3. ■^^^'-^^JU.^^yi. J. J^-'h-: Library of Health Complete Guide to Prevention and Cure of Disease p CONTAINING PRACTICAL INFORMATION ON Anatomy, Physiology and Preventive Medicine; Curative Medicine, ftrs Aid Measures, Diagnosis, Nursing, Sexology, Simple Home Remedies, Care of the Teeth, Occupational Diseases, Garden Plant Remedies, Alcohol and Narcotics, Treatment by Fifteen Schools of Medi- cine, Beauty Culture, Physical Culture, the Science of Breathing and the Dictionary of Drugs. FULLY ILLUSTRATED WITH HALF TONE AND COLORED PLATES TWENTY BOOKS— ONE VOLUME EDITED BY B. FRANK SCHOLL, Ph.G., M.D. Graduate of Jefferson Medical College, and Philadelphia College of Pharmacy 1921 EDITION HISTORICAL PUBLISHING CO. PHILADELPHIA. PA.. U.S. A 533 Copyright, 1916 E. J. STANLEY All Rights Reserved, Including that of Translation into Foreign Languages, • Including the Scandinavian 1921 EDITION Entered at Stationer's Hall, London March, ]91t) Wide Thanks to those that Have Gone Before The use of home medical books has now become general and they are recognized as being just as essential to the protection of the family, the care of health, the prevention of disease, the care of the young child; in giving assistance in the absence of the doctor, and in preventing unnecessary sickness and sufifering and the saving of life itself, as the scientific text books are essen- tial to the physician. This knowledge is not intended to make doctors out of lay- men or to encourage self medication except in emergency. It aims to teach prevention rather than cure. It is a well-known fact that over fifty per cent, of the sickness that comes to the home is unnecessary and preventable if the people have the proper knowledge. The right kind of information in the hands of the mother will prevent unnecessary sickness, take care of accidents and emergencies, and save thousands of lives, when the doctor cannot be reached in time ; it also teaches the care and nursing of the sick and the rearing of children in thousands of homes that cannot afford the professional nurse. It may be said that during the past five years the treatment and ctire of many diseases has entirey changed ; that more important discoveries and new and successful methods for the curing of disease have been proven and adopted during this time than in any similar period during the past century. The old method of treating fever was by shutting the patient in a tight room, smothering him with bedclothing, allowing no ice water, and dosing with medicine. The latest treatment whether the fever is typhoid in its character, pneimionia, or malaria fever, is to have the patient covered lightly with a sheet, the room perfectly ventilated and the temperature largely controlled by external applications. Measles is now treated by simple methods. The treatment for Scarlet Fever is materially changed and fatalities greatly reduced. So we might mention many others. It is not too much to say that the mortality of all diseases has been diminished greatly by the new treatments and nursing adopted within the hist five years. The tendency of modern treatment is toward preventive medicine and careful nursing. Of every i,ooo babies born in this country, 124 die before they are a year old. An average of three hundred thousand babies under a year old died yearly in the United States the past few years. Half of this number could have been saved if every mother in every home knew how to take proper precaution, and give proper care and nursing. If a child should be exposed to any disease — for instance, the Measles — the "Library" tells you just how many days before the rash appears and how it can affect others exposed to it. By having this information the mother can call the doctor in time and can more intelligently assist and co-operate with him. Then just think of the accidents that are happening every dav antl the doctor may be miles away. We give in the "Library" the quickest, best and the most efficient treatments in accidents and emergencies, in the absence of a doctor, and it is the duty of everyone to know what to do for the first aid to the sick and injured. If someone should take poison — for instance, "Carbolic ■ Acid" or "Lye," which are very common in the home — perhaps your child takes a drink of one of them by mistake. You call in a doctor and by the time he gets there it may be too late, but, by turning to "POISONS," you find, "For Carbolic Acid take Epsom Salts," and "for Lye take Oil." This information may save a life. And so on with every kind of emergency. They happen every day, especially with children. There's nev^er a wash-day that passes over the land but what there are numbers of cases of chil- dren getting hold of ammonia. If your little one took a swallow from the ammonia bottle, you couldn't grab it in your arms the moment it screamed and run two blocks to the doctor in time to do any good, but yoti could grab the vinegar bottle — that's always handy — and give it a good swallow of vinegar, which will im- mediatelv coimteract the ammonia. No home should be without stich information. What would you do in the absence of a doctor? Ask your- self any question about health or life and turn to the "Library" for your answer. Did you ever stop to think that one could bleed to death in three to seven minutes, before you could get medical help? Here is given the simplest and best information on just where to press. to stop the flow of blood from anv part of the body; and if you know just how, you can stop it with your own thumb or finger or by using a simple tourniquet until you can procure as- sistance; then you can wait for the doctor — hours, if necessary. It is only too true that a large majority of our women are raised in an atmosphere of false modesty that prevents them from having the necessary knowledge to take the proper care of themselves and avoid various diseases and disorders. Thou- sands of women have questions they would like answered that they will not ask their local physician on account of embarrass- ment, also expense, and this information is absolutely essential to their personal health. These minor troubles through neglect oftentimes become chronic and incurable, while, if taken at the start, they are easy to remedy. Watch carefully every little headache, cough, chill, pain or fever — they may lead to something serious. Prevention is better than cure and Prcz'eiitioii begins at home. The index under the HEADINGS will direct you to the proper place, where you can obtain the information you need to guide you. The mother is the one who looks after the health of the family. The mother is with the children twenty-four hours in the day and feels most responsible in case of sickness. That is why the "Library" is placed in the homes — IT IS FOR THE WIFE and FOR THE MOTHER. If the husband comes home sick, or a child is ill, the wife is expected to do the nursing. How is she going to do this if she never had any experience with sickness? The Nursing Depart- ment will tell her. It teaches how to make poultices, ointments, plasters, syrups, etc. ; how to change the sheets, making the pa- tient comfortable, and how to feed the sick. Of the most value to the sick room is the nurse ; she should understand how to pre- pare food and diet for the particular ailment of the patient, and to assist the doctor in battling with disease and restoring health. "Library of Health" gives you all this information in a plain, practical way that anyone can understand. Knowing from our experience that the medical specialists and teachers who stand at the head of their profession write in language of technical expression, it has been necessary for the publishers to seek the services of a competent editorial stafif, who have put the technical and scientific knowledge in a plain, prac- tical form, so that anyone can understand. JVe zvish to extend wide thanks to the contributors to this work and to the professors, physicians, specialists and lecturers of Universities and Colleges throughout the world, some of whom have gone before, and the recognized standard home medical works published in England, Germany, France, Spain and Amer- ica, from whom our editors have gleaned, as follows: Seserano Lachapelle, M.D., Professor of Anatomy, Montreal, Canada. Benito Bordas, M.D., Specialist in Febrile Diseases, Cuba. Wm. L. Powell, M.D., Specialist in Internal Medicine. George Noble, IM.D., Professor of Chest Diseases, Vienna. H. Webster Jones, M.D., Specialist in Diseases of Children, London. Prof. Van Werth, Specialist in Venereal Diseases, Dresden. John Forsyth Little, M.R., Demonstrator of Anatomy, Philadelphia. Silverio Dominguez, M.D., Specialist in Constitutional Diseases, Buenos Aires. Prof. M. Hoff, Specialist in Consumption and Germ Treatment of Disease, Vienna. C C. Vanderbeck, M.D., Ph.G., Formerly Lecturer on Hygiene, Philadelphia. Domingo Orvananos, M.D., Specialist in Diseases of the Circulatory System. A. O. Mencki, M.D., Experimental Medicine, Petrograd, Russia. Aubrey W. Marchand, D.C., Chiropractice, Davenport, Iowa. Anne McFarland Sharpe, B.A., M.D., Author of "Nervous Troubles Among Women." Jose Peon Y. Contreras, ]\1.D., Specialist in Tropical Diseases, Mexico. Joseph G. Richardson, M.D., Professor of Hygiene. A. M. Stafford, M.D., Specialist in Diseases of the Nose and Throat. F. E. Miller, A.M., M.D., Consulting Physician, St. Joseph's Hospital, New York City. Eugene Davis, M.D., Formerly Specialist in Polyclinic Hospital, Philadelphia. L. E. Fortier, M.D., Ex-Surgeon Pennsylvania Railroad Co. E. F. Roeber. M.D., Kneipp System of Natural Plealing. Jean Latauche, M.D., Lecturer on Clinical Diseases, Plospital of Charity, Paris. S. Ivi'asaki, M.D., Nagasaki, Japan. El Medico del Hogar. Hering's Domestic Physician. Warren's Household Physician. Greer's Physician in the Home. Chavasses' "Manual for Wives and Mothers." Woods' Vitalogy. American Family Physician. Newell's Family Doctor. Bilz's Natural Healing. Kelley's Domestic Medical Practice. Gunn's Revised Family Physician. Medicology. Standard Family Physician. ■ And many others. GENERAL ARRANGEMENT Although contained in one volume this work is divided into twenty Books, which in their turn are subdivided into chapters or parts. At the back of the whole work will be found a complete General Index of all matters contained in the different Books and their subdivisions, so that any disease or any remedy in any part of the work may be quickly located. But, in addition to this General Index, each chapter or part is prefixed with a special index of its own, thus giving immediate location of items to be consulted in the special sub- ject at the time under consideration. For example, let us take the common disease Asthma. On con- sulting the General Index we find the main article to be on page 523. Turning to the index at the be- ginning of this chapter (Part VI of Book IV) we may find the causes, symptoms and varieties of Asthma. If what we wish is not found in this general article, we again refer to the General Index; and we have special treatments of the disease in other parts of the work, such as Simple Remedies, Prescriptions, Homeopathic Treatment, Exercises, etc. This plan has been carried out all through the work. IMPORTANT READ CAREFULLY A TTENTION is directed to the fact that all through -^^ this book the doses mentioned are for ADULTS, except where the treatment is specifically for a child. PLEASE NOTE particularly the footnote on pages 1233 to 124S inclusive. Also note full directions given on pages 1224 and 1 7 19, to determine doses for children. Table of Contents Book I The Human Body 35 A Description of the Colored Anatomical Charts Comprising the Manikin Accompanying this Work Book n Anatomy and Physiology 73 Book III Preventive Medicine 1271 Part I The Prevention of Disease by Elimination of Disease Carriers. 127 Part II Water in Its Hygienic Relations 147 Part III Pure Air as a Condition of Healtli 181 Part IV The Hygiene of Foods and Drinks 207 , Part V Outward Enemies to Health 231 Part VI The Germ Theory of Disease 237 Part VII The Construction of Sanitary Dwelling Houses 247 Part VIII Importance of the Removal of Excreta.- 257 Book IV Curative Medicine 261 Part I The Eruptive Diseases 261 Part II The Constitutional Diseases 353 Part III Diseases of the Nervous System 401 Part IV Diseases of the Eye, Ear and Nose 4SI Part V Diseases of the Circulatory and Absorbent Systems 493 Part VI Diseases of the Respiratory System 523 Part VII Diseases of the Digestive System 555 Part VIII Diseases of the Genito-Urinary System, Including the Venereal Diseases 599 Part IX The "Urine in Health and Disease with a Series of Home Tests. 631 Part X Diseases Peculiar to Women 639 Part XI Diseases of the Skin, Hair and Nails 711 Part XII Diseases of the Bones and Muscles •. 733 Part XIII Diseases of Children 757 Part XIV Diseases and Conditions which may be Treated Surgically 783 Part XV Anesthetics and Soporifics 813 Book V First Aid to the Injured 825 Part I Accidents and Emergencies 825 Part II Bandaging 873 Part HI Poisons and Their Antidotes 881 Book VI The Diagnosis of Disease 917 With a Tal)Ie of Symptoms Arranged Alphabetically for Ready Reference Book VII The Sick Room in the Home 985 Part I A Treatise on the Science of Nursing (185 Part II The Care of the Convalescent 1043 Part III Diet in its Relation to Disease with a Table of Suitable and Unsuitable Foods for Nearly Fifty Diseases 1059 Part IV The Care of the Aged 1087 V vi TABI.E OF CONTENTS. Book Vin Sexology 1107 Part I Courtship and Matrimony 1107 Part II The Mother and the Child, Being a Treatise on the Care of the Mother Before and During Child-birth and of the Child Through Infancy 1129 Book IX Home Administration of Medicine 1199 Part I The Ideal Home Medicine Chest 1199 Part II Foods and Their Digestion 1209 Part III Tables of Weights and Measures, Doses, Pulse Rate, Den- tition, etc., etc 1223 Part IV Standard Medical Prescriptions and Simple Formulas 1233 Part V New Remedies, Their Properties, Doses and Manner of Using. 1251 Book X Simple Remedies for Many Ills. What To Do in the Absence of a Doctor 1259 Book XI The Care and Diseases of the Teeth 1301 Book XII The Occupational Diseases 1331 With a Table of Industrial Poisons arranged alphabetically, showing the effects produced by each and giving special measures of relief therefrom Book Xin Medical Materials, Their Properties and Uses 1375 Part I Inorganic or Mineral Materials 1375 Part II Organic or Vegetable Materials 1385 Book XIV Alcohol and Narcotics 1479 The Newest and Best Cures for the Drink, Tobacco and Drug Habits Book XV The Treatment of Disease hy Various Schools of Medicine. 1495 Part I Homeopathy 1495 Part II Osteopathy 1508 Part III Massage 1518 Part IV Chiropractic 1524 Part V Hydrotherapy 1527 Part VI Eclectic Medicine 1545 Part VII The Japanese Method ISS7 Part VIII The German Home Treatment 1571 Part IX Electricity and the X-Ray 1588 Part X Mental Healing, Including Mesmerism, Hypnotism, Mind Cure, Christian Science and Telepathy IS9I Part XI Human Science: Phrenology, Physiognomy and Palmistry.... 1604 Book XVt Beauty Culture and Self -Care for "Women 1623 Book XVII Physical Culture and Body -Building 1649 Book XVm The Science of Breath and a Series of Remedial Exercises . 1689 Book XIX Jiu-Jitsu 1709 Book XX Latin-English Dictionary of Drugs 1713 LIST OF ILLUSTRATIONS PAGE. Abdominal Binder 1144 Aconite. (Colored Plate) 1423 Acromio-Clavicular and Shoulder Joints 88 Ague Root. (Colored Plate) 1405 Air Passages of the Lungs 184 Alimentary Canal from Throat to Anus 101, 216 Ankle Joint, Section of • 88 Anterior Splint for Fracture of Arm 872 Apple. (Colored Plate) 1395 Application of a Bandage 805 Applying the Diaper 1144 Arm Bones S3, 84 Arteries, The 511 Artery of the Arm Ill, 793 Artificial Respiration — Mechanical 856 Artificial Respiration — Schafer System 853 Asparagus. (Colored Plates) 1398, 1415 Atlas or First Cervical Vertebrae 80 Balancing and Stretching Exercise 1G84 Bandage for Burn on Arm 873 for the Eye 873 to Fix Shoulders Back 873 for Fractured Collar Bone • 873 for Fractured Knee-Cap 873 for the Head 873 for Lower Part of Leg 873 for Mouth-breathing 1643 for Outstanding Ears 1643 Barberry. (Colored Plate) 1433 Base of Brain, Sectional View of 117 Bathing the Infant 1150 Beet. "(Colored Plate) 1399 Belladonna. (Colored Plate) 1429 Bilberry. (Colored Plate) . 1439 Bitter-sweet Nightshade. (Colored Plate) 1435 vii PIU ' LIST OF ILLUSTRATIONS. PAGE. Blackberry. (Colored Plate) 1427 Black Briony. (Colored Plate) 1437 Blood Corpuscles, ilagnified 105 Board as Splint for Fracture Below tlie Knee 873 Bone Fractures ■ 806 Bone, Section of 75 Bones of Forearm Acting as Levers 744 Bones of the Hand (Carpus) 84 Brain, The 407 Brain and Cord 121 Breast Bandages 878 Broomstick Exercise 1685 Brushing the Hair 1643 Brushing the Teeth 1643 Burrow (if Itch Insect ■ 729 Buttock and Back of Thigh 124 Calaraint. (Colored Plate) 1413 Calcified Trichina; 751 Carawav. (Colored Plate) 1435 Carrot. (Colored Plate) 1425 Cartilage, Section of 76 Cathartic. (Colored Plate) 1425 Cathartic Ramno. (Colored Plate) 1409 Celery. (Colored Plate) 1402 Cells of Human Organism 210 Cervical Cord, Section of 122 Chamomile. (Colored Plate) 1435 Changing Sheets 998 Character Lines of the Hand 1C17 Chart. — Hours of Feeding 1145 Chart.— Hours of Sleep 1145 Checking Hemorrhage in Hand or Wrist 794 Chicken-pox. (Colored Plate) 766 Chittim Bark. (Colored Plate) 1405 Cholera Germ 328 Cholera Germs. (Colored Plate) 238 Cigar-box Splint Applied to Fracture of Ankle 872 Ciliated Epithelial Tissue 74 Circulation in Frog's Foot 220 Cleansing Breath 1696 LIST OF ILLUSTRATIONS. IX PAGE. Coat Sleeve Sling 87iJ Cold Compress 16-12 Colt's Foot. (Colored Plate) 1110 Common Bramble. (Colored Plate) 11:27 Common Hedge Nettle. (Colored Plate) 1107 Comparison of Breast-fed and Bottle-fed Infants 1115 Constituents of Foods 227 Correct Position for Complete Breathing 169C Course of Femoral Artery 795 Cross-section of Head 1308 Crow-Foot. (Colored Plate) 1131 Crystalline Lens 454 Currants. (Colored Plate) 1419 Curvature of Lens • . . 4GG Daily Eecord 1021 Dandelion. (Colored Plate) '. 1427 Dental Caries. (Colored Plate) 1318 Dental Floss 1643 Diagnosis Charts 91G Diagram of Both Circulations 222 Diagram of Circulation 221 Digestive System 1302 Digitalis. (Colored Plate) 1431 Dill. (Colored Plate) 1437 Diseases of the Teeth. (Colored Plate) 1300 Dislocation of Lower Jaw 800 Dissection of Front of Forearm Ill, 123 Dorsal Vertebrae 79 Double Handkerchief Sling 872 Dressing for Broken Leg 808 Drying the Face 1642 Ear, Section of 472 Ear, The 474 Eczema. (Colored Plate) 714 Effect of Alcohol on the Stomach and Intestines. (Colored Plate) 1480 Elder. (Colored Plate) 1433 Electric Battery Treatment 1589 Emergency Splint for Ankle IMade from Cigar-box 872 Emergency Splint for Fracture of Knee-Cap 872 X UBT OF ILLUSTRATIONS. PAGE. Encysted TrichiniB 74:7 Epithelial Tissue 74 Epithelium, Columnar 74 Example of Physical Development 1650 Exercise for tlie Abdomen 1G74 for Abdomen and Trunk 1074 for Abdominal Muscles 1658 for the Back 1056, 1074 for the Bust • 1674 with Chair 1684 for the Chest 1674 for Constipation 1674 for Female Weakness 1674 for Grace and Agility 1074 for the Hips 1674 for Muscles of the Front of the Body 1658 for Prolapsed Organs 1675 for the Spine • . . . . 1G56 for the Stomach and Abdomen 1658 for the Trunk of the Body , . 1658 with Two Chairs 1684 Eye, Section of 452 Eye, The 461 Face, Nerves of 118 Fat, Section of 76 Femur, or Thigh Bone 87 Fennel. (Colored Plate) 1409 Fibula, or Minor Shin Bone 87 Filling Upper Lobe of Eight Lung 1696 Flax. (Colored Plate) 1425 Flesh Brush • 1642 Folding the Diaper 1144 Folds of the Intestines 218 Foot Bones 87 Four-tailed Bandage for the Chin 876 Foxglove. (Colored Plate) 1431 Fracture of Both Bones of Forearm 807 Fracture of Humerus 808 Front and Side Views of the Teeth and Jaws 1307 LIST OF ILLUSTRATIONS. XI PAGE. Garlic. (Colored Plate) 1417 General Exercises for Women 1674 Geranium. (Colored Plate) 1435 Glandular Epithelium 74 Golden Thistle. (Colored Plate) 1411 Grape. (Colored Plate) 1397 Grape-Fi-uit. (Colored Plate) 1395 Great Mullein. (Colored Plate) 1429 Hand Bandages 875 Hand Wrestling • . . 1C85 Head, Arteries of 109 Head Bandage 872 Heart, The 499 Heart and Lungs, Sectional View 106 Heart Cavities, Eight Side 502 Heart, Showing Arteries. (Colored Plate) 504 Heart, Showing Auricles and Ventricles 107 Hedge Mustard. (Colored Plate) 1407 Hedgewort. (Colored Plate) 1439 Hellebore. (Colored Plate) 1421 Hemlock. (Colored Plate) 1433 Henbane. (Colored Plate) 1413 Hip Joint, Socket and Ligaments 88 Home Tests for Urine. (Colored Plate) G34 Hookworms 310 Hops. (Colored Plate) 1415 Horse Chestnut. (Colored Plate) 1425 Horse-Eadish. (Colored Plate) 1417 How to Stop Bleeding 846 How to Stop Bleeding. (Colored Plate) 848 Human Milk Containing Colostrum Corpuscles 228 Human Skeleton. (Colored Plate) 736 Human Skeleton. (Full Page) 78 Humerus 83 Ideal Sick Eoom 999 Ice As a Cosmetic 1642 Infant Bathing Table 1144 Internal Organs. (Colored Plate) 504 Iris. (Colored Plate) 1427 Itch Insect 728 XJl UST OF ILLUSTEATIONS. PAGB. Japanese Ladies 1558 Juniper. (Colored Plate) lilO Kidney Disease. (Colored Plate) 590 Lacteals and Lymphatics 219 Laurel. (Colored Plate) 1-137 Leg, Arteries of 112 Leg, Front View of 124 Lemon, The. (Colored Plate) 1394 Licorice. (Colored Plate) 1127 Lily of the Valley. (Colored Plate) 1423 Linie-Tree. (Colored Plate) 1411 Liver Complaint. (Colored Plate) 590 Liver, Section of. (Colored Plate) 504 Liver, Showing Lobes and Bile Lhict 103 Lousewort. (Colored Plate) 1411 Lumbar Vertebrae 79 Lungs lOG, 183 Lungs and Their Diseases 535 Lungs. (Colored Plate) • 504 Lying-in Room 1144 L^Tuphatics 103, 104 Mammary Gland 691 Manikin of the Body. (Colored Plate) 40 Manikin of the Eye, Ear, Hand, Foot and Leg. (Colored Plates) 60 iLanikiu of the Ilead. (Colored Plate) 36 Marshmallow. (Colored Plate) 1415 Massage of the Body 1642 for the Bust 1643 for Double Chin 1643 for the Eyes • 1642 for the Face 1643 of the Scalp 1643 for Wrinkles 1643 Meadow Saffron. (Colored Plate) 1417 Ifeasles. (Colored Plate) 760 Mezereon. (Colored Plate) 1437 Mountain Balm. (Colored Plate) 1413 Muscles of the Back 92 Back of Thigh 97 LIST OF ILLUSTKATIONS. XIU PAGE. of the Body, Back View 89 of the Body, Front View 90 of the Chest 93 of Face, Jaw and Neck 91 of Forearm 94 of Front of the Leg 97 of the Larynx 529 Muscular System. (Colored Plate) 752 Mustard. (Colored Plate) 1413 Neck, Arteries of 110 Kerve Cells 76 Fifth 119 Vitaliziug Breath 1G9G Nerves, The 125 of the Face and Scalp 118 Leading to Roots of the Teeth 1324 Magnified 77 Ninth, Tenth and Eleventh 120 of the Side of the Face 441 of the Thigh 96, 123 Nettle. (Colored Plate) • 1429 Non-striated Muscle 77 Normal and Pinched Nerves 1524 Nursing Chart 1020 Nutritive Proportions of Foods 224 Oak-Tree. (Colored Plate) 1433 Onion. (Colored Plate) 1400 Operation for Cataract 464 Oregon Wild Grape. (Colored Plato) 1396 Ovary and Mammary Gland 691 Parsley. (Colored Plate) 1431 Pavement Epithelial Tissue 74 Pelvis of the Male 86 Pennyroyal. (Colored Plate) 1421 Peony. (Colored Plate) 1423 Peppermint. (Colored Plate) 1437 Perforated St. John's Wort. (Colored Plate) 1423 Peritoneum, Showing Involved Organs 102 Periwinkle. (Colored Plate) 1439 Permanent Teeth of Right Side 1306 XIV LIST OF ILLUSTRATIONS. PAGE. Plantain. (Colored Plate) 1421 Poppy. (Colored Plate) • 1421 Position for Bottle-Feeding 1161 Position for Breast-Feeding , 1145 Positions of the Vocal Cords 528 Posterior Splint for Fracture of Arm 872 Prevention of Wrinkles 1642 Properly JMade Bed 999 Proportions of Healtbj Child's Body 1145 Pulmotor 856 Pumpkin. (Colored Plate) 1400 Pyorrhoea Alveolaris 1322 Quieting the Baby 1161 Racemose Gland 74 Radius • 84 Recurrent Bandage 874 Red and \Miite Blood Corpuscles 223 Red-berried Trailing Arbutus. (Colored Plate) 1411 Red Pepper. (Colored Plate) 1403 Removing Blackheads 1642 Removing Superfluous Hair 1642 Rescue from Drowning 853 Ribs Showing Thorax 82 Rigg's Disease 1322 Right and Wrong Ways of Holding Baby 1160 Ringworm on the Hair 723 Rolier Bandage 873 Rooster Fight 1685 Rosemary. (Colored Plate) 1429 Saffron. ' (Colored Plate) 1407 Sage. (Colored Plate) 1413 Salivary Gland 98 Salvia. (Colored Plate) 1413 Santal Wood. (Colored Plate) 1405 Scald Head. (Colored Plate) 715 Scalp, Nerves of 118 Scapula or Back of Shoulder 83 Scarlatina (Colored Plate) 761 Scarlet Fever. (Colored Plate) 761 Scurvy-Grass, (Colored Plate) 1417 LIST OF ILLUSTRATIONS. XV PASS. Sebaceous Glaud, Magnified 721 Semilimar Valves of the Heart 108 Shoulder Joints - . . • 88 Simple Baudage for Foot aud Ankle 873 Simple Gland 74 Simple Spiral Baudage S72 Simple Spiral Baudage over Splint 872 Skin, The 712 Skull, Front View of 81 Small-pox, Confluent or Enmassed Form. (Colored Plate j 260 Small-pox, Discrete or Separate Form. (Colored Plate) 200 Spinal Column 7{) Spinal Cord ■ 121 Spinal Foramina 1524 Spiral Reverse Bandage 872 Stavesacre. (Colored Plate) 1411 Stimulating the Hair Roots 1643 Stomach, The 100 Stomach. (Colored Plate) f)04 Stomach Tubule lOO Stone Root. (Colored Plate) 1405 Straw Lily. (Colored Plate) 1427 Striated Muscle 77 Swallowing Muscles 215 Tansy. (Colored Plate) 1409 Teeth of Child Between Six and Seven Years of Age 1308 Teething Chart 1163 Temperature Chart 1022 Temporary Teeth in Child Aged About Four Years 1311 Temporary Teeth of Left Side 1305 Temporary Teeth of Right .Side 1305 Test for Rubber Xipplcs 1151 Thigh, Arteries of ■ 112 Thigh, Back View of 124 Thorax, The 82, 116 Thorn-Apple. (Colored Plate) 1415 Tibia or Shin Bone 87 Tomato. (Colored Plate) • 1401 Tongue. (Colored Plate) 918 Tongue, The , 99, 663 ^71 LIST OF ILLUSTRATIONS. PAGE. To Prevent Infant from Taking Your Cold 1145 Transportation of tlie Injured 856 Treatment of the Eyelashes 1642 Treatment for Moles 1642 Triangular Bandage As a Sling 873, 877 Triangular Bandage for the Head 876 Triangular Bandage for the Foot 873 Trichina and its Cyst 750 Cyst ". 749 in Human Muscle. (Colored Plate) 238 Spiralis in Human Muscles 746 Tuberculosis Bacillus. (Colored Plate) 238 Ulcerative Stomatitis 1322 Ulna, or Bone of the Forearm 84 Umbrella As Splint for Fracture Below the Kneo 873 Urinary and Generative Organs of Women G40 Urinometer, The 634 Vaccination. (Colored Plate) 271 Vaccination As a Preventive of Small-pox 268 Valerian. (Colored Plate) 1431 Valves of the Heart 516 Varioloid. (Colored Plate) 267 Veins of the Leg 114 Veins of the Upper Extremity 114 Villi of the Small Intestine 218 Vincent's Angina 1322 Vocal Apparatus 527 Vocal Cords 528 Washing the Face 1642 What to Do if Bitten by a Mad Dog or Poisonous Eejjtile. (Colored Plate) .• 828 AMiite TToarhound. (Colored Plate) 1419 Wild Strawberrv. (Colored Plate) 1439 Wolf's Bane. (Colored Plate) 1423 Wood Sorrel. (Colored Plate) 1409 Wormwood. (Colored Plate) 1425 Wrestling 1685 X-Eay Photograph 1588 Yellow Fever Mosquito 295 YeUow Goat's Beard. (Colored Plate) 1407 INDEX TO BOOK I Book I describes tlie human body and illustrates it by a series of Manikins or Anatomical Charts. The following list of contents, alphabetically arranged, will enable the reader to quickly turn to any subject or illustration desired : SUBJECTS OF THE TEXT Abdomen, Walls of Appendix, Vermiform Arms, Blood Supply of Arms, Bones of Arteries, The Bladder, The 56, Blood, Coagulation of Blood, Description of Blood Supply of Arm Blood Supply and Muscular Arrange- ment Blood-vessels of the Body Blood-vessels of the Liver Body, Muscles of Body, Structure of Bones of the Face Bones of the Skull Bones of the Spinal Column Bones of the Thigh and Leg Bones of the Trunk and Arms Brain, Base of Brain Cavity Brain, Consistency of Brain, Location of Brain, Mechanism of Brain, Sectional View of Brain, Shape of Brain, Vertical Section of Breathing Cerebellum Cerebrum Chest, Composition of Child, Position of at Birth Clitoris, The Coagulation of the Blood 33 Cranium, Base of , 37 Deftness of the Fingers 66 Development, Muscular 66 Digestive Apparatus, Description of... 51 Ear, Description of 59 Ear Drum, The 60 Eye, Description of 59 Eye, Muscles of 59 Eye, View of 36 Face, Bones of 40 Face, Muscles of 35 Fingers, Deftness of 66 Foot, Description of 62 Good Health, Picture of 35 Hand, Description of 60 Heart, Description of 48 Hymen, The 56 Intestines, The 53 Kidneys, The 58 Knee- Pan (Knee^Cap) 64 Leg, Bones of 64 Leg, Description of 63 Leg, Muscles of 6^, 65 Liver, The 52 Liver, Blood-vessels of 53 Lungs, The 45 Lungs, Breathing Capacity of 47 Lungs, Description of -15.46 Lungs, Pleura of 45 Mucles of the Body 43 Muscles of the Eye 59 Muscles of the Face 35 JNIuscIes of the Leg 63, 65 Muscles of the Neck 35, 36 Muscles of the Shoulder 43 84 INny.X TO BOOK I. Muscles of the Thigh 65 Muscular Arrangement and Blood Supply 42 Muscular Development 66 Neck-, Muscles of 35, 36 Nerve, Sciatic 64 Nose, The 38 Olfactory Nerve 38 Ovaries 56 Pancreas, The 53 Pelvis, The 44 Picture of Good Health 35 Position of Child at Birth $7 Pylorus, The 52 Respiration 47 Ribs, The 44 Sciatic Nerve, The 64 Shoulder Joints, The 44 Shoulder, Muscles of 43 Skull, Bones of 39 Skull, Shape of 39 Spinal Column 40, 44 Spinal Column, Bones of 44 Spleen, The 58 Stomach, The 52 Thigh Bones 64 Thorax, The 42 Toes, The 62 Tongue, The 38 ■ Trunk, Bones of 43 Urethra, The 56 Vagina, The 56 Veins, The 58 Vermiform Appendix 55 Voice, The 66 Womb, The > 56 LIST OF ILLUSTRATIONS Body, Manikin of 40 Ear, " " 60 Eye, " " 60 Foot, " " 60 Hand, JIanikin of 60 Head, " " .- • ■ 36 Leg, " " 60 Book I. THE HUMAN BODY. A Description of the Colored Anatomical Cluirts Composing the Manikin Accompanying this WorJc. CHART I. A PICTUEE OF GOOD HEALTH. This exquisitely beantifnl and artistic Anatomical Plate presents the head and face of a young man in the enjoyment of perfect health. Apart from the subject it so accurately and faithfully represents, it is in itself a valuable life-like portraiture of the human head and face, and shows to what perfection the art of anatomical plate printing has attained. Note the prominent perceptive faculties, the high forehead, features character- istic of a large brain and a massive and imimpaired intellect. Mark the open expression of the eye ! how true to nature and life-like. Observe the compressed lips, denoting firmness of character and determination of puri^ose. Look attentively at the bright, open, manly countenance; there are no signs of mental decrepitude, physical bodily iiafirmities, nervous fear, or exhaustion of brain power or life-force in the expression of the noble, ruddy and healthy face. It is, as its name im^jlies, typical of Per- fect Health! Muscles of the Face and Neck — This fine plate is a remarkalily real- istic and accurate representation of the head and neck, after the outer skin has been removed. It shows the bare skull, together with the ad- mirable and skilful arrangement of the muscles of the face and neck ; also the external part of the ear. There are, also, numerous blood-vessels noticed meandering over the parts exposed to view, by means of which this muscular area receives its supply of nutrient blood. The large, broad muscle observed over the forehead is the one by which we elevate the brow, and in conjunction with the orbicular muscle that is seen surround- ing the eye, we can contract the brow, as in "scowling." Muscles of the Face — The muscles of the face are those employed to give variety of expression to the countenance It is through the medium (35) 36 TnF, nnwAN nonT. of these small hut nspfnl imisclcs tlmt puhlic speakers can give facial emphasis to their ilow of rhetorical eloquence; the tragedian employs them to give dramatic cilcct to the various characters he impersonates, and the low comedian and "clown" cultivate them for facial contortion and "guying" characterization. The numerous muscles observed about the neck are those which give elasticity and mobility to the head. It ia by means of these muscles that the head can rotate on its axis, bend for- ward, backward, sidewise, and pose in the diversified attitudes and various positions it can be made to assume. THE BRAIN; AND A VERTICAL SECTION OF THE FACE AND NECK. "What the Plate Shows. — As we progress in our anatomical course of study, our attention is firmly and deeply' fixed in wonder and amazement at the marvelous mechanism revealed in the sublime profundity and grande^ir brought out in this magnificent artistic plate. It brings before our astonished vision the beautiful proportions and symmetry of the human brain as it lays in situ within its bony castle ; and as we look upon its wavy convolutions we naturally turn our thoughts to the hidden mys- teries of mind and to its superiority over matter, and to the illimitable intelloctual properties, powers and capacity of the mind, that lay quietly slumbering in the depths of the human brain, for the mind of man sur- passeth all things of human conception or construction. Below this mighty throne of reason and intelligence, on the left, we observe the cerebellum or lesser brain, the fount from whence all the vegetative or organic func- tions of life — as respiration, beating of the heart, digestion, etc. — receive their inspiration and supply of vital force. View of the Eye. — ^We can likewise view the human eye as it lays in position in its bony socket, and wonder at our Creator's munificence and benevolence in providing us with such a delicate instrument of vision with which to light our way about in the world, and view the magnificent beau- tics of nature that surround us on every hand. Here, too, we observe the teeth, those essential pre-requisitcs to personal beauty, and valuable ad- juncts to the powers of articulation and speech, protruding through the gums, their roots being visible above and below the gums; and in the lower set we see the dental nerve distributing its nervous supply to their individual and collective roots. The Neck Muscles. — This beautiful illustration brings out in bold re- lief the superficial and deep muscles of the neck, and, at the same time, we observe a faithful delineation, not only of the relative position of the CHART 1 "I. COPYRIGHT ISIC BY E . J . STANLEY CHART 1 . " //^J^i'— r) fM^v /<<> ■vV^ ( fCT^^S "* mm. CHART 1 . A- >/■ sm t!'! J- W.\rk ,<-- J/ INTEFMNIAL VIEW \ OF ba^e; of cranium SHG^NG ROOTS OF OTiVES AND OF SAME f vt>- CHART 1 \ ^' RIGHT LOBE OF:-^ /NMJIlWfl" LOBE OF CEREBELLUM '^^ /ifjy X-CEREBELLUM OR LESSER BRAIN ^^ 5 JU OR LESSER BRAIN K -J O K o o UJ -I S m VIEW OF BASE OF BRAIN SHOWING THE ORIGIN OF THE NERVES OF SPECIAL SENSES AND BLOOD SUPPLY OF BRAIN CHART 1 . SECTIONAL VIEW OF THE BEAIN, FACE AND THEOAT. Si carotid artery and jugular vein, but also of the manner in which the mus- cular and fleshy part of the neck receives its nervous supply. VIEW OF THE BASE OF THE CRANIUM. Brain Cavity. — Here in this remarkable illustration we have pre- sented to us one of the most wonderful views in the anatomy of the skull, or, in fact, of any part of the human frame. It is a view of the floor of the cranial cavity on which that curious and mysterious, but sublime organ, the brain, rests. The marvelous skill and ingenuity therein dis- played, of the complex mechanism surveyed, the beautiful and intricate manner in which the nerves of special sense are so elaborately set forth, the complicated profusion and exquisite design manifest in the distribu- tion of blood-vessels for the nourishment and support of the special organ of reason and intelligence — all claim our closest and undivided attention, and we are unconsciously led to revere the Omniscience of Him who could conceive of such intricate architecture, and perform such delicate, unique and perfect workmanship. The large opening observed in the floor of the cranial cavity is the foramen magnum, through which the spinal cord, together with the cerebro-spinal nerves, escape. SECTIONAL VIEW OF THE BRAIN, FACE AND THROAT. The Brain in its Bony Citadel. — The artist, with true anatomical in- stinct and a rare technical ability in regard to accuracy and minute detail, has performed his part of the work in this illustration with such faithful fidelity to nature that one camiot withhold a word of praise at the grand style and elaborate manner of its execution. This elegant and artistic anatomical plate represents the brain held firmly in position within its strong, bony citadel, but cleft in twain from above downward, thus showing its internal mechanism and construction; besides which it gives the internal arrangements of the nose, tongue, throat and neck. Order of Brain Mechanism — Commencing from above and descending downward we observe the following important structures, to wit: The fascia or skin covering the cranial bones ; and then a section of the bones themselves, showing their laminated structures. Between the bones of the skidl and the brain are seen the meningeal coats of the brain, which serve the double purpose of supplying it with blood-vessels and protecting that delicate organ from pressure or injury. Cerebrum and Cerebellum — We observe that the cerebrum, the seat of mind and volition, is much larger than the cerebellum or little brain ; 38 THE nUMAN BODT. and as though that was not enough area for the evolution of the mind, we see this part of the brain most curiously wrinkled and folded into various sized convolutions, thus increasing the mental surface. The more niiiiierous these convolutions arc, the higher and more noble the mental faculties and intellectual powers become. The hemisphere of the brain, here shown, is seen to be divided into three lobes, the frontal, middle and posterior. The Corpus Callosum, or the great commissure of the brain, is most faitlifullj represented, and immediately below is seen the Fornix. The peculiar apjiearance of the cerebellum or little brain presents a tree- like resemblance, whence it is called tlie arhor vitcv, or the tree of life. . The Olfactory Nerve. — The olfactory nerve is graphically displayed, branches of which are seen passing in all directions over the mucous mem- brane of the nose. A little to tlie left of the olfactory nerve is seen the posterior nares, and immediately below tlic pharynx and epiglottis, the cosophairus or gullet, tlie lar_\Tix and trachea or wind-pipe. The Tongue. — The tongue, or organ of taste and instrument of speech, is most accurately represented, the muscular fibres of which are seen running in diflferent but determinate ways, thus giving to this important organ variety and regularity of motion and aiding it to assume numerous shapes and forms. The cervical portion of the spinal column is seen, with the fleshy part of the back of the neck attached. This plate is one that commends itself to our deep and careful study. VIEW or THE BASE OF THE BRAIN, AND THE THOUGHTS IT SUGGESTS. Shape of Brain.^As so graphically delineated in this beautifid as well as natural illustration of the human brain, we glean a knowledge of the origin and source of its blood supply; the arteries are observed to distribute numerous branches in various directions along and over its sur- face, many of which penetrate its substance. As noticed, the brain pre- sents an ovoid or egg-shaped appearance, divided into two equal, lateral halves — hemispheres as they are called — thus virtually giving us two brains, the same as we have two eyes, two arms and two legs. Witli this surplus of brains, as it were, at our command, we are naturally led to ask the question, who can define the metes and boimds of the mind ? Or de- scribe the limits of our intellectual capacity ? Who can fathom the depths of thouglit? Or circumscribe our mental, educational or scientifical ac- quirements, when health crowns the human temple with its rubicimd mantle? Echo answers who! Seaaty of the Brain Views. — Every view of the human train we have BOTiTES OF THE HEAD, FACE ANT> NECK. 39 eeen in this series of magnificent and unparalleled anatomical plates has inspired onr admiration and held us spell-bound in utter astonishment and amazement at the limitless attributes, the diversified powers, and the variety of functions this wondrous and mysterious organ is called upon to perform in the hourly transaction and business pursuits of daily human life. And yet, notwithstanding the marvelous properties of this elaborate organ, it is the least solid and most unsubstantial looking body of the human casket. Consistency of the Brain. — It consists of eighty per cent, of water, seven per cent, of albumen, some phosphorized fat and a few other minor substances. Such is the composition of the mighty and powerful organ which rules the world. Whilst the brain is the seat of sensation, yet it can be cut, burned or electrified without causing pain in itself. Strange, passing strange, are the properties and powers of the brain! BONES OF THE HEAD, FACE AND NECK. Bones of the Skull. — This illustration gives an accurate and faithful representation of the head, face and neck, surrounded by an outline of the fleshy parts as they appear in the human frame. The bones of the head, eight in number, constitute the skull, and those of the face, four- teen in number, compose a strong, hard bony case, which encloses and afl'ords a suitable protection for the. brain and the four organs of special sense, viz.: sight, smell, taste and hearing. All of these bones are im- movable, except the lower jaw, which moves by means of a hinge-joint, and permits of the opening and closing of the mouth. Bones Seen in the Plate — The bones of the skull observed in this beautiful plate are: the frontal, which forms the forehead or front part of the skull; the parietal, constituting a portion of the side and top of the head ; the occipital, forming the lower and back part of the skull, and the temporal, which forms the lower part of the side and a part of the base of the cranium. These several bones are joined together by notched seams, after the manner carpenters call "dove-tailing." Shape of the Skull. — The skull, as will be seen, is oval, which adapts it to the conformation of the brain, besides giving it greater resistance to pressure. The stronger and smaller end is in front, where danger is greatest to the brain, whilst the projections before and behind shield its less protected parts. The peculiar confonnation and shape of the skull forms a strong shelter for the brain — an organ so delicate that if not so strongly guarded from injury, an ordinary blow falling upon it would destroy it forever. iO THE HUMAN BODT. Bones of the Face.- — The bones of tlie face shown in this plate are the nasal bone, forming the arch of the nose, the malar, which gives promi- nence to the cheek, the upper jaw, containing the upper teeth, and the lower jaw, containing the under teeth. The Spinal Column — That portion of the spinal column noticed in the illustration consists of the cervical vertebrae. Each vertebra is composed of a body, with seven spinous processes projecting from it. The body is perforated by a ring, through which is seen running the spinal cord, giv- ing off nerves between each separate bone. A ring of cartilage is seen inserted between each separate vertebra, the object of which is to prevent any jar reaching the brain when we run, jump, walk or stumble. CHART II. THE INTERNAL WONDERS OF THE HUMAN BODY REVEALED. THE HUMAN BODY AND ITS MARVELOUS PERFECTION. Wonderful Structure of the Body. — The human body is the highest form of animal life. It is full of beautiful proportions and divinely sym- metrical in shape, form, mould and outline. We look with honest pride and glowing admiration upon the many accomplishments that man has achieved in the world around us. We see his skill displayed in the various arts and sciences, and we look with awe upon the projects of bis intellect and reason, the realization of which is but a small question of time ! . We boast of our ships, our steamboats and our steam cars ; we are justly proud of our bridges, our viaducts and the progress of our engineering skill ; we grow enthusiastic over our telegi'aphs, our telephones, our electric lights; we feel a degree of national pride in the achievements and successes of Edison, the wizard of Menlo Park ; but wliere, let us ask, in the whole range of events, the acquirements of arts, the accomplishments of me- chanics, the achievements of architecture, the attainments of engineering, or the successes and promises of electrical sciences, can we find siich an- other structure as the human body, that curious, yet perfect world of wonders ! Man the Most Complex Body — It embodies an epitome of the whole universe ! Man is more elaborate, more complex, more God-like, than any other living organism ; more wonderful, more beautiful, more mar- velous, than any work of human ingenuity, conception or construction. CHART 2. \. COLLAR^ eONE COLLAR B««LI y^\' f UJ ec o MX i 1 P P , 1 -1 \ k: m u . *- O a < u c 00 /!-, V) CD Ul o CD v^./w: ;\v ce hi il Sv\^.^' \-i\ THIGH BOt^E 's as «« UI ; ■'' ec i ■ i£ 1 i 1 t : ® J ^ Ul ' z 1 :' ;C> 1 CO >UaiC^_B(JNES^ THICH BONIC I. / / r ^L_,, CHART 2. CHART 2. CHART 2. CHART 2. CHART 2. CHART 2. CHART 2. CHART 2. MAN THE MOST COMPLETE BODY. 41 Indeed, the mechanism, the skill and the workmanship displayed in the human body is simply perfection itself. In conception, it is divine; in design, perfect ; in architecture, grand ; in construction, wonderful ; in beauty, lovely; in form, symmetrical; in outline, sublime; in strength, great ; in arrangements, marvelous ; in mobility, transcendant ; in adapt- ability, unexcelled ; in fine, when studied in all its parts and their rela- tionship to each other, we are led to exclaim with the Psalmist David, that the human body is "fearfully and wonderfully made." Man the Most Complete Body — The all-wise Creator, when He first made man, made him perfect. lie formed every organ of the body with direct reference to the function to be performed. Every bone, muscle, nerve, organ and tissue formed in the constriiction of this wondrous or- ganism is made of the right kind of material; is of the proper form and size ; placed in the right position to subserve best the purpose for which they were individually and collectively designed, and to perform the peculiar duties assigTied to each. We cannot talk with the ears, smell •with the eyes, see with the nose, nor walk with the tongue. We cannot think with the lungs, nor breathe with the brain. The stomach was not designed to propel the blood over the system, nor the heart to digest food. The Complete Organs and Structures. — The muscles which give form and shape to the body would be powerless instruments of movement if devoid of the bones of the skeleton. Thus we see that every organ and structure was formed with direct reference to the accomplishment of a certain definite object. Hence, the bones form a frame work, to protect the delicate organs of mind, respiration, circulation, digestion and excre- tion, to serve as levers on which the muscles may act to produce motion, and to preserve the form and shape of the body ; the muscles, such as we observe in this plate, give form, shape and symmetrical proportions to the body, and produce its varied motions ; by means of the brain we think, feel and act; the nerves of the eye take cognizance of external objects, and convey their impressions to the brain; the auditory nerve distin- guishes sounds; the olfactory nerve identifies and separates the different odors brought into contact with it, and the sentient nerves of the skin are fully impressed with the touch of external objects, carry the impres- sion of their character and size to the brain, and the motor nerves carry the commands of the will to the muscular system, that the behests of the mind may be obeyed and carried out ; the heart receives the impure blood from all parts of the body, and sends it to the limgs to be purified, then receives it back again and forces it with enormous power even unto the most remote and minute part of the system; the arteries and veins are 4:2 THE HUMAN BODT. made for the express purpose of conveying the "pabnlnm of life" from the heart, and to carry the vitiated and poisonous fluid to the heart ; the lungs throw off the carbonic acid in the venous blood and replace it by oxygen; the stomach, by and with the aid of the salivary, biliary, pancreatic and intestinal juices, digests the food and transforms it into blood; the kid- neys are designed as filters, to aid in the purification of the blood; thus we observe that the various tissues and organs of the body have each their own especial use in the human economy, and their exact and definite func- tion to perform ; and as a result of the sum total of the proper required performance of all these different functions, we have not only harmony and health, but happiness of mind, soul and body as well. MUSCLES OF THE TRUNK OF THE HUMAN BODY, Muscular Arrangement and Blood Supply — In this exquisite and mag- nificent colored engraving we have a grand view of the wonderful ar- rangement of the muscles of the trunk of the human body, together with the muscular arrangement of the arms and likewise their blood supply. The tr^mk of the body is divided into two compartments- — the thorax and abdomen. The Thorax. — The thorax derives its name from the Greek word thoreo, and signifies "I leap," because the heart leaps in it. It is covered on the front part by large muscles ; the pectoralis major, or large muscle of the breast, is observed on the left side of the chest, whilst on the right it is removed and exposes the pectoralis minor, or small muscle of the breast. The dove-tailed muscle observed on each side is the serratus magnus, and is employed in expanding and contracting the chest in the act of breathing. The muscles of the chest walls, in a deep inspiration, exert a force equal to lifting a weight of 750 pounds. Walls of the Abdomen. — The muscular walls of the abdomen are nicely arranged and beautifully adapted to the functions they perform. On tlie left side we see the large oblique muscle, so named because of the direction its fibres run, and on the right side we oljseiwe the rectus muscle, the transverse muscle and internal oblique muscle, all of which are strong, broad muscles, whilst the manner in which they are so scientifically ar- ranged gives additional strength to the abdominal walls, without deterior- ating from its great mobility, and at the same time avoiding all pressure of the organs contained within this large cavity. Tliero are ninety-one muscles on each side of the trunk, or one hundred and eighty-two in aU, ninety of which are pairs, and two are single. BONES OF THE TEONK AND ABMS. iS Muscles of the Shoulder. — The largo triangular muscle of the shoulder — ^the deltoid — is one of great strength, as in fact are all the muscles of the arm. If you gi'asp the arm tightly just above the elbow-joint, and then bend the fore-arm, you will feel the bicejDS muscle of the arm become firm, hard and prominent; now straighten it again and it becomes re- laxed, whilst the muscles on the back of the arm beeojue hard and prom- inent. The muscles of the fore-arm are the flexors and pronators; that is, they flex the arm and turn the palm downward. In each upper extremity or arm there are fifty-three muscles, and we observe here the nicest and most economical method of packing away the muscles that could be improvised, securing strength, giving elegance to its form and Bhaj^e and facilitating its mobility. Blood Supply of Arm — On the right arm we obtain a glimpse of the blood supply of the arm; we sec the brachial artery giving off numerous branches, and observe the radial and ulnar arteries doing the same thing; thus securing ample nourishment to preserve the health, strength and beauty of the arm. BONES OF THE TKUNK AND ABMS. Different Forms of Bones — On turning over this flap we are brought face to face with a grim looking but useful object — the frame work of the trunk and arms. The skeleton is of a ghastly appearance and em- blematic of death; its unsightly look sends a thrill of horror through us, and we instinctively recoil from it. Yet it subserves a useful purpose in the human body, and the ugly looking bones, when carefully examined, abound in nice contrivances and ingenious workmanship; whilst each individual Iwne is designed for the esj^ecial duty it has to perform. Hence the bones differ in form; some are long, as in the arms and legs; some are short and thick, giving strength and compactness, as in the lumbar portion of the spine ; some are flat, for covering a cavity, as the skull and pelvis, and others used for a special purpose are irregular, as in the hands and feet. Combined Lightness and Strength.— But notwithstanding this diver- sity in form, the general plan constantly kept in view by the Divine Architect has been the central idea of combining lightness with the great- est possible degree of strength. The bones of the arms and legs are round, or triangular, and hollow, thus giving with the same weight a greater degree of strength than if solid, besides affording a larger surface for the attachment of muscles. 44 THE 310MAN BODY. Composition of the Chest — The chest is composed of bones, cartilages and ligaments. Its natural form is that of a cone diminishing upward; and it affords lodgment for the heart, lungs and large blood-vessels. Its walls are formed posteriorly by the seven dorsal bones of the spinal col- umn, and the ribs as far as the angle, the sides by the body of the ribs, and front by the ribs, the costal cartilages and the breast bone. The E.ibs — The ribs are twenty-four in number, arranged in pairs, twelve on each side of the chest. At the back they are fastened to the spine, and in front the seven upper pairs are tied by cartilages to the breast bone, three are fastened to each other and the cartilage above, and two, the floating ribs, are loose. The long, slender ribs give lightness ; their arched form confers strength, and the cartilages impart elasticity ; thus the three most essential pre-requisites of the chest for the protection of the delicate organs contained within this cavity are secured, whilst the freest motion in respiration is ensured. The Pelvis — The pelvis is an irregular-shaped basin, formed by the hip bones and the pubic bones in front. In the npper and back part is the foot of the spinal coliimn, consisting of a wedge-shaped bone called the sacrum. It is observed firmly planted between the wide spreading hip bones of the ]ielvis, like the keystone of an ai-ch, and gives a strong support to the bunion above. The Spinal Column — The spinal column, the lumbar portion of which is here seen, consists of twenty-four bones, between which are placed pads of cartilage. Such is the elasticity of these cushions of cartilage, that, though they become condensed through the day, making us shorter in the evening than in the morning, they resume their normal thickness wliile we are lying in bed at night. The perfection in the architecture of the spine surpasses belief; its various uses seem a bundle of contra- dictions. Bones of the Spinal Column — Tlie twenty-four bones of which it coti- sists are so stiffly locked together as to form a chain that will bear and support the heaviest of burdens, yet so flexible that it will bend like India rubber; within this wondroiis column hides a delicate nerve that would thrill at the gentlest touch, yet so securely does it rest in its bony couch that it feels not the slightest jar or shock; and resting upon this remark- able pillar of bones is borne the brain, without a tremor or a fear of danger ; to it are foimd clinging the vital organs of the chest and abdomen, secure in the protection it affords. The Shoulder Joint. — Tlie shoulder joint, formed as it is by the ehoulder-blade (scapula), collar bone (clavicle), and the arm bone, is most THE LtTNOs; TlIElK MtClIANISM AND WONbEKS. 45 beautifully designed and executed. It comprises a shallow ball and socket- joint, thus affording the freest rotary movements. The shallowness of the socket, however, accounts for the frequent dislocations of this joint; but that is compensated for by the easy, graceful carriage and swing of the arm, which a deeper socket would not permit. The Collar Bone — The collar bone is fastened at one end to the breast bone and first rib, and at the other end to the shoulder blade. It thus holds the shoulder-joint out from the chest, aids in protecting the import- ant vessels of the axilla, and gives the arm a greater range of freedom, mobility and play. THE LUNGS; THEIR MECHANISM AND WONDERS. What the Lungs Are. — The lungs ! Dense looking objects, and yet how light and buoyant ! This beautiful anatomical chart shows us a front view of the chest and lungs, with the lungs enclosed within the bony basket-work of the chest. The lungs are two large, conical bodies, placed one on each side of the chest, and occupy the greater part of its cavity. • During life they accurately adapt tliemselves to the varying dimensions of the chest ; for, imhappily, the foibles of fashion very frequently cause restriction of the lungs, by interfering with the resistance and freedom of movement of the ribs, so essential to health, by tight lacing and the barbarous usage of corsets. Pleura of the Lungs — In this chart we see also the pleura or the in- vesting membrane of the lungs, and right below it the diaphragm or midriff. Two Distinct Lungs — ^Although the lungs are two in number, as far as their structure is concerned, and are perfectly distinct from each other, having, as we obsei"ve in the chart underneath this one, the heart and blood-vessels between them, yet as regards their functions they may be considered the same, since they receive their blood from a single vessel, the pulmonary artery, and the air by one canal, the trachea or wind-pipe, and act in common with each other. Size and Shape of Lungs. — As will be observed, the lungs are not quite the same size or shape; the right lung, although somewhat shorter and thicker than the left, is the larger and stronger, being divided into three lobes; whilst the left is the smaller and weaker, divided into two lobes only, and hence more frequently subject to disease. Weight and Shape of Lungs. — The weight of the lungs varies very much; but in general they average about forty-two ounces in the malej 46 Tiri! HUMAN BODY. thirty-six in the female; the right hmg being about two oimces heavier than the left. Each lung is conical in shape, with a broad concave baae resting on the convex surface of the midriff, the apex directed upward and extending into the root of the neck about one inch above the level of the first rib. Interior Arrangement of Lungs. — On turning this flap over wo find a vertical section of the lungs, showing their interior arrangements. The lower end of the trachea divides, one portion going to each lung. These again subdivide and continue to subdivide in geometrical order, growing smaller and smaller with each division, and extending to every part of the lungs, finally terminating in a cluster of air cells, bound together by cellular tissue and forming a lohide. These lobules vary in size ac- cordingly as they ai"e located on the siirface of the lung or deeper in its tissues. Each lobule is separate and distinct from the other, and forms in itself a ]>erfect and independent lung in miniature. Function of the lobules — In this arrangement we see the boundless ■wisdom of the Creator displayed, for were it not for this wise and perfect provision — one of the very greatest importance in the process of respira- tion, since it enables each individual lobule to perform its functions inde- pendently of the rest — tubercular disease, bronchitis and inflaiumation of the lungs would not only be incurable, but would prove to be very rapidly fatal. Lung Air Cells — Each air cell varies in size from the seventieth to the one two-hundredth part of an inch in diameter. The number of air cells in the two lungs is truly surprising, there being certainlj' not less than 600,000,000, though according to Dr. Addison's computation there are 1,700,000,000, equivalent to 1,500 square feet of surface on which the process of purifying the blood is constantly and continuously going on in a healthy lung. Blood-vessels. — On the next flap we have a graphic illustration of the internal arrangements of the blood-vessels of the lungs and bronchial tubes. The pulmonary artery, arising from the right ventricle of the heart, conveys the venous blood to the lungs. It penetrates the lungs and divides and subdivides into branches, which accompany the bronchial tubes and terminate in a dense capillai-y net-work upon the walls of the air cells, where the blood undergoes that magical change, giving ujj its poisonous qualities and becoming revivified and healthful. Pulmonary Veins. — Erom this net-work of arteries and air colls the radicles of the pulmonary veins arise, and, coalescing into larger and larger branches, at length accompany the arteries and returq the blood to THE LUNGS ; THEIR MECHANISM AND WONDERS. . '^1 the left anriclc of the heart in a purified condition. The pulmonary ar- teries and veins differ from the same vessels in other parts of the body, since the former conveys venous blood, and the latter arterial blood. Breathing — Kespiration, or the act of breathing, consists of the alter- nate inspiration and expiration of air to and from the lungs ; in the pro- cess of which the lungs themselves are almost passive instruments, since their contraction and expansion takes place by means of the muscles which surround the chest. The diaphragm or midriff, which, when at rest and the lungs empty, forms a beautiful dome to the abdominal cavity, becomes depressed during the inspiratory process, and presses the walls of the abdomen outward. At the same time the ribs become elevated, thus in- creasing the size of the client. Thereupon the elastic lungs expand to occupy the entire space, whilst the current of air, in obedience to a well- known physical law, rushes dovra the wind-pipe and enters, the numerous air-cells, the result of which is inspiration. In exjiiration the reverse of this takes place. "We bend forward, draw the abdominal walls inward, press the diaphragm upward, whilst the ribs are pulled downward. All these acts simultaneously performed decrease the size of the chest, and force or exjicl the air from the lungs. Breathing Capacity of Lungs — The breathing capacity of the lungs bears a close correspondence to the stature of man. For an ordinary- sized man of about five feet eight inches in height, it will be 230 cubic inches, or about one gallon of air, and for each additional inch in stature up to six feet, there will be an increase of eight cubic inches. In a forcible expiration all the air in the lungs is not expelled ; there still remains be- hind 100 cubic inches. Thus, with this unexpclled air, the breathing capacity of an ordinary-sized man is about 330 cubic inches, or equivalent to 11 pints of air. Of the 230 cubic inches, 100 can only be forced into the lungs by the exercise of great effort, and Is available for emergencies, as striking a heavy blow, or for the purpose of training, as in singing, rowing, running, climbing, etc. ; but tlio extra amount of air always on hand in the hmgs is of great value, since it enables the lungs to perform their functions continuously, even under severe and violent exertions. Giving Up of Oxygen. — The atmosplieric air laden with its life-sus- taining property, oxygen, having passed into the lungs, gives up that vital element and receives In Its place the carbonic acid gas, water, and other refuse materials which the blood has picked up in its journey through the body, and which are no longer fitted to circidate In the blood and preserve the vitality of the body. ]^o tonic invigorates so well as a few, deep, full inspirations of pure, cold air. 48 THE HUMAN BODY. Circuit of the Blood. — The bluoJ thus purified passes back to the heart to go on its circuit through the body, every organ of which renews its energy and vigor from the magician's fiery wand, pure, healthy blood ; while the air exhaled carries off the impurities. Change in Color of the Blood — During this process the blood changes from a dark purple to a bright red. Pure air is the cheapest necessity and the gi-eatest luxury of life. Let it not be the rarest. The relative pro- portion of the respirations to the pulsations of the heart is about 1 to 4|- or 5 ; and the quantity of air required to keep the blood pure is very great. Indeed, respiration is the falling weight, the bent spring, which keeps the clock of life in motion ; the inspirations and expirations are the strokes of the pendulum which regulate it. Delicacy of the Organs — The perfection of the organs which carry on this stupendous office challenges our warmest admiration. So delicately are they arranged that the slightest pressure will cause intense pain, yet tons of air surge to and fro through their intricate passages, and bathe their innumerable cells without our knowledge, so to speak, of its coming and going. We annually perform over 8,400,000 acts of breathing, in- hale over 150,000 feet of air, and purify nearly 4,000 tons of blood ! This gigantic and unbiirdensome process goes on constantly, never weary- ing or worrying us when in robust health, and we are struck dumfounded with amazement when the cold calculations of science reveal to us its magnitude and marvelousness. Second Use of Breathing. — l^Tor is this stupendousness all. Nature dislikes a waste of energy. In addition to and by a wise adaptation and economy, the process of respiration is made to subserve a second use no less important than that of purifying the blood — the power of speech. The exhaled air, laden though it may be with the human detritus and off-scourings of the body, in passing through the vocal organs can be trans- formed into prayers of faith, songs of hope and words of good cheer, kindly encouragement and expressions of love! THE HEART AND ITS WONDERS. What the Blood Is. — The blood — ^the pabulum of life — has not in- aptly been termed "Liquid Flesh." But it is more than that, since it con- tains the materials so essential and so requisite for the building up and repair of every organ and tissue of which the body is composed. The blood is the liquid by means of which the circulation in the body is car- ried on; it permeates every nook and comer of the system, and is com- THE HEART AMD ITS WONDERS. 49 posed of a thin, colorless fluid, the i^lasnva, filled with red disks, so small, flat and thin that it requires 3,500, placed side by side, to measure one inch, and no less than 18,000, placed one upon the other, to make a col- umn one inch in height. These disks are continually forming and as con- stantly dying. Coagulation of the Blood. — According to Dr. Draper, of ISTew York, 20,000,000 die at a single breath ! Blood when exposed to the air coagu- lates, and the value of this peculiar yet intrinsic property cannot be over- estimated. When an artery is ruptured bleeding takes place, the blood coagulates and forms a plug, thus preventing further hemorrhage. Thus we observe with what Divine foresight and wisdom, not only the wants of the body are provided for, but also the accidents to which it is liable. Size, Shape and Location of the Heart — ^In this beautiful anatomical chart we obtain an accurate idea of the relative size, shape and position of that wonderful engine, the heart, whose tireless efforts to keep the wheels of life in motion are truly surprising, and fill us with amazement at the prodigious work it daily performs. The heart is an irregular, pear-shaped, hollow, muscular organ, placed obliquely in the lower and front part of •the chest, between the two lungs and inclining to the left of the centre. The base is directed toward the spine and corresponds with the fourth and fifth dorsal spinal bone, while the apex points between the cartilages of the fifth and sixth ribs on the left side. In this illustration the peri- cardium, or loose sac in which the heart is enclosed, is removed, and we see the coronary artery with its branches distributed over the outer sur- face of the complex and restless organ. Heart a Double Organ. — On looking at the heart one would think it was a single, solid organ. It is not, however, but a double organ, divided into four compartments ; the two upper ones, from their supposed resem- blance to a dog's ear, are called auricles, and the lower ones, from resem- bling a little stomach, are called ventricles. The auricle and ventricle on each side communicate with one another, but the right and left halves of the heart are each separate and distinct organs, and perform different functions — the right side propels the dark, vitiated and impure blood, whilst the left deals with the bright crimson, life-giving and life-sus- taining blood. Use of the Auricles. — The auricles serve as reservoirs to receive the blood — the right, as it comes dark and foul from its tour of the body, the left, as it filters bright and pure from the oxygenated forest of the lungs — and to furnish it to the veutriclps as they need it. This is graphic- ally shown, on the chart, the large blue vein, formed by the jugular and 50 THE HUMAN BODY. subcliiviaii veins, is seen descending downward and emptying into the right anricle; the red piilnionarj vein, fornied by the coalescing of its numerous branches, conveying rich, pure blood from the lungs and de- positing it in the left aiu-icle. Oorrespouding to the lightness of the work they perform, tlie walls of the auricles are comparatively thin and weak. Ventricles of the Heart. — The walls of the left ventricle, which pro- pels the blood to the remotest comers of the human frame, are corre- spondingly thicker and stronger than those of the right, which forces the blood to the limgs only. Arising from the right ventricle is seen the blue pulmonary artery, conveying its foul, poisonous, vitiated and venous stream to the lungs, while from the left ventricle is observed the large mnin artery of the circulatory system — tbe aorta — from the arch of which arise the right and loft carotid arteries. Changes in the Human Body — The huimm body is in a constant state of change. In the midst of life there is death. The blood disks die and new ones are bom into life. Every act of life is destructive as well as constructive. Kot a thought can be evolved but numerous brain cells die ; not a wink of the eye, a smell of a lovely rose, nor a muscular movement, but results in the death of some part of the machinery involved. Every l^nx-ess of life is a process of death. The scales of the epidermis are con- stantly' falling off and being replaced by fresh cells from beneath, and it is on the continuance of this interchange that our life, health and vigor depends. The more rapidly this change goes on, and fresh, vigorous, liealthy tissues take the place of the old lifeless ones, the more elasticity, buoyancy and strength we possess — the more healthy and robust we become. Work of the Heart — 'No slave ever performed his work more patient- ly than the heart. Its quivering task is essential to life and health. It is the fountain from whence tlie spirit flows, and on the faithful perform- ance of its fimctions every part of the lx)dy depends for the warm stream of life, motion and vigor which it unstintingly fixmishes. The ancients believed the heart to be the seat of love. Within its walls were located all that was pure, tme, good and noble, as well as the evil passions of the soul. i\jid although modem science has foimd the seat of mind, reason, consciousness and the mental powers to be located in the brain, and thus robbed the heart of its romance, yet it has revealed wonders comiected with this small organ, that certainly eclipse the mysteries associated ^^^th it in the past. Pit-a-pat ! pit-a-pat ! throbs this marvelous engine, and in response to its constant tlirolibing the blood bounds along the myi-iad of tubes, conveying messages of life and health. THE DIGESTIVE APPABATTTS AND ITS WONDEES. 51 Constancy of Heart Work — Our mind cannot stop its beatings ; it can- not stop itself; sleep does not interfere with its workings, and our daily labor only strengthens its force and regularity. This wonderful organ throbs on night and day, week in and week out, the year round, with ceaseless, tireless energy. It beats at the rate of 100,000 strokes per day, 40,000,000 per year, and not unfrequently, 2,800,000,000 without a single stoppage. It is the most powerful engine known to science. Its daily work is equal to one-third of that of all the muscles of the body. If it should expend its entire force in lifting its own weight vertically, it would rise 20,000 feet in an hour. The greatest exploit ever accomplished by a locomotive was to lift itself through less than one-eighth of that distance. Vast and constant as is this perpetual throbbing, so perfect is the machinery with which it is carried on, that there are those who do not even know where the heart lies until disease or accident reveal its location. Vitality of the Heart — Its vitality is as amazing as its strength. While life exists this tireless organ never stops. In disease, as long as a flutter of this wondrous organ exists, wo know the spark of life has not altogether vanished, and now hope is begotten that health may be restored. During such long lives as wo sometimes see, the heart has propelled no less than 500,000 tons of blood; and yet, during all this patient, unfalter- ing and unflinching labor, it has repaired itself as the waste has occurred. Heart Rhythms — The rhythm of its beats never fails until death breaks into the casket and seizes the ever throbbing pendulum at the command of the great Master Workman, silencing the quivering muscles of the heart and compelling the wheels of life to stand still. THE DIGESTIVE APPARATUS AND ITS WONDERS. Value of the Plates. — Seeing is believing; nay, it is more, it is know- ing and remembering. The mere reading of a statement on any particular subject docs not always advance our knowledge of the matter in question. The observation of a fact, or its proper illustration by appi'opriatc dia- grams, such as we observe these anatomical charts to be, not only em- phasizes the point considered, but aids us in remembering the principal features connected with tlie functions perfonned, thus advancing our knowledge of the subject discussed, and educational progress is made. Quantity and Variety of Foods. — As we have already seen, the human body consists of numerous mechanics or artisans, who are constantly at work repairing and upbuilding the miceasing destruction that is cohtin- 62 THE HUMAN BODY. ually going on. If fresh food be not daily supplied, this work would soon cease, and the lamp of life flicker out. To replace this constant waste we require nearly three pounds of solid food, and fully three pounds of liquid food for our daily allowance. But to convert the pent-up energies of bread, meat and vegetables into the tissues of our own mechanism re- quires a number of differently constructed organs, and these we now desire to draw your attention to in this beautiful chart. The organs con- sist of the stomach, liver, pancreas and intestines, which comprise the principal organs concerned in the process of digestion. The Stomach. — The stomach is an irregular expansion of the gullet or cesophagTis, and is the receptacle which receives the food when swal- lowed. Its shape has been, not inaptly, likened to the Scotch bagpipe. It will hold about three pints, though it is capable of considerable dis- tension. When moderately filled with food it measures about twelve inches in length by four inches in diameter at its widest end. The walls of the stomach consist of four distinct coats, held together by fine areolar tissue, and are arranged in the following order, from within outward: the mucous, the areolar, the muscular and the serous. The inner mucous coat is a smooth, soft, rather thick, pulpy membrane, loosely connected with the muscular coat, and secretes the gastric digestive fluid of the stomach. Fine View of Stomach Coatings. — On turning over the flap we obtain a very fine view of this remarkable membrane. The areolar coat is placed between the muscular and mucous coats, and connects with both. The muscular coat is very thick and stout, and composed of three sets of fibres, the longitudinal, circular and oblique, which form three distinct layers. The outer coat is a thin, smooth, transparent and elastic membrane, de- rived from the peritoneum, and well lubricated to prevent friction. When the fibres of the muscular wall contract, a peculiar churning move- ment of the stomach is produced, thus securing the thorough mixing of its contents, that every particle may come into contact with the solvent prop- erties of the gastric juice. The Pyloric Gate. — At the smaller end the muscular fibres contract and form a gateway — the pylorus, as it is called — which carefully guards the exit from the stomach, and allows no food to escape until properly prepared. The gastric blood-vessels are seen distributing themselves over the outer surface of the organ, thus ensuring its nutrition and repair. . The liver The liver is the secreting organ by which the bile is formed. It is situated on the right side below the diaphragm, and is of a reddish-brown color. It is irregular in form, being convex on the upper irHE DIGESTIVE APPARATUS AND ITS "WONDEEg. 53 surface, irregularly concave behind, very thin in front, and weighs aboiit four pounds. It is, therefore, seen to be the largest organ or gland in the body. It is divided into two lobes, the right and the left, the former being by far the larger. On turning the flap over, we see how intricately it is arranged internally. Blood-vessels of the Liver. — The blood-vessels of the liver are the hepatic artery and veins, and the portal vein; the lymphatic vessels are numerous, and the nerves are supplied from the pneumogastric, the phrenic and the hepatic plexus. The liver, therefore, receives two kinds of blood: the arterial, by means of the hepatic artery, and the venous, from the portal vein, from which the bile is principally formed. The bile is a dark, golden fluid, of extremely bitter taste, of which three pounds is secreted daily. When not used in digestion it is stored away in the gall-bladder, a fine view of the location of Avhich we have in this chart. The action of the bile on food, though not fuUy understood, is necessary for perfect digestion. The Pancreas, or "Sweetbread." — The pancreas, or "sweetbread," is a single glandular organ, situated transversely across the upper and back part of the abdomen, on a level with the last dorsal spinal bone. It is of an irregular, elongated form, from six to eight inches in length, an inch and a half in breadth, and from a half to one inch in thickness. It secretes about seven ounces daily of a slightly alkaline fluid containing an organic principle — pancreatin, which has the property of changing the starchy food into sugar. ^Tiilst it has this power, yet its chief work in the digestive process seems to be tlie breaking up of the fat globules into myriads of minute particles which mix freely with water, and thereby promote their absorption by the lacteals. The Intestines. — The next chart shows us the manner in which the intestines are arranged in the abdominal cavity. The entire intestinal canal is about thirty feet in length, and is divided into two portions — the small intestines, and the large intestines; these again are each subdivided into three different portions. Of the large intestines, the transverse por- tion is laid open, showing the internal arrangements. A section of the bladder is seen on this chart. Machinery of Digestion. — ^From the number and differently formed structures which constitute the digestive organs, it will be observed that that function is a very highly complex process. If the food were thrown directly into the circulating fluid, it could not be used for the purpose of nutrition. It requires for its transformation into blood, bone and muscle, ^ series of complex, machinery, each part of which is specially designed Si [TECB ■HTJMAir BODY. for the particular part it plays in tliis wonderful and complicated process. TJse of Mouth and Teeth — The mechanical part, which, although not shown in this chart, may be carefully studied in the chart giving the dif- ferent views of the head, is performed by the mouth and teeth, and the pulverized food is subjected to the action of the saliva. The lubricated morsel of food is now gathered into a ball and conveyed to the back of the mouth by the muscles of the cheek and tongue. On its arrival here, the soft palate lifts upward and closes the posterior nasal openings; the epiglottis shuts down over the trachea or "wind-pipe, forming a bridge over which the food passes, thus preventing it from falling into the res- piratory track. Duty of the Throat — The muscular bands of the throat now grasp it and pass it do^\Ti the gullet into the stomach, beyond our control. Here it comes into contact with the gastric juice, undergoes the churning motion of the stomach, is guarded over by the pylorus, thoroughly saturated and mixed before entering into the intestinal track, where it is subjected to the action of the bile, the pancreatic juice and the intestinal fluid, each with its special duty to perform. Nature's Treasures Open to Man — All this is a very complicated and diversified process, the necessity for which can only be explained upon the hyiiothesis that Xature, in her exhaustlcss munificence, has opened her proud domains, and poured forth to man the treasures of every land and every sea for food; the cornfields wave their golden, grain for him; the wheat, rye, oats, coria, maize, rice, each different, yet highly nutri- tious and sufficing; the palm, the date, the banana, the fig, the pineapple, spread out a delicious harvest on the air; the luscious apple, pear, peach, plum, cherry, tempt his ready hand ; the potato, the beet, the turnip, the tomato, the cabbage, the pea, the cauliflower, and a thousand other good things, incite his appetite, whilst to this feast is added the flesh of birds, of oxen, of sheep, of swine and of fish ; that before the waving wheat and corn, the flesh of other animals, the fruits and farinaceous foods, the running water, the luscious oyster and fish, etc., can be transformed into the refined and spiritual organization of man, it must be thoroughly pre- pared by the several steps in the digestive process — ^then, and only then, is it permitted to enter into and commingle with the highly complex, nutritious and life-sustaining fluid, the blood. Great Value and Beauty of the Plate — ^We can understand much of this wonderful process. We have looked into the stomach, watched its peculiar actions and traced its various steps, from which the scientist is THE VEBMIFOEM APPENDIX. 56 capable, in his laboratory of knives, mortars, ba'tbs, chemicals and filters, of imitating many of the operations of digestion ; but just at the moment lie thinks himself most successful, he is compelled to pause. At the threshold of that "one step more," "which Fontenelle required, "and he would surprise nature herself," he stops, and very "wisely, -without con- cealment of his designs, admires, then vs'onders, and finally worships with all the reverence of his soul. Transformation of Food Into Flesh — How strange this is — the trans- formation of food into human flesh, into human thoughts! We eat a meal; it is composed of meat, bread, vegetables and liquids. The more solid part is ground by the teeth, mixed with the difl^erent juices, dis- solved, changed, organized and is swept throiigh the body in the circula- tion of the blood. Each organ seizes its own particular food as it passes. Within the cells of the various tissues it is transformed into the soft, sen- sitive brain, or the hard, callous bone ; here into the nerve of sight, there into gristle or tendon ; here briny tears are formed, there the bland saliva ; in the stomach, acid juice; in the skin, acrid perspiration; bile for di- gestion, oil for the hair, nails for the fingers, muscle for the strong arm of toil, and flesh and fat to give shape, form and beauty to the face. Wonderful It All Is — Wonderful ! Within us is an Almighty Archi- tect, who superintends a thousand skilled laborers, that make a way which puzzles human comprehension; here a fibre of muscle; there a filament of nerve; here constructing a bone; there uniting a tendon — fashioning each with the most scrupulous care and unerring nicety. Without the buzz of a saw, or the sound of a hammer; without the slightest compres- sion, or the least particle of noise ; with a regularity, certainty and exact- ness, the glorious temple of man, in the image of his Creator, goes up and up, day by day, skilfully put together by these noiseless, tireless and expert workmen. THE VERMIFOHM APPENDIX. The chart brings into view the location and form of that wonderful little organ known as the Vermiform (wormlike) Appendix (appendage). It is an appendage of the Caecum, or lower bowel. Its uses as a bowel appendage have never been established. It occurs in other animals be- sides man. Notwithstanding its diminutive size and uselessness as an organ it is the seat of that most paiuful and dangerous disease called Appendicitis, which was formerly attributed to the presence of some for- eign body, as a grape-seed, lodged within. But it has been found in- flammation of the Appendage may arise from, numerous other causes. eg THE HUMAN BODY. Many doctors insist that a surgical operation — that is, the entire removal of it with knife — is the proper curative agent, especially in acute cases. But others insist that the knife is too frequently used, and that the dis- ease, if taken in time, is quite surely curable by other means. THE CniORIS, TIRETHEA, VAGINA AND HYMEN. These female organs show further the perfection which anatomical plate printing has attained. Clitoris. — This small organ, It will bo seen, is situated at the upper part of the vulva, or outside parts of the female generative system, ami is usually concealed by the lips of the pudenda. It performs a function during sexual intercourse similar to that performed by the penis of the male. Urethra. — This highly useful organ, common to both sexes, is, as will be seen by the plate, the canal, or medium, by means of which the urine is carried from the bladder to be voided. It is a delicately lined organ, furnished with retentive valves, and therefore susceptible to a variety of diseases. Vagina. — This word implies a sheath, and is applied to the canal which leads from the uterus (womb) to the external organs of generation in the female sex. Commonly, it implies such external organs, or organ, as depicted in the plate. Hymen — The mucous membrane, or virginal membrane, at the en- trance of the female sexxial organ, or vagina. BLADDER AND PART OF VAGINA. The function and form of the bladder are familiarly known. It is the recipient of the kidney secretions, and contains them till voided through the urinary canal. It is of tough, elastic structure, guarded at the exit by a contractile valve, by means of which the urine can be re- tained imtil the quantity becomes excessive. The plate brings out the entire urinal tract, from the bladder to the vagina, and presents a fine and useful anatomical and physiological study. •WOMB, OVARIES AND VAGINA. The Womb. — The plate beautifidly and effectively illustrates the location and formation of the womb, that wonderful organ which performs the function of parturition, and which is so constructed as to assist in all VIEwr OF THE LARGE BLOOD-VESSELS^ SPLEEN, KIDNEYS AND BLADDER. 57 the necessary efforts of birth. Its stiiictnre is elastic and strong, and it expands readily to accommodate tlie gTOwth of the child (foetus). While this is true exteriorly, its inner parts are rather delicately lined, and subject to a variety of painful diseases, generally designated as "Dis- eases of the Womb." The Ovaries — The organs are situated contiguously to the womb. They signify eggs from their shape, and they are the parts which the male semen acts iipon to produce the phenomenon of pregnancy. Their enlargement by inflammation and their passage down the fallopian tubes, once a month during the middle period of female life, produces the con- dlticm familiarly known as menstruation. The plate also affords another view of the vagina. NATURAL POSITION OF CHILD AT TIME OF BIRTH. This beautiful and effective plate shows the natural position of the child at the time of birth. It is technically called the presentment of the foetus for birth. Of presentments there are many varieties, whose study is most interesting to the obstetrician. Some of them give rise to very difficult and dangerous delivery. When the presentment is natural, as in the figure, the comfort of the mother is increased and the doctor's anxiety is miicli allayed. VIEW OF THE LARGE BLOOD-VESSELS, SPLEEN, KIDNEYS AND BLADDER. Blood Vessels of the Body. — The blood-vessels of the human body con- sist of heart, arteries, veins and capillaries. The heart and its wonders we have already referred to. In this mag-nifieent chart we are enabled to form some idea of tlie larger blood-vessels. We see the main arterial tube of the body — the aorta — from a point where it unites with the arch of the aorta; and in its descent do^\'nward along the spinal cohmin it gives off numerous branches. The Arteries — Opposite the fourth lumbar vertebra ii: is seen to split in two, and these divisions are called, from their position, the right and left iliac arteries. These are seen to divide again into the internal and external iliac arteries, the fonnor of which is distributed to the walls and viscera contained in the pelvis, then proceeding to the lower limbs after sending two important brnnehcs to the abdominal walls. The arch of the aorta gives oft' the innominate artery, which divides into the right carotid 58 I'llfi HUMAN BODY. I and right subclavian arteries ; the left carotid and left subclavian spring direct from the arch of the aorta. Each carotid arterj' divides into the external and internal carotid arteries, the former being distributed to the externa] parts of the face and head; the latter supplies the brain and internal parts of the cranium. The subclavian arteries supply the upper extremities ■with blo(Kl. Intercostal Arteries — The intercostal arteries and veins are beau- tifully ilhistrated in the chart. The veins return the blood to the heart. The large ascending and descending ven;e cava3 are seen in this illus- tration. Meaning of Artery — From the fact that at death the arteries are empty, the ancients believed them to contain air, whence their name, derived from aer, air, and tcrco, I keep, which literally means, air ducts. The Spleen — The spleen is a spongy organ, of a livid color, oval in figiire and situated in the left upper part of the abdomen and immediately behind the stomach. Its weight varies from four to ten ounces. It is largely composed of cells, but its function is little understood, though from its position it is believed to be in some way useful to the stomach during the process of digestion. The Kidneys — The kidneys are two glandular bodies, having for their functions the secretion of urine. The form of the kidney resembles a French bean ; its average length being from, four to four and a half inches, two inches in breadth and one in thickness. The two kidneys are situated one on each side of the spine in the Imnbar region, opposite the last two dorsal and two first hunbar vertebra?; they are a bro\TOish-red color flattened from before backward, and gi'ooved on the interior border for the reception of the great vessels. The Veins — The venal arteries are derived direct from the aorta; and the large veins terminate in the ascending large vein. On the right kidney is seen the super-renal capsule; w'hilst the left is cut vertically into showing the urinifcrous tubes, much convoluted and inosculating with each other. The ureter is seen arising from the pelvis of the kidney, descending in an oblique manner to the bladder. These wonderful little organs appear to act as filters, and thus assist to keep the vital stream of life in as pure and as healthy a condition as possible. The Bladder — The bladder is a thin, membranous bag, which sei-vea as a receiver of the urine secreted by the kidneys, and which remains there until voided by iirinatiou through the urethra. Bone Sections — The sections of the bones show their cancellated ap- pearance, which combines lightness with strength. THB ISnrE AND ITS WONDEES. 69 CHART III. WONDERS OF SIGHT, HEARING, TOUCH AND LOCOMOTION. THE EYE AND ITS WONDERS. Beautiful Plate of the Eye — The Ijeautiful flesh-colored engraving at the right-hand top corner of this exquisite composite anatomical plate gives a strikingly natural, life-size representation of the human eye, to- gether with its external appendages, the eyebrows, the eyelids, and the lachrymal or tear glands. Muscles of the Eye — On turning the flap we see four of the six deli- cate, hut withal strong muscles which not only hold the eye firmly in its bony orhit, but also move it upward toward the canopied vaults of heaven, downward to view the beauties of nature on earth; or sidewise, to the right or left, spanning half the horizon at a single glance! The next illustration gives us a graphic and faithful delineation of the beautiful arrangements of the numerous curtains, humors, lenses, pigments, mem- branes, nervous coats and blood-vessels which enter into the composition of this remarkable organ, each of which is exquisitely adapted to the respective functions it has to perform. Wonders of the Eye. — The human eye is one of the most wonderful, as well as delicate, organs of the body. It is the window through which ihe heart, mind and soul of man shines. Sorrow or joy, grief or mirth, pain or pleasure, sunshine or shadow are reflected throiigh this wondrous camera of light; the human passions hold their orgies in this window; truth and love dance their happy and joyous day-dreams before its lu- minous curtain; and through it accurate delineations of every object that comes within its range are carried to and photographed on the brain, the great art gallery of the soul ! Can man, with all of his great and scientific achievements, conceive of anything in the arcana of his accom- plishments more beautiful, more wonderful, or more perfect than the human eye! THE EAR AND ITS WONDERS. The External Ear — The organ of hearing consists of three parts : the external car, the middle ear or tympanum, and the internal ear or laby- rinth. The external part of the ear re]iresentcd in tliis coloi-ed engraving 19 very realistic of that essential aj)pendage to this important special organ 60 TITE rtUMAK BOOT. of sense in man. It consists of an expanded sheet of cartilage, folded in true trumpet fashion, for collecting the sound Traves and conveying them to the external meatus or mouth of the auditory canal. The Ear Drum. — On the back of this Hap is seen a strikingly natural representation of the middle ear, the tympanum or drum, as it is fre- quently called. From the bottom of the tympanum is observed the Eu- stachian tube, through which is conveyed air from the pharynx to tha middle ear. Across this chamber is seen stretched three very tiny, singular bones, which, from their shape, are called the hammer, the anvil and the stapes. These delicate bones are connectctl together, one by ball and socket joint, the other by a hinge-joint and by ligaments, and are moved "by small muscles ; they serve to convey the "wave sounds across the tym- panum cavity to the internal ear. Show of Ear Canals — The semicircular canals, and the cochlea, so named from its resemblance to a snail's shell, are also typically shown. In the next colored illustration we observe a graphic and truthful view of the delicate internal arrangement and mechanism of the internal part of the organ of hearing. Here we observe the winding stair of the coch- lea, over the surface of which the delicate fibrils of the auditory nerve expand, and the minute fibres of Corti, called from their discoverer, are seen arranged with geometrical precision, the longest at the bottom and the shortest at the top. Wonders of the Spiral Plate. — If this curious and artistic spiral plate, which is seen to wind two and one-half times round, could be unrolled and made to stand in an upright position, it would make a beautiful micro- scopic harp, not of a thousand strings, but of three thousand strings, and if it were possible to strike these delicate infinitesimal cords as we can the keyboard of an organ or piano, every conceivable variety of tone that the ear can distinguish would be produced and conveyed to the brain as the product of sound. THE HAND; ITS MECHAOTSM AND WONDEEFTJL ENDOWMENTS. "Engraving of the Hand. — To tell one that this exquisite colored en- graving represents a human hand seems almost like questioning his sanity. Yet such it is ; but how few there are who can give an intelligent account of the hand, describe its beautiful arrangements and complex mechanism, or tell of its wonderful endowments. Small in compass, compact in struc- ture, yet so skilfully ai-ranged are its blood-vessels and nerves, that they form a complete net-work over its surface. So minute are they in their ::^->':s>.f-.^^ EXTERNAL VIEW OF EYE EXTEBHAL % 'v COPVBBMT I9i6 DYE, J STAHtET CHART 3. /; H ^.¥)^ \ I \ I KNEE>; m Mini rO- Im^ Ak um / f' /f ( X 5 Gf "SB < * \ I ^JijM «^>5f,^ ^"^^ STRAIGHT 3 III I 4*,.^ 'C" -^ b^ III' ..^*^r EXTEBNAt ''^«' OF FOOT ^ COPVftlCHT ISie BV E.J.STAHtEY CHART 3. *j(^^fl\ ^^^EByitti Of ^^- Q ^^^s^s:^ ^^~^H at y^W COPVRIGHT I9ie Br E, J. STANLEY CHART 3. THH HAJTD; its TtTECKANTSM AlTD ■WOND'EKTTTTj BTTDOWMEirra. 61 distribution that the point of the finest needle cannot penetrate any pari of the hand without piercing quite a number of them. The hand is the great organ of touch and prehension, and the instnmient which distin- guishes man in the large class of mammals, since he is the only animal which possesses two perfect and complete hands. Bony Frame of the Hand — On turning over this flap we behold the bony frame-work of this wonderful organ. It is seen to consist of a num- ber of bones, so exquisitely arranged as to combine the greatest possible degree of flexibility and strength. Palm of the Hand — Below this is given an elegant, and at the same time a true and correct view of the muscular arrangement of the palm of the hand and fingers. Over the wrist is seen the annular ligament, that thin, tough, strong sheath, which binds the muscular cords and holds them firmly in place. Thus in these three anatomical charts have we depicted the perfection of the human hand. Powers of the Hand. — And how varied and useful are its endow- ments ! How wondrously adapted to the uses to which it is daily applied I Its elegance of outline, delicacy of mould and beauty of color has ever made it the attractive study of the artist ; whilst its elasticity, flexibility and strength, combined with its delicate and exquisite niobility, and per- fect adaptation as an organ of prehension, have led many philosophers to attribute man's high and gi-aceful suiDeriority even more to the hand than to the mind. Glowing thoughts are penned upon the pages of his- tory by means of tlie hand ; it wields the artist's pencil and brush, and makes the bare canvas an attractive and valuable work of art ; now it strikes the keyboard of the piano with so delicate a toiich that low, sweet, plaintive strains of music are brought forth; now the force of the blow is much greater and firmer, and louder and louder and more thrilling the musical strains. Skill of the Hand — The farmer's toil, the housewife's task, the dress- maker's deftness., the mechanic's skill, are all accomplished by the human hand. How constantly this little instrument aids us in expressing our feelings. It is the orator's chief aid in giving expression to his lofty strains of eloquence, or emphasizing his pathetic appeals. Various Uses of -the Hand — With the hand we affirm or reject a proposition with more force than with the tongue. It is the first to greet, and the last to bid our friends good-bye. We use it to express our joy and pleasure, or to give vent to our fear and horror. In the hour of peril we employ it in powerful supplication to Him to whom we look for suc- cor and help, and it adds force and power to the appeals of suffering, of 62 THE nUMAH BODY. sorrow and of woo. It bestows its loving caresses on the downy cheek of the baby, invokes tlie blessings of Heaven, pleads for mercy, or hurls curses on our enemies. Indeed, we do not always seem to realize how many notes in the tune of human life the hand of man is made to play. Its beauties, its perfect adaptability, it varied endowments, and the dif- ferent uses to which it is applied, are almost beyond our thouglits, and ho who is deprived of this useful member sustains a loss that none can esti- mate, nor the wealth of Croesus compensate. THE FOOT; ITS MECHAIHSM AND ITS WONDERFTIL ENDOWMENTS. Arrangement and Uses of the Foot. — In this exquisite colored engrav- ing is represented the human foot, the organ by which we stand, walk or run. Look at it carefully, aye, critically, and see if you can duplicate it in the whole range of man's achievements ! The general arrangement of the bony frame-work of the foot, as seen in this illustration, is strik- ingly like that of the hand. The graceful arch of the foot, composed by the tarsal and metatarsal bones, is firmly joined together by a thick layer of cartilaginous structure, not only preventing a liability to dis- placement, but giving to it an elasticity, sprightliness and strength which could never be attained by a single flat bone. In the next colored illus- tration we have a section of the foot, showing its architectural dignity and perfection. On its under or plantar surface are seen stretching from the heel forward toward the toes a number of ligaments, the principal one of which is the plantar ligament, and possesses great strength and elasticity. The Toes — The toes are observed to lie straight forward in a line ■with the general contour of the foot. This is their natural position. The beautiful outline of the natural foot, as here represented in these several different views, the gracefid arch of the instep, the elegance of its form, its marvelous elasticity and strength, all combine to make the foot not only of great perfection and beauty, but admirably fit it for the mani- fold duties it is called upon to perform. ]\lan, in his diversified labors and varied trials throughout life, is sometimes obliged to walk, run, jump, leap, climb, stand erect, lean forward, etc., and he depends upon the foot to maintain his equilibrium in the performance of these several duties. Beauty and Streng:th of the Foot. — Not only does the foot, too, fre- quently sustain heavy weights, but it must carry them as well. It like- wise affords a firm support. Were it not for this beautiful mechanism. TH^ leg; its MECnANIRM ANT? WONDERFUL ENDOWMENTS. 63 €he constant jarring and concussion which would be experienced in tb^ act of walking would inevitably destroy those delicate organs, the brain and spinal cord, and death would immediately follow. How few persons in civilized nations have perfectly natural feet! The beauty and utility of the human foot is marred ; its movements are impeded by encasement in unnatural boots and shoes; these, instead of conforming to the form and shape of the foot, make the foot adapt itseK to them. The conse- quence is corns, bunions, cross toes, ingrowing toe-nails, large joints, and a number of other evils from which so many suffer at the present day. iTHE lEQ; ITS MECHANISM AND ITS "WONDERFITL ENDOWMENTS. Leg Muscles — In every part of tlie human frame there is witnessed iample evidence of design, beauty of architecture, great skill, finished workmanship, and a perfec'; adaptability to the duties to be performed. This fact is strikingly illustrated in the beautifully executed colored plate to which attention is now drawn, showing, as it does, at a glance, the thick, strong, muscular instruments employed and the manifold intricacies involved in the act of human locomotion. This exquisitely artistic anat- omical plate represents a front view of the thigh, leg and foot, and of the fifty-four fleshy levers which, give form, shape, symmetry, strength and mobility to this useful member of the body. Quite a number of the most important are seen exposed to view, after the skin and fatty tissues have been removed. We are deeply impressed with their large size and great strength, both of which correspond with the requirements demanded in the varied work which the leg is called upon to perform. Use of the leg Muscles — The muscles observed in this plate are the principal instruments for carrying out the behests of the will in the acts of walking, running, leaping, climbing, and the gi'aceful, gliding motions of the entrancing and captivating waltz; and although we see a compli- cated piece of machinery, yet there is perfect order. Harmony, prompti- tude and exactness prevail, not only in the skilful manner in which they ere individually and collectively arranged, but in the action of the dif- ferent muscles, each one of which performs its duty either independently of, or in connection with, its fellow lever, and that, too, without inter- fering in the slightest degree witli the functions of the others. Muscular levers. — These gi'cat muscular levers bend the body for- ward on tlie thigh, and bring the legs inward toward each other, besidea moving the whole body tq and fro when walking, etc. The long, narrow- 64 THE HUMAN BODY. muscle, seen ruiming obliquely across the thigli, is tlie Sartorius iniiscle, so-called from the fact that it crosses the legs for the sartorial (tailor's) posture. It is the longest muscle in the body. The Knee-Pan. — The patella or kuee-pan is seen held firmly in posi- tion, giving greater strength and security to this important joint. Around the ankle is observed the annular ligament, binding the long silvery thongs or tendons of the muscles of the legs, thus preventing their dis- placement. It also affords security and strength to the ankle joint, though not interfering with its elasticity and motion. The foot shows ua the natural jwsition and shape in which the toes should be when encased in a boot or shoe. Thigh and leg Bones. — On turning the flap we see the bones of the thigh and leg, and a front view of the bones of the anlde joint and foot. As was to be naturally expected, we here find the largest, the longest and strongest bone in the human body, since, with every step taken, it has to bear the entire weight of that wonderfully and fearfully constructed body, and support whatever additional burdens or weights one is called upon to impose in the course of his daily labors. The bone is observed to be compressed, somewhat cylindrical in shape, but expanded at both ends, thus giving it the greatest possible degree of strength. At its lower end it articulates, and forms a hinge-joint with the knee, the strength and protection of which is further secured by the shape and position of the knee-pan. The Shin Bone. — The tibia or shin bone is also a very large, strong, triangidar-shaped bone, enlarged at both ends; the lower end, however, where it articulates and forms a hinge-joint with the foot, is larger and more prominent tban the upper end. And as if this bone was not suiB- ciently strong enough in itself to bear the weight of the body, our Cre- ator, with that boundless wisdom and forethought which everywhere in the human frame we see revealed, strengthens the legs by an additional bone, which is seen running on the outer side of the shin bone, and to which it is firmly bound at both ends. The Fibula — Xot only does this second bone — ^the fibula — ^give addi- tional strength and supjjort to the leg proper, but it likewise increases the bony area or surface of the leg, to which its powerful muscular levers are attached. The Sciatic Nerve. — The large sciatic nerve, its position, course and distribution, is gi-aphically outlined, and as we look upon this white, sen- sitive cord, we are deeply impressed with the force and truth of what Shakespeare makes one of his characters, Timun, say: THE LEG ; ITS MECHANISM AND WONDEET'UI, ENDOWMENTS. Tlie cold SCIATICA 05 Cripples our senators, that their limbs may halt As lamely as their manners." Muscles of Thigli and Leg — Turning to the next colored illustration, we have a graphic and faithful view of the deeper muscidar arrangements of the thigh and leg, together with a striking description of tlie nervous supply of the lower extremity. These beautiful, silvery threads are the wires which carry the behests of the will to the muscular levers, aud whose commands the muscles promjDtly obey; and give to the leg its wonderful and diversified endowments. To stand erect is a very difficult and complex act, and the process of walking is a no less difficult or complex function. Few persons ever realize the peril involved in walking, and it has only become safe by constant practice. Art of Walking — Walking requires the nicest adjustment, prompt action, and the finest calculations to maintain the dignity, proper attitude, equipoise and balance of the body. This is well illustrated when one runs up against any obstacle in the dark. We observe then with what head- Jong force the body is propelled forward. In walking the first thing that occurs is the inclining of the body forward; the foot is then gradually raised upon the toes, and brought from a horizontal position into an almost vertical one; at the same time the knee, which was at first con- Eiderably bent, straightens out by the advancing forward movement. Every part of the leg and thigh has changed its position except the toes ; that part farthest from the toes the most of all ; and gradually diminishing in geometrical proportions downward. How We Walk — The foot is then raised from the ground and swung forward in true pendulum fashion. The leg in so doing becomes flexed at the knee-joint, and considerably shorter, and the whole weight of the body is transferred to and supported by the leg and foot, which is planted firmly on the ground. The leg and the foot which was swinging in the air is now brought down to the ground, the muscles passing through changes just the reverse of those employed in raising it. Plant- ing this foot firmly on the ground, to prevent the body from falling, we raise the other foot, swing it forward, the leg describing the same move- ments as before, repeating the process alternately with each leg. These movements constitute the act of walking; the complexity of which is fully illustrated by the complicated machinery employed for its perform- ance, as we have seen in the beautiful plates showing the wonderful and skilful arrangements of the bones and muscles of the leg. 66 ANATOMY AND PHYSIOLOGY. Grace and Ease in Walking. — lu the several beautiful anatouiical charts illustrating tlie bony, muscular and internal mechanism of the human frame wo have been consciously awakened to its complexity; we have been forcibly impressed at the amazing skill and wisdom displayed in its nuirvelous arrangement, and at the general order, system, harmony and perfection which everywhere prevails throughout the diversified con- trivance of the body. But its wonders do not stop there. The gi-aceful motion, the case with which we walk, run, leap, dance, etc., demonstrate with what astonishing rapidity the different muscles concerned in those movements contract and obey the impulse of the Avill. The Voice. — The voice may utter one thousand five himdrcd letters in a minute, yet the articulation of each of those sounds requires a dif- ferent and distinct position of the vocal organs, tlie muscles of which move with surprising celerity and swiftness. Deftness of the Fingers. — In umsic we train the muscles of the fingers until tliey glide over the keyboard of the piano with dexterity and pre- cision, and perform the most simple and delightfully exquisite music and on to the grand, difficult and complex passage of operatic harmony. The mind of the skilful and professional violinist is upon the music which his riglit hand is executing by the varied movements of the bow, yet the muscles of his left hand and fingers are deftly engaged in determining the length of the space on the strings, the character and duration of each note ; and so rapidly, carefully, aye, even unconsciously are these complex movements niiide, that not a false note is heard, though the variation of a single hair's breadth would cause a discord, and thus spoil the pleasing effect of the mlisic, and destroy the attractiveness of its harmony. Muscle Development — The bleep muscle in the arm of the blacksmith may grow strong, hard, firm, and as solid almost as a club; the legs of the pedestrian may become large and well developed ; the hand of a prize fighter may be trained to strike a stumiing blow ^vith the force of a sledge hanmier; while the penman can describe the most beautiful curves, the engraver trace lines so delicate and fine as to be invisible to the naked eye, and the fingers of the blind acquire a delicacy of touch that almost compensates for the missing sense. Thus there are few conceptions of tlie designing mind which the muscular system of man cannot be made to execute and perfoi-m. INDEX TO BOOK II Book II treats of Anatomy and Physiology, a knowledge of which is essential to a proper study of disease. SUBJECTS OF THE TEXT Abdomen, The 93 Abdominal Aorta 1 10 Absorption 104 Air Vesicles 116 Anterior Tibial Artery 113 Aorta, The 108 Aorta, Abdominal no Aorta, Thoracic 109 Apparatus, Digestive 98 Apparatus, Respiratory lij Arm Bone 83 Arrangement of the Skin 74 Arteries, The 108 Arteries, Coronary 108 Artery, Femoral 112 Arteries, Function of 108 Artery, Popliteal 113 Artery, Radial 109 Artery, Pulmonary 113 Artery, Ulnar log Attachments, Muscle 88 Atlas, The 80 Auricle, Left 107 Auricle, Right 106 Axillary Vein 115 Back, Muscles of 91 Biceps, The 93 Blood 104 Blood, Composition of 104 Blood, Course of 106 Blood, Oxygenized 116 Bodily Organs jZ Body, Framework of 77 Bone, Arm 83 Bone, Compact 75 Bone, Frontal 80 Bone, Hyoid 82 Bone, Sphenoid 81 Bone Structure 75 Bone, Temporal 81 Bone, Thigh 8S Bones, Facial 81 Bones, Flat 79 Bones of Foot 86 Bones of Leg 85 Bones, Number of 79 Bones, 'Short 78 Bones, Side and Top of Skull 80 Bones, Skull 80 Bones, The yy Bones, Tissue. of 75 Brain, Divisions of 118 Brain, Nerves of 119 Brain, The 117 Brain, Weight of 118 Breast Muscles 93 Breathing ii6 Calf, Muscles of 97 Cardiacs 108 Cells, Forms of y^ Cells, Size of y^ Cerebellum, The ; . . . 1 19 Cerebrum, The 118 Cervical Plexus 121 Chest, The 82 Chewing, Muscles of 90 Cillia of Windpipe 74 Circulatory Apparatus 105 Circulatory System 104 Columnar Epithelium 74 Column, Spinal 79 Common Iliacs no Compact Bone 75 Composition of Blood 104 Connective Tissue 75 Cord, Spinal 120 67 68 INDEX TO BOOK n. Coronary Arteries lo8 Corpuscles los Course of Blood io6 Deltoid Muscle 93 Diaphragm, The 92 Digestive Apparatus 98 Division of the Brain 118 Divisions, Heart 105 Dorsalis Pedis 113 Duodenum 100 Endothelium 75 Epithelium 74 Epithelium, Columnar 74 Epithelium, Glandular 74 Extensors, Radial 95 External Iliac iii Extremity, Lovirer 8$ Extremity, Upper 82 Face, Muscles of 90 Facial Bones 81 Femoral Artery 112 Femoral Vein 115 Femur, The 87 Fibrous Tissue 76 Fifth Nerve 119 Flat Bones 79 Flexors 95 Foot Bones 86 Foot, Sole of 98 Forearm, The 83 Forearm, Muscles of 94 Forms of Cells 73 Framework of Body 77 Frontal Bone 80 Function of Arteries 108 Function of Nerves 116 Function, Vein 113 Gastric Juice 100 Glandular Epithelium 74 Gristle, Structure of 76 Gristle, Use of 76 Gullet, The 99 Hand, The 84 Heart, The 105 Heart Division loS Heart Sounds loS Hip Socket 85 Hyoid Bone 82 Iliacs, Common no Iliacs, External 1 1 1 Inner Trunks 122 Innominate Veins 1 13 Internal Juglar 1 13 Intestine, Small 100 Intestine, Large loi Jaw, Muscles of 91 Joints, The 86 Jugular, Internal 113 Jugular Vein 113 Juice, Gastric 100 Knee-Pan (Knee-Cap) 85 Lacteals ". 104 Large Intestine loi Larynx 115 Lett Auricle 107 Left Ventricle 107 Leg Bones 85 Ligaments of the Vertebrae 80 Liver, The 102 Lower Extremity, The 85 Lumbar Nerves 122 Lungs, The 115 Lung Lobes 116 Lung Membrane 116 Median Nerve 122 ^Median Vein 114 Medulla Oblongata 119 Membranes, Lung 116 Mouth, The 98 Muscle Attachments 88 Muscle, Deltoid 93 Muscle, The Tailor's 95 Muscles of the Back 91 Muscles of the Breast 93 ]\Iuscles of the Calf 97 Muscles of Chewing 90 Muscles of the Face go Muscles of the Forearm 94 Muscles of the Jaw 91 Muscles of the Lower Extremity .... 95 Muscles, The 87 Muscles, Thigh 95 Muscles, Thorax 92 Muscular Tissue 77 Nerve, Median 122 Nerves of Brain 1 19 Nerves, Function of 116 Nerves, Lumbar 122 Nerves, Sacral 122 Nerves, 'Spinal 121, 122 Nervous System I16 Nervous Tissue 76 INDEX TO BOOK II. 69 Number of Bones 79 Organs, Bodily 73 Outer Trunks 122 Oxygenized Blood 1 16 Pancreas, The 102 Pedis, Dorsalis 113 Periosteum 75 Peritoneum 103 Pharynx 99 Plantars 113 Plexus, Cervical 121 Popliteal Artery 113 Portal Vein 115 Posterior Tibial 113 Protoplasm yi Pulmonary Artery 113 Pulmonary Veins nS Pulsation 108 Radial Artery 109 Radial Extensors 95 Radial Vein 114 Radius, The 84 Respiratory Apparatus 115 Ribs, The 82 Right Auricle 106 Right Ventricle 106 Sacral Nerves 122 Sacrum, The 80 Saphenous Vein 115 Scapula, The 83 Short Bones 78 Shoulder, Socket of 83 Shoulders, The 82 Side Bones of the Skull 80 Size of Cells y2i Skin Arrangement 74 Skull, Bones of 80 Skull, The 80 Small Intestine 100 Socket, Hip 85 Socket of the Shoulder 83 Sole of the Foot 98 Sounds, Heart 108 Sphenoid Bone 81 Spinal Column 79 Spinal Cord 120 Spinal Nerves 121, 122 Spinal Vertebrae 79 Spine, The 79 Stomach, The 99 Stomach, Walls of 99 Structure, Bone » . 75 Structure of Gristle 76 Structure of Veins 113 Subclavian 108 Sweetbread 102 System, Nervous 116 System, Circulatory 104 Tailor's Muscle 95 Temporal Bone 81 Thigh Bone 85 Thigh Muscle . . . ; 95 Thoracic Aorta 109 Thorax, Muscles of 92 Thorax, The 82 Tibial Artery, Anterior 113 Tibial Artery, Posterior 113 Tissue of Bones 75 Tissue, Connective 75 Tissue, Fibrous 76 Tissue, Muscular 77 Tissue, Nervous 76 Tongue, The 99 Top Bones of the Skull 80 Triceps, The 94 Trunks, Inner and Outer 122 Ulnar Artery log Upper Extremity 82 Upper Extremity, Veins of 1 13 Use of Gristle 76 Veins, The 1 13 Vein, Axillary 115 Vein, Femoral 115 Vein Function 113 Vein, Innominate 113 Vein, Jugular 113 Vein, Median 1 14 Vein, Portal US Vein, Pulmonary 115 Vein, Radial 114 Vein, Saphenous US Vein Structure 113 Veins of Upper Extremity 113 Ventricle, Right 106 Ventricle, Left 107 Vertebrae, Ligaments of 80 Vertebrs, Spinal 79 Vesicles, Air 116 Walls of the Stomach 99 Weight of the Brain Ii3 Windpipe, Cilia of 74. Windpipe, The 115 Wrist, The 84 ;70 INDEX TO BOOK U. LIST OF ILLUSTRATIONS Aoromio-Clavicular and Shoulder Joints 88 Alimentary Canal from Throat to Anus loi Ankle Joint. Section of 88 Arm Uoncs 83,84 Atlas, The, or First Cervical Vertebras, So Blood Corpuscles, Magnified 105 Bone, Section of. Magnified 75 Bones of the Hand (Carpus) 84 Brain and Cord 121 Buttock and Back of Thigh 124 Carpus, or Bones of the Hand 84 Cartilage, Section of. Magnified 76 Cervical Cord, Section of 122 Cihated Epithelial Tissue 74 Corpuscles of Blood, Magnified 105 Dorsel Vertebrae, Section of. 79 Epithelial Tissue , 74 Epithelial Tissue, Ciliated 74 Epithelium, Columnar 74 Face, Nerves of 118 Fat, Section of, Magnified 76 Femur, or Thigh Bone 87 Fibula, or Minor Shin Bone 87 Foot Bones (Tarsus and Metatarsus) 87 Gland, Simple 74 Glands, Salivary 98 Hand, Bones of 84 Head, Arteries of 109 Heart and Lungs, Sectional View.... 106 Heart, Showing Auricles and Ven- tricles 107 Hip Joint, Socket and Ligaments 88 Htim.an Skeleton (full page) 78 Humcru!;, or Large Bone of the Arm, S3 Liver, The, Showing Lobes and Bile Duct loj Lumbar Vertebrae, Section of 70 Lungs and Heart, Sectional View of.. 106 Lymphatic Vessels of the Human Body 103 Lymphatics , 104 Muscle, Non-striated 77 Muscle, Striated 77 Muscles Back of the Thigh 97 Muscles of Back of Forearm 94 Muscles of Front of Forearm 94 Muscles of Front of the Leg 97 ]\Iuscles of the Back 92 Muscles of the Body, Back View 89 Muscles of the Body, Front View go Muscles of the Chest 93 Muscles of Face, Jaw and Neck 91 Nerve Cells, Group of. Magnified 76 Nerves, Magnified and Described 77 Nerves of the Thigh 96 Nerves of the Thigh 123 Nerves of the Face and Scalp 118 Nerves — iNinth, Tenth and Eleventh, 120 Nerve, Fifth 119 Ninth, Tenth and Eleventh Nerves of Organs of Sense 120 Non-striated Muscles 77 Pavcm-ent Epithelial Tissue 74 Pelvis of the Male 86 Peritoneum, Showing all Involved Or- gans 102 Racemose Gland, The 74 Radius, or Bone of the Forearm 84 Ribs, The, Showing Thorax 82 Salivary Glands 98 Scalp, Nerves of 118 Scapula, or Back of the Shoulder.... 83 Sectional View of Base of Brain 117 Section of Bone Magnified 7$ Section of Servical Cord 122 Section of the Spinal Vertebrae 79 INDEX TO BOOK II. 71 Semilunar Valves of the Heart io8 Shoulder Joints 88 Simple Glandular Epithelium 74 Skeleton (full page) 78 Skull, Front View of 81 Skull, View of the Base of 81 Spinal Column, Complete Outline of.. 79 Spinal Cord 121 Stomach, The 100 Stomach Tubule, Showing Fundus and Muscular Coat 100 Striated Muscle, Sections of •;■; Thigh, Arteries of 112 Thigh, Back View of 124 Thigh, Nerves of 96 Thorax, Transverse Section of 116 Thorax, View of 82 Tibia, or Strong Bone of the Shin.. 87 Tongue, The, Showing Mucous Mem- brane and Glands 99 Transverse Section of the Thorax or Chest 116 Ulna, or Bone of the Forearm 84 Veins of the Human Leg 1 14 Veins of the Upper Extremity of the Body 114 Book II. ANATOMY AND PHYSIOLOGY. Necessity for This Book — A brief outline of tlie structure or anatomy, and of the function, use or physiolony of tlie human organism must necessarily inaugurate any book ijurporting to present the prevention and cure of disease, for disease means disordered function, which cannot be understood without some knowledge of the normal or regular function, which in turn necessitates a study of structure. Plan of the Book As anatomy and physiology are naturally insepar- able we will interweave one with the other in the following pages, the part played by an organ being given with its description. Bodily Organs — Every animal is composed of organs, as the heart, liver, kidney, etc., and every organ consists of tissues, of which there are four varieties: epithelial, connective, nervous and muscular. Each tissue is made of numbers of cells. Forms of Cells — A cell is a microscopic bag of jelly-like substance called protoplasm, which often contains within its substance a smaller cell called a nucleus, and sometimes inside the smaller cell, a tiny dot called the nucleolus. Protoplasm. — Protoplasm is formed of water, albuminous substances, sugary material, fat and chemical salts. The chief chemical salts enter- ing into its formation are carbon, hydrogen, oxygen and nitrogen. Size of Cells — Cells vary from -^ to ,-i- of an inch in diaineter; *^ &U00 1-0 ' some tubes as in the hair-like blood-vessels, and some float in fluid as the blood corpuscles. Some have the power of moving from place to place, ameboid motion. Human Body Compared to a City. — The human body may be compared in its arrangement to a city, the houses being the organs ; the brick, stone, wood and metal the tissues, and tlie individual bricks, fragments of stone, boards or pieces of metal the cells. Human Body Compared to an Army. — Huxley compares it to an army, (T3) u AITATOMY AND PHYSIOLOGY, Figure S. — PAVE- MENT EPITHELIUM. "each cell is a soldier, an organ a brigade, the central nervous system tLe headquarters and field telegrajih, and the alimentary and eircidatory systems the commissariat." The function of a cell is the same as that of a human being, they absorb food and gi-ow, fill special offices, as protect- ing, secreting, etc., reproduce and die. Epithelium. — Epithelial tissue or epithelium means literally upon the ni^jple. It covers the entire outside of the body, as the skin, the in- side of the respiratory, alimentary and genito-urinary apparatuses as mucous membrane, and dips down into the va- rious glands which open on the skin and mucous membrane. Skin Arrangement. — On the skin it is arranged in layers as pavement epi- thelium (Fig. S) and acts as a protec- tion to the delicate structures beneath. In some places, as in the hair and nails, it is much modified to more effect- ually guard against injury. Shape in the Stomach — In the stomach, intestines and elsewhere the eijithelial cell is oblong in j^rofile (Fig. 9) and is called columnar epithelium. Cilia of Windpipe. — Some epithelium, like that in tho windpipe, has projecting from It long waving filaments called cilia (Fig. 10), The cilia wave constantly, acting as brooms, which keep the windpipe clean. Glandular Epithelium. — Secretory or glandular epithelium (Figs. 11 and 12) is found in the glands, varies in shape, and Figure 9. — CO- LUMNAR EPI- THELIUM. rigure 10. — CILIATED EPI- THELIUM. ricure 11. — SIMPLE GLAND. RACEMOSE QLANIX BONE STEUCTUEE ANT) TISSUE. 75 is the essential portion of tlie gland, i. c, tlie portion which manufactures the special secretion from the blood. Endothelium — Endothelium, lining serous sacs, joint cavities (syno- vial sacs), and the blood and lymphatic vessels, is analogous to epithelium. Connective Tissue. — Connective tissue occurs as bono, cartilage and fibrous connective tissue. Bone Structure. — Bone is fibrous tissue cemented with petrified cement. It consists approximately of one-third animal and two-thirds earthy material, the jiriucipal earthy constituents being the phosphate and carbonate of lime; lining bone is pinliish in color and oozes blood when cut. Periosteum — Externally it is covered by a membrane called perios- teum. The shafts of long bones are hollow, the cavity being filled by the marrow, which consists of blood and lymph vessels, nerves and fat sup- ported by fibrous tissue. Tissue of Bones — Bone tissue is of two kinds, spongy, which forms the very thin bones and the ends of long bones, and compact, which is found in the shafts of long bones and in the outside of flat bones. Spongy bone is made up of a meshwork of bony arches, the spaces filled with vessels, bone cells and connec- tive tissue. Compact Bone Compact bone (Fig. 5) consists of a series of concentric layers of bone disjiosed aroimd a canal called the Haversian canal which affords the passage for the blood-vessels. The layers of bone are separated from each other by small spaces called lacunae, and passing through the bony layers and connecting the lacunae are many fine chan- nels called canal iculi ; they serve to convey nourishment to the bone cells. The function of bone is to support, to protect, and to give attachment to musclee. Figure B. — SECTION OF BONE, MAGNrFIED. Y6 AITATOMT AND PHTSIOLOGT. Structure of Gristle. — Cartilage or gristle (Fig. 4) is fibrous tissue gluod together by a substance containing chondrine. It has no blood- vessels but is nourished by lymph which filters through it by means of small spaces and canals analogous to the lacuna; and canal iculi of bone. Use of Gristle. — Cartilage forms a smooth covering for the ends of bones entering into a joint ; acts as a buffer between the bones of the spine, prevents certain tubes, like the windpipe, from collapsing, and as in the external ear gathers sound. Figure 3. Figure 4. Figure 3.- Figure 4.- -FAT. -CARTILAGE. [ Magnified, ribrous Tissue. — Fibrous tissue consists ultimately of fibres which are developed from spindle-shaped cells. Its function is to hold the various Figure 67. — NERVE CELLS. parts of, and the organs themselves, together. Fatty tissue (Fig. 3) is fibrous connective tissue unfiltrated with fat. Nervous Tissue. — Nervous tissue is either gray, which is a mass of tailed cells (Fig. 57) supported by a fine connective tissue (neuroglia), or BONES OF THE BODY. rr white, whicli is made of bundles of little nerve febrils, each febril is the tail of a cell in the gray nervous tissue and is surrounded in some places by the white substance of Schwann (Fig. 58) and by a i)rimitive sheath. Figure 6. — STRIPED MUSCLE. 1, longitu- dinal section: 2. 3. 4. cross section; 5, de- taclied disk: 7. 8, Hbrijla;. del H Figure 68. — NERVES. a, axis cylinder; b. Inner border of wtiite substance; c, c. outer border of same: d, d, tubular membrane; B. tubular iibres; e. in natural state; f, under pressure; g. varicose fibres. Muscular Tissue. — kinds of miiscular ti.ssut striped, and the in- voluntary or non- striated. Volun- tary muscle (Fig. 6) is composed microscopically of the primitive fasciculi (minute bundles of febrils), each febril of which consists of a row of disks (Fig. 6) called sarcous elements. Involuntary muscle is built of a number of non- striped, spindle-shaped cells (Fig. 7) which branch and join with one another. There tllO V are I )] nil tar two V ur THE BONES. Figure 7. — NON-STRIATED MUSCLE. rramework of the Body — The body skeleton (Fig. 13) forms the framework of the body. Bones are divided into long, short and flat bones. The long bones consist of a hollow shaft of compact bone, and two broader extremities of cancellated bone. They are found in the extremities and form, levers by which the trunk is moved. la ANATOMY AND PnTSIOLOQT. Figure 13.— HUMAN SKELETON. Short Bones. — Short bones are placed where strength is more neces- sary than mobility, as in the hand and foot; their structure is spongy, covered by a thin layer of compact bone. THE SPINE. 78 Flat Bones. — The flat bones are foiind where protection of important organs is necessary, as in the skull, sternum and scapula?. They consist of two tables of compact bone filled in with cancellous tissue. Certain bones do not belong to one class alone and are called mixed bones. Number of Bones.— There are in the adult skeleton, excluding the teeth, ossicles of the ear, and Wormian bones, 200 separate bones. These are: In the spinal column :;6 In the skull 8 In the face 14 Ribs, breast bone and Iiyoid bone 26 Upper extremity 64 Lower extremity > 62 THE SPINE. Spinal Column. — The spine (Fig. 14) is a flex- ible column made of small bones called vertebrae, seven cervical, twelve dorsal, five lumbar, five sacral and four coccygeal vertebra?. Spinal Vertebrae. — A vertebra (Figs. IG and 17) consists of a solid portion in front called the body, and au arch behind, so that when placed la' Figure 16. Figure 17. Flprure 14. — SPINAL COLUMN. 1, atlas; 2, axis; 3, vertebra prominens; 4, twelve dorsal; B, fifth lumbar; G, 7, sacrum; 8. coccyx; 9, a spinous process; 10, 10. intervertebral foramina. Figure 10. — DOKSAL VERTEBRA. 1, body; 2, facet for rib; 3, superior surface body; 4, 5, Intervetebral notch; 6, spinous process; 7, articular facet for tubercle of a rib; 8, 9, articular processes. Figure 17. — LUMBAR VERTEBRA. 1, body; 2. front of the body; 3, spinous process; ^ transverse process; 5, articular process; 6, arcb; 1, splual forameo. 80 ATTATOMT AND PHYSIOLOGY. one above the other, as in Figure 14, the bodies of the vertebrsB form a support for the body and the arches a canal which contains and protects tho spinal cord. The arches are formed bv a plate of bone on each side (lamina) joined to the body or constructed portion of bone (pedicle) and imito behind to form the spinous process, which is the portion one feels when running a finger down the back. The Atlas. — The first cervical verte- bra or atlas (Fig. 15) has neither body nor spinous process, but consists of an anterior and posterior arch and two lateral masses on which rests the skull. The axis, or cervical vertebra has a projection from the upper surface of its body (odontoid Figure 15— ATLAS. I, anterior tu- proccss) which fits" in the anterior arch of bercle; 2, facet for axis; 3. posterior . . i i i • i i surface spinal canal; 4. 4, Interverte- the atlaS, permitting the head With the bral notch; transverse process; 5, , . i i» • i • i foramen for vertebral artery; 7, su- atlaS tO be rOtatcd irOm SldC tO Side, perior articular process; 8. tubercle frl, „ c««««.« n-il • i_ i: for transverse ligament. The Sacrum. 1 he SECrum COUSlstS of five vertebra? welded into one bone. It is triangular in shape and is wedged in between the haunch bones, forming the back of the pelvis. Attached to its apex is the coccyx, which consists of four vertebrae, so joined as to form one bone. Ligaments — The vertebrae are tied together by ligaments. Between each vertebra and its neighbor is a disk of cartilage, which acts as a buffer to prevent shock and allows the spine to bend in various directions. THE SKULL. Bones of the Skull — The skull is divided into the cranium or brain case and the face. The cranial bones are one occipital, two parietal, one frontal, two temporal, one sphenoid and one ethmoid. The occipital bone forms the back and under part of the skull. It is perforated by a large opening (foramen magnum) which transmits the spinal cord to the spinal canal. The cerebellum rests on its inner or upper surface, the external surface gives attachment to muscles. Side and Top Bones The parietal bones form the sides and top of the cranium, joining in the median line and being placed between the occipital bone behind and the frontal bone in front. Frontal Bone. — The frontal bone forms the forehead and forms the roof of the orbit, on the upper surface of which rests the brain. The BONES OF THE FACE. 81 orbital plates are separated by the ethmoid bone, which is spongy and filled with perforations which transmit the nerves of smell to the nose. Temporal Bone. — The temporal bone consists of a squamous or scale- like portion which overlaps the parietal bone, and a petrous or stony portion which helps form the floor of the cranium. The petrous portion lodges In the internal and middle ear. Sphenoid Bone. — The sphenoid resembles a butterfly in shape. It is Figure IS. Figure 19. Figure 18.— FRONT OF THE SKULiL. 1. OS frontalis; 2, globella; 3, supraorbital ridge; 4. optic foramen; 6. sphenoidal fissure; 6, spheno-maxlllary Assure; 7, lachrymal fossa; 8, an- terior nares; 9. intraorbital foramen; 10. malar bone; 11. symphysis menti; 12. anterior mental foramen; 13, ramus of the lower jaw; 14, parietal bone; 15. coronal suture; 16, temporal bone; 17, squamous suture; 18, great wing of the sphenoid. Figure 19. — BASE OP THE SKULL. 1. hard palate; 2, foramen incisivum; 3. palatine plate of palate bone; 4, crescenteric ridge; 5, vomer; 6, internal pterygoid plate; 7, pterygoid fossa; 8. external pterygoid plate; 9. temporal fossa; 10, basilar process; 11. foramen mag- num; 12, foramen ovale; 13, foramen spinale; 14, glenoid fossa; 15, meatus aditorius externus; 16, foramen lacerum anterius; 17, carotid foramen; 18, foramen lacerum posterius; 19, styloid process; 20, stylo-mastoid foramen; 21, mastoid process; 22, condyles of occipital bone; 23, posterior condyloid foramen. the keystone of cranial architecture binding the bones of the bead firmly together. Facial Bones. — The facial bones are: two nasal bones, forming the bridge of the nose; two superior maxillary (upper jaw) ; two lachrymal, forming a portion of the inner wall of the orbit ; two malar br cheek bones ; two palate bones forming the back part of the roof of the mouth and the corresponding portion of the floor of the nose; two inferior turbinated bones which are scrolls of bone placed in either nostril ; one vomer, form- ing the partition between, the nostrils; and the lower jaw or inferior 6 82 ANATOMY AND PIITSIOLOGT. maxillary bono, horseshoe in shape, joining with the temporal bone above and being freely movable below to permit chewing, talking, etc Hyoid Bone. — The hyoid bone is U-shaped, situated in the neck just above the larynx and gives attachment to many muscles of the tongue and throat. THE THORAX. The Chest. — The thorax or chest is an elastic bony cage made by the breast bone in front, the spine behind, and the ribs and their cartilages at the sides. It is filled by the heart and lungs, which it protects. The sternum or breast bone occupies the middle line anteriorly, is flat, and is made of three pieces, the manubrium (handle), the gladiolus (blade), and the pointed extremities, the ensiform or xiphoid appendix, these names were given by the ancients who compared it to a sword. The Ribs. — There are twenty-four ribs (Fig. 20), twelve on each side. They are joined to the vertebra behind and to the sternum, by means of car- tilages, in front. They are irregularly Bemicircular in shape, flattened antero- posteriorly, and slightly twisted on them- selves. The head joins the vertebra be- hind, the neck is the constriction in front of the head and the angle, the point of greatest curvature. The seven upper ribs unite directly with the sternum and are called true ribs. The other five are called false ribs, the upper three being united in front to the cartilages of the ribs above them, and the last two having no attachment in front are termed floating ribs. aS7, THE UPPER EXTREMITY. Figure 20. — THORAX. 1, manu- brium; 2, gladiolus; 3, ensiform pro- cess; 4, first dorsal vertebra; 5, twelftli dorsal vertebra; 6, first rib; 7, its head; 8, Its necli; 9, Its tubercle; 10, last true rib; 11, Its cartilage; 12, angle of eleventh rib; 13, Its body. The Shoulders. — The upper extrem- ity cousists of the shoulder, the arm, the forearm, and the hand. The bones of the shoulder are the clavicle and scapula connecting the arm Avith the trunk. The clavicle, collar, or key-bone is a short bone curved like the letter f, rimning horizontally between the sternum and scapula. BONES OE" THE FOEEAEM. 85 The Scapula — The scapula (Fig. 21) forms the back of the shoulder, is triangular in shape, the apex pointing downward and lies on the ribs. On the upper part of the outer surface is a thick triangular spine, the outer extremity of which (the acromion) forms the point of the shoulder. Socket of the Shoulder. — Beneath this process the upper angle is hollowed out to relieve the upper end of the arm bone. In front of this depression is a curved prominence, the coracoid process. Arm Bone. — The humerus (Fig. 22) or arm bone consists of a long cylindrical shaft, having a rounded head above for articulation with the r/^'- Figure 22. Figure 21. — SCAPULA. 1, 1, 1, oblique ridges; 2, 3, subscarular fossa; 3, superior border; 4, superior angle; 5. supra-scapular notcli: C, coracoid process: 7, acromion process; 8, spine of scapula; 9, articular surface; 10, glenoid cavity; 11. head of scapula; 12, neck; 13, in- ferior border; 14, inferior angle; 15, posterior border; 16, origin of the spine. Figure 22. — HUMERUS. 1, shaft; 2, head; 3. anatomical necit; 4, greater tuberosity; B, lesser tuberosity; C, bicipital groove: 7, ridge pectoralis major; S, internal bicipital ridge; 9, insertion of deltoid muscle; 10, nutrient foramen; 11, facet for radius; 12, facet for ulna. scapula, and a broad flattened lower extremity for articulation with the forearm bones. The Forearm. — The bones of the forearm are the ulna and the radius. The ulna (Fig. 24) lies on the inner side of the forearm when the palm of the hand faces upward. The upper extremity wliich joins the humerus, has two processes, the olecranon, forming the point of the elbow and the coronoid process, which complete the hinge joint of the elbow in front. 84 ANATOMY AND PnYSIOI.OGT. The lower end of the uhia is small and does not articulate with any bone of the wrist. The Radius The radius (Fig. 23) lies on the outer side of the fore- arm. It lias a cup-shaped head for articulation with the humerus. The rounded edge of the bead fits in a concavity of tlie ulna and is surrounded Figure 23. Figure 24. Figure 25. Figure 23. — RADIUS. 1, head; 2, articulates with ulna; 3. neck; 4, tuberosity; B, In- terosseus ridge; 6. articulates with ulna; 7, carpal surface; 8, styloid process; 9, insertion of pronator quadratus. Figure 24. — ULNA. 1, olecranon: 2, sigmoid cavity; 3. coronoid process; 4, lesser sig- moid cavity; 5, external surface: 6, interosseus ridge; 7, articulates with radius; 8, carpal surface. Figure 25.. — CARPUS. 1, ulna; 2, radius; S, interartlcular cartilage; 4, metacarpal of thumb: 5. 6, 7. 8, metacarpal bones of fingers; S, scaphoid; L. semilunar; C, cuneiform: P, pisiform; T, T, trapezium and trapezoid: M. magnum; U, unciform. by a sling-like ligament, which allows the head to rotate. The lower extremity is larger and is hollowed out to fit the wrist bones. The "Wrist. — The wrist or carpus consists of eight small bones in two rows (Fig. 25). In the upper row, beginning at the radial side, are the scaphoid, semilunar, cuneiform, and pisiform bones ; in the lower row, the trapezium, trapezoid, or magnum and unciform bones. The Hand — The band is made of five short cylindrical bones called the metacarpal bones (Fig. 25), to the lower extremity of which are BONES OF TIIIOII AND LEG. 85 attached the finger bones or phalanges, there beiHg two for the thumL and three for each finger. THE lOWER EXTREMITY. Parts of lower Extremity — The lower extremity consists of throe parts, the thigh, the leg and the foot, and is united to the trunk by the OS innominatum or haunch bone, ■which bears the same relation to the lower extremity that the bones of the shoulder do to the upper extremity. The OS innominatum (Fig. 26) consists of the ilium, ischium and pubes, which in the adult grow together and form one single bore. It is irregularly oblong in shape and twisted upon itself. The ilium is the broad upper part of the bone and forms the prominence of the hip. The ischium is the V-shaped lower portion upon wbieh we sit. The pubes is situated in front and is also V-shaped; in the adult the upjjer part is covered by hair. Between these V-shaped bones is a large opening, the obturator or thyroid foramen. Hip Socket. — At the junction of the three bones is a cup-shaped cavity, the acetabulum or socket of the hip, which receives the rounded bead of the thigh bone. In front the pubic bones join and behind the sacrum complete the bony ring of the pelvis. The pelvis (Fig. 26) is basin-shai^ed, supports the contents of the abdomen and the trunk ujion the limbs. Thigh Bone. — The femur (Fig. 27) or thigh bone is the largest and strongest bone in the body. It consists of a shaft and two extremities. The upper extremity consists of a head which is spherical and smooth, fitting into the acetabulum, and a neck which joins the shaft at an obtuse angle. The shaft siipports the body, is an important lever in locomotion and gives attachment to muscles. The lower extremity resembles the lower end of the humei'us ; it is smooth and joins with the main bone of the leg, the tibia. Knee Pan — The patella or knee pan is a small flat bono situated in the huge tendon of the great muscles on the front of the thigh. It protects the knee joint and increases the leverage. Leg Bones. — The leg bones are the tibia or shin bone (Fig. 27a) and the fibula (Fig. 28). The tibia, the larger and stronger, is expanded above to join the femur; the shaft is triangular, the sharp edge in front may be readily felt beneath the skin as the shin. The lower exti'emity gg ANATOMY AND PHYSIOLOGY. forms the inner part of the ankle joint. The fikila (Fig. 2S) is a long, slender bone lying on the outside of the leg. Its upper end joins the ex- Figure 26. Figure 20. — MALE PEI^VIS. panded upper extremity of the tibia, strengthening it, the lower end forms the outer part of the ankle joint. Foot Bones — The foot (Fig. 29) consists of the tarsus or ankle bones, the metatarsus or foot bones and the phalanges or toe bones. The bones of the tarsus are the calcaneum, os calcis, or heel bone, the astragalus "which joins the bones of the leg, the cuboid, the scaphoid and the three cuneiform bones. There are five metatarsal bones corresponding to the nietacarpar bones of the hand. The phalanges are similar to those of the hand, there being two for the great toe and three for each of the other toes. THE JOINTS. Where two bones meet a joint or articulation exists. The bones may be so soldered together (Fig. 30) as to form an immovable joint, as in the bones of the skull; they may be slightly movable as the pelvic and ver- tebral joints, or they may be freely movable as in most of the articulations of the limbs. The freely movable joints (Fig. 31) are the hinges, as the elbow; the ball and socket, as the shoulder; the gliding, as the stemo, clavicular articulation and the ring and pivot (Fig. 32) joint, as the atlo- axoid articulation. The structures entering into joint formation are bonea. THE MTISCI.ES. 87 cartilages, ligaments and syuovial membraiio which secretes the lubricat- ing fluid of the joint. (Figs. 30, 31 and 32.) Figure 27a. Figure 29 Figure 27. — FEMUR. 1, depression for round ligament; 2, head; 3, depression for rotary muscles; 4, great trochanter; 5. lesser trochanter; G. roughness for gluteus niaximus; 7, lines aspera; 8, gastrocnemius insertion; 9, external condyle; 10, depression for anterior crucial ligament; 11, depression for posterior crucial ligament; 12, origin of internal lateral ligament. Figure 27a. — TIBIA. 1, spine; 2, articulates with femur; 3, facet for fibula; 4, head; 6, tubercle; G. 6. shaft; 7, internal malleolus; S, attaches internal lateral ligament of ankle; 9, tarsal surface; 10. facet for fibula. Figure 2S. — FIBULA. 1, head; 2, articular facet; 3, insertion of external ligament ; 4, Bhaft; 5, 5. external face; 6, interosseus ridge; 7. facet for tibia; 8, external malleolus; 9, tarsal surface. Figure 29. — FOOT BONES. 1. astragalus; 2. Its anterior face; 3, os calcls; 4, scaphoid; 6, internal cuneiform; G. middle cuneiform; 7, external cuneifurm; 8. cuboid; 9, 9, metatarsal bones; 10, first phalanx of big toe; 11, second phalanx; 12, 13, 14, phalanges of other toes. It will Le iinneces.sary to describe the individual joints, reference having already been made to them in the section on bones. THE MUSCLES. Function of Muscles. — Muscles are familiar as the flesh of animals. They are attached to bones, ligaments, cartilages and the slcin, and bv their contractions cause all the movements of the body. Some muscles are arranged in sheets (Fig. 33), some are spindle-shaped, some are disposed 88 ANATOMY AKU I'llYSIOLOGT, Figure 30. Figrure 31. Figure 30. — ACROMIO-CLAVICULAR and SHOULDER JOINTS. 1. upper acromlo-clav- Icular ligament ; 2, coraco-clavlcular ligament ; 3, coraco-acromial ligament ; 4, eoracold liga- ment; 5. capsular ligament of shoulder; 6, coraco- humeral ligannent; 7, long head of bicepa. Figure 31. — HIP JOINT. 1. posterior sacro-illac ligament; 2, greater sacro-sclatlc liga- ment ; 3, lesser sacro-sciatlc ligament ; 4. great sciatic notch ; 5, leaser sclat Ic notch ; 6, coty- loid ligament; 7, Ugazuentum teres; S, attachment for capsular ligament; y, obturator ligament. Figure S2. Figure 32. — SECTION OF ANKLE JOINT. 1, tibia; 2, astragalus; 3. oa calcls; 4. scaphoid; ri, internal cuneiform; 6, metatarsal of big toe; 7, 8, first and second phalanges of great toe; 9. articular cavity between tibia and astragalus; 10. synovial capsule between astragalus and os calcls; 11, calcaneo-astragaloid ligament; 12, synovial capsule between as- tragalus and scaphoid; 13, calcaneo scaphoid ligament ; 14. calcaneo-cubold ligament; 15, synovial capsule between scaphoid and internal cuneiform; 16, synovial capsule between internal cuneiform and first metatarsal; 17, metatarao-phftlangeal articulation of great toe; 18, phalangeal articulation of great toe. in rings like the muscle which closes the monthj and in some the fihres spread out like a fan. Muscle Attachments. — They are attached by fibrous cord, the tendons, or by broad fibrous bands, the aponeuroses. The end of the muscle which has the firmer attachment is called its origin (Fig. 34), the other end its THE musci.es. 89 insertion ; this is, as a rule, merely relative, as in most cases the muscles act from either extremity; for instance, the sterno-cleido mastoid, the muscle which forms the prominent cord at either side of the neck, has its Figure 33. Flguro 33. — MUSCLES, BACK VIEW. The fascia is left upon the left limbs; removed from the right. origin from the top of the breast bone and the end of the collar bone, and its insertion into the bony prominence of the skull behind the ear, its action is to bow the head and turn the face to the opposite side ; but if the 90 ANATOMY AND PHYSIOLOOT. head be fixed it serves to raise the ribs and is thus an accessory muscle of respiration. Face Muscles — Of the numerons small muscles of the face (Fig. 35), it is not necessary to si)eak here ; as a rule they arise from the bones of the Figure 34. Figure 34. — MUSCLES, FRONT VIEW. On the right half, superficial muscles; left half, deep muscles. face and are inserted into the skin, by their mobility giving expression to the countenance. Muscles of Chewing — The muscles of the orbit will be taken up in THE MTTSCI.es. 91 connection with the eye. The muscles of mastication are the temporal, masseter, the two pterygoids and the buccinator. The temporal arises from the side of the head above the ear and is inserted into the top of the lower jaw. The masseter runs from the bony process external to the orbit, to the angle of the jaw and forms the hard mass felt in the cheek when the jaw is tightly closed. /z /o Figure 36. Figure SS.^MUSCLES OP FACE, JAW AND NECK. 1. longus colli; 2, trapezius; 3. flterno-hyoid; 4, sterno-mastoid: 6, crico-thyroid; 6, trapezius; 7, constrictor of piiarynx; 8, sterno-mastoid; 9. digastric; 10. attrahens aurem; 11. mylo-hyoid; 12, masseter; 13, depressor of lower Up; 15, orbicularis oris; 17, levator of upper Up; 19, levator of angle of moutli; 21. orbicularis palpebrarum. Muscles of the Jaw — The pterygoids run from the base of the skull to the lower jaw, moving it laterally. The buccinator is a broad, flat sheet in the cheek compressing the cheeks as when blowing or whistling, etc. The stemo-cleido mastoid has already been mentioned above. The muscles of tlie larnyx will be spoken of in connection with diseases of the throat. Muscles of the Back. — ^The most important muscles of the back are the trapezius, which pulls the head back or the shoulder upward or back- 92 ANATOMT AND PHYSIOLOGY. ward and which runs from the occipital bone and the spine as far as the middle of tlie back, to the shoulder bones; the latissimus dorsi, which draws the arm do^vn■^vard and backward, and which arises from the lower ribs, the lower half of the spine and the haunch bone and is inserted into the arm bone near its head; and the erector spinse which arises from •\:o pelvis and lumbar vertebrae and is inserted into all the vertebrae above; it inaiulains the spine erect. Muscles of Thorax — Concerning the thorax we may mention the Figure 36. Figure 36. — MUSCLES OF BACK. I. trrpezius; 2. Its origin: 3. spine of scapula: 4. latls- 3imu.s dorsi; 5. deltoid; 6. infra-spinatus: 7, external oblique; 8. gluteus medius: 9, gluteus maximus; 10, levator scapulae; 11, rhomboideus minor; 12, rhomboideus major; 13, splenius caiiitus; 14, splenius colli; 15, origin latissin^us dorsI; 16, serratus inferior posticus; 17, supra- spinatus; 18. infra-spinatus; 19, teres minor; 20, teres major; 21, long head triceps; 22. ser- ratus major amicus; 23, internal oblique. intercostal (between the ribs) muscles, external and internal, the external set raising the I'ibs and the internal set depressing the ribs in respiration. The Diaphragm. — The diaphragm is a musculo-fibrous partition form- ing the dome of the abdomen and separating it from the thorax. It is musci.es of the abdombw. 93 J3^f' S^:^'i^S attached to the lower ribs and spinal column and Is perforated by tlie aorta, inferior vena cava and gullet. It is a muscle of respiration and expulsion. The Abdomen. — The abdomen is completed in front and at the sides by a thick wall of muscles which not only aid in protecting the underlying structures but assist in expelling the urine, feces, etc., from the body. This wall is made of the external oblique muscle which runs from the ribs downward and inward to tlie pelvic bones and linea alba — the linea alba or white line occupies the midline of the abdomen and is formed by the union of the various muscular structures of the abdominal wall; the internal obliqiie muscle arises from the ilium and lower fibrous part of the external oblique (Pou- part's ligament), runs upward and inward to be inserted into the linea alba and lower ribs; the transver- salis which runs transversely be- tween the brain, spine, ribs and pelvis to the linea alba, and the rectus abdominalis which is situ- ated near the middle line of the body and runs from the ribs to the pelvis. Breast Muscles. — The pecto- ralis major and minor muscles form the fleshy masses of the breast. They run from the collar- bone, breast-bone and ribs to the caracoid process of the scapula and the humerus, the fibres con- verging from their origins to their insertions. They draw the shoulder forward and the arm across the chest. Deltoid Muscle — ^The deltoid (Fig. 37) forms the prominence of the shoulder. It arises fi'om the clavicle and scapula, the fibres con- verging to be inserted into the humerus just above the middle. It raises the arm from the side. The Biceps. — The biceps forms the prominence on the front of the Miti^ mi'^fi^-'-- ^'■■■ m '•' 'ifi P0 r- ■■'■•'■■;'.. - vt- ' )7 W/ Figure 37, Figure 37. — CHEST MUSCLES. 1. stcrno- h> Old ; 2. Bterno-mastoid ; 3, sterno-thyroid ; 4, sterno- mastoid; 5, trapezius; 6, clavicle; 7. origin pecloralis major; S. deltoid; 9, lower edge pectoral is major; 10. middle pect oralis major; 11, fibres external oblique; 12, biceps; 13, teres major; 14, serratua major anticus; 15, external oblique Interlocking with serratus niaj or. 9-i ANATOMY AND PnYSIOLOOT. arm when tlie forearm is flexed. It arises from the scapula by two heads and is inserted into the upjier end of the radius. It flexes the forearm and assists in snpinating or turning it over. The Triceps. — The triceps arises from the shoulder hlade and the back of the humerus by three heads, and is inserted into the upper end of the ulna. It extends the forearm. Muscles of Forearm — The muscles of the forearm are very numerous, and give the forearm and hand a multitude of movements. The muscles M-liich turn the palm downward arc called pronators, the most important of these is the pronator radii teres Avhich runs from the inner part of the lower end of the humerus to the radius. The most imjrortant supinator Figure 38. Figure 39. Figure 38. — MUSCLES OP BACK FOREARM. 1, bleeps; 2, brachlalls Internus; 3, biceps: 4, supinator longus; 5, extensor carpi radialis longior; 6, extensor carpi radialis brevior; 7, Insertion of these muscles; S, extensor communis digitorum: 9, extensor communis dlgltorum; 10. extensor carpi ulnaris; 11. anconeus; 12. flexor carpi ulnaris; 13, extensor minor polUcls; 14. extensor major polllcis; 15, posterior annular ligament. Figure 39. — MUSCLES OF FRONT FOREARM. 1. biceps; 2. brachialis internus; 3, triceps; 4. pronator radii teres; 5. flexor carpi radialis; 6, palmaris longus; 7. flexor sublimua digitorum; 8. flexor carpi ulnaris; 9, palmar fascia; 10. palmaris brevls; 11. abductor polllcis; 12, flexor brevls pollicia; 13, supinator longus; 14, extensor ossia metacarpl pollicls. MUSCLES OF THE LOWER BODY. 95 or muscle -whicli turns the palm upward (Fig. 38), is the supinator longus which runs from the outer part of the lower end of the humerus to the lower end of the radius. Flexors. — The radial and ulnar flexors (of the wrist) come from the inner part of the arm hone and are inserted into the hand bones. Beneath these muscles lies the flexor sublimus digitorum which divides into four tendons or leaders, one for each finger. These leaders are split so as to give passage to the leaders of the flexor profundus digitorum which are inserted into the ends of the fingers. The thumb is moved by special muscles. Eadial Extensors. — The muscles on the back of the forearm are the longer and shorter radial extensors (of the wrist), which lie behind the long supinator and whose tendons are inserted respectively into the metacarpal bones of the first and second fingers. The ulnar extensor of the wrist lies on the idnar side of the forearm, and is inserted into the metacarpal bone of the little finger. Between these muscles, in the middle of the forearm (Fig. 39), is the common extensor of the fingers which is inserted by four tendons into the backs of the last two bones of the fingers. The index and little fingers have special extensors. The hand is supplied by a number of short muscles, which give it marvelous dexterity. MUSCLES OF THE LOWER EXTREMITY. The muscles of the lower extremity consist of those of the hip, thigh, leg and foot. The psoas magnus and the iliacus, the former from the lumbar vertebra, the latter from the inside of the ilium, are inserted together into the upper part of the femur. They flex the thigh and roll it outward. The buttocks are composed of the three glutei muscles. They arise from the pelvic bones and are inserted into the upper part of the femur. They extend the hips, raise the body from the stooping posture, and hold the trunk on the thigh bones. Partly beneath them lies a group of muscles (Fig. 41), the rotators of the hip; they are the pyriformis, gemelli, the internal and external obturators, and the quadratus femoris. Thigh Muscles. — The rectus femoris with the vastus externus and internus form tlie mass of muscle on the front of the thigh. The rectus arises from the ilium, the vastus' from the femur ; they join to form a com- mon tendon which is attached to the upper end of the tibia. They extend the leg, flex the thigh, and raise the body from the sitting to the stand- ing posture. ^ The Tailor's Muscle — The sartorius, the longest muscle in the body, nms from the ilium downward and inwird across tie thigh to the inner 96 ANATOMY AND PHYSIOLOGY. side of tbe sLiii bone below tbo knee. It flexes the tbigli and crosses the legs. The biceps femoris arises from the ischium and is inserted into the ^ head of the fibula (Fig. 40). The semimembranosus and the semiteudi- nosus take origin from the ischium and are inserted into the inner part of Figure 40. — NERVES OF THIGH. 1, sympathetic ganglia; 2. third lumbar; 3. branches to illacus; 4, fourth lumbar; 6, anterior crural; 6, lurabo-sacral; 7. branch to the psoas; 8, obturator; 9. external cutaneous; 10. nerve to pectineus; 11. branch anterior crural; 12, superficial division of obturator; 13. sartorius muscles; 14. adductor longus; 15. branch to rectus; 16. deep division of obturator; 17. branches to vastus externus and crureus; 18. ad- ductor brevls; 19. branch to vastus Internus; 20, adductor magnus; 21. vastus externus; 22, Internal saphena; 23, rectus femoris; 24, patellar branch of saphena; 25, vastus Internum; 26. gracilla. the head of the tibia. They extend the hips, flex the knee, and raise the body from the stooping position. MUSCLES OF THE CALF. 07 Muscles of the Calf. — The calf of the leg is made of the solciis arising from tlie upper back part of the bones of the leg, and the gastrocnemius, arising from the lower end of the femur ; they unite in a common tendon of great size, tendo-achillis, which is attached to the back of the hsel bone. They extend the foot and raise the weight of the body in walking and running. Beneath tliem lie the popliteus and the flexors of the toes cor- responding to the flexors of the fingers in the forearm. The extensor FigTiro 4 Figure 41. — MUSCLES BACK OF THIGH. 1, fifth lumbar vertebra; 2, ilio-lumbar liga- ments; 3, crest of ilium; 4, anterior superior spinous process; 5, origin of fascia femoris; 6, gluteus medino: 7, its lower and anterior portion; 8, pyriformis; 9, gemini; 10, trochanter major; 11, insertion gluteus medius: 12. quadratus femoris; 13, adductor magnus; 14. inser- tion gluteus maximus; 15, vastus extensus; It:, long head biceps; 17, semimembranous; 18, semitendinosus; 19, tuber jschii; 20, obturator internus; 21, point of coccyx; 22, posterior coccygeal ligament; 23, 24, great sacro-sciatic ligament; 25, posterior superior spinous pro- cess; 26, posterior sacro-iliac ligaments. Figure 42. — MUSCLES FRONT OF LEG. 1, tendon of quadriceps; 2, spine tibia; 3, tibialis anticus; 4, extensor communis digitorum; 5, extensor proprius poIHcis; 6, peroneus tertius; 7, peroneus longus; 8, peroneus brevis; 9, soleus; 10, gastrccnemius; 11, extensor brevia digitorum. longus digitorum is attached to the leg bones and to the second and third phalanges (Fig. -12) of the four lesser toes by four tendons. The great 98 ANATOMY AST) rilTSIOI.OGY. too lias t\ro special flexors .iiid a special extensor and tlio little toe a special flexor. On the back of the foot is one miiscle only, the extensor brevis digi- torum, wliich assists the long extensor of the toes. Sole of the Foot — The sole of the foot, like the palm of the hand, is covered by a dense fibrous sheath, the plantar fascia, running from the heel bone to the metatarsal bones in front; it sustains the arch of the foot, and protects the vessels and nerves beneath. Immediately beneath it lies the flexor brevis digitorum, arising from the heel bone and being inserted into the sides of the second bones of the lesser toes by four ten- dons which are perforated by the long flexor tendons; and just below this is the flexor accessorius, which is attached to and aids the tendon of the long flexor. There arc numerous other small muscles in the foot which give it complicated movements. THE DIGESTIVE APPAHATTTS. What it Consists of. — The digestive apparatus consists of the ali- mentary or food canal (Fig. 72) which extends from the mouth to the anus and is between twenty and thirty feet in length, and of the various glands which open into it. The alimentary canal is divided into the mouth, pharynx, OGS023hagus, stomach, small intestine and large intestine. Its function is to digest or convert the food into an assimilable form. The Mouth — The mouth is an oval cavity containing the tongue and teeth. In it the food is ground up and mixed with saliva (Fig. 68), which yisure «8. — SALrV'ART GLANDS. duct; 5. BubllDgual. Figure 1, carotid; S, Steno's duct; 3, submailUaqr; 4, Itl ttHE STOMACff. 99 not only moistcTig it so tliat it may be readily s-n'anoT7C(l bnt acts on the Btarchy foods, changing them to sugar. The teeth are described iu the chapter on teeth. The saliva is secreted by the parotid glad below and in front of the ear, and by the submaxillary and sublingual glands, which lie in the floor of the mouth. The Tongue. — The tongue (Fig. G9) is a muscle covered by mucous membrane, containing many mucous glands and little projections called papillffi in which are lodged the ends of the taste nerves. The tongue is the organ of taste, assists in articulation, and aids in mixing the saliva -with food and keeping the food between the teeth. The Pharynx. — The pharynx is really the upper part of the cesophagus, expanded into a muscular bag. It hangs from the skull above, is four and a half inches long, and communicates with the nose, ear, mouth, cesophagus and larynx. The Gullet — The cesophagus or gullet is nine inches long, of same con- struction as the pharynx, and empties into the stomach. After the food is chewed it is forced into the pharynx which contracts and pushes it down into the oesophagus, which propels it onward to the stomach. During swal- lowing the opening into the larynx is closed by a little trap door called the epiglottis. The Stomach — The stomacH (Fig. 70) is roughly pear-shaped; the big end, lying on the left side, measures twelve inches' transversely and four inches vertically, is situated just below the diaphragm, receives the oesophagus In its upper left wall (cardiac opening), and empties into the email intestine at the extreme right (pylorus) , the opening being guarded by. a circular valve reinforced by muscular fibres. The Stomach "Walls — The stomach wall is made bf four layers: ex- ternally the peritoneimi prevents friction; next is the muscular coat which churns the food, then the cellular coat which carries the blood-vessels, Figur.: 63. THE TONGUE. 100 ANATOMY AND TUYSIOLOOY. and internally is tlic mucous membrane (tripe of cow) containing thou- sands of little glands (Pig. 71), the peptic or gastric glands, which secrete the gastric jiiicc. "When food reaches the stomach, the cardiac ori- fice and pylorus close, the stomach contracts and mixes it with the gastric juice, which is now freely secreted. The Gastric Juice — Gastric juice is made of water, salts, hydrochloric acid and pepsin. It changes albumen to peptone, which is readily ob- Flgure 70. I-'iyure 71. Figure 70. — STOMACH. Figure 71. — STOIIACH TUBULE. fundus; c, orifice; m, muscular coat. sorbed, dissolves the cellulose of vegetable and the fibrous tissue of meats. Water and some of the peptones are absorbed by the stomach. The re- maining piirtion of the food, now a liquid, passes on into the intestines. Small Intestine. — The small intestine is about twenty feet in length, one inch iu diameter, and extends from the stomach to the cecum, into which it empties. It is connected to the spine by a fold of peritoneum, the mensentery, and is contained in the lower and central portion of the abdomen. It is divided, beginning above, into the duodenum, jejunum and ileum. Duodenum — Into the duodenum empty the ducts of the liver and panci'cas. The small intestine has four coats similar to those of the stomach. In the small intestine the albumens are changed to peptones, fat emulsified, and starches converted into sugars by the action of the bile from the liver, the pancreatic juice and the intestinal juices. The pep- tones, fat and sugar are absorbed by the intestinal walls and the remain- ing portion of the food passes into the large intestine, which also absorbs to a slight extent the nutritions portions of its contents, which are now sensusated and are called feces. THE LARGE INTESTINE. 101 Large Intestine. — The large intestine is five feet in length, runs from an enlarged pouch, the cecum, into which the small intestine empties, to the anus. It is about three times as large in calibre as the small intestine. The cecum is situated in the right lower corner of the abdomen, ending Figure 72. — ALIMENTARY CANAL. 1, 3. lips; 2. 4, frccnum; 5. cheek; 6. Steno's duct; 7, roof of mouth; 8, half arches; 9, tonsils; 10, velum; ]1, tongue: 12, papiliee; 13, trachea; 14, fesophagus; 15, its interior; 16, stomach; 17, its greater end; 18, its lesser end; 19, lesser curvature; 20, greater curvature; 21, cardiac orifice; 22, pylorus; 23, 24, 25, duodenum: 2C, valvulae conniventes; 27, gall bladder; 28, cystic duct; 29, 30, hepatic duct; 21, comnton bile duct; 32, its opening; 33, 35, jejunum; 34, opening of pancreatic duct; 3G, 38, ileum; 37, V. conniventes; 39, i!eo-cecal valve; 40, 41, cecum; 42, appendix vermiformis; 43-48, colon; 49, 50, rectum;" 51, levator ani; 52, anus. below in the vermiform ajtpendix, which varies from throe to six inches in length and is about one-quartiu- inch in diameter. In the cecum the large intestine ascends to the liver (ascending colon), passes over to the 102 ANATOMY AND PHTSIOI.OQT. spleen on the left side (transverse colon), descends on the left side (de- scending colon) to the pelvis, wiiere it curls like an S (sigmoid flexure) and then ends in the rectum -which reaches the surface of the body as the anus. As the feces accumulate in the large intestine they are forced downward to the sigmoid flexure and rectum, where they remain until ex- pelled from the body. The Sweetbread — The pancreas (sweetbread) is a long, narrow gland about seven inches in length lying behind the stomach. Its duct opens in common with the bile duct, into tlu; duodenum. The Liver — The liver (Fig. 74), the largest gland in the body, weighs about four pounds, and is situated in the ' upper right comer of the abdomen, where it is retained by the peritoneum which, after forming its outer coat, runs to the abdominal walls as ligaments. It is divided into five lobes, which are made up of lobules, each about one- twentieth of an inch in diameter, be- tween which the vessels and ducts ramify. The bile duct has appended to Figure 75. Figure 74. — LIVER. R, right lobe; L, left lobe; Q, quadrate lobe; S, lobuB Splgelll; C, lobus candatus; 1. umbilical vein; 2, gall bladder; 3, hepatic artery; 4. hepatic duct: B, portal vein; 6, reflexion of peritoneum; 7, vena cava; 8, ductus venosus; 9, common bile duct. Figure 75. — PERITONEUM. I), diaphragm; L, liver; S, stomach; C, transverse colon; D, transverse duodenum; P, pancreas; I, small intestine; R, rectum; B, bladder. it a pear-shaped bag, the gall bladder, which, lying on the under surface of the liver, acts as a reservoir for the bile during the intervals of diges- tion. The bile duct unites with the pancreatic duct and empties into the THE LIVEK AND PEItlTONEUM. 103 duodenum. The liver secretes bile, stores up sugar from the blood, helps make blood, destroys poison in the blood and excretes urea and allied products. Peritoneum. — The peritoneum (Fig. 75) covers all the abdominal organs ; it is a serous sac containing a small quantity of fluid which pre- Flgure 73. Figure 73. — LYMPHATICS, a, receptaculum chyll; e, thoracic duct; v. Innomonate vein. vents friction between the organs it covers. The omentum is a double fold of peritoneum, which falls from the front of the stomach nearly to the bladder, then ascends to the transverse colon. 104 ANATOMY AND I' II YSIOl.OOY. Absorption. — Absorption nu-aiis tlic passage of materials from mucous surfaces, serous cavities or tissues into tlie lyinph or blood-vessels. The Lacteals. — Tlie digested fat in the intestines is absorbed by lympli vessels, called lacteals, because their contents resemble milk. These lacteals converge from various parts of the intestine to form the thoracic duct which passes up and empties into a large vein in the neck. The di- lated lower end of the thoracic duct is called the receptaculum chyli. The lymph from the tissue all over the body is collected into the lymphatic Figure 56. Figure B6. — LYMPHATICS. 1, saphenous vein-, 2, external Iliac; 3.' common lilac; 4, aorta; 5, ascending vena cava; 6, 7, lympliatics; 8, lower set of Inguinal glands; 9. su- perior set of inguinal glands; 10, chain of lymphatics; 11, lymphatics with circumflex iliac vessels; 12, lumbar and aortic lymphatics; 13, origin thoracic duct; 14, thoracic duct. vessels (Fig. 56) which, finally by two big trunks, the thoracic duct and the right thoracic duct, into the veins of the neck. On its way to the blood the lymjili passes through the lymph glands which frequently swell when any poison passes through tlieni, the kernels felt in the neck during an attach of tonsilitis, for example. BLOOD— CIKCULATORY SYSTEM. Composition of Blood. — Tlie blood is made from the food we eat, and it in turn feeds all the tissues of the body and drains away all their waste THE HEART. 105 products. It consists of liquor sanguinis (liquid of blood) and corpuscles (little bodies), tbe former containing water, proteids, salts, nutritive and cxcrementitious matter. The corpuscles (Fig. 54) are red, which are ■j^^ of an inch in diameter, circular and biconcave, or white, which exist in the proportion of one to three of four hundred reds, are ^jVir inch in diameter and possess amoeboid motion. When blood is exf)osed to air it clots, a stringy material proteid in nature, ^ / fibrin, which exists in solution in the liquor ^ sanguinis, entangles the corpuscles, form- ing a semisolid mass. ® ® Function of Corpuscles Blood corpus- rignrow.-BLOoD corpuscles. cleS carry oxygon from the lungs to the tissues and the liquor sanguinis carries food ; the blood drains carbon dioxide and other waste pi-oducts from the tissues to the excretory organs: skin, kidney, liver and limgs. Circulatory Apparatus. — The blood is carried to and from the tissues by the circulatory apparatus, which consists of the heart, arteries, capil- laries and veins. The heart pumps the blood through the arteries to the thin-walled capillaries where the food passes out to the tissues and waste is given to the blood ; from the capillaries the blood drains into the veins which run to the heart. The heart then sends the blood to the lungs to be purified, to the intestines for food and again, pumps it out to the tissues. The Heart — The heart is a hollow muscular organ of conical form, placed in the chest between the lungs and inclosed in a serous sac, the pericardium. It is placed obliquely; the base, to which is attached the great vessels, is directed upward and backward; the apex is directed downward and to the left, and corresponds to the interval between the fifth and sixth ribs, one inch to the inner side and two inches below the nipple. In a grown person (Fig. 61) the heart is about five inches in length, three and a half inches in breadth at its broadest part and two and a half inches thick. In the male it weighs from ten to twelve ounces and in the female about two ounces less. Heart Divisions. — The heart is divided longitudinally by a muscular partition into two halves and a transverse partition divides these halves into two cavities. The lower cavities are called ventricles and the upper ones auricles. The walls of the auricles are thinner than those of the ventricles and the walls of the right side of the heart are thinner than those of the left. •106 anato:my axi> niYsior.onY. Eight Auricle — The riglit auricle receives tlie blood from the two main veins of the body — the two vena cava. Prom the auricle the blood is forced into the right ventricle through the auriculo-ventricular orifice. This opening is guarded bv the tricuspid valve, to prevent the reilux of blood into the auricle when the ventricle contracts. This valve is corn- Figure 51. Figure 51. — HEART AND LUXGS. 1. left auricle; 2, right auricle; 3. left ventricle; 4. right ventricle; 5, pulmonary artery; 6, arch of aorta; 7. superior vena cava; 8, Innominate artery; 9. common carotid; 10, subclavian; 11. trachea; 12, larynx; 13, upper lobe right lung; 14, upper lobe left lung; 15, right pulmonary artery; 16, lower lobes of lungs. posed of three segments, to the free margin of which are attached ten- dinous cords, which, springing from the muscular ridges projecting from the inner surface of the ventricle, the columnte carnese, give support to the valves. Hight Ventricle. — The walls of the right ventricle (Fig. 52) are about one-third as thick as those of the left ventricle. Beside the opening into the auricle there is the opening into the pulmonary artery which is guarded by the semihmar valves, three semicircular folds of the lining membrane of the heart. Course of the Blood. — The blood is forced from the right ventricle through the pulmonary artery to tlie lungs, tlie .semilunar valves closing after each contraction of the ventricle so preventing any backward flow. THE HEART. 107 Xeft Auricle — The left auricle is smaller than the right but thicker; it receives the blood wliich returns from the lungs by the pulmonary veins and forces it into the left ventricle through an opening, guarded by P'igure 5 2. Figure S2. — HEART. 1, superior vena cava: 2. inferior vena cava; 2', hepatic veins; 3, right auricle; 3'. fossa ovalis; 3", aperture coronary vein; _|_, _|_, in auricula-venlricuiar groove; 4. 4, cavity right ventricle; 4'. columna; carnse; 5', 5", tricuspid valve; G, pulmonary ertery; 7, concavity aortic arch; 8, ascending aorta; 9, between innominate and left carotid; 10, auricular appendage; 11, 11, left ventricle. valves, similar to the right auriculo-ventricular orifice, except that the valve, called the mitral valve, has but two segments. Left Ventricle — The left ventricle is the thickest and strongest por- tion of the heart. The blood received by it through the auriculo-ven- tricular orifice is discharged into the main artery of the body, the aorta, througli an opening which is guarded by semilunar valves (Fig. 53) as in the case of the pulmonary artery. The cavities of the heart are lined by a delicate endothelium, which is continuous with that of the blood- vessels. 108 ANATOMY AND niTSIOLOOT. Pulsation — The heart pulsates from seventj-five to eighty times per miinitn iu the adult; in childhood it is more rapid. The strenjjth and rapidity arc governed bj the nerves v\-hich supjtly the heart with force. Heart Sound. — Upon listening to the heart two sounds are heard. The first sound, dull and heavy, is caused by the contraction of the heart, the shutting of the auriculo-ventricular valves and the rush of blood. The second sound, sharp in character, is due to the snapping shut of the semilunar valves. ^'^""' ".-sKii.i.uxAK valves. ARTERIES. rnnction of Arteries. — The arteries carry the blood from the heart to all parts of the body. It has three coats, an outer areolar elastic coat, a middle muscular coat and an inner endothelial coat. The Aorta — The main artery of the body is called the aorta (Fig. 43). It springs from the left ventricle, runs up toward the neck, then turns and descends along the spine and divides in the lower abdomen into the two common iliac arteries. Coronary Arteries. — Just after leaving the heart it sends the two coronary arteries to the heart muscle. Then as it arches through the chest it gives off on the right side the innominate artery and on the left Bide the left common carotid and the left subclavian arteries. The In- nominate divides into the right common carotid and subclavian arteries. Cardiacs — The carotids (Fig. 44) run up the neck to the top of the larynx where they divide into the external carotid ■which supplies the out- side of the head and the internal carotid which supplies the brain, ear and eye. Subclavian — Tlie subclavian (Fig. 45) supplies the chest, neck and upper extremity; when It reaches the armpit it is called the axillary artery and in the arm It is called the brachial. This trunk, called subclavian axil- lary and brachial, according to its situation, gives off numerous branches to the various structures of the shoulder and arm. At the elbow it divides into the radial and ulnar branches. The brachial lies on the inner, pro- tected side of the arm just beneath the biceps muscle. It is important to know its location when making pressure to stop hemorrhage lower down the arm. THE ^VKTEKIES. 109 Radial Artery. — The radial artery (Fig. 46) from the bend of the elbow down the radial side of the arm to the wrist, where it is frequently Figure 43. Figure 43. — ARTER1E.S OF HEAD. 1. common carotid; 2. Internal carotid; 3. external carotid: 4. occipital; 5, superior thyroid; 6, trapezius; 7. ]'n\gua.l; 8, sterno-mastoid; 9. facial; 10, temporal; 11. submental; 12, transverse facial; 13, inferior labial; 15, inferior coronary; 17, superior coronary; 19, lateral nasal; 21, angular. felt to determine the character of tHe pulse; it then winds around the base of the thumb, enters the palm between the thumb and metacarpal bone of the index finger and forms an arch (deep palmar arch), which sends branch to the thumb, index finger and palm. Ulnar Artery — The ulnar artery, larger than the radial, passes down the inner side of the forearm, giving off branches to the muscles. In the palm it also describes an arch (superficial palmar arch) which sends branches to the fingers. Thoracic Aorta. — The portion of the aorta in the thorax is called tho thoracic aorta, that in the abdomen tlie abdominal aorta. The thoracio 110 ANATOMY AND PHYSIOLOGY. aorta supples the pericardium, lungs, oesophagus and intereostal strnetures with nourishment. Abdominal Aorta — The abdominal aorta (Fig. 47) supplies the diajihragiu, stomach, liver, spleen, intestines, kidneys, ovary or testicle and muscles of the abdominal wall by branches whose names correspond to the organ it supplies. Common Iliacs. — Opposite the fourth lumbar vertebrre the aorta divides into the two common iliacs, short trunks which again divide into the internal and external iliac arteries, giving off no branches. Figure 44. Figure 44. — ARTERIES OF NECK. 1, occipital artery; 2, facial vein; 3, spinal acces- sory nerve; 4. facial artery; 5, internal jugular vein; 6, hypoglossal nerve; 7, communicans noni nerve; 8, lingual artery; 9, pneumogastric; 10. superior laryngeal nerve; 11, pliren-o; 12, superior thyroid artery; 13, sterno-mastoid; 14. common carotid; 15, clavicle; 16, sterno- hyoid; 17, subclavian; 18, orao-byoid; 19, subclavian; 20, sympathetic ganglia; 21, apex lung. The internal iliac dips into the pelvic cavity and divides into two trunks; the anterior gives off branches to the bladder, rectum, anus, genital organs, buttocks and upper part of the thigh; the posterior trunk sends branches to the buttocks, saciiim and muscles in the pelvis. THE AKTEKIES. Ill External Hiac. — The external iliac (Fig. 48) rims across the pelvis and escaping below Poupart's ligament is continued down the thigh as Figure 4 Fieure 45. — ARTERIES OF ARM. 1. axillary artery; 2. thoracica acromialls; 3, su- perior thoracic; 4, subscapular; 5, inferior scapular; 6. 7, branches to the teres and sub- scapularis; 8, anterior circumflex; 9, brachial; 10, profunda; 11. posterior circumflex; 12, profunda; 13. muscular branches; 14, branches to brachialis internus; 15, recurrent ulnar. Figure 46. — DEEP DISSECTION FRONT OF FOREARM. 1. supinator longus; 2, ulnar nerve; 3, brachialis anticus; 4, biceps; 5, musculo-spiral; G, median nerve; 7, posterior inter- osseous nerve; 8, pronator teres and flexor carpi radialis; 9, extensor carpi radialis longior; 10, brachial artery; 11, supinator brevis; 12. flexor sublimus digitorum; 13, 13. radial nerve; 14, flexor carpi ulnarls; 15, extensor carpi radialis brevier; 16, ulnar artery; 17, radial origin of flexor sublimus digltorum; 18, flexor profundus digltorum; 19, pronator teres; 20, dorsal branch ulnar nerve; 21, radial artery; 22, deep branch ulnar nerve; 23. flexor longus polUcls; 24, abductor minimi dlglti; 25, anterior interosseous nerve; 2fi, digital branches of ulnar nerve; S7. supinator longus; 28. one of lumbrlcalcs; 29, pronator quadratus; 31, flexor carpi radialis; 33, digital branches m-rlian nerve; 3 5, abductor poIUcia. 112 ANATOMY AN1> PIIYSIOLOOY. the femoral artery. It gives off two largo branches to the muscles of the belly. Femoral Artery. — The femoral artery runs a straight course clown tho thigh from the middle of the groin to the lower third of the fem.ur, where kmw Figure 47. Figure 48. Figure 47. — ARTKRIES OF THIGH. 1. aorta; 2, common iliac; 3, external Iliac; 4, epigastric; 5. circumflex iliac; 6, interna! iliac; 7, ilio-lumbar; 8, gluteal; 9, obturator; 10, lateral sacral ; 11, vesical arteries; 12, middle hemorrhoidal ; 13, Internal pudic; 14, ischiatlc; 15, femoral ; 16, foramen for femoral ; 17, profunda; IS, internal circumflex. Figure 4S. — ARTERIES OF LEG. 1, extensor proprius pollicis; 2, articular arteries; 3, anterior tibia; 4, 5, same artery; 6, recurrent branch; 7, 8, muscular branches; 9, dorsalia pedis; 10, external malleolar artery. it passes throngli an opening in the muscles and becomes the popliteal. After giving off several small vessels to the muscles of the tliigh it sends out a larc'c Irunk, the profunda, which gives off two, the circumflex and three perforating branches, which supply the muscles. THE VEINS. 113 Popliteal Artery — The popliteal is the continuation of the femoral running in the hollow behind the knee joint, dividing just below the knee joint into the anterior and posterior tibial arteries. Anterior Tibial — The anterior tibial passes forward between the bones of the leg at its upper part, passes down the front of the leg, and on the front of the foot, becomes the dorsalis pedis. Dorsalis Pedis. — The dorsalis pedis runs along the back of the foot and terminates in the artery of the great toe ; it gives off branches to the tarsus and metatarsus, the latter forming an arch and giving branches to the toes. Posterior Tibial.^ — -The posterior tibial descends along the inside of the back of the leg to the hollow behind the inner ankle, where it divides into the two plantar arteries. It gives branches to the muscles of the leg, tibia and ankle. Plantars — The internal and external plantar arteries crossing the foot form an arch, from which branches are given to the toes, in a manner analagous to those in the baud. Pulmonary Artery — From the right ventricle of the heart arises the pulmonary artery, which conveys the impure blood to the lungs to be puriiied. THE VEINS. Vein Function — After the blood flows through the capillaries it is collected by the veins, which are made by small branches joining to form larger branches and these again joining larger trunks, and so on. Vein Structure — The veins have three coats, like the arteries, but are thinner, less elastic, and when empty collapse. They have valves at intervals to prevent the backward flow of blood. Jugular Vein — The small veins of the exterior of the head follow the arteries and have similar names. They empty into the external jugular which runs do-\vn the neck and empties into the subclavian vein. Internal Jugular. — The internal jugular receives the veins from the interior of the cranium, passes down the neck with the carotid artery and imitcs with the subclavian vein to form the innominate vein. Innominate Veins — The two innominate veins are in the chest and join to become the superior vena cava. Veins of Upper Extremity. — The veins of the upper extremity (Fig. 49) besides those accompanying are a radial, an anterior and posterior idnar and a median vein. They collect the blood from the hand and fore- arm, and just above the bend of the elbow the ulnar veins unite to form joint into the anterior and posterior tibial arteries. 8 114 ANATOMY AND I'liySIOLOGT. the basilic vein, wliich passes up the inner side o£ the arm and empties into tlie axillary vein. Eadial Vein. — The radial vein forms the cei)halic, which passes up the Figure 49. risure 50. Fleure 43. — VEIN'S OF UPPER EXTREMITY. 1, axillary artery; 2. axillary vclna; 3. 4, basilic: 5, point where median basilic joins basilic; 6, posterior basilic vein; 8, anterior basilic vein; U, point where cephalic enters axillary; 10, portion same vein; 11, point where median cephalic enters cephalic; 12, lower portion cephalic vein; 13, median cephalic vein; 14, median vein; 10, anastomosing branch; 16, cephalica-poliicis veins; 17, veins of fingers; 15, lialmar vein.s. Flf,'ure GO. — VEINS OF LEG. 1, saphenous; 2, collateral branch; 3, anastomosis; 4, Internal saphenous; 5, origin of saphenous; 6, anastomosing branch; 7, branches on back leg; 8, internal vein of foot; 1), arch veins on metatarsal bones; 10, branch from heel; 11, branches on sole of foot. outside of the arm and winding around the shoulder-joint empties Into the axillary vein. Median Vein — Below the bend of the elbow the median and a branch from the deep veins empty into a large V-shaped vein; running from its BREATHING ORGANS. llg apex into which these veins empty it unites together the basilic and cephalic veins, one arm being called the median basilic and the other the median cephalic. Axillary Vein. — The axillary vein, in the armpit, runs up to form the subclavian which joins the internal jugular to form the innominate. The internal saphenous vein (Kg. 50) commences on the back of the foot, and running straight up the. inner side of the leg and thigh joins the femoral vein just below Poupart's ligament. Saphenous Vein. — The external or short sai^henous vein begins at the outer side of the foot, runs up the middle of the calf of the leg and empties into the popliteal vein. The deep veins follow the arteries and have similar names. Femoral Vein — The femoral vein receives all the veinous blood from the leg, runs with the femoral artery into the abdomen, becomes the external iiiac which joins with the internal iliac to form the common iliac. The two common iliacs join to form the inferior vena cava which runs up the spine and empties into the right auricle, receiving in its course the various abdominal veins. Portal Vein — The veins from the stomach, spleen and intestines are collected into a short trunk, the portal vein, which enters the liver. The blood from the liver is collected by the hepatic vein, which empties into the inferior vena cava. Pulmonary Veins — The four pulmonary veins start as capillaries in the walls of the air cells of the lungs, carry pure blood and empty into the right auricle. EESPIRATORY APPARATUS. In order to reach the lungs air passes through the nose, pharynx, larynx and trachea, which warm it and filter it of impurities. The Larynx. — The larynx (Adam's apple) is the organ (Fig. 55) of voice, and will be described in connection with disease of the throat. Windpipe. — The trachea (windpii^e) is made of rings of cartilage, joined by connective tissue. It is five inches long and lies just beneath the skin of the neck until it enters the chest, where it divides into the two bronchial tubes, one going to each lung. These divide and subdivide into numerous branches. The Lungs — -The lungs are conical, slate colored in adult life aud are separated in the middle of the thorax by the heart, gullet and great blood-vessels. The outer surface of the lungs is convex and smooth, the iiiner surface concave. Above it extends into the neck, below it rests 116 ANATOMY AND PIITSIOT.OGT. upon the diaphragm. The riglit Inng is the larger and is divided int/> three lobes, the left into two. Lung Lobes. — Eacli lobe is made of little lobules which consist of a little ramification of a bronchial tube communicating with air cells. Lunj Membrane. — The surface of the lung is covered by a smooth serous uieuibrane, the pleura, which is reflected upon the walls of the Figure 65. — TRANSVERSE SECTION THORAX. 1, anterior mediastinum; 2. internal mammary vessels; 3, triangularis sterni; 4. B, phrenic nerves; 6. thoracic duct; 7, cesophagus; 8, vena azygos major; 9, thoracic aorta; 10. sympathetic; R. V., right ventricle; R. A., right auricle; P. A., pulmonary artery; A., aorta; C, superior vena cava; V., dorsal vertebra. chest ; the intervening space contains a small quantity of fluid which pre- vents friction during the respiratory movements. Breathing. — When the chest is enlarged by elevation of the ribs and descent of the diaphragm the lungs follow the chest wall and expand, air rusliing into them. "When The muscles relax the elastic and over-distended lungs discharge the air through the windpipe. Air Vesicles. — In the air vesicles the blood is separated from the air bv a very thin partition through which oxygen passes to the blood cor- puscles. The expired air contains the carbon dioxide and other imjjur- ities with wliieh it has been charged while in the air vesicles. Oxygenized Bload. — The blood, after passing through the lungs, is a brighter red, riclier in oxygen, cooler and is rid of its impurities. NERVOUS SYSTEM. Function of Nerves. — The nervous system presides over all functions and harmonizes them. It permits the environs to be recognizable. It NERVOUS SYSTEM. 117 may be compared to a tcIegTapli system, of which the brain is the central station, to a rider on a hors(\, or to the captain of a stcamsliiji. It is divided into the cerebro-spinal system (brain and spinal cord with their nerves which presides over the animal functions, motion, sensation, etc., and the sympathetic system which controls the organic functions, nutri- tion, growth, etc.). The sympathetic system is composed of a series of ganglia (large mass nerve cells) in the head and along the front of the gpine, connected by nei-vous cords. The Brain. — The brain is a huge mass of white and gray nervous matter combined in and protected by the cranium. It is surrounded by Figure CI. Pi?:nre 61. — BAPR OF BRATN. 1. 2. lonf^itudinal fissure; 3. anterior lobes cerebrum; 4. middle lobe; 5, fisfcure Sylvius; C, posterior lobe; 7, infundibulum : 8, its body; 9, corporo albicHntia; 10, cinetitious matter; 11. crura cerebri; 12. pons Varolii; 13, medulla oblongata; 14, posterior prolongation of pons; 15, middle of cerebellum; 16, anterior part of cerebellum; 17, its posterior part and fissure; 18, medulla spinalis; 19, middle fissure medulla; 20, pyra- midal body; 21, reliform body; 22, olivary body; 23, olfactory nerve; 24, its bulb; 25, its external root; 26, middle root; 27, internal root; 2S, 29, optic nerve; 30. third nerve; 31, fourth nerve; 32. fifth nerve; 33, sixth nerve; 34, facial nerve; 3b, auditory nerve; 3C, 37, 38, eighth nerve. three membranes Cmeninges) : the dura mater, externally, dipping into the fissures to form the falx cerebri, tentorium, cerebelli and falx cero- belli which separate and support portions of the brain; the arachnoid, 118 ANATOMY AND PIlYSIOT.OaT. the serous membrane, supplying a fluid whicli acts as a water cushion for the brain ; and tlie pia mater, the layer carrying the blood-vessels. Weight of Brain. — The average weight of the brain is fifty ounces in males, and six ounces less in females. Divisions of Brain. — The brain is divided into the cerebrum, cere- bellum, pons varolii and medulla oblongata. The Cerebrum. — The cerebrimi is the largest part of the brain, resting on the roof of the orbit, base of skull, and tentorium cerebelli. It is Figure e2. Figure 62. — NERVES OF FACE AND SCALP. 1, attrahens aurem; 2, anterior belly occlpito-frontalis; 3, auriculo-lemporal nerve: 4. temporal branches of facial nerve; 5, attolena aurem: 6, supra-trochlear: 7, posterior belly occlpito-frontalis; 8. supra-orbital; 9, retrahena aurem; 10, temporal branch of orbital nerve; 11, small occipital nerve; 12, malar branches •it facial nerve; 13. posterior auricular nerve; 14, malar branch of orbital; 15, great occipital; 16, infra-orbital branches: 17, facial nerve; 18, nasal nerve; 19, cervico-facial division of facial; 20, infra-orbital nerve: 21, branches to digastric and stylo-hyoid; 22, temporo-facial division of facial: 23, great auricular; 24. buccal branches of facial; 25, trapezius; 26, buc- cinator nerve; 27, splenius capitis: 28, masseter; 29, sterno-mastoid; 30, supra-maxillary branches of facial nerve; 31. superficial cervical nerve; 32, mental nerve; 33, platysma; 34, Infra-maxillary branches of facial nerve. divided into lateral halves by the falx cerebri. The halves are joined by the corpus callosnm. Internally it is composed of white, and externally of gray, nervoiis tissue. The gray tissue is wrinkled into convolution and is the active portion of the brain, the white matter conducting the nerve impulses to and from it. It is the seat of memory, intelligence, reason, ■will, motion and sensation. NEEVOrS SYSTEM. 119 The Cerebellum — The cerebellum lies beneath the posterior portion of the cerebrum, is gray outside and white inside. It coordinates mus- cular movements. The pons varolii connects the various parts of the brain. It conducts impulses to and from the brain. Medulla Oblongata — The medulla oblongata is the enlarged upper end of the spinal cord resting in the cranium. It is made of blended white and gray tissue, conducts the nei-ves from the brain to the spinal cord and contains independent nervous centres which regulate the heart, lungs, blood-vessels, sweating, etc. Nerves of Brain — The brain gives off twelve nerves on each side. The nerves pass out through holes (foramen) in the skull and supply the organs of sight, smell, taste and hearing, and also motion and sensation to certain parts. They are: the olfactory (smell), optic (sight), motor oculi (motion to eye), patheticus (motion to superior oblique muscle of eye), Figure 63. Figure 63. — FIFTH NERVE. 1. orbit; 2, antrum of Hlghmore; 3, tongue; 4, lower jaw; 6, Gasserian ganglion; 6, first branch of fifth; 7, seconrl; 8. third; 9, frontal branch; 10, lac- rymal branch; 11, nasal branch; 12, internal nasal nerve; 13, external nasal; 14, external and internal frontal nerve; 15, infra-orbital; 16. posterior dental branches; 17. middle dental; 18, anterior dental; 19, terminating branches infra-orbital nerve; 20, orbital branch; 21, ptyregoid nerve; 22, five anterior branches; 2.1, lingual branch; 24, inferior dental; 2.'», mental branches; 26, superficial temporal nerve; 27, auricular branches; 28, mylo-hyoid. trifacial (sensation to face, motion to cliowing muscles and nerve of taste), abduces (rolls eye out), facial (motion to face), auditory (hearing), glosso-pharyngeal (taste and sensation), pneumogastric (presides over 120 ANATOMY ANU PHYSIOLOGY. swallownng, heart, lungs, otc-.), s])inal accessory (motion to nmscles. neck and liack and the hypoglossal (motion to tongue). Spinal Cord.— ihe spinal cord is a long tail hanging from, the back Figure 64. Figure 64. — NINTH, TENTH AND ELEVENTH NERVE. CORD. 121 of the brain and contained in the spinal canal. It is sixteen to eighteen inches long and surrounded by three nienibranes like the brain. Upper Section. — Upon section the cord (Fig. 59) is seen to be composed externally of white nervous tissue, and internally of the gray, which is arranged somewhat in the shape of the letter H. The cord is divided by two antero-posterior fissures into two eqiial lateral halves, which are united in the centre by a bridge of gray matter. The spinal cord is a great nerve cable carrying fibres to and f roiu] the brain ; it also coordinates motion, presides over the nutri- tion of certain parts and contains inde- pendent nervous centre. From the anterior horn of the gray matter arises the motor roots of the spinal nerves and from the posterior horn the sensory roots. Spinal Nerves. — Each spinal nerve, of which there are thirty-one pairs, consists of the anterior or motor and the posterior or sensory root. These unite within the spinal canal and form a single cord (Fig. 05), which passes through the opening between the vertebra; and divides into two trunks, one for the anterior and the other for tlie posterior surface of the body. Cervical Plexus. — The anterior branches of tlie four upper cervical nerves iinitc with each other to form the cervical plexus which gives off branches to the side of the head, neck, shoulders, chest and diaphragm. The Figure 53. Figure CORD. 1 <^ anterior branches of the fifth, sixth and 59. — BRAIN and 1, hemisplieres of cerebrum; 2, great middle fis- sure; S, cerebellum: 4. olfactory nerves; 5, optic nerves; 6, cor- pora albicanlia; 7, motor oculi; 8, pons Varolii; 9, fourth nerve; 10, medulla oblongata: 11, 11, nKiduUa spinalis; 12, 12, spinal nerves; IZ, Cauda equina. seventh cervical nerves unite, the fifth re- ceiving a branch from the fourth ; the eighth cervical and first dorsal nerves unite; these cords form the brachial plexus, and after sending nerve trunks lo the muscles of the neck and sides of the chest below the collar bone, these two trunks each send off a trunk which unite to fonn a third or posterior trunk 122 ANATOMY AND PIIYSIOLOOY. ■which divides into two branches, supplying the muscles and skin of the outside ami l);'ck of the arm, forearm and hand. Inner and Outer Trunks. — The inner and outer trunks are continued down the inside of the arm, and again each sends a branch to form a Figure 60. Figure 60. — VIEWS OF SECTION OF CERVICAL CORD. A, anterior surface: B. right side; C, upper surface; D. nerve roots; 1. anterior median fissure; 2, posterior median Iissure; S. anterior lateral depression; 4, posterior lateral groove; 5, anterior roots; 6, posterior roots; 6', ganglion; 7, spinal nerve; 7', posterior branch. middle cord, the median nerve. The external cord then becomes the rausculn-cntancous, and the internal, the ulnar. Median Nerve — The median nerve (Fig. 66) gives o£F branches to the muscles and to the skin of the hand. The ulnar nerve is placed on the inner side of the arm and supplies the forearm and hand. The musculo- cutaneous supplies tlie skin and muscles of the forearm and wrist. Spinal Nerves. — The twelve dorsal spinal nerves send branches along the ribs and supply the muscles of the back. lumbar Nerves — The five lumbar nerves send posterior branches to the muscles of the back; the anterior branches iinite to form a plexus which sends branches to the muscles of the belly and the genital organs ; the largest branch, the crural nerve, is distributed to the front of the thigh. Sacral Nerves — The fifth lumbar joins the sacral nerves to form the NEEVES OF SPINE AND BACK, 123 sacral plexus ; its largest branch is the great sciatic which passes down the back of the thigh j dividing at the knee into the external and internal Figure 65. Figure 66. Figure 65. — DEEP DISSECTION OP FRONT OF FOREARM. 1. supinator longue; 2. ulnar nerve; 3. brachial is anticus; 4, bleeps; 5, niueculo spiral; 6, median; 7, posterior In- terosseous; 8. pronator teres; 9. extensor carpi radial is longlor; 10, brachial artery ; 11, su- pinator brevls; 12, flexor subllmus digitorum; 13. radial nerve; 14, flexor carpi ulnarls; 15. ex- tensor carpi radialla brevior; 16, ulnar artery; 17, origin flexor subllmus digitorum; 18, flexor profundus digitorum; 19, tendon pronator teres; 20, dorsal branch of ulnar nerve; 21. radial artery; 22, deep branch of ulnar nerve; 23, flexor longus pollicis; 24, adductor minimi dlgltl; 25. anterior interosseous nerve; 26, digital branches of ulnar nerve; 27, tendon of supinator longus; 28, one of the lumbricales muscles; 29, pronator quad rat us; 31, tendon flexor carp Iradialls; 33, digital branches median nerve; 35, abductor pollicis. Figure C6.— NERVES OF THIGH. 1, sympathetic ganglia; 2, third lumbar; 3. branches to Illacus; 4, fourth lumbar; 5, anterior crural; 6. lumbo-sacral ; 7, branch of the psoas; 8, obturator; 9, external cutaneous; 10, nerve to pectlneus; 11, branch anterior crural; 12, su- perficial division of obturator; 13, sartoriua muscle; 14, adductor longus; 15, branch to rectus; 16. deep division of obturator; 17. branches to vastus externua and crureus; 18, adductor brevls; 19, branch to vastus Internus; 20, adductor magnus; 21, vastus exlernus; 22, internal saphena: 23. rectus femorlo; 24, patellar branch of saphena; 25, vastus Internus; 2C,' gracilia. 124 ANATOMY AND IMIYSIOLOGY. popliteal nerves; these are contiuued down the leg as the anterior and posterior tibial ncrvos supplying the leg and foot. Figure (;?. Figure 67a. Figure 67.— BUTTOCK AND BACK OF THIGH. 1. gluteus inaxlmus; 2. gluteus mediua; 8, glutial artery; 4, gluteus minimus; 5. nerve of obturator Internus; 6, pyrlformis; 7, pudic nerve; 8, small sciatic nerve; 9, great sacro-sclalic ligament; 10, obturator internus; 11, Inft-rior gluteal nerve; 12, tendon obturator internus; 13, inferior pudendal nerve; 14, quadratua femoris; 15. gracllia; 16, great sciatic nerve; 17, adductor magnus; 18, insertion gluteus max- inius; 19, origin of semltenilnosus and semimembranosus; 20, short head of biceps; 21, semi- membranosus; 22, tendon of biceps; 23, tendon of semitendinosus; 24, external popliteal nerve; 25, Internal popliteal neive; 26, communicana flbrelaris; 27, popliteal artery; 29, gaatrocnemlua; 31, e.Nternal saphinous nerve. Figure 67a. — FUONT OF LEG. 1, external popliteal nerve; 2, anterior tibial artery; 3, muscuIo-cutancouH nerve; 4, anterior tibial nerve; 5. peroneus longus; 6, tibia! us anticus; 7, extensor longus digitorum; S. anterior annular ligament; 9. pcrnncus brevis; 10. tendon of ex- tensor proprius pollicis; 11, extensor proprius poUicis; 12. dorsal artery of foot; 13, musculo- cutaneous nerve; 14, tendon of llbialns anticus; 15, internal branch of musculo-cutaneous nerve; 16, cutaneous branch of anterior tibial nerve; 17, external branch of musculo-cutaneous nerve; 19, deep branch of anterior tibial nerve; 21, external liaphenous nerve; 23, extensor brcvia digitorum. INDEX TO PART I OF BOOK III Preventive Medicine The Prevention of Disease by Elimination of Disease Carriers Part I of Book III tells of how disease is carried by insects and other seemingly harmless means. Consult the Part, Index and the Reference In- dex, also General Index. SUBJECTS OF THE TEXT Advice of Parents to Children in Sex- ual Matters 143 Bed Bugs 138 Bed Bugs, How to Destroy 138 Body Lice 139 Breeding Places of Flics 132 Breeding Places of Flics, How to De- stroy - 132 Breeding Places of Mosquitoes, How to Destroy 134 Carriers of Disease 130 Children, Advice Necessary in Sexual Matters 143 Cockroaches 137 Cockroaches, How to Destroy 138 Common Carriers of Disease 130 Crab Lice 140 Destruction of Erecding Places of Flies 132 Destruction of Breeding Places of Mosquitoes 134 Destruction of Cockroaches 138 Destruction of Existing Flies 133 Destruction of Existing Mosquitoes. .135 Destruction of Fleas 137 Disease, Elimination of Carriers of.. 127 Disease Prevented by Hcallhy Con- dition 128 Drinking Cup 141 Elimination of Breeding Places of Flics 132 Elimination of Disease Carriers 127 Fleas 136 Fleas, How to Get Rid of 137 Flies, Breeding Places of 132 Flies, Elimination of Breeding Places, 132 Flies, Manner of Getting Rid of 133 Fly, The 132 Germ Laden Milk 130 Gonorrhoea 143 Head Lice 139 Health as Preventive of Disease 128 Health, How to Retain 128 Insects as Carriers of Disease 131 Itch Mite, The 140 Lice 139 Lice, Body 139 Lice, Crab 140 Lice, Head 139 Malaria Carried by Mosquito 133 Milk, Germ-Laden 130 Mosquitoes as Carriers of Malaria, 133 Mosquitoes, How to Destroy 135 Mosquitoes, How to Destroy Breeding Places of 134 Mosquitoes, IIow They Develop 134 Opthalmia 143 Public Drinking Cup 141 Public Towel 142 Sexual Advice to be Given Children, 143 Syphilis 143 Towel, The Public 142 125 Book III. PREVENTIVE MEDICINE. PAKT I. THE PREVENTION OF DISEASE BY ELIMINATION OF DISEASE CAERIERS. Wben speaking of preventive medicine, we include the methods used by physicians, State and Federal Government Boards of Health, etc., to prevent the spread of disease, but most important is the work done by past and present men of science and their willing patients who have given their time, labor, and in many cases, their lives to discover the underlying causes of disease, for the latter, like everything else in this world, has its reasons for existence. Thus it can readily be under- stood that disease cannot be properly prevented when the underlying cause is unkown. Before dissection of the human body and experiments on animals were permitted, man's knowledge of his own body and disease, its causes and symptoms and treatment was mere giiesswork. Thus in past centuries the arteries were thought to contain air instead of blood ; disease was believed to be a curse from heaven or the king and everything lay in the hands of the Gods as to whether a person recovered or not. In the last century, man began to awaken from his sleep and by means of the discovery of the microscope and the permission to experiment upon living animals more and more the cause of disease, its transference from one animal to another and then from animal to man and man to man was tried, and always the same symptoms occurred in the animal or man into which the blood of the animal suffering from the original disease had been placed by injection into their blood, etc. By these methods gradually the cause of disease was found to be due to the presence of minute living bodies called bacilli or germs, etc., which were only visible when the blood, spit, urine, etc., of the sufferer was examined (127) 128 PREVENTION OF DISEASE. under the microscope nnd from tins beginning are due the marvelous results of the present day in the prevention, treatment and cure of disease. Health. — Disease can be prevented by the individual doing everything in his power to keep in the best physical condition. Disease is a common enemy of all of us, waiting to destroy, but Nature is in league with us if we obey her laws. With a normal body and pure blood should the invader arrive, the fight is on our side. But once the body is weakened by heredity as a result o^ :ur parent's or forefather's neglect of the body, through the abuse of alcohol, tobacco or immoral living, lack of exercise, overeating and loss of sleep, overwork or lack of work or improper food, then will the soil be fertile for the planting of the germs of disease. When exposed and once planted the fight will be in their favor, as the rundown body will not have sufficient vitality to overcome the invader and sickness and death result. How Can We Keep Healthy? — The best answer to that question is, to be the child of healthy parents and come from a sturdy stock. To be nursed at the mother's breast and raised out of doors in the sunshine and fresh air, to sleep with plenty of air in the room at night. To have & natural movement of the bowels once a day. And through childhood to receive three meals a day consisting of pure wholesome food, plenty of milk, free from germs, pure water and sleep from ten to twelve hours a night throughout childhood, depending on the age. To play and do work which will be in the air and develop the muscles gradually. Every child should be vaccinated any time after the sixth month and repeat at the seventh year, to be done at once, in addition during an epidemic of small pox. It is not necessary or right for a child to have scarlet fever, measles, diphtheria, etc., as so many people think. They are often followed by deafness, heart disease, Tiervous diseases and paralysis which Nature never meant to inflict a child with to go through life. Children's teeth, eyes and throat should be examined at intervals and many defects corrected. The tonsils and adenoids (growths which stop up the nose and prevent air being breathed properly) should be removed. Enlarged tonsils often cause deafness by preventing air from the throat reaching the ear cavity due to stopping the opening of the Eustachian tube which leads from the throat to the ear. Children should not be taught too many branches at school. Every school should be well lighted with plenty of fresh air. Many of the smaller schools are now being built on open roofs of buildings in large cities or on platforms placed out of doors with just a roof overhead to HOW MAY ADULTS RTSMAIN ITEAI.THY ? 129 protect the children. All schools should be held in the open where possible. There is absolutely no chance of cold if the children are warmly dressed and exj^eriments have i^roven that the children are healthier, more attentive and mentally efficient where they have been in school in the open air. How May Adults Remain Healthy? — In this day and generation the struggle for existence is becoming more and more complex, the occupations are more enacting and confining, exposure to accidents more frequent, due to modem machinery and its difficult handling. Competition in all lines is great and therefore more strain is put upon the brain and nerves of man in all walks of life. This leads in time to state of "Overwork," nervous prostration or worry, if the individual has not the physical strength to stand the battle or fails to keep himself in a normal state of body and mind by carefiil living. When in the latter condition, man is a suitable soil for development of disease which makes short work of the rundown system, and such a person when exposed to disease or accident is very apt to succumb imless some reseiTe vitality comes to the aid of him or Ler and the physician or surgeon In attendance in the ^Ineven battle for life. Man can keep his health and thus prevent disease "by Insisting on getting the best and purest of foods, working In factories or shops, dairies, bams, etc., which are well lighted and ventilated, free from dust, smoke, irritating vapors from paints, gases, acids, etc. By insisting upon regular working hours, eight hours sleep, dry and warm clothing If exposed during outdoor work, but not too warmly dressed for indoor work. Tea or coffee In moderation Is not harmful. Xight beers, Porter, Stout, Ale; •wines, as Sierry, Port, Claret, without strong preservatives or alcohol, except In small proportions, are not harmful and refresh and cheer the tired nerves. Whiskey, brandy, cognac, gin, except as medicine, are absolutely harmful and the whiskey which the Government allows to bo sold In this country Is a disgrace and a poison. More and more corpora- tions and business men are inr'sting on their employees abstaning from its use. It causes a sense of stimulation or well being, which Is temporary and Is soon followed by a sense of depression which can only be relieved by a renewal of the dose and thus stupid man continues to be temporarily stimulated, while the total effect of his Imbibing Is to lower his vitality, destroy his mind, cloud his judgment and render him vicious; ruin his appetite by Its action upon his stomach, harden his liver and destroy his kidneys. J.3Q PREVENTION OF DISEASE. COMMON CARRIEKS OF DISEASE. Why is it that Disease Spreads? — It has been found by scientists that certain definite living bodies (germs) are tlie cause of certain diseases, as tuberculosis, smallpox, typhoid fever, diphtheria, etc. ; and other diseases must be caused by other undiscovered bodies, which will some day be known. These minute living bodies are active and give off poisonous material which, destroys the tissues, organs, etc., of the body. When a person is ill, these germs arc being continually thrown off in the waste materials of the body, in the spittle, bowel movements, sweat, saliva, urine, etc. If these products of disease are allowed to remain in a vessel, the carpets, floor, soil, etc., they dry and in the form of dust are blown about in the air of the house, street or country road. If they come in contact with clothing or household furniture, they can be carried. Should a nurse or attendant upon a case be careless about disinfecting the hands or clothing during or after the management of a contagious disease, ho or she can become a common carrier by touching food, dishes, clothing, etc., used by other members of the family. Water is a common carrier of disease, particularly typhoid fever, cholera, etc. Therefore, to prevent the spread of disease, every farmer, dair}^uan, occupant of a dwelling, factory, citizens of villages, cities and States, should see that they have a clean, water supply free from germs and not contaminated by dirty water or refuse from a toilet, pig pen, stable, etc., which might contain germs carried from a patient or animal suffering from any one of the contagious diseases. One case of typhoid fever along the edge of a mountain stream, carelessly managed, thus permitting bowel movements to be thrown into or washed into the stream by rain, melting snow, etc., could cause an epidemic in every village which received its water supply from that stream or the river into which it emptied. Milk can be a common carrier of disease, such as tuberculosis, typhoid fever, scarlet fever, measles, diphtheria, etc. Most States, however, have protected the supply of milk by the enactment of laws covering the inspection of cattle, the erection of well lighted, clean and ventilated dairies, boiling and sterilization of all utensils used in its handling, even the wearing of sterile govras by the milkers and attendants, cleansing of the cows' udders before and after milking and currying and brushing the cattle and covering them with light blankets. Milk shoidd be kept at even temperature after being placed in sterile cans to prevent the forma- INSECTS AS COMMON CAEEIEES. 131 tion of germs wbicli will develop even in transit to the consumer in the country or by train or in the milk bottles prior to city delivery. Eail- roads are compelled in some States, and should be in all States, to furnish refrigerator cans with ice and the dealers in the city should particularly during the warm weather, have a refrigerator or ice in the delivery wagons to maintain an even temperature for' all milk delivered. How Can the Housewife Protect Her Children from Drinking Germ- Xaden Milk? — First make sure that the dairy from which the milk is supplied is clean and up-to-date and the city dealer delivers the milk at her doorstep in clean bottles. Do not allow it to sit in the sun in the early morning in warm weather, or about the kitchen at any time of the year, but place it immediately on ice in a clean refrigerator imtil ready to use. When taking a certain quantity of milk out of the bottle, if for the baby use a Chapin dipper, and do not allow it to stand uncovered for flies to contaminate. Milk may also be contaminated by water from any source of pollution if dairy utensils are carelessly washed with a supply of water from an infected water supply as any dirty well or one contaminated by cess pool, out-house, manure pit which is infecting water through the soil or from drainage. It is absolutely vital to a country to protect its milk supply as two thirds of the deaths under two years of age are traceable to either germ- laden milk from dairies or not properly handled by dealers, nurses, mothers, etc., who are careless or too ignorant to appreciate the danger of allowing baby's milk bottle nipple being dirty, contaminated by flies or who allow a millj bottle to sit in the hot morning sun, — result a sick baby, followed by death. Insects as Common Carriers — Great strides have been made in recent years by scientists in regard to the fiirther jii'evention of disease by studying the life habits of insects. It has been clearly proven that the poison or germ of certain diseases are carried by them, such as tuberculosis, typhoid fever, bowel complaints of children, by the common house fly; malaria and yellow fever by the mosquito ; the bubonic plague by the rat flea, of which there are several varieties, and the squirrel flea, of which there are also several. It is easily understood that to prevent the spread of a contagious disease from one individual to another, the precautions are not complete unless he or she be protected against either the bite of a mosquito or flea which has received into its own blood the poison or the germ causing the disease, which it conveys by bitiug another person. Flies should be kept 132 PEEVENTION OF DISEASE. out as, \>j coming in contact "with the spittle or discharges from ?, patient, they carry the germ or poison iipon their feet, etc., to the food, milk, water and by direct contact to another person. Thus to aid in the prevention of disease, the numerous Boards of Health of City and State have issued regulations and instructions -nhcreby these insects can be destroyed and then every person, sick or ■well, can be protected. If well, the fly is a danger by bringing disease into our home, if ill, it can convey our disease to another screenless home and start an epidemic. The Common Fly (Musca Domestica) — The only way to prevent the fly carrying disease is to destroy his breeding place, keep him out of the home, etc., when developed, by screens and swat or catch by fly paper, etc., every one seen in a room. House flies are a danger to human life. They are born in filth, feed upon garbage, sewage and waste matter of all kinds. They carry germs on the proboscis of their bodies, and a single fly is known to have carried as many as 350,000 germs and given them off into the liquid food in which it was floating. They also carry numerous germs inside their bodies which they convey to food, etc., in their vomit and bowel matter. Flies can carry disease germs of typhoid fever, consumption, diar- rhoea, dysentery and other diseases from a sufferer to you. They come in contact with your food, milk, water, etc., your sleeping child, or alight on an open wound, direct from the garbage can, the cuspidor, the spit in the street, etc., from decaying animal and vegetable matter and from the sick room. Thus every individual should do everything possible to aid the physician, city and state in destroying these kno-\vn carriers of filth and disease and thereby prevent sickness, due to carelessness and indifference by permitting flies to breed and live. How to Eliminate the Breeding Places of Flies. — ^Flies breed by laying larvse or eggs which can be seen as ilaggots in all undisturbed filth. It requires eight days for the millions of eggs to grow. Keep garbage can tightly covered, protect by screens so that flies cannot reach the garbage. See that garbage is collected promptly and cleanly. If you live in the country, bura or bury it. Allow no fllth or decaying matter of any kind to accumulate in or near your premises. Keep stable clean, place manure, old straw, etc., in screened pits, vault, or in boxes or barrels, which should be well covered. Screen all privies, vaults and openings to cesspools or drainage structures. Src that they do not overflow WHAT TO DO TO GET EID OF FLIES. 133 and use cbloride of lime freely. Pour kerosene into drains, keep drainage systems in good order and repair all leaks at once. Destroy sawdust cuspidors, they are imsauitary. Clean cuspidors daily and keep a five 2)er cent, carbolic acid solution in them all the time. Permit no dirt to accumulate in corners, behind doors, back of radiators, under stoves, etc. If there is a nuisance iu the neighborhood, notify the nearest health authority. What to Do to Get Rid of Flies — Screen your windows and doors. Do it early in the Spring before fly time and keep it iip until cold weather comes. Screen all food, especially milk. Do not eat food that has been in contact with flies. Screen the baby's bed and keep flies away from the baby's bottle, nipple and food, rattle, toys, etc. Keep flies away from the sick, especially those ill with typhoid fever, scarlet fever, diphtheria and tuberculosis, etc. Screen the patient's bed. Kill every fly seen to enter the sick-room. Disinfect all discharges, dressings, bandages, etc., from the patient and burn where possible. Catch all flies by use of sticky fly jJapers, traps and liquid poisons. A good poison to destroy flies is two teaspoonfuls formaldehyde in a pint of water sweetened with sugar and placed in saucers throughout the house. Be sure and have poisons out of reach of children and family pets. To rid an infected house of flies, burn in each room pyrethrum powder. Darken the room allowing only ray of light to enter at edge of window shades. Sprinkle pyrethrum powder over hot coals and carry about room. The flies will be stunned by the fumes and can be readily swept up. This is done because the flies will seek the light to escape the fumes aud fall near the windows. Swat the fly whenever seen. A paddle can easily be made to kill the flies with by taking an oblong sheet of vsdre gauze aud nailing it to a stick of suitable length for a handle. The Mosquito. — The mosquito is a common carrier of Yellow Tever and Malaria or "Chills and Fever" as it is sometimes spoken of by the public. Malaria is caused by a tiny parasite which can only be seen by tho microscope in the blood of man and the mosquito. It lives and multiplies in the blood of an individual suffering from the disease. How is Malaria Carried by the Mosquito ? — Let us imagine that a man has returned from some malarial country and takes up his abode in a healthy, yet mosquito infested village. This man may be fairly over his attack yet he still suffers from an occasional chill with fever. lie has no screens in his house, nor have his neighbors, unless previously told to follow such precautions. A female mosquito or several attack him 134 PREVENTION OF DISEASE. and suck his blood which contains these tiny parasites. The mosquito takes millions of these little parasites which then imdergo a development in the body of the insect and can be seen microscopically in the stomach, intestine, and the small glands in its mouth, whicb secrete the saliva. Now let us follow this mosquito and see what harm it can cause in a community. It flies through a screcnless door or window and lights on the arm, etc., of au unsuspecting neighbor. In biting a person the mosquito ejects or gives off its saliva into tbc woimd to aid in diluting the blood of the person which it has "bitten, as the blood is too thick to be sucked up througb the tiny tube in the bill (proboscis) of the mosquito. In this way the bite of the female mosquito "whose body contains the small animal parasites whieb cause Malaria, pass by means of the saliva into the blood of the person during the act of sucking up the blood. Thus the mosquito sucks up the blood of the individual and in exchange injects into his blood the saliva containing the parasites. These parasites multiply in the blood of the person bitten and produce poisons which give rise to the chills, fever, aching limbs, etc., kncmi as Malaria, Malarial Fever or "Ague," (chills and fever) . It can readily be seen bow malaria will spread when individuals in a community have millions of parasites in their blood, and at the same time mosquitoes are carrying around in their bodies, millions of the same living germs whicb they suck from the blood of the infected person, develop and inject them into the blood of every person they bite. How Mosquitoes Develop. — ^A female mosquito lays from 200 to 300 eggs at a time and always in standing water, as the eggs must have still water and no matter how filthy the water, it will not destroy the eggs or prevent their development. How to Destroy the Breeding Places of Mosquitoes Xo breeding places, no eggs and consequently no mosquitoes. When we consider that one female mosquito can lay 200 to 300 eggs at a time and then figure the number of living pests we have seen in one evening, it can readily be seen how rapidly they can develop and in what numbers increase if their breeding places are allowed to remain about any premises. Mosquitoes lay their eggs in standing water, such as is found in cesspools, drains, open sewers, catch basins, foul street gutters, stable yard pools, tin cans, rain barrels or any object which holds water. In from a few hours to a day, depending upon the temperature and surrounding conditions, the eggs open and what we know and have seen as "wrigglers" come out and can be seen in the water in which, the eggs have developed, as tiny slender HOW TO DESTROY MOSQFITOES. 135 living bodies l/^-inch. in leagth. In five to seven more days, the "wrig- glers" become "tumblers." In auotlicr five to seven days the covering of the head of the "tumblers" cracks and the fully develoi^ed adult winged mosquito comes out and, in the case of the female of the species, fiies oif ready to annoy and bite. Every individual should do everything possible to get rid of all breeding places. Examine your premises and be sure that they are free from any vessels, etc., which will receive and contain still water for one week or longer, that will afford a breeding place for mosquitoes. A loose brick causing a depression in the pavement, defective plumbing, cups, buckets, barrels, water pans in chicken yards, etc., a horse trough, a gutter on the eaves or roof of a house, bottles, barrels, tin cans,, water Bpouts out of repair or clogged up and so do not drain properly. These collectors of water should be removed and all plumbing, drains, roofs, etc., repaired. Mosquitoes will breed indoors as well as outside. Any water left in clogged sinks, toilet fixtures, water pitchers in bed rooms, slop jars buckets, tubs, spittoons, aquariums withoiit fish, or in fact any vessel which is capable of holding a few teaspoonfuls of still water, will afford a breeding place for the mosquito. ISTeglect to remove or repair the above structures is only allowing a large eroj) of mosquitoes to develop and annoy you and your neighbors by bites, disturbing your comfort, preventing rest and sleep and subjecting you to the malaria and yellow fever if you are in a district where these diseases are knovsTi to exist. Every citizen should use his influence to have every village, city and State corjjoratlon appropriate money to eliminate all marshes by filling with soil, drain all stagnant streams and have kerosene oil spread on the surface of lakes, ponds or any other body of stauding water, no matter how small. The object of using oil is to prevent the "wrigglers" and "tumblers" from getting air, for after leaving the eggs, they require air to develop. A film of oil prevents the "wrigglers" from getting the needed air and they 'are destroyed by choking. One ounce of oil is sufliclent to cover 15 square feet of water. Oil should be applied and removed once a week during the breeding season. When standing water must be kept, screen the containers or keep tightly covered, so the females cannot deposit their eggs. Screen all doors and windows. Put screens up early in the spring. How to Destroy Existing Mosquitoes — Kill every mosquito seen about the house. Every mosquito killed in the winter or spring will lessen the i36 PEEVENTION OF DISEASE? numljer of mosquitoes in the summer by thousands. TJse a paddle, made of an oblong sheet of ■wire gauze tacked on to a strip of wood, to serve as a handle, to kill both the fly and mosquito whenever seen. One of the best means of killing female mosquitoes (as they survive from one season to another) is to begin in the winter or early spring to fumigate the air with the following mixture : — Equal parts (by weight) of carbolic acid crystals and gum camphor. Liquify the carbolic acid crystals by gentle heat, break up gum camphor into small pieces and then pour tho liquid acid slowly over the camphor. The acid will dissolve the camphor completely and the solution formed is permanent and will evaporate slightly at ordinary temperatures. To fumigate a tightly sealed room, three ounces of this liquid will suffice for 1000 cubic feet of air space. Place it in a tin over an alcohol or other lamp and in addition place the lamp on a tin waiter or old pie plate, beat and it will require about one half hour to evaporate these three ounces of liquid. This solution is death to the mosquitoes and files. It is not poisonous to man and is not destructive to fabrics and materials, furniture, etc. It is not explosive, l)ut is inflammable and precaution should be taken to prevent fire. Mosquitoes found upon the ceilings of bedrooms in the evening may be quickly killed by taking a shallow tin cup or lip of a tin can, tacking it to a stick and then fill it with kerosene. Place quietly under the resting mosquito which either falls into or flics against the oil and is killed. Burn Chinese punk and mosquitoes will be driven away temporarily. Equal parts of olive oil and oil of citronella applied every half hour or so to the skin of the face, neck, hands and ankles will keep away mosquitoes. This method is useful to farmers, himters, lumbermen or laborers about woods, swamps, etc., where mosquitoes are an annoying and disease carrying pest. Fleas — There are one hundred varieties of this pest which live on dogs, cats, birds, squirrels, rats, mice, etc. It has been proven that fleas carry the germs of Bubonic Plague, which has caused as high as 113 . deaths in 119 cases during an epidemic. The disease was found to be spread by means of rats, mice and squirrels of all species and the flea (pulen fasciatus) in the fur of the animals was the medium by which the disease was conveyed to human beings by biting them and injecting the germs of Plague into their blood. The forms which pester the American homes are the House Plea (Piilrn Jrrltans), the Cat Plea (Pulen Fclinius), and the Dog Plea (Pulcn Canis). Each female flea deposits from eight to twelve whitish TO GET ErO OF FLEAS. 137 Ovoid eggs In dust or lint, under carpets and the larger crevices of wood- ■work. In the summer they develop in about four weeks from the egg to the adult flea, in winter they develoj) in about six weeks. Four to six broods, as a rule are hatched out during each summer. The House Rea occurs in dwellings, breeding in bedding, clothing, carpets, window curtains, etc. They attack their victims at night. The Cat and Dog Flea, though they annoy only their respective victims, are as troublesome to human beings as the human flea. To Get Eid of Fleas — Eemove and clean rugs, etc. Dust Pyrethrum powder into all cracks and crevices where dust or dirt may be lodged to destroy the larvse. Scrub the floor and footboards with hot soap and ■water to kill the adult fleas. To eliminate fleas on cats or dogs, dust Pyrethrum powder into the hair. The fleas will fall off while stupefied and should be immediately swept up and burned. Sleeping places of dogs and cats should be cleaned and covered with a carpet or matting that can be shaken into an open fire and the eggs, larvse and fleas with which it is generally covered, destroyed. During an epidemic of Bubonic Plague destroy all rats, mice, stray dogs and cats, etc., and protect your touse by killing all fleas whether In the furnishings or on your family pets. Flea bites are painful and if scratched may cause an abscess, followed by blood poisoning. The pain and itching of a flea bite can be counter-acted by touching the wound with ammonia water. To prevent infection, bathe the wound with a 5 per cent, solution of carbolic acid in water and bandage until healed. Cockroaches. — Cockroaches are brownish or black in color, broad and flattened in shape and smooth and hard to the touch. All cockroaches should be destroyed. They not only annoy, but, even though it has not been proven, they, no doubt, carry disease germs by coming in contact with discharges, etc., from ill persons and convey filth and germs to food, etc. They are very numerous in pantries, kitchens and In the walls near a stove and fire places. They are apt to bo abundant In oven rooms or bakeries and wherever the temperature is kept above normal. They usually appear at night or wherever light is absent and thus are protected from their common enemies. Owing to their shape they can squeeze into tiny cracks. They scurry away when surprised and generally escape capture or destruction, due to their speedy gait. They feed on animal matter, cereals and any food material; also eat woolens, leather cloth and leather bindings of books ("due to the presence of paste). They give off a fetid, nauseous odor, which persists even after thorough cleaning. They 138 PEEVENTION OF DISEASE. taint food supplies, slain slielves and dishes and -when present in large numbers, render the air of a room unbearable. This is due not only to their excretion, but mostly to an oily liquid secreted in the scent gland and a dark colored fluid in the mouth. They will destroy bedbugs. No contagious disease can bo said to be properly treated or isolated, if cock- roaches are scurrying about the -n^alls, carpets, food, etc., of a sickroom and allowed to persist and possibly convey the germs of the disease to others in the house or to neighbors. How to Destroy Cockroaches. — Take a quarter of a toaspoonful of phosporous, two level tablespoonfuls of flour, mix and make into paste with well sweetened water. Phosporous is very inflammable and should not be allowed near fire and being poisonous must not be placed where children and family pets can touch or eat it. Place the paste where the roaches can reach it. Bed Bugs — The bedbug is a small but plainly visible ovoid-shaped hug, giving off a peculiar nauseous odor. It is of a reddish brown or rusty color with some discoloration on the abdomen and is furnished with a puncturing or sucking apparatus. The eggs are tiny white oval bodies. As many as 6 to 50 batches are laid in cracks of beds, furniture, picture frames, wall paper, crevices of woodwork, floors, etc. Each batch of eggs develops in from 6 to 11 weeks, and several batches may be hatched in a season. One generation succeeds another as long as the temperature remains sufiiciently elevated. They hibernate during cold weather, during which season the insect is merely stupefied and renews its activities upon the return of warm surroundings. It is found in the dwellings of man, but other species of the same family have been found upon birds, as the common chimney swallow, pigeons and bats. The bedbug comes out at night and begins to bite and annoy. It conceals itself very cleverly and qiiickly in the day time or when surprised by a sudden light at night. It lives on the blood of man particularly, but can exist on food of other insects. It thrives best on filth and in old houses can keep alive without food for a year. Bedbugs are said to transmit smallpox. There is a possibility of tlioir carrying the germs of typhoid fever and leprosy, but this fact has not been proven as yet. The bite is poisonous to some individuals, result- ing in inflammation at the seat of the bite. This is supposed to be due to the same secretion which gives the characteristic nauseous odor. How to Destroy Bed Bugs. — Spray with pure spirits or crude tuvpen- tlue or benzine by using an ordinary nose and throat atomizer which zias. 139 can be bought in a drug store, all brass or wooden beds after scalding where possible with hot water, spray the crevices of floor, back of picture frames and where a house is "alive" with the pests repaper and paint rooms. Spirits of turpentine will kill where carbolic acid has failed. After each spraying, watch for the bedbugs as those which are not destroyed will hasten to escape and can be killed. Remember benzine and turpentine are inflammable and poisonous. No lights should be permitted in the rooms during or immediately following the use of these drugs. When articles cannot be sprayed, as books, etc., seal up the room and burn a sulphur candle. Place sulphur candle in a tin cup and place cup in a tin or metal pie plate containing water. lice — The body louse has been found to be a carrier of typhus fever. It carries the germ in its body after biting a sufferer from the disease and by biting a person can inject the germ into his blood. Lice belong to the insect family. The species which infest human beings are about 1-10 of an inch in length and are found on the covered regions of the body and clothing. Lice always grow from the eggs laid by an adult louse and never originate from filth or other matter. They hatch out within a week and the young are capable of reproduction in less than two weeks. A. single adult female will produce 5,000 lice within eight weeks. The annoyance of these pests biting a human being will cause, i£ sufiiciently prolonged, a nervous irritation, and a condition of ill health follows. There are three types of lice which infest man. The Head Lice (Pediculus Capitis), the Body Lice (Pediculus Vestimentorum) and Crab Lice (Pedicuhis Inguinalis). The Head Lice. — They are grayish in color with blackish margins and show a reddish tinge due to the blood they have sucked from their victim. The eggs or nits are seen attached to the hair shafts on the scalp at some distance from the end of the hair and are tiny white or grayish pear-shaped bodies seen iipon close examination. Treatment. — It is necessary to remove eggs and adults at the same time, so wet the hair thoroughly with crude petroleum (from any drug store) keep hair wet for three hours, then wash whole head with warm water and soap. Eepeat this wash once a day for three successive days. The eggs can then be removed by combing the hair with a fine tooth comb wet with vinegar. Where possible the treatment can be made more thoroTigh and permanent if the hair is cut short. Body Lice. — The Body Lice are larger than the head lice and are commonly found ujion the body. This type has bands across the back. 140 PEEVENTION OF UISEASE. Crab Lice — They usually develop in the seams of clothing, however, the eggs have been found upon the hairs on the body's surface. They live in concealed portions of the clothing where the skin is most conveniently reached, where the various bites are to he found most often, as around the neck, across the slioulders, the upper part of the back, around the waist and outer side of the thighs. Treatment. — All clothing worn should be boiled and gone over with a hot iron to destroy them. A hot bath should be taken by the person annoyed by the parasites. Bathing suits should be carefully boiled as they often become infested with the eggs and body lice from a person who may have worn the suit and had them upon his or her clothing or person. The Crab lice — These are a smaller type of the former species, as head or body lice. They are nearly as wide as long. They have strong legs spread out on the sides of the body, which makes them appear like crabs. They are of whitish color, slightly shaded on the shoulders and legs with a red tinge. Crab lice are found upon the hairy regions of the body other than the scalp. The spread of these pests can be checked by washing all toilet seats with scalding water, and boiling towels and linen from suspected persons. Laundries should be especially careful as to the thorough boiling and disinfection of all clothing, as the eggs of these parasites can be conveyed in bed-clothing, towels, etc. Treatment. — Shave the hair in the region of the itching and wash twice a day with a lotion made of Tincture of Larkspur y^ ounce Commercial Ether 8 ounces The Itch Mite — This parasite which afflicts man caiises the condition spoken of as "Itch," "Seven Years Itch," "Army Itch," "Jackson Itch," etc. It has an oval body with spine-like projections. The female is larger than the male and measures 1-70 of an inch in length by 1-50 of an inch in width. The female causes the development and pain of the afflicted person. She burrows into the superficial skin, forming a tortuous or a straight dotted line, slightly elevated which varies from 1/8 to 1/2 inch in length. This line if observed closely appears dark gray or blackish in color and is slightly more elevated at one end. Tlie eggs are laid in this furrow and at the elevated end is usually found the female, which has perished, as a rule. It takes almost 13 to 20 days for the eggs to develop into adult mites. The young mites feed upon the tissues of the THE PUBLIC DEINKING CUP. 14:1 body and move aboiit causing discomfort until they I'each the surface of the skin where they mate and females start a fresh burrow and deposit more eggs. The Itch Mite is commonly found in the skin between the fingers, hands, folds of the wrist, arm pits, around the stomach and about the neck. It is not known as a carrier of disease, but can be dangerous to health by causing burrows in the skin and abrasions due to scratching which afford an opening for germs to enter the system of the bitten individual. The Itch Mite can bj conveyed from one pei-son to another by means of towels, clothing, bathing suits, etc., carelessly washed, handled, or worn by anyone afflicted with the pests. Treatment. — To destroy them, have all bed linen and clothing used by the individual infested, thoroughly boiled or baked. Treat the region of the body by taking a bath, washing first with warm water and castile soap, using a brush to thoroughly open up the burrows and expose the eggs for destruction. After this, apply an ointment. Sublimed sulphur one drachm (teaspoonful) Balsam of Peru one drachm (teaspoonful) Vaseline one ounce (2 tablespoonfuls) Hub in morning and evening for from two to four days and repeat at end of a week if any itching continues. THE PUBLIC DRINKING CITP. The drinking cup is a common carrier of disease. It can and does spread consumption, syphilis and typhoid fever. Any child or adult suffering from tonsilitis, diphtheria, scarlet fever or other communicable diseases can infect another by using a public tumbler or cup, whether at a public railroad station, school house, ball park, pump, railroad train, ferry boat or steamship of any kind, etc. The most of the State Boards of Health have had laws passed in recent years to abolish the public drinking cup and those states which have not done so are neglecting the public health by not enforcing this preventive measure, which would aid in checking the spread of disease. The drinking cup should be replaced by a sterile paper cup which can be purchased in sealed packages or containers and are given away free of charge in trains, etc., and can be purchased for one penny from the slot machines in stations. They are destroyed after use and a more 142 PREVENTION OF DISEASE. refresliing and sanitary drink is obtained and the danger of contracting disease eliminated. The Public Drinking Cup Must Go. THE PUBLIC TOWEL. The toTvels in toilets, bedrooms of hotels and boarding houses can spread disease unless they are thoroughly boiled and laundered after use, Most hotels, railroad stations, Pullman cars, etc., have done away "with the ]iublic towels in toilets and. use a heavy tissue paper, either as a single towel or in rolls and torn off as needed, which is not expensive and is thrown away after use. In Pennsylvania the State Board of Health has urged saloonkeepers, etc., to do away with the forks and spoons which are placed in a tumbler of water and are used by all comers at the free lunch counter and then replaced in the tumbler of dirty water for the next victim to use. Disease can be controlled better when our proprietors of saloons, restaurants, hotels, soda fountains, etc., employ only healthy emijloyees, free from disease and take pains to boil or scald every public glass and chinaware used by not only dirty, but disease-spreading persons. The barroom towel which hangs in front of the bar in the cheaper saloons for customers to wipe their mouth' and hands upon, must not be permitted. VENEREAL DISEASES. Syphilis, gonorrhoea and a host of diseases which follow in their train, come within the scope of Preventive Medicine. They are not spread by water, air, food, or insects as are so many diseases, but develop only from contact with a sufferer (usually by co-habitation, but possible by non-sexual contact), or by the germs from a sufferer being imparted to another by towels, clothing or other articles. They may be communicated to an innocent wife by a diseased husband and vice versa, and many serious diseases and infirmities depending on these diseases may be trans- mitted to the children of the diseased, as instance the disease of Opthal- mia or Blindness in Children, which occurs at or shortly following birth, and which is usually attributable to one or both of the parents suffering from gonorrhoea, although it may arise from other causes (see Index for article on Opthalmia, its cause, treatment and prevention). Syphilis and gonorrhoea are so largely dependent on immoral inter- course that their prevention is largely a matter of moral uplifting of the VEWEEEAL DISEASES. 143' people. But, pending this morai uplifting, mueli is possible by the State and municipal governments jilacing these diseases on the list of contagious diseases which must be reported to the authorities, as is now required in respect of small-pox, scarlet fever and other diseases which are neither so loathsome nor have such far-reaching results for ill to mankind. All parents should carefully read the articles on Syphilis, Gonorrhoea and Opthalmia, to bo found elsewhere in this work (see Index), and then they should carefully guard their children and at proper age thoroughly instruct them in the fearful ravages of venereal disease. There is too much false modesty in these matters on the part of parents. The general discussion of sexual matters in novels, in sensational books on eugenics and in ordinary conversation is to be condemned, but it is the duty of every mother to her daughter and of every father to his son, to not only keep constant guard over them in these matters, but, at the beginning of puberty, to instil into their minds the real truths that they may become imbued with the horrors of venereal disease, yet realize the nobility of true sexual life. Professors and teachers in resident schools and colleges where youth is congregated should also have regard to this vital subjeot and take means to properly impart useful knowledge, and not only adopt every possible precaution to prevent students from meeting lewd persons, but by periodical medical examination discover if any venereal disease is existent, and If found in any individual then suspend such student imtil the disease be eradicated beyond the possibility of contagion. Syphilis Is a more horrible disease than small-pox and may bo easily communicated to the innocent by a common towel, by a brother kissing his sister or a son his mother, and in many other ways, and yet the Byphilltically diseased may go where they please and little or no pre- /autions are taken as to the spreading of the disease. It is estimated that i'n New York City alone 250,000 people are suffering from this loath- some disease, either inherited or acquired, and when it Is borne in mind that large numbers of these have innocently acquired It and are now in turn transmitting it to others, the enormity of the evil and the imperative need of preventive measures, will be realized. INDEX TO PART II OF BOOK III Preventive Medicine Water In Its Hygenic Relations Part II of Book III treats of pure and impure water and its various effects upon the human body, both as respects internal and external uses. SUBJECTS OF THE TEXT Air in water 148 Alkaline Waters, Diseases Caused by, 151 Alluvial Waters 163 Arsenic in Water 156 Artesian- Well Waters 165 Bathing Beneficial for Rheumatism. . .174 Baths, Cold 169 Baths, Hot 176 Baths, Hygienic Use of Cold Baths... 169 Baths, Hygienic Use of Warm Baths. 174 Baths for Old Age 173 Baths, Temperature of 169 Baths, Cold Varieties of 172 Baths, Warm 174 Bright's Disease Caused by Water... 153 Chalky Waters 164 Cholera Due to Impure Water 156 Cold Baths 1C9 Detection of Contaminated Water.... 165 Diarrhoea Due to Impure Water 159 Distilled Water 148 Drinking Water, Sources of 149 Dysentery Due to Impure Water 159 Farmhouses, Danger from Polluted Water 159 Fever Germs in Ice 161 Flesh Brush Exercise 174 Goitre, Water as a Cause of 152 Gfaveyard Waters 163 Green Waters 166 Hot Baths 176 Hydropathy - . - 1 73 Hygiene of Cold Baths 169 Hygiene of Sea Bathing 177 Hygiene of Warm Baths 174 Ice as Cause of Disease 160 Ice from Contaminated Ponds 161 Ice, Fever Germs in 161 Impure Water Cause of Diarrhoea and Dysentery 1 59 Impure Water Cause of Worms 163 Impurity of Water 152 Infectious Diseases from Impure Water 156 Iron in Water 156 Lead Poison in Water — • Apply Test for 155 Causes of 154 Detection of 154 Diseases from 155 Frequency of 153 In Rural Districts 153 Obviation of 155 Palsy from 154 Virulence of 154 Limestone Waters 164 Marsh Waters 163 Mineral Springs 130 Mountain Fever Due to Snow Water, 162 Need of Water 147 Precautions for Travelers 169 Privy, Well and Stables, Proximity of, 159 Pure Water a Sanitary Necessity. .. .163 Purifying Ingredients in Water 151 Rain Water 730 Rain Water, Purity of; Impurities in, 149 10 145 146 INDEX TO PAET II OF BOOK III. Rheumatism, Bathing Beneficial for... 1^4 River Water 150 Rock Water 163 Rules for Pure Water 167 Saline Impurities of Water 151 Sand and Gravel Waters 163 Sanitarj- Necessity of Pure Water... 163 Sca-Bathing, Hygiene of 177 Seashore- Well Waters 165 Sea Water 14S Sewer-Gas Poison Through Water. . . .160 Snowr Water, Dangers of 162 Soil Waters 164 Spring and Well Waters 150 Stagnant Water 150 Surface Waters 164 Temperature of Warm Baths 174 Tests of Water 166 Ammonia Test 168 Chemical 167 Microscopic 166 Necessity of 169 Nesler Test 168 Soap Water Test 168 Taste as Test 166 Taste Due to 167 Taste Fails as Test 167 Typhoid from Polluted Water 157 Typhoid from Well Water 158 "Warm Baths 174 Warm Baths, Temperature of 174 AVater, Air and Gases in 148 Water, Arsenic in 156 Waters, Alluvial 164 "Waters, from Artesian Wells 165 Water as a Cause of Bright's Disease, 153 Water as a Cause of Goitre 152 Water from Chalk Formations 164 Water from Clay Formations 164 Water, Contaminated, — Detection of.. 165 Water Cure 173 Water, Diseases from 151 Water, Distilled 148 Water for Drinking, Sources of 149 Water, Effect of Metallic Impurities, 153 Water from Graveyards 165 Waters, Green 166 Water, How Poisoned by Lead 154 Water, Human Need of 147 Water Impurity, Its Deadly Effects, 158 Water, In What Contained 147 Water, Infectious Diseases Caused by Impure Water 156 Water, Iron in 156 Water, Lead Poison in 153 Water from Limestone 164 Waters, ^Marshy 165 Water as a Medium for Sewer-Gas Poison 160 Water, Organic Impurities in 152 Water Precautions for Travelers 169 Water, Purity of and Impurities in Rain Water 149 Water, Quantity Needed 150 Water from Rocks 163 Water, Rules for Pure Water 167 Water from Sand and Gravel 163 Water of the Sea 148 Waters from Seashore Wells 165 Water from Snow, Dangers in 162 Waters, Soil 164 Waters, Surface 164 W'ater, Tests of. — See Tests of Wa- ter 150 Water, Varieties of 150 Waters, Yellow 166 Well, Privy and Stables, Pro.ximity of, 159 Well Waters Ijo Well Water Cause of Typhoid 158 Worms from Impure Water 163 Yellow Waters 166 PREVENTIVE MEDICINE PAET II. WATER IN ITS HYGIENIC RELATIONS THE USES OF WATER. Adaptation of Water to Human Needs — Few people who eujoy the benefits of water thiiik what a wonderful and unanswerable ai'gamient is aftbrded by them in favor of the goodness of an all-wise Creator to his creature, man. Of all the fluids with which we are acquainted water is by far the Ix^st adapted to the almost infinite variety of human wants, and it is the one of all others most abundant in nature, constituting as it does about three-fifths of the surface of our globe, and nearly seven-tenths of the bodies of man and of most animals. If the common fluid upon which we had to depend were quicksilver, or oil, its boiling-point would be so high that articles of food which we attempted to cook in it would be seriously injured in the effort to prepare them by its aid; and, on the other hand, nearly all the advantages of ice would fail us, in consequence of the exceedingly low temperature at which these substances remain fluid. Water in All Substances — Water was considered by the ancient phil- osophers as one of the four elemeiits out of which all visible objects were constructed ; and, in reality, it enters to a greater or less extent into the coniposition of nearly all natural substances. Thus, for example, some vegetables, like cabbage or celery, contain as much as ninety-five per cent, of water; and, on the other hand, close-gTained marble may contain a8 much as four per cent, of water, or almost a quart to the cubic yard. On account of its remarkable solvent powers, which enable it to take up a smaller or larger quantity of nearly every substance with which it comes in contact, water is never found pure in a natural state; and, indeed, absolutely pure water for chemical purposes can only be obtained by repeated careful distillations. (147) 148 WATEE IN ITS HYGIENIC RELATIONS. Air and Gases in "Water. — A considerable amount of air generally exists in water, and is taken up by the gills of fishes, assisting them to accomplish the proper aeration, or rather oxygenation, of their blood. The air usually mingled with water may be expelled by boiling, but is absorbed again if the boiled water is agitated with access of the atmos- phere. Boiled Water. — The insipid taste of water which has been Iwiled is due to the absence of air. Many gases besides air may be artificially or naturally mingled with water, and some, like ammonia or nitric acid, are freely soluble in it. In sea-water, the presence of common salt, with small quantities of sulphate of soda or Glauber's salt, and, of the compound of magnesia and chlorine, called chloride of magnesium, render it entirely unfit for drinking, as many a hapless shipwrecked sailor has found to his cost. Distilled "Water — At the present day, most sea-going vessels are provided with apparatus for distilling the water of the ocean, and so pro- ducing a pure and wholesome but insipid water, which can be rendered, however, more palatable by agitation with plenty of fresh air. Hence, the horrible agony of death by thirst among sailors is now much less frequent than formerly, although mariners in open boats, or cast upon small un- inhabited islands, still sometimes scan with anxious eyes the briny waste around them, beholding — "Water, water everywhere, but not a drop to drink." Sea-Water. — Sea-water varies considerably in composition, being, of course, more concentrated, as a rule, in the tropical regions, where evap- oration is most active, such, for example, as in the ilediterranean Sea and the Atlantic Ocean near the equator. According to analysis, the water in the English Channel contains in 1000 parts — Chloride of Sodium 28.05 Chloride of Magnesium 3.66 Sulphate of Mag-nesia 2.29 Sulphate of Lime 1.40 Other Saline Materials 76 Total Solid Matter 36.16 Besides these, and perhaps contributing largely to the healthful qualities of sea-water, there exist in the ocean small quantities of iodine SOUECES OF DRINKING WATER. 149 and bromide, and extremely minute amounts of some o£ the common metals. It has been found that, by dissolving a little common salt and carbonate of soda, lime and magnesia in distilled sea-water, its taste is rendered much more agreeable ; and this jjlan, it is said, is adopted in the Russian navy. Purity of Rain-Water. — The water, which rises in vapor into the atmosphere from all the oceans, seas, lakes and rivers of the globe is condensed after a longer or shorter time, and falls to the earth again as rain. Rain-water, being in reality a distilled fluid, is the nearest approach to a pure water which we find in nature, and when caught in clean vessels placed upon elevated objects is almost free from contamination. Impurities in Eain-Water — It contains, however, small quantities of organic matter, nitric acid and ammonia, all of which are washed oiit of the air through which it descends as rain. The source of the nitric acid is believed to be the nitrogen of the atmosphere, which combines with oxygen under the influence of the electric spark during thunder-storms. Nitric acid in rain-water exists in such insignificant amount as to be entirely unimportant in itself; but it adds very seriously to the danger of impregnation with lead from lead pipes, roofs and cisterns by rapidly dissolving that metal and forming the very soluble and highly poisonous salt, nitrate of lead. SOURCES OF DRINKING WATER. Evaporation — Our supplies of drinking water are, of course, derived originally entirely from the rainfall. We need not consider now how the water found its way into the air. Without entering into the details of the process of evaporation, all that the present object requires is, that we clearly recognize the fact that spring, fountain, river and lake are all alike fed from the clouds which float over our heads and send their rain upon the just and upon the unjust. Hence, then, man is wholly dependent for his supply of this vital element upon the rain which comes down from heaven. He may dwell upon the most arid plains, but he drinks from the stream which flows beside or underneath his feet — which stream is itself fed by floods that fell perhaps a thousand miles away — and wliat- ever niysterj' attaches to subterranean waters, we may be sure that, by a long enough circuit, we can trace every drop back to the clouds. 150 WATBE IN ITS IITOIENIC EELATIONS. VARIETIES OF WATER. Rain-Water. — In classifying waters, we have first to consider them as regards their sources, Kain-water, as already mentioned, is sweet and soft, and when filtered is perfectly adapted to all the purposes of life ; the one ditficulty about its use being the impossibility of collecting it pure and preserving it without contamination for the long periods of time and in the large quantities which would often be necessary. Spring, and Well- Waters. — Spring- and well-waters are almost always more or less impregnated with the soluble ingredients of the earth and rocks through which they pass, and are therefore sometimes very unsuit- able for the ordinary wants of life. As a general rule, they are colder than other waters, although hot springs are found in various parts of the world, some with a temperature as high as the boiling point. Mineral Springs. — ^]\Iineral sj^rings, notwithstanding they are much ■used for drinking, are properly medicinal agents. They comprise all those waters which contain suiRcient quantities of dissolved matters, such, for example, as iron or sulphur, as to produce thereby a positive effect upon the systems of persons partaking of them. The mineral springs of this country are frequently valuable remedial agents' in some chronic diseases. River-Water — Eiver-water Is, to a certain extent, similar to spring- water, but is much more apt tc be contaminated with sand and clay, organic material from decomposing vegetable or animal remains, the refuse of manufactories, and especially with the sewage of cities and to%vns, to which it is probable immense amounts of sickness and death are annually due in all civilized countries. Unfortunately, river-water is that which is chiefly supplied to towns and cities, and therefore finds its way into the systems of vast numbers of our fellow-beings. Stagnant Water. — Stagnant water is, from the large quantity of organic matter in a decomposing state which it holds in suspension or solution, exceedingly unfitted for drinking and culinary purposes, no matter how transparent it may appear ; and it should, in consequence, bo carefully avoided whenever running water can possibly be procured. Pond-water, canal-water, ditch-water and marsh-water all come under this category, and should be scrupulously shunned, under penalty of suffering from fever and ague, dysentery, typhoid fever, and many other dangerous maladies. Quantity of Water Needed — The quantity of water needed by man and animals must therefore be very carefully calculated, Kepeated ex- VAEIOUS -WATERS. 151 periments upon a very extended scale in England have shown that a healthy man requires daily as drink from two to four pints of water, this amount being in addition to that which is swallowed as moisture in food. The amount required for cooking is estimated at from half a gallon to a gallon or more. To this quantity, Dr. Parkes considers should be added for daily ablution, including a sponge bath, five gallons; daily share of kitchen and other utensils, and house washing, three gallons; and share of clothes washing, another three gallons; making up a total of a little over twelve gallons for each individual daily. In the poorer districts of the city of London, the amoimt used is stated to be only about five gallons daily. A shower-bath will require about four gallons extra, and a plunge- bath from forty to sixty gallons. Where water-closets are used an addi- tional quantity of from four to six gallons daily for each person must be provided. DISEASES FROM MINERAL IMPURITIES IN WATER. Purifying Ingredients. — Since all rivers, spring- and well-waters con- tain a certain amount of dissolved matters, taken up from the soil through and over which they pass, it becomes a very important consideration to determine what these ingredients are in any particular sample of water, and also the kind and degree of such impurity which will not prove injurious to health. Dr. Letheby, from investigations made in sixty-five English and Scotch towns, arrived at the conclusion that from five to twenty grains to the gallon of the compounds of lime and magnesia arc necessary to render drinking water in the highest degree wholesome. Saline Impurity. — But any quantity of saline impurity exceeding thirty-five grains to the gallon renders a water unfitted for the freest domestic use. Such water would be popularly designated as a very "hard" water, but a good deal of indifference is caused by the nature of the hard- ness, that due to sulphate of lime, and called the permanent hardness be- cause it is not removable by boiling, being decidedly most prejudicial to health. Diseases Caused by Alkaline Waters. — The symptoms referable to an excess of alkalinity, arising from the presence of these earthy salts in a drinking water, are mainly those of a dyspeptic nature. At first the cmplopnent of hard water by persons who are unaccustomed to it pro- duces diarrhoea, which is occasionally serious or even dangerous in its 152 WATER IN ITS HYGIENIC RELATIONS. character. But the long-continued use of such a drinking fluid is thought to cause habitual constipation, with the heavy train of evils, including ])ilcs and liver complaint, which depend upon it. Calculus, or stone in the kidney or in the bladder, which gives rise sometimes to the most horrible agony human beings are ever called upon to endure, is believed to be due, in many instances, to an excess of lime and magnesian salts in the drinking water. Cause of Goitre — The swelling of tho thyroid gland in the neck, producing the repulsive deformity of Goitre, or Derbyshire neck, seems to be intimately connected with mineral impurities in water. In Notting- ham, England, where this disease is not unfrequently met with, the com- mon people attribute it to the hardness of the water, and in other parts of Great Britain it is found to prevail only, or at least especially, in those districts where the magnesian limestone formation abounds. Goitre in Switzerland.— Dr. Coindet, of Geneva, Switzerland, asserts that Goitre is speedily produced in persons who drink the hard pump- water in the lower part of that town, whilst in other parts of Switzerland the use of spring-water has been followed by the development or augmen- tation of Goitre in a very few days. In India also it has been shown conclusively to prevail, to any marked extent, only where the magnesian limestone rocks underlie the soil ; but whether it is the lime and magnesian salts, or whether, as has been suggested, it is the presence of sulphide of iron in the bed-rock formation, which is the direct cause of the develop- ment of Goitre, has not yet been positively determined. It appears cer- tain, however, that Goitre is originated by some water impurity, and that this contamination is of an inorganic and not of an animal or vegetable nature. Organic Impurities in Water. — A small quantity of organic matter of vegetable origin, that is to say, an amount not exceeding three grains to the gallon, is not generally found to be injurious, but even very minute quantities of organic material of animal origin, especially if this' material is composed of the waste matters, such as urine or excrement, from man or animals, is the great cause of unwholesomeness of water. Probably one-fourth of the sickness and death in civilized communities arises di- rectly or indirectly from this one cause, and, unfortunately, even when we are fully forewarned of this imminent danger to health, it is exceedingly dilRcult, in most thickly populated places, to secure a source of water supply with which sewage has not been mingled. DISEASES FROM IMPURE WATERS. 153 Effect of Metallic Impurities. — The effects of minute traces of metallic substances in drinking water have not yet been ascertained with sufficient accuracy, but it is quite possible tliat the entire sanitary condition of a district may depend in some measure upon impurities of this description. Mr. Wanklyn suggests that the well-kno\\Ti salutary effect of what is called change of air may bo, in reality, partly due to the escape from some extremely small metallic impiirity in the water of the section of country from which removal takes place. Cause for Bright's Disease — It has long seemed probable that the increasing prevalence of that terribly fatal malady, "Bright's disease," especially in cities and large towns, may bs due to the poisonous effects of exceeding minute quantities of lead, dissolved from the lead pipes so generally employed as service-conduits, notwithstanding the protective coating which usually forms so promptly upon them. lead Poison in Water — These are probably very common throughout our whole country, and, contrary to what at first sight might be imagined, it is likely that lead much more frequently and seriously affects the health of people inhabiting small villages and country houses, than that of resi- dents in cities, notwithstanding the latter constantly use water which is brought into their houses through long lines of lead service-pipes. The explanation of this seeming paradox is that river-water, which is that usually supplied to citizens, contains in almost all cases a small amount of the sulphate of lime, sulphate of magnesia, or some other compound of sulphuric acid, which, when brought in contact with the lead pipes, is decomposed, and the resulting sulphate of lead which is formed has the happy faculty of clinging to the inside of the pipes where it is produced, and thus constituting an insoluble lining, which not only protects the tulw from fiirther corrosion, but also, what- is of far greater importance from a sanitary point of view, prevents any further contamination of the drinking water which flows through the conduit. Lead Poison in Rural Districts. — Tn rural districts, on the other hand, wherever rain-water is used for drinking purposes, it is exceedingly liable to be contaminated with lead from load-lined cisterns, lead service- or collection-pipes, lead roofs, or from the solder of tin roofs. As a rule, the purer the rain-water, the greater is its action on lead with which it stands in contact; hence, therefore, the presence of a minute quantity of some salt of sulphuric acid in water is of very great importance, and serves as an invaluable protection against lead-poisoning to the human beings and animals who may employ it for drinking purposes. 154 WATER IN ITS HYGIENIC RELATIONS. i How Lead Poisons Water.— 'Wlicn piu'e water recently boiled is placed in, or run over, l»';id, no action takes place; but if the water, after being boiled, is exposed for a short time to tlie air, from wiiich it absorbs oxygen and carbonic acid, and is then brought in contact with lead, we soon find that a whitish film, which on chemical examination is found to be com- posed of the carbonate of lead, is formed upon the metallic surface. This whitish film, which easily separates from the lead on which it appears, and becomes mechanically mixed with water, is very poisonous. Since, as already mentioned, rain-water contains usually some nitric acid, in addition to the oxygen and carbonic acid which it absorbs from the air, and this nitric acid combines with lead to form a very soluble and poison- ous nitrate of lead, it is much more dangerous than even pure aerated .vater, after standing for a short time in contact with a leaden surface. Rain-water intended for driidcing or cooking pui'poses ought, therefore, never to be collected from lead or tin roofs, transmitted through lead pipes, nor under any circumstances stored in lead-lined cisterns of any kind. Virulence of Lead Poison — In the celebrated case of the accidental poisoning of the ex-royal family of France, at Claremont, by lead which was taken up in the drinking water, the amount was found not to exceed one grain of metal to the gallon of water. From cases which have since been obsei'\'ed, it would appear that the habitual use of water con- taining one-tenth or even one-twentieth of a grain per gallon, is some- times attended with danger. In his investigation into the cause of that curious disease, as it was formerly considered, the Devonshire colic. Sir George Baker, Avho discovered that it was only a form of lead-poisoning due to the drinking of cider fermented in lead-lined vats and troughs, found that eighteen bottles of cider he examined contained four and a half gi'ains of lead, or a quarter of a grain to each bottle. Lead Palsy — Under some special circumstances, not at present well imderstood, extremely minute amounts of lead in water may prove in- jurious. Thus, for example, Dr. ^Vjigus Smith speaks of cases in which lead-paralysis, or palsy, was apparently produced by water containing only one one-hundredth of a grain of lead to the gallon. Detection of Lead in Water — The method of detecting the probable presence of lead in a sample of drinking water is so simple that every reader is advised to take the first opportunity of examining their own water-supplies, and so making sure that they or their families are not liable to the insidious dangers of lead-poisoning. In order to determine whether a water is contaminated with lead, all one has to do is to drop LEAD POISON IN WATER. 155 two or three drops of the solution of sulphide of ammonium into the suspected fluid, contained in a white bowl or large cup, and observe whether a bro^vnish or yellowish coloration is produced. If the liquid • remains perfectly clear and colorless you may be sure that it either con- tains no lead," or that such a metallic impurity is present in a quantity of less than one-tenth of a grain to the gallon, an amount which is not gen- erally injurious to health. If, however, a slight brownish tint is produced in the water which is being tested, it must not be too hastily condemned as poisoned, since either copper or iron might give rise to the same coloration with the reagent. Such a suspicious water ought, however, to be 2:)romptly analyzed by some good analytical chemist before being em- ployed for either cooking or di'iiiking purposes any further. Applying the Test for Lead — The sulphide of ammonium may be purchased at a sma^l cost, say for twenty-five cents an ounce, of most dealers in chemicals ; and, as its odor is extremely disagreeable, it should be kept carefully corked until the moment it is used. The experiment should be made upon half a pint of the suspected water; and, if the contamination is supposed to be caused by lead pipes, it is a good plan to test a portion of the liquid which has stood over night in the condiiits. The mode of discriminating the precipitate caused by iron from those due to the dangerous metals, load and copper, is to let fall a few drop of hydrochloric acid, called also muriatic acid, into the fluid. If the brownish or yellowish-brown tint disappears, we may laiow that iunocent iron is the only metallic impurity; whilst if, on the contrary, no change is effected by the addition of the acid, one of the poisonous metals, lead or copper, is present. ISTo water, however, in which the slightest tinge is produced by adding the suli)hide of ammonium, should be swallowed by man or beast until a rigid investigation by a competent water-analyist has proved it to be harmless. Difficulty of Obviating Lead Poisoning. — Attempts have been made to obviate the danger of water contamination from lead pipes in various ways, but not as yet with complete success. In some instances the pipes have been lined with other metals, such as tin or zinc ; but, at least in some instances, a galvanic action has thus been sot up, which corroded the conduits with great rapidity, and probably led, therefore, to still more dangerous pollution of the water supply. Coating the pipes on the inside with coal-tar. bituminous varnish, solution of g-utta-percha and of India- rubber, have also been experimented with, as yet with but partial success. Lead Difieases — The injurious effects of lead ui>on the humau system 156 WATER IN ITS HYGIENIC KELATIONS. are displayed first, in the production o£ dyspepsia; later, obstinate con- stipation and a peculiar kind of colic, so common among painters from the influence of lead that it has received the name of "painter's colic;" and finally, disturbance of the nervous system, especially that peculiar form • of lead-palsy called wrrst-drop, in which the power to lift up the hand is more or less com])]otely lost. Iron in Water — The presence of iron in a water, rendering it what is called Chalybeate, from tlie old Greek name for iron, renders it to many persons only a useful tonic, but in some people it causes severe headache and serious disturbance of the digestive organs. Arsenic in Water — Arsenic, coj^per and mercury are rarely found in drinking waters in America, except in streams flowing near chemical works, or unless they are introduced designedly with some murderous intention. These metals may, therefore, be practically ignored in the consideration of water from a hygienic point of view. Infectious Diseases from Impure Water — The principal acute diseases wliicli arc due to impure water are Cholera, Typlioid Fever, Piarrhcea and Dysentery; and, although it is only within a comparatively recent period that mankind has begun to realize its dangers from this source of these maladies, the accumulated evidence is already very conclusive. Cholera Due to Impure Water. — Among the remarkable outbreaks which go to prove that this mode of cholera propagation is not at all im- common, may be mentioned the following, condensed from Mr. Simons' eighth report as medical officer of the English privy council, during the prevalence of cholera in England in 18G5 : A gentleman and his wife from the village of Theydon-Bois, in Essex, had been lodging at the town of Weymouth for tAvo or three weeks, and returned home towards the end of September. On their way home they passed through Dorchester, where the gentleman was seized with diarrhoea, vomiting and cramps, which continued more or less during the next day and the day following, when he reached his own home. During the journey the wife also began to complain of pains in the abdomen, which was followed by diarrhoea and eventually by cholera, from which she died. Cholera Infection. — A few days after their return the same terrible disease rapidly attacked other members of the household, so that, within a fortnight, in that one little circle, eleven persons had been seized with cholera, including the mother, father, grandmother, two daughters, son, doctor, serving-lad, serving-mlaid, laborer and coimtry-woman, and of these eleven only three survived, namely, the son, a daughter and the TEST FOE LEAD rOISON. 157 serving-laJ. Later, in the country-woman's family, there was another fatal case. It cannot well be doubted, concluded Mr. Simon, but that the exciting cause of this succession of events was in some way or other the return of the parents from Weymouth — of the father with the remains of choleraic diarrhoea upon him, of the mother with apparently the begin- nings of the same complaint. But this is only part of the case, and the remainder teaches a most impressive lesson. All the drinking water used in the house came from a well beneath the floor of the scullery, and into that well there was habitual soakage from the water-closet. Another Case of Infection.— Another famous illustration is found in the history of the "tea-water pump" of Broad street, near Golden Square, London, which during the cholera visitation of 1854, killed nearly 500 persons in a single week, in one of the fashionable localities of the city. It has long been kno-nm that water containing five or six grains of lime and magnesia to the gallon is much to be preferred for making tea to water of any other quality. This is because the lime precipitates the astringent matter of the leaf, yet does not interfere with the solution of the desirable constituents; and hence certain wells which have this proper proportion of mineral matter come to be valued very highly by persons of nice taste. The Famous London Pump. — At any rate, the Broad street pump had in London the reputation of furnishing, in its cold sparkling waters, a better medium for "the cup which cheers but does not inebriate," than was elsewhere to be found. When the cholera invaded this neighborliood the wealthy residents retired to the fashionable suburbs which were still uninfected ; but, to the surprise of many, the cholera broke out among them with terrible severity. The health officers soon discovered, however, that those who were attacked had sent in every day to their favorite Broad street pump for their water-siipply, and, by removing the pump-handle, they quickly put an end to the epidemic. Avoiding Cholera — A first and highly important warning, therefore, which these and many other similar occurrences give us is never to drink any water which, by any possibility, could have become contaminated with the smallest pnrticle of discharge from the bowels of a person suffer- ing from cholera or choleraic diarrhoea. Typhoid Fever from Polluted Water — The remarks which have been already made with regard to the influence of impure water on the spread of cholera, apply still with greater force to the causation of typhoid fever. So common is this mode of propagation that the assertion may be ventured 158 WATEE IN ITS HTOIENIO EELATIONfl, that few readers of these pages have not lost some near relative or beloved frieud from thia dreaded disease arising in this way, although the true source of the infection ■ was perhaps, at the time it occurred, quite un- suspected. Spread of Typhoid. — Sir William Jenner, than whom no higher medi- cal authority could well be quoted, in commenting upon this point, says: Tlie spread of typhoid fever is, if possible, less disputable than the spread of cholera by the same means ; solitary cases, outbreaks confined to single houses, to small villages and to parts of largo towns, cases isolated it seems from all sources of fallacy, and epidemics affecting the inhabitants of large though limited localities, have all united to support, by their testi- mony, the truth of the opinion that the admixture of a trace of excrement, but especially of excrement from a typhoid-fever patient, with the water supplied for drinking purposes, is the most efficient cause of the spread of the disease, and that the diffusion of the malady in any given locality is limited or otherwise, and limited just in proportion as the dwellers in that locality derive their supply of drinlcing water from polluted sources. Deadly Effect of Water Impurity. — ^According to the late Dr. William Budd, it also appears to bo higlily probable that, when the poison of typhoid fever enters the system by drinl'cing water, infection is much more certain than when it is disseminated by the air and is breathed into the lungs. In support of this statemient, he instances an outbreak which occiirrcd in Wales, where out of ninety or a hundred persons who attended a ball, fully one-third was shortly afterward laid \ip with fever. Although the water was not examined, there was satisfactory reason to believe that it was polluted with sewage. Typhoid Poison from a Well. — In a report of the American Public Health Association, Dr. Austin Flint gives an account of an outbreal-- of typhoid fever in Vermont which it was possible to trace, in the most circumstantial way, to the jioisoniug of a well in some such method as has been described. A young man traveling through that region by stage-coach was taken ill, and, when he could go no further, was left at a tavern in a little hamlet to be cared for, his fllness soon proved to be typhoid fever. A small watercourse, in a shallow valley, divided the village into two portions, each of which consisted of half a dozen houses or less. In a few days new cases of the fever made their appear- ance in that part of the hamlet to which the tavern belonged — every house. IHTECTIONS FROM WATER. 159 in fact, but one was invaded with this disease — ^whilst on the other side of the stream not a case occurred. It appears that the tavern well, which was the only one upon that side of the village, furnished the water-siipply to all the families belonging there hut one. That one family had had a quarrel with the landlord of the hotel, had consequently deserted the tavern well for a more distant supply of drinking water, and so escaped swallowing the specific poison of typhoid fever in the water by which all their neighbors were stricken down. Typhoid from Milk. — It has also been proven in late years that typhoid is transmitted from infected milk, cows have been allowed to drink from streams that have had the discharges from tyjjhoid patients thrown into them. The germs have been taken into the cows and finally into the milk. This milk was distributed to families and in many cases caused tyjjhoid. Proximity of Privy and "Well. — Unless privy and well be located at considerable distance from each other, and further unless the nature of the groimd be such that the flow from the privy will be away from the sources of the well, there is always grave danger of the pollution of the well water with germs from the privy. This also applies to nearby stable yards. There are many authenticated cases of typhoid which have been directly traced to the proximity of wells to privies and stables, and the danger should not be underestimated. Danger in Farm-houses from Polluted Water. — Of course, the same conclusion holds good for country farm-houses or dwellings when, from motives of convenience, although there is space enough and to spare, but a short distance is interposed between the sides of the hole which is called the well, and which furnishes the drinking water, and the other hole nearby which is called the cess-pit, and used as a receptacle for filthy, often poisonous, excrement. Moreover, there are no doubt many instances where, owing to the inclination of beds of sand or gravel, strata of rock and so forth, impurities of these and other dangerous varieties may be carried, by underground currents, much further than the distances which have been mentioned as measured upon the surface of the earth. In other words, a cess-pool on a hill-side, 500 feet or more away from a well, may infect the water of the latter, if underground currents favor such contamination. Diarrhoea and Dysentery from Impure Water. — The instances of out- breaks of these two diseases from contaminated water-supply are very ICO WATKIt IN ITS ITYOIENIC RELATIONS. luinierous, and probal)l_y most persons can recall examples of this kind. The impurities which produce diarrhoea and dysentery are suspended earthy matters, such as are found in most river-waters after a rain; sus- pended animal and vegetable material ; sulphates and chlorides of lime and magnesia, and nitrates of ammonia and of lime. Besides the nu- merous outbreaks traceable to direct sewage contamination, there are several instances recorded of indirect |X)isoning of a water-supply from this source, as in the following curious case. Outbreak at Salford Jail. — In the Salford, England, jail there was a sudden outbreak of diarrhoea of a choleraic type, which affected more than half of the prisoners; while of the officers and their families, who were distributed throughout the building, not one was attacked. The food of the convicts was examined and found to be good; it was evident, also, that the air did not contain the cause of the disease, because both classes above mentioned were under the same conditions in that respect. Suspicion was therefore directed to the drinking-water. It was then dis- covered that, though the water supplying all parts of the prison was derived from the same source, there was one cistern for the use of the officers, and another covered cistern for furnishing to the prisoners their allowance, and that the untrapped overflow-pipe of the latter com- municated with an open sewer. On the day of the outbreak of diarrhoea in the jail, the water from this cistern was observed to be colored and to taste unpleasantly. Sewer-Gas Poison. — It had obviously absorbed cewer gas, which had ascended through the overflow-pipe, and that this had been the real cause of the disease was indicated by the fact that the diarrhoea disappeared almost as rapidly as it had broken out, when the cistern was emptied and the pipe efficiently trapped. Diarrhoea in Country Districts. — Dr. Wilson declares that, according to his experience, much of the diarrhoea which prevails in country districts during the summer and autumn amongst children is due to polluted water, drunk either as it is drawn from the well or when mixed with milk, fraud- ulently or by accident. Impure Ice as a Cause of Diarrhoea. — The fact that ice is now used by almost all classes to an extent which entitles it to rank rather as a necessity than, as formerly, as a luxury of life, renders it important that its purity should be as jealously guarded as the water-supply. It is popularly be- lieved that water frees itself from dangerous organic matter, as it does to a great degree from certain saline contaminations during the process of TYPHOID FROM IMPURE WATER. 161 freezing, and also that the vegetable or animal germs of typhoid and otliOT fevers are killed, or at least rendered sterile, by congelation of the water in which they exist. Both these ideas are, however, unquestionably er- roneous, as has been repeatedly proved by the various experiments which ignorant hotel-keepers try without the least intending it, upon their guests, on a scale which would make the boldest vivisector stand aghast before the suffering inflicted, even if it were only upon the brutes which form the subjects of his researches. A Case of Impure Ice Poison. — Such was notably the case in an epi- demic of intestinal disorder which occurred at the watering-place of Eye Beach, IST. H. From the account of Dr. Nichols, who attended most of the patients, it seems that, early in the season, a mild form of disturbance of the stomach and bowels made its appearance among the guests of a particular hotel at this favorite summer resort. The symptoms were in general giddiness, nausea or vomiting, diarrhcea and severe ab- dominal pain, accompanied by fever, loss of appetite and mental depres- sion. The well and drainage system of the establishment, which had re- cently been put in complete order, was found almost faultless, and the milk-supply of unquestionable purity; but on the attention of the phy- sician being directed to the stock of ice provided for the guests, conclu- sive proof of its dangerous qiiality was promptly obtained. The Contaminated Ice Pond — Both the house in which the ice was stored and the water from the melted ice gave off a decidedly disagi-eeable or even offensive odor. Finally, a visit to the pond from which the ice had been gathered disclosed the fact that much of the water in it was dark-colored, foul and highly contaminated with filthy marsh-mud and decomposing saw-dust. Chemical analysis showed that both it and the suspected ice contained a large excess of organic and volatile impurities, including four one-hundredths of a grain per gallon of albuminoid am- monia. Fever Germs in Ice In Connecticut, the Board of Health informs us that, in several instances, attention has been drawn to sewage-con- taminated ponds with ice-houses upon their borders, and that several isolated cases of typhoid fever, and one death, from the free use of ice polluted by sewage, had been recorded in that State. The curious natural experiment of the United States steamship Plymouth, elsewhere detailed, shows conclusively that fever germs are not infallibly destroyed by a freezing, probably not by a zero temperature, and contributes 11 162 WATEE IN ITS IITGIENIC RELATIONS. its sliare of jiroof that impure ice, especially when gathered from ponds polluted by sewage, may constitute a prolific cause of disease. Dangers in Snow-Water.^ — Snow-water, pure and fresh as it seems may be very dangerous to health in consequence of organic impurities contained in it. Mountain Fever, Kocky Mountain Spotted Fever or Tick Fever. — An acute infectious disease characterized by chill, continued fever, headache, pains in the joints and bones and an eruption on the ankles and wrists ; later all over the body. It attacks all ages and both sexes usually in the months of May and June. Stmptoms and Teeatment. — The disease follows a course of two to three weeks with a temperature of 103 to 105. The bowels are constipated and crushing pains in the limbs are quite common. The tongue is furred and nose bleeding is quite common. JSTausea and vomiting may appear during the second week. A mild type of the disease without any eruption is said to occur at times. There is no specific treatment. The patient should be protected from noise and kept in a dark room. The diet should be liquid. When tem- perature is high sponge baths should be used. Phenacetine and other an- tipyretics are used. Free purgation with calomel and salines are fre- quently used. Ague from Impure "Water. — Although the poison of fever and ague is probably, as a general rule, conveyed into the human system by the bite of mosquitoes, some cases seem to show that it may also enter the body by drinking water. Diarrhoea Outbreak from Impure Water.— ^As general conclusions in regard to contaminated water, it may be stated that: 1st. An outbreak of diarrhoea arising in a community is almost always owing to impure air, impure water, or bad food. If it affects a number of persons suddenly it is probably due to one of the last two causes, and if it extends over many families, almost certainly to water. But, as the cause of impurity may be trausient, it is not always easy to find experimental proof. Dysentery Outbreaks from Impure Water — 2d. Diarrhoea or dys- entery constantly affecting a community, or returning periodically at certain times of the year, is far more likely to be produced by bad water than by any other cause. Cholera Outbreaks from Impure Water — 3d. A very sudden and localized outbreak of either typhoid fever or cholera is almost certainly onang to the introduction of the poison by water. Malarial Outbreaks from Impure Water — 4th. The same statement is true in cases of ague or malarious fever; and, especially if the attacks DISEASES DUE TO IMPURE WATEE. 163 are serious, a possible introduction by foul water should be carefully inquired into. Worms from Impure Water— 5th. The introduction of the eggs of some of the intestinal worms, by means of driniing water, is proved in some instances and rendered highly probable in many others. People residing in districts where shallow-dip- and draw-wells are in common use, seem to be particularly subject to parasitic worms in the bowels. Pure Water a Sanitary Necessity. — 6th. Although it is not possible at present to assign to every impurity in water its exact share in the production of disease, or to prove the precise evil influence on the public health of water which is not extremely impure, it appears certain, says Dr. Parkes, that the health of a community always imi^roves when an abundant and pure water-supply is given; and, apart from this actual evidence, we are entitled to conclude from other considerations, that abundant and good water is a primary sanitary necessity. Rocks Yielding Pure Water — As a general giiide to the water im- purities that may be exjjected in waters from the various geological fornia- tions enumerated, the following condensed summary of the best known facts, as given by Dr. Parkes, will prove useful. The gi-anitic, meta- morphic, trap-rock and clay-slate waters are generally very pure, often not containing more than from two to six grains per gallon of solid matter, which is chiefly made up of carbonate and chloride of sodium, with a little lime and magnesia. The orgauic matter is very small in amount usually, but shallow wells in disintegi-ated trap-rock may, of course, be fouled by surface washings or soakage. The water from millstone grit and hard oolite is also very pure, sometimes containing only four gi-ains per gallon of mineral matters, which comprise the same saline materials as are found in granitic waters, with the addition of sulphates and a trace of iron. Rocks Yielding Impure Water — Soft sand-rock waters, on the con- trary, are often impure, containing much sodium chloride or common salt, sodium carbonate, sodium sulphate, iron and a little lime and mag- nesia, amounting altogether to from thirty to eighty grains per gallon. The organic matter may also be abundant; that is, to the extent of from four to eight grains to the gallon, or even more. Occasionally, however, these waters are quite pure. Sand and Gravel Waters — The loose sand and gravel waters also vary much in their composition, and in tolerably pure gi'avels, not near towns, the water is often very free from contamination. In many sands, which are rich in salts, the water percolating through them is, of course, much affected, the dissolved solids amounting sometimes to seventy grains per gallon, and consisting of sodium chloride, sodium carbonate, sodium sul- 164 WATER IN ITS HYGIENIC EELATION8. ]>liatc, "n-itb calcium and magnesium salts, and a good deal of organio matter. The water from the sandy plains of southern France is said to coritain enough organic matter to j^roduce ague in those who drink it. Chalky Waters. — The typical "hard" water, from chalk formations, ij very sparkling and clear, highly charged with carbonic acid, and con- tains from seven to twenty grains of calcium carbonate, a little magnesium carbonate and sodium chloride, with small and immaterial quantities of iron, silica, potassa, nitric, sulphuric and phosphuric acids in combination; organic matter is usually in small amount, and is therefore a good, com- paratively wholesome and pleasant water, whichj though hard, softens greatly by boiling. Limestone Waters. — The waters from limestone and magnesian lime- stone regions are also clear, sparkling liquids, of agreeable taste, but they differ from the chalk waters in that they contain usually more calcium sulphate, the sulphate of lime or gypsum, sometimes to the amount of twelve grains per gallon, and in dolomitic districts much magnesium sul- 2)hate and carbonate. They are not so wholesome as the chalk waters, arc Lard and soften less on boiling. Clay Waters. — The water of clayey districts is chiefly surface, and Soon runs into converging streams. They often contain much suspended matter in the form of mud, but few dissolved constituents. Waters from the mixture of sand and clay brought down by the rivers, perhaps of former ages, and called Alluvium, are generally impure. Alluvial Waters — The alluvial waters contain calcium carbonatie and sulphate, magnesium sulphate, sodium cldoride and carbonate, iron, silica, and often much organic matter, the total amount of solids reaching 120 gTains or more. Occasionally the organic matter oxidizes rapidly into nitrites, and, if the quantity of chloride of sodium is large, it might be incorrectly supposed, from analysis, that it was contaminated with sewage. Surface Waters. — Surface and subsoil waters are often highly impure, and, although very variable in com.position, are always to be regarded with suspicion until proved to be safe. Soil Waters. — Some soils contain potassium, sodium and magnesium nitrates, and give up these salts in abundance to water which soaks through them. In towns, and among human habitations, the surface and shallow- well water is often very unsafe, as already explained. It may contain large quantities of calcium and sodium nitrates, nitrites, sulphates, plios- phates and chlorides. Organic matter exists often in large amoimt and slowly oxidizes, forming nitric acid and ammonia. QUALITY OI" VARIOUS WATEES. 165 Marsli Waters. — Marsh-water always contains a large quantity of vegetable organic matter, it being not unusual to find from twelve to forty grains per gallon, and sometimes even more. Suspended organic matter is also common, but the amoimt of saline impurity is very variable. Poisoned Waters from Graveyards In water from graveyards, am- monium and calcium nitrites, and sometimes fatty acids, with much organic matter of animal origin, are met with. The water of a well at St. Didier, France, more than 300 feet from a cemetery, was found to be largely contaminated with ammoniacal salts and organic matter, which was left on evaporation. The water was clear at first, but had. a vapid taste ad speedily became putrid. Artesian-Well Waters — Artesian-weU water varies greatly in com- position, being so highly charged with saline matter sometimes that it is quite undrinkable. The artesian well at Grenelle, France, contains enough sodium and potassium carbonates to render it alkaline to the taste, although it is used for the water-supply of the town. In some cases artesian-well water contains an appreciable amount of iron; in other instances, when drawn from the lower part of the chalk formation, or the green sand below it, it is tolerably pure. The temperature of the water is iisually high in proportion to the depth of the well. Thus, for example, a well at Louisville, Kentucky, bored to the depth of over 2000 feet, discharges an immense volume of water, the temperature of which is 75 degrees Fahrenlieit. The amount of air in the water of deep artesian wells is often small, and this circumstance, with the frequently elevated temperature and high degree of saline impregnation, is apt to make stich wells very unsatisfactory as sources of water-supply. Seashore-Well Waters. — Lastly, water from wells near the seashore is apt to be brackish and objectionable on that account, even thougli it does not contain much organic matter. Dr. Parkes mentions one instance where a bored well, 150 feet deep, near the sea, yielded water impi-egnated with 500 grains of solids, including 380 grains of chlorides, per gallon. THE DETECTION OF CONTAMINATED WATER. Vigilance Over Drinking Water. — As a general rule, the examination of drinking water, in order to determine its purity, and consequent safety as a beverage, involves a chemical and microscopical analysis, which shoidd always be made when circumstances permit. Moreover, it must not bo forgotten that water which is usually pure and wholesome, may be at any 166 WATER IN ITS nYGIETTIC RELATIONS. time jiolluted by the fouling of its source during heavy rains, the occur- reuce of floods, the alteration iu the customary course and flow of sewage, manufacturing refuse, and so forth, above or below groimd. Constant vigilance over the condition of the water-sujjply is, therefore, exceedingly necessary to health ; but as complete investigation requires the skill of a professed analytical chemist, those methods of examination need only be described in detail which are especially used as giving us warning of danger, with a few of the simpler tests. Character of Water Tests. — For hygienic purposes, then, we examine water in order to discover whether it contains any suspended or dissolved ingredients which are likely to be hurtful. Some saline materials often found in water, as already mentioned, are not injurious when present in small quantities only, wliilst others, consisting of or resulting from putre- fying animal matter, are at once recognized as very dangerous to health. In any instance, reliance must not be placed upon the results of single tests, bat all the circiunstances of the case must be searched out and care- fully considered. Green Waters — Green waters generally owe their color to vegetable matters, chiefly microscopic plants, and are usually harmless, although certain bluish-green plants of this kind give rise to the disagi'eeable smell popularly denominated the pig-pen odor, and probably render the fluid unwholesome as well as disgusting. Yellow Waters. — Yellow or brown waters are the most to be feared, as their color is often due to animal organic matter, such as sewage. It is sometimes the case, however, that a yellow or brown tint is due to de- composed vegetable material, such as peat, or decayed wood, and the fluid is then merely unjileasant and not hurtful. Water is also occasionally colored in this way by some salt of iron, although in most instances the metal is precipitated as oxide of iron in the sediment. Microscopic Tests.- — The lustre or brilliancy of a water, which is recommended as a good test as to the amount of air which a specimen contains, can readily be judged by the eye; but the only satisfactory examination of the sediment must be made with the microscope, which ought to have a power of about two hundred and fifty diameters, although even an instrument of half that capacity will often reveal much of interest and importance in the deposit of a suspected drinking water. Taste Not a Good Water Test. — The -taste of a water is a very uncer- tain indicatifln in regard to wholesomeness. Of course, any badly-tasting water ought at once to be rejected, but some very agreeable waters, as far as OOLOB TEST OF WATEE. 167 tHeIr tagt'es are concerned, have proved to be dangerously contaminated with sewage of the vilest character. And yet many people are to he found all over the country who think that if a water is bright and clear it must be good; nay, if it is the drinking fluid of their own wells which is called in question, they will often indignantly resent the faintest sugges- tion that it can possibly be in the least degree injurious to health. As remarked by Dr. Fox, however, such cases as that of the servant who, coming from an obscure village near the Dartmoor, in the southwest part of England, objected to the pure water of a distant town where she was in service, becaiise it was devoid of both taste and smell, are becoming rare. Where Taste Test Fails. — As regards dissolved mineral matters, taste is of little iise, and differs in different persons. On an average, common salt is not recognized tmtil it reaches the quantity of seventy-five grains per gallon, whilst carbonate of lime is perceptible when dissolved in a water to the amount of ten grains per gallon ; iron, however, can be recognized by its astringent flavor in very small quantities, occasionally as minute an impregnation as two-tenths of a grain per gallon may be thus detected. A permanently-hard water has sometimes a peculiarly insipid or slightly saline taste, if the total salts amount to thirty-five or forty grains per gallon and the sulphate of lime or gypsum to six or eight grains. What Taste of Water is Due to. — The taste of good drinking water is due entirely to the gases dissolved ; water nearly free from the hardness of carbonate of lime, held in solution by carbonic acid, such as distilled water, is not so pleasant as the brisk, highly-carbonated waters; it may be called flat, but it is difficult to define the kind of taste or the absence of it. Rules for Pure Water — Although the general characters of a water, when examined as directed above, give only an imperfect idea of its value, they are yet important when no other investigation can be made. If the water be colorless, clear, free from suspended materials, of a good lustre, yet not too brilliant, devoid of smell and taste, except such as are recog- nized as characteristic of a safe and usable water, we shall in a majority of cases be JTistified in pronoimeing it a wholesome drinking fluid ; whilst, according to the degree in which it deviates from these characteristics, will we proportionately be sustained in regarding it with grave suspicion. Chemical Tests the Best. — Visible suspended matter is probably often the most dangerous, although there is little doubt that the microscopic germs of various diseases may exist in small aggregations without being recognizable at all by the naked eye of even the most practised observer; ICS WATER IN ITS nYGIENIO KELATIONS. and, of course, the metallic impurities, such as lead and copper, for de- tecting which rules have already been given, must often escape discovery by any examination which does not include the application of chemical tests. Nessler Test of Water — The one of these chemical reagents which it would be well to apply in every instance where it is possible to do so, is the "Xessler's test," an ounce of Avhich may be procured from almost any good chemist for twenty or twenty-five cents. It constitutes a test for the products of decomposing animal matters, especially sewage ma- terials, including human and animal excrement, and is, therefore, capable of e,'iving timely warning against the most dangerous of the common pollutions of drinking waters. The Ammonia Test. — In the whole round of chemical analysis there is no determination which surpasses that of ammonia from putrefying animal matter by this method in point of delicacy. It is questionable whether any other approaches it. Tlie ISTessler reagent is said to be capable of indicating one part of ammonia in twenty million parts of water, and even this assertion, surprising as it may seem, is given as an understate- ment of the delicacy of the test. Such being the characteristic of this way of calculating the ammonia, the great advantage of causing deter- minations of organic matter to depend on measurements of ammonia will be manifest to every one. Form of the Nessler Test. — In order to make use of this reagent, fill an ordinary wine-glass or small goblet which will hold from two to four ounces, nearly full of the water it is wished to examine, and add three or four drops of the ISTessler's solution. If a yellow or brown color, or a brownish precipitate, be produced, the water contains ammoniacal salts. As a rule, this should be regarded as a very suspicious circumstance, and should the coloration be well marked, it is almost sufficient of itself to condemn the water for drinking purposes. If a milky or curdy precipitate is also formed, it shows that the fluid is a hard water, and more or less unfit for washing. Should this whitish precipitate be excessive, it hides to a certain extent the yellowish color indicative of ammonia, so that it is necessary to take a fresh sample of the water, add to it a few drops of strong solution of caustic potash or soda, and after the precipitate of lime which is thus caused to fall has subsided, test for ammoniacal compounds with the ISTessler's reagent. The Soap-Test of Impure Water — Clark's soap-test for determining the hardness of water is prepared by dissolving a small quantity of soap. CHEMICAL TEST OF WATEE. 169 say one ounce in half a pint of a mixture of equal pa'rts of alcohol and water. It is used by dropping it into a measured quantity, such, for examjile, as an ounce of the water to be tested, until the fluid when shaken begins to form a beady lather — the relative number of drops required to produce this effect nearly indicating the comparative degi-ees of hardness of the Avaters undergoing examination. Water Test Should Always be Made — This soap-test may be used to decided advantage in all "hard-water" districts, and every one should test his water-supply at the earliest opportunity, with it, with the !tTessler's reagent for organic ammonia indicating pollution by sewage, and with the sulphide of ammonium for contamination with lead. And the appli- cation of these two latter tests is important, even although the drinking water in question has been in use for a long time by various members of a family without apparent injury, for many instances are on record in medical books where chronic derangements of health have been due to impurity of the water taken into the stomach, and yet this source of injury has been entirely unsuspected until a chemical examination of the water- supply has revealed the insidious origin of the trouble. Water Precautions for Travelers. — A wise precaution when traveling, especially in unhealthy districts or during an epidemic of any kind, is to drink none but boiled rain-water, which you can make sure has not been exposed to contamination by lead pipes, roofs or cisterns. To be eilectual, the boiling ought to be continued briskly for half an hour or longer. Rain-water is preferable in limestone regions, because the hard water con- taining lime is partially or not at all improved in this respect by boiling, and gives rise to serious diarrhoea in many of those unaccustomed to its employment. Such hard water is also probably one great cause of the very painful calculous disorders. HYGIENIC USE OF BATHS. Temperature of Baths. — Coming now to the detailed consideration of water as applied to tho hiiman skin in the form of a bath, in order to accomplish the important hygienic purposes described, it is obvious, in the first place, that temperature has a powerful influence in this respect. Cold Baths — The range of the cold bath varies more than that of any other kind, extending, as it docs, from 84 degrees Fahrenheit down to 33 degrees of the same scale. The lower temperatures included be- tween these limits would, of course, test the endurance of even the 170 WATER IN ITS nTGIEXIC RELATIONS. strongest to encounter safely the severe shock which is generally produced by the sudden application, and still more the prolonged immersion of the body in a water so near its freezing-point; but from 84 degrees to 74 degrees the reaction required is so slight that few persons who are not actually invalids are too feeble to manifest it. First Effect of the Cold Bath — A shock is experienced throughout the whole nervous system, more or less severe, according to the lower or higher temperature of the fluid, and the contracting effect of the cold aids the spasmodic contraction occurring in the small blood-vessels to drive the blood to the inner portions of the body, and allow the surface to become quickly chilled. Second Effect of the Cold Bath. — But if the cold is not too severe, or the individual is not exhausted by fatigue, or enfeebled by disease, a change in these conditions promptly manifests itself soon after leaving the bath, especially if the skin is rapidly dried by friction with some absorbent substance. The heart and pulse return to their normal rate of movement, the nervous system recovers from the sliock which it has undergone, the blood flows back to the surface of the skin, and a glow of renewed warmth is felt throughout the entire body. A Guide to Cold Bathing. — This agreeable change in the condition of the circulation and the sensations is called the reaction, and constitutes our very best guide to the employment of cool or cold bathing. If the water of a bath has been colder than is adapted to the strength of an in- dividual's constitution, reaction comes on but slowly, and several hours may elapse before the natural balance of the circulation is fully restored. In such a case, the hands, feet and nose remain chilly, and also cold to the touch of another person. The fingers, lips and indeed the whole face, has a bluish tint, and a more or less shrunken appearance. The pulse continues weak and slow, and languor and feebleness characterize all the movements. Of course, the method of deriving the greatest amount of benefit from these indications is for each person to cautiously test the power of his system to establish reaction, commencing with a bath of 70 degrees or 65 degrees, and gradually descending the scale of the ther- mometer, as he finds he is able to fully react from the depression produced by venturing among its lower depths. Time for Cold Bathing — It is recommended by some authors to resort to cold bathing either about an hour before breakfast in the early morning, or else late in the evening just before retiring for the night. The early morning bath of this kind may do very well for some few people of un- HYGIENIC USE OF BATHS. 171 usually vigorous constitutions, but as a general rule tlie evening is a better time for such a test of strength ; and for many persons the middle of the morning, that is to say, about three hours after breakfast, when the first meal of the day has been nearly all digested, and the system is fortified thereby to bear the shock and establish the necessary reaction after it, is decidedly preferable to any other period of the twenty-four hours. When to Avoid Cold Baths — Under no circumstances should a cold bath be indulged in either immediately before or immediately after a meal, on account of the tendency which its inevitable shock will have to produce more or less disturbance in the process of digestion by congesting the stomach and intestines. ISTor are cold baths suitable for individuals in either extreme of life, because both in infancy and in old age the power of developing animal heat is least efficient in its operations, and the reaction is accomplished slowly or not at all. No Cold Bath After Fatigue. — Protracted labor or exercise, whether mental or physical, if so long continued as to leave the body suffering from feelings of great weariness or exhaustion, absolutely forbid the use of the cold bath. It was under these circumstances that Alexander the Great, of Macedon, nearly perished, from plunging after a long and- fatiguing march into the icy current of the river Cydnus ; an impi-udence which, it is said, did actually prove fatal to the German emperor, the aged Fred- erick Barbarossa, at the head of his crusading army, seventeen hundred years later. In adverting to this latter event an ancient author quaintly observes: "Xo wonder if the cold water quickly quenched those few sparks of heat left in him at seventy years of age." Duration of the Cold Bath — The duration of a cool or cold bath must vary very much with the temperature of the water. When very cold the period of immersion should not exceed one or two minutes, whilst vpith water between 60 and 70 degrees, the duration of the bath may extend to a quarter or even half an hour; in every instance, however, we must be guided by the completeness of the reaction on coming out of the water. Friction After Cold Bath — Energetic friction of the whole surface of the body after bathing is highly beneficial as tending to produce the necessary degree of reaction. Active physical exercise, as well as warm and stimulating drinks, likewise aid in aecomplisliing the same desirable result. Even when a person is accustomed to the daily use of the cold bath, any sudden reduction of strength, such as may result from intem^ perance in eating, an evening debauch, or excess of any kind, particularly 172 WATEK IN ITS HYGIENIC BELATIONS. of tho sexual powers, or even over-exertion in walking or in field-sports, wiU forbid recourse to it the following morning. Kiver-Bathing. — Bathing in rivers is even more to be reconunended than that in ordinary bath-rooms during the summer season, as the gentle exercise of walking to and from the river-side, and if swimming whilst immersed in the water, promote the reaction which is so conducive to health. Evil consequences are, however, apt to result from river-bathing, if the baths are too prolonged, if too violent exertion is indulged in, or if the rays of the sun overheat the head of the bather. Dr. Bell states that he has seen continued fever, of some days' duration, and violent headache, with slight delirium, arise in boys who had thus imprudently exposed themselves. VARIETIES or COLD BATHS, Cold Sponge-Bath. — There are various ways of employing water in cold bathing, according to tho force of the current of fluid, tlie amount of surface to which it is apjilied, and so fortL Affusion and sponging are the mildest ways of using cold water as a bath, and there are few persons, not actually invalids, who cannot thus employ water, of moderately low temperature, with benefit. After the slight depression of the bodily warmth, produced by sponging with fluid of 60 or 65 degrees, of course but a mild reaction follows, but this is suitably proportioned to the feeble energies of debilitated persons. By a repetition of the process a greater endurance is developed, and colder water may ultimately be resorted to, with correspondingly increased advantage. The cool or cold sponge-bath is sometimes of great service in treating typhoid fever, and others of the eruptive diseases, as will be explained in the second part of this work. The Shower-Bath — In a shower-bath the water falls in divided streams, and thus, being generally distributed over the whole body, gives a severe shock to the system ; such a one, should the fluid be of a low tem- perature, as only the most vigorous persons can endure. The Cold Douche. — The cold douche differs from the shower-bath in that the water of a douche is poured upon the surface of the body in a solid column, instead of a number of small streams. It is sometimes highly eSicacious in reducing the violent excitement of delirious or insane patients, but, being a very powerful agent, should be used only vsdth cau- tion and close watching, never in the indiscriminate way customary in some so-called hydropathic establishments, from which it is said that more than one sudden death has been the lamentable result. COLD BATHING. 173 The Bath for Old Age. — The advance into old age of those who, in the vigor o£ youth and maturity, have accustomed themselves to the regu- lar use of the cold bath, does not necessarily interpose an obstacle to the continuance of the practice of bathing, provided the general health re- mains good. But if there be evidence of feebleness of the functions, or disorder in any one of the great systems of the body, such as the digestive apparatus, or the muscular system, so as to prevent the customary allow- ance of nutritious food or of exercise being taken, the cold i^lunge or shower-bath should be given up, and simple washing with cold water, followed by active friction, substituted in its place. Should even this prove rather too great a shock for the enfeebled powers of life, as may be evinced by want of prompt reaction subsequently, recourse to anything but the tejiid or warm bath must be strictly prohibited. The Water-Cure. — The evidence in favor of gi-eat benefit being de- rived in suitable cases from the so-called water-cure, in the numerous hydropathic establishments of Europe and this country, is very convinc- ing; and, in fact, it is probable that persons generally of great mobility of temperament, who are readily excited and readily depressed, and whose nervous system is soon exhausted by either bodily or mental efforts, will often find relief in the systematic use of a moderately cool or cold bath. Objection to Hydropathy — The difficulty is with establishments of this kind that, being carried on as business enterprises, their proprietors are not withheld, by any philanthropic considerations, from looking at every case which applies to them with an eye to business, and recommend- ing their particiilar cure to all possible patients, except where they are very sure that positive injury will result from the treatment. It is there- fore advisable, in every instance, to consult some reputable physician, who is not devoted to any exclusive system or dogma of medical practice, before submitting oneself to the powerful agencies of water as applied by hydropathic practitioners. Cold Bathing Removes Heat. — Dr. Bell judiciously remarks that there is a class of iK-oi^lc, who suffer from a sedentary life, devotion to the desk in business, or to study, and complain of troublesome heat and dryness of the hands, and sometimes of the feet, with accelerated pulse and thirst ; their appetite is not good, nor their sleep sound or refreshing. Though their systems be actually weaker than usual, yet is there morbid activity of the skiu, owing, in pni-t, to the vessels of the integument not relieving themselves by free and regular perspiration. Cold bathing, by mod- erating cutaneous excitement, and relieviug tlie perspiratory organs, re- 174: WATEE IN ITS HYGIENIC KELATIONS. moves the unpleasant feeling of heat and dryness ; and, Ly sympathy, pro- duces noarlv corrcs]iondent effects on the stomach. The Flesh-Brush and Exercise — The use of the flesh-brush and exer- cise in the open air are, it may he supposed, powerful auxiliaries to the measures just rccoiumcndcd. Cold Bathing for Eheumatism. — There are many persons who, tliough enjoying what is often called full health, are liable to colds, rheumatic pains and stitches from any slight exposure to cold or moist air. Their vascular and nervous systems are both tolerably excitable, and they are readily thrown into perspiration from even moderate exercise or warm apartments. In them it is desirable so far to regulate the functions of the skin as to moderate its stimulation, and prevent the consequent debility which follows this state. Cold bathing accomplishes this purpose, and keeps the skin in a less constant condition of excitement, renders it less liable to sweat so freely from exposure to external warmth or by active exercise, and, of course, prevents the subsequent languor and suscepti- bility to morbid and enfeebling agencies. It would be a great mistake, in such a case, to talk of the tonic action of cold bathing. Its beneficial operation is evinced here at a time when no stimulus or tonic is admissible, and in habits sanguine and plethoric, on which nearly similar effects with those from cold bathing would be produced by a moderate bleeding, re- duction of the usual quantity of food and diluent drinks. HYGIENIC APPnCATION OF WAUM BATHS. Temperature of Warm Bath — When the water used for bathing has a temperature of from 92 degrees to 98 degi'ees Fahrenheit, it produces upon the skins of most people the sensation of warmth, and although water of this degree of heat is usually employed chiefly for cleansing purposes, yet it has hygienic properties of a sufficiently marked character to render it worthy of especial notice. Since water is a much better conductor of heat than air, and esjiceially than confined air, as much caloric is extracted from the human body when immersed in water which is only a few degrees lower than the average human temperature, as by air of much greater relative coldness. Effect of Warm Bath — The warm bath diminishes the frequency of llie pulse, especially when it has been greater than natural, and this effect is almost exactly in proportion to the duration of immersion. It also renders the respiration slower, and diminishes the temperature of the THE •WATEK-CUEE. 175 body, relaxes the muscular fibre, increases the bulk of the fluids by absorp- tiou, or perhaps only by restricting evaporation from the skin, removes impurities from the surface, promotes desquamation and renewal of the cuticle, lessening the hardness of the nails and indurations of the epi- dermis. Separation of Outer Skin — The separation of the outer layers of the scarf-skin or epidermis, -which may often be seen floating in small, -whitish fragments upon the bath -water, is due to t-wo causes. In the first place, it is softened by the water, and so rendered more easily removable by slight friction; and secondly, it is in jjart pushed off by the increased fullness of the blood-vessels underneath. A humorous -writer has com- pared the epidermis which covers the "whole surface of the body to a tight shirt, and a dirty cuticle, therefore, to a dirty shirt which is gotten rid of by the aid of a bath. Take Short Warm Baths. — A prolonged daily use of the warm bath is apt to cause erujjtions on the skin similar to those which managers of -water-cure establishments pronoimce critical, and of the greatest advan- tage in certain diseases of the nervous system. Warm Baths Soothe the Nerves. — An immediate and very agreeable effect of the warm bath is to soothe a nervously excited condition and promote sleep, -which to many people is peculiarly refreshing -when pro- cured by this means. Time to Take Warm Baths. — The best period for taking a warm bath is about an hour previous to the mid-day meal, because then the disturb- ance of the circulation will have time to pass off before food is introduced into the stomach, and the secretion of the gastric juice and other fluids necessary for digestion -will not be thereby interfered -with. Duration of Warm Baths — The duration of a -warm bath ought not to exceed in ordinary cases half an hour, although in the -warm -water-cure of Leuk, in Switzerland, patients sometimes remain in the tepid fluid five hours in the morning and three hours in the afternoon, with alleged bene- fit. In the Leuk bath, persons breakfast from little floating tables, -which afterwards serve to support books and newspapers for their amusement, and it is said that the Emperor Charlemange used to hold prolonged levees ■whilst immersed in his -warm bath at Aix-la-Chapelle, -which was supplied by one of the numerous thermal springs of that famous city. Warm Baths in Acute Diseases. — The relaxing and soothing influence of the warm bath is an invaluable aid to the treatment of many acute diseases, and being, as a general rule, devoid of danger in its application. 176 WATEK IN ITS IIYOIENIC RELATIONS. is a rcmetly peculiarly adapted to domestic practice, particularly among cliildreii, before the skilled physician, who should always be sent for im- mediately when a person it attacked with any acute disease, has time to arrive. Its prompt remedial effects may often be observed in bilious colic, in painter's colic induced by the poisonous influence of lead, in spas- modic croup, in infantile convulsions, in mental excitement bordering on delirium or even violent maniacal frenzy, and in many other diseases, as will be more fully explained in the second part of this book. HOT BATHS. Temperature of the Hot Bath. — The hot bath is so designated if the water employed is above the natural blood-heat of about 98 degrees Fahrenheit, and may range as high as 110 degrees, above which it is seldom safe to use water over the whole surface of the body. Of course, habit will often enable a person to endure the local application of water having a much higher temperature than this without injury. Effect of Hot Baths — Hot baths are decidedly stimulating, and rap- idly jiroduce redness of the skin with quickening of the pulse and respira- tion. Perspiration is poured out upon the face in great abundance, the mind becomes dull and inattentive, and, if the immersion is unduly pro- longed, vertigo and apoplexy may sujiervcne. One experimenter lost, dur- ing the short space of eight minutes, in a bath of the temperature of 113 degrees, about a pound and a half of his weight. Even a hot foot- bath of 110 degrees is stated in one case to have quickened the pulse from seventy-seven to ninety-two, and to have caused some headache in about half an hour. In another instance a foot-bath of 113 degrees raised the pulse from sixty to one hundred and five beats per miniite in five minutes, and flushed the face, but without bringing on headache. Where Danger Lies. — The hot bath ought therefore to be employed cautiously or not at all by persons of sanguine temperament, and those of robust or plethoric habit of body, especially if there is any hereditary tendency to apoplexy in their families. Where Good is Derived — This powerful remedy is, however, capable of doing good service in conditions of torpid, sluggish circulation, dry and cold .skin, feebleness of muscular movement, and a low grade of sensi- bility; but great care must be used not to mistake this state of the system in an individual naturally weak and phlegmatic, or enfeebled by old age or chronic disease, for the languor of the vital processes which is pro- HOT BATHS. . 177, duced by acute inflammation, or pressure of the blood upon tlic brain or upon tlie lungs. When to Avoid Hot Baths. — In suspended animation from sunstroke, apoplexy, insensibility from inhaling noxious gases, or from swallowing narcotic jjoisons, disastrous results might be, and probably would be, pro- duced by the application of a hot bath. When to TJse Hot Baths — In exhaustion and torpor from exposure to intense cold, the hot bath, contrary to popular opinion on the sub-ject, is a most valuable remedy. Some recent experiments performed in Kussia, in order to determine what is the best way to resuscitate animals which have been subjected to such severe cold as to be almost fatal in its effects, gave the following results: Of twenty dogs treated by the customary gradual method of bringing them into a cold room which was slowly warmed, fourteen died ; of twenty similar animals introduced at once into a warm room, only eight died ; whilst of twenty in an analogous con- dition, which were placed at once in a hot bath, all recovered. local Hot Baths — Hot baths applied locally to small portions of the body only, have often proved beneficial in gout and in acute as well as chronic rheumatism, and are highly recommended by some authorities for the relief of piles, in certain affections of the kidneys, and in some female disorders. Sundry modifications of the liot bath, such as the Turkish bath, the vapor bath, and so forth, have, under certain circumstances, con- siderable value. THE HYGIENE OF SEA-BATHING. When to Refrain from Sea-Bathing — The long line of seacoast belong- ing to the United States, and the large proportion of oiir popiilation which resides within a day's journey of the ocean, by placing a salt bath within the reach of many readers, render the subject of sufficient importance to be separately discussed. On paying a visit to the seaside, it is well to refrain from bathing, and indeed from exposure to the rays of the sun on dry land also, for a day or two if possible after arrival, or until the system becomes a little accustomed to the effect of the salt air and the surroundings. The rules already given in regard to the time of bathing, and especially as to not entering the water for an hour or so before or after a meal, ought to be strictly adhered to. Duration of Sea-Baths — The time spent in the water cannot be pre- scribed with the same exactitude, since the proper length of a dip in the ocean varies very greatly with the temperature of the water and air, the 12 178 WATKE IIT ITS IITGrETfIC EEI.ATIONS. vi"-or of tbe individual's constitution, Lis temporary condition of health, and so forth. But in the state of the circulation "we fortunately have a general guide, which every one can readily consult for himself, and quickly determine vehen nature decides that the bath should promptly terminate. After the first shuddering inspiration, which is generally produced by the application of cold water to the bare surface of the body, with the quick- ened pTilse and breathing which for a few moments accompany it, the pulse, the action of the heart, and the respiration all become slower for a short time, and then are again accelerated. Signs to Stop a Sea-Bath — But if immersion in the cold sea-water is too long contiuiied, the pulse and the breathing are again reduced in frequency, a sense of chilliness comes on, and vrith this a slight blueness of the lips, and of the fingers underneath the nails, makes its appearance. The moment this is perceived it should be accepted as an imperative order to quit the water at once and restore the lost activity of the circulation, which it indicates, by energetic friction of the surface with warm, dry towels as speedily as possible. As a general rule, from five to fifteen minutes is amply sufficient time to spend in the surf, and it is far better to err on the prudent side by coming out needlessly soon, than to prolong the bath until the teeth begin to chatter and the fingers have the shriv- elled, bluish-white appearance of a washerwoman's hand, thereby risking some serious internal congestion afterwards. When the water is unusually cold, and especially when the air is also chilly, a bath in the ocean, if taken at all, should be correspondingly brief. What Sea-Bathers Should Do — In order to obtain the best results, a bather should outer the water whilst he is comfortably warm, and yet not in a free state of perspiration. It is a good plan to wet the head and breast first, or after wading only a short distance from the edge, for the purpose of avoiding the temporary fullness of the brain, which leaves some persons with a dull licadache for several hours ; also, if the sun is shining brightly, a bathing hat, or other protection for the head and nape of the neck, ought always to be worn. Adjuncts of Sea-Bathing — Floating, diving and swimming are ex- cellent ways of adding to the pleasure of the sea-bath, but the latter should not be indulged in when the surf is very heavy, when the tide is running out, or when tbere is a strong current nearly in a line with the margin of the beach, as the latter may diverge a little from the coast, and carry the bather too far out to sea before he is aware of his danger. INDEX TO PART III OF BOOK III Preventive Medicine Pure Air Necessary for Health Part III of Book III deals with effects of air upon health and shows the necessity of taking every possible precaution to secure pure air in the home. SUBJECTS OF THE TEXT Air, Action of Impurities of i86 Air, Bacteria in 187 Air a Blood Purifier 181 Air Changes, Frequency of 196, 197 Air, Composition of Pure Air 182 Air and Consumption 198 Air, Contamination by Sewer-Gases, 198 Air, Fatal Results from Impure Air, 181 Air, Impurities of 186 Air, Localities of Pure Air 183 Air, Necessity of Pure Air i8r Air Poisoning 186, 187 Air, Qualities of Pure Air 182 Air, Quantity for a Room 195 Air, Residual 185 Airs, Relative Weight of 196 Anatomy of the Respiratory Tract. . . . 183 Apartments, Size of I95 Asthma, Grinders' 201 Bacteria in the Air 187 Blood Purifier, Air as 181 Breathing, Frequency of l8s Change of Air, Necessity of Frequent Change 196, 197 Clothing 187 Coal Dust as a Cause of Consumption, 200 Cold Air 187 Composition of Pure Air 182 Consumption and Air 198 Consumption, Coal Dust as a Cause of, 200 Consumption, Saw-Grinders' 201 Contamination of Air by Sewer-Gases, igS Danger of Saliva-Loaded Dust 200 Dangers of Neglected Ventilation. .. .198 Dangers from Wet-Grinding 202 Diphtheria from Sewer-Gas 199 Diseases, Match-Makers' 203 Dust- As a Cause of Disease 2co Coal Dust as a Cause of Consump- tion 200 Danger of Saliva-Loaded Dust 200 Fume Poison 203 Grinders' Asthma 201 Magnetic Plate, The 203 Match-Makers' Diseases 203 Mechanical Fan, The 202 Metal Fumes 203 Pottery Dust 202 Saw-Grinders' Consumption 201 Tobacco Dust 203 Wall-Paper Poisons 203 Wet-Grinding, Dangers from 202 White-Lead Poison 203 Effects of Temperature 197 Examples of Sewer-Gas Poison 199 Fan, Mechanical, for Dust 202 Fatal Results from Impure Air 181 Frequency of Air Changes ig6, 197 Fumes, Metal 203 Fume Poison 203 Gas Poison, Examples of Sewer-Gas Poison 199 Grinders' Asthma 201 Grinders' Consumption 201 Health, Influence of Winds on Health, 192 Heart Function in the Respiratory Tract 184 Importance of Ozone 194 Importance of Ventilation 194 179 180 INPEX TO PART III OF BOOK III. Impure Air, Fatal Results from i8i Impurities of Air i86 Impurities of Air, Action of i86 Influence of Winds on Health 192 Larynx, The 183 Localities of Pure Air 183 Lungs, The 183 Magnetic Plate for Metal Dust 202 Match-Makers' Diseases 203 Mechanical Fan for Dust 202 Metal Dust, Magnetic Plate for 202 Metal Fumes 202 Natural Ventilation 196 Necessity of Pure Air 181 Neglected Ventilation, Dangers of 198 Origin of Ozone 194 Ozone — Importance of 194 In Pine Woods 194 Origin of 194 Property of Turpentine 194 Physiology of the Respiratory Tract, 184 Pine Woods, Ozone in 194 Plate, Magnetic, for Metal Dust 202 Poison, Examples of Sewer-Gas Poison 199 Poison, Fume 203 Poison from Sewer-Gas 199 Poison, White-Lead 203 Poisoning, Air 186, 187 Poisons in Sewer-Gas 199 Poisons, Wall-Paper 203 Pottery Dust 202 Process, Hardening 188 Property of Turpentine 194 Providing Against Weather 189 Pure Air, Composition of 182 Pure Air, Locality of 183 Pure Air, Qualities of 182 Quantity' of Air for a Room 195 Relative Weight of Airs 196 Residual Air 185 Respiration 185 Respiratory Tract — Anatomy of 183 Heart Functions 184 Larynx, The 183 Lungs, The 183 Physiology of 184 Trachea, The 183 Room, Quantity of Air for 195 Room, Sleeping 196 Saliva-Loaded Dust, Danger from.... 200 Saw-Grinders' Consumption 201 Sewer-Gas — Avoiding Poison from zoo Contamination of Air by 198 Diphtheria from 199 Examples of Sewer-Gas Poisoning, 199 Poisons in 199 Proof of Poisons in igp Typhoid from 199 Vomiting from 199 Size of Apartments 195 Sleeping Room, The 196, 197 Ventilation in 197 System of Ventilation 194 Temperature, Effects of 197 Trachea, The 183 Tract, Respiratory. See Respiratory Tract. Turpentine, Property of 194 Typhoid from Sewer-Gas 199 Ventilation — Dangers of Neglected Ventilation, 198 Effects of Temperature 197 Frequency of Air Changes 196, 197 Importance of 194 In Sleeping Rooms 197 Natural Ventilation 196 Quantity of Air for a Room 19S Size of Apartments 195 Sleeping Room, The 196 System of 194 Weight of Airs 196 Vomiting from Sewer-Gas 199 Wall-Paper Poisons 203 Weather Observations 189 Weather, Providing Against 189 Weight of Airs, Relative 196 Wet-Grinding, Dangers from 202 White-Lead Poison 203 Winds, Influence on Health 192 Lungs, The UST OF ILLUSTRATIONS 183 I Lungs, Air Passages of. .184 PREVENTIVE MEDICINE PART III. PURE AIR NECESSARY FOR HEALTH THE VITAL NECESSITY OF AIE. Value of Pure Air — There are some things in nature of which we take but little cognizance, probably from the fact of their apjiarent sim- plicity. Pure air, pure water, pure food are essential and fundamental to good health and health to happiness, so we see that our very lives depend upon the exercise of principles which we neglect to study and understand, possibly on accoimt of other and manifold duties. But natnre's laws are invariable, and the time comes when dire results follow a disregard of first principles. Any one wiU admit that pure, unadulterated food is necessary to health. Pood is converted into blood, which having circu- lated through the body is unfit for further use until purified. Air a Blood Purifier. — It is through the medium of the air, with its life-giving oxygen, that the blood is purified. It therefore follows, logic- ally, that air and pure air is necessary to health and, other things being equal, the health will be imperfect in proportion to the impurity of the air we breathe. It should be our aim to learn much of so important a con- dition of health in order that we might, so far as is possible, avoid disease. Necessity of Pure Air. — Not only is pure air of value to preserve a state of health, it is an absolute necessity. It is true that some persons with strong wills and capacious lungs can perform the feat of holding the breath, but if they endeavor to prolong the experiment from a minute and a half to two minutes the need of breathing becomes so intense that control over the muscles of the chest is lost and a deep inspiration must be drawn in spite of resolutions to the contrary. If the access of fresh air to the lungs is absolutely prevented by external force death speedily takes place, the fatal result occurring in from five to fifteen minutes. This latter condition is present in hanging and drowning and in some forms of croup in children. Pour minutes Is the limit of time a person can be deprived of oxygen and live. Fatal Results from Impure Air — IvTo better illustration of the fatal effects of impure air upon the human svstem can be brought forward than (181) 182 PTTEE AIR AS A CONDITION OF HEALTH. the lamentable history of the Black Ilole of Calcutta, a prison in India, the horrors of which have rendered it memorable even in that land of ferocious cruelty. According to the accoimt of a survivor, 146 persons were shut up on a sultry night in June in a prison eighteen feet square, furnished with only two small windows, both strongly barred with iron. The thirst and oppression of breathing felt by the unhappy prisoners soon became intense, and the scanty supply of water brought in compliance with their entreaties only made the confusion more terrible, and caused several to be trampled to death. This scene of misery proved entertain- ing to the brutal guards outside, who supplied them with water that they might have the satisfaction of seeing them fight for it, as they phrased it, and held up lights to the bars in order that they might lose no part of the inhuman diversion. Frantic Pleas for Air — ^Before eleven o'clock most of the gentlemen, who formed about one-third of the whole, were dead, and "air! air!" be- came the general cry. Renewed insults were devised for the purpose of provoking the guards to shoot them, and every man had eager hopes of meeting the first bullSt. About two o'clock in the morning the survivors crowded so much to the windows that many of them died standing, unable to fall on account of the throng. About six in the morning an order came for their release ; but at that time, out of the 146 who went into the dun- geon ten hours before, only 23 remained alive, and all these miserable survivors were in a highly feverish condition, several dying from putrid or typhus fever soon afterward. We Breathe Out Poison. — Such, then, are the frightful consequences of overcrowding together a large number of human beings, and thus depriving them of fresh air in such, a way that they are exposed to the poisons of their own contamination, comjjrising carbonic acid and the secretions from the lungs and skin. ^\Tiolesale poisonings by very impure air of this kind are fortunately seldom met with, but the gradual injury to health and destruction of life-force, produced by breathing an atmos- phere slightly contaminated with noxious ingredients, are exceedingly common, and probably give rise to or aggravate a large part of the diseases to which our flesh is heir. GUALITIES or PURE AIH. Composition. — In speaking of pure air we refer to a standard con- dition of air. The air is a mechanical mixture of elements. As ordinarily met with at the surface of our earth, pure air, when analyzed, is found to be composed of seventy-nine parts of nitrogen and twenty-one parts of QUALITIES OF PURE AIR. 183 oxygen to every one hundred parts o£ air. It contains also a considerable quantity of watery vapor, a trace of ammonia, and from three to six parts in ten thousand of that deleterious gas carbonic acid. Oxygen is the active element. If a candle be held in oxygen it would burn more brightly than in ordinary air, and so our own lives, if lived in an atmos- phere of oxygen, would be more quickly spent. Our tissues would be quickly used up. ISTitrogen, which forms so large a proportion, acts simply as a diluent ; of itself it cannot support life, and a lighted candle held in nitrogen gas is quickly extinguished. Carbonic acid gas, or, as it is called, carbon dioxide, is normal to the extent of .04 per cent., and though it is useless to animals, it is quite as necessary to plant life as is oxygen to us. Localities of Pure Air. — As air is rendered impure by respiration, the purest air is found in those localities farthest removed from human, habitation, i. e., on the mountain tops and upon the ocean. When there is a tendency to disease or during recovery from a disease residence in the mountains or at the seashore is of distinct benefit. In order to imderstand how it is that the breathing in and out of the air of a room in time vitiates it, it will be necessary to explain some points of the anatomy and physiology of the respiratory tract — and the act of respiration. RESPIRATORY TRACT. Anatomy. — The respiratory tract is made up of the lungs and the air passages leading to them. The air passages comprise the larynx or voice box, the trachea or windpipe and the bronchial tubes — two in number — which are branches of the trachea. The Larynx — The larynx is situated at the upper part of the trachea and presents in front the prominence known as Adam's Apple. The Trachea — The trachea or windpipe is four and a half inches long, and extends from the larynx to about the middle of tlie breast-bone or sternum, where it divides into the two bron- chial tubes. The Lnngs — The lungs, two in number, are eituJfted in the cavity of the thorax or chest, one on either side of the heart. The lungs are made up of lobes, and the lobes are made up of still smaller divisions called lobules or little lobes. These latter are quite small, one one-hundred and twentieth of an inch in diameter, and they The Lungs. 184J PUEE AIE AS A CONDITION OF HEALTH. represent the ultimate divisions of the bronchial tubes, which have rami- fied and subdivided like the branches of a tree. Surrounding each lung and lining the cavity of the chest is the pleura, an inflammation of which constitutes the disease known as pleurisy. Physiology — The larynx, trachea and bronchial tubes admit the air to the lungs. The larynx, in addition to this function, is the organ of voice, being supplied with the vocal cords. Voice is produced by the out- going air setting these cords into vibration. The air cells, of which the lungs are composed are the meeting places of the air and the blood for the purpose of the exchange of oxygen and car- bonic acid. Heart Functions The heart, which is a thick, strong muscular bag, pumps the blood through the lungs as it goes round and round through the circulation, at the rate of about sixteen hundred pints of the vital fluid every hour. These sixteen hundred pints of blood, by being spread out in the fine network of delicate tubes in the walls of the air-cells, get rid of nearly sixty pints of carbonic acid, and absorb rather more than sixty pints of oxygen in that length of time. Upon this gaining of fresh oxygen and getting rid of stale carbonic acid unceasingly, our very lives depend, for, as demonstrated in hanging and drowning, if this interchange of the gases in the blood is interrupted for even the space of a few minutes death is the effect. ■Unceasing Heart Pumping. — Whilst life continues, night and day, our hearts must go on pumping dark, purple, venous blood into the lungs, to be there purified and changed into red arterial blood by losing its carbonic acid and gaining fresh oxygen, which is carried to every part of our bodies, as has been just explained, conveying everywhere its own new and vigor- ous life. Night and day, too, quite as unceasingly, must the lungs do The Air Passages of the Lungs. EESIDTTAI. AIR. 185 their part, by piimpiBg in fresh air to furnish this requisite supply of revivifying oxygen; and, what is almost equally important, they must pump out the air which has been partly deprived of its oxygen, and has received in its x^lace the worn-out and now deleterious substances got rid of by venous blood. This constitutes the pulmonary circulation in dis- tinction to the circulation of the blood through various parts of the body for purposes of its nutrition which constitutes the systematic circulation. Respiration — The lungs, which contain the air, are not active in the act of respiration. The chest cavity enlarges by the contraction of the diaphragm and the elevation of the ribs and sternum, so that the chest is enlarged in its vertical, its transverse and its antero-posterior dimen- sions. With this enlargement the pressure from without is greater than the pressure from within, and the air rushes in, thereby distending the air vesicles. In expiration the chest-cavity diminishes in the diameters in which it has been increased, and, as a result, the air in the lungs is sub- jected to pressure, and consequently rushes out. The air that passes in and oiit with each respiration is called tidal air, and is equal to twenty cubic inches of air. But, after an ordinary inhalation, it is possible, by the exercise of a little eifort, to breathe in still more air, to the extent of one hundred cubic inches. This is called the complemental air. After an ordinary expiration it is still jjossible to breathe out air to the ex- tent of one hundred cubic inches. This is called the supplemental or reserve air. Residual Air — After all effort to expel air from the lungs there still remains about one hundred cubic inches, called the residual air, from the fact that it resides in the lungs. But we must not get the idea that this residual air is imchanged, for it is ever being purified. Frequency of Breathing — The respirations vary from fourteen to eighteen per minute. They are greater during infancy and childhood. It is then during respiration that the fresh air, laden with oxygen, is carried to the blood to give to the blood its oxygen, and to receive in its place carbonic acid. But the air does not meet the blood directly. On the outer side of the air cells we have the air, while distributed on its inner side we have the small blood-vessels or capillaries which have carried the blood to the lungs. So that separating the air from the blood we have, first, the walls of the air cells, and second, the walls of the capillaries. But these two are so thin and delicate that the exchange can readily take place through them. 186 PUKE AIR AS A CONDITION OF HEALTH. IMPURE AIE. The Impurities of the Air. — The light of modern research has enabled us to know much of atmospheric conditions conducive to disease and health, the latter particularly engaging our attention at this time. The impurities of the air are, first, suspended substances and, second, gaseous substances. The suspended substances are particles of almost every known substance, the most important being sand, dust, soot, pollen, micro- organisms of all kinds, particles of food and clothing. The gaseous im- purities are carbonic acid, whenever it exceeds .05 per cent. ; carbon monoxide; sulphur dioxide; sulphuric, hydrochloric and nitric acids; hy- drogen sulphide, ammonia and its compounds, and organic vapors from decomposing animal and vegetable matters. Action of Impurities of the Air — The solid impurities act by clogging up the air vesicles, thereby interfering with their function. They may of themselves be causes of disease, as in the case of micro-organisms. The gaseous impurities act, first, by virtue of their own toxic or poisonous properties and, second, by the fact that they take the place of the neces- sary clement, oxygen. Carbonic acid is normal to the extent of .04 per cent. As before mentioned, air that we inhale contains twenty-one parts of oxygen and seventy-nine parts of nitrogen to every one hundred parts of air. On the other hand, expired air contains sixteen parts of oxygen, five parts of carbonic acid and seventy-nine parts of nitrogen. If, now, "we should be placed in a room where the air is unchanged, the air inhaled contains a greater jjercentage than .04 per cent., and is consequently im- pure. Carbonic Acid — Carbonic acid is the most common impurity of air, and, with its associated organic matters from human or animal breathing, pollutes the atmosphere of closed or badly-ventilated apartments in the manner already described. Acute poisoning from contaminated air, such as took place in the Black Hole of Calcutta, is very uncommon, because people who are long shut np in over-crowded rooms always feel such an overpowering need of fresh air that they can be prevented only by main force from hurrying away from the danger to which they are exposed. Nature warns them so emphatically and irajieratively to seek a purer atmosphei-e that they become ready to sacrifice everything to obey her commands. Symptoms of Air Poisoning^. — The early symptoms of oppression from breathing impure air are too well known to require any lengthened de- scription, although the direct connection of many uncomfortable sensations EFFECTS OF EXPOSURE TO DRAUGHTS. 187 experienced iu crowded rooms, with the aerial contamiuatiorL, is not so generally understood and appreciated. Among the primary indications of physical injury to the hlood from inhaling vitiated or "second-hand" air, are a disposition to draw long, full breaths, as a result of the stifled or almost suft'ocated feeling which eai'ly makes itself apparent. This is accompanied, or soon followed, by flushing of the face, throbbing of the temples, headache and sickness at the stomach, which may even proceed so far as faintness or an actual fainting-fit, as we often see in delicate ladies accidentally wedged in crowded lecture^rooms, concert-hails or theatres. Chronic Eflfects of Air Poisoning;. — The chronic effects of long-con- tinued breathing an air which is but moderately polluted are seen in a general deterioration of the strength, appetite and digestion, a pallid dyspeptic appearance, from want of renewal of the blood. Bacteria in the Air. — Bacteriology has explained the cause of many diseases., The air is everywhere laden with them. They enter our bodies through the respiratory and digestive tracts. If our vitality or resistance is sufficient to withstand their invasion we remain in a state of health ; but, when the vitality is lowered for any reason, the bacteria invade the system and disease results. The bacteria present in the atmosphere are not, as a ride, actively disease producing. Those that do produce disease are found particularly where the discharges of diseased animals have been alloAved to collect and dry. These excretions become pulverized and are subsequently carried about in the air we breathe. The dried expectora- tion of cases of tuberculosis, of influenza, and occasionally of pneumonia, produce these diseases in this manner. The boards of health in various parts of the country are fast coming to the conclusion that expectoration upon the sidewalks, in the street cars, in public halls, and so forth, is a menace to the public well-being. In hospitals patients suffering with tuhercidous disease are obliged to expectorate in special cups or paste- board boxes, which are kept covered aiul subsequently destroyed. Similar measures might be adopted iu private practice. EVII EFFECTS OF EXPOSURE TO DRAUGHTS. Cold Air Cold air, and especially cold, moist air, is so often a factor in the production of disease that the consideration of this constantly im- pending danger to health and its hygienic treatment by the means of Buitable clothing is very important. Clothing. — Contrary to the popular notion, clothing gives no heat 188 PtTEE AIK AS A CONDITION OF HEALTH. in itself, but only saves the beat of our bodies from escaping into the surrounding air, and it does this just in proportion as it is a bad conductor of heat. The rate at which our raiment carries off the bodily heat varies from that of a thin linen coat, for example, which conveys it away rapidly, to that of a thick fur coat, through which the loss of heat into the sur- rounding air is very gradual. Upon this difference in conducting power for heat tlie relative value of different articles of dress depends. Why Clothing Comforts. — ^Much of the comfort that clothes afford is due to the fact that they give what is called an "artificial surface" to our bodies, on which the cold air can act without our feeling it so much. It is the absence of this artificial surface on the bare hands and face which makes the fingers, forehead and ears ache so with the cold, sometimes in wintry weather, and the reason that people's toes, after a while, often ache in the same way, is that the foot-coverings frequently become chilled through, so that they no longer do their duty as protectors against loss of heat. Hardening Process. — The process of "hardening oneself" consists in rendering the skin so used to ghanges from a warm to a cold air, that its blood-vessels and nerves are comparatively little affected by the contract- ing influence of the cold. "^Making oneself tender," on the contrary, is establishing the habit of staying in wai-m air, and venturing out only when well wrapped up, to such an extent that any accidental exposure to even moderately cold blasts has a powerful, or even dangerous, effect. Harden- ing the skin against the weather is just like hardening the eyes to a bright light, or the ears to loud noises. All three may occasionally prove valuable accomplishments after they are acquired, but a certain per cent, of the people who try to be thus accomplished will lose their lives, or their eyes, or their ears, in the process. No doubt thousands of young girls have died of consumjition caught in the attempt to harden themselves to going with bare amis and bare necks, in the costimie absurdly called "full dress" by fashionable society. Bangers to be Avoided — In every effort to harden oneself against the influence of changes of the air, and likewise in the practice of that accomplishment after it is acquired, any saving of clothes is often more than compensated for by a waste of extra food used up in maintaining the animal heat, through the process of burning up the fatty and starchy articles of our diet. Besides this, a great and frequently an unnecessary strain is imposed upon the digestive organs, in preparing this extra supply of nutriment, and the nervous system is also severely taxed in regard to both the digestive and the heat-regulafiug operations, so that study or WEATHEE OBSEKVATIONS. 189 other mental efforts may be seriously interfered with. Hence the harden- ing process should only be ajjplied to our bodies in the most carefully considered way, by people who are, at the time the experiment is tried, in good health, and those especially who are free from any tendency, in- herited or otherwise, to disease. When to Venture Out of Doors — As a substitute for hardening oneself by exposure to all sorts of atmospheric changes, without carefully, regu- lated protection, attention to the weather indications, or "probabilities," as published every day in the newspapers, has of late years become of great imj^ortance from a hygienic point of view. In fact, the study of sanitary meteorology, as this branch of the science might be called, for the purpose of determining what hygienic precautions in regard to cloth- ing, ought to be instituted against hot, moist, or cold air, what days or what hours convalescent patients, and especially children, may venture out of doors, when is the best time for invalids to bear removal, and at what periods neuralgic and rheumatic patients must exercise particular care against exposure, has a highly practical, and sometimes an almost incal- culable value. Providing Against Weather. — ^Any one, by consulting the daily "indi- cations" in the public prints, can provide against the weather correctly about eight times out of ten, but in order to avoid most of the remaining 20 per cent, of blunders, it is only necessary to combine the knowledge obtained from the signal office predictions with that derived from ob- eervations upon an aneroid or mercurial barometer, as described In the following pages. WEATHER OBSERVATIONS. Signal Service Bureau — From the time the great Dr. Johnson uttered his famous sarcasm upon observers of the weather, to wit, "A certain set of men pass their lives in watching the changes of the weather, and die at a good old age with the conviction that the weather Is changeable," little has been accomplished in rendering us more truly weather-wise, until the splendid results attained by our own Signal Service bureau gave a new impetus to the sttidy of meteorology. Value of Weather Observations.— Eew can dispute that not only the hyglenists of America, but also those of the Old World, are under great obligations to our National Government, which, taking timely advantage of opportunities never before presented in the history of mankind, has utilized them with marvelous success. Weather Reports. — These opportunities consist, of course, in the cir 190 PURE AIR AS A CONDITION OF HEAl,Tir. cumstances, first, that in. our American Union there is a larger compact portion of the earth's surface inhabited by civilized man, now under the same jurisdiction, and controlled by one central authority, than in any antecedent epoch; and second, that by the most extended sj'stem of tele- graphic communication ever organized, it has been possible, during the last decade, for the first time in the history of the world, to obtain in- stantaneous and simultaneous weather reports from an area of the earth's surface occupying the whole breadth of our continent, stretching from the thirtieth almost to the fiftieth parallel of latitude, and comprising more than three millions of square miles. Methods of Observing Weather. — Over this vast section of country signal stations have been established, under the direction of the Weather Bureau, at least wherever practicable, and to such extent as the yearly appropriation would permit. At these stations three observations are taken daily, at the same moment, the hours selected being 7 o'clock a. m., 3 p. M. and 11 r. m., Washington time. Weather Maps. — ^By this plan the changes from hour to hour and day to day, as well as the effects which are produced by these alterations, are noted, and after these records are forwarded to the central office, they are reproduced in a permanent form upon the daily weather map, which is transmitted as far as practicable over the country. Here these daily maps may justly be entitled "the geogi-aphy of our atmosphere." With- out examining them, we can uo more secure an accurate conception of the general state of the weather than we could gain a correct idea of the real arrangement of seas, continents and islands, as represented upon geo- grajihical maps, by walking a few miles along the coast, or climbing over a range of mountains. Storms — By means of the extensive series of observations, carried on thro\igh several years by the United States Signal Ofiice, it has been discovered that storms occur in areas of low barometer, rounded or oval in form, and two or three hundred miles in diameter, which travel across our country, from west to east, exactly opposite to the apparent movement of the sun in the heavens. The storm therefore is an immense ring or oval of wind, cloud and rain, which speeds across the country about as rajjidly as a fast express train; that is, from about 300 to 600 miles in twenty-four hours. Direction of Storms. — Such storms usually come to us from the Pacific coast, and by having telegraphic messages sent to Washington from several of the western stations on the Pacific Pailroad, announcing at what time the storm reached each one respectively, the observers of the signal office WEATHER OBSERVATIONS. 191 can, of course, tell just how fast tbat particular tempest is advancing, and calculate wlien it is due in Washington, exactly as the railroad officials can tell, if they are informed by telegi'aph, precisely what time their train tvill arrive from the west. Evidently, after being thus notified, it is an easy matter for the Washington authorities to send word to the people in the neighborhood to get ready to meet the rain in one instance, or their friends at the depot in the other. Storm Paths — The path of an area of low barometer across the con- tinent has been aptly compared to the track of an immense water-cart, tho centre of which is, as a general rule, the line of most violent storm. Tho average rate of motion for such a storm-centre is 350 miles a day, although it may vary from 100 to 1200 miles in twenty-four hours. The winds commonly blow from all quarters towards the area of low barometer, the many apparent exceptions being caused by moimtain-ranges, valleys, and so forth, turning aside the currents of air. Barometric Effects. — From this it follows that, when the area of low barometer is running on a line of high latitude, the winds felt in places on its southern margin will be from the south, and vice versa. That is to say, if at any time an area of low barometer is passing through !N^ew York and K"ew England, the winds in Philadelphia will, in a general way, be towards it and from the south; while, on the contrary, at any time when a similar area is traveling through Virginia and Maryland, the winds in Philadelphia will be from the north, and usually cooler. The esceptions to the rule of north winds being cooler and south winds warmer, are obviously due to large volumes of cold air or of warm air, respectively, having previously been blown to the north or south of a particular position. Direction of Barometric Areas — Although the general direction of the areas of low barometer seems to be round the earth towards the rising sun, their course is sometimes very irregulai", as is demonstrated by the daily weather maps, which occasionally exhibit them traveling almost due north for three or four days, during which excursion they may pass over a dis- tance of a thousand or fifteen hundred miles, before they resume their usual easterly tendency. The storm, as before remarked, is where the area of low barometer is, and as this almost always approaches us from the west or southwest, most of our storms really come from that direction. Hence there is seldom or never a true northeast storm, much as we hear people talk aboiit "northeasters ;" and a northeast wind, with rain, results from an area of low barometer situated southwest of us, and, as a rule, traveling eastward on a parallel of latitude one or two hundred miles south of our position. 192 PTJEE AIE AS A CONDITION OF HEALTH. Uses of tlie Barometer. — The use of the barometer is especially seen in determining, by its steady and gradual rise, that the edge of an oval of low barometric pressure has j^assed over a particular place. It also indicates, by its gradual fall, the oncoming of an area of low barometer, although when, as frequently happens, a storm lags behind this area a little, rain and wind may be most severe with a rising barometer. The indications afforded by barometric observations must therefore be specially studied for each particular place, and judicially combined with the daily report of probabilities from the Weather Bureau, in order to gain the greatest advantage in sanitary meteorology. INFLTJENCE OF WINDS ON HEALTH. Variety of Influences. — Wind or air in movement exercises upon human health an iniluence which depends partly ujion its rapidity, partly upon the properties which it may have acquired from the land and water over which it has passed, and lastly upon its variations. Its influence from these various causes may be either accidental or temporary, or durable and more profound. Thus, the effect of a cold or damp wind upon an individual who is in a free perspiration, as a consequence of active exer- cise just engaged in, may be t® produce a cold, a sore throat, a bronchitis, or an attack of rheumatism, according to the predisposition or weak point of the person. Hence, as already insisted upon, every man ought to study out carefully his O'wn special aptitudes, under the agency of certain ex- citing causes, to the development of particular diseases. This is indis- putably the part of wisdom, because it is far easier to avoid these ejcciting causes, which may so I'eadily bring into action the dangerous maladies to which we are predisposed, if we are well informed concerning the exact defect in our armor against their power. Deleterious Influences — A wind, if charged with injurious substances, siich as the pestilential effluvia of marshes, for example, may carry with it the causes of serious alterations in the health. Some such winds pro- duce, in countries where they blow, diseases terrible both on account of their severity and their persistence, and which cease only with the wind which has brought them. Difference in the rapidity of the movement of the air gives rise to great variations in its effects. A moderate agitation of the air, such, for instance, as a wind moving ten miles per hour, is decidedly favorable to the proper performance of the functions of the skin, to the energetic exercise of the muscular system, and to the main- tenance of an agreeable temperature. Nothing, for example, can he INFLUENCE OF WINDS ON HEALTH. 193 pleasanter, nor in their way more healthful, during the exhausting heats of summer, than the sea breezes of maritime coasts. Sea Breezes. — When cool air is in rapid motion, however, and just in proportion to that activity, a great and speedy abstraction of heat from the surface of our bodies is perceptible. Air which in repose gave merely the sensation of agi'eeable freshness, becomes cold when in movement, and cold air under a similar change of circumstances becomes frigid. Hygienic Effects of Air in Motion. — Physiologists have calculated that, with dry air in rapid motion, the loss of moisture from the surface of the skin is ten times as great as when the air is still and moist. This fact explains the necessity of avoiding, as far as possible, exposure of the body particularly when perspiring to air in rapid motion, because the dangers of chill are thereby greatly increased. On the other hand, a very dry wind rapidly parches the skin, checks its secretions, which are so important to the maintenance of health, and produces a general feeling of discomfort. The exaggerated condition of this prejudicial influence is seen in persons exposed to the celebrated sirocco of the Great Desert of Sahara. The influence of winds depends not only upon their humidity and their rapidity, but also upon the nature of the countries which they traverse. The wind which crosses the icy peaks of snow-clad mountain-ranges carries with it for a long distance the cold with which it is charged. The town of Nice, such a favorite resort for consumi:>tives in the south of Europe, would have an almost perfect climate were it not for the fierce and frigid wind called the mistral, which occasionally visits it, blo\ving from the summits of the Alps down the valley of the Ehone. Effects of Cold Air — Cold encountered without forewarning may be the cause of disease. Too often it is a predisposing cause of disease. Cold air may of itself cause disease, as is seen in frost bite, or it may produce its results by simply making the system more vulnerable. To illustrate — it was formerly thought that cold was the cause of pneumonia. We now know that pneumonia, like many other diseases, is due to a germ. Many healthy pei-sons have the germ of pnemnonia in the secretions of the mouth. If the vitality or power of resistance is good no evil effects follow. Should the same individual be "run down" for any reason and the added influence of cold be present the germs are no longer resisted and pneu- monia results. Benefits of Winds. — But no cloud is without its silver lining:, and if we but look for it, it may be found. If we examine the subject more closely we see that winds are responsible for conditions of health, that upon winds or air in motion depends the whole subject of ventilation to be 13 194 PDEE AIR AS A CONDITION OF HEALTH. discussed later. It is bj the motion of the air that respiration is possitle. Impure air is diluted hy pure air, and then rendered purer. OZONE. Among the invisible ingi-edients of air sometimes found in consider- able quantity, but not always present in any appreciable amount, is ozone. Origin of Ozone. — Ozone is made up of three atoms of oxygen, whereas free oxygen is made of but two atoms. It is therefore concentrated oxygen, and by loss of one of its atoms it is converted into free oxygen of two atoms. Importance of Ozone. — As yet, the researches of medical chemists only enable us to state that the test of Shoeubein indicates that ozone is more abundant in jiure than in impure air; in greater quantity at the seashore than in the interior, and in mountain air than in that of plains ; absent in the centre of large towns, yet present in their suburbs ; deficient in the air of a hospital ward, yet plentiful in the atmosphere outside. Ozone in Pine Woods.— Dr. Nicholson, of Michigan, found in a long series of observations that ozone was more abundant in a pine forest than in the open country during the smnmer, but less abundant during the winter; less abundant in coal-pits and over swamps than in the open country, and less abundant in the night than in the day. Property of Turpentine — The results of these investigations in regard to the air of pine woods are in accord with the statements of Dr. Schreiber, of Vienna, who declares that the turpentine exhaled from pine forests possesses to a veiy high degree the jiroperty of converting the oxygen of the air into ozone, and this fact perhaps explains why a continued resi- dence among the balsamic odors of the pines has long been credited Avith a favorable influence in cases of consunijition. The test for the presence of ozone in the air, consisting of jsaper which has been soaked in starch and iodide of potassiimi, or iodide of calcium, is not reliable VENTILATION. Importance of Ventilation — Having reviewed the serious derange- ments to health that impure air might occasion, it behooves us to consider some preventive measures to ward off disease. The great remedy against impure air is, of course, proper ventilation. System of Ventilation. — In arranging any system of ventilation, we may assume that the greatest amount of carbonic acid (and its associated organic material from the breath) which may be allowed in an inhabited VETfTILATION, 195 room, witHoTit injurious results, is sis-tenths of a gallon in every 1000 gallons of air, as already mentioned. The first question then is, how much fresh air must be supplied every hour for each person in a room, in order that this proportion of impurity may not be exceeded ? Quantity of Air for a Room. — By experiment and calculation it is found that, in order to keep up this admitted standard of purity, it is requisite that 3000 cubic feet of perfectly pure air should flow into a room hourly for every grown person occupying it. Of course, an equal bulk of more or less vitiated air must escape to give place to the pure air, and this bulk, which must be poured in and likewise emptied out hourly for each individual, would be equal to the contents of an apartment thirty feet long, ten feet wide, and ten feet high. When Increase of Air is Needed — Such a quantity, large as it seems, must sometimes be considerably increased, in order to maintain the requi- site standard of purity. For example, when lights are used, and no pro- vision is made for carrying away the products of combustion, much addi- tional pure air is needed. An ordinary gas-burner consumes the oxygen of about twenty-five cubic feet of air hourly, and produces nearly as much carbonic acid as ten men would do in the same space of time. Sick people, especially those with diseases of the lungs, and those affected with low or putrid fevers, should have a larger quantity of pure air; and it has been found that, unless 3500 or 4000 cubic feet are supplied hourly for each patient, hospital wards, for instance, are more or less haunted by offensive odors. Size of Apartments. — The size of apartments for human habitation should be directly dependent, within certain limits, upon the perfection of the ventilating and warming apparatus, because, if the room is small, it is only by securing a proper delivery of warm air that the occupants can receive their allotted 3000 cubic feet per head per hour, without suffering from dangerous or unpleasant draughts. For instance, in a room containing but 100 cubic feet, the air must be changed thirty times hourly, or every two minutes, in order to maintain the atmosphere at its standard purity. This would involve the necessity of such rapid currents of air flowing through the narrow space that it would be almost unin- habitable. Objection to Small Hooms — Besides, when the room is small, it is not possible to diffuse equally the air which enters it, because, between the inlet and the outlet, a direct current is apt to be established, so that a good deal of the fresh air passes right through, without being of any use in reducing the amount of impurity. 196 PTTEE AIK AS A CONDITION OF HEAI,TH. The Sleeping-Eoom, — The best authorities assert that, with ordinary means of ventilation, the space for every grown person should be not less than 1000 cubic feet, and that in this space the entire air should be changed three times each hour. According to this rule, a sleeping-room of ten feet wide, ten feet high, and twenty feet long, might be allotted to two people; and four persons, hut no more, should sit, eat or sleep in a room twenty feet square and ten feet high, provided it was well ventilated in the ordinary way. Frequency of Air Changes. — If the best ventilating apparatus is em- ployed, and the air is warmed to the temperature of about 65 degrees Fahrenheit, the air in a room may be changed six times hourly without causing annoyance, so that, under such exceptional conditions, an apart- ment of less than half the size above mentioned, or twelve feet wide, four- teen feet long and ten. feet high, would answer for four people. Death Eate in Small Lodgings — The dimensions given above are, unfortunately, very much larger than are generally provided in our dwelling-houses, and in the crowded lodgings of the poorer classes the allowance of space for each person often falls as low as 250 or even 200 cubic feet. Under the latter circumstances, the increased sick-rate and death-rate, and the general aspect of what a celebrated French physician graphically describes as "physiological destitution," bear witness to the disastrous effects of breathing impure air in confined apartments. Natural Ventilation.- — A certain amount of natural ventilation, as distinguished from artificial ventilation, effected by contrivances especially arranged for that purpose, goes on all the time through the many crevices, holes and pores of our dwellings, although this supply of air is, as a rule, but a small part of what is necessary for our health. It contributes, however, to the change which does progress, whilst we sit quietly within our four walls without Reeling the least draught. Relative "Weight of Airs. — Since air, like other gases, expands or con- tracts according as it is heated or cooled, warm air is, of course, lighter than cold air, and tends to escape at the upper part of a room, whilst its place is supplied by cold air, which flows in through every aperture in the lower portion. The familiar experiment of opening a door leading to a cold entry an inch or two, and then holding a lighted candle first near the bottom and then at the top of the crack, shows very clearly, by the way the flame is blown inward in the first instance, and outward in the second, how strong arc the currents of air in these two positions. Effects of Seeond-Hand Air.— ]\rany persons, especially ladies, are so sensitive to the effects of second-hand air in a room, that they can tell SLEEPING APARTMENTS. 197 in a very few minutes, by the sensations in tlie bead and lungs, whether an agreeable amount of ventilation has been provided, by leaving the door a little way open, or whether it has been shut tight. Effects of Differing Temperatures. — The rapidity with which the neces- sary interchange of air goes on through the crevices of our doors and windows depends very much upon the difference between the inside and outside temperature. This important fact is well illustrated by the fol- lowing observations of Pettenlcofer. He found that, in a room ten feet high, ten feet wide and twenty-six feet long, containing 2600 cubic feet, when the difference in temperature within and without was 34 degrees, the contents of the apartment changed once in an hour, through the ordi- nary crevices of the doors and windows. In the same room, with the same difference in temperature, but with a roaring hot fire in the stove, the change in the air increased about one-fourth. When, however, in the same room the thermometer stood at 71 degrees, whilst outside it registered 64 degrees, leaving a difference of only 7 degi-ees, ventilation went on only at the rate of 780 feet per hour, and even opening a window, the aperture of which equalled eight square feet, only increased the ventila- tion about one-half, or to 10 GO cubic feet. This experiment was very instructive, showing, as it does, that a difference in temperature of 34 degrees, with carefully shut doors, windows and crevices, has as great an influence in securing a pure atmosphere as much larger and quite unob- structed communications with the outer air, when this latter is of nearly the same temperature as that inside. Getting Rid of Foul Air — The quickest way of getting rid of foul air in a room' is by cross ventilation, or "peiflation," as it is sometimes called. This is obtained by opening windows on opposite sides of the apartment when a moderate breeze is blowing; but it is a method which cannot be relied upon, because, if the outside air is stagnant, no ventilation is secured ; whilst, on the other hand, if there is a strong wind, the violent current of air produced might be unendurable. SLEEPING APARTMENTS. Ventilating — In all rooms which are occupied most of the day, and in all sleeping rooms, proper ventilation should be secured by artificial apparatus specially designed for the purpose, as will be described in the section of this book upon Sanitary Architecture. In old houses, until proper alterations can be made, the exit of foul air ought to be pronnded for by lowering the windows at the top, and the entrance of fresh air per- mitted by raising them at the bottom. 198 PUEE AIE AS A CONDITION OF HEAI.TH. Preventing Unwholesome Draughts — Unwholesome clraughts may be prevented in the latter instance by the simple device of fastening a board across the window-frame on the inside, in such a way as to direct the incoming current air \ipward toward the ceiling of the room. Dr. Keen's arrangement, which is still simpler and equally efficient, is to fasten with tacks or pins a piece of cloth, or even strong paper, across the lower ten or twelve inches of the window-frame, and then raise the lower sash more or less, according to the weather. The convenience of this con- trivance is increased if the cloth, instead of being peiTnanently fastened to the window-frame, is held in its place by loops of tape, which allow of its easy removal as occasion requires. Dangers of Neglected Ventilation. — If we but stop a moment to con- sider we cannot fail to see the necessity of properly ventilating the sleep- ing apartments. We are oftentimes surprised at the neglect of these all- important matters by intelligent people. If the air of any room becomes imjnive during the day we are at liberty to remove to another, and oiir sense of smell or perhaps a headache indicates when such a change is desirable. But during the night the senses are at rest and the individual must breathe again and again the foul air of an imventilated room. Consumption and Air. — Speaking on the subject of patients suffering with tuberculosis or consumption under treatment, Tyson states the more nearly the temperature of the sleeping-room approaches that of the out- doors the more likely is the patient to improve. The same truth holds in cases of health. ilemove Plants at Night. — Plants should not be kept in a sleeping apartment. During the night they do not give off oxygen, hence their jn-esence is not needed. It is only under the influence of sunlight that the carbonic acid of the air is changed to carbon, which becomes a part of the plant, and oxygen which supports animal life. CONTAMINATION OF AIR BY SEWER-GASES. Dangers from Cess-Pool Germs. — A second great danger of impure air arises from its pollution by emanations from sewers and cess-pools, which frequently contain the germs of typhoid fever, diphtheria and per- haps other complaints, as vdll be more fully explained under the head of Contagion as a Cause of Disease. Dr. Letheby found that sewage-water excluded from the air and containing 128 grains of organic matter to the gallon, gave off over a cubic inch of foul-smelling gases per hour for a period of nine weeks. CONTAMINATION OF AIE BT GASE8. 199 Poisons in Sewer-Gas — Of course, the danger to persons who inhale eewer-air, or "sewer-gas," as it is often called, depends vei-y mnch upon whether it is loaded with disease-poisons as well as with foul odors, and the instances adduced by well-meaning but ignorant persons, for the pur- pose of showing that the emanations from sewers have proved harmless, are chiefly cases in which ill-smelling gases happened to be unmixed with the poisons of disease. Proof of Sewer-Gas Poisons. — It would be just as well to argue that because hundreds of ships cross the Atlantic in safety every year, there- fore no shipwrecks ever occur, as to contend that, because many people breathe sewer-gas with impunity, therefore it is never injurious to human health. That some sewer-gas is highly deleterious in its nature is proved by the following stubborn facts; and since we have as yet no tests for determining accurately the degree to which any particular sewer is in- fected with the germs of disease, our safest plan is to cut off all connection between the air of our houses and that of those dangerous channels for filth and disease-poisons. Diphtheria from Sewer-Gas — Dr. William K Thursfield, of Birming- ham, England, reports that he traced an isolated case of diphtheria to temporary exposure to sewer-gas in a house on a short line of sewer which he knew to be specifically contaminated by diphtheria. This sewer, when opened and examined by a sur\'eyor, j^roduced in him a severe diphtheric attack. Typhoid from Sewer-Gas — Dr. William V. Keating, of Philadelphia, has detailed at length four cases of typhoid fever attributed to sewer- gas from tmtrapped drain-pipes, and refers to cases of measles, scarlet fever and diphtheria in two other families ai)iiarently from the same cause. Dr. C. W. Chamberlain, of Hartford, relates a remarkable case of fatal erysipelas which was seemingly due to sewer-gas from a waste-pipe carelessly left open beneath the bed of the patient. Vomiting from Sewer-Gas — ^Dr. George Wilson quotes the account of twenty out of twenty-two boys of Clapham, England, who were attacked, and two of them died, with violent vomiting, purging and fever within three hours after standing over a choked-up drain, watching the workmen cleaning it out. Other Examples of Gas Poisons. — ISTor are these isolated instances, for the medical journals of America and Europe record numerous similar 200 PUEE AIR AS A CONDITION OF HEALTH. examples of dangerons or fatal effects from disease-poisons in sewer-air when inhaled by human beings. Avoiding Sewer Poisons — In view of this great body of evidence, showinij the direct conveyance of disease by air from sewers, it beliooves ■us all to avoid the access of snch noxious effluvia into our houses, or into any inhabited place -whence they can penetrate into the lungs, which are the usual avenue of entrance into human systems. DUST IN THE AIE AS A CAUSE OF DISEASE. Solid Particles. — Dust of various kinds floating in the air, and often occurring in such minute particles that it can only be recognized in a bright sunshine, or by the aid of a beam of electric light, as Professor Tyndall has shown, is far more potent a cause of disease than is generally supposed. Danger of Saliva-Loaded Dust. — Although affections of the stomach and bowels are often induced by the introduction of particles of injurious dust swallowed with the saliva, diseases of the lungs are chiefly to be dreaded when air loaded with substances which are mechanically or chemi- cally noxious find their way to the delicate mucous membrane which lines the recesses of our pulmonary organs. Bronchitis, catarrb and acute or chronic pneumonia, the latter often running on into one form of con- sumption, are especially to be guarded against in persons who are liable to be forced to inhale dust of various kinds. Unhealthy Trades. — The effects of dust are chiefly dependent for their severity on the large amount of the offending material, and the angrilar, rough and hard character of its particles. A large number of the unhealthy trades are insalubrious especially from this cause. Thus, for example, it is stated by ]\Ir. Simon that, excepting in one locality, 300,000 miners break down in England prematurely from bronchitis and pneumonia caused by the atmosphere in which they live. The one excep- tion is most important, because it occurs among the colliers of Durham and Xorthumbcrland, where the mines are well ventilated. Coal Dust and Consumption. — The sharply-angular fragments of coal which may be seen under a microscope to constitute coal dust, mechani- cally irritate the lungs of those who inhale them, and often give rise to the kind of consumption which is so peculiar that it is called miners' con- sumption or miners' phthisis. This malady alone cuts short the days of an immense number of laborers among coal dust, and after death their DUST AS A CAUSE OF DISEASE. 201 pulmonary organs are found filled ■with, sliarp particles of coal, wLicli teing inhaled with the breath, become imbedded in the substance of the lung, and then acting like a vast quantity of tiny splinters in the flesh, give rise to innumerable minute boils or abscesses, by "which the breathing apparatus is actually riddled with holes, and so much of it destroyed that the poor sufferers die for want of lung-substance enougb to supply prop- erly their blood with air. Saw Grinders' Consumption — The fine particles of steel and of sand thrown off in grinding saws and other tools, give rise to saw-grinders' con- sumption, particularly when dry-gi-inding is resorted to, and unless the dust is carried away from the workmen. Particles of Deadly Dust — In manufacturing these various steel and iron implements, the rough articles are firmly pressed against grindstones, which are revolving sometimes at the rate of three thousand times in a minute. Practically it is found that the degi'ee of danger to the workmen thus employed depends partly ujaon the amount of diist inhaled, partly upon the character of the particles composing this dust, and partly upon the constrained attitude which the workmen are frequently compelled to assume. What Dust Most Dangerous — The gi-inding of needles and forks is the most dangerous, because it must be done upon dry grindstones, in order to reduce the chance of the fabricated utensil becoming rusty. Scissors, razors and table-knives can be ground partly upon wet grind- stones, so that the men employed in such work run less risk of injury from it, whilst the coarser implements generally are now, as a rule, finished upon wet stones entirely, so that still less danger is incurred. Grinders' Asthma — The gi-iuders' consumption, called also the grinders' asthma from the difficulty of breathing, which is one of the prominent symptoms, comes on very gi-adaally, and often lasts four or five years before it proves fatal. At first there is only a little dr;^ cough, with scanty expectoration; later on the mucus, which is coughed up, begins to be reddish from a minute quantity of blood mingled with it ; and, although there is no fever, and the strength and appetite remain good, an examination of the chest with the stethoscope reveals serious trouble in one or both lungs. How Recovery is Possible — Still, recovery is not only possible, but probable, at this stage of the complaint, if the workman can be persuaded to abandon his occupation; but if he persists in exposing himself to the perils incurred by breathing these dangerous dusts into the lungs, the 202 PUEB AIB AS A CONDITION OI" HEALTH. pulmonary structure soon begins to ulcerate away, and painful, lingering death by consumption follows. Average life of Grinders. — Until recent improvements in regard to grinding, tlie fatality of these particles of dust, when inhaled into the lungs, was very great. According to Dr. Holland, the average age at death of twelve workmen at the trade of needle-grinding was only thirty years and eight months, and other authorities give the duration of life as from thirty-one to thirty-five years. Use of the Magnetic Plate. — In factories where steel-grinding goes on to a very great extent, the use of a large magnetic plate, for drawing to itself the metallic particles, is very useful; but, of course, it has no power to purify the air from any injurious dust, except that made up of irou or steel, and perhaps on this account it has never been popular among the workmen. Use of the Mechanical Fan — Another very efficient method is to draw away the dust in the strong current of air created by a powerful me- chanical fan. A single fan may be made to extract the dust from several grinding stones, care being taken to have the opening in the boxes which surround the stones, and in which the draught is set up underneath, so as to extract both the heavier and lighter particles. This plan adds materially to the expense of manufacture, and is therefore not very popular among the mill owners, but it so gi-eatly diminishes the dangers to the workmen, when properly adapted, that its employment should be enforced by law, in order to protect the health of the operatives. Danger from Wet-Grinding. — Although the introduction of wet-grind- ing for the coarser tools vastly decreases the chance of mechanical injury to the lungs from floating particles in the air, the artisans are often kept covered with the muddy water which is constantly being whirled off from the stones. Being thus exjiosed to the combined evil influence of cold and wet, they are especially subject to acute bronchitis, pneumonia and rheumatism, which may, however, be in part prevented if the men wear water-proof clothing whilst they are at work. Pottery Dust. — In the pottery trade there is often a large amount of dust made up of mineral particles, which are very irritating to the lungs of the operatives employed. The same may be said of the artisans who work at the trade of glass-making, the most dangerous department being that of grinding and polishing the cut-glass. Of these men more than one-third are said to die of consumption, and their average age at death is yariously estimated at from thirty to forty-two jeara, BUST A9 A OAUSH OF DISEASE. Match-Makers' Diseases — The makers of matclies, wLo are exposed to the fumes of phosphorus, suffer from a form of ulceration of the jaw- bone, if there hajjpens to be any uncovered portion upon which the poison- ous vapor can act, as for instance, around the root of a diseased tooth. The manufacture of many chemical products is exceedingly dangerous to health, and requires special precautions to reduce its evil influence as far as possible. Danger of Metal Fumes. — In some trades and under certain circum- stances the fumes of metals or particles of metallic compounds pass into the air, and render it very injurious to health for those who happen to breathe it. Brass-founders are affected with bronchitis and asthma, as in other trades where dust is inhaled by the workmen, but in addition they suffer from a disease called brass-ague or brass-founders' ague. It ap- pears to be the result of inhaling the metallic fumes, perhaps of the oxide of zinc. Symptoms of Fume Poison. — The symptoms are tightness and oppres- sion of the chest, with uncomfortable nervous sensations, followed by shivering ; unlike those of genuine ague, are not periodical. Coppersmiths are apt to be affected in a similar way by the fumes arising from the partly vaporized metal or from the solder. Tin-plate workers likewise suffer occasionally from the fumes of the soldering. White-Lead Poison — Workmen in white-lead manufactories often suffer in the same way from inhalation of fine powder of white lead, chiefly from the beds in which oxidation goes on and in the process of packing the product. And the same may be said of house painters to some extent, although lead poisoning is more apt to occur in them from swal- lowing the lead compound in consequence of want of cleanliness while taking food. Tobacco Dust. — Operatives in tobacco factories sometimes suffer from Irritation of the throat, nose and eyes by the tobacco dust, and there are some people who cannot become accustomed to an atmosphere of the weed. The greatest irritant effect seems to be produced in the manu- facture of snuff, but with the large majority of operatives, if proper care and ventilation is secured, no serious effects result after the first few weeks or months. Wall-Paper Poisons Perhaps the most common kind of poisoning from a metallic dust inhaled with the air is that developed In persons who spend much time in rooms decorated with arsenical wall papers. In some Instances, these brilliant yet treacherous decorations, which may be either 204! PtTEE AIE AS A CONDITIOIf OF HEALTH. green, purple or brown in color, have been found to contain as many as thirty-seven gi-aius of the arsenical compound to the square foot, and numerous well-authenticated cases of serious injury to health from in- halation of the atmosphere of rooms in which this arsenical dust was con- stantly floating are on record. Whenever a person who occupies a room papered with gi-een or purjde hangings begins without any obvious cause to suffer from headache, nausea, inflammation of the eyelids, dry cough, muscular tremors and impaired nervous power, the cause should at once be sought for upon the walls of the apartm,ent, and if the usual chemical tests show the presence of arsenic in a little of the paper which has been scraped off, both the patient and the paper should be promptly removed. Modem Improvements — In recent years many improvements have been made in machinery. Factories made sanitary, workmen protected from dangers of all kinds, laws enacted compelling owners of factories to protect workmen; so that at the present time the operator and mechanic does not have the many dangers to contend with he formerly had. In many places illustrated lectures are given, educating him to avoid certain dangers and conditions in connection with his work. INDEX TO PART IV OF BOOK III Preventive Medicine Foods and Drinks Part IV of Book III relates to foods and drinks and tells of their hygienic effects upon the different organs of the human body. SUBJECTS OF THE TEXT Absorption and Assimilation 218 Amount of Food Required 21 1 Animal Food 223 Arrangement of the Teeth 213 Arteries, The 220 Bile, The 217 Blood Function 220 Blood, The 223 Brushes, Effect of Hard Brushes on the Teeth 214 Capillaries 220 Care of the Teeth 214 Cell Nourishment 210 Cell Organization 210 Change of Fluids and Tissues 208 Children's Teeth 213 Circulation, Course of 222 Circulation, The 219 Classification of Foods 223 Communication of the Stomach 216 Course of Circulation 222 Diet 207 Digestibility of Foods 225 Distribution of Nutriment 219 Effects of Hard Brushes on the Teeth, 214 Fatty Foods 224 Fluids and Tissues, Change of 208 Folds of the Intestines 218 Food, Animal 223 Food, Meat 212 Food, Milk, Property of 212 Food, Mixed 212 Food, Object of 207 Food Required, Atnount of 211 Foods, Classification of 223 Foods, Fatty, Nutritive Proportions. . .224 Foods, Preparation of 224 Foods, Relative Digestibility of 225 Foods, Saccharine and Starchy 224 Foods, What They Must Supply 211 Function of the Blood 220 Function of the Tongue 214 Gastric Juice 217 Glands, Salivary 214 Glottis, The 216 Gullet, The 216 Heart Pulsations 221 Heart, Shape of ?2i Heart, The 221 Heart- Valves, The 221 Human Organs, Structure of 210 Intestinal Canal, Structure of 218 Intestine, The Large 218 Intestines, Folds of 218 Intestines, Mucous, Membrane of 218 Intestines, The 217 Large Intestine, The 218 Liver, The 217 Location of the Salivary Glands 214 Lymphatics, The 219 Material, Waste 220 Meat Food 212 Milk Food, Property of 212 Mixed Food 212 Molar Teeth, The 213 Mucous Membrane of the Intestine. . . .218 205 206 IN'DEX TO PAUT IV OF BOOK III. Muscles, Operation of. See Swallowing Nourishment, Cell 210 Number and Arrangement of Teeth, 213 Number and Location of the Salivary Glands 214 Nutriment, Distribution of 219 Object of Food 207 Organization, Cell 210 Organs, Structure of 210 Pancreas, The 217 Pancreatic Fluid 217 Preparation of Foods 224 Protoplasm 210 Pulsations, Heart 221 Quantity of Saliva 215 Relative Digestibility of Foods 225 Saccharine Foods 224 Saliva, Quantity of 215 Saliva, Secretion of 214 Salivary Glands, The — Number and Location 214 Quantity of Saliva 215 Secretion of Saliva 214 Shape of the Heart 221 Shape of the Stomach 216 Starchy Foods 224 Stomach, The — Communication of 216 Gastric Juice 217 Shape of 216 Structure of Human Organs 210 Structure of the Intestinal Canal 218 Structure of Teeth 213 Swallowing — • Glottis, The 216 Gullet, The 216 Operation of Muscles 215 Teeth, The — • Care of 214 Children's Teeth 213 Effect of Hard Brushes 214 Molar Teeth, The 213 Number and Arrangement of 213 Structure of 213 Tissues and Fluids, Change of 208 Tongue, The 214 Function of 214 Valves, The Heart 221 Veins, The 220 Waste Material 220 What Foods Must Supply 211 LIST OF ILLUSTRATIONS Alimentary Canal, The 216 Blood Corpuscles, Red and White. .. .223 Cells of Human Organism 210 Circulation, Diagram of 221 Circulations, Diagram of 222 Circulation of Web of Frog's Foot. . . .220 Colostrum Corpuscles in Human Milk, 228 Diagram of Circulation 221 Diagram of Circulations 222 Diagram of Constituents of Food 227 Folds of the Intestines 218 Human Organism, Cells of 210 Human Milk Containing Colostrum Corpuscles 228 Intestine, Small, Villi of 218 Intestines, Folds of the 218 Lacteals and Lymphatics 219 Milk Containing Colostrum Cor- puscles 228 Muscles of Swallowing, The 215 Nutritive Proportions of Foods 224 Red and White Blood Corpuscles 223 Swallowing Muscles, The 215 Villi of the Small Intestine 218 PREVENTIVE MEDICINE PART IV. FOODS AND DRINKS GENERAL CONSIDERATION. Object of Food. — The object of food is primarily to furnish the means for growth, repair, heat and energy. The mere gratifleatiou of ajjpetite, which to the detriment of health too often is regarded with undue prom- inence, is a secondary consideration and merely incidental to nature's de- mand for nutrition. Food, Half of life's Battle — It has been said that "food properly chosen, properly cooked and properly eaten is half the battle of life," and the practical value of the subject will readily be understood when it is considered that it plays an important part, not only in maintaiuiug health, but in modifying and curing diseases. The Problem of Diet. — If all members of the human family were alike it is obvious that a bill of fare could soon be arranged which would give every person the most perfect nourishment ; biit as we each differ, in some smaller or greater degree, from all others of our fellowmen, it is necessary to study the problem, of diet, as modified and limited by our own individual peculiarities and surroundings. Age, sex, occupation, climate, nationality, and so forth, all influence the quantity and the char- acter of food required, and, on the other hand, the amount and nature of food taken govern to no little extent the temperament and characteristics of people. How Food Affects Races. — It has been pointed out, and doubtless with some trxith, that racial distinctions are in a measure the result of the character of the food taken, and that the Irish and tlie Hindu would not have submitted so supinely to the rule of England had their diet, which consists chiefly of vegetables, been more highly nutritious like that of the British. '(507) 208 FOODS AXD IJEINKS. How Food is Appropriated. — In considering the subject of food, it is important to understand the method by which it is appropriated by the system and converted into blood, flesh, bone and other tissues, and how it is utili;:fd in the generation of heat and force. Change of Fluids and Tissues. — During our whole lives the fluids and the solid tissues of our systems -are constantly undergoing change. New materials in the form of infinitely minute particles of muscle, nerve, and so forth, are being produced, •while the old and worn-out atoms of these structures are removed with ceaseless activity. "While this incessant movement of these constituents of our bodies is not perceptible to the eye, even when aided by the most powerful microscopes, it nevertheless goes on, and must go on as long as life continues. In fact, the researches of physiologists tend to show, with a large amount of certainty, that the health, strength and vigor of the whole and of every part of the body is in proportion to its youth and newness. Thus it is that exercise, under due regulation and management, is a hygienic means of such great value in strengthening and developing the whole frame, especially the muscular system. Relation of Natural Forces. — In endeavoring to reach the "bottom facts" of our knowledge in regard to the forces we derive from the food taken into our stomachs, we must bear in mind that, in our own bodies, as in the whole universe around us, we have, from a scientific point of view, to deal only with material entities of various kinds and properties which we call matter, such as the chemical elements oxygen, carbon or siilphTir, and their compounds ; and principles of actions, which we demon- inate forces, among which may be instanced heat, electricity, and the at- traction of gravitation, as types. Natural Forces — The doctrine of the correlation of forces, abstruse as it sounds at first, is simply, as regards two of them, namely, heat and mechanical motion, an extension of the commonly observed fact that motion, by causing friction, produces heat, as we see in using an ordinary Lucifer or friction match. Every time we strike a match we demonstrate that motion may produce heat ; and to expand this idea into the doctrine of correlation (or relationship) of forces, it is only necessary to prove by careful and ingenious experiments, as was first done by Mr. Grove and Mr. Joule, that any certain amoimt of motion applied in any conceivable way to the production of heat, causes always exactly the same amount of heat, and contrariwise, a particular quantity of heat applied to the pro- duction of motion, originates always the same quantity of movement no matter by what kind of machinery it is applied. HOW FOOD NOUEISHE3, 809 Heat and Motion. — In this way we can, by mechanical experinfent, establish the existence of a correlation — or, to use the more familiar word introduced above, a relationship — between heat and mechanical motion, and this relationship has been found to be that the force of a weight of 772 pounds falling one foot would, if converted into heat, raise the tem- perature of one pound of water one degree of Fahrenheit's thermometer. Muscular Effort.— After clearly comprehending this idea, it is only necessary to grasp the further suggestion that, if a man is hired to lift up again the weight of 772 pounds, which in falling one foot gave us our unit of heat (namely, the heating of one pound of water, one degree), we further establish, by the additional experiment, a relationship or "correla- tion" between the number of muscular efforts he is required to make and that same heat unit. Food Re(iuired — Lastly, if we weigh the extra beefsteak or half-peck of potatoes he needs to eat, to enable him to perform so much extra labor, we find out the equivalent ounces of food for the requisite amount of muscular exertion emi;)loyGd, which is again the equivalent of our (arbi- trarily assumed) unit of heat, the quantity of heat which will raise one pound of water one degree. The Four Natural Forces. — Thus, even those readers who make no [pretensions to scientific culture can, it is hoped, understand the nature of that mutual relationship or correlation which exists between these four natural forces, to wit, heat, mechanical motion (of falling or lifted weights), muscular exertion and food. What Food Is — Food, then, is any substance which, when taken into the animal body, may enter into such new chemical combinations that it gives out its dormant force in the form of heat, muscular movement, nerve power, and so forth. How Food Nourishes. — If an article of food is completely combined with oxygen in the human system, it yields up all the force which it is capable of affording; but if it is not so adapted to the wants of the body as to be fully oxidized or burnt up, part of its force passes off with other refuse matters, and is wasted, as far as that man's nutrition is concerned. It is by learning how to avoid this waste, as well as to escape the injury excess of undigested food is apt to cause to the digestive organs, that a careful study of the articles of diet suitable for each individual, in accord- ance with the facts and conclusions detailed below, may be made so profit- able and beneficial to every one. 14 210 ffOODS AND DKINKS. STRUCTURE OF ORGANIZED BODIES. Cell Organization. — All animals and vegetables are bnilt up of minutq, separate, organized bodies, called cells, •which are put together like stones in a pavement, so as to form the skin, the muscles, the nerves, and so forth. The cell-elements or cell are made np of a nucleus or central living mass, which may he aptly compared to the yolk of an egg. Protoplasm. — Around this nucleus is gathered a little lump of formed material or protoplasm, corresponding to the white of an egg, and the whole is enclosed in a delicate membrane resembling that which lines the egg-shell. These cells are extremely small, varying from one four- thotisandth of an inch to one five-hundredth of an inch in diameter. In the epithelial scales or cells, which are packed together to form the skin, as already mentioned, the average diameter is about one fifteen-hundredth of an inch. Building of Human Organs. — The different organs of human bodies and those of the inferior animals are built up of cells very similar to those found in the vegetable kingdom, as is illustrated by the adjoining figure. This cut shows the liver-cells of man, •with the nucleus, a, and oil-drops, h, in their protoplasm. At c is depicted a free nucleus, that is, one from which the cell-wall and the protoplasm have ' '^i^'N^i' s been accidentally torn away ; and at d Cells of Human Organism. is shown a large cell •with two nuclei, illustrating the tendency to oc- casional twin-formation, which seems to run throughout all animated nature. First Step Toward Human Development. — The first step toward the development of a new being in that wonderful yet hourly miracle of re- production, as, for instance, of a young chicken inside an egg, is the divi- sion of the yoUc into a great number of little rounded parts, which soon present the appearance of a heap or miass of cells, which for a time cannot be distinguished from the white cells in the blood of the parent hen. Gradually, however, as the operation of hatching progresses, cer- tain groups of these cells vary under the influence of the vital force from other groups, until, by a continuing process of development, the liver, the heart, the skin, and so forth, are completely formed. Cell Nourishment. — In chickens, and birds generally, the young crea- ture is nourished until large enough to pick up its own food by the contents MIXED DIET. 211 of the egg, but in animals which bring forth their young alive, a curious natural provision is made for supplying the requisite nourishment from the blood of the mother. After birth, however, the necessity for food immediately becomes apparent, and in order that mere existence shall continue, external nourishmient of some sort must be regularly supplied. Furthermore, if growth and complete development are to go on, this nourishment must be accurately proportioned in kind, quantity and com- position to the exact needs of the infant animal or man. MIXED DIET REQUIEED BY MAN. Analysis of cows' milk shows it to contain — Albumen and casein S4.05 Butter 43.05 Milk Sugar 40.37 Salts 5.48 Water 857.05 Total 1,000.00 While this forms a suitable diet for young children, who, though rapidly growing, expend in labor comjiaratively little muscular force, it fails to meet the requirements of active adult life. Kinds of Diet. — iSTor, notwithstanding much argument to the con- trary, does an exclusively vegetable diet seem best adapted to man's needs. The evidences derivable from the form and arrangement of the teeth, the structure and functions of the alimentary canal, and the results of direct experiment, all indicate that, in the present age of the world at any rate, mankind thrives best, as a general rule, upon a mixed animal and vegetable diet. Amount of Food Required. — The requirements of a full-gi'own indi- vidual may be estimated by accurately determining, as has been done by scientific men, the quantities of the chemical elements carbon, hydrogen, nitrogen and oxygen, which are cast off from the body by the bowels, the kidneys, the skin and the lungs, every twenty-four hours, and then calcu- lating, what quantities of various articles of food, containing these chemi- cal elements, must be eaten daily to supply this waste. What Foods Must Supply — For instance, if we find, as some English investigators have done, that a gang of one hundred average prisoners cast off every twenty-four hours, from their lungs, kidneys and bowels, about seventy-one and a half pounds of the element carbon, and four 212 FOODS AND DRINKS. and a quarter pounds of nitrogen, it is obvious tliat carbon and nitrogen must be supplied to this amount in the food the gang of prisoners eat in order to make up for -n-bat is excreted. If tbey were to be fed upon bread and water alone it ■would require 380 pounds of the staff of life daily to keep them in good health, because it requires that ■weight to yield the four and a quarter pounds of nitrogen ■«-hich they daily cast off in the ■ways just mentioned. But in 380 pounds of bread there are 128 pounds of carbon, ■«-hich is about fifty-seven pounds more than -would be needed to replace -what these men ■would excrete. Meat Food. — On the other hand, should the authorities try the ex- periment of giving them animal food only, it ■would be necessary to allo-w them 350 pounds of lean meat, because no less than that amount ■would contain the seventy-one and a half pounds of carbon necessary to replace the quantity of this element excreted ; but lean meat contains pro- portionately a very large amount of nitrogen, and in 354 pounds of it there •would be found 109 pounds, or 105 poimds nearly in excess of -what the prisoners really required, and ■which would therefore be wasted as food. Mixed Food. — In the former case which we have supposed, each man would have to eat about four pounds of bread, and in the latter about three and a half pounds of meat every day, in order to avoid losing strength. In the first instance, there would be a good deal of starch in the bread, and in the second case, a considerable bulk of nitrogenous material, which would be quite unnecessary as food, and apt if taken into the stomach to overload it and derange its functions. A True Mixed Diet — The true way is to resort to a mixed diet, and if such were to be adopted in this instance, we would probably find that 200 pounds of bread, with sixty pounds of meat, would answer every purpose. Two hundred pounds of bread contain, besides water, sixty pounds of carbon and two of nitrogen, and sixty pounds of meat about twelve of carbon and two and a quarter of nitrogen ; making, it will be observed, exactly the quantity of each of the primary elements cast off by the 100 men daily as waste matter from the processes of life. Property of Milk Food — It is manifest, according to this calculation, that milk is not accurately suited to supporting an adult popidation, be- cause it contains too little carbon and too much nitrogen to supply the waste. This excess of nitrogen is well suited to the young animal which is actively engaged in adding to its muscular development, but is not adapted to the full-gro-wn man, who is obliged to produce force, or its equivalent, heat, by the slow combustion of carbon in his body. It is to supply this excess of carbon, beyond what exists in milk, that all the world THE TEETH. 213 over, bread or starch, which is rich in carbon in some form, is gradually added in larger and larger proportions to the food of a growing child. Proper Diet List. — Such calculations, iu regard to the other con- stituents of our food, form a basis of the utmost value for the economical arrangement of diet lists, and the distribution of limited means, as, for example, in armies and navies, with the least possible waste of the in- gredients at command. THE TEETH. Number and Arrangement. — Iu the adult human being the teeth, when perfect, are thirty-two in number, and are arranged in the following order: First, in the middle of each jaw, are the four incisors or cutting teeth; iiest, come one on each side of the group of incisors, the two canine or dog-teeth, so-called because they are very large and conspicuous in a dog's mouth; the next pair of teeth, situated just back of each canine tooth, are named the first and second bicuspids, on account of their having two points or cusps; behind these, again, we find the first, second and third molars or grinding-teeth. The Molar Teeth. — The last, or third molars, four in number, coimt- ing two in each jaw, of course, have received the name of the wisdom-teeth, because they appear about the time that people grow up and are supposed to have arrived at years of discretion. Children's Teeth — The permanent teeth are preceded during child- hood by a smaller set, only twenty in number, which are styled the de- ciduous teeth, for the reason- that they fall out or are pushed out by the larger and stronger permanent set. These deciduous teeth begin to come through the gums of babies when they are from six to twelve months old, and unfortunately give rise to much of the pain endured in childhood. The adjoining figure shows how the second set of teeth comes in behind the first, or deciduous teeth, pushing these latter out of the jaws from the sixth to the tenth or twelfth year of life. Structure of Teeth. — Each tooth has, as can be readily seen by cracking open one from a dead animal, a very hard outside shell, composed of what is called the enamel, a softer and thicker body-substance, denominated dentine or ivory, and a hollow place near the centre of this dentine, named the pulp-cavity, which during life is filled with a mass of nerves and blood-vessels. The pulp or nerve of a tooth is exceedingly sensitive, and acutely painful on the slightest touch, or even from mere exposure to the air, as, for examlple, by the breaking off or decaying away of some portion 214 FOODS ANT) DBIITKB. of the dentine or tooth-tone wliich naturally protects it, and which when removed gives rise to toothache. Care of Teeth — The prevention of such suffering lies in avoiding the decay as long as possible by keeping the teeth clean, refusing corrosive articles of food or medicine, and, when cavities begin to form, having them stopped up or filled by a skillful dentist before they have time to reach the nerve. Effect of Hard Brushes. — While frequent cleansing of the teeth is important, it is not advisable to brush them too much with hard tooth- brushes, and especially with gritty tooth-powders, thus irritating the gums and wearing away the very enamel which it is our object to preserve. What to Avoid — The teeth should never be used to break hard ob- jects ; hot and cold liquids, especially in quick succession, ought not to be brought in contact with them, as in drinking ; and strong vinegar, syrups and sweetmeats ought likewise to be kept away from the teeth. If candies are eaten at all, or at rare intervals, the sugar remaining between the teeth and around the gums should be promptly washed away by rinsing the mouth. THE TONGUE. Tongue Function. — Besides being the organ of taste and the chief agent in the production of speech, the tongue performs an important duty in bringing different portions of a mouthful of food under the molar teeth during the operation of mastication or chewing. This office of the tongue is shown to he one of great usefulness, by the fact that when paralyzed, either wholly or in part, great difficulty is experienced in chewing food, because it cannot be pushed between the grinding surfaces of the back teeth. THE SALIVARY GLANDS. Breaking up the food into a sort of coarse powder is only the. first step in its proper preparation for digestion. It must next be mixed with the liquid of the mouth, called saliva, which has the remarkable power of turning the insoluble starch of bread and other starchy foods into sohible sugar. Number and Location — The salivary glands, whose business it is to manufacture the saliva, are six in number, four being sitxiated under the tongue and the jaw. and the others seated deeply in the cheeks in front of the ears. These are called the parotid glands, and are remarkable for Ibeing the parts affected by the contagious disease named mumps. Secretion of Saliva — The saliva is poured out by different ducts, into THE ACT OF SWALLOWING. 215 various parts of the mouth, so as to become intimately mixed with the food. Its active principle, named ptyalin, plays a very important part in the digestion of the amylaceous substances, that is to say, articles of diet, such as bread, potatoes, corn, and the like, which are chiefly composed of starch. Thorough Mastication. — It is, therefore, highly necessary that chew- ing should be performed slowly enough to give time for a sufficient quan- tity of saliva to be secreted, and to be completely mixed with the food, as want of care in eating too fast is apt to be followed by the disease called dyspepsia, as already mentioned. It is difficult to urge too strongly the importance of a thorough mastication of vegetable food. Quantity of Saliva— In the hu- man being, the saliva is produced in the quantity of nearly four pints daily during health; but the secre- tion of this very important agent in the digestive process is powerfully affected by mental emotions, such as fear, anger or pity, and it is also largely influenced by certain medi- cines, such as belladonna or deadly nightshade, even in comparatively small doses. THE ACT OF SWALLOWING. Operation of the Muscles The entire process of swallowing is a series of associated muscular acts, quite independent of the force of gravitation, as may be seen in animals drinking with their heads down- wards. Although these complex movements follow each other without any check or pause, it is common to divide them into three stages, the first of ■which is the voluntary one of pushing the mass of chewed food back to the upper part of the throat or pharynx, so that it is grasped by the involuntary muscles, which send it on downward to the stomach. This operation the muscles which form the tube called the throat or gullet ac- complish by relaxing in front of the morsel of food which is being swal- lowed and contracting behind it. The adjoining figure exhibits the deep The Swallowing Muscles. 216 POOBS AT3D BKINKS. muscles of the cheek and the pharynx -with adjoining parts. The cir- cular muscle of the mouth (1) and the buccinator or trumpeter's muscle (2) help the tongue to push the food back to the upper margin of the gullet, where it is seized upon by tlie three constrictor muscles (3, 4 and 5) of the pharynx, and pushed down the gullet or oesophagus, which is represented as being cut off at 6. The Glottis — In front of the pharynx is an opening into the windpipe named the glottis, through which we breathe, but which must, of course, be closed during the operation of swal- lowing, in order to prevent our food from dropping into it. The Gullet — The gullet or oesophagus is a muscular and membranous tube, about nine inches long, which if dissected out would look very much like a thin inece of rubber hose, such as is used for watering gardens. Its duty is to carry the food from the pharynx to the stomach, and in order that it may not get stopped up by food getting wedged in it, this pipe, in consequence of its muscular structure, has the power of contracting itself in succes- sive portions from above downward, so as to push onward the articles of diet which are being swallowed. THE STOMACH. The Alimentary Canal. Shape. — The human stomach is a some- what egg-shaped bag, the walls, as the substance of the bag is called by anatomists, of which are made up first, coimting from the inside outward, of a layer or coat of mucous membrane which is similar to, and continuous with, the moist red mucous membrane which we seen lining the mouth and throat. Outside of this is a coat of muscular fibres, some running around and others diagonally across the sack, and then outside of these again is a layer of membrane or skin. Stomach Communication. — The stomach communicates, at its upper part on the left side of the body just below the heart, with the gullet, which THE DIGESTIVE APPARATUS. 217 opens directly into it, and it empties itself, on the right side, into the upper portion of the small intestine, through a sort of valve, which has received the name of the pyloric orifice, because the word pylorus means a janitor or gate-keeper. The arrangement of the stomach and other fiortions of the digestive apparatus, or alimentary canal, or alimentary tract, is well shown in the foregoing figure. Gastric Juice. — The whole of the mucous membrane, or inner lining of the stomach, is filled with glands, somewhat similar to the salivary glands, but so small that they can scarcely be seen with the naked eye. These glands all open into the cavity of the stomach, and their business is to manufacture, from the blood which flows around them, in a network of fine blood-vessels with very thin walls, that important fluid, the gastric juice, remarkable for having such a Wonderful solvent power upon the meat, eggs and other foods which constitute what is called the nitrogenous portion of our diet. Quantity of Gastric Juice. — The quantity of gastric juice very much exceeds that of the other digestive fluids, being about a gallon and a half every twenty-four hours. THE LIVER. This is the largest organ in the body, being situated below the right lung. Its office is the secretion of another digestive fluid known as bile. Bile — About one quart of bile is daily produced, it being intimately connected with the digestion of fats. Interference with its proper secre- tion is largely concerned with the production of constij^ation and the train of symptoms ordinarily known as biliousness. THE PANCREAS. The pancreas is a long, thin gland, situated behind the stomach, and constituting, in the ox, part of what is sold under the name of sweetbread. Pancreatic Fluid. — This is secreted daily to the extent of about a pint and a half. It supplements the action of the saliva and the bile by helping to dissolve the starchy materials and to finely subdivide the fatty sub- stances. THE INTESTINES. The small intestine is a membranous pipe or tube about twenty feet long, hut twisted and looped together in such a way as to occupy only the small space of a few inches in the cavity of the abdomen, which forms the 218 FOODS AND DRINKS. lower half of a person's trunk, or tody, as it is often called, in contra- distinction to the limbs and head. This tube is continuous with the pyloric opening of the stomach at its upper end, and at its lower extremity empties into the side of a much wider membranous tube, about five feet in length, called the large intestine. Ihe Large Intestine. — Most of the large intestine has received the name of the colon, and it may be justly compared to the main sewer of a city, into which pass all the waste refuse and foul materials which are of no further use, and must be gotten rid of as soon as possible. STRTJCTUKE OF INTESTINAL CANAL. Mucous Membrane. — The whole intes- tinal tube is lined with a mucous membrane, and in the small intestine this has its inner siirface covered with hundreds of thousands of little tongue-like projections called villi. These villi are represented as they appear when highly magnified in the marginal illus- tration, which is a diagram of a thin slice cut lengthwise from the wall of the tube. [Folds of Membrane. — Although the intestinal canal is so prolonged as to measure, when stretched out, over twenty-five feet, its internal surface is not suificient to perform all the work of absorbing the digested ma- terials of diet. Hence, the lining mucous membrane is throvni into folds, as shown in the appended wood-cut, simply in order, it appears, to afford surface enough for absorb- ing all the nutriment from the articles of food, and so disposing of the substances we swallow to the best and most economical advantage. Villi of the Small Intestine. The Valvute Conniventes, or Folds of the Intestines. ABSORPTION AND ASSIMILATION. In order that the food-stuffs, when altered by the digestive process, may be of any real use to the animal economy, the nutritive materials must be distributed through the different tissues and organs of the body. THE CIRCITI.ATIOTT. 219 Digestion Not Sufficient — The mere digestion of food is by no means sufficient, and no matter bow much we eat, it would accomplish nothing toward keeping our muscles, hearts and brains in active operation, un- less food-elements were absorbed after digestion into the blood, and as- similated from it into the very structure of all the different portions and organs of the animal frame. The Lymphatics.- — As shown in the adjoining illustration, the lacteals, LAC, which take their origin in the villi of the small intestine, converge and unite together, meet- ing the combined lym- phatics of the lower ex- tremities in a kind of bag, called the recep- tacle of the chyle, which is situated deeply in the abdomen and in front of the sjjine, near its mid- dle. From this the mingled chyle and lymph are carried along the thoracic duct, up to the root of the neck on its left side, where they are poured into the large veins, and so mix with the blood and be- come a part of that vital fluid. Distribution of Nu- triment — The nutritious principles of the food having been absorbed by the lacteals and carried onward by the lymphatics to the general circulation are now distributed to the various organs by the blood. THE CIRCULATION. Through these channels the blood is kept in constant motion by the ftction of a muacular pump, the heart, first passing into strong-walled The Lacteals and Lymphatics, 230 FOODS AND DEINKS. branching arteries, the walls of which gradually become thinner as the branches grow smaller. These end in a network of delicate capillaries, or hair-like tubes, through which the crimson tide flows slowly into the wider, soft-walled veins, ajJiJointed to carry it back to the heart, and thus com- plete the round of the circulation. Blood Function — In its course, it receives the nutritive materials from the stomach and intestines after digestion, the special products of the liver, spleen and the IjTnphatic glands, and the oxygen absorbed from the air in the lungs. It therefore contains and carries to their destina- tion all the materials required for the chemical and vital changes of the various tissues necessary to life. Waste Material — "While passing through the capillary networks of the different organs and structures, it takes up the waste materials re- sulting from the wearing out and decay of these portions, and carries them to the proper point of escape from the body, as, for example, the kidneys or the bowels ; at the same time the nutriment needed to rebuild the worn- out organs is allowed to ooze through the delicate vessel-walls of the capillaries, and be diffused into the surrounding tissues. Capillaries — In the human being it is difficult to demonstrate the circulation of the blood in the capillaries, but the fineness of their network and the pressure of the blood which is kept up in them to force along the vital fluid may be readily shown by pricking the finger with a needle, the point of which, no matter how small it is, can scarcely fail to pene- trate some minute blood-vessel, and let out a tiny drop of crimson blood. This wonderful arrangement can be most conveniently demonstrated in the thin membrane of a frog's foot, stretched out vmder a microscope magnifying two hundred times. Arteries and Veins. — Of the two sets of blood-vessels, the ar- teries, which convey the blood from the heart to the tips of the fingers and the ends of the toes, carry bright scarlet blood, and are generally deeply seated in the interior of tb§ body ^ad Hmbs, so as to be, as far Circulation the Web Foot. Frog's THE CIRCULATORY SYSTEM. 221 as possible, out of harm's way. The veins, which lie more generally near the surface of the body, as, for example, just beneath the skin on the back of the hand and arm, are filled with dark purple blood, which is much less pure than the arterial fluid, because it contains large amounts of the broken-down materials, the ruins, as it were, of the various bcdily or- gans, which are now on their road to be thrown away out of the system through the lungs, the kidneys and the bowels. The Heart — The heart has small chambers at the upper part to re- ceive the blood, and larger, thicker chambers at the lower end, called ventricles, to pump it oiit. The human heart is also double, having a right side made up of a moderately strong auricle and ventricle, to send the blood to the lungs, and a powerful left side or left heart, with a thicker auricle and a very thick, strong ventricle, to drive blood to all other parts of the body. The Illustration — This arrangement of the two independent sides of the heart will be better understood by the aid of the diagram in the margin, which repre- sents the two sides of the heart as separated, as they are in reality in the human breast, ■'"*'«li:lll TfiMl-H. although there fastened together and appar- ently forming biit a single organ. The arrows indicate the direction of the blood-current in the entire round of its circulation. Diagram of the Circulation. Shape of the Heart. — The human heart is a pear-shaped muscle, about the size of the fist, hollow, like a bag, but with very thick walls. It is divided inside by fleshy and membranous partitions into four parts, very much as a four- roomed house is divided into rooms by its ceiling and partitions, with communicating doors through each of the latter. The Valves. — The valves consist of a skin or membrane hung across each side of the opening between the chambers of the heart, like curtains, in such a manner that the blood, in running one way, presses them flat against the sides of the hole, and tlien, as the heart's contraction attempts to drive the vital fluid back again, some of the blood is forced in behind the curtains, and swelling them out so that they meet in the middle, makes them entirely shut off the return-cuiTent of the blood. Pulsations. — The throbbing of the heart may be felt on the left side of the body, near the lower edge of the ribs, and the beating of the pulse, which in health corresponds to the pulsations of the heart, at the wrist and 222 F00r>9 AND DEINES. over the course of large arteries elsewhere, when situated su&ciently near the surface. Number of Beats — In adult men these beats usually number about seventy, in women about seventy-five, and in children still more frequent ; in infancy being about one hundred and twenty in a minute, and decreas- ing in frequency with increasing years. Within the limits of health the heart's action may vary considerably, some habitually having a rapid and others a sluggish pulse, when in the same individual such conditions as exercise, emotion, depression or even the process of digestion, may de- cidedly modify its frequency. Course of Circulation. — The left side of the heart, marked L. H. in the figure, pumps the blood into the systemic arteries, and thus keeps these vessels over-filled; the larger systemic arteries. A., by their elasticity, exert continuous pressure on the blood with which they are distended; the smallest systemic arteries. A', by their vital contractility, check and regulate the amount of blood flowing out of the larger arteries into the capillary network, and thus keep up the constant pressure or tension in the larger arteries ; the systemic capillaries, marked S. C, are the portions of the vascular system where the great opera- tions of the blood are carried on, that where the worn-out particles from all the tissues of the body are removed and the new atoms for rebuilding these same tissues are siipplied; the wide systemic veins, V., are the passive channels conveying the impure blood back to the right side of the heart; the right or pul- monary side of the heart, E. H., pumps the blood into the arteries of the limgs and dis- tends them, though less fully than is the case with the systemic arteries; by the pulmonary arteries, P. A., the blood is carried through the pulmonai-y arterioles or smallest arteries, Ta, to the pulmonary capillaries, P. C, where it is exposed to the inbreathed air and ex- changes its poisonous carbonic acid for the ac- tive life-giving oxygen ; the letters L/i indicate the lymphatics, ending in the thoracic duct, as already described, and receiving in their course the lacteals, "Lc, which absorb the nutriment of the food from the stomach and intestines, designated by I. in tlie diagram. sx^ Diagram of Both Circulations. CLASSIFICATION OF FOODS. 223 Description of Blood — Human blood, when exposed to the air, from which it rapidly absorbs oxygen, is of a bright scarlet color; but when deprived of oxygen it is dark purplish-red. This diiference is the great characteristic distinguishing arterial from venous blood, and should always be borne in mind when attempting to staunch the bleeding from a woimd, since entirely different treatment is needed in the two cases. Red Corpuscles — The blood is not a red iluid, as it appears to be when first shed; it is composed of a watery por- ^_^ tion, called the plasma, which has a light ^'4~~'^ ^^ \ / (^^ ("a^ yellow color, and an immense number of minute corpuscles, which give to the blood its crimson hue. These little bodies, which ' \^ are called the red blood corpuscles, are ex- Red and White Blood Corpuscles, hibited in different positions in the accom- panying cut, as they appear when highly magnified; the illustration also shows two white or colorless corpuscles, one on the extreme left in a rounded condition, and the other at W, misshapen and entangled in some fibrin threads. CLASSIFICATION OF FOODS. The foods may be divided into the following classes: 1. Nitrogenous substances, or proteids, which go to form the tissues of the body, and are represented by meat, eggs, the casein of milk, and other substances consisting chiefly of albumen. , 2. The fatty or heat-producing aliments, which are derived from both the animal and vegetable kingdoms, although chiefly from the former ; they include the animal fats, such as lard or suet, butter and tlie vege- table oils, among which that from the olive is the one most consumed by civilized man. 3. The carbo-hydrates, of substances containing carbon and hydro- gen without nitrogen ; these are the saccharine or sugary, and the amy- laceous or starchy ingredients of human diet, comprising therefore sugar, molasses, bread, potatoes, beans, etc. 4 The saline or salty articles, consisting largely of common kitchen salt, with potash, lime, magnesia, and a little iron in various combina- tions. These ingi-edients of the human body, small as some of them are in amount, possess a very great importance. Animal Food. — When men are called upon to perfonn any extra 224: POODS AND DKINKS. amount of severe labor, involving gi-eat muscular exertion, there is no doubt that an additional supply of meat is of great sei-vice. Fatty Foods — In regard to the functions of the fatty constituents of food, we may at once conclude that, since the diet resorted to by in- habitants of cold countries invariably contains a large proportion of fatty ingredients, these elements play an important* part in the maintenance of animal heat. Indeed,- it has been demonstrated by experiment that the respiratory or heat-producing powers of fat are two and a half times greater than are those of the vegetable hydro-carbons, such as starch or sugar. Saccharine and Starchy Foods. — The saccharine and starchy constitu- ents aid the fatty matters in develoj^ing animal heat, although they are much less efficacious in this respect. Starch is, however, cajJable of being rapidly converted into fat by the wonderful operations of nature's labora- tory, as we see in the process of fattening pigs upon corn for market, and in this way a large store of the best heat-producing materials may be laid up in the system as a provision for the winter's cold. PKEPARATION OF FOODS. Soups and Broths. — Where economy of nutriment is an important object to be attained, it is probable that the production of broths and soups, from vegetables and meat in combination, affords many and great advantages. In making nutritious broths with a fair allowance of butcher's meat, it is advisable, when possible, to cook the vegetables sep- arately, and the meat, if intended to be eaten with the soup, should be cut up into small pieces. In any case, the meat should be put into cold water, but should not be boiled, except when the vegetables are cooked in the same utensil, a temperature of about 150 degi'ees Fahrenheit being quite sufficient. If the meat is plunged into hot or boiling water at the outset, the external layer of albumen is coagulated, and the juices are prevented from exuding. Boiled Meat. — In boiling meat, on the other hand, when the object is to retain as much as possible of the soluble juices in the meat, the piece ought to be of good size, and it should at once be plimged into boiling water, to coagulate the outside albumen. After being kept boiling for about five minutes, the saucepan should be placed aside, and the tem- perature allowed to lower gradually ; or it may be lowered by the addition of three pints of cold water to each gallon of boiling water. Boiled Fish. — In boiling fish, the addition of salt makes the flesh NUTRITIVE PROPORTIONS OF FOODS 225 90 lOO Pou»i4>«9 Spinach li Salts. Albumin. Starch, Fat. •ucar. Water. Indlgestlbla Subitancei. DIGESTIBILITY OF FOODS. 227 I firmer and more retentive of the flavor. In cooking green vegetables, they should first be carefully washed in cold water, but not allowed to remain in it, then plunged into boiling water and cooked rapidly. Po- tatoes should be boiled in their skins, and after boiling for about five minutes most of the water should be poured off, and then the potatoes should be steamed. Roasted Meat. — In roasting meat, the joint should be placed at first before a brisk, hot fire, with a view, as in boiling, to coagulate the outside albumen, and then the roasting may bo conducted more slowly. Stewed Meat. — Stewing lias this advantage over dry-baking — that there is no risk of charring, and the meat is rendered juicy and tender. Tough and strong-flavored meats are, perhaps, best cooked in this way, because they can be rendered very palatable and digestible by the addition of vegetables and seasoning. Fried Meat. — Frying is even worse than baking, unless very carefully done; but broiling on the gridiron is an excellent way of cooking chops, steaks, kidneys and small dishes of fish or fowl. lElATIVE DIGESTIBILITY OF FOODS. Not until 1825 was the question of the relative power of the stomach to digest different foods satisfactorily demonstrated. Liquids. — Liquid, such as water, both pure and when containing a small amount of nutriment in solution, as is the case with beef-tea or broth, are often quickly absorbed by the lining membrane of the stomach, very much as water is sucked up by a sponge, and pass directly into the blood. Milk — Milk is usually coagulated or clotted as we see it when curdled by rennet, which is the dried stomach of the calf, by one of the ferments in the gastric juice, but it is commonly soon dissolved again and absorbed. Bread. — Wheat-bread composed, as already mentioned, chiefly of starch, cannot be regarded as holding a place among the quickly digestible foods, since it has been found to require nearly three hours and a half for solution. Eg^gs. — Eggs, if eaten raw, may be digested in two hours, but if boiled soft may take three hours, and if hard boiled or fried, require three and a half hours for digestion. Meats — Meats of various kinds differ a good deal in their digestibil- ity; thus, for example, boiled turkey has been found to disappear from the stomach in about two hours and a quarter; boiled lamb in two and a 228 FOODS AND DEINKa half hours, and roast beef in three hours ; while fried pork requires over four hours, and roast pork five hours and a quarter for complete digestion. Fish. — Fish prove, as a rule, more easy to digest than meats; and the ordinary vegetables present less difficulty to the action of the stomach than bread, boiled rice being particularly manageable and requiring only about an hour for its entire solution. Rules Eegarding Meals.^In regard to the periods for eating, experi- ence proves that habit is one of the most important agents in determining the times we ought to partake of nourishment. When a systematic regu- larity in respect to the period when we introduce food into the stomach is observed, the digestive processes are all better accomplished, and the food is more thoroughly and completely assimilated, than when meals are eaten irregularly. Time for Meals — The prevailing custom in this country is to break- fast, soon after rising in the morning, on food nourishing enoiigh to repair the exhaustion consequent upon the long fast of the night, and yet not so heavy as to overload the stomach during the morning, when the most active exertion of the day is usually performed. Whether the most sub- stantial meal be taken at mid-day or in the evening must depend largely upon individual preference, convenience, occupation, and so forth. Exercise. — A very deliberate walk for half an hour or so in the open air, when the weather is not too cold, accompanied by the stimulus of cheerful, but not exciting nor absorbing, conversation, is a material aid to digestion. Thorough Mastication. — As already indicated, the thorough mastica- tion of articles of diet, especially by the third set of teeth, is essential to proper digestion, because, during this process of chewing, nature intends not only that the alimentary substances shall be broken up into a coarse powder, but also that this powder shall be completely mixed with the saliva, which has a powerful influence in preparing the starchy ingredients for solution. Hence persons should cat very slowly, chew thoroughly and move the mouthful of food freely about from one cheek to another, in order to amply impregnate it with the fluids of the mouth, and this pre- caution is particularly valuable when the food happens to be less digestible in quantity or quality than is customary. The diagram on following page shows the percentage of the different nutritious elements of food in eight of the common articles of diet. Effects of Overeating. — An English observer has calculated that for every death from starvation, seven occur from the effects of over- DIGESTIBILITY OF FOODS. 229 indulgence in food. When the stomach is overloaded -with, food beyond its powei' of digestion, nature often relieves the abused organ by the process of vomiting, which no doubt frequently saves jjeople who violate the laws of hygiene in this respect from the penalty of death, or at least of prolonged illness. When, however, the digestive organs are not un- loaded in this manner, the ordinary chemical changes, which occur in warm, moist animal and vegetable matter outside of the body, set in, and fermentation or putrefaction occur, large quantities of gas being some- times produced. Excess i)f Nitrogenous Food — When a superabundance of proteid sub- stances is eaten, and perhaps imperfectly digested, whilst at the same time, as often happens, a diminished quantity of exercise or labor is performed, there must almost necessarily be a disproportion between the oxygen in- haled by the lungs and the nitrogen absorbed from the food, when they BnuAN MrLE . . Cow's Milk . . . Meat • Fish ...... Peas and Beans Potatoes . . . • ProleidL Fats. Carbohydrates. Water. 7fi 6 ■m mm W. io l^jftatlWIi ftSe 68 IP ^H 2^5 Grees Veqetaelbs wM^^^g^5g~=^ j BpTKATt , ^ 36 Constituents of Foods. meet in the blood, and therefore a disturbance of the assimilative pro- cesses. It is probable that gouty and perhaps rheumatic affections arise partly in this way, although the direct influence of certain alcoholic drinks in producing gout is indisputable. Excess of Starchy Food. — Superabundance of starchy articles of diet appears to be less directly hurtful to the system, because a larger propor- tion of the excess passes off from the bowels in an unchanged condition. 230 FOOnS AND DEINKS. Troublesome corpulence may sometimes result, however, from eating too much starchy food, and it has been supposed that attacks of diabetes, a disease which is characterized by the presence of sugar in the urine, are occasionally due to the same error in diet. Contaminated Food. — Food is often rendered unwholesome and unfit for use by inherent disease by contamination with poisonous substances and by putrefactive changes. Moreover the peculiar power of absorption possessed by some foods, as milk, pineapples and bananas, is capable of causinp: the transmission of certain diseases. Decomposing- Food. — Decomposing food may give rise to alarming and fatal poisoning through the absorption of septic materials into the system. It is probable that where chemical analysis fails to reveal a cause for death, many cases giving evidence of violent gastro-intestinal intlanmiation or of profound impression of the nerve centres, are in reality due to such causes. Meat of Diseased Animals, — The meat of animals affected with such diseases as pleuro-pneunionla, murrain, anthrax, tuberculosis, Texas cattle fever and parasitic affections, as tape worm and trichiniasis are unfit for food, and precautions should be obser^'ed to guard against their employ- ment. Adulteration of Milk. — The results of the adulteration of milk are mainly those caused by withholding certain nutritious principles from the food supply. Their evil effects are seen particularly in infants fed upon ^o^°i°c* cow's milk, who are thus deprived of ^^i°''°°° much that is necessary to their sub- ^°^^^'' ©o*.° ob'IVo'^S^M^; sistence and growth. The skimming g^<.o':^'-°'»=d°o*®\^?§it4^ of milk, or the addition of water, are ^^RO?°'^s«°'^«°o^Q5to Transmission of Disease by Milk — ^focSn^^Sf^^'-IS^^l? The results ot investigation into the ^^BgS4*oJj*'^ causation of numerous epidemics and ,, tl,u r- . ■ ■ ^ i » _ / . Human Milk Containing Colostrum isolated cases of contagious diseases Corpuscles, have shown conclusively that some of these are capable of being conveyed through the agency of milk. By carelessness in cleansing dairy utensils, by feeding cows with contaminated food and watering them from stagnant or infected pools and by exposing the milk to foul and poisonous emana- tions, milk may become a source of danger to those who take it. Among the diseases which have been often spread in this way are the following: Tuberculosis, typhoid fever, scarlet fever, diphtheria, and so fortk. INDEX TO PART V OF BOOK III Preventive Medicine Outward Enemies to Health Part V of Book III deals briefly with many out- ward enemies to health, such as light, heat, climate, soil, etc. SUBJECTS OF THE TEXT Blood, Cold and , 234 Climate, Diseases Affected by 233 Climate, Soil and Health 235 Climates, Traveling in Hot Climates, 233 Clothes 234 Clothing, Poisoned 234 Clothing, Regulation of 234 Cold and the Blood , 234 Cold as a Cause of Disease 233 Cold and Elderly People 233 Cold, Local Injuries from 234 Cold and Perspiration 234 Colored Light 234 Contagion 235 Disease, Cold as a Cause of 233 Disease and Heat 233 Diseases Affected by Climate 233 Electricity 235 Electricity in Medicine 235 Eyes and Light 234 Health, Climate and Soil 235 Heat and Disease 233 Heat of the Sun 233 Hot Climates, Traveling in 233 Injuries from Cold (local) 234 Light 234 Light and the Eyes 234 Lights, Colored 234 Morbid Poisons 236 Perspiration and Cold 234 Poisoned Clothing 234 Poisons, Morbid 236 Regulation of Clothing 234 Soil, Climate and Health 235 Soils 23s Sun's Heat, The 233 Sunstroke 233 Traveling in Hot Climate 233 2:n PREVENTIVE MEDICINE PAET V. OUTWARD ENEMIES OF HEALTH Heat and Disease. — Heat becomes a predisposing cause of disease as soon as the temperature rises above 70 degrees or 80 degrees. When it begins to affect healthy life the pulse, the heart action and respiration are quickened. The skin and lungs are unable to equalize temperature, and the condition of the entire body becomes one of susceptibility to disease. The Sun's Heat. — Exposure of the body for long periods to the beat of the sun is apt to result in more or less serious disturbances, such as congestions, brain hemorrhages, meningitis, etc. Hence the need of pro- tection against the direct rays of the sun. Sunstroke — Sunstroke, or thermic fever, is the res^ilt of exposure to heat rays. Its early symptoms are faintness, thirst, great heat and dryness of skin, with prostration. As quickly as possible the body should be sub- jected to the ice or cold water treatment to neck and head. Traveling in Hot Climates — Do not travel during the heat of the day. Protect the person by some covering which will deflect the sun's rays. Rest during the mid-day hours. Content yourself with a scanty, unstimu- lating diet. Use gently stimulating baths. Wear thin, light, loosely-fit- ting clothes. Cold as a Disease Producer — Cold becomes a disturber of bodily func- tion as soon as it falls to a temperature which ceases to be agreeable. The tissues shrink, the capillaries grow sluggish, perspiration is sup- pressed, sensibility is impaired. Sudden Cold. — Sudden falls of temperature are marked by a long train of diseases, or by aggravated or fatal turns to existing diseases. This is particularly true of consumption, catarrh, influenza or grippe and bronchitis. Cold and Elderly People. — From thirty years on the humaji body 234; OUTWAED ENEMIES OF HEALTH. begins to draw on its surplus power. This power is constantly diminish- ing as we age. Hence cold affects the aged most seriously by calling largely on a diminishing power. It is difficult to sustain a "blood heat." Cold and Perspiration — Cold produces disease by checking perspira- tion, thus preventing the escape of injurious materials from the blood, and throwing more work on kidneys and lungs, which often become over- taxed. Cold and the Blood. — Cold tends to drive the blood from the blood- vessels to the surface, thus filling one or more of the circulating organs too full of blood. If any of these vessels be weak the man is handicapped in his battle against disease. Clothes. — The body loses heat by radiation, by evaporation, by rapid air movement. Hence the necessity for clothing, which cuts off radia- tion of heat, interferes with the evaporation from the body, and limits the conduction of heat by rapid air movements. Clothing, therefore, plays a most important part in warding off diseases and disease-producing conditions. Begulation of Clothing — Garments worn next the skin should be of wool or silk, as best absorbents of perspiration, and as non-conductors of * heat. Weights may be light or heavy according to the seasons or different constitutions. White or gray clothes are preferable to black, when one is subjected to direct solar heat. Poisoned Clothing. — Clothes made of dyed materials are sometimes injurious to health, as containing poisons. This is particularly so of bright colored stockings or underclothing. Local Injuries. — Cold gives rise to painful local affections, such as frost-bite and chilblains, the former involving the nose, ears and fingers, the latter the feet. Heat applications in any of these cases must be avoided. The cold treatment is best. light — Light has a powerful effect on the system, through both the blood and ner\'es. It is, therefore, an active agency in the generation of diseases and their cures. It is the essential of all growth, and particularly affects the outer tissues as well as the internal organization. Light and the Eyes — ^Light for the eyes should be carefully gradu- ated, so as to prevent impairment of vision. It has the effect, if profuse, of rendering the eyes sensitive, so that they cannot bear the effects of even subdued daylight without pain. Colored Light — Many advantages are claimed for colored light. Blue and green lights are preferable to orange, yellow or red for the eyes. CONTAGION. ^35 Certain of the colored lights act beneficially on animal and vegetable growths, and have a great influence in hastening the cTires of certain diseases. Electricity. — Electrical conditions of the atmosphere have a direct effect on the human system. On the approach of a thunder storm, one may frequently notice a difficulty of breathing. Rheumatics are pain- fully affected, neuralgia is intensified. Many existing maladies are aggra- vated by electrical conditions. Electricity in Medicine. — As a medical agent electricity has grovm rapidly in favor. As a remedy for many nervous diseases and for pain the galvanic battery has come into quite general use. It is a clean, con- venient and safe remedy. It is also economical, for the cost of an electri- cal machine is within the means of most every one, and it can be self- operated. For the X-ray consult index. Climate, Soil and Health. — It is not alone in temperature that climates differ from one another, and are endowed with the power to check or engender diseases. Into its influences on the human body must enter all the manifestations of humidity, tempest, fog, dew and wind directions. Diseases Affected by Climate — Among the diseases favorably affected by a change of climate are consimiption, bronchial affections, diseases of the throat, asthma, chronic gout and rheumatism, dyspepsia, kidney affec- tions, especially Bright's disease, and neuralgia. The advantages of a climate where sea air abounds, or where the air is rarefied and dry, are fully recognized by medical men. Soils — These affect health in the most direct manner, and through their mineral, animal and vegetable matter, also their air and water. Diseases connected with moist soils are of almost every type, rheumatism, catarrh and typhoid being most general. Moist soils are favorite breeding places for germs affecting health, and drainage systems should be made as perfect as possible. Contagion — The siibject of contagion is one of popular notoriety and apprehensiom Certain receptive conditions, or a predisposition, the nature of which is as yet unknown, exist in individuals, which appear essential to the development of the specific poisons, and the establishment of the disease. An immunity against the repetition of a malady is gen- erally conferred by one attack of a contagious disease. Thiv; safety has been proved real upon an enoi-mous scale in regard to small-pox, and, in relation to tlie other contagious disorders, a belief in such immunity from second attacks is founded upon very extended observation ; but the protec- 236 OtTTWAED ENEMIES OE HEALTH. tion acquired hy a first attack of any of tlicsc diseases is of no avail against the rest. Measles, for instance, renders the human body proof, as a rule, against measles, but leaves it as open to small-pox as before, and so on •with all the rest. Morbid Poisons. — With regard to the co-operative effect of fermenta- tion, putrescence or decomposition there is some reason to believe that it may quicken the activity or facilitate the development of specific morbid poisons in the way of a predisposing cause to their reproduction. There is no small amount of circumstantial evidence tending to show that conditions of this kind may be thus favorable to the propagation of specific diseases, even to the extent of rendering them epidemics, in con- sequence of the predisposing agency of putrefying emanations. INDEX TO PART VI OF BOOK III Part VI of Book III deals with the Germ theory of disease, explains how germs propagate and grow and the necessity of sanitary measures to pre- vent infection from them. PACE Antiquity of Germ Tlieory 237 Avoidance of Germs 243 Bacteria 238 Disease Germs 242 Germs — Antiquity of Theory 237 Avoidance of 243 Effect in the Body 241 Laws Respecting 237 Multiplication of 242 Of Scabies or Itch 241 Period of Ripening 241 rAGE Rapidity of Propagation 243 Size of 242 Itch Germs 241 Laws Respecting Germs 237, 242 Multiplication of Germs 242,- Pasteur Controversy 237 Period of Germ Ripening 241 Rapidity of Propagation 243 Sanitary Regulations 242 Size of Disease Germ 242 Transmission of Disease 241 ILLUSTRATIONS Colored Plate Showing Germs of Cholera, Trichina, Encysted Trichina and Cholera, with Ex- planatory Notes 239 237 PREVENTIVE MEDICINE. PAET VI. THE GERM-THEORY OF DISEASE Antiquity of the Theory — In order to make the sanitary precautions thus rendered advisable clearly understood, it should be explained in the first place that the germ-theory of disease, traced by some to the celebrated Pliny, vastly extended by the renowned botanist, Linnaeus, more than a century ago, since placed upon a scientific basis, particularly through the labors of the celebrated Pasteur, of Paris, and Professor Koch, of Berlin, to whom more than to all of their co-laborers in this important field belongs the honor of proving what had long been suspected, the rela- tion of micro-organisms to disease, and removing this subject from one of theory to one of incontestable fact. The Pasteur Controversy — Without relating in detail the controversy that Pasteur's announcement made in 1857 that fennentation and putre- faction were brought about by specific ferments and that these were com- posed of living cells, it is sufficient to state that this assertion led the way for further investigation, discovery and proof, with the result that the micro-organisms causing the diseases of relapsing fever, discovered by Obermeier ; that of typhoid fever, by Eberth ; of diphtheria, by Loeffler ; of cholera and tuberculosis, by Koch ; of pneumonia, by Friedlander and Frankel, and the origin of many other diseases are now known as the result of the labors of other investigators, whose claims were subjected to the test of the laws formulated by Koch before their character was established as proven. Germ Laws. — In substance these laws insist (a), "that in order to the acceptance that a specific micro-organism is productive of disease, it must be demonstrated. (&) That it is constantly present in the fluids or tissues of the individual subject to that disease, (c) Its absence from all other diseases, (d) Its isolation, growth and repeated cultivation on proper culture media, (e) Its power of reproducing the disease after inocula- tion in susceptible animals." (239) 240 BACTEBIA. BACTERIA (See Adjoining Plate). Bacteria (Greek, stick). — Bacteria are the diminutive organisms com- mon] v called Microbes (Greek, little). They are visible only under a microscope of high magnifying power. Forms — There are three recognized forms of bacteria. Spiralus. — 1. The spiral, or wriggling, form, the only form capable of progressive motion. Bacillus. — 2. The stick-like, or straight rod-like form, incapable of motion. Coccus (berry). — 3. Very like, when magnified, a period in print; incapable of motion. The Plate — Upper left-hand object. The circle shows the size of the little drop of liquid subjected to the microscojic. It is called the microscopic field. Within, in red, is a magnified section of human muscle. In its folds are seen, in white, the encysted spirala, called trichinae (hairs). They are found in diseased pork, and enter man through the eating of raw or under-cooked pork. Thorough cooking kills them. The Plate. — Upper right-hand object. This is the trichina magnified and more inature. It has taken on the sf)iral form, due to growth, and is consuming the muscle in which it is embedded. The Plate — Lower left-hand object. This shows (1) in white, four cells scraped off the intestines, in which cholera germs may lodge. The little dark objects are the spirala of cholera. They are found in the intestinal canal and feces of cholera patients. Form — They are short, comma-like elements, also in the form of U and S, and again long and spiral. They are capable of motion. They are cultivated in gelatin, agar-agar, blood serum, potato and bouillon. The Plate — Lower right-hand object. This shows the bacillus of con- sumption (tuberculosis). It is rod-like in shape, slightly curved, and rounded at both ends. It is not mobile. It may be cultivated in blood serum, glycerine and agar-agar. fncjsted Tnchma /n//umdnMusc/e Double natural size. Tr/chma in Huma/) Muscle Highly majniFied. //? C..9. P £ _ >-• go S, i_o o< Sf "3 en 1J -J ■r 5 £-3 "T fJ tfl r* 3 n-o u t/i c > ■ c m W ■= g ^> ^ ^ m s.** o ^ ^ -^ a O IJ S I- t; w en 2 ^ H: 2S ^ SMALL-POX. 269 - a Seidlitz powder or a bottle of citrate of magnesia, and then a cooling and diaphoretic mixtnre, composed of half a teaspoonfiil of sweet si)irit3 of nitre, ten grains of bromide of potassium, or phenacetnm, four grains, every three or four hours, for fever, and an ice cap to the head for the violent headache, administered every two or three hours if there is much pain or restlessness. After the primary fever subsides, with the coming out of the eruption, there are often a few days during which no medical treat- ment is necessary; but with the appearance of the secondary fever, the cooling mixture should be resumed. Quinine, tincture of iron and brandy should be given in full doses. The Itching — To relieve the itching, which is sometimes almost intol- erable, the surface of the skin may be sponged over with a weak solution of sulphurous acid or of carbolic acid, six or eight drops to the ounce of water. If no relief is obtained from these, anointing the body with cosmo- line or with cold cream may be tried ; but it is sometimes needful to mufEe the hands, especially of children, in order to prevent them from scratching ojjen the pocks after they begin to heal, and so rendering the resulting scars much deeper and more permanent. Keep the patient in a dark room and cover the face with a mask of mercurial ointment, and to prevent pitting the pustles may bo touched with tincture of iodine. The Fever — The fever, when higli, must be kept within limits, either by cold sponging or by the cold bath, the water being at a temperature of 75 degrees when the patient is first put in and then gradually lower it to 68 degrees. During convalescence bathing should be frequent, as it helps to soften the crusts. In malignant small-pox, which generally proves fatal, where very soon the face becomes so swollen that the eyelids are tightly closed and glued together, they should be frequently bathed with a saturated solution of boric acid. The mouth and nose should be kept clean and soft by frequent injections. The patient should have plenty of cold water. Should the heart become weak hypodermics of strychnine, one-thirtieth of a grain, or dram doses of aromatic spirits of ammonia by the mouth. Treatment of Malignant Small-Pox. — In malig-nant small-pox, and in the petechial or hemmorrhagic form, the black small-pox of common lan- guage, the only chance of successful treatment is to support the strength with qiiinine in four-grain doses thrice daily, or Peruvian bark and other tonics, and with stimulants such as wine or brandy or milk-punch, in the forlorn hope that unusual vigor of the constitution may thus be reinforced long enough for the violence of the disease to become expended. If the 270 THE ERUPTIVE DISEASES. patient can tlms be kept alive until after the twelfth or fifteenth day with- out any important organ becoming seriously damaged in its structure, the chance of recovery will subsequently increase every day. The disease being self-limited, it is obviously our chief duty, in the absence of any known specific, to direct our energies toward sustaining the patient's strength in his battle with the disorder, and the prospect of recovery, or prognosis, as it is termed, turns upon the relative power of endurance of the disease-poison and the patient's constitution. Diet — The diet in the early stage of small-pox, like that in most febrile conditions, should be light and unstimulating, consisting of rice, cornstarch, bread and milk, or arrow-root. Oranges or lemonade in modera- tion may be allowed, unless there is a tendency to diarrhoea. Ice water, lumps of ice, or iced carbonic acid water may be given ad libitum. Later on in the disorder, when the strength begins to fail and the pulse grows weaker, strong animal broths, beef essence, and other highly nutritious aliments are necessary; and if the pulse at the wrist should seem very feeble, and especially if it should become intermittent, milk-punch, egg- nogg, or other powerful stimulants ought to be resorted to. Nursing- in Small-Pox. — The general care of a small-pox patient ought to be afforded in accordance with directions contained in the chapter on Xursiug, and most of the special precautions for avoiding the extension of the disease, and so forth, have been pointed out in the article on Con- tagious Influence. On account of the danger of pneumonia and pleurisy, particular watchfulness is needed against taking cold from draughts of air, and during the delirium of the fourth stage, in bad cases, the atten- dant must be constantly on guard to jirevent the patient from injuring himself or others. The nurse should wear an overall and remove it on coming out of the room, and her head should be covered with a cap. VACCINATION THE GEEAT PREVENTIVE OF SMAXL-POX. Seeing, then, that small-jjox is a most painful, loathsome, and fatal disease, for which we have no cure, it becomes infinitely important to avail ourselves of the protection against its ravages afforded by Dr. Tenner's beneficent discovery of vaccination, a discovery which ought to make his name honorable whilst the world stands. And yet, strange to say, there are people bearing the general aspect of reasoning beings who oppose vaccination ; and in England, where vac- cination has been made compulsory by law, a league has been formed to 2 . ot: > oow-pox, 271 combat its enforcement, liecently the folly of these fanatics met, it is stated, with a most righteous punishment in the following circumstance: A leading anti-vaccinationist, Escott by name, who refused to have any of his children vaccinated, lately lost two of them and his wife by small- pox. Escott borrowed a suit of clothes from a friend to attend his wife's funeral, and returned them without disinfection, with the result that the lender caught small-pox and also died of it. Subsequently nearly every house in the neighborhood was infected, producing a local epidemic of small-pox, during which sixteen patients were removed to the pest-house. The only excuse for the obstinacy of such deluded people is, that more than half a century of deliverance from the horrors of small-pox has ren- dered most persons practically ignorant of its dangers. In the latter half of the eighteenth century, that is, from 1750 to 1800, small-pox attacked almost every inhabitant of England, and about one out of every five seized with it died, whilst nearly another fifth of its victims were disfigured or crippled for life. It is estimated that two-thirds of the blind people in England at that time lost their sight from small-pox. To give an idea of its relative mortality, Dr. Guy states that it caused eighteen per cent, of all the deaths, and was one hundred times as fatal as diarrhoea, with its allied intestinal disorders, and six times as fatal as apoplexy, palsy and sudden death taken together. Objections to Vaccination — These, aside from the mere sentimental ones are that in some instances erysipelas and venereal disease have been apparently caused by it, and that it has been accused of being the means of inoculating the human system with scrofula, consumption and certain cutaneous affections. Now, all of these objections can be removed by the use of what is called bovine virus, obtained direct from the cow, with- out ever having passed through any human body. Glycerinized lymph is now conceded to be tlie better vaccine virus. Duty of Vaccination This Is rendered far more imperative by the danger which every unprotected person in a commimlty exposes his neigh- bors to by becoming the starting-point of an epidemic of small-pox. Hence, although a man may have the privilege of thus trifling with his own life and health, he has no right to Imperil others by his perversity or ignor- ance ; and the good of society, which is a higher law than that of personal liberty, demands that compulsory vaccination be legally established, as it Is hoped It will bo ere many years elapse. Making Sure of Immunity — ^Evon after exposure the individual should be vaccinated, for though it may not prevent small-pox, it will ce]> 272 THE EETTPTIVE DISEASES. tuinly moderate the severity of tlic attack. The writer Las bad a case ol this kind to come under his personal observation. COW-POX OR THE VACCINE-DISEASE. How Produced. — This disease, called Vaccina in medical books, is indileed in the human being by the process of vaccination, either acci- dentally, as in the case of the young milkmaid who led Dr. Jenner to his grand discovery, or, as is usual nowadays, by being rubbed into a slight wound made for the purpose. It is apparently a modified form of small- ])ox, in which a cow-pox vesicle on the iiddcr of a cow or heifer is the com- mon original source of the infecting matter. Character — The disease is attended, as a rule, with no further erup- tion than the vesicle, ripening into a pustule at the point or points where the matter is inoculated. It is communicable by inoculation, biit not by the other ordinary modes of infection, mild in its course, and yet, gen- erally speaking, protective against small-pox. Operation of Vaccination. — This is by no means so simple and imim- portant as it seems at first sight, and it therefore ought always to be per- formed by a physician. It is better not to cut so deep in vaccinating as to cause much of a flow of blood, lest this fluid should wash the virus out of the incisions. The usual place for vaccinating is on the outside of the arm, an inch or two below the shoulder ; but if the operation fails here, as is sometimes the case after repeated trials, an attempt may be made on the calf of the leg, just below the knee. When to Vaccinate — ^Vaccination should be performed on all chil- dren between the ages of one and three months, unless some special rea- son exists for its postponement, and it is recommended to insert the virus in foTir or five places close together, so as to produce several pustules, although, by a majority of physicians in this country, one pock is thought sufficient. Revaccination — Revaccination should be performed about once in seven years, as in some instances the protection afforded appears to wear out in that time ; and, as there is no means of recognizing them, the safer way is to renew the vaccination. The Vims — The animal or bovine virus is supplied from carefully vaccinated calves by a number of producers in various parts of the country. It is usually furnished on little ivory points, shaped like a lancet-blade, or on pieces of quills. Either of these is to be moistened iu pure water, BKEAK-BONE FEVEK. 273 and then rubbed on a lightlj scarified surface, prepared as already described. The bovine virus is apt to make a very sore arm, b\it has the great advantage of avoiding all possibility of introducing the horrible poison of venereal disease into the blood of the infant operated upon. VAEICELLA OR CHICKEN-POX. For full description and treatment of this disease, peculiar to chil- dren, see Childeen's Diseases. MEASLES OR RUBEOLA OR MORBILLI, For full description and treatment of measles, see Diseases of Children. RUBELLA, ROTHELN OR GERMAN MEASLES. Definition — An acute infectious disease resembling both scarlet fever and measles, but differing from these in its short course, slight fever and freedom from complications. Cause. — It is propagated by contagion and spreads with great rapidity. Incubation — About two weeks. Symptoms. — This is a mild contagious affection, very similar in many respects to ordinary measles, but apparently differing from it, because neither disease affords any protection from the other. The color of the eruption is rather more rose-tint than in ordinary measles, the pimples are round instead of oval, and the crescentic arrangement is wanting or extremely obscure. Children are chiefly affected with German measles, although it also occurs after adult age is attained, but in any case the malady is so slight that the patients rarely feel sick enough to keep in bed, and no instances of death from the uncomplicated affection are recorded. Treatment. — The treatment, diet and nursing appropriate to German measles are the same as those recommended in the ordinary form, in the few cases where any special care is needed. SCARLET FEVER OR SCARLATINA. For description and treatment of scarlet fever, see Diseases of Chii-deen. 18 274 THE EEtrPTIVE DISEASES. BKEAK-BONE FEVER OR DENGUE. Synonyms.— Dandy, or break-bone fever. Definition. — An acute and infectious disease characterized by febrile paroxysms; pain in the muscles and joints and sometimes by an eruption on the skin. History and Geographical Distribution The disease was first recog- nized in 1779 in Cairo and in Java. The description by Benjamin Rush of the epidemic in Philadelphia in 1780 is one of the first and one of the very best articles ever written on the disease. S. H. Dickson gives a graphic description of the disease as it appeared in Charleston in 182S. Since that date there have been five or six widespread epidemics in tropical countries, the last occurring along the Gulf States in the summer of 1897, where for some time it was supposed to be yellow fever, j^one of the recent epidemics have extended to the Northern States, but in 1888 it prevailed as far north as Virginia. Cause — The rapidity of diffusion and the pandemic character are the two luost important features of dengue. There is no disease, not even influenza, which attacks so large a proportion of the population. A micro- coccus has been found in the blood of patients by McLaughlin, of Texas. Symptoms — Incubation. — Three to five days, during which the patient feels well. Persons who catch this curious complaint are often attacked with it very suddenly, frequently in the night after retiring in their usual health. The temperature rises in a few hours to 103 degrees and in one or two days may reach 106 or 107 degrees, the skin becomes dry and hot, and the countenance indicates utter helplessness and prostration ; with this febrile condition there is usually pain in the head, back, limbs and small joints, which latter swell up as in rheumatism. The pulse is rapid; loss of appetite, coated tongue, slight nocturnal delirium and con- centrated urine. The pain may be so severe that the patient cannot move. Duration — The average duration of the first febrile stage is about forty-eight hours, although it may vai-y from twelve hours to three days, after which the symptoms begin to subside and a period of remission of two or three days occurs. Debility and Eruption. — During this time general debility and mus- cular pains predominate, and fever is usually absent, but on the fourth day it reappears, and on the fifth or sixth an exanthematous eruption develops, which is sometimes more like the flush of erysipelas than the TYPHUS FEVEE. 275 papules of either measles or scarlet fever. The color, however, is not so intense, and it spreads over the whole body in forty-eight hours. Pains and Swelling. — When the eruption reaches its height, painful swellings of the lymphatic glands of the neck, back of the head, armpits and groins occur. With this tumefaction of the glands, the nose, mouth and throat become implicated, swelling up and growing excessively pain- ful. On the seventh or eighth day desquamation commences and the acute stage terminates. Malady Not Fatal. — The victims of dengue are to be commiserated for the horrible and agonizing pains which they are called upon to suffer, and which are peculiar to the disease; but they may find some comfort in the assurance that the malady is rarely, if ever, fatal. Recurrence of Pain. — The recurrence of the excruciating pains in the limbs at a time long after the subsidence of the fever must be borne in mind, as influencing any opinion ventured in regard to the probable duration of the illness. Diagnosis The diagnosis of dengue must occasionally be made from rheimiatism, measles, scarlet fever and erysipelas ; but a complete history of the case can hardly fail to clear up any doubts, particularly if dandy fever is prevailing in the locality as an epidemic. Remedies — Since the malady is not a dangerous one, anodynes to relieve the excruciating suffering, especially hypodermic injections of one-eighth or one-sixth of a gTain of morphia. During convalescence iodide of potash is recommended for the arthritic pains and tonics are indicated. TYPHUS FEVER. Synonyms. — Ship, jail or putrid fever. Definition. — An acute infectious disease favored by closely crowding human beings together, characterized by sudden onset, a maculated rash, marked nervous symptoms and a termination by crisis about the' end o£ the second week. Causes. — It is excited by an xmknown poison which is capable of being carried in the clothes. It is rare in America, though there were two mild epidemics in the Philadelphia Hospital in 1866 and in 1883; it is not uncommon in England and Ireland. Bad food, impure air and overcrowding are predisposing factors. Incubation. — Incubation is placed at about twelve days, but may be less, and its duration from ten days to two weekso 276 THE EEUPTIVE DISEASES. Symptoms.— The fever begins abruptly with severe pain in the head, back and limbs; extreme prostration, and fever which reaches its maxi- uiuiu (lO-i degrees to 105 degrees) in two or three days. The temperature remains high for about ten days when it falls by crisis (suddenly). The Eruption — It is a continued fever, attended with a dark-red or purplish mottled rash over the body, with great nervous prostration, rest- lessness and delirium, or dullness and stupor, but without any specific affection of the bowels. The eruption, which makes its appearance from the third to the eighth day of the disease, is at first slightly elevated and disappears when pressed upon with the finger; but after the second day from the time it comes out, it is persistent under pressure and continues to show this character until it fades, ten or twelve days afterward. Fatality.- — "When it proves fatal, as it does in about fifteen per cent of the cases, death usually occurs between the twelfth and twentieth days of the attack. Advent Symptoms.- — The advent of the disease is somewhat gradual, beginning with general soreness, discomfort and weariness, with loss of appetite and disturbed sleep. Shivering and a feeling of coldness, espe- cially along the spine, sometimes amounting to an actual chill, not un- frequently mark the commencement and are soon followed by beat of skin, rise in temperature and severe frontal headache. This headache is occasionally very severe and rarely absent at first, but abates about the tenth day. Disturbed Sleep. — Slumber is disturbed by dreams, is unrefreshing, and when the patient is not asleep there is a constant tendency to heavi- ness, the mind ceases to think and the attention cannot be concentrated upon any subject. He may lie ^vith his eyes open, evidently not in slumber, yet indiiferent or insensible to all which goes on around him. Bodily Weakness. — This is frequently extreme, and the sufferer often voluntarily takes to his bed on the first day of his illness. This exhaustion and prostration is totally disproportionate to the amount of muscular exertion which has been made. The eyes, when examined, are found to be dull and heavy, the white portion injected or blood-shot and a peculiar dusky flush overspreads the cheek. The Delirium — As the days pass debility rapidly increases and de- lirium comes on the latter part of the first or early in the second week. In persons of nervous, excitable temperament it commences sooner and may appear on the third or fourth night of the fever, stowing itself TYPHOID FEVER. 277 primarily, perhaps, by a little conriisiou of thought ou awaking from a restless doze. The Tongue. — The tongue is coated at first with a white fur, but after six or eight days often may become dry, swollen and covered with thick, brownish crusts of mucus and cast-off epithelial cells, which make up what is called sordes. The Bowels. — The bowels are, as a rule, constipated, and this should especially be borne in mind, because it forms an important distinguishing mark between this disease and typhoid fever, with which typhus was formerly confounded. The Pulse. — The pulse is quickened from the outset and in grave cases continues to increase iu rapidity until it may more than double its ordinary frequency, beating from one hundred and forty to one hundred and sixty times per minute. Complications — Broncho pneiimonia is perhaps the most common complication. It may pass on to gangi-ene ; iu certain epidemics gangrene of the nose, hands and toes have occurred. Diagnosis. — The diagnosis of typhus fever requires to be made in this country chiefly from typhoid fever and relapsing fever, but it is some- times difficult to distinguish it at first from small-pox, plague, erysipelas and cerebro-spinal meningitis. Treatment. — As the treatment, diet and nursing of typhus fever are similar in most respects to what is required in the far more common disease, typhoid fever, the reader is referred to our article upon the latter affection for further information. Isolation. — 'ttTien an epidemic of typhus fever breaks out iu a crowded jail, hospital or tenement, the great cause of its prevalence should, of course, at once be abolished by separating those exposed to it as widely as possible and treating the sick in isolated sheds, huts or even in tents. TYPHOID FEVER. Sjrmptoms. — Enteric fever, autumnal fever or typhus albuminalis. Definitien An acute infectious disease due to the implantation and proliferation of the bacillus of Eberth, characterized by ulceration of the lymph follicles of the intestines of the mesenteric glands and by an en- largement of the spleen. Historical The disease is easy recognizable in the descriptions of Hippocrates (B. C, 460-357) and Galen (A. D. 130-200). Doubtless John 278 THE EEUPTIVE DISEASES. Hirsam's "slow, nervous fever," described in his "Essay on Fevers" was the typboid of tbe present day, and bis "putrid maliguaut" tbe yellow fever of to-day. It was, however, the writings and teachings of tbe great French physician, Louis, which did most to disseminate a knowledge of tbe true nature of typboid fever, to which he gave the name it bears. Among some of his pupils were tbe Americans W. W. Gerhard and C. W. Pen- nock of Philadelphia and James Jackson, Jr., of Boston. To tbe former, however, is due the great honor of having first clearly laid down the difference between typboid and typhus. Causes. — Typboid fever prevails in temperate climates in which it constitutes the most continued fever. It is widely distributed throughout all parts of tbe world. Seasons — It prevails most in the autumn months, especially follow- ing a dry summer. Sex — Males and females are equally liable. Age — Typhoid fever is a disease of youth and adult life. The greatest susceptibility is between the ages of fifteen and twenty-five. It is rare after sixty and infants are seldom attacked. Immunity — As in other fevers, not all exposed to tbe infection take the disease. Some writers claim that one attack protects, but others claim that one attack predisposes to another. THE BACILLI OF TYPHOID. Bacilli in the Body — Tbe bacilli are found in tbe lymphoid tissues of the intestines, in tbe mesenteric glands, in the spleen, liver, bile and in tbe bone marrow. They also occur in irregular clumps in tbe contents of intestines and in the stools ; they have also been f oimd in the blood, urine, sweat and sputa. Bacilli Outside the Body — Tbe bacilli retain their vitality in water for weeks, but disappear from ordinary water in competition with sapro- pliytes in a few days. In milk tbey undergo rapid development without changing its appearance. They may increase in the soil and retain their vitality for months. They are not killed by freezing, but, as Pruden has shown, may live in ice for months. MODES OF CONVEYING BACIIII. >£. Contagion — The possibility of tbe direct transmission through the air from one person to another must be acknowledged, although, as TYPHOID FEVEE. 2^9 shovm by Germano, when comi^letely dried in air currents, the siieeific bacillus quickly dies. There are house eindemics in which water and food contamination can almost be excluded. The nurses and attendants who have to do with the stools and body linen of the patient are alone liable to direct infection. 2. Infection of Water — This is unquestionably the most common mode of conveyance. Many epidemics have been shown to have originated in the contamination of a well or a spring. 3. Milk — Milk may be the source of infection, as it may be con- taminated in washing out the cans with infected water. 4. Ice and Salads — In addition, the germs may be conveyed in ice, salad, celery, and so forth. A fly which has- alighted on the soiled linen or discharges from a patient may contaminate the milk or food. Bad Sewage and Drainage — Pilth, bad sewers or cess-pools cannot in themselves cause tyjjhoid fever, but they furnish the conditions suitable for the presei-vation of the bacillus. Symptoms — Typhoid fever, also called gastro-enteric fever, owing to the circumstance that the stomach and intestines are the chief seats of the disease, is characterized by a faint, scanty eruption of rose-colored spots, appearing chiefly upon the abdomen, from the fourth to the eighth day, and coming out in successive crops. Each crop of sj^ots continues visible for about three days. Cess-Pool Fever — On account of its frequent connection with bad drainage, this fever has received the vulgar but expressive name of "drain or cess-pool fever," which, despite its indelicacy, it would be well to per- petuate as a constant warning against that neglect of sanitary arrange- ments in buildings to which it is chiefly due. Initial Symptoms. — The onset of this dangerous and fearfully prev- alent disease is very often a gi-adual one. The patient for some days feels weak, languid and depressed, loses his appetite, suffers from headache, and is restless at night. In other cases, however, the malady begins with a slight chill, or a feeling of coldness running up and down the back, and among children the first decided symptom may be an attack of convulsions. Frequently, too, slight bleeding of the nose is noticed, and a little tend- ency to looseness of the bowels, which may even be aggravated by errora in diet, or other imprudence, into active diarrhoea. Secondary Symptoms. — After the stage of invasion is completed, the pulse and temperature rise steadily, the former going up to 100 beats or 110 beats, and the latter ascending to 104 degrees, or sometimes 105 280 THE EEUPTIVE DISEASES, degrees diirlng the first ■week. The heat of the body is almost always greater at night than in the morning, and this increment is so regularly advanced during the onset of the disease, that it is quite jjossible for a skilled physician to recognize typhoid fever by a glance at the record of temperature, or "temperature chart," alone in many instances. The Diarrhoea. — The diarrhcea rapidly grows more severe, and in bad cases is frequently very profuse, fifteen or twenty thin, watery evacuations occurring in every twenty-four hours. In many cases the bowels are con- stipated. Pain in the abdomen, especially in the region of the right flank, is nearly alwaj-^ complained of, and with the diarrhoea is due to the characteristic ulceration of certain oval spots in the lower portion of the small intestine, which have received the names of Peyer's patches. Bron- chial irritation and cough are common. Facial Appearance. — The face sometimes wears an anxious, haggard look, but frequently, even early in the disease, it shows the dull, indiffer- ent aspect, so often indicating an oppression of the brain, which will deepen into stupor, then coma and finally death. The flush of the face is apt to have a more dusky, purplish tint than in other fevers, and the skin is more dry and burning, or pungent, from the smaller amount of perspiration. The Delirium — In the second week delirium generally comes on, and although occasionally violent and requiring the patient to be controlled by physical force, it is more frequently of a low, muttering character. The tongue becomes dry and brown, and tympanites, or the accumulation of gas in the bowels, is generally considerable, and may cause by its enormous distension great suffering, or even lead directly to a fatal result. Ringing or buzzing in the ears with deafness is very often noticed. In bad cases the diarrhoea is often very profuse, and discharges of fluid blood, perhaps in large quantity, sometimes occur and j^rove quickly fatal. The Third Week — In the third week, if the case is to end unfavorably, the pulse grows frequent and feeble, the tongue is dry, cracked and cov- ered with brown sordes, the delirium and stupor are constant, involuntary discharges from the bowels occur, and the patient may die exhausted, or if the fatal issue comes earlier, before complete prostration of muscular strength, it may be preceded by convulsions. Signs of Kecovery. — If, on the contrary, recovery awaits the patient, the pulse falls off in frequency, the temperature gradually diminishes, the tongue cleans off usually from the edges, appetite slowly returns and the mental powers are little by little regained. TTPHOID FEVEE, 281 TTnfaTorable Symptoms. — The unfavorable symptoms, besides those above mentioned, are an unusually high temperature, 106 degrees or over, picking at the bedclothes, slipping down in the bed, and entreaties, often of pitiful earnestness, to be taken home. Special Features and Symptoms — 1. A severe facial neuralgia may put the practitioner off his guard. In cases when the patient has kept up, "fought the disease," the first manifestation may be pronounced deliriimi. In rare cases the disease sets in with the most intense cerebro- spinal symptoms, simulating meningitis. 2. There may be pronoimced pulmonary symptoms. In a few cases the disease sets in with a single chill, with pain in the side and all the characteristic features of lobar pneumonia. 3. There may be intense gastro-intestinal irritation. Occasionally there are eases with such intense vomiting and diarrhoea that poisoning may be suspected. Fever — The fever has invariably a step-ladder rise ; the evening tem- perature is from one to one and one-haK degrees higher than the morning remission. Fever of Convalescence. — After the temperature has been normal for five or six days the fever may rise suddenly to 102 degrees or 103 degrees, and after persisting from one to three or more days fall to normal. With this condition there is no furring of the tongue and no distension of the abdomen. This condition is by no means xmcommon, and is of especial importance, as it is attributed in most cases to errors in diet, constipa- tion, or excitement of any sort, such as seeing friends. Complications — 1. Thrombosis of the femoral vein, more frequently on the left side, resulting in the "milk leg." It occurs, according to Mur- chison, in one per cent, of all cases. Embolic abscesses may occur in the kidneys and lungs. 2. Albuminuria is present to some extent in all severe cases, com- monly as the result of the fever, but sometimes is the direct result of an acute nephritis. 3. Hemorrhages usually occur during the third week, and are indi- cated by a sudden fall of temperature, followed by dark red or tarry stools. 4. Cardiac complications, including pericarditis, endocarditis and myocarditis, are sometimes present. The latter may be the cause of sudden death. 5. Peritonitis may result from perforation or from extension by con- tinuity j the former is more common and is recognized by a sudden pain, 282 THE EEUPTIVE DISEASES. a fall of temperature, distension of the belly and symptoms of peri- tonitis. 6. Piieuiuoiiia may sui^ervene in the second or third week of a ty- phoid, fever, as a complication, in which the true relation is difficult to determine. Diagnosis — The diagnosis of typhoid fever must be made in its early stage from typhus fever, relapsing fever, scarlet fever, measles and small- pox. At a more advanced period it might be confounded with the typhoid condition met with in uremia and pyemia, and also with enteritis or in- flammation of the bowels, peritonitis or inflammation of the membrane covering the intestines, meningitis or inflammation of the membranes of the brain, acute bronchitis or pneumonia, and with acute consumption. The Rose-Colored Spots. — If a patient who has been suffering from headache, prostration, loss of appetite, restlessness and gradually increas- ing fever, has a slight bleeding at the nose unprovoked by accident, we may strongly suspect typhoid ; but until the rose-colored spots appear there is no certainty. Treatment — The medical treatment in typhoid fever miist be directed toward mitigating suffering, warding off complications and obviating the tendency to death. In the early stages of the complaint headache is one of the most prominent symptoms. All we can hope for is to procure some mitigation of the intense suffering it frequently occasions. Ice Application. — The application of ice to the head, either in a bladder or India-rubber bag, or, what is still better, by means of an ice- cap, made of numerous coils of thin rubber pipe, through which ice-water is kept flowing, generally diminishes the pain, which, if very intense, may require the application of one of two leeches behind the ears. For Checking Diarrhoea — Diarrhoea, if troublesome, is to be checked, but not stopped, by chalk-mixture, bismuth-mixture or astringents with opium, when necessary. Creosote .-. 6 drops Bismuth siibnitrate j drachms Mix and make into 12 papers and take one every three hours. Or, when ordinary measures fail — Silver nitrate 5 grains Extract of gentian 4 " Mix and put into pills, making 20. Take one every three hours. TYPHOID FEVEE. 283 Its use, however, after tbe first few days, must be continued with great caution, on account of permanently blackening the patient's skin. Rest. — Absolute rest in bed, with the use of the bed pan, must be enforced. Rendering Stools Innocuous — The stools should be rendered innocu- ous. This may be done by dissolving a pound of the chloride of lime in four gallons of water. Add a quart of this solution to each discharge and allow it to remain in the vessel at least an hour before disposing of it. Soiled bed clothes should be thoroughly boiled. Restlessness — In cases where restlessness rather than stupor pre- dominates small doses of bromide of jiotassium or a five-grain sujiposi- tory of powdered asafoetida in the bowel will allay the condition. When the tongue becomes dry, ten drops of the oil of turpentine given in mu- cilage every four hours, often have a very happy effect, and its influence upon the healing of the intestinal ulcerations is highly lauded, while it aids in the expulsion of the gas. Stimulants. — Generally, during the second week, sometimes a few days earlier, and occasionally a few days later, according to the violence of the attack and the patient's strength of constitution, it is advisable to begin with the use of stimulants. The best indication of their becoming needful is a slight failure of the strength of the pulse, but much experi- ence is necessary to judge correctly of the time, the quantity, and the frequency with which alcohol be administered. Kinds of Stimulants. — At first half an ounce of good whiskey or brandy, with two or three ounces of milk and half an ounce of lime-water, if nausea persists, may be allowed three times daily, but this amount must generally be increased from day to day, sometimes with great rapidity, until in the worst cases a pint and a half of brandy is swallowed in twenty- four hours. Beef tea, beef essence, and some farinaceous food, such as arrow-root or cornstarch, ought also to be urged upon the patient at this time. To Stop Hemorrhages In cases of hemorrhage fi'om the bowels, crgotin hypodermically, in full doses, fred. extract of ergot by the mouth or morphia hypodermically; aud if perforation of the intestine, in consequence of the eating through of one "of the ulcers, takes place, the very slender hope of recovery is increased a little by the administration of large doses of a gi-ain every hour of opium and by secviring perfect rest in bed. Hydrotherapy. — Since many of the worst symptoms of typhoid fever 284 THE EEDPTIVE DISEASES. seem to be due to the effect of overheated blood upon the brain, efforts to reduce the temperature by the aid of cool baths of about 70 degrees Fahrenheit six or eight times daily, or cold sponging of the whole body, have of late years taken a very prominent place in the treatment of the disease, and are believed to reduce markedly its rate of mortality. Where, in spite of judicious emijloyment of means to bring down the temperature, unconsciousness continues, great watchfulness is necessary in regard to the evacuation of the bladder, which may become dangerously distended, and even burst for want of attention. Drawing the Urine. — When examined and found to be over-full, the urine should be at once drawn oS by means of a catheter, and the opera- tion repeated twice or thrice every twenty-four hours, imtil the patient resumes control over his functions. Other treatment would be the 1. Sponge Bath. — The water should be cold or ice-cold, according to height of fever, and a thorough sponge bath should take from fifteen to twenty minutes. I have added alcohol to the water with good results. 2. Cold Pack. — If tub is not available the patient may be wrapped up in a sheet wrung out of water at 60 degrees to 65 degrees and then cold water sprinkled over him with a watering pot. 3. The Bath — The tub should be long enough so that the patient can be completely covered, except his head. Every third hour, if tempera- ture is above 102 degrees, the patient is placed in a bath at YO degrees Fahrenheit, which, after the patient is put in, can be lowered a degree or two. In it he remains for fifteen or twenty minutes. He is then taken out, wrapped up in a dry sheet and covered with a blanket. The patient's limbs and body are gently rubbed while in the bath, and on re- moving he should have a stimulant. Rectal temperature should be taken directly after the bath, and again forty-five minutes later. Should the patient be too weak for the bath, frequent sponging or Leiter's coils should be used. Constipation. — Should constipation be present, though as a rule it does no harm, it is well every third or fourth day to give an enema. If a laxative is needed during the disease give Hunyadi-Janos water. Hemorrhage — Should hefnorrhage exist it should be treated with full doses of opium and acetate of lead. Ice should be freely given, and food should be restricted for eight or ten hours. If there should be any symptoms of collapse give stimulants. Diet. — The diet of a typhoid fever patient must be watched over with TYPHOID FEVEK. 285 unceasing vigilance, as upon it and proper nursing, more than upon medi- cal treatment, the chances of success often depend. In the first stages it should be light, entirely unstimulating and unrelaxing to the bowels. No Solid Food. — Throughout the whole course of the disease no solid food ought to be allowed, and this i^recaution should be rigidly enforced on account of thereby avoiding the risk of mechanically rupturing some little hole in the intestine, at the seat of an ulcer which had almost per- forated the wall of the bowel. Such a catastrophe must, as already hinted, lead to almost certain death. Drink. — ^As the thirst is usually very great, whilst the appetite is nearly lost, it is a good plan to make the drinks somewhat nourishing in order to support the strength. Hence, gum-arabic water, barley-water, albumen-water or milk thickened with tapioca, sago or cornstarch are often highly advantageous. No Fruits — If the usual tendency to diarrhoea is at all marked, fiiiits of all kinds ought to be entirely withheld by the nurse, and even where the bowels are not disordered, fruits and vegetables, other than those enumerated, should be very cautiously given, on account of the disposi- tion to looseness of the bowels which generally exists. Many cases of death from typhoid fever may be directly traced to the murderous impru- dence of nurses and attendants in this respect. Diet for Second Week. — During the second week, when slight indica- tions of debility iisually begin to manifest themselves, a more nutritious diet becomes necessary. Thicker preparations of the farinaceous foods above mentioned should be employed, beef tea and beef essence may be added to the list, and as debility increases eggs beaten up with milk, flavored perhaps with a little wine, if they have been well borne during health, may be administered. In the latter stages, when the whole capacity of the enfeebled digestive organs is needed to take up sufficient food to sustain life, strong meat-soup, beef essence, eggs beaten up with •wine, and milk punch should alone be urged upon the patient. Injected Food Life has apparently been saved in some instances by frequently repeated small injections of beef essence, brandy and milk, with a few drops of laudanum, in order to prevent the enema from being rejected from the bowels, as is often the case in spite of all our efforts. Nursing. — In nursing the case of a typhoid fever patient, v/atchful and judicious care of a skillful attendant often contributes in those in- stances having a favorable termination, as m.ost candid physicians will admit, more than medical treatment to the sick man's recovery. The gSG THE EEUPTIVE DISEASES. suitable administration of medicines to control diarrhoea, according to the varying j)hases of that important symptom; to relieve restlessness and allay excitement; the proper employment of baths to reduce febrile heat and diminish cerebral congestion ; the constant guarding of the patient from injurious articles of food; the increasing effort to economize the failing strength, which otherwise may prove just a little lacking in the last great day of struggle with the disease, notwithstanding all the rein- forcements called upon in the way of stimulants and nutrients to support it, ail these oifer an ample field for the highest intelligence and the noblest self-sacrifice. Watching the Delirium. — The attendant upon a typhoid fever case must be on his guard, lest in his momentary absence the delirious patient gets out of bed and attempts to escape from the house, or perhaps throws himself out of a window. Even the effort at walking across the room may, in the weak conditions met with in the latter portion of the fever, so exhaust the failing strength as to load to dangerous or fatal collapse. Treating Bed-Sores. — The tendency to bed-sores, which are particu- larly apt to form over the portions of the body pressed upon in lying upon the back during typhoid and typhus fevers, must be overcome, as far as possible, by frequent change of position, the use of perforated pillows or cushions and of water-beds, and the patient should be well rubbed with alcohol twice a day, especial care being used over the parts of the body that the patient rests on while in bed, i. e., back, buttock, and so forth. As a general rule, the formation of a bed-sore in a case of typhoid fever not lasting more than twenty-five to thirty days, is evidence of care- lessness on the part of the nurse, and should never bo permitted to occTir. "When once developed, bed-sores must be kept clean and carefully dressed once or twice daily, in the hope of preventing them from spreading, as the chance of curing them until the patient can sit up Is exceedingly small. Not only Is the suffering from bed-sores very great, but the free discharge of pus which they generally yield is extremely debilitating and quickly exhausts the little remaining stock of strength. Typhoid Mortality.— The mortality of typhoid fever varies in differ- ent epidemics from 10 to 20 per cent. The older the patient the less is his chance of recovery from the malady, whilst among children the pro- portion of deaths is quite small. Walking Typhoid. — Some of the mildest cases, those to which the name of "walking typhoid" has been appropriately applied, may suddenly terminate in perforation of the bowel, and death in a few hours from SPOTTED FEVEE. 287 collapse or from peritonitis. On this account a typhoid fever patient, no matter how slight his symptoms of illness may be, should stay in bed, and swallow nothing but liquid food, until the searching test of the ther- mometer shows that all febrile movement has subsided. Management of Convalescence — Even after convalescence has fairly set in, great watchfulness is necessary. Permission to sit up in bed even ought not to be given until several days have passed without any fever, as proved by the thermometer, which should be used morning and evening throughout the complaint, and the return to solid food must be both slow and gradual. Any imprudence in diet, or slight over-exertion, may bring on a relapse, which is much worse than the original attack, and its causes ought therefore to be most sedulously shunned. Prevention of Typhoid. — The great means of preventing typhoid fever by unceasing vigilance in regard to the purity of the water, milk and air supply has already been urgently insisted on. Prevention of typhoid is now being carried out in the army and institutions by means of hypo- dermic injections of bacterius. CEREBRO-SPINAL FEVER OR SPOTTED FEVER. Definition. — An infectious disease occurring sporadically and in epi- demics, caused by a diplococcus, characterized by an inflammation of the cerebro-sjjinal meninges and symptoms of great pain in the head, back and limbs, convulsions, irregular fever, and at times petechial eruption. History. — In 1801 Vieussens first described a small outbreak in Geneva. There had been several outbreaks in the United States prior to 1875, but since that time there have been several extensive epidemics. There was a serious epidemic in Western Maryland in 1892, in New York in 1893, and from the spring of 1896 to the spring of 1898 the dis- ease has prevailed extensively in Boston and its neighboring towns. Causes — Over-crowding, poor food, foul air and bad drinking water seem to be the predisposing causes. The epidemics have occurred most frequently in winter and spring. The concentration of individuals, as of troops in barracks, seems to be a special factor; in civil life children and young adults seem most susceptible. Symptoms — Many different forms have been described, but they are best grouped into three classes : 1. Ordinary Form. — This is a malignant epidemic fever, usually at- tended with painful contraction of the muscles of the neck and retraction 288 THE EEtfPTIVE DISEASES. of the head, and frequently accompanied by a profuse purpuric eruption. It is a disease which generally comes on suddenly, runs its course with great rapidity, and proves fatal in a majority of instances. The malady is more than a mere inflammation of the membranes of the brain, or meningitis, for the whole nervous system seems to be very gravely affected from the first- Premonitory Symptoms — Premonitory symptoms are rare, but when they are met with, show themselves simply as slight headache and pain in the back, or a little uneasiness and weariness experienced for several days before acute symptoms set in. These may commence with a chill or marked shivering-fit, followed by intense vertigo, headache of intolerable severity, obstinate and violent vomiting, painful muscular stiffness, soon developing into continuous spasms, affecting particularly the muscles of the head and back. Head Distress Distress in the head is constant so long as conscious- ness lasts. The eyes are blood-shot, and express agonizing suffering, the pupils are contracted, and the countenance is pale. Excessive restlessness and general muscular agitation prevail, and the sensibility of the whole surface is so great that every touch and movement causes excruciating pain, and even touching the hair is painful. Third Day Symptoms — These symptoms increase up to the third or fourth day, when the power of swallowing begins to be affected, and the process of respiration to be imperfectly and irregularly performed, the head being dragged tightly back as far as possible, and the features fixed in the horrible and characteristic gTin of lockjaw. The delirium usually developed during the third day, if it has not sooner appeared, passes into stupor, and this in its turn deepens into coma, from which or from suf- focation death commonly releases the sufferer between the fifth and eighth day of the complaint, or in a few cases the patient may gradually improve, and after three or four weeks enter upon a tedious convalescence of many months' duration. 2, Malignant Perm There is an abrupt onset with a chill, followed by vomiting, headache, moderate fever, convulsions and rash. 3. Abortive Perm The disease begins abruptly with grave sym- toms, but terminates in a few days in recovery. Diagnosis. — The diagnosis between this disease — which, it should be stated, has also been named epidemic cerebro-spinal meningitis, or pur- puric fever — and typhus fever, typhoid fever, tetanus or lockjaw, tuber- cular meningitis and typhoid pneumonia, is usually not difficult, except in SPOTTED FEVEE. 289 the earliest stages. The fact of its epidemic prevalence generally aids at once to its recognition, except in the first few eases which occur, and even in these the intolerable headache, retraction of the head, and excessive sensitiveness of even the hair to the lightest touch, are almost always suffi- cient to characterize this strange and terrible malady. Complications — Deceptive vision from inflammation of the cornea or atrophy of the optic nerve ; defective hearing from inflammation of the auditory nerve or from suppurative inflammation of the middle ear. Pleurisy, pericarditis and parotitis are not uncommon, and headaches more or less severe may remain for months or years. Treatment — The treatment consists of dry or wet cups to the nape of the neck and along the spine, cold to the head hy means of ice-bags or bladders, or better still the ice-cap, opium in quantities of a grain every two or three hours, and especially hypodermic injections of morphia, to relieve the agonizing sufi^ering as well as for the direct curative effect ■which opiates seem to possess in some instances, and iodide of potassium, in full doses of five grains every four hours, is indicated during con- valescence, and blisters to the spine are also highly recommended. General Remarks as to Prevention — Cerebro-spinal Meningitis is a very contagious disease with a very high death rate. Death may occur "within a few hours to a few days. It is caused by a germ which is foimd in the fluid in the spinal cord. Outbreaks are more common in the winter and spring than in warm weather. It occurs both in large cities and sparsely settled country places. Its development is favored by the presence of filth, exposure to cold and wet, overwork, injury to the head, etc. Individuals of all occupations and professions can catch this disease. Its danger lies in its being a dis- ease especially of children and young adults. After forty years of age it is rare, though in a severe epidemic anyone is liable to catch it. The early symptoms of cerebro-spinal meningitis consist of a child or adult being seized with a violent headache, chill, nausea and vomiting. The patient is dizzy and acts like a drunken person. Dragging pains occur in the neck which extend along the spine and into tlie legs and arms. The patient suffers agonizing pain upon bending the head forward or from side to side. Later convulsions develop, and the patient becomes rigid, with only the back of his head and heels touching the bed. The back is arched, eyes may be crossed and bulging and he presents a terrible and hopeless picture of suffering and despair. The slightest touch will pro- X9 290 THE EETJPTIVE DISEASES. duce pain and cause the patient to utter terrifying screams. Delirium develops, followed by stupor, and unles the patient has a good consti- tution and receives special care and treatment, death follows. The rash of spotted fevers occurs as tiny scattered reddish spots, some are dark or purplish red and contain, when stuck with a needle, a reddish fluid. In the severe cases death may occur in a few hours. The germ causing this disease is supposed to enter the body through the mouth and nose and finally reaches the brain and spinal cord. The after effects of spotted fever are what makes the disease so dan- gerous. Thus various fonns of paralysis, loss of intelligence, due to the brain having been inflamed (meningitis), complete deafness and loss of yision. The spread of the disease can be prevented by a person following the laws of personal cleanliness, and removing all filth, dust, etc., from about the premises. Avoid catching a cold, and do not approach a house where a ease is. Every ease of spotted fever must be reported to the health authorities by the physician or guardian of the patient. Don't wait a minute. If there is a case in your neighborhood, be on guard and at the slightest sign of any child or young adult being taken ill with the symptoms, men- tion the above, summon your physician or the nearest health authority. The patient must be placed in a darkened, well-ventilated room. Screen all doors and windows. The attendant or nurse must not leave the room without leaving the clothing inside and the hands must be dipped in chloride of lime. The Board of Health will place a placard on the front and back doors. Whenever possible, send the patient to the contagious hospital. All bed linen, clothing, dishes, etc., must be dipped in chloride of lime solution (onc-lialf pound to a pail of water) before being washed. All cloths in which the discharges from the nose and throat have been collected must be burned. The kissing of patients is dangerous as the disease may be contracted in this manner. No one must enter or leave the room in ■which the patient is confined except the doctor or nurse. After recovery, the room must be fumigated by the Board of Health. Leave in the room all clothing worn by the j^atient and nurse, bed linen, carjjets, Curtains, etc., must be spread out so that the disinfectant can destroy all germs. Kill all flies or mosquitoes seen in or about the room or house, as they cavij the diseasCt BELAPSINQ FEVEB. 291 KEIAPSING FEVEH OB, FEBRIS RECTTRKENS. Definition. — It is an infectious disease caused by tlie spirochetes of Obenueier, characterized by a delinite febrile paroxysm which usually lasts six days, and is followed by a remission of the same length of time, then by a second paroxysm, which may be repeated three or four times. Cause. — This disease is also kno\^Ta as "famine fever" and "seven- day fever." The special conditions under which it develops are similar to those of typhus fever. Symptoms — Period of incubation appears to be short and in some cases the attack develops promptly after exposure, more frequently, how- ever, from five to eight days. Its onset is usually abrupt, without any preliminary symptoms, and the febrile attacks, usually severe though of short duration, pass away leaving the patient comjiaratively well for a few days. After an interval of about a week, however, a repetition of the primary attack is experienced, and this relapse, from which the disease takes its name, may recur four or even five times. Blood Germs — Eelapsing fever is remarkable for. being the firsti human febrile affection of a paroxysmal character which has been defi- nitely connected with the development of a vegetable organism in the blood. The peculiar vegetable organisms belonging to the spirochetes are found in the blood of relapsing fever patients by tens of thousands, and disappear during the temporary convalescence, to reappear with the recur- rence of the febrile attack. Symptoms Beginning — The onset of the malady is marked by a chill or shivering-fit, severe headache, vomiting and often jaundice; a white, moist tongue, tenderness over the pit of the stomach, constipation, en- larged liver and spleen, high-colored urine, a frequent, full and often bounding pulse, pains in the back and limbs, and frequently delirium. Further Symptoms. — These symptoms abruptly terminate between the fifth and eighth day, as a general rule, by an exceedingly copious perspiration, and, after an interval of a week, during which it may be sup- posed that a new crop of bacteria are ripening, and in which time the patient is often well enough to get up and walk about, a sudden relapse takes place, running through the same phases as the original outbreak, except, perhaps, that it is a little shorter. At Death.--^When death occurs, it is apt to happen from a fainting- fit, following excessive perspiration, or from coma, the result of suppres- 292 TUE EEDPTIVE DISEASES. sion of the renal secretion, but as seen in America the fatality is verj small, Itping; on an average less than two per cent. Diagnosis. — The diagnosis of relapsing fever cannot bo positively made by the general symptoms during tlic primary onset, but may be strongly suspected, and the relapse looked for if the disease is jirevailing, and exposure to the contagion has occurred. A microscopic examination of the blood dviring the height of the febrile movement Avill, however, determine the presence of the spiro-baeteria, and this investigation ought therefore always to bo made. 1. Treatment. — Although so far advanced in our knowledge in regard to the vegetable nature of the triie contagion of relapsing fever, we have not yet made equal progi-ess in the specific treatment of this complaint. The great problem, of course, is to find some mineral siibstance which can be taken up in the blood in sufficient quantities to check or pi'event the growth of the bacteria in that vital lliiid, without seriously injuring the patient himself. Quinine, so useful in intermittent fever, has proved al- most worthless in this disease, and our chief reliance to reduce the high temperature is at present on cool baths or cold sponging. 2. For the Headache — If the headache Is very severe, dry cups to the back of the neck and ;ilong the spine may be employed, or one or two leeches may l)e applied behind the ears, although, since the tendency of the disease is toward great debility, it is better to avoid the abstraction of blood if possible. Opium or morphia by the stomach, or still better by hypodermic injection, is often necessary to relieve the headache and the severe pain in the limbs, and If symptoms of prostration come on early, wine or brandy must be resorted to. 3. The TJrine — A very careful watch must be maintained over the functions of the kidneys, since one of the great dangers of the disease appears to be the failure of these organs to jierforra their duty of purify- ing the blood from urea, wliicli, when allowed by renal negligence to accumulate In the system frequently causes death by uremic poisoning. The urine should, therefore, be frequently examined, its total daily quantity noted, and the existence of albumen tested for. On account of its favorable action on the kidneys, sweet spirits of nitre in quantities of a teaspoonful every four hours Is ]inrticularly applicable. 4. For the Pain — For the muscular pains it is reasonable to expect that phenacetlne, antifebrin or antljiyrlu will be of great service. The febrile paroxysm demands much the same treatment as typhus fever. Sponging or cold baths and nutritious and easily assimilated food. FEBEICULA OK EPHEMERAL FEVER. 293 FEBKICULA OR EPHEMERAL FEVER. Definition — A fever of short duration, depending on a variety of irritative causes. A febrile movement, lasting twenty-four hours and then ^disappearing, may for convenience he called ephemeral fever; if of three or four days' duration, febricula. Causes — The most frequent cause of this form of fever is probably the ingestion of foods difficult of digestion. As a rule dyspepsia is per- haps the most frequent cause of such a fever. This is especially the case with children, where it is often spoken of as gastric fever. Another cause is exposure to cold, insufficient to produce bronchitis, tonsilitis or some other affection too slight to be recognized by the usual signs. Symptoms. — The symptoms of irritative fever are those usual to fever in a mild degree, i. e., moderate elevation of temperature rarely above 103 degree Fahrenheit, frequent pulse, flushed face, headache, sense of lassitude and weariness, loss of appetite, nausea aud restlessness ; in chil- dren perhaps delirium. The fever is apt to terminate suddenly by crisis on the third or fourth day. Diagnosis. — Typhoid fever — at first the diagnosis may be impossible, but the absence of diarrhoea, tympanites, abdominal tenderness, spleeniff enlargement and eruption will soon nuike the diagnosis apparent. Treatment. — Absolute rest in bed, a li(iuid diet and rejieated doses of calomel may be employed to relieve the constipation. The fever may be controlled by the following mixture : Tincture of aconite root 3 drops Spirits of nitrous ether 'i! ounce Acetate of liquid ammonia, add sufficient to make 3 fluidounces. A dessertspoonful every two hours for a child 4 years old. PROTRACTED SIMPLE CONTINUED FEVER. Definition and Cause. — It seems necessary for the present to continue this term for a feverish process of a longer duration than febricula — a fever of long duration that is not typhoid, nor influenza — lasting from two weeks to three months and without definite lesions may be put under this head. Cases of prolonged fever succeeding pneumonia and pleurisy which subsequently recover may well be ascribed to this disease. 294 THE EEUPTIVE DISEASES. Symptoms are, as will be readily understood from tliis explanation, slight cliill or chilly feelings for the initial disturbance, followed in a few hours by headache, quickened pulse, rise in temperature and constipation. Very often in persons of sensitive stomachs there is a little nausea or vomiting for twelve or twenty-four hours, and again with those of sensitive skins there may be a slight eruption of roseola, or prickly-heat, as it is often called, especially about the loins and over the back. The fever may run high enough for the overheated blood to disturb the brain and pro- duce some delirium, especially at night ; but at the end of a period, vary- ing in duration from twelve hours to ten days, the febrile symptoms usually subside without any further derangement of the system than a very copious and debilitating perspiration, or perhaps an outbreak of the vesicles of herpes, commonly denominated "cold sores," about the face or elsewhere. Such attacks as these cause much needless anxiety, needless at least in the aSTorthern States, to both physicians and patients, the former dreading the onset of tyj^hoid fever or other dangerous disease, and the latter suffering an agony of suspense from which, for a time, all the knowledge of Hippocrates or ^sculapius himself could not deliver them. Treatment — The patient in these puzzling cases should be kept in bed, and allowed only light and unstimulatlng liquid food. Cold applica- tions may be made to the forehead and temples to relieve headache, and diaphoretics combined with anodynes, such as nitre and morphia, as al- ready directed, to reduce fever and allay restlessness. Lumps of ice are useful and refreshing to the throat when swallowed and whilst there is constipation small doses of calomel repeated until there is a free bowel movement. YELLOW FEVEE. These germs, in the course of ten to fourteen days, undergo a process of development and multiplication. At the end of the period of develop- ment the germs migrate to the biting organ of the mosquito, from where they are transmitted into the blood of a healthy person through the skin, "when bitten. Each germ, in turn, when deposited in the blood vessel of the human body, multiplies and develops, and, liberating its toxin, spreads through the circulation and produces the yellow fever in it most pro- nounced form. Yellow Fever, sometimes called Yellow Jack, Sailor's Fever, Black Vomit, Gibraltar Fever, etc., is a disease occurring in tropical and sub- tropical countries. Its cause is unknown, but science has proven that the TELLOW FEVEE. 295 poison causing Yellow Fever is carried from one sufferer to another by the mosquito called the Stegomyia fasciata. Yellow Fever is sujiposed to have been imported into the Western Hemisphere by the Spanish navagitors. It was first described as a dis- ease in the middle of the seventeenth century, where it was discovered in THE YELLOW FEVEE MOSQUITO. the Antilles. The disease affects seaport towns and maritime districts in tropical and subtropical coimtries. Epidemics occurred in the seaport cities of the United States in the nineteenth century. Philadelphia suf- fered from a disastrous epidemic during the end of the eighteenth century. 296 ITHE ERtTPTlVE DISEASES. Yellow Fnver always oociirs in tlie summer and autumn months and ends uiion the appearance of frost. Havana, Cuba, Vera Cruz, Mexico; Rio Janeiro, Brazil, and ITew Orleans during the nineteenth century, until the occupation of Cuba by the Americans, were the cities known as the spots in whick Yellow Eevcr was usually present, and from which the disease spread to other seaport cities of tropical and subtropical coun- tries and the United States. The Mosquito as the Carrier of Yellow Fever Dr. Finlay, of Havana, in ISSl first called attention to the fact that the mosquito was associated ■with Yellow Fever, and about 1890 was the first to explain clearly the mosquito theory of the transmission of Yellow Fever, but he could not prove it at the time by experiment. The American occnjiation of Cuba, however, brought into application in a practical way this theory of Dr. Finlay's. Thousands of cases of Yellow Fever occurred throughout the island and became a menace to the health and lives of our troops. This brought home to the United States Government the dangers and prevalence of Y'^ellow Fever in so close a neighbor, and renewed efforts were made to prove that the mosquito car- ried the poison which caused Yellow Fever. In 1-900 Dr. Finlay had produced yellow fever in a man by allowing a mosquito to bite him two days after the insect had bitten a suiferer from Yellow Fever. This lead to experiments carried on by the U. S. Yellow Fever Commission, which confirmed, -without doubt, that the mos- quito (Stcgomi/ia fasciata) spreads the Yellow Fever. This Commission had a mosquito-proof house built with a partition dividing it into two rooms. Into one room was placed a non-immune person in a bed and mos- quitoes which had previously bitten Yellow Fever patients were liberated. They attacked and bit the vohmteer, who had purposely exposed his arms and chest. This procedure was repeated three successive times. Five days after this experiment, this man developed Yellow Fever. On the evening that this first man exposed himself to the mosquito, two other men ■who never had Yellow Fever slept in the second room, which was screened and contained no mosquitoes, and they did not catch the disease from the man in the adjoininp- room; this experiment proving that the disease could not be caught by being near or in contact with a patient. A second mosquito-proof house was constructed in which bed- clothing and wearing apparel which had been soaked in the discharges from a sufferer from Yellow Fever, were placed, and this house was en- tered for twenty-one consecutive nights by two soldiers and a surgeon YELLOW FEVEE. 297 •who handled and shook the soiled articles. This experiment was repeated by three dili'erent sets of men, each remaining twenty-one nights. Not a man contracted Yellow Fever, nor was any the worse for the experiment. This experiraent proved that Yellow Fever was not contagious and could not be caught by the handling of clothes, etc., fi-om a patient who had Yellow Fever. The absolute proof that Yellow Fever was carried by the mosquito was put to a practical test by Dr. Gorgas, of the U. S. Army, who in the cleaning of Havana destroyed every mosquito seen, cleared away all breed- ing phicps and screened all homes, hospitals and camps where Yellow Fever patients were confined. Thus Havana was made as free from Yel- low Fever and as safe to live in as the healthiest city in the world. It requires three to four days for a person to develop Yellow Fever after being l)itten liy a mosquito which has sucked the blood of a patient suffci'ing from the disease. Experiments have proven that the mosquito cannot convey the disease to another until he has bad the poison in his body for twelve days after biting a Yellow Fever patient. One attack of Yellow Fever renders the person imjmune to another attack — that is, they cannot have it twice. Prevention — The best course in Yellow Fever is to prevent its spread. Place the patient in a screened room or hospital. It is not necessary to keep him or her away from others with the disease or to exclude the family, as Yellow Fever is not contagious. Only be sure that all mosquitoes are killed and kept out of the room by screened doors and \\andows. In cases of an epidemic the local Board of Health will do well to call upm the State and Federal authorities to aid in fighting this dreaded disease. Every town or city in tropical or subtropical countries should do every- thing possible to destroy tbe mosquito and its breeding places. The following are the rules adopted by the United States Anny for the pro- tection of troops from the yellow fever mosquito: ''1st. The universal use of mosquito bars in all bari-acks and espe- cially in all hospitals, and also in field service when practicable. "2d. Tbe destniction of the larvae or young mosquitoes, com- monly known as Sviggletails,' by the use of petroleum on the water where they breed. "The mosquito does not fly far and seeks shelter when the wind blo\vs : so it is usually the case that each community breeds its own supply of mosquitoes in wnier barrels, fii-e buckets, post holes, old cans, cesspools or undrained puddles. 298 THE EKUPTIVE DISEASES. "An application of one ounce of kerosene to each fifteen square feet of water, twice a month, will destroy not only all the young but the adult females who come to lay their eggs. The water in cisterns or tanks is not affected for drinking or washing purjioses by this ajiplication if only it is drawn from below and not dipped out. "For pools or puddles of a somewhat permanent character draining or filling up is the best remedy." [Definition — ^An acute infectious disease characterized by yellowness of the skin and accompanied in the severer cases by black vomit, sup- pression of the urine, with hemorrhage from the stomach, nose and mouth. It is almost peculiar to tropical climates and not apt to spread in tempera- tures below 72 degrees Fahrenheit. It is extremely fatal. It is not con- tagious. It can only be acquired by bite of the female mosquito known aa Stegomyia fasciata. Symptoms. — Yellow fever presents three well-defined stages. The first is characterized by intense pain in the head and back, injected eyes, rapid pulse -and elevated temperature. This stage may last from twenty- four hours to six days — according to the severity of the attack, nausea and vomiting are present and become more intense on the second or third day. The bowels are "usually constipated. As early as the first morning, according to Guiteras, the face is decidedly flushed, more so than in any other infectious disease at such an early period. The second stage is characterized by the following symptoms : The Pulse — One of the diagnostic signs is that with an ascending temperature, there will be a descending pulse. On the first day the pulse is rarely more than 100 or 110 ; on the second or third day while the temperature keeps up the pulse begins to fall and may become slower to the extent of twenty beats. On the evening of the third day there may be a tem])erature of 103 degrees and a jjulse of 75 ; it may, during defer- vescence stage, go down as low as 30. The Fever — On the morning of the first day the temperature may vary from 103 degrees to 106 degrees ; during the evening of the first day and the morning of the second day the temperature keeps about the same. There is a slight diurnal variation in the second and third days. The Calm Stage — Third stage, the remission or stage of calm, as it has been called, is succeeded by a febrile reaction, or secondary fever which lasts one, two or three days, and in favorable cases falls by a short lysis. On the other hand, in fatal cases the temperature rises rapidly, becomes higher than in the initial fever and death follows shortly. The TELLOW FEVER. 299 second stage is marked by depression of the nervous and muscnlar forces, and of the general and capillary circulations, slow and intermittent pulse, jaundice, urinary suppression, passive hemorrhages from the bowels, nose, gums, uterus and nearly all the organs lined with mucous membranes and, in cases of unusual severity, also from the eyes, ears and skin. Black vomit, delirium and coma generally terminate in death. In more severe cases the symptoms resemble to a considerable extent those of relapsing fever, and it is impossible to foretell from any of these indications how serious these consequences may prove to be. In truth, these sequels constitute the most distinctive chai-acteristics of yellow fever and comprise the "black vomit," so well known and dreaded as a fatal symptom. The black vomit is frequently preceded by the white vomit, as it is called, which is a clear acid liquid, and at this time some pain is usually felt on pressTire over the pit of the stomach. The occurrence of this black vomit is well known, even among sailors to West Indian ports, as a fatal sign in yellow fever, although occasionally a patient recovers after this gloomy harbinger of death has manifested itself. The yellow- jaundiced hue of the skin, vsrhen well marked, indicates a severe form of the disease, but has by no means the terribly fatal import of the black vomit. 1. Prognosis. — There are epidemics in which all persons attacked are seriously ill or die. There are epidemics of medium intensity in which the jirogress of the disease is limited and the mortality low. Finally, there are mild epidemics in which nearly all the patients recover. The virulence of the epidemics seems to depend upon the month in which it is imported. The pathogenic bacillus increases in virulence in the months of May, June and July. On the other hand, the epidemics which are imported in the months of August, September and October are very mild, owing to the attenuation of the bacillus. 2. The Individual Attacked — Should the patient prior to his attack have been addicted to the use of alcohol, should he be debilitated from overwork, sexual excesses or bad living, and lastly, if he be old, the prog- nosis is against his recovery. The younger, the healthier and stronger the patient the greater are his chances for recovery. When the fever reaches its maximum at the onset and defervescence is continuously noted at each visit, the disease is mild ; even when the fever ranges between 103 and 104.5 degrees Fahrenheit during the first thi-ee days, with a remission of at least a degree in the morning and the exacerbations are less and less pronounced each night, the patient always gets well. When the fever 300 THE ERUPTIVE DISEASES. ranges between 104 and 105 degrees Fahrenheit, still ■with remissions of at least a degree, but with exacerbations above the degree of fever of the previous day, the disease is to be considered grave. The cases of recovery are more numerous than the fatal ones even here. But when the fever reaches 105 degrees Fahrenheit or above within the first twelve hours the disease is usually fatal, unless heroic treatment immediately produces a defen'escence of two or three degrees. Copious urine is always a good augury, even should it contain five or ten per cent, of albumen. Scanty TJrine with twenty to twenty-five per cent, of albumen on the second day, accompanying a fever about 104 degrees, indicates great danger. When tlie urine froms a complete coagulum on being heated death is certain. When anuria lasts twelve hours death is absolutely certain. Intense Jaundice on the third day, urine scanty and albuminous, with black vomit occurring at the same time, always results fatally. Black Vomit is less grave in children and in yoimg women than in adults, particularly those over forty years of age; the latter always die. Profuse Bleeding of the gums coming before or at the same time as the black vomit indicates an almost desperate state. Should it, however, occur on the fourth day and the gums being sound, the prognosis is less gloomy. Women having uterine hemorrhage on the fourth and fifth days with black vomit never recover. Treatment — There are two great jirinciples to be carried out in the treatment of yellow fever : 1. To strengthen and sustain the organism by fortifying the nervous system, by arresting congestion and by increasing the blood pressure and diuresis. 2. To consume, destroy and eliminate the toxin. First of Above. — The first of the above is met by means of cold sponging or cold batlis, administered not in a routine way, but by taking the virulence of the disease and the degree of the fever as a guide. Second of Above. — The second indication is met by putting the pa- tient in a well aerated room, night and day, and making him drink in order to cleanse his blood and to dihite the toxin and eliminate them by way of the urine, two to four quarts of Vichy water in twenty-four hours. It is during the first three days of the disease that the physician must act. Absolute Best.- — Put the patient to bed, rest is essential and indis- BUBONIC PLAGUE, 301 pensable, walking, moving or the least muscular effort always increases the fever, and consequently the disease. Aeration of the Room. — The patient must bo placed in the largest and best ventilated room in the house. Exposed to the rising sim if pos- sible. Keep the windows open night and day ; do not let patient be in a draught, but let the outside air enter and circulate freely. Cleanliness. — The patient must be kept clean ; should he be soiled by evacuation of the bowels or vomit, change the linen at once and plunge the soiled clothes in an antiseptic solution ; cleanse the patient's teeth twice a day with cooking soda and warm water. Administer morning and night an enema containing a pint of warm water and a tablespoonful of sul- phate of magnesia. The Urine should be examined each day to see how the kidneys are acting. Treatment of the Vomiting. — Let the patient eat small pieces of ice, but absohito rest for the stoniach is the better plan. Nourishment. — None should be given for the first seventy-two hours, after that milk every four hours. Starve your patient whether he be child or adult, unless the fever be below 102 degrees Fahrenheit. Vichy water in large quantities should be given from the onset of the disease. Medicinal Treatment — At the onset give one to three grains of calo- mel, depending on the age of the patient, but not enough to purge. In desperate cases enemas of strong black coffee to which is added two tablespoonfuls of brandy have been found beneficial. BUBONIC PLAGUE. Definition — An acute infectious disease, which is identical with the pestilence of India and the black death of Europe in former ages, and is attended with buboes or boils of the lymphatic glands of the groins, as well as other glands and occasionally with carbuncles. It is very easily communicated by human intercourse and is probably the most fatal of all the eruptive fevers. Cause. — Tlie specific bacillus which causes this disease was discovered by Kitasato, and occurs in the blood and in the organs of the body. It obtains entrance through the digestive an9 respiratory tracts. History. — The earliest positive accounts date from the second cen- tury of our era. From the great plague in the days of Justinian (sixth 302 THE ERUPTIVE DISEASES. century) to the miifdle of the seventeenth centiirj epidemics of varying severity occurred in Eurojie. Although the inhabitants of the Uniled States have hitherto been spared any visitation from the pLigue, yet, as the shipments of rags from Italian ports with marble, for which they are used as wrapping, is carried on quite extensively, germs of this terrible malady may at any time be imported and planted within our borders. In the last great outbreak of plague in Astrakhan, a province of southeastern Russia, the starting-point of the whole epidemic was, it is said, traced to a shawl brought by a Cossack returning from the war in Afglianistan, as part of his booty, and presented to his sweetheart. The girl wore the fatal gift for a few days, when she sickened with all the symptoms of plague and died. During the following four days the rest of her family, six in number, sickened and died. From these poor peojile the disease spread rapidly, and proved very fatal, devastating nineteen villages in that district. Its deadly march was only checked by a double cordon of soldiers being placed around the infected towns, and absolute non-inter- course, on the plan of the shot-gun quarantines of our Southern States, enforced. Symptoms — In the milder cases, patients are attacked with violent headache, transient shiverings, alternating with intense heat of skin, sometimes terminating in death from prostration. In the more severe form the persons affected are suddenly seized with palpitation of the heart, irregularity of the pulse, vomiting, difficulty of breathing, spitting of blood, and syncope or fainting. The face becomes pale, the expression apathetic, the eyes dull and the pupils dilated. The patients lie for three or four hours in a state of absolute prostration and then a violent accession of fever with delirium followed, in which the urine is suppressed and the bowels constipated. Dark purplish spots, from one-tenth of an inch to one inch in diameter, appear over the body, which exhale a peculiar odor somewhat resembling honey, and death is preceded by lethargy and col- lapse. The corpses become putrid in two or three hours after decease. Death sometimes occurs in twelve hours from the first onset. The fever may reach 10-i degrees or 106 degrees Fahrenheit, and the tongue becomes brown. The inguinal glands are most often affected, then in order, the axillary, the cervical and the popliteal. Carbuncles also develop in different parts of the skin, particularly on tlie legs, buttocks or back. Treatment — Free stimulation, nutritious food, as in the most adyna- mic forms of typhus and typhoid fever together with cool baths to BUBONIC PLAGTH. 303 combat the fever, are the measures indicated. Antiseptia treatment of tke abscesses should be practiced. Preventive Measures — In India, from 1896 to 1907, the number of cases of plague was 1,400,000, with 1,200,000 deaths. Owing to the filth and fanaticism of the people, neither curative nor preventive agencies were of much avail. It is evident that the greatest care is now demanded of every country to be watchful and to adopt all necessary measures to prevent a lodgment of the plague. Its introduction is due (1) to the arrival in a community of jjersons suffering from it, or who are in the incubative stage of the disease; and (2) through the instrumentality of rats, which are reagents of the plague. Precautions as to Persons — As to persons, precautions against the plague resolve themselves into measures of quarantine observance. Every vessel, its crew and all passengers arriving from infected ports should undergo most critical scrutiny. Temperatures should be taken on arrival, and efforts made to distinguish between the mild, or amulant, cases and those of the croupous, or pneumatic type. The history of each individual with a mild case should be carefully looked up. Examination should be made of the glandular regions, the groins, the axillae, the neck, and if buboes are found they should be carefully distinguished from those due to venereal infection. For the detection of cases of the pneumatic type, the rcsi^iratory organs should be carefully examined, and the sputum subjected to microscopic or bacteriological tests to discover, if' possible, the plague bacillus. Incubation — The period of incubation of the plague for quarantine purposes should be regarded as seven days, and individuals from ports or places where plague is knowm to prevail should be detained for a period to complete seven days from the last exposure to infection, and should be subjected to critical insjicction twice a day. Quarantine Against Rats — To prevent the introduction of the disease through the agency of rats on vessels from infected jjorts, every part of the vessel should be disinfected by sulphur fumes for the destruction of thd rodents, and their passage from vessel to shore should be prevented. The vessel should not be unloaded at a dock, but in mid-stream, by means of lighters. All rats found dead by the fumigation should be subjected to bacteriological examination, their bodies gathered and burned, and the places where they were found disinfected with a germicidal solution, or with boiling water. Fleas from the rats should be similarly guarded against, for they usually leave a dead rat, and thus help to spread the 304 THE ERUPTIVE DISEASES. plague germs. All masters of vessels, agents and consular oiScers would do well to subject their vessels to disinfection for the destruction of rata at intervals of, say, three months. Procedure in Cities — When the plague has made its appearance in a city, tlie authorities should promiJtly pass anti-plague ordinances regu- lating garbage disposal, and placing all unsanitary buildings and places in sanitary condition. All garbage and kitchen waste should bo collected and removed in covered, rat-proof cans; rat runs and burrows should be destroyed or filled in with broken glass ; house drains should bo repaired ; all nuisances should be abated; garbage should never be dumped in places accessible to rats, but should be burned ; an active campaign against rats should be inaugurated, either by traps or by poisons, such as arsenic, phosphorus paste and carbonate of baryta. Eat poisons should be fre- quently changed, as well as the manner of displaying them. After the appearance of the plague in San Francisco in September, 1907, the campaign against rats resulted, in a few months, in the capture of 278,000 rats, and the destruction by poison of 500,000. Perhaps no other agency was so potential in ridding the city of the plague. Plague in the House — Tlie house or dwelling in which plague appears should be vacated. The house should bo disinfected and fumigated, poison spread and trapping instituted to rid the premises of rats. Cellars and basements should be made rat-proof to prevent their return. Patients suffering with plague should be removed to a rat-proof hospital for treat- ment, and those who have been in contact with the dwelling should be isolated in some sanitary place for a time suiEcient to cover the period of incubation of tlie disease. Serum Treatment — ^Yhile, as has been seen, the TJ. S. Bureau of Health relies chiefly on preventive measures for the extermination of bubonic plague, it by no means ignores the agencies which modem science places at its disposal for immunization from tlio disease or for dislodging it from the system. It has, therefore, experimented much with the prophylactic (preventive) fluid of Dr. Ilaffkine, by inoculating the system "with it. In some cases it gave gratifying results, and in others proved disappointing. So also the antipest serum of Dr. Yersin has been tried and found to contain prophylactic qualities of a decided character, but the duration of the immunity offered is very uncertain; however, in the treatment of actual cases of plague this antipest serum has been found decidedly beneficial if used sufficiently early in the disease and in suffi- BUBONIC rLAQDE. 305 ciently large closes. This serum is produced by the Pasteur Insfitulc at Paris, France, and at the Bacteriological Institute at Ljou. Outgoing^ Quarantine — If the city iu whicli the jilague has made its appearance is a seaport, all outgoing vessels should be subjected to careful scrutiny, and should be thoroughly fumigated with sulphur before taking on cargo to insure the destruction of rats. Wharves should bo rendered rat-proof; gangways should bo fended and guarded day and night, and all articles of cargo attractive to rats should be kept in rat-proof enclosures. Rags intended for export from a plague-infested city should l^e thoroughly sterilized, or else destroyed entirely, for it is quite possible that they may contain the dressings used in the treatment of jslague cases. They may also contain the dejecta of plague-infected rats. Personal Protection Against Plague. — The following statement is made by Charles S. Braddock, Jr., M. D., of Iladdoufield, K j_^ ]^fe chief medical inspector of the lioyal Siamese Government, in his "Notes on Bubonic Plague as Seen in Siam :" "Personally in attending (plague) patients I always used plenty of coal oil on my shoes and stockings and on my leggings, as it has been shown that this kept the fleas away, a fact whicli was practically demonstrated in Bombay and Calcutta, wdiero tlie coolie cmjiloyees of the oil companies Avere found not to contract the disease which was raging all around them. The investigators in India found that on the death of a rat the infected fleas promptly left the dead rat, and if a non-infected rat was placed near them promptly attached themselves to him, and in a few days he was infected and died of plague. In the town of Petchaburi I traced the great and excessive death rate among the children to the fact that after the rats died the infected fleas took up their habitat on the pariah dogs, and, these being petted and fed by the children, the children suffei-ed proportionately. As the peoj)le are Buddhist in religion, and will not destroy life, my application to have the dogs killed was not granted. One of the most effective measures to stop the disease after all disinfection and sanitation was accomplished was to wash all floors and furniture with crude coal oil, and sprinkle it with a watering pot in large quantities imdcr the houses and over the ground in the vicinity." 20 306 IHE EEUPTIVE DISEASED SLEEPING SICKNESS. {Hwman Trypanosomiasis.') Sleeping sickness is a disease affecting human beings, ■wlilch is caused by the parasite — Trypanosoma Gambiense, getting into the blood, due to the bite of the Tetse Fly. It is usually fatal. Sleeping sickness has occurred for the last hi:ndred years on the VFest coast of Africa, and the disease includes the country between the Gambia and Congo rivers. In 1896 to 1001 this disease occiirred in Uganda, Africa. It -was evidently brought there by the natives who came from the Congo State where the disease prevailed. It was not recognized until 1901, when the cases became numerous. Kace — This disease can develop in any race of people if exposed to; the bite of the Tetse Fly. Occupation. — Any work which leads a native or foreigner to spend much time on the shores of the rivers and lakes within the sleeping sickness territory, exposes himself to the disease. Native negroes contract sleeping sickness more than the whites, due to the fishermen, canoemen and other inhabitants being half naked and thus constantly bitten by the Tetse flies, 30 to 80 per cent, of them having the parasite in their blood. Any person of any age or condition of health will develop sleeping sickness if bitten by a fly which has previously sucked the Trypanosoma ifrom the blood of a sufferer from the disease. Cause. — The sleeping sickness is due to a minute, wriggling, worm- like parasite, called the Trypanosoma Gambiense, named by Doctor Diitton. of England, in 1901, who was sent to investigate this disease which was causing the slow death of thousands of negroes in Africa. This parasite is only seen when blood is drawn from a vein or lymphatic gland and examined under the microscope. It is very difficult to discover and often requires several examinations of the blood before it can be seen. When the Trypanosoma flrst is injected beneath the skin by the bite of the fly it passes to the lymphatic system, where it is found in great numbers, causing a swelling of the lymph glands, then passing in small numbers into the general circulation. These parasites only reproduce themselves within the human body. They do not pass out in the urine or stools, but only when the lymphatic, duct blood fluids are withdra^vn. SLEEPING SICKNESS. 307 Sleeping sickness is not contagious, but is considered infectious. A delicate parasite which is incapable of living outside of the human body cannot be conveyed by drinking water, food, dust, etc., as other germs are. Entry of Germ into the Human Body. — The Trypanosoma is con- veyed from the sick to the well by the Tetse Fly (Glossina Palpalis), and it is the only species of fly known to harbor the parasite. Wherever sleeping sickness prevails, the Tetse Fly is correspondingly abundant upon the shores of the rivers, lakes, etc. This has been proven by taking flies which were caught in the sleei^iug sickness zones and alluring them to bite monkeys, the latter developing the symptoms of the sleei^iug sickness. The Tetse Fly cannot transmit the disease after three days have elapsed since biting a sufferer. The disease usually develops in a new case from eight to forty-eight hours after the fly has bitten a previous sufferer. The Tetse Fly is only found along the shores of rivers and lakes, where there is forest, which consists of high trees, thick jungles and dense undergrowth. They are never seen on open sandy beaches backed by grass plains, nor in the grass of the grassy plains even though long and tangled. Symptoms, First Stage — After a person is bitten by a Tetse Fly, the trypanosoina is injected beneath the skin and then reaches the lymphatic and blood fluids of the body, wherein it multiplies. As far as is known they do not appear in the general circulation until twenty days have elapsed. The course of this stage of sleeping sickness is very slow and takes months and possibly years for the symptoms to develop. The average is between three months to three years or more. During this period the sufferer is attending to his ordinary work and feels well, but there is an enlargement of the glands of the back of the groins and armpits, which can be observed and felt as swellings bulging the skin in these parts of the body. If fluid is drawn from these swelling glands, after many careful searches the trypanosoma can be seen by the microscope. These glandular enlargements, with, of course, the finding of the parasites, and the history of a person having been in a sleeping sickness area, and bitten by the Tetse Fly are symptoms and facts which will prove that the patient is suffering from this disease. Second Stage — During this period the patient is apparently lazy and inclined to lay around and sleep during the day. He becomes more sleepy as the disease advances, the expression of the face is sad and apa- thetic, he is mentally dull, the eyes are dull and heavy, the eyelids droop. 308 THE EEUPTIVE DISEASES. The body is 'well nourished uutil late in the disease, if the patient is well fed. Headache is present, or there is complaint of dull pains in other parts of the body. The pulse is rapid and weak. The lymphatic glands are seen and on feeling, are about the size of a pea to that of a bean. There is never any eruption (rash) upon the skin. The patient walks with a weak gait, uncertain and shufSing. The hand grip is lost and the hands tremble when held out at right angles to the body. The tongue trembles when extended. The voice is mumbling, weak and monotonous. The fever during this time is from 101 to 102 degrees Fraheuheit in the evening. These symptoms generally grow worse uutil after weeks or months the patient is unable to talk, walk, or feed himself. He is confined to bed, sleeps continually, is usually neglected and not fed by the ignorant relatives and friends, and becomes very thin. During the last two or three weeks the urine and stools pass without his knowledge and the temperature drops to 92 degrees Fahrenheit and he dies in a state of coma (stupor). Treatment. — There is no known remedy whicb will kill the trypa- nosoma in the human body, nor any drug which will aid the patient in fighting the attack. It is a fatal disease and so far as is known every sufferer from sleeping sickness sooner or later dies from its effects. Iron, quinine and arsenic have been used as tonics, but with no resiilts as to cure, simply prolonging life. Every known drug has been tried without success. Prevention — Sleeping sickness is difficult to prevent owing to its oc- currence in a country which is inhabited by ignorant and superstitious savages, infested with the Tetse Fly, which alone spreads the disease. The fly cannot easily be destroyed owing to the dense jungles and forests which spread out from the shores of the lakes and rivers in the sleeping sickness areas. These cannot be burnt owing to their green and damp condition. If the natives were intelligent they might be urged to move from the infested region, but only the intelligent ones do this, the remainder would rather die than leave their shambles and their tribes. If removal does take place care must be taken to see that no species of Tetse Fly is present which, might convey the disease to the new location. Among intelligent people the disease is preventable by not living in a sleeping sickness area, or if compelled to live there by wearing cloth- ing which covers the body completely and mosquito helmets for the face, and the screening of all doors and windows of houses, etc. Kill all flies seen indoors and remove all vegetation in the vicinity of the dwelling HOOKWORM DISEASE. 309 and cultivate the ground if i^ossiblc. Do not expose joiirself in any way to the bite of the Tetse Fly. HOOKWORM DISEASE. The spread of hookworm disease is duo cliiefly to the lack of sani- tary privies in the Southern homes and schools of the people in the vil- lages, towns, etc. The depositing of bowel movements upon the soil and a poor sewage disposal is a means by which the parasite reaches the water supply. In some of the Southern colleges thirty per cent, of the students and as high as ninety-five per cent, of the pupils in the common schools showed the hookwonu in the discharges from the bowels and the bladder, as proven when they were examined by the microscope. Those who had the disease were backward students as compai'ed with the uninfected pupils, thus showing how the disease lowered their capacity for work and study. If one child has a case of hookworm disease in the home or school, and the latter have unsanitary jirivics, every child in them is liable and usually does contract this dangerous, contagious disease. Cause of Hookworm Disease. — It is caused by a small, round worm about half an inch long and as thick as a pin. The forms occurring in man do not develop to maturity in the lower animals. The special variety discovered in this country has been named the "Necator Americanus" or "American Murderer" by Dr. Stiles. Its color varies from a dead white to a dirty gray, sometimes red from the continued blood which it ha.? ■iiucked from its victim. How the Parasite Gets Into the Body. — The worms do not multiply in the body, but the adult females deposit great numbers of eggs in the small bowel, from a few hiindred to throe or four thousand every day, which are carried out with the normal bowel movement. The eggs hatch out the young worms called larva? In tlic course of twenty-four hours. Within a week the tiny organism has shed its skin twice, like a snake docs. It lives In this cast-off skin, but takes no food after the first few days following its escape from the eggs. After shedding its skin, the young worm is capable of entering the human body of another person when passed out in the bowel movement of the person In which It is developed. It may enter the human body in one of three ways. First, it may be swallowed with con- taminated food, milk or water. Secondly, it gets Into the body by boring through the skin. Third, the eggs, larvae or young worms may be carried on the legs of flies. 310 THE EEDPTIVE DISEASES. In boring tlirougli tke skin the young worms produce tlie condition kno^Ti as "dew poison" or "ground itch" or "too itch," which is usually the first symptom of hookworm disease. The "dew poison" occurs mostly about the feet and ankles, but in miners or farmers who work in infected or polluted ground, and sometimes in children, the "dew poison" appears in the hands and arms. After boring through the skin, the worm enters the blood stream and passes through the heart to the limgs, makes its way up to the windpipe or is coughed up and swallowed, and after its passage down the gullet to the stomach fiually enters the small bowel. Ilaving HOOKWORMS.— A, female; B, male. reached the bowel where it elects to remain, the tiny worm sheds its skin twice more, becomes fully developed and mates. The worms are provided with strong jaws and a hollow tooth somewhat like a snake. The worm hooks itself to the wall of the bowel by its strong jaws and sucks the blood of the child or adult in which it lives. Thus it wounds the wall of the bowel, sucks the red blood and weakens the patient. In addition the worm mixes the blood, after digesting it with its own poisonous bowel matter and injects or squirts it through this hollow tootk into tke body of tho EOOKWOEM DISEASE. 311 patient. Thus the hookworm is first — a blood destroyer; and second — a blood poisoner. Symptoms. — If a child is infected with the parasite before puberty (adultage), the physical and mental condition is retarded. A boy or girl sixteen may j^resent the body and mind of one of eight or ten years of age, and yoimg men and women of twenty may appear to be not more than twelve or fifteen. The skin is pale, perspiration or sweat absent, cuts or bruises heal slowly. In the early stages of the disease "ground itch," "dew itch" or "toe itch" is often found iipon the feet, ankles or hands. The hair may be normally developed upon the head, but on other parts of the body where it ought to be it is generally absent or scarce. The face, feet, ankles, and in extreme cases the entire body, may be swol- len. This swelling disappears rapidly after treatment. Body weight is reduced. The chest is thin, ribs prominent, the shoulder-blades stand out upon the back and the patient appears "round-shouldered." The expres- sion of the patient is anxious or very stupid. The appetite may be light or it may be ravenous, the child being unable to obtain enough food at an ordinary meal to satisfy its appetite. The patients often develop a desire for abnormal articles of food and this is why sufferers of hookworm dis- ease are called "dirt eaters :" They crave and eat lemons, pickles, salt, pepper, sour milk, chalk, clay, ashes, tobacco, mortar, plaster, sand, gravel, sticks, decayed wood, paper and cloth. ISTausea and vomiting are frequent and there is tendency to heartburn and pain over the pit of the stomach. The blood is impoverished, the patient suffering from thin blood or anasmia as a result of the red cells of the blood being destroyed and the blood poisoned by the worms which suck it out and at the same time in- ject into it the poison from their bowel movements. The only sure way of diagnosing hookworm disease is to examine the bowel movements of the jiatient under the microscope and find the eggs, or to see the tiny worms, the size of an ordinary pin with the naked eye, which appear before or after treatment in the stools. Hookworm disease is termed the "lazy disease." This is due to the sufferers' muscles being very soft and weak. The shirking of work and study is not due to laziness, but is nothing more or less than weakness or weariness because the hookworm is sucking their blood. They must be con- sidered ill and treated as such. Treatment. — In curing hookworm disease, we do not treat the pa- tient, biit the worms. The remedies used either kill or cause the worm to loosen its hold on the wall of the small bowel. The treatment must always 312 TUE ERUPTIVE DISEASES. be given under the care of a physician. It is simple and nsnally very effective if directions are properly followed. It can be given to those who cannot afford to stay away from business or work by having them take the treatment on Saturday evening or Sunday morning. The best treat- ment is to give the drug thjnnol in capsule form. The bowels must be thoroughly emptied lief ore the thymol is taken, so that all mucous and undigested food which surrounds the worm is re- moved, thus giving the thymol an opportunity to come in direct contact ■with the hookworm to properly affect a cure. Directions to Patient — At bedtime for two nights before taking the capsules, take an ordinary dose of epsom salts and during the intervening day between the nightly doses of salts, eat only liquid foods, such as milk and soups. On the second morning after taking the first dose of salts, do not get up, and eat nothing at all, and at 6 A. M. take one-half of all the capsules of thymol and at 8 A. ]\r. the remaining half. The number of capsules to be taken and tlie amount of each one depends upon the age (uot apparent age) of the patient. This nmst be judged by the physician in attendance. At ten o'clock the same day take a dose of epsom salts, but do not take oil, fats or alcohol while taking the capsules, as these sub- stances render the thymol absorbable by the digestive tract and poisonous symptoms occur. After the bowels have moved thoroughly following the ten o'clock dose of salts, the patient may eat an ordinary meal, and it will not he necessary to stay in bed. This treatment is recommended by Dr. Lock, Inspector of tlie Slate Board of Health of Kentucky. The Size of the Total Dose of Thymol. — Under 5 years old Yl grains. Fi'om 5 to 9 years old 15 grains. From 10 to 1 i years old 30 grains. From 15 to 19 years old 40 grains. From 20 to 59 years old CO grains. Above CO years old 30 to 45 grains. (Recommended by Dr. Stiles.) It lias been proven that after one treatment of thymol, as recom- mended by Dr. Lock and Dr. Stiles, ninety per cent, of the eases are ciired. The bowel movements must be examined under the microscope two weeks after each treatment for the purpose of finding the pin-sized Worms. If present, the thymol treatment must be repeated until all worms are absent from the bowel movements. The anffimia and debility of all sufferers from the hookworm disease HOOKWORM DISEASE. 313 will soon disappear when the worms are destroyed and the food the patient takes is absorbed and used to make blood by the system, instead of being destroyed and poisoned by the hookworm. However, iron tonics and nourishing food must be given to build up the blood and aid recovery. Prevention of Hookworm Disease — Board of Health, state, coimty and city, in the Southern States are spending thousands of dollars to wipe out the hookworm. It has been discovered that the worm develops as a result of "soil pollution." Not only can it be prevented, but at the same time the methods used are preventive of typhoid fever and other germ dis- eases, whose jioisonous elements are carried in the bowels and urine from the infected person to the soil and water. Hookworm disease is spread as a result of the carelessness of persons who dispose of their bowel matter upon the soil and by the use of unsani- tary privies and toilets which drain upon the soil or a water supply. Shade and moisture are necessary for tlie eggs and larvse of the hook- worm to hatch and develop. Therefore, those who are infected with hookworm disease, and use the shaded spots where no privies are, to pollute the soil, are dejiositing and spreading their disease by their carelessness; as shady spots are usually moist and make the best place for the hook- worm to develop. In some States even of this country many homes in villages outside of the towns and cities which have a sewage system and schoolhouses, etc., have no privies. (Think of it in the twentieth century in America.) Only the wealthier families have an occasional toilet on the premises, and these are absolutely rmsanitary and are built apparently to only shield the user. Is it any wonder that hookworm disease, typhoid fever, cholera infantum and dysentery thrive amid such surroundings ? Hookworm disease can be prevented from spreading by first curing the present sufferers Avith the thymol treatment, the building of sewage systems in the larger tovms and villages with sanitary toilets, the build- ing of properly constructed fly-proof privies on farms, in schoolhouses, etc., the removal of all privies from a location where the waste matter can drain on to the soil which can be washed by rain or melting snow into a spring, creek, river or any other water supply of a house, camp, farm, dairy, etc. Children or adults in a region where hookworm disease is prevalent must wear shoes to protect their feet and ankles from the larvaj upon the skin, as they will bore through and In this way get into the system. Boil all water and milk and cook vegetables. 314 THE EEUPTIVE DISEASES. In the Southern States particularly, and others also, any child or adult who is apparently "lazy" and always tired with a puify abdomen, tremendous appetite, swollen eyes, and loss of weight with ansemia, must be taken to a physician or public dispensary to ascertain whether or not he is suffering from the hookworm disease, and if a sufferer, receive treatment at once. Kill all flies about, screen doors and windows and construct a sanitary privy. PELLAGRA. Pellagra is a disease the cause of which is not definitely known. So far scientific investigation has not disclosed any germ as the cause, though some physicians believe it is an infectious disease and can be caught from a new case appearing in a community for the first time. It has been proven though that it is the result of a poison which exists in spoiled maize, Indian corn or corn products. This theory was first ex- plained by Ballardini, an Italian physician, in ISii, his theory being that the maize underwent a change by reason of the growth of a fungi on the grain, which acted as a poison to the system, and could be recognized in the grain as a greenish color. Another theory put forth by Dr. Scaulon, of the London School of Tropical Medicine, is that the "black-fly" or "sand- fly" (simuUum repatans) causes it. Still another theory is that it is due to the stable-fly (Stomonys calcitrans) ; the mosquito is also considered as a carrier of pellagra. Others claim that no matter what the definite cause is, it is a disease which is being imported into this country by the hordes of immigrants from Italy. Whatever its cause, pellagra is a serioiis disease and has been a na- tional scourge in Italy and other European countries for more than a hun- dred years. An epidemic occurred in Italy in 1907 during which 100,000 cases occurred and at least 50,000 cases in Eoumania. Thus it can be seen how prevalent the disease may become during an epidemic and cause great mortality as well as loss of health and money to citizens and the State. Several cases have occurred in women who have washed the clothes of patients suffering from this disease, due to a poison being thrown off from the glands of the armpits which has been collected upon the clothing and may have caused the disease in the laundresses, showing that the disease is apparently infectious. People who eat spoiled maize or Indian com have developed pellagra and from our present knowledge of the disease it would seem that this is the main cause of tke symptoms. PEI.I.AGEA. 315 The early symptoms of pellagra are marked enougk to recognize the disease, but in cases seen where the patient has had it for some time, un- recognized, it is difficult to make the diagnosis. The first symptom com- pained of is an inability to walk straight. Persons can't step where they ■want to. They have an inclination to run forward, also a sudden contrac- tion of the muscles of the back which may almost throw the sufferer out of bed. Later on a reddish rash appears, and this is characteristic of pellagra in that it appears upon the same spot on both hands, arms or sides of the chest, etc. Another marked symptom is the salty taste in the mouth, the mouth also is inflamed, patient also complains of great wearines and expresses it as "leg tire." The patient is dull, cannot think quickly and dizziness is complained of. Pain occurs along the spinal column. Prevention of Pellagra. — Avoid eating corn bread or meal unless sure that the corn is fresh and has not undergone "heating." Avoid alcoholic drinks. All flies and mosquitoes must be killed, as they may carry the poison which causes the disease, and their breeding places must be removed. It is not necessary to isolate a patient from his family, but the ordinary precautions of disinfecting the hands after handling the patients, his or her clothes, etc., should be followed. A physician should be summoned, as the treatment requires such skillful handling that no layman can cure himself with any known remedy. A sufferer can only recover by following a course mapped by his physician, as to diet, mode of living and medicines to be taken. Pellagra and Com — The scientists of Italy and Eoumania where pellagra has existed for upwards of one hundred years, state that when com is harvested, while the ear is yet moist, because of not having been given time to dry out in the field, it is particularly apt to mildew in the barn. The same thing is true of even matured corn in particularly moist climates. When corn that is damp from any cause is placed in tight barna or cars for shipping, it is likely to mold. This mold is extremely danger- ous, regardless of what may be the cause of its development. The presenco of the mold may be determined by any individual, for it is none other than the mustiness that we have all smellcd in corn upon occasion. That musty odor is the warning of the presence of a danger that cannot be over- estimated. 31G THE ERUPTIVE DISEASES. MAXARIAL FEVERS. ITndcr this groiiji are inohidcd infectious diseases caused by a para- site Plasmodia, which are spread from one person to another by the bite of the niosqiiito (anoplieles maculopennis) which contains the parasite in its body, llaharial fevers are spoken of by the public as ague, swamp fever, cliills and fever, etc. The malarial fevers occur in periodic at- tacks and are classified as : (1) regularly intermittent periodic fever of the tertian or quarter tyj)e; (2) irregular fever of remittent or continued type; (3) chronic malaria or a condition resulting from repeated attacks of malaria with ana?mia and enlargement of the spleen. Etiology. — Influences predisposing to the spread of the disease. Con- ditions which favor the development of the mosquito as heat and moisture found in stagnant pools, lakes, rivers or any still body of water. Areas of special prevalence are found in tropical and subtropical countries — Panama, Central America, India, ISTorthern Africa, especially along the coast and river basins. Malaria is prevalent along the shores of rivers in the Southern States of the United States, particularly along the Gulf States. Malarial fevers have almost disappeared from New England and New York. It is very infrequent in eastern Pennsylvania, New Jersey and Maryland. The Northwestern States, the Pacific coast, and the regions north of the St. Lawrence Piver are practically free from malaria. Season. — In the tropics malarial fevers are most prevalent during the rainy season. In temperate climates a few cases occur in the sj^riiig, the greater number of cases occur in the early autumn. locality. — Malarial fevers occur more in the country or outlying dis- tricts of a large city. This is due to the fact that the anopheles maculo- pejinis, the only species of mosquito which conveys the parasite, breed in small, shallow pools and stagnant waters. The culcinioc, the mosquito seen about the home in suburbs or cities free from marsh lands, etc., do not carry the parasite of malaria. They prefer human habitations and deposit their eggs in still water which is allowed to stand in rainpipes roof gutters, cesspools, barrels and other containers about the premises. Hence malaria is more prevalent outside of cities. The cause of malarial fevers was discovered in 1880 by Doctor Laveran, a French army surgeon in Algiers. He examined the blood of patients suffering from chills and fever and found the parasite which caused the s}nu])toms was present in every case. This tiny parasite has MALARIAI^ FEVERS. 31 7 been termed the Plasmodium Malarisi. It has been discovered and proven that the parasites causing mahirial fever have a definite course and de- velopment in the blood of man and the hodj of the mosquito. The Parasite in Man — Three species of parasites are recognized as causing the dift'erent types of fevers in sufferers from malaria; (a) tlie tertian is caused by the Plasmodium Vivax ; (b) the quartan by the Plas- modium Malaria; (c) the estivo-autumnal (Perincenis) by the Plas- modium Immaculatum. The Tertian Parasite {Plasmodium Vivax). — This species when in- jected into the blood of a person by the bite of a mosquito — the anopheles maeulopcnnis — causes a fever which occurs every forty-eight hours. The fever residts from the parasite imdergoing a development in the red cells of the blood, in which new parasites are developed at the same time, de- stroying the cells, then they attack fresh cells, at which times the fever develops and they repeat this imtil treatment is Instituted. But the ter- tian parasite never causes chills or fever vmtil its period of development is completed — forty-eight hours. The Quartan Type (Plasitwdiiun Malaria). — This species also carried by the mosquito is the cause of quartan fever. Its cycle of development in the red blood cells of man is seventy-two hours, when the new parasites are liberated and attack fresh blood cells, thus causing chills and fever once every seventy-two hours. The Estivo-Autunmal Parasite (Plasmodium Immaculatum). — This parasite is the cause of estivo-autumnal fever {Perincenis), which is the most malignant type of malarial fever. It is conveyed by the bite of the mosquito — anopheles macidopennis. Its development takes place in the red cells of the blood in the liver, spleen and bone-marrow, and usually requires forty-eight hours to develop. This parasite will not caiise a great deal of fever, but a continuous one which lasts for some time and goes up very high and remains up until recovery occurs, when it drops suddenly. The parasites of tertian fevers can only be seen by withdrawing the blood from a finger or lobe of the ear and examining it under the micro- scope. The estivo-autumnal parasite is not often found in the peripheral blood of the body. Each parasite causes its own type of fever and no other. The Parasite in the Mosquito — The connnon species of mosquito which carries and spreads malaria is the anopheles maculopennis. There are many species, but wherever malaria is found the anopheles is always in the neighborhood. The anopheles cannot convey malaria unless it has sucked the blood of a patient suffering from malaria. Its bite ahme docs 318 THE EETJPTIVE DISEASES. uot caiise the disease unless it has the jiarasite in its body, and the para- site does uot develop in cold climates. Thus the anopheles can live in regions not malarious and still be harmless, but should one of this species bite a sufferer of malaria, who recently arrived and had the parasite in his blood, then the mosquito could spread the disease by biting another person. Persons living in malarious countries should be familiar with the habits and appearance of the mosquitoes seen within the house or about the premises. The culex or ordinary mosquito which is not a carrier of malaria can be recognized by its position from the anopheles maculo- pennis. The former rests upon the ceiling or wall with its posterior pair of legs turned up over its back, and the body, if not dragged down by the ■weight of blood, is nearly parallel with the wall. Its wings show no spe- cial marking. The anopheles maculopennis, when resting, places the posterior pair of legs upon the wall or ceiling or allows them to hang down, and the body is held at an angle of 45 degrees with the surface upon which it rests. The wings of this species show distinct markings. Part Played by Mosquito in Spreading Malaria — Let us take, for example, a man suffering from the tertian type of malarial fever. In forty-eight hours the malaria parasite has undergone a development, sexual and non-sexual, in the man's red blood cells, thus forming new jiarasitcs. The non-sexual developments have formed spores, these spores find their way into a red cell and begin the sexual development, which progresses until the cell develops into a different shape, called Garaetocyte, now the mosquito bites this patient and takes into his stomach these Gametocytes, which are at this time of both sexes — male, the Microgamiti, female, Macrogamet. The cells reproduced by the Macrogameti penetrat- ing the body of the Macrogamet, a single cell resulting — called the Zygote, the latter passes into the wall of the stomach of the mosquito, when it develops in an oocyst containing sporeblasts which develop into sporo- zoites. The mature oocyst bursts and these accumulated sporozoites reach- ing the circulation of the mosquito are carried to the salivary glands, and when the mosquito bites a fresh victim, he injects the young sporozoites into his blood through his proboscis as he sucks the blood, and the develop- ment of the parasite is repeated, as in the first patient. Symptoms — Malaria usually develops in a person in from a few days to two weeks after being bitten by a mosqiiito. The symptoms of the tertian and quartan types are practically the same, and are spoken "of as the paroxysm. MALARIAL FEVERS. 319 The paroxysm is knowTi as the chill or "ague fit," and is described under three stages : cold, hot and the sweating. Cold Stage — During this period the patient at first complains of loss of energy, yawning, pain in the pit of the stomach, sometimes nausea and vomiting with headache. Shivering conmipuces which develops into a chill. The teeth chatter, there is violent shaking of the whole body, and distressing sensations of extreme cold. The face is blue, the body is cov- ered with goose-flesh, the temperature of the surface of the skin is sub- normal. This stage lasts from fifteen minutes to an hour or more. The danger of the attack lies in how long the cold stage has progi-essed. Hot Stage. — The cold sensations are replaced by those of heat. The face becomes flushed and the fever is high, 101 to lOi degi-ees Fahren- heit, the pulse is free and strong, headache is present and delirium occurs in some cases. The patient complains of urgent thirst and is distressed by the sensations of extreme heat which he feels within the body. The dura- tion of this stage usually lasts from thirty minutes to three or four hours. Sweating Stage. — Perspiration appears upon the forehead and face, later the entire body is drenched. The duration of this stage is variable. The patient finally falls into a sleep, from which he awakes very weak, but refreshed. The entire paroxysm may last from two to six hours depending upon the severity of the attack. Between the paroxysms the patient feels well and considers himself in normal health. The paroxysms are due to the breaking down of the red cells and the liberation of a poison from the parasites, produced during the maturity of the parasites in the red blood cells of the sufferer; also the liberation of the new parasites (Sporozoites). A paroxysm which occurs every forty-eight hours in malaria is due to the presence in the blood of the tertian parasite, and it is called tertian fever. A paroxysm occurring every seventy-two hours is due to the presence in the blood of the quartan parasite ; then we speak of this as quartan fever. In some cases of malaria, a paroxysm occurs every day (quoditian fever). Then it is due to the fact that two gi-oups of parasites are present, which undergo segmentation on alternate days. This is spoken of as a doiible tertian period. Tf two groups of the quartan parasite are present in the blood, the paroxysms occur every seventy-two hours on alternate days, thus there will be two days of chills, fever and sweats, with a day in between, free from an attack. This is spoken of as a double quartan; if three groups 320 THE ERUPTIVE DISEASES. are present there ■will be a daily attack (Quotidian Fever), this is called a triple quartan. The Estivo-Autumnal, or Perincenis Malarial Fever — This type of fever prevails in southern Italy and Russia, tropical countries and the Gulf section of the United States. It usually develops in the last part of the summer or early autumn. It is characterized hy irregularity due to tlie parasites in the blood, which have a cycle of development of about forty-eight hours, being in numbers or groups and does not mature upon certain definite days. The intensity is due to the dangerous nature of the poison produced by the parasite at the time of the sporulation of the numerous groups. Symptoms — The sufferer from the estivo-autumnal type of malarial fever does not have a paroxysm occurring at regular intervals, but suffers from a high fever, which begins and stays high ujitil recoveiy. There may be no chills but fever and sweats are symptoms. The face is flushed, severe lieadache is present, the pulse is bounding and enlargement of the spleen occur.'j. Jaundice of the skin is seen. This fever may be very mild, or the j)atient may suffer from a severe form. The most dangerous types of estivo-autumnal fever are gi-ouped under the perincenis fevers. These are characterized by grave symptoms and unless properly treated and protected against reinfection may result in death. These types of perincenis malaria are called (1) Algid form, (2) comatose fonu, (8) hemorrhagic form. Malarial Cachenia or Chronic Malaria — This is a condition of health occurring in patients who have had and been exposed to malaria numliers of times and did not receive proper treatment and protection from the bite of the mosquito which carries the parasite. It is characterized by an ana-mia (thinning of the blood), OTtli enlargement of the spleen. The patients are very thin and lose weight, the coiuplexion is muddy with brown spots in the skin. Shortness of breath occurs upon slight exertion, and the ankles are usually swollen. The spleen becomes so large that it resembles a tumor kno\vii in the Southern states as "Ague Cake." Vomiting of blood may occur and is usually fatal if a symptonu Treatment. — In the tertian and quartan types quinine is given in 15 to 30 grain doses (preferably in solution), at the time the temperature declines and repeated if necessary upon the follo\\'ing day. The treatment should be continued for at least a month, but the dose must be gradually reduced. Keep this up liowever if the paroxysms occur or the parasite is seen in the blood of a patient when examined under a microscope. MALARIAI, FEVEES. 321 In the estivo-autumnal type quinine should be given in five-grain doses every four hours imtil the active symptoms have cleared up, then five grains every six hours for the next three days. During the following week the patient must receive 15 grains once a day every other day, and for two mouths, following give 15 grains every sixth day until all danger is passed. In this way the disease can he cured. Also be sure that the patient is protected from reinfection or moves away from, the malarious country until cured. I>o not stop quinine treatment until parasites cannot be found in blood, and chills and fever and enlarged spleen, etc., are absent. Treatment of Malarial Caehenia, or Chronic Malaria. — Quinine, iron, arsenic and various tonics have been used, but the best treatment is to remove to a non-malarious country with a high altitude and avoid living again in a nxalarious country. Sufferers from malarial fever will recover more qiiickly if confined to bed. Quinine acts in curing malaria by directly destroying the malarial parasite. Prevention of Malarial Fevers. — As malaria microbes are carried from one person to another by the mosquito (Anopheles Maculopennis) its spread can be prevented by destroying the mosquito, screening all doors and windows, etc., wearing clothing which protects the body com- pletely, wearing a mosquito helmet over the head and face, or smearing oil of citronella over the face and hands at intervals. If choosing a site for a house or camp, or any building, high, dry ground should be selected, away from all still bodies of water, if possible drain all stagnant pools, etc., fill in with earth water which cannot be drained and prevent mosquitoes from laying their eggs in these hiding places. Kerosene freely used about the premises upon any still body of water will prevent the development of the anopheles and thus destroy the common carrier of malaria. Persons living or traveling and exposed to malaria can oftentimes protect themselves from contracting the disease, even though exposed to the bites of the mosquito, by taking five to ten gi'ains of quinine once a day, two or three days a week. Of course some people contract the disease regardless of this precaution. See Part T of "Book TIT (Preventive Medicine for further habits of the mosquito and methods of destruction. 21 332 THE EKUPTIVB DISEASES. AGUE OR INTERMITTENT FEVER. Agne or Intermittent fever is invariably prevalent in swampy coun- tries. In olden times it Avas attributed to the insects rising at night-time from the swampy ground, but now it is known that it is obtained only by means of the mosquito, which finds its best breeding place in swamps and still waters. It is to be observed that it is only the female mosquito which is able to impregnate malaria in the human victim. Symptoms. — Characterized by three distinct stages of fever, chill and sweat. The paroxysm is usually preceded by a feeling of uneasiness and discomfort, sometimes langour and yawning, which forewarns the patient of its coming. 1. The Clull or Cold Stage. — ^Begins gradually ; first there is a creep, then another, a little more severe, then another, each growing in severity until the teeth chatter and the body shakes violently. Not only does the patient look cold, but a surface thermometer will indicate a reduction of the skin, temperature. The rectal temperature during the chiU may be greatly increased. It lasts from fifteen minutes to an hour. 2. The Hot Stage. — ISText comes the hot stage, in which all the symptoms of fever are manifested, comprising headache, nausea or vomit- ings heat of skin, which may attain an elevation of 105 degrees, full, strong, rapid pulse and occasionally delirium lasting from a half hour to four hours. After this follows the sweating stage, during which pro- fuse perspiration takes place and the temperature is reduced, as a con- sequence, nearly or quite to the natural standard. The paroxysms, thus constituted, generally recur with considerable regiilarlty, but may vary a good deal in different cases in regard to the interval between each par- oxysm. Varieties of Ague — The varieties of ague designated in accordance with this difference are, first, the quotidian or daily ague, in which the fit comes on usually at the same hour every day; second, the tertian ague, the most common form, when the paroxysm returns every forty-eight hours whilst the disease continues ; third, the quartan, where the fit occurs every seventy-two hours, or on every fourth day; and fourth, the Irregular ague, in which the fits are not distinctly periodical. Under this head Is included the kind of periodical neuralgia affecting the forehead, and hence denominated brow-ague. In the quotidian form the paroxysm is apt to be IKTEEMITTENT FEVEB. 323 the most prolonged and may last for sixteen hours ont of the twenty-four, leaving of course only eight hours between its termination and the com- mencement of a new chill; in the tertian form, the fit is less protracted, lasting on an average about ten hours ; and in the quartan it is stiU shorter, having an average duration of only six hours. In a fit of tertian ague continuing ten hours, we may expect to find the chill lasting from half an hour to an hour, the febrile stage, during which the patient often de- clares he feels as thoiigh he were burning up, extending over from three to five hours and the sweating stage occupying the remainder of the time. Complications. — The most common secondary affection which occurs in the course of Intermittent fever, and appears to be directly dependent upon it, is the chronic enlargement of the spleen, called "ague-cake." During the cold stage of the fit, It Is probable that the spleen Is always more or less distended with blood, which, being driven from the surface of the body whilst the chill lasts, finds its way to the Internal organs and especially the spleen, in unusual quantity. Such congestion, if frequently repeated, seems to lead, In a majority of cases, to a z'eal increase in amount of the structure of the spleen, and consequent enlargement of the organ. The Ague-Cake. — The "ague-cake," when fully developed, may attaia a magnitiide of a foot or more in length by ten Inches in breadth, and even when much smaller than this may be felt as a hard, painful and movable tumor, on the left side of the abdomen, a few inches below the heart. Such increase in size of the spleen generally indicates a rather profound impression of the malarial poison upon the system, and renders the pros- pect of speedy cure far less hopeful. lack of Blood. — ^Another serious complication of prolonged ague is the intense anemia, which so many persons who suffer from malarial [poisoning often exhibit to a marked degree. The absence of the natural supply of good, rich, red blood gives td the skin, and especially that of the face, a dull, yellowish tint, which in malarious regions is displayed by most of the Inhabitants, even the children exhibiting a pallid sallowness pitiful to behold. There is also a peculiar dejected, woe-begone expres- sion of countenance, which is almost characteristic of malarial poisoning, and feelings of muscular weakness and fatigue on the slightest exertion arei very common. [Diagnosis. — The diagnosis of ague Is seldom difficult after the first paroxysm, as the regular recurrence at the same hour of the day Is a feature which Is so characteristic that it has given the name of "periodical ifevers" to the febrile affections caused by malaria. At the first enset, it 324 THE iOKUPTIVE DISEASES. is impossible to distinguish the chill from the initial symptom of a gi'eat iiiimlier of diseases, but a microscopical examination of the blood will quickly decide. The plasmodium of malaria is found in the blood during the paroxysms. Treatment. — In the medical treatment of all the periodical fevers, we fortunately possess a specific of wonderful power in quinine and the other alkaloids of Peruvian bark, which have a direct control over the malarial poison, by checking the development of the hacillus malarioe, which has been already referred to as being the cause of ague. Quinine Treatment — It is the custom to j)repare the system for the administration of quinine, by the purgative action of full doses of blue- jiill or other active cathartic. Give quinine in sufficient doses, during the sweating stage, to produce the slight deafness and ringing in the ears which mark the occurrence of cinchonism, as it is denominated. As a general rule, it is quite possible to do this before the time for another paroxysm, even with an attack of intermittent fever of the quotidian type. The antiperiodic must, however, in order to effect a cure, be continued in full doses of from ten to thirty gi-ains daily, for three or four days, then reduced to half or one-third this quantity for a few days, and so per- severed in for throe weeks. Preventing Fever Recurrence. — For the purpose of counteracting the tendency which intermittent fever possesses of recurring in its original violence at intervals of exactly one week, it is advisable to take the full dose of from ten to thirty grains, or whatever amount has been found to produce slight buzzing in the ears, on the sixtli and seventh, the thir- teenth and fourteenth, and the twentieth and twenty-first days from that on which the last chill was experienced. In this way not only the peri- odicity of single ague-fits, but also the periodicity of groiips of the inter- mittent fever paroxysms, appears to be most effectually extinguished. An East Indian Cure. — In case quinine fails or is not tolerated, other alkaloids of Peruvian bark, and preparations of the bark itself, should be fairly tried. A famous East Indian mixture for the cure of ague is Warburg's tincture, and it may be resorted to when ill-success with other forms has been met with. Use of Peruvian Bark — The alkaloids of Peruvian bark are, as a rule, much more efiicacious in solution with some mineral acid, such as the dilute sulphuric acid. Other Treatments — Where for any reason Peruvian bark and its preparations fail to cure ague, the best substitute, although a far inferior EEMITTENT OR CONTINUED FEVERS. 325 one, is probably arsenic, particularly in the form of Fowler's solution, administered in quantities of five drops thrice daily, and formerly well known under the name of the tasteless ague-drop. For the cold stage, wrap the patient up well in blankets and apply hot-water bags, besides giving hot drinks. For the fever, cool sponging will relieve the patient. Diet. — No particular care of the diet is requisite in intermittent fever, except to counteract as far as possible the tendency to anemia and general debility, by a liberal supply of the most nutritious food which the diges- tive powers are able to assimilate. In like manner, as the patient is not confined to bed, directions about nursing are imnecessary. Prevention of Ague — Tlie remedy to be used in preventing an attack of malarial poisoning, when temiDorary residence in a fever and ague district is unavoidable, is quinine used internally, as already suggested, in doses of six or eight grains daily. THE MORE IRHEGTJLAR, REMITTENT OR CONTINUED FEVERS. Place and Seasons. — This type of fever occurs in temperate climates, chiefly in the later summer and fall; therefore it is sometimes called estivo-autumnal fever. The severer forms of it prevail in the Southern States, where it is known as the bilious remittent fever. The entire group of cases included under the term remittent fever are bilious, re- mittent and typho-malarial fevers. Symptoms. — These, as to be expected, are often irregular. In some instances there may be regular intennittent fever, occuring at uncertain intervals of from twenty-four to forty-eight hours, or even more. In the cases with longer remissions the paroxysms are longer. Commonly, how- ever, the paroxysms show material differences; their length averages over twenty hours, instead of ten or twelve; the onset occurs often without chills and even withovit chilly sensations. The rise in temperature is usually gradual and slow, instead of sudden, while the fall may occur by lysis instead of by crisis. There is a marked tendency to anticipation, while frequently from anticipation of one paroxysm and retardation of another more or less continuous fever may result. In the cases of con- tinuous and remittent fever the patient, when seen early in the disease, has a flushed face and looks ill, the tongue is furred, the pulse full and bounding, but rarely dicrotic. The temperature may range from 102 degrees to 103 degrees or go even higher. Diagnosis. — The diagnosis of remittent malarial fever may be def- 326 THE ERUPTIVE DISEASES. initely made by an examination of the blood. The small, actively, motile, hyaline forms of the estivo-autiimnal parasite are to be found, while if the case has lasted over a week, the larger cresentic and ovoid bodies are usually seen. Treatment The treatment of remittent fever is essentially that of intermittent fever. The continued nature of the fever and the tendency to a typhoid state demands a liquid diet, with the careful addition of stimulants. PERNICIOTJS MALARIAL FEVER OR CONGESTIVE CHILL. Character. — Pernicious malarial fever differs in no respect from or- dinary ague and bilious remittent, except in its greater severity. The disease is observed under three forms: First, the comatose or apoplectic form, the patient speedily loses consciousness, as though the chief force of the poison was expended upon the brain, disturbing its functions to such an extent as almost to abolish them. The fever is usually high and the skiu hot and dry. Should the patient regain consciousness a second attack may come on and prove fatal. Second Form — In the second or algid form the symptoms of intense chill are prolonged, it may be for some hours, and death occurs in fatal cases from pure debility or asthenia, without reaction coming on. Al- though the patient is apathetic, the mind remains clear to the last. Vom- iting and purging are the prominent symptoms, and the disease might readily be mistaken for Asiatic cholera, if it happened to occur whilst an epidemic of that malady was raging, were it not that the urine is never albuminous. The Hemorrhagic . Form — In the third group of cases, denominated hemorrhagic malarial fever, the prominent peculiarity is bleeding, gen- erally from the kidneys, but sometimes from the stomach, bowels, nose and mouth. Diagnosis. — As one might expect, the blood shows marked changes in malarial fever. In the regular intermittent type there is a loss in the red corpuscle after each paroxysm, which may be considerable, but which is rapidly compensated for during the intermissions. In the estivo- autunmal fever the losses are often greater and more permanent. Treatment. — As in the other kinds, give quinine, but in larger doses. In the case of the pernicious disease to get the effect more rapidly give quinine hypodermically as much as thirty grains at a time. Excessive care must be used to avoid abscesses. OHOLEBA MOEBtJb. 327 Quinine sulphate 60 grains Saturated solution tartaric acid 68 drops Distilled water to make 2 drachms. Take 30 drops three times daily. In addition to the use of quinine, stimulants must be given for the asthenia, artificial heat for the low temperature. Morphine hypoder- mically to relieve pain and allay nausea. CHOLERA MORBUS. Definition — An acute gastro-intestinal catarrh, characterized *by pro- fuse vomiting, purging and painful cramp. Causes — This malady, which is not contagious, occurs at times almost as an epidemic, and is occasionally fatal, so that no instance of it, however mild at first, ought to be allowed to run on without treatment. Although generally induced by indulgence in indigestible food, especially unripe fruits, there seems to be at certain seasons of the year some external in- fluence promoting the tendency to disorder of the bowels, which is atmos- pheric. Especially frequent are these attacks in July and August. Cold and dampness are also regarded as predisposing agents. Symptoms The primary symptoms are uneasiness at the pit of the stomach, nausea, retching and then vomiting, followed by severe watery diarrhoea, consisting of a large amoimt of the watery portions of the blood, and containing only a little albumen. The whole system is thus affected, in part by sympathy, but also to some extent, it is probable, by the change in the specific gravity and constitution of the blood. The attack is often abrupt, a patient being awakened out of sleep by a sudden seizure during the night. This is, however, no doubt because the preliminary uneasi- ness, nausea and slight colicky jiains, which manifest themselves in a diurnal onset of the malady, are unfelt in the unconsciousness of profound slumber. The vomiting and purging, when once commenced, recur in rapid succession, and sometimes even simultaneously, and enormous quan- tities of fluid are evacuated from the system, often with the result of producing intense thirst. This thirst cannot, however, be gratified for some time, because the irritable stomach refuses to retain the smallest amount of fluid. Collapse may supervene and the skin become cold, clammy and ashen hued, the eyes sunken and the pulse frequent and feeble. Diagnosis. — The only difiiculty about the diagnosis of cholera morbus or sporadic cholera is when true Asiatic cholera is epidemic, then, if a 328 THE EBUPTIVE DISEASES. iiiioniscopical pxamination of the dejecta be made, wil!, if it be Asiatic c'iii>lera, reveal tlie ciniima-sluiiied bacillus. Treatment. — For tlic [lain in tliu abdomen hot apf)lications, morphine, cue-quarter graiu, hypodermically ; to be repeated when necessary. When the pain is less severe opium may be given by the mouth or rectum in the form of laudanum — ten drops by the mouth or twenty-five drops in a tablespoonful of thin starch by the rectum. When vomiting is the most troublesome symptom the following is beuehcial : Creosote 6 drops Bismuth subnitrate 2 drachms Mix and put into 13 papers. Take unc every hour. The prostration reipiires stimulants like aromatic sp'irits of ammonia, thirty to sixty drops at a dose or whiskey. ASIATIC CHOLERA. Definition — An acute infectious disease, due to the implantation of the comma bacillus of Koch, characterized by vomiting, purging, rice- water evacuations and suppression of urine. History. — It first made its appearance in the United States in 1832. Since that time there have been several ej^idemics, all of which are traceable to immigration. The most serious epidemic of recent time started in India in the spring of 1892, passing from thence to Persia, Austria, Germany and Holland. A few cases reached London and ISTew York. Causes — The disease- poison of cholera undoubtedly reproduces and multiplies itself during the course of the com- plaint, being propagated by a contagion, given off mainly, if not entirely, by the evacuations from the bowels, in which the germs of disease propagate themselves, even after their dis- charge, so that the stools be- «'• The Cholera Germ. ASIATIC CHOLERA. 329 come more vinilent after they are passed, especially when mixed with water. The extended researches of Dr. Koch have proved beyond all ques- tion the existence of the cholera germ {comma bacillus) in drinking water, and traced its development in the intestines of persons who had died of the disease. The illustration shows the ajjpearance of this cholera germ, which it is so important for every one at the peril of his life to avoid. When magnified about six hundred diameters one of the minute intestinal glands may be found to contain, as shown at a, h and c, minute bacteria or bacilli, as they are technically called, which, from their resemblance to the cui^ved portion of a comma, but without the head of that punctuation mark, have been named the Comma hacilli. Sometimes these bacilli unite at their ends with their curves turned in opposite directions, so as to produce an S shape, or even a spiral formation. This Comma Bacillus is the direct cause of cholera by its lodgment in the intestines, where it has been proved, by examination of nearly one hundred cases, to develop with great rapidity. It is easiest to detect in the earlier stages of the disease, because later on it is obscured by the development of a great many other forms of bacteria. It is distinctive of the mildest as well as of the most severe attacks, and has therefore an important diagnostic value. It is capable of successful cultivation in meat broth, in milk, on slices of potato, and especially on gelatine, in which it grows in a singular manner, pi-oducing a gi-adual liquefaction of the stiff gelatine aroimd the gi-owing colony, which sinks down into the jelly in a peculiar way. The comma bacillus thrives best at temperatures between 70 degrees and 135 degrees Fahrenheit, but is not destroyed and only has its growth checked by a cold of IS degrees below the freezing point. It is, however, readily killed by drying, by the removal of all ani- mal material upon which it can feed, or by acidifying the medium in wiiich it is growing with a mineral acid. Under ordinary cii'cumstances the bacillus when swallowed is destroyed by the gastric juice being digested in the stomach, but when there is any derangement of the stomach, from errors of diet or any other cause, so that the acid digestive liquid is de- ficient or absent, the bacillus escapes destruction, and may pass on into the intestine where the fluids are alkaline and it is able to develop with great rapidity. This fact in regard to the growth of the bacillus in alkaline fluids solely is one of great importance, not only in regard to the treatment of cholera, but also in connection with the subject of diet, since it is obviously highly necessary to avoid everything which, by producing 330 THE BEUPTrVB DISEASES. indigestion, could interfere with the production of the precious gastric juice. Modes of Infection — In cholera epidemics we have, says Dr. Koch, instances amounting to actual experimental infection of man, as, for examj)le, in the infection of those engaged in washing linen soiled with the discharges from the bowels of patients affected with cholera. An event of this kind is reported in the first outbreak of cholera in this country, when it was introduced into Quebec forty-two years ago. Infection by Clothing.— Linen or other clothing soiled with choleraic discharges contains the bacilli often in a pure form, and if infection occurs through this medium it must be by the comma bacilli, frequently the only microscopic organism present, except those which are known to be inno- cent. Infection by the Hands. — The hands of a person washing or handling such clothes may be soiled, and the bacilli introduced into the mouth by direct contact, or through the food which thus becomes contaminated, or the washing water may come in contact with the lips, and thus in some way the human being be fed with an extremely minute quantity of a pure culture of the comma bacilhis. Infection by "Water — "When Dr. Koch was investigating the disease in India he observed an instance in which a certain tank furnished the water for drinking and other purposes to many people among whom the cholera was raging. lie found the comma bacilli in this tank, and learned on inquiry that the clothes of the patients were washed in it. Around the tank were some thirty or forty huts inhabited by upward of two hundred people, and of these persons seventeen died, whilst the number of those taken sick was not ascertained. The tank in this case also received the refuse from the dwellings. In fact, it is common in India for the Hindoos to bathe in the tank which affords their water-supply, to wash their uten- sils in it, to deposit their excrement upon its bank, and if a hut has a latrine, or substitute for one, its outflow is apt to be into the tank. In this particular instance it was found, after a time, that the bacilli became less abundant in the tank-water, and coincidently the cholera declined among the inhabitants of the huts along its shore. Here, if the epidemic had been the cause of the bacilli, instead of the result of their develop- ment, the number 'of these minute organisms ought to have been aug- mented after the disease began to be less violent. For further dissemina- tion of the disease, the cholera discharge must be retained in a moist state, since complete drying seems to destroy the poisonous property of OHOLEEA. 331 the virus; and this view is sustained by what we have long known in regard to the spreading of cholera by contaminated water-supply, or more directly by soiled hands, or even conveyance by insects, as, for example, by blow-flies alighting upon meat and other food. Drains may be infected, and through them the drinking water polluted; but as the virus cannot preserve its activity in a dry state little can be hoped for from aerial dis- infection, nor does it seem probable that, except imder certain conditions of unusual moisture can cholera be transmitted by r^.erchandise or by letters, even if the latter are not disinfected, but only by human inter- course. Symptoms. — Period of incubation ranges from two to five days. The symptoms of cholera commonly present themselves sufficiently gradual to admit of arrangement into three distinct groups or stages: 1. Preliminary Diarrhoea — This may set in abruptly without any previous indications. More commonly there are for one or two days colicky pains in the abdomen, with looseness of the bowels, perhaps vomit- ing, with headache and depression of spirits. As a rule the temperature is not elevated. 2. The Stage of Collapse — Spasmodic griping pains are felt and de- pression of the powers of circulation and resjjiration come on, attended with a sense of faintness and oppression over the heart, whose beat at times is hardly discernible, and the pulse at the wrist may be absent. Copious piirging, at first of the contents of the intestines, and afterward of a thin, watery fluid, I'esembling water in which rice has been washed, having an alkaline reaction, and sometimes tinged red with blood, soon commences, and is usually accompanied with violent vomiting and a sensation of burning heat in the stomach. In a short time, perhaps within a few hours, there results from this excessive drain upon the circu- lation, coldness and dampness of the whole surface of the body, lividity of the lips, cold breath, an unquenchable thirst, a feeble, rapid pulse, difficult respiration, with extreme restlessness, and suppression of the secretion of the kidneys. Symptoms in Fatal Cases. — In fatal cases are noticed blueness of the whole body, the sunken and horror-stricken countenance denominated the Hipprocratic face, popularly known as the appearance of being struck with death, and a peculiarly suppressed voice, this condition ending either immediately in fatal collapse or in reaction followed by violent secondary fever. 3. Stage of Reaction. — This is characterized by return of warmth 332 ITHE EKUPTIVK DISEASES. and colds, tlie latter more slowly and the re-ostablislunent of secretions. Especially favorable is the return of the urinary secretion. Along with these changes the vomiting and purging occur at longer intervals. The heart's action becomes stronger, and there are no abdominal pains. Not infre(iucntly this favorable condition is interrupted by a recurrence of a severe diarrhosa, and the jiatient is carried off in a collapse. Other cases pass into a condition of what has been called cholera-typhoid, a state in which the patient is delirious, the pulse rapid and feeble and the tongue dry. Death finally occurs with coma. These sjmiptoms have been at- tributed to uremia. Diagnosis. — The only affection with which Asiatic cholera could be confounded is the cholera morbus, which occurs as a rule during the sum- mer months, of which mention has been made. Preventive Measures — Preventive measures are all-important, and isolation of the sick with thorough disinfection have effectually prevented the disease from obtaining a foothold in either the United States or in England. The course of cholera during the last epidemic which visited the United States, and ravaged the Mississippi Valley in 1S73, reafHrmed the lessons of previous outbreaks of this disease abroad. This was especially the case as regards the supreme importance of pure water-supplies in cities and villages, all of which should be boiled before using, and of hav- ing all wells and water-springs which are nsed by the people effectually guarded against any possible soakage and contamination from privies and other sources of defilement by excrement. It must be admitted that the history of outbreaks of cholera, in all parts of tlic world, conspicuously illustrates the vital importance of procuring all siipnlies of drinking-water from sources which cannot become polluted by the soakage into them of intestinal discharges, or from outflowings in any such way as to be carriers of bowel-diseases, particularly not of cholera and typhoid fever. The story of the Broad street pump in London, Avhich killed five hundred peo- ple in one week during the last gi'eat cholera epidemic, and was found to have its water contaminated by soakage of cholera evacuations from an adjoining cess-pool, has already been related, but it should be retold to every one as a terrible warning against the almost universal dangers of water-pollution. An item in the London Lancet, printed in 1882, states that a recent analysis of the water of the Holy Well of ^lecca, avhich is so eagerly drunk by the pilgrims, as a part of their religious rites, shows the water to be sewage, about ten times stronger than the average London OHOXEBA. 333 sewage. And during the same month that this report was given, came the news that the cholera had made its usual annual appearance among the pilgrims to the shrine of Mahomet in the Holy City of Mecca. It therefore appears extremely probable that by suitable investigation of the water of the Holy Well, there might be found in it a perennial supply of the cholera germs, and such a demonstration of the true origin of the frightful cholera epidemics which, spread by the caravans of returning Moslem jiilgrims, have so often devastated large sections of Europe and Asia, would be a triumph for experimental hygiene of which the whole world of science might bo proud. The iraj3urity of tlie local atmosphere of a dwelling, a village, or a particular district, is proved to be a matter also of piiblic concern, and environed in a jjoUuted atmosphere, the palatial mansions of wealth and gayety may suffer equally with the tenements of the humblest classes. The specific migratory power of cholera, whatever its nature, has the faculty of infecting districts in a manner most detrimental to health only when the atmosphere is fraught with certain jiroducts, susceptible under its influence of undergoing poisonous transformations. Through the un- polluted atmosphere of cleanly districts it migrates perhaps without a blow because that which it can kindle into poison is not there. Disinfection — 1. The vomited matter and the discharges from the bowels are to be gathered and put in a carbolic solution one to twenty, or chlorinated lime one to ten, some of which should be in the vessel before it is used. In the country where the excreta can be thrown in a pit, "whitewash" is a cheap disinfectant. 2. After vomiting, the mouth of the patient should be rinsed with a solution of hydronapthol one to five thousand, care being taken that none of it is swallowed. After each evacuation from the anus the but- tocks and thighs should be washed with soap and water. 3. All body and bed linen soiled with the discharges should be im- mediately moistened with a carbolic solution one to sixty, removed from the ajiartment in a covered vessel and boiled for one-half hour in a one per cent, solution of washing soda, or 1 to 2000 of bichloride of mercury. 4. Napkins, towels, and so forth, should be treated in like manner. 5. All dishes, knives, forks, spoons, and so forth, after each meal, should be boiled for the same length of time in the same medium. G. The remains of meals should be thrown in whitewash and removed at the end of each day. 334 THE EETJPTIVE DISEASES. 7. Door knobs are liable to be soiled by the bands of one carrying out the excreta and should be carefully watched. 8. In cases of death the body, without being washed, should be wrapped in sheets wet in a solution of bichloride of mercnry and should be buried promptly. Directions for Nurses. — 1. Xurses should not hold any direct com- munication with others while in attendance on the case. 2. They should under no conditions take their meals in the same room with the patient. After touching the patient her hands should be washed in bichloride of mercury one to one thousand. 3. The teeth should be cleansed after each meal, as the mouth affords a peculiar favorable nidus for decomposing matter and would therefore be favorable for the growth of the cholera bacillus. Treatment — The successful treatment of cholera depends largely upon how i^romptly remedial measures are commenced, for if the first sign of relaxation of the bowels is met at once by an energetic astringent and opiate, such as the mixture of a teaspoonful of syrup of galls, ten drops of laudanum, and one drop of chloroform, repeated every hour if neces- sary, or a compoimd of ten drops each of spirits of camphor, tincture of capsicum and laudanum, to which, if there is any vomiting, five grains of bismuth should be added, it is certain that many lives might be directly saved by medical treatment. External applications of heat should be made, warm applications to the abdomen will be foimd grateful to the patient. Sometimes a pill of opium and acetate of lead, with a little capsicum, using, for example, one-half of a grain of opixun, two gr-ains of the sugar of lead, and a quarter of a grain of cayenne pepper, is singularly sei-viceable, and being carried in small compass is especially convenient for travelers. Pain Treatment. — Should the pain be great control it with one-fourth grain injections of morphine hypodermically. As owing to the profuse discharges the blood is very much concentrated, subcutaneous injections of normal salt solution should be given. The following well-known cholera or diarrhoea mixture is of great value in the early stages: Spirits of camphor „ i " Tincture capsicum I " Pure chloroform 3 drachms Alcohol sufficient to make 5 ounces. Mix and take one teaspoonful every one or two hours. DIPHTHERIA. 335 DIPHTHERIA. Definition. — An acute infectious disease clue to Klebs-Loefler bacillus, characterized by a local fibrinous exudate usually upon the mucous mem- brane of the throat, with a moderate fever, glandular enlargements and great iirostration. Cause. — The disease is endemic in all large cities, and becomes epidemic at times ; while other contagious diseases have diminished in the past decade, diphtheria has increased, particularly in cities. Contagiousness — Diphtheria is a highly contagious disease, and is readily transmitted from person to person. The bacilli may be received from (1) discharges of diphtheria patients, (2) from the secretions of the nose and throat of convalescent cases, in which the virulent bacilli per- sists, (3) from the throats of healthy individuals who have acquired the bacilli from being in contact with others having the virulent bacilli on their persons or clothing. Dangers of the Disease — ISTo disease of temperate regions proves more fatal to physicians and nurses. There seems to be particular danger in examining and swabbing out the throat; for in the gagging, spluttering and coughing efforts the patient may cough mucus and flakes of mem- brane into the physician's throat. The bacillus attaches itself to the bedding, clothes and room of the patient with great tenacity. Attack Upon Children — Very young children are rarely attacked, the age of predilection being from the second to the fifteenth year. The great- est number of deaths occur between two and five years of age. Girls are attacked in larger numbers than boys. Adults are frequently affected. Symptoms — Period of incubation is from two to seven days; oftener two (Tyson). According to the location we may speak of the pharyngeal, laryngeal and nasal varieties. 1. Pharjmgeal. — The symptoms are those of an ordinary febrile at- tack. Slight chilliness, fever and aching pains in the back and limbs, usually the temperature rises in the first twenty-four hours from 102 to 103 degrees Fahrenheit. There is a slight redness and feeling of sore- ness in the throat, generally upon one or both tonsils, and on careful exam- ination the tonsils and adjacent portions of the fauces are found to be a little swelled. A whitish-gray patch of false membrane, looking at first like a small ulcer in the mucous surface, next makes its appearance, and this may spread until, by the third day, it has covered the tonsils, fauces and perhaps the uvula. 336 TUE KRDPTIVE DISEASES. The False Membrane. — If this false membrane is forcibly torn away, as, fiu' oxainple, by some of the various forecps which were at tirst invented for the pnrj)ose, a raw bleeding surface is exposed, which in a few hours is again covered with a new growth of the layer of membrane. This structure, which is partly composed of an exudation of lymph and partly of a fungoid growth, the micrococcus diphtheriticus, quickly undergoes putrefactive changes, together with the outer layer of mucous membrane lying immediately beneath it, so that there is often a superficial ulcera- tion, from which an unhealthy discharge flows, and a jsutrid odor fre- quently emanates constantly, in sevore cases of diphtheria. Thickness of the Membrane. — The thickness and density of the false membrane varies greatly in different cases, and in different epidemics. Sometimes it is scarcely thicker than writing-paper, and has hardly more consistence than thick cream. At other times it is firm and tough, almost like leather, and may even attain the thickness of a quarter of an inch. Although in mild cases and those of moderate severity, its color is grayish- white, in debilitated states of the system, and when there is a tendency to bleeding from the throat and other mucous surfaces, it may be tinged, I)robab]y by the altered blood elements of a yellow, yellowish-brown, or dark-brtiwn hue. Diagnosis (a) There may be no local manifestation of the mem- bi-ane, but a simple catarrhal angina, associated sometimes with a croupy cough. The detection iu these cases of the Klebs-Loefler bacillus can alone determine the diagnosis. (h) There are cases in which the tonsils are covered with a pulta- ceous exudate, not a consistent membrane. (c) Cases which begin and often run their entire course with the local picture of a typical lacunar amygdalitis, they may be mild, but in other cases there is a rapid development of membrane and extension of the disease to the pharynx and nose with septic and constitutional symptoms. 2. Nasal Diphtheria — In membranous or fibrinous rhinitis, a very remarkable affection seen usually in children, the nares are occupied by thick membranes, but there is entire absence of constitutional disturb- ances. Ravenel collected seventy-seven cases, all of which ran a benign course, and in all but a few the membrane was limited to the nose and the constitutional symptoms were slight or absent. On the other hand, nasal diphtheria is apt to present a most malignant type of the disease, high DIPHTHEEIA. 337 fever, marked glandular evolvement and great prostration by epistaxis and by excoriation of tbe lips. 3. Laryngeal Diphtheria — The affection begins like an acute laryn- gitis, wiLh a slight hoarseness and rough cough, to which the term croupy has been applied. After these symptoms have lasted a day or two, with varying intensity, the child suddenly becomes worse, usually at night, and there are signs of impeded respiration. These cases are always serious. Difficulty of Breathing — ^At first tbe difficulty in breathing is paroxys- mal, owing probably to a spasm of the muscles of the glottis. Soon the dyspncea becomes continuous, inspiration and expiration become difficult, particularly the latter. The voice is husky and is reduced to a whisper. The color gradually changes and the imperfect aeration of the blood is shown in the lividity of the lips and finger tips. Restlessness comes on and the child tosses from side to side, vainly trying to get breath. Oc- casionally in severer paroxysms portions of the membrane are coughed up. The Fever. — The fever is rarely very high, and the condition of the child at the onset is good. The pulse is always increased in frequency. In favorable cases the dyspnoea is not very urgent, and the color of the face remains good. In unfavorable cases the dyspna?a becomes more and more urgent, the cyanosis deepens, and the child, after a period of rest- lessness, sinks into a semi-comatose state, and death finally occurs from poisoning of the nerve centres by carbon dioxide. 1. Complications. — Hemorrhages from the nose or throat may occur in severe ulcerative cases. Skin rashes are not infrequent. In very bad cases, with extensive sloughing, the septic particles may reach the bronchi and excite gangrenous processes, which may lead to severe and fatal hemorrhages. 2. Renal Complications. — These are common, albuminiira is present in all severe cases; nephritis may set in quite early in the disease; it sets in at times with complete suppression of the urine. 3. Paralysis. — Tliis is rather frequent, occurring in from ten to even twenty per cent, of cases. Diagnosis — The onset is more sudden than in scarlet fever, the fever higher, the pulse more rapid and the tongue presents a strawberry appear- ance. For the rest of the diseases it is sufficient to state that, for the purpose of insuring proper sanitary precautions, it is advisable to con- sider all cases of sore throat, with fever and prostration of strength, in which patches of false membrane, however small, appear upon the tonsils 22 338 THE EEtrPTIVE DISEASES. or fauces, as diphtheritic in their character. All cases should be treated as di{)htlieria imtil the contrary is proven by a culture. Preventive Measures — Recent investigations having proved that the poison of diphtheria is ^Jortable, communicable by infection, and capable of reproducing itself outside of the hiunan body, diphtheria must now be ranked as both a contagious and infectious disease. The following rules are therefore more imperative than ever before : 1. When a child or young person has a sore throat, a bad odor to its breath, and especially if it has fever, it should immediately be separated and kept secluded from all other persons, except necessary attendants, until it be ascertained whether or not it has diphtheria, or some other communicable disease. 2. Every person known to be sick with diphtheria should be promptly and effectually isolated from the public. Only those persons who are act- ually necessary should have charge of or visit the patient, and these visi- tors should be restricted in their intercourse with other individuals. Children residing in a house where there is a case of diphtheria should not be permitted to attend school. 3. When a case of diphtheria is fully developed, the same precautions in regard to free ventilation, disposal and disinfection of discharges, bed or body linen, and so forth, isolation during convalescence (or manage- ment of the corpse should death unfortunately occur), and so forth, ought to be enforced which have already been recommended in regard to small- pox and cholera. 4. It is particularly important that persons whose throats are tender or sore from any cause, should avoid possible exposure to the contagion of diphtheria. Children imder ten years of age are in much greater danger of taking the disease, and after they do take it of dying from it, than are grown persons. But adults are not exempt, and mild cases in them may cause whole series of fatal attacks among children. 5. IN^umerous instances are recorded where the contagion of diph- theria has retained its virulence for weeks or months, in cesspools, heaps of decaying vegetable matter, damp walls, and so forth, and been carried for long distances in clothing, in sewers, in waste pipes from stationary washstands, and in other conduits. Hence all sewer connections and other carriers of filth should be well ventilated and disinfected, and children particularly should not be allowed to breathe the air of any water-closet, cesspool, or sewer into which discharges from patients sick with diphtheria DIPHTHEEIA. 339, have entered, nor drink water or milk wbiek has been exposed to suck air or tke atmosphere of the sick-room. 6. Beware of any person who has a sore throat; do not kiss such a person or take his or her breath ; do not drink from the same cup, blow the same whistle, nor put his pencil or pen into your mouth. 2. Treatment — Local treatment — ^germicides and disinfectants are best applied when possible by the spraying apparatus at intervals of an hour, or at most every two hours. If the spray cannot be used, as is often the case with children, a soft sponge may be used. The most satis- factory solution for this purpose is equal parts of peroxide of hydrogen and Dobell's solution. Carbolic acid may be used in the proijortion of fifteen drojjs to an ounce of glycerine and water. Boric acid in saturated solution is fairly good. Where there is the laryngeal form the patient should breathe an atmosphere saturated with the vapor of slacked lime. In all cases antitoxin should be given. 2. Constitutional Treatment. — For checking the growth of the mem- brane the preparations of mercury are good. The bichloride of mercury in dose of one-forty-eighth to one-twelfth (Tyson) for an adult, in con- junction with the tincture of the chloride of iron and chlorate of potas- sium every two hours. Early in the cases calomel in small doses every hour. These doses are given to adults, and they need not be much re- duced for children. Quinine should form part of the medical treatment in doses from ten to twenty-four grains in twenty-four hours. Other prescriptions are: 1. Bichloride of Mercury 1 grain Tincture Chloride of Iron 1 ounce Two to six drops every three hours in water. 2. Chloride of Potash 1 drachm Tincture Chloride of Iron IM; drachms Syrup of Lemon 1 ounce Spirits of Mindererus 4 ounces Mix. Dose: one teaspoonful every two hovirs. If this prescription cannot readily be filled a fairly good substitute is the Tincture of Chloride of Iron. Get about one ounce of this and take ten drops in a wineglassful of water three times a day. This is a valu- 340 THE ERUPTIVE DISEASKf,. al)lo tonic, but if there is iiuicli fiiiliirc of strpnwtli, use the followiuir in udditiou to tlie ohloritle of iron: 3. Siilpliate Quinine (Powder) 1 drachm Best Brandy 1 pint Mix and dissolve. Dose: two teaspoonfuls every three hours in half a glass of water. Diet. — Stimulating, nourishing and easily assimilated food is neces- sary. Milk is preferred to all else, fortified with full doses of whiskey, two drachms to an ounce being required in all severe cases. Milk may be alternated with, animal broths. When deghitition is difficult nutrient enematas may bo given. For this peptonized milk is best. Opening the Windpipe. — When laryngeal obstruction is imminent intubation or tracheotomy should be performed. This is rarely necessary when antitoxin is used. Lives have been saved by both these operations. Such cases sliould breathe air charged with vapor of lime. 3. Serum Treatment — It has been fully demonstrated that antitoxin or the scrum of immunized animals, is the best therapeutic agent in diphtheria. Tlie investigation conducted by the American Pediatric Society has show^l that the mortality under the serum treatment in 5,79-4 cases was only 12.3 per cent. The strength of the serum is measured in units, the latter being equal to 1 c.cra. of "normal serum," which is the blood serum of an immunized animal so active that one-tenth of a c.cm. will antagonize ten times the minimum of dijihtheria poison fatal to a guinea pig weighing 300 grams. For children over two years old the initial dose should be from 1,500 to 2,000 units in all severe cases, in- cluding those of laryngeal stenosis ; this dose to be repeated in from eighteen to twenty-four liours if there is no improvement seen, and again in twenty-four hours if the course of the disease is imfavorable. The third dose is rarely necessary. ]\lild cases should receive 1,000 units for the first injection, a second is rarely necessary. In cases injected during the first two days the mortality is less than 5 per cent. The qiiestion of immunizing those exposed to the disease is a very practical one. It has been carried out on a very large scale in some institutions with satisfactory results. The immunity is only transient and only persists a few weeks. Diphtheria antitoxin is injected beneath the skin and is not a pain- ful procedure and rarely has ill-effects if properly given and the pre- cautions of cleanliness are followed as to the skin of the patient, the DIPHTHEEIA. 341 needle used and hands o£ the nurse and physician. Every adult case should receive a dose of antitoxin of 3,000 units immediately ui^on the jihysician heing sure that the patient has di^jhtheria. In severe cases as high as 20,000 or more units have been given in repeated doses with- out ill effects and the child has recovered. Those in attendance, as nurses, physicians and all persons who have come in contact with the patient, must receive at least 500 units as a preventive measure against taking the disease. Those who cannot afford to jiurchase antitoxin can secure it from the authorities of the local Boards of Health iu most States. In large cities it can ho procured from the police stations. Every parent or guardian should submit to the early use of anti- toxin and thereby save human life. Those exposed to it should also sub- mit and protect themselves and prevent the spread of this highly dan- gerous and contagious disease. Public funerals cannot be held in case of death from diphtheria. Cremation oi" burial in a sealed casket is necessary. General Remarks.- — Diphtheria is a highly contagious disease, occur- ring mostly iu children between the ages of two and fifteen years. In- fants in the first year of life are rarely affected. Death is most frequent between children of two to five years of age. It occurs mostly during the winter. It can be caught by persons of all walks of life by coming in contact with a patient or his or her clothing, bed linen, etc., which has not been disinfected. It can be carried in water, milk, by the dried discharges from the patient's nose and throat, being blown about in the air, dirty streets, gutters, alleys, cesspools, etc. It requires from two to seven days for a person to develop diphtheria after being exposed to it. Its early symptoms consist of slight chilliness, in young children con\'ulsions, older children and adults complain of a sore throat. There may be vomiting. Examine the throat at once. The tonsils and arches of the soft palate appear reddened, swollen and a whit- ish membrane in spots or as a solid layer will be seen covering the tonsils and later on this spreads to the nose, throat, larynx, etc., depending on the severity of the attack. The child will complain of a tightness in the throat, pain or swelling and if the attack is sudden and severe, the face and lips become bluish and breathing is difiieult, and there may be a whisfling sound upon taking each breath, due to the membrane filling the larynx and throat. The germs of this disease are present in the nose and 342 THE EBUPTIVE DISEASES. throat of the patient. Summon a physician at once. The guardian or physician must notify the local Board of Health. The sick person must be placed, whenever possible, in a room away from the rest of the family, all imnecessary furnishing removed, a nurse or attendant placed in charge and no one permitted to enter or leave the room but the nurse and physician imtil disinfection is completed by the Board of Health. Cats, dogs and all the family pets must be removed from the room and quarantined outside of the house. The physician should wear a cotton gown and cover his head with a cloth of suitable texture. The nurse must wear a similar gown and cover the hair with a cloth. On leaving the room, the physician and nurse must leave the head covering and gown in the room, also disinfect their hands in a disinfectant of 5 per cent, carbolic acid solution or bichloride of mercury (1 tablet to a pint of water). Persons living in a house where diphtheria has developed should not leave until they have taken a bath in water containing bichloride of mer- cury, washed their hair and had their clothing disinfected by the Bureau of Health. A sheet must be hung across the door leading to the sick room and this sheet dipped in and kept moist by a solution of chloride of lime (1 tablespoonful to a i^ail of cold water). The knob of the door should be washed off daily with the chloride of lime solution. INTITJENZA OR LA GRIPPE. Definition — An acute infectious disease, appearing at irregular inter- vals, characterized by extraordinary rapidity of extension and the large number of people attacked. Causes. — It is caused by the bacillus of Pfeiffer. It spreads with remarkable rapidity. In the large pandemic of 1889-1890 some of the large prisons escaped entirely. The outbreaks of the epidemics are in- dependent of all seasons and meteorological conditions, though the worst epidemics have been in the colder seasons of the year. One attack does not protect. A few persons do not appear liable to the disease. Symptoms — Incubation is from one to four days. The onset is usu- ally abrupt, with fever and its associated phenomena. Usually there is coryza and sneezing, with or without watering of the eyes and headache. No age is exempt, as it attacks with impunity the infant as well as the old man. There is generally a cough, to which is added very soon profuse expectorations. OLAlirDEES OE FAEOT. 343 Expectorations — The cough may be paroxysmal, with prostration at the end of the spell. It often persists, while the bronchitis may pass into broncho-pneumonia, or a croupous-pneumonia may supervene. Another mode of onset is by extreme and sudden jjrostration. This prostration is apt to be prolonged even in mild eases far beyond what seems reasonable. Mental Depression. — This is a frequent symptom, and suicide has been its terminal act. There is always more or less fever, ranging from 101 degrees to lOG degrees Fahrenheit. Delirium is nearly always associated with a high fever. Nausea and Vomiting — ^With the onset of the fever there may be nausea and vomiting, or the attack may set in with abdominal pains, pro- fuse diarrhcea and collapse. Diagnosis — During a pandemic the cases offer but slight difficulty. The profoundness of the prostration, out of all proportion to intensity of the disease, is one of the most characteristic features. Treatment. — Isolation should be practiced if possible. Old people should be guarded against all sources of infection. The secretions, nasal and bronchal, should be disinfected. In every case the disease should be regarded as serious and the patient kept in bed until the fever has com- pletely disappeared. From the onset the treatment should be supporting, and the patient should be well fed and nursed. At night ten grains of Dover's powder niay be given. At the onset a warm bath is sometimes grateful in relieving the pains in the back and limbs. If there is much fever and delirium small doses of antipyrin or phenacetin may be given and an ice-cap applied to the head. In cases with great cardiac weakness stimulants should be given freely and during convalescence. Strychnia in full doses and good, nutritious diet, cheerful surroundings and change of air are essential. The depression of spirits following this disease is one of its most unpleasant and obstinate features. GIANDERS OR FARCY. Definition. — ^An acute infectious disease, usually commencing with a specific inflammation of the mucous membranes of the nose and throat, and Originating in contagion derived from a glandered horse, ass or mule, and characterized by the aj^peamce of vesicles in the mucous membrane of the mouth and between the toes and nodules beneath the skin ; in the latter it is called farcy. Cause. — The disease belongs to the infective granulomata. The local 344 THE KUUmVE DISEASES. manifestations in the nostrils and skin of the horse are due to one and the same cause. Man becomes infected by contact with diseased animals, and iisually bj inoculation on an abraded surface of the skin. The con- tagion may also be received on the mucous membrane. Symptoms — The disease has an incubation of from three to five days. At this time there is a febrile movement, with malaise and loss of appetite. On the mucous membrane of the lips and tongue and sometimes on the hard palate come vesicles containing a yellowish serum. There is a sensation of heat and burning through the mouth, and the swelling may be so great as to make speech difJicidt and swallowing painful. There is copious salivation. Almost simultaneously appear vesicles between the fingers and toes and around the nails. Treatment — If seen early the wound shoidd be either cut out or thoroughly destroyed by caustics and an antiseptic dressing apjjlied. In the acute cases there is very little hope. In chronic cases recovery is possible, though often tedious. ANTHRAX OR MALIGNANT PUSTULE. Definition — An acute infectious disease of animals, due to the bacillus anthracis, especially affecting cattle and sheep, but transmissible to man. Causes. — It is very prevalent in Europe and Asia, but is rare in this country. A protective inoculation, with a mitigating virus, has been in- troduced by Pasteur. In animals the disease is conveyed sometimes by direct inoculation, as by the bites and stings of insects, by feeding on the carcasses of animals which have died of the disease, but more commonly by feeding in jiastures in which the germs have been preserved. Pasteur believes that the earth worm plays an important part in bringing to the surface and distributing the bacilli which have lieen propagated in the buried carcass of an infected animal. Certain fields or even farms may thus be infected for an indefinite period of time. Symptoms — Anthrax has a period of incubation of about one week, after which there are a number of modes of manifestation of the disease. 1. External Anthrax or Malignant Pustule This occurs most fre- quently on the exposed stirfaces, the arms, face or hands, and produces in a few hours a slight i-edness like that from a mosquito bite, and after- ward a little blister. This is soon succeeded by a spreading hardness of the surrounding tissues, which mortify and turn black. Crops of sec- ondary vesicles appear, the neighboring lymphatic glands become in- MALIGNANT PUSTULE. 345 flamed, the breath grows fetid, and there is thirst, high temperature and frequent pulse, and death may take place in from twelve to forty-eight hours, with all the symptoms of profound blood-poisoning. Occasionally recovery takes place, but it is only in mild cases, in which all the symp- toms, local and general, are less severe ; the vesicles dry up into scabs and the hardness passes away. 2. Malignant Anthrax, Edema — This form begins in the eyelid, and from thence passes into the head, arms and hands. It is characterized by the absence of the vesicles and by the most extensive oedema, which may follow, rather than precede, the constitutional symptoms. The most fatal cases are seen when inoculation takes place about the head and face. A feature in both these forms of malignant pustule, to which many writers refer, is the absence of feelings of distress or anxiety on the part of the patient, whose mental condition may be perfectly clear. He may be with- out apprehension, even though his condition is very critical. Diagnosis — Diagnosis can be readily made from the character of the lesion and the occupation of the patient. When in doubt a microscopical examination of the fluid from the pustule may show the presence of the bacillus. 3. Intestinal Form — In these cases the infection is usually through the stomach and intestines and results from eating the flesh or drinking the milk of diseased animals. It may, however, follow an external in- fection if the germs are carried to the mouth. In acute cases there are dyspnoea, cyanosis, great anxiety and restlessness, and toward the end con- vulsions or spasms of the muscles. 4. Wool Sorters' Disease — This Important form of anthrax is found in large establishments in which wool or hair is sorted and cleansed. The hair and wool Imported into Europe from Eussia and South America ap- pear to have Induced the largest number of cases. Many of these show no external lesion. The Infected material being swallowed or Inhaled with the dust. Symptoms There are rarely any preliminary symptoms. The pa- tient is seized with a chill, becomes faint and prostrated, has pains in the back and legs and the temperature rises to 102 degrees or 103 degrees Fahrenheit. The breathing is rapid, and there is much pain in the chest. There may be a cough and signs of bronchitis. There may be vomiting, and death may occur within twenty-four hours. In more protracted cases there may be diarrhoea, delirium and unconsciousness. Treatment. — In malignant pustule, the site of inoculation should 346 ITHl} EETJPTIVB DISEASES. he destroyed by the caustic or hot iron and a little powdered bichloride of mercury sprinkled over the exposed surface. The local development of the bacilli about the site of inoculation may be prevented by the sub- cutaneous injections of carbolic acid or bichloride of mercury. The in- jections should be made at various 2>oints around the pustle, and may be repeated two or three times a day. Internal Treatment — The internal treatment should be confined to the administration of siimulants and plenty of nutritious food. Davies- Colley advises ipecacuanha powder in doses of five to ten grains every three or four hours. In the malignant form, particularly the intestinal variety, little can be done. Keep the bowels active. ERYSIPELAS OR ST. AITTHONY'S FIRE. Definition. — This is a specific, contagious inflammation of the skin, tending to spread over large portions of the ciitaneous surface with the usual signs of inflammation — pain, heat, redness and swelling. Causes. — This complaint has, as a rule, for its starting point some slight wound or abrasion of the skin, although occasionally it seems to arise spontaneously, affecting the head and face in such instances more fre- quently than any other portion of the body. It is particularly prevalent in the spring of the year. It can be conveyed by a third person. The poison certainly attaches itself to clothing, furniture and bed-room walls. Recently delivered women and persons who have been the subjects of surgical operations are particularly susceptible to it. Predisposing^ Causes. — Predisposing causes are Bright's disease, alco- holism and debility. The specific agent of the disease is a strejDtococcus gi-owing in long chains, the streptococcus erysipelatous. * Symptoms — Period of incubation is variable from one to eight days. The stage of invasions is often marked with a rigor and followed by a rapid rise in temperature and other signs of an acute fever, when there is a local abrasion, the spot is slightly reddened, but if the disease is idio- pathic there is seen within a few hours a slight redness over the bridge of the nose and on the cheeks. The swelling and tension of the skin increase and within twenty-four hours the external symptoms are well marked. The Skin — The skin is smooth, tense and cedematous. It looks red, feels hot and the superficial layers of the skin may be lifted as small blebs. The swelling increases rapidly, and during the second day the eyes are usually closed. BLOOD POISON. 347 Fnrtlier Symptoms. — The first affected parts gradually become pale and less swollen as the disease extends. When it reaches the forehead it progresses as an advancing ridge, perfectly well defined and raised; and often on palpation hardened extensions can be felt beneath the skin, which is not yet reddened. Even in cases of modei-ate severity the face is enormously swollen, the eyes closed and the lips oedematous, the ears thickened, the scalp is swollen and the patient's features quite unrecog- nizable. Blood Poisoning. — The lymphatic vessels and glands, especially the cervical, are almost always more or less affected, and poisoning of the blood as in pyemia not infrequently occiirs. One attack of the disease, so far from affording any protection, generally leaves the patient par- ticularly susceptible to the malady for a long time, perhaps for life. Delirium is present, the tongue becomes dry, the pulse feeble and there is marked tendency to death from toxemia. In the majority of cases, however, even with extensive lesions the constitutional disturbances, con- sidering the height of the fever range, are slight. Treatment. — Isolation must be carried out. A practitioner in attend- ance on a case of this disease should not attend a woman in confinement. The disease is self-limited, and a large majority of cases get well without any internal medication. Diet — The diet should be nutritious and light. Stimulants are not required, except in the old and feeble. For sleeplessness, restlessness and delirium chloral and the bromides may be given, or if these fail, opium ; when the fever is high the patient may be bathed or sponged. Of the internal remedies the tincture of the perchloride of iron has been highly recommeuded. local Treatment. — ^For the local treatment, two per cent, solutions of carbolic acid, the corrosive sublimate solution 1 to 2,000. In the Poly- clinic Hospital in Philadelphia the application of ichthyol ointment over the reddened area, and should there be a wound, washing it out with normal salt solution have proved very efficacious. To prevent spreading, paint the margin of the inflammation with tincture of iron. SEPTICEMIA OR BLOOD POISON. Definition It is a condition in which, with or without a local site of infection, there is a microbic invasion of the blood and tissues, but in which there are no foci of suppuration. 348 THK ERUPTIVE DISEASES. Symptoms. — Illustrative cases of the more usual form of septicemia are puerperal fever, following a retained placenta, infection by scarlet fever, or difficult labor involving lacerations and the poisoning by a dis- secting wound. Tbe symptoms set in from three hours to four days, v.sually twenty-four hours. Initial Symptoms.- — The usual initial spnptom is a chill varying in severity; it may, however, be preceded by a headache and malaise and is always followed by a high fever. In bad cases the chill is repeated daily and the temperature rises high. I have knovai of one instance in which it went to 10G.7 degrees Fahrenheit. The patient is restless, the tongue at first red and glazed becomes dry and leathery, the pulse at first full and bounding becomes weak and compressible with a rate of 130 or more. Prostration is marked. The Fever — The fever is subject to remissions which give rise to the inexperienced to delusive hope. The chill is followed by profuse sweating and further prostration, the mind early begins to wander and delirium of the low muttering kind is soon established. There is a tenderness over the abdomen in puerperal cases and in all a tendency to enlargement of the spleen with hypostatic congestion of the lungs and often broncho- pneuniiiiiia will result. Diagnosis. — This is usually easy, the resemblance of the more serious form to intermittent fever has been referred to. In this disease the remissions are not so total and the patient remains very ill. Treatment. — In treatment all possible infecting foci should be re- moved by surgical methods; after this the strength should be supported by quinine, strychnine and stimulants. The food should be liquid and of the most nourishing kind. The fever should be reduced with cold sponging and quinine. PYEMIA OR PUS BLOOD POISON. Definition. — Pyemia is a general febrile affection due to sepsis, char- acterized by recurring chills and profuse sweats with remissions or inter- missions in the fever, also by abscesses variously disseminated in the different tissues and organs of the body. Causes. — The same essential cause lies at the bottom of pyemia as of septicemia, but associated with this disease are the important etio- logical factors, thrombosis and embolism. Fragments of a venous throm- bus, due to a phlebitis at the seat of putrid inflanmiation, are broken off and carried in the circulation until a lodgment !s effected. These PUS BLOOD POISOIT. 349 fragments swarm with bacteria and tbe embolus excites intense inflam- mation, which goes on to abscess formation. The emboli may lie multiple, and there will be as many abscesses as there are emboli. The seats of election are lungs, liver, spleen, kidneys, brain and joints and the various connective tissues in the order above given. Other Causes — Other causes are gunshot injuries of bone and com- pound fractures, gonorrhoea and prostatic abscesses. Symptoms. — A rapidly rising fever, often so closely followed by a chill that its previous existence is often not suspected. The severity of the chill is proportionate to the intensity of the infection. The tempera- ture during the chill reaches 103 degrees to 105 degrees Fahrenheit, and is followed by a sweat and fall in temperature, after which the latter rises again to a point even righer than was at first attained. The tempera- ture may rise and fall several times, but as a rule each one goes higher than the preceding one. Other Symptoms. — The other symptoms of fever are also present, thirst, loss of appetite and nausea. The strength of the patient rapidly wanes and he soon sinks into a condition of exhaustion and semi-conscious- ness from which he may be aroused to take medicine and nourishment. Diagnosis is not usually difficult ; a careful study of the case will show marked differences in history to typhoid fever and malarial fever. There are no rigors followed by sweats in typhoid, and finding tlie plasmodium malaria; in the blood of suspected patient will settle the case should it bo malaria. Treatment is like that of septicemia. Remove the foci of infection surgically, and after that the symptoms are to be combated and the strengih supported to the utmost. PART II OF BOOK IV Treats of the constitutional diseases, their causes, diagnoses, prognoses and treatments. Acute Bright's Disease 395 Acute General Dropsy 393 Acute Rheumatism 353 Causes of 354 Symptoms of 353 Treatment of 3S6 Anemia 389 Causes of 389 Diet in 390 Symptoms of 389 Treatment of 390 Arthritic Rheumatism 361 Beri-Beri 39i Causes of 39i Symptoms of 391 Treatment of , 391 Bright's Disease 395 Acute 395 Causes of 395 Chronic 395 Diet in 395 Symptoms of 395 Treatment of 395 Cancer 363 of Bones Z7i of Brain 371 Causes of 367 Colloid 372 Diet in 374 of Duodenum 371 of Kidney 371 of Liver 371 Membranous 373 Prevention of 364 Skin 373 Soft 373 of Spleen 371 Symptoms of 369 Transmission of 367 Treatment of 374 of Uterus 37i Cancerous Dropsy 372 Carcinoma 363 Chronic Bright's Disease 395 Diet in 397 Symptoms of 396 Treatment of 396 Clironic Gout 362 Chronic Rheumatism 359 Symptoms of 359 Treatment of 360 Colloid 378 Cancer 372 Constitutional Diseases, The 353 Cretinism 384 Causes of 384 Symptoms of 384 Treatment of 385 Diabetes 385 Causes of 385 Diet in 386 Mellitus 383 Symptoms of 385 Treatment of 386 Dropsy, Acute General 393 Cancerous 372- Diet in 394 General 392 Local 392 . Symptoms of 392 Treatment of 393 Dry Leprosy 379 Elepliantiasis 379 Fever, Riicumatic 353 General Dropsy 391 Gonorrheal Rheumatism 361 Gout 361 Causes of 362 Chrenic 362 Hereditary 362 Symptoms of 361 Treatment of 36« 351 352 INDEX TO PAKT II OF BOOK IV. Hereditary Gout 3^2 Land Scurvy 386 Causes of 386 Symptoms of 386 Treatment of 387 Leprosy 379 Causes of 379 Dry 379 Symptor.13 of 379 Treatment of 380 Local Dropsy 392 Lumbago 358 Treatment of 358 Lupus 37S Symptoms of 378 Treatment of 378 Malignant Disease 363 Melanosis 373 Membranous Cancer 373 Muscular Rheumatism 358 Neck, Stiff 358 Noli MeTangere 378 Ophthalmia 382 Diet in 382 Symptoms of 382 Treatment of 382 Pain in the Side 358 Treatment of 359 Pleurodynia 3S8 Podagra 361 Purpura 386 Rheumatic Fever 353 Rheumatism, Acute 353 Arthritic 361 Chronic 359 Gonorrheal 361 Muscular 358 Syphilitic 361 Rickets 383 Causes of 383 Diet in 384 Symptoms of 383 Treatment of 384 Scorbutus 388 Scrofula .3S1 Causes of 381 Symptoms of 381 Treatment of 381 Scurvy 380 Causes of 388 Diet in 389 Land 386 Symptoms of 388 Treatment of 388 sSkin Cancer 373 Soft Cancer 373 Stifif Neck 358 Treatment' of 358 Sj'philitic Rheumatism 361 LTraemia 397 Uraemic Poisoning 397 Causes of 397 Symptoms of 397 Treatment of 398 CURATIVE MEDICINE PAKT II. THE CONSTITUTIONAL DISEASES Meaning of Constitutional Diseases. — By constitutional or organic dis- ease is generally meant a visible disorder of structure; that disease and disorder are, however, essentially the same thing, is clear from the cir- cumstance that function and organism are united. The state of the organ will always influence the functiou, just as a power aiDplied to any ma- chinery will produce effects according to the nature of the machine and the materials acted upon. The power and function of the machine are dependent on its intrinsic mechanism, though set to work by an extrinsic influence. The mode of working is not visible in the vital organs, nor are the functions of life mechanical, except so far as they act in time and space. ACUTE HHETJMATISM OR RHEUMATIC FEVER. Symptoms. — Acute rheumatism is an inflammation of the joints, characterized by general fever, by pain, heat, redness and swelling of the joints affected, and by a tendency to leave one joint suddenly and fasten upon another. The affection sometimes commences by chills and fever, and general uneasiness ; and these symptoms (rheumatic fever) may last for twenty-four hours or more before the local manifestations show them- selves. More frequently the local symptoms make their appearance at the same time with the fever, and occasionally they are present some little time before it supervenes. The Pain — The pain in the joint or joints affected, commonly but little felt while the patient is perfectly quiet, becomes intense on the slightest motion, so that he is rendered completely helpless. The super- ficial joints become swollen and tense, they are hott«r than natural, and the skin covering them is generally more or less reddened. The Swelling. — The swelling is sometimes mainly caused by effusion within the capsular ligament of the joint itself, at others by the inflamma- 23, (353) 354 CONSTITUTIONAL DISEASES. tion and thickening of the tibrons tissues external to the joint. The pulse is geuerally full, strong and moderately frequent, rarely rising over 100 heats in a minute; the skin is warm and copious sour perspirations are commonly present; the tongue is thickly coated, the bowels somewhat constipated and the appetite completely lost. Freaks of Iniammation — The inflammation at first affects one or two joints, rarely three ; after a variable time it commonly leaves the joints first affected as suddenly as it attacked them, and fastens on some other articulation ; often, however, new points are attacked without the disease leaving its orig-inal seat. As a rule the larger joints are the ones most liable to be attacked, the knees, elbows, ankles, wrists and hips; more rarely the smaller joints of the toes and fingers become affected. Heart Attack. — Besides the articulations, acute rheumatism fre- quently attacks the heart, not by metastasis or transferrence of the inflam- mation from one part to another, but by seizing on the fibrous textures of the heart as in one of the series of textures liable to the disease. Some- times the pericardium is attacked (pericarditis), sometimes the lining membrane of the heart's cavities (endocarditis). The younger the patient the more liable is the heart to be affected; so that when rheumatism occurs previous to the adult age the heart is attacked in a large majority of cases. Rheumatism Hereditary — The rheumatic constitution is frequently hereditary, and rheumatism is peculiarly a complaint of cold, damp sea- sons and climates. Causes — The cause of rheumatism has provoked more thought and research than any of the commoner diseases; at least one type of the disease is due to excess of fibrin in the blood. There is an exudation of this fibrinous material into the sheaths of nerves about tendons, especially where inserted into the bone, the fascise of muscles, the serous capsules of organs, their ligamentous attachments, in joints, heart valves, and so forth, wherever fibrous tissue is found normally. This fibrinous exudate organizes into bands, fungus, nodules, and so forth, of cicatricial tissue, obstructing circulation and movement of parts and modifying cell nutri- tion. The presence of this fibrinous exudate makes the muscles hard and stiff, so that they contract with difficulty and pain, yet appear large and strong. Impinging upon nerves it causes pain and perverted nerve action. Especially is this the case where the deposit occurs near the bony opening whence tlie nerves emerg The Fibrous Exudation. — This fibrinous exudate is precisely like the ACTTTE RHEUMATISM. 355 membrane of diplitlieria, of membranous dysmenorrhea, colitis and croup, the exudate in lobar pneumonia, and so forth. Its appearance in the mus- cles and other structures is also preceded by a similar weakening of the vaso-motor nerves. When the blood gets into this hyjjerjjlastic state it must get rid of the excess of fibrin-forming materials in some way, or it would finally solidify, organize like a clot, and the individual turn to stone. So nature sounds the alann, and sacrifices a part to save the organism. But sometimes her warnings are not heeded. A Chief Cause. — The chief exciting cause, we know, is the application of cold to the body when unusually heated. Cold is more liable to pro- duce this effect when combined with moisture, whence a cold and humid atmosphere and wet or damp clothes are the most frequent sources to which rheumatism can be traced. Partial cold, as when parts of the body are subjected to currents of cold air, is very apt to give rise to rheumatism ; when the body is predisposed a very transitory exposure of this kind will suffice to bring on an attack ; if the ciirrent be sustained for any time, few will wholly escape some contingent suffering. Of the fact that rheuma^ tism is so excited there can be no doubt. When it is reflected, however, that for every instance of rheumatism so induced, numbers continually endure as much or greater exposure to the alleged cause without any disease ensuing, too much importance should not be attached to it. Diagnosis — The only disease with which it is liable to be confounded is gout. Formerly discrimination in this respect was deemed of high imijortance, the prevailing theories of gout demanding a course of treat- ment very different from that to which rheumatism was subjected. In the present day a juster pathology of gout assimilates the treatment of both diseases sufficiently to render extreme accuracy of discrimination of very slight moment. Prognosis. — The prognosis is dependent on the promptitude with which suitable treatment is resorted to. Generally speaking, there is little immediate danger to life, there being no inflammatory disease of equal intensity which so little deranges the vital functions. This, most proba- bly, is owing to the disease expending its violence in the joints and other external parts, and being little prone to attack the viscera. The peculiar character of the inflammatory action, too, and the little liability which it has to pass into suppuration, or undergo the other changes consequent to phlegmonous inflammation, may account for the safety with which even the metastasis of rheumatism to internal parts is borne. It is certain 356 CONSTITUTIONAL DISEASES. that such metastasis is not attended with so much danger as the severity of the Bviuptoms would seem to denote. Management of Acute Rheumatism — One of the most important points in the management of acute rheumatism is to watch the supervention of the morbid action in the fibro-serous tissues of the heart. It is not neces- sary to repeat here the symptoms of pericarditis and endocarditis, hut the occurrence of dyspnoea, with more or less anxiety, jerking or feeble and rapid jiulse and tumultous action of the heart ought to direct the atten- tion of the practitioner to that viscus, and if he discovers by the physical signs and functional phenomena the existence of inflammatory action there, it must be treated as if the disease were unconnected with rheuma- tism, for no truth is better established than that, although acute rheuma- tism, seated in the fibrous and muscular tissues around the joints, is remarkable for its great and rapid change of location; chronic rheuma- tism loses this mobility when it fixes upon a serous membrane. Treatment — 1. Acute rheumatism produces, we have seen, diseases of the heart; it is, therefore, incumbent on the practitioner to prevent the continuance of the rheumatic inflammation of the serous membrane of the heart. The indications are to subdue fever and remove inflammation. The promptitude with which the local inflammation in its earliest stage yields to the treatment by which a plethoric state of constitution is cor- rected, and febrile action allayed, and the obstinacy of the local ailments, whenever the constitutional state is overlooked or inadequately treated, furnish the best proofs of the correctness of this pathology. 2. The treatment has been pursued in various ways — ^bleeding, mer- curials, mercurials with Durgatives, opium, sulphate of quinine and nitrate of ootassa in large doses have been at various times resorted to. Of these methods, tnose by large doses of sulphate of quinine and by nitrate of potassa nave seemed to have an influence in controlling and cutting short the disease, and the treatment by quinine appears to be successful in the acutest and most violent attacks; but they are both subject to incon- venience and dangers which coimterbalance their advantages. 3. The treatment which is most generally relied on is the alka- line. Our aim being to liquefy and eliminate the fibrinous deposit. The iodides, ammonia preparations, jaborandi, hot vapor baths, massage, and counter-irritation have all been employed ; overfeeding, especially with meats and highly concentrated foods, should bo rigorously avoided. Persons having this fibrous diathesis should employ a resolvent treatment at intervals, for weeks at a time. Exercise must be systematic, and too ACUTE RHEUMATISM. 357 much cannot be said of the value of hot vapor baths, massage and joint movements. 4. If the heart shows signs of being affected, and embolism or phle- bitis occur, use ammonia, carbonate and acetate with nitro-glycerine, warmth to and rubbing of extremities with mercury to move the bowels. The old custom of venesection and cups, in vigorous subjects, was very fair practice. It made the patient thirsty and so called for diluents to thin the viscid blood. The cups relieved engorged parts, and paved the way for a better circulation through them. 5. The fibrous diathesis varies from that of the uric acid, and the same treatment will not always relieve the rheumatic pains of both. In the former, there is a tendency to congestion of the brain, the liver and kidneys are apt to be sluggish. In the uric acid type of rheuma- tism irritability is contrasted with the torpor which characterizes the fibrous. Enlarged joints are common, and storms of disease sweep over the system. Muscular development is slight, and the powers of endurance small. In the fibrous diathesis the patient is well developed, tough and resisting. As rheumatism is invariably accompanied by loss of appetite and embarrassed metabolism, it is naturally the result of accumulated secre- tions and imperfect excretion, hence it is best treated by freeing the bodily outlets and carefully measuring the supplies. While recognizing the necessity of salicylate treatment, we would advise that such be com- bined with mild cholagogues, diaphoretics and diuretics. The salicylate appears to exert a general action on all the excretions in the exact pro- portion in which such is needed. 6. If any organ requires but little correction, it receives no more, and on that account sufficient force is retained to exercise itself where it is more in demand. As a result, the beneficial effects of the salicylic acid treatment are utilized to their fullest extent without being followed by bad reactionary conditions. Treatment Kest in bed and the parts kept warm. The affected parts should be wrapped in cotton. Give freely alkaline mineral waters In the strong frequent doses of salicylic acid or the salicylates. R.— Acid Salicylic l% drachms Sodii Bicarb 2 drachms Tr. Card. Co 6 drachms Syrup 1^2 ounces Water q. s. to make four ounces. Two teaspoonfuls every three or four hours. 358 CONSTITUTIONAL DISEASES. Or, R. — Sodii Salicylate 3 drachms Syrup 2 ounces Water of peppermint 2 ounces Two teaspoonfuls every three or four hours until relieved. Or five-grain closes of aspirin every three or four liours. The alka- line treatment can he used hy giving the following: R. — Potass. Bicarb i drachm Lemon juice 2 drachms Water I ounce After the acute symptoms and pain have subsided, Basham's Mix- ture in dessertspoonful doses three or four times a day. Oil of winter- green applied to the affected joint will often relieve the pain. MUSCULAR HHEUMATISM. Of the minor painful maladies this is, perhaps, the most common in many parts of the country. It may attack any muscle, but its three most decided and painful phases are lumbago, stiff neck and pain in the side (pleurodynia), all of which yield to the same or analogous treatments. Lumbago. — This affects the large muscles of the back and loins, sometimes extending to the lowest parts of the spine. The pain is severe and often of sudden occurrence, very much as if one had sprained his back. Treatment Apply locally chloroform liniment on hot flannel. A porous plaster is often effective. Assume and hold a restful position. Take internally two gTains each of quinine and phenacetin, with one twelfth of a grain of belladonna every three hours until relieved. Stiff Neck. — This is also called cervical rheumatism. It affects the large muscle at the side of the head behind the ear, extending down to the collar or even the breast bone. Treatment. — Apply locally chloroform liniment on hot flannel. As- smne and keej) a restful position. Take internally two grains each of quinine and phenacetin, with one-twelfth of a grain of belladonna every three hours until relieved. Pain in the Side (Pleurodynia) arises from a rheumatic affection of the muscles concerned in breathing, especially the short, flat muscles CHRONIC RHEUMATISM. 359 between tbe ribs, called intercostal muscles. It is also called intercostal rheumatism. The pain produced resembles that of pleurisy, and some- times excites alarm lest some more serious disease is present. A test of the lungs with the stethoscojie Avill detennine whether the condition is pleuritic or not. Absence of cough or fever, and soreness, upon touch, of the muscles on the side affected, also show that pleurisy is not present. Treatment. — 1. As in all cases of muscular rheumatism, put the affected muscles at rest as far as possibile. Of course this will be hard to do, because these muscles are engaged as helps in respiration, but the object may be aided by applying strips of adhesive plaster, overlapping each other, around the affected side, so as to compress it tightly. 2. Apply an ordinary porous jjlaster to the side affected. 3. Treat internally by taking every three hours, until relieved, a dose consisting of two grains each of quinine and phenacetin, witli two grains of Dover's powder. 4. Fifteen drops of wine of colchicum, with a quarter of a grain of opium, used in very small but often repeated doses, is often beneficial in all the above forms of muscular rheumatism. 6. In all of the above forms of muscular rheumatism — ^lumbago, stiff neck and pleurodynia — where the suffering is intense, a hypodermic injection of a quarter of grain of morphia will afford prompt relief. CHRONIC RHEUMATISM. Character — The distinctive characters of this malady are a febrile state of the general system, with more or less pain and swelling in certain tissues and joints. And in this, precisely as in acute rheumatism, the con- tinuance of febrile action undermines the general health, while the local inflammation, however indolent, disorganizes the joints, occasioning even- tual decrepitude. The pain and swelling of joints with progressive thickening of the ligaments and effusion in the several bursse sufficiently evince the morbid actions from which such effects result. But coincident with these will generally be found a quickened pulse, some inercasod heat of skin and a furred tongue. Symptoms. — Chronic rheumatism presents itself under two forms. In one of tlie joints are swollen and painful, the pain being aggi'avated by motion; there is no general fever and the appetite may be good and the digestion sound. The affection is exceedingly obstinate, attacking new joints without leaving those first affected ; it frequently attacks the smaller 360 CONSTITUTIONAL DISEASES. joints, rendering them permanently swollen and deformed, while the immobility to which the joints are sometimes reduced may cause atrophy of the muscles connected with them. Gout. — When the type is precise and definite it presents sharply- drawn distinctive characters which distinguish it from gout; but it must be admitted that there are many eases in which it exhibits so great a resemblance to chronic gout that it is almost impossible to establish an absolute distinction between the two diseases. Mobility is the primordial character of rheumatism ; this character at once presents itself. • In gout — on the other hand — mobility does not show itself until the malady has become inveterate, until the attacks, which at first Avere strictly local, have frequently recurred, or the progress of the regular manifestations has been interfered with. Treatment — 1. In the treatment alkalies and diuretics are of service, also the iodide of potassa, while the different mineral waters are frequently of great service. Warm salt water baths, the use of flannel and stimulat- ing liniments afford relief. 2. It would be vain to enumerate the various stimulants which have obtained character for the cure or relief of this disease. The prin- cipal are the different essential oils; various balsams and gum resins; sudorific decoctions; electricity. Any of these may benefit according as the general constitution is prepared for their operation, or as the special ailment may require. If there be no plethoric or febrile state present, their use will at least be harmless, if not beneficial ; but should the case bo such as to need depletory treatment and the operation of mercury, then must the use of such stimulants as are now named be watched with great caution. Warm bathing and active exercise are among the unexception- able and most powerful means of relieving chronic rheumatism. Local Treatment 1. The local treatment as directed for the regular or acute rheumatism also requires to be assiduously employed. For this various liniments are useful ; none are better than those containing oil of turpentine, oil of wintergreen, oil of sassafras, ammonia and laudanum, diluted with soap liniment, or where pain is considerable, chloroform or aconite liniment. Blisters may be applied in obstinate cases. Dry cup- ping to the back, leaving a number of cups on for twenty or thirty minutes at a time makes a more pervading favorable impression sometimes than might have been expected. 2. For rigidity of the joints and even for pain in them or in the muscles, pouring hot water continuously over the parts does great service. GOUT OE PODAGRA. 361 The hot bath or vapor bath, or, as some prefer, the hot dry-air bath (130 degrees to 200 degrees) will be powerful for relief in many cases. Electric Treatment — Electricity also will aid in hastening the restora- tion of use to the stiffened parts. SYPHILITIC RHEUMATISM. This affects the long and flat bones chiefly, and mostly between the joints, not at them. Generally there is nodosity upon the bones affected, or some degree of periosteal inflammation at least. Our main reliance in this affection is the iodide of potassium. ARTHRITIC RHEUMATISM. This designation is applied to a form of subacute or chronic Inflam- mation of one or more large joints of greater severity than ordinary chronic rheumatism. Effusion into the joints, with deformity and perma- nent lameness may occur. The treatment pursued in chronic rheumatism has proved beneficial. GONORRHEAL RHEUMATISM. A peculiar inflammation of one or more joints occasionally commenc- ing in the course of gonorrhea or even of urethral inflammation from forced catheterism. The local affection may be severe, with suppuration in a few cases and anchylosis of the joint in many. It appears to be an ichorsemic affection ; the result of absorj^tion into the blood of morbid matter effused into the membrane of the irretbra. GOUT OR PODAGRA. Character — A painful disease affecting principally the fibrous tissues about the smaller joints and intimately connected with an excess of uric acid and its compounds in the blood. Various names have been given according to the part affected, as podagra when in the feet, chiragra when in the hands, and so forth, but all such and probably many cases of neu- ralgia, accompanied by oxalic deposits in the urine, are mere forma of one disease. Symptoms. — ^A common attack of acute gout is generallj' preceded by uneasiness, indigestion, loss of appetite, nausea and vomiting, biliary derangement, dull pains or numbness in the parts affected, often with 362 CONSTITUTIONAL DISEASES. feverish symptoms; but in some cases, on the contrary, the disease comes on in the midst of apparent health and well-being, and occasionally at night during refreshing sleep. In most cases it makes itself known by an acute pain in the joint of the great toe. Further Symptoms. — This is accompanied by feverish symptoms, urinary sediment, extreme tenderness, restlessness, involuntary muscular contractions, sleeplessness and perspiration; the affected joint is swollen, red and hot. This series of symptoms may last four or five days, to be followed after a day or two by three or four others, continuing in all from two to three weeks; the severity of the attack, its persistence, its seat and its metastases vary according to circumstances. Chronic Gout.— When gout becomes chronic the attacks are more irregular, less severe, more frequent and sudden, leaving one joint for another after slight exposure to cold and moisture, excess at table or vivid emotions; in this form the continuance of the pain and the fear of in- juring the gouty joints render its subjects cross, fretful and disagreeable. Chalky Deposits. — Toward the end of the spell chalk-like deposits are thrown out about the joint in some, but not in all cases. The suffer- ing with the gouty inflammation is often very intense. Hereditary Gout — Hereditary gout is sometimes podagi-a or foot- gout, but more often is of the hardening kind. Neuralgia, indigestion, palpitation and urticaria or eczema upon the skin are its most common manifestations. In such a system rheumatism and other affections are to a considerable degree modified by the "gouty tendency." Causes — High living with indolent habits generates gout. Even excess of animal food, with scanty exercise, has been known to produce it. But strong wines and malt liquors much increase the tendency. Weak wines do not seem to have the same effect. Diagnosis — Between gout and rheumatism there is great resemblance. In gout the small joints are chiefly affected; in rheumatism the larger joints. Bepetition of attacks is much more frequent in gout; their dura- tion is greater in rheumatism. In gout the heart is seldom attacked and spasmodically; in rheumatism the heart is often subject to inflammation. In gout the stomach is sometimes spasmodically affected with violent symptoms ; in rheumatism, almost never. In gout, and not in rheumatism, uric acid is in excess in the blood. In pure gout, colchicum does good ; in rheumatism, hardly ever. I Treatment. — 1. There are few diseases which have more empirical , remedies extolled for their cure than gout; almost every drastic purgative, OANCEE, OK MALIGNANT DISEASE. 363 diuretic, tonic aud narcotic has been pressed into the service either for external or internal use. To say nothing here of soothing topical appli- cations, colchicum has enjoyed, and deservedly, a great reputation in the treatment of gout and neuralgia between the attacks and in their chronic forms; it is most eflicacious when it acts upon the skin and bowels. The acetate of potash and other alkalies are in favor both for their diuretic property and as alkalizing the acid in the blood and urine. 2. During the attack colchicum and the alkalies are the remedies. Wine of the root of colchicum may be given in ten- or twenty-drop doses several times daily. The stomach and bowels are sometimes irritated by large doses ; but for a few days most patients will bear fifteen drops thrice daily. It should be stopped when relief has been obtained. Carbonate of potassium — ten to thirty grains at once with half-drachm doses of rochelle salts will be important in addition. Opiates or other anodynes may be craved by the jjatient during the extremity of his pain. 3. Gouty attacks affecting the stomach or heart spasmodically are usually sudden, violent and jirostrating, requiring prompt stimulation, as brandy, laudanum, Hoffman's anodyne or chloroform. Small or mod- erate doses of one or another of these should be giver, at short intervals. Mustard plasters to the epigastrium or chest and back will be important, and the feet may be placed in hot mustard water for revulsion. Diet. — Regulation of the diet is of primary importance. But it should not be too low, especially when the patient's habits have been those of free living. ISTourishment must be full, while the digestive power is economized and positive stimulation avoided. Attention to hygienic rules and avoiding exposure to dampness, cold and fatigue of body or mind are absolutely necessary as aids in the treatment of this disease. To promote all this adequate exercise is the natural agent, the use of which cannot be superseded by any medicines however valuable or how- ever laudctd. CA2TCER, OH MAIIGNANT DISEASE. Cancer is a disease the cause and method of spreading of which is not tiefinitely known. It starts by the growth of cells in an organ or skin of the body which are exactly like normal body tissue, but differ from the cells which are normal for the organ in which it develops. These ab- normal cells constituting cancer, renew themselves and encroach upon the normal cells of the organ involved, so that its function is interfered with and ultimately destroyed. Cancer of the stomach, liver, etc., grow until 364 CONSTITUTIONAL DISEASES. they encroach upon adjoining organs and practically eats its ■way into the vitals of the patient until removal or death occurs. Cancer can spread to other parts of the body by the poisonous cells, from the original seat ©f the growth, getting into the blood and lymphatic channels. As soon as the wall of a blood or lymph channel becomes eaten through these cells are washed to other organs, and wherever they happen to be checked start a secondary growth. This habit of cancer cells traveling by the former method and starting up secondary tumors resembling the primary growth is spoken of as "metastasis." Do you know that after thirty-five years of age one in every eight females and one in every eleven males die of cancer, that the death rate from cancer between the ages of fifty and sixty is not surpassed by any other disease as a cause of death in women, and only slightly by tuberculosis in men. "What are the early signs or danger signals of this scourge, which, if recognized by the sufferer, may save his life ? According to Dr. Childe, the eminent English surgeon, the suscep- tible localities for cancer are: (1) Cancer of the breast. Here the danger signal is a small lump or thickening of any kind. In women over forty years old, this lump is a cancer from the start in at least 90 per cent, of the cases. In a woman of any age, the finding of a lump in the breast should be immediately followed by its removal by operation. (2) Cancer of the uterus (womb). The danger signal here is any irregular bleeding, especially after menopause (change of life), or the onset of a discharge in a woman who has been free from it previously, or the change in character of a previously present discharge, so that it be- comes more profuse, more foul or more irritating. (3) Cancer of the lip, mouth and tongue. The danger signal here is a little wart or sore that will not heal. (4) Cancer of the skin. The danger signal here is any sore that will not promptly heal or any wart or mole which suddenly begins to grow rapidly. (5) Cancer of the stomach and intestines. Here the danger signals are not so apparent as on the surface of the body. After forty years of age, the onset of obstinate indigestion, persistent colicky pains in the ab- domen, persistent diarrha3a and especially the vomiting of blood or the pasage of blood in the stools. Loss of weight. Prevention. — The cause of cancer is unknown, and whether contagious or not is imsettled. Therefore, we cannot prevent its spread by isolating OANCEE, OE MALIGNANT DISEASE. 365 the person in quarantine. If the disease were known to be due to a germ or parasite, insects, etc., then it could easily be cured, as other contagious dis- eases, by destroying the cause and preventing others from contracting the disease by coming in contact with sufferers from cancer. However, any sufferer from cancer in a family should be kept in a separate room, and all doors, windows, etc., screened to keep flies and mosquitoes out, and kill all insects seen that may alight upon the dressings or any exposed surface of the body. Disinfectants should be at hand for the nurse, attendant and physician to disinfect their hands after attending to the patient. All dis- charges, bedclothing, wearing api^arel, dishes, etc., used by the patient should be disinfected with chloride of lime solution (one ounce to half a pail of water) as a precaution. Teeatment. — There is only one way of preventing the spread of this disease, and that is by immediately consulting your physician and inform- ing him of a growth or mole, etc., or any distressing pain or symptoms which affect any portion of your body. Do not wait. Cancer spreads slowly and treacherously until it has gained a hold, and then it may be too late. When the surgeon sees your case, submit to an operation at once. If the stomach or womb, etc., are involved, you will be saved a slow and pain- ful death. Complete and early removal of a cancer by operation is the safest cure. Even then it will return, but these cases are rare where the patient has acted promptly. No Medicine Will Cure Cancer — ^Avoid Patent Medicines They are fakes ; your money will be wasted, while your tumor will grow. There have been numerous cures recommended in the treatment of cancer where operations cannot be made. The best of these is the Radium Treatment. This is very expensive, but in time the government and our wealthy citizens will see that the poor can receive treatment according to their station in life with a nominal charge or fee. It has cured some cases, but others have succumbed Dr. Seelye, of Daytona, Florida, JJ. S. K., recommends the treat- ment of cancer {epithelioma) by direct sunlight, by concentrating the rays of the sun upon the growth, early, by means of a magnifying glass such as may be purchased imder the name of a "reading glass" for half a dollar or less. He claims permanent cures in mild cases so treated. Common Form of Cancer. — The most familiar and characteristic form of cancer is that wliich attacks the female breast or womb, usually past the middle period of life. It first appears as a local induration situated 360 CONSTITUTIONAL DISEASES. beneath the skin, in the glandular tissue of the organ, for the most part in the neighborhood of the nipple. It increases slowly in size, becomes ad- herent to the akin and involves more and more of the substance of the breast. Cancer Pains — In most cases sharp lancinating pains are experienced at this time, sometimes causing much distress. When the glandular sub- stance of the breast has become fully affected, it is also found to be adher- ent to the walls of the chest, so that it can no longer be moved from side to side, and the skin over its whole surface is discolored. Smooth in texture, raised in irregular knobs or eminences and in spots red and tender. The Ulceration. — The early hardness now yields to local softening, the skin gives way at some prominent point, and the ulcer thus formed shows no tendency to heal, but constantly enlarges and discharges a dark- colored and fetid exudation. Subsequently the morbid growth involves the subjacent muscles, the ribs and even the substance of the lungs. In- ternal cancer, however, is often developed as a secondary affection with- out being directly continuous with the external growth. The patient may be gradually exhausted by the pain, discharge and constitutional irritation dependent upon external cancer alone, or the fatal termination may be principally due to the secondary affection of the internal organs. Course of Cancer — The course of cancer is for the most part slow, requiring several years to pass through its successive stages. This is gen- erally the case in cancer of the breast. In other forms, particularly where the morbid growth is softer and more vascular at the outset it often terminates fatally in a few months or even weeks. Train of Cancerous Symptoms. — The cancerous humor possesses these characteristics : 1. The peculiar jjowcr of infiltrating every tissue as it encroaches ui")on it. 2. It spreads to the lymjjhatic glands of the neighborhood through the absorbents. 3. It affects the body generally through the vascular system, thus giv- ing rise to secondary deposits, that is to say, to the development of similar growths in the viscera or remote parts, the lungs and liver being particu- larly prone to its attack. 4. It is liable to recur after removal. The stroma is abundant, tough and resisting, giving a tuberoid cir- cumscribed api^earance to the mass when superficial. It is of great hard- ness, and when fully developed is firmly adherent to the adjacent parts. OANOEE, OB MALIGNANT DISEASE. 367 Upon sections it presents a bluish-wliite, glistening appearance and yields a creamy, oily fluid known as cancer juice. When situated subcutaneously, as in the mamma, the tumor commonly assumes a dark purple or livid color, and is subject to darting, stinging or neuralgic pains. It is apt to ulcerate, when the sore will present hard and everted edges and the neigh- boring lymphatics will become indurated and enlarged. It is found most frequently in the mamma, liver, stomach and rectum. It is more frequent in women than in men. It is of slow growth, and rarely occurs before forty or forty-five years of age. Causes — The observations which we have made on the relative fre- quency of cancer as to age, sex-temperament and condition of life contain the greatest part of what we have to say on the predisposing causes of the disease. Among these have long been enumerated the frequent and dire-jt operation of irritating substances ; external injuries, especially blows; the abuse of stimulating potions ; immoderate indulgence in venery ; the de- pressing influence of moral afflictions; bad food, conjoined with the de- bilitating effects of cold and otherwise unhealthy habitations ; the inju- rious influence of one or more of these jjredisposing causes on particular organs being determined or modified by the individual or accidental cir- cumstances of the case. Cancer May be Hereditary — The frequent occurrence, however, of cancer in individuals in whom none of these predisposing causes seem to have cooperated in the production of the disease has led many pathologists to consider it as having an hereditary origin. Transmission of Cancer Germ. — The gei-m of the disease, or cancerous virus, is transmitted from the parent to his offspring. The evidence on which this opinion rests is shown in the fact that the material element of the disease is contained in the blood, and is separated from this fluid after the manner of nutrition and secretion, either in the molecular structure or on the free surface of organs; and that, while the formation of the disease is thus going on, there may be no appreciable physical or physi- ological modification of the part in which it is observed. It is thus that we meet with carcinomatous tumors in the brain, which, from their bulk and other characters, must have existed long before the functional disturb- ance of the organ gave signs of their presence ; and we have an equally striking example of the silent development of these tumors in the eye, imtil acting simply as a foreign body, they obstruct the rays of light and render vision more or less imperfect. Cancer Pimple. — In persons, too, apparently in the enjoyment of the 368 CONSTITUTIONAL DISEASES. most perfect health, -we often see the disease making its appearance in the form of a small pimple, proceeding more or less rapidly in its course, extending in breadth and depth and terminating ultimately in death, in spite of all the means which art has devised. In others, a similar pimple arises under similar or even vmfavorablo circumstances, proceeds like the former to ulceration, and although it may have been neglected, irritated and excited from time to time, disappears and leaves the patient in perfect health. Diagnosis. — It is not until carcinoma has made some progress that we are sometimes able to recognize its presence in internal organs by means of a careful consideration of the local and general symptoms which we have enumerated. Little importance in general is to be attached to any one of them taken individually. But when the local signs, viz., the changes in the bulk, form and situation of organs, occasioned by the disease, its relative frequency in different organs and in particular portions of the same organ are taken in connection with the special and general modifi- cation of function which may be present in individual cases, the greatest possible assistance is afforded us in establishing the diagnosis. Thus it is more easy to detect cancer of the stomach than of the lungs, of the latter than of the brain; because of our being able to ascertain the presence of the greater number of the local signs of the disease in the first case, only a few of them in the second and none at all in the third. Further Diagnosis.— And when the sense of sight can be applied with that of touch and hearing the diagnosis seldom presents much difficulty, as in the case of carcinoma of the os uteri and rectum. It is necessary to observe that too much reliance is not to be placed on the presence of these general symptoms which constitute the cancerous cachexia, for there are morbid conditions of the stomach and duodenum associated with the de- rangements of the biliary secretion which give rise to a state of debility and emaciation, accompanied with discoloration of the skin, which so closely resembles this cachexia that the one is not to be distinguished from the other. Difficulty of Diagnosis. — The difficulty of establishing the diagnosis in such cases is likewise increased by the circumstance that the same chronic character prevails in both. It is hardly necessary to remark that the pres- ence of carcinoma in an external part of the body is to be regarded as a diagnostic sign of great importance in all cases of a doubtful character in which functional derangement of an internal organ has existed for some time. In such a case we should regard the frequent occurrence of vomit- CANCEE, OK MALIGNANT DISEASE. 36C ing after meals as indicating the existence of carcinoma of the pylorus, even should no tumor be felt in this situation or dilatation of the stomach. Abdominal Tumor. — If the presence of a tumor were detected in any part of the abdominal cavity we should not hestitate to say that it was of the same nature as the external affection, and the occurrence of paralysis, under the same circumstances, would justify us in attributing it to car- cinoma of the brain or spinal cord. Possibility of Cure. — In no disease is a fatal determination so uni- versally admitted as in carcinoma. The possibility of the cure of cancer of the internal organs has never been supported by substantial evidence, and the examples are few indeed in which we are disposed to believe that the disease has been removed from an external part by surgical or other means, without its recurrence in the same or some other part of the body at some other future period. Symptoms. — Changes in the color, temperature, circulation and nutri- tion of the affected organ cannot be detected by direct observation, and those of bulk consistence and form can be determined only in certain organs, and at a more or less advanced period of the disease, such as the stomach and intestines, liver, spleen, kidneys, ovaries and uterus, lungs and mesenteric glands, in all of which organs these changes may be recog- nized either by the touch, percussion^ or auscultation. But it is more particularly the change of bulk which is detected by these means, and which, as a local symptom of the presence of cancer, is that to which the greatest importance is to be attached. The increase of bulk which ac- companies the presence of cancer is not perceptible until the disease has made some progi'ess. It is most considerable in solid organs, such as the liver, kidney, ovaries and so forth, and is seldom very marked in hollow organs, such as the stomach or intestines. Further Symptoms — Considerable increase of hvik may, however, have taken j^lace in the walls of the stomach and intestines without our being able to detect its presence, which happens when cancerous matter accumulates in the direction of the internal surface of these organs. In such cases an increase of bulk of a different kind is produced, viz., dilata- tion, in consequence of the obstacle presented by the carcinomatous matter to the passage of the food or feces. When dilatation of the stomach is thus produced, the obstacle is situated at the pylorus; when of the small intestines, it is, in the great majority of cases, situated at the termination of the duodenum or commencement of the jejunum and caput cecum coli; 2-i 370 CONSTITUTIONAL DISEASES. and at the sigmoid flexure of the colon and rectum when the dilatation occupies the larger intestines. Bulk of Stomach. — The increase of bulk which the stomach and intes- tines acquire in consequence of an obstacle of this kind is sometimes very great. In some cases of scirrhus pylorus the stomach has been found to occupy the greater part of the abdominal cavity, stretching down to the sjTujjhysis of the pubis and from one lumbar region to another; and the large intestines sometimes measure from four to six inches in diameter M'hen similarly affected. We have seen the small intestines equal in size to the ordinary dimensions of the stomach. It is important to know that the extent of the dilatation is not to be taken as the measure of the extent of the disease. The greater the dilatation the gTcater we may infer is the obstacle by which it is occasioned, but this obstacle may con- sist in a slight scirrhus enlargement, which prevents the passage of the food or feces as effectually as when it is occasioned by one or more tumors of considerable size or great thickening occupying se^'cral inches in length of the whole circumference of the walls of the stomach and intestines. Pain of Cancer — The only modification of the sensibility which as a local symptom accompanies cancer is that of pain. There is, however, no symptom of carcinoma more deceptive than pain. Of all varieties of car- cinoma it is that of scirrhus which is most frequently accompanied vnth pain, and it is also in this variety that the pain is most severe, acute and lancinating. Vomiting is an invariable consequence of carcinoma of the pylorus, accompanied with a diminution of bulk of the orifice of this part sufficient to interrupt or impede the exit of the chyme or indigested food. Vomiting in Cancer — Perhaps the most frequent cause of vomiting is the mechanical obstacle occasioned by the carcinomatous substance in the pyloric portion of the stomach. The quantity and quality of the matters vomited are variable. Both will be modified by the quantity and quality of the food and drink ; the former by the capacity of the stomach and the absence or presence of irritation ; the latter by the nature of the iugesta, the state of digestion and the stage and variety of the disease. It is only at the early stage of carcinoma, or at least before softening and ulceration have taken place, that the vomiting consists of a watery or mucous secre- tion. In the great majority of cases, and always toward the termination of the disease, the contents of the stomach ejected by vomiting contain a substance resembling the lees of wine, a mixture of chocolate or soot and water. The substance may appear in the form of little particles, patches or streaks, and indicates the effusion of the blood into the cavity of the CANCER, OB MALIGNANT DISEASE. 371 stomach from hemorrhage, either in consequence of the softening of the carcinomatous matter or the sloughing of this suhstance and of the con- tiguous parts. Cancer of liver — Carcinoma of the liver may occur without any appreciable derangement of the special function of the organ being ob- served. There is often no apparent alteration in the quantity or quality of the bile, even in the most extensive forms of cancer of the liver. Cancer of Kidney — There is no apparent modification of the secre- tion of urine in cancer of one of the kidneys, although the disease may be so extensive as to leave no trace of the natural structure of the organ. Cancer of Uterus. — The much more frequent occurrence of cancer after than before the cessation of the menstrual discharge, prevents us from estimating accurately the influence which this disease exercises on the special function of the uterus and ovaries. Impregnation, however, has been luiown to have taken place in carcinoma of the os uteri, and of one of the ovaries. Cancer of Spleen — As regards the spleen, its cellular organization may be completely effaced by the presence of the carcinomatous matter, and consequently it is rendered incapable of receiving more blood than is necessary for the nutrition of its solid parts and the growth of the disease. Cancer of Duodenum — Cancer of the duodenal extremity of the pan- creas, in consequence of the compression of the duct which passes in this direction, gives rise to an accumulation of the secretion of this organ, and great dilatation of the duct throughout its whole extent. Diminished or suspended absorption are the occasional consequences of cancer of the mesenteric and lymphatic glands. Cancer of Brain. — The functional lesions which accompany cancer of the brain, cerebellum and spinal cord vary considerably with the seat of the disease relative to these organs individually, as well as to particular portions of them. But in neither of these respects does it give rise to any symptoms which can be regarded as pathognomonic of its presence. As a foreign body it gives rise sometimes to a degree of compression sufficient to produce partial or complete paralysis, loss of memory or difficulty of speech and derangement of the intellectual faculties. Symptoms But these latter changes depend principally on the irrita- tion and softening of the substance of the brain in contact with tlie car- cinomatous mass. Even paralysis is more frequently produced by these subsequent changes than by compression. The Spinal Cord. — Paralysis of the superior and inferior extremities 372 CONSTITUTIONAL DISEASES. of the muscles of respiration, and of the bladder and rectum take place in carcinoma of the spinal cord, the seat and extent of the paralysis depend- ing on the portion of the spinal cord occupied by the disease. General Symptoms. — The general symptoms of carcinoma do not make their ajipearance before the last stage of the disease. Their severity de- pends much on the nature of the organ and the extent to which it is af- fected, but it is principally the irritation produced by the presence of the cancerous substance during the period of softening, sloughing and ulceration that determines the gravity of these symptoms. It is in this, the last stage of the disease, that the circulation and innervation become deranged, and that fever and a diminution of the nutritive function are first observed. It is likewise at this period, but more frequently a few days or weeks before death, that the skin assumes a pale earthy or dull ochrey tint ; the debility and emaciation make rapid progress, and all the functions of the economy become implicated in the deteriorating influence of the disease. It is this group of the general symptoms which constitute what is called the cancerous cachexia. Fever Symptoms. — The febrile symptoms, as well as the diminution of nutrition in general, are greatest when the seat of cancer is the uterus or stomach, and least in those organs as the brain and lungs, in the former of which softening and in the latter compression may terminate in death before either of these symptoms has become conspicuous. General dropsy does not often occur and is never great. Ascites frequently accompanies carcinoma of the liver. Cancerous Dropsy. — Dropsy of the inferior extremities occurs more frequently in cancer of the ovaries and uterus than of any other organ. It is the consequence of compression of the iliac veins, but it may also be occasioned by the extension of the inilaumiation -which accompanies the ulcerative stage of the disease to these vessels. Compression of the vena cava by tumors in the liver, or by the enlarged mesenteric glands, may also give rise to the same state of the inferior extremities. Colloid Cancer — Colloid or alveolar carcinoma is characterized by the stroma being tolerably thick and so arranged as to divide the mass into a number of cystiform chambers, or alveoli, which are occupied by a jelly- like substance. Generally pale and transparent this may be firm as the white of a hard-boiled egg in the older cells, or of the consistency of half dissolved glue or currant jelly. In any form it is non-adherent to the walls of the cells, and may be readily removed. The disease assumes two forms, the circumscribed and infiltrated. The former is met with in CANCEE. OK MALIGNANT DISEASeT" 373 subcutaneous tissue and in the bones of the extremities, constituting the osteo-sarcoma and spina ventosa. The latter is seen in the walls of the alimentary canal. It is of much slower growth than either of the above varieties, and rarely or never ulcerates or softens. Black Pigment — Melanosis is a form either of scirrhus or encephaloid, in which a deposit of black pigment has taken place. Soft Cancer — Encephaloid or soft carcinoma possesses a matrix less abundant and firm than in the preceding variety. So deficient is this that the mass is of jelly or brain-like consistency. Its cells are for the most part large, with a tendency to assume the caudate form. The growth may be circumscribed (forming tumors often of immense size) , or it may occur in the tissues as an iniiltration. It is elastic, occasionally fluctuating un- der jiressure, as though pus was present. "When opened it shows a whitish-yellow surface, dotted with pinkish spots during life. It is very vascular, giving a purplish-red tinge to the contig-uous skin and possessing oftentimes a distinct fruit. Hemorrhage resulting from the spontaneous rupture of some of these vessels is not infrequent, forming apoi^lectic clots in the interior if confined, but constituting frightful loss of blood if rup- turing the matrix. When ulcerated the surface of the tumor assumes a dark, sang-uineous appearance, in which condition it is often described as fungus hematodes. From the first the peculiar cancerous cachexia is better marked in this than in any other kind of malignant growth. Its most frequent sites are the eye, cavities of face, articular ends of bones, the testicles, uteriis and breast. The disease runs its course rapidly. Skin Cancer — Epithelioma or epithelial cancer differs from the above in having an imperfectly defined matrix which possesses a tendency to form concentric lamluaj around the cellular elements. These are gen- erally mixed up with altered epithelial cells of the parts, and are more constant in their outline than other cancerous growths. Epithelioma is found chiefly at the margin of the mouth and at the anus, though it is occasionally seen on the hands and feet. Cancer of Bones Osteoid cancer is defined as a malignant tumor, usually commencing in the bones, consisting almost entirely of bone and followed by similar growths in the glands and viscera. Membranous Cancer — Villous cancer is the name given to cancer in a mucous membrane when covered with a villous or velvet-like groAvth. A host of remedies have been proposed for the cure of cancer; the greater number of them have been tried in almost every form of the 374 CONSTITUTIONAL DISEASES. disease, but they have nearly all failed to justify the high praises bestowed on their curative virtues. Kemedies. — 1. The remedies which retard or arrest the progress of cancer consist of those which exercise a direct or indirect influence on the nutritive function of the affected organ. Among the former are those which operate directly — the local abstraction of blood by means of leeches and compression hold the first rank. The first of these means should be employed for a considerable length of time, at intervals of one, two or three days, and the quantity of blood taken should be regulated chiefly by the strength of the patient. The diminution of bulk of the original tumor which follows this mode of treatment is sometimes very consider- able. 2. In the great majority of cases the tumor is not entirely removed. It may be reduced from the size of a hen's egg to that of a nut, and in this state remain stationary for years without giving rise to pain or any inconvenience whatever. The alternate use of local bleeding and compression effect more rapidly the reduction of bulk just noticed than when either is employed separately. 3. Although compression and local bleeding are employed benefi- cially they are by no means to be altogether relied upon. In consequence of a modification of nutrition in general, and consequently of that of the affected organ, the beneficial effects of some general remedies in car- cinoma of external organs are chiefly to be attributed. Some of these remedies appear to modify nutrition by effecting some unknown change in the composition of the blood, as aconitum, couium and arsenic ; others, by acting on the capillary circulation and absorption, as mercury, in altera- tive doses, and various preparations of iodine. 4. The beneficial effects of tonics, as preparations of iron, the fixed and volatile alkalies, mineral waters and all other remedies which in- crease the vital energies, invigorate digestion and promote absorption and secretion, may also be referred to a favorable change induced in the nutritive function of the affected organ by the introduction of these remedies into the circulating system. 5. The salutary operation of these local and general remedies is much increased by a judicious combination of both, regulated according to the circumstances of individual cases. Diet. — But while employing any of these remedies it is of the utmost importance to regulate the diet and regimen of the patient in such a CANCER, OE MALIGNANT DISEASE. 375 manner that neither of them may interfere with the operation of the remedy employed. Virtues of Conium — For example, the curative virtues of coniuni depend greatly on the quantity of food consumed by the patient, that is to say, the operation of this remedy is more or less powerful when only a small quantity of food was allowed and hardly perceptible when the quantity was considerable. The following has been our experience with the use of conium in this disease: 1. The patient takes a dose of the extract of conium, morning and evening, two hours before each meal. The amount of the first dose is half a grain, which is gradually increased to six grains each time. This dose is continued for about three weeks in order that the organs may become habituated to its operation, and is afterward increased to twelve grains each time, beyond which it is not necessary to carry the remedy, because of its influence being sufficient. The twelve-grain dose is continued from two to four weeks. 2. After each dose of conium, as well as at meals, the patient uses a glass of the decoction of sarsaparilla. 3. Only the third of the ordinary quantity of food is allowed, which ought to be very simple and divided into three small meals. 4. If the conium disagrees in one form it should be given in another or the aconitum may be used instead, but in lesser quantity than the conium. Toward the end of the treatment the dose of the conium is gradually diminished and the diet gradually increased. Further Eemedies — The only class of remedies which can be expected to afford any essential benefit are those that are capable of inducing a new condition in the system by modifying the function of nutrition, such as the various preparations of iodine, combined with a thorough change of everything surrounding the individual. The cachexia is the real mor- bid condition and the cancerous affections in particular organs are but so many evidences of it, as tubercles in the lungs are mere expressions or indications of another form of cachexia, equally possessing the whole system. Hence it is that cancerous tumors on the external parts of the body are so apt to recur after they have been removed by the surgeon. Removal of Tumors. — Still it must be admitted that in cases of scir- rhus tumors, when they have been removed early, there has very fre- quently been no return of the disease. In such cases the cachexia has been less strongly marked and time, apparently, has not been permitted for tlic 376 CONSTITUTIONAL DISEASES. local niiseliief to Increase the morbid disposition. It would seem, too, that the particular species of cancer influences the probability of recovery. There are a few examples of permanent recovery after the removal of encephaloid tumoi-s. Remedies for Cancerous Fevers — The remedies best calculated to pre- vent, remove or mitigate the local and general effects of carcinoma of internal organs vary with the nature of these effects and the seat of the disease. The state of irritation and fever and pain, at whatever period of the disease they may occur, may be greatly moderated by the use of conium, aconitum, ojjium, hyoscyamus, the acetate or muriate of morphia, while at the same time the use of all kinds of stimuli is to be avoided, par- ticularly if the digestive organs be the seat of the disease, and the patient himself kejit as much as possible in a state of quiet of body and mind. Treatment. — When cessation of pain and a return of strength and ap- petite take place, treatment is suspended for a month. It is then resumed for two consecutive months, then suspended for two months, and recom- menced, continuing during a month. This plan is pursued for at least two years, which by pursuing the patient is not only greatly benefited, but frequently cured. Ferruginous preparations must not be omitted when there is great anemia caused by profuse hemorrhage or imperfect nutrition. Hemorrhages — Hemorrhages are treated by rhatamy, sulphuric acid and ice. When they have been arrested, and when the pain is subdued, bitters, such as the decoction of cinchona, infusion of quassia, or of Col- umbo root, are given; sometimes also certain remedies which combine bitter with slightly purgative properties, such as rhubarb, are used; and finally the preparations of iron. Classes of Eemedies — The only class of remedies that can be expected to afford any essential benefit are those that are capable of inducing a new condition in the system, by modifying the fimction of nutrition, such as the various preparations of iodine, combined with a thorough change of everything surrounding the individual. The cachexia is the real morbid condition, and the cancerous affections in particular organs are but so many evidences of it, as tubercles in the lungs are mere expressions or indications of another form of cachexia, equally possessing the whole sys- tem. Hence it is that cancerous tumors on the external parts of the body are so apt to recur after they have been removed by the surgeon. StiU it must be admitted that in cases of cancerous tumors, when they have been removed early, there has been frequently no return of the disease. In CANCER, OK MALIGNANT DISEASE. 377 such cases the cachexia has been less strongly marked, and time, ap- jxirently, has not been permitted for the local mischief to increase the morbid disposition. Mitigation of Pain. — When the carcinoma or cancerous disease has arrived at that period when the cancerous cachexia announces the exten- sive and fatal termination of the disease, the efforts of the physician must be directed solely to the mitigation of the sufferings of the patient. If this symptom were removed, there are many cases in which carcinoma would run a much longer course, and give rise to comparatively little functional derangement. Termination of Cancer — With regard to the termination of cancerous affections of the hollow organs, it takes place frequently in the uterus and stomach, the rectum and urinary bladder, the transverse arch of the colon and jejunum, and the peritoneum. The perforation of the rectum, blad- der and peritoneuni is the consequence of the extension of the disease from the uterus ; that of the transverse arch of the colon, the consequence of its extension from the stomach. If the OS uteri be the seat of the disease additional benefit may be derived from the use of leeches applied to this part, and also sedative in- jections. It is only in this latter situation that sloughing and ulceration can be detected, and local remedies applied to remove some of the dis- agreeable effects of the one, or retard the progress of the other. Anti- septic disinfectants are perhaps the best remedies we can employ in this case, as they not only destroy the disgusting odor which accompanies this stage of the disease but remove the putrid and in-itatiug fluids which are then discharged. The retention of the contents of hollow organs from compression or obstruction is an occurrence to be guarded against by regu- lating the quantity and quality of food, for negligence in this respect may be followed by fatal consequences if the obstacle be situated in the in- testines. Further General Treatment The same general treatment is applic- able to all forms of cancer. If the growth be well defined, as in carcinoma of the breast, of not very long standing and not involving neighboring l;5anphatic glands, it may be remo\'ed, but severe hemorrhage from a large encephaloid cancer or the complication of important structures in any variety having deep attachments will preclude any operative procedure. Even when extirpated under favorable conditions it is very apt to return, eventually to destroy the patient. The removal of epithelial growths by the knife, or their destruction by caustic applications before glandular 378 CONSTITUTIONAL DISEASES. evolvement has supervened, in many instances may effect a permanent eure. In the last few years the X-ray has been used in the treatment of cancer with marked benefit, especially the external variety. In fact, many cures are reported. Care in Removing Cancerous Growths. — ^When a cancerous tumor has been removed all surrouudiug jjarts should be carefully examined, because it is not uncommon to find small cancerous tubercles in the connective tissue, fascia or muscular sheaths, which, if passed by unheeded, would soon increase and give rise to a recurrent growth. COLLOID. Characteristics. — This new growth, formerly called colloid cancer, gelatinous or gum cancer, is no longer considered to be malignant, in the sense of its having the power to infect other and distant portions of the system. Its great characteristic is the formation of a new growth in the large open meshes of which it exists a glue-like, gelatinous, transparent substance like half dissolved ganu arable. This matter is strikingly trans- parent. Greenish-yellow is its predominant hue. This jelly-like matter is exceedingly soft; a colloid mass is, however, firm and resisting; al- though not apt to be produced elsewhere, these gi'owths may obtain an immense size and even prove fatal by the disturbances which they cause in the system. Fortunately they are quite rare in this country. LTJPTJS OR NOLI ME TANGERE. Character. — This is a spreading, tuberculosis inflammation of the skin, usually of the face, tending to destiiictive ulceration. Its name is supposed to be derived from a fancied resemblance which the sores left in the progress of the disease have to the bite of a wolf. Symptoms. — 1. The "lupus erytheniatosus" occurs chiefly upon the face, and is symmetrical; each patch has Avell-defined edges and a red, scaly surface with small horny points upon it, due to accumulation in the dilated mouths of sebaceous ducts. 2. The "lupus vulgaris" has its origin in a skin tubercle, or tubercles, of a flat form, fleshy consistence and pink, shining appearance, and these at times ulcerate. This lupus ulceration, when once originated, progresses steadily, destroying every tissue it attacks, and when it reaches the nose, its favorite seat, it simulates cancer. Treatment — In the treatment of lupus, although the disease has ELEPHANTIASIS OE TRUE LEPROSY. 379 probably a constitutional origin and requires tonic treatment, both by medicine and regimen, there is no disease that derives more benefit from local treatment. Quinine, with vegetable tonics; cod-liver oil and iodide of potassium are all useful in this respect. When the ulceration is super- ficial and the skin is not deeply infiltrated, the local application of cod- liver oil on lint and the covering up of the part with cotton to keep it warm has in some cases worked wonders. ELEPHANTIASIS OR TRUE LEPROSY. Symptoms — This is a constitutional, hereditary affection, essentially chronic in its nature, showing itself mainly as shining tubercles of differ- ent sizes, of a dusky red or livid color, on the face, the ears and often on the legs, the skin being thickened, wrinkled, rough, unctuous, devoid of hair, and the perspiration from it highly offensive. After a time there is a circular margin enclosing the central red part free from scales and quite resembling the irregular scaliness of psoriasis. When the local disease has reached its highest degree a remarkable constitutional affection appears. The patient then becomes very languid, asthmatic, particularly at night time ; smothering fits seize him, he coughs violently and spasmodically, and spends the night in perfect sleepless- ness, falling into excessive, colliquative, clammy sweats, which give an intolerably fetid odor. His voice becomes weaker and hoarser, the ap- petite for food and drink is preternaturally increased, and the temper becomes gloomy. Finally, various nervous symptoms arise — fainting, convulsions, paralysis of some parts — and death arrives, preceded by the highest degree of exhaustion. Causes — Its origin has been ascribed to want of cleanliness and to miwholesome diet, especially the constant use of bad fish, to long-con- tinued exposure to the heat of a tropical sun, to dampness of situation or occupations requiring the frequent immersion of the limbs in cold water. "Where Occurs — The disease occurs chiefly in warm climates — Arabia, China, India and some of the West India Islands. Dry Leprosy In this the wasting of the disease is circumscribed, and limited to all the muscles of the hand. The skin is thick, reddened, and completely anesthetic; the fleshy masses have entirely disappeared, and the fingers assume the shape of claws. This disease rarely attacks women. It is accompanied with great torpor of mind and sluggishness of- body. Mental depression amounting to extreme melancholy is the natural con- 330 COKSTITDTIONAL DISEASES. sequence of so hopeless a malady. Yet the general licalth, for a length of time, suffers infinitely less than could have been anticipated, the actions of the respiratory and digestive organs continue longer unaffected, and even the cutaneous functions are still tolerably performed, as is evidenced by abundant perspiration. Progress of the Disease is very slow, and its termination, though it may be deferred for many years, is almost always fatal, the imfortunate patient being in the meantime dreadfully deformed and mutilated, and literally dying by inches. The patches spread slowly till the surface of the whole body may be at length inflicted, and its sensibility lost. There is neither pain nor itching, and usually no swelling. After a few months the internal functions become deranged, the pulse gets very slow and heavy, "as if moving through mud," the bowels grow costive, and there is much sluggishness of mind, and tendency to sonmolency. The skin of the extremities becomes fissured and rough, and ulcers appear under the metatarsal or metacarpal joints — the integuments seeming to be simply absorbed — or sloughing off in successive layers of about half an inch in diameter, without any previous tumor, suppuration or pain. A serous discharge ensues and there is loss of sensation and a tendency to ulceration and death of the parts. In the advanced stage of the disease the eyes are fierce and staring, and the voice hoarse and nasal. Character. — Leprosy is not a contagious disease, but is propagated by inheritance, depending on some specific taint transmitted from parents to children. The two forms of this horrible disorder are the tuberculated and the non-tuberculated or anesthetic. Treatment — The only hope of exterminating this dreadful disease appears to lie in the adoption of hygienic measures tending to improve the general condition, both physical and moral, of the leprous poor. Without this medical treatment is of little or no avail, but, with the aid of improved sanitary surroundings, tonics and alteratives, especially prep- arations of iron and iodine, have a very beneficial effect. Much may be hoped also from the systematic employment of baths, either saline or sulphureted, in this affection. Leprosy Germ. — A bacteria claimed to be the cause of leprosy, and named the bacillus leprar, was discovered in Norway in 1874, and its existence in the tubercles of this disease has been confirmed, although its causative power has not yet been completely demonstrated. An internal and external remedy is as follows: SCKOFULA. 38l Corrosive sublimate 2 grains Bismuth subnitrate I drachm Amylum Vi drachm Arsenious acid 20 grains Cosmoline i ounce Make ointment. Over a patch of skin three or four inches square rub the ointment in well once daily for about two weeks, then treat a fresh portion until the body is covered. SCROFTILA. Causes. — A blood disease manifesting itself In a great variety of organs and characterized when fully developed by the presence of a pecu- liar unorganized matter termed scrofulous. The causes are chiefly her- editary transmission and deprivation of pure air. It is closely allied to pulmonary consumption. Symptoms. — The scrofulous habit, when strongly marked, is easily recognized. The skin is usually delicate and irritable ; the patient suffers very readily from chilblains, and in childhood is more liable than others to cutaneous diseases. The mucous membranes partake the delicacy and irritability of the skin. The edges of the eyelids are apt to be red and swollen ; the eye is very liable to be attacked by inflammations ; hemor- rhages from the nose, cold in the head and enlarged tonsils are frequent. The muscles commonly want firmness, and the whole system is deficient in stamina. Diagnosis. — Scrofula is eminently a disease of childhood, while con- sumption belongs to a later period, bitt neither is confined to any age. One of the forms in which scrofula most commonly and earliest shows itself is swelling of the lymphatic glands in various parts of the body, more particularly about the neck. These become enlarged and firmer, and after a time a deposition of the peculiar curd-like matter is found to have taken place in their interior. After a time suppuration occurs, the swellings become softer and the skin over them assumes a dusky red hue, gradually becomes thinner and finally bursts, giving outlet to an un- healthy pus mixed with the curd-like deposit of the disease. The ulcers left heal slowly and with difficulty, and imless great care is exercised pro- duce deformed cicatrices. Treatment. — 1. In the constitutional treatment of these cases of stru- mous adenitis, nutritious food, suitable warm clothing, attention to clean- liness and residence in pure air are the most important requisites. Iodine iu its different forms, especially the syrup of the iodide of iron, is given 382 CONSTITUTIONAL DISEASES, in doses of twenty-five drops thrice daily, and quinine and iron each in gi-ain doses three times a day, with one-sixtecuth of a grain of arsenic, or phosphites and hypophosjDhites of lime and magnesia, in tablespoon doses of the syrup, are frequently of great service. Also the iodide of am- monium in three-grain doses three times a day. 2. In endeavoring to produce a reduction of the swollen glands by causing an absorption of the contents, the tincture of iodine painted on with a camel's-hair brush, or small feather, so as to smart severely but not to raise a blister, and repeated daily for a week or so until the skin peels oif is a valuable resource. A milder application of the same remedy is by the use of the ointment of iodine rubbed into the skin over the en- larged gland, night and morning, for weeks and even months if requisite. 3. Cod-liver oil is an anti-strumous remedy of great power, and is more readily taken by the young than by adults; generally sea bathing and sea air are mostly the best of remedies^ Ophthalmia — Strumous ophthalmia occurs in children between the time of weaning and the end of the ninth or tenth year. Its chief symp- toms are redness of the white of the eye, with the formation of little blisters or pustles, often ending in minute ulcers on the cornea or clear portion. The eyes water very freely, and the intolerance of light is exces- sive, so much so as almost to be indicative of the disease. Treatment. — The management of these cases will tax the skill of both nurse and doctor to the fullest extent, although internal remedies are often also required, the nursing and outward applications are the most important. Great attention must be paid to cleanliness, and warm bath- ing of the eyes with anodyne fomentations are very serviceable. Appli- cations of the wine of ojiium or of a solution of nitrate of silver, of a strength of from five to ten gi-ains in an ounce of water, although they smart severely at first are often of very great benefit. Diet. — Good diet is indisi^ensable in strumous affections. Hence the invalid should have all the advantages of an abundance of good mutton and beef, vegetables and ripe fruits in season, raw eggs, milk and cream, tepid or cool baths and sea air. PRESCRIPTION I. R. — Cod-liver oil and hypopliosphites 5 ounces One or two tablespoonfuls three times a day. EICKETS. PRESCRIPTION 383 R. — Citrate of iron and quinine lo grains Cod-liver oil I ounce Glycerine i Take a tablespoonful three times a day. RICKETS. Causes. — The cause of rickets seems to be anything which induces enfeebled assimilation of food and impaired nutrition of body. Hence this affection is sometimes met with in such weakly children of even wealthy parents as suffer from defective action of the vital forces. Like scrofula, it is, however, especially a disease of the poorer classes. Insuffi- cient and especially improper food, the constant respiration of foul, im- pure air, residence in dark, damp, cold or filthy dwellings, these and sim- ilar circumstances readily serve, in all probability, to generate rickets. Symptoms. — This disease rarely appears before the seventh month, and most commonly does not declare itself until the child first begins his attempt to walk. "When a child is about to be affected with rickets he becomes dull and languid, the appetite is variable and capricious, the bowels are irregular, the stools unhealthy and usually pale. Constitu- tional disturbance now arises, and a febrile state is soon established ; the limbs become emaciated ; the belly tumid ; the face full and the head dis- ju-oportiouately large; the forehead projecting, and the sutures of the cranium remaining open or perhaps expanding slightly. The extremities of the long bones which are least concealed by muscle, as those of the wrists and ankles, and the sternal ends of the ribs, particularly these last, are swelled out into knobs. The legs begin to bend outward at the knee, giving rise to the deformity of bow-legs, or less frequently the knees are thrown forward and the feet outward, making the child what is called knock-kneed, and usually crippling it more or less for life. The bones of the arms and the collar bones may also become very much curved and twisted, showing that the popular delusion as to the cause of bow-legs has little foundation in fact. The deformity of the chest is often very great, the back being flattened, the breast bone pushed forward and the natural curve of the ribs lessened. In such cases the child is said to be pigeon- breasted. Diagnosis — This, of course, must be difficult in the early stage, as the symptoms closely resemble scrofula at that time, but after the curva- ture of the bones commences there can no longer be any doubt, as such softening of the bones during childhood only occurs in rickets. 384 • CONSTITUTIONAL DISEASES. , Treatment — The medical treatment of rickets must be subordinate to tlie hvgieiiic, since far more depends upon good food, jiroper clothing and pure air than on drug medication. Milk diluted with limewater, Lie- big's food, and, if the; infant is old enough, beef tea, extl-act of beef, raw meat, eggs, and so forth, should be giveii in abundance. The phosphates or hypophosphates of iron, lime, quinine and strychnia, as recommended when treating of scrofula, are very useful, and if the child is capable of digesting cod-liver oil it ought also to be administered. Should the diar- rhoea be troublesome a chalk and soda mixture, containing a grain of each as a dose for a baby one year old, or a mixture containing a grain of bis- muth in each dose for an infant of that age "will probably be of essential service, and after the feverish symptoms are controlled the child, in suit- able weather, should almost live in the open air, especially if a seaside atmosjjhere can bo obtained. Diet. — If the disease has occurred at a very early age it may be advisable to try the effect of changing the wet-nurse; and in general it will be proper to wean the child about the end of the ninth month, for protracted suckling is certainly one of the debilitating causes which dis- jiose to rickets. While the child continues at the breast the diet of the nurse or mother ought to be carefully attended to, in order that the milk may prove nutritious and easy of digestion ; or its powers may be assisted by allowing the infant, in addition, small quantities of gelatin, beef tea, or yolk of egg, provided the absence of febrile excitement will permit. After the child has been weaned the diet must be suited to the degree of constitutional irritation which exists; but one leading principle should lie to support the strength as much as possible without quickening the circulation or oppressing the stomach. CRETINISM. Causes. — A condition of persons in whom partial or complete idiocy is combined with great bodily deformity of the whole body, due to bad water, lack of sunlight, and life in deep valleys like those of the Alps. Symptoms — There are three varieties, first, complete or incurable cretinism, which is characterized by idiocy, deaf-dumbness, deficiency of general sensibility and entire absence of reproductive power; second, semi-cretinism, which is a degree of the malady in which the mental faculties are limited to the impressions of the sense and the bodily wants. The general sensibility is obtuse, the head is badly formed and drooping. DIABETES OE DIABETES MELLITUS. 385 the speech is rudimentary and the reproductive powers are feeble or absent; third, incomplete or curable cretinism, in which the mental facul- ties, though limited, are capable of development. Treatment. — 1. The first thing to be accomplished is the removal of the young cretin, as soon as possible after the disease exhibits itself, to a pure, bracing atmosjjhere. 2, The treatment requires an abundance of pure water for drinking, washing and bathing; warm and cold baths and douches; friction of the skin with brushes and stimulating liquids to rouse its action; warm clothing ; mineral tonics ; nourishing food ; iodine, cod-liver oil and phos- phates. The effort to develop the mind must follow the attempt to re- store the body to a healthy condition. DIABETES OH DIABETES MELLITTJS. Causes — Twice as many men as women have this disease : It is most frequent among young and middle-aged adults; the mortality from it being greatest from fifteen to fifty-five. It is more common in cities and manufacturing districts than in the open country; occasionally it is hereditary. The exciting causes appear to be exposure to cold and wet; drinking cold water largely when heated; excessive use of saccharine food ; intemjierance ; violent emotion ; febrile diseases, and organic affec- tions and injuries of the brain and spinal cord. Symptoms. — In this remarkable disease there is an excessive discharge of urine containing grape-sugar, the saccharine jirinciple of grapes and of honey called glucose, being produced in the body in great quantity and eliminated from the kidneys. The exhaustion, which results from the immense loss of fluid, sometimes amounting to several gallons daily, is often accompanied by other disturbances of the system due to the presence of sugar in the other secretions and in the blood and to the modifications of the nutrition thus effected ; opacity of the crystalline lens of the eye — constituting diabetic cataract — is occasionally one of the modifications of structure ; shrinking of the substance of the brain is another, and a peculiar form of inflammation of the lungs is another. It is a disease which commonly, after a longer or shorter course, proves fatal. Diagnosis — The detection of sugar in the urine, not temporarily, but for a considerable time, is of itself sufficient to make out the case. ProgTiosis. — ^Recovery is not impossible in diabetes, but a large ma- jority of cases end in death. Amelioration — keeping the disease in abeyance — is often an attainable end. 25 386 CONSTITDTIONAL DISEASES, Treatment The most positive influence in diminishing the disease belongs to opium or codoiuii ; but this does not n])i)e!ir to interfere with the progress of the disease. The alkalies, pepsin, iron, quinine, salicylate of soda, alum, iodine, nitric acid, turpentine and the inhalation of oxygen, have all been employed. Diet. — Since it is found that the amount of sugar discharged in the urine fluctuates very much in accordance with the starchy and saccharine materials which are eaten, it is the best for the diet of a diabetic patient to be freed, as far as possible, from substances which can be converted into glucose by the digestive organs. Hence the effort should be, in treating diabetes, to abstain from all starchy food as well as from every solid and liquid containing sugar. That meat and eggs may be taken, as a derangement of the liver is not found to be pi'oduced by them, and fish is a most important article with which to vary the monotony of the diet. Skimmed milk appears to answer a very good purpose in this disease. The following prescription is of value in diabetes mellitus: R. — Salicylate of soda 3 drachms Fowler's solution i drachm Glycerine i ounce Water 1V2 ounces Mix and take a teaspoonful three times a day. PUSPURA OH LAiro SCURVY. Causes. — It chiefly occurs iu individuals of delicate habit or enfeebled by their occupations or mode of life ; by confined, low or damp habitations, scanty food, hard labor, grief, anxiety, fatigue and watching. On the other hand purpura frequently occurs where no causes of a debilitating or depressing nature can be supposed to have existed. Varieties — The two varieties which are distinguished are the simple and the hemorrhagic, in the latter of which the malady is accompanied by bleeding from some of the mucous membranes of the body. Symptoms. — ^^"arious symptoms denoting general disorder of the system precede the appearance of the spots in purpura, generally for some weeks. In most instances languor, weariness on very slight exer- tion, faintness and gnawing pains in the stomach are complained of. Tho appetite is variable, generally poor, but sometimes there is an inordinate desire or craving for food. The tongue is yellowish and coated with a viscid fur, the countenance sallow or dingy, or the face may have a pale and bloated appearance with swelling beneath the eyelids. The purple PUEPUEA OE LAND SCUEVT. 387 spots usually appear upon the legs and afterward witliout any certain order on the thighs, arms and trunk of the body, and their formation is attended with great weakness and much depression of spirits. Deep- seated pains are felt about the region of tlie stomach as well as in the chest and loins. One of the most distressing and dangerous symptoms is when the patient becomes of a sallow complexion, waxy-colored and dingy, dropsical swellings of the feet and legs with deep and gangrenous sores appear, general dropsy often prevails and the sufferer dies exhausted. Diagnosis. — The diseases with which purpura is most likely to bo confounded are typhus fever attended with scurvy. The origin and course of the complaint, the period at which the petechise appear, the extent and variety of the accompanying hemorrhages will make its diagnosis clear. Treatment — 1. In the treatment of this disease we are not to be guided by the name or external appearances, but by diligent attention to the symptoms and especially to the state of the functions and the habit and constitution of the patient. "Where high excitement prevails with strength of pulse and vigor of constitution, and we have reason to suspect inflam- mation, purging, with a suitable antiphlogistic diet, are the appropriate remedies. 2. Where a quite opposite state exists all active depletion must be abstained from and the strength supported by beef-tea and other meat nutriment; at the same time tonics, such as quinine or Peruvian bark, the diluted mineral acids in five or ten-drop doses, iron and strychnine, must be administered. The following offers a good treatment: R. — Syrup of the superphosphate of iron 1V2 ounces Liquor of peroxide of hydrogen 1V2 " Glycerine '. . 1V2 " Water iVa " Take a tablespoonful three times a day. Or, R. — Oil of turpentine 3 drachms Fluid extract of digitaUs I drachm Mucilage gum-arabic 1% ounces Peppermint water I ounce Make an emulsion. Take a teaspoon ful every three hours. 588 CONSTITUTIONAL DISEASES. SCORBUTUS OR SCURVY. Character. — This is a disease allied to purpura, but attended with a spongy condition of the gums, and livid patches under the skin of consid- erable extent, which are harder than the surrounding structure. It has been stigmatized as the great plague of the ocean, and has been denomi- nated sea scurvy to distinguish it from land scurvy or purpura. Causes. — That the essential cause of scurvy is deprivation of fresh food, and, in almost all cases, of fresh vegetable food, is proved. Fresh meat will retard it in the absence of vegetables, but neither this or oranges and lemons will altogether prevent it through long periods. Additional promotive causes are severe cold, fatigue, exposure and mental anxiety or home-sickness. Symptoms. — 1. Languor, debility and lowness of spirits first occur; then swelling, sponginess and bleeding of the gums; the teeth loosen, and the breath is offensive. Palpitation of the heart and dyspnoea may be present. Spots (from subcutaneous extravasation of blood) appear on the limbs. Diarrhoea and dysentery often come on. Death may take place by a gradual exhaustion or by sudden syncope. 2. A remarkable peculiarity of scurvy is the readiness with which all parts of the body suffer from pressure, and the slightest possible blow may produce an extensive bruise, a small eruption like flea-bites is often to be seen on the legs, and about the same time the muscles of the legs and thighs are apt to become hard and painful, and in a day or two the skin over the painful part grows yellow and then purple. These puriile spots may be as large as the palm of the hand at first, and are liable to extend "until they cover half of the limb. 3. As the disease advances all the symptoms become aggravated. The loss of physical power increases, the purple spots have a tendency to ulcerate, and the resulting ulcers are especially distinguished by their putrid fungoid appearance, and their great tendency to bleed. Diagnosis — Purpura hemorrhagica is undoubtedly not identical with scurvy, although "purpuric" extravasations are common to both. Pur- pura does not depend, as scurvy does chiefly, upon a fault of diet ; nor are the gums affected in purpura. Treatment — 1. The great remedy for scurvy is lemon or lime juice ; in seemingly desperate eases the most quick and sensible relief has been obtained from lemon juice, when no other remedy seemed to avail. When the acid operates violently upon the stomach and bowels of those who are ANEMIA. 389 much weakened, the addition of wine and sugar is strongly recom- mended. 2. A solution of nitrate of potash in vinegar has been most advan- tageously made use of in the proportion of one ounce of nitrate in one quart of vinegar, and a tablesjjoonful of this given two or three times a day. 3. Fresh vegetables alone will restore what is wanting. Potatoes, tomatoes, oranges and lemonade are the most generally available articles. If any medicine is useful as an adjuvant, it is the tincture of the chloride of iron in moderate doses. Sometimes citric acid does good. For the gums a wash of tannic acid or tincture of myrrh in diluted glycerine will be useful, or alum, brandy and water. Salt and whiskey rubbing of the skin will aid in dissii^ating the j^etechiaj. Diet — Medical men in charge of expeditions to a distance, for ordi- nary supplies should always insist on measures being taken to furnish enough fresh vegetables, or, next best, dessicated potatoes ; after the latter onions, tomatoes, turnips, and so forth, and oranges and lemons rank. Wine is also decidedly though not infalliby anti-scorbutic. The following is a good anti-scurvy remedy : R. — Common salt lo scruples Chlorate of potash % ounce Rochelle salts 5 scruples Phosphate of soda 3 scruples Lemon juice 6 ounces Syrup of lemon 14 ounces Water 7 pints To be used as a drink several times a day. ANEMIA. Causes — Poverty of blood. This is a special, morbid state, in which there ia fullness of the surface of the body and deficiency of the red corpuscles of the blood. It is a common affection among women, and per- sons of both sexes who are ill-fed, or from any cause badly nourished, in crowded localities. It is occasioned by loss of blood, from disease or injury causing hemorrhage, from excessive suckling in a mother or wet-nurse, severe or protracted diarrhcea, or (more rarely) leucorrhea, typhoid or other forms of fever; the malarial influence, sustained for a considerable time ; deficiency of food, light, warmth, or fresh air. Symptoms — The face, the hands, and the general surface are pallid and slightly waxen or icteroid in their hue. There are vertigo, faintish- 390 CONSTITUTIONAL DISEASES. ness, palpitation and an impaired action of tlic organs generally, espociallj of the stomach and bowels; digestion being deranged, with flatulency, constiijation, and so fortL Diagnosis — This is very much aided by the detection of various mur- murs, as the watery blood passes through the heart and larger veins. The jugular veins of the neck are often the seat of a well-marked venous hum in profound anemia. Treatment — 1. In almost all cases it is essential to put the patient on nourishing diet, and esj^ecially where the anemia has been caused by im- perfect nourishment ; yet care must be taken in the very impressible con- dition of the system which exists in these cases, that undue excitement be not induced. 2. Our first effort should be to supply the materials for enriching the blood, and especially those which are necessary to construct the red cor^DUS- cles, a deficiency of which appears to be the essential element in this malady. Iron, which enters into their constitution more abundantly than of any other tissues of the body, is hence obviously called for, and should be administered in -nhatever form can best be assimilated. Where it is well tolerated there is probably no better preparation than tincture of the chloride of iron, in twenty-drop doses three times daily, 3. In cases where the tincture of the chloride of iron is not applic- able, or is objected to by the patient, the powdered iron, called also iron reduced by hydrogen, in doses of a grain thrice daily, can almost always bo borne, and is frequently of the greatest service. All the compoimds of iron require, however, to be used for a long time, usually several ■weeks and often for several months, in order to cure the anemic condition. 4. The citrate of iron or the citrate of iron and quinine, in doses of from three to five grains, possesses one' great advantage over many other preparations of this useful metal in the fact that while perfectly soluble they produce iipon the organs of taste little of that styptic or ink-like im- pression which to many persons is so exceedingly disagreeable. The beef, wine and iron is also a most valuable remedial agent when properly pre- pared. Diet — The best food which the stomach can digest, and there is no doubt that the iron which exists in beef and mutton and gives much of its red color to the muscular fibres of the flesh, is in the most favorable state for assimilation into the human system, and often has a large share in the improvement which we are perhaps too ready to attribute to the chemical compounds prescribed. GENEEAI. DROPS Y. 391 R. — Corrosive sublimate 2 grains Liquor of chloride of arsenic i drachm Diluted hydrochloric acid Mi ounce Tincture chloride of iron V2 ounce 'Syrup 3 ounces Water 2 ounces Take a dessertspoonful in a wineglass of water after each meal. BERI-BERI. This is a very fatal but obscure disease occurring in Ceylon, the Malabar coast and outer ports of British India. Causes — The causes are very obscure. It is a disease of debility, arising from a want of stimulating and nourishing diet, impure air and exposure to a moist and marshy atmosphere while the frame is debilitated by residence in an unhealthy station. Symptoms — It commences with the symptoms of anemia and pro- ceeds to the development of acute dropsy. Diagnosis — The paralytic symptoms, together with the dyspnoea and dropsical effusions are suiEcient to distinguish it from other diseases. In no disease is internal congestion so strongly marked, doubtlessly due to the congestion of blood in the brain and spinal marrow. Treatment — 1. Mercury here appears to be the sheet-anchor, but must be administered to produce ptyalism. Saline and antimonial medicines will be called for and the strength supported by cordial liquors. Stimu- lating liniments should be applied to the extremities and a tonic plan of treatment pursued. 2. In the more severe cases where the dyspnoea, vomiting, spasms and other symptoms are violent apply blisters to the breast, hot fomenta- tions and hot baths, and exhibit the strongest cordials and antispasmodics. R. — Muriate of pilocarpine 3 grains Water V2 ounce Inject 10 to 20 minims with hypodermic syringe. GENEEAL DROPSY. Definition. — A morbid collection of fluid in one or more of the serous cavities within the body or in the areolar tissue beneath the skin and in other situations. Causes — A dropsical accumulation is to be distinguished from the eiTusion of liquid which takes place in certain inflammatory diseases, 392 CONSTITUTIONAL DISEASES. pleurisy, jjeritonitis, pericarditis, and so forth. In other diseases the effusion is due to inflammation, whereas in dropsy transudation takes place intact, the part where it occurs being inflamed. Local Dropsy — Dropsy may he local or general. It is local when the effusion of liquid is confined to a single serous cavity or to the areolar tissue within a limited space. General Dropsy — Dropsy is said to he general when effusion into tfce areolar tissue beneath the skin exists more or less over the whole body, accompanied with effusion into certain serous cavities, especially the pleural and peritoneal. Symptoms. — The symptoms of dropsy vary somewhat, according to the primary disturbance which has been the original cause of the effusion. If the blood is deteriorated by an undue proportion of water or is charged with excrementitious materials, such as urea, which ought to be eliminated by the kidneys in the urine, or contains a large excess of white corpuscles, its circulation through the capillary vessels is much impeded. The dropsy in these cases often begins in the form of cedema or swelling about the feet and ankles. The rej^roduetive organs often become enormously swollen and ascites or dropsy of the abdomen soon sets in. After a time the increasing ascites, by pressing up the diaphragm, interferes with the respiration, causing distressing dyspnoea, which is more urgent in pro- jiortion as the blood is watery from anemia. The urine is often scanty and apt to contain an excess of urates, but it is only markedly albuminous when, as frequently happens, the kidneys become secondarily implicated. Among the latter sjTnptoms are palpitation of the heart, deficient perspira- tion, mental distress, thirst, constipation, daily increasing weakness, and so forth. Symptoms of Cardiac Dropsy — ^Disease of the mitral or aortic valves in the heart is the most common cause of cardiac dropsy. The injured valve, sooner or later, interferes so much with the circulation that serious disturbances become manifest. At first, perhaps, there is only shortness of breath on going up a steep flight of stairs, or other active exertion, with some palpitation and debility, but after a few weeks or months the feet and ankles may begin to swell, the skin putting on a peculiar white and glistening appearance. As the effusion extends upward rest in the recumbent posture becomes impossible, and even in the sitting position only unrefreshing snatches of slumber can be obtained. The heart's action grows daily more and more embarrassed, the lungs more or less GENEEAL DKOPSY. 303 congested and a frothy expectoration sometimes streaked with blood appears. Further Symptoms. — In the variety of general dropsy, which proceeds from disease of the liver, serous effusion into the cavity of the abdomen is the most prominent symptom. Whether the original hepatic disorder is congestion or hypertrophy of the liver, cancer, contraction or chronic hepatic inflammation, the dropsical symptoms usually commence with exudation of fluid into the abdominal cavity from the surface of its lining membrance, the peritoneum. Dropsy of the feet and legs, however, sub- sequently sets in. Acute General Dropsy — Acute general dropsy from disease of the kidneys, or acute inflammatory dropsy may arise when the functions of the skin are suddenly suppressed, thus allowing certain morbid materials to accumulate in the blood and to set up inflammation in the secreting tubes of the kidneys. Typical examples of this form of dropsy are seen when, from exposure to cold, the action of the skin is checked during the stage of desquamation of scarlet fever, compelling the kidneys to remove the scarlatinal poison from the system when it seems to be particularly obnoxious to the renal tissues. In such cases the urine either gradually br all at once becomes scanty, dark brown in color, and on being tested by boiling is found to be loaded with albumen. Diagnosis. — The diagnosis of dropsy is usually made with ease, by the fact that the indentation produced ou firm pressure with the finger upon the enlarged foot remains for a minute or so before it is filled up by return of the watery fluid into the connective tissue. This evidence of the existence of dropsy is most conclusively obtained when the test is applied over some bone which naturally lies only a little way beneath the skin, as for example, the breast-bone or the shin-bone. Treatment. — 1. The treatment of dropsy, either local or general, in- volves measures indicated by the diseases which stand in a causative rela- tion to the dropsy. Exclusive of these indications it is often an object of treatment to effect either removal or diminution of the dropsical accumu- lation. Remedies which produce watery evacuations from the bowels, and those which increase the secretion of urine are chiefly relied upon for this. 2. The liquid in serous cavities may be removed by a pimcture or an incision, an operation called paracentesis, or, commonly, tapping. In some cases of dropsy of the chest paracentesis is resorted to. Tapping of the abdomen is often employed, and is in many cases useful, not only by relieving suffering but promoting recovery. B94I CONSTITUTIONAL DISEASES. 3. In cases of general oedema or anasarca, if the effusion be very- large, great relief is sometimes obtained by minute punctures of the lower limbs, through which the serum drains away in abundance. 4. "Where the acute general dropsy is dependent upon suppression of the action of the skin and kidneys, active purgation and the use of diuret- ics are to be employed. Jalap and cream of tartar (ten grains of the former with three drachms of the latter) every day or two will answer well for catharsis. A strong cathartic is croton-oil. The dose is a single drop, and this will operate in many instances most violently, producing within half an hour sickness, vomiting and profuse alvine evacuations. iDiuretics — The diuretics most satisfactory are the infusion of juniper berries (a pint daily), acetate of potash, citrate of jjotash, squills and sweet spirits of nitre. Colchicum is perhaps the most powerful of remedies, and we have succeeded with it in conjunction with mercurials in acting upon the kidneys in hepatic disease when no other remedy had any effect. Tonics, anodynes, and so forth, may, in visceral dropsy, be of more importance than diuretics. Of course it is desirable to lessen the ac- cumulation of fluid, but the effects of the remedies used must be carefully observed, and one symptom must not be allowed to overshadow all the rest. Diet. — In general dropsy attention to the diet is very important and efforts should be made to restrict the patient to the smallest amount of fluid with which he can sustain life comfortably. With respect to the nicer question of food, dry articles of food should be selected. It must be varied with tlie nature of the dropsy and the symptoms with which it is attended, and whoever imderstands the meaning of a phlogistic (in- flaunnatory) and antiphlogistic (opposed to inflammation) regimen will know how to apply either of these, or to vary from one to the other, as circumstances may require. For general dropsy: R. — Powdered jalap 20 grains Cream of tartar 3 drachms Powdered ginger 5 grains To be taken at one dose before breakfast, two or three times a week. Dropsy of kidneys: R. — Tincture digitalis I drachm Infusion of buchu 4 ounces Water 4 ounces Take a teaspoon ful every three hours. BEIQHT'S DISEASE. 395 Heart dropsy: R. — Strychina Sulpli i grains Bascham's Mixture 4 ounces Two tcaspooufuls 3 times a day. BRIGHT'S DISEASE. AlbTiminuria, dependent upon structural cliange in the kidneys, or to speak more correctly, disease of the kidney, characterized by albumen and dropsy. Causes. — It is a glandular disease of the cortical part of the kidney which gives occasion to the secretion of urine, Avhich contains albumen and is of less specific gravity than natural, and which destroys by induc- ing other diseases. It is one-third more common in males than in females. It mostly occurs between the ages of forty-five and sixty-five. Acute Bright's disease is most often produced by cold and damj^uess, next by scarlet fever, pregnancy, or violent intemperance. The chronic form is greatly promoted by exposure to cold and wet, and is caused moreover by abuse of spirituous liquors. Other predisposing causes are gout, consti- tutional syphilis and affection of the bladder and urethra. Acute Bright's Disease. — After exposure to cold, or a drunken fit, or scarlet fever, the patient is seized with chilliness, headache, nausea, vomit- ing, pain in the back and limbs, checking of perspiration and oppression in breathing. Fever follows and the face, trunk and limbs become puffy with anasarca. Effusion may also occur in the pleura or peritoneum. The urine is scanty, heavy and dark in color from the presence of blood and very albuminous. The disposition to void it occurs more frequently than in health. The deposit from it, under the microscope, shows blood- corpuscles, loose renal epithelium, tube-casts and shapeless masses of fibrin. After one, two or three weeks, or even a longer period, the attack pro- ceeds to one of three terminations: recovery, death or lajise into the chronic state. Death residts through uremia, secondary pneumonia, pleurisy, peritonitis, hydrocephalus or ascites. Probably two-thirds or more of the cases in the acute form recover. Treatment — Cupping the loins, hot water or hot air or "blanket bath," active purging, as with cream of tartar and jalap, or citrate of magnesium and diaphoretics, as citrate of potash or liquor ammonia acetatis. Diet — Should be liquid and simply nutritious. Chronic Bright's Disease — This approaches so slowly as seldom to be 396 CONSTITUTIONAL DISEASES. detected until after the lapse of months or years. Gradual loss of strength, pallor or pufEness of the face, shortness of breath and frequent disposition to urinate are early signs of it. But they are not always present ; the denouement of the disease may be by a convulsion, oedema of the lungs, dinuiess of vision, or some violent local inflammation. Symptoms. — Albuminous urine, deposits of tube-easts and renal epithelium, dryness of skin, frequent micturition, especiallj' at night ; gen- eral dropsy, or local effusions into the cavities, indigestion, anemia, uremic effects (headache, dizziness of sight, convulsions, coma, vomiting, diar- rhoea), enlargement of the heart and secondary inflammations, bronchitis is especially common. The progi'ess of the case is usually interrupted by exacerbations and intervals; each fresh attack leaving the patient mani- festly worse than before. Diagnosis. — The presence of albumen in the urine, with dropsy, not of sudden origin or brief duration, is indicative of this affection. The microscope will show also free renal epithelium and tubular casts in the urine; in advanced cases the casts are sjirinkled with oil-dots. Treatment. — 1. Iron will do more good than any other medicine, un- less it be cod-liver oil in persons of strong stomach. They may be very Avell combined. The tincture of the chloride of iron is as good as any other chalybeate as a general rule. AYith some the citrate of iron in solu- tion, or a carbonate, or the iodide, will agree more readily. As an astringent the ammonio-ferric alum is claimed to possess the power of checking the waste of albumen through the kidneys. 2. For the dropsy warm baths and hydrogogue cathartics are useful. Of the latter cream of tartar and jalap, two- or three drachms of the bitartrate with ten or twenty grains of jalap two or three times a week, are the favorites. If serious di'ojisical accumulations threaten life, elate- rium (one-sixth or one-fourth grain every four hours, in pill, until it acts) may be given, or the pill of squills, powdered digitalis, etc. 3. If the warm baths do not agree or fail to produce diaphoresis try the hot-air bath, at 130 degrees to 150 degrees Fahrenheit. This rarely fails to produce free perspiration. For weaker invalids the vapor bath is available. Of diuretics, acetate of potassium, spirits of nitrous ether, and compound si:)irit of juniper Avill be least likely to disappoint, 4. But all will not unfrequently fail. We have as a last resource for the relief of great oedema the use of incisions with a lancet or needle in the swollen legs and feet. Care should be taken that erysipelas does not fol- UREMIC POISONING. 397 low, bj repeated warm sponging of the limbs and washing them with diluted glycerine. Diet — Nourishing diet, of which milk may generally be part, is of the utmost consequence. Regimen or hygienic management is of the utmost importance. Avoidance of exposure to cold, wet or great fatigue ; the reform of intemperance, if it has existed, or all other excesses, will be indespensable. Clothing should be sufficiently warm, with flannel next to the skin. Bathing frequently at such temperature as is borne without either chill or relaxation, and the bowels should be kept regularly open. The following are approved remedies : R. — Chloride of soda and gold 3 grains Corrosive sublimate 3 grains Extract of gentian sufficient to make 6o pills. Take one three times a day. R. — Iodide of soda •. IS grains Phosphate of soda Vj drachm Common salt 3 drachms Water sufficient to make solution. Divide into three equal parts, and take one part every eight hours. UREMIC POISONING (UREMIA). Ursemic poisoning (urspmia) is also known as acute uraemia, urgeinia convulsions, ursemic intoxication and uremic coma, according to attending conditions. It may be described as a group of nervous phenomena which sometimes develop during the course of acute or chronic Bright's disease, being due to the retention in the blood of what is supposed to be urea. An attack of acute ura?mla is always serious. The outcome depends upon the amount of jioison retained, the length of time it has been in the system and the condition of the organs of elimination. If there be any suspicion of an ursemic condition the urine should be frequently examined. Causes. — Suppression of urine due to Bright's disease, cancerous kidney, the puerperal or lying-in state, operations on the uterus, bladder, reetmn, etc., or any condition causing the failure of the kidneys to properly perform their functions. Symptoms. — TTsually before the attack there is a decrease in urinary secretions, although in rare instances, during or immediately prior to the appearance of the uraimic phenomena, the normal flow of urine may 398 CONSTITUTIONAL DISEASES. largely exceed the normal amount. Commonly the onset is with headache, dizziness of vision, vertigo, deafness, dilated and sluggish pupils, dark, uunatiiral color of face. There is generally a chill or chilliness followed by fever, but there may be cool skin from the onset. The condition may develop slowly and gradually or it may come on suddenly by convulsive seizure followed by coma. In the latter case it is sometimes mistaken for apoplexy, but these differences are to be noted: (a) In uraemia the patient has usually been suffering from dropsy, while this is not common in apoplexy ; (b) in ura?mia coma is generally preceded by the symptoms above discribed, while in apoplexy coma is usually immediate; (c) the breathing in urafmic coma causes a sharp, hissing sound, while in apoplexy there is snoring; (d) greater or less paralysis always occurs with apoplexy while in urn?mia there is no paralysis. Treatment. — During an attack elimination should be procured by a drop or two of croton oil in a little sweet oil, or a quarter grain of elaterin, or the following enema may be used ; Epsom Salts 2 ounces Glycerine 1 ounce Hot Water 4 ounces Free sweating should be encouraged by the use of hot packs, vapor or hot-air baths and the administration of Jaborandi. To relieve the con- vulsions give inhalations of chloroform, rectum injections of chloral and venesection. PART III OF BOOK IV Describes the nervous diseases and their causes, symptoms, diagnoses, treatments and effects. Aphasia 423 Symptoms of 423 Treatment of 426 Apoplexy 422 Congestive 422 Hemorrhagic 423 Symptoms of 422 Treatment of 423 Arachnitis 416 Prevention of 416 Atrophy of the Brain 426 Treatment of 427 Atrophy, Progressive Muscular ....431 Brain, Atrophy of 426 Congestion 420 Dropsy of 421 Fever 409 Fever, Symptoms of 409 Hypertrophy of 426 Paralysis of 404 Softening of 401 Catalepsy 439 Cerebral Congestion 420 Cerebritis 413 Convalescence in 420 General 414 Suppressed Menstruation in ...420 Symptoms of 413 Treatment of 416 Chorea 438 Chronic Meningitis 412 Congestion, Cerebral 420 Congestive Apoplexy 422 Convulsions, Infantile 435 Cramp, Writer's 428 Croup, Causes of 437 Spasmodic 437 Symptoms of 438 Treatment of 438 Delirium Tremens 443 Symptoms of 443 Treatment of 443 Dementia 446 Diphtheritic Paralysis 430 Symptoms of 430 Treatment of 430 Dropsy of the Brain 421 Symptoms of 421 Treatment of 421 Epilepsy 436 Symptoms of 436 Treatment of 437 Face, Paralysis of 404 Facial Palsy 427 Symptoms of 427 Treatment of 428 Falling Sickness 436 F'ts 435 Symptoms of 435 Treatment of 435 General Cerebritis 414 Symptoms of 414 Heat Exhaustion 426 Symptoms of 426 Treatment of 426 Hemicrania 441 Hemiplegia 428 Symptoms of 428 Treatment of 428 Hemorrhagic Apoplexy 423 Hydrocephalus 421 Hydrophobia 433 Symptoms of 434 Treatment of 434 Hypertrophy of the Brain 426 Treatment of 427 Hypochondriasis 439 Hysteria 439 Symptoms of 439 Treatment of . . . : 439 Hysterical Paralysis 429 Symptoms of 429 399 400 INDEX TO I'AilT III OF BOOK IV. Treatment of 429 Idiocy 447 Imbecility 447 Infantile Convulsions 43s Paralysis 431 Symptoms of 431 Treatment of 431 Inflammation of the Brain 413 of the Spinal Marrow 421 Insanity 444 Symptoms of 445 Treatment of 447 Intercostal Neuralgia 441 Lead Palsy 430 Locomotor Ataxia 431 Symptoms of 431 Treatment of 431 Lock-Jaw 432 Symptoms of 432 Treatment of 433 Loss of Memory 404 of Speech 423 ^Madness 444 Mania 446 Symptoms of 446 Treatment of 446 Alelancholia 445 IMemory, Loss of 404 Meningitis, Chronic 412 Spinal 421 Mercurial Palsy 430 ]\Iigraine 441 Symptoms of 441 Muscular Atrophy 431 Myelitis 421 Nervous Diseases 401 Neuralgia 440 Intercostal 441 Symptoms of 440 Treatment of 442 Neurasthenia 447 Symptoms of 447 Treatment of 448 Palsy 427 Facial 427 Lead 430 Mercurial 430 Scrivener's 431 Symptoms of 427 Wasting 432 Paralysis 427 Agitans 430 of the Brain 404 Diphtheritic 430 Face 404 Hysterical 429 Infantile 431 Reflex 429 Syphilitic 430 Paraplegia 428 Symptoms of 429 Treatment of 429 Progressive Muscular Atrophy 431 Rabies 433 Rgflex Paralysis 429 Treatment of 429 St. Vitus' Dance 438 Symptoms of 438 Treatment of 438 Sciatica 441 Scrivener's Palsy 431 Symptoms of 431 Treatment of 432 Softening of the Brain 401 Symptoms of 403 Treatment of 405 Spasm of the Glottis 437 Spasmodic Croup 437 Spinal Meningitis 421 Treatment of 422 Sun Stroke 426 Symptoms of 426 Treatment of 426 Syphilitic Paralysis 430 Tetanus 432 Wasting Palsy 432 Wrist Drop 430 W^riter's Cramp 428 ILLUSTRATIONS Brain, The 407 Face, Nerves of 441 Nerves, The 425 Nerves of Side of Face 441 CURATIVE MEDICINE PAET in NERVOUS DISEASES Division of Nerves. — 1. Motor nerves or those in which irritation pro- duces muscular contraction. 2. Sensitive nerves, or nerves of common sensibility, in which irri- tation is followed by an agreeable or painful feeling, according to the nature or degree of the stimulation. 3. Nerves of special sense in which irritation excites the peculiar sensations of light, sound, taste, etc. Many sensitive nerves arise from nervous centres in such close proximity to motor nerves that a stimulus applied to the former will react upon the latter and produce not only a 'direct sensation, but what is technically called a reflex action. It is a remarkable fact that whatever part of a sensitive nerve be irritated, whether it be the centre, the middle, or the extremity, the same sensation will be produced. Nature of Nervous Force — We can judge of the nature of the nervous force only by its effects. The muscular contraction caused by the irrita- tion of a nerve is due to the development of a peculiar vital force in the nerve structure, which is imlike any of the known physical forces. It bears certain analogies to electricity. 1. The identity of their effects on muscular fibre. 2. The rapidity of their action without producing any appreciable effect on the parts between the point of irritation and the point affected. 3. The extreme sensibility of nerves to the electric current. 4. The phenomena of electrical fishes. SOFTENING OF THE BRAIN (RamoUissement) . Peculiarity. — It is the consequence of chronic or acute inflammation, or it may occur from obliteration of the arteries. Softening of the mucous membrane of the digestive organs is of much more frequent occurrence than softening of the brain. 26 (401) 402 KEKVOITS DISEASES. Causes. — Two causes appear to cooperate in producing softening of the brain. The first is of a mechanical, the second of a physiological nature, serosity, or pus, when in considerable quantity, appear to effect, mechanically, a diminution of the cohesion of the tissue in Avhich they are contained. The pressure ■which they exercise arrests the circulation, and it would appear absorption also; for if this function were performed we should have an excavation or ulcer formed instead of a mass of soft, pulpy tissue. The circulation being thus arrested nutrition ceases to be accom- plished and the molecules of the tissues are disunited and detached. If while these changes are going on, or at some subsequent period, the func- tions of absorption be resumed, the softened tissue is partially or wholly absorbed and solutions of continuity of various extent are formed. The physiological cause, therefore, of softening is referable to a change in the vital properties of the affected tissue. iDegree of Softening. — The degi-ee of softening of the cerebral sub- stance may vary from a slight diminution of the natural consistence of the part to that of cream or even of thin milk. The first stage of softening of this substance is often so slight that it is hardly perceptible to the touch, and may, even when considerable, if not accompanied by some peculiarity of color, be altogether overlooked. Physical Characters. — The color of inflammatory softening of the cerebral substance presents considerable variety, dependent on the quantity of blood contained in the affected part. Eedness and vascularity are, in general, greater in the first than in the second stage, but the degree and extent of either greatly depend on the qiiantity of blood in the cerebral vascular system. When the redness which accompanies softening arises from the presence of effused blood it may always be regarded as evidence that the softening is of recent occurrence. Other Evidences of Softening — But there are other modifications of color which accompany softening of the cerebral substance. They indicate that the disease has existed for a considerable time, several weeks, or two or three months. The principal modifications of color consist of brown, yellow and orange, either separately or combined, and occupy either the softened substance, the part of the brain contiguous to it, or both at the same time. They are not observed unless the softening has been c-'-ompanied by effusion and originate in changes taking place in the eltused blood. When Softening May Occnr — Softening may occur in the brain and medullary substances at the same time. It may also occupy several por- SOFTENING OF THE BKAIN. -iOS tions of the brain at the same time, as the septum lucldiim, fornix and walls of the lateral ventricles, the corpora striata and thalami, one or more lobes, a portion of one or both hemispheres, the brain and cerebellum, and is rarely met Avith in the latter organ without its being present in the former. Circumstances which give great variety and complexity to the functional derangement by which it is accompanied. Symptoms. — As the symptoms of the first period of inflammatory soft- ening of the brain must necessarily be those of inflammation of this organ, it would be superfluous to describe them here. It may, however, be observed that the severity of these symptoms does not always indicate a corresponding condition as to the extent of the softening which they pre- cede, nor do they present any one character which can be regarded as a sign that the inflammation on which they depend will terminate in soften- ing. When, however, they are taken in conjunction with those of the second period, they are frequently of great value as they afford us the means of establishing our diagnosis in cases where it would be otherwise impossible. Symptoms of Second Period — The symptoms of the second period of inflammatory softening of the brain are of an entirely opposite character to those of the first period. Those of the first de2:iending on the presence of irritation, or a morbid stimulus, are characterized by a state of excite- ment; whereas those of the second being the consequence of the soften- ing or disorganization of the cerebral substance, are necessarily marked by a state of prostration, collapse or paralysis. They are annoimced by the gradual or sudden diminution of the intellectual powers, by the occur- rence of stupor or coma, by paralysis, difficulty or loss of speech and diminution of the sensibility of the skin, eye and ear. The relative fre- quency, degree and extent of these symptoms, as well as the order of their occurrence, present considerable variety. Thus, the derangement of the intellectual faculties, such as their dirainiition, suspension or abolition, is always present at the commencement of the second period, that is so soon as the softening of the cerebral substance has taken place. In some cases the derangement Avhich they manifest is at first slight, increases gradually or rapidly and terminates in their entire abolition. In others these facul- ties are, from the commencement, gravely compromised and give no signs whatever of their existence. Peculiar Symptoms — It is not rare to meet with eases in which their dorangomeut is marked by remissions and exacerbations, or the occurrence of lucid intervals succeeded by ]n-ofound stupor. The delirium which 404: NEEVOTIS DISEASES. accompanies tlie first period of inflammatory softening either disappears or diminishes greatly in intensity when the second period is announced by the derangement of the intellectual faculties to which we have alluded. It diminishes with the diminution of these faculties and ceases when their suspension or abolition is indicated by the presence of coma and complete paralysis. Loss of Memory. — ^An imperfect state or the entire loss of memory and speech are necessary consequences of these latter conditions of the intellectual faculties. But the absence of any derangement of these facul- ties is not necessarily imaccompanied by derangement of memory and speech, particularly the latter, for a patient may recover the consciousness of his existence, perceive and comprehend what is passing aroimd him, and yet be incapable of expressing himself in words on account of jjaralysis of the muscles by means of which the act of speech is accomplished. The diminution, suspension or abolition of the intellectual functions are always accompanied with paralysis of the muscles of voluntary motion, and the degree of the paralysis is, generally, in the direct ratio of the extent of the derangement manifested by these functions. Brain Paralysis. — The paralysis is rarely complete at the commence- ment. It is generally progressive with occasional alternations of increase and decrease before it becomes ultimately complete. The situation and extent of the paralysis present considerable variety and in many cases seem to correspond with the situation and extent of the softening, in the same manner as in apoplexy. The paralysis occupies one or both extremi- ties of the same side when the softening is limited to one of the hemis- pheres of the brain, and paraplegia or universal paralysis is produced when both hemispheres, the pons varolii, etc., are the seat of this lesion. Paralysis occurs more frequently in the superior than in the inferior extremlticG ; the seat of the lesion of the former being in the corpus striatum, and of the latter, the optic thalamus of the opposite side of the brain. Paralysis of Face Muscles. — Paralysis of the muscles of the face, of the eye, of the touguo and of deglutition, depends likewise in the situation of the softening. Paralysis of the bladder and rectum is a frequent occur- rence of softening of the brain, and gives rise, in the first place, to an accumulation of the contents of these organs, and afterward to their in- voluntary escape, more particularly of the urine, from the distension of the bladder and the subsequent dilatation of its sphincter. It is under similar circumstances of the brain that the organs of hearing and of sight, SOFTENING OF THE BEAIN. i05 ■whicli in the first inflammatory jicriod of softening are highly susceptible, are rendered obtuse to a degree that a strong light or loud sounds im- pressed on the eye and ear jiass unjDerceived. Permanent Muscular Contraction — One of the most constant symptoms of inflammatory softening of the brain is a state of permanent contraction of the flexor muscles of the extremities. The last symptom which we shall notice is that of pain. This does not depend on the state of softening of the cerebral substance. It is the consequence of irritation or morbid excitement of the brain, the dis- organization of which has not yet taken place. It is generally most severe when it occurs as a precursory symptom, but it frequently accompanies the first period of the disease, and presents remission and exacerbations, variable in duration and degree. Treatment. — There are no successful eases recorded of softening from obliteration of the arteries, and in the few cases of the inflammatory forms of the disease, which have terminated favorably, it is more than probable that the softening was very limited in extent and affected the superficial or less important parts of the brain. As regards the state of softening, which, in point of fact, consists in a solution of continuity of the cerebral substance, it must be obvious that we possess no remedial agent capable of obviating such a change. The diseased state, therefore, of which we are treating, is incurable ; that is to say, the solution of continuity of which it consists will remain, even though the patient should recover. The essen- tial part of the treatment of softening of the brain relates, consequently, to the local morbid conditions which immediately precede tliis change, viz. : the diseased state of the arteries on the one hand and inflammation of the brain on the other. This state of the arteries, like the softening to which it gives rise, is, so far as we yet know, beyond the control of remedial agents. When, therefore, it is ascertained that the softening is the consequence of this state of the arteries, the only hope that can be indulged is partial relief, and the prolongation of life for a short period beyond that at which the disease would have proved fatal had it been allowed to run its natural course. Staying Treatment — It is possible that the attack may be delayed by judicious treatment, employed when the first symptoms of cerebral de- rangement are perceived, such as pain in a particular part of the head, confusion of ideas, giddiness or unusual drowsiness and listlessness, to- .•^otlier with a prickling sensation or uujnbness in the muscles of the ex- tremilie?, face or tongue. 406 NERVOUS DISEASES. THE BEAIR Figure No. i. 1,1,1,1. Motor track delineated from the front columns of the spinal marrow to the hemi- spheric ganglion. 2. Pyramidal body. 3. Eminences in the medulla ob- longata. 4. Variolus bridge. 5. Legs of the brain. 6. Streaked body. 7. Hemispheric ganglion. 8. Cerebellum. 9. Olfactory nerve. 10. Optic nerve. 11. Fourth pair of nerves. 12. Sensory root of the fifth pair. 13. The seventh and eighth pairs of nerves. 14. Front suture. 15. Mammillary elevation. 16. Corpora geniculatum. Figure No. 2. I, I. Section of the callous bod}-. 2. Transparent partition. 3. Front column of the vault. 4. Section of front suture. 5. Central substance of the chamber. 6. Sylvius' aqueduct. 7. Pineal gland. 8. Medullar band which extends from the pineal gland to the front suture. 9. Section of the legs of the brain. 10. One of the white bodies, or mammillary bodies. 11. Gray excrescence. 12. Section of the intricacy of the optic nerves. 13. Optic nerve beyond the intri- cac}'. 14. Olfactory nerve. 15. Front surface of the hemi- sphere. 16. Fissure between the back and middle lobes of the brain. Figure No. 3. 1. Front extremity of the fissure of the brain. 2. Back extremity. 3. Front lobes of the brain. 4. Middle lobe. 5. The Sylvius fissure. 6. Back lobe. 7. Infundibulus point. 8. Its body. 9. White or mammillary bodies. 10. Ash-colored matter. 11. Legs of the brain. 12. Variolus' bridge. 13. Upper end of the medulla ob- longata. 14. Back prolongation of the va- riolus bridge. 15. Middle of the cerebellum. 16. Front part. 17. Back part. 18. Upper part of the .spinal mar- row. 19. Middle fissure of medulla ob- longata. 20. Pyramidal body. 21. Recti form body. 22. Oval body. 23. Olfactory nerve. 24. Its bulb. 25. Its external root. 26. Its middle root. 27. Its internal root. 28. Optic nerve beyond the intri- cacy. 29. The same before the intricacy. 30. Motor of the eye or third pair. 31. Pathetic nerves or fourth pair. 32. Trigeminus or fourth pair. 33. External motor or sixth pair. 34. Facial nerve. 35. Auditive nerve. 3*^.37.38. Eighth pair. Figure No. 4. • I. Vertical section of the head. 2. Frontal cavity. 3. Greater falcc of the brain. 4 Its origin from the rooster's comb. 5. Its union along the sagital suture. 6. Lender or concave edge. 7. Counteraction to the cere- bellum store. 8. Cerebellum store. 9. Union to temporal bone. 10. Free edge of same. 11. Tortuous elevations of the front right lobe of the brain. 12. Front extremity of the callous body. 13. Transparent partition. 14. Section of the front suture. 15. Front parts of the vault. 16. The middle of same. 17. Back end. 18. Inner side of the bed. 19. Section of streaked bodies. 20. Side walls of the third ven- tricle. 21. The dura mater, turned upside down. 22. Section of the internal car- otid artery. Figure No. 5. 1. Front lobe of the brain. 2. Back lobe. 3. Middle lobe. Fia. 1.— View of the course of the front columns of the spinal marrow turminatiug iu the hemispheric ganglions of the brain. Fig. 2.— Middle vertical section of tho callous body. The inner left side of the brain is also seen. Fig. 3. — View of the base of the bruin and ceiebel- lum, together with the nervea. ISKq Fig. 4.— Section of the head showing the greater scythe, the horizontal apophysis of the diameter between the brain and the cerebelhun and other oarts found under the middle Hue of the head. Pkj- 5. — View of tiie appearance of the ttirtnoua elevations of one side of the brain, seen from above. THF BRAIN. For an explanation f»f the illualrallun^ Kee text on opposite page Wt 408 NERVOUS DISEASES. Further Treatment. — Bleodiiig fi'oiu the temples, cupping in the nape of the ucc'k, or small general bleedings, repeated from time to time as cir- cumstances may require, may, by diminishing the quantity of the blood, facilitate the circulation of this fluid through the brain. But, perhaps, the greater advantage would be derived by keeping the bowels freely open without inducing excitement or debility, chiefly by means of the neutral salts. The compound aloetic pill will be advantageously employed in those cases in which the disease occurs after the cessation of the cata- menia, or suppression of a hemorrhoidal discharge. A diminution of the circulating fluids, as well as their equalization, will be effected likewise by promoting all the secretions, particularly those of the urine and bile. iDiet — The food and drink of the patient should be particularly attended to. His diet should consist of those kinds of food which are most easily digested, and which afford the greatest quantity of nourish- ment in the smallest bulk. Ardent spirits, strong wines, fermented liquors, even strong coffee or tea and all stimulants should be avoided as more or less injurious. Treatment of Second Period — The treatment of the second period, or that of softening from inflammation, is the same in principle as that of the former, in so far as it regards the state of excitement with which this morbid change is generally accompanied; But if the paralysis be fairly established and, notwithstanding the depletory and sedative measures which have been employed, continues to increase, neither our own ob- servation nor the recorded experience of others would recommend a steady perseverance in the means, the debilitating effects of which have not been sufficient to overcome the inflammatory excitement of the first period. Bleeding and active purgatives should now be laid aside; blisters or sinapism should be ajJijlied to the inferior extremities, the nape of the neck and superior part of the spine ; the head should be kept cool by the constant application of evaporating lotions ; the bowels evacuated once or twice a day by means of a mild aperient, or by injections, the secretion of urine and the cutaneous perspiration should also be promoted by remedies of the least stimulating qualities. The retention of the urine is a complication which must l^e sedulously watched, that this fluid may be removed before it accumulates to a degree to prove injurious; stimuli or tonics should now be employed with a view to support the strength of the patient, but they ought never to be employed to such an extent as to produce excitenuuit, as the powers of life are already greatly exhausted by the stimulus of the disease. BEAIN FEVEE. !409 BRAIN FEVER. (Cerebral Macula.) Difficult Diagnosis. — Under tliis term we propose to include the path- ology, symptoms and treatment of the inflammatory affections of the brain and of its membranes. We adopt this plan, not merely because of the intimate relation subsisting between these structui'es, but because when we trace the history of a number of acute affections of the encephalon and examine the lesions of structure presented after death, we shall frequently find that the substance of the organ, as well as the investing membranes, has been involved in the disease. Hence arises the difficulty of establish- ing the diagnosis between inflammation of the parenchyma of the brain and that of its membranes. Symptoms. — When either the arachnoid or pia mater, which closely invest the brain, are extensively inflamed, the functions of this oi'gan become inevitably disturbed by sympathetic irritation, without its paren- chyma necessarily partaking of the inflammation, or if the inflammation extends to the parenchyma it is mostly confined to the sujierficlal layer of cortical substance. Hence meningitis, besides headache and intense fever, we have an increase of the general sensibility, preternatural acute- ness of the external senses, violent delirium and convulsions, and, finally, collapse, coma and death. Extensive and acute inflammation of the hemispheres of the brain will be characterized by a nearly similar train of symptoms. Two Classes of Inflammation — We shall proceed to consider inflam- mation of the encephalon under two divisions, viz. : 1. Inflammation of th.e membranes of the brain (meningitis) ; 2. Inflammation of the sub- stance of the brain fcercbritis). Inflammation of Brain Membrane — An examination of the structure of the brain and of the peculiarities of the circulation in it and ui)on it woiild lead us to the inference that if the meninges be the seat of inflam- mation, the contiguous cerebral substance must participate in some degree in the irritative influence. In other organs the vessels, after entering them by trunks and branches of various sizes, branch out and ramify in their interior until they become capillary in their spongy and areolar tissue. ■ But in the brain a different arrangement takes place, the vessels, after entering at the base of the skull, communicate freely with one 410 NEEVOUS DISEASES. another and then branch out upon the surface of the brain, ramifying in an extended web of cellular tissue (jiia mater) ; in this way they become reduced to so great a degree of tenuity before they enter the substance of the organ that it may be said to be surrounded by a vascular atmosphere from which its supplies are derived. Hence it is, that as the meninges and the contigiioiis cerebral substance are supplied from the same source, each will more or less become affected by any inflammatory action set up in the other. Sympathetic Symptoms — Cerebral irritations are divisible into two gi-eat classes, symptomatic and idiopathic. Symptomatic irritation is for the most part connected with and dependent as a morbid condition of the chylopoctic A'iscera. We frequently observe that for weeks previous to the occurrence of pain or any disturbance in the head the digestive func- tions have been impaired, the bowels confined or irregular and the stools nnnatural. In many of these cases, when the headache, retching, irreg- ular fever and even coma have set in, speedy and permanent relief has followed the use of purgatives, and the other means usually resorted to for correcting disordered functions. An irritative influence is in such cases propagated from the digestive organs to the brain by reason of the close sympathetic connection which subsists between them in health and in disease, and that irritation, if kept up for a while, will pass into positive inflammation, marked by its usual consequences. The irritation of worms and of teething may also induce similar results, more particularly in those constitutionally predisposed. We frequently observe these cerebral affec- tions to spring up during the course of other diseases, of which they may be considered as complications, viz. : continued fever, scarlatina, measles, whooping-cough, and they not infrequently follow accidents or injuries. Varying^ Symptoms — This affection presents a train of symptoms which varies in dift'orent ages and in different temperaments. Its most marked and ordinary character at its outset is an increased sensibility to all sorts of impressions, the ordinary external influences producing inor- dinate effects. Thus, a child is restless and sleepless, seldom even dozing, or if he does doze from time to time starting and waking up ; he attends to every sound, the eyes are suffused, the retina is so sensitive to liglit that he wiidis or turns away if his face is directed to a window or to a light; the pupil is generally contracted but not invariably so. The head is often moved about or from side to side, so are the limbs ; the temper is peevish and nothing seems to soothe this irritable condition but motion up and down the room in the arms of the nurse or attendant. BEAIN FEVEE. » 411 Bowel Symptoms. — The state of the bowels varies much in different instances, they may be confined or relaxed, but the stools do not present any umiatural appearance. Increased Animation. — There is a minor degree of this state which is marked by increased animation and liveliness, which with ordinary ob- servers may pass for an increase of health and vigor, though an atten- tive observer will readily perceive that the countenance wants that dis- engaged air which exists in health, and on making a closer examination he will find that the eyes frequently close and wink and the countenance assumes an expression as of frowning; the hand, too, is frequently raised toward the head, and the fingers are fixedly closed. Indifference. — We occasionally observe a state the very opposite of this, a state characterized by want of animation, accompanied by plaint- ive moaning at times, and an indifference to surrounding objects. Though the patient does not sleep, yet his state is not that of waking, and if roused, betrays fretfulness and ^peevishness. These may be considered as so many indications of an incifdent irritation, which in some constitutions may arise independently of any assignable agency, but which in many cases is referrable to an irritation propagated to the brain from the peripheral extremities of the nerves during dentition, or by worms in the alimentary canal, or by vitiated secretions, or a torj^id liver. Fever Symptoms. — The symptoms above indicated are by some denomi- nated fever, some epithet being iisually added for the purpose of indicat- ing its source, or its nature ; hence the terms gastric, irritative and hydro- cephalic fever. Morbid Excitement — The most expressive term which we can employ is that of "sensitive erethism," or morbid excitement. It is distinct from inflammation of the brain, of which it is frequently the precursor, and according to individual peculiarities, or other modifying circumstances, it may end in cerebritis, meningitis or that modification of the latter called hydrocephalus, and this termination is but too often unexpected by the practitioner, whose attention has perhaps been directed to secondary indi- cations and minor effects, while the ercthismal state of the brain has crept on imheeded. The condition here indicated cannot be supposed to exist unaccoiupanied by an increased flow of blood through the cerebral vessels, or in other words, an increase in their degree of tension ; and as the tension may vary from a slight degree of fullness to the greatest of which the vessels are susceptible, such a state of local determination of blood will soon end in inflammation if not subdued by proper means. 412 • NEKVOrS DISEASES. Further Symptoms — Tlie actual inflammatory attack is generally ushered in by headache more or less violent (the pain being referred to the temples, the vortex or forehead, sometimes to the occiput and base of the skull), by intolerance of light, heavy and suffused eye, with quick pulse, are also attendants; so, in many instances, is vomiting. In those who have suffered much from mental disquiet spasmodic twitchings are sometimes perceived, not unlike those which arise from slight electric sparks. In children and very young persons it frequently commences with a sudden and long-continued convvilsiou without any previous warning. After a while the convulsive movements cease, a remission takes place, and the patient appears fi'ee from complaint for one or more days, when a second attack occurs which may terminate in coma or deatli. Changes in Membrane. — Aftei having been the subject of inflamma tion the membranes present varioiis changes dependent either on the dura- tion and intensity of the attack or T)n the frequency of its recurrence ; but all of them are referrable to the following heads, viz. : simple redness of the arachnoid ; thickening and opacity with increased firmness ; serous ef- fusion beneath or iipon it or into the ventricles; puriform or sero- purulent exudations ; false membranes ; increased vascularity and thicken- ing of the pia mater. We also find lesions consisting of granulations scattered in the meninges 'over the surface of the brain and in the sylvan fissure, which have been shown by the microscope to be of a tubercular nature. CHRONIC MENINGITIS. The Delirium. — Meningitis is in many instances so slow in its progress as to a:ssume the chronic form. We have then delirium and progressive paralysis as constant attendants. The delirium is at first partial, it is a monomania with weakness of intellect, but, after a time it passes on to maniacal excitement and finally subsides into confirmed idiocy. The paralysis in those cases does not exhibit a total privation of sensation and motion in any particular part of the body; it is at first slight, but grad- ually increases and extends to the whole muscular system, rendering the gait feeble and vacillating and iiltimately destroying the power of motion. It is remarkable that the diminution of sensation is not proportioned to that of motion. Spasmodic movements with contraction and rigidity of the limbs sooner or later set in, and, finally, epileptic attacks, which ter- minate in fatal apoplexy. The Paralysis — The paralysis which occurs presents this remarkable HiTFLAMMATION OF BRAIN StJBSTAKOB. ^13 feature, that it seems to shift about from one hour to the other, one day, for instance, the right leg is found to be drawn up with greater energy than the left, when the sole of the right foot is tickled, but on repeating the examination a few days afterward it is the left leg which now feels and moves better than the right. It would seem from this as if the paralysis has shifted from one side to the other, but such is not the case, the limb which was first palsied is still so, but the illusion arises from the circum- stance that the palsy has not increased in degree in the first limb, while the second limb has become involved to a great degree. Motor power has not returned in the former, but has been more gravely impaired in the latter. After-Death Facts. — The lesions which are found after death subse- quently accoimt for these facts. When the right limbs alone were para- lyzed the brain is found to be disorganized on the left side ; but when the paralysis apparently shifted from one side to the other both hemispheres are found diseased, but more deeply and more extensively on the opposite side to that of the limbs which were most palsied. This apparent mobility of paralytic symptoms more frequently occurs in meningitis than in any other complaint. Causes. — Meningitis is a frequent consequence of injuries of the head, of fractures, concussion or even wounds of the scalj). It not infrequently happens that a woimd of the head heals rapidly and that the patient returns to his usual occupation thinking himself quite well, but after ten or fourteen days he begins to feel pain in the situation of the wound which gradually increases in intensity, and in a very short time all the symptoms of cerebral inflammation become manifest. A child may suffer serious injury from a fall, and as all mention of the accident is suppressed by his immediate attendant, it escapes the notice of others and no ill effects fol- low perhaps for a week or two; the child then, however, loses appetite, becomes restless and irritable, febrile excitement, delirium and convul- sions succeed and too often are the precursors of a fatal termination. I^TLAMMATION OF BRAIN SUBSTANCE (Cerebritis) . Symptoms. — The most usual premonitory symptoms are a general uneasiness and restlessness with a tendency to congestion in the head; a sense of weight and fullness ; occasional attacks of pain in the head, or of temporary apoplexy or epilepsy; flushing of tlie face and increased heat of the head; drowsiness and vertigo; preternatural acuteness of the ex- iSH: NEEVOUS DISEASES. ternal senses; intolerance of light and optical illnsions; contraction of the pui^ils. strabismus or imperfection of sight ; tinnitus aurium or various other noises in the ear; confusion of thought; failure of the memory; mental excitement or depression, or some striking alteration in the habitual character and pursuits of the individual. Additional Symptoms — In some cases there is little appearance of indisposition throughout the day, but the symptoms are aggravated at night; the sleep is uneasy or disturbed by alarming dreams, and in chil- dren there is often grinding of the teeth. Pains in the limbs and fre- quent cramps, general lassitude and muscular debility are often felt, al- ternating vith fits of shivering and fcvcrishness ; the digestive functions are disordered ; there is a general loss of appetite ; often obstinate vomit- ing; the bowels are either irritable or torpid, the secretions being always unhealthy. Symptoms Following^ Inflammation. — The above symptoms precede either general or partial inflammation of the brain. Those which follow indicate more esjiecially the invasion of partial and chronic inflammation, a long-continued, fixed and deep-seated pain in one part of the head ; jiain, numbness, weakness, a sensation of creeping and tingling in one extremity or in one-half of the body, or confined to one portion of the extremity; there may be niimbnesS and loss of power in one finger only or in one set of muscles. Sometimes the speech is affected so as to produce a degree of hesitation, stuttering or indistinctness of pronunciation, drowsiness, languor, depression of spirits are observed, also more particularly in the chronic form of cerebritis. Some of these premonitory symptoms may have been present for weeks, for months, or even for a year, or for a longer period. General Cerebritis — General cerebritis is always acute. Its symptoms are divisible into two periods, viz. : 1. The period of irritation or excite- ment. 2. The period of collapse. Symptoms — The sjTnptoms which characterize the period of excite- ment are intense pain extending over the greater part of the head; great excitement of the cerebral functions; violent delirium; preternatural acuteness, of both the external and internal senses; intolerance of light; brightness, redness, wildness or jirotrusion of the eyes ; contraction of the pupils ; tinnitus aurium ; flushing of the face ; throbbing of the temporal arteries; paroxysms of general convulsion; rigidity of some of the mus- cles on one or both sides of the body in the interval of the paroxysms. There are also severe shooting pains in the extremities, greatly increased INTLAMMATIOTT OF BEAIN. !il5 by extending them; twitching of the muscles of the face; rolling of the eyes; quick, suspicious and irregular breathing; rapid, full and hard pulse; subsultus tendinum; red and dry tongue, cither tremulous when protruded or in violent motion, j)ushing out the cheek or forcibly thrust out of the mouth; great thirst; occasionally severe vomiting, especially in children; scanty and high-colored urine. The paroxysms of convul- sion are always attended with an exacerbation of the symptoms. The respiration is hurried, and the pulse rises suddenly, forty or fifty beats in a minute. When the convulsions subside the pulse and respiration be- come comjiaratively slow and feeble. Further Symptoms. — The S3^uptoms just enumerated may last from twelve to forty-eight hours or more, when they are succeeded by others of an opposite character, which constitute the second period or that of col- lapse. The headache is now no longer complained of ; delirium gradually passes into stupor or coma ; the preternatural acuteness of the senses is succeeded by obtuseness and insensibility; the convulsions subside into general muscular relaxation and more or less comijlete paralysis succeeds. The pupils become dilated and motionless; the eyes sunk, pale and dim; there is sometimes strabismiis or deafness; the pulse is rapid, small, un- equal or intermittent; there are frequent rigors, the skin afterward feel- ing cold and covered with a clammy sweat; the face is pale, sunk and cadaverous ; the respiration is slow or irregular and stertorous. When the patient lies senseless on his back and swallows with difficulty, the fatal issue is not far distant. There may be several alternate paroxysms o£ excitement and collapse until the patient finally sinks into a state of coma which soon ends in death. Diagnosis — When the inflammation occupies at the onset a large portion of the brain, it is generally complicated with meningitis and characterized by disturbance in all the vital functions. Course of the Disease. — When, however, a smaller portion of the brain is engaged in inflammation the course of the disease is seldom so rapid; its invasion is more gradual and preceded by symptoms of irritation in some of the organs of voluntary motion, sensation or intelligence. Con- vulsive rigidity and retraction of the muscles are sometimes observed in connection with meningitis; but it may be generally distinguished from spasmc^io paralysis by several well-marked signs. There is no actual paralysis, and when the convulsive retraction intermits the patient fully recovers the power of voluntary motion in the same manner as after the paroxysms of spasmodic rigidity in tetanus. This convulsive rigidity is 416 MEKVOUS DISEASES. scarcely ever limited to one region or to one side of tlie body as in partial cercbritis, but affects a variety of parts at the same time on both sides. Treatment The inilammatory nature of the more acute forms of cerebritis and arachnitis is so obvioiis that their treatment has always been conducted in correct principles. Until very lately, however, the inflam- matory character of partial and chronic cerebritis was either entirely over- looked or imperfectly understood, that though active treatment was some- times adopted at the beginning of the disease it was soon laid aside, and remedies of an opposite description substituted. These affections were in fact generally set down as nervous, mistaken for rheumatism, neuralgia, nervous dyspepsia and debility or nervous palsy, and treated by tonics, electricity and stimulants ; the fatal termination of the disease being thus accelerated. Preventive Treatment. — Cerebritis and arachnitis are so formidable that their prevention is of no less, if not greater importance, than their treatment. It is extremely imjiortant to have recourse to active measures on the very first appearance of any of the premonitory symptoms, how- ever trifling ; as we may thus succeed in effectually removing that state of congestion and irritation of the brain, which is the precursor of inflam- mation. The means of accomplishing this are the careful and timely re- moval of all the exciting causes ; of every source of irritation, both bodily and mental ; regulation of the diet ; avoiding all excesses ; relaxation from study; change of air; general and local blood letting, counter-irritation, with occasional purgatives. Vigilance Required — Great vigilance is particularly required in the cerebral affections of infants and children who frequently suffer without complaining. A predisposition to affection of the brain may often be suspected by some slight cast or rolling of the eyes; by dilatation of the pupils, or occasional startings or attacks of spasmodic croupy breathing during sleep ; there may be every other appearance of perfect health with these symptoms, which are often only evanescent. Relieving Congestion — "When it is necessary to relieve the brain from habitual congestion by occasional topical bleeding, the method of taking blood from parts as remote from the disease as possible seems to us pref- erable to that of abstracting blood from the head itself. Wlien the ves- sels of a part are partially emptied of their blood, if they have been much weakened by long-continued over-distension or previous disease, so as to have lost their elasticity, there will be an immediate flow of fresh blood to the part ; this will take place on mere hydrostatic principles. INFLAMMATION OF BEAIN. 417 Uses of Bleeding. — No fact is better establiilied than that the loss of an exceedingly small quantity of blood from certain parts of the body is sufficient to relieve distressing symptoms of congestion and oppression in others most remote from them; as, for instance, a very slight discharge of blood (one or two ounces) from the hemorrhoidal veins being suffi- cient instantly to remove vertigo, flushing, earache or oppressed breath- ing; the same is the case in a still more striking manner with the cata- menia, although some account must be taken of the influence of uterine irritation over the system. We prefer, therefore, in cases of habitual con- gestion in the brain, taking blood occasionally from the feet or legs, by opening a vein or applying leeches and letting them bleed in a foot-bath; or the application of leeches to the arms whenever practicable. We have found this the surest method of affording permanent relief, and by re- peating it at certain intervals the tendency to cerebral congestion may be completely overcome. We have pursued this plan in lunatics with the very best results. Cooling the Head. — The insertion of an Issue Is often advisable as a preventive in people of a plethoric habit. The head should be kept cool by the frequent use of cold ablutions, the hair cut short, the head and shoulders raised at night ; tight bandages round the neck must be avoided ; the daily use of the cold shower bath Is often very beneficial, but a reac- tion takes place In the head unless it be used with the feet Immersed in hot water. The feet, legs and lower parts of the body ought to be carefully kept warm and dry. Further Treatment — In the treatment of cerebritls, when fully de- velojied, attention must be paid to its two periods of excitement and col- lapse. The remedies chiefly to bo relied upon arc blood letting, general and topical pvirgatives, cold applications to the head and counter-irritation. Treatment of More Acute Cases. — In the more acute cases the patient must be freely bled from a large orifice. If the symptoms continue iin- abated the bleeding must, however, bo repeated several times, at intervals of a few hours, and this practice must be carried during the first period -of the disease to the utmost limit of the patient's strength. It often happens that very little impression Is made on the disease by the first bleeding and no amendment takes place until after the second. The symptoms often abate after bleeding, but a fresh exacerbation may take place in the course of a few hours. Topical bleeding, by cupping or leeches, Is, under such circumstances, highly beneficial. Head Treatment.— The head must be shaved, and pounded ice mixed 27 418 NEEVOUS DISEASES. with cold water and vinegar may be applied to the scalp. A very effectual method of applying cold is by making the patient hold his head over a basin and pouring a stream of cold water on it from a certain height ; this often removes the heat and flushing and calms the excitement; it should be repeated as often as the heat and flushing return. The application of cold to the body is always followed by a reaction, and the temporary relief refrigerants afford will be succeeded by an increase of the inflammatory symjjtoms and their use become decidedly injurious imless their depress- ing action be kept np by a steady and repeated application. Other Remedies. — The remedies next to bleeding and cold, and often not less efficacious, are active purgatives, which must be administered at short intervals until copious evacuations be procured. In some cases no marked amendment has taken place until the bowels have been freely moved ; they are sometimes exceedingly torpid, for reasons which have already been assigned, and large doses of cathartics may be required. Com- binations of calomel, jalap, scammony, followed by any of the purga- tive mineral waters, are the purgatives on which the most reliance can be placed. Croton oil is sometimes a valuable remedy, from the facility of its administration and certainty of its effects. Mercury may be given freely as a purgative. Use of an Emetic. — "We have sometimes found tartar emetic of great service when there was no irritability of stomach to prevent its being tolerated ; the power of tartar emetic in controlling the action of the heart and subsiding the inflammatory diathesis is now fully established ; a solu- tion in the proportion of one grain to the ounce and a tablespoonful given every hour or two, suspending it should vomiting occur, has often been attended with great benefit. The remedy is in general well tolerated, owing to the torpor of the stomach ; violent vomiting should, however, be prevented, as it would obviously be extremely injurious. Treatment of Second Stages. — In the second stage of acute cerebritis, that of collapse and coma, general blood letting is to be used most spar- ingly; decided advantage, however, has resiilted from a moderate bleed- ing even at a late period. In this stage topical bleeding is more generally indicated. There are periods of exacerbation in the symptoms which should be watched and overcome by these means, which may be persevered iu as long as there is any hardness and resistance in the pulse. We have seen a patient instantly recover from a state of profound coma by the abstraction of a very small quantity of blood with the cupping glass. In this stage we may have recourse to counter-irritation with advantage; INFLAMMATION OF BEAIN. 419 blisters may.be apj^lied between the shoulders, to the occiput or to the neclc or legs. There is an objection to their being applied to the whole head, that it prevents the subsequent application of cold. We have, however, in desperate cases, seen a decided amendment follow the application of a large cap blister. Particular attention should be paid to the abdominal region, and especially that of the bladdex-, which ought to be examined morning and evening in order to detect retention of urine, and we must take care not to be led into error by an incontinence of urine from the over-distension of the bladder; this must be obviated by drawing off the Tirine Avith the catheter twice a day. Treatment of Chronic Forms. — In the more chronic forms of cerebritis, unattended with fever or much general excitement, the same activity of treatment is of course not admissible. We must still, however, pursue the antijjhlogistic plan, modifying it according to the urgency of the symptoms. During the period of irritation, with cephalgia, vertigo, or rigid sjiasm of the extremities, moderate bleeding, general and topical, purgatives aud counter-irritation are the only remedies from which any advantage is to be expected ; they must bo repeated at longer or shorter intervals, according as the strength of the patient and the continuance of the symptoms may seem to indicate. A great deal is to be accomjilished in all chronic inflam- mations by persevering in a moderate course of antiphlogistic treatment. We must watch carefully any signs of amendment, remembering that there is a great tendency to collapse, and that the natural course of the complaint is characterized by irregular remissions and exacerbations. When to Cease Active Treatment — When the period of irritation is over, and is followed by a remission of all signs of excitement, by a com- plete paralysis of the muscles, and by other evident signs belonging to the period of softening and suppuration, the strength of the patient must no longer be reduced by active treatment. In all inflammatory diseases, when the stage of excitement and disorganization is over, a process of repara- tion commences, which requires for its completion a certain degree of power in the constitution. If at this period we persevere in lowering the general strength, we de2:)rive the constitution of its natural resources and interfere with its healing operations. When the Excitement Turns. — It becomes, therefore, an object of con- siderable importance to watch the moment when the tide of excitement is on the turn, and when the powers of the constitution are verging to a state of collapse, in order that we may abstain from an injurious inter- ference, husband the patient's sti-ength and even support it if required. 420 NERVOUS DISEASES. This precaution is particularly uecessary in old jieople and. young chil- dren. Convalescence. — After convalescence has been established the patient will still require to be closely watched for some time before his recovery can bo considered fully coutirmed ; he must bo kept perfectly quiet, free from every species of excitement and the regimen duly regulated. When the brain has once suffered from inflammation it is slow in recovering its tone, and the most trifling cause, such as a slight mental exertion or emo- tion, a full meal, and so forth, has been in many cases sufficient to occasion a relapse. Suppressed Menstruation — When cerebritis has occurred after sup- pressed evacuations or the metastasis of other diseases, we should endeavor to procure their return. If menstruation is suppressed, leeches should be ajiplied to the pubis or inguinal regions, and the frequent use of hot pediluvia recommended. If cutaneous eruptions or rheumatic gouty pains in the joints previously existed, blisters or rubefacients are to be applied to the parts originally affected. Summary of Symptoms of Brain Congestion The following summary gives a connected view of the various morbid conditions of the brain, which are the effects of congestion and inflammation, together with their symptoms : Cerebral Congestion — Cerebral congestion, over-distension of vessels; vertigo, tinnitus auriura, confusion of sight, cei>halgia, if the pressure in the vessels be carried to a sufficient extent to intercept the circulation ; simple apoplexy, seldona fatal, recovery rapid. Permanent Cerebral Congestion. — If the cerebral congestion be per- manent, or returns frequently ; drowsiness, oppressed intellect ; the vessels become weakened and on a sudden increase of congestion are ruptured ; extravasation of blood, sanguineous apoplexy ; destruction of cerebral sul> stance and compression; loss of consciousness, permanent or temporary; sudden and complete paralysis without spasmodic affection of the muscles. General Congestion. — General congestion, followed by inflammation of a considerable portion of the brain ; deep injection ; partial sanguineous infiltration; dotted and ecchymoscd striated appearance of the cerebral substance; general cerebritis (combined usually with arachnitis). Period of high excitement of all the cerebral functions, with general convulsions, followed by a period of collapse and coma. Partial Congestion — Partial congestion and inflammation of the brain; 1st period, the same deep injection and sanguineous infiltration. SPINAL MENINGITIS. 421 more circumscribed ; partial ccrebritis. Partial symptoms of irritation in the organs of motion and sense; weakness, pain, numbness, spasmodic paralysis, confined to one side or a few regions of the body. 2d period, infiltration of piis in the cerebral substance ; softening ; abscess ; complete paralysis; relaxation and flaccidity of the muscles; loss of feeling; aboli- tion of some of the external senses or intellectual faculties ; death, either gradual or sudden, by the extension of the inflammation or by pressure. Cerebral Inflammation. — After sanguineous apoplexy and sudden and complete paralysis, inflammation of the cerebral substance surrounding the coagulum; consecutive ccrebritis, the paralyzed limbs affected with pains, convulsive motion, spasmodic rigidity. Slow Congestion — Slow and gradual congestion with very slight irri- tation; long, continued state of low inflammation, ending sometimes in softening, sometimes in induration, or else in an infiltration of serous fluids and white softening. Various forms of chronic ccrebritis, sense and motion very gi-adually weakened and impaired without pains or spasmodic rigidity in the muscles. DROPSY OF BRAIN. (Hydrocephalus. ) Causes — "Water in the head; dropsy of the brain. This is almost always an affection of early life. Sometimes it is congenital. It is mostly a passive dropsical eft'usion ; certain cases show signs of a chronic or subacute inflammatory condition of the arachnoid membrane of the brain. Symptoms. — Languor, strabismus, convulsions, loss of appetite and increase in the size of the head. This last may be enormous. Treatment — Moderate purging every few days, or once a week, sus- taining the strength by nourishing food, and, if it be borne, cod-liver oil; diuretics; shaving the head and rubbing it nightly with mercurial oint- ment ; occasionally blistering the back of the neck, in a child. Pneumatic aspiration may perhaps prove useful in hydrocephalus. To remove the fluid gradually and safely mild stimulating baths have a very beneficial influence. INFLAMMATION OF THE SPINAL MARROW, MYELITIS, SPINAL MENINGITIS. Symptoms. — The symptoms of this uncommon affection arc : constant and severe pain in tlie back increased by motion ; spasmodic contractions 422 ITEEVOTJS DISEASES. or rigidity of the muscles followed by paralysis, fever, constipation of the bowels and retention of urine. In myelitis proper, as distinguished from spinal arachnitis, there is no pain or muscular rigidity hut only paralysis of motion and sensation. Treatment. — Cupping or leeching along the spine, followed by a blister and active purgation with saline cathartics, constitiite the essential parts of the treatment of simple inflammation of the spinal cord or of its membranes. APOPLEXY. Causes. — These have been divided into external or obvious, and in- ternal or such as can only be discovered after death. The external causes or those acting mechanically by evoking pressure on the brain; snch are fracture of the skull with depression of a portion of bone, or blood extrava- sated immediately beneath tlie fractured bone without depression. The reality of this cause is shown by the effect of direct pressure made upon the surface of the brain by the point of the finger in cases where a portion iof the skull has been removed by the trepan, or on the fontanelle on opening between the cranial bones in the head of infants. Causes tend- ing to increase the arterial action of the brain, either by direct application to the head itself, or indirectly through the medium of other organs. Causes which operate by impeding the return of blood from the brain, as stooping; the application of a tight ligature round the neck so as to compress the internal jugular veins; tumors of any kind so situated in the Deck or chest as to interrupt the return of blood from the brain to the heart; diseases of the heart or lungs impeding the transmission of the blood through the pulmonary vessels ; or a voluntary suspension of breath- ing after a full inspiration ; or in blowing wind instruments, or in making great muscular efforts of any kind. The internal causes ai-e those that are only discoverable after death, viz. : extravasation of blood in the substance of the braifi. or in the ventricles, or serous accumulations iu any of tlie cavities or between its membranes. Symptoms — We have two forms of geni:ine apoplectic seizure : con- gestive and hemorrhagic. In the first the premonitory symptoms are, carotids, distension of the temporal arteries and jugiilar veins; constipa- tion, languor, dullness, drowsiness, dimness of sight, vertigo, headache. The attack is marked by sudden stupor ; with slow and sometimes snoring respiration, full and slow pulse, dusky or turgid appearance of the face. The total loss of perception may be brief, its partial absence or deficiency T,osg OP SPEECH. 423 continuing for some time. Slight convulsive movements are not uncom- mon. Paralysis of the muscles occurs only for a short time after the attack, if recovered from. Hemorrhagic Apoplexy — In hemorrhagic apoplexy generally no clear premonition is given, the attack being very sudden; a stroke, literally unconsciousness is complete for some seconds, minutes or hours. After this, general or local paralysis, most often hemiplegia (paralysis of one side of the body) is left; the mental powers also, in many cases, being impaired at least temporarily, during the coma; the breathing is com- monly stertorous and the pulse slow and somewhat full, the head hot and the face more or less dark or flushed. But the fullness of the blood-vessels and heat of the head are much less, as a rule, than in congestive apoplexy. The younger the patient and the more vigorous his antecedent health the more probable is the existence of the congestive form; and, also, the better the prosf)ect of recovery from hemorrhage within the cranium, if only the effects of pressure be exerted at the time. Treatment — 1. If, in a person under fifty, not before of broken con- stitution, we find the head hot, face turgid and flushed, the arteries and veins of the neck and temples full, the pulse also strong, and the heart's impulse so (or the heart's action vigorous though the pulse at the wrist be oppressed) blood may be taken, carefully, from the arm or by cups or leeches applied to the back of the neck. 2. Older and more doubtful cases may be treated tentatively with cups alone, aided by mustard plasters to the legs, back and epigastrum in turn; with laxative injections into the rectum during the attack and saline purgatives afterward. The head should be kept raised and cooled with wet cloths until its temperature becomes normal. If the hair be thick, it should be cut very short or shaved off entirely and an ice-cap placed thereon over the whole surface. When, however, there is reason, as usually is the case in really old or broken-down patients, to believe the structural degeneration, arterial or that of ramollissement, is the source of the attack, loss of blood will be out of place. Iodide of potassium for some time will aid absorption. loss OF SPEECH. (Aphasia.) Symptoms.- — Loss of speech may occur as one of the symptoms of disease of the brain, either functional and transient, or organic and irre- 424 NEHVOUS niSEASES. THE NERVES Figure No. I. I. Plexus or bunch of nerves in the carotid region. 2. Sixth external motor nerve. 3- First branch of the 5th ophthal- mic nerve. 4- A branch on the nose partition, which goes to the incisive foramen. 5- Concurrent branch of the I'id- ian nerve, dividing itself into cirotid and petrosas branches. 6. Back branches of the palate. 7- Lingual nerve joined by the tympanum cord. 8. Hard part of the 7th pair or facial nerve. 9- Upper cervical ganglions. 10. Middle cervical ganglions. II. Lower cervical ganglions. 12. Roots of the great splenic nerve. 13- Lesser splenic nerve. 14- Renal plexus. IS. Solar plexus. i6. Mesenteric plexus. 17. Lumbar ganglions. i8. Sacrum ganglions. 19- Vesical plexus. 20. Rectum plexus. 21. Lumbar plexus. 22. The rectum. 23. The bladder. 24. The pubis. 25. Crest of the ileum. 26. The kidney. 27. The aorta. 28. The diaphragm. 29. The heart. 30. The larynx. 31. The submaxillar gland. 32. The incisive teeth. 33. The nasal partition. 34. Globe of the eye. 35. 36. Cavity of the cranium. Figure No. 2. 1. Section of the bone of the fore- head. 2. Section of the occipital bone. 3. Muscles in the back of the neck. 4. Integuments on the skin. 5. Frontal cavity. 6. Middle spongy bone. 7. Lower spongy bone. fj. Middle passage of the nose. 9. Lower passage of the nose. 10. Thickness of the roof of the mouth and depth of the nose. 11. Opening of the eustachian tube. The catheter is at the nose and is going through the tube. 12. Cartilage of the nasal division. 13. Coiio-iiloso muscle. 14. Veil of the palate. Figure No. 4. 1.1. The cubital nerve. 2.2. The ramus profundis dorsalis (deep-seated nerve of back of arm). Extreme of the cutaneous nerve of the arm. Branch of the radial nerve. Back view of the digital nerves, or of the fingers. Back branch of the cubital nerve. 3- 4- 5,5- FxQ. 1.— Tiie great gympathellc uerve Fig. 3. — View of tlie nervous system in man, showing the nerv- ous centres (the brain ami the spinal near rowj whence start the other nerves which piovide the whole body. Vm. 4.— Vifw of l!ie nerves on the back part of the forearm and hand. THE NERVES. Fur an explauatloxi uf the iUiLiLratiouii sou text on opposite page. 425 426 liTEEVOTTS DISEASES. movable. Such a loss of language is termed aphasia, not articulation, as in aphonia, but expression is, in this affection, wanting. The power to unite words from memory, to convey meaning, is lost ; but, in some cases, at least, they may be copied correctly. Causes. — Hemiplegia of the right side has in a number of examples coincided with aphasia, and, several times, also, autopsy has shown soften- ing or other lesion of the left anterior portion of the cerebrum. Valvular lesion of the heart sometimes accompanies this disease. Treatment. — Cases of aphasia are very rare. There is no special measure of treatment except that of general principles, and treat untoward ones as they arise. SUN STROKE. Symptoms. — This is a disease occurring in persons exposed to exces- sive heat and characterized by vertigo, sometimes with violent pain in the head, gradual increase of listlessness and torpidity and a desire to lie do-wn. The feverish sj-mptoms may culminate in more or less sudden and com- plete insensibility. Treatment. — The most obvious demand in regard to treatment is to abstract the excessive heat from the body as rapidly as possible, and this can be most speedily accomplished by cold sponging, rubbing the head, neck and chest with ice or by the cold pack. Light should be excluded from the patient as far as possible, and if the pulse is feeble stimulants should be given by the moiith or by injection. If prompt improvement does not occur the hair should be cut short and a blister api^lied to the nape of the neck. Heat Exhaustion — In heat exhaustion the patient is generally found with a cool skin, a feeble pulse and pallid face, without disturbance of the intellect. In such a condition stimulants, dry heat of hot-water bags or bottles, mustard plasters to the stomach and perfect rest and quiet are indicated. HYPERTROPHY AND ATROPHY OF THE BRAIN. Meaning. — Hypertrophy means an actual enlargement or overgrowth of the brain structure generally, while atrophy signifies a general wasting of the substance of the brain Causes — The brain is sometimes the seat of morbid growths, includ- ing cancers, fibroid and bony tumors, tubercular deposit in large masses, PAEALYSIS OE PALSY. 427 and casts containing parasites. All these affections are, fortunately, very seldom met with. Treatment. — The treatment in such cases is, of course, to cut out the tumor and the affected portion of the nerve with as little delay as possi- ble, whenever it can he accomplished. PARALYSIS OE PALSY. Causes. — Palsy is one of the most common and most distressing mis- fortunes which mankind is obliged to suffer. Yet its various forms are rather symptoms of deep-seated disease than disease themselves. Thus palsy of a limb is very frequently a symptom of structural disease of the brain or spinal cord, but it occasionally occurs from a diseased nerve trunk itself. It may affect a whole limb or only part of one, and is sometimes limited to a group of muscles in a particular region. Symptoms — The following conditions give rise to paralysis of motion: 1. Disease or injury to a nerve in some part of its course, destroy- ing its power of transmitting the force, which is expressed by a contrac- tion of the muscle to which the nerve is distributed. 2. A disease of some portion of those central parts of the nervous system, whence the nerve takes its origin, or with which it may be con- nected directly or indirectly. Varieties of Palsy. — There are many varieties of palsy, among the most important of which are the following: According to its nature it may be motor (acinesia), and sensory paralysis (anesthesia). Facial Palsy — This is an affection of the portio dura of the seventh pair of cephalic nerves, the motor nerve of the face. It occurs at any age, usually from rheumatoid inflammation of the sheath of the nerve at its escape through the cranium, through the stylo-mastoid foramen. Symptoms — One side of the face is without change of expression, and the eye on that side is not closed (in severe cases) from the paralysis effecting the orbicularis palpebra muscle. The tongue is not affected in the movements. The facial motor nerve is not often involved in the much more serious cases of cerebral palsy. Diagnosis. — Absence of disturbance or of incompleteness of control over the tongue, while the power over the eyelid is partly or wholly lost with the absence of severe cerebral symptoms, will, especially in a young person, make the diagnosis easy as well as important. 428 JfEEVODS DISEASES. Treatment.- — The treatment of this form of local palsy may be by repeated small blisters behind the ear, followed, when convalescence has begun, by some warm covering (cotton wadding, flannel or silk) to protect the part from cold. Writer's Cramp — Pressure npon a nerve may cause its paralysis, gen- erally temporary. A man lias been known to have his hand rendered powerless for throe weeks by sleeping all night with his arm bent under his head. Friction, the enderaiic application of strychnia and galvanism may be used in such a case. Writer's cramp or scrivener's palsy, is the result of exhaustion of certain muscles from over-use. Its cure is rest. Hemiplegia. — This means half palsy and is a paralysis in which one lateral half or side of the body is stricken with powerlessness so accurately that it is customary to define the condition by the terms right and left. Causes — Brain lesion is most often the cause of this affection ; either an apoplectic clot, a tumor or softening. Symptoms. — In severe cases the arm and leg may be equally motion- less, but if there is any difference between them the leg is generally the limb less affected, the last to be attacked, and the first to recover some of its powers. Suddenly, almost always, but uot always with loss of con- sciousness, the patient loses the power of motion and more or less sensa- tion on one side. In complete cases the j^arts involved are the arm and leg, the muscles of mastication and half the tongue. Treatment. — 1. Essentially the same principles are applicable to this as have been mentioned in connection with ajioplexy. The younger the patient the more vigorous bis or her previous health, and the fuller the circulation the more approi^riate may be the general or local abstraction of blood to diminish pressure upon the brain. Where softening is appre- hended bleeding should be exceptional and cautious. Eest, regulation of the bowels, and counter-irritation of dry cups to the iipper part of the spine, and afterward a blister, with friction, as with brandy and red pepper, or whiskey and hot water, or salt and spirits, to the affected limbs. 2. In the hysterical form, if it lasts long, electricity may be aj^plied locally with safety and advantage. In any curable case passive exercise of the weak limbs will be very useful. Paraplegia — Paraplegia is that form of palsy in which one-half of the body below the chest and including the lower limbs is stricken with the disease. Causes. — Spinal disease or injury is its source, with or without core- PARALYSIS OR PALSY. 429 bral implication or complication. It may come suddenly or gradually; generally its beginning, at least, is sudden. Symptoms. — When the spine is affected, as well as iu the reflex form, numbness in the feet and pain in the back are apt to be early signs. The power of motion is lessened or lost in the lower limbs. The muscles may be either relaxed or contracted. The lesion of the spinal marrow, if pro- gressive, is productive of loss of power over the bladder and bowels. Bed-sores with deep ulceration and sloughing may occur in protracted cases. Treatment. — When myelitis is believed to exist, at an early stage, local depletion to a moderate extent may be advised. In many cases coun- ter-irritation by repeated sinapisms, or stimulating liniments will be proper. While inflammation or active irritation of the spinal cord is made apparent by the symptoms (pain, cramps, muscular twitching or rigidity), strychnia is not suitable. After these have subsided it may be given, not more at first than the thirtieth of a grain twice daily. If it produce jerking movements of the hands or feet, or nervous restlessness, or any marked imeasiness it should be suspended. Electricity may be used with similar caution in a secondary stage of parajalegia. Hysterical Paralysis. — In females this is among the many foi'ms of functional disorder which that strange but not yet clearly defined dis- order, hysteria, may produce. Diagnosis, — The affected limb, in walking, is dragged after the other, as if a dead weight ; while in cerebral hemiplegia the palsied leg and foot are brought round in a curve, the body being bent toward the sound side at the time. Treatment. — Tonics, good nourishment and change of air are most required in all hysterical cases. For the paralysis itself electricity is use- ful. Mild shocks for a few minutes twice a day may be given with advantage. Eeflex Paralysis — Causes — Worms, dysentery, diarrhoea, uterine irri- tation, teething and external injuries are all thought to induce reflex paralysis in certain instances. Diphtheritic and scarlatinal palsies have been placed in the same category. The simplest and clearest cases are those of wovinds. Treatment. — In true reflex paralysis the removal of the irritant cause produces instant relief. When the nature of the case does not admit of such prompt relief, if the diagnosis be clear, the same indication roinni'^r;, to address our remedial measiires to the seat or source of ]ieriplior:il 430 NERVOUS DISEASES. irritation. Palliate, if we cannot cure the trouble there, and we will ob- tain palliation, if not i-elief, of the reflex disability. Electricity has proved signally useful in the subsequent treatment. Diphtheritic Paralysis. — After the termination of an attack of diph- theria, commonly within three weeks, the muscles used in swallowing and speaking, less often those of the upper and lower limbs and the sense of sight may be partially paralyzed. Loss of sensibility usually accompanies the loss of motor power. This condition of things may last for weeks or even months, but is generally recovered from. Causes. — The inunediate cause of the paralysis of the peripheral lesion of the nervous terminations is the toxemic influence upon those centres of the morbid poison of diphtheria. Treatment — Passive exercise, stimulating friction and electricity, change of air and sea-bathing are suitable measures for this affection. Syphilitic Paralysis. — The most unequivocal instances of this nature are accounted for by periostitis within the cranium, involving the dura mater, or by nodular exostosis pressing upon the brain. The most remark- able fact connected with such cases is the prompt curative effect upon it of iodide of potassimn. lead Palsy. — Considerable time of exposiire to the influence of lead is generally necessary to cause this. So commonly does it first affect the extensor muscles of the forearm that the cognomen of "wrist drop" is often applied to it. When it lasts for some" weeks the muscles waste away. Symptoms. — A blue line is observed to form along the edge of the gums. Pain precedes the palsy and attends recovery of power. Mostly, though after a long time,- lead palsy is recovered from. Treatment. — Iodide of potassium appears to act as an eliminant of the lead accumulated in the system. Ergot is also useful. Faradic elec- tricity has been found decidedly beneficial used in moderate strength for a few minutes two or three times a day. Mercurial Palsy — This is occasionally met with in those who work in metal. Mostly tremor is a predominant symptom. Early withdrawal from the influence of the caiise and the continued use of the iodide of potassium are the principal measures of treatment. Paralysis Agltans, called also shaking. palsy, is described as a more or less constant involuntary and uncontrollable shaking of the hands, arms, head or, progressively, of the whole body. Slight or moderate degrees of such tremor are common enough from general nervous debility. Extreme PABALTSIS OR PALST. 431 cases evince the wreck of the cerebro-spinal system and are, therefore, incurable. In other cases the treatment is upon general principles. Progressive Muscular Atrophy — This is still another uncommon and incurable form of paralysis due to a gradual decay and wasting of the muscles, but commencing sometimes with an apparent enlargement or hypertrojjhy of these organs. Locomotor Ataxia — This results from a disease called sclerosis, or hardening of certain motor-centres in the brain and spinal cord, or syphilis. Symptoms. — Eheumatoid pains precede loss of power, occasional stra- bismus (cross-eye) and incontinence of urine may occur. Then there is an awkward, unsteady gait; the sensibility of the feet becomes blunted, and walking is insecure. If the patient shuts his eyes he falls down, and even with them open he reels as if drunk. The duration of this progres- sive disease varies from six months to ten or twenty years. Treatment. — Hygienic management, general tonics, electricity and very careful use of strychnia. Infantile Paralysis — This is a variety developed in very young chil- dren and occasionally jjresent from time of birth. As a rule this palsy arises from disease of the spinal cord and its membranes. Symptoms — It comes on with acute symptoms of fever and con- vulsions, ending in paralysis of one or more limbs. In some cases the child gradually recovers from the effects of the malady, but in many the impairment is permanent and the limb, ceasing to develop in proportion to the rest of the body, ajjpears in the adult as if shrunken and withered, constituting a lamentable and hopeless deformity. Treatment — Much can be done towards preventing complete loss of power by persevering and systematic movements, api^lication of galvanism and exercise as suggested in the article on hemiplegia. Scrivener's Palsy. — Called also writer's cramp. It is the result of long continued and unnatural excitement of the nerves coutrolliug the fingers and hand in writing. Symptoms — The earliest indication is a painful sense of fatigue and weakness which comes on shortly after commencing to write. Sooner or later this begins to be accompanied by involuntary spasms of the muscles employed in holding the pen and the handwriting grows unsteady, scrawly and almost illegible. At first the spasms and irregular movements can be more or less controlled by voluntary effort, but they gradually become worse and worse, until at last the use of the pen is an impossibility. 432 NERVOUS DISEASES. Treatment. — IJcst from writing, tonics and electricity accomplish a cure in some instances, but the prospect of recovery is small, and it is, therefore, very important to avoid the disease by moderation in writing, or by the use of the ingenious typewriter. Wasting Palsy. — A few of the muscles of one limb, or the voluntary muscles of the whole body may lose their power and then waste away to almost nothing. Insidious in its approach the affection may last from six months to several years. It may end in recovery. The shoulder and ball of the thumb are frequent points of commencement for the palsy and atrophy. lOCK-JAW. (Tetanus.) Description — When a patient is the subject of an imcontrollable spasmodic contraction of the muscles of the lower jaw, he is said to have "trismus" or lock-jaw; and when the same condition attacks other or all the voluntary muscles of the body ho is said to have "tetanus." Causes — 1. Tetanus includes trismus and generally begins with it, though trismus may be a local affection. It is found in children as a result of dentition, and in adults as a consequence of diseases involving the teeth, gums or jaws. It is a spasmodic affection produced by reflected irritation set up by a local disease, is rarely associated with any con- stitutional disturbance and is, for the most part, cured on removal of the cause. 2. Tetanus is likewise generally associated with some local source of irritation, some wound or injury, it is then called "traumatic;" when an external or visible cause can be made out, it is denominated "idio- pathic ;" when rapid in its coui'se it is called acute ; when slow, chronic. The acute form is usually the result of an accident and generally fatal. The chronic is for the most jiart idiopathic and more curable. Symptoms. — There are no general or local premonitory symjjtoms by which the onset of this affection can be rccogiiized, and the earliest indi- cations of its approach are generally a difficulty in opening the mouth, with stiffness in the miiscles of the lower jaw ; yet these symptoms may be so slight as to pass unheeded, or to be misinterpreted, when, however, some rigidity of the muscles of the neck, throat or abdomen can be made out and the first indications of the "tetanic grin" recognized. 3. As the disease progresses the muscular system of the body gen- HTDEOPHOBIA, OR RABIES. 433 erally will be more or less affected, and, in different cases, different groups of muscles will be involved. Those of the back are most frequently attacked and their contraction may be so powerful as to cause an arching backward of the frame. The muscles of respiration are, as a rule, af- fected only in acute cases, and the chief danger to life consists in the severity of the spasms which attack them. When severe the first spasm may be fatal and may occur at an early or at a remote period of the affection. When the jaw is unlocked by a spasm of the dejiressor muscles, the tongue is sometimes suddenly shot out from between the teeth and often wounded. 4. As the disease advances the jaws become completely fixed and deglution is then impossible. The spasms of the muscles of the frame become more intense and frequent and the powers of the jjatient rapidly decline. The pulse which was rapid becomes more feeble, while the expression of the countenance betokens agony of the body and despair of the mind. The slightest manipulation or movement of the patient sets up a fresh spasm, and any emotion may do the same. The skin becomes bathed with a cold sweat, and, if death is not caused by suffoca- tion, exhaiistion soons puts an end to suffering. Treatment. — Among the specific remedies which have been greatly trusted the Calabar bean stands foremost and may be given in full doses, such as half a grain of the extract in two or three hours. Camphor is also recommended in doses of from five to ten grains. The bromide of ammonium or potassium has been administered with advantage. It was hoped that a valuable drug for this disease had been found in chloroform, but experience has not jiistified the expectation. The hydrate of chloral has now taken its place and been of some service. Indian hemp in doses of a grain every hour, aconite and belladonna in qiiantities of one-fourth of a grain have also been recommended. Ice applied in bags along the spine has apparently been of great value. The administration of remedies by subcutaneous injection, in these cases, promises to be a valuable ad- junct to practice enabling us rapidly to introduce into the system drugs which act antagonistically to tetanic spasm. Tetanus antitoxine should be administered early. HYDROPHOBIA, OR RABIES. Meaning the "dread of water," which is more correctly termed "rabies" is a disease contracted from a rabid animal, generally from its bite through the saliva or mucus. 28 434 NEEVOUS DISEASES, Stages of the Disease. — In the dog there are three well-marked stages of the complaint. The first is the melancholic, characterized by melan- choly, depression, sullenness and fidgetiness; the second, the furious, by excitement or rabid fury, and the last, ihe paralytic, by general muscular debility and actual paralysis. Symptoms. — 1. In man the disease may show itself at any period from six weeks to a year after the inoculation. A month or more after the bite of a mad dog, or other rabid animal, the wound having healed, irritation is felt in it, nervous restlessness also exists which increases (in most cases) to violent, angry delirium. Then difficulty of swallowing occurs from a spasm of the muscles of inspiration (gasping) taking place at the moment of deglutition, making the patient choke. 2. The same spasmodic gasping is brought on by any sudden im- pression, as of sound, a flash of light or even a current of air passing over the face. Insomnia exists; the patient gTows prostrate and must die for want of food and drink, even if the affection of the cerebro-spinal axis were not itself fatal. 3. There is intense thirst, but the characteristic dread of water, not as a fluid, however, but as connected with the difficulty of drinking. The sight of water is freqiiently sufficient to bring on shuddering, yet it is when the patient carries water to his lips that he is seized with the typical terrors. 4. A rabid man is always rational and tries to drink, but the attempt excites terror and the expression of his inability. His eyes become fixed, features contracted and his countenance expressive of the deepest anxiety, his limbs shake, and the whole body shivers. The paroxysm lasts a few seconds, then subsides, but only to be renewed on the slightest breath of air touching the body. During the calm sudden terror of an unknown kind haunts the mind and imaginary calling of friends often exists. , Symptoms of last Stage ^In the third and last stage the longing for drink becomes intense, with an increasing inability to take it; the voice becomes hoarse and the mouth full of frothy fluid. The patient tries te get rid of this by spitting, and then becomes frightened at its results. Convulsive seizures increase in frequency and intensity, the spasm of the respiratory muscles threatening life ; at last a fatal spasm takes place and death by asphyxia ensues. Treatment — There is not satisfactory evidence that a case of genuine rabies canina or hydrophobia has ever been cured. If we cannot cure, what can or should we do? We may certainly promote easy death by INFANTILE CONVULSIONS. 435 allaying the wretched sufferings of the patient by nitrous oxide, ether, or chloroform. Hypodermic injection of atropia or morphia might, per- haps, more effectually quiet the suffering and even afford more possibility of cure than inhalation of anesthetics. In all cases of bites from dogs or animals, however, in which the faintest suspicion of rabies exists, free cauterization with lunar caustic should be performed. Mental stimu- lants, in the way of inspiring hope and removing fear, must be duly ad- ministered and such general treatment as may be needed. No drug has yet been discovered that has the least influence on the disease, either in preventing or curing it. What is known as the "Pasteur cure for hydrophobia" is in gi-eat favor among some medical men. It is rather a preventive agent or treat- ment and no doubt possesses great value. FITS OR INFANTILE CONVULSIONS. Causes. — The exciting causes are numerous, constipation of the bowels, indigestion, worms, irritation of the gums in teething and excite- ment of the brain, as by fright, are about the most frequent. Many acute and chronic diseases of infancy (scarlet fever, meningitis, whoop- ing-cough, and so forth) have convulsions among their occasional symp- toms or complications. Symptoms — Premonition of a fit is often observed in the child's fret- fulness, or restlessness, or gritting of the teeth in sleep. When a fit comes on the muscles of the face twitch, the body becomes rigid at first, then in a state of twitching motion, the head and neck are drawn backward, the limbs violently flexed and extended; sometimes these movements are con- fined to certain muscles, or are limited to one side. Treatment — 1. The treatment of a, child during the convulsion is, of course, to be directed first toward relaxing the spasm, and immediately after that is accomplished to removing the cause of the trouble, which, in two cases out of three, will prove to be irritation of the gums or bowels. To shorten the paroxysm the child should at once be placed in a warm bath and a cloth wrung out of cold water applied to its head. 2. If the gums are swollen, or have been tender and irritated at the time of teething, lance them freely, dividing the tense gum down to the coming tooth. If the bowels have not been moved give at once an enema of castor oil, soap and glycerine, or some other laxative material, with warm water. If there is reason to suppose that the intestinal worms, 436 NEEVOirs dtseases. which most children harbor, are causing disturbance, active vermifuges such as a grain of sautonino before dinner and supper for a child two years old, followed by two grains of calomel at bed-time, ought to be employed. 3. Cupping the back of the neck, in some cases where time is allowed by a protracted fit, may be resorted to, especially dry cups. Full doses of bromide of potassium, asafetida and valerian are often very useful in diminishing the excitability of the nervous system, which is especially great during the age of childhood. PRESCRIPTION NO. i. R. — Bromide of ammonia 40 grains Bromide of potash Ms drachm Sy n-.p I ounce Water i ounce Half a teaspoonful fur a child 2 years old, every three or four hours. PRESCRIPTION NO. 2. R. — Bromide Soda 3 drachms Bromide potash 3 drachms Liq. potass, ars i Ms drachms Peppermint water 3 ounces Infus. gentian co 5 ounces Tablespoonful three times a day for an older child. FALITNG SICKNESS OR EPILEPSY. Periodical convulsions with unconsciousness during the attack. Causes. — Hereditary transmission of this disease is common. Intem- perance, venereal excess and self-abuse, blows on the head and fright are among the most frequent exciting causes. Symptoms Premonition occurs in a minority of cases before an at- tack; headache, dizziness, terror, spectral illusions, a creeping or blowing sensation, like that of a current of air or stream of water, beginning in a hand or foot and extending toward the trunk. Then, often with a scream, the patient falls down and is violently convulsed. Foaming at the mouth, grinding of the teeth and biting of the tongue are common; the face is flushed, the eyeballs roll, the pupils are unaffected by light, sometimes vomiting, or involuntary urination or defecation takes place; the respira- tion may be very laborious. The fit lasts on an average from five to ten SPASMODIC CEOUP. 4:37 minutes. The interval between the attacks may be from several mouths dowTi to a few days. lu old cases there ma^' be two or three paroxysms daily. They vary much, even in the same individual. The condition after the attack is also various, generally drowsiness or deep sleep follows it, or headache, debility or delirium, sometimes maniacal frenzy. Treatment — 1. During the paroxysm, when habitual, little can be done. Place the patient so that he cannot strike his head or limbs against anything hard, loosen the clothing about the neck to form free respiration and circulation and insure fresh air about the patient, protect the tongue from being bitten, if possible, by placing a cork or piece of India rubber between the teeth. Care must be taken that such an object does not pass into the throat and choke the patient, which can be prevented by tying a strong string to it. 2. To break up the recurrence of the fits is the problem for which a vast number of remedies have been tried in vain. Bromide of potash, valerianate of zinc, belladonna, arsenic and digitalis have all been em- ployed. Strangely enough this disease is v.ei*y apt to improve temporarily under any new treatment, no matter how absurd, which takes a strong hold on the jjatient's imagination. 3. Self-management is very imiDortant to the epileptic. Temperance with nutritious diet is necessary ; regularity of the evacuation of the bowels is imperative ; abundant exercise in the open air, short of exhaustion, does good; systematic gymnastics have even cured some cases. PRESCRIPTION. R. — Bromide of potash 3 drachms Bromide of soda 3 drachms Bromide of ammonia 3 drachms Iodide of potash l'^ drachms Iodide of ammcnia I % drachms Tincture of columb:;; i % ounces Water 6 V4 ounces Take two teaspoonfuls before each meal and three tea- spoonfuls at bcJ-tirae. SPASMODIC CROUP OR SPASM OF THE GLOTTIS, Causes. — This is the most important of several varieties of simple spasm in different parts of the body, among which ordinary croup is a familiar example. It consists in a spasm of the muscles of the glottis or i38 NERVOUS DISEASES. opening into the windpipe, by which a crowing or croupy cough is pro- duced, with hard or stridulous breathing. Symptoms. — This disease especially occurs in young children, where it is due to some reflex irritation, such as that of teething, reflected from the nerve centres which control the muscles of the glottis. It may gener- ally be distinguished from the alai'ining malady, true croup, by its coming on suddenly without fever, marked heat of skin or quickened pulse. Treatment. — To relax tlio spasm sprinkling of a little cold water in the face, or tickling the fauces with the finger or with a feather, so as to produce vomiting, frequently answers the pvirjiose. Should it fail the child should be immediately placed in a warm bath. After an attack the gums should be carefully examined and freely lanced if found swol- len, every attention being paid to the general health. Much needless alarm would be spared to anxious parents and nurses If it were generally understood that there is no likelihood of tliis disease leading on to the fatal malady, true croup, which may always be excluded from considera- tion if the child is free from fever, coughs loudly and has no huskiness of the voice. Give syrup of ipecac frequently until vomiting takes place. CHOREA OR ST. VITUS' DANCE. Causes. — From six to sixteen, in both sexes, especially often, how- ever, in girls, chorea occurs. Nervous debility is almost always present before the attack. Fright is a frequent cause, overfatigue or mental ex- citement, blows or falls may produce it. Rheumatic fever is sometimes followed by it. Symptoms — Incessant and irregxilar movements of the voluntary muscles over Avhich the will has but partial control. Walking in severe cases is difiicult or unsafe ; the hands cannot be regulated enough to write or work; speech may be affected; the muscles of the face often twitch grotesquely. The pupil is, in some cases, unnaturally dilated ; palpitation of the heart may occur, and also constipation and indigestion. The urine is of great density; the countenance assumes a blank and foolish expres- sion, and the mind itself may iu time grow seriously enfeebled. Treatment — Good diet, salt bathing and systematic gymnastic exer- cises will suffice for mild cases. Where marked anemia exists iron (citrate, phosphate or hypophosphate, tincture of chloride, syrup of iodide) is important. Obstinate cases may be treated with Fowler's solution of arsenic, in small doses, gradually increased. Cod-liver oil HYSTEEIA. 439 should be given if great debility exists. In chronic cases the tonics before mentioned vnth the addition of the hypophosphites should be resorted to, and change of climate is very likely to be of service. HYSTERIA. From its occurrence nearly always in females and from a supposition of its originating in some affection of the womb, this name has been given to a variable disorder, of which the main characteristic is morbid ex- citability of the whole nervous system. Symptoms — 1. A "fit of hysterics" is a paroxysm whose natiire may vary from mere uncontrollable laughter or crying to a severe epiliptiform convulsion. This last, however, differs from epilepsy in that being les3 complete loss of consciousness and in its curability. 2. Simulation of other diseases, indeed the assumption of severe functional disorders of different organs, is a common trait of hysteria. There may be hysterical amaurosis ; hysterical insanity is not uncommon ; nor is hysterical paralysis or coma rare. Retention of urine, coughj aphonia, and so forth, are often thus produced. Catalepsy. — Catalepsy or trance is a condition allied to hysteria in some respects, in which the whole frame lies prostrate and helpless, or that a limb, lifted up, falls back as if it were relaxed and dead while yet the consciousness of the person affected may be retained without the sensitiveness to physical pain. This curious state of existence is not well understood, and in our present ignorance of its nature the chief importance lies in its being distinguished from death early enough to prevent that most horrible of all human misfortunes, being buried alive. Hypochondriasis. — This is a very obstinate affection, often hereditary, and occurring more frequently in meii than in women. During the attack there is apparently great depression of mind without mental disease. The patient imagines he is afEicted with maladies of the most varied kinds; is tormented with ideas of impending miseries and dangers; thinks he suffers from swellings or contortions of the body, which may be purely creations of fancy. This disorder in the male corresponds very nearly to hysteria in the female and like it can only be cured by attention to the general health. Tonics, exercise and cheerful occupation are the best remedies. Treatment of Hysteria — Much skill and care will often he. required in the management of hysteria, as each one has peculiarities of its own. 440 NERVOUS DISEASES. Generaly a tonic regimen is demanded. Iron and cod-liver oil are most often the apjjropriate remedies. Bromide of potassium is sometimes quite useful. For a paroxysm of '"hysterics" asafetida is universally safe and reliable in pills of three grains each. Sinapisms and pediluvia are also proper. Menstruation is often irregular in hysterical women ; it should be regulated as far as possible. Exercise iu the open air, as a rule, is very important for such persons. Mental and emotional excitement should bo avoided ; but tranquil, even engrossing, occupations wiU be beneficial. For hysterical paralysis electricity is promptly useful. Cold bathing, espe- cially the shower-baths or sea-bathing, when followed by reaction, will do good. NEUEALGIA. Meaning — Pain, without inflammation or other disorder, except that of the nerve or nerve-control involved; literally neiwe pain. This may affect any of the sensitive nen-os. It is also sometimes referred to parts which have, in health, no sensibility; as the heart, stomach, and so forth. Different names are given according to its site. Thus, tic doiileureux is facial neuralgia; hemicrania, that affecting one side of the head; sciatica, that of the hip ; gastrodynia, neuralgic pain in the stomach ; pleurodynia, in the side. Angina pectoris is, chiefly, a neuralgic affection of the heart. Symptoms. — The pain is generally acute, shooting or darting, with tenderness of the part upon pressure. There is, however, no heat or swelling, or throbbing of the blood-vessels in pure neuralgia. Complicated eases occur in which inflammation and neuralgia exist together, and in- flammation of the fibrous neurilemma may be the immediate cause of the neuralgic pain. Causes. — ISTeuralgia is always dependent upon debility arising from one cause or another, as, for instance, anemia, mental anxiety, gout, rheu- matism, syphilis and dyspepsia. In fact, a great German authority upon nervous diseases declares, with as much truth as poetry, that "neuralgia is the prayer of the nerves for iron in the blood." l^ext to the sciatic nerve no other is so often the seat of neuralgic pain as the trifacial, and this is, perhaps, partly owing to the fact that the superficial branches are spread out over a large surface upon the side of the face and more exposed to cold and changes of the weather than any other part of the body where the epidermis is equally delicate. Terminal branches of the trifacial come out through the bones of the head at points over the eye, beneath the eye and at the side of the chin — as shown UEUEALGIA. 441 in the marginal illustration. These, then, are the tender points, where all the branches of this nerve are involved in the neuralgia, and it is from these points that the darting bony pains seem to radiate. Hemicrania or Migraine. — This is a combination of neuralgic symp- toms with ordinary headache occurring in paroxysms, and usually limited to one side of the head or brow. It is ajit to conuiience in childhood and go on to advanced age, occurring in both sexes, but more often in women than in men. In women the attacks are especially apt to appear just before the men- strual period or during its course. Causes — The headache is probably due to excitement of the sensitive filaments of the trifacial nerve — distri- buted to the dura mater — and also to the sympathetic fibres accompanying the blood-vessels, which connect the nervous supply of the brain with that of the stomach so intimately. Symptoms. — As gener- ally manifested it increases rapidly soon after waking in the morning, with chilliness, loss of appetite, sliminess of the mouth, sickness of the stomach, vomiting of a little greenish fluid, and at last the headache be- comes so intense as to be almost nnlx^arable. Sciatica. — This is often associated with both rheumatism and gout, but is also frequently brought on by catching cold. Occasionally it is due to accumulations in the bowels, or to diseases of the Ixjnes through whicli the nerve makes its exit. The painful points are usually found back of the trochanter or most projecting point of the thigh bone, at certain spots in the thigh about the knee and ankle joints. Intercostal Neuralgia — This, like intercostal rheiunatism, resembles the pain of pleurisy and of pneumonia, and has often given rise to un- Distrlbutlon of Nerves on the Side of the Face. 433 NEEVOUS DISEASES. founded anxiety as to the existence of these more dangerous diseases. It may be at once distinguished by careful examination of the lungs. Neuralgias of the arms, neck, shoulder, and so forth, are unhappily common and sometimes very intractable. Pathology. — At least three soiirces of pain are possible. 1st. Local disease aifecting a nerve. 2d. A morbid state of a sensorial nerve centre. 3d. A morbid condition of the blood. Neuralgia always fixed or return- ing in the same spot, is likely, although not certain, to depend upon a fault in the nerve itself, as neuroma (tumor of a nerve). Radiating pain must at least involve part of a nerve centre. Flying pains, never long seated in one part of the body, are due to a defect or morbid poison (as that of gout or malaria) in the blood. Treatment of Neuralgia. — 1. This must, of course, depend upon the cause or nature of the case. Tic douleureux often depends upon decay of the teeth; if so, they miist be attended to. Other purely local neu- ralgias require local treatment. Laudanum or paregoric, applied by satu- rating a cloth and laying it upon the part covered by oiled silk to prevent evaporation, is an efficient local anodyne. So is chloroform, similarly ap- plied; it is very pungent, burning like mustard. Sinajjisms will some- times relieve promptly. 2. Mere warmth, as of flannel steeped in hot water, will do in some instances. Rubbing for a few moments with saturated tincture of aconite root until the skin tingles, or the application of ointment of veratria, twenty grains to the ounce of vaseline, may be used in severe cases. In the most obstinate ones a blister may be applied, dressed, after removal of the cuticle, with two grains of the acetate of morphia, diluted with ten grains of gum arable. Carbolic acid is a powerful local anesthetic, though (unless diluted with oil or glycerine) very irritating to the skin ; or, most prompt usually of all, solution of morphia may be hypodermically injected. 3. Of anodynes internally used, belladonna has, for neuralgia, the greatest reputation. It will not quell suffering so directly as opium or morphia, but it will more entirely do away with the neuralgic state. For this, however, iron, especially in combination with quinine or strychnia, is the most effective medicine. Cases of neuralgia which will not be benefited by iron are decidedly exceptional 4. In some instances application of the galvanic current will remove the pain of neuralgia as if by magic, and when relief can thus be secured it is far preferable, as tlie distressing sickness, headache and qonstipation, which so often result from opium and other narcotics, may thus be avoided. DELrEITTM TREMENS. 443 Auxiliary Treatment — The hygienic treatment is almost equally im- portant with the medicinal, and a thorongh examination of the habits of life pursued by the patient will almost always lead to the discovery of some violation of sanitary law, which must be corrected before a hoped- for cure can be realized. PRESCRIPTION I. R. — Menthol 20 grains Ext. Belladonna 5 grains Chloral 5 grains Vaseline 3 drachms Apply the ointment to face where pain is seated. PRESCRIPTION 2. R. — Citrate of caffeine ic grains Phenacetine % drachm Make ten capsules. Take one every 2 or 3 hours. PRESCRIPTION 3- Tablets acetanilide and sodium bromide. One as needed every three or four hours. DELIRIUM TREMENS. Causes may arise imder two different conditions or circumstances. Where stimulants are suddenly withdrawn from one accustomed to them; and, while their use in excess is continued. Symptoms. — Sleeplessness, debility, tremors, horror, hallucinations, often with loss of digestive power. The insomnia is a cardinal symptom ; if the patient sleeps a whole night he recovers. Debility varies in degree in different cases ; in a first attack it is not always great, tremor is nearly always present. The illusions of the patient are wonderfully real, and usually dreadful. He is pursued by demons or beset by moral enemies; he cannot bear to be alone, especially in the dark. Sometimes, however, the visions are indifferent, or even amusing. Treatment — If the patient be not much prostrated, give only ale or porter, a bottle or two in the day, with hop tea ad libitum and a grain of opium every three or four hours. Very weak patients, accustomed to spirits, might have a tablespoonful of whiskey or brandy every two, three or four hours, according to their condition. Hydrate of chloral sometimes 444 NERVOUS DISEASES. answers as well as, or better than, opium. Bromide of potash with tinc- ture of hyoscyanus repeated every three to four hours. Diet. — Beef tea and mutton broth, and so forth, seasoned with red pepper, are preferred as diet. In an obstinate case sleep may follow the raising of a blister upon the back of the neck. Substituting valerian for opium, or combining the fluid extract or tincture of valerian with morphia solution answers well in some cases. Injection of laudanum into the rectum is occasionally resorted to. Success in treatment has been ob- tained from the use of chloroform in doses of one or two drachms. The corrugated stomach of a sj^irit drinker will probably bear the pungency of chloroform better than anetheis. The large majority of first attacks of mania-a-potu are curable. Third and fourth attacks are often fatal, or are followed by permanent insanity. PRESCRIPTION I. R. — Indian hemp lo grains Divide into 12 pills. Take one every two or three hours until drowsy. PRESCRIPTION 2. R. — Hyoscyamus I grain Alcohol I drachm Water I drachm Inject 5 to 10 minims with hypodermic syringe. INSANITY OR MADNESS. Causes — 1. This consists chiefly in a particular organization of the brain and nervous system, rendering those individuals so constituted liable to become insane when exjiosed to the influence of certain agencies, which in other persons either give rise to a different train of morbid phenomena, or are, perhaps, devoid of any injurious effects. 2. Among the agents which give rise to madness there is none more influential than intemiierance, or the frequent use of ardent spirits. That the predisposition to madness, when it has once arisen, is frequently trans- mitted, is a fact too well established to admit of doubt. 3. The exciting causes of insanity may be divided into moral or psychical and physical. The principal psychical are grief, fright, anxiety, care, or an excited state of any passion ; the emotions aroused by disap- pointment, excessive or prolonged employment of the intellectual facul- ties, and so forth. Anything which will produce a hyperemia of a por- INSANITY OB MADNESS. 445 tion or the whole of the brain by which the nutrition and consequently the normal function is interfered with. 4. The principal i>hysical causes are drunkenness and the use of narcotic or poisonous drugs, want of food, want of sleep and over-exertion ; other nervous diseases such as epilejisy, chorea and hysteria; severe in- juries to the head, particularly from blows, causing fracture of the skull or concussion of the brain, sunstroke and tumors in the brain. Acute febrile diseases as typhoid, typhus and malarial fevers, and it may occur during the course of jmeumonia in the form of acute mania. The poison of Asiatic cholera may so interfere with the nutrition of the brain as to produce not only transient delirium but mania, which may continue sev- eral days or weeks. Acute rheumatism is sometimes a cause, chronic con- stitutional diseases are frequent causes, and among the most formidable of these is constitutional syphilis. Diseases of the genital organs some- times exert an important influence in producing insanity. Symptoms — 1. The earliest symptoms of coming insanity are de- pressed manner, unusual excitement, anger and rashness. 2. An important symptom in all forms of insanity is impairment of the faculty of attention. The inconsistency of the beliefs of the insane is one of the earliest noticeable symj^toms, and they are classed as "delu- sions" and "hallucinations." A delusion is a false belief in regard to some fact which generally concerns the patient, and which is so strongly rooted that all attempts to reason him out of it are futile. A hallucination is a false perception of one of the senses ; the patient may fancy that he sees a spirit or a person who does not exist. iMelancholia — This may be acute or chronic, and is marked by ex- treme depression of both mind and body. The first stages of melancholia are generally preceded by a condition called hypochondriasis, which may be considered as the mildest form of insanity. There is a feeling of bodily illness at this time more than at any other, or in any other form of insanity. Treatment. — 1. The treatment of a case of chronic or subacute melan- cholia will vary with its history and symptoms. An asylum is not indis- pensable if the patient's means are sufficient to provide him with proper care. He may be benefited by travel and change of scene ; but when his condition will not admit of this a proper place, either a private house or an asylum, should be selected, and an attempt made by therapeutical and hygienic measures to restore the cerebral defect by sleep and nourishment of the body. 456 NEEVOUS DISEASES. 2. There are three conditions which require constant attention : want of sleep, rejection of food and constipation. To remedy tlie first chloral is most beneficial. The practical aim is to produce sleep, regularity of the evacuations by laxative medicines and to sustain the strength with nourish- ing food and wine. Mania. — There are two varieties, the acute and chronic. In the acute form the excitement is extreme, and follows closely \ipon the delusion or derangement of ideas. In the chronic form the delusion or derangement is confirmed but less obtrusive, while the excitement is subdued or comes on at long intervals. Mania has generally a sort of stage of incubation, during which sleeplessness is one of the most important and earliest symptoms. In another class of patients the primary symptoms are those of gloom and despondency, out of which the maniacal excitement appears to develop. In both varieties there is generally a marked departure from the individual's usual state of physical health. The difPerent forms of mania in which the disposition to commit murder, suicide or arson, or to steal, is quite uncontrollable, are well known. "When a single tendency of this kind is very prominent the case is usually denominated one of monomania. Treatment — The treatment consists on regulating the bodily fimc- tions, giving food freely, combined with plenty of drink, also wine, and in the judicious use of chloral. Kest is of the highest importance, and baths of warm water are of great benefit, the head to be kept cool during the operation. Purgatives at the outset of the attack may be of use, as aiding to arrest it. PRESCRIPTION. R. — Fluid extract of conium i % drachms Fluid extract of hyoscyamus i '-4 drachms Hydrate of chloral 2% drachms Syrup of orange peel I Mt ounces Take a teaspoonful every two or three hours, as occa- sion requires. Dementia — Dementia is literally a want of mind, and the word indi- cates a condition in which there is feebleness of intellectual grasp, or attention, imbecility of word and act and general deficiency of mental power. It is one of the common terminations of both mania and melan- cholia, and if long continued, its outward signs are a vacant and puzzled look, a laclc-lustre eye, a weak smile and a meaningless laugh. This kind of insanity is almost a natural termination of extreme old age and is then iraUEASTHENIA. 447 called senile dementia. Not infrequently the subjects o£ it become paralytic. Imbecility — Imbecility is a condition in -wbich the mind is from birth unfitted for the active and thoughtfid duties of life, and in which the person affected is said to be half-witted, or wanting in general in- telectual capacity. This condition of deficient mental development may be associated with moderately good physical health in early life, but there seems to be usually some taint in the system, so that the family of im- beciles is, as a rule, short-lived, the members dying early of consumption, diabetes, or of some degeneration of the brain and spinal cord. Idiocy — ^Idiocy is a still lower grade of mental weakness, in which the intellectual faculties are below the standard necessary for reasonable life. In the true idiot the head is of a reduced size and the appetites and propensities are very little, or not at all, controlled by reason. Many idiots are deaf and dumb, but most of them retain their sight. The sad condition of these poor creatures may be often ameliorated by systematic training, but complete cure after jjuberty is hopeless. Treatment of Insanity. — The treatment of insanity is generally best carried out in asylums for the purpose. To quiet a patient temporarily, or on his way to a suitable institution, bromide of potassium in quantities of thirty grains, or chloral in fifteen-grain doses every two or three hours, morphia by hypodermic injection, or otherwise, and even chloroform by inhalation may be necessary. NEURASTHENIA. Neurasthenia, sometimes referred to as spinal irritation, nervous exhaustion, etc., is a functional condition of the nervous system, causing a lessened desire to perform or attend to the various duties of life. Causes — Heredity is sometimes a factor; it may be an outcome of various chronic diseases ; nervous temperament ; overwork ; sexual excesses ; alcoholism ; excessive use of tobacco, etc. Symptoms — Neurasthenia may affect any organ of the l)ody. One of the earliest manifestations is a weakness of the mental faculties in not being able to .concentrate the tbotights, endeavoring to do so bringing on headache, fear, feelings of weakness and depression, palpitation of the heart, coldness of the bands and feet and chilliness, often followed by flashes of heat. In males genito-urinary disorders frequently occur with dread of impotence. In females painful menstruation, ovarian irritation 448 NEEVOUS DISEASES. aud irritable uterus are frequently present. Care should be taken in diagnosing to distinguish between neurasthenia, or true nervous exhaus- tion, and nervous debility accompanying some organic disease. TkriVtment. — Sight must not be lost of the fact that the patient is a sick individual and should have rest, quiet and good food. Pleasant com- panionship and relief from responsibility arc essential iind where possible travel is especially recommended, care being taken, however, that the patient does not become fatigued. Among the internal remedies of value are arsenic, strychnia, the valerianates, Pil. Carm-Allen and the hypo- phosphites. Neuritis — Simple neuritis, an inflammation of the nerve trunk, char- acterized by pain (often severe), impaired sensation and atrophy. Among the principal causes may be included wounds, injuries and compression of the nerves, exposure to cold or wet, rheumatism, syphilis. Tlie affected nerve is red and swollen; the fibres have undergone some granu- lar change. The inflammation may extend upward or downward. In long standing cases the diseased nerves are found to be made up largely of connective tissue replacing the degenerated structure. The most de- cided symptom is pain, with tenderness along the course of the nerve trunk, of a burning, tingling, tearing and often intense character, in- creased by pressure or motion. Sometimes contractions and muscular cramps occur, followed by impaired motion. The prognosis is favorable with proper treatment. Treatment. — The affected part should be placed at rest. If the dis- ease is severe, blister along the course of the nerve. Internally full doses of iodide of potassium. Sodium salicylate and phenacetiue are often useful. Locally, sedative lotions. Leadwater and laudanum, oil of tea- berry. Various liniments often relieve the intense pain. Syi^hilitic cases, iodide of potassium does the most good. If due to rheumatism, the salicylates and alkalies are indicated. If anemia is present, iron and hypophosphites is indicated. PART IV OF BOOK IV Treats of the structure and diseases of the eye, ear and nose. Abscess in the Ear 480 Treatment of 480 Acne Rosacea 488 Treatment of 488 Adenoids 489 Amaurosis 463 Treatment of 463 Anatomy of the Ear 473 of the Nose 483 Aqueous Humor, Tlie 454 Asthenopia 465 Treatment of 465 Astigmatism 469 Treatment of 469 Auditory Canal 473 Auricle, Eczema of 478 Hematom.a of 479 Boils 480 Bones of the Nose ». . . .484 Bony Tumor of the Ear 481 Cartilages of the Nose 484 Cataract 463 Catarrh '. . . 485 Fetid 487 Nasal 4S5 Catarrhal Conjunctivitis 456 Treatment of 456 Cerumen, Impacted 481 Choroiditis 463 Treatment of 463 Conjunctivitis 455 Catarrhal 456 Diphtheritic 458 Phlyctenular 456 Cornea, The 452 Inflammation of 459 Crystalline Lens 453 Day-Blindness 470 Treatment of 470 Diphtheritic Conjunctivitis 458 Treatment of 459 Drum, Ear 476 Ear, Abcess in 480 Anatomy of 473 Bony Tumor of 481 Diseases of 473 Drum, The 476 Perforation of 482 Thickening of 483 Foreign Objects in 477, 481 Insects in 477 Tumors of 478 Earache 482 Treatment of 482 Ear-Wax 476 Eczema of the Auricle 478 Treatment of 478 Epistaxis 485 Eustachian Tube, Innamniation of.. 483 Exostosis 481 Treatment of 481 Eye, The 451 Socket, The 451 Structure of 451 Fetid Catarrh 487 Treatment of 487 Foreign Bodies in the Ear.... 481, 487 Treatment of 481 Furunculosis 480 Glaucoma 465 Treatment of 465 Granulated Eyelids 472 Grape-like Tumors 488 Gutta Seroma 463 Hematoma of the .A.uricle 479 Treatment of 479 Hordeolum 471 Impacted Cerumen 481 Inflammation of the Cornea 459 of the Eustachian Tube 483 of the Lachrymal Gland 470 Insects in the Ear 477 29 449 450 INDEX TO PAET IV OF BOOK IV. Iris, The 452 Iritis 462 Treatment of 462 Keratitis 459 Treatment of 459 Labyrinth. The 476 Lachrymal Gland, Inflammation Qf..470 Lens, Crystalline 453 Mastoiditis 479 Causes of 479 Treatment of 479 Membrane, Schneiderian 484 Myopia 466 Treatment of 466 Nasal Catarrh 485 Causes of 486 Polyps 488 Causes of 488 Treatment of 488 Nerve, Olfactory 484 Night-Blindness 470 Causes of 470 Treatment of 470 Nose, Anatomy of 483 Bleed 48S Causes of 485 Treatment of 485 Bones 484 Cartilages 484 Warts on 489 Objects in the Ear 477 Olfactory Nerve, The 484 Ophthalmia 455 Neonatorum 457 Treatment of 457 Purulent 457 Pustular 456 Strumous 456 Ossicles 476 Ozena 487 Perforation of the Ear Drum 482 Causes of 482 Treatment of 482 Phlyctaenular Conjunctivitis 456 Polyps, Nasal 488 Pupil, The 452 Purulent Ophthalmia 457 of Infants 457 Treatment of 457 Pustular Ophthalmia 456 Treatment of 456 Retina, The 451 Structure of 453 Retinitis 462 Causes of 462 Treatment of 463 Schneiderian Membrane 484 Sclerotic Coat, The 452 Sclerotitis 462 Treatment of 462 Semi-circular Canals, The 477 Short-Sight 466 Sight, Weak 465 Socket of the Eye 451 Squinting 471 Causes of 471 Treatment of 472 Stirrup, The 477 Strabismus 471 Strumous Ophthalmia 456 Stye : 471 Treatment of 471 Trachoma 459, 472 Treatment of 459 Trichiasis 471 Tumors of the Ear 478 Bony 481 Grape-like 488 Tympanum, The 476 Vitreous Humor, The 454 Wax 481 in the Ear 476 Plugs 476 Treatment of 481 Warts on the Nose 489 Weak Sight 465 Wild Hairs 471 Treatment of .471 ILLUSTRATIONS Crystalline Lens 454 Curvature of Lens 466 Ear. The 472, 474 Eye, The 461 Eye, Section of 452 Operation for Cataract 464 CURATIVE MEDICINE PART IV DISEASES OF THE EYE, EAR AND NOSE Importance of Subject. — The diseases of the eye are so important, and serious injury or loss of the organs of vision is such a terrible misfortune, that they demand a careful consideration. For the better comprehension of this group it will be needful, however, to give some preliminary ex- planation in regard to the eye, and also the ear and nose, with their appendages. Wonders of the Eye. — The eye is probably the most wonderfully in- genious and complex organ of the human body, and being proportionately delicate, requires to be guarded with the greatest care. Few catastrophes are more grievous than that of total blindness, and most people would rather lose all the other senses than be deprived of sight. Structure of the Eye. — The intricate structure of the eye may perhaps be best comprehended if we remember that its general plan is that of a photogi'apher's camera, the convex glass in the front of which corresponds with the crystalline lens of the eye, a picture of external objects being formed upon the artist's ground-glass plate in the one case, and upon the retina at the back part of the eyeball in the other. The Ketina — Now, the retina is simply the expanded optic nerve, which has the peculiar power of perceiving lights or colors, and the chief difference between the eye and the camera is, that in the former temporary impressions only are perceived by the brain, through the optic nerve and retina, and in the latter instrument these temporary impressions are in- tended to be rendered permanent on the sensitive plate or paper, as a photographic picture. The Eye Socket The eye is carefully protected from accidental in- jury by being embedded in a deep cavity or socket in the solid bones of the face and head, which guard it jealously from attack on either side and at the back. This socket is much larger than the eye itself, and the bony cavity is filled up behind and at the sides of the eyeball with an admirable cushion and packing of soft fat, 451 452 DISEASES OF THE EYE, EAE AND NOSE. The Cornea. — The eye itself, as can be readily seen in that of a pig or sheep from a butcher's shop, is a white ball almost exactly round, except ■where the clear circle projects a little in front. This clear part, called the cornea (1), is as transparent as glass, and set in the space made for it in the white part of the eyeball, very much as a watch crystal is set in its frame. The white portion of the ball, called the sclerotic coat (2), is a tough membrane, very strong and dense, which gives shape to the organ of vision, and protects the extremely delicate structures within. The cornea and sclerotic coat each average about one-twentieth of an inch in thickness. The Iris — Inside of the cornea is a circular curtain, with a round hole in the middle, called the iris (7), so named because it varies so much in color, being frequently blue in blonde individuals, and brown or black in brimettes. The Pupil — The round hole in the centre of the iris is called the pupil, and is the black spot seen on looking into a person's eye. This spot va- ries in size according to the amount of light, being larger in the shade and smaller in bright sunshine. In human beings it always remains round, imless the iris is dis- eased, but in the cat, for ex- ample, it changes its shape, becoming a narrow slit in a strong light. Use of the Iris This closing up of that curious cur- tain, the iris, is a beautiful provision for shutting oil an excessive amount of light, which would otherwise pass through the pupil in too gi-eat quantity, and irritate the sensitive parts of the organ of vision within. The Sclerotic Coat — The sclerotic coat is lined on its inside with a thin layer of black membrane, called the clioroid coat (3), which seems to have almost exactly the same object as the black lining of the photog- Section of the Human Eye. STEUCTUEE OF THE EYE. 453 rajjlier's camera, namely, to absorb any extra rays of light, and so prevent tlie picture from being indistinct. Structure of Retina. — Inside of the choroid coat, and immediately in contact with it, lies the retina, a third hollow ball, made up of an expan- sion of the optic nerve, which enters the eye at the back (8), through openings in the sclerotic and choroid coats. The retina is made up of several layers, the outermost of which is formed by the terminations of the nerve-fibres in what are called the rods and cones of vision. These rods and cones are so wonderfully sensitive that through them we can perceive the differences of color and outline in the images of objects formed within the eye. They therefore correspond to the sensitive plate in the camera of a photographer. Other Portions of the Eye. — The remaining portions of the eye are chiefly useful in forming this image of which we take cognizance, and act upon the light exactly as the lenses of an opera-glass or of a camera do, except that they are provided with a more convenient way of changing the* focus as may be required. The first of these which the light reaches, after it penetrates the cornea, is the crystalline lens (12). Ciystalline Lens — This lens can be readily seen by squeezing it out of the eye of a pig or sheep after death, is very much like a large dew- drop or rounded diamond, in size, shape and general appearance, and is solid enough to bear gentle handling. It has the form of a small, thick magnifying glass or lens, and if held over the letters of a printed book, is at once seen to have the same power of making objects seen through it look larger. Position of Crystalline lens. — The crystalline lens is placed in the eyeball a little behind the iris, and is large enough to extend out beyond the edge of the pupil, unless that opening in the curtain is wider than usual. If it were not so perfectly transparent we could see the crystalline lens every time we looked a person straight in the eyes, as is shown in cases of cataract, a disease where the lens becomes first milky and then opaque, so that its position can easily be recognized, and the edge of the iris seen to move over it, as the pupil expands and contracts under the influence of varying degrees of light. Arrangement of Focus. — Every one who has looked much throiigh a telescope or opera glass, knows that a different arrangement of focus ia needed to show a near and distant object clearly, and that this altered focus is obtained by adjusting the relating positions of the component lenses. In the living eye, nature contrives to obtain this necessary effect 454 DISEASES OF THE EYE, EAR AND NOSE. Flexible Crystalline Lena. of t\YO or more leuses with a single one, by making that one (the crystal- line) soft enough to change its shape a little, as shown in the diagram, and then providing a muscle called the ciliary muscle (M), through the action of which the lens may become more convex, that is, rounded (as at B), and so enable us to see near objects more dis- tinctly. It is the mecharir ical effort required to keep this little muscle con- stantly on the stretch that causes the eyes to feel so tired after long applica- tion over reading small print or doing fine tcorlc of any kind. Hence, avoidance of too prolonged a strain of this nature ^s an important part of the hygienic care of the sight, on account of such a tendency as exists to exhaust the power of this muscle. The Aqueous Humor — The space between the crystalline lens and the cornea is filled by the aqueous humor (11), a watery fluid bathing the front and back of the iris, which, floating thus in a clear, transparent fluid, has an opportunity to move with entire freedom, and so most per- fectly perform its duty as a curtain to shut off any excess of light when- ever there is danger of a superabundance injuring the sensitive retina within. The aqueous humor, being shut in by the convex cornea, must, of course, take the shape of that clear membrane, and, forming with it a convex lens, still further aids the crystalline body in bringing the rays of light to a focus upon the retina, and so forming a sharp image upon that sensitive membrane. Action of Aqueous Humor. — The action of the aqueous humor in this instance is precisely similar to that of water poured into a glass globe standing in the sunshine. Whilst the globe is empty, it has but little ef- fect in concentrating the sun's rays into a focus, biit when filled with water, its power as a lens is considerable, and it may even operate so ener- getically as a burning-glass as to set fire to inflammable substances placed at a proper distance. Want of suitable curvature, and also in many cases the fact of its being curved unequally in different directions, by making the lens or magnifying glass too strong or too weak, has much to do with causing imperfect sight. Vitreous Humor The chief bulk of the eye is made up of the vitreous OPHTHALMIA. 455' tumor, •which receives its name from its vitreous or glassy appearance. This tiuid is contained in the cavity of the retina, and has running through it numerous fine, interlacing fibres, as transparent as itself, which prob- ably help to prevent the delicate retina from being injured by its shaking about during violent movements of the head and body. Duty of Vitreous Humor — The vitreous humor has little or no share in aiding to form the image upon the retina, but does perform an important duty in keeping the globe distended, so that in a sound eye the retina is held at the exact distance, where it can receive images of objects cast upon it in their sharpest and best defined condition. ILo-w to Understand the Eye — -An excellent way to understand fully how the eye acts as an optical instrument, is to actually make a camera of the eye of an ox or other large animal, by cutting away the sclerotic coat at the black part, and then shading this in a small box, for instance, so that the images formed by cornea and crystalline lens can be seen inverted upon the translucent retina at the hinder portion of the eye. Eye Diseases. — The diseases of the eye, according to the nomenclature here followed, are seventy-five in number, so that it is impossible properly to describe the treatment of any but the more important. Among the first of these are to be ranked the diseases of the conjunctiva. CONJUNCTIVITIS OR OPHTHALMIA. Character. — This is an inflammation of the delicate membrane over the front of the eye, covering the whole of the cornea, and the part of the sclerotic coat or white of the eye, which is naturally visible. Symptoms — The usual symptoms of inflammation can nowhere be observed more distinctly than in the eye ; the four great characters of this morbid process, as described by Celsus, about the beginning of the first century, being very apparent. Here, as elsewhere, redness, heat, pain and swelling are the indications of inflammation, just as they were in the days of the old Roman physician, more than eighteen hundred years ago. The redness of the eye in this afEection varies with the intensity assumed, but in severe cases it may completely obscure the white of the eye, so that the whole surface, except the cornea, appears quite red. The pain and burning heat of the eyes are sometimes almost unendurable. The Swelling. — The swelling of the conjunctiva is often so consider- able as to rise up all around the edge of the cornea, and tliis projection of the inflamed membrane may be so great as to prevent the eyelids from 456 DISEASES OF THE EYE, EAE AND NOSE. being closed. Intolerance of light and profuse flow of tears, the latter resulting from irritation sympathetically extended to the lachrjTnal gland, which supi^lies those persuasive drops of salt-water, are common symptoms in some forms. Catarrhal Conjunctivitis — Catharral- conjunctivitis or catarrhal oph- thalmia, as it is also named, is the form of this affection usually produced by cold. Redness and pain, as if a particle of dust had got into the eye, with a free discharge of water, are the first symptoms. Intolerance of light is not very great, unless the cornea becomes involved. Vision may be slightly obscured, but is seldom seriously affected. Treatment. — 1. The treatment consists of active purgation with calo- mel (one-tenth to one-fifth of a grain every hour until one to two grains are taken), followed by epsom or rochelle salts. Soothing lotions to the eye, as, for example, that of sassafras pith with a very little extract of belladoima to begin with, and, after a day or two, applications of weak solutions of lunar caustic (silver nitrate) should be used. R. — Silver nitrate 15 grains Distilled water I ounce Mix. Directions. — Apply to the inner eyelids with a little cotton wrapped on a toothpick or a matchstick. The ap2:)licatiou should be made once a day for several days, and although the caustic solution smarts severely at first, it leaves, after fifteen or twenty minutes, an astonishing feeling of relief to the affected organ, and in favorable cases rapidly red^ices the inflammatory action. 2. To prevent the eyelids from adhering during sleej), and so aggra- vating the trouble when pulled apart in the morning, an ointment should be used, preferably that recommended by Professor Pegensticker, which is a favorite of most physicians. The formula is: R. — Yellow oxide of mercury i grain Vaseline or cosmoline i ounce Mix thoroughly and apply lightly to inner eyelids night • and morning. 3. In many cases "ordinary salt water or a 2 per cent, solution of boric acid will suffice to effect a cure. Simple conjunctivitis of a chronic nature is often associated with catarrh of the nasal mucous mem- brane, and may be cured by correcting the catarrh of the membrane." Pustular Ophthalmia — This, called also phlyetsenular conjunctiritla OPHTHALMIA. 457 and stramous oijhthalmia, is tbe form in whicli the scrofulous predisposi- tion to disease is very apt to manifest itself in young children. It is almost always accompanied with an eczema of the head or face. Treatment — In this aifection general treatment for the constitutional disease is the most important. .The patient should be placed in the best hygienic surroundings. The eyes should be kept clean with an antiseptic solution, as a 2 per cent, boric acid wash, and the yellow oxide of mercury ointment, mentioned above, rubbed into the eyes once or twice daily. Purulent Ophthalmia — This is a more violent and contagious form of conjunctivitis, in which the sight is sometimes seriously endangered. The discharge of thick, yellow pus or matter is abundant, and the inflammation sometimes progresses with great rapidity. Treatment — Active purgation, leeching followed by blisters behind the ears, and application of the stronger solutions of nitrate of silver, are often necessary to preserve the sight. In the contagious variety great care must be taken to avoid conveying the disease from the sick to the well by the use of soiled towels, handkerchiefs, and so forth. Spread of the Infection. — In bad cases it is probable that the infection may occur by being wafted along in the atmosphere through a large room, or even through a whole house, as is seen sometimes in boarding schools and children's infirmaries. Purulent Ophthalmia of Infants (ophthalmia neonatorum). — This is another contagious form of the disease, affecting new-born children and, if not properly attended to, destroying their sight. It is the result of an infection with the gonocoecus which Niesser discovered in 1879 to be the cause of gonorrhea. The inflammation develops in less than three days after birth. Symptoms First there is redness and irritability of the conjunctiva. 2. In about twenty-four hours an excessive secretion of tears and a whitish discharge appears. 3. This is followed later by a swelling of the lids and of the conjunc- tiva and a change in the character of the discharge from a whitish to a yellow, purulent type. 4. The child suffers very little at first, but later, when the discharge becomes more plentiful and thinner, the patient loses his appetite, is rest- less and suffers a great deal of pain. Treatment The treatment is divided into two classes. 1. Prophy- laetive or preventive ; and 2, Curative. 1. That prophylaxis is possible was demonstrated by Crede, a noted 458 obstetrician of Bonn, who reduced tlie percentage of these cases in the wards of his hospital frDin 13 per cent, to less than 2 per cent. Application of the Treatment. — This he accomplished hy dropping one or two drops of a 2 per cent, solution of nitrate of silver in the eyes of new-born infants. This procedure is commanded by law in some com- munities. American authorities only recommend it where the birth canal is presvimed or kno^^^l to be affected. Analysis of Prophylactic Treatment — The Cyclopedia of Medicine and Surgery (Gould and Pyle) says: The prophylactic treatment consists: 1. In removing the disease from the mother before labor if possible. 2. Through disinfection of the vagina before labor with solution of creolin, carbolic acid, boric acid, salicylic acid, mercuric chloride or other antiseptic. 3. Thorough disinfection of the child's eyes as soon as born. These precautions should be carried out in all suspicious cases. 2. Curative Treatment — After the disease has made its appearance, the most strenuous efforts and the most unceasing vigilance and care are demanded to prevent a partial or total loss of sight. Many of the blind we see about us, for whom we feel so much sympathy, can blame their un- fortunate condition upon the lack of treatment in the first few days of their lives. If possible a physician should be summoned at once and his orders followed implicitly, and it may be necessary for him to see the child several times a day to make the necessary applications. Eules for Treatment. — If a physician can not be had, thorough atten- tion to the following rules will probably result in a cure: 1. Cold applications which tend to lessen the amount of local inflam- mation. 2. Frequent and thorough flushings of the eyes with mild antiseptics, as boric acid in distilled water all day and night every hoiir or two. 3. The application of lunar caustic (silver nitrate) ten grains in the fluid ounce of distilled water, two or three times a day. 4. If any ulcers appear on the cornea, weak yellow oxide of mercury ointment should be rubbed, thoroughly but gently, into the lids twice a day. 5. Xourishment, cleanliness and warmth must be maintained. Diphtheritic Conjunctivitis — This is a condition of the eye caused by an infection with diphtheria. Fortunately it is extremely rare in America. Symptoms. — Pain is present, the lids are swollen and hard. The dig- DISEASES OF THE COENEA. 459 charge is scanty and may be watery or a thin pns. The constitutional symptoms of diphtheria may be present. Treatment — Instillations of very weak solutions of atrophine will re- lieve the pain. Antitoxin should be administered very early. Otherwise the treatment is the same as in purulent conjunctivitis. Trachoma — Granular conjunctivitis, or granular lids, is also a con- tagious disease of the eyes. Symptoms — The inner sides of the lids become rough, inflamed, and covered Avith little projections which irritate the cornea at every move- ment of the ball or lids. It seriously affects vision, and is often very obstinate, but can frecjuently be vastly benefited. Treatment. — 1. Perseverance in constitutional treatment. 2. Local applications of nitrate of silver solution, or sulphate of copper to the granulations. 3. Unless improvement follows soon, local treatment should be dis- continued and a specialist consulted. There is rarely complete recovery. DISEASES OF THE CORNEA. Causes — Keratitis or inflammation of the cornea may occur from a punctured wound of the eye, or it may be the result of the scrofulous dia- thesis, or even more commonly of inherited syphilis. It occasionally resiilts in ulceration of the cornea, which sometimes perforates this struc- ture and, allowing the humors of the eye to run out, irrevocably destroys the sight. Treatment — Local treatment of the accompanying conjunctivitis and the use of atropia to keep the pupil dilated, so that it, the iris, may not become involved in the inflammation, are important, but the chief reliance must be placed upon constitutional remedies for those general diseases, of which this affection of the eye is little more than a symptom. The white spot or scar left by an ulcer of the cornea is generally permanent, and not only disfigures the organ of vision, but more or less completely obscures the sight for life. Preventive Treatment — Since a scar of this kind is so injurious and when once fully formed can scarcely ever be removed, the ounce of preven- tion is of tenfold importance, and every care should be taken, by securing the most skillful treatment for ophthalmia as promptly as possible, to re- duce to its smallest dimensions the danger of such a catastrophe to sight. 460 DISEASES OV THE EYE, EAE AND NOSE. THE EYE Figure No. i. — Iris, ciliary muscle and coroidca membrane. 1. The pupil. 2. Ciliary muscle. 4. Arteries of the coroidea mem- brane. 5i5.5.S- Sclerotic tunic, cut circularly and removed. 7. The optic nerve. Figure No. 2. — Vertical section of ihe pupil. Figure No. 3. — Artificial eye. Figure No. 4. — External muscles of pupil. I. Part of the sphenoidal hone to which some muscles are at- tached. 2.2. External straight muscle. 3. Optic nerve. 4. Internal straight muscle. 5. Upper straight muscle. 6. Lower straight muscle. 7. Upper oblique muscle. 8. Insertion of the upper oblique muscle of the pupil. 9. Lower oblique muscle. 10. Sclerotic tunic. 11. Cornea. .12. Cartilaginous pulley of the upper oblique muscle. Figure No. 5. — View of the second pair of optic nerves. 1. Globe of the eye. The left, per- fect. The right one has the sclerotic and coroidea tunics removed, sliovving the retina. 2. Quiasm of the optic nerve. 3. The whitish bodies. 4. The infundible. 5. Varolius bridge. 6. The medulla oblongata. 7. Third pair: motor nerves of the eye. 8. Fourth pair : pathetic. 9. Fifth pair: trigcminous. 10. Si.xth pair : external motors. 11. Seventh pair: auditive and facial nerves. 12. Eighth pair : pneumogastric, ac- cessory, spinal and glosso- pharyngeal. 13. Ninth pair : hypoglossus. Figure No. 6. — Lachrymal apparatus (the skin of the eyelid has been re- moved). 1. Cartilage of the eyelid. 2. Insertion of the eyelashes. 3,3. Lachrymal ends or openings of lachrymal canals in the eye- lids. 4. Conduit to the nose. 6. Cul-de-sac at the orbital extrem- ity of the canal. 7. Lower corner of the eye. 9. Lachrymal gland. 10,10. Canals carrying tears to the eye. Figure No. 7. — Formation o* an. image on the retina. Fia. 1. — The iris, the ciliary muscle and coroiilea ineiiil»raiie. Fia. 3. — An artificial eye. FiQ. 2. — Vertical section of the pupil. Fin. 4. — Exfernnl niusoles of the puj>il. F'Q. 5. — View of tlic 6f<'nml pair of optic nerves. Fig. 6. — Lachrymal :ip]>aralus (eyelid skia has been removed). Fio. 7. — Kdrnialion of an imatre in the retina THE EVE. For an explanation of the illustrations see text on opposite page. 46J 462 DISEASES OF THE EYE, EAE AND NOSE. DISEASES OF THE SCLEHOTIC COAT. Symptoms — Inflammation of the sclerotic coat, or sclerotitis, is gen- erally characterized bv the intense, deep-seated pain it causes, and by the pink hue of the white of the eye produced. The chief varieties are the rheumatic and the syphilitic. Treatment. — The treatment is to be more especially directed towards counteracting by general remedies the poisons of these two virulent con- stitutional affections. miTTS. Character. — This is an inflammation of the iris, which may be simple or gouty, syphilitic or scrofulous. Symptoms — Its symptoms are intense pain in most cases, although in others little uneasiness is felt ; change in color of the iris, contraction of the pjupil, and impairment of vision. Inflammation of the iris has always pos- sessed a great interest for physicians, because it is the only cavity lined by a serous membrane into which we have the privilege of looking and seeing what is going on when the membrane which forms its boundary is in- flamed. Hence, the observation of a case of iritis is not only the most interesting, but also the most instructive, lesson in the sciences of path- ology and therapeutics which nature ever vouchsafes to us, as we carefully watch the progress of the disease and the effects of medical treatment from day to day. Treatment. — Since one of the greatest dangers of iritis is that the pupil will be drawn together by the whitish lymph infused in the inflam- matory process, and, by being thus closed, shut off the sight, it is vei'v important to keep this opening of the pupil as large as possible by the use of belladonna, or its active principle, atropia, throughout the attack of iritis. Besides this, general bleeding, or free leeching behind the ears, or on the nape of the neck, followed by repeated blistering, should be em- ployed, and active purgatives with merciiry to slight salivation contribute toward the cure. Opium by hypodermic injection to relieve the intense pain, and cool anodyne applications to the affected organ, are valuable palliatives. RETINITIS. Character. — This is an inflammation of the retina and seldom occurs alone. It may be due to Bright's disease, may result from a specific taint, or may be of the hemorrhagic variety. The last named condition is nearly OATAEAOT. 463 always in the aged and is an occasional accident happening in cases where the kidneys are hard and shnmken. Treatment. — The treatment is of course directed to the disease which causes this inflammation. CHOROIDITIS, Causes. — This is also usually in conjunction with systemic diseases, as tuberculosis, syphilis, rheumatism and gout. The suppurative variety may be due to a blow or may be carried from some distant suppurative process. Treatment. — The treatment is directed to the cause and is mostly general. AMAUROSIS OR GUTTA SERONA. Character — This is a disease of the retina, dependent upon various changes of the retinal surface and ending in an inability of the nervoua expansion to receive and transmit visual impressions from the outside world to the brain. Causes. — 1. It may be produced by exposure of the eye for a longer or shorter period to a white, dazzling object like snow, and snow-blindnes3 is the most familiar example of this affection. 2. It also occurs occasionally from accidents, such as lightning-stroke and blows on the head. 3. It may be due to degenerative changes in the retina following exhausting illness, or connected with sympathetic irritation. 4. Excessive use of tobacco sometimes produces it. Treatment — ^^Vhere the cause of amaurosis can be discovered and removed, some hope of cure may be indidged, but ordinarily the melan- choly fate of becoming permanently blind — as the poet Milton was ren- dered by this malady — awaits the patient. Of course, the earlier treat- ment is imdertaken the better is the chance of arresting the malady before utter destruction of the sight is accomplished. CATARACT. Character. — This is an inappropriate but long-established term indi- cating an opacity of the crystalline lens of the eye. In cataract, the lens becomes white and opaque, first at some point on its surface, or in the capsular membrane which envelops the albumenoid substance of whicli 4G1: DISEASES OF THE EYE, EAR AND NOSE. the lens is composed. The opacity extends, until at length the whole of the lens may be involved, and blindness rendered complete. Development of Cataract — The development of cataract is usually slow in its progress, except in the case of diabetic cataract, or cataract from a pimctured wound, which may form in a few days. The process of becoming totally opaque is called by surgeons the ripening of the cataract, and it is customary to wait for the cataractous change or ripen- ing to he complete before any. operation is attempted for its cure. Causes — Most frequently there is some change in the vascular system supplying the lens, and to this lack of nutrition is due. Senility, diabetes niellitus, convulsions, injury, exposure and privation are the causes. Treatment — No medical treatment, as yet discovered, is of any avail in the treatment of cataract, but the disease may be entirely remedied by the operation of ex- traction, which is illustrated in the accompanying figure. As there shown, a peculiar, wedge-shaped knife, called a cataract-knife, is used to cut an opening in the edge of the cornea, through which the opaque lens is carefully drawn out, and then the eye closed lip and per- mitted to heal. Restoration of Vision. — When successful, as this operation proves in the hands of skillful oculists nearly nine times out of ten, useful vision is restored, and by the aid of very thick spectacles, to substitute the lost crystalline lens, the patient is often enabled to read, write or sew, as well as before being attacked with this disease. This operation of extracting the cataract is generally the most successful with the common form, which occurs in old people, where the crystalline lens is not only opaque, but hardened into a sort of horny substance. Treatment of Other Forms — In some of the other varieties of cataract, such as that produced by wounds or other injuries, especially in young people, the treatment by breaking up the lens with a very delicate knife, about the size of a large needle, is resorted to with success. The old- fashioned operation for cataract by couching, or reclination of the opaque crystalline lens, is now generally abandoned, as being much less satisfac- tory in every way than the process of extraction. Cataract Often Hereditary — The tendency to the formation of cataract Operation for Cataract. WEAK SIGUT. 465 is often hereditary, but something can be done by hygienic care of the eyes to avert, or at least to postpone, its active development. Since it has been found that operatives who use their eyes opposite to a very strong light — such as glass-blowers — are particularly liable to cataract, it is advisable to avoid such exposure as much as possible. Effect of Electric Lights.^ — Very probably electric lights may tend to ju'omote the formation of cataract, unless guarded with special care. It is a curious fact, however, and one which at once disproves the fanciful theory that cataract is a disease of over-civilization and excessive study, that cataracts are frequently met with in animals, especially the horse, where the disease may often be seen in great perfection. GIATJCOMA. Symptoms.— This is a disease in which tte most prominent symptom is an increase in the tension of the eyeball. By primary glaucoma we mean an increase in tension originating in the eye itself independent of any outside influence. Secondary glaucoma is the same condition due to an injury, some previous inflammatory process, or resulting from valvular heart disease, and so forth. If the glaucoma is simple in character, the first symptom is partial loss of vision. In cases of inflammatory character pain may be the first feature to attract attention and may be much more severe at times. Predisposing factors are heredity, excesses of various kinds, gouty or rheumatic tendencies. Treatment — Medical treatment is of value in some primary cases. Warm applications may ease the pain, or instillation of one-quarter to one per cent, solution of eserine. Operative measures of various kinds may be necessary from iridectomy to complete removal of the globe. WEAK SIGHT OR ASTHENOPIA. Weak or enfeebled sight, though a term in familiar use, is not easily defined as specially connected with any constant change in the eyeball. Causes — It may be due to an irritable condition of the retina, or to an impoverished state of the blood. More frequently, perhaps, it arises from a want of power to keep up the accommodation of the eye for dis- tances, to nervous anxiety about the sight, or to the commencement of one of the serious organic diseases about the eyes and its appendages. Treatment. — Except in the latter case, much can be done by treat- 30 466 DISEASES OF THE EYEj EAB AND NOSE. ment, using general and local tonics, and by care of the eyes in the modo to be pointed out in the next article. SHORT-SIGHT OR MYOPIA. Character. — This is a very common condition of vision in which, from the greater convexity or improper position of the lenses of the eyeball, the focus of parallel rays of light does not fall upon the retina, but at some point in the vitreous humor. This error of development, as it often is, •will be better comprehended by the aid of the annexed figure, in which is shown a diagram of the eyeball and the course of the rays of light, to form a clear and distinct image of the arrow, on the retina at h, h. If, however, the eyeball is elongated, so that the retina occupies the position of the line marked 3, as is often found to be the case in near-sighted per- sons, it is obvious that the rays of light will have passed their true focus, The Error In Curvature of Lena. and consequently when they reach the retina in this wrong position can only give a blurred and indistinct image of the object. Remedy. — The remedy for myopia is the use of a concave glass, ac- curately adapted to the particular eye for which it is employed, and just strong enough to render the rays of light so divergent when they strike the cornea that they will be brought to an exact focus upon the misplaced retina, in its unnatural position, making in this way one error precisely coimterbalance the other. Application of the Remedy — This remedy should by all means be applied even in early youth, in order to prevent the effort of accommoda- tion, the straining of the eye to see as much as other children do at school and elsewhere, from not only increasing the myopia, but laying the foundation of more serious disease and ultimately, perhaps, destroying the sight. Increase of Short-Sightedness. — The alarming increase of myopia, and SHORT SIGHT. 467 especially Its prevalence among young people of both sexes in city schools, must have caused many observant biologists to speculate as to the exact mechanism by which the imfavorable influences of our present civilization ■were at work so as to bring about this rapid deterioration of the visual organs in the last few generations of mankind. Myopia Hereditary — There is no doubt also that myopia is hereditary, and that according to the great law of '"the extinction of the unfit," the children of myopic parents are pi'cdisposed to the development of this disease. Hence they will almost certainly suffer from it if they are exposed to conditions which would be apt to engender near-sightedness in healthy eyes, from any taint of hereditary tendency. Preventive Measures — Among the general conclusions arrived at by scientists for aiding in this object, so important to the rising generation, the following are worthy of especial notice : 1. In the iirst place, study-rooms should be well lighted during the day, and especially toward evening, because a feeble or badly-arranged light compels us to diminish the distance between the eye and the book whilst reading or writing. 2. Light should be allowed to enter from the left side. Illumination from the front is more or less dazzling, and obliges the pupils to bend forward too much, or to sit sidewise in constrained and fatiguing positions. Again, light coming from behind is entirely insufScient, because in great measure cut off by the head and upper part of the body of each scholar. 3. The windows of a school-room should be large and high, 'and be arranged along the left side of the apartment, so as to shed the light upon desks placed in rows, at right angles to the wall in which the windows are cut. 4. The light from above, furnished by a skylight, is not so good as that derived from lateral illumination. The light of lamps is recom- mended as being preferable to gas, and the gaslight shining through ground-glass globes is condemned as being particularly objectionable. 6. The inclination of the desk at which the pi:pil sits to read or write Is a matter of no small importance. Desks which are horizontal, or only slightly inclined, favor the development of myopia, by compelling thte scholar to bend the head over a good deal whilst reading or writing. Such a position brings on, as a result of mere weight of the blood, passive con- gestion of the head and eyes, and this in turn results In an Intra-ocular tension, insensible, perhaps, when it first appears, but very marked in its effects when long and constantly continued. 468 DISEASES OF THE EYE, EAE AND NOSE. Children's School Desks — Besides, a child who acquires the habit of leaning forward in this manner is very apt to bend nearer and nearer his book, as the muscles of his back become fatigued, and thus, by straining his power of accommodation at short focus, promote the rapid development of myopia. The desks of school children should therefore be sharply in- clined at an angle of -iO degrees or 45 degrees when used for reading, and their seats should not be too high, and should be furnished with comfort- able backs. 6. Great care should be taken to secure school-books well printed in large, clear type ; since those printed in small, indistinct letters, upon bad paper, with poor ink, as is the case with too many of the classics and the dictionaries in common use, necessitate a close approximation of the eyes to the page, and consequently exaggerated efforts at accommodation, favor- ing myopia. Furthermore, all punishments of school children which con- sist in depriving them of recreation or exercise out of duors, or in adding to their amount of study, and consequent employment of the visual ai> paratus, should be relin(pnslic'd. Faults of School Furniture. — The general principles which must be kept in view in the construction of seats and desks for school children, according to the investigation of Cohn and others, may be expressed as follows : The faults of school furniture which give rise to injurious postures, and so conduce both to myopia and asthenopia, as well as to scoliosis or lateral curvature of the spine, are: 1. Want of, or unsuitable, backs. 2. Too great a distance between the seat and the desk. 3. Disproportion, generally too gi-eat a difference between the height of the seat and that of the desk. 4. Wrong form and slope of the desk. Ideal School Desks. — Dr. Liebreich gives a very clear exposition of the way in which these defects cause the diseases already mentioned, ami concludes with the subjoined recommendations, which he considers, how- ever, less advantageous than what he calls the American jDlan of having the seat and desk made to every child's' measure, or the Swiss system, where seven or more different sizes of seats and desks are manufactured to suit the different classes: 1. One and the same size and model desk should be used for chil- dren and grown-up persons of both sexes. ASTIGMATISM. 469 2. The adaptation to the height of each child should he effected hj varying the height of the seat and the footboard. 3. The edge of the table is always to be in a perpendicular line above that of the seat. 4. ^0 seat is to be without a back, and the top of this is always to bo one inch lower than the edge of the table for boys, and one inch higher than the edge of the table for girls. 5. In all classes where the boys change places the height of the seat is to be regulated in proportion to the average height of the pupils. 6. In all girls' schools, in all those boys' schools where the children do not change places, in boarding schools, and in private schoolrooms, the seat of each child should be accurately regulated in proportion to its height. Back Support, Etc — The support for the back should incline only a few degrees from the perpendicular, and be so arranged as to press upon the spinal column jiist above the hips of the pupil. The breadth of the seat should be considerable, in order to support most of the thighs, and its height just such as to allow the feet to rest easily upon the footboard. The desk should be so arranged, by means of a hinged flap or otherwise, as to hold the book at an angle of 40 degrees or 45 degrees whilst reading, and ihe paper at an angle of 20 degrees whilst writing is being performed by the scholars. ASTIGMATISM. Definition — This term is applied to a defect of sight due to a differ- ence in the curves of the cornea and crystalline lens in different directions ; that is to say, the cornea, for example, may be so cui'ved in the direction of a horizontal line through it as to have a focus of one inch, and be so much less curved on a perpendicular line that its focus in that direction is an inch and a quarter. The result of this different refraction, in different meridians of the globe of the eye, is necessarily an indistinctness of vision, because all the rays of light entering the eye from a bright point are not brought precisely to a point again upon the retina as they should be. Treatment — This defect, which is found to be exceedingly common, especially in myopic eyes, can be very accurately corrected by the use of properly adjusted cylindrical glasses, which are so arranged as to distort the rays of light before they enter the eye just enough in a contrary direction to cause them to be brought to an exact focus by the imperfect cornea and crystalline lens of the astigmatic eye. '470 DISEASES OF THE EYE, EAK AND NOSE. Use of Spectacles. — Spectacles giving this compensation ought to be procured and faitlifuUj worn, not only because their use will tend to pre- serve the e^'es, which would otherwise be apt to grow strained in the effort to niaie up for this defect by accommodating the lens, but also on account of the headache which is often the result of such constant effort to adapt the eye to clearer vision. Day-Blindness — Day-blindness is a term used to describe a disease in which the person affected can only see when the light is subdued, as in the twilight. Night-Blindness. — !Night-blindness, on the contrary, indicates a con- dition in which there is indistinctness of vision, except in a bright light. Causes. — The causes of these two conditions are not very well under- stood, but night-blindness is known to chiefly affect those who have used their eyes too long and too steadily in a brilliant illumination or who have been exposed to intense or sparkling light. Treatment. — liest is the chief means of cure, but prevention of these diseases by the proper protection of the organs of vision by colored glasses, or by the mechanical apijliances mentioned when speaking of light, is in- finitely preferable. DISEASES OF THE TEAR APPARATUS. Characxer. — The lachrymal gland, which suj^plies the tears, and is situated at the upper and outer angle of the eye, is subject to inflamma- tion and the usual structural changes which result from that process. The most common disease, however, connected with the lachrymal apparatus is obstruction of the lachrymal duct or tube, which runs from the inner corners of the eyelids down into the cavity of the nose, and conveys the .tears into the nasal cavity, which, under ordinary circumstances, they merely serve to keep comfortably moist. Causes — This obstruction may result from inflammation of the lining membrane of the duct, caused, perhaps, by cold or brought about by acute or chronic inflammations of the nasal chambers. If neglected, abscess may result requiring surgical interference. Treatment. — In its incipiency attention to the nasal passages and correction of the deformities and catarrhal condition there may suffice to effect a cure of the constriction of the duct. While acutely inflamed, anodyne lotions, as lead water and laudanum, cold or hot applications should be faithfully tried. When dilatation of the duct is demanded it shotild be continued until a cure is effected. DISEASES OF THE EYELIDS 471 DISEASES OF THE EYELIDS STYE OR HOEDEOLTJM. A stye is a little boil at tke edge of the lid. Causes. — When styes recur, refractive errors should be at once sus- pected and corrected. Ill health favors a stye as it does boils in other localities. Uncleanliness is sometimes the cause. Symptoms — These are so well known that it is not necessary to go into them. Suffice it to say that when a yellow spot is discernible on the stye, it is ripe and should be opened. Treatment — To hasten the pointing of a stye, apply hot compresses for fifteen minutes every two hours. Tonics are indicated in the debili- tated ; glasses — properly fitted — should be worn, and a boric acid eyewash used until long after the stye has disappeared. whd hairs or trichiasis. Dangers. — This is the name for that growing in of the eyelashes, com- monly known as wild hairs in the eye. Even one of these hairs, by rub- bing upon the sensitive cornea whenever the patient winks, may cause much irritation and even injury to the sight. Treatment. — Temporary relief is afforded by pulling out the offend- ing hairs with small tweezers, but often a surgical operation is necessary to accomplish a permanent cure. SQUINTING OR STRABISMUS. Character. — This disease is the commonest of the derangements of the eyeballs within their orbits. In it the eye is involuntarily drawn from its straight position to one or the other side, so that the natural and agree- able parallelism of its axis with that of its fellow is not maintained. When the eyes are turned in toward the nose, as is more commonly the case, the strabismus is called convergent, and when the squint is outward, it is spoken of as divergent strabismus. Causes — This defect is due either to shortening of one of the six little muscles by which the eyes are moved in their sockets, or to the spasmodic contraction of one of these muscles, or to paralysis of one of them and relative over-action of its natural opponent. Strabismus is in 472 DISEASES OF THE EYE, EAE AND NOSE. some eases an acquired affection, and may even resnlt from the bad habit among children of imitating deformities of this kind. More frequently it appears to be the product of hereditary tendency. It may affect both eyes in the same person, and even in the same direction, and is then called double strabismus, or it may be confined to one eye, the other remaining j^erfectly healthy. Treatment. — Something can be done in the treatment of this malady when it first commences in children who are not too young to wear spec- tacles by having these arranged with half pieces of black glass, so that the patient is compelled to look straight forward. But the simple opera- tion of cutting through a part or the whole of the contracted muscle is in suitable cases the best remedy, and often, not always, proves perfectly successful in removing the deformity. TRACHOMA (Granulated Eyelids). Trachoma is a highly contagious disease which attacks the eyes. It is a granular conjunctivitis, characterized by small, sago-like elevations on the conjunctiva, followed by the lids adhering to the eyeball, ulcers form and the eyelids contract and are deformed, at the same time destroying the sight. Persons of all ages suffer from this disease and school children are exposed to it in the moimtainous districts of Kentucky and other States in the United States. The disease is spread by the ignorant persons of pauper countries, where their habits are dirty. They usually know nothing of sanitation or hygiene. They live in large numbers in small huts or cabins, which are scarcely large enough for two people; all using the same towel and sleeping in the same bed with the one who suffers from the disease. Prevention — A child or adiilt suffering from trachoma must be iso- lated from the rest of the family, school children, etc. As these cases occur among the very poor they should receive treatment in a public in- stitution. The State and Federal authorities can prevent its spread by appropriating money to fight the disease, by sending into the mountainous districts, physicians and nurses to treat and educate the people; erect suit- able buildings to place the sufferers in until cured. Every person with granulated eyelids or sore eyes should summon a physician, or report the trouble to the local board of health, as immediate attention to the trouble will prevent blindness and protect others. No case DISEASES OF THE EAE. 473 should be treated by home remedies. Delay means blindness to you and others in the com.muniti/. Do not use a towel that any one else uses if you have granulated lids. Do not go near any public place where people congregate. Do not use the family linen, etc. Blindness spreads through ignorance of the individual, the State's and the National Government's indifference to the dangers of gonorrhoea and trachoma by not appropriating funds to fight them. The negligence of the sufferer from gonorrhoea, his shame and lack of treatment are rea- sons for blindness. Educate your children in the danger of these diseases, watch their morals and have them treated when contaminated. Be free from disease before marriage. DISEASES OF THE EAR. Number of Diseases. — The number of diseases of the ear is twenty- foiir, but as a majority of them require for their recognition and effective treatment more or less peculiar and costly apjiaratus, only a few of the most important require notice in this chapter. For the imderstanding of these, however, a brief re- view of the anatomy of the ear is necessary. Anatomy of the Ear The external ear, or auricle, as anatomists call it, is sup- I^osed by many people to be the chief part of the organ of hearing, but in reality the essential pieces lie in- side the head, some, indeed, imbeddod in the most solid bone of the skull, and one so hard that it has received the name of the petrous or rocky portion of the tem- poral bone. Auditory Canal — Besides the auricle, which is all that portion of the ear projecting from the head, the external ear is considered by anatomists Section of Right Ear. 474 DISEASES OF THE EYE, EAE AND NOSE. THE EAR AND ORGANS OF HEARING Figure No. i. I, 2, 3. The inner cavity open, show- ing the spiral lamina. 4, 5, 6. Rest of the cells of the inner cavity. 7, 8. Vestibule. 9, 10. Upper canal. II, 12. Lower canal. 13. Outer canal. 14, 14. Semicircular membranous canal. 15,16,17. Acoustic or auditive nerve. Figure No. 2. I, 2. Origin and end of the helix. 3. Antihelix. 4. Antitrajus. 5. Tragus. 6. Lobe of the outer part of the ear. 7. It points to the navicular pit, and is in front and over the wing. 8. Shell. 9. Outer auditive duct. flGURE No. 3. 1. Swelling of the upper semicir- cular canal. 2. Swelling of the outer canal. 3. Swelling of the lower canal. 4. Upper semicircular membra- nous canal. 5- Outer membranous canal. 6. Lower membranous canal. 7. Spaces between the semicir- cular membranous and bony canals, supposed to be filled with coatunni humor. 8. Common duct formed by the union of upper and lower membranous canals. 9. Place where the inner semi- circular canal opens into the elliptical urn of the vestibule. 10. Elliptical urn which contains the: 11. Breschid otocones. 12. Spheric urn containing also some : 13. Otocones. 1415,16,17,18. Expansions of the acous- tic nerve to the membranous canal and the elliptical urn, and also the spheric. 19. Turns of the spiral lamina. .20. Ladder of tympjinum. 21. Nervous expansion to the back swelling. ■ 22. Vestibule ladder. 23. Modiolus. Figure No. 4. I. Thickness of outer covering of inner cavity. 2, 2. Vestibule ladder or upper cover of the spiral lamina. 3, 3. Tympanum ladder or lower cover. 4. Hook of the inner cavity. 5. Centre of the infundible. 6. Round opening communicating with the tympanum. 7. Thickness of the outer cover of the vestibule. 9. Oval opening. ID. Orifice of the aqueduct of the vestibule. 11. Lower semicircular canal. 12. Upper semicircular canal. 13. Outer semicircular canal. 14. Swelling of the lower canal. 15. Swelling of the upper canal. 16. Conmion orifices of upper and lower canals. I". Swelling of the outer canal. Figure No. 5. 1. Normal size. The other is much enlarged. 2. Zone of acoustic nerve. 3. Arrangement of filaments in the vesicular zone. 5. Membranous zone. 6. Bony texture of the modiolu";. 7. Opening between the two lad- ders. Figure No. 6. 1, I. Zone of the acoustic nerve. 2, 2. Filaments of the same in the bony zone. 3, 3. Anastomosis in the vesicular zone. 4, 4. Membranous zone. 5, 5. Fold of outer edge. 6, 6. .'Vxis of inner cavity. 7. The modiolus. 8, 8. Outer bony walls of the inner cavity. 9, 9. Bony layers of the spiral la- mina. 10. Vestibule ladder. 12. Hook of the inner cavity. 13. Infundible. 14. Horse hair passed through the course of the spiral lamina. Pig". 1. — view or the labyrinth In a straight Fig. 2. — View of the left ear In Us normal position, open to show the distribution of the state, nerves. Pig-. 3. — View, very much enlarged, of the Fig. 4. — View of the labyrinth on the left external phase of tlie bony labyrinth of llie ^^i^* wc^. ,,^^^ v,i ,1.^; „,i , w , .....^ side, open throughout, in order to show Us refWlde. 'open', eiposUig^The vestibule a"nd 'its structure— enlarged. contents, etc. Flpr. T,. — Figure or imaginary plan of the Fig. 6. — Vertical section of the Inner cavity Inner cavity of the ear. of the ear, very much enlarged, showing ih>' arrangement and connection of the different parts. THE EAR AND ORGANS OF HEARING For an explanation of the illustrations see text on opposite page. 475 476 DISEASES OF TTIE EYE, EAR ANB NOSE. to include the auditory canal (aj or opening into the head, and the deli- cate tympanic membrane or drumhead (b), which is drawn across the auditory canal like a curtain, at a depth of about one inch and a quarter from the outside. The Ear Drum. — The middle ear, as it has been named, called also the drum of the ear, is bounded outwardly by the tympanic membrane, and inwardly by the bony portion of the labyrinth or internal ear. It in- cludes the Eustachian tube (c), which is a fleshy pipe, communicating- through the head with the upper and back part of the throat, and it con- tains the ossicles or little bones of the ear (d, e, and f). Ossicles or little Bones — The ossicles are three in number, and are named from their resemblance to the familiar objects after which they are called — the hammer (d), the anvil (e), and the stirrup (f). These re- markable little bones play a curioiisly elaborate part in the mechanism of hearing. The Labyrinth. — The chief portions of the internal ear, or labyrinth, as it is often called, on account of its perplexing structure and function, are the cochlea or snail-shell (g), and the semicircular canals (h). The appearances of these are sufiiciently indicated by their names, and their positions can be best understood by looking at the adjoining picture. Tse of the Auricle. — The object of the auricle in man is to collect the waves of sound, just as the broad mouth of an ear-trumpet does, and it seems to have no other duty in the process of hearing. In order to pre- vent, as far as possible, the entrance of insects with the sound-waves into the auditory canal, the exterior opening of this tube is guarded by stiff, coarse hairs. Ear-Wax. — It is also generally covered with a sticky, bitter substance, the ear-wax, secreted by numerous ceruminous glands (i), apparently to stop, or disgust, any adventurous creatures which may attempt to make their way in toward the drum. This provision is highly necessary, be- cause the tympanic membrane is so exceedingly sensitive that a very slight touch, even from the foot of a small insect, would cause intense pain. iDelicacy of the Drum. — On account of this great delicacy of the mem- brane of the drum, it is unsafe to put any hard object into the ear for the purpose of cleansing it. Hence, the corner of a towel is far better to wipe out the ear than an earjiick or any other solid instrument. Wax Plugs Sometimes a firm plug of wax accumulates in the ex- ternal auditory canal, and causes deafness, which, however, can be en- DISEASES OF THE EAE. 477 tirely and immediately cured if the hardened wax is removed by syring- ing with warm water. Foreign Objects in the Ear — When children put heads, grains of corn, and so forth, into their ears, no attempt should be made to pick them out with hairpins or bodkins, lest, on the contrary, they bo pushed further down the tube. It is much wiser to send for a physician, who is provided with suitable, delicate forceps for removing them without risk of such a serious addition to the original misfortune. Insects in the Ear. — If an insect makes its way into a person's ear, notwithstanding nature's safeguards against such an accident, the patient should at once lie down on the opposite side and have the affected ear filled with olive oil, which wiU probably kill the creature and cause it to float up to the mouth of the auditory canal, where it can be picked out. Oface of Auditory Canal. — The office of tlie auditory canal is to convey sounds, after they have been collected by the aiiricle, to the drum-head, which is caused to vibrate just as that of a soldier's drum does when it is beaten, or rather as the sounding-board of a piano does when the keys are struck. The vibrations thus produced are transmitted along the chain of ossicles, that is to say, the handle of the malleus or hammer, being fastened to the tympanic membrane, moves with it. In thus moving it tilts the incus or anvil slightly over, and this motion of the anvil in its turn causes a slight oscillation of the stapes or stirrup. The Stirrup. — But the stirrup is fastened by its foot-plate to the membrane covering a little hole in the bony Avail of the labyrinth, called the oval window, so that any vibration of the drum-head or tympanic membrane is carried along over this chain, or bridge of bones, to the cov- ering of the oval window. Behind this latter membrane the whole laby- rinth is filled with a watery fluid, which bathes the terminations of the auditory nerve in the cochlea. The Semicircular Canals — The exact use of the semicircular canals is not understood, but there is little doubt that the fine hairs proceeding from cells found in the cochlea ai'e thrown into vibrations by undulations trans- mitted from the membrane of the oval window through the fluid contained in the cavities of the labyrinth. Then these vibrations of sound are per- ceived by the delicate nerve-fibres, in whicli auditory nerve terminates, very much as the imdulations which constitiite light and color are per- ceived by the filaments of the o])tic nerve, where they terminate in the rods and cones of the retina. Obvioiisly, with such a complicated and excessively delicate mechanism for carrying on the process of hearing. 478 DISEASES OF THE EYE, EAE AND NOSE. the wonder is, not that few people hear imperfectly, but that everybody is not as deaf to all sound as the world has been in previous ages to the teachings of hygiene. DISEASES OF THE ATJKICLE OF THE EAR. Ear Tumors. — This outer part of the ear is the occasional seat of gouty and otlier deposits, which give rise to prominences and irregularities of its surface ; it may also bo affected with a kind of vascular tumor called hajmatoma, and still more frequently be the seat of benignant and malig- nant or cancerous tumors, and of various malformations. Sizes of the Ear. — In persons of slight and delicate organizations, with a scanty stock of vitality, the outer ear is often exceedingly small, altliough it may be perfectly shaped. In persons of large build and actively cir- culating blood, the auricle is sometimes relatively large, the lower lobe being pendulous and of exaggerated development. What Large Lobes Indicate. — As a rule, a large lobe of the ear indi- cates a free vascular supply of blood to the brain, and is said to be to some extent a sign of epilepsy, and of other kindred nervous diseases. Danger from Earrings — If people choose to run the risk of suffering from the dangerous little tumors which are sometimes caused by the barbarism of wearing earrings, they shoiild be very careful to diminish the chance of iujiiry as much as possible by having the auricle pierced with a clean, bright instrument, and by preventing the cartilage, which sometimes comes quite low down in the lobe of the ear, from being wounded. Boxing and Pulling Ears — Children should never be punished by "boxing" or pulling the ears. The former piece of brutality might in- stantly burst the tympanic membrane, causing deafness for life, and the latter is liable to originate severe inflammation of the auricle, leading to the same unfortunate result. ECZEMA OF THE AURICLE. Symptoms. — The symptoms of this affection are the same as of aciite eczema and the reader is referred to the article on that subject. There is also a chronic form in which the skin is thickened and crusts are formed. Causes — 1. Detention, when it is due to nerve-irritation. 2. Discharges from the ear which irritate the auricle. DISEASES OF THE EAJJ. 479 3. Hoods by pressing the auricle against tlie side of the head and pre- venting the evaporatiou of the perspiration. 4. A chronic form sometimes found in old peojjle is due, likely, to a weakened "tone" of the tissues. Treatment. — The treatment is the same as in eczema of other parts of the body. Where it is possible, the cavise should be removed. Cleanli- ness is essentia], but water is contra-indicated and the crusts should be removed by olive oil. The ammoniated mercury ointment, which is oiScial and to be had at all drug stores, should be applied twice daily after thorough cleansing. Cod-liver oil and iron ai-e often used as internal remedies. HEMATOMA OF THE AUKICLE. Definition. — This is a swelling of the auricle in which there is an infusion of blood between the cartilage of the auricle and the perichon- drium. It is frequently caused by traumatism and often occurs in the insane. Symptoms. — The symptoms are swelling and slight pain. Treatment — Gruber recommends, if the blood is coagulated, incising the tumor and removing the clot. Painting with tincture of iodine is advised for the thickening. Cold or warm applications may be tried to relieve the pain. MASTOIDITIS. This is an inflammation with pus filling up the porous j)ortion of tlie mastoid bone back of the ear. It may be primary or secondary, though the latter is seldom observed. Among the predisposing causes are inflam- mation of the middle ear, exanthematous diseases, la grippe, tuberculosis, syphilis and pathogenic infections. There are instances on record where it has existed for months without subjective or objective signs, but as a rule it characteristically manifests itself at an early stage. Symptoms — The symptoms of acute or primary mastoiditis are heat, redness and swelling of the skin behind the auricle, and tenderness upon pressure. This primary disease usually terminates in three or four days in recovery or else in an involvement of the deeper structures with the formation of an abscess. In the secondary form the symptoms vary in difi^erent individuals, manifesting themselves before or after spontaneous rupture of the drum. Tenderness, persistent or remittent pain and redness with swelling over 480 DISEASES OF THE EYE, EAK AND NOSE. the mastoid and bulging of the superior and posterior auditory canal, are the most prominent symptoms. The temperature varies from normal to 10-i degrees F. and is much higher in infants as a rule than in adults. If the ease be observed before rupture the drum will be seen bulging in the posterior and superior portions. After the rupture of the drum the discharge from the ear is usually profuse. Treatment. — The treatment of mastoiditis is divided into medical and surgical — ^by medical in this instance being meant minor surgical methods and the application of antiphlogistic remedies. When early ob- served effort should be made to abort acute inflanmiation of the mastoid by cold application by use of the Leiter coil or cracked ice bags. This should be continued for twenty-four hours without interruption. The patient should be absolutely confined to bed and given light diet and gentle purga- tiva If the pain and inflammation continue after forty-eight hours an operation will in most cases be necessary. To relieve elevation of tempera- ture, acetanilid in five-gTain doses may be repeated hourly until fifteen grains have been taken. Mastoiditis is of suck serious character and is liable to such com- plications that if it be suspected the best medical advice obtainable should be secured without delay, for none but an expert can properly care for the sufferer from this disease and know just whether an operation be necessary or not. DISEASES AND AFFECTIONS OF THE AUDITORY CANAL BOILS OR FURUNCULOSIS. Character. — This is one of the most painful maladies that flesh is heir to. It is rendered so frightfully painful by the fact that it is shut in between a layer of strong cartilage and solid bone. Probably the most common cause of abscess in the ear is taking cold, although picking the ears with hard, sharp instruments sometimes seems to excite it. As it is impossible to tell which side of the auditory canal the abscess is going to form, early in the case, lancing must be deferred. Treatment — As a rule, all that can be afforded in the way of relief is gained by hot poultices made out of ground flaxseed, bread and milk, or little bags of hops dipped in hot vinegar and changed very frequently, or as soon as they grow cool. As soon as the abscess is well localized it should be opened by a physician, thereby relieving the patient of a great deal of suffering. In the meantime some respite and sleep may be ob- FOREIGN BODIES IN THE EAE. 481 tained by the use of opium suppositories containing one grain eacli useil every four hours, or hypodermic injections of one-eighth to one-half of a grain of morphia. BONY TUMOR OR EXOSTOSIS. Causes. — An exostosis or bony tumor occasionally springs from the walls of the auditory canal, pushing the mucous lining before it, and filling up part or all the calibre of the tube. It is most frequently mot with in people of a rheumatic or gouty tendency. Until chiseled away it is sometimes very painful and a serious obstacle to hearing. WAX OR IMPACTED CERUMEN. Causes. — This is the name given to that condition in which the canal is partially or completely filled with ear-wax. The wax may be very hard and may be mixed with dirt and dust. It is caused sometimes by the shape of the canal, and on the other hand is often due to one's occupation. Symptoms — Deafness, dizziness and buzzing in the ear are frequently complained of, but to make sure that impacted wax is i^resent it should be seen. It appears as a dark mass in the canal. Treatment — If the wax is soft, it may be removed by repeated syring- ings with warm water. If it is hard, the canal should be filled with warm olive oil and then the syringing tried. An instrument of any kind should never be introduced into the canal for its removal by the unskilled hand. FOREIGN BODIES IN THE EAR. Symptoms. — Inanimate foreign bodies, such as beads, buttons, grains of corn, etc., give rise to the same symjjtoms as impacted wax. In tlio case of grains, water tends to swell them and so makes their removal more difficult. In such cases the surgeon should be called upon. .Use of Syringe — Insects occasion great pain which may simulate intense neuralgia, or, by a reflex action, may refer the pain to the teeth and so lead one astray. The syringe should be used and heated water is very grateful to the patient, soothing the inflamed part. Great care is necessary that the water is not hot enough to do injury. tt 482 DISEASES OF THE EYE, EAE AND NOSE, DISEASES OF THE TYMPANIC MEMBRANE OF THE EAR EARACHE. Character — Inflammation of the drum-head is an acutely painful affection, sometimes attended "with fainting fits in its early stages, and usually resulting in deafness because the membrane is left thickened, and therefore incapable of properly responding to the vibrations of sound. Treatment. — Leeching, followed by blisters behind the ear, or on the nape of the neck and opium internally or hypodermically, to mitigate the suffering, which is often Tery severe, will prove of great value. Hot applications to the ear in the shape of bags of hops, a stove lid wrapped in flannel, or the hot-water bottle may be sufficient to give relief. Treatment of Children. — In young children a hot foot bath will relieve by dilating the small blood-vessels of the lower extremities and so drawing some of the blood from the inflamed area. As hot water as can be borne may be dropped into the ear. A two per cent, solution of cocaine will generally relieve the pain. PERFORATION OF THE TYMPANIC MEMBRANE. Causes. — This is especially liable to occur during the course of scarlet fever from suppuration of the middle ear, and if neglected leads to per- manent deafness. Hence, in scarlatina, the ears of a child should be carefully examined daily with the little conical ear-speculum, if there is the slightest complaint of pain in them, in order to prevent this disaster by early puncture of the drum-head, which allows the escape of the im- prisoned pus, and so saves the organ of hearing. Still, when the per- foration remains in the drum-head the auditory sense is often only slightly impaired. Treatment. — Suppurating or running ears need, above all things, that cleanliness should be maintained as much as possible. If pus remains in the middle ear, a chronic inflammation is kept up and normal tissue is destroyed — eaten away as one might say. Hearing becomes more and more difficult and lif^is constantly in jeopardy, for the bone may become affected and the brain finally exposed to infection and a brain-abscess develop. Cleanliness may be maintained usually by washing out the ear with a hot solution of carbolic acid two or three times daily. A two per cent, strength is sufficient. If this fails to cure the ear, whick would DISEASES OF THE NOSE. 483 be evidenced hj a cessation of all symptoms, especially pain and discharge, a specialist should be at once consulted. Dead or necrosed bone may be present, or granulation tissue — "proud flesb," — and shoidd be removed as soon as possible. Thickening of Tympamiin — Thickening and condensation of the tym- panic membrane are liable to occur in advanced life, the delicate skin forming the drum-head undergoing a slow process of change, by which it loses its elasticity and becomes firm and hard almost like the nail of the finger. Of course, in this condition the vibrations into which it should naturally be thrown are rendered very imperfect, and the hearing is correspondingly defective in old people who are the subjects of this de- generation. DISEASES OF THE EUSTACHIAN TUBE. Causes. — The Eustachian tube is liable to inflammation from exten- sion of disease from the throat, even such a simjjle irritation as that of a common cold. It is also subject to obstruction and contraction, so that the air cannot pass freely through it into the cavity of the tympanum, as it should do in health. When this takes place, the vibration of the drum is interfered with, there is pressure within the cavity, and consequently a sense of fullness and deafness is experienced, which is very oppressive. Treatment. — This distressing condition can often be greatly relieved by calling in a skillful aurist, who may pass a probe or hollow tube along the Eustachian canal into the middle ear, and so restore the communica- tion of the latter with the external air. Diseases of the Middle Ear — ^Diseases of the middle ear and of the internal ear comprise inflammation, ulceration and abscess. All these are very painful, difiicult to recognize with certainty, and, as a rule, beyond the power of any but the most skillful treatment. In every case, an experienced aurist should therefore be immediately called in, and until he arrives the severity of the pain may, perhaps, be held in check by some of the means suggested when speaking of abscess of the auditory canal. DISEASES OF THE NOSE. Anatomy of the Nose — The organ of the sense of smell is much more extensive than people who have never studied anatomy imagine. Instead of being merely a triangular projection of some two or three inches long, and an inch or an inch and a half high, occupying the middle of the face it is a large double cavity reaching far back into the head, and communi- ■tS4 DISEASES OF TIIK KYK, K^Ul AND xNOSE. eating by the posterior uares or hinder nostrils willi tl; ■ upper part of the throat. Tlio external portion of the nose is composed at its \ipper third of small bones, which are continued at its lower part by plates of cartilage. Nose Bones and Cartilages. — These cartilages and bones are covered on the outside with a thin skin, and on the inside with a mucous mem- brane, which, in the deeper recesses of the cavity is identical and con- tinuous with that of the mouth and throat. The external division between the two nostrils is carried \ipward and backward by a flat, very thin bone named the vomer ; and the sides of the two cavities, which are continuous with the exterior nostrils, are partly filled up with soft, spongy processes of boue, three of which are called the turbinated bones, because they are rolled up like a scroll. The Mucous Membrane These turbinated bones are covered, like the rest of the nasal cavities, with a mucous membrane, named the Schnci- derian membrane, richly supplied with blood-vessels, which approach very near its soft and delicate surface. It is from these small, but active, little blood-vessels that the hemorrhage usually comes iu bleeding from the nose. The Olfactory Nerves. — The nerves of smelling, called the olfactory nerves, enter the upper part of the nose through openings in the sieve-like bone, which forms the roof of the nasal fossa. After passing into the nose, these olfactory nerves divide up into a great number of tiny branches, which run along under the surface of the Schneiderian membrane, and are spread'out upon the superior and middle turbinate bones, and on the sides of the partition between the two nasal cavities. The great use of the tur- binated bones and processes is to furnish a large extent of surface upon which these branches of the olfactory nerve can be expanded. *"■ Functions of the Olfactories. — And this spreading out of the olfactory nerve is evidently iu order that the sensitive filaments uiay, on occasion, come in contact with as large a number as jiossible of the exceedingly minute, odorous particles which many substances, such as musk or cam- phor, are constantly giving off in such abundance. How We Smell. — These odorous particles have the power of affecting the terminal filaments of the olfactory nerves in different ways, which we recognize as the agreeable or disagreeable odors of the objects from Mhieh they originate. The excessive minuteness of such particles may be comprehended from the fact that tlie a]>artment of the Empress Jo- sephine iu one of the French Imperial palaces was found, after twenty- NASA I. CATAKKll. 485 four years of disuse, to give off a distinct odor of the musk employed by tliat uui'ortuuate lady when slie occupied it. Uses of the Sense of Smell — The power of distinguishing odors, which to some animals, including all those beasts which pursue their prey by scent, is one of the most vitally important, chiefly serves as a means of gratification or its opposite to human beings. Hygienic Office of Smell. — But altliough the sense of smell does not in civilized communities contribute anything toward sustaining life by help- ing us to secure food, it has a very useful hygienic oiRce, which should never be forgotten, in guarding us against some of the most common and dangerous causes of disease, in foul air and polluted water. Nose as a Warming' Organ — Besides this the nose has an important work to do in warming and, to some extent, jiurifying the air we breathe, as tliat air is drawn through the narrow and winding passages among the turbinated bones. The Schneiderian membrane over which this air passes being generally moist, and more or less covei'ed with adhesive mucus, helps to catch not only the odorous particles, but larger and more hurtful impurities, and so is quite mechanically a valuable protector to hiimau health. NOSE BLEED OR EPISTAXIS. Causes. — Nose bleed may be due to a blow, picking the nose, the pres- ence of a foreign body in the nose, or to the use of instruments in the nose. Diseased conditions within the nose often occasion it. In girls it uuiy replace the natural menstruation. Diseases of the heart, liver and kid- neys niay give rise to it. Treatment. — In cases of slight bleeding, pressure or the snuiUng of ice-water may suffice. If these fail, cotton dipped in a one to ten thousand solution of adrenalin, should be packed into the nostril and kept there for ten or fifteen minutes. Iron, tannic acid and alum — the remedies our grandmothers used — are now supplanted by this modern drug which does not irritate the delicate lining of the nose as the old remedies did. If the adrenalin solution does not check the hemorrhage, it may be necessary for the physician to plug up both the anterior aud posterior nostrils by the aid of an ingenious little instrument which has been devised for that purpose. NASAL CATARRH. Forms and Causes. — "Catarrh" is a word derived from the Greek word l-nf.nrheo, nu'aiiiug to flow down, and is used in medicine to designate a. 48fi DISEASES OF THE EYE. EAR AND NOSE. particular form of iuflammation of the mucous membrane. It has many forms and is due to many causes, and no one has ever found nor ever will find one remedy for catarrh. This truth should be better and more gen- erally known by the intelligent public Causes. — As causes of catarrh may be mentioned : 1. Climatic influences. Many patients lose their catarrh when they change from one climate to another. 2. Inherited predisposition. One caimot inherit catarrh, but the weakness of the mucous tissues may be inherited and so predispose to the affection. 3. Indigestion, constipation, intestinal parasites (worms), heart, limg, liver and kidney diseases are often provocative of a catarrhal state of the nasal mucous membrane. 4. Many fevers at their beginning or during their course are accom- panied by acute catarrhal disturbance. Typhoid fever, measles, and scar- latina are examples. 5. Deformity within the nasal chambers is one of the most frequent factors, and local remedies are of no avail as far as a permanent cure is concerned. In these cases the only sensible treatment is the correction of the deformities, thus bringing the organ into a condition as near the normal as possible. Catarrh as the Cause of Tuberculosis. — There is a general belief that catarrh is to blame for the great majority of the cases of consumption. This needs some modification before it is to be accepted. Surroundings, family predisposition, climate, and weak, non-resisting tissues are as much to be blamed for the occurrence of this terrible malady. Catarrh does, however, play some part as a factor. liability of Infection. — Professor Osier, of Johns Hopkins Univer- sity, says on this subject: "The liability of infection in the cervical and bronchial glands in children is pi-obably associated with the common oc- currence of catarrhal processes in the throat and bronchi." This mean? that neglect of catarrhal conditions in a child makes that child more likely to be infected with tuberculosis, and if the family has a history of tuber- culosis there is all the more reason for thoroughness of treatment of the existing catarrhal condition. FETID CATAEEH OE OZENA. 48^ FETID CATAKRH OR OZENA, Character. — This is a term applied to a form of catarrh characterized by a horrible and peculiar stench and the formation in the nose of crusts of dried secretions upon which the fetor depends. Causes — In some cases it is due to a constitutional disease, as syphilis. In the majority of instances, however, it is the continuation of a catarrhal inflammation, in which the mucous membrane shrinks— atrophies — and the secretions therefrom are changed, becoming more tenaciovis and con- centrated. Symptoms — These are the crusts and the peculiar fetor mentioned above. Treatment. — Cleanliness is the great sine qua non — a fact easily re- membered when one realizes that the fetor is from the decomposing crust. To detach the crusts various washes have been prescribed. A solution of bicarbonate of soda is a good solvent and may be prescribed as follows : R. — Bicarbonate of soda 2 ounces Common table salt I ounce Menthol 4 grains Mix. Directions: Half a teaspoonful in a cup of warm ■water, snuffed up the nose until the nostrils are clear. Use twice daily. Or, R. — Bicarbonate of soda 2 ounces Biborate of soda V> ounce Salicylic acid I drachm Menthol 4 grains Mix. Directions: Same as for preceding presc.iption. Or, R. — Liquor antiseptic alka 6 ounces Use freely night and morning with an atomizer. Or, R. — Dobell's Solution. Dilute with three or four parts of warm water and use as a nose wash. Steam Inhalations. — If these washes are not effectual in removing the crusts, steam or hot vapor inhalations may be tried. In obstinate cases it is often necessary to remove the crusts with some force, either 488 DI8EASKS OF THE EYE, EAR AXD NOSE. with cotton on a probe or with forceps. After the crusts are gotten rid of, antiseptics and deodorizants should be employed. Weak solutions of potassium permanganate, bichloride of mercury, and when the patient can stand the pain, a one-half to a one per cent, solution of formaldehyde. Removal of Dead Bone. — -When the fetor is due to dead bone, the dead bono should be at onoe removed. Treatment of Syphilitic Catarrh. — If a syphilitic taint, cither in- lu riii-d or acquired, is the foundation of the odor, proper constitutional trc.iiinent should be instituted at once and maintained until long after the ]ia,-al symptoms have disappeared. GRAPE-LIKE TUMORS OR NASAL POLYPS. Causes. — Nasal polyps are grape-like tumors which are dependent from the upper and outer wall of the nose — on the inside — and are sup- ])osed to be one of the possible results of chronic inflammation of the lining mucous membrane. They are rarely seen before the fifteenth year. Symptoms — When small they may present no sjTuptoms. If they are large they may cause obstruction to the respiration, pervert the nasal secretions, cause headaches, give a nasal twang to the voice, and, in some cases, undoubtedly provoke asthmatic attacks. Treatment. — The treatment is removal, which may be accomplished by twisting the tumor free from its attachment, by cutting it at its base, or preferably by using a wire snare. ACNE ROSACEA. Nature. — This is a skin disease affecting usually the skin-covering of the nose, is chronic, and is characterized by redness, thickening of the ekin, and more or less acne. Causes. — These are various. According to Brof. Van Harlingen, "in early life it is generally due to anemia and debility, nervous prostra- tion or dyspepsia. In later life the use of sinrituous liquors is often the cmisc. and, perhaps nearly as often, dyspepsia in some of its forms." In women, disturbances of the menstrual function, even pregnancy, may act as a causative factor. Treatment — To be successful persistence in treatment is often neces- sary. The first thing to be done is to remove the cause. "Uterine and menstrual derangements are to be looked after, the stomach and bowels kept in good order, and all hygienic measures used to improve the general WAETS ON THE NOSE 489 health. Alcoholic and malt liquors are to be totally eschewed. Tea and coffee should be drunk in moderation and not strong. Inveterate tea drinkers are very apt to have red noses." The Favorite Drug.- — The favorite drug both for internal and external use in this disease is ichthyol. Internally it may be administered in ])ep permint vrater, equal parts of each, ten drops being the dose and given every four to six hoiirs. Locally it may be used as an ointment or as a paint : R. — Ichthyol I drachm Subnitrate of bismuth i drachm Ammoniated mercury i drachm Vaseline lo drachms Mix. Apply freely before retiring. (Dr. Latoir.) R. — Ichthyol _ I ounce Oil of eucalyptus lo drops Oil of bergamot S drops Mix. Paint on at night; wash off in morning with soap and warm water; then apply dusting powder. (Merk.) Vleminck's solution is recommended by Stelwagon, diluted one to ten parts of water. The formula for the strong solution is: R. — Calcis « . . . . % ounce Sublimed sulphur i ounce Water lo ounces Boil down to six ounces and filter. Apply locally three or four times a day. ADENOID GROWTHS, These growths resemble proud flesh. They grow in the back parr of the nostrils, and are generally due to catarrhal conditions. They block the nose passages, producing snoring and difficult breathing. The treat- ment consists in scraping them away witli a scoop, or even with the finger, to the great relief of the patient. WARTS ON THE NOSE. Treatment. — Warts in this locality are often mistaken by the laity for cancer and afford the charlatan and the advertising doctor an op- portunity to make "cures" of this greatly feared disease. Warts in this locality are treated just as in other parts of the body. PART V OF BOOK IV Tells of the circulatory and absorbent systems of the body and the affections to which they are subiect. Addison's Disease So6 Symptoms of 506 Treatment of 506 Aneurism 508 Causes of 50& Symptoms of 508 Treatment of 509 Angina Pectoris S19 Symptoms SiP Treatment of 519 Arteritis 520 Symptoms of 520 Treatment of 520 Asthma, Heart S20 Ausculation 494 Bloody Tumor S08 Chronic Pericarditis 502 Treatment of S02 Valvular Diseases S16 Symptoms of Si7 Treatment of Si7 Cyanosis 497 Dilatation of the Heart S14 Symptoms of S 14 Treatment of SiS Embolism 507 Symptoms of So7 Treatment of 507 Endocarditis 502 Causes of 503 Diet in SoS Symptoms of 503 Treatment of 505 Enlargement of the Heart 515 Diet in 516 Symptoms of 515 Treatment of 516 Fainting 518 Symptoms of 518 Treatment of 518 Goitre 507 Symptoms of 507 Treatment of 508 Grave's Disease 507 Heart Asthma 520 Symptoms of 520 Treatment of 520 Palpitation of 497 Pang 519 Inflammation of the Lymphatic Glands 512 Symptoms of 512 Treatment of 513 of the Veins 509 Leucocythemia 514 Causes of 514 Symptoms of 514 Treatment of 514 Lymphatic Glands. Inflam — ation of.512 Palpitation of the Heart 497, 518 Symptoms of 518 Treatment of 519 Pericarditis 497 Chronic 502 Diet in 502 Symptoms of 500 Treatment of 501 Phlebitis 509 Symptoms of 509 Treatment of 509 Splenitis 513 Symptoms of 513 Treatment of S14 Syncope 518 Tumor, Bloody 508 Valvular Disease, Chronic 516 Veins, Inflammation of 509 ILLUSTRATIONS Arteries, The S" Heart, The 499 Heart Cavities, Right Side 502 Internal Organs S04 Valves of the Heart 516 491 CURATIVE MEDICINE PAET V. DISEASES OF THE CIRCULATORY AND ABSORBENT SYSTEMS New Medical Views. — Affections of this class were, until recently, supposed to present symptoms of very much the same general character, and therefore to constitute a class of maladies which possessed consider- able unity in their intrinsic nature. They are now, however, found to consist of a variety of distinct affections producing very different and sometimes opposite symptoms. Thus hypertrophy produces increased and dilatation diminished force of the circulation. Tn order, therefore, to appreciate the value and familiarize ourselves with the nature of each class of symptoms, it is necessary to study the several affections in an isolated form. We are thus enabled, on meeting with a compound case — one consisting of a complication of several of the simple affections — to analyze or unravel the symptoms, ascertain the relative importance of each class, and in this manner establish rational and secure principles of treatment. In conformity with this view, the various articles on the diseases of the circulatory and absorbent systems, instead of being as- sembled under the present head, are, for facility of reference, diffused alphabetically throughout the work. ACTION OF THE HEAKT. Hearing the Heart-Beats. — If we apply the ear, with or without the stethoscope, to the cardiac region of a person in health, we perceive most distinctly a series of sounds of a very marked and peculiar kind, sub- divided into uniform parts by a brief interval of silence after every second Bound. Two sounds follow each other instantly, or within so short a space (493) 494 DISEASES OF THE CIECTTLATOKT SYSTEM. that the ear separates them rather by difference in their quality than from the intervention of any notable cessation of sound; then ensues a brief but well-marked pause, which is again succeeded by the first of the timo sounds. This series of sounds may be perfectly well represented, as t) rhythm, by musicial notation. The relative duration of the sovmds and pause is rei^resented by Lawrence to be nearly as follows: the whole being divided into four parts, two of these are occupied by the first sound, and one by the second sound and the pause respectively. Difference in the Sounds — The two sounds differ in kind as well as in duration. The first is nearly double the length of the second, of a graver and more siibdued tone, rather louder at its commencement than at its termination, as if it was about to die away, when suddenly inter- rupted by the second. The second is brief, smart and clear, like a gentle tap with the pulp of the finger on a solid table, or like the sharp sound produced by the pulling back of a valve, the cracking of a whip, or the lapping of a dog. Exactly synchronous with the first sound, there is per- ceptible, in most cases, a well-marked impulse or shock communicated evidently by a body in motion within, in the walls of the chest. Every one acquainted with anatomy and physiology will at once conclude that the sounds and impulse just described are produced by the motions of the heart; and this conclusion will be justified and confirmed by an ex- amination of the pulse in the extremities. It will be found, in all healthy subjects, that there is an invariable connection between the sounds and the pulse ; every stroke of the latter corresponding very accurately with every repetition of the twin sounds; as, under every variation of circumstances as to loudness, frequency, and so forth, the same exact relation is per- ceived, it cannot be doubted that there exists an essential physical con- nection between the causes of the sounds and the pulse. Rhythm of the Heart — The first motion of the heart which interrupts the interval of repose is the auricular systole. It is a very slight and brief contractile movement, more considerable in the auricular appendix than elsewhere, and propagated with a rapid vermicular motion toward the ventricle, in the systole of which it terminates rather by continuity of action than by the sucession of a new movement. The ventricular systole commences suddenly and is accompanied with a considerable diminution of the volume of the organ. Synchronoiis with the systole are the first sounds — the impulse of the apex against the ribs and the pulse in vessels near the heart; in the radials the pulse follows at a barely appreciable interval. ACTION OF THE HEABT. 495 The Diastole Motion. — The systole of the ventricles is followed by their diastole, during which they return, by an instantaneous expansive movement, sensible to the touch and sight, to the same state (with respect to size, shape, position, and so forth), as during the previous interval of re- pose. This movement, or diastole, is accompanied by the second soimd, by an influx of blood from the auricle, by a retractile motion of this cavity most observable at its sinus, and by a retrocession of the apex of the heart from the walls of the ch«st. Next succeeds the intervals of repose, dur- ing which the ventricles remain at rest, in a state of fullness though not of distension, through the whole period intervening between the second and the first sounds; but the auricle remains at rest during the first portion only of the period, the remainder being occupied by its next contraction, with which recommences the series of actions described. 1. The ventricular systole occupies half the time of a whole beat. 2. The ventricular diastole occupies one-fourth or one-third. 3. The interval of ventricular repose occupies one-fourth, or rather less, during the latter half of which the auricular systole takes place. Causes of the Motions. — The auricles, which are always in a state of fullness, arrive, during the first half of the period of ventricular repose, at the state of distension, by which they are stimulated to contract. The object of the contraction at this movement is to propel a small additional quantity of blood into the ventricles for the purpose of bringing them from the state of fullness to that of distension; an object which could not be accomplished without a contraction, as the blood could not other- wise force its way into the ventricles against the resistance offered by their elasticity. The cavities, then, being brought to the state of dis- tension, are by this stimulated to contract; they expel a greater or less proportion of their contents ; in small animals — frogs, for instance — they expel the whole; which is proved by the ventricle being full. In larger animals they do not appear to expel the whole, but the fact does not admit of demonstration. During the act of expulsion, the apex is tilted up, in consequence of the retraction of the ventricles toward the base and upon the auricles, which, in a state of extreme distension, are placed like a fulcrum beneath them. Causes of Diastole Motion. — The diastole appears to be occasioned by several concurrent causes, viz. : 1. That power of the muscle by which it reverts from the state of contraction to that of relaxation, and in virtue of which it exercises a degree of motion. It may be called elasticity. '499 DIBEASKB OF THK CIRCUI>ATORT STSTEM. 2. The distension of the aiiricles, which is greater at this momeni than at any other, as they have heen filling during a longer period ; namely — that of the ventricular contraction, or half a whole beat. 3. The weight of the ventricles collaj)sing on the distended auricles underneath them. 4. The width of the auricular-ventricular orifice, which allows the Wood to shoot in instantaneously and with great facility. It is obvious that, as so many powerful causes conspire to promote the influx of the blood, an auricular contraction for this purpose would be superfluous. The escape of blood from the aiiricles during the diastole causes the slight retraction observable in them at the same moment. The expelled blood being instantly replaced from the vena cava, distension of the auricles recommences, and the same series of actions is renewed. Causes of the Sounds. — -The ventricular systole is the cause of the first sound, by the impulse which it communicates to the blood within it, thereby exciting sonorous vibrations of the fluid. If the sound of the muscular contraction contributes at all to the first sound it can only be in a very slight degree. The ventricular diastole is the cause of the second sound, by the reaction of the walls on the blood, and the con- sequent production of sonorous vibrations, when its cause is abruptly arrested by the completion of the diastole. Hence this sound is loud, brief and clear. The auricles are not concerned in the production of the two sounds, as they take place when these cavities are motionless ; nor do they appear to be productive of any sound, as no third sound is audible. Auscultation or Sounding. — We now proceed to examine more mi- nutely the phenomena produced by the actions of the heart, in health and disease, with the view to deduce therefrom such diagnostic signs as they are capable of affording. It is hardly necessary to premise that the aus- cultatory diagnostics of cardiac diseases are founded precisely on the same principles as those which apply to diseases of the lungs. GENERAL SYMPTQMS OF HEART DISEASE. Physical Signs — Disturbance of the functions of the heart must neces- sarily produce decided effects throughout the whole circulatory apparatus. Appreciable modifications of the arterial pulse of the state of the veins and capillaries show that the circulation is embarrassed. The pulse irregii- lar, unequal and intermittent, as are the pulsations of the heart very PEKICARDITIS. 497 small; but when there is considerable hypertrophy of the left ventricle, the pulse is also hard and vibrating, presenting sometimes a peculiar fremitus, which is most distinct in the carotid, subclavian and radial arteries. In some cases the arterial pulsations succeed one another, stroke by stroke, and this reduplication of the pulse is coincident with a regurgi- tant murmur heard on auscultating the heart. The insufficiency of the aortic valves is characterized by a bellows-murmur at the base, accompany- ing the second sound of the heart, and by a bounding pulse with flexuosity of the radial artery. Symptoms. — When disease of the heart has reached a pretty advanced stage, the existing impediment to the venous circulation is indicated by swelling of the veins near the heart ; those, for example, of the neck and face; and this turgescence is particularly obvious in the external jugular veins, where it is sometimes accompanied by undulatory pulsations, an- alagous to and synchronous with the arterial pulse. This is the venous pulse indicative of hypertrophy of the right ventricle. Further Symptoms — In addition to the embarrassment of the venous, there is embarrassment of the capillary circulation, which declares itself by a livid tint of the 'skin, swelling of the face, j^uffiness of the eyelids, a bluish color of the lips, and more or less injection of the skin of the extremities. Palpitation — As palpitation is under all circumstances dependent on over-excitement of the nerves of the heart, the i^henomenon is always es- sentially the same. The varieties which it presents arise merely from differences in the causes and from the different routes which these causes pursue in order to arrive at and convey their stimulus to the heart. Blue Skin — Cyanosis is a morbid appearance which consists in the skin assuming a blue, purple or violet color, especially in those parts Avhere the cutaneous capillary vessels are superficial, as on the cheeks and lips. It is generally accompanied by difficult respiration, palpitation of the heart with diminution of the natural temperature, an irregular or intermitting pulse, and is often attended with dropsical symptoms, the face especially, in addition to the purple color, being bloated and edematous ; all these symptoms are much aggravated by any exertion. PERICARDITIS. Intensity of the Disease. — Its intensity varies considerably in different cases, being sometimes excruciating and sometimes slight or even wanting, 32' 498 DISEASES OF THE CIKCULATOEY SYSTEM. THE HEART On the opposite page will be found a diagram of the heart. This illus- tration gives a front view of the organ with the pericardium or sac which covers it removed, thus showing the relative position of the heart, lungs and connect- ing arteries. The thin line around the upper part of the heart proper and crossing the arch of aorta shows the cut edge of the pericardium. The fol- lowing is a key to the numbers given in diagram: I — The trachea or windpipe, through which air is conveyed to the lungs. 2&3 — Right and left common carotid arteries. 4&5 — Right and left sub. clavian arteries. The right arises from the innominate artery, as shown in figure 6, and the leTt from the aorta at the termination of the arch. 6 — Innominate artery. The origin of this artery is the arch of the aorta, and subdivides into the right sub. clavian and the right common carotid arteries. 7&8 — Right and left innominate veins or nameless veins. These veins unite to form the superior vena cava. 9 — Superior vena cava or superior hollow vein. Through this trans- mission of blood is made to the heart from the head and neck. ID — Arch of the aorta. The curved parts between the ascending and descending portions of the aorta. II — Ascending aorta or the large arterial trunk arising from the left ventricle of the heart and giving origin to every artery ex- cept the pulmonary and its branches. 12 — The pulmonary artery. The branches of this artery supply all parts of the lungs. 13 — Right atrium and auricula. 14 & 15 — Right and left lung. In the drawing they are laid back, exposing the position of the heart and the various arteries and veins. The air passing through the small air vessels oxygenate or purify the blood, a most necessary function in all warm- blooded animals. The seat of the much-dreaded and fatal disease. Pulmonary Tuberculosis, is in the lungs. 16 — Conus Arteriosus. The upper angle of the ventricle is prolonged into a conical pouch termed the Conus Arteriosus. 17 — The right ventricle or cavity in the heart for the pulmonary circulation. iS— The left ventricle for the general or systemic circulation. DISEASES OF THE CIKCULATOKY SYSTEM. 499 THE HEART For an explanation of this illustration see text on opposite page 500 DISKASKS OK TJIE CI Itc; UI-ATORY SYSTEM. There is also more or less tenderness on pressure over the region of the heart, and its action is notably increased. With these local symptoms are associated those pertaining to the system at large which accompany symp- tomatic fever. As the afPection is almost always developed in connection with other diseases, the symptoms of the latter are of course combined with those of the former. Diagnosis. — The diagnosis or recognition of pericarditis has been ren- dered prompt and positive by means of auscultation and pei'cussion. Soon after the attack the exudation of fibrine occasions a friction sound with the heart's movements, and this is proof of the existence of the disease. Afterward, when considerable liquid has been eifused into the sac, the friction sound may cease, but it is practicable to determine the presence and the quantity of liquid withiii the sac by physical signs, which are obtained only by auscultation and percussion. The danger in cases of pericarditis depends, other things being equal, on the intensity of the inflammation, the quantity of exuded fibrine and the amount of effused fluid. Aside from these conditions, much depends on the diseases with which it is associated. Symptoms. — When developed in connection with rheumatism, it ends in recovery in the majority of cases; but occurring in connection with diseases of the kidneys, with pleurisy or pneumonia, and in cases of pyemia, it ends in death much oftener than in recovery. ^Mien death is not sudden, the disease destroys life by slow asthenia or exhauslion. As a rule from the outset we have acute inflammatory fever, a pungent, burning, lancinating pain in the region of the heart, shooting to the left scapula, shoulder, and upper arm, but rarely descending below the elbow, or even quite to it. The pain is increased by full inspiration, by stretching the left side, and especially by pressure between the pre- cardial ribs, and by forcing the epigastrium upward underneath the left hypochondrium. WTien the inflammation is only subacute the pain is more or less dull, and does not lancinate. There is inability of lying on the left side, and sometimes In any position but one, which is most com- monly on the hack, dry cough, hurried respiration, palpitation of the heart, the impulse of which is sometimes violent, boimding and regular, though its heats may at the same time be unequal in strength, at other times it Is feeble, fluttering and irregular, pulse always frequent, and gen- erally, at the outset, full, hard, jerking and often with a thrill. Causes. — The most frequent caiises are blows or excessive pressure in the pericardial region, inflammation propagated from the lungs or PBBIOABDITISo 601 pleura, and far above all, rheumatism. From this cause children and young persons suffer much oftener than others. The remaining causes are those of inflammation in general, viz., cold, febrile excitement, and so forth. Treatment.- — As regards treatment, acute pericarditis claims in gen- eral the measures indicated in other inflammatory affections. The anti- phlogistic treatment, in as energetic a form as circumstances will allow, should be employed with the utmost promjititude. The loss of a few hours at first may be irretrievable, and hence hesitation and indecision may seal the fate of the jjatient. These measures, however, are in many cases to be modified by the circumstances pertaining to the diseases with which this is associated. Strength of tlie Remedies. — The strength of the remedies employed must in each case be apportioned to the vigor of the patient's constitution ; but the object is the same in all, expeditiously to prostrate the action of the heart, and for a time to keep it prostrate by preventing the re-estab- lishment of reaction. If this object can be accomplished for the first twenty, thirty or forty hours, the disease frequently does not rally, but remains perfectly under the control of remedies. Additional Treatment. — In addition to the above measures diluent cooling drinks — as four scruples of bitartrate, or two of nitrate of potassa in a quart of water, and flavored at pleasure — should be allowed in un- limited quantity, in order by diluting the blood to render it less stimulant to the heart. ISTauseating doses of tartrate of antimony, as one-sixth to one-eighth of a grain every two hours, may be employed with advantage. Colchicum often proves useful, especially so when the disease is of rheu- matic origin. Calomel, trusted still by some and abused by others, may be confined to open asthenic cases in previously good constitutions. Where the rheumatic diathesis is marked, alkalies will ]>v indicated. Carbonate or bicarbonate of potassium, or birarbonate of sodium, may bo given in scruple or half doses, with as much of rochelle salts, three or four times a day. Continued Treatment. — Should pain continue in the advanced stages of the disease, blisters may be resorted to, and repeated in quick succes- sion, with great advantage. For the stage of effusion we have occasion- ally found a third or a fourth necessary, condiiiied willi the use of diur- etics, as squills, juniper, sps. ether, nit., and so forth, varied and cdu- tiuiiod mitil absorjitioii occurs. Tonics will often ])roniote the same end. Convalescence — An individual who has recently been affected with pericarditis is peculiarly liable to a recurrence of it, especially if it has 502 DISEASES OF THE CIECUIATOEY SYSTEM. resulted from rheumatism, and if the reparation has heen incomplete. In this case, should rheumatism return, it rarely fails to be accompanied with a renovation of the pericarditic symptoms. Diet. — A very spare unstimulating diet and extreme tranquillity must be imperatively enjoined until the action of the heart has become per- fectly and permanently natural. This should consist wholly of the weak- est slops, as barley, water gruel, weak tea, arrow root, and so forth. Chronic Pericarditis. — Chronic pericarditis may be a sequel of the acute affection, or the inflammation may be subacute from the first. In some cases the inflammation continues with an abundant exudation of lymph, agglutinating the in- ner surfaces of the sac, and proving fatal by slow ex- haustion. In other cases a large accumulation of liquid takes place, amounting to several pounds in weight, and to the exhaustion inci- dent to the persistance of the inflammation is added the compression of the heart thus occasioned. In both varieties of the disease, as a rule, proves fatal sooner or later. Treatment of Chronic Pericarditis — A rapidly de- pressing case of pericard- itis, with cold, blue skin and feeble, irregular pulse, will require, instead of the above, a supporting or stim- ulating treatment from the first; with dry cups and blisters instead of local or general bleeding; and quinine, ammonia and whiskey, instead of sudorifics or laxatives. Cavities of Right Side of Heart, with tlieir Valves. ENDOCAKDITIS. Signs of the Disease. — Inflammation of the internal membrane of the heart. In this affection the inflamed membrane is in contact with the ENBOCAEDITIS. 503 blood contained within the cavities of the heart ; hence, although fibrinous exudation takes place as in pericarditis, the exuded lymph is in a great measure washed away from the membrane and carried into the circula- tion. A portion, however, adheres to the membrane, roughening the sur- face in contact with the blood, and giving rise to an abnormal sound (an endocardial or bellows murmur), which is an important physical sign of the disease. Moreover, upon the little masses of lymph which adhere to the membrane, coagulated fibrine from the blood contained in the cav- ities of the heart is apt to be deposited, and in this way are produced the so-called vegetations or warty growths, which being sometimes detached and carried into the arteries with the current of the blood, are arrested in vessels too small to allow of their further progress, become fixed and occasion an obstruction which may lead to hemorrhage (hemorrhagic in- farctions), and to the impairment of nutrition within a circumscribed area beyond the point at which the obstruction is seated. These movable plugs or emboli, as they are termed, play an important part in afl^ectiona proceeding from disturbance of the circulation and nutrition in different organs of the body, more especially the brain. local Effects.- — The local effects of endocarditis are also of much im- portance as laying the foundation for progressive changes, especially in the valves of the heart, constituting what are called valvular lesions. The inflammation in endocarditis is generally limited to the left side of the heart; that is, to the endocardial membrane lining the left ventricle_ and the left auricle. Causes. — Like pericarditis, this is very rarely a primary disease, and in the great majority of cases it occurs in connection with acute articular rheumatism. It is evidently due to the same internal agency which in rheumatism causes the inflammation within the joints; this agent, being a morbid principle in the blood, is supposed to be lactic acid. Diagnosis, — Its develojsment is attended with little or no pain or other subjective symptoms referable to the heart; the diagnosis rests wholly upon physical evidence attained by auscultation. The roughening of the endocardial membrane within the left ventricle causes, as already stated, an adventitious sound or murmur, and the production of this murmur, while a patient is under observation, constitutes the proof of the presence of the affection. Symptoms — The symptoms produced are blueness and coldness of the skin, the result of the disease affecting the valves of the heart so as to render them more or less incompetent to perform their functions, and 604 DISEASES OF THE CIRCULATORY SYSTEM. HUMAN INTERNAL ORGANS. THE ITJNGS. Upper Left-Hand Plate. — This handsome plate shows, at the top, the windpipe (trachea) entering the lungs. It divides into two branches, one for each lung, and each branch subdivides, so as to carry air to every part of the lung. Lobes. — The plate shows the two great parts of the lungs, right and left lobes. These are filled with the air cells. Notice in the lobes the immense number of veins which form the circulatory system of the lungs. Heart. — The heart is seen in its true position, to the right of the centre. Pulmonary Vein. — To the left of the centre is seen the great pulmonary vein, carrying the lung-blood to the left auricle of the heart. Pleura. — The pleura niembrano is seen surrounding the entire lungs and wall- ing them in. THE LIVER. Upper Right-Hand Plate. — The liver is the largest gland in the body. Situated on the right side, and partly covers the stomach. Lobes. — The plate shows its two lobes on upper surface and five on under surface. Vessels. — The entire circulatory system is shown — portal vein, hepatic artery, hepatic duct, lymphatic and smaller veins. To the left, in pear-shape, is the gall bladder. THE HEART. Lower Left-Hand Plate. — The plate shows the cone-shaped heart, situate in the cliest, between the lungs, its apex toward the left. Though supplying blood to the whole body, it yet has its own circulation, as seen by its veins. Cavities. — It has four cavities, an auricle and ventricle on each side. The right auriile receives the venous blood and pumps it into the right ventricle. The right ventricle throws its blood into the left auricle. The left ventricle pumps it into the aorta and thence through the body. The upper section of the plate shows the aorta and the great pulmonary vein. THE STOMACH. Lower Right-Hand Plate. — The plate shows the stomach when one is in a re- clining position. Veins. — The numerous veins show how well it is nourished. Li'c'er. — To the left is the liver. Above it is the opening through which food passes from the gullet (oesophagus). At the opposite end is tbe pyloric gate, through \xhich the partly digested food passes into the duodenum (twelve-mch bowel). Muscles. — .^round the stomach, in brown and white, are seen the powerful abdominal nuiscles. The white represents streaks of fatty matter. The stomach is usually about twelve inches long and four inches in diameter Lungs & ffedrtin Position Section of liver The fieart S/iowingThe Great Arfens. TheStomdcfi - /rout view rigure/n Rec/ining Position /fumdn Interna/ organs. COPYRUSHT 19 IG OV E , J STANLEY ENDOCAEDITIS. 505 diminisliiiig the size of the mitral or aortic orifice so as to produce more or less obstruction to the passage of blood. Obstruction of the flow of blood through the orifices within the heart, and regurgitation, lead to enlarge- ment of the organ and to various morbid effects in other organs; indis- tinctness of the heart sound, feebleness and irregularity of the pulse, nausea and vomiting, anxiety of expression and fainting. Treatment — In every case the important question is, less the state of the particular valves than the amount of interference with the func- tional action of the heart. In young persons remarkable recoveries some- times take i^lace. In other instances, adaptation of the heart itself, and of the general system by degrees, is effected, so that quite good health, and even capacity for exercise, niay be attained, while the physical signs of the local organic change remain. Sudden death is less common in heart dis- ease than is pojiularly supposed. The Circulation — The circulation should be kept as tranquil as pos- sible by a quiet life and a moderate imstimulatihg diet. The food, how- ever, should be rather nutritious, comprising a little animal food or soup twice a day, in order to keep the muscular system in general, and that of the heart in particular, in tone. The same may be promoted by a clear, bracing, dry air. The general health and strength may likewise be im- proved by the occasional exhibition of bitters, mineral acid and chaly- beates, with aromatics. The stomach, in particular, should be kept in good order, as its derangements, even a little flatulence or acidity, have a surprising effect in disturbing the action of the heart. The same may be said of the biliary secretion, when there is an unequal distribution of venous power, indicated by hysterical symptoms, and so forth, antispas- modics will be found useful. Value of a Bath. — Attacks of dyspnoea are best relieved by immers- ing all the extremities in warm water, a blanket being thrown around the patient to promote perspiration, and fresh, cool air being admitted to satisfy the craving for breath. While this is being done he should take an antispasmodic draught, composed of either laudanum, camphor, am- monia, and asafetida, combined according to circumstances. It may be repeated two or three times, at intervals of from half an hour to an hour, according to circumstances. Diet. — For the avoidance of attacks the more important of the meas- ures of management relate to a proper regulation of the habits of life as regards diet, exercise and so forth. While excessive muscular exercise is to be avoided, such an amount as is taken, without discomfort, may bs 506 DISEASES OF THE CIECULATOEY SYSTEM. highly useful by improving the general condition of the system ; while excesses in eating and drinking are hurtful, a deficient alimentation is not less so. In brief, the great end of treatment is to render the system tolerant of the lesions as much and as long as possible, and this end is promoted by such a course of management, hygienic and medicinal, as conduces to the general welfare of the economy. ADDISON'S DISEASE. Nature. — Certain forms of general anemia which are neither attri- butable to excessive antecedent hemorrhages, nor to profuse or long con- tinued intestinal fluxes, and which cannot by symptoms be connected with any diathesic state or marsh miasmatic influences, forms of general anemia, in fact, which appear to' supervene under the influence of non- recognizable causes, in which besides the debility and languor of the pa- tient, are characterized by a bronzed hue of the integuments, and which is most strikingly apparent on the skin of the hands, penis, groin, scrotum and axilla. It has been termed by Addison the bronzed disease. Symptoms — The malady begins slowly, and its existence is not at first perceived. The patient has difficulty in fixing with precision the date at which he experienced its earliest symptoms. Its first manifesta- tions are general discomfort, an enfeebling of the physical and moral faculties, and a state of real languor. The arterial pulsations are small and feeble, the pulse full, soft and easily compressed. The appetite is capricious, the patient showing repugnance to animal food, or a dimin- ished appetite. At first digestion proceeds in a normal manner ; at a later stage this function is disturbed by intractable vomiting. This symptom is accompanied by pain, or at least by a painful sensation in the epigastric region. The patient wastes away, and yet the most minute examination fails to discover any sign of organic change sufficient to account for the great disturbance of health and extreme anemia which exist. Finally there is a state of extreme debility. Treatment. — In the treatment, having no specific remedy, we are obliged to direct our measures against the symptoms of anemia ; ferrugi- nous medicines, preparations of cinchona, and a tonic regimen are indi- cated. Decided advantage has followed the use of a combination of glycerine, in two-drachm doses, with fifteen or twenty minims each of chloroform and tincture of chloride of iron. QOITEE. 507 OBSTRUCTION OR OCCLUSION OF THE ARTERIES EMBOLISM. Symptoms. — When the right half of the heart has received an em- bolus and the pulmonary artery is obstructed, collapse o£ the lungs, partial or entire, follows. Pleurisy, hemorrhage or bronchitis may also occur, or the symptoms may be great anxiety and dyspnoea, with reduction of the temperature of the body, a systolic murmur may be heard on ausculta- tion; the rhythm of the heart becomes irregular, and pulsation of the jugular veins may be noticed. Giddiness may be present, with blueness and edema of the hands, feet, or both. Where emboli have become broken up and decomposed, septicemia results, commonly known as pyemia. Treatment. — The objects we should have in view in the treatment of a vessel occluded by an embolus are, to favor the venous circulation through the limb by its elevation, and to establish the arterial collateral circulation by maintaining the warmth of the limb by means of cotton carefully wrapped round it over oil lint. Pain can be relieved by seda- tives, while the powers of the patient are to be maintained by nutritious diet, by stimulants carefully administered and by tonics. When gangrene has taken place the parts may be covered with some antiseptic material, as carbolic acid in a watery or oily solution, one part to thirty, or with powdered chloral. When the line of demarcation has formed and the gangrenous part can be removed by amputation, such an operation may be performed. GOITRE (GRAVE'S DISEASE). Goitre may be simple or exopthalmic. Simple goitre is a local affec- tion with only symptoms such as dyspncea, or the cough as of a broken- winded horse and difficulty in breathing on slight exertion. Exopthalmic goitre is a disease of the nervous system characterized by protrusion of the eyeballs, enlargement of the thyroid gland and palpitation of the heart, a peculiar thrill in the blood-vessels and a general deterioration in muscular and brain power. The veins and arteries of the thyroid glands are en- larged. As a rule the development of the disease is gradual. The goitre is elastic and rather soft. The protrusion of the eyeballs follows the swelling of the gland. The disease is more common with women than with men. 50S DISEASES OF THE CIIICIJ r,AI()KY SYSTEM. Recovery occurs in a fair miiiibpr of cases, Imt the course is slow. Although occasionally sporadic, it is essentially an endemic disease in cold and damp countries, as in the deep valleys of the Alps, the Pyrenees, the North American Rockies, the Cordilleras of South America, and the chalky districts of Derbyshire, England. Treatment. — Simple goitres are to be treated on ordinary principles, viz., by attention to the general health, the inhalation of fresh air and by tonic medicines. Filtered or distilled water should always be taken, moro particularly in districts where chalk, lime and magnesia abound. Iodine has always been held in high repute in this disease, in the form of com- pound solution of iodine, tbree drops in a glass of milk, three times a day. For some years we have employed tonics alone by the mouth, and have ordered the air in the room to be kept iodized by means of solid iodine put into a box with a perforated lid ; the metal thus evapo- rates steadily into the room wlicre the patient sits and sleeps, and in this way it becomes absorbed. ANEURISM OR BLOODY TUMOR. Causes — A low form of iuflnmination of the arterial walls is with- jut doul)t the most common predisjtosing cause, while over-action of tlie heart and circulation is the exciting one. Direct injury to an artery (traumatic) is an occasional cause. s# Symptoms. — Tlie early symptoms of aneurism are very uncertain. It often happens that the patient's attention is first directed to some swell- ing-, although it mav be only that of local throbbing, some weakness or stiffness of an exti-emity, or some nerve pain preceding the discovery of the disease ; yet such symptoms are not constant. When, however, you are consulted for pain which shoots dovsm the course of a nerve running in contact with a large artery, you should allow the thought of aneurismal pressure to pass through your mind, and, when this is associated with the presence of a tumor connected with the vessels, the suspicion of its being aneurismal should be excited. If this timior be soft and pulsating, and becomes tense on the application of pressure to the trunk of the artery on the distal side, and placid, non-pulsatile and vanishing on pressure in the vessel below, the chances of its being aneurismal amount almost to a certainty. Should it expand again readily on the removal of pressure, this expansion is accompanied with a peculiar thrill on the readmission PHLEBITDS OE INlflAilMATlON OF THE VEIKS. SO^ of blood into the sac, with a bellows murmur or aneurismal bruit, svucbro- nous with the pulse. Treatment. — The spontaneous cure of an aneurism is caused by the coagulation of the blood in the sac; how to induce this coagulation by natural processes is our aim ; therefore, it is necessary to have a feeble cir- culation through it ; for this purpose, rest in the recumbent position is an essential point of practice, and shoidd be maintained in every case. When the force of the circulation is too strong and the powers of the patient are good, bleeding under this circumstances is not only rational but scien- tific. Medicines do not seem to have much influence in the coagulating process, though the acetate of lead has been found useful and iodide of potassium. The local treatment is based on similar principles, the aim being to diminish the circulation through the sac. This may be effected by the following means, viz., by compression in one of its forms of the artery above the aneurism, indirect; by compression of the aneurism itself, direct; by the Hunterian oiJeration, viz., the application of a liga- ture to the artery on its cardiac side ; by imitating the rare natural process of closiire of the artery on its distal side by the application of a ligature, or by pressure, or by the artificial production of an embolic plug,, by Fergusson's method of manipulation, and last of all it may lit laid opeu and both ends tied. The treatment by electro-puncture, injection, and the introduction of some foreign body into the sac may be adopted in excep- tional cases. V PHLEBITIS OR INFLAMMATION OF THE VEINS. Symptoms. — The most prominent symptom of an obstructed vein is edema of the parts below the obstruction, some fullness of the superficial veins, local pain and tenderness ; constitutional disturbance of variable degrees of severity generally preceding. When superficial veins are in- volved the symptoms may be chiefly local, but in the case of deep veins constitutional disturbance is certain to accompany local action. Among the superficial veins the saphena of tlie leg and thigh is most commonly affected, and is often a sequelae of a varicose condition. Under these cir- cumstances the tortuous, dilated, indurated vein becomes a marked object, set as it were in a frame of hardened inflamed skin and a cellular tissue. Treatment.— The two great indications for treatment in these cases are to favor venous circulation of the part, and to improve the general condition of the patient. 510 DISEASES OF THE CIECni.ATORT SYSTEM. THT] ARTERIES Figure No. i. — Arteries of the palm of the hand and front of forearm. 3. Deep part of the raised pronator of the radius. 4. Long supinator muscle. 5. Long flexor of the thumb. 6. Square pronator. 7. Deep flexor of the fingers. 8. Cubital flexor of the wrist. 9. Annular ligament, with the ten- dons that pass under the centre of the palm of the hand ; the member is on the tendon of the long palmary muscle divided near its insertion. 10. The brachial artery. 12. Radial artery. 13. Recurring radial artery joining the end of the upper deep one. 14. Superficial veins. 15. Cubital artery. 16. Superficial palmary arch from which spring digital branches to three and one-half fingers. 17. Magna artery of the thumb and radial artery of the index. 18. Back cubital recurring artery. 19. Front interosseous artery. 20. Back interosseous artery passing through the interosseous mem- brane. Figure No. 2. I. Primitive carotid artery dividing itself into carotid external and carotid internal. 3. Occipital branch to the back part of the skull. 4. Upper hyoides artery. 5. Lower pharyngeal artery. 6. Masseter artery. 7. Submental artery. 8. Lower coronary artery. 9. Upper coronary artery. 10. Deep branch. 11. Back cervical artery. 12. Continuation and fold of the oc- cipital. 13. Descending branch for muscies of the neck. 14. Posterior auricular. 15. 15. Temporal artery. 16. Parietal branches. 17. Frontal branches. 19. Orbitary branches. 20. Subclavian artery. Figure No. 3. Thoracic aorta. The three branches from left to right are the unnamed ones. The primitive left carotid and the sub- clavian left one. The small branch in the curve is the bronchial one. Figure No. 4. 1. The liver. 2. The stomach. 3. Upper gut 4. Pancreas. 6. Great mesenteric artery. 7. Gastric branch. 8. Spleen. 9. Pyloric branch. 10. Pancreatic branch. 11. Hepatic artery. 12. Duodenal branch. 13. Cystic artery. 14. Branches to the stomach. IS, 16. Spleenic arteries 17. Gastro-epiploic artery. 18. Descending aorta. 19. Great mesenteric artery. Figure No. 5. 1. Cheek arteries. 2. Coeliac axis. 3. Gastric artery. 4. Hepatic artery dividing itself into right and left branches. 5. Spleenic artery. 6. Supra-renal artery on right side. 7. Right renal artery, which is longer than the left. 8. Lumbar arteries. 9. Upper mesenteric artery. 10. The two spermatic arteries. 11. The lower mesenteric. 12. The middle sacras. 13. The common iliac. 14. Internal iliac of the right side. 15. External iliac. 16. Epigastric artery. 17. Circumflex iliac artery. 18. Femoral artery. Fisure No. I. Fiffure No. 2. Fiffure No. 4. Ficure No. S THE ARTERIES. for an ezpUnatloa of the iUustratioiiB see text uu upputdle 511 512 DISEASES OF TUE CIECULATORY SYSTEM. Tke first is attained by elevation of the limb, the foot being raised liighcr tlian the hip, and by the application of -warmth. The second can be carried out by the administration of a simjjle nutritious diet, tonics, such as quinine, bark or iron, and stimulants carefully adjusted to the wants of the individual case. Pain must be allayed by both local and general means, as poppy fomentations, and the internal use of sedatives. Leeching should never be resorted to, nor the use of mercury. When suppuration appears it must be. dealt with on ordinary principles, but it is well, as a rule, to evacuate it as soon as it has declared itself. » INFLAMMATION OF THE LYMPHATIC VESSELS AND GLANDS. Symptoms. — 1. The absorbent glands with their ducts are liable to in' flamniation, adenitis or angeioleucitis, and this action is the result of the absorption of some septic material. It is almost always associated Avith a wound, punctured or open-inilamed suppurating, healing; with some point of irritation or suppuration, even a papule or pustule; with some centre from which morbific elements may be taken up. In what is called a simple wound the inflammation of the absorbents may be acute, but in poisoned it is violent and diffused. The inflammation always follows the course of the absorbents, leading from the centre of absorption toward the glands; that is, toward the body, and it never spreads backward. When it has reached the glands, the diseased action ceases to spread, that is, it expends its force upon the group of glands in which the absorbents naturally end, and does not extend through another series of absorbents to a second group. When pyemia follows or comj^licates the case, it may be open to question whether the poisonous fluid circulating in the lym- phatics has not been allowed to pass into the blood through its usual chan- nels, viz., throxigh the inflamed glands onward, and set up inflammation in the tubes and glands, was taken directly into the blood through the venous channels, thus giving rise to blood-poisoning. 2. Pain and tenderness in some of the glands are generally early symptoms, and with these, or some following them, will be seen a band of redness varying in diameter, leading from the wound or infecting centre toward the gland. This red line may be continuous or interrupted ; it may be a thin streak or a broad stripe of redness, and in some instances BO radiate into the surrounding tissues as to simulate erysipelas. The whole line of redness is very painful, and with these local symptoms thera DISEASES OF TIIK SI'I.tCION. 513 will also be some febrne disturbance. The red lines follow the course of the absorbents and not of the veins. Treatment — AVhen any indications of absorbent inflammation show themselves the wound or sore should be well cleansed and anv collection of pus let out. The effected limb should be raised, the foot, when in- volved, brought higher than the hip ; the hand or e.bow than the shoulder, and warm poppy fomentations should be applied along the whole course of the lymphatics up to the grouji of glands in which they tenuiuate. As soon as suppuration appears the abscess must bs opened, whether this follows directly upon the inflammation or subsequently. A saline purge should be administered ; sedatives should be given to allay pain. When suppuration has taken place tonics may be administered. In chronic cases, where induration in the track of the ducts remains, mercurial oint- ment and friction are sometimes valuable DISEASES OF THE DUCTLESS GLANDS. The glands without any outlet in the body are three m number, namely: the thyr-oid, situated in the front of the neck; the sjileen, located in the left side below the heart, and the supra-renal capsules, which are placed one over each kidney, deep in the loins on either side of the spinal column. Although the functions of these organs are still tmdetermined, many of their diseases are well knov?n. DISEASES OF THE SPLEEN (SPLENITIS). Symptoms. — Diseases of the spleen may be acute or chronic. The acute symptoms are a sensation of cold and partial rigor, a feeling of weight, fullness and pain in the left side extending to the left shoulder, increased on pressure and coughing ; thirst ; some degree of nausea ; dry cough with the usual symptoms of pyrexia. Wandering pains in the limbs, sometimes ending in collections of pus under the integuments of the thigh, arm, and so forth, are not uncommon in chronic splenitis. In the latter periods of the disease the debility and emaciation become very great; the complexion darkens and the appetite fails. Hectic, more or less violent, comes on with diarrhoea or vomiting of imconquerable per- tinacity and blood is frequently discharged both upward and downward. There is a simple enlargement of the spleen from mere temporary congestion, as when brought on by sudden mental emotion or by oscilla- tions of the circulation from internal causes. In temperate climates the 33 514 DISEASES OF THE CIECULATOET SYSTEM. more permanent enlargement or hypertrophy of this organ, not heing accompanied by the same violence of constitutional disease as in the latter, is usually of a passive character and is owing to relaxation of fibre. The most frequent causes of enlarged spleen are ague (ague cake) and remit- tent fever. The most characteristic symptoms are a sense of weight in the left side with or without evident swelling ; inability to lie on the right side with ease ; debility ; disordered stomach ; dry cough and absence of fever. Treatment — The indications of treatment are: first, to remove the cause ; secondly, to restore the organ to its natural condition ; and thirdly, to improve the general health. If ague be the exciting cause it must be combated by appropriate remedies, warm and brisk purgatives should be given once or twice a week so as to affect the upper bowels. Mercurials should be omitted. The bowels being kept more open than ordinary, the nascent irritative stage having gone by and the case being strictly pas- sive, tonics are to be bad recourse to and especially the acids with prepara- tions of iron. Leucocytheinia. — Leucocythemia or white-cell blood is a disease of the circulating fluid often associated with enlargement of the spleen and supposed to be caused in part by the morbid condition of that organ. The great characteristic of this malady, as its name indicates, is the pre- ponderance of Avhite corpuscles in the blood. Symptoms. — The general or constitutional symptoms are a slowly pro- gressive anemia, weakness and emaciation, with incapacity for exertion, shortness of breath and digestive derangements. The bodily temperature is often somewhat raised and sometimes persistently elevated. The urine may be normal in appearance but less urea appears to be secreted in it. In the later stages there is a tendency to dropsy and to hemorrhage from various surfaces, especially the mucous membranes. The only certain mode of determining this remarkable disease is by a microscopic examina- tion of the blood. Treatment. — ISTo specific for leucocythemia has yet been discovered. The constitution requires generous support, if not stimulation. Tincture of the chloride of iron in doses of ten or fifteen drops three times a day sometimes acts admirably. DILATATION OF THE HEART. Symptoms. — Dilatation of the heart is indicated, upon physical ex- ploration, when, with extended impulse of the heart we have duUnesa on EITLAEGEMENT OF THE HEAET. &15 percussion beyond the usual limits. If true hypertrophy or muscular thickening be present the impulse is very forcible as well as extended. The heart-sounds are apt to be clear, though not lovid, in attenuated dila- tation; rather loud, but dull-toned, in enlargement with thickening. It is most often induced by valvular obstruction or regurgitation, com- pelling unusual and continued eiiorts to sustain this circulation. Some- times, however, it is more truly idiopathic, following causes of over- action of a heart otherwise sound, thus, violent exercise, self -abuse, coffee, tobacco, alcohol, and so forth, are, with good reason in predisposed cases, accused of producing it. Treatment — In the treatment avoidance of such exciting causes and particularly of violent exercise, alcohol and venery, is the main principle. Robust or plethoric patients may bear and be benefited by occasional leech- ing or cupping over the heart. Acetate of lead as an astringent cardiac sedative has proved useful in the dose of one grain thrice daily, with care to avoid saturnine poisoning. Digitalis here acts as a tonic to the heart, through ganglionic influences, lessening rapidity of action when that de- pends on debility, and veratnim viride as a sedative and palliative in violent acceleration of the pulse, as in muscular hypertroj^hy and in some forms of palpitation. ENIAEGEMENT OF THE HEART. Symptoms. — Enlargement of the heart and its extent are easily deter- mined by means of physical signs, palpation and percussion. By the touch it is found that apex beat is more or less lowered and carried to the left of its normal situation. Between the apex and the base of the organ are found impulses not perceptible in health. By percussion the bound- aries of the organ are readily ascertained in the great majority of cases. The vocal resonance also, as heard with the stethoscope, enables the physi- cian to define the limits to which the organ extends. Palpitation and aus- cultation furnish signs by which predominant hypertrophy may be differ- entiated from dilatation. If hypertrophy predominates the impulses of the heart as felt by the hand are strong, and often there is a heaving move- ment extending over the region of the heart. The first sound of the heart, over the apex, is abnormally loud, long and booming. On the other hand, if dilatation be considerable or great, weakness of the organ is denoted by feeble impulses and by diminished intensity, together with shortness and 510 DISEASES OF THE ClKCULATOItV SYSTEM. a valvular quantity of the first sound of the heart in the situation of the apex. Treatment.- — In addition to purgatives we have seen the most decided advantage result from diuretics, and not only when there was dropsy, but equally when there was none. Their mode of operation appears to be ultimately the same as that of jjurgatives, viz., they drain off the serous portion of the blood. We have found many patients, conscious of the benefit which they derived from this class of remedies, to be in the con- stant habit of taking cream of tartar, brown tea and other similar pojjular medicines. One patient, affected with, contraction of the mitral valve to the size of an ordin- ary pea, by these means warded off dropsy beyond the slightest edema of the feet for ten years. When decided dropsy appears it must be combated by the most efficient diuretics, the acetate, or tar- trate and nitrate of potash, squill, digitalis, spirits of nitre, etlier, and so forth, as no class of remedies is more variable and uncertain than this. When one fails another should be resorted to. Diet — The treatment consists of a highly nutritious diet, into which fatty articles should enter sparingly, together with the employment of hygienic measures and remedies designed to give tone to and to invigorate the heart. CHRONIC VALVTJLAR DISEASE. RAV Bird's-Eye View of the Valves of the Heart. Diagnosis — The diagnosis of valvular disease has been rendered very complete by means of auscultation. With very rare exceptions it gives rise to adventitious sounds or murmurs, the characters of which, as re- gards their situation, their transmission in different directions, and their relations to the heart sounds, enable the physician not only to determine their existence but to localize tliem and to distinguish between those which involve obstruction and regurgitation. When valvular disease has ad- CHKONIC VALVULAK DISEASE. 517 vanced sufficiently to produce obvious symptoms referable to eitber ob- struction or regurgitation, or to both, they will destroy life sooner or later. Whether the disease of the valves be cartilaginous, osseous, or con- sist of vegetations, the general symptoms are the same if the degree of contraction be equal. The general sjanptoms are cough, copious watery expectoration, dyspnoea, orthopnoea, frightful dreams and starting from sleep. Edema of the lungs, pulmonary apoplexy, passive hemoptysis (sputa stained with dark or grumous blood), turgescence of the jugular veins, lividity of the face, anasarca, injection of almost all the mucous membranes, passive hemorrhages, esiiecially of the mucous membi'anes, engorgement of the liver spleen, and so forth, and congestion of the brain with symptoms of oppression, sometimes amounting to apoplexy. The preceding illustration represents a hardened section of the heart, cut transversely across the organ so as to show how the pocket-like valves come together in the middle of the openings in order to close those orifices. At LAV are seen the two flaps of the mitral valve, which shuts off the return current of the blood as it is being driven by the strong left ventricle into the aorta, and at Ao are depicted the three flaps of the aortic valve, which is closed by the return current of the blood from the great aorta after it is pumped into that large blood-vessel by the ventric- ular contraction. It is plain to be seen that if the edges of these valves are rough or ragged or perforated, they cannot shut tightly and will allow some leakage to occur. Symptoms. — When the disease is combined witli liypertrophy or dila- tation, as is commonly the case, the symptoms are more severe than those of hypertrophy or of dilatation alone, the paroxysms of palpitation and dyspnoea in particular being more violent, more obstinate and more easily excited. The action of the heart is irregular. The pulse is small, weak, intermittent, irregular and unequal. Treatment — Since we can neither replace or repair the damaged valves of the heart, the principles of treatment for chronic valvular disease are, in general terms, such as diminish the force and activity of the circulation, occasional venesection to a moderate extent, an unstinailating and rather spare, though sufficiently nutritious diet, a tranquil life, with respect both to the body and the mind, and a good state of the digestive organs and alimentary canal. When there is dropsy diuretics are of the greatest utility. They are remarkably beneficial in an anterior stage of the disease ; for, by drawing off the serous portion of the blood, they diminish the quantity without 518 DISEASES OF THE CIRCULATOET SYSTEM. deteriorating the quality of the fluid, and thus relieve palpitation and dyspnoea and obviate infiltration, without materially reducing the patient. When diuretics do not remove dropsy and purgatives have failed, the practitioner is compelled to resort to puncturing. We say compelled, be- cause the remedy is a last and dangerous resource. The danger, however, may be considerably diminished by making small punctures with a grooved needle, and allowing the fluid to ooze slowly during four or five days or a week. When incisions are made with a scalpel or lance, the fluid is evacuated quickly, as in twelve or forty hours, and the patient, according to our observation, generally dies. FAINTING OR SYNCOPE. Complete and, commonly, sudden loss of sensation and motion with considerable diminution or entire suspension of the pulsations of the heart and respiratory movements. Symptoms. — It is to be distinguished from an epileptic or apoplectic fit by the fuller and apjiareut failure of the pulse and respiration, as well as by the previous history, if that can be obtained from friends or by- standers. Treatment. — Syncope is, commonly, an affection of no consequence, but sometimes it is an index of diseased heart. Generally recovery from a swoon is rapid if the patient is laid flat upon the ground, without any pillow, the clothing loosened from the neck and a little cold water sprinkled in the face and the apiDlication of volatile substances to the nostrils are all that will be required during the fit. If recovery is delayed a turpentine injection or one containing a little whiskey and water should be administered, and the electro-magnetic current may be transmitted through the walls of the chest to stimulate the failing powers of the lungs and heart. PALPITATION. Symptoms. — All excessive or consciously disturbed action of the heart is commonly thus designated. Over-action in particular may have either one of the following origins: Nervous or hysterical, dyspeptic, rheumatic or gouty, hypertrophic. All of the above forms of merely functional disturbance of the heart, and especially the purely nervous, may be known from' hypertrophic over- action, or the conscious impulse of dilatation of the heart, by the fact AHQINA PECTOKIS OK IIEAET PANG. 519 that they are not increased by moderate exercise ; are often, indeed, much diminished thereby. Treatment. — The treatment must vary according to its cause. If nervous, invigoration of the system and enrichment of the blood are most probably required, by iron and other tonics and regimen. Dyspepsia will require appropriate treatment ; as a part of which exercise in the open air will not be counter-indicated at all by sympathetic palpitation. ANGINA PECTORIS OR HEART PANG. Symptoms. — It is a disease of an intermitting character in which the patient has intervals of comparative ease or perfect health between par- oxysms of greater or less suffering. It is characterized by sudden attacks of severe pain, extending from jhe heart along the left arm, with a sense of stricture in the chest, prostration and alarm. The pain is rarely con- fined to its primary and principal site in the cardiac region, but increases, in different instances, very variously both in direction and extent. It shoots upward or downward or to the right side and almost always through the left side of the chest toward the shoulder and axilla and very fre- quently into the left arm. . Treatment — The violence of the patient's sufferings and the belief in the nervous or spasmodic nature of the pain, suggested by its sudden invasion, would naturally lead the medical attendant, in the first place, to attempt to afford relief by anodynes ; siich attempts, however, have gener- ally been attended with less success than might have been expected. In angina, as in toothache or tic douloureux, gastralgia, colic, or other violent pains, nature seems as if she scorned to be controlled by art, although so much under the influence of similar applications when less needed, as in the case of milder pains. Antispasmodics, cordials, carminatives, and so forth, have been much recommended and employed ; and, upon the whole, with better success than anodynes. The inhalation of one or two drops of nitrate of amyl sometimes relaxes the spasm and affords prompt relief. Small doses of nitro-glycerlne and hypodermic injections of from one- eighth to one-half grain of morphia also partly relieve the pain after a little longer delay. But although these or other means may afford relief, or may even ward off death, it is evident that every kind of treatment confined to the paroxysm is of very slight importance. Compared with that which is to be employed in the interval, the former can, at most, afford temporary relief ; the latter may cure the disease. 520 DISEASES OF THE ClUCULATOKT SYSTEM. HEAUT ASTHMA, Symptoms Asthma from disease of tlie heart often imitates the characters of the other varieties, and this jierhaps for a very simple reason ; that the lungs are in much the same state as in those varieties. Thus the asthma is humid or humeral when there is permanent engorgement of the lungs, causing copious sero-mucous effusion into the air passages, as in cases of contraction of the mitral valve. It is dry Avhen the engorge- ment is only transitory, as in cases of pure hypertrophy. It is continued ■when there is a permanent obstruction to the circulation, and may be con- vulsive when the heart has svifiicient power to palpitate violently. Treatment — Numberless remedies have been tried ; among them stramonium, nitrate of amyl, chloroform inhalations, and so forth. Arsenic enjoys full favor and deservedly holds an important rank as a therapeutic agent. DISEASES OF THE ARTERIES. The larger blood-vessels, both arteries and veins, are liable, like the heart itself, to various structural changes in disease, which, of course, lead to more or less serious disturbances in the circulation of the blood. Symptoms. — Arteritis or inflammation of the substance of a blood- vessel, commonly commencing with the inner coat of the artery and ex- tending throiigh the whole structure of the wall of the tube, is a rare af- fection and scai-cely ever detected before deatL Fatty and calcareous degenerations of the arteries are much more common, and consist in the deposit of fatty or chalky material in th.r,- arterial walls, generally in patches varying in size from a mere speck t . an inch or more in diameter. This condition is commonly spoken of a? a hardening of the arteries. Treatment — These diseases do not occur until after middle life, and no satisfactory treatment has been found. PART VI OF BOOK IV Treats of the diseases of the respiratory system, their causes, symptoms and treatments. Acute Bronchitis 533 Acute Laryngitis 526 Symptoms of 526 Treatment of 526 Acute Phthisis 543 Symptoms of 543 Treatment cf 544 Aphonia 529 Treatment r f 529 Asthma 523 Causes of 523 Hay S^S Symptoms of 524 Treatment of 524 Bends, The 5Si Bronchial Catarrh 530 "ronchitis 532 Acute 533 Capillary 532 Chronic 533 Diet in 533 Simple 532 Treatment of 533 Capillary Bronchitis 53a Symptoms of 532 Catarrh, Bronchial 530 Caisson 551 Cause of 551 Symptoms of 552 Treatment of 552 Catarrhal Laryngitis 526 Catarrh, Nasal 525 Chronic Bronchitis 533 Causes of 533 Treatment of 534 Chronic Laryngitis 526 Symptoms of 527 Treatment of 527 Chronic Pulmonary Consumption. .544 Symptoms of S44 Treatment of S46 Cold in the Head 525 Compressed Air Disease 551 Consumption 543 Causes of 543 Chronic Pulmonary 544 Galloping 543 Hofif Prescription for 547 Coryza 525 Cough 530 Causes of 530 Symptoms of 530 Treatment of 530 Croup 528 Cold, Rose 525 Diseases of the Respiratory System. 523 Distension of the Lungs 537 Dropsical Laryngitis 526 Emphysema 537, 550 Causes of 537 Symptoms of J3 7 Treatment of 538 Fever, Hay ; 525 Galloping Consumption 543 Hay Asthma S25 Hay Fever 525 Causes of ■ 525 Symptoms of 525 Treatment of 525 Hoff Prescription for Consumption, .547 Hydrothorax 550 Inflammation of the Larynx 526 of the Lungs 534 Laryngitis 526 Acute 526 Catarrhal 526 Chronic 526 Dropsical 526 Laryngoscope, The 528 Larynx, The 529 Inflammation of 526 Loss of Voice 529 521 622 INDEX TO PART VI OF BOOK IV. Lung Distension 537 Lungs, Inflammation of 534 Nasal Catarrh 525 Causes of 525 Symptoms of 525 Treatment of 525 Outdoor Sleeping in Tuberculosis 541 Paralysis of the Vocal Cords 5-^8 Phthisis, Acute 543 Pulmonary 543 Pleurisy 54^ Causes of 548 Diet in 55'' Symptoms of 548 Treatment of 549 Pneumonia 534 Causes of 534 Diet in 537 Symptoms of 534 Treatment of 536 Pneumothorax SSO Pulmonary Phthisis 543 Respiratory System, Diseases of 523 Rose Cold 525 Simple Bronchitis 532 Symptoms of 532 Throat Ulcers 528 Treatment of 528 Tuberculosis 538 Cause of 539 Outdoor Sleeping in 541 Symptoms of 539 Treatment of 539 Tumors in Vocal Cords 528 Ulcers, Throat 528 Vocal Cords 52S Paralysis of 528 Tumors in 528 Voice, Loss of 529 ILLUSTRATIONS Lungs and their Diseases, The 535 Muscles of the Larynx 529 Positions of the Vocal Cords 528 Vocal Apparatus 527 Vocal Cords, Positions of 528 CURATIVE MEDICINE PART VI DISEASES OF THE RESPIRATORY SYSTEM ASTHMA. Causes — An exciting cause may be an impurity of the blood. More commonly it arises from indigestion, bronchitis or valvular disease of the heart. Hay asthma is caused by the inhalation of particles such as arise from dried hay. The pollen from flowers and also from dogs, cats and other animals frequently give rise to it. Symptoms. — This disease comes on in paroxysms. The paroxysm may be preceded for a variable time by a sense of oppression and constriction about the chest, with wheezing respiration. "In many instances, however, it develops without any warning and most commonly at night. The pa- tient awakes suddenly, scarcely able to breathe, and is forced to assume the sitting posture, or even to stand erect, with the shoidders raised and fixed, the head thrown back, the mouth open and all the extraordinary muscles of respiration brought into play to assist those powers of the system which are usually sufficient for the purpose. The face, in severe cases, wears an aspect of terror, the eyes are widely opened, the skin is pale and dusky and often bedewed with sweat. The feet and hands are cold and the pulse small and quick. The breathing, however, is not hur- ried, but inspiration is short and jerky and expiration inordinately pro- longed. On jjercussion, the resonance of the chest is found to be increased and auscultation shows the vesicular breath-soimds are weak or suppressed and attended with whistling or cooing noises called rales. Toward the end of an attack, which may last for several weeks, cough comes on with the expectoration of small, fimi, solid pellets of mucus, in rare cases mixed with blood. The duration varies greatly, the paroxysm passing off in a few minutes or lasting for many days. When it continues long, or is left (523) 524 DISEASES OF THE RESPIRATOET SYSTEM. to itself, it is apt to subside gradually ; but if brief or cut short by treat- lueut. it often ends abruptly. Diagnosis. — The diagnosis rests upon the paroxysmal and usually sudden nature of the onset, the absence of moist rales as determined by auscultation, and the complete recovery of patients in the intervals of their attacks. The cooing and whistling sounds heard all over the chest show the absence of any serious obstruction in the larynx and trachea, and the muscular effort being made for the purpose of inflating the lungs chiefly in asthma, from heart disease, instead of also in exjiiration as in the sjiasmodic form, which we are now considering, is another indication of value. Treatment. — 1. Among the most certain treatments are the inhalation of chldroform or ether and the hvpodorniic injection of an eighth or a quarter of a grain of morphia, either of which, in a majority of instances, may be depended on to relax the spasm and afford jirompt relief. 2. Some of the most reliable internal remedies are chloral in fifteen- grain doses, which shoidd be employed with gi-eat caution, or not at all if the heart is organically affected ; ten or fifteen drops of tincture of lobelia or of ipecacuanha, as a nauseant or emetic, belladonna, valerian and strong black coffee. 3. The inhalation of the vapor of stramonium leaves, produced either by burning them on a red-hot shovel or smoking them in a pipe, and of the smoke of soft bibulous paper which has been soaked in strong salt- pet-e water and then dried, often affords relief, and, perhaps, as often fails in its desired object. 4. The treatment during the interval lietween the paroxysms must be directed toward building np the general health and fortifying the nervous system against the exciting causes of the disease. In some instances the action of small doses of lobelia is highly b.Mieficial, and in others, patients who have been for years great sufferers from asthma enjoy a complete immunity from the malady as long as tliey keep themselves under the influence of iodide of potassium by taking from five to ten grains of it three times daily. 5. If medicinal treatment for the prevention of asthma proves unsuc- cessful, a change of climate and particularly a sea voyage should be under- taken, and it is claimed by some physicians in Colorado that the air of that region is almost a specific against asthmatic complaints. NOSE CATAKBH. 525 HAY FEVER. Symptoms. — Hay asthma or rose cold, commonly called hay fever, is a very prevalent form of asthmta which comes on with symptoms of ordinary but severe. cold in the head, constant sneezing, gi'eat discharge from the nose and in many eases intense diificulty of breathing. Many sufferers from this curious malady are perfectly well imtil a certain day in one of the months of June, Jidy or August of every year, when they wake up in the morning, perhaps, with the symptoms above described. Causes. — As already remarked, this form seems to be due to the inhalation of pollen from certain grasses or flowers, but when once com- menced it may continue for several days, or even weeks, after its sup- posed cause has been removed. Treatment — The inhalation of sulphate of quinine in powder has been highly recommended in this aifection, but the air (and other attrac- tions) of various watering places seems to be the most popular and satis- factory remedy. The White Mountains or certain seaside resorts are looked upon by some patients as absolutely necessary for their health and comfort during an attack of this complaint. Adrenalin used in an atom- izer three to six times a day will afford great relief. Various Forms of Asthma. — Under the title of industrial asthma have been grouped several kinds of jjulmonary disease, incident to different trades and occupations. These include saw-grinder's asthma, miner's asthma, potter's asthma and miller's asthma, caused by the mechanical irritation of minute particles of dust in the respired air. NOSE CATARRH. Symptoms — This disease, so well known to every one as a common "cold in the head," is often epidemic, and is characterized at first by chilliness with sneezing and later by an abundant discharge of fluid from the nose. \\^hen severe it is attended with slight fever, pain and sense of weight in the head, pain in the limbs, prostration of strength, irritability of temper and inactivity of mind. Causes — Its origin can generally be traced to some imprudent viola- tion of the laws of hygiene, such as exposure to dravights, insufficient clothing, sudden cooling when heated, and so forth. Treatment — The number and diversity of the infallible remedies for a common cold is sufficient evidence of their generally unsatisfactory 526 DISEASES OF THE RESPIEATOET SYSTEM. nature, but as the natural duration of the disase is from three to five days, the third or foiirth medicine which receives twenty-four hours' trial often gains the credit of accomplishing a cure. If, as is usually the case, the bowels are constipated, a saline purgative, such as a Seidlitz powder or a bottle of citrate of magnesia, will usually relieve the headache, and then light diet, abstinence from fluids for a day and ten grains of Dover's powder at bed-time often seem to hasten the departure of this unwelcome guest. LAHYNGITIS OE INFLAMMATION OF THE LARYNX. Three Forms. — This disease, which is one of the accompaniments of a common cold whenever hoarseness of the voice comes on, presents itself iinder three forms: First, the acute or edematous; second, the subacute or catarrhal, and third, chronic laryngitis. The first of these varieties may, if not properly treated, prove quickly fatal, by closing up the avenue of entrance for the air to the limgs and thus causing death by suifocation. Symptoms of Acute Form. — Acute or dropsical laryngitis may com- mence as a slight catarrh, quickly followed by high fever. Speech, cough and respiration are all soon modified. The voice at first metallic, soon becomes whispering. The cough primarily clear and shi'ill, then harsh and croupy, is also reduced to little more than a whisper, and a peculiar noise like a loud whisper accompanies both inspiration and expiration, which are, from the beginning almost, laborious and wheezing. As soon as the dropsical swelling comes on and still further narrows the opening of the glottis, the effort to breathe becomes exceedingly painful and difiicult and the patient's countenance expresses great anxiety. Treatment — 1. Since acute laryngitis in the adult may destroy life in a few days, or even hours, it should be treated actively from the first onset by bleeding, if the patient is robust, or by leeching, active purgation with five- or ten-grain doses of calomel and jalap and calomel in grain doses every two hours to the extent of producing slight salivation as rapidly as possible. 2. If the inflammatory swelling proceeds or if dropsy comes on and interferes with the respiration sufficiently to cause lividity or blueness of the lips, the operation of opening the windpipe should be at once per- formed. It is better to open the trachea or windpipe sooner than is abso- lutely necessary, than to postpone the operation imtil the blood has been rendered very impure by want of a proper supply of oxygen ; yet even uj) LAETNGITIS OE INFLAMMATION OF THE LAEYNX. 527 to the last gasp and for, perhaps, a minute afterward, life may be saved by the surgical operation. 3. For children the danger to life from this malady is comparatively slight, so that bleeding and calomel may generally be dispensed with, and emetics, such as syrup of ipecacuanha or Coxe's hive syrup, in ten-drop doses every three hours for a child of three years old, with the inhalation of warm opiate vapors, as, for example, that from the siwut of a tea- pot, in which has been placed with a small quan- tity of boiling water fif- teen or twenty drops of laudanum, are generally sufficient. Subacute rorm. — The subacute form of laryngi- tis rarely passes into the acute variety, and is, therefore, of but little im- portance. If severe, the same treatment by expec- torants, nauseants and an- odynes, recommended in acute laryngitis of chil- dren may be employed. Complete rest of the voice should be enjoined and inhalations of the various anodyne and astringent sprays are of great service in chronic cases. Chronic Laryngitis Symptoms. — Chronic laryn- gitis is accompanied with actual thickening of the vocal cords, which, if the deposit be not subsequently absorbed, produces a permanent change in the voice. The respiration is usually but little affected, yet there may be a little tickling cough, an expectoration of small fragments of mucus and an almost constant desire to clear the throat. Image of Vocal Apparatus as Seen In the Laryngoseopio Mirror Held Far Back In the Mouth. 528 DISEASES OF TITK REf=iPIRATORY SYSTEM. Treatment. — Eest, by the avoidance o£ sjiealving above a whisper, a wami, moist atmosphere and medicated inhalations, are the important elements of treatment in this affection in its simple form. The Laryngoscope. — By means of a small, metallic looking-glasa, called a laryngoscope, a view of the epiglottis, the glottis itself, and, in favorable instances, the interior of the larynx, with some of the \ipper rings of tlie trachea, may be obtained. Such a view is given in the ac- companying illustration. Treatment of Throat Ulcers — When, by means of the laryngoscope, the existence and seat of an ulcer can be established, it should be touched with a strong solution of nitrate of silver, in the hope of thereby promoting a tendency to heal; or inhalations of astringent solutions, such as that of the sulphate of zinc, or of copper, and of carbolic. acid may be employed. TRUE CROUP OR PSEUDO-MEMBRANOUS CROUP. For a full description of the causes and treatment of this disease see pages 437, 980, 1272. DISEASES OF THE VOCAL CORDS. Tumors in Vocal Cords. — The develojiment of new growth or little tiunors within the cavity of the larynx is a cause of local obstruction to the breathing, which is iiappily rare. The three different kinds which have been met with are, first, the warty growths, having a firm structure, and attached to the inner surface of the larvngeal cavity by a broad base ; second, polypoid growths, .similar to those already mentioned as occurring in the nose, of a soft and jelly-like consistence attached to the mucous membrane by a pedicle or stem; and, third, cysts or hollow bags, containing, in some in- stances, parasites. Paralysis of Vocal Cords. — Paralysis of the vocal cords, resulting in aphonia or loss of the voice, is a very grave misfortune under certain cir- cumstances, as, for example, to clergymen or lawyers. Changes in Vocal Cords. — The clianges in position which these vocal cords undergo in the different processes in which they are concerned, will Changes of Position of the Vocal Cords. DISEASES Ol'' HIE VOCAL COKDS, 529 probably be understood by reference to the accompanying diagram. At A is sliown the appearance of the chink of the glottis, formed by the edges of the vocal cords, as it appears when examined by the laryngoscope wiiilst the patient is engaged in singing. B exhibits the condition in V. Inch it nsnally appears during easy and quiet respiration ; and at C is represented the arrangement during forced inspiration or drawing a long breath. Muscular Arrangement of Larynx — Tlie figure in the margin illus- trates the arrangement of the muscles of the larynx, as seen after the membrane and elastic tissue constituting the vocal cords has been removed. Tli. represents the large and firm thyroid cartilage; Ary the upper ends of the aryte- noid cartilages, to which the posterior ends of the vocal cords are attached ; V indicates the position of the vocal cords. At Arp is represented the band of muscle called the posterior arytenoid muscle, which has the duty of pulling the arytenoid cartilages to- gether, and so narrowing the slit of the glottis between the vocal cords as to cause the production of just the right sound for any particular note in singing. The mechan- ism of hoarseness in the voice or cough is Muscles of the Larynx, simply as may be understood with ease from this diagram, that the edges of the vocal cords becoming thickened by congestion or slight inflammatory action can no longer vibrate quickly enough 1o pnnluce the higher notes of the voice. Loss of Voice — In paralysis of the muscles of the glottis, which, small as they are, the explanation given a few pages back shows to be very im- portant, not only is the power to produce audible voice sounds lost, but breathing is rendered difficult, and great distress is produced by the inability to take a long breath. Aphonia, or loss of voice, is of two kinds, the simulated and the true. An imitation of the real disease is generally hysterical in its character, and though it may last for a long time, is never really permanent; it may sometimes be recognized by the aid of the laryngoscope. Treatment. — True aphonia is due to actual jialsy of these little laryn- geal muscles, is generally (Ie[i('n(l(>iit '.ipiin some serious injury or disease, and therefore in most instances iiici:i-ab]o. The treatment of the pre- 530 DISKASES OF THE RESPTEATOET SYSTEM. tended aphonia is that of hysteria. In bad cases chloroform may be given with advantage. During the intervals between the attacks, the bitter tonics, cod-liver oil and iron, and treatment for any uterine derangement, as described in the chapter on Diseases Peculiar to Women, should such disorder exist, are strongly indicated and will generally accomplish a cure in the course of time. COMMON COUGH OR BRONCHIAL CATARRH, Character. — This every-day disease is a subacute inflammation affect- ing the larynx, trachea, and larger bronchial tubes, sometimes commenc- ing with nasal catarrh and traveling down, as it were, to the pulmonary organs. At other times, or in other patients, it appears to originate in the larjTix, and does not affect the nasal passages at any time during its course. Predisposing Causes. — The predisposing causes to this common affec- tion are enumerated as being the loose, flabby texture of tissue in certain individuals, especially those who are the subjects of the scrofulous dia- thesis, and rickety children; second, a previous attack, and third, effem- inate modes of life. Direct Causes.— The directly exciting causes are: 1. Chilling of a portion of the skin, and especially the change of temperature of a portion of the body produced by sitting in a draught of air whilst perspiring freely, or with damp clothing or wet shoes. 2. Irritants acting directly on the mucous membrane lining the air- passages, such as diist, acrid vapors, or hot and cold air, and the grinders, millers and stone-cutters. 3. Obstruction to the current of the blood through the great branches of the aorta below the origin of the bronchial arteries, such as may be caused by abdominal drojisy, accumulation of gas, or of refuse matter in the intestines. 4. As a result of morbid states of the blood, as seen when bronchial catarrh is a premonitory symptom of typhoid fever, measles and small-pox. Symptoms. — The general symptoms of a common cold on the breast are so well known to every one that it is not worth while to occupy space in describing them, and yet, frequent as is popular acquaintance with this disease, few persons realize the terrible dangers which attend upon a neglected cough. Treatment — 1. The most important thing in relation to this malady COMMON COUGH OR BRONCHIAL CATARRH. 531 is to prevent its occurrence. This could probably be accomplisbed in four cases out of five by the exercise of a troublesome amount of prudence, which, however, would be well expended were young peopl« willing to make the effort to escape this frequent cause of early death. "When, how- ever, a person is unfortunate enough to contract a cough by his own im- prudence or otherwise, it may often be cut short by bringing on a free perspiration. A good way to accomplish this is to take a hot mustard foot- bath and ten grains of Dover's powder on retiring for the night, wrapping the throat up in flannel if it feels sore, and being very careful not to undo, and more than undo, the beneficial work of this treatment by uncovering oneself in the night, or by imprudent exposure the next day. 2. If this method is not resorted to early enough, or if it fails and the cough goes on unchecked, ten-drop doses four times a day of anti- monial, or ipecacuanha wine, and nitrate of potash, or muriate of am- monia in quantities of five grains every three or four hours, are generally useful. 3. By the third or fourth day great advantage may be derived from the use of a mixture of half a teaspoonful each of syrup of squills and syrup of wild cherry with one-twelfth grain of cyanide of potassium every six hours. If this remedy agrees with the patient it may be taken more frequently or in sufficient doses to quiet the cough through the night, but it must be used with great caution, as it contains ingredients which are poisonous in over-doses, or ammonia chloride, 1^ drachms; Brown's mix- ture, 4 ounces. One to two teaspoonfuls every three hours. 4. Should the disease persist notwithstanding the employment of these various medicines, counter-irritation with croton oil and tincture of iodine applied to small spots on the upper part of the chest in front, or croton oil alone rubbed on the back, also with great caution, should be re- sorted to without that further delay during which the catarrhal irritation of the bronchial tubes might become clironic, as it is commonly phrased, and the cough get such a hold that it cannot be shaken off. Auxiliary Treatment — A very important part of the treatment is the breathing of a continuously warm, moist atmosphere, and for children especially, the prescription of one warm room is probably more conducive to recovery than any one of the medicines suggested. Particularly ought young children, in Avhom previous experience lias shown there exists any tendency to croup, to be guarded against the development of that dan- gerous affection by even the slight additional exposure of passing through 532 DISEASKS OF THE KESPIRATORY SYSTEM. a cool entry to their im>als. At the same time the apartment to which the invalid is coniined must not be kept too warm, and due attention should be paid to its proper ventilation. BKONCHITIS, Character — This disease, an inflammation of the bronchial tubes, or air-passages leading to the pulmonary vesicles, is characterized by hoarse- ness and moderate cough, with heat and soreness of the chest in front, all these being more or less intense according to the severity of the attack. In every common cough there is always some bronchitis, but the element of danger lies in the extension of the inflammatory action to the smaller bronchial tubes or bronchioles, and the approximation consequently to that fatal form of the malady termed capillary bronchitis. Simple Bronchitis Symptoms. — Simple bronchitis is usually ushered in with a slight chilliness, general discomfort, and some febrile disturbance. A sense of constriction about the chest and some deep-seated soreness beneath the breast bone soon follow. The respiration is slightly increased in frequency, but no urgent dyspnoea is generally present, unless the patient is a suflFeror from some chronic affectioH of the heart or lungs, as, for examjile, valvular disease of the former organ. Cough is uniformly present in bronchitis, is worse after sleep, and, as a rule, paroxysmal. The expectoration is at first scanty and viscid, but soon becomes more abxmdant, white and frothy, and still later yellowish or muco-purulent. In this latter stage the cough is looser, less painful, and the phlegm is expec- torated more easily. Capillary Bronchitis Symptoms. — Capillary bronchitis usually develops out of the sim]ile form, and therefore its onset can hardly be said to be characterized by any well-marked symptoms. Occasionally, however, a sharp chill defines the date of its attack. When developed, the patient breathes with difficulty, the. complexion is dusky, and the countenance be- trays anxiety. The superficial veins are over-filled, as a consequence of the obstruction to the pulmonic circulation, and the movements of the sides of the nostrils are exaggerated. The respiration and pulse are quick- ened, the former very much so, and out of proportion to the latter. The cough is almost constant, and the expectoration, at first frothy, and after a time yellowish, is expelled with considerable difficulty. Troublesome pains in the intercostal muscles, brought on liy the unremiftin"^ exertion of coughing, are of frequent occurrence, the temperature rises to a consider- BKuJvcinTis. 533 able elevation, and the restlessness is extreme ; the renal excretion is scanty, and sometimes a little albuminous. In fatal cases the prostration becomes intense, the skin livid, cold and clanuny. Dropsy of the feet and legs may come on, and at last fitful drowsiness or muttering delirium precede coma and death. Acute Bronchitis Diagnosis — The diagnosis of acute bronchitis is or- dinarily not difficult. Capillary bronchitis must be distinguished from pneumonia, which can generally be done by the greater amount of fever and disturbance of the respiration as well as the dullness on percussion, tubular breathing, and irregular distribution over the chest of the latter affection. In acute tuberculosis, or galloping consumption, the violence and irregularity of the fever, the rapid collapse of strength, and the ex- treme dyspnoea, out of all proportion to the physical signs, indicate the nature of the case in most instances. Treatment — 1. A threatened attack of bronchitis may sometimes ap- parently be cut short by a hot foot-bath and dose of Dover's powder, as already suggested, and a full dose of ten grains of salicin or of quinine will perhaps aid the good work of this treatment. 2. After the disease is fully developed the remedies are chiefly pal- liative, and consist of opiates, such as morphia, belladonna, or preferably, in many cases codeia, in half-grain doses, to quiet the cough and promote the expectoration. The softening of the secretion, and easing of the inces- sant cough, are also promoted by keeping the patient in a moist atmos- phere, as suggested in regard to croup. 3. Pain in the chest can often be relieved by mustard-plasters and stimulating liniments, or painting with tincture of iodine. Half tea- spoonful doses of the syrups of squills, ipecacuanha and lobelia, every two, three or four hours, according to the urgency of the symptoms, are probably useful, and the iodide of potassium, in five-grain doses, if well borne by the patient without irritating the mucous membranes of the eyes and throat, as it sometimes does in a singular way, is highly recommended. Diet — There is no need of restricting the diet in this disease, and any wholesome food which the patient craves may be allowed. In the treatment of the capillary bronchitis of young children it is necessary to use opiates with much greater caution, and the occasional administration of an emetic, to aid in clearing out the accumulated niueus, is important. Counter-irritation by mustard or turpentine may be tried, and dry cup- ping often gives great relief. Chronic Bronchitis. — Chronic bronchitis is a very common malady, 534 DISEASES OF THE EESPIEATOBY SYSTEM. its frequency increasing with the coming on of old age. It may be chronic from the outset, or be the result of the acute form. Chronic limg diseases generally are apt to lead to it, and so does the abuse of alcohol. Treatment. — Chronic bronchitis, especially when in the form called dry catarrh, is often relieved by iodide of potassium and colchicum. PNEUMONIA OR INTLAMMATION OF THE LITNGS. Causes. — This disease, called also lung fever, is the most serious of the common acute diseases of the pulmonary organs. Long continued exposure to cold is apt to be the exciting cause of pneumonia; but there are some reasons for supposing that it is, at least in many instances, a local manifestation of a general disease, perhaps contagious in its char- acter. It often comes on in the course of other grave maladies and adds very much to their fatality. The Stages. — The three stages through which this complaint passes in typical cases, are, first, that of congestion, where the lung is engorged with blood; second, that of red-hcpatization, in which the inflamed lung is dark red and solid like a piece of liver, sinking in water and breaking down readily imder the pressure of the finger; and, third, the stage of grey-hepatizatlon, in which the affected pulmonary tissue is still dense, but of a yellowish-grey color. Symptoms. — 1. The symptoms of an ordinary attack of pneumonia, coming on from exposure to cold, in a robust adult, are quite character- istic. The disease usually sets in with a single severe and prolonged chill, after which the temperature of the body rapidly rises to a high point and this rise is accompanied by the customary symptoms of fever. Pain is commonly felt about the region of the nipple on the affected side and is sharp, stabbing and aggravated by movement in breathing or otherwise, and also by pressure. 2. There is, likewise, well-marked dyspnoea, characterized by ex- tremely frequent, shallow breathing, quite different from the kind of dyspncea observed in bronchitis and in asthma; the rapidity of respira- tion ranges from twice to four times the frequency of health; that is, from about thirty to sixty per minute; and this increase in the number of the respiratory efforts is partly due to fever, partly to impurity of the blood and partly to the pain which prevents drawing a full breath. The sides of the nostrils are commonly in active movement at every inspiration. 3. The third prominent symptom is cough, generally frequent, hack-. Consumption; Interveslcular changes. Fl£. 1. — Pleuropneumonia. ■-\ /-■•., ^-..;^ -- v^rr Pig-. 3.^ — Surface of the breast in a normal condition; con- tours of cardial torpor to the left of the ImomsI l»one. Tho Fig. 4. — Croupo-is or v sIchI.t spaces included In the dotted lines reiirc^f^n; ih«' intcnnediati- pnoLinonla- Estate of consolldu spaces. lion. THE LUNGS AND THEIR DISEASES 635 536 DISEASES OK TlIK KESIMHATOHV SVSl'K.M. ing aud constrained on aecount of the suffering which it causes. It is dry at first, but on the second or third day the patient commences to bring up at each paroxysm of cough, some of the peculiar, viscid material of exactly the color of rusty iron. This expectoration does not occur in young children, is often absent in secondary pneumonia and in the pneu- monia of the aged. The fever usiially attains its height on the second or third day. 4. The pulse is usually strong and full at the outset, but later on in the attack it becomes small and weak, partly as a result of the imperfect filling of the arteries from obstruction of the pulmonary circulation and partly from cardiac feebleness. The cheeks are fliished to a very marked degree and an eruption of little blisters, a variety of herpes, is sometimes present upon the lips, which are of a dusky hue. Prostration, feebleness, headache, restlessness and delirium at night are common. The tongue is dry and coated, the thirst is eager, but the appetite for food is lost and the bowels are costive. 5. In favorable cases, these symptoms which have been detailed gradually increase up to the fifth, sixth, or seventh day and may then rapidly subside, the temperature falling to the natural standard two or three days later, and the solidified portions of the hmg clearing out occa- sionally with wonderful celerity. The cough and dyspnoea speedily abate, and the sputum becomes yellow and muco-purulent. When the malady ends fatally, death usually occurs about the end of the first or early in the second week, and results from failure of the action of the heart, or else from pulmonary embarrassment. Treatment — 1. There is no doubt that the intense pain accompanying the onset of pneTimonia can be promptly relieved by blood-letting; but since the tendency of the disease is toward death by debility and it is im- possible to say in any given case how far over the pulmonary structure the inflammation will extend, we can never feel sure that the loss of the vital fluid abstracted will be safely borne by the patient. In very robust per- sons, in the prime of life, it is proper to bleed; becaiise the chance of dim- inishing the violence of the attack thereby is at least equal to the danger of seriously decreasing the strength. In less vigorous individuals, leech- ing or cut-cupping, and in patients of feeble constitutions, dry-cupping will generally afford considerable relief. 2. Large doses of quinine, even as much as twenty or tw^enty-five grains, may be given at the first onset, in the hope of cutting sliort the disease and later on for the purpo^'e ' f reducing tlis fever, wliich in itself EMl'llYSEMA. 58T is a great cause of danger, as already explained. Opiates in the form of Dover's powder, tlie hypodermic injection of morphia, or of codeia in half-grain doses, M^hen the latter medicine siiits the patient, are of great service in diminishing suffering, jirocuring sleep and allaying cough. 3. Toward the latter part of a severe attack the chief treatment is that of nutrition and stimulation, and as there is often in this disease a great tolerance by the nervous system of alcohol, such as we see in typhoid fc\cr, immense amounts of milk-punch, or diluted brandy and whiskey, are sometimes consumed with apparent benefit. Alcoholic stimulants .sliould never be given to the extent of producing symptoms of intoxica- tion, but short of this point they are of great service in keeping up the action of the heart and thus preventing the fatal eifect of cardiac failure. 4. Since the immediate cause of death in many examples of fatal pneumonia is the over-distension of the right side of the heart, with conse- quent separation of fibrin in the partially stagnating blood constituting heart-clot, it is advisable to diminish this tendency to coagailation of the blood in the heart and the production of a thrombus by the administra- tion of five grains of carbonate of anunonia every three or four hours, wdiich, however, ought not to be continued for more than a day or two. Diet During convalescence from inflammation of the lungs danger from relapse is not nearly so great as in many other maladies, such, for exanqjle, as diphtheria, and hence free indulgence of the appetite for all wholesome food and out-door exercise, as soon a§ the strength permits, uiay be allowed. EMPHYSEMA (LUNG DISTENSION). Varieties — The two varieties of emphysema are, first, the vesicular, m whicli tlie vesicles are distended and dilated, and the interlobular, in which the air has escaped from the air-cells in consequence of their rupture, and diffused itself through the connective tissue of the pulmonary substance. This condition is commonly the result of accidents leading to great straining in the respiratory muscles, as in the violent jiaroxysms of whooping-cough and of asthma, and men or animals who are the subjects of emphysema are popularly and very accurately described as "broken winded." Symptoms. — The symptoms of emj^hysema are in direct proportion to the amount of lung-tissue affected, and consist of dyspnoea which re- sembles that of asthma ;ind is unlike tliat of vahnilar disease of the heart in being esjieeially marked during the effort at expiration. Coiigh is j538 DISEASES OF THE EESPIEATOEY SYSTEM. usually present, but is not attended with expectoration, unless the disease is complicated •with chronic bronchitis, as is frequently the case. In bad oases of emphysema the interference with the aeration of the blood is so great that the complexion is dusky and the patient languid and dull. Treatment. — The treatment of this disease is limited to palliating the symptoms as much as possible, and remedying the maladies, such as chronic bronchitis or asthma, with which it is frequently complicated. Anodynes, which apjDcar urgently called for to relieve the pain and dis- tress must be employed with caution on account of the imperfect aeration of the blood, which is already an element of danger. Dry cupping be- tween the shoulders is often of service, and the use of quinine, iron and strychnia, as directed in anemia, is beneficial by improving the general health. Change of residence to a warmer and more equitable climate than that of the northern United States is probably the best remedy we can urge upon patients afflicted with enqjhysema. TTIBERCTILOSIS, How We Get Tuberculosis. — We can get tuberculosis only by receiving into the body the little germs known as the tubercle bacilli. The consump- tive infects another, or gives tuberculosis of the lungs to another, by means of the tubercle bacilli in the material coughed up from the diseased lungs, which often contains millions of these germs. The germs get out of the body of a person who has tuberculosis, not only in the material which is coughed up, but also in the little drops, too small to be seen, which are sprayed out when persons with tuberculosis cough or sneeze. Great care should be taken to destroy all material coughed up by the consumptive, and to avoid careless covighing and sneezing. If this is not done, and the sputiim is discharged on the floor or carpets or clothing, the germs may live for months, especially in dark, damp, unventilated bedrooms, living rooms, and workrooms. The germs will live in the darkness and dampness for a long time, and are stirred up in dusting and sweeping these rooms, and float in the air and may be breathed into the lungs, or may fall upon^articles of food and be taken into the body in that way. The disease is often called CONSUMPTION', for the reason that during its progress the patient loses weight rapidly, and hence seems to be consumed. Tuberculosis may infect any other part of the body besides the lungs, such as the bones, joints, intestines, glands, brain, spinal cord, TUBERCULOSIS. 539; and tlie skin, but of all forms of inflammation, that of the lungs is most common. The tuhercle hacUlus is the only cause of the disease. Tweuty- five hundred of these germs placed end to end would not be one inch in length. These germs may gradually spread through the greater part of one or both lungs, destroying tlie usefulness of those organs until finally the patient dies of the disease. Many people tliink that pulmonary tuberculosis comes from a cold or some other disease, or is inherited. This is not correct. The reason ■why people develop tuberculosis after a prolonged cold or pneumonia or other exhausting disease is because their systems have run down to such an extent that they are not strong enough to resist the tubercle bacilli when taken into their bodies. These germs are widely distributed, and practically all people breathe them in at times. If their systems are in excellent condition, the germs do not gain a foothold and start the disease. Any condition that weakens the body predisposes one to consumption. Symptoms — There are a number of symptoms which might lead a person to suspect that he has pulmonary tuberculosis, namely: loss of weight, loss of appetite, loss of color, fever in the afternoon, cough and expectoration lasting for several weeks, spitting of blood or streaks of hlood in the sputum, chills, night sweats, difficulty in breathing, and pains in the chest. In incipient tuberculosis the commonest symptoms are loss of weight with cough and expectoration. When these symiDtoras occur it does not necessarily mean that tuberculosis exists, but it would be wise for a person Laving them to consult a physician. Medicines — There is no medicine that will cure consumption. It is a waste of time and money to use so-called "Consumptive Cures." All advertised cures of this nature are frauds. Doctors who advertise should loe avoided as much as medicines which are advertised. Reputable doctora do not advertise. Treatment — The treatment for tuberculosis is rest, with plenty of fresh air, and enough good wholesome food. No medicine is necessary except in cases where other diseases are present. The disease may bo cured at home in many instances if it is recognized early, and proper means are taken for its treatment. Wlien a number of a family is found to have consumption and cannot be sent to a sanatorium, arrangements for taking the cure at home should be made as soon as the disease ia discovered. It is important, iu the treatment of tuberculosis, to breathe air that 540 BISEASES Oh' TIIM HKSl'II; \ I'OIJY KYSTKM. is fresh and pure, to eat an abundance of good food, to stop heavy work and ■worry, and to take a bodily and mental rest by lying down before and after the noon and evening meals. To obtain the first, the patient must live out of doors. This means that as many hours of the day and night as possibla should be spent in the open air, and in order to carry out this treatment some place must be provided which is not only protected from wind, but also from rain and snow, as nothing except the most severe cold weather shoxild prevent the patient from living and sleeping there. The outdoor shelter shoulil be large enough for a bed, a reclining chair, and a table. It should overlook ])](>asant and sanitary surroundings if possible, as it is to be the home of the patient for months, and will give better results if comfortable and attractive. Tenement house dwellers and persons living in apartment houses in large cities sliould make every effort possible to give the open air treatment to a member of the family who contracts tuberculosis. First, consider the possibility of moving into the suburbs or nearby small towns. If this cannot be done, try to obtain from the landlord the use of the roof, and build a small shack there. If this is beyond the means of the family, use one room Avith a window opening on the street or large court for the patient, and then place the head of the bed beside the window and cover it with a window tent. The cost of a window tent is about $10, and if it cannot be obtained, take two large heavy cotton sheets, sew them together along the edge, tack one end of the double sheet to the top of the window casing and drop the lower end over the outer side of the bed, fastening the bottom of the sheet to the bedrail with tape. There will be enough cloth hanging on each side of the window to form the sides of the tent, and these should be fastened to the window casings. A window tent can be made at home for about $3 by using 12 or 15 yards of heavy denim or light canvas. One straight jiiece of denim should be hung from the top of the window casing to the outer side of the bed, and the openings between this and the side window casings filled in with sides cut and fitted from the balance of the cloth. By these methods the patient gets fresh air from tlie Avindow and the room is kept warm in cold weather as a place for dressing and toilet purposes. During mild and warm weather the tent can be removed and the window kept open both at top and bottom. How to Arrange a Porch. — If tlie family lives in a small town or in the country, it will usually be found that a norch is the most convenient way of providing open-air quarters. Tn selectiiiir a site for the porch. IDBEKCULOSIS. 541 it is well to reniiMnlicr that the patient should be j)lacc(I out of doors 111 sufh a way that the cuic can be taken with comfort at all seasons of the year. For the winter months the best place is on the south side of the house, as there will be found the greatest amount of sunshine. If this cannot be done, choose first the east, or second the west side, but not the north side except as a last resort, for it is a windy and cold position in winter. The back of the house is usually better than at the front, if the porch cannot be seen from the street. Tlte most important thing is to find a sheltered spot, for luind is much harder to hear than intense cold. If the house has permanent verandas, and you cannot afford a special porch, use a veranda, and obtain privacy by putting up canvas curtains or bam- boo screens. How to Build a Cheap Porch — A useful porcli can bo built for $12 or $15 with cheap or second-hand lumber, and if only large enough to receive the bed and a chair will still be effective for the outdoor treatment. The roof can be made with a canvas curtain or a few boards and some tar pajier. The end most exposed to the wind and rain and the sides below the railing should be tightly boarded to prevent draughts. A window can be used for the approach, but it will be more convenient if it is cut down to the floor and a small Dutch door put in below the window sash. Second and third story porches are supported from the ground by long 4 by 4: posts, or, when small, they can be held by braces set at an angle from the side of the house. Bed and Bedding for Outdoor Sleeping — An ordinary iron bedstead with woven wire spring 3 feet G inches wide and a moderately thick mattress are all that are necessary except for cold weather. A good hair mattress is best, but when this cannot be obtained, a cotton-felt mattress can be bought for $4, or a wool mattress for about $10. Over the mattress ]ilace an old blanket or a cotton bed-pad, the same width as the mattress, and on this the ordinary bed sheets or blanket-sheets. For those who like heavy bed covering as many blankets as desired may be used. Those who prefer light covering can use do^vn comforts, or lamb's wool or cotton-filled comforts, or the material for wool or cotton quilts can be obtained for about $2 and warm covering made at home. Very cheap, light, but waiiu covering can be made by using paper blankets placed between two thicknesses of outing flannel or bed covers. These paper blankets are sold for fifty cents each and wear for about six months. A woolen horse blanket with an oiilsiilc «( canvas can be used as a covering to protect the bediliiig in \',( t niid slormy weather. 542 DISEASES OF THE EESPIEATORY SYSTEM. Sleeping-Bags. — In very severe weather a sleeping bag may be used, and this is made by sewing blankets together around the edges, leaving the top open, using as many layers as desired. The blankets should be 7 feet long by 4 feet wide. Arrangement of Pillows — Place two pillows in form of an Inverted V, with the apex at the top of the bed and the head at the point where the two pillows meet. This position allows the shoulders to nestle between the pillows and protects them from the cold wind. How to Prepare the Patient for the Night — In cold weather the out- door sleeper should get into the bed in a warm room and have some one roll him out of doors. If this is impossible, use a warm dressing-gown in going back and forth from the dressing room to the porch, and warm the bed by placing in it for a few minutes before retiring a hot water bag, hot bricks, soapstoncs or bottles filled with hot water. In some cases it is well to leave a hot stone or bottle wrapped in flannel at one corner of the bed, where it will throw off heat slowly during the night. All covers except the top blanket or comfort should be tucked in under the bed-pad. The topmost cover is then tucked under the mattress to keep the under covers from sliding off when the sleeper is restless. Clothing Worn at Night — A woolen undershirt, a sweater and a long outing flannel nightgown or bathrobe are iisually worn, but in very cold weather some patients wear a jiair of drawers made of flannel, a pair of bed-socks or knitted slippers, and a woolen abdominal bandage. Never cover the head wilh the hedclothes. The patient can wear a knitted skull-cap long enough to be pulled down to the end of the nose and over the ears, or a knitted helmet which covers the whole of the head, face and Ticck, with the exception of a small opening for the nose and mouth. Care slioTild be taken not to interfere with the inhaling air or to allow the breath as it is exj^elled from the nose or mouth to come in contact with the cloth and fonn icicles. Chapping of the face during the night can be prevented by using cold cream or vaseline aboiit the nose and lips. General Directions — Eest is a most important part of the open air treatment, and exercise must be regulated by the doctor. Always have at hand an extra wrap, and never remain out if chilled. Cold weather should have a bracing effect, and when it does not, go into a warm room and get a hot drink, preferably milk, remaining indoors until comfortably warm. AYhen going out again use more wraps and keep behind a shield or screen that breaks the force of tlic wind. Always be cheerfiil and hopeful -. never waste your strength in anger or being cross. Lead a temperate life, go to bed early and get up late; do not use alcohol in CONSUMPTION. 543 any form except when prescribed by jonv doctor. Do away with tobacco if jiossible, and use only weak tea and coffee in small quantities. Never swallow the matter coughed up, but always destroy every particle by spitting in a paper or cloth which can be burned. Never allow the hands, face, or clothing to be soiled by sputum, and if this happens by accident, wash the place soiled with soap and hot water. Men who have consump- tion should not wear a mustache or beard, unless it is trimmed close. Particidar care must be taken, when sneezing and coughing, to hold in the hands before the face a cloth which can be burned. Soiled bed-clothes, night-dresses, other washable garments and personal linen should be handled as little as possible until they are boiled prior to their being washed. The dishes used by the patient miist be boiled after each meal. All this means care and work, but must be done both as a protection to the household and in order to bring about a speedy cure for the patient. Deep or full breathing is especially recommended to those who have consumption or any weakness of the lungs. See article on deep breathing. CONSUMPTION OR PULMONARY PHTHISIS. Character. — Tubercular jjlithisis or true pulmonary consumption is that form in which the peciiliar tubercular matter is deposited in the lungs in small masses or tubercles, varying in magnitude, but generally about the size of a mustard seed. Sucli tubercles become centres of irritation, inflammatory action and suppuration, or formation of abscess, and these processes end by destroying a smaller or larger spot of the hmg-substance, and leave a cavity or vomica in the pidmonary structure. Causes — The disease is constitutional, and according to the reseai'chas of Dr. Koch, the celebrated Berlin microscopist, contagious, the whole malady being the result of development in the lung of a very minute bac- terium, named by Dr. Koch the bacillus tuberculosis. Tn America it is usually developed between the time of puberty and tlie twenty-iifth year, and in nine cases out of ten seems to be primarily lighted up by a cold or some depression of the nervous system. Early Indication — Hemoptysis or spitting of blood, usually in small quantity and only serious as a symptom of very grave import, is often one of the earliest indications of pulmonary consumption. Galloping^ Consumption. — Acute phthisis or galloping consumption is the most rapid form of this terrible disease, and has been known to prove fatal in the short space of six weeks. It usually commences with chills and fever of the hectic type. Cough, dyspnoea on very slight exertion and 544 DISEASES OF TlIK IJKSl'I UATOK Y SVSTKM. out of all proportion to apparent amount of disease in the lungs, is almost a characteristie of the complaint. The expectoration soon becomes profuse, and is freijueutly tinged or streaked with hlood. This blood is never mixed throughout the sputum so as to give it the color of rusty iron, which is so indicative of pneumonia. The pulse is frequent and feeble, the tongiie red and furred, the appetite poor or absent entirely, and there is often a tendency to diarrhoea. 2. In the rapid jjrogress of the disease there is, after a few weeks, great exhaustion, profuse sweating, speedy emaciation and restlessness, amounting in persons of nervous temperament to delirium. Acute phthisis coming on in this way is almost without exception fatal, but in rare cases there may be a decrease in the violence of the symptoms, and the patient enjoys a temporary improvement, only, however, to pass into the ordinary condition of chronic consumjJtion. Treatment. — The treatment of some of the very few cases which have ever been reported as cured was that of rest in bed, a liberal supply of fluid nutritious food and stimulants, frequent application of iced cloths to the chest to subdue the fever, these being at once removed if there was any tendency to faintness thereby produced, hypodermic injections of atropia to check tlie sweating, and pills or powders containing two grains of quinine, a half grain of digitalis, and opium in amounts of from a quarter to half a grain, four, five or six times daily. CHRONIC PULMONARY CONSTIMPTION. Symptoms — 1. The onset of chronic pulmonary consumption is gener- ally gradual, and marked by one or more of the symptoms of progressive debility and by loss of flesh, chronic dyspepsia, diarrhoea, alterations in the voice, and in females suppression of the monthly periods. In more than half the cases spitting of blood occurs, and a cold or cough is ap- parently the starting-point in verv many instances. A dull, aching pain just below the collar-bones in front or the sho^ilder-blades behind is very often complained of, even whilst the amount of tubercular deposit is small, and is probably due to little spots of pleuritic inflammation. ^Muscular pains in various parts of the frame are often present. The short, dry, hacking cough of early phthisis is usually referred to some irritation about the larynx or trachea, but is, in reality, due to irritation of the bronchial mucous membvnne. 2. Weakness of tlie voice and hoarseness are verv c(]nini(n), and a CHEONIC PDLMONAHY CONSUMPTION. 645 purplish mark upon the edges of the gums, where they come in contact with the teeth, is often observable, and is thought by some physicians to have considerable diagnostic value. In at least lifty per cent, of the patients spitting of blood appears early, and recurs at various intervals, giving the first positive evidence of the existence of consumption. Very rarely, however, is the expectoration of blood in the early stage of con- sumption directly dangerous to life. 3. Among the other symptoms loss of strength is one of the most constant. The patient soon finds that slight exertion, such as ascending a little hill, or even a short flight of stairs, causes fatigue, hurries the breathing and often gives rise to palpitation. The uterine functions in women are apt to be disturbed, and the liver becomes congested and tender. The tongue gets red and irritable, and little sores called apthse form upon its sides and on the mucous membrane of the fauces. 4. Hectic fever coming on toward evening and giving a deceptive appearance of the flush of health to the emaciated countenance develops. There is a total loss of appetite with great thirst, and the loss of flesh is almost visible from day to day. The hair grows thin and loses it attach- ment to the scalp. The debility is extreme and exhaustive night sweats make their appearance. In females there is a total cessation of the menses, which is a most discouraging evidence of failure in vital power. An unmanageable diarrhoea often sets in and conspires with the other causes of debility to utterly prostrate the unfortunate invalid. The lower limbs become very painful, and dropsical swelling of the feet and ankles appears, constituting what is vulgarly called the bloating consumption. 5. Toward the close, cough and abundant expectoration become, if possible, even more troublesome. Great nervous restlessness, cramps in the legs, pain about the loins, distress in passing water, utter prostration and the ever present difficulty of getting the breath, tend to render the last few nights of existence most agonizing. Diagnosis of Consumption — It is so important that the diagnosis of consumption should be made at the earliest possible period, when the chance of life by change of climate is greatest. After the disease is fully developed, and the abimdant expectoration, great loss of flesh and strength, night sweats, and associated sore throat from laryngeal tuberculosis mani- fest themselves, there is often no room for doubt that consumption haa developed, even withoui the aid of auscultation and percussion ; but in the incipient stage just grounds for suspicion are furnished by the presence of slight hacking cough which has resisted the usual remedies, a little 35 546 DISEASES OF THE RESPIRATORY SYSTEM. spitting of blood, provided the patient can be sure that it does not come from the gums or from the back part of the nose, and marked dyspeptic symptoms with loss of flesh and strength out of proportion to the length and apparent severity of the illness. Treatment — 1. The treatment of consumption consists in the pallia- tion of symptoms and the administration of tablespoonful doses, thrice daily, of cod-liver oil, the phosphates or hypophosphites of iron, lime, and the alkalies ; the internal and external use of iodine, and last but not least, of persistent counter-irritation over the diseased spot in the lung, gen- erally near its top and just below the collar-bone, with tartar emetic oint- ment. Nearly all the cases of recovery from well-defined phthisis, coming under the observation of the writer, have been apparently due in large measure to this system of ireatment. 2. In the second stage of consumption — that is, after the deposit of tubercular matter has begun to soften and before any large cavities have formed — the prospect of cure by this or any treatment Is diminished; but even from the third stage — that of the formation of large cavities and extensive destruction of lung-tissue — recoveries occasionally occur. 3. The palliative treatment of consumption further consists in re- lieving the cough and pain in the chest by expectorants and anodjmes, improving the appetite and strength by tonics and stimulants, controlling the diarrhoea with astringents and correcting the derangements of diges- tion with antacids and other anti-dyspeptic remedies. 4. Most patients afflicted with phthisis will find themselves for a time benefited by, first, a cough mixture composed of acetate of morphia, cyan- ide of potassium, syrup of squills, and syrup of wild cherry or syrup of tolu, as already suggested, used chiefly at night to promote sleep in the nocturnal hours and allow the expectoration necessary to relieve the lungs from their accumulated load of sputum to be carried on In the daytime; or elix. of terpen, hydrate and codeine ; second, by a pill of two grains of quinine, half a grain of digitalis, and one-fortieth of a grain of strychnia, with the addition of half a grain of iron, should the condition of anemia exist and there Is no tendency to spitting of blood to forbid Its employ- ment; third, by a mixture of a teaspoonful of syrup of krameria, five grains of prepared chalk, twenty drops of compound spirit of lavender and ten of wine of opium, to check diarrhoea when that appears ; and ■fourth, by powders containing five grains each of bismuth, soda, charcoal and pepsin, or ten of lacto-peptlne, with wineglassful doses of the Iiifu- HOFF rEESCRIPTION FOE CON SUMPTION. 547 sioiis of gentian or coliirabo, as may be found best adapted to tlie par- ticular case as stomachics. 5. For patients mth whom morphia or opium disagrees, codeia, lactu- carium, chloral, bromide of potassium, or hyoscyamus may perhaps be substituted, and in some instances morphia, where illy borne alone, be- comes quite acceptable to the stomach wheu associated with one one- hundredth of a grain of atropia, or with twenty gTaius of bromide of potassium. 6. A^^len obstinate diarrhcEa torments the invalid, the metallic astrin- gents, such as half a grain of sulphate of copper, or one-quarter of a grain of nitrate of silver, thrice daily, are frequently useful, or ten-grain doses of subjiit. bismuth succeeds in controlling the intestinal disorder whon all other remedies prove unavailing. The profuse aud debilitating night sweats may often be checked by sponging with finely-powdered alum and whiskey, by full doses of quinine, or by hypodermic injections of the sulphate of atropia. 7. Seeing, however, that the prospect of curing consumption by medical treatment is so mournfully gloomy, it becomes doubly important to urge that every piatient whose circimistances will admit should resort to a change of climate. And this migration ought to be made ^vith scarcely a day's delay after some amply competent authority has de- termined by thorough examination the necessity of such a change in the colder seasons of the year. THE HOFF PRESCRIFIION FOR CONSUMPTION. Professor Iloff, of Vienna, claims most beneficial resiilts from the following f oiimila : Arsenic Acid 1 part Carbonate of Potash 2 parts Cinnaiuyllic Acid 3 parts Heat this until a perfect solution is obtained, then add twenty-five parts cognac and three parts watery extract of opium which has been dis- solved in twenty-five parts of water and filtered. Dose: At first take six drops after dinner and supper, gradually in- creasing to twenty-two drojis. As long as the patient shows sigiis of improvement the dose should not be increased. It is sometimes beneficial to reduce it. Professor Hoff claims that the physiological action of this remedy is 548 DISEASES OF THE KESPIRATORY SYSTEM. peculiar, in that it docs not arrest seci'etion in the respiratory or intestinal tract, while it has marked power to control inflammation and irritation. It stops all unnecessary and injurious cwighs, relieves the soreness, quiets the irritation and brings rest. He claims that the results are usually highly satisfactory, that the cough diminishes more or less rapidly, dream- less sleep follows, the sjratum becomes looser and the appetite increases. He claims that it supersedes cod-liver oil in more ways than one, not the least of which is that it is palatable, consequently it does not disorder di- gestion or produce nausea. By its use the cough is at once ameliorated, the perspiration is diminished, the patient is strengthened, thereby en- abling him to expectorate the loosened miicus with gi'eater ease, and fre- quently the consumptive steadily improves and regains health. Professor Hoif claims that mild cases have been quickly cured and partial cures have been eilected in severe cases, the appetite and weight increasing steadily and there being a steady lessening of fever, night sweats, insomnia and asthmatic symptoms. He points out that in using the treatment the patient must keep the kidneys in order. The duration of treatment depends upon the condition of the patient. Professor Hoff declares that mild cases are sometimes cured in a few months while those more severe may require a year or two. It is essential that the solu- tion be taken after eating, when the stomach is full. PLEURISY. This disease is an inflammation of the pleura, or delicate membrane which surrounds each lung. Causes — Pleurisy presents itself under two forms — the acute and the chronic. Its common cause is exposure to cold, but sometimes it arises from injury, as, for example, from the pleura being wounded by the jagged end of a broken rib; or, secondarily, adjacent inflammation, such as takes place around a nodule or tubercular deposit in consumption, or in the course of some other disease, for instance, Bright's disease or scarlet fever. Symptoms 1. The onset of acute pleiirisy may be insidious, but gen- erally, Avhen arising from its usual cause, exposure to a very severe cold, it is rather sudden and marked by repeated chills. As soon as the patient reacts from these, the temperature begins to rise and thus furnishes a distinguishing symptom which often enables the complaint to be dis- criminated from pneumonia. PLEURISY. 549 2. At the same time, or very soon after the rise in temperature, pain, cough and dyspnoea are observed. The pain is ahnost always referred to the affected side, a few inches below the nipple, and is sharp and darting, described as resembling a stab with a keen knife, esi^ecially on trying to take a deep inspiration or to cough. As a rule, the diificulty of breathing is slight and mainly due to the pain in the side and to the febrile excite- ment in the system. The cough is short, hacking, and accompanied with little or no expectoration; the pulse is quickened; the tongue is some- what furred, the appetite impaired, but the thirst is increased, and the bowels are confined. 3. After a variable period, averaging, perhaps, between one and two weeks, the attack usually terminates in recovery, with or withoiit a con- traction of the wall of the chest on the affected side, according as the lung is able to expand after being compressed by the effused fluid ; or the malady may end in the chronic form of pleurisy, or very rarely in the uncomplicated affection it may have a fatal result. 4. In chronic pleurisy the effused liquid remains in the pleural sac, without becoming absorbed. It is especially apt to become purulent in a short period in children, or in persons whose health is impaired from any cause. When this degeneration takes place there is always more or less febrile disturbance of a hectic type set np in the system generally. The skin of the affected side after a while becomes, over the seat of the effusion, reddened, tender, swollen and dropsical. The finger nails are often clubbed, as in consumption, and night-sweats are not infrequent. Cough is apt to be troublesome and may be accompanied by an expectora- tion of muco-pus, which in rare cases possesses a putrid odor. Diagnosis. — The diagnosis of pleurisy without the aid of auscultation and percussion, must often be difficult, at least for the first few days of the attack, but it can sometimes be made from pneumonia by the lower grade of fever, the small amount of dyspnoea, and the total absence of rusty expectoration. It can he distinguished from bronchitis by the small amount of cough, and the sharpness of its pain, and from acute phthisis by the strength being but slightly diminished. Treatment — 1. The treatment of pleurisy in the first stage, when acute pain is the most prominent symptom, is bleeding, leeching or cup- ping over the affected side, if the patient is robust and previously in good health. In persons of feeble constitution it is better to apply ten or twelve dry cups, and then use hot j^oultices with laudanum for the further relief of pain, than to deplete the system, or turpentine and sweet oil. If 550 DISEASES OF THE RERPIRATOT5Y SYSTEM. suited to the patieut, hypodermic injections of morphia are of great ser- vice. After the second day free watery purgation by a tablespoonful o£ rochelle salts, epsom salts, or a bottle of citrate of magnesia, and a restric- tion of the amount of fluid taken into the stomach, are advisable, in order to limit the tendency of effusion into the pleural sac as far as possible. If the febrile movement runs very high, veratrum viride or aconite, in three to five-drops doses of its tincture, may be given to reduce the pulse and heart's action, but this is rarely necessary. 2. In the second stage after effusion has occurred, the chief indica- tion is to reduce the amoimt of this serous liquid as speedily as possible, and for such a purpose diuretics and saline purgatives or elaterium, in quantities of half a grain every three hours, or so as to cause abundant watery discharges, may be given ; counter-irritation by iodine and small blisters being kept Tip over the diseased side of the thorax. If the liquid is effused in large amount and causes much interference with respiration, it may be necessary to draw it off by means of an aspirating apparatus. Diet — As the cure progresses tonics, good nourishing food and early exerc"se in the open air in suitable weather, are highly important. Hydrothoras — This is the name applied to that diseased condition where there is an accumulation of water or serous fluid in the cavity of the chest. It may be the result of pleuritic inflammation, but not un- frequently occurs in dropsy without inflammatory action. Sometimes it increases to an enormous amount, pressing on the lungs and displacing the heart, with such great interference to the respiration and circulation as to prove the immediate cause of death, unless removed by aspiration, or exhaling the breath through an opening in the pleura. Pneumothorax — This is the term applied to the morbid state in which air has entered and partly occupies the cavity of the pleura, compressing the lung in the same way though less forcibly than does a watery effusion. This accident sometimes occurs from the rupture of the vesicles of the lung through the pleural membrane into the cavity of the pleural sac. At other times it results from some injury to the chest, such as a gun-shot wound or the fracture of a rib. Where closure of the aperature by which this air found an entrance can be secured, it may be necessary, in order to relieve the oppression of breathing, to pump out the air by means of the aspirating apparatus. Emphysema — This is the accumulation of air under the skin in the Bubcutaneous connective tissue j it is a curious result occasionally met with CAISSON OR COMPKESSED AIE DISEASE. 551 from wounds of the pleura, such as those produced by compound fractures of the ribs aud other causes. This distension of the integument with air may progress until all semblance of humanity is lost aud yet entire recovery takes place. It may almost always be prevented by proper at- tention to the primary injury. Other Diseases of the Pleura — The membrane of the pleura may be affected with cancer, simple tumors, tubercle and parasitic growths, but these are very uncommon, except as secondary manifestations of extensive disease of the same kind in other portions of the body, in which cases the latter are consequently the proper subjects of whatever treatment becomes needful. CAISSON OR COMPRESSED AIR DISEASE. This is a disease occurring among laborers, engineers or any person compelled to work for any lengtii of time in timnels, jetties, foundations for bridges, etc., where it is necessary for a caisson to be used containing compressed air. It is, therefore, not a germ disease, but causes sickness among laborers by the constant breathing ijito their lungs this compressed air. The latest theories in regard to how this compressed air aft'ects the system of healthy persons are that the tissues and fluids of the body be- come saturated with the gasses of the atmosphere to a degree which depends upon ( 1 ) the amount of pressure of the compressed air in the caisson ; (2) the length of time they are exposed to it; (3) the activity of the cir- culation and the ability of the individual's tissues as regards the rapidity with which the gases are absorbed. No matter how high the compressing of the air in the caisson is, symptoms do not occur until the man leaves the caisson and breathes the atmospheric air. The disease is principally due to the formation of air bubbles (chiefly nitrogen) within the body brought about by decompression (meaning that the atmospheric air removes the pressure from the lungs when the person is relieved from the compressed air in the caisson. This relief takes place so rapidly that the gases fonned in the blood cannot be carried to the lungs and thrown off as gradually as they entered; as a result, gases in the fonn of air bubbles, form in the blood and tissues and damage them by the force of their expansion. When a man is in a caisson working under compressed air, the tirst 563 DISEASES OF TITE RESPIEATOKT SYSTEM. effects lie notices are more of a functional nature than the symptoms of caisson disease, they are practically mechanical due to the pressure of the contained air. He feels that the car-drum membranes are forced inward, -svhicli cause discomfort, perhaps pain. The^' may rujiture. Rise of tem- perature with sweating due to the heat caused by the compressed air. It is diificult to force the air out of the lungs. Whistling or whispering can- not be done, and the attempt causes a sensation of numbness In the lips, which also do not move. The voice Is changed and Is done through the nose. A sensation of well being and excitement Is felt by the laborer. The skin does not change Its color nor Is the normal rate of the pulse altered. The Symptoms of Caisson Disease. — These never occur while the man is In the caisson, but usually come on In fifteen minutes to twenty-four hours after he has left the caisson and breathes normal atmospheric air. Pains in the knees and elbows are the most frequent symptoms ; they also occur at times In abdomen. The pains in the knees cause the person to bend his knees and the attitude has been termed "the bends." Dizziness occurs and is spoken of by the laborers as the "staggers." Nausea and vomiting may come on. Difficult breathing develops in some men and Is spoken of as "chokes." Prostration and collapse occur rarely and the patient becomes unconscious. These symptoms have been followed by death. Itching of the skin occurs, supposed to be due to the presence of air bubbles In the sweat glands In the skin. Workers in compressed air who have followed such labor for years are usually apt to suffer from deafness, "bends" or severe pains In the knees. Temporary or permanent paralysis of the legs and arms are a rare complication. Treatment for this Disease. — There is, of course, no home treatment Most of the large contractors who builds tunnels, bridges, etc., have their own physicians at hand to treat all laborers overcome upon removal from the caisson. Special treatment is necessary under the care of speciallsta in this disease. There is no method of preventing this disease as long as men must work under compressed air. It attacks the healthiest of men who are free from disease and well nourished at the time of going to work. PART VII OF BOOK IV Treats of the Digestive System and the diseases affecting the different parts, giving the best and newest treatments. Abdominal Dropsy 593 Atrophy of the Liver 592 Abscess of the Gum 559 Abscess of the Liver 591 Treatment of 592 Abscess of Tonsil 565 Acute Gastritis 567 Acute Stomatitis 556 /Esophagus, Diseases of 566 Anus, Fissure of 589 Aphthous Stomatitis 556 Treatment of 556 Appendicitis 575 Treatment of 577 Appendix, Inflammation of 575 Function of 575 Ascites 593 Treatment of 593 Baby's Sore Mouth SSS Bowels, Inflammation of 574 Cancer of the Lip 555 Cancer of the Tongue 560 Treatment of 560 Cancer of the Stomach 571 Treatment of 571 Cancrum Oris 557 Cirrhosis of the Liver 592 Clergymen's -Sore Throat 561 Colic 587 Hepatic 592 Liver 592 Colitis 574 Treatment of 574 Congestion of Liver 591 Constipation 583 Treatment of 583 Costiveness 583 Dentition, Difficult 550 Diarrhcea 581 5 DifiRcult Dentition 559 Diseases of the Lip 555 Dropsy, Abdominal 593 Dysentery 579 Treatment of 580 Dyspepsia 568 Treatment of 569 Enteritis 574 Treatment of 574 Epulis 559 Falling of the Anus 589 Fissure of the Lip 555 Fistula in Ano 589 Follicular Stomatitis 556 Gall-Stones 590, 592 Treatment of 590, 593 Gangrenous Stomatitis 557 Gastritis, Acute 567 Treatment of 567 Gullet, Stricture of 566 Gum, Abscess of 559 Gum Boil 559 Treatment of 559 Gum, Inflammation of 558 Gum Tumors 559 Hare-lip ....555 Hemorrhoids 588 Hepatic Colic 592 Hernia 584 Inflammation of the Appendix 575 Bowrels 574 Gum 558 Mouth 555 Stomach 567 Tonsils 561 Intestinal Obstruction 578 Treatment of 579 Worms 586 Jaundice 590 554 INDEX TO PART Vl OF BOOK IV. Lip, Cancer of S5S Diseases of 555 Fissure of 555 Ulceration of 555 Liver, Abscess of 591 Atrophy of 592 Colic 592 Liver Complaint 594 Treatment of 595 Liver, Congestion of 591 Treatment of 591 Liver, Cirrhosis 592 Diseases of 590 Waxy 592 Mercurial Stomatitis 558 Mouth, Inflammation of 555 Noma 557 Palate, Perforation of 559 Parasitic Stomatitis 557 Perforation of Palate 559 Treatment of 560 Peritonitis 573 Treatment of 573 Piles 588 Treatment of 588 Pin-Worms 587 Prolapsus Ani 589 Putrid Sore Mouth 557 Quinsy 565 Treatment of 565 Round- Worm 586 Rupture 584 Treatment of 585 Salivation 558 Simple Stomatitis 556 Treatment of 556 Sore Mouth, Baby's 555 Putrid 557 Sore Throat 561 Clergymen's 561 Stomach, Cancer of 571 Inflammation of 567 Ulcer of 571 Stomatitis 555 Acute 556 Aphthous 556 Causes of 555 Follicular 556 Gangrenous 557 Mercurial 558 Parasitic 557 Simple 556 Symptoms of 556 Ulcerative 557 Stricture of the Gullet 566 Tape- Worms 587 Teething 559 Throat, Sore 561 Thrush 557 Tongue, The 562 Cancer of 560 Ulceration of 560 Tongue-Tie 560 Treatment of 560 Tonsillitis 561 Treatment of 564 Tonsils, Inflammation of 561 Abscess of 565 Tumors of the Gum 559 Ulcer of the Stomach 571 Symptoms of 572 Treatment of 573 Ulceration of the Lip 55S Ulceration of the Tongue 560 Treatment of 560 Ulcerative Stomatitis 557 Treatment of 557 Waxy Liver 592 Worms, Intestinal 586 ILLUSTRATIONS The Kidney 590 The Liver 59a The Tongue 563 CURATIVE MEDICINE TART VII. DISEASES OF THE DIGESTIVE SYSTEM In considering the maladies of the digestive system frequent refer- ences must be made to the anatomy of the alimentary tract, and to the physiology of digestion. LIP DISEASES. Among the common diseases of the lips are nlceration and fissure, which may often be induced to heal by light apijlications of nitrate of silver solution, in conjunction with diligent improvement of the general health. Cancer of the lip is not uncommon among men in advanced life, but is less frequent in females. It should be operated on in accordance with the rules already laid down, in discussing the subject of cancer. Hare-lip is a curious malformation, in which the upper lip has failed to develop in such a way as to unite in the centre previous to birth, and the child is left with a deep cleft, sometimes reaching all the way from the edge of the nostril. This malformation can generally be remedied by a surgical operation. STOMATITIS OR INFLAMMATION OF THE MOUTH. This is commonly met with in young infants, and is called "baby's fore mouth." It consists of an inflammation of the mucous membrane of the moiith and tongue. Causes. — These may be : 1. Mechanical, chemical, thermal or parasitic. 2. Poisons, as mercury or lead. 3. In certain debilitating diseases, as consumption or diabetes. 4. It is most commonly found in young children, in connection with (555) S56 DISEASES OF THE HIGESTIVE SYSTEM. digestive disturbances, due to artificial feeding and bad hygienic sur- roundings, especially during the summer months. General Symptoms — There are six chief subdivisions of stomatitis, and seven general symptoms common to all varieties. These are heat, pain and redness of the mouth, increased salivation, foul breath, restlessness and disinclination to nurse. VARIETIES OF INFLAMMATION OF THE MOUTH (STOMATITIS) I. ACUTE OR SIMPLE STOMATITIS. This is the most common form in inflammation of the mouth, and is usually the result of the action of irritants. It is freqiient at all ages and is especially common in imhealthy subjects suffering from, digestive dis- turbances. Symptoms — General redness. There may be areas of marked con- gestion wlicre irritation is most intense. Mastication is painful. Treatment — In infants the month should be carefully sponged after each feeding. Chlorate of potash and sulphite of soda as mouth-washes and gargles, of the strength of a dram to four ounces of water, are useful, or, in severe cases, a dilute solution of nitrate of silver (three or four grains to oimce) may be applied, and attention ought to be paid to im- proving the general health by the use of tonics, nutritious food, and so forth. II. APHTHOUS STOMATITIS OR FOLLICULAR STOMATITIS. This is characterized by the presence of small raised spots or vesicles, ■which may rupture, leaving small ulcers, surrounded with a red bole. This form of stomatitis occurs most frequently in children under three years of age. There are usually some digestive disturbances present. Treatment. — Correct digestive disturbances ; sterilize the milk ; nurse at regular intervals, and cleanse the mouth with a linen rag after each nursing. Ajiply to mouth and gums three or four times a day : Boric acid 15 grains Glycerine '- ounce Water up to 2 ounces If the disease does not yield to this treatment, touch the ulcers with solid nitrate of silver stick. GANGKENULS STOMATITIS. 667 III. PUTRID SORE MOUTH OR ULCERATIVE STOMATITIS. This variety occurs especially in children after the first dentition. It is thought by some to be infections, as it at times occurs in widespread epidemics. It attacks both adults and children. Symptoms. — It occiirs with low condition of nutrition. The gums of the lower jaw are chiefly affected. They are swollen, red and spongy. There is increased salivation, the teeth become loose, the breath foul and mastication painful. In rare cases there is necrosis (decay) of lower jaw. Treatment. — Correct the hygiene. Touch ulcers with nitrate of silver, and use as a moiith-wash a solution of chlorate of potash, fifteen grains to the ounce. The best remedy is chlorate of potash, given internally, in doses of two grains, three times a day, to a child, and double that amount to an adult. IV. PARASITIC STOMATITIS OR THRUSH. This disease is dependent upon the growth of an irritating fungus (Saccharomysis albicaiis). The development of thrush over the whole lining membrane of mouth and throat is very common shortly before death in wasting diseases, such as consumption and diabetes. It may occur at any age, but is especially common in children. Symptoms — It begins on the tongue as slightly ra.sed pearly spots, which spread and coalesce. The membrane can be scraped off, and is readily recognized under the microscope. It may spread to the pharynx, oesophagus or larynx. Treatment Correct the hygiene; treat as any gastric disturbances. Tonics are often indicated. Locally, use sulphite of sodium, one dram to the ouuce of water, or Borax I drachm Glycerine 2 drachms Water 6 drachms Apply two or three times a day to gums and mouth. V. GANGRENOUS STOMATITIS, OR CANCRUM ORIS OR NOMA. This terrible, but fortunately rare, disease is usually seen in debili- tated children, between the ages of two and six years. It usually follows one of the specific fevers, especially measles and whooping-cough. Symptoms. — The general symptoms of stomatitis are marked. Th ; 658 DISEASES OF THE DIGESTIVE SYSTEM. mucous membrane is first affected, usually of the gums or of one cheek. The process begins gradually. Externally the cheek is swollen hard, red and glazed, and inside the mouth is seen an ulcer with a great deal of proud flesh or slough. Treatment — Good hygiene ; alcoholic stimulants ; nutritious food and tonics, as iron, quinine and strychnia. Locally, there is nothing that will do much good, but the actual caiitery applied to tlie surface is said to be of some use, as is the application of fuming nitric acid, followed by soda, the surrounding parts being protected with lint soaked with oih VI. MERCURIAL STOMATITIS OR SALIVATION. This form is very seldom seen at present, except in those who work in mercury. Causes — It may be caused by the administration of mercury in any form. It is most commonly produced by large doses, or even small doses, of calomel in those who are especially susceptible. Symptoms. — Those first noticed are tenderness of the gums, mani- fested by forcibly bringing the teeth together, redness of gums near the insertion of the teeth, a metallic taste and an increased flow of saliva. If the disease is not checked at this stage these symptoms will become ac- centuated, and there will be profuse flow of saliva, foul breath, redness, swollen and tender gums. In severe cases there may be ulceration of the gums. Treatment. — The administration of mercury should be suspended as soon as there is the first symptom of salivation. Bowels should be opened by magnesium sulphate (half an ounce) ; best taken in half a glass of water before breakfast. Hot baths should be taken every evening, and alkaline waters should be taken in large quantities. Atropine sulphate, one one-hundredth of a grain may be taken twice a day, and iodide of potassium, five grains, thi'ee times a day. DISEASES OF THE GUMS These generally require the care of a dentist, and when connected with affections of the teeth, or their sockets in the alveolar processes, are usually so painful that prompt application to a dental practitioner is made. Inflammation of the Gum. — This, when conjoined with ulceration at DIFFICPLT DENTITIOS, 559 the root of a tooth, gives rise to horrible suffering which lasta for three or four days, when it is usually relieved by the discharge of matter or pus. This may be hastened by hot applications. Treatment. — The pain can be somewhat mitigated by anodynes, such as ten grains of Dover's powder or one-sixth of a grain of morphia, and poultices, but the best treatment is the extraction of the offending tooth, or the perforation of the alveolar process to the seat of trouble by drilling a hole through the spongy bone. ABSCESS OF THE GTJM OR GUM BOIL. This is sometimes followed by ulceration, which may be hard to heal unless the whole cause of the difficulty is removed, which can now be accomplished imder nitrous oxide gas so quickly, painlessly and safely, that no time should be lost in resorting to it. One extremely skillful operator in Philadelphia has now administered the gas for operations on the teeth in over one hundred thousand cases without a single fatal result. Hypertrophy and atrophy of the gums are sometimes met with. DIFFICULT DENTITION. Treatment — A very common cause of diseases of the stomach and bowels, and also of convulsions in children, is to be found in the harden- ing or induration of the gums at the time of teething, and this blunder of nature's ought to be promptly remedied whenever the gums in infants at the time of the first dentition are found to be red, swollen, and hot to the touch, by the use of the lancet. This little operation of lancing the gums, which, simple as it is, has probably saved the lives of thousands of young children. After the incisions are made bleeding should be en- couraged, but care must be taken by wiping it off with a handkerchief to prevent the infant from swallowing the blood. It is astonishing what relief is often afforded to the little sufferer by a timely lancing of the gums. Gum Tumors. — Tumors of various kinds sometimes make their ap- pearance upon the gums, the most common of those which are non-malig- nant being the fibrous growths called epulis, often apparently caused by the irritation of diseased and neglected teeth. They all usually require surgical operations for their removal. Perforation of Palate — Perforation of the hard palate or roof of the mouth is sometimes a malformation present from birth, and due to the 5G0 DISEASES OF THE DIGESTIVE SYSTEM. same kind of arrest of development as bare-lip. At other times it may be due to venereal or scrofulous disease. A surgeon can do much to cure this deformity by operation, or to remedy the defect if incurable by surgical appliances, which substitute most ingeniously the deficient por- tions of the mouth. DISEASES OF THE TONGUE The Tongue is subject to almost all the diseases already spoken of as affecting the inside of the mouth, for which similar treatment is required. Troublesome little ulcers on the tongue can often be promptly cured by holding in contact with the sore a pinch of powdered borax for ten or fif- teen minutes. Deeper ulcers may require touching with the solid nitrate of silver, and if dependent upon the constitutional taint of syphilis will be very difficult to heal without the use of internal remedies also. CANCER OF THE TONGUE. Cancer of the Tongue appears sometimes to have its origin late in life from the local irritation of the stem of a pipe in habitual smokers, or from the sharp corner of a broken or isolated tooth. Hence it is important to avoid these exciting causes as much as possible. The operation for re- moval of cancer when seated in the tongue is more justifiable than almost any other, because, if recurrence should take place in the glands of the neck, or still better, in some internal organ, death comes to the victim in a much less painful and horrible form. TONGITE-TIE. Tongue-tie is a malformation in which, from the prolongation of the little membranous band, called the frsenum, underneath the tongue, the organ, even to its very tip, is in some cases tied down to the lower jaw. If, as occasionally happens, it interferes with a baby's nursing, it should be operated upon the next day after birth by nicking the band at the front edge, and then tearing it back to about the usual position. No cut- ting operation should be resorted to, except in this very superficial way, on account of a very active little artery which lies at the root of the tongue, and which, if wounded, might bleed so as to endanger an infant's life before the hemorrhage could be checked. On this account, if nursing DISEASES OF THE TIIEOAT. 561 is not seriously interfered with, it is better to wait some months before thus untying the tongue. DISEASES OF THE THROAT Sore throat, which may bo considered as comprising inflammation of the mucous membrane lining both the fauces and the pharynx, as they nearly always occur together, is one of the commonest disorders. It is occasionally produced by attempting to SAvallow some irritating article of food, or poison, but is ordinarily the result of cold. It also occurs in the course of various febrile affections, such as scarlet fever. Symptoms. — The symjjtoms are jiain on swallowing, redness of the surface, and at first dryness, but after a day or two later excessive secretion from the mucous membrane. Subsequently to partial recovery from an acute sore throat, the condition may be one of relaxation, the membrane remaining loose and flabby, and often thrown into projecting folds. This state usually follows cold and sore throat, but may be induced by mechanical causes, such as severe, hoarse cough, screaming, shouting, or over-straining in reading or singing. It may also be brought on by excessive smoking. Clergymen's Sore Throat. — One form of this malady, called clergy- men's sore throat, is the result of excessive iise of the voice in church service when the health is already impaired, especially when the air of the apartment in which such exertion is made has been rendered impure by overcrowding. In bad cases of sore throat, the inflammation may go on to ulceration, especially if neglected. The generally relaxed condition of the throat is partaken of by the uvula, or palate, as it is incorrectly called by many people, and this hanging down lower than it ought, may cause a hacking cough by tickling the epiglottis. The above is a description of sore throat in general. The most com- mon form of inflammation of the throat is tonsillitis. TONSILLITIS OR INTLAMMATION OF THE TONSILS. Causes — The disease is most common in the young. It is rare in infants. Exposure to cold and wet with bad hygienic surroundings seem to be the chief exciting causes. Some writers claim that there is a close relation between this and rheumatism, but Osier has not found the rela- ?i6 5G2 DISEASES OF TilE DIGESTIVE SYSTEM. THE TONGUE Figure No. i. i. Hyoides bone joining many muscles of the tongue. 2, A Muscles fastened at the cor- ners of the jaw-bone to pull in the tongue. 3. Muscle formed by the outer edge. 4. Deep muscle which turns the tongue toward the side. 5,6,7. Muscles which facilitate the turning of the food in the mouth. 8^8. Salivary glands. 9. Muscle of the bottom cf the mouth. 10. Cross muscle formed by the l.p. Figure No. 2. I, 1. Muscles which form the outer border. 2. Hyoides bone. 3. 3. Muscles which move the base of tbe tongue. 4.4. Exterior insertion of trans- versal muscles. 5. 5. Junction line of the transver- sal muscles. Figure No. 3. 1. Tonsils or glands of the throat. 2. Base of the epiglottis or valve to close the windpipe in swallowing. 3. Lateral arches. 4. Muscles joining the tongue to the epiglottis. 5. Blind apertures in the base of the tongfue called "blind fora- men." 7. Nerve endings like thread. 8,9. Fungiform nerve endings. 10. Apex of the tongue. Figure No. 4. 1. Exterior muscle of the tongue. 2. Apertures of mucous glands. 3. Apex. 4. Under muscles with the cover removed. 5. Periglottis turned back. 6, 7. Conduits at the base of the tongue. 8. Nerve endings at the base. 9. Salivary glands. 10. Muscles joining the tongue to the epiglottis. 11,12. Depressions upon the peri- glottis. Figure No. 5. 1,2. Salivary conduits. 3. Wharton conduits. 4. Sublingual gland. 5. Branches or arms of the jaw- bone. Figure No. 6. I. Nerve endings of the tongue. 2, 2, 2. Submucous pellicle. 3. Muscular larynx (deep). 4. Band which joins transversal muscles. 5. Transversal bands of the mus- cles. 6, 6, 7, 7. Salivary conduits. 8. Muscles for pulling in the tongue. Fig. 1. — View of the muscles of the tongue — lower surface. Fig. J. — Front view of the upper surface of the tonpue; as also of the arch of the bone of the palate. Fig. 5. — View of the lower jav bone witli the tongue turned up. Fig. 2. — View of the under surface of the tongue with its musclesi Fig. 4. — View of the back of the tongue, from which, by masceration. the periglottis has been removed and turned back on the right side. Fig. 6. — ^View of a section of the front part of the tongue, seen from behind. THE TONGUE. For an explanation of the illustrations see text on opposite page. 563 564 DISEASES OF THE DIGESTIVE SYSTEM. tiou between the two very striking, except iu one point, viz., "that an attack of acute rheumatism is not infrequently preceded by an attack of inllammation of the tonsils. Personal susceptibility and heredity play an important part iu its productions. At times it runs through a family, or a community, with such rapidity as to suggest an infectious origin. Symptoms. — In the mild forms there may be no other symptoms than redness and dryness of the throat with painful swallowing. The tonsils may be felt as hard lumps just behind the angle of the jaw. Symptoms of More Severe Forms — In the more severe forms it may begin with a chill followed by a rise of temperature which in children may reach as high as 105 degrees Fahrenheit. Pains in the back and limbs are not uncommon. local Symptoms — The local symptoms are those of the mild form accentuated. If only one tonsil is swollen the uvula is drawn to the affected side. Follicular Form. — In this variety white patches may be seen covering the tonsil. These are due to the accumulation of degenerated epithelial and white blood cells in the depressions, or cryps, in the tonsil. Dia^osis — The follicular form must be distinguished from diph- theria. The membrane of diphtheria is not in patches, but continuous over the surface of the tonsils, and extended up itpon the pillars of the fauces and uvula, and is greyish-white in color. When this is stripped off it leaves a raw, bleeding surface, which is not the case when the con- tents of the cryps are expressed in follicular tonsillitis. Constitutional Treatment — Bowels must be freely opened with calo- mel, one-quarter grain every half hour, for six doses; followed by mag- nesia sulphate (epsom salts), one-half ounce, to be given one hour after last dose of calomel ; ten grains of Dover's powder at bedtime. Salicylate of soda is often beneficial, and may be given as: R. — Salicylate of soda 5 drachms Iodide of potassium 2% drachms Syr. sarsaparilla l'-^ ounces Water sufficient to make four ounces. Take one drachm every four hours. The dose must be reduced in children to about half. Local Treatment. — Gargles of borax, ten grains to the ounce, or salt au'l -ivater. hot. The following will be found very serviceable: QUINSY OK ABSCESS 0¥ TONSIL. 565 R. — Tincture chloride of iron i ounce Glycerine i ounce Chlorate of potash Vi drachm Shake well before using, and use one drachm of the mixture to one ounce of water, as a gargle. Clean teeth after using. Sprays of glyco-thjonoline or supra-renal extract are good; or swab throat with equal parts of tincture of iron and glycerine. ariNSY on ABSCESS OF TONSIL. This disease is a cause of great suffering to some persons in youth and middle age, but is rare in childhood, and often ceases its molestations after individuals commence the decline of life. Causes. — Exposure to cold and wet are its common exciting causes. Symptoms — In the catarrhal form of quinsy the inflammation is often superficial, and after causing much pain and difficulty of swallowing, sub- sides in three or four days without suppuration. In the severer variety an abscess or boil forms in the substance of the tonsil, attended with great pain and swelling, difficulty of swallowing, a good deal of fever, and some loss of strength. The patient often suffers from earache, and is somewhat deaf on account of the inflaimnation extending along the Eus- tachian tube. The breathing through the mouth is much interfered with, but the danger of suffocation is apparent only. The disease lasts on an average about seven days, but the abscess may break on the fifth day, or may linger until the teuth day, unless earlier oiieued by the lancet. The complaint is very apt to recur, and the sufferer from one attack rarely escapes without several every winter, until the tendency, which may be hereditary, is exhausted. Treatment — The treatment consists m an effort to abort the disease by leeching, externally, and the use of guaiacum in teaspoonful doses of the tincture four times daily, by the mouth. If these remedies fail, poultices of little bags of hops dipped in hot vinegar and sprinkled Avith laudanum, and hypodermic injections of a quarter of a grain of morphia, may afford some relief. When suppuration is established, the period of suffering can be abbreviated by lancing the swelling in the throat, pro- vided the spot where the abscess points is high enough to be felt by the finger. The operation is performed by having a long, narrow-bladed knife wrapped with sticking plaster to within a quarter of an inch of its poipt, ^nd then passing this down the throat, guarding it with the finger, 566 DISEASES OF THE DIGESTIVE SYSTEM. and giiidod by the touch, as the patient can rarely open the mouth wide enough to admit of seeing, a small incision is made into the softened por- tion of the tumor. The relief afforded either by puncture in this way, or by spontaneous rupture, is wonderfully great. No after-treatment is necessary; but as before mentioned, the complaint is very liable to recur, and it often happens, that in persons who are strongly predisposed to it, the first imprudent exposure on venturing out will light up the disease in the opposite tonsil, with an almost exact repetition of the suffering, within two weeks. DISEASES OF THE (ESOPHAGIJS OR GULLET. Inflammation of the Gullet — This is a rare affection, and usually due to swallowing some hot or corrosive liquid, although it may occur from the extension of simple or erysipelatous inflammation from the throat, or of the former variety from the stomach. Ulceration is also uncommon, although it does occur in connection with syphilitic complaints. Stricture of Gullet. — This is the most frequent form of disease of the gullet. Varieties of Stricture — 1. Spasmodic stricture is a narrowing of the tube, caused by simple contraction of its muscular fibres. This condition is especially met with in hysterical females, and, though alarming at the time, seldom proves fatal to life. Traumatic Stricture — 2. This is the variety in which the constriction has been caused by irritation and inflammation due to an injury inflicted on the surface of the tube, in any part of its length, by the swallowing of scalding water or of some corrosive substance, or by a wound. The result of such a stricture is to render the act of swallowing always difficult, unless relieved by a surgical operation. Simple Organic Stricture. — 3. This is occasionally seen, in which there is a mere narrowing of the gullet, without any apparent tendency to ulceration. The most common and fatal form of stricture is that due to cancerous deposit and ulceration. It may cause death by producing a complete obstruction, so that neither food nor drink can enter the stomach, or by ulcerating into some of the adjoining vital structures. The surgical operations sometimes performed for its relief are of very doubtful benefit or propriety. IKFLAMMATION OF THE STOMACH. 667 ACUTE GASTRITIS, INTLAMMATION OF THE STOMACH. The simplest and most common form of inflammation of the stomach is characterized by active congestion and excessive secretion of mucus, a condition known under the name of gastric catarrh, and very similar to that so frequently met with in the throat and air-passages. Causes.— The causes of this malady are indigestible food, especially in children, irritant poisons, or alcoholic excess. But it may occur in con- nection with gout or as a symptom in some of the eruptive fevers. Symptoms — The symptoms of acute gastritis are pains, which are often severe over the pit of the stomach, shooting through to the back, and increased by taking food, but temporarily relieved by vomiting. Tenderness over the pit of the stomach is always present, and nausea and vomiting are prominent symptoms, the vomited matter consisting of a glairy mucus, stained with bile of a greenish-yellow or bright green color. The tongue is coated with fur, whilst the edges and tip are fre- quently red and irritated. The bowels are apt to be confined, and the urine scanty and high colored. These symi:)toms often set in with chilli- ness, followed by restlessness, hot skin, headache, and other febrile symp- toms. In bad cases there may be great prostration, with cold, clammy skin, a weak, rapid pulse, some difficulty of breathing, and obstinate hiccough. Generally, however, under proper management, these distress- ing symptoms subside after a time, although they sometimes pass into those of the chronic form of gastritis. General Treatment. — The treatment of this disease is, in the first place, if consequent upon the introduction of some poison or irritating material, to get rid of the offending substance by means of an emetic, followed by a purgative, which is perhaps in most cases best administered by enema. Diet — The food should be entirely liquid, and given in very small quantities; in fact, most cases woiild do better if nutritive injections were depended on to sustain life for a few days or a week or two. The thirst may be relieved by sucking small pieces of ice, but iced champagne is sometimes borne by the stomach when everything else is rejected, and iced carbonic-acid water is often acceptable. Medicinal Treatment. — With the exception of subnitrate of bismuth, in quantities of five grains, and drop-doses of diluted hydrocyanic acid, it is usuallv advisable not to provoke the irritable stomach with medicines, 568 DISEASES OF THE DIGESTIVE SYSTEM. the hypodermic injection of morphia being used to relieve the pain, if the j)atient can take morphia, or morphia and atropia, ia doses of one-eighth of a grain of the former and one one-hundredth of the latter in that way without nausea being produced. Thin and light poultices, as, for instance, of flaxseed meal and laudanum, laid over the region of the stomach, are frequently of service, or if the pain is very severe a few leeches may be ajjplied. Convalescence from this malady is generally slow, and requires great care in regard to diet and exertion. DYSPEPSIA. This affection, the great torment of civilized life, is to be considered rather as an unnatural functional difficulty than as a structural disease. Varieties of — Among its three chief varieties may be mentioned: First Form. — The form due to sympathetic relations with other organs which are themselves in a morbid state, and which is therefore explainable as a reflex action. Of such a type is the nausea and occasional vomiting which attends irritation of the brain, lungs, liver or uterus. Sea-sickness is believed to be a form of this reflex dyspepsia. Second Form. — This form is attributable to a scanty secretion of gastric juice, and is characterized by slowness of "digestion, long retention of food in the stomach, prolonged distress after eating, especially with feelings of weight and uneasiness at the pit of the stomach, a tendency to decomposition of the food in the alimentary canal .with the evolution of fetid gases and the appearance of undigested food in the evacuations from the bowels. The food may be considered to be delayed in the stomach when it remains there for more than two or three hours. Dyspepsia of this kind is often inherited, but much can be done to aggravate the ten- dency by mental over-exertion, prolonged and intense anxiety, especially if commencing directly after meals, sedentary habits, gluttony, and the use of alcoholic and other stimulants. Third Form — This form of dyspepsia appears to be owing to some abnormal quality of the gastric juice, and to diminished peristaltic move- ment of the stomach, so that food is not sufficiently "mixed up with the digestive fluids. Symptoms — One of the most characteristic symptoms of this con- dition is pain at the cardiac end of the stomach, to which tlie name of cardialgia has been applied, on account of tlie distress being in such close proximity to the heart. Many dyspeptics, being also more or less hypo- DYSPEPSIA. 569 flionrlriacs, imagine from this symptom that they are subjects of organic disease of the heart, and suffer intense, yet groundless, mental anxiety on that account. The names of heartburn, pyrosis and water-brash are applied to slight modifications of this symptom. Tobacco contains a poisonous principle which, in many persons, favors the development of dyspepsia, and some individuals suffer from smoking even a single cigar. General Symptoms. — Inability to absorb liquids occurs in some vari- eties of dyspepsia, so that fluid which has been swallowed may be heard splashing around in the gastric cavity on any foi'cible agitation of the body, the stomach being usually distended to a great extent. As further aids in distinguishing between dyspepsia from deficient secretion of the gastric juice, and deficient motion of the stomach, it should be remembered that in the former neither flatulence nor constipation are generally pres- ent, whilst in the latter variety flatulence is one of the most characteristic symptoms and constipation is usually well marked. Some of the worst cases of dyspepsia from deficient secretion of the digestive fluid, in which pain after taking food and other symptoms are particularly severe, ap- pear entirely free from flatulence. The tendency of the fermentation which goes on in the slowly digesting food seems to be of a kind in which gases are not evolved. In all these forms there is a loss of appetite. The tongue is usually broad, pale and flabby. The pidse is weak, soft and compressible, and palpitation of the heart frequently occurs. There may be dyspnoea on exertion and a short dry cough, the stomach-cough of the older authors. The general nutrition, of course, suffers, and the face is pallid and bloodless to a greater or less degree. Treatment — ^Diet — 1. The treatment of dyspepsia must be chiefly diatetic, although medicines are not powerless in this complaint. In the first place all indigestible food, such as pork, veal and salt meats, and richly-made dishes, such as pastry of every description, ought to be avoided. In the acid forms of dyspepsia, which are connected with de- ficient muscular movement, pastry and saccharine substances are par- ticularly harmful, and vegetables and fruit should be partaken of spar- ingly. In some instances an exclusive milk diet, persevered in for some weeks, has appeared to produce marvelously good results ; but, except un- der such a regimen, water ought to be the habitual drink. Cocoa, de- prived of its fatty ingredients, is often much to be preferred to tea and coffee, and those accessory foods, if taken at all, should be weak, cool and well diluted with milk. Rich or effervescent wines should be avoided, but the lighter Ehine wines or ale, or extract of malt, are often useful in 6t0 mSlCASES OF THE DIGESTIVE SYSTEM. atonic dyspepsia, with impaired movement of the digestive organs. In order to improve the general health all the agencies which favor the im- provement of the nutrition and enrichment of the blood, snch as abun- dant exercise in the fresh air, tepid or cool bathing, and warm clothing should be pressed into service. The successful prescription of a famous English physician to a rich and indolent patient who came to him com- plaining of the tortures of dyspepsia was, "Go and live on a shilling a day and earn it." Medicinal Treatment. — 2. In the medicinal treatment for dyspepsia acconi])anied by undue acidity, as evidenced by the frequency of heart- burn, if the urine is scanty and lets fall an abundant deposit, alkalies, such as the bicarbonate of soda or potash in quantities of ten to twenty grains thrice daily, are useful, and are best taken three or four hours after a meal. In acidity with anemia and debility, mineral acids, such as the diluted nitro-hydrochloric in five-drop doses, serve the purpose better. Vegetable bitters, of which columbo in doses of a wineglassful of the infusion thrice daily generally proves the mildest, and nux vomica or strychnia are good digestive tonics, and in slow digestion benefit is some- times derived from very minute doses of ipecacuanha. A good prescription is: R. — Tincture nux vomica 4 drachms Tincture cinchona 2 ounces Tincture gentian 2 ounces Simple cUxir 2 ounces Teaspoonful three times a day. For vomiting, besides the remedies already spoken of under gastritis, very small quantities of Fowler's solution of arsenic, in two-drop doses, or creosote mixture may be tried. For flatulence the aromatic carmini- tives, such as ginger and cardamon, and powders of two grains each of charcoal with bismuth, also coimter-irritation by means of small blisters over the stomach are often of gi-eat service. When the secretion of gastric juice is scanty, pepsin or lactopeptine, in quantities of ten grains, fre- quently proves itself invaluable as an aid to digestion; or a prescription containing : R. — Dilute hydrochloric acid 2% drachms Pepsin (soluble) 2 drachms Glycerine i ounce Elix. aromatica 2 ounces Water, sufficient quantity for 4 ounces Take one drachm of the mixture in water three times a day. Best taken through glass tube. TTLOEB OF THE STOMACH. 571 CANCER OF THE STOMACH. The stomach is one of the most frequent seats of cancer, which is especially apt to attack this organ in men advanced in life who have sub- jected their digestive apparatus to more or less constant irritation. The tendency is very often hereditary. The cardiac end of the stomach is generally the seat of epithelial cancer, and the pyloric extremity of hard cancer or scirrhus. Its tendency is to extend aroimd the organ, and hence it leads to an annular or ring-like constriction. Symptoms. — The symptoms are those of gastritis or mere dyspepsia at first, but after a few weeks or months, in a majority of instances, a small amount of blood is vomited, and serves to indicate pretty clearly the true nature of the case. The blood in cancerous hematemesis of this kind being effused slowly and in small quantity is altered by the action of the gastric juice so as to present a brown color. This tint and the minute clots in which it appears have caused the expressive name of coffee ground vomit to be applied to it. Although not an infallible sign, it constitutes one of the surest early evidences we possess of the existence of cancer of the stomach. This disease is distinguished from gastric ulcer, which it most resembles, by its occurrence in advanced life instead of in the young; by the presence of a hereditary predisposition; by the character of the hematemesis ; by the greater diffusion of the tenderness ; by the constancy of the pain ; by the cancerous cachexia, and, as emaciation advances, by the increasing tumor, which can be distinctly felt in most cases through the thinned walls of the abdomen. The average duration of cancer of the stomach is from six months to one year, and it always proves fatal. Treatment. — The only treatment which offers any hope of recovery ia surgical. ULCER OF THE STOMACH. Causes. — This remarkable disease is attributed to the corroding action of gastric juice on the very membrane which has secreted it, in con- sequence of the vitality of that membrane becoming impaired by throm- bosis of some small artery in the wall of the organ. Disorder of menstrua- tion may develop an ulcer, tight lacing or any occAipation which necessi- tates constant leaning over, as in shoemaking or tailoring. It is more common in females than males, and is more frequent in young women than those of middle or advanced age. Traumatism or swallowing any 572 DISEASES OF THE DIGESTIVE SYSTEM. corrosive substance may lead to ulceration. Anderson believes that alcoholism, pvphilis or mental worry may lead to the condition. Appearance. — A simple gastric ulcer is round or oval, about one- quarter to one-half an inch in diameter, veith thin, clean-cut margins as if punched out, but deepest in the centre, like a shallow funnel, though varying in depth from a mere destruction of the mucous membrane to complete perforation of all the coats. It is usually single and most com- monly situated at the back of the organ near its lower or pyloric oritice. The ulcer may happen to eat into some large blood-vessel, in which case serious or fatal hemorrhage is apt to occur. Terminations. — The terminations of such an ulcer are the favorable ones of its healing up with or without puckering in the wall of the stomach, or, on the other hand, of perforation, which may occur with the escape of the contents of the stomach into the peritoneal cavity. Such an accident is generally followed by peritonitis and almost certain death. Symptoms. — The symptoms of gastric ulcer are pain and tenderness over the pit of the stomach, this pain coming on shortly after taking food, and increasing until the organ is emptied by vomiting. Sometimes the distress seems to extend through into the back. The seat of tenderness coincides with that of pain, and is localized over a comparatively small surface. Vomiting of blood occurs in about one-third the cases, and though not so frequent as in cancer is much more profuse. It may be either in black clots or fresh blood, and not infrequently blood is passed by the bowels. Vomiting of food half an hour or an hour after eating 13 usual, and various dyspeptic symptoms are met with. The pain is often described by the patient as of a gnawing character, and is commonly made worse by condiments, animal food, saccharine substances and alcohol ; whilst the pain in neuralgia of the stomach is frequently relieved by these articles of diet. Medicinal Treatment — The most successful treatment of gastric ulcer is ])erfect rest in bed and nourishment entirely by nutritive injections, for a period of from one to three weeks, or until the subsidence of the pain and tenderness indicate the healing of the ulcerated spot. Prussic or hydrocyanic acid and bismuth, as directed in gastritis, may be given to control vomiting, and morphia hypodermically, guarded if needful by atropia, to relieve pain. Stomach should be washed out twice a day. Small blisters over the stomach are frequently useful, and the first food administered should be lime-water and milk in very small quantities, gradually increased as the power of the organ to retain food is found to PEEITONITIS. 573 be restored. If vomiting of blood comes on, perfect rest, the quieting of the peristaltic motion of the stomach and whole digestive tube by full doses of a grain every two hours of opium, or one-sixth of a grain of morphia, and the use of acetate of lead by the stomach in qiiantities of two grains every three hours, tannic acid and gallic acid by enema, and five grains of ergotin hypodermically, are to be resorted to. Ice in small pieces may be given frequently, and cold cloths apjilied over the gastric region. Perforation is indicated by severe pain and shock. Surgical Treatment. — If the patient grows worse in spite of medical treatment, if hemorrl)age is profuse, if pain is severe, or if the tenderness is marked, surgical treatment must be resorted to and should only be done by a skilled surgeon. A number of cases of perforation and hemorrhage have been saved by a surgical operation. PERITONITIS. Character — This dangerous malady is an inflammation of the perito- neum or serous sac covering the intestines, liver, spleen, and so forth, and reileeted upon the inner surface of the wall of the abdomen. It is prob- ably more liable to become quickly and violently inflamed than any other structure of the body. It may be either general or local. Local perito- nitis may occur whenever any of the organs of the abdominal cavities be- come the seat of inflammation. Causes — 1. Exposure to wet and cold. 2. Traumatism. 3. It may result from the perforation of an ulcer occurring in stomach, intestines or liver. 4. Inflammation of the uterus following confinement and constitut- ing child-bed fever, which we see. 5. It may be secondary to some morbid disease as tuberculosis, rheu- matism or Bright's disease. Symptoms. — A chill with moderate fever, rapid pulse, intense ab- dominal pain, abdominal rigidity, painful respiration. The patient lies with thighs flexed, features are pinched, vomiting persistent and bowels are usually constipated. Treatment. — Absolute rest is essential. Restrict the diet. Give fre- quent doses of opium, one grain, or morpliine, one-quarter grain. Hot or cold applications to the abdomen. In non-perforating cases give saline 574 DISEASES Oil' THE mOESTlVE SYSTEM. purge. In perforating cases, which are the most frequent, a surgical operatiou offers the only hope. ENTERITIS OR INELAMMATION OF THE BOWELS. Symptoms. — This disease is not very common, but may arise from taking cold, from the abuse of purgatives, from swallowing or inhaling irritant poisons, and from peritonitis. Its symptoms are diarrhoea with pain, often very severe, increased on pressure and most intense about the navel or in the right flank. The frequent discharges temporarily relieve the gi'iping jiains, which, however, soon return. The pulse is excited, generally full and strong and marked fever is present. Treatment — The treatment is by anodyne fomentations or poultices to the abdomen, such as the flaxseed poultice with laudanum, and grain doses of opium by enema or suppository. Kest in bed must be strictly enjoined. COLITIS. Acute dysentery, bloody flux, an acute inflammation of the mucous membrane of the large intestine, generally catarrhal, characterized by fever and sometimes followed by ulceration. The causes are summer and autumn seasons, sudden changes in the atmosphere, errors in diet, impure drinking water, etc. Symptoms. — Begins gradually with diarrhoea, loss of appetite, nausea and slight fever, which continues for two or three days. When the dysen- tery symptoms develop, pain on pressure along the colon, colicky pains about the navel, burning in the rectum, and a desire to expel it or tenesmus, stools contain mucus and blood, urine scanty and high colored, duration about one week, patient emaciated. This may lead on to a chronic con- dition. Treatment.- — Patient should bo confined to bed, even in mild cases. Discharges should be disinfected with chlorinated lime, diet should be bland and unirritating. Milk and lime-water, broths, egg albumen. Be- gin treatment with a dose of castor oil. or if fever is high epsom salts, two drams, or four drams of rochelle salts, until copious discharge, for the pain and tenesmus. Opium in some form, or one-lwlf grain extract opium and two grains sugar of lead every two or three hours, or: APPENDICITIS. 57S R. — Dil. sulphuric acid % ounce Tr. opii. deod I ounce Spirits camphor I ounce Tr. capsicum % ounce Spirits chloroform V2 ounce Brandy I % ounces One teaspoonful diluted every two or three hours. Twenty to thirty grains of subnitrate of bismuth is also valuable every two or three hours during convalescence. Cod liver oil, syr. of lacto phosphate of lime and the following are effective: R. — Strych. sulphate % grain Acid muriatic dil 2 ounces Tr. gentian co. aJ 4 ounces Teaspoonful in water before meals. APPENDICITIS OR INFLAIOIATION OF THE APPENDIX. Function of Appendix — Appendicitis is the term applied to inflamma- tion of the vermiform appendix. It is almost invariably the primary lesion of all those various conditions known as typhlitis or perityphlitis, terms which are well relegated to obscurity. The appendix is a small tube or diverticulum coming off from the postero-interual i)art of the caecum or beginning of the large bowel, and has no function in man. but in herbivora and rodents is a functionally active organ. The jiosition of the appendix corresponds about to a point two inches from the anterior spine of the pubis on a line down from the spine to the umbilicus. This point is known as McBumey's point. Causes — At one time it was supposed that foreign bodies, as seeds, pins, etc., were important etiological factors in the production of the disease, but Fits' statistics show that only twelve per cent, of cases are caused by foreign bodies. Appendicitis is a bacterial disease, usually pro- duced by the bacteria which are nominally present in all parts of the gastro-intestinal tract, which have a powerfiil action when the vitality of the appendix becomes impaired from any cause, as when the deverticulum is bruised, obstructed, or in a state of catarrhal inflammation. Where non-traumatic inflammation occurs the swelling of the mucous membrane occludes the tissues, obstructing the full communication be- tween the appendix and ccecuni, and the appendix becomes converted into a closed sac. Dieulafoy maintains forcibly that appendicitis is always caused by the conversion of tlie appendix into a closed cavity. Partial 576 DISEASES OF THK IIIGKSTIVK SYSTEM. obstruction may be caused by calculi, which are composed of fecal ma- terial mixed with salts of lime or magnesia. These calculi are not formed in the colon but in the appendix. Pozzi believes that appendicular colic may be caused by bending of the appendix, and holds that pain may arise when there is no lesion of the appendix. A foreign body may pro- duce immediate perforation, giving rise to a diffuse septic peritonitis. Where the lesion of the appendix is occluded it begins to swell and be- comes very much congested, the blood supply becomes lessened or cut off entirely. The microbes multiply with great rapidity and the wall of the appendix may become gangrenous, or it may ulcerate and perforate. In- terference with the blood supply of the appendix will predispose to ap- pendicitis. When the appendix becomes inflamed gradually, the peritoneum around it partakes of the process and adhesions are usually formed, thus walling off the appendix. In a case of this kind, if perforation should occur or the inflammation go to the formation of pus, the adhesion would protect the general peritoneal cavity from the poisonous materials. Who Are Most Subject — Appendicitis occurs most frequently in males, as the blood supply is more abundant. It is rare in infants, but occurs most frequently between the ages of sixteen and thirty years. Appendicitis that subsides may at any time recur, and the life of the patient is under constant menace. It always recurs after a second attack. Varieties. — Appendicitis is divided into the catarrhal, obliterative, suppurative and gangrenous forms, but as a matter of fact appendicitis is always one disease which varies in intensity, and it is useless to divide it into a number of symptomatic groups. Symptoms. — 1. In what is known as appendicular colic there are colicky pains in the right iliac region most marked over MeBurney's point, but radiating towards the umbilicus, nausea, vomiting and usually constipation, but no tenderness in the right iliac fossa or abdominal rigidity. 2. In a genuine case of appendicitis the patient feels listless and out of sorts for two or three days before the attack, loss of appetite, furred tongue, foul breath and constipation is the rule, but in exceptional cases there may be diarrhoea. 3. The onset is usually with colicky pains which at first may be general over the whole abdomen but most intense over MeBurney's point. Circumscribed tenderness over ]\IcBurney's point and across may be felt. APPENDICITIS. 5Y7 There is moderate fever, and vomiting is usually present with constipa- tion, abdominal muscular rigidity. 4. As the attack progresses the fever becomes more intense, radi- ating towards the umbilicus and the tenderness over McBurney's point recrosses. The pulse increases and fever rises, vomiting becomes worse, respiration more rapid and thoracic in character. The patient lies upon the back with right leg drawn up. The urine is scanty and highly colored. Any case may become suddenly desperately grave because of perforation or gangrene. Terminations — Appendicitis may terminate in recovery, in death, or in a condition of lowered vitality, renewed attacks being certain to occur.' Treatment. — 1. In appendicular colic apply a hot water bag over McBurney's point, give a saline cathartic and watch patient for fur- ther symptoms. 2. Many surgeons give a cathartic in undoubted eases of appendicitis, but the increased peristalsis and tension caused is liable to give rise to perforation. 3. In a genuine case of appendicitis perfect rest, liquid diet, ice bag to McBv.rney's point. Do not use opivnn in any form- as it masks the symptoms. If the symptoms are not better in thirty-six hours, operate. 4. McBurney says, if six hours after the beginning of the attack the patient is no worse there is no pressing danger, if in twelve hours symp- toms are not intensified they will soon begin to abate, but if in twelve Lours the symptoms have become worse, operation is necessary. 5. It is always better to operate in the interval between the attacks than during an attack. It is not safe to delay operation in a pus case. It must be remembered that the mildness of the symptoms is no assurance that even in an hour or two gangrene or perforation will not occur. A person of generally good health who suffers for some time with vague digestive troubles may find himself a victim. Pain occurs in the right side of the abdomen between the ribs and the hip. It is accompanied by colicky paroxysms, inore or less violent, which may or may not be followed by vomiting of food or bile. The colic eventually subsides, but a fixed pain continues, sometimes exactly limited to the point of the appendix and sometimes spreading more or less over the bowels. The muscles of the appendix region become hard. Usually there is but little fever. Notwithstanding the general opinion of physicians that operation is necessary, there are many eminent medical men who are of the opinion 37. 678 DISEASES OF THE DIGESTIVE SYSTEM. that appendicitis is in many cases open to medical treatment capable of effecting cure. The following prescription is one of the best which has been compounded for this trouble. Cascara Compound. Cascarin Ya grain Aloin 14 grain Podyphyllmn 1/G grain Ext. Bella Leaves y^ grain Strychnine Sulph 1/60 grain Oleresin Ginger % grain Take one at night or night and morning. All drastic cathartics must be avoided. The prescription just given should properly regulate the bowels. It is intended to remove all gases, sweeten the stomach and aid digestion. It is claimed on high authority that it will prevent appendicitis and surgical operation if it is taken in due time. Rest is necessary and the intestines should be kept in a quiet condi- tion. An ice cap may be applied over the seat of the pain. It is advisable that the patient go to bed and assume such position as will — so far as possible relax the abdominal muscles. Abdominal movements such as may be caused by sneezing, coughing, etc., should be avoided. The diet at first should consist only of small quantities of cold or lukewarm milk, oatmeal, bouillon, etc. ; avoid meat and starchy foods. It is held by some that there is great virtue in the external use of kerosene oil in cases of appendicitis. If unfavorable conditions continue, or attacks are fre- quent, the appendix should be removed. We recommend consultation with physician without delay. INTESTINAL OBSTRUCTION. This term is applied to the obstruction of any part of the intestinal canal It may be acute or chronic. Causes. — Obstruction may be caused : 1. By a band, which, becoming looped or attached to one or more organs, forms a noose through which the intestine slips. This manner of compression is known as strangulation. DTSENTEET. B7S 2. By one portion of gut slipping into another. This is known as intussusception or invagination. 3. By kinking of the gut. 4. By the narrowing of the lumen, Ly contraction of scar tissue or the encroachment of tumors. 5. By the pressure of foreign bodies large enough to obstruct the lumen. Symptoms of Acute Obstruction or Complete Obstruction The active symptoms are usually preceded by a period of constipation, with a feeling of lassitude, furred tongue and foul breath. 1. Pain comes on abruptly, first colicky, then continuous and intense. 2. Vomiting quickly supervenes and is, first, of the stomach contents, then bilious, and finally fecal. 3. Abdominal distension occurs if the obstruction is in the lower bowel, but may not be present if the obstruction is high up. Constitu- tional symptoms are those of shock. Thirst is intense, urine scanty and highly colored. Symptoms of Chronic or Partial Obstruction Spnptoms appear grad- ually with the increase of the narrowing until there is complete obstruc- tion, or the s\inptoms of acute obstruction occur from time to time. Treatment — Purgatives are contra-indicated. Pood must bo with- held and nutrition given only by the rectum. Give opium or morphine for the pain in doses of one grain of the former and one-quarter grain of the latter. Accessory Treatment. — Washing out the stomach twice a day to con- trol the vomiting. Distension of the bowel with gas or water should be practiced in doubtful cases and in intussusception. Senn recommends the infiltration of hydrogen gas. If these methods fail to relieve the obstruc- tion a surgical operation must be done at once. DYSENTERY. This is a febrile disease, characterized by severe colicky pains, fol- lowed by straining, which I'esults in scanty mucous or bloody stools, con- taining little or none of the natural fecal matter or excrement. Causes. — It is especially prevalent in warm climates, and warm weather and bad hygienic surroundings play an important role in its production. Indigestion of irritating foods, exposure to cold or wet, cer- tain debilitated states, as scurvy, Bright's disease, etc., seem to be pre- 580 DISEASES OK TIIK DIGESTIVE SYSTEM. disposing causes ainl may alone produce the simple form. Tlie tropical form is due to an animal parasite, the amoeba coli. Symptoms — There is moderate fever, severe colicky pains in the ah- c'.omen, jH'ostration, tenesmiis or straining, constant desire to defecate with small mucus and bloody stools. These symptoms are aggravated during the night and early morning, and leave behind them the tormenting sensa- tion that there ahvays remains in the bowels something which has yet to be discharged. This sensation, which is technically called tenesmus, in- creases, and ultimately becomes the most striking feature of the disease. ^Yhen the malady is fully established, the evacuations consist of bloody slime, sometimes tinged with bile, and containing shreds of membranous- like exudation th^o^vn off from the interior of the bowels. They exhale an odor almost peculiar to dysentery, very offensive and'yet quite different from that of ordinary feces. This complaint may prove fatal in con- sequence of the great loss of blood, but it more commonly causes death by wearing out the patient. Other Symptoms. — When a fatal termination threatens, the symptoms assume a typhoid character, with great iJrostration, dry, brown tongue, hiccough and vomiting. In favorable cases improvement begins about the end of the first week, but convalescence is usually very protracted, and many cases stop half way, as it were, continuing to suffer for months or years with the chronic form of the affection. Common to Children. — This disease is very common among young children, being especially prevalent and fatal among those who are cruelly kept in cities during the hot summer months, and it is the usual result of starvation or deterioration of food, especially if long continued and ac- companied by hardship and privation, being then an extension of the diarrha-a which is apt to be first produced. Treatment — A mild laxative is indicated in the beginning as epsom salts, three drachms, or castor oil and laudanum might be selected. Bis- muth is a valuable remedy. Absolute rest in bed and bland, non-irritating liquid diet. The following may be found useful: R. — Sulphat of morphia Vj grain Bismuth 40 grains Creosote 15 drops Simple syrup 2 ounces A teaspoon ful every three liours. After the more violently acute stage has passed, laudanum injections. or opium by suppositories, with such astringents as two grains of acetate DIAKEHCEA. 581 of lead, half a grain of nitrate of silver, and of sulphate of copper com- bined with small doses a quarter or half a grain of opium by the mouth, are generally beneficial, but care must bo taken not to check the disease too suddenly by the use of these remedies. Additional Treatment. — Flushing out the bowels with a saline solu- tion may be tried, or starch water containing one grain of opium may be found beneficial. Hot fomentations over the abdomen may be used to relieve the pain. Injections of warm solutions of quinine, 1-5000 have been used in dysentery with advantage. Creolin, a drachm to the pint, has given good results. Diet. — The diet, as pointed out before, should consist of the blandest and most unirritating substances, such as boileil milk with lime-water, beef essence, boiled rice, and if the debility is extreme, raw eggs beaten up with milk. Stimulants should not be administered unless absolutely neces- sary, on account of their locally irritating effect. DIARRHCEA. Causes — In many cases this conmion malady is also rather a con- sequence or symptom of some morbid condition than itself a disease. The frequent discharge of loose or fluid evacuations from the bowels, without griping pain or tenesmus, is sometimes a wise effect of nature to get rid of some injurious or indigestible material, which has been imprudently swallowed into the stomach and has from there passed into the bowels. Diarrhoea may likewise be produced by some violent mental impression, or by exposure to taking cold, the bowels instead of the throat being often the weak spot of the Individual. It also results from privation of food, food of poor quality, and many analogous causes. Medicinal Treatment — In the treatment of diarrhoea from Indigest- ible food no attempt should, as a rule, be made at first to check it until the offending material, whatever it may be, is cast out of the system. In fact, a gentle and soothing laxative, such as a dose of castor-oil with a few drops of laudanum to hasten along the conservative action of empty- ing out the intestinal canal, is often of great service. Stoppings Evacuations. — After tliis is accomplished, however, each ad- ditional evacuation is an evil, which should be prevented by the use of five grains of bismuth or chalk, with three grains of tannic acid, or In a teaspoonful of either syrup of galls, or syrup of krameria, and a quarter of a grain of opium, or by opiates ci)nd)incd with carminatives like laven- 582 DISEASES OF THE DIGESTIVE SYSTEM. der, or ginger, and camplior, a good mixture being ten drops of laudanum, fifteen of compound spirits of lavender, and five of spirits of camplior, taken on a lump of sugar every Lour or two until relieved. Additional Treatment. — If the stomach is unsettled, as is frequently the case, the opiate and astringent may be administered with advantage by enema or suppository, and in patients who cannot, or think they cannot, retain medicines in either the stomach or rectum, hypodermic injections of the eighth of a grain of morphia may often be resorted to with the happiest effect. Diarrhoea Mixture — A good rule in taking a diarrhoea mixture is to use a moderate dose evefy two hours, provided the loose passages recur within that time, but if at the end of two hours there has been no liquid or semi-liquid evacuation in the interval, to wait until such a one occurs before resorting again to the remedy. In this way the blunder of so over- doing the good work of checking the diarrhoea as to inflict upon the system its opposite evil of constipation may generally be avoided. The patient thus gains from the remedy all the good with as little of the necessary evil, which lurks in the bottom of every cup of blessing, as possible, a desideratum which should constantly and persistently be kept in view in every kind of medical treatment, as well as all other affairs of life. Other Remedies — Among the various other valuable remedies often Leneficial in this exceedingly common disorder, may be mentioned the tincture of kino, catechu and logwood, acetate of lead, sulphate of copper and suljjhate of zinc, nitrate of silver, spirits of chloroform, tincture of capsicum, spirits of camphor, compound spirits of lavender, and so forth. Accessory Treatment — In cases of diarrhoea, where the tongue is Avhite and coated, the pulse accelerated, the temperature a little raised, and some pain or soreness, increased by pressure, is felt in the abdomen, small doses of epsom or Glauber's salts, in conjunction with hyoscyamus and opium, and perfect rest in bed with the most rigid attention to diet, are necessary, lest the slight irritation of the mucous lining of the ali- mentary canal become aggravated into actual inflammation, and more serious disease, such as dysentery, enteritis or obstinate chronic diarrhoea result Diet. — The diet of a person suffering from diarrhoea must be very strictly regulated, and, in fact, nothing but tapioca, sago, boiled rice or milk-toast with boiled milk, twice-boiled water, Ix'ef-tea and table-tea. should, as a rule, be put into the stomach. Even after the malady seems to be cured, much caution must be exercised about returning to the or- OONSTIPATIOH. B83 dinarj diet. This disease, like most others, indeed, exhibits as it passes awaj a singular analogy to a conilagration, which for days after it has apparently bcsn extinguished is ready to break out again, if the remain- ing sparks happen to be fanned into a flame by the wind or any new fuel is supplied. CONSTIPATION OR COSTIVENESS. Definition. — This diseased condition, the direct opposite of the preced- ing one, may be defined as a retention of the fecal matters beyond the usual period, so that the}' are passed with difficulty and in a comparatively hardened state. Causes. — The causes of constipation are almost infinitely various. Every form of impaired digestion may originate it ; the existence of piles or hemorrhoids, a sedentary life, application to study, amenorrhea and uterine disease in females, all are apt to induce it, and almost every acute disease is frequently ushered in by constipation. It is more often met with among women than men, probably because the female sex fail to exercise sufficiently In the open air ; and many articles of food lai'gely con- tribute to establish the evil of habitual constipation. Treatment of the Acute Form. — If the trouble be occasional and acci- dental, any of the milder laxatives, such as a tablespoonful of epsom or Glauber's salts, rochelle salts, castor-oil — which Is the safest purgative, as a rule — ten or fifteen grains of rhubarb, senna, or the various purgative mineral waters may be employed. For some patients, injections of warm water, or soap and water, answer a very good purpose, and if administered with care are iierfcctly harmless. Treatment of the Habitual Form — Habitual constipation is best treated by tlie regulation of the diet, partaking of fresh or stewed fruits, bran bread and vegetables In season, in ^jroportions sufficient to antagonize the torpor of the bowels ; at the same time resorting to active exercise in tlie open air, and endeavoring to correct any faulty habit of life, which may be the primary cause of the trouble. If the difficulty had its origin in hereditary tendency, or other deep-seated modification of the organism, laxatives should be resorted to, because, in the writer's opinion, at least, the evils of constipation are far greater than those arising from the con- stant employment of these medicines. Additional Treatment. — It Is probable that for most persons saline laxatives, such as rochelle salts, or jmrgatlve waters during the sumTner, and m cold weather pills of a grain of rhubarb, one-sixth of a grain of 584" DISEASES OF TUB DIGESTIVE SUsTEMo poflophyllin and a grain of coniponnd extract of colocyntli, tcaspoonful doses of the eomponnd liquorice powder, or fid. extract of cascara sagrada daily will be beneficial. This acts as a tonic to the uuiscular coat of the bowels. Relieving Constipation — ^Obstinate constipation — that is, absence of evacuation for several days, or a week or two — is a dangerous condition, and should never be permitted to occur, since the large and densely-packed masses of feces may require the operation of drastic cathartics to dislodge them, and such medicines, in accomplishing their Avork, sometimes set up serious or fatal inflammation. Liberal potations of castor-oil, aided by large enemas, may first be tried in such u cas: ; then senna, in tcaspoonful doses of the fliiid extract ; then quarter or half-grain doses of tartar emetic, in conjunction with epsom salts, and if these fail, it may be necessary, under skillful advice of a physician, to resort to drastic cathartics, such as gamboge, calomel, elaterium and croton oil, provided no organic obstruc- tion exists. HERNIA OR RUPTURE. Definition. — Ilernia is the name usually applied to the protrusion of some portion of the bowel or any abdominal viscera through the wall of the abdomen. Varieties. — We may have umbilical hernia or protrusion of the bowel at the navel, a form often seen in children ; and hernia in the gi-oin or in- guinal hernia, which is probably a most common variety. It has been estimated that about one man in every seven is affected with hernia, but in most cases the intestine is kept in its jdace more or less perfectly by some form of tru s When a hernia can be pushed back it is callcii re- ducible. An irreducible hernia cannot be returned into the cavity of the abdomen, and is constantly in danger of being inflamed, by some ac- cidental blow for instance, and so becoming strangulated. Causes. — Ilernia is sometimes produced or driven out under some treacherous truss, which should protect against such an accident, by very slight causes, all of which shoiild be carefully guarded against by those who have any hereditary tendency to this disease. It may be forced out by a jerk, such as suddenly pulling open a door that sticks, or by a fall, by an attempt to lift a heavy weight or to raise a moderate one whilst in a constrained position, or any other act wdiich tends to bring a strain upon tlie bowels, making them bear downward. It is also favored in its occurrence by overeating, by excessively exhausting exertion, and by JIEKNIA OR EUrTURE. 585 severe effort at times when the body is enfeebled by disease. It is more common on the right than on the left side of the body. Symptoms. — The symptoms of strangulated hernia are intense pain, not only in the neighborhood of the rupture but over the whole abdomen and especially around the navel, obstinate vomiting, and cessation of the passages from the bowels. At first there may be one or two evacuations of the fecal matters already below the seat of strangulation, but after that is cleared out the bowels cease to move, and if the strangulation is unre- lieved the vomiting, which persists in spite of all remedies, results in bringing up fecal material through the throat. This is a very curious phenomenon, and seems to indicate that nature in her stupid zeal to get rid of digested materials, on finding that the usual avenue downward is blocked, soon reverses the normal peristaltic movement and tries to evac- uate the bowels through the mouth. In accordance with this idea the im- portance of such stercoraceous vomiting, as it is called, in the diagnosis of strangulation of a hernia, or some similar obstruction, is very great. Treatment of Strangulated Hernia. — When fecal vomiting occurs, if undecided before, not a moment should be lost in sending for the best medical skill which can be procured, and which even then may arrive too late. In the absence of medical assistance, reduction of an obstinate hernia on the point of becoming strangulated, or perhaps already com- pressed, may sometimes be accomplished by putting the patient in a warm bath, and so relaxing the system as already explained; or a full dose of opium or morphia, the former preferably by enema, may perhaps have the desired effect; or lastly, the administration of ether or chloroform, by one who is accustomed to giving these anesthetics, by still more fully relaxing the system, may happily allow the endangered fold of the intestine to be pushed back into its proper place. If the hernia cannot be reduced an operation is absolutely necessary and is attended with but very little risk in the hands of a skilled surgeon. Treatment of Reducible Hernia. — In this form of hernia the contents of the sac can be reduced into the abdominal cavity. The treatment may be palliative or radical. Palliative Treatment. — Prevent constipation, avoid sudden strains and violent exercise and order a truss. The continual employment of a truss, especially in young persons, may bring about a cure. The day truss should be applied before rising in the morning and be removed after lying down at night, when a light truss may be substituted. A truss is always uncomfortable at first, but a person soon grows used to it. It should be 586 DISEASES OF THE DIGESTIVE SYSTEM. kept i^erfeetly clean, and it is well to dust berated talc powder upon the skin under the pad at least once a day. A truss which does not keep the hernia up increases pain and does harm. Too strong a spring tends to enlarge the hernial opening and thus aggravates the cause. Radical Treatment. — This is operative and the sac is completely closed and a new canal formed. These operations show a very small percentage of recurrences. INTESTINAL WORMS. The intestinal canal is often the home of parasites, commonly called worms, and in many parts of the country nearly all children between the ages of one and seven years, as well as many older persons, are troubled with these pests. Varieties — 1. In childhood the usual inhabitant of the bowels is the round-worm or ascaris lumbricoides, a creature attaining the size of a large earth-worm, which it resembles in appearance, except that it is whitish or brownish, and stifFer and harder in its structure. 2. Children are also often infested with the oxyuris, commonly called the thread-worm, pin-worm, or scat-worm. This parasite is sometimes found in great numbers about and just within the fundament. In size they are very nearly that of a very small pin or piece of thread about half an inch long, but by tlicir number and activity they often contrive to prove very troublesome guests to their unwilling host. 3. The third common parasite which preys upon the human species is the ta?nia solium or tape-worm, of which some account has already been given. These parasites are always introduced into the system from out- side, cither with food or drink, and hence one great reason for the good cooking so strenuously urged in a former chapter. They are a great source of irritation as long as they remain, and in childhood, by the reflex irri- tation their movements in the intestines are capable of exciting, constitute one of the common causes of convulsions. Exactly what articles of food convey the eggs of the round-worms and the pin-worms into the human system has not yet been discovered, but the tape-worm is known to iind its entrance into our bodies Vy the eating of raw meat, generally beef or pork. Symptoms of Round-Worms. — The symptoms are often absent. "When present there are usually symptoms of dyspepsia, diarrhoea, with mucous stools, colicky pains in abdomen, voracious appetite which it is almost impossible to satisfy. There is anemia and often reflex nervous pbenom^ COLIC. 587 •pa such as "night terrors," grinding of the teeth, itching of the nose and anus, twitching of the face and limbs and there may be convulsions. Treatment — The diet should he restricted before the remedy is ad- ministered. The most effective remedy is santonin, which is best given with calomel, as in the following: R. — Santonin 5 grains Calomel 5 grains Sugar 20 grains Divide into ten powders, and take one powder morn- ing and evening. Fluid extract of spigelia, one to three fluid drachms, often proves very effective. Symptoms of Pin-Worms — These chiefly affect the lower colon and rectum, and produce severe itching of the anus and adjacent parts. Treatment — Flush out the bowel with water, then inject infusion of quassia chips two or three drachms to the pint of water. Symptoms of Tape-Worm — These are frequently absent. There may be dyspeptic symptoms, colicky pains in abdomen, loss of flesh, capricious appetite and at times reflex nervous phenomena as vertigo, ])alj5itation, "night terrors," convulsions, itching at nose and twitchings of limbs and face, especially the latter. Treatment — A light diet for a day or two previous to the administra- tion of the remedy, so that the worms will be himgry enough to feed upon the drugs administered. After an unsubstantial breakfast admin- ister one of the following efficient remedies : Pumpkin seeds, two to three ounces, oleoresin of aspidium, one to two drachms ; pomegranate, one drachm. Auxiliary Treatment — Before giving any of these the bow-els shoidd be thoroughly emptied by a good purge, and about twelve hours after the administration of the remedy another Jiurge, preferably castor oil, should be given. The treatment is successful only when the head is passed, so the stools must be watched carefully. If not successful the first time try again in a day or two. COLIC. Colic is an acute spasmodic affection of the bowels without diarrhcea or much fever, but attended with severe cramps of the abdominal muscles. Causes — Its most common causes are indigestible food, reflex irrita- tion from the uterine or ovarian disease, and lead poisoning. 588 DISEASES OF THE DIGESTIVE SYSTEM. Symptoms. — Tlie great characteristics of colic are the griping, twisting pains, radiating from the navel and relieved by pressure. Care must be taken not to mistake these pains for those of strangulated hernia, or the converse, which \vt)uld be a much more serious blunder. Treatment — The treatment is to relax the spasm by opiates, and remove the offending material if there is any in the bowels. Tor the former purpose twenty or thirty drops of laudanum by enema or hypo- dermics of one-eighth of a grain of morphia, and for the latter a table- spoonful of castor oil or a Seidlitz powder answer very well in most instances. HEMORRHOIDS OR PILES. Hemorrhoids or piles are exceedingly common and troublesome com- plaints, consisting of little tumors which form at the edge or just inside the fundament, and give rise to intense suffering, especially when the bowels are evacuated. Varieties. — There are three varieties : external, internal and mixed. Causes. — Their production is favored by constipation, sedentary habits, hard seats, and some forms of liver complaint. Symptoms — The inflammatory enlargement is detected and is tender and inriamed. Pain on evacuation of bowels. The external variety does not bleed. Very often their surface, which in the internal variety is com- posed of the distended mucous membrane, exudes blood, in which case they are called bleeding piles. When seated outside the margin of the fundament tliey are not so apt to bleed, and receive the name of blind piles. Treatment. — They niay generally be prevented from developing by proper attention to the bowels, non-stimulating diet and rest, and, whilst small, an ointment of ten grains of extract of belladonna, thirty grains of tannin, and twenty grains of powdered opium in an ounce of simple oint- ment, will usually relieve them. Auxiliary Treatment — Injections of cold water into the rectum, bath- ing the parts with cold water after each bowel movement, or an ointment of riirysarohin IS grains Iodoform 5 grains Extract belladonna lo grains Vaseline 4 drachms Apply tlircc times a day. Apply this night and morning after carefully cleansing the part. Ex- tract of homamelis is a valuable application for external piles, When the FIST0LA IN ANO. 589 acute symptoms subside use lead water and laudanum. If the internal piles prolapse and inflame use, in addition to the above, Allinghour's oint- ment on the parts. If the piles are protinidiug and reduction cannot he affected put the patient to hed, give a hypodermic of morphine sulphate one-fourth grain and apply hot poultices. Surgical Treatment — If hemorrhoids do not yield to the above treat- ment surgical operation is necessary, which is accompanied with very little danger. It may be done under local anesthesia, but general anes- thesia enables an operator to accomplish his task with more thoroughness. FISTULA IN ANO. Causes. — Fistula in auo is a very painful disease, in which a com- munication at the side of the fundament is opened through the flesh into the rectum, or lower bowel, above the sphincter or muscle which ordinarily keeps it closed. It is usually the result of an abscess at the side of the intestine. There are several varieties of fistula, in the worst of which the fecal matters from the intestines constantly leak out through the hole or sinus, and besides causing great irritation and pain, render the sufferer disgusting to every one whom he approaches. Most of these different forms of fistula can, however, be cured by severe surgical operations. Fissure of the Anus. — This is another painful affection, in which a slit or crack appears in the side of the fundament, often the result of a small ulcer at the edge of the opening. As it must be torn apart eveiy time the bowels move it is very difficult to heal. Sometimes fissures of this kind can be cured by touching the sore with caustic, and using laudanum injections to keep the intestine in a state of comparative rest, but if these fail a surgical operation is the only remedy. Prolapsus Ani, called also falling of the bowel, is the coming down of the rectum, which protrudes outside of the body sometimes to the dis- tance of three or four inches. It generally results from constipation, and is especially apt to occur in weakly and neglected children. The protrud- ing portion of the intestine should be carefully aild gently pushed back to its place with the fingers covered with a well-oiled silk handkerchief, and suitable apparatus obtained from the instrument makers to keep it in position. Sometimes an operation is necessary. 690 DISEASES OF THE DIGESTIVE SYSTEM. DISEASES OF THE LIVER JAUNDICE. Jaundice is rather a symptom of disease than a separate mahidy. Causes. — It may be due to a suppression of the secretion of bile by the hepatic cells; or, again, by an over-activity of these elements, and a super- abundant supply of bile in the system; or, thirdly, by obstruction to the outflow of bile, and reabsorption of its elements into the blood. Symptoms. — It consists of a morbid yellowness of the skin, the white of the eye and other parts ; but in bad cases this yellowness may become so intense as to appear olive-green, brown or even black. The i;rine is also of a _yellow or saffron color, but the discharges from the bowels are pale and devoid of the natural brownish-yellow tint, sometimes having the bluish-white of potter's clay. Troublesome itching of the skin, slow pulse, low temperatures, debility and a tendency to hemorrhage from the mncous membranes are frequent in jaundice. Diagnosis. — The most important practical point is to detennine whether the gall-ducts are obstructed or not. If they are closed, so that the stools contain no bile, the jaundice speedily becomes intense and the swollen gall-bladder can sometimes be felt below the edge of the ribs. When not obstructed, the reverse is the case. Jaimdice which comes on suddenly is probably due either to a gall-stone or to nervous disturbance. Intense jaundice which has developed very gradually probably results from pressure outside of the gall-duct, such as would be produced by a tTunor or cancer. Gall-Stones. — Intermittent attacks of jaundice point to gall-stones in old people, and to catarrh of the bile-ducts in children. Paroxj'smal pain preceding jaundice points to gall-stones; following jaundice, to cancer of the liver. Jaiindice with great enlargement of the liver, if the latter is painful and tender on pressure, indicates cancer; if painless, it sug- gests the waxy or lardaceoias condition of the liver. When jaundice ac- companies ascites, it is ustially due either to cancer or cirrhosis. The danger of life from jaundice, unless it does indicate some fatal disease like cancer or cirrhosis, is small ; but in its severer forms it is often very obstinate, lasting for weeks or months. Treatment. — The treatment consists of small doses of calomel or blue LIVER COMPLAINT. Normal or healthy liver Diseased liver KIDNEY DISEASE. Healthy kidney Bright's disease COFTfllCHT ISiS BYE, J STANlCf ABSCESS OF THE LIVEB. 591 pill followed by a saline purge for a few days, avoiding salivation. The mercurial medicine may be substituted or aided by five grains of extract of taraxacum; podophyllin and leptandrin, in quarter-grain doses, and bicarbonate of soda in quantities of ten grains. Later on in tbe attack, five-drop doses of diluted nitro-muriatic acid may be administered with advantage, leaving a few days' interval between the last dose of any mercurial and the acid remedy. The phosphate of soda is also useful. Jaimdice of Infancy — It is very common to observe jaundice com- mence in the first or second day after birth. Usually of no importance. Probably due to diminished pressure in the portal system or to potent ductus arteriosus. Recovery takes place in a few days or weeks. The severe forms may depend on septic poisoning with inflammation of the umbilical vein, congenital inflammation of the liver due to syphilis or congenital absence of the hepatic duct. CONGESTION OF THE IIVER. Causes.— Acute congestion of the liver may result from cold, from over-eating, or from the abuse of alcohol. Symptoms — Its symptoms are enlargement of the organ with tender- ness on pressure, and a feeling of painful tension on the right side just above the edge of the ribs, often radiating to the right shoulder, slight jaundice, furred tongue, loss of appetite and scanty, high-colored urine are present, and the whole group of symptoms constitues the condition commonly designated as "being bilious." Treatment. — ^It is generally relieved by a small blue pill, or small doses of calomel followed by a saline purgative, and attention to diet for a few days. If neglected this form may run on to chronic congestion or lay the foundation of inflammation of the liver. ABSCESS OF THE LIVER. Abscess of the liver is the formation of pus in the substance of the organ. There may be one large abscess cavity or many small ones. Causes — 1. It may be due to injury. 2. The presence in the liver of the amvela culi of dysentery. 3. Foreign bodies, gall-stones and retained bile. 4. Septic emboli which may come through the hepatic artery but usually through the portal vein from other diseased viscera and produce a purulent inflammation of the vein. 593 DISEASES OF THE DIOESTIVE SYSTEM. Sjnnptoms. — The fever is of the hectic variety, high in the evening and low ill the morning. Chills are sometimes present; pain is variable and may be felt in back of right shoulder. The liver is enlarged, painful and tender, ^Marked jaundice is rare. There may be bulging, and fluctu- ation is sometimes detected. Treatment. — There is only one treatment, whicli is surgical. Degenerations of the Liver.- — Acute atrophy of the liver, waxy liver, and fibroid deposit in the liver are various forms of degeneration for which little can be done by medical treatment and which are fortunately rare. Not so, however, as far as regards infrequency, with cirrhosis of the liver, called also drunkard's liver and hob-nail liver, because of its origin in the abuse of alcohol and the peculiar contracted form which it presents. The process which the liver undergoes is a condensation of the substance and destruction of the secreting cells, with thickening of the connective tissue. The whole liver gi-adnally contracts, ceases in great measure to manufacture bile and, becoming an obstruction to the venous circulation, produces ascites or abdominal dropsy, under which the suf- ferer generally succumbs. LIVER OR HEPATIC COLIC (GALL-STONES). Gall-stones are hard concretions whicli form within the gall-bladder, and when they attempt to pass out through the gall-duct often give rise to the most excruciating agony which the human being is capable of suffering. Symptoms. — This pain is called hepatic colic, on account of its grip- ing, tearing character, and may generally be distinguished by its coming on and passing off suddenly; by its frightful intensity; by being deep- seated instead of superficial; by being accompanied with vomiting and by the pulse being rapid and feeble. The onset may be marked by a chill and fever. It may last from a few moments to several days, and is often so severe that strong men will sometimes writhe and roll around on the floor, screaming in their agony. It seldom comes on before middle life, and women are much more frequently attacked than men. The pain is chiefly in the upper part of the abdomen on the right side. If a gall-stone remains in the duet for more than twelve hours, it is usually followed by jaundice coming on two or three days later. The affection terminates either by the stone slipping back into the gall-bladder or passing out through the duct into the bowel, in which latter event it may be found DEOPST OF THE ABDOMINAI, CAVITY. 593 in the evacuations during the next week, and should always he searched for. The stone usually varies in size from that of a small shot to an inch or more in diameter, and in color from yellowish-white to dark-brown. If single, it is usually oval or rounded ; but if two or more have been formed, the first one is marked by impressions of the others, and thus the prospect of future attacks can be estimated. Notwithstanding the alarming suffer- ing the danger to life is small, and death rarely eventuates from hepatic colic. Treatment — The treatment is by thirty-drop laudanum enemas or hypodermic injections of a quarter of a grain of morphia and one-one- hundredth of a grain of atropia, with chloroform or ether by inhalation, if the pain is unendurable. Hot fomentations, or hot baths, sometimes afford partial relief. In order to prevent the recurrence of hepatic colic, small doses of carbonate of soda, alkaline mineral waters, or a mixture of chloroform and turpentine have been higlily reconiniended. Value of X-Ray — The use of the X-ray was found valuable in the diagnosis of gall-stones. ASCITES OR DROPSY OF THE ABDOMINAL CAVITY. Symptoms. — The prominent symptom of ascites is the distension of the abaomen, which sometimes becomes enormously swollen, and by the pressure upward of the diaphragm gives rise to distressing dyspnoea. Treatment. — When possible endeavor to i-emove the cause. Purge freely with concentrated salines, compound jalap powder twenty to tliirtv grains, elaterium one-eighth grain. Increase the action of the kidneys by infusion of digitalis two drachms, citrate of caffeine three to five grains, diuretin fifteen to thirty grains. Atixiliary Treatment — If the effusion is large and does not yield to the above treatment tapping is indicated, which is a procedure accom- panied by very little danger. No anesthetic is required, and it gives almost immediate relief to the dyspnoea. Care must be taken not to draw off the fluid too rapidly, as this might cause collapse. 38 394 DISEASES OF TIIK DIQKSTIVJ; SYSTEM. LIVER COMPLAINT. Causes. — A congoPtcd .state of tlio liver which may depend on an obstruction in the portal and hepatic Yenous system, in which there is a deficiency of tone in the veins which prevents the normal ascent of the hlood from the lower parts of the body, thereby distending the vessels and causing an accumulation of blood. This inability of the blood to ascend against gravity is found in a great variety of chronic diseases. A very frequent cause of disease of the liver is the indulgence in alcoholic stimulants and the eating of too highly seasoned food. Symptoms — 1. Perhaps there is no disease in the whole human frame in which symptoms assist less. In some of the more acute forms of the disease the sjTnptoms are urgent, but except in a few instances they convey little or no information with respect to the nature or progress of the disease, and in the more chronic forms irreparable mischief is often established before the patient even suspects that there is anything wrong. There are, however, certain general svmptoms which, when present, en- able us to pronounce pretty positively as to the existence of liver disease, thoiigh they will not assist in determining its nature. These are dropsy, indigestion and jaundice. The tongue is generally coated and commonly furred. A disagreeable, bitterish taste is felt in the mouth, and eructa- tions take place, sometimes bitter, cutting, acrid and even excoriating the lining of the throat. The skin may bo hot and dry-parched and rough, or it may be too relaxed, giving rise to cold, clammy sweats. 2. There is no excretion, not even excepting the bowel evacuations, "which is more frequently deranged in diseases of the liver than urine. Thus, bile may be detected in the urine when no other irregularity is present by the application of muriatic acid. 3. Kot unfrcqucutly a jtatient has lost the power of assimilation, not from any well defined organic lesion of the liver or alimentary canal, biit rather because of a stagnation of want of proper secretion through the ducts of the liver. When these become deficient in secretion the healthy action of the liver is arrested and various disorders immediately begin to be manifested. The bowels do not move freely ; the bile, instead of getting excreted by the intestines, is taken up by the blood. In consequence the internal organs suffer end a bilious attack follows. After frequent attacks the skin becomes sallow, rough and yellowish, and you are affected with headache, constipated bowels, coated tongue, pain in the right shoulder and side from the poison left behind in the blood. Here is the first seat-origin of pulmonary consumption. LIVEE COMPLAINT. 595 4. The so-called biliousness, indigestion, capricious appetite, pain after food, eructations, acidity, flatulence, irregularity in the bowels, ■whether as constipation or diarrhoea, point almost always to this disturb- ance, and it is a most potent factor in causing and inviting other diseases. 5. The modern liver is a degenerate organ ; the average digestion far below the standard of old, and its function abnormally feeble and slow. Gout and uric acid congeries prevail to a remarkable extent, and the ailments, directly or indirectly attribiitable to malnutrition, meet the busy practitioner at every turn, The bilious attack of olden time, for which mercury was a specific, and that of to-day are alike. The former was almost always the invariable penalty of a "surfeit," brought on by inordinate indulgence in the pleasures of the table, in an age when the "three-bottle man" was a hero of every convivial gathering, and the ap- petite on the morning following a "night out" iisually unequal to the most exacting demands of a bountifully-spread board, without the aid of the seductive but dyspepsia-breeding cocktail. The latter-day biliousness, on the other hand, comes on insidiously, often without apparent cause, and follows the most trifling indiscretion in diet. The digestive organs being weak to begin with, a slight excess of intestinal decomposition is easily provoked, and the whole system becomes gi'adually saturated with its poisonous products. This condition, therefore, is not amenable to the mercury treatment. Treatment — 1. The successful treatment of the modern form of the disorder is but just begim when all putrescent elements of ingested food have been carried off by purgation. The condition remaining, in which there are large amounts of slowly accumulated deposits in the system which the unaided efforts of nature are impotent to remove. A pill composed of aloin, may-aiiple and nux vomica, an eighth of a grain of each, may be taken at night, or night and morning, until the bowels become regular. By their judicious use the digestion will be im- proved, also the general health, thereby avoiding those principal sequences which attend the constipated condition. 2. Medicines should be "arms of precision." The physician cannot push his remedies to the limit of safety unless he has perfect confidence in their purity and accuracy. This combination accomplishes this in a threefold manner. The may-apple increases the healthy action and secretion in the ducts of tlie liver. The nux vomica, by its stimulating and tonic effect on the stomach, enables it to better assimilate and digest the food; while the aloin completely cleanses the walls of the alimentary e«nal. 596 DISEASES OF THK niGF.STIVE SYSTEM. Through their combined action the system is restored to its normal standard. This is the secret of their curative power in the treatment of liver disease. This secret is one of immense power. They not only stimulate the brain by their action in generating more gray matter, but in some mysterious manner vivify the great sympathetic nerve wliioli covers the bowels and energizes the eighth pair of nerves which supplies the liver. They speedily affect the liver, restore the gland to its jiristinc activity, and the bowels become regulai*, the complexion clear, the breath sweet and the whole body seems rejuvenated, proving that the liver ha? renewed its normal function. "When the bowels do not move freely the liver becomes congested, and the bile, instead of being excreted by the intestines, is taken up by the blood. In consequence the internal organs suffer and a bilious attack follows. After frequent attacks the skin becomes sallow, rough and yellowish, and you are troubled with headache, constipated bowels, coated tongue, pains in side, and your whole system feels out of sorts. For this condition take three pills on retiring at night. For an aggravated attack of biliousness or chronic liver disease take one pill three times a day for one week. Take one pill each night at bed- time for two weeks, after which take one pill twice a week for about three weeks. For a slight attack of bilioiisness, indigestion, and so forth, take two pills on retiring and one pill each night afterward until five have been taken. Auxiliary Treatment. — "When suffering from this disease the diet should first be considered. Light gruel or toast water and buttermilk or skimmed milk can be taken. Light mutton or chicken broth, after removing the greasy portion from the top. Food should not be eaten between meals, of any kind. Alcohol or malt liquors, as also tobacco, are to be avoided. For the relief of pain in the side over region of liver apply a hot hop poidtice, or, what is preferable, a hot-water bag should bo placed over this region and replenished so as to keep up constant heat. In severe cases the tension may be relaxed by a mustard plaster or an application of spirits of turpentine well rubbed in. This acts as a counter- irritant and often gives speedy relief. If the patient continues to vomit, a little lime-water and milk — a teaspoonful of lime-water in a cup of milk — or a mustard plaster made with the white of egg and applied to pit of stomach will frequently give immediate relief. Regarding diet, it should bland and unirritating. PART VIII OF BOOK IV Treats of the diseases to which the Genito-Urinary System is subject. Bladder, Inflammation of 607 Stone in 608 Bloody Urine 603 Bright's Disease, Acute 600 Causes of 600 Symptoms of 601 Treatment of 601 Urine in 601 Bright's Disease, Chronic 602 Causes of 602 Symptoms of 602 Treatment of 602 Calculus 608 Catheter, use of 610 Chancre 620 Treatment of 620 Chancroid Sore 618 Colic, Renal or Nephritic 606 Cystitis 607 Chronic 608 Urine in 607 Congenital Syphilis 620 Symptoms of 620 Diseases of the Urinary System 599 Emissions, Involuntary 626 Epididymitis 615 Floating Kidney 605 Formin Compound, Use of in Gonor- rhoea 614 Gravel 608 Gonorrhoea *. 61 1 Diet in 613 Formin Compound in 614 Sanmetto Treatment 614 Secondary Treatment 613 Symptoms of 612 Third Treatment 613 Treatment of 612 Gonorrheal Complications 615 Hematuria 603 Hysteria, Suppression of Urine in.. 605 Inipotency 628 Inflammation of the Bladder 607 Involuntary Emissions 626 Kidneys, Function of 599 Kidney, Floating or Movable 605 Movable Kidney 603 Nephritis, Acute 600 Nephritis, Chronic 603 Nephritic Colic 6o6 Prostate Gland 611 Cure of 611 Causes of 611 Diseases of 611 Pus in the Urine 604 Pyuria 604 Renal Colic 606 Salvarsan, Use of in Syphilis 625 Sanmetto Treatment for Gonor- rhoea 614 Six-O-Six (606) Treatment in Sy- philis 62s Sofe-chancre 618 Spermatorrhoea 626 Causes of 627 Results of 627 Treatment of 627 Stone in the Bladder 608 Stricture of the Urethra 609 Causes of 609 Treatment of 609 Suppression of the Urine 604 in Hysteria 605 Treatment of 603 Swelled Testicle 613 Syphilis 617 Cause of 617 Chancroid Sore 618 Congenital 620 Constitutional Treatment 620 Conveyed by Conception 621 Eruptions 619 597 598 INDEX TO PAKT VIII OF BOOK IV. Syphilis, Hand and Feet Rniptions.619 Hereditary 622 Mercury Unreliable in 625 Salvarsan Treatment 625 Secondary Constitutional Symp- toms 618 606 Treatment 625 Sofe-chancre 618 Symptoms 617 Tertiary Symptoms 619 Tertiary Treatment 621 Tonics, Use of 621 Transmission of 622 Treatment, Secondary 620 Vegetable Treatment 625 Syphilitic, Marriage of 621 Tertiary Syphilis 619 Treatment of 621 Testicle, Swelled 615 Tonics, Use of, in Syphilis 621 Uremia 603 Urethra, Inflammation of 611 Stricture of ... 609 Urine, Bloody 603 In Cystitis 607 Pus in 604 Suppression of 604 Varicocele 616 Vegetable Treatment in Syphilis 625 CURATIVE MEDICINE PART VIII. DISEASES OF THE URINARY SYSTEM The Urinary Organs. — The important group of organs whicli makes up this system comprises the kidneys, two glandular bodies about four inches long, and of the peculiar sliai)e of a kidney-bean, with their outlet pipes communicating with the bladder, and its exit tube the urethra, opening in both sexes in conjunction with the organs of generation. Office of the Kidneys. — The ofBce of the kidneys in the animal economy is to secrete the urine "which passes from each gland down its separate ureter into the bladder, where it may be stored to the amount of half a pint or a pint, and from which it oiight, at suitable intervals of from four to six hours, to be evacuated. The ingredients of the urine being waste material, poisonous to the organism if retained in the blood, it will readily be understood why the suppression of the renal secretion, in certain morbid conditions, or its retention in consequence of any obstruc- tion to its outflow, in the narrow ureters or urethra, may give rise to some of the most horribly painful and fatal diseases which mankind is ever called upon to endure. Function of the Kidneys — The function of the kidneys is purely an eliminative one, and a full understanding of its performance could only be gained by a study of the intricate structure of the organs, too complex to be considered here. It is sufficient for the present purpose to state, that the blood entering each kidney by its largo renal artery is purified by having removed from it the elements of a poisonous substance, urea, with uric or lithic acid, phosphoric acid, and sulphuric acid, variously combined with potash, soda, lime, magnesia, and probably other refuse matters in smaller amounts. These solid ingredients of the urine are dis- solved in the forty or fifty ounces of v/ater which is also during health (599) 600 DISEASES OF THF UEINARY SYSTEM. talvcn out of the blood lij tho kidneys, and in this way the urine is manu- factured. The purified blood, after giving up these deleterious matters in. the renal organs, is returned to the general circulation by the renal veins. Passage of Urine. — In perfect health a man of average size would pass iu the forty-eight ounces of urine, which he should daily evacuate from his bladder, an ounce and one-third of urea, nearly an ounce of chlorides, sulphates and phosphates, and from eight to twelve grains of uric acid. If, for any reason, the amount of water filtered out of the blood is less than this, there is danger that some solid constituents of the urine may crystallize within the urine or bladder, and being, perhaps, washed into the ureters in the one case, or into the urethra in the other, block up these outlets and give rise to the horrible agony of nephritio colic, gravel or stone in the bladder; or, again, even slight inflammation iu these small tubes may result in a contraction or stricture, which hinders the passage of the urine, and also causes great suffering to the unfortunate patient. Guide to Kidney Disease — The chief guide to diseases of the kidneys is, necessarily, therefore, a chemical and microscopical examination of the urine, with the sediments which fall from it, in each individual case, and this should never be neglected in any but the most temporary and in- significant derangements of the urinary apparatus. ACITTE WEPHKITIS OR ACUTE BRIGHT'S DISEASE. Nature of the Disease — Acute Bright's disease, called also acute nephritis, is a malady in which the kidney becomes greatly enlarged and vascular, with its minute convoluted tubes, in which the urine is primarily manufactured, plugged up with epithelial cells. ' These epithelial cells in the form of casts of the renal tubules are voided in the urine together with albumen, and sometimes with blood. The obstruction to the outflow of the urine and the interference with the function of the kidney give rise to the most serious general symptoms. Causes. — Acute Bright's disease is a rather common complication of scarlet fever, and is one of the dangers most to be dreaded in that malady. It also occurs in cholera, yellow fever, scarlet fever, erysipelas and diph- theria, and may be produced by alcoholic intemperance, or by exposure to cold and wet, particularly by sitting on a wet or cold object, such as a stone step. Certain poisons which are eliminated through the kidneys, as COl cantharides and turpentine. Pregnancy is also a potent factor in tho cause of the disease. Symptoms. — The symptoms are, first, in many cases, chilliness, fol- lowed by fever, some pain in the loins and across the lower part of the spine, scanty high-colored and albuminous urine, and in a day or two dropsy, or watery effusion imder the skin, beginning beneath the lower eyelids or in the organs of generation, but soon becoming general over the whole body. Uremic coma may develop at any time. The Urine. — Scanty always, and at times entirely suppressed. Smoky in appearance, high specific gravity, rich in albumen and throws down a heavy sediment, which, when examined microscopically, ■will be found to contain hyaline, blood and epithelial casts, and free blood and epithe- lium. Treatment — The treatment, which is successful in a majority of the cases, consists in keeping the patient in bed in a room with a warm, moist and equable temperature, purging gently with those laxatives which cause watery discharges from the bowels, such as small doses of five grains of jalap and thirty grains of cream of tartar, promoting free perspiration by the use of sweat baths, which are given by placing the patient in a tub of water at the temperature of 106 degrees Fahrenheit for twenty minutes. Give a thorough rub and place in bed between blankets with hot water bottles, or hot cans around, but not touching the patient. A blanket shoiild be interposed between the skin and the hot cans. Allow free perspiration for an hour to an hour and a half. Sweat- ing may be aided by giving from one-twelfth grain to one-eighth grain of pilocarpine. Guard against collapse by giving strychnine sulph., one- twentieth grain. Dry cups followed by hot fomentations over loins. In bad cases, with robust patients, cut-cups or leeches may be used in place of the dry cups, and acetate or citrate of potash in twenty-grain doses, with ten drops of tincture of digitalis or squills, and half a teaspoonful of sweet spirits of nitre are often given with benefit. Citrate of caffeine in one to two grain doses may be tried. Infusion of digitalis in one drachm doses is especially beneficial in cliildren. Diuretin in from ten to twenty grains three times a day for adults, and two to five grains for children will often give good results. Eascham's mixture, two draclims thrice daily. Niemeyer recommends a pill if cedcma is present, composed of blue mass, powdered digitalis, powdei'ed squill, oafh of one grain. Take one of these thrice daily. The following combination may prove efficient in troublesome dropsy : 602 DISEASES OF Till' UltlNAKY SYSTEM. Sparliiir siilph 4 grains Caffeine citrate 20 grains Lithia bcnzoatc 40 grains Divide into ten powders, and take one every three hours. CHRONIC BRIGHT'S DISEASE OR CHRONIC NEPHRITIS. Causes. — It may follow the acute, or may be chronic from the be- giiiiungj. Males are most frequently attacked. Adult life, frequent ex- posure to ■vvet and cold, alcoholism and congestion from heart disease and syphilis are the chief predisposing causes. Symptoms — The symptoms of well-defined chronic Bright's disease are albuminous urine, containing renal epithelial cells and tube-casts, more or less drojjsical effusion, esjJecially noticeable about tlie face and ankles, anemia, shortness of breath, a peculiar dryness of the skin, dyspepsia, headache and giddiness, together with a tendency to dimness of sight and inflammation of the retina of the eye, uremia or blood-poisoning from the retention of the urea, which ought to be removed by the kidneys in the circulating fluid, secondary inflammations, such as pneumonia and pericarditis and hypertrophy of the heart. Its presence can only be posi- tively ascertained by thorough microscopical examination of the urine, and such examinations repeated from time to time are the best guides as to the necessary treatment. The variety is essentially chronic, running a course of months or years, with a tendency to temporary improvement under treatment, on the one hand, and to subacute exacerbations in consequence of unhygienic imprudences on the other. It almost always proves fatal in the end, however, by uremia with or without convulsions, by secondary inflammations, or perhaps by general debility. It is estimated that uremia causes death in about one-third the cases. Treatment. — The treatment for chronic albuminuria is in the main hygienic. liesidonce in a warm and equable climate. A quiet life with- out mental worry, with" gentle but not excessive exercise, is recommended. In addition the bowels should be kept regular, skin active by daily tepid bath with friction. Abundant pure water or some pleasant mineral water should be drunk. The underclothing should be wool or silk, and the diet non-nitrogenous, and in severe cases absolute diet of skimmed milk will prove beneficial, unless dropsy or symptoms of uremia require active remedies. "Further Treatment. — Sliould the former be very troublesome, and diuretics, as suggested when speaking of the acute form, fail to act, as BLOODY TTRINE. 603 frequently happens, recourse must be had to the hydrogogue cathartics, such as a quarter of a grain of elateriuin, already spoken of, with hot-air or vapor baths to j)romote elimination by the skin, as a partial substitute for the inefficient work of the crippled kidneys. If marked symptoms of uremia appear, such as headache, drowsiness, involuntary muscular twitchings, sudden and violent vomiting and diarrhcEa, recourse to the active cathartics should be had at once, without any preliminary trial of a diuretic, and if \iremic convulsions or coma come on, full doses of elate- rium or a drop of croton oil will probably be required immediately to avert death. During the convulsion chloroform may be given by inhalation to restrain the violence, and perhaps shorten the pai'oxysm. Many cases of uremia are benefited and life prolonged by blood letting of from six to twelve ounces, depending upon the pulse, and fol- lowed by an injection of saline solution from one to two pints beneath the breasts, or in subcutaneous structures of the axilla, strength of solution about one teaspoonful of salt to a pint of distilled water, to be injected at about the temperature of 100 degrees Fahrenheit. Care must be taken to thoroughly cleanse the skin at the jioiut at wliich the needle is to be inserted. Early in the case Bascliam's mixture does good. HEMATURIA OR BLOODY URINE. This is more a symptom of other diseases than a disease in itself. Causes — Stevens gives as the causes thus: 1. Vicarious menstruation. 2. Traumatism applied to any part of the genito-urinary tract. 3. General blood dyscrasia as in sijecific fevers, jiurpura, malaria, scurvy, etc. 4. Congestion of the kidney from chronic heart, lung or liver disease. 5. Acute inflammation of any part of the genito-urinary tract. 6. Stone in any part of the genito-urinary tract. 7. Varicose veins in neck of bladder. 8. It may occur without obvious cause. 9. Parasites in genito-urinary tract. 10. Tumors and tubercle of the kidney. The presence of blood may be suspected from the red, smoky or brownish color of the urine, and positively determined by a microscopical examination. If the blood is clotted it generally comes from the bladder, and if coagulated in long round strings, like earth-worms, it may have been 604 DISEASES OF THF URINARY SYSTEM. effused in the uretlira, from a rupture or ulcer in that membranous tube. Treatment. — The most inqwrtaut thing is to discover the cause and treat that. If this cannot be done tincture of chloride of iron, which is especially useful in debilitated patients in twenty-drop doses every three hours, gallic acid in quantities of live grains, and ergot, or two grains of acetate of lead and half a grain of opium every four honrs. The effect of the general remedies may be aided by the injection of a weak solution of alum in cold water, thrown into the bladder by means of a catheter if the case is urgent. Where a large mass of coagulated blood is formed in the bladder it may sometimes be gotten rid of by the injection of a solu- tion of pepsin, which, if the ingenious plan succeeds, dissolves the clot of blood. PYURIA OR PUS IN THE URINE. Causes — 1. Suppurative inflammation of the kidney. 2. Calculus (stone) or tuberculosis of kidney. 3. Cystitis or suppurative inflammation of the bladder. 4. Urethritis. Inflammation of urethra. Symptoms. — Urine is alkaline and has a cloudy sediment. There is usually frequent and urgent desire to urinate, especially if the pus is from the bladder or posterior urethra. Diagnosis. — Diagnosis can only positively be made from microscopical examination. If from abscess of kidney flow of pus is intermittent. If from calculus or tuberculosis of kidney the flow is constant, as it is in cystitis or urethritis. Treatment. — The treatment consists in removing the cause. SUPPRESSION OF THE URINE. Description. — This is an affection in which the work of the kidneys in secreting the urine is very defective or altogether abolished. There may be some pain in the back or irritability of the bladder, the patient becomes anxious and restless, then dull and drowsy, and finally after an interval of from three to eight days usually dies comatose. In other in- stances there is nausea and vomiting, hiccough, and the whole -body ex- hales a urinous odor. Where the suppression is less complete, and depends upon some obstruction to its outflow in the ureters, bladder, or urethra, tlif mind remains clear for a long time, perhaps, and the unfortunate patient is fully conscious of the intense local suffering and general dis- FI-OATING OB MOVABLE KIDNEY. 605 tress produced. The time during which the urine may be suppressed and yet the patient recover varies considerably. Hysteria. — In hysteria, cases where no urine has been passed for ten days are reported, but such instances are not free from suspicion of pos- sible deception on the part of the patient. Children when teething will sometimes for days together void only a few drops of urine at once, and that at several hours' interval. The urine passed at such times is ex- tremely high colored, stains the linen, and is passed with great pain, the child crying bitterly, as it scalds the sensitive surface over which it flows. This disease probably arises, at least in some instances, from over-con- gestion of the kidney. Treatment — The treatment recommended is to place the patient in a warm bath, and give a saline diuretic, such as a teaspoonful of cream of tartar, or twenty grains of acetate of potash dissolved in half a pint of water, combined with a moderate laxative. The sweet spirits of nitre, in half teaspoonful doses, is also frequently Tiscful. Digitalis leaves made into a poultice, or the tincture of digitalis added to a flaxseed poultice, have often proved beneficial, and the digitalis may also be used internally with advantage in the form of a teaspoonful of infusion every four hours, or Dover's powder, ten grains for an adult. riOATING OR MOVABLE KIDNEY. The mobility of the kidney depends upon the relaxation of the sur- rounding structures. Causes. — Females are most usually affected, probably due to the dif- ference in dress between them and the males. Middle life. Any disease producing rapid marked emaciation predisposes to it. A congenital i-elaxa- tion of surrounding tissues. Muscular exertion. Eepeated pregnancies. Diagpnosis is made by feeling kidney in abnormal position. Symptoms — There is a dragging sensation in back. Kidney may be- come swollen and jtainful to the touch. There is a sense of uneasiness and attacks of neuralgic pains. Emotional disturbances are often excited by this condition. Treatment. — Use abdominal binder or pad. Eegulate diet. Avoid exertion. If the condition persists the only treatment is surgical. 606 DISEASES OF THF UKINARY SYSTEM. RENAL OR NEPHRITIC COLIC. Causes. — Since the ureters commence inside the kidneys as funnel- shaped tuhes, it is obvious that any solid substance capable of entering the upper part and yet a little too large to pass the lower portion, will stick fast, and can only progress as the pressure of the constantly secreted urine behind it drives it along with sufficient force to dilate the pipe and allow it to move onward. This process of dilatation is horribly painful, and with that of passing a gall-stone, and of certain forms of neuralgia, makes up the worst physical suffering of humanity since the Spanish Inquisition was abolished. The little stones which cause such agony in this way are generally composed of uric acid, or less commonly of oxalate of lime, deposited from the urine inside the kidneys, and washed down from the seat of their formation by the outflow of that fluid. It is not positively determined whether they crystallize out of the urine because they are produced in too large quantity in the system, or because a de- ficient amount of water to hold them in solution is filtered out of the blood; but in either case, increasing the bulk of the renal secretion by drinking a larger quantity of water daily, is a most rational method for diminishing the tendency to their production. Symptoms. — The first symptom of an attack of renal or nephritic colic is usually pain in the region of the loin on the affected side. This rapidly increases in severity until it becomes excruciating, and radiates downward toward the groin, the testicle on that side being drawn up, a symptcT>i constituting in males — who arc chiefly the subjects of this malady — an important diagnostic sign. With the pain, nausea and vomit- ing are ajit to occur, and llic body is covered with a cold sweat. Treatment — The treatment of nephritic colic is to relieve the pain, if only moderately severe, by hypodermic injections of morphia and atropia, or laudanum enemas, as advised in the article upon gall-stones; but if the suffering is intense, by the inhalation of ether or chloroform. In order to mitigate the pain sufiiciently by these anesthetics, it is not usually needful to administer them to complete unconsciousness. A few whiffs will lull the distress so as to make it endurable for the time, and as this blessed influence passes off, it can be renewed by a repetition of the in- halation. Persons whose hearts and lungs are healthy, can thus be kept in comparative comfort with comparative safety, for several hours, or until the passage of the stone out of the lower end of the ureter into the bladder renders the anesthetic no longer necessary. INTLAMMATION OF THE BI.ADDKE. 607 Passage of Stone. — It is probable that both morphia and ether tend, besides, to hasten the exit of the stone bj relaxing the spasm, which no doubt is caused by the irritation of the angular corners of the cruel little calculus as it makes its way through the slender and sensitive tube of the ureter. After the passage of a stone of this kind into the bladder, it usually is voided with the urine, in the course of the next day or two. and in order to make sure that the enemy has been completely gotten rid of, it is best to carefully examine all the urine which comes away in the next few days after an attack. The character of the stone, when found, will aiford some information as to the best mode of treatment to be adopted for the purpose of avoiding the formation of others of like structure. Prophylactic Treatment — Those who are subject to attacks of nephritic colic shoiild live a quiet life, avoiding exertion as far as possible. The diet should be regulated as in gout. Diuretics should be taken and water in large quantities. Sir William Roberts recommends what is known as the solvent treat- ment. Citrate of potash in doses of half to one drachm every three hours. Osier has not found this satisfactory. Piperazine in doses of five grains three times a day may prove useful as a solvent. CYSTITIS OR INFLAMMATION OF THE BLADDER. Symptoms of Acute Cystitis. — There is great frequency and urgent desire to urinate. The passage of very little urine at each act, accom- panied by great pain above the pubis, and in the perineum radiating to the end of the penis and in the loins and sacral region. The Urine. — The urine, at first clear, loses its transparency, becomes full of thick mucus and contains blood and pus. A rectal examination is very painful. Treatment — In treatment of cystitis remove the cause if possible. Put patient to bed, apply hot applications to perineum, give suppositories containing opium, one grain, and belladonna, one-sixth of a grain. Hips should be elevated and bowels opened by salines and glycerine enemas. Au exclusive milk diet is often beneficial. For the pain give a powder containing — Extract liyoscyamus 4 grains Extract cannabis indica 4 grains Sugar 20 grains Divide info ten powders, and take one every three hours. 608 DISEASES OF THE UKINARY SYSTEM. Or five-grain doses of I'onnin in half glass of water tlirce or four times a day. Suppositories of ichthyol, one grain, are often beneficial. All alco- bolic stimulants must be avoided. Symptoms of Chronic Cystitis. — In this condition there is frequent urination, but it is not so marked as in the acute form. The urine is am- moniacal, fetid and filled with tenacious mucus and pus ; not infrequently blood. Constitutional symptoms rarely appear. Tuberculosis is a fre- quent cause of cystitis, and by careful straining and examination the bacillus tuberculosis can be foimd. This form is accompanied by pyuria (passage of urine) and pain. Treatment — 1. If possible, the cause must be removed. Water is drunk in large quantities. Salol and boric acid, five grains each, every four hours, is very good. 2. Urotropin, five gi-ains six times a day, catheterize twice a day, and irrigation of the bladder with solution of silver nitrate, one grain to a pint of water, or solution of permanganate of jwtassium (1-20,000). The bladder is washed oiit by attaching a glass nozzle to the catheter at one end, and to a funnel -with rubber tube at the other. The funnel is raised to four or six feet above the patient, and bladder filled, and then fluid allowed to flow out. This is repeated several times until it returns clear. CALCITLTJS, GRAVEL OR STONE IN THE BLADDER. This is an extremely painful and annoying disease caused by stone or stony deposit in the bladder. "When the system is healthy the ingredi- ents forming gravel or stone are carried off without difiiculty by the secre- tion of the kidneys. But when there is excess of uric or any other acid these particles sometimes unite and gradually grow and many find deposit in the kidneys or bladder. It is supposed by some authorities to be in part due to the lime and magnesium contained in the hard water used for drinking in certain districts. It is more common in men than in women. Symptoms. — Small gravel stones may pass off with the urine, some- times with great pain, others remain to grow into stone. Wben the gravel or stone is too large to pass through the urethra the patient is subject to terrific spasms of pain, in groin, kidney, testicles, thigh and abdomen, but generally pointing to the direction which the stone seeks an exit ; nausea and vomiting sometimes set in. and the pulse becomes weak and complexion pala The patient is rendered uneasy by frequent desires to STRICTURE OF THE UKETHRA. 609 pass uriue. The flow of iiriue is often sudJeuly stopped and then resumed upon change of position. This is due to the stone obstructing the passage of urine at the neck of the bladder. Treatment. — The medical treatment is only palliative, and similar to that recommended in cystitis and solvent in nephritic colic. The sur- gical operation of opening the bladder and taking out the stone, called lithotomy, and of lithotrity or crushing the stone, if of suitable size and texture, within the bladder, by means of a very ingenious instrument, afford, when successful, as they are in a large proi>ortiou of cases, a. complete cure. In acute forms warm baths, suppositories of a grain of opium and one-sixth of a grain of belladonna, flaxseed tea and the iise of salty jjur- gatives are recommended. In chronic gravel, teas or fluid extracts of buchu are often used, and in stublxirn cases five-drop doses of diluted nitromuriatic acid, or salicin in five-grain doses, thi-ice daily, may be given. Relief may sometimes- be obtained from a mixture of two teaspoon- fuls of powdered borax and five of cream of tartar, dissolved in a pint of water, the doses being t"wo or three dessertspoonfuls four times a day. To relieve intense pain the following enema may be used: Thin-boiled Starch 2 ounces Laudanum 30 drops This injection must be retained in the bowels as long as posible. If pain is very severe, put in forty drops of laudanum. In place of this injection thirty drops of laudanum may be given internally every six hours, but the warm enema is better. Hot compresses over the abdomen and back are also useful. STRICTURE OF THE URETHRA- Causes. — Usually the attention is attracted by the circumstance that the desire to urinate becomes more frequent, and the force of the stream diminishes, so that the renal secretion dribbles away in drops, or runs off in a very fine stream not larger than a knitting-needle. There is more or less pain in passing water, and a good deal of straining is required to accomplish the operation, which begins to be dreaded from day to day, and even from hour to hoiir. Treatment. — The treatment of stricture is purely surgical, as, being a mechanical obstruction, medicines can accomplish nothing for its relief. 29. 61C DISEASES OF THE UKINAHY SYSTEM. The usual method is hy gradual dilatation, using first a small steel rod bent at the suitable curve and highly polished. This is to be warmed and thoroughly oiled, and then carefully passed into the bladder through the urethra, scarcely any force being employed. The great danger is that some of the inflamed and softened tissues in the neighborhood of the obstruction may give 'way, and what is called a false passage being formed, the condition of the patient is rendered far worse than before. Using the Steel Rod. — The largest size that can be used successfully having been introduced, it is allowed to remain a few minutes and then an instrument of a little greater diameter is employed, and so on until the urethra, not without considerable suffering, is stretched to the original magnitude. In most instances, however, this dilating process must be kept up for months, the patient himself learning how to use the proper iiistrument, and introducing it at longer and longer intervals for a year or two until completely cured Various other methods for relieving the obstruction of stricture have been devised, such as external incision, cauterization, and so fortli. Emergency Treatment — In the emergency of an attack of retention of urine, in a man who is the subject of stricture, coming on whilst far from m.edical assistance, the first thing to do is to get into a warm bath, since this will often procure sufficient relaxation of the spasm, which always makes up part of the narrowing of an irritated stricture, to allow a little urine to dribble away, perhaps whilst bathing, and so relieve the distress of the patient. If this fails a laudanum and belladoima injection or sup- pository, or a full dose of twenty drops of laudanum, will frequently have the desired relaxing effect, or ten grains of Dover's powder. Self-Use of the Catheter. — Care should be taken to drink as little fluid as possible, so as to diminish the amount of the renal secretion to a minimum, imtil the avenue for its escape is again partially unclosed. If a catheter can be procured, the patient should try to pass it himself, choos- ing the time when he is still partly under the influence of the opium, which dulls the excessive sensibility of the urethra. Substitute for Catheter — In the absence of a catheter it has been most ingeniously suggested by Dr. Levis, of Philadelphia, to use a piece of bell-wire, doubled and bent to the right curve, along the sides of which, if safely introduced, euough urine might flow to relieve the over-distended bladder. GONOEEHEA. 611 DISEASES OF THE PROSTATE GLAND. Causes and Cure. — Among the diseases of the j^rostrate gland tlie most important are chronic enlargement and calcuhis. This gland is situated just in front of the neck of the bladder, and encircles its outlet, the urethra. Hence its enlargement is apt to interfere with the outflow of the urine from the bladder as soon as it increases beyond a certain point. The difficulty thus caused in passing Avater is especially apt to affect elderly men, and would be very serious had not surgical science supplied a jjeculiarly formed instrument, called the prostatic catheter, by which the impediment can usually be overcome temporarily. Inflammation of Tlrethra. — The urethra, which constitutes the final channel through which the renal secretion flows in making its exit from the body, is likewise subject to inflammation, and to obstruction from calculus, and, most important, to narrowing in consequence of inflam- matory action. This contraction of the canal is called, as most people are aware, stricture of the urethra, and notwithstanding the numerous tales of accident producing this trouble, which are poured into the credulous ears of physicians, its true caiise is, at least nine times out of ten, gonor- rhea, which will therefore be considered in this connection. When a stricture is present a bougie should be used GONORRHEA. Character. — Gonorrhea, or, as it is vulgarly called, the clap is a specific inflammation of the urethra, the result of contagion and very sel- dom innocently acquired In the female it affects chiefly the vagina, and frequently extends to the uterus and ovaries. Gonorrhoea is one of the most contagious diseases. It is caused by the germ called gonococcus, discovered by Professor Neisser. It spreads through illicit intercourse. This disease is scarcely less dangerous, and is more prevalent than syphilis. It attacks all ages and spreads unchecked from one individual to another. It is a disease born of immorality and filth, and is a menace to the eyes of every child born of a woman suffering from the disease, or any person using or handling clothing, towels, etc., upon which the dis- charges from the penis (male) and vagina (female) have collected. The danger of gonorrhoea and the main reason it spreads is due to the fact that the average sufferer thinks it a trifling disease, also that he de- G12 DISEASES OF THE UKINAEY SYSTEM. lays treatment because he is ashamed or frightened to tell his father or motlier or even the family doctor — the man he should go to at once. Thus treatment is delayed while the sufferer becomes worse, uses secretly the patent medicines advertised, the family towel, puts his wash in the family laundry, eats and works along side of you and me, sleeps in hotels, the berths of sleepers, ocean liners, etc., where innocent children and others may come in contact with the germs of this filthy disease. It is a mistake for a sufferer from gonorrhoea not to consult his own physician for treatment, who will protect him (much as he doesn't want to), instead of going to a physician of doubtful reputation, for there is no disease from which the quack reaps such a harvest as gonorrhoea, and every one poses as a specialist in its treatment. The dangers from gonorrhoea in the female are far worse than in the male, as it leads to complications in the womb, ovaries, etc., and causes peritonitis and is responsible for many deaths from blood poisoning following child birth. But innocent married women who suffer from gonorrhoea are the ones to be pitied and suffer the most, for they are ignorant of their condition, and if maimed wonder why they are ill with a filthy discharge and often must undergo painful operations. They fail to receive proper and early treatment for modesty holds them back and they blame the trouble on some other cause. Symptoms. — The first symptom in the male is a slight uneasy sensation or tickling at the mouth of the urethra, which is generally felt between the second and seventh day after exjiosure to infection. On examination the organ is found slightly reddened, and the natural discharge of mucus a little increased, and more viscid than usual. These signs of irritation soon pass into those of inflammation, in which the redness, heat, pain and swelling, characterizing that process, are all experienced in an exaggerated form The discharge becomes thick, yellow or greenish, and the pain on passing water, which must be done frequently, is very severe. Erections are frequent and painful. The penis is bent downward. These erections are called chordee. Sweling and inflammation of the glands in the groins, commonly called a bubo, is common, but the irritation seldom goes so far as to result in suppuration and abscess. Orchitis or inflammation of the testicle is more frequently obsei-ved. The disease is apt to last under the best treatment for a period of from four to six weeks, and if n^leeted or badly managed may be months before it is cured. Treatment- — The most important part of the treatment is rest in bed, but as this cau seldom be secured the inflamed parts should be supported GONOBEHEX. 613 by a suitable suspensory bandage. At first the treatment must be that of inflammation elsewhere, that is by saline purgatives, such as a table- spoonful of epsom salts, low diet, and half teaspoouful doses of sweet spirits of nitre or ten grains of Dover's powder to promote j^erspiratiou. Wrapjiing the affected parts in cloths soaked in a mixture of four ounces of lead-water and two grains of acetate of morphia, and covered with oiled- silk is useful, and the injection of dilute solutions of the same medicines, made by mixing an ounce of this liquid with three ounces of water may be cautiously tried, or a one per cent, solution of protargal. In the first few days irrigation with a one to five thousand solution of permanganate of potassium. The scalding on voiding urine may be mitigated by drinking freely of flaxseed tea containing two drachms of acetate or bicarbonate of potash to the pint, and a belladonna and opium suppository at night, repeated in two hours if needful, will generally prevent much trouble from chordee. Internally globules copa-kava, one four times a day, are effective in acute or chronic conditions. Diet. — The diet should be rice, bread with very little butter, milk, and, if necessary to keep up the strength, soft-boiled eggs. Meat, alcoholic and malt liquors, acids and condiments, are particularly objectionable. Secondary Treatment — After the first violence of the inflammation begins to subside the injections, such as silver nitrate, one grain to six ounces of water, or copper siilphate, one-half grain to the ounce, or acetate of lead and sulphate of zinc, each three grains to one ounce of water, may be made stronger gradually, allowing them to be of sufficient activity to produce a little smarting, lasting not longer than five minutes, each time they are used. They should be employed directly after each passage of urine, provided that does not occur oftener than once in two hours. At this period the administration of balsam of copaiba is usually commenced, and a good article of oil of sandalwood appears to be even more efiicient in checking the remaining discharge, two capsules of either remedy being taken four times daily. Third Treatment — In the course of another w^eek injections of acetate of zinc, sulphate of copper or nitrate of silver, one or two grains to the ounce of water, may come into service with benefit, but great care must still be exercised in regard to errors in diet, a single glass of malt liquor being frequently sufficient to bring on a relapse. If neglected or badly treated the malady may run into the chronic form, which is called gleet, and often proves exceedingly rebellious to treatment. Five-gi-ain doses of salol, ten drops each of tincture of chloride of iron with tincture af can- 61? DISEASES OF THE URIXAKT SYSTEM. tharides thrice dailj often, however, succeed in bringing about a favorable change, and the introduction of a bougie smeared with belladonna oint- ment three times a week is apt to contribute to the cure. Formin Comp — There are few who cannot recall the day of balsam, copaiba and zinc injections. What a change in the treatment of disease — the antiseptic or gennicidal treatment of the modern day ! In the treat- ment of any disease of the genito-urinary tract the urine should be ren- dered sterile. Experiments made with formin comp. prove conclusively its value as a genito-urinary germicide, and the brilliant results obtained from its use place it foremost among the remedies of the genito-urinary specialist. In gonorrhea, acute and chronic, it serves to restrict the area of infection and prevent reinfection. Obstinate cases that bave resisted other treatments should be placed on formin comp. in five-grain doses every three or four bours. It will clear up the urine without perverting its chemical reaction. The trouble with agents which make the urine alkaline is that they are incompatible with the gastric juice and must be given in doses large enough to more than neutralize the acid of the stomach. Formin comp. preserves the acidity of the gastric juice and pro- duces an antiseptic irrigating fluid of the urine without interfering with the digestion or irritating the kidneys. The Sanmetto Treatment. — "We have also another agent possessing wonderful specific influence over the urinary organs when there is irri- tation or inflammation. It is called sanmetto, and is a combination of sandalwood and saw palmetto. It acts as a great vitalizer, increasing the strength of the reproductive organs, hastening their action, promoting their secreting jiower and increasing their size. The usual dose is a teaspoonful four times a day. It is generally recognized by the profession that there is no disease which is so common and presents as many dangers to the human race at large as gonorrhea. The great danger lies in the fact that medical men are apt to be careless about the treatment, l^o man can pronoimce bis patient well and be sure that his urethra is free from the specific micro- organism imless he is able to make a thorough bacteriological examina- tion of the patient's urine and of any discbarge which may issue from his genito-urinary organs. The great source of general infection is the man who is told that he is "over his dose" because his dischai'ge is apparently checked and be is able to urinate without using bad language at every dribble of urine. He is sent away with a host of virulent micro-organisms lying extant in his urethra. EPIDYDIMITIS. 615 Track of Gononhea — The urethral inflammation commences at the meatus and travels slowlj backward. There is no ulceration. The dis- ease tends to limit itself and to become localized at the bulb, where the disease rans its course. Instead of getting well we have gleet, in which there is a certain amount of sticky fluid, often only a drop at the meatus in the morning continues to be secreted after gonorrhea, from altered patches of the urethra, or coming from the stretched and congested mem- brance behind a stricture. Gleet, then, is a symptom of two structural lesions, and signifies that there are patches of congestion in the canal, covered or not by granulations, or that stricture exists, and that the dis- charge comes from behind it. When an individual with a gleet is found to be gouty it is particularly advisable to enforce strict urethral hygiene. Gonorrheal Complications. — Of the complications of gonorrhea we may have inflammatory phymosis, chordee, retention of urine and hemor- rhage. The idea of aborting gonorrhea by the internal use of balsams has been abandoned. By abortive treatment is now understood the injec- tion of any irritating soluble substance iuto the uretlira for the purpose of inflaming the canal. Of these substances is nitrate of silver or argyrol, of the strength of half a grain to one oxmce of water, the injection being carefully repeated every two or three hours until a trace of blood is seen in the discharges. Then all treatment must cease. The syringe used in the abortive treatment should never hold more than two drachms, and the fluid injected must be brought well into contact with every portion of the first inch and a half of the urethra In true gonorrhea the abortive treatment will not avail after the dis- ease is more than forty-eight hours old. EPIDIDYMITIS OR SWELLED TESTICLE. Swelled testicle (epididymitis) frequently accompanies or follows gonorrhoea and may appear at any stage of the disease, but it may result from several excesses without gonorrhoea, to the introduction of instru- ments into the bladder or to a blow upon the testicle. Usually but one testicle is inflamed though occasionally both are affected and sometimes the swelling switches from one to the other. Although a most painful affection the disease is seldom dangerous and usually there is a complete recovery. Symptoms. — There is sometimes a dragging sensation in one of the 616 DISEASES OF THE URINABT SYSTEM. groins, tenderness in the connecting cord and pain in tlie back a day or so before any actual discomfort is felt in the testicles. There is apt to be a chill or chilly sensations at the onset of the disease, but the unmistakable symptom is the swelling of the testicle and the accompanying severe pain. The swelling increases steadily and the pain correspondingly augments, sometimes being of an aching character and sometimes neuralgic, occasion- ally darting to the hips and back. Nausea and vomiting are frequently an accomj)animent of the swelling. The influenced testicle may become swollen to the size of a man's fist and cause painful tension of the scrotum. The duration of the disease varies. The severe symptoms usually subside in four or five days, but the enlargement and tenderness may continue for some weeks. In some cases where there has been considerable inflam- matory deposit, the convoluted portion of the seminal canal at the back of the scrotum, known as the epididymus, may remain in a hardened state for months or years. Treatment — The patient should remain in bed, the scrotum being elevated in such manner as to relieve the tension of the cord. This also tends to moderate the rush of blood to the testicle. If early in the case the scrotum be scarified with nitrate of silver in strong solution (40 to CO grains to each ounce of distilled water) the pain will be alleviated and sometimes completely banished. When pain is unusually severe relief may be afforded by a hypodermic injection of morphine under the skin at the location of the cord. Half an ounce of muriate of ammonia and one ounce of alcohol in a pint of water makes a lotion which applied to the testicle with absorbent cotton, often gives gratifying relief. A thick, warm linseed-meal poultice also frequently abates pain. Other treatments are lead water and laudanum. The testicle should later be supported by a proper bandage or suspensory. Severe tension of the scrotum may be relieved by pricking the scrotum in such manner as to let out the serum, but this should not be attempted by anyone but a competent surgeon. VARICOCELE. Varicocele is a term used to designate a swollen or knotty condition of the spermatic or testicle veins. It occurs in about ten per cent, of males. The veins when felt by the fingers impart an impression as of a bunch of earth woitus inside the scrotum and is generally on the left side. Among causes given are constipation, ungratified desire and exces- SYPHILIS. 617 sive sexual indulgence. In some severe chi-onic cases there may be a washing away of the testicle. The treatment is either palliative or radical. The former is simply in the use of some means of affording the patient temporary relief, which may be accomplished by use of a proper fitting bandage or suspensory, frequently bathing the part with cold water. The radical cure is by cutting or tying the vessels. Local applications are not of material benefit. SYPHILIS. Par-reaching Effects. — Directly syphilis Is due to immorality of In- dividuals and did it aifect only the guilty, humanity in general would not be so much concerned, but owing to its nature the disease is such that it is easily corammiicated to the Innocent. Not only may it descend to off- spring unto the fourth and fifth generation, but it may be given to a mother or a sister by a kiss or may be conveyed by use of a towel or any other article which the diseased has handled. It may be conveyed in so many ways that It is almost Impossible to give them In detail, and thus it is that humanity in general, whether innocent or guilty, are deeply con- cerned and should not only be on personal guard but should act unitedly to the end of isolating victims as if the case were small-pox and so even- tually suppress the disease. Cause- — It is a disease the result of a specific poison produced solely by direct implantation of the contagious material, usually the purulent discharge from a venereal sore in a previously diseased person. Development — About a month after it is In any mode implanted in the human system It appears to begin a development throughout the whole organism, and penetrating to every part of the body, affects especially the skin, glands and throat In the form of secondary symptoms, and still later the cartilages and bones as tertiary manifestations, until finally, if un- checked, it often proves fatal, after intense and prolonged suffering. Local Symptoms. — The first symptom of this horrible disease is usually a primary sore or chancre, which appears as a small pimple or blister upon some part of the organs of generation, or point of contact, any time within two or three weeks after the infection Is received. The great distinction between the syphilitic ulcer, or true chancre, and the chancroid, or non- syphilitic sore, is that the former has a hardened base, but the most 618 DISEASES OF THE URINARY SYSTEM. eminent surgeons admit that neither this nor any other criterion is in- fallible. The infecting pimple may dry up without ulcerating, but more conunonly a cup-shaped sore from an eighth to three-eighths of an inch ill diameter, and with raised edges, is formed, and unless modified by treatment lasts for a month or six weeks, when it heals up, leaving a hard- ened lump of a dark red coppery or bronze color, which is often several months in completely disappearing. The glands in the groins during the •ulcerating stage of the primary chancre become swollen, hard and slightly painful, but seldom suppurate. After some weeks the other lymphatic glands partake of this enlargement, and gradually those in the armpit, in the neck and behind the ear give evidence of the general infection. The Chancroid Sore. — The chancroid, sofe-chancre or non-syphilitic sore, generally develops in a few days from the date of infection, first as a minute vesicle, then a pustule, and later as an nicer, round or oval in shape, with clean-cut edges, and without any hardening of the base. The floor of the ulcer is generally covered with a thick yellowish matter, which is virulent and contagious in the highest degree. The glands in the groins are often not swollen, but if affected are much more apt to suppurate, con- stituting a bubo, the discharge from which is also intensely contagious. It is therefore far more troublesome than the primary syphilitic sore, and yet infinitely to be preferred to the latter on account of the absence of any constitutional infection. The following is a diagnosis between chancre and chancroid: Chancre. 1. Appears two to twenty days after ex- posure. 2. Is usually single. 3. Inflammatory phenomena compara- tively slight. 4. Discharge is serous or bloody and readily inoculable. 5. Margins of preputial orifice are not markedly inflamed. 6. Marked induration. 7. Buboes are invariably present, and in both groins; tliey rarely sup- purate. Chancroid. 1. The interval between exposure and appearance is much shorter. 2. May be multiple. 3. Inflammatory phenomena, heat, pain, redness and swelling very marked. 4. Discharge, profuse, purulent, very ir- ritating and readily inoculable. 5. Induration, if present, is not marked. 6. Buboes, if present, are usually on one side, and suppurative. . Constitutional Symptoms; Secondary — After a true or hard chancre has developed, and no matter whether it has healed promptly or is still open, there appears in about four weeks, on an average, from the first infection the first of the train of general or constitutional symptoms. These consist of the tumefaction of the lymphatic glands, followed after a STPHiLia. 619 few weets more by fever, headache, rheumatic pains and soreness of the throat. About the tenth week after the dearly-bought pleasure its un- fortunate purchaser usually finds a crop of eruption appearing upon his skin, sometimes slight and easily concealed, but oftener well defined and in a tell-tale abundance, which instantly reveals his guilty secret. The Eruptions. — This eruption may bo of pimples, pustules, or scales, the former being the most common and having a new copper-colored red or brownish-red tint, which, when well marked, is to the experienced eye very characteristic. It is apt to be especially abundant round the sides of the nose and angles of the mouth and eyes, the roots of the hair on the forehead and back of the neck, the centre of the breast, the inner side of the limbs, and around the armpits and groins. Hand and Feet Eruptions. — An important diagnostic mark of the scaly, syphilitic erujition is its appearance on the palms of the hands and the soles of the feet. These manifestations are also particularly liable to appear as pustules among the hair of the scalp. In some cases the whole body is thickly covered. After persisting for periods varying from two or three weeks to as many months, these spots usually fade, leaving behind them brownish stains which are very persistent, but ultimately may give place to pale scars, somewhat like the pitting of small-pox in a very mild fornu Other Appalling Symptoms. — In a minority of instances the patient escapes any well defined symptoms, but suffers instead from one of the following manifestations of secondary syphilis, which often accompany the eruptions also: Alopecia or falling of the hair, which in bad cases may include not only that of the head, but also the eyelashes and eye- brows; flat whitish sores in the mouth and anus, called mucous patches, the discharge from which in the former situation may easily convey, by kissing, the whole vile disease to a perfectly innocent person; inflamma- tion of the iris injuring or even destroying the sight ; and local diseases of the generative organs. Tertiary Symptoms — The late or tertiary symptoms of venereal dis- ease are disease of the cartilages and small bones of the nose and throat, producing the shocking disfigurement of the countenance sometimes seen, especially among sailors ; disease of the bones of the skull leading to per- sistent and excruciating headache, and sometimes actually perforating the cranium ; disease of the tibia or large bone of the leg between the knee and ankle; disease of the nails which may entirely Tilcerate out; disease of arteries which, of course, is most apt to prove fatal, and peculiar new '620 DISEASES OF THE UEINABY SYSTEM. growths called gummy tumors, whicli may appear in all parts of the system. Congenital (Birth) Syphilis. — Congenital syphilis generally shows itself between the third and sixth week after birth, by cutaneous eruptions, similar to those seen in the secondary period of acquired syphilis, and of most frequent occurrence upon the buttocks, abdomen, palms and soles. Symptoms — Congestion and subacute inflammation of the mucous membrane of the nose, with increased discharge, vulgarly called the snuffles, also appear, and the infant has usually a peculiarly shriveled, weazened aspect, like that of a prematurely old man. Mucous patches from about the baby's mouth may infect the mother or nurse, and kera- titis or inflammation of the cornea of the eye is lamentably common. Early and active administration of mercury is very important lest the syphilitic cachexia prove fatal. local Treatment of Chancre. — The treatment of the primary sore, or chancre, is much disjiuted. Cauterization with nitric or trichloracetic acid, or the acid nitrate of mercury, and subsequent dressing with black- wash — a mixture of a drachm of calomel, and a pint of limewater — is much employed; but the application of iodoform is highly recommended. Complete excision of the sore, with its hardened base, in the hope of preventing secondary symptoms, has been tried without success, even when performed early. If the enlarged glands in the groins give rise to much discomfort, they should be painted over with the tincture of iodine or twenty per cent, ichthyol ointment. Treatment by Caustic — The prompt destruction of the chancroid ulcer by caustic, and the dressing with black-wash or yellow-wash, is ad- visable, and hope may be entertained of thus putting an end to the whole malady. If the glands in the groins go on to suppuration, however, very serious trouble may be anticipated before a cure is effected. Constitutional Treatment. — The treatment of the secondary symptoms is by the iise of mercury, which, although decried by some physicians, is considered by our best authorities as the only effectual remedy for syphilis. It may be administered by inunction of mercurial ointment, by fumi- gation, or in the form of half a grain of calomel, or blue pill, or one-third of a grain of the iodide of mercury thrice daily, or proTiodide of mercury one-fourth gi-ain three times a day. It is also given by hypodermic injec- tions of the bichloride, one-third grain, once a week. The injection must be made deep into the muscles. Proper precautions must be taken to cleanse the needle and syringe before using, also the skin at point at which SYPHILIS. 621 the needle must be inserted. This treatment should be kept up at intervals for a year or two after an apparent cure has been effected. To obtain its beneficial effects, which are often very marked and satisfactory, it is not necessary to induce severe salivation, which, probably, in former times, often aggravated the ultimate effects of the syphilitic poison. Treatment of Third (Tertiary) Stage. — In the tertiary stage, iodine and iodide of potassium, in the form of the compound iodine solution, or the iodide occasionally in very large doses of fifteen or twenty grains, thrice daily, are the great remedies ; but they may sometimes be associated with mercurials to much advantage. In a majority of instances, the development of well-marked tertiary symptoms may be prevented by judicious treatment in the second stage of the complaint, and even when a slight tendency to disease of the bones and cartilages is displayed, a combination of the iodides with mercury will often avert disastrous con- sequences, or the sirop Gibert. TTse of Tonics — Throughout the whole management of the case the administration of tonics, such as iron, quinine and strychnia is very im- portant, and strict attention to hygiene by promoting the best general health is an almost indispensable condition to securing a favorable result ; also frequent hot baths. Should Syphilitics Marry? — Professor Alfred Fournier, in a late in- structive work on syphilis and marriage, formulates some valuable con- clusions in regard to the very diflicult problem, from a hygienic point of view, whether a syphilitic person ought to marry or not. He asserts that a man who enters upon marriage, with syphilitic antecedents, may become dangerous : first, to his wife ; second, to his children ; third, to the interests of his family. In the first place the wife is apt to be infected directly by contact with the pus of secondary lesions ; and Dr. F. says : "I know from long experience that it is rare to see a yoimg wife live with a syphilitic man, or conversely, without the health of the former being effected by the diseased one." It was this which caused a witty French observer to say: "The pox is partaken of by a married couple equally, just like the daily bread." Syphilis Conveyed by Conception. — Secondly, a man may convey syphilis to his wife by causing conception, as when a young girl, pure and healthy, is married to a man whose venereal disease has not been thor- oughly cured. Tlie physician calls a few months later and finds her dis- eased with, for example, distinct secondary symptoms, such as cutaneous syphilides, mucous patches in the month, scabs on the scalp, swelling of B22 DISEASES OF THE URINAKY SYSTEM. the glands in tlie neck, headache, vague pains, lassiUide, febrile attacks, loss of hair, and so forth — all this without a trace of chancre, and even without that faithful comiianion of a chancre, a bubo, which M. Ricord calls so aptly the posthumous witness of a chancre. In these lamentable instances, the wife-mother infected without having had any primary symp- toms, and whose husband has long been freed from all external indications, is diseased, not from that husband, except indirectly, but from her child still within her womb. Danger to Children — As respects the danger to children: Although offspring may be begotten by a syphilitic father who enjoys good health, yet the hereditary influence of paternal syphilis is very far from being as innocent, minute or negative as has been maintained. Development of the Inherited Tendency — This inherited tendency may be developed in the three following modes : Either that, which is an exceptional case, by the transmission of syphilis to the foetus ; or that, which is sufficiently common, by the death of the child ; or lastly, by the inherent degeneration of the germ, which ultimately reveals itself under a great variety of morbid conditions. "Worst Form of Danger. — But the worst form of danger to the family of a syphilitic father is that communicating the disease to the wife, the paternal and maternal influences will act upon the same side, and most disastrously conspire in unison against the fruit of any pregnancies which may result. In such sad cases we can predict that, with a few rare excep- tions, either, first, and the child will die before birth ; or, second, it will be born with syphilis, and with all the possible and serious consequences of infantile syiihilis, which in many cases are equivalent to death itself; or finally, third, it may be born without syphilis, but with uncertain health, with a weak nature and a feeble constitution, which will probably expose it to a rapid death ; with menacing morbid tendencies ; with a predisposi- tion to certain organic diseases— in a word, to a relatively speedy decay; this terrible fate being visited again and again upon successive innocent babes. Transmission of Syphilis — At the New Orleans meeting of the Public Health Association, Dr. Gihon of the Navy, as chairman of a committee on the subject, presented a valuable report, in which he remarked : "Every one instinctively shrinks from the touch of the sufferer with small- pox, but how few realize that a syphilitic is a leper also to be most scru- pulously shunned ? How few mothers are aware of the danger, to them- selves and their children, from nurses and housemaids drawn from a part STPHILI3. '62S of the population in which every fifteenth person is thus diseased ? How few parents suspect the peril to their daughter from her accepted lover's kiss, since he may be that one in about every five young men among the better classes who has a venereal disease, which there is one chance in two is sypliilis." Transmission of Syphilis by Kissing — These are not mere speculations, for Professor Gross reports that he has seen many cases communicated by kissing; and he tells of fifteen women, nine children, and ten men diseased by a single midwife, who had a chancre on her finger, contracted in the exercise .of her profession, and who had thus carried the disease from house to house. Transmission by Cooks and Nurses. — Dr. J. Marion Sims says: "I have seen a cook and a chambermaid with syphilitic ulcers on their fingers ; I have seen nurses infected by the children they had nursed, who were born of syphilitic parents, in turn infecting sucking babes, born of healthy parents; and I have known a drunken vagabond husband to contract syphilis and communicate it to his wife, who in turn gave it imwittingly to her four children, simply by using the same towels and washbowl." Transmission by Towels — One of this very committee adds the case of an estimable and venerable lady, who lost her eyesight that year, from a venereal affection arising from using a towel in her son's room, care- lessly left by him upon the rack ; and of another, the wife of a clergyman, who the preceding summer sought relief at a Virginia spring for a hor- rible affection contracted in domestic contact with her servant. Transmission by Pipes and Cigars.— The present Surgeon-General of the Navy saw a number of cases of chancre of the lips among the smokers of one set of cheroots, of which the M'rappers had been moistened by the saliva of a Manila cigar girl ; and at Beyroot he learned that it was not unusual for syphilis to be contracted by using a narrjliileh that had been pressed by the lips of a diseased smoker. How many people would venture to eat Smyrna figs if they had seen the top layer of the choicest box pressed flat with the saliva-wetted thumb of the packer, who, there was one chance in ten, was a syphilitic ? Transmission by Exhalation — A certain lady was terribly alarmed when told by her husband, a physician, that she had invited to her tabic a young man who, in the course of a physical examination that morning, he had found to have his mouth and tongue covered with mucous patches ; and that her daughter was dancing in a public ballroom with another whose body was repulsive with syphilitic eczema. 624; DISEASES OF THE UEINAET SYSTEM. Transmission by Instruments — An editorial in one of our Philadel- phia medical journals not long since stated: "It has happened to the writer to be recently called to see a man of most respectable surroundings, ■who bore an unmistakable venereal sore upon his lip, and subseqiiently manifested all the features of secondary syphilis. It was said that this sore had followed a trifling surgical operation upon the part ailected for the removal of a slight deformity, during which the instruments or the hands of the surgeon had inoculated him with syijhilis. Ever-Present Dangers. — This energetic committee urged that it should be promulgated evcryvi'here throughout the community, that so long as syphilitics are allowed to go unrestrained the spotless woman and the innocent child share the danger of this horrible contamination with the libertine and the courtesan. The Various "Ways of Transmitting Syphilis Let it be known by every- one, they exclaim, that this fearful pest may be communicated: 1. By the blankets of the sleeping car, the sheets, towels and napkins of the steamship, hotel and restaurant. 2. By the hired bathing dresses at a seaside resort, and the costumes rented for the fancy ball. 3. By the chipped edges of cups and plates, as seen at any hotel or eating house, and by the half-cleansed knives, forks and sjioons of the same. 4. By public drinking vessels in a railway car or station, as well as the public urinal or water-closet. 5. By the barber's utensils, the comb and brush in the guest chamber, the hatter's measure, or the borrowed hat. 6. By the surgeon's and dentist's instruments, or the vaocinator'a lancet. 7. By the broom or dust-brush handled by a parlor maid, or by the spoon or cup touched by the mouth of a cook or nurse. 8. By whistles and other toys sold to children in the streets by ven- dors with poisoned lips or fingers. 9. By playing or visiting cards which have been used, and especially by car tickets and paper money circulating in a city like Philadelphia, where 50,000 syphilitics are at large. 10. By the grasp of a friend's hand or the kiss of a betrothed lover, by the son to his mother and sister, the husband to his wife and unborn child, and by the latter to its mother. SYPHILIS. 625 SYPmilS— A VEGETABLE TREATMENT. Hematesene. — Under tlie former methods of treatment there was no remedy in the pharmacopoeia "which could be relied upon as a specific for syphilis, although there were many that had a very beneficial influence in aiding the disappearance of the symptoms. It was then, indeed, a question whether the disease could ever be effectually cured. Mercury Not Relied On. — In former times it was thought that in mer- cury we possessed a specific against the disease, and when aU sores were looked upon as syphilitic, and mercury was administered, a large pro- portion of supposed cures were recorded. In our modern times, however, the supposed success of the mercurial plan is not recognized. The New Specific. — Recent investigation and research have brought to light a remedy called hemetesene, which is as much a specific for syphilis and blood-poisoning as quinine is for intermittent fever. Mer- cury and the iodides produce injurious effects if long continued, and should be avoided. Patients who have been treated by the old plan im- prove rapidly after taking hemetesene. In some patients an itching is produced; in others an eruption on portions of the body or limbs; in a few watery blisters in the palms of the hands and soles of the feet which require no particular attention except to cleanse them with water, adding a few drops of carlx)lic acid. Comparison of Treatments. — This vegetable treatment is a certain anti- dote to blood-poison, and increases the number of red corpuscles in poor blood, while mercury and the iodides often produce a rim-down condition of the system if taken for a length of time. Effect of This Vegetable Treatment. — The effect of hematesene as a constitutional remedy rests, unquestionably, in its power of eliminating specific poison from the blood, and in its tonic power, increasing the pro- portion of red corpuscles in impoverished blood, thus enabling the system to throw off disease. ANOTHER TREATMENT FOR SYPHILIS. Salvarsan 606 Antisyphilitic Remedy. Many observers at the present time are experimenting vnth this new remedy brought before the medical profession by Dr. Ehrlich, of (term any. The opinions of the profession at present vary as to whether we have a 40 626 DISEASES OF THE tTRINART SYSTEM. specific for the cure of syphilis. At present it has proven successful in quite a number of cases, while some physicians have reported bad eilects following its use. The following will give a resume of the facts developed at this time, and also the mode of treatment. Of course, it should not be administered by anyone except a qualified physician. Syphilis is an in- fection of the system by spiroclioeta pallida. This is one of the protozoal type of organism, such as malaria, relapsing fever, etc. The pathological pecularity of organisms of this type is that they rapidly acquire immunity to the antitoxins developed in the body against them, and thus establish a more or less permanent residence in the body constituting a chronic affec- tion. The protozoa also rapidly develops resistance to small doses of chemical poisons introduced into the system against them for curative purposes, as malaria is cured by quinine in large doses. Mercury and arsenic are two chemical agents foimd to be especially destructive to the germ of syphilis. It having been foimd difficult to introduce enough mercury into the system to destroy the germs, without seriously injuring the patient, attention was turned to arsenic. By ex- periments Dr. Ehrlich announced to the profession that a combination of arsenic with soda would prove effective. This he has named Salvarsan, or 606. Salvarsan is a light-yellowish powder, containing about thirty-four per cent, of arsenic ; when dissolved in water forming strongly acid solu- tions, on account of this acid reaction, it must be neutralized before use. The preparation is administered only with great care by a physician, intravenous or by subcutaneous injection. Some observers have secured similar results by the use of cocodylic acid, a salt of the allotropic form of arsenic, by injections of one or two grains. It also appears that mercury, instead of being contra-indicated, at the same time may aid in a cure. It is hoped that all that is claimed for it will be fulfilled, and that hu- manity will be cured of this so-called great pox. SPERMATORRHCEA OR INVOLUNTARY EMISSIONS. As an appendix to the unsavory subjects discussed in this chapter, a few remarks upon spermatorrhoea and its usual cause are appropriate here. It would be impossible to estimate, with any approach to accuracy, the vast amount of anxiety and mental suffering needlessly endured in our com- munity in regard to this disease. It is sad to think of the many men. llsrVOLTJNTAEY EMISSIONS. 62f young, middle-aged and those who are still young in age and strength, who suffer from one or more of the above conditions, robbing them of all that is precious and so important to them. Many men are mere pigmies of what they should be. Because of this decline they are backward and sensi- tive, unaggressive in their business, easily discouraged, weak and nervous, instead of being strong and vigorous. The Disease and Results. — That the disease called spermatorrhoea ex- ists, and in rare cases does result in the utter wreck of mind and body, which is painted by these designing quacks in such sombre colors, cannot be denied, but that nineteen out of every twenty young men who have be- come alarmed by the occasional or even frequent occurrence during sleep of what they have learned to control whilst awake, have no real ground for their agonizing fears is equally indisputable. Causes. — The usual cause of spermatorrhoea, of course, cannot be freely discussed in a popular work like this, and yet enough may be ex- pressed in veiled language, the meaning of which will be only or chiefly comprehended by those who need the lessons inculcated, to accomplish, it is hoped, much good. Many young persons of both sexes, after beingj made aware of the danger in which they were becoming involved through evil examples, perhaps, of school associates, have earnestly tried to escape the thraldom of bad habits or early indiscretions. Treatment by Will Power — Some of those who have succeeded, by the exercise of a resolution, and strength of will, for which they deserve great credit, have overcome their enemy, but are yet haunted with the fear that they have been irreparably injured in the struggle. This fear is entirely unfounded, as time will infallibly prove. Treatment by Exercise and Nutrition.— A second and larger class are still discouraged by frequently recurring evidence that they are not in a natural and healthy condition, and some may even be so disheartened as to feel almost hopeless. For such plenty of exercise in the open air, good nutritious food, chiefly vegetable, occupation of the mind in some study or suitable recreation, and the proper medical treatment, can with a con- tinued exercise of the will power during the waking hours speedily ac- complish a cure. Treatment by Hygiene and Medicine. — To a third class, who find them- selves still unable to overcome temptation, much aid will be afforded by adopting the plan of hygienic and medical treatment hereunder indicated, and by diminishing, as the drugs mentioned can do, the force of the im- pulse itself, they may so reduce its power that a little additional resolu- 628 DISEASES OF THE UEINAKT SYSTEM. tion will suffice to achieve a victory. In this struggle they may find some support in the grand old maxim, "lie that ruleth Ids o%\ti spirit is greater than he who taketh a city." Among the best remedies for this condition is the piU cann-aven. This should be taken for some time. mPOTENCY IN MALES AND FEMALES. Impotence means a lack of ability to properly perform the sexual act. It may be partial or complete. In females it may be due to faults in the ovaries, absence of perfect development, displacements, inflammations or degenerations, faults in the oviducts or fallopian tubes, faults in the uterus, faults in external organs, etc. Morbid conditions of the vagina should be corrected and morbid conditions of the "womb overcome. Hot injections and hot baths are of great service where inflammation is a cause. In males impotency may be due to advanced age, disease of testicles, absent or defunct erection, spinal irritation, malformation, non-develop- ment of the organs, early abuses, loss of will power, sexual excesses, gonorrhcea, gleet, alcoholism, etc. In all cases, whether male or female examination should be made by a competent physician (avoid quacks) in order to determine the actual cause. The general health should be looked after and a tonic treatment should be carried out, among the remedies used being damiana, strychnine, phosphorus, etc. A good pill is the neuro-tonal or compound damiana. A direct and useful remedy is cantharides in three-drop to ten-drop doses three times a day. Dilute phosphoric acid, phosphate of iron and ergot of rye are also valuable. These remedies may be used by either sex and should be continued for some time. Apparent impotency in the male is frequently due to lack of confi- dence. A newly-married person who finds difficulty in this way should not become disheartened. A full imderstanding of conditions and a masterful reassertion of confidence will prove of more avail than medicines. PART IX OF BOOK IV Treats of the Urine in health and disease and gives a series of tests for urine which may be used in the home. Acidity of Urine, Test for 634 Alkalinity of Urine, Test for 634 Gravometer 634 Hydrometer 634 Specific Gravity of Urine, Test for... 634 Table of Urinary Constituents 633 Tests of Urine 634 Urine, The 631 Acid, Test for 634 Alkaline, Test for 634 Amount of 631 Color of 631 Consistency of 632 Constituents of 633 Density of .633 Examination of 634 Reaction of 633 Specific Gravity of 632 Table of Constituents 633 Tests for 634 Test for Specific Gravity 634 Transparency of 632. Urinometer 634 Home Tests for Urine (full page in colors) 634 ILLUSTRATIONS The Urinometer •634 629 CURATIVE MEDICINE PAET IX. URINE IN HEALTH AND DISEASE. As a rule, in chronic diseases one of the first manifestations is a change in the urine, sometimes noticeable by appearance, but in other eases only discernible by careful examination. We shall first consider urine in normal condition and then the effects upon the same when the body Is diseased. Amount. — The normal quantity of urine varies from 2| to 3-| pints in the twenty-four hours, the quantity being greater with men than with women. It is decreased by free perspiration and increased by chilling of the skin. The quantity of fluids taken is of course a factor. Different diseases affect the quantity in different ways, causing an increase in diabetes, in some nei"vous diseases, like hysteria and convulsions, also in apoplexy, convalescence from acute and inflammatory diseases and in enlargement of the heart. It is decreased by heat, in fevers, shock, stoppage due to heart disease, acute congestion of the kidneys, in diseases accompanied by purging and vomiting. In all forms of Bright's disease (with the exception of chronic diffuse and interstitial kidney trouble) and in all diseases before death, the decrease is due to obstruction in the bladder or the urethra. Color — The normal color is light amber, which deepens in shade if the quantity voided be decreased, and vice versa. The quantity of fluids drunk and the extent of perspiration also have effect on color. In disease it will be found pale, in diabetes, hysteria, interstitial nephritis and like disorders, the specific gravity usually remaining at or near normal with the exception of diabetes, whore the specific gravity is very high, owing to the presence of sugar. It is high-colored in most other diseases and in acute fevers and inflammation. Heddish color indicates the presence of 631 632 THE tJBINE IX llEAiTlI AXD DISEASE. abnormal coloring matter, usnallj blood. A dark brown color may bs a sign of hemorrhage of the kidney. Urine which turns greenish on stand- ing contains bile pigments. In cancer the iirine becomes almost black on standing, in typhus and cholera, blue. Both diet and drugs have effect on color. After taking rhubarb or senna the urine is apt to be brownish, santonin produces yellow and methyl causes a bluish color. Odor. — There is a peculiar aromatic or urinous odor from normal urine, which becomes putrid and ammoniacal on standing. Fresh urine which has these latter characteristics indicates bladder trouble ; a fecal odor indicates a fistule between the urethi'a and rectum. The odor may be changed by vegetables or drugs, turpentine giving the odor of violets, asparagus, turnips, cubebs, copaiba, sandalwood, etc., each producing their o^^^l peculiar odor. In diabetes the urine smells sweet. A par- ticularly foul smell, as of sulphur, is given off when there is pus in the bladder. Consistency. — The normal consistency is that of water, but it becomes thick and sometimes stringy on standing, more particularly after it has become alkaline. Where there is much sugar or albumin there is a ten- dency to frothincss. Transparency — Freshly passed urine in normal state is always clear, but after standing a faint cloud of excrete matter floats near the center and eventually settles to the bottom. This is increased in cystitis, pros- tatitis, urethritis and other catarrhal conditions of the urethral tract. It is more pronounced in women than in men. It may be distinguished from other cloudy substances by its tendency to float in the center and its preciijitation by an excess of acetic acid. Bacteria, phosphates, or jnis cause turbid urine. If due to bacteria, the turbidity is not cleared with acetic acid, whereas if due to phosi^hates, it Avill be cleared by a few drops of acetic acid. Urates cause a deposit to settle quickly, pus pro- duces an opaque color which in a few minutes settles to the bottom. Specific Gravity — The noi-mal specific gravity varies from 1.010 to 1.025. It is low when an increased quantity is passed and high when the quantity is diminished. Determination of specific gravity should be made by taking a small quantity of the total passed in twenty-four hours, care being taken that the vesel is absolutely clean before starting and that it is kept covered between the urinations. The specific gravity is increased at the beginning of acute fevers, after severe operations, at the commence- ment of acute Bright's disease and when the urine contains blood. It is exceptionally high in diabetes, sometimes reaching as high as 1.050. It EXAMINATION OF UEINE. 633 is diminished in Bright's disease (excepting the first stage of acute above referred to), in all forms of impaired circulation due to heart disease, iu hysteria and iu chronic interstitial nephritis. Reaction — The normal reaction is slightly acid, excepting after meals, when it may be neutral or even alkaline. Acidity is increased by a red- meat diet and diminished by obstruction aud iuflammatiou of the urinary tract. Constituents. — The most important organic aud inorganic solid con- stituents held iu solution are: Urea, from 308 to 617 gi-ains daily; wic acid, from 6 to 12 grains; urates of sodium, ammonium, potassium, cal- cium and magnesium,, from 9 to 14 grains; pliosphates of sodium, etc., from 12 to 45 grains, and chlorides of sodium; etc., from 154 to 247 grains daily. The following table shows specifically the amount of solid matter contained in 1000 grains of urine of different densities. Specific Gravity. Solids. Water. Specific Gravity. Solids. Water. Specific Gravity. Solids. Water. [Specific Gravity. Solids. Water. 1001 2 3.3 997.67 1011 25.63 974.37 1021 48.93 951.07 1031 72.23 927.77 1002 4.66 995.34 1012 27.96 972.04 1022 51.26 948.74 1032 74.56 925.44 1003 6.99 993.01 1013 30.29 969.71 1023 53.59 946.41 1033 76.89 923.11 1004 9.32 990.68 1014 32.62 967.38 1024 5.5.92 944.18 1034 79.22 920.78 1005 n.65 998. .35 1015 34.95 965.05 1025 58.25 941.75 1035 81.55 918.45 1006 13.98 986.02 1016 37.23 962.72 1026 60.50 939.42 1036 83.88 916.12 1007 16.31 98.3.69 1017 39.61 960.39 1027 62.91 937.09 1037 86.21 913.79 1008 18.64 981.36 1018 41.94 658.06 1028 65.24 934.76 1038 88.54 911.46 1009 20.97 979.03 1019 44.27 955.73 1029 67.57 932.43 1039 91.87 909.13 1010 23.30 976.70 1020 46.60 953.40 1030 69.99 930.40 1040 93.20 906.80 The manner of using the above table is as follows: The density of urine passed in twenty-four hours having been ascertained, as hereafter explained under the caption "Examination of Urine," a glance at the table will show the proportion of solid matter and water in 1000 grains of the urine, then taking the weight of tlic whole quantity of urine passed in the twenty-four hours, the solids drained off by the kidneys may be determined by the simple rule of proportion. Urine passed shortly after drinking excessively is pale and has a low specific gi-avity, varying from 1.003 to 1.009. That passed soon after the digestion of a full meal has a specific gravity of from 1.020 to 1.030. The best specimen of average density and nature of healthy urine is obtained in the morning before eating or drinking, and iu perfect health should range from 1.015 to 1.025. 634 TJIE URINE IN HEALTH AND DISEASE. EXAMINATION OF URINE. ^0n M ii tA m The Urinometer. Different tests of urine are made for the discovery of different constituents, but in respect of all tests it is first necessary to determine whether the urine is acid or alkaline and to ascertain the specific gravity. Acidity or Alkalinity — Dip a piece of blue litmus paper in the urine and if on removing the color of the paper is changed to red or reddish-brown it will indi- cate that the urine is acid. If there be no change in the color of the paper then use yellow turmeric or red- dened litmus paper. If the color still remains unaltered tlie urine is neutral, that is, it is neither acid nor alka- line, but if the yellow turmeric becomes brown, or the reddened litmus changes to blue, the urine is alkaline. Specific Gravity. — For this purpose a urinometer should be obtained (see accompanying cut). It is also known by the names of hydrometer and gravometer and can be obtained at all surgical instrument houses and most drug stores. It is graduated in such manner as to show the different degrees of specific gravity and is utilized in connection with a small glass tube, also graduated, into which the urine is poured. When placed in still water the urinometer will sink to a cer- tain point, and as all solids immersed in fluid displace a bulk equal to themselves, it follows that the urino- meter will not sink as deep in a fluid which is denser than water. The instrument having been immersed in the tube of urine and come to rest, the number on the graduated scale which stands at the sni'face of the licpiid plus 1.000 will represent the specific gravity of the urine. For instance, if the number at the surface be 7, the specific gravity will be 1.007; if it is 28, it will be 1.028. z p Qi O CO H c/1 Ui U O X I IM, jmism. ■•■WW* JV«MI.II» ^ > fc fe c aj j= S '^■5 (A ^ K J U Q i >> ^ " v^ :j -- (0 c I-l D <.ba ti" -■ 4) ::i " ni -J ;: ■'■ "^: y. - c/1 H -a u bo c« V: sc ■ -0 C '"^ C nS k'^ c/1 How to Examine the Urine Specific Gravity — This should be done vrith a Uriuometer. In health it varies from 1.012 to 1.025. In disease from 1.002 to 1.040. Deter- mination shonld he made from 21 lionrs' ■iirino. Reaction. — Xormal iirine is slightly acid, and the test can be made Avith Litmus paper. If acid it turns the blue paper red or pink. Transparency. — Xormal urine freshly passed is clear, but on standing it becomes cloudy and finally there is a precipitate. Consistency Xormal is practically the same as -^vater ; becomes thick and stringy on standing. Odor. — Xormal urine has an aromatic or urinous odor ; on standing becomes amnioniacal. Albumen. — Test : Boil the urine and add a small quantity of nitric acid. If there is a precipitate and it does not dissolve albumen is present. Sugar. — Test : Take a teaspoouf ul of Fehling's or Haines' Solution ; boil and add a few drops of urine. If sugar is present there will be a reddish precipitate. If no sugar it will remain clear. Indican — Test : To a teaspoonful of hydrochloric acid add one drop of nitric and fifteen drops of urine and stir. In five to twenty minutes an amethyst color denotes normal amount present; a deep violet shows more than the normal amount. PART X OF BOOK IV Describes the many diseases which are peculiar to women, their causes, diagnoses, symptoms and various modes of treatment. Abdomen, Changes in 689 Abortion 678, 681 Criminal 682 Dangers of 682 Divisions of 681 Evil of 6-8 Treatment of 678, 684 Abscess of Breast 675 Afterbirth, Expelling the 699 Amenorrhea 640 Atresia of the Vagina 657 Baby's First Bath 701 Putting to Breast 70S Suckling, The 704 Biith of Child 695 Presentation of Child 695 Bladder, Diseases of 673 Inflammation of 673 Irritability of 673 In Pregnancy 694 Stone in 674 Bleeding of the Vulva 654 Bottle, Cleanliness of 7o6 Breast, Abscess of 675 Cancer of 676 Diseases of 675 Inflammation of 67s Milk 704 Putting Baby to 70S Tumors of 676 Bringing up the Infant by Hand. . . .705 Bulb Syringe 647 Buttock Presentation in Childbirth. 696 Cachexia in Cancer of Womb 663 Cancer of the Breast 676 Cancer of the Vagina 658 Cancer of the Womb 662 Cachexia in 663 Hemorrhage in 662 Hemorrhage, Checking of 664 03 Injections for 664 Morphine, Use of 663 Visceral Disorders 663 Carbuncle, Urethral 657 Care of the Skin 677 Cessation of Menses 640 Change of Life 679 Child, Attending the 699 Child-bed Fever 702 Child-birth 69s Buttock Presentation 696 Mother's Dress in 696 Presentation of Child 695 Should Child Not Cry 700 Shoulder Presentation 696 Wrong Presentations 701 Child Blemishes Produced in Preg- nancy 693 Child, Delivery of 698 Child, Presentation of at Birth 69s Child, Weaning the 706 Cleanliness of Nursing Bottle 706 Closet, the Outdoor 650 Coccygodynia 657 Conception C79, 685 Conception of Twins 686 Constipation 648 Causes of 648 Diet in 651 in Pregnancy 694 Nausea 649 Poisoning in 649 Prescriptions for 652 Treatment of 651 Contraction of Womb 699 Contraction of Vagina 656 Convulsions, Puerpeial 703 Crabs 656 Cracked Nipples 702 Criminal Abortions 681 6 636 INDEX TO PART X OF BOOK IT. Cystic Tumors of the Ovary 669 Cystitis 673 Delayed Menstruation 641 Delivery of Child 698 Dilution of Milk 706 Diseases of the Bladder 673 and Marriage 678 of External Genital Organs. .. .653 of the Female Breast 67s of the Ovaries 667 of the Oviducts 667 of the Uterus 659 of the Vagina 657 of the Womb 659 of Women, List of 639 Disorders of Menstruation 640 Displacement of Ovary 669 of Womb 664 Douche, The 647 Douching, Position in 648 Dressing, Mode of 677 the Navel 701 Duration of Labor 695 Dysmenorrhea 641 Ectopic Pregnancy 686 Endometritis 659 Enlarged Veins in Pregnancy 694 Exercise in Pregnancy 693 Excessive Menstruation 643 Meaning of 643 Plugging the Vagina in 644 Removal of Tumors 644 Treatment 644 Expelling the Afterbirth 699 Extra Uterine Pregnancy 707 Symptoms of 707 Treatment of "07 Falling of Womb 666 Fetid Dis(?harge in Leucorrhea 646 Fever, Child-bed 702 Puerperal 702 Fibrous Tumors of Uterus 65o Treatment of 660 Fibrous Tumors of Womb 660 First Stage in Labor 697 Flooding in Childbirth 700 Food During Pregnancy 692 Proper Kinds of (>^7 Fountain Syringe 647 Genital Organs, External 653 Gonorrhea 671 Gonorrhea, Diseases Induced by 672 Treatment of 672 Hematoma of the Vulva 6.54 Hyperemesis of Pregnancy 694 Impregnation, How it Occurs 686 Infant, Bringing Up by Hand 705 Management of 704 Inflammation of the Bladder 673 of the Breast 67s of Oviducts 667 of the Vagina 658 of Vulva 653 of Walls of Womb 660 Injection, Vaginal 647 Labor 694 After-management 701 Birth Presentation 695 Buttock Presentation 696 Duration of 695 Duration of Second Stage 695 First Child 695 First Stage 697 Length of First Stage 697 Mother's Dress in 696 Pains of First Stage 697 Period of 697 Premature 695 Preparations for 696 Second Stage 697 Shoulder Presentation 696 Stages of 696 Third Stage 698 Lacerations of the Perineum 670 Length of First Stage in Labor ....697 Leucorrhea 645 Fetid Discharge 646 Injection for 646 Treatment of 64s Lining Membrane of Womb 659 Malignant Tumors of Vagina 658 ]\Iammary Gland 689, 690 Mammitis 675 Management of Infant 704 Mania, Puerperal 703 Marriage with Disease 678 Mastitis 675 ]\Ienopause 679 Menorrhagia 643 Menses, Cessation of 640 Menstrual Period 678 Menstruation 639 INDEX TO I'AET X OF BOOK IV. 637 Beginning of 639 Delayed 641 Disorders of 640 Excessive 643 Frequency of 640 Painful 641 Parent's Dnty in 639 Suppressed 640 Treatment 641 When to Avoid Medicines in. ...641 Metritis 660 Metrorrhagia C43 Midwife, Duty of 6g8 Milk-leg 703 Milk, Dilution of 706 Mother's 704 Testing the 705 Miscarriage 681 Morning Sickness 688, 693 Mother, Attention to, after Child- birth 700 Avoid Excitement 705 Dress in Childbirth 696 Milk 704 Nausea in Constipation 649 Nausea in Menstruation 642 Navel, Dressing the 701 Nipples, Cracked 702 Sore 702 Preparation of 697 Nurse, The Wet 70S Nursing Bottle, Cleanliness ot 706 Nursing Mothers to Avoid Excite- ment 705 Nursing, Time for 705 Orgasm, Lack of 687 Ovaries 667 Diseases of 667 Treatment of 668 Ovaritis 667 Ovary 690 Displacement of 669 Prolapsus 669 Tumor of 669 Overwork 677 Oviducts, The 667 Diseases of 667 Inflammation of 667 Ovule, The 685 Painful Menstruation 641 Bearing Down Pains 642 Meaning of 641 Nausea 642 Purgation in 643 Treatment 642 Pains in Labor 697 Parturition 693 Perineum 670 Lacerations of the 670 Period of Labor 697 Plugging the Vagina 644 Poisoning in Constipation 649 Polypus Tumor of Womb 661 Pregnancy 688 Care During 692 Child Blemishes in 693 Condition of Bladder in 694 Constipation in 694 Duration of 68g Ectopic 686 Enlarged Veins in 694 Exercise in 693 Extra LTterine 707 First Indication of 688 Food During 692 Hyperemesis of 694 Morning Sickness in _. .688 Quickening Period 689 Toothache in' 694 Uterine 688 Vomiting in 693 Pregnancy Table 692 Premature Labor 695 Preparing the Nipples 697 Prevention of Flooding in Child- birth 700 Prolapsus of Ovary 66g of Womb 666 Pruritus Vulva 654 Puberty in Women 639 Puerperal Conditions 702 Convulsions 703 Fever '..... 702 Mania 703 Pyosalpinx 668 Quickening Period in Pregnancy . .689 Removal of Tumors 644 Salpingitis 667 Scabies 655 Second Stage in Labor 697 Shoulder Presentation in Child- birth 696 638 INDEX TO PART X OF BOOK IV. Skin, Care of 677 Skin Diseases of the Vulva 655 Sore Nipples 702 Spermatozoids 686 Movement of 686 Sterility 687 Stone in Bladder 674 Suckling the Baby 704 Suppressed Menstruation 640 Syringes 647 Bulb 647 Fountain 647 Table, Pregnancy 693 Temperature of Douches 648 Testing the IMilk 70S Third Stage in Labor 6g8 Tight Lacing 678 Time for Niirsing 705 Toothache in Pregnancy 694 Treating the Womb 699 Tumors, Cystic, of the Ovary 66g Fibrous, of Uterus 660 of the Ovary 669 of the Vagina 658 of the Vulva 655 Polypus, of Womb 661 Removal of 644 Twins, Conception of 686 Ulceration of Womb 661 Menstruation in 661 Treatment of 661 Urethral Carbuncle 657 Uterine Pregnancy 688 Extra 707 Uteriis 659 Cancer of 662 Diseases of 659 Fibrous Tumors of 660 Inflammation of 659 Lining Membrane of 659 Polypus Tumor of 66t Ulceration of 66i Vagina 657 Atresia of the 657 Cancer of 658 Contraction of 656 Diseases of 657 Inflammation of 658 Malignant Tumors of 658 Plugging the 644 Vaginal Injection 647 Proper Way to Take 647 Vaginismus 656 Vaginitis 658 Veins, Enlarged in Pregnancy 694 Visceral Disorders of Womb 663 Vomiting in Pregnancy 693 Vulva, Tlie 653 Bleeding of 654 Inflammation of 653 Itching of 654 Skin Diseases of 655 Tumors of the 655 Vulvitis 653 Treatment of 653 Weaning the Child 706 Wet Nurse, The 705 Whites 64s Womb 659 Backward Displacements 665 Cancer of 662 Contracting the 699 Diseases of 659 Displacements of 664 Falling of 666 Fibrous Tumors of 660 Forward Displacements of ... .664 Inflammation of 659 Lining Membrane of 659 Polypus Tumor of 661 Prolapsus of 666 Treating the 699 Ulceration of 661 Vv^omen, Interesting Facts Concern- ing 677 Wrong Presentations in Childbirth. 701 ILLUSTRATION Ovary and Mammary Gland 691 Urinary and Generative Organs.. .640 CURATIVE MEDICINE PART X. DISEASES PECULIAR TO WOMEN List of Diseases. — The diseases peculiar to the female sex comprise those of the uterus (womb), ovaries and their appendages, the vagina, external generative organs and mammary glands (breasts). Divisions of Woman's Life. — The life of a woman may be divided into five periods. They are infancy, puberty, maturity, the menopause and senility. Period of Puberty. — Puberty is the jjcriod in which the child becomes the woman, this is the period when she begins to menstruate. It is the time when the breasts begin to assimie a rounded fonn, her general contour becomes sharpened, and her generative organs have reached their full development. jMaturity extends from puberty to the menopause, and is the period during which women bear children. MENSTRUATION. A Mother's Duty. — Menstruation or the monthly flow is characterized by a bloody discharge from the womb, and occurs at regular periods, usually every twenty-eight to thirty days. It is the duty of every mother to explain to her female offspring this condition of affairs, detailing when it occurs, how often to expect it, and the use of the napkin during this period. Too many mothers, on account of a mock modesty, allow their children to pass through the establishment of this function in total ignor- ance. Such practice, however, should be condemned. Beginning of Menstruation. — I have often seen children run to their mother when the first drop of blood appeared, frightened beyond descrip- tion. The first flow usually appears between the ages of twelve to four- (639) Q4Q DISEASES PECDLIAR TO WOMEN. teen. In the torrid zone it appears two or three years earlier, thus these children are capable of child bearing at so early a period. Frequency of Menstruation. — Every woman is a law unto herself. As before stated, menstruation usually appears every twenty-eight to thirty days ; some women, however, menstruate every four to six weeks and are in perfect health. A napkin should always be worn during the flow; surprising as it may seem, many fail to do so. DISORDERS OF MENSTRUATION'. Suppressed Menstruation (Amenorrhea) . — This is a term applied to the absence of menstruation, between jiuberty and the menopause. Causes. — Pregnancy, and when nursing; anemia (impoverish-ment of the blood (is a very frequent cause; consumption, debilitating diseases, non-development of the generative organs; obesity and after the ovaries tave been removed. Symptoms — Amenorrhea may come on suddenly or be of gradual development. Tlie former variety is often the result of some violent excitement, fright or mental shock due to the setting in of some fever or other acute disease, or to that common and very dangerous cause, espe- cially in young girls, imprudent exposure to cold or wet during the monthly flow. Symptoms in Anemic Persons — If due to anemia the patient has a pallor, and the margins of the lips will be pale, she will look ''bleached out," shortness of breath, palpitation of the heart, swelling of the feet and ankles, headache and constipation. Symptoms in Consumptives. — If due to consumption, cough and night sweats will be present, accompanied by marked emaciation (wasting away). When amenorrhea comes on gradually it is apt to indicate some serious chronic disease, which should be immediately investigated and attended to by a skillful physician. Cessation of Menses — When the cessation of the menses is part of such a severe malady as consumption or Bright's disease, it often appears to be only nature's method of economizing the failing strength of the invalid, so that any interference would be likely to prove positively hurtful. On the other hand, the natural reappearance of the menses after a stoppage in the course of a chronic malady may be welcomed as a favornblo indication of a tendency toward improvement. Symptoms Attending Stopped Menses. — The constitutional disturbanoe Mons Veneris. Pubic Bone. Clitoris. Urelhra. Bladder. Urachus. Ovary. Broad Lisrament. 9 10 II 12 13 14 15 1 6, Womb. Neck of Womb. Vagina. Rectum. Anus. Rectum covered by Peritoneum. Spinal column. Spinal cord. The abo\e outline drawing will sho and Generative Organs of Women, all pelvis. This is shown by dividing the above downward. The various parts a brrs, so that the position and shape o w the relative position of the Urinary contained within and surrounding the body directly throueh the centre from re plainly shown and tlesisrnated by num- f each organ can be readily seen. PAINFUT- MENSTEDATION. 641 'from abrupt suppression of the monthly flow is generally very great. There is usually severe pain in the region of the womb, similar in char- acter to that of colic, and hysterical excitement, or even convulsions, and mania, may be the direct effect. Treatment. — When due to anemia, iron is the best remedy, given in the form of Blaud's pill, one four to five times a day. When taking iron it is always a good rule to take a dose of epsom salts once a week, in order to counteract the constipating effect of the drug. Other remedies are, a teaspoonful of the elixir of quinine, iron and strychnia, three to four times a day ; the pill of the same ingi'edients, ono four to five times a day ; per- manganate of potash, two grains three times a day; or the bin-oxide of manganese, two grains three to four times a day. When to Avoid Medicines. — The possibility that absence of the monthly period may be due to pregnancy should always be borne in mind, in which case it would be dangerous and criminal to administer any of the usual remedies for restoring the flow. Treatment When Due to Cold. — When due to exposure to cold and wet resort to hot mustard foot baths or hip baths, mustard plasters to the inside of the thighs, calves of the legs and ankles. A hot sitz bath is also worthy of trial. This consists of partially filling a "foot tub" with hot water, allowing the patient to sit in it, and covering her with a blanket. She should remain in the bath for five to ten minutes. The but- tocks and thighs are then thoroughly dried, and she is j^ut to bed. If con- stipated the bowels should be regulated. (See Constipation.) Vaginal injections of hot water are also to be employed. (See "How to Use the Douche.") Treatment of Young Girls. — The treatment of delayed menstruation in young girls who have passed the age of puberty must be on general principles adapted to improving the general health, imless there are signs of the menstrual blood being retained inside the womb, a dangerous con- ditio"n which should always be considered in such instances and relieved as early as possible by a surgical operation. - PAINFUL MENSTRUATION (DYSMENORRHEA). Meaning of the Disease. — By this is meant painful menstruation. The pain may occur Ix^fore, during or after the flow. Many varieties hava been described, such as the obstructive, congestive, mechanical, neuralgic, and so forth, but it is very difficult at times to differentiate them. 41 642 DISEASES PECUNIAE TO WOMEN. Causes. — Usually due to tlie womb being out of its normal position, tumors, aiul inflammatory diseases of the womb and ovaries. Symptoms — A woman who enjoys health not only menstruates reg- ularly, but does so with perfect freedom from suffering, but unfor- tunately there are very few members of the female sex who pass through the whole period of their sexual vigor without being called upon to en- dure more or less frequently attacks of dysmenorrhea. Pain With the Flow — Some women experience great pain with each flow, from the commencement of puberty, every month, until the change of life relieves them. With the majority, however, pain is only the ex- ceptional accompaniment. "With some women marriage effects a cure, whilst in others, especially when there is sterility, it either aggravates or originates the dysmenorrhea. Under no circumstance, however, would a physician advise a woman suffering with dysmenorrhea to be married in the blind hope that it would effect a cure. Bearing-Down Pains. — ^Bearing-down pains, not severe, are often present, accompanied by a sensation of weight. The pains as a rule are cramp-like, and intermittent, varying in severity. At times the pains are followed by the expulsion of blood clots which oftentimes affords relief. Severe pains as a rule necessitate the sufferer going to bed, where she may have to remain for several hours to a day or two. As a rule constipation is present, again diarrhoja may be troublesome. Nausea. — ISTausea followed by vomiting adds to the severity of the attack. Headache is invariably present. The pains may extend from the lower part of the abdomen down both legs. Pain in the back is often- times quite marked, the sensation being that of the back splitting open. Treatment. — The existence of dysmenorrhea depends upon so many conditions that the treatment employed in one case will seldom relieve the next. During the attack of pain, the patient should take a hot sitz bath, and if the suffering is very severe, may have a suppository of half a gi-ain of opium combined with a quarter of a grain of belladonna. 'Un- der no consideration should a hypodermic injection of morphine be given, without a physician's advice. Again, a sitz bath may be given, followed by a turpentine stupe, and ten grains of Dover's powder. Tincture of belladonna five drops every three hours may be given; or the following: antipjTine five grains every hour until four doi?es are taken, then every three hours Tintil relieved; acetanilid five gi-ains in the same manner; tincture of gelsemium ten drops every three hours; bromide of soda or potassium twenty to thirty grains every three hours; or as a final resort, EXCESSIVE MENSTRUATION. 643 if the above-named remedies fail to afford relief, morphine, either by the mouth or a hypodermic injection, but only ou the advice of a physician. Hot vaginal injections should also be tried, using at least a gallon of water. Purgation. — Often when the attack is accompanied by constipation, a purgative dose of epsom salts or aloes will be of service. Attention to the General Health — Between the attacks attend to the general health. Emjjloy the tonics mentioned in the treatment of amen- orrhea. Take plenty of out-of-door exercise. Avoid undue excitement, straining or heavy lifting, the bicycle and dancing, as the time for the flow approaches. Prevention of the Pain — An endeavor should be made to prevent the pain if jjossible. The best drug for this purpose is tincture of gelsemium, five drops after meals, to begin ten days before the flow is expected. This is to be continued until the flow is well established, then cease until within ten days of the next period. It will prove advantageous at times to com- bine with the gelsemium five drops of the tincture of cannabis indica. When Drugs Fail. — If drugs fail to afford relief, then it may be nec- cessary to dilate and curet (scrape) the womb, an operation which, when properly performed, will give excellent results. This operation will only keep the patient in bed ten days, and at the end of the second week she V ill be able to resume her routine duties. EXCESSIVE MENSTRUATION (Menorrhagia and Metrorrhagia). Meaning of the Disease — When the monthly flow persists longer than hsual or is excessive in amount it is called menorrhagia. When there is a bloody discharge from the womb between the monthly periods it is termed metrorrhagia. Causes. — Both may be due to obstruction of the general circulation of the blood, from disease of the heart, lungs and liver. Tumors of the womb, inflammatory disease of the womb, ovaries and tubes. The more frequent causes are, getting out of bed too soon after confinement, re- tained portions of conception, due to im2'>roper care during a miscarriage (see Miscarriage), polypus tumors of the womb and cancer. Symptoms — Anyone suffering from either of these conditions should be examined by a physician in order that he may ascertain the exact caucs and remove it ; otherwise delay due to home treatment, should the cause be a dangerous one, may prove fatal. In a woman otherwise having 644 DISEASES PECULIAR TO WOMEN. a iionnal flow, she will notice that the flow lasts a day or two longer, or may be excessive iu amount, requiring a greater number of napkins than usual. Excessive Flow — The flow may be so excessive as to require rest in bed. AMien a large amount of blood is lost there will be pallor of the skin, dizziness, headache, extreme prostration, specks will appear before the eyes, she mjay feci as though she was falling through the bed. Or again, if the condition present is a menon-hagia, there will be a discharge of blood between the periods, which discharge, if it becomes excessive, will give rise to the same symptoms just mentioned. Treatment. — In the treatment of menorrhagia there are two indica- tions to be fulfilled, first to check the present hemorrhage; and, second, to remove the cause upon which it depends, and so obviate the certainty of its recurrence. To accomplish the first of these desirable objects, which should not, however, be attempted in any monthly period, until the usual amount of blood has been eliminated from the system, say until the second or third day of the flow, try half a leaspoonful of ergot every three hours. Kest in bed is, however, an important part of the treatment, without which all the good accomplished by skilKul medical care may be speedily dissipated. Other remedies are, half a teaspoonful of hydrastis cana- densis every three hours ; half a teaspoonful of witch hazel every three hours; gallic acid, 5 grains every four hours. Stypticin iu 5 grain doses. A very good prescription for bleedings of this kind is as follows : R. — Ext. hydrastis fluid (colorless) i ounce Ext. ergot fluid V2 ounce Ext. hamamelis fluid I ounce Aqua, q. s , 3 ounces Sig. One teaspoonful every tliree hours. Plugging the Vagina — If these remedies fail and the case is an urgent one, it will be necessary to tampon or plug up the vagina with pieces of raw cotton, lamb's wool, or linen cloth, taking care not to employ an undue amount of force in introducing these materials. They should have a string securely attached to theml in order to facilitate their re- moval. In no case should such a plug or tampon be allowed to remain longer than t\Venty-four to thirty-six hours, for fear of poisoning the system with the putrifying blood entangled in it. When the tampon has been removed, if tlie bleeding is not checked, tampon again. Removal of Tumors. — If the bleeding is due to the presence of tumors, it will be necessary to have them removed. LEUCOEEHEA OR WHITES. 645 Further Treatment — Freqxiently medicines and tampons fail to con- trol the henioiThages, esjjecially when there is proud flesh in the womb, and when the muscles of the womb are unable to contract. In such an event the only procedure is to dilate and euret the womb, which operation will remove the source of the trouble. In some cases of dysmenorrhea enlargement and congestion of the ovaries appear to be the important factors in the production of the malady. Such attacks are apt to be very intractable, imless the disordered conditions of the ovaries are remedied, usually by an operation. LEUCORRHEA OR WHITES. Character of Whites. — This prevalent, troublesome and disagreeable condition, vulgarly termed the "whites," consists of a discharge of mucus or muco-pns from the womb, neck of the womb and vagina. It is very similar to that occurring from the nose during a cold in the head. In fact, the condition of the mucous membrane giving rise to leucorrhea is often one of catarrhal inflammation. Causes — It may be brought on by taking cold ; by local excitement ; by inflammation of the neck of the womb, the womb proper or the lining membrane of the womb; oftentimes the trouble is localized in the raucous membrane of the vagina; disease of the ovaries and tubes may also be at fault. It is frequently due to a "ran down" system, yet women in perfect health may be affected ; in the latter class it is probably nature's method of overcoming an excess in the richness of the blood. Character of the Discharge. — The character of the discharge varies; it may be thick and tenacious, or it may be liquid, when it will run down the limbs in a stream and greatly soil the clothing. As ordinarily seen, it is not usually accompanied with much pain, but when very profuse, dis- tress in the back and a dragging sensation in the lower part of the pelvis, often described as a bearing down feeling, are the sjanptoms most fre- quently observed. The discharge is generally more abundant a little while before, and for two or three days after the occurrence of the flow. In fact, when the leucorrhea is severe, this increase of the flow of whitish matter sometimes continues for a couple of weeks after the monthly period with increased violence, showing how greatly it depends upon a congestion of the parts concerned for its jiroduction. Treatment. — The treatment of this rather intractable malady, besides the necessary attention to the general health, by the use of tonics and noup- 646 DISEASES PECULIAE TO WOMEW. ishing food, consists of llie employment of astringent injections into the vagina. For building up the health the following pill will he found of service : R. — Acidi arseniosi (arscnious acid) I grain Ferri reducti (reduced iron) lo grains Quinia sulph. (quinine) 20 grains M. Fiat in pil. No. XX. Sig. — One pill after each meal and at bedtime. Additional Treatment. — If the leucorrhea is due to irritation of the ovaries, ajiplj a cantharidal plaster over the groin on both sides. The best results, however, are attained by the employment of vaginal injections, such as a teaspoonful of ereolin to two quarts of hot water ; twenty grains of sulphate of zinc, or ten grains of sulphate of copper in the same quantity of water ; thirty grains of alum to the pint ; and a teaspoonful of lysol to two quarts of water are all worthy of a trial. A very cheap injection is made by adding one ounce of powdered oak bark to each pint of water, or one ounce each of tannic acid and glycerine to two quarts of water. Treatment for Petid Discharge — When the discharge is fetid, perman- ganate of potassium should be used one-half drachm to one pint of water. This solution will stain linen, so be careful to avoid sjilashing It over the douche pan. (See IIow to Use the Douche.) Another veiy good drug to eradicate the odor of this discharge is bichloride of mercury. The drug- gists dispense a tablet containing seven and seven-tenths grains of the drug. One of these tablets added to two quarts of water makes a solution the strength of which is 1-4000. Such a soltition should be used two or three times a day. All the injections above mentioned can be used night and morning, but if the discharge is profuse, three times a day will not bo too often. An Injection for Whites — A very useful astringent injection for leucorrhea, whatever may be its cause, is the vaginal astringent douche tablet. This tablet can be used night and morning and is effective and con- venient. local Applications.^TThen the leucorrhea is caused by catarrhal in- flammation of the cavity of the womb, as is frequently the ease, injections into the vagina are, of course, almost worthless, and local applications made by a j^hysician are very important, and should be faithfully perse- vered in, sometimes for many months. HOW TO USE THE DOTJCHa. 647 HOW TO USE THE DOTJCHE OR VAGINAL INJECTION". Varieties of Syringes — Before proceeding further let me describe the proper manner of taking a douche. First the varieties of syringes. These are numerous, but for practical purposes there are only two which aro used to any extent. They are the Davidson, or bulb syringe, and the Fountain syringe. The Bulb Syringe. — The bulb syringe is not to be recommended, be- cause it is dirty, a great deal of muscular energy is required to work it, hence is tiresome and necessitates too much preparation for its use. It is very difficult to employ this syringe while lying down, and this is the only position in which a douche should be taken. Using the Bulb Syringe — In using this kind of a syi-inge generally a pint of the solution is placed in a basin over which the woman squats, and by sqTieezing the bnlb forces the liquid into the vagina as fast as it runs out, thereby filling the syringe joints with the vaginal secretions, and returning to the vagina as soon as they flow away the iminirities which have left it. If, however, a woman prefers this kind of a syringe, and insists on sitting over a bucket or other receptacle, then the solution should be placed in one basin, and that which is forced into the vagina pennitted to run into the vessel upon which she is sitting. Object of Using the Syringe. — The object of using the syi-inge is to bathe the vagina and neck of the womb. By sitting on a vessel the latter is prevented, for just as soon as a woman sits down, then the vagina is doubled on itself in such a manner as to prevent the solutions reaching the womb. The Fountain Syringe — The Fountain syringe is to be advocated, not only for this purpose, but for all-round family use. This syringe consists of a bag of soft rubber with a long tube and a series of hard rubber nozzles. The largest size is intended for the vagina. The "Alpha" is the best, because it has a valve at the opening which prevents' the solution from running out at the top. This is a great advantage because the bag can be laid on the floor, a shelf or anywhere without spilling its contents. Proper Way to Take Vaginal Injections. — The proper way to take a vaginal injection is as follows: First fill the douche bag, which should hold at least two or four quarts, with the solution which is to be nsed. Hang it on a nail, which should be driven near the bed. Then place the douche pan on the bed. A good douche pan should be large and capable of 648 DISEASES PECULIAE TO WOMEN. holding at least one to two gallons. They are made of tin and agateware. Then lie down in i)ed, placing the douche pan imdcr you in such a position that tlie buttocks rest on the top of the pan, in order that the solution after leaving the vagina will run directly into the pan without splashing over. Improper Positions in Douching. — This is the correct way to take a douche. The other methods of sitting over a basin, or standing over a vessel, are to be condemned. This is the only way in Avhich the womb can be bathed with the solution nsed, and not less than one to two quarts should be emijloyed when a drug has been added; and when plain hot water is used, four to six quarts will not be too many. Temperature of Douches. — All vaginal douches should be as hot as the patient can stand, and under no circumstances should cold water be used, as it is injurioiis. In exceptional cases hot water increases the pain in- stead of relieving it, and is then advantageously replaced by lukewarm water. What Women Should Avoid — Under no condition should a woman en- deavor to introduce the small nozzle into the womb, or endeavor to force a solution of any kind into the womb. This is an exceedingly dangerous practice, and many a woman by so doing has sown the seed of pelvic in- flammation, which has only been relieved by the removal of both ovaries, aud in some cases the womb. CONSTIPATION. Woman a Constipated Animal. — The eminent Dr. Goodell once said: "Woman is a constipated animal." While we do not desire to class the gentler sex as an animal, still this statement contains a gi-eat deal of truth, for by far the greater majority of women are constipated. Causes — This troublesome state can be attributed to a number of causes, the most frequent of which is leading a sedentary life; omitting daily exercise, which tends to excite the secretions of the bowels and liver to their proper activity. Another very frequent cause is laziness pure and simple, the patient failing to go to stool when informed by nature that such should occur. A Very Frequent Cause — Modesty is a very frequent cause of con- stipation in women, because a woman prefers to suffer rather than to go to a closet which may be somewhat publicly situated. Hereditary mus- cular weakness, hepatic torpor, lack of secretions in the lower bowels, back- CONSTIPATION. 64:9 •ward displacement of the womb and lacerations of the perineum are fre- quent causes of constipation. Symptoms. — General weakness, a feeling of languor and mental de- pressions are frequent symptoms; nervousness, headache, loss of appe- tite and a furred tongue may also occur. Individuals differ in this mat- ter, one feels wretched all day without the accustomed evacuation, another is comfortable all the week except on the day which, by purge or enema,, the bowels are relieved. More Serious Symptoms. — ^When persistent the accumulation of the 'feces' leads to serious symptoms, such as idceration of the colon, perfora- tion of the bowel, piles and inflammation of the bowels. The bowel con- tents may become dry and hard, forming large masses, which can only be removed by a physician with a great deal of difficulty. Nausea. — In women who have been habitually constipated, attacks &f diarrhoea with nausea and vomiting should excite suspicion, and lead to a thorough examination of the lower bowel. Poisoning. — Part of the bowel contents may be absorbed by the sys- tem, giving rise to a general poisoning, which will recur at stated periods, until the constipation is cured. Costiveness is the recognized cause not only of hemorrhoids, of pelvic congestion, of inflammation of the womb and of disorders of the digestive apparatus, but also of the fecal poisoning just mentioned. For if diseases breed from bad drainage without the body, how much more from bad drainage and defective sewerage within the body! Feeble mothers beget feeble children — children who are car- ried from the womb to the grave, or who peak and pine under the heritage of ill health. Other Causes. — Such then being the condition of the majority of American women, what is the cause ? Probably no single cause has had BO much influence in producing the peculiarly delicate condition for which women living in the country and in small towns in America are notorious, as the discomfort, inconvenience and frequent repulsiveness, and, I may add, indecent exposure, of their closet accommodations. Insufficieny of Closet. — In the teeming tenement house of any of our large cities there is usually but one closet, and that is invariably a cess- pool, wet and foul, reeking with filth, poisoned by noisome stenches, defiled by lewd couplets or by obscene cuts, indecent from tliin parti- tions and wide chinks, or from being preoccupied by one of the opposite sex. Under such conditions what woman can avoid schooling herself into the habit of resisting the evacuation of her bowels ? 650 DISEASES PECULIAR TO WOMEN. Inconvenient Privies. — In the small houses of tradesmen and of me- chanics the water-closet is rarely to be found, nor are the houses of the better classes always supplied Avith this luxury. The privy is then usually placed at the farther end of the yard, and approached by a long and un- sheltered path. It is, therefore, almost inaccessible in bad weather or on dark nights, and is overlooked by the backbuildings of all the neigh- boring houses. Eisk to Women — To a delicate woman the exposure to the weather is a serious risk; to one who is menstruating it is a constant menace; while to the refined woman the exposure to view compels the postpone- ment of her physical duties to nightfall, or until driven to them by a sheer necessity which knows no law. Country Closets — Nor does the condition of the closets in the coun- try present a more agreeable contrast. In many parts of the Southern and Western States a clump of bushes, the shelter of a rock, the nearest grove affords the only accommodations. But take the most thickly set- tled States, where is the small farmhouse whose privy invites rather than repels an operation of the bowels ? Privy a Misnomer.-^The very name of privy is a misnomer. How seldom is the building hidden by clumps of evergreen, or a screen of lattice work. How often is it not an embarrassing distance from the house, at the end of a long trail, or, at least, of a long unkept path, which frequently runs parallel with a street or with a road. The Outlandish Privy — \Yhere in the country, and for that matter in cities also, is not to be found the privy made \ip of rough boards rudely spiked together, with cracks wide enough to spoil all privacy, with a door without a bolt, and generally hanging by one hinge, with a crescent- shaped hole for a window, and with its sole object of furniture a barrel of rasping corncobs ? When is it ever sheltered from the rude blasts of winter, or not poisoned by noisome stenches, acrid vapors and imclean flies ? After such an unsightly but truthful picture, can we wonder that the calls of nature are looked upon as grievous dispensations of Provi- dence, as hateful duties which are to be put off as long as possible and obeyed as seldom as necessary? Hepellant Conditions — Imagine now broad daylight, with its busy traffic, a rainy or a dark night, the grass wet with dew, or the ground cov- ered with snow, or the temperature, perchance, many degrees below zero. Under such circumstances what woman can respond to the calls of nature without putting herself to great discomfort, to great risk, indeed, if she CONSTIPATIOIT. 651 be menstruating, or without blunting the edge of her womanly sense of decorum. The Antidote. — I have told you the bane ; now what is the antidote ? Clearly such closets as a civilized Christian people — a people living in the twentieth century — are not degraded in using ; closets that are decent, com- fortable and accessible; closets that invite rather than repel those in which an operation of the bowels is not tantamount to being buffeted by Satan for a season. Country Earth Closets. — In cities, and in towns which are supplied with water works and good drains, the use of the water closet ought to become universal. In the country, where such a luxury can be attained by the rich alone, the earth closet is the only substitute; I cannot too strongly urge its adoption. Treatment — Much may be done by systematic habits. Set a cer- tain time of the day, and at that time go to the closet and endeavor to have an evacuation. Continue with this each day, and permit nothing to interfere with this duty at that particular time. The desire to go to stool should always be granted ; when there is a desire, go by all means. Treatment of Stout "Women — In stout women with flabby abdomens the muscles should have the support of a bandage. E-xercise is of great value; by far the best being horseback riding at least an hour a day, or every other day. Massaging the abdominal muscles is also of value. Much good can be accomplished by the daily use of the "home gymna- sium," or dumb bells and Indian clubs. Diet. — The diet should also be regulated. Very often if a plateful of cracked wheat is used at breakfast each morning, and bran bread taken in addition, a chronic tendency to constijiation can be removed. Milk is not to be recommended. Green or caimed corn is of great service. Fruits also do good. Nothing is so good as a glass of cold water taken on arising in the morning jiist before breakfast ; or if the cold cannot be borne, then a glass of as hot water as can be swallowed may be substi- tuted. It must be remembered that strawberries, raspberries and black- berries are constipating rather than pui-gative. Coilee has a binding effect on some persons ; brandy is distinctly constipating, whereas whiskey has no influence one way or the other. Treatment by Medicines. — The use of drugs for the relief of consti- pation consists in those that unload the bowel, which has become filled, and those which will cure the tendency. Let us consider the first variety. For this purpose may be mentioned epsom salts, half to one tablespoonful, 652 DISEASES PECULIAR TO WOMEN. preferably taken in the morning on an empty stomach; mercury, in the form of calomel, one-tifth of a grain every hour until about ten closes are taken, then following with a bottle of citrate of magnesia ; castor oil, half to one tablespoonful, or twenty grains of powdered rhubarb at bedtime. To Cure Tendency. — Of the second class, half to one teaspoonful of the fluid extract of cascara sagrada at bedtime, or a dessertspoonful of phosphate of soda in one-quarter of a glass of hot water before breakfast. Khubarb is not to be recommended for constant use, as it is astringent, and after the bowels have moved the constipation will be more pronounced than before. Mercury is exceedingly harmful if used continuously as a purge, and is the cause of much ill health, bad teeth, and digestive troubles. Castor oil is notorious for its tendency to ultimate constipation. Very Best Drugs — Of the curative class of drugs none compare to cascara sagrada, which should be used in the form of the tasteless fluid extract, or cascara cordial. This is the only drug which moves the bowels and at the same time tends to make the future movements more easy and regular; the dose is ten to twenty drops of the fluid extract every night at bedtime, or one to six teaspoonfuls of the cordial. If the fluid extract, in the doses above mentioned, fails to act, increase the quantity each night until at least a teaspoonful if necessary. The following three prescriptions will be of value : Aloes 20 grains Extract of nux vomica 4 grains Extract of physostigma 3 grains Extract of belladonna 4 grains Make into twenty pills. Take one pill at night or one night and morning. Oy, Resin of podophyllum 2 grains Extract of nux vomica 4 grains Extract of physostigma 3 grains Extract of belladonna 4 grains Make into twentv pills. Take one at night or night and morning. Or, Aloin 2 grains Extract belladonna 2 grains Strychnine ^* grain Extract cascara i6 grains Make into l6 pills. One at night. Injections. — The employment of enemas, or injections, as a routine practice is to be discouraged. In cases where it is necessary to use them DISEASES OP THE EXTERNAL GENITAL OEGANS. 653 for temporary relief, and to get rid of tlio gas, a little soap, eommon salt, , and a few drops of turpentine may be added to the water. DISEASES OF THE EXTERNAL GENITAL ORGANS. Vtilvitis. — This is an inflammation of the vulva, the part so often referred to by women as their "person" or "privates." It is divided into several different varieties, which can only be distinguished by a physician. Causes. — One of the most frequent is lack of cleanliness; irritating discharges from the vagina and womb, -which trickle over the parts ; tight fitting drawers, which rub and chafe; injuries, as striking against chair, or falling on an object; selfabuse; excessive or brutal intercourse; preg- nancy ; fevers ; may follow a long and difficult labor ; and is apt to occur during an attack of diabetes. Symptoms — General discomfort, sensations of burning which amount at times to severe pain ; burning pain during urination ; the parts are usually swollen and very red. In diabetic vulvitis the itching is intense and oftentinies is the first symptom of diabetes. Every woman -who passes large quantities of water and suffers from intense itching of these parts should have her urine analyzed to see if it is due to diabetes. Owing to the fever and swelling the parts at first are dry, due to the lack of secre- tion; but as this increases the parts become raw and very painful. Treatment — Cleanliness is the first consideration. Warm sitz baths, hot vaginal injections' of plain water, or water to which has been added creolin one-half a teaspoonful to two quarts, borax a teaspoonful to the quart, or a dessertspoonful of salt to the quart. Use these several times a day. After thoroughly cleansing the parts, they may be dusted with talcum powder, starch, or starch and bismuth, equal quantities, bismuth or borax. Checking the Beginning.— Oftentimes the attack can be checked at the beginning by applications of lead-water and laudanum. The best way to apply this is to soak a piece of absorbent cotton, about the size of the hand, with it, and place it in between the legs. Treatment by Injection — If the irritation is due to worms, a rectal injection will usually remove them. If the itching is very severe try hot vaginal injections of bichloride of mercury, seven grains to the quart; salicylic acid the same strength; or a solution of hyposulphite of soda, one ounce to the pint of water. After the parts have been dried any of the followiug will be found beneficial: benzoated zinc ointment; iodofoi-m 654 DISEASES PECUT.IAR TO WOMEN. ointment; solution of carbolic acid, half a teaapoonfiil to a cup of water; uitrate of silver, eight grains to the ounce of distilled water, and painted over tlie parts oftentimes affords the greatest relief. The bowels should be kept freely open. PRURITUS (ITCHING OF) VULVA. Definition. — By pruritus is meant itching; the privates are the one part of a woman most frequently affected with this troublesome condition. Pruritus is not a disease, but a symptom of other conditions. Causes. — It is of frequent occurrence during pregnancy, and very often the result of uncleanliness ; is invariably caused by irritating dis- charges from the vagina; may be associated with tumors of the parts, and is often present during the course of diabetes. Symptoms. — Intense itching, the woman is almost driven to despera- tion, and scratches the parts until they bleed. The itching is usually aggravated by walking or becoming warm in bed. This condition may be so marked as to lead to melancholia. The intense suffering causes loss of sleep, exhaustion, and sometimes alarming nervous depression. The more the patient is compelled to scratch, the more the parts are irritated. Treatment. — Eemove the cause if it can be found. In order to re- move irritating discharges sitz baths and vaginal douches, as described in the treatment of vaginitis, are used. After thorough cleansing of the parts they may be dusted with calomel, bismuth, starch or lycopodium powder. The calomel is generally preferred. Before applying the powder first dry the parts. Great relief is sometimes experienced from a gauze compress over the vulva, saturated with a solution of lead-water and laudanum, equal parts. This dressing should be frequently changed. Auxiliary Treatment. — The intense itching which appears at night after retiring can often be prevented by applying to the vulva cloths wrung out in hot water. Ointments are useful from their soothing effects and, in addition, they protect the parts from the irritating discharges. These are iodoform ointment, sulphur ointment and zinc ointment. HEMATOMA (BLEEDING) OF THE VULVA. This term is applied to any hemorrhage which may occur in the tissues of the privates. It usually occurs on one side, rarely on both. Causes. — The most frequent are falling on a sharp substance; very often while housecleaning a woman will stand on a chair which, should it SKIN DISEASES OF THE VULVA. 655 Blip, may cause her to fall in such a manner as to straddle the back of it ; the insane may self-inflict wounds in this spot. Among other causes are intercourse, pregnancy, tumors and diseases of the blood-vessels supplying the affected parts. Symptoms — The symptoms are practically those of injury to any other part of the body. The bleeding may be very profuse, especially if there is a cut. If the parts are only bruised the bleeding will be more or less extensive, the blood simply jjouring out into the tissues, causing a swelling of the parts. There will be pain of a sharp or tearing nature, which may be accompanied by faintness. If the swelling is large, it may press on the urethra, and cause difficulty In passing water. Treatment. — The bleeding may be controlled by the application of ice or by using pressure or both. Simply take a clean napkin and hold it tightly against the injured parts. After the blood has been in the tissues for a few hours a hard blood-clot forms. If this is not absorbed within a few days the part should be lanced and the clot turned out. If the swelling is small lead-water and laudanum applied to the parts on pieces of gauze may cause it to disappear. TUMORS OF THE VULVA. The vulva, like any other portion of the body, is subject to the occur- rence of tumors which may or may not be malignant. If such a tumor growth should occur a physician shoidd be consulted, in order that he may diagnose its exact nature and institute the jiroper treatment. Too often innocent looking growths have been allowed to go unattended, which, when too late, have been found to be cancers. SKIN DISEASES OF THE VULVA. The skin of the vulva may be affected with various skin diseases, as eczema, erythema, acne, herpes, prurigo, scabies, pedicuH and erysipelas. Causes. — The various diseases are due to irritating discharges from the vagina or womb, menopause, vesico-vaglal fistula, indigestion, diabetes, and in stout persons during exceedingly hot weather. Scabies. — Scabies is due to the parasite acorns scabiei. This parasite may spread from some other part of the body. This itch-mite burrows into the skin and gives rise to intense itching, which increases when the body is warm. It is usually due to uucleanliness and coming in contact ■with uncleanly persons similarly affected 656 DISEASES rECTTLIAB TO WOMEN. Crabs Pcdiculi are often found about the external genitals. This is also a parasite, commonly called "the crabs." These parasites localize themselves in the hair, and can be seen clinging to it They are generally contracted through intercoiirse with indecent women. Too often husbands thus affected bring them home and innocently cause a similar condition with their wives. Treatment — Hot vaginal injections, as advised for diseases of the vagina. Local soothing applications should te made, such as bismuth powder, ten per cent, solution of. carbolic acid, benzoated zinc oxide oint- ment three to four times a day ; powdered zinc oxide three to four times a day; acetanilid and chalk equal qixantities, three to four times a day; car- bolized zinc ointment three times a day, and lycopodium powder several times daily. If scabs are present wash them off with almond or other bland soap, after which apply any of the above ointments. Keep the bowels open daily, resorting to the treatment as advised for constipation. Accessory Treatment. — If scabies are the cause take a warm bath with free use of soap, followed by dusting the parts with sulphur. Sulphur ointment has been highly recommended. If due to pediculi, the best treatment is to shave the hair and thor- oughly rub in a ten per cent, ointment of oleate of mercury three times a day, or blue ointment four times a day; bichloride of mercury, five grains to a pint of water, bathing the parts several times daily ; or carbolic acid solution several times daily. VAGINISMUS, OR CONTRACTION OF VAGINA. Vaginismus is a painful spasmodic contraction of the vagina which more or less prevents intercourse. Causes.^ — Very frequently due to an extremely sensitive condition of the remnants of the hymen, which will produce violent contraction of the muscles of the vagina. It may also be caused by a fissure of the vagina, erosions of the parts, fissures of the anus and an urethral carbuncle. Treatment. — If due to a carbuncle it should be taken out, which opera- tion will confine the woman to bed for five to seven days. When due to a thick hymen it will need the attention of a physician. Among the reme- dies which may be tried at home are injections of a teaspoonful of lauda- num to a pint of hot water ; an ointment of iodoform ; or fifteen to twenty grains of bromide of sodium three to four times a day. DISEASES OF THE VAGINA. 657 COCCYC GDYNIA. It consists of a very painful condition of tlie muscles at the very tip of the spine. Is most common in women who have borne children. Causes — Injuries during childbirth, blows and falls striking the tip of the spine, cold or exposure of the buttocks, and uterine or ovarian diseases. Symptoms — Severe pains in the region of the tip of the spine, in- creased by motion. Treatment — During the acute attacks it may be necessary for a physi- cian to administer hypodermic injections of morphine to relieve the pain. As a rule an operation will be the only treatment to render a complete cure. URETHRAL CARBUNCLE. This is a small raspberry-like growth which is very sensitive, and to be found at the mouth of the urethra. Causes — These are uncertain. No definite cause has as yet been de- cided upon. Symptoms — It gives rise to severe itching and pain. During urina- tion, as the water runs over it, the pain is more or less excruciating, so marked that women will oftentimes withhold from passing their water until they are further unable to withstand the calls of nature. Treatment — An operation is imperative, as no other treatment will afford relief. DISEASES OF THE VAGINA ATRESIA. OF THE VAGINA. Causes. — This means &n absence of the vagina, or a closure of it. The child may be born this way, in which case it is due to improper develop- ment in the womb. Or, as is more frequently the case, it is acquired, due to caustic remedies carelessly applied, a long and tedious labor, extensive idcerations, and a hymen which does not have an opening. Symptoms — In children born with this deformity it is often not noticed until puberty, when the child should menstruate. In fact, men- struation does occur, but owing to the absence of the opening in the hymen it is prevented from escaping and accumulates in the womb. Each month menstrual pains will recur, but there will be a failure of the blood to escape. . Treatment. — This is purely operative. d2 658 'DISEASES PECULIAE TO WOMEN. VAGINITIS. Vaginitis 19 an inflammation of the vagina. Causes. — A rundown system, anemia, systemic conditions producing congestion of the pelvis, such as pregnancy and tumors. !May be due to friction produced by a badly fitting pessary, to irritating discharges from the womb, to excessive coition. Symptoms. — Feeling of heat in the vagina; pain in the pelvis; at times a frequent desire to pass water; itching and burning about the entrance to the vagina; backache; loss of appetite and at times nausea; leucorrhea. Treatment. — When the inflammation is acute Iceep quiet, not neces- sarily in bed. Keep the bowels open, and give a light diet, no meat. If there is much pain use a five-grain oiiium suppository. If the itching is severe take frequent warm sitz-baths and vaginal douches of hot water con- taining either of the following: Borax one teaspoonful to the pint, sugar of lead water one teaspoonful to the pint, or half a teaspoonful of creolia to two quarts. These injections should be used several times daily. MALIGNANT TUMORS OF THE VAGINA. The vagina may be the seat of cancer. It may begin here, or spread to this canal from the bladder, rcctiun or womb. Symptoms. — Cancer usually appears from thirty to forty-five years. The important symptoms are hemorrhage, which, often follows straining at stool, or after coition ; a foul discharge, which is very repulsive ; it may be thick, but as a rule is watery; pain, this is always present, but not as a rule, until after the disease is well developed.- Treatment. — The disease tissue should be removed, of course, by a surgeon. If the disease is well advanced before discovered, as a rule it is too late for operation. If such be the case the indications are to maintain the strength of the patient, relieve the pain and counteract the foul smell- ing discharge. The first may be accomplished by tonics and out-of-door exercise. These cases, as a rule, are not bedridden \mtil a short time before death. To relieve the pain resort to opium. This is the only drug on which we can rely. Begin with a sixth of a grain four to five times a day, gradually increasing it as needed during the course of the disease. For. counteracting the odor of the discharge the best drug to use is perman- DISEASES OF THE tJTEBUS OE WOMB. 659 ganate of potash, in a vaginal douche, five grains to two quarts of water. These douclies should be used frequently during the day. Auxiliary Treatment — A woman suflering from this disease should always wear a napkin, which should he burned as soon as removed from her person. Allow plenty of fresh air to circulate in the room. Those who handle any cloths which come in contact with these discharges should wash their hands at once, using plenty of soap and warm water. DISEASES OF THE UTERUS OR WOMB INTLAMMATION OF LINING MEMBRANE OF WOMB (ENDOMETRITIS). Inflammation of Lining Membrane of Womb. — This is an inflamma- tion of the lining membrane of the womb. Causes. — Often due to taking cold just before or while menstruating. The introduction of unclean instruments into the womb; the introduction of knitting needles and other instruments by women in an endeavor to produce an abortion. Gonorrhea is oftentimes at the bottom of the trouble. Inflammation of the womb often spreads to this membrane, or the inflammation may begin in this membrrne and spread to the womb. Symptoms. — There is a sensation of we.ght in the pelvis and slight pain. The discharge is at first profuse, thin and watery, biit later becomes thick and tenacious, like the white of an egg. Menstruation may or may not be painful. Treatment — ^During the acute attack rest in bed, with an ice bag over the lower part of the abdomen, or if this is not comfortable, a hot water bag. The bowels should be well moved, preferably by a dose of epsom salts. The diet should consist of liquids, cornstarch, gelatine and the like. Large quantities of hot water should be used as vaginal injec- tions three to four times a day. Inflammation of the Womb — ^A new and effective remedy for this disease consists of a mixture of five ounces of vaseline with three drachms of boracic acid. Make this into fifty suppositories and insert one in the vagina each night on retiring; or, if found more convenient, take a small piece of the mass, about the size of a cherry, and insert as above. This treatment serves also to correct irregularity of the menses. Hot water injections daily. 060 DISEASES PECUNIAE TO WOMEN. INFLAMMATION OF THE WALLS OF WOMB (METRITIS). Inflammation of Walls of Womb. — Metritis is an inllaunuatioii of the imiscular •walls of the womb. Causes. — The most frequent cause is getting out of bed too soon after a confinement ; abortions ; exposure to cold during menstruation will give rise to it, also sexual excesses and lacerations of the womb. Symptoms. — The acute attacks usually begin with a chill, generally followed by a fever. Pain is more or less marked, and may extend dowai the legs, and be especially troublesome on the left side of the abdomen over the ovary. The monthly flow is apt to be accompanied by a great deal of pain. Treatment. — The treatment is the same as endometritis. FIBROUS TUMORS OF THE UTERUS. Symptoms. — They give rise to pain, more or less severe at times, and to hemorrhages, whicb may cause death. The pain is especially severe during the menstrual period. The hemorrhages may occur several times between the monthly periods, or the monthly period itself may last for a week to ten days. Treatment. — For the pain, morphine as a rule is the only drug which affords relief, one-sixth to one-fourth of a grain every four hours. Tinc- ture of gelsemium, ten drops every three hours, may prove of service. For the bleeding try a teaspoonful of the fluid extract of hydrastis every three hours, or a teaspoonful of the fluid extract of ergot every four hours. If drugs fail to control the hemorrhage it may be necessary to pack the vagina with gauze, which pressing against the womb usually controls it. The following is a very good prescription, which should be tried in all cases of bleeding from the womb : R. — Extract of hydrastis fluid f colorless) i ounce Extract of hamamelis fluid i ounce Extract of ergot fluid '/< ounce Peppermint water, to make 3 ounces M. Sig. — Teaspoonful every four hours. Or, thyroides, one drachm, ilake thirty capsules, one three times a day. Very often the fibroid can be removed with complete success. ULCERATION OF T]1E WOMB. 661 POITPTTS TXTMOR OF THE WOMB. Character. — This disease, which is one of the most * common causes of excessive hemorrhage from the womb at the monthly periods, is of considerable importance. The term polypus is employed to designate especially a tumor which is attached to the inner surface of the womb by a well defined neck or pedicle. Symptoms. — The most important is profuse menstruation. After a time, as the tumor grows larger, and becomes more of an irritant, there are likewise frequent discbarges of blood between the periods, often amount- ing to attacks of flooding. There is also a leucorrheal discharge which may be tinged with blood. Occasionally there are paroxysms of pain. Treatment. — Unless the tumor is removed the case is hopeless. The operation sim2:)ly consists in twisting the polypus off of its pedicle or neck. The patient is required to stay in bed ten days to two weeks. ■UICERATION OF THE WOMB. Cause. — In a majority of cases inflammation of the neck of the womb is soon followed by ulceration. This appears around the neck of the womb, and just within the womb's neck. Symptoms — 1. The inflammations and ulcerations mix and run into each other, resulting in raw places, granulations or pimply surfaces, and hardened parts. Sometimes the pimply patches become red and hard, the whole surface spongy, and bleeding will set in on the slightest touch. 2. As ulceration progresses it wrecks the mouth of the womb and eats deeply into the womb cavity, giving it an imsightly appearance. Pus or matter flows freely at times and at other times scantily. It may be thick and yellow, or thin and of lighter color. A sensation of heat and smarting exists and sometimes severe pain in the right side of the ab- domen and in the back part of the head. Menstruation — Ulceration generally changes the character of the menstruation. Sometimes it becomes profuse and painful, at others scanty; and then it may be either frequent or tardy, giving rise to dis- tress and pain in the lower part of the bowels and even in the groins and thighs. Treatment — 1. A tea made of the white pond lily, affords an excel- lent remedy. It should be used internally and as an injection ; in the former ease in doses of half a teacupful three times daily. The fluid ex- 6B2 • DISEASES PBCtTLIAR TO WOMEN. tract may be used in place of the tea in ten- or fifteen-drop doses twice a day. 2. Tannic acid, or in place of it a decoction of oak bark, used as an injection night and morning, gives excellent results. 3. The application of tannic acid directly to the ulcers has effected many cures. 4. Ilalf a teaspoonful of boracic acid to a pint of water, injected when warm, and repeated twice a day, is a highly recommended remedy. 5. A decoction of golden seal used twice a day as an injection has been found to give satisfactory relief. Accessory Treatment. — Where injections are depended upon, their virtue can be increased by simple injections of warm water between times, and as often as every two or three hours. CANCER OF THE WOMB. Character. — The womb is the one part of a woman's body most fre- quently attacked by cancer. The disease may begin in the neck or the body of the womb. "When situated in the neck of the womb it looks not imlike a cauliflower, hence the term "cauliflower cancer." Causes. — It is more frequent among the whites. The lower classes are more susceptible than the upper. It is extremely rare that a woman who has not borne a child is ever affected with cancer of the womb. In Tinmarried women who have had cancer of this organ the confession of an abortion has often been elicited, showing that pregnancy had occurred. As a rule a badly-lacerated ceiwix (neck of the womb) is very prone to cancer, the disease invariably starting in such a state of affairs. Heredity plays a more or less important role, especially when can- cer existed in the mother, or the mother's side of the family. Symptoms — In the very early stages they are absent. As the disease progresses the following will appear: 1. Hemorrhages. 2. Uterine dis- charges. .3. Pain. 4. Visceral disorders. 5. Cachexia. Hemorrhage — This is usually the first symptom, and is generally due to ulceration and breaking down of the parts. Unfortunately it is at- tributed to the irregularities of the menopause, or to a return of the monthly flow after that period. Hence it is the bleeding of cancer is very often disregarded until it has progressed beyond the hope of a cure. The reappearance of hemorrhage two or three years after the menopause is strong proof of cancer and should receive immediate attention. OAKCER OF THE WOMB. 663 Examination. — Every ■woman who Las passed the fortieth year, and has vaginal bleeding, or leucorrheal discharge mixed with blood, should at once consult a physician and insist upon an examination being made. Too often women through a mock modesty or for other reasons refuse to have an examination, and this stubbornness has cost many a woman her life. The symptoms of many of the diseases of the womb and ovaries are sim- ilar, and it requires a thorough examination, at times under an anesthetic, in order to ascertain the true condition of the pelvic organs. Pain — This does not appear early, but late in the disease, as a rule too late for an operation. As the disease progresses the pain will spread over the entire portion of the lower abdomen, especially so when the bladder and rectum become involved; the pain is excruciating and intol- erable. This torture is constant and docs not ease of its own accoimt. A woman suffering from, cancer of the womb truly does live a hell upon earth. Visceral Disorders. — These are generally due to the extension of the disease, or to the pressure of the womb on the surrounding organs. The bladder becomes very irritable, there is a constant desire to pass urine, and the patient will strain and strain in an endeavor to squeeze out a few drops in order to obtain a little relief. As the ulceration progresses fistulas may develop, the openings extending into the womb, the bowels or the rectum. Constipation becomes very troublesome. Cachexia — This is a characteristic symptom, and appears several weeks after the onset of the disease. It consists of a peculiar yellowish discoloration of the skin of the entire body. It is marked by emaciation, and the patient may waste away to "skin and bones." Treatment. — If seen early and the disease is limited to the womb, this organ should be removed at once. If the disease does not return in three years then the woman is fairly safe. But if the disease is not limited to the womb and has spread into the surrounding structures, and an operation be performed, the cancer is very liable, and invariably does, return. Use of Morphine — If the woman refuses operation, or should an operation be performed and the disease return, there is only one drug that will ease the pain, and that is morphine. The patient must practically be kept under its influence. In short, she becomes an opium fiend, not through choice, but from necessity. This drug may be given, one-quarter of a grain three to four times daily, increasing the dose as required ; but always by the advice of a physician. 664: DISEASES PECUI.IAE TO WOMEN. Checking the Hemorrhage. — If the hemorrhage becomes troublesome it may be necessary to curet the womb in order to control it. Drugs have little or no effect on it. Packing the vagina with antiseptic gauze will at times prove beneficial. Injections. — The discharge must be attacked with might and main. For this purpose resort entirely to vaginal injections, using permanganate of potassium, seven grains to two quarts of water, three to four times daily ; bichloride of mercury, same strength and as often. These douches at times weaken the patient; in that case probably two a day will be sufficient, but never less than this. The odor of the room may be very disagreeable. In order to counteract this place around the floor in saucers, pure carbolic acid, and air the room as often as possible. DISPLACEMENTS OF THE WOMB. Character. — The womb, like every other organ of the body, is subject to deviation from its normal position. The womb is situated in the pelvis between the bladder and the rectum. The bladder is attached to the front of the neck of the womb while the rectum is very close to, but not inti- mately attached to the back of the womb. WTien the womb becomes displaced the whole organ may turn for- ward (anteversion), or backward (retroversion). Or the womb may bend on itself. If the top of the womb falls forward then it is called ante- flexion, or if it should fall backward then it would be retroflexion. The symptoms and causes of the displacements vary more in degree than kind. rOEWARD DISPLACEMENTS. Causes — The most frequent causes are clianges in the uterine tissues, following an abortion or confinement. Lack of proper muscular support plays an important part, also congestions, tumors, lacerations of the pelvie floor, tiglitly fitting clothing, and prolapse of the vagina. Symptoms — Dysmenorrhea and sterility are frequently present. Leu- corrhea may be troublesome. When the displacement is so great that the womb presses on the bladder, this organ will become irritated, causing fre- quent irritation, and a more or less constant distress in the lower part of the abdomcH. This irritation may give rise to inflammation of the bladder. Treatment. — If the menstruation is painful use the remedies as de- scribed for dysmenorrhea. For the leucorrhea, employ the remedies ad- vised for that condition. If inflammation be present local treatments with BACKWARD DISPLACEMENTS. 665 the hot vaginal douches are to be employed. If a tumor is the cause it should be removed. The ideal treatment is to rejilace the organ. BACKWARD DISPLACEMENTS. These include retroversion and retroflexion. These are the most fre- quent varieties, and are more or less easily controlled. Causes. — General lack of muscular tone of the uterine muscles, im- proper care during confinement, veearing a tight binder too long after being confined, tumors, pregnancy, falls, .blows, distended bladder and lacerations of the perineimi. Symptoms. — Painful menstruation, as a rule, the first day or two of the flow, frequent miscarriages, leucorrhca, constant dull aching pain in the small of the back, dragging pains in the lower portion of the abdomen and thighs, headache, constipation, the bowel movements are at times painful, the bladder may be irritable, and at times the urine may escape when the woman laughs heartily. Treatment. — 1. First of all the organ must be replaced in its normal position. If not fastened down by inflammation a physician can replace it; at times an anesthetic may be required. After the organ is replaced the pliysician will introduce a pessary to keep it in its normal position. A pessary is a rubber ring of various shapes. This instrument should be removed at least once a month, cleansed and replaced. While the pessary is in the vagina use a douche of hikewarm water once a day. If the pessary feels uncomfortable, or is painful on getting up or sitting down, it should be taken out and replaced; if still giving rise to trouble, it is in all probability too large, and a smaller one should be tried. 2. If inflammation exists, this is to be cured by local treatments and hot vaginal douches. For the leucorrhea, see description of that con- dition. For constipation, see constipation. 3. If the pessary maintains the uterus in its normal position, and re- lieves all the symptoms, then it is optional with the patient whether or not she will submit to an operation. If, however, the local treatments, and all other remedies fail to afford relief, then it Mali become necessaiy to open the abdomen, and perform one of tlie many operations for sewing- the womb in its proper position. 4. If the uterus is fastened down by inflammation, local treatments will do no good, and an operation will be the only proper treatment. 666 DISEASES PECULIAR TO WOMEN. PROLAPSUS (FALIING) OF THE WOMB, Prolapsus of tlie womb is a descent of tbo organ below its proper position in tbe pelvis, better known as "falling of the womb," and may occur in two different degrees. The term prolapsus is applied to any falling downward of the organ, which is not so great that tbo womb passes outside tbe body; whilst the latter, called procidentia, is that con- dition in which the uterus escapes partially or entirely beyond the ex- ternal organs of generation. Causes. — Falling of the womb is more apt to occur after maturity is attained, and appears especially in those who have led laborious lives, or who have exercised themselves too much in lifting or carrying heavy weights. Hence cooks, laundresses, market-women and nurses, who lift and carry large and heavy infants, are especially liable to suffer from prolapsus. Women who have lx)rne children are more frequently af- fected than those who are sterile, and lingering or instrumental labors, or getting up too soon after confinement, ^particularly predispose to it. Among the direct causes may bo found congestion, hypertrophy or tumors of the uterus. Violent bearing-down efforts in labor, straining in ob- stinate constipation and forced respirations, such as occur in coughing, lifting heavy weights, and so forth, are also direct causes of falling of the uterus. Symptoms — The symptoms of this complaint are sensations of full- ness and weight about the pelvis, wearisome backache, and leucorrhea. Menstruation is not usually interfered with and obstinate constipation is very common. As the prolapse increases the bladder will be pulled down, which ■will interfere with its functions; such as frequent desire to void urine, the inability to completely empty it each time, resulting in an inflamma- tion of its mucous membrane. The rectum Avill be dragged down in the same manner, giving rise to more or less difficulty in the bowel move- ments. Treatment. — In the first stage, consists in the employment of a pes- sary to hold the womb up to its proper level. If the perineum is lacer- ated, this must be repaired, otherwise a pessary will drop out. The only satisfactory treatment for this condition, especially when the womb hangs out, is an operation, whicli consists in amputating the neck of the womb, sewing up the lacerations of the perineum, and opening the abdomen in order to stitch the womb where it belongs. Nothing else will afford relief. DISEASES OF THE OVARIES. 667 This condition too often generates cancer of the womb, and if the -women so affected would only consent to have this operation done they will be free from all the symptoms caused by this displacement, and oftentimes "will be fortunate enough to prevent a cancerous growth of these parts. DISEASES OF THE OVIDUCTS. The oviducts are two tubes, one on each side of the womb, and con- Tey the egg from the ovary into the uterine cavity each month. These ducts are subjected to inflammatory disease, which may terminate in a good recovery or develop into an abscess. Salpingitis.— This is an inflammation of the oviduct. It may effect one or both sides. Causes — Usually due to gonorrhea, or poisoning following labor, catching cold during the menstrual period, and excessive exercise. A cause usually overlooked is disrobing and lying down in a draught after a prolonged exercise, when the body is very much overheated. Symptoms — This disease may be acute or chronic. During the acute stage there will be fever, a great deal of pain on the side of the inflamed tube. This pain is increased on walking or standing. The patient while lying on her back prefers to have the knees drawn up and the lower part of the abdomen is extremely sensitive. During the chronic stage there is pain in the affected side, which is increased on walking, running up and down stairs, intercourse and sweep- ing. Menstruation as a rule is painful, coming on a few days before the flow. Treatment. — ^Rest in bed during the acute attacks, and thorough pur- gation of the bowels. Copious hot water vaginal douches, at least twice a day. Ice bags over the lower portion of the abdomen are highly recom- mended. DISEASES OF THE OVARIES. The ovary may be attacked by inflammation, wliich may or may not form an abscess, tumors, benign and malignant, which may be solid or cystic. Ovaritis. — By this is meant an inflammation of the ovary. Cause. — A frequent cause in young girls is too close confinement in school, at work or overstudy. May be due to blood poisoning following a miscarriage or confinement, to gonorrhea, inflammation of the Avomb, salpingitis and using a cold instead of a hot vaginal douche, standing in 668 DISKASTCS PECITT.TAR TO WOMEN. a draught after being overlieated, or wbile tbe body is in an overheated condition, jumping into a very cold bath. Symptoms. — Tbe jjain is excruciating, and is situated low down in the abdomen, near the gi'oin; this pain oftentimes shoots down the log of the affected side. The pain may extend into the back and hip. The lower part of the abdomen is extremely sensitive, and the sufferer will not permit anyone to touch it. Even the weight of the bed clothing may give rise to so much distress that a prop will be necessary in order to prevent the bed- clothing coming in contact with the skin. Fever will be present, the height of which will depend on the severity of the attack. Voiding urine, and the bowel movements may be accompanied by more or less pain. These symptoms occur during an acute attack. Treatment — During the acute attack rest in bed is imperative. An ice bag should be applied over the affected ovary, providing the skin is not too sensitive to stand it. If this is not well borne, try a hot water bag, or flaxseed poultice. In addition to these, which always tend to ease the pain, opium should be given by the mouth or with a hypodermic needle. When the pain is so great as to demand opium, of course only a physician should prescribe it. Accessory Treatment — At times any of the following drugs may af- ford relief. Antipyrine, five grains every three hours ; acetanilide four grains every three to four hours; or the two combined, giving two grains of each every three hours ; or tbe tiucture of gelsemium ten drops every three to four hours, in a teaspoonful of water ; for reducing the fever tincture of aconite one drop every hour. The following prescription is often of value in all varieties of inflammation of the ovary, irrespective of the cause: R. — Tincture of gelsemium 2 drachms Tincture of cannabis indica 2 drachms Peppermint water 3 ounces One teaspoonful, repeat in two hours, then every three hours. When the inflammation becomes chronic, local treatments should be persevered in for several weeks; combined with hot vaginal injections. If there be leucorrhea use the remedies advocated under that heading. If the local treatments do not aff'ord relief then it will be necessary to have an ojieration, which Avill consist in removing the ovary if badly diseased, or if slightly so then only that portion wluV-h is affected. Pyosalpinx. — If an acute attack of ovaritis does not get well, or TDMOBS OF THE OVAET. 6G9 develojis into a cbronic condition, and pus forms, then it is called pyosal- pinx, which means pus in the tube or oviduct. Symptoms — They will be those of ovaritis, only more so. Chills may also be present, due to the absorption of the poisonous material from the pus. Treatment. — This consists in the removal of the ovary and tube, as no other procedure will effect a cure. Too often women suffering from this condition will delay operation until the last possible moment, which delay invariably costs their life. ODisplacement of the Ovary — The ovary may drop down from its normal position, in so doing it always falls back of the womb. This is called prolapsus of the ovary. Prolapsus of the Ovary — Causes — Generally due to enlargement of the ovary, which may be caused by inflammation or tumors. A sudden fall or misstep will at times cause an ovary of normal size to fall down- ward, which Avill invariably become inflamed. Symptoms. — Pain located deeji down in the pelvis, which may be of a dull aching character, or sharp and shooting. The bowel movements are frequently painful, due to the distended rectum pressing against the ovary. Intercourse is very painful and may be accompanied by nausea. Treatment. — Local treatments and the use of the hot vaginal douche may afford some relief, but invariably it is necessary to remove the ovary, which operation will require a rest in bed of three to four weeks. TUMORS OF THE OVARY. The tumors of the ovary may be solid or cystic. The former may be benign or malignant. The solid tumors are divided into the fibrous, mus- cular and cancerous, the latter of which is extremely rare. Cystic Tumors of the Ovary — These cysts are divided in the small and large. The former attain tlie size of an egg or the fist, while the latter may grow to any size, holding many gallons of liquid. Causes The immediate cause is very obscTire ; usually due to inflam- mation of the ovary, sudden amenorrhea, excessive intercourse and blows on the abdomen. These tumors may be present at any age, from infancy to advanced old age, but are most common during the period of sexual activity, between the twentieth and fortieth years. Strange to say they are most frequent in the unmarried woman and those who have not borne children. 670 DISEASES rECULIiUt TO -WOMEN. Symptoms. — 1. The womau may first notice that one side of the abdomen is larger than the other, and later on will be able to feel a lump on that side. This may increase rapidly in size, the whole abdomen becoming distended, and looking not unlike pregnancy. Indeed, the woman herself may suspect that she is pregnant. Later on, there will be a sensation of weight in the pelvis, the bowel movements will be painful and the bladder very irritable, due to the pressure of the tumor. Painful and profuse menstruation is of frequent occurrence. 2. As the tumor increases in size there will be pressure symptoms, swelling of the legs, due to pressure on the blood-vessels, the privates may become swollen, due to the pressure on their blood supply ; when the tumor becomes sufficiently large to press on or near the diaphragm there will occur shortness of breath. Besides these the face will have a pinched expression, characteristic of this kind of tumor; there will be marked loss of weight and general debility. 3. Pain more or less constant will be present, and at times violent in character. This may be due to peritonitis, caused by the irritation of the tumor. Treatment. — 1. The only cure is, of course, operation. If the cysts are very small, about the size of a pea, they can be removed from the ovary, and this organ allowed to remain. But, on the other hand, if they are the size of a pigeon's egg or larger, then it will be necessary to re- move the ovary with the tumor. 2. The old method of tapping the cyst and drawing off its contents is to be condemned as dangerous. 3. The operation of ovariotomy, or removal of the ovary, will neces- sitate the patient remaining in bed three to four weeks. lACERATIONS OF THE PERINEUM. Character.— This consists of tears of the anterior and posterior walls of the vagina, during childbirth. The laceration may extend through the posterior vaginal wall into the perineal body. Symptoms. — 1. "When the anterior or front wall of the vagina becomes torn the support of the bladder is iisually disturbed, and there will be more or less trouble in voiding urine. In addition there will be an in- ability to entirely empty the bladder each time, which may result in in- flammation of the bladder. 2. When the posterior or back wall of the vagina is torn the QONOKKHEA. 671 symptoms are more marked. This laceration as a rule extends through the muscle which is the main sup^jort of the womb from below, by holding up the fielvic floor, and in this way supporting the womb. These m.useles are two in number, one ou either side. Treatment. — 1. After labor the parts should be thoroughly inspected to see if a laceration has occurred. If so it should be sewed up at the time. When a physician tells a woman that she is torn — and it is no fault of his that such does happen— and desires to insert stitches, she should allow him to do so. Too often women will not permit it, and they regret it only once, and that is as long as they live. 2. If the tears are sewed right after the baby is born they will in- variably heal and the parts will be restored to the same condition they were in prior to labor. If not the muscles and tissues do not heal together, and the woman will begin to suffer from all kinds of pelvic symptoms, such as forward and backward displacements of the womb, prolapse of this organ, prolapse of the bladder and obstinate constipation. 3. These lacerations are divided into complete and incomplete. The first consists of those in which the tear extends through the bowel, the latter a tear of any extent near, or down to, but not through the bowel. If these lacerations are not repaired at the time, then it will only be a ques- tion of time before such an operation will be necessary, so why not permit the physician to do as he thinks best at the time these lacerations occur. 4. If the laceration is complete there will be a loss of control of the bowels, and they will move without the knowledge of the woman. If the^ tears are not repaired at the time, it is useless to attempt it less than three months after labor, if so a poor result will usually be obtained. GOIfORRHEA. Character. — This is an inflammatory disease commonly called "the clap." Greater than any other danger, presented to woman, is sexual in- tercourse with a man who has gonorrhea or syphilis; the former is the more destructive. The attack of gonorrhea in the male at the time of intercourse may be acute, chronic, or one which had not been thoroughly cured. A Serious Disease While gonorrhea in man in most cases is a trifling disorder, although there are exceptions in which it leaves a serious con- dition or becomes fatal, are not so very rare; in woman it is one of the most serious diseases. j672 DISEASES PECULIAR TO WOMEN. Many an innocent and previously healthy woman, shortly after mar- riage to a man who siij)posed himself to have heen cured of gonorrhea years before, may get a destructive gonorrheal infection. Diseases Induced by Gonorrhea. — When we take into consideration that a gonorrheal infection in a woman may cause inflammation of the vulva, vagiua, urethra, bladder, lining membrane of the womb, the womb itself, the tubes and the ovaries; that the inflammation of the tubes and ovaries as a rule result in abscesses, nay more, that too often both ovaries have to be removed, and oftentimes the womb with it, then you will realize the dangers of an attack of this disease in a woman. Causes. — They have been mentioned, intercourse with a man who has had an attack of gonorrhea, or is still suffering from an old attack which has not been thoroughly cured, and yet his physician has probably dis- charged him as "cured." Very frequently you will hear a person say that it was contracted from a water closet; this is impossible, especially with a man, but, a woman, under very rare circumstances, may come in contact with pus which has escaped from the male on to the seat of the closet. I have never heard of such an instance happening; although it is possible it is extremely improbable. Symptoms. — 1. These consist first, of a burning and itching sensation in the '"privates," followed in a day or two by a discharge, which in a few days generally becomes profuse. The pain in these parts then becomes more or less unbearable. Each time the bladder is emptied there is a "burning, scalding sensation, due to the urine flowing over the inflamed jiarts. 2. If the inflammation spreads to the urethra and bladder there will te all the symptoms of cystitis (which see). If the disease extends to the uterus there will be all the symptoms of acute inflammation of the womb, which will necessitate the woman going to bed. As the disease spreads to the tubes and ovaries the pain in the lower part of the abdomen will become intense and the fever increase ; both of which will become intensi- fied if abscesses form. Treatment — This consists in vaginal injections of permanganate of potash, five grains to a quart of hot water four times daily ; bichloride of mercury, seven and one-half grains to the quart, same as before ; or appli- cations to the vagina of nitrate of silver, thirty to forty gi-ains to the ounce of water. The latter should be done by a physician. A woman who has the symptoms first mentioned may at once suspect she has gonor- DISEASES OF THE BLADDER. 673 rhea, and should consult a physician immediately and place herself under his care. DISEASES OF THE BLADDER. The bladder may be irritable and yet not inflamed, so a special de- scription will be made. Irritability of the Bladder. — This may arise from purely functional causes and is of frequent occurrence in nervous women. Oftentimes present in diseases of the womb and vagina, and when the front wall of the vagina has been lacerated. Also present in displacements of the womb. It may follow abdominal operations and parturition fchildl)irth). Symptoms. — Similar to those of cystitis. The urine from an irritaltle bladder is always clear, never contains pus. Treatment. — Build up the constitution by the use of tonics. (See (Anemia.) Eegidate the bowels. The following may be tried: R. — Atropine sulphate '/j grain Distilled water 4 ounces Five drops in water ifter meals. If the woman is extremely nervous, fifteen grains of the bromide of potassium or sodium every four hours will prove of value. Cystitis. — This is an inflammation of the mucous membrane of the bladder and may be acute or chronic. Causes. — Acute cystitis may be caused by exposure to cold; gonor- rhea; dirty instruments, particularly a catheter; pressure of the child during labor; inflammation of the peritoneum or pelvic organs; blows and falls when the bladder is distended with urine, and the improper use of certain drugs. Chronic cystitis may be a continuation of the acute form, especially by pressure of the uterus during pregnancy, or large tumors. Symptoms. — 1. The acute form frequently begins with a chill, fol- lowed by fever, which is not very high. There is considerable pain in the lower portion of the abdomen, difhcult and painful urination, and the urine is very cloudy. The desire to urinate at night may be very trouble- some, and is apt to become more or less constant. There is a continuous feeling of pressure and weight over the bladder. 2. In the chronic condition the pain is not so severe, but constant desire to pass water, especially at night, is very distressing. When there ■w a desire to pass water the patient must go at once, being unable to hold (43. 674 DISEASES PEOCLIAR TO WOMEN. her water. If she shouUl lift, heavy weights or cough tlie water va&y dribble away. Treatment. — 1. All instriiments that are introduced into the bladder should be thoroughly cleansed and rendered antiseptic. The acute form is best treated by rest in bed and an ice bag over the bladder. If the latter is not tolerated, then try a hot water bag. A very good drink is flaxseed tea. If the pain is severe, one-half grain of opium suppository will afford relief, repeating in about three hours if necessary. The following prescription will be found very useful: R. — Tincture of aconite I drachm Sweet spirits of nitre I ounce Liquor potassii citratis 6 ounces A dessertspoonful every four hours. All alcoholic liquors must be restricted, and the diet should consist of milk and broths. 2. If the disease becomes chronic the patient should be kept on a bland diet. Vegetables, such as asparagus and those containing salts, and all alcoholic liquors should be prohibited. 3. If the urine is highly acid it should be rendered neutral by the benzoate of sodium ; if it is alkaline, it should be rendered less irritating by the acetate or citrate of potassitun. 4. Salol, five grains, four times a day is an excellent drug for this condition. Mineral waters sitch as Bethesda, Vichy and Buffalo Lithia are to be taken, at least several glassfuls a day. 5. Great relief is afforded by washing out the bladder, of course this can be done only by a physician. 6. If the water constantly dribbles away, it may be cured by stretch- ing the neck of the bladder. This will necessitate remaining in bed for about a week. Stone — Stone in the bladder of course requires an operation for its removal. There is a prevalent idea that a stone in the bladder can be dis- solved by medicines and lithia water. This is a false impression and a great many quacks take advantage of it, generally to extort money from the sufferer. DISEASES OF THE FEMALE BKEAST. 675 DISEASES OF THE FEMALE BREAST The breast is subject to inflammation, abscesses and tumors. MASTITIS OR MAMMITIS, INFIAMMATION OF THE BREAST. Causes — This may be produced by blows on the breast, or to any of the usual causes of inflammation. It may occur at any age, and in either sex. An acute attack is more often found present in nursing women dur- ing the first week or month after delivery. If such happens it is in- variably due to > cracked nipples. Symptoms — At first only an uneasiness of the breast Is noticed, then a chill occurs which is usually followed by fever. The gland becomes intensely swollen, red and exceedingly painful. The inflammation may be so great as to cause an abscess. Treatment — This consists in preventing an abscess from forming. To accomplish this wash the nipples thoroughly three to four times a day, and stop the baby nursing the affected breast. The breast should be emptied of milk, by the cautious use of the breast pump. Cloths saturated in a solution of lead water and laudaniim should be applied several times a day, and over these lay an ice bag, or rub frequently with hot lard. ABSCESS OF THE BREAST. If the inflammation does not subside an abscess invariably resiilts.' Treatment. — 1. If It appears that piis is forming hot applications should be made, preferably flaxseed poultices, to be renewed as soon as they become cooled. 2. As soon as pus is detected the breast should be incised and the cavity drained. 3. Too often women refuse to allow their physician to lance the breast, thinking it will come to a head and be well In a few days. This is a great mistake. The breast should be freely opened, in order that the pus can easily run out. If necessary an anesthetic should be taken, In order that the physician may accomplish thorough work. At times It may be necessary to insert a drainage tube; depending entirely upon the time which has elapsed from the formation of the pus until the time It is incised. 6Y6 DISEASES I'JiCULIAit TO WOMKN. TUMORS OF THE BREAST. These may he benigii or malignant. Tumors of the former type can be readily removed, and will not give rise to further trouble. On the other hand, those of the latter class, which are of a cancerous nature, are very ajit to return, unless operated on early and thoroughly. CANCER OF THE BREAST. Character. — Very often a woman will strike her breast against a hard object, or may be struck by a fist. This blow may be followed by a luiaji, which in a few days may disappear. i Again, a woman while dressing may notice a lump in the breast, and think nothing further about it, or may try to cure it by rubbing in camphorated oil, or other household liniments. These lumps frequently are the early stages of cancer, and the longer the delay the greater the risk. When a woman discovers a lump in the breast she should consult a physician at once in order that he may properly treat and watch it. If the lump continues to grow and remains hard then he will, or rather should, advise an operation. Under sucb circumstances these lumps are invariably a beginning cancer. Treatment. — If the lump is small then it may not be necessary to remove the entire muscles, but simply the breast. On the other hand, if the lump is large and of long standing, or if the breast is immovable, that is, cannot be moved from side to side, then the breast, muscles and all sur- roimding tissue will demand removal. Kccurrence may follow. Many women can be cured of cancer of the breast, providing they will consult a good physician early, which is, as soon as a lump is noticed ; and if such does not become smaller or disappear in two weeks, submit at once to an operation or the application of the X-ray. Beware of Quacks. — It is surprising the number of women who will scorn the advice of a physician, and place themselves under the care of a charlatan or a quack. This class has killed more women than any of the most malignant of diseases, and yet the State will sanction their existence. Beware of quacks, especially when a cancer exists. These deceivers and money extortionists advertise to remove these growths by the "roots." Such growths have no roots. And yet how many women will stand the torture of the acids which they apply to eat out the tumor, in preference to a clean-cut operation, imder an anesthetic, which will keep them in bed FACTS OF GEEAT VALUE TO WOME^. CTT only two weeks. While the "eating out the roots" process reijuires a torture of several weeks. SOME INTERESTING FACTS OF GREAT VALUE TO WOMEN Preventing: Disease — Education has a great influence in the develop- ment of diseases peculiar to women. During early childhood, when the pelvic organs are undergoing their development, the child must not be confined to the house and at school all day. She should be allowed as many hours recreation a day as feasible, in order that she may enjoy out-door exercise, and obtain all the fresh air possible, which is of so vital importance to her constitution. Too long daily practice at the piano or organ is also harmful. What to Avoid. — Everything that causes an increase of blood to the womb and ovaries should be avoided. In this category belong sexual excitement brought on by reading suggestive novels; by looking at ob- scene pictures ; by masturbation (self-abuse) ; sodomy and even normal coition if performed too violently. Care of the Skin — The care of the skin is of great importance. Baths, daily or two or three times a week, should be encouraged. The accumu- lation of dirt blocks up the sweat glands, and nature is unable to throw off the impurities through these vessels. The Jewesses from Eussian Poland are very susceptible to disease, and their appearance conveys to one the idea that they never wash their bodies. Overwork. — All work and no play is a fruitful cause of ill health. Every woman who has the cares of a household should indulge in open- air exercise, or daily walks. Golf, horseback riding, walks, gathering flowers and the like, are to be highly commended, because they combine exercise with open air. Proper Food. — There is room for improvement regarding food. Many girls have a loathing for food in the morning, and often take noth- ing but a cup of coffee, and at times not even that, and go to school, and allow their brains to work for hours on an empty stomach. Such a practice is to be condemned in the strongest terms. It is not only a very bad habit, but it sjioils the appetite, tends to cause a sour stomach, and impoverishes the blood, which leads to nervous disturbances. The same may be said of candy, the immoderate use of which among girls and women corresponds to alcoholic beverages and tobacco in men. Uode of Dressing — Some few suggestions regarding the mode of 678 DISEASES PECULIAR TO WOMEN. dressing may be of value. One of the most frequent causes of congestion of the pelvis is the ''decollete" evening dress and the bell-shaped nether garments. High heels, when worn at an early age are apt to change the normal inclination of the pelvis, a cause of tedious and difficult labors. Tight Lacing — Of much more importance is the use of the corset. A loose corset at the best is more or less binding. Tight lacing, of course, should be avoided, it displaces the various organs in the abdomen, push- ing them in all directions, excepting the normal, and causes a crowding down of the pelvic organs, hence a fruitful cause of diseases of women. The Menstrual Period — JS^eo-lect during menstruation is one of the most fruitful causes of female diseases. Dancing and skating during this period should not be permitted. Sexiuxl intercourse at this time, to say the least, is a repulsive habit, yet it is not of rare occurrence. Such a practice is very apt to result in a pyosalpinx (abscess of the oviduct, which see). Marriage with Disease. — Marriage with existing disease of the pelvic organs is a frequent cause of unhappiness for both husband and wife. Disease of such organs may jirove destructive of all sexual desire or may prevent the possibility of conception. But if these should not ensue, there still remains the greater and more appalling danger of defective child de- velopment in the womb, or of the actual transmission of disease to off- spring. Such calamities are all too frequent, and those who would enter the marriage estate should feel certain that their pelvic organs are free from diseased conditions. Evil of Abortions — Abortions, however brought about, play their part in causing inflammatory and nervous wrecks of women. They are the source of many serious and, ofttimes, permanent diseases. Causes of abor- tion are very numerous. Among those most common are displacement of the womb, ulceration of the neck of the womb, too much exercise, heavy lifting, jar from a slip or fall, strong emetics, powerful purging, etc. Treatment of Abortion If the symptoms are slight, it may be that nothing more than a few days' rest will bo required, keeping the body as much as possible in a horizontal position, taking occasional cooling drinks, and at bedtime a jiill comj^osed of one grain of camphor and two grains of sugar of lead. In addition, a mustard plaster may be applied to the lower part of the back to allay any pain that may be experienced. If the conditions are severe, and flooding should set in, accompanied with marked symptoms of miscarriage, a napkin wetted with cold water, or vinegar and water, should be laid upon the external genitals. Rest in bed is important. CHANGE OF LIFE (mENOPAUSk), 679 If the symptoms are not thus allayed, recourse mnst be had to the plug- ging of the vagina with pieces of cloths soaked in a solution of alum or tannin; fill the vagina full and then place a fold of linen in the genital fissure and apply a bandage. Remove the plug in from five to ten hours, and replace if the discharge continues. Conception — Every young couple intending to enter the marriage relation should know what a terrible curse they are liable to transmit to their future children through ignorance of the vital principles which regu- late reproduction. This attended to, it then remains with the mother to mold the infant growing within her by being herself at the time what she would like her child to be. The physical obstacles to conception are chiefly those diseases which have been previously described. When it is dependent on the causes which produce painful menstruation, or profuse menstruation, or a suppression of menstruation, the remedies are the same as are pointed out for those complaints. If inflammation of the ovaries be the cause, a cure may be effected, provided the inflamed condition be removed. If inflammation or ulceration of the neck of the womb be the obstacle, the remedy may be found in the treatment reconrmended for these affections. CHANGE OF LIFE (MENOPAUSE). This is better known as the "change of life," also called the cll- matcric. Time and Character — It comes on gradually, extending over a period of three to four years; it comprises the times when the monthly flow begins to be irregular, gradually diminishes and ceases altogether. As a rule in most women it begins about the age of forty-five, but invari- ably so between forty-five and fifty years. Those who menstruate early continue to menstruate longer than those who begin late, hence have a late menojjause. Those who suffer from a chronic inflammation of the womb or are weakened by severe uterine hemorrhages begin to change life sooner than a healthy woman. When the menopause comes on gradually the woman is not very liable to have severe xlisturbances, but if it comes on abruptly the dis- comforts are very bad, and the general strain of symptoms are marked. Dangers of the Period. — This period is a critical point of a woman's life. Too often women while passing through this stage pay little atten- tion to it, and every bad symptom is attributed to the "change of life." 680 DISEASES I'ECULIAU TO WOMEN. This is tlie time of all others that cancer of the womb ami breasts are prone to develop. Every woman with a lunqi in her breast, which de- velops during this period, should consult a physician at once. When- ever bleeding- takes place from the vagina, after the nienopause has ended, invariably signifies beginning cancer, and the woman should immediately submit to an cxa77iination. Symptoms. — 1. The first symptom of the menopause is irregularity in the menstrual flow, as regards the time and quantity. The intervals be- tween the menstrual periods will become extended, say every five to six, seven or eight weeks. Sometimes, on the contrary, menstruation becomes more frequent. The periods last longer, say six to eight days. There will be congestion of the head, causing a red face, headache and indistinct vision, buzzing in the head and ears, dizziness, the sleep is disturbed by dreams, and at the time the flow should occur may have bleeding of the nose. 2. Besides the above, there may be catarrh of the stomach, and in- testines; congestion of the liver, rendering it torpid; the kidney disturb- ances generally appear in the form of a sediment in the urine. Leu- corrhea may be very troublesome. An eruption of the skin of the face may occur, and there may be intense itching, burning or smarting sensa- tions all over the body. The vulva may be the seat of most distressing itching. 3. A very disagreeable feature of the "change" is the fever and sweats; this consists in a rush of blood to the head, the body becomes very warm and then breaks out into profuse perspiration. This may occur at any time and place. When others think the room very cool, she will think it exceedingly warm. 4. The heart is often affected in the form of palpitations and short- ness of breath. The nervous system also shows evidences of a general upset. Sometimes the limbs become very trembly. The temper is sub- ject to great changes, and the sexual appetite may be greatly increased. She may become delirious, or even go insane. 5. The organs of generation undergo marked changes. The uterus, vagina, vulva, ovaries and breast all shrink and become greatly reduced in size. Treatment. — 1. Although this is a perfectly natural process, which is of normal occurrence in every woman's life, conditions will arise demand- ing interference. Above all keep the bowels open. For the sediment in the urine it is ABOETION. 681 well to driiik; Vichy or Seltzer water freely during the day ; or to take half a teaspoonfiil of hicarbonate of soda in a tumblerful of water in the course of the day. 2. The congestion of the head and the disturbances of vision are re- lieved by hot footbaths, with or without mustard, and of the cold water eye douche five minutes three times daily. 3. Lukewarm general bath taken three times a week will keep the skin in good condition, which is of value. 4. Those women who have a tendency to stoutness should adhere to a restricted diet, such as fish, meat, green vegetables, lettuce, salad and juicy fruits. Milk and beer are prohibited. 5. The few women who lose ilesh must be well fed, and have choco- late and plenty of milk to drink, providing they can digest them. G. A sudden suppression of the flow during this period is jiarticularly dangerous, hence- she should avoid getting the feet wet, wet skin, and should not take a cold bath nor wash the privates with cold water. All these refer to when the menses are present. 7. If hemorrhages occur employ the remedies advocated for the treatment of menorrhagia and metrorrhagia. 8. If the bleeding is quite profuse, pack clean pieces of linen tightly in the vagina, and allow them to remain imtil a physician is consulted, which should be immediately. This method of packing the vagina will control the bleeding until the physician arrives and institutes more radical measures. A good uterine tonic such as the pil uter ova often does much to relieve the nervous condition and allay pain and distress. MISCAKRIAGE OR ABORTION. Meaning^. — Abortion is the expulsion of the product of conception from the womb. It is also called miscarriage, by which name it is better known. Amongst the laity at large the term miscarriage is generally used when this accident happens without any violence on the part of the mother, whereas abortion is applied when attempts have been made to bring on this condition by the introduction into the womb of instruments. Divisions Abortion has been divided into spontaneous or natural and accidentah A better division is spontaneous and artificial. The latter class is divided into therapeutic and criminal ; therapeutic abortion is that in which it is done by the physician in the interest of the mother's life or health, while criminal abortion is without this or any other justification. 6S2 DISEASES TECnLIAR TO WO.MEX. It is further divided into comiilete and incomplete ; threatened and in- evitable. Complete Abortion — By eomi>lete is meant that all the product of conception, foetus and afterbirth, is expelled ; incomplete, when only a part of it comes away, invariably the foetus, the afterbirth or part of it remain- ing in the womb ; when the symptoms of an abortion appear, and it can be checked, it is spoken of as a threatened abortion; whereas, if it is in- evitable, when in spite of all that is done, miscarriage occurs. Criminal Abortions. — The greater number of miscarriages occur in the first three months of pregnancy. It has been shown by statistics that criminal abortion is more frequent from the third to the sixth month than in the first two months. The explanation of this fact is due, that up to three months the woman hopes that there is simjily a delay in the appear- ance of the flow, but when this hope fails she is ready to resort to any pro- cedure to end a pregnancy which now becomes almost certain ; on the other hand, when six mouths have elapsed the life of the child has become so manifest that she shrinks from its destruction. Movements of the foetus in the womb make successful appeals to the mother's conscience, if not to her love also, for the salvation of the new life which dwells within her womb as its sanctuary. Dangers of Abortion. — -It is surprising the number of criminal abor- tions that occur yearly, and which fail to come to notice, unless the victim dies, when an expose is made by the coroner. And even then many women die with the names of the abortionist and her seducer sealed upon her cold lips. Women do not for one instant think of the damage which is wrought to their generative organs, when they introduce some instru- ment or "what not" into the womb in order "to open it," so that a mis- carriage will occur. Inflammations, displacements of the womb, and pelvic abscesses, and abscesses of the ovaries too frequently follow these foolhardy attempts. How many women have sacrificed their lives in this criminal and damnable manner ? Causes. — 1. The causes of this unfortunate condition are numerous, they may be due to disease of the foetus, placenta, womb or the mother. Then again the father may be at fault. For instance, men who are con- firmed alcoholics, or suffering from consumption or syi^hilis will invariably have a serious effect on their offspring, in that if pregnancy should occur the foetus dies within a month or so after conception. Abortion is of frequent occurrence in the wives of men who work in lead. 2. Violent exercise, as running, dancing, jumping, riding on a hard ABOKTION. 683 trotting horse or over a rough road ; lifting heavy weights, falls, blows, tight corsets, surgical oiscrations, especially if on the organs of generation, are very prone to cause an abortion. Frequency of intercourse is not an unfrequent cause. 3. Among other causes which may bo attributed to the mother, are Infectious diseases, such as typhoid fever, during which she is very apt to abort; syphilis, this is one of the most frequent causes; backward dis- placement of the womb plays a very important part in this condition ; a pregnant woman working in a tobacco factory is very liable to miscarry. 4. Again, violent sneezing or cough may be the cause. Tumors of the womb and malignant disease of this organ are also active factors; though as a rule a woman with cancer of the womb rarely becomes preg- nant, the same applies to large fibrous tumors, and the smaller when located in the cavity of the womb. High altitudes will also produce an abortion, and it is asserted that in certain mountainous countries pregnant women descend to the valleys to escape the accident. 5. Medicines play an important role in the causation of this accident, such as active cathartics, laxatives and even emetics. The administration of quinine has been followed by miscarriage, although oftentimes it has been attributed to the disease and not to the medicine. But many of these drugs cannot be blamed for the accident, as there usually exists a tendency of some kind to a miscarriage. 6. The foetus may be affected by the same diseases as the mother, which, if it should cause the death of the foetus, will produce an abortion. Excessive distension of the womb due to plural pregnancy is apt to pro- duce premature contractions of the womb, with a resulting miscarriage. Symptoms — -1. There may be premonitory symptoms such as flushing of the face, alternate flushes, and of heat and chilliness, pain in the back, irritability of the bladder which may extend to the rectum. The characteristic symptoms are hemorrhage and pains. These pains begin in the lower part of the abdomen and on both sides of the same, in the groin or just above it. As the condition progresses these pains extend to the back, and later on pass around to the front. The pains begin first, to be soon followed by a bloody discharge, or vice versa. Some cases have a gush of watery fluid early in the attack, which may be slightly discolored with blood; this discharge does not necessarily indicate rupture of the ovus and hence that miscarriage is inevitable, for it may occur from inflammatory diseases of the womb. 2. The flow of blood is very much greater than that which occurs 68f DISEASES TECULIAIl TO WOMEN. in menstruation ; large clots are very apt to be passed, in which, if care- fully souglit for, the ovum may be found. 3. After seven or eight weeks of pregnancy the symptoms of abortion are quite plain. Prior to that time it may be mistaken for a case of pain- ful menstruation. 4. If the pregnancy has advanced beyond three months the foetus as a rule escapes first, soon to be followed by the afterbirth. If the after- birth is not expelled the woman is liable to suffer from hemorrhages iiutil it is removed. These hemorrhages may be so great as to cause a fatal result, pro\ading the woman has not a physician in attendance. Treatment 1. If a woman is subject to repeated miscarriages she should exercise every care to place herself in the best surroundings during each pregnancy. At the regular time each monthly flow is expected she should remain in bed for a few days; this will give the body absolute rest and may tide her over to full time. If she has been in the habit of aborting at a special time, say the third or fourth month, when that period is reached she should go to bed several days before the time expected and remain there at least two weeks. 2. If the abortions are due to syphilis, a course of mercury and iodide of potash should be instituted. If due to a backward displacement of the womb, this should be corrected by placing the womb in its normal position and holding it there with a pessary, or by an operation if necessary. Sexual intercourse during preguaucy should bo jjrohibited, as this is a very frequent cause of miscarriage. 3. ^^^len a pregnant woman feels pains in the lower part of the abdomen, soon followed by the discharge of blood, or sudden discharge of blood followed by pain, she has in all probability a threatened mis- carriage. She should loosen all her clothing and lie down ; her drinks should be cold ; twenty drops of laudanum with half a teacupf ul of water should be injected into the rectum, or a half grain opium suppository may be inserted. If the symptoms are not abated in one hour the injection or suppository should be repeated, and again at the end of the second and third hours if needed. If the patient is very restless and nervous, twenty to thirty grains of chloral may be added to one of the opium injections; if such is done do not use warm water, but the yolk of an egg and some warm milk, in order to prevent the drug from irritating the bowel. 4. The opium may be continued from day to day as long as there is hope of arresting the abortion. Meantime once in two days the bowels should be opened by a warm water injection, or by a mild laxative. CONCEPTION. 685 Should the pain and hemorrhage cease it is better for the patient to re- main in bed for three or four days after this cessation ; when she gets up she should only gradually resume her usual habits of life, even then as an experiment, and be prepared to return to bed at the first recurrence of the former symptoms. 5. Unfortunately in the majority of cases the hemorrhages do not cease, or having stopped return, and the abortion is apparently inevitable, or the flow may be so great that it will be necessary to complete the abortion in order to save the life of the woman. 6. If the abortion is inevitable stop the bleeding and empty the womb. Hot water injections may be valuable to accomplish the former. If they do not suffice, then the vagina should be tightly packed with antiseptic gauze, antiseptic lamb's wool, or pieces of boiled linen or muslin. In order to hold the packing in place, a najjkin should be tightly applied. T. When an inevitable abortion is assured the physician may pack the vagina with tampons and allows them to remain for eighteen or twenty- four hours, and usually when removed the ovum (if it has not been previously expelled) and the afterbirth will be found forced out of the womb. If the afterbirth does not come away in twenty-four hours the woman should be placed under an anesthetic and the womb emptied of its contents. If not the discharge in a few days will have a very bad odor, and the patient develop blood poisoning. Every woman who has a miscarriage shoiild remain in bed at least ten days to two weeks after such an occurrence. The women who do not properly attend to this accident are the ones who later in after life pay the penalty, which either means chronic invalidism, or the removal of one or all of her pelvic organs, which may or may not result in death. CONCEPTION. Character A woman who has conceived is pregnant ; pregnancy be- gins with conception and ends with labor, jiroviding an abortion does not occur. It is normal when the uterine cavity contains the fecundated ovule or ovules; and abnormal, ectopic or extra-uterine, should it or they be outside of that cavity. The Ovule or Egg. — ^Each month when menstruation occurs an egg or ovule, as it is called, escapes from the ovary. An ovule may come from the one ovary or from both, or two or more may come from tlie sue, '686 DISEASES PECULIAR TO WOMEN. and so forth. Leading from the ovai-j into tlic cavity of the womb is a tube called the oviduct. When the egg or ovule drops from the ovary, it falls into the end of this tube, which by a wave-like motion conveys it to the cavity of the womb, where it remains until the next menstrual period, when it is carried off with the flow. A new one is then deposited. It is estimated that women during their menstrual age pass many thou- sands of ovules. Twins — If one ovule passes down and the woman becomes preg- nant that month the result will be one baby; if there are two ovules and ini]ircgnation occurs, the result will be twins, and so on. Ectopic Pregnancy. — On account of disease, or from other causes, the progress of the ovule or egg may become obstructed, then the egg or eggs will become lodged in the tube. Should it or they become impreg- nated while lodged in the tube, the pregnancy will be an extra-uterine or ectopic pregnancy. How Pregnancy Occurs.- — How does impregnation occur ? When the male has intercourse with the female the semen of the male is deposited in the vagina of the female in such a position as to ''bathe" the neck of the Avomb. The heat of the parts causes this gelatinous seminal discharge to liquefy. The semen is merely a solution to convey the spermatozoids. The spermatozoid is composed of a head, of a tail and of an intermediate segment, sometimes called the body. The entire length of the human spermatozoid is not more than 1-500 to 1-325 of an inch. The spermatozoids have an eel-like motion, the tail being the motile power. The spermatozoids move along until one of them comes in contact with the ovule, the head then enters the latter, and tlie tail drops off. Conception then occurs. Although there are thousands of the spermatozoids in each seminal discharge, it only requires one to fecundate the ovule. Movement of Spermatozoids. — Their rate of movement varies. It has been estimated about three inches in three hours. They have been found alive in men who have been executed seventy and even seventy-two hours after death. In the human female they were found endowed with active movements in the neck of the womb seven or eight days after coition. In temperate climates boys of twelve years may have discharges simulat- ing the seminal fluid, but it is unusual for spermatozoids to be found in these discharges before they are fifteen or sixteen years old. One care- ful investigator claims that about one-half of men between sixty and eighty years of age are capable of fecundation. STEEILITY. 687 STERILITY. Causes.— 1. When a woman is imablo to become pregnant she is said to be sterile or barren. At least one marriage out of every eight is child- less. It is commonly believed that the fault is always, or nearly always, to be found in the wife, but modern investigation has shown that the husband is at fault in about one case out of every six. When the male is at fault it may be due to impotence, which is an inability to perform the sexual act to aspermatism, although he may succeed in getting an erection he may be unable to have an ejaculation of semen; or to zoo- spermia, the condition in which the ejaculated semen does not contain, spermatozoids, and, therefore, has no fertilizing power. Or again the testicles may be improperly developed. 2. If the female is at fault it may be due to the absence of the ova. In chronic inflammatory diseases of the ovaries the ovule may disap- pear, or the end of the oviduct may become closed. If such be the case, the egg will drop into the general peritoneal cavity and be absorbed. Another cause is incapacity for sexual intercourse, such as absence of the female organs of intercourse, inflammatory diseases and tumors of the vidva and vagina. If the perineum is badly torn the seminal fluid will flow out, a cause of sterility. 3. A frequent cause is a very small opening in the neck of the womb, which is not sufiiciently large to permit the spermatozoids to enter, and is termed stenosis. This should be dilated and is curable. Treatment — If due to inflammatory disease resort to the remedies described for the various inflammations of the generative organs. If the end of the oviduct is occluded, and tumors are present, or should the perineum be badly torn, or a small opening in the neck of the womb be the cause, then an appropriate operation will be the only pro- cedure which will tend toward future conception. Lack of Orgasm. — A condition for which a physician is frequently consulted is lack of the normal feeling of the highest sexual excitement, called orgasm. With such the fault is probably due to some imperfec- tion in the nervous system. The lack of orgasm may be found in other- wise healthy women, and not a barrier to conception. In those who have never experienced the orgasm it is often incurable. With others the use of tonics, or pill neuro-tonal or comp. damiana will be found effective. 688 DISJSASKS i-KCUI.IAK TO WOMEN. UTERINE PREGNANCY. Nature's Most Wonderful Miracle — It has been well said lliat every pregnant woman should be looked upon as a laboratory in which nature is performing that most wonderful of all her miracles, tiie fashioning of a new human being, and that nothing should be allowed in any way to disturb or derange this most important operation. Could such an idea be constantly kept in mind not only by mothers themselves, but by all those who surround or even momentarily approach the female M'ho is performing the most sublime duty of her sex, that of continuing the race, and every effort made to aid her in accomplishing this great function in the most perfect manner possible, what vast improvements might be looked for, even in the next generation of mankind. First Indication of Pregnancy — The first indication of pregnancy is generally the stoppage of the monthly periods, and it is also one of the most reliable of the early indications. It should be remembered, how- ever, that there is no certain sign of pregnancy, none which has not been found to fail, and lead into errors which were profoundly mortify- ing, if not worse, up to the time when the heart of the infant can bo heard to beat through the walls of the mother's abdomen. This beat of the child's heart can seldom be positively identified before the fifth month, and often not until the sixth. Failure of Signs — In some instances pregnancy may occur and yet the monthly flow continue. This is quite common for one or two months, and less frequent for four or five. In fact, some mothers assert that the first intimation they had of being pregnant was quickening or feeling the motion of the child, which generally makes itself evident about four and a half months from the date of conception. The Morning Sickness. — Morning sickness occurs with most females for the first few months of pregnancy, and some females when pregnant suffer intensely from it. It usually comes on whilst dressing, not being felt on first getting up, and when not very sevei'e often passes off later in the day to recur, however, the next morning. It differs from other forms of sickness, such as those which are due to disease of the stomach itself, in that as soon as the vomiting is over the patient is often perfectly well again, and can take food immediately afterward. The sensitiveness of the stomach to odors and flavors, and the peculiar ease with which feel- ings of nausea are brought on by such impressions is a very significant UTEEINE rREGNANCY. 689 sign, and rarely fails, if supported by the other visual symptoms, to indi- cate pregnancy when it is well marked. Changes in Mammary Gland. — Changes which occur in the mammary glands are valuable corroborative signs. They consist in the enlargement and puifiness of tlie nipple, the darkening and increase of size of the areola, and occasionally the secretion of milk. These indications show themselves during the second and third months. ftuickening Period. — Quickening is the feeling of the movements of the child, which is so constantly noticed by the mother about the end of four and a half months, or just half way through the pregnancy, that it often helps to fix the time of the approaching confinement. The first sensation is described as being like the fluttering of a bird, or the creeping of an insect, but after a few weeks it becomes progressively more decided, and more perceptibly like the struggles of an infant with human arms and legs. The popular idea that up to the time of quickening the child in the womb is not alive is, of course, totally erroneous, because if the infant was not living from the very day of conception it would not grow and develop. It is only felt primarily at this period because before the date of quicken- ing its struggles have been too feeble and made too deeply in the cavity of the abdomen to be perceptible. Changes in Abdomen. — In the early months of pregnancy the abdomen is often even flatter than in the unimpregnated female, but after the period of quickening enlargement occurs, and in the latter months becomes so great as to cause, in many instances, a good deal of distress by mere pres- sure, distension and weight. The stretching of the skin necessary to ren- der it capable of covering the uterine tumor generally gives rise to nu- merous cracks in its surface, which remain as whitish scars through after life. Changes in Disposition. — Changes in temper and disposition, longings for strange and unsuitable food, drowsiness, toothache, heartburn, palpita- tion of the heart, and so forth, are less constant and therefore less reliable symptoms of pregnancy, some of which, however, occur in a large propor- tion of the cases. Duration of Pregnancy — This average date is i:sually considered for the fruit of the womb two hundred and eighty days, or forty weeks, or a week over nine calendar months, from the day of the cessation of the menstrual discharge when last seen at the commencement of pregnancy. In order to be able to make this calculation accurately it is a good plan for every married woman to keep upon a calendar a regular account of the U '69C mSEAKES rECULIAK TO WOMEN. OVARY AND MAMMARY GLAND Figure No. i. — The ovary, showing the vesicular bursted and the large grums which tills its cavity. Figure No. 2. — Change in the breast from pregnancy. A. Nipple. B. Sebaceous tubercles. C. Spots in the branded areola. D. Marks due to the enlargement of the skin. Figure No. 3. — Lobes of a mammary gland. A. Acinos. B. Canaliculi or small canals. C. Conduit formed by several small canals. Figure No. 4. — Mammary gland. Figure No. 5. — Mammary gland in a woman. a. Nipple. b. Areola. c. c, c, c, c. The gland lobes. 1. Breast or enlarged part of one of the conduits which carry milk. 2. Extremities of the conduits which carry milk. Figure No. 1. Figure No. S. _ -,i mf:^^ f "a> Figure No. 2. Figure No. 4 Figure No. 5. OVARY AND MAMMARY GLAND For an explanation of tlic illustrations sec text on opposite page. 601 692 DISEASES rECTri,iAK to "womett. day in oaeh month -n-hen she ceases to be unwell, so that if at any time before the next period impregnation should occur, she may have at hand the precise datum upon which to base her preparations. The date of quickening, when that is a prominent symptom, as is the case in most pregnancies, ought also to be carefully noted. Pre^ancy Tahle.- — The table given below is one which will prove reasonablv accurate: Jan Oct. I S -• 3 9 10 4 5 II 1 2 6 7 13 14 8 I ^ 9 10 11 16 17 18 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 2U 27 28 29 30 31 10202122232425262728293031 1234567 Nov. Feb. 1 8 2 3 9 lo 4 5 1113 6 7 13 14 8 IS 91011 16 17 l3 12 13 14 15 16 17 18 19 20 21 22 23 24 25 20 2? 28 192021222324252627282930 12345 Dec. Marc Dec. I 6 2 3 7 8 4 5 9 10 6 7 II J2 8 13 9 10 1 1 II IS iS 12 13 14 15 16 17 iS 19 20 21 22 23 24 25 20 27 28 29 30 3 I 17 18 19 20 21 23 23 24 25 26 27 28 29 3031 12345 Jan. April Jan. I 6 2 3 7 8 4 5 9 10 6 7 11 12 8 13 9 10 II 1 I IS ifi 12 13 14 15 16 17 18 19 20 21 22 23 24 25 20 2728 29 30 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1234 Feb. May Feb. I S 2 3 6 7 4 5 8 9 6 7 10 II 8 12 9 10 II 13 U IS 12 13 14 IS 16 17 18 19 20 21 22 23 2425 26 27 2829 30 31 16171819202123232425262728 1234567 Jl/arrft March I 8 2 3 9 lo 4 5 11 12 678 13 14 IS 9 10 1 1 16 17 18 12 13 14 15 16 17 iS 19 20 21 22 23 24 25 26 27 28 29 30 19202122232125262728203031 123456 April' July April I 7 11 4 5 10 11 6 7 12 13 8 14 9 10 11 151617 12 13 14 IS 16 17 18 19 20 21 22 23 24 25 26 27 2S 29 30 31 1319202122232^252627282930 1234567 ifav Aug. Mmi I 8 2 3 9 lo 4 5 II 13 6 7 13 14 8 IS 9 10 11 16 17 iS 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19 20 21 22 23 21 25 26 27 28 29 30 31 1234567 June Sept. June 1 8 2 3 9 10 4 S 11 12 6 7 13 14 8 IS 9 10 II 16 17 18 12 13 14 15 16 17 1 3 19 20 21 22 23 24 25 26 27 28 29 30 192021222324252627282030 1234567 July Oct. July I 8 2 3 9 10 4 5 II 12 6 7 13 14 8 IS 9 10 11 iS 17 iS 12 13 14 13 16 17 iS 19 20 21 22 23 24 25 26 27 28 29 30 31 19202123232425262728293031 1234567 AutT. Nov. Auf). I 8 2 3 9 10 4 5 11 12 678 13 14 IS 9 10 1 1 l5 17 18 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 20 2 1 22 23 24 25 26 27 28 29 30 19 20 21 22 23 24 25 26 27 28 29 30 31 123456 Sept. Dec. Sept. I 7 2 3 8 9 4 5 10 II 6 7 12 l;! 8 14 9 10 11 IS 16 17 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 18 19 20 21 22 23 24 25 26 27 28 2930 1234567 Oct. Explanation — Find in the top line the date of the last menstruation the figure below will indicate the date when the confinement may be ex- pected. If the date of menstruation is April 8, then the date of expected confinement will be January 13. Care During Pregnancy — The pregnant woman should a.?k herself, before making even a trivial variation from habits of life, which have been proved by experience conducive to her individual health, "can this change produce any injurious effect upon the future, mental or physical, of my darling baby ?" and imless the answer is unequivocally in the negative, it is her duty to refrain from incurring unknown risks by alteration of diet, exercise, sleep, clothing, and so forth, which, previous experience has taught her, contribute most effectually to the preservation of her perfect sanitary condition. Food During Pregnancy. — The amount of food taken into the system during the early period of pregnancy, as intimated by nature in the broad hint of morning sickness, should be rather less and of a more easily digested quality than at ordinary times. But in the latter mouths, when PEEGNANCT. 693' the infant is rapidly developing and material must "he supplied for muscles and bones in abundance, the quantity of aliment should be largely in- creased. It is better, however, to eat more frequently than to run any risk of over-loading the stomach at such time. Exercise — The amoimt of exercise should also he ample, since this 13 vitally important for the proper assimilation of food into the blood, whence it is transferred to the foetus in the womb, and contributes, of course, every litom of the material composing the little body. Care must be taken, how- ever, to avoid violent exercise of any kind for fear of bringing on abortion with all its dangers to the mother, and in the earlier months with certain destriiction to the child. Child Blemishes. — As regards the production of blemishes and defor- mities in the infant by mental impressions of the mother during preg- nancy, there is a large amount of evidence that such an effect is produced, although many of the stories of such occurrences are grossly exaggerated or totally without foundation. At the same time a calm and equable frame of mind is greatly to he desired during the Avhole period, and anything which is likely to operate in the direction of causing mental shock, de- pression or excitement should be scrupulously avoided. Vomiting. — 1. Among the diseases of pregnancy are excessive vomit- ing, which may be treated Avith tablespoonful doses of lime-water, iced carbonic acid water, or iced champagne, ginger, bismuth, hydrocyanic acid, and two-grain doses of oxalate of cerium ; heartburn, from which half a teaspoouful of bicarbonate of soda or ten drops of aromatic spirits of ammonia affords relief. 2. If the nausea is due to a prolapsed or bactward displaced womb, the condition will be relieved by rejilacing the womb and inserting a lamb's wool tampon. A method which often suffices is to give the mother a cup of hot tea and a cracker about an hour before she arises. The following prescriptions are advocated: Tincture of nux vomica 3 drachms Hydrochloric acid '.i ounce Essence of pepsin 3 ounces Teaspoonful after each meal and at bed-time. Bismuth subnitratc 2 drachms Tincture of nux vomica 10 drops OMake into ten powders. One powder every hour. Carbolic acid or creosote 10 drops Subnitrate of bismuth 2 drachms Ikl^kp into ten powders. One every two hours, 591 DISEASES PECULIAR TO WOMEN. Excessive Vomiting, Treatment of. — The nausea and vomiting may be so pronounced as to be uncontrollable and is then called the hyperemesis of pregnancy. "When this exists nothing will remain on the stomach, and the woman rapidly loses flesh and becomes very much exhausted. When blood appears in the vomited matter of these cases the termination, as a rule, is unfavorable. The treatment consists of emptying the womb, in other words, pro- ducing an abortion, and is one of the exceedingly few reasons for which a physician is justified in producing an abortion. Constipation, Treatment of the. — Constipation, which must be meddled with very cautiously by the aid of mild saline laxatives, such as a teaspoon- ful of rochelle salt, a dessertspoonful of castor oil, or injections of soap and water; and piles, the discomfort of which can be palliated only by the use of some such ointment as that already recommended, or daily doses of cascara. Toothache, Treatment of the — If toothache comes on care must be taken that sound teeth are not extracted in the vain hope of relieving it. When teeth decay rapidly in pregnancy it seems sometimes to be due to the removal of the bony materials for the purpose of building up the skele- ton of the fcEtus, and efforts should be made by supplying the lime salts as phosphates or bypoiihospliites mixed with the food to remedy the difB- culty. Finely powdered bones have been shrewdly recommended. Enlarged Veins, Treatment of the — Enlargement of the veins of the legs sliould be treated by bandages or elastic stockings, and dropsy of the feet and ankles should lead to an immediate examination of the urine, lest some tendency to albuminuria may be threatening. Bladder, Treatment of the — Irritation about the bladder, perbaps witb incontinence and retention, occasion much inconvenience, but can often be relieved by gentle laxatives and diuretics, siich as the cream of tartar, or, if very troublesome, by a belladonna and opium suppository. The patient should, however, be guarded against the possibility of becoming fond of the action of anodynes, especially opium or chloral, at this trying .time. LABOR. Definition. — Labor is the end of pregnancy, and may be defined as the process by which the foetus and the afterbirth are separated from the mother. T^ature's design being the continuance of the race, the foetus must have reached such development before its expukion that it is viable ; LABOE. 695 that is, capable of living external to the mother. If, therefore, the product of conception be expelled before such capability, the process is not called labor, but abortion or miscarriage. Premature Labor — Should labor occur in the seventh or eighth month it is called premature, because the foetus has not attained its perfect de- velopment ; if labor be delayed beyond nine months it is called postponed, if the foetus be alive, but missed if it be dead. Parturition. — Parturition is a term very often used instead of labor. When parturition occurs, with the efforts of the womb and the woman alone, it is called natural ; but if it is necessary to render aid, usually by the apiilication of forceps, it is called au artificial or instrumental labor. In order that a labor may be natural the foetus must not exceed the normal size and the presentation must be normal, also the passageway and the muscular forces required to cause the expulsion of the passenger. Duration of Labor — This varies with race, place, climate, manner of living, hereditary, physical conformation, whether first or subsequent labor, and with the sex, presentation and position of the child. Labor is shorter in warm than in cold climates, in savage than in civilized races, in women in the country accustomed to plain food, outdoor exercises and regular habits, than in those leading opposite lives in the city. In the primipara (a woman who is having her first baby) it is longer than in the multipara (a woman who has had more than one child) ; it is also longer when the face or buttocks come first instead of the head, and with male than female children. Labor with First Child — ^^As a rule the primipara is in labor fifteen to twenty hours; the multipara six to eight hours. If the primipara is thirty-five years old and more, labor may be prolonged for twenty-one to twenty-seven hours; above forty-one years labor is very apt to be thirty- three hours. Duration of Second Stage. — The second stage of labor is generally one- third that of the first stage. The majority of labors begin between 9 and 12 P. M., and end between 9 P. M. and 9 A. M. Birth Presentation. — The presentation of the child varies. By far the greater majority of the children are born head first. The child may present by the head, buttocks (when it is called a breech) , face and either ehoulder. The vertex or head may demand forceps application at times, especially if at the expiration of any hour during the second stage it fails to progress. Should the face present, the physician will endeavor to push it up and change it to a vertex, otherwise it will be necessary to apply 696 DISEASES PECULIAR TO WOMEN. forceps. Such a child will have a blackened face, which diseoloi-ation at the end of a week or ten days will disappear. Buttock Presentation. — If the buttocks present, more or less difficulty will occur, and it may be necessary to apply force to the after-coming head. Shoulder Presentation — A shoulder presentation will require an entire change of the position of the child, as this is an imiDossible labor. As a rule both feet are brought down first, the head being born last. Preparations for Labor. — The lying-in chamber should be large enough for suitable ventilation, and yet not so large as to be with difficulty heated. Every precaution to secure for the invalid a full supply of un- polluted air should be instituted, and conveniences for affording hot water at short notice are of importance. The bed should be a hair or spring mattress, which ought to be covered with some waterproof material ; over this a thick, old spread, newspapers or comfortable, to absorb the blood and other discharges, should be laid, and this again covered with a sheet. The remaining bed-covering must be arranged according to the season of the year. In this room should be collected all the clothing which will be needed for the comfort of the mother and expected infant, and besides the articles of every-day use there should be provided a strong sheet, which can be tied around the post at the foot of the bed, for the patient to pull upon during her pains, a firm cushion for her to press her feet against if she so desires, an abundant supply of towels, plenty of soap and warm water, a pound or so of lard free from salt, a few yards of flannel, a soft, warm shawl or small blanket to receive the baby in before it is washed, sharp-edged but blunt-pointed scissors to cut the cord or navel string, eight yards of coarse sewing cotton doubled eight times and knotted at the two ends for tying the cord, a binder of strong new muslin about a yard and a half in length and half a yard wide, or larger if needful, and a paper of large, strong safety pins for fastening the same around the invalid's abdomen after she is delivered. The Mother's Dress — The dress of the patient should be the usual chemise and night-dress rolled up around her waist, so as to keep them from being soiled, and a sheet folded in four and pinned around her limbs as a skirt, fastening it at the right side so that it can easily be un- pinned and slipped down out of the way when the labor is completed. Stages of Labor. — Labor, jiarturition or confinement, is divided into three stages. The first consists in the dilation of the mouth of the womb, sufficiently large to permit the foetus to escape. The second constitutes I^AliUll, 697 tlic biitli of the cliilJ. Tlio third is the expulsion of the placenta or after- liirth. Pirst Stage of Labor — During the first stage of labor the patient may wall: around the room, sit up iu a chair or lie upon a lounge, as is most agreeable to her, but when the mouth of the uterus is dilated to the size of a silver half-dollar she should take her jjosition upon her left side, with her hips near the edge of the bed, and about a foot lower down than she is accustomed to lying. In this jiosturc the medical attendant can best aid her in her trial until toward the end of the process, when some advantage is often gained by placing the patient upon her back. Preparing the Nipples — Preparation of the nipples should be made by washing them with strong green tea, or solution of a drachm of tannin in two ounces of cologne water, twice daily for thi-ee weeks before con- finement, in order to harden the skin and render it less liable to crack and become sore whilst nursing. Period of Actual Labor — The period of actual labor is generally ushered iu with slight griping pains in the abdomen, and more or less aching in the back, which come on at first, joerhaps, at intervals of half an hour, lasting for a minute at a time ; then at intervals of ten or fifteen minutes, and so on until they grow severe and the sjoace of respite between them dwindles to five, four or even three minutes. Pains and Length of First Stage — In the first stage of labor the pains have a cutting or tearing character, and are commonly felt in the stomach, or lower part of the abdomen, and also in the back. They are accompanied by a frequent desire to pass water, produced by the pressure of the child's head upon the urinary bladder as it descends, and often by a disposition to evacuate the bowels, from a similar cause. Pressure of the head like- wise frequently produces severe cramps iu the legs, which may be partly relieved by friction, but often disappears as the labor progresses. The duration of this stage varies greatly, but in a labor of twelve hours' dura- tion, the usual proportion would probably be ten hours in the first stage, an hour and three-quarters in the second stage, and fifteen minutes in the third. Pains of Second Labor In the second stage of labor the character of the pains and the expulsive efforts which accompany them is changed. They now become what are commonly called bearing-down pains, in which the patient almost instinctively endeavors to aid the contractions of the uterus in its efforts to empty itself, by straining as if at stool ; and, indeed, should she seem reluctant to yield to this disposition, she ought to be in- 698 DISEASES PECULIAR TO WOMEN. structed to bear down exactly as if her bowels were being moved whilst constipated. The cries emitted are generally more like prolonged grunts, and can be readily recognized at a considerable distance by one who is familiar with their peculiarities. After a continuance of these pains for one, two or more hours the child's head, if that comes first, as happens in probably nineteen out of every twenty cases, begins to press upon the external parts or vulva, and finally, with an unusually forcible pain, often with a piercing cry from the mother, her baby's head emerges into the world. As a rule, the next pain expels the shoulders and hips, the rest of the body offering little resistance to the expulsive efforts of the womb after the head is born. Third Stage of Labor. — The third stage, consisting In the delivery of the placenta, is usually attended with one or two slight pains, by which the afterbirth is forced out of the womb into the vagina, whence it must usually be removed by the medical attendant. Although in the majority of caseswany intelligent person could suc- cessfully manage a case of labor, there are numerous accidents, malposi- tions and complications, which may occur without any warning in any particular case, so that if skilled medical assistance can possibly be pro- cured it should by all means be sent for. The man or woman who neg- lects this rims a terrible risk of being the murderer of the mother or 6f the child, perhaps of both. Duty of Midwife — But if no qualified physician is procurable, the acting midwife should from time to time, say every ten minutes dur- ing the second stage of labor, anoint the vulva or external parts of gen- eration of the patient freely with lard, at the same time examining very gently, with the finger, what progress is being' made In the descent of the head, supposing, as is usually the case, that forms the presenting part, as this too frequently causes puerperal sepsis, which see. The Delivery. — The moment the head Is born the finger should be repassed in around the Infant's neck, so as to find out whether the navel- string is wound around it, as not unfrequently happens. If such Is tbo case, the cord should be pulled down a little, and the mother urged to bear down for the child's sake, as rapidly as possible, and complete the birth ; when the cord must be Immediately loosened and slipped over the baby's head to save it from strangulation. At the same moment the head of the child comes into the world the midwife's other hand should be placed upon the lower portion of the mother's abdomen, and the uterus pressed upon gently. LABOE. 699 Treating the Womb. — As the body of the child is born the uterus should contract to the size of a ball, apparently about five inches in diameter, and if this does not take place, the womb should be firmly grasped through the walls of the abdomen, in the hand, and so stimulated to due contraction. This is very important, because, if it does not occur promptly the patient may bleed to death in a very few minutes. Attending the Child — As soon as the womb is found to be properly contracted into this hard ball, attention should be turned to the child. If it cries at once, the cord may be immediately tied an inch and a half from its attachment to the infant, with the sewing-cotton already pro- vided, and then cut half an inch above this again, that is, half an inch further away from the child, squarely off. The baby is then to be lifted up, with both hands clasped around its body, for it is very slippery, and received by an attendant in the flannel or old blanket, which has also been prepared. The attendant ought either to hold it until the labor is com- pleted, or to place it on its left side, in some safe situation, preferably in its cradle or crib, not in an armchair, where it may be crushed to death by being sat upon. Expelling the Afterbirth. — ^During this time the midwife should keep her hand upon the patient's abdomen, gently pressing and knead- ing the womb occasionally, in order to promote the recurrence of a con- traction, strong enough to expel the placenta. As long as the afterbirth remains the woman is not safe from dangerous or fatal flooding; but whilst the uterus continues firmly contracted, and feels like a hard ball under the fingers of the midwife, there is but little danger. After five or ten minutes, if slight pains come on, the mother should bear down a little, and the cord be gently pulled upon, when, in many instances, the placenta comes away. As it reaches the vulva, the patient should be told to cease her efforts, and the midwife should twist the afterbirth round and round on itself, eighteen or twenty times, gradually withdrawing it at the same moment. This is to wind the membranes, or bag which held the water into a string, if possible, inside the vagina, and perhaps the uterus, so that they may all come away with the placenta in safety. The mass, when removed, should be laid away for subsequent careful examina' tion, in order to determine whether any part has been left in the mother, as the effects of such an accident are much to be dreaded. Contracting the Womb. — The attention of the midwife should, how- ever, immediately return to the mother, and her hand at once applied again over the abdomen, when the womb ought to be felt as a ball of somQ "TOO DISEASES PECDI.TAR TO WOMEN. three and a Lalf inches in diameter, or about the size of the new-horn baby's Lead, and even harder lliau before. If not so felt, firm pressure and friction over the abdomen must be made to induce it to contract. Should it not do so within a minute or two the midwife must iutroduco her hand up the vagina into the cavity of the womb, under strictly anti- septic precautions, and pulling out the clots of blood she will probably find there, strive again to excite the womb to its proper contraction. To Prevent Flooding.. — Should these efforts prove unavailing, not a moment is to be lost, for the next five minutes will perhaps cost the patient her life by flooding. Let, therefore, a piece of ice, a sponge dipped in vinegar, or a peeled and gashed lemon, be carried up with one hand and rubbed around inside of the womb, whilst the other hand of the midwife, by firm pressure and friction over the patient's abdomen, con- tributes to stimulate that uterine contraction in which lies the mother's only safety. Or a teaspoonful of ergot, repeated in fifteen to twenty minutes. As soon as this is accomplished, as it probably will be by these remedies, a tight bandage should be pinned around the patient's body, with two or three folded napkins beneath it, pressing upon the part of the abdomen over the womb, to prevent relaxation, which hajipily seldom oc- curs when thus treated. Making the Mother Comfortable ^After being securely bandaged, the patient may be lifted up a little, out of the wettest part of the bed, if it can be done without any effort on her part; but for fear of flooding, the more quiet the parturient is kept for the first two hours after labor, or until ihe blood has had time to clot firmly in the large, open-mouthed veins of the uterine cavity, the less is her danger. When the patient is made as comfortable as possible, a clean napkin, loosely folded, is to be placed be- tween the thighs, but not pressed up tightly against the vulva, lest it act as a plug and prevent the detection of flooding, should that come on. Shonld the Child Not Cry — In case the child docs not cry when first born, its mouth should be carefully cleared of mucus and other obstruc- tion, and a little cold water sprinkled upon its breast. Should this fail in rousing a gasping' effort at breathing, the baby, still attached to the cord, if that is pulsating, should be put into a basin of very warm water, and after a minute or two, when the surface of its body is well heated, the dash of cold water over its face and breast again tried. If still unsuccess- ful, the baby should be wrapped up in hot flannels, and artificial respira- tion, by blowing into the moiith whilst the nostrils are held, and then forcing the air out by compressing the chest, attempted as a forlorn hope. The writer has found the results of dry heat, applied by cautious roast- ing before a fire, promising enough to warrant further employment in otherwise hopeless cases. Baby's First Bath — If, on the contrary, the child cries lustily, and the mother is doing as well as can be expected, the cord should be again examined to verify the fact of its being securely ligated, and the baby given its first bath. The infant shoidd be rubbed all over with lard, to soften the vernix caseosa or cheesy matter with which it is more or less covered, then well washed with white castile soap and milk-warm water and thoroughly dried. Dressing the Navel. — The cord is dressed by being drawn through a. hole cut in the middle of a ijiece of soft old linen, folded once, and trimmed to four inches square, and after being wrapped in this is laid upward on the baby's stomach, and bound in place by a belly-band o£ silver flannel, fitted snugly but not too tight, and secured by safety pins or a few stitches, or the cord can be dressed in absorbent cotton and freely covered with boric acid. Of the Throng Presentations — The management of labor when the back of the head does not come downi first, and especially when the but- tocks, feet, or arms present, is so apt to be difficult and dangerous that a physician ought always to be simimoued, even from a great distance and at the utmost inconvenience, shoidd any signs of a "cross-birth," as it is popu- larly called, be detected, or should unusual delay in delivery render ob- struction probable. It will sometimes bo a comfort to a woman in labor who is anxiously awaiting the physician's arrival to be reminded that if the birth comes before the doctor it will be because everything is all right, whilst, on the contrary, if there be anything wrong, the physician will usually have ample time to reach her before his services are actually needed. After-Management of labor. — The management after labor should be such as will best avoid any excitement, either mental or physical, liable to light up inflammatory action in the womb, which has just been the sub- ject to such momentous change. The patient, in ordinary cases, ought to remain in bed until the twelfth or the fourteenth day, partaking of semi- solid food until the third day, when the bowels should be moved. For this purpose she may bo given a bottle of the citrate of magnesia in two doses, one-half hour apart, salts or an enema. After the bowels have been thoroughly moved, solid food shoidd be given. She should not receive company for at least three days, but devote all her energies to the task f02 DISEASES TECULIAU TO WOMEN. of recovering as speedily as possible, both on her own account and for the cake of the frail, new life so utterly dependent upon her care. PUERPERAL CONDITIONS. Character. — The puerpcrium, or the puerperal stage, is the two weeks following the birth of the child. It begins immediately upon the expul- sion of the placenta. Among the conditions of the puerperal state may be mentioned after- pains, which, though seldom troublesome subsequent to first deliveries, may in others cause more suffering than the labor itself. After-Pains They can, however, be greatly relieved by the iise of ergot just as delivery is accomplished, and of one-half grain opium sup- positories, or forty-drop laudanum injections, or a Dover's powder, in two or throe hours if they persist. Sore Nipples. — Soreness of the nipples and cracked nipples are very apt to come on in patients with tender skins from the constant irritation of the baby's gums in nursing, and are unfortunately very difficult to heal, because the same irritation which originated the trouble in the first place is continually kept up. Treatment of Nipples. — Vaseline, zinc ointment, laudanum and ni- trate of silver sometimes succeed in curing the sore, but the most success- ful plan is to use a wooden shield with a rubber nipple if the baby can be persuaded to consent to the innovation. Women who suffer in succeed- ing pregnancies from this condition may do much to prevent its recur- rence. About three months prior to the expected date of confinement, rub the nipples night and morning with cocoa butter and expose them several hours daily in the sunlight. Before and after nursing the nipples of the mother and the mouth of the baby should be washed with a solution of a teaspoonful of boric or boracic acid in a tumblerful of water. The nipples should be thoroughly dried. Danger of Cracked Nipples — The great danger of cracked nipples is that it may lead to abscess of the mammary glands (the so-called gathered breasts). CHILD-BED FEVER OR PUERPERAL FEVER. Character — Puerperal fever is a very dangerous disease, which I3 invariably due to a lack of antiseptics. All cloth or napkins that come in contact with the vulva of the woman which have not been boiled, the CHILD-BED FEVEB. 103 hands of those attending to her unless thoroughly washed, all instruments used unless rendered aseptic will carry dirt of some kind, giving rise to this condition, which, practically speaking, is blood poisoning. It generally comes on or about the third to the fourth day after delivery with a violent chill, great thirst and extreme prostration. Symptoms — The uterine discharge, or lochia, which should persist for ten days to two weeks, becomes very foul, the odor of which is nauseating, or it quickly dries up. The fever may run very high, and diarrhoea with obstinate vomiting may set in. The mind soon grows clouded, if the attack be a severe one, muttering delirium makes its appearance, and the patient often dies on the third to the seventh day of the attack in a condition similar to that observed in typhus fever. Treatment. — A large majority of the cases prove fatal, but full doses of twenty to thirty grains of quinine, with one-thirtieth grain of strych- nine sulphate every two to three hours, succeeds in saving a small propor- tion of the cases. If an abscess forms, be it in the pelvis or elsewhere, it shoiild be incised and drained. Cold sponge baths every two or three hours will reduce the fever, and an ice bag to the head will oftentimes prevent brain complications. Injections of bichloride of mercury should be used once or twice a day. Puerperal Mania — This is a form of insanity liable to come on a week or ten days after confinement, in which there is frequently a singu- lar aversion to the child, and perhaps to the husband also. A tendency to suicide is also prominent, and patients thus affected should be watched with the most unremitting care. Under perfect rest, nourishing diet, moderate stimulation and sedatives persons generally recover. Puerperal Convulsions — These may come on before or during labor, as well as in the montli following delivery. They are generally due to accumulation of urea in the blood, the consequence of temporary Bright's disease, resulting probably from the pressure of the uterus containing the foetus upon the kidneys. The treatment has already been pointed out under the head of uremia. Milk-Leg — This is an inflammation of the lymphatics of the limb, coming on especially toward the end of the second week after labor and deriving its name from the milk-white appearance usually presented by the skin of the affected part. As the febrile state of the system is apt to cause drying up of the milk, it was formerly supposed that in some mysterious way the lacteal fluid was transferred to the leg. At first it 104 DISEASES PECnLIAR TO WOMEN. may be quite painful, but after the integument becomes accustomed to distension, the sensations are rather those of weight and discomfort than of positive suiferiug. The treatment is by hxudauuni or turpentine fo- mentation at first, and later with stimulating and anodyne liniments, Avhich hasten a little the naturally tardy convalescence. The ordinary duration of the affection is from a month to six weeks. MANAGEMENT OF THE INFANT. Suckling the Baby. — After a baby has received its first bath, and been for the first time introduced to the mysteries and miseries of clothes, it should be put to the breast for the purpose of extracting whatever nourishment nature has there provided for it, and also as the commence- ment of its education in the art of nursing, a business upon which its life for some months will depend. Curiously enough whilst some chil- dren take hold of the breast as if by instinct, others must be taught to nurse, and show for this vital operation all the perverse imwillingness of Shakespeare's schoolboy, notwithstanding it is the one thing in the world they have to do. Mother's Milk the Best — ^Every mother ought, if possible, to suckle her own infant, not only for her own sake but for that of the child. Statistics show that babies nursed by their mothers, amid the unfavor- able surroundings of prison life, thrive better than those who are brought up by hand in healthy country districts outside, and no woman in good health, who can furnish the nourishment, should be spared the reproach of risking the life and health of her ofi'spring if she refuses to perform her maternal duties in this regard. A mother undertaking the suck- ling of her infant should, moreover, do so with a mind fully alive to its importance, and with a firm determination that no pleasi:res of society or of fashion shall interfere with its conscientious performance, or else she had better not attempt it at all. Amount of Breast Milk — The amount of milk contained in the breast, especially with the first child, is very small for two or three days, but in some forty-eight hours the rush of milk, as it is called by nurses, com- mences, and is often attended with some fever, and marked pain and soreness in the breasts. The remedy for this disturbance in the mother's system is, however, very simple and conveniently at hand, and as the child, which, if healthy and vigorous, generally has a good appetite, draws out the milk which nature has provided for its special benefit, all these MANAGEMENT OF TIIK INFANT. Y05 uneasy sensations soon subside. If the coming in of the milk is unusually delayed, it may be necessary to give the baby a little cow's milk, well diluted and sweetened with sugar of milk; but this is seldom required. Mothers to Avoid Excitement — During the time a mother is nursing her infant every care should be used to avoid any violent mental excite- ment or shock, which is exceedingly apt to influence the secretion of the mammary glands to a certain extent, just as it does that of the lachrymal gland, and render the lacteal fluid temporarily unwholesome or poison- ous to the infant; or it may completely suppress the secretion of milk, with very serious consequences to both the parent and her offspring. The Wet Nurse. — If, for any reason, the mother is unwilling or un- able to suckle her infant, the next best chance for the baby's life is to procure a good wet nurse. When such an alternative is adopted, great care should be exercised in selecting the foster-mother, and the physician's advice ought always to be obtained vipon this important subject. Bringing^ Up by Hand. — Should the mother fail to nurse her child, and no good wet nurse is procurable, the child must be brought up by hand, a species of manipulation which contributes, it is probable, more than anything else to swell the lists of infant mortality in most largo cities, as well as to some extent in country districts. Although goat'"; milk is used occasionally in this country as an infant's food, practically the choice is narrowed down in most cases to cow's milk, and the great object should be to secure this from healthy animals, pure and free from all admixture, as pointed out in an earlier chapter upon milk as an article of diet, and in a perfectly fresh condition. Testing the Milk. — All milk Tised for the feeding of young infants, especially in the summer, should be earefiilly tested, and particularly in regard to its acidity, with litmus paper. If found to be acid it ought to be at once rejected, and a sample of pure, sweet milk obtained. Putting Baby to the Breast. — A new-born infant is not hungry, con- sequently it need not be put to tlie breast for three or four hours or more. This will also give the mother a chance to obtain a little needed rest. For the first twenty-four to thirty-six hours the baby should be put to the breast every four to six hours. The subseqiient twenty-four hours about every three to four hours. About the third day or so, when the milk is well established, the baby sliould be nursed every two to three hours. Time for Nursing — Under no consideration nurse the baby between 11 P. M. and 5 to 6 A. M. If mothers would only institute this from 45 706 DISEASES PECULIAB TO WOMEN. the time of birth, both she and the baby will obtain a good night's sleep. Should the baby awaken, change its position, and give it a little water to drink, and invariably it will go off to sleep. Another bad practice is to give the baby the breast every time it cries, in order to quiet it. It should be conquered from the beginning, so do so. Weaning the Child. — The time for weaning, generally about the age of nine months, should be determined partly by the growth of the teeth, presiiming, of course, that the mother's health is not suffering in the meanwhile. When the first lower middle incisor teeth appear, which usiially hapjiens about the sixth or seventh month, the mother may begin to diminish the number of times for suckling more rapidly, at the same time replacing the breast milk, of which the infant is deprived, by cow's milk thickened with oatmeal, barley or wheet flour, and so forth. After the child has four teeth it should be weaned, although if the infant is feeble or the season unfavorable, the period of nursing may be extended a few months longer. Dilution of Milk — If the new-born baby is not nursed and fresh cow's milk i^ employed, it should at first be diluted with half its bulk of pure, tepid water, sweetened with a teaspoonful of sugar of milk to one- quarter of a pint of milk, and a few grains of salt. Condensed milk will not require sweetening, but should be freely diluted so as to resemble human milk in color. For the first month of a child's life it may be mixed in the proportion of one part of the condensed milk to ten or twelve of warm water. Cleanliness of Nursing Bottle. — The most rigorous cleanliness of the nursing bottle and nipples must be insisted on, and imder no consideration should the long rubber flexible tube apparatus be employed. It is an exceedingly dirty arrangement, as it cannot be properly cleaned. Simply use a very plain bottle, keeping the nipples in a soda solution. Foods Other than Milk — "When a child does not seem to thrive well ujjon pure or diluted cow's milk, it has often been advised to resort speedily to mixtures of milk with meat broths, raw eggs, and so forth. Bretoimeau reported, as early as 1818, that when children under his care who were suffering with tabes mesenterica, were fed with milk and meat broth, they rapidly improved, and other authorities recommend this mixture as the next best thing to woman's milk, or the malted milk can be tried. KXTEA TTTEEINE PEEONANCT. Y07, EXTRA UTERINE PREGNANCY. This constitutes a pregnancy occurring in the oviduct and not in the cavity of the womb. Symptoms. — 1. The woman will have all the symptoms of pregnancy. A pregnancy of this kind invariably follows a long period of sterility. The woman who has previously menstruated regularly will miss a period and consult a physician. If he examines her to ascertain the cause of the stop- page of the flow, and this variety of pregnancy is present, he will find the uterus very slightly enlarged and a mass to one side of it. 2. About four to eight weeks, as the foetus continues to grow, the dis- tended tube may rupture, or the contents may be expelled through the end of the tube (tubal abortion). 3. If the tubal abortion or rupture occurs, the woman will first notice a sudden, sharp, severe pain in the abdomen. This will be followed by fainting spells which may or may not end in death, due to the loss of blood. Treatment — If the condition is recognized prior to rupture, the wo- man should submit to an operation at once, before rupture takes place, which accident invariably terminates in death. If the woman is not seen by a physician imtil rupture does occur she should be operated on at once, in order that the bleeding vessels may be tied. In a few rare cases nature checks the bleeding, which will be fol- lowed by a second rupture, usually with fatal results. PART XI OF BOOK IV Treats of the diseases of the skin, hair and nails. Barber's Itch 724 Causes 724 Precautions in 725 Treatment of 725 Brown Patches in Scald Head 727 Boils 715 Bunions 719 Carbuncles 716 Chigger 727 Corns 719 Diseases of the Skin 711 Eczema 713 Erythema 711 Flesh-worms 72a Freckles 720 Herpes 714 Impetigo 715 Itch 727 Disinfection for 729 Symptoms of 727 Treatment for 728 Itching 720 Lice 729 Treatment for 729 Lichen 717 Moist Tetter 713 Nettle Rash 713 Pemphigus 714 Pimples 716 Prurigo Symptoms 717 Pityriasis 718 Precautions in Barber's Itch 725 Prickly Heat 717 Pruritus 720 Psoriasis 717 Pustular Eruption 715 Redness cf the Skin 711 Ring-worm of the Body 724 Ring-worm of the Head 723 Scabies 727 Scald Head 726 Brown Patches in 727 Scalp Disease 718 Treatment of 718 Seborrhea 720 Shingles 714 Skin Diseases 711 Classes of 711 Due to Vegetable Parasites 722 Skin Glands, Diseases of 720 Flesh-worms 720 Seborrhea 720 Skin Redness 711 Strophulus 716 Tetter 717 Treatment of 718 Urticaria 713 Warts 719 ILLUSTRATIONS Burrow of Itch Insect 729 Eczema, Scaly Form 714 Eczema, Simple Eruption 714 Itch Insect 728 Ring-worm on tlic Hair, Effect of.... 723 .Sebaceous Gland, Magnified 721 Scald Head 715 The Skin 712 709 CURATIVE MEDICINE PAKT XI. SKIN DISEASES This class of affections embraces diseases of the skin, hair and nails, md therefore includes maladies which occasion much distress and deform- ity, but are seldom dangerous to life. Classes of Skin Diseases — Skin diseases are easily recognized, but there is sometimes difficulty in distinguishing between the different forms. They divide themselves thvis : 1. Those of an eruptive (erythematous") character. 2. The catarrhal, in which the conditions resemble those belonging to inflammation of the mucous membrane. 3. The vesicular, which is composed of small blisters. 4. The pustular, made up of pustules or small boils, containing pus or matter. 5. The papular, in whick pimples appear, containing neither water nor pus. 6. The scaly eruptions in which the affected parts are covered with dry, whitish layers of epithelial cells. 7. Skin diseases caused by animal or vegetable parasites, of which the itch is a remarkable illustration. SKIN REDNESS (Erythema). Symptoms — Erythema is the name applied to the redness due to ii superficial inflammation of the skin. It is the mildest form of skin dis- ease, and is apt to affect fat people in hot weather. Infants are liable to be affected with it behind the joints. Treatment.— See Nettle Eash. (7H) a. Epidermis or cuticle. h. Dennis or true sicin. C. Nerve prolongations- THE SKIN 712 d. Blood-vesseli. e. Oil cells. /. Glands. ECZEMA. 713 NETTLE RASH (TJrticaria) , Symptoms — This is an eruptive affection which sometimes comes out quite suddenly, and is attended with a most troublesome itching. It is characterized by the formation of ''wheals" or rounded patched of elevated skin, whiter than the surrounding parts, which are slightly reddened at the margins. Causes — It may arise from the bites or stings of insects; from the eating of certain fish, especially shellfish; or from reflex irritation, and other causes. Treatment. — It is greatly aggravated by scratching, and, like simple erythema, is relieved by dusting with finely-powdered oxide of zinc and starch, with lycopodium, or even with rye flour. Lotions of lead water, benzoic acid and borax are also sometimes useftil. Locally carbolic acid, two drachms; glycerine, two drachms; water, one pint. Small doses of calomel, followed by a saline. MOIST TETTER OR ECZEMA. Symptoms. — Eczema, sometimes called moist tetter, is a catarrhal in- flammation of the skin usually attended with a breach of siirface. It pre- sents at first irritable, raw, red patches, with occasional little blisters which soon break and a fluid is discharged, which in drying forms crusts or scabs. Later on the patches become dry, scaly, and often cracked. This is a form of skin disease which is often seen in young infants, in whom it sometimes receives the name of milk-crust. The pain, burning and itch- ing of eczema are intense, and yet it is only aggravated by scratching. It is especially apt to appear aboiit the flexures of the joints, as, for ex- ample, in the hollows of the elbows and knees. Treatment. — Many formulas have been recommended and iised for this prevalent condition. Stimulation of the skin is of great importance, and various drugs have been used for that purpose, such as resorcin, tar, camphor, etc. The following have been recommended by various spe- cialists on the disease: R. — Camphor i drachm • Oleate zinc 2 drachms Powd. starch i ounce Use freely as a dusting powder. 714: SKIN DISEASES. R. — Acid boric 2 drachms Acid carbolic Vj drachm Glycerine '/i drachm Water i pint Apply twice a day. Resorcin Vi drachm Bismuth subnitratc 2 drachms Glycerine 2 drachms Lime water _. 4 ounces Apply two or three times daily. Some cases do better with an ointment, when tlie following may Le applied : R. — Ichthyol I drachm Pulv. Camphor Vi drachm Zinc ointment I ounce SHINGLES OR HERPES. Symptoms. — Herpes, which is a good type of the vesicular affection of the skin, is characterized by little blisters which come out in small groups, and when appearing about the mouth and nose constitute the cold-sores with which almost everyone is familiar. Shingles Proper. — A severe form called herpes zoster, or the "shin- gles," comes on with smarting and burning pain in a belt half way around the body of large patches of the eruption. It is distressing and tedious, often lasting a month or six weeks, but rarely dangerous. The popular idea that it will prove fatal if it goes all around the body is without foundation. Treatment. — The only treatment is to apply anodynes and soothing lotions, such as the morphia and lead water recommended in erysipelas, and administer opiates to relieve the pain, or pil acetanilide comp. PEMPHIGUS. Character — Pemphigus is another vesicular eruption, characterized by the formation of large blisters, from half an inch to two inches in diameter, resting on slightly reddened surfaces, and mostly attended with severe itching. These blisters sometimes appear on the fingers, but com- monly attack the lower limbs. They should be punctured at once and borio acid applied. They generally indicate a more or less impoverished state of the system, in which iron, quinine, strychnine and good nutritious food are called for. •^ «?^^ ''^ -a t, < z N >. I I K T. S. SCALD HEAD (Favus). BOILS. 715 Remedy. — ^Arsenic is also very useful, and locally sootliing ointments or absorbent powders may be employed. IMPETIGO (Pustular Eruption). Character. — Impetigo is the most common of the pustular eruptions, and is characterized by the formation of separate pustules, somewhat like those of small-pox. They may attack any part of the body, but are most apt to appear upon the face and limbs. This disease, like eczema, which in many respects it resembles, seems as if it were an aggravated form of impetigo, and is especially frequent among children, although adults are not exempt. Impetigo is always associated with general debility, defective nutrition, or hygienic neglect. Remedies — The treatment is by good food, tonics, Avith cod-liver oil, and strict attention to cleanliness. Soothing applications, such as Gou- lard's cerate, should be made first to the pustules, but later on a very mild mercurial ointment is more effectual. Mild antiseptics or boric acid can also be used. BOILS, Causes — Boils, those common and exceedingly troublesome inflictions upon mankind, are classed under the head of pustules. With all the ad- vances we have made in late years in pathology, the cause of boils still remains undiscovered. Sometimes they seem to be due to high living, and in other cases poor diet appears to determine the advent of a troublesome series of these parts. One boil is very apt to precede a crop of fifteen or twenty, although there is no certainty that this will be the result. Treatment — 1. The best way of managing a boil is to poultice it with flaxseed or bread and milk, containing laudanum to ease the pain. If the boil is small, the poultice may be spread upon a piece of oiled silk, which prevents it from becoming dry, and held in place by a bandage, or by a square piece of linen upon each corner of wliicli has been daubed a little spot of adhesive plaster, the stick of plaster being melted in the Hame of a candle for the purpose. This holds a dressing of any kind on a broad, flat surface of the body, as, for instance, the skin of the back, very satis- factorily. 2. When the boil softens in the centre, and the fluctuation of matter can be detected, or its yellowish color can be seen under the skin, some twenty-four hours of suffering may be saved by Laving it lanced, and the pain of the cut may be abolished by freezing the surface with ether spray, 716 SKIN DISEASES. or by stroking it with a little bag containing a mixture of ice and salt. In certain eases it is important to lance a boil early, so as to prevent the bur- rowing of the pus toward sonic important structure; but ordinarily, if the sufferer dreads the knife, there is uo actual necessity for using it, and the boil may safely be left to break of its own accord, under the poultice, one, two or three days later than the time when it is ripe for lancing. 3. Lancing the little pimple, with which a boil first commences, exactly through the middle, which can be done almost painlessly under the ether spray, will nearly always ci:t short this troublesome affection. Ten or twelve grains of quinine daily, so as to j^roduce slight cinchonism for a week, occasionally breaks up a course of boils, but is by no means an infallible remedy. CARBUNCLES. Character. — Carbiuicles chiefly differ from boils in the larger area in- volved in the inflammation, from which a core of dead connective tissue, called a "slough," several inches in diameter, may come away. Car- buncles are apt to come on the nape of the neck, and on the back, but may appear on any part of the body. A large carbuncle will sometimes keep a patient in bed for a month or six weeks, and the pain and exhausting discharge wears out the strength so much that it may cause death ; if a second of large size appears, after the first begins to heal, as it is not very unusual, it quite frequently proves fatal. Treatment. — Poultices of flaxseed meal, bread and milk, powdered slippery elm bark, or of yeast ; anodynes to relieve pain ; and twelve grains of quinine daily, with tincture of iron to support the strength, constitute the appropriate treatment. Early and free incisions into the inflamed tissue, made after freezing the part, are of great service. After opening apply equal parts of carbolic acid and glycerine. PIMPLES. The papules or pimples are solid elevations of the skin, containing neither water like the vesicles, nor pus like the pustules. They are three in number, including strophulus, the red gum or tooth-rash peculiar to infants, lichen or prickly lieat and prurigo. Strophulus. — This consists of an eruption of innumerable small, red- dish pimples, which occur for the most part on the face, neck and arms of young children. The irritation and general disturbance is slight. The eruption is usually caused by digestive derangement of .some kind, as, for PSORIASIS. 717 instance, that of cutting a tooth, and passes away with the cessation of ita cause. Treatment — The only treatment necessary is some mild, saline laxa- tive, and a lotion of very weak solution of carbonate of soda, five or ten grains to the ounce, with a teaspoonful of glycerine, to allay the itching if that appears to be very troublesome. Prickly Heat or Lichen.— This is very common in hot weather, in the simple form of reddish pimples, which itch a great deal but usually sub- side on the approach of the cooler season. It sometimes takes on a severe form, and may even become chronic. Treatment. — In mild cases tepid baths, plain and easily digested food, an occasional saline laxative, with a tablespoonful of infusion of gentian, and five grains of bicarbonate of potash or soda internally, three times daily, will effect a cure. To relieve the itching, solutions of borax, vine- gar or carbolic acid may be used with advantage. In aggravated cases the more powerful tonics, with tablespoonful doses of cod-liver oil and one- sixteenth of a grain of arsenic three times a day must be resorted to. Prurigo Symptoms — This is characterized by an eruption of pale, slightly elevated pimples, most situated on the trunk of the body, and attended with very intense irritation, especially at night, so that the marks made by the patient's nails in scratching can almost always be seen, and aid in recognizing the malady. It is frequently the result of the presence of the vermin with which so many dirty people are infested. Remedies — Cleanliness, by the aid of strong alkaline baths, and the use of an ointment of carbolic acid, or if white precipitate, with the administration of tonics and good food will generally effect a cure. Some- times, however, the disease, unless it is carefully treated early, proves very obstinate, being kept up in great measure by the constant scratching, which it is very difficult for the patient to abstain from. PSOHIASIS (Tetter). Character. — Psoriasis is the most important scaly eruption; in certain of its varieties it probably constituted one form of the leprosy of the Bible. It is characterized by the appearance, at first, of oval or rounded patches of slight irritation, tlien upon these an eruption of scales, which grow dense and white toward the centre. Afterward the spot expands from its outer edge, where the skin is often reddened and slightly raised above the level of the surrounding surface. This is the skin disease to 718 BKIN DISEASES. which the name of "dry tetter" is commonly applied. In the worst or in- veterate form, the whole body may be covered with these white scales, ex- cept the face, the palms of the hands and the soles of the feet. Even these do not always escape. The incrustation of scales in this variety of psoriasis is thick and dense. When it has lasted for some time, the skin chaps and breaks, after which there is severe soreness with exudation of fluid from the broken surface, intense irritation and itching, with great general and physical exhaustion, lasting for many weeks, or perhaps months. In rare cases it may even prove fatal. In the milder form, it is especially apt to appear very symmetrically upon the knees and elbows, and is most common between the fifteenth and twenty-fifth year of life. It is prone to recur in a patient who has once manifested it, but is not contagious. Often it is hereditary, and may be associated with a gouty or rheumatic taint in the system. Treatment.- — The treatment consists of careful attention to diet, avoid- ance of alcoholic stimulants, and the administration of arsenic in the form of Fowler's solution, five drops thrice daily. Externally soothing lotions or ointments are required in the first stage, and mild mercurial or tar ointments are of service after it has become chronic. R. — Ol cade i drachm Lanoline i ounce Apply twice daily. R. — Tar ointment I drachm Petrolatum I ounce Apply twice daily. R. — Chrjsarobin 15 grains Lanoline I ounce Apply to each spot twice daily. PITYRIASIS (Scalp Disease). Character. — i'ityriasis is a squamous disease especially apt to affect the scalp when it appears in the milder form, giving rise to the shedding of an immense number of bran-like scales, resembling an exuberant crop of dandruff. Treatment. — The condition of the health in general should be looked after. Iron and arsenic are given, also calcium sulphide locally for the scalp. WABTS, CORNS AND BUNIONS. 719 ^■—Tt green soap 4 ounces Alcohol 2 ounces Dilute and use as a shampoo, if crust or scales. After removal apply R.— Sulphur precip i drachm Salicylic acid 10 grains Petrolatum i ounce Or, R-— Tr Cantharide 3 drachms Tr capsicum 3 drachms Castor oil 2 drachms Bay rum 3 ounces "WARTS, CORNS AND BUNIONS. Hypertrophies of the skin are all unusual diseases, except warts and corns, which are common enough to make up for all the rest. The com- ing and going of warts on the hands is as much a mystery now as in former ages, when the most ridiculous remedies were gravely prescribed. Wart Remedy. — Warts can be destroyed by caustics, of which nitric acid is the most severe and effectual, and chromic acid perhaps the least painful. When arising from the poison of syphilis, they are sometimes extremely sore and troublesome, so much so as to require removal by sur- gical operation. Causes and Treatment of Corns.— Corns are similar to warts in their structure, except that they have a much thicker layer of epidermis over their surface. They are almost always produced by the pressure of tight shoes, and may be avoided by caution in this respect. They can usually be prevented from giving much trouble by carefully trimming out the centre of the corn at short intervals, or by wearing one of the varioiis forms of perforated corn-plasters in common use. In cutting corn, the incision should never go through the epidermis, so as to cause bleeding, since dan- gerous inflammation has thereby been set up. R. — Salicylic acid % drachm Ex. Cannabis Ind 10 grains Collodion 4 drachms Apply daily for 3 or 4 days when the callous can be removed. Bunion Treatments — A bunion is generally made up of a corn on the Bide of the great toe, and an irritated synovial sac or bursa beneath it. It is also the result of wearing too tight a shoe, especially such as are too narrow at the point. When inflamed, it should be soothed with lead water and laudanum ; a loose shoe, or one with a piece cut out of the side, being !Wom. After the reduction of tke inflammation, benefit may be obtained 720 SKIN DISEASES. hj painting with tincture of iodine. A bunion should never be neglected, as it is liable to suppurate, leaving a troublcsonio indolent sore, which may for years cripj)le the patient, even if permanent lameness does not result. PRURITUS (Itching). Character. — Pruritus is a very common disease of the skin, which is characterized by itching without any eruption or other apparent change in the appearance of the part affected. Children and elderlv people arc par- ticularly apt to suffer thus, and the localities involved are generally those about the orifices of the body. Causes Sometimes, like prurigo, it may be traced to the irritation caused by vermin, usually the pediculus corporis or body-louse, which may be gotten rid of by attention to cleanliness and the application of weak mercurial ointment, a tincture of larkspur, or various other home rem- edies. AYheu not thus produced, the cause must be sought in some de- terioration of the general h.ealth. Treatment As local applications, lotions of borax, half an ounce to the pint, or of carbolic acid, one or two teaspoonfuls to the pint, and oint- ments of zinc camphor, belladonna or morphia are useful. FRECKLES. Freckles consist of a deposit of oxide of iron from the blood, just beneath the epidermis or in its lower layers. They may often be dissi- pated by painting with tincture of iodine or frequent application of per- oxide of hydrogen. DISEASES OF SKIN GLANDS. Seborrhea. — In seborrhea there is an excessive production of secre- tion, made up of oily matter and cast-off epithelial cells, which accumu- lates upon the surface in the form of thin, j-ellowish scales. It is especially common on the skin of young infants. Treatment. — The layers of scales may be removed by the use of white eastile soap and warm water, and if there is no inflammation of the skin, a mild carbolic or white precipitate ointment may be used to prevent their return. Flesh-worms. — Acne, commonly called pimples or flesK-worms, com- ing, as it does, upon the face just at the time when young people of both sexes begin to feel most anxious about their personal beauty, gives rise DISEASES OF SKIN GT-ANDS 721 to a far greater amount of unbappiness than many of the serious mala- dies to which flesh is heir. It is an inflammation of the sebaceous glands of the skin upon the face and back, and elsewhere, which comes on in successive crops, and gives rise to the spotted and pimply countenances which are often so unsightly or even repulsive. Description. — These sebaceous glands, one of which is well delineated in the accompanying wood-cut, are generally situated, as there indicated, by the side of a hair, and if in- flamed, caused by the pressure they exert when distended, an in- flammation of the surrounding dorm constituting the pimple of acne. In the figure is exhibited a hair in its follicle, highly mag- nified. At Y and 8 appear the curious little muscles which have the power of erecting the hair in conditions of sudden fright or horror. They are, as is well known, much more active in ani- mals — for instance, the cat — than in mankind. 9 and 10 in- dicate a large, and 11 a small, se- baceous gland, both opening on the skin by the side of the shaft of the hair at 12. The small, black spot generally visible near the centre of an acne pimple is popularly supposed to be the head of a flesh-worm, which can be squeezed out by pressure at the sides of the papule. In reality, however, the yellow thread which looks like the body of a worm, is only the hardened secretion of a sebaceous gland, the top of which, being exposed to the air, has collected dust and dirt, and so become black. Treatment. — Ko advantage is gained by squeezing out these little 46 A Magnified Sebaceous Gland. 723 BKIN DISKABKS. plugs of fatty matter, as in most cases tlie bruising of the parts more lliau compensates for any benefit afforded by the relief of internal pres- sure in the pimple from retained secretion. A great many local applica- tions for the cure of acne are offered for sale, some of which are com- posed of powerful poisons, and are liable to do great and permanent in- jury. A safe and often useful lotion is made of precipitated sulphur, variously combined with mucilage of sassafras-pith, glycerine and cam- phor ; or an ointment of precipitated sulphur, with vaseline, a drachm to the ounce, or white precipitate with vaseline, half a drachm to the ounce, may be employed. Accessory Treatment — The most important part of the treatment is attention to any general derangement of health, especially of the diges- tive apparatus, or, in females, of the menstrual function. Internally one-quarter grain of calcium sulphide three or four times a day is often beneficial. Diet. — Errors in diet will often bring out a crop of acne, and articles of food which contain fried butter or fat of any kind, appear to be apt to have this effect. Pastry of all varieties, particularly mince-pie, buck- wheat and other hot cakes, sausage, cheese and nuts should all be avoided, as well as spirituoiis and malt liquors in every form. Although the treat- ment and hygienic care, as thus advised, will generally diminish the ac- tivity of the eruption, they may not always effect a cure, and consolation must be sought in the fact that it seldom persists unless kept up by im- prudence, after the period of maturity in the organism has been attained. SKIN DISEASES DDE TO VEGETABLE PARASITES, Causes. — It is now generally admitted that the fungus growths found so constantly in and among the epithelial scales of the epidermis are the causes, and not the mere accompaniments, of a curious group of skin maladies. The development of fungus not only invades the skin, but affects also the hair and the hair-follicles. Though the variety of vegetable growth differs in the different diseases, each presents the same general features, consisting of microscopic threads nam»d mycelium, cor- responding to the stem of a larger plant like a grape-vine, and micro- scopic seeds sometimes produced in bunches like grapes, and called spores. The full recognition of the fact, as it is believed to be by the present writer, that the fimgous growth is the essential cause of the whole disease ifi vitally important, because upon it depends the system of preventing BnTG-WORM OF THE nBAD. 723 these maladies from spreading to healthy persons, by total destruction of the spores or seeds of the respective diseases. A Case in Point — In the instance of a member of the author's family, a little girl -was infected with the fungus of Favus just underneath the tip of her chin, probably from spores left by some diseased child on the sill of a car window, from which she had been looking out, and at the time of being attacked with this complaint, which was fortunately rec- ognized at once, and put an end to by appropriate treatment, she was in perfect health. Hing-worm: of the head. Symptoms. — Tinea tonsurans or ring-worm of the head is the most common of these vegetable parasitic diseases. It shows itself as a dry, scaly patch, rounded or oval in outline, which gradually grows larger and larger, the hairs dying and dropping out at the centre, so that ultimately a bald spot of from half an inch to two inches in diameter is left. The same fungus which produces this malady in the head sometimes develops among the hair of the beard, producing what is called tinea sycosis or bar- ber's itch, and upon the other parts of the body where it is denominated tinea circiuata or common ring- worm, with which, however, no worm has anything to do. Further Symptoms — Ring-worm of the scalp com- mences usually as a little plmjjle, which soon spreads and takes on its characteristic ring-like appearance, showing a circle of minute scales, jjimples and vesicles at the circumference of the patch. As the disease ad- vances the hairs included in the circle become dull, dry, twisted and easily broken off, whilst the epider- mis and stumps of the hairs become covered with a The Effect of Ringworm greyish-white powder, consisting chiefly of the vege- oa the Hair. . table growth. Illustration If one of these broken hairs is put into a drop of caustic potash solution, and examined imder a high power, such as 250 diameters of the microscope, its shaft can be Seen as repre- Bented in the figure, penetrated ■with the mycelium of the fungus, called the tricophyton tonsurans, and floating around may often be detected separate spores of the same plant as indicated at the upper part of the wood-cut on bfith sides of the hair. 724 SKIN DISEASES. EING-WORM OF THE BODY. Tinea circinata, which is also denominated herpes circinatiis and ring-worm of the body, begins like that upon the head with a siiiail pimple, but soon spreads with great rapidity, and the rings of eruption may attain a diameter of four or five inches. Characteristic — The great characteristic by which this affection can almost always be recognized is its healing up in the middle, so that the appearance is presented, after a time, of a patch of healthy or slightly reddened skin, surrounded by an angry, red ring about a quarter of an inch wide. Such an arrangement of the eruption is peculiar to ring-worm and suggests that the fungus in its growth at the centre of the ring has exhausted some material found in the skin which is necessary for its de- velopment. "Were this not the case it would almost certainly continue to flourish in the middle, as well as at the edges, so that the course of ring worm affords a strong argument in favor of that part of the germ theory which supposes that the immunity conferred by one attack of small-pox, for instance, is due to the exhaustion in the entire system of some in- gredient necessary to the growth of the specific small-pox fungus. BARBER'S ITCH. Character. — Tinea sycosis, or barber's itcli, is the variety of the dis- ease in which its vegetable cause happens to develop upon the chin of an adult, male patient. A great amount of irritation is usually set up, perhaps, from the roots of the hairs constituting the beard, extending more deeply into the substance of the true skin, and the plant therefore producing a deeper-seated inflammation of the parts as it grows down along the sides of the hair-follicles, than in the non-hairy portions. Hence large papules, and even pustules resembling those of acne in its aggra- vated state, are apt to be formed, and the itching and burning, as well as the disfigurement, are occasionally very troublesome to the patient. Perhaps among the vegetable parasitic diseases there is none to which persons are more liable to be exposed than this tinea sycosis or, as it is .commonly called, the barber's itch. Causes. — As before observed, any one of the innumerable epidermic scales, continually shed from human integument and constantly floating in the atmosphere around us, whence they are deposited with other ma- terials in the form of dust, may be freighted with spores, or seeds enough 725 of tlie fungus which causes tinea, to infect thirty, forty or fifty individuals should they meet with proj^er conditions for growth and reproduction. If persons fully realize this truth they can, of course, readily understand that all the ordinary precautions usually resorted to in barber's saloons, to W'it, those of having separate cups, razors and brushes for each indi- vidual customer only diminish the danger of infection, and by no means insure a certainty of escaping the disease. For not only is the air of the room liable to carry separate epidermic scales, which may each convey the infection, but many of the operations connected with the process of shaving are still more likely to be the means of communication. For instance, the razors which are employed, even if they be individual prop- erty, are all sharpened with the same strap, upon which may have been spread, a few moments before you enter to be shaved, a few score epi- thelial cells from a case of tinea, one or two of which, should they acci- dentally adhere to the surface of your razor, as it certainly is quite pos- sible for them to do, would be amply sufficient to implant the disease upon your face. In like manner the towels which are used, the brushes and combs, and even more certainly the hand of the barber himself, may prove the most efficient carriers of contagion which could possibly be devised. Precautions — In order to prevent the spread of these vegetable para- sitic diseases the precautions already suggested must be rigidly enforced. All articles of clothing which have been worn in contact with parts of the body where the parasite grows should be purified by immersion in boiling water, or, if the nature of the material does not permit this, by baking at a heat of 250° Fahrenheit. All bed linen, bandages, brushes, combs and towels, or other articles suspected of similar contact, should be treated in the same way; and, of course, should be used by no other person until thus purified. The patient, if a child, should be kept by itself as far as possible, and those having charge of the case should thoroughly wash themselves after handling the parts affected. It is probable that the use of a strong carbolic acid soap, or of sulphite of soda or chlorinated soda solution would add to the security against attack, and with such pre- cautions there is little danger that the malady will be transferred to others. Of course after proper treatment has once been put into opera- tion, the danger of infection is still further diminished. Treatment. — 1. The essential point in treatment is to apply to the roots of the hairs a preparation which will kill the fungus, just as weeds are destroyed in an asparagus bed by sowing the ground with salt. In 726 SKIN DISEASES. order to do this, the hair — if any exists — should first be removed, and llie surface made as clean as possible. When the hair is not very thick, (ir has already been nearly destroyed by the disease, a cure may perhaps be effected by lotions or ointments of suljihuric acid, carbolic acid or sali- cylic acid. An ointment of verdigi'is is a favorite home remedy, and often succeeds after causing a good deal of unnecessary irritation. 2, Tincture of iodine, applied twice a day for fourteen days, and the spot then covered with the ointment of corrosive sublimate, of about two grains to the ounce, is an effectual method of treatment, which may be employed with great caution in obstinate cases, or the following solu- tion applied at night : Hyposulphite of soda, one drachm ; water, one ounce. Where the hair is very thick and strong it is sometimes necessary to pull it out with tweezers, as will be directed in speaking of favus, al- though this severe operation is, hapjiily, not often required. SCALD HEAD. Character. — Tinea favosa or favus, called also scald head and honey- comb ring-worm, is characterized by its peculiar dry, sulphur-yellow crusts, in the form of little cups about a quarter of an inch in diameter. In advanced cases, however, these cups run together, so that their well- defined form can, perhaps, with difficulty, be recognized, except at the edge of a patch. A peculiar mouse-like odor is emitted from a child's head bearing a good crop of favus, this being probably produced by the spores of the fungus coming in contact with terminal branches of the olfactory nerve of the observer. On careful inspection, each cup is usually seen to surroimd a hair, and there Is commonly little trouble in detecting the fungus spores and mycelia on microscopic examination. Causes. — Although this disease is more frequently met with upon the heads of neglected, ill-nourished children than elsewhere, there is little doubt that any one of these spores of the achorion schoenleinii, as the fungous cause is denominated, might, under favorable circumstances, germinate and give rise to an abundant crop of favus in the hair, beard, or skin of the most vigorous individual upon whom they happened to be deposited. In some cases the fungus of favus attacks the nails, developing be- neath them and by the pressure which it causes producing their absorption and perforation. Much local inflammation about the root of the nail is lUxoB set up. ITOH (scabies). 727 Treatment. — The treatment of faviis consists in removins the crusts by softening with a poultice, cutting or shaving oil the hair, and then rubbing in thoroughly sulphur or tar ointment. If the spot is small a weak solution of corrosive sublimate may bo painted over it, but this powerful poison requires very careful management. In obstinate cases it may be necessary to pull out the hair, either by the process of avulsion, where a cap made of adhesive plaster is suddenly torn oil the head, bring- ing the hair with it, or by extracting six or eight hairs at a time with tweezers. This latter operation, called epilation, is denominated by Sir E. Wilson "the purgatory of avulsion," and condemned as little loss cruel. Brown Patches. — Tinea versicolor or chloasma depends on the growth in the epidermis of a fungus similar to that of ring-worm, but bearing its spores in heaps like bunches of grapes. The disease, which is seldom troublesome, is characterized by brownish-yellow, slightly scaly, irregular patches, which appear on the front of the chest and sides of the neck. It may also affect other parts of the body. As it does not penetrate deeply into the epidermis it is easily cured by painting with tincture of iodine, tincture of chloride of iron, gr solution of sulphurous acid. ITCH (SCABIES OR CHIGGER). Causes. — Scabies or the itch, the most important skin disease caused by an animal parasite, was called in former times, when its true cause was but little understood, the seven-years' itch, because it was so hard to cure. At present it is universally admitted that the whole cause of this most annoying malady is the itch insect, or itch-mite, which is represented in the cut on the next page as it appears under the microscope if laag-nified about two hundred diameters. From the irritation sot up by the parasite, and still more from the scratching to which it drives the unfortunate pa- tient, vesicles, pimples and pustules are formed and grouped together in every variety. Symptoms. — 1. The itching, which is terribly severe even in daytime, is generally much worse at night after becoming warm in bed. The fa- vorite haunts of the insect upon its human domain are the hollows of the elbows and knees, the front of the wrist and the backs of the hands just below the roots of the tingers ; but it is also found in other portions of the body where the skin is tender. The palms of the hands and the soles of the feet are not infrequently infested, notwithstanding the integu- ment is thick in these parts. In a vast majority of cases showing the '?28 BKIN DISEASES, / -, discrete or separate eruption on the palms and soles it is due to either scabies or syphilis, and the presence of itching in the former and its absence in the latter of these two diseases enables us to distinguish them with great certainty. 2, The accompanying eruptions of scabies vary somewhat in their character according to situation. Thus the prurigo of itch is generally best defined upon the forearms, the lower part of the abdomen, and the upper and inner portion of the thighs. A vesicular eruption is more fre- quent about the fingers and breasts of thin-skinned people, and pustules are met with in children especially on the hands, feet and hips. 3. In searching for a specimen of the insect, which can be seen quite distinctly with a good mag- nifj'ing glass, it is well to look for one of the pimples, which has, ex- tending from it, a little whitish line about an eighth of an inch long and generally somewhat curved. This is the burrow of the female insect, in which she has laid her eggs and is raising a happy little family to fol- low her example and live off the fat of the land they inhabit. If the top g of the burrow is scratched through very carefully at its outer end with the point of a fine needle, and then the tiny round dot which may be found there picked out on the needle and transferred to a slip of glass, positive evidence of the nature of the disease can be at once detected by suitable examination under a microscopic or hand-magnifier. Illustration. — The adjoining figure represents one of these burrows of the acarus scabies or itch insect, and in it is seen the mother of the family at the upper extremity, whilst eggs and young in various stages of development are depicted in different portions of the gallary excavated for their accommodation in the epidermis of their hospitable host. Treatment. — The treatment of scabies should be by applications which, whilst they tend to kill the insects, will increase as little as possible the irritation of the skin. If this irritation is not already too great, the The Itch Insect JIagnified Two Hundred Times. LtOE. Y29 patient should go into a warm bath and scrub himself with brown or soft soap for half an hour; he should then lie in the bath for another half hour, and after being thoroughly dried, rub himself with the compound sulphur ointment all over, except the head, for twenty minutes, allowing the oint- ment to remain on the body all night. This whole process should be re- peated every night for three times, which will probably end the lives of the itch insects and so terminate the malady. Disinfection. — In order, however, to avoid being reinfected from the clothing upon which some of the acari or their eggs r.iay remain, every article that will bear washing should be thor- oughly boiled, and those pieces of ap- parel which would bj injured by Avater should be several times pressed with a hot iron, so as to completely destroy the parasites. Further Treatment. — When the skin is very irritable the application of Peruvian balsam or the styrax oint- ment should be tried at first, and it ought to be remembered that even in ihose whose skins are not remarkably fender the sulphur ointment, if used \cry vigorously, is apt to prodncc an eczematous eruption, which, however, quickly subsides on the cessation of the application. The Burrow of the Itcll Insect. IICE. Treatment for lice — The three kinds of pediculi or lice which infest the head, the body and the jaibcs of num, differ in their appearance under the microscope, being apparently each best fitted for the special part it has to play in tormenting the human family. They can all be defeated in this great business of their lives by strict attention to cleanliness, fre- quent bathing, and the application of mercurial ointment diluted with five times its bulk of lard. For the purpose of avoiding salivation, this oint- VSO BKIN DISEASES. ment should not be used directly after a bath, nor rubbed in very strongly, nor, in fact, allowed to remain in coufact witli the skin any more than necessary, or a one to one thousand solution of bichloride of mercury may be applied. PART XII OF BOOK IV Tells of the bones and muscles of the human body and the diseases to which they are subject. Abdominal Muscle 7S2 Abscess within a Joint 742 Ankle-to-Knee Bones lyj Arm Bones 735 Leverage of 744 Atrophy of the Muscles 746 Attachment, Muscular 743 Bones ^zz Ankle Ti7 Arm 735 Brittleness 740 Chest 739 Chicken 734 Chondroma 740 Diseases of the 733,740 Dislocation of 739 Face 738 Inflammatory Affections 740 Knee Ti7 Leg 72,7 Marrow of the 734 May be United 733 Necrosis 740 Nodes 740 Number of 733 Osteoma 740 Osteomalacia 740 Osteomata 741 Softening of 740 Synovitis 741 Skull , 7i7 Spine 738 Structure of , 734 Thorax 739 Wrist 735 Brittleness of Bone 740 Canals. Telescopic View of tlie 734 Chest Bones 739 Muscles 752 Chicken Bones 734 Chondroma 740 731 Coxalgia 742 Detecting Trichina 751 Discovery of Trichinae 749 Diseases of the Bones 733 , 740 of the Muscles 7^1, 746 Dislocation of Bones 739 Epidemics of Trichiniasis 750 Exhaustion Caused by Trichina; ....748 Face Bones 738 Muscles 745, 752 Flexor Muscles 745 Fluid, Synovial 735 Foot Muscles 752 Forearm Muscles 752 Formation of Skull 738 Fracture, Repair of 739 Fragilitis Ossicum 740 Hand Muscles 752 Head Muscles 752 Hip Disease 742 Hip Muscles 752 Human Skeleton, Parts of 736 Hypertrophy of the Muscles 746 Inflammatory Diseases of Muscles.. 746 Intercostal Muscles 745 Involuntary Muscles 743 Joint, Abscess within 742 Joints, Kinds of 735 Knee-to-Ankle Bones 7:^7 Leg Bones 7},7 Muscles 752 Leverage of Arm 744 Leverage, Muscular ....; 744 Longest Muscle 745 Marrow of the Bones 734 Muscles 742 Abdominal 752 Atrophy of 746 Chest 752 Degeneration of 753 Diseases of the 733, 746 732 INDEX TO PAET XII OF BOOK IV. Flexor 74S Foot 752 Forearm 752 Hand 752 Head 752 Hip 752 Inflammatory Diseases of 746 of the Face 745, 752 Hypertrophy of 746 Intercostal 745 Involuntary 743 Leg 752 Longest 745 Neck 752 Number of 744 Shoulder 752 of Spinal Colum:i 745 Thigh 752 Voluntarj' 743 Muscular Attachmc;.t 743 Leverage 744 Muscular Sj-ster.i 7 ;-, 752 Composition 742 Involuntary 743 Mechanism 743 Voluntary 743 Muscular Function 742 Myositis 753 Necrosis 740 Nodes 740 Number of Bones 733 of Muscles 744 Neck Muscles 752 Ossification 753 Osteoma 740 Osteomalacia 740 Osteomata 741 Paralysis Caused by Trichina ....748 Pott's Disease 742 Repair of Fractures 739 Shoulder Muscles 752 Skull Bones Ty7 Skull Formation 738 Softening of Bone 740 Spine Bones 738 Spinal Column, Muscles of 745 Sprains, Nature of TZ7 Structure of Bones 734 Synovial Fluid 735 Synovitis 741 Thigh Muscles 752 Thorax Bone Tyj Trichinas 747 Characteristic Sign of 748 Discovery of 749 Effects of 747 Exhaustion in 748 How they Breed 747 Method of Detection 751 Paralysis in 748 Trichinae Spiralis, Size of 749 Vitality of 730 Trichiniasis 746 Epidemics of 750 Tumors 753 Vitality of Trichinae 750 Voluntary Muscles 743 iWrist Bones ,. 735 ILLUSTRATIONS Bones of Forearm Acting as Levers 744 Calcified Trichin» 751 Encysted Trichina 747 Human Skeleton, Parts of 736 Muscular System 752 Trichina Cyst 749 Trichina and Its Cyst 7So Trichina Spiralis in Human Muscles 746 CURATIVE MEDICINE PAUT XII. DISEASES OF THE BONES AND MUSCLES Bones.- — The skeleton is tlie framework of the hody, and is composed of an articulated assemblage of hard organs, the bones. It serves to preserve the shape of the body; forms cases for the pro- tection of the vital organs, and gives attachment to muscles and forms levers of movement. Number of Bones. — The number of distinct pieces or bones compos- ing the skeleton varies at different periods of life. Some remain distinct from the first moment of their development, such generally being of the simplest form, such as the bones of the carpus or wrist, and the patella or knee cap. Others, which are viewed as single bones in the adult, not only consist of several pieces in the beginning,, but in the progress of develop- ment have other pieces successively added, as in the case of the vertebrsB or bones of the spine and the thigh bones. May Unite Bones — Again bones considered as distinct pieces when the body has arrived at maturity, at a later period may become united with those which are contiguous, as in the coossification of the cranial bones. Therefore in the adult skeleton the number of bones to which we usually refer are two hundred and six, exclusive of the teeth and sesamoid and wormian bones, which are not imiform in number. Of this number twenty-six are found in the backbone or spine; twenty-two in the skull and face ; the ribs count twenty-four, twelve on each side, whether the per- son be man or woman ; each arm has thirty-two bones, and each leg has thirty. These bones vary very much in size, shape and thickness, and all have been named and described with great minuteness by anatomists. Composition of Bones The bones under every modification of shapo and mechanical arrangement are constituted by precisely the same elemen- CTSS) 734] DISEASES OF TUB BONES A^'l) MUSCLES. tary matters, the principles of wliicH are an animal auJ an earthy suh- stance, in intimate combination. Phosphate of lime is the most abundant mineral material, being about 51 parts in the 100 of bone. Carbonate of lime, 11.3 parts ; fluoride of calcium, 2 parts. The animal matter of bone is gelatinous, allied to cartilage ; originally every bone is developed from cartilage by ossification. The mineral matter of bone increases with age ; making bones of the old more brittle. There is more of it also in some bones and parts of bones than in others. Structure of Bone — A good idea of the structure of a bone may be gained by picking the second joint of a chicken or turkey clean, and then sawing off about an inch of the upper end and splitting this piece in half lengthwise Avith a hatchet or strong knife. This thigh-bone of a turkey corresponds to the femur or thigh-bone in a human being, where it lies near the centre of the leg and reaches from the hip to the knee. Ita upper end may be recognized by its having upon it a single round knob, which formed part of the hip-joint. Marrow of the Bone. — On examining such a bone it is found to be hol- low in the middle, and partly filled with a fatty substance called the marrow of bone. In this marrow run important little blood-vessels, which carry the blood to nourish the bone, and from it they pass and repass to minute channels running lengthwise in its substance, which are called the Haversian canals, after the name of the jihysician who first discovered them. In dried bones, and especially when they have undergone pro- longed bleaching in the open air, such as those of a long dead horse or cow, these Haversian canals may be readily seen, looking like fine pores in the broken ends of the bones. Telescopic View of the Canals — Under the microscope they are dis- covered to be encircled with rings of lacuna, or little holes in the bone sub- stance, each of which communicates with its neighbors by very minute branching tubes. During the life of an animal the lacuna are filled with soft, jelly-like bone-corpuscles, but in dried bones these gelatinous bodies shrivel up, leaving the lacuna empty, except of air, which, by refracting light differently from what the solid bone does, makes the lacuna look like black dots under the microscope. Bones of a Chicken. — If the breast-bone of a young chicken is ex- amined it will be found that its smaller end is made up of the tough, milk- white or semi-transparent substance caUed gristle or cartilage. When a BTEUCTUEE Oe BONE. 73S chicken is first hatched nearly all its bones are chiefly composed of carti- lage, and as it gro'svs older they gradually become more and more ossified, that is, changed into bone. But certain portions of the body commonly remain cartilaginous through life, as, for instance, the gristly bands which fasten the ribs to the breast-bone, and the rings of the trachea or windpipe. Bones of Arm. — The bones of the arm, counting from the shoulder downward as it hangs at the side, are first the humerus or arm-bone, which extends to the elbow, and next the two bones of the fore-arm, which make up the part from the elbow to the wrist, and are named the radius and ulna. The latter of these two bones projects on the under side of the arm, and the radius has: the hand attached to it, and is rolled part way around the ulna every time the hand is turned over from the position of prona- tion, or lying with its palm downward, to that of supination or lying ^ipon its back. This is a very imjjortant movement, and great care must be taken by the use of properly padded splints to save it, when the radius and ulna of the fore-arm are fractured by accident, as very frequently happens. Bones of Wrist. — The wi-ist or carpus is composed of eight small bones, each with a hard name derived from Greek or Latin, and the palm of the hand is formed by four of the metacarpal, a word meaning beyond the wrist bones, the metacarpal bone of the thumb making the fifth. The bones of the fingers consist of three rows of phalanges, the thumb having two phalanges only. Besides the bones mentioned, anatomists reckon the shoulder-blade, or scapula, and the collar-bone, or clavicle, as belonging to the arm, or. as they name it, the upper extremity. Kinds of Joints. — The joints of the ann exemplify the two chief kinds of articulation made use of in the human body, namely, the ball and socket joint, of which the shoulder is an example, and the hinge-like joint, of which the elbow is a good illustration. The joints between the meta- carpal bones and the first row of the phalanges of the fingers, that is, those at the roots of the fingers, are imperfectly formed ball and socket joints, and allow, as anyone can see in his own hands, of a good deal of lateral or sidewise, as well as backward and forward motion. The other articula- tions of the fingers are hinge-joints, and like the hinges of a gate, permit only of a back and forth motion. The Synovial Fluid The ends of bones where they rub against each other inside the joints are covered with firm smooth cartilage, and tO diminish the friction as much as possible these polished surfaces of cartilage are kept slippery by a peculiar liquid named the synovial fluid 736 DTRKASKS Ol.' 1 UK BONES AND MUSCI-ES. PARTS OF THE HUMAN SKELETON. Top Central Plate. — This shows the bones of the cranium, or head, - eight in number. The large frontal bone forms the forehead The articulation of the teeth are prominent. It also shows the facial bones, or those of the face, fourteen in number. Middle Central Plate. — This shows the bones of the chest ; the sternum, or breast bone, in the centre ; the ten true and two floating ribs on either side, and part of tlie backbone, to which the ribs are attached. lower Central Plate. — This plate shows the bones of the pelvis. Pelvis means basin. It is the basin or girdle by which the bones of the lower body, as the hip bones, are joined to the upper. The two large side bones are the os inuominata, or unnamed bones. The central triangular bone i3 the sacrum, a composite bone, forming the union between the vertebraa and OS coccyx, or tail end of the backbone. Tipper Left-Hand Plate — This represents the eight bones of the carpus (wrist) ; the five of the metacarpus (between wrist and phalanges), and fourteen bones of tlie phalanges (battle rank bones), twenty-seven in all. Next Figure Below. — This is the sacrum, detached from the pelvic girdle. It is also seen in lower middle plate. It is called sacrum (sacred), because it was of old offered up in sacrifices. Third Left-Hand Figure. — This is a section, or single joint of the backbone, or spinal cord. Bottom Left-Hand Plate. — This represents the femur, or great thigh bone. It is cylinder-shaped, and the largest, longest and strongest bone in the body. Upper Right-Hand Plate. — This represents the bones of the foot. They are divided into three classes. 1. Tarsus, or ankle bones, seven in all. 2. Metatarsus (between tarsus and phalanges), five in all. 3. Phalanges (battle-rank bones), fourteen in all, a total of twenty-six foot bones. Middle Right-Hand Plate — This represents a part of the backbone or spinal column. It consists of a series of vertebrae, within which is the spinal cord oj- nerve, to injure whieli means paralysis or death. Lower Right-Hand Plate. — This is the humerus (shoulder), or bone of the upper arm. It is the only bone in the upper arm, and it revolves on the scapula (shoulder-blade) above, and the ulna and radius of the fore- arm below. Parts oft/ie //uman SAe/eton. cop,«K„r i»,6 i>vt.j.srA.-iu;r or "joint-water." This sjnovial fluid, called also tke synovia, acts the part of oil to a door hinge, and when sometimes in old people the synovia becomes scanty, their joints will creak and grow stiff, just as the hinges of a door do for want of oil. The ends of the bones in a joint are held in place by a tough, firm wrapper, called the capsular ligament, which encloses them tightly on all sides, and also prevents the synovia from escaping and being lost. Bones of Leg. — In general arrangement the bones of the legs are very similar to those of the arms, making allowance for the difference in func- tion of the two pairs of limbs. The thigh-bone or femur is the longest and strongest bone in the body, as might be expected from the larger share of work in walking, running and leaping it has to perform. It is articulated (or jointed) to the pelvis at the lower corner of the body by the hip-joint, a ball and socket articulation, which allows of considerable movement in every direction. Knee to Ankle. — From the knee to the ankle, the leg, like the fore- arm, is furnished with two bones. One of these, called the tibia, is the ehin-bone, forming the front of the leg and the inner side of the ankle, that is, the side next the other limb. The bone on the outer side of each leg and each ankle is named the fibula, and is much smaller than the tibia, its partner in the business of supporting the weight of the body. The ankle or tarsus is composed of seven bones instead of eight, as are found in the carpus, and it is articulated below and in front, near the middle of the foot, with five metatarsal bones. At the front, ends of the metatarsal bones are jointed on the toes, each with its three rows of phalanges, except the great toe, which, like the thumb, has but bxo. Nature of Sprains — The ankle-joint is more apt to be "sprained" or "strained," than any other, and this accident, therefore, requires a fev.- words of explanation here. A strain of a joint is' the result of moving the bones which compose it too far, or in an imnatural direction, so that the capsular and other ligaments are stretched or perhaps torn a little by the force applied. A strained joint is very painful, apt to swell rapidly, and often proves troiiblesome for months, or even years, if not properly treated. Until a doctor comes, the injured articulation should be placed in an elevated position, so that the blood will drain away from it, kept perfectly quiet, and covered with cloths wrung out of hot or cold water, so as to reduce the danger of inflammation. Bones of Skull. — The bones of the skull or cranium are broad, com- paratively thin, and curved in such a way as to make a hollow casa or Ml 738 DISEASES OF TIIK KONKS AND MUSCLES. oval box, shaped a good deal like an egg, for the i)roteetion of the brain, which is placed inside of them. Tlie most important are the frontal or forehead bone, the two temporal or temple bones and the occipital bone, which is at the back of the head. These bones are united together by seams or sutures, consisting of a curious kind of dove-tailing, which fas- tens them so firmly together that, in their natural state, it is impossible to get them apart -without breaking them. Character of Skull Formation — The arch form of the skaW makes it much more capable of resisting blows upon the head ; but if these are so severe as to fracture the bones, especially if they are dented in so as to press upon the brains, unconsciousness is often very quickly produced. Tliis would hajipen miich more frequently were it not for the layer of spongy matter interposed between the hard plates which form the cranial bones. Bones of the Face. — The bones of the face are comparatively light and thin, except the lower jawbone, into which are set the lower teeth, and which is the only bone about the head which is furnished with a movable joint, except the occipital bone, where it rests upon the neck. Bone of Spine — The spine or backbone is made up of twenty-four vertebra;, the sacrum and the coccyx. These latter bones seem to be each composed of several vertebra;, which, for the purpose of being rendered stronger, have growTi fast together. The uppermost vertebrte is called the atlas, because upon it the head is supported ; and the second is named the axis, because upon it the atlas, and with it the whole head, turns, as in shaking the head negatively. The upper seven vertebras are called the cervical or neck bones; the next twelve are designated as the dorsal or back vertebr£e; and the last five are named the lumbar vertebrte or vertebrae of the loins. These twenty-four bones are fitted together in such a way as to form a continuous tube, which receives and protects the spinal cord or spinal marrow just as the upper continuation o-f the spinal cord — that is, the brain — is encased and protected by the bones of the skull. The vertebrae are jointed so as to allow considerable motion, both sideways, forward and backward, and have between each pair a cushion of fibro- cartilage, which serves to preserve the brain from injury by the shocks and jars which would otherwise be given to it in jumping, running and various other movements. The sacrum, which is continuous vrith the vertebrae, is united with two large, flat and irregularly-shaped bones, to form the pelvis or basin at the lower part of the trunk. The pelvis sup- ports the spine and the organs in the abdominal cavity, and is in its turn OIBLOCATION OF BONE8. 739 sustained on each side by the thigh bones, which prop it np at the hip- joints, as already indicated. Bones of the Thorax or Chest — The heart and hmgs are protected by a bony cage composed of the twenty-four ribs, which lie a little be- neath the skin of the thorax or chest and in thin persons can be easily felt at the sides or near the breast-bone. This breast-bone or sternum is sit- uated directly in the middle or front of the thorax and has the front ends of the ribs attached to it by cartilages, named the costal or rib-cartilages, which allow of the outward and upward movement of the ribs, necessary in breathing. The back or posterior ends of the ribs arc jointed on to the verte- brae of 4he spinal coluum in such a way as to allow of needful motion, and yet secure sufiieicnt stability and firmness. Dislocation of Bones — ^When a dislocation occurs, or, as it is com- monly called, a bone is put out of joint, the bones composing an articu- lation have been pulled or twisted so hard as to displace thom, breaking some of the ligaments Avhich are arranged to keep them in their proper positions. Example of Dislocation. — Generally, a person whose arm, at the Bhoulder, for example, is dislocated, suffers a good deal of pain and loses the use of the limb until the bones are put back in their places again, or as it is called, the dislocation is reduced. A dislocation is one of the heavy penalties people often have to pay for imprudent over-exertion in lifting and wrestling, or for carelessly letting themselves have falls and hard knocks, or becoming entangled in railway accidents. Bepair of Fractures — The repair of broken or fractured bones is a wonderful process of nature, in which a material called callus, at first like putty, is formed aroimd the broken ends, holding them together, feebly at first, but afterward it gradually hardens, imiting them more firmly indeed. Since this "knitting" of the broken bones may occur in almost any position they happen to lie in, or are pulled into by the irritated muscles in the neighborhood, it is evidently very important that they should bo put and kept in exactly the right place. For this purpose there are many ingenious splints and bandages devised and used by surgeons. See Acci- dents and Emergencies and Surgical Diseases. '740 DISEASES or THE BONES AND MUSOLES. DISEASES OF THE BONE. Inflammatory Affections. — These sometimes follow woiinds^ but are more common as result of syphilitic or scrofulous disease. There is swell- ing and pain of affected part (especially at night). Unless overcome in early stage, necrosis is apt to follow. Necrosis — This disease is akin to mortification of the flesh and is sometimes called Death of the Bones. It may occur from injuries to and inflammation of the periosteum or may be due to phosphorous poisoning. There is dull, deep-seated — sometimes acute — pain, followed by increase of size and the formation of new bone aroimd the old. There is tenderness and distension and a breaking down of tissue with a discharge of pus and of small particles of bones. Blood poisoning frequently ensues from absorption of dead bone tissue that has not found outlet. To prevent this an incision should be made over a swelling in bone troubles if pus be sus- pected and thus permit escape of diseased parts. This should only bo done by a skilled surgeon and under thorough antiseptic conditions. Tem- porary relief is obtainable by poultices and quieting fomentations. Surg- ery is usually necessary, all diseased bone being scraped away. Nodes. — These are hard, bony swellings, which are apt to occur as tertiary symptoms of constitutional syphilis. They are most common in long bones and are frequently found on the front surface of shin-bone. They are often painful for a time, particularly at night, but yield promptly to treatment with the iodide of potassium in the majority of cases. Softening of Bone (Osteomalacia) — This is an uncommon disease ob- served in adults ; seldom seen in males, occurring in greater frequency in. females. It is characterized by a softening of the bones, rendering them very liable to break or bend on the application of little force; resulting from absorption or deficiency of the earthy matters in the bones. Brittleness of Bone (Fragilitis Ossicnm) — This is an affection of bone in which the inorganic are out of projiortion to the organic constituents, rendering the bones brittle; there is an apparent increase of the earthy matters, with a diminution of the vascularity of the bone. Children and young persons seem to suffer most from this disease, and in many instances an hereditary tendency can be traced. Osteoma (Chondroma). — The bones are subject to tumors, to cartila- ginous or other growths. They form hard rounded tumors, fixed to their point of origin. They may attain a huge size — but are usually smalL WSEASKS OF BOIHBS. 741 They grow slowly without pain or other symptoms except such as' may be caused by their bulk or pressure, and interfere with the functions of neighboring nerves. Osteomata are liable to inflammation and necrosis, but never under- go malignant or cancerous degeneration. Chondromata may not only become inflamed, and necrosis and sloughing follow; but it becomes can- cerous in some instances ; for instance, after an injury to a bone, a chon- droma may appear and develop with terrible rapidity, and upon its re- moval may return, become cancerous and form secondary tumors else- where. Treatment. — If osteomata or chondromata are removed whilst small the operation is to be recommended, but when left imtil a huge tumor has developed, of the nature of which no doubt can be entertained, any interference is of questionable propriety. Synovitis. — Among the important diseases of the joints must be men- tioned synovitis or inflammation of the lining membrane, by which the synovia or joint-water is secreted. This disease, usually attended with severe pain, and when the joint is a large one accompanied with much constitutional disturbance and fever, appears in two forms, the acute and the chronic. Causes — The acute form is usually the result of injury, which may be very slight in its character, as even the least puncture of the joint by which air can enter is liable to produce it. Acute synovitis rims its course in ten or twelve days, causing much swelling and severe suffering on the slightest movement of the limb to which the joint is attached. The chronic form is commonly a continuation of the acute, and may itself result in softening and what is called pulpy degeneration of the synovial membrane. Treatment — The treatment of synovitis is by free leeching of the affected part; perfect rest in bed, with the limb elevated and secured in a splint if needful ; low diet with saline purgatives, such as epsom salts or seidlitz powders, and anodynes to relieve pain. In the chronic form small blisters and painting with tincture of iodine are likely to prove useful. Inflammation of the synovial structure of the joints is apt to take on a rheumatic, scrofulous or syphilitic character in persons who are con- stitutionally under the influence of these taints. In such instances the appropriate treatment for them, as already pointed out, is to be associated with that for ordinary synovitis. Ulceration of the cartilages may occur in a joint as a consequence «f T42 UTSEASES OF THE BONES ANT> MUSCLES. long-continued inflammation, causing intense pain, nml nsnally disabling the limb. Its liability to occur renders the prompt treatment of synovitis doubly important. Abscess (Coxalgia). — Abscess within a joint is rare in healthy per- sons, bwt in the scrofulous it is by no means uncommon, and in strumous children abscess in the hip-joint, causing the lamentably frequent affec- tion, coxalgia, is a malady of much importance. Treatment — The general treatment in these sad cases is that already indicated for scrofula, but the local trouble should be immediately at- tended to by an exjiericnced surgeon, and remedied as far as possible by; the aid of the complicated apparatus devised for the purpose. Pott's Disease. — This consists of a tubercular inflammation of the bodies of the vertebrae or spinal bones, and their cartilages ; and is most common in children between two and ten years of age, altho\igh it may occur at any age. In some cases the affection appears to follow a slight injury to the spine in those of tubercular or strumous tendencies, in others the disease develops without apparent exciting causes. Symptoms — Rigidity of spine, tenderness and local pain are the prominent early symptoms. Abscess may occur early, but is most com- mon in the late stages. Deformity or spinal curvature nsually occurs as a result of the disease process, depending upon the an^ount of breaking down in the bones and the falling together of the vertebra?, and may be gradual or rapid in its development. Treatment is as indicated in article on Coxalgia. THE MUSCTJIAH SYSTEM. Muscular Function. — The power which moves different parts of the frame, according to the directions of the will, as, for instance, the legs, in walking, is produced by the contraction of muscles. These muscles form the lean meat of animals and of the human body, and, except in very fat people, make wp a larger portion of the bulk of the frame than any of its other constituents. Composition — They are composed, as is readily seen in a piece of fresh beef or mutton, of long strings of reddish material, which, imder the microscope, are found to be made up of a multitude of fine, beaded threads, arranged in small bundles, and called the ultimate muscular fibres. They exercise power in moving the limbs, and so forth, by shorten- ing up or contracting when excited by the nervous fluid, sent to them through the nerves from the brain, as ordered to do so by the will. THE MTrSOTri.AB BYSTKlf. 743 Mechanism — The exact mechanism of moving the arm, for instance, by the process of contraction, may he easily imderstood from the picture shown on page 752, in wHich it is readily perceived that the shortening up of the muscle must pull up the hand, bending the arm at the elbow-joint, and changing the position from that represented in the second, to that shown in the third figure. Precisely the same kind of operations accom- plish the motions of lifting the feet in walking or climbing, swinging the arm in throwing a ball, ojiening and shutting the mouth, and, indeed, of most of the voluntary movements of which we are capable. Voluntary and Involuntary — But whilst many of the muscles are con- trolled by the will and are, therefore, called voluntary, many of them arc not so ruled, and hence have received the name of involuntary. Most Important Involuntary Muscles — ^Among the most important of the involuntary muscles are the heart, the intercostal muscles, the muscles between the ribs which help to expand the lungs in respiration, and the muscular fibres of the alimentary canal, which aid in pushing along the food in digestion. Fortimate is it for us that such is the fact ; for other- wise, when our wills were off duty, as in sound sleep, the operations of these vital organs would stop, and life, which depends upon them, soon cease. Muscular Attachment — The muscles are usually attached to the bones, and move them by sinews or tendons, Avhich are made of white, fibrous tissue, the strongest and most flexible material in the body. These ten- dons are like long, round, white cords, such as may be seen in the lower part of the leg of a chicken. The largest tendon in the human body is that of the heel, called the tendon Achilles, which is the continuation of the big muscle of the calf of the leg. This powerful muscle is used in jumping and, since it acts at a great disadvantage, is necessarily very strong in order to be able to throw the entire body forward, as in making a leap. Origin and Insertion. — As a general, but by no means imiversal, rule, a muscle has one attacliment which is fixed, commonly spoken of as its origin, and a second, called its insertion, upon which it acts by drawing it toward the origin when the muscular substance contracts. Muscles mostly pass in a straight line between their two attachments, but some- times they act around an angle by sliding over a pulley, or by means of a small bone in the tendon, like the knee-pan. The muscles are so attached that they are always slightly on the stretch, and thus, at the moment they begin to contract, they are in an advantageous position to bring their ru D1SEA«BI OI TUB BONES AND MU80LK8. action to bear on the bones which they move. When the contraction ceases, the bones are drawn back to their former position without anj sudden jerk. Muscular Leverage — The muscles commonly act upon the bones as levers, by working upon the short arm of the lever, so that more direct force is required on the part of the muscle than there is weight in the body moved. From this arrangement, however, the indispensable advan- tage is gained that the small contraction of the muscle causes an extensive movement of the part acted upon, and much greater rapidity of motion is secured. Each of the three orders of levers is met with in the different bones of the human skeleton; often, indeed, all three varieties are found in the same joint, as for example, the elbow, where the simple flexion and extension of the biceps and triceps muscles, which are large, fleshy masses on the front and back of the arm, between the shoiilder and elbow, afford excellent illustrations, as sho\\Ti in the accompanying figure. Illustration of Leverage — The arm is used as a lever of the first order when the triceps is caused to contract, and by pulling ujion the upper end of the forearm moves the hand around the elbow- joint, which serves as a fulcrum. This is shown in tlie uj)per diagram in which the hand is repre- sented as striking a blow with a dagger. Again the aiTU furnishes an example of a lever of the second order, when the hand resting on a point of support, such as a table, acts as the fulcrum, and the triceps muscle pulling on the ^ upper end of the ulna or smaller arm bone, by \ '^^^^.x straightening the arm lifts a weight placed upon it in front of the elbow. The third order of levers is exemplified by the arm when bent by the contraction of the bi- ceps in ordinary flexion of the elbow. Here the muscle, which is the power, is placed between the fulcrum, which is the lower end of the humerus at ''"as "ive^rt of 7hrTifr«"'' ^^^ clbow-joiut, and the weight, which is lifted in °"^'"' the pnlm of the hand, «s shown in the lower dia- Number of Muscles.— The whole number of muscles in the human being is not far from five himdred, mostly arranged in pairs on opposite TM.a MUBODLAK SYSTEM. 745 sides of the bead, body or limbs. It is, tberefore, manifestly impossible to describe tbem all in detail tere, and yet there are a few wbich are important enough to require notice. Important Muscles of the Face — Among the muscles of the face should be mentioned those of the eye, six in number, four of which turn the eye- ball up or down, inward toward the nose or outward toward the temple, as becomes necessary to see an object distinctly. The muscles of expression are especially attached about the mouth, and produce their effects by puck- ering up the lips, as in whistling; drawing wp the corners and widening the mouth, as in laughing ; pulling down its angles, as in weeping, and so forth. The masseter muscles placed inside the cheeks between the upper and lower jaws are very strong, and enable human beings to chew up some very hard articles of food in the operation of mastication, as has been already explained. Flexor Muscles — The action of the large muscle of the front of the arm, called the bicej^s or two-headed muscle, has been already described. The muscle of the forearm, which shut the fingers as in clasjiing the hand, are called the flexors, because they flex or bend the fingers. The tendons by which their power is conveyed may be readily felt on the inside of the ^vrist of a man who tries to shut his hand when the fingers are forcibly held open by another person. The forearm muscles which open out the fingers after the hand is closed, in doubling up the first for in- stance by the flexors, are called the extensors. The tendons of the ex- tensor muscles, when the latter are strongly contracted, show very dis- tinctly on the back of the hand, as straight, hard cords, running from the root of each finger to the middle of the wrist. Muscles of the Spinal Column — The spinal column is almost sur- rounded, except in front, by a thick mass of muscles, which gives the great strength required by many kinds of laborers, such as porters who carry heavy loads upon their backs. The muscles of the leg, which are needed in walking, running and jumping, are very large and strong, correspond- ing to the hard Avork they are called upon to perform. The longest Muscle. — The longest muscle in the body is the sartorius or tailor's muscle, which is so named because it helps to bend the lower limbs into the cross-legged posture so . frequently adopted by tailors. It lies on the inside of the thigh, is thin and narrow, but sometimes measures over two feet in length. Intercostal Muscles. — The intercostals are flat, thin layers of muscular fibres, which extend from the lower edge of each rib, except the last pair, 746 DISEASES OF THE BONES AND MUSCLES. to the upper margin of the rib next below. In tliis way they fill up all the spaces between the bars of the bony cage in which the lungs are contained, and, when tliey contract, pull iip these bars or ribs so as to widen and deepen the cavity of the thorax, and so cause air to be drawn into the lungs. DISEASES OF THE MTJSCLES. Inflammatory Disease — Inflammatory disease of the muscular system, except as it is connected with rheumatism or pyemia, is extremely un- common. When it occurs it is liable to go on to suppuration, and the for- mation of abscess. The pain is dull and aching rather than acute, r.nd the disease is to be treated as already directed in speaking of the manage- ment of boils. Hypertrophy and Atrophy. — These occur in muscles and i>roduce ef- fects important or otherwise, according to the jjosition of the muscle in the animal economy. The most important hyper- trophy is that of the muscle composing the heart, the influence of which has been detailed in the article on valvular disease affecting this organ. Contractions. — Palsy and spasm in various forms have also been considered in the chapter on diseases of the nervous system, upon which these disturbances chiefly, thought not entirely, depend. Trichiniasis.- — The most important disease of the muscular system not yet discussed is its infection with parasites, and particularly with the trichina spiralis or pork worm, which, in consequence of the late embargoes upon American hams and bacon, has assumed a national or, indeed, an international im- portance. The great fatality in many cases of trichiniasis, as the malady produced by the trichina has been named, and the ease with which the whole trouble can be avoided by a proper understanding of the nature and origin of the affection, render a full account of the entire malady and its means of prevention singularly appropriate to a popular work like the present one. The Trichina Spiralis — The trichina spiralis, which is next, perhaps, to the echinococcus, the most dangeroiis animal parasite infecting man, is found also in pigs, foxes, giiinca-pigs, rats, cats, mice, marmots, polecats, badgers, and more rarely in some other animals, including the dog. A Trichina Spiralis in Human Muscles. DISEASES OF THE MUSCLES. 747 physician of Philadelphia found that of ten cats which ho dissected in 1879 nine were infested with trichinse. Sources of Trichinae — Pigs, from whicli the human race is most apt to become diseased with trichina, are supposed to become themselves in- fected, chiefly from eating rats, the ofFal of other pigs, and the excreta of human beings containing trichinaj. It is doubtful whether a single case of trichiniasis in man ever occurred where the patients became infected otherwise than by eating raw or underdone pork, and the most common sources of infection arc sausages, ham and bacon. How Trichinae Breed — If the trichinas existing in diseased pork are very yoimg they may bo simply digested, when they reach the human stomach, without being developed. But if the parasites have attained their fuller growth, the cysts which contain them are alone dissolved by the gastric juice, and the erabyro is set free. These embryos, after they pass through the pylorus and duodenum, soon be- come mature, and their thread-like ap- pearance renders them quite easily recognizable by the naked eye. Coimt- less eggs are now discharged by the females, and in about a week's time the new brood of trichina3 hatched out from these eggs begin to make their way to the muscles, either by boring their way through the soft tissues, or by being carried along by the current of blood in the blood-vessels, or per- haps by both of these methods of progression through the body. These larval triehinaj attain their full size in about two weeks from the time they leave the egg. The males and females are each about one-thirtieth of an inch long and about one seven-hun- dredth of an inch broad. Effects of Trichinae — In some few favorable cases severe gastro- intestinal inflammation is set up, and the parasites are violently expelled by diarrhoea, without being able to enter the muscles at all, so that if it Encysted Trichina More Highly Magnified Showing Structure of the Parasites. 748 DISKASBS OF THE BOITES AITD MUSOLKS. ■were possible to detect the malady with certainty at this stage, nature thus suggests the appropriate treatment by drastic purgatives. In the majority of instances, however, the migration of immense numbers of larval trichina} from the intestinal canal takes place, and occupies in gen- eral about four days only. In this brief space of time even the most dis- tant muscles of the body may all be invaded. Symptoms. — Among the earlier symptoms of the trichina disease are a general feeling of debility and discomfort, and a loss of appetite, to which succeed nausea and vomiting, diarrhcea, prostration of strength, and a sen- sation of stiffness about the neck, arms and legs. These evidences of illness resemble, it will be observed, to a great extent, the first stage of typhoid fever, for which the cases are usually mistaken if there is no point in the history of the patient to suggest trichiniasis. The further progress of the parasites through the tissues sets up high fever, with frequent pulse and copious offensive perspirations, although the temperature of the body sel- dom or never reaches the elevation which characterizes that of typhoid. For some days the stiffness of the limbs seems to increase, while all the muscles become painful, swollen, and very sensitive to the touch. A Characteristic Sign — ^About the end of the first week the attention of the attending physician is usually awakened (if it has not previously been aroused) to a suspicion of the trichina disease by the appearance of an edematous swelling of the eyelids and root of the nose. This is often the first characteristic sign of trichiniasis, and should be looked for at this period of the illness in all cases of supposed typhoid and rheumatic fever. During the second week movement of the intercostal miiscles in respira- tion grows very painful, thus preventing to a great extent the necessary repose of the patient. If the diaphragm is invaded, severe hiccough is apt to come on, and when the larval trichinae commence to infest the laryngeal muscles hoarseness and loss of voice make their appearance. Cause Paralysis and Exhaustion — When a large quantity of trichinous meat has been eaten, so that the immigration into the muscles of the afflicted patient is by millions, they soon cause an almost paralyzed con- dition, attended by excessive exhaustion. The facial edema continues through the second week, when it generally disappears, and is followed by swelling of the feet and legs, and ultimately of the trunk. At the end of the third week, if the patient suiwives to this period, the pulse and respira- tion are very frequent, the tongue is red and dry; the mouth can scarcely 1)0 opened, the sweating is profuse, the pain so severe that little or no sleep can be obtained, and there is great anxiety or delirium, death. frequently DiaXASltiti Vif THK MUSOI.BS. '749 occurring in tie fourth or fifth week, witL symptoms of jirofound ex- haustion. Complications — Complications, sucli as pneumonia, peritonitis nml pleurisy, are not uncommon, but in favorable cases when the number cf triehinte is comjDaratively small, or the constitution of the patient un- usually vigorous, the pain, swelling and diarrhcea begin to abate, the op- pression of breathing ^Jasses off, the desire for food returns, sleep is ob- tained, and the anemic patient enters upon a slow and tediou3 con- valescence ; the parasites having become encysted within the muscles, these gradually become acclimated, as it were, to the presence of the foreign bodies, and slowly regain most or all of their original powers and iimctions. Further Symptoms. — After piercing the fibrous eheath of the muscular fibre bundles, the embryonic trichluEB become encysted within lemon-shaped capsules (generally one worm in each capsule), of a sort of con- nective tissue, in which they have some freedom of movement. After a time, these capsules, which, of course, are fixed to one spot in the muscle, become calcified, a process which occupies in man about two years. During this jieriod there is often, for a time, in patients who recover, some loss of power, for a while almost complete, in muscles or groups of muscles; but not infrequently, after this stage is reached, entire re- covery ultimately seems to take place. Still, this in- fested condition of the muscle, which probably exists in thousands of people who walk about utterly unconscious of it, may be the yet undetermined cause of rheumatism and paralysis, or promote the development of consumjition and other wasting diseases. Size of Mature Trichinae Spiralis — The mature trichina; — tlie males being about one-eighteenth and the females about one-eighth of an inch long — live in the intestines for six or eight weeks. They never reach the soft tissues of the body, In which their young larvae are so abundant, "but are discharged, from time to time, with the excreta of the patient, either alive or after their death has occurred. Discovery of Trichinse.- — Trichina;, as well as cysticerci, were first dis- covered in human beings in the dissecting room, by Dr. Simon, in 1S35. Professor Leidy was the first to detect them In the pig. They were, however, repeatedly observed without their true import being ascertained l^til 1860, when Dr. Zenker, of Dresden, explained their origin and Commencing Calcification of Trichina Cyst. 750 DISBASKS OF THE BONKS AND IMUSCI.ES. relation to certain symptoms of obscure attacks of sickness, and described the disease trichinosis or trichiniasis. In the same year Leukart piiblished his elaborate and trustworthy investigations upon the subject of the trichina. Previous to ISCO the trichina had been identified only once in pork, although, as occurring in man, it had been well known for a quarter of a century. It is not decided how it will retain its vitality when encysted in human muscles. Eemarkable Vitality of the Trichinae. — Professor Langenbeck, of Ber- lin, has reported a case where, in removing a tumor from the neck of a patient, eighteen years after the man had an attach of trichiniasis, which passed for poisoning at the time, he found living trichina; in the frag- ments of attached muscles; and it is stated on good authority that they have been known to exhibit signs of life after a still greater lapse of time. As in this instance, before Zenker's discovery, very many cases passed for jjoisoning, for typhoid and rheumatic fever, and for other diseases. An epidemic involv- ing over five hundred persons in Blankenberg, Ger- many, was treated as an outbreak of gastro-rheumatic fever, and it was only several years afterward that the attention of one of the gentlemen who suffer(>d from the disease being called to Zenker's discovery, he submitted to an operation for the removal of a small piece of one of his pectoral muscles, in which Trichina and Its Cyst encvstcd trichina3 were detected, and the true nature Completely Calcified. ^ ' of the disorder which had affected the five hundred patients many years previously was revealed for the first time. Epidemics of Trichiniasis. — In this country severe epidemics have oeciirred in Xew York, Mississippi and Iowa, and isolated cases are from time to time appearing in various other States. In 1S75, it is stated, that there were some eighty cases of trichiniasis in Berlin, and about seventy- five near Hanover. A group of cases occurred in 18S2 in Bridesburg, and another near 'New York. In 1874: there was quite a severe epidemic in the family of a pork packer residing in Buffalo, N^ew York. The disease is as rare in France as it is common throughout the German Empire. Vitalty of Trichinae After Death of Infected Hog. — In pork the trichinae may be found either encysted or naked among the muscular fibres. It is not certain how long they may live after the pig is killed, but they are known to be capable of propagation after remaining for DISEASES OF THE MTJS0LE8. 751 one hundred days in putrid pork. The frequency of the disease in swine is probably as great, if not greater, in America than elsewhere ; but here mankind is not so often infected, because less raw or under-dono sausage, ham, bacon, and so forth, is eaten with us than in Eurojie. Of 1,394 hogs taken at random, and examined by the Chicago Academy of Sciences, twenty-eight were found to be infected with trichinae; but this large pro- jiortion can only be accounted for on the supposition that au epidemic among swine Avas then raging. Method of Detecting Trichinae — The editor of the American Journal cf Mici'oscopy recommends that in examining the flesh of swine suspected of being infected with tricliinas, the following method should be adopted : The parts of the animal to be first tested are the diajihragm, the tenderloin, and the muscles of the head and throat. In the ham, the most likely place to find the parasites is Avhere the muscle ends in tendon. A thin slice should be cut off with a sharp scalpel, or with a pair of scissors curved on the flat. This thin section should then be soaked for some minutes in acetic acid, spread out on a glass slide, and covered with a thin glass in the ordinary way ; or, if the section happens to be very thick, a compres- sorium, in which the two plates of glass are forced together by means of a lever and screw, will be found very useful. A little instrument constructed on the plan o£ the compressorium, and called a "trichinoscope," is sold to supply the popular demand for home pro- tection against triehiuic. Infected Pork Should be Destroyed All pork which has been found to contain trichina? should be seized, condemned and destroyed, either by fire or by strong mineral acids, siich as the sulphuric or nitric. Mere burying of 2:)oisonous meat of this kind is obviously not sufiicient. Moreover, the question as to whether owners of such carcasses should not be compensated for all property confiscated, is well worthy of consideration; because if siich was the rule, butchers and dealers would have no inducement for concealment and fraudulent sale. Only Safe Rule. — In spite, however, of any apparently perfect system of inspection, such as that adopted in Germany, dangerous meat, from some cause or other, will necessarily escape observation, so that the only Human Muscle Containin Calcified .Trichinae. (Natural Size.) ?62 DISEASES OF THE BONES AND MUSCLES. safe rule for us to adopt, and to urge upou everybody else, is never to cat any pork •which has not been thoroughly cooked. It is not safe to trust to pickling and smoking, even when these processes" are combined, as is ordinarily the case, and it must be borne in mind that meat is seldom thoroughly cooked when cut in slices more than an inch thick. The fact that two dangerous and often fatal maladies like trichiniasis and cysticercus disease, both of which are generally beyond the reach of medical treatment when once they have infected the human system, are not infrequent from eating pork which has been imperfectly cooked, should render the employment of this culinary precaution in regard to all meats imiversal, especially as it is a safeguard so easily applied. Myositis — This affection consists in an inflammation of the voluntary muscles, and may arise from injury to or overuse of a miiscle, from gout or rheumatism, from secondary syphilis, or from infection followed by suppuration. Treatment — The treatment for injury or overuse of muscle is ab- solute rest of muscle and the local ajiplication of anod;)Tie lotions. If due to rheumatism or syphilis, prompt relief wiR follow treatment appropriate to these affections. Degeneraton of Muscles — Fatty degeneration is occasionally observed in muscular tissue — in which the tissue is converted into a fatty granular mass. Treatment. — By use of passive motion, massage and electricity to im- prove nutrition of the muscles. Ossification — Ossification of a portion of a muscle, or more fre- quently of its point of insertion into a bone, is occasionally observed as a result of long-continued irritation. Its course is slow and unaffected by treatment. Tumors. — Muscles may be the seat of cancerous, syphilitic, vascular, cartilaginous or osseous growths. The treatment depends entirely upon their nature ; non-malignant growths can often be removed by dissection ; canceroiis or malignant growths involving miiscles of the extremities should be cut out or, as many cases call for, prompt amputation of the limb. T/)e /luscu/dr System Front w/ew. COPVmOHT I9ie BYC.J STANLtr DISEASBS OF THE MUSOIiBS. 753 THE MUSCULAR SYSTEM (See Adjoining Plate). The plate presents a comprehensive view of the front muscles of the body. They may be grouped and viewed thus : Head Muscles. — 1. These are seen above the eyes, and are used for elevating the upper eyelids and corrugating the forehead. Face Muscles — 2. These are muscles of expression and mastication. Those about the eyes are used in winking and opening and shutting. Those seen at either side of the nose lift the cheeks and lips. Those at the sides control the lower jaw in eating. Neck Muscles. — 3. These serve to lower and raise the head and turn it from side to side. Shoulder Muscles — 4. These embrace the shoulders and upper arm. They are the great lifting and hitting muscles. The prominent one on the upper arm is the biceps muscle, or muscle with two heads. Muscles of Forearm — 5. These control rotary, flexor and extensor motion, from the elbow to the wrist. Hand Muscles — 6. These control all hand motions — opening and shutting, i-otation, flexor and extensor movements. Chest Muscles — 7. These are radiating from sides to centre. They control the twisting, elevation and lowering of the upper part of the body. Abdominal Muscle — 8. This is seen in the centre, in white. It is intimately connected with breathing and raising and lowering the dia- phragm. At its top is the solar plexus, the spot upon which prizefighters seek to deliver their knockout blows. Hip, Thigh and leg Muscles — 9. These powerful muscles cooperate for every kind of movement and exhibition of strength. The two strap- like muscles of the upper leg are the sartorial, or tailor's muscles, which enable us to cross our legs. Lower Leg Muscles. — 10. These are also powerful, and possessed of rotary, flexor and extensor power. They largely control the feet in walk- ing, operating clear to the ankle joint. Foot Muscle — 11. These control from instep to toes, each toe having its elevating and depressing muscle. The rotary motion of the foot is imparted wholly from the ankle. 18 SLP 2 1 1993 UC IRVINE LIBRARY 3 1970 01015 4950 Date Due FEB 28 1978 RiCD FEE fri973 vTo Hr