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  No. 113,
W.D.S.G.O.
NO.A11JA&
3—613




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Ptofct   : 
JOHNSON'S
FAMILY   PHYSICIAN,
FROM
Cjje Jblest HJebical JntJoriticiJ.
GIVING NUMEROUS AND DANGEROUS DISEASES TO WHICH THE HUMAN RACE IS SUBJECT-
  THE SYMPTOMS AND TREATMENT, OR WHAT IS NECESSARY TO BE DONE IN AN EMER-
      GENCY FOR THE PATIENT BEFORE THE PHYSICIAN ARRIVES, THEREBY
            ALLEVIATING SUFFERING AND OFTEN SAVING LIFE.
BY
        E. DARWIN HUDSON,  Je., M.D.
(Peofessob of Pkactice of Medicine, Woman's Med. College of the N. Y. Infirmary.)
             With Articles from the most Eminent Physicians,

AMONG WHOM ARE WILLARD PARKER, ALONZO CLARK, C. R. AGNEW, WILLIAM DETMOLD, ABRAHAM
  JACOBI, MARY C. P. JACOBI, STEPHEN 6MITH, E. C. SEGUIN, Je., E. KRACKOWIZER, WEIR MITCHELL,
    AUSTIN FLINT, W. A. HAMMOND, J. C.  DALTON, C. HEITZMANN, C. P. RUSSEL, SAMUEL
         ST. JOHN, FREDERICK ZINSSER, P.  P. FOSTER, EDWARD CURTIS, DAVID
                 WEBSTER, G. H. WYNKOOP, etc., etc., etc.
ILLUSTRATED.
ALVIN
   NEW YORK:
J.  JOHNSON &  SON,
11 GREAT JONES STREET, NEAR BROADWAY,
         MDCCCLXXX. 
A
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%
WBA
 H  *X5j
Entered according to Act op Congress, in the year One Thousand Eight Hundred and Eighty.

      by Alvin J. Johnson, in the Office of the Librarian op Congress, at Washington.

                              ALL RIGHTS RESERVED.
   electrotyped by                               printed by
Westcott &  Thomson,                  John A. Gray, 18 Jacob Street,
    Philadelphia, Pa.                                New York.
PAPER MANUFACTURED BY
\
y
bound by
Seymour  Paper Co.,                        james Somerville,
       NewYork-                                    New York. 
PREFACE.
   The  articles  in  Johnson's Family Physician were prepared  by distinguished
physicians, whose names in the Contributors' List will be recognized as authorities in the
profession.  They were not written in the cause of "popular medicine"—that is, either
to pander to an idle curiosity or passive interest in the mysteries of our body and its ail-
ments—or to educate the public to practise empirically upon  themselves.  On the  con-
trary, each article was intended to present the essential facts as to some disease or ailment,
or allied  topic, in the light of the most advanced research of the healing  art in our time,
and  to give to reading and thinking people some conception of the opinions and prac-
tices, as  regards disease and its treatment, which  are recognized by the most prominent
teachers  and practitioners of medicine.  A series  of concise accounts of  diseases, alpha-
betically arranged for convenience in  consultation, is the result, each detailing the na-
ture and treatment of each disease in much the same way that the  educated and  friendly
physician of the  family would detail his  views to an intelligent and  interested patient
competent to understand  and appreciate  them.  Prescriptions and routine methods of
treatment are avoided, but the characteristic symptoms of the disease, by which it may be
readily recognized, are stated, the methods of diagnosis pointed out, the rationale of the
treatment, the special indications to be observed, and the most  approved remedies enume-
rated.  In a populous community such knowledge, far from detracting from the patron-
age of physicians, should increase the public confidence in such as  are well qualified, and
strengthen the popular faith in the resources of medical science.   It is further believed
that the  methods of treatment herein given,  being representative of the  views of the
profession, will enable the  public to  detect  not only  the  obsolete  practice  of  those
who do  not  grow in their  art, but also the  eccentric, pretentious, and unwarrantable
methods  and deceptions of  charlatans, who  so often  thrive only  by the total  lack of
information  on the part of their patrons.  But in the  rural districts,  in  sparsely-settled
and new  countries, the mine and camp, in travel by land and  sea,  as well as in the exig-
encies of sudden  accident and unforeseen sickness at night, suffering is assuaged or dis-
ease or death is often averted by " a little  knowledge " on the  part of the layman.   This
work aims to disseminate such knowledge,  and details correct instructions which  may
bridge over the  period and danger until the  doctor  be found.   The  importance of
promptly meeting medical emergencies is well illustrated by  their frequent  occurrence,
and  the  efficient  measures taken in the great capitals of Europe and our own country to
meet them.  In such cities as London, Paris, and New York, where physicians are num-
bered by thousands, the instances  are  numerous where protracted  search must be  made
for physicians busy in their rounds of practice, and death by accident, by poison, or by
sudden illness results from the ignorance of friends or bystanders to intelligently do  some
simple and  proper thing.  To meet these emergencies " the night medical service" of
Paris and other  continental cities, and the ambulance system of New York and other
American cities, have been devised.  The maxim that " a little knowledge is a dangerous
thing" has too long been quoted to discourage popular information on  technical subjects,
and  is fast falling into disrepute.  The good citizen begins to feel that every division of
science has practical bearings on his every-day life and the well-being of  the community.
The great Dutch  physician Boerhaave, in a treatise on the preservation of health, it is
said, presented a  book of leaves, all blank save one, on which  was  imprinted, " Keep the
feet warm, the head cool, and the  bowels open."   But since the days of  Boerhaave per-
sonal safety from pestilence has been vastly  increased, the  mortality record  of  every
disease has been steadily lowered by means of  wise methods of prevention and improved
remedies, and human longevity considerably increased, as shown by indisputable figures—
contrary  to  the prevalent misconception  that  our race is degenerating.   The  thinking
men and wonten of our day will therefore expect  instruction as to these modern means
of protection and cure, and recognize the value  of some knowledge of the nature of
Miasm or Malaria, of Contagious Diseases, the Germ Theory of Disease, of  Parasites and
Poisons,  of Vaccination and Wounds.
   Diseases  have been treated of under those technical names by which the practising
physician usually designates them, but popular synonyms have in numerous  instances
been introduced to facilitate the reader's search  for desired  topics.
                                                  E. Darwin Hudson, Jr., M.  D.
  New York, March, 1880.
                                                                          3 
         editor and  contributors.
JOHNSONS   FAMILY  PHYSICIAN.
E. DARWIN HUDSON, Jr., M. D., Prof, of Practice op Medicine, Woman's Medical College
    of the N. Y.  Infirmary, and one of the Regular  Contributors  to "Johnson's Universal
    Cyclopaedia."
ALONZO CLARK, M. D., Pres. of the N. Y.  College of  Physicians and Surgeons, Medical
    Department,  Columbia College, and one of the Regular Contributors to "Johnson's  Uni-
    versal  Cyclopaedia."

WILLARD PARKER, M. D., LL.D., Prof, of Surgery, Columbia  College, Medical Department,
    AND  ONE OF THE ASSOCIATE EDITORS OF " JOHNSON'S UNIVERSAL  CYCLOPAEDIA."

C. R. AGNEW, M. D., the Distinguished Oculist and Aurist, and one of the Regular Contributors
    to "Johnson's  Universal Cyclopaedia."

WILLIAM DETMOLD, M. D., Prof. Emeritus of Clinical and Military Surgery, Medical De-
    partment, Columbia College, New York, and one of the Regular Contributors to "Johnson's
    Universal Cyclopaedia."
ABRAHAM  JACOBI, M. D., Clinical Prof, of the Diseases of Children, School of Medicine,
    Columbia College, and one op the Regular Contributors to "Johnson's Universal  Cyclo-
    paedia."

MARY  C. P.  JACOBI,  M. D., Prof, of Materia Medica in the Medical College established
    by Elizabeth Blackwell, M. D., in New York, and one of the Regular Contributors to
    "Johnson's Universal Cyclopaedia."

STEPHEN SMITH, M. D., Member of  the  New York City Board of Health, and one of the
    Regular Contributors to "Johnson's Universal Cyclopaedia."

E. C. SEGUIN, Jr., M. D., Clinical Prof, of Diseases of  the Mind and Nervous System, College
    op Physicians  and Surgeons, New York, and one of the Regular Contributors to "Johnson's
    Universal Cyclopaedia."
E. KRACKOWIZER, M. D., established the German Dispensary, New York, and was one  of the
    Regular Contributors to "Johnson's Universal Cyclopaedia."

WEIR MITCHELL,  M.D., Author and Distinguished  Physician in Philadelphia, Pa., and one
    of the Regular Contributors to " Johnson's  Universal Cyclop.edia."

AUSTIN FLINT,  M. D.,  Prof, of Principles and  Practice  of Medicine in Bellevue Hospital
    Medical College, New York, and one of the Regular Contributors to "Johnson's Universal
    Cyclopaedia."

W. A. HAMMOND, M. D., late Surgeon-General U. S. Army, and one of the Regular Contributors
    to " Johnson's  Universal Cyclopaedia."
J. C DALTON, M. D., Prof, of Physiology and Hygiene, School  op Medicine, Columbia College,
    New York, and one  of the Regular Contributors  to "Johnson's  Universal  Cyclopaedia."

C. HEITZMANN,  M, D.,  one of the best-known Authorities on  Skin  Diseases, and one  of the
    Regular Contributors to " Johnson's Universal Cyclopaedia."

C P. RUSSEL, M. D., an Authority on  Hydrophobia, etc., and one of the Regular Contributors
    to "Johnson's Universal Cyclopaedia."
SAMUEL ST. JOHN, M. D., Prof, of Chemistry and Medical Jurisprudence, Medical Department
    of Columbia College, New York, and one of the  Regular  Contributors to " Johnson's  Uni-
    versal Cyclopaedia."
FREDERICK  ZINSSER, M. D., an Authority on Skin and Venereal Diseases, and one  of the
    Regular Contributors  to "Johnson's Universal Cyclopaedia."
F. P. FOSTER, M. D., an Authority on Vaccination and Smallpox, and one of the Regular
    Contributors  to  "Johnson's Universal  Cyclopaedia."
EDWa\RD CURTIS,  M. D., Prof,  of Materia Medica and Therapeutics, Medical Department
    of Columbia  College,  New  York, and one of the Regular Contributors  to "Johnson's
    Universal  Cyclopaedia."
DAVID  WEBSTER, M. D., Author of the Article " Sight, Defects of," in " Johnson's  Universal
    Cyclop.edia."
G. H. WYNKOOP, M. D., a well-known Physician in  New York, and one of the  Regular Con-
    tributors to "Johnson's Universal Cyclopaedia."

                                  AND  OTHERS.

                           ALVIN J.  JOHNSON  & SON, Publishers.
  New York, March, 1880. 
                    JOHNSON'S

HOUSEHOLD   TREASURY
                                 OF
         USEFUL  INFORMATION.
THE   FAMILY   PHYSICIAN.
   Abra'sion. See Wounds (contused, etc.).
   Ab/scess [Lat. absces'sus, from abs, "away
 from," and ce'do, to " go," because the pus
 separates itself from the  rest of the body],
 in surgery, is a circumscribed collection of
 pus in any part of the animal organism, as
 distinguished from "purulent infiltration,"
 which designates such a collection not cir-
 cumscribed.  The term " diffuse abscess " is,
 however, applied, though improperly, to pur-
 ulent infiltration.  An  " acute abscess " is
 one which is the result of active inflamma-
 tion.  " Cold abscess " is the result of chronic
 inflammation.  The tendency of an  acute
 abscess is to " point" or " come to a head;"
 that is, from the outward pressure of the
 accumulating pus the walls yield mechani-
 cally in the direction of least resistance.  In
 favorable cases the evacuation of the pus,
 natural or artificial, is the initiation of re-
 covery ; but if the abscess be of the " cold "
 variety, or be deep-seated  and extensive, or
 be associated with symptoms of blood-poi-
 soning, the question of  recovery becomes a
 much more complicated one.  The general
 symptoms of abscess are  fever and subse-
 quent rigors; the local  are  "pain,  heat,
 redness, and  swelling,"  followed by  soft-
 ness and fluctuation of the fluid contents.
 Abscesses  should be poulticed  to  hasten
 pointing  and  evacuation, and  to  relieve
 pain when mature they may be evacuated
 by incision.
  Ac/ne.   See Skin Diseases.
  Ad'dison's  Disease [named  from its dis-
 coverer, the late Dr. Addison of Guy's Hos-
 pital,  London], or  Supra-renal Melasma, a
 rather rare disease, the most obvious symp-
 tom of which is a gray-black or bronze  color
 of the skin, gradually coming on.  The  chief
 lesion discovered after death is a cheesy de-
generation of the supra-renal  capsules, the
result of peculiar chronic inflammation. Pa-
tients usually suffer from  extreme debility,
depression of spirits, pain in the epigastrium
and back, often accompanied by dyspepsia,
vomiting, diarrhoea, and grave nervous symp-
toms.   No remedy is known, and the dis-
ease, though careful nursing is extremely
useful,  is probably never cured.
  A/gue [probably from the Fr. agu, an old
form of aigu, "sharp," in  allusion  to the
violence of the disease]  is the common name
for the  Intermittent Fever  (which see).
  Albuminuria  [from albumen  and the Lat.
urVna,  "urine"] is the presence of albumen
in the  urine, constituting a very important
symptom of disease.  Albumen is sometimes
observed in small proportion in the urine of
persons apparently healthy. Artificial ob-
struction (by vivisection and ligation) of the
emulgent veins in the lower animals pro-
duces albuminuria, thus illustrating the fact
that passive engorgement of the kidney may
cause this symptom, as in organic disease of
the heart.  Albuminuria has been reported
as following the injudicious use of oil of
turpentine, in which case it results from an
active congestion of the kidney.  Albumi-
nuria is sometimes associated with dyspepsia,
in which case it may be either  a temporary
and probably unimportant symptom, or a
precursor of Bright's  disease  — a  malady
which is among the most formidable of all
with which we  have to deal.  In the latter
disease it is  chiefly due to  two causes—(1)
checked perspiration by exposure  of the
body to cold and wet, and (2) excessive use
of alcoholic drinks. This symptom has also
been observed  in  malarial  and typhoid fe-
vers, pneumonia,  smallpox, scarlet  fever,
measles, erysipelas, peritonitis, consumption,
pregnancy, rheumatism, leucocythsemia, pur-
pura, and a great variety of other conditions..
In most cases it results from a degeneration
of the  kidney,  characterized  by swelling,
opacity, and molecular decay of the renal
epithelium.
  Albuminuria is detected either by acidu-
lating and boiling the urine in a test-tube
                              5 
6
THE FAMILY PHYSICIAN*.
or by adding nitric acid.  In either case the
albumen coagulates into a white, semi-solid
mass. Albuminuria is best treated by atten-
tion to hygienic conditions, and diuretics.
   AFcoholism.  See Intoxication.
   Alope'cia.  Sue Baldness.
   Amaurosis  [Gr. dfiavpuaic, from ay.avp6u,
to "darken")  a  term  formerly much em-
ployed to designate total or partial blindness
dependent upon diseases of the optic nerve,
either at its origin,  in its course, or in the
retina;  the  last-mentioned seat  of the dis-
ease being by far the most frequent.  If the
local disease be temporary or functional, the
sight will probably be regained, but in the
majority of  cases  there is no such hope.  It
may arise from many causes, one of  the
most remarkable  of  these being  the exist-
ence of Bright's disease;  and in  cases re-
sulting  from this cause there is an organic
change  in the structure of the retina, read-
ily discernible by  the aid of the ophthalmo-
scope.   Amaurosis sometimes comes on at
once, but is generally gradual in its attack.
The treatment varies  with  the  extremely
various   pathological conditions.  Active
treatment is seldom  called for, and no item
in the cure of this disease is more important
than attention to the hygienic condition.
   Anee'mia  [from the Gr. a, priv., and at/ua,
"blood"],   also  called Spanae'mia  [from
(T7ravdc, "scarce," "rare," and aiya, "blood"],
a  morbid condition  of the body in  which
the blood is of an abnormal composition,
there being  usually a deficiency in the nor-
mal number of red corpuscles, a poverty of
albumen, and  an  excess of salts, the  abso-
lute amount of the blood being usually be-
low that observed in  health.  This condition
is  not properly a  disease, so much as a re-
sult of some disease  or lesion, such as dys-
pepsia,  haemorrhage,  excessive   secretion
from any gland or surface, insufficient nu-
trition, defective aeration of the blood, con-
sumption, cancer, malarial  or other slow
poisoning, leucocythsemia, excessive labor, or
long-continued mental troubles.  The symp-
toms are, first, great debility, paleness of
face, lips, and tongue, wasting of the tissues,
various  cardiac, arterial, and  venous mur-
murs, a  small and often rapid pulse, clear-
ness and low  specific gravity of the urine.
Late in  the disease the feet swell and sweat-
ing is observed.  The treatment is, first, if
possible, to  remove the cause.   Next,  the
proper conditions  for recovery must be es-
tablished, such as proper food, due exercise,
and good air. Tonics, if they are well borne
by the patient, are generally useful.  Strych-
nia, quinia,  and, above  all, iron, are often
extremely useful.  The iron is generally
thought to act as  food, there being an actual
deficiency of iron in  the blood.
  Anasarca.  See Dropsy.
  Anchylosis.  See Ankylosis.
  Aneurism [Or. avsvpvoua, a "widening"],
a pulsating tumor filled with blood, and
communicating more or less directly  with
an arterv, the tunics of which are wholly or
partially destroyed.   A  "true"  aneurism
has one or more  arterial coats in its wall.
A  "false"  aneurism has  a wall  of  con-
densed areolar  tissue, the arterial coat hav-
ing disappeared.   A  " traumatic "  aneur-
ism originates  in a wound or other acci-
dental injury.    A  "varicose"  aneurism
communicates with both an artery and  a
vein,  but the  term sometimes signifies  a
mere  symmetrical dilatation of an  artery.
When such dilatations occur  in groups or
knots, it is a " circoid " aneurism.  When
the blood  gets between the  coats  of an
artery, and thus forms a  tumor,  it is  a
" dissecting"  aneurism.   The  heart and
its vessels  are  liable to aneurismal dila-
tations.
  Aneurisms not traumatic are frequently
traceable to a degeneration of the arterial
coats, known as atheroma.  In  general, an-
eurism of the extremities, when sufficiently
near the surface,  as when  it occurs in the
" popliteal space " (the hollow of the knee),
may be treated with a fair  prospect of suc-
cess by long-continued compression, mechan-
ical or digital.   " Ligation," or tying  the
artery, sometimes succeeds.  Galvano-punc-
ture has its advocates  as a means of cure.
The  injection  of  powerful astringents  has
succeeded in some cases, but is not to be
regarded as a safe proceeding.  The pros-
pect,  especially in aneurisms  of  the aorta
and its great branches, is  that the disease
will prove fatal, though  there  are very in-
frequent  cases which spontaneously recover
by the formation of a clot within the tumor,
which gradually  shrinks into a hard, some-
times a chalky, mass.   The administration
of sedatives and  medicines which increase
the proportion  of fibrine in the blood  has
been  often  advocated.   Prolonged  fasting
has been recommended,  but in general the
safest way is for the patient to avoid all ex-
cesses, and to make use of a nutritious diet,
without attempting  a cure.   One of  the
most  remarkable  effects of aneurism is the
absorption of neighboring tissues,  and even
of bones, from the continual pressure.  The
aneurism sometimes finallv bursts internally.
  Angina Pectoris ("angina of the breast"),
called also Breast-Pang  and  Heart-Stroke,
an intense pain  occurring in paroxysms,
and usually commencing in  the  region of
the heart or at the lower end of the breast-
bone,  and extending  along  the  left  arm,
more  rarely going toward the right  side.
It  is  characterized by a feeling of extreme 
THE  FAMILY
PHYSICIAN.
7
constriction of the chest, as by a band or
cincture, producing a sense of suffocation,
faintness, and often apprehension  of  ap-
proaching death.  Angina pectoris may be
due to organic or functional heart disease.
The grave cases result from dilatation and
aneurism of the heart or embolism of  the
arteries of the heart.  Functional cases are
due to emotional causes and debility. Men
over fifty years of age are most frequently
attacked.  Valerian, aromatic stimulants,
morphine,  and nitrite of  amyl are useful
in the attack, which is usually, not always,
short. Between paroxysms the patient should
lead a tranquil, retired life, and make use
of  a plain,  nutritious diet.
  Ankylosis,  or Anchylosis [from  the  Gr.
aynvloq, "bent"], in surgery, a stiffened and
more or less fixed and immovable joint, so
called  from the crooked position often seen
in limbs with such joints.   Ankylosis may
result from suppurative inflammation, as in
" white swelling " of the knee, and is to be
regarded as a favorable termination of such
disease.  These  cases  result often  in neo-
plastic  exudations—new tissues—adhering
to the cartilages of both articulating bones;
and not unfrequently these new growths are
partly or completely ossified, converting the
two bones into one.  The  cartilages or  lig-
aments  of a joint may become  shrunken
from disease,  the  opposing synovial mem-
branes may adhere to each other, or other
important structural changes may  prevent
motion.  " Spurious ankylosis " is a case in
which  a spasm or cicatrical contraction of
the muscles, or even of the skin,  prevents
motion, while the joint itself is not the seat
of disease.  Cases of so-called hysteria some-
times are accompanied by a stiffness of  one
or more joints; but such cases are readily
detected after the administration of an  an-
aesthetic, when the  joint at once becomes
movable.
  The prospect of recovery of motion in an
ankylosed  joint is  small  indeed.   Joints
stiffened  at  an inconvenient angle may be
put into better shape  during anaesthesia,
and then be allowed to  become ankylosed
again in the desired position.  Excision of
joints has been considerably practised, and
with some success as a means of cure.
  Anthelmintics [Gr. avri,  " against," and
elfiivq,  a  " worm"]  are medicines which
either destroy or drive out intestinal para-
sites ; the former  are called vermicides, the
latter vermifuges.  The last named are most
commonly employed. Against the ordinary
lumbricoid worm  [Ascaris  lumbricoides), or
round-worm, an infusion or  fluid extract of
senna and spigelia (pink-root) is safe and
efficacious.  To drive out the worrying seat-
worms or thread-worms (Oxyurus or Ascaris
vermicularis) nothing is better than santonin,
introduced into the bowels in the form of a
suppository.  For the more formidable tape-
worm (Tcenia) carbolic acid, oil of turpen-
tine, oil of fern, kousso, pumpkin-seeds, and
pomegranate-seeds are used.  It is important
that the head of the tape-worm shall pass
away, as, till that happens, the joints con-
tinue to be reproduced.
  An/thrax.  See Carbuncle.
  Apho/nia (loss of voice) may be (1) nervous
aphonia, temporary and cured by time, rest,
tonics, and electricity, or (2)  aphonia due
to disease of the vocal cords. (See Throat,
Diseases of.)
  Aphthae.  See Mouth, Diseases of.
  Ap'oplexy  [Lat. apoplexia, from the Gr.
drrS, " away," and Tclr/aau, to " strike;" as we
speak of a stroke of apoplexy or of paraly-
sis], a disease marked by the sudden failure
of volition, sensation, motion,  and mental
action, the symptoms being caused by a pres-
sure upon the brain originating within the
cranium.   Apoplexy  is  of various kinds,
differing not so  much in symptoms as in
pathology.  The typical form is character-
ized by an escape of blood into the substance
of the brain  from a ruptured  vessel.   The
rupture itself may be caused (1) by a non-
inflammatory, fatty  degeneration  of the
blood-vessel, caused by  bad nutrition, etc.;
(2) by a brittle condition of the vessel, re-
sulting from an inflammatory process.  These
causes may be supplemented by a full  habit
of body or  by a  hypertrophied heart, or
both; and it is easy to see how such second-
ary causes might assist  in the rupture  of a
weakened blood-vessel.  Apoplexy may, how-
ever, be produced by an extravasation of
blood between the membranes, by a sudden
and large serous  effusion into the ventricles
of the brain, or  even  by a congestion (hy-
peraemia) of the  brain.   The apoplectic
stroke  may end in partial recovery  or in
speedy death.  Cases not fatal generally re-
sult in permanent or temporary paralysis of
one side of the body (hemiplegia), usually on
the side opposite that in which the  mischief
has occurred.
  The symptoms of apoplexy are often un-
expected.  The patient falls suddenly  (with
or without an outcry), his respirations are
long, slow, and stertorous, the pulse is slow,
one or both the pupils usually small.  If the
patient  does  not die  during the attack, a
secondary inflammation follows which may
destroy  life.  Bleeding  may be resorted to
if the pulse be strong  and the heart and
lungs in good condition, but it is  often in-
jurious.   Mustard to the extremities and
frictions of the skin should be resorted to,
and the bowels should be moved by enema.
Persons  having  reason  to  fear apoplexy 
THE  FAMILY  PHYSICTAN.
should avoid excesses of all kinds, yet live
upon nutritious food, paying special atten-
tion to hygienic conditions.
  Arthritis.  See Rheumatism and Syno-
vitis.
  ArthrKtis Deformans. See Rheumatism.
  As/caris [Gr. amapig], (plu. Ascar'ides), a
genus of intestinal parasites, of which the
most common is the round-worm,  Ascaris
lumbricoides, found in the intestines  of man.
Children frequently have them, principally
in the small intestines.  The body of this
worm is round, elastic, with a smooth sur-
face, of a whitish or  yellowish color;  it
tapers  especially towards the anterior ex-
tremity, which commences abruptly by three
tubercles which  surround the mouth.   The
body is transversely furrowed with numerous
fine lines, and marked also with  four lines
from head to  tail.   In the female there is
usually a constriction of the body at  the dis-
tance of about one-third of its length from
the mouth.  Sometimes, especially in young
and weakly children,  their accumulation
may cause  serious disturbance; even  con-
vulsions may be thus produced.   There are
no symptoms (apart from the passage of the
worms from the bowels) invariably connected
with their presence.  Itching of the nose,
capricious appetite, swelling of the abdomen,
and grinding the teeth when asleep, may all
occur,  but they may also  be produced by
other causes.   Ascaris vermicularis is the
small  white  thread-worm or  seat-worm,
which,  although called  dampig by  Hippo-
crates, is by most recent writers called Oxy-
uris vermicular^.  Its length is from  two-
twelfths to five-twelfths of an inch, the fe-
male being larger than the  male.  The head
is blunt, widening  on each side; the body
tapers  (at least in the female) to a point.
Seat-worms, by  the itching  they produce,
often distress children very much; they are
less frequently met with in adults.  (For treat-
ment of worms, see Anthelmintics.)
  AscKtes [from the Gr. aandq, a "  skin," a
leathern bag for water, alluding to the shape
of  the  patient's abdomen], dropsy of the
abdominal cavity,  is most frequently an in-
dication of portal  obstruction,  caused by
" cirrhosis" or other disease of  the  liver,
which  hinders the return  of venous  blood
to the heart and causes pressure in the veins,
leading to transudation of serum into the
peritoneal (abdominal)  cavity.   In  other
cases it is a symptom of general  dropsy; or
it may result from cancer or tubercle of the
peritoneum; or, in children especially, it
may appear as a temporary and quite inex-
plicable phenomenon, without serious  dan-
ger or  distress.  Ascites must be regarded
in almost all eases as very grave; in a few
cases the  immediate danger passes away for
the time; but such results are temporary and
unfrequent.   The treatment is palliative.
Diuretics  may  be useful, but  hydragogue
cathartics are much more effective  in  re-
lieving  the  symptom.    Tapping  may be
practised where the dropsy very seriously
distends the  abdomen.   The diagnosis  be-
tween ascites and ovarian dropsy is some-
times very difficult.  The distinctive marks
can be appreciated only by the skilled phy-
sician.
  Asphyxia [from the Gr. a, priv., and oQvfa,
the "pulse"], originally meaning cessation
of the  motion of the heart,  has  by usage
come to signify arrest of breathing (proper-
ly apncea) by suffocation or  strangulation.
It occurs in  drowning,  by water excluding
air from the lungs; in  hanging or choking,
by the compression of the windpipe,  pre-
venting the entrance of air; in the presence
of certain gases, as chlorine or pure car-
bonic acid,  by  spasmodic closure  of  the
glottis  or entrance  to  the windpipe.  It
has  been proved by careful observations
that after death by asphyxia the left cavi-
ties of the heart are empty,  and  the right
distended with blood.  This is owing to  the
fact  that venous blood, not renewed by  ex-
posure to the oxygen of the air, will not cir-
culate through the lungs, thus being forced
to accumulate in the right or venous side of
the heart.  The mode  of treatment  of  as-
phyxia  must depend  on its cause.  (See
Drowning.)  In partial strangulation,  ab-
straction of blood in moderate amount may
unload the heart and promote the movement
of the blood, after the cause  of obstruction
has been removed.  For asphyxia from ir-
respirable gases the first necessity is a supply
of pure air.   When the heart has almost or
quite ceased to beat for a few moments, life
is sometimes restored by artificial respira-
tion or  by application  of galvanic electri-
city to the chest.
  Asth'ma, az'ma [Gr.  acdfia, a "gasping for
breath"], a  term somewhat vaguely used
to designate diseases characterized by diffi-
culty of breathing occurring  in paroxysms;
thus, spasm  of  the glottis  is sometimes
called " thymic asthma;" autumnal catarrh
is known as " hay asthma;" the dyspnoea
(difficult breathing) of  Bright's disease  has
been, with questionable  propriety, called
"uraemic asthma;"  and similar symptoms
arising from heart or lung disease have  also
been mistaken for true asthma, which, how-
ever, may be associated with these various
diseases.  True  asthma, according  to  Nie-
meyer, includes only those cases where the
point of the irritation producing the attack is
either at the  origin of the vagus nerve or in
some remote part of its course.  This does
not exclude cases of reflex asthma, such, for 
THE  FAMILY  PHYSICIAN.
9
  example, as  may occur  in  uterine disease.
  Others state that irritability and congestion
  of the bronchial mucous membrane are es-
  sential elements of the disease; and the
  readiness with which powdered ipecac, the
  exhalations from feathers, etc., will excite
  paroxysms, would  appear to  confirm this
  view.  It is rare to find  structural changes
  of any organ in cases  of simple asthma.
  The trained diagnostician  alone can dis-
  criminate  between  asthma  and  dyspnoea
  from  other chest diseases.  True or nerv-
  ous asthma consists in a  paroxysmal spasm
  of longer or shorter duration, attacking the
  muscular elements  of  the bronchial tubes,
  diminishing temporarily their  calibre, and
  thereby  obstructing respiration.   Notwith-
  standing the great  distress which may ac-
  company the attack, the immediate danger
  is not  great.  The smoking of saltpetre-pa-
  per or of stramonium-leaves, the administra-
  tion of opiates, coffee,  belladonna, conium,
  cannabis, chloral, vapor of chloroform, etc.,
  may or may not  relieve the paroxysm.   Io-
  dide of potassium benefits many cases, per-
 manently or temporarily. Quinia, Fowler's
 solution, iron, and other tonics  are often
 useful.  A nutritious diet, with careful reg-
 ulation of the bowels, is important.  The
 compressed air-bath and  inhalation of oxy-
 gen are recommended as  affording  great re-
 lief during the paroxysm. Asthma in many
 cases  is  accompanied  by a bronchial ca-
 tarrh.
   Astigmatism.  See Eye, Diseases  of.
   Ataxia.  See Spine, Diseases of.
   Auscultation, application of the ear to the
 surface of the body, chiefly to the chest for
 the  detection of the healthy and  diseased
 sounds of the heart and  lungs.
   Bald/ness [alopecia),  [Gr. a/Lairr/?, a "fox,"
 this animal being subject  to baldness].  Loss
 of hair may be  either general or partial,
 sudden or gradual.  It  occurs in men more
 often than in women.   Senile  baldness,
 the result of age, comes  on gradually, the
 hair becoming thin on the crown or on the
 temples and forehead.  It results from loss
 of nutritive activity of  the hair-follicles,
 which  atrophy  and  render the loss irre-
 parable.   When  baldness follows severe
 sickness,  or results prematurely from con-
 stitutional debility or  nervous  shock and
 overwork, the hair-follicles are intact though
 inert, and may be stimulated to new  activ-
 ity by  tonic  applications.  Rest, regular
 habits,  good diet, cod-liver  oil, iron, and
 tonics  generally,  by  invigorating the sys-
 tem, favor the regrowth of the  hair.   The
 capillary  circulation  of the scalp must be
stimulated by shampooing, kneading, brush-
ing, and by the use of lotions which irritate
without stimulating.  Cantharides and am-
  monia, in union with  oils or unguents, are
  very efficacious in curing baldness.
    Ban/dages [from the Anglo-Saxon bin'dan,
  to " bind;" literally, anything used for bind-
  ing], the bands or wrappers used by sur-
  geons to dress wounds, to compress bleeding
  vessels, to rectify the deformity produced by
  fractures or other injuries, and to unite parts
  in which there is a solution of continuity.
  They are commonly composed of soft mus-
  lin,  linen, or flannel.  Sometimes they are
  made immovable after application by being
  soaked  in starch or glue.  The art of band-
  aging consists  in applying  pressure with
  exactly the required  firmness, and evenly.
  It is important to avoid  interrupting  the
  circulation of the blood.  Unskilful band-
  aging has caused mortification of a limb.
  The arm  should never be tightly bandaged
  (unless  temporarily, to arrest haemorrhage)
  without the  hand being  subjected to an
  equal' amount  of  pressure;  and  the same
  rule applies  with regard to the  leg  and
  foot.  To make a bandage fit  well upon a
  limb, the  roller should be drawn smoothly
  as far as  it can be, and  then reversed by a
  turn of the hand  from time to time, pro-
  ducing  a  spiral by the overlapping of the
  successive turns.   A bandage for  the arm
  may be from  two to two and a quarter
  inches wide;  for  the lower extremity, two
  and  a half inches;  for the chest, three
  inches.  In the treatment of wounds, how-
 ever,  and of stumps of  amputated  limbs,
 bandages are less resorted to  now than for-
| merly, many surgeons preferring lighter and
 cooler dressings, with  adhesive strips, etc.
 One  of  the most  useful of bandages  for
 emergencies is  the "Spanish windlass," to
 check serious  bleeding from any part  of
 either extremity.   It  is  merely a strip of
 muslin  or a  pocket handkerchief  passed
 around  the upper  part of the limb, tied in
 a knot,  and then  twisted  firmly by a stick
 or bayonet passed under it,  so as to press
 with sufficient  force to arrest the arterial
 circulation.  It must not be  left on many
 hours, but its  temporary  application  has
 often  saved life.   In like  manner, free
 bleeding from a wound  of the scalp may
 be controlled  by a compress and  bandage
 tightly applied around the head. Esmarck's
 bandage is an elastic ribbon  of rubber for
 application to the  arm or leg before ampu-
 tation or other  serious operations.  By its
 compression the blood of the member is ex-
 pelled upwards into the vessels of the body,
 and the  operation is  rendered " bloodless."
 Rubber bandages are also used with brilliant
 results in treating ulcers and varicose veins
 and reducing dropsical  swelling in the legs.
   Dextrine or starch bandages, the plaster-
 of-Paris  bandage, and water-glass bandage 
10
THE  FAMILY PHYSICIAN.
 are now  applied  most successfully in the
 treatment of fractures of the bones of the
 extremities, in place of other splints.   The
 starch or dextrine bandage is made by sat-
 urating  several successive  layers  of  care-
 fully-applied bandage, or cloth of loose tex-
 ture, with thick boiled starch, which when
 dried converts the soft fabrics into a rigid
 case.   The plaster  of Paris or  gypsum  is
 prepared by making a thin paste  of equal
 parts of plaster and water,  which may be
 soaked into the bandages or cloths fitted to
 the shape of the broken limb.   Salt added
 to  the water  hastens the " setting" of the
 plaster.   Glue is added where the setting is
 desired to be slow.  The water-glass or sili-
 cate  bandage is made of silicate of potash
 or  silicate of soda dissolved in caustic pot-
 ash or  soda.   It  possesses  great strength,
 and is very light.  Each layer of the roller
 bandage as it is applied is brushed over with
 the solution of the  silicate,  which at once
 dries. A final coating secures the smooth
 dressing for the exterior.
   Barba/does Leg.  See Elephantiasis.
   Barker's Itch, a term applied somewhat
 indiscriminately  by the  public  and  many
 physicians  to two distinct diseases.
   1.  A  majority  of  cases are instances  of
 impetigo mentis, or pustular  eruption on the
 face from the irritation of too frequent and
 close shaving. The  face is inflamed, red,
 tender,  and nodular,  with  numerous  pus-
 tules of various size, discharging  pus, which
 mats in the stumps of the beard  and  forms
 scabs.  But the beard does  not fall, and if
 isolated hairs be pulled out and the bulb
 examined microscopically, it is found to be
 free from any of the parasitic sporules which
 mark the second and contagious form.
  2.  The second form is the true " barber's
 itch," contracted by contact of person or
 the soiled  and contaminated  razors  and
 brushes of the barber.  It is termed sycosis,
 tinea sycosis, and  meniagra, and is really
 "ringworm in the beard."   Each  hair of
 the infected beard is covered with a whitish
 powder of parasitic scales or sporules.  The
 parasitic vegetation is the Microsporon men-
 tagrophytes, probably identical with  the Tri-
 cophyfon tonsurans of simple ringworm.  The
 face is variably inflamed with nodules of
 hardening and pustules,  and has  patches
 and arcs of whitish  scales.   In  either  the
 impetigo mentis or the true sycosis the inflam-
 mation is to be removed by frequent appli-
 cations of cold water,  perfect cleanliness,
 and soothing lotions, as of glycerine, opium,
 and acetate of lead.   With  the  first form
such  methods will suffice.  In the second
or  parasitic form all  the  infected  hairs
should be  pulled out with  the depilation-
forceps, and the parasites destroyed in the
  hair-follicles  by "parasiticide" lotions  or
  unguents.  Chief  of  these are sulphurous
  acid, either pure or diluted, carbolic acid
  in glycerine, weak solutions of corrosive
  sublimate, and ointments of sulphur, iodide
  of sulphur, nitrate of mercury, and  white
  precipitate.
    Basedow's  Disease, called also  Graves'
  Disease  and Exophthalmic Goitre, is  a dis-
  ease more common among women than men,
  and characterized  by prominent eyeballs,
  slightly  enlarged thyroid gland, palpitation
  of the  heart, and generally by anaemia.
  Basedow's  disease  frequently, though not
  always, ends in recovery. Its  cause is stated
  by Niemeyer to be probably  a paralysis of
  the vasomotor nerves.   It is best treated by
  good food, chalybeates, gentle exercise, and
  hygienic measures.
    BiFious CoKic and CaFculus.  See Liver,
  Diseases of.
    Bilious Fe/ver, an indefinite term not in-
  cluded in any accepted classification of dis-
  ease.   It is equally applied  to attacks of
  extreme indigestion with associated irrita-
  tive fever [febricula); to the disturbance
  of persistent constipation and torpid  liver,
  when  fever  coexists with  headache,  foul
  tongue, bad breath, loss  of appetite,  load-
  ed bowels, general  languor, and chilliness;
  to obscure forms of malarial  fever  (remit-
  tent) ; to unpronounced  and  mild cases of
  typhoid; and to many other cases when the
  physician lacks in diagnostic  ability.  The
  cases which may be termed  bilious  fever
  are such as are due to inactive liver, cos-
  tiveness,  and  disordered  digestion,   and
  marked  by  chills, general  malaise,  and
  dark  complexion, but yield promptly to a
  vigorous cathartic treatment and corrected
  diet.
    Birth-marks.  See N^evus.
    Bites of Serpents.   See Poison of Ser-
  pents.
    Blad/der  [Lat. vesica;  Fr. vessie], a mus-
  culo-membranous sac contained in the an-
  terior part of the pelvis.   It is absent in all
  invertebrate animals.  A few  cartilaginous
  fishes possess it; so do Batrachia (frogs, etc.)
  and  Chelonia (turtles).  No birds have it,
  although the ostrich and cassowary  have a
  dilatation of the cloaca somewhat resembling
  it.  It is present in all Mammalia.  In man
  the bladder is nearly triangular when empty,
  oval when full.  The ureters  (one on each
  side) convey the urine to it from the kidneys;
  and this  is voided, by the contraction of the
  bladder,  through the urethra.  The entrance
  to the latter is guarded by a valve, partly
  muscular, called  by  some  anatomists the
  sphincter vesica?.  Distension of the bladder
  (retention of urine) from any obstruction of
i  the urethra  is a very painful and sometimes 
THE  FAMILY
dangerous affection.  It may be spasmodic,
but it is more often the effect of a stricture
or contraction of the passage from local dis-
ease.   In low fevers it is not uncommon for
a kind of paralytic distension of the bladder
to occur.   In either of these cases the re-
moval of  the urine by means of a catheter
is of great importance.   The bladder is also
liable  to  inflammation (see Cystitis)  and
to chronic irritability, either of which may
cause great distress. (For stone in the blad-
der see Calculus.)
   Bleeding, or Haem'orrhage [from the Gr.
cuua, " blood," and pew, to " flow "], in surgery,
denotes the escape of blood from the vessels
which normally contain it.  When the escape
takes place into the tissues it is called " ex-
travasation."  Haemorrhage into an internal
cavity is said  to  be " concealed."  A slight
cut through  the integument is usually fol-
lowed by loss of  blood, chiefly  from  the
capillaries.  Capillary bleeding will in many
cases cease spontaneously, or it may require
compression or the application of medicines,
such  as persulphate of iron or tannic acid.
These medicines are called haemostatics or
styptics.  Arterial bleeding is recognized by
the fact that  the blood  escapes in jets  and
is of a bright-red color.   Arterial bleeding
tends spontaneously to grow less, both from
the feebleness of the heart's  action which
naturally follows, and from the retraction
and contraction  of the  arterial walls,  and
the consequent formation of a clot of blood,
which plugs the wound; but it may be neces-
sary to resort to ligation or tying, to acu-
pressure or compression of the artery by
needles, or to pressure,  mechanical  or  by
hand, upon the course of the artery between
the heart and the wound.  A handkerchief
may be tied around and then twisted with a
stick.  The wounded part should be elevated
if possible.   Venous bleeding  is not gene-
rally very formidable.  It may be recognized
by the steady flow of dark blood. A great
source of danger when large veins are cut
is that air  may enter the circulation; in
which case death may immediately follow.
  Haemorrhage from an  internal and inac-
cessible surface may be treated by astringents,
as gallic acid, or by ergot, which is especially
important in puerperal haemorrhage.   Some
individuals have what is known as the haem-
orrhagic diathesis—a disposition to bleed ex-
cessively even after a slight injury.  A tend-
ency to haemorrhage from the mucous sur-
faces is characteristic of some diseases, such
as typhoid fever.
  Bleeding, or Blood-letting, the abstraction
of blood from the circulation as a means of
curing or preventing disease.  This operation
is performed either  by opening a vein (vene-
section or phlebotomy), by abstraction from
PHYSICIAN.                         H
the capillaries by means of leeches or cups,
or more rarely by opening an artery (arte-
riotomy).  Bleeding was formerly in exten-
sive use in the treatment of many diseases,
generally of an acute or active character;
and though it has to a great extent been
superseded by other measures, of late years
it has been attracting the attention of the
medical profession as a valuable therapeutic
measure in a certain limited class of diseases.
While it  is liable to abuse, and while, like
many other active measures in the treatment
of disease, it may become a source of mis-
chief,  it is nevertheless, when  used with
judgment, a valuable help in the treatment
of some disorders.
  Blennorrhea [Gr. p.hva, " mucous," and
pku, to "flow"], an abnormally copious dis-
charge from any mucous membrane.   After
inflammation of the urinary mucous mem-
brane a gleety discharge frequently continues
for a long period [gleet).  Tonics, fresh air,
careful regimen, and astringent  lotions are
the remedies.
  Blindness is caused by diseases and inju-
ries  of the  eye-ball or the  optic  nerve.
Opacity of  the cornea, cataract, inflamma-
tion of the retina, and sclerotina and amau-
rosis are its chief causes.  The curability of
blindness depends  upon the disease causing
it.  (See Eye, Diseases of.)
  Blisters are plasters which, when applied
to the skin, raise  the cuticle into  vesicles
filled with serous fluid.  They have for their
object  a counter-irfitation or diversion of
inflammatory action from an internal part
to the surface  of the body.  The common
blister is made of cantharides or Spanish fly
(Cantharis or Lytta vesicatoria), mixed with
a convenient proportion of lard and wax.
If applied too long it produces  distressing
affections of the urinary bladder.  In chil-
dren and  sensitive persons a layer of thin
gauze may be placed between the blister and
the skin.  Under no circumstances should a
blister be left long upon children, as it may
produce sores which are difficult to heal.
When the  blister  has  raised, the  vesicles
should be pricked  and their fluid contents
allowed to trickle  away, the  vesicated sur-
face being then dressed with simple cerate
or lard.
  Blood, Spitting  of.  See Haemoptysis.
  Blood,  Vomiting of.  See Ha$:mateme-
sis.
  Blood/y Flux.  See Dysentery.
  Boil [Lat. furunculus], a hard,  painful, in-
flammatory tumor  on  the  surface  of  the
body, which begins as  a point  of a dusky
red color, and is hot, aching, and throbbing.
These  symptoms increase in severity for
several days, when it is of a conical form,
with a broad firm base, and has on the apex 
12                         THE FAMILY
 a whitish point, which contains a little mat-
 ter ; this opens and after a few  days more
 there is discharged a slough of cellular tis-
 sue, and the cavity left heals, leaving a de-
 pressed scar.   Boils often attack young and
 plethoric persons, and their appearance is
 not  incompatible with  robust  health, al-
 though they  may  be so numerous  as  to
 greatly reduce the strength.  Men in train- |
 ing  for  athletic  exercises,  or  others who j
 have suddenly changed  their  habits,  are
 subject to them.  Sometimes  boils continue
 to succeed each other for  a length of time.
 The treatment of boils is simple.  The in-
 testinal canal should be cleared by laxative
 medicines, and  the digestive  powers im- I
 proved by tonics  and antacids.   The tinc-
 ture of perchloride of iron is often a useful j
 remedy.   The skin should be kept healthy
 by  frequent washing,  while the inflamed
 point should be poulticed. Wet lint is a suf-
 ficient application after the core has been
 thrown off. Free incision of the boil greatly
 hastens its course.
  Brain, Diseases of.  See Brain  Fever j
 (meningitis),  Apoplexy, and  Nervous
 Diseases;  also,  Concussion  of the
 Brain.
  Brain Fever is  a popular name for acute
 cephalic meningitis (see  Mf.xixoitis),  a
 dangerous disease, characterized in its ear-
 lier stages by very  high  fever and  intense
 headache, usually followed by delirium and
 death.  Inflammation  of the brain itself
 (encephalitis)  is less common, but is even
 more fatal than the former. It is not always
 easy to discriminate between the two during
 life.  Cold applications to the head and mild
 but persistent derivative treatment are gene-
 rally indicated.
  Breast, Abscess of,  chiefly arising from
 overloading of the breast with milk, follow-
 ing childbirth.  It is best prevented  by a
 brisk purge, quinine, and febrifuges, and the
 unloading of the breast by the  nursing in-
 fant, the  breast-pump, thorough rubbing,
and  inunctions of warm camphorated oil.
 When abscess is formed it must be poulticed
or incised.
  Bright's  Disease  (or Ne'phria), so called
after the English physician, Dr.  Bright, who
first  investigated  its character, consists es-
sentially of a degeneration of epithelium of
the kidneys.   This impairs  the  excreting
powers of the organ, so that the urea is not i
properly removed from the blood.  The dis-
ease is characterized by albuminuria.  When i
we apply heat  and nitric  acid to  the  urine
from a kidney  so affected, albumen is coagu-
lated;  under  the microscope  we observe
casts  of the   tubules  of  the  diseased or-
gan.  Headache  and sickness  of stomach
are common symptoms, and dropsy usually
 PHYSICIAN.

 attends the disease.  The  retina is usually
 attacked  by a  degenerative  inflammatory
 disease, which impairs the  sight, and  is de-
 tected by the ophthalmoscope.
  The  causes are, indulgence  in strong
 drinks, exposure to wet and cold, gout, and
 syphilis.   The  indications  for  treatment
 are, to remove  any of those causes which
 may  be present, relieve congestion of the
 kidneys, at the same  time endeavoring to
 increase strength by iron and other tonics.
 When considerable dropsy occurs, cathartics
 may be called for.  Bright's disease may be
 either acute or chronic.  The prospect of
 recovery is small,  but  patients sometimes
 attain a comfortable, but generally a precari-
 ous, degree of health.
  Bro/ken Bones.  See Fracture.
  Bro/ken Breast. See Breast, Abscess of.
  Bronchitis  [from bronchus, and -itis,] in-
 flammation or hyperaemia  (congestion) of
 the mucous membrane lining  the  air-pas-
 sages, and usually accompanied by a more
 or  less excessive secretion of mucus  from
 that membrane.  Young children, old peo-
 ple, and those who are feeble or ill-nour-
 ished are especially liable to it.   More or  j
 less  bronchitis is usually  associated with  j
 pulmonary  consumption,  with obstructive
 heart disease, and with  asthma.  It is often
 seen in patients with intermittent fever, ty-  j
 phoid, measles, and smallpox.   Perhaps the  |
 most  fruitful cause is  exposure to sudden
 and extreme changes of the weather, leading
 primarily to that form  of acute bronchitis
 which is known as a "cold  on the lungs."
 Influenza is an epidemic bronchitis caused
 by some unknown influence probably exist-
 ing in the air.  (See Influenza.)
  The symptoms of bronchitis are of vari-
 ous  character, varying according  as  the
 disease is seated in the larger or the smaller
 bronchi; the disease is also much more for-
 midable in young children and in aged per-
sons than in others.  There is especial dan-
ger in the case of infants  that collapse of
small  portions  of the lung  may ensue.
 Bronchitis may be  either chronic  or acute.
 Uncomplicated chronic bronchitis may re-
quire the use of sedatives or tonics, with
systematic exercise  and careful attention to
the other hygienic conditions, but the treat-
ment of individual  cases will vary with  the
circumstances and  special  condition of the
 atient.  Acute bronchitis  is in general to
 e treated by expectorants or emetics, to re-
move the secretion, and by diaphoretics and
counter-irritants, such as  mustard, on the
extremities and the chest, to relieve the con-
gested blood-vessels of the bronchi.  When
the case is extreme and suffocation threat-
ened, an infant may be often relieved by  a
 warm bath.  There are other special reme- 
THE  FAMILY  PHYSICIAN.
13
  dial measures which may be resorted to under
  the advice of the physician.
    Bron'chocele.   See Goitre.
    Bruises.  See Wounds (contused).
    Bunion, or Bunyon, a painful  inflamma-
  tion of the bursa mucosa, or membranous sac
  of the great-toe joint.   The pressure of a
  boot causes  it.   Rest and  poulticing  will
  generally subdue the attack, and wearing a
  shoe so  constructed as to save the  bunion
  from pressure will usually prevent a recur-
  rence.
    Burns and  Scalds.  Burns arise from the
  application of a hot solid body or flame, and
  scalds from  hot water or  steam.   Severe
  burns are often fatal, especially to children;
  quite as  much, perhaps, from the shock
  which attends them as from any appreciable
  injury.   In all cases  the clothes should be
  removed with great care, so as not to re-
  move the cuticle with them.  If cold water
  be agreeable to the patient, it  may be cau-
  tiously applied.  Pain and shock may often
  be relieved by  opiates or stimulants.  The
  injured  surfaces are to be dressed with car-
  ron  oil  (a mixture of olive oil and lime-
  water), with collodion, with oiled  cotton, or
  they  may simply  have  flour dredged  over
  them.  When the  surface takes on an  un-
  healthy action and granulations are exces-
  sive, a weak solution of nitrate of silver or
 other local stimulant  may produce good
 results.
   CaPculus, or  Stone, a concretion formed
 within the body from the deposition of mat-
 ters  which normally  remain  in  solution.
 The most important calculi are those formed
 in the kidneys or bladder (urinary calculus),
 and those formed in the gall-bladder or bil-
 iary ducts (biliary calculus, or gall-stone).
 Both of these give  rise to intense pain, and
 may  even threaten  life.  Calculi of less im-
 portance  may form  in the salivary ducts and
 elsewhere.
   Biliary calculus may generally be assumed
 to exist when  excessive pain suddenly arises
 in the right side beneath the ribs, and when
 in a few hours jaundice comes on.   But ab-
 solute proof that these symptoms depend on
 calculus is often wanting. The pain is more
 severe while it lasts than almost any other
 form  of  suffering.   It may be  relieved by
 large doses of opium or by the inhalation
 of ether.  Gall-stones impacted in the ducts
 sometimes have proved fatal, but much more
 frequently they  find their way, sooner or
 later, into the  intestines.
  Urinary calculus is  a  disease most com-
 mon in advanced life and in the male sex.
 It is  frequent in gouty persons, or among
those who pursue sedentary occupations and
live freely.  Certain local conditions pro-
mote  it,   especially  an excess  of mineral
 matter in drinking-water.  It is common in
 England, Ireland, Russia, France, Northern
 Italy, and Egypt.  In the U. S. it is most
 frequent in Kentucky, Tennessee, West Vir-
 ginia, Ohio, and Indiana.  In its early stages
 the disease presents  itself in the form of
 gravel, shown by the passage of  numerous
 small gritty  concretions,  observed  in the
 urine as a deposit like sand, present at the
 time of passing  the  urine, and  not merely
 after it has cooled.  Calculus in the bladder
 is at first  attended with little pain, as com-
 pared with that  caused by the stone  in its
 passage downward from  the kidney;  but
 unless removed the calculus is  sure to en-
 large, and it then becomes the cause of most
 intense distress.  The most trustworthy evi-
 dences of  stone in the bladder are the use
 of the sound, smarting and  burning pain
 experienced after  the bladder  has  been
 emptied, with occasional  temporary stop-
 pages of the urine.
   The chief  varieties of  urinary calculus
 are—1. Uric acid, urates of ammonia, soda,
 lime,  etc.  (brick-dust sediment, red sand)  ;
 2. Phosphates of ammonia and magnesia,
 lime, etc. (the lime phosphate, mixed with
 ammonio-magnesian  phosphate, constitutes
 the  "fusible  calculus,"  one  of  the com-
 monest kinds) ;  3. Oxalate of  lime  (mul-
 berry calculus); 4. Carbonate of lime (chiefly
 in domestic animals); 5. Cystine; 6.  Xan-
 thic oxide (very rare);  7. Very rarely in-
 deed do leucine, tyrosine, and other disease-
 products form calculous concretions. 8. Cal-
 culi of fibrine, etc. are also reported. 9. Cal-
 culi are frequently composed of numerous
 layers, having perfectly distinct  chemical
 composition.  When calculus has once form-
 ed  in  the urinary organs no cure exists ex-
 cept the removal of it from the body, but in
 the earlier stages much may be done to check
 the malady by careful regulation of the diet
 and mode of living, with the use of solvents
 adapted  to the particular  form  of deposit
 found.
  Can'cer  [from the  Lat. cancer, a " crab,"
 the swollen veins around it  being likened
 to crabs' claws], the popular  name for car-
 cinoma, a disease characterized  by tumors
 or slow ulcerations in various parts, having
 a malignant character, and usually ending
 in death.
  Among the tumors admitted by general
 consent into the order of cancers  there are
 widely  different  degrees  of  malignancy;
 some having the tendency to spread rapidly
 and infect  the system at an early period,
 while others remain local for a considerable
time, and may be removed with good  hope
of a permanent recovery.
  The  practical distinction or diagnosis of
these tumors is founded upon a careful com- 
14                         THE FAMILY PHYSICIAN.
parison of the characters of malignant and
non-malignant tumors,  and also upon a
thorough knowledge  of  the  anatomy and
relations of  the  textures  in which they
arise.   The attempts to distinguish  these
from  other  growths  call for the highest
qualities of the surgeon,  including a know-
ledge of minute structure as obtained by the
use of the microscope.
  The most common seats of cancer are, the
female breast, the eye, the  tongue, the lip,
the male genital organs; the liver, stomach,
uterus, rectum, gullet, peritoneum, and lym-
phatic glands.  Scirrhus or hard cancer, ob-
served most frequently in the breast, uterus,
and  stomach, is  more frequently solitary
than  encephaloid  (brain-like),   otherwise
called  medullary  or soft cancer;  the rare
colloid cancer is of a glue-like consistency;
melanosis,  or melanic  cancer,  a  variety
charged with  brown  or  black pigment,  is
almost always multiple in its occurrence;
while epithelial cancer, or epithelioma, of
which examples are frequently found in the
lip and  tongue, is so generally solitary as to
have led some pathologists to place it in a
class altogether apart  from the truly cancer-
ous growths.   Again,  there are varieties of
fibrous and of cartilaginous tumor, as well
as certain  tumors  of bone and  bone-like
tumors in soft parts (osteoid), which occupy
a doubtful position between the  malignant
and  non-malignant growths, the so-called
" cauliflower excrescence " being one of the
number.
  A tumor falls under the suspicion of being
cancer when it infiltrates  the texture  in
which it arises and passes into the surround-
ing textures; when it invades the lymphatic
glands; when it is attended by stinging  or
darting pains, or by  obstinate and slowly
extending ulceration; when it occurs in a per-
son having impaired health or past middle
life, and is not traceable to any known cause
of inflammatory disease or  local irritation,
nor to any other known  constitutional dis-
ease, such as  syphilis  or  scrofula.  But the
elements of diagnosis here referred to ought
to be early submitted to the scrutiny and
judgment of a well-educated medical ad-
viser.
  The  removal of cancerous tumors is  re-
sorted to by surgeons, and when performed
early in well-selected  cases it has been fol-
lowed by long-continued exemption.  Ope-
rations are  rarely performed  after the lym-
phatic glands are  involved, or when there is
evidence of a deteriorated constitution or  of
internal disease.
  Can/crum 0/ris (synonyms, noma, aqueous
cancer), a mortification of the cheek, mostly
in children  who  have long  suffered from
poverty, moist or close air, or fever.  The I
proximate cause is generally found in  an
imprudent administration of mercury, or in
the inanition  and dissolution of the blood
from measles, typhoid fever, whooping cough,
or dysentery.    It is  almost  always fatal.
When the malady is developed the diseased
portion must  be disinfected by  permanga-
nate of potassa or carbolic acid, or destroyed
by concentrated mineral acids, chloride  of
zinc, arsenic paste, or the red-hot iron. The
general condition of the patient requires a
generous  diet, and the administration  of
stimulants and iron,  or quinia,  or both
combined.
  Can/ker in the Mouth.  See  Mouth, Dis-
eases OF.
  Car/buncle  [Lat. carbunculus,  a " small
coal"], the anthrax of surgical writers, is a
violent and painful  inflammation, larger
than a boil, on any part  of the skin, most
frequently on  the back.  The part swells
and hardens, and, as the  disease advances,
assumes a livid  redness.  The cuticle often
rises  in blisters, and  a number of small
openings  may occur, through which  matter
escapes.   The  origin of carbuncle seems to
be constitutional, and it is usually attended
by great suffering and  considerable prostra-
tion.   It is sometimes fatal, especially to old
people. In its  treatment, besides supporting
the patient's strength and softening the skin
by warm poultices, it is usual  to divide the
skin early and freely with a knife, or to de-
stroy  its surface with caustic.
  Carcino/ma.  See Cancer.
  Cardiargia,  or Car'dialgy [from KapSLa, the
"heart," and dA>of, "pain"], literally, "pain
in the heart."   The term is commonly ap-
plied, however, to the uneasiness (heartburn)
connected with indigestion, the seat of which
is really in the stomach.  Relieved by bicar-
bonate of soda, bismuth, and guarded diet.
(See Indigestion.)
  Carditis, inflammation of the heart.  See
Endocarditis and Pericarditis.
  Ca'ries, a term used to designate both open
ulcer of bone  and chronic ostitis or inflam-
mation of the connective tissue of bone,
with solution of the earthy part.  It begins
as an inflammation, accompanied by perios-
titis, followed  by exudation of new materials
and softening. Sometimes the bone-cells are
filled with a  reddish  fluid, and there  are
masses of tubercle.  After caries has existed
for some  time the abscess bursts; its aper-
ture remains open, discharging a fluid which
contains particles of  bone.   If  a probe be
passed through this opening, it will be felt to
sink into a soft, gritty substance;  this is cari-
ous bone.  It is molecular death of bone, while
necrosis is death of a  large mass of bone.
  Caries  usually selects the  vertebrae, the
bones of  the  wrist and foot, and  the  soft 
THE FAMILY PHYSICIAN.
15
 ends of long bones forming joints.  Carious
 vertebrae yield  under the  weight  of  the
 trunk, and the spine curves forward or to
 one side.  In joints  the  part enlarges,  the
 cartilages become affected,  matter forms,
 and  amputation  of  the limb or  excision
 of the joint is  frequently necessary.  The
 causes of caries are  constitutional, such as
 bad nutrition, syphilis, old age,  and other
 depressing conditions.  It may be accident-
 ally determined by any irritation, such as a
 blow  or exposure to atmospheric changes.
 The  treatment consists  in  supporting  the
 patient by judicious change of air, by  the
 use of tonics, such as cod-liver oil, which in
 scrofula appears to combat the constitutional
 predisposition.  In those parts where the dis-
 eased bone can be reached  it may be care-
 fully removed, so as  to leave a healthy sur-
 face.
   Caries of the teeth is a very common dis-
 ease.   It is believed to be caused by dyspep-
 sia and the  use of too hot food and drink,
 but especially by neglect to  clean the teeth
 after eating.
   Cat'alepsy [from the Gr. Kara, intensive,
 and  laufidvu, to  "take"],  a condition  in
 which a person becomes more or less com-
 pletely unconscious,  but does not fall.   If
 standing at the commencement, he remains
 so during the attack, the countenance  re-
 taining the expression the patient wore at
 the outset.   If  the limbs of the patient  be
 placed in a new position by attendants, the
 position is retained.   This  disease is a rare
 one, and indeed is probably not so much a
 peculiar disease as a symptom of other dis-
 eases.  It has been observed in both sexes,
 and  may occur  in  insane persons or  in
 those  suffering with  chorea  and other ner-
 vous affections.   The attack is usually short,
 but may be  indefinitely prolonged.  Treat-
 ment must be addressed to the general con-
 dition.  Catalepsy is  so rare that its charac-
 ter is not well understood.
   Cat/aract  [Gr.  naTap'pdicTrjg,  from Kara,
 "down," and   priywui,  to  "break,"   so
 named because  the ancients believed that
 a  kind of veil  fell  down within  the eye,
 obscuring vision], an opaque state of the
 crystalline lens of the eye, of its capsule, or
 both.   Cataracts  are  thus  lenticular, cap-
 sular, or lenticulo-capsular.  Various other
 kinds  are enumerated, such as the soft cat-
 aract,  in which the lens  is soft, and some-
 times  even liquid ; the hard cataract, when
 the lens may be as hard as bone, with many
 of intermediate  consistency.   Lamellar cat-
 aract affects a limited  part of one or more of
 the lamellae, or layers of the lens. " Gold-leaf
 cataract" is  of  a shining yellow, and con-
tains cholesterine and crystalline degenera-
tion-products.  Cataract is generally white,
but sometimes is brown,  black, bluish, sil-
very, etc.  It sometimes has a pearly lustre.
   Cataract begins in a gradual impairment
of vision, some months  generally  elapsing
before sight  is lost.   The pupil  is sensitive
to light and atropia, vision being clearest
when the pupil is large.  There is no pain
or intolerance of light.  The patient sees as
in a mist, but almost always can perceive at
least  the presence of light.  The pupil on
examination is  seen to be opaque, but the
eye is neither hardened  nor softened,  and
the expression of the face is quite natural.
One or both  eyes may have cataract.  It is
most frequent  in elderly  persons, but may
occur  at any age;  children are sometimes
born with it.  Medical treatment for cata-
ract is useless, but the skilful surgeon can
treat the disease  often with  the happiest
results.  The operation is either (1) extrac-
tion of the lens and its capsule, (2) depres-
sion or couching of the same, or (3) lacera-
tion with appropriate instruments, with  a
view of inducing absorption of the diseased
part.   This last operation is the most com-
mon, and often is the only one  admissible.
Great  care should be taken for a long time
to prevent inflammatory action.   The place
of the lens is supplied by a kind of specta-
cles called cataract glasses.  By these means
the sight is often to a great degree restored.
   Catarrh/ [from the Gr. Kara, " down," and
piu, to "flow"], in  medical language is  a
condition characterized by hyperaemia (or
congestion) of the blood-vessels of any mu-
cous surface,  with great increase of the prop-
er secretion  of the part.  Thus, there may
be catarrh of the  nose, the throat, the  air-
passages, the bowels, the  vagina, the blad-
der,  or the  urethra;  but in  popular lan-
guage  " catarrh " designates either a " cold "
in general, a  " cold in the head," or a chron-
ic catarrh of the posterior  nares (nostrils)
and throat.   Catarrhs in general arise from
exposure to  cold and wet  and  to sudden
atmospheric  changes.  They are most com-
mon in persons who are ill-fed, and who are
not accustomed to out-of-door exercise.  The
variety of catarrh known as a " cold "is by
no means always easy of cure.  The popu-
lar belief that " a cold must have its run "
has some foundation.   Hot foot-baths, laxa-
tives, sedatives, demulcents, mild stimulants,
or diaphoretics  may, however, prove useful
in many cases.  Judicious exercise, bathing,
and life  in the  open air  tend to overcome
the morbid  inclination to take cold from
which some patients suffer. Chronic catarrh
of the posterior  nostrils is an obstinate dis-
ease, best treated by systematic exercise and
attention to other  hygienic  conditions, and
by the use of salt water as a nasal  douche.
(See Nostrils,  Diseases of.) 
16
THE  FAMILY  PHYSICIAN.
   Chan'cre.  See Syphilis.
   Chick/en-Pox, a contagious febrile  dis-
 ease, chiefly of children, and  bearing some
 resemblance to  a very mild form of small-
 pox.  Chicken-pox is distinguished by an
 eruption of vesicles or blebs, which rarely
 become pustular or yellow, and leave only a
 very slight incrustation, which falls off  in a
 few days, without any permanent mark or
 pit as in smallpox.  It is a disease of little
 or no  danger, the fever being often hardly
 perceptible,  and never lasting  long.   It
 usually occurs but once in any one patient.
   ChiFblain [Lat.pernio], one of the second-
 ary effects of cold and moisture  upon the
 human system, principally affecting the feet,
 hands, nose,  ears, etc.  Chilblains are  fre-
 quently chronic in their character.  Mild
 cases are marked by  swelling and redness
 of the affected part, accompanied  by intol-
 erable itching.   The   more  severe forms
 assume an ulcerated,  and  sometimes even
 a gangrenous, character.   Those  troubled
 with chilblains should  carefully protect the
 feet and  hands from cold, should wash  the
 feet frequently and dry them very thorough-
 ly,  and avoid  going near a fire when they
 are  very cold.   Benzoated  oxide-of-zinc
 ointment, citrine ointment, borax and sugar
 of lead in oil or glycerine, tincture of iodine,
 sulphurous acid solution, and  various stim-
 ulant applications are  all  useful.   The se-
 verer forms may need surgical treatment.
  Chlorosis [from the Gr. x^uf»k, "pale
 green"], a disease almost peculiar to young
 women and  girls,  and usually associated
 with other troubles peculiar to that time of
 life.   It takes its name from a greenish-
 yellow tint of the skin which some patients
 exhibit.   There  is also great pallor and
 debility,  often disturbance of the  heart's
 action, breathlessness,  and  a variously per-
 verted and capricious appetite.  The disease
 is characterized by a deficiency of the cell-
 elements of the blood.  Most cases  are read-
ily  curable  by  exercise, good air,  proper
food and clothing, and, above all, by iron,
which is almost a specific in this disease.
  Cho/king, the obstruction of the pharynx
or oesophagus, or more  rarely of the larynx
or trachea,  by masses of   food  or other
foreign bodies.  Choking by obstruction of
the pharynx  or  oesophagus is  sometimes
relieved by  the  operation  of  an  emetic,
sometimes by the use  of gullet-forceps, of
which  there are many varieties, or by other
appropriate  instruments.   CEsophagotomy,
or cutting, has been resorted to, but  this is
one of the most  formidable operations of
surgery, and is not often necessary.  When
foreign bodies lodge in the larynx, aphonia,
or loss of speech, is  one of the symptoms.
If  the substance is in the  windpipe  or
bronchi, the surgeon may often detect its
presence by auscultation.  The  symptoms
caused  by foreign bodies in the oesophagus
are often surprisingly like those which occur
when similar bodies lodge in  the air-pas-
sages.   These symptoms are various; there
may be spasmodic coughing, redness of the
face, ineffectual  attempts to swallow,  and
great discharge  of  saliva,  and generally
there is great difficulty of breathing.  Sur-
gical aid should always be called.
  'ChoFera   [Gr.,  probably  from  x°^v,
"bile"], a  disease characterized by purg-
ing and vomiting, followed by great pros-
tration, and in many cases by fatal collapse.
Comparatively mild cases  occur with  fre-
quency even in temperate latitudes, and are
known as sporadic cholera or cholera mor-
bus ; and such cases, though very distress-
ing, are seldom fatal, while the more severe
or epidemic form (known  as Asiatic chol-
era) appears to arise in India, where  it is
endemic, and to  be  carried by ships, cara-
vans,  religious pilgrimages,  etc. westward
to Egypt, Persia,  and Arabia, and thence to
Europe and around the world by the regu-
lar channels of commerce.  The disease is
probably of miasmatic origin, and local
conditions  may  favor  or check  its local
development;  but  whether  the   disease
ought to be  called contagious or not is  one
of the  most  warmly  disputed  points  in
medicine.  It is  certain that habitual per-
sonal contact with the sick  is often not fol-
lowed by the disease.  It is held  by many
that the disease is propagated by drinking-
water ; by others, that  its germs  are taken
up from the air the patient breathes.  It is
regarded by many as certain that the  dis-
ease is largely propagated from  the stools or
alvine discharges of the sick; and all such
discharges should be treated with  powerful
disinfectants, and deposited, if possible, in
places not frequented by those who are well;
and especial care should be taken not to let
them be thrown into vaults and privies in
common use.
  Without describing the various stages of
the fatal disease—the premonitory painless
diarrhoea, the alarming and profuse purga-
tion which follows, carrying off  the fluids of
the body, the profound collapse, the reaction,
with the dangerous febrile condition which
may follow—it is enough to say that treat-
ment  should  be chiefly preventive.   No
diarrhoea in  a cholera season should  be  ne-
glected.  Opiates will  usually  control  the
precursory  diarrhoea.   During the active
stage of the disease cold compresses to  the
bowels are sometimes useful.  The adminis-
tration of diffusive stimulants in small doses
during the stage of collapse should be per-
sisted in.  Friction by the hand may relieve 
THE  FAMILY  PHYSICIAN.                         17
the spasm of the muscles.  Great care should
be taken for a long time lest a relapse should
occur.  The  food of convalescents should be
of the very lightest and blandest character
for some days.
  ChoFera Infantum, or Acute Intestinal
Catarrh/.  This intense and dangerous form
of infant diarrhoea is  mostly found in hot
climates, the hot season, and close air;  more
amongst the  poor than the rich.  The usual
cause  is improper feeding in hot weather.
The former is a direct injury ; the latter, by
debilitating the nervous system and lower-
ing the functions of all the digestive organs,
diminishes the general strength  and power
of endurance.  Nursing infants are but sel-
dom affected; many infants will recover from
an attack by being returned to the mother's
or nurse's breast.  Still, an  improper con-
dition of breast-milk (an  undue  proportion
of water, or fat, or caseine, or the admixture
of medicinal agents taken by the mother or
nurse, or a change produced by mental emo-
tions in the latter) is known to be injurious.
Weaned infants, however, and such as are
brought up  on artificial food, are  mostly
attacked.  Artificial food is seldom identical,
in its  nutritive value, with mother's milk.
Cow's milk contains less sugar  and  more
butter and caseine than mother's milk, and
requires cooking and skimming before being
diluted with water (better still, barley-water).
Vegetable food is dangerous unless carefully
selected and prepared.  Thus it is that the
first passages in cholera infantum contain un-
digested food of all sorts, particularly lumps
of coagulated milk, which is also brought up
by vomiting.  Afterwards the  passages are
very thin,  watery, of an acid or fetid smell,
very copious and frequent; vomiting accom-
panies  this diarrhoea, more or less.   Moan-
ing and crying are soon replaced by debility,
and even  complete collapse;  the  body is
rapidly deprived of a large  portion of the
water  contained  in it, and emaciates; the
eyes lie deep in the orbits  ; the sutures and
fontanelles of the skull sink;  the skin be-
comes dry, the feet and hands cold, while
the temperature of the trunk is rising; the
face looks shrunk and senile; the pulse be-
comes  weak  and frequent, the voice feeble,
the expression of eyes and face listless, and
stupor or coma or convulsions set in.  Death
is a frequent  result.  The  principal  preven-
tive  consists  in supplying the well infant
with proper artificial  food when  no breast-
milk is available, and at regular  times, and
in attending  to its general health.   When
the disease has  made its appearance the
principal  means of checking it are the fol-
lowing: during the first few (3-6-8) hours
no food or drink ought to be given.  The
irritated stomach must be kept at  rest;
vomiting will cease on that condition only.
After that time give a teaspoonful of ice-
water or a small piece of ice (size of a bean),
with or without a few drops of brandy, every
five or ten minutes, as long as the tendency
to vomit persists.  When  feeding is  to be
recommended,  avoid milk  (except breast-
milk) in whatever form.  Barley-water, oat-
meal gruel (strained), in tea or tablespoonful
doses, now and then, with the white of eggs
(1-3 in twenty-four  hours), will readily be
taken  and well digested.   Many cases will
get well with this dietetical treatment.  At
the same time the air must  be kept as cool
and fresh as possible, day and night.  The
infant will recover  faster out of than in
doors.   The medicinal treatment, which is,
under  all circumstances,  the  domain of  a
physician, varies according to the nature of
the case.  Mercurial remedies (calomel) can
be avoided.   Subnitrate  of bismuth, with
opium in small doses, and  preparations of
chalk, nitrate of silver, astringents, such as
tannic or gallic acids, catechu, are frequently
resorted to, the latter principally in cases
which threaten to become chronic.
  Cholera Morbus,  acute gastro-intestinal
catarrh in the adult.  It  is chiefly caused
by errors of diet during the summer season,
the stomach and intestines being irritated
by indigestible food, acrid juices of fruits,
or cold liquids at a time when  the body is
overheated. Vomiting, purging, paroxysms
of painful colic, physical prostration, are the
chief symptoms.  Relief is obtained by ano-
dynes, stimulants, warm enemata, and  ex-
ternal  use of  mustard draughts and  hot
water.
  Chores [Gr. x°Pe'ia, a  "dance"], or St.
Vitus's  Dance, a disease  characterized by
irregular,  involuntary, and often grotesque
muscular action, without appreciable organic
change in any tissue, and generally without
pain or any known  derangement of mental
action or of sensation.  It  is most common
in children after the second dentition and
before puberty; much more common in girls
than in boys;  sometimes attacks pregnant
women and other adults, though some cases
once called adult chorea would now be recog-
nized as locomotor  ataxy, a very different
disease.   Chorea is sometimes  hereditary,
sometimes epidemic.  Many  writers have
classed the dancing mania (the original " St.
Vitus's dance"), tarantism,  and the strange
excesses of certain  religionists  (dervishes,
French prophets, "jumpers," and " convul-
sionists")  all as varieties of chorea.  Stam-
mering has been called a chorea of the vocal
organs.  The disease is sometimes associated
with rheumatism and with  anaemia.   Such
complications should receive special treat-
ment.   The  metallic tonics are generally 
18
THE  FAMILY  PHYSICIAN.
useful, and so are systematic  gymnastics,
life in the open air, and a kind and unob-
trusive  discipline,  which  shall teach  the
young patient the  power of the will  over
the movements of the body.
  Club-Foot [Talipes).   This deformity is
mostly congenital, and usually  affects both
sides.  The inner margin of the foot is ele-
vated, the external one depressed and touches
the ground.  The deformity becomes more
pronounced when the child begins to walk,
sometimes to such an extent that the upper
part of the foot takes the place of the sole.
The leg becomes emaciated. A rational  ex-
planation is yielded by the  consideration of
the early condition of the foetus.  The low-
er extremities are  first formed  (about  the
end of the first month of pregnancy) on the
anterior aspect of the abdomen of the foetus,
under the skin, in such a manner that  the
knee-pit is looking towards the abdomen.
In order to assume its normal shape  the
whole extremity, including  the foot, has to
turn round its axis. When this process, as
far as the foot is concerned, remains incom-
plete, club-foot  is  the result.   Club-foot,
when acquired after birth, results from  par-
alysis of the extensors  of the foot.   In that
case the action of the  flexors results in the
same deformity.   Mild  cases require but
little treatment.   Manual stretching of the
foot, proper bandaging, the application of
a splint or plaster  of  Paris, are often  suf-
ficient.   More serious cases require the cut-
ting of one or more of the flexors  (tendo
achillis, plantar  aponeurosis, anterior tibial
muscles), with bandaging or the wearing of
an appropriate apparatus (Scarpa's shoe).
  CoFic [Lat. colica; Fr. colique; from the
Gr.  KUAuidq, "pertaining to the colon"], a
term applied to diseases attended with severe
pain of" the abdomen; its supposed particu-
lar connection with the large intestine is not
always certain.   The disease is caused, at
least in part, by irregular contractions of the
muscular coat of the intestines.  This com-
plaint arises from  various causes and  ex-
hibits different symptoms.  It is sometimes
attended with constipation,  and ceases when
the regular action of the bowels is restored.
A good  remedy in such cases is a dose of
castor oil (about one ounce for an adult), with
twenty  or  twenty-five  drops of laudanum.
Warm  baths  and  fomentations  are often
necessary.   When colic resists mild  and
simple remedies,  medical assistance should
be procured, for  colic is closely allied, as a
symptom, to several severe and dangerous
diseases. Painter's colic arises from the ab-
sorption of lead into the system, and there-
fore attacks persons employed in lead-mines
or using preparations in which lead is used.
This latter disease is often called colica Pic-
 tonum, or " colic of the Pictones," the latter
 being the ancient name of the inhabitants
 of Poitou, where this disease was once com-
 mon.  (See Enteralgia ; also Biliary Colic
 and Renal (kidney) Colic under article Cal-
 culus.)
   Co'ma [Gr. nuua, " heavy sleep"], a medi-
 cal term signifying a  state of lethargy or
 unnatural profound sleep. It occurs in apo-
 plexy, epilepsy, and other diseases of  the
 brain.   The patient is  quite  or nearly in-
 sensible to external impressions.   Coma is
 also seen in narcotic  poisoning.    In  the
 fatal forms the  breathing is stertorous, the
 pupils of the eyes dilated, insensible to light,
 and immovable.
   Concussion  [from the Lat. concutio, con-
 cussum, to " shake  violently "  (from  con, in-
tensive, and quatio, quassum, to "shake")],
 in surgery, the  disturbance caused by a fall
 or blow.  In all severe injuries a concussion
 or shock is caused to  the nervous system,
 which may require the assiduous care of a
 physician.  (See Shock.)
   Concussion of the  Brain  [Lat.  commotio
 cerebri] sometimes causes alarming symp-
 toms, even to suppression of the functions
 of the brain, yet without any apparent or-
 ganic  disease.   Slight concussion  of  the
 brain (popularly called "stunning") causes
 vertigo, loss  of memory, tinnitus  aurium,
 and stupefaction;  but these are temporary.
 When more severe, there is loss of sensation
 and volition,  with  vomiting, the patient be-
 ing apparently in a sound sleep, but without
 stertorous breathing.  The pulse is variable,
 being more rapid  and feeble than  in com-
 pression of the  brain;  the extremities  are
 cold.   Little  can be done until reaction oc-
 curs, when the case can be treated according
 to general principles.  In some cases of con-
 cussion it is necessary to use local or general
 stimulants, but usually moderate  heat  ap-
 plied to the  surface, abundant supplies  of
 air, and proper adjustment of the  injured
 parts are all that are  required until con-
 sciousness is  partly restored, when a small
 portion of wine or other stimulant  may be
 useful.  The  effect of these should  be care-
 fully noted, and the patient should be placed
 in a comfortable position in bed during the
 process.  In all cases  absolute rest is essen-
 tial.  If the concussion has been severe, the
 patient is often not secure until a long time
 after,  even  though  apparently  well,  for
 serious  nervous lesions may be slowly de-
 veloped.
   Congenital Diseases.  These must be dis-
 tinguished from hereditary  diseases, which
 may show themselves either soon after birth
 or at some later period, and from malforma-
 tions of the infant, resulting from  either an
. arrest  of  development  or a disease of the 
THE  FAMILY  PHYSICIAN.
19
 foetus contracted during its  intra-uterine
 life.   Congenital diseases proper  are—1st,
 transmitted from the diseased mother either
 before or during birth; 2d, acquired during
 birth, without a direct maternal influence;
 3d, acquired  shortly before  birth.  To the
 first  class belong puerperal  fever  and pri-
 mary syphilitic  and gonorrhoeal infection;
 to the second, asphyxia, atelectasis (unex-
 panded condition) of the lungs, and cephal-
 haematoma (sanguineous  tumor upon the
 head); to the third, acute fatty degenera-
 tion of the foetus and newly born.  Puerperal
 fever is transmitted from the mother; the
 blood of the babe is infected.   The principal
 symptoms are high fever, abscesses in the
 subcutaneous tissue, particularly around the
 joints, erysipelas, and a severe  form of jaun-
 dice.  It terminates fatally within a limited
 number of days, rarely  weeks. When the
 vagina of the mother is infected with syphi-
 litic  ulceration,  the  child is subject to be
 attacked with a, primary ulceration. When
 it  is the seat of gonorrhoeal  discharge,  it
 gives rise to the most dangerous  forms of
 purulent  inflammation of the eyelids, which,
 unless treated at once,  is apt to result in
 blindness.  The treatment consists in abso-
 lute  cleanliness; the eyes must be opened
 frequently and washed out with water.  Ice
 is  applied constantly to  the  outside, and a
 solution of nitrate of silver to  the inside of
 the eyelids.  Asphyxia is mostly seen after
 protracted labor or  abnormal  presentation
 of the child,  the breech or  the feet being
 born before the head.  The child is  born
 almost or apparently lifeless, blue or  pale,
 with no respiration and  no pulsation of the
 heart.  Artificial respiration is brought on
 by slapping the buttock  of the babe, by al-
 ternately placing it in warm and cold water,
 by slapping its breast with a wet  cloth, by
 swinging it forcibly in the air, by the appli-
 cation of an electro-magnetic current to  its
 chest.  When the surface is very blue a few
 drachms  of blood may be allowed to flow
 from the untied umbilical cord.  Atelectasis
 depends on an absence of the  normal expan-
 sion of the lungs which follows the entrance
 of the air. The  muscles of  the chest may
 not be sufficiently developed, or their inner-
 vation may not be satisfactory from some
 disease of the  brain, or  the  lungs may  be
 inflamed or filled with mucus or some for-
 eign substance introduced into  them during
 birth (blood, mucus, amniotic  liquor, etc.).
 Emetics will empty the  lungs  (tickling of
 the fauces is sometimes sufficient),  mustard
 plasters and the electrical current excite the
 nerves, and the above-mentioned  methods
of inducing respiration will restore  the nor-
mal action.
  Congestion  [Lat.  congestio, from  con,
j "together,"  gero,  gestum,  to "carry" or
| "heap"],  fulness of blood,  or hyperaemia.
 Congestions are either active  or passive.
 Active  congestions  are always essential
! parts  of a further  morbid process, such as
 inflammation.  Passive congestions are often
 determined  by some  mechanical cause of
 obstructed or retarded circulation.  Active
 congestions  of the brain or lungs are in
 themselves very alarming symptoms of dis-
 ease ;  while the passive congestions, result-
 ing from  cirrhosis of  the  liver or  from
 organic disease of the heart, are fruitful
 causes of local or general dropsies.
   Congestive  Fever.   See Intermittent
 Fever and Remittent Fever.
   Constipation [from the  Lat.  con,  inten-
 sive, and stipo, to "stow," to "crowd," refer-
 ring to that  state of the rectum in which it
 is  impacted with fecal matter], a condition
 of the system marked by sluggish action of
 the bowels upon their contents,  due  either
 to diminished secretion of the juices of the
 mucous membrane or to a want of action of
 the muscular coat of the intestines.  Seden-
 tary habits predispose to constipation, and
 so does too large  a proportion  of animal
 food.  Brown bread, ripe fruits, fresh vegeta-
 bles, and active exercise tend to avert this
 disorder.   An  abdominal compress of cold
 water, covered  with   a flannel bandage,
 sometimes  proves  beneficial.   For  many
 cases the use of mild cathartics is necessary.
 They  may be  taken  in proper doses for
 many years without bad  effects.  The use
 of nux vomica in small daily doses is  often
 useful, and the  same is true  of belladonna
 in some constitutions.   It is frequently ad-
 visable to employ enemata of warm or cold
 water, and also kneading or careful manip-
 ulation of  the  abdomen. But perhaps the
 most  rational  treatment is a careful read-
 justment of the diet and the adoption of
 active  habits of life.    Ill-chosen and ill-
 cooked food, perhaps  the  most frequent
 cause  of intestinal  troubles, should be espe-
 cially  avoided.  There is no doubt also that
 habitual constipation may in some instances
 be overcome by the persistent and system-
 atic attempt to perform the impaired func-
 tion at a regular time each day.
   Consumption [Lat.  consumo, consumptum,
 to "wear away "], the popular name of vari-
 ous  diseases characterized by a  wasting of
 the  body, such, for example,  as " anaemia "
 (known as  "consumption of the blood"),
 but applied especially to phthisis pulmonalis,
 a very common and very fatal disease of the
 lungs.   It  has  long been taught, upon the
 authority of Laennec,  Louis, and Andral,
 that the characteristic symptoms of pulmo-
 nary consumption depend upon the presence
 in the  lung-tissue of a new growth, or neo- 
20                         THE FAMILY PHYSICIAN.
plasm, called Tubercle  (which see); but
the studies of Virchow, Niemeyer, and other
recent pathologists  have demonstrated that
cases of originally tuberculous consumption
are quite rare, although they do  occur, the
presence of the tubercles giving rise to local
pneumonic inflammation in their neighbor-
hood ; while ordinary consumption is gener-
ally characterized by (1) local consolidation,
(2) cheesy degeneration  of the solidified
spot, and (3) destruction of the degenerated
tissue and  formation of a cavity.  This is
the direct result, in  most cases, of a " catar-
rhal" inflammation—that is, of an inflam-
mation  of  an epithelial  surface, such  as
lines  the   air-passages—the inflammation
being associated with  a free discharge of
mucus from the surface of the membrane.
Next, the  air-vesicles of the lungs  become
filled by inhalation and  by other  means
with the young cells of the secretion.  If, as
in non-fatal cases of ordinary  pneumonia,
these cells  soon undergo  liquefaction and
absorption, the patient recovers.   But if the
accumulation of cells  remains unabsorbed
in the air-vesicles, it suffers a cheesy degen-
eration,  a  sort of slow  decay.  It  appears
that an inflammatory  process is  set  up
around  this caseous degenerate mass, and
that the cheesy degeneration is soon present
in the inflamed  lung-tissue  itself.   After a
time the degenerate mass  may  assume a
more or less complete purulent  form, and
may be discharged by  coughing.    This,
however, does not  always  happen.   The
mass may be absorbed, the  pulmonary tis-
sue become indurated and callous, without
a  trace  of tubercle;  the bronchial tubes
may become dilated, and the disease, spread-
ing slowly, may disorganize but not con-
sume the  lungs.  This  is a very common
condition in old consumptive cases.  Mean-
while, the  less  changed bronchi near the
seat of  the disease pour forth a  profuse
catarrhal secretion, causing  copious expec-
toration. The pleura near  the seat of the
disease becomes  thickened,  and adheres by
organized  exudations to  the  wall of the
chest.   In the  majority  of   cases  these
changes begin at the apex of one  or both
lungs.
  The first  subjective symptoms are usually
dull pains about  the collar-bones, tightness
across the chest, and there is frequently a dry,
hacking cough in the morning and late  at
night. Headache, weariness, dyspepsia, and
loss of appetite are often present.  The pulse
increases permanently, in most cases exceed-
ing 90 or 100 beats in a minute. The rapid-
ity of breathing is  usually  increased.  An
early symptom is a high  evening tempera-
ture—103°  or 104° F.   In  the  second stage
night-sweats are often extremely severe, pus
is  freely expectorated, hectic  fever is deci-
dedly present, the pulse is more frequent.   In
the third stage, when considerable cavities
often form in the lung, the preceding symp-
toms  are  much  intensified;  colliquitive
diarrhoea supervenes, and yet in many cases
the patient continues serene and hopeful, and
the mind is remarkably clear and active.
  The causes of consumption are very nume-
rous.  Niemeyer assigns the first place as a
cause to that depraved, ill-nourished state
(called  the  scrofulous diathesis)  in which
there is a tendency to the increased produc-
tion of young cells.  Any depressing circum-
stance may  tend  to  the establishment  of
consumption.  An hereditary tendency is
one of the most  important of these circum-
stances, but any depressed state of the parent,
especially of the mother, whether consump-
tion,  starvation, anaemia, scrofula, or any
other dyscrasia,  appears to have a nearly
equal effect on the offspring.   Bowditch and
others have  shown that, other things being
equal, it is most frequently observed in places
where the air and  soil are charged with
moisture.  Cold weather in itself appears to
have  little or no tendency  to  produce the
disease, but  a very changeable  temperature
is one of its most fruitful causes.
  There has been considerable discussion as
to whether consumption is  or is not a con-
tagious  disease;  and  facts are  not wanting
which appear to show a danger of infection,
especially to those who take  care of and
intimately   associate   with   consumptives.
Another interesting  question is whether
consumption is ever caused or promoted  by
habitual drunkenness, either in the case  of
the drunkard or of his offspring.   The best
opinion among physicians appears to be that
while in selected cases alcoholic stimulants
may be useful adjuvants, the remedy is a
dangerous one, since there is no doubt that
many more  consumptives are injured than
are benefited by it.  On the  offspring of the
consumptive the effect of hard drinking is
confessedly deplorable. Over-study at school
appears to develop the disease in some young
people.  Overwork, factory-life, the grinding
of metals, cabinetmaking, and all  kinds  of
dusty or sedentary work are undoubtedly
prolific  sources  of the disease.    Mental
trouble, excessive care, too  frequent child-
bearing, and sexual excess are to be reckoned
in the list of causes.   Consumption fre-
quently follows measles, typhoid fever, and
whooping cough, not improbably  resulting
from the bronchitis which accompanies those
diseases.
  It is  also  thought that pregnancy will
check the disease in the female; and while
there are numerous observations which go to
show that for the time the disease is some- 
THE  FAMILY PHYSICIAN.
21
times (but not always) held in abeyance, it
is certain that this abeyance is often followed
by  a  period  of greatly  increased activity;
and the probability that a child born in such
circumstances will be sickly and short-lived
ought to prevent  the  resort to any such
practice as a curative measure.
  The physical signs of consumption are
those which  are determined by inspection,
palpation,  auscultation,  and percussion of
the chest.  Their relative importance can be
appreciated by none except the well-trained
and experienced diagnostician.
  The treatment of consumption cannot be
di-eu^-ed except in the most general  terms,
for no  disease is  less  amenable to mere
routine treatment.   Yet there is no reason-
able question that, especially in its earlier
stages, this disease is a  curable one.  One
of the first requisites is  the  establishment,
if possible, of normal nutrition—a process
which is usually much  impaired in those
liable to this disease.  The use of such tonics
as quinia and strychnia in some conditions,
the administration of cod-liver oil, either as
food or for its assumed alterative powers, and
judicious change of climate, are among the
most useful measures.  Alcoholic stimulants
benefit some  patients and injure others, and
on the whole do more harm than good; the
hypophosphite-; of soda and lime appear to
cause increase of weight and diminution of
cough and expectoration in many  cases;
thorough counter-irritation  of  the  chest-
walls is a very  important adjuvant;  the
wearing of sufficient clothing to protect the
body from  sudden  changes of  temperature
is not less important.  Systematic, and even
severe, physical labor benefits some patients,
but others  appear to be injured by any but
the gentlest  exercise.   Special  symptoms,
like diarrhoea and night-sweats, will require
palliative treatment. Life in the open air
is advisable, except in wet and bleak weather.
The dry air of the Western plains and of the
Rocky Mountain region, the equable weather
of Florida, and the dry, sandy soil and bal-
samic exhalations of the great pine  forests
of the South, are believed to afford favorable
conditions for recovery in many cases.  Much
depends on the peculiar  history and tem-
perament of individual cases, and the proper
appreciation  of these conditions is likely to
tax the judgment of the ablest practitioner.
  Contu sion.  See Wounds.
  ConvuFsions [from the Lat. convello, con-
vulsum, to " pull violently "], an acute nervous
affection occurring  in  paroxysms,  during
which the  patient  loses  consciousness, the
muscles of the body are  spasmodically con-
tracted, and the limbs  first  stiffened  and
twisted, then agitated by irregular involun-
tary movements.   The face is distorted, the
eyeballs rolled upward, the teeth clenched,
biting the tongue, which protrudes at the
beginning of the attack.  Respiration is ar-
rested by the stiffening of the chest-muscles
and by  closure of the glottis;  the patient
grows black in the face,  and froth oozes
from the mouth,  and sometimes from the
nostrils; the veins of the neck swell.  After
some time the muscles relax again, respira-
tion is restored, the agitation of the limbs
ceases, the patient either returns entirely to
consciousness or falls  into a heavy sleep,
which may last several hours.  The appear-
ance and  the nature of the attack are the
same in the  convulsions of epilepsy and in
the so-called eclamptic convulsions of chil-
dren or of women in childbirth.  They may
result from any cause that first irritates and
then suddenly abolishes the functions of the
brain and spinal cord.   Convulsions occur,
therefore, in diseases of the nervous cen-
tres; in diseases of other organs of the body,
that transmit irritation to these  centres;
finally,  in morbid  conditions  of the blood
which interfere with their nutrition.  Lender
the first head may be mentioned congestion
or anaemia  (bloodlessness)  of the brain, in-
flammations, tumors, finally premature ossi-
fication of the bones of the head, by which
the brain becomes subject to abnormal pres-
sure.  In  other  cases  more obscure there
seems to exist in the brain and cord a con-
genital  susceptibility to irritation, and con-
sequent exhaustion of functions, so that the
most trifling circumstance may occasion a
convulsion.    It is then that are observed
the convulsions of hysteria and of epilepsy.
The latter is only distinguished by the con-
stitutional tendency that persists during the
intervals of the attacks, and suffices to cause
their removal.  The hysterical  convulsion,
however, offers some peculiarities, and con-
sciousness, though perverted,  is  not abol-
ished, the interference  with respiration  is
less complete than in typical eclampsia, and
leads  to involuntary laughing and crying;
there is no lividity of the face or frothing at
the mouth;  the  return  to consciousness  is
immediate,  without the transition  stage of
heavy  sleep.   Neither the irregular con-
vulsive  movements of chorea  ("St. Vitus's
dance,"  "clonic"  muscular  contractions)
nor the rigidity  of tetanus ("tonic"  mus-
cular contractions) are sufficient to consti-
tute a convulsion in which  the two forms of
muscular contraction are combined, the last
occurring  at the beginning, the first at the
end of the  attack.
  Convulsions dependent on transmitted ir-
ritations occur principally in children. They
may occur spontaneously, owing to a con-
genital predisposition by which normal phys-
iological processes become irritating, or they 
22                         THE FAMILY
 may be  excited  by inflammation  of the
 gums in dentition, by indigestion, by worms,
 by the  invasion of acute diseases, as pneu-
 monia  or eruptive  fevers;  by some  acci-
 dents, as extensive burns. Women in child-
 birth are liable to convulsions of a similar
 character, which  may  be  excited  by the
 mere act of parturition.  This  dangerous
 complication (puerperal eclampsia)  is more
 frequently, however, associated with an al-
 teration of the blood that is liable to occur
 during  pregnancy, and due to transient kid-
 ney disease (nephritis).  The kidneys act
 imperfectly, and hence part of the elements
 of the urine that should be secreted by them
 are retained in the blood, poisoning it, while
 at the same time part of the albumen of the
 blood passes off in the  urine.  These con-
 vulsions are therefore  called  albuminuric
 or uraemic, and afford most striking illus-
 trations of the morbid  influence of altered
 blood upon the nerve-centres.  They occur
 also in genuine nephritis or Bright's disease,
 and in that which often complicates the sec-
 ond and third stages of scarlet fever.  Vari-
 ous mineral or narcotic poisons introduced
 into the blood have a similar effect to  urae-
 mia in causing convulsions.
   Any  convulsion may  prove  fatal if the
 arrest  of respiration  be sufficiently  pro-
 longed.   The  danger varies very much ac-
 cording to the cause, the uraemic convulsions
 of women in childbirth [puerperal eclampsia)
 being far the most frequently fatal.   After
 them may be successively ranked—uraemic
 convulsions in primary nephritis, or that
 complicating scarlet fever, and those caused
 by narcotics (opium) or mineral  poisons
 (lead).
   The treatment of convulsions may some-
 times be addressed exclusively to the cause,
 as in the last three cases  just mentioned,
 where the danger of the paroxysm itself is
 known  to  be small.   In  the  other cases,
 where life is  liable to   be  endangered by
 the duration or rapid repetition of convul-
 sive attacks, these urgently demand relief.
 Means of relief are—1st, compression of the
 carotids; 2d, alcoholic stimulants ; 3d, vene-
 section ; 4th, chloral; 5th, chloroform ; 6th,
 anti-hysterical medicines ; 7th, warm baths;
 8th,  cold applications  to  head.   Each is
 adapted to a special ■ case.  Compression of
the carotids has been used  principally in
 idiopathic epilepsy (where, as said, the par-
 oxysm itself is often left without treatment).
 It is intended to relieve  the congestion ex-
 isting at  the  base of the brain,  and has
sometimes proved  successful.  Cold  appli-
cations are used for the  same purpose, and
may be  combined  with the other methods
of treatment.  Stimulants  are only  used |
where the convulsion results from haemor- j
PHYSICIAN.
 rhage or inanition.   Venesection may be
 required  in cases of intense venous conges-
 tion of the brain, as indicated  by extreme
 lividity  of the  face and distension of the
 veins of the neck.   It is most often needed
 in  puerperal  convulsions.  Large  doses of
 chloral are especially useful for  infantile
 convulsions, or for those of scarlet fever,
 or during the interval of attacks to prevent
 their renewal.   Veratrum viride is  a power-
 ful agent to lower the pulse and  increase the
 force of the heart's impulse; hence it may
 be used in the same cases as venesection, to
 dissipate  the  stagnation of blood in the
 veins.  The warm  bath may  be  used in
 nearly all cases,  except  perhaps  in puer-
 peral convulsions, where it  may  be con-
 tra-indicated by the difficulty and danger
 of moving the patient.
  An hysterical convulsion may be treated
 with the nervous stimulants formerly called
 antispasmodics, especially  assafoetida, va-
 lerian, ether (internally).
  Corn [clavus), [from cornu, a "horn"], a
 horny accumulation of epidermic cells upon
 the surface of the human foot, produced by
 the pressure of  the boot  or  shoe.   Corns
 may be softened by hot water or poultices,
 and the horny part can be carefully removed
 with  the  knife.  When painful, they may
 be generally much relieved by the occasion-
 al application  of a solution  of nitrate of
 silver.  Various  surgical appliances  have
 been  devised for the relief of corns, which
 when neglected  may  give rise to serious
 trouble.
  Corpulency.  See Obesity.
  Cos'tiveness.   See Constipation.
  Cough [Lat. tussis], a physiological act or
 operation, which consists  in the sudden ex-
 pulsion of air from the lungs, at the begin-
 ning  of  which act the  glottis is closed.
 Coughing is designed  for the expulsion of
 foreign  or secreted  matters  from the  air-
 passages.  It is largely a reflex action, gen-
 erally arising from local irritation.  When
 the irritation is the result of disease, cough-
 ing may be a very important symptom.  It
 is partly voluntary and partly involuntary.
 A cough may sometimes be relieved by ex-
pectorant remedies, by  mucilaginous diluent
 draughts,  by  warm foot-baths,  by stimu-
 lants, and very  often  by small doses of
 opium or  of other sedatives.
  CoxaFgia, or CoxFtis  [morbus coxarius,
 " hip-joint disease"), a chronic inflammation
of the hip-joint, which may begin either in
the head of the thigh-bone or the socket of
the hip-bone, or else in the membrane {sy-
novial) that lines its cavity, but which finally
extends to all  its tissues, cartilages,  liga-
ments, and surrounding soft parts.  Inflam-
mation  of the  bones  {osteitis),  by far the 
THE  FAMILY  PHYSICIAN.                         23
most  common origin of the disease in chil-
dren, is chronic and insidious in its devel-
opment, and is  favored by the  incomplete
ossification and active nutrition of the bones
in childhood.  Inflammation of the lining
membrane [synovitis) is the most frequent
form of hip disease in adolescence, and then
is often of rheumatic  origin.  Chronic in-
fantile  coxitis  principally  affects children
between one and five  years of age, and is
often awakened by a fall or blow, especially
when such accident occurs to children of a
lymphatic or scrofulous constitution.  The
very first  symptom is lameness, followed by
pain, first felt in the knee, afterwards ex-
cited in the  joint itself by direct pressure,
by motion'of the limb, or  by the weight of
the body resting upon it.  To  lessen this
weight  the patient rests on the ball of his
toes,  and drags the leg in walking, stiffly
extending it.  At this stage it is turned a
little outward by spasmodic contraction of
the muscles  on  the  outer  side of the joint.
But very soon, in order to still further lessen
the weight,  the body bends  over  on the
thigh, and the  arm and  lame part of the
back, with the  abdomen,  are carried for-
ward.   When the patient  lies down, there-
fore, a  space is  left  between the body and
the bed, and if the spinal column be forcibly
straightened  out and the curve flattened, the
thigh in turn is bent on the body by drag-
ging of the muscle that runs from the spinal
column to the head of the thigh-bone [psoas).
Still,  for the purpose of  lessening weight,
the hips are  tilted towards the painful side,
and  appear oblique, while the leg is thus
apparently lengthened. Behind, the nates
are flattened.  It soon becomes impossible
to glide the  head of the thigh-bone in its
socket; the  whole hip moves with  every
motion  communicated  to the leg.  This
sign is most  characteristic  of the confirmed
disease; it is due first to the spasmodic rigid-
ity of muscles—later to inflammatory ad-
hesions.
  In  the second stage liquid is poured out
into the cavity of the joint to increase the
space of  this  cavity, the thigh  is more
strongly bent on  the body (flexed), and
drawn inward (adducted), so that the foot
crosses the opposite leg.  The affected limb
is therefore apparently shortened.  A swell-
ing appears  in the groin  and at the outer
aspect of the thigh; the pain becomes in-
tolerably severe; standing  and walking are
impossible.
  In  the  third  stage the  cavity fills with
matter,  the ligaments  of  the joint are  re-
laxed, abscesses  form in the neighborhood,
and all  the soft parts are swollen by inflam-
matory  exudations.  Dislocation occasion-
ally though rarely occurs.   More often the
head of the thigh-bone separates  from its
shaft and adheres to the socket of the joint,
while the  socket  itself is enlarged.  The
patient's strength  is severely undermined,
hectic fever sets  in, the emaciation  is ex-
treme, and death may occur gradually from
exhaustion, or more rapidly from acute ab-
sorption of pus.
  The diagnosis  of morbus coxarius is only
difficult in the first stage.  The lameness
may simulate that of muscular paralysis,
from which it is distinguished by the free-
dom with which the head of the thigh-bone
may be moved; or the pain in the knee may
fix  suspicion on  the wrong joint;  or the
thigh may exactly imitate hysterical muscu-
lar  contraction; but  in this affection-the
limb relaxes completely under chloroform.
  The  prognosis  for spontaneous cure  is
always  very  unfavorable.  After suppura-
tion death may be caused by pyaemia, by
exhaustion, by general  tuberculosis,  or by
amyloid disease.  Appropriate treatment of
the first and second stages offers about 50
per cent, of recoveries;  operative treatment
of the third stage has  so  far cured  about
one-third  of the cases submitted to it.  In
a large  number of cases,  although the in-
flammation is arrested, and hence  life  is
saved, the joint becomes  permanently im-
mobilized (ankylosis) by fibrous bands with-
in and around its cavity, that hold the ar-
ticular surfaces firmly together (false anky-
losis).  This  result is  to  a certain  extent
favored  by the treatment  adopted for the
cure of inflammation; it is important there-
fore that the  stiffened limb be left  in the
most favorable position for  use—namely,
extension.
  The  treatment varies according  to the
stage of the disease.  During the primary
osteitis that so often precedes inflammation
of the joint,  and  is indicated by the one
symptom of lameness, constitutional treat-
ment is to be adopted—cod-liver  oil, iron,
cinchona,  nourishing food, fresh  air,  and
salt-water bathing.  As soon as the  move-
ments of the joint are  compromised, local
treatment  becomes of primary importance.
It aims—1st, to immobilize the joint, so  as
to prevent friction of the inflamed  parts;
2d,  to extend the limb, so as to separate  as
much as  possible the folds of  the  lining
membrane, to reduce to a minimum size the
cavity of the joint, and thus favor the re-
absorption  of fluids; finally, to leave the
limb in  the best position  for use should it
become  permanently stiffened.  The  limb
can only be  maintained in extension  by a
force sufficient to  overcome the spasmodic
muscular contractions.  Many apparatuses
are devised for this  purpose, in  which the
limb is straightened out and fastened to an 
24                         THE FAMILY
inflexible plane,  and forcibly  retained in
this  position by means either  of a weight
attached to the foot or a sliding screw at
the knee.  The simplest form of apparatus
is made by swathing the limb in bandages
stiffened by  plaster of Paris or dextrine.
These are only adapted to the earliest stage,
or when cure  is already progressing.  It
enables the patient  to  walk about.  This
facility is also  afforded by steel apparatus
that supports the limb at the waist and foot,
and gradually extends it by continued trac-
tion at the  knee.  In other cases the patient
is kept in bed,  the leg fastened to a simple
long splint, with a cross-piece under the
foot, to which  is attached the  weight.  A
large double gutter, in which were  laid the
entire pelvis and both  lower extremities of
the patient, was formerly famous, but is now
seldom used.  During  the employment of
such apparatus ice  may be  applied to the
joint to subdue acute inflammation, occa-
sionally blisters, where fluid has been rap-
idly effused, more often pressure by means
of elastic bands, a powerful means of pro-
moting reabsorption.
  When suppuration has occurred within
the joint, and especially when pus has dis-
charged  externally by one or more fistulae,
it is necessary to amputate (resect) the head
of the  thigh-bone.  Very extensive destruc-
tion of the hip-bone and certain general dis-
eases, amyloid disease or general tuberculo-
sis, with uncontrollable diarrhoea, contra-in-
dicate  the  operation.  After it, death may
result from such complications or from  sur-
gical fever (pyaemia, septicaemia).  When
successful,  however,  the patient is  rescued
from an otherwise  certain death,  and the
joint recovers its integrity, ankylosis being
much less frequent than after treatment by
immobilizing apparatus.
  Creeping  PaFsy.  See Cp.uveilhier's
Disease  and  Progressive  Muscular
Atrophy.
  Croup.   All the forms of croup have one
thing in common—viz. an obstruction (ca-
tarrhal or  inflammatory) in  the interior of
the larynx, particularly on the vocal chords.
The milder form is called " false croup " or
" pseudo croup."  The larynx is reddened,
its mucous  membrane swelled, and its secre-
tion of mucus usually increased.   Thereby
the passage of air through the larynx is im-
peded, and spasmodic action of its muscular
apparatus effected.   It  is  frequently found
in children who have  before suffered from
"colds," especially  from  catarrh of the
throat  and enlarged tonsils, and who have
been too carefully kept from  the  contact
with cold air and cold water.  The attack
of " pseudo croup " is sudden or preceded by
nasal or bronchial  catarrh.   It takes place
PHYSICIAN.
after the  child has  been asleep for some
hours.   It wakes up about midnight with a
barking cough, loud  and laborious  respira-
tion, small and frequent pulse, and more or
less fever.   In bad cases  the veins of the
neck and face swell, the face is bloated and
bluish, and suffocation  appears imminent.
This attack may last from half an hour to
six hours.  It terminates  in perspiration,
the cough becoming moister, the  voice being
hoarse,  but may return in the next night.
Some children are apt to have many attacks
in the course of many years.  There are no
membranes in the throat, no glands swollen
round the  neck.  A very  severe attack re-
quires an emetic (powdered ipecac, sulphate
of zinc, sulphate of copper,  turpeth  mine-
ral) ; milder attacks require very little or no
treatment.  Let the  child drink a little hot
milk at short intervals.  It must not sleep
longer than an hour at a time,  and should
take a drink on waking up.   Put a mustard
plaster round  the neck, or apply cold water
at short intervals. Where the throat is sore,
ice-pills every five or ten minutes; where in-
halation is very spasmodic, half a teaspoon-
ful of paregoric (one dose) or one grain of
Dover's powder. Treat the consecutive gen-
eral  catarrh for four  or five days with uni-
form warm (not  hot) temperature  of the
room, warm water inhalations (kettle on the
stove), small doses (hourly) of ipecac, or an
antimonial preparation or muriate of am-
monia.  Where there is a chronic catarrh
of the throat (dryness, redness, swelled ton-
sils, hacking cough, snoring), a  teaspoonful
of glycerine as a preventive at bed-time.
  While this  " pseudo croup," commonly
called " croup," is  a very mild disease—we
have never seen a case terminating fatally—
the other  form, or  "true croup," "mem-
branous croup," is very dangerous.  Under
ordinary circumstances, and with  a treat-
ment exclusively medicinal, ninety out of a
hundred die.  It consists sometimes in sim-
ple inflammatory  swelling  ("laryngitis"),
but usually in the obstruction of the larynx
by a deposit of a whitish, grayish, or (through
admixture with a little blood) darker " croup-
ous " or " diphtheritic " membrane.  The de-
posit may take place upon or into the normal
tissue of the organ.   It seldom originates in
the larynx;   sometimes ascends from the
trachea; mostly descends from  the throat,
where it is discovered in one or more small
spots or over  a larger surface.   In excep-
tional cases it extends over the interior sur-
face of the nose, and  the mouth.  Such de-
posits may be known to exist for days; they
will  then descend, result  in  hoarseness, in-
creasing to complete absence of voice (apho-
nia), and in great difficulty  of  respiration,
with final suffocation.  When  the deposits 
THE  FAMILY PHYSICIAN.
2o
 cover the whole interior of the larynx, both
 inspiration and expiration are impeded, and
 aphonia is complete.   When they result in
 serous (watery) swelling of the larynx (espe-
 cially the posterior insertion of the vocal
 chords)  only,  expiration is  easier and  the
 voice not entirely  suppressed.   The  first
 stage is either that of throat diphtheria or
 of a  simple catarrh only, which is  attended
 with but little fever,  and  therefore  little
 thought of.   It may  last a few days.   In
 the second stage (twelve hours to fourteen
 days) the symptoms  of obstruction  show
 themselves;  the voice is hoarse, and at last
 absent;  respiration is  slow, labored,  and
 loud; the muscles  of  the neck and chest
 exerted  to their utmost;  the insertion  of
 the diaphragm drawn  in  with  every inspi-
 ration, deep grooves forming with every in-
 spiration above and below the clavicle, the
 child tossing about, supporting  itself on its
 knees, and  throwing  the head backward.
 The  lips  begin  to exhibit a  bluish hue.
 This symptom (cyanosis)  increases in the
 third stage,  where the influence of the  in-
 sufficient oxygenization of the blood is more
 visible  in  general paleness, bluishness,  in
 sleepiness, in the  frequent and  irregular
 pulse, in the cool surface, convulsive twitch-
 ings, and  loss of  consciousness.  Unfortu-
 nately, the latter  symptom is not constant,
 many children dying with undisturbed  in-
 tellect.   Death is  the result of direct suffo-
 cation, or the result of a complication of the
 disease with  bronchitis or pneumonia.  Me-
 dicinal  treatment  is  very  unsatisfactory.
 We seldom  succeed in  dissolving and  re-
 moving  the  membranes.  Nitrate-of-silver
 applications  to the larynx  have justly been
 discarded.  Inhalation of  diluted lime-wa-
 ter through an atomizer or of lactic acid in
 glycerine and water (1: 8-10)  has proved
 successful  in  a few instances.  Emetics are
 of use in such cases only  where the mem-
 branes are known to be partially loosened
 (peculiar flapping sound in respiration), or
 when the presence of mucus, in  addition  to
 a  membrane,  proves dangerous.   Ice-pills
 frequently, ice applications  to  the throat,
 moist air, 1-2  grains of chlorate of potassa
 in a  teaspoonful of water  every |—1 hour;
 inhalations of carbolic acid, either  through
 an atomizer or sprinkled through the room;
 muriate of ammonia evaporated on  a stove
 or hot coal,—all such  means  may be tried,
 but not  to such  an extent as to interfere
 with a copious supply of pure air, the effect
 of which may still be improved by inhala-
tion of oxygen gas.  Where the disease runs
 its course with fever, quinia, seldom aconite
or veratrum.  Most cases  will resist treat-
ment.  Twenty or twenty-five per cent, will
be saved by tracheotomy, an operation con-
 sisting in the artificial opening of the wind-
 pipe below  the  obstructed  larynx.   This
 opening in the trachea is  kept patent by
 means of a silver or hard-rubber tube  in-
 serted in it until the disease has disappeared
 from the larynx.   The relief given by this
 operation  is surprising, and although the
 mortality after its performance is still very
 great, death is almost always easier, result-
 ing more from exhaustion than from suffo-
 cation.
   Cruveilhier's Disease. See Progressive
 Muscular Atrophy.
   CystFtis [Gr. mnc, the bladder], inflam-
 mation of the bladder.  It may be acute or
 chronic.  It is more frequent in men than in
 women.  It may be the result of blows, kicks,
 bruises, punctured or incised wounds. It also
 occurs from holding the urine too long, from
 urine which is irritating—either highly acid
 or very alkaline—or from  the irritation of
 calculus and gravel in the  bladder.   In
 men it frequently  results  from gonorrhoea
 of the urinary passage; in old men,  from
 enlarged  prostate  (neck of the bladder),
 causing  constant  detention  of alkaline
 urine; and in women, from inflammations
 and diseases of the uterus and pelvic cel-
 lular tissue.  The symptoms are chilliness,
 fever, nausea  and  vomiting,  prostration
 of strength,  pain and sense of  heat  over
 the bladder, constant desire to urinate, often
 with inability to do so, and the voiding of
 urine thick and creamy like pea-soup, which
 under the microscope is found  to be full of
 mucous and pus cells, epithelial scales from
 the bladder, and frequently blood.   The
 treatment consists in applying in some cases
 ice-packs over the   bladder, in others hot
 poultices and fomentations sprinkled with
 laudanum,  opiates   and  chloral  by  the
 mouth to allay pain, the free use of alkaline
 and demulcent drinks, and the withdrawal
 of the urine  by the  catheter twice  daily if
 practicable, and washing out the bladder with
 tepid or cool water, medicated or carbol-
 ated.  In chronic cystitis in men the  urine
 must be regularly drawn and  the  bladder
 washed out.  If stricture exist, it must  be
 dilated or incised.  In women  an artificial
 opening into the vagina is sometimes  made
 to cure the bladder by constant free drainage.
   Deaf'ness, loss or imperfection of hearing,
 may be congenital  or acquired, permanent
 or temporary, complete or partial.  It may
 be (1) " nervous;" (2) the result of local dis-
 ease or accident.  (See Ear, Diseases of.)
   DelirFum Tre/mens  [i. e. "trembling de-
 lirium"), a morbid affection caused by the
 action of alcoholic drinks, and  often afflict-
ing hard drinkers after severe  accidents or
attacks of acute disease. Delirium, tremb-
ling and subsultus of the muscles and ten- 
26
THE  FAMILY PHYSICIAN.
 dons, wakefulness, and rapid pulse, are cha-
 racteristic symptoms. The patient sometimes
 suffers extremely from the most frightful ap-
 prehensions, and frequently  thinks he sees
 grotesque and horrible objects.   The tongue
 has a thick furry coat, the skin is generally
 cool and covered with sweat, and the patient
 gives forth a characteristic saccharine odor.
 The blood and fluids of the brain are loaded
 with  alcohol, and often  (especially in old
 patients)  there  are abundant  degenerative
 changes in the brain, lungs, liver, etc. Death
 occurs in  about  one-sixth of the cases.  The
 mortality appears to  have  been formerly
 much  greater than at present.  The treat-
 ment is various.  Sleep may be induced by
 the use of chloral or bromide of potassium,
 and in long-continued cases opiates may be
 cautiously administered  with the happiest
 results.  Patients nearly always call for al-
 cohol in some form, but this desire should
 not,  as a general rule,  be gratified.  The
 strength  should be  kept up by beef-tea,
 milk, raw eggs, etc.  Cinchona bark or qui-
 nine should be given as a tonic, and chloral,
 bromides, and valerian  to secure sleep and
 allay excitement.
  Dengue,* den'ga, a disease known by the
 names of dunga, dandy, breakbone fever,
 etc.,  an epidemic, seldom fatal, which has
 prevailed at different times in the southern
 parts of the U. S. and in the East and West
 Indies.   Its symptoms are headache, fever,
 pain and  swelling of the  smaller joints, an
 eruption of the skin, and gouty pains which
 often cause lameness  for a considerable time.
 It appears to be of a rheumatic character.
  Diabe'tes [Gr. SiajSr/r^g, from Sid, "through,"
 and flaivu, to "go"], the  name of two dis-
 eases  characterized by the excessive excre-
 tion of urine; whence the name.   Diabetes
 insipidus (now called Polyuria, which see)
 is distinguished  from the  other much more
 dangerous disease by the fact that the urine
 consists chiefly of water.  It is neither fre-
quent nor formidable. But Diabetes mellitus,
  sweet" or "honeyed diabetes" [Mellituria),
is one of the most incurable and serious of
diseases.  The urine has its specific gravity
greatly increased by the presence of diabetic
sugar, a substance believed to be identical
 (in most  cases)  with liver-sugar, and very
closely approaching grape-sugar in its com-
position and reactions.  In some cases it ap-
pears to be muscle-sugar [inosite).  The dis-
ease is further characterized by indigestion,
intense  thirst, wasting, prostration  of mind
and body, and in many cases by degenerative
changes in  the  tissues.   Its  causes  are ob-
scure and its treatment not well understood.
  * Dengue is the Spanish for " dandy " or " fop,"
and is applied to this disease on account of the re-
markable stiffness of the patient's motions.
Some  cases are greatly benefited by opium
and the use of strictly nitrogenous food, like
bran or gluten bread and skim-milk.   Tem-
porary diabetes has been observed after the
administration of woorari  poison and other
drugs.
   Diarrhce'a [didppoia, from did, "through,"
and piu, to " flow"], a disease characterized
by frequent soft alvine discharges; acute or
chronic intestinal  catarrh.  Many writers
have  drawn nice distinctions  between  the
various assumed varieties  of  this disease,
which indeed is very frequently a symptom
rather than  a distinct  disease;  but  nearly
every  case is in reality due to inflammation
or  irritation of some part of the intestinal
canal.  Diarrhoea as a symptom  of cholera,
dysentery, typhoid fever,  pulmonary  con-
sumption, and some forms of peritonitis, is
treated of  under these respective  heads.
When resulting from local or general disease
of the alimentary canal, its symptoms and
treatment vary greatly according to the age
of the patient.   In infants  both its  acute
and chronic  forms are very frequent and
fatal.    These cases often  depend on  im-
proper food  and clothing—less  frequently
upon  disturbances caused  by dentition than
is generally supposed.   These cases require,
first, a careful attention  to hygienic  con-
ditions.  Flannels should  be worn next to
the skin.   If a  milk-diet  should disagree,
as it often does, finely-cut raw beef or strong
broth  may  be given to the child.  Medi-
cation should generally be cautious,  but
active.  Many children suffer  or die from
over-medication,  and still more,  probably,
from   lack  of active treatment.  If  scy-
balous masses of fecal matter  exist in  the
bowels, they should be cleared out by cathar-
tics, such as rhubarb, etc., with aromatics
or castor oil.  The proper use of astringents,
tonics, and opiates in infantile diarrhoea is
a  matter   requiring  much discrimination.
Chronic diarrhoea in the adult is an obsti-
nate and rather common disease.   A certain
proportion of the  cases are improved by
iron,   quinia, salicine, and other  tonics.
Change of climate,  visits to  mild  saline
chalybeate  springs, sea-bathing,  etc.  are
useful  in  many  instances.   Balsam  of  co-
paiba relieves some patients with surprising
readiness.   Astringent  remedies, as  kino,
catechu,  and  opiates, have much value as
palliative, and sometimes as curative, agents.
The " diarrhoea  and cholera mixtures" for
adults  contain usually astringents, opiates,
chloroform, capsicum,  and  camphor.   In
the simple acute diarrhoea of  temperate
climates adults previously well are in gen-
eral promptly cured by these agents,  ju-
diciously administered.
  Diphtheria [from  the  Gr.  6i<p6kPa,  the 
THE FAMILY PHYSICIAN.
27
 " skin"  of an animal,  in  allusion to the
 false  membrane described below], an acute
 disease,  characterized by inflammation of
 the mucous membrane of the pharynx, at-
 tended by an exudation of lymph, often as-
 suming the character of a false membrane,
 which may extend into the  larynx and air-
 passages, into the oesophagus, and  into the
 mouth,  occasionally  also appearing upon
 raw or mucous surfaces of other parts of the
 body; it is also attended by  prostration and
 albuminuria, which may or  may not be per-
 sistent.   Diphtheria is not  a new  disease,
 but its nature having been  investigated by
 Bretonneau (who gave it the name  diphthe-
 ritis), it has of late received  much attention,
 more  especially from its present frequency
 and the terrible fatality which distinguishes
 it.  Its duration and symptoms are variable,
 and the distinctive exudation is by no means
 of uniform appearance.  In general,  the
 mucous membrane  is  dark  and congested,
 and  the exudation  growing  from   one  or
 more centres if torn away leaves a bleeding
 and sensitive surface.  The membrane itself
 frequently is the seat of a microscopic vege-
 table  growth [oidium), believed by some to
 be an essential part of the disease itself.
 The prognosis is  always grave, no case be-
 ing free  from danger.   The mildest attack
 may be followed  by  paralysis  or by fatal
 prostration.   No routine treatment   can be
 laid down for this  disease.   In  mild cases
 it is permissible to use detergent chlorinated
 washes and local applications of carbolic
 acid, sulphate of zinc, and glycerine for the
 mouth, and the general  treatment may be
 mainly expectant, provided the pulse is firm.
 When the constitution is depressed, sulphate
 of quinia has the happiest effects upon many
 cases.   Tincture of iron, alcoholic stimulus,
 carbonate and muriate of ammonia, with nu-
 tritious liquid diet,  are  needed in  severe
 cases.  The  inhalation of vaporized water
 is an excellent measure.  The treatment of
 the various sequelae  of diphtheria requires
 the careful  use of tonics, such as  strychnia
 and iron, with the best hygienic conditions.
   Dipsomania [from the Gr. diipa, "thirst,"
 and uavia, " frenzy"] is  a term  sometimes
 applied to Delirium Tremens (which see),
 but of late more especially used to designate
 a morbid  craving for alcoholic drinks, some-
 times  called  methomania.    Of late,  this
 craving is looked  upon as a  disease,  and it
 has been very successfully treated in "in-
 ebriate asylums"  in  various countries.
  Dislocation [from the Lat. dis, " apart,"
 and  loco,  locatum, to "place"], otherwise
 called Luxa'tion [from the Lat. luxo, luxatum,
to "loosen"], in  surgery, is the displace-
ment of a bone from its proper relation to
another bone with which it  is articulated. J
 A  "complicated" dislocation  is  the dis-
 placement  of a bone,  accompanied  by a
 severe  local lesion of the soft parts, or frac-
 ture of a bone.  " Congenital" dislocations
 are those which  occur  before  birth.   The
 restitution of a dislocated bone is called its
 "reduction."  Beduction  of recent  luxa-
 tions is usually a  comparatively  easy task
 to  those who have the requisite knowledge
 and experience, but in old and long-neglected
 cases it is frequently a most formidable op-
 eration, and is liable to be followed by bad
 consequences to the patient.
   Drop/sy [a corruption of the old English
 hydropsy; Gr. vdpuf, from  vdop,  "water;"
 Lat. hydropisis;  Fr. hydropisie; Ger.  Was-
 sersucht [i. e. "water-sickness")], a disease
 characterized by excess of the natural secre-
 tion of fluid in any of the serous cavities of
 the body or  in the areolar  tissue. If the
 cerebro-spinal fluid be increased,  it consti-
 tutes hydrocephalus, or " water on the brain."
 If  the excessive secretion (exudation)  takes
 place  from the pleura, it is called hydro-
 thorax, or "dropsy of the chest."  If the
 fluid collect in the abdominal cavity, the
 disease is called ascites (from the Gr. do/cog, a
 " skin," or leathern bag for  water or  wine,
 alluding to the form of the patient's body),
 a disease which may arise without assign-
 able cause, but which most frequently comes
 from cirrhosis of the  liver,  a  contracted,
 hardened condition of that organ,  mechani-
 cally obstructing the portal circulation, and
 thus leading to transudation  of serum  from
 the blood-vessels.  Habitual intemperance
 is its most frequent cause. General dropsy
 of the .serous and  areolar tissues is called
 anasarca  (from the Gr. avd,  "throughout,"
 and cap% (gen. oapicdg), the  "flesh").   Ob-
 structive  organic  disease of the heart and
 degenerative diseases of the kidneys are the
 most frequent causes   of general dropsy,
 which is therefore a very  important symp-
 tom.  Hydropericardium,  or  "water on the
 heart," hydrarthrus, or effusion into a joint,
 hydrorachis, which is seated in the spinal
 canal,  and  hydrocele,  in the scrotum, are
 forms of dropsy. Ovarian dropsy or ovarian
 tumor is a  fluid   collection  occurring in
 ovarian cysts, which may be  unilocular (of
 one sac) or multilocular (composed of many
 aggregated  cysts), the  whole  frequently
 forming a mass of enormous size. Thus far,
 its only successful treatment consists in the
 removal of the cysts by excision, one of the
 boldest, and, on the whole, one of the  best,
 of the more recent surgical operations.
  Drowning, death by long-continued  sub-
 mersion in water.  The recovery of persons
 after apparent death  from drowning  is a
very  important subject.   The  following
rules  are derived  from  the  experience of 
28                         THE FAMILY
 the best  physicians: (1) It  is necessary in
 all cases to keep the body cool until respira-
 tion be re-established, since the application
 of warmth  (both  in  frozen  and  nearly
 drowned persons) seems to arouse those dor-
 mant  energies that absolutely  require the
 aeration of the  blood, which failing, death
 ensues.  (2)  Respiration must be artificially
 established, either by direct inflation of the
 lungs by the breath or the bellows, or, much
 better, by the "Marshall Hall method"  or
 some of its modifications.  The patient be-
 ing in a horizontal position to facilitate the
 exit of water from the lungs, and  the head
 being  slightly raised, the lungs are alter-
 nately inflated and  compressed  by gently
 rolling the body  from a prone to a half-
 prone position (upon one side), and revers-
 ing the process.  The lungs may also be
 inflated by retracting  the arms with  some
 force, and by pressure upon the thorax. (3)
 Expose the face and chest to the  air,  unless
 the weather be  very cold.   (4)  Rub the
 limbs upward, and put dry clothing upon the
 patient. (5) Avoid the use of the galvanic bat-
 tery, which is always dangerous, even in ex-
 perienced hands. (6) Continue these opera-
 tions until, if possible, natural respiration be
 re-established. Cases are reported where arti-
 ficial respiration had to be kept up for hours
 before signs of life appeared. Similar treat-
 ment should be employed in  all cases of so-
 called "asphyxia" from whatever cause.
   Duchenne's Disease.   See Tabes Dor-
 salis.
   Dys'entery [Gr. dvcevrcpia,  from tivg, "ill,"
 "painful," and evrepa, "intestines"],  a feb-
 rile disease, characterized  by paroxysms of
 pain in the  bowels, and by scanty though
 often frequent bloody, mucous  stools.  The
 glands and tissue of  the  large intestine are
 inflamed,  and sometimes, though rarely, the
 small intestine shares the disorder.  It may
 be acute or chronic,  and is a frequent and
 formidable disease,  especially  in  hot cli-
 mates.  It is sometimes epidemic,  and then
 is peculiarly fatal among children.  Many
 times  it  attacks  and decimates  armies.
 Sporadic cases in civil practice usually re-
 cover with little treatment.  Pain is relieved
 by opium or Dover's powder.  Gentle pur-
 gatives, as rhubarb or salines, are extremely
 useful.  Enemata of warm water will often
 relieve  tenesmus.   Astringents,   copaiba,
 opiated starch injections, etc., are  useful
 adjuvants in some cases.   Opium and bella-
 donna  are given as  suppositories.  Perfect
 rest^on the back is desirable.
   Niemeyer regards  epidemic dysentery as
 a disease distinct from the common or spo-
 radic disease.  He considers it truly infec-
tious.  The severer cases of this disease are
not much benefited by treatment.  Even the
PHYSICIAN.
  mild cases are apt to assume a chronic form,
  which may prove fatal. This disease is akin
  to  cholera, and perhaps to  intermittent
  fever.   It  is endemic  in  Southern Europe.
  The endemic dysentery of Egypt is a dis-
  tinct disease,  caused by the presence of a
  trematode  worm (the  Bilharzia hozmatobia)
  in the walls of the intestine.
   Dyspepsia [Gr. Svane^ia, from 6vg,  " diffi-
  cult," and  ttetttu, to "digest"], a disordered
  functional  state of the stomach without ap-
  preciable organic disease; indigestion  of
  food, with  the  resulting symptoms, such as
  flatulence,  pyrosis,  pain,  etc.    Dyspepsia
  may be the forerunner or concomitant  of
  consumption or of  Bright's disease,  but it
  is much more  frequently the result of im-
  proper habits with regard to food, exercise,
  etc.  Dyspepsia exists  in two forms: (1) Ir-
  ritative dyspepsia;  (2) atonic  dyspepsia, a
  debility of the stomach.  In cases where the
  coats of the stomach are irritable, bismuth
  is a standard, safe, and useful remedy. The
  mineral acids, as the nitro-muriatic, are be-
  lieved to correct depraved  secretions.  The
  hyposulphites are sometimes  useful  where
  microscopic plants [Sarcina and Torula) ex-
  ist in the stomach.  Rhubarb with alkalies,
  followed by sulphate of quinia, is frequent-
  ly beneficial.  The bitter tonics tend to cor-
 rect gastric atony.
   When there is no gastric catarrh or ulcera-
j tion there is great, and often complete, relief
 obtained by sea-bathing, nutritious food, and
 the administration of iron.  Dyspepsia with
 depression  of spirits and a red uric-acid de-
 posit in the urine is often cured by water-
 treatment,  with  visits to saline mineral
 springs.  (See Indigestion.)
   Ear, Diseases of.  The ear is  divided into
 three parts: 1. The external  ear, including
 the auricle  and external auditory canal; 2.
 The middle ear, including the drum or tym-
 panum, the mastoid cells,  and Eustachian
 tube;  3. The  internal  ear, including the
 labyrinth   and   auditory  nerve.   Any of
 these structures may be diseased.  The au-
 ricle, or external ear, may be  wanting, im-
 perfect, or  deformed.  The auditory  canal
 may be congenitally closed, or contracted
 either at its orifice or throughout its length.
 Supernumerary  auricles sometimes  exist!
 The  auricle is subject to  cutaneous  erup-
 tions, both  acute and chronic—herpes, im-
 petigo, eczema,  erysipelas.   The auditory
 canal is frequently the seat  of  foreign
 bodies, as in children, who put beads, but-
 tons, etc. in the ear, or when insects, as bugs
 and bees, enter the ear.  The canal, however,
 is  chiefly  obstructed by  cerumen,  or ear-
 wax, which may accumulate in great quan-
 tity, so as to occupy and occlude the  entire
 passage, and exclude sounds.  It may press 
THE  FAMILY  PHYSICIAN.
29
on the tympanum (drum of ear).  It is a
most frequent  cause of deafness.  Cerumen
is to be removed by the surgeon with forceps
or probes, and also by the ear-syringe and
warm  water   or  weak  alkaline  solutions.
The auditory canal is frequently the seat of
little abscesses or "boils in the ear."   They
are painful, though not dangerous.  For a
time they  occlude the passage and  cause
partial deafness, which  subsides with  the
pain when the  abscess discharges.   The
treatment  should be warm  poultices and
fomentations  to the region  of the ear,
leeching in severe cases, and free use of
sweet oil and  laudanum in  the  ear  until
the abscess breaks.   If the  abscesses tend
to re-form frequently, or a chronic discharge
remains (otorrhoea), an aurist should be con-
sulted, who will apply  nitrate of silver or
other healing remedies to the ulcer or gran-
ulations  from which the pus  flows.  In
scrofulous  children this discharge [strumous
otorrhaza) cannot safely be suddenly check-
ed by astringent injections or local applica-
tions, as inflammation of the mastoid cells,
disease of the  inner ear, and death of  a part
of the temporal bone, with secondary brain
disease, may   be the  results.   Strumous
otorrhoea should be treated cautiously, while
the system is  being  corrected by nutritious
food, cod-liver oil, iodine,  iron, and  tonics
generally.   Otorrhoea sometimes develops
polypi, which occlude the meatus  and re-
quire  surgical removal.   Exostoses,  bony
growths, sometimes project into the  canal.
The membrana tympani, or drum of the  ear,
may be injured by the introduction of sharp
instruments, or ruptured by sudden impaction
of air  compressing it from without, as by a
box on the ear, the  noise of a loud explo-
sion,  as of blasting, cannon, or  even fire-
arms.  It may also be ruptured by air from
the throat through the Eustachian tube sud-
denly and  forcibly pressing from  within, as
in violent  blowing of the nose,  vomiting,
and paroxysms of whooping cough.  Such
ruptures usually heal.  The membrana tym-
pani is liable to congestion and to acute  and
chronic inflammation.  If temporary, con-
gestion and   inflammation  may leave no
deafness, but  in  proportion as the drum is
thickened and hardened the hearing  is  im-
paired or lost.  The drum may grow hard
and scar-like or be the seat of chalky masses.
It is frequently inflamed by the extension of
disease from the throat through the Eustach-
ian tube, as in  chronic catarrh, acute ton-
sillitis, diphtheria, scarlatina, and measles.
The tympanum is quite apt to be ulcerated,
and permanent perforation of the drum, ex-
ternal  otorrhoea, and deafness result.   The
perforation may be minute or include nearly
the whole  drum.  Often, if the Eustachian
tube be not closed, the person can blow  air
from the throat through the perforated drum
into the external auditory canal, with a per-
ceptible sound.  An artificial drum or mem-
brana tympani of hard rubber can be worn.
It is introduced daily by the patient after
cleansing the ear, and restores the hearing
very perfectly in many  cases.   Moistened
cotton wool, introduced  clean  each day,
effects the same  result in a measure. The
auditory canal and drum may be covered
with a yellow mould,  minute fungi [Asper-
gillus), which can be removed by a weak so-
lution of carbolic acid and sulphate of soda.
The Eustachian tube is liable to be occluded
by catarrhal  thickening of its lining mem-
brane, the product of catarrhal throat trou-
bles.  This is the explanation of the most
frequent form of deafness—catarrhal deaf-
ness.  Air  does  not  gain  access   to the
inner side of the drum of the ear. The
Eustachian  tube  is to  be  restored to its
open state by means of the  Eustachian
catheter or Politzer's bulb.  The ossicles—
the chain of little bones in  the inner  ear
which transmit  the sound-vibration of the
tympanum to the auditory chambers—may
become thickened or  necrosed, or so firmly
united (ankylosed) that they cannot move.
The  labyrinth — semicircular  canals  and
filaments  of  the auditory  nerve—may be
the seat of inflammatory and degenerative
changes causing deafness.  In  Menierre's
disease giddiness,  staggering, and vomiting
coexist with decreased hearing, and are sup-
posed to be due to blood-serum or pus in the
semicircular  canals.  Often the  deafness is
associated with symptoms of cerebral disease,
which indicate that the auditory nerve is in-
volved at its  origin or course in the brain.
   The chief  diseases  of the ear are these:
1. Deafness; 2.  Otorrhoea, or purulent dis-
charge from the ear; 3. Otalgia, pain in the
ear, the result of abscess or acute catarrh or
inflammation, and often reflex  or sympa-
thetic, dependent  on sore throat, or, again,
a pure neuralgia, with no existing ear dis-
ease, caused  by poor health, impoverished
blood, or nervous and hysterical tempera-
ment.   (See  Deafness.)
   Ec'zema [Gr.  in&ua, an " eruption," from
etc, "out," and £«j, to "boil"], commonly
called Salt Rheum, a vesicular disease of the
skin, characterized by watery blisters smaller
than those of herpes and larger than ordinary
sudamina.  Eczema is often accompanied by
intense itching, and is frequently transformed
into a pustular or scabbing disease.  It is gen-
erally chronic.   Its treatment is both local
and general.  The  local treatment, when the
epidermis is thickened, is by alkaline appli-
cations, with or  without tarry or astringent
admixtures.  The "benzoated ointment of 
30
THE  FAMILY  PHYSICIAN.
 oxide of zinc " is an excellent application.
 If the system has received a specific taint,
 the  iodides, with mercury judiciously used,
 are indispensable, and produce the happiest
 results.   Arsenic in  small doses  is an ex-
 tremely useful tonic in many cases. Change
 of air and visits to thermal and other springs
 and baths, though not strictly curative, often
 appear to be wonderfully palliative.
   Elephantiasis  [from  the  Gr.  eM(j>ag,  an
 " elephant," because it was fancied that the
 legs of those who suffered with it resembled
 those of an  elephant], as at present used,
 designates the disease anciently  known as
 elephantiasis Arabum,  the " elephantiasis of
 the  Arabians," so called  to distinguish it
 from the  elephantiasis Graicorum, the " ele-
 phantiasis of the Greeks," which was prob-
 ably identical with leprosy.  Elephantiasis
 is rare in Europe and North America, though
 not  unknown in  either.   It is endemic in
 the Levant and the East and West Indies.
 The foot and leg, or sometimes other  parts,
 become greatly enlarged and enormously in-
 creased in density and hardness, the skin as-
 suming a remarkable  roughness and usually
 a darkness of hue.  The prognosis is usually
 grave, very few  cases  recovering, though
 many cases remain  completely  stationary
 after the  disease  is  once established.   In
 fatal cases suppuration  and erysipelas  are
 the  active symptoms.   The treatment is
 thus  far unsatisfactory.   The use of iron,
 iodine and quinia, with bandaging, is rec-
 ommended.
   Em bolism [Gr. EfifioAiofidg, from kv,  " in,"
 and  (3dAAu,  to "throw"], in  pathology, is
 the  presence of  a clot  [embolus) in  the
 arteries or veins.  Some writers also apply
 the name to the fixed venous clot [thrombus).
 Embolism in the  brain is a recognized  cause
 of hemiplegia and of  an apoplectic form of
 seizure in many respects identical with  the
 phenomena  of true  apoplexy  or cerebral
 haemorrhage. An extensive embolism of the
 lungs may lead to sudden death; a smaller
 one  may lead to  local pneumonia, abscess,
 pyaemia, or gangrene.  Embolism, though
 frequently fatal,  is sometimes followed by
 recovery.
  Endocarditis [from endocardium and  the
 termination -itis, denoting "inflammation"],
 an inflammation  of  the  endocardium.   It
 is generally of rheumatic character, and,
 though not often  immediately fatal, it is a
 frequent cause of organic disease and  de-
 formity of the heart  and its valves.  It is
 frequently associated  with pericarditis, and
its occurrence is  one of the results always
to be feared in rheumatic fever.   It is usu-
ally  attended by  pain or discomfort about
the heart, and is  detected by auscultation.
It produces peculiar murmurs in the heart,
 the significance of which can only be  ap-
 preciated  by the trained physician.   The
 disease is very intractable.  Sedatives, such
 as  hydrocyanic acid, belladonna, aconite,
 and digitalis, may be useful in acute stages!
 The alkaline treatment for  rheumatism is
 often  advantageous.   Salicylic  acid  and
 salicylate  of  soda  are  the  most recent
 and  effectual remedies.  Patients  some-
 times, though not very frequently, entirely
 recover.
   EnteraFgia [from  theGr. hrepov, the "in-
 testine," and dlyog, "pain"], a name given
 in  some medical works to colic,  especially
 of  the form attended by spasmodic contrac-
 tions in the muscular coat of the intestine.
 The disease is best relieved by hot applica-
 tions,  anodynes, hypodermic  injection  of
 morphine, and by the cautious use of chlor-
 oform.  The  tendency of late  writers  is to
 limit the use of the  term enteralgia to cases
 of  Neuralgia (which see)  of the intes-
 tines.
  Enteritis [from theGr. IvrEpov, "bowel,"
 "intestine,"  and the termination -itis, de-
 noting, in modern medical  nomenclature,
 "inflammation"],  an inflammation  of the
 small  intestines.  Active  inflammation  of
 the bowels, in adults at least, is frequently
 confined to the peritoneal coat, and the dis-
 ease is hence called peritonitis.  When the
 mucous coat of the bowels alone is actively
 involved,  it is frequently a fatal  disease in
 children, but  in adults, with care, the ma-
 jority of cases recover.   Catarrhal enteritis
 is benefited,  and generally cured,  by gentle
 purgation.  But in  active disease of this
 kind cathartics will often  greatly aggravate
 the evil. Such cases are best treated by rest,
 opiates, poultices to the abdomen, and bland
 nourishment.  " Typhlo-enteritis " or inflam-
 mation  of the caecum, when caused by  ab-
 scess or perforation  of  the appendix caeci
 is not unfrequently  fatal; when otherwise
 caused,  recovery is to be looked for.
  Epilepsy  [Lat.  epilepsia;   Gr.  iTtil^ia,
 from km,  "upon," and  Aau/3dvu, to "take,"
 to "seize"], a disease of the nervous system,
 in which there are occasional seizures or fits
 of sudden  and complete loss  of conscious-
 ness, usually  associated with  convulsions
which  become clonic, and finally impede
respiration.   The attack may last from two
to twenty minutes, and is followed  by ex-
haustion and  sleep.  In other  cases, called
 petit mal (Fr. for "little sickness"), the loss
of consciousness is but momentary, and there
 is no convulsion or falling down, as in ordi-
 nary attacks.
  It has been customary to say  that this
 disease  is  merely functional,  because  in
 most cases there is  little or  no  apparent
 organic change of  the brain  observable 
THE  FAMILY PHYSICIAN.
31
after death;  but the present opinion  of
pathologists appears to be that sufficiently
careful observation will detect lesions, how-
ever minute,  sufficient to account for the
symptoms.  Dilatation of blood-vessels in
the  medulla  oblongata  is frequently  ob-
served.  The  disease itself is  of a fright-
ful  character, apart  from  the  unhappy
effects it may produce upon the mind of
the  patient.
   When occurring in  childhood, and espe-
cially during the  period of dentition, it may
after a time be spontaneously cured.   It is
sometimes hereditary, and often is caused by
various excesses, by blows on  the  head, or
by excessive fright.
   The treatment  during the paroxysm, if it
be habitual, is simply to place the patient
where he cannot  hurt  himself,  to loosen his
clothing, and give him plenty of fresb. air.
Between  the paroxysms the patient should
avoid all excesses of eating, of drinking, or
of any other kind.  Systematic  exercise, and
even gymnastics, never carried so far as to
produce much weariness, are often beneficial.
Nutritious food, with avoidance of coffee, to-
bacco, and  stimulants, is usually advisable.
Of medicines, the bromides  of  potassium
and of ammonium are  useful in warding off
the  attacks, and  the continuous  use of the
bromides for a term of one or two years will
effect a cure in many cases.  Tonics, such as
iron, arsenic, and quinia, are useful in spe-
cial cases, but in others are apparently worse
than useless.
   Notwithstanding the terrible effects of this
disease upon the minds of many of its vic-
tims, not a few distinguished men have been
epileptics, as were Cambyses, Caesar, Mo-
hammed, Petrarch, Henry IV. of England,
Napoleon, and Byron. The ancients, it is
said, sometimes  called this disease morbus
basilicus  ("king's disease"),  from the idea
that great men were especially liable to it;
and among its numerous names was morbus
sacer (the "sacred disease"),  because  the
gods were  believed to have especial care
over its victims.
   Epistax/is.  See Nose-Bleed.
   Erysipelas  [Gr. EpvainsTuig, probably from
epvdpog, "red," and ireAog, akin to the Lat.
pellis, "skin"], a disease probably of mias-
matic origin,  sometimes associated with a
peculiar  rose-colored eruption  of the skin,
whence the name.  The  inflammation at-
tending this disease is of a peculiar low type
which j#  but little understood.  It may ter-
minate favorably by resolution, less favor-
ably by abscess (which is apt to be diffuse—
i. e. not limited to a single spot—and is then
very dangerous),  or the termination may be
in gangrene and  the death of  the  patient.
The disease is very common in military hos-
pitals, seating  itself  in wounds,  when  it
proves frequently fatal.  Erysipelatous dis-
eases sometimes assume an infectious and
almost an  epidemic character.  Puerperal
fever, peritonitis, phlebitis, and a long cata-
logue of diseases of low type are akin  to
erysipelas.   Its  infectious  character is ad-
mitted.   The famous old  " Dreadnaught"
hospital-ship in the Thames became so poi-
soned by it that she  had  to be destroyed.
The best treatment is a sustaining one.  Pure
air, a milk diet, and the use of quinia and
iron, with stimulants, are  in general indi-
cated.   The sulphites and other disinfectant
remedies may be employed.  Externally, it
is  safest to  use  only the blandest applica-
tions—carbolized lotions, lead and  opium
wash, etc.
  Eye, Diseases of.  See articles Amaurosis,
Granular Lids, Blindness, Cataract,
Myopia, Squinting, Ophthalmia, Sight,
Defects of, etc.
  Facial  NeuraFgia, paroxysmal  pain  in
the head and face.   The cause of the  neur-
algia is a morbid state  of the nervous cen-
tre giving origin to the nerve (trigeminus);
and  this morbid state  may itself be the re-
sult  of  simple malnutrition (anaemia), of
blood-poisoning  (malaria), of inherited pre-
disposition,  of irritation of other  sensitive
nerves (bad teeth), tumors pressing on the
nerve, and inflammation of the nerve itself.
Remedies are anodynes  and external use of
hot water and soothing lotions.
  Fa/cial  ParaFysis, a paralysis of the su-
perficial muscles of the face, due to a loss
of the motor property of the nerve supply-
ing them—the seventh or facial nerve.  The
symptoms  are  loss of  expression  on the
affected side of  the face, a drawing of the
mouth and features, generally to the opposite
(healthy)  side, inability to close the eyelids
on the  palsied side, slight impairment  in
articulation, owing to palsy of a part of the
muscles of the tongue.  When both sides
of the face are palsied, the face appears like
a smooth  mask, the mouth (lips) is  open,
the eyes cannot be closed. The pathological
conditions which produce this palsy may be
disease of the cerebrum, pons Varolii, or of
the medulla  oblongata, pressure upon the
nerve in the skull  or  in the  canals in the
petrous bone, injuries to the nerve in these
locations or upon  the face, or the sudden
impact of cold air upon the face (draught).
  FainFing [Syncope), a more or less com-
plete and  sudden loss of sensation and of
the power of  motion, usually attended by
feebleness of the circulation and respiration.
Fainting is due to anaemia of the brain, its
proximate cause; more remotely it may be
caused by loss of blood, by profound emo-
tional disturbance, or by heart disease.  In 
32                         THE FAMILY PHYSICIAN.
 profound  and protracted syncope there  is
 danger of death by heart-clot.  Fainting is
 to be treated by placing the patient on his
 back in a horizontal  position, or with the
 head and chest slightly depressed below the
 level of the rest of the body; by admission
 of fresh air to the patient; and, in prolonged
 eases, by applying diffusive stimulants—as
 ammonia, camphor to the nostrils, alcoholic
 stimulants by the  mouth and rectum, and
 resorting to artificial  respiration  and the
 electric battery.  Fainting is seldom fatal,
 unless in cases of severe disease.
   FalFing of  the Fun/dament.   See Rec-
 tum, Diseases of (prolapse).
   FalFing of  the Womb.  See Prolapsus
 Uteri and Uterine  Diseases.
   Far-Sighiedness.  See Sight,  Defects
 of.
  Fat'ty Degeneration, in pathology, a con-
 dition in which the minute structural ele-
 ments of the tissues of living organisms are
 gradually replaced by fat-globules.  In man
 this diseased condition has been observed in
 nearly all the tissues, though some authorities
 state that the nerves and the red corpuscles
 of blood are not liable to this change. Fats,
 though always of organic origin, and often
 closely associated  with living tissues, are
 never, it is believed, truly organized bodies;
 and consequently they are not regarded as
 ever truly vitalized, any more than are the
 water and the lime which are found in liv-
 ing organisms.  In this view, fatty  degen-
 eration is a molecular death of the tissues.
  In the liver at first it is merely an excess
 of the normal fatty element, which, however,
 encroaches upon the organized elements of
 those structures, and becomes a true fatty
 degeneration.  It attacks the muscles, the
 heart, the  bones,  the brain (yellow  soften-
 ing), the cornea [arcussenilis), and the kidney
 in many cases of so-called Bright's disease.
  Fa'vus  [Lat.  "honeycomb"],  or Scald
 Head {i.  e. "scabby  head," from scall,  a
 "scab"), a disease formerly known as  tinea
 and porrigo, generally  seated on the hairy
 part of the scalp, but sometimes attacking
 the roots of the nails and other parts.   This
 disease  is caused  by a parasitic vegetation.
 These  fungi are known as Achorion Schoen-
 leinii and Puccinia favi, but are now believed
 to be abberrant forms of the species known
 as the yeast-plant, Cryptococcus cerevisoz.  Fa-
vus is a contagious disease, best prevented
by cleanliness, and  best cured by carefully
removing the hair and applying parasiticide
medicines, such as  have the power  of de-
stroying low  organisms.  Sulphurous  and
 carbolic acids  and weak solutions  of corro-
sive sublimate are the  best  applications.
It leads to permanent baldness.
  Febric'ula [a diminutive of the Lat. febris,
 "fever"], or Ephem'eral Fever, a short fever-
 ish  attack  lasting from one day to a week,
 marked by a rapid pulse, a furred tongue,
 and often by a very considerable increase of
 heat and by headache.  Persons  suffering
 from febricula are said to be "threatened
 with a fever," and are too often improperly
 dosed.  A warm bath, warm or cold water
 to drink as  best suits the patient, the use of
 enemata if called for, and other simple treat-
 ment is sufficient, for the disease will  pass
 away of itself if  allowed  to do so.   It is
 often followed by an eruption or a stage of
 profuse sweating.   Febricula may be asso-
 ciated with a severe cold, a profound emo-
 tional disturbance, or with some excess on
 the patient's part.  It is especially common
 during  epidemics  of typhoid  and typhus
 fevers.
  FeFon.  See Whitlow.
  Fe/ver  [Lat. febris,  allied to ferveo, to
 "glow," to " be hot"].   In distinction from
 other diseases,  which,  however  grave or
 extended, are  confined  to certain  organs,
 fever may be  said to be  a perversion of
 all  the  physiological functions.  Fever oc-
 curs in a great variety of forms and differ-
 ent degrees.
  The early symptoms are a sensation of
 general malaise, bodily and mental languor,
 headache, pains in the back and limbs,  loss
 of appetite, accelerated pulse, and chill; af-
 ter  a certain length of time  a  sensation of
 heat, not merely felt by the patient himself,
 but also by others.  The skin feels hot  and
 dry, the pulse  remains quick, but is  fuller,
 the respiration is hurried and irregular, the
 general restlessness becomes very great, the
 thirst intense, the appetite is wholly lost, the
 tongue is coated with a whitish  film,  the
 mucous membrane of the mouth and throat
 is dry, the urine is scanty, of a deeper color
 but clear, and of a greater specific gravity.
 After this stage of dry heat there is profuse
 sweating, the dryness  of the mouth and the
 thirst  diminish,  the respiration   becomes
 deeper, more regular, and less frequent, the
 pulse soft.
  Not all the symptoms just described must
 necessarily be present to pronounce a certain
 condition  of the system as febrile in cha-
 racter.
  One symptom is never wanting in fever,
which can be measured  with mathematical
 exactitude, which  always keeps in true re-
 lation to the degree of the fever: it is the
increase of the temperature of the  body as
determined  by the thermometer.  It varies
from  98.5° F. (normal temperature of  the
body) to 108° F., or a little  more  (37.5° to
42° C.).   There is no more certain and trust-
worthy guide to a correct  judgment of the
dangers threatening  health  and  life from 
THE  FAMILY PHYSICIAN.
33
fever than the thermometer, and it is now
universally adopted by the medical profes-
sion as a means of diagnosis  and prognosis
in levers.
  Fevers are idiopathic (primary) and symp-
tomatic  (secondary),   idiopathic fevers are
also called  essential  fevers.   All  zymotic
fevers, be  they contagious  or  miasmatic,
belong  to this class.   Symptomatic  fevers
require  a local disease as a preceding con-
dition.  Such  are  inflammatory, catarrhal,
rheumatic, hectic fevers; also all fevers named
after  the  organs  whose  diseased condition
causes them—brain,  lung,  gastric,  enteric
fever.
   Contagious  and infectious fevers  are the
result of peculiar substances,  which get
into the circulation either from the air we
breathe or in food and  drink.  Secondary
fevers are generated  in  a similar manner,
the local diseases producing some substance
which, absorbed, contaminates the blood in
such a way that fever must follow. (The more
important varieties of fever are described,
with their treatment,  under their alphabet-
ical heads.)
   Fe'ver and  A'gue.   See Intermittent
Fever.
   Fistula [Lat., a "pipe"], a term used in
pathology to designate an abnormal  canal,
usually of small length and diameter, lead-
ing from one organ to another (vesicovagi-
nal fistula), or from some cavity of the body
to the external world (gastric fistula, fistula
in ano).
   Fistula is called (1)  complete, when it
has two orifices; (2)  incomplete or  blind,
when it has only one;  (3) external, when
the opening is through the skin; (4) inter-
nal, when it opens only into a cavity of the
body.  The two most prominent character-
istics of a fistula are the constant discharge
from it of a thin purulent fluid,  with which
the secretions  of the organ affected are mix-
ed, and the obstinacy with which it resists
the healing process. This latter results from
the nature of  the wall of the fistula, which
in recent  cases is formed of soft, unhealthy
granulation-cells  which  have no tendency
to unite to  form  either  cicatrix or cuticle.
In  older cases the walls  consist  principally
of condensed connective tissue, inseparable
from  the surrounding parts.  A fistula of
long standing also exerts a change in the
tissues through which it passes, these be-
coming  more  dense, and finally indurated,
and the integument around its orifice cal-
lous and sometimes warty.
  Fistula  is caused (1)  by wounds which
penetrate  passages giving natural exit to
the secretions, or those which follow a long
and deviating  course through many tissues;
(2) by ulceration and the  sloughing process;
| (3) by abscess.  The last is the most frequent
 cause.
   The passage of a bullet through any region
 of the body sometimes leaves a canal which
 fails to  unite;  and whenever  a necrosis of
 bone  occurs  there are usually one or more
 tracks following a winding course from it to
 the outside of the body.  These passages
 are often called fistulae, but the more appro-
 priate name for them  is  simis.
   Fistula commonly  occurs  in persons of
 an enfeebled  constitution.  Where it results
 from abscess it is more frequently the chronic
 than acute form which gives rise to it.  Fis-
 tulae Were formerly supposed to furnish exit
 for morbid humors, and surgeons hesitated
 to attempt their cure.  At the present time
 some surgeons  refuse to operate on a fistula
 in ano in a patient having phthisis.
   The cure of fistula depends upon producing
 union of its walls through the agency of
 healthy  granulation - cells.   This may be
 brought about  by stimulating applications,
 as the injection of nitrate of silver, corrosive
 sublimate, etc.  in solution, or the applica-
 tion of the red-hot iron.  Where the walls
 are old and indurated, it is necessary to dis-
 sect them out and remove them  altogether,
 bringing the lips of the wound together by
 sutures.
   Fit.  See Convulsions, Apoplexy, and
 Epilepsy.
   FlaFulence, the accumulation of gas, the
 product of fermented  food, in the stomach,
 consequent upon indigestion (see Indiges-
 tion and Dyspepsia), or in the intestines,
 where it is detained  by faeces.  (See Con-
 stipation.)  Flatulence causes gurgling or
 rumbling sounds in the bowels, and may be
 voided by belching of wind by the mouth or
 downward from the rectum.   It is the fre-
 quent cause  of colic or  intestinal cramp.
 (See Enteralgia and Colic.)  When hab-
 itually present, it dilates the bowels and
 creates a large abdomen.  The appropriate
 remedies are  those detailed in the treatment
 of indigestion and constipation.
   Flu'or AFbus.  See Leucorrhcea.
   Frac/ture  [Lat. fractura,  from  frango,
 fractum, to  "break"].   In  surgery,  the
 term fracture is used  to indicate a rupture,
 or solution of continuity, occurring in os-
 seous tissue, or in  rare cases in cartilag-
 inous tissue partly  ossified.  By  simple
 fracture is meant one in  which no  wound
 exists admitting  air  to the seat of frac-
 ture.  A compound fracture is one in which
 such  a  wound  does   exist.   A complicated
 fracture is one in which  some other  seri-
 ous injury is inflicted, at or near the site
 of the fracture, or in which,  from  the sit-
 uation of the rupture, the healing process
 cannot progress as  favorably as  is  usual; 
34                         THE FAMILY PHYSICIAN.
as when a large  blood-vessel or nerve-trunk
is torn  by the broken  bone,  or when the
fracture extends into a joint-cavity.  A com-
minuted fracture is one in which the bone is
broken into several small pieces at the point
of rupture, and is rarely produced  except
by direct violence, as by a blow or crushing
force.  A complete fracture  is one in which
the rupture extends through the whole thick-
ness of the bone, while if  only a portion
of the fibres  are broken, as sometimes hap-
pens in children, the fracture is called in-
complete,  or the  "green-stick  fracture" of
some  writers,  from its resemblance  to the
fracture produced by bending  a stick of
green wood until some of the fibres  give
way.  The terms transverse, oblique, and lon-
gitudinal refer to the direction of the rupture
in relation to the long axis  of the bone, the
great  majority of the fractures of the  long
bones belonging to the  second class.  The
term stellate is applied to a series of fractures
radiating from a centre, as seen sometimes
in fracture of the skull from a wound pro-
duced by a pointed instrument.
  Causes of Fracture.—These may be external,
from violence adequate  to  break a normal
bone,  or internal, the bone being too  fragile
to resist ordinary forces.  External  causes
embrace direct violence, where the rupturing
force  is applied  opposite the point where
the bone  breaks  (as a blow or crushing
force which fractures the bone at the point
of contact);  and indirect  violence,  where
the bone is bent beyond the  power of its
elasticity to restore  itself,  and  gives  way,
usually at some distance from the point of
application of the fracturing force (as when
a fall  upon the shoulder fractures the collar-
bone).  Muscular force is generally acknow-
ledged as a cause of fractures,  especially in
particular  situations—e. g. fracture  of the
point  of the elbow or of  the knee-pan.  The
internal or predisposing cause is a brittleness
of  the  bones  called " fragilitas  ossium,"
which occurs sometimes in early or middle
life as a result of disease (although it may
occur in those otherwise healthy), and al-
most universally in advanced  life from the
preponderance of earthy and  deficiency of
elastic matter.
  The signs  of  fracture are pain, swelling,
and tenderness at the point of fracture, change
in shape of the  limb, false point of  motion,
and crepitation, though any, or even all, of
these  signs may be absent.  The pain comes
from  laceration  of some  nerve-filaments
and pressure  upon  others  by the  broken
bone, or by the  blood  escaping  from torn
vessels, which gives rise to the swelling that
occurs at first, the subsequent swelling being
due to products  of inflammation or of the
reparative  process.  The  change in shape
is due  partly to this swelling, and partly to
displacement of the broken bones either by
muscular  action or  by movements  of the
patient.  The false point of motion  comes
of course  from the want of continuity of
the bone,  and  the  crepitation is a fine gra-
ting elicited when  the ends  of  the  broken
bone are gently rubbed together, and which
may be appreciated by  the  ear or  touch.
If the  fracture be impacted—that is, if the
broken ends  are firmly locked together, as
sometimes  happens — none of  these  signs
may be present in  a  marked  degree,  and
some of them,  such as crepitation and false
motion, not at all.
  Fractures generally  unite by  the deposi-
tion of bony material  between and around
the  broken ends  of the bone,  forming an
exception to the rule that prevails for most
other structures, that union after rupture  is
effected by means of fibrous or  connective
tissue;  and  the reason  is apparent,  since
fibrous  tissue does not form a sufficiently
rigid bond of union to enable the bone to
perform its functions, as we see in cases of so-
called  "ununited fracture," when the union
is of a fibrous nature.  The union of  a sim-
ple fracture consists of two  processes—one
to  accomplish  a  temporary purpose, the
other for the permanent union ;  the former
to support and bind together the fragments,
while the latter consolidates them.   A few
days after  the fracture the bone, its perios-
teum  (membrane  surrounding  the  bone),
and the neighboring  tissues pour   out  a
quantity of plastic material around and be-
tween  the broken ends, which gradually
hardens, and at the end of the fourth week
consolidates the fragments.  This is called
the " provisional callus," and the hardening
process continues until it is  converted into
bony tissue.  The  plastic material effused
between the fragments is  much slower in
ossifying than that which is internal  or ex-
ternal  to it;  and this, which is destined to
form the permanent bond of union, is called
the  " definitive callus."   While the  defini-
tive callus is forming the provisional callus
is gradually  being absorbed;  and  finally,
many months after the fracture, the provis-
ional  callus entirely  disappears, and the
fragments are united by the definitive callus
alone,  which is true bone; and the site of
the  fracture  may be  indicated only by a
slight enlargement at that point.  The union
of  compound fractures is entirely different.
In  these the provisional callus is almost or
quite  absent, and  the definitive callus  is
formed by a process  of  granulation from
the ends of the fragments, the granulations
being  gradually converted into bony tissue.
It is a  process requiring  several months,  or
sometimes years,  and is  attended  with  a 
THE  FAMILY  PHYSICIAN.
35
greatly  increased amount  of danger from
exhaustion  through  long - continued  sup-
puration and absorption of purulent mate-
rial.  The  difference  in the mode of union
seems to be due to the irritation produced
by the air, or something conveyed by  the
air  to the  wound.
  The treatment of fractures  consists essen-
tially in restoring the fragments to their
original position, and holding them there
by some form of rigid  apparatus which shall
not cause discomfort  or injury to the pa-
tient.  Of  course general treatment is to be
employed also if the circumstances require;
but simple fracture in a healthy individual
requires no special  medication or system of
dieting, as  the old modes  of practice were
wont to inculcate.   The  rigid  apparatus
used to retain the fragments in their proper
position is  called a splint, which consists of
two kinds—padded and moulded.  If the
splints are made of straight,  inflexible ma-
terial, they cannot be  adapted to the irreg-
ularities of the limb  without more or  less
padding at certain points; while if made
of material which  at the time of its appli-
cation is soft and pliable, it may be moulded
to the shape  of the  limb, and, becoming
hard  and rigid, will  serve to support and
retain the  fragments.  Splints of the first
variety  are made  of  wood, sheet iron,  tin,
zinc,  etc.,   while gutta-percha,  felt,  sole
leather, starch, soluble  glass,  or plaster of
Paris are used for  the second class.   Frac-
tures sometimes fail to unite, and are called
ununited fractures. This may be the con-
sequence of faulty position of the fragments,
or  of  something  interposed  between  the
broken  ends, impeding union, but it more
frequently  arises from some constitutional
defect.   The location of the fracture may
prevent union, especially if either fragment
be poorly supplied with blood, as in certain
fractures of  the  neck of  the  thigh-bone,
which frequently unite only by fibrous tis-
sue. Ununited fractures may often be made
to unite by irritating the  parts at the site
of  fracture,  as by rubbing  the bones to-
gether,  drilling them by means of a long
needle, or by wiring the bones together.
  Frost-bite  and Freezing  are conditions
caused by the action of cold  upon the ani-
mal economy.  Frost-bite is local  and par-
tial—freezing is general and more  or less
complete.  Severe  frost-bite  may lead to
gangrene, but the milder forms often  result
in nothing  worse than chilblains, which are
very annoying, but not dangerous.  General
freezing, if  rapid, may result in  speedy
death ; but more frequently the vital func-
tions  pass  for  a  time into a state of abey-
ance, which  may last,  it is  said, for some
days, and then be terminated by death. In
recovering frozen and unconscious persons
it is held that a very slow restoration of the
normal temperature is safest, apparently be-
cause sudden warmth arouses those dormant
energies which demand immediate aeration
of the blood, which  failing, death at once
ensues.
  Fu'runcle.  See Boil.
  Gall Stones.  See Calculus.
  Gan/grene  [Gr. ydyypaiva], the  death, or
partial death, of an organ or any portion
of the body.  Debility from any cause, and
especially from old age, is the great predis-
posing agency.   Among the exciting causes
may be mentioned mechanioal injuries and
obstruction either to the ingress of arterial
blood to, or egress of venous blood from, a
part.  The' immediate cause of the death of
a part is  always the complete cessation  of
the capillary circulation in it. A distinc-
tion is generally made into wet and dry gan-
grene, according to the condition of the part
affected.  Another division is  into constitu-
tional and local.   Gangrene usually  begins
with a diminution in the sensation and tem-
perature  of the  part, the  cuticle becomes
detached, and a serous fluid is found beneath
it.  The limb  crackles under the  finger,
owing to the presence of gases which are
evolved by the decomposing tissues.   These
symptoms increase until all sensation is lost,
and the part becomes colored greenish-black
by the sulphuretted hydrogen set free  during
the process.  The treatment must necessarily
vary  according to the cause.   The  system
should be supported, and inflammation, if
present,  allayed.  If there be any chance
of saving the part, the temperature  should
be kept up by warm fomentations.
  GicFdiness!  See Vertigo.
  Gleet,  the  chronic stage  of  urethritis,
deeply seated and  most  difficult of cure.
(See  Gonorrhoea.)
  Goitre (gutter, the "throat"); synonyms,
Bronchocele, Derbyshire Neck.   This is an
enlargement  of the thyroid gland,  which
lies  across  the front of  the windpipe.   It
probably originates  in hypertrophy  of  the
natural gland-structure, and the concurrent
formation of cysts in tbe  interstices of  the
gland-tissue.   These  cysts are of varying
size, and generally contain a more  or less
solid glairy matter, blood, earthy   concre-
tions, etc.  The disease has been supposed
to be due  to  the drinking of snow-water,
but it occurs where there is no snow.   Al-
though manifesting itself to a  greater or
less  extent in all parts of the world, it is
more prevalent in the chalky parts of Eng-
land, especially Derbyshire and Nottingham,
and in mountainous districts, among which
may be named the Himalayas, Andes, Alps,
the Tyrol, and the valley of the Rhone.  It 
36                         THE  FAMILY  PHYSICIAN.
is seen upon almost all cretins.  Goitre is
also a symptom of a peculiar affection known
as Graves' or Basedow's Disease (which
see), which consists, besides the enlargement
of the thyroid gland, of an unusual promi-
nence of the  eyeballs  and a very rapid ac-
tion  of the heart.  This tumor, called ex-
ophthalmic goitre, is not goitre at all, and
usually disappears with the general disease.
[Niemeyer).   Unless it be very large, goitre
causes but little inconvenience, but it often
attains to such a size as  to produce serious
trouble by  pressure on the neighboring im-
portant  parts—the large  veins,  trachea,
oesophagus,  etc.   The  treatment usually
adopted is  iodine,  both  applied externally
and  administered  internally, to cause ab-
sorption.   Extirpation  is  sometimes  per-
formed.  In  India powerful  mercurial in-
unctions  are  successfully employed.
  Gonorrhoea [Gr. yovh, "semen," and />ew,
to " flow," a misnomer], acute catarrh of the
urethra, a disease which is usually of impure
venereal origin.  It is a painful disease, and
may result in the chronic catarrh called gleet,
or may lead  to stricture,  epididymitis, en-
larged prostate, and other serious evils.  Its
treatment should be entrusted only to prac-
titioners of the highest character.  Quacks
extort large sums  of  money  from persons
suffering from this disorder and its  conse-
quences.  The most efficacious remedies are
copaiba, cubebs, and sandalwood internally,
and  local injections  of  bismuth, sugar of
lead, and sulphate of zinc  in weak solution.
(See Stricture and Gleet.)
  Gout [goutte, a "drop"], an inflammation
of the fibrous and  ligamentous parts  of the
joints, and is dependent upon mal-assimila-
tion.  It derives its name from having been
thought to be produced by a liquid falling
[goutte d goutte], "drop by drop," into the
joints, and, although  this theory has long
since been proved to be erroneous, it still re-
tains the name. We generally find an he-
reditary predisposition to this affection.   It
can be traced through  many generations,
and is found in about two-thirds of the cases.
Next frequently we find it  in persons  enjoy-
ing the luxuries of the table, drinking wine
and beer, and taking but little exercise.   It
was  formerly considered a disease of high
life, but is now just as common among the
poorest people in England as among the rich.
It was not so in  Sydenham's time.    The
ballast-heavers of London have more gout
than any other class  in the world.  They
work in the water, and drink large quanti-
ties  of malt liquors daily.  The  principal
change observed in  the blood is a  great
excess of uric acid, and the deposit  in the
affected joints is made up almost entirely
of urates.  But " we neither know whether
the uric-acid diathesis be the primary and
chief anomaly  in  gout, and  whether it be
not accompanied by other and more import-
ant changes in the composition of the blood,
nor do we know the disturbances of nutrition
by which  one of the constant  products of
normal nutrition, uric acid, is formed in ex-
cess."  [Xiemcyer.)  We have certain symp-
toms premonitory to an attack of gout.  The
digestive apparatus is disturbed, and we find
that the patient loses his appetite; he will
also suffer from pain and a sense of weight or
fulness in  the region of the stomach, accom-
panied by acid eructations, heartburn, irregu-
larity of the bowels, and flatulence.  Some-
times he  will vomit a phlegmy  material.
The patient now complains of a dull head-
ache, and  feels indisposed for any work, and
becomes irascible.   This last  symptom  is
well known among the laity as a premonition
of gout.  The urine becomes  highly con-
centrated ;  the specific  gravity runs up to
1025-1030; it is of a deep amber or red color,
and deposits  on cooling large quantities of
uric acid  and the urates, which  are com-
monly known as the " brickdust  deposit."
This concentrated urine often causes a burn-
ing and pain as it passes along the urethra,
and has even been known to excite a muco-
purulent discharge.  Dr. Graves speaks of
an unavoidable desire  in  these patients to
grind the teeth, which  is caused by painful
sensations in  the genital organs, and which
seem to be relieved  in no other way.  To
such an extent is  this sometimes practised
that we find gouty individuals with the teeth
worn almost entirely away.  The next symp-
tom noticed is small sharp pains throughout
the whole economy; this precedes the attack
of gout  but a few days.  Now the  attack
begins,  generally  during  the night, by a
burning, piercing pain  in  the great toe,
generally the metatarsophalangeal articula-
tion.  The patients have different modes of
expressing this variety of pain—some sim-
ulating  it to the driving of a nail into the
foot, others to the teeth  of a dog  crushing
the bones  or  to  having the toe squeezed in
a vice.  The patient tumbles and tosses from
one side of the bed to the other, seeking a
position in which he may get some rest; but
this is denied by his visitor, who never lets
go his grip for more than a couple of seconds
at a time.  At the end  of  three or four
hours the pain has become almost intoler-
able, and is so severe that the patient cannot
bear even the weight of the bed-clothes upon
the affected part. Towards morning the pain
diminishes, and  the patient breaks out in a
perspiration and falls asleep.  The following
day the affected joints  are found  to  be red
and swollen, but the pain is a great relief
from that of the previous night;  they con- 
THE  FAMILY  PHYSICIAN.
37
 tinue in this  way until evening, when the
 scene of the  previous night is  re-enacted.
 After a week of this suffering the patient is
 generally temporarily freed from his trouble;
 the redness and swelling gradually subside,
 and the upper layer of the skin peels off and
 itches greatly.   The patient now feels better
 than  he did before  the attack.   After re-
 peated attacks the disease may degenerate
 into chronic gout, in which the  attacks are
 quite frequent;  there is  a purplish appear-
 ance  of the affected joints,  and, owing to
 synovial effusions and deposits of  lithate
 of soda, they are cedematous and deformed.
 Abscesses frequently form in or about the
 joints, and concretions of urate of soda may
 escape from them when opened.
  Nervous gout, also called atonic,  anom-
 alous, or irregular gout, is a name given to
 a variety which occurs in persons of hered-
 itary  gouty tendencies, in whom the  debili-
 tated constitution is not in  a condition to
 develop a normal attack of gout.  It gener-
 ally occurs in nervous and poorly-nourished
 individuals, and appears as dyspepsia, cough,
 etc., accompanied by palpitation of the heart,
 irregular pulse, dizziness, syncope, etc.  It
 is  this variety  which  sometimes  proves
 fatal.
  The only disease with which  gout could
 be confounded is rheumatism, but it differs
 from it in the  following points: " (1) Rheu-
 matism affects chiefly the young or middle-
 aged;  gout, the elderly.  (2) Rheumatism
 prefers the larger joints; gout, the smaller,
 and especially the feet and hands.  (3) Gout
 is attended with more obvious disorder of
 the digestive organs; the pain is of a more
 burning character, and the swelling greater
 and more vividly red."
  The treatment may  be divided into two
 stages—viz. that during the paroxysm, and
 that during the interval between the parox-
 ysms.  Colchicum is the favorite drug used
to cut short the attack.   If the pain is  ex-
cessive it may be relieved by opiates.   The
bowels should be opened.   Salicylic  acid
and  salicylate of soda are beneficial.  In
the treatment  during the interval between
the paroxysms attention should  be paid to
the diet  and  regimen  of the patient; he
should take  his meals  regularly; should
eat  plenty of  vegetables, meat but once a
day, and   should abstain from alcoholic
drinks,  especially ale  and beer, and  take
a certain  amount of exercise in the open
air daily.   The regular use of mild mineral
waters,  which are diuretic  and laxative,
tends to avert the attacks and to lessen or
remove the constitutional taint.  Particular
attention should be taken to keep the bow-
els regular.
  Granular Lids.  See Ophthalmia.
  Grav'el, a disease manifested by the forma-
tion of small concretions either in  the kid-
neys or bladder, and their expulsion with
the urine.  They are generally composed of
some of the salts of urine, and are deposited
either  on  account  of being in abnormal
abundance, or in consequence of the urine
not being  of the  proper  reaction to hold
them  in solution.  When they form  in the
kidneys, they sometimes cause the most ex-
cruciating pain when passing along the ure-
ter to  the  bladder, giving rise to what is
commonly  known as renal colic.   Gravel
may be divided into three varieties, accord-
ing to  its composition—viz. (1) uric acid or
red gravel  (see Lithic-Acid Diathesis)  ;
(2) oxalate of lime (see Oxaluria) ; (3)
phosphatic deposits (see Phosphatic Dia-
thesis) . Other rare varieties are mentioned
in the art. Calculus (which see).
  Graves'  Disease.   See Basedow's  Dis-
ease.
  Green Sick/ness.   See Chlorosis.
  Grippe.  See Ixfluenza.
  Gunshot Wounds, wounds produced by
balls or other projectiles propelled by the
force of an explosive, such as gunpowder,
gun-cotton, or the like.  They differ in some
essential points from other wounds;  they are
generally accompanied by shock, and com-
plicated by the presence of foreign bodies
in the wound, such as the ball or projectile
itself  and  pieces of clothing or  accoutre-
ments  which  the ball has carried with it
and before it. Another element of their
danger  consists in the fact that they gen-
erally occur in large numbers—i. e. in war
—when the accumulation of a large num-
ber of  suppurating  wounds  gives rise to
dangerous  complications, such as  erysipe-
las, pyaemia, and hospital gangrene; add to
that, that in protracted wars the constitution
of the  men has already suffered by  camp-
life, bad diet, and exposure, producing ty-
phus,  dysentery, scurvy, etc.   When, after
the discovery of gunpowder, gunshot wounds
first became known, surgery being then in
its infancy, these wounds were looked upon
as the result of some supernatural and malif-
icent agency, and were therefore often treat-
ed by incantations and the like, or they were
looked upon as poisoned either by the pow-
der or the ball, and were treated with a view
to destroy the poison—for instance, by pour-
ing boiling oil into the wound.   At the pres-
ent day the treatment of gunshot wounds has
become more simple and rational; even the
extraction  of  the ball is no  longer looked
upon as of such absolute necessity as for-
merly.   Still, some erroneous notions have
prevailed till very recently.  Thus, it was
maintained that the wound of exit of the
ball was always larger than that of entrance 
38                         THE FAMILY PHYSICIAN.
Recent investigations have shown that the
above is  not true, and that the wound of
entrance  is  often larger than that of exit.
Another  mistaken idea has prevailed with
regard to what was called the " wind of the
ball."  Recent investigations have proved
that a spent round-shot may roll over a
part of the body when it touches at  an
obtuse angle like a wheel, crushing every-
thing beneath the skin, without breaking or
wounding the skin itself.
  Taking a statistical  view of gunshot
wounds and their fatality on a large  scale,
we  find that on an average the  number of
those killed  outright on the field of battle to
those wounded is about in the proportion of
1 to 5, and that of the wounded about 14 to
15 per cent, will die of their wounds.  Thus,
the  number  of killed in battle in the U. S.
army during the civil war was 59,850.   The
number of  gunshot wounds  from May 1,
1861, to June 30, 1865, was 235,585; of the
latter, 33,653, or 14.2 per cent., died of their
wounds.  The Confederate army lost 57,425
killed in  battle, and had 227,871 wounded.
  Haematemesis [Gr.alfia, "blood," ande^ew,
to " vomit"]. Vomiting of blood, or haemor-
rhage, from the stomach, is the result chiefly
of ulcer of the stomach,  cancer of the stom-
ach, or extreme inflammation or congestion
of the stomach, as when caused by corrosive
irritants,  excess of alcoholic drinks, or the
presence  of  serious  disease  of  the  liver.
Htemorrhage from the stomach is to be dis-
tinguished  chiefly from  bleeding from the
lungs and bronchi. Blood from the stomach
is vomited;  it is preceded or accompanied
by  food,  gastric mucus,  and gastric juice;
it is brought up with  a sense of nausea and
straining; it often is changed by digestive
juice to a dark, coffee-ground appearance;
usually there is a pain  or burning sensa-
tion over the pit of the stomach.  Haemor-
rhage from  the stomach is treated by per-
fect rest  on the back, cold packs over the
stomach,  bits of ice swallowed, preventing
the  swallowing of food  or drink for some
time, feeding by the rectum  or  cautiously
by the mouth.  Opiates  or other anodynes
may be administered by the rectum or hy-
podermically to  check   the  tendency to
vomit.
  Haemoptysis   [Gr.  alua,  "blood,"  and
TTTvaig, "spitting"], the  expectoration of
blood from  the vessels  of  the   lungs  or
from the  mucous membrane of the thoracic
air-passages.  Haemoptysis occurs in pul-
monary consumption, in heart disease, etc.
It is sometimes vicarious in cases of sup-
pressed menses.  The  significance of  haem-
optysis in any  case can only be estimated
by the trained diagnostician.  The remedies
usually administered for  haemoptysis are di-
lute sulphuric acid, ergot, gallic acid, lead-
acetate, opium,  turpentine, common salt,
and other  haemostatics.   Perfect quiet of
mind and body is to be sought.  Ice to the
chest and the swallowing of lumps  of ice
are often effective.
  HaenForrhage.  See Bleeding.
  HaenForrhage from the Lungs.  See Haem-
optysis.
  HaenForrhage  from  the Stomach.   See
HvEMATEMESIS.
  HaenForrhoids.  See Piles.
  Hair, Diseases  of.   See Baldness and
Barber's Itch.
  Hay  Asthma, Hay Fe'ver, or AutunFnal
Catarrh', a disease recurring in certain in-
dividuals at certain seasons every year, as
in June (rose cold), in the hay-making sea-
son (hay fever), or  (in this country  espe-
cially)  in the autumn, whence the  name
autumnal catarrh.   It is a catarrhal  affec-
tion  of the nasal (and  sometimes of the
bronchial)  passages, often with some fever
and more or less asthmatic spasm.  Some-
times incessant sneezing and coryza  are the
only prominent  symptoms.  It is  not ob-
served  in very hot or very cold countries, on
the sea, or at considerable heights  in  some
mountain-regions.  It is very probably caused
by pollen from some plants, but it is by no
means  certain of  what  species they are.
Removal from districts where  the disease
prevails is  the only means of cure, but the
usual  palliatives  may  be employed.  The
insufflation of quinine, either in powder or
a saturated solution, at the  inception of the
disease, is claimed  to cut short  the  specific
catarrh while yet limited to the  nostrils and
fauces.
  HeacFache (Cephalalgia) is of many kinds.
It is often the result of indigestion, of ex-
cess in eating or drinking,  of  malarial or
other  specific poison, of uterine disease, or
of neuralgia.  It is also a common symptom
of many fevers and other acute diseases.  If
persistent headache  be not relieved by a
correction of the hygienic conditions as re-
gards  diet, clothing,  exercise, etc., the case
requires medical treatment, the character of
which must depend upon the probable  cause
of the  difficulty.  Opiates, chloral,  paul-
linia,  citrate of caffeine  will  deaden the
pain; aconite, chloroform, and chloral cam-
phor may be applied externally; aromatic
spirits  of ammonia, bicarbonate of  soda,
and laxatives  are  efficient when  stomach
disorder is the cause.
  Hearing, Defects7 of.   See  Deafness
and Ear, Diseases of.
  HearFburn.  See Cardialgia.
  Heart  Diseases.   Hypertrophy  or en-
largement  of  the  heart is generally due
to some obstacle  to the  circulation,  re- 
THE FAMILY PHYSICIAN.                         39
 quiring increased strength of muscle to over-
 come  it,  as a diseased valve,  or  a  tumor
 pressing upon a large artery, or a large or-
 gan so diseased that the circulation through
 it is seriously obstructed.  It is produced by
 the mental emotions, which increase  the
 force and  frequency  of heart-beats, as fre-
 quent anger and the anxieties  that  excite
 the heart.   Its subjective manifestations are
 a  strong  impulse  of the heart-beats and
 shortness of breath on exertion.  The phy-
 sician discovers it by many signs, the  chief
 of which is the extension of dulness on per-
 cussion to the left of  the line of the healthy
 heart.  The heart,  once enlarged, never re-
 turns again to its original size, and alone it
 rarely causes death.  This usually is the re-
 sult of secondary disorders, apoplexy or kid-
 ney disease, or it may wait for the  intercur-
 rence of other entirely distinct diseases.
   Dilatation of  the  heart is an enlargement
 of its  cavities.  The left ventricle may be
 so dilated  that  its  capacity is considerably
 greater than  would be sufficient to contain
 the whole of a healthy heart.   The dilata-
 tion may be in all of the four cavities, or
 may be confined to one.  The ventricles are
 far more liable to  dilatation than the aur-
 icles, and the left much more than the right.
 Dilatation and hypertrophy very commonly
 go together, so  that  eccentric hypertrophy
 or  hypertrophy with  dilatation, already ex-
 plained, associated with and caused by mor-
 bid changes in the shape and function of the
 valves, is the most common form  of  heart
 disease.  The conditions of  the  heart  may
 be regarded as alternately active and passive
 —active in systole, passive in diastole.   If in
 the passive state, while the blood is flowing
 naturally into a heart-cavity, there is at the
 same time a  reflux of blood into the same
 cavity in consequence of a defective  valve,
 dilatation of that cavity will be sure to occur.
 The extended wall of such a cavity may not
 be thicker  than it is  in health, yet as it
 bounds a greater space it will require more
 material, and is hypertrophied by multipli-
 cation of the muscular fibres.  In this state
 the heart has been known to weigh  sixty
 ounces, or  six  times  its natural _ weight.
 Hearts like these are  enormitas cordis, or cor
 bovinum vel taurinum.  They are almost al-
 ways found in persons who have had rheu-
 matism and heart disease in childhood, and
 have grown to  manhood with  a damaged
 heart.   It  is noticeable that  children bear
 these cardiac affections better than adults.
The body, as it  grows, seems to accept and
tolerate an amount  of such disease  that
 would overwhelm a grown-up person. When
it  begins thus early,  it is usually carried to
manhood, and often to advanced manhood.
It  is the repetition of the attack which is
fatal in childhood.  Dilatation with hyper-
trophy is, after it reaches a certain stage of
progress, attended by shortness of breath on
exertion,  sometimes palpitations, irregular
heart-beating,  and consequently irregular
pulse.   Its  chief danger  is, however,  an
induced or secondary Bright's disease, with
dropsical  swellings of the legs and body;
without which the common  forms of heart
disease  are not generally fatal.  There is a
form  of dilatation of the heart in which
there is  not  only no  hypertrophy,  but in
which the walls  of one  or all the  cavities
gradually grow thinner and thinner  by fatty
degeneration and absorption  of the muscu-
lar tissue, till  this tissue is  almost  wholly
removed,  and the walls  are  stretched  and
expanded in the effort to expel the blood
from their cavities.  But this is a rare dis-
ease, and  may be passed with the statement
that it is possible.
  Simple  atrophy of the  heart, (diminished
size and weight)  occurs only with  wasting
diseases;  it should not  be  regarded  as a
disease.
  Diseases of the  Valves of the Heart.—En-
docarditis, or  inflammation  of  the lining
membrane of the cavities of the heart, is
a common attendant  on acute rheumatic
inflammation of the joints, but it may occur
without rheumatism.   This inflammation is
one of the principal causes of derangement
and imperfection  in these essential append-
ages of the  heart.  Thus, endocarditis ex-
pends its force principally on those duplica-
tions of the endocardium which  constitute
the valves.  It deposits a new material be-
tween their folds, and at first  increases their
thickness.  A portion  of this new material
is converted into fibrous structure, and final-
ly the fibres contract.  The  result  is, that
these valves become thick and unyielding,
so that the semilunar  cannot be applied to
the arterial wall  when the blood is forced
into the aorta  or pulmonary artery.  The
mitral and tricuspid  grow stiff and hard,
and  do not fully give place to the blood
passing from the  auricle  into the ventricle.
Again, this new fibrous structure contracts
and shortens the valves,  so that their parts
cannot meet  properly  and prevent the  re-
flux of the blood.  So blood from the ven-
tricles sent into the great arteries will flow
back again into the heart, to be forced out
again by  new  contraction.   This is insuf-
ficiency, or regurgitative  disease of  a valve;
The stiff, unyielding state, when it obstructs
the current, is called obstructive disease of the
valve (stenosis).   The valves  are  thickened
also by the deposit between their folds of a
yellowish  substance, made up  partly of small
microscopic cells, and partly  of fat-globules,
called atheroma, one of the products, it is be- 
40                         THE FAMILY PHYSICIAN.
lieved, of a slow or chronic inflammatory
action.  In time this atheromatous deposit
is apt to be converted into, or rather is re-
placed by, a hard  calcareous material,  or
even organized bone-structure. In the same
way the least organizable portion of the de-
posit of  acute  inflammation (endocarditis)
may slowly be  replaced by the same mate-
rial. This is the ossification of the valves.  It
is not  a very  frequent occurrence, and is
limited usually to a small portion of a valve.
But it does mischief, partly as an obstacle to
the blood-current,  but more by irritating
these movable folds and keeping up chronic
inflammation in them, and causing thicken-
ing, inflexibility, and shortening (just de-
scribed), or increasing them if they have
already occurred.
  Rupture  of  the valves is  possible.   The
aortic  valve may yield in  the  bottom of
one of its cups;  or the  marginal thread
may separate  from the deeper part of the
cup; or the upper attachments of the  cups
to tbe aorta may give way;  or the anterior
leaf of the mitral valve may be  perforated;
or one or more of  its tendinous  cords may
be broken.  These  accidents usually occur
after the ruptured part has been weakened
by the deposit in it of  a plate of atheroma;
yet they may yield without previous disease,
but then always at  the time of  great exer-
tion of muscular strength in lifting weights,
running, jumping  the rope,  or the  like.
The reader  may  remember to have seen a
few years ago  a newspaper  statement that a
girl about twelve years old had been serious-
ly injured by jumping the  rope  nearly 200
times without stopping.  It was  ascertained
in that case that there was rupture at the
mitral  valve, probably of some of its tendin-
ous cords.
   Vegetations on the Valves.—This is another
of the results  of inflammation.   They are
minute hard warts  that are formed on the
free surface of the  aortic valve just below
its  thickened  margin.  These  are chiefly
important  as   being  the  occasion of  the
deposit of masses of the fibrin of the blood
upon the valves, so  producing large granu-
lar-looking warts,  which obstruct the out-
flow from the  ventricle. . Any roughening
of a valve-surface by inflammatory or other
disease, or by  rupture, may cause the de-
posit of these fibrinous concretions.   When
they occur they not only obstruct the flow
of  the  blood,  and  partially disable  the
valves, but portions of them may be wash-
ed off into the  arterial current, and be car-
ried into a distant organ, as  the  brain,
spleen, or kidney; and one  of these reach-
ing an  artery too small to receive it, it stops
there, and cuts off  the arterial  blood from
all portions of the  organ usually supplied
by  the  obstructed vessel.   This  mode  of
plugging up the arteries is called embolism ;
the plug itself is an embolus.
  In the advanced stages of these diseases
of the valves and muscular structure it is
not difficult  to  arrive at the opinion that
there is heart disease.  Shortness of breath,
induced by exercise, the strong heart-beat-
ing, beating of the vessels in the neck, and,
when  the  kidneys  become diseased,  the
dropsies, the distress produced  by  lying
down, tell  the truth but too certainly.  But
they do not  designate the particular form
or  forms  of disease.   This  can  only  be
learned by  listening to the sounds produced
by  the  action of the heart, and by actual
measurement by percussion.  Thus, in ad-
dition to the two natural sounds remaining,
from one to four new ones may be produced,
called  murmurs.   If there is  a  murmur
heard most distinctly under the breast-bone,
where  the  third ribs are joined to it, and
while the  ventricle is contracting (in sys-
tole), it is probable that there is obstructive
valvular disease, either in the aorta or pul-
monary artery, and the chances are thirty
to one that it is in the  former, for in this
proportion  at least is valvular disease found
more frequently on  the left than on  the
right side.   Indeed,  the grave valvular dis-
eases of the right heart are almost always
found to have occurred before birth.  The
aortic-valve murmurs are heard distinctly
at the junction of the third costal cartilage
of the  left  side  with  the breast-bone, as is
also the pulmonary murmur, which is rare.
If there is a murmur with and  after  the
second,  heard most distinctly at  the same
place, it indicates  insufficiency—that is,  re-
gurgitation, as already  explained. It will
be remembered that the two hearts contract
simultaneously,  and  that the  two second
sounds are  simultaneous.  If, then, the sec-
ond sound on one side is silenced by deform-
ity  of the valve, the valve on the other side
is, in all probability, normal, and produces
its  own normal  second sound   strongly
enough to be heard.   A  murmur heard
most distinctly  in the left and lower  part
of the heart-region  (towards the apex) is
referred to a diseased mitral valve.  If it
is in systole, the valve is insufficient, and
there is regurgitation from the  left  ven-
tricle into  the  left  auricle.   If  it  is  in
" the period of repose "—that is, the period
between the  second  natural sound of  the
heart and  the recurring first — it will  in-
dicate  an  obstruction,  from  stiffness  or
other diseased change in the valve, to the
flow from  auricle  to  ventricle,  for it is in
this period that the auricle is  emptying
itself into  the ventricle.   There is nothing
in the tone or other characters of these mur- 
THE  FAMILY  PHYSICIAN.                         41
 murs which indicates the character of the
 valve-change, except  that a musical mur-
 mur is sometimes  produced by  the string
 left when  the thicker border of an aortic
 cup is split off from the membrane below
 it,  or a similar cord may be formed by rup-
 ture of  the mitral valve.  This must be
 learned, if it can be learned at all, from the
 general history and symptoms of each par-
 ticular  case.
  With two exceptions, these murmurs are
 positive indications of change in the form,
 thickness,  dimensions, or  structure of these
 halves.   There may be an anaemic  murmur
 with the ventricular contraction at the aortic
 opening when the blood is thin, or does not
 contain  its normal quantity of animalized
 elements—or, in other words, when it con-
 tains too much water (hydroozmia and chlo-
 rosis)—and there may be actual regurgita-
 tion, and the corresponding murmur at  the
 mitral valve, caused by the irregular or im-
 f>erfect contraction  of fleshy columns of the
 eft ventricle.  The same rules are applicable
 to valvular diseases of the right heart, except
 that the murmurs of the tricuspid valve are
 heard at the junction of the sternum  and
 fourth right rib, and those of the pulmonary
 artery at the junction of the left third rib
 with the same bone.
  These are the common forms of heart  dis-
 ease; and  there  will be  in this article no
 better  place than here to say that the pop-
 ular opinion of their  fatality is  erroneous.
 Few persons can hear the announcement that
 they have disease of the heart, of whatever
 kind, without hearing in it  the  command,
 "Set thine house in order, for thou shaft
 surely die," and the general expectation is
 that the death will be sudden.  It is true
 that there are sudden deaths from heart  dis-
 ease even in persons who  have not been ill
 enough to consult a physician.  But these
 sudden deaths are exceptions. For one such,
 a quarter of a hundred live on  until death
 comes  through some  disease which  could
 not have been looked for, or  the kidneys
 become involved in secondary Bright's  dis-
 ease, and perhaps become the chief actor
 in the concluding  scene.   The writer  dis-
 covered in  a young lady thirty-four years
 ago mitral  regurgitation and decided hyper-
 trophy of the heart.  Now she is the mother
 of seven children, and, as  far as her friends
 can judge, is in perfect health, except that
 she has shortness of breath  at times.   He
 examined a gentleman sixty-five years  of
 age who  had obstructive aortic disease and
 hypertrophy, in whom he traced the origin
 of the  affection back to an attack of rheu-
 matism  when the patient was fifteen years
 old; yet this gentleman had had the energy
to amass for himself a fortune of a million
of dollars, and to build up the fortunes of
two brothers;  and that too in the good old
times of honest industry.  He knows physi-
cians who carry considerable heart disease
for indefinite years through an active  prac-
tice.  He knew one, an old gentlemen, who
had the disease nearly all  his life, and con-
tinued his  professional work till within a
few days of his death.  His  heart weighed
after  death  two pounds three  ounces and
two  drams.   The  former  possessor of the
heart which weighed 57 ounces, referred to
in this article, became diseased  when  he
was six years old, and he died at twenty-
eight,  having  been active as foreman in a
large cotton-mill till  four weeks before his
death;  and even then death  was caused
more  by the  kidneys than  by the heart.
These  are not rare instances, but represent
the important  fact that these diseases, even
when extreme, do not generally cause death
without aid from another important organ ;
and when moderate in degree, if the avoid-
able causes  of their increase are  avoided,
have, till the age of sixty and upward, but
little  influence in shortening life,  except,
again, with  the concurrence of other and
dangerous diseases.
  Pericarditis.—As the lining membrane of
the cavities is subject to inflammation, so is
the external covering.  This and the lining
of the fibrous  pericardium are alike liable.
They are indeed but one membrane.   Peri-
carditis and  endocarditis often occur at the
same time, being both  produced by an ex-
tension or migration of articular rheumatism,
or rather by that same state of the system
which causes the articular disease.  Either
of these diseases  may  accompany Bright's
disease.  Beyond the concurrence with these
affections the causes of pericarditis are not
well defined.   The disease itself, as well as
endocarditis, has only been intelligently ob-
served during  the  present  century.  The
changes produced  by pericarditis are, first,
an increase in the quantity of blood in the
vessels of the membrane; second, absorption
of the fluid which in health diminishes the
friction between the heart and pericardium;
third, the discharge from the engorged blood-
vessels  of the  fluid portion of the blood
(liquor sanguinis) in condition to form new
tissue, false membrane, or of the more watery
parts, known as serum.  Both of these prod-
ucts  of this  inflammation  are commonly
found, but the serum is usually much the
most  abundant  and the  most oppressive.
When there is little serous fluid the disease
may run its course with but little  general
disturbance; but when the quantity is large
there is a rapid pulse, oppressed breathing,
and  a tendency  to  faint when sitting or
standing.  The pericardium is distended by 
42                         THE FAMILY  PHYSICIAN.
its watery contents, sometimes even to ten-
sion ;  then  the normal  dilatation of the
heart-cavities  becomes difficult.  But this
fluid is absorbed usually in about a week,
and the pericardium comes back to its con-
tact with the heart.  The common opinion
regarding the fibrinous coating produced by
inflammation is that it receives blood-vessels,
and remains for a time the  medium of the
union which almost always  takes place be-
tween the pericardium and the heart, after
pericarditis; but according to  some late
German teachings it readily breaks up into
granular and  fatty matter,  and is carried
away by absorption; and they account for
the adhesion by stating that the serous mem-
brane is roughened during the inflammatory
process by the production on its surface of
many little  granules or warts  composed of
fibrin,  and  that these  mutually grow into
the opposite surface, and so cause a blend-
ing. There is produced by the dry condition
of the membrane, caused by  the first en-
gorgement of the vessels, a distinct creaking
or rubbing noise as the heart  moves in the
pericardium—a "to-and-fro" sound, in time
with the pulse.  This sound is renewed when
the fibrinous exudation takes  place, heard
first in systole, and soon  after  in both con-
traction and expansion of the  heart.   This
may be interrupted when the serous effusion
lifts the pericardium off  from  the heart, to
be  renewed  again when the serum  is ab-
sorbed and  contact is renewed.  The  adhe-
sion above spoken of takes place soon after
the renewal of contact, so that in this re-
currence the friction-sound does not com-
monly continue for more than a day. When
the area of dulness on  percussion is rapidly
extended to the left of the heart and above
the third rib, and this extension follows the
friction-sound, it is produced by the serous
effusion.   The heart-sounds under these cir-
cumstances  become a little  less distinct as
the heart is buried in water.   This is the
condition indicated by the  phrase "water
on  the heart," popularly supposed to  be a
common malady, but it is not found to exist
in one in twenty of the cases in which it is
suspected.   Pus is not often  found in the
pericardium after inflammation.   In chronic
pericarditis,  implying chronic distension of
the heart-sac, the fluid causing the disten-
sion is partly pus (sero-purulent).  Chronic
pericarditis  is  a grave  disease; it is almost
always fatal.  In it the pericardium, in one
case treated  by the writer, was found to con-
tain a gallon of sero-purulent fluid.  Acute
pericarditis is rarely fatal in the first attack.
But in young  persons  subject to recurring
rheumatism each return  is more and more
dangerous;  even the  third is  not unfre-
quently fatal.
  Pneumo-pericardium (air or gaseous matter
in the pericardium).—A man amid the hor-
rors  of  delirium  tremens had a plate on
which two teeth were set detached from his
mouth, and  he tried  to  swallow it, but it
was stopped in the oesophagus (gullet) at a
point just behind the heart.  A projecting
angle of the plate pierced the walls of the
oesophagus  and pericardium, and opened a
passage by which the food and drink pass-
ed directly into the latter. Air also entered
the pericardial sac.  With each contraction
of the  heart there was a splashing noise,
such as is produced by the  agitation  of a
bottle containing air  and water.  Cancerous
disease sometimes  produces a similar open-
ing.  Gaseous matter of some sort—perhaps
carbonic acid gas—is in rare instances lib-
erated in this sac, and, so far as is known to
the writer, there is always fluid in the cavity
at the  same time.  The splashing in  con-
traction  of the heart is  heard even a few
inches  from the body.  The signs of this
kind of pneumo-pericardium pass away as
the signs of the pericarditis which it accom-
panies  disappear.  The perforation  of the
pericardium with admission of air is almost
always fatal, while the elimination of gas
in the cavity is not generally attended with
serious consequences.
  Carditis, or myocarditis, is an inflammation
of the muscular structure of the heart.  It is
an occasional attendant of endocarditis or pe-
ricarditis, or may occur independently.  The
symptoms are vague  and uncertain, so that
it is difficult, and often impossible, to recog-
nize it during life.  It is, then, chiefly known
by certain conditions found after death.  In
limited portions of the left ventricle, or in
the  septum of the ventricles, the muscular
fibres are broken up into fatty matter and
fine  granules, forming  what is commonly
called an abscess;  indeed, real abscesses are
seen when the cause of the carditis is septi-
caemia (poisoning of the blood by decompos-
ing  animal matter),  as in gangrene of the
lungs.   But what is more frequently met
with is a cicatrix, one or more, showing that
while the muscular element is broken down,
its fibrous  covering  (perimysium)  has in-
creased  in quantity,  and forms a depressed
cicatrix, the pyoid matter having been ab-
sorbed and carried away.  These cicatrices
do not  always restore the strength of the
structure they replace.  Hence, they some-
times yield  gradually, producing aneurism
of the heart.  Such is the current  view of
myocarditis, but the writer gravely  doubts
whether  this kind of fatty degeneration of
the  cardiac  muscle is the result of full in-
flammatory action.
  The muscular fibres of the heart sometimes
undergo a fatty degeneration, in which, with- 
THE  FAMILY  PHYSICIAN.                          43
  out change of size or change  in the valves,
  little globules of oil have replaced the mus-
  cular substance.  This degeneration weakens
  the heart, and causes it to act irregularly,
  changes its color from dark  red to yellow'
  and materially diminishes its firmness.  The
  disease is named, after the English surgeon
  who first described  it,  Quain's degeneration,
  or, better, Quain's disease.  The same gentle-
  man has recently announced that there is an
  hypertrophy of the heart, which is caused
  by an increase of the fibrous structures of the
  organ, while the muscular elements remain
  unchanged.  The admission of the existence
  of such a disease awaits further investigation.
  Should the observation be verified, we shall
  have  to admit  into medical  nomenclature
  Quoin's hypertrophy.
    Fatty heart has long  had  a significance
  very different from that of " Quain's disease."
  There is always on the outer  surface of the
  heart a limited  amount of what is  called
  adipose tissue, or, in common language, "fat."
  This  tissue is  composed of layers  of cells
  almost  large enough to be seen by the un-
  assisted eye, each having one or more capil-
  lary blood-vessels passing  over and nearly
  around  it.  These cells contain oil, the quan-
  tity of which is large when a person is said
  to be "fat,"  or they are empty and small
  when he is pronounced to be " lean." This tis-
  sue is  found under the skin in many parts of
 the body, but not in all, and in considerable
 quantity in the abdominal cavity.  The por-
 tion of it that naturally belongs to the heart
 is small, and lies outside the muscular struc-
 ture, and within its external serous invest-
 ment (serous pericardium).  The quantity of
 this is sometimes dangerously increased.  It
 increases always at the expense of the muscle
 of the organ, so that the muscular wall be-
 comes thin at  certain places; and as  the
 adipose  tissue has not the strength of mus-
 cular, which it has displaced, the heart-wall
 is weakened where it is most increased.  The
 undiminished strength of the other portions
 of the wall of the same cavity will sometimes
 cause this weaker part to give way.
  Rupture of the heart occurs in the manner
 just described.  It may occur also when the
 wall of either ventricle is weakened in one
 part only or principally.  This may be the
 effect of a local development of Quain's dis-
 ease ; of an ulcer caused by the deposit of
 atheromatous  matter on the outer surface,
 and its subsequent softening; of abscess and
 pseudo-abscess resulting from  myocarditis,
 as above described; or from aneurism of the
heart, in which an external tumor is formed
by the internal pressure of the blood and the
gradual yielding of a limited portion of the
wall.  Tli ere is  then  really a broken heart.
When this rupture occurs, the  blood  pours
 through it, and soon fills the pericardial sac,
 and the heart-dilations are prevented. Such
 a sudden death is preceded by few symptoms,
 and sometimes by none.  This occurrence is,
 however, rare. When it results from adipose
 degeneration, it  is commonly found in the
 right ventricle;  when from other causes of
 local weakness, it is usually found in the left.
    Heart- Clot.—-In rare  instances the blood
 coagulates in the heart  before death.  This
 coagulation may be  the cause of death, or
 the subject of it may survive for years.  It
 may occur in the left ventricle, where it may
 be an inch or more in diameter, but being
 attached to the  raised cross-muscles of this
 cavity,  it  does not obstruct the  passage of
 the blood into the aorta.  The fibrin which
 constitutes this  mass is  arranged in layers,
 and in  most of the few instances that have
 been seen the central  portion had  already
 broken  down into a yellowish fluid, which
 has  been  erroneously'taken for pus.  Clots
 and fibrinous aggregations, formed  in  the
 heart-cavities during life, may be the cause
 of death, either suddenly.or remotely.  The
 clots found  after death usually  fill one  or
 more of the cavities, and are attached to the
 cavity-wall in all its circuit, or they are di-
 vided into two parts—one yellow or  yellow-
 ish-white, glistening, and not wholly opaque;
 the other very dark, almost black.  In hun-
 dreds of instances such coagulations as these
 have been regarded  as  ante-mortem  clots,
 and the immediate cause of death.  If a clot
 is  formed before death, the heart must con-
 tract upon it at  least once.  One such con-
 traction is sure to separate it from its adhe-
 sion  through a considerable portion of its
 circumference. The production of the light-
 yellow clot is only possible when the blood
 has been at rest long enough to allow its red
 corpuscles to sink in the fluid as far  as this
 buffy portion extends; and the reason for its
 forming so considerable a portion  of the
 whole coagulum  is that  the blood does not
 usually coagulate in the  body till about six
 hours after death.
  Embolism and Thrombosis of the Coronary
 Arteries  of  the Heart.—The first of these
 terms refers to the fact that clot or fibrinous
 concretion may form in the heart, as already
 explained, and that a part or the whole of
 it may be detached and carried forward till
 it reaches  an arterial division  too small to
 receive it;  it cannot go back, but must re-
 main there, preventing  the  circulation  of
 arterial blood in the artery beyond it, till it
 is disintegrated and carried away.  It is pos-
 sible  that a portion of a fibrinous concre-
 tion on the valves or wall of the left ven-
tricle,  so detached, may  enter one  of the
coronary arteries, and so  obstruct  it.   But a
section of the aortic valve covers the  mouth 
44                          THE FAMILY  PHYSICIAN.
 of each of these vessels during the contrac-
 tion of the ventricle, and they receive their
 blood in  the reflux, after the closure of the
 valve; and the force that propels it is the
 elasticity of the aorta.  This protected con-
 dition must  render such an accident very
 rare.  What we are  more familiar  with  is
 thrombosis, or the coagulation of blood in
 the artery.  This cuts off half of the supply
 of blood to the heart;  a pretty rapidly in-
 creasing feebleness of the heart-action fol-
 lows, with a  weak  and  slow  pulse, great
 prostration of strength,  extreme paleness
 of  countenance,  coldness  of the feet and
 hands, and  after  these  symptoms death
 occurs in ten to twenty hours in the ma-
 jority of the cases.
  Angina pectoris  (breast-pang).   See  An-
 gina Pectoris.
  Deformities and  Defects.—The growth  of
 the heart may be arrested in any of the stages
 of foetal  life.  The most  common of these
 defects is  an  open foramen  ovale, permit-
 ting venous blood from the right auricle to
 mingle with the arterial in the left.  This is
 produced when the current through the pul-
 monary artery is obstructed.   This state of
 the heart  is  known  as morbus cozruleus, or
 blue disease.  The name, however, applies
 equally to other congenital defects that per-
 mit venous blood to pass into the left heart
 or into the aorta to circulate in the arteries,
 producing blueness of the skin.  This color
 is not constant, except in a few, but  is  pro-
 duced by crying, a fit of coughing,  excite-
 ment, or unusual  physical exertion.  It is
 not incompatible with a life of limited dura-
 tion, but is likely to be attended  by  dimin-
 ished growth  of body,  bodily  and mental
 sluggishness, shortness  of breath, palpita-
 tion at times, and occasional fainting.   If
 the subject of any of these defects survive
 the first years of life, the defect  alone will
 not probably  be the immediate cause  of
 death, but it  will  diminish  the power  of
 resisting  a fever, a pneumonia, or any grave
 disease, and especially one that disturbs the
 balance of the two circulations.
  Less than  ^ (4 per cent.) of all  deaths
 are caused by all  these  agencies put to-
gether;  a very  large  proportion of  the
deaths so occurring are in persons of ad-
 vanced age; even  when  disease fastens on
the heart,  it does not, as a  rule, preclude
the hope and  expectation of "length of
 days;" and counting, from  youth to  age,
 not one in a hundred  persons has any kind
of disease or defect of the heart.   (See also
articles a^x.emia, PaVLPITATion.)
  Hec/tic  Fever  [Gr.  inrudg,  from  kljig,
 "habit"], a fever which is so continued as
to constitute a habit (s^ig)  of the body.
Such  fevers are probably always  symptom-
 atic of some local or  extended irritation.
 Thus, hectic  attends pulmonary consump-
 tion, chronic pleurisy with extensive exuda-
 tions,  peripheral caries of the bones, etc.
 Hectic, as it occurs in pulmonary consump-
 tion, is sometimes intermittent, with even-
 ing  exacerbations; sometimes almost con-
 stant.   The latter kind generally affords a
 bad augury, and  it cannot  in general  be
 much relieved by treatment;  but  intermit-
 tent hectic  may often be  palliated, greatly
 to the patient's relief.   Remedies are there-
 fore directed against the primary disease.
   Hemiplegia [from the  Gr.  y/ui-,  "half,"
 and nAriyr], a "stroke"], that  kind of paral-
 ysis which affects only one side of the body;
 or if both sides are affected, it is  from the
 occurrence,  a very  rare  one, of  double
 hemiplegia—that is, of two concurrent par-
 alytic  strokes, one affecting each side.  It
 manifests itself usually in the upper and
 lower  extremities of one side, and in the
 parts of the head which are supplied by the
 fifth nerve.   It may be  the result  of  an
 apoplectic stroke, or of a  slow effusion, or
 of the growth of a tumor within the brain.
 Owing  to the decussation of the pyramids,
 the paralysis takes place usually on the side
 of the body opposite to the side of the brain
 in which the lesion has occurred.   For ex-
 ample, if  there be a tumor growing in the
 left  hemisphere of the  brain, the  paralysis
 will, as a rule, be manifested in the right
 side of the  body, because the nerve-fibres
 cross over from side  to side  near the base
 of the brain.  But if the lesion occur below
 this  crossing, there may be hemiplegia  on
 the same  side.  Hemiplegia  affects  chiefly
 the nerves of motion,  but affects more  or
 less  those of sensation also.  Temporary
 attacks of hemiplegia are  also observed in
 chorea, epilepsy, and hysteria.  The treat-
 ment of hemiplegia varies  with the condi-
 tion of the  patient and the  cause  of  the
 stroke.  Generally, time and rest are im-
 portant to the relief of the patient.
  HepatFtis  [Gr.  yirap,  the  "liver"],  an
 inflammation of the liver.  Hepatitis is not
 a  very common  disease  in   any  country.
 Several kinds are recognized: (1) Suppura-
 tive hepatitis, or abscess of the liver, some-
 times occurring in India, but rare in other
 countries.  (2) Interstitial  hepatitis, called,
 rather  incorrectly, cirrhosis, known  also as
 granular  liver and gin-drinker's liver.  It
is  incurable, and is probably always caused
by the improper use of alcoholic drinks.  It
 frequently leads  to ascites  or abdominal
dropsy.  (3) Portal phlebitis, or inflamma-
tion of the  portal vein, may occur.  (4)
Inflammatory  disease  of the  liver is some-
times a syphilitic complication.   Each of
the above-named conditions is a grave one, 
THE  FAMILY  PHYSICIAN.
4")
and in few cases can treatment be of much
avail.
   Her/nia [Lat.], the protrusion of a viscus
from  the cavity  to  which it normally be-
longs ;  but  the term is generally used to
express the protrusion of an abdominal vis-
cus, as  when  we speak  of other forms of
hernia  we express it thus: hernia cerebri,
hernia corneae, etc.   The predisposing cause
of hernia is a weakness of some portion of
the abdominal walls, and there are certain
parts which  are naturally  weaker  than
others,  as the  inguinal, umbilical, and fem-
oral  regions.   This weakness  very often
exists congenitally, and may be increased or
produced by injury, disease,  or pregnancy.
Among  the  exciting causes  may be men-
tioned violent muscular exertion, jumping,
straining from lifting heavy weights or at
stool, playing on  wind  instruments,  etc.
The usual contents of a hernial sac is a por-
tion of  the small intestine or the omentum,
but we  may find portions of any of the vis-
cera  in  it, especially when the abdominal
walls are congenitally  weak.   The  sac is
formed  of peritoneum, which  is covered by
the integument and  subjacent fasciae.
   Hernia is generally divided in two ways :
lst,according to its situation, as inguinal, fem-
oral, umbilical, diaphragmatic;  2d, accord-
ing to the condition of the protruded viscus,
as reducible, irreducible, and strangulated.
Reducible hernia is that variety in which
the contents of the sac may be returned into
its normal cavity without recourse to a sur-
gical  operation.   It sometimes disappears
spontaneously when the patient seeks the
recumbent position,  but more  often needs a
greater  or less  amount of pressure  to be
made in  the  proper direction.  The reduc-
tion is facilitated by raising the foot of the
bed in  which the  patient reclines,  and by
the inhalation of ether or chloroform.  The
symptoms of  it  are—the  appearance of a
soft and compressible swelling at some por-
tion of  the abdominal wall, which increases
when the patient stands up and diminishes
when he lies  down; by placing the hand
upon  the tumor and directing the patient
to cough a distinct impulse is imparted.
The treatment usually  adopted consists of
the reduction of the contents, and the appli-
cation of a suitable truss to prevent the re-
protrusion.  If the  patient is young, this
method will effect  a radical  cure in time,
but in the adult recourse must be had to an
operation to effect this.
  Irreducible  hernia differs from reducible
in that  the  protruded viscus cannot be re-
turned into its normal cavity.   The general
causes of it  are adhesions between the sac
and its contents, the growth of membranous
bands across the sac, or enlargement of the
contents. It is much more troublesome than
the preceding variety; in the first place, it
is  much more inconvenient, and  is always
exposed to the danger of strangulation ; the
patient suffers from indigestion, constipation,
colic, flatulence, and dragging pains in the
loins.  The treatment of this variety must
be generally  palliative, and consists of the
patient's avoidance of all violent exercise;
regulation  of  the  bowels, which should
never be allowed to become confined; and
the wearing of a truss  to support and pro-
tect the tumor.
  " Hernia is said to be strangulated when
it is constricted in such a way that the con-
tents of the protruded bowel cannot be pro-
pelled onward, and the return of its venous
blood is impeded."  There is always more
or less  inflammation,  caused by the con-
striction.  The  causes of this condition are
sudden  enlargement of the contents of the
sac by faeces or gas, or congestion or swell-
ing of  the neck of the sac.  The symptoms
are—pain, flatulence, a desire to go to stool,
constipation,  nausea,  and  vomiting,  the
vomited matter after a time becoming ster-
coraceous.  The tumor is hard, and cannot
be replaced in  the abdominal cavity, and
there is very little  impulse transmitted  to
the hand when the patient  coughs. The
pain in  the tumor  continues  to  increase,
and  extends  over  the whole of the abdo-
men ; the countenance assumes an anxious
expression ; the pulse becomes  small and
wiry, and the skin cold and clammy.  Should
the pain cease, and the  tumor feel doughy
and crepitate when handled, we may be sure
that the intestine has mortified ; when this
happens there  is very little hope for the
patient; in fact, the only chance for recov-
ery now is by an artificial anus.   The object
of treatment  is to return the intestine into
its  cavity.  When  this cannot be accom-
plished  by manipulation, or manipulation
combined with  warm baths and the admin-
istration of ether—the patient having first
been placed in such a position that all the
parts in the  neighborhood of the trouble
shall be completely relaxed—recourse must
immediately be had to an operation.  This
consists  in enlarging the  constricted por-
tion, so  as to allow of the return of the gut.
It  is done by cutting down to the sac, and
either opening it and dividing the stricture,
or dividing the  stricture without opening
the sac, or  by merely incising the neck  of
the sac.
  Her'pes [from the Gr. kpnu, to "creep"],
a name applied  to several skin diseases, cha-
racterized by  the development of a series  of
vesicles  or clusters of vesicles, which general-
ly run a definite, self-limited course.  By far
the most important of these diseases is Her- 
46                          THE FAMILY PHYSICIAN.
pes zoster, zona, or " shingles," as it is called.
This may surround one  thigh  or one arm
with a band of vesicles, or  more frequently
it  starts  from the backbone and follows an
intercostal space half round the body.  More
rarely it goes half round the neck or half
across the face. There is usually some neur-
algic pain, and sometimes  considerable fe-
ver.  The disease  must depend upon some
abnormality in the nervous action, as it fre-
quently maps out upon the surface the part
of the integument supplied by  some one
branch of a nerve.  The vulgar have a great
dread of "the shingles," and believe that
when it so extends as to completely girdle
the patient he will die.  But, in the first
place, it  almost never does go more than
half way around  the  body,  and, what  is
more, there would be no danger if it should,
for the disease is  a self-limited or cyclical
one, and the patient is sure to get well if let
alone.  Other forms of so-called herpes, such
as  H. circinatus, are caused by parasitic veg-
etation, and should be treated with applica-
tions of sulphurous acid and water or other
parasiticide agents.
  Hic'cough, or  Hic'cup  [Lat. singultus], a
clonic spasm of  the diaphragm and of the
glottis  accompanied by a sharp sound, pro-
duced by the rush of  air  into the larynx
from without.  It may attend an over-dis-
tension of the stomach with food, and some-
times accompanies intoxication.   In young
children  it often is the forerunner of intes-
tinal disturbances.  When  persistent, it is,
in  some diseases, such as  low fevers, perito-
nitis, and gangrene, a rather grave symptom.
Lumps of ice frequently swallowed or small
doses of antispasmodic medicines will usual-
ly  relieve obstinate hiccough.
  Hip-joint, Diseases of.  See Coxalgia.
  Hives.   See Nettle Rash.
  Hooping Cough. See Whooping Cough.
  House'maid's  Knee (so called because it
is said, though with little reason, to be most
common among housemaids, who scrub stairs
and floors  upon their  knees), an acute or
chronic dropsical effusion into the bursa be-
fore the  knee-pan.  It is easily diagnosti-
cated, and does  not communicate with the
knee-joint  proper.  Acute cases may be
cured by rest and the application  of iodine,
mercurials,  and  tight bandages;  chronic
ones, by compression with  suitable splints,
or even by evacuation and injection of iodine
solution into the sac.
  HydaFid, a morbid growth characterized
by the development of a cyst, which contains
an aqueous and  transparent fluid, in which
floats a parasitic worm, generally the acepha-
locyst. The term was formerly used to desig-
nate any encysted tumor containing a trans-
parent liquid, but is" now restricted to that
form which encloses a parasite.  The organs
most commonly affected by this peculiar dis-
ease are the uterus, ovaries, and liver;  next
frequently we find it in the breast and testi-
cles, but rarely in other  parts of the body.
It generally appears as a round hard tumor,
which occasions more or less pain and in-
convenience ; this tumor is made up of hy-
datids, although we sometimes have it occur-
ring singly, when it will be proportionately
large.  Each parasite consists of a body and
head;  around the latter  we find a row of
teeth  which are hook-like and sharp.   The
body is solid, and displays a number of ovoid
bodies beneath  its coat, which  give  it a
speckled appearance.  As  the  tumor in-
creases in size, if it is near the surface, we
can feel fluctuation;  the pressure under the
skin causes it to ulcerate, and the hydatids
may thus perish.  If they are situated in
some internal organ,  they may produce  very
serious complications, as peritonitis, osteitis,
etc.  The treatment consists in excision if
they are sufficiently superficial, otherwise we
can do nothing.
  Hydrocele [Lat. hydrocele; Gr. bdpoia'ftw,
from Mup, "water," and afar/,  " tumor"], an
accumulation  of water  between  the  two
serous coverings of the testicles  or of the
spermatic cord, known as  the tunica vagina-
lis. It may follow an inflammation of the
testes, but generally follows strains.  It may
affect both sides at the same time, but usually
we find the effusion on one side only. It
forms a pear-shaped, painless tumor, which
causes uneasiness to the patient only on ac-
count  of its size; it sometimes  grows so
large as to reach nearly down to the knees.
Unless the sac in which the fluid is enclosed
be abnormally thick and distended to its ut-
most by the contained fluid, fluctuation can
be felt.   There  is no  impulse  felt upon
coughing.   By stretching the integuments
over the tumor, and placing a candle behind
it in  a dark room, the light will be trans-
mitted ; this would not occur if the swelling
were solid.  Another test to determine the
consistence of it is to plunge a needle into
the mass, and see whether it falls over to
one side and floats about, or retains the po-
sition  in which  it was placed.  The treat-
ment  of hydrocele may be divided  into the
palliative and the radical.  The former con-
sists in drawing off the effused fluid by the
trocar and canula ; this relieves the patient
for a  longer or  shorter time, but the sac is
apt to fill again, when the operation has to
be repeated. We find patients submitting
to this operation from once to four times an-
nually throughout their  lives,  rather  than
submit to  a procedure which  is perfectly
harmless and would ensure their complete
recovery.   The radical cure is effected by 
THE  FAMILY
exciting an inflammation in the sac which
shall cause the opposing surfaces to adhere,
and thus obliterate the cavity and prevent
further effusion.  This is sometimes accom-
plished by irritating the surfaces with the
end of the canula before it is withdrawn,
but this method is uncertain.  Generally, it
is done by injecting some stimulating fluid;
for this it was customary to use port wine or
zinc lotion, but more recently tincture  of
iodine seems to be the favorite.  If there is
much inflammation, cold applications locally
and opium internally are the indications.
   Hydrocephalus  [Gr. vSpoKE^alov,  from
v6up, "water," and KscpaAy, "head"], a drop-
sical effusion of fluids  into the interior  of
the skull, occupying one or more of the ven-
tricles of the  brain or  the  sub-meningeal
space,  or  both.   Acute hydrocephalus is
ordinarily a symptom of Meningitis (which
see), particularly of tubercular meningitis;
but cases occur in which no tubercle can be
discovered after death.  The causes of chronic
hydrocephalus are various.   It is regarded
as certain that arrest of development of the
brain-substance, pressure upon the veins of
Galen  by masses of tubercle or cancer, and
in  fact any condition which obstructs the
venous circulation in the brain, may lead to
hydrocephalic effusion.  The large majority
of  cases are congenital, and  hydrocephalus
must be set down as a disease (or symptom)
belonging to  infantile life; but cases  occa-
sionally occur  in mature life or in old age.
Dean Swift, after three years of illness, died
with hydrocephalus, the result, doubtless, of
organic brain-disease.   The prognosis  of
chronic hydrocephalus is very grave.  The
child may live for many years,  but (with
rare exceptions) becomes idiotic, and  in
some cases is epileptic.   The head becomes
distended, the fontanels remain  open, ossa
triquetra form in the courses of the cranial
sutures, and in some cases quarts of fluid are
effused, consisting of water, with earthy salts
and a little albumen; while in acute hydro-
cephalus there is sometimes much albumen
present, with some pus-corpuscles or a little
blood.   When the disease is detected early,
mercurial inunctions, with the administra-
tion of the iodides, may possibly afford bene-
fit.  Treatment by systematic compression
or by tapping the skull (the latter operation
to be followed by firm compression) has been
tried in many cases, but the most common
result  has been the speedy  death  of the pa-
tient, although in a few instances it would
appear that more or less advantage has been
obtained by these means. The term spurious
hydrocephalus is sometimes applied to infan-
tile typhoid  or other  enteric  disease, the
general symptoms of which may simulate
those of acute meningitis.
PHYSICIAN.                          47
  Hydrophobia (syns. Rabies, Rabies cani-
na,  Rabies contagiosa),  [from  the  Greek
Mop, "water," and  $6jlog,  "fear"]  is  a re-
markable disease to which both the human
species and probably all of the brute crea-
tion are subject. We can discover only rare
allusions to it previous to the Christian era.
Such  references, however,  are sufficient to
indicate that,  although  it  may not have
been  so prevalent  among the nations of
antiquity  as  among those of more modern
periods, yet  it was  in very  ancient  times
recognized as a peculiar disorder infesting
certain  animals,  and  even  man  himself.
There are two passages  in Hippocrates
which appear to  indicate that he had ob-
served its characteristic symptoms  in man,
but failed  to regard it  otherwise than as a
variety of idiopathic phrenitis.  His con-
temporary, Democritus, however, who was
a famous traveller, had probably encounter-
ed the disease in foreign regions, as he was
evidently  well acquainted  with   its most
striking peculiarities.  We are informed by
the distinguished physician  Coelius  Aure-
lianus that Democritus, in a treatise upon
opisthotonos, had described the affection in
the human subject, admitting its origin from
the bite of rabid animals, but considering it
simply as a  form of  tetanus.  Theocritus
and Plato  refer to madness among wolves.
Aristotle, in his History of Animals, remarks
that dogs are afflicted with madness, quinsy,
and gout; that the first  renders them furi-
ous and inclined  to bite other  animals,
which thereupon also become rabid; and
that all animals except man are liable to be
seized with and destroyed by the malady so
engendered.
  In the early portion of the Christian era
the allusions to this  affection become more
frequent.  Virgil,  in his  Georgics,  classes
rabies among the  distempers of cattle and
sheep induced  by a pestilential  condition
of the atmosphere.   Ovid speaks of a rabid
she-wolf and rabid centaurs (rabidi Bimem-
bres),  and  Pliny of the bite of a mad dog.
Horace employs the  expression rabies canis.
The disease  is mentioned by Columella, a
writer on husbandry in the first  century,
who alludes  to an opinion common among
shepherds  that a  dog  may  be  ensured
against rabies by biting off the  last bone of
its tail on  the fortieth day after birth.   This
is still a popular  superstition.  Suetonius
refers to wild  animals affected with mad-
ness (fera rabida).   Dioscorides, in the time
of Nero, appears to be the first who  claims
to have actually observed  and treated the
disease.  Both he and Galen  describe  it as
attacking  animals and men, and  agree in
the opinion of its communicability  from the
former to  the  latter by contact of morbid 
48                         THE FAMILY PHYSICIAN.
 saliva with the  second  skin.   But Galen,
 and  Celsus  as  well, concern  themselves
 rather with the  prevention  and treatment
 of hydrophobia than  with its history  and
 progress.  AVccording to Plutarch, it was not
 until the time of Pompey the Great that the
 rabific poison first began to manifest itself
 among human beings.  Coelius  Aurelianus
 is  the first to furnish an  accurate detailed
 description of the affection in man, and of
 the various controversies regarding it.  He
 called it passio  hydrophobica.   vEtius,  a
 Mesopotamian  doctor of  the  sixth century,
 is the first to furnish anything like an ac-
 curate description of rabies in  dogs.  A
 century later the physician Paulus JEgineta
 gives an excellent account of hydrophobia,
 dividing it into two varieties—viz. that aris-
 ing from inoculation, always  fatal, and that
 due to nervous irritability, capable of cure.
 A  similar distinction is  now  sometimes
 made,  particularly   by  French  authors.
 Rhazes affirms  that  a  certain hydrophobic
 man barked by night like  a  dog and died,
 and that another when he beheld water was
 seized with trembling, extreme  terror, and
 rigors.  Avicenna, at the commencement of
 the eleventh century,  describes hydropho-
 bia with  considerable  fulness,  noticing
 several of its phenomena  ignored by  the
 Greek and Roman authors.   He terms it
 simply canis rabidi morsus.  In 102(5 an out-
 break of rabies among dogs is mentioned in
 the laws of Howel the Good.   From that
 time  it appears to have been well known
 in  England, numerous  specific  remedies,
 charms,  and incantations  against it  being
 recommended  in old  Anglo-Saxon manu-
 scripts still extant.   On the continent  of
 Europe the modern history of rabies is  ob-
 scure until the thirteenth century.  One of
 the earliest reports of  scientific  interest
 refers to wolves afflicted with the disease  in
 Franconia, Germany, in  1271, where more
 than thirty shepherds and peasants fell vic-
 tims to their attacks.   Since that period we
 find frequent mention of  the affection  as
 prevailing in an  epizootic  form in almost
 every country of Europe, but more particu-
 larly  in the wooded districts of Germany,
 Switzerland, and  France, appearing to  at-
 tack principally  wolves,  dogs, and foxes.
 Vulpine madness, however, was not noticed
 until the beginning of the  present century
 in Europe, although it had  appeared in the
 neighborhood of Boston, U. S., in 1768.  In
 1770 rabies made  its first  appearance in the
 French West Indies, and in 1785 it became |
extremely prevalent  throughout  the IT. S.,
and since that time the disease in both ani-
mals  and men  has occupied a  prominent
 lace  in our medical  literature.   In Asia its
 istory, as  we  have  seen,  is  very ancient.
 It has never appeared in Australia or New
 Zealand.
   The popular belief that hydrophobia is in
 all animals characterized by an abhorrence
 of icater was long since proved to be erro-
 neous.  The mad dog laps it eagerly, and will
 not  hesitate to swim in it when it obstructs
 his  course.   In the ease  of  man, however,
 the attempt to drink, or whatever is suggest-
 ive in any manner of that act, induces such
 dreadful spasms of the muscles of degluti-
 tion and respiration, with sense of suffoca-
 tion, that a horror of fluids, even though
 associated with intolerable thirst, may be
 truly regarded as one of the  most promi-
 nent and characteristic features of the dis-
 ease.  For  these reasons a  distinct  term,
 rabies, has been employed by some writers
 to designate this  affection  as it  prevails
 among  the  brute creation, the word hydro-
phobia  being restricted to the  disorder as
 manifested in man.
  It is almost universally  conceded that the
 introduction  of  a specific virus, from a rabid
 animal, into  the system, through either an ac-
 tual  wound,  an  abraded surface, or a delicate
 mucous  membrane, is an essential preliminary
 to the development  of this affection  in  man.
 But  its  origin among  brutes has always
 been, and still is, a subject of much  dis-
 cussion.  Hydrophobia certainly infests, and
 by many is regarded as originating de novo
 among, certain Carnivora—viz. the dog, wolf,
 jackal, cat, skunk, and raccoon—while her-
bivorous and other creatures, including man,
 contract it by  inoculation alone.  Of the
various  conditions asserted  as favoring its
spontaneous development in the canine race,
 few have even a probable foundation.  They
are principally  repressed sexual desire, ex-
tremes of atmospheric temperature, excite-
ment of anger, want of water, and putrid or
insufficient  food.  Still another presumed
influence is the presence under the  dog's
tongue  of a worm-like appendage, whose
extirpation in puppyhood is considered an
infallible preventive of the disease.  This
idea  may doubtless  be referred to a  very
ancient myth.  Pliny speaks of it, terming
the peculiar  appendage lyssa.  The Germans
term it  Tollwurm, or worm of madness, and
among them it  has  long been a popular su-
perstition.  The practice  of  removing this
so-called worm still exists in Thrace, Tur-
key,  Greece, Roumania, Moldo-Wallachia,
Spain, and even in the Southern U. S.  Its
efficacy  has  been entirely disproved by sci-
entific investigation, and the operation may
be best characterized, in the expressive lan-
guage of Dr. Johnson, as "a substance-
nobody   knows  what,  extracted—nobody
knows why."  The other  presumed causes
of spontaneous  hydrophobia  would appear 
THE  FAMILY PHYSICIAN.
49
 to be  equally equivocal.  Unsatisfied sala-
 city, putrid food, hunger, thirst, anger, and
 extremes of temperature are manifestly cir-
 cumstances which obtain among dogs quite
 generally  throughout the world.  But in
 some regions abounding in dogs hydropho-
 bia has  always, so far as can be  learned,
 been either totally unknown or  extremely
 rare, while in others exempt from  it for
 ages it has only recently appeared, and in
 most instances can be traced positively to
 importation. Such exemption has been par-
 ticularly noticed in various islands through-
 out the world and in  isolated localities.  It
 is related that Mr. Meynell, the most emin-
 ent English sportsman of the last century,
 preserved his kennel of hounds from hydro-
 phobia during many  years by forcing every
 new dog to undergo  a rigid quarantine of
 several months preparatory to his admission
 into the pack.
   Rabies canina prevails indifferently in all
 seasons.  It seems quite well established that
 all creatures liable to contract the disease are
 also in a greater or less degree competent to
 transmit it, and we know of no animals ex-
 empt from it.  It is  true that herbivorous
 and ruminating beasts, owing to the forma-
 tion of their jaws and teeth, as  well  as to
 their seldom attempting to bite when rabid
 (sheep only excepted), rarely communicate
 the  disease;  and hence  the belief,  enter-
 tained for some time by such eminent men
 as  Sir Astley Cooper and  the  veterinary
 professors  Coleman and Renault,  that the
 power to propagate  the affection was con-
 fined to  such animals as naturally employ
 their  teeth for weapons of offence.   The
 fallacy of this  opinion has been proved by
 numerous  unquestionable experiments, and
 it is now likewise conceded by the best au-
 thorities that the saliva of  a hydrophobic
 human being is capable of inoculating the
 disease.
  The dog affords us  the most frequent op-
 portunities for observing the phenomena of
 this redoubtable affection.  Hydrophobia in
 the dog  has been by some writers divided
 into two varieties, dumb and furious rabies,
 according as the animal  is silent  and un-
 demonstrative or noisy and fierce.  Other
 authors  recognize  still  a  third  variety,
 which  they term tranquil rabies, where the
 animal is quiet, indifferent,  and unaggres-
 sive.  Virchow considers the different forms
 merely as  prolonged  conditions  or stages,
 which, according to him, are—1st, the stage
 of melancholy;  2d, the irritable and furious;
3d, the paralytic stage.  The disposition to
bite  is not apt to be exhibited until the af-
fection is well established.  The  disease is
first manifested by constant restlessness, un-
easiness, and irritability of temper, the dog
     4
of fondling or  sociable disposition becom-
ing snarly, morose,  and shy, retiring under
pieces of furniture, into  dark corners, or
the interior of its kennel, but not remain-
ing long in any one spot, and being contin-
ually engaged  in  licking,  scratching, or
rubbing some portion of its body.  Costive-
ness and vomiting  are often present.  The
appetite  becomes depraved.   The  counte-
nance undergoes a marked change—assumes
an appealing expression or becomes the very
picture of ferocity.   In the early stages the
animal's attachment for its master appears
greatly exaggerated, and  as long as it re-
tains its consciousness it  will  refrain from
injuring him.   Two early and characteristic
signs of rabies are a peculiar delirium,
causing the animal to  snap at imaginary
objects in the air, and a remarkable alter-
ation in  its voice,  the bark  ending  very
abruptly and singularly in a howl a fifth,
sixth,  or eighth higher than  at the com-
mencement.  Sometimes  it  will  utter  a
hoarse inward bark, rising slightly in  tone
at the close.  Common symptoms  are  stra-
bismus and twitchings  of the face.   In a
couple of days the animal begins tp lose
control of  its voluntary  muscles  and ex-
periences difficulty in eating and drinking.
In the early stages frothy spume or slaver
is generally seen dripping  from  its jaws,
but  this  soon lessens in  quantity and be-
comes thick and glutinous, adhering to the
corners of the mouth and  fauces, and caus-
ing intense desire to drink.  It is now in-
sensible to pain—will munch burning coals
or even  mutilate itself without  apparent
suffering.  It exhibits an  inclination to es-
cape from home, to which it will sometimes
return after many hours of absence.   It is
restless and  savage, wandering about, at-
tacking  imaginary objects  or venting its
fury upon  real ones.  If  confined,  it gives
utterance to the peculiar bark and howl
described.  When at large, however, it gives
forth no warning noise, but seems only de-
termined upon a straightforward  trot. If
interfered  with,  and  more  especially if
struck, it will  wreak its vengeance  on the
offender, but will seldom, as a rule,  go out
of its way to do a mischief, and if pursued
will  generally endeavor to escape.  It does
not continue its progress long, but becomes
exhausted, and moves with unsteady, totter-
ing  gait,  drooping tail,  head  toward the
ground, mouth  open, and  protruded  tongue
of a lead-blue color; finally,  paralysis en-
sues, first of the hind quarters and then of
the whole body, which  is promptly followed
by death.  Its  duration rarely  exceeds ten
days ; the ordinary  time is from four to six
days.  Nothing has been positively deter-
mined with regard to the  interval elapsing 
50
THE  FAMILY  PHYSICIAN.
between the receipt  of the injury and the
appearance of rabies in the dog and other
animals.   It seldom, however, exceeds six
months.
  Hydrophobia in our own species possesses
a deep and melancholy interest on account
of the peculiarity of  its mysterious  and
often prolonged latency,  the  horrible in-
tensity of  its paroxysms, and its irresistible
fatality.  The  virus  of  the rabid animal,
when once its insidious operation has begun,
defies the most  consummate therapeutical
skill.  When the rabific poison  has  been
deposited within the body no extraordinary
appearances succeed about the point of re-
ception, which seems to heal and cicatrize
entirely in a natural  manner. At that spot,
however, the virus remains  perdu until at
some uncertain period it comes forth stealth-
ily upon its deadly  errand.  The duration
of this latency  is no less variable in man
than  in the lower animals.   According to
Thamhayn's statistics of 220  cases of hydro-
phobia in the human subject  (in Schmidt's
Jahrb'ucher, 1859), the period of incubation
in 202 instances ranged from three days to
six months.  In 145, or the  large majority,
it extended to from  four to  thirteen weeks.
One  occurred after  four years, and another
after five  and a half years.
  One of the earliest symptoms  is usually
a tingling sensation at the  cicatrix, which
sometimes opens and  discharges a thin ichor-
ous fluid.  In a short time the person grows
dejected, morose, taciturn, restless, and ir-
ritable ; he seeks solitude and shuns bright
and  sudden light.  Within a period varying
from a few hours to several  days the more
serious and characteristic symptoms are de-
veloped.  The patient is  sensible of a stiff-
ness  or tightness about the throat, and  is
troubled with some difficulty of swallowing,
especially liquids. Deglutition soon becomes
impossible unless attempted with the utmost
resolution.  The real paroxysms of the dis-
ease then supervene: they are either spon-
taneous or produced  by anything suggestive
in the slightest degree of the idea of drink-
ing ; they are preceded by chills and tremors.
During these attacks sensations of stricture
about the throat and chest are experienced;
the respiration is painful  and  embarrassed,
and  interrupted with sighs and sobs; in fact,
there occur terribly violent spasms of the
muscles of the throat, almost intercepting
the  entrance of air into the  trachea.  In
the intervals between the paroxysms the pa-
tient is sometimes calm and collected, retain-
ing full consciousness and knowledge of his
condition, but  generally he exhibits  more
or less excitement and irregularity, and oc-
casionally has  fits  like  those of insanity.
Frequently he is seized with a  species of
delirium; he seems to see about him swarms
of flies ; he converses with imaginary per-
sons or fancies himself in the midst of perils.
When suddenly addressed, however, his hal-
lucinations are  for a time dispelled.  Occa-
sionally, in some of his fits of violence he
will attempt to bite  his attendants, will
roar, howl, curse, and endeavor to destroy
anything in his  reach.   He often seems con-
scious of the  approach of such attacks, and
will beg to be restrained. Hyperaesthesia of
the skin and acute sensibility  of the  nerves
distributed to the other organs of the senses
are usual.  A very characteristic symptom
is the copious secretion of a viscid, tenacious
mucus in the fauces, which the patient con-
stantly  hawks up and spits  out with vehe-
mence in every direction, producing a sound
sometimes  imagined  to resemble a dog's
bark.  The tongue is at first coated and red,
afterwards  dry and brown.   Occasionally
there is vomiting of a " coffee-ground" fluid.
The pulse  is quick and excited, becoming
very frequent and feeble before death. The
urine is high-colored  and scanty. It gen-
erally  contains albumen,  sometimes  sugar.
The temperature of the body is  always ele-
vated, which is coincident with rapid waste
of tissue.  Often within a few hours a plump
and well-nourished patient grows shrunken
and emaciated, and the  face of  youth is
transformed into the shrivelled visage of old
age.  As the disease advances cerebral dis-
order becomes more and more marked.  The
eyes are staring, bloodshot and always open,
frequently with dilated pupil;  the  speech
is abrupt,  rapid,  and incoherent,  and  at
length there is  confirmed  delirium.  Some-
times remissions occur, and the patient eats,
and even drinks, with great difficulty, how-
ever.   Towards the end such a remission,
with complete subsidence  of agony and agi-
tation, is not uncommon.  But this relaxa-
tion is only a delusive calm, the prelude to
dissolution, which is usually unattended with
violent symptoms.   Death ordinarily ensues
from  asphyxia.  The duration  of the dis-
ease is generally from two to  five days.   It
has been known to terminate within twenty-
four hours, four of such cases being recorded
by Thamhayn, while in a case mentioned
by Tardieu  life  was  prolonged  for nine
days.
   It is now  quite generally  admitted that
although  hydrophobia  may  be originally
due to a blood-contamination, its  action
when  developed is manifested  exclusively
through the nervous system, and principally
that portion whose functions are governed
by the medulla oblongata.
   In man the most careful examinations of
those who have perished  from hydrophobia
have proved inconclusive as to the pathogeny 
THE  FAMILY  PHYSICIAN.
51
of the disease.   In some instances the cere-
brum, cerebellum, medulla oblongata, spinal
cord, and eighth pair of nerves, in both
origin and distribution,  have been found
apparently normal after the closest scrutiny
with the naked eye as well as skilful micro-
scopical investigation.  Congestion, effusion
of lymph, and  even softening,  have occa-
sionally been observed in portions of  the
brain, medulla, or cord, but these and all
other lesions thus far discovered in the body
can  only be regarded as results of the dread-
ful disturbance  in the nervous centres and
respiratory and circulatory systems.  Auten-
reith, Brandreth, and Sallin have seen the
nerves communicating with the cicatrix in-
flamed.  The distinctive character, however,
of these disease-germs remains to be estab-
lished.   There is a special  hysterical  or
mental hydrophobia, as Trousseau named it,
induced by emotion on seeing hydrophobic
patients, through fear  of the disease after
having been bitten, or even in very nervous
people from simply hearing the description
of a case.   In  this spurious hydrophobia
there is only difficulty in swallowing, and
no  convulsions, scantiness of urine, or ele-
vation  of temperature.   It is very  rarely
fatal.
  When once the rabific virus has declared
its presence in the human system, all meas-
ures hitherto adopted would appear unavail-
ing  to arrest its course.   With our present
knowledge the most satisfactory treatment
after the disease  has  appeared consists  in
simply  fulfilling rational indications—viz.
by palliating the symptoms as far as possi-
ble,  excluding  all  controllable  causes  of
mental and  physical disturbance, and sup-
porting the powers of the system with stim-
ulants and appropriate alimentation.  There
is no doubt, however, that we have at our
command effectual prophylactic means  for
destroying the poison, provided they be em-
ployed  within  a reasonable time  after  the
infliction of the injury.  These precautions
consist  in the application of a  ligature, if
possible, to impede the circulation from the
wound, in sucking  the  wound, and  in its
thorough cauterization, nitrate of silver be-
ing the most valuable agent; but if this be
not  available, the hot iron, a burning coal,
potassa fusa, or  almost  any acid may be
used.
  Hypertrophy [Gr. vwep, "over," and rpo<f>v,
"nourishment"],  in  pathology,  the over-
growth  of any  part or  organ, or the dis-
proportionately large size of such an organ.
Hypertrophy is simple, homoeoplastic, het-
eroplastic, or hyperplastic, these terms de-
fining the character of the  added material
which gives  the increased size.   It may be
caused—1st, by an increased exercise of the
part, an exemplification of which we have
in the blacksmith's  arm; 2dly,  by an  in-
creased supply of blood to a part, the part
being healthy; 3dly, from some local  de-
rangement,  as may  be seen in exostoses,
fatty tumors, etc.   The treatment of hyper-
trophy  has  been  very  unsatisfactory;  in
fact, we can do next  to nothing for patients
suffering from the first and second varieties.
The third should be removed by the knife
if any inconvenience is caused.
   Hypochondria  (pi.),  [Gr.  rd  vnoxdvdpia,
the  regions  "under the cartilages"], in
anatomy,  the regions of  the abdomen on
either  side of the  epigastrium.  The  name
is also given  to the diseased condition of
late more frequently  called hypochondriasis
by the medical profession.
   Hypochondriasis  [so-called from the old
belief that the hypochondria were the seats
of the disease], a morbid state of mind, more
common in  men than in  women, in which
the patient  imagines that he suffers from
diseases which he does not possess, and in
which he suffers from subjective sensations
entirely  unaccounted for  by the objective
signs of disease in  his case.  The disease
itself is real.  It may result from dyspepsia,
from sexual excess, or from other causes in-
terfering with the nutrition  of  the  nerve-
centres.  The disease may amount to posi-
tive insanity, and is  then classed as  melan-
cholia.  Medicine and hygienic regimen of-
ten do but  little  good.   Cheerful  compan-
ionship, fishing, hunting, and boating, long
journeys, even the reading of well-selected
novels—in fact, anything which  will divert
the mind from its habit of morbid self-ob-
servation—will be found  useful.
   Hyste/ria  [from vartpa,  the "womb"], a
peculiar nervous affection which in former
times was supposed to have had its seat in
the womb, but at  the present day Hasse's
theory of its origin is generally received—
viz. that it  arises from a nutritive derange-
ment of the general nervous system, both
central and  peripheral.  This may be caused
by any organ of  the body being diseased,
and there can be no  doubt but that it is de-
pendent most frequently upon disorders of
the uterus and ovaries, simply because these
affections produce a deeper impression upon
the nervous system.   This condition of the
nervous  system  may also be  produced by
improper nourishment.  There is a predis-
position to the disease manifested.  A tend-
ency, either  congenital or acquired, plays a
much more important part in inducing this
affection than all the causes enumerated.
  Hysteria  generally attacks women from
the age of puberty to the decline of men-
struation. It is of rare occurrence among
men, and in them is produced in "a manner 
52
THE  FAMILY  PHYSICIAN.
similar to that in which  it is produced in
the opposite sex.   Hysteria may  manifest
itself in a great variety of  ways;  in fact,
it simulates  almost  every  known disease,
and  often with the greatest care the prac-
titioner is unable to differentiate them. The
most  common form, however, is the hyster-
ical  fit.  In some cases this  consists merely
of the twitching of the muscles of  a par-
ticular  region, as of the face, arm, or leg.
In other cases the whole body is affected at
once.   The  patient generally laughs  and
cries alternately;  this is due to spasm of the
group of muscles which operate in producing
these acts.   Another very common accom-
paniment of these paroxysms is the so-call-
ed globus hystericus; this consists in the sen-
sation as of  a ball rising from  the  uterus
and  ascending through  the abdominal and
thoracic cavities to the throat, and is caused
by a spasmodic contraction  of the  oesopha-
gus.   The patient may scream, tear her hair
and clothes,  and beat her breasts.  In severe
cases we sometimes have  loss of conscious-
ness  and convulsions; when  this occurs it is
almost impossible to distinguish it from epi-
lepsy.   The  fits usually terminate  with the
discharge of a large quantity of almost col-
orless urine.   Perhaps the next  most com-
mon manifestation of the disease is hyper-
aesthesia, either general  or  localized, but
most  frequently  the latter.  Under  this
heading would come hysterical peritonitis,
in which the patient will complain of great
pain and tenderness over  the region of the
abdomen; she will jump and cry out upon
the slightest touch.  Accompanying this
condition there will be a  rapid pulse and
increased temperature.  The characteristic
of the hysterical affection is  that the pain is
not aggravated upon deep pressure,  and if
you distract  the patient's attention from her
trouble you can very often knead the abdo-
men  without the  least discomfort to her.
The " stitch  in the side " of young girls and
women can  generally be  ascribed to hys-
terical hyperaesthesia.   The opposite con-
dition, anaesthesia, may occur sometimes,  to
such an extent that the patient will allow
your finger to be thrust into her eye or needles
to be plunged deeply into  the flesh without
wincing. Hysterical  hemiplegia and para-
plegia very often occur.  They are very per-
plexing cases, and can hardly be differenti-
ated by any but a careful and experienced ob-
server.  Paralysis of the muscular  fibres of
the bladder,  or spasm of its sphincter,  is
sometimes simulated.  Hysterical patients
very often pretend that they are  suffering
intolerably from retention  of urine, and can
only be relieved by the introduction of the
catheter several times a day; which, indeed,
seems to be all that they desire. When such
an affection is made out beyond a doubt to
be feigned, it is best to leave the patient to
her own resources.  Even in  cases where
this has  been done, the patients have been
known to drink their own urine in order to
carry out the deception.  Gravel and stone
in the bladder are other diseases simulated;
the patient will put common  gravel in the
urine after it has been voided and pretend
to have  passed it,  or  she  may even place
sand in the urethra.  Watson records a case
in which a young woman made the surgeons
in one of the London hospitals believe that
she had  stone in  the bladder, and who act-
ually  submitted to  be  tied upon a table in
the position usually adopted  for operations
for lithotomy, before a theatre full of stu-
dents, before the  deception was discovered.
Hysteria very commonly mimics affections
of the spine and joints.  Patients have been
known to have been kept on their backs for
months,  and even years, and to have had
blisters, leeches, and issues almost constant-
ly applied for supposed disease of the spine,
which subsequently was ascertained  to  be
purely nervous.   So with hip-joint disease,
etc.
  There  are  many hysterical affections re-
ferred to the fauces—aphonia or loss of voice,
mock laryngitis or pharyngitis, stricture of
the oesophagus, and many curious sensations.
One patient imagined that a number of tape-
worms came up  from  her stomach  to  her
throat, filled  her  ears, and came out upon
her tongue.  Every time she  attempted to
catch them with her finger they would dis-
appear.  This occurred several times a day,
and it was  impossible to persuade  her that
such a thing could not  happen. Among the
other more common affections  simulated by
hysteria  are pleurisy, consumption, cough,
hiccough, indigestion, in which the patient
swallows a quantity of air, and then pre-
tends to  be suffering from tympanitis and
eructations;  vomiting  also  sometimes  ac-
companies  this hysterical dyspepsia,  simu-
lating cancer of the stomach.  Very often
patients  suffering from hysteria have a de-
praved appetite; they eat very little of any-
thing, especially  at table, and will hardly
touch meat at all, except it be a little ham;
they will devour slate-pencils, wafers, chalk,
pickles,  lemons,  and  such out-of-the-way
articles.  Notwithstanding this mode of life,
their health does  not materially deteriorate.
  We next come to speak of the treatment.
This  may be divided into two modes—viz.
that of the paroxysm, and that between the
paroxysms.   In  the  first  stage  the dress
should be loosened and plenty of fresh air
admitted into the room.  Spectators  should
not remain in the room, and the attendants
should maintain quiet and composure. Cold 
THE FAMILY PHYSICIAN.                          53
water  may  be dashed  in  the face;  some-
times it is necessary to continue doing this
for quite a while (fifteen or twenty minutes),
but the patients will generally succumb  at
last.  Strong aqua-ammonia may be held to
the nostrils.   The bowels may be unloaded
with an enema of soap and water, or, better,
of  mixtura assafoetida.   Forcibly holding
the patient's mouth and nose for a moment,
thus suspending respiration, will often divert
all the patient's energy to restore breathing,
and at once break the attack.   When great
nervous excitement exists, chloral, bromides,
opiates, valerian, musk, etc. may be given at
short intervals.  In the intervals  between
the paroxysms, or in the other forms of hys-
teria, laxatives, tonics, and the correction
of  any diseased function should be our first
care.   Iron, in the  form  of the carbonate,
Blancard's and Bland's pills, and the muri-
ated tincture  of iron, benefit most cases.
Besides this, the patient may take assafoetida
pills, infusion of quassia, cinchona bark, and
quinia.
   Ichthyosis  [Gr. Irfv:, a "fish ;" i. e. "fish-
skin disease "J, a disease of the human  sub-
ject characterized by the presence of scaly
growths in or upon the integument.   Three
distinct diseases  have  been called by this
name: (1) Intra-uterine ichthyosis, in which
the vernix caseosa, or glutinous secretion of
the skin of the foetus, becomes hardened into
a  horny armor, crippling  the development
of  the child  and  leading to  its  death.
(2) True  ichthyosis  is a hypertrophy of the
papillary  layer of the skin and of the epider-
mis.  The patient is covered, as to  a great
part of the  body and limbs, with unsightly
scales of  forms varying in different patients.
This disease is thus far quite incurable.  It
is generally hereditary, but is not always so.
Ichthyosis has been known to cover the skin
of the knee after recovery from severe de-
structive  disease  of the joint.   Frequent
bathing and anointing are useful, but never
curative.  (3) The so-called sebaceous ich-
thyosis depends on excessive functional ac-
tivity of the sebaceous glands, the secretion
of which  rapidly hardens into scales.  This
disease is often caused by some reflex dis-
turbance,  and is curable as a rule.
  IFeus [Gr. siledg, a  " twisting;" Lat. vol-
vulus or miserere mei], a very painful disease
of  the intestine, produced  by mechanical
obstruction, as by twisting, intussusception,
or knotting of the entrail.  Intense pain, per-
sistent vomiting (sometimes stercoraceous),
hiccough, etc. are characteristic symptoms.
Intussusception, or the passage of a part of
the intestine into the cavity of another part,
is  one of the most  common conditions,  as
when the  lower part of the small intestine is
slipped down  into the large intestine.   The
disease is very often fatal.  Spontaneous re-
duction of the displacement may occur;  the
intussuscepted part may slough away and an
inflammatory process occur, resulting in re-
covery ; dilatation of the bowels by the bel-
lows may effect a cure.  As a last resort, gas-
trotomy may be tried with possible success.
  ImpetFgo [Lat. an " attack," from impeto,
to " rush upon"], a skin disease, resembling
eczema in being more or less diffuse inflam-
mation, but resulting, unlike eczema, in pus-
formation.  The crusta lactea of young infants
is one of its forms, which are rather numer-
ous.  True impetigo is not contagious.  It
frequently is cured by time alone, but if per-
sistent should  be treated with oxide-of-zinc
ointment or some other mild stimulant. The
so-called impetigo figurata is a distinct dis-
ease, depending  on the presence  of Tricho-
phyton tonsurans, a parasitic vegetation. Epi-
lation of the part with irritant washes, as of
corrosive sublimate,  will  cure  the  disease,
which is truly contagious.
  Indigestion, or Dyspepsia [Gr. 6vg, "bad,"
and TriirTO), to  "digest"].   Indigestion  has
many forms, and includes groups of symp-
toms  indicative  of departure from one or
many of the conditions of healthy digestion.
The digestive process  is  complex, and is
performed  by  the  agency of the  saliva, the
gastric juice, and the intestinal, pancreatic,
and biliary secretions.  For the proper secre-
tion of these several digestive  fluids  the
blood must be in a  healthy state, and be
freely supplied to the glandular structure of
the stomach and intestines. The innerva-
tion essential  to the digestive process de-
mands moderation of mental activity, emo-
tional tranquillity, vigor and healthful action
of  the  nervous  centres,  especially of  the
sympathetic system.  Tonicity of the mus-
cular walls of the stomach  and intestine is
essential for the thorough  contact and ad-
mixture of food  with the  digestive  fluids,
for its transit through the intestinal tract,
and for the regular  evacuation from  the
bowels of undigested and excretory matter.
Indigestion may be gastric or intestinal—
often the  two combined.  It is either pri-
mary—an essential disorder of the digestive
apparatus—or secondary  and symptomatic
of disease in other organs.  Obstruction of
the circulation of the blood by chronic dis-
ease of a large vascular organ—as the liver,
spleen, or kidney—induces passive  conges-
tion of the mucous surfaces.  Heart disease,
rapidity  of circulation,  and elevation  of
temperature in fevers and  febrile disorders
cause gastro-intestinal engorgement, catarrh,
and indigestion.   When bile is imperfectly
eliminated, when urea is imperfectly excre-
ted by the kidneys,  when fecal matter is
retained and absorbed, the effete elements 
54
THE FAMILY  PHYSICIAN.
 circulating in the blood excite gastric or in-
 testinal or gastro-intestinal catarrh.    Pri-
 mary or idiopathic indigestion includes all
 cases in which careful investigation has  fail-
 ed to discover a dependency on other disease.
 It may be a simple  functional disorder of
 digestion, or due to an organic cause in some
 part of the digestive tract.  Functional dys-
 pepsia is termed atonic.  Organic dyspepsia,
 if mild and due  to  temporary and  slight
 lesions of  the  secretory surface,  is termed
 irritative;  if severe, it is designated chronic
 gastritis, a condition which  by associated
 symptoms and physical exploration may be
 found to depend upon ulcer, cancer, or in-
 flammatory thickening.  Atonic  dyspepsia
 may be due to defective innervation—from
 continuous and exhaustive mental action;
 from emotional disturbances, as excitement,
 sorrow, fear; from prolonged  exercise  and
 fatigue; from dissipation.  It may be caused
 by deficient supply and quality of the blood,
 inactive circulation from indolence and ne-
 glect of exercise, anaemia and impoverished
 blood from privation or recent sickness.  De-
 ficient or  perverted secretion  of digestive
 fluids results.   Reversely, digestion may be
 interfered with by excess of blood and gas-
 tric catarrh, when neglected  cleanliness or
 chilling of the skin or  cold extremities  de-
 termines blood  to  internal parts.   Obesity,
 indolence,  general debility may lower  the
 tonicity of the  muscular  structure of  the
 stomach and intestines, and weaken the peri-
 staltic  movements, causing failure in  the
 contact of  food  with digestive fluids, and
 resulting in its accumulation and fermenta-
 tion. As a rule, however, nerve-force, blood-
 supply, and digestive  apparatus are not pri-
 marily at fault, and are adequate to ordinary
 digestion, the majority of indigestions being
 the  result of gross excesses of diet and vio-
 lations of hygienic law, excess of food,  too
 frequent meals, rapid eating with incomplete
 mastication and insalivation, food unfit  for
 digestion or  improperly and  insufficiently
 cooked,  the habitual use  of  condiments,
 rendering the peptic glands dependent upon
 their stimulus, the imbibition in excess of
 liquids, as  water,  tea, or coffee, at meals,
 causing dilution of the gastric juice.  Alco-
 holic stimulants create temporary and arti-
 ficial appetite, but soon destroy healthy  di-
 gestion.  Tea,  coffee,  and tobacco  impair
 the innervation of the  stomach.
  The chief symptoms of gastric indigestion
 are sense of fulness,  weight,  distress, and
 dull pain over the stomach, coated or irrita-
 ble tongue, foul breath, perverted  appetite
—usually poor in  the morning, and often
morbid and irregular—sometimes  nausea
 and  vomiting, eructations of gas, regurgita-
tion of acid or alkaline liquids and of  food,
often  constipation,  and  less  often  colicky
pain, with irregularity and looseness.  There
may exist lassitude, mental inactivity, drow-
siness, cranial oppression, headache, vertigo,
sometimes clouded vision, diplopia or double
vision, and numerous nervous symptoms and
perversions of the senses may exist;  short-
ness of breath, sighing respiration, pnecor-
dial distress, palpitation and irregular action
of the heart.   There may be  poor circula-
tion;  relaxed and pallid or sallow surface
and complexion; cold hands and feet; in
women, menstrual disorders.  With the more
marked and aggravated symptoms there may
be mental depression, anxiety, despondency,
and apprehension,  constituting  hypochon-
dria.   A diagnosis of the form of dyspepsia
is  essential to a correct treatment.  Atonic
may be distinguished from irritative dyspep-
sia by the following differences:
                      In  Irritative  Dyspepsia.
In Functional or Atonic
      Dyspepsia.
 1. Deficiency or irregu-
     larity of appetite,
     absence of thirst.
 2. Ingestion of food af-
     fords sense of com-
     fort for a time.
 3. Food retained.
 4. Condiments     and
     stimulants craved,
     aid digestion, and
     cause sense of com-
     fort.
 5. Languor and inapti-
     tude for exertion
     during digestion.
 6. Tongue pale, broad,
     flabby, thinly fur-
     red.
 7. Breath foul.
 8. No fever.
 9. Persons  in  general
     good  health  and
     flesh.
10. Constitutional symp-
     toms few.
                       1. Morbid craving for
                           food, morbid thirst.
                       2. Ingestion   of  food
                           causes distress.
                       3. Food  often ejected
                           when taken, or soon
                           after.
                       4. Condiments    and
                           stimulants create or
                           intensify distress.
                       5. Pain and mental dis-
                           tress  during diges-
                           tion.
                       6. Tongue small,  com-
                           pact, red, with ele-
                           vated  papillae  or
                           sensitive  abraded
                           patches.
                       7. Breath may or  may
                           not be foul.
                       8. Often slight fever.
                       9. Reduced health, bad
                           nutrition, and  ema-
                           ciation.
                      10. Variable general ef-
                           fects.

The symptoms of functional and irritative
dyspepsia often coexist.   In functional  dys-
pepsia the  fermentation  of  food develops
gases.  Eructations may be of carbonic  acid
gas from acetous  fermentation, of hydrogen
and carbonic acid gas from  decomposition
of  hydrocarbons or  fatty food,  or  of  sul-
phuretted hydrogen  from decomposition of
nitrogenous substances, as meats, eggs.  Of
regurgitated liquids,  the  most common  is a
clear, opalescent, insipid,  alkaline  liquid,
sometimes  saltish or  brackish, probably the
accumulation in  the oesophagus of  saliva,
and its frequent rising in the throat is known
as waterbrash or pyrosis.   In gastric  catarrh
gelatinous  mucus may rise in  the  throat.
The regurgitation  of  acid,  acrid  liquid
causes  sense  of  burning in  the stomach, 
THE FAMILY PHYSICIAN.                         55
 beneath the sternum, and  in the throat—
 technically,  cardialgia,  popularly termed
 heartburn.   Such fluid is usually serum or
 sero-mucus, containing acetic or lactic acid.
 If brown, acrid, bitter, rancid, and offensive,
 it is due to the conversion of fatty food into
 butyric acid.  Food may be regurgitated at
 various stages of its digestion.  When food
 is ejected many  hours after ingestion, it
 may  present  products of  fermentation—
 sporules of  Torula cerevisia;, or sporules ag-
 gregated  into  segmentated,  cubical masses,
 known  as  Sarcinas ventriculi   (sarcina,  a
 "wool-pack").  Coffee-ground substance in
 ejecta is due to blood which has undergone
 gastric digestion, and  indicates an abraded,
 ulcerated, bleeding surface.  The accumu-
 lation of food and its  ejection en  masse
 hours after ingestion  denote obstruction at
 the lower or pyloric orifice.   The prevalent
 idea  that gastric juice is often regurgitated
 is erroneous.  Bile appears in regurgitated
 fluids seldom, and in vomited  matter only
 after prolonged or violent emesis.  In aged
 persons a steady progressive loss of appetite,
 progressive  inanition  and emaciation, and
 death from  slow  asthenia,  without  other
 symptoms of  indigestion  or evidence  of
 disease in other  organs, result  from degen-
 eration of the gastric and intestinal tubules,
 the peptic glands.   When fatty food passes
 in the faeces undigested, disease of the pan-
 creas may be suspected.
   Atonic dyspepsia predisposes  to acute in-
 digestion, sub-acute gastritis, gastro-enteric
 catarrh—the cholera morbus of adults and
 cholera  infantum  of  children — whenever
 exciting causes are superadded, as  the im-
 bibition of cold water or eating acrid fruits,
 chilling  of  the  heated body in  summer.
 Indigestion may at first induce looseness  of
 the  bowels,  irregular  action, or diarrhoea,
 but ultimately produces  constipation.  In-
 digestion, by developing  lactic acid in  ex-
 cess,  is the  frequent cause  of rheumatism.
 It is  the  source of the lithic-acid or  gouty
 diathesis.  Indigestion is  the frequent cause
 of urinary precipitates. Imperfect digestion
 of nitrogenous food gives  rise to oxalic acid,
 oxalate of lime in the urine, irritation and
 congestion of  the  kidneys  and  bladder.
 Indigestion  in  young  and susceptible chil-
 dren  and infants is the most frequent cause
 of convulsions and sudden febrile  attacks.
 It may be the chief or only cause of chorea
 (St. Vitus's dance).  Chronic irritative dys-
 pepsia is  most often the result of alcoholic
 excess, less often of excessive errors of diet,
 or may be  symptomatic of gastric ulcer,
 pyloric constriction, or malignant disease.
  In  the  treatment of indigestion regula-
tion of diet alone often effects a cure.   The
diet should be nutritious, moderate in quan-
tity, taken at regular intervals, and slowly
eaten. The food at breakfast should be simple
and laxative, at dinner substantial, at sup-
per light. Of dishes there should be variety,
yet simplicity, including animal food, vege-
tables, and  fruits in restricted  quantities.
Bread should be stale or aerated.  Milk may
be freely taken, corrected with soda or lime-
water. Fatty food, grease, sugar, and pastry
should  be  avoided.  Artificial  adjuvants
to  the  diet, as  Liebig's  prepared food,
Ridge's food, and malt extract, are of value.
Drink of any kind at meals should be very
limited.   Attention  to  general regimen is
essential. There must  be outdoor  exercise,
freedom  from mental stress, from  physical
fatigue, and dissipation in any  form.   By
clothing,  active  friction,  and  judicious
bathing  the  external  circulation  is  kept
vigorous.  Tendency of the food to decom-
pose  demands correctives.  For the acid
stomach, bicarbonate of soda, the bicarbon-
ate of potash, or lime-water; for  alkaline
fluid and gastric mucus, dilute mineral acids
and acidulated drinks.  Bismuth, either the
subnitrate or subcarbonate, is the remedy
for pyrosis.   When the  stomach fails to
digest albuminoids,  pepsine may be given.
Pancreatine will aid the intestinal digestion
of  fat.   Fermentation  of food,  with  fetid
products  and foul breath, may be treated
by the sulphite, bisulphite, or hyposulphite
of  soda,  the  sulpho - carbolate  of soda;
charcoal  is   also efficacious.  In  atony of
the stomach,  carminatives, as ginger,  cal-
amus, capsicum, and compound tincture of
cardamum,  stimulate  glandular secretion;
bitter vegetable tonics,  chamomile, quassia,
calumbo,  gentian, wild-cherry bark, casca-
rilla  and cinchona  barks,  create  appetite,
and nux vomica increases the muscular tone
and activity of the  stomach and intestines
and prevents flatulence.  Quinine and  fer-
ruginous  tonics, as the citrate of iron  and
quinine, the  lacto-phosphate and carbonate
of iron, and Blaud's pills produce general
vigor, improve the blood, and aid digestion.
Laxatives are essential when  constipation
exists; violent cathartics are to be avoided.
Laxative  food,  as the coarse cereals  and
ripe  fruit before breakfast,  may be tried.
Tamarinds and figs,  St. Germain tea, senna,
and magnesia may be used to stimulate the
bowels to action.   Often  active  exercise,
walking,   or  horseback riding will suffice.
Rubbing and kneading the  bowels or the
application  of electricity to the abdominal
muscles  will  cure  obstinate constipation.
Rhubarb, podophyllin,  or dried  ox-bile in
small quantities may be needed to  increase
the secretion  of bile,  aloes to unload  the
rectum, belladonna  and   nux  vomica  to
create permanent tonicity and regular action 
56
THE  FAMILY  PHYSICIAN.
of  the bowels.   A  judicious combination
of  these remedies in a  tonic-laxative pill
may be taken until  the  stomach and intes-
tines resume healthy and vigorous activity.
Saline purges are to be avoided.  But the
milder mineral waters may be taken when
acid indigestion is present or there is a per-
sonal tendency to rheumatism or gout.
  InebrFety   [Lat.  inebriare,  "to   make
drunk"],  in  the  present  acceptation of
the  term, is used to denote the diseased
condition  of the system produced by the
habitual use of alcohol.  Its synonyms are
alcoholism, dipsomania, and  oinomania.  Al-
cohol introduced into  the  circulation acts
upon, and to a certain extent destroys, the
red corpuscles of the blood,  and thus, sec-
ondarily, affects  all the organs of the body.
Its  most common mode of introduction into
the system  is in the  form of spirituous and
fermented drinks; and in those addicted to
its  habitual use  the principal lesions are
chronic hyperaemia and  subsequent soften-
ing of  the brain, cirrhosis and fatty degen-
eration of the liver, fatty degeneration of
the kidneys, and fatty degeneration  of the
heart.   Formerly, inebriety was regarded as
a crime, but within a few years science has
shown  it to be  a disease, and institutions
have been established for its treatment and
cure. Statistics from these institutions have
demonstrated—I. Inebriety is a disease, and
is curable.  II.  Relapses may or may not
occur.   The patients in hospitals for the
treatment of inebriates may be divided into
three classes—viz. I. Those who by social
indulgence,  without  hereditary taint, have
become inebriates.   These, as a  class, are
curable by  the  aid  of an  institution.  II.
Those  in whom the  disease is inherited, in
which  cases it manifests itself in paroxysms
("sprees") at variable intervals.   These are
more difficult to restore to health.  III. Those
who seem totally depraved in all their in-
stincts, and exhibit no desire  for restoration
to health.   These, as a class,  are incurable,
and should,  for the protection of society, be
placed under permanent restraint in  insti-
tutions distinct from  those of a reformatory
character.   Carefully prepared reports from
hospitals for inebriates  show that a very
large percentage (between 50 and 60) of
the patients  treated in them are restored
permanently.   (See  Delirium  Tremens,
Dipsomania,  Intoxication, Methoma-
NIA.)
  Infantile  ParaFysis, paralysis of a mus-
cle, group of muscles, a limb or side, com-
ing on suddenly in an infant or young child.
It is due to congestion of the brain or spinal
cord, often excited by the irritation of teeth-
ing, indigestion, or constipation.  Most cases
are temporary, others leave squint, club-foot,
paralysis, and shortening of a limb.  The
affected member must be exercised by knead-
ing and electricity,  to prevent its wasting
while time permits the lesion of the nervous
centre to be removed.  Cod-liver oil, iron,
tonics, and out-of-door life are the  requi-
sites.  (See articles Club-Foot and Squint-
ing.)
  Inflammation  [Lat. inflammo,  inflamma-
tum, to " kindle," filamma, " flame"], a mor-
bid process characterized by heat, redness,
pain, and swelling. The  predisposing cause
may be anything which  tends to  influence
injuriously the  animal economy—plethora
or anaemia.  When a part has once been the
seat of inflammation, it is very liable to  be
affected again under the slightest exciting
cause.   Age is a predisposing cause  of in-
flammation ; in infancy the parts most sub-
ject to become inflamed are the bowels,
pharynx,  larynx, and  brain, whereas dur-
ing adult life these parts are seldom affect-
ed, the favorite seat then being the lungs,
heart, urinary apparatus, etc.  Sex exerts
a certain  influence;  a female is  more apt
to suffer from peritonitis,  phlebitis, or cellu-
litis in consequence  of the  parturient act.
So the temperament,  food, occupation, cli-
mate, etc. all influence, to a greater or less
extent, the susceptibility of the individual
to be attacked by inflammation.  The excit-
ing causes may  be divided into  the consti-
tutional and local; the former includes all
those agents which are capable of rendering
the blood  impure, as poisonous gases, cold,
heat, etc.  The local cause is generally an
injury of some kind, either chemical or me-
chanical.  Every vascular part may be the
seat of inflammation, and usually in pro-
portion to the  amount of its vascularity.  It
also seems necessary that nerves should  be
present.  Cartilage contains no nerves and
but few vessels, and is therefore rarely the
seat of inflammation.  Epidermis,  hair, and
the nails are never inflamed, being destitute
of blood-vessels, nerves,  and lymphatics.
  Inflammation  is  generally divided into
the acute and  chronic varieties;  the former
runs a rapid course and is attended by well-
marked symptoms—pain, heat, redness, and
swelling.  These  have been given  as  the
symptoms of inflammation from   the  time
of Hippocrates.  The swelling is caused  by
enlargement of the vessels, and more par-
ticularly from serous effusion, which takes
place into the adjacent tissues;  at a later
period we have plastic exudation, which in
the end  tends to lessen  the size of a part.
The redness is a leading feature, and is due
to enlargement of the vessels  and  an in-
crease of the  coloring-matter of the blood.
Pain is not essential to"the disease—pneu-
monia and encephalitis are not painful dis- 
THE  FAMILY
PHYSICIAN.                         57
 eases—but external inflammations are  al-
 ways attended with pain, which is due to
 pressure upon the ultimate.sensitive nervous
 filaments.  Serous membranes stand next to
 fibrous structures of joints in the severity of
 inflammation, although we may have  serous
 membranes inflamed  without pain,  as in
 puerperal peritonitis.  The heat is  a  direct
 result of hyperaemia.  It is  chiefly felt in
 external inflammations;  the part  receives
 more blood, and. is consequently of  a higher
 temperature, than the rest of the surface, but
 it never rises above the  heat of the  blood.
 Acute inflammation is always attended by
 more or less fever, which may be ushered in
 by a chill.  The pulse runs  up to  100-120,
 the respirations are increased in number to
 25 or 30 per minute, and the temperature is
 raised to'102°-104° F.; the secretions are
 suppressed, and there is headache and some-
 times delirium.   Many attempts have been
 made to ascertain the exact changes  which
 take place in a part attacked by inflamma-
 tion by  artificially producing  an  inflam-
 mation in the  web of a  frog's  foot or the
 wing of a bat, and closely  watching the
 changes under a powerful microscope; these
 observations  have led to the following con-
 clusions : In inflammation the first change
 is in the ganglionic system of nerves, but
 of this system we know nothing except its
 effects.   This nervous system influences the
 various determinations of blood, as seen in
 blushing and the local temporary engorge-
 ment of nervous  women; as also  conges-
 tions, which are  not  mechanical  in  their
 cause, but  occur from a passive  state of the
 vessels.  Next we will notice the  changes
 which are seen to occur in the blood-vessels.
 There is  at  first active congestion of the
 part, and this condition is caused by inter-
 nal or external irritation.   Soon stagnation
 is observed to take place at points.  In the
 natural state the red blood-corpuscles never
 touch the  walls of  the  capillaries, but in
 inflammation  this rule no longer  obtains,
 and they begin to adhere  to  the walls  and
 to each other.   This is known as the stasis;
 as it increases the vessels continue to dilate,
 and very soon after the stasis is  established
 the  vessels begin to exude their contents,
 which make  their appearance amongst the
 tissues.   This exudation is not a coagula-
 tion of the blood as seen outside the  body;
 it is serous at first, but is soon followed by
 an effusion of lymph  or  liquor sanguinis,
 which, according  to the old theory, might
 be  organized  into false membrane or de-
 generate into pus, it depending  on  the tis-
 sues involved and the constitution of the
patient.   At  the present time, however,
Cohnheim's theory of the formation of pus
is the one generally received—viz. that the
corpuscles  are  identical  with  the white
blood-corpuscles, which are exuded through
the walls of the vessels.  In process of time
the  false  membrane  becomes  smooth.   It
has not yet been ascertained whether nerves
are formed in the tissues or not.  Two theo-
ries  are given  to account for the formation
of vessels in these new  productions—viz.
Vogel's and Hunter's.  Vogel believes that
he  has seen the membrane  itself produce
the blood, and afterwards the vessels to con-
tain this blood, and  he  says  that  finally
these new vessels communicate with the old
ones.  Hunter believes that the new vessels
are given off from the old ones.  After ves-
sels have been formed  in  these new tissues
contraction commences, and both the mem-
brane and the vessels become  smaller and
firmer.  This contraction sometimes proves
a serious matter, as in the contraction of
bands around the intestines, especially  in
the neighborhood of the rectum; the effects
of the  contraction  are also serious about
the pericardium, causing at times hypertro-
phy of the heart;  the pleura  suffers least
from it.
  The  duration and  character  of  the  in-
flammation  vary with  the condition of the
part  affected and the constitution  of the
patient.  When once fairly  established, it
may destroy life by exhaustion  or by inter-
fering with the function of some important
organ, as the lungs or heart.  It may also
terminate  in  resolution, suppuration,   or
mortification.   Resolution consists  in the
restoration of the affected part to its normal
condition without suppuration having taken
place.  It is by far the most favorable ter-
mination  of inflammatory  action.   Sup-
puration consists of the formation of a fluid
called pus,  as described above;  it is a yel-
lowish liquid, in which float numerous small
round granular corpuscles.  When the pus
is  thin, dirty, and acrid, it  is called ichor.
When suppuration continues for any length
of time, it  gives rise  to  a fever known  as
hectic fever. This  is  diurnal in character,
commencing with  a  chill,  followed  by a
fever, and  then sweating.  The chill lasts
from half  an  hour to an hour, the fever
from one  to two hours.   In a great many
cases the three stages  are not well marked,
one, or  even two, of them being oftentimes
omitted. The inflammatory action may be
so  intense  as  to deprive the  part of  its
proper supply of blood, and so  cause ulcer-
ation and  mortification  (see Gangrene);
this condition is attended by a symptomatic
typhoid fever, the symptoms of which are—
dry tongue with sordes, trembling, restless-
ness, delirium, muscae volitantes, pulse fee-
ble, small, and frequent, involuntary evacua-
tions. 
58                         THE  FAMILY  PHYSICLvN.
   Treatment of Inflammation.—We have local
 and constitutional means for combating this
 condition; sometimes one alone will do the
 work, but generally we employ them con-
 jointly.  The first thing to be done is to re-
 move the cause, if discoverable; if not, the
 bowels should  be freely moved once a day,
 and the skin and kidneys be made  to act by
 the administration of diaphoretics  and diu-
 retics.  Careful attention should be paid to
 the  diet and  regimen of the patient, and
 heat and moisture applied to the  inflamed
 part, either in the form of poultices or spon-
 gio-pyeline  or  the hot-water bath.  If the
 patient be  plethoric and  the pulse hard
 and full, it will be a great benefit  at times
 to bleed him.   This practice has been much
 decried of late, but surgeons are  not very
 averse to local blood-letting, which may be
 done by scarifications with a lancet,  by wet or
 dry  cupping, or leeches.  It seems  to afford
 instant relief to the  patient by removing
 pressure and consequent irritation of the in-
 flamed part.  Cold evaporating lotions con-
 tinuously applied are a great relief.   They
 cause the capillaries to contract, and there-
 by diminish the afflux of blood.
   Inflammation of the Bow/els. See Peri-
 tonitis.
   Inflammation of the  Brain.  See  Brain
 Fever and Meningitis.
   Inflammation  of  the  KicFneys.   See
 Bright's Disease and Renal Diseases.
   Inflammation of the Liv/er.  See Hepa-
 titis.
   Inflammation of the  Lungs.  See  Pneu-
 monia.
   Inflammatory RheiFmatism.  See Rheu-
 matism.
   Influen/za [It.; as if produced by the in-
 fluence of the stars], an essential, infectious,
 epidemic febrile disease, characterized by a
 variable degree of constitutional disturbance,
 especially nervous  depression, and  having a
 local expression in irritation and catarrhal
 inflammation of the air-passages and their
 appendages.  The name  influenza" is Ital-
 ian,  indicating " the influence "  of a prevail-
 ing  atmospheric cause.   In France it is
 termed la grippe, from agripper, to " seize,"
 indicating the sudden, precipitate  onset of
 the epidemic and  of the individual attack.
 It is also termed epidemic catarrh, epidemic
 bronchitis,  and, better,  epidemic catarrhal
 fever.  It is described as first prevailing in
 Europe in the  tenth  century, and  later  in
 the years 1311,1387, and 1403.  But its cer-
tain  and  undoubted record begins  with the
 epidemic of 1510.   Since that  time  to the
year 1875 there have been ninety-two epi-
demics, of variable severity and at irregular
intervals.  These epidemics are singularly
uniform in identity of characteristics  and in
obedience to law  of origin and diffusion.
The disease appears suddenly in the E. or
N. E., usually in the N. of Europe, excep-
tionally in the Indies or Northern Asia, and
travels to the W.   It  travels  in cycles, in-
vading the whole  of Northern Europe, of-
ten extending to America, and exceptionally
felt in the equatorial regions and the south-
ern hemisphere.  Unlike cholera, its diffu-
sion does not depend on human commerce.
Its  progress is rapid, a great wave from  E.
to W. precipitating itself upon communities
and countries with a suddenness  warranting
the names popularly applied to  it—" light-
ning  catarrh,"  "he  petit  courrier," "la
grippe."   Less often it appears coincidently
at places far removed, as at the Cape of Good
Hope and London in 1836.  In its zone  of
progress it often appears simultaneously at
many isolated foci, from which it seems to
radiate until disseminated over  vast areas.
Its influence is not confined to the continents,
but is immediately exerted  at mid-sea upon
all who sail into the districts of atmospheric
infection.   Appearing in a community, it
attacks a  majority of its members,  of both
sexes, of all ages  and social position, and
with a rapidity precluding the idea of com-
municability.  No  nationality is  exempt,
and as a rule only a fractional part of the
population escapes its effects.  It would ap-
pear to attack preferably women, next adult
males, and lastly children.   In some epi-
demics children are exempt.  During the
prevalence of influenza the animal  vitality
is lowered, the type of other diseases  is mod-
ified, assuming adynamic or typhoid forms,
and tending to a greater general mortality.
Influenza is not confined to man, but often
extends its epidemic influences  to the do-
mesticated animals, especially the horse, and
is known as the epizootic.  In  England the
epidemics of 1728, 1732, 1733, 1737, 1743,
1803, 1831, and 1837 were accompanied by
the epizootic among cows, horses, and dogs.
The pestilential epizootic extending through-
out the U. S. in 1872-73, attacking  in New
York 16,000 horses, was an epidemic of in-
fluenza, prevailing with great severity.  The
influenza is first  recorded  in America  in
1577.  The chief epidemics in Europe have
extended to this country.  The most notice-
able ones are that at the close of the war of
1812, those of 1843, of 1872, and the recent
season 1874-75,  in which  pneumonia has
existed as a frequent and fatal complication.
Of the intimate nature of the  subtle atmo-
spheric or telluric cause of influenza nothing
is definitely known.  Schonbein regarded an
excess of ozone in  the air  as  producing
bronchial  irritation.  Prout attributed  the
disease to selenuretted hydrogen.  Much has
been written of its concurrence with the ap- 
THE  FAMILY  PHYSICIAN.                         59
 pearance of comets and meteoric showers,
 and the opinion is in favor that electrical
 and magnetic disturbances of the atmosphere
 are related to the epidemics.  The advocates
 of the " germ-theory of disease " regard in-
 fluenza as due to the wide dissemination, by
 air-currents, of animalculae or cryptogamic
 vegetable products—malarial emanations.
 Ehrenberg  describes "dust-fog currents" in
 the higher  strata of  the atmosphere,  from
 which many genera of animalcules may be
 collected.  The epidemic of influenza occurs
 at all seasons of the year, often in the spring,
 and in both warm and cold, in dry and damp
 or foggy weather.  The usual duration, in
 one locality, of an epidemic is from four to
 six weeks, exceptionally much longer. There
 may be local recurrences in the same season,
 but as a rule the victims of the first are ex-
 empt from the second attack.
   As regards the disease, it is thought that
 a specific poison is absorbed and circulates
 in  the blood,  irritating the nerve-centres,
 producing prostration and  febrile  disturb-
 ance, and causing hypersecretion  and in-
 flammation of  the mucous lining of the air-
 passages.  The symptoms  vary in  severity
 in  different epidemics and in individual
 cases.  The onset is sudden, announced in
 severe cases by a marked rigor, more often
 by chill and  shivering,  alternating  with
 flashes of heat.  Then follow general lassi-
 tude, debility, nervous prostration,  soreness
 and stiffness of the limbs, pains in the neck,
 back, and loins, headache, frontal oppres-
 sion,  pain in the orbits,  cheek-bones,  and
 root of the nose, injection and sensitiveness
 of the eyes, with copious flow of tears—often
 heated, the " fiery tears " of the early records
 —sneezing and tingling, followed by watery
 and often acrid discharge  from the nose,
 soreness of the tonsils, Eustachian tubes and
 ears, experienced in swallowing, hoarseness,
 a short,  frequent, harassing cough,  with
 slight expectoration,  and a slight fever of
 the remittent form, having its exacerbation
 towards evening.  The fever is seldom pro-
 nounced, but the restlessness, irritability, ex-
 haustion, and mental depression are marked,
 and usually disproportionate to the bronchial
 complication.  In other cases there  is sore-
 ness,  tightness,  and pain beneath the  ster-
 num,  dyspnoea, sense of suffocation,  and
 danger of capillary bronchitis or pneumonia.
 These unfortunate complications  are  the
 chief  causes of death from  influenza, and
 occur mainly in the aged, in invalids, and
 in delicate  children.   The  usual duration
 of mild cases is from three to five days, of
grave cases  from seven to ten days.  The
termination of the disease is often as sudden
as its onset, and frequently  occurs with a
critical and profuse perspiration or diarrhoea.
The mortality from uncomplicated influenza
in healthy persons is very slight.   Influenza
has no pathology indicative of its specific
nature, and presents only the lesions of the
associated catarrh—tumefaction and redness
of the mucous  lining of the nose, the tear-
duct,  and eyelids, the frontal and maxillary
sinuses, of  the throat, Eustachian tube, and
membrana  tympani, of the larynx and bron-
chial  tubes, and the lesions of pneumonia
when it  exists.  The majority of cases are
mild and require no treatment.  A purge at
the outset may shorten their duration. More
marked  Cases require a preliminary purga-
tive, a low diet, the avoidance of exposure
to cold, resort to hot draughts, as of lemon-
ade or elder-bloom tea, to stimulating foot-
baths, to the use of Dover's powder, Tully's
powder,  spiritus Mindereri, or other reme-
dies to secure free perspiration, and the re-
lief of bronchial congestion  by inhalation
of steam, by ammonia, or by stimulating
expectorants. Headache and distress in the
nose  and  orbits, due  to irritation of the
Schneiderian membrane and its  processes,
may be relieved by the inunction of oil  or
grease or by the insufflation of warm  ano-
dyne  solutions.   Quinine in doses of five
grains three times a day, if taken at the be-
ginning, may cut short the attack.  When
the bronchitis  tends  to become  capillary,
quinine  or tincture of bark is indicated  to
support  the strength, ammonia to favor the
liquidity and discharge of mucus, and the
oil-silk jacket to favor free secretion.  The
extensions  of pneumonia may be limited by
arterial  sedatives, carbonate of ammonia,
quinine,  and anodyne poultices or fomenta-
tions.  It is essential to proper treatment to
remember  that blood-infection is primary
and bronchitis  or pneumonia is secondary;
the constitutional disease will admit of no
depressing  remedies, and the speedy termi-
nation of  the inflammatory  complications
will follow supporting measures.   During
epidemics of influenza the aged  and feeble
should keep within-doors in well-warmed
rooms, and partake of quinine, ammonia,
and guarded but nourishing  diet, as meas-
ures of prevention.
  IntenFperance. See Delirium Tremens,
Dipsomania, Inebriety, Intoxication,
and Methomania.
  IntermiFtent  Fe'ver, Ague,  Fever  and
Ague, an essential, periodic fever resulting
from  infection  of the blood by malaria  or
marsh-miasm.  Malaria emanates from de-
composing  vegetable matter exposed to the
action of the air and  the sun's heat.  It
exists in  swampy districts and in low, damp,
undrained places, upon the banks of rivers,
upon  inlets of salt water, where variable
water-level  and tides expose a  saturated 
60                         THE FAMILY PHYSICIAN.
 soil to the  atmosphere.   Malaria is  most
 concentrated  and intermittent  fever  most
 prevalent and severe in the tropics, where
 vegetation is luxurious, and a soil enriched
 by decaying plants  and  falling foliage is
 subjected to the extreme influences of alter-
 nate seasons of rain and drought.  In tem-
 perate regions it is present in new districts,
 disappearing  as the land is populated, cul-
 tivated,  and  drained.  It may  appear  in
 cities by the exposure of  marshy subsoil
 when excavating to build, or by the escape
 of malarial air  from defective street-sewers
 constructed  in  a swampy substratum  or
 emptying on a malarial water-course, whose
 tidal  changes  dam  back  marsh-miasm,  to
 escape in the various  quarters from which
 the sewers extend. Intermittent fever occurs
 in paroxysms separated by intermissions or
 non-febrile  periods.   The  paroxysms  may
 recur daily,  constituting the  " quotidian "
 form, or  on alternate days,  the " tertian "
 form, since  it recurs on the  third day, in-
 cluding the previous attack.  There is also
 a  " quartan " form.  Exceptionally,  there
 may be  a  " double quotidian," with one
 strong and one  mild  attack  each day; a
 " double tertian," with a  daily  onset,  that
 of every second day being  relatively weak ;
 a " double quartan," having two attacks  in
 every three  days.  Febrile paroxysms  usu-
 ally recur at a definite hour each day  or
 alternate  day.  A recurrence of successive
 paroxysms at an earlier hour for each attack
 is  termed " anticipating,"  and indicates an
 increasing malarial  influence.  When the
 paroxysms come at a later period, with suc-
 cessive attacks,  it is termed " postponing "
 or " retarding," and indicates a subsidence
 of the malarial influence.   Paroxysms may
 occur a few hours after exposure to malaria
 or after  a period of incubation as long  as
 two weeks.  A paroxysm has three distinct
 periods or stages: (1) cold stage;  (2) hot
 stage;  (3) sweating stage.  The average
 duration of the  cold stage is  one-half  to
 three-quarters of an  hour; it may be a few
 moments or two to three hours.  It begins
 with shivering,  chilliness in the loins, ex-
 tending to back and limbs, muscular tremor,
the lips quiver, teeth chatter, and the whole
body is shaken.  The respiration is sighing,
the pulse feeble, the face pale or livid, the nails
 livid, the fingers waxen and cold. The general
 surface is pale, cold, often shrivelled.   The
thermometer in the  mouth or armpit, how-
 ever, reveals an increased  temperature of
the blood even in the cold stage, the blood
having been expelled from the skin and ex-
tremities by the involuntary contraction of
the elastic tissues of the skin.  During the
first stage there is therefore a determination
of blood  to  internal  organs, which may be
 dangerously   congested,  constituting  the
 " pernicious "   or   " congestive "  forms.
 Headache, vomiting,  tenderness  over the
 liver and spleen, are symptomatic of such
 congestion.  The transition from the cold
 to the hot stage is gradual; chilliness ceases,
 flashes  of heat are  felt,  "the coldness
 melts away."   The  skin  becomes hot and
 red, pulse full and  bounding,  the  face
 flushed,  headache  increases,  the  temper-
 ature of the surface may be 105° or 106° F.
 The duration of the hot stage is from three
 to eight hours.  The third or sweating  stage
 at first is gradual; moisture appears on the
 face,  soon  on  the  trunk and extremities.
 Heat, headache, thirst, and restlessness sub-
 side, the temperature falls rapidly, the per-
 son is drowsy, falls into long and refreshing
 sleep, with profuse or slight sweating.  The
 duration of this stage is from three to four
 hours.  During the  intermissions or  apy-
 rexial periods there may be good health, or
 in graver cases impaired  digestion, debili-
 ty, pallor, or sallow, cachectic complexion.
 Malaria  impoverishes the  red corpuscles
 and  lessens the albumen of the blood.   In-
 termittent fever tends to recur when incom-
 pletely cured,  either in marked  paroxysms
 or in less pronounced " latent,"  " masked,"
 " concealed"  forms, vague symptoms  of
 chilliness and  weariness known  as " dumb
 ague," or in periodic neuralgia.  The spleen
 is often permanently enlarged, and is termed
 " ague cake."  The periodical  recurrence
 of the paroxysms is due to successive efforts
 at elimination, the interval being  the  time
 required for the zymotic material of malaria
 to redevelop and impress the system.
  The paroxysms require no treatment other
than warm drinks  and blanketing during
the cold stage, cooling drinks and sponging
during the febrile or hot stage.  The treat-
ment for the prevention of the  paroxysms
is to be in the  periods of intermission.  The
chief of remedies is the Peruvian or cincho-
na bark, and the alkaloids derived from it.
Quinine is mostly used in the form of the
sulphate and bisulphate, less often the mu-
riate. Cinchonine is an alkaloid resembling
quinine,  but  less powerful.  The mother-
liquor from which these alkaloids are pre-
cipitated is evaporated, and an impure, crude
sediment, in part quinine and' cinchonine,
and  mainly quinidia and  cinchonidia,  or
amorphous alkaloids,  is obtained, and  is
much used—known as " chinoidine."   Sali-
cine, the alkaloid of willow bark, berber-
ine, piperine,  apiol,  eucalyptus, and  other
vegetable  substitutes are  weaker and less
efficacious than quinine. Crude or unbleach-
ed quinine, an  inexpensive  article, has re-
cently been ascertained to  have the full effi-
cacy. Quinine is given either  in one full 
THE  FAMILY  PHYSICIAN.
61
dose of ten or more grains or  in  divided
doses of five grains three times a day to
break  the paroxysms,  and continued in
smaller doses for many days to prevent their
recurrence.  Fowler's solution of arsenite
of potash is second only to quinine in power.
Nitric acid, sulphites of soda, ferrocyanide
of iron, chloride of ammonium are also used.
The patient  may be more efficiently and
permanently cured  by  combining  chola-
gogue cathartics, and subsequently employ-
ing iron and tonics generally.  The preven-
tion of intermittent fever is to be sought by
soil-drainage, by  avoiding  damp night air,
and sleeping in closed rooms well above the
ground.  The sunflower freely planted ad-
jacent to dwellings has been considered pro-
tective by absorbing malaria, and more re-
cently the Eucalyptus globulus, or Australian
fever tree, has  been extensively planted  in
Algiers, at the Cape of Good Hope, and  in
Cuba, and is asserted to lessen, or even eradi-
cate, malaria by its presence.
   Intoxication [Lat. in, and toxicum, "poi-
son "], the cumulative effect of an acro-nar-
cotic poison on the nervous centres.  The
term is most  commonly used to designate
the  condition  of  a  person who has been
brought  under the influence of  alcohol by
successive  imbibitions during a short space
of time, but should  not be confined exclu-
sively to the poisoning by alcohol; opium,
stramonium, cannabis  indica, and all the
poisons belonging to the above-mentioned
class, will  produce intoxication when taken
in sufficient quantity.
   Intoxication may  be divided  into the
acute, sub-acute,  and chronic varieties.
Acute intoxication is a disease very rarely
seen, even by the physician.  It  is produced
by drinking a  large  quantity of some spir-
ituous liquor in a very short space of time.
This is followed soon afterwards by sudden
coma (loss of sense, sensation, and voluntary
motion), which may be complete or incom-
plete. We have present here the symptoms
of coma—viz.  stertorous respiration, dila-
tation of pupils, frothing at the  mouth, etc.
Unless  assistance  speedily arrives  these
symptoms  generally terminate in death  in
from half an  hour  to five or six hours.
Every endeavor should be  made to arouse
the  patient from his  lethargic  condition.
An  active emetic, as sulphate of zinc, may
be administered, or, better still, the stomach-
pump should be used to evacuate the stom-
ach.  Ammonia may be given  as an anti-
dote, and if the patient be able to swallow
he should  take large draughts of tea.  The
sub-acute form may be seen any and every
day in the week.   It is the ordinary form
of intoxication indulged in by persons either
voluntarily, for the  pleasant and exhila-
rating effect on the senses during one of its
stages, or involuntarily, Jn consequence of
a depraved appetite  growing out  of the
former method.  We  see  some men—and,
unhappily, women also—who are seldom or
never in a sober condition; others who im-
bibe a little at all times, and get intoxicated
whenever  they are under undue excitement
or depression ; and still others who " go on
a burst" once every  three, six, or twelve
months, and in the mean time totally ab-
stain from any of the intoxicants.   To this
class belong those individuals who inherit
the tendency to inebriation.  Alcohol, taken
to a degree to produce sub-acute intoxica-
tion, excites the vascular  and nervous sys-
tems ; all the secretions are at first arrested,
and the temperature of the body is lowered,
and not, as has been generally believed, in-
creased.  If taken by a person who is not
accustomed to  it, it occasions derangement
of the stomach, and  nausea  and vomiting
are  the result.  The principal effect,  how-
ever, is noticeable upon the nervous system.
There is a general feeling of increased phys-
ical power, and the mental faculties are ex-
hilarated.  The patient at first talks ration-
ally, but is very verbose and grows confiden-
tial.  Incoherence follows upon  this, and
then delirium and sopor.   The effect is also
seen on the .cerebellum by the impairment
of the power of co-ordination, causing  at
first the staggering gait, and ending in com-
plete loss of muscular power.  When this
stage occurs the individual  generally falls
into a deep sleep, from which  it is almost
impossible to waken him.  When conscious-
ness is restored there  is a feeling of depres-
sion, which the patient seeks to relieve by
a resort to stimulants.  Little  can be said
of  the palliative treatment of this variety
of intoxication.  With the exception of the
employment of emetics to unload the  stom-
ach, and  the  administration of  ammonia
and tea as antidotes, the  patient should be
allowed to " sleep it off."  (For the chronic
effect of acro-narcotic poisons see Inebri-
ety and Methomania.)
  Itch.  See Scabies.
  Jail Fe'ver, a form of Typhus (which see).
  Jaun/dice.  This is a greenish-yellow color
of the skin which is produced by the presence
of  the  coloring-matter of the bile in the
blood.  It is not a specific disease, as is gener-
ally supposed by the  laity, but a symptom,
which, taken in connection with other symp-
toms, points to the affection which gives rise
to it.  We might as well speak of vomiting,
headache, etc. as diseases:  they are not, but
merely prominent symptoms of many varied
morbid processes.  If jaundice occurs in any
great abundance, or persists for a length of
time, we find all the  secretions tinged with 
02                         THE  FAMILY PHYSICIAN.
 the bile, the urine becomes saffron-colored,
 and  the  stools,  being deprived  of their
 coloring-matter,  are  whitish.    We  may
 have jaundice produced in two ways—either
 from suppression or retention of bile; the
 former is due to some  disease of the liver
 which incapacitates it for  performing its
 function; therefore the bile, which  in the
 healthy  state of the  organ is constantly
 being filtered from the blood,  accumulates
 in it.  Jaundice  from  retention of  bile  is
 produced in this way: The bile, having been
 already formed, is prevented from making
 its way into the intestines by some obstruc-
 tion in the bile-ducts; it is therefore re-
 absorbed, and again makes its appearance
 in the blood.  The obstruction  to the ducts
 may be either external or internal.   Exter-
 nally, we may have tumors of various kinds
 pressing on the ducts, as cancer of the pyloric
 end of the stomach, of the duodenum or the
 end of the  pancreas, or a colon impacted
 with faeces.  Internally the gall-duct may be
 plugged up by mucus, or, what is far more
 common,  by  a  biliary  calculus passing
 through it;  this is accompanied by a great
 deal of pain;  indeed, it  is said to  be the
 most severe pain that  can be  felt.  Some
 idea of it may be had from a knowledge of
 the fact that the common bile-duct is very
 seldom larger than a  goose-quill, and the
 stones which  pass  through it' are  seldom
 smaller in  diameter—sometimes attaining
 the size of  a pigeon's egg.   Accompanying
 the jaundice and pain in these cases we
 have nausea, vomiting, hiccough, flatulence,
 and in the  intervals between the intensity
 of the  pain the  patient is  exhausted  and
 drowsy.  There is generally much more pain
 felt by the passage of a calculus for the first
 time  than  subsequently, as the  ducts are
 generally left distended for its successors.
 Besides the above forms of jaundice there  is
 also a malignant form, which is analogous
 to typhoid, yellow, or remittent  fever, and  is
 marked by typhoid symptoms from the be-
 ginning of the attack,  and is accompanied
 by  haemorrhages  from  the  mucous  mem-
 branes and  skin.   It  almost  always ends
 fatally.  In jaundice from suppression the
 urine only contains those ingredients  of the
 bile which  pre-exist in  the blood—viz. the
 bile  coloring-matter and  cholesterine;  in
 that from retention we  also have the bile-
 salts which  have been  formed in the liver,
 and afterwards absorbed and eliminated by
the kidneys. To determine the former, nitric
acid is generally added;  it produces a  bright
grass-green  color  with  the coloring-matter
of the bile.  The bile-salts, however,  can
only be detected by Pettenkofer's test, which
is as follows: To the suspected liquid add a
few drops of a solution of cane-sugar, and
I then slowly, drop by drop, sulphuric acid;
[ at first a red color will be produced, which
 will afterwards change to a lake, and then
 to a deep purple.
   The technical name of jaundice is icterus,
 from the Greek name of the golden  thrush,
 which, according to  Pliny, when seen by a
 jaundiced person would die and the patient
 recover.  Now, however, we treat the affec-
 tion more scientifically, looking to its origin.
 Where it is due to suppression little  can be
 done except in cases of acute inflammation
 of the  liver, but in those  cases due to ob-
 struction there is more success with it.  The
 indications are to improve the patient's gen-
 eral condition by a  proper  and nutritious
 diet.   Fats of all kinds should  be avoided,
 as they cannot be digested without the as-
 sistance of the bile.  Next, we should attend
 to the constipation from which these patients
 almost invariably suffer;  for this rhubarb,
 senna, and  aloes are  the favorites.   Opiumi
 should  be given to relieve the intense pain.
 After the removal of the obstruction we may
 hasten  the  disappearance of  the jaundice,
 and the annoying  itching  which accom-
 panies it, by steam  and alkaline baths.
   Joints, Diseases of.  See Ankylosis, Hip-
 joint Disease, Synovitis, Housemaid's
 Knee.
   Kid'ney Diseases.  See Renal Diseases.
   Laryngitis  [from  Gr. lapvys, "larynx"],
 an inflammation of the mucous membrane
 lining the larynx.   It may be divided into
 acute and chronic forms.   Acute laryngitis
 generally commences as  an  inflammation
 of the pharynx, which is  afterwards com-
 municated to the larynx, although it  does
 occur  independently in  the larynx itself.
 The cause  is  generally " a cold,"  or  ex-
 posure  to sudden changes of temperature,
 or it may  be traumatic;  and  the symp-
 toms  consist of hoarseness, a sensation of
 tickling and dryness in the throat,  and
 more  or less cough and  expectoration.
 With ordinary care  it subsides  in a couple
 of days without any medical interference,
 or at most a warm bath followed by gentle
 diaphoresis.  In very severe  cases inhala-
 tions of infusion of hops may be used every
 two or three hours with decided  advantage,
 but we should be very wary about making
 astringent  local applications with a sponge
 or brush.  Simple  chronic catarrh  of  the
 larynx  is  usually a sequela  of the acute
 form, or arises by  extension of a similar
 inflammation of the pharynx  and posterior
 nares.  The symptoms are somewhat similar
 to those of the acute form, though  not as
 well marked, and in addition there is an al-
 most constant hawking and hemming kept
 up by the patient to clear his throat from
 the continually accumulating mucus.  In 
THE  FAMILY  PHYSICIAN.                         63
 the treatment of this, as in that  of all in-
 flammations,  the  first indication is  to re-
 move all irritation, and the patient should be
 cautioned against swallowing  large masses
 of food  at a  time, or, what is a very com-
 mon practice in this country, partaking of
 very warm dishes, followed by large draughts
 of ice-water.  All the food taken  should be
 of equable medium  temperature, neither
 too hot  nor too cold, and  the inhalation of
 hot and cold  air and  noxious vapors, dust,
 etc. should be avoided as much as possible.
 Besides  all this, the general health should
 be by no means neglected, and local medica-
 tion seems to be very beneficial.  Standard
 solutions of  nitrate of  silver, sulphate of
 copper,  perchloride of iron, iodine, etc. are
 those most commonly used; they seem to
 produce a better result when changed from
 time to time,  and  the  application  should be
 made by means of a camel's-hair brush from
 twice to five or ,six times weekly.
   Laryngeal  phthisis  occurs in connection
 with pulmonary  phthisis;  the symptoms
 differ little from  those  of an ordinary la-
 ryngitis, but  upon  examination the carti-
 lages are found thickened, and often there
 is  ulceration  affecting both them and  the
 cords.   Syphilitic  laryngitis  exists  as a
 manifestation of that dire affection, syph-
 ilis.  It is principally  from the previous
 history of the case  and an exploration of
 the chest that we differentiate it from la-
 ryngeal  phthisis.  Sometimes the destruc-
 tion  of  tissue is appalling.  In the latter
 two varieties the chief reliance must be
 placed on the constitutional treatment of
 the disease of which they  are but symp-
 toms ; but still, local medication should not
 be ignored.   In ulcerative laryngitis, from
 whatever cause, powdered iodoform  seems
 to  have  the  most  beneficial  effect.    (See
 Throat Diseases.)
   Lead/-Poisoning, a diseased condition re-
 sulting from the presence of a considerable
 amount of lead in the system.  This condi-
 tion is induced in various ways: (1) By the
 use of lead pipe for the conduction of drink-
 ing water. Happily, a large proportion of
 the waters used for drinking and cooking
 have not the power to take up lead in solu-
 tion, but there can be no doubt that a very
 great number  of cases of lead-poisoning are
 induced in this way.  (2) By the use of lead
 pipes in  racking off wines, cider, and  beer ;
 by  the use of  lead-lined  chambers in soda-
 water apparatus and the like.  It is  very
 certain that the use of leaden siphons  for
 drawing  cider and vinegar from  the  cask
 is  a very common practice among farmers
 and dealers in the FT. S.; and a dangerous,
senseless, and  even criminal, practice it un-
doubtedly is.   (3) By the use of lead paints;
hence the name "painter's colic" applied to
one symptom of lead-poisoning ; plumbers,
type-setters,  and operatives  in  white-lead
works are often its victims.  Symptoms.—
These are (1) pain, often intense, in the ab-
dominal region, with constipation, some-
times, though  rather  rarely, accompanied
by acute inflammatory  symptoms;  (2)  a
blue line visible on the gums near  the roots
of the teeth;  the gums and teeth often foul
and tender; the breath offensive, the mouth
having  a  metallic taste;  (3)  sometimes
icterus  or jaundice—the skin dark rather
than  yellow;  the  patient usually looking
pinched and haggard;  (4) there  is a certain
proportion of  cases  which  have  "lead-
palsy,"  affecting primarily the extensors of
the  wrist.  This   is  the  affection  called
"wrist-drop," though  wrist-drop  is some-
times seen with no  other indication of lead-
poisoning.  Lead  rheumatism  sometimes
occurs,  and disease of the brain  from lead-
poisoning, while delirium, convulsions, and
coma are not unknown, but these forms  are
rare.   Treatment.—Opium is the sheet-an-
chor in ordinary lead-poisoning.  It relieves
the pain, and even at times the obstinate
constipation of this disease.   Cathartics are
extremely  useful,  except when  there  is
much tenderness of the bowels.  In such
cases their use should be deferred for a time.
Iodide of potassium is  prescribed in chronic
cases, and is believed to assist in  the elimin-
ation of the metal.   Sulphuric acid and the
sulphates are administered with a view to
precipitating lead from the circulation.
  Lep/rosy [Gr. Xerrpa, "leprosy"], "an in-
curable constitutional  disease of adult life,
which is especially prevalent in tropical and
sub-tropical climates."  (Robert Liveling.)
It may be divided into three forms, as fol-
lows : "First. Macular leprosy, character-
ized by an eruption  on  the  skin, accom-
panied  by anaesthesia.   Second. Anaesthetic
leprosy, of which  the chief  features  are
anaesthesia and discolorations of  the skin
and atrophy of the muscles, with ulceration
and mutilation of the hands and feet.  The
third form, or  tuberculated leprosy, is cha-
racterized by a bronzing  and tuberculated
thickening of the  skin, especially of the
face, ears, hands, and feet, followed by simi-
lar changes in the mucous membrane of the
upper part of  the alimentary and respir-
atory tracts, ending fatally in from two to
fifteen years, by intercurrent disease in some
vital organ."   (Liveling.)
  Leprosy, or elephantiasis Grozcorum, is  a
disease  which has  been  known  and justly
dreaded from  the  earliest ages.   We find
frequent mention of it  in the Bible, but the
disease as there spoken of evidently includ-
ed many other skin affections, which at that 
64
THE  FAMILY  PHYSICIAN.
time they were unable to differentiate.  The
proof of this is that the cases are there men-
tioned as having recovered, which we now
know would have been impossible had they
been true leprosy.  The leper has always
been an outcast  from  society, both on  ac-
count of  the  loathsomeness of his disease
and the idea which has prevailed of its con-
tagiousness.   During the Middle Ages nu-
merous  leper-houses were established  in
various parts of Europe, where those suffer-
ing from the disease were confined, and pro-
hibited by law from appearing in the streets.
Now, however, that it is known that the dis-
ease can only be transmitted from parent to
offspring,  the  laws are more  lax on  this
point, and a leper-house is  a  thing seldom
heard of.  At the present  time leprosy is
most prevalent in Syria and Egypt, and the
cases  met with  throughout  Europe  and
America are rare.  Almost every drug in
the pharmacopoeia has  been  used in the
treatment of this disease, but without avail,
and now the treatment  is principally palli-
ative.  Good food, clothing, and the pre-
vention of marriage amongst lepers are the
only means we possess to better  their con-
dition and decrease their number.
  Leucocythae'mia  [Gr.  Aevudg,  "white,"
Kvrog,  "cell," and dc/na, "blood"], or  Leu-
chaemia,  a disease of the  human subject,
characterized by a very great excess of the
white cells in the blood, and by  a corre-
sponding diminution of the proportion  of
red corpuscles.  It is accompanied by en-
largement of the spleen or of some of the
lymphatic glands, or of both, and cases are
reported accompanied by disease of the me-
dullary mass in the bones, which mass takes
on, or perhaps normally possesses, the lym-
phatic function.   In  some  cases the white
blood-cells are not to be distinguished from
the normal ones;  in others they are smaller
and accompanied by free nuclei  and gran-
ules.  The liver is frequently  enlarged.  A
haemorrhagic diathesis  is often  developed.
The patient wastes away and becomes anae-
mic.  Of  the  causation* and  cure of this
disease nothing is known. It is always fatal,
but often chronic.
  Leucorrhcea [Gr.  Aevadg, "white," and
'peu, to "flow"],  the  "whites," a catarrhal
flow from the vaginal or  uterine mucous
membranes.  This disease is  an exaggeration
of the normal mucous secretion, and is often
consequent upon a somewhat  inflammatory
condition of the mucous membranes.  Rest,
the use of iron and other tonics, and astrin-
gent washes  are often  highly  beneficial.
Sometimes the catamenia assume a leucor-
rhoeal character, especially towards the close.
The cervix uteri  is often involved in a sub-
acute or chronic inflammation,  which not
unfrequently is best treated by local caustic
or other applications.
  Lith/ic-Ac/id Diath/esis, a name given to
that condition of the general system which
favors the production  of lithic acid or its
salts in the urine.  It has been, and  still is
by  many, regarded as a  peculiar diseased
state  in which the acid or its salts are pro-
duced in the blood, and separated  therefrom
by the kidneys;  but  those taking an oppo-
site view hold that the salts are formed in the
urine, either in the pelvis of the  kidney or
the bladder, but always after it has been ex-
creted ;  also, that the peculiar condition of
the system favoring it is one of mal-assimi-
lation.  Lithic or uric acid occurs in the
urine as small crystals  of an amber color,
varying in diameter from ■5-03j31yt;li to x^th
of an inch ;  they are usually either lozenge
or drum shaped.  It may also exist in com-
bination with ammonia, soda, or lime, form-
ing the urates of those bases.  The  urates
form  the sediment generally  found in the
urine in nearly all acute inflammations, fe-
vers, gout, rheumatism, diseases of the liver,
etc., and they indicate a highly acid condi-
tion of the fluid, by which they are precipi-
tated  from those substances which should
hold them in solution.   When deposited in
any part of the urinary tract they  may form
into gravel or stone. (See Calculus.) Treat-
ment should be corrective. The aliment has
not been properly assimilated; in  four cases
out of five abuses at the table are the source
of the trouble.
  Liver, Diseases of.   See Ascites, Cal-
culus,  Colic,  Gall-stones, Hepatitis,
Jaundice.
  Lockjaw.  See Tetanus.
  Locomotor Ataxia. See Tabes Dorsalis.
  Loss of Voice. See Aphonia and Throat,
Diseases  of.
  Lumba/go [Lat.], or Crick in the Back, is
a sub-acute rheumatism, often very severe,
and seated in the lumbar region.  Strong
liniments, rubbing with the hand, the ap-
plication of the electrical brush,  and cup-
ping are all useful.
  Lung  Fe'ver.   See Pneumonia.
  Lu/pus  [Lat., "wolf"], a disease of the
human  subject, most commonly  attacking
the face, and beginning in nodules in the
skin.  Sometimes this disease is observed in
syphilitic or scrofulous patients, but in many
cases no predisposing diathesis can be found.
It usually  attacks the young after puberty,
and is rare  after the age of forty.   It  is
roughly divided into lupus exedens, or de-
vouring lupus,  and  lupus non  exedens, in
which there is no ulceration; but in  this
last form  there  are sometimes  neoplastic
growths in the integument, which degener-
ate and  shrink away, horribly distorting the 
THE  FAMILY  PHYSICIAN.
65
face.  There are many minor varieties known
to the surgeon.   True lupus, if neglected,
becomes one of the most  dreadful of dis-
eases, destroying  the tissues as completely,
and often  far more rapidly,  than cancer.
Happily, it is commonly a much less  pain-
ful disease, and it is so far local that if thor-
oughly destroyed by caustics there is room
for hope  of permanent recovery. If the
disease  should return the application  of the
caustic  must be  repeated.   Cod-liver oil,
iodine applications,  and general tonics are
often useful.
   Mala'ria.  See  Intermittent Fever,
Miasma, Remittent Fever.
   Malig/nant Diseases.  See Cancer.
   Malig'nant Sore Throat.  See Diphthe-
ria.
   Malig'nant Pustule, a disease communi-
cable from the lower animals to  man (and
especially from horned cattle), though some-
times, apparently, originating in man with-
out contagion.  It is apparently the same as
" black quarter " in  neat cattle and " mur-
rain " in sheep.  It sometimes attacks those
who handle  the  hides,  and  especially the
hair, of the lower  animals; and is believed
to  be  sometimes propagated by insects,
which,  flying  from the  animal   which  is
diseased, may alight upon some abrasion or
pimple on the skin of a human subject, and
thus transmit the disease.  In its inception
it  resembles a boil, or sometimes  a carbun-
cle, seldom very painful; the pustule soon
becomes the seat of gangrene, sometimes
emitting a remarkable  fetor;  there  is an
intense fever, with  profound septic symp-
toms ; and unless  active treatment be em-
ployed  death is certain  to follow; which,
indeed, is often the case with the best treat-
ment.   To be effectual the treatment should
be undertaken early.  But, unfortunately, it
is  often impossible to distinguish the disease
early,  unless it assumes  a quasi-epidemic
character, as sometimes happens.  The use
of powerful caustics upon the pustule, with
general stimulants, tonics, and concentrated
food, is sometimes effectual in saving life.
   Maras/mus, consumption of the bowels,
abdominal phthisis,  is a wasting disease of
the entire body, dependent upon scrofulous
or tubercular degeneration of the mesenteric
glands.   It is chiefly a disease of  children,
especially the bottle-fed, those in  asylums,
or  illy cared for.   It  often coexists with
the presence of tubercles  in the  lungs  or
tubercular  meningitis, and  frequently is de-
veloped by the exhaustive influence of a
difficult dentition or persistent summer diar-
rhoea.  The prognosis is always bad.   The
treatment is  entirely nutritive.  Fresh air,
the seaside, abundance  of  pure milk, rich
diet, cod-liver oil by the mouth and by in-
unction,  and tonics  may save some cases.
More often  the emaciation is progressive,
and the patient dies of exhaustion or in the
coma and convulsions of associated brain
trouble.  The  enlarged mesenteric glands
can often be distinctly felt.
  Marks. See  Birth-marks and N^evus.
  Mea/sles  [Lat. morbilli],  (Rubeola), the
most frequent of the eruptive fevers.  It is
met with chiefly in the young (rarely in the
first half year of life) and in such adults as
have not contracted it in childhood.  Most
people are affected  but once in  a  lifetime,
but the  cases of second,  third, and even
fourth  attacks,  are  not uncommon.   Its
contagion is most effective about the time
when the eruption  first shows itself, but it
remains  active  until the skin has  been re-
stored, by peeling (desquamation) and suc-
cessive  development, to  its  normal  state.
The eruption  consists  of small  elevated
reddish  spots  (like a  raspberry),  which
merge  into  each other, and form discolora-
tions of the size of  a pea to that of a dime-
piece, interrupted by normal white skin.  In
from eight to twelve days after contagion
a number of premonitory symptoms develop,
such as  cough  (loose or  barking),  languid
eyes, nasal  catarrh, headache,  and fever.
At  the end  of  four  days the  eruption ap-
pears, first on temples, forehead, and cheeks,
progresses downward a day or two, and dis-
appears in about four days.  The skin will
peel off in very  small scales (not in  flakes as
in scarlet fever), and be in a normal condi-
tion after a week.  Meanwhile, the cough will
become looser, the discharge from nose and
bronchial tubes less, and fever subside. The
large majority  of cases run this mild and
normal course with a very small mortality.
But there are cases  and  epidemics accom-
panied with great danger in consequence of
complications.  The main danger lies in the
accompanying  inflammation of the bron-
chial tubes  and  lungs, which may prove
fatal in  a short time,  or result  in  chronic
inflammation  and  consumption.   Besides
these, inflammation of throat, ear (not so fre-
quently as in scarlatina), eyes, and  kidneys
may remain behind.  As  these affections
are very  serious, every  case, no matter how
mild,  ought to be seen once or twice by a
physician.   The usual treatment  of mild
cases consists in rest in bed from three  to
eight  days,  moderate  darkness, and cool
temperature (67-68° F.) of the room, cool-
ing beverages.  AVhere cough is  obstinate a
child of two years  may  take twenty-five
drops of paregoric or one grain of  Dover's
powder  at bed-time.  In some cases  there
is a difficulty  in regard to distinguishing
measles from scarlet  fever, especially where
the former  is  also  complicated with sore 
66                         THE FAMILY PHYSICIAN.
throat of a simple or diphtheritic character.
The ushering-in symptoms belonging to the
respiratory organs, such as described above,
are characteristic  of measles, while scarlet-
fever symptoms take hold of mouth, throat,
and the digestive tubes in general.
  Meningi'tis  [Lat. meninges, "membrane,"
and  -itis,  an  affix denoting  "inflamma-
tion"], inflammation  of the  membranes
which envelop the brain and spinal cord,
termed cerebral, spinal, and cerebro-spinal
meningitis  according as the inflammatory
process is limited  to the region of the cere-
brum  or brain, the region of the cord, or
involves the investments of both.  Acute
cerebral meningitis results from injuries of
the head, as fractures and diseases of the
cranial bones, inflammation  and suppura-
tion of the  middle and  internal ear, from
excessive mental labor, from perverted states
of the blood, as in typhus fever and acute
rheumatism.   Sub-acute or secondary men-
ingitis, of less intensity, occurs  in many of
the febrile diseases.  The tubercular men-
ingitis  of children is the result  of mal-
nutrition of the blood or of actual tubercle
of the brain.  Spinal meningitis most often
follows injury or  disease of the vertebrae,
less  frequently  is excited  by  rheumatic,
gouty, and tubercular blood states.  It  may
occur, as among soldiers in the field, from
exposure in sleeping on the ground.   Cer-
ebro-spinal meningitis is usually epidemic,
and is but one manifestation of a malignant
febrile disease, the cerebro-spinal or spotted
fever.   Acute meningitis is treated locally
by  cold applications and counter-irritants,
internally by remedies reducing the action
of the heart.  In  secondary meningitis we
treat the  primary  disease,  the  exciting
cause.  Tubercular meningitis requires im-
proved hygiene,   diet, tonics,  and altera-
tives.  Cerebro-spinal  meningitis  requires
nourishing diet, tonics, and  stimulants to
resist  the  degenerated  blood state,  and
opium is  pre-eminent in curative effects.
(See Brain  Fever.)
  Menta'gra.  See Barber's Itch.
  Methomania [from the Gr. yidv, "wine,"
and  y.avia,  "mania"], irresistible desire or
morbid craving for intoxicating substances.
(See Dipsomania, Inebriety.)
  Mias/ma [Gr. /niaaua, "stain," from fiialvsiv,
to "contaminate"], an emanation, especially
that from the earth in low marshy districts,
which is capable of penetrating the human
system, and producing therein certain mani-
festations of disease.  It probably consists of
cryptogamic growths, the product of veget-
able fermentation.   It is never generated un-
less the average temperature of the day is 60°
F., and sometimes a much higher tempera-
ture is required, as in yellow fever, which
 never occurs below 80° F.  Another thing
 necessary for its  production is moisture,
 hence we do  not  find  it in dry or  sandy
 regions.  Besides these, it is essential that
 there should  be vegetation;  accordingly,
 we find  it in the extensive marshes of warm
 latitudes, and not in high and cold  regions.
 Exceptions to this rule may be found in the
 Dismal  Swamp and  in the bogs of Ireland,
 which do not produce it.  New alluvial soils,
 when there is a subsoil  of clay, are espe-
 cially adapted to its production.  Miasmatic
 diseases  may  and do occur where miasm is
 not produced, as it may be carried from one
 place to another by  rivers, and  it seems to
 be more prevalent on the eastern than on
 the western bank.  It is also  found at the
 mouths  of rivers.  The drying up of an in-
 undation is apt to reproduce it where it has
 previously existed.  It is formed  about mea-
 dows that have been flooded for the purpose
 of cultivation.   A wet  season followed by
 dry  weather  is eminently productive of it,
 but  a continuous  wet  season not  so.  In
 miasmatic  regions turning up the soil will
 give rise to this poison in  great  abundance.
 In the  excavation of the Erie Canal  the
 fever was renewed  in regions where it had
 ceased.  Mill-ponds when low produce miasm.
 It can be conveyed  by the wind over level
 surfaces for several miles.
   The circumstances which are unfavorable
 to the production of miasm are—1st, high lat-
 itudes and altitudes.   Mountain-regions are
 generally free from this disease.   Primitive
 forests  are  little subject to miasmatic affec-
 tions, but whether this is due to the shade or
 to absorption  by the leaves is not  known.
 Free ventilation diminishes the danger, and
 the more stagnant the air the  more concen-
 trated will be the poison.  Obstacles may
 be interposed to cut off  the miasm.   A
 screen  of trees will  very often  preserve  a
 house from malarious influence;  this is true
 also  of hills.   Inundation appears to drown
 it out for a time,  but as  soon as the water
 disappears  it  returns.  Cultivation  of the
 soil  while  continued will drive away the
 miasm.   The drainage of  marshes is a pro-
 tective measure, although it requires some
 years to exhaust it.   This is very strikingly
 illustrated in  the drainage of large  cities.
 Cold has the power  of destroying it, and
 when miasmatic diseases  occur in  winter
 they are due  to exposure during the pre-
 vious season.   Certain  plants growing  in
 the marshes  have  the power  of destroying
 it.  Night  adds to the power  of the poison
 —day dissipates it.   No  point  in the his-
 tory of  miasm is probably better  settled
 than this.  It is known to be more  active
 on  the  ground  than on  neighboring  ele-
i vations,  and  the upper stories of a  house 
THE  FAMILY  PHYSICIAN.                         67
 are safer than  the  lower.   Many persons
 suffer from  miasm  without having fever;
 these  persons lack mental and physical
 power;  the  countenance is pale, and the
 period of life is shortened.  The influence
 of the poison may be seen even in animals
 which are  fat enough, but  certain diseases
 of the viscera appear when they are pre-
 pared for market.  Miasmatic  fevers may
 return any number of times.  Quinine will
 both cure and prevent them.   (See Inter-
 mittent Fever.)
   Menierre's Disease. See Ear, Diseases of.
   Milk Fever, a name  applied by midwives
 to a short febrile attack which sometimes
 attends the beginning  of the milk-secreting
 process, a  few days after childbirth.   It  is
 sometimes  ushered in  by  profound and
 rather alarming chills, but is unimportant
 except as  sometimes simulating the onset
 of puerperal fever, for which it is occasion-
 ally mistaken.  Farmers and veterinarians
 apply the name to puerperal peritonitis of
 the lower animals, and to a severe form of
 cerebro-spinal meningitis which sometimes
 attacks cows after calving.  The last-men-
 tioned disease is treated  by cathartics, mer-
 cury,  aconite, and heat to the spine;  the
 former,  by  opium,  aconite, mercury, and
 hot abdominal  fomentations.
   Milk Leg.  See Phlebitis.
   Mortification.  See  Gangrene.
   Mouth, Diseases of.  Inflammation of the
 mouth is designated stomatitis.  Simple sto-
 matitis or catarrh of the  mouth results from
 the irritation of decayed teeth, of hot or cold
 food or drinks, of chemical  or medicinal ir-
 ritants, and by using tobacco and pipes.  It
 occurs in infants during dentition; they may
 cease to nurse, and the irritation of the sen-
 sitive  nerves of  the mouth may cause reflex
 spasm or convulsions.   Its symptoms are  a
 sense  of burning, tenderness, tension, foul
 taste, the adherence of viscid  mucus, and a
 diffuse redness.   The  treatment comprises
 the frequent cleansing of the mouth by cold
 water, alkaline gargles, as of carbonate of
 soda, and the correction of the known cause.
 Ulcerative stomatitis appears in points upon
 the tongue,  the interior of the  lips and
 cheeks, where mucous  glands  have been
 obstructed, swollen, and ulcerated,  or in-
 flamed in the courses  of catarrhal stoma-
 titis.   Aphthae, or croupous stomatitis, pre-
 sent small white spots  with red borders,
 known as canker, and erroneously termed
 blisters or vesicles.  They contain no fluid.
 The white  spot  is a, fibrinous patch of in-
 flammatory  exudation  upon  the  mucous
 membrane.  This soon is thrown  off, leav-
 ing a  painful excoriation.  Aphthae  occur
most  often  among* teething children  who
are poorly  nourished.  The spots may be
  numerous and isolated, or coalesce in irreg-
  ular patches.  Their  treatment is by diet,
  correcting  indigestion, and chlorate of pot-
  ash  as a specific.  Diphtheritic  stomatitis
  or cancrum oris,  sloughing  inflammation of
  the mouth, results from salivation and from
  defective hygiene in  asylums for orphans
  and foundlings or among soldiers in barracks.
  With modern hygiene it has become infre-
  quently contagious or epidemic.  The first
  appearance of  diphtheritic matter  should
  be  cleared away,  chlorate  of  potash hero-
  ically employed, the patches cauterized with
  nitrate of silver, and the strength vigorously
  sustained.  Scurvy causes stomatitis of vari-
  able severity.   Nursing  children contract
  primary syphilitic ulcers of the mouth from
  infected mothers or wet-nurses. Muguet or
  thrush, erroneously termed aphthae, is a para-
  sitic disease.  It occurs  in infants  during
  the first month of life, and in adults only
  preceding death by slow, exhaustive disease.
  In  these  two states  the  mouth is much
  opened to  the  air, which dries  secretion,
  and mastication  is  slow.  The parasitic
  plant  Oidium albicans gains entrance and
  attachment.  It develops  at first in white
  frosty patches on the  tongue and  sides and
  roof of the  mouth.  It  consists  of round
  spores  and delicate  filaments. Later, the
  patches are thick, curd-like,  and  yellow,
  due  to fatty degeneration.  The deposits
  should  be  removed and the  exposed sur-
  faces  kept clean and bathed  with  a solu-
  tion of sulphite of soda.
   Mumps  [Dutch  mumms].  This is  one of
  the infectious and contagious diseases, and
  belongs to the  same  class with  whooping
  cough, measles,  scarlatina,  etc. It is often
  met with when the two latter are prevailing.
  In  some localities with a  moist  and  cold
  climate it is very frequent (endemic).  The
  principal  sufferers are  cbildren  (mostly
  male)  of from seven  to fourteen years, but
  adults  are  not  exempt.  Its period of pre-
  paratory development  (incubation)  lasts
  from one to three weeks; its principal symp-
  toms are—moderate fever;  pain on pressure
  over the region of the parotid gland, mostly
  of the  left side  (but  of the opposite side
  also, and  sometimes  of both) in front of
  and below the ear; considerable swelling of
  that region and the whole  cheek and chin;
  difficulty in deglutition and respiration, cor-
  responding Avith the  amount  of  swelling;
  change of the voice;  fulness of the head;
  and  dizziness.  In  many cases the  spleen
  and  numerous  lymphatic  glands are  also
  tumefied.   In men the testicles and seminal
  glands, in women the ovaries,  may  also
  swell, and catarrh of the mucous membranes
  of the  eyelids, nose, and  mouth is not un-
|  frequent.  The disease lasts from a few days 
6s
THE  FAMILY  PHYSICIAN.
to a week; the swelling will subside grad-
ually ;  in some cases, bowever, the parts
remain large and hard;  in a few an abscess
will form.  The treatment is simple.  Reg-
ulate the diet, give  less meat, more milk,
gruel, fruit; vegetable acids (lemonade) or
dilute muriatic acid  (ten to fifteen drops in
a tumblerful of water) as a beverage, mild
purgatives (Rochelle salts,  seidlitz powder,
cream of tartar).  The best local applica-
tions are raw cotton  and cold water; warm
water or poultices only when an abscess has
commenced to form.  No internal treatment
except quinine when  the fever is high,  and
iodide  of potassium  when  induration  re-
mains behind.  It is  understood, however,
that such treatment ought to be under the
superintendence of a physician.
  MyelFtis [Gr. pvEA6g, "marrow"], inflam-
mation of the  substance of the spinal cord.
At  the beginning of this century nearly all
affections of the spinal marrow were classi-
fied under the title myelitis, but some prog-
ress has  been  made in separating these va-
rious diseases.   Our knowledge is, however,
as yet very imperfect, and in the classifica-
tion offered below there are doubtless some
errors.  Forms of myelitis may be best class-
ified, according to the  product of the in-
flammatory process, into softening myelitis,
purulent myelitis, hyperplastic myelitis, and
degenerative myelitis,  (a.) The first of these
forms, softening myelitis, is closely allied to
non-inflammatory softening  (from throm-
bosis, embolism,  etc.), and  it  is  probable
that future researches will reduce the fre-
quency of  its  recurrences.  After death a
small part of the spinal cord, usually a seg-
ment involving all its columns and the gray
matter, is found softer than usual, or even
in a semi-fluid state, reddish or reddish-yel-
low in  color, sometimes white or yellowish.
The substance of the spinal marrow is dis-
integrated, and a  microscopic examination
shows the presence of altered nerve-fibres
and cells, granular  bodies, fatty  detritus.
The symptoms during the life of the patient
consist in impairment or loss of the power
of motion and of sensibility in all parts of
the body below the softened spot.  For ex-
ample, a focus of myelitis in the middle
dorsal  region  will cause paralysis of the
lower limbs (paraplegia)  and of the blad-
der and  lower bowel; a focus in the upper
cervical  region will  produce palsy of the
entire  body except  the diaphragm.   The
symptoms may be developed rapidly, with
pain and spasm, loss of function being com- j
plete in a few  days, or during many months
the patient complains of increasing numb-
ness, loss of  sensibility and  power.  The
prognosis i^ worse in proportion to the acute- j
ness and  to the higher location of the focus. ]
Treatment  occasionally arrests the disease,
but probably never cures it.   (b.) Suppura-
tive myelitis is exceedingly rare, and we do
not know any symptoms which can serve to
distinguish it from any acute myelitis.  The
purulent matter is collected in the shape of
small abscesses, or purulent  elements  are
found diffused among the nervous fibres and
cells,   (c.) Hyperplastic myelitis is relative-
ly common, and is  that which gives rise to
the various forms of "sclerosis."   The in-
itial lesion  in these cases is increased activ-
ity and volume of the neuroglia or frame-
work  of the spinal cord, with consequent
wasting of the nervous anatomical elements.
Later,  products of degeneration  appear in
the shape of granular and amyloid bodies.
The affected portion of the spinal cord is
found hardened, like boiled white of egg or
soft cartilage; it is grayish  or yellowish in
color, and presents a translucent instead of
the normal dead-white appearance.   The
microscope shows  increased neuroglia, dis-
integrating nerve-fibres and cells, granular
bodies (especially around the blood-vessels),
and amyloid bodies.  Sclerosis of the spinal
cord may be classified, according to its dis-
tribution in the organ, into  (1) striped scle-
rosis, which may extend upward and down-
ward in any of the columns—in the posterior
columns producing the disease clinically
known as locomotor ataxia; in the anterior
or antero - lateral columns  produce  para-
plegia, with loss of motion alone or chiefly;
in the lateral part of the antero-lateral col-
umns giving rise to contracture of the limbs.
There may be (2) a limited sclerosis, involv-
ing the several  columns and the gray matter
at any part of the spinal cord, producing a
chronic paraplegia;  and (3) nodular (or in-
sular) sclerosis, sclerose en plaques, in which
the disease affects a  number of spots upon
or in the spinal cord (and brain), the nod-
ules being  distributed in a wholly irregular
manner.  The symptoms produced by nodu-
lar sclerosis  are very irregular, depending
upon  the location  of the first and of the
largest nodules; there are observed loss of
power  and sensibility (rare)  in the limbs,
mental  and sensorial symptoms,  (d.) De-
generative  myelitis includes two  principal
forms: (1)  a parenchymatous inflammatory
(?) change in nerve-fibres  or ganglion-cells;
and  (2)  the changes which  occur in the
spinal  cord in consequence of a  lesion in
the brain or in the spinal  cord.  Finder the
first head are to be classed those changes in
the anterior horns of the spinal cord which
give rise to paralysis  accompanied by wast-
ing of the affected muscles, or to wasting of
the muscles primarily; acute, sub-acute, and
chronic spinal paralysis  (infantile spinal
paralysis, spinal paralysis with atrophy in 
THE  FAMILY  PHYSICIAN.
6(J
the adult), progressive muscular atrophy,
labio-glasso-pharyngeal palsy.   The  lesion
consists in a clouding and granular disin-
tegration of the ganglion-cells  of the ante-
rior horns, with some as yet ill-understood
change in  the  substance in which they are
imbedded.  Occasionally this lesion involves
the greater part of the anterior horns in a
longitudinal  way, and soon leads to death
by  asphyxia (acute  ascending palsy).  In
some of these forms sensibility is relatively
little impaired, in others not at all.  The de-
generative myelitis which is caused by some
other lesion of the nervous centres consists in
wasting of the nerve-fibres and the deposit
of numerous amyloid and granular bodies.
  Myopia  [Gr. pwj,tn "close," and ui/;, the
"eye"],  short-sightedness, due to excessive
convexity of the cornea or to  convergence
of the visual axes of the  eyes.  It  is pro-
duced  by excessive use and straining of the
eyes, or impaired health and nervous excit-
ability, which  disorder the motor muscles
of the eye, and the "accommodation" or
tension of the eyeball,   determining the
convexity of the cornea.  But the bad habit
of holding books  or other objects too near
the eye, especially with children at  school
and with  artisans,  is the  most frequent
cause.   It  is to be remedied'  by disuse or
rest of the eye, corrected habits, and appro-
priate glasses.   (See Sight, Defects of.)
  Near-SighFedness.  See Myopia.
  Nae'vus,  points or patches of variable size
on various  parts of the surface of the body, of
blue or purplish venous hue. These are often
congenital, and are termed birth-marks, and
frequently  have a fanciful resemblance to
persons or objects  which  appeared to or
alarmed the mother previous to the child's
birth.   Such marks often  present only dis-
coloration, due  to a venous capillary net-
work,  without  vessels  of  perceptible size.
Naevi,  as a rule,  are perceptibly vascular
and elevated; they can be emptied of their
blood by pressure with the finger, and again
fill  when the pressure is withdrawn.  Naevi
are treated by puncture with the white-hot
needle,  by caustics, compression, electroly-
sis, styptic injections, and excision.
  Necro'sis [Gr. vinpuoic, a "killing"], the
death of a  large piece of bone or of a whole
bone in the  living subject, as distinguish-
ed  from caries, the ulceration or molecular
death of bone.  Necrosis may result from in-
jury,  from periostitis, from  phosphorus-
poisoning,  and  from syphilis.  It may be
superficial, central, or total.  Necrosis almost
always calls for surgical interference  for its
complete cure.   The dead  bone finally sep-
arates as a sequestrum from the  living bone,
and until  it is  quite detached it is worse
than useless to attempt to operate.   The
sequestrum is usually enclosed in a case of
new bone, which must be cut through before
the removal can take place.   If the patient
be young and otherwise healthy, the removal
of the sequestrum is usually followed by re-
covery.   In all cases a generous diet, with
appropriate tonic treatment, is called for.
  ' Nerv'ous Diseases, affections of the ner-
vous systems, which are either organic or
functional; i. e. diseases produced or accom-
panied by an anatomical alteration which
can be recognized with  the naked eye or the
microscope, and such as are  caused by mor-
bid states not accompanied by any such
alterations.   It  is,  however, probable  that
intimate chemical  changes, not to be recog-
nized with our present means of observation,
occur in  organs which  are  " functionally "
diseased.  The growth  of physiological and
psychological knowledge  in  the  last few
years has caused  mental affections to be
classed with nervous diseases.  Besides these
there are  the  following principal morbid
states (many of which  are treated of separ-
ately in this  work  under appropriate head-
ings) : anaemia, hyperaemia, mal-nutrition of
the great nervous  centres;  hysteria, spinal
irritation, epilepsy, chorea,  neuralgia, teta-
nus, catalepsy; inflammations of the brain,
spinal cord,  and nerves  (and their  enve-
lopes);  tumors and injuries of the same;
apoplexy.  It should be borne in mind that
many nervous diseases, so called,  are  only
expressions of general pathological states or
sympathetic reactions to local morbid states
of non-nervous organs.  It  has been taught
that certain nervous diseases, such as insan-
ity, hysteria,  epilepsy, etc., become more fre-
quent with increasing  civilization.  This is
not fully established, and yet there can be no
doubt that the strains of social life, the strug-
gle for existence, the enormous striving of
ambition, the intemperate use of sensual grat-
ifications, cause the above diseases in a more
or less direct manner.  Nervous diseases—or,
more exactly speaking, the liability to nerv-
ous disease—are very easily transmitted from
parents to their children, this being most
strikingly shown in insanity, hysteria, epi-
lepsy, neuralgia, apoplexy.   An important
factor in the development  of  nervous dis-
eases is wrong education, the cultivation of
the mental powers during the age of growth,
not enough rest, and insufficient (especially
fatty) food being allowed.   The evil effects
of school-life are seen in both sexes, though
perhaps more often in the female. Mens sana
in corpore sano is not  a mere adage, but  a
physiological truth.  (See articles on special
nervous  diseases, viz.,  Apoplexy, Brain
Fever, Catalepsy, Chorea, Concussion
of the  Brain, Cruveilhier's Disease,
Delirium  Tremens,  Duchenne's  Dis- 
70                         THE  FAMILY  PHYSICIAN.
 ease, Epilepsy, Facial Neuralgia, Fa-
 cial  Paralysis,  Hemiplegia,  Hydro-
 phobia, Hysteria, Infantile Paraly-
 sis, Lead-Poisoxing, Meningitis, Meth-
 omania,  Myelitis,  Neuralgia,  Neu-
 ritis,  Paralysis, Paralysis  Agitans,
 Paraplegia,   Progressive  Muscular
 Atrophy,  St.  Vitus's  Dance,  Scriven-
 er's Palsy,  Spinal Diseases,  Stupor,
 Sunstroke, Tabes  Dorsalis (locomotor
 ataxia), Tetanus, Vertigo.)
   Nettle-Rash, or Hives [Lat. urticaria], con-
 sists of elevations of the skin of the size of
 a pea or a bean, or larger.  These elevations
 are usually white, or white with a red centre,
 or white with a  red margin, or red or white
 with a small vesicle in the centre.  The dis-
 ease is of an acute character; the elevations
 spring  up  quite suddenly, and  disappear
 after hours or days.   Frequently  they re-
 turn ; some people do not get rid of the pre-
 disposition  to them for  many  years.  The
 anatomical condition of the skin is that of
 an inflammation with effusion.  The cause
 of this is either external or internal.  Ex-
 ternal causes are contact Avith nettles, the
 influence  of insects,  a hot bath, the sun.
 In  predisposed persons gentle pressure with
 the finger, friction, or slight irritation, suffice
 to produce it.  Internal causes  are such  as
 irritate the  nerves  of the digestive organs,
 the genito-urinary organs, or the blood-ves-
 sels ; certain articles of food, such as cham-
 pagne, beer, sausage,  strawberries,  raspber-
 ries,  currants, oysters; medicines, such  as
 quinine or cod-liver oil.   A general irrita-
 bility of the nervous system may produce it.
 Not infrequently, therefore, it sets in with
 fever, sometimes with a  chill, always with
 burning and itching.  The treatment is sim-
 ple, but not always efficient.  Locally, the
 use of glycerine, cold-cream, mild solutions
 of carbolic acid in water.  The diet must be
 regulated—no coffee, spice, beer, not much
 meat.  The  stomach must be improved by
 alterative treatment or bismuth or muriatic
 acid, according to circumstances. Mild pur-
 gatives will  be beneficial.
  NeuraFgia [Gr. vevpov, "nerve," and dlyog,
 "pain"].  Pain  in the course of a  nerve is
 a symptom  of  many morbid  conditions.
 The track and distribution of a cerebral,
 spinal, or visceral nerve may be the seat of
the  pain, which is sharp,  occurs in par-
 oxysms repeated  at  intervals of  a  few
seconds or  a day,  the pain between the
 aroxysms disappearing  or being replaced
 y soreness  or dull pain.  The suffering is
 often very intense.  One curious feature of
neuralgic pain is its occurrence on one side
of the body  only at any one time.  Usually
no redness or inflammation is visible in the
affected region, though an exception to this
I rule is observed in neuralgia of the face,
 during attacks of which the eye  is red and
 lachrymose.  The  parts which are the seat
 of pain are usually over-sensitive during the
 paroxysms, and numb between them;  there
 may even be loss of sensibility.  Along  the
 track of the affected nerve one or more ten-
 der points are  usually  found.  Neuralgias
 are divided (1) on  the basis of their distri-
 bution,  (2)  on the  basis of  their  causes.
 The former, or topographical  classification,
 includes   the  following  varieties  among
 others:  facial,  occipital, brachial,  inter-
 costal  neuralgia, sciatica.   According  to
 the  second  or  aetiological   classification,
 there are—malarial, gouty, anaemic, hys-
 terical  neuralgias; neuralgias  from injuries
 to nerves, from inflammation of nerves, and
 from disease of the  nervous  centres.  Be-
 sides, in the present state of science, there
 are cases of neuralgia for which no cause
 can  be  made  out—idiopathic  neuralgia.
 The rational treatment of  neuralgia con-
 sists in  treating the  pathological' states
 which cause it.  For the immediate relief
 of neuralgic pain the best remedies are  (1)
 the external application of the  hot-water
 bag, chloral-camphor,  oil  of  peppermint,
 aconitine ointment, and lotions  containing
 aconite, opium, and chloroform, and in some
 cases local leeching  or blistering;  (2) the
 internal  administration  of anodynes,   as
 chloral, opium, belladonna.    Electric cur-
 rents give immediate relief in many cases.
   IMeurFtis [Gr. vsvpov, "nerve"], inflamma-
 tion of nerves.   Neuritis may  be localized,
 but tends to extend  above  and  below the
 starting-point;   it may  lead  to myelitis.
 Peri-neuritis is that form of inflammation
 of nerves  in which the general sheath of
 the  nerve and the circumjacent  connective
 tissue are the  seat of trouble.  The nerve
 appears to the naked eye larger, reddened,
 oedematous, and may be  unnaturally  fixed
 in its bed of connective tissue.  The causes
 of peri-neuritis  are partly unknown; cold
 may cause it, as well  as injuries, and it is
 possible that the gouty disposition produces
 it. The symptoms of neuritis are pain, numb-
 ness, loss of function, expressed by paralysis
 and anaesthesia.
   Nose-Bleed (technically, Epistaxis).  It is
 usually due to a ruptured  vessel of small
 size on the mucous surfaces  of the nostrils.
 It may occur where the nostrils have been
 thinned or eroded by the bad habit of pick-
 ing  the nose, by the erosion of the  surface   >
 by catarrhal ulceration, or by a determination   j
 of blood to the head, inducing  rupture of a
 vessel.  The hitter  occurrence  is the result
 of a too full habit, an excited circulation as
 in active children, or  from excitement, vio-
 lent exercise, or overheating by the sun, and 
THE  FAMILY PHYSICIAN.
71
 of hypertrophy and dilatation of the heart.
 Nose-bleed also results from blows on the
 nose.   It occurs in typhoid fever and other
 low diseases, where the blood is depraved.
 Nose-bleed is to be checked by rest on the
 back, cold to the nose, the use of cold water,
 tannin and cotton in  the  nostrils; when
 severe a physician should be called  to plug
 the nostrils from the mouth.
   Nostrils, Diseases  of.   The nostrils or
 nares  are divided into the anterior nares,
 which  can be  seen by external  inspection
 of the  openings of the nose, and the pos-
 terior nares, to be seen only by  aid of small
 circular mirrors placed in the back of the
 throat to reflect light, admitted through the
 mouth, to  the nasal  cavities above.  The
 most common  of their  diseases is  catarrh.
 Nasal catarrh  is produced by  cold  air, by
 insufflating dust, or by irritants.  It is the
 beginning of many cases  of laryngitis  and
 bronchitis.  It is the chief catarrhal condi-
 tion in influenza, in which  disease catarrh
 extends through the nasal ducts to the eyes,
 the Eustachian tubes  to the  ears, and into
 the frontal  sinuses.  Simple recent nasal
 catarrh produces a watery, alkaline  serum.
 When more pronounced the catarrhal flow
 is  less  serous, contains  mucous corpuscles,
 and is viscid or even tenacious—is yellowish
 and purulent in color.   Chronic  catarrh
 may result in constriction of the anterior
 nares,  in  the  development  of  exuberant
 granulations, and polypus.  In the posterior
 nares, by  extension to  the throat, it more
 often results in permanent or obstinate naso-
 pharyngeal catarrh.  Such chronic  catarrh
 may give rise only to habitual coughing and
 hawking of mucus, but  it often impairs the
 hearing by tumefaction at the aperture of
 the Eustachian ducts or by extension to the
 middle ear.   Nasal polypus is  an attached
 tumor in the nostrils, originally a small pro-
 jecting mass of granulations or enlarged
 glandular  tissue.   When chronic nasal ca-
 tarrh has  resulted in ulceration and death
 of the cartilages or bones of the nose, the
 discharge is often offensive, and  is  known
 as ozaena.  Close examination will discover
 particles  of necrosed  matter.    Ozaena is
 more often the result  of nasal  catarrh in
 strumous, tubercular, and syphilitic persons.
 Epistaxis or Nose-Bleed (which see) is the
 result of local causes, as irritating or pick-
 ing the nostrils; it is a frequent occurrence
 in  persons  having  disease of  the   mitral
 valve of the heart;  it is a symptom peculiar
 to typhoid fever; it is often due to excessive
 exercise and to excitement.  The catarrhal
 diseases of the nostrils are treated by topical
 applications, inhalations, and sprays. Ozae-
 na demands the insufflation or injection of
antiseptic washes  or the surgical removal
  of dead bone.  Polypus  is removed by cut-
  ting or tearing.   Nose-bleed  is checked  by
  cold applications on  the nose, by plugging
  the nostril with lint, or the introduction of
  styptics, as tannic acid, pernitrate and per-
  sulphate  of  iron.   In  extensive bleeding
  from  the  nose  the  nostrils  have  to  be
  plugged from behind.
    Obes/ity [Lat. obesitas; synonyms, Poly-
  sarcia, Corpulence], an abnormal  deposit of
  adipose  tissue  under the integument and
  around the viscera.  The amount of adipose
  tissue in the  organism may be considerably
  augmented without giving rise to any incon-
  venience on  the part of the individual in
  the way of encumbering his  movements or
  interfering with the functions of the viscera,
  etc.;  but such  a condition would  not come
  within the scope of this article.  It is still
  a condition of health, and the term obesity
  should only be  applied to those cases where
  the deposit of fat is so great as to incommode
  the patient.   Of the causes of obesity we
  may  mention, first, hereditary susceptibility.
  It is  not at  all uncommon to meet certain
  families in which most of the members are
  corpulent,  and sometimes the  tendency to
  become so may be traced through several
  successive  generations.   Inactivity and se-
  dentary occupations exert a very material
  influence  over  the production of fat, es-
  pecially  when  combined with  a  rich diet.
  In women  the predisposition to corpulence
  exists in the first years of child-bearing, and
  again after the  " change of  life;"  in men,
  between the  ages of  forty and sixty.  The
  exciting cause is generally found to 'be mal-
  assimilation,  due to some derangement of
  the digestive organs.  We mostly find it in
  individuals who indulge in a rich diet, and
  especially if it contains fatty matters.  Ar-
  ticles  abounding in sugar and starch and
  alcoholic and malt liquors seem to favor the
  production of fat to no  inconsiderable ex-
  tent.   The symptoms of obesity  may  be
  enumerated as follows: Diminution of men-
  tal  and bodily activity, impeded action of
  the viscera, the organs of respiration, circu-
  lation, and digestion.  The  slightest exer-
  tion will  bring on panting; the blood is
  comparatively deficient in quality and quan-
  tity, and, as  a  result, the muscles become
;  weak and flabby.  The countenance becomes
|  bloated and  sallow, and the patients are
j  liable to suffer  from a variety of affections
  which depend on mal-assimilation, as gout,
  rheumatism, etc.   Often fatty degeneration
  of the heart or liver  coexists, and we then
  have the symptoms of these maladies super-
  added.  Mr. Harvey has shown, in his late
 work  on corpulence, that the  senses of hear-
 ing, taste, smell, or sight are often absent
 altogether  or blunted to a very  annoying 
72                         THE  FAMILY PHYSICIAN.
  extent in corpulent  persons.  In the treat-
  ment of obesity alkalies internally and al-
  kaline baths have long occupied  a promi-
  nent place, and even at the present advanced
  stage of medical science we hear physicians
  daily prescribing  small doses  of  soda, po-
  tassa, etc. with a view to procure  a saponi-
  fication  of the fat  in  the interior of the
  body.   Such a course of treatment is simply
  ridiculous.  If a jockey wishes to " condi-
  tion" a horse that has  acquired too  great a
  deposit  of  adipose  tissue, the course he
  adopts is a well-known  one, and is pursued
  also by  professional pedestrians, gymnasts,
  etc.  It  consists of a regulated diet and sys-
  tematic exercise in the open air.   The case
  of corpulence treated successfully which has
  gained  the greatest notoriety is that of Mr.
  Banting.  He  adopted  a  regular  course of
  dieting,  in which there was an absence of
  fatty, starchy, and  saccharine matters.  This
  should  be rigidly  adhered to, and in addi-
  tion no  alcoholic or malt  liquors should be
  partaken of  whatever.  Both body and
  mind should be exercised daily.
    Odontalgia.  See Toothache.
    OphthaPmia  [Gr.  b<p6aAfi6g,  "eye"], in-
  flammation of the eye.  This term,  once
  widely  comprehensive,  is now  usually re-
  stricted to inflammations  of the membrane
  lining the eyelids  and covering the exposed
  surface of the  eyeball,  the conjunctiva.  It
  is divided into (1) catarrhal, (2)  granular,
  (3) purulent.
     Catarrhal Ophthalmia, or conjunctivitis, is
  the mildest form of inflammation of the con-
  junctiva.  It may be caused by over-use of
  the eyes, by the application of the catarrhal
  discharges of " sore eyes," by the contact of
  dust, smoke, or any irritating substance, by
  riding in the wind, or  by " catching cold."
  Its most common symptoms are inability to
  use the eyes, an itching, smarting, or burn-
  ing sensation, an unpleasant dryness of the
  eyes, or, on the  other hand,  an unusual
  quantity of mucous secretion,  causing the
  lids to adhere  to each other.  The eyeballs
  usually become red, and upon  everting the
  eyelids  their  lining membrane  is  found
  to be still more reddened.  This affection
  does  not imperil  the eyesight if properly
  treated.
    Granular Ophthalmia, or granular lids, as
  it is popularly called, is a much more serious
  affection. It may be brought on by any of the
  causes which produce catarrhal ophthalmia,
  and is also contagious, being carried  from
  eye to eye througb  the medium of towels,
|  wash-basins, etc.   It  is  characterized by
  numerous small elevations  or  granulations
  upon the conjunctiva of the lids, producing
  a roughness.  These granulations act as  a
  foreign  body, and  by rasping the sensitive
surface  of  the cornea  during the act  of
winking produce a superficial  inflammation
of the cornea called pannus.  The sight is
then  obscured, the  eyes  are  lachrymose,
painful  and  sensitive  to  light, and some-
times,  resisting  all  treatment, go  on  to
hopeless blindness.
  Purulent Ophthalmia, or conjunctivitis, is
a more dangerous disease.  About 10  per
cent,  of the eyes affected with it are lost.
It is  usually  produced by  contagion,  but
may come from " a cold."  It  is character-
ized by  great swelling and tenderness of the
eyelids, and by a very  copious  discharge of
a thick, purulent secretion from between
the lids.
  The first  of these affections—viz. catar-
rhal ophthalmia—usually demands very lit-
tle treatment beyond simple cleansing of the
eyes with tepid water.   Maltreatment often
aggravates  the affection.  Every  form  of
poultice, such as  bread and water or  milk,
alum  curds,  slippery elm, etc., should  be
scrupulously avoided,  as  they weaken  the
inflamed membrane  and  convert a simple,
self-limiting malady into a destructive one.
The "best eye-wash" in existence is water
containing in solution common table-salt in
the proportion of a teaspoonful to the pint.
Its  effects  may  be  indefinitely varied by
changing its temperature from 32° to 100°
F.,  and usually the patient may be allowed
to choose that temperature which  gives the
most comfort.  In granular ophthalmia long
and careful treatment is required at skilful
hands.  In purulent ophthalmia the treat-
ment must be prompt and vigorous from the
start.   In that of infants almost  incessant
cleansing is needed;  and here the best wash
is warm water, followed once or twice a day
by a solution of one or  two grains of nitrate
of silver dissolved in an ounce of pure water,
or five or ten grains of alum  in the same
quantity of water. Competent advice should,
however, be early sought to apply more act-
ive measures in bad cases.  In the purulent
ophthalmia of adults, whether "Egyptian"
or gonorrhoeal, active  treatment  is needed
early—leeches, ice, nitrate of silver. Where
the lids are much swollen, and  by their stiff-
ness and weight  prevent  free cleansing or
the easy escape of pus, an incision at  the
outer  angle of the eyelids horizontally down
to the temporal edge of the orbit should be
early made.   Such an incision "lets blood"
freely, and  relieves the eyeball from dam-
aging pressure.   The  occurrence  of catar-
rhal, purulent, or granular ophthalmia in a
school, reformatory, or other public institu-
tion among children or adults is usually due
to ignorance or carelessness on the part of
some one responsible for  the police of said
institution, and should be subjected to rigid 
THE  FAMILY
PHYSICIAN.
7 o
inquiry and  correction.   Many  scores of
children contract eye diseases in the schools
and  reformatories of our large cities which
ultimately  result  in  hopeless   blindness.
Overcrowding and insufficient   provisions
for isolating initial  cases  are  mainly to
be blamed for  this  sad  result.  So great
is this evil  in some of the large institutions
that it becomes a grave question whether it
would not  be well to scatter the inmates in
rural families that are ready to take them,
and abolish the  institutions.
  OtaFgia.  See Ear, Diseases  of.
  Otorr'hcea.   See Ear, Diseases of.
  Ova/rian Drop/sy, accumulation of aserous
and albuminoid  fluid  in cystic enlargements
of the Graafian  follicles of the ovary.  The
ovarian cyst  may  be single (unilocular) or
multiple (multilocular).  In some instances
it  exists free in the  abdominal  cavity; in
others by pressure it  has excited numerous
inflammatory adhesions.  The swelling ap-
pears  at first on one or other side of the
abdomen, but, increasing, occupies the me-
dian  portion, and  increases in size with the
accumulation of fluid until the abdomen
may equal  or exceed the size of the abdo-
men in pregnancy, large uterine tumors, the
dropsy of cirrhosis (see Ascites), Hydatid
(which see),  or the  cancerous  fatty-waxy
liver.  Ovarian dropsy is to be distinguished
from the above conditions.
   Before the modern operation of "ovario-
tomy," or extirpation of the sac, the prog-
nosis was bad.   Death finally resulted from
exhaustion, unless  relieved in exceptional
cases  by tapping  or accidental rupture.
Ovariotomy  was  first  performed  by an
American  physician and  surgeon,   Dr.
Ephraim   McDowell.  At  first  attended
with  great mortality, now, by the  aid of
improved  methods  and  instruments,  the
antiseptic method,  and trained nurses, the
mortality is  light.  A great  majority re-
cover.  Dr. Spencer Wells  of London has
performed  ovariotomy nearly  one  thou-
sand  times.  The  late Dr. Atlee of Phila-
delphia had  operated on a larger  number
of cases than any American surgeon.  The
late Dr. Peaslee of  New York ranked  high
in number of cases and favorable results.
One or more exploratory tappings are made
before operating, to give relief to  the pa-
tient  and verify the  diagnosis.   Dropsy of
the broad ligament in general appearance
resembles ovarian dropsy, but differs as re-
gards the quality of the contained fluid and
the result of operation.
  Ovariotomy.   See Ovarian Dropsy.
  Oxalu/ria [Lat., "oxalic urine"], a mor-
bid condition of the  general system which
favors the constant excretion of oxalic acid
by the kidneys.  It  is also known as the
oxalic-acid diathesis.   At the present time
the members of the medical profession are
divided in  regard  to their opinions on this
subject, some believing in such a condition
constituting in itself a disease, others regard-
ing it merely as a result of mal-assimilation ;
that is, " a derangement in the act by which
living bodies appropriate and transform into
their own substance matters with which they
may be  placed  in contact."  (Dunglison.)
The latter view is perhaps the correct one,
for we generally find those persons who have
a constant  and large deposit of oxalate of
lime in the urine suffering more or less from
dyspepsia.   They  are  restless and  uncom-
fortable during the digestion and assimila-
tion of their  meals, are troubled with flatu-
lence and eructations, and, as a rule, they
are more or less hypochondriacal.  The ad-
vocates of  the belief  that the oxalic-acid
diathesis constitutes in itself a disease give
the following symptoms as accompanying
the excretion  of oxalate of lime: Emacia-
tion,  nervousness,  painful susceptibility to
external impressions,  and hypochondriasis.
The patients are incapable of exerting them-
selves in the least without suffering from fa-
tigue ; they are irritable and easily excitable;
and there is more or less impotence.  A
prominent symptom is a severe and constant
pain  or  sense of  weight across the  loins.
The above train of symptoms undoubtedly
very frequently co-exist with the presence
in the urine of oxalate of lime;  the major-
ity of them are the symptoms of dyspepsia,
and may be present without the occurrence
of oxalate of lime, and, conversely, oxalate
of lime may be produced in immense quan-
tities without any of these symptoms  being
present.  Thus, we may have calculi of the
salt repeatedly formed both in the pelvis of
the kidney  and in the bladder.  We also
repeatedly find oxaluria occurring in phthi-
sis, heart disease,  bronchitis, rheumatism,
anaemia, cirrhosis, cancerous diseases, and
even in a state of perfect health.  Especially
is this the case if we do not examine the
urine for twenty-four hours after it has been
passed, as  during  that time the mucus in
the urine putrefies and communicates its
alterations to the rest of the fluid, and lactic
and oxalic  acids are produced from some of
the undetermined animal matters contained
in the excretion. As fast as the oxalic acid is
formed it unites with  the lime Avhich is in
solution  in the urine, and thus oxalate of
lime  is produced.   This oxalate of lime is
entirely insoluble in water and in the urine,
even  when heated to the boiling-point, so
that it is difficult to understand how it could
have  been  held  in solution previously, and
it surely could not have been excreted by the
kidneys in any other condition.   Oxalate of 
74                         THE  FAMILY
PHYSICIAN.
   lime occurs in the urine in the form of minute
   octohedral or  dumb-bell-shaped  crystals,
   varying in size from a ten-thousandth to a
   thousandth of an inch in diameter.  The for-
   mation of oxalic acid in the blood is occasioned
   by the mal-assimilation of certain articles of
   diet, especially those containing sugar, but in
   exactly what manner has not yet been de-
   termined  by physiologists.   Hence,  sugar
   and all saccharine matters should be avoid-
   ed  as much  as possible.  Attention should
   be  paid to the general health, and particu-
   larly to the digestive organs.  As medicines,
   nitro-muriatic acid, given  either  alone or
   combined with tonics, and laxatives seem to
   be the favorite remedies.
     Ozae'na [Gr. o^aiva, from ofriv, to " have an
   offensive smell"], a disease of the nose, cha-
   racterized by a discharge of fetid muco-pur-
   ulent matter from the nostril.   It may de-
   pend  upon  caries, and may be a symptom
   of cancer, syphilis, glanders, or scurvy. It
   often  follows scarlatina, or even  a severe
   cold.  General tonic treatment,  good food,
   and weak local disinfectants are indicated
   in simple ozaena; but if there be caries, or
   any specific  disease of which it is a symp-
   tom, such a disease will require attention.
     Painter's Colic.  See Colic and  Lead-
   Poisoning.
     Palpitation [Lat. palpitatio; Fr. palpita-
   tion ;  Gr. ■jzaAfidg;  Gcr. Herz/clopfen].  The
   heart usually performs its  important work
   without attracting any attention, the person,
.   to use a common phrase, " not knowing that
   he has a heart." The perceived and forcible
   beatings  are  called " palpitation."   It may
   occur in a healthy as well as in a diseased
   heart, caused by physical exertion, mental
   excitement, the use of tobacco, flatulent dys-
   pepsia, a watery state  of the blood  (anosmia
   or hydroozmia), or a sense of palpitation may
   arise from increased nervous sensitiveness,
   without any real increase in the force of the
   heart-beats;  while on the other hand, in
   enlargement of the heart the beats may be
   very strong, and yet not be recognized, ex-
   cept by an external examination.  In hyper-
   trophy and  in fatty  degeneration of the
   heart palpitation is a  common occurrence,
   generally coming in paroxysms, lasting from
   a few minutes to some days, with equally
   varying intervals. The extract of nux vom-
   ica  and the tincture of aconite are much re-
   lied on to subdue the  excited heart when it
   is diseased, while secondary palpitation in
   the healthy heart is treated by removing the
   cause.  (See  Heart Diseases.)
     PaFsy.  See Paralysis.
     ParaFysis [Gr. trapalvEiv, to "relax"], im-
   pairment or loss of voluntary or  normal re-
   flex motion through defective nervous ex-
   citation.   This definition excludes cases in
which the voluntary power of motion is lost
by reason of injuries or diseases of muscles,
bones, joints, etc.  Sometimes paralyzed parts
are the seat of involuntary  (reflex) move-
ments, which may be  very  extensive and
powerful.  It is not proper to apply the term
"paralysis" to the condition  of loss  of sen-
sibility.  Any part of the body containing
muscular fibres, striated or unstriated, may
be paralyzed.  Thus, we have  paralysis  of
the heart, of the  arteries, of  the bowels,  of
the limbs, or of the muscles of the face, the
eyeball, etc.  Paralyses are classified in two
ways, according  to  their distribution, and
according to the morbid conditions  causing
them.  I"nder the first head there are hemi-
plegia (palsy of one-half of the body longi-
tudinally), paraplegia (palsy of the legs and
lower half of the body), general paralysis
(palsy of  the whole  body),  glossoplegia
(palsy of the tongue), etc.   Under  the sec-
ond head are cerebral paralysis  (caused by
disease of the encephalon), spinal paralysis
(produced  by disease of the spinal cord),
peripheral  paralysis  (caused  by disease  of
the nerves),  functional  or reflex paralysis
(not caused by material disease of nervous
organs), and toxaemic paralysis  (induced by
the presence of a poison in the blood).  (See
Hemiplegia, Infantile Paralysis, Pa-
ralysis  Agitans, Paraplegia, Progres-
sive  Muscular Atrophy, Scrivener's
Palsy.)
  ParaFysis Ag'itans, or senile palsy, an in-
voluntary tremor of  the whole body, or ex-
ceptionally of a part, due to old age, to pri-
vation and  exposure  to cold, and also to the
ennervating  influence  of alcoholic  abuse,
opium, tobacco,  coffee,  tea.  There is  no
true paralysis or  loss of motor  power, but
continuous tremor, due  to malnutrition  of
the nervous centres.  It need  not  shorten
life.   It is amenable  to rest, warm clothing,
good diet, and tonics.
  Paraplegia [Gr. TrapaTrlrfaoEiv, to " strike
beside"]  paralysis of the lower limbs and
(usually) of the lower part of the trunk, in-
cluding the.bowels and bladder.   There may
be anaesthesia (loss of sensibility) or  dysaes-
thesiae (morbid sensations) in the same parts.
Although the limbs are not under the con-
trol of the will, they are often  the  seat  of
strong movements of an involuntary or re-
flex  character.   The cause  of paraplegia
nearly always is  a disease in or about the
spinal cord, in any part below the medulla
oblongata; usually, the  lesion is in the dor-
sal or lumbar part of the organ.  (See Mye-
litis.)  The same symptoms may  appear,
without gross disease of the spinal cord, in
consequence  of irritation in  some external
part, of the action of cold upon the body,
disease of the  bowels,  etc. 
THE  FAMILY PHYSICIAN.
   PericardFtis.  See Heart Diseases.
   Peritoneum.  See Peritonitis.
   Peritonitis  [Gr.  nEpiTeivEtv,  to  "stretch
 over"],  inflammation of the peritoneum, a
 serous membrane investing the viscera  of
 the abdomen;  popularly designated  " in-
 flammation of the bowels."  The peritoneum
 has two  layers, and constitutes a closed sac;
 the external layer lines the abdominal walls;
 the internal is reflected over  the stomach
 and intestines, liver, spleen, ovaries, uterus,
 and bladder.   These opposed  surfaces are
 smooth  and lubricated  by secreted serum,
 permitting  the free movements of the vis-
 cera, their ascent and descent in respiration,
 and the peristaltic movements of the bowels.
 Traumatic peritonitis is the result of bruises,
 wounds, and surgical operations,  idiopathic
 peritonitis is a primary inflammation; it may
 result from perverted conditions of the blood
 or from checked perspiration  and chilling
 of the abdomen or lower extremities.  Local
 peritonitis is a  frequent occurrence, the in-
 flammatory process  being limited to the
 peritoneal investment of a single viscus,  as
 the liver, uterus, or ovary.  Puerperal peri-
 tonitis, or metro-peritonitis, is inflammation
 of the uterus  and peritoneum  occurring  in
 women following confinement.  (See Puer-
 peral Fever.)  Tubercular peritonitis is
 chronic  and slowly progressive, consisting
 in the deposition of successive strata of in-
 flammatory lymph, alternating with miliary
 tubercles, with interspersed masses of caseous
 matter, or yellow tubercle;  tubercle usually
 coexists  in the  lungs  and other organs.
 Acute peritonitis, as  a  rule,  is of sudden
 onset.   Abdominal  pain is its  prominent
 symptom, at first localized, but quickly dif-
 fused over the  entire abdomen.  The pain
 is increased by pressure, by the movements
 of respiration, and by tension of the abdo-
 minal muscles.  The breathing is therefore
 chiefly thoracic, the diaphragm fixed to pre-
 vent abdominal movement, and the respira-
 tion is correspondingly shallow, restrained,
 and rapid.  The limbs  are retracted upon
 the body to relax tension of the  abdominal
 surface.  There is  temporary paralysis of
 the muscular  coat  of the bowel; constipa-
 tion results, also extreme flatulent distension
 of the intestines, and general tumefaction
 of the abdomen, which,  when percussed, is
 resonant—a condition termed  tympanitis.
 The inflamed surface is so extensive, invests
 so many important organs, producing ex-
 tensive  peripheral  nerve-irritation as well
 as impressions on the plexuses  of the sym-
 pathetic  nerve,  that the  constitutional de-
 pression  is very marked.  The face is pale,
 haggard, and  anxious, wearing an expres-
sion of great suffering.  The teeth are set,
the lips  tightly drawn,  the  eye  set  and
sunken,  the  cheeks collapsed—in extreme
cases constituting the Hippocrafic fades, or
fades griffe"  of the French.  Peritonitis is
always a dangerous disease, but its termina-
tion will depend upon early diagnosis and a
correct treatment, conducted with vigor and
persistence.   When  incipient, it may  be
aborted or limited by local use of ice or cold
water, local dry cupping,  cardiac  sedatives,
as  veratrum  and  digitalis,  and a   single
prompt saline purge.   If fully developed,
opium is the supreme remedy, to allay pain
and secure absolute rest  of  the  intestines
from their physiological  peristaltic action.
In peritonitis the tolerance of opium is very
great.  The cold  water or ice-pack, if judi-
ciously used, will be  of  value during  the
acute period  of the disease, but later warm
and anodyne applications are preferable.
The diet during the disease should .be liquid,
and cathartics should be avoided.
  PhlebFtis  [Gr. flty, <plE(i6g, "vein," and
-itis, affix denoting inflammation], inflam-
mation of the  coats  of  a vein or  veins.
Phlebitis may occur in any part of the body
from direct injury and accidental or surgical
wounds.   Idiopathic  or  primary phlebitis
occurs  chiefly in  the lower  extremities,
especially in the tortuous expansions and
dilated pouches of varicose veins.  When a
vein is inflamed its contained blood coagu-
lates, adheres to  the walls of the vessel;  a
local fibrinous mass (thrombus) obstructs or
wholly  suspends  the  circulation.   Excep-
tionally, this thrombus organizes, connect-
ing  with the nutritive capillaries of  the
venous  coats.   More often  it  partly  or
wholly breaks down, disseminating pus and
contaminating the blood,  or giving off par-
ticles which are carried by the blood  to the
different parts of  the  body, and may lodge
in the small vessels of large organs, occlud-
ing them.  Such plugs or  emboli  deprive  a
tract of tissue of its nutritive blood-supply,
and lead to the condition of fatty degenera-
tion or abscess.  Phlebitis, if acute, may be
announced by chills and febrile disturbance
preceding  the local   inflammation.   The
affected vessels are hard, tortuous, promi-
nent, visibly  elevated. if the surface be
viewed in profile.   There is a dusky redness
over and in  the  immediate vicinity of the
vein, with slight tumefaction and  redness
of an  erysipelatous character,  shading off
into adjacent tissues.  Nodular prominences
exist at the site of the valves in the  veins.
The vein is sensitive to touch, and the entire
part tender and painful if moved.  CEdema
or dropsical swelling,  evidenced by pitting
upon pressure, may result from the obstruct-
ed circulation ;  in the extremities this  swell-
ing  may be considerable, with sense of great
weight, due to accumulated  venous  blood 
76
THE  FAMILY  PHYSICIAN.
and serous transudation.   Following child-
birth, phlebitis occasionally occurs, usually
in the lower extremities, due to local throm-
bi  following the perverted  blood of the
puerperal state, and probably resulting from
absorption of septic matter by  the open
uterine sinuses.  This painful condition  is
known as, phlegmasia alba dolens, and popu-
larly termed  "milk leg."   Indeed, at pres-
ent the  infection  of the  blood  by septic
matter and local thrombosis as the causes
producing  phlebitis  is generally  conceded.
Phlebitis and venous thrombosis are chiefly
interesting as  endangering  embolism in
other parts of the  body, metastatic  ab-
scesses.   The "multiple  abscesses" of the
liver follow inflammation of the venae portae.
Coexisting abscesses in the brain, lung, liver,
spleen, and kidneys  may  develop  from  a
general poison of the blood.  When a vein
is enlarged and  rigid, as in the sinuses of
the cranium, the veins of old haemorrhoids,
or stricture of the rectum, or the varicose
veins of the  leg, its  inflammation  is very
liable to  infect the system.   The treatment
of phlebitis will be by local antiphlogistics
and internal administration  of  antiseptics
and tonics.
  Phlegmasia (synonyms, Phlegmon, Phleg-
monous Inflammation, Pseudo-erysipelas, Dif-
fuse Abscess), an acute inflammation of the
subcutaneous cellular tissue, tending to sup-
puration, in  which  the  pus  formed has a
tendency to become infiltrated through the
tissues, instead of collecting into one place,
as in ordinary acute abscess.  The causes of
this variety of inflammation are sometimes
very obscure.  It has often been ascribed to
infection or  an ordinary  cold,  but these
causes are in all probability only hypotheti-
cal.  We do find it resulting from mortify-
ing shreds  of tissue in wounds and compli-
cating injuries, but in by far the  greater
number of  cases it arises spontaneously in
debilitated individuals—persons  suffering
from mal-assimilation, and  who have conse-
quently   a  thin  and  impoverished  blood,
which is incapable of producing a healthy
inflammatory action.  In such individuals
we  generally find  it  occurring in the ex-
tremities, especially in the fingers and hand.
The symptoms  of phlegmasia are  those of
ordinary   inflammation  somewhat aggra-
vated—viz. pain, heat, redness, and swell-
ing ; there  is always more or less oedema of
the affected part, and, as  a consequence of
it and the swelling, we have a tense, shining
skin;  a  throbbing, synchronous  with  the
pulse-beats, is one  of the  chief symptoms
of the disease, and generally  immediately
precedes  the suppurative process.  In a few
days the  skin becomes red  at one  or more
points, and  fluctuation  appears.    Some-
times the oedema and swelling exist to such
a marked  extent that the skin is deprived
of blood,  and consequently  becomes gan-
grenous; and as a complication  we often
have  immense sloughs of integument com-
ing away, exposing the uncovered muscles
and fasciae beneath.  Accompanying these
local symptoms there is always a high fever.
In the treatment the first indication  should
be to remedy as far as possible the condition
of the system which has acted as a  predis-
posing cause of the trouble; for this pur-
pose aperients  and such tonics as quinine
and iron  should be given.  Locally, sup-
puration should be hastened by warm appli-
cations, and  as soon as fluctuation appears
at any point an exit should be made  for  the
pus by the lancet; should two or more out-
lets be found to communicate subcutaneous-
ly, the sinus or sinuses should be laid open
the entire  length, and be  allowed to heal
from the  bottom.  Sometimes local  deple-
tion, if practised at the  outset of the dis-
ease, will cut it short.
  PhosphaFic DiatfFesis, a name given by
some  physicians to a condition of the gen-
eral system in which the salts of phosphoric
acid are found in abnormal abundance in
the urine.  These salts occur normally  in
the proportion of 12J  parts in 1000,  in  the
form of  the  phosphates  of soda, potassa,
magnesia,  and  lime;  but, unless they  are
present in superabundance, the  urine is
capable of holding them in solution when
acid.   However, when the proportion is  ab-
normal, although held in solution in acid
urine at the temperature of the  body, they
are  precipitated when the  temperature is
raised to the boiling-point, and  show them-
selves throughout the liquid either as gran-
ular or crystallized phosphate  of lime  or
crystals  of phosphate  of  ammonia and
magnesia.  We  may  even  find  them   in
perfectly  healthy  urine after  decomposi-
tion has  set in.  As soon as the excretion
becomes alkaline from this cause, the gran-
ular phosphate of lime, being only soluble
in acid fluids, is  precipitated.  The next
change produced by  decomposition  is  by
the  action of the carbonate of ammonia
on the phosphates of soda and magnesia,
giving rise to the phosphates of magnesia
and ammonia and of soda  and ammonia.
Under certain circumstances the urea of the
urine is altered in the kidneys or  bladder;
carbonate of ammonia is formed,  which
unites with the phosphate of magnesia and
gives  rise  to the  triple  phosphate.  The
tendency to the formation  of  this  salt is
very often  accompanied by some disease in
the  urinary passages, most commonly  in-
flammation of the bladder.   Independently
of this, we generally find  the deposit in the 
THE  FAMILY  PHYSICIAN.
i t
 urine of persons suffering from general de-
 bility ;  also  in  those who have overworked
 themselves or have been depressed by over-
 anxiety, insufficient nourishment, or sexual
 excesses.   In them the complexion is sallow
 and  the circulation poor.  They generally
 suffer from cold hands and feet.  The treat-
 ment for this condition should be strict at-
 tention to the  mode of life of the  patient,
 which  will  generally need correction.  A
 generous   diet,  plenty  of exercise in  the
 open air, cold bathing, and tonics will do a
 great deal in  a short  time.   If indicated,
 opium  may  be  given to relieve the anxiety.
   PhthFsis.  See Consumption.
   Piles, or Haemorrhoids  [Gr. ai/xa, "blood,"
 and peeiv, to  "flow"], vascular and fibro-vas-
 cular tumors of the lower bowel or rectum
 — termed  external  piles  when  below  the
 sphincter muscle and upon the verge of the
 anus; internal piles when above the sphinc-
 ter.  In structure they  are due to conges-
 tion  of the haemorrhoidal veins, which are
 a part of the portal venous circulation, re-
 turning blood from the intestines through
 the portal vein and liver to the vena  cava
 and  the  heart.  Piles  when chronic  are
 varicose veins of the anus and rectum,  with
 fibrous  thickening of the tissues and mucous
 membrane investing them.   Piles  seldom
 afflict persons  who  are robust, abstemious,
 frugal,  and  engaged  in active exercise.
 They result from  excessive eating  and
 drinking, congestion of the liver, alcoholic
 excesses, and constipation and costiveness.
 Sedentary  occupation favors their develop-
 ment.  Cavalry officers and railway travel-
 lers suffer  from  piles—in part from consti-
 pation, in  part  from the influence of inces-
 sant  jarring and hypostatic congestion of
 the  lower  bowel. The abuse of harsh and
 powerful cathartics, drinking water impreg-
 nated with mineral substances, and too  fine,
 non-laxative diet may develop piles.  Preg-
 nant women have piles from pressure of the
 gravid uterus upon the veins. Piles are often
 the result of overheated blood and plethora,
 and hence are a frequent  disease in tropical
 countries  and very  hot seasons.   Internal
 piles  may  increase in size, and in efforts of
 evacuation be  protruded  from the bowel.
 By this  stretching the haemorrhoidal tumors
 in time become pedunculated, and are forced
 out with every act of defecation.  They re-
 quire to be constantly returned: failure to
 do this  may result in their strangulation,
 ulceration, bleeding, and even removal by
 gangrene.  External  piles when inflamed
 may also ulcerate and bleed.  Haemorrhoids
when inflamed  render  evacuations  of the
bowels very  painful, and  cause suffering in
sitting and walking.   Patients  with  hae-
morrhoids  usually  discharge  mucus from
the anus, and sometimes shreds and patches
of organized lymph.  They are to be pre-
vented,  and also treated  in  their  milder
forms  and  stages, by  regulated, laxative
diet, active exercise, and  mild  saline ca-
thartics.  When pedunculated they may be
removed by the knife, ligature, or galvano-
cautery.  When piles are strangulated they
must be reduced in size by  ice or cold water,
oiled, and returned.  Ulcerated and inflamed
piles are treated by cold  applications, as-
tringent and anodyne ointments, and free
evacuation of watery stools by use of saline
cathartics.
  Pin-worm (Oxyuris vermicularis), a para-
sitic worm, white, filamentous, from  one-
eighth to one-half of an inch long, accumu-
lating in infants or children in considerable
number  in  the rectum, and causing, espe-
cially during rest, a burning and itching
sensation in the mucous membrane of the
anus.  The disease is generally temporary,
and  disappears spontaneously.   (For treat-
ment see  Anthelmintics  and Vermi-
fuges.)
  Pleu/risy  [Gr. n-AEvpd, "the side"], an in-
flammation of the pieura, the closed serous
sac which invests the lung, separates it from
the bony wall of the chest, and  enables it
to move freely with the alternating expan-
sions and contractions of respiration.  The
causes of pleurisy are exposure to damp and
cold, congestion in the course of acute febrile
diseases, and extension of inflammation from
the lung  when  the  seat of pneumonia  or
superficial tuberculosis.  Local pleurisy over
a mass of tubercle in the lung-surface is a
conservative process, since by pleuritic thick-
ening and adhesions perforation of the pleura
and collapse of the lung are prevented.  The
pleura is, in health,  bathed by a slight se-
cretion of clear serum, which lubricates the
opposed surfaces and favors  ease and freedom
of lung-movement. An evanescent and slight
attack of pleurisy, consisting in  a tempor-
ary suppression of this normal secretion and
a dry congested state of the opposed pleural
walls, is  of  frequent  occurrence:  it will  be
indicated by a slight stitch and  soreness in
one side of the  chest,  a slight, dry  cough,
and  slight febrile disturbance, quickly dis-
sipated  by rest, warm clothing, hot drinks,
and  evacuation  of  the bowels—agencies
which establish  the  equilibrium of the cir-
culation.  Acute pleurisy is announced by
an initial chill, by marked elevation of tem-
perature, frequent pulse, rapid, shallow, and
checked breathing, each inspiratory act pro-
ducing a lancinating or stabbing pain in the
side  of the  chest, the result of attrition  of
the dry, swollen, and sensitive inflamed sur-
faces.  There is a dry, irritative, hacking
cough, without  expectoration, the effort of 
78
THE  FAMILY  PHYSICIAN.
coughing  producing  the  local  pain  or
"stitch" in the side in its greatest intensity.
Soon  the  distended  blood-vessels  of the
pleura are relieved by the escape of the
serous or watery element of the blood, tran-
suding their  coats  into the cavity of the
pleural sac.   This "effusion" may be abun-
dant  and  consist of pure serum, filling the
entire cavity and compressing the lung.  In
other cases it is sero-plastic, leaving an ele-
ment of plastic matter or products of  rapid
cell-formation  on  the  inflamed surfaces.
Still other cases have only plastic exuda-
tion, agglutinating the two pleural surfaces,
and liable to organize and form permanent
adhesions, which bind down and cripple the
lung and render it liable to certain forms of
phthisis.  When effusion or exudation takes
place the  pleuritic  stitch ceases.   But the
presence of fluid in the pleura causes short-
ness of breath, disturbed circulation, and
impaired health. In vigorous constitutions
the fluid is soon removed by absorption, but
in the feeble  and sickly it remains and be-
comes purulent.  Acute pleurisy is treated
by antiphlogistic measures, anodynes  to re-
lieve  pain, counter-irritants, and  rich diet,
tonics, iodide of potassium, during the con-
valescence to ensure the absorption of the
effusion.   When the fluid is purulent it has
to be evacuated by puncture with the trochar
and canula, or more safely by the aspirator,
a  force-pump withdrawing  fluids through
tubes of  small  calibre.   When pleurisy
has  left  adhesions,  counter-irritation  by
iodine, comp. iodine ointment, etc., must be
resorted to, and the  lungs systematically and
persistently inflated to prevent compression
by the organizing deposit on  their surface.
When such deposits and adhesions are es-
tablished, they  are liable to  increase by
fresh congestive or inflammatory  attacks
from  time to time—a condition of chronic
pleurisy.  Chronic pleurisy causes persist-
ent cough, congestion of adjacent lung-sub-
stance, spitting  of blood, and  various steps
of fibrous or interstitial phthisis, or the de-
velopment of specific tubercle when the per-
son has the inherited specific taint. Pleurisy
in a majority of cases is harmless  and re-
covered from; in the feeble, scrofulous, and
consumptive, and in cases  of unusual se-
verity, it is fatal by exhaustion or the sub-
sequent development of consumption.
  Pleu'ro-Pneumo'nia (see Pleurisy and
Pneumonia).  In seasons of unusual sever-
ity* °f great cold and high winds, when in-
fluenza prevails in epidemics and fevers tend
to the malignant and asthenic forms,  acute
pneumonia with coexisting pleurisy, attack-
ing one or both lungs, seems  to arise from
general  atmospheric causes, which depress
the individual  vitality,  and to share in the
low type and unusual fatality of other pre-
vailing diseases. The aged, feeble, and con-
sumptive are most  in danger.  The symp-
toms and physical signs of  pleurisy and
pneumonia  may be  clearly  present, but
often are  vague, and marked by the ex-
treme prostration and other  features resem-
bling typhoid or typhus.  Pleuro-pneumonia
of widespread prevalence and fatality occa-
sionally occurs among domestic animals.
  Pneumo/nia [Gr. kvivuuv;  pi. iwEvfiovsg,
"the  lungs"],  inflammation  of the lung,
of the lining of the air-sacs, and of  the in-
terstitial framework of the lung.  Pneumo-
nia more recently has been  classified into
(1) catarrhal pneumonia,  when only the
air-sacs are involved, filled  with  products
of catarrhal inflammation, extending from
the bronchial tubes;  (2)  croupous pneu-
monia,  where the air-sacs are  filled with
solid  lymph exuded  from  their  inflamed
walls; (3) interstitial pneumonia, a slow and
chronic inflammatory infiltration and  con-
solidation of the fibrous structures which
surround the air-sacs and minute bronchial
tubes.   But pneumonia, as commonly term-
ed in England and this country, consists  of
the croupous form only, an inflammation of
the air-sacs,  which are  the  functional ele-
ments of the lung  for the oxygenation  of
the blood  and the liberation of  carbonic
acid gas.   Pneumonia is usually  confined
to one  lung, rarely is double.  It is  further
designated as " vesicular pneumonia," as the
air-sacs or  vesicles are  involved,  and  as
"lobar  pneumonia,"  one  lobe only fre-
quently inflamed, or the disease attacking
the lobes successively.  Primary pneumonia
in healthy persons occurs more often in the
right lung, beginning, as a rule, at the base
of the lung, and progressing upward toward
the apex.  In old and feeble persons it may
begin at the apex, but pneumonia when local
or commencing at  the apex is usually sec-
ondary to tubercle in the lung, deposits  by
broncho-pneumonia, or former plastic pleu-
risy.  Pneumonia  is  a  disease chiefly  of
adults, and more often of males.   It results
from  catching  cold, fatigue,  impoverished
condition of the blood, the congestions and
perverted blood-states of acute  and malig-
nant febrile diseases.  It is announced by a
heavy  chill,  high fever, rapid  respiration,
frequent pulse, flushed  cheek—on the side
of the affected lung;  in severe cases by de-
lirium and symptoms of a typhoid  nature.
There is acute pain in the side, due to con-
gestion  of the pleura, and a duller,  heavier
pain or soreness of the side, with sense of
weight, due to excess  of blood and the solid
products of inflammation in the lung. There
is cough, with expectoration of mucus tinged
with blood or  rust-colored;  and  in grave 
THE  FAMILY  PHYSICIAN.
79
cases brownish  or  dark sputa,  resembling
tobacco-juice or prune-juice, and indicative
of a decomposed state of the blood, and the
exuded elements filling the vesicles.  The
contents of the  vesicles are gradually soft-
ened and expectorated, and the lung restored
to its normal state. Acute pneumonia  of
adults, although grave  in  its  symptoms, is
usually  recovered  from, and,  contrary  to
popular  apprehension, seldom leads to sub-
sequent consumption. Pneumonia, so called,
in children is usually acute catarrhal inflam-
mation of the minute  bronchial tubes and
air-sacs, occurring  in one  or many lobules
of both lungs.   It is liable  to leave portions
of lung-substance inactive, collapsed, or con-
solidated, and develop the catarrhal form of
phthisis. Pneumonia  is variously  treated
with tartar emetic and calomel,  and locally
cold water and  ice-bags may abort or limit
the  inflammation.   Warm applications, as
poultices, warm anodyne fomentations, cot-
ton batting, and oil silk afford the greatest
comfort  and favor resolution  and removal
of the exudation  from the air-sacs.  Car-
bonate and muriate of ammonia as diffusive
stimulants and to liquefy the exuded lymph,
calisaya bark  or  quinine,  mild  alcoholic
stimulation, and rich liquid diet to sustain
strength, veratrum viride  to  control  the
heart and lessen pulmonary congestion, are
the most approved and successful agents.
  PoFson.  See Toxicology  and  Lead-
Poisoning.
  PoFson of Ser'pents.  The venom of ser-
pents is  formed in a gland which lies back
of and below the eye on each side, and the
gland  of either side, discharges its poison
through a duct which leads to the base of
the hollow fang.  The poison is  in all ser-
pents a thin yellow fluid, which  is made up
chiefly  of albuminoid  matters in solution,
and  resembles white of egg.   One of these
albumen compounds is the poison, the others
are inert.  The poison is active—half a drop
of rattlesnake venom will kill a pigeon—and
when dried  it  preserves  its virulence for
years;  neither is it altered by contact with
weak acids, strong  alkalies, alcohol, iodine,
bromine, or any disinfectant  like chlorine
or carbolic acid.  The  recent researches  of
Indian surgeons corroborate the prediction
made years ago by Dr. Weir  Mitchell  in
America, that the action of all  the various
snake-venoms would be found  in time to be
alike.  In fact, they differ only in that some
produce more local effects, and some destroy
sooner than others the coagulability of the
blood.
  The effects are divisible into local and gen-
eral, immediate and remote.   The venom
having been injected under the skin by the
fang, the first effect is a general feebleness,
in which the heart shares, and which is or
is not accompanied by nausea and vomiting.
If the dose be large, the animal or man dies
within a  time which  varies from  twenty
minutes to hours; but if, in man, he sur-
vives several days, the tendency is  to re-
covery.  The first effects are upon the nerve-
centres of breathing, and  of the heart and
muscles in general. If the early depression
passes over, recovery is often sudden,  or else
the creature poisoned enters the second stage
of the poisoning.   This is characterized by
blood-changes and by a general degradation
in the nutrition of every tissue, so that  all
suffer more or less. The series of changes
begins with lessened  or lost power  of the
blood to clot;  at the same time the texture
of the smaller vessels is  so altered as to
allow of  the  escape  of the  incoagulable
blood, which,  if  the  animal survive long,
finds its way into  the tissue of nearly every
organ, causing  thus symptoms which vary
as the organ most affected is the brain, spinal
cord, liver, lungs, or kidneys. These changes
result, therefore, in bleeding from the mu-
cous surfaces of the breathing or digestive
organs, and in oppressed respiration, bloody
stools or bloody urine, and finally  in coma
or convulsions, which close the scene.  These
facts account for the variety of descriptions
given by authors  of the causes of death in
snake-bite.  The local symptoms vary with
the snake, but vary in degree only.  First,
there is thrown out about the fang-track a
vast  amount of blood, which,  as it cannot
clot,  soaks through the  tissues, and even
stains the bones.   The muscles near  by
soften, and at  last inflammation comes on,
with great swelling and pain, and with, at
last,  more or less local death of the part.
  Snake-venom does not affect plants.  Seeds
will  germinate in it, and it does  not check
the growth of the yeast-plant or inhibit the
development of bacteria or vibriones;  but
to all life above these it is fatal when  inocu-
lated in sufficient  amount, while it does not
seem to have  any power  to  injure when
swallowed ; so that the author has even fed
pigeons on it,  giving  20 or  30 drops a day
for a week without harming them.  Mixture
with gastric  juice alone does not destroy its
power, but it is altered below the stomach,
and  seems unable to  enter  the blood in a
virulent form  by this  channel.   Birds die
easily from venom—cold-blooded creatures
slowly, unless kept very warm.
  There  is  no antidote  yet known. The
proper treatment is to tie a ligature around
the part bitten, and at once to lay open the
wound in the  line of the fang-mark. It is
useless to  apply any local dressing, save to
put the part in hot water to provoke copious
bleeding.  If within reach of full  help, an 
80                         THE FAMILY PHYSICIAN.
elastic bandage should  be put around the
whole limb, after Esmarch's plan for blood-
less operations, until time is given to deal
with the part bitten.  This would be better
than  a mere ligature alone, which causes
swelling  beyond  it.  After ligation every
effort should be made  to squeeze out the
venom  from the  wound.  Next,  alcohol
should be given until the heart is excited,
when the ligatures may  be loosened a little,
so as to admit to  the  general circulation
some of the poison,  which soon or late must
reach it.   When the heart begins to fail the
ligature should be tightened again and more
stimulus given,  and so the poison which re-
mains may be fought in detail.   The alcohol
is not an antidote.  Men bitten when dead
drunk die; it is a stimulus to carry the sud-
denly-enfeebled system  over this  time of
weakness.   For the second stage there is
little to do but to ease pain and wait.
  PoFypus, a tumor of any mucous cavity, as
the external auditory canal, nostrils, throat,
urethra, or uterus.   A polypus by growth in
size and weight drags on its neck or attach-
ment, which is  termed its pedicle.  It may
reach great size and protrude from its cavity
or passage.  Excision is the common treat-
ment.  (See  Ear Diseases, Nostrils, Dis-
eases of, Tumor, and Uterine Diseases.)
  Polyuria, a disease characterized by ex-
cessive excretion of urine, consisting chiefly
of water.   (See Diabetes.)
  Prick/ly Heat, a popular name for eruptive
skin disrates, occurring  in hot weather and
characterized by itching and  sensations of
stinging.  In India there is quite a formid-
able variety of lichen called by this name.
A popular remedy is the use of saline  ca-
thartics, which  doubtless are sometimes ad-
vantageous.  Frequent  bathing  and the
avoidance of exposure to the sun's rays are
recommended.
  Progressive Mus'cular AFrophy, or creep-
ing palsy—Cruveilhier's disease, so named
from the great anatomist—a disease occur-
ring mostly in artisans,  as gold-beaters and
mechanicians, who  by striking or other  in-
cessant action transmit a shock to the nerves
of the arm and to the spinal cord. The ante-
rior or motor roots of the  spinal nerves de-
generate, and the muscles  of the hand, arm,
and trunk progressively are paralyzed and
wasted.    Exposure to  wet and cold may
cause the  disease.
  Prolapsus Uteri, falling of  the womb or
uterus, its descent below its normal position
in the pelvis; in extreme cases a protrusion
of part or the whole of  the organ from the
body.  Enlargement of the uterus by  in-
flammation, uterine and abdominal tumors,
relaxation of the tissues which are the an-
atomical supports of the organ, rupture of
the perineum by instrumental delivery, sud-
den violence in falling or jumping, are the
chief causes of prolapsus.
  Puer'peral Fe'ver, a fever occurring only
to women, following childbirth, and charac-
terized by acute metro-peritonitis, or inflam-
mation  of  the  uterus and peritoneum.  It
may occur in isolated cases in private prac-
tice, but more  commonly develops in hos-
pitals and  lying-in asylums, where numer-
ous patients are aggregated, the air vitiated,
and  especially if unfavorable surgical eases
—erysipelas, gangrene, suppurating wounds,
pyaemia, or septicaemia—are present.  Under
such circumstances many  cases coexist  or
occur consecutively, and  often spread to in-
dividuals in  the  surrounding  community.
Such epidemics, and its spread by seeming
contagion,  have led some to regard it  as
a specific and  contagious  disease.   But a
counter-opinion has greater weight of au-
thority, that it is indeed only a condition
of  blood-poisoning by  the absorption of
septic or purulent matter  on the recently-
exposed and often lacerated interior of the
uterus, or the  inflammation of that organ
and  the peritoneum  by  the  presence of
septic matter in the blood.  Sudden suppres-
sion of the discharge following labor, sewer-
gas,  emanations from decomposing animal
or vegetable matter, are causes of puerperal
fever.  Puerperal fever is chiefly character-
ized by the symptoms of  peritonitis—swell-
ing, tympanitis, tenderness and pain in the
abdomen,  constipation, nausea and  vomit-
ing,  marked elevation of temperature, and
rapid, feeble pulse; the  exhaustion varies
with the case; the patient may die early of
collapse or following typhoid symptoms of
several days' duration.  The treatment com-
prises veratrum viride to control  the circu-
lation, opium  as  a specific in peritonitis,
and  antiphlogistic local applications to the
abdomen.   Cold cloths or ice, sedulously
employed  at the outset,  may abort the in-
flammation  or  lessen its  severity, but when
the  disease is  established warm  anodyne
fomentations are  preferable.   Nutritious
liquid food, quinine, and  alcoholic stimulus
must be administered  at regular  intervals
and  in doses determined by the  degree of
prostration.
  Puerperal Ma/nia, perversion of the mind
in women immediately after childbirth and
during the first week thereafter, exception-
ally occurring before delivery, or developed
weeks or  months  after labor by excessive
and  exhaustive nursing.   It  may therefore
be considered as a derangement of the mind
due to the influences of the childbirth upon
the sympathetic nervous system  and  emo-
tional  nature  of  the  mother.   Puerperal
mania may be  characterized by mental agi- 
THE  FAMILY  PHYSICIAN.                         81
tation or excitability, or, reversely, the pa-
tient may sink into a state of mental apathy,
moodiness, reticence, or despondency. There
will be restlessness, inability to sleep, head-
ache, impaired appetite, coated tongue—in
some cases an increase of temperature.  The
bowels are usually constipated, the urine
diminished in quantity.  The  secretion  of
milk is  often lessened  or suspended.   Al-
though the delirium in some cases is violent,
no evidence of  inflammation or other or-
ganic disease of the brain or its membranes
has  been detected as the lesions to which
the  symptoms would lead on  post-mortem
examination.  In the delirious form and in
the  melancholic form there is equally  an
aversion to the father or the child.  Suicide
and murder of the child are occasional oc-
currences.  Puerperal mania may be ex-
pected to occur in women of nervous tem-
perament or those predisposed to insanity;
in such  also as  are greatly reduced by pre-
vious  ill-health, by haemorrhage during or
following delivery, or whose blood has been
impoverished by absorption of malaria and
putrescent effluvia. The prognosis is favor-
able; the mind in most cases is, in time,
restored to a normal condition.  The patient
of puerperal mania may wholly escape it at
subsequent childbirths if the system be for-
tified in advance by iron to correct anaemia,
and care be taken to prevent unusual loss
of blood during  parturition.  Where insan-
ity or emotional  excitability is a family trait,
mania may recur with successive labors de-
spite all precautionary efforts.  The treat-
ment varies  with the form of  mania and
severity of symptoms.   The infant in  most
cases is to be removed, as it is unsupplied
by the mother's breast-milk, and its influ-
ence is often pernicious ;  when left, it should
have a constant attendant to guard it against
injury at the hands  of  its  mother.   Firm
but gentle control of the patient is essential,
and often removal from husband, family, and
familiar friends is essential to the quiescence
of mind and body.  Best and sleep must be
ensured by cerebral sedatives and soporifics,
as bromide  of potash, hydrate  of chloral,
hyoscyamus, or  the preparations of opium
when borne without excitement, as codeine
and the deodorated tincture of opium.  Even
the hypodermic  injection of morphine  may
be required in obstinate insomnia and de-
lirium. The constipation is  to be corrected,
the diet must be nutritious, and the appe-
tite,  if deficient, stimulated  by use of tonic
elixirs and  wine.   The strength must be
sustained and the blood enriched by  cod-
liver oil, quinine,  and iron.
  Pustule,  Malignant.   See  Malignant
Pustule.
  Putrid Sore Throat.   See Diphtheria.
   Pyae'mia  [Gr. nvov,  "pus,"  and alpa,
 "blood"], a very fatal disease which occurs
 during the progress of suppuration in some
 part of the body, and believed to be due to
 the  entrance of purulent matters  into  the
 blood.  As it is most frequently met with
 in hospitals where there are many wounded
 persons, some surgeons regard the exciting
 cause in these cases to be  a miasm which
 arises from unhealthy wounds and poisons
 healthy wounds.  This disease is ushered in
 with a chill, followed by a febrile, and then
 by a sweating, stage.  The chills are often
 repeated and at irregular periods, sometimes
 as many as three occurring in a day.  Toward
 the termination of the case they are less fre-
 quent.  Though the surface feels cold during
 the chill, the temperature of the body rises,
 and in the  hot stage may reach  105°  to
 108° F.   There are loss of appetite, thirst,
 want of sleep, emaciation, sallow skin, and
 prostration.   Acute cases run a course of
 from six  to  ten clays,  and chronic  cases
 from three  to four weeks.   Death results
 from exhaustion, due to the poisoning of
 the blood; secondary inflammations, as pleur-
 isy ; and the formation of abscesses in  in-
 ternal organs, as the lungs, liver, and spleen,
 or in the joints and  cellular tissue.
  Pyro/sis [from  nvpumg,  a "burning"].
 This name is applied to an affection of the
 stomach characterized by the regurgitation
 of a considerable quantity of liquid when
 the stomach  is empty of food.  The liquid
 expelled may be insipid to the taste or salt-
 ish, and it is sometimes acid. It is not vom-
 ited, but regurgitated, and the regurgitation
 is not accompanied by the sense of nausea
 which usually attends  acts of vomiting.
 The popular name for the affection is water-
 brash. The  regurgitation  takes  place  es-
 pecially in the  morning, before food has
 been taken.  A sensation of  burning is gen-
 erally felt in the region of the stomach, and
 frequently in  the throat during and after
 the  passage of  the  liquid.   This  burning
 sensation  is implied in the name  pyrosis.
 The regurgitations in pyrosis are to be dis-
 tinguished from those which are  incident
 to indigestion.   The latter  consist  of food
 or drink which has  been taken  into the
 stomach, and which excites irritation  in
 consequence of the  chemical changes aris-
 ing from defective  digestion; whereas the
 liquid regurgitated in pyrosis is the morbid
 product of secretion from the glands of the
 stomach.   Pyrosis may be associated with
 indigestion or  dyspepsia,  but   not infre-
quently the digestive processes are but little
or not at all disturbed.  The  affection occurs
oftener in women than in  men.   It is an
affection of middle  or advanced life, being
of extreme infrequency in  young persons. 
82                         THE FAMILY  PHYSICIAN.
It is  of more frequent occurrence  in some
countries than in others.  It is said to be a
frequent malady in Scotland and  Ireland.
It has been attributed to the use of oatmeal
largely as an article of diet.  Persons living
on a  poor, insufficient diet  are more likely
to suffer from it than those who live well or
generously.  It is not a grave affection, nor
does it denote a tendency to any important
disease  in  the stomach or elsewhere.  It is
generally  controlled very  speedily  by the
carbonate or  subnitrate of bismuth in doses
of  from 20  to  30 grains,  given twice or
thrice daily.   The  treatment,  in other re-
spects, embraces  the use of tonic remedies,
nutritious  alimentation, and  hygienic in-
fluences.  (See Indigestion.)
   Quin'sy, acute suppurative tonsilitis, or
inflammation of the tonsil, terminating in
abscess.  The term " quinsy " is  a  popular
perversion of Lat. cynanche,  the technical
designation of  a sore throat.   It  attacks
adults,  less  often children;  the two  ex-
tremes of life, infancy  and old age, being
quite  exempt from it.  One attack  usually
leaves subacute  or chronic disease  of the
tonsil, which  predisposes  the  person  to
repeated  attacks  in  .subsequent  seasons.
Quinsy  is most  often  unilateral, less  fre-
quently attacking the two  tonsils  success-
ively,  and  rarely  coincident upon  both
sides.  It  occurs in persons of full  habit,
often  the  plethoric, and especially when
the diet has  been excessive and  luxurious.
With such predisposing conditions must be
superadded,  as  an immediate or exciting
cause, some  exposure  of the body to  wet
or cold.   Quinsy may follow  checked per-
spiration,  chilling the  extremities,  or wet
feet.  The attack is manifested by soreness
of the throat, increased by  swallowing  and
talking, soon actual pain,  rigidity  of the
jaw, hypersecretion of saliva, coated tongue,
labored breathing, and sense of obstruction,
tension, and  tumefaction   in the  throat.
With the first development of pus,  intense
throbbing pain exists.   The disturbance of
the general  system is  variable.  In  mild
cases  only impaired appetite  and sense of
lassitude exist; in graver attacks there may
be a slight or marked chill at the onset, and
a succession  of  light chills;  the tempera-
ture elevated to  102° or 104° F.; the pulse
full and bounding; the mind delirious at
night, and by  day the face expressive of
great  fatigue  from loss of sleep, of suffering,
and of alarm and apprehension of impend-
ing suffocation.   Internal examination dis-
closes the  tonsils symmetrically enlarged,
extending to the median line of the throat
and obstructing it.  Palpation by  the  fin-
ger may detect the softness and fluctuation
of pus.  In from five to eight  days the sup-
purated tonsil bursts, all the symptoms van-
ish, and recovery is speedy.   In its forma-
tive or first stage quinsy may sometimes be
aborted by scarification, by ice in the mouth,
cold gargles or spray, and astringent gargles
or applications,  as of alum or tannin, and
by internal administration of  saline cathar-
tics and arterial sedatives.  Quinine boldly
administered  may abort  it.   When devel-
oped, the inhalation of steam,  warm ano-
dyne  gargles, soothing poultices  or fomen-
tations  externally, anodynes  to secure rest,
tonics and diet to sustain the strength, and
early  evacuation  of pus with  the knife, are
the essentials of treatment.
  Rash, a popular name for the acute exan-
thematous or eruptive diseases, or more fre-
quently for the eruption itself which attends
such diseases. Nettle rash or urticaria, scar-
let rash (roseola), and canker rash  (scarlet
fever) are the diseases generally called by
this  name,  which, though convenient  for
nursery use, is of no scientific value, for the
diseases have nothing in common with each
other.
  Rectum,   Diseases   of   [Lat.  rectus,
"straight"].  The rectum is  the third and
last portion of the great intestine, receiv-
ing the fecal  matters  from the colon, and
opening outward by the  anus.   Not infre-
quently in  new-born  children  occur con-
genital defects of the rectum;  such are pre-
ternatural narrowness of the  anus, imper-
forate anus, absence of the anus, with par-
tial or  complete  non-development of the
rectum.  In  childhood disease of  the rec-
tum  is  exceptional;  atony and  relaxation
of its muscular coat may result in obstinate
constipation and overloading of the rectum
with  faeces.   Reversely,  in  strumous and
delicate children continued diarrhoea may
result in prolapse of the rectum  or protru-
sion, usually of the mucous membrane  only,
less frequently of the muscular coat. Adults
are subj ect to numerous rectal diseases.  Dys-
entery is not infrequently limited to the rec-
tum.  (See Dysentery.)  Chronic ulcer is
a frequent sequel of the destruction of tis-
sues in dysentery; ulcers may also arise from
tubercular or syphilitic deposit.   Irritable
ulcer of the lower end of the  rectum,  espe-
cially just within the sphincter  muscle of
the anus, is  termed a fissure.   It causes  in-
tense  pain when  stretched by the passage of
faeces, and the dread of suffering causes vol-
untary inaction of the bowels and  habitual
constipation.  Fissure often can be detected
only by use of the  rectal  speculum, the pa-
tient  being  anaesthetized by chloroform.
Stricture of the  rectum is often the result
of former dysenteric inflammation, ulcera-
tion, sloughing, and the subsequent forma-
tion  of dense scars of fibrous  tissue.   It 
THE FAMILY  PHYSICIAN.
83
results  in  obstruction, difficult and small
stools, constipation, straining and bearing-
down pain in the bowels, loins, and lower
region of the back, with general depression
of health.  Stricture  is often the  result of
cancer of the rectum, when, in addition to
the symptoms and signs of stricture, exist
also the cachectic facial  appearance  and
progressive emaciation  of the body  indica-
tive of cancer, and intense lancinating pains
in the rectum, due to the malignant local
growth.  Haemorrhoids or  piles (see Piles)
are the frequent result  of congestions and
inflammation of the  abundant venous cir-
culation of the rectum  and anus.  Polypus
of the rectum is an attached tumor, origin-
ating  in a  relaxed fold of mucous mem-
brane, or in a  haemorrhoidal mass, or re-
dundant growth following the healing of
ulcers; it may grow  to such size as to ob-
struct the bowel, or by the dragging efforts
of defecation  be protruded from the body.
Fistula in ano  is the result  of abscess ad-
jacent to the lower  bowel or verge of the
anus, the purulent contents being discharged
into the rectum, and leaving  an  unhealed
passage or sinus.  There may be an addi-
tional sinus opening on  the surface without
the anus;  fistula may also be "blind," or
terminating in a cul-de-sac  adjacent  to the
bowel, but opening only externally.  The or-
igin of fistula is  usually piles, constipation,
or other disease of the lower rectum.  Intense
neuralgia of the rectum, though a frequent
forerunner of malignant  disease, is  often
present in persons reduced in health or of
highly nervous  temperament.  Pruritus of
the anus (obstinate itching) is often present,
associated with  constipation, piles,  the cli-
macteric period, and old age.  Eczema often
affects the anus.
  Preternatural  narrowing of the  rectum
demands stretching by the fingers, aided by
anaesthesia and  the  use of rectal  sounds.
The imperforate anus is to be punctured or
incised,  and  kept open by  sounds while
healing.   Prolapse  usually yields  to  im-
proved diet, tonics, and internal and local
use of astringents.  Excision of a  chronic
prolapsed rectum is rarely demanded.  Ul-
cers may be treated  by astringent  tonics,
but more effectively by local use of suppos-
itories or direct caustic applications through
a speculum of  considerable  size.   Fissure
may be cured by keeping the bowels habit-
ually open and by local use of anodynes, as-
tringents, and mild caustics.  A more cer-
tain cure is by rupture of the sphincter ani
under  anaesthetics, allowing the fissure or
ulcer  a period of rest.  Stricture when not
malignant may  be relieved by cautious in-
cision  and subsequent  use  of large rectal
sounds.  The  operation endangers  perito-
nitis and  portal phlebitis (inflammation of
the portal vein), with abscess of the  liver.
Cancer of the rectum is incurable.   The in-
tense pain is modified by keeping the bowels
open and by local and internal use of ano-
dynes, opium and atropine being most effi-
cacious.  (See Fistula and Piles for  treat-
ment.)  Neuralgia, pruritus, and eczema de-
mand local use of anodyne and emollient
suppositories and ointments, while the con-
stitution is improved by corrected diet and
tonics.
  Relapsing [Lat. relabor, relapsus, "to fall
back"] Fe'ver, also known as Famine Fever,
and, technically, as Febris Recurrens.  Its
nature is  undetermined—by some regarded
as a form of typhus,  by others as due to
malaria.   It occurs only at intervals of some
years, and then during seasons of privation
and insalubrity, attacking chiefly the  lower
classes, ill  fed and housed.  It has been so
prevalent in crowded communities, as Liver-
pool, as to be regarded an epidemic and con-
tagious  disease,  but careful study connects
it with dietetic and telluric causes, prevail-
ing in the form of a non-contagious endemic.
Its formative or incubating stage  is  from
four to ten days; rarely it is spontaneous in
its development.  Its onset is sudden; the
patient, having  been  perfectly well at the
time, is able to fix the exact time of the
attack.  It begins with an abrupt and severe
rigor, or chill with nervous tremor, and im-
mediate sense of extreme weakness.  There
is sharp frontal  headache, pain in the back
and limbs; then follow flushed face, thirst,
dry tongue, high pulse, and a  steady ascent
of body  heat.   The facial expression and
temperature are characteristic.  The  mind
is unaffected, and the conscious face, with
the sunken but  clear and full eye, wears a
pitiable, helpless, appealing look.  The com-
plexion has  a  bronzed  hue,  and may be
slightly jaundiced.  The temperature stead-
ily ascends during four or five days to 105°,
106°, 107°, 108°  F.—an unusual fever heat
unaccompanied  by brain symptoms or dan-
ger of death.  Physical  examination may
detect enlargement of the liver and spleen;
the urine may  contain not only albumen
and urea in excess, but blood  and casts  in-
dicative of acute congestion of the kidneys.
The fever and extreme depression last from
five to seven days, when,  with  some critical
evacuation, as  profuse perspiration,  diar-
rhoea, or urination, a sudden abatement and
rapid convalescence sets  in.   Appetite and
strength  are  slowly returning, and the in-
valid is about, when, on the  fourteenth day
from the first attack, he is seized by a second
or relapse resembling the first.   Very rarely
a third, fourth, and even a fifth relapse oc-
curs.   Relapsing fever, however severe, is 
84                         THE FAMILY PHYSICIAN.
 rarely fatal.   During the epidemic in New
 York the cases were in the general hospitals
 with other patients, and no evidence of con-
 tagion followed.  The treatment during the
 active period  is essentially  antiphlogistic
 and expectant—cooling drinks, gentle saline
 laxatives, sponging, light diet; during con-
 valescence, free use of concentrated  liquid
 diet, tonics, especially liberal use of quinine
 and brandy.
   RemiFtent [Lat. remittere, to "send back"]
 Fe/ver, a non-infectious, non-contagious fe-
 ver of malarial origin, but differing from in-
 termittent fever in that it has no prolonged
 intermission or apyrexial period.  Although
 there  is at no period of the  twenty-four
 hours a complete cessation of fever, there is
 daily a perceptible or marked abatement or
 diminution of the elevated temperature and
 associated symptoms.  This period is termed
 the  remission.  The characteristics of this
 fever vary with the country and season in
 which it occurs.  The ordinary autumnal
 remittent, the bilious remittent "of England
 and the  IT. S., is comparatively mild.  Re-
 versely, the remittent of intensely malarial
 regions, as the borders of the Mediterranean,
 the  Isthmus  of Panama  and of Suez, the
 African  jungles, and  of  Bengal, is severe
 and fatal.  When the invasion of the  dis-
 ease is mild there will have been a precur-
 sory period of malaise, languor,  mental in-
 aptitude, and  sleepiness.  When violent in
 its onset, often no such warning symptoms
 have pre-existed, but the initiatory chill has
 been speedily  followed by intense delirium,
 changing to coma, internal congestions, and
 death.   Such " congestive,"  " pernicious,"
 " fulminating," or lightning-like attacks are
 rare in temperate climates.  Usually, remit-
 tent fever is  ushered in by a distinct chill
 or by  general chilliness and  sense of cold
 down the back.  There are headache, giddi-
 ness, mental dulness, and  confusion, a sense
 of oppression  and lassitude;  soon there is
 delirium. The face is flushed, the pulse full
 and  frequent,  the tongue dry and furred,
 the skin intensely hot, the temperature rising
 as high as 105° F.  In the bilious form there
 are nausea and vomiting, pain at the epi-
gastrium, with tenderness on pressure.  Fre-
quently,  the fever thus runs at  its height,
without modification, during sixteen or eigh-
teen hours, when the remission begins. Such
a period  of fever is  accompanied usually by
symptoms indicative of congestion of im-
portant internal viscera. Thus, with the first
fever-period pulmonary congestions  have
been denoted by labored breathing, thoracic
oppression, and livid face.  With the remis-
sion  these secondary congestive signs abate.
The  remission  usually begins toward morn-
ing,  though in grave cases  postponed and
 irregular,  succeeding  a  febrile  period of
 twenty-four or even thirty-six hours.  The
 remission may last from an hour or two to
 eight or twelve, the attack  being  mild in
 proportion  as  remissions  are definite and
 prolonged.  The return of fever may have
 a  mild precursory  chill,  the temperature
 again rises, and new  congestive symptoms
 develop, perhaps of the liver, as shown by
 hepatic pain and tenderness  and vomiting
 of bile.  Thus, in successive febrile periods
 various internal viscera  are  the  seat of a
 determination  of blood—the ovaries  and
 uterus  often,  as  shown  by  metrorrhagia.
 The duration  of remittent  fever may be
 seven, fourteen, or twenty-one days, seem-
 ing to observe a law of septenary crises.   It
 may  terminate  abruptly  in  resolution  by
 sweating, or lose its distinctive type and run
 into a low, typhoid fever.  The person con-
 valescent presents a noticeably dusky com-
 plexion, a  depression  of the health  and
 strength for many months, and inactivity
 of the liver, with liability to jaundice. Per-
 cussion often  demonstrates enlargement of
 the liver and spleen.  In fatal cases autopsy
 reveals  a characteristic "bronzing" or pig-
 mentation  of  the liver and  spleen.'  The
 treatment of this fever should keep in view
 to quickly  shorten the exacerbations or fe-
 brile  periods  and relatively  lengthen  the
 remissions.  Cold and effervescing draughts
 and saline aperients should be given at once
 and repeatedly, and the period of remission
 utilized by the free exhibition of quinine to
 anticipate and lessen the gravity and dura-
 tion of the  next  period of fever.  In critical
 cases  quinine  to act certainly must be ad-
 ministered  in full doses  hypodcrmically—
 ordinarily,  in large  repeated  doses  by the
 mouth.   Congestion of special organs, the
 brain, lungs, liver, demands local measures,
 leeching, cupping, blisters, warm  and ano-
 dyne fomentations.  The usual antiphlogis-
 tic agencies are indicated, and supporting
 liquid food at regular intervals.   Tonics, as
 bitter vegetable infusions  and the mineral
 acids, hasten convalescence.
  Re/nal [Lat. renes, " kidneys "]  Diseases,
 or Diseases of the Kidneys, are  mostly of
 an inflammatory nature.  According to the
 location and character, there are many dif-
 ferent affections.  Inflammation of the pelvis
 is called pyelitis, and is generally a continu-
 ation of catarrh of the bladder.  The tissue-
 of the kidney proper might be the  seat of
 all kinds of inflammatory processes, from
simple hyperaemia (and in consequence there-
of bursting of blood-vessels and bleeding) to
the most severe forms of hyperplastic action,
with deposition  of diphtheritic and croup-
ous masses. The name Bright's Disease
 (which see) used to comprise the majority 
THE  FAMILY  PHYSICIAN.
85
of these forms, which a more distinct know-
ledge now keeps asunder.  The most im-
portant symptoms of the kidney troubles
arise  from the fact that the epithelium of
the canaliculi is detached, thereby allowing
the albumen to escape. (See Bright's Dis-
ease.)  In more advanced  cases the secre-
tion of urine is hindered, and even suppress-
ed, and the urea in the blood (uraemia) leads
the affection to a fatal end.  Of other renal
disorders  may be mentioned the formation
of gravel and stone, giving origin to so-call-
ed renal colic and some  new formations, es-
pecially cancer of the kidneys.  Perinephri-
tis  is  inflammation of the cellular  tissue
around the kidneys; large abscesses may
take their origin therefrom, which can be
cured  by  making  an incision and thereby
giving  the pus a free outlet.  (See articles
on Albuminuria, Bright's Disease, Cal-
culus, Diabetes, Lithic-Acid Diathesis,
Oxaluria, Phosphatic  Diathesis.)
  Retention [Lat. retentio] of Urine, a con-
dition in  which the urine cannot be evac-
uated  from  the bladder at all, or only with
great difficulty, the former being known as
complete,  the latter as incomplete, retention.
It should not be confounded with suppression,
in which the urine has not been excreted by
the kidneys, and consequently the bladder
is empty.   The symptoms consist of a great
and urgent desire to pass water, and partial
or complete inability to do so; this is accom-
panied  by repeated straining efforts and vio-
lent pain,  and extreme distress and restless-
ness ; the  countenance assumes an anxious
expression, the pulse is quick, and the skin
dry.  The bladder is more or less distended
according to the protraction of the trouble,
and its position may be ascertained by per-
cussion above the pubes.  If this condition
is not speedily relieved,  it results in rupture
of some portion of  the urinary tract and
extravasation of the contents of the bladder
into the surrounding parts.  Here the urine
acts as a foreign body, and causes an inflam-
mation which soon terminates fatally.
  As  the  treatment of this condition varies
with its cause, we shall have to consider them
together.  The causes are numerous, and may
be classified as those due to—(a) mechanical
obstruction;  (b) paralysis of bladder,  partial
or complete; (c) hysteria.  The  agents me-
chanically obstructing the flow of urine are
numerous.  Organic stricture of the urethra
is a very  common one, but it causes com-
plete retention only when, after exposure of
some  kind or over-indulgence in spirituous
liquors  or sexual excitement, there is con-
gestion or spasm added  to  it, and the ure-
thral canal thus made impervious. The at-
tempt  should  here be made to  use a small
catheter, but  if this cannot be done,  the  I
 warm bath, local  abstraction of blood, and
 the administration of ether or chloroform
 should be superadded.  Should these means
 fail, the only resource left is to " tap " the
 bladder, either through the rectum or above
 the pubes.  This is done at the present time
 by means of the aspirator.  The relief, how-
 ever, is only temporary; the stricture  still
 remains, and some  operation  must be re-
 sorted to for its relief.  Spasmodic  contrac-
 tion of the muscle surrounding the neck of
 the bladder  or of the muscular coat of the
 urethra sometimes exists as a cause  of re-
 tention ;  when such  is the  case, the  warm
 bath, purgatives, opium, and chloroform are
 the remedial agents.  Inflammation  along
 the urethral  canal  (gonorrhoea)  often has
 retention of  urine as a complication.  Here
 it  is caused by an intensely-congested and
 swollen mucous membrane, and the  same
 treatment as for  muscular spasm  may be
 adopted. • Amongst  the other  mechanical
 causes  the most important are—(a) a small
 calculus impacted in the urethra;  (b) small
 tumor  in the urethra;  (c) clotted blood in
 the urethra  or  bladder; (d) foreign bodies,
 as pieces of  bougies, catheters, etc., in the
 urethra; (e) tumors  of  any kind,  external
 to the  urethra, which press upon it.   This
 last cause operates quite frequently, and it
 embraces all those cases of  retention due to
 chronic enlargement of the prostate, inflam-
 mation or acute congestion of the prostate,
I abscesses in  the  perineum, pressure  of a
 loaded rectum,  a displaced uterus, the head
 of the  child during labor, or a pelvic  tumor
 of any kind upon the neck of the  bladder.
 The treatment should always be directed to
 the removal  of the  cause,  and where this
 requires any great amount of time, we have
 the  catheter  and  aspirator as palliative
 means.   Paralysis of the bladder, causing
 retention, may  be due to voluntary  reten-
 tion  repeated and long kept up, apoplexy,
 injury  to the spine, acute over-distension of
 the organ, shocks to the system from capital
 operations, and in  certain high fevers, as
 typhoid, typhus, etc.  The treatment in all
 these cases should be by the catheter.  Hys-
 terical retention is  a disease of the mind,
 and  depends wholly upon  the volition of
 the patient.   (See Hysteria.)
   RhachFtis.  See Rickets.
   Rheumatism [Gr. pEVfiaricfiog], an inflam-
 mation which attacks fibrous  structures in
 various parts of the body,  and most com-
 monly those of the joints. It presents itself
 under  various forms, but they may  all be
 embraced under the following :  acute rheu-
 matism and  chronic  rheumatism.
    Acute rheumatism,  known also as inflam-
 matory rheumatism and rheumatic fever, may
 be defined as an idiopathic inflammation 
86                         THE FAMILY PHYSICIAN.
of the  synovial  capsule  of one  or  more I
joints, which is accompanied by slight ex-
udation into the  joint and oedema of the
connective tissue  surrounding it.   There
seems to be an hereditary predisposition  to
the disease, and the attacks are very liable
to recur in  the same individual.  It occurs
in healthy persons between the ages of ten
and  forty.   The exciting cause is generally
found  to  be a " cold"  or a residence  in
damp places;  it usually occurs in the win-
ter and spring, and is oftenest met with  in
the temperate zone.  Before the  onset  of
the disease  there is at times a feeling  of
malaise  lasting for a  few  days; sometimes
the malady is ushered in  suddenly  by a
chill, which is immediately followed by a high
fever and  pain in one or more of the larger
joints.  This  pain  soon becomes  unbear-
able,  and  the patient cannot allow the
slightest motion, nor even the weight of the
bed-clothes.  The  affected joint will  be
found swollen, and at times red.  The joints
most commonly affected are the knee,  foot,
shoulder, elbow, and hand.  When a  num-
ber of joints  are affected at one  time the
patient's condition  is indeed pitiable, as it
is impossible for  him to make the slightest
movement without suffering  the  most in-
tense agony.  The  complications  liable  to
be encountered  are inflammations of the
fibrous structures  of the heart, lungs, brain,
and  spinal  cord,  and the  duration of the
disease, if untreated,  is from two to five  or
six weeks.  It generally ends in recovery,
except in  those cases which have a severe
complication.   The treatment  should con-
sist of purgatives, diuretics, narcotics, and
colchicum ; locally,  either evaporating  lo-
tions or warm applications, the latter best
secured by warm water and alcohol (2 parts
to 1), and  surrounding the limb with flan-
nel.  If treated at its outset by the more re-
cent remedies, salicylic acid and salicylate
of soda, in heroic doses, the disease may  be
broken  up within forty-eight hours, though
the patient remains much debilitated.  This
treatment has the great advantage of avert-
ing the danger of heart complications.
   Chronic rheumatism is a chronic idiopathic
inflammation  of  the fibrous tissues of the
body, which produces very little change  in
the  structures of the affected part.   The
predisposing causes may be congenital  or
acquired.   It may follow the acute variety,
or exist from the beginning  as  a chronic
affection;  one attack predisposes to another.
The  exciting causes are those of acute rheu-
matism and damp weather and an easterly
wind.  There are several varieties of chronic
rheumatism.  In one there is a constant
pain, lasting for a long time in certain sin-
gle joints, which  is aggravated by pressure
or motion.  In another a series of mild at-
tacks of rheumatism, simulating greatly the
acute  variety,  generally  occurs  at  every
change of weather or  upon  the slightest
exposure.   When once established it is gen-
erally  hard to  get rid of.  Muscular rheu-
matism is  a chronic  rheumatism   of  the
fibrous sheaths of the muscles, and is known
as lumbago when occurring  in  the back,
where  it occasions ludicrous contortions of
the body when the patient attempts to move,
in order to spare the  affected parts;  wry
neck  is a similar affection  in the neck ; and
pleurodynia is a chronic rheumatism of the
muscles of the side  and  chest.   As to the
treatment of chronic rheumatism, we have
no specific.  Probably the  nearest to it is
the iodide of potassium,  which  should be
given.   Sedatives are also useful to relieve
pain and  procure sleep.  Particular atten-
tion  should  be paid to  the  digestive or-
gans, as derangement always aggravates the
trouble.  The various mineral springs pos-
sess  no virtue except from the diuretic ac-
tion  of their waters.
  Rick/ets, a term applied to a distortion of
the bones, especially those of the extremities,
which  is the result of a diseased condition
arising from mal-assimilation of  the ingre-
dients  which properly form the  bone-sub-
stance, and by  which they are deprived of
the proper supply of earthy materials.  It is
a disease of early life, occurring as a rule in
infants from twelve to  eighteen months of
age.   The  predisposing causes are the in-
fluence of an  impure  or poisonous atmo-
sphere, improper  food  and clothing, and
poorly ventilated, damp apartments, espe-
cially if they be deprived of' sunlight.  The
symptoms are not well marked and charac-
teristic in  the  early stages;  they  develop
gradually and  almost imperceptibly.  The
little patient seems to lose  his spirits,  and
his general health fails; indigestion sets in,
and  is accompanied by swelling of the ab-
domen  and colic.  As a consequence, we
have emaciation taking place to a marked
degree, the muscles becoming  soft and flab-
by, the face sallow, and the skin dry,  and
there are  scanty and turbid urine and thin
foetid  evacuations.   The  fontanelles  and
sutures remain open until a late period, and
there are often noticed a profuse sweating of
the scalp, and  a rolling of the  head upon
the  pillow which results in a baldness of
the back of the head.   The teeth are very
late  in making their appearance, and decay
rapidly after doing so.  As the  disease ad-
vances the bones grow softer and softer, and
become distorted by  the superincumbent
weight and muscular contraction.   The
bones  of  the extremities  are bent, short-
ened,  and  twisted, and the ends enlarged. 
THE  FAMILY  PHYSICIAN.
87
 The ribs become flattened  by atmospheric
 pressure, and  drawn  inward by the con-
 traction of the diaphragm, and as a conse-
 quence we  have the sternum pushed  for-
 ward in front, and the deformity known as
 pigeon or chicken  breast.  As a disease of
 the bones, rickets is never dangerous.  It is
 from the deformities resulting, and their in-
 terference with the  action of the lungs and
 other viscera, that  the  danger arises.  The
 treatment can be summed up in a few words
 —fresh air, sunlight, good food, bathing,\and
 cod-liver oil.  The deformities may be rem-
 edied  to a certain extent  by the  use of
 splints.  In after life, when the bones have
 become hardened, a wedge-shape piece may
 be taken from the  convex side and splints
 applied.
   Ring'worm, a parasitic cutaneous disease
 occurring most frequently among children
 and upon the face and neck. It was  for-
 merly described as  herpes circinatus, and re-
 garded as a vesicular disease.  It is more
 properly  tinea circinatus, being  analogous
 to  tinea sycosis, or  barber's itch, and tinea
 decalvans, or bald spots  of the head.   These
 diseases are due to  a parasitic growth, con-
 sisting of innumerable  sporules which find
 a nidus  in  the hair-follicles and   excite
 secondary inflammation of the skin.   Ring-
 worm  is contagious, not  only from  person
 to  person by close  contact,  but in  the  un-
 cleanly is transplanted  from spot to spot on
 the head and hands or wrists.   The treat-
 ment is by " parasiticides," or remedies des-
 tructive to parasitic life.   Local applica-
 tion of tincture of  iodine,  iodine and am-
 monia,  sulphurous  acid, sulphur dry or in
 ointment, carbolic acid, creosote, oil of cade,
 mercurial ointment, oleate of mercury, solu-
 tion of corrosive sublimate,  and cantharidal
 collodion.
   Ru'pia  [from the Gr.  pimog, "filth"],  a
 severe and chronic skin disease, usually, but
 not always, syphilitic in its origin.  It gene-
 rally  begins  in blebs filled  with  a sanious
 fluid.  These finally become ulcers covered
 by a  thick  scab.   The disease appears in
 broken-down patients, and is to be met with
 tonics, good  food,  cleanliness, the  use  of
 iodide of potassium, etc.  Locally, the ul-
 cers may be  poulticed and then touched
 with caustic.
   Rupture.   See Hernia.
  Saint Anthony's Fire.  See Erysipelas.
  Saint VFtus's Dance.  The form of disease
that received  this  name  was a species of
chorea which broke out  at Strasbourg in the
year 1418, following the plague.   The same
disease  appeared in Aix-la-Chapelle as an
epidemic in the fourteenth century, and was
then known  as "St. John's Dance."  Al-
most simultaneously a malady originated in
Italy, there called tarantism, and identical
with the dances of St. John and St. Vitus.
These several conditions presented common
symptoms, consisting of jumping, fantastic
dancing, and involuntary cries; with these
strange symptoms there was catalepsy, when
the victim would have visions of either St.
VitU3 or  St. John.  These  seizures would
last until the sufferer was entirely exhaust-
ed.  On  the feast-day of St. John  the dis-
order made its appearance.   The people in
the course of their dissipation would kindle
large fires through which  men and  women
leaped, believing that the attacks would be
aborted by this procedure.  The excitement
attendant upon this undoubtedly brought
on the disease.   The dance of St. Vitus re-
ceived its name from the fact that the suffer-
ers went when afflicted to the chapel of St.
Vitus, assured that this holy person would
listen to  their  prayers and those  of  the
priests, who also sang masses and interced-
ed for them.  All persons of this class who
before  had St. John's dance now had  the
dance of St. Vitus.
  This name is  applied to the disease even
at the  present day  as a common term.  In
the seventeenth century the disease changed
its  character somewhat, hysteria being a
prominent symptom, and  there was a dis-
appearance of a great many of the maniacal
outbursts.  The  condition  known as tarant-
ism was  supposed to be due to the bite of
the tarantula, but in reality it was caused
by actual morbid fear of the consequences of
a bite.   The patients were dull and moody
until  they heard certain  kinds  of  music.
They would then leap into the air in a state
of frantic excitement, and dance in  an  ex-
travagant manner; some would be impelled
to cast themselves into  the  sea, and others
would  commit disgraceful sexual excesses.
They usually danced until utterly worn out,
and then fell to the ground.  Wind instru-
ments and drums produced the music which
seemed to influence them the most quickly.
There are numerous cases of chorea  record-
ed in late years that closely simulate  the
tarantism of several hundred years  ago.
Dr. Kinder Wood of England had a patient
who suffered from this form of chorea;  the
roll of a drum would stop the attacks. A
species of dancing disease very closely allied
to St. Vitus's dance appears in certain parts
of Africa, particularly in Abyssinia.  The
disease is known as tigritier.  The  malady
begins  in an acute form, and runs at first
the course of an ordinary continued  fever.
The priest is appealed to, who arranges  the
programme  and conducts  the ceremonies.
He leads  the patient out into the market-
place ;  when music is played by a band of
his dusky friends he begins to dance, and 
88                         THE  FAMILY  PHYSICIAN.
continues all day; he then  stops, turns ir-
resolutely, and starts off on a run, and  goes
a great distance, not stopping till utterly
fatigued, when some one of the tribe strikes
him on the back with the  flat part of the
blade of a large knife, and asks  him his
name.   If the disease has disappeared and
the mind cleared up, of course he  will be
able to tell it.   Full  particulars of this in-
teresting condition are given by many of the
English travellers.
  It seems as if these* same superstitious
diseases  were not confined  to the  Middle
Ages or to barbarous  people.   Frequent
illustrations of a modern form are shown
at the present day among the many fanat-
ical  sects affected by kindred conditions.
Dancing Shakers, dancing  dervishes,  and
the members  of religious societies in France
known as convulsionnaires have these pecu-
liar  choreiform  attacks as a  part  of their
religious ceremonies.  Our own camp-meet-
ings abound  in  examples.   Attacks of the
disease  last  frequently  for  months,  and
young women  often  become the  victims
of a peculiar morbid emotional state which
frequently renders their incarceration in an
asylum a matter of  necessity.  These at-
tacks result from a depressed condition of
the system, as a sequence  of a  long-con-
tinued state  of  emotional  excitement, of
fasting, and, to  a certain  extent,  contact
with other individuals affected like them-
selves.  Scheie de Vere relates in his Mod-
ern Magic that in the consecration of a mag-
nificent church at Liege a great many peo-
ple affected  with  St. Vitus's dance  gave
themselves up  to shameless  dances,  and
falling  exhausted, after  spasms  and  con-
vulsions, requested friends to  press  violent-
ly upon their chests, and thus a seizure was
stopped.
  The violent forms  of chorea of  modern
times differ  from  the ancient St.  Vitus's
dance so far as the mental condition is con-
cerned.  The  victims  of  the disease  now
rarely  believe themselves to  be possessed.
The superstition  and ignorance of the Mid-
dle Ages did much to  foster a general belief
in possession  by  the devil.   Tbis is  evident
from the manner in which cures were effect-
ed, by the laying on of hands and  exorcis-
ing by the priests.  Of course the power of
advanced religious knowledge and increased
ability for reasoning, improved morals, and
increase  of Christian  faith  have  entirely
changed the barbaric character of  the dis-
ease.   (For symptoms and  treatment see
article on Chorea.)
  Salaam7 ConvuFsions, a rare and remark-
able disease  of  children,  accompanied by
rapid bowing of the head.  It sometimes
occurs periodically.   It is a clonic spasm of
 the sterno-mastoid muscles.  Its  cause, na-
 ture, and treatment are very obscure.  Iron,
 zinc,  and nux vomica have  been  recom-
 mended.  The disease may possibly pass
 away with the completion of the teething
 process, but  epilepsy or  idiocy  sometimes
 follows.
   Salivation [Lat. saliva], a specific irrita-
 tion of the salivary glands, mouth  and throat
 by  mercury.   In former years, mercury, in
 heroic doses,  ranked  as  a remedy second
 only to  bloodletting.  Salivation  was a fre-
 quent occurrence—intentionally produced in
 many cases, in others the  accidental result
 of large doses and individual susceptibility.
 Children  will  endure large doses of mer-
 curials without salivation; adults are rela-
 tively susceptible.   An open  and active
 state of the skin, kidneys,  and bowels favors
 immunity from salivation, even  when  the
 mercurial taken is considerable;  reversely,
 if opium or any remedy which checks  the
 glandular activity and functional excretion
 of kidneys or bowels  be taken before or at
 the same time, even small doses of mercury,
 thus detained in the  system, may salivate.
 Mercury to-day is chiefly employed in laxa-
 tive and cathartic doses, eliminating itself
 as it performs its  intended action;  also in
 small repeated doses  for alterative effects in
 some intestinal disorders of children and in
 certain specific diseases of adults.   Hence,
 salivation is rare to-day.  Salivation is man-
 ifested by a  coppery  or metallic taste, by
 soreness of the gums,  tenderness of the jaws
 and teeth when pressed together or closed
 with force, excessive  secretion and flow of
 saliva, even  dribbling from  the  mouth;
 swollen, red, ulcerated gums; swollen, coated,
 salvy tongue, taking the imprint of the teeth;
 and a foul "mercurial" breath.   In grave
 cases, spongy,  bleeding,  sloughing gums,
 loosened teetb,  swelling  of the  face and
 neck, and even gangrene of the mouth, may
 result.  There is accompanying constitu-
 tional depression, slight irritative fever, pain,
 sleeplessness, and sense of choking.  The
 condition requires prompt saline  cathartics,
 very astringent gargles  for the mouth, rich
 liquid food, and tonics.
   Salt Rheum.  See Eczema.
   Scabaritic Disease.   See Scabies.
   Sca/bies [Lat.], or Itch, is a parasitic dis-
 ease of the skin.  It affects  chiefly  the hands,
 more especially the webs of the fingers, their
 inner surfaces, and the back  of  the hand.
 Less frequently it  extends  to the arms,  and
 rarely the feet, legs, and abdomen are affected.
 The scalp may be invaded, but the face  is
 exempt.  This disorder infests children, who
 receive  the peculiar insect from  person to
 person by contact in  school or play,  and its
. lodgment  is facilitated  by neglect to wash 
THE FAMILY PHYSICIAN.
89
perspiration and dirt from the hands.  Per-
sistent and annoying itching is experienced;
careful inspection  detects small red eleva-
tions, points of irritation, papular at first;
soon these  become vesicular or watery  at
the tip, white-capped points, and often from
scratching are rendered pustular, and later
scaly.   Closer inspection discloses small red
lines connecting these vesicles or branching
from them into adjacent healthy skin. These
red lines are subcuticular channels, produced
by the burrowing of the itch-insect beneath
the cuticle or scurf-skin, and the vesicles are
the result of inflammation to which its pres-
ence and irritation  have given rise.  The in-
sect will not be found in the fluid or cavity
of the vesicle, but by laying open the diverg-
ing canals with a  fine needle may often  be
found at its end.   This parasitic insect is
known as the Acarus scabiei,  or Sarcoptes
hominis.  It is a minute whitish insect, from
xtnjth to ^jtli of an inch long.   The male is
least often  found,  being  migratory  in his
habits,  and  small.  His head  is provided
with two mandibular organs and four palpi
or bristles; the adult-male has eight legs.
The female is sedentary in habits, and more
easily found, especially at the ends of chan-
nels, where she lays her eggs.   The  acarus
makes its progress  beneath the epidermis  by
means of suckers or disks upon  its legs, and
by aid of bristles  upon  its back, directed
backward.  Hahnemann ascribed itch  to a
supposititious cause, a subtle humor, which
he termed psora ; but the microscope has es-
tablished the parasitic nature of the disease.
The treatment of scabies is to kill the para-
sites.   Remedies   producing  this end are
termed parasiticides.   Chief among these
is sulphur,  in  ointment,  powder, or  vapor.
Sulphurous acid is  a convenient application.
Carbolic acid, kerosene,  petroleum,  strong
alkalies, solution of corrosive sublimate are
also efficacious. Even when cured as a spe-
cific disease, the redness and vesicles may
linger,  a chronic  condition  of irritation.
Soothing ointments are then indicated.
   Scald.  See Burns and Scalds.
   Scald-Head.  See Favus.
   Scarlatina  [N.   Lat.],  or Scarlet  Fever,
one of the acute eruptive or exanthematous
fevers.  Chiefly a disease of childhood with'
immunity for adults, increasing as the period
beyond puberty lengthens.   It  is an infec-
tious disease, but propagated often by con-
tagion or close aggregation of children,  as
in schools,  asylums, or at play; therefore
occurring sometimes in local epidemics;  at
other times, with a graver type and great
mortality, involving whole communities.  In
different individual cases, as well as different
seasons  and epidemics, it assumes variable
degrees, from  a trivial disorder to a malig-
nant  and hopeless attack.   However,  no
case is without danger.  While in the well-
defined scarlatina sore-throat,  high fever,
and the scarlet eruption or " efflorescence "
are present, in the undeveloped and trivial
attack the kidneys are perhaps equally liable
to be  seriously involved.   Physicians recog-
nize three marked varieties: (1) Scarlatina
simplex,  simple scarlet fever, in which the
" rash " or eruption is fairly developed, the
patient comfortable, and  complications do
not exist; (2) scarlatina anginosa, where an
unusual soreness  of the throat, with forma-
tion of pseudo-membrane resembling diph-
theria, is present;  (3) scarlatina latens, a latent
form, where the eruption  may be absent or
doubtful, but grave injury  is done by the
scarlatinal poison in the blood to the nerve-
centres or the kidneys.  Like  other  con-
tagious diseases, scarlatina has its period of
" incubation " or development;  four to six
days  usually  intervene  between  exposure
and the consequent attack.   The  fever de-
velops,  sometimes a simple and steady rise
of temperature,  more often with projectile
vomiting, nervous excitement, and exhaus-
tion indicative of a powerful impression on
the nervous centres.  The temperature may
rise to 104° or 107° F., higher in fatal cases.
The throat is already florid and tender, the
tongue  studded with sensitive red  papillae.
At the end of twenty-four hours of fever the
eruption appears—an efflorescence composed
at first of minute red points upon a flushed
surface, and later of a uniform scarlet  hue.
It develops  upon the body and neck before
the face, being especially developed over the
upper half of the back. The face and lower
extremities are soon involved, and the cuti-
cle, destroyed by the high  temperature of
the surface, may  begin  to fall by the  fifth
day.   This  process of  " desquamation"
varies.   In mild cases, when sponging or
bathing  has  been employed to allay fever,
no  flaking or falling of the cuticle is seen.
In  others it  may slowly separate in shreds
and patches.   Still again, the cuticle cover-
ing fingers and toes may exfoliate intact,
forming perfect casts or like the finger of a
glove.  During and  following this desqua-
mation danger is greatest of acute inflam-
mation of the kidneys, the  " desquamative
nephritis" constituting  the most  serious
sequela  or complication  of scarlet fever.
Scarlet fever is a grave disease.  The mortal-
ity is  very variable, from 1 in 5 to  1 in 25,
according to class of patients and type of
epidemics. The  chief causes of death are
early convulsions, diphtheritic throat compli-
cations, and uraemic poison and dropsy from
implication  of the kidneys.  Scarlatina  is
chiefly to be distinguished  from  measles,
since  these are the two prominent  eruptive 
90                         THE FAMILY PHYSICIAN.
fevers of childhood.  It lacks the early de-
velopments of measles—watery eyes, sneez-
ing, cold in the nose,  loaded tongue—and
presents  its  peculiar eruption two days ear-
lier than that of measles.
  (1)  In scarlet fever  treatment is chiefly
directed to confining the temperature within
limits  by the use  of  aconite, diaphoretic
drinks,  blanketing,  frequent sponging,  or
even the wet pack.  (2) To favoring the ac-
tion of the kidneys by digitalis and emolli-
ent alkaline drinks, as flaxseed tea and soda.
The inunction of lard, practised by the Ger-
mans,  and  of butter of cacao, protect  the
skin and guard the kidneys from congestion.
(3)  To maintain the strength and counteract
the poison  of the disease.  Quinine and
tincture of iron are chiefly indicated, in free
and frequent doses.  Sulphite  and  sulpho-
carbolate of soda and salicylic  acid may be
administered for their antiseptic effect. Lib-
eral liquid diet throughout, and mild alco-
holic  stimulus  when   convalescing.   The
throat may require  cold gargles, cold and
disinfecting sprays.  Secondary kidney dis-
order—dropsy and scanty urine—calls  for
dry cups over the kidneys, the  hot-air bath,
elaterium as a purge, digitalis, and alkaline
diuretics.
  Scarlet Fe'ver.  See Scarlatina.
  SciaFica  [L. Lat.], neuralgia ischiadica, a
neuralgia of  the  great sciatic nerve,  the
sacral plexus, or any of the nerves of the
thigh and hip.   According to Niemeyer, the
cutaneous nerve of the  thigh, the  superficial
branches of the peroneal nerve, and the sural
nerve are the principal  seats of what is call-
ed  sciatica.  Exposure, rheumatism, gout,
tumors near the nerve, fecal masses, haemor-
rhoids, diseased vertebrae, metritis, and peri-
metritis are reckoned among the causes.  It
sometimes follows a severe labor in childbed.
Laxatives, cupping, leeching, the moxa blis-
ters, hot baths, and local or general anodynes
are frequently palliative, and sometimes cura-
tive.  Periodic sciatica may often be relieved
by quinine.   Salicylic acid, iodide of potas-
sium, and turpentine are sometimes extreme-
ly useful, and so is the constant electric cur-
rent.   It is, however, a most obstinate and
distressing complaint.
  Scrivener's PaFsy, or Writer's Cramp, a
derangement of the motor nerves of  the
fingers and thumb, usually of the right hand,
caused by over-exercise with the  pen, com-
bined with inattention  to the mechanism of
the arm.   It may  also attack  musicians,
milkers, seamstresses, shoemakers, and oth-
ers who  employ to excess the same nerves,
but is then generally known by other special
names,  sucb as "cobbler's  spasm."  It is
frequently attended with spasmodic and  in-
controllable movements of the fingers.  Dis-
continuance of the causative vocation is es-
sential.   Devices  to  steady  the  hand  and
efforts to train the left hand to act as a sub-
stitute fail, showing that a defect has  been
developed at the educated brain-centre pre-
siding  over  the trained muscular activity
which was employed to excess.  It should
be treated with tonics, particularly iron, and
galvanism  has been employed with  good
effect.
  ScroFula  [Lat. scrofa, " a breeding sow,"
swine being affected  by a similar disease] ;
also known  as Struma (from Lat. strvere, to
"build"), since the  lymphatic glands  are
enlarged in this condition.   Persons of the
lymphatic temperament are  most liable to
develop the  marked symptoms of struma or
scrofula.  Scrofula is hereditary in many
families.  In many other persons it arises
de novo from bad hygiene and regimen, es-
pecially in children when rapidly develop-
ing.  Disordered digestion, uncleanly  skin,
deficient clothing,  foul air,  are  its  causes.
Many symptoms  of disordered blood-states
formerly grouped as scrofulous are now dis-
tinguished as having definite causes.   Ecze-
ma, though  often an exponent of struma, is
as often due to other causes—nervous  in-
fluences, rheumatic taint, gastric  and intes-
tinal derangements.   The scrofulous person
is light complcxioned, the skin is white, the
body often full, or even obese, but the mus-
cles soft and flabby.   In the  child the head
is large relative to the  body, the eyes full
and wbite, the  teeth white, tending to frac-
ture and early decay.  The chest often lacks
symmetry, the breast-bone  promine*nt, the
bones of the arms and legs often are unduly
long, with prominent bulbous extremities.
Such conditions, more advanced, constitute
the " rickets."   The  chief characteristic of
scrofula is the susceptibility of the glandular
system.  Either persistently or with every
slight impairment of health the glands of
the neck, groin, abdomen, etc. become  in-
durated and enlarged.  Such swellings may
be  evanescent or  leave permanent indura-
tions.  The glands of the neck  frequently
are so engorged with " scrofulous " exudative
matter that it becomes " caseated "—a state
of  fatty degeneration—or  actually  suppu-
rates, producing scrofulous abscess.  Scrof-
ula is  not, then, a definite specific disease,
but a condition of serious perversions of the
nutritive qualities of the blood, and result-
ing affections of the various tissues and or-
gans of the body.  Enlarged glands, moist
skin diseases, superficial abscesses, unsym-
metrical developments of the teeth,, nails,
and bones are some of its  manifestations.
Inherited scrofulous  taint may remain la-
tent until developed by depressing sickness.
Thus, measles, a harmless disorder in robust 
THE  F^
   children, is hazardous when struma lurks in
   the system.  The bottle-fed infant and the
   foundling are more often scrofulous than the
   nursed, home-reared child.  The mucous and
   serous surfaces are very liable to disease in
   struma,—subacute  and tubercular menin-
   gitis, hydrocephalus, chronic bronchial ca-
   tarrh, diarrhoea and cholera  infantum, and
   marasmus.   The relation of scrofula and the
   pulmonary tuberculosis of adults is disputed.
[   That strumous and scrofulous  persons are
   very liable to develop phthisis is, and  has
   always been,  generally  conceded.   Very
   prominent pathologists to-day regard  scrof-
   ula and tuberculosis as separated only in de-
   gree.  The discovery by the microscope that
   yellow tubercle is merely " caseous " or fatty
   metamorphosed matter, and gray tubercle an
   exudation or deposit rather than a definite
   structure, supports this view.  The disastrous
   effect of pulmonary tubercle depends largely
   upon the preceding low blood-state, largely
   upon the close structure and functional dis-
   turbance  of the lung invaded.  Simon terms
   scrofula the soil for tubercle;  AVilks calls
   scrofula a primary tubercle, a secondary form
   of a common disease.  A majority of cases
   of pulmonary consumption  are,  however,
   disconnected  with  scrofula or struma, the
   result  of  preceding inflammatory processes
   in the  pleura, bronchial tubes, or lung-tis-
   sues.  The treatment of scrofula is hygienic
   and nutritive—warm clothing, bathing, fric-
   tion to the skin, pure air, correct rich diet,
   special articles of diet, as the hydrocarbons
   or fats and preparations of phosphates.  Iron,
   iodine, and arsenical preparations act as al-
   teratives to reduce glandular enlargements.
     Scur/vy [Lat. scorbutus,  a hybrid  word
   from a Scandinavian  root, scorb, and the
   Latin  termination -utus], a diseased blood-
   state, induced chiefly by prolonged privation
   of fresh  vegetable  and animal food.  Al-
   though not exclusively a sailor's malady, its
   ravages have been  most disastrous at sea,
   devastating,  previous to this century, the
   navies and merchant marine of all nations.
   Pizarro's  squadron  included  2700 men, of
   whom  but 100 survived.  Ships were often
   lost adrift at  sea, the crew unable to work
   and perishing.   Anson's English fleet in
   1742 in nine months lost  626  out of 961
   men.  The chief cause of this  pest of the
   marine was the  exclusive  diet—salt  meat
   and hard, dry bread, with impure and de-
   ficient  drinking-water—upon which sailors
   subsisted during prolonged voyages.  Expo-
   sure to cold or to tropical heat, fatigue, and
  the unsanitary and foul condition  of  ships
   contributed to the  development of scurvy.
   As early as 1617, Wodall recorded the vir-
  tues of lemon-juice  in  curing this disease,
  and in  isolated cases its use  and a  vegetable
PHYSICIAN.                         91
 diet saved the crews  so treated.  But not
 until the latter half of the eighteenth cen-
 tury were improved ship hygiene and vege-
 table diet at sea enforced.  Thus, only thirty
 years after Anson's fearful loss, Capt. Cook
 sailed on a three years' voyage around the
 world, losing but one man by disease. Parry
 in three polar expeditions of a year and a
 half and two years' duration lost only 7 men
 out of 334.  To-day, scurvy is almost un-
 known at sea, but it occurs occasionally on
 land, in garrisons and  prisons,  and in  com-
 munities suffering from starvation. - All of
 the symptoms of scurvy are  directly  con-
 nected with the impoverished,  impure state
 of  the blood.  The fibrin of  the blood is
 less and  its coagulability  decreased;  the
 salts of soda are lessened, the red corpuscles
 are dark, poorly  oxygenated,  and tend to
 disintegrate.  All parts of  the body are cor-
 respondingly  ill  nourished.    The face is
 cachectic and sunken, the  body emaciated,
 the limbs are feeble and seem unduly heavy.
 The gums become dark, bloody, relaxed, and
 spongy.  There is an early tendency for the
 vitiated blood to escape from its vessels—an
 occurrence favored both by its thinned con-
 sistency and by the changed nutrition of the
 capillary walls.   At first, mulberry-colored,
 purple spots of variable  size appear on the
 legs, later on the body—a mere transudation
 of serum and blood-pigment in solution be-
 neath  the epidermis.   Later, larger  purple
 spots  or diffused patches  appear upon a
 tough, indurated,  leathery  base, due to ef-
 fusion of  blood   in quantity beneath  the
 true skin or between superficial  muscles,
 infiltrating and coagulating in the minute
 interspaces of the connective tissue.  Such
 patches are painful to  touch; they may be-
 come the site of  bloody blebs or  of  ulcers.
 Bloody serum often  transudes   into  the
 pleural cavities, embarrassing  the respira-
 tion ;  also into the pericardium, peritoneum,
 and the cavities  of the joints.   "Bloody
 flux," or dysentery, is frequent; also vomit-
 ing of blood and nose-bleed.  Death occurs
 from exhaustion.   Critical  cases may rapid-
 ly change  for  the better,  and mild cases
 quickly recover,  when put upon  support-
 ing and vegetable diet.  Onions,  cabbage,
 radishes, horse-radish,  " scurvy-grass"  or
 spoon-wort,  water-cresses—the  entire class
 of the Cruciferae—are especially efficacious;
 all  the  vegetable acids,  lemons,  limes,
 oranges, cherries, currants,  apples,  are valu-
 able.   Sauerkraut is extolled by  the  Ger-
 mans, combining  vegetable food and acids.
 Animal broths, tonics, and regimen are es-
sential adjuvants to this treatment.  Modern
improvements in  sailing ships  and the use
of steam at sea, by shortening voyages, have
tended  to  lessen sickness  among sailors. 
1)2                         THE FAMILY PHYSICIAN.
The improved hygiene of ships, the supply
of fresh meat and vegetables prescribed by
law for sailors, and the modern methods of
keeping  such articles hermetically  sealed
for long  voyages, have rendered scurvy an
unknown  disease.
  Sea'-Sickness, a nervous affection attended
with nausea  and convulsive vomiting, pro-
duced by the oscillations of a  ship at sea.
Its origin and nature are still  very imper-
fectly known. It may attack the strong and
cautious, while the debilitated and  incau-
tious go free.  It may  attack in calm weath-
er and on smooth waters, while a storm and
a rough sea fail to produce it.   It may pass
away  after the lapse  of a few hours, or last
during a long voyage.   Dr.  Chapman ex-
plains it as an undue accumulation of blood
in the nervous centres along  the back, and
especially in  those segments of the spinal
cord related to the stomach and the muscles
concerned in vomiting, and recommends  as
the best remedy  against  it the application
of ice-bags to the spinal column.   In some
persons its violence is prevented  by small
doses of opium, or by soda-water  or saline
draughts in  the effervescent  state.  Cham-
pagne will alleviate,  and relief is derived
from  nitrite  of  amyl, the latter in pearls
which can be crushed in the handkerchief,
or a few drops in  a phial can  be carefully
inhaled.
   Se'nile  PaFsy.   See  Paralysis  Agi-
tans.
   Serpent or Snake-bites.  See Venom.
   Shin'gles (a disease).   See  Herpes.
   Shock [O.  H. Ger. Scoc], sudden vital de-
pression, the  peculiar  effect upon the animal
system produced by violent injuries or vio-
lent mental emotions. It is especially a sur-
gical term. Following serious accidents, the
crushing of a limb by a railroad injury or
its removal by a cannon-ball, extensive su-
perficial  burns, extensive surgical  proce-
dures, as amputations or ovariotomy, and as
the result of blows over important organs,
concussion of the  brain, a kick or sudden
blow in the region of  the  stomach  over the
solar plexus—a powerful impression is made
on the nerve-centres proportionate to the ex-
tent of the superficial or peripheral  nerve-
irritation.   Every  sensation conveyed,  in
the state  of  health,  from the surface  to
the nerve-centres, and  recognized by the
brain, whether as sensation of simple touch,
of pain, or a special sense, as taste or smell,
involves the functional activity and wear  of
the ganglionic or nerve-cells.  A violent im-
pression  upon many  superficial nerves in-
volves sudden and violent action in the
ganglionic centres.  When the surface im-
pression  is extreme, the functional activity
of the brain and  other  central ganglia  is
disturbed, or may  be temporarily or per-
manently suspended.  The vital  phenom-
ena of the body—consciousness, respiration,
heart-action,  capillary circulation—are de-
pressed in proportion to the shock received
by  the  nerve-centres.  The symptoms  of
shock are extreme pallor  and coolness  of
the face  and surface of the body, a small,
feeble, slow pulse, infrequent  and often  ir-
regular respiration; if conscious, the mind
feeble, often  unconscious,  or deep  coma
with relaxation of the muscles.  In special
cases  delirium,  hiccough,  convulsions  are
present.   The  circulation  and  respiration
may be  so depressed that  death is  imme-
diate, or  speedily ensues unless  reaction is
artificially hastened.   Sensation of pain is
annulled: in the gravest injury, as the lace-
ration and removal of a limb by a cannon-
ball, there may be no pain and no loss of
blood during the period of shock;  the period
of shock, if survived,  is followed by reac-
tion, a resumption  of ganglionic or central
nerve-power,  and revival of the dependent
functions; extreme loss of blood is a prom-
inent cause of shock, producing sudden anae-
mia, inanition, and disturbed action of nerve-
centres.  The depressing after-effect of the
inhalation of chloroform and  ether, and of
alcoholic excess, is  sometimes  spoken of as
shock, but with  doubtful  propriety.  The
influence of  great  mental excitement  or
depression in causing shock is  undoubted.
The sight of blood causes  many to faint.
Fright, terror, sudden sorrow have  caused
the hair to  turn white in a night—have
produced delirium,  convulsions, incurable
epilepsy, dementia, permanent nervous pros-
tration, and  death.  No satisfactory  lesion
or organic change has been found to explain
shock, as when  autopsies  have been per-
formed following  sudden death by lightning
or blows over the solar plexus.   The treat-
ment of shock is to be directed to the imme-
diate development of reaction.   The sink-
ing pulse must be rallied by ammonia and
alcohol, by stimulating enemata, heat to the
extremities and surface.  Counter-irritants
to the extremities, epigastrium, and occiput
aid to equalize capillary circulation.  The
galvano-electric poles to the  region of the
medulla  and diaphragm may facilitate res-
piration.  In mild cases of shock external
warmth,  a little diffusible stimulant,  and
rest are  all that  is required.
  Sight,  Defects  of.   Defects of  sight are
due either to (1) errors of refraction,  (2)
opacities of the refractive media, (3) lesions
of the optic nerve, retina, or choroid, or  (4)
continued exclusion of the  eye  from visual
purposes,
  (1) In  the lesser degrees of deviation from
the normal  condition of refraction (emme- 
THE  FAMILY  PHYSICIAN.
9b"
 tropia) the vision can generally be raised to
 the normal standard by the use of suitable
 glasses, but  in  very high degrees of ame-
 tropia the sight can rarely be raised to over
 one-half or two-thirds the normal.  In high
 degrees of myopia and myopic astigmatism
 there  is usually an  affection of the choroid
 (staphyloma posticum), which increases  the
 area of Mariotte's " blind  spot," and, when
 extensive, encroaches upon the region of
 the  macula  and  interferes  very seriously
 with  the acuity of the sight.  In high  de-
 grees  of hypermetropia and of hyperme-
 tropic and mixed  astigmatism all objects
 are seen under large circles of dispersion,
 and hence with great indistinctness. The
 eyes  are thus, under the influence of pro-
 longed bad  vision, so affected that they do
 not, even when an existing  refractive error
 has  been corrected,, at once exhibit the  ex-
 pected sharpness of vision.   In young sub-
 jects this defect often passes away quickly
 under exercise of the organs with the cor-
 recting lens.  It is difficult, and  often  im-
 possible, to correct with glasses those defects
 of vision arising from irregular astigmatism.
   (2) Serious defects of sight may arise from
 opacities of  the cornea so slight that they
 can only be perceived by the aid of the oph-
 thalmoscope or of a powerful convex lens.
 In the other extreme the cornea may be  en-
 tirely  opaque,  thus  reducing the vision to
 bare perception of light.  Where the pupil
 is covered with opaque cornea, and another
 part of the cornea is transparent, vision is
 often in a great measure restored by making
 an artificial  pupil immediately behind  the
 clear portion of the  cornea.  The deformity
 produced by opacity of the  cornea is some-
 times  removed by tattooing the  white spot
 with India-ink.
   Next we have opacities of the  crystalline
 lens and its  capsule.  An infrequent form
 of opacity of the anterior capsule is the un-
 absorbed remains of the pupillary membrane
 of foetal life. This  usually  consists of one
 or more filaments of opaque  tissue stretched
 from  the pupillary border of the iris to a
 point of attachment near the centre of  the
 anterior capsule.  Opacities of the lens con-
 stitute what is  known as cataract.   This,
 like  nearly all other affections of the  eye
 causing defects of sight, may be either con-
 genital or acquired.  It  may be the result
 of a blow  upon the eye,  or of diabetes, or
 of the general breaking down of the system,
 and consequent mal-nutrition of the lens, due
 to old age.   Whatever may be its  cause, it
 can in no case be removed except by surgical
 operation.
   Opacities of the vitreous may  be due to
haemorrhage  from the retinal or choroidal
vessels, and the consequent mingling of blood
with the vitreous humor, or to inflammatory
or degenerative changes in the humor itself.
A curious  form of vitreous opacity is  pro-
duced by the formation of numerous crystals
of cholesterine  in that fluid,  presenting a
brilliant ophthalmoscopic  picture,  like a
shower  of  sparkling meteors.
   (3) Inflammation or atrophy of the optic
nerve, or of either of the coats forming the
back wall of the eye, separation of the retina
from the choroid, tumors of the optic nerve
and  retina, haemorrhage into the substance
of the  retina, all produce grave defects of
vision, 'and can be diagnosticated only by
means  of the ophthalmoscope.
   (4) In cases  of squint of one eye, either
convergent or divergent, the image of the
object formed upon the  retina  of the devia-
ting eye is  almost always involuntarily sup-
pressed. Thus  the eye is  excluded from
vision,  and gradually loses the  power of
performing its function, as would be the case
with any other  unused  organ.  When such
an eye has been restored  by operation to
parallelism with its fellow, the visual power
not unfrequently increases to a marked de-
gree.   In alternating squint, where the indi-
vidual  sees first with one eye and then with
the other,  the  sight remains good  in both
eyes.   Hence in these cases there is not the
same urgent necessity for an early operation.
In cases where  one eye is  emmetropic and
the other very  hypermetropic, more or less
impairment of vision of the latter usually
occurs.   This, if it has not gone  too  far,
may often be remedied by daily and regular
exercise of the  amblyopic  eye with a glass
correcting  the  refraction,  the perfect  eye
being temporarily excluded.   Cases occa-
sionally come under observation where it is
impossible  to detect any cause for the defect,
which  may range from  a slight impairment
of vision to total blindness.  Ophthalmolo-
gists not very infrequently meet with cases
in which defective vision  of  one eye had
existed  for  many years  before  it was acci-
dentally discovered.
  Skin Diseases.  The human  skin is  sub-
ject to the same morbid processes to which
other organs of the body are.  The  diseases
appear  as  primary or secondary  eruptions,
the former  being immediate products of the
morbid processes,  the latter  produced by
further  development  or changes  of  the
primary eruptions.   Primary forms are—
(1) The macule or spot, a change of the  nor-
mal color of the skin without elevation, not
uniformly distributed  over the surface, aris-
ing from hyperaemia, haemorrhage, or  in-
flammation, sometimes  from  anomalies of
the distribution of the coloring granules of
the skin, the pigmentum.  More or less uni-
form changes of the color of the surface are 
94                          THE  FAMILY PHYSICIAN.
termed discolor ations.  (2) The papule or pim-
ple, a projection above the surface, varying
in size between a millet-seed and a lentil,
produced by diseases of the cutaneous glands,
inflammation, and new growths of the papil-
lary layer.  (3) The tubercle, a solid projection
of the size of a lentil up to that of a hazel-
nut.   (4)  The wheal is slightly raised above
the surface, and greatly exceeds the thickness
in horizontal extension, varying in size from
that of a finger-nail to that of the palm of
the hand.  (5) The tumor forms a solid pro-
jection of the size of a walnut to that of a
man's fist.   (6) Vesicles are elevations of the
epithelial layer of the skin produced by a
transparent or milky fluid, corresponding in
size  to that of papules, and as such never
being of a long  duration; while (7) blebs
surpass  the size of vesicles up to that of a
goose's egg, and (8) pustules always  contain
pus, and therefore form superficial abscesses
of the skin.   Vesicles, blebs, and pustules
almost always are surrounded by inflamma-
tory areas.
  Secondary forms of eruptions are—(1) The
excoriation, a flat abrasion of the epithelial
layer of the skin, arising  from destruction
and  rupture of primary eruptions, very oft-
en through scratching with the finger-nails.
They always heal without  the formation of
a scar.  (2) Theulcer presents a loss of sub-
stance penetrating into  the derma,  which
heals slowly and with formation of a cica-
trix.  (3) Fissures are elongated cracks in
the skin on  parts liable to  much  stretch-
ing.   (4)  Scales are produced  by detached
epidermis.   (5)  Crusts result from  drying
of an exuded fluid or of extravasated blood.
If the scales or crusts or  the sebaceous se-
cretion  be  placed one over  the other in
strata, they are termed (6)  lamellated crusts.
(7) Scars or cicatrices  are  connective-tissue
formations, which replace deeper losses of
substance of the derma.
  The causes of  diseases  of the skin are
either rooted in the whole organism, or they
are local ones, by which the skin is primarily
or chiefly attacked;  hence the division into
symptomatic and idiopathic affections of the
skin. There exist eruptions on the  general
covering which  are  intimately  connected
with and caused by diseases of  the whole
organism, such as in variola, scarlet fever,
measles, syphilis.  Certain  rashes occur in
typhoid fever, in purulent infection  of the
blood, so-called pyaemia, in scrofnlosis, scor-
butus, etc.  Moreover, diseases of internal
organs may involve the skin, especially af-
fections of the intestinal tract, of the liver
and  spleen, of the internal genital  organs,
of the  urinary apparatus, of  the   nerve-
centres.   There are, lastly, normal processes
—the dentition, menstruation, pregnancy—
which lead to various kinds of cutaneous
affections.   Hereditary transmission is of a
doubtless influence in causing skin diseases
(syphilis, psoriasis, leprosy, etc.); further-
more, the age, the business, the mode of life,
and climate.  But the most potent agencies
for producing affections of the skin are those
external to the body, attacking the skin di-
rectly.  Besides general injurious influences
—heat and cold, dryness  and moisture, dif-
ferent arts and trades—merely local diseases
are caused by the operation of caustic sub-
stances,  neglect  of cleanliness or  exagger-
ated washing and rubbing with strong  kinds
of soap, long-continued pressure upon cer-
tain parts, and  parasitic organisms which
penetrate  the skin.   The scratching of the
patient himself who  suffers from itching is
an important cause for producing mechani-
cally lesions  of  the  skin.  Thus,  parasites
give rise to such affections by irritating the
skin directly  or  by exciting the sensibility
of the cutaneous nerves by producing the
sensation of itching.   Besides the vegetable
"parasites, living within the skin, Trichophy-
ton, Microsporon, Achorion, and Oidium, there
exist animals wbich dwell within the tissues
of the skin—the itch-insect (Acarus scabiei),
the pimple-mite  (A. folliculorum), the sand-
flea (Pulexpenetrans), the Guinea-worm, the
harvest-bug—or merely seek their food upon
the skin's surface, such as the different kinds
of lice, the flea, the bed-bug, the mosquitoes,
and gnats.
   With regard to these causing agencies  of
skin diseases  the treatment will  either be a
universal or a merely local one.  If we suc-
ceed in removing the cause of the disease,
perfect cure is possible, especially of affec-
tions produced  by local injurious  agencies,
parasites, external irritations, and the like.
Skin diseases rooting in the general consti-
tution need a general treatment, either sur-
gical or internal.  There exist many skin
diseases which can be radically cured, while
other ones can be removed temporarily only,
without  the view of radical cure;  and still
other ones are incurable.  Many diseases run
their course without any treatment, or their
course cannot be modified by the physician;
in  these diseases, therefore, the indifferent
treatment  is  attended with  the best results.
The treatment of certain skin diseases va-
ries, however, greatly, depending upon the
views  about  their  causation;  thus,  very
often internal remedies are given unneces-
sarily where mere local treatment is sufficient
to cure a skin disease.
   In  considering the different varieties  of
affections  of the skin, we propose  to follow
in  all  essential points  the  classification
adopted by the  Vienna  school, the cham-
pion  of which is Hebra.   His experience, 
THE  FAMILY PHYSICIAN.                          95
 together  with an  unprejudiced mind,  led
 him to doctrines more in accordance with
 clinical observation than those of other der-
 matologists of either the past or the present
 time.  The changes of the skin, by too great
 an afflux of blood (hyperaemia) or  lack of
 blood  (anaemia), as such do not produce dis-
 eases of their own, being always of a tran-
 sient character or rooted  in  diseases of the
 whole organism.  We therefore omit their
 consideration.
   1. Diseases  due to  Perverted States of the
 Secretions  of  the Cutaneous   Glands.—The
 sweat-glands of  the  skin produce  a  fluid,
 the perspiration, which contains 99.3-99.5
 per cent, of water, the residue consisting
 of solid matters, among which are chloride
 of sodium, phosphate  of lime, hydrochlo-
 rate of ammonia,  and traces of iron and
 of fatty matters.  Even in the normal state
 each individual  diffuses around him a spe-
 cial odor.  There are persons with a pecu-
 liar rancid odor of their perspiration, a dis-
 ease called bromidrosis, either universal or
 local—for instance, lasting in the armpits,
 on the feet—in spite of the most scrupulous
 cleanliness.  This disease is  always depend-
 ent on too copious  perspiration  (hyper hidro-
 sis), and curable by repeated treatment with
 diachylon ointment.   The  secretion of a
 colored perspiration is  termed chromidrosis.
 The sebaceous glands, which secrete a fatty
 mass,  may produce the sebum in excessive
 quantity,  there being no impediment  to its
 secretion—the so-called seborrhoza.  The dis-
 ease is very common on the scalp (dandruff),
 and always leads  to loss of the hair.   It
 yields readily to  certain preparations of tar,
 and a  new growth of hair can very often be
 obtained.  If, on the contrary, the excretion
 of the sebaceous mass be interfered  with,
 the result is  its accumulation within the
 glands or their ducts, the so-called " flesh-
 worms "—comedones.  In the mass of a flesh-
 worm  there is often found  an insect, the
 Acarus folliculorum.  The flesh-worms, again,
 are the most common causes  of pimples, as
 they act upon their neighborhood like for-
 eign  bodies.   Hardened  flesh-worms are
 termed milium.   Sometimes   the sebaceous
 glands become very much enlarged, giving
 rise to appearance of tumors, atheroma, which
 if pedunculated are termed  molluscum, but
 are not contagious  at all.  Too scanty pro-
 duction of sebaceous matter leads to brittle-
 uess and  desquamation of the epidermis—
pityriasis simplex and xerosis.
  2.  Diseases due to Inflammation.—Inflam-
matory affections of the skin either termi-
nate within a short period of time, with a
definite duration, these being  called acute, or
the development and involution of the erup-
tion take place less quickly, the inflammation
being  of a  longer  duration  from repeated
relapses — chronic  inflammatory processes.
The acute inflammations, again, are either
caused by contagion, and  themselves  gen-
erate an infectious matter, or they do not
owe their origin to contagion nor  develop
it during their course.   The acute contagious
inflammations, so-called exanthemata, are due
to diseases which attack the whole organ-
ism, are attended  with febrile  symptoms,
present certain definite appearances on the
surface of the body, and run a course the
duration of which can be computed before-
hand.   In  these diseases — measles, scarlet
fever,  and smallpox—the sympathy of the
entire organism  is manifested by symptoms
of  various  kinds, both while the  rash is
present and also after its  disappearance.
They therefore cannot be regarded as  mere
skin diseases.  The acute, non-contagious in-
flammations have a definite typical course,
as their  symptoms succeed one another in
regular order. If the inflammation be man-
ifested mainly by redness, with  a slight ex-
udation of the fluid part of the blood,  fugi-
tive rashes are produced, which when spread
over large parts  of the surface  and do not
produce the sensation of itching, are termed
erythema, but when presenting isolated red
spots are termed roseola.   Extended and
isolated superficial inflammations,  accom-
panied with stinging or itching sensation,
receive the name of urticaria, the latter be-
ing  always characterized by the develop-
ment of  wheals.  Diseases  of  this  kind
often are  produced by  disturbances of the
stomach or by local irritations of the skin—
for instance, by  certain coloring-matters of
cloths, stockings, etc.—and accompanied by
fever.  They usually disappear after a short
period of time  without special treatment,
but are very liable to recurrences.  To the
group  of acute,  non-contagious  inflamma-
tions belong all  diseases produced mechan-
ically or by poisons, by too high or  too low
a temperature;  furthermore, the erysipelas
and furuncles.   The difference in the  ana-
tomical characters  depends on  the extent,
the  penetration   into  the  depth, and -the
termination of  the inflammation.  Lastly,
there exist acute inflammations  with accu-
mulation  of fluid  beneath  the  epidermis,
leading to  the  formation  of vesicles and
blebs, with  short duration  and  no liability
to return.    In  this  group  we  enumerate
the herpes (hives) and miliaria.  The herpes
zoster (shingles) is the most important of the
forms of herpes, it being more extensive and
the number of groups of vesicles much larger
than in common forms of  hives.  The seat
of shingles  always  corresponds  to the dis-
tribution of certain cutaneous nerves ;  they
almost always are confined to one-half of 
96                         THE FAMILY PHYSICIAN.
 the body, and  always accompanied with in-
 tense pains.  Shingles attack the individual,
 in most  instances,  only once in the life;
 unfortunately, very little  can be done  for
 the relief of the pains.   The chronic inflam-
 mations are characterized by  a  tendency to
 repeated relapses and the protracted course
 which they  run. One group of these dis-
 eases is  formed  by  eruptions which mani-
 fest themselves by a superficial  redness and
 slight swelling, affecting principally the pa-
 pillae of the derma, and are attended with
 an excessive production of epidermis, but
 only with trifling sensations of itching, ten-
 sion, or  pain.   Such are psoriasis,  lichen,
 and pityriasis  rubra.   Psoriasis is  a very
 common  disease, characterized  by  white,
 rough,  uneven epidermical patches  on a
 dark-red  ground,  dispersed  all over the
 body, mainly on the elbow and knee joints.
 The patches are not liable to any  further
 change, such as suppuration and ulceration;
 they leave no scars,  though they are some-
 times followed by persistent pigmentation.
 Sensations of pricking  or  itching are com-
 plained of only when the patches first come
 out; afterward there are no subjective symp-
 toms.  The disease  occurs  almost only  on
 otherwise healthy and strong individuals. It
 is, however, harmless, but very liable to recur
 after it has been removed by local  caustic
 and tar applications, together with internal
 administration of arsenic, carbolic acid, etc.
   A second group of inflammatory skin af-
 fections is characterized  by intense  itching,
 and besides the  primary form of eruption
 they irresistibly provoke scratching in con-
 sequence of the itching; this, again, gives
 rise to those further changes in the skin
 which are known under the name of excor-
 iations.  To this group belongs a very com-
 mon disease  termed eczema, and a rare dis-
 ease termed prurigo.   The eczema (moist tet-
 ter or salt rheum) is a skin disease of usually
 chronic course, characterized either  by the
 formation of aggregated papules and vesi-
 cles, or by more  or less deeply-red  patches
 covered with thin scales, or in  other  cases
 by a moist surface; while in any of these
 forms there may be developed in addition
 partly yellow and gummy, partly green  or
 brown, crusts.  The  different stages  of one
 and the same malady are therefore—papu-
 lar, vesicular, squamous, weeping, and crus-
 tous eczema.   The disease rarely turns into
 a dangerous  one, but is very troublesome
 on account of great itching and the conse-
 quences of scratching. It is curable in every
stage—by indifferent remedies when  acute;
by ointments, especially the diachylon and
zinc ointment, when weeping; by tar prep-
arations when  scaly;  and caustics  when
chronic and  having led  to hardening (so-
 called hypertrophy), of the skin.  Internal
 remedies almost always are useless.
   A  third group of chronic inflammatory
 skin  diseases  embraces those  pimply and
 pustular affections which arise from inflam-
 mation of the hair-sacs and sebaceous glands.
 They are recognized as forms  of acne, and
 distinguished into dispersed acne, sycosis, and
 acne  rosacea.  The dispersed  acne on  the
 face,  the chest, and the back—one  of  the
 most  disfiguring  diseases—is  always pro-
 duced by accumulation of sebaceous masses
 in the glands  (flesh-worms), and is entirely
 curable by repeated emptying of the glands
 and  irritating  agencies,  without  internal
 treatment.   Analogous are  the cause  and
 the treatment  of acne rosacea, which pro-
 duces the most common forms of red nose.
 Even this disease  is, if not neglected  too
 much,  entirely curable.   The  healing  of
 sycosis (barber's  itch) can be  obtained  by
 application of  diachylon ointment,  repeated
 shaving and pulling of  the hairs, in the
 sheaths  and follicles of which  the inflam-
 mation is mainly situated.
   To the fourth group  of chronic inflam-
 mations belong the  eruptions in shape  of
 blebs, termed pemphigus, an incurable dis-
 ease.   Chronic inflammations  of the skin
 of very variable but characteristic forms are
 produced by a general disease, syphilis; here
 the skin is merely symptomatically attacked,
 besides different other organs.  With trau-
 matic lesions of the skin, as well as with its
 inflammatory diseases, very often hemor-
 rhage, escape of blood from the vessels into
 the tissues,   is  combined.  Haemorrhage  is
 furthermore a symptom of universal disease
 in scorbutus, in purpura rheumatica, and mor-
 bus maculosus.
   3. Diseases due to Hypertrophy.—Too co-
 pious production of any tissue  of the skin
 may be  a consequence of a chronic inflam-
 matory process, or it may occur  without the
 symptoms of irritation as a consequence of
 anomalous congenital  productivity.   The
 corn and  the tyloma, for instance, are prod-
 ucts of a long-continued local irritation  of
 the skin, but we know of instances in which
 tyloma, the  hardening and hypertrophy of
 the skin of the palms and the soles, must be
 considered as a congenital disease.  The ele-
phantiasis arabum, an immense hypertrophy
 of  all constituting tissues of the  skin,  is
 doubtlessly due to chronic  inflammation  of
 the lymphatics; while ichthyosis, the exube-
 rant growth of  epidermis, is due to the con-
 genital hypertrophy  of the papillae.   Warts
 and papillary growths of  the skin  may  be
 produced by  either kind—local irritation as
 well as anomalous function of papillae. Horns
 of the skin,  hypertrophy of the nails and
 the hairs—polytrichia—always are dependent 
THE FAMILY PHYSICIAN.                          97
on congenital anomalies in the formation of
the tissues of the skin.  The pigment-gran-
ules of the rete mucosum are very often hy-
pertrophied,  leading to formation of brown
spots,  ephelides  (freckles), chloasma (liver-
spots), while long-continued irritation  of
the  skin leads to universal dark discolora-
tion—melasma.
  4. Diseases due to Atrophy are based on the
same principles as the too copious formation
of certain  parts of the skin—hypertrophy.
Inflammation often produces first hypertro-
phy, afterward ulceration, loss of substance,
and atrophy. Leprosy, lupus, and scleroder-
ma are instances of such combined diseases.
In  leprosy tumors  first appear, which sub-
sequently shrink or ulcerate, or  the shrink-
age is the immediate symptom of the disease
—morphew;  here the decreased sensibility
of  the  attacked  parts is one of the  main
symptoms.   All these diseases  lead to sec-
ondary ulceration, loss of parts of the  skin,
even parts of the body.  The treatment is
only in lupus successful, but  even here not
invariably.   Hypertrophy of the pigmentum
is not rarely combined with its partial atrophy
in vitiligo, leukopathia, etc.  Merely to atrophy
are  due the  senile changes of the skin, the
white color  of the  hairs, the early falling
out  of the hairs  without visible cause, the
localized atrophy of hairs in alopeda areata.
A plain atrophy is also the xeroderma. But
very little  can be done with  regard to the
cure of these diseases.
  5. Diseases due to New Growths. — New
growths or tumors either belong to the con-
nective-tissue formations  of the  skin, the
derma, or they are products of an anomalous
epithelial growth.   Tumors of the former
kind may be benign or innocent—viz.  pain-
less, not ulcerating, not recurring after ex-
tirpation, and not infecting the organism,
such as fibroma,  a  variety of which is the
formation of scars without preceding lesion,
the so-called  cheloid; furthermore, papilloma,
growth of the papillary layer, embracing most
of the warts and nozvi; lastly, angioma, erec-
tile tumors produced by copious new forma-
tion of blood-vessels.   Or the  connective-
tissue tumors are malignant—viz. painful,
ulcerating, producing  new growths around
the first-formed tumor, and  easily recurring
after extirpation, even leading to secondary
formations of identical tumors in the lungs,
the  liver, etc., such  as sarcoma, one variety
of which, the pigmented or melanotic sarcoma,
forms the most malignant kind of tumors of
the  organism.  Cancer is considered  to be
essentially an epithelial  formation, which
always is malignant.   In all tumors the rad-
ical  extirpation is the only reliable means
of curing the disease, very  often of saving
the life of the patient.
     7
  6.  Diseases due to Anomalies of Innervation
—Neuroses. — Many  of the already-named
diseases of the skin can be looked upon as
being disturbances of the nerves in the first
instance (urticaria, herpes zoster, leprosy, atro-
phy  of pigment).  Besides, we know dis-
turbances in the property of sensation  of
the skin,  lowered sensibility—anaesthesia—
and  excited sensibility—hyperesthesia.  To
the latter kind  belongs the itching of old
persons, pruritus senilis, which malady often
is treated  successfully  by internal adminis-
tration of carbolic acid.
  7.  Diseases due to  Parasites—The scabies
is produced  by the presence of the  itch-in-
sect  within the epidermis.   It begins with
development of small vesicles, mostly on the
skin of the  hands, especially that between
the fingers, these places being the most ex-
posed to invasion of  the insect.  The erup-
tion  is accompanied with  severe  itching,
which compels the patient to scratch.  By
simply scratching a  certain length of time,
all symptoms of eczema arise, even boils and
furuncles.  The disease is readily curable by
local application or preparations of sulphur.
Analogous is the action of the flea, the bed-
bug, the louse.   By vegetable parasites are
produced slightly-scaling and itching brown
spots, pityriasis versicolor ; furthermore, herpes
tonsurans  (ring-worm), a very common dis-
ease, appearing first  in the shape of small
vesicles or ring-like  red eruptions, which,
when situated on the  parts provided with
hairs, lead to baldness; lastly, favus, a dis-
ease  kindred to ring-worm.  If we  succeed
in killing the parasites  locally, a perfect cure
can be  obtained  in  a  short period of time,
but on  the scalp and  the  beard these dis-
eases usually are  very obstinate.  (See spe-
cial  articles on  skin diseases, Barber's
Itch,  Boil, Burns, and Scalds,  Chick-
en-pox, Corns, Eczema, Elephantiasis,
Erysipelas, Herpes, Ichthyosis, Itch,
Leprosy, Lupus, Nettle  Rash,  Rash,
Ringwoem, Rupia, Scabies, Scald Head,
Scurvy, Warts.)
  SmalFpox,  or  VarFola,  is the most  im-
portant of the group of acute general con-
tagious diseases known as the exanthematous
fevers, since, when not controlled by vacci-
nation, it is the  most fatal of them all.  It
is said to have prevailed in Eastern countries
from the most remote antiquity, but its early
history is  shrouded in  obscurity.  Aaron or
Ahroon, an Alexandrian priest, who lived in
the early part of the seventh century, is said
to have first described  the  disease in an ex-
tinct  work  entitled Pandects of Medicine.
Some have traced an  allusion to it in certain
passages of the  Old Testament, as, for in-
stance, Moses' record of " the plague of boils
and  Mains."  The Greek writers included 
98                         THE  FAMILY  PHYSICIAN.
 smallpox and measles under the term Aoi/uKq.
 The Latin word variola, now generally em-
 ployed by medical writers, is said to  have
 been first used  by Constantinus Africanus
 in the eleventh century.  The first appear-
 ance of smallpox in Europe is supposed by
 some to have been the epidemic cum pusulis
 et vesicis, quoz mulium populum affecerunt morte,
 described  by Gregory de Tours as  having
 prevailed  in France  in the  reign of King
 Childebert about the year 520;  it is more
 generally considered, however, that the  dis-
 ease was first brought to Europe by the Sar-
 acens about the year 710.  Spreading  from
 Spain, it  soon overran  Europe,  but spared
 for a time certain isolated countries, such as
 Denmark, where it first appeared in 1527.
 It was carried to the West Indies in 1517
 by the adventurers who  hastened to profit by
 Columbus's discovery of the New World. It
 reached Mexico in 1520, and Brazil in 1563.
 Farther north it first appeared in Maryland,
 having been brought there by  an English
 ship in the early part of the seventeenth
 century.  Thence it rapidly spread through
 Virginia, the Carolinas, New England, and
 other portions of the colonies.
   Up to the beginning of the present centu-
 ry, when its ravages were decidedly checked
 by Vaccination (which see), it continued
 its course  as a deadly pestilence almost al-
 ways and everywhere  present,  sparing no
 age, sex,  condition, or  nationality, no  one
 being safe from it except by virtue of having
 already passed through  its perils.  Its his-
 tory, like that of the other acute contagious
 diseases, is that, while always prevailing to
 a certain extent, especially in large cities, it
 rages as an epidemic every few years. This
 periodical recurrence of epidemics is doubt-
 less chiefly due to the fact that each epidemic
 exhausts  nearly all the subjects  susceptible
 to the disease, so that a  certain time has to
 elapse for a sufficient number of others to be
 born into  the world to  afford the material
 for a fresh outbreak.   The last  great epi-
 demic of smallpox began in 1870, overrun-
 ning all Europe and North  America, and
 abated in  1873.
  Of the   original  cause of smallpox  we
 know nothing, but we do know that it now
 never occurs save as the consequence of in-
 fection conveyed from one person to another.
 The contagion exceeds  in virulence that of
 any other disease.  The infectious principle
 is known to reside in the fluid contents  of
 the pocks  and in the  crusts resulting from
 their desiccation, and it is probable that it
is  also contained in many if  not all of the
fluids of the body.  Moreover,  it pervades
the emanations  from the  person, so  that
actual contact with the sick is not necessary
to the conveyance of the disease.  To what
 distance the volatile contagium may extend
 is uncertain, but it is known to have crossed
 a river  1500 feet wide.  In its fixed condi-
 tion,  attached to articles of clothing, bed-
 ding, merchandise, mail-matter, paper-mon-
 ey, etc., it is very energetic and  persistent.
 The disease is communicable at all  periods
 of its course, even in the period  of incuba-
 tion,  before any symptoms have occurred,
 and as  late as the  close of the stage of de-
 crustation; but probably it is most intensely
 contagious during the vesicular stage of the
 eruption.  Even the dead body  is capable
 of conveying the infection.  It may also be
 carried from one person to another without
 the person who carries it  himself suffering
 an attack. This is termed " mediate conta-
 gion."  It is  reasonably  certain  that the
 prevalence of the disease is more or less in-
 fluenced by the season of the year, and per-
 haps  by the state of the weather, but the
 effects of these differ in different countries
 and in different years, so  that the  precise
 part which they play in the production  of
 epidemics can scarcely be stated.
  Very few persons (certainly not more than
 five  in every hundred)  are naturally and
 permanently insusceptible to smallpox, and
 very  few are  even temporarily insuscepti-
 ble, except from having already had the dis-
 ease or  from having been vaccinated.  Very
 young infants  have been  supposed to  be
 rather  insusceptible to the infectious dis-
 eases, yet it  is among  children,  including
 very young ones, that smallpox  makes  its
 greatest havoc, and it  is by no means rare
 for it to attack the unborn child.  One at-
 tack of the disease  generally exempts the
 affected person from  subsequent attacks, but
 in exceptional cases second attacks do occur,
 and even fifth and sixth attacks have  been
 recorded.   The immunity conferred by vac-
 cination is almost as complete as that which
 results from having had the disease.
  On contracting the smallpox  contagion
 the individual shows no signs of the disease
 until after the lapse of a period of incubation,
 which generally lasts thirteen  days.   It is
 occasionally a few days shorter,  especially
 in persons who have been vaccinated, and
 in the case of inoculated smallpox it is re-
 markably abridged,  the local phenomena
 resulting  from the  inoculation  being ob-
 served to begin in two  or three days.  The
 initial stage is usually ushered in by a vio-
lent chill or by repeated slighter  chills, fol-
lowed  by high fever,  weakness,  vomiting,
 severe  headache,  and  pain in  the back.
 Delirium  is  frequently observed, and  in
children convulsions or coma.  This stage
lasts from two to four (usually three) days,
and death may occur before its termination.
A preliminary rash—commonly of a roseo- 
THE FAMILY PHYSICIAN.                         99
lous character—is sometimes observed dur-
ing the initial stage.  This is of some value
from a prognostic point of view, but  mu^st
not  be confounded with the  essential rash
which marks the eruptive stage.  Little red
elevations  of the  skin  (somewhat pale at
first) appear upon the face and head, and a
few hours afterward upon the  back, breast,
arms, abdomen, legs, and feet.  These ele-
vations vary in size from that of a millet-
seed to that of a pin-head.  They are  often
more plainly to be felt than seen.  They are
usually the most numerous on the face. On
the second day after their appearance  (fifth
day  of the disease) they have increased in
size, constituting  distinct papules, and are
of a darker hue.   On the third  day (sixth
of the disease) they are more conical, and
each papule shows at its summit a minute
vesicle containing a clear,  lymphy  fluid.
These  vesicles encroach more  and  more
upon  the area of the papule from day to
day, the remains of the  latter  being visible
as a delicate red  line surrounding the  vesi-
cle.   The vesicle itself is flattened, circular,
of a pearly-white color, and very frequently
depressed at  the,centre ("umbilicated").
By  the  seventh  or eighth day  (tenth or
eleventh of the disease) it has reached the
size  of a split pea, and, the central depres-
sion being effaced, is nearly hemispherical
in shape.  On the outbreak of the eruption,
or soon  afterward, the  fever  disappears or
moderates for the time being, according to
the severity of the case; but about the  sixth
day  of the eruption (ninth of the disease)
the  contents  of   the vesicle,  which  have
gradually been  growing  opaque, become
completely  changed into pus.   In  other
words, the  vesicle becomes a pustule, the
red line or halo surrounding it becomes in-
creased in breadth, and the stage of suppu-
ration or maturation begins.  In mild  cases
this  stage  is  accompanied by little or no
fever, but in severe cases of confluent small-
pox  the secondary fever is generally well
marked,  being sometimes announced  by a
chill or chills, and lasting from three to six
or eight days,  according to the severity of
the  case.   With the renewal of fever  there
is a  return of headache, nervous disturb-
ances, such  as delirium, etc.; the skin be-
comes enormously  swollen,  so  that the
countenance is frightfully  disfigured', and
the  pustules are exquisitely  painful,  espe-
cially  upon  the  face, the hands,  and the
feet.   At this time the formation of boils is
quite common,  and numerous complications
are apt to occur, such  as erysipelas, diffuse
inflammation of the cellular tissue, pyaemia,
gangrene, affections of the organs of special
sense, pleurisy and other inflammatory dis-
eases of the respiratory apparatus, affections
of the heart and great vessels, and occasion-
ally abdominal inflammations.  About  the
eleventh or twelfth day of  the  eruption
(fourteenth  or fifteenth of the disease)  the
pustules begin to  dry up, which process
characterizes the stage of desiccation.   The
general and local symptoms now gradually
abate, and the pustules, beginning generally
with those on the face, dry into hard,  dark-
brown crusts.   Preceding  this occurrence,
a yellowish, gum-like exudation frequently
takes place upon the surface of the  pustules,
especially if they have been ruptured, and
concretes into a rough, brittle  coating over-
lying the darker and firmer crusts.  Dur-
ing the stage of maturation and the earlier
portion of that of desiccation the  patient's
body exhales a peculiar and repulsive odor,
which, together  with his frightful appear-
ance, makes him an object  of horror as well
as of pity.   The  process of incrustation is
often accompanied by intolerable  itching,
and by scratching the course is so interfered
with that secondary and tertiary crusts often
form;  and this fact, as well as the  varying
severity of the cutaneous lesions, makes the
period of decrustation somewhat  variable.
After the crusts  have fallen off, the sites of
their former attachment  remain visible for
a considerable time in  the  form of red and
somewhat elevated spots, giving the patient
a peculiar mottled appearance.  In course
of time the redness and swelling disappear
without leaving any permanent marks, or
else (in case the pocks  have involved the
papillary  layer  of the skin) the spots  be-
come whiter than the surrounding  skin,
radiated and depressed scars remaining for
life.   The  individual is then  said to  be
pock-marked.
  As to the structure of the pock (vesicle or
pustule), it is not a mere tent-like elevation
of the cuticle from distension by a subja-
cent fluid, but the  inflammation begins in
the lower layers of the epidermis (the  rete
Malpighii), and  soon results in  the exuda-
tion of fluid into the substance of that por-
tion of the skin, separating  its cells and
forming a multilocular swelling.  Hence it
is  that, on  puncturing the vesicle, only a
small portion  of its contents escapes,  the
fluid being contained in a  number of sep-
arate  compartments.   Along with  these
changes  in the epidermis  (and   perhaps
preceding them, and therefore more essen-
tial) the subjacent papillae of the derma,
and even the fibrous  corium, become  hy-
peraemic and  subsequently infiltrated.   In
so-called "diphtheritic" pocks the bases of
the papillae  are so swollen  and gorged with
blood that their summits  become strangu-
lated, as  it were, and die.   These dead and
bloodless heads of the affected papillae form 
100                        THE FAMILY PHYSICIAN.
a white, pultaceous mass upon the floor  of
the pock—the "false membrane" of the
older writers.  Its formation is always fol-
lowed by pitting.   The umbilication of the
pock is, as regards the mode of its produc-
tion, still a matter of dispute.  Many have
supposed  it to be due to a bridle-like action
of that portion of the epidermis which dips
down to form the  lining of a sebaceous or
sudoriparous follicle, and they  assume that
such a follicle constitutes the usual centre
of a pock.  Others attribute it to the early
commencement of desiccation at the centre of
the pock while yet the exudation  is increas-
ing at the border.   In the vesicular stage of
the pock the contents consist of a clear, vis-
cid, albuminous fluid  (lymph),  containing
epithelial debris,' leucocytes, and very mi-
nute globular bodies, about ^utnnjth  0I"  an
inch in diameter, termed microspheres, mi-
crozymes, etc. (also falsely called bacteria).
It is probable that these latter bodies are,
par excellence, the bearers of the contagium.
They are supposed to be of a fungous na-
ture, but attempts at their cultivation have
resulted in nothing satisfactory.   The crust
includes the " false membrane " already men-
tioned, and occasionally a portion of sloughy
tissue from the corium, or the subcutaneous
layer of cellular tissue, is found attached
to it.
  Numerous varieties of smallpox are spoken
of by writers.  In the first place, we have the
discrete and the confluent forms. In the former
the pocks are separate and distinct from each
other, the secondary fever is mild or altogeth-
er wanting, and, except for complications, the
disease is not specially dangerous.  The lat-
ter, as its name implies, is characterized  by
a running together of the pocks, and is al-
ways severe and frequently fatal.   Semi-con-
fluent eruptions show appearances midway
between  those of the discrete and the con-
fluent, and betoken a corresponding sever-
ity of the disease.   In corymbose smallpox
the pocks are aggregated  in clusters or in a
single cluster, the eruption being elsewhere
discrete.   This form is rare  and very dan-
gerous.   Malignant smallpox (black or hae-
morrhagic smallpox) is characterized by the
early occurrence of blood-poisoning, result-
ing in effusions of blood into the  pocks and
into the substance of the organs and tissues
of the body, and in haemorrhages from the
mucous surfaces.   It may prove fatal before
the eruption has had time to appear.   Such
cases  have  been called purpura variolosa.
Benign smallpox (variola verrucosa, or cor-
nea, stone-pock, horn-pock, or wart-pock) is
of occasional occurrence. It is exception-
ally mild, although the primary fever may
be severe. The pocks are abortive, and there
is no secondary fever and no pitting. Small-
pox without eruption (variola sine exanlhemate,
the febris variolosa of Sydenham) is of rare
occurrence.  The whole process consists of
the primary  fever.  Varioloid is smallpox
mitigated by previous vaccination.   The
initial fever may  be severe, but the erup-
tion is moderate, many of the pocks shrivel
early, and there is no secondary fever.
  In regard to the sequeloz or after-effects of
smallpox, it may first be stated that  it is
capable of rousing  into activity any dor-
mant diathesis or morbid tendency, such as
the scrofulous, tubercular,  syphilitic,  etc.
Some  have supposed  that  an  attack  of
smallpox  had a  tendency to improve the
general health; but not  only is there  no
foundation for this opinion, the very re-
verse is  the case.  Ophthalmia, blindness,
chronic ulcers, enlargements of the  lym-
phatic glands, inflammation  of  the ear,
boils  or  abscesses,  cancrum oris,  pestilen-
tial bubo and carbuncle,  laryngitis, saliva-
tion, dropsy, necrosis, and many other affec-
tions  have been known to  follow  the dis-
ease,  apparently owing their origin to  its
occurrence.
  The post-mortem appear.ances in smallpox,
besides the results  of  inflammatory com-
plications,  consist mainly in degenerative
changes in the organs, especially the liver,
the kidneys, and  the  spleen, and  haemor-
rhagic effusions.    On  the   mucous mem-
branes, particularly near the natural open-
ings of the body, pocks are found essentially
like those on the skin.   In the trachea they
extend down to its  bifurcation, and some-
times into the  bronchi of the second and
third orders.  The  brain and spinal  cord
are sometimes  congested and oedematous,
but generally  healthy.
  The diagnosis of smallpox is easy in cases
where the eruption is well advanced, but in
the earlier stages, as well as in sporadic cases
and modified forms,  it is often difficult, and
sometimes impossible.   It is most apt to be
confounded with measles, chicken-pox, pus-
tular syphilides, acne, and lichen among skin
affections, and with typhus,  relapsing fever,
pneumonia, meningitis, and several  other
acute inflammatory diseases.  Too much re-
liance should  not be placed upon  the ap-
pearance of the eruption, particularly in its
earlier stages.  The initial  fever of small-
pox  is usually productive of a higher  tem-
perature than is that of measles (105° F. or
over  in the former, and from 102° to 104° F.
in the latter); and in measles the catarrhal
symptoms occur earlier than in smallpox.
In chicken-pox there is little or no premon-
itory fever, and, if there be any, it lasts only
twenty-four hours before  the eruption ap-
pears, and the latter is more superficially
situated and more  rapidly developed  than 
THE  FAMILY  PHYSICIAN.
101
 that of smallpox.   Syphilitic eruptions and
 acne cause little or no fever, and can only
 be mistaken for smallpox by a too exclu-
 sive attention to the cutaneous appearances.
 Febrile lichen may for a short time be con-
 founded with  smallpox, but the  eruption
 occurs  after only one day's illness, appears
 on various parts of the body indifferently,
 and does not advance beyond the formation
 of papules.   The preliminary  roseola of
 smallpox often resembles the rash of scar-
 let fever, but its localization, together with
 the absence of the marked throat symptoms
 of the latter disease, will serve to distinguish
 it.  The early diagnosis of smallpox from
 exanthematic typhus is often very difficult.
 In the  former disease, however, the temper-
 ature falls on  the appearance of the rash,
 but does not in the latter.  The appearance
 of the eruption will distinguish variola from
 the first  attack of relapsing fever.   The
 acute inflammations are to be  distinguish-
 ed by a close attention to the  local symp-
 toms proper to them, and by the non-occur-
 rence of eruption.
   The mortality of smallpox varies in differ-
 ent epidemics,  ranging in unmodified cases
 from 15 to 50 per cent. Of 46 haemorrhagic
 cases observed by  Curschmann, all proved
 fatal, while 235 cases of unmodified variola
 (including the  46 haemorrhagic cases)  re-
 sulted in 99 deaths—a  mortality of over 42
 per cent.  Marson, of  the London Small-
 pox Hospital,  records  1838  cases  of con-
 fluent  smallpox, with  937  deaths (50 per
 cent.),  614 semi-confluent  cases, with 51
 deaths  (8 per cent.), and 202 discrete cases,
 with 8  deaths  (4 per cent.).   Of 4896 cases
 of smallpox  after vaccination  (including
 good, bad, and indifferent vaccination), Mar-
 son saw death result  from  smallpox alone
 in 316  cases  (6.56 per cent.).   Confluent
 smallpox, even if the eruption be confluent
 only on the face  and discrete elsewhere,
 often proves fatal.  Certain  abnormal con-
 ditions of the pocks—a flat, white, and pasty
 appearance,  with   claret-colored areolae on
 the limbs—are of ill omen. Young children
 and aged persons are particularly apt to die
 if attacked by the disease.  Symptoms of
 blood-poisoning or of a severe  implication
 of the nervous  system, as well as affections
 of the air-passages, are of bad import.  Preg-
 nant and lying-in women are in very great
 peril from  smallpox.  In the former abor-
 tion usually precedes death.  Drunkards also
 are very apt to die.  Robust and healthy
 persons, in  good hygienic circumstances, are
 much more apt to recover than are those of
 the opposite description.  Death may take
 place at any period of the  disease, but is
most common during the secondary  fever.
  The treatment of smallpox consists in hus- ;
banding the resources of the patient, and in
early detecting and combating complications.
No sort of medication or regimen exerts any
curative effect in the  proper sense of the
word.  Many so-called  specifics have  been
vaunted, but there is no satisfactory proof
that they have ever accomplished anything.
Vaccination, although of such signal efficacy
in preventing smallpox, is utterly powerless
to cure it; and it has  not been  shown that
vaccination of a  person already  suffering
from smallpox can  even  ameliorate  the
disease, whether done in the ordinary way
or by the subcutaneous  injection of vaccine
lymph.  No treatment will prevent pitting.
  The prevention of smallpox  may be al-
most certainly accomplished  by thorough
Vaccination  (which  see).  Avoidance of
exposure  to  the  contagion will  also, of
course, prevent the disease, but  this is dif-
ficult,  and  often impossible,  to  manage.
Smallpox patients should always be isola-
ted, and the funerals of those who die should
be  strictly private.  All clothing,  bedding,
etc. which may have become infected should
be  destroyed by  fire, or, if too valuable to
be sacrificed, it should be disinfected by heat
(as high as 212° F.) or by the fumes of burn-
ing brimstone.  Every  one  exposed to the
disease should be at once revaccinated.  Pa-
tients are capable of conveying the infection
until all the crusts have fallen off.
  Snake-Bites.  See Venom.
  Spasm  [Gr. Gira.ay.6g, from tntdu, to " draw
or stretch"], sudden and involuntary mus-
cular contraction.  The relaxation and ten-
sion of muscular tissue are dependent on
nerve-force.  Spasm of muscle  may result
from disturbance of the nerve-centres,  from
peripheral irritation of  the affected part, or
from irritation of other organs or surfaces,
reflected from  the nerve-centres.   When
spasmodic rigidity is persistent for any length
of time, it is termed tonic  spasm.   Such is
the period of rigidity at the beginning of
the epileptic attack and the prolonged rigid-
ity of tetanus and cerebro-spinal  meningitis.
When  spasm is brief and recurs rapidly, it
is termed clonic spasm.  Such are the inter-
mitting and repeated muscular contractions
following the inception  of the true epileptic
attack, and constituting the more  ordinary
epileptiform  attacks or " fits " of children,
the contractions of chorea and  of  hysteri-
cal  seizures.  The graver spasmodic diseases
are true epilepsy, epileptiform attacks  from
many causes, as indigestion and worms  in
children, renal  disease in adults, and in the
course of severe acute diseases, narcotic poi-
soning, etc., chorea or  " St. Vitus's dance,"
tetanus, hydrophobia.  Many lesser and local
states of spasm frequently occur.  Sneezing
and coughing are spasmodic contractions of 
102
THE FAMILY PHYSICIAN.
the respiratoiy tracts excited by irritation
of the nasal or bronchial mucous membrane.
Spasm of the larynx in nervous tempera-
ments causes  aphonia.   Asthma  is  spas-
modic constriction of many bronchial tubes,
producing dyspnoea. Whooping cough unites
extreme  hyperaesthesia  and  spasm of  the
bronchi with spasmodic  constriction at  the
larynx—a succession  of violent expiratory
spasms or coughs, followed by a sonorous or
whooping inspiratory sound.   Spasm of the
heart, evidenced by  dyspnoea,  praecardial
distress, and disturbed circulation, by inter-
mitting and irregular heart-beats, has many
causes—excess of food, indigestion, narcotic
depression.  Angina pectoris, or spasm  of
the heart, with associated spasm of the tho-
racic  walls, is  frequently due to disease of
the coronary arteries, the nutrient vessels of
the heart-wall. Spasm of the diaphragm may
be  clue to indigestion, to  taking cold, or to
gouty or  rheumatic vice.  Intestinal colic
and cholera morbus are conditions of pain-
ful spasmodic constriction of  the intestines,
due to cold or bad diet.   In invalids and
persons of sensitive nervous system painful
spasms of various internal and external parts
may develop suddenly from unknown or triv-
ial exciting causes.  The immediate relief
of spasm  is secured by so-called antispas-
modics or nervines, as valerian, musk, cam-
phor; by anaesthetics, narcotics, and  seda-
tives, as chloral hydrate, bromide of potash,
hyoscyamus, belladonna, opium.  The per-
manent cure, when admissible, demands the
correction of known causes, as debility, in-
digestion, and the rheumatic, gouty, and
other blood-taints.
   SpFnal Curvatures, two kinds—(1) lateral
curvature; (2) angular curvature.   Lateral
curvature is a deviation of the spinal column
at one or several points from the position
which it occupies in health in the median
line of the back.  It occurs in children, in
young, imperfectly-developed, feeble,  and
growing adults, more especially women, and
less often in men.   The spine normally oc-
cupies the middle of the back, with a slight
convexity to the right in the  dorsal region;
in this central position it is  acted upon by
many forces—the weight of the head and
trunk, the lateral traction of the arms in
all physical efforts, of the thoracic  and ab-
dominal muscles in breathing—and beneath
has a divided  support of the two lower ex-
tremities through  the intervention of  the
pelvis.  A lateral  curvature  may  develop
connected with  any  one of  these forces;
when the bones are poorly nourished, the
spine may yield to the weight it supports.
Habitual  use  of one  arm  to  the exclusion
of  the other  may  cause  deviation of  the
spine, cervico-dorsal, to  the stronger side—
a common occurrence in weakly children at
school, housemaids, and in some confining
meehanieal vocations.  Disease of one lung,
as phthisis, chronic pneumonia, pleuritic ad-
hesions, and chest contraction, by  limiting
respiratory movement  on one  side, often
causes dorsal curvature to the more active
side.  Shortening of one limb, hip-joint dis-
ease, persistent limping from  any cause, by
tilting the pelvis throw the spine out of cen-
tre and develop lumbar curvature.   When-
ever a curvature is thus primarily established,
a secondary curvature  develops at another
part of the vertebral column, a*nd to the op-
posite side, and thus the erect position of
the body is maintained.   The affected spine,
viewed anteriorly or posteriorly, presents a
double curvature, a tortuous line whose upper
and lower ends can be connected by a verti-
cal straight line, representing the component
of all the forces, weight, etc., which the
spine sustains.   The  collective vertebrae of
the spinal column are so  articulated  and
curved antero-posteriorly, the pressure taken
in the "bodies" only, the lateral and pos-
terior processes restrained by attached  mus-
cles, that lateral curvature causes rotations
of individual vertebrae.
  Lateral curvature,  if of long standing,
may so modify  the  size and  conformation
of the lung, so change the nutrition  and
structure of the intervertebral cartilages, and
the muscular volume of the two sides of the
body, that cure is  impossible or incomplete.
More often it is curable  by correcting bad
habits, as favoring one side in standing, sit-
ting, or sleeping, resort to light gymnastics
and special passive movements, and the use
of apparatus which»removes weight  from
the spine and applies pressure or traction to
counteract the curves.  General tonic treat-
ment, cod-liver oil, and phosphates, out-of-
door life, warm clothing, stimulating baths,
and regulated diet are indicated in all cases.
  Angular curvature is  of more serious na-
ture.  It is termed  Potts's disease, and  is
usually  an  expression  of a  tubercular or
scrofulous  blood-taint.    Exceptionally,  it
may  arise  in previously  vigorous  persons,
starting  from a local injury  of the verte-
brae, followed by disintegration. More often,
when health is reduced  and the nutrition of
the osseous  and  cartilaginous structures  is
defective, the intervertebral bodies  atrophy,
or are absorbed owing to pressure; the  bony
vertebrae thus brought into contact form an
abrupt joint or antero-posterior angle, which
replaces  the normal graceful curve,  and pre-
sents  a more or less angular prominence on
the back. The approximated vertebrae tend
to caries or death and gradual disintegration:
in proportion to the extent of this  destruc-
tion of the vertebral bones and the inter- 
THE  FAMILY  PHYSICIAN.                        103
mediate cushion of cartilage, the body above
sinks forward and downward upon the parts
beneath, and the angle is  abrupt and acute.
Caries of the spine usually develops a local
abscess, slow in  formation, often with little
pain or heat, and tending to disseminate its
contained pus beneath adjacent flat muscles
of the back; the pus may finally point under
the skin of the back or side, or travel around
to the front of the abdomen, appearing as a
soft tumor in the  groin, or even below the
flexure of the thigh ; in these latter positions
erroneously taken for hernia.
  Early vertebral disease is indicated by pain
in a fixed spot, increased by pressure, by firm
tapping, by the sudden  concussion of jump-
ing, or  by sudden turning; the pain often
shoots around the body.  The strength wanes,
and the weight  of the  body causes fatigue,
which is relieved by reclining, by supporting
the shoulders, or by  traction on the lower
extremities when lying down.  Loss of flesh
and appetite, elevated temperature, and hec-
tic fever develop as caries is established, and
local inspection reveals  a change of the nor-
mal curves or a perceptible projecting apex.
The early arrest of angular curvature is se-
cured in various ways—by rest  on the side,
with ice-bags to the irritated congested spine,
pest with extension and counter-extension ;
but, when admissible,  the plaster-of-Paris
bandage may be applied to the body, and the
patient may  exercise.   Cod-liver oil, phos-
phates,  Peruvian  bark, iron,  and  concen-
trated diet are to be faithfully administered.
When abscess  has developed,  it  may  be
" aspirated "—subcutaneously  removed by
needle-tube and pump.  Where angular cur-
vature is fully developed, apparatus is em-
ployed  to place  the body erect, remove the
angular protrusion in the back, and permit
the spinal column to become "ankylosed,"
or rigidly united.
  Spinal Diseases.   See  Infantile Par-
alysis, Meningitis, Paraplegia, Pro-
gressive Muscular  Atrophy,  Spinal
Curvatures, Tabes Dorsalis.
  SpiFting of Blood.   See Hemoptysis.
  SpoFted Fever.  See Fever.
  Sprain  [0.  Fr. espreindre], a stretching
or wrenching of a joint,  without  displace-
ment of the bones, and  either with or with-
out lesion of  ligaments  or tendons.   Severe
sprains  are sometimes quite as serious and
lasting in their effects as dislocations. Per-
fect rest, cold or sometimes hot lotions (if
the latter be more agreeable to the patient),
with the use  of splints for mechanical sup-
port and opiates to relieve pain, are required
in the treatment.  The removal of swelling
and stiffness may be hastened by "massage,"
gentle and protracted  kneading.
  SquinFing  [Dutch,  schuinte], technically
termed  Strabismus  [from Gr.  (7Tpa{liay.6g,
"squinting"],  obliquity of the axis of one
eye; inability to bring both visual lines to
bear simultaneously upon one point,  one
always deviating from the object.  If the

                 Fig. 1.
Muscles of the Eyeball.
squinting eye deviates inward, it is termed
convergent strabismus ;  if outward,  diver-
gent strabismus;  if  downward,  which  is
rare, strabismus deorsum vergens.  The normal
position of the eye and correct  direction of
its visual line depend on the tonicity of the
four recti muscles, attached one above, one
beneath, and one on  each  side of the eye-
ball.  If one muscle is  relatively weak or
paralyzed, the eye is deflected to the oppo-
site by the stronger or intact muscle.   Con-
vergent squint is  very common in  young
children of" four to six years when  learning
to spell or read with small letters.  It may
be periodic, and present only when looking
intently and with effort, one eye being con-
verged to facilitate or compensate  the "ac-
commodation" or power of the eye to adapt
itself for different  distances and objects.
Such internal squint  may be  checked  by
Fig. 2.
Operation for Strabismus.
use of larger letters or by checking the bad
habit of approximating objects.  When the
eye is hypermetropic, having  a low refrac-
tive power, a short  antero-posterior diame-
ter, and rays are not focused  in the retina,
voluntary  convergence  of   the  eye  and
habitual  squint  are  the common result.
Children suffering from indigestion, worms,
or debility  often  suffer  from convergent 
104                        THE  FAMILY  PHYSICIAN.
squint, in some cases due to spasm  of the
internal rectus muscle, in others to debility
or paralysis of the external rectus muscle.
In disease of the brain, convulsions, menin-
gitis, hydrocephalus, etc., squint may occur.
Divergent squint is  most often present in
myopic or near-sighted persons in efforts to
see distant objects, the squint disappearing
when the object is approximated or  by the
use of  spectacles for distance.  It  may also
occur from paralysis of the internal rectus,
or when that muscle  has been too freely cut
for the cure of convergent squint.   In con-
vergent strabismus, unless  very marked, in
order to determine the squinting eye it may
be necessary to place a lighted candle or the
finger two or three feet in front of the face
in the median  line, or, again, closing each
eye alternately, to study the extreme  lateral
movements  inward and  outward  of each.
Periodic  strabismus may yield to correct use
of the  eyes, the aid of spectacles,  galvaniz-
ing the  weak  muscle, and improving the
general health.   When marked and persist-
ent,  it calls for operation—incision  of the
ocular  conjunctiva or mucous membrane,
hooking up the tendon of the muscle close
to the cornea and severing it.
  StanFmering  [Ang.-Sax. stamer], an affec-
tion  of the faculty of speech characterized
by irregular, imperfect, or spasmodic actions
of the  muscles concerned in articulation.  It
is in reality a  chorea of the muscles con-
cerned, a defective power of co-ordination.
It may be manifested under two somewhat
different  forms.  In  the  one there is a dif-
ficulty in beginning the enunciation of words,
and  this is  especially shown in regard to
those words which  begin with what are call-
ed the "explosive consonants" (b, p), and
which  require the sudden opening of the
lips.   In the other form the word is begun,
but after the enunciation  of a syllable there
is a  spasmodic, and for  a  time uncontrol-
lable, reiteration of the same syllable.  To
this variety the term stuttering is sometimes
applied.  Stammering  is  one of the  mimic
diseases,  and may  be acquired by careless-
ness in speech or by association with  others
similarly affected, or even by mocking such
persons.  In the majority of cases it disap-
pears after  the  attainment of adult age,
probably in consequence of the  constant
efforts of the subject to improve his habit of
speaking. It is always increased by emo-
tional disturbance, especially fright and ap-
prehension, and is much mitigated, and often
cured,  by the patient acquiring confidence
in himself, never attempting to speak in a
hurry or  when the chest  is empty of air, or
by reading measured sentences slowly and
with deliberation.  Stammerers never have
any difficulty in singing, for they know that
a certain definite manner is to be observed,
and this gives them the confidence they re-
quire.  The affection is  sometimes perma-
nently removed in time by the patient per-
forming some trifling muscular action con-
sentaneously with the enunciation of the
words  over which he stumbles. Thus, if he
stammers at the word baby, he can prevent the
fault by moving a finger at the very instant
that he begins to  utter the word, and so on.
  StonFach, Diseases of.  The most frequent
diseases of the stomach  are its functional
disorders.  (See Indigestion.)  In addition
to these milder and  chronic conditions, the
stomach  is liable to acute and organic dis-
ease.   Acute gastritis is of rare occurrence,
the result of violent mechanical or  chemical
irritation, incised and punctured  wounds,
swallowing corrosive poisons or putrid and
acrid  food.   It is characterized by violent
ejection of all food, gastric mucus,  traces of
blood  and bile, by sense of local burning
pain, by pallor of the face, feeble flickering
pulse, cold extremities, and  collapse.  Per-
forating ulcer of  the stomach may occur in
both sexes from tubercle or specific gummy
tumor  of the gastric walls,  but most fre-
quently exists in young women, often of full
habit, due to rupture or  embolism of some
small  blood-vessel, and resulting  softening
of a conical  segment of the stomach-wall
thus deprived of nutriment.  The symptoms
are pain in the stomach upon reception of
food, its  rejection, and  occasional haemor-
rhage when the ulcerative process has eroded
a blood-vessel.  Haemorrhage from the sto-
mach is termed H^ematemesis (which see),
and must be discriminated from Haemopty-
sis (which see), the spitting of blood from the
lungs.  Cancer of the stomach occurs more
often in men than  in women—most  often oc-
cupies  the pyloric end, rarely the upper car-
diac orifice.  It is usually the hard or scir-
rhus form of cancer.  It often occurs in per-
sons of cancerous family history, in others
with no hereditary taint and previous per-
sonal health, following irritative dyspepsia.
When  at the pylorus, food is  detained in the
stomach, and after a  time is ejected in great
 ?[uantity, mixed with mucus, blood, and many
 ungous products  of fermentation, especially
Torulae and Sarcinae ventriculi.  There is  a
local darting pain, and often a local indurated
tumor  felt at the epigastrium through the
emaciated abdominal wall; the face is dark
and cachectic, the body wasted;  strength
fails, death comes by exhaustion.   Extreme
neuralgia of  the stomach — gastralgia or
gastrodynia—may occur,  dependent on de-
ranged nerve-centres or rheumatic or  gouty
vice of the blood.
  Stomatitis.  See Mouth, Diseases of.
  Stone in the Bladder.   See Calculus. 
THE  FAMILY PHYSICIAN.
105
   Strabismus.  See Squinting.
   Strangulation  [remotely from  the Gr.
 arpayyalTj, a "halter"]  denotes, primarily,
 the mechanical closure  of  the  air-passages
 of the  neck,  so  as to  prevent  respiration.
 Death by strangulation is speedy, but there
 may be a chance of recovery for a consider-
 able period.  Artificial  respiration,  stimu-
 lant applications  to the  extremities and
 chest, and of  ammonia  to the  nostrils,
 should be tried.   Only  when all  other
 means  have  failed should  the  galvanic
 battery,  a  dangerous instrument,  be em-
 ployed.   After apparent   recovery,  death
 may speedily ensue from secondary causes.
 (See Drowning.)
   Strangury  [Gr.  cTpdy%,  a "drop," and
 ovpelv, to "urinate"], a suppression of the
 urine.  The name is especially applied  to
 such suppression when it  depends on the
 presence  of spasm  or tenesmus  of the ure-
 thra.  It may be caused by the too free use
 of Spanish-fly blisters or of oil of turpen-
 tine, or it may attend  the presence of cal-
 culi in the bladder. The  warm bath, hot
 fomentations,  mucilaginous drinks, bland
 enemata,  and the  like  will usually relieve
 the untoward symptom.
   Stricture [Lat.  strictura; Gr. GTeyvuoig],
 a constriction  or  compression of the tubi-
 form organs of the body, as the oesophagus,
 the larynx, the windpipe, the intestines, the
 anus, the urethra, the lachrymal ducts, and
 others.  Strictures  are  produced either by
 new formations on the inside of the tubes,
 or by pathological changes  in the walls and
 coatings of the same (cicatrization), or by
 the pressure of new formations or of atro-
 phies outside. Examples of the first class are
 croup  and diphtheria, which  by deposition
 of  fibrinous masses on the interior  of the
 larynx  and the windpipe  narrow in  these
 organs  sometimes  to suffocation.   A  stric-
 ture of the third  class  is  frequently pro-
 duced in  the oesophagus by a neighboring
 cancer, which  may compress it to imper-
 meability.  The most frequent strictures are
 those of  the  urethra;  they  are generally
 produced  by  pathological  changes  in the
 coatings of the organ.  Injuries of the pe-
 rinaeum and the penis, with or without rup-
 ture of the urethra, may  originate them,
 but their most general cause is inflamma-
 tion of the mucous lining  of the  urethra,
 gonorrhoea. Inflammation,  if it spreads a
 little beyond the mucous lining, gives rise
 to new formation of connective tissue, which
 either directly compresses the urethra, form-
 ing a callous ring around it, or contracts it J
by  atrophic cicatrization around the tube.
The immediate consequences of urethral
stricture are symptoms  of  impediment to j
free micturition.   The urethra  behind the
stricture is dilated by the pressure of the
accumulated  urine.  The bladder  is  not
thoroughly emptied, and undergoes inflam-
matory irritation  by chemical decomposi-
tion of its  contents.  The  urine becomes
alkaline, with a putrid  and pungent smell
of ammonia.   The desire to urinate is very
great, and never ceases.   In more advanced
stages  the urine sometimes breaks through
the wall of the urethra behind the stricture,
and either makes a fistula by breaking also
through the skin, or infiltrates the surround-
ing tissue, and so causes uraemia, and often
death.   In other cases, inflammation of the
bladder extends to the kidneys, and there
produces pyelitis and inflammation of the
kidney proper.  Strictures sometimes close
up the urethra entirely, or become so nar-
row that the urine can only be passed  out
in single drops by the  strongest  and most
painful efforts.  Speedy relief by operation
is necessary in such cases to save the life of
the patient.  The treatment of stricture con-
sists either in gradual dilatation or in ex-
ternal  or internal urethrotomy.   Gradual
dilatation is  effected by inserting bougies,
or catheters,  or  sounds  of increasing sizes.
Every  day or less frequently a larger instru-
ment is passed through the stricture to the
bladder, until the normal size of the ure-
thra is attained.  After this, the last bougie
is used occasionally for some time to pre-
vent a  relapse.  The majority of the author-
ities now consider gradual dilatation  the
best, surest, and safest  treatment of stric-
ture.   In cases where no instrument can be
passed  through the  stricture, or where for
other reasons dilatation  cannot be resorted
to, external urethrotomy is indicated.  The
operation is performed  by cutting into the
urethra from the  perinaeum, thereby open-
ing the stricture lengthwise.  It is kept open
by regular cathetrization, so that the heal-
ing wound leaves a canal of normal size.
Internal urethrotomy is only applicable in
cases  where  a sound can still be  passed
through the narrowed passage large enough
to guide a  small  knife, which  cuts and
opens  the stricture  from  inside.   Another
method sometimes resorted to is the rupture
of  the stricture  by forcing through it a
large, conically-shaped steel sound (forcible
dilatation).
  Stu/por [Lat.].   Stupor or coma is that
condition in  which, when fully developed,
the functions of the brain, so far  as  the
mind is concerned, are  entirely suspended,
and the individual lies unconscious, breath-
ing heavily, and without the power of vol-
untary motion.  It may be induced by pres-
sure upon the  brain, as from  a  depressed
piece of bone of the skull, or the entrance
of some foreign body, as a bullet; by a blow 
106
THE  FAMILY  PHYSICIAN.
or fall, causing concussion  of  the brain or
compression from extravasated blood;  by
the rupture of a blood-vessel, causing cere-
bral haemorrhage;  by  the circulation  of
poisoned blood through the cerebral vessels,
as occurs, for  instance,  when  an  over-dose
of opium or alcohol has been taken.  Stupor
is to be distinguished from sleep, with which,
though sometimes confounded, it has in real-
ity little or no analogy.   In the first place,
stupor never occurs in the  healthy individ-
ual, while sleep is a necessity of life.  It is
easy to awake  a  person  from sleep, while it
is often impossible to arouse him from stu-
por.  In sleep the mind may be active; in
stupor it is, as it were, dead.  An  increased
amount of blood  in  the brain will cause
stupor, whereas sleep is  the result of a  di-
minished quantity of  blood in the cerebral
tissue.
  Stupor is a symptom of serious importance
in various injuries and diseases to which the
brain is liable.  It may exist in all  degrees
of  severity; and in the partial forms the
subject  is either  not  entirely  unconscious,
or, if so, may be roused by impressions made
upon the organs of the special senses, though
usually  only for a short time.  There is a
form of stupor, met with in certain diseases
of the brain, in which the individual, though
unconscious, is nevertheless not altogether
deprived of the power to think and to move
the limbs.  There is,  in fact, a marked de-
gree of  restlessness, though the movements
are, as it were, automatic, and the speech is
incoherent.   This condition is known as
" coma vigil."  It generally only occurs in
cases of great gravity,  and it indicates a
fatal termination.  (For special conditions
and treatment see Apoplexy, Concussion
of the Brain, Fainting, Shock, Typhoid
Fever.)
  Subluxation.  See Sprain.
  Suffocation.  See Asphyxia.
  Sunstroke,  Insolatio,  or  Coup de Soleil,
prostration of the animal vitality from long
exposure to the direct  heat of the sun. The
method of this nervous  exhaustion  may be
by peripheral nerve-irritation in the exten-
sive tract of overheated, congested skin, but
more often  is due to the overheating of the
blood in the peripheral capillaries, and the
sedative influence exerted  by  it  upon the
nutrition of the central ganglia.  Sunstroke
has been regarded as a state  of paralysis
of  the  vaso-motor or ganglionic nervous
system.   In its first form or stage, that of
congestion  and excitement, the surface of
the body is intensely red and hot—a condi-
tion often disconnected with any actual sun-
burn, but due to general capillary relaxation
and congestion consequent upon the impair-
ment of the nerve-centres which control the
elastic arterial walls.  For the same reason,
the various large glands and organs of the
body—liver, spleen, kidneys, lungs—are en-
gorged with blood, swollen, and very tender
to touch.  The brain is congested, stimulated
to excessive and incoherent mental action.
The temperature of the body may be 112° F.
or more; the pulse full, hard, bounding; the
heart's action tumultuous;  the breathing is
hurried, labored, and noisy; the conjunctiva
reddened, pupil contracted;  there may be
headache, delirium, convulsions.   In graver
cases, either at the outset or later as a second
stage, one of depression or shock following
that of  excitement, the various  vital func-
tions  may be alarmingly depressed, indica-
ting suspended nutrition and organic change
of the irritated nerve-centres.  The patient
becomes unconscious; the pulse feeble, com-
pressible,  and irregular; breathing slow, ir-
regular, stertorous ; the  surface may be cool
and pale; convulsive action  is absent, and
the muscular  system completely relaxed.
Death may occur  suddenly by syncope or
paralysis  of the heart,  by pulmonary con-
gestion,  by  exhaustion, or by convulsion.
After death the blood does not coagulate;
hence there is no marked rigor mortis or
rigidity  of the body.  Physical fatigue, ex-
haustion, over-clothing,  bad ventilation, de-
ficient drinking-water, alcoholic excess, are
predisposing causes of sunstroke.   Disturb-
ance of the natural moisture, evaporation and
radiation from the skin,  is regarded the im-
mediate cause of the overheating of the blood;
hence, a murky, damp heat is attended with
more  cases of  sunstroke than when the at-
mosphere, though hot, is dry and clear.  The
treatment of sunstroke consists in prompt-
ly withdrawing caloric from the overheated
body, or, when  shock and coma are present,
by diffusible stimulants and revulsive agents,
maintaining strength and relieving cerebral
congestion.  The cold douche to the head,
neck, and chest, evaporating  lotions or ice-
bag to  the  head and spine,  the  wet sheet
swathing  the entire body, and cold immer-
sion are agencies to be employed with judg-
ment  to the overheated body with the best
results.   Bromides may be employed, but
arterial  sedatives, as digitalis or  veratrum,
are dangerous.  Reversely, in coma and the
sinking  stage or form, sinapisms, blankets,
and heat may be applied to the surface, rich
liquid food, ammonia, and alcohol adminis-
tered  by mouth or  rectum, blisters applied
over the nape  of the neck.
  Suppuration [Lat.suppuratio, "abscess"],
a term employed in  medicine and surgery
to designate the  process of  pus-formation
on the granulating surface of wounds in ab-
scesses and in unhealthy action or inflam-
mation of the mucous and serous free mem- 
THE  FAMILY  PHYSICIAN.
107
 branes.  Pus, popularly termed " matter," is
 a creamy-yellow, opaque fluid, composed of
 a liquid portion, liquor puris, and pus-cells or
 corpuscles.   As it is developed in abscess or
 granulating wounds, either from degenera-
 tion of existing tissues or from  hasty, im-
 perfect, or  retrograde cell and tissue forma-
 tion, its constituents  are to be studied only
 as vitiated and changed  forms of the cellu-
 lar and liquid  elements of the blood or of
 the  elementary cells, as lymph, epithelial,
 and mucous cells, which have but recently
 developed from the blood.  The creamy con-
 sistency and yellow color of pus varies with
 the  abundance or scarcity of the pus-cells
 in the  liquor puris  or colorless  pus-serum.
 These  pus-cells,  though somewhat  larger
 than the white blood, lymph, and  mucous
 corpuscles,  are not  easily distinguishable.
 They are lacking in power to organize and
 form cells and tissues, and are characterized
 by the presence of one or several nucleated
 masses, which are rendered visible by dilute
 acetic acid, which clears away the granu-
 lar opacity  of the albuminoid cell-contents.
 Pus-cells tend to speedy disintegration, their
 contents undergoing fatty degeneration, and
 their cell-walls rupturing, disseminating fat-
 ty and necrosed or dead granules through-
 out the liquor puris.  Such pus is not creamy
 and yellow, but often thin, watery, dirty or
 brown  in color, and has an offensive smell,
 and is termed  ichorous pus; pus is  often
 discolored by blood.  The pus  formed  on
 free surfaces, as on the mucous lining of the
 nose or bronchial tubes, is largely a product
 of cast-off  or  rapidly-formed and degene-
 rated epithelial cells. In other places, as
 abscesses, where congestion or inflammation
 exists,  good authorities  maintain that the
 white blood-corpuscles migrate through the
 coats of the capillaries,  and,  failing to or-
 ganize, become pus-cells.  This occurs either
 as the result of over-pressure, inflammations
 of dense structures notably terminating in
 suppuration, or in consequence of impurity
 of the blood or lowered vitality of the nerv-
 ous force.   Suppuration when drcumscribed
 constitutes abscess, which tends to discharge
 through the nearest  surface,  either  of the
 exterior of  the body or of  some internal
 cavity.   Diffuse suppuration  occurs  in ery-
 sipelas  and  in catarrhal inflammations, as
 of the air-passages, stomach, and intestines
 and  bladder.   The  formation  of  pus  is
 hastened by applications of heat  and moist-
 ure—hot fomentations  and poultices.  Its
 formation is often announced by a slight
 chill, and accompanied by a febrile disturb-
 ance and pulsating, throbbing pain, either
 dull  or intense, at the point of pus-forma-
tion.  Diffuse or uncircumscribed suppura-
tion  of the  solid tissues endangers  life by
 absorption of purulent or ichorous septic
 matter;  pus absorbed into the blood  de-
 velops pyaemia or septicaemia, characterized
 by  lowered vitality,  hectic  fever,  sallow
 cachectic complexion, sweet  breath, multi-
 ple abscesses in different parts of the body,
 exhaustion, and death.
   SweaFing Sickness, one of the  several
 prevalent and fatal epidemics occurring dur-
 ing the fifteenth, sixteenth, and early  part
 of the seventeenth centuries.  It  was also
 known  as "pestilent sweat"  and  as  the
 " English ephemera," as the English people
 both  at home and  abroad were chiefly at-
 tacked.  In Germany, Holland, Sweden, and
 Denmark it prevailed more mildly.  It first
 appeared in England in 1485. It  was of
 brief period both in individual cases and in
 duration of single epidemics. Fully half of
 the population in infected towns were taken
 down with the disease, the mortality great,
 but where death did not result all  danger
 was past in twenty-four hours, and epidemics
 rarely lasted a  month.  Of  the five great
 English epidemics of the sweating sickness,
 the remaining four were in 1506,1517,1528,
 1551.  The attack consisted of  a febrile and
 sweating period.  It commenced with pains
 in the back, shoulders, and limbs, flushes of
 heat, oppression at the liver and  stomach,
 pain in the head, delirium, palpitation, fol-
 lowed by heaviness and desire to sleep, which
 in fatal  cases tended to become  profound
 coma or stupor.  Profuse sweating now set
 in, in favorable cases leading to speedy con-
 valescence.  The patient was liable to one
 or many relapses.  The disease spared the
 aged  and young, attacking chiefly middle-
 aged, plethoric men of all  classes and rank.
 Both in England and on the Continent the
 greater  prevalence  of this disease  among
 Englishmen was attributed to their peculiar-
 ly gluttonous, excessive diet.  By Hecker,
 Guy, and others the several epidemics of
 this disease are ascribed to preceding periods
 of atmospheric and telluric insalubrity, the
 influence of gathered armies, and to  the ab-
 sence of house  and street drainage in the
 larger cities and towns.   Its period of incu-
 bation, rapid progress, and speedy convales-
 cence disconnect it from epidemics of the
 typhus  class.   Hecker has  termed it "a
 rheumatic fever in  the  most exquisite  form
 that has ever yet been seen in the world."
 It has also been regarded a form of influenza
| or catarrhal fever.  Guy  considers  it un-
 doubtedly of malarial nature, an ague  with
 short febrile and sweating  stages, often ma-
 lignant  and fatal in  the first or congestive
 period, and  in convalescence leaving, as in
 all malarial periodic disorders, a temporary
 lassitude  and frequent recurrences.  The
 treatment most successful in these epidemics 
108
THE  FAMILY  PHYSICIAN.
was absolute rest for twenty-four hours, and j
blanketing, warm air, and warm drinks to
hasten profuse sweating.
  Syco/sis.  See Barber's Itch.
  Syn'cope.  See Fainting.
  Synovial MenFbrane  [Gr. avv, "with" or
" resembling," and uov, " egg "], a membrane
in the animal in structure resembling serous
membrane, but having a secretion unlike the
thin watery product of the latter, and term-
ed synovia or synovial  fluid, denoting that
it is thick, viscid, and glairy like the white
of an egg. There are three classes of syno-
vial membranes  in the  human body:  (1)
The articular, or those lining the lateral ana
antero-posterior walls of the closed cavities
of the joints, and secreting  a fluid to  lubri-
cate the opposed cartilaginous surfaces  of
the  articulating  bones.   (2)  Vaginal  or
sheath-like synovial membranes, which sur-
round the tendons when passing through
osseo-fibrous  canals or  grooves in the sur-
faces of bones, as is the case in the hand
and foot. (3) Bursae  (Gr. fivpca,  "a bag"),
little synovial  sacs or cushions interposed
between parts moving one upon the other
with friction, as where a tendon  glides over
or presses directly upon a bony prominence.
The synovial fluid  consists of  nearly 95 per
cent, of water, rendered viscid by mucus,
epithelial cells, fat,  albumen, and salts. The
synovial membranes are often  diseased.
  Synovitis.  Acute synovitis,  acute inflam- j
mation, may  attack any joint as the  result
of violent injury, exposure to cold,  rheu-
matic taint, or less often from vitiated blood
in the course  of fevers and other diseases.
The symptoms are local swelling, extreme
tenderness upon touch  or pressure, pain
when moved, and often persistent agonizing
pain caused by the distension of the sensi- |
tive inflamed  cavity by a hypersecretion of
fluid.  Penetrating  wounds of  the large sy-
novial cavities, whether gunshot, incised, or
occurring in connection  with  fractures, are
serious,  often  necessitating the  loss of  a
limb.  Chronic synovitis is often a product
of tubercular or scrofulous hereditary taint,
with injury or over-use  as incipient or  ex-
citing cause.   The destructive  process often
involves the ends of the bones and the liga-
ments which are softened and disintegrated.
Abscess, partial dislocations, and  ankylosis,
or stiff joint, are the chief misfortunes which
result.  The synovial bursae often become
swollen and prominent  by  hypersecretion,
and also by injury and inflammation.  Such
is the ganglion or " weeping sinew " of the
back of the wrist.   It resembles a cystic tu-
mor ; its contents must be evacuated and the
membranous  sac irritated  or lacerated to
obliterate it by adhesive inflammation. The
occurrence of distended bursae, and difficulty ,
of cure in many cases, are due to their con-
nection with the cavity of an adjacent joint.
  Syphilis [etymology uncertain],  the lues
venerea of old  authors, and vulgarly known
in English as " pox."   Syphilis is a specific
venereal  disease, contracted chiefly in im-
pure sexual congress, rarely by other and ac-
cidental  inoculation,  and also capable of
transmission in a chronic form from parent
to offspring.  Syphilis is first manifested by
an initial sore at the point of inoculation
on the genitals.   This initial sore is known
as a  chancre, and constitutes primary syph-
ilis.   It appears, on an average, two weeks
after the  cohabitation by which the conta-
gion was transmitted.  At the time of coitus
the  syphilitic virus was received in  some
fissure or abrasion, or absorbed by the folli-
cles  or thin skin of the parts.  It then  re-
mained latent in the system  for  a period
of incubation  until the appearance of the
chancre, which denotes not  merely  local
venereal poison, but a specific infection of
the entire body.  The true chancre is single,
the presence of several venereal  sores deno-
ting  that they  are "chancroids"  or  false
chancres, also termed "softchancres." Atrue
chancre is smooth, with thin adherent edges
and  a livid-red base,  with but little matter.
Its edges are decidedly indurated, the hard-
ness being peculiarly  circumscribed.  False
sores, on the contrary,  have sharp-cut, square
edges, a dirty gray base, with more or less se-
creted pus, and are either soft at the edge or
have an area of inflammatory thickening ex-
tending out into the adjoining tissues.  The
initial sore, or ulcer,  or  chancre may heal
with or without cauterization.   But in from
twenty-five to fifty days later  the constitu-
tional infection is further demonstrated by
the appearance  of a cutaneous eruption on
the various parts of the body,  the  face, and
in the hair.  This eruption may appear even
as late as six  months.  It may be a simple
roseola, or scattered roseate  spots, or a pap-
ular eruption.   About this  time a concur-
rent  eruption appears  in  the mouth and
throat, mucous patches on the tongue and
walls of the  mouth, inflammation, ulcer-
ation, and exudation in the soft palate.  Iritis
is liable to occur at the height of the erup-
tive period, which is designated the period of
secondary syphilis.   If untreated, syphilis
is likely to progress,  and affect  not merely
the superficial structures—skin and mucous
membrane—but also the special organs and
deep tissues.   Periostitis, or  inflammation
of the fibrous sheath of bones, is next in
order; soreness of the shins, swollen glands
in the neck and groin, scabs in the scalp,
falling of the  hair, gummy tumors beneath
the skin, finally breaking as  small abscesses,
inflammation  and loss of the nails of the 
THE FAMILY PHYSICIAN.
109
fingers  and toes, nodes on the skin, ostitis,
with  persistent  rheumatoid  pains  in the
limbs at night, ulcerative destruction of the
palate  and nasal bones, are all liable to
occur progressively in from  six  months to
three years when the disease is not checked
by specific treatment or it has been implant-
ed in a constitution shattered by dissipation.
Extensive changes in the brain, liver, glands,
bones, etc. gradually take place, and the dis-
ease being fastened upon the system,  " ter-
tiary syphilis," ineradicable, is said to  exist.
The sexes contaminate each  other  with
syphilis only when a fresh  initial  sore  is
present.   But either parent  may transmit
syphilis to the  child in utero.   In this way
the father, if having secondary  or tertiary
syphilis, may beget a syphilitic child  with-
out inoculating the mother, but the  mother
becomes contaminated  by the child so be-
gotten  before its birth by the intercommu-
nication of the maternal  and foetal circula-
tion.  The syphilitic foetus often is still-born,
syphilis being a common cause of miscar-
riage at the third to the seventh month of
utero-gestation.  But if born  alive it usually
is poorly nourished,  covered  with  large
patches of syphilitic ecthyma, and has the
"snuffles," a peculiar syphilitic infantile
catarrh.  Its chances of living are not  good,
and it  steadily declines or is taken off by
the first intercurrent disease of infancy.  A
syphilitic child may inoculate the nipple of
a  healthy wet-nurse.  Reversely, a syphil-
itic wet-nurse probably can infect a healthy
infant.
   Constitutional syphilis, whether acquired
by inheritance or existing as tertiary syph-
ilis, constitutes a serious vice of the blood,
and endangers phthisis and steady failure of
bodily  powers.   When a syphilitic  sore or
chancre is contracted, it should  at once be
submitted to a competent physician.   If un-
doubtedly a true chancre—single, hard, and
livid—it may be healed either by cauteriza-
tion or by the milder applications for ordinary
sores.   But the constitution must be treated
for the  general taint which has  entered the
blood.   It is a rule with many to heal the sore
and wait twenty-five or more days that the
appearance of an eruption and sore throat may
prove to the physician  and patient  beyond
cavil that the sore was a true chancre, and
not a false chancre or an erosion, and also that
syphilis has to be combated ; for an imme-
diate  specific treatment, by masking the
secondary stage, may  cast doubt upon the
reality of the disease, and lead  the patient
to neglect long-continued and curative treat-
ment.   The treatment of secondary syphilis
is at first by mercurials, until the eruptions,
sore throat, and other manifestations begin
to yield ;  then by a "mixed  treatment" of
mercury and iodide of potassium.   The per-
son  under such  specific  treatment  should
observe regular hours, eat and sleep well,
avoid  stimulants, and, if necessary,  take
tonics and appetizers to co-operate with the
specific remedies by improving the general
nutrition.   Specific treatment may at the
onset border on  salivation, to produce  an
impression on  the disease, but  thereafter
should  be continued in small doses for a
long period.  In good constitutions the dis-
ease may vanish from  sight in a few weeks,
but  is liable to crop  out at  intervals and
leave  vague sequelae  like  neuralgia  and
catarrhs, unless the remedies be used stead-
ily or intermittingly for two or more years.
It is thought that four years  should elapse
between the contraction of  syphilis  and
the date when marriage is justifiable or the
patient is safely  insurable—events which
demand a thoroughly purified and  uncon-
taminated blood.  The complete eradication
of the taint is questioned by some authorities.
  Tabes Dorsa/lis, Phthisis  Spinalis, Du-
chenne's  Disease,  better known as  Pro-
gressive Locomotor Ataxia, a degenerative
condition of the  posterior gray column  of
the spinal cord,  usually by  the  successive
steps of fatty degeneration, granular disin-
tegration, and atrophy, from which the terms
tabes and phthisis, denoting "wasting."  The
term "progressive locomotor ataxia" is de-
scriptive of the chief features of the disease.
Ataxia (Gr. a privative, and rdgtg, "arrange-
ment" or "order") designates the peculiar
loss of control in this disease over groups of
muscles which in health are co-ordinated or
employed in unison.  This deranged, inhar-
monious action of muscles is limited chiefly
to the  lower  extremities, and manifested
when attempting to walk; hence the  term
"locomotor," while the affix "progressive"
indicates  the steady and hopeless progress
of the malady.  The sight  aids  greatly in
,the  precision  and  certainty  of walking.
Hence, in the early stage of ataxia the gait
may be unsteady only at night, twilight, or
when  the eyes are closed.   In more ad-
vanced stages the patient  has  not sufficient
control to stand with the eyes shut, and, on
attempting to walk the limbs  move  irregu-
larly and  wildly, the feet  coming  down
abruptly with a flapping sound, the  patient
catching at support or falling. The limbs,
though wholly beyond control for walking,
are not paralyzed, and retain full power, as
demonstrated by the dynamometer. Intense
pains,  of electric rapidity and lancinating
severity, shoot  from the feet to the  thighs,
trunk,  and often to the head.  The soles of
the feet often  are  anaesthetic, and seem to
the patient puffy, as if walking on down or
velvet.  There  may be anaesthesia of other 
110                        THE  FAMILY PHYSICIAN.
 parts.   The rectum and bladder may be im-
 paired, and the sexual appetite and power
 are  usually  annihilated.   There  may be
 local dull pain over the spine, denoting the
 point of disease, and also  a slight sense of
 constriction at a corresponding level, as if a
 string were tied round the body. The mind,
 as a rule, is  sound, except so  far as long-
 continued intense pain, sleeplessness, and
 knowledge of  the  desperate and  hopeless
 nature of the disease dispirits and demoral-
 izes.  Alcohol freely taken relieves the pain,
 and  opium, especially  administered  subcu-
 taneously.  But the pain  constantly recurs,
 and  hence either the alcohol or opium habit
 is apt  to  become established in ataxic pa-
 tients.  Cold and changeable weather inten-
 sifies their distress.   Hence, they should be
 placed in warm, sunny rooms, protected from
 damp  and chilly air,  and well housed in
 winter.  This disease of the spinal cord  is
 in some cases induced by  intemperance ; in
 others by licentious excess and  specific dis-
 ease;  in  others it  would seem the reflex
 result  of disease of the bowel  and the uri-
 nary tract, as in stricture of  the rectum,
 haemorrhoids, urethral stricture, etc.  Ha-
 bitual exposure to  inclement weather and
 the rheumatic and gouty vices of the blood
 may induce it.  When due to specific blood-
 states, as rheumatism, gout,  and syphilis,
 there is hope of cure or arrest of the disease
 by specific treatment.  But more often the
 cause  is obscure and of slow, insidious ap-
 proach;  it is surely  "progressive,"  and
 treatment is limited to general tonic  and
 hygienic measures,  and assuaging pain by
 anodynes.
  TaFipes.  See Club-Foot.
  Tapeworm, Taenia [Gr. ratvia, "tape"],
 a species of entozoa or intestinal worm in-
 fecting the alimentary canal of men as well
 as dogs, sheep, and  other  animals.   In Ice-
 land, where  the dogs, sheep,  and masters
 often are housed together and drink from,
 the same receptacles,  the transmission of
 the parasite from animals to men is com-
 mon, every seventh person being said to
 have tapeworm, and  many the associated
 disease. Hydatids (which see).  The tape-
 worm  is so called because it is flat,  soft,
 broad, and white,  and not unlike a tape.
 It consists of a head, which is the -vitalizing
 part  of the worm and essential to its life;  a
 neck, usually half an  inch long and  one-
 eighth or less broad; and a variable num-
 ber of quadilateral  segments or "links,"
 which, according as they  are few or  many,
 extend the worm from  10  or 20 feet  to  100,
 or even 150 feet, in length.  Each  link is
generated at the neck, intermediate between
the neck and the previous link.  Thus links,
as they are formed, are pushed on to make
way for new intermediate links.  The links
farthest removed from  the  head and neck
are therefore the oldest, and with age they
will have grown thicker, firmer, and broader,
so as to be one-quarter or one-half an inch
broad  in  many cases.  Each link or seg-
ment is composed of homogeneous fibrous
structure, with no alimentary canal, but a
water-like circulation by  imbibition which
extends from link to link.  The links  are
held together by an almost transparent al-
buminoid substance. Each link is bisexual,
having a central female duct full of ova and
lateral male organs.  The  actual lifetime of
an undisturbed tapeworm is variously stated,
probably three years.
  There are three varieties of  tapeworm:
1. Tenia solium; 2.  Tenia medio-canellata ;
3. Botriocephalus latus or Toznia lata. The first
grows to great length, 100 or  150 feet, and, as
its name  implies, is usually alone or single.
Its segments are longer than they are broad,
the neck long, often  an inch, and the head
has a  nose-like prominence, two rows of
silicious hooks, a dozen  or more in each
row, and  back of  them  four  "suckers."
The second has neither snout nor hooks on
the head, only the  suckers;  the neck  is
shorter and the links are thicker, shorter,
and broader.  The third variety has on the
head only two lateral slits or suckers, a short
neck, and very broad links.
  The  tapeworm is usually detected by the
patient finding links in the passages from
the bowels.   The symptoms caused by its
presence are not dissimilar to those of gas-
tric and intestinal indigestion.  The worm
is usually in the small intestine, rarely in
the stomach or lower bowel.  Colicky pains,
sense of motion in the bowels, capricious
and impaired appetite, defective health and
strength, and lack of flesh are its chief in-
dications.
  Tapeworm is cured  by remedies which
impair the vitality of the worm or wrest it
from its hold by its hooklets and suckers on
the mucous membrane.  They may bring it
away piecemeal, but until the head is  se-
cured it will continue to renew.  The plan
usually pursued is to cause the patient to
empty  the stomach and bowels by a cathar-
tic,  as castor-oil, then to fast twelve hours,
following  which a full  dose of a specific
medicine is  given, and again in the morn-
ing a  cathartic  to bring  away  the worm.
The  remedy  so given may  be the fluid ex-
tract of male fern,  powdered  kousso, de-
coction of pomegranate-bark, or  powdered
pumpkin-seeds, all of which are efficacious.
Other remedies, as carbolic acid, turpentine,
opium, calomel, are given in small repeated
doses, often  with good  results.   (See An-
thelmintics and Vermifuges.) 
THE  FAMILY
PHYSICIAN.
Ill
  Tap/ping  (Paracentesis), in  surgery,  is
the piercing of the walls of a  cavity so  as
to draw off a  dropsical or other collection
of fluid.   The  abdomen, chest, scrotum,
and even the head, are often tapped for the
removal of such effusions.  The trocar and
canula answer for the performance of the
operation in many  simple cases.  In some
others the contained fluid has to be removed
by the aspirator, an  instrument acting as a
pump  or syringe.  Tapping often affords
great relief, and occasionally  is  of  great
service toward recovery, especially  in cases
of pyothorax and hydrothorax.
  Teeth.  See Toothache.
  TeFanus [Gr. rhavog], a dangerous spas-
modic disease characterized by paroxysms
of tonic  muscular  contraction, succeeding
each other with varying frequency  for days
or weeks.  The spasms usually appear first
in the muscles  of  mastication, producing
the condition  popularly known as "lock-
jaw," then involve the large muscles of the
trunk, then those of  the  extremities and
those concerned in respiration.  In a par-
oxysm the patient's face is livid or purple,
his respiration suspended, his  whole body
rigid  and usually arched backward, owing
to the greater power of the muscles of the
back.  Such a spasm lasts several  seconds,
and  may cause death by arrest of respira-
tion.  Fever of varying intensity is  present,
and  extreme  exhaustion follows the  par-
oxysms.   Death is the  more common issue
in acute cases, occuring in two  or five days.
Occasionally,  tetanus of less  intense  type
becomes chronic, lasting weeks.   The, causes
of tetanus are wounds, especially ragged
and punctured wounds in parts richly sup-
plied with nerves, and certain  atmospheric
conditions  not   yet  accurately  known.
Dampness and great variations  between the
diurnal and nocturnal temperature seem to
favor the occurrence of the disease.   It* is
probable that tetanus arises from unknown
causes independently of injury.  The essen-
tial pathological  condition of  the  nervous
system in tetanus is not known, though a
number of recent investigations seem to in-
dicate that in many cases there exists a dif-
fuse, central myelitis, or inflammation of the
spinal cord. Tetanus has been  successfully
treated by chloral hydrate, opium, chloro-
form, cannabis indica, curara, and by timely
removal or separation of the nerves which
are irritated by the wound.
  Throat, Diseases of.  Although the spe-
cialty of the study and treatment of throat
diseases is designated " laryngology,"  it in-
cludes diseases of the  posterior nares, the
fauces, pharynx, and larynx. Exceptionally,
some of these  diseases may be suspected,  or
even diagnosticated, from symptoms only, as
laryngitis from  hoarseness,  stridulus,  and
aphonia;  chronic tonsilitis  from muffled
voice and habitual snoring; elongated uvula
and  papular  pharynx  from habitual spas-
modic pharyngeal cough.  But physical ex-
ploration, the direct examination of the oral
cavity and the passages to the posterior nares
and larynx, is essential both to diagnosis and
to correct treatment.  Simple examination—
the depression of the tongue by a spoon or
tongue spatula—will suffice in many cases,
exhibiting  the tonsils,  soft palate, uvula,
posterior wall  of the pharynx, and the top
of the  epiglottis.  To discover the root of
the tongue, the entire epiglottis, the true and
false vocal cords, the chink of the glottis,
and even the upper rings of the trachea and
division of the bronchia, the laryngoscopic
mirror must  be employed.   Laryngoscopy
may be performed by the use of either bright
sunlight or a concentration of artificial light.
Specialists  employ lamps with  condensing
Healthy Larynx.
prisms, and where very bright light is de-
sired the oxyhydrogen light is used; with
such methods of illumination the examina-
tion is  conducted in a dark room.  A good
light, whether the sun's rays or artificial, is
reflected, by a concave mirror held by the
physician or  worn upon  a head-band, into
the patient's opened mouth.   The patient's
tongue being drawn forward and gently held,
a small circular or oval laryngeal mirror is
introduced.  There are several sizes of mir-
rors,  varying in diameter from one-quarter
to one inch in diameter;  they  are attached
to delicate handles at an angle, so that when
passed  to the back of the throat  they catch
the rays thrown into  the mouth by the con-
cave mirror,  and  reflect them  downward,
illuminating  the larynx.   The  parts thus
rendered luminous present a distinct picture
in the  small laryngeal mirror  above them;
and this is seen by the observer through the
perforated centre of the concave mirror, since
the axes of light return by reflection to the
reflecting surface from which they started.
  The  laryngoscopic examination is easily
accomplished after a brief period of prac-
tice.   More difficult is the exploration of the
upper  pharynx and the posterior  nares,
termed rhinoscopy.  The uvula has to be 
112
THE  FAMILY  PHYSICIAN.
 drawn forward, and the reflecting laryngeal
 mirror  passed well back and  turned up-
 ward.  When correctly held, a distinct im-
 age of the septum between the nostrils, and
 of the extensive corrugated surfaces of the
 naso-pharyngeal  spaces,  is transmitted to
 the eye.  Patients are easily trained to per-
 mit the presence of the throat mirror, and
 even to explore their own throats (auto-laryn-
 g< >scopy). The movements of the vocal cords
 are displayed best by phonating a (eh).   All
 of these several connecting parts of the throat
 are richly supplied with blood-vessels, lined
 by a mucous  membrane, secreting  mucus.
 They are therefore liable to hypersecretion
 of mucus, or catarrh, which may be acute,
 subacute, or chronic; to active and passive
 congestions,  inducing  redness,  heat,   and
 swelling;  to active inflammations, with for-
 mation  of submucous abscess, erosion of the
 epithelial covering of the mucous membrane,
 or  ulceration  and  sloughing of  its deeper
 layers.  Such  destruction of soft tissue may
 induce necrosis of the underlying hard struc-
 tures, the  nasal  and  laryngeal  cartilages.
 Inflammation  may terminate  in an exuda-
 tion,  developing organized  membranes, as
 those of croup and diphtheria.   Repeated
 congestions and inflammations tend to en-
 gorge and hypertrophy the structures of the
 mucous membrane and glandular bodies em-
 bedded  in it.  The papillae of the back  of
 the throat and of the columns  of the fauces
 are very often thus enlarged.  The surface
 is seen to be studded with prominent ovoid
 papules or tubercles, a  condition known as
 ' clergyman's  sore throat," and technically
 as " papular pharyngitis."  Polypoid growths
 of variable size develop in the nares, pharynx,
 and on  and around the vocal  cords—prod-
 ucts of  papular growth and of granulation
 process.
  A most alarming and critical condition is
 acute oedema of the glottis.  The secretion
 of the region of the larynx being suddenly
 checked, as by cold, or the seat of sudden
 determination  of  blood,  serum  transudes
 from the overloaded blood-vessels into the
 loose submucous connective tissue, and cre-
 ates a sudden dropsy and tumefaction.  The
 distended,  swollen structures  overlap  the
 opening of the glottis, and occupy the ven-
 tricles of the larynx, preventing inspiration,
 and threaten immediate death by  suffoca-
 tion.  The laryngoscopic mirror definitely
 locates the  seat of these dropsical sacs, and
 is the sure guide  to efficient scarification
 and evacuation of their contained  fluid.
 The vocal cords may be affected  by spasms,
producing hoarseness, aphonia, and  labored
respiration, in which case the mirror detects
the unusual approximation and irregular
action of the cords, and excludes the pres-
ence  of more  serious  inorganic  disease.
One of the  vocal cords may be found par-
alyzed,  inactive, and relaxed, while  the
other remains normal.  Such paralysis of a
cord may be due to vocal inflammation or
abnormal growth, or may depend upon  le-
sions of the recurrent nerves in the neck, or
again, coexisting with paralysis of one-half
of the body, depend on a lesion of the brain
—softening, embolism, apoplexy.   Ulcera-
tion or  inflammation may so seriously dam-
age the vocal cords  that cicatricial or scar-
like tissues are formed, tending to contract
and harden; in time the chink of the glottis
becomes contracted and narrow — termed
"stenosis of the larynx."   The aperture
being no longer adequate for the ingress or
egress of air, gradual suffocation must ensue
unless surgical relief is afforded.  Extensive
destruction of the vocal  cords  often occurs
from syphilis  and epithelial cancer.
  The more  accurate  diagnosis  of  throat
diseases, and intelligent study and  classi-
fication by aid of laryngoscopy, have led to
corresponding progress  in treatment.  Ap-
plications are no longer applied at random
by probangs, uncertain of the condition that
exists and of the parts which are reached.
Remedies are  applied with accuracy by va-
rious methods, with  definite regard for the
indications of each  case.  Astringents—as
cold water, alum, tannin, tincture of iron,
and solutions  of nitrate  of silver—are em-
ployed to contract blood-vessels, lessen con-
gestions and relaxations of surfaces.  Caus-
tics are used to remove papular and granular
developments, and induce absorption of hy-
pertrophied  structure.   Local  applications
are made to heal ulcers.  Inflammation is
checked, limited, and cured by warm solu-
tions and vapors impregnated with salts of
soda, ammonia, and  potash, or in other cases
by cold gargles or spray.  The salines tend
to increase and liquefy the secretions of the
throat;  resin oil and astringent agents lessen
them; carbolic acid, chlorine, etc. disinfect
them when septic.   Anodynes  are given to
allay pain, either by the  stomach or locally.
Electricity is applicable directly to the par-
alyzed vocal  cord.  The  knife is constantly
of service in treating throat diseases, for the
excision of the  tonsils and uvula, opening
abscesses, the incision of hard papules, pre-
ceding  use of caustics, removal  of polypi,
the scarification of oedema of the glottis, and
for the operations of tracheotomy and laryn-
go - tracheotomy, whenever, by congestion,
inflammation, ulceration, stenosis, tumors,
cancer, sudden oedema, croupous or diphthe-
ritic membrane, or  whatsoever obstruction,
the larynx is closed  to the passage of air and
death is imminent by suffocation.
  ThronFbus [Gr. 6p6u[Jog, a " clot"], in pa- 
THE  FAMILY PHYSICIAN.
113
 thology, designates the fixed venous blood-
 clot Thrombus often accompanies phlebitis.
 It is conceded that dilatation or contraction
 of a vessel or great weakness of the heart's
 action, may favor the formation of thrombus.
 Thrombi are liable to putrefactive changes,
 whence follow metastatic  abscesses and  a
 long train of deplorable consequences. When
 thrombus exists, a rich diet, tonics, and pure
 air afford the only prospect of recovery.
   Thrush.  See Mouth, Diseases of.
   Tic Douloureux.   See Neuralgia.
   Tongue, Diseases of.   The  tongue may
 be  inflamed  from  various causes, as  hot
 drinks and irritants.  It  is often the seat
 of apthae,  ulcers,  "cancers," the result of
 catarrh of the mouth. The "coated tongue"
 may be due to a relaxed, flaccid, and pale
 condition  of  the papillae, and when notice-
 ably coated has an accumulated stratum of
 thickened saliva and rapidly exfoliated epi-
 thelial cells; the yellow color the result of the
 fatty metamorphosis which the  cast-off cells
 speedily undergo.  When the stomach is in-
 flamed or irritable, the papillae of the tongue
 will  often appear  as distinct points.   The
 tongue is occasionally attacked by epithelial
 cancer. Ranula is a cystic tumor beneath the
 tongue, due to occlusion of some one of the sali-
 vary ducts.  When any part of the tongue is
 the seat of  motor paralysis, loss of sensation
 or taste, the part so deprived may be experi-
 mentally  defined, and a study of the nerve-
 supply of the tongue will point to the part
 of the brain in which the lesion exists.  Ex-
 ceptionally, in infants the "fraenum" or fib-
 rous cord beneath  the  tongue is too short;
 the  "tongue-tied"  infant cannot nurse well,
 and  when  older  speaks imperfectly; the
 cure is by  cutting.
   Tonsillitis.   See Quinsy.
   Tooth/ache may be due to diseases of the
 dentine of the tooth itself—caries, ostitis,
 exostosis;   to  congestive  inflammation or
 disease of the  nerve in the tooth; to inflam-
 mation of the gums and alveolar processes
 or bony sockets of the teeth, with or with-
 out  more general  disease of the upper or
 lower jaw, as  when fractured or affected by
 scrofula, syphilis, or  phosphorus; to simple
 nervous debility or disorder, as from  emo-
 tional causes,  excitement, fatigue; to gen-
 eral blood states, as  in  invalids from  any
 cause, especially phthisis, anaemia, and ma-
 laria.  The cause of toothache  should, if
 possible, be discovered.   It is usually due
 to diseased teeth, which should be filled or
 extracted.   Abscess of the gums should be
incised.  When purely neuralgic, improved
diet, out-of-door life, and tonics are  indi-
cated.   Malaria demands quinine; anaemia,
iron; struma,  cod-liver oil.  The  nervous
cases yield  to  opiates,  sedatives, and ner-
vines.   For the immediate relief of tooth-
ache  local  leeching, cupping,  poulticing,
fomenting,  lotions  of  chloroform,  lauda-
num, and aconite,  embrocations of oil of
peppermint and chloral camphor, and the
use  of opiates, chloral-bromides  by the
mouth, are  useful measures.
  ToxicoFogy  [Gr. to^ikov,  "poison," and
Aoyog, " discourse," a treatise on poison].  Poi-
sons are classified  with  reference to their
source, as  (1)  animal,   (2)  vegetable,  (3)
mineral, and  also  with  reference to their
method of action:  (1) corrosive and irritant
poisons,  such as  corrode  or inflame the
stomach; (2) narcotic and sedative poisons,
which, being absorbed by the mucous mem-
brane, enter the blood and act on the nerve-
centres.  The corrosive poisons are—1. Acids
—oxalic, hydrochloric, sulphuric, nitric.  2.
Strong alkalies—ammonia, caustic  potassa,
and soda; alkaline earths—baryta and lime.
3. Metallic and other bases and their salts—
corrosive sublimate, arsenic, sulphate of cop-
per, tartar emetic, acetate of lead (sugar of
lead), sulphates of iron and  zinc, nitrate of
silver,  phosphorus, iodine, creasote,  carbolic
acid.   The narcotic and  sedative  poisons are
chiefly  opium, belladonna,  stramonium,
hyoscyamus, aconite,  digitalis,  veratrum,
tobacco, lobelia.  Chloral hydrate is anaes-
thetic  and  depressant in large doses.  Hy-
drocyanic acid depresses the heart or is im-
mediately fatal.  Strychnia and nux vomica
act specifically on the nervous system, causing
muscular rigidity  and spasmodic contrac-
tions.  Poisons are often  taken with suicidal
intent, by accident, as by children or by adults
erroneously as medicine or drink, and when
carelessly dispensed by druggists, as oxalic
acid instead of salts, morphia or strychnia
instead of quinine.   The symptoms of poi-
sons are chiefly extreme disturbance of the
stomach, the breathing, and the pulse, often
with impairment of sight and great bodily
weakness, pallor, and cold surfaces.   Corro-
sives and irritants cause burning  pain in the
stomach.
  Antidotes for poisons should be given im-
mediately,  while waiting the arrival of  a
physician.   For poisoning by acids give alka-
lies, solutions of soda, potassa, lime, ammo-
nia ; afterwards white of eggs and sweet oil to
soothe the stomach; for poisoning by alkalies
give dilute  acids, as vinegar  or lemon-juice,
and olive oil, which unites with the alkalies
to form a soap and renders them inert; for
corrosive sublimate, white of eggs and wheat
flour; for arsenic, the hydrated peroxide of
iron, kept by most druggists and many physi-
cians.  It can be made by adding aqua am-
monia  to liquor ferri-persulphatis, or even to
common tincture of iron; the resulting pre-
cipitate is to be used in tablespoonful doses. 
114
THE  FAMILY  PHYSICIAN.
   The new dialyzed iron is a ready and efficient
   antidote ; magnesia may be used if no other
   remedy is obtainable. For sulphate of copper,
   white of eggs, milk, flour; for tartar emetic,
   oak-bark, tannin; later, opium to allay pain
   in  the stomach. For sugar of lead (acetate
   of  lead), sulphate of magnesia, making an
   inert sulphate of lead  in the stomach and
   system;  for sulphate of iron (copperas) and
   sulphate  of zinc, bicarbonate  of soda, freely
   given ; for nitrate of silver, common salt, free-
   ly given, converting it to chloride of silver;
   for phosphorus,  a mustard  emetic;  later,
   opium  and ice to quiet the stomach; for
   iodine, boiled starch; for creasote and carbolic
   acid, olive oil and white of eggs.  In opium poi-
   soning, (opium,  laudanum, morphine, pare-
   goric), emetics,  as sulphate of zinc or cop-
   per, the stomach-pump,  frequent draughts
   of  strong coffee, constant exercise, as walk-
   ing to prevent sleep,  belladonna by the
   mouth, atropine  hypodermically,  and the
   electric battery  to the diaphragm and chest
   to keep up breathing ; for belladonna, opium ;
   for stramonium,  hyoscyamus, aconite, digitalis,
   veratrum, tobacco, and lobelia, alcohol  freely,
   to restore the pulse ; for chloral hydrate, alco-
   hol and the electric current.  Hydrocyanic
   acid is usually instantly fatal; in small doses
   it depresses the pulse, and alcohol is the rem-
   edy.  Poisoning by wild fruit and berries is
   usually due to  the sedative  effect of their
   juices, and demands vomiting, and alcohol
   to  sustain  the heart;  so also in poisoning by
   the flesh of pigeons or game which has fed on
   wild  berries.    Strychnia (and nux vomica)
i   poisoning requires inhalations of chloroform
   and chloral by the mouth or hypodermically.
    TrichFna Spiralis, a parasitic nematoid
   worm infesting  the muscular tissue of the
   {)ig, the rat, and some other animals, and
   iable to occur also in man.  As commonly
   found, this worm is a quiescent  encysted
   parasite, occupying, often in great numbers,
   the tissue  of  the voluntary  muscles.  The
   cysts are oval in form,  more or less shuttle-
   shaped or pointed at the two extremities,
   lying between and parallel with the muscu-
   lar fibres, about u\jth of an  inch  long and
   Tcuth of an  inch wide.   'When of  recent
   origin, they are  quite transparent and color-
   less, and hardly discernible by  the naked
   eye;  after  a  certain  period they  become
   partly opaque from  the  deposit  of calca-
   reous matter, and are then visible as minute
   whitish specks scattered through the muscu-
   lar tissue.   The worm  lies perfectly free in
   the cavity  of the cyst, coiled upon itself in
   a spiral  manner, from  which circumstance
   its specific name is derived. When stretched
   out it is of a tapering, cylindrical form ^th
   of an inch long, jjsjjth  of an inch  thick in
   its  widest  portion.  Its posterior extremity
is blunt and rounded, but the anterior half
of the body tapers gradually from  behind
forward, and is comparatively slender. The
mouth and anus are situated  respectively at
the anterior and posterior extremities, and
the intestine runs in a direct line from one
to the other.  The sexes are separate, differ-
ent individuals being either male or  female,
but the sexual organs are incompletely de-
veloped, and do not exhibit  any functional
activity.  The worm  often moves distinctly
while still in  the  cavity  of  the cyst, the
movements  consisting of  occasional  slug-
gish,  partial flexion  and extension  of the
two  extremities.   In this  imperfect  and
practically  sexless condition the parasite
may continue for an indefinite time, retain-
ing its vitality, but undergoing no percepti-
ble change.  When, however, a portion of
trichinous flesh  is devoured in the raw state
by man or certain kinds of inferior animals,
the muscular tissue and  the  encysting cap-
sules  are  liquefied by  digestion, and the
worms are set  free in the cavity of  the in-
testine.  Here they at once increase in size,
and  in  about  two  days  become developed
into mature and sexually  perfect trichinae.
The sexes are  now readily distinguishable
from each other.  The male is  ^th of an
inch  long, with a folded spermatic tube
occupying the  posterior  half of the body,
and  terminating externally  at  the anus,
where  it is provided with two projecting
conical copulatory appendages.  The female
is half as long again as the male, and nearly
the whole of its posterior two-thirds is oc-
cupied by the ovarian tube, which contains
the eggs, and which terminates in an exter-
nal orifice or vulva, at the anterior fifth of
the body.   At  this time fecundation takes
place by union  of the sexes, and the  female,
at the end of seven days from the introduc-
tion of the  trichinous food, begins  to pro-
duce living embryos, which  are discharged
successively from the vulva  into the sur-
rounding cavity of the intestine.  The pro-
duction of these embryos  is very abundant.
According to Pagenstecher, it is often pos-
sible to count  500 or  600 at one time, fully
formed or in process of development, in the
body of a  mature female; and as the gene-
rative act continues for at least a week or ten
days, it is  possible that each female trichina
gives  birth in the intestine to 1000  or 2000
living young.
  The embryos, when discharged from the
body  of the female,  are rather less than
vjfojth of an inch in length, nearly straight,
and tapering somewhat toward the anterior
extremity.  They immediately begin  to pen-
etrate the walls of the intestine and disperse
themselves over the body.  They have been
found under these circumstances in the sub- 
THE  FAMILY  PHYSICIAN.
115
  stance  of the intestinal walls, in the mes-
  entery, the diaphragm, the  peritoneal and
  pleural  cavities, and  thence outwardly in
  all the voluntary muscles of the trunk and
  limbs.  Their passage takes place quite rap-
  idly, as they may be found in the diaphragm
  of the rabbit on the eighth to the thirteenth
  day after feeding with trichinous food, and
  on the fifteenth or sixteenth day in the mus-
  cles generally.  On their first arrival in the
  muscular tissue  they  are apparently quite
  free, and capable of moving slowly from one
  point to another; but they soon afterward
  become  enveloped in  a  closed  capsule or
  cyst, and there  grow to a larger size.  As
  they increase in  length within the confined
  space of the cyst, they become gradually
  coiled up, thus  assuming the spiral  form
  characteristic of  the encysted worm.  They
  are  then shut off  from immediate contact
  with the surrounding tissues,  and pass at
  once into the quiescent condition.
    This process of the development of adult
  trichinae in the intestine and the dispersion
  of their  young throughout  the system pro-
  duces in man and animals a severe and often
  fatal illness, known as trichinosis.   Its earli-
  est symptoms are those of intestinal irrita-
  tion, caused by the growth  and activity of
  the  ingested  worms — namely,  abdominal
  pains, nausea, vomiting, and diarrhoea. There
  is also fever and loss of appetite.  Then fol-
  lows an oedematous swelling of the  face,
  body, and limbs,  with  muscular  pains and
 tenderness, especially on motion ; so that the
 patient lies helpless, with the arms and legs
 in a semiflexed position, and any  attempt at
 either active  or  passive movement  causes
 suffering. This corresponds with  the period
 of dispersion of the embryonic worms and
 their establishment in the muscular  tissue.
 There is  also marked difficulty of chewing
 and swallowing,  owing  to the invasion of
 trichinae  into the corresponding muscles;
 hoarseness or loss  of voice, due to their pres-
 ence in the laryngeal muscles; and even in
 some cases serious disturbance of respiration,
 from a similar affection of the diaphragm
 and the intercostals.  The  fecundity of the
 adult worms, and  the abundant emigration
 of their embryos into the muscular system,
 are fully sufficient to account for these symp-
 toms.  In man, after death from trichinosis,
 there have been found  in the same subject
 in the gastrocnemius muscle of the leg 30,000
 young trichinae to the  cubic inch; in the
 biceps muscle of the arm, nearly 70,000; and
 in the deltoid muscle at the shoulder, over
 90,000 in  the same space.  The severity of
the disease, other  things being equal, is in
direct proportion to the quantity of trichinous
food ingested and the number of living para-
sites which  it contained.  In severe cases
  death  may take place within the first  two
  days, from the intensity of the diarrhoea  and
  febrile disturbance.   More commonly,  the
  fatal termination occurs in the fourth or fifth
  week.   If the patient survive this  period,
  the chances of recovery are much increased,
  as the parasites have then become encapsuled
  and are  passing into a  state of quiesence.
  When this is accomplished, the morbid symp-
  toms  gradually subside, and the patient is
  restored  to a  comparatively  healthy condi-
  tion.   The encysted  trichinae, however, re-
  main imbedded in the  muscular tissue  for
  very  long periods,  and it  is not  known
  whether they ever entirely disappear.  They
  have  been found in  a man eighteen years
  after the attack produced by their invasion.
   The source of this infection for man is
  almost invariably trichinous pork;  for al-
  though the rabbit, the cat, the rat, the mouse,
j  the sheep, and the calf are all susceptible to
  the disease, as proved  experimentally  by
  feeding them  with trichinous flesh, yet in
  the sheep and calf it is only exceptionally
I  produced under these  circumstances,  and
 never shows itself spontaneously either  in
 them or in the rabbit.  It could not be pro-
 duced in any of the birds experimented on
 by Pagenstecher—namely, the common fowl,
 the turkey, the pigeon, and the goose—nor
 in frogs or newts, nor in several  species of
 invertebrates.  The only animals in which
 it occurs spontaneously and  frequently  are
 the rat and the pig; and the latter has been
 the source of infection  for man in every  in-
 stance thus far known.  The disease, as  af-
 fecting the human subject, is most frequent
 in Germany, owing to the habit among cer-
 tain parts of the population of eating ham,
 sausages, and even fresh pork, in an uncooked
 condition.  Within twelve  years  after the
 first recognized case, which happened  in
 Dresden in 1860, there were eleven recorded
 well-marked local epidemics, of which the
 most disastrous was that at Hedersleben in
 1865, where, out of 2000 inhabitants, over
 300 were  taken sick and 101 died.  In the
 U. S. it is rare, occurring mainly in isolated
 cases or among members of a single family
 who have partaken of the same food.
   The danger of infection by trichinosis con-
 sists in taking as food pork which is imper-
 fectly cooked.  The fat of pork is not inju-
 rious in this respect, as the adipose tissue
 never contains  trichinae.   But the muscular
flesh in any of its varieties, as fresh pork,
ham, sausages,  or the  lean parts of bacon, is
liable to produce the disease.   The pig from
which the meat is taken may have long since
recovered  from the original attack, present-
ing a perfectly healthy appearance when
brought to  the slaughter-house,  and the
parasitic cysts  are usually too minute and 
116
THE  FAMILY  PHYSICIAN.
transparent  to  attract the attention of the
butcher or  the provision-dealer.   Neither
pickling nor smoking, as ordinarily practised,
will destroy the vitality of the trichinae, and
they may be found still  living in  ham or
bacon  cured by either process.   The  only
protection is that afforded  by thorough cook-
ing.  The trichinae are killed by a tempera-
ture  of 160° F., and meat which has  been
subjected  for a short time to this tempera-
ture is  harmless.  Care must be taken, how-
ever, that all parts of the meat used be heated
to the requisite point, otherwise it is as dan-
gerous  as if  the whole of it were taken raw.
  A ham, if boiled for a short time, may be
raised  to a much higher  temperature  than
160° on the outside, while its internal parts
are still below that point; and fresh  pork
which  has been roasted  or broiled may be
thoroughly cooked externally, but still red
and juicy within.  The only safe rule to fol-
low is that the fresh meat should be broiled
or roasted until its color is changed through-
out, and that for hams the boiling should
be continued until  the internal  parts are
perceptibly softened as well as the exterior.
Since, in some instances, trichinae have  been
found in pigs slaughtered for the market in
so large a proportion  as  1 in 50, these pre-
cautions are indispensable for protection from
the disease.
  A further consideration of importance re-
lates to the source  of infection for the pig
itself.  Since this  is  practically the  only
animal from which man  contracts  the dis-
ease, if trichinosis  could be prevented  or
extirpated in the  pig, the human subject
would  also be free from it.  But as  the en-
cysted  muscular parasite, whether in man,
the pig, or the  rat, is  always  quiescent and
sexually unproductive, it is not  fully evi-
dent how  the continuation of its species is
provided for.   No doubt  rats are often  con-
taminated by each other,  since they are well
known  to eat each other's flesh when de-
prived  of ordinary supplies  of food; and
the cat is naturally infected by devouring
rats and mice.  But as the pig neither feeds
upon human flesh nor habitually upon  rats,
it is not easy to see why the affection should
be so frequent  among swine, or how  it is
perpetuated  and transmitted  from one to
the other.   There are probably two modes
in which this takes places : First, nearly all
slaughter-houses are the abundant  resort of
rats,  which  feed upon the refuse material,
and thus  after'a time often become trichi-
nous.   During  the first period of intestinal
irritation in these animals some of the adult
worms  may be discharged with the evacu-
ations,   and  accidentally  mingled  with the
food  of the  remaining pigs.  It is possible,
also, that pigs may occasionally seize and
devour rats dead or dying from trichinosis.
Secondly, the waste bits  of flesh and  the
general debris of slaughter-houses are some-
times,  when  removed by  washing,  allowed
to run  into the feeding-troughs ; and  lastly,
the flesh of  a  pig dead  from  incidental
causes, and therefore not considered as fit for
the market, may be used as food for the re-
mainder  of the  drove.  In  some or  all of
these ways a certain number of swine may
be annually  contaminated,  and thus serve
to perpetuate the  disease.   The methods,
accordingly, which are most likely to reduce
its frequency, and,  if possible, to extermi-
nate it altogether, are—first, the maintenance
in slaughter-houses of extreme cleanliness,
no waste material  being permitted  to re-
main over night to serve  as an attraction
for rats, nor allowed to mingle with  the food
of the  remaining pigs;  and secondly, swine
should never be fed with the flesh of one of
their own  species which has died from in-
jury or disease.
  Trichinia'sis,  or  Trichinosis, a disease
induced  by eating  the  trichinous  flesh of
swine.   (See  Trichina spiralis.)
  Tu/bercle  [Lat. tuberculum], a name ap-
plied to  certain diseased  and  degenerative
products  in the animal body, and  chiefly
interesting in its  relation  to  pulmonary
phthisis  or  consumption.    In the remote
periods of  medicine persons dying of con-
sumption were known to have in their lungs
yellow  masses of cheesy consistency.  These
were rudely designated  tubercle.  By Stark
in 1785,  by  Matthew Baillie in 1794,  and
Boyle in 1810, a new body was described,
termed miliary tubercle; this minute body,
about  the  size of  a millet-seed, of gray
color, semi-translucent, and of gelatinous
consistency, has come  to be regarded as true
tubercle.  The miliary  or  true tubercle is
therefore to be looked for in the acute tu-
berculosis of  children, in tubercular inflam-
mation  of the  brain, pleura, peritoneum,
and wherever in a consumptive and tainted
constitution  acute  marasmus  supervenes.
The  yellow  masses, now known as  crude
tubercle, have been resolved by the micro-
scope into wasted, shrivelled cells and fatty
granules, which give the homogeneous cheesy
consistency.  Hence,  so-called " yellow tu-
bercle" may  be  the second and advanced
stage of true tubercle, or  the " fatty degen-
erative," retrograde stage of innocuous 'ma-
terial in the body, as when acute inflamma-
tion has given rise to plastic lymph,  which
fails to organize.  Under such circumstances,
in a person hitherto healthy, with no  tuber-
cular tendency, an unfortunate inflamma-
tory attack may lead  to deposits which be-
come fatty or " cheesy," and these caseous
masses liquefy or soften,  forming  cavities. 
THE  FAMILY  PHYSICIAN.
117
It is, then, the tendency  of abnormal  de-
posits, whether true  tubercle  or simple
cheesy matter, to  compress  the healthy
tissues and cause their waste, and to soften
and form cavities, that leads to consumption
and death.  Yellow tubercle is most liable
to develop, following acute sickness, in those
who are  delicate  and ill-nourished.  The
relation of miliary or true tubercle to  the
scrofulous or strumous diathesis is unsettled,
the opinion steadily gaining that " scrofula
is the soil in which tubercle grows."   Buhl,
Sehuppel,  and others claim that tubercle
develops upon the minute lymphatics which
permeate  all  the  structures of  the  body.
(See Consumption  and Scrofula.)
   Tubercular Meningitis.  See Meningitis.
   Tu/mor [Lat., a "swelling"], in patholo-
gy,  is defined by Boyer  as "any  preter-
natural eminence on any part of the body,"
but in a narrower  sense swellings which are
the recognized results of inflammation  and
extravasation are excluded,   Tumors  are
primarily  divided  into  two  great classes,
malignant and non-malignant tumors.  To
the  first belong all the  numerous varieties
of cancer, epithelioma, and the various can-
croid  diseases.   (See Cancer.)   To  the
second class (benign tumors) belong a vast
number  of varieties,  the classification of
which is  difficult.  A convenient mode is
that which classes them according to  the
tissue  of which they are composed.  They
may be  arranged  as follows: (1) Fibrous,
fibroid, and connective tissue tumor, fibro-
ma ; (2) fatty tumor,  lipoma;  (3) cartilage
tumor, chondroma; (4) bone tumor, osteoma,
exostosis;  (5) muscle tumor, myoma;  (6)
nerve  tumor, neuroma ; (7) erectile, cavern-
ous, or blood tumor, angioma;  (8.)  the so-
called  sarcoma,  or   flesh  tumor,  which,
according  to  Billroth, consists of develop-
mental connective tissue  which  does  not
become perfect bone-cartilage or other tis-
sue, but  undergoes some  one or more of
several  peculiar   degenerative   changes;
many  varieties are noted:  (9) lymphoma, or
hypertrophy  of the  lymphatic  and other
ductless  glands; (10)  papilloma, or hyper-
trophy of skin  elements;  (11)  cystoma,
hollow or cystic tumor, containing a fluid or
semi-fluid  mass.   It may be observed  that
many  tumors combine the characters of two
or more of the above classes, and also that,
according  to a prevalent  doctrine,  many
apparently benign tumors  approximate and
may finally take on malignant characters.
   typhoid Fe'ver.  See Typhus and  Ty-
phoid Fevers.
   Ty'phus and Ty'phoid Fevers [lyphusfaom
Gr. rv(pog, "stupor;" typhoid, from Gr. rvyog,
"stupor," and eldog, "form"], two idiopathic
or essential  continued fevers, by some au-
thorities regarded as a  greater and  lesser
degree  of  one common  disease, but by  a
majority of physicians conceded to be dis
tinct diseases  with  certain  resemblances.
Typhus is  the  more acute,  virulent, and
fatal, the more sudden  and pronounced in
its onset, rapid in its course, and in cases of
recovery terminating promptly by a  crisis.
Typhoid is insidious in its development, less
abrupt  in its onset, slower in  the develop-
ment of its symptoms, which are less acute,
and terminates by a prolonged  and gradual
convalescence.  Typhus  is known  as ship-
fever, jail-fever, camp-fever,  etc., being the
product of vast aggregations  of humanity
under unhygienic conditions, especially de-
ficient  ventilation; so that the rebreathing
of air loaded with emanations from crowded
living beings  is its chief cause.  With the
sanitary reform  of barracks, ships, prisons,
etc. it  has been reduced to  a  minimum.
Typhoid fever is far more  prevalent,  occur-
ring in all countries, among all classes of
society, in isolated and healthy country vil-
lages as well as in the larger towns and
 cities.  It has variable  degrees of severity,
 and  a  variable predominance of  different
 classes of symptoms in different persons and
 seasons.  It may be induced by purely ex-
ternal  causes, as by bad ventilation,  sewer-
gas,  exhalations of decomposing matter in
 cellars  or near houses, privies, and especially
 the contamination of  drinking water,  as
 when springs or wells receive by percolation
 the surface-water from  outbuildings.   In
 other  cases typhoid fever would  seem to
 have a purely intrinsic  origin, the morbific
 matter being collected within the person's
 system by deficient elimination.  Thus, it is
 induced in  persons of nervous  temperament
 by prolonged  and excessive mental or bodily
 effort, care, exposure, fatigue, and privation
 of food. The nervous type is then developed,
 justifying the German designation of "nerv-
 ous fever," since the depressed nervous sys-
 tem suspends the nutritive processes of the
 body, and effete matter  becomes present in
 excess  of the nutritive supply.   Typhoid
 fever is also known as adynamic and asthenic
 fever,  indicating the peculiar exhaustion
 characterizing  it; pythogenic fever (Gr.
 ■Kvdog,  "filth," and  ysvao), to  "generate").
 In typhoid fever the Peyer's glands of the
 small intestine are invariably swollen, infil-
 trated  with typhoid matter, and often ulcer-
 ated or sloughed  out;  hence from  this
 specific lesion  the  disease  is also  called
 enteric fever, abdominal  typhus, and ileo-
 typhus.  Typhus fever has an  average dura-
 tion of two weeks, characterized  by initial
 chill, active delirium, contracted pupil, dark-
 coated tongue, dusky suffusion of the face, a
i high temperature, a rapid and feeble pulse, 
118
THE  FAMILY  PHYSICIAN.
 and often weak  heart-sounds.  The body-
 heat rises steadily, remains constant at its
 height, when at the end of the second week
 speedy recovery  ensues, with profuse per-
 spiration, or the case becomes more  serious
 or fatal.  Exceptionally, the relapse is  ter-
 minated by a crisis as late as the end of the
 third week.  Typhoid is of longer duration
 —at least three  full weeks of the active
 fever, and several weeks of gradual conva-
 lescence.   During a week to ten days ante-
 cedent to the actual attack the specific poison
 or materies morbi is incubating, and the pa-
 tient  is languid,  feeble, and depressed.  It
 is ushered in by headache, chill or chilli-
 ness, and elevated temperature; later, follow
 muttering delirium, semi-consciousness  or
 "coma-vigil," wild  excitement and  tossing
 of the body, picking of the bedclothes ;  the
 face is  suffused and  blank,  the  tongue
 coated; the teeth may have "sordes," a de-
 posit  of  blackened  and  dry  saliva;  the
 abdomen is tender  on pressure, tumefied,
 and emits  a  drum-like sound  when  per-
 cussed ; the bowels are often loose, the stools
 being " ochre-colored,"  and often  found to
 contain the shreds or entire body of slough-
 ing intestinal glands ; in the second week in
 many  cases minute spots appear  on  the
 lower  part of the chest and  upper part  of
 the abdomen, coming in crops of twelve or
 more,  each crop  lasting about three days.
 The temperature, as  shown  by the medical
 thermometer,  has a  peculiar and  almost
 diagnostic course in typhoid fever.  There
 is after the initial  rise an ascent for four  or
 five days of about 2° F.  each evening, and a
 descent in the morning of 1° F., making a
 dailv gain of 1° F.   Thus, the temperature
 reaches 103°, 104°, 105° F.; it then remains
 nearly constant for several days, when to-
 ward the  end of the second week  it has a
 gradual descent in the same manner of a
 degree daily ; during convalescence there is
 a marked daily variation  of temperature,
 resembling intermittent fever—an  evidence
 of the  debilitated and susceptible state  of
 the convalescent,  and of the periodic efforts
 of the recuperating system to cast off mor-
 bific matter.   The modern  treatment  of
typhus  and typhoid may  be summed  up
 chiefly as good  nursing, fresh air, food, and
support by tonics and  stimulants.   Cold
 water may be of the greatest value, either
 sponging, the cold pack, affusion, or immer-
 sion, to reduce the unusually high and dan-
gerous  temperature of the body.   (See arti-
cle  Fever.)
  UFcer and Ulceration [Gr. eAmg; Lat. ul-
 cus], the process of molecular death  or dis-
integration  occurring on the surfaces of the
body at  points where  nutrition is low  in
eonsequence of local irritation or injury or
defective  circulation  and bad  states of the
blood.  Localized inflammation is often the
determining cause of an ulcer, by locally oc-
cluding the capillaries and arresting or weak-
ening local circulation and nutrition ;  thus,
the canker is often an ulcer in the mouth due
to stomatitis ;  the ulcerated tonsil has been
previously inflamed, either acute or chronic.
Sluggish venous circulation often causes ul-
cers, as ulcers upon the legs from varicose
veins or weak circulation of the aged ; ulcers
upon haemorrhoids or varicosity of the anus.
When wounds have failed to  heal promptly,
their border and surface may take  on the
ulcerative process, and  become bathed with
a weak watery serum containing black gran-
ular detritus.  The presence of foreign sub-
stances, as a splinter in the flesh or  dead
bone in a limb, creates secondary  ulcers.
Pressure and constant irritation are causes,
as upon the feet from ill-fitting boots, and
bed-sores from long lying.  Lowered nerve-
tone and depressed temperature favor ulcer-
ation, the paralyzed limb easily ulcerating.
Ulcers are classed as—(1) Simple or healthy
ulcers, if the term is  not a misnomer—that
is, ulcers having a healthful tendency to heal.
(2) Weak ulcers, lacking the florid color and
healing tendency of the first class; they often
result from the debilitated health of the sub-
ject.  (3) Indolent ulcers; often all recupera-
tive power is lost; usually the border is thick-
ened and  elevated, and may be indurated.
(4) Irritable ulcers are painful, and may bleed
upon touch.   (5) Inflamed ulcers.   Ulcers
are liable to become inflamed upon slight
local irritation or derangement of the blood,
use of alcohol, and exposure to cold.  (6)
Sloughing ulcers, conditions often following
the inflamed  ulcer or  very  low states of
health.  (7) Serpiginous ulcers, when some
specific vice of the blood gives it a tendency
to spread, and it pursues a tortuous, serpen-
tine course.   (8) Specific ulcers, with under-
mined edges, due to  primary  deposits be-
neath the skin,  which soften and discharge
upon the surface.
  The simple ulcer needs simply to be kept
clean and protected by any  bland cooling
lotion or ointment; the weak and indolent
requires stimulating applications; the indu-
rated often requires the  incision of its thick-
ened borders or removal by strapping with
plaster; the elastic bandage will effect a speedy
cure in many cases; the inflamed ulcer calls
for cold and evaporating lotions—the slough-
ing for antiseptics.  In all forms the diet
must be rich, the appetite  maintained by
tonics, and the blood enriched by iron and
often alteratives.
  UmbiFical Hernia.  See Hernia.
  IFrinary CaFculi and Deposits.  Deposits.
—Urine in disease often deposits on stand- 
THE  FAMILY PHYSICIAN.                        119
ing various kinds of sediments, which differ
in properties and composition according to
the causes which induce  their formation.
Both  morphological  and  chemical bodies
are thus separated.   The  former  class in-
cludes such  substances as blood,  pus,  and
mucus-corpuscles, epithelial scales, sperma-
tozoa, etc.; to the latter class belong urates,
uric acid, phosphates,  calcic oxalates  and
carbonates, hippuric  acid, cystine, leucine,
xanthine, tyrosine,   etc.   These  deposits
form  light flocculent powders or  compact
grains (gravel), or they collect in larger con-
cretions, forming calculi.  The most com-
mon  sediments  contain  uric acid.  This
often  separates in a free state, forming red
gravel, or it is deposited in the form of  am-
nionic or sodie urates, which sometimes ap-
pear in  perfectly healthy urine.   A crystal-
line or amorphous  deposit, consisting of
ammonio-magnesic phosphate, forms what
is known as white gravel.
   Calculi in the Bladder.—These vary greatly
in size and composition, and are frequently
composed of concentric layers of  different
composition,  arranged  around a clot  of
blood or a foreign substance as a nucleus :
the exterior layer is  often phosphatic,  but
never uric, in character.  The most typical
forms have the following composition:
Uric.
	.... 92.8
	.... 3.2
	1.0 .... 3.0
Phosphatic.	... 9.77
Ammonio-magnesic phosphate....	, 34.74 38.35 3.14 2.55 .. 6.87
Oxalic.	.... 63.5
	, 6.2 .... 30.3
As a rule, the oxalic calculi are the hardest,
the phosphatic  being the softest.  The fol-
lowing are  the best characterized forms of
calculi:  Uric add calculi, of a brownish-red
color and  smooth  surface.  When  heated
they fuse, and emit a peculiar odor,  leaving
but a little ash.  They give the reactions for
uric acid.  Ammonic urate calculus is rare in
occurrence.  It is more easily soluble in water
than the preceding, and dissolves in  hot po-
tassa solution,  witb evolution of ammonia.
Caldc oxalate constitutes the mulberry calcu-
lus, which has a dark-brown color and is very
hard.  When heated before the blow-pipe.
it  first blackens, then burns to a white ash
consisting of calcic carbonate.  It dissolves
in hydrochloric and in nitric acids, but not
in acetic acid.  Calcic phosphate forms the
bone earth calculus (08P2Ca3),  which is of
rare occurrence, and often consists of lam-
inae  of crystals radiating  from a nucleus.
It is of a light-brown  color,  dissolves in
hydrochloric acid, but is infusible before the
blow-pipe.   Ammonia - magnesic phosphate,
or triple phosphate calculus (08PAIg_,Am2),
is white and  brittle; fuses with difficulty,
emitting an ammoniacal odor, and  readily
dissolves in acids.  Fusible calculus, which ap-
pears to be a mixture of the two preceding
varieties, forms white friable masses which
often acquire a large size.  It fuses readily,
and  is easily  soluble in  acids.   Xanthine
calculi are of  a  pale-brown color,  have a
lamellar  fracture  and  a polished surface,
which acquires a high lustre when rubbed.
They  dissolve in potash  solution  and in
nitric  acid, but very sparingly in  hydro-
chloric acid.   Cystine calculi are semi-trans-
parent, and have a dark-yellow color and a
crystalline texture.  The last two forms are
of unfrequent occurrence.  Compound  cal-
culi, consisting of a succession of  laminae
composed of several of the foregoing vari-
eties,  also occur.   (See article Calculus
or Stone.)
   IFrine, Retention of.  See  Eetention
of Urine.
   IFterine Diseases.  Diseases of the womb
or uterus, so-called  " female diseases," are
comparatively infrequent in the women of
aboriginal and savage  tribes,  and  in  civ-
ilized  races among the  women of rural dis-
tricts who labor, are much in the open air,
and  free from artificial and  effeminate habits
of dress and living.  For the most part they
exist in delicate women, those whose health
is impaired by some other and  primary dis-
ease, and relatively more  often in  women
resident  in great  cities. The  predisposing
causes of a majority of all uterine diseases
are the constant recurrence  during the great-
er part of adult life of the menstrual period,
the complications and sequelae of child-bear-
ing,  and the intimate nervous and vascular
sympathy connecting the uterus with every
part of a Avoman's organism.   Uterine  dis-
eases comprise also the derangements of the
appendages of the uterus—the ovaries, va-
gina, and peri-uterine connective tissue  and
ligaments which  maintain the organ nor-
mally in situ.   The uterus is subject  to con-
gestion and  to inflammation  from many
causes, as suppressed menstruation, catching
cold, falls, blows upon the  abdomen. Con-
gestion and inflammation  are  indicated by
a sense of fulness, weight, warmth, and pain,
with tenderness on  pressure in the lower
part of the abdomen, especially in standing
or walking;  and  relieved  by  lying down.
The  disease may  be limited to the inner 
120                        THE  FAMILY  PHYSICIAN.
mucous membrane, to the body of the organ,
or the exterior investing loose tissue, or rare-
ly involve  all.   The term  metritis denotes
inflammation  of the body proper of  the
organ, endo-metritis of the  mucous interior,
peri-metritis of the surrounding elastic  tis-
sues which  fill the cavity of the pelvis.  This
tissue, when extensively inflamed,  is often
infiltrated with new plastic matter, the prod-
uct of the  vascular engorgement, and this,
becoming set, " fixes " the uterus for a time,
so that it is rigid and  immovable—a con-
dition termed pelvic cellulitis and peri-uter-
ine cellulitis.  This loose tissue is occasion-
ally the  seat of profuse haemorrhage from
a ruptured vessel, as in lifting, jumping, or
falling.   The effused blood remains fluid or
semi-fluid, and gravitates in the pelvis; this
blood-tumor, termed " pelvic haematocele,"
often presents in the vagina.
  The normal uterus is a symmetrical organ,
with a straight  axis, and the  cavity  of its
body and neck  slightly  open; its normal
position  is that of  slight anteversion,  or
upright,  and from above inclining slightly
backward.  But attacks of congestion and
inflammation change its shape, size, sym-
metry,  and position.  Thus, either  from  ex-
ternal pressure or adhesions, or from soften-
ing or  thickening of its own walls, it may
be drawn down—either backward,  forward,
or to either side; the organ as a whole may
be tilted, giving rise to " version;" or  the
body may be bent on the neck, a condition
termed " flexion."   According to the direc-
tion which the  displacement or deformity
of the uterus takes, we have anteversion, re-
troversion,  right and left lateral version, and
anteflexion, retroflexion, and right and  left
lateral flexion.  Flexions of the uterus  are
a common  cause of " dysmenorrhoea,"  or
difficult menstruation, since by the bending
of the uterus its canal is bent and constrict-
ed,  and the free escape of menstrual  blood
is prevented;  this  flexion of  the uterine
canal  is  also a cause of sterility, since sem-
inal elements  cannot enter the organ and
produce conception.  Whenever the uterus
is enlarged, as by congestion or inflamma-
tion, is the  seat of a polypus or tumor, or is
pressed  down  by growths in the cavity of
the abdomen, and also whenever in debili-
tated persons its ligaments and outside sup-
ports are weakened  and relaxed, it tends to
gravitate below its natural position in  the
pelvis, and  even to project from the body.
This "falling of the womb" is termed "pro-
lapse," and, when extreme, "procidentia."
The lower  end  of the uterus, the  neck or
cervix, is often ulcerated as the result of
congestion, inflammation, contact of its  end
with the floor of the pelvis, and the irrita-
tion of the  acrid mucus discharged in endo-
metritis.   Tumors may develop within the
cavity of the uterus, in the substance of its
walls, or upon its outer surface, either be-
neath its serous covering or loosely attached
by pedicles.  The uterus is occasionally the
seat of cancer, and chiefly at the climacteric
period or " change of life."   The ovaries—
whose functional work, the production and
periodic discharge of the ovules, is the para-
mount physical feature of woman's sex—are
subject to attacks of congestion, inflamma-
tion,  haemorrhage, and  intense neuralgia.
The fibrous framework of these organs may
increase  and develop  fibrous tumors;  but
especially frequent and important are " ova-
rian cysts " or " ovarian dropsy."  The ovisac
becomes  distended with fluid  in  order to
rupture and eject the ovule;  it then, again,
is  filled  by the  serum  of the coagulated
blood from the haemorrhage consequent upon
the rupture.  The ovisac is liable to fill, and
by a process of vascular activity and growth
in its wall becomes a cyst of greater or  less
size:  cysts may be present of small size and
in numbers never attracting attention, or,
reversely, grow either by secretion  or  drop-
sical  transudation to  contain ten,  twenty,
sixty, or more pounds of serous fluid.  Such
ovarian cysts may be single sacs, or divided
by partitions into compartments. The broad
ligaments on either  side of the uterus less
often  are  the seat of dropsical cysts devel-
oped between their folds.  The vagina, the
intervening passage which connects the sur-
face of the body with  the womb within, is
the frequent seat of catarrhal inflammations,
in which  mucus is more or less profusely
secreted, causing a discharge termed " leu-
corrhoea" (Gr. Aevnog, "white" (matter), and
pElv, to " flow ").  It  may also be acutely in-
flamed, " vaginitis;"  the seat of ulcers, and
also of spasm, witb or  without pain, a con-
dition termed " vaginismus."  This passage
is, very exceptionally,  anatomically defec-
tive, being wholly or  partially wanting or
constricted.   Most common  of all uterine
diseases are merely functional derangements
or irregularities of menstruation. By amen-
orrhoea  is understood  absence of menstru-
ation ; dysmenorrhoea  is characterized  by
pain, sickness,  and  deficient  flow  at  the
period; and menorrhagia is a prolonged
and  excessive menstrual flow, or persistent
loss of blood from the  uterus, as when can-
cer or polypus exists.  In the treatment and
cure of uterine diseases correct  diagnosis is
essential at the outset.   True, most of them
are benefited by use of general tonics,  by
rest, corrected habits, and by supporting the
abdominal viscera; but many are  not even
alleviated by these general measures. Physi-
cal exploration,  both manual and by aid of
the speculum, will often reveal an unsuspect- 
THE  FAMILY PHYSICIAN.                         121
ed disease, and point to the special topical
treatment or surgical procedure which is
the essential means  of cure.
  Vaccination [Lat.  vacca, a "cow"], the in-
oculation of the human being with vaccine
or cowpox, to protect against smallpox or
variola.  Jenner discovered vaccination in
1796.   He  had  previously  observed that
milkmaids  who contracted the pustules of
cowpox in their hands while milking cows
affected with vaccinia did  not have small-
pox.  He further demonstrated that vaccine
virus, when "humanized"—i. e. transmitted
from arm to arm through  many persons—
preserves its protective efficacy against small-
pox.  Vaccination has replaced inoculation
(with virus of smallpox), and is now gener-
ally practised in all  civilized countries.  In
many it is obligatory; in England every in-
fant must be vaccinated before three years
old.  Vaccination has had the result (1) to
reduce the prevalence of smallpox to a mini-
mum.   In centuries  past a majority of per-
sons had it, and 30,000 persons have died in
one year of it in Great Britain;  now but a
few hundred.  (2) To diminish the danger
of individual attacks, as the type  of the dis-
ease has been rendered mild by  hereditary
influence of vaccination.   Exceptionally,
the disease attacks the vaccinated, but in a
mild form,  varioloid.  There is  no danger
of transmitting disease by vaccination (1st)
if only cowpox, which has never entered the
human body, be used; (2d) if in using human-
ized virus—i. e. taken from a child's arm or
the scat)—healthy children only are used as
agents  of transfer;  and even in doubtful
eases if only vaccine  lymph, free from blood,
is taken.  Vaccination is usually performed
on  the  arm, at  the  insertion of the deltoid
muscle.  The Spanish vaccinate girls  on the
leg, to avoid the scar on the arm.   Vaccina-
tion should be carefully performed with a
clean lancet or needle.  The vaccination
matures on the eighth day—a circle of white
vesicles with a red congested base or areola.
Jenner  said it looked like pearls on a rose-
leaf.  After the eighth day there may be
much swelling and soreness, and a scab forms,
to drop off on the twenty-fourth day.   Vac-
cination had better be done by a  physician,
and never near the joints, as serious results
follow  from  inflammation.   Vaccination
should be repeated once in seven years until
mid-life.  Physicians, nurses, and other ex-
posed persons should be vaccinated  more
often.   When a person  has been directly
exposed an immediate vaccination antici-
pates smallpox, as that disease  has twelve
to fourteen  days for incubation.
  Varicose Veins, relaxation of the  coats
of the superficial veins, with increased cali-
bre, occurring most  frequently in the lower
extremities.  Gravitation, the weight of the
venous blood-column above, and the difficulty
of the ascent of blood from the feet to the
body, determine the greater frequency of the
disease in the veins of the legs.  Varicose
veins are common in aged men,  the result
of senile degeneration of the various tissues,
including attenuation of the coats  of vessels;
less often it occurs in mid-life to robust men
of the gouty habit, and who by vocation are
constantly standing; walking does not favor
the condition, since the  movements of the
superficial  muscles and  tension  of the in-
tegument help to  lift the  blood upward.
Even in youth violent exercise, as in the
gymnasium, by unduly taxing the tension
of the vascular system,  causes a breaking
down of the valves in the veins and venous
dilatation or varicosity.  In women the chief
and not unfrequent cause is pregnancy.  Wo-
men who have borne several  children will
often have marked varicose veins, the result
of the pressure of the gravid  uterus upon
the veins in the pelvic  cavity, and conse-
quent detention of the venous  blood in the
lower extremities.   Varicose veins occur ex-
ceptionally in other parts of the body—upon
the scalp and side of the neck, and upon the
abdomen in the region of the groin.  Vari-
cocele in the male is a local varicosity of the
spermatic veins.  Haemorrhoids or piles are
due to repeated passive  congestions of the
haemorrhoidal veins at the verge of the anus;
obstruction to  the  portal circulation is the
primary cause, but if of frequent  recurrence
and long standing the veins become varicose.
Varicose veins, as seen in the lower extremi-
ties, are increased in diameter with inequali-
ties of calibre,  and present nodular  enlarge-
ments or  pouches at  intervals;  there are
greater relaxations at the site of former valves
or  at the points  of division of veins.  The
veins are also tortuous, since the longitudinal
fibres of the coat are relaxed  no less  than
the circular;  the tortuosity  accommodates
the increased length of the vessel  and favors
the ascent  of  the blood.  Varicose veins
when appearing do not necessarily  indicate
debility  or degeneration, but  should warn
the patient at once to abandon vocations in-
volving violent exertion, to habitually regu-
late the diet and bowels, and neutralize and
remove any rheumatic or gouty  vice.  The
varicose  limb  may be  benefited by daily
friction, cold effusion, and salt bathing. But
the extension of the disease is best checked,
and the  best prospect of cure ensured,  by
constant external support. This  is secured
by uniform bandaging,  or  by wearing  an
elastic stocking or laced leg-corset.  The
elastic stocking,  made of rubber webbing,
is of the  greatest  value to those who can
afford the  silk and rubber webbing and 
 122                        THE FAMU/

 keep them constantly renewed when stretched
 by wear.  The inferior stocking by stretching
 at points  leaves bands of circular constric-
 tion which aggravate the disease rather than
 give the intended benefit.  The cheapest and
 most efficient appliance is a case or corset of
 strong jean fitted to the shape of the limb
 and lacing up in front.  Varicose veins are
 radically cured by ligation and  by hypoder-
 mic injection of a drop of liquor ferri-per-
 nitratis within the vein. The latter method,
 carefully performed, may afford permanent
 relief,  with the precaution  to tightly  band-
 age  the part  for several hours to prevent
 blood-clots from reaching the heart. Arsen-
 ical  preparations act well on varicose veins.
   Varioloid.  See Smallpox  and Vacci-
 nation.
   Vene/real Diseases.   See Blenorrhcea,
 Chancre,  Gleet, Gonorrhoea,  Stric-
 ture,  Syphilis.
   Ven'om [Lat. venenum], the poisons elabo-
 rated by healthy animals as distinguished
 from virus,  the  virulent liquid product of
 disease in animals or  man.  Some   insect
 stings  are  virulent, though as  a rule they
 are mild and  relieved  by simple measures.
 Bees and  wasps  as a rule leave their sting-
 in the wound they inflict;  this should be
 extracted, the wound protected  from the air
 or bathed  in cooling and stimulating evapo-
 rating  lotions; ammonia is a useful applica-
 tion.   The scorpion is  dangerously venom-
 ous in  the tropical regions of the Indies and
 Africa, but in  the milder climates it inhabits
 does little  harm.  Contrary to the fabulous
 accounts of the tarantula venom, it  rarely
 causes  death,  and  seldom causes alarming
 symptoms.  In all countries  there are ven-
 omous  serpents,  their number diminishing
 with increase of population and high  culti-
 vation  of  soil.  Islands are comparatively
 free.  Ireland is said to be quite free, and
 England has but one, the viper.  The  chief
 venomous serpents of the U. S. are the rat-
 tlesnake, moccasin, and adder.  The phoora
 of India and the cobra are  exceedingly vir-
 ulent.  The venom of serpents is elaborated
 in special glandular apparatus  adjacent  to
 the mouth, stored  in a sac  or canal, and
 reserved for sudden voluntary ejection as a
 part of the reptile's means of self-defence.
 The  effect of the poison upon man may be
 immediate, rapid, and speedily fatal, or slow
 and  incomplete.  The  venom, which  prob-
 ably has definite living germs,  a  contagium
vivum,  is believed to rapidly multiply  itself
in the  blood, and quickly pervades the en-
tire body, vitiating the red corpuscles and
the nutrition of the tissues.   In some  cases
the nerve-centres  are  primarily  attacked,
various nervous  phenomena being speedily
followed by paralysis of the medulla ob-
PHYSICTAN.
 I longata, and death.  More  often a definite
  period, short or long, intervenes before death.
  A prickling, burning pain is felt in the wound,
  increases to intensity, and extends to adja-
  cent parts.  The limb or part swells and in-
  flames  (phlebitis),  and as a  result of ob-
  structed circulation the part becomes  speed-
  ily a'dematous or  dropsical, and assumes a
  variety of  changed colors  from disturbed
  circulation and the decomposed state  of the
  blood—from dark red to livid white, to blue,
  purple, mottled, and leaden hue.  The limb
  may become cold, and, if life is not destroy-
  ed, in  time slough away.  These  changes
  may extend over the entire body.  The mind is
  anxious, depressed, often deranged.  Breath-
  ing is embarrassed, there is profuse sweating,
  vomiting, and jaundice, and death occurs by
  paralysis of the nerve-centres or exhaustion.
    Venomous  wounds  should  at  once  be
I  cleansed, encouraged to bleed freely by suc-
  tion or excision, a ligature speedily placed
  on the  limb, or the part sedulously rubbed
  toward the wound and away from the centre
  of circulation,  to evacuate all  contaminated
  blood.   Bold and thorough  cauterization is
  of value. Strength is to be kept up by the
  heroic use of  alcohol, ammonia, and other
  stimulants.  (See Poison of Serpents.)
|    Ver'mifuges  [Lat.  vermis,  "worm," and
  fugare, to  "cause to flee"],  also termed
  Anthelmintics   [Gr.  avri,  "against," and
I  eAyivg, " worm "], also Helminthagogues [Gr.
  EAuivg,  " worm,"  and  ayuv, to  " lead"  or
  "expel"], remedies  intended  to  remove
!  worms from the stomach and intestines, and
  prevent their  recurrence by the destruction
  of their germs.   Properly they are  fco  be
  distinguished  as vermicides, or those which
  kill the  worms,  and vermifuges, those rem-
  edies which by moving the bowels violently
j  or by their rough or irritating qualities dis-
i  lodge and bring away the  entozoa  alive.
|  The remedy that is destructive to the worm
|  must at  the same  time be innocuous as re-
  gards the patient,  and not injurious to the
  alimentary tract.  Remedies which simply
  stupefy or destroy the worm must be follow-
  ed by  the exhibition of an  efficient purga-
  tive  to  remove  the  destroyed parasite, as
  well as to demonstrate the success of their
  action.   Pink-root (Spigelia marilandica) is
  well known, and for children  much used in
I  the form of fluid  extract of spigelia and
|  senna.   The oil of wormseed (Chenopodium
  anthelminticum) is  employed, as is Spigelia,
I  against round worms.   For the same pur-
|  pose, and preferable, is santonine, the acid
  extract  of Santonica  or  Levant wormseed
i  (Artemisia contra).   It is pleasantly admin-
i  istered in flavored lozenges; may be  given
  at night, followed by cathartics in the morn-
|  ing.   Cowhage  (Mucuna pruriens)  is  less 
THE  FAMILY  PHYSICIAN.                        123
used than formerly. Thread-worms are usu-
ally in the lower bowel, and easily removed
by enemata of salt and water, aloes in milk,
or any irritating  or  astringent material  in
solution.  The removal of tapeworm is often
difficult.  Remedies  should, as  a rule,  be
preceded by  free evacuation of the  stom-
ach and bowels by cathartics, and little food
taken at the time.  The best opportunity is
thus given to dislodge the head, which ad-
heres by tentacles or hooklets; for, though
many yards of the worm be evacuated, ex-
cept the head be obtained there is no cure.
The chief remedies for tapeworm are pump-
kin-seeds broken up  and given in an electu-
ary of sugar  or emulsion of water or milk,
followed by a purge;  turpentine in emulsion
of acacia mucilage and castor oil; decoction
of pomegranate;  the oil of male fern (Filix
mas);  and, preferably,  kousso  (the  flowers
and fruit of Braycra anthelmintica, a tree  of
Abyssinia).   It is efficient,  yet  safe to the
patient, and gives little inconvenience. Each
morning half an ounce of the powdered flow-
ers is taken in water, or 20 to 40 grains  of
the active extract, kousine, may be taken in
a  wafer.  No purge is  necessary;  watery
stools are produced,  and  the  worm is dis-
charged dead.  (See Anthelmintics.)
  Ver/tigo  [Lat.], a  subjective or apparent
impairment of the equilibrium of the body.
It assumes two principal forms: In one it ap-
pears to the subject as if the objects in  his
vicinity were whirling  about  him;  in the
other, he fancies that he is forced to fall  in
some definite direction, forward, backward, or
to either side.  Vertigo is rarely if ever con-
tinuous, bjut occurs in paroxysms provoked
by some appreciable  cause, as changing pos-
ture, eating, using the eyes, etc.  The sub-
jects of vertigo often stagger or fall  in con-
sequence of the sensation of motion. Ver-
tigo is sometimes the expression of disease
of the  brain, or of  interference with the
circulation of blood in that organ, but more
usually it is  a sympathetic disorder, caused
by indigestion, anaemia, sudden impairment
of parallelism between the two eyes, disease
of the internal organs of hearing, etc. Ver-
tigo may be artificially produced by the ad-
ministration of stimulants (alcohol), and  by
the application of galvanism to the head in
a  transverse  direction  or  to  the superior
ganglion of the cervical sympathetic nerve.
A variety of subjective unsteadiness, with-
out definite direction to the apparent move-
ment,  is  better  designated as  dizziness.
Temporary  relief is given by alcoholic
stimulants, ammonia, musk.  The  proper
management  of  vertigo  consists  in the
treatment of the  disease causing  it.
  VPrus  [Lat.], animal fluids produced  in
diseased conditions or by morbid processes,
and  capable  of developing  disease when
transmitted to other  animal bodies.  Thus,
man may be inoculated by the virus of hu-
man origin,  smallpox, syphilis,  etc., vac-
cinia of the cow, glanders of the horse, and
rabies  canina  or hydrophobia.  A minute
amount of the virus gaining access to the
body is sufficient, by self-multiplication, to
infect the entire volume of the blood and
contaminate every part of the body.  Pecu-
liar cells or germs, having  temporary vital-
ity and tendency to reproduce themselves
(contagium. virum), constitute the active ele-
ments of all viruses.  Having gained entrance
to the system, they for a time seem dormant,
but are really multiplying, and this period
is well  designated as one of "incubation."
Thus, smallpox appears twelve or more days
after admission of virus, vaccinia within a
week, hydrophobia on an average forty days.
There are no specifics against the effects of
viruses when once in the system.  Hygienic
and  supporting measures  may  prepare the
body to meet  those  effects and pass safely
through.  (See also  Venom.)
   Vision, Defects' of.  See Sight, Defects
of.
   Voice,  Loss  of.    See Aphonia  and
Throat, Diseases of.
   VonFiting  [Lat. vomo,  -Hum,  to  "throw
up;" see Indigestion].   Vomiting is a
reflex  contraction  of the muscular  coats
of the stomach, ejecting its contents.  It is
an involuntary and  spasmodic act.  Vom-
iting may be  the result  of disease of the
brain,   of the  pneumogastric  nerve,  of
the  walls of  the stomach, of  catarrh  or
inflammation  of its  mucous  lining;   it
may be  the  result of indigestible  food,
bile  or mucus in the  cavity of  the sto-
mach,  or a sympathetic  reflex  result  of
disease in other organs, as the uterus, ova-
ries, or liver.   The vomiting of pregnancy
and  of uterine or ovarian disease, the  pecu-
liar morning nausea and vomiting of Bright's
disease of the kidneys, bilious  vomiting,
vomiting  of gastric  catarrh, and the  vom-
iting at the onset of acute fevers  and erup-
tive  diseases of children, and vomiting from
surgical  causes, as fracture at the  base  of
the skull, concussion and inflammation  of
the brain, are to be distinguished, each from
the  other, in  some  instances  by  peculiar
features  of the act  of vomiting,  but  more
often by observation  of the associated symp-
toms.  (See Stomach, Diseases  of.)  At
the  onset of  vomiting  the face   may  be
deathly  pale; the  surface  becomes  cool
and  bathed with  clammy sweat; the  pulse
small and feeble; and  great prostration re-
sults.  In some instances  faintness occurs,
or even fatal syncope.   An occasional acci-
dent during vomiting is the impaction  of 
124                        THE FA MIL
solid food or  artificial teeth in the larynx,
causing suffocation.   Robust  persons, but
little  depressed  by  vomiting,  become red
in the  face during the effort, and  later are
cool and slightly pale.  The clothes should
be  loose when vomiting,  fresh air in the
room, water at hand  for cold affusion to the
face if needed.  Stimulants may be needed
to counteract collapse.   Ice, carbonic-acid
water,  creosote,  oxalate of cerium, dilute
hydrocyanic  acid, are useful remedies.
  VonFiting  of Blood.  See HyEMATEME-
SIS.
  Warts,  or  VerriFc*  [Lat.  verruca,  a
"wart"],  are developed  by  hypertrophy,
abnormal growth, of  the papillae of the
skin.   They  may  be round and  ovoid  or
conical, thread-like, or broad and flat.   The
so-called "seeds"  or points of a  dry wart
correspond to the number of papillae which
have   become  elongated  and  thickened.
Each papilla of the skin has an independ-
ent supply of blood by a little  loop of capil-
lary blood-vessels at  its  base.  Hence, mere
removal  of the wart  is  followed by  its
renewal from the  well-nourished  base and
remaining cells which have transmitted the
tendency  to  excessive  growth.  Cases are
often cited of warts  communicated by the
blood from other warts, but the best author-
ities deny them.  Warts  occur chiefly  in
children, between the second and fourteenth
year; their cause is uncertain.  Their dura-
tion is indefinite ; they sometimes disappear
suddenly, probably by contraction of the vas-
cular papillary base and casting off of the su-
perabundant dry cells.  When  they are kept
free from handling or irritation, the diet is
corrected, and alteratives are  given, they
may slowly disappear.   The common treat-
ment is to snip them off and touch the base
with nitric acid, glacial acetic acid, or lunar
caustic; saturation with tincture of thujar
or thuya (arbor vitse) daily has the effect  to
speedily remove them in many cases.
  Wa'terbrash.   See Pyrosis and Indi-
gestion.
  Water on the  Brain.   See Hydroceph-
alus.
  Wax'y Degeneration, a diseased condition
of the  tissues of the  living body, in which
parts of organs are changed into  the sub-
stance  known as  lardaceine, or  "animal
amyloid," a peculiar albuminoid substance
which  some have tried to  identify  with the
glycogene of the liver.   Though an albumi-
noid, it has reactions somewhat like  those
of starch.  It takes a deep-brown  red from
iodine, dissolves  in warm water, cannot  be
melted, swells but does not dissolve in sul-
phuric acid, and  does not dissolve  in ether.
It is   apparently  isomeric  with   albumen
(Friedrich and Kekule).  It has often been
PHYSICIAN.
confounded with true starch, with which it
is sometimes  associated.  Organs seriously
affected by waxy degeneration,  when cut,
have a half-transparent look.   It has  been
detected  in the brain, nerves, spleen, liver,
kidneys,  muscles, arteries,  bones,  glands,
adventitious tissues, cancers, and in various
other situations.  Rickets, syphilis, pulmo-
nary consumption, diabetes, chronic kidney
disease, and malarial and mercurial poison-
ing are among the conditions with which it
is associated.  It is seldom or  never detect-
ed during life.  The treatment naturally is
for  the disease with which  it  is associated.
Some cases of obscure and undiagnosticated
ill-health doubtless arise from this degener-
ation.  Not much that is definite can as yet
be said of the  causes  and  treatment.   In
suspected cases the patient is to be put into
the best hygienic conditions, and untoward
symptoms  should receive attention.
  Wen [Ang.-Sax. wenn], a cystic tumor oc-
curring upon the surface of  the  body, espe-
cially frequent on the scalp.  It originates
by the occlusion of a follicle of the skin or
scalp, and the subsequent slow accumulation
of sebaceous matter secreted by the lining
of the steadily-increasing cyst.  The tumor,
therefore, is round and symmetrical,  and,
causing a distension of the  overlying  skin
or scalp,  is smooth and shiny.  It  may be  j
soft, semi-solid, or indurated,  according as
its contained sebaceous matter is fluid, rich
in pultaceous fatty granules, or  has  had  its
fluid elements  absorbed, leaving only inspis-
sated and calcific substance.  The wen is a
harmless, non-malignant tumor.  Whether
single  or present in large numbers, its re-
moval is easy and harmless.  The overlying
tissues are  to be incised, without cutting
into  the  wen, when with the handle  of a
scalpel or  a  small ivory paper-cutter the
round, ball-like cyst may be pried or peeled
out.   If the cyst has been cut into and the
cheesy contents evacuated, the membranous
sac must be seized with forceps and gently
drawn out,  for if left  it will  refill.  Once
properly  removed, it cannot return.   (See
Tumor.)
  Whites. See Leucorrhcea and Uterine
Diseases.
  WhiFlow, better known as Felon, a  pain-
ful  inflammation of the fingers and  toes,
more  often  affecting the last  joint of the
fingers.  The  felon may arise  from a  local
bruise; more  often  it  is the result of dis-
turbed and deteriorated states of the blood.
From  the  latter  causes a number of felons
may develop successively.  A point of  local
tenderness  and hardness is observed; swell-
ing and induration increase, with persistent,
deep-seated pain, at first dull, later  more!
severe, with sense of tension, and ultimately 
THE  FAMILY  PHYSICIAN.                        125
 lancinating and throbbing.   The felon in-
 volves the periosteum, or fibrous sheath of
 the bone, and the unusual  pain attending
 this  condition is due to  the dense and  un-
 yielding  structure  of the part and the de-
 generation of the  inflammatory exudation
 into  pus.  The periosteum  is usually sep-
 arated from the bone by the  burrowing pus,
 giving rise  to  the sense of tension;  the
 bone, so deprived of  its sheath and nutritive
 vessels, is liable to die, dead bone being a
 frequent sequel of felon.  The constitutional
 disturbance  is marked, the  result of great
 suffering, the local injury, and  the absorp-
 tion  of pent-up pus into the blood.  When
 detected  early, a felon may sometimes be
 dissipated by an ice-pack or  by a small blis-
 ter ;  more often it will progress.  Early and
 efficient incision of the point of induration
 may avert further suffering and prevent the
 formation of  much  pus.   Poulticing is a
 slower and painful way of bringing the pus
 to the surface; it should be evacuated with
 the knife as  soon as  detected.  Dead bone
 and  stiff joints need never  follow felon if
 opened early.  In severe cases anodynes may
 be needed to secure sleep and  allay  pain;
 quinine to sustain strength; and sulphites
 to correct the blood in recurring  felon.
   Whoop/ing Cough, a disease generally oc-
 curring but once in the life of an individual,
 and  usually during infancy or childhood, is
 characterized by paroxysms of  convulsive
 coughing, followed by a  long  ringing in-
 spiration, whence the name.   It is the chin-
 cough of  early English physicians, the per-
 tussis of Sydenham,  and the coqueluche of
 French authorities,  and was formerly con-
 founded with the catarrhal affections, which
 it  much  resembles in its symptoms  and
 earlier diagnosis.  It consists of  two ele-
 ments—a  general bronchial  catarrh and a
 peculiar hyperaesthesia or morbid sensitive-
 ness  of the  air - passages,  manifested  by
 paroxysms of protracted  coughing, termi-
 nated by a whoop.   The  simple disease is
 rarely if  ever fatal, but when complicated
 with  pulmonary or cerebral disease it is ex-
 tremely dangerous.   Whooping  cough  de-
 mands  care in diet, warm clothing, avoid-
 ance  of exposure to cold and  damp, sus-
 taining remedies when the  strength  flags,
 and the use of antispasmodic and sedative
 remedies  to allay the  paroxysms of cough-
 ing.   Chloral  and bromides are efficient.
 Quinine  in  small doses  may  be  given
 throughout the  attack.
  WonFen, Diseases  of.  See   Uterine
 Diseases.
  Worms.  See articles on Anthelmintics,
Ascaris, Tapeworm, Vermifuges.
  Wounds.  Wounds  are  classified accord-
ing to the  nature of the injury, as (1) punc-
 tured  wounds, made with  pointed  instru-
 ments ;  (2)  incised wounds,  produced  by
 cutting  instruments  or  sharp  edges;   (3)
 lacerated wounds, in which the borders of
 the wound are irregular, ragged, and torn,
 and the result of great force, dull  instru-
 ments, or tearing;  (4) poisoned wounds, in
 which either an  animal venom or virus or
 some impure, poisonous,  or irritating mat-
 ter has gained entrance to the injured tissues
 and contaminated  the  blood; (5) gunshot
 wounds, which as a rule are penetrating  and
 may be lacerated, but  are peculiar from
 other wounds, owing to the character of the
 missile, the shock they give to the part  and
 to  the nervous system,  and the grave com-
 plications  to which  they are  liable.   (6)
 Contusions and  " contused wounds"  are
 also classed with wounds, but the contusion
 is not properly a wound, since there is no
 actual solution of continuity  of the flesh,
 unless it be an abrasion of the skin; and a
 contused wound is  simply a punctured,  in-
 cised,  or lacerated  wound  whose  borders
 and adjacent tissue are severely contused.
 The tissues at the  seat of a contusion  are
 often seriously injured, many minute blood-
 vessels are ruptured, and the escaped blood,
 settling  in the tissues,  causes an " ecchy-
 mosis,"  a black  or blue-black mottling of
 the part.  As the blood is decomposed and
 slowly absorbed, this color changes to black-
 ish-green,  greenish-yellow,  dark leather-
 color,  and lighter shades till  it disappears.
 In  other contusions there is  subcutaneous
 laceration of tissues, or such shock to their
 vitality that  they speedily disintegrate, and
 the devitalized part sloughs in a mass or be-
 comes the seat of  ulcers.  Punctured wounds
 are relatively the  most serious  class, for they
 are often poisoned by the entrance, if  not
 of  venom  or virus,  of  foreign matter,  as
 rust, dust, splinters,  clothing, etc.,  which
 cause suppuration at the bottom of the deep
 puncture, and lead to grave inflammation,
 erysipelas, and contamination of the blood
 by retained unhealthy pus.  The punctured
 wound is to be well washed, cleansed of  all
 blood-clots and dirt, and  if deep or  in  the
 vicinity  of dense fibrous tissue, as  in  the
 hand or foot, or near joints, must be freely
 cut and  converted into an  incised wound.
 Incised wounds heal in several ways. They
 heal most promptly and simply when per-
 fectly smooth, clean cuts, free from clotted
 blood, and in the  flesh of persons in perfect
 health.   Thus, a clean  cut, whose borders
 do not gape or separate,  may, if instantly
 closed  and sealed from  the air by plaster
or collodion,  heal in  a  few  hours, and  ap-
proximately warrant the  designation "im-
mediate union."  More  often  a day or two
is required; the wound, being cleansed  of 
126                        THE FAMILY PHYSICIAN.
 clots or foreign matter,  is  exposed  for a
 moment to the air, and closed either by ad-
 hesive  plaster or stitches of silk or silver
 wire.  The opposed surfaces are glazed over
 by a film of coagulated nutritive fluid ex-
 uded from the  blood, and this, filling the
 interspace,  agglutinates  the  walls  of the
 wound  and  organizes  a  firm  " scar" or
 cicatrix of fibrous tissue.  This scar, if a
 mere line, may soon  disappear by absorp-
 tion and the part seem again perfect.   Such
 speedy  healing  is termed " union  by  first
 intention " or " primary  union."  When a
 wound has been lacerated, or a considerable
 area of tissue has been removed, the deficit
 has  to be made up by a  slower process of
 new tissue-growth; new cells develop, one
 by one,  in superimposed  strata, until the
 level of the surface  is reached, when the
 skin begins to heal and shoot over the raw
 area.  This is the process of " healing by
 granulation," far slower  than  the  others,
 and,  if the  wound be large, a severe tax
 upon the strength and health of the patient.
 In lacerated wounds the more ragged points
 if left will be destroyed by ulceration or
 sloughing before the  wound can  begin to
 heal, and the delay often converts the wound
 into a suppurating, weak, and indolent ulcer;
 therefore, it is better,  in cases of ulceration,
 to remove  the  irregularities and  convert
 them into  incised wounds, either straight !
 or irregular, which can be brought together
 and  heal.   When  an  incised  wound  has J
 failed  of union  by  " first intention,"  its j
 walls become granular; they may be  ap-
 proximated, and soon  unite, constituting the j
 process  of " union by second  intention."
 In the  granulation the  growth of tissue I
 may become  exuberant and rise above the J
 surrounding  healing  parts on the healthy,
 intact surface.   Such  excess of granulation
is popularly termed "  proud flesh."  It must
be reduced  by use of  astringents or com-
pression, or destroyed by caustics, and the
site stimulated to a healthier action.  Poi-
soned wounds (see article Venom) as a rule,
should  be  laid  freely open  by  incision,
treated by disinfectant lotions, and the gen-
eral  strength of the  patient sustained by
diet, tonics,  and  stimulants.   Contusions
often call for stimulating lotions, as turpen-
tine and oil, to counteract the shock of the
part, and hot cloths  to maintain the  tem-
perature and  restore  the  circulation when
cold.  The healing of a wound is facilitated
by pure air,  regular  hours for sleep, plain
but rich diet, and abstinence from alcohol.
The "antiseptic method" of healing wounds
consists in using Lister's spray of carbolic
acid or thymol at the time of the incision,
or of keeping the parts  constantly disin- j
fected by carbolic wash or antiseptic cotton. !
   Writer's Cramp.  See Scrivener's Pal-
 sy.
   Yel'low  Fe/ver, so called because  of the
 peculiar yellow tinge of the skin charac-
 terizing it, and for the same reason techni-
 cally  designated  typhus  icterode,  icterus be-
, ing the  classical name of "yellow  jaun-
 dice."   It  is not a form of typhus  fever,
 but resembles it  in the prostration,  blood-
 disorganization, and  softening of internal
 organs which are features in both.  Yellow
 fever prevails chiefly  in  tropical  and  warm
 climates.   When occurring in  temperate
 or cold zones  it  has  been  imported in the
 course of commercial travel.  It is indige-
 nous chiefly in the West Indies, upper coasts
 of South America, the borders of the Gulf
 of Mexico, and the Southern  U. S,  It oc-
 curs in isolated, sporadic cases at all seasons
 in seaports, to which it has been transported
 in ships.   Rigid  quarantine  of  all  ships
 coming from  yellow-fever  localities, and
 their fumigation  before  disembarking pas-
 sengers and cargo, have averted the epi-
 demics formerly  so frequent.  It  is gener-
 ally conceded that there is  a  specific mor-
 bific element, a portable fomites or fermen-
 tative substance, which propagates  this dis-
 ease.  This maferies morbi, when  imported
 and let loose, will prove innocuous unless
 the weather be  warm or mild and the air
 moist.  It  rarely  develops when  the  mer-
 cury is below 70° F., and frost or  freezing
 weather effectually terminates its career.
 Insalubrious, damp, low, and  filthy locali-
 ties are more likely to be its points of suc-
 cessful  lodgment, as when  emigrants  from
 yellow-fever ports,  on landing,  go to the
 dense  and uncleanly  tenement districts of
 the  larger cities.   But in the same way it
 may  be carried  into  the  healthiest  resi-
 dences.  It is thus the  poison is  imported
 and carried directly to certain  points which
 become foci of the disease, from which, un-
 less brought  under immediate and  rigid
 sanitary surveillance, it  radiates with more
 or less havoc.   By the  intercourse of busi-
 ness and personal visits it may be carried
 from the infected localities to other points,
 which  in  turn  become  foci  of  contagion.
 But there is no general atmospheric con-
 tamination, no  infection, no contagion ne-
 cessarily, except as the air vitiated by the
 breath, vomit,  and stools of the  patient is
 inspired.  Yellow  fever is not now regarded,
 as formerly, a fever of malarial origin,  allied
 to intermittent  and remittent.  It prevails
 on the coasts and  in large cities, sparing the
 contiguous country, which is often swampy
 and afflicted severely by malaria.   The ne-
 groes of the South, although susceptible  to
 malaria, enjoy  a relative  immunity   from
 yellow  fever.   Yellow fever haa  no  perio- 
THE  FAMILY  PHYSICIAN.                        127
dicity—that is, alternations of febrile periods
and  remissions; from the onset  of the at-
tack to its  termination  it is  a continuous
fever.  Quinine and other antimalarial rem-
edies do not control it, or especially relieve
it beyond their general tonic effect. Yellow
fever has no definite duration of its period
of incubation or formation. In some cases,
for two or three days  or more, there will be
general lassitude, loss of appetite, and sense
of debility.   In graver cases the attack may
be precipitate and speedily fatal; reversely,
there are "walking cases," in  which,  with
jaundice and even mental disturbance, the
muscular power is retained.   There is usu-
ally an  initial  chill, some headache,  and
slight increase of temperature.  Exception-
ally, the thermometer in the  mouth or ax-
illa  will register a high  degree, as  in other
fevers—103°, 104°, 105° F.—but more often
the body-heat is but  little elevated, and in
some cases  is lowered.  The pulse is  but
little accelerated.  The stomach is irritable
at an early date, due to the poisonous influ-
ence of bile in the blood upon the origin of
the pneumogastric nerve, as well as by sym-
pathy with the congested liver.  The mind
may be mildly  or actively delirious.  The
skin  grows  yellow,  and, when   vomiting
causes exhaustion and  wasting,  is  often
shrivelled.  The  blood  has  become  seri-
ously impaired by the morbific poison, and
its decomposed  and watery elements  tend
to transude the coats of the vessels. Hence,
with the effects  of vomiting, vessels in the
congested stomach are unloaded, and  the
already disorganized  blood, being further
perverted by the action of gastric juice,
presents a coffee-ground,  or again  a tar-like,
appearance, known as "black vomit."  This
is regarded  as a critical or even fatal sign ;
and  with  reason, since it is an evidence of
serious destruction of red blood-cells.  Ex-
haustion and collapse are the result of such
conditions  unless stimulating and  sustain-
ing  treatment is  assiduously  adhered to.
The average duration is  a week, and cases
vary in character from a  mild fever, with
gastric disorder, to a malignant and incura-
ble typhus icterode.   There is no specific
treatment.  No depressing remedies should
be employed.  Cold and evaporating lotions
to the head may prevent  brain symptoms;
ice,  effervescing waters  or champagne  in
small quantity, and other remedies for com-
posing the stomach, are valuable.   Carbo-
nate of ammonia may help to oxygenate
the  blood.  But "the Spanish  method"—
quiet, discreet nursing, warm  drinks, and
blanketing, and, later, abundant nutrition
—is found to be the  most successful means
of  cure.   The mortality  varies with the
character  of the epidemic, the class of per-
sons it has  attacked, their  hygienic  sur-
roundings, and the  discretion  with which
cases are treated;  it may be as low as 5  or
as high as 75 per cent.
  Zymo'sis.  See Zymotic Diseases.
  ZymoFic Diseases [Gr. fi^ow, to  "fer-
ment"],  those diseases which, gaining ac-
cess to  the human system, whether by infec-
tion or contagion, through a small  amount
of materies morbi or  causative germ-matter,
thereafter develop or multiply this substance
in the blood, each for a definite period of in-
cubation, at the end of which the disease man-
ifests itself.  Thus, smallpox has a latent  or
incubating or formative period  of twelve  to
fourteen days; typhoid fever has a forma-
tive period of  seven to ten days, measles of
eight to twelve days.  During these periods
of latency, zymosis, or multiplication of the
disease-germ  in the  blood and throughout
the body, is  thought to  progress. 
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