Part 140

_Diarrhœa and Dysentery._--Beyond everything stands a strict regulation of the diet. When the intestinal canal is in a diseased state almost any substance introduced into the stomach acts mischievously, and it is not infrequently necessary to suspend all food until the intestine is in a condition to bear it. Every solid article is then mischievous, but even fluids, by reason of their temperature, may act as prejudicially. In most cases taking a few spoonfuls of warm soup, or drinking a mouthful of cold water will immediately be followed by severe colics, and soon afterwards by evacuations. Only allow lukewarm soups or other drinks, and only by a spoonful at a time. Of course these stringent rules apply to very obstinate diarrhœa, and especially dysentery, for there are many cases of temporary diarrhœa in which the patients continue to eat fruits and the like, and still soon get well. Such cases must, however, not be taken into account, and it is always most prudent at the commencement of diarrhœa to cut off the supply of food as far as possible, and at all events to prohibit all articles likely to augment the affection.

Opium is the most valuable medicine in diarrhœa, for it keeps the sphincter in a state of permanent contraction, a contraction which is often propagated to the large intestine, and the small intestine is unable to propel its contents far enough to induce the irritation which causes their expulsion. When, by reason of this contraction, these contents are retained, their amount may become considerably diminished by the absorption of the fluid. Frequently, however, there is no spot of the canal which is not so diseased as to prevent such absorption taking place, and then the diarrhœa will continue in spite of the opium and of the contraction of the sphincter. It appears, moreover, that opium, besides its action on the muscular portion of the canal, exerts, by contact, a soothing effect upon the mucous membrane. In consequence of the diminution of the irritation of this membrane, its secretion is probably lessened, as are possibly those of the liver and pancreas. However this may be, opium acts very favourably in profuse secretion from the intestinal mucous membrane. From ½-3 gr. may be given in the 24 hours, the best preparation being the _ext. opii aquosum_.

If opium or morphia do not suffice, it must be aided by astringent remedies, by far the best of which, and the most easily supported, is zinc sulphate. One would have supposed that tannin in its separate state would have proved more useful than zinc, but this is not the case, and it is much less easily borne. It acts much better and more energetically when employed as a household remedy (e.g. as a decoction of sloe or wild pear tree) than in its separated form, and is then of great service in practice among the poor. Alum is of no use whatever in diarrhœa. Lead approaches zinc in efficacy, but still it is less certain than it. The dose should not be greater than ¼ gr., and this may be repeated every 2-3 hours, and at most every hour. If these means do not suffice, we must have recourse to enemata of salep or starch (with which may be combined 1 gr. opium or ½ gr. zinc) not throwing up more than 2 oz. at a time. If the clyster does not cause pain in the rectum, and the disease continues obstinate, the dose of zinc may be increased to 2 gr. Tannin may be added to the enema, but the zinc is far more serviceable. In the most obstinate cases we must have recourse to cauterisation; but this is only the case when there is a diseased condition of the lower part of the rectum. Very obstinate cases of blenorrhœa confined to the anus maybe completely cured by the application of silver nitrate, in substance as high as it can be passed. The injection of a strong solution does not usually attain the same end. (Prof. Skoda.)

A case of chronic diarrhœa, which had lasted for nearly 40 years, was cured by the administration of a saturated solution of salt in cider vinegar, 1 dr. being taken 3 or 4 times a day; it always produces good results.

For cholera, a ready remedy is Dr. Rubini’s tincture of camphor, taken on sugar, not in water. Or 1 teaspoonful cayenne pepper in ½ wine glass brandy.

To stop violent diarrhœa, take 2 drops each brandy and laudanum in 1 teaspoonful water every 3 minutes; go up to 60 doses if necessary.

Dr. Christopher Elliott speaks strongly in favour of the use of camomile tea in infantile diarrhœa. The dose for infants under 1 year is ½-1 dr., and double that quantity for older children, given 2 or 3 times a day, or oftener. The _rationale_ of the action is the power the drug possesses of subduing reflex excitability. This power belongs especially to the volatile oil contained in the flowers.

_Dislocations._--These are distinguished from broken bones by stiffness at the joint, intense pain and swelling. They demand surgical skill and must not be touched by any one but a doctor.

_Ear complaints._--Do not wear anything over the ears which presses upon them. Growths may occur in the ear from the custom of wearing ear-rings, and especially when of base metal, although gold ones sometimes give rise to the same. Such may require removal by the surgeon’s knife. Inflammation may be set up in the lobe after piercing it for wearing ear-rings, should a portion of gristle happen to be transfixed by the needle, and all the more likely should that be a dirty or rusty one. The best thing to do is to bathe it frequently with hot water. The silly habit of pulling children’s ears is very liable to cause disease and injury. Never “pick” the ears with any sharp implement. For removing excess of wax, syringe gently with warm water, softening it first, if necessary, by dropping a little glycerine and water or soda dissolved in water, into the ear for a night or two. Any foreign body (including insects) accidentally getting into the outer ear can generally be removed by dropping a little warm water or salad oil into the ear, and then inclining the head. The popular dread of their getting into the brain is utterly unfounded: the drum head of the ear is an effectual stop. Dr. Jacobi remarks that closing the mouths of infants and children and simply blowing into the nose is often a very valuable method of relieving earache, the cause of the trouble probably being a catarrhal affection of the Eustachian tube. Perhaps even better is the method of inflating the ear by blowing into it gently, while the mouth and nose are held closed, and syringing the ear with warm water. Much harm has been done by putting oil, chloroform, laudanum, the heart of roasted onion, and similarly improper things into the ears of children.

_Eye complaints._--In every case skilled advice should at once be sought. The following remarks relate only to what should be done in urgent cases ere professional assistance can be obtained. In inflammation, simple bathing with water (either cold or tepid as the sensations may direct) is the safest remedy, and no other application should be had recourse to, till sanctioned by the doctor. The practice of applying poultices, common bread and water, bread and milk, tea-leaves, porridge, &c., to an inflamed or injured eye is totally wrong, often endangering the sight. Keeping wet cloths applied to the eye, and bandaging up an inflamed eye, may also be productive of much mischief, and should never be employed without orders.

A particle of foreign matter entering the eye will often produce such a flood of tears that it is soon washed out, especially if the eye be kept closed and not rubbed for a few minutes; but sometimes the irritating substance finds its way under the upper eyelid, and remains fixed there by the pressure of the lid. In some cases plunging the face into cold water and opening the eyes under the water will suffice to remove it, but generally the eyelid requires to be turned inside out, and the offending body picked off with a feather; or the upper eyelid drawn forwards off the eye by means of the eyelashes, and the lower eyelid pushed up under it: when the eyelids are released, the eyelashes of the lower lid will brush over the inner surface of the upper lid, and almost certainly remove any substance that may lodge there. To evert the lid, lay a bodkin or pencil along it, and turn it up by taking hold of the eyelashes about the middle, the patient meanwhile looking down. Should such simple means fail, the eye may be tied up with a pad of cotton wool over it, so as to prevent the eyelid moving till professional advice be secured.

Serious damage is frequently occasioned by lime or other caustic substance getting into the eye. Wash the eye as quickly as possible thoroughly with cold water or vinegar very much diluted with water (say 1 teaspoonful vinegar in 2 oz. warm water), a stream being allowed to course across the opened eye, while any particle of caustic substance that remains should be carefully removed. A drop of castor oil or olive oil applied every half-hour to the inside of the eye will greatly allay irritation. Never bandage or poultice. In all cases of injury the less done at home the better. A light pad of cotton wool applied over the closed lids and kept in position by a handkerchief or a pledget of cotton wool soaked in _cold_ water reapplied _cold_ at least every 5 minutes, may be employed till the doctor comes.

Dr. Louis Fitzpatrick says he has never seen a single instance in which a stye continued to develop after the following treatment had been resorted to: The lids should be held apart by the thumb and index finger of the left hand, or a lid retractor, if such be at hand, while tincture of iodine is painted over the inflamed papilla with a fine camel’s-hair pencil. The lids should not be allowed to come in contact until the part touched is dry. A few such applications in the 24 hours are sufficient. (_Lancet._)

_Hair complaints._--Ladies should undo their hair at night, unplait the hair, and wear it loosely in a net. In this way the nourishment of the hair is duly provided for. Night-caps should always be light. When forced to remain in bed for long periods, through illness, have the hair oiled and combed with a coarse comb daily; if circumstances permit, the head may be washed twice a week with soap and water, warm, lukewarm, or cold, as taste or health directs. In long-continued illness, it is often advisable to cut the hair, so as to reduce its length by about a third, not merely from considerations connected with the cleanliness of the hair, but also that stronger aftergrowth may be encouraged. Few realise the injurious effects of curling-irons and hair-dyes.

Ordinary baldness may be constitutional or local. The former is a matter for the medical man. For persistent daily loss of hair, the following remedy is recommended by Pincus:--15 gr. soda bicarbonate dissolved in 1 oz. water; a little to be well rubbed into the scalp daily, and persisted in. Sir Erasmus Wilson says that a lotion composed of 1 oz. each spirits of hartshorn, chloroform, and sweet almond oil, added to 5 oz. spirits of rosemary, and well rubbed into the roots of the hair after brushing, is effective; it may be used half-strength, diluted with eau-de-cologne. Other lotions are:--(_a_) 2 dr. tincture of Spanish flies, ½ oz. tincture of nux vomica, 1 dr. tincture of capsicum, 1½ oz. castor oil, 2 oz. eau-de-cologne; apply night and morning with a sponge to the roots of the hair after brushing. (_b_) 2 oz. spirit minderus, ½ dr. ammonia carbonate, ½ oz. glycerine, ½ oz. castor oil, 5 oz. bay rum; apply as in (_a_). These will be found serviceable in the treatment of commencing general baldness, where the whole scalp is parting with its hair. Singeing the hair is not of the slightest use for hair stimulation, and the frequent use of the “curling-tongs” cannot but be detrimental to the health of the head-covering. When the hair demands a tonic application, the following--which any chemist will compound--may be tried:--1 oz. tincture of red cinchona bark, 2 dr. tincture of nux vomica, ½ dr. tincture of cantharides, add eau-de-cologne and coconut oil to make up 4 oz.; apply to the roots of the hair with a soft sponge night and morning. Where means are being taken to restore the health in cases of sudden or premature greyness of hair, Dr. Leonard recommends the following application:--2 oz. coconut oil, 3 dr. tincture of nux vomica, 1 oz. bay rum, 20 drops oil of bergamot. Washing with egg yolk is highly commended in such cases.

The common trouble known as dandriff (dandruff) frequently occurs in strumous (scrofulous) individuals who are anæmic (poor-blooded) and have a sluggish circulation, marked by cold hands and feet. Adolescence is its peculiar time of appearance, and chlorotic (greenish skinned) young girls are apt to be annoyed by it. It is an attendant upon chronic debilitating diseases, as rheumatism, syphilis, phthisis, and the like, and comes on after profound disturbances of the constitution, such as fevers and parturition. Dyspepsia and constipation are very common exciting causes or aggravants of the disease. Improper care of the scalp, the use of the fine-toothed comb, and of pomades, hair “tonics,” and hair-dyes will give rises to disorder.

A good deal in the way of prevention, according to Dr. Jackson, can be accomplished by proper care of the scalp and general health. The brush should have its bristles well set into the back, placed in little clumps at regular distances and rather far apart, and those in each clump should be of unequal length and arranged so that the longest ones are in the centre of the group. It is well to have two brushes, one stiff enough to warm the scalp when used with vigour, and one quite soft. The comb should be made with large teeth set wide apart; held up to the light the teeth should show no roughness or inequality of surface. The fine-toothed comb should be banished from the toilet table, as it is an active agent in producing inflammatory conditions of the scalp. In the morning the hair should be thoroughly opened up in all directions with the comb, and it and the scalp brushed vigorously with the stiff brush. Then the soft brush should be used in parting the hair, in polishing it, and in subsequent brushings during the day.

Do not wash the head too much. The so-commonly practised daily sousing of the head in water is hurtful to the hair and scalp, especially if they are not carefully and properly dried afterwards, and a little oil or a vaseline rubbed into the scalp. It is not the daily sousing which is objectionable, but the insufficient aftercare. Water renders the hair dry, and the daily sousing only washes the head superficially. A good shampoo every week or ten days for those persons exposed to a good deal of dust, and every 2-3 weeks for other people, is sufficient for cleanliness. For the shampoo, soap and water, borax and water, or the yolk of an egg beaten up in lime water, are all simple and good, but it must not be forgotten to wash out these materials with plenty of clean water, and to thoroughly dry the hair and scalp.

Patent hair “tonics,” pomades, washes, and dyes are to be avoided. None of these dressings is needed by the healthy scalp, and proper care will preserve the hair in better condition than they will. The nearer the body can be kept to the standard of perfect health by means of bathing, exercise, and good diet, the less likely is dandruff to develop. When, therefore, the disease has appeared, first inquiries should be concerning the general health, and first efforts addressed to remedying anything found to be wrong.

If the case presents itself with a decided accumulation of scales, or if crusts are present, saturate with sweet almond oil, before going to bed, and place over the head a flannel cloth soaked in the oil, and outside of all an oiled silk cap. Next morning shampoo thoroughly with soap and water, using by preference the tincture of green soap, and wash out the soap with plenty of water. The scalp is then to be dried by vigorous rubbing with a coarse towel, and the hair by pulling it through a soft towel. If the crusts by this method are not completely removed, the oil should be kept on during the day, the head again soaked at night, and washed with the soap and water in the morning. If the scalp should appear very hyperæmic after the crusts are removed, anoint the head with red vaseline or some simple ointment, as rose ointment, until lessened. When the crusts are removed and the hyperæemia overcome, have an ointment composed of 1 dr. sulphur loti to 1 oz. vaseline, applied every morning to the scalp. If the scales form rapidly, apply every night, and the sulphur ointment every morning, and wash the head every second or third day. As soon as scaling is lessened stop the use of the oil, but continue the ointment, at first using it every second morning, then gradually reducing its application to once a week. Throughout this plan of treatment the head should be shampooed about once a week with a tincture of green soap, borax and water, or the yolks of 3 eggs beaten up in 1 pint lime water, to which ½ oz. alcohol is added. Another excellent ointment for these cases is composed as follows:--

℞ Hydrarg. ammon. gr. xx. Hydrarg. chlor. mitis. gr. xi. Petrolati 1 oz.

This applied once or twice a day has yielded admirable results in a number of cases of simple dandruff. Its consistence, being that of a salad dressing, renders it an elegant pomade for private practice. Its use should be combined with the occasional shampoo as directed above.

The persistent and systematic use of either of the two plans of treatment, together with a proper oversight over the general health, should cure every case of dandruff. But be prepared for occasional relapses.

_Headaches._--Headaches vary much in degree and in kind. Their causes may be grouped under 3 types--(1) when the blood-supply of brain and body is at fault; (2) when some distant organ (such as stomach or liver), with which the brain is in sympathy, is out of order; and (3) when there is some affection of the nervous system, and especially of the brain: or “circulation,” “digestive,” and “nervous” headaches. Circulation headaches arise from the condition known technically as _anæmia_ (bloodlessness) of the brain, in which the mental powers are weakened, and much brain-work will result in headache. Chief among its causes are a feeble heart and excessive drain on the system, especially among women, the evil frequently lying in the excessive use of purgative medicines. Hyperæmia (excessive blood supply) may also give rise to headache in those who use the brain to such an extent as to cause excessive waste, to repair which an increased flow of blood to the head takes place, and may be so great as to overwhelm the nerve-centres. This is often aggravated by an irregular mode of life and too much stimulants. Interference with the blood return to the heart may be due to causes within the chest, such as chronic bronchitis or heart obstruction, to swellings in the glands of the neck pressing on veins which convey the blood back to the heart, and improper dress, such as tight stays, or tight collars and cravats.

In the bilious or dyspeptic headache, also known as the “sick headache,” the brain sympathises with the stomach or liver in its affliction, and thus is due to those errors of diet which lead to indigestion or dyspepsia, e.g., unwholesome food, late suppers, hasty and inefficient mastication, and continuous drinking and wine-bibbing.

The nervous system itself seems to be chiefly at fault in organic, nervous, and neuralgic headaches. The organic headache often precedes insanity. The nervous headache, more commonly known from the nausea and vomiting which occur during an attack, as “sick headache,” is due to various exciting causes, such as brooding over unpleasant thoughts, bodily fatigue, dietetic errors, too little exercise, overstraining of vision, loud noises of a disagreeable character, unpleasant smells, and even disturbances of the weather; it is often inherited. The attack may sometimes be warded off by the application of atropine; the tendency to attack has been got rid of by the use of a proper pair of spectacles. The neuralgic headache is a form of tic douloureux, has its seat in one or other of the nerves of the head, and may be excited by decayed teeth, exposure to cold, and similar causes. It rarely occurs, even in those conditions, unless the nervous system is lowered in tone. Many people have decayed teeth without suffering the slightest ache so long as they keep their health at par. Too much work, bodily or mental, or exposure to conditions which act injuriously on the health, result in a neuralgic headache.

Any irregularity in the mode of life, such as errors in diet and drink, must be particularly shunned by those who are liable to any form of headache. Where alcohol is found to do good, it should be taken only in small quantities and with the meals. All worry and excitement must be avoided. Sleep in sufficiency, as well as moderate exercise, is essential. When headaches continue to burden the frame and to make life miserable, change of air or scene, prolonged absence from business, pleasant society, music, and other enjoyments may help to get rid of them. Sometimes all that is wanted may be cod-liver oil, or some other nutrient and tonic medicine. During the paroxysms of sick headache, complete rest on sofa or bed in a darkened room is found by many to be the only thing which gives relief; while others believe they are assisted to endure by drinking cups of strong tea or coffee. Those who suffer from this tendency, and disorders of vision, should consult an oculist regarding the condition of their eyes. (Dr. Maxwell Rose.)

_Indigestion._--Indigestion may be due to the food or condition of the stomach. The food may be defective in quality. There may be excess or deficiency of the normal ingredients, saccharine, starchy, albuminous, or fatty, or some of the natural indigestible materials which form a part of all food. The food may be introduced in an indigestible form on account of defects in the cooking of it, or imperfect mastication, or from its having undergone putrefaction or fermentation, which arrests the functions of the stomach. Imperfect mastication of food is a very common cause of indigestion. Eating too much is probably the most common of all causes of indigestion. The secretion of the gastric juice in the stomach seems to be proportioned to the amount of material required for the nourishment of the system. Food taken in excess of this amount acts as a foreign substance undergoing fermentation and putrefaction, and occasioning much disturbance in the system. Much may be done for the cure of indigestion by eating very abstemiously of suitable food, thoroughly masticated, taking exercise in the open air, breathing pure air, and observing the laws of health generally. The amount of food should be reduced until the quantity is reached which the stomach can digest without evincing any symptoms of indigestion.