Chapter 8
Constipation.--This trouble is often only aggravated and made chronic by the use of purgatives. Some simple change of diet, such as a ripe uncooked apple, eaten before breakfast, or a fruit diet for a day or two may put all right. So also with the use of wheaten meal porridge or bread. When this can be taken with pure CANE SYRUP (_see_), the two together will make such a change in the food as will frequently banish all inaction of the bowels. Rest must be reckoned on, especially if the patient has been using purgatives freely. Do not act as if castor oil were a necessary article of diet. When the constipation is more obstinate, in the case of a child, good golden syrup may be given, a teaspoonful after each meal. A quarter of a pound of the best Spanish liquorice, costing sixpence, should be boiled in a pint of water down to three-quarters of a pint and strained. A dessertspoonful of this after each meal may be given instead of the treacle. It is the best tonic we know, and infinitely better than quinine and other costlier drugs. If a stronger mixture be desired, put half-an-ounce of senna leaf in the juice while being boiled. This may be increased to a whole ounce of senna if still stronger effect be desired.
Some are more liable than others to attacks of constipation, but chronic constipation may generally be put down to errors in diet, or want of sufficient exercise. Indigestible foods, such as pastry and heavy puddings, as well as foods which leave little residue in the intestine, such as white bread, puddings, arrowroot, are highly constipating. Tea has also a similar effect, also large quantities of meat. Constipation is seldom found in vegetarians, since vegetables and fruits act as a stimulus to the intestine. Brown bread and oatmeal porridge have also an aperient effect. If it is suspected that milk has been a cause of constipation in any particular case, it may be boiled and used with coffee instead of tea.
Much may be done by judicious exercise to relieve chronic constipation, and help the liver to work (_see_ Appendix; Physical Culture). Deep breathing will also affect the intestines and urge a motion. Bathing and massage of the abdomen are also useful (_see_ Massage). Clothing should be light and loose, tight lacing being a frequent cause of constipation.
Every effort should be made to keep the bowels regular, as protracted constipation leads to many painful affections, such as headaches, piles, and even inflammation of the intestine, the various products of putrefaction being absorbed and carried through the blood stream. A daily motion should invariably be solicited at a regular hour. On rising, before the morning bath, is a good time, though some prefer just before retiring to bed, and more, probably, go immediately after breakfast. The great thing is to get into the habit of going daily at a fixed time; nothing should be allowed to interfere with this, and it is highly desirable that children should be accustomed to this habit. Parents should, therefore, see that the schools selected have sufficient closet accommodation, as schools in private houses often have but the one closet for a large number. As a result of this restricted accommodation, the habit of using aperient medicines is acquired with _very_ injurious results, for if the call of nature is neglected the desire passes away, and constipation is inevitable. It soon comes to be a settled condition and will often be the cause of life-long ill-health. The evils from the formation of such a physical habit will far outweigh all the so-called accomplishments that may be acquired.
Hot or cold water taken in sips throughout the day has often proved a most valuable cure for constipation.
When artificial means are required to move the bowels, an enema is much to be preferred to drugs. The way to administer it, so as to be most effective, is as follows: Use a fountain enema holding three quarts. Put into it two or three quarts of water as warm as can be comfortably borne. A teaspoonful of salt added to the water will make it more effective, or soapy water may be used, made from M'Clinton's soap. The fountain should be hung up as high above the patient as the india-rubber tube will allow. The patient should lie on the right side, with knees drawn up. The tube should then be introduced into the rectum, and should be three or four inches in. The water may then be turned on with the thumb valve. If the abdomen can be rubbed by an attendant in an upward direction it will be better. The water should be retained, if possible, twenty minutes or half-an-hour.
A HOT FOMENTATION (_see_) over the liver, before using the enema, will make it more effective.
A bulb enema syringe may be used instead of the fountain, and less water--a pint or even less, and the water tepid or cold, may be preferred by some. The disadvantage of a bulb syringe is however that sometimes air gets in along with the water, causing pain and discomfort.
Consumption, Prevention of.--This most insidious and deadly disease is caused by a tiny vegetable growth derived from persons or animals already suffering from tuberculosis. The spit of consumptive patients swarms with such germs, and when it dries and becomes dust the germs may be stirred up and breathed, or may mix with food, _e.g._, milk, and so enter the body. A dried handkerchief may also carry the infection.
But these germs, though continually carried into the lungs of almost all, do not develop in all. The healthy body can resist them, and it is only in the body which possesses little resistance, owing to a low state of health, that they take root, and so start the disease.
Want of pure air, such as is caused by badly ventilated rooms, dark, damp, and dirty houses, want of good food, or bad food, alcoholic drinks, frequent illnesses, dirty habits, are powerful causes in producing this low state of health, which is so favourable to the growth of the consumptive germ. Therefore we insist on fresh air, especially for children in schools, for employees in factories, for clerks in offices. All places of public resort should be provided with proper ventilation. The breath from the lungs is loaded with poisonous organic matter, and if continually re-breathed poisons the blood. The smell of a room is often an indication of whether the air is pure or not, especially in the nostrils of one entering from the outer air. Let all windows be kept open day and night, and let fresh air and sunlight continually flood the room. Nothing will kill disease germs quicker. Avoid choosing a residence with but little open spaces around, such as basement tenements and back to back houses. Have an open fireplace in the room. Gas or oil for lighting, heating, or cooking renders the air impure, and in need of constant renewal. _See_ Air.
Dirt, either in the house or around, poisons the air, and refuse should be removed to a distance from the dwelling. Tea leaves should be sprinkled on floors before being swept. Remove dust with damp dusters, which should be boiled. Cleanliness should be strictly attended to, and schools and factories should be plentifully supplied with soap and water.
The food consumed by the vast majority of people is far from being as nourishing as it should be. Tea and white bread have replaced porridge and milk. This should not be. Cocoa might with advantage replace tea, and porridge and milk by itself would make a highly nutritious meal (_see_ articles on Diet).
Stimulants are not required by the healthy body, and intemperance is a fruitful predisposing cause of consumption. Skim milk is not a suitable food for the young. _See_ Infants' Food.
Infectious diseases, such as Typhoid and Scarlatina, are frequently conveyed by cow's milk. There is also reason to believe that in certain cases of Tuberculosis the infection has been conveyed by milk from tuberculous cows. These risks can only be absolutely avoided by sterilising the milk, _i.e._, by placing the jug in a pan of water and bringing the water to the boil, keeping it so for twenty minutes. If the milk is kept covered, and rapidly cooled by placing in another pan of cold water, but little boiled taste will be felt. Sometimes, however, sterilised milk disagrees with an infant; if so, the strictest watch must be kept on the history of the milk used.
It should be remembered that this disease is not hereditary. It is only the delicacy of constitution predisposing to the disease that is inherited. This delicacy may, especially in childhood, be remedied. We have known hundreds of tender children made strong by liberal daily MASSAGE (_see_). In all cases where hereditary weakness is feared this should be resorted to. In many cases nothing more is needed to banish consumption out of families than the stimulation of the skin by this massage. Wearing linen underwear (_see_ Underwear) also assists in this direction and prevents chills. As it is of prime importance to increase the chest capacity, and this is most easily done in youth, great attention should be paid to chest expanding exercises (_see_ Appendix) and deep breathing. The cultivation of singing will greatly help.
Consumption, Treatment of.--Turning now to the case when consumption has actually shown itself, the above treatment is exactly the course to be pursued. But we would emphasise the fact that unlimited fresh air and good nourishing foods are the only cure. If the patient can afford it, it is best to go to one of the Sanatoria for consumptives in order that he may see how the fresh air cure is practically carried out. It means simply breathing every mouthful of air as pure as it can possibly be obtained. Sleeping out in a hut, with the side completely open, and with protection only from the rain, with abundance of clothing, and, if necessary, hot-water jars to supply the required heat, is strongly recommended, and every hour of the day, as far as possible, should be spent in the open air, reclining or taking gentle exercise.
The food should be nourishing and abundant. Plenty of milk, butter, and eggs should form the basis of the diet. The strictest precautions should be taken against spreading infection, and the patient be made to understand that these measures are intended not only to protect the public and his friends, but to allow of his social intercourse with them, and to assist his own cure. The source of danger being the spit, it should be collected in a pocket spittoon or piece of paper, and be destroyed before it has time to dry. Spitting on floors or elsewhere is highly dangerous. The spittoon should be boiled carefully. A consumptive should not swallow his phlegm, as the disease may thus be conveyed to parts of the body not already infected. Kissing a consumptive person on the lips is attended with risk, and consumptive patients should not wear a heavy moustache or beard, as the phlegm drying on the hair is a source of danger.
The bed on which the consumptive lies should not be in a corner, but out from the wall, so as to admit of cleaning and ventilation. Curtains and carpets are dust catchers; reduce the amount of such articles as much as possible. In the event of a death from consumption, the room occupied by the invalid should not be used again until it has been thoroughly disinfected. The Public Health Authorities are usually ready to carry out this work. If not, the floor and woodwork should be wiped with damp dusters, and then scoured with soap and water. If the walls are papered, the paper should be well damped, stripped off, and burnt. If the walls have been white-washed, this should be renewed with limewash, containing a quarter of a pound of chlorinated lime to the gallon of limewash. The quilt, pillow case, blankets, and sheets of the patient's bed should be steeped in boiling water and then washed.
Often consumption is associated with wasting sores on the neck or other parts, which are extremely difficult to heal. These should be soaked in warm weak ACETIC ACID (_see_) daily, and dressed with olive oil. They may be greatly mitigated, if not cured, by this simple means. _See_ Abscess; Bone, Diseased. The directions as to diet in cases of abscess apply also to these cases. Besides such outward applications, the rubbing along each side of the spine should be applied. _See_ Children's Healthy Growth. The ARMCHAIR FOMENTATION (_see_) may also be used.
The very rapid pulse, and extreme fever, which accompany advanced and rapid consumption, may often be greatly mitigated by cooling cloths applied over the heart. Sponging over the whole body with vinegar or weak ACETIC ACID (_see_) also greatly refreshes the patient. It may be done under the bedclothes, so as to avoid all possibility of chill. Cold cloths over the heart and chest, if they cause chilliness, may be accompanied with fomentation of the feet and legs.
The temperature of a consumptive should be recorded three times a day, and if above normal the patient should stay in bed till it is reduced.
When the temperature has been reduced, gentle exercise is very useful. Gradually increasing walks should be taken each day.
Contraction of Sinews.--This often occurs at the knee, bending the joint so that the patient cannot stretch his limb or walk properly. The injury in such a case is usually at the ends of the sinews, where they are inserted into the bone. If the limb be straightened and put up in splints, so as to secure perfect rest, it is well to see that once every twenty-four hours it be removed from its fastenings and treated in some way to obtain a cure. Otherwise the whole limb will harden into a straight and unbendable condition, worse than its original bend. When the fastenings are removed, then, each day, let the limb be rubbed and bathed for an hour. Treat the whole body with soaping and oil rubbing (_see_ Lather and Massage). While bathing the limb it is to be rubbed with this soap, and the lather rubbed gently into all the skin. Rub, after soaping and drying, with hot olive oil. Dry this off, and wrap the limb in warm flannel. With this treatment no splints or plaster jackets are at all likely to be required. The limb usually soon comes right.
Sometimes this contraction affects the hip joint, and causes great distress and lameness. The upper end of the thigh bone is even sometimes drawn a little out of its proper position. For this, the muscles of the back, and specially of the side and hip which is lame, are rubbed with gentle pressure and hot olive oil as often and as long as may be convenient. Strong fomentations are also applied for half-an-hour daily (_see_ Armchair Fomentation). We know of one case in which this treatment has cured such contraction both of the knee and hip joint. Whether the cause be rheumatism or other trouble, or an injury, the treatment is the same.
Convulsions.--For an ordinary convulsive attack in the case of a child, hold the child's head over a basin and pour tepid water (blood heat, 98 deg. F.) over the head. This will usually be sufficient. If not, seat the child in a bath of hot water nearly up to the waist. If bad, indigestible food causes the fit, give teaspoonfuls of hot water every few minutes for some hours. If the case is obstinate, a BRAN POULTICE (_see_) may be put over the lower back, and cold towels gently pressed over the stomach and bowels.
Fits from children's teething are more troublesome. They may often be prevented by placing a compress wrung out of cool water along the spine while the infant is warm in the cradle, and changing it so as to maintain the cooling effect. A handkerchief folded eight ply does very well. Four or five changes may be sufficient. Rub with a little warm oil when the cloth comes off. If the fits do come on, treat as above directed for fits from indigestion.
Cooking.--The cooking of vegetables requires particular care. The valuable salts and other nutritive ingredients they contain are easily dissolved by water, and when they are drained, and the water thrown away, as is usually done, all this nutriment is lost. Double cooking pots are easily procurable for meat, porridge, etc. These are quite suitable for vegetables--cabbage, turnips, carrots, peas, etc. The vegetable should be placed, without water, in the inner pot; it will take somewhat longer to cook than when boiled in the usual way. The outer vessel should be partly filled with water kept boiling. Any juice which comes out of the vegetable should be served in the dish along with it. It may be thickened with a little flour and butter, or if a regular white sauce is being made, the juice should be used instead of part of the water. If no double boiler is procurable, an ordinary tin can, inside a saucepan will serve very well. Many who consider certain vegetables indigestible, as usually prepared, will find that when cooked in this way they agree with them perfectly. The fact that the colour of cabbage, peas, etc., is not so green as when boiled in a great deal of water, is not of importance, when the flavour and wholesomeness are so much increased. In stews and vegetable soups the salts are, of course, preserved.
Cooling in Heating.--Often it is difficult to get a sufficient cooling effect by means of cold cloths without unduly chilling the patient. When the head has to be cooled, as in the very dangerous disease meningitis, the effect must pass through the mass of the skull before reaching the brain. A large and long continued application is needed for this. The surface is apt then to be overcooled before the interior of the head is affected. In such a case the surface of the head, when the patient feels it too cold, should be gently rubbed, as directed in Eyes, Squinting, until this feeling goes off. Then the cooling may be resumed. Or if rubbing be disagreeable, a warm cloth may be applied for a short time, and cooling then resumed. In this way a succession of _waves_ of heating and cooling can for a long time be sent through the surface, with good effect and no chill. The short heating restores the surface, and does not interfere with the cooling effect reaching the interior parts. The same principle applies to cooling any part of the body (_see_ Bathing). Any _deep-seated_ inflammation is best reached in this way.
For instance, in the large hip-joints it is of vast importance to reach inflammatory action in parts that are not near the surface, and cold cloths, pressed constantly, produce distress in the surface, if there is no intermission in supplying them. The patient is apt to rush to the conclusion that he must just yield to be blistered, painted with iodine, covered with belladonna plaster, or burned with red-hot irons! That is, he will yield to be made a great deal worse in every respect than he is, because he is not aware that it is quite possible to cure him without making him worse even for a moment.
Coughs.--These will be found treated under the various heads of Colds, Bronchitis, Consumption, etc., but some particular cases of _mere cough_ demand special attention. A tickling cough sometimes comes on, and seems to remain in spite of all efforts to get rid of it. It is worse at night, and keeps the sufferer from sleeping, causing much distress. Where the breathing organs are weak, this cough is caused by an extra flow of blood to them, especially on lying down, the blood acting as an irritant by pressing where it should not. In such cases a BRAN POULTICE (_see_) applied as directed for Bronchitis, with cooling applications to the part where the tickling is felt, should soon effect a cure. _See_ Restlessness.
We had a case lately in which these features were very marked. It seemed as if the patient had caught cold and this was showing itself in severe and alarming coughing. The skin was yellow, and there were other signs of failure in the organs that purify the blood. Irritating substances were passing into the lungs because of failure in the liver and kidneys, and not from anything in the lungs themselves. In such cases the cough is merely a way of throwing off everything which ought not to be in the breathing organs.
The remedy is very simple. Let the patient take about three tablespoonfuls of hot water every ten minutes for four hours. Before these four hours are expired, the substances causing irritation will be so diluted that they will cease to irritate, and the organs failing to do their duty will be in full working order.
Cramp in the Limbs.--The treatment of this is to apply cold cloths to the roots of the nerves which govern the affected limb or limbs. For the legs, the cold is applied to the lower spine; for the arms or hands, it is applied to the upper part. The limbs affected should also be rubbed briskly with the hands, or a rough towel. Often the irritating heat causing the cramp is in but a small part of the spine, and the whole body is cold, or at least too chilly to make the cold cloths a pleasant cure. In such a case FOMENTATION (_see_) of the feet and legs will supply sufficient heat to make the cure by cold pleasant and safe.
Cramp in the Stomach.--This very severe trouble, though resisting ordinary methods of treatment, is not difficult to cure by right means. If help is at hand, the patient may be placed in a shallow bath, and cold water splashed with a sponge or towel against the back. A bad case has been cured with two minutes of this treatment. After it, the patient must be well dried and put to bed.
When help is not available, a substitute for the cold splashing is a thick cold compress, the length of the spine, which must be laid on the bed, and the patient lie down on it. This must be changed when it grows hot, and a few changes usually give relief.
Persons who are suffering have often very strong prejudices. For example, one who has decided most firmly that he "cannot do at all with anything cold," is suffering from cramp, and nothing but cold will relieve him, but you must not even hint at any such application. You must in such a case consider how this prejudice took its rise. You will probably find that cold has been unskilfully applied to this patient, and bad effects have been produced, not by the cold, but by its unskilful application. For instance, in a case of cramp the irritation and excess of heat may be both confined to a very small space, no more than that which is filled by the root of one nerve; the rest of the body may be cold rather than hot. There is need first that this general cold should be dealt with, and a general heat produced by some means or other. This is usually best done by packing feet and legs in a hot blanket fomentation. But this again is not an easy matter when cramp prevails. If you move the limbs in the least the cramp comes on, and the patient screams with pain. Still, you need not be defeated; you can let the limbs lie, and heat them from above by placing the hot blanket over them as they lie. As soon as you get heat raised in the body generally, by some such means as this, you are safe enough to apply all the cold that is needed. That may be so little that a common pocket-handkerchief will be enough. This wrung out of cold water, and folded so as to cover about three inches square of the lower part of the spine, may be gently pressed. If this is really well done, there will be no shivering from the cold, and there probably will be a cessation of the cramp. The one thing wanted is that the cold cloth shall be placed right over the root of the nerve which is irritated, and consequently overheated. The prejudice is thus overcome, and it is seen that cold is not to be absolutely avoided, because it has been once or twice, or many times, wrongly applied.