Desserts—Plain milk pudding of tapioca, sago, arrowroot or stewed fresh fruit (all without sugar or cream), raw ripe fruits.
Drinks—Weak tea or coffee (without sugar or cream), hot water, pure, plain or aerated water.
Must Not Take—
Strong soups, rich made dishes of any kind, hot bread or biscuits, preserved fish or meats, curries, red meats, eggs, fats, butter, sugar, herrings, eels, salmon, mackerel, sweets, creams, cheese, dried fruits, nuts, pies, pastry, cakes, malt liquors, sweet wines, champagne.
ACUTE GENERAL PERITONITIS. (Inflammation of the Peritoneum, Lining of the Abdominal Cavity).—Causes. Primary; Occurs without any known preceding disease, and is rare. Secondary; Occurs from injuries, extension from inflamed nearby organs, such as appendicitis or infection from bacteria, without any apparent lesion (disease of the bowel). Perforation causes most of the attacks of peritonitis. Peritonitis may accompany acute infections or accompany chronic nephritis, rheumatism, pleurisy, tuberculosis and septicemia. Peritonitis occurs from perforation of the bowel in typhoid fever also, and it frequently occurs after appendicitis and sometimes after confinement.
Symptoms.—This is often the history of one of the causes mentioned above, followed in cases with perforation or septic disease by a chill or chilly feeling and pain, varying at first, with the place where the inflammation begins. The patient lies on his back, with the knees drawn up, and the body bent so as to relax the muscles of the abdomen, which are often rigidly contracted,—stiff at first on the side where the pain starts. The pain may be absent. The abdomen becomes distended, tympanitic (caused by gas). An early symptom is vomiting and it is often repeated. There is constipation; occasionally diarrhea occurs. The temperature may rise rapidly to 104 or 105 and then become lower; it is sometimes normal. The pulse is frequent, small, wiry and beats 100 to 150 per minute; the breathing is frequent and shallow. The tongue becomes red and dry and cracked. Passing the urine frequently causes pain; sometimes there is retention of urine. The face looks pinched, the eyes are sunken, the expression is anxious, and the skin of the face is lead colored or livid. Hiccoughs, muttering, delirium or stupor may be present.
Recovery, Prognosis, etc.—The action of the heart becomes weak and irregular, respiration is shallow, the temperature taken in the rectum is high, the skin is cold, pale and livid, death occurs sometimes suddenly, usually in three to five days; less often thirty-six to forty-eight hours; or even after ten days. The results depend mainly upon the cause of the inflammation, and the nature of the infection, infectious disease that produces it, being usually very bad after puerperal sepsis (after confinement), induced abortion, perforation of the bowel or stomach, or rupture of an abscess.
LOCAL PERITONITIS.—This may come from local injury, but it is usually secondary to empyema, tuberculosis, or cancer, abscess, perforation of the stomach or bowel, ulcer, etc.
Symptoms.—Onset is usually sudden. There is sudden local pain, increased by any movements; tenderness, and vomiting; then chills, irregular fever, sweating, difficult breathing, emaciation.
TREATMENT OF THE ACUTE PERITONITIS.—There must be absolute rest, morphine by hypodermic method, one-fourth to one-half grain to relieve the pain. Ice cold and hot fomentations with some herb remedy like hops, smartweed, etc.; or cloths wrung out of hot water with five to ten drops of turpentine sprinkled on them. This is very good when there is much bloating from gas.
The turpentine should be stopped when the skin shows red from it. The cloths should not be heavy or they will cause pain by their weight. Ice water can be used when cold cloths are needed.
For vomiting.—Stop all food and drink for the time and give cracked ice.
Diet.—Should be hot or cold milk with lime water or peptonized milk if necessary. If the feeding causes vomiting, you must give food by the rectum. For the severe bloating enemas containing turpentine should be given, one to two to six ounces of water used with ten to thirty drops of turpentine in it; sometimes it is necessary to resort to surgery.
TUBERCULAR PERITONITIS.—This may occur as a primary trouble or secondary to tuberculosis of the bowels, lungs, and Fallopian tube. It is most frequent in males between twenty and forty.
Symptoms.—These are variable. It may occur like acute peritonitis with sudden onset of high fever, pain, tenderness, bloating, vomiting and constipation; these symptoms passing into those of chronic peritonitis. Often there are gradual loss of strength and flesh, low and irregular fever; frequently the temperature goes below normal with a little ascites tympanites, constipation, diarrhea and masses in the abdomen which consist of the omentum (apron covering the bowels) rolled up and matted into a sausage-shaped tumor in the upper part of the abdomen, or of thickened or adherent coils of the bowel, enlarged mesentric lymph nodes, etc. Spontaneous recovery may occur, or the course of the disease may resemble that of a malignant tumor.
Treatment.—If there is effusion and few adhesions, cutting in and removing the fluid may help. In other cases good nourishing diet with cod liver oil is best.
ASCITES. (Hydroperitoneum. Abdominal Dropsy).—This is an accumulation of serous fluid in the peritoneal cavity. It is but a symptom of disease.
Local Causes.—Chronic peritonitis, obstruction of the portal (vein) circulation as in cirrhosis of the liver, cancer or other liver disease, from heart disease, tumors, as of the ovaries or enlarged spleen. All these mentioned may produce this dropsy.
General Cause.—Heart disease, chronic nephritis, chronic malaria, cancer, syphilis, etc.
Symptoms.—Gradual increasing distention of the abdomen, causing sometimes a sense of weight, then difficulty of breathing from pressure. The abdomen is distended, flattened at the sides unless it is very full. The skin may be stretched tense, superficial veins are distended. The navel may be flat or even protrude and around it the vessels may be greatly enlarged. There is fluctuation when you tap sharply at one side, while holding your hand on the other side you feel a wavy feeling.
PHYSICIANS' TREATMENT for Ascites.—First treat the disease causing it. Sometimes it is necessary in order to prolong life to repeatedly tap the patient as in cirrhosis of the liver. When it is caused by the heart or kidneys, give cathartics that carry away much liquid, hydragogue cathartics. One dram of jalap at night followed by a big dose of salts before breakfast. Cream of tartar and salts are good, equal parts. Or cream of tartar alone, one to two drams, with lemon juice in water in repeated doses. Digitalis and squill, of each one grain to cause great flow of urine. Infusion of digitalis is also good to increase flow of urine, when the heart is the real cause of the ascites. These treatments take the liquids away through the proper channels, the bowels and kidneys.
Ascites caused by an Ovarian Tumor.—The tumor must be removed. I am not in favor of indiscriminate operating, but operations often save lives. I remember one case in which I very strongly urged the lady to have an operation performed. It was a case of ascites, caused, as I was sure, by a tumor of the ovary. The lady, as almost all people do,—and I do not blame them for it,—dreaded even the thought of an operation, but she was finally compelled to have an operation or die. She filled so full that it was almost impossible for her to breathe. She went away from home in terrible shape, almost out of breath, and returned home a well woman and has remained so. Such cases formerly died. But not all cases of ascites can be cured by an operation, it depends upon the cause. In many cases all one can do is to doctor the cause, if that cannot be removed, make the patient's remaining days as comfortable as possible.
DISEASES OF THE RECTUM AND ANUS.—The lower part of the alimentary canal is called the rectum, originally meaning straight. It is not straight in the human animal. It is six to eight inches long. The anus is the lower opening of the rectum. In health it is closed by the external Sphincter (closing muscle). Disease may wear this muscle out and then the anus remains open, causing the contents of the bowel to move involuntary.
CONSTIPATION. Causes.—1. Mechanical obstruction.
2. Defective motion of the bowels.
3. Deficient bowel secretions.
4. Other causes. Mechanical obstruction.—Anything that will hinder the free and easy passage of the feces (bowel contents). Too tight external sphincter (rectum) muscle, stricture, tumors, etc. Bending of the womb on the bowel.
Defective Worm-like Bowel Movement.—Irregular habits of living head the list causing this defective action. Everyone should promptly attend to Nature's call. Some people wait until the desire for stool has all gone, and in that way the "habit" of the bowels is gradually lost. Everyone should go to stool at a certain regular time each day, and at any other time when Nature calls. If a person heeds this call of Nature, the call will come regularly at the proper time, say every morning after breakfast. If these sensations (Nature's calls) are ignored day after day, the mucous membrane soon loses its sensitiveness and the muscular coat its tonicity, and as a result, large quantities of fecal matter may accumulate in the sigmoid (part of the bowel) or in the rectum without exciting the least desire to empty the bowels. Again, irregular time for eating and improper diet are liable to diminish this action also. Foods that contain very little liquid and those that do not leave much residue are liable to accumulate in the bowel and at the same time press upon the rectum hard enough to produce a partial paralysis.
Deficiency of the Secretions.—Many of the causes that hinder worm-like motion are also likely to lessen the normal secretions of the bowel. Some kinds of liver diseases tend to lessen the secretions of the bowel, because the amount of bile emptied into the bowel is lessened. Sometimes the glands of the intestine are rendered less active by disease and other causes.
Sundry Causes.—Diabetes, melancholy, insanity, old age, paralysis, lead poisoning and some troubles of local origin, like fissure of the rectum, ulceration, stricture and polypus.
Symptoms.—Headache, inattention to business, loss of memory, melancholy, sallow complexion, indigestion, loss of appetite, nervous symptoms. Spasmodic muscular contraction of the external sphincter. The bowel contents press upon it; spasm of this sphincter muscle is frequently brought on by the presence of a crack in the mucous membrane, caused by injury inflicted during expulsion of hardened feces. Instead of aiding a bowel movement, the muscles now present an obstruction beyond control of the will and aggravate the condition. The most frequent cause of disease of the rectum is constipation and anyone of the following local diseases of the rectum and anus may be a symptom of constipation. (1) Fissure or crack of the anus. (2) Ulceration. (3) Hemorrhoids (piles). (4) Prolapse (falling). (5) Neuralgia. (6) Proctitis and periproctitis.
Fissure of the anus is a common local symptom of constipation. The feces accumulate when the bowels do not move for a few days, the watery portion is absorbed; they become dry, hard, lumpy, and very difficult to expel, frequently making a rent (tear) in the mucous membrane and resulting eventually in an irritable fissure. Ulceration of the rectum and the sigmoid (part of the bowel) is a symptom of persistent constipation, because the pressure exerted upon the nourishing blood vessels by the fecal mass causes local death of the tissues.
Hemorrhoids (Piles) may be produced by constipation in several ways; first by obstruction to the return of the venous (dark) blood. Second, by venous engorgement (filling up) of the hemorrhoidal veins during violent and prolonged straining at stool. Third, as a result of the general looseness of the tissues in those suffering from constipation.
Prolapse (Falling of the Bowel).—This falling of the rectum may be partial or complete, and may be caused by straining or by the downward pressure exerted by the fecal mass during the emptying movement of the bowel. It may also be the result of a partial paralysis of the bowel caused by pressure of the feces upon the nerves.
Proctitis and Peri-Proctitis.—Inflammation of the rectum and surrounding tissue that may or may not terminate in an abscess and fistula, sometimes follows injury to the very sensitive mucous membrane by the hardened feces.
Neuralgia of the Rectum.—This may sometimes result from the pressure of the fecal mass upon the nearby nerves causing pain in the sacrum coccyx (bones).
MOTHERS' REMEDIES.—1. Constipation, a Good Substitute for Pills and Drugs.—"Two ounces each of figs, dates, raisins, and prunes (without pits) one-half ounce senna leaves. Grind through meat chopper, and mix thoroughly by kneading. Break off pieces (about a level teaspoonful) and form into tablets. Wrap each in a wax paper and keep in covered glass jars, in a cool place. Dose.—One at night to keep the bowels regular. Very pleasant to take."
2. Constipation, Substitute for Castor Oil.—"Take good clean figs, and stew them very slowly in olive oil until plump and tender, then add a little honey and a little lemon juice, and allow the syrup to boil thick. Remarks.—Keep this in a covered glass jar and when a dose of castor oil seems necessary, a single fig will answer every purpose. Not unpleasant to take."
3. Constipation, Hot Water for.—"A cup of hot water, as hot as one can drink it, a half an hour before breakfast." The hot water thoroughly rinses the stomach and helps the bowels to carry off all the impurities.
4. Constipation. Excellent Nourishment for Old People.—"A tablespoonful of olive oil three times a day internally for weak or very old people: it can be injected,—used as an enema." Olive oil will be found very beneficial for young people as well as old. It acts as a food for the whole system and is very nourishing.
5. Constipation, Salt and Water for.—"A pinch of salt in a glass of water taken before breakfast every morning. I have found it a very good remedy." This is a remedy easily obtained in any home and will be found very helpful. Few people seem to realize how valuable salt is as a medicine. It acts as a stimulant and loosens the bowels.
6. Constipation, Water Cure for.—"Drink a quantity of water on retiring and during the day." This simple home remedy has been known to cure stubborn cases of constipation if kept up faithfully.
7. Constipation, Tonic and Standard Remedy for.—"Calomel one ounce, wild cherry bark one ounce, Peruvian bark one ounce, Turkish rhubarb ground one ounce, make this into one quart with water, then put in sufficient alcohol to keep it." Dose:—Take a small teaspoonful each morning when the bowels need regulating, or you need a stimulating tonic.
8. Constipation, Glycerin and Witch-Hazel Remedy Where Castor Oil Failed— "Equal parts of glycerin and witch-hazel." Dose :—One teaspoonful every night at bedtime. In severe cases where you have been unable to get a movement of the bowels by the use of other cathartics, take a teaspoonful every two hours until the bowels move freely. This remedy has been known to cure when castor oil and other remedies have failed.
9. Constipation, Well-known Remedy for.—
"Fluid Extract Cascara Sagrada 1 ounceSyrup Rhubarb 1 ounceSimple Syrup 2 ounces
Mix."
One teaspoonful at night or fifteen drops four times a day for an adult.
10. Constipation, Effective Remedy, in the most Stubborn Cases of.—
"Fluid Extract Cascara Sagrada 1 ounceFluid Extract Wahoo 1 ounceNeutralizing Cordial 2 ounces
Mix."
Adults may take a teaspoonful of this mixture before retiring, this will be found very effective in the most stubborn cases of constipation.
11. Constipation, Remedy from a Mother at Lee, Massachusetts.—
"Senna Leaves 1/2 poundEnglish Currants 1/2 poundFigs 1/4 poundBrown Sugar 1 large cup
Chop all together fine. Dose:—One-fourth to one-half teaspoonful every night. Do not cook. The best remedy I know."
12. Constipation, Fruit and Hot Water Cure for.—"Drink a pint of hot water in the morning before eating. Eat fruit, plenty of apples, eat apples in the evening, and they will loosen the bowels. Chew them fine, mix with saliva."
13. Constipation, Herb Tea for.—"One ounce senna leaves steeped in one-half pint of hot water, with a teaspoonful of ginger powdered; strain. This is a most certain and effective purge, and mild in its action upon the bowels. Dose:—A cupful at bedtime. This is far superior to salts."
14. Constipation, Purshiana Bark Tea Without an Equal for.—"An infusion of one ounce of purshiana bark to one pint of boiling water; infuse for one hour and strain. It stands without an equal in the treatment of constipation in all its varied forms. Dose:—One teaspoonful, morning and evening according to symptoms or until the bowels are thoroughly regulated." This is fine for constipation, especially if of long standing. It may be used in connection with cascara. This will give relief when other remedies fail.
PHYSICIANS' TREATMENT for Constipation.—Too much reliance has been placed upon medicine in the treatment of this disease and too little attention given to diet, and the establishment of regular habits in eating, exercising, sleeping and attending to the calls of Nature. Also, local disease of the rectum has been overlooked until of late years. Remedies of a laxative and cathartic nature soon lose their power and the dose must be repeated or a new remedy must be given. This method of treatment is well recommended and is very good.
1—Stretching of the sphincter.
2—Frequent rectal and abdominal massage.
3—Copious injection of warm water (in the beginning only).
4—Application of electricity over the abdomen and in the rectum.
In addition to this treatment which must be carried out by a physician the patient must observe the following rules: Go to stool daily, and as near the same time as is convenient, correct errors of diet. Drink an abundance of water and eat sufficient fruit. Take plenty of outdoor exercise; take a cold bath every morning followed by a thorough rubbing. Dress warmly in winter and cool in summer. Change of temperature or climate if the case demands it. Be temperate in all things affecting the general health. Stretching the sphincter must be done carefully, but in a thorough manner. It can only be done properly by an experienced person. Stretching of the sphincter closes the opening so that the feces are not passed at all times. It is circular in shape. Sometimes this grows larger, stiffer, or it acts spasmodically. The opening is often so tight in some people that it is difficult to introduce even a finger, and it frequently produces a spasm of pain in the bowels, stomach and head to do so. This kind will produce constipation or make it worse. In such cases it should be stretched thoroughly but carefully so that the muscle will be able to close the opening and the bowel contents will not pass at any time unhindered. There are two methods of stretching the muscle—forcible or gradual. The forcible method is generally done by inserting the two thumbs into the anus and stretching the muscle thoroughly in every direction until there is no resistance. (Dilators are made for this purpose, but unless they are very carefully used they will tear the muscle). The forcible method should be done under an anesthetic. Gradual stretching is done when an anesthetic cannot be used. It is better to do too little than to do too much at the first sitting. The muscle is very stubborn sometimes, and it requires careful handling or the irritability will be increased. An instrument in the hands of a careful man is all right. They can be stretched by the fingers or the Wales' bougie, thus: Patients should come to the office two or three times a week, the instrument (bougies) are introduced and allowed to remain within the bowel until the muscle resistance is overcome, and many times their withdrawal will soon be followed by a copious stool. Forcible stretching is seldom required more than once, if a large sized instrument is used from time to time afterward, just as in gradual stretching; when thorough dilatation has been accomplished, the muscle instead of acting as an impassable barrier to the discharge of the feces, now offers only passive resistance, but sufficiently strong, however, to prevent any unpleasant accidents, yet not strong enough to resist the power of the expulsory muscles when the latter are brought into full play during stool. Large quantities of feces do not now accumulate; consequently the pressure upon the mucous membrane and neighboring nerves is eliminated, and the bowel regains its normal sensibility and strength. There are now sold dilators in sets for self use in almost every drug store. These when used continuously do good and successful work.
Abdominal Massage. (Kneading, Rubbing, etc.).—This is an essential feature in the treatment. It was practiced by Hippocrates hundreds of years ago. Place the patient in the recumbent position upon a table which can be so manipulated that the head may be raised or lowered, the body rolled from side to side. Gentle but firm pressure is then made with the palm of the hand and the ball of the thumb over the large intestine beginning in the lower right groin region. Then go up to the ribs on the right side, then over the body to the same place on the left side and down to the left lower side and center, accompanying the pressure by kneading the parts thoroughly with the fingers. Repeat this several times for about ten to twelve minutes. At first this should be practised every day; later twice a week. Special treatment should be given the small intestines and liver when the bile and intestinal secretion are lessened. In children gentle rubbing of the abdomen with circular movements from right to left with a little oil for ten minutes daily will help to increase the action of the bowels and often bring on a normal movement.
Copious Warm Water Injections.—This is good at the beginning of the treatment when the feces become packed. They soften the mass and aid its discharge. The water must go above the rectum into the colon. To do this a colon tube from eighteen to twenty-four inches long, a good syringe (the Davidson bulb) hard rubber piston or a fountain syringe, the nozzle of which can be inserted into the tube, are required. The patient is placed in the lying down position on the left side with knees drawn up, with the hips elevated. Oil the tube and pass it gently and slowly up the bowel for a few inches until it meets with a slight obstruction. A few ounces of water are then forced through the tube and at the same time pressure is made upward with the tube; by these means the obstruction will be lifted out of the way each time the tube meets with resistance; the procedure must be repeated until the tube is well within the colon. Attach the syringe to the tube and allow the water to run until the colon is distended. A quart to a gallon of warm water can be used depending upon the age and amount of feces present. The water should be retained as long as possible.
The injections should be continued daily until all the feces has been removed. They should not be used for weeks as has been recommended. If soap suds are used in the enema, green or soft soap should be used, not the hard soap.
Electricity.—One pole may be placed over the spinal column and the other moved about over the course of the colon, or one over the spine and the other over the rectum.
Again constipation is caused by the womb lying upon the rectum. Change this condition. (See diseases of women).
Rules.—Patients should go to stool daily at the same hour, usually after the morning meal. You can educate the bowel to act daily at the same hour or after breakfast; or on the other hand not more than once in two or three days in those who are careless in their habits. Some patients need to have two or three movements daily in order to feel well. It may take time to educate the bowels to do this, but it can be done in many cases and many persons become constipated because they put off attending to the educated bowel's call, and often produce constipation by carelessness. It is surprising how many educated people put off this duty; Nature neglected, soon ceases to call. If constipated persons will persevere in going to the closet at or near the same time every day and devote their entire time while there to the expulsion of the fecal contents, and not make it a reading room, they will bring about the desired result. Patients are apt to become discouraged at first; they should be informed that the final result of the treatment is not influenced by the failure of the bowel to act regularly during the first few days. Do not strain to expel the stool.
Corrections of Errors in Diet.—This is one of the necessary features in the treatment. All kinds of foods known to disagree should be discarded. The foods should be easily digested. In children the diet should be rich in fats, albuminoids and sugar, but poor in starches. A reasonable amount of fruits such as apples, oranges, and figs should be allowed. Meals should be at regular hours. Foods that can be used:
May Take—
Soups.—Meat broths, oyster soup.
Fish.—Boiled fish of all kinds, raw oysters.
Meats.—Almost any fresh tender meat, poultry, game, not fried.
Farinaceous.—Oatmeal, wheaten grits, mush, hominy, whole wheat bread, corn bread, graham bread, rye bread.
Vegetables.—Boiled onions, brussels sprouts, spinach, cauliflower, potatoes, asparagus, green corn, green peas, string beans, salads with oil.
Desserts.—Stewed prunes, figs, baked apples with cream, ripe peaches, pears, oranges, apples, melons, grapes, cherries, raisins, honey, plain puddings, fig puddings, apple charlotte.
Drinks.—Plenty of pure water, cold or hot, new cider, buttermilk, orange juice, unfermented grape juice.
Must Not Take—
Salt, smoked, potted or preserved fish or meats, pork, liver, eggs, new bread, puddings of rice or sago, pastry, milk, sweets, tea, nuts, cheese, pineapple, spirituous liquors.
Foods classed as laxatives are honey, cider, molasses, and acid fruits, such as apples, pears, peaches, cherries, and oranges. Berries are effective laxatives on account of the acids and seeds they contain. (Huckleberries are constipating). Prunes, dates and figs are good and effective, also fruit juices.
Drinks.—There are few laxatives better than a glass of cold water or preferably hot water, taken upon an empty stomach before breakfast; water prevents the feces from becoming dry and massed, and stimulates the intestinal movements. A pinch of salt added to the water increases its effectiveness.
Out-door Exercise.—This should be taken regularly and freely.
Bathing.—The best time is before breakfast, and in as cold water as possible. The bath should be followed by a thorough rubbing of the skin with a Turkish towel.
Clothing.—Warm clothing in winter; cool clothing in summer. Cold weather induces constipation, and warm weather diarrhea. Moderate manner of living is everything.
PHYSICIANS' TREATMENT for Constipation. 1. One year to three years.—For infants one teaspoonful or less of black molasses or store syrup, or of olive oil; and Mellin's food eaten dry, is good for babies a year and older.
2. Small Children.—Increase cream in the milk, give oatmeal or barley water. Castile soap suppository, enema, massage, castor oil, or citrate of magnesia if drugs are needed.
3. Older Children.—In older children, fruit, oatmeal, etc. Black molasses is good for children, one to two teaspoonfuls.
4. Fluid Extract of Cascara Sagrada.—Dose: ten to sixty drops at night. This is good for a great many cases and sometimes it cures the trouble, but on the other hand it seems to injure some people.
5. The Aromatic Cascara is also good; doses are larger and pleasant to take. This is more agreeable for children.
6. The Compound Licorice Powder is a mild, simple laxative and effective. It is composed of senna eighteen parts, licorice root powder sixteen parts, fennel eight parts, washed sulphur eight parts, sugar fifty parts. Dose:—One to two teaspoonfuls.
7. For one dose, or one capsule, the proportions would be:
ONE AMOUNT FORCAPSULE ONE DOZENAloin 1/4 grain 3 grainsExtract of Belladonna 1/8 grain 10 grainsExtract Nux Vomica 1/4 grain 3 grainsPowdered Gentian 3 grains 36 grains
Mix and put up in twelve capsules and take one at night.
There are many tablets and pills made that can be bought at any drug store. No doubt some of them are first class, though perhaps not attaining to that high degree of virtue claimed in their advertising columns.
ITCHING OF THE ANUS. (Itching Piles) (Pruritus ani).Causes.—An inherited or an acquired nervous constitution. Disease of the colon, rectum or anus. Improper diet. Skin affections in that region. Operations about the rectum and anus with resulting discharge sometimes. Diseases in the neighboring organs. Disease of the general system. Diarrhea, discharge of mucus and pus, fissure, etc. Irregular habits and dissipation. Over-seasoned foods such as lobster, salmon, shell-fish and foods containing much grease or starch are especially conducive to it; the same is true of tea, coffee, cocoa, strong alcoholic drinks. Skin diseases, lice, pin worms often cause it.
After Operations.—Some part has not healed, and there is left an irritating discharge.
Symptoms.—There is intense itching at the anus, increased by warmth, and contact of the buttocks. The itching grows worse after the patient becomes warm in bed. It may spread and extend to the scrotum, down the limbs and sometimes over the lower back.
PHYSICIANS' TREATMENT FOR ITCHING OF ANUS. Preventive and Palliative.
DIET.—May Take.—Strong drink must be prohibited; tea, coffee, cocoa, if used at all should be sparingly used. A light diet such as bread, milk, eggs, nourishing soups, kumiss and a little fresh fish, broiled steak, etc., may be used.
May Not Take—Hot cakes, pastry, parsnips, cheese, pickles, beans, cucumbers, cabbage, oatmeal, pork, shell-fish, salmon, lobster, salt fish, confectionery and starchy or highly seasoned foods are to be prohibited. Regular meals, no lunches between meals, and the patient must not over-eat at any time. Long course dinners and over-indulgence in highly seasoned foods and wines aggravate it.
Remedies for Bath.—The bowels should move daily and the parts should be kept clean. The parts should be bathed with hot water or weak solutions of carbolic acid, alcohol or listerine, the heat being especially soothing. Bathing the parts with bran, oatmeal, flaxseed, salt, rice, slippery elm teas, or tar water adds much comfort to these parts. Do not wash much with soapy water.
1. Separate the Buttocks with Gauze, a thin layer of cotton or a piece of soft cloth. This eases the soreness, pain and itching by absorbing the secretions and preventing irritations while walking. The patient should not scratch the parts. Direct pressure over the itching parts with a soft cloth, or by drawing a well oiled cloth across the sore parts several times gives relief.
2. Dr. Allingham Recommends the introduction of a bony or ivory nipple-shaped plug into the anus before going to bed. It is self retaining, about two inches in length, and as thick as the end of the index finger. He claims it prevents the night itching by pressing upon the many veins and terminal nerve fibres of the parts. When the rawness is extensive and the parts are highly inflamed, the patient should be kept to bed and kept on his back with the limbs separated until the irritation is allayed.
3. Local Applications.—Soothing remedies: These can be used when the parts are inflamed and raw. Lead and opium wash, or boric acid, or linseed oil, or starch, or cocaine, and zinc stearate with boric acid. This form of zinc adheres to the parts when rubbed on, and is thus more valuable.
4. The following is good to dust in the parts:—
Boric Acid 2 dramsStearate of Zinc 2 dramsTalcum 1 dram
Apply as a dusting powder.
5. The following is good for the raw parts:—
Carbolic Acid 1 scrupleMenthol 10 grainsCamphor 10 grainsSuet enough to make 1 ounce
Mix. Apply freely two or three times daily after cleansing the parts.Melt the suet and when partially cold, add the other ingredients.
6. The following is good for the itching and to heal the raw surfaces:—
Carbolic acid 1 dramZinc oxide 1 dramGlycerin 3 dramsLime water 8 ounces
Mix and apply once or twice daily to relieve the itching.
7. Carbolic acid 1 dramCalamin prep 2 dramsZinc oxide 4 dramsGlycerin 6 dramsLime water 1 ounceRose water enough to make 8 ounces
Mix. Keep in contact with the itching area by means of gauze or cotton while the itching is intense.
8. For injections into the rectum for rawness of the mucous membrane, the following is well recommended. Use three drams of this at one time.
Fluid extract Witch Hazel 2 ouncesFluid extract Ergot 2 dramsFluid extract Golden Seal 2 dramsCompound tincture Benzoin 2 dramsCarbolized Olive or Linseed Oil 1 ounceCarbolic acid 5 per cent
Mix and shake well before using.
9. For the same purpose:— Ichthyol 1 dram Olive oil 1 ounce
Mix and apply in the rectum on a piece of cotton.
PILES. (Hemorrhoids).—Hemorrhoid is derived from two Greek words, meaning blood and flowing with blood. "Pile" is from a Greek word meaning a ball or globe. Hemorrhoids, or piles, are varicose tumors involving the veins, capillaries of the mucous membranes and tissue directly underneath the mucous membrane of the lower rectum, characterized by a tendency to bleed and protrude. They were known in the time of Moses.
Varieties.—There are the external (covered by the skin) and the internal (covered by mucous membrane).
Causes.—Heredity. More frequent in males. Women sometimes suffer from them during pregnancy. Usually occurs between the ages of twenty-five and fifty. Sedentary life, irregular habits, high-grade wines and liquors, hot and highly seasoned and stimulating foods. Heavy lifting. Those who must remain on their feet long or sit on hard unventilated seats for several hours at a time. Railway employees, because they take their meals any time and cannot go to stool when Nature calls, causing constipation. Purgatives and enemata used often and for a long time. Constipation is perhaps the most frequent cause: when a movement of the bowels is put off for a considerable time the feces accumulate and become hard and lumpy and difficult to expel. If this hard mass is retained in the rectum, it presses upon the blood vessels interfering with their circulation and by bruising the vessels may induce an inflammation of the veins when the hardened feces are expelled; straining is intense, the mass closes the vessels above by pressure and forces the blood downward into the veins, producing dilatation when the force is sufficient. One or more of the small veins near the anus may rupture and cause a bloody (vascular) tumor beneath the mucous membrane or skin.
External Piles.—Two kinds, venous piles and skin or simple enlarged tags of skin. Venous piles usually occur in robust persons. They come on suddenly and are caused by the rupture of one or more small veins during the expulsion of hardened feces. There may be one or more, and may be located just at the union of the mucous membrane and the skin. Their size is from a millet-seed to a cherry, livid or dark blue in color, and appear like bullets or small shots under the skin. At first they cause a feeling of swelling at the margin of the anus; but as the clot becomes larger and harder, there is a feeling of the presence of a foreign body in the lower part of the anal canal (or canal of the anus). The sphincter muscle resents this and occasionally contracts, spasmodically at first, producing a drawing feeling; later these contractions become longer and more frequent, and there is intense suffering caused by the pile being squeezed, and this suffering may be so great that sleep is impossible without an opiate. Because of the straining, irritation of the rectum and pain in the sphincter, the piles soon become highly inflamed and very sensitive. The clot may be absorbed without any treatment. Occasionally it becomes ulcerated from the irritation, infection takes place and an abscess forms around the margin of the anus terminating in a fistula.
Skin Piles. (Cutaneous).—These are enlarged tags of the skin. They frequently follow the absorption of the clot in the venous piles where the skin is bruised and stretched. There may be one or many and usually have the skin color. These cause less suffering than the venous variety, and sometimes they exist for years, without any trouble, providing care is taken; but when bruised from any cause, such as a kick or fall, sitting on a hard seat, stretching of the parts during stool, or when they become irritated by discharges from the rectum or vagina, they become inflamed and cause much annoyance and pain. When they are acutely inflamed they swell greatly, are highly colored, swollen, painful, and extremely sensitive to the touch and cause frequent spasmodic contractions of the sphincter muscle and may finally result in an abscess. The pain is usually confined to the region of the anus, but may go up the back, down the limbs or to the privates.
MOTHERS' REMEDIES FOR PILES. Sulphur and Glycerin for.—"Equal parts of sulphur and pure glycerin. Grease parts." This preparation is very healing, and will often give relief even in severe cases.
2. Piles, Strongly Recommended Remedy for.—
Extract Belladonna 15 grainsAcetate lead 1/2 dramChloretone 1 dramGallic acid 15 grainsSulphur 20 grainsVaseline 1 ounce
Mix.
In protruding, itching and blind piles, this ointment will give you almost instant relief. If kept up several days it will promote a cure."
3. Piles, Good Salve for.—"Red precipitate two and one-half drams, oxide of zinc one dram, best cosmoline three ounces, white wax one ounce, camphor gum one dram." It is much better to have this salve made by a druggist, as it is difficult to mix at home. This it a splendid salve and very good for inflammation.
4. Piles, Smartweed Salve for.—"Boil together two ounces of fresh lard and half an ounce smartweed root. Apply this to the piles three or four times a day." This is very healing, and has been known to cure in many cases when taken in the early stages.
5. Piles, the Cold Water Cure for.—"Take about a half pint of cold water and use as an injection every morning before trying to have a movement of the bowels." This simple treatment has cured many cases where the stronger medicines did not help.
6. Piles, Simple Application and Relief from.—"Mix together one tablespoonful plain vaselin and one dram flower of sulphur. Apply three times daily and you will get relief."
7. Piles, Steaming with Chamomile Tea for.—"A tea made of chamomile blossoms and used as a sitz bath is excellent; after using the sitz bath use vaselin or cold cream and press rectum back gently."
PHYSICIANS' TREATMENT for Piles.—What to do first.—The palliative treatment of both varieties of external piles is the same. In all cases the patient should lie flat on his back in bed and remain there for a few days. Highly seasoned foods and stimulants, tea, coffee, whisky, wine, etc., must be discarded. Secure a daily half liquid stool by the use of small doses of salts, Hunyadi or Abilena water. Cleansing the parts with weak castile soap water is essential to allay the pain, reduce the inflammation and soothe the sphincter muscle; cold, or if it is more agreeable, hot applications may be kept constantly on the parts. Hot fomentations of hops, smartweed, wormwood, or poultice of flaxseed, or slippery elm, or bread and milk give almost instant relief in many cases; while in others soothing lotions, and ointments or suppositories are needed.
The lead and laudanum wash is always reliable.
Lead and Laudanum Wash.—
Solution of Subacetate of Lead 4 dramsLaudanum 20 dramsDistilled water enough to make 4 ounces
Mix thoroughly and apply constantly ice cold on cotton to the sore parts.
The following ointments, lotions, and suppositories to be used freely within the bowels and to the piles, are effective in relieving the pain, reducing inflammation and diminishing pain and spasm in the sphincter.
1. Ointment of Stramomium 1-1/2 dramsOintment of Belladonna 2-1/2 dramsOintment of Tannic Acid 1/2 ounce
Mix thoroughly and apply inside and outside the anus.
2. Camphor Gum 1 dram Calomel 12 grains Vaselin 1 ounce
This must be thoroughly mixed. Apply freely within the anus and to the piles. Good for the pain.
3. For External Piles cleanse them well with a sponge dipped in cold water, and then bathe them with distilled extract of witch hazel.
4. If there is much itching with the piles use the following salve:—
Menthol 20 grainsCalomel 30 grainsVaselin 1 ounce
Mix and apply to the piles.
5. I use quite frequently the following for sore external piles:
Chloroform and Sweet oil in equal parts
Apply freely with cotton or on to the piles. Ten cents will buy enough to use.
Operation for Piles.—When these measures do not relieve the pains or the piles become inflamed from slight causes and often, it is best to operate. This can be done in a few minutes with a local anesthetic and the patient frequently goes to sleep afterward, almost free from pain. Inject a three per cent solution of eucaine, or six per cent solution of cocaine. Thoroughly cleanse the part and hold the buttocks apart, pierce the pile at its base with a thin sharp-pointed curved knife, laying it open from side to side. Remove the clot with a curette, cauterize the vessel and pack the cavity with gauze to prevent bleeding and to secure drainage.
Cutaneous (skin) piles are operated upon as follows.—Each one is grasped in turn with a pair of strong forceps and snipped off with the scissors, or removed with a knife. Close the wound with sutures, if necessary, and dress it with gauze. Small ones need no sutures. Be careful not to remove too much tissue. Much after-pain can be prevented by placing in the rectum a suppository containing one-half grain of opium or cocaine before either of the above operations are performed. The after treatment is quite simple. Keep the patient quiet, cleanse the parts frequently, and secure a soft daily stool. Cleanse with tepid boiled water with clean sterilized gauze and give salts in small doses, one to two drams to produce a stool.
INTERNAL PILES. Symptoms.—The two prominent symptoms are bleeding and pain. The bleeding is usually dark. It may be slight and appear as streaks upon the feces or toilet paper; it may be moderate and ooze from the anus for some time after a stool, or it may be so profuse as to cause the patient to faint from loss of blood while the "bowels are moving." Death may follow in such a case unless the bleeding is stopped. The blood may look fresh and fluid or if retained for some time, it looks like coffee grounds, sometimes mixed with mucus and pus. Patients who bleed profusely become pale and bloodless, and are very nervous and gloomy and they believe they are suffering from cancer or some other incurable trouble. The first the patient notices he has internal piles is when a small lump appears at the end of the bowel during a stool and returns spontaneously; afterwards the lump again protrudes after the stool and others may appear. They become larger and larger, come down oftener and no longer return spontaneously, but must be replaced after each stool. As a result of this handling, they grow sensitive, swollen, inflamed and ulcerated, and the sphincter muscle becomes irritable. Later on one or more of the piles are caught in the grasp of the sphincter muscle and rapidly increases in size. It is then hard to relieve them, and when returned they act as foreign bodies, excite irritation and they are almost constantly expelled and the same procedure goes on at each stool. The sphincter muscle contracts so tightly around them as to cause strangulation and unless properly treated they become gangrenous and slough off.
Recovery, Pain, etc.—The pain is not great in the early stages, but when the muscle grasps and contracts the pile or piles it becomes terrible and constant. Piles rarely end fatally. Palliative treatment does not afford a permanent cure. They frequently return, but by care and diet many can be kept from returning so frequently. They should be treated upon their first appearance when the chances of a permanent cure without an operation are much better.
PHYSICIANS' TREATMENT for Internal Piles.—What to do first. The cause should be removed. Restore a displaced womb. Regulate the bowels, liver, diet, and habits. Much can be accomplished by these measures if properly used, in allaying inflammation diminishing pain and reducing the size of the piles. These measures will not cure them if they are large, overgrown and protruding. When the piles are inflamed, strangulated or ulcerated, the patient should remain in bed in a recumbent position and hot fomentations of hops, etc., and hot poultices, of flaxseed, slippery elm, bread and milk, the ice bag, or soothing applications and astringent remedies, should be applied to the parts. In some cases cold applications are the best. The cold or astringent applications give the best results where the piles are simply inflamed and the sphincter muscle does not act spasmodically, jerkily. But when the piles are strangulated, "choked tight" by the sphincter muscle, hot fomentations, poultices and soothing remedies give the most relief, because they reduce spasmodic contractions of the muscle and allay the pain. Instead of the poultices and fomentations, the "sitz" bath can be used. Put in the steaming water, hops, catnip, tansy, pennyroyal, etc., and the steam arising will frequently give great relief. This can be given frequently; ten to twenty drops of laudanum can be added to the poultices when the piles are very painful.
1. For inflamed piles, the following combinations may be used:—
Gum Camphor 1 dramCalomel 12 grainsVaselin 1 ounce
Mix thoroughly and apply freely around the anus and in the rectum on the piles.
The external parts should always be bathed with hot water, thoroughly, before using.
2. Gum Camphor 2 dramsChloretone 1 dramMenthol 20 grainsOintment of Zinc Oxide 1 ounce
Mix and apply directly to the piles.
3. When there is a slight bleeding, water of witch-hazel extract, one to two ounces to be injected into the rectum. This witch-hazel water freely used is good for external piles also. This is good and well recommended.
4. If the protruded pile is inflamed and hard to push back, the following is good and recommended highly:—
Chloretone 1 dramIodoform 1 dramGum Camphor 1 dramPetrolatum 1 ounce
Mix and use as a salve.
5. An ointment composed of equal parts of fine-cut tobacco and raisins, seedless, chopped fine and mixed with enough lard, makes a good ointment to apply on both external and internal piles.
6. Tea of white oak bark, boiled down so as to be strong, and mixed with lard and applied frequently, is good as an astringent, but not for the very painful kind. It will take down the swelling.
7. Take a rectal injection of cold water before the regular daily stool. This will soften the feces and decrease the congestion.
Preventive Treatment.—This is very important and includes habits and diet and other diseases. If the patient is thin and pale give tonics. Correct any disease of any neighboring organ. Attend to any disease that may be present.
For Constipation.—Take a small dose of salts or hunyadi water so as to have one semi-solid stool daily. If necessary remove any feces that may even then be retained, by injections of soap suds or warm water containing oil. Discontinue injections as soon as a daily full stool can be had without it.
Habits.—Full-blooded people should not use upholstered chairs as the heat of the body relaxes the tissues of the rectum. A cane seated chair is best or an air cushion with a hollow center. It is best to rest in bed, if possible, after stool for the rest relieves the congestion and soreness. An abundance of out-door exercise, when the piles are not present, or bad, consisting of walking or simple gymnastics may usually be indulged in; violent gymnastics and horseback riding must be avoided. A daily stool must be secured.
Diet.—Such patients should avoid alcoholic beverages, spiced foods, strong coffee, and tea, cheese, cabbage, and old beans.
Foods Allowed.—Potatoes, carrots, spinach, asparagus, and even salads, since they stimulate intestinal action and thus aid in keeping the stool soft. Stewed fruits, including grapes, oranges, pears, and apples. Water is the best to drink. Meats: tender broiled, boiled or baked beef—do not eat the inside part to any great amount. Other meats, but no pork or ham, fresh fish, chicken. The foods should not be too highly seasoned; vinegar is not to be used to any extent and this excludes pickles, etc.
PERIPROCTITIS. Abscess Around the Anus and Rectum. (Ano-rectal) (Ischio- rectal Abscess).—This is an inflammation of the tissues around the rectum which usually terminates in the above named abscess. It occurs mostly in middle-aged people. Men are affected more often than women.
Causes.—Sitting in cold, damp hard seats; horseback riding, foreign bodies in the rectum such as pins, fish-hooks, etc., blows on the part, kicks, tubercular constitution, etc.
Symptoms.—Inflammation of the skin, like that of a big boil, some fever, throbbing pain, swelling of the part, heat and fullness in the rectum, these symptoms increase until the pus finds an outlet into the rectum.
PHYSICIANS' TREATMENT for Periproctitis.—Little can be done in a palliative way. It generally terminates in an abscess. Make the patient as comfortable as possible, by applying cold or hot things to the part, rest in bed, mild laxatives to keep the bowels open. Cut it open as soon as possible, and it should be laid wide open, so that every part is broken up. Then it should be thoroughly washed and scraped out. Sometimes it is necessary to use pure carbolic acid to burn out the interior. The dressing should be as usual for such wounds and removed when soiled and the wound washed out with boiled water and then gauze loosely placed in the bottom and in every corner of the wound. The dressing should be continued until all has been healed from inside out. Be sure to leave no cotton in to heal over it. Such patients should be built up with nourishing foods, and should remain quietly in bed. Cod liver oil is good for some patients. Iron, etc., for others. Keep the bowels regular. Outdoor life and exercise. If treated right it should not return.
FISTULA IN ANUS.—This usually follows the abscess. It has two openings, one upon the surface of the body near the anus, and the other in the rectum. There are a great many varieties of fistula, but it is unnecessary to name them. What can be done for them?
PHYSICIANS' TREATMENT.—If the general health is good an operation is the best thing to do, but patients in the last stage of consumption, nephritis, diabetes, or organic heart disease, are not apt to receive much benefit from an operation. The patient in poor condition should be given the treatment suitable to his condition, according to the advice of a trusted physician.
KIDNEYS.—The kidneys are deeply placed and cannot be felt or distinctly identified when normal. They are most accessible to pressure just below the last rib, behind. The right kidney usually lies lower than does the left, but even then, the lower part of this kidney is an inch above the upper part of the hip bone, or an inch above a line drawn around the body parallel with the navel. The kidney is about four inches long. The long axis of the kidneys corresponds to that of the twelfth rib; on an average the left kidney lies one-half inch higher than the right.
[Illustration: Kidneys, Ureters and Bladder.]
As stated before, each kidney is four inches long, two to two and one-half in breadth, and more than one inch thick. The left is somewhat longer, though narrower, than the right. The kidney is covered with what is called a capsule. This can be easily stripped off. The structure of the kidney is quite intricate. At the inner border of each kidney there is an opening called the pelvis of the kidney, and leading from this, small tubes penetrate the structure of the kidney in all directions. These tubes are lined with special cells. Through these tubes go the excretions (urine) from the body of the kidneys, to the pelvis, and from the pelvis through the ureters, sixteen inches long, to the bladder.
KIDNEY TROUBLE. MOTHERS' REMEDIES.—1. Kidney Trouble and Inflammation of the Bladder, Cornsilk for.—"Get cornsilk and make a good strong tea of it by steeping slowly, and take one ounce three or four times a day. This acts well on the kidneys, and is a harmless remedy to use."
2. Kidney Trouble, Flaxseed and Lemons for.—"Make a tea by placing the flaxseed in a muslin or linen bag, and suspend it in a dish of water, in the proportion of about four teaspoonfuls for each quart of water. After allowing the seeds to soak for several hours remove the same and tea will be ready for use. The addition of a little lemon juice will improve the flavor. Give in quantities as may be found necessary."
3. Kidney Trouble, Temporary Relief for.—"Rub witchhazel on stomach and back; use freely." This is an old-time remedy, and can be relied upon to at least give temporary relief. The witch hazel has a very soothing effect upon the parts affected.
4. Kidney and Bladder Trouble, Buchu Leaves for.—"Get five cents' worth of buchu leaves at any drug store, and make a good strong tea of it by steeping. This acts nicely on the kidneys. This remedy is easily prepared, and is not expensive."
5. Kidney Trouble, Common Rush Root for.—"Take a handful of the root of common rush in one and one-half pints of water, boil down to one pint. Dose:—One tablespoonful every two or three hours. For a child ten years, give one teaspoonful four times a day. For a child of four to six years, one-half teaspoonful four times a day."
6. Kidney Trouble, Effective and Easy Cure for.—
"Fluid Extract of Cascara Sagrada 1 ounceFluid Extract of Buchu 2 ouncesFluid Extract of Uva Ursi 2 ouncesTincture Gentian Comp 1 ounceSimple Syrup 1 pint
Mix the above ingredients and give a teaspoonful four times a day. This is a very good remedy, as the cascara sagrada acts on the bowels and the buchu and uva ursi acts on the kidneys, carrying off all the impurities that would otherwise be retained in the system and cause trouble."
7. Kidney Trouble, Sheep-Sorrel Excellent for.—"Make a decoction of sheep sorrel, one ounce to pint of water; boil, strain and cool. Give wineglassful, three or four times a day. If necessary apply the spinal ice bag to kidneys." The sheep sorrel is a good kidney remedy, and the ice bag by continuous application will relieve the congestion.
MOVABLE KIDNEY. (Floating Kidney. Nephroptosis).—Causes.—This condition is usually acquired. It is more common in women than in men, possibly due to lacing and the relaxations of the muscles of the abdomen from pregnancy. It may come from wounds, lifting too heavy articles, emaciation.
Symptoms.—They are often absent. There may be pain or dragging sensation in the loins, or intercostal neuralgia; hysteria, nervousness, nervous dyspepsia and constipation are common. The kidney can be felt. A dull pain is caused by firm pressure. Sometimes there are attacks of severe abdominal pain, with chill, fever, nausea, vomiting and collapse. The kidney becomes large and tender. The urine shows a reddish deposit and sometimes there is blood and pus in the urine.
Treatment.—If the symptoms are not present, it is best for the patient not to know the true condition, as nervous troubles frequently follow a knowledge of its presence. If the symptoms are present, replace the kidney while the patient is lying down and retain it by a suitable belt. Also treat the nervous condition. If the symptoms are of the severe kind an operation may be needed to fasten the kidney in its proper condition. This is quite generally successful, and does away with much suffering and pain. The pain may be so severe at times as to require morphine. Sometimes the pain is due to uric acid or oxalates in the urine. For this regulate the diet.
Diet for Movable Kidney.—The diet should be such as to produce fat. Milk is excellent where it is well borne; if not well borne give easily digested meats, such as chicken, roast beef, broiled steak and lamb chop; fish of various kinds and vegetables, such as spinach, carrots, asparagus and cauliflower; of fats, butter, cream, and chocolate; for constipation, cider, buttermilk, grape-juice, fruits and honey.
ACUTE CONGESTION OR HYPEREMIA OF THE KIDNEYS.—This occurs at the beginning of acute nephritis; in acute infectious diseases, after taking turpentine, chlorate of potash, cantharides, carbolic acid, alcohol, etc.; after one kidney has been removed.
Kidney.—The kidney is enlarged, dark red, while the covering is very tight (tense). The urine is scanty, and there is increased specific gravity (normal is 1015 to 1020) and contains albumin and a few casts.
Treatment.—The cause should always be removed if possible. Rest in bed, and as a diet use only milk; if the congestion is bad, use dry cupping over the kidneys and inject large quantities of hot normal salt solution in the bowels. Hot fomentations of wormwood or smartweed are of benefit. If you can get the patient into a sweat the congestion will be somewhat relieved by it.
CHRONIC CONGESTION OF THE KIDNEYS. Causes.—Diseases of other organs and obstruction to the return of the circulation in the veins. Cirrhosis of the liver causes it. The kidney is enlarged dark red, the urine is diminished, with albumin and casts and sometimes blood.
Treatment.—Remove the cause if possible. Fluid diet, like milk, broths, etc. Dry cupping or sweating materials can be used. Rest in bed if possible. The bowels should be kept open, and the kidneys should rest.
BLOOD IN THE URINE. (Haematuria). Causes.—The congestion of the kidneys, pernicious malaria, etc., nephritis, tuberculosis, kidney stones. The urine looks smoky and dark, or bright red.
Treatment.—This depends upon the cause. The patient must rest in bed and the kidneys should not be stimulated. Cold applications to the loins. Hot applications would injure.
URAEMIC TOXAEMIA.—This means poison in the blood occurring in acute and chronic nephritis (inflammation of the kidneys). The cause is unknown. The disease is acute and chronic.
ACUTE URAEMIA. Symptoms.—The onset may be sudden or gradual. The headache is severe, usually on the back top of head (occipital) and extending to the neck; there is persistent vomiting with nausea and diarrhea attending it. This may be due to inflammation of the colon. Difficulty in breathing, which may be constant or comes in spells. This is worse at night, when it may resemble asthma; fever if persistent, is usually slight until just before death. General convulsions may occur. There may be some twitching of the muscles of the face and of other muscles. The convulsions may occur frequently. The patient becomes abnormally sleepy, before the attack, and remains so. One-sided paralysis may occur. Sudden temporary blindness occurs sometimes. There may be noisy delirium or suicidal mania. Coma (deep sleep) may develop either with or without convulsions or delirium, and is usually soon followed by them; sometimes by chronic uraemia or recovery.
CHRONIC URAEMIA.—This develops most often in cases of Arterio-sclerosis or chronic interstitial nephritis, (one kind of Bright's disease). The symptoms are less severe than those of acute uraemia, but similar, and of gradual onset, sometimes with symptoms of the acute attack. There is often constant headache and difficult breathing; the tongue is brown and dry, sometimes there is nausea, vomiting, diarrhea, sleeplessness, cramps of the legs and much itching may be present. It may last for years. Death may occur when the patient is in coma (deep sleep). There may have been mania, muscular twitchings or convulsions before death.
Treatment.—Found under "Chronic Interstitial Nephritis."
ACUTE BRIGHT'S DISEASE. (Acute Inflammation of the Kidneys. Acute Nephritis).—This occurs chiefly in young people and among grown men. Exciting causes are exposure to cold, wet, burns, extensive skin tears (lesions), scarlet fever, diphtheria, typhoid fever, measles and acute tuberculosis, poisons; and pregnancy is one cause when it occurs in women.
Symptoms.—After exposure or scarlet fever the onset may be sudden, sometimes with chills or chilliness, variable fever, pain in the loins, watery swelling of the face and extremities, then of other portions of the body like the abdomen, then general dropsy. Sometimes there is nausea, vomiting, headache, delirium, or very deep sleep. The urine is scanty, dark colored, of increased "specific gravity" and contains albumin, cells and casts. Anemia is marked. After some fever disease, the onset is gradual with anemia, swelling of the eyelids, face and extremities; scanty thickish urine containing casts, then headache, nausea, vomiting, little or no fever, dry skin. In these cases there may be gradual recovery, attack of uraemia, or they may end in chronic nephritis.
Diagnosis.—Examine the urine often in pregnancy, scarlet fever, etc., and especially when watery swelling is noticed.
Recovery.—The result in your children when it comes with scarlet fever is not so good. It may run into chronic nephritis. In adults when it is due to exposure the rule is recovery.
Treatment.—The patient must be kept in bed until there is complete recovery. He should be clothed in flannel.
Diet and Nursing.—This must be of milk, water or mineral water in large quantities; milk or buttermilk should be the main article of food. You can give gruels made of arrowroot or oatmeal, barley water, beef tea and chicken broth. But it is better to stick strictly to milk. As the patient gets better, bread and butter, lettuce, watercress, grapes, oranges, and other fruits may be given. The return to a meat diet should be gradual. The patient should drink freely of mineral waters, ordinary water or lemonade, these keep the kidneys flushed and wash out the "debris" from the tubes. One dram of cream of tartar in a pint of boiling water, add the juice of half a lemon and a little sugar; this when taken cold is a pleasant satisfactory diluting drink. Cream of tartar one dram, juice of lemon, sugar sufficient, water one pint, may be given whenever desired. There should be hot water baths daily or oftener; or you can produce sweating by placing hot water jars around the patient, and watch to see whether it is too weakening. It can also be done by introducing steam underneath the bedding, that is then lifted a little, so that the steam vapor can circulate about the patient. Be careful not to burn the patient with the hot steam. This, of course, is done through a hose attached to a steaming kettle. Also see treatment of dropsy under "scarlet fever."
Bowels, Attention to.—They should be moved every morning by a saline (salt) cathartic, if necessary, especially if the dropsy continues. This produces watery stool. Cream of tartar and epsom salts, equal parts, is good remedy; one-half teaspoonful every three hours for a child one year old until the bowels move freely; one-half to one ounce can be given to an adult.
CHRONIC BRIGHT'S DISEASE. (Chronic Parenchymatous Nephritis. Chronic Diffuse Desquamative or Tubal Nephritis. Chronic Diffuse Nephritis with Exudation). Causes.—Young adult life and most common in males. It may come from acute inflammation of the kidneys that was due to exposure, pregnancy, or scarlet fever, or follow excessive use of alcohol, etc. In children it usually follows acute inflammation of the kidneys or scarlet fever.