are various, and sometimes very peculiar, such as a particular smell; that of a rose, for instance, has been known to occasion it; certain objects presented to the sight; surprise, joy, fear, or any sudden emotion; loss of blood, or anything which tends to debilitate. Symptoms. — The first sensation of fainting is generally a singing in the ears; then the sight becomes confused, and all the senses deadened; a clammy sweat breaks out over the body, the countenance becomes deadly pale, and the limbs refuse to support the weight of the body, and the sufferer sinks to the earth helpless and motionless. Treatment. — Place the patient in a horizontal position; free the face, neck, and upper part of the chest from all tight clothing; let the fresh air play freely upon them, and sprinkle the face with cold water, holding to the nostrils from time to time some Volatile stimulant, such as hartshorn or ammonia. As soon as swallowing can be accom- plished, administer about thirty drops of spirit of wine, or sal volatile, in water. The after-treatment will of course depend on the cause. Persons subject to fainting should be careful in frequenting crowded rooms, or going anywhere where the air is bad. Tight dresses should be avoided; and no excitement be allowed. A well regulated diet, 362 DISEASES OF ADULTS. cold bathing, and vegetable tonics will usually cure this distressing infirmity. DISEASES OF THE STOMACH. INFLAMMATION OF THE STOMACH OR ACUTE GASTRITIS. Inflammation of the mucous membrane of the stomach. Causes. — The corrosive poisons such as the mineral acids, corrosive sublimate, carbolic acid, copper, etc. ; indigestible food in the stomach ; alcohol in excess or irritating medicines ; exposure to cold, wet, and fevers. Symptoms. — Loss of appetite ; coated tongue ; bad breath ; vomiting ; fever; headache; burning sensation in the palms of the hands and the soles of the feet; pain and tenderness over the stomach; constipation or diarrhcea. When the result of poisons there are nausea; vomiting; cold, clammy skin; slight perspiration; low, weak pulse; intense heat and burning in the stomach; thirst; purging; and collapse. Prognosis. — In non-poisonous cases or a mild type the attack lasts about a week and usually terminates favorably. In poisoning cases the patient often dies from shock or exhaustion and not infrequently from starvation. Those who do recover are generally always troubled with gastric affections. Treatment. — When due to poisoning a physician should be called without delay and the stomach washed out and the proper antidote administered. (See Poisons and their Antidotes, page 611.) Ice internally and externally will afford relief. Milk and lime water should be administered after the stomach has been thoroughly emptied and other nutriment given by the rectum. Cases due to other causes are best relieved by emptying the stomach with an emetic followed after action by a brisk cathartic such as Epsom salts, Hunyadi water, or Apenta water, and the application of hot bran poultices, sprinkled with laudanum, to the seat of pain. After which the diet should be carefully selected — liquid diet at first, gradu- ally increased until the regular diet is resumed. The use of bitter tonics such as : tincture of nux vomica, five to ten drops, and Fairchild's MILK SICKNESS. 363 essence of pepsin, one teaspoonful in a wineglass of water before each meal. Or:— Bicarbonate of Soda, 3 drams. Subnitrate of Bismuth, 2 drams. Chloroform Water, 3 ounces. Mix and add : — Peppermint Water, 1 ounce. Cherry-laurel Water, 2 ounces. Take a tablespoonful four times a day. MILK SICKNESS. Causes. — A disease chiefly confined to the West, where the cattle roam at large in the woods or over prairies, and eat food which poisons the milk. Symptoms. — Sickness at the stomach, weakness and trembling of the legs. There is vomiting and a peculiarly offensive breath. These symptoms continue for weeks, and are often all that are shown in this complaint ; but in some severer cases there are chills and flashes of heat, great oppression about the heart, anxiety, deep breathing, heat in the stomach, violent retching and vomiting, alarming heart action, and throbbing of the large vessels, and cold extremities. In most cases, the vomiting returns every hour or two, attended by a great burning at the pit of the stomach, the substance thrown up having a peculiar bluish- green color and a sour smell. As soon as this discharge takes place, the patient falls back upon the pillow, and lies easy until another paroxysm occurs. The tongue is covered with a whitish coat, and the bowels are obstinately costive. The pulse is weak and rapid. Treatment. — The treatment cannot vary much from that pursued for inflammation of the stomach. Some cathartic to move the bowels should be given. WATER BRASH. Water brash consists in a discharge from the stomach, generally in the morning, of a thin fluid, sometimes insipid. A burning heat or pain of the stomach attends it, and seems to cause the discharge. The amount thrown up varies from a spoonful to a pint. Cause. — It is due to acid indigestion. 364 DISEASES OF ADULTS. Treatment. — Ten or fifteen drops of ammonia water in half a tumblerful of cold water will quiet the distress and stop the discharge. The best remedy for this discharge is the subnitrate of bismuth, taken at meal times, three times a day, in 30-grain doses. The tincture of nux vomica in 5-drop doses is good. The blood should be im- proved by tonics containing iron, and the food should be nourishing and digestible. NAUSEA AND VOMITING. A sensation of sickness associated with vomiting. Causes. — Although the feeling of nausea itself is referred to the stomach, and may be due to causes connected with that organ, it may arise from various causes, as excess in eating and drinking, and foulness or weakness of the stomach. It also frequently originates in disorder in other and distant parts of the body. Treatment. — Calomel, one half to one fourth grain, and bicarbonate of soda, two grains, every two hours for eight or ten doses. Three hours after the last dose take a purgative dose of Hunyadi water. After the bowels have been thoroughly moved, the use of pepsin, bismuth, and strychnia is in order. When the nausea and vomiting are so persistent that these remedies cannot be retained their administration may be preceded by the follow- ing :— Carbolic Acid, 4 grains. Bismuth Subnitrate, 2 drams. Glycerine, 3 drams. Peppermint Water, to make 3 ounces. Mix. Give one tablespoonful every two hours until relieved. Or:— Bismuth Subnitrate, 160 grains. Dilute Hydrocyanic Acid, 30 drops. Cinnamon Water, 2 ounces. Mix. Give one teaspoonful every two hours. The nausea and vomiting of drunkards is relieved by : — Strychnia Nitrate, % grain. Fowler's Solution of Arsenic, 20 drops. Glycerine, 3 drams. Water, to make 2 ounces. Mix. Give one teaspoonful every four hours. DYSPEPSIA. 365 CRAMP OR SPASM OF THE STOMACH OR GASTRALGIA. Violent paroxysms of pain in the stomach. Causes. — A form of neuralgia of the stomach; a result of neuras- thenia ; gastric cancer, or ulcer ; malaria ; anaemia ; syphilis ; indiscre- tions of diet; worry; menstrual disorders; excessive use of tobacco. Symptoms. — Sudden, severe, griping pains in the stomach ; f aint- ness; shrinking of the countenance; intermittent pulse; cold hands and feet. The pain is often so severe as to cause outcries from the patient. Some relief is felt from pressure on the stomach. The pain usually subsides in half an hour. Exhaustion follows the attack. When the pain suddenly subsides there are often vomiting or eructions of gas or thin fluid like water, mild perspiration and flow of reddish urine. The pain is relieved by taking food. Prognosis. — Not dangerous but may be persistent. Treatment. — The paroxysm is relieved by: — Chlorydine, 20 to 30 drops. Repeat in one hour if necessary. If the attack is mild give: — Antipyrine, 10 grains. and apply a hot water bag over the stomach. Or:— Spirit of Chloroform, 1 dram. Compound Spirit of Lavender, 1 dram. This is useful to dispel gas and relieve distention of the stomach. During the intervals the cause is to be combated. For nervous causes, rest, freedom from worry, outdoor exercise, and care that nc irritating food is taken. DYSPEPSIA OR INDIGESTION. This is one of the most common ailments to which mankind is subject. Causes. — Accidental fits of indigestion are of frequent occurrence, and are caused by overloading the stomach with food, and indulging freely in wines, spirits, or other intoxicating liquors. Confirmed or chronic indigestion may depend on debility or want of tone of the 366 DISEASES OF ADULTS. stomach, or it may be caused by the lining or mucous membrane of this organ being in a state of irritation, or chronic inflammation. One of the most frequent causes of indigestion is improper mastication of the food; such food is bolted, instead of being reduced to a pulp, thereby presenting to the digestive organs a hardened mass, difficult to digest. Another cause is habitual inattention to diet, both with regard to the quality and quantity of food, irregular meals, drinking large quantities of warm, relaxing fluids, and using malt liquors too freely. A third cause is insufficient exercise; a fourth cause, impure air; and, beside these, there are numberless other causes, which in a greater or less degree exercise their baneful influence upon the stomach. Symptoms. — One of the most frequent signs of indigestion is loss of appetite, perhaps even an absolute repugnance and disgust at the very thought of eating. Sometimes the appetite is capricious and uncertain, or it may be ravenous. Sometimes nausea comes on imme- diately after the food is swallowed; and sometimes, without any nausea, the food is ejected by vomiting. There is usually an obscure feeling of uneasiness, fullness, distention, and weight in the region of the stomach, occasionally amounting to pain, or even severe pain, with flatulence and eructation. Some persons suffer pain when the stomach is empty, others immediately after taking food, or the pain may not begin for two or three hours after a meal, and then continue for some hours. Sometimes the pain comes on at uncertain intervals accompanied by a sensation of distention, much anxiety, and extreme restlessness. Costiveness is a very frequent concomitant of dyspepsia, but sometimes it is attended by diarrhoea. Among the innumerable disorders that are produced by dyspepsia are palpitation of the heart, irregularities of the pulse, asthma, pain in the head, with the loss of mental energy, and some confusion of thought. One of the worst of the occasional concomitants of dyspepsia is that state of mind which is known as hypochondriasis. There is languor, listlessness or want of resolution, with an apprehension of some great evil in the future. Such persons are particularly attentive to the state of their own health, and, from any unusual feeling, perhaps of the slightest kind, they apprehend great danger, or even death itself. Kinds of Dyspepsia. I. Irritative Dyspepsia, as the name implies, is caused by one or more of the many possibilities of irritation of stomach resulting from DYSPEPSIA. 367 coarse, unchanged diet, or alcoholic excesses. One of the most marked symptoms is vomiting; and the tongue is pointed, small, and red. II. Acid Dyspepsia, marked by water brash, sour stomach, with the acidity extending to the intestines and the urine. III. Flatulent Dyspepsia, accompanied by very great development of gas in the abdomen, dizziness, worry, and hypochondriasis. IV. Nervous Dyspepsia is the common form seen among business and professional men. It is caused largely by rapid eating and sedentary life. The symptoms are sleepiness after eating; dizziness; sleepless nights ; loss of memory ; headache ; and general nervousness. Prognosis. — The outlook is favorable provided proper treatment and good hygiene are observed. Otherwise the duration may be indefinite. Treatment. — Before we proceed to give the remedies applicable to this disorder, we lay before our readers what is of equal consequence, both as regards prevention and cure — viz., diet and regimen. Rise early; sponge the body freely with cold water; eat a slice or two of stale bread, together with a piece of broiled beefsteak cooked rare, f or breakfast. After a short rest, exercise should be taken for two hours or upwards. The dinner hour should not be earlier than four or five hours after breakfast, and the best time in the day for this meal is the noon hour. The food should be taken plain without sauces. Roast beef or mutton are the best of all meats, both as regards nourish- ing properties, and the ease with which they are digested. Avoid coffee ; buttermilk or koumyss may be used instead. Bitter tonics may be used, and a pepsin powder after each meal. After dinner, rest and quiet for an hour are desirable. About four or five hours after dinner a cup of tea with stale bread and good butter, with fresh or preserved fruit, may be eaten sparingly. Retire early. This mode of living will generally render a person exempt from habitual indigestion; never- theless, in spite of these precautions, occasional attacks of this derange- ment will make themselves felt. Starchy, sweet, and fat food must be avoided. The food must be well chewed, and only small quantities taken at a time. Liquids should be taken in only very small quantities and alcoholic stimulants should not be taken in any quantities. As a medicinal help to digestion, taka-diastase taken in 2 to 4 grain doses after meals is very beneficial. 368 DISEASES OF ADULTS. Or:^ Pepsin, i dram. Dilute Hydrochloric Acid, 4 drams. Glycerine, 4 drams. Cherry-laurel Water, 2 ounces. Take one teaspoonful in water before each meal. Flatulency, wind on the stomach, may be relieved by the use of purified animal charcoal in the form of tablets. One allowed to dis- solve in the mouth occasionally. Heartburn and the burning sensation in the stomach are benefited by:- Subnitrate of Bismuth, 20 grains. Aromatic Powder, 5 grains. One such dose as required. Vomiting is present in Irritative Dyspepsia. (See "Nausea and Vomiting," page 364.) Great benefit is felt from drinking from a half to one pint of hot water an hour before each meal. This has the effect of washing or irrigating the stomach and exciting it to healthy action. Constipation is frequently a troublesome and dangerous attendant. (See "Constipation," page 370.) GASTRIC ULCER OR ULCER OF THE STOMACH. The cause of this condition is not quite settled. It attacks young women more frequently than men. Those who are anaemic, over- worked, and underfed, and those who have suffered injury in the region of the stomach are most susceptible to this disease. Symptoms. — Disturbances of digestion associated with pain at the pit of the stomach. This pain is of a burning, boring, or gnawing character, increased by taking food, and may be felt at once after eating, or an hour or two after the meal. Pain is frequently felt in the back. Vomiting of blood is quite constant. The patient may be emaciated, or appear well nourished. Blood is sometimes found in the stools. The disease is of a chronic character and frequently leads to 4 perforation of the stomach wall. Prognosis. — The patient may recover under favorable treatment; but the greatest danger arises from perforation of the bowel, which requires prompt surgical attention. Treatment, — Rest in bed should be enforced. Feeding should be CANCER OF THE STOMACH. 369 conducted through the rectum to give the stomach a complete rest, or the patient should partake by the mouth of only skimmed milk, two ounces, and limevvater, one ounce, every two hours. The pain is relieved by use of anodynes. The hemorrhages are controlled by the administra- tion of acetate of lead, one or two grains twice daily, or a capsule con- taining one or two grains of stypticin three times daily. Silver nitrate, one fourth grain every four hours, has a beneficial effect upon the ulcer, but it is useless here to further describe the treatment, which can be carried out only under the intelligent guidance of a physician. GASTRIC CANCER OR CANCER OF THE STOMACH. This condition occurs more commonly in men after the fortieth year. Causes. — Heredity; gastric ulcer; and alcoholism. Scientists now believe it to be due to a cancer germ. Symptoms. — It develops slowly, with gradual loss of strength, indigestion, fermentation, dyspepsia, and foul breath. There is vomit- ing, after meals, of partially digested food and blood which is more or less altered, giving the vomit a black or coffee ground appearance. A new growth may be felt over the region of the stomach, at which point there is much tenderness amounting to pain which is dull, heavy, and increased by pressure (even by the weight of the clothing) and after eating. The patient is emaciated, has some fever, the bowels are constipated and, because of the presence of blood, the stools are black and tar- like. Dropsy of the lower extremities, particularly of the ankles, is present. Prognosis. — The disease terminates usually within a year after its recognition. The patient is melancholy, but the mind is clear to the end. Medical treatment is of little avail. Surgical intervention fre- quently prolongs life. Treatment. — This is palliative and is directed towards sustain- ing the strength of the patient and allaying pain. The food must be predigested. The best form is peptonized milk. This is conveniently prepared by adding five grains of the extract of pancreas and fifteen grains of bicarbonate of soda to one pint of milk. The mixture is 370 DISEASES OF ADULTS. then placed in a vessel of water and kept at a temperature of about ioo or 1 1 5 Fahrenheit for one hour. Beef, eggs, and similar food may be peptonized. (See "Food for the Sick," page 281.) In cases where the stomach is not able to retain food, rectal feeding must be resorted to. (See "Nursing," page 235.) Digestion is improved and fermentation of the food in the stomach is prevented by: — Sulphate of Strychnia, y 2 grain. Dilute Hydrochloric Acid, 4 drams. Infusion of Gentian, to make 5 ounces. A tablespoonful in water before each meal. Bad breath may be relieved by charcoal tablets, or by from %. to J of a grain of carbolic acid in water. No stimulants should be used. DISEASES OF THE BOWELS. CONSTIPATION. When there is an undue retention of the contents of the bowels, their contents become hard and are expelled with difficulty and some- times with pain. Causes. — Neglect of the usual time of going to stool, extraordinary heat of the body, copious sweats, taking food that is dry, heating, and difficult of digestion; sedentary life, or a diseased state of the liver or spleen, sometimes from stricture in the rectum. Treatment. — The first thing to be done is to establish the habit of trying to evacuate the bowels every day at a certain hour; the best time for most people is just after breakfast. It matters not if the bowels do not act; the practice of attempting should be persisted in, and in time it will break up the confined state of the bowels. Adopt a diet free from all astringents, taking care especially that there is no alum in the bread. Let the food consist of a due admixture of meat and vegetables for dinner; the beverage, water. For breakfast stale bread or dry toast, with a moderate quantity of butter, honey, fish, or bacon; cocoa is, perhaps, preferable to tea or coffee; porridge made of Scotch oatmeal. Regular exercise, either walking or horseback riding-, should be taken. Apples, pears, stewed prunes, raisins, gruel with INTESTINAL INDIGESTION. 371 currants, broths with spinach, leeks, and other soft pot-herbs are excellent laxatives. If the above mode of living fail to relax the bowels, inject a warm water enema. Hunyadi Janos water is a very beneficial aperient. On- Bicarbonate of Soda, . 2 drams. Tincture of Nux Vomica, 4 drams. Tincture of Capsicum, 1 dram. Tincture of Rhubarb, 1% ounces. Compound Infusion of Gentian, ... to make 6 ounces. Take a half-tablespoonful in water after each meal. Or:— Fluid Extract of Cascara Sagrada, . . 1 ounce. Tincture of Nux Vomica, Y / 2 ounce. Syrup of Ginger, y 2 ounce. Infusion of Sarsaparilla, to make 3 ounces. Take a teaspoonful in water three times a day. For beneficial mineral and aperient waters, see Hydrotherapy. INTESTINAL INDIGESTION. Defective and imperfect digestion of food after it has passed from the stomach. Causes. — Imperfect diet; overeating; worry; mental weariness; abuse of tobacco and stimulants ; irregular hours ; sedentary occupation ; diseases of the stomach, liver, or intestines; malaria; deficiency of intestinal secretions; or loss of tone of the intestines. Symptoms. — Abdominal pain; distention of the abdomen; both occurring some hours after meals (these symptoms are delayed much longer after eating than are similar signs of stomach indigestion) ; emaciation ; anaemia ; nervousness; flatulency; coated tongue; loss of appetite; diarrhoea; and headache. Sometimes the liver is involved, then there are jaundice, dark-colored urine, and light-colored, clayey stools. In chronic cases the pain is first felt in from two to six hours after eating; difficulty of breathing; constipation; and dry, harsh skin are manifested. Treatment. — The pain is to be relieved by hot applications and a cathartic to expel the irritating matter. 372 DISEASES OF ADULTS. Calomel, -J grain. Bicarbonate of Soda, 2 grains. Powdered Ipecac, 1-6 grain. Sugar of Milk, 3 grains. Make six such powders and take one every two hours. This is to be followed by a full dose of Epsom salts, Rochelle salts, Hunyadi Janos water, or Apenta water. The intestines are then stimulated by: — Tincture of Nux Vomica, 2 drams. Dilute Hydrochloric Acid, 4 drams. Compound Tincture of Cardamom, 4 drams. Essence of Pepsin, to make 3 ounces. A teaspoonful every three hours in water. Or, in more severe cases, give : — Phosphate of Soda, 1 ounce. Dilute Phosphoric Acid, 4 drams. Syrup of Lemon, 1 ounce. Chloroform Water, 3 ounces. Peppermint Water, 3 y 2 ounces. Take a tablespoonful in a wineglass of water after each meal. In chronic cases much benefit is derived from aperient waters. See Hydrotherapy, The following pill often produces excellent results in -chronic cases : — Arsenate of Soda 1-20 grain. Sulphate of Strychnia, 1-32 grain. Pure Pepsin, 2 grains. Take one such pill after each meal. The diet must be restricted to easily digested food, such as milk, eggs, and beef. DIARRHOEA. Causes. — The causes which produce diarrhoea are indigestible food, or food taken in too great quantities; acid fruits, irritating sub- stances taken into the stomach; the abuse of active purgative medicines; the application of cold to the body; and the suppression of perspiration. Symptoms. — This disease consists in a copious and frequent dis- charge of matter from the bowels, accompanied by griping. There is a sense of weight and fullness in the lower part of the stomach, attended with a murmuring noise, arising from the presence of a great DIARRHCEA. 373 collection of wind. This feeling is relieved after every evacuation which takes place and is renewed before a second ensues. In addi- tion to these symptoms, the patient is troubled with nausea, vomit- ing, and, if the purging be not quickly arrested, by great exhaustion and depression of the vital powers, accompanied by more or less colicky pain. It is distinguished from dysentery by the absence of blood in the motions. The appearance of the stools in the commencement of the disease is sometimes thinner than natural, in consequence of a large quantity of fluid being poured out by the intestines. They are some- times slimy and of a green color; sometimes they are yellow, and sometimes of a dark brown, accompanied by a very fetid smell. As the disease advances they become very watery, and similar to coffee grounds; the strength rapidly fails, the countenance turns pale, the skin is dry ind stiff, great emaciation takes place, and dropsy frequently ensues. Treatment. — In the treatment of this disease, attention must be paid to the cause which produces it, and the remedies administered accord- ingly. If it is caused by indigestible food, or should the stools be scanty and frequent, and accompanied by some degree of bearing down, four or six drams of castor oil, with five drops of tincture of opium, will afford great relief. If it is caused by the abuse of purgative medicines, they must be discontinued, and the following mixture administered : — ■ Tincture of Rhubarb, 1 ounce. Tincture of Opium, 30 drops. Spirit of Lavender, 4 drams. Cinnamon Water, 5 ounces. Make a mixture, and take two tablespoonfuls every four or six hours. If it has proceeded from the application of cold to the surface of the body, or the suppression of perspiration, every effort must be made to restore the secretion by the administration of ten grains of Dover's powder, taken in a little gruel or water. The following is a good mixture: — Prepared Chalk, 3 drams. Spirit of Lavender, 2 drams. Compound Tincture of Cardamom, 2 drams. Tincture of Opium, y 2 dram. Cinnamon Water, 6 ounces. 374 DISEASES OF ADULTS. Make a mixture, and take two tablespoonfuls every three or four hours until the diarrhoea ceases. Another line of treatment for all forms of diarrhoea is to free the bowels from offending matter by a full dose of castor oil ; then take, every three hours, a pill containing: — Extract of Opium, J4 grain. Camphor, 3 grains. Or:— Insert a 1 -grain opium suppository into the rectum once, twice, or thrice, daily. When it arises from ulceration of the intestines, as often happens in consumption and other protracted diseases, the most effectual astrin- gents, in addition to those already recommended, should be employed, such as catechu, kino, alum, logwood, and tannin. The following is a good mixture in these cases : — Chalk Mixture, 5 ounces. Tincture of Catechu, 4 drams. Tincture of Kino, 3 drams. Syrup of Poppies, 2 drams. Tincture of Opium, 30 drops. Make a mixture, and take two tablespoonfuls three or four times a day. The diet in these cases should consist of sago, arrowroot, and rice puddings, made with or without milk. It will be necessary for those persons who are subject to frequent attacks of this complaint, either from a peculiar weakness or irritability of the bowels, to live temperately and abstain from unwholesome food. Eclectic Treatment for Diarrhoea. If caused by cold or obstructed perspiration, keep the patient warm ; drink freely of astringent herb teas ; use the tepid bath, and wear flannel next the skin. A little snakeropt tea will also be found useful. If there is much griping, a hot fomentation of garden mint should be applied to the stomach. Speedy relief has been effected by taking twelve drops of laudanum in half a gill of the best brandy. Repeat, if necessary, in about an hour. In obstinate cases, the jelly of slippery elm and blackberry, in equal parts, mixed with a little powdered ginger or cinnamon may be used. For chronic looseness, the following decoction is very good : — DYSENTERY. 375 Bistort Root, bruised, 3 ounces. Water, 1 quart. Boil twenty minutes; then add: — Cloves, bruised, I ounce. Cranesbill and Wild Mint, of each, y 2 ounce. Catechu, 2 drams. Boil ten minutes longer, strain, add : — Loaf Sugar, 1 pound. Dose, three tablespoonfuls three or four times a day. The following has also been used with excellent results : Take equal parts of tincture of rhubarb, spirits of camphor, essence of peppermint, and laudanum. Dose, for an adult, one teaspoonful every hour if necessary; less according to age of the patient and severity of the disease. DYSENTERY. A disease accompanied by frequent and scanty discharges from the bowels, and tenesmus or great bearing down of the rectum. The stools are mucous, bloody, or slimy, and contain little or no fecal matter. Causes. — The causes which produce this disease are a cold and moist state of the atmosphere, quickly succeeded by heat; the suppres- sion of the perspiration,, whereby the blood is thrown from the external upon the internal vessels; immoderate use of spirituous liquors, unwholesome .food, exposure to noxious exhalations, or to the effluvia arising from the bodies of persons laboring under the disease. It frequently appears in hospitals which are not properly ventilated, and other places where a number of sick persons are crowded together ; while in situations where great attention is paid to ventilation and cleanliness, it seldom extends beyond the individual in whom it originates. Symptoms. — This disease is ushered in by all the concomitants of inflammatory fever — such as cold shivering succeeded by heat of skin, frequency of pulse, loss of appetite, nausea, and diarrhoea. This stage is quickly followed by severe griping pains, and pain in the abdomen, frequent desire to go to stool, accompanied by straining and painful bearing down of the rectum — the evacuations consist of more or less fecal matter. The stools frequently vary in appearance, being some- times pure mucus, or mucus streaked with blood and containing pus, 376 DISEASES OF ADULTS. and it not unfrequently happens that pieces of membrane, arising from ulceration of the lining of the intestines, are seen floating in the dejections. The stools number from 5 to 20 or more in 24 hours. Treatment. — Confinement to bed, the patient using a bedpan; the stools thoroughly disinfected with chloride of lime. The diet must be fluid, non-irritating, and nutritious, such as milk and limewater; white of egg, alone, or with milk and brandy; beef and mutton broths; chicken soup; oyster soup; clam juice. Castor oil, two to four tablespoonfuls in brandy or whisky; ten to twenty drops of laudanum may be added with great benefit; or Epsom or Rochelle salts in two teaspoonful doses every hour until thorough movement. The pain and excessive movements may then be controlled by the insertion (into the rectum) of a 1 -grain opium suppository every four hours. Hope's camphor mixture works well in many cases. It is as fol- lows : — Nitrous Acid, 1 dram. Camphor Mixture, 8 ounces. Mix and add : — Tincture of Opium, 40 minims. Mix and take one fourth of this mixture every four hours. The bowels should be washed out with salt solution twice daily : a teaspoonful of table salt dissolved in a pint of hot water. Chronic cases are benefited by the following: — Tannalbin, 1 ounce. Ichthalbin, 1 ounce. Sugar of Milk, 30 grains. Mix and divide into thirty powders. Directions : One three times daily before meals. When convalescence is established, such reconstructives as cod liver oil, and elixir iron, quinine, and strychnine, in one to two teaspoonful doses after meals, are efficient. CHOLERA MORBUS. This is a disease prevalent in hot, damp weather. From the great amount of bile secreted, it is also called Bilious Cholera. Causes. — Excessive heat, sudden atmospheric changes, wet feet, indigestible food, and unripe fruits. CHOLERA MORBUS. 377 Symptoms. — This disease begins with sickness and distress at the stomach, succeeded by violent gripings with vomiting of thin, dirty yellowish, whitish, or greenish fluid. The contents of the upper bowels may be vomited. The nausea and distress continue between the vomit- ing and purging, and the pain at times is intense. The pulse is rapid, soon becoming small and feeble, the tongue dry, the urine high colored, and there is much thirst, though no drink can be retained on the stomach. Treatment. — Apply a large mustard poultice over the stomach and liver. Give large draughts of warm teas, by which means the stomach will be cleansed of all its solid contents. Warm injections must be given frequently, and hot bricks applied to the feet, while the whole body should be swathed in warm flannels and hot water bottles applied to keep up the body temperature. Hot brandy, in which is a dose of cayenne, is excellent to quiet the vomiting and griping. A few drops of laudanum in the injections may be given, if the pain is excessive. Or:— Extract of Opium, %. grain. Camphor, 3 grains. Make into one pill. Give one such pill every three hours for an adult. Or:— Morphine Sulphate, 1 grain. Quinine Sulphate, 1 dram. Aromatic Sulphuric Acid, enough to dissolve. Magnesia Sulphate, 2 ounces. Peppermint Water, to make 4 ounces. Shake. Take one to two teaspoonfuls in a glass of water, after stools. This is known as the "Army Hospital Mixture." Diet: Milk and raw eggs. Keep patient in recumbent position. If these remedies do not afford immediate relief a physician should be summoned without delay. Eclectic Treatment for Cholera Morbus. No time must be lost in treating the severe stages of this disease. Give the patient copious drinks of whey, warm barley water, thin water gruel, or weak chicken broth. Bathe the feet and legs in warm saleratus water, and apply warm fomentations of hops and vinegar to the bowels. In addition to these, apply a warm poultice of well stewed garden mint, or a poultice of mustard and strong vinegar will be found 378 DISEASES OF ADULTS. of much service. The vomiting and purging may be stopped by the following : — Ground Black Pepper, i tablespoonf ul. Table Salt, i tablespoonf ul. Warm Water, y 2 tumblerful. Cider Vinegar, y 2 tumblerful. Dose, a tablespoonful every few minutes. Stir and mix each time until the whole is taken. Nourishing diet should be taken by the patient. A wineglassful of cold camomile tea, once or twice a day, would be very beneficial, as would ten drops of elixir of vitriol, three or four times a day, or a tea made of black or Virginia snakeroot. Flannel should be worn next the skin, and the warm bath should be frequently resorted to. COLIC. Colic is a name given to several varieties of disease characterized by severe pain of the bowels, with distention or flatulence, but without looseness or diarrhoea. Physicians distinguish several varieties of this complaint: Spasmodic, in which the principal symptoms are sharp and spasmodic pains about the navel; that occasioned by indigestible food, gas, or acrid matter in the intestines; bilious, when accompanied by vomiting of bile, or by obstinate costiveness; lead or Devonshire colic, which is due to the poison of lead. Causes. — Among the most frequent causes may be named worms, poisonous or unwholesome substances, indigestible food, gout, rheuma- tism, intense cold, acid fruits, and unripe vegetables. Symptoms. — The symptoms of colic, in general, are distention of the lower region of the belly, with twisting pain, and very commonly vomiting and costiveness. PAINTERS' COLIC. Lead or painters' colic is characterized by obstinate costiveness, and vomiting of bile. The pain comes on in paroxysms. The spasms gradually become more violent, and, if not alleviated, become unbearable. Treatment. — Give immediately from thirty to forty drops of lau- danum and apply heat over the abdomen. Hot drinks containing peppermint, spearmint, and composition tea generally afford relief. COLIC. 379 For the treatment 'of paralysis, or palsy arising from the absorption of lead, which is generally confined to the wrists, use galvanism, friction, and shampooing, with chalybeate waters. Those engaged in the manufacture of lead, or in occupations in which one or other of its preparations are frequently handled, may generally escape its baneful effects by strict attention to cleanliness. They should never take their meals where they work, or with unwashed hands. Let them eat fat meat, and butter, and take acidulous drinks, especially those rendered so by sulphuric acid. The men employed at the Birmingham white lead works have been almost free from this disease, to which they were much subject before, since they have mixed a little of the above acid with their molasses beer. From the first attack of lead colic patients generally recover; but unless they change their occupations, or observe the above precautions with scrupulous care, the attacks are repeated, each time with greater violence, and they will become, eventually, miserable cripples. WIND COLIC. Wind colic is a severe and distressing pain in the bowels ; sometimes a stoppage, and swelling about the pit of the stomach and the navel. The complaint may be caused by weakness in the digestive organs, by indigestible food, unripe fruit, or costiveness. Treatment. — If the pain is caused by having eaten anything indi- gestible, an emetic should be immediately taken. If this does not bring relief, a dose of salts, or sweet tincture of rhubarb, may. If there is no sickness at the stomach, a little ' essence of peppermint in water, or brandy, or gin in hot water, may be sufficient to expel the wind and give relief. If there be costiveness, and continued pain, a stimulating injection should be given. BILIOUS COLIC. Bilious colic is a painful disease. There is griping, twisting, tearing pain about the navel, or sometimes over the whole abdomen. Causes. — It is caused by irritating articles taken into the stomach, the presence of bile in the stomach, long exposure to cold, torpid liver and skin, great unnatural heat, etc. Symptoms. — It comes and goes by paroxysms. Sometimes the abdomen is contracted, at other times enlarged, and stretched like a 380 DISEASES OV ADULTS. drumhead. At first the pain is relieved by pressure, but after a time the abdomen grows tender to the touch. There is thirst and heat, and vomiting of bilious matter from the stomach. In the worst cases, the pulse is small, the face pale, the features are shrunk, and the whole body is covered with a cold sweat. Treatment. — Administer an active cathartic immediately. Give a mixture of: — Pulverized Camphor, 4 grains. Cayenne, 1 grain. White Sugar, 1 scruple. This, divided into eight powders, and given once in fifteen minutes, will relieve the pain, at the same time a mustard poultice should be laid upon the abdomen. If the pain does not yield, give a teaspoonful of paregoric. The sickness of stomach may be allayed by hot draughts in which are a few drops of laudanum; one drop of croton oil in a crumb of bread will often purge successfully; or castor oil and spirits of turpentine, equal parts, in two tablespoonful doses, may be used before trying the other. A warm bath is good, and bottles filled with hot water, placed at the feet and sides, to promote perspiration. Eclectic Treatment for Colic. A decoction of equal parts of skullcap and high cranberry bark, to which is added a tablespoonful of the compound tincture of Virginia snakeroot, has been found very useful. Apply over the stomach and bowels hot fomentations of wormwood and boneset, or hops, stra- monium leaves, or hops and lobelia. In flatulent colic the legs should be bathed in warm water, and poultices of mustard or hot salt placed over the bowels and stomach. The bowels may be opened with a dose of castor oil, and ginger or peppermint tea may be drunk freely. To ease the pain, from thirty to sixty drops of paregoric may be given. In very severe cases, a mixture compounded of equal parts of laudanum, tincture of camphor, and essence of peppermint, in teaspoonful doses, may be given. In some cases a teaspoonful of spirits of turpentine, taken with a tea- spoonful of castor oil, has been found to give immediate relief. For painters' or lead colic, the following is highly recommended : — Sulphate of Magnesia, y 2 pound. Powdered Alum,. 1 ounce. Sulphuric Acid, iy 2 drams. Boiling Water, iy 2 pints. PILES. 381 Mix. Dose, a tablespoonful in a wineglassful of water; repeat every hour until it operates upon the bowels. To prevent the acid from injuring the teeth, the solution may be sucked through a quill or a glass tube. After the bowels have been freely opened, the medicine should be continued for weeks or months, in doses sufficient to produce one or two passages every twenty-four hours. The sulphuric acid, by uniting with the oxide of lead in the system, forms the sulphate of lead, which is a harmless salt. The following is recommended to be taken by persons who are exposed to the bad influence of lead : — Elixir Vitriol, T / 2 ounce. Tincture of Prickly Ash Berries, 1 ounce. Dose, a teaspoonful in a gill of water, and repeat three or four times a day. PILES OR HEMORRHOIDS. These consist of small tumors, situated on the extremity of the rectum. The piles are usually accompanied by a sense of weight in the back, loins, and lower part of the abdomen, together with pain in the head, sickness at the stomach, and flatulence in the bowels. If the tumor break, a quantity of blood is voided, and considerable relief from pain is obtained; but, if they continue unbroken, the patient experiences great pain. Treatment. — The following treatment will generally prove bene- ficial : — Confection of Senna, 1 ounce. Flowers of Sulphur, 1 ounce. Jalap, in powder, 1 dram. Balsam of Copaiba, y 2 ounce. Ginger, in powder, ]/ 2 dram. Cream of Tartar, y 2 ounce. Syrup of Ginger, a sufficient quantity to form the whole into an electuary. Mix. Take a teaspoonful every three hours, until the bowels are freely open. At the same time make use of the following lotion : — Goulard's Extract, 3 ounces. Laudanum, y 2 ounce. Mix and apply to the parts repeatedly. When the piles are very painful and swollen, the patient should sit over steaming hot water. 382 DISEASES OF ADULTS. Either of the following may be used to advantage: — - Powder of Oak Galls, i ounce. Elder Ointment, i ounce. Mix and anoint the parts night and morning. Sublimed Sulphur, y 2 ounce. Cream of Tartar, iy 2 drams. Confection of Senna, i ounce. Syrup sufficient to form an electuary. A teaspoonful to be taken at bedtime. The parts should be bathed with cold water after each evacuation, then dried and bathed again with witch hazel. At bedtime insert the following suppository into the rectum: — Cocaine, y% grain. Extract of Hyoscyamus, i grain. Zinc Oxide, 3 grains. Mix and make into one suppository. FALLING OF THE BOWEL. Prolapse of the rectum most frequently occurs with children and aged persons, though it takes place at all ages, and commonly in connection with piles, irritation from worms, or stone in the bladder; much straining of the bowels at stools will also occasion it. Treatment. — The bowel may be returned without difficulty, by means of gentle pressure with the fingers, covered with oil. If allowed to remain down long, it will become swollen, congested, and require the aid of a physician. Children so affected should have their bowels kept in a lax state with gentle aperients, and they should not be suffered to remain long on the stool; the loins should also be bathed with cold water; and an enema, consisting of a grain of sulphate of iron, dissolved in an ounce of rain water, should be thrown into the bowels after each motion. INFLAMMATION OF THE PERITONEUM OR PERITONITIS. This is an exceedingly painful and dangerous disease, from its extent and connection with important organs. It may exist either as an acute or chronic disease. FISTULA. 383 Causes. — Its causes are various, as cold, mechanical injuries of the peritoneum, the development of tumors, etc. Women in childbed are peculiarly liable to it. Symptoms. — There is usually great pain, tenderness and board-like hardness of the abdomen, accompanied with fever, and a frequent pulse. Sometimes, at first, the pain is confined to one spot; but it generally soon extends over the whole of the abdomen. It is very severe, and much increased by any motion, even coughing, sneezing, or drawing a long breath. Even the weight of the bedclothes is sometimes unbear- able. The pain is acute and cutting, and sometimes occurs in paroxysms; and the patient usually lies on the back with the knees drawn up. The bowels are usually constipated, but sometimes the reverse; and commonly there are present nausea, vomiting, and hiccough. Treatment. — Apply hot fomentations and at once send for a physician. FISTULA. This is a troublesome ulcer near the anus, which communicates with the rectum. Causes. — Persons who follow sedentary occupations are more liable to them. Treatment. — Sometimes a cure will be effected by attending to the general health, and the injection of some astringent lotion, as solution of sulphate of zinc (forty grains to one pint of water). If this fails, it will be necessary to make a complete division with the knife of the whole of the parts between the fistula and the bowel, and the edges of the wound kept apart by lint, in order to allow the cavity to fill up by granulation. OBSTRUCTION OF THE BOWEL. An impediment, either mechanical or paralytic, against the passage of matter through the intestine. Causes. — Innervation of the bowel; malformation; telescoping of one portion of the bowel into the other; the growth of bands or mem- branes; the passing of the bowel through other openings, as in hernia or rupture; twisting of the bowel upon itself so as to obstruct the passage; the presence of foreign bodies in the bowel. 384 DISEASES OF ADULTS. Symptoms. — Sudden and violent pain; vomiting; passing of bloody mucus when the form of telescoping is present and the obstruction is only partial; straining; complete constipation; vomiting sometimes of a sort of faecal matter ; rapid pulse ; and high temperature. Prognosis. — The general prognosis is not very good. The liability to sloughing of the parts, or of perforation, is very great. Operation with proper antiseptic observance gives much better results than formerly and the ratio of fatality is constantly decreasing. Where the cause is simple paralysis of the bowel there may be nothing more than a twisting of the bowel, which may suddenly right itself. Treatment. — The treatment is invariably surgical. APPENDICITIS OR INFLAMMATION OF THE APPENDIX. Inflammation of the vermiform (worm-shaped) appendix, an open- ing into the caecum (the enlarged commencement of the large intestine). The vermiform appendix is about one third of an inch in diameter and from one to six inches long. It does not lead anywhere and its use is obscure. Causes. — About 85 per cent, of the cases are due to the presence of micro-organisms lodged in the appendix under favorable conditions of growth. The majority of the rest of the cases are due to the presence of faecal matter and a few of them to the presence of foreign bodies, such as stones of small fruits, etc. As this is a blind passage without means of drainage very favorable conditions for the growth of micro-organisms may easily be set up in it. While the disease attacks all ages it occurs most frequently between the fifteenth and the thirtieth years. It attacks six times as many men as women, probably by reason of the greater frequency of catarrhal inflammatory diseases among men. It is least common among the poorer classes. The inflammation passes through the several stages of simple inflammation, ulceration, gangrene, and perforation. The greatest fatality attends the gangrenous type, from which sudden death often results without much preliminary disease. The greatest pain is felt from the formation and imprison- ment of pus in the appendix. Symptoms. — The symptoms vary not only in kind but in degree; so that it cannot be said that any one line of symptoms will be present in all cases. There is always pain in the abdomen, but it is often so distributed that the patient is unable to locate it with precision. This APPENDICITIS. 385 pain varies from sharp, to agonizing, but its attack is usually sudden. A valuable indication of the disease is the rigidity of the muscle on the right side running from the pubic bone up to the ribs. Sometimes there is vomiting, slight fever, and quick pulse. After some days there may be a swelling on the right side of the abdomen due to the forma- tion of pus. Prognosis. — This varies with the type of the disease. Simple inflammatory cases will probably all recover. Gangrenous cases will probably all die. The latter demand prompt surgical care, in which case a majority may recover. Treatment. — Rest in bed; application of ice over the appendix. The intestines are not allowed to do any work that can be avoided. No food or drink is to be taken; no purgatives are used; and no muscular exertion is to be permitted. This is intended to reduce or to control the inflammation and is maintained for thirty-six hours. If at the end of that time there is not a marked improvement, an opera- tion is necessary. In such cases the operation is usually performed without an hour's delay. But when there is an improvement, the prevailing practice is to postpone the operation until after there has been a recurrence of the attack; then to operate in an interval. But of course all of that is a matter for the surgeon to decide. DISEASES OF THE LIVER AND SPLEEN. JAUNDICE OR ICTERUS. Catarrhal inflammation of the mucous membranes of the bile-ducts by which the flow of bile is obstructed. Causes. — Inflammation excited by excesses of eating and drinking; exposure; congestion of the liver; pneumonia; malaria; and fevers. Symptoms. — Pain in the stomach; foul tongue; loss of appetite; nausea and vomiting; slight diarrhoea; and fever. After from three to five days the whites of the eyes become yellow; the whole body gradu- ally assumes a yellowish tinge; the fever disappears; the skin is dry and itches; the bowels constipated; stools clayish or whitish in color; wind in the bowels ; much colic ; urine scanty and dark-colored from the presence of bile products. Prognosis. — The disease usually runs two or three weeks and the termination is favorable. 386 DISEASES OF ADULTS. Treatment.— The patient should rest in bed; avoid exposure; and eat ripe fruits, vegetables, milk and limewater, broths, lean meat, eggs. No starch, sweet food, or fats should be given. The bowels must be kept open by: — Calomel, . y 4 grain. Bicarbonate of Soda, 3 grains. Take one such powder every two hours until twelve have been taken; then follow with a dose of Hunyadi Janos water. Or:— Bicarbonate of Soda, 4 drams. Tincture of Nux Vomica, 2 drams. Tincture of Capsicum, 1 dram. Tincture of Rhubarb, . . 2 ounces. Compound Infusion of Gentian, ... to make 6 ounces. Take a dessert-spoonful in water every three or four hours. The itching of the skin may be relieved by sponging with a weak solution of carbolic acid ; or by a hot bath in which a little carbonate of potassium has been dissolved. This bath may be given night and morning. Eclectic Treatment for Jaundice. As the stomach is usually disordered, it is well to give an emetic, and after it has acted freely administer a gentle purge. Should there be coldness about the feet or body, use the hot bath, or bathe the whole body with hot vinegar and water. A decoction made of dandelion and barberry root may be drunk freely. If these do not give immediate relief, take the following: — Golden Seal and Capsicum, of each, 1 dram. Bitter Root and White Poplar Bark, of each, 2 drams. Cover with boiling water. When cool, add half a pint of Holland Gin. Dose, a wineglassful three times a day. A strong tea of peach tree leaves, about half a pint taken daily; or from ten to forty drops of the tincture of bloodroot, taken three times a day, either in water or herb tea, have been highly recommended. GALLSTONES. Gallstones are concretions, sometimes formed in the gall bladder; they vary greatly in size, some being smaller than a pea, and some as large as a walnut; they often remain in the gall bladder without GALLSTONES. 387 causing any uneasiness; but, when one of any considerable size passes into the duct, it gives rise to violent spasmodic pains which cease only when the stone has effected its passage into the bowels. The gall duct is, in caliber, no larger than an ordinary goose quill, and therefore this operation is often a difficult and protracted one;, its symptoms are agonizing pain in the region of the bladder, often accompanied by shivering and vomiting; when the obstruction has passed into the com- mon duct, and so stopped the flow of bile from the liver, there will be jaundice, with white and chalky stools. When there are these symp- toms, with absence of pain on pressure, and no fever, we may safely conclude that inflammation is not the exciting cause, but gallstones. Treatment. — The proper treatment in an attack of this kind is hot applications over the seat of pain. The pain should be relieved by anodynes or the hypodermic injection of morphia. Such treatment, however, is safe only in the hands of a competent physician. There is commonly great acidity of the stomach while gallstones are passing; hence an alkaline draught is of service, say half a teaspoonful of bi- carbonate of soda in a good quantity of warm water. Should the stomach reject these remedies, an anodyne may be administered in a clyster (forty drops of laudanum, in a pint of thin gruel). Hot bran poultices, sprinkled with laudanum, may be applied to the seat of pain. During the passage of gallstones much relief may be obtained by the use of ether, one dram to a pint of olive oil, one half of this amount to be taken during the seizure and repeated in twelve hours. When the foregoing lines of treatment fail there is danger that the calculus or stone may perforate the gall bladder or the walls of the biliary passages and surgical intervention should be sought. CONGESTION OF THE LIVER. In this condition the arteries or veins are over-distended with blood, causing slight jaundice, melancholia, and digestive disturbances. When the veins are congested- the cause is due to disease of the heart and lungs. When the arteries are congested the condition may be due to alcoholism, irregular dietary, constipation, or atmospheric changes. Symptoms. — Headache, feverishness, a furred tongue, loss of appetite, nausea, sometimes vomiting, constipation, and the urine is suppressed and highly colored. The skin becomes gray, sallow, or muddy in color. The white of the eye is tinged with yellow. There 3 88 DISEASES OF ADULTS. is sense of weight in the region of the liver and weariness in the lower extremities. Treatment. — When associated with disturbances of digestion, wash out the stomach by drinking copiously of lukewarm water and irritating the throat to cause the water to be returned. Then give a dose of castor oil, or calomel one-fourth grain and bicarbonate of soda one grain every half hour for six or eight doses ; follow this with a dose of salts (Epsom or Rochelle), or a dose of Hunyadi water. A light nutritious diet together with bitter tonics, such as nux vomica ten drops, dilute nitro-hydrochloric acid ten drops, in half a glass of water fifteen minutes before each meal, constitutes the subse- quent treatment. When due to disease of the heart and lungs, the treatment will be directed to these organs and a competent physician consulted. GIN-DRINKER'S LIVER. This condition is due to diseases of the heart and lungs, syphilis, and chronic alcoholism. There are two types — that in which the liver contracts and that in which the liver is enlarged. Symptoms. — Those of a chronic catarrhal condition of the stomach and bowels associated with a slight jaundice, the urine being scanty and high colored and on standing throwing down a heavy deposit. There is abdominal dropsy, more or less pain over the region of the liver, nausea, and vomiting. The vomited matter contains blood, and the stools are sometimes tarry owing to the presence of blood. The patient becomes emaciated and greatly debilitated. Death usually follows within a year after the appearance of abdominal dropsy. Treatment. — Consult a physician at once. CANCER OF THE LIVER. This condition affects men most frequently. It is rarely found in women and children. The disease makes its appearance usually after the fortieth year. Causes. — Heredity, and possibly a cancer germ; this latter point is not yet settled. Symptoms. — General ill health, loss of appetite, nausea, vomiting, jaundice, constipation, loss of strength and weight. There is usually INFLAMMATION OF THE SPLEEN. 389 some tenderness and pain, increased by pressure over the region of the liver. Sometimes a distinct tumor mass may be felt in the vicinity. Fever is not common and when present is only moderate. Towards the termination of the disease the additional symptoms are headache and delirium. Treatment. — Treatment is unsatisfactory. The condition terminates in death, but medical aid should be sought for relief of the early symptoms and later will be required for relief of pain. INFLAMMATION OF THE SPLEEN. This is often the result of chills and fever, and is very difficult and stubborn to cure. Symptoms. — A feeling of tightness and pain in the left side — the pain being increased on pressure, or by lying upon the left side. Some- times the organ enlarges, so as to be felt by the hand. There is some- times numbness, weakness of the legs, palpitation of the heart, difficulty of breathing, inability to exercise much, obstinate constipation, vomiting of food, piles, dry skin, tongue coated white or red, low spirits, and occasionally dropsical affections. Treatment. — Treatment should be about the same as in inflam- mation of the liver. After the active inflammation is subdued, the warm bath may be used once or twice a week. In the chronic form of the disease, counter-irritation with the compound tar plaster, with mustard poultices, or tincture of iodine, will be particularly needed. Keep the bowels open, and, if the patient is pale and bloodless, give iron combined with quinine and arsenic as a tonic. The following may be used : — Dried Sulphate of Iron, 30 grains. Quinine, 1 dram. Arsenious Acid, 1 grain. Mix and divide into thirty pills. Take one three times a day. DISEASES OF THE KIDNEYS. DIABETES INSIPIDUS OR EXCESSIVE FLOW OF URINE. This condition is more frequently met with in men than women. It occurs in early adult life. 39Q DISEASES OF ADULTS. Causes. — It may be hereditary, or it may be due to certain diseases of the nervous system ; diseases of the brain ; spotted fever ; and injuries to the head. Symptoms. — The affection is characterized by great thirst, and enormously increased flow of urine, which is pale or very light straw color. The amount passed in twenty-four hours may be from one to six gallons. The urine is slightly acid, contains neither albumen nor sugar. The general health of the patient is usually good, but the appetite is voracious. Treatment. — If syphilis is a causative factor mercury and the iodide of potash will prove of benefit. When due to nervous irrita- bility, use the following: — Valerianate of Ammonia, 40 grains. Sodium Bromide, 2 drams. Compound Spirits of Lavender, 1 ounce. Simple Elixir, to make 2 ounces. Mix. Give one teaspoonful three times daily in a wineglass of water. Constipation should be relieved by the use of one compound vege- table cathartic pill at bedtime. (See "Constipation," page 370.) DIABETES MELLITUS OR SUGAR DIABETES. Symptoms. — This condition, met with in middle life and more fre- quently affecting men, is evidenced by an increased flow of urine — as much as seven or eight gallons may be voided in twenty-four hours. The color of the urine is pale, the odor sweetish, and sugar is constantly present. There is excessive thirst and appetite. The bowels are constipated, the skin is harsh and dry. The breath has a sweetish odor. The loss of weight and strength is progressive. The temper is irritable and the external genital organs itch intensely. The circulation in the extremities is sluggish. Disturbances of digestion, melancholia, and diseases of the heart, lungs, liver, and kidneys frequently appear during the course of the disease. Gangrene of the extremities is another complication met with. The diabetic patient is usually impotent. Treatment. — Consult a physician. The condition can be greatly ameliorated and some cases cured by careful dieting and judicious treatment. BRIGHT'S DISEASE. 391 CONGESTION OF THE KIDNEYS OR RENAL CONGESTION. This is an acute catarrhal inflammation of the kidneys. Two varieties are known, termed active or arterial congestion, and passive or venous congestion. Causes. — The active variety is due to exposure to cold, injuries to the kidney region, extensive superficial burns, certain fevers, and the elimination in the urine of irritant substances, such as cantharides, copaiba, cubebs, turpentine, chlorate of potash, carbolic acid, etc. The passive variety is due to clotting of blood in the renal (kidney) vessels or diseases of heart or lungs. Symptoms. — Pain over the kidneys and running diagonally down to the pelvis and testicles, irritation of the bladder with constant or pressing desire to urinate, the urine being scanty, high colored, and containing some blood and albumen. There is headache, nausea, and sometimes vomiting. In the passive variety, when due to diseases of the heart or lungs, the urine is scanty, high colored, and contains albumen; dropsy soon appears. Treatment. — If the condition is not promptly treated serious damage to the kidney structure and chronic Bright's disease may develop. Therefore one should not attempt self-treatment but should consult a qualified physician. ACUTE BRIGHT'S DISEASE. Causes. — This disease may follow congestion of the kidney or be associated with infectious fevers such as scarlatina, diphtheria, typhoid, etc. "It is frequently met with in the course of pregnancy or may be due to the elimination of certain irritants such as cantharides, copaiba, turpentine, carbolic acid, arsenic, etc.; exposure to cold; injuries to the back. Symptoms. — It is a disease occurring in early life; at any rate it is more common in young than in old life. Dropsy is an early symptom, appearing first in the face with puffiness of the lower eyelids and later extends to the lower extremities and then to the abdomen. The onset, when sudden, is characterized by chill, fever, nausea, and per- sistent vomiting, aching pains in the small of the back, diarrhoea, irritation of the bladder and a desire to pass water frequently. The urine being bloody, presents an appearance like beef washings. There 392 DISEASES OF ADULTS. is decided anaemia and general weakness. The condition lasts from ten days to three or four weeks. Affections of the heart, lungs, pleura, and peritonitis may develop as complications. Treatment. — Call a physician at once. Put the patient in bed, administer plenty of water and a strict milk diet. The outlook is favorable if promptly treated, but as uraemic poisoning may develop, self-treatment should not be risked. CHRONIC BRIGHT'S DISEASE. There are two distinct types of chronic Bright's disease : one in which the connective tissue of the organ is stimulated to overgrowth resulting in a large white kidney; the other in which the kidney sub- stance contracts and is called a small, red, granular, gouty, or contracted kidney. Large White Kidney: This sometimes follows acute Bright's, or may be due to chronic malarial poisoning, chronic alcoholism, chronic mercury poisoning, syphilis, etc., and is a disease occurring usually before the fortieth year. Symptoms. — In the beginning the symptoms may not be well defined. Later there will appear pufrmess of the lower eyelids and face, marked anaemia, emaciation, and general weakness. The quantity of urine in the beginning is decreased but frequently voided. Later in the disease, when the kidney substance contracts and we have to deal with a contracted white kidney, the urine changes from a high colored fluid to a thin watery liquid and is increased in amount. Albumen is constantly present in the urine of this type of Bright's. Dropsy eventually becomes general, and when the pleural sacs or cavities are involved, breathing becomes very difficult from compression of the lungs by fluid. A dropsical laryngitis may develop and the voice become husky. Treatment. — Rest in bed and a milk diet are of prime importance. The dropsy is relieved by purgation and sweating. A splendid diuretic to increase output of urine, lessen the amount of albumen and overcome general weakness is the following: — Strychnia Sulphate, 54 grain. Tincture of Chloride of Iron, 5 drams. Solution of Ammonium Acetate, 2 T / 2 ounces. Sweet Spirits of Niter, iy 2 ounces. Water, to make 6 ounces. UREMIA. 393 Mix and take one teaspoonful every four hours followed by a glass of cold water. If the condition is due to syphilis, anti-syphilitic treatment will be required. A course of quinine in addition to the above diuretic will benefit cases due to chronic malaria. Prognosis. — As the condition is serious and unless carefully treated leads to a fatal ending, one afflicted with this disease should place him- self under the continued care of a competent physician. Small, Red, Granular, or Contracted Kidney : This is a disease of middle life and old age and is rarely met with earlier than the fortieth year. It affects men more commonly than women. Causes. — Somewhat similar to those of Large White Kidney; gout, alcoholism, mercury or lead poisoning, syphilis, worry, and the excessive consumption of red meats. Symptoms. — The disease is frequently well established before it is recognized. There is great thirst, also disorders of digestion, with loss of weight, and impaired hearing and vision. The skin is of a dead white, pasty color, is harsh, dry, scaly, and itches intensely. Nosebleed and cerebral hemorrhage are common. Nausea and vomiting occa- sional. The patient is drowsy. Convulsions, epilepsy, or apoplexy may develop. Dropsy, save of the white of the eye (the Bright's eye), seldom appears. Because of changes in the heart and blood vessels, there is shortness of breath on slight exertion. The urine is increased and of a pale and colorless appearance; there is rarely any sediment. Albumen is occasionally present. Treatment. — Rest and selected diet. Avoidance of alcoholic beverages. As uremic poisoning is very common and very severe in this type of Bright's disease, the patient should not attempt self-treat- ment, but abide by the advice of a qualified physician. URAEMIA. Causes. — By this term is meant certain manifestations of disturb- ances of the higher nerve centers, due to poisons, or waste products circulating in the blood, which poisons, or waste products, the kidneys fail to eliminate, as in Bright's disease and other affections of the kidney; in the course of pregnancy; and after operations on the rectum, uterus, bladder, etc. Symptoms. — It may develop gradually, or suddenly with convul- sions followed by stupor, or coma. There is suppression or decrease 394 DISEASES OF ADULTS. of urine and more or less general dropsy. Usually the condition begins with a chill, or chilliness, dizziness, headache, and disturbances of vision and hearing. Gastro-intestinal symptoms may predominate — nausea, vomiting, rapid breathing, fever, and increased pulse rate, the vessels being full and tense. These symptoms may be followed by convulsions and death, or the patient passes into a profound sleep and dies. Convulsive seizures may predominate; these are epileptic-like, and there may or may not be loss of consciousness. There is high fever, rapid pulse, and short hurried breathing. The patient may pass into a profound sleep, the subject being overcome by the poison in the blood — death ends the scene ; or he may, after deep sleep of several hours, awaken and make a good recovery. Another manifestation of uraemia is that which comes on slowly with drowsiness, headache, and general irritability, and associated gastro-intestinal disorders, high fever, rapid pulse and respiration, or suddenly the patient is struck down as in apoplexy. The breathing sound is of a hissing character, the fever is high, the pulse flabby and weak but rapid, and consciousness is never regained. Or after sleep, more or less profound, the patient slowly recovers. Treatment. — Send immediately for a physician. Put the patient to bed. Remove the clothing. Apply artificial heat by means of hot water bottles (being careful not to burn the patient), or bathe with hot water and alcohol. Inject two or four tablespoonfuls of Epsom salts in four or five ounces of warm water into the rectum to promote elimi- nation through the bowels, and to stimulate the flow of urine. Apply hot cloths, wet with the infusion of foxglove (digitalis) over the bladder. Morphia sulphate, one fourth grain by hypodermic injection and repeated in two hours if needed, is most efficient in controlling convul- sions. Subsequently after an acute attack of uraemia, Keasbey and Mattison's Alkalithia, a teaspoonful in a glass of water (not too cold) one half an hour before meals, is of much benefit as a stimulating diuretic. SUPPRESSION OF URINE. If there is a frequent desire to pass water, attended with much difficulty, it is called Strangury. If none is made it is called suppres- sion of urine. INCONTINENCY. 395 Causes. — Inflammation of the urethra; a lodgment of hard, faecal matter in the rectum, spasm at the neck of the bladder, exposure to cold, intemperance, stone in the kidneys or bladder, and enlargement of the prostate glands. Symptoms. — A constant desire, or feeling of necessity, to pass water, with pain and difficulty in passing it; and much enlargement of the bladder. If stone in the kidney be the cause, there is often nausea, vomiting, and acute pain in the loins; if stone in the bladder, the stream of water will be divided into two or suddenly checked. Treatment. — If much inflammation and irritation exist, all strain- ing to expel the urine should be avoided, and a catheter should be introduced every six hours, to draw it. The following will be found very useful remedies : Anodyne diuretic draught : — Mucilage of Gum Acacia, 6 ounces. Olive Oil iy 2 ounces. Mix well in a marble mortar, then add : — Sweet Spirits of Niter, 6 drams. Laudanum, 1 y 2 drams. Fennel Water, 3 ounces. Mix and take three tablespoonfuls every three hours. Or this : Demulcent diuretic draught : — Acetate of Potash, 2 drams. Laudanum, 1 y 2 drams. Syrup of Marshmallows, iy 2 ounces. Fennel Water, . . 8 ounces. Mix. Take three tablespoonfuls every three hours. The bowels may be kept free by using the following emollient clyster : — Balsam of Copaiba, 2 drams. The yolk of an egg. Rub this and the balsam together ; then add : — Castor Oil, y 2 ounce. Laudanum, 1 dram. Compound Decoction of Marshmallows, ..11 ounces. Mix. Inject up the rectum; this soothes the parts. INCONTINENCY OF URINE. This is rather a more troublesome than dangerous complaint, and young children and aged persons are most liable thereto. 396 DISEASES OF ADULTS. Causes. — Most generally from a relaxation of the sphincter muscle of the bladder, from weakness, but sometimes it is caused by some irri- tating substance in the bladder, as a too acid condition of the urine or an inflammation of the mucous layer of the bladder; in children, it may arise from sleeping on the back, or from worms or eating too heartily at night. Treatment. — For children : — Citrate of Potash, I dram. Sweet Spirits of Niter, 6 drams. Camphor Water, to make 2 ounces. Mix. Two teaspoonfuls in a wineglass of water every three hours. Not to be given after four p. M. For adults : — Tincture Iron Chloride, 3 drams. Tincture Nux Vomica, 2 drams. Tincture Cantharides, 2 drams. Fluid Extract of Belladonna, 1 dram. Water, to make 3 ounces. Mix. Take a teaspoonful three times daily after meals. GRAVEL OR RENAL CALCULI. The condition of "stone in the kidney" due to the formation of accumulations of solid matter derived from the urine. Causes. — The conditions which are the fundamental cause of this formation are not at present quite clear. The fact that there is a quantity of solid matter in the urine is not the cause; for solid matter is present in all urine. There is a sticky, albuminous substance present which binds the solid matter together, and there is also some influence which causes it to form crystals. The stones are of all sizes from that of sand, which takes the common name of gravel and is often passed out through the urethra with the urine; up to a size of two or three inches in circumference, so that these cannot pass out through the natural channels. They vary also in color according to the nature of the solid matter of which they are composed. Those of uric acid and the urates are red and smooth; those of the phosphates, white and rough. Stones often show layers of different colors when cracked open, which is the result of deposits of different matter at different times. Symptoms. — Stones may be present in the kidneys for years without any indications of their presence. Sometimes the first sign is the GRAVEL. 397 passage in the urine as gravel. But when the stone escapes into the ureter, it sets up that chain of symptoms known as renal colic. The pain in this case often becomes excruciating agony. It is caused by the stoppage of the passage by the stone; by the pressure of the urine upon the stone, which often causes a tearing of the membranes; and by the natural contraction of the ureter on account of the presence of the stone in it. The pain of renal colic does not confine itself to the immediate vicinity of the kidney and parts most affected; but radiates so as to extend into more remote parts. The paroxysms of pain may last for a few minutes or for hours. They often terminate suddenly on the escape of the stone into the bladder. Presence of blood in the urine on testing is a symptom of great value. This is from the laceration of the parts caused by the passage or lodgment of the stone. Prognosis. — The condition is serious and, while not an essentially fatal disease in many cases, there is always fear lest the patient die during the lodgment of the stone. The danger of recurrence is also great. Treatment. — This is directed first of all to the relief of the patient from the horrible agony of the "colic." A hypodermic injection of morphine, or of atropine, is often needed. Inhalations of chloroform are often given when the heart can stand it. If the patient is quiet enough hot applications over the kidneys are helpful. In the intervals the patient must drink copiously of a good water; if the urine is alkaline, he must take a lithia water. The following will render the urine acid : — Urotropine, 5 to jy 2 grains. Take one such dose every three hours. Or:— Ammonium Benzoate, 20 grains. Take one such dose in water every three hours. If the urine is acid, large quantities of water should be drunk daily and : — Bicarbonate of Potassium, 1 5 to 20 grains. Take one such dose three or four times a day. The diet must be carefully attended to; and any evidence of the presence of intestinal indigestion must be acted upon at once. Sweet wines and beer are not to be taken; no alcohol of any kind is the better rule. As exercise carries off the excess of uric acid, it is well for the 398 DISEASES OF ADULTS. patient, more especially if he lead a sedentary life, to carry healthful exercise almost to the point of fatigue. At the same time he must drink copiously of water suited to his needs. Large draughts of water are necessary to keep the urine at the proper point of dilution. This is an effective way of carrying off the solid constituents of the urine, by which the formation of the stones is carried on. Serious and complicated cases of this disease require the attention of a surgeon. INFLAMMATION OF THE BLADDER OR CYSTITIS. Inflammation of the mucous membrane lining the bladder. Causes. — Retention of the urine and consequent distention of the bladder; foreign substances such as large stone in the bladder; inflam- mation of the adjacent parts and organs; enlarged prostate gland; chronic Bright's disease; and stricture of the urethra. Symptoms. — The acute form of the disease is marked in its approach by chills; fever; loss of appetite; and sleeplessness. The urine is frequently passed but only drop by drop, and the effort is followed by severe straining efforts. Pain over the bladder and a burning sensation in the urethra follow. The urine is often of bad odor and cloudy. Prognosis. — This is governed by the cause. Ordinarily acute inflammation is of favorable termination. When chronic, it is incur- able after enlargement of the bladder ensues. Treatment. — A milk diet with careful avoidance of highly seasoned or stimulating liquids; rest in bed; and warm applications over the bladder. The bowels are to be kept open, for which purpose use : — Bitartrate of Potash, i dram. Tincture of Senna, i dram. Manna, y 2 ounce. Warm Water, iy 2 ounces. To be taken at one dose. If the urine is acid (for tests of urine, see Index) the urine must be well diluted by copious drinking of a good lithia water. If the urine is alkaline, it may be changed by use of : — Ammonium Benzoate, 20 grains. Take one such dose every three hours. Or:— Solution of Citrate of Potassium, 1 ounce. INFLAMMATION OF THE BLADDER. 399 Take one such dose every three hours. The general condition excited by the disease is much improved by use of : — Tincture of Hyoscyamus, 6 drams. Paregoric, 6 drams. Bromide of Potassium, 8 scruples. Bicarbonate of Soda, 8 scruples. Solution of Potassium Citrate, .... to make 8 ounces. Take a teaspoonful in water every two hours. Chronic inflammation of the bladder is attended by dull pain and frequent, scanty flow of urine. The urine contains large quantities of pus ; upon standing, a sediment of the nature of the white of an egg forms; this sediment shows phosphates and pus globules under the microscope. Prognosis. — This is not favorable in chronic cystitis. Treatment. — The diet should be mild and the alkaline mineral water should be freely used. Eucalyptol, in from ten to fifteen drop doses every four hours, well diluted ; or from five to ten drops of santal oil in capsules after meals may be given internally. The bladder may very beneficially be irrigated with an antiseptic every day. For this purpose use, first, tepid water, about two ounces, for a few days, then every day either : — Salicylate of Soda, . . 1 dram. Water, 1 pint. On- Boric Acid, 1 dram. Water, 1 pint. Only two ounces of either of these to be used until the capacity of the bladder is determined. 4 oo DISEASES OF ADULTS. INFECTIOUS DISEASES OF ADULTS DENGUE OR BREAKBONE FEVER. An acute, epidemic fever (pronounced dangay), often called dandy fever. Causes. — It is believed that a micro-organism causes dengue. It is a disease of warm climates, being restricted in America to the southern states. It breaks out in a locality with sudden violence and attacks all classes and ages; but it disappears in cold weather and is not met with in high altitudes. Symptoms. — The fe^er quickly rises to 105 ; intense headache; burning pains in the temples; pain in the back; swelling in the joints; stiffness; pain in the muscles; nausea; vomiting; constipation, and a scarlatina-like rash. This stage lasts for from a few hours to two or three days. The symptoms then subside and there is an interval of two or three days. The second attack of the spasm is equally sudden but far less severe: the patient is weak; the rash is intensely itching; it remains for two days, and the skin peels off. The disease lasts for about eight days. Relapses are very common. Prognosis. — The outcome is always favorable in cases of healthy adults; old age and a state of debility are serious conditions, and it is among such cases that the greatest number of deaths occur. Treatment. — Absolute rest in bed is required, and in mild cases this is often all the treatment that is needed. In severe cases, an antipyretic and sedative is given such as : — Potassium Citrate, 5 grains. Sweet Spirits of Niter, -. . 30 drops. Take one such dose in a dessert-spoonful of water three times a day. The headache is relieved by applications of ice to the head (see page 241 ). If the face is flushed and there is throbbing in the head a hot foot bath is advisable. (See page 257.) The pains in the body are relieved by a hot tub bath. If the fever is high and long continued, which is seldom the case, sponging with tepid water will reduce it. (See page 251.) The poisons of the fever are eliminated by the kidneys; to insure this, the patient should be encouraged to drink freely. ERYSIPELAS. 401 ERYSIPELAS. An acute infectious disease marked by more or less fever and a pecul- iar inflammation of the skin. Causes. — The micro-organism Streptococcus erysipelatis. A state of weakness or of debility and abrasions of the skin are predisposing causes. It is not a strongly infectious disease; one attack predisposes to others. Symptoms. — Erysipelas comes on suddenly with a chill; nausea; vomiting ; sometimes convulsions ; general illness ; headache ; pains in the limbs, and a fever of about 105 ; pulse is correspondingly high; tongue, coated ; diarrhoea or constipation ; urine, high-colored and scanty ; delirium is often present. An eruption of red spots appears, and soon they run together to form a violet or crimson patch on the skin, gen- erally on the face and neck. The patch is swollen, hot, and tender; the border is w T ell-marked and distinct. The affected parts burn, tingle, and itch; the surrounding parts are dropsical and puffy; this continues for five or six days ; then the skin of the affected part peels off and the fever declines. Sometimes the disease is inclined to creep to other parts; it is then called "traveling erysipelas." Prognosis. — Recovery is almost certain except in cases of those suffering from chronic alcoholism, and in the traveling form. Treatment. — In mild cases a laxative should first be given. This is followed by : — Tincture of the Chloride of Iron, 2 drams. Glycerine, 1 ounce. Water enough to make 2 ounces. Take one teaspoonful three times a day. Apply vaseline to the erup- tion. Or:— Ichthyol, 1 dram. Vaseline, 1 ounce. Use as an ointment to the affected part. In severe cases the patient should take : — Sulphate of Quinine, 2 grains. Extract of Belladonna, j4 grain. Tincture of Chloride of Iron, 10 to 20 drops. Take one such dose every three hours. The diet should be liquid, and it may be necessary to use alcoholic stimulants, preferably a good port wine. 4Q2 DISEASES OF ADULTS. For local treatment the following produces excellent results: — Carbolic Acid, y 2 ounce. Oil of Turpentine, i ounce. Tincture of Iodine, i ounce. Alcohol, i ounce. Glycerine, y 2 ounce. Apply locally to the eruption. Or:— Sugar of Lead, I dram. Water, ' i pint. Laudanum, i dram. Pour a small quantity on a cloth and apply to the part. HYDROPHOBIA OR RABIES. An acute, infectious disease originating in the lower animals and communicated by them to man. Cause. — The cause is a peculiar virus contained in the nervous sys- tem, saliva, and urine of animals. This is conveyed to man usually by the breaking of the skin by a bite. It is believed that it is occasioned by a micro-organism, but that fact is not yet clearly established. The dis- ease shows itself in about 1 5 per cent of the number of cases of dog bite. It appears in from one week to two or more months from the time of the bite. If it does not appear within three months the chances are very great that the person will escape it. Symptoms. — The first stage lasts about twenty-four hours. The part begins to itch and burn, and the old scar may reopen. There are fear, anxiety, thirst, and the so-called fear of water, from which the disease takes its name. This symptom, on attempting to drink, is caused by the spasm of the pharynx, which is aggravated upon the thought of swallowing. This is the marked symptom of hydrophobia and serves to identify the disease. The stage of excitement follows, with difficulty in breathing and swallowing; there is marked sensitiveness to light and sound; fever to 103 ; often mania or delirium. This lasts for from one to three days. In the last stage the spasms subside; the heart fails; there is great prostration; and death follows from either convulsions or suffocation. This stage lasts for from six to eighteen hours. Prognosis. — In true hydrophobia, recovery is very rare after the disease is established. Treatment. — Immediate excision (cutting out) of the wound or burning with caustic or hot iron is imperative. If no other means are at hand the virus may be sucked out of the wound. This can be done HYDROPHOBIA. 403 without fear of contagion provided there are no sores or scratches in and around the mouth for the poison to enter. The object in burning or cauterizing is to prevent the absorption of the poison into the system, either by removing the poison or by closing up the mouth of the absorb- ing vessels. The spasms may be controlled by a narcotic. The patient's strength is to be kept up by rectal feeding, as swallowing is impossible. (See page 236.) Symptoms of Hydrophobia in a Dog. — It is really of more impor- tance in diagnosing this disease to know the symptoms which appear in a dog than to know about those which appear in man. For if we can be quite sure that the dog does not show any signs of madness, we have the assurance that the person bitten will not be affected. The habit of shooting or otherwise killing a dog that has bitten one is wrong, at least until after an opportunity for a thorough study of his case has been afforded. Dr. Hare says that a dog is at first stupid and heavy and often cross and restless. When he stands up he is inclined to sway and stagger as he runs. He refuses food and water, though he may gulp down pieces of cloth, wood, etc. He may be obedient and not bite his master. He may bark at and bite strangers. His bark is hoarse and muffled, more of the nature of a series of yelps. The lower jaw never closes completely as in health. Then follow thirst and the inability to drink by reason of the contraction of the muscles of the throat, which are first attacked by the disease. Then comes the stage of excitement, in which he develops mania or delirium, running about as though in fear; mouth open; saliva flowing from it; and the dog seems to be blinded, for he runs into objects that he meets, snapping and biting. Emacia- tion comes on quickly. Paralysis follows ; convulsions ; and death on the sixth, eighth, or tenth day. It is not generally known that there is a form of the disease called the "dumb rabies," in which the dog does not bark or display any signs of mania or delirium. Dr. Gill, a veterinary surgeon of New York, has said that the dog has the appearance of having a bone in his mouth. He not only does not avoid water but often plunges into it and swims. Dr. Gill's advice on this point is : "Beware of a dog when he becomes dull and hides away, appears restless, is always on the move and prowl- ing, whose countenance is somber and sullen, and who walks with his head down like a bear. Beware of one who barks at nothing when all is still. Beware of the dog that barks incessantly and tears up things. Look out for the dog that has become too fond of you and is continually licking your hand and face ; and beware, above all, of the dog that has 404 DISEASES OF ADULTS. difficulty in swallowing, who appears to have a bone in his throat, and of one who has wandered away from home and returns covered with dirt, exhausted and miserable." INFLUENZA OR LA GRIPPE. An acute, highly infectious, febrile disease, which affects large areas at the same time. Causes. — It is caused by the bacillus of Pfeiffer, which was first isolated and studied in 1892, when the disease came into prominence during the epidemic. It can be conveyed by contact and the usual infec- tious methods; the germs remain in the nasal passages for some time after an apparent recovery so that it is possible, for a person to reinfect himself. Atmospheric influences seem to be instrumental in the wide spread of the disease; and debilitating diseases which leave the patient's vital resistance lowered also are predisposing causes. Symptoms. — Ordinary cold in the head, coryza, and influenza have many symptoms in common during the early stages. There are severe chill; rapid rise of temperature to 105 ; general illness; congestion of the nasal passages ; difficulty in breathing ; general depression ; pain in the chest, back, and limbs ; serious heart difficulty, and prostration. Prognosis. — In young and healthy adults the termination is almost invariably favorable; but in the case of very young patients or very old persons, the disease is more serious. Complications also make the prog- nosis sometimes very grave. Treatment. — Rest in bed is the first essential. An eminent authority has said : "He who remains out of bed during an attack of la grippe takes his life in his hands." The diet must be semi-solid. (See page 281.) The utmost care must be taken in disinfecting all the discharges from the body. As the nasal passages are often the seat of the bacillus, care must be taken to burn cloths used as handkerchiefs by the patient. (See page 152.) The bowels must be kept open by J4 grain doses of calomel every two hours. Hot foot baths and hot tub baths are beneficial in the early appearance of the disease. (See page 251.) The coal tar products have been used in enormous quantities in this disease, but they are to be avoided by reason of the heart's condition. The pain in the back, chest, and limbs may be relieved by : — Salicine, - 5 grains. Sulphate of Quinine, - 2 grains. One such dose to be taken in a capsule every five hours. Hot stupes are of great relief . (See page 234.) LOCKJAW. . 405 The congested state of the nose and throat is relieved by : — Compound Tincture of Benzoin y 2 ounce. Boiling Water, 1 pint. Frequently inhale the vapor from this while very hot. Also : — Chloride of Ammonium, 10 grains. Tincture of Hyoscyamus, 15 drops. Syrup of Ipecac, 5 drops. Whisky, y 2 dram. Chloroform Water, i l / 2 drams. Take one such dose in water every three or four hours. Food must be nutritious and easily digestible during the attack in order to keep up the patient's strength. During convalescence good food and tonics must be supplied to ward off complications. LOCKJAW OR TETANUS, An acute, infectious disease marked by such rigidity of the muscles that the jaws are locked and the limbs are set. Cause. — It is communicated by the entrance of the Bacillus tetanus into the system through wounds or abrasions of the skin. It is found in soils of gardens about stables and manure piles. It is most prevalent in the United States in Louisiana, New York, Pennsylvania, Texas, and Ohio, in the order mentioned. The bacillus has been found on the object that causes the wound, although it may come from other contact. The prac- tice of going barefoot is predisposing. Most of the deaths have been Fourth of July celebration accidental deaths caused by wounds from the toy explosive pistols. Symptoms. — The symptoms are characteristic : the muscles become set and rigid; the lower jaw is immovable by reason of the spasm in the masseter muscles; the muscles of the face contract so as to give the appearance of a horrible laugh (risus sardonicus) , the body is arched by the contraction of the muscles in the back; temperature ranges from ioo° to 106 . Prognosis. — The deaths are higher in the acute than in the chronic form; in the latter only 50 per cent and in the former 80 per cent. In very severe cases death occurs on the second day, sometimes on the sixth. Treatment. — Tetanus antitoxin injection is the very first step in the treatment. The wound must be thoroughly washed after cauterizing or excision, if this latter is possible. The wash should be some antiseptic 4o6 DISEASES OF ADULTS. wash not too strong. (See page 261.) The wound must not be closed during the early stages. It is of the utmost importance that bacilli, if present, be allowed to escape, or be thoroughly washed out. The safest way to treat wounds that may develop tetanus is to cause them to heal by granulation, not by first intention. As soon as the disease develops, it is important to look after the nour- ishment of the patient. If the attack is the acute variety this is not so necessary; but in the more chronic form it will be necessary to resort to the extraction of one or more teeth to admit the passage of the stomach feeding tube, or to pass it through the nose. Narcotics and sedatives are used to control the paroxysms. MALARIA, INTERMITTENT OR REMITTENT FEVER. An infectious, intermittent or remittent fever, marked by enlarge- ment of the spleen, anaemia, and chills. Causes. — It is due to a micro-organism, the Plasmodium malariae, which gains access to the body through the bite or sting of a mosquito belonging to the genus anopheles. Dangerous places in this respect are marshes and low, damp ground that harbor and breed mosquitoes. As the mosquito is of nocturnal habits, the disease is most generally con- tracted at night. Symptoms of the Intermittent Type of Malaria. — There are four stages of this form; cold, hot, sweating, and the interval when fever is absent. Cold Stage. — Severe chill ; fever ; thirst ; headache ; nausea and, some- times, vomiting; lasting not over an hour, when it is followed by the Hot Stage. — Pulse rapid; fever increases; skin red and hot; thirst; nausea and vomiting, and headache; all symptoms of fever greatly in- creased. These symptoms last for less than an hour, or sometimes per- sist for five or six hours. The fever suddenly subsides and and the patient passes into the Sweating Stage. — The sweat appears first on the forehead and then rapidly spreads over the entire body; headache ceases; the pulse drops to normal ; in from one to three hours the patient falls into a refreshing sleep and begins the Stage of Freedom from all signs of the disease. These attacks may occur daily, every other day, or may appear on two consecutive days and skip the third, or, again, may appear every fourth day. MALARIA. 40; Prognosis. — Recovery is the general rule, if the patient is treated. Without treatment there is danger of the disease becoming chronic or complicated. Treatment. — During the cold stage the patient may take hot drinks ; warm applications and one or two teaspoonfuls of Hoffman's Anodyne in water may be given. During the hot stage he may take cooling drinks such as : — Cream of Tartar. 1 ounce. Hot Water, 1 pint. Allow it to cool and use liberally as a drink. Allay the fever by alcohol sponging (page 253). During the sweating stage, sponge the body with warm water or with alum and hot water in these proportions : — Alum, 4 drams. Alcohol, 4 drams. Water, 1 pint. Apply with the hand or with a sponge. During the interval of freedom from symptoms give : — Calomel, 4 or 5 grains. Bicarbonate of Soda, 4 or 5 grains. Follow this dose in four or five hours with a saline aperient such as Hunyadi Janos water, Epsom or Glauber's salts. About four or five hours before the expected return of the attack, give a heavy dose of : — Sulphate of Quinine, 10 to 15 grains. Or a Clark Powder consisting of : — ■ Sulphate of Quinine. 10 grains. Capsicum, 2 to 4 grains. Powdered Opium, 1 grain. After the fever has been broken up and the paroxysms do not return give :— Fowler's Solution of Arsenic, 5 to 10 drops. in water every four hours for an extended period. Or:— Tincture of Chloride of Iron, 20 drops. Take in water every four hours. Or:— Dried Sulphate of Iron, 30 grains. Sulphate of Quinine 30 grains. Arsenious Acid, 1 grain. Extract of Gentian, 40 grains. 408 DISEASES OF ADULTS. Divide into 30 capsules and take one after each meal. For preventive measures, see page 156. GLANDERS OR FARCY. This is a malignant disease occurring in the horse and mule and which man is liable to contract by inoculation or simple contact with the skin. It is a horrible and loathsome disease, and often proves fatal. An animal affected by it should at once be killed and the body buried. Symptoms. — The chief symptom of its presence in the animal is inflammation of the lining membrane of the nostrils, which becomes ulcerated, and emits a bloody, fetid, sticky, yellowish discharge. Shortly after a person contracts the disease there are febrile symptoms, probably vomiting and diarrhoea; small ulcerating tumors form under the skin hi various parts of the body, and the peculiar viscid discharge from the nostrils commences which is characteristic of the disease. Domestic treatment should not be attempted, but a competent physician employed without delay. SMALLPOX OR VARIOLA. An acute, epidemic, contagious disease affecting the entire body. Causes. — It is believed to be due to a parasite called Cytoryctes vaccinae, which is of great vitality and persistence. The disease is spread by clothing and the air. Symptoms. — The incubation period, that is, the time from exposure to the disease until it appears, is from ten to sixteen days. The attack is sudden. There is first a chill ; vomiting ; intense pains in the head and in the back, the latter running down the legs. The extreme severity of these pains is often enough to excite suspicions that the on-coming dis- ease is smallpox. The fever quickly runs up to 103 and 104 in the first few days. The pulse is rapid, from 100 to 130 beats per minute, but full and strong. The face is red and the eyes bloodshot. Coarse red spots appear during the third day upon the forehead and lips. This eruption is sometimes preceded by a rash very much resembling either that of scarlet fever or of measles. As soon as the true eruption appears the other symptoms abate. The eruption passes through several stages, from the hardness of shot to mature pustules filled with matter sur- rounded by a red band. On the tenth day, or a day or so later, the pustules begin to dry up and crust over. The odor is powerful and offensive as soon as the scabs or crusts have formed. These latter fall SMALLPOX. 409 off from the seventeenth to the twenty-fourth day, leaving the character- istic pit or scar known as "pockmark." When the pustules run together, the disease is known as Confluent Smallpox, and is a more dangerous form of the disease, as all of the symptoms are aggravated. When the pustules are blackened by blood in the form of hemorrhage, the disease is known as Malignant or Black Smallpox. Cases of this form are nearly always fatal. Those who have been vaccinated take the disease in a modified form, of shorter duration, and without fever. This is known as Varioloid. Prognosis. — In the ordinary form about four out of a hundred die; in the confluent form, fifty out of a hundred ; and in the black or malig- nant form, nearly all die. In the mild type of those who have not been vaccinated, the fatality is from twenty to sixty out of a hundred. Vac- cination exerts a positive protective influence against the disease, either preventing it altogether or changing it to varioloid. Treatment. — Isolation, disinfection, and full preventive measures to be taken as given on page 152. The patient is put to rest in bed in a darkened room, kept at a temperature of about 65 °. The diet must be light and easily digestible, consisting of milk, eggs, eggnog, soups, broths, oysters, beef juice, supplied every three hours. Headache is relieved by the ice cap or sinapisms to the head ("Nursing," page 241). The fever at the start may be allayed by 10 grain doses of phenacetine or antipyrine; or by from 5 to 10 grains of acetanilid, or 5 grain doses of antifebrine. Insomnia and delirium are treated by opium, chloral or trional. Fever is reduced by cold sponge baths (page 252). The mouth and nose should be syringed with Dobell's solution (page 329). The eyes, which become inflamed, should be washed with a solu- tion of boric acid. The mouth should be washed with an antiseptic solution, both for cleanliness and comfort ("Nursing," page 241). Itching caused by the eruption may be allayed by the application of Carron Oil, which is equal parts of limewater and olive oil. Or the following ointment may be used: — Eucalyptol, 1 dram. Carbolized Vaseline, 1 ounce. Apply lightly to the pustules with a feather. Hot water dressings are also grateful. These washes and oils, in addition to allaying the itching, also in a measure prevent pitting. See * 'Vaccination." 4 io DISEASES OF ADULTS. TYPHOID OR ENTERIC FEVER. An acute, infectious fever, in which the lower intestine, the spleen, and the mesenteric glands are chiefly iirvolved. Causes. — It is caused by infection from the bacillus typhosus of Eberth, the discoverer. This is taken into the body in food, such as drinking water, milk, ice, oysters, etc. The bacillus excites a catarrhal inflammation of the lining of the intestine, which later ulcerates and sometimes causes perforation of the bowel. The disease passes through a period of incubation which varies from one to three weeks. Symptoms. — The disease begins with a feeling of general illness and it is usually some days before any well-marked symptoms appear. Among the earliest are an aching in the forehead, pain in the back and limbs. There is a state of mental dullness, and sometimes a slight deaf- ness. At first the tongue is coated, but very soon the edges become clean and red, while the coating in the middle persists. During the first week the headache increases and is accompanied by sleeplessness and thirst. A mild degree of fever is noticeable, and there are often repeated attacks of nosebleed. The bowels are generally constipated during the first week, but sometimes diarrhoea sets in early, and the stools are the char- acteristic pea-soup stools of the disease. Meanwhile the temperature climbs up day by day, until, at the end of the first week, it is from 102 to 104 , being higher at night than in the morning. The pulse gains as the fever rises, and at the end of the first week it is from 90 to 100 beats per minute. Between the seventh and the ninth day there appear' on the abdomen from five to thirty red spots which disappear on pressure. These come in crops and remain for from three to five days, when they are fol- lowed by another group. The tongue is dry and shows cracks on the surface. Diarrhoea is profuse, and at the end of the second week the fever has reached the crisis. If the attack is severe the patient is deliri- ous, marked by muttering, the teeth and lips are covered with crusts or coatings called sordes. During the third week the symptoms continue and become intensified. The skin is dry and harsh and the patient shows great emaciation. Improvement is looked for at any time between the fourteenth and twenty-eighth days, according to the severity of the attack. During convalescence the patient emerges from the attack thin, feeble and hungry. Prognosis. — While upon the whole this is favorable in the total num- ber of cases, it is hard to give an accurate prognosis in any particular case. So much depends upon whether the patient has gone to bed early TYPHOID FEVER. 411 in the attack and conserved his energy to withstand it. The degree of absorption of poisonous matter during the course of the disease, and the chances of perforation of the bowel, are also large factors, to say nothing of the many complications which may arise. Among these latter are ulceration of the entire gastro-intestinal tract, or of parts of it, hemorrhage from the bowel, pneumonia, meningitis, and paralysis. A sudden drop in the temperature to normal is a grave symptom, and sug- gests perforation. Still coma, where the patient is apparently awake but takes no notice of his surroundings, is also serious. Then there is always the very great possibility of a relapse. Treatment — If the patient is put to bed early in the attack his chances are greatly improved. Rest, tranquillity of mind and body, mean much as a fortification against the long period of emaciating and enervating fever. That form of the disease popularly known as "walk- ing typhoid," while mild in the demonstration of symptoms, is very fre- quently the most pernicious by reason of the grave complications which so often cause a fatal termination of it. There is probably no other disease which demands and so well repays good nursing as does typhoid. Thorough nursing and exact and persistent preventive measures are half the battle. All of the preventive means as laid down on page 152 must be rigidly used. Half hour doses of one quarter grain of calomel should be given until one or two grains have been given or until the bowels move. This is followed by some such mild saline aperient as Hunyadi Janos water, Epsom or Glauber salts. Throughout the course of the disease give : — Dilute Hydrochloric Acid, 5 to 10 drops. Essence of Pepsin, 1 teaspoonful. Give one such dose every six hours after eating. The fever is to be reduced by the cold rub, cold sponge bath, cold pack, or Brand's cold plunge bath. Full directions for the administra- tion of these for reduction of fever are to be found on page 231. The diet is absolutely a liquid diet for the first and often for the greater part of the second week.. The patient takes from one to one and a half quarts of milk in the twenty-four hours in small quantities every two or three hours. If the stools show curds, too much milk is being given and it must then be diluted with limewater or Vichy. The milk may be peptonized to render it more easily digestible. (See page 288.) Towards the last of the second week the patient may take soft boiled eggs, little more than warmed through so that they may be drunk from a glass. Or the eggs may be beaten and strained. Mixed with milk they may 4 i2 DISEASES OF ADULTS. be rendered more palatable by flavoring with vanilla, lemon juice, etc. Among the broths that may be given, chicken is, perhaps, the best. If there is a tendency to diarrhoea after the broth, it is probably due to the fat in it. To correct this, set the broth to cool, when the fat will rise and form on the top ; it may be skimmed off, and the broth warmed over. In constipation, the fat, of course, should be given with the broth. Gruels from rice, cornstarch, barley well-cooked may now be added to the list, but they may be a little difficult to digest. This may be overcome by the addition of a little taka-diastase to them. There is no objection to giving the patient small quantities of cool, but not iced, water when he craves it to allay thirst. The mouth is to be washed and swabbed frequently with listerine, glyco-thymoline, or boric acid solution. (See "Nursing," page 254.) If prostration be indi- cated by weakened heart action or slow pulse, whisky or brandy may be given in half-ounce doses every three hours in the milk to promote digestion. The use of the bath to reduce temperature is intended to take the place of antipyrine and the other fever agents, not to be taken along with them. The cold method is sufficient, and the drugs only increase the already great exhaustion. Diarrhoea is not to be checked unless the stools exceed more than three in the twenty-four hours. For this purpose give : — Subnitrate of Bismuth, 20 grains. Carbolic Acid, 1 drop. Paregoric, 15 drops. Tincture of Deodorized Opium, 8 drops. Mucilage of Acacia, 1 dram. Water, , 3 drams. Give one such dose every three or four hours. Constipation may be best treated by enemas. (See "Nursing," page 254.) Accumulation of gas in the intestines and the abdomen, called tym- panites, is relieved by cold compresses, ice bag, or turpentine stupes to the abdomen. (See "Nursing," page 254.) Headache is treated with ice bag to the head, and if necessary : — Bromide of Soda, 10 grains. Take one such dose every two or three hours. Insomnia is often relieved by a glass of hot milk, or one ounce of whisky in water. Delirium is largely prevented or lessened by keeping up the strength. TYPHUS FEVER. 413 TYPHUS FEVER. Typhus fever is a kind of contagious fever, characterized by the ordi- nary symptoms of other fevers, accompanied with debility in the nervous and vascular systems, and a tendency to putrefaction. Causes. — The cause of typhus is contagion, the activity of which is much increased by the crowding of human beings into close, ill-ventilated and filthy places with insufficient nutriment, and other causes which tend to depress the vital power. It is eminently contagious and infectious, and often prevails epidemically in jails, on shipboard, and in famine- stricken regions. Symptoms. — The symptoms are great prostration of strength, high fever, weak and irregular pulse, nausea, vomiting, flushed countenance, parched and furred tongue, and excessive thirst. In the worst cases black or purple spots appear on the skin ; there is a peculiar fetid smell, and sometimes there are discharges of blood. The duration of this fever is uncertain : sometimes it terminates between the seventh and fourteenth day, and sometimes it is prolonged five or six weeks. Its duration de- pends greatly upon the constitution of the patient, and the manner of treating the disease. The most favorable symptom is a warm sweat after the fourth or fifth day. This will continue some time and carry off the fever. Eruptions about the mouth and nose may be regarded as favorable. Prognosis. — The unfavorable symptoms are excessive looseness of the bowels, with a hard, swelled abdomen, black or livid blotches break- ing out on the skin, sore mouth, cold, clammy sweat, change of voice, inability to put out the tongue, a constant inclination to uncover the breast, difficulty of swallowing, sweat, and sputum tinged with blood, and the urine black, or depositing a black sediment ; such symptoms indi- cate death. Treatment. — In the early stages of this disease it is best not to inter- fere much with nature. The principal aim ought to be to keep up the patient's strength until the fever poison has expended itself. When seen early, however, it is often of advantage to administer an emetic; and the patient's uneasy sensations will be much soothed by sponging the surface of the body with cold or tepid water. When the powers of life begin to fail, a stimulating course of treatment should be commenced, — such as strong beef or chicken tea, with wine or brandy frequently admin- istered, taking care that it does not aggravate the febrile symptoms. 4H DISEASES OF ADULTS. When there is much general irritability and sleeplessness, a dose of opium may be given. The patient should be in a large, well aired apartment, and the windows kept open as much as possible. As the patient begins to recover, a course of tonics will be necessary to expedite his restoration to health. The attendants usually contract this fever. For preventive and disinfecting means, see page 155. YELLOW FEVER. An acute, infectious fever occurring in three stages — the febrile, the interval or remission, and the collapse. It occurs most frequently in June, July, August, and September. The regions most affected are the tropics in certain well defined areas, from which it is never absent. Natives and negroes within those areas are, to a greater or less extent, immune, but strangers are very susceptible. Cases occur in other parts of the world, many of them being carried by ships. Seaport towns are most likely to have such cases. Cause. — It is communicated by a micro-organism, the Bacillus icter- oides, which is carried and transmitted in the bite of a mosquito, the Stegyomia fasciata. Symptoms. — It usually breaks out after from one to six days after exposure to the infection. The symptoms of the first or febrile stage are : general illness and weakness; headache; chill; high fever, running up to 104 or 106 ; pains in the back, head, and limbs; pulse is rapid; face flushed ; stomach nauseated ; eyes bright. One of the most marked pecul- iarities of the symptoms is the action of the pulse, which mounts up at first as the fever rises and then suddenly shows a tendency to fall. The urine is high-colored and scanty; the bowels are constipated; and the patient emits a peculiar odor from the body. This stage lasts for from one and one half to three or four days. The second stage, or the interval, is marked by a fall in the tempera- ture to about 99 or ioo°, with a general lessening in the severity of the symptoms. Recovery may take place at this stage. If not, it lasts for from a few hours to four days, when the third stage begins. The symptoms of the period of collapse are : a return of all the symp- toms with greater violence; jaundice; black or "coffee-ground" vomit; hemorrhages from the bowels and mucous membranes generally; w T eak pulse ; cold skin ; irregular breathing ; and death from exhaustion without loss of consciousness. Prognosis. — Fatality runs from 15 to 85 per cent. Unfavorable symptoms are black vomit, suppression of urine, high fever, and collapse. CHOLERA. 415 Treatment. — Rest in bed; mild laxatives such as castor oil, citrate of magnesia, and calomel in the early or first stage; in the early stages the diet must be confined to milk, sago, and arrowroot, and similar bland articles. As the disease advances, the strength should be kept up with broths made from lean meat, and thickened with bread crumbs, oatmeal or barley. Strict cleanliness must be observed about the patient and the bed linen. Good nursing is of great importance. If the stomach is very irritable and the vomiting excessive, give : — Powdered Rhubarb, 20 grains. Bicarbonate of Soda, 20 grains. Powdered Peppermint Leaves, 1 teaspoonful. Laudanum, 15 drops. Brandy, 1 tablespoonful. Boiling Water, 1 gill. Mix. Sweeten with loaf sugar and give a tablespoonful every hour. The patient should be supported by stimulants such as alcohol, strych- nine, etc. ASIATIC CHOLERA. The Asiatic, malignant, or pestilential cholera is a very violent form of disease. It commonly comes on without any warning in one whose previous health has been apparently sound. Or it may be preceded by acute diarrhoea, with nausea and vomiting. Causes. — An acute specific germ infection, the particular germ being the Comma bacillus. The cholera stools transmit the infection. Symptoms. — There are three stages : the first stage is the stage of invasion, in which there are symptoms of mild diarrhoea, colic, general weakness, some chilliness, headache, and sometimes nausea and vomit- ing. The second stage: the diarrhoea increases, the discharge is thin, colorless, and like rice water. Vomiting is more constant, there is great prostration, the skin is cold and clammy although the temperature may be quite high, the features are pinched, urine is scanty, the pulse almost imperceptible, the eyes sunken and surrounded by a dark circle; the patient sinks into a state of apathy, and, unless a favorable change speedily takes place, he soon expires. This stage may last from a few to forty-eight hours. Third stage or stage of reaction : when reaction does take place, the pulse gradually returns, the natural warmth of the body is restored, the urine is more copious, the vomiting stops, fever and diarrhoea 416 DISEASES OF ADULTS. gradually subside. Frequently, however, the reaction is accompanied by fever of a typhoid type, which prolongs convalescence or terminates fatally in from four to eight days. Treatment. — Put the patient at rest in bed,, withhold food for a few hours, quench the thirst by allowing the patient to suck pellets of ice. Give large doses of calomel, three to five grains every two hours for three or four doses. Follow with a dose of castor oil, wash out the bowels with two or three gallons of hot water to which is added com- mon salt, one level teaspoonful to the quart. This should be done twice daily. For the diarrhoea nothing succeeds better than the following, accord- ing to the late Roberts Bartholow : — Deodorized Tincture of Opium, 3 drams. Aromatic Sulphuric Acid, 5 drams. Mix. Give ten to twenty-five drops every hour or two in one or two tablespoonfuls of water. Vomiting is best controlled by use of : — Carbolic Acid, 4 grains. Bismuth Subnitrate, 2 drams. Glycerine, 3 drams. Peppermint Water, to make 3 ounces. Mix. Give a tablespoonful every two hours until relieved. Hot applications over the bowels are also beneficial : the body heat should be kept up by means of hot water bottles externally and hot coffee by the rectum. Nutritious diet is required. The following has been very effectual in curing severe cases of virulent cholera : — Tincture of Opium, Tincture of Camphor, and Spirits of Turpentine, of each, .... 3 drams. Oil of Peppermint, 30 drops. Mix. Dose, one teaspoonful in brandy and water, for the mild form of cholera ; and one tablespoonful for the more virulent. As a preventive the following may be taken in cholera times : — Bicarbonate of Soda, 1 scruple. Ginger, 8 grains. Take in a glass of water, after breakfast and supper. GENERAL DISEASES OF ADULTS ANEURISM. A sac of blood formed by the expansion within defined limits of the coats of an artery. There are aneurism of the arch of the aorta, of the thoracic aorta, and of the abdominal aorta. Causes. — A weakening of the coats or walls of an artery; exertion; the break-up of the tissues in old age; alcoholism; syphilis; diabetes; malaria; gout; rheumatism; Bright's disease; exposure and excesses of various kinds. Symptoms. — An elastic, pulsating tumor may be felt in the region affected; auscultation reveals an aneurismal murmur; deep-seated pain in the thorax or part affected; paralysis from pressure on the nerves; difficulty in breathing and in speaking are often noted; pupils may be contracted or dilated ; sometimes a cough is present ; loss of flesh ; anxious expression, and sometimes gastric disturbance. These symptoms vary according to the location of the aneurism. Prognosis. — The prognosis is unfavorable. The average duration of life after the formation of an aneurism is from one to four years. Death may come suddenly as a result of over-exertion or anger, when the result is a hemorrhage; or it may result from gradual exhaustion. Treatment. — Tuffell's treatment consists of absolute rest of mind and body, including rest in bed, starvation diet (see page 278) for three months at least. Potassium iodide is administered in gradually increas- ing doses to the limit. The object of the treatment is to cause the blood in the sac to coagulate and to prevent rupture. Surgical treatment con- sists in the tying of the artery (when small) on both sides of the aneu- rism; puncture and galvanic treatment are also used with more or less success. APOPLEXY, CEREBRAL HEMORRHAGE, EMBOLISM OR THROMBOSIS. A stroke characterized by paralysis *and sudden insensibility. Causes. — This may be due to cerebral hemorrhage, a bursting of a blood vessel in the brain; the escaping blood presses upon the brain and causes an injury to the tissues, which results in paralysis. This is the 418 DISEASES OF ADULTS. most common type of apoplexy and seldom occurs before the fortieth year, but most frequent in men between the fortieth and the eightieth year. The bursting of the blood vessel is often the result of : heredity, Bright's disease, gout, rheumatism, chronic alcoholism, syphilis, and diseases of the heart and the arteries. Immediate causes of the rupture are : acute indigestion, violent physical exertion, fits of rage, and excesses of any kind. Symptoms of Cerebral Hemorrhage. — The presence of a ruptured blood vessel in the brain is usually first announced by dizziness; pain in the head; numbness of legs and arms; nosebleed, and fear of falling. The attack or stroke may come rather slowly, pre- ceded by vomiting; or may come suddenly with coma, insensibility, and, if standing at the time, the sufferer falls to the ground with the muscles relaxed; breathing is irregular, slow, and noisy, the noise being caused by paralysis of one cheek, which flaps in and out with the breathing; pulse is full and slow, and there is throbbing of the large carotid blood vessels (in the neck). The face is very red; the pupils of the eyes either contracted or dilated, but not influenced in size by the action of a light placed before them. There is always more less fever. Prognosis. — The attack usually lasts for from one-half an hour to five or six hours. If it extends to more than twenty-four hours, with insensibility, the termination will probably be fatal. Generally the effects are felt for several weeks, the mind then clears up, the headache ceases, there may be partial or full recovery from the paralysis, and this condi- tion may last for some years. But there is always danger of another attack with increasing probability of a fatal termination. Symptoms of Thrombosis. — These come on gradually and are per- sistent. There are drowsiness; headache; dizziness; loss of conscious- ness ; paralysis of at least one side of the face ; later, paralysis of the arm, and one by one the other parts, until, within twenty-four or thirty-six hours from the time of the first symptoms, there is paralysis of the entire one half of the body. The paralysis may develop without loss of con- sciousness. The mental impairment is greater than in cerebral hemor- rhage. The patient is profoundly emotional, weeping and sighing fre- quently. Prognosis of Thrombosis. — While there is frequently some im- provement in the paralytic condition, the case eventually proceeds, per- haps years after the attack, to softening of the brain and general paraly- sis ; and the patient dies either in a comatose state or in convulsions. EMBOLISM. ' 419 Symptoms of Embolism. — This condition develops suddenly, with twitching of the muscles, dizziness, more or less mental confusion, head- ache, loss of consciousness, paralysis of one side of the body, usually the right side. Prognosis of Embolism. — After some weeks there may be a com- plete recovery. This is characteristic of the mild cases in which the symptoms are less grave in nature. In the serious form, death may result in a day or two from plugging of the large blood vessel. This state is to be feared when the insensibility lasts for a long time — twenty- four hours or more. The patient may regain consciousness; but passes through progressive stages of dementia, softening of the brain, and aphasia (the inability to remember words). Death finally ensues from exhaustion. Treatment. — If there are warnings of the approach, the efforts are directed towards reducing the pressure of the blood on the vessels of the brain. This is done by bloodletting and a brisk purgative such as : — Epsom Salts, 2 ounces. Glycerine, 1 ounce. Boiling Water, 3 ounces. Give with great care as an enema. Leeches may be applied to the mastoid process (the large eminence behind the ear). If the attack is sudden, at once loosen the clothing around the neck and throat so that the blood vessels are not restricted. Place the patient in a cool, quiet room. Let him lie rather on his side, with face turned a little downward to prevent the tongue from falling back and obstruct- ing the breathing. Slightly raise the head and shoulders. Apply an ice bag to the head. Bloodletting should quickly follow to relieve the brain pressure, and a cathartic is to be given. In insensibility this is best given in the form of : — Croton Oil, 1 to 3 drops. Glycerine, 15 drops. Place this with a medicine dropper well back near the root of the tongue to insure that it will be swallowed. If, during the attack, the face becomes very pale and the pulse irreg- ular, give stimulants such as Aromatic Spirits of Ammonia, y 2 teaspoonful in water very cautiously. 4 20 DISEASES OF ADULTS. The fever may be reduced by an alcohol sponging (page 253). The blood clot formed in the brain must not be absorbed too quickly, lest hemorrhage ensue. For this purpose give : — Solution of Arsenite of Potash 5 drops. Syrup of Lacto-phosphate of Lime, 2 drams. One such dose three times a day. The diet must be liquid or semiliquid (page 278) The patient must be kept scrupulously clean, his wants must be inquired into, if power of speech is wanting or impaired, and every attention paid to him in his helpless condition. Electric treatment is beneficial for paralysis. Massage and warm salt baths are effective (page 270). In Embolism and Thrombosis, rest, and the same position as directed in cerebral hemorrhage. Place ice to the head for relief of headache and control of hemorrhage or inflammation. To promote absorption of the blood and to re-establish circulation give : — Ammonium Carbonate, 3 drams. Ammonium Iodide, 3 drams. Solution of Ammonium Acetate, 4 ounces. Give one teaspoonful in half a glass of water three or four times a day. This is to be continued for a long period. If syphilis is determined as the cause of the disease, remedies such as iodide of potassium or of soda and mercury are to be given under the careful guidance of the attending physician. EPILEPSY. Epilepsy is a form of disease which receives its name from the sud- denness of its attack. It is also called the falling sickness, because the patient, if standing, suddenly falls when an attack comes on. By the ancients it was called the sacred disease, from being supposed to be due to the influence of the gods or evil spirits. Causes. — Among the causes which give rise to epilepsy are external injuries done to the brain by blows, wounds, fractures, and the like; or pressure from water on the brain, and tumors. Violent affections of the nervous system, sudden frights, strong mental emotions, acute pains in any part, worms in the stomach or intestines, teething, suppression of EPILEPSY. 421 the menses, excesses and masturbation, are causes which also produce epilepsy. Sometimes it is hereditary. Prognosis. — When it arises from hereditary predisposition, or comes on after the age of puberty, or when the attacks are frequent and of long duration, it is usually difficult to effect a cure ; but when it occurs in early life, or is occasioned by worms or any other accidental cause, it may be remedied. Symptoms. — The attack is usually without warning. The patient may be in his ordinary health, engaged, perhaps, in his usual occupation, when all at once he utters a piercing scream, and falls to the ground. Immediately thereafter the face becomes violently distorted, the head is usually drawn to one side, the eyes are set and staring, or roll wildly about, the color of the skin becomes dark and livid, and the veins swollen and turgid; there is frothing at the mouth; the muscles of the lower jaw act violently, producing gnashing of teeth, and frequently the tongue is injured; the arms are sometimes thrown violently about, and the lower limbs may be agitated in a similar manner, while the fingers with great power clutch at whatever comes in their way. The breathing is at first heavy and difficult, but afterwards it becomes short, quick, and sterto- rous, and is often accompanied with sighing and moaning. One side of the body is commonly more agitated than the other. After a longer or shorter period, the convulsive movements gradually diminish, and the patient seems to recover a faint glimmering of consciousness; but the look which he casts around is stupid and heavy, and he goes off into a lethargic sleep, from which he does not awake for some hours. There is no consciousness of anything that occurred during the paroxysm. On coming out of the fit, there is generally headache and always languor, and it may be days before he fully recovers from the effects of the attack. The duration of the paroxysm is usually from five to ten minutes; but sometimes several attacks follow one another in succession, and it may be then protracted for several hours. The most frequent, perhaps, of the con- sequences of confirmed epilepsy is insanity, either in the form of acute mania or monomania following the attacks, or of gradual imbecility, without any acute seizure. Though the fit usually comes on suddenly, yet there is sometimes distinct warning of its approach. It varies in different individuals, and may be lowness of spirits, irritability, dizziness, noises in the ear, floating specks before the eyes. There is, however, a particular sensation which is said to be felt by some immediately before the attack, and which is known as the aura epileptica. It is variously 422 DISEASES OF ADULTS. described as resembling a current of air, a stream of water, or a slight convulsive tremor, commencing in one of the limbs, and proceeding up- wards to the head, when the patient is deprived of all consciousness. Epilepsy is commonly divided into idiopathic, when it is a primary dis- ease, depending on some affection of the cerebro-spinal system; and sympathetic, when produced by an affection in some other part of the body — as the stomach, bowels, liver, circulating system, etc. Treatment. — During the attack, the principal thing is to see that the patient does no self -in jury — especially a piece of cork ought to be placed between the teeth, to prevent injury to the tongue ; the dress should be loosened about the neck and chest ; the head, if possible, a little raised ; and a free circulation of air maintained. Where the disease can be traced to any special exciting causes — as injuries of the head, worms, teething, etc., — the treatment should first be directed to its removal. When a plethoric state appears to occasion the disease, the patient's diet is to be restricted, frequent purgatives are to be administered, and every- thing avoided that may determine the blood to the head. If there are marks of debility, a generous diet, with tonic medicines and other means of strengthening the system, will be proper. The cold shower bath is recommended if it can be well borne, otherwise the tepid bath. The oil of turpentine, in frequent doses of one-half to one dram, is said to be of service in many cases. Bromide of potassium is a very valuable remedy, given in doses of ten to twenty grains three times a day. Stimu- lants, particularly ether, are said occasionally to keep off an attack. In this disease great care is necessary in the matter of diet, and moderation in quantity and quality are material points. When the appropriate remedies are judiciously employed, and the proper regimen strictly adhered to, epilepsy is often permanently cured, and the suffering is greatly mitigated even in those forms which do not admit of cure. Eclectic Treatment for Epilepsy. — Observe the same general treat- ment as before recommended. Give an emetic. The following is a good one: — Pulverized Lobelia, i ounce. Pulverized Bloodroot, . . . .y 2 ounce. Seneca, i scruple. Ipecac, 6 drams. Cayenne, 4 scruples. Mix. Dose, half a teaspoonful in warm water; repeat three or four times, at intervals of fifteen minutes. CONCUSSION OF THE BRAIN. 423 Bathe the feet and legs in warm water; apply mustard poultices to the nape of the neck ; keep the bowels open ; and remove all tight band- ages, and give plenty of fresh air. An excellent preparation is the following : — Peony, 1 ounce. Peruvian Bark, 1 ounce. Valerian, ' 1 ounce. Snakeroot, Yi ounce. Simmer them together in two quarts of water till reduced to one; add one pound of sugar. Give the patient from one-half to a wineglass- ful three times a day. On the approach of a fit, give a teaspoonful of fine salt three times a day; it will shorten the patient's sufferings. A person liable to this affliction should exercise the greatest caution in regulating the passions. CONCUSSION OR INFLAMMATION OF THE BRAIN. The result of a shock, blow, or other injury upon the brain without any outward appearance of a w T ound. Causes. — This is nearly always produced by a blow or a fall; it is one of the most frequent injuries to which the brain is exposed; it may be either slight or severe, in proportion to the severity of the exciting cause; in the former case the effect is but momentary — the patient is stunned, but very soon recovers consciousness, and perhaps feels no more of it, except a little tenderness of the part struck. It should be borne in mind that concussion of the brain is not always the result of a blow ; it may be produced by a violent shock to the nervous system, such as that caused by coming down heavily on the feet from a leap. Symptoms. — Among the symptoms of inflammation of the brain, or its investing tissues, may be mentioned as prominent : Shivering, suc- ceeded by heat in the skin ; great thirst ; tongue furred ; pain in the head ; intolerance of light; bloodshot eyes, with a wild, wandering look; sick- ness, and delirium. There may be violent and obstinate vomiting, as a first symptom, followed after a time by others. In the latter case he remains unconscious, without the power to move or speak; the pulse is slow and feeble, the breathing difficult, frequently there is vomiting, and an unnatural contraction or dilation of the pupils of the eyes. 424 DISEASES OF ADULTS, Prognosis. — If it is simple concussion, a fatal termination is not likely; but sometimes the shock causes rupture of the substance of the brain itself, or its inclosing membranes, or of one or more of its blood vessels, causing effusion; in this case the patient may never rally from his state of stupor, or, if he does, it will be but for a short time; there will probably be convulsions, paralysis, and other symptoms resembling apoplexy. All these are characteristic of inflammation. In so sensitive an organ as the brain, it must be evident that an inflamed state of the tissues is by all means to be avoided; hence, when reaction sets in after the stunning and depressing effects of concussion have passed off, keep the head cool and the patient quiet. Treatment. — In this case but little can be done beyond putting the patient to bed, and keeping the surface of the skin warm by friction and hot applications ; when there is extreme depression, a little brandy or sal volatile may be given, but very sparingly, because, if death does not ensue, there will be reaction, with an inflamed state of the organ. If a physician is not within reach, and the alarming symptoms increase in intensity, the hair of the head should be cut or shaved off, and towels wet with cold water applied; if iced, so much the better. A thorough cathartic should be given. To reduce the pulse and cause perspiration, give four drops of tincture of veratrum, in a little sweetened water, every hour, till the desired results are produced. INFLAMMATION OF THE OUTER COVERING OF THE BRAIN OR PACHYMENINGITIS. Causes. — Fracture of the skull; necrosis (death) of the bones of the head; penetrating wounds in the head; chronic alcoholism; Bright's disease; syphilis; erysipelas, and tuberculosis. Symptoms. — These are always obscure and the diagnosis is often extremely difficult. Dizziness; headache; sensitiveness of the eyes to light ; delirium ; convulsions ; coma ; apoplectic strokes ; epileptic fits, and paralysis, are among the most frequent indications of this condition. Prognosis. — Death usually terminates the condition. Treatment. — This is purely symptomatic and must be adapted to the conditions as they arise. Surgical attention, especially trephining, offers hope of a favorable ending in some cases, especially those caused by wounds of the head. MENINGITIS. 425 ACUTE MENINGITIS, CEREBRAL OR BRAIN FEVER. Inflammation of the inner and middle coverings of the brain, with an exudation from the blood vessels. It is most frequent in young persons and in males. Causes* — Infectious fevers ; erysipelas ; typhoid fever ; influenza ; pneumonia; diphtheria; disease of the middle ear, and of the bones of the head; abscess of the brain; overwork; insomnia of long duration; acute alcoholism; sunstroke; syphilis, and a micro-organism. Symptoms. — Headache; general irritability; weakness; dizziness; vomiting; constipation; fever, and coated tongue. Then follows the stage of invasion. The fever rises to from 103 to 104 ; pulse from 100 to 120; face, flushed; eyes, congested; headache, intense and con- tinuous ; ringing in the ears ; intense sensitiveness to light ; delirium, and intense sensitiveness of the skin. The second stage, or period of excitement, lasts for from one to fourteen days, and is marked by an increase of all symptoms ; rolling of the eyes ; delirium amounting almost to mania ; twitching of the muscles of the face; bending back the head; arching the body backward, and occasional outcry. Drawing the finger nail across the abdomen leaves a red line characteristic of this disease. The third stage, or stage of depression or collapse, follows. It is marked by paralysis; the patient becomes quiet; delirium and muscular contortion subside ; sleepiness ; coma ; fever abates ; pulse, slow and irreg- ular; the sphincter muscles relax and the urine and the faeces are voided involuntarily, and the breathing is jerky. Prognosis. — Death usually follows on the first or second day of the third stage.- Should a patient survive he is usually less mentally bright, and is likely to suffer much from headache and epilepsy. Treatment. — Absolute rest in bed in a dark and well-ventilated room. The head elevated and ice applied to it. Only liquid food is given. When the patient is unconscious, or unable to swallow, it must be given by the rectum (page 235). Delirium and convulsions are con- trolled by narcotics administered by the physician. Vomiting is relieved by doses of chloral. The fever and high temperature are controlled by sponge baths and rubs (see page 253). Leeches or fly-blisters behind the ears, at the back of the neck, and on the temples are of service in relieving the blood flow to the brain. Venesection (bloodletting) is often resorted to. 426 DISEASES OF ADULTS. NERVOUS PROSTRATION OR NEURASTHENIA. A condition of nerve-tire or exhaustion attended by an inability or lack of desire to attend to ordinary work and duties. Causes. — Excessive nervous and mental strain; overwork; emotion; alcohol; tobacco; combined fatigue and mental anxiety; nervous tem- perament and heredity. Symptoms. — Irritability of temper; mental weakness; inability to concentrate the attention : attempts to engage the mind are attended by headache, dizziness, restlessness, fear, depression of spirits, and physical weariness. There are a persistent feeling of pressure on the head; dis- turbance of sleep, either insomnia or unrestful slumber; pain in the back; dyspepsia, and mental disorders. Prognosis. — If the unfavorable conditions which have brought about the condition can be removed, the outlook is favorable ; but the cure may take a very long time, and the patient is usually in some measure per- manently affected by the attack. Treatment. — The ''rest cure" as first suggested by Dr. S. Weir Mitchell is the only rational and curative treatment that can be given. The efforts must be directed to restore to the patient the loss of nervous energy to which his condition is due. It is almost hopeless to attempt to give the required degree of rest and upbuilding at home. A sani- tarium or hospital must be chosen and the patient submit himself to the discipline of his attendants. But if home conditions are very good, and the patient can have a trained or otherwise competent nurse to devote entire time and attention to his welfare, a cure can be effected. The patient is not allowed to sit up. but must have perfect physical and mental rest in bed. He must not receive or write letters nor read, for this is using up the nervous and muscular energy which is sought to be restored. Lack of exercise is to be made up by daily massage. Electric treatment once a day is also beneficial. This is to be supplemented bv bathing (^see page 251). The food is to be nourishing and easily digested. It is best given in small quantities at intervals of about three hours. An excellent tonic for this condition is : — Fluid Extract of Coca, 2 drams. Dilute Phosphoric Acid, 6 drams. Tincture of Nux Vomica 1 dram. Syrup of Ginger iy 2 ounces. Peppermint Water to make 6 ounces. Take a tablespoonful in water after each meal. LOCO-MOTOR ATAXIA. 427 LOCOMOTOR ATAXIA. A disease causing degeneration of the spinal cord and nerve roots, resulting in loss of control of the muscles. Causes. — Syphilis; alcoholism: exposure: and wounds or injuries are the principal, direct or indirect, causes of the disease. Symptoms. — There are three stages of the disease: 1. Loss of se::sation; 2. Inability to direct or control motion: 3. Paralysis. The attack comes on very gradually, and among the first indications are sharp. darting pains in the legs and feet: loss of feeling in the feet, such as the inability to distinguish between hard and soft substances stepped on : if the spinal cord is affected in the upper part there is difficulty in operat- ing several sets of muscles in the fingers at the same time, such as are demanded in the act of buttoning the clothing. A tingling or burning is felt on the surface of the body in the waist, legs. feet, knees, and ?.::kies. There is also a tightened feeling around the waist as though a belt were tightly strapped about it. The inability to operate more than one set of muscles at a time is called lack of coordination, and is notice- able in an attempt to walk in a straight line. This test is usually applied in the early stages by directing the patient to try to do so with the eyes dosed. The patient is also asked to stand with the feet close together and to close the eyes : if the disease is begun he will have great dimculty in standing erect in such a position, but will sway about and perhaps fall. There is no loss of power in the muscles but simply an inability to control the movements of the limb. The optic nerve is affected early in the progress of the disease, and the sight is affected in the direction of color-blindness or in double vision. These symptoms become more and more pronounced as the disease advances, especially in the way of loss of sensation, until the patient is unable to feel a pin prick in the feet. There is also considerable emaciation: ulcers on the feet: loss of hair; and sensations of pain in many parts of the body, caused by certain organs becoming affected by the progress of the disease. There may be griping pains and vomiting; pain in urinating; pain in the rectum, with hemorrhoids : spasms of coughing ; difficult}" in breathing and constriction of the pharynx; and pains in the region of the heart. The disease leads up ultimately to paralysis, and in rare cases is attended by loss of mental power. Prognosis. — The outlook is unfavorable; the disease may extend 428 DISEASES OF ADULTS. over a period of several years ; there may be times when recovery seems possible; but the termination is death. Treatment. — Absolute rest in bed; excitement, mental distress and worry, and excesses are to be avoided; and the treatment should be directed towards the improvement of the general health. To this end the diet must be nutritious, and cod-liver oil, hypophosphites, and strych- nine are to be given. If syphilis is the cause, that is to receive its special form of treatment. Massage and clearly defined forms of exercise are of benefit. Frankel's system of exercises aims to teach the patient the control of his muscles all over again as though this had been forgotten. This is the correction of the lack of coordination of muscles. There are many varieties of exercises which will produce great benefit. Among others a plank is arranged with a number of cup-like hollows placed along its length at intervals and numbered; this is placed at the foot of the bed and the patient is directed by the nurse to place his heel in such and such a number. A chalk line is drawn along the floor and he is required to walk as nearly along it as he can. A small flight of stairs is used with a railing on each side for support ; the patient walks up one or two steps and down on the other side by using his legs without assist- ance from his hands. These and many other ingenious forms are fol- lowed, not to an exhausting degree; and while they are not curative of the disease, they teach control of the movements, and in conjunction with massage they keep up the muscular tone of the limbs and encourage the patient. Baths, both plain and medicated, are of great service; but the cold bath should be employed only when the vitality is great enough to recover from its stimulating effects. Electricity in some of its several forms of applications is also of benefit in many cases. Certain mechan- ical devices have been employed in the form or harness by which the strain was removed and transferred, but they are not now used. PALSY OR PARALYSIS. The total loss or diminution of motion or sensation, or both, in any part. There are several kinds of palsy or paralysis, such as the paralysis agitans, the shaking, or, as it is sometimes called, from the peculiarity of the patient's gait, the dancing palsy ; hemiplegia, when one side of the body only is smitten ; and paraplegia, when it is the lower half which is more or less deprived of its nervous power; but in all cases it is the brain which is the seat of disorder; and if this is confined to one of its PALSY OR PARALYSIS. 429 hemispheres, the attack, if it does not include both sides, is most likely to fall on the opposite side of the body. Causes. — The rupture of a vessel of the brain is one of the most common causes of paralysis, and this may occur without there being any decided apoplectic symptoms. A slight transient faintness, and confu- sion of ideas, may precede the attack, or it may come on during sleep, so that the patient may only be made aware that he is paralyzed by his inability to speak plainly, or to move a limb, or one side of his body. Sometimes the attack is gradual, and occupies a considerable time, — days, weeks, and even months elapse before the loss of nervous energy becomes complete ; and this helplessness may be produced by a succession of slight shocks, as it were, or by the gradual stealing on of an appar- ently torpid condition. This latter is more commonly the case when the disease arises from a decided state of general debility, which in time involves the brain, until the structure gives way and softening is the con- sequence. Hard drinkers, and others whose lives or habits necessitate a frequent state of cerebral excitement, are liable to this disease. With such the progress of the disease is generally rapid. One of the chief causes is pressure upon or disease of the brain or spinal cord. When confined to the lower part of the body, there may be reason to believe that the defect of power is in some cases but func- tional. In this case the cause may be long exposure of the lower limbs to wet and cold, self -abuse, excessive indulgence in venery, inflammation of the bowels or kidneys, effusion in the spinal cord from a blow, a burn, or other injury; disease of the womb, or of the urethra, may also give rise to it. Palsy of either of the limbs may be caused by pressure, and general palsy by the action of lead or mercury upon the system; there- fore those who work in these metals are peculiarly liable to be so affected, such as button gilders, glass silverers, plumbers, etc. The most danger- ous form of this kind is when it affects the muscles of respiration, in which case it rapidly proves fatal. Symptoms. — Among the premonitory symptoms of paralysis may be named headache, confusion of ideas, loss of memory, impaired vision, drowsiness, and partial stupor, with, frequently, numbness, and pricking or tingling sensation in the limb or part about to be attacked. With persons of a full habit, there will be heat and flushings in the face, and most of the signs of an approaching fit of apoplexy; then follow indis- tinct articulation, loss of power, and the other marked and unmistakable indications of an actual attack. 430 DISEASES OF ADULTS. Treatment. — A proper treatment, in the case of a patient of a full habit, is strong purgatives — about five grains of calomel, followed by senna mixture, or croton oil pills, every four hours, until they operate freely. When there is faintness and confusion of intellect, give a tea- spoonful of sal volatile in a glass of water, and repeat it in an hour, if required; no alcoholic stimulants should be administered; put the feet and legs in a hot mustard bath, and place the patient in a warm bed, with head and shoulders well raised. After they have once acted well, keep the bowels gently open with rhubarb or castor oil; let the diet be spare, and the quietude of the patient as perfect as possible. After the acute stage of the disease has passed, local stimulants should be used, and the affected parts well rubbed with the hand or a flesh brush. Electricity and galvanism may also be employed where there is no reason to suspect structural disorganization. In paraplegia it is often very difficult to get the bladder to act ; and when it does, the urine flows from it involuntarily. Great attention should be paid to this, and stimulant diuretics given ; the tincture of cantharides, in ten drop doses, is perhaps the best. Sulphur baths and chalybeate waters often afford relief. In palsy of the face, if it is caused by a blow or cold, hot fomentations and stimulating liniments should 'be applied; as also in palsy of the hands, fingers, or other extremities, with electro-magnetism, persevered in for a considerable time. In all cases of chronic paralysis, it should be borne in mind that the nervous system requires arousing and stimulating to a due performance of the functions necessary to life. In nearly all there is a sluggish action of the bowels, which are often obstinately con- stipated, and require the strongest purgatives to keep them at all open. It is sometimes better to employ enemas than continue giving drastic medicines. The paralytic patient frequently enjoys pretty good general health, and eats heartily ; and this increases the above difficulty, especially if the patient is a heavy person, with little power of self -movement. When confined entirely to bed, sores and sloughing ulcers are not un- common ; an air or water bed greatly obviates the danger of them. INFLAMMATION OF THE JOINTS OR ARTHRITIS. Inflammation of the large joints of the body, chiefly the knee, elbow, hip, and sometimes the ankle. It is marked by the increase of liquid around the joint, attended by redness, swelling, and pain. INFLAMMATION OF THE JOINTS. 431 Causes. — There are a variety of forms due to rheumatism, gout, gonorrhoea, injuries, syphilis, and the tubercle bacillus of consumption. Symptoms. — Marked redness; pain; swelling; fever in the joint; and indications of the flow of liquid into the part. The pains are indica- tive of the nature of the affliction, whether rheumatic, gouty, or tuber- cular. In tubercular inflammation, called white swelling, there is a gradual disintegration of the joint with a slow-forming, indolent, swell- ing* caused by the Bacillus tuberculosis. There is suppuration, which affects the ends of the bones and the cartilages. These latter sometimes are completely destroyed by the inflammatory conditions so that the ends of the bones which form the joints are not separated but strike together causing intense pain. Treatment. — There must be perfect rest to the joint and the patient must not bear the weight of the body upon it. All attempts to use the joint only irritate the already much-inflamed tissues and increase the per- nicious condition. The internal treatment must be that suggested by the disease which causes the swelling. Local applications include cold ice and compresses to reduce the in- flammation; counter-irritants such as blisters, cautery, etc., to promote absorption of the fluid; extension apparatus, and immovable splints to keep the inflamed surfaces apart, and to prevent motion; and surgical operation in tuberculosis cases such as hip joint disease and similar affec- tions. (For cold applications and counter-irritants, see page 256.) A local application for white swelling is : — Powdered Gum Ammoniac, 2 ounces. Vinegar of Squill, Enough to form a paste. Spread upon a piece of leather and apply daily to the joint. Hip Joint Disease. — This generally occurs in children of a scrofu- lous habit. It prevails in cold, moist climates, and usually attacks chil- dren between the ages of seven and fourteen, though it is frequently met with before and after that time of life. Symptoms. — The first symptom complained of is generally pain in the knee. Sooner or later the patient is observed to walk awkwardly and less vigorously than usual. Pain is felt in the hip joint itself, and, though aggravated by motion, often becomes more severe from time to time. Collections of matter make their appearance, most frequently in the outer wall of the hip, but occasionally in the groin and hip. The 432 DISEASES OF ADULTS. patient, after a tedious illness, recovers with a stiff joint, and wasted or shortened limb. Treatment. — As this disease is generally pretty far advanced before it is discovered, but little can be done for it in the way of domestic treat- ment. A surgeon should be consulted. As a general rule, counter exten- sion may be used to advantage. STIFFNESS OF JOINTS OR ANCHYLOSIS. This may be caused by the introduction of the larva of an insect, or from a violent blow or fall, either of which will often bring on an inflammatory action, with an exudation and deposit of gritty matter, which settles between the bones forming the joints, and thus prevents their free movement. Treatment. — Take a vessel sufficiently deep to admit of the immer- sion of the leg up to above the knee. Nearly fill it with water of the temperature of 98 , and pour in a strong decoction of elder flowers and tar. Take this bath night and morning; and apply to the affected part, three times a day, compresses saturated with the following lotion : — Liquor of Ammonia, 2j^ ounces. Camphorated Alcohol, 3 drams. Bay Salt, 1 J4 ounces. Water, 1 quart. Mix. The compresses should remain on for ten minutes at a time. Afterwards apply a plaster made as follows : — Lard, 10 ounces. Yellow Wax, 3 ounces. Mix these over the fire, with just sufficient hot water to form a mass; and add grated camphor, three ounces. Remove from the fire and let it cool. When sufficiently congealed, spread it with the blade of a knife or the handle of a spoon upon a piece of linen of the size required ; and cover the whole with oilskin. Or, bathe the part night and morning with warm salt and water ; rub well in, two or three times a day, almond oil ; and, at the same time, endeavor by gentle movement to loosen the joint. RHEUMATIC FEVER OR ACUTE ARTICULAR RHEUMATISM. An infectious, but not contagious, disease which affects the large joints of the body, and is by some called acute inflammatory rheumatism. Causes.— There is clear evidence that the disease is caused by an RHEUMATIC FEVER. 433 infectious micro-organism. The predisposing causes are exposure to dampness and cold ; wearing wet clothing ; living in damp localities ; sud- den fall of temperature; enfeebling fevers and other diseases; male sex; and previous attacks. The disease is seldom seen in persons under ten or over fifty years of age. It is most common between the ages of twenty-five and thirty-five. Symptoms. — The attack is usually sudden and comes on at night; there are chills; pain and stiffness in the joints; loss of appetite; usually moderate, but sometimes very high, fever; the perspiration is profuse and the sweat is of an acid reaction with a peculiar odor. There are thirst ; scanty urine ; constipation ; and excess of urates in the urine. The pain and the perspiration prevent sleep ; the patient is exhausted and the skin is covered with rash or prickly heat caused by excessive perspiration. The pain is intensified by efforts to move; the larger joints are affected; those of the fingers and toes usually escape; there are heat, redness, and swelling at the joints; and the inflammation skips about from one to another joint. But the joints are affected in regular order, that is, both knee joints, both elbow joints, at the same time. The duration of an attack is from thirteen to twenty-one days when not attended by com- plications. These may prolong the attacks for five or six weeks; and relapses are to be expected. Prognosis. — Recovery is the rule in simple cases. Xot more than three per cent of the cases terminate fatally; but in complicated cases the mortality is higher, depending upon the nature of the accompanying disease. Treatment. — Absolute rest in a bed provided with blankets only. Sheets are not to be used. The clothing worn by the patient should also be of wool, and the bed-clothing must be arranged so as not to press upon the inflamed joint. The diet should be a milk diet, and at no time should food which is difficult of digestion be given. The patient should be encouraged to drink copiously of water for the purpose of flushing out the kidneys to carry off the poison of the disease. There should be a dose of calomel followed by a saline purgative such as Hunyadi Janos water, Epsom or Glauber's salts. Salicylic acid or some of the salicylates are of great benefit : — Salicylic Acid, Yz ounce. Solution of Acetate of Ammonia, 4 ounces. Sweet Spirits of Niter, 1 ounce. Simple Syrup, 1 ounce. Take a tablespoonful in a wineglassful of water every three nours. 434 DISEASES OF ADULTS. Or:— Salicylate of Soda, i ounce. Compound Tincture of Cinchona, 3 ounces. Peppermint Water, 3 ounces. Take a dessert-spoonful at first every three or four hours. On signs of relief from it, increase the intervals to every six hours. Or:— Acetate of Potassium, 1 ounce. Salicylic Acid, y 2 ounce. Lemon Syrup, 2 ounces. Peppermint Water, 8 ounces. Take a tablespoonful in a wineglass of water every three hours. If, after five or six days of such treatment, there is no improvement, it is likely that salicylates are not the treatment required and that they will not cure. It is well then to give : — Potassium Iodide, 4 scruples. Elixir of Cinchona, iy 2 ounces. Infusion of Gentian, 1 y 2 ounces. Water, 1 ounce. Take a dessert-spoonful in water every three or four hours. Or:— Wine of Colchicum Root, 10 drops. Iodide of Potassium, 15 grains. Take one such dose three or four times a day. The joints may be well anointed with : — Icthyol, 1 ounce. Lanolin, 1 ounce. and the joints may be wrapped in cotton batting. Or:— Bicarbonate of Soda, 2 ounces. Laudanum, ^2 ounce. Boiling W^ater, 2 pints. Moisten flannel cloths with the above and wrap them around the joints. When the pain in the joints is great and they are inflamed, blisters of the size of a silver dollar are to be placed around the joint. If the pain persists : — Mercurial Ointment, y 2 ounce. Belladonna Ointment, y 2 ounce. Apply locally to the joints. MUSCULAR RHEUMATISM. 435 There is very great danger of heart complications ensuing from an attack of rheumatic fever, and the danger exists for two or three weeks after apparent recovery. It is therefore absolutely necessary that the patient remain in bed for some days after he is apparently well. Going out under two weeks after he is able to sit up is running a great risk. The exertion of attention to business is too great a demand upon the weakened heart's action, and, even though immediate affections are not noted, there is danger of sowing the seeds of chronic heart disease for the future. MUSCULAR RHEUMATISM. An acute or chronic inflammatory affection of the muscles, marked by pain, stiffness, and tenderness of the muscles. Causes.— It is nearly always caused by exposure to cold, damp, or direct drafts of cold air. A previous attack is a predisposing cause ; and it affects adults only. The varieties of muscular rheumatism are : — Rheumatic Headache. — (See page 308.) Wry Neck or Stiff Neck or Torticollis, which is rheumatism of the muscles of the neck. It generally affects only one side of the neck and back of the head. The head is twisted towards the affected side, and great pain attends any effort to turn it straight. Rheumatism of the Thorax affects the muscles of chest and the intercostal (between the ribs) muscles. Deep breathing, coughing, and sneezing increase the pain. Lumbago is rheumatism in the mass of muscles at the back. It is one of the most common forms, and usually involves both sides. All attempts to move greatly aggravate the pain. When it occurs in com- plication with sciatica the pain is intense. Prognosis. — This is always favorable. Treatment. — Rest is the first essential. Hot poultices composed of two-thirds pilocarpus leaves and one-third flaxseed meal are to be applied to the muscles affected. They are to be changed every two hours. For internal administration give : — Antipyrine, 10 grains. One such dose every three hours. Or:— Salicylate of Strontium, 10 to 15 grains. 436 DISEASES OF ADULTS. One such dose three times a day. If the rheumatism has been caused by cold, a very hot or turkish bath or a hot pack will remove the pain and stiffness, especially if the bath is followed by vigorous massage (pages 256 and 266). Acupuncture is often of great relief in difficult cases. Where there are great pain and loss of sleep give: — Powdered Ipecac and Opium, 10 grains. Potassium Nitrate, 5 to 10 grains. Give one such dose in the form of a powder night and morning. The following is a valuable liniment where only a small area is affected : — Oil of Wintergreen, I ^ drams. Alcohol, 2 ounces. Rub thoroughly into the affected part. In chronic cases and in lumbago, it is desirable to see that the bowels move regularly. Hunyadi Janos water, Epsom or Glauber's salts will be sufficient to secure this. NEURALGIA. A disease of the nervous system marked by sudden, darting, sharp pain which follows the course of the nerve. Causes. — Neuralgia is usually a result of impoverished nerves, and requires the use of nerve tonics. It can frequently be traced to diseased growth of the bone about those parts through which the nerves pass; and, in some severe cases, it has been found to depend upon the irritation caused by foreign bodies acting upon those highly sensitive organs. Among its exciting causes we may mention exposure to damp and cold, especially if combined with malaria; and to these influences a per- son with a debilitated constitution will be more subject than another. Anxiety of mind will sometimes bring it on, and so will a disordered state of the stomach ; more particularly, a state in which there is too much acid. Tea, coffee, tobacco, and opium are prolific causes of neuralgia, as well as of other diseased conditions of the nerves. There are several forms of the disease, according to the part affected. Neuralgia of the Head, Tic douloureux or Fothergill's disease, is treated on page 306. Neuralgia of the Neck and Arm affects the arm, hand, shoulder, shoulder blade, breast, and neck. NEURALGIA. 437 Neuralgia of the Back and Side, or Intercostal Neuralgia, affects the parts mentioned. Sciatica is neuralgia of the sciatic nerve which runs into the hip, inside of the thigh, calf of the leg, ankle, and heel. Facial Neuralgia affects the nerves of the face. Symptoms. — A violent, darting, and plunging pain, which comes on in paroxysms. Except in very severe and protracted cases, there is no outward redness nor swelling to mark the seat of the pain, neither is there usually constitutional derangement, other than that which may be caused by want of rest, and the extreme agony of the suffering while it lasts, which may be from one to two or three hours, or even more, but it is not commonly so long. Tenderness and swelling of the part some- times occurs where there has been a frequent recurrence and long con- tinuance of the pain, which leaves the patient, in most cases, as suddenly as it comes on. Its periodic returns and remissions, and the absence of inflammatory symptoms, are distinctive marks of the disease. Treatment. — This must depend upon the cause. If it is a decayed tooth, which, by exposure of the nerve, sets up the pain, it should be at once removed, as there will be little peace for the patient until it is. If coexistent with neuralgia there is a disordered stomach, efforts should be made to correct the disorder. If the patient is living in a moist situa- tion, he should at once remove to a higher level, and a dry, gravelly soil. Tonics, such as quinine and iron, should be given, and a tolerably gen- erous diet, but without excess of any kind. In facial neuralgia, blisters behind the ears have been found serviceable; and, if the course of the nerve which appears to be the seat of the mischief can be traced, a bella- donna plaster, or a piece of cotton soaked in laudanum and laid along it, will sometimes give relief; so will hot fomentations of poppies or bran poultices sprinkled with turpentine. An application of chloroform on lint has sometimes proved very effectual in relieving severe neuralgic pains, and so has an ointment composed of lard and veratrum, in the proportion of six grains of vera- trum to one of lard. A mixture of chloroform and aconite has been recommended for facial neuralgia, the form of preparation being two parts of spirits of wine, or eau de cologne, one of chloroform, and one of tincture of aconife, to be applied to the gums of the side affected, by means of a finger cov- ered with a piece of lint, or soft linen, and rubbed along them, — the danger of dropping any into the mouth being thus avoided. When the 438 DISEASES OF ADULTS. pain is connected with some organic disease, as a decayed tooth, or chronic inflammation of the gums or of the sockets, or superficial necrosis of the bone, substitute tincture of iodine for the spirit in the above formula. The shower bath, plenty of exercise in the open air, and attention to whatever will build up the general health must be carefully attended to. Persons at all liable to this painful affection should be extremely careful not to expose themselves to wet or cold; above all, not to sit in draughts. A very slight cause will often bring it on, where there is the least tendency to it. One severe and troublesome form of neuralgia is earache. It often occurs in children at the time of dentition. It may be distinguished from pain of an inflammatory character. The following pill, known as Dr. Gross's pill, is of great value in all cases of neuralgia : — Sulphate of Quinine, 2 grains. Sulphate of Morphia, 1-20 grain. Sulphate of Strychnia, 1-30 grain. Arsenious Acid, 1-20 grain. Extract of Aconite, y 2 grain. Take one such pill every one, two, or three hours, according to the severity of the attack. Or:— Sulphate of Quinine 2 grains. Reduced Iron, 1 grain. Arsenious Acid 1-20 grain. Aconite, 1-120 grain. Take one such pill every four or five hours. In intercostal neuralgia the following is of great benefit: — Chloral, 1 dram. Powdered Camphor, 1 dram. Menthol 1 dram. Rub together in a mortar, and paint over the affected part with a brush as needed. In sciatica, 10-grain doses of antipyrine, or phenacetine, may be given twice a day. A flannel bandage should be applied to the whole length of the affected limb and changed daily. To prevent the pain caused by movement of the leg, Mitchell recommends the use of a splint reaching from the armpit down to the heel, strapped close to the body and limb. ANAEMIA. 439 Application of a blister to the part along the course of the nerve is also beneficial. In extreme pain, narcotic injections will be required. ANAEMIA. A disease of the blood in which there is a deficiency of red blood corpuscles and hemoglobin (the red coloring matter of blood). Causes. — Deficient food; impure air; lack of sunshine; overwork; worry; prolonged nursing; cancer; Bright's disease; consumption; malaria; syphilis; etc. Symptoms. — The skin, lips, tongue, gums, and ears are pale ; loss of appetite ; capricious appetite ; irritable temper ; depression of spirits ; gen- eral weakness ; occasional dizziness and fainting ; palpitation of the heart and shortness of breath follow moderate exertion; excited heart action; hands, feet, and lower eyelids are puffy; face of a waxy appearance; menstruation is irregular, painful, or suppressed; dropsy of the ankles is present; and many complications may arise in long continued anaemia. Prognosis. — Where the cause can be determined upon and promptly removed the outlook is favorable; but in direct or primary conditions the prospect is not so good. Treatment. — Exercise; fresh air in abundance; sunshine; and a nutritious diet are first indicated. Tonics of iron, arsenic, strychnine, and quinine are very valuable. Carbonate of iron in from 2 to 5 grain doses, Basham's Mixture, or Blaud's pills may be used. In administer- ing iron, great care must be taken not to bring about a constipated con- dition. Smith's "four chlorides" is an excellent tonic: — Corrosive Chloride of Mercury, 1 to 2 grains. Solution of Chloride of Arsenic, 1 dram. Tincture of Chloride of Iron, 4 drams. Dilute Hydrochloric Acid, 4 drams. Simple Syrup 4 drams. Water enough to make 6 ounces. Take one dessert-spoonful in a wineglass of water after meals. Chlorosis or Green Sickness is a form of anaemia, of unknown cause. The number of red blood corpuscles is normal, but the percentage of hemoglobin in each corpuscle is deficient. It is a disease to which boys and girls in their early teens are subject, but it is more common among* girls than among boys. The skin has a more or less greenish, gray, or muddy tint. The patient is dull ; there is a pain at the pit of the stomach ; 440 DISEASES OF ADULTS. and dark circles around the eyes. Menstruation is delayed, scanty, and irregular as well as painful. Constipation is common. Treatment. — Practically the same as in anaemia. CEREBRAL ANAEMIA. A decrease of the supply of blood in the vessels of the brain. It is either general or partial. Causes. — Partial anaemia of the brain usually results from the obstruction of one or more of the blood vessels in the brain, and may be caused by thrombosis or embolism (page 417). General anaemia is caused by hemorrhages ; wasting diseases ; sudden shock ; weak heart action; heart disease; or is seen during recovery from severe attacks of fever. Symptoms. — General anaemia of the brain is marked by great pale- ness; fainting; dizziness, which is increased by exercise; headache, less painful when lying down; frequent yawning; and occasionally by con- vulsions. Partial anaemia is indicated by a loss of power in some special muscles in the part of the body which is controlled by the area of the brain which is affected. Prognosis. — Where the disease is caused by frequent and severe hemorrhages, the outlook is not favorable ; if the cause is one which can be removed, the recovery is almost certain. Treatment. — If general anaemia is the cause, the treatment must be along the lines of nourishing food, iron, arsenic, quinine, strychnia, as indicated on page 439. On the removal of the cause by such means the symptoms will disappear. It is not necessary that the patient pass all of the time in bed, but lying down for certain hours during the day will be of much relief. If fainting is frequent, follow the treatment as given on page 361. The treatment must be directed at the cause, and remedial measures advised for such conditions must be followed. For improve- ment of the blood these are valuable: — Tincture of the Chloride of Iron, 15 drops. Dilute Phosphoric Acid, 5 drops. Solution of Chloride of Arsenic, 3 drops. Lemon Syrup, J^ dram. Syrup of Ginger to make 2 drams. Take one such dose every six hours in a wineglass of water. CONGESTION OF THE BRAIN. 441 Or:— Sulphate of Strychnia, 1 grain. Sulphate of Quinine, 48 grains. Dilute Hydrochloric Acid, 2 drams. Compound Tincture of Gentian, 3 ounces. Water, to make 6 ounces. Take a teaspoonful in water after each meal. CONGESTION OF THE BRAIN. An undue fullness of the small blood vessels (capillaries) of the brain; often called "rush of blood to the head." It is called active full- ness when the arteries are affected ; passive when the veins are filled with blood. Causes. — Active or arterial fullness is caused by full-bloodedness (plethora) ; enlargement of the left ventricle of the heart; excesses in eating and drinking; protracted mental labor; acute alcoholism; sun- stroke ; tying of a large artery in a surgical operation ; and inhaling amyl nitrite. Passive fullness is caused by dilatation of the right side of the heart; pressure of accumulations of gas and liquids on veins in several parts of the body. Symptoms. — These may be sudden or gradual ; they are more marked while the patient is lying down. There are headache; neuralgic, dart- nig pains; interference with hearing and sight; buzzing in the ears; flashes of light before the eyes; dizziness; contraction of the pupils; impaired mental powers ; irritability of temper ; red face ; congested eyes ; and beating of the large blood vessels in the neck (the carotids) ; dis- turbed sleep; and twitching of the limbs. Prognosis. — Cases of moderate degree last for a few hours or days and pass off; but have a tendency to return. Severe cases are of the nature of apoplexy but usually are forerunners of a hemorrhage of the brain. Treatment. — Elevate the head; apply ice bag or cold cloths to the head (page 256) and warm applications to the feet. Leeches may be applied to the large process behind the ear (the mastoid) ; dry cups may be used on the neck (page 238). In severe cases of an apoplectic nature, bloodletting will be beneficial. Good results follow the energetic use of purgatives such as : — Croton Oil, 3 drops. Glycerine, 15 drops. 442 DISEASES OF ADULTS. Give one such dose placed well back on the tongue. Or the following enema : — Epsom Salts, 2 ounces. Glycerine, 1 ounce. Boiling Water, 4 ounces. Administer as an enema gently (page 234). A mustard application to the back of the neck is often useful in mild cases. DIZZINESS OR VERTIGO. A condition in which either the person affected or the objects around him seem to be in a state of rapid, circular, rotatory, or backward and forward motion. Causes. — It may be caused by paralysis of the muscles of the eye, by eye-strain or astigmatism ; in which cases it is called ocular vertigo or dizziness. Meniere's Disease is the name given to the sudden severe dizziness resulting from an affection of the semicircular canals (the coch- lea) or the labyrinth in the inner ear. It is the result of a hemorrhage or of the escape of pus or other discharges in that disease. Gastric Vertigo is the commonest form and is caused by indigestion in the stomach or in the intestines, liver trouble or constipation. Nervous Vertigo is the result of excesses, the excessive use of tea, coffee, tobacco or alcohol, as well as of organic brain diseases. Senile Vertigo, or the vertigo of old age, is caused chiefly by anaemia of the brain, as well as by changes in the eye in old age (presbyopia). Symptoms. — The symptoms common to all forms of vertigo or of vertigo from whatever cause are a sensation of objects revolving around the sufferer or of the objects remaining stationary and the patient seem- ing to move around them ; the attack is sudden ; sight is indistinct ; mind is confused; the patient is liable to fall, and grasps at a support; some- times vomiting and nausea are present ; but there is no loss of conscious- ness, though the patient may fear it. Other symptoms are peculiar to the several forms. In Ocular Vertigo, which usually follows too close an application to reading, sewing, fine work, there are headache; pain in the eyeballs; and floating specks before the eyes. In Meniere's disease of the ear there are noises in the ear; objects move with a variety of motions; there is often a rising and sinking DIZZINESS OR VERTIGO. 443 motion as though the patient were borne on a wave; the sufferer often falls by reason of the suddenness of the attack ; moroseness ; irritability of temper, and suspicion ; and the attack is usually of long duration. In gastric vertigo there are usually the symptoms of indigestion, such as flatulency ; heart-burn ; nausea ; pain after eating ; constipation or diar- rhoea; and often great pain in the back of the neck. In nervous vertigo there is irritability of temper; sleeplessness; head- ache; nausea; vomiting; and sometimes symptoms of epilepsy and soft- ening of the brain. In senile vertigo, dizziness of old age, the attack usually follows exer- tion, or even that of sitting erect or standing ; the head swims ; chilliness and weakness, with temporary blindness or darkness, are felt. Prognosis. — This is favorable in ocular and gastric vertigo ; good in nervous vertigo, unless it is organic in its nature; bad in true Meniere's disease and in senile vertigo. Treatment. — In ocular vertigo, the proper treatment is that given by a good oculist, and consists in the application of good fitting lenses for the correction of eye trouble of even slight degree. In Meniere's disease, the patient must lie down, not necessarily in bed. A 2-grain dose of sulphate of quinine every four hours for an extended period is advisable. In gastric vertigo, attention must be paid to the regulation of the diet. See diet for dyspepsia (page 281.) It may be well to start with a milk diet exclusively and gradually extend it as improvement takes place. It is well in such cases to take : — Fowler's Solution of Arsenic, 2 to 3 drops. Take in water after each meal. When the digestion is slow, 6 to 8 drop doses of nux vomica may be taken in water after each meal. In cases of constipation : — Fluid Extract of Cascara Sagrada, 1 ounce. Glycerine, 1 ounce. Compound Tincture of Cardamom, y 2 ounce. Peppermint Water, y 2 ounce. Take a teaspoonful in a wineglassful of water three times a day. For nervous vertigo, the cause must be treated. Where it is caused by excesses or abuse of narcotics these are easily regulated. For senile vertigo the diet must be highly nutritious, and a moderate use of whisky may be permitted. 444 DISEASES OF ADULTS. In all forms of vertigo the patient should not use tea, coffee, tobacco, malt or alcoholic liquors, except as above stated, or highly seasoned foods. ABSCESS. A collection of pus or matter which forms a cavity in and among tissues and parts which before the attack were entirely closed. It there- fore has no communication with the outside until such times as it ripens and bursts. In this respect it differs from an ulcer, which is on a free surface, and is open from the beginning. It differs from a collection of pus or matter in a natural cavity of the body, because that accumulates in a cavity which previously existed, and was not made by the breaking down of tissues. Cause. — The cause of an abscess is inflammation. That state may be constitutional and produced by such diseases as consumption, scrofula, pyaemia, or other diseases caused by the invasion of contagious microbes ; or it may be the result of local causes, such as injury or the presence of a foreign body. Sometimes an abscess breaks or points at or very near the site of the cause. In other cases it may be far away from it; as in the case of Psoas abscess, which appears in the groin, although the exciting cause is in the spine. The pus formed in this case burrows among the tissues of the muscles and forms an abscess at a considerable distance from the starting point. Symptoms. — Acute abscesses are attended by inflammaton, redness, pain, caused by the pressure upon the nerves; heat, and sometimes by hemorrhage when blood vessels have been involved and broken down by the progress of the abscess. Chronic abscesses are slow in development and are not attended by heat or pain. Treatment. — Take a slightly cooling and gentle aperient such as Hunyadi Janos water, Epsom or Glauber's salts, or a Seidlitz powder. Foment the part with hot flannel, and apply a poultice of linseed meal. In parts where the poultice is difficult to retain, it must be put in a bag made of muslin with a tape attached to each corner of the bag to fasten it on and retain it in its place. The poultice should be renewed every six or eight hours. When the abscess looks white in the center, it is ripe and should be opened. After discharging pretty freely, a slip of lint should be inserted by a probe, and renewed once or twice a day, according to the nature of the discharge. After this the part should be supported by a bandage, or slips of adhesive soap or plaster, to facili- ULCERS. 445 tate contraction; and the aperture should be left open to facilitate the discharge. When healed, tonic medicine and change of air should be resorted to. During the continuance of the abscess, the patient should live on food which is plain and nutritious, without being stimulating, avoiding at the same time, except under extraordinary circumstances, wine, spirits, and beer. ABSCESS IN THE EAR. Apply warm fomentations ; syringe the ear with warm water. When the abscess has broken and discharged freely, the ear must be kept clean, and a syringeful of slightly astringent lotion, such as ten grains of sul- phate of zinc to a quarter of a pint of rose water, should be injected luke- warm twice a day. Or this will be found beneficial : When there is much discharge, injections of warm soap and water should be used to cleanse the ear, and a little fine boric acid blown into it with a quill or powder blower. This treatment should be followed twice a day until the discharge ceases. ULCERS. A loss or destruction of the parts on a free surface caused by the death of the tissues. Cause. — An ulcer may be the result of a wound or bruise, not usually a recent one; it may be tuberculosis (or scrofulous), caused by the tubercle bacillus; varicose, caused by varicose veins; syphilitic; or the result of irritation. Symptoms. — They appear on the mucous membranes, such as the mouth, tongue, throat, stomach, bowels, etc. ; and on the outer surfaces of the body. They present a variety of appearances and are classified according to their condition. A healthy ulcer is one which is proceeding satisfactorily to a cure, or is healing. It has smooth, unhardened edges, a flow of colorless or yellowish thin fluid; red surface; covered with painless little growths like grains; and by a formation of skin growing over the surface or coming out from the edges. An inflamed ulcer is swollen, painful, with puffy edges, painful little grains on the surface, and more or less covered with pus or a thick yellow secretion. A slough- ing ulcer is inflamed, with rough overhanging edges, and a sloughing or eating away of the tissues. A fungous or weak ulcer has pale, flabby grains abundantly covering the surface and projecting above it. A 446 DISEASES OF ADULTS. callous or hard ulcer or indolent ulcer has hard, discolored edges, pale, and very few grains, and a bad smelling discharge of pus. A cold ulcer occurs at the extremities, especially the feet, and is the result of bad circulation and nutrition of the parts. A perforating ulcer occurs in locomotor ataxia, and is the result of loss of nerve supply. Treatment. — In tuberculous and syphilitic ulcers, the treatment is constitutional and directed to the cure of the diseases. Others receive protective and antiseptic dressings. A good dressing is : — Iodoform, i dram. Vaseline, i ounce. Apply locally. Oxide of zinc ointment and aristol are also effective in the dressing of ordinary ulcers. Weak and fungous ulcers require stimulation by touching the ulcer with nitrate of silver (lunar caustic) in stick form or in solution as follows : — Nitrate of Silver, 30 grains. Water, y 2 ounce. This is to be applied to the surface of the ulcer once daily. This is effective in ulcers in the mouth and throat, as in putrid sore throat, and sore mouth. Another beneficial local application is Black Wash, made as follows : — Calomel, 1 dram. Limewater, 1 pint. Apply locally once daily. Proud Flesh. — This is a name applied to the red granulations which often appear on the surface of wounds and ulcers. If they rise above the level of the skin they may be destroyed by a caustic application, such as the nitrate of silver or sulphate of copper (blue stone) ; a few grains of red precipitate, or a little powdered lump sugar. The first-named of the above is the most effectual, but care should be taken in applying it only to touch the spots themselves. CORNS. In the treatment of corns, the first object should be to remove thf\ exciting cause; comfortable, well-fitting boots or shoes should be sub- stituted for those of an opposite character, and the corn, after the foot has been soaked in warm water to soften it, should be pared carefully INGROWING NAILS. 447 away, particular care being taken not to wound the more sensitive part. When the outer surface is removed, there will be perceived in the center a small white spot, which should be carefully dug out with a pointed knife or other sharp instrument. When this, too, is removed, cover the seat of the corn with a small circular piece of thick, soft leather spread with soap or diachylon plaster, and leaving a small hole in the center, corresponding with that from whence the root of the corn has been taken. Should any of this latter remain, so as to cause irritation, apply to it, every second or third day, a piece of lunar caustic, scraped to a point and slightly moistened. Some persons apply strong acetic or other acid ; but this is not so effectual, and more likely to cause inflammation, which will be best allayed by a warm poultice of bread crumbs, moistened with Goulard's extract, the foot being held up as much as possible, and the system kept in a cool state with saline aperients, etc. Soft corns, which form chiefly between the toes, are often very pain- ful and troublesome; let them be cut away as close as possible with a pair of scissors, and then dressed with rags wet with Goulard's extract, or a solution of sugar of lead ; ivy leaves form, for such, a cool, pleasant protection from friction; they should be put on fresh every day. Beneath the corner of the nail of the great toe a peculiar kind of corn sometimes occurs; it should be cut or scraped out with the finger nail, and caustic applied as above directed. Mere callosities of the skin on the hands and fingers are not corns, although often called so ; they have no roots and are not painful, therefore it is best not to interfere with them ; for, if removed, others would come in their places, while the friction in which they originate is kept up. INGROWING NAILS. It often happens that a tight or ill-made shoe, by continual pressure on one part of the nail, forces it into the flesh, and thus causes great pain and inconvenience. Treatment for the Toe. — First procure an easier shoe, which will allow the nail to take its natural course ; then take a piece of glass, and with it scrape the whole length of the middle of the nail persistently and yet with a delicate hand. By this means the center of the nail will eventually be rendered so thin that it may be readily bent, and in this flexible condition it gives way to the upward pressure of the skin on its outward edges, readily bends, and offers no further resistance. The 448 DISEASES OF ADULTS. cause of irritation being withdrawn, the tenderness soon heals, and the proud flesh drops down. An ingrowing nail may be caused by an improper mode of cutting it. Nails should never be clipped at the corners, but cut straight across the top, if anything, slightly notched in the middle. This leares a sufficient amount of resistance at the corners ; for, wear what shoes we may, there must always be a certain degree of pressure on the nail, which should be provided for. Treatment for the Finger. — Wrap the affected finger in a compress moistened with a lotion made as follows: — Liquor of Ammonia, i ounce. Camphorated Alcohol, . . i dram. Bay Salt, % ounce. Water, J4 pint. Mix, and shake well together. After ten minutes, remove this and replace it by a compress anointed with camphor pomatum, and kept in place till next dressing by a rubber finger-stall drawn over it. Then dis- solve one and a quarter ounces of camphor in a gill of brandy, wet a narrow band with this solution, place it round the root of the nail, and let it remain there until the next dressing. The finger nails should be cut of an oval shape, corresponding with the form of the finger; they should not be allowed to grow too long, as they thereby are rendered more liable to accident ; neither should they be .too short, as they thus deprive the ends of the fingers of their protection and support. When the nails are naturally ragged or ill-formed, they should be gently scraped, afterwards rubbed with lemon, then rinsed with water, and well dried with a towel. If the nails grow more to one side than the other, they should be cut in such a manner as to make the points come as near as possible to the center of the end of the finger. CHILBLAINS. Chilblains are an inflammatory affection of the skin, generally con- fined to the extremities, and especially to the fingers and toes. Exposure to sudden alternations of heat and cold usually gives rise to these trouble- some visitations, which are rather characterized by itching and irritation than pain. Persons of scrofulous habit and languid circulation are most subject to them, as children and aged persons. It is a popular fallacy that to keep the surface of the skin in a state of unnatural warmth, by CHILBLAINS. 449 hot bottles and woolen socks by night, and fur linings and feet-warmers by day, is the best way to prevent chilblains ; but this only serves to keep up a constant perspiration, and so weakens the tone of the system and increases the liability to them. A nightly footbath of cold or — for aged persons — of tepid salt and water, with plenty of friction with a rough towel, and exercise during the day, will be most likely to keep chilblains from the feet; and for the hands, a careful rubbing so as to get them carefully dry after every washing or dipping in water, and an avoidance of all unnecessary exposure to severe cold, are the best preventive meas- ures. It is a good plan to have a pan of oatmeal always at hand, and to rub them well over with that after they have been wetted, and wiped as dry as possible. This will absorb any moisture left by the towel, and have a softening and cooling effect. Bathing the feet and hands every night in warm water in which a small quantity of salt is dissolved is one of the best preventives against chilblains. Treatment. — Should chilblains come, as sometimes they will in spite of all precautions, let them be gently rubbed every night and morning with some stimulating application ; alcohol, spirits of turpentine, or cam- phorated spirits of wine are all good for this purpose ; but the application which we have found most efficacious is a lotion made of alum and sul- phate of zinc — two drams of each to half a pint of water, rubbed in warm ; it may be made more stimulating by the addition of one ounce of camphorated spirits. When the chilblains are broken there must be a different course of treatment; the ulcers formed are often difficult to heal, especially in weakly and ill-conditioned persons; there is generally a great deal of inflammation, which must be subdued by means of bread and water poultices applied cold, and afterwards by cooling ointments, such as the cerate of acetate of lead, or spermaceti ointment, with forty drops of Goulard's extract added to the ounce; should there be a dispo- sition to form proud flesh, the ointment of red precipitate should be used. On the first symptoms of the appearance or the return of the redness or itching, wash the parts with a little warm spirits of rosemary to which a few drops of turpentine have been added. If the itching persists it can be relieved by a bath of: — Alum, 1 ounce. Rock Salt, 2 ounces. Borax, 2 ounces. Powder and mix. Add two teaspoonfuls to a footbath of tepid water and soak the feet for fifteen minutes. 4SO DISEASES OF ADULTS. The application of camphor has a most soothing effect. Another good lotion is : — Glycerine, y 2 ounce. Tincture of Iodine, 10 grains. Laudanum, 10 grains. Mix and shake until thoroughly dissolved. Apply with a camel's- hair brush to chilblains that have broken as well as to those which have not. RASHES. Patches of superficial redness of the skin ; they may occur on any part of the body, and are generally accompanied by increased heat and irritation — sometimes by swelling, inflammation, and considerable pain; they are not contagious. When red blotches occur in the face they are generally connected with some constitutional derangement — often with dyspepsia — to the cure of which the general treatment must be directed ; the face should be washed in warm water, and the blotches dabbed with camphorated spirits. ROSE RASH. Rose rash is common with children during dentition, and is there- fore called tooth rash. It arises from intestinal irritation, and most usually shows itself about the face, although it may appear on any part of the body. With adults it usually occurs in hot weather; fatigue, drinking largely of cold water, or eating indigestible food, will bring it forth. It sometimes occurs during the eruptive form of smallpox, and sometimes after vaccination. Mild aperients, such as rhubarb and mag- nesia, cooling drinks, tepid baths, with frugal diet and rest, are the best remedies. There is usually considerable itching with these rashes, which may be allayed by the application of Goulard's extract or some other cooling lotion. HIVES OR NETTLE RASH. This is an eruption of the skin similar to that produced by the sting of nettles. It is not dangerous nor contagious. Causes. — It is generally thrown out by some particular kind of food which disagrees with the system, such as crabs or other shellfish, or mackerel ; certain vegetables are likely to produce it, such as mushrooms, RASHES. 451 cucumbers, bitter almonds, or strawberries. Copaiba, cubebs, valerian, or the fumes of turpentine inhaled during house painting are also likely to occasion nettle rash. Symptoms. — The eruption consists of little, solid eminences of irreg- ular outline, but generally roundish or oblong, and either white or red, or both white and red. It is accompanied with intense heat, and a burn- ing or tingling in the affected spots. No part of the body is exempt from nettle rash. There are two varieties of this disorder, one of which is regarded as acute, the other as chronic, and either persistent or inter- mittent. The acute form is usually preceded or attended with feverish- ness, and a feeling of general uneasiness, headache, nausea, and vomit- ing. In general it appears in the morning, vanishes in the course of a few hours, and perhaps reappears again twice or thrice during the day. It usually disappears entirely in six or eight days. The chronic form of this complaint is intractable and difficult to remove, coming and going for a lengthened period, but with little or no feverishness. Treatment. — An emetic should be first administered, if the eruption is caused by anything recently taken into the stomach; it should be fol- lowed by a saline aperient — senna mixture, with salts, is perhaps best, and this repeated until the bowels are freely moved ; if the febrile symp- toms do not subside, a mixture composed of sweet spirits of niter, two drams; liquor of acetate of ammonia, one ounce; and camphor mixture, five ounces, should be given, two tablespoonfuls every four hours. In the chronic form, a simple diet, active exercise, an avoidance of any articles of diet likely to excite the eruption; keeping the bowels regular by gentle aperients combined with antacids; a five-grain rhubarb pill an hour before dinner, or a small piece of the root chewed, are good reme- dial means; the tepid bath should be occasionally used, or sponging, to keep the skin in a healthy state ; to allay the irritation, dust starch powder over the eruptions, or use a lotion made of rose or elder flower water in half a pint of which has been dissolved one dram of carbonate of ammo- nia and one-half dram of sugar of lead. DISCOLORED SKIN. Moles, freckles, and sunburn are some of these affections. Freckles are brown spots on the face and hands caused by exposure to the sun. Persons affected with these unsightly discolorations may remove them, without using cosmetics, by merely stimulating the absorb- 452 DISEASES OF ADULTS. ent vessels of the skin to take them up and carry them away. Any smart stimulant will act in this way; but it has been found that the safest are taken from the vegetable kingdom. One of the best and easiest is With- ering's cosmetic lotion, which is made of a teacupful of soured milk, and a small quantity of scraped horse-radish ; let this stand from six to twelve hours, then use it to wash the parts affected twice or thrice a day. Moles in the skin, or, as they are commonly called, mother-marks, are beyond the reach of medical treatment; if they are ever removed, it is at the risk of causing a greater disfigurement ; therefore they had better be left alone, the more especially as they not infrequently answer a useful end — that of positive identification. Large moles which tend to enlarge should be removed by the surgeon, as they sometimes develop into can- cerous growths. DISORDERS OF THE SWEAT GLANDS. The proper action of the skin is of the greatest importance to the health. Too much or too little perspiration may produce serious conse- quences; but can generally be corrected by cold or warm baths, tonics, friction, and proper clothing. DISORDERS OF THE OIL GLANDS. When the skin is not well taken care of, or when a person has very sedentary habits, the action of the oil glands becomes sluggish ; the matter in the tubes becomes hard and dry and distends them, sometimes raising them above the surface, and the ends become black. Again, the oily matter is poured out too profusely, so that the skin shines with it; or, at times, there may be so little that the skin is harsh and dry. Treatment. — For roughness and hardness of the skin, wash with soap and water every night, and rub well into the skin an ointment made of olive oil, four ounces; carbolic acid, one dram. Take a dose of sul- phur and cream tartar twice a week. Where the oil tubes have hardened, and formed a horny growth, the body should be washed with a quart of water, in which a teaspoonful of saleratus is dissolved ; and twice a day use the following ointment : — Elder Flower Ointment, i ounce. Blue Vitriol, I scruple. For blackheads in the skin, wash in strong soapsuds twice a day, and rub briskly with a coarse towel, and use the following lotion : — PRICKLY HEAT OR LICHEN. 453 Corrosive Sublimate, 5 grains. Cologne, 2 ounces. Soft Water, 6 ounces. Mix and apply each night and morning. A spare diet will do much in some cases toward improving the skin. PRICKLY HEAT OR LICHEN. This is a disease caused by intense and long-continued heat; but it may be excited by the same causes which produce the nettle rash, when the system is prepared for it. It is one of the most annoying plagues of a tropical climate. Symptoms. — The general character of the disease is that of a diffuse eruption, with red pimples, and a troublesome sense of tingling or prick- ling. There is more or less general irritation, and sometimes a little fever at the commencement. Treatment. — For the relief of the itching and burning sensation attendant on prickly heat, which in tropical countries are often absolutely unbearable, the best remedy is cold water — using caution when the patient is perspiring. Live sparingly, and take a few doses of a mild purga- tive, as the following: — Powdered Aloes, . .- 2 drams. Powdered Rhubarb, 1 dram. Powdered Jalap, 2 drams. Powdered Cream of Tartar, 4 drams. Magnesia, 1 dram. Best Honey, 1 ounce. Mix well, and divide into one hundred and twenty pills; take two, three, or four on going to bed. IRRITATION, ITCHING OR PRURIGO. A papulous affection of the skin, accompanied by troublesome itching. Sometimes it is attended with a sensation as of ants or other insects creeping over and stinging the skin, or of hot needles piercing it. This disease, although not dangerous, is a cause of great discomfort, and sometimes even misery; it attacks persons of all ages, and is not easily got rid of, sometimes lasting for months, and even years. Treatment. — Wash well, every evening before going to bed, with 454 DISEASES OF ADULTS. castile soap, and allow it to dry in. Brandy or alcohol may be used in the same manner. An ounce of lemon juice in a pint of water, or vinegar used in the same proportion, will be found useful ; also, water and spirits of camphor. The diet should be carefully regulated, and all stimulants avoided. ITCH OR SCABIES. An animal parasitic disease of the skin, highly contagious and liable to affect persons of all ages and stations of life. Cause. — It is caused by the itch parasite, acarus or sar copies scabiei. It is contracted by contact ; bedding, clothing ; etc Symptoms. — The itch mite at once begins burrowing in the skin, causing an intolerable itching. In the efforts of the patient to obtain relief by scratching, the skin is often broken. The eggs of the insect are deposited under the skin in burrows, which are increased in number to accommodate the brood as hatched. The itching is worse at night, and crusts are likely to form as a result of the severe scratching. Favorite sites are the hands, between the fingers, wrists, breasts, and the inside of the thighs. The surest identification of the disease is by detection of the insect with a magnifying glass. Prognosis. — The disease is not self-limited, that is, it will not cure itself without treatment. It is not a difficult disease to get rid of by proper measures. Treatment. — The bedding and clothing of those affected must be thoroughly disinfected or sterilized (page 163). The insect is to be first killed, then the inflammation excited by its presence is to be allayed. Sulphur is the specific in this case : — Precipitated Sulphur, 1 dram. Vaseline, 1 ounce. Apply locally at night. The face and head are not to be treated, but the rest of the body is to be covered with this ointment for four suc- cessive nights. Proper care must be taken to avoid soiling the bedding. The patient may wear old underclothing, socks, and a flannel gown to afford this protection. On the fifth day a hot bath is to be taken, the clothing changed, and the treatment repeated, if necessary. If the dis- ease has not disappeared, a third application is necessary. It may be that after the third application only a few isolated sections are left. These are to be treated with : — ECZEMA. 455 Carbolic Acid, 5 to 10 grains. Vaseline, 1 ounce. ECZEMA, HERPES OR TETTER. After a slight feverish attack, lasting two or three days, clusters of small, transparent pimples, filled sometimes with a colorless, sometimes with a brownish lymph, appear on the cheeks or forehead, or on the extremities, and at times on the body. The pimples are about the size of a pea, and break after a few days, when a brown or yellow crust is formed over them, which falls off about the tenth day, leaving the skin red and irritable. The eruption is attended with heat, itching, tingling, fever, and restlessness, especially at night. Ringworm is a curious form of tetter, in which the inflamed patches assume the form of a ring. Treatment. — The treatment should consist of light diet and gentle laxatives. If the patient be advanced in life, and feeble, a tonic will be desirable. For a wash use : — ■ White Vitriol, 1 dram. Rose Water, 3 ounces. Mix ; or an ointment made of : — Elder Flower Ointment, 1 ounce. Oxide of Zinc, 1 dram. MOIST ECZEMA. This is an eruption of minute, round pimples, about the size of a pin's head, filled with colorless fluid, and terminating in scurf. It is preceded by languor, faintness, perspiration, and a prickling of the skin. Another species of this disease is called sun-heat, which is an eruption of a white or brownish color, w T hich generally terminates in yellow scabs. It occurs only in summer, and affects those parts which are uncovered. In still another species, the eruption is attended with pain, heat, itching, intense smarting, and a swelling of the affected part. When the blisters break, the water runs out, irritates and inflames the skin. Treatment. — Spare diet, cooling drinks, gentle purgatives, and warm baths. In old, chronic cases, apply externally either limewater or cor- rosive sublimate in a wash proportioned of five grains to one pint of soft water. In the last two forms of the affection, apply nitrate of silver in solution to the parts. 456 DISEASES OF ADULTS. MILK CRUST ECZEMA. This eruption consists at first of slightly elevated pustules or pimples, closely congregated, with an inflamed border. These break, and the surface becomes red, excoriated, shining, and full of pores, through which a thin, unhealthy fluid is poured out, v/hich gradually hardens into dark, yellowish-green scabs. When this tetter invades the head or scalp, it causes the hair to fall off and is termed a seal!. Treatment. — Vapor bath and water dressing. The crusts should be removed by a weak lye, made from hard wood ashes or potash ; then an ointment should be applied, made of : — Mild Nitrate of Mercury Ointment, 3 drams. Sugar of Lead, 16 grains. Rose Water Ointment, 1 ounce. RINGWORM. Ringworm is an eruptive disease of the skin — more particularly of the head — and of which there are several kinds. Causes. — Ringworm has its seat in the roots of the hair, and is believed to be attended by the growth of parasitic fungi ; its predisposing causes are any derangement of the general health from ill or under feeding, breathing impure air, drinking bad water, uncleanly habits, scrofula. Its immediate or exciting cause is generally contact with those affected with it, or using combs or hair brushes which they have used. Wilson remarks that improper food is a frequent predisposing cause, and that he has observed it in children fed too exclusively on vegetable diet. It is said to occur spontaneously in children ill-fed and uncleanly, and it is readily propagated by contagion. It has recently been dis- covered that this disease is owing to the presence of a cryptogamic para- site, called the trichophyton. Symptoms. — The most common kind commences with clusters of small, light-yellow pustules, which soon break and form into thin scabs, which, if neglected, become thick and hard by accumulation. When removed, they appear again in a few days; and by these repetitions the incrustations become thicker, and the area of the patches extends, so as, if unchecked, to affect the whole head, and extend also to the forehead and neck. The patches are of an irregular, circular form. This disease occurs generally in children of three or four years and upward. Treatment. — The treatment consists in applying to the parts some CARBUNCLE. 457 preparation which will destroy the fungus. The first thing to be done is to remove the hair. Afterward the parts should be washed with a solution of bichloride of mercury (one part to 250 parts of water), or with a solution of sulphurous acid, one part to eight of water. The general health should be at the same time attended to, and nutritious diet, tonics, cod-liver oil, and regular exercise used when necessary. The vesicular form of ringworm is the simplest and most amenable to treatment; sometimes it disappears after careful washing and poul- ticing, with, perhaps, a few applications of any astringent lotion; but the pustular form is far more troublesome and intractable, spreading often very rapidly, and running into ulcerous sores, and sometimes reap- pearing when it is thought that a cure has been effected. Nothing but the greatest care and attention will then eradicate it. Any child afflicted with this disease should be separated from other children, on account of its contagious nature; wearing each other's caps and bonnets will be likely to spread it through a whole school. The following will speedily cure this affection : — Naphthol, 1 dram. Citrine Ointment, 1 dram. Thymol, 5 drops. Vaseline, 1 ounce. Mix and make into an ointment and apply twice a day. CARBUNCLE OR ANTHRAX BENIGNA. A painful, deep-seated, dark red inflammation of the skin, ending in the death of the tissues affected. Causes. — The primary cause is a micro-organism; predisposing causes are bad health, diabetes, and injury to the part. Symptoms. — The first appearance is in the form of an inflamed area on the back of the neck, on the shoulder, or between the shoulder blades. It is rounded in shape ; and the area soon becomes hard, circular, and flat. It varies in size from that of a hazelnut to an orange. The color is purplish or violet. After a week or ten days the skin breaks and sloughs off, leaving passages for the outlet of pus. Finally the entire area assumes the appearance of a large purulent ulcer, with firm edges, and the granulations of an ordinary healthy ulcer appear, and the part heals, leaving a scar. The growth of the carbuncle throughout these stages is attended by heat, pain, and throbbing. 458 DISEASES OF ADULTS. Prognosis. — The outlook is always serious, as blood poisoning is more than a possibility at almost any stage. Treatment. — The general health must receive attention from the beginning of the attack. To this end the diet must be nourishing; stim- ulants are required. A valuable tonic for this condition is : — Tincture of the Chloride of Iron, 15 drops. Solution of the* Chloride of Arsenic, 3 drops. Lemon Syrup, y 2 dram. Syrup of Ginger, to make 2 drams. Take one such dose every six hours. Or:— Sulphate of Strychnia, 1 grain. Sulphate of Quinine, 48 grains. Dilute Hydrochloric Acid, 2 drams. Compound Tincture of Gentian, 3 ounces. Compound Tincture of Cardamom, to make 6 ounces. Take a teaspoonful in water after each meal. The local treatment consists of the injection of a saturated solution of crystals of carbolic acid in every direction throughout the tissue. It is very painful for a time, but is very beneficial. Stick caustic potash may be used to cauterize the sloughing tissues. When incision is necessary, the cuts are made in the form of a cross (crucial incision). When gan- grene threatens, the parts must be well treated with antiseptic solutions. If septicaemia (blood poisoning) threatens, it is necessary to cut the parts out. BOIL OR FURUNCULUS. An acute affection of the skin marked by the presence of one or more superficial abscesses or boils. Causes. — The follicles of the hair become impregnated with micro- organisms which produce pus. Predisposing causes are poor health; anaemia; diabetes; uraemia; friction or injury to the skin; uncleanliness ; and contact with certain substances such as tar and petroleum, which act as irritants. Symptoms. — The boil begins in the sebaceous gland (a sweat gland) and never in the tissues. As soon as it has attained a certain size the parts affected form a core of dead tissue, and when the boil is mature the core comes away with the pus. Although boils occur in numbers and in crops as well as singly, they show no tendency to spread. The EXCESSIVE PERSPIRATION 459 abscess begins as a small, round spot, highly inflamed, and of a reddish color. It runs its course in about a week, at the end of which time it is raised, rounded, pointed, with a yellowish point in the center. This yellowish center is called the core; when no core is formed the boil is spoken of as "blind." The pain is dull and throbbing; increased on pressure, and usually worse at night. Boils in the armpit, and parts other than the neck and face, are deeper seated and more painful than others. Treatment. — Warm applications are required to hasten the forma- tion of pus. It is necessary to protect the parts from pressure and fric- tion by means of soap plaster and adhesive plaster. EXCESSIVE PERSPIRATION OR HYPERIDROSIS. A disturbed condition of the sweat glands, marked by an excessive secretion of sweat. Causes. — The condition has never been satisfactorily explained. Disturbance of the sympathetic nervous system often has some connec- tion with the affection. There are many variations, both in character and degree, of the disease. It may be acute or chronic; general or partial; constant or intermittent. Local manifestations of it are usually confined to the hands, feet, armpits, and genitals. Excessive perspiration of the hands is annoying on account of its profuseness ; as often as it is dried, there is an immediate flow which interferes with the use of the hands in certain occupations, and renders the wearing of gloves impossible. Excessive perspiration of the feet is still more annoying and often offen- sive. The socks and shoes become bathed with the perspiration which, being retained, gives rise to an offensive odor. The feet are rendered tender by its presence and the patient becomes foot-sore. When the dis- ease affects the armpits and the genitalia, the odor is also often very offensive, much more so in males than in females. Prognosis. — Cases are often hard to manage, as the conditions per- sist in spite of care and attention. When the affection is local, especially in the feet, the prognosis is favorable. Treatment. — Local treatment is by far the most effectual. Bathe, cleanse, and immediately dry the part. One of the best local applications is tincture of belladonna applied either diluted or full strength. Astrin- gent lotions, such as alum, or tannic acid, made in the proportion of from 460 DISEASES OF ADULTS. i to 8 drams to a pint of water, are also effective. In such cases the astringent closes the pores of the skin in the part and cuts off the secre- tion. Dusting powders are also beneficial. Among the best of these are: — Salicylic Acid, 20 grains. Oleate of Zinc, 1 ounce. To be applied locally. Or, after the parts have been washed in a weak solution of carbolic acid : — Salicylic Acid, y 2 dram. Prepared Chalk, 1 ounce. Dried Alum, 1 ounce. When powdered finely apply with a powder puff. On- Salicylic Acid, 1 dram. Powdered Starch, 3 drams. Powdered Soapstone, 3 y 2 ounces. This powder is to be sifted into shoes and stockings. Frequent change of hose and the drying and airing of shoes are necessary in all cases. LICE. These disgusting vermin most commonly appear when cleanliness is neglected, and especially in cases where the body clothing and bed clothing are used continuously without change. But there appear to be certain habits of body and certain seasons of the year which are favor- able to the generation of this kind of vermin, — as, for instance, spring and autumn. Treatment. — Wash the body well with vinegar and water, and after- wards rub in a lotion made as follows : — Camphor, grated, y 2 ounce. Best White Wine Vinegar, 1 pint. Water, 1 pint. Mix, and apply night and morning. Or take equal parts of garlic and mustard, moisten with vinegar, and rub into the skin twice a day. For lice on the scalp, the most effective treatment consists in soaking the hair thoroughly, three or four times a day, with kerosene oil, and wrapping the head in a cloth for twenty-four hours. Then wash the head with green soap and hot water. Apply the ointment of ammoniated mercury. In very rare cases it may be necessary to repeat this treatment once only. SPECIAL DISEASES. 460* DISEASES OF SPECIAL RESEARCH. Hookworm Disease (Uncinariasis). The parasite, Uncinaria americana, which causes this disease, was discovered in 1902. Its eggs are deposited in the intestines of the human being, but develop after they escape from the body. These larvae pass through the skin into the blood, which carries them through the heart to the lungs, thence to the air passages, into the mouth, and on through the body. A second method of infection is through the mouth either with contaminated food or water, or from earth containing the larvae. The malady is more common in warm, moist localities among persons living in unhygienic conditions. Physicians in southern Florida estimate that 90 per cent, of the rural population harbor the parasite to a greater or less degree ; 90 per cent, is the estimate for Porto Rico. The skin, waxy-white to dirty yellow in color, becomes dry like parchment, and in the first stage itches seriously ; a swelling of face, ankles, legs, or entire body may be present ; anxious, stupid expression of face ; prominent abdomen ; finally emaciated ap- pearance ; appetite variable but abnormal ; nausea frequent ; muscles soft, flabby, and weak ; fever usually present. Anaemia is the most pronounced symptom. For treat- ment thymol, male fern, and, recently, beta- naphthol, are used. Infantile Paralysis (Anterior poliomye- litis). An inflammation of those parts of the spinal cord concerned in muscular move- ments and development. It begins sud- denly and is followed by a paralysis of the muscles controlled by the nerve cells at- tacked, and may be transmitted to any mem- ber of a community it has once invaded. It is infectious, frequently epidemic, and rages mostly in hot weather. The germ passes into the system through the moist lining of the nose and mouth. The symp- toms are difficult to determine during the period of development, which is from one to fourteen days after exposure. There is usually a slight running at the nose ; the pulse is rapid and irregular, often difficult to count, and the temperature varies from 101 to 107 degrees; pains and extreme ten- derness in back and limbs, the paralysis of which frequently follows in 48 hours. It is generally an acute disease, the greatest sufferers being children, one to five years old, although in 1910 there were many cases among persons much older. Data collected in Scandinavia indicate that the infection can be carried by intermediate persons to the healthy from the sick, whether slightly or seriously stricken. Massachusetts physi- cians have concluded that insects and dust aid in spreading the malady. Pellagra (Maidismus). In Italy tin- cause is attributed to the use of fermented maize by the peasantry, the ones mainly affected by it. The symptoms are similar in both the acute and chronic types. In the early stage they are : redness of the skin like severe sunburn, inflammation of the mouth and stomach, severe dyspepsia, and diar- rhoea ; in the more advanced stages intense pains in the head and spine occur, mental depression follows, and many cases end in permanent insanity. It is rapidly fatal in the acute, form, death usually ensuing in a few weeks or months. The chronic cases are milder and, according to Italian scien- tists, patients live from twenty to thirty years. Pellagra has been known for over 200 years. In Spain, Portugal, and Cen- tral Italy, where it is called "Italian leprosy," it is particularly prevalent. The people in these localities live largely upon maize, which is frequently harvested before it is ripe and stored in damp places, where it ferments. Whiskey prepared from this maize, as well as corn-mush, corn-bread, or polenta, may convey the poison. Alcoholism is considered by some as a chief cause of the disease. Both sexes and all ages are subject to it, but the majority of the cases occur in later adult life. In 1911 no treat- ment had been devised to arrest its progress. Sleeping Sickness (Trypanosomiasis). It is caused by microscopic wormlike para- sites called trypanosomes. The germ is car- ried by the tsetse-fly and the disease spreads in the rainy season. During the first stage, which lasts from two months to a year, occasional fever is present, the temperature varying from 99 to 102 degrees; a swelling of the lymphatic glands is another common early symptom ; the second stage shows a marked change in the appearance of the victim ; the facial expression is heavy and dull, all exertion is absent. This condition becomes very marked as the malady pro- gresses ; walking and all speech are difficult, and finally impossible ; during the last week the patient is in a state of complete coma. Until 1908 the disease was invariably fatal. Dr. Paul Ehrlich of Germany sought and dis- covered in dyestuffs a specific which he called arseno-phenyl-glycin, which cures all ani- mals, and is now being successfully tried upon human beings. After two injections of small doses, a definite cure is effected. This dis- ease was first reported in 1803, but nearly a century had passed before any attempts were made to arrest it. It is confined to the equatorial regions of Africa, and affects both the white people and negroes. It is estimated that in this region within ten years fully 400,000 persons had died with it. PROGRESS OF MEDICAL SCIENCE The oldest medical knowledge, the Egyp- tian, is found in the Papyrus Ebers, which dates from the sixteenth century B.C. The Babylonians had no physicians, but used in- cantations against disease. The Hindus were proficient in medicine and surgery very early ; their influence upon Arabian medical knowledge was very great. From the Bible and the Talmud we learn of the science among the Jews, 1500 B.C. The Vedas, the sacred books of India, show that medicine was practiced in that country as early as the eleventh century B.C. The origin of Chi- nese treatment is lost in tradition. Among the Greeks and Persians the healing art was studied about 500 B.C., when Pythagoras explained the philosophy of disease and the action of medicine. The Romans learned the science at Alexandria, and carried it home to Rome. SOME NOTABLE EVENTS AND SCIENTISTS. Hippocrates, "the father of medicine," most celebrated physician of antiquity 470-357 B.C. Difference between arteries and veins discovered by Praxagoras 335 B.C. Herophilus founded human dissection, discovered nerves and lymphatics. .300 B.C. Erasistratus distinguished sensory and motor nerves, traced their origin and and that of veins and arteries. . .280 B.C. Electricity for treatment of headache. .. .43 Galen, the first anatomist, an authority on the pulse, author of 83 medical works still extant 130-203 Dioscorides, author of "Dc Materia Medica," a work still used by the Turks and Moors, lived in the latter part of the first or second centuries. Smallpox and measles first described by Rhazes, an Arabian 850-923 The first pharmacopoeia by Avicenna, author of a famous system of medi- cine, The Canon 1 000 Albucasis wrote on surgery and per- formed difficult operations -1106 First dissection at Strassburg 1517 Fallopius described the structure of the ear; discovered Fallopian tubes. .1523-1562 Eustachio discovered the thoracic duct, the Eustachian tube, and the rudimen- tary valve of the heart -1574 William Harvey explained the circula- tion of the blood (1628), which made a revolution in physiology 1578-1657 Capillary circulation, the pigmentary layer of the skin, structure of the lungs, kidneys, and spleen discovered by Marcello Malpighi 1628-1694 Leewenhoeck discovered the corpuscles of the blood, the spermatozoa, and bacteria in the mouth ( 1683) ... 1632-1723 Hoffmann explained influence of the nervous system 1660-1742 First transfusion of blood in man 1667 Tourniquet used at siege of Besancon. .1674 Existence of septic poisons proved by Albert von Haller 1708-1777 Inoculation for smallpox introduced into England from China 1721 Surgery made a science by John Hunter 1728-1793 Scientific study of insanity ; reformed methods for treatment, Binel. .. 1745-1826 Cures by mesmerism by Frederick A. Mesmer 1778 Edward Jenner completed the discovery of vaccination for smallpox 1796 First use of thermometer in disease. .. 1797 Diagnosis advocated by Corvisart 1808 Homeopathy by Samuel Hahnemann. .. 1810 Stethoscope invented by Lsennec 1816 Sir Charles Bell discovered that poste- rior roots of the spinal nerve cause sensation, and anterior, motion 1816 Chloroform discovered by Guthrie 1831 First modern germ theory suggested by the discovery of the yeast plant 1836 Theory of contagion advanced by Henle 1840 Hypnotism discovered by James Braid. .1841 Laughing gas used by Horac^ Wells. .. 1844 Ether first used by Dr. W. T. G. Mor- ton in surgical operations 1846 Chloroform used as an anaesthetic by Sir James Simpson 1847 Cohn proved that bacteria are plants. . .1853 Fermentation and putrefaction explained by Pasteur 1857 Virchow supplied the "cellular path- ology" 1858 Laryngoscope perfected by Czermak and Turck 1858 Sir Joseph Lister, founder of "antisep- tic surgery" (1861) 1827-1912 Osteopathy explained by Dr. Still 1874 Inoculation for hydrophobia by Pasteur 1885 Theory of germ diseases fully adopted 1885 Laveran discovered the Plasmodium of malaria 1880 Koch placed tuberculosis among germ diseases 1882 Bacillus of diphtheria discovered by Klebs and Loeffler 1883 Bacillus of tetanus (lockjaw) discovered by Nicolaier 1884 Serum therapy generally adopted 1889 Dr. Koch discovered lymph for check- ing growth of tubercle 'bacillus 1890 Antitoxin for diphtheria discovered by Behring 1892 X-Rays used in medicine 1895 Antitoxin for tetanus discovered 1897 Erysipelas serum used by Marmorek. . . 1902 Radium used in treatment of cancer. .. 1908 "606," a remedy for syphilis discovered by Dr. Paul Ehrlich 1911 Vaccination for typhoid fever compul- sory in U. S. A 1911 Spinal meningitis serum discovered by Dr. Flexner 1911 BOOK V. WOMANHOOD AND MOTHERHOOD MENSTRUATION. Menstruation or the monthly flow takes place, generally, between the fourteenth and sixteenth years of age, sometimes as early as eleven or twelve. A considerable period may elapse between the first and second appearance ; but, when it is properly established, its recurrence at regular periods may be calculated on with great certainty, unless some functional derangement of the system interferes with it. Ordinarily, a lunar month of twenty-eight days is the intervening period ; but with some women the discharge occurs every third week. The discharge resembles blood in color, but it does not coagulate. The quantity is from three to five ounces, and the process occupies from three to seven days. The cause of this monthly flow is the ripening and expulsion of the egg from the ovaries. "Omne vivum ex ovo" (Every living thing comes from an egg or germ) is the universal law of reproduction. This can be shown as well in the vegetable as in the animal kingdom. The oak from the acorn, the ear of corn from the grain planted by the farmer, the robin and the elephant, all springing from germs, go to prove the truthfulness of this law. Every seed, every egg, contains a germ, which, when brought under proper influences, will produce its own kind. Thus far all is plain enough, but where do these germs originate? It has been ascer- tained that each animal, as well as each plant, is provided with an organ for the production of these cells or germs. In the female this organ is the ovary. The ovaries are two in number — small, oval bodies, about one inch in length, a little more than half an inch in breadth, and a third of an inch in thickness. Each ovary is attached to an angle of the womb, about one inch from its upper portion, by a ligament. The whole physio- logical function or duty of the ovary is to mature and deposit its ovum or egg every twenty-eighth day, from the age of fifteen to that of forty- five, or for about thirty years. This function is suspended only during pregnancy and nursing, but sometimes not even then. There are cases on record where the woman has had her courses regularly during the time she was pregnant, and there are many with whom lactation does not 4 62 WOMANHOOD AND MOTHERHOOD. interfere. During the ripening and discharge of the ovum into the canal or tube which conveys it into the womb, the generative organs become very much congested, looking almost as if inflamed. This con- gestion at last reaches such a height that it overflows, and produces a discharge of blood. Menstruation consists merely in the ripening and discharge of an ovum which, when not impregnated, is washed away by the menstrual blood. It will be seen that a woman can become pregnant only at or near the time of her menses. The marvelous regularity of men- struation has always excited great wonder. When we look around, we see that both animal and vegetable life have regular times at which germ production takes place. Fruits and vegetables ripen, and animals produce their young, at certain periods. It is a law of nature. Now, since we have shown that menstruation consists in the ripening and regular deposit of an egg — the flow being but the outward, visible sign of such an act — it is possible that a woman may menstruate without any manifes- tation. To prove this, there are many cases on record where a woman has married and become pregnant without having had the least show, which would be impossible if she did not menstruate. Again, a woman who has always been regular may have several children, without in the meantime having had any sign. This may be explained by her becom- ing pregnant during the time she was nursing her first child, carrying it to the full term, again becoming pregnant, and so on, until, being no longer impregnated, her courses return, and are regular thereafter. Menstruation commences at about the age of fourteen or fifteen in this country. In warmer climates it appears earlier, and in colder ones later.. Menstruation, menses, courses, catamenia, monthly periods, and "being unwell," are some of the terms by which this function is desig- nated. The appearance of the menses before the fourteenth year is regarded as unfortunate, indicating a premature development of the organs; while their postponement until after the sixteenth year is gen- erally an evidence of weakness, or of some disorder of the generative apparatus. If, however, the person has good health, and all her func- tions are regular; if her spirits are not clouded, nor her mind dull and weak, it should not be considered necessary to interfere to bring them on, for irreparable injury may be done. The first appearance of the menses is generally preceded by the following symptoms: headache, heaviness, languor, pains in the back, loins, and down the thighs, and an indisposition to exertion. There is a peculiar dark tint of the coun- tenance, particularly under the eyes, and occasionally uneasiness and a MENSTRUATION. 463 sense of constriction in the throat. The perspiration has often a faint, sickly odor, and the odor of the breath is peculiar. The breasts are enlarged and tender. The appetite is fastidious and capricious, and digestion is impaired. These symptoms continue one, two, or three days., and subside as the menses appear. The menses continue three, five, or seven days, according to the peculiar constitution of the woman. The quantity discharged varies in different individuals. Some are obliged to make but one change during the period, but they generally average from ten to fifteen. It is during the menstrual period that the system, especially of young persons, is more susceptible to both mental and physical influences. Very much depends upon the regular and healthy action of the discharge, for to it woman owes her beauty and perfection. Great care should there- fore be used to guard against any influences that may tend to derange the menses. A sudden suppression is always dangerous ; and among the causes which can produce it may be mentioned sudden frights, fits of anger, great anxiety, and powerful mental emotions. Excessive exer- tions of every kind, long w r alks or rides, especially over rough roads, dancing, frequent running up and down stairs, have a tendency not only to increase the discharge, but may produce falling of the womb. The quantity and duration of the monthly flow varies greatly in dif- ferent women, but the regular recurrence of the flow is important to health. This should be borne in mind, and due care taken not to suppress the discharge by exposure to cold or wet, or by violent exertion of any kind about the time when it may be expected. It is desirable that young females should be properly informed by their mothers, or those under whose care they are placed, of what may be expected at a certain age, or they may be alarmed at the first appearance of the menses, taking it to be some indication of a dangerous disease or injury, and perhaps, by mental agitation, or resort to medicines, do themselves harm. DELAYED OR OBSTRUCTED MENSTRUATION OR AMENORRHOEA. If the menses do not appear at the usual age or for some years after, no alarm need be felt, provided there are no constitutional derangements which can be attributed to this cause. If the girl has not developed about the hips and breast, and feels not the changes peculiar to this period, it would be very injurious to attempt to force nature. If, however, she 464 WOMANHOOD AND MOTHERHOOD. is fully developed, and her general health suffers, a course of treatment will be necessary. Causes. — An undeveloped state of the ovaries or womb ; an impover- ished condition of the blood; or the patient may be phthisical (consump- tive). Symptoms. — Unnatural heats and flushings, headache, tendency to faint, and hysterical symptoms are common, also symptoms of anaemia. (See "Anaemia.") If the patient is consumptive there will be cough, general debility, night sweats. (See "Phthisis.") Treatment. — If due to imperfect development of the organs of generation consult a physician. As a rule, however, but little can be done. If due to anaemia, treat accordingly. If due to phthisis (consumption), treat accordingly. If there is no congenital defect of organs of generation, anaemia, or phthisis, menstruation will appear in due season. Hot vaginal douches may be employed for the purpose of deter- mining an increased blood supply to the parts, thereby favoring menstruation. SUPPRESSED MENSTRUATION OR AMENORRHOEA. Suppression is the stoppage of the menses after they have once been established. It may be either acute or chronic. Causes. — Sudden cold, wet feet during the flow, fear, strong emo- tions, anxiety, or any cause that affects the general health. Chronic suppression may result from the acute, or from defective nutrition of the organs ; from the early termination of menstrual functions, or from weakness occasioned by leucorrhcea. Symptoms. — The symptoms usually present are those mentioned in delayed menstruation, but in a more aggravated form. In chronic sup- pression, failure of the general health, loss of appetite, pains in the head, back, and side, and constipation are the usual symptoms. At the regu- lar periods when the menses ought to appear, there will be great excita- bility, and an aggravation of the above symptoms. With those of full habit, there will be a strong, bounding pulse, with acute pain in the head, back, and limbs ; with the feeble, extreme languor, trembling, shiv- ering, and pale visage. MENSTRUATION. 465 Treatment. — A physician should be consulted and his advice fol- lowed in every particular. Where the flow has stopped suddenly from exposure, the patient may take warm drinks, salient aperients, till the bowels are opened; have hot bran poultices applied to the lower part of the abdomen; immerse the feet and legs in hot mustard water. The patient must be kept as quiet as possible. If the flow fails to appear, wait until the next period and use the hip bath a few days before the period. To the bath may be added a little mustard; and, on every occasion, active friction with dry, coarse towels should be used. Also give the following, which seldom fails if persisted in : — Barbadoes Aloes, 1 dram. Sulphate of Iron, 1 dram. Powdered Cayenne, y 2 dram. Extract of Gentian, y 2 dram. Simple Syrup, Sufficient quantity. Mix and make into sixty pills. Dose, one pill night and morning, during and between periods, for tonic effect. The warm hip bath should be used about the proper period of menstruation ; and it would be well to given some uterine stimulant, such as a mixture composed of spirits of turpentine, made into an emulsion with yolk of an Qgg, and essence of juniper, about six drams of the first and one of the last, in a six-ounce mixture, one ounce to be taken three times a day. Attempts to promote the discharge in any case must not be prolonged much beyond the menstrual periods, between which all possible means must be taken to strengthen the system — good diet, plenty of active exercise, the use of the shower bath, or cold or tepid sponging are proper remedies. If the amenorrhcea proceeds from a want of energy in the uterine organs, as is often the case after frequent miscarriages, childbearing, inflammation, leucorrhcea ("whites"), there will probably be a white discharge only, accompanied by acute pain across the flat of the pelvis, vertigo, and hysteria. Weakly young women, before the appearance of the menses, and elderly ones, at the time of cessation, or "change of life," as it is commonly called, are often so affected. In such a case aloes, good nutritious diet, and the recumbent position as much as pos- sible during the periods. 466 WOMANHOOD AND MOTHERHOOD. PAINFUL MENSTRUATION OR DYSMENORRHOEA. This is menstruation preceded, accompanied, or followed by pain. Causes. — Neuralgia, abnormal congestion of the generative organs, closure of the mouth of the womb, excessive contraction of the mouth of the womb, new growths in the womb, displacement of the womb, or disease of the ovaries. Symptoms. — The pain may be sharp, shooting, and shifting, or there is sense of weight, bearing down sensations in the back and flat of the pelvis, flashes of heat, a flushed face. Or there may be spasmodic, cramp- like or colicky pains, accompanied by the expulsion of membrane from the inner surface of the womb, which may be mistaken for blood clot or the product of conception, but which if floated in water shows one surface smooth, the other rough and shaggy. In all forms the pain is usually relieved when the flow becomes full and free. Treatment. — Those cases due to obstruction to the outflow of menstrual fluids, and those due to ovarian disease, require the services of a competent physician. Neuralgic cases, and those associated with excessive local conges- tion, are benefited by hot water vaginal douches, hot hip baths, hot applications externally over the region of the womb, together with the use of the following rectal suppository: — Extract of Belladonna, i 1 /* grains. Cocoa Butter, a sufficient quantity to make three rectal suppositories, one of which may be inserted every four or five hours, until pain is relieved. Should constipation coexist, a purgative dose of Epsom salts ad- ministered in a little hot water for quick effect will be of benefit. Between periods, take plenty of fresh air and exercise, nutritious foods and tonics, such as recommended in the article on "Anaemia." Or, one teaspoonful of elixir iron, quinine, and strychnia in a wine- glass of water may be taken after each meal. PROFUSE MENSTRUATION. This appears either as a prolonged or excessive period and is called menorrhagia, or as a flow occurring irregularly between the period:^ known as metrorrhagia. It may be due to local disease of the womb or its appendages, or to disease of the heart, lungs, liver, etc. Treatment. — To check the hemorrhage, the following is efficient : — MENSTRUATION. 467 Hydrastin, 6 grains. Ergotin, 12 grains. Gallic Acid, 36 grains. Mix, and divide into twelve capsules and give one every two or three hours as required. When due to disease of the womb (the most common cause), heart, lungs, etc., a physician should be consulted. MENOPAUSE OR CESSATION OF MENSTRUATION. Cessation gives notice that the period of childbearing is past. With females of our age and country, the courses commonly continue up to the age of from forty to fifty ; sometimes they cease at about thirty-five, and in a few instances they have been known to continue up to the age of sixty. This cessation marks what is commonly termed the change of life in women, and with those of average health it occasions little or no disturbance of the general system. There may be flushings of the face, and a sense of fullness in the head, with occasional dizziness, but with those who are weak and nervous, or suffering from organic disease, we generally see a marked change at this period. With most persons the stoppage of the menses is a gradual process — the intervals become protracted, the quantity decreases, and by and by disappears; with some the cessation is sudden and complete. THE WOMB. This most important organ is situated in the cavity of the pelvis — from whence, when distended in pregnancy, it rises into the abdomen. It is of a flattened pear shape, and is held in its place by elastic liga- ments. In its natural state it is about three inches in length by two in breadth across the broadest part, and one in thickness. At the period of puberty it weighs about one and a half ounces; after parturition, from two to three ounces; and in the ninth month of utero-gestation, from two to four pounds. It is supplied with glands, vessels, and nerves, the latter of which constitute an extensive network over its entire surface. The ovaries are two in number — one on each side of the uterus. They are nearly as large as the male testicles, and perform a corresponding function. When the egg (or ovum) has been perfected in the ovary, it is seized by the extremity of one of the Fallopian tubes, and conducted to the uterus. 468 WOMANHOOD AND MOTHERHOOD. FALLING OF THE WOMB (PROLAPSUS UTERI). This is the falling of the womb from the weakening of its supports, and the pressure of the viscera above, generally increased by tight lacing and the pressure of the clothing sustained by the abdomen. Consti- pation, and the daily effort to dispel the contents of the rectum and straining, aid in the production of this trouble. An abnormally large pelvis, pregnancy, and the weight of tumors, abdominal dropsy, violent coughing, and the relaxation of the vaginal walls, all tend to produce this downward displacement. Symptoms.— Severe pain, sometimes hemorrhage and bearing down sensations; pain at the back of the head; backache, and aching loins; frequent passing of small quantities of urine; constipation; whites (leucorrhcea) ; irregular, scanty, or profuse and painful menstruation; sterility. Treatment. — This can be instituted only by a physician. The womb is also liable to fall either backwards (Retroversion) or forwards (Anteversion) , but the treatment of these conditions must be confided to an experienced physician. CANCER OF THE WOMB. Symptoms. — Sudden, shooting pain through the abdomen, which disappears entirely, or leaves after it a dull aching or gnawing sensation, accompanied by discharge of a fluid which is sometimes pale and thin, but soon becomes thicker, yellower, perhaps streaked with blood, and very offensive, is suggestive of cancer. This pain is gradually rendered more severe and almost constant, and an exhausting hemorrhage sets in, perhaps continuing until checked by fainting. In other cases, a burn- ing heat, followed by a fetid discharge of matter which is mixed with streaks or spots of blood, is experienced. Treatment, — Cleanliness, fresh air, plain, nutritious diet, regula- tion of the bowels, and tranquillity of mind, are all that can be recommended in a work like this. The woman who has the misfortune to be visited with this affection must resolutely determine to retire from the active duties of life, and abstain from indulgences which would excite her passions and increase the circulation of blood. Bland, sooth- ing nourishment, and local applications, are all that can be administered until she can have judicious and experienced medical assistance. Her bowels should be kept open; the fetid and erosive discharges should be DISEASES OF THE WOMB. 469 washed away by antiseptic injections as carbolic acid water or creolin — one teaspoonful to every quart of warm water. POLYPUS OF THE WOMB. When a woman has been wasting away for some time with copious hemorrhages, and the remedies recommended under the head of "Flood- ing" have been faithfully but unsuccessfully tried, there is great reason to suppose that she has a polypus, and medical advice should be at once procured. Formidable as the last two diseases are, they are not always beyond the reach of surgery. An operation is imperative. The ovaries, uterus, and Fallopian tubes are so closely connected in situation and function that they are generally inflamed together. The cause may be weakness, causing a local determination of some general disturbance, such as cold or irritation of these organs. It usually fol- lows childbirth, abortion, or excessive and violent sexual intercourse. ULCERATION OF THE NECK OF THE WOMB. Ulceration of the neck of the womb is produced by corroding dis- charges and the irritation of continual sexual intercourse. It is readily cured by abstinence, vaginal injections, and direct application to the parts of a strong solution of nitrate of silver once in five or six days; or by the ulcers being touched with solid nitrate of silver once in five days. FLOODING (UTERINE HEMORRHAGE). This commonly occurs after abortion or labor, or it may be occasioned by disease of the womb. Immoderate flow of the menses is also called flooding, and to this some women are very subject. It is extremely weak- ening to the system and therefore should be checked as soon as possible. Treatment. — The best treatment is perfect quiet, and astringent and tonic medicines like the following : — Tincture of Sesquichloride of Iron, 2 drams. Infusion of Quassia, 6 drams. Mix, and take a tablespoonful every four hours. If there is much pain and irritation, add tincture of conium, or hyoscyamus, two drams. (See treatment of "Profuse Menstruation.") Should this not have the desired effect, consult an experienced physician, as there is reason to fear disease of the womb. 470 WOMANHOOD AND MOTHERHOOD. INFLAMMATION OF THE OVARIES (OVARITIS). This disease is characterized by pain, heat, swelling, perhaps red- ness, in one or both groins. It is to be treated as any other inflamma- tion — sitz baths, with rest, and a strict diet. The bowels must be occasionally opened by a gentle aperient, as castor oil. Injections of tincture of belladonna and hyoscyamus are very useful and soothing. INFLAMMATION OF THE WOMB. The treatment is much the same, with the addition of local treatment of the inner surface of the womb, which must be directed by a physician, after thorough examination. WHITES (LEUCORRHOEA). There is no disease so common among women as this complaint. Few married women, particularly if they are mothers, escape its attacks. Very generally this troublesome discharge is associated with general debility, especially if profuse for any length of time. Hence it is very desirable that attention should be paid to it at the commencement; for, if neglected, it may seriously impair the constitution. Causes. — Over-exertion and irritation of the uterine organs. It may also be brought on by diarrhoea, piles, worms, irritation of the bladder or of the nervous system, excessive sexual intercourse, miscarriage, abortion, and displacement of the womb. Weakness, too, is a cause as well as a consequence of this affection; confinement in a warm atmos- phere and luxurious living must likewise be numbered among its exciting causes. Symptoms. — In leucorrhoea the discharge is commonly white and thick. After a while the color will perhaps change; sometimes the dis- charge will become very acrid, causing abrasion and smarting. In this stage it is apt to cause a gleety discharge from the urethra of one hav- ing sexual intercourse with the patient. Ere long, if the disease is not checked, we get great local irritation and constitutional disturbances : there will be costive bowels, pains in the loins and back, great lassitude, with nervous and hysterical affections. Menstruation, too, will be irregu- lar, at times altogether suspended, and at others profuse. Treatment. — If the patient is of full habit, saline aperients should be taken, and a spare diet observed; local ablutions should be prac- tised three or four times a day, using occasionally a decoction of WHITES. 47* poppies for the purpose; the hip bath, and an injection of alum and water, with a scruple of powdered opium in each pint, will also be found serviceable. The recumbent position should be preserved as much as possible, and the parts kept cool. Local treatment will be of little avail in cases of long standing unless the general health be attended to. To keep the bowels open, take five grains of compound rhubarb pill as often as required; and to strengthen and cool the system the following mix- ture : — Sulphate of Iron, 12 grains. Diluted Sulphuric Acid, 1 dram. Sulphate of Magnesia, 3 drams. Cinnamon Water, 12 ounces. Mix, and take two tablespoonfuls two or three times a day. Local treatment : — Zinc Sulphate, 1 ounce. Acetate of Lead, 1 ounce. Mix; one teaspoonful in two quarts of warm water as a vaginal douche morning and night. Or:- Borax, 4 ounces. Baking Soda, 8 ounces. Chlorate of Potash, 4 ounces. Mix; two level tablespoonfuls in two quarts of warm water as a vaginal douche twice daily. Or, mucol, a teaspoonful to a quart of water twice daily as a vaginal douche. Women who have leucorrhcea should avoid all predisposing causes, such as wines and other stimulants, luxurious living, and sensual indul- gences of all kinds, especially, and anything which has a tendency to enervate and enfeeble the frame. Early rising and regular open-air exercise, warm and comfortable clothing, good food and tonic medicine, with the use of the shower bath and bathing — these will prove the best preventives. PRURITIS VULVAE. This term designates a condition characterized by excessive irrita- tion and itching of the external genitals. It may be due to uncleanli- ness, general debility, anaemia, disorders of digestion, diabetes, diseases of the uterus, and change of life. Pregnant women frequently suffer from it. 472 WOMANHOOD AND MOTHERHOOD. Treatment. — Strict cleanliness, hot water douches, and the parts should be bathed with black wash (one dram of calomel to a pint of limewater) or baking soda, or borax, one dram to a pint of cold water, or the following ointment may be applied : — Salicylic Acid, 15 grains. Thymol or Ichthyol, 1 y 2 drams. Vaseline, 1 ounce. Mix, and apply as required. If the itching becomes very intense the application of a nitrate of silver solution (ten grains to the ounce) may be required. This should be used very carefully. The tissues turn dark on application of the last solution. Alkaline waters are sometimes of benefit, such as alkalithia — a tea- spoonful of which may be administered one to three times daily in a glass of water half an hour before meals to render the urine bland and non-irritating. General Tonic Treatment. — Elixir iron, quinine, and strychnine, one teaspoonful in a wineglass of water after each meal. Or, Phillips' Phospho-Muriate of Quinine, one teaspoonful in a wine- glass of water after each meal. MOTHERHOOD. PREGNANCY. Utero-gestation, or the period from the time of conception to that of delivery, extends over a space of forty weeks, or two hundred and eighty days. In making the necessary provision for the coming of labor, it is best to count back three calendar months from the date of the last menstruation and add seven days ; for example : if menstruation appeared June 16, count back three months to March 16, and add seven days, which would make March 23 the probable date of confinement. If conception takes place while the woman is nursing, the day of delivery can be approximately estimated by the size of the abdomen, but this is a very unsatisfactory method. A better plan is to note the appear- ance of quickening (foetal movements), which is felt usually about the middle of pregnancy (the end of the twentieth week), and count the day of delivery to be between twenty and twenty-one weeks later. 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P. s 02 S rH • CD • li 6^ o rQ : rH K r^^ co ^ 1 1 & I 474 WOMANHOOD AND MOTHERHOOD. the end of the fourth lunar month or later. They are : ( i ) quickening ; (2) hearing the fcetal heart-beat (the listener's ear being applied to the woman's abdomen), only a trained ear can detect it; (3) the ability to trace the outline of the foetus through the abdominal wall. Other signs of pregnancy, termed "doubtful signs," are: — 1. The Cessation of the Menses. — This is by no means an unfail- ing sign, for sometimes this discharge will cease from other causes, and sometimes it will continue after conception has taken place. 2. Morning Sickness. — This generally commences about the fourth or fifth week and lasts to about the fourth month. With some this is but slight and causes little inconvenience ; but with others it is more con- tinuous and serious, sometimes causing the rejection of nearly all food for a very considerable period. This symptom, again, cannot be taken as a proof of pregnancy; it is merely a suspicious circumstance, to be watched in connection with others. 3. Dyspepsia and Cravings. — The woman's appetite is capricious, and she may long for peculiar articles of diet or those out of season. 4. Enlargement of the Breasts. — They generally increase in size about two months after conception. They also become tender and sore ; they throb and burn, and, when pressed by the hand, have a hard, knotty feeling, in consequence of the swelling of the glands by which the lacteal fluid is secreted. The nipple, also, becomes more prominent, and in- creases in diameter, while the areola around it assumes a purplish tinge, and has on it several little raised pimples of a yellowish white color. 5. Enlargement of the Womb and Abdomen. — In the fourth month, this becomes very perceptible, — the womb, which may now be felt as a firm, rounded body, having ascended above the pubes, and pushed the bowels up into the abdomen. 6. Bladder Disturbances. — Urine is voided more frequently owing to pressure on the bladder. This condition is relieved after the fourth month as the womb rises out of the pelvic cavity into the abdominal cavity. It reappears during the last month of pregnancy when the womb with its contents sinks into the pelvis. 7". Changes in the Skin Covering the Abdomen. — There may be a slight brownish discoloration of the skin around the navel and extend- ing downward, and similar brownish patches may appear on the fore- head, face, and neck. These disappear after confinement. Where the abdominal skin is stretched, white lines appear and remain after confine- ment. PREGNANCY. 475 Conduct During Pregnancy. — A pregnant woman should be aware that the advantages obtained by well-regulated habits are by no means exclusively conferred on her, but that others equally important are likewise conferred on the child, for whom a larger supply of nutrition, and of a better quality, will thus be provided; and so its career of life will commence strong, vigorous, and less liable to those morbid debilities and derangements which affect the children of the indolent, the pam- pered, or the debauched. From the moment, therefore, that conception has taken place, a new and most sacred duty devolves upon the female. She is bound by all the ties of maternal sentiment, of humanity, and of moral and religious obligations, to protect the being in her womb against every circumstance, under her control, which might have an unfavorable influence on its delicate organization. Diet During Pregnancy. — The peculiar tendency to irritation in pregnancy renders it especially proper to avoid undue excitement. Moderation and simplicity of food are especially proper in this case. As the appetite is frequently very craving during this period, an inordinate indulgence in rich and high-seasoned food is among the most common errors ; and this mistake is the more readily fallen into from the errone- ous idea which many entertain, that, as the foetus draws its nourishment from the maternal system, a greater quantity of aliment is required in pregnancy. The exercise of caution in the selection of proper food appears to be particularly important towards the termination of gestation. When the stomach is in a weak and irritable state, oatmeal, the lean part of mutton, tender beef, soft-boiled eggs, and stewed apples consti- tute appropriate articles of nourishment. But it is always to be recol- lected that the temperate use of food is of more consequence than the selection. Coffee and tea may be moderately used; but alcoholic drinks should be studiously avoided. The temptation to indulge in small potions of cordial, or brandy, in the early months of gestation, is often very strong; but it ought to be firmly checked, or the deplorable habit of soli- tary dram drinking may be the result of indulgence. The sensibilities of the stomach, in some instances, undergo extraor- dinary derangement, especially in weak and delicate women. Articles of food, which, previous to pregnancy, were very grateful and congenial, become highly disagreeable, and an almost irresistible craving for sin- gular and even disgusting substances is experienced. This remarkable irregularity of the appetite is usually called a longing. If the substances 476 WOMANHOOD AND MOTHERHOOD. longed for be not evidently of an injurious character, they should not be withheld; in some instances, these longings may be regarded as in- stinctive calls of the stomach for articles favorable to the health of the individual. Thus, when a strong desire for eating chalk, charcoal, or clay is manifested, we are admonished that the digestive powers are feeble and that there is a tendency to acidity in the stomach. In such cases the means of relief are alkalines, mild laxatives, and tonic vegetable bitters. Dress and Exercise. — The custom of wearing corsets during gesta- tion cannot be too severely censured. It gives rise to functional disorder of the stomach and liver, as well as to uterine hemorrhage and abortion in the mother; it likewise impedes the regular nourishment of the foetus in the womb. The clothing should always be sufficient to protect the body against the injurious influence of cold; the abdomen and feet espe- cially should be guarded against injury from these causes. In winter, or cold and damp seasons, the use of a flannel bandage or roller around the abdomen will be found very beneficial and comfortable. All kinds of agitating exercise, such as riding in carriages with rapidity over rough roads, dancing, lifting or carrying heavy loads, — in short, all masculine and fatiguing employment whatever, — ought to be avoided by pregnant women; and the more so as gestation approaches the term of its regular completion. During the eighth and ninth months of pregnancy unusual exertion or fatigue is particularly apt to excite premature labor. Riding in an easy carriage on even roads, or moderate walking, may be enjoyed with great propriety, and usually with obvious advantage during gesta- tion. Moral Influences. — Tranquillity and cheerfulness of mind are of prime importance during pregnancy. Convulsions, severe hysteria, spasms, syncope, hemorrhage, and abortion may be produced by violent anger, terror, or jealousy, during pregnancy. Intense grief will occa- sion debility, indigestion, jaundice, and various other functional disorders. A strong excitement of the imagination is supposed by some to be capable of producing impressions on the foetus in the womb. The Breasts.— The breasts and nipples should be particularly attended to during the latter months of gestation, in order to prepare them for suckling the infant. For some weeks before the expected termination of gestation, the nipples should be daily washed with luke- warm water, then dried by exposing them to the free air, and after- wards gently rubbed for five or six minutes with a soft piece of flannel, PREGNANCY. 477 or with the extremities of the fingers. When the skin of the nipples is very delicate and sensitive, they may be washed with brandy and water, or a wash composed of two drams of the tincture of myrrh, one dram of laudanum, and two ounces of water. In using this, the nipples should be first bathed with lukewarm water, and dried and rut bed as before directed, and then washed with the lotion. Com- pression of the breasts by corsets, or any other artificial means, is carefully to be avoided. When the nipples are very small, or sunk in the breasts, they should be drawn out by means of a suction pump or with a common clay tobacco pipe. This process should be repeated several times daily, until they have acquired a sufficient degree of prominency. Care of the Teeth During Pregnancy. — To insure in a child a clear mouth full of strong teeth, we should begin with the expectant mother. She must bring herself into as perfect a physical condition as possible by not violating the laws of nature regarding diet, rest, sleep, and fresh air. She must have plenty of fresh air and moderate exer- cise, sleep well and long enough; she should chew her food slowly and thoroughly, eat a generous mixed diet, not forgetting that baby must have bone salts from which to form its bones and teeth, for very soon after the beginning of pregnancy there is being created a more than normal demand upon the system of the mother for these bone forming elements. Now the question arises, "Where must they come from?" Noted physiologists, by a careful study of the chemistry of the tissues, have presented to science many important data, concerning, among other things, the influence of our diet upon the formation of various tissues within our bodies, and it is only comparatively recently that they have satisfied themselves that in order to supply the wants of the system the food must consist of a combination of elements which are represented in the tissues, so that for the elements required in the baby's system we must look to the diet of the mother. Hence, if we wish to harden baby's bones and present it with a good set of teeth, which will not be too chalky and brittle and will have the natural elements of good tooth structure to resist decay, we must give it a good inheritance to such, conditions by incorporating into the mother's food the elements of bone formation in some form or other, whether it be in the form of medicine or in the articles of food she should take. Many cases of deficient nutrition in pregnancy are treated by supply- ing the system with the- required elements in a medicinal form, but 47^ WOMANHOOD AND MOTHERHOOD. as nature provides these in abundance in many articles of food, in a form far more palatable than medicine and yet far less expensive, we can conceive of no need in the average case of anything but good judgment in the diet given. When we know that an analysis of bone reveals principally the phosphate and carbonate of lime, with the chloride of sodium and phosphate of magnesia present in small quantities as its inorganic or mineral (earthy) matter, and that it is this which we are particularly desirous of in the structure of our teeth, we shall then have to assume that unless we introduce plenty of these bone forming elements into the system of the mother to supply this want, they will be taken from the mother's bones — to the harm of the mother. As want of space prevents us from noticing the different foods which yield the individual salts, it will suffice to say that it is the phosphate of lime to which bone owes its firmness and hardness, and this salt occurs in combination most abundantly in any of the cereal preparations which are made from the whole kernel of wheat, oats, or rye; but preeminent among useless, yes, destructive, foods, and that for which there is so little compensation for the eating, is common white flour, for the gluten, which is the life-giving principle of the wheat, is entirely left out of this foolishly fashionable white flour, and it is time we were considering the consequences, as it is cruel to feed our children upon so imperfect food, for a child deprived of lime phosphates in its foods will have rickets, curvature of the spine, and loss of teeth; and an adult eating an excess of starch in the form of fine white flour has gout, rheumatism, and obesity, with early loss of teeth. A person, young or old, subsisting chiefly upon pies and cake and other fancy pastry and desserts, as is the case in many well to do families that boast of good living, loses his teeth in spite of eternal vigilance and most skillful dentistry, but still people scoff at dietary reform and blame the dentist and the Creator for their imperfect teeth. Why not, then, adopt the wholesome loaf of whole wheat bread, which contains four times as much proteid matter as an equal weight of white bread, place it upon your tables, and the children will soon convince you that it is a wholesome, healthful, natural food, and to your own taste all other breads will soon seem flat and unsatisfying? We find alkaline, phosphates, and other soluble salts in meat, eggs, milk, etc. ; also many articles of the vegetable kingdom might be added as a typical diet, to the exclusion of too much pastry cooking. TEETH. 479 And just now a word in regard to the mother's teeth at this period It is an old but very true saying that for every child a tooth, and many practitioners will be ready to even more than substantiate this statement by saying that for some mothers the birth of even one child has been the starting point for the loss of nearly all the teeth they have, for the disturbances of nutrition during pregnancy often cause an acid condition of the mouth and a very highly inflamed condition of the mucous membrane, sore and bleeding gums, while at times so very painful does this condition become that the thorough cleansing of the teeth is made impossible, and the food stuffs remaining around about the necks of the teeth undergoing the process of fermentation and acid formation, also making a feeding ground for bacteria, which under such favorable conditions of heat and moisture grow, thrive, and multiply in untold numbers, render in turn a still further acid condition by their waste products, producing a most favorable condition in all for the destruction of the teeth. We have, then, first of all, to prepare the mother's mouth to resist these conditions and avoid suffering by a visit to a good dentist, who, with a knowledge of the conditions, will with the least possible incon- venience to the patient put the teeth into a condition to insure comfort for this period. Failure in this measure may result in a great deal of suffering, for it is during this time that such disturbances as will necessarily arise will be, by the reflex nervous mechanism, referred to any diseased tooth along the path of the fifth nerve (which supplies the teeth). Oftentimes these conditions give rise to a severe toothache for several hours where there are no diseased teeth in the mouth. The teeth being in good order, we must now watch the saliva and keep it neutral (neither acid nor alkaline in reaction). A convenient test for such conditions can be made by the use of litmus paper, which can be had in any drug store, made in two colors, red and blue. By touching this paper to the tongue when moist with saliva, if it be acid the blue paper will be turned red in color; if alkaline, red will be turned blue by this test. This acid condition may be locally corrected by the use of slightly alkaline mouth washes. The one most often recommended by dentists is called milk of magnesia (Phillips'), and in case of inflamed gums, as referred to above, any good antiseptic mouth wash might be of service, among which may be mentioned boro-lyptol, listerine, pasturine, and glyco-thymoline ; but where gums are very soft and spongy a more 4 8o WOMANHOOD AND MOTHERHOOD. astringent wash is necessary to harden and shrink the gums, such as the following prescription calls for : — Tannic Acid, iy 2 drams. Iodide Potassium, 12 grains. Tincture of Iodine, 1 dram. Tincture of Myrrh, 1 dram. Rose Water, 6 drams. Dissolve the tannic acid and iodide of potassium in the rose water and add the tinctures, then strain. Use one teaspoonful of this to one-half glass of warm water twice daily as a mouth wash. Should this wash not relieve the condition it is because its use is too superficial to reach the seat of the trouble, which has been of so long standing that it will require some prophylactic treatment by a dentist, who can render no greater service to humanity in any way than in the thorough cleansing of the teeth under the free margins of the gum and in such places as the patient cannot reach by the use of the tooth brush. And while many have listened to the careful warnings of our elders, never to enter the dental office for any dental services while in a pregnant condition, a consensus of opinion of best authors tells us that in these days, with modern facilities for relief rather than for torture, in the hands of a good, careful dentist, it is better for the patient's general condition to have dental work of necessity done in a temporary way than to suffer the consequences which follow the neglect of such services when needed. For to maintain a cheerful attitude, which is desired above all, during pregnancy, as there is no tonic which will keep up the general tone of the system like peace of mind and happiness, would be just as hard to do while under the depressing influence of a few growling teeth, as it would be for us to live up to all the teachings of the Bible. Now, reasoning from a most rational conclusion that as, first, all plant and animal life must draw its nourishment from sources contain- ing in sufficient quantity their physical constituents, as animals it is evident that we develop and subsist solely upon such substances as are taken into our bodies. With this fact made clear, it is plain that such foods must contain in definite proportions precisely the chemical ele- ments of which our bodies are composed, or perfect development is impossible. It is also plain and reasonable to suppose that if these laws be kept with fairly good judgment, we may expect, under normal CONSTIPATION. 481 conditions, to have a well born, healthy child, fully developed and well rounded, with sound tissues and plenty of vitality, — the realization of every mother's fondest hopes. DISEASES OF PREGNANCY. MORNING SICKNESS. This complaint is sometimes very troublesome and obstinate. Treatment. — The patient should have breakfast in bed, and remain in a recumbent position for some time after. Small lumps of ice put into the mouth and allowed to dissolve will sometimes give relief. Give, if the sickness is troublesome, three times a day, a mixture composed of one scruple of bicarbonate of soda, dissolved in a wine- glassful of water, to which add a tablespoonful or two of lemon juice. Drink while effervescing. The following will also be of service: — • Bismuth Subnitrate, 80 grains. Dilute Hydrocyanic Acid, 16 drops. Cinnamon Water, to make 1 ounce. Mix, and take a teaspoonful every two hours until nausea and vomiting are relieved. CONSTIPATION. During the latter months of pregnancy constipation is nearly always present, the pressure upon the lower bowel being the cause. Violent cathartics should not be taken. A moderate dose of castor oil may be administered about every other day, or as often as necessary; but if the stomach nauseates at repeated doses of this, try the following mixture : — Sulphate of Magnesia, 1 ounce. Infusion of Roses, 6 ounces. Cinnamon Water, 2 ounces. Dose, a wineglassful every morning early. Or:— Maltzyme with cascara, or maltine with cascara, may be taken on retiring, in one-half to one teaspoonful dosage. Or: — Sharp and Dohme's Pil Lepactic, one or two pills on retiring. 4S2 WOMANHOOD AND MOTHERHOOD HEARTBURN. This may be removed by moving the bowels with a little magnesia, and taking a wineglassful of limewater in milk two or three times a day; or carbonate of magnesia, ten grains, in cinnamon water, with one dram of tincture of gentian; or a tablespoonful of Phillips' milk nf magnesia in a like amount of water will frequently relieve this condition. INCONTINENCE OF URINE. The frequent desire to urinate is most frequently due to pressure upon the bladder ; sometimes, however, the condition is due to nervous- ness. In any event one tablet of cystogen in a glass of water three times a day will afford relief. Or :— ' Formin 160 grains. Peppermint Water, ,...,.. 2 ounces. Mix. A teaspoonful three times daily in a wineglass of water will be beneficial Or:— Alkalithia 5 one teaspoonful in a glass of water one to three times daily one-half hour before meals- Owing to the frequent occurrence of diseases of the kidney during pregnancy and the serious consequences attending the same, no preg- nant woman should neglect to send her physician a sample of morning urine once a month for the first seven months, twice during the eighth month, and each week during the last month, that he may determine the presence or absence of kidney trouble. Nor should she neglect to inform her physician should she suffer persistent headache, dis- turbances of vision, persistent constipation, puffiness of the face, swelling of the feet, scanty flow of urine, or hemorrhage from the vaginal tract however slight. Shame, or delicacy, should not prevent the woman from disclosing to her physician the fact of any past or present local infectious disorder of herself or husband Strict attention to these suggestions may save her, and her as yet unborn child, serious affliction and even life. COUGH AND SHORTNESS OF BREATH may occur during the early months of pregnancy, A soothing cough MELANCHOLY. 483 mixture will benefit the cough, but, if it is persistent, the following frequently affords relief : — Oil of Sandal Wood, 2^ drams. Emulsion of Almonds, .... enough to make 4 ounces. Mix. One dessert-spoonful three times daily. Or:— Codeine, . 2 grains. Dilute Hydrocyanic Acid, 16 drops. Spirits of Chloroform, 3 drams. Glycerine, 3 drams. Syrup of Wild Cherry, to make 2 ounces. Mix. A teaspoonful in water every three or four hours. During the latter part of pregnancy, owing to the enlarged uterus pressing upward, there may be shortness of breath and cough. Relief may be obtained by using above mentioned remedies, but the condition usually persists until the womb sinks into the pelvis or until the child is born. PRURITIS VULVAE OR ITCHING OF THE EXTERNAL GENITALS. This has already been described in the chapter on "Womanhood" (page 471). INSOMNIA OR SLEEPLESSNESS. A cup of hot malted milk on retiring, a warm bath, or a hot foot- bath will frequently induce sleep. If this is not sufficient the follow- ing will be of service : — Potassium Bromide, 3 drams. Fluid Extract of Valerian, 6 drams. Simple Elixir, to make 3 ounces. Mix. Take a dessert-spoonful in a little water one hour before retiring. MELANCHOLY, DESPONDENCY, ETC. Despondency frequently seizes upon those who are about to become mothers; but generally, if the health be pretty good, it is shaken off as the great trial approaches. There are some women who are never so well and cheerful as during the time of pregnancy, but there are many to whom it is indeed a period of trial and suffering; and 484 WOMANHOOD AND MOTHERHOOD. especially is this the case with those who are about to become mothers for the first time. If it is apparent that the mental condition is becoming serious, treatment should be instituted. Treatment. — Keep the bowels open with some simple aperient, such as Hunyadi water or Apenta water, administered half an hour before breakfast. The diet should be light, nutritious, and easily assimilable. To quiet the nervous system the combination recommended above for insomnia should be given two or three times daily as required. A change of environment is advised. The patient should take a due amount of exercise in the open air daily, and her surroundings should be cheerful. VARICOSE VEINS. For cramps and pains in the legs, with swelling and varicose veins, sponge the legs with cold vinegar and water, and put on roller bandages or elastic stockings, and rest in a recumbent position. HEMORRHOIDS OR PILES. After each movement of the bowels, the parts should be bathed with cold water, dried and bathed with witch-hazel, and afterward anointed with : — Ointment of Nutgall, 1 ounce. Ointment of Stramonium, 1 ounce. Ointment of Belladonna, 4 drams. Mix. Apply locally and insert a little within the anus. Or:— Iodosyl suppositories, No. 12. Insert one on retiring. The bowels should be moved daily by the use of some simple aperient, Hunyadi water or Apenta water, half an hour before break- fast. Or:— Pil lepactic, No. 12. One on retiring. FALSE PREGNANCY. A condition frequently observed about the turn of life. The catamenia become irregular, previous to their final cessation, or are suppressed for a few periods; at the same time nausea or vomiting is experienced, the breasts enlarge, become sensitive or even slightly ABORTION. 485 painful, the abdomen grows fuller and more prominent, distention of the intestines by flatus communicates a sensation like that produced by the motion of a foetus ; the nervous system is generally much disturbed, and the woman feels convinced that she is pregnant, an idea which, at the time of life alluded to, is cherished by the sex with an ex- traordinary devotion, and relinquished with proportionate reluctance; and not infrequently at the end of the supposed gestation, the delusion is rendered complete, and almost assumes the character of a reality, by the occurrence of periodical pains strongly resembling labor. ABORTION OR MISCARRIAGE. The premature expulsion of the foetus from the womb, — that is, before the seventh month. After that period, if delivery occurs before the ninth month, it is called premature labor. Causes. — A sudden shock to the system by a fall or a fright ; strain- ing, or overreaching; the administration of strong purgatives or emetics; sexual indulgence, or aught which may tend to debilitate the system; malformation of the generative organs; fevers and severe inflammations; syphilis or constitutional disease of any kind; the growth of polypi or tumor in the cavity of the uterus, or adhesion to the surrounding viscera; and too great contractibility of the uterine fibers and blood vessels may cause miscarriage. Frequently a diseased condition of the foetus itself causes miscarriage. Two classes of females, very different in constitution and appearance, are liable to abortion, namely, those of a plethoric habit, and those in a weak and irritable condition. Those who continue to suckle after conception has again taken place render themselves liable to it, because a certain amount of nutriment required by the foetus goes to the formation of the lacteal fluid. Miscarriage is generally attended with much pain. It weakens the system, and often severely tries the constitution of the sufferer, whose liability to the accident increases with each occurrence. The periods at which it is most likely to take place are said to be about a month after conception, again in twelve weeks, and again in the seventh month, — the liability increasing in those stages which correspond with the periods of menstruation. Some women invariably miscarry at a certain stage; and thus, although often in the way to become mothers, are never blessed with offspring. By this it will be sufficiently plain that pregnant women ought to 4 86 WOMANHOOD AND MOTHERHOOD. avoid all violent exercises of the body, strong mental excitement, over- indulgence of sensual appetites, exposure to wet, or any extremes of weather, or aught which may tend to constitutional derangement of whatever kind; and those who have once aborted should be doubly careful on account of their greater liability. Symptoms. — These vary considerably, according to the stage of pregnancy, but usually there are slight pains in the loins and parts about the womb. There is a sense of bearing down, a frequent desire to make water or to evacuate the bowels, and a feverish state of the system generally. A discharge of blood commonly follows, sometimes in clots, at others in gushes; and this will continue until the foetus is expelled. As the patient cannot be considered out of danger until relieved of the ovum, the discharge ought to be carefully watched, and preserved for the examination of the medical man, should he not be present during its progress, which is much to be preferred. Treatment. — The first object when the premonitory symptoms above mentioned set in, is, if possible, to prevent abortion. To this end the patient must at once assume a recumbent position, and on no account be suffered to move more than may be absolutely necessary. She should be covered with clothing sufficient to keep her warm but not overheated, and a pillow be placed under the hips. Forty or forty-five drops of laudanum in six tablespoonfuls of starch water should be injected into the rectum, or a suppository containing one-half grain of extract of opium may be inserted into the rectum to quiet the uterine contractions. The bowels should be moved gently by such simple laxatives as Seidlitz powder, citrate of magnesia, Apenta water, Hun- yadi water, castor oil, a glycerine suppository inserted into the bowels, or the administration of a simple soap and water injection should the opiates cause constipation. If these measures fail the abortion is no doubt inevitable and a physician had better be summoned, whose efforts will be directed to the relief of pain, prevention of exhaustion, and finally the removal of the uterine contents. The best preventives of miscarriage are the frequent use of the cold hip bath, and sponging the lower part with cold water; strict attention to diet, and avoiding all violent purging medicines ; moderate, gentle exercise, and entire abstinence from sexual intercourse during the first months of pregnancy. About abortions voluntarily produced, we can only warn women of the folly and danger of resorting to unprincipled empirics, or the use of powerful drugs. Death frequently results from the employment CONFINEMENT. 487 of such means as are necessary to produce abortion, and it is far more honorable to bear the shame and disgrace of being the mother of illegitimate offspring than to incur the risk and sin of destroying your own and another life. Women in wedlock have positively no excuse for violating the parental instinct or wishing to commit so base a crime. PREMATURE BIRTH. A birth which occurs between the seventh and ninth month of pregnancy is called premature. It is a contingency to be most care- fully guarded against, for a child born before its regular time can scarcely be expected to have the strength and vigor of one which attains its full development in the womb. Nevertheless cases have been known in which the early-born child has grown up hearty and strong, and there are also cases in which, for the mother's sake, a premature labor is desirable, as giving the only possible chance of producing living offspring at all. Of course, none but a physician should be intrusted with the delicate task of bringing about a premature labor, and only malformation of the pelvis (deformity), or serious disease of the heart or kidneys, justifies the procedure. CONFINEMENT OR PARTURITION. Few women who are near their confinement are sufficiently cautious of exposing themselves to unnecessary fatigue and atmospheric changes. Take only gentle exercise, and avoid getting wet, chilled, or heated in crowded assemblies. Miscarriages, difficult labors, and frequently last- ing injury to mother -and child, if not death of one or both, are not infrequently the results of imprudence at this critical period. Therefore we impress upon all our readers who are likely to become mothers, the duty which they owe to themselves, their friends, and their future off- spring, and advise them to refrain from the exciting pleasures and labo- rious occupations of life. Let all the preparations for the little stranger be made in time, and the services of an experienced nurse engaged. Let the mother, or some female, be at hand to aid, counsel, cheer, and encourage, not only at the actual period of labor, but for some time previously. And let the mother in expectancy be treated with all possible love and gentleness. She may be fidgety and whimsical, — let her whims be indulged. She is fre- 488 WOMANHOOD AND MOTHERHOOD. quently in a state of great nervous excitement, — let her be soothed and dealt with tenderly. Preparation of the Bed and Patient. — Cover the mattress with a rubber sheet and over this place a cotton or linen sheet, fastening both securely with safety pins. A second rubber sheet is then placed across the middle of the bed and covered with another cotton or linen sheet. On top of these and under the woman's buttocks place a pad (one yard square and three inches thick) of cheese cloth or other material padded with cotton. This pad receives all discharges. When labor is completed this pad, together with the upper rubber and cotton sheets, are removed and the patient rests on a dry, clean bed. The patient's bowels should be emptied by means of soap and water injection or a glycerine suppository, and urine voided before she goes to bed. An empty bowel and bladder facilitates labor. When the patient goes to bed her nightdress should be rolled up above the small of the back to prevent soiling, and the abdomen and thighs be covered with a small sheet. We will suppose that the inevitable hour has come, and that the labor pains are regular, and that delivery proceeds properly, although perhaps slowly. If she be a strong, healthy woman, and no unusual complications arise to disturb the natural process, but little aid or inter- ference may be required. There will be the usual warning symptoms : intermitting pains in the back, slight at first, but increasing in intensity. There will probably be a slight discharge of mucus, stained with blood, and perhaps also a considerable discharge of a clear fluid, popularly called "the waters." This is an albuminous liquid filling up the mem- brane in which the foetus floats, and so preventing pressure. It some- times does not escape until labor has actually commenced by the falling down of the child into the pelvis. When this takes place, the recumbent position should be assumed. Previous to this, it is best for the patient to sit upright or walk gently about, and so assist the action of the uterus. When the labor pains become very great, the patient should be placed on the bed, previously guarded by some waterproof material, on her left side, and not far from the edge, so that needful assistance can be easily rendered. She should have a tightly-rolled pillow placed between her knees. If there is no unnatural obstruction to the delivery, it is best left to nature. Should the patient in the struggle become very faint and weak, a little brandy and water may be administered at short intervals, but this must be stopped as soon as the labor is over, or inflammatory action may ensue. CONFINEMENT. 489 In due time — it may be in two hours, or four, or six, or even, in the case of a first child, twenty-four hours — the infant is born, and treated according to the directions given in the management of infants. As soon as the child is born, , and the navel string has been cut and tied (see management of newborn, p. 495), a broad bandage or towel may be passed around the body of the mother, so as to cover the hips, drawn tightly, and pinned or tied, so as to sustain a pressure upon the womb, and stimulate the vessels to return to their normal condition. Before this is done, however, it will be best to grasp the uterus with the hand and with gentle pressure force the removal of the placenta, commonly called the afterbirth. For a few hours after labor, the patient should be disturbed as little as may be. If the pulse is thin and feeble, and the cheeks colorless, put a very little brandy and water between her lips now and then; but stop instantly if it produces flushing or restlessness ; and do not give it at all unless there seems urgent necessity for a stimulant. Soiled bedclothes and body linen may be changed as soon as the condition of the patient will permit; but all this should be done very carefully and gently to prevent fatigue. If the afterpains are severe an anodyne draught may be given. It may be composed of from twenty to thirty drops of tincture of opium, or one-eighth of a grain of morphine, in an ounce of water. For eight or more days after labor, the recumbent position should be strictly maintained; and the same rule holds good after a miscarriage. Some women feel so well and strong in a day or two that they will sit up, and sometimes even get out of bed and make themselves useful in the house. We have seen a woman at the washtub three days after she had been confined; and we have heard of females undergoing the pains of labor under a hedge by the roadside, and in a few hours proceeding on their journey with their babes at their breasts. But these women were semi or entire barbarians; they had not been delicately nurtured. With the immense advantages, we must also take some of the disadvan- tages of civilization, and those who give birth to children surrounded by all its comforts and luxuries, must not attempt to emulate the Indian squaw. If they do, they will inevitably suffer for their temerity. Get- ting about too early after confinement is, perhaps, the most fruitful of all sources of uterine disease. Delicate women, especially, do wrong to attempt it, and the strong will be likely to render themselves weak by the practice. 490 WOMANHOOD AND MOTHERHOOD. THE BREAST. We use this term in its restricted sense, as applied to the glands for the secretion of milk. Their full development depends greatly upon habit and constitution, being in some much more early prominent than in others. In pregnancy their fullest development commences : the breast swells, and the nipple enlarges, and by, or near, the time of deliv- ery, it is filled with lacteal fluid. Too frequently the proper enlargement of the breast is retarded by tight lacing. The consequences are an insuf- ficient supply of milk, or a failure of it altogether ; or a nipple so flattened and pressed into the breast that it cannot be taken hold of by the mouth of the infant. INFLAMMATION OF THE BREAST. This is a common affection. Various causes may produce it, such as a blow, exposure to cold, etc., but the most common cause is infection through fissured nipples. When it occurs within the first week after delivery, the symptoms are caking of the breast, a lump forming here or there in the substance of one or both breasts. The breasts are pain- ful and red. The patient experiences a chill or chilliness. There is fever, rapid pulse, thirst, and loss of appetite. Treatment. — Preventive. The bowels should be moved daily, the breasts should be washed before and after nursing with a boric acid solution (one teaspoonful to a pint of water). If fissures develop, a breast shield should be used and the fissures treated with compound tincture of benzoin applied with a camel's-hair brush to the fissure only. Or, they may be covered with subnitrate of bismuth and castor oil, equal parts. Compression of the breasts by bandage, a brisk purgative, such as Epsom salts. On this treatment the condition frequently subsides within twenty-four or thirty-six hours. Should it persist, as it frequently does in those cases which commence during the third or fourth week after delivery, the symptoms already enumerated become more marked, and the caked portion of the breast becomes soft and fluctuating. Pain is constant and of a throbbing character. If suppuration takes place, we have to deal with abscess of the breast and treatment is surgical. The child must not be allowed to nurse an inflamed breast. The milk may be withdrawn by means of a breast pump, the breast kept at rest by means of a tight fitting bandage. The breast may be smeared with ointment of belladonna applied once daily and stroked toward the nipple, .MILK FEVER. 491 Or, lint kept wet with lead and opium wash may be applied. Internally a brisk purge with Epsom salts repeated daily to lessen the formation of milk, and the following capsule to reduce fever and lessen inflammation : — Quinine Sulphate, 30 grains. Powdered Opium, i l / 2 grains. Extract of Aconite Root, 2 grains. Mix; and divide into six capsules. Take one every three hours. If suppuration takes place, the treatment is surgical. SORE NIPPLES. These frequently occur after childbirth. Xipple shields may be readily procured, and should be used when the nipples are too sore and tender to bear the application of the infant's mouth. Equal parts of glycerine and tannin make a good application. It should be applied with a camel' s-hair brush, first wiping the part dry with a soft piece of linen. Or, each fissure may be treated twice daily with silver nitrate. twenty grains, dissolved in an ounce of water and applied by means of a camers-hair brush (this causes the tissues to turn black). These must be washed off before the child nurses. MILK FEVER. At the onset of lactation, the patient may suffer a slight feverishness. Causes. — The cause may be a cold, or any obstruction to the flow of milk from the breast. Symptoms. — Its first symptoms are increased heat of the system, preceded by shivering, and sometimes accompanied with vertigo and slight delirium. These are followed by severe headache, thirst, dry tongue, quick pulse, throbbing of the temples, and intolerance of light. Treatment. — Spare diet, perfect tranquillity, cooling drinks, and saline medicines ; the head should be kept somewhat elevated, and bathed with cold water or evaporating lotions. If the symptoms should become worse in spite of this, apply frequent cooling lotions to the head, and put the feet in a warm mustard bath. Most lying-in women have more or less of this fever, which is no doubt an effort of Xature to rouse the hitherto dormant mammary organs to secrete a proper quantity of milk. 49^ WOMANHOOD AND MOTHERHOOD. THE LOCHIA. This is a discharge from the uterus, which appears after the birth of the child and delivery of the afterbirth, and continues for from two to four weeks. For the first week it is blood color, thereafter the color gradually disappears until it becomes clear. The napkins applied should be perfectly sterile, and changed frequently during the first two or three days. Should any putrid odor attach to the discharge, the physician should be notified at once, and hot water vaginal douches containing a small teaspoonful of creolin to the pint should be used three or four times daily. If, after the blood has disappeared from the discharge, it should reappear, as it frequently does when the woman gets up too soon, she should return to bed, use the hot vaginal douches already mentioned, and take twenty drops of tincture of chloride of iron, well diluted, three times daily. If the blood discharge is very free, fluid extract of ergot, thirty drops three times daily, may be taken to arrest the flow. AFTERPAINS. These seldom appear after the birth of the first child, but following subsequent labors, particularly if the womb has not been thoroughly emptied of afterbirth and blood clots, they are very severe. Treatment. — Immediately after delivery of the child, fluid extract of ergot, one-half to one teaspoonful, should be administered to cause the uterus to contract and expel its remaining contents. For relief of pain, five grains of Dover's powder; or one-eighth grain morphia; or two teaspoonfuls of the camphorated tincture of opium (paregoric), may be given and repeated every four hours as necessary. CONSTIPATION AFTER DELIVERY. The bowels should be moved at the end of the second or third day by the use of Hunyadi water, Apenta water, Seidlitz powder, or a pill containing : — Aloin, % grain. Belladonna, y% grain. Strychnia Sulphate, 1-60 grain. Ipecac 1-16 grain. DIET AFTER LABOR. 493 RETENTION OF URINE. The urine should be voided some seven or eight hours after delivery. If difficulty is experienced in passing urine the woman may rest on her hands and knees. Frequently this change of position will enable her to urinate freely. Hot applications over the bladder, or sprinkling cold water over the region of the bladder, are sometimes efficacious. If these do not suffice, the water must be drawn off through a surgically clean catheter. DIET AFTER LABOR. For the first twenty-four hours, tea, coffee, cocoa, milk, water, and toasted bread may be allowed; on the second and third days, the fore- going liquids, together with soups, beef tea, poached eggs, oysters raw or stewed. From the fourth to sixth days, the breast of chicken, baked potatoes, junket, wine jelly, malted milk, cereals, may be added to the diet already given. On and after the sixth day the patient should gradually return to her regular diet, avoiding pork, cabbage, turnip, beans, and all fried and greasy foods. Her diet should be nutritious and easily digestible. PUERPERAL MANIA OR NERVOUSNESS. This disease frequently attacks women either a little before, during, or shortly after childbirth, and sometimes during nursing. Symptoms. — Great nervous irritation; the face is commonly pallid, the eye troubled, the tongue white, and skin hot ; the mind wanders and conduct is very irregular. Treatment. — Give a purge of senna and salts, and keep the bowels regular by the compound rhubarb pill. Keep the room darkened and let the patient be kept quiet, and free from the interruption of friends. Promote sleep by use of bromides (bromide of ammonium, bromide of soda, bromide of potash, of each ten grains), administered twice or thrice daily as required. If the patient refuses to swallow, suitable treat- ment will be injected hypodermically by the attending physician. Or, bromide of ammonia, forty-five to sixty grains, together with chloral hydrate, fifteen to thirty grains, suspended in milk, may be injected into the rectum. 494 WOMANHOOD AND MOTHERHOOD. CHILDBED FEVER OR SEPTICEMIA. Causes. — The retention of the afterbirth, either in whole or in part, and the decomposition and absorption of it into the circulation. This decayed matter added to the blood brings about a condition of blood poisoning. Symptoms.— It usually appears in from two to four days after con- finement. It is almost invariably manifested by a severe chill, or at least by a sensation of cold. The temperature rises and may reach 105 degrees or 106 degrees, or even higher. The pulse rate follows the rise in tem- perature and reaches from 130 to 160 beats a minute. At the onset the face is flushed. The patient rarely complains of pain. There is very rarely delirium or unconsciousness in the early stages. The dis- charges from the vagina have a fetid odor, and usually diminish in quantity. Peritonitis may complicate the trouble, in which case there is pain in the abdomen, and the temperature does not run so high as in the simple cases of blood poisoning. Prognosis. — This is one of the most serious complications of child- birth. Much depends upon prompt recognition of symptoms and imme- diate attention. The prognosis is always grave. Treatment. — In all cases of confinement when there is the slightest appearance of a chill, immediately notify the physician in charge. The same is to be done when a fetid odor attends the discharge. If the antiseptic vaginal douche is not sufficient to prevent this sign of decom- position, that is evidence of retention of the placenta, or afterbirth, or part of it. This matter must be removed at once. There must be no blood clots or coagulated blood remaining in the uterus or vagina. A wash of two quarts of warm water to which either twenty or thirty drops of carbolic acid or from three to four drams of boric acid have been added must be used to flush out the parts. This is to be repeated once only in from three to four hours. After that, once a day is sufficient. No medicine will be of any use so long as any of the foreign matter remains in the organ. The bowels must move freely; good liquid or semi-liquid food is to be given; and such general symp- tomatic treatment as the developments of the case may call for. v* H !* 5 BOOK VI. CARE, FEEDING, AND DISEASES OF CHILDREN. J. W. WOODS, M.D. Medical College of University of New York ; Sometime Attending Physician Midwifery City of New York ; Attending Physician Diseases of Children, Northwestern Hospital. Care of the Newborn Child. — After the cord has been tied the child is to be placed in a warm blanket in a warm room, while the nurse gives attention to the mother. The eyes of the child are to be thoroughly cleansed with warm water, or, better, with a solution of boric acid of the strength of a teaspoonful of boric acid to one pint of warm water. This is best administered with a dropper or glass rod, and the eyes and eyelids afterwards wiped dry with a piece of lint. Before bathing, the child's body is to be well oiled or anointed with vaseline to soften the cheesy substance with which the body is covered. This substance is called the vernix caseosa. It is not absolutely necessary to remove all of this matter at the first washing, for that sometimes requires more violence than is good for the delicate skin of the child. It will come off of its own accord in a very short time. The first bath is then to be given in water of ioo°. Great care is necessary in handling the child lest it fall by reason of the oily coating which it has received. After bathing, attention is given to the cord to see that it has not slipped during the bath. The mouth is cleansed with tepid water with great care, for the parts are very delicate and will not stand any roughness. The cord is to be covered with a dusting of powdered boric acid, or Salicylic Acid, I dram. Powdered Starch, 19 drams. This is dusted over the stump of the cord. It is not well to use too strong an antiseptic dressing for the cord, as that will prevent the stump from falling off as soon as desired. The navel is then covered with a piece of lint or dry gauze or absorbent cotton. A strip of flannel of about eight or ten inches in width is then passed around the child's body loose enough to admit of the easy introduction of a finger under it. Before dressing completely it is well to look the child over in examina- tion for any injuries received during delivery or for deformities, etc. As soon as it is dressed it is to be placed in its crib wrapped in warm blankets. Should there be any indication of poor circulation, cold feet, or the like, the child should have hot water bottles placed near to it in 496 CARE OF CHILDREN. the crib, but not touching it. The usual precautions about tightness of corks, and absence of danger of leakage are to be exercised. First Suckling of the Child. — In a few hours after bathing the infant may be put to the breast. For the first two days the breasts yield a peculiar milk called the colostrum. It is very nourishing and mildly laxative. The child should partake of this every four hours. The Meconium. — The fecal matter formed in the bowels of infants before birth is called meconium. Its timely removal is a matter of no small importance. Nature has furnished the appropriate purgative for this purpose in the colostrum. The small portion of fluid which the child usually receives at the breasts during the first two days possesses a decidedly purgative character and generally causes the entire evacua- tion of the bowels. Nothing can be more prejudicial to the child's health than the almost universal custom of administering some artificial purgative to bring about this effect. If the child is permitted to suckle before the proper milk is secreted adequate -purgation will follow naturally in nine cases out of ten. When, however, the child's bowels do not move, give a pinch of brown sugar in a teaspoonful of water, or one-half teaspoonful of olive oil, or a small injection of soap and water. During the first two days of life the discharge from the infant's bowels is black; sometimes tinged with green; but on the third or fourth day, when the mother's breasts are secreting true milk, they change to yellow. Urine. — If the infant does not void urine during the first twenty-four hours, sprinkle the region over the bladder with cold water, or give the infant a warm bath. If this does not suffice call the attention of the physician to the matter at once. It may be that no urine is secreted because the child has had too little nourishment, or there may be some deformity of the urinary tract. DISEASES OF NEWBORN CHILDREN. APPARENT DEATH OR ASPHYXIA. A pulseless and lifeless appearance of the newborn child. Causes. — Interference with the circulation of the blood before or during birth; pressure on the cord; or natural weakness and debility of the child. Symptoms. — If there is only slight asphyxia the child is pale; anaemic ; the limbs lifeless ; and the heart beats feebly, If the asphyxia ASPHYXIA AT BIRTH. 497 is more severe and breathing has occurred prematurely, the face is purple; eyes, bloodshot; pulse, slow and full; and gasping breathing. Prognosis. — If the heart action is audible, however faint, there is always hope; there is danger of pneumonia or of brain trouble if life is saved. Treatment. — In most cases the child begins to breathe and cry as soon as it is ushered into the world. This, however, is not always the case. Many children manifest no signs of animation when born, who may, nevertheless, be re-animated by prompt and judicious man- agement. When this state of apparent death depends on lack of oxygen, the infant's countenance exhibits a livid or deep red and bloated appearance; the eyes are prominent, and the surface of the body is warm and reddish. Sometimes the body is flaccid, and the navel string has ceased to pulsate. Everything depends on the speedy resusciration of the child. When the cord pulsates vigorously, little effort is usually required for setting the vital functions again in opera- tion. An effort may be necessary to excite the respiratory functions by artificial inflation of the lungs and compression of the thorax with the hands. In inflating the lungs a silk handkerchief folded double, or a fine napkin, should be laid over the mouth of the infant; the nurse should then apply her mouth to that of the babe, at the same time closing its nostrils, and endeavor by moderate but uniform force of insufflation to fill its lungs with air. The covering of the infant's mouth is recommended as a means of avoiding rupture of the pulmo- nary air cells. Some infants remain for a minute or two after birth without any or with few efforts to breathe, although they will open their eyes and move their extremities with considerable vigor. A few drops of water sprinkled on the chest or abdomen will instantly cause them to breathe and to cry out lustily. The main point of caution in cases of this kind is to avoid tying the cord until its pulsation has ceased or has become quite feeble. In all cases where respiration does not ensue immediately after birth, or is in any degree embarrassed, prompt attention must be given to the removal of the mucus which is usually lodged in the mouth and larynx of newborn infants. A swab of absorbent cotton should be carefully introduced into the mouth, and the tenacious slime brought away. Infants are sometimes born in a state of asphyxia. If in such cases the cord pulsates it must on no account be divided until pulsation has ceased. The mouth should be immediately cleared in the manner 498 CARE OF CHILDREN. just indicated, and a little cold spirits, or cold water, be dashed on the pit of the stomach. So long as the cord beats, some stimulant such as brandy, spirits of camphor, or ether, may be applied to the lips and nostrils. It is also proper to rub the body and extremities gently with dry, warm flannels. When the pulsation of the cord has ceased, and the child still continues in this state, the cord must be divided and the infant wrapped in dry and heated flannel, which is better than the warm bath. It is not well to hastily abandon infants in this condition; thirty minutes and even a longer period may elapse before the child begins to breathe. In all cases where resuscitation has been effected from a state of asphyxia, it is of the utmost importance to permit the infant to lie perfectly at rest for several hours, before it is subjected to the agitation and fatigue of washing and dressing. Infants born between the seventh and eighth month generally remain in a somnolent condition for several weeks, and ought to be as little disturbed by washing and dressing as possible. Occasionally feeble infants suddenly sink into a condition of syn- cope, or apparent death, after everything seems to be going on well. This death-like condition usually continues for a few minutes and then gradually passes off leaving the infant in a languid and fretful state. This affection is probably the result of some intestinal irritation. During the paroxysm efforts must be made to re-excite the vital power by wrapping the child's body in a piece of thick flannel wrung out of hot whisky. A drop of ether, or of spirits of camphor, should be applied to the nostrils and lips and weak mustard plasters may be laid on the soles of the feet. JAUNDICE OF NEWBORN INFANTS. A yellow discoloration of the skin which appears within three or four days after birth. Causes. — Frequently it is the result of too tight application of the band around the abdomen. Prognosis. — Generally good. Treatment. — The mere loosening of the band has often been suffi- cient to relieve the condition. Should the condition not then subside, one-fourth grain of calomel with a grain or two of white sugar or of sugar of milk may be given twice' daily for a day or two. If free purg- ing does not follow, this condition must be relieved by the use of castor ERYSIPELAS AT BIRTH. 499 oil. The daily use of the warm bath and gentle friction with the bare hand over the region of the liver and stomach will be beneficial, provided there is no tenderness of the region or any inflammation. INFLAMMATION OF THE BREASTS OF INFANTS. An inflammation of the glands of the breasts of children of either sex. Causes. — There is a common superstition among nurses that the secretion of a few drops of milk in the breasts of newborn infants, both male and female, is to be squeezed out for good luck. Others call it "witches' milk." Efforts to press this milk out causes a rupture of the delicate glands and consequent inflammation. Symptoms. — The breasts become red, swollen, and tender. If it does not pass away almost at once an abscess forms with the secretion of pus. Prognosis. — Generally good; but erysipelas often results as a com- plication, and this is usually fatal. Treatment. — Usually this does not require treatment ; but, if an abscess forms, the attention of a doctor will be required. ERYSIPELAS OF NEWBORN INFANTS. An infectious disease that attacks newborn infants and in no way differs from the erysipelas of adults. Also called St. Anthony's Fire and The Rose. Causes. — The infectious micro-organism which causes the disease to appear from two to seven days after birth, circumcision, or injury in which the skin is broken. Symptoms. — There is high fever; rapid pulse; sometimes convul- sions and diarrhoea. The disease begins generally on the lower parts of the body as a small, red blotch, and gradually spreads over the abdomen and thighs, presenting a swollen, dark red surface. In most cases, soon after inflammation is established, vesicles make their appear- ance, and the disease soon assumes a dangerous condition, the danger of suppuration and gangrene being very great. Prognosis. — The earlier the age the less favorable the prognosis. Very fatal in infants younger than three weeks. Treatment. — The air is to be excluded by local applications of cornstarch, cotton wool, collodion, or a five per cent solution of ichthyol, or a mixture of ichthyol and vaseline in equal parts. Holt recommends a ten to twenty-five per cent ointment of ichthyol spread 5oo CARE OF CHILDREN. upon muslin, applied daily, and covered with gutta-percha tissue to prevent drying. Good nursing, nutritious food, and stimulants to keep up the pulse are also required. LOCKJAW OF THE NEWBORN OR TETANUS. An acute, infectious disease marked by paroxysms or spasms. Causes. — It is caused by the micro-organism known as the tetanus bacillus. This infectious organism usually gains entrance through the wound about the navel. Symptoms. — Usually the first sign of the disease appears between the fifth and tenth days, in the form of stiffness of the jaw and attend- ant difficulty in nursing. The child first relaxes and then stiffens and remains rigid for a minute or two. This rigidity increases and affects the entire body. The body becomes wooden in its stiffness. The pulse, breathing, and temperature rise very high. Prognosis. — The outlook is very bad. Fatal cases seldom last more than forty-eight hours and often only twenty-four. Treatment. — This consists chiefly in the use of narcotics and anaesthetics to control the spasms. The tetanus antitoxin has proven beneficial where it could be given in time. The child must be kept quiet without unnecessary moving, bathing, etc. Feeding is best conducted through the nasal tube. SORE EYES OR OPHTHALMIA OF THE NEWBORN. A highly infectious disease of the eyes in newborn children. Causes. — A micro-organism contained in some secretion of the mother which comes in contact with the infant's eyes during labor. Where the child opens its eyes prematurely this danger of infection is increased. Symptoms. — There is a warning symptom which takes the form of a red line drawn around the lids as though done with red ink. If this is neglected the disease passes on to the second stage, during which the eyelids swell, a thick, purulent matter begins to issue from the eyes; the child becomes fretful and uneasy and keeps the eyes per- sistently closed. In the third stage the swelling of the lids increases, and ulceration of the cornea results. Prognosis. — Good so long as the cornea is not involved and abscess and perforation do not result. This is the most fruitful cause of blindness of children. Nearly one-third of all cases of blindness of INFLAMMATION OF THE NAVEL. 501 children result from this disease. With good nursing and early attention the prognosis is favorable. Treatment. — The child should be isolated and the doctor called at once. If neglected in its early stages, the eye may be permanently injured and the sight destroyed. Constant attention must be given to washing out the eye with an antiseptic solution. It does not so much matter which is chosen so long as the application is made often. The following is a good one to use: — Boric Acid, 1 heaping teaspoonful. Hot Water, 1 pint. In applying this use a dropper and inject the solution into both sides of the eye and see that the application is made to the entire surface of the eye, every twenty minutes, night and day. Once or twice a day the eyes are to be treated with a few drops of a fifteen to twenty-five per cent solution of argyrol. The next most helpful application is cold compresses applied every few minutes by keeping fresh compresses on blocks of ice. If only one eye is affected the unaffected eye is to be kept covered with an antiseptic applied to a cloth, to prevent infection. These cloths may be kept in place over the well eye by strips of adhesive plaster. The greatest cleanliness is to be observed and cloths are to be destroyed after use in any way about the patient. There is also very great danger of the nurse becoming infected unless the strictest antiseptic precautions are observed. INFLAMMATION OF THE NAVEL OR OMPHALITIS. Causes. — This condition may be brought about either by bandaging too tightly, or may be the result of infection. The tying of the cord leaves a wound which is a favorable place for the entrance of germs of disease. This condition is aggravated by uncleanliness, the result of which is really a sort of blood poisoning. Symptoms. — Usually during the second or third week of the infant's life there may be noticed redness, swelling, and hardness around the navel. This will result in disappearance, abscesses, or gangrene according to the promptness and efficacy of treatment or the lack of these precautions. Usually the condition terminates in a number of small abscesses which may be only on the surface of the wall of the abdomen or may be more deeply seated. There may be sloughing of the parts, or an eruption similar to that of erysipelas, or gangrene of the parts may result. 502 CARE OF CHILDREN. Prognosis. — This is favorable if treated in time. There is danger of the inflammation extending to the peritoneum causing peritonitis and the danger is then very greatly increased. Treatment. — As soon as inflammation of the part is detected, the utmost cleanliness must be observed. Wash the parts thoroughly but not roughly with a solution of boric acid of the strength of one tea- spoonful of boric acid to a pint of water. Then dress the parts with aristol, or with equal parts of the nitrate of bismuth and iodoform. If there is an appearance of granulations, which are the little grain- like growths which attend ulceration, the parts should be touched care- fully with a solution of : — Nitrate of Silver, ' . 10 grains. Water, i ounce. The inflammation of the parts surrounding the navel, which some- times occurs and resembles the eruption of erysipelas, may be kept in check by the use of cloths dipped in the boric acid solution. If gangrene forms it may be removed by the application of the peroxide of hydrogen. The inflammation of the veins and arteries of the navel is a serious complication or, really, extension of the inflammation. The prognosis in such cases is very bad. RUPTURE OF THE NAVEL OR UMBILICAL HERNIA. Causes. — This results from the imperfect healing of the wound at the navel, and the formation of an opening large enough to permit of the protrusion of a part of the bowel. Where this opening does not heal well, or when there is a weakness of the wall of the abdomen, such conditions as the formation and accumulation of gas in the intes- tines, accumulations of masses of fecal matter, continuous crying may produce force or pressure enough to cause the bowel to protrude. Prognosis. — The majority of cases yield to simple treatment; others persist until adult life; but there is always the possibility of peritonitis resulting from the strangulation of the bowel. Treatment. — Mechanical pressure to keep the bowel in place and to , great de- pression ; collapse ; chilly most of the time ; violent vomiting and purging ; give early in the disease. Arsenicum, 3 x, excoriating discharges; bright red tongue, with burning of stomach and bowels ; patient wild and restless ; useful in all stages of the disease. Veratrum Alb., 1 x, cold sweat; violent vomiting and purging ; cramps of different muscles of the body. Cuprum Aceticum. 30. also for cramps with empty retching : also to be used as a prophylactic. The diet should be milk with a little brandy added. Asthma. — Arsenicum, 3 x, Euphorbia Pilulifora, 1 x, Ipecac, 1 x, Veratrum Viride, 1 x. Arsenicum, 3 x, hay-fever, watery excori- ating discharges from the eyes and nose. Euphorbia PH., 1 x, suffocative cough ; considered a spe<- : fic by many. Ipecac, 1 x, nausea and vomiting, followed by violent fits of coughing. Veratrum Vir., 1 x, hard, difficult breath- ing ; tight, wheezing cough ; full, hard, bounding pulse. Back, Lameness (Lumbago )l — Rhus Tor., 3 x, for painful condition of the muscles from a sprain or wrench. HOMEOPATHY. 6 77 For crick of the back, Ferrum Phos- phoricum, 3 x. Baldness. — To prevent the hair from falling after fevers, etc., Fluoric Acid, 6 x, and Silicea, 30. Barber's Itch. — Sulphur Iodide, 3 x, every six hours, and apply Blue Ointment. Bilious or Remittent Fever. — Gelsemi- num, 1 x, the leading remedy for remittent fever ; pain in the head on the left side. Bryonia, pain on the right side of the head, extending to its base ; yellow coated tongue ; sallow complexion ; constipation or alternate constipation and diarrhoea. Merc. Protoide, 3 x, jaundice during the fever. Phosphorus, 3 x, may be given if there is a cough at the same time of the jaundice. n Bleeding from the Nose (Epistaxis). — Aconite, 1 x, for plethoric persons, with hard, quick, wiry pulse. Carbo Veg., 3 x, severe nosebleed, several times daily, with pale face before and after each attack. Nitric Acid, 3 x, disposition to nosebleed. Bleeding from the Lungs (Hemoptysis). — Hamamelis, , ten drops, every hour, for dark blood which is profuse or scant. Veratrum Vir., 1 x, congestion of the lungs, with full, hard, bounding pulse. Phosphorus, 30, disposition to frequent hemorrhages with dry, hacking cough. Bronchitis. — Aconite, 1 x, at commence- ment, with hot, dry skin and quick pulse. Bryonia, 3 x, bronchial tubes feel sore ; dry cough, also, at commencement, may be given alternate with Aconite. Sambucus, 1 x, very useful for young children. Verat. Vir., 1 x, full, bounding pulse ; difficult breathing, also Antimonium Tart., 3 x, Kali Bichromicum, 3 x, and Ipecac, 1 x. Keep the chest wrapped in cotton batting. Canker of the Mouth. — Merc. Cor., 3 x, one of the best remedies. Catarrh. — Aconite, 3 x, acute catarrh, feverishness ; pain in the head, eyes, nose, etc. Bryonia, 3 x, in addition to the acute catarrh of the nose, it has a dry cough with stitches in the chest. Kali Hydroidicum, 3 x, sneezing ; watery discharges from the eyes and nose which excoriates ; pain in the fore part of the head. Cessation of Menses. — At this time women are subject to "hot flashes." Lache- sis, 30, profuse menses from granular trouble of the mucous membrane and other troubles. At this time women needs the care of an able physician, and should consult him frequently, if everything is not perfectly normal. Chapped or Cracked Lips. — Bryonia, 3 x, dry, chapped lips. Chicken Pox (Varicella). — Aconite, 3 x, fever ; restlessness ; generally all the remedy needed. Antimony Tart., 3 x, if the eruption sup- purates, this remedy will be useful to prevent scars. Hepar Sulphur, 3 x, useful for a week or so after any of the eruptive diseases. Milk diet the best. Cholera Morbus. — Same remedies as Asiatic cholera, adding Colocynth, 2 x, for violent, griping pain in the bowels. Chronic Catarrh. — Calc. Carb., 30, Kali Bichromicum, 3 x, Sanguinaria, 3 x, Sulphur, cc. Colic — Colocynth, 3 x, is generally the first remedy called for. Plumbum Carb., 30, long continued colic with constipation. Chamomilla, 30, colic during dentition. Contcussion of the Brain. — Keep the patient quiet ; apply cold cloths to the head and give Arnica, 3 x, every hour or two, for a few days. Congestion of the Brain. — Belladonna, 1 x, full, beating blood vessels ; full pulse ; red, flushed face ; mild delirium ; dilated pupils. Bromide of Potash, five grains, every hour, to an adult, until better. Veratrum Vir., 1 x, full, bounding pulse ; nausea with terrible pain in the head. Constipation. — Nux Vom., 3 x, where the trouble arises from an inaction of the muscular coats of the intestines. Opium, 30, stool hard, composed of small hard balls. Bry., 3 x, is given for alternate constipation and diarrhoea. If the child is taking cow's milk, salt it. Do not give physic ; and if the above remedies do not cure, go to a physician. Convulsions (Fits). — Belladonna, 3 x, flushed face ; throbbing of the blood vessels going to the head. Cicuta Virosa, 6 x, twitching and jerking of the muscles all over the body ; movement of the muscles about the mouth causing a chewing motion. Gelseminum, 1 x, violent fever ; full com- pressible pulse. The whole body is con- vulsed. Costiveness (Constipation). — Nux Vom- ica, 3 x or 30, useful after using much cathartic medicine ; persons of sedentary habits, no desire for stool, and, if there is, it cannot be accomplished. Plumbum, 30, stools of hard, small balls, frequent attacks of colic. Sulphur, cc, remedies do not give desired effect ; piles, with burning pain in rectum. Drink a glass of oatmeal water, every morning, on rising. Cough. — Aconite, 1 x, croupy cough ; spasmodic cough. Bryonia, 3 x, hard, dry cough, with pain in head and chest. 678 SPECIAL SYSTEMS. Belladonna, short, dry, hollow, convulsive cough, worse at night ; flushed face and cerebral congestion. Hepar Sulph., 3 x, irritating cough ; hoarse- ness, excited by exposure to cold. Rattling of mucus in the throat ; croup. Kali Bichro., 3 x, cough, with tough, stringy expectoration. Phosphorus, 30, dry cough with tickling in the throat. Worse from talking or read- ing aloud. Spongia, 1 x, dry, hoarse, croupy cough, with pain in the larynx. Alternate with Aconite, in croup, every fifteen minutes. Castanea Vesca, 1 x, five drops, every two hours, in whooping cough. Cuprum Aceticum, 30, also useful in whooping cough so violent as to often throw the patient into convulsions. (See also Asthma.) Cramp. — Cuprum Aceticum, 30, a very useful remedy. Cramp of the Legs. — Relieved by Cuprum Acet., 6 x. Cramp or Spasm of the Stomach (Gas- tralgia). — Dioscorea, 1 x, five drops every fifteen minutes. Nux Vom., 3 x, and even (j> , five drops, three times daily, will generally cure the disposition to cramp of the stomach. Bryonia, 3 x, useful if the cramp comes on immediately after eating. Lactopeptine, ten grains after each meal. Croup. — Aeon., 1 x, and Spongia, 3 x, alternately, for spasmodic croup. Defective Appetite. — Bryonia, 3 x, if caused by a torpid liver, also China, 6 x. Nux Vom., 1 x, from anxiety; overworked nervous system and constipation. Apply to a physician to ascertain cause. Delayed Menstruation. — If caused by a cold or wetting the feet at a previous period, give Aeon., 1 x, particularly if the patient is feverish and has congestion of the head, also in young girls who are away from home, at school, etc. Puis., 3 x, will generally restore the menses or bring them on when suppressed. Sanguinaria, 3 x, when delayed menses are accompanied by a cough, neuralgia of the head, bleeding from the nose and cramp in the stomach, etc. Senecin, 3 x, cough with suppression of the menses. Diabetes. — Uva Ursa, 1 x, ten drops every three hours in Diabetes Insipidus. Diabetes Mellitus. — Arsenicum, 3 x, very hungry and thirsty ; pale skin ; loss of strength ; dryness of mouth and throat ; ex- cessive urination ; watery diarrhoea. Phosphoric Acid, 1 x, loss of nerve force, with frequent urination. Gratify the thirst by an abundance of good water or skim milk. The diabetic should be warmly clad. Diarrhoea. — Camphor (p , sudden diarrhoea with chilliness. Dulcamara, 3 x, diarrhoea caused from getting wet ; worse at night, bilious stools. China, 1 x, painless, summer diarrhoea. Chamomilla, 30, diarrhoea in children, ac- companying teething. Arsenicum, 3 x, chronic diarrhoea; red, burning tongue ; vomits — even a small amount of water, in fact, everything taken into the stomach. Ipecac, 1 x, diarrhoea and dysentery ac- companied by much nausea. Veratrum Alb., 1 x, vomiting and diarrhoea attended with cold sweating ; cholera mor- bus ; cholera infantum. Avoid all animal food during an attack of diarrhoea. A little brandy may be added to milk with benefit. Dilatation of the Heart. — Digitaline, 3 x, will strengthen a weak heart. Phosphorus, 3 x, valuable as a tonic, giv- ing tone to the system. Diphtheria. — Call your physician. Apis Mel., 3 x, in diphtheria with much swelling of the throat, internally, and a stinging pain. Phytolacca Dec., 1 x, violent fever, with much stiffness of the neck, early in the disease. Mercurius Cor., 3 x, much swelling of the throat externally ; the membrane is very offensive. Kali Bichromicum, 3 x, croupous diphthe- ria, with tough, stringy mucus. In connection with the Kali Bich., 3 x, use a spray of a solution of Chloride of Lime and hot water : one part of the solution to ten parts of hot water. Use a steam atomizer. Never swab the throat, but use gargles of alcohol and water. Diseases of the Heart. — Inflammatory diseases require Aeon., 1 x, for fever; quick wiry pulse ; pain and anguish, and with this may be alternated Bry., 3 x, if caused by rheumatic poison. Arsenicum, 30, burning pain, with effusion in the sack ; suffocative attacks ; coldness of the surface ; anxious and fears death. Cactus, 2 x, a feeling in the heart as though grasped by an iron hand. Veratrum Vir., 1 x, strong, loud beat of the heart, with difficult breathing ; bronchitis. Diseases Occurring During Pregnancy. — Morning Sickness (Nausea). This is generally relieved Dy Nux, 3 x, and to be given for faintness and nausea with con- stipation. Bry., 3 x, is also a valuable remedy, where the nausea begins or is made worse by moving about ; must lie in bed or she will vomit. This is a reflex action of the sym- pathetic nerves, the real cause being con- gestion and often ulceration of the uterine neck. A small amount of hot water (one HOMEOPATHY. 679 pint) may be used by vaginal injection once daily, to which may be added Hamamelis or Borax. Diseases of the Spinal Cord. — Seek professional advice at once. Aeon., 1 x, for the fever and anxiety. Gels., 1 x, patient is very nervous, with convulsions. Cicuta Virosa, 6 x, violent convulsions from irritability of the spinal cord. Dizziness (Vertigo). — Digitaline, 3 x, for dizziness caused by an enfeebled heart which has produced ansema of the brain. China, 1 x, caused by loss of blood or severe diarrhoea. Many other remedies are indicated from special causes which can only be located by a physician. Dropsy. — Arsenicum, 3 x, a very useful remedy in dropsy with much debility ; red tongue and much thirst for cold water, but a small amount satisfies. Digitaline, 3 x, heart dropsy, more parti- cularly, but useful in any kind, from what- ever cause. Helleborus Nig., 3 x, dropsy of the brain ; after scarlatina, etc. Skim-milk diet useful in dropsy from kidney disease. Dysentery. — Aconite, 1 x, very feverish; quick, wiry pulse at the commencement of the trouble ; if the discharges are principally of blood, alternate with Merc. Cor., 3 x, every half hour. Ipecac, 1 x, nausea and vomiting, with bloody, greenish stools ; it also quiets tenes- mus. Arnica, 3 x, dysentery, attended by much urging to go to stool. Injections of very hot water, after each stool, will relieve. Avoid all animal food ; cold milk best article of diet. Dyspepsia (Indigestion). — Arsenicum, 3 x, caused by ice cream ; burning in stomach : red tongue ; thirst ; the least swallow of food or drink causes pain. Bryonia, 3 x, sense of pressure as from a hard lump in the stomach ; bitter taste with headache. Carbo Veg., 3 x, much gas in stomach. Hydrastis, 1 x, for pain coming in two or three hours after meals. Lactopepiine, five to ten grains after each meal, is useful to help the stomach until it regains its functions. Eat slowly, masti- cating the food thoroughly. Avoid such articles of food as are known to disagree. Earache (Otalgia). — Aconite, 1 x, from cold; patient very restless. Puis., 3 x, steady pain, but does not drive the patient about as Aconite does. Aconite, £>, two or three drops on cotton, in the ear, very useful. Tobacco smoke, blown into the ear, will ease the pain. Enlargement of the Uvula, which is relaxed, Hyoscyamus, 1 x, every two hour^. A tea of Gold Thread useful as a gargle. Epilepsy (Falling Fits). — To ward off an attack use Nitrite of Amyl, by inhalation. Bell., 3 x, holds a high place in chronic epilepsy of young and full blooded subjects. Cuprum Acet., 30, violent convulsions; pale face. Nux Vom., 3 x, useful as a tonic to the nervous system. Erysipelas. — Aconite, 1 x, erysipelas of the face, with a quick, wiry pulse. Belladonna, 3 x, intense redness of the skin ; high fever ; smooth surface ; violent headache ; delirium. Rhus Tox., 3 x, vesicular, purplish colored skin. Powder with dry starch or flour. In the phlegmonous variety, call a physi- cian. Exhaustion. — If caused by hemorrhage, diarrhoea, etc., nothing is better than China, 1 x. If from non-assimilation of food, give Calc. Phos., 3 x. Arsenicum, 3 x, useful for indigestion, with burning of the stomach, also from the effects of typhoid fever. Phosphoric Acid, 1 x, nervous exhaustion from excesses. Beef tea is useful ; use also milk. Eyes. — For simple inflammation of the eyes, the white of the eye being red, give Bell., 3 x, every two hours. For hot, scald- ing, watery discharge from the eyes, Kaii Hydroidicum, 3 x. A cinder or any foreign body in the eye should be early removed. Any trouble causing severe pain in the eye is serious, and an oculist or good surgeon should be consulted. Fainting (Syncope). — Aconite, 30, the best remedy to prevent its frequent occur- rence. Aqua Ammonia or Spirits of Cam- phor, by inhalation, are restoratives ; also sprinkling water in the face. Falling off of the Hair. — Silicea, 30, will stop the hair from falling off after a severe sickness, which has caused debility. At the same time a wash of Bay Rum and water, two ounces of each and Aqua Ammo- nia, one drachm, will be found useful. Falling of the Womb. — A result of either a ruptured perineum or an increased weight from above (tumors, enlargement, etc.). The treatment is principally mechan- ical and surgical. Lilium Tig., 30, much used in these troubles. Felons. — Belladonna, 3 x, for redness of the finger, with throbbing pains after sup- puration has taken place. Hepar Sulph., 3 x, will hasten a cure. Have it opened, early ; by so doing you will save much suf- fering, and, possibly, the loss of a finger. Fevers, in General. — Aconite, 1 x, give the remedy when you find a quick, firm, hard, wiry pulse. 68o SPECIAL SYSTEMS. Baptisia Tinct., 1 x, give this for a quick, fine, soft, compressible pulse; typhoid fever; diarrhoea, etc. Gelseminum, 1 x, give for a full, bounding pulse, that is compressible and does not resist the finger. Veratrum Vir., 1 x, full, hard, incompres- sible pulse and resists the finger. Fever axd Ague (Intermittent or Ma- laria). — China, Quinine, in recent ague, never in chronic cases, all the stages are well marked, the chill is usually in the morning from nine to ten. Arsenicum, 3 x, chronic ague; one stage runs into another, often one stage is left out ; very thirsty ; rapid and excessive prostration ; dropsical swellings. Eupatorium Perf., 1 x, thirsty several hours before a chill and continues through it ; short chilly stage ; long hot stage and slight sweating. Phos. Acid, 1 x, very profuse sweat. Gels., 1 x, severe nervous symptoms. Natrum Mur., 30, chronic ague. Arseni- cum, 30, Ipecac, 3 x, Cedron, 3 x, Sulph., 30, for dumb ague. Foetid Breath. — Salicylic Acid, 3 x, a powder, three times daily, will correct it, when the stomach is at fault. Decayed teeth should be filled or removed. Gallstones. — Where a person is known to suffer from these concretions, give six tablespoonfuls of Olive Oil, at bedtime, repeated in two days, at the same time give CJiina, 6 x, a dose three times daily, and it will rarely fail to cure. An anesthetic will give the only relief while they are passing through the gall duct. Gangrene, Mortification. — Remove it when possible by amputation, if it be of a limb, from injury. A superficial slough can be treated by a flaxseed meal poultice, to which add charcoal. A poultice made from crushed, boiled carrots, is also a good one. Internally, give Arsenicum, 3 x, every two hours, if there is much burning about the slough. Secale, 3 x, for dry gangrene of the toes. A weak solution of Carbolic Acid, ten drops to one pint of hot water, should be used as a wash. Glandular Swellings. — When as a result of diphtheria, put on salt pork, and give Merc. Protoide, 3 x, internally. When from a cold, Hepar Sulph., 3 x, is generally the remedy. If from scrofula, Calc. Phos., 3 x, and Calc. Iodide, 3 x, are the best remedies. Gout. — The leading remedy is Colchicum, 1 x, five drops every three hours ; avoid highly seasoned and animal food, liquors of all kinds. Gumboil. — Bell., 1 x, will often remove the inflammation that leads to i gumboil. Merc. Viv., 3 x, when caused by a decayed tooth. Open as soon as pus forms. Hay Fever (Asthma). — Arsenicum, 30, is the chief remedy. Sanguinaria Nitrate, 3 x, will often help when there is severe sneezing and a watery condition of the eyes. Headache. — Bilious or sick headache will call for Iris Vers., 3 x, or Cocculus, 30, at the time of the pain, taking China, 30, or Nux Vom., 3 x, twice a day at other times. Con- gestive headache requires Bell., 3 x, if with- out vomiting; if with vomiting, Veratrum Vir., 1 x, at the time. During the interval, take Sanguinaria, 30, or Pulsatilla, 30. Hiccough (Spasm of the Diaphragm). — A few drops of vinegar on sugar will gener- ally control it. Moschus, 3 x, is the homoeo- pathic remedy. If occurring during the course of a severe illness, a tight bandage across the chest oftentimes prevents its reappearance. Hip Joint Disease (Coxalgia). — Bell., 3 x, when there is soreness about the joint dis- covered by pressure. Calc. Carb., 30, twice daily; should be given steadily to correct the strumous con- dition. Calc. Iod., 3 x, and Calc. Phos., 3 x, for the same condition. If from an injury, Arnica, 3 x, may be the most useful remedy. The joint should be placed at rest by patent splints, and the child placed under the care of a reputable surgeon. Hoarseness. — Causticum, 30, from singing and over-use of the voice. Spongia, 3 x, or Kali Bich., 3x, when caused by croup. Phos., 30, from the effects of a cold, always worse in the evening. Hypochondria (See Hysteria) . — Nux Vom., 3 x, the most useful remedy. Hysteria. — This is a perverted nervous action, generally arising from uterine or ovarian disease, and the cause must be found and properly treated to lead to a cure. Gels., 1 x, very nervous, with hysterical convulsions. Moschus, 3 x, useful in many of the symp- toms, such as palpitation of the heart, cramp of the stomach, neuralgia, etc., of hysterical subjects. Hysterical Convulsions. — Nux Vomica, 3 x, violent drawing backward of the head and feet toward each other. Convulsions from passion, Chamomilla, 30 : injury, Hypericum, 1 x: worms, Cina, 3 x, Cicuta, 6 x : fright, Ignatia, 30. Incontinence of Urine. — Wetting the bed is very common during childhood. If caused by worms, or intestinal irritation, Cina, 30, will benefit. Ferrum Acet., 3 x, in delicate blonde children. Equisetum Hyemale, 3 x, is also a useful remedy to break up the habit. HOMEOPATHY. Inflammatory Blush (Erythema). — Bell., 3 x, all the remedy required generally. Inflammation of the Ear (Otitis). — Aeon., 1 x, fever caused by cold. Puis., 3 x, alternately with the Aeon. Hepar Sulph., 3 x, should an abscess develop. Inflammation of the Eye (Ophthalmia). — Aeon., 1 x, from cold ; feverishness. Bell., 3 x, acute redness of the conjunctiva or white of the eye. Keep hot compress on the eye, to wh*ich may be added Bell.ty , ten drops to a teacupful of hot water ; compress to be wet in this solution. Use no eye washes. If not better in a few days, call your physician, for, if the deeper tissues are affected, you cannot diagnose it. Inflammation of the Bladder (Cystitis). — Aconite, 1 x, acute pain, with fever, alter- nating with Cantharides, 3 x, which has constant or frequent desire to urinate, fol- lowed by severe pain. Apis Mel., 3 x, stinging pain, when passing water, in the bladder. If the inflam- mation is caused by Spanish-fly blister, with severe strangury give Camphor

, sixty drops of each added to two glasses each half full of water, and giving a teaspoonful every quarter hour, has relaxed the muscles and cured many cases. The disease is fatal in a large per cent of cases. Lumbago. — Rhus Tox., 3 x, if from getting wet or a strain. Measles. — Usually a very mild disease ; particularly under homoeopathic treatment. Aeon., 3 x, during the first two or three days. Sneezing ; hacking cough ; fever and restlessness. Bell., 3 x, much pressure of blood to the brain ; mild delirium. Cuprum Acet., 30, sudden disappearance of the eruption when only partially out. Puis., 3 x, much running of a watery fluid from the eyes and nose ; cough ; diarrhoea, etc., one of the best remedies in this disease. Sambucus, 1 x, if there is much bronchitis, give this remedy. Hepar Sulph., 3 x, toward the end of the disease, to prevent sequelae The same remedies are used in malignant or Black Measles, but a physician should be called, for any remedy in the Materia Medica may become necessary. Membranous Croup. — Kali Bich., 3 x, the best remedy. A Solution of Chloride of Lime, by inhalation. It often becomes necessary to perform tracheotomy. Milk Fever. — Seldom requires much, but if severe give Aeon., 1 x. Should the brain suffer and the patient talk in her sleep, Bell., 3 x, will be suitable. Milk Leg (Phlegmasia Dolens). — Aeon., 1 x, and Puis., 3 x, alternately, will often cut an attack short at the beginning. Ex- tract of Hamamelis is a good application, locally. Mumps (Parotitis). — Aeon., 1 x, Puis., 3 x, and Merc, 3 x, are the remedies. Avoid taking cold and other remedies will not be needed. Nausea. — Ipecac, 1 x, is generally all the remedy needed. Violent nausea and vomit- ing, when not controllable by ipecac, may find a remedy in Antimony Tart., 3 x. Neuralgia. — Aeon., 1 x, from cold, with fever, in teeth and face. Bell., 3 x, pain in the teeth and face, more particularly on the right side ; red, flushed face. HOMEOPATHY. 683 Colocynth, 2 x, severe pain on left side of face. Ars., 3 x, pain as of hot needles piercing through the skin ; cases of a chronic na- ture. Cheledonium Maj., 3 x, pain in right shoulder and side. Phos., 3 x, severe, long-continued neural- gia of any part of the body. The application of heat is very beneficial. Galvanism will often hasten the cure of the remedies. Neuralgia of the Heart (Angina Pec- toris). — Amyl Nitrite, by inhalation at time of attack. Ars., 3 x, a very useful remedy to prevent the recurrence of an attack. Smoking should be stopped by those who suffer from the disease. Nightmare. — A dose of Nux Vom., 3 x, at bedtime will usually overcome the trouble. Noises in the Ear (Tinnitus Aurium).— One of the best remedies is Puis., 3 x, for this trouble. China, 1 x, for noises in the ear as a result of losing a large amount of blood. Ear wax should be removed by putting a few drops of glycerine in the ear at night, for two or three times. Obstructed Menses. — May be malforma- tion and need the care of a surgeon. When caused by congestion, Bell., 3 x, is the proper remedy. Hot vaginal injections, containing a few drops of Fluid Extract of Belladonna, may also be used. Painful Menstruation (Dysmenorrhea). — A very common trouble in flexions of the womb and disease of itself or its appen- dages. If acute and caused by a cold, Aeon., 3 x, will be the remedy. Puis., 30, will be found to be an admirable remedy at the time of the pain, when ovarian. Thuja Oc., 1 x, once a day during the intervals ; congestion of the ovaries ; a flexion should be overcome ; a narrow canal should be enlarged. Pains in the Side. — Relieved by Aeon., 1 x, and Bryonia, 3 x. Painter's Colic. — Opium must be ad- ministered in one grain doses, every two hours, until better. Kali Hydroidicum, 1 x, useful to eradicate the lead from the system. Palpitation of the Heart. — Aeon., 3 x, when the result of fright ; severe and pro- longed anxiety. Cactus Grand., 3 x, when due from fatty heart. Coffea, 3 x, nervous palpitation. Moschus, 3 x, severe and acute attacks. Agaricus, 3 x, if due from excessive use of tobacco. China, 3 x, if from tea drinking. Palsy (Paralysis). — When acute, follow- ing an attack of apoplexy, Arnica, 3 x, will hasten the absorption of the blood in the brain. Nux Vom., 3 x, and Gels., 1 x, will restore the nerve stimulus to the affected muscles in many cases. Faradization is very useful. Papulous Scall (Eczema). — The reme- dies most generally used are Croton Tig., 30, for ulcerating skin. Rhus Tox., 3 x, severe itching, with thickened, red skin. Canth., 3 x, vesicular (watery) blisters on the skin. Graph., 30, dry, cracked skin. Ars., 3 x, old, chronic cases ; dry, fish scaly skin. Sulphur, cc, will benefit cases which have become chronic and do not respond to the other remedies. Ointments generally aggra- vate the trouble. Paralysis, Agitans (Shaking Palsy).— Should be treated by a physician, as well as Paraplegia (paralysis of the lower extremi- ties), as they arcgenerally caused by some deep seated disease of the nerve centers. Periodic Headache (Malarial). — May re- quire Quinine to break it up : one dose of five, ten, or fifteen grains, the night before an expected attack, followed by Ars., 3G, once daily for a month or so. At the time of pain no remedy can equal Gelseminum, 1 x. Headache from a diseased condition of the brain will require Zinc Phos., 3 x, and sedatives prescribed by a physician. Headache of young persons of sedentary habits, free indulgers at the table, can be promptly helped by Nux Vom., 3 x, one dose daily, at bedtime. Nearly all forms are curable by homoeopathic treatment. Piles (Hemorrhoids). — Aesculus Hip., 3 x, pain in the back ; constipation and piles. Collinsonia, 1 x, very useful for piles that protrude, with constipation. Hamamelis, 1 x, bleeding piles, both in- ternal and external. Nux Vom., 3 x, and Sulphur, 30, have cured many cases, in alternation, Sulph. in the morning and Nux at night. Suppositories made from the above remedies are also very useful. Pleurisy (Pleuritis).— Aconite, 1 x, and Bry., 3 x, alternately. Aeon., 1 x, during the first two or three days, with fever, fol- lowed by Bry., 3 x, for four or five days, and later, Sulphur, cc, to finish up the case. Hot poultices should be applied to the chest. Profuse Menstruation (Menorrhagia). — Calc. Carb., 30, the remedy most useful in the large majority of cases. Never take iron in. such cases. If the above does not help, go to a physician for examination. One of the most frequent symptoms of polypus, Hbfoid tumors, granular degeneration of the mucous membrane of the womb, and even cancer, is the profuse menses. When the 684 SPECIAL SYSTEMS. flow continues all the time, and stops for a day or two and again returns (Metrorrhagia), depend upon it, your case needs the attend- ance of a specially trained physician. Prolapse of the Rectum. — Nux Vom., 3 x, three times daily, will help it, also Podo- phyllum, 3 x, in the same way. It is often necessary to wear an instrument for a time. Go to a surgeon. Puerperal Fever. — A blood poisoning caused by absorption of offensive or putrid material, either by an abrasion of the vaginal tract, or through the uterine blood vessels. It should be prevented by using a warm vaginal injection, every twelve hours, con- taining a little Calendula, for two weeks. If at any time the lochial discharge becomes offensive, use Carbolic Acid enough to scent the water, and give Kreasotum, 4 x, inter- nally. Aeon., 1 x, Bell., 3 x, Ars., 3 x, Verat. Vir., 1 x, Baptisia , or 1 x, Rhus Tox. and Radicans, 3 x, and many other remedies are used, but without the proper cleansing of the vaginal tract, they are of little use. Purulent Ophthalmia. — Merc. Sol., 3 x, and Sulph., cc, will be all the remedies needed, generally. An eye wash of Nitrate of Silver, one-half grain to the ounce of water, should be used twice daily, until better. A towel used by a person suffering from this disease should not be used by others, as the disease is infectious. Retention, Suppression and Difficulty of Voiding the Urine. — Apply hot cloths over the kidneys, and give Aeon., 3 x, every hour. Canth., 3 x, will often succeed when Aeon. fails. The case should be examined for any malformation. Rheumatism. — Aconite, 1 x, characteristic fever, caused by cold ; pain and restlessness. Bry., 3 x, swelling of the joints, which are very painful and worse from moving about. Merc. Viv., 3 x, obstinate inflammation of single joints, worse at night; deep pain, as if it were in the bones ; profuse perspiration, but not relieved by it. Puis., 3 x, subacute cases with little fever ; pains shift rapidly from one joint to another. Rhus Tox., fever ; parts red and swollen ; pains drawing, tearing, burning, feels worse when at rest and better from continued motion. Worse damp or wet weather. Wrapping the swollen joints with cotton batting relieves the pain very much. A solution of Bicarbonate of Soda and hot water, for bathing, is also useful. Rheumatic Headache. — Calls for Bry., 3 x, if worse by moving about and better at rest, but if better moving about and worse at rest, Rhus Tox., 3 x. Salicine, five grains every two hours, may be given with one of the other remedies. Rickets. — Calc. Carb., 30, and Calc. lod., 3 x, Kali Tod., 3 x, Iodine, 3 x, are the prin- cipal remedies for this defect of osseous nutrition. Ringworm (Herpes Circinatis). — Sepia, 30, one dose daily, for a week, will cure. Cantharides <(> , locally, also will cure. Running of the Ear. — Apply to a sur- geon. Merc, 3 x, and He par Sulph., 3 x, inter- nally. Scarlatina Anginosa. — Apis Mel., 3 x, great swelling of the throat, so much so that the blood cannot flow freely to and from the brain, which causes a comatose condition. Merc. Iod., 3 x, great swelling of the glands about the throat externally ; ulceration of the throat. Scarlet Fever or Scarlatina. — Simple scarlet fever should be treated by Aeon., 1 x, if there be much fever, with wiry pulse ; restlessness, etc. Bell., 3 x, is almost a specific for this form. It has red face ; sore throat ; slight delirium. Rhus Tox., 3 x, much itching of the skin in connection with the symptoms under Aeon, and Bell. Scarlatina Maligna. — Ailanthus, 1 x, very malignant cases, violent vomiting ; se- vere headache ; dark, red face ; rapid, small pulse ; high temperature ; muttering deliri- um ; dark, livid, miliary rash. Cuprum Acet., 30, pudden retrocession of eruption, followed by vomiting ; convulsions ; rolling of eyes ; distortion of face ; stupor and delirium ; brain severely affected. Muriatic Acid, 1 x, severe ulceration of the throat. For Nephritis and Dropsy, following scarlet fever, Ars., 3 x, Asclepius Syrica, 3 x, Apis Mel., 3 x, and Terebinth., 1 x, are the remedies. Give all other children in the house Bell., 3 x, who have been exposed to the disease. The diet should be principally milk. All acids should be excluded. Keep a careful watch of the patient for a month or more and the child should not be allowed to return to school for, at least, six weeks. Sciatica. — Aeon., 1 x, fever, with rest- lessness, caused by a cold. Bry., 3 x, pain is increased or brought on by movement. Cimicifuga, 1 x, drawing, tearing pain over the course of the sciatic nerve. Rhus Tox., 3 x, pain is better from warmth and worse during stormy and wet weather, better from shifting one's position. Bry. and Rhus are the chief remedies. Galvanism should be resorted to if the trouble does not yield readily to medicine. Scrofula (King's Evil). — Calc. Carb., 30, Calc. Iod., 3 x, Iodine, 3 x, Kali Hydroid., 3 x, Sulphur, cc HOMEOPATHY. 68 S Calc. Carb., 30, for fair skinned, plump, waxy children ; teeth delayed ; swollen glands ; discharges from eyes, ears, nose, etc. Calc. Iodide, 3 x, same as Calc. Carb., when the latter does not succeed. Iodine, 3 x, glandular enlargements, with wasting of the muscular tissue. Child is very thin in flesh. Mesenteric glands en- larged. Kali Hydroid., 1 x, little nodules under the skin ; lymphatic system involved deeply ; disease of the bones, etc. Cod-liver oil is often useful in those cases that are especially emaciated, and who do not seem to assimilate food, yet plenty is taken ; it should not be taken if fever is present. Scurvy. — Citric Acid, 1 x, or lemon juice, the best remedies. Kali Bich., 3 x, salivation with sore gums and hemorrhage under the skin. Acid Sulphuric, dilute, five drops every three hours, for hemorrhage from mouth, stomach, or bowels. The diet should con- sist of fresh meat, vegetables, and milk. Sea-Sickness. — Cocculus, 30, the great remedy for sea-sickness, either from vessel sailing, car or carriage riding. Simple Inflammatory Fever. — Rarely re- quires anything more than Aeon., 3 x. Slow or Nervous Fever. — Bryonia, 3 x, yellow coating on tongue ; constipation ; pain in the right side of the head ; lips dry and cracked. Nitric Acid, 3 x, torpid, sluggish liver ; sallow complexion ; acid or bitter taste in the mouth, when the fever has continued thirty or thirty-five days without recovery. Hyoscyamus Nig., 1 x, for sleeplessness during nervous fever. Bathe the patient with a solution of Bicarbonate of Soda and hot water, once daily. Snuffles, or Cold in the Head. — Aeon., 3 x, and Bry., 3 x, are the remedies most generally useful. Kali Iod., 3 x, also an admirable remedy. Sore Mouth (Aphtha). — Ars., 3 x, and Merc, 3 x, are the remedies, internally. Use a wash of Golden Seal, fluid extract, one part to ten of water. Sore Nipples. — Give Silicea, 30, inter- nally, and apply Calendula