Victorian London - Publications - Etiquette and Household Advice Manuals - Cassells Household Guide, New and Revised Edition (4 Vol.) c.1880s [no date] - Domestic Medicine (1) - (2) Diseases Incidental to Children - (3) cont. - (4) Eruptive Fevers - (5) cont. - (6) . . . (7) Chicken-pox - (8) Worms. Abscess. Ague - (9) Apoplexy. Asthma - (10) Biliousness and Bilious Attacks - (11) Biliousness or Bilious Disorders, Including Jaundice

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Volume 1

[-41-]

DOMESTIC MEDICINE.- I.

IN commencing a system of domestic medicine it is necessary to determine the classification of subjects. The best arrangement of diseases will be that which is most practical, which can be most easily comprehended and recollected. We will endeavour to be practical in our division of diseases, and also to be simple in the language which we use, avoiding technical phrases as much as possible. Before describing particular diseases we shall devote a few lines to a consideration of the symptoms by which we may know that a person is out of health, and we shall be particular in pointing out symptoms which imply a serious case, or one for which the doctor should be sent. It is lamentable to see in some cases how the importance of symptoms is overlooked until disease has made serious advance. Let us, accordingly, first mention 

A FEW SYMPTOMS THAT SHOULD ALWAYS BE CONSIDERED GRAVE ENOUGH TO JUSTIFY US IN SENDING FOR THE DOCTOR.

    1.  Foremost among these is a shivering, or what doctors call a rigor, a Latin word meaning a stiff coldness. Most inflammations and fevers begin with more or less of this shivering or rigor, and it is a symptom to which doctors always attach importance. It may be a severe shivering, severe enough to make the teeth of the patient chatter and the bed shake; or it may be slight enough only to. make the patient feel a little cold, as if cold water were running down the back. Sometimes there is only a paleness of the face and the surface generally to represent this peculiar symptom. This shivering is a very remarkable thing, and the exact nature and cause of it is yet a matter of discussion among doctors. But, nevertheless, the significance of it is admitted on all hands and it is in many cases the beginning of an illness more or less severe ; often of only a sore throat, but often, too, of an internal inflammation, or of rheumatic fever, or of one of the eruptive diseases, such as scarlet fever or small-pox.  In lying-in-women it is generally a significant thing, but the exact significance of it can only be judged of by  a doctor. It may mean the beginning of an abscess in the breast, or it may simply denote a weed, that is, a slight child-bed fever, characterised by alternate shiverings and sweatings, or it may imply a child-bed fever of a more serious kind, or an inflammation of the womb. It is probable that this symptom - a rigor - is a nervous symptom, and that it depends upon some effect produced upon the nerves or the nervous centres. In children it is sometimes represented or replaced by a thorough convulsion. It is always an important thing, though the exact significance of it is to be determined by other symptoms which do not always immediately follow. These symptoms are generally pain in some part, as, for example the throat, or in joints, or, in lying-in-women, in the breast In other cases an eruption will succeed the rigor. When a shivering does occur, the proper thing to do is to administer some warm drink, put the patient to bed, apply warmth to the feet and cover the body well, and, if he is not soon well, to send for the doctor. 
    2. Another symptom of interest and importance is an unusual heat of the body, or, as doctors say, an elevation of the temperature. The natural heat of the body is about 98º. The temperature may be judged of roughly by the hand, but much more accurately by a thermometer, the bulb being placed under the tongue or in the arm-pit, the body being carefully covered over with bed-clothes. The patient should be an hour in bed before the thermometer is used. A very convenient and sensitive thermometer for medical purposes, and costing half-a-guinea, lately invented, will be found very useful for this purpose. It is at the same time an index thermometer, that is to say, it has a short column of mercury detached from the mercury of the bulb by a little air, which remains at any point to [-42-] which it has been raised by the heat of the patient, after the withdrawal of the instrument. This increased heat of the body is not only a symptom of the severity of disease, but it is a very early symptom. Dr. Burdon Sanderson, during the cattle-plague, made the interesting observation that the very first symptom which occurred was this elevation of temperature. When to all ordinary appearance the animal was well, a thermometer thrust into an internal part, often showed an elevation of the temperature of the body by two or three degrees; and in these cases he was able to predict confidently that the animal was in for cattle-plague. The advantage here was that the animal might sooner be slaughtered and removed from contact with other animals before the more contagious stages of its disease occurred. And so in human diseases a rise of temperature is an early and significant symptom, and one not difficult to ascertain. A child, a few years old, will not unwillingly become a party to an interesting thermometric observation, and will hold the bulb of the thermometer under its tongue. The writer may illustrate these points by a case:- A little girl at church on a Sunday evening, and making no particular complaint was noticed the next day to be rather hot in the skin, by the medical man who was calling at the house for another purpose. Sore throat was immediately suspected and soon after found. And the thermometer being at hand, it was kept in the mouth by the little patient, and found to rise to 102º Fahrenheit. The patient may feel shivery, and yet the thermometer will show an elevation of temperature: - so early does this occur in disease. As our object at present is to specify early symptoms which imply complaints serious enough to have a medical opinion upon, we will not dwell further upon the significance of an elevated temperature. We will only say, with the view of showing our readers how careful and precise medical science is becoming, that the thermometer is often used for ascertaining the existence of serious disease when other symptoms are very vague, and also for determining the danger of particular cases. A very high temperature occurring in the course of diseases, such as fevers or rheumatic fever, is a dangerous symptom. If a high temperature succeeds a severe shivering, the case is certainly one for medical, not domestic treatment.
    Shiverings and subsequent heat, or alternate shiverings and heat, accompanied with general aching and soreness, are the symptoms by which we may generally judge of the onset of some acute attack. Other preliminary symptoms occur, according to the particular nature of the disease setting in. For example, sickness generally accompanies the preliminary shiverings and heats of scarlet fever ; sneezing and red eyes, those of measles severe acute pain in the back, those of small-pox. But these will come in for more particular notice under the head of the special diseases which they characterise. The grand thing to remember here is that shiverings an subsequent heat of the body are generally the indications of a smart attack of some kind. 
    Let us now mention a few symptoms which may not be the forerunners of any acute attack, but which must nevertheless be seriously regarded; amongst these we may notice - sickness, loss of flesh, loss of colour, loss of strength. 
   
Sickness may be of no consequence. It may be caused by an error of diet, eating unwholesome food or forbidden fruit, and it may cure itself. There is one kind of sickness, against neglecting which we warn people, that is, a very acute, incessant sickness in children or young people, accompanied with costiveness. Such a sickness as this leading the patient to vomit even water, should be regarded as of serious import. Vomiting is a common symptom at the outset of scarlet fever. Of this more hereafter. Pending the arrival of a doctor the proper treatment of it is the blandest food in small quantities, such as milk, or milk water; and a little effervescing drink from time to time. 
   
Loss of Flesh, Loss of Colour, or Loss of Strength, if they occur either singly or together, are things to take advice about rather than to take physic for.  
    With these preliminary hints about important symptoms, we will give in a future number a more detailed notice of particular diseases.

[-83-]

DOMESTIC MEDICINE.-II.

DISEASES INCIDENTAL TO CHILDREN.

IN treating of the diseases which are incidental to childhood, we shall content ourselves with noticing those of common occurrence. Now, as most of our ailments are the result of our own imprudence or misfortune, it might be expected that childhood would be free from disease; but it is really the most dangerous part of life, if we exclude age, which has been called second childhood. The organisation of an infant is a very sensitive one, capable of being injured by many things, especially by improper food, by bad air, by cold, and by heat. In some large towns it is very difficult to rear children ; in Liverpool, for example, one child in every four dies before attaining the age of twelve months. It would be well if people would regard the constitution of a child as a thing requiring great consideration and care. Generally speaking, the life of a child is endangered by affections of its nervous system, such as convulsions; or of its bowels, such as diarrhea; or of its breathing apparatus, such as bronchitis; but these are by no means the only dangers with which childhood has to contend. In these papers we propose to treat shortly of the following diseases of children:- 1, convulsions ; 2, diarrhoea ; 3, dentition; 4, bronchitis and croup, and nervous croup 5, eruptive fevers ; 6, whooping cough; 7, certain skin diseases ; and 8, worms.

CONVULSIONS.

    These are of common occurrence in young children, owing to the extreme sensitiveness of their nervous system ; still a child is not always convulsed when it is said to be so. Nurses are very fond of talking about "inward convulsions," which often mean nothing more than a few slight twitches about the muscles of the face, especially of the lips. Such twitches often precede or forbode an attack of convulsions, but are not themselves entitled to this name. When a real fit comes on it is too easily perceived. The twitching of the face is no longer slight, but of the nature of a jerk; the muscles of the trunk and limbs are alternately stiffened and relaxed; and if the muscles of the chest and body are much affected, the child becomes blue from the way in which the fits interfere with respiration.
   
Causes - What are the causes of such fits? They vary in different cases; but they may be resolved into three or four principal classes. First, some fault in the food of the child. The food may be unfitted to the tender wants of the infant. It may be artificial milk instead of maternal; or it may be bad milk instead of good. And even in the case of a child fed with its own mother's milk it may happen that a sudden derangement of the mother's milk - as, for example, by a fright - will occasion a convulsion in the child. Another error of diet, recognised as an occasional cause of fits in children, is giving too much food at one time - gorging the stomach. Another common cause of fits is the irritation caused in sensitive children by the process of teething. It is amazing how one or more teeth pressing on the gum may irritate and derange a child. Prolonged diarrhoea, exhausting a child, will be occasionally followed by a convulsion. Worms in the bowels are often a cause of convulsions in children, and may be considered to be the cause in any particular case if they have been noticed before the occurrence of the fits, and if the fits cease after the expulsion of the worms. Our list of the causes of such attacks would be incomplete if we did not specify bad air. Formerly, in the Rotunda Lying-in Hospital, Dublin, a large proportion of the children used to die of fits. No less than a sixth of the children died within a fortnight after their birth of the disease known as the lock-jaw of infants, in which not only the muscles of the jaw, but the other muscles of the body are affected with a stiffness. The children attacked with it almost invariably died. Dr. Joseph Clarke entirely abolished this disease in the Rotunda by securing the better ventilation of the wards by a system of shafts. We mention this disease, not only because it is of the nature of fits, but also because its complete extinction in the Rotunda is one of the most striking instances that can be brought forward of the good effects of fresh air.
   
Treatment.- When a child is attacked with convulsions, pending the arrival of the doctor, two or three things may be done by those in attendance. First, let them be advised not to be too excited or too officious. It is very alarming to see a child convulsed, but generally children do not die in fits, and the best service will be that which is rendered in quietness. The things which it is generally right to do are to admit plenty of air to the child's face, and to put it into a warm bath (not too hot), in such a position as to give it plenty of air in breathing. The further treatment of the child will be best judged of by the medical man; but if from any cause his arrival be delayed, the steps to be taken must depend on the probable causes of the attack. If the child should have taken doubtful food, this source of irritation must be rectified. If it have taken a large quantity of food, there would be little harm in trying to excite vomiting, in the interval of the fits, by tickling the mouth with a feather or with the finger. If the child be in an exhausted state from previous diarrhoea or other causes, a little simple food should be introduced, either breast-milk or fresh milk and water, or barley water, or, if the child be very much reduced, a little very weak brandy and water sweetened with sugar. If the gum is red or swollen over a coming tooth, nothing gives such relief as lancing the gums; this, of course, can only be done by a medical man. But the medical man is sometimes foolishly opposed by parents in this matter. We need scarcely remark that in the actual fit the child will not be able to swallow, and during this time the attendants should be careful to let it have plenty of air.
    Before leaving the treatment of children subject to convulsions, we should say the great duty of friends is to preserve such children from the causes of them, which we have specified, and in every way to strengthen the children, It should be remembered that fits imply a morbid sensitiveness, which is often constitutional. By good food, by pure air, by plenty of sleep, and regular living on the part of the parent, such sensitiveness is diminished, and with it the chance of fits.

DIARRHOEA.

    This, like the preceding, is a very common ailment of children. It is the cause of much of the mortality of young children; and where it is not fatal it often greatly weakens and injures the system. It is so common, and it injures a child so slowly and gradually, that it is on the whole too lightly regarded. We shall describe the general causes of it, and some domestic means by which it will often be remedied ; but if these fail we advise parents not to neglect to get medical advice for diarrhoea. A child with diarrhoea should especially not be neglected when it looks pale, when it is cold and clammy in the skin, and when it lies with its eyelids half closed. The diarrhoea of children may be divided for practical purposes into two classes:- 1, that which occurs in very young children in the first few weeks or months of life ; and 2, that which occurs in children about and after the age of six months, during the period of teething. Both these forms of diarrhoea are most apt to occur and most difficult to cure during summer and autumn.
    1. The Diarrhoea of very Young Children.- This generally depends on errors of diet, on, artificial food [-84-] or on something faulty in the milk of the mother. The motions of the child are generally green in colour, and frequently passed. The child cries much, or gives other signs of uneasiness in the bowels. Very often some degree of vomiting exists along with this diarrhoea. Such a case as this is eminently one for good domestic management. It is impossible to lay down rules that will suit every case; but wise women will find out what food agrees with a child and what seems to poison it. This kind of diarrhoea is often seen in children that are fed with the bottle, or in other artificial ways. And it is wonderful how such children will often improve as soon as a wet-nurse is got for them. The green motions become yellow, the wrinkled skin looks plump and fresh again, and the expression of the face alters from an aged, haggard look to a happy, well-fed appearance. Where a wet-nurse cannot be procured, the best artificial food should be given, and of this, generally speaking, the best is that which is made of milk and water in equal proportions, a or in the proportion of two-thirds milk to one-third water. it should be sweetened with a little sugar, and given at a temperature of 90º to 95º Fahr. It is of the greatest moment that the milk should be fresh and free from all acidity. In the way of domestic medicine, a tea-spoonful or two of lime-water may be given mixed with the food, or a teaspoonful of the following mixture may be taken two, three, or four times a day
    Chalk mixture ... ... .. 6 drachms.
    Bicarbonate of soda ... .. 6 grains. 
Where the diarrhoea depends on any temporary fault of the mother's health, this must be rectified by appropriate means, especially by simple diet and quietness of mind. If the diarrhoea is not quickly removed by domestic care and treatment, medical advice should be taken on the subject.
    2. The Diarrhoea of Teething Children. - Many a children never cut a tooth without having some diarrhoea. If it continues long, or if it is associated with vomiting, or if the child is getting obviously thinner, then it should be regarded seriously, and the doctor should be sent for. The domestic treatment of it will consist in the most careful regulation of the mother's living, favouring good milk on her part; where the child is brought up by the hand, in giving suitable food, especially milk as above directed. If this produces vomiting, then give barley-water, or barley-water and milk, until the stomach settles a little. If the child is very exhausted, and lies with its eyes half closed, then a little very weak brandy and water may be administered. For example, a teaspoonful of pale brandy may be put into a wineglassful of water and sweetened ; of this a teaspoonful may be given frequently. If the motions are green, and the skin hot and dry, two teaspoonfuls of the above chalk mixture may be given every three or four hours. If there is sickness or sweating, the following mixture will often answer better
        Dilute sulphuric acid ... ... 12 minims.
        Compound tincture of cardamoms 1 drachm.
        Simple syrup... ... ... ... 2 drachm.
        Water ... ... ... ... ... 1½ ounce.
    A teaspoonful or two teaspoonfuls to be taken (according to the age of the child) every three, four, or six hours.
    When diarrhoea occurs in older children than those of a year or two, it should not be checked immediately, especially if it have followed close upon some obvious error of diet. It may even be proper in this latter case to give a very small quantity of castor oil or Gregory powder. If the diarrhoea continues, then the above mixtures may be procured in twice the quantity, and a dessert-spoonful or a table-spoonful given every three or four hours. Generally speaking, it will be safe to begin with the chalk mixture, and if this is not effective the other may be tried. If the case is urgent, however, or the child delicate, or the summer very hot, it will be proper to take medical advice at first.
   
Inflammatory Diarrhoea.-Sometimes, particularly in· young children fed with the bottle in unhealthy large towns, diarrhoea resists all remedies, and changes its character; the motions losing altogether the appearance of ordinary motions, becoming green and sour, consisting largely of slime, perhaps mixed with a little blood; sometimes they resemble spinach or chopped vegetables. Vomiting is apt to set in. The little patient gets very pallid and thin, and soft and flabby. The case is not now one of simple diarrhoea. It requires the best medical skill, and should at once be removed from the sphere of domestic medicine.

[-114-]

DOMESTIC MEDICINE - III.

DISEASES INCIDENTAL TO CHILDREN (continued from p.84)

    Teething -The process of teething is a natural one, and should be unattended with any particular symptoms of ailment. It generally begins about the sixth or seventh month, though in some children, especially those of a rickety constitution, its commencement is often long deferred. There are two sets of teeth in the human body: the first or temporary set, and the second or permanent. The eruption of the first set of teeth is finished in from two to three years. The eruption of the permanent teeth extends from the age of six to that of twenty-five years. The first teeth to appear are generally the front teeth of [-115-] the lower jaw, and then the two corresponding teeth of the upper. Although teething is a natural process, it is often accompanied with certain ailments ; the most common of these are diarrhoea and bronchitis, especially; the former. Diarrhoea is so common an accompaniment of the process of teething, that by some it is considered natural. In any great degree, however, it is weakening, and should not be disregarded. We shall treat of the various ailments which are apt to happen during teething, under the heads of their various names, such as Diarrhoea, Bronchitis, Convulsions, &c. We shall only here remark that the child during teething is unusually sensitive, and requires to be preserved from extremes of heat and cold; to be fed regularly and very simply. When a tooth is obviously pressing on the gum, and the gum is swollen or red, and the child disordered in any way, no objection should be offered by parents to having the gum lanced. The relief afforded by this measure is often most marked.
    Bronchitis and Diseases of the Breathing Apparatus.- Few diseases are more common in young children than some degree of bronchitis, especially, perhaps, in the earlier or teething years of life. This complaint is not only common, but it is attended with some danger, and, unless speedily relieved, a doctor should be sent for. The disease consists in an inflammation of the bronchial tubes leading to the lungs. The wind-pipe divides into two tubes, these two divide into other two, and these again subdivide into two more, and so on until they attain a great minuteness; and on the minutest air-tubes the cells of the lungs are placed. Bronchitis, or inflammation of these tubes, is one of the most fatal diseases in our climate, especially to young children and old people. The symptoms of bronchitis vary according to the extent of the disease, and as the disease affects more the smaller or the larger bronchial tubes. The child is quickly bereft of its usual liveliness, and shows the following symptoms:- It is feverish; the breathing is quick, and the nostrils expand more or less; there is cough, which at the first is probably hard and painful, often snaking the little patient cry; a wheezing-sound may be heard with the breathing. All these symptoms are apt to be worse at night, the breathing getting shorter and the child getting hotter. If the smaller tubes are much affected, the inconvenience in breathing, and the fever, and the danger of the disease are the greater. All such symptoms are more serious when they occur on delicate children, or in such children as have large heads, or who have their teeth slowly and late. If these symptoms occur only in a slight degree, they may yield to a little domestic treatment. If the weather be cold, the child must be kept in a room comfortably warm. Large linseed poultices should be applied to the chest, the first of which may contain a few grains of mustard. The following mixture may be given 
        Ipecacuanha wine... ... ...1 drachm.
        Spirits of nitre ... ... ... 1 drachm.
        Syrup ... ... ... ... 2 drachms.
        Bicarbonate of potash... ... 6 grains.
        Water ... ... ... ... 1½ ounce.
    A teaspoonful may be given to a child nine months old, a little more or less to older or younger children, or according to the severity of the symptoms. If the first few doses cause a little sickness, they will do no harm.
    The above mixture is very good for feverish coughs in children. The symptoms which indicate danger, and the need for regular medical advice, are great feverishness, quick or laboured breathing, and any duskiness or blueness of the colour of the face.
   
Croup and Nervous Croup - We will treat first of real croup, which consists of inflammation in the upper part of the wind-pipe. It occurs for the most part in children between the ages of two and five years, and is more common in boys than girls. It is noticed that the children of certain families are more liable to croup than the children of other families. The disease often comes on in the night. It may set in with symptoms of a common cold, with more or less hoarseness and soreness about the top of the wind-pipe; the child becomes feverish and coughs quite peculiarly - the peculiarity consisting in the cough having a dry, hoarse, harsh, ringing sound, the "clangey" or "brassy" cough described by Dr. Cullen. The cough does not acquire this brassy sound all at once, probably not before twenty-four or thirty-six hours. It is very characteristic, and needs only to be heard, and to be associated with a feverish state of the child, to teach us that croup is present. More or less coincidently with this cough, occurs a peculiarity of breathing. The child breathes with a crowing or barking sound. This crowing or barking sound in breathing, together with the brassy cough, the restlessness and feverishness, and the general difficulty in breathing, get worse at times, and especially they all tend to be worse at night. The severity of the case is to be judged of by the degree of fever and the amount of the peculiar noises in coughing and breathing which we have described. These sounds are caused by the swelling and inflammation at the upper part of the wind-pipe, which may be so great as almost to block it up, in which case the child becomes blue, and breathes with painful struggles and difficulty. We need not say that in such a case as this, medical assistance should be sought as soon as possible. In the meantime, the child should be put into a warm bath. After this a large linseed poultice should be put upon the chest, and a sponge dipped in hot water (as hot as can comfortably be borne by the child) should be applied to the neck of the patient for a quarter of an hour or twenty minutes at a time; on discontinuing the sponge, a little dry flannel should be wrapped round the neck. The child should be in a warm room, in which a kettle should be kept boiling, sending out steam into the apartment, as moisture in the air is very agreeable and beneficial in this disease. If any difficulty or delay is experienced in getting a doctor, and the cough is brassy and the breathing of the crowing kind described above, a little ipecacuanha wine should be procured, and of this a third, or a half, or the whole of a tea. spoonful may be given every quarter of an hour, in a very little water, until vomiting is produced. The smaller doses will do for children about two years of age, or even lesser ones for younger children. The hotter the child, the older it is, and the more ringing the cough, the more ipecacuanha wine will it need. After vomiting has been brought about, ten drops of the wine may be given in two tea-spoonfuls of water every three or four hours, till relief is obtained. Children liable to croup should not sleep in cold rooms. It should be added that many cases of croup are of the nature of diphtheria, and the appearances of this disease should always be looked for in croupy cases.
   
False or Nervous Croup (Child-crowing).- This disease is liable to be confounded with true croup, but it is quits. different in its nature. Like true croup, it is most apt to occur in the night. It may occur quite suddenly. It is a nervous disease and not an inflammatory one. It is characterised by a sudden difficulty - almost a suspension - of breathing. When breathing does take place, it is accompanied by a loud crowing sound, which gives the name to the disease, It is really a spasm of the muscles of respiration, and maybe accompanied by twitches of the thumbs or face, and even by general convulsions. It differs from true croup in that it occurs to younger children, often between the ages of six and nine months. It often comes on while the child is getting a tooth. It is not attended with fever, like true croup, and comes on and goes off suddenly. A warm bath should be given, and a medical man sent for. The child might be suffocated in one of the attacks. If a tooth is pressing on the gum, it should be lanced, and this measure often relieves wonderfully.

[-186-]

DOMESTIC MEDICINE.-IV.

ERUPTIVE FEVERS.

WE shall, under this head, treat only of the more common forms of eruptive fevers, such as scarlet fever - or, as it is the fashion now, to call it, scarlatina - measles, small-pox, and typhoid and typhus fevers. These diseases constitute the principal epidemics, and, with infantile diarrhoea, cause a large proportion of the deaths in any community, especially in large towns. At the moment at which we write, scarlet fever is very fatal. We shall treat of it first.
   
Scarlet Fever, or Scarlatina, used for a long time to be confounded with measles; but it is a very distinct disease in its symptoms and in its importance. Sometimes it occurs in such mild forms as to be of no consequence ; at other times it is a very serious disease indeed, and comes nearer to a plague than any common disease we have. It is not only serious in itself, but apt to be followed, after the lapse of weeks, by dropsy, rheumatism, and other consequences that are in themselves dangerous. All we shall do, therefore, is to point out the general character of the disease, and the general and domestic treatment of the patient. We take it for granted that the doctor will be called in. If we insert a few more specific instructions, it will be for those who are beyond the reach of medical advice.
    Scarlet fever begins, like other eruptive fevers, with symptoms of ailment - shivering, sickness, lassitude, and headache. In addition to these symptoms, there is more or less of sore throat, and the back of the mouth and throat are generally reddish in colour. The soreness of the throat is a very characteristic feature of scarlet fever. On the second day of the disease the eruption appears in the form of a red rash; it comes on nearly everywhere at about the same time, but is generally visible on the neck and chest before it shows itself on the face. Like the sore throat and the rash, the appearance of the tongue is very characteristic in scarlet fever ; it is covered with a white fur, through which appear little red papillae or points, giving the appearance described as the "strawberry tongue." There is generally a good deal of fever present, the temperature of the skin is high, and the higher it is, generally speaking, the more serious is the case.
    Supposing the case to be a mild one, all these symptoms are present in a moderate degree. The throat is not very sore, the swelling of the neck is not very great, the fever is moderate, and the amount of eruption moderate. It is common to say that when the eruption comes well out, the patient is in less danger, but this is not the case. The more intense and extensive the eruption, the more severe is the disease.
    The worst cases of scarlet fever are those in which the disease begins with great severity; as when it sets in with delirium or convulsions, when the throat is very sore, and there is great and quick swelling of the neck, making swallowing and breathing difficult, and when the temperature is very high. According to the severity of the disease is likely to be the course of it. The very mild cases go on very well. About the fifth day, the skin, which has been the seat of the rash, begins to peel off. This process is called desquamation, and it may extend over eight or ten weeks, during which the patient must be considered to need care, especially protection from cold.
    But, even in mild cases, recovery is apt to be interrupted by some unsatisfactory symptoms. Of these, the most common is swelling of the eyelids and face generally, and other parts of the body, accompanied with a remarkable paleness of the skin. This is the dropsy after scarlet fever, and it occurs, to say the least, as frequently after mild attacks as after severe ones. It may be accompanied by sickness or headache, or, still worse, by convulsions. It does not generally happen till fifteen or twenty days after the eruption, and may be a month after it. Coincidently with this dropsy, the urine may become scanty, and darker in colour.
    Very bad cases of scarlet fever are apt to terminate fatally, at a very early period. Breathing becomes loud and difficult, there is a heaviness and stupor about the mind, and a tendency to wander ; the temperature of the body is often very high, and the patient may die in two or three days, and before the appearance of much eruption.
    A child with scarlet fever should be kept in bed ; and, even in mild cases, if the weather is cold, he should be kept in bed for a considerable time after the eruption has disappeared, so as to avoid exposure to cold. Even when he gets up, he should be kept in a comfortable temperature, so as not to be chilled. The throat should be gargled with warm water. A little sponge mop, dipped in pleasantly warm water, may be frequently used for cleansing it, with great relief and advantage. A very good mixture for the first few days of the disease is the following:-
    Chlorate of potash... ... ... 1 drachm.
    Spirits of nitre ... ... ... 1½ drachms.
    Simple syrup ... ... ... 4 drachms.
    Water ... ... ... ... 4 ounces
Mix one table-spoonful every four hours in as much water. For children below four years, a dessert-spoonful.
    If dropsy sets in, the child should be kept warm in bed. Generally speaking, a little purging is good, and five or ten grains of the compound powder of jalap may be given every morning, or every other morning, unless there is diarrhoea, which should not be checked; and if there is not much fever, the following mixture may be given:-
    Tincture of the perchloride of iron 1 drach
    Simple syrup... ... ... ... 3 drachms
    Distilled water ... ... ... 6 ounces
    One table-spoonful every six hours. Children under four years, a dessert-spoonful, or two tea-spoonfuls.
    In very bad cases of scarlet fever, and in the unavoidable absence of medical advice, keep the throat clear with the mop, as advised above, and give the following mixture:-
    Sesquicarbonate of ammonia ... 36 grains.
    Simple syrup ... ... ... ... ½ ounce.
    Water ... ... ... ... ... 6 ounces.
    One table-spoonful every three hours. Children under four, a dessert-spoonful.
    To Prevent the Spread of the Disease.- When scarlet fever occurs in a house, the child affected should be kept in a large room, and separated from the rest of the family. The nurse should not mix with the rest of the family before changing her clothing and undergoing careful ablutions. The patient's chamber should be divested of everything to which the contagion is apt to stick. The linen, bedclothes, &c., as used, ought to be well boiled, or exposed to a dry heat, 200º Fahrenheit. A solution of chloride of lime (one pound to eight gallons of water) ought to be kept in the room in plates or basins. Another measure which tends to prevent the spread of the disease is to oil the patient's skin well and daily, while it is peeling off. A little of the solution of chloride of lime should be mixed with the various discharges from the patient's body.
   
Measles -The next very common eruptive fever which we have to describe is measles. Few complaints are better known in the domestic sphere, because it affects nearly every one once in their lifetime, generally in their childhood, and, also, because it has well-marked and easily recognised symptoms.
    Supposing measles to be abroad, it may be suspected that a child is going to have them if it has a hard, croupy cough, fever, loss of appetite and thirst, and if these symptoms are accompanied by sneezing and red-looking eyes, and other signs of a cold. The patient, if old enough, may complain of weight and heaviness, and pain in the forehead. Sometimes vomiting occurs but [-187-] not so often as in scarlet fever. This stage may last from two to five days. Then, at the end of from two to five days the eruption occurs, first on the forehead and neck, then the face, and then gradually in from twenty-four to thirty-six hours, extends over the trunk. It consists of little red points, slightly elevated, which run into each other so as to have the appearance of circular, or crescentic, patches of eruption. The eruption disappears on pressure, but soon returns again. When the eruption appears, the severity of the symptoms increases. Often the cough is much relieved by the appearance of the eruption, and on the second day of it, the symptoms begin to abate. By the close of the third or fourth day after the eruption, it has well nigh disappeared in the order in which it came out. Simple cases soon get well ; but a few complications may arise, and a few consequences may give trouble, such as eruptions on the skin.
    The most serious complication likely to arise, or to attend upon an attack of measles, is inflammation of the chest, and in winter this is most likely to be troublesome and even dangerous. The symptoms of this are the continuance of cough and feverishness, and quick breathing after the eruption has been out for a few days, by which time, in simple cases, all the symptoms should be undergoing abatement. Whether the inflammation affects the substance of the lung, or only the bronchial tubes, is a matter that can only be determined by a medical man. Generally speaking, in mild weather and in tolerably healthy children, measles is not a fatal disease.
   
Treatment.-The domestic treatment of measles consists in keeping the patient in bed, in a room with a comfortable temperature, and in administering light diet. If the case is mild, that is, if the feverishness is not great, and the breathing is but little quickened, little more treatment is required. The following mixture would tend to cool the patient and relieve the hard or croupy cough
    Citrate of potash ... ... ... 2 scruples.
    Ipecacuanha wine ... ... ... 1½ drachms.
    Simple syrup ... ... ... 3 drachms.
    Water ... ... ... ... 4 ounces.
    One table-spoonful to be taken every four hours by a child from three to five years old. More or less to older or younger children, and according to the fever and hardness of the cough.
    If the case is at all severe, a doctor should be called in. Indeed, in any case of measles this should be done; for the chest is apt to be seriously and insidiously affected, and the disease is apt to leave "dregs" as they are called, or consequences which require judicious treatment. To prevent the disease spreading, the same measures must be adopted as in the ease of scarlet fever. There is not quite the same urgency, inasmuch as the disease is not generally so fatal.
    It is very curious that scarlet fever and measles were confounded until comparatively recently. Our tabulated description will sufficiently indicate the difference of the diseases.

SCARLET FEVER MEASLES.
1.In the early symptoms, vomiting is a prominent feature. There is an inflamed state of the throat.  1.In the early symptoms, sneezing, cough, and other  symptoms of a cold are prominent. Throat not affected.
2.The eruption occurs on second day of the fever. 2.The eruption does not generally occur so soon; generally on the fourth day.
3.The colour of the eruption bright scarlet. The eruption is in large patches extensively diffused. 3.Eruption is darker, and  and occurs in small circular, or crescentic patches.
4.The skin peels off freely. 4.Slight casting off of skin.
5. Dropsy often follows.  5. Dropsy does not follow

    Vaccination and Small-Pox.-We shall not spend much space over small-pox, for it has no business to trouble anyone now. Vaccination if well done, and repeated once or twice en the course of life, is practically a complete protection against this most horrible disease. The law of the land, in the shape of the Compulsory Vaccination Act, wisely requires every child to be vaccinated before it is three months old, unless a certificate of its unfitness be produced from a medical man. Some dissatisfaction has been at times expressed with this most beneficent law; but most unreasonably so. Vaccination is a most simple operation, it seldom causes much inconvenience, though now and then in children disposed to have skin eruptions, it occasions one. It is still more seldom, or never, the medium of transmitting serious disease, and it practically, as we have said, is a protection against one of the most loathsome and deadly diseases to which the body is subject. The protective power of vaccination may be judged of by the fact, that at the Small-Pox Hospital they did not have one case of small-pox among the nurses or attendants for a period of twenty years or more. Every nurse on entering the hospital is re-vaccinated. The safety of these nurses, not after the vaccination, but after the re- vaccination, shows that vaccination only needs to be repeated to be a perfect protection against small-pox even in a small-pox hospital. There is nothing grander, and yet nothing more simple, nothing more beneficent in the whole history of medicine than vaccination, and nothing can be more unreasonable than the prejudice which it is attempted just now to create against it. If it occasionally gives activity to an eruptive tendency in a child, this is of slight importance, compared with the awful eruption of small-pox from which the child is saved, involving the risk, be it remembered, of permanent disfigurement, of blindness, and other consequences. It should also be explicitly stated that small-pox is followed by eruptions much more frequently, and much more troublesome, than in the case of vaccination. As regards the risk of transmission of serious disease from one child to another, it is so rare as never to have been seen by many surgeons of great experience; and even if this peril has to be incurred, it is by no means so great as that of the loathsome disease from which it saves. Driven from every other stronghold, the anti-vaccinationists have tried to show that while small-pox has been prevented by vaccination other diseases have in consequence become more rife. Well, there is no proof of this. It is a baseless piece of assumption, and even if there was any ground for the idea, most people would prefer anything to small-pox. To object to be saved from small-pox because you may incur some other disease, would be about as reasonable as to refuse to be saved from a railway collision, because you might at some future day sprain your ankle in getting out of an omnibus. On the whole, nothing can be more unreasonable than the objection to be vaccinated. It is not only unreasonable, but it is selfish, for an unvaccinated person is apt to get small-pox and may then convey a dreadful disease to others. Twenty persons have been known to get the small-pox from one person recovering from it. In the light of these facts, it is clear that all persons should submit cheerfully, nay, thankfully, to the Compulsory Vaccination Act, and have their children vaccinated. Not only so, all wise persons will be revaccinated, at least once in their lifetime, and have their children revaccinated as they grow up to maturity. The operation should be done with matter in a moist state and direct from arm to arm. Much has been said lately about having matter direct from the cow; but this is of little consequence, provided that matter be taken from a healthy child. At the surgeries of public vaccinators, parents can judge for themselves of the healthiness of children, but this does not lessen the responsibility of vaccinators, who must consider the selection of good and safe matter a point of the most vital importance.

[-215-]

DOMESTIC MEDICINE.-V.

ERUPTIVE FEVERS (continued from p. 187).

Small-Pox would occur in childhood even more frequently than the other diseases, but for vaccination. Hence we may notice it here. Supposing an epidemics of small-pox to be abroad, all un-vaccinated children should be vaccinated; grown-up persons and children over seven who have not been re-vaccinated should be re-vaccinated, and should avoid contact with persons affected with small-pox. We shall first describe the symptoms of an attack, and then give some general account of its course and treatment. It is not easy, while a person is sickening for small-pox, to be quite sure about the fact. About twelve days elapse after the poison of small-pox has been received, before decided symptoms show themselves. At the end of this time there is shivering, often severe, and vomiting, and a general feeling of lassitude and illness. Another significant symptom is pain in the back, often so acute as to absorb the patient's attention, and lead him to think that his back has been hurt. There is also heat of skin, thirst, and loss of appetite. About two days after the shivering, the eruption begins to appear ; first as little red points, which gradually ripen into the spots of small-pox. These points enlarge, in three or four days a little fluid begins to appear at the top of them, and they go on to ripen into the fully developed vesicle of small-pox, containing first a clear fluid, and then small-pox matter. The spots appear first in the face, neck, and wrists, secondly on the trunk, and lastly on the lower extremities ; they fill and ripen be the ninth day, at which time the pustules break and crusts or scabs form, which begin to fall off in four or five days more. The severity of the disease depends on the amount of the eruption, which is as a rule less when small-pox occurs after vaccination; and it has been observed that the more vaccination marks there are, and the deeper they are, the less severe is the disease. If the small-pox is slight, the spots remain distinct; if; on the other hand, the spots are numerous, they run into each other. The case is then said to be one of confluent small-pox. Occurring in the unvaccinated it is a horrible disease, and fatal in more than one in three cases.
   
Treatment.-The domestic treatment of a patient with small-pox consists in the administration of light pleasant drinks and simple diet, such as gruel, weak beef tea, milk and tea, barley-water, plain water, tepid sponging; in frequent changes of well-aired linen, and in keeping the patient in a well ventilated room, and in a bed without curtains and that does not unduly heat the patient. The room should be as thinly furnished and as free from curtains and carpets as possible, as the contagion of smallpox is very intense, and gathers about such things. For the relief of irritation in the eruption, olive oil may be applied, or equal parts of glycerine and rose-water, after bathing with tepid water. The medical treatment will of course devolve upon a medical man. In places where a medical man is not to be had, the above treatment is the most important. Violent purging should be abstained from. If the patient has been unvaccinated - and, indeed, in any severe case - the greatest danger sets in about the eleventh day of the disease, and the eighth of the eruption. The fever then increases and the swelling of the skin and face is greatest, and renders the patient both uncomfortable and most unseemly to behold. Delirium, twitchings, or diarrhoea are bad symptoms at this stage. If the anti-vaccinationists could see a case at this stage of the disease often, they would talk more gratefully and sensibly about vaccination. The patient now requires to be well supported by strong beef tea, and if much depressed, and the spots do not fill well, by wine.
   
To prevent the Disease spreading.--.Let every person in the house be re-vaccinated, and the patient isolated as much as possible. Clothes must either be destroyed or dealt with as we have recommended in the case of scarlet fever, and exposed thereafter for a considerable time to the air. The scabs contain the matter of the disease, and, as they fall off, should be carefully collected and burnt.

TYPHOID AND TYPHUS, AND INFANTILE INTERMITTENT FEVERS.

Before leaving the eruptive fevers, we must notice typhoid and typhus fevers, not because they occur so frequently in childhood as the fevers we have already noticed, but because they are accompanied with an eruption, and will be better understood, perhaps, if treated in this connection. They resemble the other eruptive diseases of which we have treated, not only in having eruptions attended with fever, but in the fact that persons do not, as a rule, suffer twice from them, it is well to impress on the readers of a popular book on diseases, that typhoid and typhus fevers are essentially different diseases ; that they are different in their causes, different in their symptoms, different in their duration, different in their risks, and especially different in the degree of their contagiousness. The difference of these diseases has been made out in a great measure by our own distinguished countryman, Sir William Jenner, physician to Her Majesty Queen Victoria. As typhoid is the more common disease of the two, especially in childhood, we shall treat of it first.
   
Typhoid Fever- or, as it is called when it affects children, Infantile Remittent Fever - often sets in insidiously, with general signs of illness, such as headache, great muscular weakness and soreness, heat of skin, and furred tongue. If these symptoms persist for several days without cough, or rheumatic pains in joints, or sore throat to give them explanation; and if to these symptoms is added more or less diarrhoea, and in the course of eight or ten days a slight eruption of red spots or pimples, which disappear under pressure, then it is pretty clear that the case is one of typhoid fever. The spots occur on the abdomen, chest and back. They may be very few in number, not more than two or three, or they may be as many as thirty or forty. If the spots are very numerous, and the eruption continues, the disease is generally severe, or at least prolonged. The eruption does not come out all at once, but spots show themselves generally about the eighth day, and on the following days others appear. Each spot has a duration of from three to fifteen days. Muscular weakness, fever or heat of skin, diarrhoea and the eruption of rose or red spots, and a furred tongue tending to become dry, constitute the principal features of this disease. As the disease proceeds, more or less delirium occurs. The diarrhoea is a very important and peculiar symptom. It depends upon the fact, that in this disease the small intestine is almost invariably affected. The little glands in it are either swollen or inflamed, or actually ulcerated. In this way diarrhoea is caused, and the absorption of food into the system is interfered with. Hence, the patients lose flesh fast, and often become extremely emaciated. The appearance of the motions is almost always unhealthy and relaxed; they are very offensive, of a peculiar yellow-ochrey colour, and they separate on standing into a supernatant fluid and a flaky sediment. The intestine is sometimes so much ulcerated as to bleed freely-the blood appearing in the motions. Consistently with this state of the bowels, there is generally tenderness and some swelling of the abdomen (stomach). When the disease occurs in children, it is not so fatal as in adults, and it is characterised by remarkable remissions of - that is to say, improvements in - the symptoms. The child who has been hot and restless, and perhaps slightly delirious in the night, is comparatively well about nine or ten in the morning, and remains so for three or four hours. The fever is essentially connected with the state of the intestine but there may be cough and other complica-[-216-]tions. It is a disease which extends over several weeks In the case of children it is not a very fatal disease, though a disease of great importance and severity, often leading to extreme emaciation, which suggests fears that there is some other complaint about the child It will be readily understood that with such a sensitive condition of the intestine, the child or even the adult passing through or recovering from this disease is apt to be hurt by irritating or injudicious diet.
    We should not fail to say, that bed sores are not uncommon in this disease, owing to the patient lying so long on his back, and this in a prostrate condition.
   
Causes.-In the great majority of cases typhoid fever seems to arise from a very particular cause - namely from animal or vegetable matter in a state of decay or putrefaction, and especially from sewage matter. In every house in which cases occur, drains should be looked to, to see if there is any escape of sewage matter or of sewage gases. A very common cause of the disease in badly drained towns or villages, is the admixture of sewage matter with drinking water. This is very apt to happen if well water is used. Every now and then we hear of wholesale epidemics of this disease occurring in the line of a certain set of water-pipes, houses supplied by other water-pipes being exempt amid prevailing disease. The motions of persons affected with this disease are charged with the power of conveying it, so they should be at once disinfected and completely removed. All drains of the house should be disinfected also. For this purpose a teaspoonful or two of crude carbolic acid should be mixed with every motion ; and the same should be frequently put into the water-closet pan. Motions should not be allowed to remain long in the room.
   
Treatment.- We need scarcely say that typhoid fever is not a disease for domestic treatment only. The domestic treatment will consist chiefly in the administration of proper food ; in anticipating the natural wants of the patient independent of suggestions from him ; in looking for any redness or sore of the back, and in keeping the patient as clean as possible consistently with not disturbing or raising him too much. Beef tea, broth, and milk will be the best diet ; but towards the second or third week the patient may require stimulants. The exact decree mind kind of these must be determined by a medical man. There has been a tendency of late years to administer too many stimulants both in fever and other diseases but used moderately and judiciously, they are undoubtedly beneficial in this disease. We should repeat here the caution about giving animal or other solid food during convalescence from typhoid fever. Great care should be taken in consideration of the fact that the intestine is only recovering from a state of ulceration. Relapses may be induced, and other harm done by giving solid food too soon. The apartment of the patient should be kept airy without exposing him to draughts of air. The skin of the back should he frequently looked to. Inflamed spots may be bathed with a little spirits of camphor, and a water or an air cushion should be placed under the part on which the patient lies constantly. If the disease is infectious or contagious at all, it is only slightly so-unlike typhus, which we shall immediately describe ; and if proper care be taken to remove and disinfect all the discharges of the patient, especially the motions, to rectify and disinfect the drains,  and to purify the water supply, there is little fear of it spreading. The rest of the treatment must devolve on a medical man, and requires much judgment.
   
Typhus is not so common in children as in adults, nor, probably, is it so common in children as typhoid.  It is a disease arising out of a state of poverty; want and overcrowding are the conditions in which it arises But when it occurs, it is intensely contagious, and may affect any one who has much to do with the patient It often prevails epidemically during seasons of general scarcity. Its chief centres are large towns, especially Glasgow and Liverpool. Its chief victims are the poor, and those who have unavoidable or kind relations with them - unlike typhoid, which attacks rich and poor indiscriminately. 
    The symptoms of the disease somewhat resemble those of typhoid fever - that is to say, it sets in with heaviness, muscular weakness, headache accompanied with fever, and furred tongue, which soon becomes dry. There is great prostration of nervous and muscular strength. The points of distinction between this disease and typhoid are principally two or three: first, in the nature of the eruption; secondly, in the absence generally of diarrhoea and of that tenderness of some parts of the abdomen which are so common in typhoid ; thirdly, in the disease being of shorter duration, and more apt to come to a height and change definitely on a given day in the way of a crisis, such as the fourteenth day. A favourable crisis is shown by a decided fall in the temperature of the patient, or by a fall in the pulse, or by the recurrence of sleep after prolonged watchfulness, or by the concurrence of a number of these favourable symptoms. Relapse is not common in typhus.
    When fatal, it is usually so between the twelfth and twentieth days. The greater the age of the patient, the greater the danger of the disease.
    The eruption, or rash of typhus, appears about the seventh day, or earlier ; it consists of irregular spots of a dusky or mulberry hue, and after the first two or three days scarcely disappears under pressure. The spots do not come and go, as is the case with the rose spots of typhoid ; they all appear in the course of three or four days, and remain throughout the disease.
   
Treatment-The general and more domestic treatment of typhus does not differ from that of typhoid. The nervous prostration is greater, the weakness of the circulation is greater, and hence stimulants form a more indispensable part of the treatment, but their use must, of course, he dictated by medical judgment. Good ventilation, plenty of simple nourishment, such as beef tea, milk, &c. ; attention to the wants of the patient ; looking closely to the state of the back for redness or sores, and being ready with an air or a water cushion, and doing everything for the patient with as little disturbance or movement of him as possible, are the principal points in the domestic management of cases of typhus fever.
    But there is another point of great importance; it is this : to remember that the disease is very contagious, and that therefore the number of persons exposed to the risk should not be greater than is proper or unavoidable. The room should be freed from carpets and curtains, and have a comfortable amount of fire in it. Above all, it should be well aired. All the discharges of the patient should be disinfected, as directed in the case of typhoid. Clothes should be disinfected by prolonged boiling, or by exposure to a dry heat of coo degrees, and afterwards to fresh air.
    It will be understood how significant and important is the occurrence of such diseases as typhoid and typhus. On any large scale they are matters of public interest, for they imply errors in the social conditions of the people, such as it is the duty of good government, local and imperial, to prevent. Epidemics of typhoid happen so often, and on such a huge scale, in connection with palpable faults and flaws in the water supply of towns and villages, that it has been considered the time has come for making water companies responsible in damages to the sufferers or their survivors. Often, of course, the fault is more that of the individual householder than of the water companies.
    Epidemics of typhus suggest extensive destitution and the crowding of the poor into ill-ventilated houses; they arc to be decreased by everything tending to improve the physical condition of the people.

[-226-]

DOMESTIC MEDICINE.-VI.

RELAPSING FEVER.

THIS is a disease suggestive of extensive destitution. It often occurs in populous towns. It differs from typhus in being not at all fatal, and in the fact that the sufferers are liable to relapse. After being ill for a week, they seem to be getting pretty well for another week, and then they have a return of all the symptoms. Like typhus it is very contagious, and seems to affect nearly all the members of the poor homes in which, for the most part, it occurs.
    The symptoms are shiverings, headache, muscular pains followed by fever, rapid pulse, thirst, pains in the epigastrium, and vomiting. Blood-stains like bruises may appear, but there is no proper eruption. There is considerable prostration. On the fifth or the seventh day there is great improvement, till about the fourteenth, when the patient relapses. On the the third or fourth day after this, the patient again improves and gradually gets well. The disease is seldom fatal.
    The patient should be isolated or sent to the fever hospital. Little treatment is required, other than simple nourishing food and rest in bed.

HOOPING-COUGH

This disease is like the diseases discussed in our last papers in two respects it is intensely contagious, and it seldom occurs more than once. The main features of it are very palpable and very familiar. It is from time to time extensively prevalent throughout the country.
    Hooping-cough generally begins with symptoms of a common catarrh or cold, such as sneezing, cough, and feverishness. After these symptoms have lasted for about a week, the cough begins to show the peculiar characteristics of hooping-cough, which may be said to be two: first, it is paroxysmal-that is, it comes on in severe fits, with intervals of comparative freedom ; secondly, it is attended with a hoop. In the majority of cases the paroxysms or fits of coughing are worse in the night. There is every variety in the severity of the symptoms of cold which usher in hooping-cough. They may be quite mild, or they may be very sharp.
    The peculiar character of this disease is the hoop, which we shall try to explain. It arises from the spasmodic closing of the upper part of the windpipe. The child affected with hooping-cough, at the end of a fit of coughing severe and prolonged, is apparently in a state of impending suffocation. The air has been all, or nearly all, expelled from the lungs by the successive acts of coughing. The face is red or blue ; the nose, or any part of the mucous membrane of the head or chest, may bleed; and the whole frame seems shaken and terrified. To all appearances the child is in extremity for want of air. The only comfort is that, as a matter of fact, here, at least, when matters are at their worst they mend. Just when the child seems on the point of suffocation, it draws in a long breath through the closed glottis, or upper part of the windpipe. It is the passage of air through this narrow chink that gives rise to the sound with which we are all so familiar. This, so far from alarming us, may reassure us that air is getting in where it is badly wanted. The fit of coughing may now terminate, but generally it begins again after the hoop, which is seam followed by a number of short, hurried coughs, until some glairy phlegm is coughed or vomited up, and the child breathes again like other people.
    Occurring in its simplest form, hooping-cough is a nervous or spasmodic disease, coming on in fits of coughing, and leaving the patient in the interval pretty well. But it is seldom that it is altogether so simple as this, and we may specify two or three ways in which the disease is apt to be complicated.
    First, the child is apt to have inflammation of the chest. Generally there is more or less of bronchitis ; but in a considerable number of cases there is a good deal of bronchitis, which alters the character of the cough, and which rosy be known by feverishness, quick breathing, wheezing sounds, and the other symptoms which we have described under the head of bronchitis. Bronchitis alters the sound of the cough. After a day or two it prevents [-227-] the hoop. As the bronchitis subsides the hoop returns. If the child is of a healthy constitution, the probability is, that with proper treatment the bronchitis will terminate favourably ; but it is an important complication, requiring good medical judgment. Inflammation of the lungs itself may occur, and may be known by similar symptoms to those of bronchitis, and especially a very hot skin.
    Another complication of hooping-cough is convulsions - They may come on suddenly, or be preceded by drowsiness. They are more apt to happen in teething children or in children of a certain delicate constitution, characterised by a large head, large stomach, small limbs late teething, late walking, &c. Frequent vomiting, occurring independently of fits of coughing, in connection with any tendency to convulsions, is a serious symptom.
    Another effect of hooping-cough sometimes causes anxiety - a great loss of flesh and flabbiness of the child This occurs often quite independently of serious disease, probably from weakness and exhaustion, consequent on the harassing nature of the disease. If this loss of flesh concurs with a feverish temperature of the body, it is more serious than when the body is cool.
   
Treatment.- There are few diseases for which more various remedies have been prescribed than hooping-cough, from which we may learn that it is a difficult disease to treat, or make any very favourable impression on. Only in very simple cases would it be right to trust to domestic treatment - that is to say, in cases where the fits of coughing are not very severe ; where the patient is little thinned by the disease, and breathes well in the intervals of the fits. In these cases a few simple remedies may be tried. Amongst these a very safe remedy is Roche's embrocation. The following is the in recipe for compounding this famous, though somewhat dear, liniment:-
    Olive oil ... ... ... ... ... 1 part.
    Oil of cloves ... ... ... ... ½ part.
    Oil of amber ... ... ... ... ½ part.
    Among internal remedies that may be tried are alum. Three or four grains rosy be given to a child a year and a half or two years old every four or six hours in water. It is most likely to be useful in cases in which there is a great accumulation of phlegm, and in which the skin is cool. Another valuable remedy is dilute nitric acid, in the following form:-
    Dilute nitric acid... ... ... 1drachm.
    Spirits of nitre ... ... ... 2 drachms.
    Simple syrup .. ... ...  ½ounce.
    Water ... .. ... ... 6 ounces.
A child five years old may take a table-spoonful every four or six hours in as much water, according to the frequency of the cough. Younger children can take one, two, or three teaspoonfuls every four or six hours.
    During the actual fit of coughing let air be admitted freely to the child, whose mouth should be kept clean. Everything tight about the dress should be removed. For the emaciation which is apt to occur in hooping-cough a little cod-liver oil is a good remedy. A teaspoonful night and morning to begin with, increasing the dose gradually.
    Supposing all other remedies to fail, a change of air is a most powerful one, and often cures the disease. In all cases, as recovery begins, it is a valuable means of restoring the child to complete health, in moving about with hooping-cough, or any other infectious disease, it is not only in accordance with the requirements of the law, but with those of common sense and consideration, that all possible precautions be taken not to carry the disease to other persons.
    The diet of a child suffering from hooping-cough should be simple, unstimulating, and nourishing; milk, especially, is good.
    If symptoms of inflammation of the chest set in, the case is, of course, past domestic treatment, and therefore need not be further discussed.

MUMPS.

Here we have another disease that may seem very different from the eruptive fevers we have discussed, and yet has many points of resemblance. It is often epidemic; it is very infectious ; it seldom attacks persons more than once in a lifetime ; it is seldom propagated except by infection - that is to say, by communication with some other child or perocn who has had the disease. It is like the fevers in another respect - that it is attended for a time with smart feverishness.
    The disease consists essentially in a kind of inflammation, rather an enlargement, of the large gland, called the parotid, which lit s between the jaw and the car; the other glands under the jaw and under the tongue are likewise sometimes affected. Every swelling of these glands must not be called mumps, but the name must be restricted to that large and painful swelling which occurs in the above situation, and which affects a great number of persons at one time - in other words, is contagious. The swelling is tender and painful, and has a bruised feeling, and renders the jaws stiff; the tongue is white, and the patient generally feverish and unwell. As the saliva which moistens the mouth and food proceeds mainly from the gland affected, the secretion of it is often much lessened, enticing the mouth to be dry, which adds farther to the difficulty in chewing occasioned by the stiffness of the jaws.
    As a general rule, the older the patient the more painful is the mumps. The disease is most common in children over five years. It is not very serious in itself, for it has a strong natural tendency to get well in seven or eight days, leaving the patient somewhat pale. But there is a peculiarity about the disease that sometimes adds to the danger of it, and greatly to the alarm or pain that it occasions. The brunt of the disease may be more or less suddenly transferred from the parotid gland to other parts, especially to the breasts in girls or to the testicles in boys. This change is shown by severe pain and swelling in those parts, and a rapid subsidence of the swelling between the jaw and the ear. Sometimes the transference of the disease is to the head, which then gives rise to nervous symptoms, drowsiness, or delirium. Occasionally the swelling at the angle of the jaw has not made much impression on the patient or his friends, and may quickly disappear, so that the swellings in other parts, or the nervous symptoms, are the first things noticed, and may occasion a greater alarm than if they occurred in clear connection with mumps. Still, these cases are very exceptional, and mumps generally is not a dangerous or serious disease, though a painful one.
   
Treatment. -Though the disease tends to subside in a few days, like most other diseases, it is the better for a little judicious medical treatment. If the case is acute and severe, a medical man should be sent for. In eases which are simpler, or advice is difficult to be got, the following measures will tend to help the patient, and diminish the pain. Poppy fomentations should be used frequently to the swellings - three or four times a day; after using these, a warm piece of flannel should be applied to the part. The following mixture may be given to children at or about five years old:-
    Chlorate of potash ... ... ... 1 drachm.
    Tincture of perchloride of iron 24 to 36 minims 
    Simple syrup ... ... ... ... ½ounce
    Water ... . .. ... 6 ounces
    Mix thoroughly, and, take one tablespoonful every four or six hours.
    The diet of the patient should be simple, and such as can easily be swallowed, as milk, broths, beef tea, &c. and the like.

[-271-]

DOMESTIC MEDICINE.-VII.

CHICKEN-POX.

BESIDES the eruptive fevers, already noticed, we must treat of chicken-pox, one of the most frequent of the diseases of children. It is familiar to mothers and nurses, and consists in the appearance of little spots, round, not depressed in the centre like those of small-pox-very much the same kind of appearance as we might conceive to be produced by dipping a brush into boiling water and sprinkling it over the body. This eruption is preceded by slight indications - generally very slight - of indisposition, such as chilliness, headache, weariness, and sometimes aching in the back and limbs. Often nothing particular is noticed in the child till the eruption appears as little spots, first over the trunk, and then over the face and limbs. They soon fill with clear, or very slightly turbid fluid. They do not extend deeply into the skin, and they do not destroy its substance as the spots of small-pox do. On the third day of the disease the spots begin to dry up. On the fourth day this drying progresses rapidly, and soon after leaves a scab, which in a few days falls off and little trace of the spots is left but slight redness.
    Chicken-pox has been thought by some to be a modification of small-pox. But it is not so. It is quite a distinct disease. Neither vaccination nor small-pox protects from chicken-pox. Chicken-pox occurs almost exclusively in childhood. The spots are of a different shape, not being depressed in the centre, and containing only one compartment, not many. The disease cannot be given by inoculation, as can small-pox, and it is altogether slighter than small-pox.
    It is of little importance itself, excepting that it is very infectious, and pretty sure to affect children exposed to it. Occasionally, like any other eruptive fever, it leaves in some children a tendency to other eruptions for a time. It occurs for the most part in very young children.
   
Treatment.- But little else than domestic treatment is required, though, if there is any undue degree of feverishness or indisposition, it will be well to consult a doctor. A very light diet of milk, and general quietness, are all that are necessary. A little cooling medicine, however, does good, such as the following for a child a year old
        Citrate of potash ... ... ... 18 grains.
        Simple syrup ... ... ... 1 drachm.
        Water ... ... ... ... 1½ ounces.
    Mix. A teaspoonful three or four times a day.
    For older children a mixture in twice the quantity might be made up, and a proportionate dose given.

[-302-]

DOMESTIC MEDICINE.—VIII.

WORMS.

WE now come to a disease in which domestic medicine is apt to be thought quite sufficient. The symptoms of worms are often very equivocal and doubtful, and the cause of worms is a still more difficult question. Yet every old lady thinks herself a judge of when a child has worms, and often puts aside the fine speculations of embarrassed doctors, by exclaiming, " That child is troubled with worms." Nevertheless, the question of worms, and the cure of them, when their presence is ascertained, are among the things that require judgment; and it may here be said that, probably, worms are not so common in human beings, even in children, as is generally supposed. They are very rarely met with in young children under a year. They are more frequently met with in the children of the poor, which is probably due to the fact of their being ill-fed, and to their houses being badly ventilated and unhealthy. The principal worms which affect the human body are of three kinds : the first, the small threadworm (Ascaris vermicularis) ; secondly, the roundworm (Lumbrici); thirdly, the long tapeworm, which is flat, and made up of links or segments (Taenia).
    The Small Thread-worm, so called from the fact that it is like pieces of white thread, is very common in young children, and exists low down in the bowel, very near the seat. Hence it often causes much itching here, and sometimes also in the neighbouring passages, especially of female children. The child is apt also to pick its nose, and grind its teeth at night ; to have a variable appetite ; to look pale and pinched. These symptoms are quite sufficient to make us suspect the presence of worms ; but they have other causes, and there is only one proof of our suspicions being right—and that is actually seeing worms.
    The Round-worm is not unlike a garden worm, and is narrow at both ends. It is of a light yellow or brown colour. It infests a higher part of the intestine than the thread-worms, and not the large intestine, but the small. It may even crawl up into the stomach and be vomited, or it may crawl up higher and enter the nostrils, or even the windpipe ; but such cases are very rare. It may exist singly or in great numbers. The mucous membrane in contact with the worm may be inflamed from the movements of the worm or worms. They occasionally wriggle their way into all the recesses of the bowels. They give rise locally to colicky, gnawing pains about the navel, and often to a kind of diarrhoea; and occasionally serious nervous symptoms are caused by round-worms, such as squinting, twitching of the muscles, or actual convulsions, heaviness, headache, grinding the teeth in sleep, and picking the nose ; but, as we have said, these symptoms may have other causes, and we cannot be sure that they arise from worms unless we see the worms; and even when worms are known to co-exist with serious symptoms, it does not follow that they are the cause of the symptoms. In addition to these symptoms, the child is often pale, and has a fetid breath and a quickened puIse. At the same time the child's general health may be little impaired.
    The Tape-worm (Taenia solium) is a long flat worm consisting of many segments, or four-sided pieces. It is of a white colour, and has a length of five to fifteen feet. I t has its abode in the smaller intestine ; and, is rare in early life. The symptoms are not in themselves characteristic apart from the presence of links, or pieces of the worm in the motion; but in a patient who by this sign is known to have had tapeworms, its presence may be again suspected if he is depressed, and has uncomfortable or gnawing feelings about the stomach, irregular appetite, and the other symptoms which we have described as often caused by worms.
    Worms may cause severity or irregularity in the symptoms of other diseases.
    Causes.—Worm disease is much more common in some places than others; thus, in Paris there are few cases; while in the provinces, and other parts of France, it is a common affection ; it is more common, as we have said, among the poor than the rich. Good food, thoroughly cooked, tends to prevent the disease. Certain unhealthy states of the constitution favour worms, as paleness, indigestion, &c. Too much fruit and too much sugar are favourable to worm disease, and underdone bad meat, probably, often contains the germs of worms, especially of tape-worm. It is often observed that people who are troubled with tape-worms, are fond of meat underdone or half-cooked, especially of pork.
    Treatment and Remedies. — The treatment depends largely on the kind of worm. For the small thread-worm a local remedy is the best in the form of an injection. It comes directly into contact with the worms, and destroys them. The following injection may be used :—

Tincture of perchloride of iron ...  ½ drachm.
Infusion of quassia ... ... 8 ounces.
                Mix.

A sixth part of this may be injected every other night into the bowel till the symptoms are relieved.
    Injections of three or four ounces of lime-water, too, containing ten or fifteen drops of tincture of perchloride of iron, are also very useful for the cure of these small worms.
    For the Round-worms, two or three grains of santonine for one or two nights, followed next morning by a dose of castor oil, is a good remedy ; but it should be given only by a medical man.
    For Tape-worm there is one remedy that is generally most effective, the oil of male fern in some such form as the following :—

Oil of male fern ... ½ to 1 drachm.
Mucilage of acacia ... 1 ounce.
Peppermint water ... 1 ounce.
          M ix.

To be taken early in the morning ; the stomach having been cleared by light feeding the day before on broths, beef tea, &c. &c. It is very seldom that this remedy fails to bring away the worm either at once, or after a second dose.  A few days' interval should be observed between the doses. A dose of castor oil may be given the day before the dose of fern oil is given, and, if necessary, the day after. In addition to worm medicines, care should be taken to give the patient good air, good, sound, well-cooked food, and a little tonic medicine containing iron, such as the following, for a child five years old :—

Tincture of perchloride of iron ... 1 drachm.
Simple syrup ... 1 ounce.
Infusion of quassia ... 6 ounces.
          Mix

One table-spoonful night and morning, in water, after meals.
    [-302-] Leaving this subject and turning to other common diseases, we shall adopt the following alphabetical arrangement in treating of the common diseases that we mean to describe; and when we have reached the end of our list, should space remain, we shall treat, by way of supplement, of any subjects that we may have omitted:—

Abscess.
Ague.
Apoplexy.
Asthma. See Bronchitis.
Bilious Disorders, including Jaundice.
Bladder, Diseases of.
Boils.
Bronchitis, including Asthma.
Carbuncle.
Colic.
Common Cold, including Influenza.
Constipation.
Consumption.
Deafness.
Debility.
Diabetes.
Diarrhoea.
Diphtheria.
Dropsies.
Drunkenness.
Dysentery.
Dyspepsia, including Flatulence, Constipation, and Bilious Disorders.
Epilepsy.
Erysipelas.
Faintness.
Flatulence.
Goitre.
Gout.
Gravel.
Heart, Diseases of.
Influenza. See Common Cold.
Insanity.
Jaundice.
Kidney, Diseases of
Hysterics.
Lead Poisoning.
Liver. Ste Bilious Disorders.
Lungs, Inflammation of.
Lumbago.
Paralysis.
Piles.
Pleurisy.
Rheumatic Fever.
Rheumatism.
Scurvy.
Sore Throat.
St. Vitus's Dance.
Styes.
Water in the Head.

ABSCESS.

An abscess means any collection of matter within a circumscribed cavity. This may vary in size from a common boil to those large collections of matter which are connected, for the most part, with diseases of the glands or of the bones. Boils will be treated of by themselves ; and larger collections of matter, either in the neck or, still more, in the groin, are generally attended with some fault of the system which requires medical consideration. Such collections in the neck often occur in teething children. They should not be poulticed too long, and the matter should be let out almost as soon as it is certain that it is there ; for, if the opening of the abscess by a lancet is deferred too long, the skin gets thin, and is destroyed by pressure. In this way ugly scars of the neck are often left, which would be prevented by an early small opening. The same remarks hold equally true of collections of matter in the groin. In the groin and in the arm-pit swellings of the glands often occur in which matter is formed. These generally depend on sores in the neighbourhood, as in the foot or leg in the one case and in the fingers or arm in the other. Such sore places should be poulticed. Patients with abscesses require good support. [See BOILS.]

AGUE.

Ague is a disease not much seen in England now, except in some marshy parts, chiefly along the eastern coast — in parts of Kent, Essex, Cambridgeshire, Norfolk, Lincolnshire, and the East Riding of Yorkshire. Agues used to be very frequent and fatal, even in London. James I. and Cromwell both died of ague contracted in the metropolis. Doubtless the decline of the disease is due to the improved drainage of the country. It is still very common in some countries, as along the low and level coast of Holland ; in pans of Italy, especially the Pontine Marshes, near Rome ; in parts of America, as North and South Carolina and Virginia ; in various parts of India and Africa. The ague is a fine specimen of a
periodical disease. it comes on in fits at a particular time, as if it kept a watch, goes through distinct stages, and then leaves the patient pretty well, as he continues to be until the next fit returns. An ague-fit consists of three well-marked stages : 1st, the cold stage ; 2nd, the hot stage ; and 3rd, the sweating stage. There are different kinds of ague — the quotidian (daily), the tertian (third day), the quartan (fourth day ague). In the first kind there is an interval of twenty-four hours between the fits; in the second of forty-eight hours ; and in the third of seventy-two. In the daily form the fit occurs for the most part in the morning; in the tertian form at noon; in the quartan form in the afternoon.
    Symptoms.— As we have said, the ague has three stages — the cold, the hot, and the sweating. The cold begins by the patient feeling very shivery, until he shakes and chatters with his teeth and looks the picture of cold and misery. It lasts from half an hour to three hours. It then gives place to the second or hot stage, in which the patient gets as uncomfortably hot as he was previously cold. This stage may last from three to twelve hours — generally not less than three — it is succeeded by the sweating stage, which does not last more than a few hours, and ends in complete relief. The patient is left comparatively well in the interval. But if the disease is not treated with the wonderful remedy for it, various internal discomforts and congestions are apt to arise. The internal organs — especially the spleen and the liver — seem to get loaded with blood during the cold stage, and sometimes remain for a time congested and enlarged.
    Treatment. — The treatment of ague is perhaps the most successful thing in the practice of medicine, for we have a remedy that is almost a specific for it, and cures it like a charm. We mean quinine. If the value of quinine, or bark — for quinine is just the active part of bark — had been discovered in time, probably the lives of both James I. and Cromwell would have been saved. It is curious to think what might have been the political consequences of the earlier discovery of this medicine. As will be readily imagined, the treatment of the disease varies in its stages. When a patient is in the first stage the only thing to do is to promote the return of warmth by covering him over with warm blankets, putting warm bottles to the feet, stomach, &c., and giving warm drinks. In the hot stage, on the other hand, the heat must be moderated by light clothing, cooling or effervescing drinks ; and in the sweating stage the chief thing to do is to administer freely pleasant drinks, and to let the patient be still and comfortably covered. It is in the interval of the fits that the great remedy must be administered ; and the administration of it in any particular case should be regulated according to medical advice. Where this cannot be had we may lay down the following rules:—Two or three grains of quinine should be given in water containing a few drops of dilute sulphuric acid every four or six hours. Sometimes a dose of opening medicine greatly helps the favourable action of the quinine. If the disease occurs in a very severe form, or in a tropical country, larger quantities of quinine will very likely be required; and the patient should begin to take it in the sweating stage. If the quinine does not soon take effect, it is probable that there is some internal congestion hindering the patient's recovery, about which he should take advice. If he cannot get this he may take a purgative, put large mustard plaisters over the liver and spleen — that is to say, at and below the edge of the ribs — on both sides, and then resume the quinine.
    There are other diseases in marshy countries which are very apt to have the feature of periodicity, and the treatment of them is often rendered much more successful by the addition of quinine to other medicine; as all who have had experience in this direction know.
 

[-318-]

DOMESTIC MEDICINE.—IX.

APOPLEXY.

THE word is derived from two Greek words— apo [in Greek script in original, ed.], by means of; plesso [in Greek script in original, ed.], to strike — because those attacked often fall down as if from a blow.
    Symptoms.-The ordinary features of the disease are a sudden loss of consciousness, unattended with any convulsion ; the breathing is laboured and heavy, and the face generally flushed. The patient falls suddenly down. The loss of consciousness may not be quite complete ; and in this case speech may be lost or only impaired. One side will be more or less paralysed.
There are many variations in the way in which the attack comes on. For example, the patient may at first look pale, and the loss of consciousness may be gradual, and not sudden. In this case there is apt to be vomiting. Again, there may be some amount of convulsion, or working of the arm or leg of one side. The important thing for people to know is the difference between apoplexy and drunkenness, and between apoplexy and faintness. It is common in the streets and in police-stations to treat a man with apoplexy as if he were "only drunk." And in a country where, alas! men are too often seen deeply drunk in the streets, it is not so remarkable that this mistake should be made. It is not always easy to distinguish between drunkenness and apoplexy. Drinking tends to produce apoplexy, and then a man may be both drunk and the subject of apoplexy. The guiding points are the smell of drink and the account of persons who know the patient, and the fact that drunken persons are not generally so profoundly asleep as not to allow of being roused. Between apoplexy and faintness the points of distinction are principally these. A faint person is pale ; the breathing is quiet, not noisy, as in apoplexy; the pulse can scarcely be felt at the wrist, whereas in apoplexy it is apt to be full Apoplexy occurs for the most part in elderly persons, and in men ; faintness in younger persons, especially women, and when in close places.
    Causes of Apoplexy.—The occurrence of apoplexy in a person generally shows that there is something wrong in the walls of the blood-vessels of the head. They have lost their healthy elasticity—become too soft or too hard—and given way instead of expanding when a little extra pressure was put upon them. It is not so much that people have short necks or long ones as that they have unsound blood-vessels. This is worth everybody's knowing ; for while people cannot alter the length of their necks, they can—so great is the control of people over their health—do a good deal to keep their blood-vessels sound or to spoil their blood-vessels. Let us give, then, a few hints to people who fear apoplexy; whose father or mother perhaps have had it; or who have lived hard, and have some warnings of it, such as dizziness, slight loss of memory, slight paralytic attacks, and the like. Let nobody think that there is any reason why he should die of apoplexy because his father did. Doubtless it is sometimes hereditary; but a great deal can be done to prevent the development of hereditary diseases. The points to be aimed at to prevent apoplexy are a regular life, free from all excess or intemperance. Excess in eating or drinking is very bad for persons with any tendency to apoplexy. Anything which loads the blood with alcohol or strong animal food tends to produce that condition of the blood-vessels which leads to apoplexy. So, persons with this tendency should drink very little, and claret, or, at most, very weak sherry and water should be their stimulant; and teetotalism, if they are not weak or very much jaded, should be tried. An occasional dinner of fish or fowl will be beneficial. Suppers should be light. Sleep should be regularly taken, and neither too much nor too little. Probably of the two extremes the more [-319-] common now-a-days is too little. Exercise in the open air, and healthy, well-ventilated rooms, especially sleeping-roomis, is also important. Care and worry—things very difficult to avoid in this world—should be avoided as much as possible. Attention to these points will greatly tend to preserve the healthy condition of the blood-vessels and other parts of the body., on the integrity of which safety from apoplexy depends. We need not add that nothing tight about the neck should be worn. If what we have said be true, we need not say that much drinking, much eating, indolence, and inactivity, horror of the fresh air, and love of close, warm rooms, are the ways by which apoplexy is to be produced.
    Treatment.—This, of course, is a matter for a medical man. But supposing a person to be attacked with apoplexy, his head and shoulders should be raised, his necktie, and any other tight garment, should be unloosed. And nothing more should be done till a doctor arrives.
    Prospects of the Case.—Recovery may be quick from this condition, or it may be gradual, or death may result in a few minutes, or hours, or days. Let the nature of the disease be considered, and all this variety of result will be understood. The disease consists in the breaking of a blood-vessel, and the escape from it of blood. If the blood is in great quantity, and in the central parts of the brain, death will probably result ; if it is in small quantity, and the escape of more is prevented by quietness, this blood will be absorbed and consciousness will return, and any want of power in the side will gradually be supplied. It will easily be understood that when blood escapes into the brain it tears it up. If there is much of this, even if the blood itself be absorbed, some paralysis is likely to remain. Of course, when an attack has once happened it is not less apt to happen again. In order to prevent this, the same precautions should be taken as we have described for preventing a first attack.

ASTHMA.

Asthma is a disease in which bad breathing comes on in somewhat severe sudden attacks, characterised by a loud wheezing noise. It is a spasmodic disease, that is to say, the muscular fibres surrounding the small bronchial tubes, through which the air passes to the lungs, contract, and so diminish the calibre of the bronchial tubes, often to an excessive fineness, which makes breathing painful, difficult, and very noisy. These attacks of spasmodic breathing are sometimes occasioned by something in the air that irritates the passages. Some substances in the air will excite a fit of asthma in some people—such as ipecacuanha. The writer knows a patient in whom the odour of a linseed poultice often excites asthma. It is not always the clearest air that suits the patient best, for people troubled with asthma have been known to breathe better in the atmosphere of St. Giles's than at Hampstead. On the other hand, people that have scarcely been able to breathe in the more crowded parts of London have got well on Hampstead Heath. Sometimes asthma is brought on by excitement, or emotion of any kind, as fear, love, &c. Sometimes it is brought on by heavy suppers, by indigestible or irritating food. The writer knows a medical man who has cured himself of a liability to asthma in the night by either not taking any supper, or only a very light one. The disease is more common in men than women ; it is often hereditary.
    Symptoms.—The sight of a person with asthma is very characteristic. There is quite a gasping for breath, the eyes staring, the breathing accompanied by a loud or a fine wheezing noise, and the patient assuming a peculiar position—if standing, probably having his hands resting on the back of a chair ' • if sitting, leaning slightly forward, with the hands on the knees, the mouth open and greedy of air. The lips will become livid or blue if the breathing is not soon relieved. Attacks often come on in the night.
    Treatment.—A medical man should be sent for, but before he arrives a few things may be done calculated to relieve the patient. Plenty of air should be admitted to the room. If indigestible food has been taken, a stimulating emetic may be given, as half an ounce of mustard in hot water. After the operation of this, or at once, if an emetic is not judged necessary, a cup of strong coffee may be administered. A strong mustard plaster may be applied to the chest. Various substances, smoked or inhaled, have the power frequently of relieving the fit of asthma. Among the most homely of these is the smoke of burnt nitre paper, that is of brown paper dipped in a strong solution of salt- petre (nitrate of potash) and dried. The smoke of this burnt paper often relieves the asthmatic attack. So does a pipe of tobacco, especially in those not accustomed to take it. Medicated cigars, too, are prepared for these attacks, especially cigars of Stramonium and of Datura Tatula. These should only be taken under medical advice, but they are often singularly useful.
    All these failing, the asthmatic patient should try change of air. Nobody can tell him what air will suit him best, for the disease is so capricious, that sometimes it is benefited by an air that one would expect to be injurious. But the effect of change of air is often magical, and this remedy often succeeds when all others fail. As a general rule the patient in taking a change of air should go to an atmosphere entirely different from that in which he is living. Anything wrong in the general health should be put right. The asthmatic should live regularly and simply, and, as far as possible, he should live in the atmosphere that suits him the best. (See Bronchitis.)

[-334-]

    DOMESTIC MEDICINE.—X.

    BILIOUSNESS AND BILIOUS ATTACKS.

    WE will treat first of biliousness. As we have already said, people are very fond of attributing all sorts of symptoms to bile, and are rather pleased than otherwise, when ailing, to be told that their liver is affected. The symptoms generally held to show that people are "bilious" are such as the following :—Want of appetite, foul tongue, constipation, sallow or dingy complexion, flatulence, and other symptoms of indigestion. If any pain about the right shoulder or side is added to these symptoms, then they would be held by "liver" doctors and their patients to be unmistakably bilious. And so they may be ; only people should know that really very little is known concerning the symptoms of too much bile, or too little bile, or bad bile. Cases of jaundice are better understood ; but the less obvious affections of the liver are yet very obscure ; and no great harm and very much good would be done if people talked and thought a little less about their livers. It is probable that in many cases in which the above symptoms are present, the stomach and the intestines are as much at fault, or more, than the liver. Where the complexion gets dingy, the skin greasy and not clear, the countenance rather bloated, where the bowels are costive, where there is a general sluggishness of body and mind, and where digestion goes on slowly and uncomfortably, with much wind ; in this case probably the small intestines are as much at fault as the liver. But this is the condition called "biliousness." The state of the bowels is characteristic ; the motions are hard, dry, and dark, and the urine is frequently thick.
    Causes.—The causes of this condition are various. It is not uncommon in those who have resided for some time in a climate hotter than their original one. It is almost natural to some people ; and in others it is largely brought on by inactivity, by too much food and beer or stimulants, and by want of exercise in the fresh air.
    Treatment.—It is in such cases as this that the discipline of a hydropathic establishment, if not its water, does good. But, short of such a costly remedy as this, much may be done by careful diet and simple living to cure this condition of biliousness, which is both depressing and distressing. A mild purgative occasionally in the morning will do good—such as a teaspoonful or two of Epsom salts in cold water, or a tumbler-full of equal parts of Frederickshaller and hot water. Light food, such as a fish dinner occasionally in place of a heavy dinner, and the use of water, with a glass or two of cheap French wine, in place of the rich beer and hot spirits which are too largely used in daily life in England. Where the light French wines are not liked, nothing stronger than a little weak sherry and water should be taken. Bilious people should eat brown bread, too, instead of white, and should use water freely for washing all over the body every morning.
    Bilious Attacks should be distinguished from "biliousness." Biliousness is a slow habit of dull health. Bilious attacks occur at intervals. They are characterised by severe headache, furred tongue, sickness, perhaps vomiting, and occasionally there is diarrhoea, though there may be constipation. The vomited matters at first consist only of food taken, or of the mucus of the stomach ; but if vomiting continues, then the vomit may be yellow or green. Such attacks are accompanied with shiverings and a feeling of illness. They occur frequently in persons subject to them ; sometimes they seem to occur almost at regular intervals. Notwithstanding that such attacks are called bilious attacks, it is probable that the stomach is as much to blame as the liver. The vomiting of bile proves nothing as to "biliousness," for if vomiting occurs from any cause and goes on long enough, some bile will find its way into the stomach and be vomited up.
    Causes.— Such attacks often come on without any very obvious cause. But in other cases it is possible to trace these to one of two causes. A cold east wind, or a long continuance of wet cold weather, especially if it be long continued, will produce such attacks in a large number of people. The complaint is really a sort of "cold" in the stomach—what doctors call gastric "catarrh." Very often it is preceded and followed by symptoms of a cold. At other times this is the only cold experienced ; and just as other people would get a cough or cold out of exposure to an east wind, persons subject to bilious attacks will get one of these. Another common cause of the attacks we have been describing is an indiscretion in diet—taking something indigestible. Different people will find different things to disagree with them, and it is impossible to lay down a rule of forbidden food that would apply to all cases. But every person may easily find out for himself what does disagree, and abstain from it. Sometimes such attacks come on not from the bad quality but the bad quantity of food—too much. People indulge in too much food, or too much wine, or spirits or beer.
    Treatment.—When such attacks occur they will often yield to domestic measures. The principal points are, rest both of the stomach and the system. The patient should first be quiet ; and if very bad, he should lie down, and give his stomach nothing to do for a few hours, more than drinking a little water or a little thin milk-and-water ; thereafter he may take a little barley-water, or mutton broth, or beef tea, without fat, and wait till some appetite comes upon him before taking stronger food. If he is cold and shivers, hot bottles may be applied to the feet. In addition to these measures, if the sickness is troublesome, a little mustard plaister may be applied over the stomach, and an effervescing draught may be taken every three or four hours, consisting of a teaspoonful of the effervescing citro-tartrate of soda of the British Pharmacopœia. Should the sickness continue, or be accompanied with other persisting symptoms, a medical man should be consulted. The great thing for people subject to such attacks is to avoid them. By avoiding exposure to cold and wet, and such articles of food and drink as are likely or known to disagree with them or to irritate the stomach, it will often be possible to prevent such attacks coming on.

[-349-]

DOMESTIC MEDICINE.—XI.

BILIOUSNESS OR BILIOUS DISORDERS, INCLUDING JAUNDICE (continued from p. 335).

    EVERYBODY thinks himself a physician for this complaint. Of all theories that occur to people to explain little errors of their health, none occurs more commonly
    than that of Bile—" it's only bile." No organ of the body has more blame laid
    upon it than the liver. It is the best abused organ in the body. It is a curious fact, but one that may often be noticed, that ailing people seem to derive great satisfaction from thinking, or being told, that their "liver is affected." What makes this more curious is the fact that though the liver is a large organ, and though it secretes about two pounds or two pounds and a half of bile everyday, of a dark golden brown colour, the wisest people are still very uncertain about the uses of this big organ and all the bile that is formed in it. It is often the case, however, that what learned men know least about ignorant men talk most about. It is easy to talk glibly about that of which little is known. Let us try to tell our readers what little is made out as to the uses of the liver, or rather of the bile that flows out of it into the intestine just below the stomach.
       First, the bile in some way or other assists digestion. It especially assists the digestion of oily matters.
       Then, though it is not necessary to the digestion of meat and eggs, and such like (albuminous) substances, it is necessary to prevent the putrefaction of these in the intestines.
       Thirdly, it removes from the blood things that would injure the system if there were no liver to remove them.
       Fourthly, it contributes something to the formation of the motions from the bowels, but not so much as used to be thought. A great part of the bile that is formed in the liver and thrown out into the intestines is absorbed again into the system from the intestines—not thrown out of the body with the motions.
       Some cases of disease of the liver occur in which no bile is formed in it. The bile is retained in the blood. If this disease is extreme and intense—that is, if no bile is separated from the blood, the chances are that the patient will die heavy and in a deep sleep. For if the urine or the bile, instead of being separated from the blood, are left in it, they act as poisons, and cause either convulsions or coma ; that is, insensibility and death.
    Let us now try to describe the two common cases of jaundice and the so-called bilious attacks.
       [-350-] Jaundice.—Jaundice is a disease easily recognised by non-medical persons, for its chief sign is a yellowness of the skin and of the white of the eye. There may be any degree of this discoloration from slight yellow, such as is seen in most babies a few days after birth, to intense green yellowness, such as often shows disease of the liver. The motions are pale and without their usual colour. There is indigestion, flatulence, and dislike for fatty matters, which are not easily digested. There may be pain over the stomach and liver, or there may not be any pain, and as we have implied, the skin and the eyes get yellow, because what should be separated from the blood by the liver, is not, and gets into all parts of the system. The bowels are generally costive.
       Causes.—Now this state of jaundice may arise either because no bile is formed in the liver, or because, after being formed, it does not get into the intestine. This last is the most common case of jaundice. It may be stopped from getting into the intestine by something blocking up the ducts which convey the bile; one of the most common, and really a very common, cause of obstruction to the flow of the bile is the formation of little stones in the gall bladder—gall stones—which in passing through the duct that connects the gall bladder with the intestine give rise to severe symptoms, which we shall now describe.
    Symptoms of Gall Stones.Probably after some uneasiness about the right side there sets in, often suddenly, severe pain in the right side or more towards the stomach, so severe as to make the patient writhe. Vomiting soon comes on and is troublesome, though it tends to relieve the pain. The pulse is not much quickened, nor is there much fever. There is often more or less of the yellow tinge of jaundice in the skin or in the eye, and then one may be pretty sure that the case is one of gall stones. In such cases the motions passed after the pain has ceased often contain stones, and should always be carefully examined.
       Another common cause of jaundice is when the little ducts we have mentioned become inflamed, and their walls get thickened, and the passage of bile along them is hindered.
       There is a form of jaundice, occurring in summer or autumn, which we may call painless jaundice, that is not uncommon. It is jaundice and nothing more than that, and the heavy indolent state that accompanies it.
       The most unfavourable cases of jaundice are those which occur in older people, and especially in those who have lived very hard, or very anxiously; and in which, notwithstanding the use of means, the jaundice persists.
       Treatment.—The reader will not expect us to advise him to treat himself for a complaint which may depend on many different states, and requires very various treatment. But we shall aim at giving a few useful hints to persons affected with gall stones, or having occasional attacks of jaundice. Gall stones occur most frequently in women, and in those who lead a somewhat easy or rather indoor life, especially if they take beer or porter, and have a tendency to become stout. Such persons should live carefully and be chary of beer, and should take exercise in the open air. When an attack of sudden pain from gall stones comes on, a doctor should be sent for. Hot fomentations to the side, drinks of warm water, and hot applications to the feet, should all be used. If the pain is very severe, and a doctor cannot be had, ten drops of laudanum may be given to a grown-up person, and may even be repeated in an hour or two if relief does not come. If, however, the pain shows any tendency to yield to the former measures, the laudanum should be dispensed with.
       Lastly, let us say a word to hard livers, and all who are conscious that they drink more than is good for them. Whenever they see their eyes or skin getting yellow, let
    them know that their sin is finding them out, and that it is beginning to affect very vital parts, and that if they do not take thought and mend, they will go steadily from bad to worse. But in such cases, it is often wonderful how improvement in health follows improvement in habits.

 

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