,the ,home ,medical ,library ,by ,,kenelm ,,winslow1 ,b4,a4,s41 ,m4,d4 ,formerly ,assistant ,professor ,comparative ,therapeutics1 ,harvard ,university2 ,late ,surgeon to the ,newton ,hospital2 ,fellow of the ,massachusetts ,medical ,society1 etc4 ,with the ,cooperation of ,many ,medical ,advising ,editors and ,special ,contributors ,,in ,,six ,,volumes ,first ,aid 33 ,family ,medicines 33 ,nose1 ,throat1 ,lungs1 ,eye1 and ,ear 33 ,stomach and ,bowels 33 ,tumors and ,skin ,diseases 33 ,rheumatism 33 ,germ ,diseases ,nervous ,diseases 33 ,insanity 33 ,sexual ,hygiene ,woman and ,child 33 ,heart1 ,blood1 and ,digestion ,personal ,hygiene 33 ,indoor ,exercise ,diet and ,conduct for ,long ,life 33 ,practical ,kitchen ,science 33 ,nervousness and ,outdoor ,life 33 ,nurse and ,patient ,camping ,comfort 33 ,sanitation of the ,household 33 ,pure ,water ,supply 33 ,pure ,food ,stable and ,kennel ,,new ,,york ,the ,review of ,reviews ,company #aijg ,medical ,advising ,editors ,managing ,editor ,,albert ,,warren ,,ferris1 ,a4,m41 ,m4,d4 ,former ,assistant in ,neurology1 ,columbia ,university2 ,former ,chairman1 ,section on ,neurology and ,psychiatry1 ,new ,york ,academy of ,medicine2 ,assistant in ,medicine1 ,university and ,bellevue ,hospital ,medical ,college2 ,medical ,editor1 ,new ,international ,encyclopedia4 ,nervous ,diseases ,,charles ,e4 ,,atwood1 ,m4,d4 ,assistant in ,neurology1 ,columbia ,university2 ,former ,physician1 ,utica ,state ,hospital and ,bloomingdale ,hospital for ,insane ,patients2 ,former ,clinical ,assistant to ,sir ,william ,gowers1 ,national ,hospital1 ,london4 ,pregnancy ,,russell ,,bellamy1 ,m4,d4 ,assistant in ,obstetrics and ,gynecology1 ,cornell ,university ,medical ,college ,dispensary2 ,captain and ,assistant ,surgeon 7in charge71 ,squadron ,a1 ,new ,york ,cavalry2 ,assistant in ,surgery1 ,new ,york ,polyclinic4 ,germ ,diseases ,,hermann ,,michael ,,biggs1 ,m4,d4 ,general ,medical ,officer and ,director of ,bacteriological ,laboratories1 ,new ,york ,city ,department of ,health2 ,professor of ,clinical ,medicine in ,university and ,bellevue ,hospital ,medical ,college2 ,visiting ,physician to ,bellevue1 ,st4 ,vincent's1 ,willard ,parker1 and ,riverside ,hospitals4 ,the ,eye and ,ear ,j4 ,,herbert ,,claiborne1 ,m4,d4 ,clinical ,instructor in ,ophthalmology1 ,cornell ,university ,medical ,college2 ,former ,adjunct ,professor of ,ophthalmology1 ,new ,york ,polyclinic2 ,former ,instructor in ,ophthalmology in ,columbia ,university2 ,surgeon1 ,new ,amsterdam ,eye and ,ear ,hospital4 ,sanitation ,,thomas ,,darlington1 ,m4,d4 ,health ,commissioner of ,new ,york ,city2 ,former ,president ,medical ,board1 ,new ,york ,foundling ,hospital2 ,consulting ,physician1 ,french ,hospital2 ,attending ,physician1 ,st4 ,john's ,riverside ,hospital1 ,yonkers2 ,surgeon to ,new ,croton ,aqueduct and other ,public ,works1 to ,copper ,queen ,consolidated ,mining ,company of ,arizona1 and ,arizona and ,southeastern ,railroad ,hospital2 ,author of ,medical and ,climatological ,works4 ,menstruation ,,austin ,,flint1 ,,jr41 ,m4,d4 ,professor of ,obstetrics and ,clinical ,gynecology1 ,new ,york ,university and ,bellevue ,hospital ,medical ,college2 ,visiting ,physician1 ,bellevue ,hospital2 ,consulting ,obstetrician1 ,new ,york ,maternity ,hospital2 ,attending ,physician1 ,hospital for ,ruptured and ,crippled1 ,manhattan ,maternity and ,emergency ,hospitals4 ,heart and ,blood ,,john ,,bessner ,,huber1 ,a4,m41 ,m4,d4 ,assistant in ,medicine1 ,university and ,bellevue ,hospital ,medical ,college2 ,visiting ,physician to ,st4 ,joseph's ,home for ,consumptives2 ,author of ,consumption3 ,its ,relation to ,man and ,his ,civilization2 ,its ,prevention and ,cure4 ,skin ,diseases ,,james ,c4 ,,johnston1 ,a4,b41 ,m4,d4 ,instructor in ,pathology and ,chief of ,clinic1 ,department of ,dermatology1 ,cornell ,university ,medical ,college4 ,diseases of ,children ,,charles ,,gilmore ,,kerley1 ,m4,d4 ,professor of ,pediatrics1 ,new ,york ,polyclinic ,medical ,school and ,hospital2 ,attending ,physician1 ,new ,york ,infant ,asylum1 ,children's ,department of ,sydenham ,hospital1 and ,babies' ,hospital1 ,n4 ,y42 ,consulting ,physician1 ,home for ,crippled ,children4 ,bites and ,stings ,,george ,,gibier ,,rambaud1 ,m4,d4 ,president1 ,new ,york ,pasteur ,institute4 ,headache ,,alonzo ,d4 ,,rockwell1 ,a4,m41 ,m4,d4 ,former ,professor ,electro-,therapeutics and ,neurology at ,new ,york ,post-,graduate ,medical ,school2 ,neurologist and ,electro-,therapeutist to the ,flushing ,hospital2 ,former ,electro-,therapeutist to the ,woman's ,hospital in the ,state of ,new ,york2 ,author of ,works on ,medical and ,surgical ,uses of ,electricity1 ,nervous ,exhaustion 7,neurasthenia71 etc4 ,poisons ,e4 ,,ellsworth ,,smith1 ,m4,d4 ,pathologist1 ,st4 ,john's ,hospital1 ,yonkers2 ,somerset ,hospital1 ,somerville1 ,n4 ,j42 ,trinity ,hospital1 ,st4 ,bartholomew's ,clinic1 and the ,new ,york ,west ,side ,german ,dispensary4 ,catarrh ,,samuel ,,wood ,,thurber1 ,m4,d4 ,chief of ,clinic and ,instructor in ,laryngology1 ,columbia ,university2 ,laryngologist to the ,orphan's ,home and ,hospital4 ,care of ,infants ,,herbert ,b4 ,,wilcox1 ,m4,d4 ,assistant in ,diseases of ,children1 ,columbia ,university4 ,special ,contributors ,food ,adulteration ,s4 ,,josephine ,,baker1 ,m4,d4 ,medical ,inspector1 ,new ,york ,city ,department of ,health4 ,pure ,water ,supply ,,william ,,paul ,,gerhard1 ,c4,e4 ,consulting ,engineer for ,sanitary ,works2 ,member of ,american ,public ,health ,association2 ,member1 ,american ,society ,mechanical ,engineers2 ,corresponding ,member of ,american ,institute of ,architects1 etc42 ,author of ,house ,drainage1 etc4 ,care of ,food ,,janet ,,mckenzie ,,hill ,editor1 ,boston ,cooking ,school ,magazine4 ,nerves and ,outdoor ,life ,s4 ,,weir ,,mitchell1 ,m4,d41 ,,ll4,d4 ,,ll4,d4 7,harvard1 ,edinburgh1 ,princeton72 ,former ,president1 ,philadelphia ,college of ,physicians2 ,member1 ,national ,academy of ,sciences1 ,association of ,american ,physicians1 etc42 ,author of essays3 ,injuries to ,nerves1 ,doctor and ,patient1 ,fat and ,blood1 etc42 of scientific works3 ,researches ,upon the ,venom of the ,rattlesnake1 etc42 of novels3 ,hugh ,wynne1 ,characteristics1 ,constance ,trescott1 ,the ,adventures of ,francois1 etc4 ,sanitation ,,george ,m4 ,,price1 ,m4,d4 ,former ,medical ,sanitary ,inspector1 ,department of ,health1 ,new ,york ,city2 ,inspector1 ,new ,york ,sanitary ,aid ,society of the #ajth ,ward1 #ahhe2 ,manager1 ,model ,tenement-houses of the ,new ,york ,tenement-house ,building ,co41 #ahhh2 ,inspector1 ,new ,york ,state ,tenement-house ,commission1 #ahie2 ,author of ,tenement-house ,inspection1 ,handbook on ,sanitation1 etc4 ,indoor ,exercise ,,dudley ,,allen ,,sargent1 ,m4,d4 ,director of ,hemenway ,gymnasium1 ,harvard ,university2 ,former ,president1 ,american ,physical ,culture ,society2 ,director1 ,normal ,school of ,physical ,training1 ,cambridge1 ,mass42 ,president1 ,american ,association for ,promotion of ,physical ,education2 ,author of ,universal ,test for ,strength1 ,health1 ,strength and ,power1 etc4 ,long ,life ,,sir ,,henry ,,thompson1 ,bart41 ,f4,r4,c4,s41 ,m4,b4 7,lond47 ,surgeon ,extraordinary to ,his ,majesty the ,king of the ,belgians2 ,consulting ,surgeon to ,university ,college ,hospital1 ,london2 ,emeritus ,professor of ,clinical ,surgery to ,university ,college1 ,london1 etc4 ,camp ,comfort ,,stewart ,,edward ,,white ,author of ,the ,forest1 ,the ,mountains1 ,the ,silent ,places1 ,the ,blazed ,trail1 etc4 ,illustration3 ,,harvey ,,washington ,,wiley1 ,ph4,d41 ,,ll4,d4 ,the researches of ,dr4 ,wiley1 ,chief of the ,bureau of ,chemistry in the ,united ,states ,department of ,agriculture1 were important factors in hastening the enactment of the present pure food law4 ,he analyzed the various food products and made public the deceptions practiced by unscrupulous manufacturers4 ,he aroused attention throughout the country by pointing out the necessity of a campaign of education1 in order1 as stated in ,volume ,v1 ,part ,,ii1 that the housekeeper might be able to determine the purity of every article of food offered for sale4 ,as an example of his methods1 he organized a poison squad of government employees who restricted themselves to special diets1 consisting of food preparations containing drugs commonly used as adulterants4 ,in this way he actually demonstrated the effect of these substances upon the human system4 ,the ,home ,medical ,library ,volume ,,ii ,,the ,,eye ,,and ,,ear ,,the ,,nose1 ,,throat ,,and ,,lungs ,,skin ,,diseases ,,tumors 33 ,,rheumatism ,,headache 33 ,,sexual ,,hygiene ,by ,,kenelm ,,winslow1 ,b4,a4,s41 ,m4,d4 7,harv47 ,formerly ,assistant ,professor ,comparative ,therapeutics1 ,harvard ,university2 ,late ,surgeon to the ,newton ,hospital2 ,fellow of the ,massachusetts ,medical ,society1 etc4 ,,insanity ,by ,,albert ,,warren ,,ferris1 ,a4,m41 ,m4,d4 ,former ,assistant in ,neurology1 ,columbia ,university2 former ,chairman1 ,section on ,neurology and ,psychiatry1 ,new ,york ,academy of ,medicine2 ,assistant in ,medicine1 ,university and ,bellevue ,hospital ,medical ,college2 ,medical ,editor1 ,new ,international ,encyclopedia ,,new ,,york ,the ,review of ,reviews ,company #aijg ,copyright1 #aijg1 by ,,the ,,review ,,of ,,reviews ,,company ,,the ,,trow ,,press1 ,,new ,,york ,contents ,,part ,i ,,chapter ,,page ,i4 ,,the ,,eye ,,and ,,ear #ac ,foreign ,bodies in the ,eye--,black ,eye--,twitching of the ,eyelids--,wounds and ,burns--,congestion-- ,conjunctivitis--,pink ,eye--,strain--,astigmatism-- ,deafness--,foreign ,bodies in the ,ear--,earache--,simple ,remedies4 ,,ii4 ,,the ,,nose ,,and ,,throat #ea ,nosebleed--,foreign ,bodies in the ,nose--,cold in the ,head--,toothache--,mouth-,breathing--,s ore ,mouth-- ,pharyngitis--,how to ,treat ,tonsilitis--,quinsy-- ,diphtheria--,croup--,laryngitis4 ,,iii4 ,,the ,,lungs ,,and ,,bronchial ,,tubes #hg ,acute and ,chronic ,bronchitis--,coughs in ,children-- ,liniments and ,poultices--,cough ,mixtures--,treatment of ,pneumonia--,consumption--,asthma--,infl uenza1 its ,symptoms and ,cure4 ,,iv4 ,,headaches #aac ,causes of ,sick ,headache--,symptoms and ,treatment-- ,headaches ,caused by ,indigestion--,organic ,disease a ,frequent ,source--,nervous and ,neuralgic ,headaches-- ,effect of ,poison--,heat-,stroke4 ,,part ,,ii ,i4 ,,growths ,,and ,,enlargements #abc ,cancers--,fatty ,tumors--,use of ,patent ,preparations ,dangerous--,symptoms and ,cure of ,rupture--,the ,best ,kind of ,truss--,varicose ,veins--,varicocele--,external and ,internal ,piles--,operations the ,most ,certain ,cure4 ,,ii4 ,,skin ,,diseases ,,and ,,related ,,disorders #aci ,itching1 ,chafing1 and ,chapping--,treatment of ,hives--,nettlerash--,pimples--,fever ,blisters--,prickly ,heat--,cause of ,ringworm--,freckles and ,other ,skin ,discolorations--,ivy ,poison--,warts and ,corns-- ,boils--,carbuncles4 ,,iii4 ,,rheumatism ,,and ,,kindred ,,diseases #afi ,inflammatory ,rheumatism--,symptoms and ,treatment-- ,muscular ,rheumatism--,lumbago--,stiff ,neck--,rheumatism of the ,chest--,chronic ,rheumatism--,rheumatic ,gout-- ,scurvy in ,adults and ,infants--,gout1 its ,causes and ,remedies4 ,,part ,,iii ,i4 ,,health ,,and ,,purity #aia ,duties of ,parents--,sexual ,abuse--,dangers to ,health--,physical ,examination of ,infants--,necessary ,knowledge of ,sex ,functions ,natural--,the ,critical ,age of ,puberty--,marriage ,relations4 ,,ii4 ,,genito-,,urinary ,,diseases #aii ,gonorrhea in ,men and ,women--,dangers of ,infection-- ,syphilis1 its ,causes1 ,symptoms1 and ,treatment-- ,incontinence and ,suppression of ,urine--,bed-wetting-- ,inflammation of the ,bladder--,acute and ,chronic ,bright's ,disease4 ,,part ,,iv ,i4 ,,insanity #bbi ,mental ,disorder ,not ,insanity--,illusions of the ,insane--,hallucinations and ,delusions--,signs and ,causes of ,insanity--,paranoia--,how the ,physician ,should ,be ,aided--,the ,best ,preventive4 ,appendix4 ,,patent ,,medicines #bde ,advice ,regarding the ,use of ,patent ,medicines--,laws ,regulating the ,sale of ,drugs--,proprietary ,medicines--,good ,remedies--,dangers of ,so-called ,cures--,headache ,powders--,the ,great ,american ,fraud4 ,part ,i ,,the ,,eye ,,and ,,ear1 ,,the ,,nose ,,and ,,throat1 ,,the ,,lungs ,,and ,,bronchial ,,tubes1 ,,headaches ,,by ,,kenelm ,,winslow ,,chapter ,i ,the ,eye and ,ear ,injuries to the ,eye--,inflammatory ,conditions--,pink ,eye--,nearsightedness and ,farsightedness--,deafness--,remedies for ,earache4 ,,cinders ,,and ,,other ,,foreign ,,bodies ,,in ,,the ,,eye4--,foreign bodies are most frequently lodged on the under surface of the upper lid1 although the surface of the eyeball and the inner aspect of the lower lid should also be carefully inspected4 ,a drop of a two-per-cent solution of cocaine will render painless the manipulations4 ,the patient should be directed to continue looking downward1 and the lashes and edge of the lid are grasped by the forefinger and thumb of the right hand1 while a very small pencil is gently pressed against the upper part of the lid1 and the lower part is lifted outward and upward against the pencil so that it is turned inside out4 ,the lid may be kept in this position by a little pressure on the lashes1 while the cinder1 or whatever foreign body it may be1 is removed by gently sweeping it off the mucous membrane with a fold of a soft1 clean handkerchief4 ,hot cinders and pieces of metal may become so deeply lodged in the surface of the eye that it is necessary to dig them out with a needle 7which has been passed through a flame to kill the germs on it7 after cocaine solution has been dropped into the eye twice at a minute interval4 ,such a procedure is1 of course1 appropriate for an oculist1 but when it is impossible to secure medical aid for days it can be attempted without much fear1 if done carefully1 as more harm will result if the offending body is left in place4 ,it is surprising to see what a hole in the surface of the eye will fill up in a few days4 ,if the foreign body has caused a good deal of irritation before its removal1 it is best to drop into the eye a solution of boric acid 7ten grains to the ounce of water7 four times daily4 ,,black ,,eye4--,to relieve this condition it is first necessary to reduce the swelling4 ,this can be done by applying to the closed lids1 every three minutes1 little squares of white cotton or linen1 four fold and about as large as a silver dollar1 which have laid on a cake of ice until thoroughly cold4 ,this treatment is most effective when pursued almost continuously for twenty-four hours4 ,the cold compresses should not be permitted to overlap the nose1 or a violent cold in the head may ensue4 ,the swelling having subsided1 the discoloration next occupies our attention4 ,this may be removed speedily by applying1 more or less constantly below the lower lid1 little pieces of flannel dipped in water as hot as can be borne4 ,the cloths must be changed as often as they cool4 ,repeat this treatment for a half hour every two hours or so during the day4 ,,stye4--,a stye is a boil on the eyelid2 it begins at the root of a hair as a hard swelling which may extend to the whole lid4 ,the tip of the swelling takes on a yellowish color1 breaks down and discharges matter or pus4 ,there are pain and a feeling of tension in the lid1 and1 very rarely1 some fever4 ,when one stye follows another it is well to have the eyes examined by an oculist1 as eye-strain is often an inviting cause of the trouble1 and this can be corrected by the use of glasses4 ,otherwise the patient is probably run down from chronic constipation and anaemia 7poverty of the blood7 and other causes1 and needs a change of air1 tonics1 and exercise out of doors4 ,in a depreciated condition1 rubbing the lids causes introduction of disease germs4 ,the immediate treatment1 which may cut short the trouble1 consists in bathing the eyelid for fifteen minutes at a time1 every hour1 with a hot solution of boric acid 7half a teaspoonful to the cup of water74 ,then at night the swelling should be painted with collodion1 several coats1 being careful not to get it in the eye1 as it would cause much smarting4 ,if the stye persists in progressing1 bathing it in hot water will cause it to discharge pus and terminate much sooner4 ,,twitching ,,of ,,the ,,eyelids4--,this condition may be due to eye-strain1 and can be relieved if the eyes are fitted to glasses by an oculist 7not an optician74 ,it is frequently an accompaniment of inflammation of the eyes1 and when this is cured the twitching of the lids disappears4 ,when the eyes are otherwise normal the twitching is frequently one of the signs of nerve fag and overwork4 ,,wounds ,,and ,,burns ,,about ,,the ,,eyes4--,slight wounds of the inner surface of the eyelids close readily without stitching if the boric-acid solution 7ten grains to the ounce of water7 is dropped into the eye four times daily4 ,burns of the inner surface of the lids follow the entrance of hot water1 hot ashes1 lime1 acids1 and molten metals4 ,burns produced by lime are treated by dropping a solution of vinegar 7one part of vinegar to four of water7 into the eye1 while those caused by acids are relieved by similar treatment with limewater or solution of baking soda 7half a teaspoonful to the glass of water74 ,if these remedies are not at hand1 the essential object is attained by washing the eye with a strong current of water1 as from a hose or faucet4 ,if there is much swelling of the lids1 and inflammation after the accident1 drop boric-acid solution into the eye four times daily4 ,treatment by cold compresses1 as recommended for black eye1 will do much also to quiet the irritation1 and the patient should wear dark glasses4 ,,sore ,,eyes2 ,,conjunctivitis4--,the mucous membrane lining the inner surface of the eyelids also covers the front of the eyeball1 although so transparent here that it is not apparent to the observer4 ,inflammation of this membrane is more commonly limited to that portion covering the inner surfaces of the lids1 but may extend to the eyeball when the eye becomes bloodshot and the condition more serious4 ,for the sake of convenience we may speak of a mild form of sore eye1 as congestion of the eyelids1 and the more severe type1 as true conjunctivitis 7see p4 #ah74 ,,congestion ,,of ,,the ,,eyelids4--,this may be caused by smoke or dust in the atmosphere1 by other foreign bodies in the eye2 frequently by eye-strain1 due to far- or near-sightedness1 astigmatism1 or muscular weakness1 which may be corrected by an oculist's 7never an optician's7 prescription for glasses4 ,exposure to an excessive glare of light1 as in the case of firemen1 or1 on the other hand1 reading constantly and often in a poor light1 will induce irritation of the lids4 ,the germs which cause cold in the head often find their way into the eyes through the tear ducts1 which connect the inner corner of the eyes with the nose1 and thus may set up similar trouble in the eyes4 ,symptoms4--,the eyes feel weary and as if there were sand in them4 ,there may be also smarting1 burning1 or itching of the lids1 and there is disinclination for any prolonged use of the eyes4 ,the lids1 when examined1 are found to be much deeper red than usual1 and slightly swollen1 but there is no discharge from the eye1 and this fact serves to distinguish this mild type of inflammation from the more severe form4 ,treatment4--,the use of dark glasses and a few drops of zinc-sulphate solution 7one grain to the ounce of water7 in the eye1 three times daily1 will often cure the trouble4 ,if this does not do so within a few days then an oculist should be consulted1 and it will frequently be found that glasses are needed to secure freedom from irritation of the eyes4 ,in using eye-drops the head should be held back1 and several drops be squeezed from a medicine dropper into the inner corner of the eye4 ,,conjunctivitis2 ,,catarrhal ,,inflammation ,,of ,,the ,,eyes4--,in this disorder there is discharge which sticks the lids together during the night4 ,the inner surface of the lids is much reddened1 the blood vessels in the lining membrane are much enlarged1 and the lids are slightly swollen4 ,the redness may extend to the eyeball and give it a bloodshot appearance4 ,there is no interference with sight other than momentary blurring caused by the discharge1 and occasionally there is very severe pain1 as if a cinder had suddenly fallen in the eye4 ,this symptom may occur at night and awaken the patient1 and may be the reason for his first consulting a physician4 ,one eye is commonly attacked twenty-four to thirty-six hours before the other1 and even if it is thought that the cause is a cinder1 in case of one eye1 it can hardly be possible to sustain this belief in the case of the involvement of both eyes4 ,there is a feeling of discomfort about the eyes1 and often a burning1 and constant watering1 the tears containing flakes of white discharge4 ,when the discharge is a copious1 creamy pus or matter1 associated with great swelling of the lids and pain on exposure to light1 the cause is usually a germ of a special disease1 and the eyesight will very probably be lost unless a skillful physician be immediately secured4 ,early treatment is1 however1 of great service1 and1 until a physician can be obtained1 the treatment recommended below should be followed conscientiously2 by this means the sight may be saved4 ,this dangerous variety of inflammation of the eyes is not rare in the newborn1 and infants having red eyes within a few days of birth should immediately receive proper attention1 or blindness for life will be the issue4 ,this is the usual source of that form of blindness with which babies are commonly said to have been born4 ,all forms of severe inflammation of the lids are contagious1 especially the variety last considered1 and can be conveyed1 by means of the discharge1 through the agency of towels1 handkerchiefs1 soap1 wash basins1 etc41 and produce the same or sometimes different types of inflammation in healthy eyes4 ,therefore1 if the severe form of conjunctivitis breaks out among any large number of people1 as in schools1 prisons1 asylums1 and almshouses1 isolation of the patients should be enforced4 ,,pink ,,eye4--,this is a severe epidemic form of catarrh of the eye1 which is caused by a special germ known as the ,koch-,weeks bacillus4 ,the treatment of this is the same as that outlined below4 ,the germ of pneumonia and that of grippe also often cause conjunctivitis1 and catching cold1 chronic nasal catarrh1 exposure to foul vapors and gases1 or tobacco smoke1 and the other causes enumerated1 as leading to congestion of the lids1 are also responsible for catarrhal inflammation of the eye4 ,treatment4--,in the milder attacks of conjunctivitis the treatment should be that recommended above for congestion of the lids4 ,the swelling and inflammation1 in the severer types1 are greatly relieved by the application of the cold-water compresses1 advised under the section on black eye1 for an hour at a time1 thrice daily4 ,confinement in a dark room1 or the use of dark glasses1 and drops of zinc sulphate 7one grain in an ounce of water7 three times a day1 with hourly dropping of boric acid 7ten grains to the ounce of water7 constitute the ordinary treatment4 ,in inflammations with copious discharge of creamy pus1 and great swelling of the lids1 the eyes should be washed out with the boric-acid solution every half hour1 and a solution of silver nitrate 7two grains to the ounce of water7 dropped into the eye1 once daily1 followed immediately by a weak solution of common salt in water to neutralize the nitrate of silver1 after its action has been secured4 ,the constant use of ice cloths1 already mentioned1 forms a necessary adjunct to treatment4 ,the sound eye must be protected from the chance of contagion1 arising from a possible infection from the pus discharging from its mate4 ,this may be secured by bandaging the well eye1 or1 better1 by covering it with a watch crystal kept in place by surgeon's plaster4 ,in treating sore eyes with discharge1 in babies1 the infant should be held in the lap with its head backward and inclined toward the side of the sore eye1 so that in washing the eye no discharge will flow into the sound eye4 ,the boric acid may then be dropped from a medicine dropper1 or applied upon a little wad of absorbent cotton1 to the inner corner of the eye1 while the eyelids are held apart4 ,hemorrhages occurring under the conjunctiva 7or membrane lining the inner surface of the lids and covering the front surface of the eyeball7 may be caused by blows or other injury to the eye1 by violent coughing1 by straining1 etc4 ,dark-red spots may appear in the white of the eyeball1 slightly raised above the surface1 which are little blood clots under the conjunctival membrane4 ,no special trouble results and there is nothing to be done except to wait till the blood is absorbed1 which will happen in time4 ,if the eyes water1 solution of zinc sulphate 7one grain to the ounce of water7 may be dropped into the eye1 twice daily4 ,hot applications are beneficial here to promote absorption of the clot4 ,,eye-,,strain4--,eye-strain is commonly due to either astigmatism1 nearsightedness1 farsightedness1 or weakness of the eye muscles4 ,the farsighted eye is one in which parallel rays entering the eye1 as from a distance1 come to a focus behind the retina4 ,the retina is the sensitive area for receiving light impressions in the back of the eyeball4 ,sight is really a brain function2 one sees with the brain1 since the optic nerve endings in the back of the eye merely carry light impressions to the brain where they are properly interpreted4 ,in order that vision be clear and perfect1 it is essential that the rays of light entering the eye be bent so that they strike the retina as a single point4 ,in the farsighted or hyperopic eye1 the eyeball is usually too short for the rays to be properly focused on the sensitive nerve area in the back of the eye4 ,this defect in vision is1 however1 overcome by the act of accommodation4 ,there is a beautiful transparent1 double-convex body1 about one-third of an inch thick1 which looks very much like an ordinary glass lens1 and is situated in the eye just back of the pupil4 ,this is what is known as the crystalline lens1 and the rays of light are bent in passing through it so as to be properly focused on the retina4 ,the foregoing statements have been made as though objects were always at a distance from the eye1 so that the rays of light coming from them were almost parallel4 ,yet when one is looking at an object within a few inches of the eye the rays diverge or spread out1 and these the normal eye 7if rigid7 could not focus on the retina--much less the farsighted eye4 ,but the eye is adaptable to change of focus through the action of a certain muscle1 situated within the eyeball about the lens1 which controls to a considerable extent the shape of the lens4 ,when the muscle contracts it allows the lens to bulge forward by virtue of its elasticity1 and1 therefore1 become more convex4 ,this is what happens when one looks at near objects1 the increased convexity of the lens bending the rays of light so that they will focus as a point on the retina4 7,see ,plate ,i1 p4 #cj47 ,now in the farsighted eye this muscular control or accommodative action must be continually exercised even in looking at distant objects1 and it is this constant attempt of nature to cure an optical defect of the eye which frequently leads to nervous exhaustion or eye-strain4 ,the nerve centers1 which animate and control the nerves supplying the eye muscles to which we have just alluded1 are in close proximity to other most important nerve centers in the brain1 so irritation of the eye centers will produce sympathetic irritation of these other centers1 leading to manifold and complex symptoms which we will describe under this head4 ,but these symptoms do not necessarily develop in everyone having farsightedness or astigmatism1 since both are often present at birth4 ,the power of accommodation is sufficient to overcome the optical defect of the eye1 providing that the general health is good and the eye is not used much for near work4 ,if1 on the other hand1 excessive use of the eyes in reading1 writing1 figuring1 sewing1 or other fine work is required1 and especially if the health becomes impaired1 it happens that the constant drain on the eye center in the brain will result in a group of symptoms which we will consider later4 ,failure of accommodation comes on at about forty1 and gradually increases until all accommodation is lost at the age of seventy-five4 ,for this reason it is necessary for persons over forty-five years of age1 having normal or farsighted eyes1 to wear convex glasses in reading or doing near work1 and these should be changed for stronger ones every year or two4 ,these convex glasses save the eyes in their attempt to make the lens more convex when looking at near objects in farsightedness1 and also prove serviceable in the same manner when accommodation begins to fail in the case of what is called old sight4 ,the neglect to provide proper glasses for reading any time after the age of forty-five1 and the failure to replace them by stronger lenses when required1 distinctly favor the occurrence of cataract in later life4 ,in the act of accommodation1 in addition to the muscular action by which the lens is made more convex1 there is the tendency for the action of another group of muscles outside the eyeball1 which turn the eyes inward when they are directed toward a near object4 ,here then is another source of trouble resulting from farsightedness1 i4 e41 the not infrequent occurrence of inward squint occasioned by the constant use of the muscles pulling the eyes inward during accommodation for near objects4 ,again1 inflammation of the eyelids1 and sometimes of deeper parts of the eyeball1 follows untreated hyperopia4 ,early distaste for reading is often acquired by farsighted persons1 owing to the strain on the accommodative apparatus4 ,the convex lens is that used to correct farsightedness4 ,,nearsighted ,,eye4--,in the nearsighted eye the eyeball is too long for parallel rays entering the eye to be focused upon the retina2 they are bent1 instead1 to a point in front of the retina1 and then diverge making the vision blurred4 7,plate ,i1 p4 #cj47 ,the act of accommodation in making the lens more convex will not aid this condition1 but only make it worse1 so that it is not attempted4 ,eye-strain in this optical defect is brought on by constant use of the eye muscles 7attached to the outside of the eyeball7 in directing both eyes inward so that they will both center on near objects2 the only ones which can be seen4 ,outward squint frequently results1 because the muscular efforts required to direct both eyes equally inward to see near objects are so great that the use of both eyes together is given up1 and the poorer eye is not used and squints outward1 while the better eye is turned inward in the endeavor to see4 ,nearsighted persons are apt to stoop1 owing to the habitual necessity for coming close to the object looked at4 ,their facial expression is also likely to be rather vacant1 since they do not distinctly see1 and do not respond to the facial movements of others4 ,nearsightedness1 or myopia1 is not a congenital defect1 but is usually acquired owing to excessive near work which requires that the eye muscles constantly direct both eyes inward to see near objects4 ,in so acting the muscles compress the sides of the eyeballs and tend to increase their length1 interfere with their nutrition1 and aggravate the condition when it is once begun4 7,see ,diagram47 ,concave lenses are used to correct myopia1 and they must be worn all the time4 ,,astigmatism4--,this is a condition caused by inequality of the outer surface of the front of the eyeball1 and rarely by a similar defect in the surfaces of the lens4 ,the curvature of the eyeball in the astigmatic eye is greater in one meridian than in the opposite4 ,in other words1 the front of the eyeball is not regularly spherical1 but bulges out along a certain line or meridian1 while the curvature is flattened or normal in the other meridian4 ,for instance1 if two imaginary lines were drawn1 one vertically1 and the other horizontally across the front of the eyeball intersecting in the center of the pupil1 they would represent the principal meridians1 the vertical and the horizontal4 ,as a rule the meridian of greatest curvature is approximately vertical1 and that of least curvature is at right angles to it1 or horizontal4 ,rays of light in passing through the different meridians of the astigmatic eye are differently bent1 so that in one of the principal meridians rays may focus perfectly on the retina1 while in the other the rays may focus on a point behind the retinal field4 ,in this case the eye is made farsighted or hyperopic in one meridian1 and is normal in the other4 ,or again1 the rays may be focused in front of the retina in one meridian1 and directly on the retina in the other2 this would be an example of nearsighted or myopic astigmatism4 ,farsightedness and nearsightedness are then both caused by astigmatism1 although in this case not by the length of the eyeball1 but by inequality in the curvature of the front part 7cornea7 of the eyeball4 ,for example1 in simple astigmatism one of the principal meridians is hyperopic 7turning the rays so that they focus behind the retina7 or myopic 7bending the rays so that they focus in front of the retina71 while the other meridian is normal4 ,in mixed astigmatism1 one of the principal meridians is myopic1 the other hyperopic2 in compound astigmatism the principal meridians are both myopic1 or both hyperopic1 but differ in degree2 while in irregular astigmatism1 rays of light passing through different parts of the outer surface of the eyeball are turned in so many various directions that they can never be brought to a perfect focus by glasses4 ,it is not by any means possible for a layman to be able always to inform himself that he is astigmatic1 unless the defect is considerable4 ,if a card1 on which are heavy black lines of equal size and radiating from a common center like the spokes of a wheel1 be placed on a wall in good light1 it will appear to the astigmatic eye as if certain lines 7which are in the faulty meridian of the eyeball7 are much blurred1 while the lines at right angles to these are clear and distinct4 ,each eye should be tested separately1 the other being closed4 ,the chart should be viewed from a distance as great as any part of it can be seen distinctly4 ,all the lines on the test card should look equally black and clear to the normal eye4 ,astigmatism is corrected by a cylindrical lens1 which is in fact a segment of a solid cylinder of glass4 ,the axis of the cylindrical lens should be at right angles to the defective meridian of the eye1 in order to correct the astigmatism4 ,eye-strain is caused by astigmatism in the same manner that it is brought about in the simple farsighted eye1 i4 e41 by constant strain on the ciliary muscle1 which regulates the convexity of the crystalline lens4 ,for it is possible for the inequalities of the front surface of the eyeball or of the lens to be offset or counterbalanced by change in the convexity of the lens produced by the action of this muscle1 and it is conceivable that the axis of the lens may be tilted one way or another by the same agency1 and for the same purpose4 ,but1 as we have already pointed out1 this continual muscular action entails great strain on the nerve centers which animate the muscle1 and if constant near work is requisite1 or the health is impaired1 the nervous exhaustion becomes apparent4 ,the lesser degrees of astigmatism often give more trouble than the greater4 ,illustration3 ,,plate ,i ,plate ,i ,,anatomy ,,of ,,the ,,eye ,the upper illustration shows the six muscles attached to the eye4 ,the ,superior ,rectus ,muscle pulls and directs the eye upward2 the ,inferior ,rectus1 downward2 the ,external and ,internal ,rectus ,muscles pull the eye to the right and left2 the ,oblique ,muscles move the eye slantwise in any direction4 ,lack of balance of these muscles1 and especially inability to focus both eyes on a near object without effort1 constitute eye-strain4 ,the lower cut illustrates the relation of the crystalline lens to sight4 ,lens ,nearsight ,focus shows the lens bulging forward and very convex2 ,lens ,farsight ,focus shows it flat and less convex4 ,this adjustment of the shape of the crystalline lens is called accommodation2 it is effected by a small muscle in the eyeball4 ,in the normal eye1 the rays of light from an object pass through the lens1 adjusted for the proper distance1 and focus on the retina4 ,in the nearsighted eye1 these rays focus at a point in front of the retina2 while in the farsighted eye these rays focus behind the retina2 the nearsighted eye being elongated1 and the farsighted eye being shortened4 ,,weakness ,,of ,,the ,,eye ,,muscles4--,there are six muscles attached to the outside of the eyeball which pull it in various directions1 and so enable each eye to be directed upon a common point1 otherwise objects will appear double4 ,weakness of these muscles or insufficiency1 especially of those required to direct the eyes inward for near work1 may lead to symptoms of eye-strain4 ,when reading1 for example1 the muscles which pull the eye inward soon grow tired and relax1 allowing the opposing muscles to pull the eye outward so that the eyes are no longer directed toward a common point1 and two images may be perceived or1 more frequently1 they become fused together producing a general blurring on the page4 ,then by a new effort of will the internal muscles pull the eyes into line again1 only to have the performance repeated1 all of which entails a great strain upon the nervous system1 and may lead to permanent squint1 as has been pointed out4 ,in addition to these symptoms caused by weakness of the eye muscles--seeing double1 blurred vision1 and want of endurance for close work--there are others which are common to eye-strain in general1 as headache1 nausea1 etc41 described in the following paragraph4 ,symptoms of ,eye-strain4--,headache is the most frequent symptom4 ,it may be about the eyes1 but there is no special characteristic which will positively enable one to know an eye headache from that arising from other sources1 although eye-strain is probably the most common cause of headache4 ,the headache resulting from eye-strain may then be in the forehead1 temples1 top or the back of the head1 or limited to one side4 ,it frequently takes the form of sick headache 7p4 #aac74 ,it is perhaps more apt to appear after any unusual use of the eyes in reading1 writing1 sewing1 riding1 shopping1 or sight-seeing1 and going to theaters and picture galleries1 but this is not by any means invariably the case1 as eye headache may appear without apparent cause4 ,nausea and vomiting1 with or without headache1 nervousness1 sleeplessness1 and dizziness often accompany eye-strain4 ,sometimes there is weakness of the eyes1 i4 e41 lack of endurance for eye work1 twitching of the eyelids1 weeping1 styes1 and inflammation of the lids4 ,in view of the extreme frequency of eye-disorders which lead to eye-strain1 it behooves people1 in the words of an eminent medical writer1 to recognize that the subtle influence of eye-strain upon character is of enormous importance inasmuch as the disposition may be warped1 injured1 and wrecked1 especially in the young4 ,some of the more serious nervous diseases1 as nervous exhaustion1 convulsions1 hysteria1 and ,st4 ,vitus's dance may be caused by the reflex irritation of the central nervous system following eye-strain4 ,treatment of ,eye-strain4--,the essential treatment of eye-strain consists in the wearing of proper glasses4 ,it should be a rule1 without any exception1 to consult only a regular and competent oculist1 and never an optician1 for the selection of glasses4 ,it is as egregious a piece of folly to employ an optician to choose the glasses as it would be to seek an apothecary's advice in a general illness4 ,considerably more damage would probably accrue from following the optician's prescription than that of the apothecary1 because nature would soon offset the effects of an inappropriate drug2 but the damage to the eyes from wearing improper glasses would be lasting4 ,properly to determine the optical error in astigmatic and farsighted eyes it is essential to place drops in the eye1 which dilate the pupil and paralyze the muscles that control the convexity of the crystalline lens1 and to use instruments and methods of examination1 which can only be properly undertaken and interpreted by one with the general and special medical training possessed by an oculist4 ,the statement has been emphasized that farsighted and astigmatic persons1 up to the age of forty-five or fifty1 can sometimes overcome the optical defects in their eyes by exercise of the ciliary muscle which alters the shape of the lens1 and1 therefore1 it would be impossible for an examiner to discover the fault without putting drops in the eye1 which temporarily paralyze the ciliary muscles for from thirty-six to forty-eight hours1 but otherwise do no harm4 ,after the age of fifty it may be unnecessary to use drops1 as the muscular power to alter the convexity of the lens is greatly diminished4 ,opticians are incompetent to employ these drops1 as they may do great damage in certain conditions of the eye which can only be detected by a medical man specially trained for such work4 ,opticians are thus sure to be caught on one of the horns of a dilemma2 either they do not use drops to paralyze the ciliary muscle1 or1 if they do employ the drops1 they may do irreparable damage to the eye4 ,any abnormality connected with the vision1 especially in children1 should be a warning to consult an oculist4 ,squint1 cross-eye 7,strabismus71 as has been stated1 may often result from near- or far-sightedness1 and it may be possible in young children to cure the squint by the use of glasses or even drops in the eye1 whereas in later life it may be necessary to cut some of the muscles of the eyeball to correct the condition4 ,it is a wise rule to subject every child to an oculist's examination before entering upon school life4 ,,deafness4--,sudden deafness without apparent reason is more apt to result from an accumulation of wax than from any other cause4 ,it is a very common ear disorder4 ,the opening into the ear is about an inch long1 or a little more1 and is separated from that part of the ear within1 which is known as the middle ear1 by the eardrum membrane4 ,the drum membrane is a thin1 skinlike membrane stretched tightly across the bottom of the external opening in the ear or auditory canal1 and shuts it off completely from the middle ear within1 and in this way protects the middle ear from the entrance of germs1 dust1 and water1 but only secondarily aids hearing4 ,the obstruction caused by wax usually exists in about the middle of the auditory canal or opening in the ear1 and only causes deafness when it completely blocks this passage4 ,the deafness is sudden because1 owing to the accidental entrance of water1 the wax quickly swells and chokes the canal2 or1 in attempts to relieve irritation in the ear1 the finger or some other object is thrust into the opening in the ear 7auditory canal7 and presses the wax down on the ear drum4 ,the obstruction in the ear is usually a mixture of waxy secretion from the canal1 and little scales of dead skin which become matted together in unwise efforts at cleansing the ear by introducing a twisted towel or some other object into the ear passage and there turning it about2 or it may occur owing to disease of the ear altering the character of the natural secretion4 ,in the normal state1 the purpose of the wax is1 apparently1 to repel insects and to glue together the little flakes of cast-off skin in the auditory canal1 and these1 catching on the hairs lining the canal1 are thrown out of the ears upon the shoulders by the motion of the jaws in eating4 ,nothing should be introduced into the ear with the idea of cleansing it1 as the skin growing more rapidly from within tends naturally to push the dead portions out as required1 and so the canal is self-cleansing4 ,symptoms4--,sudden deafness in one ear usually calls the attention of the patient to an accumulation of wax4 ,there is apt to be more or less wax in the other ear as well4 ,noises in the deaf ear and a feeling of pressure are also common4 ,among rarer symptoms are nausea and dizziness4 ,but the only way to be sure that deafness is due to choking of the ear passage with wax is to see it4 ,this is usually accomplished by a physician in the following way3 he throws a good light from a mirror into a small tube introduced into the ear passage4 ,this is1 of course1 impossible for laymen to do1 but if the ear is drawn upward1 backward1 and outward1 so as to straighten the canal1 it may be possible for anyone to see a mass of yellowish-brown or blackish material filling the passage4 ,and in any event1 if the wax cannot be seen1 one is justified in treating the case as if it were present1 if sudden deafness has occurred and competent medical aid is unobtainable1 since no harm will be done if wax is absent1 and1 if it is present1 the escape of wax will usually give immediate relief from the deafness and other symptoms4 ,treatment4--,the wax is to be removed with a syringe and water as hot as can be comfortably borne4 ,a hard-rubber syringe having a piston1 and holding from two teaspoonfuls to two tablespoonfuls1 is to be employed--the larger ones are better4 ,the clothing should be protected from water by towels placed over the shoulder1 and a basin is held under the ear to catch the water flowing out of the canal4 ,the tip of the syringe is introduced just within the entrance of the ear1 which is to be pulled backward and upward1 and the stream of water directed with some force against the upper and back wall of the passage rather than directly down upon the wax4 ,the water which is first returned is discolored1 and then1 on repeated syringing1 little flakes of dry skin1 with perhaps some wax adhering1 may be seen floating on the top of the water which flows from the ear1 and finally1 after a longer or shorter period1 a plug of wax becomes dislodged1 and the whole trouble is over4 ,this is the rule1 but sometimes the process is very long and tedious1 only a little coming away at a time1 and1 rarely1 dizziness and faintness will require the patient to lie down for a while4 ,the water should always be removed from the ear after syringing by twisting a small wisp of absorbent cotton about the end of a small stick1 as a toothpick1 which has been dipped into water to make the cotton adhere4 ,the tip of the toothpick1 thus being thoroughly protected by dry cotton applied so tightly that there is no danger of it slipping off1 while the ear is pulled backward and upward to straighten the canal1 is gently pushed into the bottom of the canal and removed1 and the process repeated with fresh cotton until it no longer returns moist4 ,finally a pledget of dry cotton should be loosely packed into the ear passage1 and worn by the patient for twelve or twenty-four hours4 ,,persistent ,,and ,,chronic ,,deafness4--,a consideration of deafness requires some understanding of the structure and relations of the ear with other parts of the body1 notably the throat4 ,it has been pointed out that the external ear--comprising the fleshy portion of the ear1 or auricle1 and the opening1 or canal1 about an inch long--is separated from that portion of the ear within 7or middle ear7 by the drum membrane4 ,the middle ear1 while protected from the outer air by the drum1 is really a part of the upper air passages1 and participates in disorders affecting them4 ,it is the important part of the ear as it is the seat of most ear troubles1 and disease of the middle ear not only endangers the hearing1 but threatens life through proximity to the brain4 ,in the middle ear we have an air space connected with the throat by the ,eustachian tube1 a tube about an inch long running downward and forward to join the upper air passage at the junction of the back of the nose and upper part of the throat4 ,if one should run the finger along the roof of the mouth and then hook it up behind and above the soft palate one could feel the openings of these tubes 7one for each ear7 on either side of the top of the throat or back of the nose1 according to the view we take of it4 ,then the middle ear is also connected with a cavity in the bone back of the ear 7mastoid cavity or cells71 and the outer and lower wall is formed by the drum membrane4 ,vibrations started by sound waves which strike the ear are connected by means of a chain of three little bones from the drum through the middle ear to the nervous apparatus in the internal ear4 ,the head of one of these little bones may be seen by an expert1 looking into the ear1 pressing against the inside of the drum membrane4 ,stiffening or immovability of the joints between these little bones1 from catarrh of the middle ear1 is most important in producing permanent deafness4 ,the middle ear space is lined with mucous membrane continuous with that of the throat through the ,eustachian tube4 ,this serves to drain mucus from the middle ear1 and also to equalize the air pressure on the eardrum so that the pressure within the middle ear shall be the same as that without4 ,when there is catarrh or inflammation of the throat or nose it is apt to extend up the ,eustachian tubes and involve the middle ear4 ,in this way the tubes become choked and obstructed with the oversecretion or by swelling4 ,the air in the middle ear then becomes absorbed in part1 and a species of vacuum is produced with increased pressure from without on the eardrum4 ,the drum membrane will be pressed in1 and through the little bones pressure will be made against the sensitive nervous apparatus1 irritating it and giving rise to deafness1 dizziness1 and the sensation of noises in the ear4 ,noises from without will also be intensified in passing through the middle ear when it is converted into a closed cavity through the blocking of the ,eustachian tube4 ,a very important feature following obstruction of the ,eustachian tubes1 and rarefaction of the air in the middle ear1 is that congestion of the blood vessels ensues and increased secretion1 because the usual pressure of the air on the blood vessels within the middle ear is taken away4 ,this then is the cause of most permanent deafness1 to which is given the name catarrhal deafness1 because every fresh cold in the head1 or sore throat1 tends to start up trouble in the ear such as we have just described4 ,repeated attacks leave vestiges behind until permanent deafness remains4 ,in normal conditions every act of swallowing opens the apertures of the ,eustachian tubes in the throat1 and allows of equalization of the air pressure within and without the eardrum1 but if the nose is stopped up by a cold in the head1 or enlargement of the tonsil at the back of the nose 7as from adenoids1 see p4 #fa71 the process is reversed and air is exhausted from the ,eustachian tubes with each swallowing motion4 ,the moral to be drawn from all the foregoing is to treat colds properly when they are present1 keeping the nose and throat clean and clear of mucus1 and to have any abnormal obstruction in the nose or throat and source of chronic catarrh removed1 as enlarged tonsils1 adenoids1 and nasal outgrowths4 ,,foreign ,,bodies ,,in ,,the ,,ear4--,foreign bodies1 as buttons1 pebbles1 beans1 cherry stones1 coffee1 etc41 are frequently placed in the ear by children1 and insects sometimes find their way into the ear passage and create tremendous distress by their struggles4 ,smooth1 nonirritating bodies1 as buttons1 pebbles1 etc41 do no particular harm for a long time1 and may remain unnoticed for years4 ,but the most serious damage not infrequently results from unskillful attempts at their removal by persons 7even physicians unused to instrumental work on the ear7 who are driven to immediate and violent action on the false supposition that instant interference is called for4 ,insects1 it is true1 should be killed without delay by dropping into the ear sweet oil1 castor1 linseed1 or machine oil or glycerin1 or even water1 if the others are not at hand1 and then the insect should be removed in half an hour by syringing as recommended for wax 7p4 #ce74 ,to remove solid bodies1 turn the ear containing the body1 downward1 pull it outward and backward1 and rub the skin just in front of the opening into the ear with the other hand1 and the object may fall out4 ,failing in this1 syringing with warm water1 as for removal of wax1 while the patient is sitting1 may prove successful4 ,the essentials of treatment then consist1 first1 in keeping cool2 then in killing insects by dropping oil or water into the ear1 and1 if syringing proves ineffective1 in using no instrumental methods in an attempt to remove the foreign body1 but in awaiting such time as skilled medical services can be obtained4 ,if beans or seeds are not washed out by syringing1 the water may cause them to swell and produce pain4 ,to obviate this1 drop glycerin in the ear which absorbs water1 and will thus shrivel the seed4 ,,earache4--,earache is due usually not to neuralgia of the ear1 but to a true inflammation of the middle ear1 which either subsides or results in the accumulation of inflammatory products until the drum is ruptured and discharge occurs from the external canal4 ,the trouble commonly originates from an extension of catarrhal disease of the nose or throat2 the germs which are responsible for these disorders finding their way into the ,eustachian tubes1 and thus into the middle ear4 ,any source of chronic catarrh of the nose or throat1 as enlarged and diseased tonsils1 adenoids in children1 or nasal obstruction1 favor the growth of germs and the occurrence of frequent attacks of acute catarrh or colds4 ,the grippe has been the most fruitful cause of middle-ear inflammation and earache in recent years4 ,any act which forces up fluid or secretions from the back of the nose into the ,eustachian tubes 7see section on ,deafness7 and thus into the middle ear1 is apt to set up inflammation there1 either through the introduction of germs1 or owing to the mechanical injury sustained4 ,thus the use of the nasal douche1 the act of sniffing water into the nose1 or blowing the nose violently when there is secretion or fluid in the back of the nose1 or the employment of the post-nasal syringe are one and all attended with this danger4 ,swimming on the back1 diving1 or surf bathing also endangers the ear1 as cold water is forcibly driven not only into the external auditory canal1 but1 what is more frequently a source of damage1 into the ,eustachian tubes through the medium of the nose or throat4 ,in this case the plugging of the nose with cotton would be of more value than the external canal1 as is commonly practiced4 ,if water has entered the ,eustachian tube1 blowing the nose and choking merely aggravate the trouble4 ,the wiser plan is to do nothing but trust that the water will drain out1 and if pain ensues treat it as recommended below for earache4 ,water in the ears is sometimes removed by jumping about on one foot with the troublesome ear held downward1 and if it is in the external canal it may be wiped out gently with cotton on the end of a match1 as recommended in the article on treating wax in the ear 7see p4 #ce74 ,in the treatment of catarrh in the nose or throat only a spray from an atomizer should be used1 as ,dobell's or ,seiler's solutions followed by menthol and camphor1 twenty grains of each to the ounce of alboline or liquid vaseline4#a ,exposure to cold and the common eruptive diseases of children1 as scarlet fever1 measles1 and also diphtheria1 are common causes of middle-ear inflammation4 ,in the latter disorders the protection afforded by a nightcap which comes down over the ears1 and worn constantly during the illness1 is frequently sufficient to ward off ear complications4 ,although earache or middle-ear inflammation is common1 its dangers are not fully appreciated1 since the various complications are likely to arise1 and the result is not rarely serious4 ,extension of the inflammation to the bone behind the ear may necessitate chiseling away a part of the skull to liberate pus or dead bone in this locality1 and the occurrence of abscess of the brain will necessitate operation4 ,the use of leeches in the beginning of the attack is of great value1 and though unpleasant are not difficult or painful in their application4 ,one should be applied just in front of the opening into the ear 7which should be previously closed with cotton to prevent the entrance of the leech71 and the other behind the ear in the crease where it joins the side of the head and at a point a little below the level of the external opening into the ear4 ,a drop of milk on these spots will often start the leeches immediately at work1 or a drop of blood obtained with a pin prick4 ,when the leeches are gorged with blood and cease to suck1 they should be removed and bleeding encouraged for half an hour with applications of absorbent cotton dipped in hot water4 ,then clean1 dry absorbent cotton is applied1 and pressure made on the wounds if bleeding does not soon stop or is excessive4 ,the after treatment of the bites consists in cleanliness and the use of vaseline4 ,the patient must stay in bed1 and the hot-water bag be constantly kept on the ear till all pain ceases4 ,if the drum perforates1 a discharge will usually appear from the external ear4 ,then the canal must be cleansed1 once or more daily1 by injecting very gently into the ear a solution of boric acid 7as much of boric acid as the water will dissolve71 following this by wiping the water out of the canal with sterilized cotton1 as directed for the treatment of wax in the ear 7p4 #ce74 ,the syringing is permissible only once daily1 unless the discharge is copious1 but the canal may be wiped out in this manner several times a day with dry cotton4 ,it is well to keep the opening into the ear greased with vaseline1 and a plug of clean absorbent cotton loosely packed into the canal to keep out the cold4 ,excessive or too forcible syringing may bring about that complication most to be feared1 although it may appear through no fault in care1 i4 e41 an implication of the cavity in the bone back of the ear 7mastoid disease74 ,germs find their way through the connecting passage by which this cavity is in touch with the middle ear1 or may be forced in by violent syringing4 ,when this happens1 earache1 or pain just back of the ear1 commonly returns during the first or second week after the first attack1 and tenderness may be observed on pressing on the bone just back of the ear close to the canal4 ,fever1 and local redness and swelling of the parts over the bone in this region may also occur4 ,confinement to bed1 and constant application of a rubber bag containing cracked ice1 to the painful parts must be enforced4 ,if the tenderness on pressure over the bone and pain do not subside within twenty-four to forty-eight hours1 surgical assistance must be obtained at any cost1 or a fatal result may ensue4 ,the opening in the drum membrane1 caused by escape of discharge in the course of middle-ear inflammation1 usually closes1 but even if it does not deafness is not a necessary sequence4 ,the eardrum is not absolutely essential to hearing1 but it is of great importance to exclude sources of irritation1 dust1 water1 and germs which are likely to set up middle-ear trouble4 ,more ordinary after-effects are chronic discharge from the ear following acute inflammation and perforation of the eardrum1 which may mean at any time a sudden return of pain with the occurrence of the more dangerous conditions just recited1 together with deafness4 ,bearing all this in mind it is advisable never to neglect a severe or persistent earache1 but to call in expert attention4 ,when this is not obtainable the treatment outlined below should be carefully followed4 ,symptoms4--,pain is severe and often excruciating in adults4 ,it may be felt over the temple1 side and back of the head and neck1 and even in the lower teeth1 as well as in the ear itself4 ,the pain is increased by blowing the nose1 sneezing1 coughing1 and stooping4 ,there is considerable tenderness usually on pressing on the skin in front of the ear passage4 ,in infants there may be little evidence of pain in the ear4 ,they are apt to be very fretful1 refuse food1 cry out in sleep1 often lie with the affected ear resting on the hand1 and show tenderness on pressure immediately in front or behind the ear passage4 ,dullness1 fever1 chills1 and convulsions are not uncommon in children1 but1 on the other hand1 after some slight illness it is not infrequent for discharge from the ear to be the first sign which calls the attention of parent or medical attendant to the source of the trouble4 ,for this reason the careful physician always examines the ear in doubtful cases of children's diseases4 ,unless the inflammation subsides with treatment1 either a thin1 watery fluid 7serum7 is formed in the middle ear1 or pus1 when we have an abscess of the ear4 ,the drum if left to itself breaks down in three to five days1 or much sooner in children who possess a thinner membrane4 ,a discharge then appears in the canal of the external ear1 and the pain is relieved4 ,it may occasionally happen that the ,eustachian tube drains away the discharge1 or that the discharge from the drum is so slight that it is not perceived1 and recovery ensues4 ,discharge from the ear continues for a few weeks1 and then the hole in the drum closes and the trouble ceases4 ,this is the history in favorable cases1 but unfortunately1 as we have indicated1 the opposite state of affairs results not infrequently1 especially in neglected patients4 ,treatment4--,the patient with severe earache should go to bed and take a cathartic to move the bowels4 ,he should lie all the time with the painful ear on a rubber bag containing water as hot as can be comfortably borne4 ,every two hours a jet of hot water1 which has been boiled and cooled just sufficiently to permit of its use1 is allowed to flow gently from a fountain syringe into the ear for ten minutes1 and then the ear is dried with cotton1 as described under the treatment of wax in the ear 7p4 #ce74 ,no other drops of any kind are admissible for use in the ear1 and even this treatment is of less importance than the dry heat from the hot-water bag1 and may be omitted altogether if the appliances and skill to dry the ear are lacking4 ,ten drops of laudanum#b for an adult1 or a teaspoonful of paregoric for a child six years old1 may be given by the mouth to relieve the pain4 ,the temperature of the room should be even and the food soft4 ,if the pain continues it is wiser to have an aurist lance the drum1 to avoid complications1 than to wait for the drum membrane to break open spontaneously in his absence4 ,loss or damage of the eardrums may call for artificial eardrums4 ,they do not act at all like the drumhead of the musical instrument by their vibrations1 but only are of service in putting on the stretch the little bones in the middle ear which convey sound4 ,some of those advertised do harm by setting up a mechanical irritation in the ear after a time1 and a better result is often obtained with a ball of cotton or a paper disc introduced into the ear by an aurist4 ,illustration3 ,,plate ,,ii ,plate ,,ii ,,anatomy ,,of ,,the ,,ear ,the illustration on the opposite page shows the interior structure of the ear4 ,the concha and ,meatus1 or canal1 comprise the external ear1 which is separated from the middle ear by the ,drum ,membrane4 ,wax is secreted by glands located in the lining of the meatus1 and should be detached by the motion of the jaws during talking and eating4 ,if it adheres to the drum membrane it causes partial deafness4 ,the internal ear1 or labyrinth1 a cavity in the bone1 back of the middle ear1 consists of three parts3 the ,cochlea1 the ,semicircular ,canals1 and a middle portion1 the ,vestibule4 ,the middle ear is connected with the throat by the ,eustachian ,tube4 ,sound vibrations1 which strike the drum membrane1 are conveyed by means of a chain of three small bones through the middle ear to the nervous apparatus of the internal ear4 ,the ,eustachian tube and middle ear are lined throughout with mucous membrane1 and any severe inflammation of the throat may extend to and involve the tube and the middle ear1 causing deafness4 ,,moderate ,,or ,,slight ,,earache4--,a slight or moderate earache1 which may1 however1 be very persistent1 not sufficient to incapacitate the patient or prevent sleep1 is often caused by some obstruction in the ,eustachian tube1 either by swelling or mucous discharge4 ,this condition gives rise to the train of effects noted in the section on deafness4 ,the air in the middle ear is absorbed to some extent1 and therefore the pressure within the ear is less than that outside the drum1 so that the latter is pressed inward with the result that pain1 and perhaps noises and deafness ensue1 and1 if the condition is not relieved1 inflammation of the middle ear as described above4 ,treatment4--,treatment is directed toward cleaning the back of the nose and reducing swelling at the openings of the ,eustachian tubes in this locality1 and inflating the tubes with air4 ,a spray of ,seiler's solution#c is thrown from an atomizer through the nostrils1 with the head tipped backward1 until it is felt in the back of the throat1 and after the water has drained away the process is repeated a number of times4 ,this treatment is pursued twice daily1 and one hour after the fluid in the nose is well cleared away the ,eustachian tubes may be inflated by the patient4 ,to accomplish this the lips are closed tightly1 and the nostrils also1 by holding the nose2 then an effort is made to blow the cheeks out till air is forced into the tubes and is felt entering both ears4 ,this act is attended with danger of carrying up fluid into the tubes and greatly aggravating the condition1 unless the water from the spray has had time to drain away4 ,blowing the nose1 as has been pointed out1 is unwise1 but the water may be removed to some extent by clearing the throat4 ,the reduction of swelling at the entrance of the ,eustachian tube in the back of the nose can be properly treated only by an expert1 as some astringent 7glycerite of tannin7 must be applied on cotton wound on a curved applicator1 and the instrument passed above and behind the roof of the mouth into the region back of the nose4 ,rubbing the parts just in front of the external opening into the ear with the tip of one finger for a period of a few minutes several times a day will also favor recovery in this trouble4 ,,footnotes3 #a ,see p4 #di4 #b ,caution4 ,ask the doctor first4 #c ,tablets for the preparation of ,seiler's solution are to be found at most druggists4 ,,chapter ,,ii ,the ,nose and ,throat ,cold in the ,head--,mouth-,breathing--,toothache--,s ore ,mouth--,treatment of ,tonsilitis--,quinsy--,diphtheria4 ,,nosebleed4--,nosebleed is caused by blows or falls1 or more frequently by picking and violently blowing the nose4 ,the cartilage of the nasal septum1 or partition which divides the two nostrils1 very often becomes sore in spots1 owing to irritation of dust-laden air1 and these crust over and lead to itching4 ,then picking the nose removes the crusts1 and frequent nosebleed results4 ,nosebleed also is common in both full-blooded and anaemic persons2 in the former because of the high pressure within the blood vessels1 in the latter owing to the thin walls of the arteries and capillaries which readily rupture4 ,nosebleed is again an accompaniment of certain general disorders1 as heart disease and typhoid fever4 ,the bleeding comes usually from one nostril only1 and is a general oozing from the mucous membrane1 or more commonly flows from one spot on the septum near the nostril1 the cause of which we have just noted4 ,the blood may spout forth in a stream1 as after a blow1 or trickle away drop by drop1 but is rarely dangerous except in infants and aged persons with weak blood vessels4 ,in the case of the latter the occurrence of bleeding from the nose is thought to indicate brittle vessels and a tendency to apoplexy1 which may be averted by the nosebleed4 ,this is uncertain4 ,if nosebleed comes on at night during sleep1 the blood may flow into the stomach without the patient's knowledge1 and on being vomited may suggest bleeding from the stomach4 ,treatment4--,the avoidance of excitement and of blowing the nose1 hawking1 and coughing will assist recovery4 ,the patient should sit quietly with head erect1 unless there is pallor and faintness1 when he may lie down on the side with the head held forward so that the blood will flow out of the nose4 ,there is no cause for alarm in most cases1 because the more blood lost the more readily does the remainder clot and stop bleeding4 ,as the blood generally comes from the lower part of the partition separating the nostrils1 the finger should be introduced into the bleeding nostril and pressure made against this point1 or the whole lower part of the nose may be simply compressed between the thumb and forefinger4 ,if this does not suffice a lump of ice may be held against the side of the bleeding nostril1 and another placed in the mouth4 ,the injection into the nostril of ice water containing a little salt is sometimes very serviceable in stopping nosebleed4 ,blowing the nose must be avoided for some time after the bleeding ceases4 ,if none of these methods arrest the bleeding the nostril must be plugged4 ,a piece of clean cotton cloth1 about five inches square1 should be pushed gently but firmly into the nostril with a slender cylinder of wood about as large as a slate pencil and blunt on the end4 ,this substitute for a probe is pressed against the center of the cloth1 which folds about the stick like a closed umbrella1 and the cotton is pressed into the nostril in a backward and slightly downward direction1 for two or three inches1 while the head is held erect4 ,then pledgets of cotton wool are packed into the bag formed by the cotton cloth after the stick is withdrawn4 ,the mouth of the bag is left projecting slightly from the nostril1 so that the whole can be withdrawn in twenty-four hours4 ,the bleeding nostril may be more readily plugged by simply pressing into it little pledgets of cotton with a slender stick1 but it would be impossible for an unskilled person to get them out again1 and a physician should withdraw them inside of forty-eight hours4 ,,foreign ,,bodies ,,in ,,the ,,nose4--,children often put foreign bodies in their nose1 as shoe buttons1 beans1 and pebbles4 ,they may not tell of it1 and the most conspicuous symptoms are the appearance of a thick discharge from one nostril1 having a bad odor1 and some obstruction to breathing on the same side4 ,if the foreign body can be seen1 the nostril on the unobstructed side should be closed and the child made to blow out of the other one4 ,if blowing does not remove the body it is best to secure medical aid very speedily4 ,illustration3 ,,plate ,,iii ,plate ,,iii ,,the ,,nasal ,,cavity ,in the illustration on the opposite page1 the ,red ,portion indicates the ,septum of the nose1 the partition which separates the nostrils4 ,inflammation of the membrane lining the nasal cavity is the condition peculiar to catarrh or cold in the head4 ,deformity of the septum may obstruct the entrance of air into the nose and create suction on the walls of the nasal cavity1 causing an overfilling of the blood vessels1 or congestion1 with subsequent thickening of the mucous membrane4 ,polypi1 small growths which form in the nose1 or enlargement of the glands in the upper part of the throat 7just beyond dotted line at inner edge of red portion7 also block the air passages and give rise to mouth-breathing and its attendant disorders4 ,another cause of mouth-breathing is extreme swelling of the membrane which covers the turbinated bones of the nose4 ,,cold ,,in ,,the ,,head ,,from ,,overheating4--,chilling of the surface of the body favors the occurrence of colds1 in which lowered bodily vitality allows the growth of certain germs always present upon the mucous membrane lining the cavities of the nose4 ,dust and irritating vapors also predispose to colds4 ,overwarm clothing makes a person susceptible to colds1 while the daily use of cold baths is an effective preventive4 ,there is no sufficient reason for dressing more warmly in a heated house in winter than one would dress in summer4 ,it is1 moreover1 unwise to cover the chest more heavily than the rest of the body4 ,some one has wisely said3 ,the best place for a chest protector is on the soles of the feet4 ,the rule should always be to keep the feet dry and warm1 and adapt the clothing to the surrounding temperature4 ,among the germs which cause colds in the head1 that of pneumonia is the one commonly found in the discharge from the nose4 ,when pneumonia is epidemic it is therefore wise to take extra precautions to avoid colds1 and care for them when they occur4 ,the presence of chronic trouble in the throat and nose1 such as described under ,mouth-,breathing1 ,adenoids1 etc4 7p4 #fj71 is perhaps the most frequent cause of colds1 because the natural resistance of the healthy mucous membrane to the attack of germs is diminished thereby1 and the catarrhal secretions form a source of food for the germs to grow upon4 ,it should also be kept in mind that cold in the head is the first sign of measles and of grippe4 ,colds are more common in the spring and fall4 ,symptoms4--,colds begin with chilliness and sneezing1 and1 if severe1 there may be also headache1 fever1 and pain in the back and limbs1 as in grippe4 ,the nose at first feels dry1 but soon becomes more or less stopped with secretion4 ,the catarrh may extend from the back of the nose through the ,eustachian tube to the ear1 causing earache1 noises in the ear1 and deafness 7see p4 #da74 ,this unfortunate result may be averted by proper spraying of the nose1 and avoidance of blowing the nose violently4 ,treatment4--,treatment must be begun at the first suspicion of an attack to be of much service4 ,the bowels should be opened with calomel or other cathartic2 two-fifths of a grain for an adult1 half a grain for a child4 ,rest in bed for a day or two1 after taking a hot bath and a glass of hot lemonade containing a tablespoonful or two of whisky1 is the most valuable treatment4 ,the ,turkish bath is also very efficacious in cutting short colds1 but involves great risk of increasing the trouble unless the patient can return home in a closed carriage directly from the bath4 ,of the numerous remedies which are commonly used to arrest colds in the first stages are two which possess special virtue2 namely1 quinine and ,dover's powder1 given in single dose of ten grains of each for an adult4 ,both of these remedies may be taken1 but while the ,dover's powder is most effective it is often necessary for the patient to remain in bed twelve to eighteen hours after taking it on account of nausea and faintness which would be produced if the patient were up and moving about4 ,rhinitis tablets should never be used4 ,they are generally abused1 and1 indeed1 some fatal cases are on record in which they caused death4 ,drugs are of little value except in the beginning of a cold1 when they are given with the hope of cutting short an attack4 ,the local applications of remedies to the inflamed region is of service4 ,at the onset of the cold1 ,seiler's solution 7conveniently made from tablets which are sold in the shops7 or ,dobell's solution should be sprayed from an atomizer1 into the nostrils1 every half hour1 and1 when the discharge becomes thick and copious1 this is to be discarded for a spray consisting of alboline 7four ounces7 and camphor and menthol 7each thirty grains71 used in the same manner as long as the cold lasts4 ,containing bottles should be stood in hot water1 in order that all sprays for the nostrils may be used warm4 ,it is well to give babies a teaspoonful of castor oil and a warm bath1 and keep them in bed4 ,if there is fever with the cold1 five drops of sweet spirit of niter may be given in a teaspoonful of sweetened water every two hours4 ,liquid vaseline1 or the alboline mixture advised for adults1 may be dropped into the nostrils with a medicine dropper more conveniently than applied by spray4 ,,toothache4--,when there is a cavity in an aching tooth it should be cleaned of food1 and a little pledget of cotton wool wrapped on a toothpick may be used to wipe the cavity dry4 ,then the cavity should be loosely packed1 by means of a toothpick or one prong of a hairpin1 with a small piece of absorbent cotton rolled between the fingers and saturated with one of the following substances1 preferably the first3 oil of cloves1 wood creosote or chloroform4 ,if wood creosote is used the cotton must be well squeezed to get rid of the excess of fluid1 as it is poisonous if swallowed1 and will burn the gum and mouth if allowed to overflow from the tooth4 ,,alveolar ,,abscess 7improperly called ,ulcerated ,tooth74--,an ulcerated tooth begins as an inflammation in the socket of a tooth1 and1 if near its deepest part1 causes great pain1 owing to the fact that the pus formed can neither escape nor expand the unyielding bony wall of the socket4 ,this explains why an abscess near the tooth is so much more painful than a similar one of soft parts4 ,there may be no cavity in the tooth1 but the tooth is commonly dead1 or its nerve is dying1 and the tooth is frequently darker in color4 ,it often happens that threatened abscess at the root of a tooth1 which has been filled1 can be averted by a dentist's boring down into the root of the tooth1 or removing the filling4 ,it is not always possible to locate the troublesome tooth1 from the pain1 but by tapping on the various teeth in turn with a knife1 or other metal instrument1 special soreness will be discovered in the ulcerated tooth4 ,the ulcerated tooth frequently projects beyond its fellows1 and so gives pain when the jaws are brought together in biting4 ,treatment4--,the treatment for threatened abscess near a tooth consists in painting tincture of iodine1 with a camel's hair brush1 upon the gum at the root of the painful tooth1 and applying1 every hour or so1 over the same spot a toothache plaster 7sold by all druggists74 ,the gum must be wiped dry before applying the moistened toothache plaster4 ,water1 as hot as can be borne1 should be held in the mouth1 and the process repeated for as long a time as possible4 ,then the patient should lie with the painful side of the face upon a hot-water bag or bottle4 ,the trouble may subside under this treatment1 owing to disappearance of the inflammation1 or to the unnoticed escape of a small amount of pus through a minute opening in the gum4 ,if the inflammation continues the pain becomes intense and throbbing2 there is often entire loss of sleep and rest1 fever1 and even chills1 owing to a certain degree of blood poisoning4 ,the gum and face swell on the painful side1 and the patient often suffers more than with many more serious diseases4 ,after several days of distress1 the bony socket of the tooth gives way1 and the pus makes its exit1 and1 bulging out the gum1 finally escapes through this also1 to the immediate relief of the patient4 ,but serious results sometimes follow letting nature alone in such a case1 as the pus from an eyetooth may burrow its way into the internal parts of the upper jaw1 or into the chambers of the nose1 while that from a back tooth often breaks through the skin on the face1 leaving an ugly scar1 or1 if in the lower jaw1 the pus may find its way between the muscles of the neck1 and not come to the surface till it escapes through the skin above the collar bone4 ,pulling the tooth is the most effective way of relieving the condition1 the only objection being the loss of the tooth1 which is to be avoided if possible4 ,if the pain is bearable and there are no chills and fever1 the patient may save the tooth by remaining in bed with a hot-water bottle continually on the face1 and taking ten drops of laudanum to relieve the pain at intervals of several hours4 ,then many hours of suffering may be prevented if the gum is lanced with a sharp knife 7previously boiled for five minutes7 as soon as the gum becomes swollen1 to allow of the escape of pus4 ,the dentist is1 of course1 the proper person to consult in all cases of toothache1 and the means herein suggested are to be followed only when it is impossible to obtain his services4 ,,mouth-,,breathing 7including ,adenoids1 ,chronic ,tonsilitis1 ,deviation of the ,nasal ,septum1 ,enlarged ,turbinates1 and ,polypi74--,any obstruction in the nose causes mouth-breathing and gives rise to one or more of a long train of unfortunate results4 ,among the disorders producing mouth-breathing1 enlargement of the glandular tissue in the back of the nose and in the throat of children is most important4 ,glandular growths in the upper part of the throat opposite the back of the nasal cavities are known as adenoids2 they often completely block the air passage at this point1 so that breathing through the nose becomes difficult4 ,associated with this condition we usually see enlargement of the tonsils1 two projecting bodies1 one on either side of the entrance to the throat at the back of the mouth4 ,in healthy adult throats the tonsils should be hardly visible2 in children they are active glands and easily visible4 ,we are unable to see adenoids because of their position1 but can be reasonably sure of their presence in children where we find symptoms resulting from mouth-breathing as described below4 ,the surgeon assures himself positively of the existence of adenoids by inserting a finger into the mouth of the patient and hooking it up back of the roof of the mouth1 when they may be felt as a soft mass filling the back of the nose passages4 ,other less common causes of mouth-breathing1 seen in adults as well as children1 are deviation of the nasal septum1 swelling of the mucous membrane covering certain bones in the nose 7turbinates71 and polypi4 ,deviation of the nasal septum means displacement of the partition dividing the two nostrils1 so that more or less obstruction exists4 ,this condition may be occasioned by blows on the nose received in the accidents common to childhood4 ,the deformity which results leads in time to further obstruction in the nose1 because when air is drawn in through the narrowed passages a certain degree of vacuum is produced and suction on the walls of the nose1 as would occur if we drew in air from a large pair of bellows through a small thin rubber tube4 ,this induces an overfilling of the blood vessels in the walls of the passages of the nose1 and the continued congestion is followed by increased thickness of the lining mucous membrane1 thus still further obstructing the entrance of air4 ,a one-sided nasal obstruction in a child with discharge from that side leads one to suspect that a foreign body1 as a shoe button1 has been put in by the child4 ,polypi are small pear-shaped growths which form on the membrane lining the nasal passages and sometimes completely block them4 ,they resemble small grapes without skins4 ,these1 then1 are the usual causes of mouth-breathing1 but of most importance1 on account of their frequency and bearing on the health and development1 are adenoids and enlarged throat tonsils in children4 ,adenoids and enlarged tonsils are often due to inflammation of these glands during the course of the contagious eruptive disorders1 as scarlet fever1 measles1 or diphtheria2 probably1 also1 to constant exposure to a germ-laden atmosphere1 as in the case of children herded together in tenements4 ,symptoms4--,the mouth-breathing is more noticeable during sleep2 snoring is common1 and the breathing is of a snorting character with prolonged pauses4 ,children suffering from enlarged tonsils and adenoids are often backward in their studies1 look dull1 stupid1 and even idiotic1 and are often cross and sullen2 the mouth remains open1 and the lower lip is rolled down and prominent2 the nose has a pinched aspect1 and the roof of the mouth is high4 ,air drawn into the lungs should be first warmed and moistened by passing through the nose1 but when inspired through the mouth1 produces so much irritation of the throat and air passages that constant colds1 chronic catarrh of the throat1 laryngitis1 and bronchitis ensue4 ,the constant irritation of the throat occurring in mouth-breathers weakens the natural resistance against such diseases as acute tonsilitis1 scarlet fever1 and diphtheria1 so that they are especially subject to these diseases4 ,but these are not the only ailments to which the mouth-breather is liable1 for earache and deafness naturally follow the catarrh1 owing to obstruction of the ,eustachian tubes 7see ,earache1 p4 #dj1 and ,deafness1 p4 #ch74 ,deformity of the chest is another result of obstruction to nose-breathing1 the common form being the pigeon breast1 where the breastbone is unduly prominent4 ,the voice is altered so that the patient1 as the saying goes1 talks through the nose1 although1 in reality1 nasal resonance is reduced and difficulty is experienced in pronouncing ,n and ,m correctly1 while stuttering is not uncommon4 ,nasal obstruction leads to poor nutrition1 and hence children with adenoids and enlarged tonsils are apt to be puny and weakly specimens4 ,treatment4--,the treatment is purely surgical in all cases of nasal obstruction3 removal of the adenoid growths1 enlarged tonsils1 and polypi1 straightening the displaced nasal septum1 and burning the thickened mucous lining obstructing the air passages in the nose4 ,none of the operations are dangerous if skillfully performed1 and should be generally done1 even in the case of delicate children1 as the very means of overcoming this delicacy4 ,the after treatment is not unimportant1 consisting in the use of simple generous diet1 as plenty of milk1 bread and butter1 green vegetables and fresh meat1 and the avoidance of pastries1 sweets1 fried food1 pork1 salt fish and salt meats1 also the roots1 as parsnips1 turnips1 carrots and beets1 and tea and coffee4 ,life in the open air1 emulsion of cod-liver oil1 daily sponging with cold water while the patient stands in warm water1 followed by vigorous rubbing1 will all assist the return to health4 ,,sore ,,mouth2 ,,inflammation ,,of ,,the ,,mouth4--,there are various forms of inflammation of the mouth1 generally dependent upon the entrance of germs1 associated with indigestion or general weakness following some fever or other disease4 ,unclean nipples of the mother or of the bottle1 or unclean bottles1 allow entrance of germs1 and are frequent causes4 ,irritation of a sharp tooth1 or from rubbing the gum1 or from too vigorous cleansing of the mouth1 may start the disease4 ,some chemicals1 especially mercury improperly prescribed1 produce the disease4 ,the germs may gain admission in impure milk in some cases4 ,inflammation of the mouth is essentially a children's disease1 only the ulcerated form being common in adults4 ,symptoms4--,in general1 the mouth is hot1 very red1 dry1 and tender2 the child is fretful and has difficulty in nursing1 often dropping the nipple and crying2 the tongue is coated1 and there may be fever and symptoms of indigestion1 as vomiting2 sometimes the disease occurs during the course of fevers2 later in the course of the disorder the saliva often runs freely from the mouth4 ,simple ,form4--,in this there are only redness1 swelling1 and tenderness of the inside of the mouth4 ,the tongue is at first dry and white1 but the white coating comes off1 leaving it red in patches4 ,after a while the saliva becomes profuse4 ,the treatment consists in washing the mouth often in ice water containing about one-half drachm of boric acid to four ounces of water by means of cotton tied on a stick1 and holding lumps of ice in the mouth wrapped in the corner of a handkerchief4 ,it is well also to give a teaspoonful of castor oil4 ,aphthous ,form4--,in this there are yellow-white spots1 resulting in little shallow depressions or ulcers1 on the inside of the cheeks and lips1 and on the tongue and roof of the mouth4 ,these occur in crops and last from ten to fourteen days4 ,the disease is often preceded by vomiting1 constipation1 and fever1 with pain in the mouth and throat1 and is accompanied by lumps or swelling of the glands under the jaw and in the neck4 ,the treatment consists in the use of castor oil1 and swabbing the mouth1 several times a day1 after each feeding1 with boric-acid solution1 as advised before1 or better with permanganate of potash solution1 using ten grains to the cup of water4 ,thrush 7,sprue74--,this form is due to the growth of a special fungus in the mouth1 causing the appearance of white spots on the inside of the cheeks1 lips1 tongue1 and roof of the mouth1 looking like flakes of curdled milk1 but not easily removed4 ,there are also symptoms of indigestion1 as vomiting1 diarrhea1 and colic4 ,the disease is contagious1 and is due to some uncleanliness1 often of the bottles1 nipples1 or milk4 ,sometimes ulcers or sore depressions are left in the mouth1 and in weak children1 in which the disease is apt to occur1 the result may be serious1 and a physician's services are demanded4 ,the treatment consists in applying saleratus and water 7one teaspoonful in a cup of water7 to the whole inside of the mouth1 between feedings1 with a camel's-hair brush or with a soft cloth4 ,a dose of castor oil is also desirable1 and great care as regards cleanliness of the bottles and nipples should be exercised4 ,ulcerous ,form4--,this does not occur in children under five1 but may attack persons of all greater ages4 ,it is often seen following measles and scarlet fever1 and in the poor and ill nourished1 and after the unwise use of calomel4 ,there are redness and swelling of the gum about the base of the lower front teeth1 and the gums bleed easily4 ,matter1 or pus1 forms between the teeth and the gum1 and the mouth has a foul odor4 ,the gum on the whole lower jaw may become inflamed1 and a yellow band of ulceration may appear along the gums4 ,the glands under the jaw and in the neck are enlarged1 feeling like tender lumps1 and saliva flows freely4 ,in severe cases the gums may become destroyed and eaten away by the ulceration1 and the bone of the jaw be diseased and exposed4 ,as in the graver cases it may become necessary to remove dead bone and teeth1 and the very dangerous form next described may sometimes follow it1 it will be seen that it is a disease requiring skilled medical attention4 ,the treatment consists in using1 as a mouth wash and gargle1 a solution of chlorate of potash 7fifteen grains to the ounce7 every two hours4 ,cases usually last at least a week4 ,gangrenous ,form4--,this is a rare and fatal form of inflammation of the mouth and occurs in children weak and debilitated from other diseases1 as from the contagious eruptive fevers1 chronic diarrhea1 and scurvy4 ,it is seen more often in hospitals and is contagious4 ,a foul odor is noticed about the mouth1 in which will be seen an ulcer on the gum or inside of the cheek4 ,the cheek swells tremendously1 with or without pain1 and becomes variously discolored--red1 purple1 black4 ,the larger proportion of patients die of exhaustion and blood poisoning within one to three weeks1 and the only hope is through surgical interference at the earliest possible moment4 ,,canker4--,a small1 shallow1 yellow ulcer1 appearing on the inside of the lips or beneath the tongue during some disorder of the digestion4 ,it is very tender when touched and renders chewing or talking somewhat painful4 ,treatment consists of touching the ulcer carefully with the point of a wooden toothpick which has been dipped in pure carbolic acid 7a poison7 and then rinsing the resulting white spot and the whole mouth very carefully1 so as not to swallow any of the acid4 ,inflammation of the mouth occurs in two other general diseases1 in syphilis and rarely in diphtheria4 ,in children born of syphilitic parents1 deep cracks often appear at either side of the mouth and do not heal as readily as ordinary sores1 but continue a long time1 and eventually leave deep scars4 ,in diphtheria the membrane which covers the tonsils sometimes spreads to the cheeks1 tongue1 and lips1 but in either case the general symptoms will serve to distinguish the diseases1 and neither can be treated by the layman4 ,,mild ,,sore ,,throat 7,acute ,pharyngitis74--,the milder sore throat is commonly the beginning of an ordinary cold1 although sometimes it is caused by digestive disorders4 ,exposure to cold and wet is1 however1 the most frequent source of this form of sore throat4 ,soreness1 dryness1 and tickling first call attention to the trouble1 together with a feeling of chilliness and1 perhaps1 slight fever4 ,there may be some stiffness and soreness about the neck1 owing to swelling of the glands4 ,if the back of the tongue is held down by a spoon handle1 the throat will be seen to be generally reddened1 including the back1 the bands at the side forming the entrance to the throat at the back of the mouth1 and the uvula or small1 soft body hanging down from the middle of the soft palate at the very back of the roof of the mouth4 ,the tonsils are not large and red nor covered with white dots1 as in tonsilitis4 ,neither is there much pain in swallowing4 ,the surface of the throat is first dry1 glistening1 and streaked with stringy1 sticky mucus4 ,treatment4--,the disorder rarely lasts more than a few days4 ,the bowels should be moved in the beginning of the attack by some purge1 as two compound cathartic pills or three grains of calomel1 and the throat gargled1 six times daily1 with potassium chlorate solution 7one-quarter teaspoonful to the cup of water71 or with ,dobell's solution4 ,in gargling1 simply throw back the head and allow the fluid to flow back as far as possible into the throat without swallowing it4 ,the frequent use of one of these fluids in an atomizer is even preferable to gargling4 ,as an additional treatment1 the employment of a soothing and pleasant substance1 as peppermints1 hoarhound or lemon drops1 or marshmallows or gelatin lozenges1 is efficacious1 and will prove an agreeable remedy to the patient in sad contrast with many of our prescriptions4 ,the use of tobacco must be stopped while the throat is sore4 ,illustration3 ,,plate ,,iv ,plate ,,iv ,,the ,,larynx ,the illustration on the opposite page shows the upper part of the larynx and the base of the tongue4 ,during the inspiration of a full breath1 or when singing a low note1 the ,epiglottis lies forward and points upward1 as shown in the cut1 with the glottis 7the passage leading into the windpipe between the vocal cords7 wide open4 ,during the act of swallowing1 the epiglottis is turned downward and backward until it touches the ,cricoid ,cartilage1 thus closing the glottis4 ,the cricoid cartilage1 which forms the upper part of the framework of the larynx1 rests on the ,adam's apple4 ,the ,false ,vocal ,cords are bands of ligament1 and take no part in the production of sound4 ,the ,true ,vocal ,cords move during talking or singing1 and relax or contract when sounding1 respectively1 a low or high note4 ,hoarseness and cough occurring during laryngitis1 diphtheria1 and croup1 are the result of inflammation of the mucous membrane lining the larynx4 ,,tonsilitis 7,follicular ,tonsilitis74--,tonsilitis is a germ disease and is contagious4 ,exposure to cold and wet and to germ-laden air renders persons more liable to attacks4 ,it is more likely to occur in young people1 especially those who have already suffered from the disease and whose tonsils are chronically enlarged1 and is most prevalent in this country in spring4 ,the disease appears to be often associated with rheumatism4 ,tonsilitis begins much like grippe1 with fever1 headache1 backache and pain in the limbs1 sore throat1 and pain in swallowing4 ,on inspecting the throat 7with the tongue held down firmly by a spoon handle and the mouth widely open in a good light1 preferably sunlight7 the tonsils will be seen to be swollen1 much reddened1 and dotted over with pearl-white spots4 ,sometimes only one tonsil is so affected1 but the other is likely to become inflamed also4 ,occasionally there may be only one spot of white on the tonsil4 ,the swelling differs in degree2 in some cases the tonsils may be so swollen as almost to meet together1 but there is no danger of suffocation from obstruction of the throat1 as occurs in diphtheria and very rarely in quinsy4 ,the characteristic appearance then consists in large1 red tonsils covered with white spots4 ,the spots represent discharge which fills in the depressions in the tonsil4 ,the fever lasts three days to a week1 generally1 and then subsides together with the other symptoms4 ,with apparent tonsilitis there must always be kept in mind the possibility of diphtheria1 and1 unfortunately1 it is at times impossible for the most acute physician to distinguish between these two diseases by the appearances of the throat alone4 ,in order to do so it is necessary to rub off some of the discharge from the tonsils1 and examine1 microscopically1 the kind of germs contained therein4 ,the general points of difference are3 in diphtheria the tonsils are usually completely covered with a gray membrane4 ,in the early stage1 or in mild cases of diphtheria1 there may be only a spot on one tonsil1 but it is apt to be yellow in color1 and is thicker than the white spots in tonsilitis4 ,these are the difficult cases4 ,ordinarily1 in diphtheria1 not only are the tonsils covered with a grayish membrane1 but this soon extends to the surrounding parts of the throat1 whereas in tonsilitis the spots are always found on the tonsil alone4 ,the white spot can be readily wiped off with a little absorbent cotton wound on a stick1 in the case of tonsilitis1 but in diphtheria the membrane can be removed in this way only with difficulty1 and leaves underneath a rough1 bleeding surface4 ,the breath is apt to have a bad odor in diphtheria1 and the temperature is lower 7not much over #ajj deg4 ,f47 than in tonsilitis1 when it is frequently #aja deg4 to #ajc deg4 ,f4 ,notwithstanding these points1 it is never safe for a layman to undertake the diagnosis when a physician's services are obtainable4 ,on the other hand1 when this is not possible and the patient's tonsils present the white1 dotted appearance described1 especially if subject to similar attacks1 one may be reasonably sure that the case is tonsilitis4 ,treatment4--,the patient should be put to bed and kept apart from children and young persons1 and1 if living among large numbers of people1 should be strictly quarantined4 ,for1 although the disease is not dangerous1 it quickly spreads in institutions1 boarding schools1 etc4 ,if the tonsils are painted with a solution of silver nitrate 7one drachm to the ounce of water71 applied carefully with a camel's-hair brush1 at the beginning of the attack1 and making two applications twelve hours apart1 the disease may sometimes be arrested4 ,it is well also at the start to open the bowels with calomel1 giving three grains in a single dose1 or divided doses of one-half grain each until three grains have been taken4 ,pain is relieved by phenacetin in three- to five-grain doses as required1 but not taken oftener than once in three hours1 while at night five to ten grains of ,dover's powder 7for an adult7 will secure sleep4 ,for children one-half drop doses of the 7poisonous7 tincture of aconite is preferable to phenacetin4 ,the outside of the throat should be kept covered with wet flannel wrung out in cold water and covered with oil silk1 or an ice bag may be conveniently used in its place4 ,a half teaspoonful of the following prescription is beneficial unless it disagrees with the stomach4 ,it must not be taken within half an hour of a meal1 and is not to be diluted with water1 as it acts1 partly through its local effect1 on the tonsils when allowed to flow from a spoon on the back of the tongue4 ,rx ,glycerin #d ounces ,tincture of chloride of iron #a_/b ounce ,mix4 ,directions1 half teaspoonful every half hour4 ,a mixture of hydrogen dioxide1 equal parts1 with water can also be used to advantage as a spray in an atomizer every two hours4 ,the phenacetin and ,dover's powder must be discontinued as soon as the pain and sleeplessness cease1 but the iron preparation and spray should be continued until the throat regains its usual condition4 ,a liquid diet is desirable during the first part of the attack1 consisting of milk1 cocoa1 eggnog 7made of the white of egg71 soups1 and gruels2 orange juice may be allowed1 also grapes4 ,the bowels must be kept regular with mild remedies1 as a ,seidlitz powder in a glass of water in the morning1 or one or two two-grain tablets of extract of cascara sagrada at night4 ,,quinsy4--,quinsy is a peritonsilitis2 that is1 it is an inflammatory disease of the tissues in which the tonsil is imbedded1 an inflammation around the tonsil4 ,the swelling of these tissues thrusts the tonsil out into the throat2 but the tonsil is little affected4 ,quinsy involves the surrounding structures of the throat1 and usually results in abscess4 ,the disease is said to be frequently hereditary1 and often occurs in those subject to rheumatism and gout4 ,it is seen more often in spring and autumn and in those living an out-of-door existence1 and having once had quinsy the victim is liable to frequent recurrences of the disease4 ,quinsy is characterized by much greater pain in the throat and in swallowing than is the case in tonsilitis1 and the temperature is often higher--sometimes #ajd deg4 to #aje deg4 ,f4 ,when the throat is inspected1 one or both tonsils are seen to be enlarged and crowded into its cavity from the swelling of the neighboring parts4 ,the tonsils may almost block the entrance to the throat4 ,the voice is thick and indistinct1 the glands in the side of the neck become swollen1 and the neck is sore and stiff in consequence1 while the mouth can be only partially opened on account of pain4 ,for the same reason the patient can swallow neither solid nor liquid food1 and sits bent forward1 with saliva running out of the mouth4 ,the secretion of saliva is increased1 but is not swallowed on account of the pain produced by the act4 ,sleep is also impossible1 and altogether a more piteous spectacle of pain and distress is rarely seen4 ,having reached this stage the inflammation usually goes on to abscess 7formation behind or above or below the tonsil71 and1 after five to ten days from the beginning of the attack1 the pus finds its way to the surface of the tonsil1 and breaks into the mouth to the inexpressible relief of the patient4 ,this event is followed by quick subsidence of the symptoms4 ,quinsy is rarely a dangerous disease1 yet1 occasionally1 it leads to so much obstruction in the throat that death from suffocation ensues unless a surgeon opens the throat and inserts a tube4 ,occasionally the pus from the ruptured abscess enters the larynx and causes suffocation4 ,quinsy differs from tonsilitis in the following respects3 the swelling affects the immediate surrounding area of the throat2 there are no white spots to be seen on the tonsil unless the trouble begins as an ordinary tonsilitis2 there is great pain on swallowing1 and finally abscess near the tonsil in most cases4 ,treatment4--,a thorough painting of the tonsils at the onset of a threatened attack of quinsy with the silver-nitrate solution1 as recommended under tonsilitis1 may cut short the disorder4 ,a single dose of calomel 7three to five grains7 is also useful for the same purpose4 ,the tincture of aconite should be taken hourly in three-drop doses until five such have been swallowed1 when the drug is to be no longer used4 ,the constant use of a hot flaxseed poultice 7as large as the whole hand and an inch thick1 spread between thin layers of cotton and applied as hot as can be borne1 and changed every half hour7 gives more relief than anything else1 and may possibly lead to disappearance of the trouble if employed early enough4 ,the use of the poultices is to be kept up until recovery1 although they need not be applied so frequently as at first4 ,a surgeon's services are especially desirable in this disorder1 as early puncture of the peritonsillar tissue may save days of suffering in affording exit for pus as soon as it forms4 ,,diphtheria4--,the consideration of diphtheria will be limited to emphasizing the importance of calling in expert medical advice at the earliest possible moment in suspicious cases of throat trouble4 ,for1 as we noted under tonsilitis1 it is impossible in some cases to decide1 from the appearance of the throat1 whether the disease is diphtheria or tonsilitis4 ,a specimen of secretion removed from the throat for microscopical examination by a bacteriologist as to the presence of diphtheria germs alone will determine the point4 ,when such an examination is impossible1 it is always best to isolate the patient1 especially if a child1 and treat the case as if it were diphtheria4 ,diphtheria may invade the nose and be discoverable in the nostrils4 ,a chronic membranous rhinitis should be treated as a case of walking diphtheria4 ,antitoxin is the treatment above all other remedies4 ,it has so altered the outlook in diphtheria that1 formerly regarded by physicians with alarm and dismay1 it is now rendered comparatively harmless4 ,the death rate has been reduced from an average of about forty per cent1 before the introduction of antitoxin1 to only ten per cent since its use1 and1 when it is used at the onset of the disease1 the results are much more favorable still4 ,this latter fact is the reason for obtaining medical advice at the earliest opportunity in all doubtful cases of throat ailments2 and1 we might add1 that the diagnosis of any case of sore throat is doubtful1 particularly in children1 whenever there is seen a whitish1 yellowish-white1 or gray deposit on the throat4 ,antitoxin is an absolutely safe remedy1 its ill effects being sometimes the production of a nettlerash or some mild form of joint pains4 ,in small doses1 it will prevent the occurrence of diphtheria in those exposed1 or liable to exposure1 to the disease4 ,the proper dose and method of employing antitoxin it is impossible to impart in a book of this kind4 ,paralysis of throat1 of vocal cords1 or of arms or legs--partial or entire--is a frequent sequel of diphtheria4 ,it is not caused by antitoxin4 ,the points which it is desirable for everyone to know are1 that any sore throat--with only a single white spot on the tonsil--may be diphtheria1 but that when the white spot or deposit not only covers the tonsil or tonsils 7see ,tonsilitis7 but creeps up on to the surrounding parts1 as the palate 7the soft curtain which shuts off the back of the roof of mouth from the throat71 the uvula 7the little body hanging from the middle of the palate in the back of the mouth71 and the bands on either side of the back of the mouth at its junction with the throat1 then the case is probably one of diphtheria4 ,but it is often a day or two before the white deposit forms1 the throat at first being simply reddened4 ,the fever in diphtheria is usually not high 7often not over #ajj deg4 to #ajb deg4 ,f471 and the headache1 backache1 and pains in the limbs are not so marked as in tonsilitis4 ,,membranous ,,croup4--,membranous croup is diphtheria of the lower part of the throat 7larynx71 in the region of the ,adam's apple4 ,if in a case of what appears to be ordinary croup 7p4 #hc7 the symptoms are not soon relieved by treatment1 or if any membrane is coughed up1 or if1 on inspection of the throat1 it is possible to see any evidence of white spots or membrane1 then a physician's services are imperative4 ,it is not very uncommon for patients with mild forms of diphtheria to walk about and attend to their usual duties and1 if children1 to go to school1 and in that inviting field to spread the disease4 ,these cases may present a white spot on one tonsil1 or in other cases have what looks to be an ordinary sore throat with a simple redness of the mucous membrane4 ,sore throats in persons who have been in any way exposed to diphtheria1 and especially sore throats in children under such circumstances1 should always be subjected to microscopical examination in the way we have alluded to before1 for the safety of both the patient and the public4 ,there is still another point perhaps not generally known and that is the fact that the germs of diphtheria may remain in the throat of a patient for weeks1 and even months1 after all signs in the throat have disappeared and the patient seems well4 ,in such cases1 however1 the disease can still be communicated in its most severe form to others4 ,therefore1 in all cases of diphtheria1 examination of the secretion in the throat must show the absence of diphtheria germs before the patient can rightfully mix with other people4 ,gargling and swabbing the throat with the 7poisonous7 solution of bichloride of mercury1 #a part to #aj1jjj parts of water 7none of which must be swallowed71 should be employed every three or four hours each day till the germs are no longer found in the mucus of the tonsils4 ,,hoarseness 7,acute ,laryngitis74--,this is an acute inflammation of the mucous membrane of the larynx4 ,the larynx is that part of the throat1 in the region of the ,adam's apple1 which incloses the vocal cords and other structures used in speaking4 ,hoarseness is commonly due to extension of catarrh from the nose in cold in the head and grippe4 ,it also follows overuse of the voice in public speakers and singers1 and is seen after exposure to dust1 tobacco1 or other smoke1 and very commonly in those addicted to alcohol4 ,symptoms4--,hoarseness is the first symptom noticed1 and perhaps slight chilliness1 together with a prickling or tickling sensation in the throat4 ,there is a hacking cough and expectoration of a small amount of thick secretion4 ,there may be slight difficulty in breathing and some pain in swallowing4 ,the patient feels generally pretty well1 and is troubled chiefly by impairment of the voice1 which is either husky1 reduced to a mere whisper1 or entirely lost4 ,this condition lasts for some days or1 rarely1 even weeks4 ,there may be a mild degree of fever at the outset 7#ajj deg4 to #aja deg4 ,f474 ,very uncommonly the breathing becomes hurried and embarrassed1 and swallowing painful1 owing to excessive swelling and inflammation of the throat1 so much so that a surgeon's services become imperative to intube the throat or to open the windpipe1 in order to avoid suffocation4 ,this serious form of laryngitis may follow colds1 but more often is brought about by swallowing very hot or irritating liquids1 or through exposure to fire or steam4 ,in children1 after slight hoarseness for a day or two1 if the breathing becomes difficult and is accompanied by a crowing or whistling sound1 with blueness of the lips and signs of impending suffocation1 the condition is very suggestive of membranous croup 7a form of diphtheria71 which certainly is the case if any white1 membranous deposit can be either seen in the throat or is coughed up4 ,whenever there is difficulty of breathing and continuous hoarseness1 in children or adults1 the services of a competent physician are urgently demanded4 ,treatment4--,the use of cold is of advantage4 ,cracked ice may be held in the mouth1 ice cream can be employed as part of the diet1 and an ice bag may be applied to the outside of the throat4 ,the application of a linen or flannel cloth to the throat wrung out of cold water and covered with oil silk or waterproof material1 is also beneficial1 and often more convenient than an ice bag4 ,the patient must absolutely stop talking and smoking4 ,if the attack is at all severe1 he should remain in bed4 ,if not so1 he must stay indoors4 ,at the beginning of the disorder a teaspoonful of paregoric and twenty grains of sodium bromide are to be taken in water every three hours1 by an adult1 until three doses are swallowed4 ,inhalation of steam from a pitcher containing boiling water is to be recommended4 ,fifteen drops of compound tincture of benzoin poured on the surface of a cup of boiling water increases the efficacy of the steam inhalation4 ,the head is held above the pitcher1 a towel covering both the head and pitcher to retain the vapor4 ,the employment1 every two hours1 of a spray containing menthol and camphor 7of each1 ten grains7 dissolved in alboline 7two ounces7 should be continued throughout the disease4 ,if the hoarseness persists and tends to become chronic1 it is most advisable for the patient to consult a physician skilled in such diseases for local examination and special treatment4 ,,croup4--,croup is an acute laryngitis of childhood1 usually occurring between the ages of two and six years4 ,the nervous element is more marked than in adults1 so that the symptoms appear more alarming4 ,the trouble frequently arises as part of a cold1 or as a forerunner of a cold1 and often is heralded by some hoarseness during the day1 increasing toward night4 ,the child may then be slightly feverish 7temperature not over #ajb deg4 ,f41 usually74 ,the child goes to bed and to sleep1 but awakens1 generally between #i and #ab ,p4,m41 with a hard1 harsh1 barking cough 7croupy cough7 and difficulty in breathing4 ,the breathing is noisy1 and when the air is drawn into the chest there is often a crowing or whistling sound produced from obstruction in the throat1 due to spasm of the muscles and to dried mucus coating the lining membrane1 or to swelling in the larynx4 ,it is impossible to separate these causes4 ,the child is frightened1 as well as his parents1 and cries and struggles1 which only aggravates the trouble4 ,the worst part of the attack is1 commonly1 soon over1 so that as a rule the doctor arrives after it is past4 ,while it does last1 however1 the household is more alarmed than1 perhaps1 by any other common ailment4 ,death from an attack of croup1 pure and simple1 has probably never occurred4 ,the condition described may continue in a less urgent form for two or three hours1 and very rarely reappears on following nights or days4 ,the child falls asleep and awakens next morning with evidences of a cold and cough1 which may last several days or a week or two4 ,the only other disease with which croup is likely to be confused is membranous croup 7diphtheria of the larynx71 and in the latter disorder the trouble comes on slowly1 with hoarseness for two or three days and gradually increasing fever 7#ajc deg4 to #aje deg4 ,f47 and great restlessness and difficulty in breathing1 not shortly relieved by treatment1 as in simple croup4 ,in fifty per cent of the cases of membranous croup it is possible to see a white1 membranous deposit on the upper part of the throat by holding the tongue down with a spoon handle and inspecting the parts with a good light4 ,croup is more likely to occur in children suffering from adenoids1 enlarged tonsils1 indigestion1 and decayed teeth1 and is favored by dry1 furnace heat1 by exposure to cold1 and by screaming and shouting out of doors4 ,treatment4--,place the child in a warm bath 7#aja deg4 ,f47 and hold a sponge soaked in hot water over the ,adam's apple of the throat1 changing it as frequently as it cools4 ,hot camphorated oil rubbed over the neck and chest aids recovery4 ,if the bowels are not loose1 give a teaspoonful of castor oil or one or two grains of calomel4 ,the most successful remedies are ipecac and paregoric4 ,it is wise to keep both on hand with children in the house4 ,a single dose of paregoric 7fifteen drops for child of two years2 one teaspoonful for child of seven years7 and repeated doses of syrup of ipecac 7one-quarter to one-half teaspoonful7 should be given every hour till the child vomits and the cough loosens1 and every two hours afterwards4 ,the generation of steam near the child also is exceedingly helpful in relieving the symptoms4 ,a kettle of water may be heated over a lamp4 ,a rubber or tin tube may be attached to the spout of the kettle and carried under a sort of sheet tent1 covering the child in bed4 ,the tent must be arranged so as to allow the entrance of plenty of fresh air4 ,very rarely the character of the inflammation in croup changes1 and the difficulty in breathing1 caused by swelling within the throat1 increases so that it is necessary to employ a surgeon to pass a tube down the throat into the larynx1 or to open the child's windpipe and introduce a tube through the neck to prevent suffocation4 ,the patient recovering from croup should generally be kept in a warm1 well-ventilated room for a number of days after the attack1 and receive syrup of ipecac three or four times daily1 until the cough is loosened4 ,if ipecac causes nausea or vomiting1 the dose must be reduced4 ,the disease is prevented by a simple diet1 especially at night2 by the removal of enlarged tonsils and adenoids2 by daily sponging1 before breakfast1 with water as cold as it comes from the faucet1 while the child stands1 ankle deep1 in hot water2 and by an out-of-door existence with moderate school hours2 also by evaporating water in the room during the winter when furnace heat is used4 ,when children show signs of an approaching attack of croup1 give three doses of sodium bromide 7five grains for child two years old2 ten grains for one eight years old7 during the day at two-hour intervals and give a warm bath before bedtime1 and rub chest and neck with hot camphorated oil4 ,,chapter ,,iii ,the ,lungs and ,bronchial ,tubes ,meaning of ,bronchitis--,symptoms and ,treatment--,remedies for ,infants--,pneumonia--,consumption the ,great ,destroyer--,asthma--,la ,grippe4 ,,cough 7occurring in ,bronchitis1 ,pneumonia1 ,consumption or ,tuberculosis1 ,asthma1 and ,influenza or ,grippe74--,cough is a symptom of many disorders4 ,it may be caused by irritation of any part of the breathing apparatus1 as the nose1 throat1 windpipe1 bronchial tubes1 and 7in pleurisy and pneumonia7 covering membrane of the lung4 ,the irritation which produces cough is commonly due either to congestion of the mucous membrane lining the air passages 7in early stage of inflammation of these tissues71 or to secretion of mucus or pus blocking them1 which occurs in the later stages4 ,cough is caused by a sudden1 violent expulsion of air from the chest following the drawing in of a deep breath4 ,a loose cough is to be encouraged1 as by its means mucus and other discharge is expelled from the air passages4 ,a dry cough is seen in the early stages of various respiratory diseases1 as bronchitis1 pneumonia1 pleurisy1 consumption1 whooping cough1 and with irritation from enlarged tonsils and adenoids 7see p4 #fa7 occurring in children4 ,irritation produced by inhaling dust1 or any irritation existing in the nose1 ear1 or throat may lead to this variety of cough4 ,the dry cough accomplishes no good1 and if continuous and excessive may do harm1 and demands medicinal relief4 ,bronchitis4--,cough following or accompanying cold in the head and sore throat generally means bronchitis4 ,the larynx or lower part of the throat ends just below the ,adam's apple in the windpipe4 ,the windpipe is about four and a half inches long and three-quarters to an inch in diameter1 and terminates by dividing into the two bronchial tubes in the upper part of the chest4 ,each bronchial tube divides and subdivides in turn like the branches of a tree1 the branches growing more numerous and smaller and smaller until they finally end in the microscopic air sacs or air cells of the lungs4 ,the bronchial tubes convey air to the air cells1 and in the latter the oxygen is absorbed into the blood1 and carbonic acid is given up4 ,bronchitis is an inflammation of the mucous membrane lining these tubes4 ,in cough of an ordinary cold only the mucous membrane of the windpipe and1 perhaps1 of the larger tubes is inflamed4 ,this is a very mild disorder compared to inflammation of the smaller and more numerous tubes4 ,in bronchitis1 besides the ordinary symptoms of a severe cold in the head1 as sneezing1 running of mucus from the nose1 sore throat and some hoarseness perhaps1 and languor and soreness in the muscles1 there is at first a feeling of tightness1 pressure1 and rawness in the region of the breastbone1 with a harsh1 dry cough4 ,the coughing causes a strain of the diaphragm 7the muscle which forms the floor of the chest71 so that there are often pain and soreness along the lower borders of the chest where the diaphragm is attached to the inside of the ribs4 ,after a few days the cough becomes looser1 greatly to the patient's comfort1 and a mixture of mucus and pus is expectorated4 ,in a healthy adult such a cough is usually not in itself a serious affair1 and apart from the discomfort of the first day or two1 there is not sufficient disturbance of the general health to interfere with the ordinary pursuits4 ,the temperature is the best guide in such cases2 if it is above normal 7#ih-c_/e deg4 ,f47 the patient should stay indoors4 ,in infants1 young children1 enfeebled or elderly people1 bronchitis may be a serious matter1 and may be followed by pneumonia by extension of the inflammation from the small bronchial tubes into the air sacs of the lungs1 and infection with the pneumonia germ4 ,the principal signs of severe attacks of bronchitis are rapid breathing1 fever1 and rapid pulse4 ,the normal rate of breathing in adults is seventeen a minute1 that is1 seventeen inbreaths and seventeen outbreaths4 ,in children of one to five years the normal rate is about twenty-six breathing movements a minute4 ,in serious cases of bronchitis the rate may be twenty-five to forty in adults1 or forty to sixty in children1 per minute4 ,of course the only exact way of learning the nature of a chest trouble is thorough1 careful examination by a physician1 for cough1 fever1 rapid breathing and rapid pulse occur in many other diseases besides bronchitis1 particularly pneumonia4 ,pneumonia begins suddenly1 often with a severe chill1 headache1 and general pains like grippe4 ,in a few hours cough begins1 short and dry1 with violent1 stabbing pain in one side of the chest1 generally near the nipple4 ,the breathing is rapid1 with expanding nostrils1 the face is anxious and often flushed4 ,the matter coughed up at first is often streaked with blood1 and is thick and like jelly4 ,the temperature is often #ajd deg4-#aje deg4 ,f4 ,if the disease proceeds favorably1 at the end of five1 seven1 or ten days the temperature1 breathing1 and pulse become normal suddenly1 and the patient rapidly emerges from a state of danger and distress to one of comfort and safety4 ,the sudden onset of pneumonia with chill1 agonizing pain in side1 rapid breathing1 and often delirium with later bloody or rusty-colored1 gelatinous expectoration1 will then usually serve to distinguish it from bronchitis1 but not always4 ,whenever1 with cough1 rapid and difficult breathing occur with rise of temperature 7as shown by the thermometer7 and rapid pulse1 the case is serious1 and medical advice is urgently demanded4 ,treatment of ,acute ,cough and ,bronchitis4--,in the case of healthy adults with a cough accompanying an ordinary cold1 the treatment is very simple1 when there is little fever or disturbance of the general health4 ,the remedies recommended for cold in the head 7p4 #ee7 should be taken at first4 ,it is also particularly desirable for the patient to stay in the house1 or better in bed1 for the first day or two1 or until the temperature is normal4 ,the feeling of tightness and distress in the chest may be relieved by applying a mild mustard paper over the breastbone1 or a poultice containing mustard1 one part1 and flour1 three parts1 mixed with warm water into a paste and spread between two single thicknesses of cotton cloth about eight inches square4 ,the tincture of iodine painted twice over a similar area forms another convenient application instead of the mustard4 ,if the cough is excessive and troublesome at night the tablets of ammonium chloride compound with codeine are convenient4 ,one may be taken every hour or two by an adult1 till relieved4 ,children suffering from a recent cough and fever should be kept in bed while the temperature is above normal4 ,it is well to give infants at the start a grain of calomel or half a teaspoonful of castor oil1 and to children of five to eight years double the dose4 ,the chest should be rubbed with a liniment composed of one part of turpentine and two parts of camphorated oil4 ,it is well also to apply a jacket made of sheet cotton over the whole chest4 ,it is essential to keep the room at a temperature of about #gj deg4 ,f4 and well ventilated1 not permitting babies to crawl on the floor when able to be up1 or to pass from a warm to a cold room4 ,sweet spirit of niter is a serviceable remedy to use at the beginning3 five to fifteen drops every two hours in water for a child from one to ten years of age1 for the first day or two4 ,if the cough is harsh1 hard1 or croupy 7see p4 #hc71 give syrup of ipecac every two hours3 ten drops to an infant of one year or under1 thirty drops to a child of ten years1 unless it causes nausea or vomiting1 when the dose may be reduced one-half4 ,if children become stuffed up with secretion so that the breathing is difficult and noisy1 give a teaspoonful of the syrup of ipecac to make them vomit1 for until they are six or seven years old children cannot expectorate1 and mucus which is coughed up into the mouth is swallowed by them4 ,vomiting not only gets rid of that secretion which has been swallowed1 but expels it from the bronchial tubes4 ,this treatment may be repeated if the condition recurs4 ,in infants under a year of age medicine is to be avoided as much as possible4 ,a teaspoonful of sweet oil and molasses1 equal parts1 may be given occasionally to loosen the cough in mild cases4 ,in other cases use the cough tablet for infants described on p4 #ia4 ,a paste consisting of mustard1 one part1 and flour1 twenty parts1 is very useful when spread on a cloth and applied all about the chest1 front and back4 ,the diet should be only milk for young children during the first day or two1 and older patients should not have much more than this1 except toast and soups4 ,in feeble babies with bronchitis it is wise to give five or ten drops of brandy or whisky in water every two hours1 to relieve difficulty in breathing4 ,children who are subject to frequent colds1 or those in whom cough is persistent1 should receive ,peter ,moeller's cod-liver oil1 one-half to one teaspoonful1 according to age1 three times daily after eating4 ,one of the emulsions may be used instead if the pure oil is unpalatable4 ,adenoids and enlarged tonsils are a fruitful source of constant colds and sore throat1 and their removal is advisable 7see p4 #fa74 ,hardening of the skin by daily sponge baths with cold salt water1 while the child stands or sits in warm water1 is effective as a preventive of colds1 as is also an out-of-door life with proper attention to clothing and foot gear4 ,treatment of ,pneumonia4--,patients developing the symptoms described as suggestive of pneumonia need the immediate attention of a physician4 ,if a person is unfortunate enough to have the care of such a case1 when it is impossible to secure a physician1 it may afford some comfort to know that good nursing is really the prime requisite in aiding recovery1 while skillful treatment is of most value if complications arise4 ,one in every ten cases of pneumonia in ordinarily healthy people proves fatal4 ,in specially selected young men1 as soldiers1 the death rate from pneumonia is only one in twenty-five cases4 ,on the other hand1 pneumonia is the common cause of death in old age2 about seventy out of every hundred patients who die from pneumonia are between sixty and eighty years of age4 ,infants under a year old1 and persons enfeebled with disease or suffering from excesses1 particularly alcoholism1 are also likely to die if stricken with the disease4 ,the patient should go to bed in a large1 well-ventilated1 and sunny room4 ,the temperature of the room should be about #gj deg4 ,f41 and the patient must not be covered so warmly with clothing as to cause perspiration4 ,a flannel jacket may be made to surround the chest1 and should open down the whole front4 ,the nightshirt is worn over this2 nothing more4 ,daily sponging of the patient with tepid water 7#he deg4 to #ij deg4 ,f47 should be practiced4 ,the body is not to be all exposed at once1 but each limb and the trunk are to be separately sponged and dried4 ,if the fever is high 7#ajd deg4 ,f47 the water should be cold 7#gg deg4 to #gb deg4 ,f471 and the sponging done every three hours in the case of a strong patient4 ,visitors must be absolutely forbidden4 ,no more than one or two persons are to be allowed in the sick room at once4 ,the diet should consist chiefly of milk1 a glass every two hours1 varied with milk mixed with thin cooked cereal or eggnog4 ,it is wise to give at the beginning of the disease a cathartic1 such as five grains of calomel followed in twelve hours by a ,seidlitz powder1 if the bowels do not act freely before that time4 ,to relieve the pain in the side1 if excruciating1 give one-quarter grain morphine sulphate1#d and repeat once1 if necessary1 in two hours4 ,the application of an ice bag to the painful side frequently stops the pain1 and1 moreover1 is excellent treatment throughout the course of the disease4 ,the seat of pain usually indicates that the lung on that side is the inflamed one1 so that the ice bag should be allowed to rest against that portion of the chest4 ,water should be freely supplied1 and should be given as well as milk even if the patient is delirious4 ,the bowels are to be moved daily by glycerin suppositories or injection of warm water4 ,dover's powder in doses of five grains is useful to assuage cough4 ,it may be repeated once1 after two hours' interval if desirable1 but must not be employed at the same time as morphine4 ,after the first two or three days are passed1 or sooner in weak subjects1 give strychnine sulphate1 one-thirtieth grain1 every six hours in pill or tablet form4 ,the strychnine is to be continued until the temperature becomes normal1 and then reduced about one-half in amount for a week or ten days while the patient remains in bed1 as he must for some time after the temperature1 pulse1 and breathing have become normal4 ,,consumption2 ,,tuberculosis ,,of ,,the ,,lungs2 ,,phthisis4--,this disease demands especial attention1 not only because it is above all others the great destroyer of human life1 causing one-seventh of all deaths1 but because1 so far from being a surely fatal disease as popularly believed1 it is an eminently curable disorder if recognized in its earliest stage4 ,the most careful laboratory examinations of bodies dead from other causes1 show that very many people have had tuberculosis at some time1 and to some extent1 during life4 ,the reason why the disease fails to progress in most persons is that the system is strong enough to resist the inroads of the disease4 ,the process becomes arrested by the germs being surrounded by a barrier of healthy tissue1 and so perishing in their walled-in position4 ,these facts prove that so far from being incurable1 recovery from consumption frequently occurs without even our knowledge of the disease4 ,it is only those cases which become so far advanced as to be easily recognized that are likely to result fatally4 ,many more cases of consumption are now cured than formerly1 because exact methods have been discovered which enable us to determine the existence of the disease at an early stage of its development4 ,consumption is due to the growth of a special germ in the lungs4 ,the disease is contagious1 that is1 it is capable of being communicated from a consumptive to a healthy person by means of the germs present in the sputum 7expectoration7 of the patient4 ,the danger of thus acquiring the disease directly from a consumptive is slight1 if one take simple precautions which will be mentioned later1 except in the case of a husband1 wife1 or child of the patient who come in close personal contact1 as in kissing1 etc4 ,this is proved by the fact that attendants in hospitals for consumptives1 who devote their lives to the care of these patients1 are rarely affected with consumption4 ,the chief source of danger to persons at large is dust containing the germs derived from the expectoration of human patients1 and thus finding entrance into the lungs4 ,consumption is said to be inherited4 ,this is not the case1 as only most rarely is an infant born actually bearing the living germs of the disease in its body4 ,a tendency to the disease is seen in certain families1 and this tendency may be inherited in the sense that the lung tissue of these persons possesses less resistance to the growth of the germ of consumption4 ,it may well be1 however1 that the children of consumptive parents1 as has been suggested1 are more resistant to the disease through inherited immunity 7as is seen in the offspring of parents who have had other contagious diseases71 and that the reason that they more often acquire tuberculosis is because they are constantly exposed to contact with the germ of consumption in their everyday home life4 ,it is known that there are certain occupations and diseases which render the individual more susceptible to consumption4 ,thus1 stone cutters1 knife grinders and polishers1 on account of inhaling the irritating dust1 are more liable to the disease than any other class4 ,plasterers1 cigar makers1 and upholsterers are next in order of susceptibility for the same reason2 while out-of-door workers1 as farmers1 are less likely to contract consumption than any other body of workers except bankers and brokers4 ,among diseases predisposing to consumption1 ordinary colds and bronchitis1 influenza1 pneumonia1 measles1 nasal obstruction causing mouth-breathing1 and scarlet fever are the most important4 ,no age is exempt1 from the cradle to the grave1 although the liability to the disease diminishes markedly after the age of forty4 ,about one-third more women than men recover from consumption1 probably because it is more practicable for them to alter their mode of life to suit the requirements of treatment4 ,it is1 then1 the neglected cold and cough 7bronchitis7 which offers a field most commonly favorable for the growth of the germs in the lungs which cause consumption4 ,and it is essential to discover the existence of the disease at its beginning1 what is called the incipient stage1 in order to have the best chance of recovery4 ,it becomes important1 therefore1 that each individual know the signs and symptoms which suggest beginning consumption4 ,cough is the most constant early symptom1 dry and hacking at first1 and most troublesome at night and in the early morning4 ,expectoration comes later4 ,loss of weight1 of strength1 and of appetite are also important early symptoms4 ,dyspepsia with cough and loss of weight and strength form a common group of symptoms4 ,the patient is pale1 has nausea1 vomiting1 or heartburn1 and there is rise of temperature in the afternoon1 together with general weakness2 and1 in women1 absence of monthly periods4 ,slight daily rise of temperature1 usually as much as a half to one degree1 is a very suspicious feature in connection with chronic cough and loss of weight4 ,to test the condition1 the temperature should be taken once in two hours1 and will commonly be found at its highest about #d ,p4,m41 daily4 ,the pulse is also increased in frequency4 ,night sweats are common in consumption1 but not as a rule in the first stage2 they occur more often in the early morning hours4 ,chills1 fever1 and sweating are sometimes the first symptoms of consumption1 and in a malarial region would very probably lead to error1 since these symptoms may appear at about the same intervals as in ague4 ,but the chills and fever are not arrested by quinine1 as in malaria1 and there are also present cough and loss of weight1 not commonly prominent in malaria4 ,persistently enlarged glands1 which may be felt as lumps beneath the skin along the sides of the neck1 or in the armpits1 should be looked upon with suspicion as generally tuberculous1 containing the germ of consumption4 ,they certainly demand the attention of early removal by a surgeon4 ,the spitting of bright-red blood is one of the most certain signs of consumption1 and occurs in about eighty per cent of all cases1 but rarely appears as an early warning4 ,the pupils of the eyes may be constantly large at the onset of the disease1 but this is a sign of general weakness4 ,pain is also a frequent but not constant early symptom in the form of stitch in the side1 or pain between or beneath the shoulder blades1 or in the region of the breastbone4 ,this pain is due to pleurisy accompanying the tuberculosis4 ,shortness of breath on exertion is present when consumption is well established1 but is not so common as an early symptom4 ,the voice is often somewhat hoarse or husky at the onset of consumption1 owing to tuberculous laryngitis4 ,to sum up then1 one should always suspect tuberculosis in a person afflicted with chronic cough who is losing weight and strength1 especially if there is fever at some time during the day and any additional symptoms1 such as those described4 ,such a one should immediately apply to a physician for examination of the chest1 lungs1 and sputum 7expectoration74 ,if the germs of tuberculosis are found on microscopical inspection of the sputum1 the existence of consumption is absolutely established4 ,failure to find the germs in this way does not on the other hand prove that the patient is free from the disease1 except after repeated examinations at different times1 together with the inability to discover any signs by examination of the chest4 ,this examination in some instances produces no positive results1 and it may be impossible for the physician to discover anything wrong in the lungs at the commencement of consumption4 ,but1 generally1 examination either of the lungs or of the sputum will decide the matter1 one or both giving positive information4 ,the use of the ,x-rays in the hands of some experts sometimes reveals the presence of consumption before it is possible to detect it by any other method4 ,there is also a substance called tuberculin1 which1 when injected under the skin in suspected cases of consumption causes a rise of temperature in persons suffering from the disease1 but has no effect on the healthy4 ,this method is that commonly applied in testing cattle for tuberculosis4 ,as the results of tuberculin injection in the consumptive are something like an attack of grippe1 and as tuberculin is not wholly devoid of danger to these patients1 this test should be reserved to the last1 and is only to be used by a physician4 ,treatment4--,there is no special remedy at our disposal which will destroy or even hinder the growth of the germs of tuberculosis in the lungs4 ,our endeavors must consist in improving the patient's strength1 weight1 and vital resistance to the germs by proper feeding1 and by means of a constant out-of-door life4 ,the ideal conditions for out-of-door existence are pure air and the largest number of sunshiny days in the year4 ,dryness and an even temperature1 and an elevation of from #b1jjj to #c1jjj feet1 are often serviceable1 but not necessarily successful4 ,when it is impossible for the patient to leave his home he should remain out of doors all hours of bright days1 ten to twelve hours daily in summer1 six to eight hours in winter without regard to temperature1 and should sleep on a porch or on the roof1 if possible4 ,in the ,adirondacks1 patients sit on verandas with perfect comfort while the thermometer is at ten degrees below zero4 ,a patient 7a physician7 in a ,massachusetts sanitarium has arranged a shelf1 protected at the sides1 along the outside of a window1 on which his pillow rests at night1 while he sleeps with his head out of doors and his body in bed in a room inside4 ,if it becomes stormy he retires within and closes the window4 ,if the temperature ranges above #ajj deg4 ,f4 patients should rest in bed or on a couch in the open air1 but1 if below this1 patients may exercise4 ,a steamer chair set inside of a padded1 wicker bath chair1 from which the seat has been removed1 makes a convenient protected arrangement in which a consumptive can pass his time out of doors4 ,if the patient is quite weak and feverish he may remain in bed1 or on a couch1 placed on a veranda or balcony during the day1 and in a room in which all the windows are open at night4 ,screens may be used to protect from direct draughts4 ,no degree of cold1 nor any of the common symptoms1 as night sweats1 fever1 cough1 or spitting of blood1 should be allowed to interfere with this fresh-air treatment4 ,the treatment may seem heroic1 but is most successful4 ,the patient must be warmly clothed or covered with blankets1 and protected from strong winds1 rain1 and snow4 ,during clear weather patients may sleep out of doors on piazzas1 balconies1 or in tents4 ,nutritious food is of equal value with the open-air life4 ,a liberal diet of milk and cream1 eggs1 meat and vegetables is indicated4 ,raw eggs swallowed whole with a little sherry1 or pepper and salt on them1 may be taken between meals1 beginning with one and increasing the number till three are taken at a time1 or nine daily4 ,if the appetite is very poor it is best that a glass of milk be taken every two hours1 varied by white of egg and water and meat juice4 ,drug treatment depends on individual symptoms1 and can1 therefore1 only be given under a physician's care4 ,sanitarium treatment is the most successful1 because patients are under the absolute control of experts and usually in an ideal climate4 ,change of climate is often useful1 but patients should not leave their homes without the advice of a competent physician1 as there are many questions to consider in taking such a step4#e ,there is a growing tendency among physicians to give consumptives out-of-door treatment at their homes1 if living out of cities1 as careful personal supervision gives much better results than a random life in a popular climatic resort4 ,prevention4--,weakly children and those born of consumptives must receive a generous diet of milk1 eggs1 meat1 and vegetables1 and spend most of their time in the open air4 ,their milk should be heated for fifteen minutes to a temperature of #afj deg4 ,f41 in order to kill any germs of tuberculosis1 unless the cows have been tested for this disease4 ,the patient must have a separate sleeping room1 and refrain from kissing or caressing other members of the family4 ,the care of the sputum 7expectoration7 is1 however1 the essential means of preventing contagion4 ,out of doors1 it should be deposited in a bottle which is cleaned by rinsing in boiling water4 ,indoors1 paper bags or paper boxes made for the purpose are used to receive the sputum1 and burned before they become dry4 ,the use of rags1 handkerchiefs1 and paper napkins is dirty1 and apt to cause soiling of the hands and clothes and lead to contagion4 ,plenty of sunlight in the sick room will cause destruction of the germs of consumption1 besides proving beneficial to the patient4 ,no dusting is to be done in the invalid's room2 only moist cleansing4 ,all dishes used by a consumptive must be boiled before they are again employed4 ,,asthma4--,this is a disorder caused by sudden narrowing of the smaller air tubes in the lungs4 ,this narrowing is produced by swelling of the mucous membrane lining them1 or is due to contraction of the tubes through reflex nervous influences4 ,it may accompany bronchitis1 or may be uncomplicated4 ,it may be a manifestation of gout4 ,the sufferers from asthma are usually apparently well in the period between the attacks4 ,the attack often comes on suddenly in the night2 the patient wakening with a feeling of suffocation4 ,the difficulty in breathing soon becomes so great that he has to sit up1 and often goes to a window and throws it open in the attempt to get his breath4 ,the breathing is very labored and panting4 ,there is little difficulty in drawing the breath1 but expiration is very difficult1 and usually accompanied by wheezing or whistling sounds4 ,the patient appears to be on the brink of suffocation2 the eyeballs protrude2 the face is anxious and pale2 the muscles of the neck stand out2 the lips may be blue2 a cold sweat covers the body2 the hands and feet are cold1 and talking becomes impossible4 ,altogether1 a case of asthma presents a most alarming appearance to the bystander1 and the patient seems to be on the verge of dying1 yet death has probably never occurred during an attack of this disease4 ,the attacks last from one-half to one or several hours1 if not stopped by treatment1 and they often return on several successive nights1 and then disappear1 not to recur for months or years4 ,attacks are brought on by the most curious and diverse means4 ,atmospheric conditions are most important4 ,emanations from plants1 or animals1 are common exciting agencies4 ,fright or emotion of any kind2 certain articles of diet2 dust and nasal obstruction are also frequent causes4 ,patients may be free from the disease in cities and attacked on going into the country4 ,men are subject to asthma more than women1 and the victims belong to families subject to nervous troubles of various kinds4 ,the attack frequently subsides suddenly1 just when the patient seems to be on the point of suffocation4 ,there is often coughing and spitting of little yellowish1 semitransparent balls of mucus floating in a thinner secretion4 ,asthma is not likely to be mistaken for other diseases4 ,the temperature is normal during an attack1 and this will enable us to exclude other chest disorders1 as bronchitis and pneumonia4 ,occasionally asthma is a symptom of heart and kidney disease4 ,in the former it occurs after exercise2 in the latter the attack continues for a considerable time without relief4 ,but1 as in all other serious diseases1 a physician's services are essential1 and it is our object to supply only such information as would be desirable in emergencies when it is impossible to obtain one4 ,treatment4--,an attack of asthma is most successfully cut short by means of one-quarter of a grain of morphine sulphate#f with #a_/bj of a grain of atropine sulphate1 taken in a glass of hot water containing a tablespoonful of whisky or brandy4 ,ten drops of laudanum1#g or a tablespoonful of paregoric1 may be used instead of the morphine if the latter is not at hand4 ,sometimes the inhalation of tobacco smoke from a cigar or pipe will stop an attack in those unaccustomed to its use4 ,in the absence of morphine1 or opium in the form of laudanum or paregoric1 fifteen drops of chloroform or half a teaspoonful of ether may be swallowed on sugar4 ,a useful application for use on the outside of the chest consists of mustard1 one part1 and flour1 three parts1 mixed into a paste with warm water and placed between single thicknesses of cotton cloth4 ,various cigarettes and pastilles1 usually containing stramonium and saltpeter1 are sold by druggists for the use of asthmatic patients4 ,they are often efficient in arresting an attack of asthma1 but it is impossible to recommend any one kind1 as one brand may agree with one patient better than another4 ,amyl nitrite is sold in pearls or small1 glass bulbs1 each containing three or four drops1 one of which is to be broken in and inhaled from a handkerchief during an attack of asthma4 ,this often affords temporary relief4 ,to avoid the continuance of the disease it is emphatically advisable to consult a physician who may be able to discover and remove the cause4 ,the diet should consist chiefly of eggs1 fish1 milk1 and vegetables 7with the exception of beans1 large quantities of potatoes1 and roots1 as parsnips1 beets1 turnips1 etc474 ,meat should be eaten but sparingly1 and also pastries1 sugar1 and starches 7as cereals1 potato1 and bread74 ,the evening meal ought to be light1 dinner being served at midday4 ,any change of climate may stop asthmatic seizures for a time1 but the relief is apt to be temporary4 ,climatic conditions affect different patients differently4 ,warm1 moist air in places destitute of much vegetation 7as ,florida1 ,southern ,california1 and the shore of ,cape ,cod and the ,island of ,nantucket1 in summer7 enjoy popularity with many asthmatics1 while a dry1 high altitude influences others much more favorably4 ,,influenza2 ,,la ,,grippe4--,influenza is an acute1 highly contagious disease due to a special germ1 and tending to spread with amazing rapidity over vast areas4 ,it has occurred as a world-wide epidemic at various times in history1 and during four periods in the last century4 ,a pandemic of influenza began in the winter of #ahhi-ij1 and continued in the form of local epidemics till #aijd1 the disease suddenly appearing in a community and1 after a prevalence of about six weeks1 disappearing again4 ,one attack1 it is1 perhaps1 unnecessary to state1 does not protect against another4 ,the mortality is about #a death to #djj cases4 ,the feeble and aged are those who are apt to succumb4 ,fatalities usually result from complications or sequels1 such as pneumonia or tuberculosis2 neurasthenia or insanity may follow4 ,symptoms4--,there are commonly four important symptoms characteristic of grippe3 fever2 pain1 catarrh2 and depression1 mental and physical4 ,grippe attacks the patient with great suddenness4 ,while in perfect health and engaged in ordinary work1 one is often seized with a severe chill followed by general depression1 pain in the head1 back1 and limbs1 soreness of the muscles1 and fever4 ,the temperature varies from #ajj deg4 to #ajd deg4 ,f4 ,the catarrh attacks the eyes1 nose1 throat1 and larger tubes in the lungs4 ,the eyes become reddened and sensitive to light1 and movements of the eyeballs cause pain4 ,sneezing comes on early1 and1 after a day or two1 is followed by discharge from the nose4 ,the throat is often sore and reddened4 ,there may be a feeling of weight and tightness in the chest accompanied by a harsh1 dry cough1 which1 after a few days1 becomes looser and expectoration occurs4 ,bodily weakness and depression of spirits are usually prominent and form often the most persistent and distressing symptoms4 ,after three or four days the pains decrease1 the temperature falls1 and the cough and oppression in the chest lessen1 and recovery usually takes place within a week1 or ten days1 in serious cases4 ,the patient should go to bed at once1 and should not leave it until the temperature is normal 7#ih-c_/e deg4 ,f474 ,for some time afterwards general weakness1 associated with heart weakness1 causes the patient to sweat easily1 and to get out of breath and have a rapid pulse on slight exertion4 ,such is the picture of a typical case1 but it often happens that some of the symptoms are absent1 while others are exaggerated so that different types of grippe are often described4 ,thus the pain in the back and head may be so intense as to resemble that of meningitis4 ,occasionally the stomach and bowels are attacked so that violent vomiting and diarrhea occur1 while other members of the same family present the ordinary form of influenza4 ,there is a form that attacks principally the nervous system1 the nasal and bronchial tracts escaping altogether4 ,continual fever is the only symptom in some cases4 ,grippe may last for weeks4 ,whenever doubt exists as to the nature of the disorder1 a microscopic examination of the expectoration or of the mucus from the throat by a competent physician will definitely determine the existence of influenza1 if the special germs of that disease are found4 ,it is the prevailing and erroneous fashion for a person to call any cold in the head the grippe2 and there are1 indeed1 many cases in which it becomes difficult for a physician to distinguish between grippe and a severe cold with muscular soreness and fever1 except by the microscopic test4 ,influenza becomes dangerous chiefly through its complications1 as pneumonia1 inflammation of the middle ear1 of the eyes1 or of the kidneys1 and through its depressing effect upon the heart4 ,these complications can often be prevented by avoiding the slightest imprudence or exposure during convalescence4 ,elderly and feeble persons should be protected from contact with the disease in every way4 ,whole prisons have been exempt from grippe during epidemics1 owing to the enforced seclusion of the inmates4 ,the one absolutely essential feature in treatment is that the patient stay in bed while the fever lasts and in the house afterwards1 except as his strength will permit him to go out of doors for a time each sunny day until recovery is fully established4 ,treatment4--,the medicinal treatment consists at first in combating the toxin of the disease and assuaging pain1 and later in promoting strength4 ,hot lemonade and whisky may be given during the chilly period and a single six- to ten-grain dose of quinine4 ,pain is combated by phenacetin1#h three grains repeated every three hours till relieved4 ,at night a most useful medicine to afford comfort when pain and sleeplessness are troublesome1 is ,dover's powder1 ten grains 7or codeine1 one grain71 with thirty grains of sodium bromide dissolved in water4 ,after the first day it is usually advisable to give a two-grain quinine pill together with a tablet containing one-thirtieth of a grain of strychnine three times a day after meals for a week or two as a tonic 7adult74 ,only mild cathartics are suitable to keep the bowels regular as a ,seidlitz powder in the morning before breakfast4 ,the diet should be liquid while the fever lasts--as milk1 cocoa1 soups1 eggnog1 one of these each two hours4 ,a tablespoonful of whisky1 rum1 or brandy may be added to the milk three times daily if there is much weakness4 ,the germ causing grippe lives only two days1 but successive crops of spores are raised in a proper medium4 ,neglected mucus in nose or throat affords an inviting field for the germ4 ,therefore it is essential to keep the nostrils free and open by means of spraying with the ,seiler's tablet solution 7p4 #di71 and then always breathing through the nostrils4 ,,footnotes3 #d ,caution4 ,dangerous4 ,use only on physician's order4 #e ,arizona1 ,new ,mexico1 ,colorado1 and the ,adirondacks contain the most favorable climatic resorts in this country4 #f ,caution4 ,dangerous4 ,use only on physician's order4 #g ,this dose is only suitable for strong1 healthy adults of average weight and those who are not affected peculiarly by opium4 ,delicate women and others not coming under the above head should take but half the dose and repeat in an hour if necessary4 #h ,caution4 ,a powerful medicine4 ,,chapter ,,iv ,headaches ,treatment of ,sick ,headache--,effects of ,indigestion--,neuralgia--,headaches ,occasioned by ,disease--,other ,causes--,poisoning--,heat ,stroke4 ,headache varies according to its nature and causes4 ,the first variety to be considered is sick headache or migraine4 ,,sick ,,headache4--,this is a peculiar1 one-sided headache which takes the form of severe1 periodic attacks or paroxysms1 and is often inherited4 ,it recurs at more or less regular intervals1 as on a certain day of each week1 fortnight or month1 and the attacks appear and disappear at regular hours4 ,the disorder generally persists for years and then goes away4 ,if it begins in childhood1 as it frequently does between the years of five and ten1 it may stop with the coming of adult life1 but if not outgrown at this time it commonly vanishes during late middle life1 about the age of fifty-one in a man1 or with the change of life in a woman4 ,while in many instances arising without apparent cause1 yet in others sick headache may be precipitated by indigestion1 by eye-strain1 by enlarged tonsils and adenoids in children1 or by fatigue4 ,there may be some warning of the approach of a sick headache1 as mental depression1 weariness1 disturbances of sight1 buzzing in the ears1 or dizziness4 ,the pain begins at one spot on one side of the head 7more commonly the left71 as in the eye1 temple1 or forehead1 and later spreads over the whole side of the head and1 in some cases1 the neck and arm4 ,the face may be pale1 or pale on one side and red on the other4 ,the headache is of a violent1 boring nature1 aggravated by light and noise1 so that the patient is incapacitated for any exertion and is most comfortable when lying down in a quiet1 dark room4 ,vomiting usually comes on after a while1 and often gives relief4 ,the headache lasts several hours or all day1 rarely longer4 ,the duration is usually about the same in the case of any particular individual who is suddenly relieved at a certain hour generally after vomiting1 a feeling of well-being and an enormous appetite following often4 ,patients may feel perfectly well between the attacks1 but if they occur frequently the general health suffers4 ,in the majority of cases there is no apparent cause discoverable save heredity1 and for these the following treatment is applicable4 ,each case should1 however1 be carefully studied by a physician1 if possible1 as only in this way can any existing cause be found and removed4 ,treatment4--,any article of diet which experience has shown to provoke an attack should naturally be avoided4 ,a ,seidlitz powder1 or tablespoonful of ,epsom salts in a glassful of water1 is advisable at the onset of an attack4 ,rubbing the forehead with a menthol pencil will afford some relief4 ,hot strong tea with lemon juice is sometimes of service4 ,to actually lessen the pain one of the following may be tried3 phenacetin 7eight grains7 and repeat once in an hour if necessary until three doses are taken by an adult2 or1 migraine tablets1 two in number1 and do not repeat2 or fluid extract of cannabis indica1 two drops every half hour until relieved1 or until six doses are taken4 ,,headache ,,from ,,various ,,causes4--,it is impossible to decide from the location or nature of the pain alone to what variety of headache it belongs1 that is1 as to its cause4 ,it is only by considering the general condition of the body that such a decision can be attained4 ,headache from ,indigestion4--,the pain is more often in the forehead1 but may be in the top or back of the head4 ,the headache may last for hours1 or off and on for days4 ,dull headache is seen in biliousness when the whites of the eyes are slightly tinged with yellow and the tongue coated and yellowish1 and perhaps dizziness1 disturbances of sight and a feeling of depression are present4 ,among other signs of headache due to indigestion are3 discomfort in the stomach and bowels1 constipation1 nausea and vomiting1 belching of wind1 hiccough1 and tender or painful eyeballs4 ,in a general way1 treatment for this sort of headache consists in the use of a cathartic1 such as calomel 7three-fifths of a grain7 at night1 followed by a ,seidlitz powder or a tablespoonful of ,epsom salts in a glass of cold water in the morning4 ,a simple diet1 as very small meals of milk1 bread1 toast1 crackers with cereals1 soups1 and perhaps a little steak1 chop1 or fresh fish for a few days1 may be sufficient to complete the cure4 ,sympathetic ,headaches4--,these are caused by irritation in various parts of the body1 which is conveyed through the nervous system to the brain producing headache4 ,headache from eye-strain is one of this class1 and probably the most common1 and1 therefore1 most important of all headaches4 ,there is unfortunately no sure sign by which we can tell eye-headaches from others1 except examination of the eyes 7see p4 #bi74 ,redness1 twitching1 and soreness of the eyelids1 and watering of the eyes1 together with headache1 after their excessive use may suggest the cause in some cases4 ,the pain may be occasioned or almost constant1 and either about the eyes1 forehead1 top or back of the head1 and often takes the form of sick headache4 ,the headache may at times appear to have no connection with use of the eyes4 ,when headache is frequent the eyes should always be examined by a competent oculist 7a physician7 not by any sort of an optician4 ,decayed ,teeth4--,these not uncommonly give rise to headache4 ,disorders of the ,nose and ,throat4--,such troubles1 especially adenoids and enlarged tonsils in children1 enlarged turbinates1 and polypi 7see ,nose ,disorders1 p4 #fj7 are fruitful sources of headache4 ,in nose-headaches there is often tenderness on pressing on the inner wall of the bony socket inclosing the eyeball4 ,diseases of the ,maternal ,organs4--,these in women produce headache1 particularly pain in the back of the head4 ,if local symptoms are also present1 as backache 7low down71 leucorrhea1 painful monthly periods1 and irregular or excessive flowing1 or trouble in urinating1 then the cause of the headache is probably some disorder which can be cured at the hands of a skillful specialist in women's diseases4 ,nervous ,headaches4--,these occur in brain exhaustion and anaemia1 and in nervous exhaustion4 ,there is a feeling of pressure or weight at the back of the head or neck1 rather than real pain4 ,this is often relieved by lying down4 ,headache from anaemia is often associated with pallor of the face and lips1 shortness of the breath1 weakness1 and palpitation of the heart4 ,rest1 abundance of sleep1 change of scene1 out-of-door life1 nourishing food1 milk1 cream1 butter1 eggs1 meat1 and iron are useful in aiding a return to health 7see ,nervous ,exhaustion1 ,vol4 ,,iii1 p4 #ag74 ,neuralgic ,headaches4--,the pain is usually of a shooting character1 and the scalp is often exceedingly tender to pressure4 ,they may be caused by exposure to cold1 or by decayed teeth1 or sometimes by inflammation of the middle ear 7see ,earache1 p4 #dj74 ,headache from ,poisoning4--,persons addicted to the excessive use of tea1 coffee1 alcohol1 and tobacco are often subject to headache from poisoning of the system by these substances4 ,in tea1 coffee1 and tobacco poisoning there is also palpitation of the heart in many cases2 that is1 the patient is conscious of his heart beating1 irregularly and violently 7see ,palpitation1 ,vol4 ,,iii1 p4 #aga71 which causes alarm and distress4 ,cessation of the habit and sodium bromide1 twenty grains three times daily1 dissolved in water1 administered for not more than three days1 may relieve the headache and other trouble4 ,many drugs occasion headache1 as quinine1 salicylates1 nitroglycerin1 and some forms of iron4 ,the poisons formed in the blood by germs in acute diseases are among the most common sources of headache4 ,in these disorders there is always fever and often backache1 and general soreness in the muscles4 ,one of the most prominent symptoms in typhoid fever is constant headache with fever increasing toward night1 and also higher each night than it was the night before4 ,the headache and fever1 together often with occasional nosebleed and general feeling of weariness1 may continue for a week or two before the patient feels sick enough to go to bed4 ,the existence of headache with fever 7as shown by the thermometer7 should always warn one of the necessity of consulting a physician4 ,headache owing to germ poisons is also one of the most distressing accompaniments of grippe1 measles1 and smallpox1 and sometimes of pneumonia4 ,the headache caused by the poison of the malarial parasite in the blood is very violent1 and the pain is situated usually just over the eye1 and occurring often in the place of the paroxysm of the chill and fever at a regular hour daily1 every other day1 or every fourth day4 ,if the headache is due to malaria1 quinine will cure it 7,malaria1 ,vol4 ,i1 p4 #beh74 ,the headache of rheumatism is owing also to a special poison in the blood1 and is often associated with soreness of the scalp4 ,if there are symptoms of rheumatism elsewhere in the body1 existing headache may be logically attributed to the same disease 7see ,rheumatism1 p4 #afi74 ,the poison of gout circulating in the blood is sometimes a source of intense headache4 ,the headache of ,bright's disease of the kidneys and of diabetes is dull and commonly associated with nausea or vomiting1 swelling of the feet or ankles1 pallor and shortness of breath in the former2 with thirst and the passage of a large amount of urine 7normal quantity is three pints in twenty-four hours7 in the case of diabetes4 ,the headaches of indigestion are also of poisonous origin1 the products of imperfectly digested food being absorbed into the blood and acting as poisons4 ,another variety of headache due to poisoning is seen in children crowded together in ill-ventilated schoolrooms and overworked4 ,still another kind is due to inhalation of illuminating gas escaping from leaky fixtures4 ,headache from ,heat ,stroke4--,persons who have been exposed to excessive heat or have actually had a heat stroke 7,vol4 ,i1 p4 #dj7 are very prone to headache1 which is made worse by movements of the head4 ,sodium bromide1 twenty grains dissolved in water1 may be given to advantage three times daily between meals in these cases for not more than two days4 ,phenacetin in eight-grain doses may also afford relief1 but should not be used more often than once or twice a day4 ,constant ,headache4--,this1 afflicting the patient all day and every day1 and increasing in severity at night1 is suggestive of some disease of the brain1 as congestion1 brain tumor1 or meningitis1 and urgently demands skillful medical attention4 ,part ,,ii ,,tumors ,,skin ,,diseases ,,rheumatism ,,by ,,kenelm ,,winslow ,,and ,,albert ,,warren ,,ferris ,,chapter ,i ,growths and ,enlargements ,benign and ,malignant ,tumors--,treatment of ,rupture--,hernia in ,children--,varicocele--,causes of ,varicose ,veins--,external and ,internal ,piles4 ,,tumors4--,a tumor--in its original meaning--signifies a swelling4 ,as commonly used it means a new growth or enlargement of a part1 which is not due to injury or inflammation4 ,tumors occur at all ages1 in both sexes1 and may attack any part of the body4 ,tumors are usually divided into benign and malignant growths4 ,in a general way the malignant tumors are painful2 they do not move about freely but become fixed to the adjacent parts2 their growth is more rapid2 they often have no well-defined borders2 frequently they return after removal2 the skin covering them is often attached and cannot be moved readily without also moving the tumor4 ,malignant tumors are divided into cancers 7carcinomata7 and sarcomas 7sarcomata74 ,cancer is much more frequent than sarcoma4 ,cancer occurs more often in persons over thirty2 there appears to be a hereditary tendency to it in some families1 and a number of individuals in the same house or locality sometimes develop cancer as if it were in some way communicated from one to another4 ,the common situations of cancer are the breast and womb in women1 and the lip and stomach of men4 ,the neighboring glands become enlarged1 as are shown by the lumps which form under the jaw in cancer of the lip1 and which may be felt sometimes in the armpit in cancer of the breast2 these are1 however1 late signs1 and the growth should never be permitted to remain long enough for them to develop4 ,paleness1 weakness1 and loss of strength often attend the development of cancer1 but many do not exhibit these symptoms4 ,sarcoma is often seen in the young and well nourished2 it grows very rapidly2 the skin is usually not adherent to the tumor2 there is generally no pain2 heredity has no relation to its development2 paleness is absent in many cases2 the favorite seats are the muscle1 bone1 glands of neck1 brain1 and many other localities2 it is not nearly so common as cancer4 ,cancer of the breast begins as a lump1 occurring more often to the outside of the nipple1 but may develop in any part4 ,it may or may not be painful at first1 but the skin becomes attached to it2 and sooner or later the nipple is drawn in4 ,it is seen in women over forty1 as a rule4 ,lumps in the breast1 occurring during the nursing period1 are often due to inflammation1 but these generally have no relation to cancer unless they persist for a long time4 ,any lump which appears in the breast without apparent cause1 or which persists for a considerable time after inflammation ceases1 should be promptly removed by the surgeon1 as without microscopic examination the most skilled practitioners will be unable absolutely to distinguish between a harmless and malignant tumor4 ,as even so-called benign tumors often become cancerous 7e4 g41 inflammatory lumps in the breast1 warts1 and moles71 an eminent surgeon 7,dr4 ,maurice ,richardson7 has recently formulated the rule that all tumors1 wherever situated1 should if possible be removed1 whatever their apparent nature4 ,cancer of the womb may be suspected in middle-aged women if flowing is more profuse than is usual1 or occurs at irregular times2 if there is a discharge 7often of offensive odor7 from the front passage2 and sometimes pain1 as backache1 and perhaps paleness4 ,early examination should be sought at the hands of a physician2 it is suicidal to delay4 ,cancer of the stomach is observed more often in men over forty1 and begins with loss of appetite2 nausea or vomiting2 vomiting of blood2 pain in the stomach2 loss of weight1 and paleness4 ,some of these symptoms may be absent4 ,improved methods of surgery have rendered early operation for cancer of the stomach a hopeful measure1 and if cure does not result1 the life will be prolonged and much suffering saved4 ,cancer of the lip arises as a small lump1 like a wart generally1 on the lower lip in men from forty to seventy4 ,sometimes it appears at first simply as a slight sore or crack which repeatedly scabs over but does not heal4 ,its growth is very slow and it may seem like a trivial matter1 but any sore on the lower lip in a man of middle age or over1 which persists1 should demand the immediate attention of a surgeon1 because early removal is more successful in cancer of the lip than in any other form4 ,there are1 of course1 many comparatively harmless or benign forms of tumors which will not return if removed and do not endanger life unless they grow to a large size4 ,among these are the soft1 flattened1 fatty tumors of the shoulders1 back1 buttocks1 and other parts1 and the wen4 ,this is often seen on the head and occurs frequently on the scalp1 from the size of a pea to an egg1 in groups4 ,wens are elastic lumps1 painless and of slow growth1 and most readily removed4 ,space does not permit us to recount the other forms of benign tumors and it would be impossible to describe how they could be distinguished from malignant growths4 ,causes4--,the causes of tumors are almost wholly unknown4 ,there is no other branch of medicine which is receiving more scientific study the world over than cancer1 and some definite and helpful knowledge may soon be expected4 ,a cancer can be communicated by introduction of cancerous material into healthy tissues4 ,this and other reasons have led many to believe that the disease was caused by a special germ2 a chemical cause is thought to be the origin of cancer by other authorities4 ,neither of these theories has been substantiated and we are still completely at sea in the matter4 ,cancer appears to be excited sometimes by local irritation1 as in the lip by the constant irritation of the hard1 hot stem of a clay pipe2 cancer of the tongue by the irritation of a rough1 sharp tooth4 ,blows and injuries are also occasional agencies in the development of cancer4 ,malignant growths not rarely arise from moles and warts4 ,treatment4--,early removal by the knife is the only form of treatment which is to be considered in most cases4 ,delay and neglect are suicidal in malignant disease4 ,cure is successful in just so far as the operation is done early4 ,if dread of surgical operation were not so prevalent1 the results of removal of cancer would be immeasurably better4 ,the common1 bad results of operation--that is1 return of the disease--are chiefly due to the late stage in which surgeons are compelled to operate through the reluctance of the patient and1 strangely enough1 often of his family medical man4 ,cancer should be removed in so early a stage that its true nature can often not be recognized1 except by microscopical examination after its removal4 ,if ,maurice ,richardson's rule were followed1 many cancers would never occur1 or would be removed before they had developed sufficiently to show their nature4 ,all treatment by chemical pastes and special remedies is simply courting fatal results4 ,most special cures advertised to be performed in sanitoriums are money-getting humbugs4 ,even the ,x-ray has proved useless except in the case of most superficial growths limited to the skin or when directed against the scar left by removal of a cancer2 and while the growth may disappear during treatment1 in a large proportion of cases there is a recurrence4 ,but when tumors are so far advanced that removal by the knife is inoperable1 then other means will often secure great relief from suffering and will prolong life for a very considerable period in many cases4 ,,rupture4--,hernia or rupture consists in a protrusion of a portion of the contents of the abdomen 7a part of the bowel or its covering1 or both7 through the belly wall4 ,the common seats of rupture are at the navel and in the groin4 ,rupture at the navel is called umbilical hernia2 that in the groin either inguinal or femoral1 according to slight differences in site4 ,umbilical hernia is common in babies and occurs as a whole in only five per cent of all ruptures1 whereas rupture in the groin is seen to the extent of ninety-four per cent of all ruptures4 ,there is still another variety of hernia happening in the scars of wounds of the belly after injuries or surgical operations1 and this may arise at almost any point4 ,causes4--,rupture is sometimes present at birth4 ,in other cases it is acquired as a result of various causes1 of which natural weakness of the part is the chief4 ,twenty-five per cent of persons with rupture give a history of the same trouble in their parents4 ,rupture is three times more frequent in men than in women1 and is favored by severe muscular work1 fatness1 chronic coughing1 constipation1 diarrhea1 sudden strain1 or blows on the abdomen4 ,symptoms4--,rupture first appears as a fullness or swelling1 more noticeable on standing1 lifting1 coughing1 or straining4 ,it may disappear entirely on lying down or on pressure with the fingers4 ,in the beginning there may be discomfort after standing or walking for any length of time1 and later there is often a dragging pain or uneasiness complained of1 or a sensation of weakness or griping at the seat of the rupture4 ,in case the rupture cannot be returned1 it is called irreducible and is a more serious form4 ,the great danger of hernias is the likelihood of their being strangulated1 as the term is2 that is1 so nipped in the divided abdominal wall that the blood current is shut off and often the bowels are completely obstructed4 ,if this condition is not speedily relieved death will ensue in from two to eight days4 ,such a result is occasioned1 in persons having rupture1 by heavy lifting1 severe coughing or straining1 or by a blow or fall4 ,the symptoms of strangulated hernia are sudden and complete constipation1 persistent vomiting1 and severe pain at the seat of the rupture or often about the navel4 ,the vomiting consists first of the contents of the stomach1 then of yellowish-stained fluid1 and finally of dark material having the odor of excrement4 ,great weakness1 distention of the belly1 retching1 hiccough1 thirst1 profound exhaustion1 and death follow if the condition is not remedied4 ,in some cases1 where the obstruction is not complete1 the symptoms are comparatively milder1 as occasional vomiting and slight pain and partial constipation4 ,if the patient cannot return the protrusion speedily1 a surgeon should be secured at all costs--the patient meanwhile lying in bed with an ice bag or cold cloths over the rupture4 ,the surgeon will reduce the protrusion under ether1 or operate4 ,strangulation of any rupture may occur1 but of course it is less likely to happen in those who wear a well-fitting truss2 still it is always a dangerous possibility1 and this fact and the liability of the rupture's increasing in size make a surgical operation for complete cure advisable in proper subjects4 ,treatment4--,two means of treatment are open to the ruptured3 the use of the truss and surgical operation4 ,by the wearing of a truss1 fifty-eight per cent of ruptures recover completely in children under one year4 ,in children from one to five years1 with rupture1 ten per cent get well with the truss4 ,statistics show that in rupture which has been acquired after birth but five per cent recover with a truss after the age of fifteen1 and but one per cent after thirty4 ,the truss must be worn two years after cure of the rupture in children1 and in adults practically during the rest of their lives4 ,a truss consists of a steel spring which encircles the body1 holding in place a pad which fits over the seat of hernia4 ,the ,knight truss is one of the best4 ,the truss is most satisfactory in ruptures which can be readily returned4 ,in very small or large hernias1 and in those which are not reducible1 the action of the truss is not so effective4 ,in irreducible ruptures there is likely to be constipation and colic produced1 and strangulation is more liable to occur4 ,a truss having a hollow pad may prove of service in small irreducible ruptures1 but no truss is of much value in large hernias of this kind4 ,every person with a reducible rupture should wear a proper truss until the rupture is cured by some means4 ,such a truss should keep in the hernia without causing pain or discomfort4 ,it should be taken off at night1 and replaced in the morning while the patient is lying down4 ,in cases where the protrusion appears during the night a truss must be worn day and night1 but often a lighter form will serve for use in bed4 ,to test the efficiency of a truss let the patient stoop forward with his knees apart1 and hands on the knees1 and cough4 ,if the truss keeps the hernia in1 it is suitable2 if not1 it is probably unsuitable4 ,operation for complete cure of the hernia is successful in #ie cases out of #ajj1 in suitable subjects1 in the ruptures in the groin4 ,the death rate is but about #a in #ejj to #a1jjj operations when done by surgeons skilled in this special work4 ,patients with very large and irreducible hernias1 and those who are very fat and in advanced life1 are unfavorable subjects for operation4 ,in young men operation--if it can be done by a skillful surgeon and in a hospital with all facilities--is usually to be recommended in every case of rupture4 ,umbilical hernias and ventral hernias1 following surgical operations1 may be held in place by a wide1 strong belt about the body1 which holds a circular flat or hollow plate over the rupture4 ,these have been the most difficult of cure by operation2 but recent improvements have yielded very good results--thirty-five cures out of thirty-six operations for umbilical rupture1 and one death1 by ,mayo1 of ,rochester1 ,minn4--and they are usually the very worst patients1 of middle age1 or older1 and very stout4 ,umbilical rupture in babies is very common after the cord has dropped off4 ,there is a protrusion at the navel which increases in size on coughing1 straining1 or crying4 ,if the rupture is pushed in and the flesh is brought together from either side in two folds over the navel1 so as to bury the navel out of sight1 and held in this position by a strip of surgeon's plaster1 reaching across the front of the belly and about two and one-half inches wide1 complete recovery will usually take place within a few months4 ,it is well to cover the plaster with a snug flannel band about the body4 ,the plaster should be replaced as need be1 and should be applied in all cases by a physician if one can be secured4 ,,varicose ,,veins4--,varicose veins are enlarged veins which are more commonly present on the legs1 but are also seen in other parts of the body4 ,they stand out from the skin as bluish1 knotty1 and winding cords which flatten out when pressure is made upon them1 and shrink in size in most cases upon lying down4 ,sometimes bluish1 small1 soft1 rounded lumps1 or a fine1 branching network of veins may be seen4 ,oftentimes varicose veins may exist for years--if not extensive--without either increasing in size or causing any trouble whatsoever4 ,at other times they occasion a feeling of weight and dull pain in the legs1 especially on long standing4 ,when they are of long duration the legs may become swollen and hard1 and eczema1 with itching1 is then not uncommon4 ,this leads to scratching and sores1 and these may enlarge and become what are called varicose ulcers1 which are slow and difficult of healing4 ,occasionally an old varicose vein may break open and give rise to profuse bleeding4 ,causes4--,varicose veins are more frequent in women1 especially in those who stand much1 as do cooks4 ,any obstruction to the return flow of the blood from the veins toward the heart will produce them1 as a tight garter about the leg2 or the pressure of the large womb in pregnancy upon the veins1 or of tumors in the same region4 ,heart and lung diseases also predispose to the formation of varicose veins4 ,treatment4--,varicose veins are exceedingly common1 and if they are not extensive and produce no discomfort they may be ignored4 ,otherwise1 it is well to have an elastic stocking made to come to1 or above1 the knee4 ,the stocking should be put on and removed while lying down4 ,cold bathing1 outdoor exercise1 and everything which will improve the general health and tone are desirable1 also the avoidance of constipation4 ,in the most aggravated cases surgical operation will cure varicose veins4 ,bleeding from a broken vein is stopped by pressure of a bandage and lying on the back with the foot raised on a pillow4 ,,varicocele4--,this consists of an enlargement of the veins in the scrotum above the testicle of the male1 on the left side in most cases4 ,the large veins feel more like a bunch of earthworms than anything else4 ,if they cause no discomfort they may be entirely neglected and are not of the slightest consequence4 ,even when they produce trouble it is chiefly imaginary1 in most instances1 since they are a common source of worry in young men in case of any irregularities in the sexual functions4 ,advantage is taken of this fact by quacks1 who find it for their profit to advertise all sorts of horrible and impossible results of the condition4 ,the testicle on the diseased side may become smaller than its fellow1 but in few cases does any serious consequence result from varicocele4 ,pain in the hollow of the back may be the only symptom of varicocele in cases where there are any symptoms4 ,a dragging pain in the groin1 a pain in the testicles and about the rectum and in the bladder may cause complaint4 ,causes4--,varicocele occurs usually in young1 unmarried men and often disappears of itself in later life4 ,undue sexual excitement may produce the condition4 ,treatment4--,when any treatment is necessary1 the application of a snugly fitting suspensory bandage--which can be procured at any good drug shop--and bathing the testicles night and morning in cold water1 with the avoidance of constipation and of the cause noted1 will be generally sufficient to relieve any discomfort arising from varicocele4 ,the enlargement of the veins will not1 of course1 be altered by this treatment1 and absolute cure can only be effected by a surgical removal of the veins1 which is not a serious undertaking1 but is rarely necessary4 ,,piles--,,hemorrhoids4--,piles consist of enlarged1 and often inflamed1 veins in the rectum1 or lower part of the bowel4 ,external ,piles4--,these are bluish swellings or little lumps which project from the bowel1 interfering with walking or the toilet of the parts1 and are sometimes exquisitely tender and painful when inflamed4 ,in the course of time these become mere projections or fringes of flesh and cause no trouble unless through uncleanliness or other reasons they are irritated4 ,the treatment of external piles may be summed up in great cleanliness--washing the parts after each movement of the bowels2 rest in bed1 if the soreness is great2 the application of cold water or powdered ice in a rubber bag1 or of hot poultices1 and of various drugs4 ,among these are hamamelis extract1 or witch-hazel1 with which the parts may be frequently bathed2 an ointment of nut-gall and opium2 or extract of belladonna and glycerin1 equal parts4 ,sitting in cold water1 night and morning1 in a tub also will prove serviceable4 ,the more rapid and effectual method of cure consists in opening of the recent pile by the surgeon1 or clipping off the fleshy projections4 ,the bowels should always be kept regular in any form of piles by small doses of ,glauber's or ,epsom salts taken in a glass of hot water on rising1 or some mineral water4 ,in case these do not agree1 extract of cascara or compound licorice powder may be taken at night4 ,equal parts of sulphur and cream of tartar is an old-fashioned domestic cathartic of which a teaspoonful may be taken each morning to advantage in piles4 ,internal ,piles4--,in the beginning patients with internal piles feel as if the bowels were not wholly emptied after a passage1 and sometimes there is difficulty in urinating and also pains in the hollow of the back and in the thighs4 ,there is often pain on movement of the bowels1 and blood follows the passage4 ,later1 blood may be lost at other times1 and the loss may be so great as to cause pronounced paleness and weakness4 ,itching is a frequent occurrence4 ,mucus and pus 7matter such as comes from an abscess7 may also be discharged4 ,loss of sexual desire and power is not uncommonly present4 ,there may be no external protrusions2 but bleeding1 itching1 and pain during movement of the bowels are the chief symptoms4 ,if the pain is very severe during and also after a passage1 it is probable that there is also present a fissure or crack in the flesh1 or ulcer at the exit of the bowel which needs surgical attention4 ,it not infrequently happens that the piles come out during the bowel movement1 when they should be thoroughly washed1 greased1 and pushed back4 ,sometimes this is impossible1 although after lying down for a while and applying ice or cold water the mass may shrink so as to admit of its return4 ,when a large mass is thus protruded and cannot be returned1 and becomes nipped by the anus muscles1 it undergoes inflammation and is very painful1 but a cure often results from its destruction4 ,such a mode of cure is not a safe or desirable one1 however4 ,treatment4--,the cold sitz baths in the morning or injections of a half pint of ice water after a passage are useful4 ,ointments may be introduced into the bowel upon the finger1 or1 better1 with hard rubber plugs sold for the purpose2 or suppositories may be employed4 ,an ointment1 containing sixty grains of iron subsulphate to the ounce of lard 7or1 if there is much itching1 an ointment consisting of orthoform1 thirty grains1 with one-half ounce of lard71 will prove of value4 ,also the injection of one-half pint cold water1 containing a teaspoonful of extract of hamamelis1 after a passage1 affords relief4 ,two or three grains of the subsulphate of iron may be employed in suppositories1 and one of these may be introduced three times daily4 ,the compound gall ointment or the glycerite of tannin will be found to act successfully in some cases4 ,when one remedy does not serve1 try another4 ,the only positive cure for piles consists in surgical operation for their removal4 ,self-treatment is not recommended1 as the physician can do better1 and an examination is always advisable to rule out other conditions which may be mistaken by the layman for piles4 ,causes4--,piles are seen chiefly in adults1 in those in advanced life1 and in those who exercise little but eat much4 ,constipation favors their occurrence1 and the condition is commonly present in pregnant women4 ,fatigue1 exposure1 horseback exercise1 or an alcoholic debauch will cause their appearance4 ,certain diseases also occasion the formation of piles4 ,,chapter ,,ii ,skin ,diseases and ,related ,disorders ,household ,remedies for ,itching--,chafing and ,chapping--,hives1 ,cold ,sores and ,pimples--,ringworms1 ,warts and ,corns--,eczema and other ,inflammatory ,disorders4 ,no attempt will be made to give an extended account of skin diseases1 but a few of the commoner disorders which can be readily recognized by the layman will be noticed4 ,although these cutaneous troubles are often of so trivial a nature that a physician's assistance is unsought1 yet the annoyance is often sufficient to make it worth while for the patient to inform himself about the ailment4 ,then the affections are so frequent that they may occur where it is impossible to procure medical aid4 ,whenever an eruption of the skin is accompanied by fever1 sore throat1 headache1 pains in back and limbs1 vomiting1 or general illness1 one of the serious1 contagious1 eruptive diseases should be suspected1 particularly in children1 and the patient must be removed from contact with others1 kept in isolation1 and a physician immediately summoned4 ,,itching 7,pruritus74--,itching is not a distinct disease by itself1 but a symptom or sign of other skin or general disorders4 ,occasionally it must be treated as if it were a separate disease1 as when it occurs about the entrance to the bowel 7anus71 or to the external female sexual parts 7vulva71 or attacks the skin generally1 and is not accompanied by any skin eruption except that caused by scratching1 and the cause be unascertainable4 ,itching1 without apparent cause1 may be due to parasites1 as lice and fleas1 and this must always be kept in mind2 although debilitated states of the body and certain diseases1 as gout and diabetes1 are sometimes the source4 ,commonly1 itching is caused by one of the many recognized skin diseases1 and is accompanied by an eruption characteristic of the particular disorder existing1 and special treatment by an expert1 directed to remedy this condition1 is the only reasonable way to relieve the itching and cure the trouble4 ,it may not1 however1 be improper to suggest means to relieve such a source of suffering as is itching1 although unscientific1 with the clear understanding that a cure cannot always be expected1 but relief may be obtained until proper medical advice can be secured4 ,the treatment to be given will be appropriate for itching due to any cause1 with or without existing eruption on the skin1 unless otherwise specified4 ,if one remedy is unsuccessful1 try others4 ,for itching afflicting a considerable portion of the skin1 baths are peculiarly effective4 ,cold shower baths twice daily1 or swimming in cold water at the proper time of year1 may be tried1 but tepid or lukewarm baths are generally more useful4 ,the addition of saleratus or baking soda1 one to two pounds to the bath1 is valuable1 or bran water obtained by boiling bran tied in a bag in water1 and adding the resulting solution to the bath4 ,even more efficient is a bath made by dissolving half a cupful of boiled starch and one tablespoonful of washing or baking soda in four gallons of warm water4 ,the tepid baths should be as prolonged as possible1 without chilling the patient4 ,the bran water1 or starch water1 may be put in a basin and sopped on the patient with a soft linen or cotton cloth and allowed to evaporate from the skin1 without rubbing1 but while the skin is still moist a powder composed of boric acid1 one part1 and pulverized starch1 four parts1 should be dusted on the itching area4 ,household remedies of value include saleratus or baking soda 7one teaspoonful to the pint of cold water71 or equal parts of alcohol1 or vinegar and water1 which are used to bathe the itching parts and then permitted to dry on them4 ,cold solution of carbolic acid 7one teaspoonful to the pint of hot water7 is1 perhaps1 the most efficacious single remedy4 ,but if it causes burning it must be washed off at once4 ,dressings wet with it must never be allowed to become dry1 as then the acid becomes concentrated and gangrene may result4 ,calamine lotion 7p4 #ade7 is also a serviceable preparation when there is redness and swelling of the skin4 ,when the itching is confined to small areas1 or due to a pimply or scaly eruption on the skin1 the following ointments may be tried3 a mixture of tar ointment and zinc ointment 7two drams each7 with four drams of cold cream1 or flowers of sulphur1 one part1 and lard1 twelve parts4 ,,chafing ,,and ,,chapping4--,chafing occurs when two opposing skin surfaces rub together and are irritated by sweat1 as in the armpits1 under the breasts and beneath overlapping parts of the belly of fat people1 and between the thighs and buttocks4 ,the same result is caused by the irritation induced by discharges constantly running over the skin1 as that seen in infants1 due to the presence of urine and bowel discharges1 and that irritation which arises from saliva when the lips are frequently licked4 ,the latter condition of the lips is commonly called chapping1 but it is proper to consider chafing and chapping together as the morbid state of the skin1 and the treatment is the same for both4 ,chafing occurs more often in hot weather and after violent exercise1 as rowing1 riding1 or running1 and is aggravated by the friction of clothing or of tight boots4 ,it may1 on the other hand1 appear in persons who sit a great deal1 owing to constant pressure and friction in one place4 ,the parts are hot1 red1 and tender1 and emit a disagreeable odor when secretions are retained4 ,the skin becomes sodden by retained sweat1 and may crack and bleed4 ,the same redness and tenderness are seen in chapping of the face and lips1 and cracking of the lips is frequent4 ,in chafing the first requisite is to remove the cause1 and then thoroughly wash the part with soap and water4 ,then a saturated solution of boric acid in water should be applied with a soft cloth1 and the parts dusted with a mixture of boric acid and powdered starch1 equal parts1 three times daily4 ,if the lips are badly cracked1 touching them1 once daily1 with a stick of silver nitrate 7dipped in water7 is of service4 ,,hives2 ,,nettlerash 7,urticaria74--,hives is characterized by the sudden appearance of hard round or oval lumps in the skin1 from the size of a pea to that of a silver dollar1 of a pinkish-white color1 or white in the center and often surrounded by a red blush4 ,the rash is accompanied by much itching1 burning1 or tingling1 especially at night when the clothes are removed4 ,the peculiarity of this eruption is the suddenness with which the rash appears and disappears2 the itching1 the whitish or red lumps1 the fact that the eruption affects any part of the body and does not run together1 are also characteristic4 ,scratching of the skin often brings out the lumps in a few minutes4 ,the swellings may last a few minutes or hours1 and suddenly disappear to reappear in some other place4 ,the whole trouble usually continues only a few days1 although at times it becomes a chronic affection4 ,scratching alters the character of the eruption1 and causes red1 raw marks and crusts1 but the ordinary swellings can be seen usually in some part of the body4 ,rarely1 the eruption comes in the throat and leads to sudden and sometimes dangerous swelling1 so that suffocation has ensued4 ,with hives there are no fever1 sore throat1 backache1 headache1 which are common to the contagious eruptive disorders1 as measles1 scarlet fever1 etc4 ,indigestion is the most frequent cause4 ,certain articles of diet are almost sure to bring on an attack of hives in susceptible persons2 these include shellfish1 clams1 lobsters1 crabs1 rarely oysters2 also oatmeal1 buckwheat cakes1 acid fruits1 particularly strawberries1 but sometimes raspberries and peaches4 ,nettlerash is common in children1 and may follow any local irritation of the skin caused by rough clothes1 bites of mosquitoes and fleas1 and the stings of jellyfish1 ,portuguese man-of-war1 and nettles4 ,treatment4--,remove any source of irritation in the digestive canal1 or externally1 and employ a simple diet for a few days1 as bread and milk4 ,a dose of castor oil1 one teaspoonful for children2 one tablespoonful for adults1 or some other cathartic is advisable4 ,locally we use1 as domestic remedies1 a saturated solution of baking soda 7or saleratus7 in water1 or equal parts of alcohol or vinegar and water to relieve the itching4 ,the bath containing soda and starch 7p4 #ada7 is the most useful treatment when the nettlerash is general4 ,calamine lotion is one of the best applications which can be employed for this disorder4 ,it should be sopped on frequently with a soft cloth and allowed to dry on the skin4 ,,calamine ,,lotion ,zinc oxide #a_/d ounce ,powdered calamine #a_/d ,limewater #f ounces ,mix and shake before applying to the skin4 ,if choking is threatened1 give an emetic of mustard1 one teaspoonful1 and warm water1 half a pint4 ,,pimples2 ,,blackheads 7,acne74--,this eruption is situated chiefly on the face1 but often on the back1 shoulders1 and chest as well4 ,it is a disorder which is seen mostly in young men and women at about the age of puberty4 ,it consists of conical elevations of the skin1 from a pin head to a pea in size1 often reddened and tender on pressure1 and having a tendency to form matter or pus1 as shown by a yellow spot in the center of the pimple4 ,after three to ten days the matter is discharged1 but red elevations remain1 which later become brown and disappear without scarring1 except in rare cases4 ,blackheads appear as slightly elevated black points1 sometimes having a yellowish tint from which a little1 thin1 wormlike mass may be pressed4 ,pimples and blackheads are both due to inflammation about the glands of the skin which secrete oily material2 the mouths of the glands become plugged with dust1 thus retaining the oily secretion and causing blackheads4 ,then if these glands are invaded by germs producing pus1 we have a pimple1 which usually results in the formation of matter as described above4 ,constipation and indigestion favor the occurrence of pimples and blackheads2 also a poor state of the blood1 or anaemia4 ,treatment4--,tea1 coffee1 tobacco1 and alcohol should be avoided1 together with veal1 pork1 fats1 and cheese4 ,the bowels must be moved daily by some proper cathartic1 as cascara tablets containing two grains each of the extract4 ,the dose is one to two tablets at night4 ,the blackheads should be squeezed out with a watch key1 or with an instrument made for the purpose1 not finger nails1 and pimples containing matter must be emptied after being pricked with a needle 7which has been passed through a flame to kill germs on it74 ,if there is redness of the skin and irritation associated with pimples1 it is sufficient to bathe the skin with very hot water and green soap three times daily1 and apply calamine lotion 7see p4 #ade7 at night4 ,in other cases1 when the skin is not sensitive1 and zinc or mercury has not been used1 the employment of sulphur soap and hot water at bedtime1 allowing the suds to dry and remain on the face during the night1 is to be recommended4 ,an ointment consisting of half a dram of precipitated sulphur with half an ounce each of powdered starch and vaseline applied each night1 and hot water used on the face three times daily are also efficacious4 ,sulphur lotion is better than sulphur ointment4 ,,cold ,,sore2 ,,fever ,,blister4--,cold sores occur usually about the lips or at the angles of the mouth1 although they may appear anywhere on the face4 ,cold sore has a round1 oval1 or irregular outline1 from the size of a pea to that of a quarter of a dollar1 and is seen as a slightly raised patch on the skin on which is a group of very minute blisters1 three to twelve in number4 ,cold sore may be single or multiple1 and near together or widely separated on the face4 ,having first the appearance of a red patch1 it later becomes covered with a brown crust from the drying of the contents of the tiny blisters4 ,cold sore often gives rise to burning1 itching1 or tingling1 the disfigurement usually causing more annoyance1 however1 than the pain4 ,the duration of the trouble is from four to twelve days4 ,cold sores are commonly induced by indigestion and fevers1 and also are occasioned by local irritation of any sort1 as from nasal discharge accompanying cold in the head 7from which the name is derived71 by the irritation produced by a pipestem or cigar1 and by rubbing the skin4 ,treatment4--,picking and scratching are very harmful1 and cigar or pipe smoking must be stopped4 ,painting the sore with collodion1 by means of a camel's-hair brush1 is poor treatment in the early stages4 ,better use spirits of camphor1 and afterwards1 if there is much itching or burning1 sopping the eruption with calamine lotion 7p4 #ade7 will relieve the discomfort4 ,,prickly ,,heat 7,miliaria74--,this is a common eruption of adults in hot weather1 and very frequently attacks children4 ,it consists of fine1 pointed1 red rash1 or minute blisters1 and occurs on parts of the body covered by clothing1 more often on the chest4 ,the eruption is caused by much sweating1 leading to congestion and swelling of the sweat glands4 ,burning1 stinging1 and itching accompany the disorder4 ,the condition must be distinguished from the contagious skin eruptions4 ,in the latter there are fever1 sore throat1 backache1 headache1 and general sickness1 while in prickly heat there is no general disturbance of the system1 or fever1 unless the eruption comes out in the course of fevers1 when it is of no significance except as one of the symptoms of fever4 ,treatment4--,the treatment of prickly heat1 occurring in hot weather1 consists in avoiding heat as much as possible and sponging the surface with cold water1 and then dusting it with some simple powder1 as starch or flour1 or better1 borated talcum4 ,to relieve the itching1 sponging with limewater or a saturated solution of baking soda 7as much as will dissolve7 in water1 or bran baths1 made by tying one pound of bran in a towel which is allowed to soak in the bath1 are all good remedies4 ,,ringworm ,,of ,,the ,,body2 ,,ringworm ,,of ,,the ,,scalp4--,this skin disease is caused by a vegetable fungus and not by a worm as the name suggests4 ,the disease on the body and scalp is caused by the same parasite1 but ringworm of the body may attack adults as well as children1 and is readily cured2 ringworm of the scalp is a disease confined to children1 and is difficult of cure4 ,ringworm is contagious and may be acquired from children with the disease1 and therefore patients suffering from it should not be sent to school1 and should wear a skull cap and have brush1 comb1 towels1 and wash cloths reserved for their personal use alone4 ,children frequently contract the disease from fondling and handling cats and dogs4 ,symptoms4--,on the body1 ringworm attacks the face1 neck1 and hands4 ,it appears first as small1 red1 scaly spots which may spread into a circular patch as large as a dollar with a red ring of small1 scaly pimples on the outside1 while the center exhibits healthy skin1 or sometimes is red and thickened4 ,there may be several patches of ringworm near each other and they may run together1 or there may be only one patch of the disease4 ,ringworm of the scalp occurs as a circular1 scaly patch of a dusty-gray or pale-red color on which there are stubs of broken hairs pointing in different directions1 and readily pulled out4 ,the disease in this locality is very resistant to treatment4 ,there are no crusts or itching as in eczema4 ,treatment4--,the application of pure tincture of iodine or carbolic acid to the spots with a camel's-hair brush1 on one or two occasions1 will usually cure ringworm on the skin4 ,on the scalp the hairs should be pulled out of the patch of ringworm1 and each day it should be washed with soap and water and a solution of boric acid 7as much acid as the water can dissolve71 destroying the cloth used for washing4 ,the following ointment is then applied3 sulphur1 one part2 tar1 two parts2 and lard1 eight parts4 ,it is desirable to secure the services of a physician in this disease1 in which various remedies may have to be tried to secure recovery4 ,if untreated1 ringworm is likely to last indefinitely4 ,,freckles1 ,,tan1 ,,and ,,other ,,discolorations ,,of ,,the ,,skin4--,freckles appear as small1 yellowish-brown spots on the face1 arms1 and hands1 following exposure to the sun in summer1 and generally fading away almost completely in winter4 ,however1 sometimes they do not disappear in winter1 and do occur on parts of the body covered by clothing4 ,freckles are commonly seen in red-haired persons1 rarely in brunettes1 and never on the newborn4 ,their removal is accomplished by the employment of agents which cause a flaking off of the superficial layer of discolored skin1 but after a few weeks the discolorations are apt to return4 ,large1 brown spots of discoloration appearing on the face are observed more often in women1 and are due to disorder of digestive organs of the sexual organs or to pregnancy2 they also occur in persons afflicted with exhausting diseases4 ,tan1 freckles1 and discolorations of the skin generally are benefited by the same remedies4 ,treatment4--,prevention of tan and freckles is secured through nonexposure of the unprotected skin to the sun1 though it is doubtful whether the end gained is worth the sacrifice1 if carried so far as to the avoidance of the open air and sunlight whenever possible4 ,boric acid 7sixteen grains to the ounce of water7 is an absolutely harmless and serviceable agent for the removal of skin pigmentations4 ,the skin may be freely bathed with it night and morning4 ,corrosive sublimate is the most effective remedy1 but is exceedingly poisonous if swallowed accidentally1 and must be kept out of children's way1 and should not be applied over any large or raw surface of skin or on any mucous membrane4 ,its application is inadvisable as soon as any irritation of the skin appears from its use4 ,the following preparation containing it is to be painted on the skin with a camel's-hair brush1 night and morning3 ,,poisonous ,,sublimate ,,solution ,corrosive sublimate #g grains ,alcohol #a-a_/b ounces ,glycerin #a-a_/b ,oil of lavender #aj drops ,mix4 ,the following lotion is also efficacious3 ,zinc oxide #cj grains ,powdered starch #cj ,kaolin #fj ,glycerin #b drams ,rose water #b ounces ,mix4 ,,directions4--,shake and paint on spots1 and allow the preparation to dry2 wash it off before each fresh application4 ,it is best to use only cold water1 rarely soap1 on the healthy skin of the face4 ,warm water favors relaxation of the skin and formation of wrinkles4 ,,ivy ,,poison4--,the poison ivy 7,rhus toxicodendron71 poison sumach 7,rhus venenata71 and poison oak 7,rhus diversiloba of the ,pacific ,coast1 ,u4 ,s4 ,a47 cause inflammation of the skin in certain persons who touch either one of these plants1 or in some cases even if approaching within a short distance of them4 ,the plants contain a poisonous oil1 and the pollen blown from them by the wind may thus convey enough of this oil to poison susceptible individuals who are even at a considerable distance4 ,trouble begins within four to five hours1 or in as many days after exposure to the plants4 ,the skin of the hands becomes red1 swollen1 painful1 and itching4 ,soon little blisters form1 and scratching breaks them open so that the parts are moist and then become covered with crusts4 ,the poison is conveyed by the hands to the face and1 in men1 to the sexual organs1 so that these parts soon partake of the same trouble4 ,the face and head may become so swollen that the patient is almost unrecognizable4 ,there is a common belief that ivy poison recurs at about the same time each year1 but this is not so except in case of new exposures4 ,different eruptions on the same parts often follow ivy poisoning1 however4 ,treatment4--,a thorough washing with soap1 especially green soap1 will remove much of the poison and after effects4 ,saleratus or baking soda 7a heaping tablespoonful of either to the pint of cold water7 may be used to relieve the itching1 but ordinary lead and opium wash is the best household remedy4 ,forty minims of laudanum#i and four grains of sugar of lead dissolved in a pint of water form the wash4 ,the affected parts should be kept continually wet with it4 ,aristol in powder1 thoroughly rubbed in1 is almost a specific4 ,,warts4--,warts are flattened or rounded outgrowths from the outer and middle layers of the skin1 varying in size from a pin head to half an inch in diameter4 ,there are several varieties4 ,seed ,warts4--,these have numerous1 little1 fleshy projections over their surface1 which are enlarged normal structures 7papillae7 of the middle layer of the skin1 together with the thickened1 outer1 horny layer4 ,threadlike ,warts4--,these are seen along the edge of the nails1 on the face1 neck1 eyelids1 and ears4 ,they are formed by the great prolongation and growth of the projections1 or papillae of the middle layer of the skin just described4 ,flat ,warts1 raised but slightly above the surface are more common in old people4 ,moist ,warts occur where they are softened by secretions of the body1 as about the sexual organs 7in connection with diseases of the same71 and about the anus 7or opening of the bowel74 ,they are of a white1 pink1 or red color1 and consist of numerous1 little1 fleshy projections1 usually covered with a foul-smelling secretion4 ,warts most commonly appear on the hands of children1 but may appear on any part of the body and at all ages4 ,they may disappear quickly or remain indefinitely4 ,they are not communicable from one person to another4 ,treatment4--,warts may be removed by painting them frequently with the fresh juice of the milkweed1 or with acetic acid or tincture of iodine4 ,these remedies are all harmless1 but somewhat slow and not always effective4 ,application1 morning and evening1 of a saturated solution of washing soda 7impure bicarbonate of potash7 will often remove a wart4 ,,corns4--,corns are local1 cone-shaped thickenings of the outer layer of the skin of the feet1 due to pressure and friction of the shoes1 or opposed surfaces of skin between the toes4 ,they are not in themselves sensitive1 but pain follows pressure upon them1 as they act as foreign bodies in bearing down upon the sensitive lower layers of the skin4 ,continued irritation often leads to inflammation of the skin around and beneath the corn with the formation of pus4 ,ordinarily1 corns are tough1 yellowish1 horny masses1 but1 when moistened by sweat between the toes1 they are white1 and are called soft corns4 ,treatment4--,comfortable shoes are the first requisite2 well-fitting and neither tight nor loose4 ,pressure may be taken off the corns by surrounding them with felt rings or corn plaster4 ,to remove the corn the foot should be soaked for a long time in warm water1 in which is dissolved washing soda1 and then the surface of the corn is gently scraped off with a clean1 sharp knife4 ,another useful method consists in painting the corn1 night and morning for five days1 with the following formula1 when both the coating and corn will come off on soaking the same for some time in warm water3 ,salicylic acid #cj grains ,tincture of iodine #aj drops ,extract of ,cannabis ,indica #aj grains ,collodion #d drams ,mix4 ,when the tissues about the corn become inflamed the patient must rest with the foot elevated and wrapped in a thick layer of absorbent cotton saturated with a hot solution of corrosive sublimate 7one tablet to the pint of water7 and covered with oil silk or rubber cloth4 ,pus must be let out with a knife which has been laid in boiling water4 ,if corns are removed by the knife the foot should be previously made absolutely clean1 the knife boiled1 and the paring not carried to the extent of drawing blood4 ,the too-close removal of a corn may lead to infection of the wounded tissues with germs1 and in old people1 and those with feeble circulation1 gangrene or erysipelas may result4 ,soft corns are treated by removal of the surface layer1 by soaking in washing soda and hot water and scraping as above stated1 and then the corn should be dusted with a mixture of boric acid and zinc oxide1 equal parts1 and the toes kept apart by pads of absorbent cotton4 ,,callus ,,and ,,cracks ,,of ,,the ,,skin4--,callus consists of round or irregular1 flattened1 yellowish thickenings of the upper or horny layer of the skin4 ,the skin becomes hypertrophied and resembles a thick1 horny layer1 caused by intermittent pressure of tools1 shoes1 etc4 ,the whole palm of the hand or soles of the feet may be the seats of a continuous callus4 ,callus is not harmful1 except in leading to cracks of the skin near the bend of joints1 and1 rarely1 in causing irritation1 heat1 pain1 and even the formation of pus in the skin beneath4 ,callus usually disappears when the exciting cause or pressure is removed4 ,treatment4--,the hands and feet should be soaked continuously in hot baths containing washing soda1 and then should be covered with diachylon 7or other7 ointment4 ,this may be done each night2 or collodion 7one ounce containing thirty grains of salicylic acid7 may be painted1 night and morning for several days1 on the callus1 and then1 after soaking for some time in hot water1 the surface should be scraped off with a dull knife and the process repeated as often as necessary to effect a cure4 ,fissure or cracks of the skin caused by callus are treated in the same manner3 by prolonged soaking in hot water1 paring away the edges1 and applying diachylon ointment or cold cream to the part4 ,inflammation about callus must be cared for as recommended above for inflamed corns4 ,,boils4--,a boil is a circumscribed inflammatory process1 caused by the entrance of pus-producing germs into the skin either through the pores 7the mouths of the sweat glands7 or along the shafts of the hair1 and in this way invading the glands which secrete a greasy material 7sebaceous glands74 ,in either case the pus germs set up an inflammation of the sweat or sebaceous glands1 and the surrounding structures of the skin1 and a small1 red1 itching pimple results4 ,rarely1 after a few days1 the redness and swelling disappear1 and the pus1 if any1 dries and the whole process subsides4 ,this is called a blind boil4 ,but usually the boil increases in size for several days1 until it may be as large as a pigeon's egg4 ,it assumes a bright-red sharply defined1 rounded shape1 with a conical point1 and is at first hard and then softens as pus or matter forms4 ,there is severe pain of a throbbing1 boring character1 which is worse at night1 and destroys the patient's sleep and appetite4 ,there may be some fever4 ,the glands in the neighborhood may be enlarged and tender1 owing to some of the pus germs' escaping from the boil and lodging in the glands4 ,if the boil is not lanced1 it reaches its full development in seven to ten days with the formation of a central core of dead tissue and some pus1 which gives to the center of the boil a whitish or yellowish-brown appearance4 ,the boil then breaks down spontaneously in one or more places 7usually only one7 and discharges some pus1 and1 with a little pressure1 also the white1 central core of dead tissue4 ,the remaining wound closes in and heals in a week or two4 ,boils occur singly or in numbers1 and sometimes in successive crops4 ,when this happens it is because the pus germs from the previous boils have invaded fresh areas of skin4 ,causes4--,boils are thus contagious1 the pus germs being communicated to new points on the patient's skin1 or to that of another person4 ,local irritation of the skin1 from whatever cause1 enables the germs to grow more readily4 ,the existence of skin diseases1 as eczema 7salt rheum71 prickly heat1 and other sources of itching and scratching1 is conducive to boils1 as the pus germs contained in ordinary dirt are rubbed into the irritated skin4 ,whenever the skin is chafed by rough clothing1 as about the wrists and neck by frayed collars and sweaters1 etc41 boils are likely to occur4 ,also when the face and neck are handled by barbers with dirty hands or instruments1 a fruitful field is provided for their invasion4 ,while boils are always the result of pus germs gaining entrance to the skin glands1 and1 therefore1 strictly due to local causes1 yet they are more prone to occur when the body is weakened and unable to cope with germs which might do no harm under other circumstances4 ,the conditions favoring the occurrence of boils are3 an impoverished state of the blood1 errors of diet and indigestion1 overwork1 dissipation1 and certain diseases1 as typhoid fever1 diabetes1 and smallpox4 ,boils are thought to occur more frequently in persons with rough skin and with a vigorous growth of dark hair4 ,they may be situated on any part of the body1 but certain localities are more commonly attacked1 as the scalp1 the eyelids1 cheeks1 neck1 armpits1 back1 and buttocks4 ,boys and young men are generally the sufferers4 ,treatment4--,the importance of cleanliness cannot be overestimated in the care of boils if we keep their cause in mind4 ,dirty underclothes or fingers used in squeezing or otherwise handling the boil1 may carry the trouble to fresh parts4 ,any sort of local irritation should be removed2 also all articles of clothing which have come in contact with the boils should not be worn until they have been washed in boiling water4 ,there is no single remedy of much value for the cure of boils1 although pills of calcium sulphide 7each one-tenth grain7 are commonly prescribed by physicians1 every three hours4 ,the most rational measure consists in removing the general causes1 as noted above1 if this is possible4 ,when the patient is thin and poorly nourished1 give food and cod-liver oil2 and if the lips and skin are pale1 iron arsenate pills 7one-sixteenth grain each7 are to be taken three times daily for several weeks4 ,a boil may sometimes be arrested by painting it with tincture of iodine until the boil is almost black1 or with a very heavy coating of collodion4 ,if a boil continues to develop1 notwithstanding this treatment1 one should either use an ointment of vaseline containing ten per cent of boric acid spread on soft cotton over the boil1 or1 if the latter is very painful1 resort to the frequent application of hot flaxseed poultices4 ,when the boil has burst1 and pus is flowing out on the surrounding skin1 it should be kept very clean by frequent washing with hot water and soap and the application of a solution of corrosive sublimate 7one part to #a1jjj7 made by dissolving one of the tablets1 sold everywhere for surgical purposes1 in a pint of warm water4 ,this will prevent the lodgment of the pus germs in the skin and the formation of more boils4 ,poultices mixed with bichloride 7corrosive sublimate7 solution are less likely to encourage inoculation of neighboring areas4 ,the poultices should be stopped as soon as the pain ceases1 and the boil dressed as recommended above1 dusted with pure boric acid and covered with clean absorbent cotton and bandage4 ,after pus has begun to form in a boil recovery will be materially hastened by the use of a knife1 although this is not essential4 ,the boil should be thoroughly cleaned1 and a sharp knife1 which has been boiled in water for five minutes1 is inserted1 point first1 into the center of the boil1 far enough to liberate the pus and dead tissue4 ,by this means healing is much more rapid than by nature's unassisted methods4 ,pure carbolic acid1 applied on the tip of a toothpick1 thrust into the head of a boil1 is generally curative4 ,when many boils occur1 consult a physician4 ,,carbuncle4--,a carbuncle is similar to a boil in its causation and structure1 but is usually a much more serious matter having a tendency to spread laterally and involve the deeper layers of the skin4 ,it is commonly a disease of old persons1 those prematurely old or debilitated1 and occurs most frequently on the neck1 back1 or buttocks4 ,it is particularly dangerous when attacking the back of the neck1 upper lip1 or abdomen4 ,carbuncle often begins1 with a chill and fever1 as a pimple1 and rapidly increases in size forming a hot1 dusky red1 rounded lump which may grow until it is from three to six inches in diameter4 ,occasionally it runs a mild course1 remains small1 and begins to discharge pus and dead tissue at the end of a week and heals rapidly4 ,more commonly the pain soon becomes intense1 of a burning1 throbbing character1 and the carbuncle continues to enlarge for a week or ten days1 when it softens and breaks open at various points discharging shreds of dead tissue and pus4 ,the skin over the whole top of the carbuncle dies and sloughs away1 leaving an angry-looking excavation or crater-like ulcer4 ,this slowly heals from the edges and bottom1 so that the whole period of healing occupies from a week to two1 or even six months4 ,the danger depends largely upon blood poisoning1 and also upon pain1 continuous fever1 and exhaustion which follow it4 ,sweating and fever1 higher at night1 are the more prominent signs of blood poisoning4 ,carbuncles differ from boils in being much larger1 in having rounded or flat tops instead of the conical shape of boils1 in having numerous1 sievelike openings1 in the occurrence of death of the skin over the top of the carbuncle1 and in being accompanied by intense pain and high fever4 ,treatment4--,carbuncle demands the earliest incision by a skilled surgeon1 as it is only by cutting it freely open1 or even removing the whole carbuncle as if it were a tumor1 that the best results are accomplished4 ,however1 when a surgeon cannot be obtained1 the patient's strength should be sustained by feeding every two hours with beef tea1 milk and raw eggs1 and with wine or alcoholic liquors4 ,three two-grain quinine pills and ten drops of the tincture of the chloride of iron in water should be given three times daily4 ,the local treatment consists in applying large1 hot1 fresh flaxseed poultices frequently1 with the removal of all dead tissue with scissors1 which have been boiled in water for ten minutes4 ,when the pain is not unbearable1 dressings made by soaking thick sheets of absorbent cotton in hot solution of corrosive sublimate 7#a to #a1jjj as directed under ,boils1 p4 #afa7 should be applied and covered by oil silk or rubber cloth and bandage4 ,they are preferable to poultices as being better germ destroyers1 but are not so comfortable4 ,when the dead tissue comes away and the carbuncle presents a red1 raw surface1 it should be washed twice a day in the #a to #a1jjj corrosive-sublimate solution1 dusted with pure boric acid1 and covered with clean1 dry absorbent cotton and bandage4 ,,eczema2 ,,salt ,,rheum2 ,,tetter4--,eczema is really a catarrhal inflammation of the skin1 with the exudate 7fluid that escapes7 concealed beneath the surface1 or appearing on the surface after irritation has occurred4 ,the many varieties are best classified as follows3 7#a7 ,eczema of internal origin1 including cases due to morbid agencies produced within the body1 cases due to drugs1 and possibly reflex cases4 7#b7 ,eczema of external origin1 including cases caused by occupation1 by climate1 or by seborrhea4 ,eczema of internal origin almost invariably appears on both sides of the body at once1 as on both cheeks1 or both arms1 or both thighs4 ,its border shades into the surrounding skin1 it is dotted with papules 7or heads7 filled with fluid1 and its surface is clean and not greasy4 ,as it spreads1 the symmetry of distribution is lost4 ,among the morbid agencies producing this variety of eczema are the products of indigestion4 ,among the drugs producing it is cod-liver oil4 ,occupation eczema occurs first on exposed parts1 as the hands1 arms1 face1 and neck1 in those who handle irritant dyes1 sugar1 formalin1 etc4 ,climatic eczema includes the winter itch1 common in this latitude1 appearing on wrists and ankles in the form of clean1 scaly patches1 often ringed4 ,the seborrheic variety spreads from the scalp to the folds of the skin4 ,its borders are sharply defined1 and its crusts and scales yellowish and greasy4 ,it spreads from a center in all directions at once4 ,treatment4--,the treatment of eczema puzzles a physician1 and only specialists in skin diseases are able easily to diagnose the subacute or chronic forms4 ,it may appear different1 and need different treatment almost from day to day1 and consequently only general suggestions can be made for home management of a case of this disease4 ,the outlook is always good2 and even in the case of weak and debilitated patients1 there is excellent chance of cure4 ,the diet must be regulated at once4 ,meat should be eaten in small quantities once a day only1 and none but very digestible meats should be eaten1 as fowl1 beef1 and lamb4 ,sugar and sweet food need be cut down only when there is indigestion with a production of gas4 ,fresh air and exercise are imperative4 ,five grains of calomel1 at night1 followed by one heaped tablespoonful of ,rochelle salts dissolved in a full tumbler of water the next morning before breakfast1 should be repeated twice a week till marked improvement is seen4 ,meanwhile1 external treatment must be pushed4 ,generally speaking1 ointments must not be used on weeping or exuding surfaces2 all scales and crusts must be removed from the surface2 and acute patches must be soothed1 chronic patches stimulated4 ,water is harmful and increases the trouble2 but it is necessary to use it once1 in cleansing the affected area1 in the form of soap and water4 ,if there are thick1 adherent crusts1 a poultice of boiled starch1 covered with a muslin cloth1 will loosen them in a night4 ,thickened or horny layers on the palms and soles may be covered with salicylic plaster 7ten per cent strength71 which is removed after two days1 and the whole part soaked in warm water1 when the horny layer is to be peeled off4 ,thickened surfaces are best treated with wood tar1 in the form of oil of cade ointment1 or the pix liquida of the drug shops mixed with twice its amount of olive oil4 ,this should be well rubbed into the affected part4 ,seborrheic eczema of the scalp and neighboring areas is best treated with a four per cent ointment of ammoniated mercury1 rubbed in once a day for five days1 followed by the application of a solution of resorcin in water1 four grains to the ounce4 ,weeping and exuding patches should be treated with powdered stearate of zinc1 or oleate of bismuth1 or aristol1 either one dusted on till the area is fairly covered4 ,when the surface begins to dry up1 the following paste may be applied3 ,salicylic acid #e to #ae grains ,zinc oxide #b drams ,powdered starch #b drams ,vaseline #a ounce ,if weeping returns1 stop the ointment and resume the powder treatment1 or use the following lotion3 ,zinc oleate #a dram ,magnesium carbonate #a dram ,ichthyol #a_/b ounce ,lime water #d ounces ,when the skin after scaling off becomes thin1 all swelling having disappeared1 lead plaster is of service1 or diachylon ointment twenty-five per cent1 made with olive oil4 ,an eczema of moderate extent should recover after four to six weeks' treatment1 unless the soles or palms be attacked1 when six or more months of treatment may be necessary4 ,if itching is pronounced1 remove crusts and scabs after soaking with olive oil1 dust borax1 finely powdered on the surface4 ,if the itching is not controlled in twenty minutes1 wipe off the borax with a very oily cloth 7using olive oil71 and then apply a little solution of carbolic acid 7made by adding a half teaspoonful of carbolic acid to a pint of hot water74 ,if this does not allay the itching1 wipe it off thoroughly with the oiled cloth1 and rub in the tar ointment made of equal parts of pix liquida and olive oil4 ,after the itching ceases1 treat as directed according to the variety existing4 ,itching often disappears after a good saline cathartic has acted--,rochelle salts1 solution of magnesia citrate1 or phosphate of soda4 ,scratching must be avoided4 ,in the case of children it is prevented by putting mittens of muslin on the hands4 ,the best cathartic for young children is a teaspoonful of castor oil4 ,carbolic-acid solution must not be used on them4 ,the folds and creases of their skin must be kept dry and powdered with borated talcum4 ,a great point in the treatment of all eczema is to avoid the use of water1 and to substitute oiling with olive oil and wiping off for the usual washing of the affected area4 ,,baldness ,,and ,,dandruff4--,baldness is commonly caused by seborrhea of the scalp1 an affection probably due to a microbe1 and consisting of an inflammation of the skin1 with great increase of dandruff of a thick1 greasy variety4 ,sometimes it appears as a thick film1 not only covering the scalp1 but also the forehead and back of the neck4 ,the greasy substance should be removed with olive oil or vaseline1 and the scalp treated with ointment of ammoniated mercury1 four per cent strength4 ,shampoos with tar-soap suds should be given once in four or five weeks1 and the hair should not be wet with water between the shampoos4 ,the hair must be arranged by combing1 the brush being used to smooth the surface of the hair only4 ,deep and repeated brushing does great damage1 which is equalled only by the frequent washing some ill-advised sufferers employ4 ,massage of the scalp is useless to control seborrheic eczema1 which is practically always present in these cases4 ,tight hats are sometimes a cause of baldness4 ,the lead used in the preparation of the sweat leather of hats is said to be a cause of loss of hair over the temples4 ,when once killed1 hair can rarely be made to grow again4 ,early treatment of seborrhea is the best preventive of baldness4 ,the baldness occurring during an attack of syphilis1 when the hair falls out in round patches1 is treated and often relieved by antisyphilitic remedies 7see p4 #baj74 ,,footnotes3 #i ,caution4 ,poisonous4 ,,chapter ,,iii ,rheumatism and ,kindred ,diseases ,causes of ,rheumatic ,fever--,relief of ,pain in the ,joints--,lumbago--,stiff ,neck--,gout--,symptoms and ,cure of ,scurvy4 ,,rheumatic ,,fever2 ,,inflammatory ,,rheumatism2 ,,acute ,,rheumatism4--,this variety of rheumatism is quite distinct from the other forms1 being in all probability due to some special germ4 ,it occurs in temperate climates during the fall1 winter1 and spring--less often in summer4 ,persons more frequently suffer between the ages of ten and forty years4 ,it is rare in infants2 their pain and swelling of the limbs can be attributed more often to scurvy 7p4 #ahj71 or to surgical disease with abscess of joint or bone4 ,exposure to cold and damp1 in persons insufficiently fed1 fatigued1 or overworked1 is the most common exciting cause4 ,symptoms4--,rheumatic fever may begin with tonsilitis1 or other sore throat1 with fever and pains in the joints4 ,the joints rapidly become very painful1 hot1 red1 swollen1 and tender1 the larger joints1 as the knees1 wrists1 ankles1 and elbows1 being attacked in turn1 the inflammation skipping from one joint to another4 ,the muscles near the joints may be also somewhat swollen and tender4 ,with the fever1 which may be high 7the temperature ranging from #ajb deg4 to #ajd deg4 ,f471 there are rapid pulse1 copious sweating1 and often the development of various rashes and minute blisters on the skin4 ,there is also loss of appetite1 and the bowels are constipated4 ,the urine is usually very dark-colored4 ,altogether1 victims of the disease are truly pitiable1 for they suffer agony1 and are unable to move without increasing it4 ,the weakness and prostration are marked4 ,small1 hard lumps1 from the size of a shot to that of a pea1 sometimes appear on the skin of the fingers1 hands1 wrists1 knees1 and elbows4 ,these are not tender2 they last for weeks and months4 ,they are seen more often in children1 and are most characteristic of rheumatic fever1 but do not show themselves till late in the disease4 ,complications of rheumatic fever are many4 ,in about half the cases the heart becomes involved1 and more or less permanent crippling of the heart persists in after life4 ,unconsciousness and convulsions may develop--more often when the fever runs high4 ,lung trouble and pleurisy are not infrequent4 ,chorea or ,st4 ,vitus's dance follows inflammatory rheumatism1 in children1 in some instances4 ,repeated attacks at intervals1 varying from one to four or five years1 are rather the rule--more particularly in young persons4 ,acute rheumatism frequently takes a milder form1 with slight fever 7the temperature running not over #ajj deg4 or #aja deg4 ,f47 and slight pain1 and swelling of the joints4 ,in children this is a common occurrence1 but heart disease is just as apt to follow1 and1 therefore1 such cases should receive a physician's attention at the earliest moment4 ,recovery from rheumatic fever is the usual result1 but with an increased tendency to future attacks1 and with the possibility of more or less permanent weakness of the heart1 for acute rheumatism is the most common origin of chronic heart troubles4 ,the milder form often follows the more severe1 and may persist for a long time4 ,the duration of rheumatic fever is variable2 in severe cases the patient is bedridden for six weeks or so4 ,rheumatism may be named through a mistake in diagnosis4 ,there are numerous other febrile disorders in which inflammation of the joints may occur4 ,among these are gonorrhea1 pneumonia1 scarlet fever1 blood poisoning1 diphtheria1 etc4 ,the joint trouble in these cases is caused by the toxins accompanying the special germ which occasions the original disease1 and the joint inflammation is not in any way connected with rheumatism4 ,the constant attention of a physician is emphatically demanded in every case of rheumatic fever1 since the complications are so numerous1 and since permanent damage of the heart may be prevented by proper care4 ,only frequent examinations of the heart by the medical man will reveal the presence or absence of heart complications4 ,treatment4--,it appears extremely doubtful whether rheumatic fever can be cut short by any form of treatment4 ,the disease is self-limited1 that is1 it will pass away of itself after a certain time4 ,the pain1 however1 can be rapidly abated by treatment4 ,warmth is of great value4 ,it is best for the patient to sleep between blankets instead of sheets1 and to wear flannel nightgowns1 changing them as often as they become damp with sweat4 ,to facilitate the changing1 it is well to have the nightgowns slit all down the front1 and also on the outside of the sleeves4 ,wrapping the joints in cotton batting and applying splints to secure absolute rest are great aids to comfort4 ,the diet should be fluid1 consisting of gruels1 milk1 broths1 and soups4 ,to relieve pain in the joints1 cloths1 wrung out of a saturated solution of baking soda and very hot water1 wrapped about the joint and covered with oil silk will be found extremely serviceable4 ,oil of wintergreen is another remedy which has proven of value when applied to the joints on cloths saturated in the oil and covered with cotton wool4 ,the bed must be smooth and soft1 with good springs4 ,high fever is reduced by the employment of cold to the head and by sponging the body with cool water at intervals of two hours or so4 ,the two drugs of most value are some form of salicylic acid and an alkali4 ,sodium salicylate in solution in water should be given to the adult in doses of ten to fifteen grains every two hours till the pain is relieved1 and then once in four hours as long as the fever lasts4 ,at the same time baking soda should be administered every three hours1 one-half a level teaspoonful dissolved in water1 and this may be continued as long as the fever persists4 ,the patient must use a bedpan in relieving the bladder and bowels1 and should remain in bed for a great while if the heart is damaged4 ,it is a disease which no layman should think of treating if it is possible to obtain the services of a medical man4 ,,muscular ,,rheumatism 7,myalgia74--,in this disease there is pain in the muscles1 which may be constant1 but is more pronounced on movement4 ,exposure to cold and wet1 combined with muscular strain1 frequently excite an attack4 ,on the other hand1 it often occurs during hot1 dry1 fine weather4 ,attacks last usually but a few days1 but may be prolonged for weeks4 ,the pain may be dull1 as if the muscle had been bruised1 but is often very sharp and cramplike4 ,there is1 commonly1 slight1 if any1 fever1 and no general disturbance of the health4 ,the following are the most common varieties3 ,,lumbago4--,this attacks the muscles in the small part of the back4 ,it comes on often with great suddenness1 as on stooping or lifting4 ,it may be so severe that the body cannot be moved1 and the patient may fall in the street or be unable to rise or turn in bed4 ,in less severe cases the pain catches the patient when attempting to straighten up after stooping4 ,pain in the back is often attributed by the laity to ,bright's disease1 but is rarely seen in the latter disorder1 and is much more often due to rheumatism4 ,,stiff ,,neck4--,this is a very common variety of muscular rheumatism1 and is seen more especially in young persons4 ,it may appear very suddenly1 as on awakening4 ,it attacks the muscles of one side and back of the neck4 ,the head is held stiffly to one side1 and to turn the head the body must be turned also1 as moving the neck causes severe pain4 ,sometimes the pain on moving the neck suddenly1 or getting it into certain positions1 is agonizing1 but when it is held in other positions a fair amount of comfort may be secured4 ,,rheumatism ,,of ,,the ,,chest4--,in this form there is more or less constant pain1 much increased by coughing1 sneezing1 taking long breaths1 or by movements4 ,it attacks usually one side1 more often the left4 ,it may resemble neuralgia or pleurisy4 ,in neuralgia the pain is more limited and comes in sharper attacks1 and there are painful spots4 ,the absence of fever in rheumatism of the chest will tend to separate it from pleurisy1 in which there is1 moreover1 often cough4 ,examination of the chest by a physician1 to determine the breath sounds1 is the only method to secure certainty in this matter4 ,muscular rheumatism also affects the muscles about the shoulder and shoulder blade and upper part of the back2 sometimes also the muscles of the belly and limbs4 ,treatment4--,rest1 heat1 and rubbing are the most satisfactory remedies4 ,in stiff neck1 rub well with some liniment1 as chloroform liniment1 and lie in bed on a hot-water bag4 ,phenacetin or salophen in doses of ten grains1 not repeated more frequently than once in four hours for an adult1 may afford relief2 only two or three doses should be taken in all4 ,in lumbago the patient should remain in bed and have the back ironed with a hot flatiron1 the skin being protected by a piece of flannel4 ,this should be repeated several times a day4 ,or a large1 hot1 flaxseed poultice may be applied to the back1 and repeated as often as it becomes cool4 ,at other times the patient may lie on a hot-water bag4 ,plasters will give comfort in milder cases1 or when the patient is able to leave the bed4 ,a good cathartic1 as two compound cathartic pills1 sometimes acts very favorably at the beginning of the attack4 ,salicylate of sodium is a useful remedy in many cases1 the patient taking ten grains three times daily1 in tablets after eating1 for a number of days4 ,in rheumatism of the chest1 securing immobility by strapping the chest1 as recommended for broken rib 7,vol4 ,i1 p4 #hd71 gives more comfort than any other form of treatment4 ,many other measures may be employed by the physician1 and are applicable in persistent cases1 as electricity and tonics4 ,the hot bath1 or ,turkish bath1 will sometimes cut short an attack of muscular rheumatism if employed at the onset of the trouble4 ,,chronic ,,rheumatism4--,chronic rheumatism is a disease attacking persons of middle age1 or after1 and is seen more commonly in poor1 hard-working individuals who have been exposed to cold and damp1 as laborers and washerwomen4 ,several of the larger joints1 as the knees1 shoulders1 and hips1 are usually affected1 but occasionally only one joint is attacked4 ,there is little swelling and no redness about the joint2 the chief symptoms are pain on motion1 stiffness1 and tenderness on pressure4 ,the pain is increased by cold1 damp weather1 and improved by warm1 dry weather4 ,there is no fever4 ,the general health suffers if the pain is severe and persistent1 and patients become pale1 dyspeptic1 and weak4 ,the disease tends rather to grow worse than recover1 and the joints1 after a long time1 to become immovable and misshapen4 ,life is not1 however1 shortened to any considerable degree by chronic rheumatism4 ,heart disease is not caused by this form of rheumatism1 although it may arise from somewhat similar tendencies existing in the same patient4 ,it may be distinguished from other varieties of rheumatism by the fact that the larger joints are those attacked1 and also by the age of the patients and general progress of the disease4 ,it very rarely follows acute rheumatism4 ,treatment4--,the treatment of chronic rheumatism is generally not very successful unless the patient can live in a warm1 dry climate the year round4 ,painting the joint with tincture of iodine and keeping it bandaged in flannel affords some relief4 ,the application of a cold1 wet cloth covered with oil silk and bandage1 by night1 also proves useful4 ,hot baths at night1 ,turkish baths1 or special treatment conducted under the supervision of a competent medical man at one of the hot1 natural1 mineral springs1 as those in ,virginia1 often prove of great value4 ,rubbing and movement of the joints is of much service in all cases2 any liniment may be used4 ,drugs are of minor importance1 but cod-liver oil and tonics may be required4 ,these should be prescribed by a physician4 ,,rheumatic ,,gout 7,arthritis74--,notwithstanding the name1 this disease has no connection with either gout or the other forms of rheumatism described4 ,it occurs much more frequently in women1 with the exception of that form in which a single joint is attacked4 ,the disease may appear at any age1 but more often it begins between the years of thirty and fifty-five4 ,the cause is still a matter of doubt1 although it often follows1 or is associated with1 nervous diseases1 and in other cases the onset seems to be connected with the existence of influenza or gonorrhea1 so that it may be of germ origin4 ,constant exposure to cold and dampness1 excessive care and anxiety1 and injury are thought to favor the disease4 ,the disease is sometimes limited to the smaller joints of the fingers and toes1 little1 hard knobs appearing on them4 ,at times the joints may be swollen1 tender1 and red1 and are usually so at the beginning of the disease1 as well as at irregular intervals1 owing to indigestion1 or following injury4 ,at first only one joint1 as of the middle finger1 may be attacked1 and often the corresponding finger on the other hand is next affected4 ,the joints of the fingers become enlarged1 deformed1 and stiffened4 ,the results of the disease are permanent so far as the deformity is concerned and the stiffness which causes interference with the movement of the finger joints1 but the disease may stop during any period of its development1 leaving a serviceable1 though somewhat crippled1 hand4 ,in these cases the larger joints are not generally involved4 ,there is some evidence to indicate that this form of the disease is more commonly seen in the long-lived4 ,general ,form4--,in this type the disease tends to attack all the joints1 and1 in many cases1 to go from bad to worse4 ,the hands are usually first attacked1 then the knees1 feet1 and other joints4 ,in the worst cases every joint in the body becomes diseased1 so that even movements of the jaw may become difficult4 ,there are at first slight swelling1 pain and redness about the joints1 with tenderness on pressure4 ,creaking and grating are often heard during motion of the affected joints4 ,this condition may improve or subside for intervals1 but gradually the joints become misshapen and deformed4 ,the joints are enlarged1 and irregular and stiff2 the fingers become drawn over toward the little finger1 or bent toward the palm1 and are wasted and clawlike4 ,the larger limbs are often bent and cannot be straightened1 and the muscles waste away1 making the joints look larger4 ,in the worst cases the patient becomes absolutely crippled1 helpless1 and bedridden1 and the joints become immovable4 ,the pain may be great and persistent1 or slight4 ,usually the pain grows less as the disease advances4 ,numbness and tingling of the skin often trouble the patient1 and the skin is sometimes smooth and glossy or freckled4 ,the general health suffers1 and weakness1 anaemia1 and dyspepsia are common4 ,even though most of the joints become useless1 there is often sufficient suppleness in the fingers to allow of their use1 as in writing or knitting4 ,in old men the disease is seen attacking one joint alone1 as the hip1 shoulder1 knee1 and spine4 ,children are occasionally sufferers1 and in young women it may follow frequent confinements or nursing1 and often begins in them like a mild attack of rheumatic fever4 ,the heart is not damaged by rheumatic gout4 ,it is frequently impossible to distinguish rheumatic gout from chronic rheumatism in the beginning4 ,in the latter1 creaking and grating sounds on movement of the joints are less marked1 the small joints1 as of the hand1 are not so generally attacked1 nor are there as great deformity and loss of motion as is seen in late cases of rheumatic gout4 ,outlook4--,it often happens that after attacking several joints1 the disease is completely arrested and the patient becomes free from pain1 and only a certain amount of interference with the use of the joint and stiffness remain4 ,life is not necessarily shortened by the disease4 ,the deformity and crippling are permanent4 ,treatment4--,rheumatic gout is a chronic disease in most instances1 and requires the careful study and continuous care of the medical man4 ,he may frequently be able to arrest it in the earlier stages1 and prevent a life of pain and helplessness4 ,in a general way nourishing food1 as milk1 eggs1 cream1 and butter1 with abundance of fresh vegetables1 should be taken to the extent of the digestive powers4 ,everything that tends to reduce the patient's strength must be avoided4 ,cod-liver oil and tonics should be used over long periods4 ,various forms of baths are valuable1 as the hot-air bath1 and hot natural or artificial baths4 ,a dry1 warm climate is most appropriate1 and flannel clothing should be worn the year round4 ,moderate exercise and outdoor life1 in warm weather1 are advisable1 and massage1 except during the acute attacks of pain and inflammation1 is beneficial4 ,surgical measures will sometimes aid patients in regaining the usefulness of crippled limbs4 ,,scurvy4--,scurvy used to be much more common than it is now4 ,in the ,civil ,war there were nearly #ej1jjj cases in the ,union ,army4 ,sailors and soldiers have been the common victims1 but now the disease occurs most often among the poorly fed1 on shore4 ,it is caused by a diet containing neither fresh vegetables1 preserved vegetables1 nor vegetable juices4 ,in the absence of vegetables1 limes1 lemons1 oranges1 or vinegar will prevent the disease4 ,it is also thought that poisonous substances in the food may occasion scurvy1 as tainted meat has experimentally produced in monkeys a disease resembling it4 ,certain conditions1 as fatigue1 cold1 damp quarters1 mental depression and homesickness1 favor the development of the disease4 ,it attacks all ages1 but is most severe in the old4 ,symptoms4--,scurvy begins with general weakness and paleness4 ,the skin is dry1 and has a dirty hue4 ,the gums become swollen1 tender1 spongy1 and bleed easily1 and later they may ulcerate and the teeth loosen and drop out4 ,the tongue is swollen1 and saliva flows freely4 ,the appetite is poor and chewing painful1 and the breath has a bad odor4 ,the ankles swell1 and bluish spots appear on the legs which may be raised in lumps above the surface4 ,the patient suffers from pain in the legs1 which sometimes become swollen and hard4 ,the blue spots are also seen on the arms and body1 and are due to bleeding under the skin1 and come on the slightest bruising4 ,occasionally there is bleeding from the nose and bowels4 ,the joints are often swollen1 tender1 and painful4 ,constipation is rather the rule1 but in bad cases there may be diarrhea1 nausea1 and vomiting1 and the victim becomes a walking skeleton4 ,mental depression or delirium may be present4 ,treatment4--,recovery is usually rapid and complete1 unless the disease is far advanced4 ,soups1 fresh milk1 beef juice1 and lemon or orange juice may be given at first1 when the digestion is weak1 and then green vegetables1 as spinach 7with vinegar71 lettuce1 cabbage1 and potatoes4 ,the soreness of the mouth is relieved by a wash containing one teaspoonful of carbolic acid to the quart of hot water4 ,this should be used to rinse the mouth several times daily1 but must not be swallowed4 ,painting the gums with a two per cent solution of silver nitrate in water1 by means of a camel's-hair brush1 twice daily1 will also prove serviceable4 ,to act as a tonic1 a two-grain quinine pill and two ,blaud's pills of iron may be given three times daily4 ,,infantile ,,scurvy4--,scurvy occasionally occurs in infants between twelve and eighteen months of age1 and is due to feeding on patent foods1 condensed milk1 malted milk1 and sterilized milk4 ,in case it is essential to use sterilized or pasteurized milk1 if the baby receives orange juice1 as advised under the care of infants1 scurvy will not develop4 ,scurvy is frequently mistaken for either rheumatism or paralysis in babies4 ,symptoms4--,the lower limbs become painful1 and the baby cries out when it is moved4 ,the legs are at first drawn up and become swollen all around just above the knees1 but not the knee joints themselves4 ,later the whole thigh swells1 and the baby lies without moving the legs1 with the feet rolled outward and appears to be paralyzed1 although it is only pain which prevents movement of the legs4 ,sometimes there is swelling about the wrist and forearm1 and the breastbone may appear sunken in4 ,purplish spots occur on the legs and other parts of the body4 ,the gums1 if there are teeth present1 become soft1 tender1 spongy1 and bleed easily4 ,there may be slight fever1 the temperature ranging from #aja deg4 to #ajb deg4 ,f4 ,the babies are exceedingly pale1 and lose all strength4 ,treatment4--,the treatment is very simple1 and recovery rapidly takes place as soon as it is carried out4 ,the feeding of all patent baby foods--condensed or sterilized milk--must be instantly stopped4 ,a diet of fresh milk1 beef juice1 and orange juice1 as directed under the care of infants1 will bring about a speedy cure4 ,,gout4--,notwithstanding the frequency with which one encounters allusions to gout in ,english literature1 it is unquestionably a rare disease in the ,united ,states4 ,in the ,massachusetts ,general ,hospital there were1 among #bh1jjj patients admitted in the last ten years1 but four cases of gout4 ,this is not an altogether fair criterion1 as patients with gout are not generally of the class who seek hospitals1 nor is the disease one of those which would be most likely to lead one into a hospital4 ,still1 the experience of physicians in private practice substantiates the view of the rarity of gout in this country4 ,we are still ignorant of the exact changes in the bodily condition which lead to gout1 but may say in a general way that in this disease certain products1 derived from our food and from the wear and tear of tissues1 are not properly used up or eliminated1 and are retained in the body4 ,one of these products is known as sodium biurate1 and is deposited in the joints1 giving rise to the inflammation and changes to be described4 ,gout occurs chiefly in men past forty4 ,the tendency to the disease is usually inherited4 ,overeating1 together with insufficient exercise and indulgence in alcohol1 are conducive to its development in susceptible persons4 ,injuries1 violent emotion1 and exposure to cold are also thought to favor attacks4 ,the heavier beers and ales of ,england1 together with their stronger wines1 as port1 ,madeira1 sherries1 and champagne1 are more prone to induce gout than the lighter beers drunk in the ,united ,states and ,germany4 ,distilled liquors1 as brandy and whisky1 are not so likely to occasion gout4 ,poor man's gout may arise in individuals who lead the most temperate lives1 if they have a strong inherited tendency to the disease1 or when digestion and assimilative disorders are present1 as well as in the case of the poor who drink much beer and live in bad surroundings1 and have improper and insufficient food4 ,workers in lead1 as typesetters and house painters1 are more liable to gout than others4 ,symptoms4--,there is often a set of preliminary symptoms varying in different persons1 and giving warning of an approaching attack of gout1 such as neuralgic pains1 dyspepsia1 irritability1 and mental depression1 with restless nights4 ,an acute attack generally begins in the early morning with sudden1 sharp1 excruciating pain in the larger joint of one of the big toes1 more often the right1 which becomes rapidly dark red1 mottled1 swollen1 hot1 tense1 shiny1 and exceedingly sensitive to touch4 ,there is commonly some fever2 a temperature of #ajb deg4 to #ajc deg4 ,f4 may exist4 ,the pain subsides in most cases to a considerable degree during the day1 only to return for several nights1 the whole period of suffering lasting from four to eight days4 ,occasionally the pain may be present without the redness1 swelling1 etc41 or vice versa4 ,other joints may be involved1 particularly the joint of the big toe of the other foot4 ,complete recovery ensues1 as a rule1 after the first attack1 and the patient may thereafter feel exceptionally well4 ,a return of the disease is rather to be expected4 ,several attacks within the year are not uncommon1 or they may appear at much longer intervals4 ,occasionally the gout seems to strike in4 ,in this case it suddenly leaves the foot and attacks the heart1 causing the patient severe pain in that region and great distress in breathing2 or the abdomen becomes the seat of violent pain1 and vomiting1 diarrhea1 collapse and death rarely result4 ,in the later history of such patients1 the acute attacks may cease and various joints become chronically diseased1 so that the case assumes the appearance of a chronic form of rheumatism4 ,the early history of attacks of sharp pain in the great toe and the appearance of hard deposits 7chalk stones7 in the knuckles and the ears are characteristic of gout4 ,the greatest variety of other disorders are common in those who have suffered from gout1 or in those who have inherited the tendency4 ,goutiness is sometimes used to describe such a condition4 ,in this there may never be any attacks of pain or inflammation affecting the joints1 but eczema and other skin diseases2 tonsilitis1 neuralgia1 indigestion and biliousness1 lumbago and other muscular pains1 sick headache1 bronchitis1 disease of heart and kidneys1 with a tendency to apoplexy1 dark-colored urine1 stone in the bladder1 and a hot1 itching sensation in the palms of the hands and soles of the feet1 all give evidence of the gouty constitution4 ,treatment4--,one of the most popular remedies is colchicum--a powerful drug and one which should only be taken under the direction of a physician4 ,a cathartic at the beginning is useful2 for instance1 two compound cathartic pills or five grains of calomel4 ,it is well to give five grains of lithium citrate dissolved in a glass of hot water every three hours4 ,laville's antigout liquid1 imported by ,fougera of ,new ,york1 taken according to directions1 may suffice during the absence of a physician4 ,the inflamed toe should be raised on a chair or pillow1 and hot cloths may be applied to it4 ,the general treatment1 between the attacks1 consists in the avoidance of all forms of alcohol1 the use of a diet rich in vegetables1 except peas1 beans1 and oatmeal1 with meats sparingly and but once daily4 ,sweets must be reduced to the minimum1 but cereals and breadstuffs are generally allowable1 except hot bread4 ,all fried articles of food1 all smoked or salted meats1 smoked or salted fish1 pastry1 griddle cakes1 gravies1 spices and seasoning1 except red pepper and salt1 and all indigestibles are strictly forbidden1 including ,welsh rarebit1 etc4 ,fruit may be generally eaten1 but not strawberries nor bananas4 ,large quantities of pure water should be taken between meals--at least three pints daily4 ,mineral waters offer no particular advantage4 ,part ,,iii ,,sexual ,,hygiene ,,by ,,kenelm ,,winslow ,,chapter ,i ,health and ,purity ,duties of ,parents--,abuse of the ,sexual ,function--,false ,teachings--,criminal ,neglect--,secure the ,child's ,confidence--,the ,best ,corrections--,marriage ,relations4 ,every individual should know how to care for the sexual organs as well as those of any other part of the body1 providing that the instruction be given by the proper person and at the proper time and place4 ,such information should be imparted to children by parents1 guardians1 or physicians at an early age and1 if this is neglected through ignorance or false modesty1 erroneous ideas of the nature and purpose of the sexual function will very surely be supplied later by ignorant and probably evil-minded persons with correspondingly bad results4 ,there is no other responsibility in the whole range of parental duties which is so commonly shirked and with such deplorable consequences4 ,when the subject is shorn of the morbid and seductive mystery with which custom has foolishly surrounded it in the past1 and considered in the same spirit with which we study the hygiene of the digestion and other natural functions1 it will be found possible to give instruction about the sexual function in a natural way and without exciting unhealthy and morbid curiosity4 ,a word in the beginning as to the harm produced by abuse of the sexual function4 ,the injury thus received is purposely magnified tenfold for reasons of gain by quacks who work upon the fears of their victims for their own selfish purposes4 ,the voluntary exercise of the sexual function--unlike that of any other important organs--is not necessary to health until maturity has been reached2 on the contrary1 continence is conducive to health1 both physical and mental4 ,even after maturity1 unless marriage occurs1 or by improper living the sexual desires are unnaturally stimulated1 it is quite possible to maintain perfect health through life without exercising the sexual function at all4 ,undue irritation of the sexual organs causes disorder of the nervous system1 and if continued it will result ultimately in overfatigue and failure of the nervous activities which control the normal functions of every organ in the body4 ,in other words1 it will result in nervous exhaustion4 ,damage is also wrought by exciting local irritation1 congestion1 and inflammation of the sexual organs which result in impairment of the proper functions of these parts and in local disorders and distress4 ,it is unnecessary further to particularize other than to state that abuse of the sexual organs in the young is usually owing to the almost criminal neglect or ignorance of the child's parents4 ,but so far from increasing alarm in the patient it is almost always possible to enable the child to be rid of the habit by kindly instruction and judicious oversight in the future1 and no serious permanent local damage to the sexual organs or general injury to the nervous system will be likely to persist4 ,the opposite teaching is that peculiar to the quack who prophesies every imaginable evil1 from complete loss of sexual function to insanity4 ,any real or fancied disorder of the sexual function is extremely apt to lead to much mental anxiety and depression1 so that a cheerful outlook is essential in inspiring effort to correct bad habits and is wholly warranted in view of the entire recovery in most cases of the young who have abused their sexual organs4 ,insanity or imbecility are seldom the result but more often the cause of such habits4 ,it is a sad fact1 however1 that1 under the prevailing custom of failure of the parents to exercise proper supervision over the sexual function of their children1 self-abuse is generally practiced in youth1 at least by boys4 ,this often leads to temporary physical and mental suffering and is very prejudicial to the morals1 but does not commonly result in permanent injury except in the degenerate4 ,children at an early age--three to four years--should be taught not to touch1 handle1 rub1 or irritate their sexual organs in any way whatsoever except so far as is necessary in urination or in the course of the daily cleansing4 ,if there seems to be any inclination to do so it will usually be found that it is due to some local trouble to which a physician's attention should be called and which may generally be readily remedied by him4 ,it is always advisable to ask the medical adviser to examine babies for any existing trouble and abnormality of the sexual organs1 as a tight1 adherent1 or elongated foreskin in boys--and rarely a corresponding condition in girls--may give rise to much local irritation and remote nervous disturbances4 ,the presence of worms may lead to irritation in the bowel1 which excites masturbation in children4 ,girl babies should be watched to prevent them from irritating the external sexual parts by rubbing them between the inner surfaces of the thighs4 ,as the child begins to play with other children he or she should be cautioned to avoid those who in any way try to thwart the parents' advice1 and be instructed to report all such occurrences4 ,it is wise also to try and gratify the child's natural curiosity about the sexual function so far as may be judicious by explanations as to the purpose of the sexual organs1 when the child is old enough to comprehend such matters4 ,the reticence and disinclination of parents to instruct their children in matters relating to sex cannot be too strongly condemned4 ,it is perfectly natural that the youth should wish to know something of the origin of life and how human beings come into the world4 ,the mystery and concealment thrown around these matters only serve to stimulate his curiosity4 ,it is a habit of most parents to rebuke any questions relating to this subject as improper and immodest1 and the first lesson the child learns is to associate the idea of shame with the sexual organs2 and1 since he is not enlightened by his natural instructors1 he picks up his knowledge of the sex function in a haphazard way from older and often depraved companions4 ,evasive replies with the intent of staving off the dreaded explanation do no good and may result in unexpected evil4 ,by securing the child's confidence at the start1 one may not only keep informed of his actions but protect him from seeking or even listening to bad counsels4 ,at the age of ten or twelve it is well that the family physician or parent should give instruction as to the special harm which results from unnaturally exciting the sexual nature by handling and stimulating the sexual organs and also warning the child against filthy literature and improper companions4 ,at the age of puberty he should be warned against the moral and physical dangers of sexual intercourse with lewd women4 ,the physical dangers refer to the great possibility of infection with one or both of the common diseases--syphilis and gonorrhea--acquired by sexual contact with one suffering from these terrible disorders 7p4 #aii74 ,it is usually quite impossible for a layman to detect the presence of these diseases in others1 or rather1 to be sure of their absence1 and the permanent damage which may be wrought to the sufferer and to others with whom he may have sexual relations is incalculable4 ,it is generally known that syphilis is a disease to be dreaded1 but not perhaps that it not only endangers the life and happiness of the patient1 but the future generation of his descendants4 ,gonorrhea--the much more common disease--while often treated lightly by youth1 frequently leads to long1 chronic1 local disease and may even result fatally in death2 later in life it may cause infection of a wife resulting in chronic invalidism and necessitating surgical removal of her maternal organs4 ,these possibilities often occur long after the patient thinks he is wholly free from the disease4 ,gonorrhea in women is the most frequent cause of their sterility1 and also is a common source of abortion and premature birth4 ,it is the cause in most cases of blindness in infants 7p4 #bje7 and also of vulvo-vaginitis in girl babies4 ,furthermore1 gonorrhea is so alarmingly prevalent that it is stated on good authority that the disease occurs in eighty per cent of all males some time during their lives4 ,the disease is not confined to prostitutes1 but is common1 much more frequently than is suspected1 in all walks and classes of life and at all ages4 ,even among boys attending boarding schools and similar institutions the disease is only too frequent4 ,it is particularly important that the true situation be explained to boys about to enter college or a business career1 for it is at this period of life that their temptations become greatest4 ,alcohol is the most dangerous foe--next to bad companions--with which they must contend in this matter1 for1 weakened by its influence and associated with persuasive friends1 their will gives way and the advice and warning1 which they may have received1 are forgotten4 ,idleness is also another influential factor in indirectly causing sexual disease2 hard physical and mental work are powerful correctives of the passions4 ,it may be of interest to readers to know that but recently an association of ,american physicians1 alarmed by the fearful prevalence of sexual diseases in this country1 has been taking measures to inform youths and adults and the general public1 through special instruction in schools1 and by means of pamphlets and lectures to teachers and others1 of the prevalence and great danger of this evil4 ,when young adult life has been attained it is also desirable for the parent1 or the family physician1 to inform the young man or woman--especially if either is about to enter a marriage engagement--that close and frequent personal contact with the opposite sex1 especially when the affections are involved1 will necessarily1 though involuntarily1 excite local stimulation of the sexual organs and general irritability and exhaustion of the entire nervous system4 ,long engagements--when the participants are frequent companions--are thus peculiarly unfortunate4 ,it is only when the sexual functions are normally exercised in adult life1 as in sexual intercourse1 that sexual excitement is not harmful4 ,young women about to marry should receive instruction from their mothers as to the sexual relations which will exist after marriage4 ,most girls are allowed to grow up ignorant of such matters and in consequence may become greatly shocked and even disgusted by the sexual relations in marriage--fancying that there must be something unnatural and wrong about them because the subject was avoided by those responsible for their welfare4 ,any excess in frequency of sexual intercourse after marriage is followed by feelings of depression and debility of some sort which may be readily attributed to the cause and so corrected4 ,any deviation from the natural mode of intercourse is pretty certain to lead to physical disaster2 thus1 unnatural prolongation of the act1 or withdrawal on the part of the man before the natural completion of the act in order to prevent conception1 often results in deplorable nervous disorders4 ,in conclusion1 it may be said that parents must take upon themselves the burden of instructing their children in sexual hygiene or shift it upon the shoulders of the family physician1 who can undertake it with much less mental perturbation and with more intelligence4 ,otherwise they subject their offspring to the possibility of incalculable suffering1 disease1 and even death--largely through their own inexcusable neglect4 ,,chapter ,,ii ,genito-,urinary ,diseases ,contagious ,disorders--,common ,troubles of ,children--,inflammation of the ,bladder--,stoppage and ,suppression of ,urine--,causes and ,treatment of ,bright's ,disease4 ,,gonorrhea4--,gonorrhea is a contagious inflammation of the urethra1 accompanied by a white or yellowish discharge4 ,it is caused by a specific germ1 the gonococcus1 and is acquired through sexual intercourse with a person suffering from this disease4 ,exceptionally the disease may be conveyed by objects soiled with the discharge1 as basins1 towels1 and1 in children1 diapers1 so that in institutions for infants it may be thus transferred from one to the other1 causing an epidemic4 ,the mucous membrane of the lower part of the bowel and the eyes are also subject to the disease through contamination with the discharge4 ,the disease begins usually three to seven days after sexual intercourse1 with symptoms of burning1 smarting1 and pain on urination1 and a watery discharge from the passage1 soon followed by a yellowish or white secretion4 ,swelling of the penis1 frequent urination1 and painful erections are also common symptoms4 ,the disease1 if uncomplicated and running a favorable course1 may end in recovery within six weeks or earlier1 with proper treatment4 ,on the other hand1 complications are exceedingly frequent1 and the disorder often terminates in a chronic inflammation which may persist for years--even without the knowledge of the patient--and may result in the infection of others after all visible signs have ceased to appear4 ,treatment4--,rest is the most important requisite2 at first1 best in bed2 if not1 the patient should keep as quiet as possible for several days4 ,the diet should consist of large quantities of water or milk1 or milk and vichy1 with bread1 cereals1 potatoes1 and vegetables--absolutely avoiding alcohol in any form4 ,sexual intercourse is harmful at any stage in the disease and will communicate the infection4 ,aperient salts should be taken to keep the bowels loose4 ,the penis should be soaked in hot water three times daily to reduce the inflammation and cleanse the organ4 ,a small wad of absorbent cotton may be held in place by drawing the foreskin over it to absorb the discharge1 or may be held in place by means of a bag fitting over the penis4 ,all cloths1 cotton1 etc41 which have become soiled with the discharge1 should be burned1 and the hands should be washed after contact with the discharge2 otherwise the contagion may be conveyed to the eyes1 producing blindness4 ,it is advisable for the patient to take one-half teaspoonful of baking soda in water three times daily between meals for the first four or five days1 or1 better1 fifteen grains of potassium citrate and fifteen drops of sweet spirit of nitre in the same way4 ,painful erections may be relieved by bathing the penis in cold water1 urinating every three hours1 and taking twenty grains of sodium bromide at night in water4 ,after all swelling and pain have subsided1 local treatment may be begun4 ,injections or irrigations with various medicated fluids constitute the best and most efficient measures of local treatment4 ,they should be used only under the advice and management of the physician4 ,no greater mistake can be made than to resort to the advertising quack1 the druggist's clerk1 or the prescription furnished by an obliging friend4 ,skillful treatment1 resulting in a complete radical cure1 may save him much suffering from avoidable complications and months or years of chronic trouble4 ,at the same time the first medicines advised are stopped and oleoresin of cubebs1 five grains1 or copaiba balsam1 ten grains--or both together--are to be taken three times daily after meals1 in capsules1 for several weeks1 unless they disturb the digestion too much4 ,a suspensory bandage should be worn throughout the continuance of the disease4 ,the approach of the cure of the disease is marked by a diminution in the quantity and a change in the character of the discharge1 which becomes thinner and less purulent and reduced to merely a drop in the passage in the early morning1 but this may continue for a great while4 ,chronic discharge of this kind and the complications cannot be treated properly by the patient1 but require skilled medical care4 ,in this connection it may be said that most patients have an idea that the subsidence or disappearance of the discharge is an evidence of the cure of the disease4 ,experience shows that the disease may lapse into a latent or chronic form and remain quiescent1 without visible symptoms1 during a prolonged period1 while susceptible of being revived under the influence of alcoholic drinks or sexual intercourse4 ,it is important that treatment should be continued until all disease germs are destroyed1 which can only be determined by an examination of the secretions from the urethra under the microscope4 ,the more common complications of gonorrhea are inflammation of the glands in the groin 7bubo71 acute inflammation of the prostate glands and bladder1 of the seminal vesicles1 or of the testicles4 ,the latter complication is a most common cause of sterility in men4 ,formerly it was thought that gonorrhea was a local inflammation confined to the urinary canal and neighboring parts1 but advances in our knowledge have shown that the germs may be taken up into the general circulation and affect any part of the body1 such as the muscles1 joints1 heart1 lungs1 liver1 spleen1 kidneys1 etc41 with results always serious and often fatal to life4 ,one of the most common complications is gonorrheal arthritis1 which may affect one or several joints and result in stiffness or complete loss of movement of the affected joint1 with more or less deformity and permanent disability4 ,another complication is gonorrheal inflammation of the eye1 from direct transference of the pus by the fingers or otherwise1 and resulting in partial or complete blindness4 ,,gonorrhea ,,in ,,women4--,gonorrhea in women is a much more frequent and serious disease than was formerly supposed4 ,the general impression among the laity is that gonorrhea in women is limited to the prostitute and vicious classes who indulge in licentious relations4 ,unfortunately1 this is not the case4 ,there is perhaps more gonorrhea1 in the aggregate1 among virtuous and respectable wives than among professional prostitutes1 and the explanation is the following3 ,a large proportion of men contract the disease at or before the marrying age4 ,the great majority are not cured1 and the disease simply lapses into a latent form4 ,many of them marry1 believing themselves cured1 and ignorant of the fact that they are bearers of contagion4 ,they transmit the disease to the women they marry1 many of whom1 from motives of modesty and an unwillingness to undergo an examination do not consult a physician1 and they remain ignorant of the existence of the disease until the health is seriously involved4 ,in women1 gonorrhea is not usually so acute and painful as in men1 unless it involves the urethra4 ,it usually begins with smarting and painful urination1 with frequent desire to urinate and with a more or less abundant discharge from the front passage4 ,in the majority of cases the infection takes place in the deeper parts1 that is1 in the neck or body of the womb4 ,in this location it may not give rise at first to painful symptoms1 and the patient often attributes the increased discharge to an aggravation of leucorrhea from which she may have suffered4 ,the special danger to women from gonorrhea is that the inflammation is apt to be aggravated during the menstrual period and the germs of the disease ascend to the cavity of the womb1 the tubes1 and ovaries1 and invade the peritoneal covering1 causing peritonitis4 ,pregnancy and childbirth afford favorable opportunities for the upward ascension of the germs to the peritoneal cavity4 ,the changes caused by gonorrheal inflammation in the maternal organs are the most common cause of sterility in women4 ,it is estimated that about fifty per cent of all sterility in women proceeds from this cause4 ,in addition to its effects upon the child-bearing function1 the danger to the health of such women is always serious4 ,in the large proportion of cases they are made permanent invalids1 no longer able to walk freely1 but compelled to pass their lives in a reclining position until worn out by suffering1 which can only be relieved by the surgical removal of their maternal organs4 ,it is estimated that from fifty to sixty per cent of all operations performed on the maternal organs of women are due to disease caused by gonorrheal inflammation4 ,treatment4--,rest in bed1 the use of injections of hot water1 medicated with various astringents1 by means of a fountain syringe in the front passage three times daily1 and the same remedies and bath recommended above1 with hot sitz baths1 will usually relieve the distress4 ,in view of the serious character of this affection in women and its unfortunate results when not properly treated1 it is important that they should have the benefit of prompt and skillful treatment by a physician4 ,otherwise1 the health and life of the patient may be seriously compromised4 ,the social danger of gonorrhea introduced after marriage is not limited to the risks to the health of the woman4 ,when a woman thus infected bears a child the contagion of the disease may be conveyed to the eyes of the child in the process of birth4 ,gonorrheal pus is the most virulent of all poisons4 ,a single drop of the pus transferred to the eye may destroy this organ in from twenty-four to forty-eight hours4 ,it is estimated that from seventy-five to eighty per cent of all babies blinded at birth have suffered from this cause1 while from twenty to thirty per cent of blindness from all causes is due to gonorrhea4 ,while the horrors of this disease in the newborn have been mitigated by what is called the ,crede method 7instillation of nitrate of silver solution in the eye immediately after birth71 it still remains one of the most common factors in the causation of blindness4 ,another social danger is caused by the pus being conveyed to the genital parts of female children1 either at birth or by some object upon which it has been accidentally deposited1 such as clothes1 sponges1 diapers1 etc4 ,these cases are very common in babies' hospitals and institutions for the care of children4 ,quite a number of epidemics have been traced to this cause4 ,the disease occurring in children is exceedingly difficult of cure and is often followed by impairment in the development of their maternal organs4 ,much of the ill health of young girls from disordered menstruation and other uterine diseases may be traced to this cause4 ,another serious infection in babies and young children is gonorrheal inflammation of the joints1 with more or less permanent crippling4 ,,syphilis2 ,,the ,,pox2 ,,lues4--,syphilis is a contagious germ disease affecting the entire system4 ,while commonly acquired through sexual intercourse with a person affected with the disorder1 it may be inherited from the parents1 one or both4 ,it is often acquired through accidental contact with sources of contagion4 ,syphilis and tuberculosis are the two great destroyers of health and happiness1 but syphilis is the more common4 ,symptoms4--,acquired syphilis may be divided into three stages3 the primary1 secondary1 and tertiary4 ,the first stage is characterized by the appearance of a pimple or sore on the surface of the sexual organ not usually earlier than two1 nor later than five to seven1 weeks after sexual intercourse4 ,the appearance of this first sore is subject to such variations that it is not always possible for even the most skillful physician to determine positively the presence of syphilis in any individual until the symptoms characteristic of the second stage develop4 ,following the pimple on the surface of the penis comes a raw sore with hard deposit beneath1 as of a coin under the skin4 ,it may be so slight as to pass unnoticed or become a large ulcer1 and may last from a few weeks to several months4 ,there are several other kinds of sores which have no connection with syphilis and yet may resemble the syphilitic sore so closely that it becomes impossible to distinguish between them except by the later symptoms to be described4 ,along with this sore1 lumps usually occur in one or both groins1 due to enlarged glands4 ,the second stage appears in six to seven weeks after the initial sore1 and is characterized by the occurrence of a copper-colored rash over the body1 but not often on the face1 which resembles measles considerably4 ,sometimes a pimply or scaly eruption is seen following this or in place of the red rash4 ,at about1 or preceding1 this period other symptoms may develop1 as fever1 headache1 nausea1 loss of appetite1 and sleeplessness1 but these may not be prominent4 ,moist patches may appear on the skin1 in the armpits1 between the toes1 and about the rectum2 or warty outgrowths in the latter region4 ,there is sore throat1 with frequently grayish patches on the inside of the cheeks1 lips1 and tongue4 ,the hair falls out in patches or1 less often1 is all lost4 ,inflammation of the eye is sometimes a symptom4 ,these symptoms do not always occur at the same time1 and some may be absent or less noticeable than others4 ,the third stage comes on after months or years1 or in those subjected to treatment may not occur at all4 ,this stage is characterized by sores and ulcerations on the skin and deeper tissues1 and the occurrence of disease of different organs of the body1 including the muscles1 bones1 nervous system1 and blood vessels2 every internal organ is susceptible to syphilitic change4 ,a great many affections of the internal organs--the heart1 lungs1 liver1 kidneys1 brain1 and cord--which were formerly attributed to other causes1 are now recognized as the product of syphilis4 ,the central nervous system is peculiarly susceptible to the action of the syphilitic poison1 and when affected may show the fact through paralysis1 crippling1 disabling1 and disfiguring disorders4 ,years after cure has apparently resulted1 patients are more liable to certain nervous disorders1 as locomotor ataxia1 which attacks practically only syphilitics2 and general paresis1 of which seventy-five per cent of the cases occur in those who have had syphilis4 ,inherited ,syphilis4--,children born with syphilis of syphilitic parents show the disease at birth or usually within one or two months4 ,they present a gaunt1 wasted appearance1 suffer continually from snuffles or nasal catarrh1 have sores and cracks about the lips1 loss of hair1 and troublesome skin eruptions4 ,the syphilitic child has been described as a little old man with a cold in his head4 ,the internal organs are almost invariably diseased1 and sixty to eighty per cent of the cases fortunately die4 ,those who live to grow up are puny and poorly developed1 so that at twenty they look not older than twelve1 and are always delicate4 ,it is to be noted that syphilis is not necessarily a venereal disease1 that is1 acquired through sexual relations4 ,it may be communicated by kissing1 by accidental contact with a sore on a patient's body1 by the use of pipes1 cups1 spoons1 or other eating or drinking utensils1 or contact with any object upon which the virus of the disease has been deposited4 ,any part of the surface of the body or mucous membrane is susceptible of being inoculated with the virus of syphilis1 followed by a sore similar to what has been described as occurring upon the genital parts and later the development of constitutional symptoms4 ,the contagiousness of the disease is supposed to last during the first three years of its existence1 but there are many authentic cases of contagion occurring after four or five years of syphilis4 ,diagnosis4--,the positive determination of the existence of syphilis at the earliest moment is of the utmost importance in order to set at rest doubt and that treatment may be begun4 ,it is necessary to wait1 however1 until the appearance of the eruption1 sore throat1 enlargement of glands1 falling out of hair1 etc41 before it is safe to be positive4 ,treatment4--,the treatment should be begun as soon as the diagnosis is made1 and must be continuously and conscientiously pursued for three years or longer4 ,if treatment is instituted before the secondary symptoms1 it may prevent their appearance so that the patient may remain in doubt whether he had the disease or not1 for it is impossible for the most skilled specialist absolutely to distinguish the disease before the eruption1 no matter how probable its existence may seem4 ,this happens because there are several kinds of sores which attack the sexual organs and which may closely simulate syphilis4 ,the treatment is chiefly carried out with various forms of mercury and iodides1 but so much knowledge and experience are required in adapting these to the individual needs and peculiarities of the patient that it is impossible to describe their use4 ,patients should not marry until four or five years have elapsed since the appearance of syphilis in their persons1 and at least twelve months after all manifestations of the disease have ceased4 ,if these conditions have been complied with1 there is little danger of communicating the disease to their wives or transmitting it to their offspring4 ,they must moreover1 have been under the treatment during all this period4 ,abstinence from alcohol1 tobacco1 dissipation1 and especial care of the teeth are necessary during treatment4 ,results4--,the majority of syphilitics recover wholly under treatment and neither have a return of the disease nor communicate it to their wives or children4 ,it is1 however1 possible for a man1 who has apparently wholly recovered for five or six years or more1 to impart the disease4 ,without proper treatment or without treatment for the proper time1 recurrence of the disease is frequent with the occurrence of the destructive and often serious symptoms characteristic of the third stage of the disease4 ,while syphilis is not so fatal to life as tuberculosis1 it is capable of causing more suffering and unhappiness1 and is directly transmitted from father to child1 which is not the case with consumption4 ,syphilis is also wholly preventable1 which is not true of tuberculosis at present4 ,it is not probable that syphilis is ever transmitted to the third generation directly1 but deformities1 general debility1 small and poor teeth1 thin1 scanty growth of hair1 nervous disorders1 and a general miserable physique are seen in children whose parents were the victims of inherited syphilis4 ,in married life syphilis may be communicated to the wife directly from the primary sore on the penis of the husband during sexual intercourse1 but contamination of the wife more often happens from the later manifestations of the disease in the husband1 as from secretion from open sores on the body or from the mouth1 when the moist patches exist there4 ,it is possible for a child to inherit syphilis from the father--when the germs of syphilis are transmitted through the semen of the father at the time of conception--and yet the mother escape the disease4 ,on the other hand1 it is not uncommon for the child to become thus infected and infect its mother while in her womb2 or the mother may receive syphilis from the husband after conception1 and the child become infected in the womb4 ,the chief social danger of syphilis comes from its introduction into marriage and its morbid radiations through family and social life4 ,probably one in every five cases of syphilis in women is communicated by the husband in the marriage relation4 ,there are so many sources and modes of its contagion that it is spread from one person to another in the ordinary relations of family and social life--from husband to wife and child1 from child to nurse1 and to other members of the family1 so that small epidemics of syphilis may be traced to its introduction into a family4 ,syphilis is the only disease which is transmitted in full virulence to the offspring1 and its effect is simply murderous4 ,as seen above1 from sixty to eighty per cent of all children die before or soon after birth4 ,one-third of those born alive die within the next six months1 and those that finally survive are blighted in their development1 both physical and mental1 and affected with various organic defects and deformities which unfit them for the battle of life4 ,syphilis has come to be recognized as one of the most powerful factors in the depopulation and degeneration of the race4 ,,involuntary ,,passage ,,of ,,urine--,,bed-,,wetting ,,in ,,children4--7,incontinence of ,urine74--,this refers to an escape of urine from the bladder uncontrolled by the will4 ,it naturally occurs in infants under thirty months1 or thereabouts1 and in the very old1 and in connection with various diseases4 ,it may be due to disease of the brain1 as in idiocy or insanity1 apoplexy1 or unconscious states4 ,injuries or disorders of the spinal cord1 which controls the action of the bladder 7subject to the brain71 also cause incontinence4 ,local disorders of the urinary organs are more frequent causes of the trouble1 as inflammation of any part of the urinary tract1 diabetes1 nephritis1 stone in the bladder1 tumors1 and malformations4 ,the involuntary passage of urine may arise from irritability of bladder--the most frequent cause--or from weakness of the muscles which restrain the escape of urine1 or from obstruction to flow of urine from the bladder1 with overflow when it becomes distended4 ,it is a very common disorder of children and young persons1 and in some cases no cause can be found2 but in many instances it is due to masturbation 7p4 #aic71 to a narrow foreskin and small aperture at the exit of the urinary passage1 to worms in the bowels or disease of the lower end of the bowels1 such as fissure or eczema1 to digestive disorders1 to retaining the urine overlong1 to fright1 to dream impressions 7dreaming of the act of urination71 and to great weakness brought on by fevers or other diseases4 ,in old men it is often due to an enlargement of a gland at the neck of the bladder which prevents the bladder from closing properly4 ,a concentrated and irritating urine1 from excessive acidity or alkalinity1 may induce incontinence4 ,children may recover from it as they approach adult life1 but they should not be punished1 as it is a disease and not a fault4 ,exception should be made in case children wet their clothing during play1 through failure to take the time and trouble to pass water naturally4 ,it is more common among children at night1 leading to wetting of the bed1 but may occur in the day1 and often improves in the spring and summer1 only to return with the cold weather4 ,children who sleep very soundly are more apt to be subject to this disorder4 ,treatment4--,in the case of a disorder depending upon one of so many conditions it will be realized that it would be folly for the layman to attempt to treat it4 ,children who are weak need building up in every possible way1 as by an outdoor life1 cold sponging daily1 etc4 ,if there is in boys a long foreskin1 or tight foreskin1 hindering the escape of urine and natural secretions of this part1 circumcision may be performed to advantage by the surgeon1 even in the infant a few months old4 ,sometimes a simpler operation1 consisting of stretching or overdistending the foreskin1 can be done4 ,a somewhat corresponding condition in girls occasionally causes bed-wetting and other troubles4 ,it can be discovered by a physician4 ,children who wet their beds1 or clothes1 should not drink liquid after five in the afternoon1 and should be taken up frequently during the night to pass water4 ,the bed covering must be light1 and they should be prevented from lying on the back while asleep by wearing a towel knotted in the small part of the back4 ,elevation of the foot of the bed a few inches is recommended as having a corrective influence4 ,masturbation1 if present1 must be corrected4 ,it is a very difficult disorder to treat1 and physicians must be excused for failures even after every attempt has been made to discover and remove the cause4 ,even when cure seems assured1 the disorder may recur4 ,,inflammation ,,of ,,the ,,bladder 7,cystitis74--,the condition which we describe under this head commonly causes frequent painful urination4 ,primarily there is usually some agency which mechanically or chemically irritates the bladder1 and if the irritation does not subside1 inflammation follows owing to the entrance of germs in some manner4 ,the introduction into the bladder of unboiled1 and therefore unclean1 instruments is a cause2 another cause is failure to pass urine for a long period1 from a feeling of delicacy in some persons when in unfavorable surroundings4 ,nervous spasm of the urinary passage from pain1 injuries1 and surgical operations constitutes another cause4 ,inflammation may extend from neighboring parts and attack the bladder1 as in gonorrhea1 and in various inflammations of the sexual organs of women1 as in childbed infection4 ,certain foods1 waters1 and drinks1 as alcohol in large amounts1 and drugs1 as turpentine or cantharides applied externally or given internally1 may lead to irritation of the bladder4 ,exposure to cold in susceptible persons is frequently a source of cystitis1 as well as external blows and injuries4 ,the foregoing causes are apt to bring on sudden or acute attacks of bladder trouble1 but often the disease comes on slowly and is continuous or chronic4 ,among the causes of chronic cystitis1 in men over fifty1 is obstruction to the outflow of urine from enlargement of the prostate gland1 which blocks the exit from the bladder4 ,in young men1 narrowing of the urethra1 a sequel to gonorrhea1 may also cause cystitis2 also stone in the bladder or foreign bodies1 tumors growing in the bladder1 tuberculosis of the organ4 ,paralysis of the bladder1 which renders the organ incapable of emptying itself1 thus retaining some fermenting urine1 is another cause of bladder inflammation4 ,symptoms4--,the combination of frequency of and pain during urination1 with the appearance of blood or white cloudiness and sediment in the urine1 are evidences of the existence of inflammation of the bladder4 ,the trouble is aggravated by standing1 jolting1 or active exercise4 ,the pain may be felt either at the beginning or end of urination4 ,there is also generally a feeling of weight and heaviness low down in the belly1 or about the lower part of the bowel4 ,blood is not frequently present1 but the urine is not clear1 if there is much inflammation1 but deposits a white and often slimy sediment on standing4 ,in chronic inflammation of the bladder the urine often has a foul odor and smells of ammonia4 ,treatment4--,the treatment of acute cystitis consists in rest--preferably on the back1 with the legs drawn up1 in bed4 ,the diet should be chiefly fluid1 as milk and pure water1 flaxseed tea1 or mineral waters4 ,potassium citrate1 fifteen grains1 and sweet spirit of nitre1 fifteen drops1 may be given in water to advantage three times daily4 ,hot full baths or sitz baths two or three times a day1 and in women hot vaginal douches 7that is1 injections into the front passage71 with hot poultices or the hot-water bag over the lower part of the abdomen1 will serve to relieve the suffering4 ,if1 however1 the pain and frequency attending urination is considerable1 nothing is so efficient as a suppository containing one-quarter grain each of morphine sulphate and belladonna extract1 which should be introduced into the bowel and repeated once in three hours if necessary4 ,this treatment should be employed only under the advice of a physician4 ,in chronic cystitis1 urotropin in five-grain doses dissolved in a glass of water and taken four times daily often affords great relief1 but these cases demand careful study by a physician to determine their cause1 and often local treatment4 ,avoidance of all source of irritation is also essential in these cases1 as sexual excitement and the use of alcohol and spices4 ,the diet should consist chiefly of cereals and vegetables1 with an abundance of milk and water4 ,the bowels should be kept loose by means of hot rectal injections in acute cystitis4 ,,retention1 ,,stoppage1 ,,or ,,suppression ,,of ,,urine4--,retention refers to that condition where the urine has been accumulating in the bladder for a considerable time--over twelve hours--and cannot be passed4 ,it may follow an obstruction from disease1 to which is added temporary swelling and nervous contraction of some part of the urinary passage2 or it may be due to spasm and closure of the outlet from nervous irritation1 as in the cases of injuries and surgical operations in the vicinity of the sexual organs1 the rectum1 or in other parts of the body4 ,overdistention of the bladder from failure to pass water for a long time may lead to a condition where urination becomes an impossibility4 ,various general diseases1 as severe fevers1 and conditions of unconsciousness1 and other disorders of the nervous system1 are frequently accompanied by retention of urine4 ,in retention of urine there is often an escape of a little urine from time to time1 and not necessarily entire absence of outflow4 ,treatment4--,retention of urine is a serious condition4 ,if not relieved1 it may end in death from toxaemia1 caused by back pressure on the kidneys1 or from rupture of the bladder4 ,therefore surgical assistance is demanded as soon as it can be obtained4 ,failing this1 begin with the simpler methods4 ,a hot sitz bath1 or1 if the patient cannot move1 hot applications1 as a hot poultice or hot cloths applied over the lower part of the belly1 may afford relief4 ,injections of hot water into the bowel are often more efficient still4 ,a single full dose of opium in some form1 as fifteen drops of laudanum#aj or two teaspoonfuls of paregoric#aj or one-quarter grain of morphine1#aj will frequently allow of a free passage of urine4 ,the introduction of a suppository into the bowel1 containing one-quarter grain each of morphine sulphate1#aj and belladonna extract1 is often preferable to giving the drug by the mouth4 ,these measures proving of no avail1 the next endeavor should be to pass a catheter4 ,if a soft rubber or elastic catheter is used with reasonable care1 little damage can be done1 even by a novice4 ,the catheter should be boiled in water for ten minutes1 and after washing his hands thoroughly the attendant should anoint the catheter with sweet oil 7which has been boiled7 or clean vaseline and proceed to introduce the catheter slowly into the urinary passage until the urine begins to flow out through the instrument4 ,a medium-sized catheter is most generally suitable1 as a ,no4 #af of the ,french scale1 or a ,no4 #h-a_/b of the ,english scale4 ,,brights ,,disease ,,of ,,the ,,kidneys4--,bright's disease of the kidneys is acute or chronic1 and its presence can be definitely determined only by chemical and microscopical examination of the urine4 ,acute ,bright's disease coming on in persons previously well may often1 however1 present certain symptoms by which its existence may be suspected even by the layman4 ,,acute ,,bright',s ,,disease2 ,,acute ,,inflammation ,,of ,,the ,,kidneys4--,acute ,bright's disease is often the result of exposure to cold and wet4 ,inflammation of the kidneys may be produced by swallowing turpentine1 many of the cheap flavoring extracts in large amounts1 carbolic acid1 and ,spanish flies2 the external use of large quantities of turpentine1 carbolic acid1 or ,spanish flies may also lead to acute inflammation of the kidneys4 ,it occurs occasionally in pregnant women4 ,the contagious germ diseases are very frequently the source of acute ,bright's disease either as a complication or sequel4 ,thus scarlet fever is the most frequent cause1 but measles1 smallpox1 chickenpox1 yellow fever1 typhoid fever1 erysipelas1 diphtheria1 cholera1 and malaria are also causative factors4 ,symptoms4--,acute ,bright's disease may develop suddenly with pallor and puffiness of the face owing to dropsy4 ,the eyelids1 ankles1 legs1 and lower part of the belly are apt to show the dropsy most4 ,there may be nausea1 vomiting1 pain and lameness in the small part of the back1 chills and fever1 loss of appetite1 and often constipation4 ,in children convulsions sometimes appear4 ,the urine is small in amount1 perhaps not more than a cupful in twenty-four hours1 instead of the normal daily excretion of three pints4 ,occasionally complete suppression of urine occurs4 ,it is high-colored1 either smoky or of a porter color1 or sometimes a dark or even bright red1 from the pressure of blood4 ,stupor and unconsciousness may supervene in severe cases4 ,recovery usually occurs1 in favorable cases1 within a few weeks1 with gradually diminishing dropsy and increasing secretion of urine1 or the disease may end in a chronic disorder of the kidneys4 ,if acute ,bright's disease is caused by1 or complicated with1 other diseases1 the probable result becomes much more difficult to predict4 ,treatment4--,the failure of the kidneys to perform their usual function of eliminating waste matter from the blood makes it necessary for the skin and bowels to do double duty4 ,the patient should remain in bed and be kept very warm with flannel night clothes and blankets next the body4 ,the diet should consist wholly of milk1 a glass every two hours1 in those with whom it agrees1 and in others gruels may be substituted to some extent4 ,the addition to milk of mineral waters1 limewater1 small amounts of tea1 coffee1 or salt often makes it more palatable to those otherwise disliking it4 ,as the patient improves1 bread and butter1 green and juicy vegetables1 and fruits may be permitted4 ,an abundance of pure water is always desirable4 ,the bowels should be kept loose from the outset by salts given in as little water as possible and immediately followed by a glass of pure water4 ,a teaspoonful may be given hourly till the bowels move4 ,epsom or ,glauber's salts are efficient1 but the compound jalap powder is the best purgative4 ,children1 or those to whom these remedies are repugnant1 may take the solution of citrate of magnesia1 of which the dose is one-half to a whole bottle for adults4 ,the skin is stimulated by the patient's lying in a hot bath for twenty minutes each day or1 if this is not possible1 by wrapping the patient in a blanket wrung out of hot water and covered by a dry blanket1 and then by a rubber or waterproof sheet1 and he is allowed to remain in it for an hour with a cold cloth to the head4 ,if the patient takes the hot bath he should be immediately wrapped in warmed blankets on leaving it1 and receive a hot drink of lemonade to stimulate sweating4 ,for treatment of convulsions1 see ,vol4 ,i1 p4 #ahh4 ,vomiting is allayed by swallowing cracked ice1 single doses of bismuth subnitrate 7one-quarter teaspoonful7 once in three hours1 and by heat applied externally over the stomach4 ,recovery is hastened by avoiding cold and damp1 and persisting with a liquid diet for a considerable period4 ,a course of iron is usually desirable after a few weeks have elapsed to improve the quality of the blood2 ten drops of the tincture of the chloride of iron taken in water through a glass tube by adults2 for children five to ten drops of the syrup of the iodide of iron4 ,in either case the medicine should be taken three times daily after meals4 ,,chronic ,,bright',s ,,disease4--,this includes several forms of kidney disease4 ,the symptoms are often very obscure1 and the condition may not be discovered or suspected by the physician until an examination of the urine is made1 which should always be done in any case of serious or obscure disorder4 ,accidental discovery of ,bright's disease during examination for life insurance is not rare4 ,the disease may exist for years without serious impairment resulting4 ,causes4--,chronic ,bright's disease often follows and is the result of fevers and acute inflammation of the kidneys4 ,it is more common in adults4 ,overeating1 more especially of meat1 and overdrinking of alcohol are frequent causes4 ,gout is a frequent factor in its causation4 ,the disease has in the past been regarded as a local disease of the kidneys1 but recent research makes it probable that there is a general disorder of the system due to some faulty assimilation of food--especially when the diet itself is faulty--with the production of chemical products which damage various organs in the body as well as the kidneys1 notably the heart and blood vessels4 ,symptoms4--,the symptoms are most diverse and varied and it is not possible to be sure of the existence of the disease without a careful physical examination1 together with a complete examination of the urine1 both made by a competent physician4 ,patients may be afflicted with the disease for long periods without any symptoms until some sudden complication calls attention to the underlying trouble4 ,symptoms suggesting chronic ,bright's disease are among the following3 indigestion1 diarrhea and vomiting1 frequent headache1 shortness of breath1 weakness1 paleness1 puffiness of the eyelids1 swelling of the feet in the morning1 dropsy1 failure of eyesight1 and nosebleed1 and sometimes apoplexy4 ,as the disease comes on slowly the patient has usually time to apply for medical aid1 and attention is called to the foregoing symptoms merely to emphasize the importance of attending to such in due season4 ,outcome4--,while the outlook as to complete recovery is very discouraging1 yet persons may live and be able to work for years in comparative comfort in many cases4 ,when a physician pronounces the verdict of chronic ,bright's disease1 it is not by any means equivalent to a death warrant1 but the condition is often compatible with many years of usefulness and freedom from serious suffering4 ,treatment4--,medicines will no more cure ,bright's disease than old age4 ,out-of-door life in a dry1 warm1 and equable climate has the most favorable influence upon the cause of chronic ,bright's disease1 and should always be recommended as a remedial agent when available4 ,proper diet is of great importance4 ,cereals1 vegetables1 an abundance of fat in the form of butter and cream--to the amount of a pint or so a day of the latter1 and the avoidance of alcohol and meat1 fish and eggs constitute the ideal regimen when this can be carried out4 ,tea and coffee in much moderation are usually allowable and water in abundance4 ,the underclothing should be of wool the year round1 and especial care is essential to avoid chilling of the surface4 ,medicines have their usefulness to relieve special conditions1 but should only be taken at the advice of a physician1 whose services should always be secured when available4 ,part ,,iv ,,disease ,,and ,,disorder ,,of ,,the ,,mind ,,by ,,albert ,,warren ,,ferris ,,chapter ,i ,insanity ,insanity is the name given to a collection of symptoms of disease of the brain or disorder of brain nutrition or circulation4 ,the principal test of insanity lies in the adjustment of the patient to his surroundings1 as evidenced in conduct and speech4 ,yet one must not include within the field of insanity the improper conduct and speech of the vicious1 nor of the mentally defective4 ,crime is not insanity1 though there are undoubtedly some insane people confined in prisons who have been arrested because of the commission of crime4 ,then1 too1 while mental defect may exist in the insane1 there is a certain class of mental defectives whose condition is due not to disease of the brain1 but to arrest of development of the brain during childhood or youth1 and these we call idiots or imbeciles2 but they are not classed with the insane4 ,mental ,disorder ,not ,insanity ,we frequently hear repeated the assertion1 ,everybody is a little insane1 and the quotation is reported as coming from an expert in insanity4 ,this quotation is untrue4 ,the fact is that anyone is liable to mental disorder2 but mental disorder is not insanity4 ,to illustrate3 a green glove is shown to a certain man and he asserts that its color is brown1 and you cannot prove to him that he is wrong1 because he is color-blind4 ,green and brown appear alike to him4 ,this is mental disorder1 but not insanity4 ,again1 a friend will explain to you how he can make a large profit by investing his money in a certain way4 ,he does so invest it and loses it1 because he has overlooked certain factors1 has not given proper weight to certain influences1 and has ignored probable occurrences1 all of which were apparent to you4 ,he was a victim of his mental disorder1 his judgment1 reason1 and conception being faulty2 yet he was not insane4 ,again1 you answer a letter from a correspondent1 copying on the envelope the address you read at the head of his letter4 ,a few days later your answer is returned to you undelivered4 ,in astonishment1 you refer to his letter and find that you have misread the address he gave1 mistaking the number of his house4 ,this was an instance of mental disorder in your not reading the figure aright2 but it was not insanity4 ,what ,autopsies of the ,brain ,reveal ,the changes in the brain accompanying or resulting from disease1 as found in some chronic cases of insanity in which autopsies are made1 consist largely in alteration of the nerve cells of the brain4 ,the cells are smaller and fewer than they should be1 they are altered in shape1 and their threads of communication with other cells are broken4 ,nerve cells and often large areas of gray matter are replaced by connective tissue 7resembling scar tissue71 which grows and increases in what would otherwise be vacant spaces4 ,all areas which contain this connective tissue1 this filling which has no function1 of course1 cease to join with other parts of the brain in concerted action1 and so the power of the brain is diminished1 and certain of its activities are restricted or abolished4 ,curious ,illusions of the ,insane ,in the normal brain certain impressions are received from the special senses3 impressions of sight or of hearing1 for example4 ,these impressions are called conscious perceptions1 and the healthy brain groups them together and forms concepts4 ,for instance1 you see something which is flat and shiny with square-cut edges4 ,you touch it1 and learn that it is cold1 smooth1 and hard4 ,lift it and you find it heavy4 ,grouping together your sense perceptions you form the concept1 and decide that the object is a piece of marble4 ,again1 you enter a dimly lighted room and see a figure in a corner the height of a woman1 with a gown like a woman's4 ,you approach it1 speak to it and get no reply1 and you find you can walk directly through it1 for it is a shadow4 ,perhaps you were frightened4 ,perhaps you imagined she was a thief4 ,your first judgment was wrong and you correct it4 ,the insane person1 however1 has defective mental processes4 ,he cannot group together his perceptions and form proper conceptions4 ,his imagination runs riot4 ,his emotions of fear or anger are not easily limited4 ,he has to some extent lost the control over his mental actions that you and other people possess if your brains are normal4 ,the insane man will insist that there is a woman there1 and not a shadow1 and to his mind it is not absurd to walk directly through this person4 ,he cannot correct the wrong idea4 ,such a wrongly interpreted sense perception is called an illusion4 ,another example of illusion is the mistaking the whistle of a locomotive for the shriek of a pursuing assassin4 ,what ,hallucinations ,are ,the insane man may also suffer from hallucinations4 ,a hallucination is a false perception arising without external sensory experience4 ,in a hallucination of sight1 the disease in the brain causes irritation to be carried to the sight-centers of the brain1 with a result that is similar to the impression carried to the same centers by the optic nerves when light is reflected into the eyes from some object4 ,an insane man may be deluded with the belief that he sees a face against the wall where there is nothing at all4 ,when the air is pure and sweet and no odor is discoverable1 he may smell feathers burning1 and thus reveal his hallucination of smell4 ,delusions ,common to ,insanity ,the insane man may have wrong ideas without logical reason for them4 ,thus1 an insane man may declare that a beautiful actress is in love with him1 when there is absolutely no foundation for such an idea4 ,or1 he may believe that he can lift #ejj pounds and run faster than a locomotive can go1 while in reality he is so feeble as scarcely to be able to walk1 and unable to dress himself4 ,such ideas are delusions4 ,sane people may be mistaken2 they may have hallucinations1 illusions and delusions2 but they abandon their mistaken notions and correct their judgment at once1 on being shown their errors4 ,sane people see the force of logical argument1 and act upon it1 abandoning all irrational ideas4 ,the insane person1 on the other hand1 cannot see the force of logical argument2 cannot realize the absurdity or impossibility of error4 ,he clings to his own beliefs1 for the evidence of his perverted senses or the deductions from his disease-irritation are very real to him4 ,when we find this to be the fact we know he is insane4 ,yet we must not confound delirium of fever with insanity4 ,a patient suffering from typhoid fever may have a delusion that there is a pail by his bed into which he persists in throwing articles4 ,or he may have the hallucination that he is being called into the next room1 and try to obey the supposed voice4 ,certain delusions are commonly found in certain types of insanity4 ,depressed patients frequently manifest the delusion that they have committed a great sin1 and are unfit to associate with anyone4 ,excited and maniacal patients often believe they are important personages--kings or queens1 old historical celebrities1 etc4 ,paranoiacs commonly have delusions of persecution and of a conspiracy among their relatives or their associates or rivals4 ,victims of alcoholic insanity have delusions regarding sexual matters1 and generally charge with infidelity those to whom they are married4 ,general paretics in most cases have delusions of grandeur2 that is1 false ideas of great strength1 wealth1 political power1 beauty1 etc4 ,the emotion which accompanies mental activity is generally exaggerated in all insane people except the demented4 ,one sees extreme depression1 or undue elation and exaltation1 or silly glee and absurd joy4 ,intensity of emotion is frequent4 ,crimes ,impulsively ,committed by the ,insane ,an interesting mental feature of many insane patients is the imperative conception1 or imperative impulse4 ,this is a strong urging felt by the patient to commit a certain act4 ,he may know the act is wrong and dread the punishment which he expects will follow its commission4 ,but so constantly and strongly is he impelled that he finally yields and commits the act4 ,crimes are thus perpetrated by the insane1 with a full knowledge of their enormity4 ,the fact that such impulses undoubtedly exist should modify the common test1 as to an insane person's responsibility before the law4 ,the statute in many countries regards an insane criminal as responsible for his act1 if he knows the difference between right and wrong4 ,this decision is unjust and the basis is wrong2 for an impulse may be overwhelming1 and the patient utterly helpless during its continuance4 ,however1 a patient who has committed a crime under stress of such an irresistible impulse should be put under permanent custodial care4 ,physical ,signs of ,insanity ,the physician who is skilled in psychiatry finds in very many insane patients marked physical signs4 ,there are pains1 insensitive areas1 hypersensitive areas1 changes in the pupils of the eyes1 unrestrained reflex action1 and partial loss of muscular control1 as shown in talking1 walking1 and writing4 ,constipation and insomnia are very early symptoms of disease in a very large proportion of the insane4 ,it is productive of no good result for a layman to try to classify the insane4 ,the matter of classification will be for several years in a condition of developmental change4 ,it is enough to speak of the patient as depressed or excited1 agitated or stupid1 talkative or mute1 homicidal1 suicidal1 neglectful1 uncleanly in personal habits1 etc4 ,illustrations of ,various ,types ,there are very interesting features connected with typical instances of several varieties of insanity1 as they were noted in certain cases under the writer's care4 ,a depressed patient with suicidal tendencies cherished the delusion that war with ,great ,britain was imminent1 and that in such an event ,british troops would be landed on ,long ,island between ,new ,york ,city and the spot where he conceived the cattle to be kept4 ,this1 he argued1 would cut off the beef and milk supply from the city4 ,he therefore decided to do his part toward husbanding the present supply of food by refusing to eat2 an act which necessitated feeding him through a rubber tube for many weeks4 ,he also attempted suicide by drowning1 throwing himself face downward in a shallow swamp1 whence he was rescued4 ,this young man was an expert chess player even during his attack4 ,a maniacal patient wore on her head a tent of newspaper to keep the devil from coming through the ceiling and attacking her4 ,she frequently heard her husband running about the upper floor with the devil on his back4 ,as a further precaution she stained her gray hair red with pickled beet juice1 and would occasionally hurl loose furniture at the walls and ceilings of her rooms and assault all who approached her4 ,a man who presented a case of dementia pulled the hairs from his beard and planted them in rows in the garden1 watering them daily1 and showing much astonishment that they did not grow4 ,he spent hours each day in spelling words backward and forward1 and also by repeating their letters in the order in which they appear in the alphabet4 ,when he wanted funds he signed yellow fallen leaves with a needle1 and they turned into money4 ,a case of general paresis 7commonly though improperly called softening of the brain7 passed into the second stage as a delusion was uppermost to the effect that there was opium everywhere2 opium in his hat1 opium in his newspaper1 opium in his bath sponge1 opium in his food4 ,he thereupon refused to eat1 and was fed with a tube for two years1 at the end of which time he resumed natural methods of nutrition and ate voraciously4 ,another general paretic promised to his physician such gifts as an ivory vest with diamond buttons1 boasted of his great strength while scarcely able to walk alone1 and declared he was a celebrated vocalist1 while his lips and tongue were so tremulous he could scarcely articulate4 ,fixed ,delusions of ,paranoia ,paranoia is an infrequent variety of insanity in which the patient is dominated by certain fixed delusions1 while for a long time his intellect is but slightly impaired4 ,the delusions are usually persecutory1 and the patient alleges a conspiracy4 ,he is generally deluded with the belief that he is a prominent person in history1 or an ,old ,testament worthy1 and there is usually a religious tinge to his delusions4 ,a patient of the writer believed himself to be the reincarnation of ,christ1 appearing as the ,christ of the ,jews and the ,christ of the ,christians in one4 ,over the head of his landlord1 who requested overdue rent1 the patient fired a revolver1 to show that the reign of peace had begun in the world4 ,he wrote a new bible for his followers1 and arranged for a triumphal procession headed by his brother and himself on horseback1 wearing white stars4 ,how the ,physician ,should ,be ,aided ,when there is a suspicion of irrationality in a person's conduct1 and certain acts or speeches suggest insanity1 the whole surroundings and the past life must be considered4 ,frequently when the eyes are once opened to the fact of insanity1 a whole chapter of corroborating peculiarities can be recalled4 ,it is wise to recall as many of these circumstances as possible and note them in order as they occurred1 for the use of the physician4 ,strikingly eccentric letters should be saved4 ,odd arrangement of clothes1 or the collecting of useless articles1 should be noted in writing4 ,changes in character1 alteration in ideas of propriety1 changes in disposition1 business or social habits1 and great variation in the bodily health should be noted in writing4 ,delusions1 hallucinations1 and illusions should be reported in full4 ,it conveys nothing to anyone's mind to say that the patient is queer2 tell what he does or says that leads you to think he is queer1 and let the physician draw his own inferences from the deeds or speeches4 ,write down1 for example1 that the patient talks as if answering voices that are imaginary2 or that the patient brought an ax into the dining room and stood it against the table during the meal2 or that he paraded up and down the lawn with a wreath of willow branches about his neck2 in each case stating the actual fact4 ,it is important to ascertain exactly what the patient's habits are1 as to the use of alcoholic beverages1 tobacco1 and drugs 7such as opium71 and also as to sexual matters4 ,to secure such information is extremely difficult1 and the help of a close friend or companion will be necessary4 ,after the mind begins to waver many a patient plunges into dissipation1 though formerly a model of propriety4 ,the ,causes of ,insanity ,the two great causes of insanity are heredity and stress or strain4 ,lunacy is not infrequent in children of epileptic1 alcoholic1 or insane parents1 and those born of parents suffering from nervous disease frequently are in such condition that shock1 intense emotion1 dissipation1 or exhausting diseases render them insane4 ,drinking alcoholic beverages is the most potent factor in the production of insanity4 ,mental strain1 overwork1 and worry come next4 ,adverse conditions1 bereavement1 business troubles1 etc41 rank third1 equally with heredity4 ,the arterial diseases of old age1 epilepsy1 childbirth 7generally in the neurotic71 change of life1 fright and nervous shock1 venereal diseases1 sexual excesses or irregularities follow in the order named4 ,a ,temperate1 ,virtuous ,life the ,best ,preventive ,to avoid insanity1 therefore1 one should lead a righteous1 industrious1 sensible life1 preserve as much equanimity as possible1 and be content with moderate pleasure and moderate success4 ,in many cases1 people who are neurotic from early youth are so placed that unusual demands are made upon them4 ,adversity brings necessity for overwork1 duties are manifold1 and responsibilities are heavy4 ,in ignorance of the fact that they are on dangerous ground and driven by circumstances1 they overwork1 cut short their sleep1 and1 conscientiously pressing on1 finally lose their mental balance and insanity is the result1 a great calamity which is really no fault of theirs4 ,undoubtedly such is frequently the sad history2 and for this reason1 as well as for the general reason that the insane are simply ill1 all insane should be cared for sympathetically4 ,to consider the insane as constantly malevolent is a relic of the old-time1 absurd belief that insane people were possessed of the devil4 ,it is no disgrace to be insane1 and the feeling of chagrin at discovering disease of the brain in a relative is another absurdity4 ,avoidance of insanity should be studied with as much devotion as avoidance of tuberculosis4 ,yet there should be no detraction from the fact that the heredity is strong4 ,no one should be allowed to marry who has been insane1 for the offspring of the insane are defective4 ,the tendency of the times is toward nervous and mental disorder4 ,in the large cities the strain is too constant1 the struggle is too keen1 the pace is too swift4 ,haste to be rich1 desire to appear rich1 or ambition for social distinction has wrecked many a bright1 strong intellect4 ,this is the age of the greatest luxury the world has ever seen1 and a large proportion of people in cities are living beyond their means1 in the gratification of luxurious desires or the effort to appear as well as others4 ,stress and strain are voluntarily invited4 ,children are pushed in their studies and overloaded with too many subjects4 ,genius and insanity1 worry and dementia1 proceed among us hand in hand2 the overwrought brain finally totters4 ,false ,ideas ,regarding ,insanity ,curious ideas regarding insanity are common1 and are apparently fostered by the reportorial writers of the daily papers4 ,we read of people who are insane on a subject4 ,this is an impossibility4 ,many people can be drawn out and led into a betrayal of their mental condition only when a certain topic or idea is discussed4 ,but although exhibiting their insane condition only when this topic is broached1 they are in no respect sane4 ,not every act of an insane man is an insane act1 we must remember4 ,forgetfulness of this fact leads to errors in the superficial4 ,you will hear people say that a certain person must be sane1 because during a half day's companionship nothing astray was noticed4 ,true1 there may be a long period of self-control1 or of absence of test2 but occasional conduct will establish the fact of constant insanity4 ,again1 we hear the expression3 ,he cannot be insane2 there is too much method in such madness4 ,the answer to this silly remark is that there is method in all madness except some epileptic insanity and terminal dementia4 ,insane people prepare careful plans1 with all the details thoroughly considered1 and perfect methods to escape from hospitals with the greatest cunning4 ,one must never take it for granted that the insane person is so demented mentally as to be unable to appreciate what is said and done4 ,one should never talk about the insane man in his presence1 but should include him in the conversation as if sane1 as a general rule1 allaying his suspicions and avoiding antagonism4 ,do not agree with the delusions of an insane person1 except so far as may be necessary to draw them out4 ,yet avoid argument over them4 ,simply do not agree1 and do not strengthen them by appearing to share them4 ,his food should be prepared for him1 and his medicines administered to him as to any other sick person4 ,his baths should be regularly taken4 ,a depressed patient should be very carefully watched4 ,if the slightest suspicion of a suicidal impulse be present1 the patient should never be left alone4 ,many a valuable life has been saved through the moral support of constant companionship2 while we read very frequently of the death of an insane patient who sprang from a window during a brief period of relaxation of watchful care4 ,some people think it a protection to one insane to elicit from him a promise not to be depressed1 and not to do anything wrong4 ,one might as well secure a promise not to have a rise of temperature4 ,the gloom of despondency and the suicidal impulse are as powerful as they are unwelcome and unsought2 and the wretchedly unhappy patient cannot alone meet the issue and resist4 ,it is unreasonable to be offended by acts or speeches of an insane patient1 to bear a grudge or expect an apology4 ,very frequently such a patient will turn savagely upon the nearest and dearest1 and make cutting remarks and accusations or exhibit baseless contempt4 ,all this conduct must be ignored and forgotten2 for the unkind words of an unaccountable and really ill person should not be taken at all seriously4 ,should a patient escape from home1 it is the duty of the one in charge without hesitation to overtake him1 and then accompany him or at least follow at a short distance4 ,the nurse should go with and stay with the patient1 telephoning or telegraphing home when opportunity offers1 and finally securing aid2 he should know where the patient is at all times1 foregoing sleep if necessary to protect his charge1 and should avoid as long as prudence permits the publicity of an arrest2 though the latter may finally be essential to safety1 and to the prevention of embarking on a voyage1 or taking a train to a distance1 or purchasing weapons4 ,diversions4--,music favorably affects many patients1 so the pleasure of listening to it should be afforded at frequent intervals4 ,patients should be encouraged to absorb themselves in it4 ,it is often possible to take insane people to opera1 musical comedy1 or concert4 ,vocal and instrumental practice at suitable intervals is of great value in fixing the attention1 filling the mind with desirable thoughts and memories1 and allaying irritability4 ,drawing and painting are of service when within the number of the patient's accomplishments4 ,intellectual pastimes1 as authors1 anagrams1 billiards1 chess1 and many games with playing cards1 are generally helpful4 ,gardening1 croquet1 and tennis are very desirable4 ,golf1 rowing1 swimming1 and skating are excellent1 but are within the reach of very few insane patients4 ,all regular occupation that necessitates attention and concentration is of supreme value2 in fact1 insane patients not infrequently ask for occupation and find relief in the accomplishment of something useful1 as well as in the healthful sleep and increased appetite that attend judicious physical fatigue4 ,the ,beneficial ,atmosphere of ,sanitariums ,after caring for an insane patient for a time at home1 the question arises as to the desirability of sending him away to a sanitarium4 ,generally this is a wise course to pursue4 ,the constant association with an insane person is undermining2 the responsibility is often too heavy2 children1 often inheriting the same neurotic tendency and always impressionable1 should not be exposed to the perverting influence2 it may not be safe to keep a patient with suicidal or homicidal impulses in his home2 the surroundings amid which the insane ideas first started may tend to continue a suggestion of these ideas4 ,removal to strange locality and new scenes1 the influence of strangers1 the abandonment of all responsibilities and duties1 and the atmosphere of obedience1 routine1 and discipline are all beneficial4 ,an insane person will generally make a greater effort for a stranger than for a familiar relative4 ,discipline1 in the form of orders of the physicians1 and exact obedience is very often very salutary4 ,there is a feeling with some that all discipline is cruel4 ,this is not so1 for the conduct of an insane person is not all insane1 but frequently needs correction4 ,many cases of mental alienation improve promptly under custodial care1 many need it all their lives4 ,a great many cases of insanity are never obliged to go away from home1 and there is a considerable number who carry on a business while still insane1 rear a family1 and take care of themselves4 ,in general1 a depressed patient should be kept at home as long as there is absolute safety in so doing4 ,most other forms of mental disease progress more rapidly toward recovery in sanitariums or hospitals equipped for such patients4 ,prospects of recovery are never jeopardized by confinement in a proper institution4 ,mental and physical rest1 quiet1 regularity of eating1 exercising1 and sleeping are the essentials which underlie all successful treatment of these cases4 ,dietetics1 diversion by means of games1 music1 etc41 regular occupation of any practicable sort1 together with the association with the hopeful1 tactful1 and reasoning minds of physicians and nurses trained for this purpose are of great value4 ,it must be remembered that in wholly civilized localities madhouses have been replaced by hospitals1 keepers have been replaced by nurses and attendants1 and the old methods of punishment and coercion have been long since abandoned1 in the light of modern compassionate custody4 ,certain forms of insanity are hopeless from the start4 ,few recover after two years of mental aberration4 ,omitting the hopeless cases1 over forty per cent of the cases of insanity recover4 ,about sixty per cent recover of the cases classed as melancholia and mania4 ,most recoveries occur during the first year of the disease2 but depressed patients may emerge and recover after several years' treatment4 ,,footnotes3 #aj ,caution4 ,dangerous4 ,use only on physician's order4 ,,appendix ,patent ,medicines#aa ,the term patent medicine is loosely used to designate all remedies of a secret1 non-secret1 or proprietary character1 which are widely advertised to the public4 ,this use of the name is erroneous1 and it is better first to understand the exact difference between the different classes of medicines generally comprised under this heading4 ,only in this way can one comprehend their right and wrong use4 ,a ,patent ,medicine is a remedy which is patented4 ,in order to secure this patent1 an exact statement of the ingredients and the mode of manufacture must be filed with the government4 ,these true patent medicines are generally artificial products of chemical manufacture1 such as phenacetin4 ,the very fact of their being patented makes them non-secret1 and if an intelligent idea is held of their nature and mode of action1 they may be properly used4 ,physicians with a full knowledge of their uses1 limitations1 and dangers often1 and legitimately1 prescribe them1 and thus used they are the safest and most useful of all drugs and compounds of this class4 ,a ,nostrum4--,the ,century ,dictionary defines a nostrum as a medicine the ingredients of which1 and the methods of compounding them1 are kept secret for the purpose of restricting the profits of sale to the inventor or proprietor4 ,some nostrums have stated1 on their label1 the names of their ingredients1 but not the amount4 ,there has been no restriction upon their manufacture or sale in this country1 therefore the user has only the manufacturer's statement as to the nature of the medicine and its uses1 and these statements1 in many instances1 have been proved utterly false and unreliable4 ,a ,proprietary ,medicine is a non-secret compound which is marketed under the maker's name4 ,this is usually done because the manufacturer claims some particular merit in his product and its mode of preparation1 and as these drugs are perfectly ethical and largely used by physicians1 it is to the maker's interest to maintain his reputation for the purity and accuracy of the drug4 ,familiar instances of this class are3 ,squibb's ,ether and ,chloroform1 and ,powers ,weightman's ,quinine4 ,from the above definition it may be seen that the only unreliable medicines are those which are1 in reality1 nostrums4 ,in regard to all of these medicines the following rules should be observed3 ,first4--,don't use any remedy that does not show its formula on the label4 ,second4--,no matter what your confidence in the medicine1 or how highly recommended it is1 consult a physician before using very much of it4 ,third4--,take no medicine internally without a physician's advice4 ,throughout this chapter the word patent medicine will be used in its widely accepted form1 in the everyday sense1 without regard to its legal definition1 and will be held to include any of the above-mentioned classes1 unless a direct statement is made to the contrary4 ,in ,germany the contents of patent medicines are commonly published1 and in this country1 notably in ,massachusetts1 the ,state ,boards of ,health are analyzing these preparations1 and making public their findings4 ,in ,north ,dakota a law has been passed which requires that a proprietary medicine containing over five per cent of alcohol1 or any one of a number of specified drugs1 be labeled accordingly4 ,,pure ,,food ,,bill4--,a far-reaching and important step1 in the movement for reform of patent medicines and for the protection of the public1 has now been taken by the ,united ,states ,government4 ,on ,june #cj1 #aijf1 an act was approved forbidding the manufacture1 sale1 or transportation of adulterated1 misbranded1 or poisonous or deleterious foods1 drugs1 medicines1 or liquors4 ,this act regulates interstate commerce in these articles1 and went into effect ,january #a1 #aijg4 ,section #g of this act states3 ,that for the purposes of this ,act an article shall be deemed to be adulterated3 in case of drugs3 ,first4 ,if1 when a drug is sold under or by a name recognized in the ,united ,states ,pharmacopoeia or ,national ,formulary1 it differs from the standard of strength1 quality1 or purity1 as determined by the test laid down in the ,united ,states ,pharmacopoeia or ,national ,formulary official at the time of investigation2 ,provided1 that no drug defined in the ,united ,states ,pharmacopoeia or ,national ,formulary shall be deemed to be adulterated under this provision if the standard of strength1 quality1 or purity be plainly stated upon the bottle1 box or other container thereof although the standard may differ from that determined by the test laid down in the ,united ,states ,pharmacopoeia or ,national ,formulary4 ,second4 ,if its strength or purity fall below the professed standard or quality under which it is sold4 ,section #h states that a drug shall be deemed misbranded3 ,first4 ,if it be an imitation of or offered for sale under the name of another article4 ,second4 ,if it 7the package1 bottle or box7 fails to bear a statement on the label of the quantity or proportion of any alcohol1 morphine1 opium1 cocaine1 heroin1 alpha or beta eucaine1 chloroform1 cannabis indica1 chloral hydrate1 or acetanilid1 or any derivative or preparation of any such substances contained therein4 ,what are the motives which impel persons to buy and use patent medicines8 ,the history of medicine offers a partial explanation4 ,in somewhat remote times we find that the medicines in use by regular physicians were of the most vile1 nauseating1 and powerful nature4 ,we read of purging gently with a teaspoonful of calomel4 ,then during the wonderful progress of scientific medicine1 beginning a little more than a half century ago1 the most illustrious and useful workers were so busily engaged in finding the causes of disease and the changes wrought in the various organs1 in observing the noticeable symptoms and in classifying and diagnosticating them1 that treatment was given but scant attention4 ,this was nowhere more noticeable than in ,germany1 the birthplace1 home1 and world-center of scientific medicine1 to which all the medical profession flocked4 ,patients became simply material which could be watched and studied4 ,this was an exemplary spirit1 but did not suit the patients who wanted to be treated and cured4 ,this fact1 together with the peculiar wording of the laws regulating the practice of medicine1 which allow anyone with the exception of graduates to treat patients1 but not to prescribe or operate upon them1 accounts for the number of quacks in ,germany4 ,dr4 ,jacobi states that there is one quack doctor to every two regular physicians in ,saxony and ,bavaria4#ab ,another cause for the use of patent medicines is mysticism4 ,ignorance is the mother of credulity4 ,it is reported#ac that ,cato1 the elder1 recommended cabbages as a panacea for all sorts of ills1 that he treated dislocations of the limbs by incantations1 and ordered the ,greek physicians out of ,rome4 ,the ignorant are greatly influenced by things that they cannot understand4 ,therefore1 as the mass of people are utterly ignorant of the changes in structure and function of the body caused by disease1 and also the limitations of medicines in their power of healing such alterations1 their belief in the mysterious power said to attach to patent medicines is not surprising4 ,when testimonials of the efficacy of patent medicines purporting to come from respectable divines1 merchants1 and statesmen are offered1 the proof of their power seems incontestable4 ,economy and convenience are added incentives to the employment of patent medicines4 ,this method of saving the doctor's fee is engendered by those physicians who themselves write prescriptions for nostrums4 ,why not1 indeed1 eliminate this middleman 7the doctor7 and buy the nostrums direct8 ,so say the unthinking4 ,but what doctor worthy of the name would prescribe a medicine the composition of which he was ignorant8 ,yet it is frequently done4 ,as ,dr4 ,cabot has so aptly put it1 what would be thought of a banker or financial adviser who recommended his client to buy a security simply on the recommendation of the exploiter of the security8 ,yet that is exactly the position of a doctor who recommends a nostrum4 ,in view of the fact1 therefore1 that persons of undoubted intelligence are in the habit of purchasing and using remedies of this character and since many of the most widely advertised preparations are extremely harmful1 even poisonous1 we have taken the liberty of pointing out a few danger signals1 in the guise of extravagant assertions and impossible claims1 which are characteristic signs of the patent medicines to be avoided4 ,,danger ,,signals4--,there are many picturesque and easily grasped features in the literature1 labels1 and advertising of patent medicines that spell danger4 ,when these features are seen1 the medicine should be abandoned immediately1 no matter what your friends tell you about it1 or how highly recommended it may have been by others than your physician4 ,claiming a ,great ,variety of ,cures4--,perhaps of all features of patent medicine advertising1 this is the most alluring4 ,no one drug or combination of drugs1 with possibly one or two exceptions1 can or does cure any disease4 ,patients recover only when the resistance of the body is greater than the strength of the disease4 ,this body resistance varies in different persons1 and is never just alike in any two individuals or illnesses4 ,the patient must be treated and not the disease1 so it is the aim of every conscientious physician to conserve and strengthen the vital forces and1 at the same time1 guard against further encroachment of the disease4 ,there is no cure-all1 and even if a drug or combination of drugs were helpful in any single case1 they might easily be totally unsuited1 or even harmful1 in another case1 with apparently similar symptoms4 ,when a maker claims that his particular concoction will cure a long list of diseases1 the assertion bears on its face evidence of its falsity4 ,one of the most widely advertised and largely sold catarrh remedies claims to cure pneumonia1 consumption1 dyspepsia1 enteritis1 appendicitis1 ,bright's disease1 heart disease1 canker sores1 and measles4 ,this is absolute fraud4 ,no matter what virtues this medicine might have in the treatment of one or two ailments1 no one remedy could possibly be of service in such a varied list of diseases1 and it could not cure one of them4 ,another remedy bases its assertion of cures on the fact that it claims to be a germ killer1 and assumes that all disease is caused by germs4 ,to quote from its advertising literature1 it claims to cure thirty-seven diseases which are mentioned by name1 and then follows the assertion that it cures all diseases that begin with fever1 all inflammations1 all catarrhal contagious diseases1 all the results of impure or poisoned blood4 ,in nervous diseases--acts as a vitalizer1 accomplishing what no drugs can do4 ,it would seem that an intellect of any pretensions would recognize the fraudulent nature of this claim1 yet thousands of bottles of this stuff are annually sold to a gullible public4 ,these wide and unjustifiable claims are real danger signals1 and any medicine making them should be avoided4 ,there are many other remedies for which just as great claims are made2 the two instances cited are merely representative of a large class4 ,it is a waste of time1 money1 and health to buy them with any idea that they can fulfill their pretensions4 ,claiming to ,cure ,headaches4--,the use of any headache powders or tablets should be avoided1 except on the advice of a physician4 ,the presence of pain in the head1 or in any other part of the body1 may be a symptom of a serious and deep-seated disorder1 and it may often be a serious matter to temporize with it4 ,at the best1 these pain relievers can give only temporary relief1 and their use may prove to be dangerous in the extreme4 ,their action is dependent upon one of the modern coal-tar products1 usually acetanilid1 because it is the cheapest4 ,but1 unfortunately1 acetanilid is also the one with the most depressant action on the heart4 ,the danger of headache powders lies in the habit which they induce1 because of their quick pain-relieving qualities and their easy procurability1 and from overdosage4 ,if a person is otherwise in good health1 the use of one headache powder will in all probability do no harm1 but the dose should not be repeated without a doctor's authority4 ,many deaths have occurred from their continued use1 or because of an idiosyncrasy on the part of the taker1 but it is their abuse more than their use which has brought upon them such almost universal condemnation4 ,therefore1 while the physician may advocate their use1 do not take them without his advice and specific directions as to kind and dosage4 ,claiming ,exhilaration4--,these medicines1 by their insidious character1 constitute a particularly dangerous variety4 ,they depend1 for their effect1 upon the amount of alcohol that they contain4 ,many conscientious temperance workers have not only unsuspectingly taken them1 but have actually indorsed them4 ,recently the published analyses of several ,state ,boards of ,health and the investigations made by ,samuel ,hopkins ,adams1 and published in his series on ,the ,great ,american ,fraud have shown that a majority of the tonics1 vitalizers1 and reconstructors depend for their exhilarating effect upon the fact that they contain from seventeen to fifty per cent of alcohol2 while beer contains only five per cent1 claret eight per cent1 and champagne nine per cent4 ,pure whisky contains only fifty per cent of alcohol1 yet few people would drink three wineglassfuls in forty-five minutes#ad as a medicine pure and simple4 ,the ,united ,states ,government has prohibited the sale of one of these medicines to the ,indians1 simply on account of the fact that as an intoxicant it was found too tempting and effective4#ae ,if one must have a stimulant it is better to be assured of its purity4 ,these medicines are not only costly1 but contain cheap1 and often adulterated1 spirits4 ,their worst feature is that they often induce the alcoholic habit in otherwise upright people4 ,commencing with a small dose1 the amount is gradually increased until the user becomes a slave to drink4 ,could the true history of these widely used medicines be written1 it would undoubtedly show that many drunkards were started on their downward career by medicinal doses of these tonics and bracers4 ,claiming ,pain-relieving or ,soothing ,qualities4--,the properties of this class of remedies depend generally upon the presence of cocaine1 opium1 or some equally subtle and allied substance4 ,it should be needless to state that such powerful drugs should be taken only upon a physician's prescription4 ,habit-forming and insidious in character1 they are an actual menace4 ,when present in cough syrups1 they give by their soothing qualities a false sense of security1 and when present in soothing syrups or colic cures for babies1 they may be given with fatal result4 ,never take a medicine containing these drugs without a full understanding of their dangerous character1 and a realization of the possible consequences4 ,testimonials4--,these may mean anything or nothing2 generally the latter4 ,they are usually genuine1 but1 as ,mr4 ,adams observes1 they represent1 not the average evidence1 but the most glowing opinions which the nostrum-vender can obtain1 and generally they are the expression of a low order of intelligence4#af ,it is a sad commentary on many men and women1 prominent in public life1 that they lend their names and the weight of their testimony to further the ends of such questionable ventures4 ,political and newspaper interests are responsible for the collection of this class of testimonials4 ,an investigation of some men1 who permitted the use of their names for this purpose1 revealed that many of them had never tasted the compound1 but that they were willing to sign the testimonials for the joy of appearing in print as prominent citizens4#ag ,prominent ministers and distinguished temperance workers are often cited as bearing testimony to the virtues of some patent medicine4 ,it has been shown that1 while the testimonials were real1 the people who signed them had little right of credence1 and were possessed of characters and attributes which would show their opinions to be of little value4 ,money and energy can be productive of any number of testimonials for any remedy4 ,while some of them may be authentic1 yet the fact that a medicine cured any one of the signers is no evidence that it will cure or even help anyone else4 ,many people recover from diseases with no medicine at all1 and isolated cures can never be taken as a criterion of the value of any remedy or method4 ,offering ,money ,back ,unless ,cured4--,careful reading of this clause in most advertising literature will show that there is a string attached4 ,the manufacturers are usually safe in making this proposition4 ,in the first place1 the average person will not put the matter to a test4 ,the second reason why this is a safe proposition for the maker is1 that if the medicine does not cure1 the patient may die1 and dead men are hardly possible claimants4 ,claiming to ,cure ,diseases ,incurable by ,medicine ,alone4--,probably no class of people are greater users of patent medicines than those unfortunates afflicted with the so-called incurable diseases4 ,the very fact of the serious nature of their complaint1 and the dread of surgical intervention1 makes them easy victims to the allurement of sure cures4 ,the committee on the prevention of tuberculosis of the ,charity ,organization ,society of ,new ,york ,city has announced in decided terms that there is no specific medication for consumption4 ,cancer1 likewise1 cannot be cured by the use of internal medicine alone4 ,surgery holds out the greatest hope in this dread disease4 ,the medicines claiming to cure these diseases are1 therefore1 of the most fraudulent nature4 ,their use is positively harmful1 for in taking them priceless time is lost4 ,never temporize if there is any suspicion of the existence of such diseases as consumption or cancer4 ,self-treatment with patent medicines in such cases is worse than useless--it is actually dangerous to life itself4 ,consult a physician at the earliest possible moment1 and put no faith in patent medicines4 ,there are1 however1 as has been pointed out1 certain patent and proprietary medicines which may properly be employed by the physician4 ,these include the newly discovered1 manufactured chemicals of known composition and action2 and single substances or combinations of known drugs in known proportions1 which can only be made to best advantage by those having the adequate facilities4 ,the habit of prescribing proprietary mixtures of several substances for special diseases is1 however1 generally a matter of laziness1 carelessness1 or ignorance on the doctor's part4 ,this follows because no disease is alike in any two patients2 because any one disease has many phases and stages2 and because a doctor should always treat the patient and not the disease4 ,thus a doctor1 after carefully questioning and examining the patient1 should adjust the remedy to the peculiarities of the patient and disease4 ,it is impossible to make a given combination of drugs fit all patients with the same disease4 ,the quantity of patent medicine sold in the ,united ,states is enormous4 ,a series of articles by ,samuel ,hopkins ,adams appeared in ,collier's ,weekly during #aije and #aijf1 in which he not only showed the fraudulent character of many of the best-known patent medicines1 giving their names and most minute details concerning them1 but furnished much reliable information in an interesting and convincing manner4 ,in the course of these articles he pointed out that about one hundred millions of dollars are paid annually for patent medicines in the ,united ,states4 ,as explaining this1 in part1 he affirmed that as many as five companies each expended over one million dollars annually in advertising patent medicines4 ,what ,are the ,good ,ones ,good ,for8--,in any great movement1 when a dormant public suddenly awakens to the fact that a fraud has been perpetrated or a wrong committed1 the instinctive and overwhelming desire is for far-reaching reform4 ,in efforts to obtain needed and radical improvement1 and with the impetus of a sense of wrong dealing1 the pendulum of public opinion is apt to swing too far in an opposite direction4 ,there are bad patent medicines--the proof of their fraudulent character is clear and overwhelming2 but there are good ones whose merits have been obscured by the cloud of wholesale and popular condemnation4 ,it is true that the manufacturers of even some of the valuable ones have an absurd habit of claiming the impossible4 ,this attitude is to be regretted1 for the makers have thus often caused us to lose faith in the really helpful uses to which their products might be put4 ,however1 it is well in condemning the bad not to overlook the good4 ,the mere fact that a medicine is patented1 or that it is a so-called proprietary remedy1 does not mean that it is valueless or actually harmful4 ,the safety line is knowledge of the medicine's real nature1 its uses and its dangers2 the rules given above should be rigorously followed4 ,it is far easier to give general indications for the guidance of those wishing to shun unworthy patent medicines than to enable the reader to recognize the worthy article4 ,it is safe to assume1 however1 that there are certain simple remedies1 particularly those for external application1 which have a definite use and are dependable4 ,in justice it must be said that great improvement has taken place1 and is now taking place in the ethical character of patent medicines1 owing to recent agitation1 and what is true concerning them to-day may not be true to-morrow4 ,the only proper1 ethical patent medicine is the one showing its exact composition1 and refraining from promise of a cure in any disease4 ,such a one might1 nevertheless1 advertise its purity1 reliability1 advantageous mode of manufacture1 and the excellence of its ingredients with more modest and truthful claims as to its use4 ,the purchaser of a patent medicine pays not only for the ingredients1 the cost of combining them1 and the maker's just profit1 but he also pays the exploiter's bills for advertising and distributing the finished product4 ,with such standard remedies as those mentioned above1 this added cost is usually a good investment for the purchaser1 because trade-marked remedies which have made good possess two advantages over those less advertised1 and over their prototypes in crude form3 procurability and integrity4 ,even at remote cross-roads stores1 it is possible to obtain a popular remedy1 one which has been well pushed commercially4 ,and an article sold in packages sealed by the makers gets to the consumer just as pure as when it left the laboratory4 ,this is not always true of ingredients held in bulk by the retailer2 witness the evidence brought forward in recent prosecutions for drug adulteration4 ,it is not the purpose of this chapter1 in any sense1 to advertise or place the seal of its unrestricted approval upon any one article of a class4 ,its position in the matter is absolutely impartial4 ,but in order that it may be as helpful as possible1 it definitely mentions the most widely known1 and therefore the most easily obtainable1 remedies4 ,there are other equally good remedies in each case1 but as it would be almost impossible to mention each individual remedy with similar virtues now on the market1 the ones discussed must be taken as representative of their class in each instance4 ,do not forget that the use of these simple remedies does not justify their abuse4 ,they may make great claims while their use is really limited4 ,do not rely upon them to do the impossible4 ,vaseline4--,this is pure and refined petroleum1 and will be found of much service in many forms of skin irritation4 ,it is useful in the prevention of chapping1 for softening rough skin1 for preventing and healing bleeding and cracked lips1 as a protective dressing in burns1 cuts1 or any acute inflammation of the skin where the cuticle has been injured or destroyed1 or where it is desirable that a wound should be protected and kept closed from the air4 ,rubbed over the surface of the body when a patient is desquamating or peeling after scarlet fever or measles1 it keeps the skin smooth1 soothes the itching1 and prevents the scales from being carried about in the air and so infecting others4 ,vaseline is a soothing1 nonirritating1 and bland protective ointment for external use4 ,it is perfectly harmless1 but should not be used for severe skin disease or for internal use1 unless recommended by a physician in conjunction with other means of healing4 ,pond's ,extract4--,although the makers have claimed special virtues for this remedy1 it is in reality an extract of hamamelis or witch-hazel1 and probably differs little in its application or results from the ordinary marketed extract made by the average druggist4 ,it is mild and bland1 harmless when used externally1 but should not be used internally unless ordered by a physician4 ,it is soothing and healing when applied to wounds1 sprains1 and bruises2 diluted with water it is a pleasant gargle for a sore throat1 and may be applied externally on the throat by means of a flannel wrung out in a solution of it in hot water4 ,for nosebleed it is often efficient when snuffed up the nose1 or when pledgets of cotton are soaked in it and placed in the nostrils4 ,it may be used as an application in ulcers or varicose veins1 and from two to four teaspoonfuls with an equal amount of water injected into the rectum two or three times daily will often prove of great help in piles1 particularly if bleeding4 ,it gives relief when used for sore or inflamed eyes or eyelids1 but in this1 as in all other serious inflammations1 it is not a cure all1 and the physician should be consulted if the relief is not prompt4 ,listerine4--,of the many mild liquid antiseptics ,listerine is probably the best known4 ,the remarks and recommendations concerning it1 however1 are equally applicable to many other remedies of a somewhat similar nature1 such as glycothymoline1 borolyptol1 lythol1 alkalol1 formalid1 etc4 ,listerine is a solution of antiseptic substances with the addition of thymol and menthol in quantities sufficient to give it a pleasant odor and taste4 ,it has a very strong hold on the public1 and is a deservedly useful remedy4 ,listerine has many helpful uses4 ,it is potent enough to kill many germs1 and is excellent for this purpose when used as a mouth wash1 particularly during illness4 ,in acute cold in the head it is soothing to the mucous membrane of the nose1 if used diluted with warm water as a nasal douche4 ,it serves a similar purpose when used as a gargle in mild sore throat4 ,if there is any reason to suspect that dirt or other foreign matter has come in contact with a sore or cut1 the wound may be freely washed with a solution of listerine in order to clean it and render it as nearly aseptic as possible4 ,when there are distinct signs of inflammation it should not be relied upon4 ,do not use it internally without a physician's advice4 ,scott's ,emulsion4--,this is a good emulsion of cod-liver oil1 widely prescribed by physicians for the many patients who are too delicate-stomached to retain the pure oil4 ,for those who can take the refined oil straight1 ,peter ,moeller's brand is in a class by itself4 ,in certain conditions cod-liver oil is one of the most valuable remedies known4 ,as a concentrated and reconstructive food in many wasting diseases it is of great service4 ,weak and puny children1 and all suffering from malnutrition may take it with benefit4 ,it does help produce flesh1 increase strength1 and add to the body's resisting powers4 ,it does not contain any medicinal properties1 and its virtue is largely in its fat or oil1 but as an aid to other remedies1 or alone1 when increased nutrition is desired1 it is a reliable and helpful remedy4 ,antiphlogistine4--,there are many clay poultices on the market3 antiphlogistine1 antithermoline1 cretamethyl1 sedol1 unguentum1 yorkelin1 and the ,emplastrum ,kaolini of the ,u4 ,s4 ,pharmacopoeia4 ,antiphlogistine1 being probably the most widely known1 is here discussed4 ,it is of value when a poultice is indicated4 ,it is preferable to the homemade varieties in that it retains heat for a longer period of time and is antiseptic4 ,it should never be used in deep-seated inflammations1 such as peritonitis1 appendicitis1 deep abscesses of any part of the body1 or other serious conditions1 unless recommended by a physician2 for such ailments need more thorough treatment than can be afforded by any poultice4 ,it is perfectly harmless1 and may be used with decided benefit in aborting or preventing many inflammatory diseases4 ,applied in the early stages of a boil1 felon1 or carbuncle it may either abort the trouble or1 if the disease has already progressed too far1 it will hasten suppuration and shorten the course of the disease4 ,when a poultice is indicated in bronchitis or pleurisy it is an excellent one to use2 it will afford much comfort1 and often hasten recovery4 ,in nursing mothers1 when the breasts become full and tender and signs of beginning inflammation are present1 antiphlogistine spread in a warm and thick coat over the breasts will often afford relief4 ,platt's ,chlorides4--,when it is desirable to use a liquid disinfectant ,platt's ,chlorides will be found a useful article1 as will lysol and other marketed products4 ,the source of a foul smell or dangerous infection should never be overlooked4 ,no disinfectant can offer a safeguard if plumbing is defective1 or other unsanitary conditions exist2 in fact1 disinfectants are often deprecated1 since they afford a false sense of security4 ,if a contagious disease exists in a household1 other means than the use of a disinfectant must be taken in order to prevent the spread of the contagion4 ,disinfectants do have their uses1 however1 and are often essential4 ,in case of an illness of a contagious or infectious nature1 a solution of ,platt's ,chlorides or a similar disinfectant should be kept in all vessels containing or receiving discharges from the body4 ,pails containing such a solution should be in readiness to receive all cloths1 bedding1 or washable clothes which have come1 in any way1 in contact with the patient4 ,,footnotes3 #aa ,the publishers announce this chapter as prepared independent of ,dr4 ,winslow or any of the ,advising ,editors4 ,considered as an effort to give helpful information1 free of advertising on the one hand and sensational exposures on the other1 the article meets with the approval of conservative physicians4 ,but the problems dealt with are too involved at present for discussion direct from the profession to the public4 #ab ,jacobi1 ,jour4 ,am4 ,med4 ,assn41 ,sept4 #bi1 #aijf4 #ac ,ibid4 #ad ,s4 ,h4 ,adams1 ,the ,great ,american ,fraud4 #ae ,ibid4 #af ,s4 ,h4 ,adams1 ,the ,great ,american ,fraud4 #ag ,s4 ,h4 ,adams1 ,the ,great ,american ,fraud4 ---------------------------------------- ---------------------------- ,,transcriber',s ,,note4 ,the prescription symbol has been transcribed as ,rx4 ---------------------------------------- ----------------------------