2. Stage of Ataxia (Disturbance of motion).—The disturbance of motion (ataxia) is very marked, especially in the lower extremities; the walking becomes difficult and uncertain; there is difficulty in rising or rapid turning; the legs are wide apart; feet lifted too high and come down too forcibly; the length of the steps is irregular, and the body is imperfectly balanced. If the patient stands with his feet together and eyes closed he begins to sway, (Romberg's symptom), which is due to a defect in controlling the muscles from impairment of sensation. There may be imperfect use of the hands in dressing, writing, etc.; lancinating pains are marked in all cases and come on in paroxysms. The pains are mostly in the legs, but also occur in the arms, head, loins, back, and trunk. Then the sense of touch is partially lost. The prick of a pin may not be felt until a few seconds after being applied. This stage may last for years and remain at a "standstill;" but it is usually progressive, and advances to the third stage.
3. The stage of paralysis is marked by a gradual change to the worse, and the patient must remain in bed, because he cannot get out. The lower and sometimes the upper extremities have lost a great deal of their power of sensation: The joints, mostly the knee and hip joints show on both sides of the body a painless swelling, owing to the great quantities of watery liquid there. Dislocations and fractures occur simultaneously. Bed-sores and peculiar ulcers on the sole of the foot also occur. The urine dribbles away constantly, for all control of the bladder is lost. Death occurs from exhaustion; bedsores, inflammation of the bladder, or pneumonia coming on as a complication.
Treatment;—The only thing to do when the patient has this disease is to make him comfortable and arrest the progress of it, if possible. It is incurable, but treatment sometimes arrests the progress and at least lessens the suffering and prolongs life as long as it is worth living to them. I have given a longer description than was necessary, for I wanted men who live such fast lives to understand what it brings them for most cases are caused by syphilis. The description could have been made longer and other symptoms and complications put in. I think enough has been given and perhaps this description may deter some one from going the same road.
The Diagnosis is made at first by the fatigue, peculiar pains, loss of the knee jerk, the peculiar pupil and history of syphilis. Later it is made from the ataxia; the peculiar walk, etc., and the bladder disturbances.
HEREDITARY ATAXIA. Friedrich's Disease.—This peculiar disease is due to a degenerative disease of the posterior and lateral columns (parts) of the spinal cord, occurring in childhood, and often in several children of the same family.
Causes.—More in boys than in girls and oftener in the country districts. Heredity is frequently a cause and it is traced to syphilis, epilepsy, alcoholism, and insanity in the ancestors. Several children of the same family may have it.
Symptoms.—In very young children it is noticed that they are slow in learning to walk; the child staggers in trying to stand or to walk; it uses its hands clumsily, and has difficulty in speaking. The movements of the hands are peculiar, the hands move like in chorea, the speech is slow and drawling.
Recovery.—Very doubtful, but they may last for years.
INFANTILE PARALYSIS. (Acute Anterior Polio Myelitis).—This is an acute disease occurring almost exclusively in young children with paralysis, followed by rapid dwindling of the muscles of the parts affected by the paralysis.
Causes.—Found in children under three years old. It is more common in summer than in winter. It often follows scarlet fever, measles, and diphtheria.
Symptoms.—The onset is usually sudden; often the child is put to bed at night seemingly well and in the morning is found paralyzed in one or more limbs. High fever or chills, general feeling of illness, pain all over the body, decided brain symptoms, like delirium or convulsions and intermittent contractions of the muscles may usher in the disease. These forerunning symptoms may last a short time or for several weeks, after which the paralysis is noticed, being extensive as a rule, and affecting one, two, or all of the extremities and sometimes the muscles of the trunk. This general paralysis soon disappears being left permanently in only one extremity, chiefly in one leg. The other symptoms disappear. The paralyzed part atrophies (wastes) rapidly. The disease is very rare in adults. If the paralysis does not show a decided change within the first few months, full recovery is doubtful.
Treatment.—During the acute stage there must be absolute quiet and rest with a diet that is not stimulating, one that is easily digested; ice to the head or cold cloths, counter-irritation to the spine; electricity should be used after a few weeks. There is quite a good deal of this paralysis, and the case should receive careful attention from the start.
TASTE.—Taste-Buds.—There are three kinds of papillae or eminences on the human tongue,—the circumvallate, the fungiform and the filiform. The circumvallate are from seven to twelve in number and lie near the root of the tongue, arranged in the form of a V, with its open angle turned forward. Each one is an elevation of the mucous membrane, covered by epithelium and surrounded by a trench. On the sides of the papillae, embedded in the epithelium, are small oval bodies called taste-buds. These taste-buds consist of a sheath of flattened, fusiform cells, enclosing a number of spindle-like cells whose tapering ends are prolonged into a hair-like process. As the filaments of the gustatory nerves terminate between these rod-like cells, it is probable that they are the true sensory cells of taste.
In the human tongue taste-buds are also found in the fungiform papillae, often seem as red dots scattered over its surface; and to an area just in front of the anterior pillar of the fauces. It is also possible that single taste-cells are scattered over the tongue, as the sense of taste exists where no taste-buds can be found.
[Illustration: Taste Buds.]
Many so-called tastes are really smells. This is easily proved by compressing the nostrils and attempting to distinguish by taste different articles of food.
The taste sensation is greatest when the exciting substance is at the temperature of the body. There is no perceptible sweetness to sugar when the tongue has been dipped for a half-minute in water either at the freezing temperature or warmed to 50 degrees C. Neither is there any sense of taste until the substance is dissolved by the natural fluids of the mouth, as will be seen by wiping the tongue dry and placing sugar upon it.
The four primary taste-sensations are bitter, sweet, sour and salt. These probably have separate centers and nerve fibers. Sweet and sour tastes are chiefly recognized at the front and bitter and alkaline tastes at the back of the tongue. The same substance will often excite a different sensation, according as it is placed at the front or back of the tongue.
There are also laws of contrast in taste sensations. Certain substances will enhance the flavor of another and others will destroy it. Again, certain tastes may disguise others without destroying them, as when an acid is covered with a sweet.
INSANITY. History.—The earliest reference to insanity is found in the book of Deuteronomy. Another reference is in Samuel where it speaks concerning David's cunning and successful feigning of insanity. "And he changed his behavior before them and feigned himself mad in their hands, and scrabbled on the door-posts of the gate, and let his spittle fall down upon his beard," Feigning insanity under distressing circumstances has been one of man's achievements throughout the centuries. It is spoken of in Ecclesiastes. Jeremiah says in regard to the wine cup: "And they shall drink and be moved and be mad." Nations also were poisoned by the wine cup, for Jeremiah says, "Babylon has been a golden cup in the Lord's hands, that made all the earth drunken. The nations have drunken of her wine, therefore the nations are mad." Greek writers speak of cases of mental unsoundness as occurring with some frequency in Greece. The inhabitants of the Roman Empire were afflicted with mental unsoundness and Nero was considered crazy. In ancient Egypt there were temples and priests for the care of the insane.
Hippocrates, who lived four hundred years before Christ, was the first physician who seemed to have any true conception of the real nature of insanity. For many centuries later the masses believed that madness was simply a visitation of the devil. The insane, in the time of Christ, were permitted to wander at large among the woods and caves of Palestine. The monks built the first hospital or asylum for the insane six centuries after Christ.
A hospital for the insane was established at Valencia in Spain in 1409. In 1547 the hospital of St. Mary of Bethlehem was established near London and was known as "Bedlam" for a long time.
The first asylum to be run upon reform principles was St. Luke's of London, founded in 1751. About 1791 Samuel Hahnemann established an asylum for the insane at Georgenthal, near Gotha, and the law of kindness was the unvarying rule in the institution. Hahnemann says in his Lesser Writings: "I never allow any insane persons to be punished by blows or other corporeal inflictions." Pineli struck the chains from the incarcerated insane at the Bicetre, near Paris in 1792 or 1793.
There has been a gradual tendency during the last century toward better things in the behalf of the insane. A hundred years ago they were treated with prison surroundings and prison fare. Then asylum treatment began to prevail. This means close confinement, good food, sufficient clothing and comfortable beds. Asylum care means the humane custody of dangerous prisoners. "From the asylum we move on to the hospital system of caring for the insane and this system recognizes the fact that the lunatic is a sick man and needs nursing and medical treatment in order to be cured. Hospital treatment has been gradually introduced during the past thirty years or more," and in time it will eventually supercede asylum treatment and prison or workhouse methods in the management of the insane everywhere.
Causes of Insanity.—There are many and various causes. One author states: "Mental abnormality is always due to either imperfect or eccentric physical development, or to the effects of inborn or acquired physical disease, or to injurious impressions, either ante-natal or post natal, upon the delicate and intricate physical structure known as the human brain." Some physical imperfections, more than others, give rise to mental derangements, and some persons, more than others, when affected by any bodily ailment, tend to aberrated conditions of the mind. Some impressions more than others, are peculiarly unfortunate by reason of their crowding effects upon the brain tablets of a sensitive mind. To these natural defects and unnatural tendencies, we apply, in the general way, the term "Insane Diathesis." This diathesis may be inherited or acquired. Those who are born to become insane do not necessarily spring from insane parents or from an ancestry having any apparent taint of lunacy in the blood. But they do receive from their progenitors oftentimes certain impressions upon their mental and moral, as well as upon their physical being, which impressions, like iron molds, fix and shape their subsequent destinies."
The insane diathesis in the child may come from hysteria in the mother. A drunken father may impel epilepsy, madness or idiocy in the child. Ungoverned passions, from love to hate, from hope to fear, when indulged in overmuch by the parents, may unloose the furies of unrestrained madness in the minds of the children. "The insane may often trace their sad humiliation and utter unfitness for life's duties back through a tedious line of unrestrained passion, of prejudice, bigotry, and superstition unbridled, of lust unchecked, of intemperance uncontrolled, of avarice unmastered, and of nerve resources wasted, exhausted, and made bankrupt before its time. Timely warnings by the physician and appeals to his clients of today, may save them for his own treatment, instead of consigning them to an asylum where his fees cease from doubling, and the crazed ones are at rest." The causes of the insane diathesis (constitution) are frequently traceable to the methods of life of those who produce children under such circumstances and conditions that the offspring bear the indelible birthmark of mental weakness. Early dissipations of the father produce an exhausted and enfeebled body; and a demoralized mind and an unholy and unhealthy existence in the mother, are causes. Fast living of parents in society is a fruitful cause of mental imperfections in their children. "The sons of royalty and the sons of the rich, are often weak in brain force because of the high living of their ancestry."
The fast high livers of today are developing rapidly and surely, strong tendencies to both mental and physical disorders. Elbert Hubbard says of those who live at a certain hotel and waste their substance there, that they are apt "to have gout at one end, general paresis at the other, and Bright's disease in the middle."
Drunkenness, lust, rage, fear, mental anxiety or incompatibility, "if admitted to participation in the act of impregnation will each, in turn or in combination, often set the seal of their presence in the shape of idiocy, imbecility, eccentricity, or absolute insanity."
Diogenes reproached a half-witted, cracked-brained unfortunate with this remark, "Surely, young man, thy father begat thee when he was drunk."
Burton in his anatomy of melancholy states that: "If a drunken man begets a child it will never likely have a good brain," Michelet predicts: "Woe unto the children of darkness, the sons of drunkenness who were, nine months before their birth, an outrage on their mothers."
Children of drunkards are often "sad and hideous burlesques upon normal humanity." Business worry may cause unsoundness in the offspring generated under such conditions.
One father had two sons grow up strong and vigorous, mentally and physically, while a third son was weak, irresolute, fretful, suspicious and half demented. The father confessed to his physician that on account of business troubles he was half crazy and during this time the wife became pregnant and this half-crazy son was born and the father states that "he inherits just the state of mind I was then in." Many such cases could be mentioned. "A sound body and a cheerful mind can only be produced from healthy stock." Mental peculiarities are produced by unpleasant influences brought to bear upon the pregnant mother. The story is told of King James the Sixth of Scotland, that he was constitutionally timid and showed great terror at a drawn sword. His father was murdered in his mother's presence while she was pregnant. Children born under the influence of fear may be troubled with apprehensions of impending calamity, so intense that they may become insane at last. An instance is given of "an insane man who always manifested the greatest fear of being killed and constantly implored those around him not to hurt him." His mother lived with her drunken husband who often threatened to kill her with a knife.
Other Causes of Insanity. Imperfect Nutrition.—Whatever tends to weaken the brain or exhaust the central forces of life must favor the growth of insanity. The brain is not properly nourished.
Blows and Falls upon the Head.—Sometimes such injuries are forgotten, but they result infrequently in stealthily developed, but none the less dangerous, conditions, which may result in the derangement of all mental faculties. A child should not be struck on the head. Teachers or parents should not box a child's ears. One author says such a person "is guilty of slow murder of innocents."
Fright is Another Cause.—Punishing a child by locking it in a dark room or by "stories of greedy bears or grinning ghosts produces, oftentimes, a mental shock that makes a child wretched in early life, and drives him into insanity at a later date." Overtaxing the undeveloped physical powers is another cause.
Insanity is most Prevalent among the Working Classes.—Our factories, shops and stores frequently employ the young of both sexes and they are overtaxed by day and night and they become feeders of our hospitals for the insane. Another cause is forced education in the young. Our present school system tends to break down the body. The work may not be too hard, but the amount of anxiety and worry, which this work causes in the minds of sensitive children, tends to enfeeble them. Many children are sensitive, with nervous temperaments, and they are easily affected by the strain of mental toil. Delicate children should be kept in the open air and their physical condition should be considered more than their mental. Girls, especially, at the age of puberty, should be built up instead of rushed through a heavy routine of study. Herbert Spencer says: "On old and young the pressure of modern life puts a still increasing strain. Go where you will, and before long there comes under your notice cases of children, or youths of either sex, more or less injured by undue study." Here, to recover from a state of debility thus produced, a year's vacation has been found necessary. There you will find a chronic congestion of the brain that has already lasted many months and threatens to last much longer. Now you hear of a fever that has resulted from the over excitement, in some way, brought on at school. And, again, the instance is that of a youth who has already had to desist from his studies, and who, since he has returned to them is frequently taken out of his class in a fainting fit.
Social pleasure also tends to weaken the system of parents who produce nervous and weakened children. Another great cause of insanity is the unnatural, improper and excessive use of the sexual organs, and diseases that often come from indiscriminate sexual relations. General paresis is very often caused by specific disease. I might go on and enlarge upon these causes, but enough has been written to give warning to those who are breaking nature's laws.
Classification.—There are many classifications. I will mention only the leading names, such as Melancholia, Mania. Dementia, General Paresis.
MELANCHOLIA (Sad Mania).—Melancholia is a disease characterized by great mental depression.
Causes—Predisposition, physical disease, dissipation, work and worry, shock, brooding. In simple melancholia the mildest attack may be called the "blues."
ACUTE MELANCHOLIA.—Is generally the result of some mental shock.
CHRONIC MELANCHOLIA is the end of all other forms of mental depression. All these have their own peculiar manifestations and need a special line of treatment.
MANIA.—This type of insanity means a raving and furious madness. There are many cases of this kind. The causes are many and may be the same as those which produce melancholia. In melancholia the shock, etc., causes depression, while in the mania the causes of mental injury tend to produce irritation and excitement. In dementia, the causes of insanity tend to exhaust the body and to mental failure, while in general Paresis "the shock of disease comes after long and unwise contact with worry, wine and women." Insufficient sleep often causes mania. It often follows after exhausting and irritating fevers. Long continued ill health, together with worry, etc., may cause it.
To sum up, "mania" may result from any unusual shock or strain upon the nervous system; or it may come after any unusual mental excitement in business, politics or in religion. Such are the exciting or stimulating causes, but we must go back of the presence of worldly misfortune and trace the tendency to mental disorder through channels of hereditary influence. "Infants are born every day whose inevitable goal is that of insanity." What is said in the Bible about sins of the parents is true.
DEMENTIA.—This term literally means "from mind," out of mind, and such a person is in a state of the most deplorable mental poverty. We all have seen such cases and some cases are not only very sad but disgusting.
PRIMARY DEMENTIA comes on independently of any other form of insanity.
SECONDARY DEMENTIA follows after some other form of insanity,—chiefly melancholia or mania. Dementia may be acute or chronic.
SENILE (OLD AGE) DEMENTIA may be Primary.—Acute dementia attacks both sexes, but it occurs most often in females, though in a milder degree. It is a disease of youth, being rarely seen beyond thirty years of age. It seems to depend often upon exhausting influences operating at a period of rapid growth. Monotony of thought and feeling or want of mental food can also induce it. Children who are sent at an early age into factories often pass into the condition of acute dementia. Prison life also tends to produce such a condition. Acute diseases such as typhoid and other fevers are sometimes followed by acute dementia. Persons frequently go "out of their mind" suddenly in this age, and upon recovering from acute dementia, the patient finds a great "vacancy of memory."
Chronic Dementia.—Shakespeare says, "Last scene of all, that ends this strange, eventful history, is second childishness and mere oblivion; sans teeth, sans eyes, sans taste, sans everything."
"The Sans Everything."—Is the sad and hopeless obscuration by time or disease of the once bright, vigorous, scintillating mental powers of exhuperant and lusty youth. Everyone has seen such people who are partially or hopelessly demented. It may come from diseases, such as epilepsy and syphilis; alcohol produces it.
Senile dementia is the result of old age and of acquired brain disease. It is different from simple old age or dotage. In old age the mind is weakened, but the patient is conscious of it, such a person forgets a name or date and gropes about in his memory to find it.
The demented person is not conscious of loss of memory, but applies wrong names to persons, and serenely thinks he is right.
The senile demented person does not realize his condition, and if there is any mental power left he cherishes delusions or false beliefs.
The victim of old age is unconscious of his weakness.
GENERAL PARESIS.—Wine, worry and women produce a great many cases of this disease. The doctors claim a notorious criminal now committed to one asylum and about whom we have read so much, is a victim of this disease.
First stage.—There is worry, anxiety, sleeplessness and melancholy.
Second stage.—Stage of mania, wealth, power, and grandeur, alternating in some cases with attacks of temporary depressions.
Third stage.—Patient passes into a condition of subacute or chronic mania, with a slow tendency to decadence of all the powers, idiotic.
Fourth stage.—Stage of physical and mental failure and of death. Syphilis causes most cases. It usually develops between twenty-five and fifty years. The outlook for such cases is very unfavorable, as the patient usually dies from one to eight or ten years after the beginning of the disease.
TREATMENT.—There have been great advances made in recent years in the treatment of persons mentally unsound. They should be placed under proper treatment at an early stage. The causes have been given so that preventive measures may be taken.
RHEUMATIC GOUT. (Rheumatic Arthritis. Arthritis Deformans).—Cause.—It occurs most often from thirty to fifty-five, usually in women, generally at or after the change of life, and most frequently in those who have not had children. The involvement of the joints is most common in adult males.
Exciting cause may be: Exposure to cold and wet, improper food, unhygienic surroundings, worry, blows and acute infections.
Conditions.—Several joints are usually involved symmetrically. At the edge of the joints there is formation of new bone covered with cartilage, causing the enlargement of the bone and often partial loss of motion in that joint.
Symptoms.—Several distinct types exist. 1. General progressive types which may be acute or chronic.
Acute.—This occurs usually in women from twenty to thirty and at the change of life. It comes on like acute joint rheumatism, many joints being affected, permanent enlargement appearing early, redness of the joints rarely existing, the pain being very severe, some fever, feel very tired, with anemia, loss of flesh and strength. The first and later attacks are often associated with pregnancy, confinement or nursing.
Chronic Type.—There is a gradual onset of pain or stiffness in one or more joints, usually of the fingers, then of the corresponding joints of the other side and then other joints. The swelling at first may be in the soft parts of the joints with effusion in the joints and tenderness. The pain varies from slight to severe. Periods of improvement and getting worse alternate; the joints becoming enlarged and deformed, often nearly stiff in partial bending on account of the thickened bone and soft tissues. The muscles that move the joint dwindle and there may be changes in the skin and nails of the parts affected due to the want of proper nourishment. Disturbances of the stomach and anemia are common. The heart is not affected. There may be only a few joints affected, or many, with great deformity, before the disease reaches the period of inactivity.
2. Monarticular or one joint type.—This usually occurs in males over fifty; one joint or a few large joints may be affected, generally with shrinking of the corresponding muscles. If it occurs in the hip it is called Morbus Coxae Senilis,—Hip joint disease in the aged.
Recovery.—The disease usually goes on with intervals of improvement and often results in great crippling and disability. In some cases it becomes permanent.
General Treatment.—The climate should be warm and dry. The patient should avoid exposing himself; lead a general hygienic life, with as nourishing food as his digestion will permit. The chief line of treatment should be to improve the general health and relieve the pain. The stomach, bowels, and kidneys should be kept working well. Nourishing food should be taken, but its effect must be watched. Cod-liver oil to build up the system, iron and arsenic may be of value. Sometimes iodide of potash is good. Early and thorough treatment at Hot Springs offers the best hope of arresting its progress, the Hot Springs in Bath County, Va., and in Arkansas. Much can be done at home by hot air baths, hot baths, and compresses at night to the tender joints.
Local.—Massage carefully given is helpful. The hot air treatment is good.Baking the joints is now frequently done.
GOUT (PODAGRA).—A disorder of nutrition characterized by excess of uric acid in the blood, attacks of acute arthritis (inflammation of joints) with deposit of urate of sodium in and around the joints; with various general symptoms.
Causes.—Heredity; male sex, usually appears from thirty to fifty and rarely under twenty; from continued use of alcoholic liquors, especially fermented, with little or no exercise; too much meat. Unhygienic living with poor food, and excessive drinking of ale and beer may be followed by the "poor man's gout." It is common in lead workers.
Symptoms. Acute Type.—There is often a period of irritability, restlessness, indigestion, twinges of pain in the hands and feet; the urine is scanty, dark, very acid, with diminished uric acid and deposit when it is cooled. The attack sets in usually early in the morning with sudden intense pain in a joint of the big toe, generally the right; less often in an ankle, knee, wrist, hand or finger. The part swells rapidly, and is very tender, the overlying skin being red, glazed and hot. The patient is usually as cross as a wounded bear. The fever may be 103. The pain may subside during the day, and increase again at night. There is no suppuration (pus forming). The symptoms usually decrease, gradually, the entire attack may last from five to eight days. Scaling of the skin over the sore part may follow. After the attack, the general health may be improved, and the joint may become normal or but slightly stiff. It recurs at intervals of a few months commonly.
Retrocedent Gout.—This is a term applied to serious symptoms which sometimes go with rapid improvement of the local joint conditions. There are severe pains in the stomach, nausea, vomiting, diarrhea, pain in the heart, difficult breathing, palpitation, irregular and feeble action of the heart with brain symptoms, probably from uraemia. These attacks often cause death.
Chronic Gout, Causes, etc.—Frequent acute attacks; many joints, beginning with the feet, become stiff and deformed, perhaps with no motion. The overlying skin may ulcerate, especially over the knuckles. Dyspepsia, arterio-sclerosis, enlargement of the left ventricle of the heart and a great quantity of urine with low specific gravity are common. The patient is morose and irritable. Eczema, chronic bronchitis, frequently complicate the case.
Death often occurs from uraemia, meningitis, pleurisy, pericarditis or peritonitis.
Treatment, Preventive.—Live temperately, abstain from alcohol, eat moderately, have plenty of fresh air and sunshine, plenty of exercise and regular hours. These do not counteract the inherited tendency. The skin should be kept active, if the patient is robust, by the morning cold bath with friction after it; but if he is weak and debilitated, the evening warm bath should be substituted. The patient should dress warmly, avoid rapid alternations in temperature, and be careful not to have thc skin suddenly chilled.
Diet in Gout.—Most persons over forty eat too much. Eat reasonably and at regular hours and take plenty of time to eat. Do not eat too freely of meats and avoid too much starchy and sugary foods. Fresh vegetables and fruits may be used freely, except cranberries and bananas.
Dr. Osler of England says.—While all stimulants are injurious to these patients some are more so than others, particularly malted liquors, champagne, port and a very large proportion of all the light wines. Take large quantities of water on an empty stomach, mineral waters are no better than others, but treatment of chronic and irregular gout at springs gives the advantage of regular hours, diet, etc.
[Illustration: A Skiagraph (X-RAY photograph) of the hand. Made for the purpose of locating piece of needle. Photo by P. M. Campbell, Detroit, Mich.]
Diet from a prominent hospital for gout patient:—
May Take—
Soups.—Fresh fish soups, vegetable broths clear.
Fish.—Raw oysters, fresh fish, boiled.
Meats.—Fat bacon, boiled or broiled chicken, game (all sparingly).
Farinaceous.—Cracked wheat, oatmeal, rice, sago, hominy, whole wheat bread, or biscuits, rye bread, graham bread or rolls, crackers, dry toast, milk toast, macaroni.
Vegetables.—Mashed potatoes, green peas, string beans, spinach, cabbage, cucumbers, cresses, lettuce, celery.
Desserts.—Plain milk pudding, junket, rice and milk, sago and milk, stewed fruits, all without sugar.
Drinks.—Weak tea (no sugar), milk, buttermilk, toast water, pure water, cold or hot.
Must Not Take—
Veal, pork, goose, duck, turkey, salted, dried, potted or preserved fish or meat (except fat bacon), eels, mackerel, crabs, salmon, lobster, eggs, rich soups, gravies, patties, tomatoes, sweet potatoes, asparagus, mushrooms, rhubarb, lemons, pickles, vinegar, fried or made dishes, rich puddings, spices, pies, pastry, sweets, nuts, dried fruits, tobacco, coffee, cider, malt liquors, sweet wines, champagne.
Treatment.—In an acute attack raise the affected limb and wrap the "sick" joint in cotton wool; warm fomentations may be used. The wine or tincture of colchicum in doses of twenty to thirty drops may be given every four hours in combination with the citrate of potash, fifteen grains, or the citrate of lithium five to ten grains. Stop the tincture of colchicum as soon as the pain is relieved and then you can give wine of colchicum ten drops every four hours, watching for irritation of the stomach, bowels and kidneys.
Dr. Hare of Philadelphia says.—For hospital practice a very useful mixture is made by adding one part of bicarbonate of sodium to nine parts of linseed oil. The joint is then wrapped in a piece of lint soaked with this concoction. In some cases oil of peppermint has been recommended. In chronic gout Dr. Hare also gives for diet milk and eggs, the white meat of chicken; fruits, cooked without sugar being added, are allowed. Tea and coffee being used only in moderation. If any wine is taken it must be followed by copious draughts of pure water and the last article should be used ad libitum. On the other hand, pastries and, more than all, sweet wines, are the worst things that such a patient can take, and must be absolutely prohibited.
RHEUMATIC FEVER (Articular Rheumatism).—Causes. This may be acute or chronic. It is an infectious disease characterized by inflammation of several joints. The joints are held in place by ligaments and are inclosed by a thin membrane. In this acute rheumatism these parts become congested and inflamed, there is redness and swelling, heat and pain. Fluid is passed into the joint sometimes and then the parts look watery (oeclematous). The inflammation and swelling cause great pain in the joint.
Predisposing.—A damp climate, winter and spring, young adults and persons who are exposed to damp, wet and cold.
Condition.—There is congestion of the soft parts of the joints and effusion into the joint cavities of a watery fluid. Endocarditis, pericarditis, myocarditis, pleurisy and pneumonia may complicate it. The first named, endocarditis, is very common and as the mitral valves become inflamed it is likely to leave valvular trouble unless carefully watched and treated at the time.
Symptoms.—The invasion may be gradual, with a very tired feeling and often tonsilitis; but it is usually sudden, with pains, soreness in one or more joints and fever. The knees, ankles, elbows and wrists are much affected, but it frequently goes through almost every joint in the body and sometimes repeats the terrible dose. I know, for I had it twice. The suffering, torture and pain sometimes are simply indescribable and almost too hard to bear. The joints become hot, red, painful, swollen and tender to touch and motion. It seems to hurt worse when anyone comes near, for the patient is afraid of careless handling.
Fever.—This runs from 102 to 104 and is modified by profuse perspiration with bad odor and, generally, it does not afford any relief. The urine is very acid, very thick and looks like thick, strong coffee. The symptoms frequently disappear partially from one joint or joints as they begin in other joints, attacking several in rapid succession, the fever varying and changing with the degrees of joint involvement.
We may see the shoulder and hip, the elbow and wrist, knee and ankle, etc., all affected at once: Heart complications are frequent and bear close watching, for they are dangerous to life and the future health of the patient. The patient becomes very anemic and this progresses rapidly. When improvement does begin it is gradual; or the disease may become chronic. Care must be taken not to be too active when improvement sets in or you will cause a return by using the joints before they have become thoroughly well. I did the same thing in my anxiety to get out, but would never be as reckless again. Pain and stiffness of the joints often last long after convalescence has set in. One who has had this disease once is liable to another attack if he is not careful.
MOTHERS' REMEDIES. 1. Articular Rheumatism.—A gentleman sends us the following treatment for articular rheumatism and writes as follows: "I send you the following treatment for articular rheumatism because I used it myself and was cured in a very short time, in fact, about ten days. It was a number of years ago in the early spring when my knee joints, ankles and wrists began to pain me and continued to become worse for about a week, at the end of which time both my knees were perfectly stiff. I sent for my physician; he wrapped my knees with common baking soda; taking long wide bandages he was enabled to have the baking soda a fourth of an inch thick around the knee, raising the bandage as he laid the soda on; after this was completed I had heavy wet hot cloths laid around my knee and renewed every fifteen or twenty minutes for probably eight or ten hours. In the meantime I was taking the salicylate of soda and the cathartic, veronica water, as directed below. The following day I sat up with my legs resting on a chair, straightened out, and hot flat irons at my knees. I began this treatment on Saturday, and the following Thursday was able to walk about and go out of town, and never had rheumatism since, but at two or three different times I suspected it was coming on and used the salicylate of soda and veronica water as a successful preventive; at least the rheumatism did not materialize.
Veronica Water.—Dose:—Glassful every two and one-half hours till bowels are free, then one dose a day.
AlsoSalicylate of Soda 1 ounceWater 6 ounces
Large teaspoonful every two hours with a quinine pill every other dose."
2. Rheumatism, Cotton Excellent for Inflammatory.—"Take a roll of cotton batting and wrap the limb, or part of the body affected, as firmly and tightly as possible, without tearing the cotton, let it remain "twenty-four hours, then tighten it up by unwinding and rewrapping the cotton as tight as possible, as on the first application, and so continue every twenty-four hours until cured, which, in my case, was three days. I had been troubled with rheumatism for a long time, and was unable to walk. I tried everything, doctors and all, but nothing helped me. A lady from Cincinnati, who was visiting at a neighbor's, called at my house one day and learning what was the matter with me, advised me to put cotton on as stated above. I had no faith in it, but I had tried everything else and concluded I would try that, with the result that it cured me. Possibly if a case should require a longer time for a cure than mine it might be necessary, or be better, to replace the cotton with a fresh roll. The rewrapping every twenty-four hours is intended to keep the cotton batting firmly and tightly around the part affected as the swelling recedes."
Prevention.—Wear flannel late and early. Keep from taking cold. Put off wet things of every kind immediately upon getting home and dry your body and put on dry well-aired clothes. Never sleep in a damp bed, under damp unaired clothes. When you go away from home do not sleep in a room or bed that has been unoccupied for any length of time, especially if there is no furnace in the house. Do not sit down in wet damp clothes, stockings, shoes, etc. Do not sit down anywhere to "cool off." It is inviting trouble and sickness. Do not lie on the damp ground, do not sleep on the first floor of an old damp house. Have plenty of sunlight and air in your sleeping room. These directions apply to the chronic cases also. It does not matter so much if one is wet or sweating as long as he keeps moving or working. On wash day do not dry your clothes in the kitchen or sitting room, or put them on your bed, unless they have been thoroughly dried, aired and warmed before using. These little things mean much in real life.
PHYSICIANS' CAUTION for Articular Rheumatism.—Go to bed and remain there and do not get up too soon, for remember the parts are still tender when they may not be painful.
Local Treatment.—1. There must be absolute rest. Remove the sheets from the bed and wrap woolen cloths or blankets about the patient and protect the inflamed joints from the weight of the coverings. Cover the joints with gauze or absorbent cotton, after putting on the parts a thick coating of ichthyol ointment.
2. Sometimes hot fomentations are helpful in relieving the suffering; sometimes cold cloths are best.
3. The following is good. Apply with cloths wrung out of it:
Carbonate of Soda 6 dramsTincture Arnica 10 ouncesGlycerin 2 ouncesWater 9 ounces
4. Oil of Wintergreen 1 ounceCompound Soap Liniment 8 ounces
Mix.
Rub the affected parts with oil of wintergreen and then wrap the parts in cotton wool and soak with the solution.
5. "A layer or two of gauze saturated with methyl-salicylate is wrapped around the painful joints and covered with paraffin paper, or other impervious dressing, held in place by a bandage. This is renewed once or twice daily until the pain in all the joints is relieved."
6. Internal.—Sodium salicylate or aspirin given until the pain and temperature are relieved; usually five to ten grains of sodium salicylate every three hours for an adult; or five grains of the aspirin every three hours.
7. Dr. Hare recommends for the beginning in a strong, healthy individual, ten drops of the tincture of aconite at once in a little water, and follow it by a teaspoonful of a mixture containing fifteen drops of tincture of aconite and two ounces of water everyone-half hour, until perspiration on the skin betokens the circulatory depression through the action of the drug. I use aconite in this disease very often, but not in such doses as the first one. It seems to me that it is uselessly large. I use about one-tenth of a drop at a dose everyone to two hours during the first twenty-four hours.
Nursing.—The nurse must have the patience of Job to attend a patient sick with this disease; but you must remember the suffering is awful. The patient may be very restless and the pillows may need rearranging every few minutes. Also be careful how you handle the patient. It hurts terribly to be even touched. A rough, hearty person has no business to care for such a patient. I allow patients to say anything they wish, for this is a painful disease. They may swear at me if they wish. I know how it is, for I was there twice, the last time for six long weeks. Have patience and courage and cheer your patient. Do not look cross or scold.
Diet.—Milk mainly, broths, gruels, albumen water, oyster or clam broth, milk toast, buttermilk, kumiss. Do not give solid food. Water, lemonade, vichy or carbonated water.
CHRONIC RHEUMATISM.—Causes.—Heredity may predispose to it. It is most common in those who are exposed to hard labor in the cold and wet; especially in women about middle age. It occasionally follows sub-acute, but rarely acute rheumatism.
Symptoms.—Many large joints are usually affected; sometimes it may be only one joint; at times, the small joints only are affected. It may be only on the one side. It usually persists in the joints involved, but may attack others. The chief symptoms are stiffness of the joints, especially after a rest and this diminishes after some motion, also pain, which grows worse in damp weather. The joints may be tender to the touch, slightly swollen, rarely red. They may in time become entirely stiff and deformed. The general health may be good or there may be anemia, dyspepsia and valvular disease due to sclerosis,—hardening of the valves of the heart.
Prognosis.—This is good as to life, but the disease is often progressive.
Treatment. Preventive.—A warm, dry, unchangeable climate, good surroundings, good food; keep the stomach and bowels and kidneys in good condition, avoid taking cold. Do not sit down in a draft to "cool off." Do not go into a cool room in summer when you are warm or sweated. Do not sleep in a bed that has not been used for months and kept for "company." Do not dry your clothes in the kitchen and in that way make the whole house steamy and damp. Do not sleep under unaired damp covers or in a damp night dress. Always air and dry your bedding and night dress before using. Do not take a hot bath and go into a cool room to cool off, but wrap yourself up so as to be warm and cool off gradually. Any additional cold will cause more rheumatism.
Sleeping rooms on the first floor are an abomination for rheumatic persons. Do not sit down in wet clothes, stockings or shoes. Take them off immediately on getting home, wipe yourself dry and put on dry garments. Care in such little seemingly foolish things will do wonderful things for a rheumatic person. I had two rheumatic attacks in my first year of practice. Since then I have learned caution and through a hard and busy life I have kept myself reasonably well by looking after such little aids and cautions as, the above. I never sit down for any length of time in damp or wet clothes, and if I can do that, persons that are not driven like doctors can do the same. These cautions apply to not only this kind of rheumatism, but to all kinds of rheumatism, neuralgias, and to inflammatory diseases, such as neuritis, tonsilitis, pneumonia, pleurisy, etc. Hot air baths, Hot Springs, massage will be more effectual in this disease than in the former. Iodide of potash also is very useful. Flannel underwear, heavy and light weight, is very beneficial in rheumatism. Great benefit can be derived at home by wrapping the affected joints in cold cloths, covering with a thin layer of flannel and protected by oiled silk. A great many cases are helped by using hot fomentations of hops, wormwood, smartweed, etc. Turpentine applied locally to the joints is effective, but it is very likely to injure the kidneys when used freely and in these days when there are so many diseases of the kidneys one must be careful or they will produce an incurable and serious disease in the place of one that is painful, but not necessarily dangerous. Many of the simple remedies have a good effect on the rheumatic troubles.
PHYSICIANS' TREATMENT for Rheumatism.—Dr. Hare gives the following to rub on large joints:
1. Ichthyol 1/2 to 1 ounceLard 1 ounce
2. Tincture of Aconite 6 dramsTincture Arnica 1 ounceOil of Turpentine l ounce (l or 2)Soap Liniment enough for 8 ounces
Use as a liniment three times a day. This can be used for some weeks.
3. Strong Water of Ammonia 6 dramsOil of Cajeput 1 dramTincture of Belladonna 1 to 2 ouncesCamphor Liniment enough for 8 ounces
Use as a liniment.
4. Tincture of Aconite 1 ounceTincture Belladonna 2 dramsStrong Ammonia Water 4 dramsChloroform Liniment 6 drams
Used as a liniment on chronic or inflamed muscles or joints.
5. Iodide of Potash 1/2 ounce Compound Syrup of Sarsaparilla 3 ounces Distilled Water 3 ounces
Mix and take a dessertspoonful in a glass of water two hours after meals for chronic rheumatism.
[Illustration: Muscular System.]
6. This is prepared by Parke, Davis & Co., and made into a syrup:
Red Clover 32 grainsQueen's Root 16 grainsBarberry 10 grainsPrickly Ash Bark 4 grainsBurdock Root 16 grainsPoke Root 16 grainsHonduras Bark 16 grainsIodide of Potash 8 grains
This portion to each fluid ounce of the syrup.
7. The following is good:
Equal parts of each of the following:Blue Cohosh RootBlack Cohosh RootPoke RootYellow Dock RootBlue Flag RootPrickly Ash RootBurdock RootDandelion Root
Bruise them thoroughly or grind them coarsely, steep and make a tea and drink freely of it. If you wish you can take three to five grains of Iodide of Potash to each dose. This may in time disorder the stomach and you may then stop it for a time. All these can be used in muscular rheumatism also. The food should not be rich or highly seasoned. Spices are bad for such patients. Pickles, mustard, etc., are best let alone.
MUSCULAR RHEUMATISM.—This is a very painful affection of the voluntary muscles, called also neuralgia, or according to its location, torticollis (stiff neck, wry neck), pleurodynia, lumbago (rheumatism in the back).
Causes.—Predisposed to it by previous attacks, having a rheumatic or gouty constitution (diathesis). It follows sudden exposure, hence it is most common in men.
Symptoms.—Local pain in the muscles, sharp or dull, aching constant, or caused by certain movements and is usually relieved by pressure. It lasts from a few days to several weeks and frequently recurs. The common forms are: Lumbago. This affects the muscles of the back, and usually comes on suddenly with a sharp stich-like pain, and is chiefly seen in those who labor hard, often completely disabling them for a time.
Torticollis (stiff or wry neck).—It is usually on the side or back of the neck. Comes from a draught of cold wind on the neck, etc.
Pleurodynia, pain in the chest muscles, etc.—With pain in all movements of the chest, resembling intercostal neuralgia or pleurisy.
Diet for Rheumatism from the Head Nurse of a Prominent Hospital:—
May Take—
Soups.—Mutton broth, chicken or beef tea, in small quantities.
Fish.—Raw clams or oysters, fresh fish (whiter kinds) boiled.
Meats.—Chicken, calf 's head, sweetbread, tripe, broiled fat bacon or broiled ham (all sparingly).
Farinaceous.—Whole wheat, corn or brown bread, arrowroot, rice, dry toast, milk toast.
Vegetables.—Spinach, green peas or cabbage (well boiled), celery, lettuce, cresses, radishes.
Desserts.—Milk, rice or arrowroot pudding, (all without sugar), junket.
Drinks—Tea (without sugar), buttermilk, pure water, plain with lemon or lime juice (no sugar).
Must Not Take—
Pork, veal, turkey, goose, duck, fried fish or salt meats, cooked oysters or clams, salted, dried, potted or preserved fish or meats (except fat bacon or ham), crabs, salmon, lobster, eggs, rich made dishes, gravies, potatoes, tomatoes, beans, asparagus, mushrooms, candies, rich puddings, pies, pastry, nuts, cheese, coffee, cider, malt liquors, wines.
Treatment for Stiff Neck.—Wry Neck, (torticollis).—Warmth applied either dry or moist as hot salt bag or fomentations of hops, etc. Parke, Davis & Co., Detroit, now make a preparation called capsicine. This is very good for this trouble, rubbed on thoroughly as directed. It can be bought at most drug stores. It is also good for headaches and neuralgias. The same line of treatment, hot and cold applications, can be given for pain in the chest muscles (pleurodynia) and lumbago.
A MOTHERS' REMEDY for Stiff Neck.—Hot Salt and Oil of Sassafras.—"If troubled with stiff neck, fill a bag with hot salt and sleep on it, or rub the neck with oil of sassafras which, by the way, is also excellent for lumbago and to scatter, not cure, rheumatism pains."
PHYSICIANS' TREATMENT for Rheumatism.—Preventive.—Avoid exposure as stated for other rheumatism. Rest the chest by strapping with adhesive plaster as in pleurisy. Porous plasters are good and liniments; sometimes help is obtained by rubbing freely with camphor. Hot dry or wet applications are frequently useful. Mustard plaster is very good when the space is not too great. Mix the mustard with the white of an egg and after it is taken off grease the part and keep on warm cloths. Hot foot baths and hot drinks of lemonade or teas, after which the person should go to bed and sweat and remain there for some hours.
Liniment.—
Oil of Wintergreen 1/2 to 1 ounceCompound Soap Liniment 8 ounces
Mix and rub on thoroughly.
MOTHERS' REMEDIES.—Lumbago, Menthol Liniment for.—Apply the menthol liniment, cover with a thick cloth and put the hot water bottle next to it and go to bed. If up through the day have a cotton batting sewed to cloth and keep affected parts warm, using the liniment freely." The menthol liniment will be found an excellent remedy for lumbago, The menthol absorbs quickly and by applying the hot water bottle relief is sure to follow.
1. Weak Back, Vinegar and Salt for.—"One tablespoonful of salt and one tablespoonful of vinegar to a quart of hot water. Bathe the back, then rub well with sweet oil and relief will soon follow,"
2. Weak Back. Simple Remedy for.—"Aching may be relieved by taking a large pinch of buchu leaves, steep and drink. Sweeten if desired. Use a pint of water for steeping the leaves," This is a good remedy for a weak back, resulting from kidney trouble. The buchu leaves acts quickly on the kidneys and it is surprising to see how quickly the backache will disappear. You can purchase a two ounce package for five cents at any drug store.
3. Weak Back, Good Liniment for.—
"Tincture of Aconite 1 ounceOil of Wintergreen 1/2 ounceTincture of Belladonna 1 ounceTincture of Arnica 1 ounceAqua Ammonia 2 ounces
Mix and use as a liniment."
This is a very good liniment.
4. Lameness, Chloroform Liniment for.—"Chloroform liniment is the best for all lameness and sore limbs."
5. Lameness, Plantain Leaves and Cream for.—"Make ointment from plantain laves, simmered in sweet cream or fresh butter. This is very cooling."
MOTHERS' REMEDIES.—1. Rheumatism, Saltpetre Good in Cases of.—"One ounce of saltpetre to one pint of water. Take one teaspoonful of the above in a large glass of water, about six times daily." The saltpetre acts on the kidneys, carrying off the impurities in this way. Care should be taken not to continue this treatment too long at a time, as continued use would result in injury to the kidneys.
2. Rheumatism, Rochelle Salts for.—"One teaspoonful rochelle salts in one-half glass water every other morning." This acts on the bowels and cleanses the system.
3. Rheumatism, Flowers of Sulphur Will Relieve Pain of.—Sciatica is sometimes very much improved by wrapping the limb for one night with flowers of sulphur."
4. Rheumatism, Three Simple Ingredient Liniment for.—"One pint pure cider vinegar, one pint of turpentine, four fresh eggs, put the egg shells and all in the vinegar, let stand until the vinegar eats the eggs all up, then add the turpentine." This makes a fine liniment.
5. Rheumatism, Sulphur Good for.—"Cases of chronic rheumatism are often relieved by sulphur baths and sulphur tea. Dose:—Powder sulphur and mix with molasses. A teaspoonful three times a day," Sulphur is a good blood purifier and laxative.
6. Rheumatism, Horse-Radish for.—"An excellent and well-known remedy for rheumatism is to make a syrup of horse-radish by boiling the root and add sufficient sugar to make it palatable. Dose:—Two or three teaspoonfuls two or three times a day,"
7. Rheumatism, Simple Remedy to Relieve Pain of.—
"Peppermint 1 ounceOil of Mustard 1/4 ounceVinegar 1 pintWhite of one egg.
Beat egg; stir all together."
8. Rheumatism, Liniment for Chronic.—
"Olive Oil 1 pintSassafras Oil 2 dramsCamphor Gum 2 ouncesChloroform 1/2 ounce
Dissolve the camphor in the oil and when dissolved add the chloroform and four ounces of turpentine or rosemary. Rub the parts well night and morning. If the limbs are very sensitive to cold, add to the mixture two ounces of tincture of capsicum."
9. Rheumatism, Herb Remedy for.—
Tincture Colchicum Seed 4 ouncesGum Guaiacum 4 ouncesBlack Cohosh Root 4 ouncesPrickly Ash Berries 4 ouncesIodide Potash 1 ounce
Dose for adult, one teaspoonful three times a day in wineglassful of water or milk."
10. Rheumatism, Three Things that Will Help.—
"Best Rye Whisky 2 pintsGround Burdock Seed 1/2 poundPoke Berry Juice 1/2 pint
Mix, shake well before using.
Dose for adults, one and one-half or two tablespoonfuls night and morning." In severe cases take three times a day. This is a thoroughly tried remedy and is a very successful one.
11. Rheumatism, Good Liniment for.—
"Alcohol 1 ounceOil of Wintergreen 1 dramChloroform 5 dramsGum Camphor 1/2 ounceSulphuric Ether 3/4 ounceOil of Cloves 1/2 dramOil of Lavender 1 dram
Mix and apply externally for rheumatism and you will find it a very beneficial remedy."
12. Rheumatism, Camphor and Alcohol for.—"Soak cotton batting in alcohol and camphor and apply on part." Application to the affected parts will frequently give relief in some rheumatic patients, when in others no relief is obtained by this method, it being necessary to take something internally.
13. Rheumatism, Sweet Fern Tea Excellent for.—"Sweet fern tea taken three times a day. Dose, one cupful. Father has used this successfully himself."
14. Rheumatism, Well-known Celery Remedy for.—"Celery tea several times a day with plenty of celery cooked or raw as a regular table food. Cut the celery in pieces, boil until soft in water and let the patient drink the tea, then make a stew of the remaining bits. If fresh celery cannot be obtained, celery preparations can be found at the drug store.
15. Rheumatism, Flowers of Sulphur Relieves.—"Rheumatism is effectually removed by enveloping the limb one night with flowers of sulphur." The flowers of sulphur can be purchased at any drug store, and will give great relief, especially in severe cases.
16. Rheumatism, Poultice for.—"Apply belladonna ointment to seat of pain, poultices applied very hot. Sulphur applied to painful part is very effective, after which the parts should be enveloped in flannel." The belladonna ointment acts like a fly blister, but not quite so severe. The ointment can remain on for some time without blistering. This treatment relieves by removing the inflammation from the sore parts.
17. Rheumatism, Novel Relief for.—"The best remedy is electricity. It cured me; I used medical battery." Electricity has been known to help in a great many cases, but should be applied by a competent person.
18. Rheumatism, Snake Root and Lemons Good for.—"Make use of lemon juice freely. Use decoction of black snake root, one ounce to pint of boiling water; a tablespoonful four times a day. Wet compress renewed every two hours applied to painful joints."
The black snake root is a remedy that was used by the early settlers for this trouble. The wet compresses are very soothing, but care should be taken not to wet the bed clothing, as the patient would then take cold.
19. Rheumatism, Another Good Liniment for.—
Alcohol 5 ouncesAmber 30 dropsTincture of Pinoum 30 dropsHemlock Oil 30 dropsTincture of Iron 30 dropsAconite 30 drops
DIABETES MELLITUS.—A disorder of nutrition in which sugar accumulates in the blood and is excreted in the urine, the daily amount of which is greatly increased.
Causes.—Hereditary influences play an important role and cases are on record of its occurrence in many members of the same family. Men are more frequently affected than women, the ratio being about three to two. Persons of a nervous temperament are often affected. It is a disease of the higher classes. Hebrews seem especially prone to it. The disease is comparatively rare in the colored race; women more than men in the negro,- nine to six. In a considerable proportion of the cases of diabetes the patients have been very fat at the beginning of or prior to the onset of the disease. It is more common in cities than in country districts. The combination of intense application to business, over-indulgence in food and drink, with a sedentary life, seem particularly prone to induce the disease. Injury to or disease of the spinal cord or brain has been followed by diabetes. It is much more frequent in European countries than here. Acute and chronic forms are recognized in the former.
Symptoms.—The only difference is that the patients are younger in acute forms, the course is more rapid and the wasting away is more marked. The onset of the disease is gradual and either frequent passing of urine (six to forty pints in twenty-four hours) or inordinate thirst attracts attention. When it is fully established, there is great thirst, the passage of large quantities of sugar urine, a terrible appetite, and, as a rule, progressive emaciation. The thirst is one of the most distressing symptoms. Large quantities of water are required to keep the sugar in solution and for its excretion in the urine. Some cases do not have the excessive thirst; but in such case the amount of urine passed is never large. The thirst is most intense an hour or two after meals. The digestion is generally good, but the appetite is inordinate. Pain in the back is common. The tongue is usually dry, red and glazed, and the saliva is scanty. The gums may become swollen. Constipation is the rule. The skin is dry and harsh and sweating rarely occurs. The temperature is under normal. In spite of the enormous amount of food eaten a patient may become rapidly emaciated. Patients past middle life may have the disease for years without much disturbance of the health; on the other hand I have seen them die after that age. Progress is more rapid the younger the person. Death usually occurs from coma of diabetes. This is most common in young patients.
1. There is a sudden onset after exertion of weakness, feeble pulse, stupor, coma, death in a few hours.
2. Sudden headache, coma, death in a few hours.
3. After nausea, vomiting or a lung complication, there are headache, delirium, abdominal pain, rapid labored breathing, sweetish odor of the breath, stupor, rapid feeble pulse, coma and death within a few days.
Recovery.—Instances of cure in true diabetes are rare.
Treatment. Preventive.—The use of starchy and sugary articles of diet should be restricted in families with a marked disposition to this disease. Sources of worry should be avoided and he should lead an even quiet life, if possible, in an equable climate. Flannel and silk should be worn next to the skin, and the greatest care should be taken to promote its action. A lukewarm and, if tolerably robust, a cold bath should be taken every day. An occasional Turkish bath is useful.
Diet.—Let the patients eat food of easy digestion, such as veal, mutton and the like, and abstain from all sorts of fruit and garden stuff. In Johns Hopkins' Hospital these patients are kept for three or four days on the ordinary ward diet, which contains a moderate amount of carbo-hydrates, in order to ascertain the amount of sugar excretions. For two days more the starches are gradually cut off. They are then placed on the following standard non-carbohydrate diet.
Breakfast: 7:30, six ounces of tea or coffee; four ounces of beefsteak, mutton chops without bone, or boiled ham; one or two eggs.
Lunch: 12:30, six ounces of cold roast beef; two ounces celery, fresh cucumbers or tomatoes with vinegar, olives, pepper and salt to taste, five drams of whisky with thirteen ounces of water, two ounces of coffee without milk or sugar.
Dinner: 6:00 P. M., six ounces of clear bouillon; seven and a half ounces of roast beef; one and one-half drams of butter; two ounces of green salad with two and a half drams of vinegar, five drams of olive oil, or three tablespoonfuls of some well-cooked green vegetable: three sardines; five drams of whisky with thirteen ounces of water.
Supper: 9:00 P. M., two eggs, raw or cooked, thirteen ounces of water .
The following is a list of articles which a diabetes patient may take as given by one of the best authorities in the world on diabetes:
Liquids: Soups.—Ox tail, turtle bouillon and other clear soups. Lemonade, coffee, tea, chocolate and cocoa; these to be taken without sugar, but they may be sweetened with saccharin. Potash or soda water and appollinaris, or the Saratoga-vichy and milk in moderation may be used.
Animal Food.—Fish of all sorts, including crabs, oysters, salt and fresh butcher's meat (with the exception of liver), poultry and game, eggs, buttermilk, curds and cream cheese.
Bread.—Gluten and bran bread, almond and cocoanut biscuits.
Vegetables.—Lettuce, tomatoes, spinach, chickory, sorrel, radishes, asparagus, water-cress, mustard and cress, cucumber, celery and endives; pickles of various sorts.
Fruits.—Lemons and oranges, currants, plums, cherries, pears, apples (tart), melons, raspberries and strawberries may be taken in moderation. Nuts, as a rule, allowable.
Must Not Take—
Thick Soups and Liver. Ordinary bread of all sorts (in quantity), rye, wheaten, brown or white. All farinaceous (starchy) preparations, such as hominy, rice, tapioca, arrowroot, sago and vermicelli.
Vegetables: Potatoes, turnips, parsnips, squashes, vegetable-marrows of all kinds, beets, common artichokes.
Liquids: Beer, sparkling wine of all sorts and the sweet aerated drinks.
Medicines. Codeine.—A patient may begin with one-half grain three times a day, which may be gradually increased to six or eight grains in the twenty-four hours (under the doctor's care); withdraw it gradually when sugar is absent or reduced as far as possible.