Chapter 11

Even if the swelling is caused by rupture this treatment is the best. The rupture must be reduced (_see_ Rupture) and sustained by a proper truss, for which the patient should apply to a responsible surgical instrument maker. This treatment alone has cured many dropsical patients. Where failure of the heart's action complicates the trouble, this treatment will usually relieve the heart as well as kidneys. For drink in such cases see article Drinks. For food give whatever is most easily digested and passed into good blood. Wheaten-meal food, oatmeal jelly, etc., are good. _See also_ Biscuits and Water.

Drowning.--Many valuable lives have been saved by an elementary knowledge of what to do in the case of one apparently suffocated or drowned.

Commence treatment immediately in the open air, with the face down, neck and chest exposed, and all tight clothing such as braces removed.

The points to be aimed at are--first and _immediately_, the Restoration of Breathing; and secondly, after breathing is restored, the promotion of Warmth and Circulation. The efforts to restore Breathing must be commenced immediately and energetically, and persevered in for one or two hours, or until a medical man has pronounced that life is extinct. Efforts to promote Warmth and Circulation beyond removing the wet clothes and drying the skin must not be made until the first appearance of natural breathing, for if circulation of the blood be induced before breathing has recommenced the restoration to life will be endangered.

_First_: Roll the patient over on his chest, with one of the arms under the forehead, when the water will readily leave the mouth. _Second_: If breathing does not recommence then, place him on his face, supporting the chest on a roll of clothing. Turn the body gently on the side, then briskly on the face repeating these movements, about 15 times in the minute. (By placing him on his chest the weight of the body forces the air out; when turned on the side air enters the chest). Five minutes is the longest that can be afforded to this treatment. _Third_: Turn him on his back, draw his tongue forward, keeping it forward by a band passing over it and under the chin, placing the roll of clothing under the shoulder blades. Then, kneeling at his head, grasp the arms just below the elbows, draw them above the head, keeping them stretched for about two seconds. Then turn down the arms and press them firmly for two seconds against the sides of the chest. (The outstretched position allows air to be drawn into the lungs, the other position allows it to be pressed out.)

When a spontaneous effort to respire is observed, proceed to induce Circulation and Warmth. This is accomplished by rubbing the limbs upwards with firm grasp and pressure underneath the warm blankets, or over the dry clothing which through bystanders or other means should have been already procured, apply hot flannels, hot water bottles, heated bricks, etc., to the pit of the stomach, the armpits, between the thighs and the soles of the feet.

Allow abundance of fresh air to play about the patient. Administer a teaspoonful of warm water, and then if the power of swallowing have returned, give hot milk, coffee, etc., in small quantities. The patient should be kept in bed and a disposition to sleep encouraged.

The above treatment should be persevered in for some hours, as it is an erroneous opinion that persons are irrecoverable because life does not soon make its appearance, persons having been restored after persevering for many hours. The appearances which generally accompany Death, are: Cessation of the heart's action, eyes half-closed, pupils dilated, tongue approaching to the inner edges of the lips, lips and nostrils covered with a frothy mucus. Coldness and pallor of surface increase.

_Cautions_: Prevent crowding, avoid rough usage; if the body is on the back have the tongue secured. Never hold up the body by the feet. Never place the body in a warm bath, unless under medical direction, and even then only momentarily.

Dwining.--We give this name to a trouble from which we have been able to save some patients, as expressing best the general failure and weakness which sometimes constitute a serious danger, even where all specific symptoms are wanting. Some cases of this kind we have cured, when they were supposed to be hopelessly dying, by the use of simple soap lather. The skin of the patient is usually dry, and the pulse feverish. In such a case take lather, made as directed in article Head, Soaping, and spread it gently all over the stomach and heart. Repeat this six or seven times, keeping the patient warm in bed. Then, after drying, do the same thing to the back. This does immense good. For the general skin stimulation, rub over with the mixture for NIGHT SWEATS (_see_). The skin is rubbed over with this five or six times, once a day.

Where there is no feverishness, but rather cold feelings, then use the _warm_ lather as directed, and rub well all over afterwards with hot olive oil. This treatment alone we know to have cured many.

Dysentery.--This is an affection of the bowels of the nature of diarrhoea, but much worse, as in it _blood_ accompanies the bowel discharge. It usually begins as diarrhoea, and at this stage may be cured by either warm vinegar and water or simple cold water injected into the bowel (_see_ Diarrhoea). Where there is any reason to suspect the water supply, that should be boiled for half-an-hour and cooled before use. Attention to the diet, taking for a time _milk_ diet alone, is also important. Nothing can be better than boiled bread and milk, giving no more than the sufferer feels he needs. When the diarrhoea has passed into true dysentery, with blood discharge, or the trouble begins as such, then enemas of weak acetic acid, or vinegar and water, given _warm_ (_i.e._, a little over blood heat), must be used instead of cold water. As much vinegar should be used as will make the mixture (_see_ Acetic Acid) very slightly smarting when applied to a tender part of the skin--say, to the corner of the eye. What is wanted is just as much acid as will act healingly on the injured vessels, and no more. An enema of this water mixed with acid may be repeated as long as required with perfect safety and good effect every time. Even if the disease has made very serious progress, this will tell upon it powerfully. These warm enemas should be very resolutely followed up as long as they give the least comfortable feeling. No one who has not felt their magical effect can conceive how powerful they are. We have seen a patient on the point of giving in and lying down as a helpless invalid made perfectly fit for work in less than an hour by this mode of treatment.

Where the trouble has passed into that stage where the patient is much weakened, in addition to this the ARMCHAIR FOMENTATION (_see_) should be employed; or if the patient be too weak, the fomentation may be properly wrapped round him in bed without rising. If the patient be too weak for wrapping round the body, he may be first wrapped round the legs, and so strengthened as to stand the stronger remedy. Olive oil must be rubbed on the skin before and after fomenting. The heat may be kept up for an hour. If too weak to stand even this, the feet and legs may be first fomented, and afterwards the body. This treatment has saved many cases from disaster. _See also_ British Cholera; Diarrhoea.

Dyspepsia.--_See_ Indigestion.

Earache.--In the common form this is purely neuralgic. The nerves are in shape and distribution like some tender plant, the root in the brain or spinal cord, and the ends of the branches in the organs supplied by them with nerve power. They are best affected, and most easily cured, by applications to the root rather than the branch ends. This is greatly the case with earache, which is a trouble of the nerves of the ear--not those of hearing, but the ordinary nerves supplying the part. The remedy is to press cold cloths on the _back of the head and neck_. This will often give instant relief. It is best done when the patient is thoroughly warm. If he be cold and clammy in feeling, the feet and legs must be well fomented before applying the cooling. Rub all parts treated with warm olive oil when the treatment is finished.

Ears, Running.--In this trouble there is indicated a failure somewhere of the clearance of waste from the body. This matter gathers locally in the ear, where suppuration and discharge take place. A cure must not be directed to the ear alone, but first the general waste-removing system should be stimulated with special reference to its service in the ear. Rubbing the back with hot olive oil and gentle pressure for a long time, say forty minutes daily, will go further to cure the ears than anything which can be done to themselves. Gatherings, by this treatment, are often quickly dissolved and dispersed.

Where actual waste matter runs out of the ear, the treatment is to have a round camel's-hair brush and soak the interior of the ear, using the brush, with warm weak vinegar, or weak acetic acid, just sour to the taste; then brush with a little fine almond oil, and wipe very gently as dry as possible.

Another way is to syringe the ears very gently with this dilute acetic acid; do not force the acid strongly against the internal parts of the ear, but rather let it soak in. It may be continued as long as is felt agreeable. Do this twice a day; have also a good warm bran poultice placed at the back of the head and neck for an hour each day, oiling the skin before and after. This is best done at bedtime. If this treatment be pursued carefully, the ears should soon come right.

Ears, Singing in the.--Partial deafness is often accompanied by noises in the ear, which are very annoying. This is caused by the internal state of the ear, and is often due especially to the state of the aural nerve. Similar noises are heard also when we place our fingers in our ears, or when we hold a shell or hollow vessel against one of them. In the latter case, what we hear is the rush of blood in the vessels of the ear. In this way, singing in the ears often arises in the course of the treatment recommended in the last article for running ears. If it become too loud, a cessation of the heating at the back of the head, and a brief cooling application, will relieve it. Therefore, in such cases, it is well to use COOLING IN HEATING (_see_).

Eczema.--Skin eruptions, known under this name, have very various causes. Treatment must vary accordingly.

Where the cause is a failure of the skin to act properly, the _whole_ skin of the body, especially the chest and back, will be dry and hard. In this case apply SOAPY BLANKETS (_see_).

If the soapy blanket be too severe on the patient, then apply general lathering with M'Clinton's Soap. Use a badger's-hair shaving brush, and have the lather like whipped cream with _no free water_ along with it. We have known a few of these applications cure a case of long standing.

Where general debility is present, along with the disease, use all means to increase the patient's vitality. Simple diet is best (_see_ Diet, Saltcoats' Biscuits, Barley, Assimilation, Digestion), and abundance of fresh air, within and without the house, by night and by day.

Where the disease results from a parasite, some ointment should be used, and is best applied under the immediate direction of a specialist in Diseases of the Skin.

Elbow Joint.--See Armpit Swelling and Bone.

Enemas, Cold Water.--Prejudice often exists against _cold_ treatment of any kind, but it must be overcome, unless the sick would lose some of the most precious means of relief which we possess. The Enema Syringe, or Fountain Enema, may be had from any druggist, and is used to inject liquid into the lower bowel. To inject _cold water_ by this means is a most efficient method of relief for internal heat and irritation, as well as for DIARRHOEA (_see_). Sick headaches are also often instantly cured by this means. What we are here concerned with, however, is to say that this remedy is as _safe_ as it is simple, so long as discomfort is not felt by the patient. Cold enemas may be given repeatedly, where they are felt to be comforting, without any danger whatever. If the bowels move after the first application, there is no need to be alarmed. Repeat the cold injection, and the diarrhoea will cease. The _cold_ enema does not produce or aggravate constipation; on the contrary, it often relieves and cures the sluggish bowels. In cases where medicine has to be almost constantly taken, its use, and the disuse of the drugs, will often effect a complete cure. In many instances in which outward cooling cannot be borne, the thermometer will indicate that there is excessive internal heat, and the pulse will be quick also. In such cases it will be possible to give the most delightful relief by cautiously applied internal cold.

Fever that might be relieved by cold packing and sponging with vinegar, or some such means, will be far more speedily reduced by these cold injections, and fever which cannot be reduced by these means alone will give way when this is added.

There are cases in which a sort of paralysis of the lower bowel renders what is called "opening medicine" constantly necessary. The consequence of these continued doses is to produce greater and greater paralysis, and ultimately death itself; in these cases the cold enema is of great value. If there is lack of power in the bowel, it is well to increase it by a warm bran poultice, or hot bag on the back, and to brace the vessels and muscles within with the cold enema. (_See_ Constipation.)

Epidemics.--The key to action in case of epidemics prevailing in the district is found, when we consider that always, many residing amid infection escape it. They do so in virtue of better resisting power, rather than because no seeds of disease ever reach them. In case of epidemic, then, besides daily sponging with acetic acid or vinegar, and _scrupulous cleanliness_, everything should be done to increase health and vitality in the household. Plenty of fresh air and sunlight, open windows day and night, and good plain food, are most powerful aids to resisting disease. The milk and water used in the household should all be boiled and _allowed to cool_ before use, the boiling lasting half-an-hour. The family where all this is done may expect to escape infection, and therefore may maintain that calmness and freedom from fear which is itself a very important help against it.

Epilepsy.--The first sign of such an illness is a brief and slight attack of "absence." We notice once or twice that the person "loses himself" for a few moments, but recovers so speedily that we scarcely are sure whether anything of importance has occurred. He is perfectly unaware that he has so "lost himself" or been "absent" at all. That part of the brain on the activity of which consciousness depends has been for the moment inactive.

There is another symptom--that is, the "falling" which gives one of its titles to this malady. It is called "the falling sickness." There is a peculiarity in the falling of one who is affected in this way. In some cases consciousness partially remains, but the balancing power of the brain is lost. A patient in this case sees the ground rise till it strikes him violently on the forehead. We remember a friend telling us that he was walking along a railway, when all at once the rail seemed to rise and strike him in the face: he had fallen on the rail, and seriously wounded himself. The same thing occurs to the person who has taken enough alcohol to deprive him for the time of brain action for the usual balancing of his body. Just as there is a certain part of the brain which gives men consciousness, so is there a part which gives muscular control, such as we use in balancing the body, and there is a stream of vital action flowing from the nerve sources by which both are supplied. If this stream is diverted from these organs, "absence" and "falling" are the natural and necessary result.

There are many cases in which there are only "absence" and "falling," but in others, symptoms much more alarming appear. The next of these which we notice introduces us to a totally distinct element in our explanation. It is found in the "screaming" that follows instantly on unconsciousness, and precedes the "falling" generally. The sufferer is entirely unaware of all that occurs with him, and screams by no voluntary act on his part. The symptom is purely bodily, and expresses no thought or feeling, good or bad, though it is similar to the scream of terror, and makes the same impression on the uninformed hearer. The muscles are used in the scream of epilepsy, just as the muscles of ordinary movement are used in St. Vitus' Dance, but there is nothing of the mind whatever in the movement. The organ of the mind is unsupplied with vital action, but the organs of voice are over-supplied. It is beyond doubt this over-supply which shows itself in the scream, for there is nothing else to account for it.

The same thing is true of the movements of the jaw that are so terribly strong, and so sorely wound the tongue, in the case of those suffering in this way. The jaws open and shut with great force, and without the mind regulating their movement. All the motor nerves are convulsed with strong action, and the muscles they supply are wrought to the utmost, while all consciousness and control are entirely suspended. There is such an overwhelming supply of activity to the mere muscular system that the sources of that supply are soon exhausted, and the motion ceases for a time. Consciousness does not at once return fully, but the convulsions cease, and something like a sleep follows before the brain has its needed supply.

How is it that vital action seizes these mere motor nerves and leaves the brain? There is a symptom in cases of epilepsy which tends to throw some light on this question. It is seen in the extreme activity of the brain, indicated by the incessant talking of the patient before a series of convulsions come on, when taken along with the extreme depression and silence that follow such a series. During whole nights, even, the sufferer will talk, till every organ is exhausted; then comes a series of violent convulsions, then a season of perfect silence and bewilderment.

This explanation of the disease points to the remedy. That which will nurse the brain, and at the same time lessen nervous force in the system, will tend to cure the evil. Strong fomentations round the lower part of the body may be used. Soap in fine LATHER (_see_) should be made to cover the skin at bedtime, and washed off with weak ACETIC ACID (_see_) in the morning. Easily digested food should be taken, and all so-called stimulants strictly avoided. We should endeavour to secure the soothing of the spinal system of nerves. This is done in a degree that is incredible to those who have not actually witnessed it by a persevering use of the cold treatment of the back. The best time is early in the morning, after the patient has had a good night's sleep. For a whole hour spinal treatment should then be used. We have no faith in any royal road to success in such a cure, but we have faith in common sense and right good work. Taking three towels, and putting two of them in cold water, the "operator" is ready to begin. It will be well first to rub the patient's back gently with a little warm olive oil. This will obviate all danger of shock or shiver when the cold cloth is placed on the skin. Then wring out one of the cold towels thoroughly, so as to have it damp and not dripping; fold it lengthways eight ply. Put the one over the other, place both on the centre of the patient's back as he is sitting up in bed to receive them, keeping the damp towel next the skin. Adjust these cloths nicely, make the patient lie down upon them, and cover him snugly up with the bedclothes. So long as the feeling is nice, let well alone. When the towel becomes hot, wring out the second, and change it on the back. Carry this out for a full hour, and if the patient is disposed to go to sleep again, encourage him to do so.

Continued for weeks every morning this humble treatment, without any addition, has an incredibly soothing effect on an excitable system. But it will be well to add to it some nursing of the head and feet, so that every encouragement may be given to a diffusion of nerve action over the body. At night, before going to bed, the feet and legs should be bathed in hot water for a quarter of an hour, dried, rubbed gently with warm olive oil, and a pair of soft cotton stockings drawn on. While the patient is being treated, every possible wearing and irritation of the brain must be avoided, and when lying on the cold towel, the head should be soothingly rubbed by a gentle hand. If an actual violent attack comes on, loose all tight clothes, place a piece of cork between the patient's teeth to prevent biting the tongue, give plenty of fresh air, and keep the patient in a recumbent position.

Everything should be done, by training, to increase the patient's self-control, and all stimulants should be avoided as most injurious. _See_ Head, Rubbing the.

It is important that those liable to these attacks should be kept employed. Nothing is so harmful as idleness. Everything tending to good health is of value, but the essentials of the treatment are found in soothing the spine as above, and stimulating the brain by the head rubbing. Unless in cases in which the very structure of the system has been, so to speak, altered by long-continued disease of this sort, we should look for good results from such treatment as this. Even in the worst cases it would be possible to mitigate the severity of the distress.

A difference in the focus of the eyes often causes a strain on the brain in the effort to adjust them. This sometimes causes epilepsy, and we have known many cases cured by the use of spectacles made to correct this inequality. In all cases of this disease, therefore, an optician should be consulted, to see if there is any defect in the eyes.

Other illnesses are sometimes mistaken for epilepsy: for example, the liver and kidneys in a defective state and impurities passing in the blood to the brain, will explain certain forms of that which passes as epilepsy. It is often easy to cure attacks of this nature by merely bringing the liver and kidneys into working order. If there is a yellowness of the skin, or other signs of the blood failing to be purified in a natural way, then that should first be dealt with, and the fits will often be removed as soon as good action is established in the purifying organs. But in all cases in which there is anything like real "fits," it will be found of great importance to study the over-and-under-actions of the nerve system as by far the most essential elements in the disease. _See_ Jaundice.

Eruptions.--_See_ Hives; "Outstrikes;" Saltrome, etc.

Erysipelas.--This troublesome disease is also known as St. Anthony's Fire, or the Rose. The skin becomes fiery red or even purplish in hue. A violent heat and pain in the part accompany this, and fever and general disturbance of the system follow in a severe case. Swelling of the parts follows, with much distress and danger. _Air_ irritates violently the sore parts, and is usually excluded.