FOOTNOTES:[9]Caution. Poisonous.
[9]Caution. Poisonous.
[9]Caution. Poisonous.
Rheumatism and Kindred Diseases
Causes of Rheumatic Fever—Relief of Pain in the Joints—Lumbago—Stiff Neck—Gout—Symptoms and Cure of Scurvy.
RHEUMATIC FEVER; INFLAMMATORY RHEUMATISM; ACUTE RHEUMATISM.—This variety of rheumatism is quite distinct from the other forms, being in all probability due to some special germ. It occurs in temperate climates during the fall, winter, and spring—less often in summer. Persons more frequently suffer between the ages of ten and forty years. It is rare in infants; their pain and swelling of the limbs can be attributed more often to scurvy (p.180), or to surgical disease with abscess of joint or bone. Exposure to cold and damp, in persons insufficiently fed, fatigued, or overworked, is the most common exciting cause.
Symptoms.—Rheumatic fever may begin with tonsilitis, or other sore throat, with fever and pains in the joints. The joints rapidly become very painful, hot, red, swollen, and tender, the larger joints, as the knees, wrists, ankles, and elbows, being attacked in turn, the inflammation skipping from one joint to another. The muscles near the joints may be also somewhat swollen and tender. With the fever, which may behigh (the temperature ranging from 102° to 104° F.), there are rapid pulse, copious sweating, and often the development of various rashes and minute blisters on the skin. There is also loss of appetite, and the bowels are constipated. The urine is usually very dark-colored. Altogether, victims of the disease are truly pitiable, for they suffer agony, and are unable to move without increasing it. The weakness and prostration are marked. Small, hard lumps, from the size of a shot to that of a pea, sometimes appear on the skin of the fingers, hands, wrists, knees, and elbows. These are not tender; they last for weeks and months. They are seen more often in children, and are most characteristic of rheumatic fever, but do not show themselves till late in the disease.
Complications of rheumatic fever are many. In about half the cases the heart becomes involved, and more or less permanent crippling of the heart persists in after life. Unconsciousness and convulsions may develop—more often when the fever runs high.
Lung trouble and pleurisy are not infrequent. Chorea or St. Vitus's dance follows inflammatory rheumatism, in children, in some instances. Repeated attacks at intervals, varying from one to four or five years, are rather the rule—more particularly in young persons. Acute rheumatism frequently takes a milder form, with slight fever (the temperature running not over 100° or 101° F.) and slight pain, and swelling of the joints. In children this isa common occurrence, but heart disease is just as apt to follow, and, therefore, such cases should receive a physician's attention at the earliest moment. Recovery from rheumatic fever is the usual result, but with an increased tendency to future attacks, and with the possibility of more or less permanent weakness of the heart, for acute rheumatism is the most common origin of chronic heart troubles. The milder form often follows the more severe, and may persist for a long time. The duration of rheumatic fever is variable; in severe cases the patient is bedridden for six weeks or so.
Rheumatism may be named through a mistake in diagnosis. There are numerous other febrile disorders in which inflammation of the joints may occur. Among these are gonorrhea, pneumonia, scarlet fever, blood poisoning, diphtheria, etc. The joint trouble in these cases is caused by the toxins accompanying the special germ which occasions the original disease, and the joint inflammation is not in any way connected with rheumatism. The constant attention of a physician is emphatically demanded in every case of rheumatic fever, since the complications are so numerous, and since permanent damage of the heart may be prevented by proper care. Only frequent examinations of the heart by the medical man will reveal the presence or absence of heart complications.
Treatment.—It appears extremely doubtful whether rheumatic fever can be cut short by any form of treatment. The disease is self-limited, that is, it will pass away of itself after a certain time. The pain, however, can be rapidly abated by treatment. Warmth is of great value. It is best for the patient to sleep between blankets instead of sheets, and to wear flannel nightgowns, changing them as often as they become damp with sweat. To facilitate the changing, it is well to have the nightgowns slit all down the front, and also on the outside of the sleeves. Wrapping the joints in cotton batting and applying splints to secure absolute rest are great aids to comfort. The diet should be fluid, consisting of gruels, milk, broths, and soups. To relieve pain in the joints, cloths, wrung out of a saturated solution of baking soda and very hot water, wrapped about the joint and covered with oil silk will be found extremely serviceable. Oil of wintergreen is another remedy which has proven of value when applied to the joints on cloths saturated in the oil and covered with cotton wool.
The bed must be smooth and soft, with good springs. High fever is reduced by the employment of cold to the head and by sponging the body with cool water at intervals of two hours or so.
The two drugs of most value are some form of salicylic acid and an alkali. Sodium salicylate in solution in water should be given to the adult in doses of ten to fifteen grains every two hours till the pain is relieved, and then once in four hours as long as the fever lasts. At the same time baking soda should be administeredevery three hours, one-half a level teaspoonful dissolved in water, and this may be continued as long as the fever persists. The patient must use a bedpan in relieving the bladder and bowels, and should remain in bed for a great while if the heart is damaged. It is a disease which no layman should think of treating if it is possible to obtain the services of a medical man.
MUSCULAR RHEUMATISM(Myalgia).—In this disease there is pain in the muscles, which may be constant, but is more pronounced on movement. Exposure to cold and wet, combined with muscular strain, frequently excite an attack. On the other hand, it often occurs during hot, dry, fine weather. Attacks last usually but a few days, but may be prolonged for weeks. The pain may be dull, as if the muscle had been bruised, but is often very sharp and cramplike. There is, commonly, slight, if any, fever, and no general disturbance of the health. The following are the most common varieties:
LUMBAGO.—This attacks the muscles in the small part of the back. It comes on often with great suddenness, as on stooping or lifting. It may be so severe that the body cannot be moved, and the patient may fall in the street or be unable to rise or turn in bed. In less severe cases the pain "catches" the patient when attempting to straighten up after stooping. Pain in the back is often attributed by the laity to Bright's disease, but is rarely seen in the latter disorder, and is much more often due to rheumatism.
STIFF NECK.—This is a very common variety of muscular rheumatism, and is seen more especially in young persons. It may appear very suddenly, as on awakening. It attacks the muscles of one side and back of the neck. The head is held stiffly to one side, and to turn the head the body must be turned also, as moving the neck causes severe pain. Sometimes the pain on moving the neck suddenly, or getting it into certain positions, is agonizing, but when it is held in other positions a fair amount of comfort may be secured.
RHEUMATISM OF THE CHEST.—In this form there is more or less constant pain, much increased by coughing, sneezing, taking long breaths, or by movements. It attacks usually one side, more often the left. It may resemble neuralgia or pleurisy. In neuralgia the pain is more limited and comes in sharper attacks, and there are painful spots. The absence of fever in rheumatism of the chest will tend to separate it from pleurisy, in which there is, moreover, often cough. Examination of the chest by a physician, to determine the breath sounds, is the only method to secure certainty in this matter.
Muscular rheumatism also affects the muscles about the shoulder and shoulder blade and upper part of the back; sometimes also the muscles of the belly and limbs.
Treatment.—Rest, heat, and rubbing are the most satisfactory remedies. In stiff neck, rub well withsome liniment, as chloroform liniment, and lie in bed on a hot-water bag. Phenacetin or salophen in doses of ten grains, not repeated more frequently than once in four hours for an adult, may afford relief; only two or three doses should be taken in all. In lumbago the patient should remain in bed and have the back ironed with a hot flatiron, the skin being protected by a piece of flannel. This should be repeated several times a day. Or a large, hot, flaxseed poultice may be applied to the back, and repeated as often as it becomes cool. At other times the patient may lie on a hot-water bag. Plasters will give comfort in milder cases, or when the patient is able to leave the bed. A good cathartic, as two compound cathartic pills, sometimes acts very favorably at the beginning of the attack. Salicylate of sodium is a useful remedy in many cases, the patient taking ten grains three times daily, in tablets after eating, for a number of days. In rheumatism of the chest, securing immobility by strapping the chest, as recommended for broken rib (Vol. I, p. 84), gives more comfort than any other form of treatment. Many other measures may be employed by the physician, and are applicable in persistent cases, as electricity and tonics. The hot bath, or Turkish bath, will sometimes cut short an attack of muscular rheumatism if employed at the onset of the trouble.
CHRONIC RHEUMATISM.—Chronic rheumatism is a disease attacking persons of middle age, or after, and is seen more commonly in poor, hard-working individuals who have been exposed to cold and damp, as laborers and washerwomen. Several of the larger joints, as the knees, shoulders, and hips, are usually affected, but occasionally only one joint is attacked. There is little swelling and no redness about the joint; the chief symptoms are pain on motion, stiffness, and tenderness on pressure. The pain is increased by cold, damp weather, and improved by warm, dry weather. There is no fever. The general health suffers if the pain is severe and persistent, and patients become pale, dyspeptic, and weak. The disease tends rather to grow worse than recover, and the joints, after a long time, to become immovable and misshapen. Life is not, however, shortened to any considerable degree by chronic rheumatism. Heart disease is not caused by this form of rheumatism, although it may arise from somewhat similar tendencies existing in the same patient. It may be distinguished from other varieties of rheumatism by the fact that the larger joints are those attacked, and also by the age of the patients and general progress of the disease. It very rarely follows acute rheumatism.
Treatment.—The treatment of chronic rheumatism is generally not very successful unless the patient can live in a warm, dry climate the year round. Painting the joint with tincture of iodine and keeping it bandaged in flannel affords some relief. The application of a cold, wet cloth covered with oil silk and bandage, by night, also proves useful. Hot baths at night,Turkish baths, or special treatment conducted under the supervision of a competent medical man at one of the hot, natural, mineral springs, as those in Virginia, often prove of great value. Rubbing and movement of the joints is of much service in all cases; any liniment may be used. Drugs are of minor importance, but cod-liver oil and tonics may be required. These should be prescribed by a physician.
RHEUMATIC GOUT(Arthritis).—Notwithstanding the name, this disease has no connection with either gout or the other forms of rheumatism described. It occurs much more frequently in women, with the exception of that form in which a single joint is attacked. The disease may appear at any age, but more often it begins between the years of thirty and fifty-five. The cause is still a matter of doubt, although it often follows, or is associated with, nervous diseases, and in other cases the onset seems to be connected with the existence of influenza or gonorrhea, so that it may be of germ origin. Constant exposure to cold and dampness, excessive care and anxiety, and injury are thought to favor the disease. The disease is sometimes limited to the smaller joints of the fingers and toes, little, hard knobs appearing on them. At times the joints may be swollen, tender, and red, and are usually so at the beginning of the disease, as well as at irregular intervals, owing to indigestion, or following injury. At first only one joint, as of the middle finger, may be attacked, and often the corresponding finger on the other hand is next affected. The joints of the fingers become enlarged, deformed, and stiffened. The results of the disease are permanent so far as the deformity is concerned and the stiffness which causes interference with the movement of the finger joints, but the disease may stop during any period of its development, leaving a serviceable, though somewhat crippled, hand. In these cases the larger joints are not generally involved. There is some evidence to indicate that this form of the disease is more commonly seen in the long-lived.
General Form.—In this type the disease tends to attack all the joints, and, in many cases, to go from bad to worse. The hands are usually first attacked, then the knees, feet, and other joints. In the worst cases every joint in the body becomes diseased, so that even movements of the jaw may become difficult. There are at first slight swelling, pain and redness about the joints, with tenderness on pressure. Creaking and grating are often heard during motion of the affected joints. This condition may improve or subside for intervals, but gradually the joints become misshapen and deformed. The joints are enlarged, and irregular and stiff; the fingers become drawn over toward the little finger, or bent toward the palm, and are wasted and clawlike. The larger limbs are often bent and cannot be straightened, and the muscles waste away, making the joints look larger. In the worst cases the patient becomes absolutely crippled,helpless, and bedridden, and the joints become immovable. The pain may be great and persistent, or slight. Usually the pain grows less as the disease advances. Numbness and tingling of the skin often trouble the patient, and the skin is sometimes smooth and glossy or freckled.
The general health suffers, and weakness, anæmia, and dyspepsia are common. Even though most of the joints become useless, there is often sufficient suppleness in the fingers to allow of their use, as in writing or knitting. In old men the disease is seen attacking one joint alone, as the hip, shoulder, knee, and spine. Children are occasionally sufferers, and in young women it may follow frequent confinements or nursing, and often begins in them like a mild attack of rheumatic fever. The heart is not damaged by rheumatic gout.
It is frequently impossible to distinguish rheumatic gout from chronic rheumatism in the beginning. In the latter, creaking and grating sounds on movement of the joints are less marked, the small joints, as of the hand, are not so generally attacked, nor are there as great deformity and loss of motion as is seen in late cases of rheumatic gout.
Outlook.—It often happens that after attacking several joints, the disease is completely arrested and the patient becomes free from pain, and only a certain amount of interference with the use of the joint and stiffness remain. Life is not necessarily shortened bythe disease. The deformity and crippling are permanent.
Treatment.—Rheumatic gout is a chronic disease in most instances, and requires the careful study and continuous care of the medical man. He may frequently be able to arrest it in the earlier stages, and prevent a life of pain and helplessness. In a general way nourishing food, as milk, eggs, cream, and butter, with abundance of fresh vegetables, should be taken to the extent of the digestive powers. Everything that tends to reduce the patient's strength must be avoided. Cod-liver oil and tonics should be used over long periods. Various forms of baths are valuable, as the hot-air bath, and hot natural or artificial baths. A dry, warm climate is most appropriate, and flannel clothing should be worn the year round. Moderate exercise and outdoor life, in warm weather, are advisable, and massage, except during the acute attacks of pain and inflammation, is beneficial. Surgical measures will sometimes aid patients in regaining the usefulness of crippled limbs.
SCURVY.—Scurvy used to be much more common than it is now. In the Civil War there were nearly 50,000 cases in the Union Army. Sailors and soldiers have been the common victims, but now the disease occurs most often among the poorly fed, on shore. It is caused by a diet containing neither fresh vegetables, preserved vegetables, nor vegetable juices. In the absence of vegetables, limes, lemons, oranges,or vinegar will prevent the disease. It is also thought that poisonous substances in the food may occasion scurvy, as tainted meat has experimentally produced in monkeys a disease resembling it. Certain conditions, as fatigue, cold, damp quarters, mental depression and homesickness, favor the development of the disease. It attacks all ages, but is most severe in the old.
Symptoms.—Scurvy begins with general weakness and paleness. The skin is dry, and has a dirty hue. The gums become swollen, tender, spongy, and bleed easily, and later they may ulcerate and the teeth loosen and drop out. The tongue is swollen, and saliva flows freely. The appetite is poor and chewing painful, and the breath has a bad odor. The ankles swell, and bluish spots appear on the legs which may be raised in lumps above the surface. The patient suffers from pain in the legs, which sometimes become swollen and hard. The blue spots are also seen on the arms and body, and are due to bleeding under the skin, and come on the slightest bruising. Occasionally there is bleeding from the nose and bowels. The joints are often swollen, tender, and painful. Constipation is rather the rule, but in bad cases there may be diarrhea, nausea, and vomiting, and the victim becomes a walking skeleton. Mental depression or delirium may be present.
Treatment.—Recovery is usually rapid and complete, unless the disease is far advanced. Soups, freshmilk, beef juice, and lemon or orange juice may be given at first, when the digestion is weak, and then green vegetables, as spinach (with vinegar), lettuce, cabbage, and potatoes. The soreness of the mouth is relieved by a wash containing one teaspoonful of carbolic acid to the quart of hot water. This should be used to rinse the mouth several times daily, but must not be swallowed. Painting the gums with a two per cent solution of silver nitrate in water, by means of a camel's-hair brush, twice daily, will also prove serviceable. To act as a tonic, a two-grain quinine pill and two Blaud's pills of iron may be given three times daily.
INFANTILE SCURVY.—Scurvy occasionally occurs in infants between twelve and eighteen months of age, and is due to feeding on patent foods, condensed milk, malted milk, and sterilized milk. In case it is essential to use sterilized or pasteurized milk, if the baby receives orange juice, as advised under the care of infants, scurvy will not develop.
Scurvy is frequently mistaken for either rheumatism or paralysis in babies.
Symptoms.—The lower limbs become painful, and the baby cries out when it is moved. The legs are at first drawn up and become swollen all around just above the knees, but not the knee joints themselves. Later the whole thigh swells, and the baby lies without moving the legs, with the feet rolled outward and appears to be paralyzed, although it is only pain whichprevents movement of the legs. Sometimes there is swelling about the wrist and forearm, and the breastbone may appear sunken in. Purplish spots occur on the legs and other parts of the body. The gums, if there are teeth present, become soft, tender, spongy, and bleed easily. There may be slight fever, the temperature ranging from 101° to 102° F. The babies are exceedingly pale, and lose all strength.
Treatment.—The treatment is very simple, and recovery rapidly takes place as soon as it is carried out. The feeding of all patent baby foods—condensed or sterilized milk—must be instantly stopped. A diet of fresh milk, beef juice, and orange juice, as directed under the care of infants, will bring about a speedy cure.
GOUT.—Notwithstanding the frequency with which one encounters allusions to gout in English literature, it is unquestionably a rare disease in the United States. In the Massachusetts General Hospital there were, among 28,000 patients admitted in the last ten years, but four cases of gout. This is not an altogether fair criterion, as patients with gout are not generally of the class who seek hospitals, nor is the disease one of those which would be most likely to lead one into a hospital. Still, the experience of physicians in private practice substantiates the view of the rarity of gout in this country.
We are still ignorant of the exact changes in the bodily condition which lead to gout, but may say ina general way that in this disease certain products, derived from our food and from the wear and tear of tissues, are not properly used up or eliminated, and are retained in the body. One of these products is known as sodium biurate, and is deposited in the joints, giving rise to the inflammation and changes to be described. Gout occurs chiefly in men past forty. The tendency to the disease is usually inherited. Overeating, together with insufficient exercise and indulgence in alcohol, are conducive to its development in susceptible persons. Injuries, violent emotion, and exposure to cold are also thought to favor attacks.
The heavier beers and ales of England, together with their stronger wines, as port, Madeira, sherries, and champagne, are more prone to induce gout than the lighter beers drunk in the United States and Germany. Distilled liquors, as brandy and whisky, are not so likely to occasion gout. "Poor man's gout" may arise in individuals who lead the most temperate lives, if they have a strong inherited tendency to the disease, or when digestion and assimilative disorders are present, as well as in the case of the poor who drink much beer and live in bad surroundings, and have improper and insufficient food. Workers in lead, as typesetters and house painters, are more liable to gout than others.
Symptoms.—There is often a set of preliminary symptoms varying in different persons, and giving warning of an approaching attack of gout, such asneuralgic pains, dyspepsia, irritability, and mental depression, with restless nights. An acute attack generally begins in the early morning with sudden, sharp, excruciating pain in the larger joint of one of the big toes, more often the right, which becomes rapidly dark red, mottled, swollen, hot, tense, shiny, and exceedingly sensitive to touch. There is commonly some fever; a temperature of 102° to 103° F. may exist. The pain subsides in most cases to a considerable degree during the day, only to return for several nights, the whole period of suffering lasting from four to eight days. Occasionally the pain may be present without the redness, swelling, etc., orvice versa.
Other joints may be involved, particularly the joint of the big toe of the other foot. Complete recovery ensues, as a rule, after the first attack, and the patient may thereafter feel exceptionally well. A return of the disease is rather to be expected. Several attacks within the year are not uncommon, or they may appear at much longer intervals.
Occasionally the gout seems to "strike in." In this case it suddenly leaves the foot and attacks the heart, causing the patient severe pain in that region and great distress in breathing; or the abdomen becomes the seat of violent pain, and vomiting, diarrhea, collapse and death rarely result. In the later history of such patients, the acute attacks may cease and various joints become chronically diseased, so that the case assumes the appearance of a chronic form ofrheumatism. The early history of attacks of sharp pain in the great toe and the appearance of hard deposits (chalk stones) in the knuckles and the ears are characteristic of gout.
The greatest variety of other disorders are common in those who have suffered from gout, or in those who have inherited the tendency. "Goutiness" is sometimes used to describe such a condition. In this there may never be any attacks of pain or inflammation affecting the joints, but eczema and other skin diseases; tonsilitis, neuralgia, indigestion and biliousness, lumbago and other muscular pains, sick headache, bronchitis, disease of heart and kidneys, with a tendency to apoplexy, dark-colored urine, stone in the bladder, and a hot, itching sensation in the palms of the hands and soles of the feet, all give evidence of the gouty constitution.
Treatment.—One of the most popular remedies is colchicum—a powerful drug and one which should only be taken under the direction of a physician. A cathartic at the beginning is useful; for instance, two compound cathartic pills or five grains of calomel. It is well to give five grains of lithium citrate dissolved in a glass of hot water every three hours.
Laville's antigout liquid, imported by Fougera of New York, taken according to directions, may suffice during the absence of a physician. The inflamed toe should be raised on a chair or pillow, and hot cloths may be applied to it. The general treatment, betweenthe attacks, consists in the avoidance of all forms of alcohol, the use of a diet rich in vegetables, except peas, beans, and oatmeal, with meats sparingly and but once daily. Sweets must be reduced to the minimum, but cereals and breadstuffs are generally allowable, except hot bread. All fried articles of food, all smoked or salted meats, smoked or salted fish, pastry, griddle cakes, gravies, spices and seasoning, except red pepper and salt, and all indigestibles are strictly forbidden, including Welsh rarebit, etc. Fruit may be generally eaten, but not strawberries nor bananas. Large quantities of pure water should be taken between meals—at least three pints daily. Mineral waters offer no particular advantage.
Part IIISEXUAL HYGIENEBYKENELM WINSLOW
SEXUAL HYGIENE
BY
KENELM WINSLOW
Health and Purity
Duties of Parents—Abuse of the Sexual Function—False Teachings—Criminal Neglect—Secure the Child's Confidence—The Best Corrections—Marriage Relations.
Every individual should know how to care for the sexual organs as well as those of any other part of the body, providing that the instruction be given by the proper person and at the proper time and place. Such information should be imparted to children by parents, guardians, or physicians at an early age and, if this is neglected through ignorance or false modesty, erroneous ideas of the nature and purpose of the sexual function will very surely be supplied later by ignorant and probably evil-minded persons with correspondingly bad results. There is no other responsibility in the whole range of parental duties which is so commonly shirked and with such deplorable consequences. When the subject is shorn of the morbid and seductive mystery with which custom has foolishly surrounded it in the past, and considered in the same spirit with which we study the hygiene of the digestion and other natural functions, it will be found possible to give instruction about the sexual function in a natural way and without exciting unhealthy and morbid curiosity.
A word in the beginning as to the harm produced by abuse of the sexual function. The injury thus received is purposely magnified tenfold for reasons of gain by quacks who work upon the fears of their victims for their own selfish purposes. The voluntary exercise of the sexual function—unlike that of any other important organs—is not necessary to health until maturity has been reached; on the contrary, continence is conducive to health, both physical and mental. Even after maturity, unless marriage occurs, or by improper living the sexual desires are unnaturally stimulated, it is quite possible to maintain perfect health through life without exercising the sexual function at all. Undue irritation of the sexual organs causes disorder of the nervous system, and if continued it will result ultimately in overfatigue and failure of the nervous activities which control the normal functions of every organ in the body. In other words, it will result in nervous exhaustion.
Damage is also wrought by exciting local irritation, congestion, and inflammation of the sexual organs which result in impairment of the proper functions of these parts and in local disorders and distress. It is unnecessary further to particularize other than to state that abuse of the sexual organs in the young is usually owing to the almost criminal neglect or ignorance of the child's parents. But so far from increasing alarm in the patient it is almost always possible to enable the child to be rid of the habit bykindly instruction and judicious oversight in the future, and no serious permanent local damage to the sexual organs or general injury to the nervous system will be likely to persist. The opposite teaching is that peculiar to the quack who prophesies every imaginable evil, from complete loss of sexual function to insanity. Any real or fancied disorder of the sexual function is extremely apt to lead to much mental anxiety and depression, so that a cheerful outlook is essential in inspiring effort to correct bad habits and is wholly warranted in view of the entire recovery in most cases of the young who have abused their sexual organs. Insanity or imbecility are seldom the result but more often the cause of such habits. It is a sad fact, however, that, under the prevailing custom of failure of the parents to exercise proper supervision over the sexual function of their children, self-abuse is generally practiced in youth, at least by boys.
This often leads to temporary physical and mental suffering and is very prejudicial to the morals, but does not commonly result in permanent injury except in the degenerate. Children at an early age—three to four years—should be taught not to touch, handle, rub, or irritate their sexual organs in any way whatsoever except so far as is necessary in urination or in the course of the daily cleansing. If there seems to be any inclination to do so it will usually be found that it is due to some local trouble to which a physician's attention should be called and which may generallybe readily remedied by him. It is always advisable to ask the medical adviser to examine babies for any existing trouble and abnormality of the sexual organs, as a tight, adherent, or elongated foreskin in boys—and rarely a corresponding condition in girls—may give rise to much local irritation and remote nervous disturbances. The presence of worms may lead to irritation in the bowel, which excites masturbation in children. Girl babies should be watched to prevent them from irritating the external sexual parts by rubbing them between the inner surfaces of the thighs. As the child begins to play with other children he or she should be cautioned to avoid those who in any way try to thwart the parents' advice, and be instructed to report all such occurrences. It is wise also to try and gratify the child's natural curiosity about the sexual function so far as may be judicious by explanations as to the purpose of the sexual organs, when the child is old enough to comprehend such matters.
The reticence and disinclination of parents to instruct their children in matters relating to sex cannot be too strongly condemned. It is perfectly natural that the youth should wish to know something of the origin of life and how human beings come into the world. The mystery and concealment thrown around these matters only serve to stimulate his curiosity. It is a habit of most parents to rebuke any questions relating to this subject as improper and immodest, and the first lesson the child learns is to associate the ideaof shame with the sexual organs; and, since he is not enlightened by his natural instructors, he picks up his knowledge of the sex function in a haphazard way from older and often depraved companions.
Evasive replies with the intent of staving off the dreaded explanation do no good and may result in unexpected evil. By securing the child's confidence at the start, one may not only keep informed of his actions but protect him from seeking or even listening to bad counsels. At the age of ten or twelve it is well that the family physician or parent should give instruction as to the special harm which results from unnaturally exciting the sexual nature by handling and stimulating the sexual organs and also warning the child against filthy literature and improper companions. At the age of puberty he should be warned against the moral and physical dangers of sexual intercourse with lewd women. The physical dangers refer to the great possibility of infection with one or both of the common diseases—syphilis and gonorrhea—acquired by sexual contact with one suffering from these terrible disorders (p.199). It is usually quite impossible for a layman to detect the presence of these diseases in others, or rather, to be sure of their absence, and the permanent damage which may be wrought to the sufferer and to others with whom he may have sexual relations is incalculable. It is generally known that syphilis is a disease to be dreaded, but not perhaps that it not only endangers the lifeand happiness of the patient, but the future generation of his descendants. Gonorrhea—the much more common disease—while often treated lightly by youth, frequently leads to long, chronic, local disease and may even result fatally in death; later in life it may cause infection of a wife resulting in chronic invalidism and necessitating surgical removal of her maternal organs. These possibilities often occur long after the patient thinks he is wholly free from the disease. Gonorrhea in women is the most frequent cause of their sterility, and also is a common source of abortion and premature birth. It is the cause in most cases of blindness in infants (p.205) and also of vulvo-vaginitis in girl babies. Furthermore, gonorrhea is so alarmingly prevalent that it is stated on good authority that the disease occurs in eighty per cent of all males some time during their lives. The disease is not confined to prostitutes, but is common, much more frequently than is suspected, in all walks and classes of life and at all ages. Even among boys attending boarding schools and similar institutions the disease is only too frequent. It is particularly important that the true situation be explained to boys about to enter college or a business career, for it is at this period of life that their temptations become greatest. Alcohol is the most dangerous foe—next to bad companions—with which they must contend in this matter, for, weakened by its influence and associated with persuasive friends, their will gives way and the advice andwarning, which they may have received, are forgotten. Idleness is also another influential factor in indirectly causing sexual disease; hard physical and mental work are powerful correctives of the passions.
It may be of interest to readers to know that but recently an association of American physicians, alarmed by the fearful prevalence of sexual diseases in this country, has been taking measures to inform youths and adults and the general public, through special instruction in schools, and by means of pamphlets and lectures to teachers and others, of the prevalence and great danger of this evil.
When young adult life has been attained it is also desirable for the parent, or the family physician, to inform the young man or woman—especially if either is about to enter a marriage engagement—that close and frequent personal contact with the opposite sex, especially when the affections are involved, will necessarily, though involuntarily, excite local stimulation of the sexual organs and general irritability and exhaustion of the entire nervous system. Long engagements—when the participants are frequent companions—are thus peculiarly unfortunate. It is only when the sexual functions are normally exercised in adult life, as in sexual intercourse, that sexual excitement is not harmful.
Young women about to marry should receive instruction from their mothers as to the sexual relations which will exist after marriage. Most girls are allowed to grow up ignorant of such matters and in consequence may become greatly shocked and even disgusted by the sexual relations in marriage—fancying that there must be something unnatural and wrong about them because the subject was avoided by those responsible for their welfare.
Any excess in frequency of sexual intercourse after marriage is followed by feelings of depression and debility of some sort which may be readily attributed to the cause and so corrected. Any deviation from the natural mode of intercourse is pretty certain to lead to physical disaster; thus, unnatural prolongation of the act, or withdrawal on the part of the man before the natural completion of the act in order to prevent conception, often results in deplorable nervous disorders.
In conclusion, it may be said that parents must take upon themselves the burden of instructing their children in sexual hygiene or shift it upon the shoulders of the family physician, who can undertake it with much less mental perturbation and with more intelligence. Otherwise they subject their offspring to the possibility of incalculable suffering, disease, and even death—largely through their own inexcusable neglect.
Genito-Urinary Diseases
Contagious Disorders—Common Troubles of Children—Inflammation of the Bladder—Stoppage and Suppression of Urine—Causes and Treatment of Bright's Disease.
GONORRHEA.—Gonorrhea is a contagious inflammation of the urethra, accompanied by a white or yellowish discharge. It is caused by a specific germ, thegonococcus, and is acquired through sexual intercourse with a person suffering from this disease. Exceptionally the disease may be conveyed by objects soiled with the discharge, as basins, towels, and, in children, diapers, so that in institutions for infants it may be thus transferred from one to the other, causing an epidemic. The mucous membrane of the lower part of the bowel and the eyes are also subject to the disease through contamination with the discharge. The disease begins usually three to seven days after sexual intercourse, with symptoms of burning, smarting, and pain on urination, and a watery discharge from the passage, soon followed by a yellowish or white secretion. Swelling of the penis, frequent urination, and painful erections are also common symptoms. The disease, if uncomplicated and running a favorablecourse, may end in recovery within six weeks or earlier, with proper treatment. On the other hand, complications are exceedingly frequent, and the disorder often terminates in a chronic inflammation which may persist for years—even without the knowledge of the patient—and may result in the infection of others after all visible signs have ceased to appear.
Treatment.—Rest is the most important requisite; at first, best in bed; if not, the patient should keep as quiet as possible for several days. The diet should consist of large quantities of water or milk, or milk and vichy, with bread, cereals, potatoes, and vegetables—absolutely avoiding alcohol in any form. Sexual intercourse is harmful at any stage in the disease and will communicate the infection. Aperient salts should be taken to keep the bowels loose. The penis should be soaked in hot water three times daily to reduce the inflammation and cleanse the organ. A small wad of absorbent cotton may be held in place by drawing the foreskin over it to absorb the discharge, or may be held in place by means of a bag fitting over the penis. All cloths, cotton, etc., which have become soiled with the discharge, should be burned, and the hands should be washed after contact with the discharge; otherwise the contagion may be conveyed to the eyes, producing blindness. It is advisable for the patient to take one-half teaspoonful of baking soda in water three times daily between meals for the first four or five days, or, better, fifteen grains of potassium citrate and fifteendrops of sweet spirit of nitre in the same way. Painful erections may be relieved by bathing the penis in cold water, urinating every three hours, and taking twenty grains of sodium bromide at night in water. After all swelling and pain have subsided, local treatment may be begun.
Injections or irrigations with various medicated fluids constitute the best and most efficient measures of local treatment. They should be used only under the advice and management of the physician. No greater mistake can be made than to resort to the advertising quack, the druggist's clerk, or the prescription furnished by an obliging friend. Skillful treatment, resulting in a complete radical cure, may save him much suffering from avoidable complications and months or years of chronic trouble.
At the same time the first medicines advised are stopped and oleoresin of cubebs, five grains, or copaiba balsam, ten grains—or both together—are to be taken three times daily after meals, in capsules, for several weeks, unless they disturb the digestion too much. A suspensory bandage should be worn throughout the continuance of the disease. The approach of the cure of the disease is marked by a diminution in the quantity and a change in the character of the discharge, which becomes thinner and less purulent and reduced to merely a drop in the passage in the early morning, but this may continue for a great while. Chronic discharge of this kind and the complications cannot betreated properly by the patient, but require skilled medical care.
In this connection it may be said that most patients have an idea that the subsidence or disappearance of the discharge is an evidence of the cure of the disease. Experience shows that the disease may lapse into a latent or chronic form and remain quiescent, without visible symptoms, during a prolonged period, while susceptible of being revived under the influence of alcoholic drinks or sexual intercourse. It is important that treatment should be continued until all disease germs are destroyed, which can only be determined by an examination of the secretions from the urethra under the microscope.
The more common complications of gonorrhea are inflammation of the glands in the groin (bubo), acute inflammation of the prostate glands and bladder, of the seminal vesicles, or of the testicles. The latter complication is a most common cause of sterility in men. Formerly it was thought that gonorrhea was a local inflammation confined to the urinary canal and neighboring parts, but advances in our knowledge have shown that the germs may be taken up into the general circulation and affect any part of the body, such as the muscles, joints, heart, lungs, liver, spleen, kidneys, etc., with results always serious and often fatal to life. One of the most common complications is gonorrheal arthritis, which may affect one or several joints and result in stiffness or complete loss of movement of the affected joint, with more or less deformity and permanent disability. Another complication is gonorrheal inflammation of the eye, from direct transference of the pus by the fingers or otherwise, and resulting in partial or complete blindness.
GONORRHEA IN WOMEN.—Gonorrhea in women is a much more frequent and serious disease than was formerly supposed. The general impression among the laity is that gonorrhea in women is limited to the prostitute and vicious classes who indulge in licentious relations. Unfortunately, this is not the case. There is perhaps more gonorrhea, in the aggregate, among virtuous and respectable wives than among professional prostitutes, and the explanation is the following: A large proportion of men contract the disease at or before the marrying age. The great majority are not cured, and the disease simply lapses into a latent form. Many of them marry, believing themselves cured, and ignorant of the fact that they are bearers of contagion. They transmit the disease to the women they marry, many of whom, from motives of modesty and an unwillingness to undergo an examination do not consult a physician, and they remain ignorant of the existence of the disease until the health is seriously involved. In women, gonorrhea is not usually so acute and painful as in men, unless it involves the urethra. It usually begins with smarting and painful urination, with frequent desire to urinate and with a more or less abundant discharge from the front passage. In the majority ofcases the infection takes place in the deeper parts, that is, in the neck or body of the womb. In this location it may not give rise at first to painful symptoms, and the patient often attributes the increased discharge to an aggravation of leucorrhea from which she may have suffered. The special danger to women from gonorrhea is that the inflammation is apt to be aggravated during the menstrual period and the germs of the disease ascend to the cavity of the womb, the tubes, and ovaries, and invade the peritoneal covering, causing peritonitis. Pregnancy and childbirth afford favorable opportunities for the upward ascension of the germs to the peritoneal cavity. The changes caused by gonorrheal inflammation in the maternal organs are the most common cause of sterility in women. It is estimated that about fifty per cent of all sterility in women proceeds from this cause. In addition to its effects upon the child-bearing function, the danger to the health of such women is always serious. In the large proportion of cases they are made permanent invalids, no longer able to walk freely, but compelled to pass their lives in a reclining position until worn out by suffering, which can only be relieved by the surgical removal of their maternal organs. It is estimated that from fifty to sixty per cent of all operations performed on the maternal organs of women are due to disease caused by gonorrheal inflammation.
Treatment.—Rest in bed, the use of injections of hot water, medicated with various astringents, bymeans of a fountain syringe in the front passage three times daily, and the same remedies and bath recommended above, with hot sitz baths, will usually relieve the distress. In view of the serious character of this affection in women and its unfortunate results when not properly treated, it is important that they should have the benefit of prompt and skillful treatment by a physician. Otherwise, the health and life of the patient may be seriously compromised.
The social danger of gonorrhea introduced after marriage is not limited to the risks to the health of the woman. When a woman thus infected bears a child the contagion of the disease may be conveyed to the eyes of the child in the process of birth. Gonorrheal pus is the most virulent of all poisons. A single drop of the pus transferred to the eye may destroy this organ in from twenty-four to forty-eight hours. It is estimated that from seventy-five to eighty per cent of all babies blinded at birth have suffered from this cause, while from twenty to thirty per cent of blindness from all causes is due to gonorrhea. While the horrors of this disease in the newborn have been mitigated by what is called the Crédé method (instillation of nitrate of silver solution in the eye immediately after birth), it still remains one of the most common factors in the causation of blindness. Another social danger is caused by the pus being conveyed to the genital parts of female children, either at birth or by some object upon which it has beenaccidentally deposited, such as clothes, sponges, diapers, etc. These cases are very common in babies' hospitals and institutions for the care of children. Quite a number of epidemics have been traced to this cause. The disease occurring in children is exceedingly difficult of cure and is often followed by impairment in the development of their maternal organs. Much of the ill health of young girls from disordered menstruation and other uterine diseases may be traced to this cause. Another serious infection in babies and young children is gonorrheal inflammation of the joints, with more or less permanent crippling.
SYPHILIS; THE POX; LUES.—Syphilis is a contagious germ disease affecting the entire system. While commonly acquired through sexual intercourse with a person affected with the disorder, it may be inherited from the parents, one or both. It is often acquired through accidental contact with sources of contagion. Syphilis and tuberculosis are the two great destroyers of health and happiness, but syphilis is the more common.
Symptoms.—Acquired syphilis may be divided into three stages: the primary, secondary, and tertiary. The first stage is characterized by the appearance of a pimple or sore on the surface of the sexual organ not usually earlier than two, nor later than five to seven, weeks after sexual intercourse. The appearance of this first sore is subject to such variations that it is not always possible for even the most skillful physicianto determine positively the presence of syphilis in any individual until the symptoms characteristic of the second stage develop. Following the pimple on the surface of the penis comes a raw sore with hard deposit beneath, as of a coin under the skin. It may be so slight as to pass unnoticed or become a large ulcer, and may last from a few weeks to several months. There are several other kinds of sores which have no connection with syphilis and yet may resemble the syphilitic sore so closely that it becomes impossible to distinguish between them except by the later symptoms to be described. Along with this sore, lumps usually occur in one or both groins, due to enlarged glands.
The second stage appears in six to seven weeks after the initial sore, and is characterized by the occurrence of a copper-colored rash over the body, but not often on the face, which resembles measles considerably. Sometimes a pimply or scaly eruption is seen following this or in place of the red rash. At about, or preceding, this period other symptoms may develop, as fever, headache, nausea, loss of appetite, and sleeplessness, but these may not be prominent. Moist patches may appear on the skin, in the armpits, between the toes, and about the rectum; or warty outgrowths in the latter region. There is sore throat, with frequently grayish patches on the inside of the cheeks, lips, and tongue. The hair falls out in patches or, less often, is all lost. Inflammation of the eye is sometimes a symptom. These symptoms do not alwaysoccur at the same time, and some may be absent or less noticeable than others.
The third stage comes on after months or years, or in those subjected to treatment may not occur at all. This stage is characterized by sores and ulcerations on the skin and deeper tissues, and the occurrence of disease of different organs of the body, including the muscles, bones, nervous system, and blood vessels; every internal organ is susceptible to syphilitic change.
A great many affections of the internal organs—the heart, lungs, liver, kidneys, brain, and cord—which were formerly attributed to other causes, are now recognized as the product of syphilis. The central nervous system is peculiarly susceptible to the action of the syphilitic poison, and when affected may show the fact through paralysis, crippling, disabling, and disfiguring disorders.
Years after cure has apparently resulted, patients are more liable to certain nervous disorders, as locomotor ataxia, which attacks practically only syphilitics; and general paresis, of which seventy-five per cent of the cases occur in those who have had syphilis.
Inherited Syphilis.—Children born with syphilis of syphilitic parents show the disease at birth or usually within one or two months. They present a gaunt, wasted appearance, suffer continually from snuffles or nasal catarrh, have sores and cracks about the lips, loss of hair, and troublesome skin eruptions. The syphilitic child has been described as a "little old manwith a cold in his head." The internal organs are almost invariably diseased, and sixty to eighty per cent of the cases fortunately die. Those who live to grow up are puny and poorly developed, so that at twenty they look not older than twelve, and are always delicate.
It is to be noted that syphilis is not necessarily a venereal disease, that is, acquired through sexual relations. It may be communicated by kissing, by accidental contact with a sore on a patient's body, by the use of pipes, cups, spoons, or other eating or drinking utensils, or contact with any object upon which the virus of the disease has been deposited.
Any part of the surface of the body or mucous membrane is susceptible of being inoculated with the virus of syphilis, followed by a sore similar to what has been described as occurring upon the genital parts and later the development of constitutional symptoms. The contagiousness of the disease is supposed to last during the first three years of its existence, but there are many authentic cases of contagion occurring after four or five years of syphilis.
Diagnosis.—The positive determination of the existence of syphilis at the earliest moment is of the utmost importance in order to set at rest doubt and that treatment may be begun. It is necessary to wait, however, until the appearance of the eruption, sore throat, enlargement of glands, falling out of hair, etc., before it is safe to be positive.
Treatment.—The treatment should be begun as soon as the diagnosis is made, and must be continuously and conscientiously pursued for three years or longer. If treatment is instituted before the secondary symptoms, it may prevent their appearance so that the patient may remain in doubt whether he had the disease or not, for it is impossible for the most skilled specialist absolutely to distinguish the disease before the eruption, no matter how probable its existence may seem. This happens because there are several kinds of sores which attack the sexual organs and which may closely simulate syphilis. The treatment is chiefly carried out with various forms of mercury and iodides, but so much knowledge and experience are required in adapting these to the individual needs and peculiarities of the patient that it is impossible to describe their use. Patients should not marry until four or five years have elapsed since the appearance of syphilis in their persons, and at least twelve months after all manifestations of the disease have ceased. If these conditions have been complied with, there is little danger of communicating the disease to their wives or transmitting it to their offspring. They must moreover, have been under the treatment during all this period. Abstinence from alcohol, tobacco, dissipation, and especial care of the teeth are necessary during treatment.
Results.—The majority of syphilitics recover wholly under treatment and neither have a return ofthe disease nor communicate it to their wives or children. It is, however, possible for a man, who has apparently wholly recovered for five or six years or more, to impart the disease. Without proper treatment or without treatment for the proper time, recurrence of the disease is frequent with the occurrence of the destructive and often serious symptoms characteristic of the third stage of the disease. While syphilis is not so fatal to life as tuberculosis, it is capable of causing more suffering and unhappiness, and is directly transmitted from father to child, which is not the case with consumption. Syphilis is also wholly preventable, which is not true of tuberculosis at present. It is not probable that syphilis is ever transmitted to the third generation directly, but deformities, general debility, small and poor teeth, thin, scanty growth of hair, nervous disorders, and a general miserable physique are seen in children whose parents were the victims of inherited syphilis. In married life syphilis may be communicated to the wife directly from the primary sore on the penis of the husband during sexual intercourse, but contamination of the wife more often happens from the later manifestations of the disease in the husband, as from secretion from open sores on the body or from the mouth, when the moist patches exist there.
It is possible for a child to inherit syphilis from the father—when the germs of syphilis are transmitted through the semen of the father at the time ofconception—and yet the mother escape the disease. On the other hand, it is not uncommon for the child to become thus infected and infect its mother while in her womb; or the mother may receive syphilis from the husband after conception, and the child become infected in the womb.
The chief social danger of syphilis comes from its introduction into marriage and its morbid radiations through family and social life. Probably one in every five cases of syphilis in women is communicated by the husband in the marriage relation. There are so many sources and modes of its contagion that it is spread from one person to another in the ordinary relations of family and social life—from husband to wife and child, from child to nurse, and to other members of the family, so that small epidemics of syphilis may be traced to its introduction into a family. Syphilis is the only disease which is transmitted in full virulence to the offspring, and its effect is simply murderous. As seen above, from sixty to eighty per cent of all children die before or soon after birth. One-third of those born alive die within the next six months, and those that finally survive are blighted in their development, both physical and mental, and affected with various organic defects and deformities which unfit them for the battle of life. Syphilis has come to be recognized as one of the most powerful factors in the depopulation and degeneration of the race.
INVOLUNTARY PASSAGE OF URINE—BED-WETTING IN CHILDREN.—(Incontinence of Urine).—This refers to an escape of urine from the bladder uncontrolled by the will. It naturally occurs in infants under thirty months, or thereabouts, and in the very old, and in connection with various diseases. It may be due to disease of the brain, as in idiocy or insanity, apoplexy, or unconscious states. Injuries or disorders of the spinal cord, which controls the action of the bladder (subject to the brain), also cause incontinence. Local disorders of the urinary organs are more frequent causes of the trouble, as inflammation of any part of the urinary tract, diabetes, nephritis, stone in the bladder, tumors, and malformations. The involuntary passage of urine may arise from irritability of bladder—the most frequent cause—or from weakness of the muscles which restrain the escape of urine, or from obstruction to flow of urine from the bladder, with overflow when it becomes distended.
It is a very common disorder of children and young persons, and in some cases no cause can be found; but in many instances it is due to masturbation (p.193), to a narrow foreskin and small aperture at the exit of the urinary passage, to worms in the bowels or disease of the lower end of the bowels, such as fissure or eczema, to digestive disorders, to retaining the urine overlong, to fright, to dream impressions (dreaming of the act of urination), and to great weakness brought on by fevers or other diseases. In old men it is oftendue to an enlargement of a gland at the neck of the bladder which prevents the bladder from closing properly. A concentrated and irritating urine, from excessive acidity or alkalinity, may induce incontinence.
Children may recover from it as they approach adult life, but they should not be punished, as it is a disease and not a fault. Exception should be made in case children wet their clothing during play, through failure to take the time and trouble to pass water naturally. It is more common among children at night, leading to wetting of the bed, but may occur in the day, and often improves in the spring and summer, only to return with the cold weather. Children who sleep very soundly are more apt to be subject to this disorder.
Treatment.—In the case of a disorder depending upon one of so many conditions it will be realized that it would be folly for the layman to attempt to treat it. Children who are weak need building up in every possible way, as by an outdoor life, cold sponging daily, etc. If there is in boys a long foreskin, or tight foreskin, hindering the escape of urine and natural secretions of this part, circumcision may be performed to advantage by the surgeon, even in the infant a few months old. Sometimes a simpler operation, consisting of stretching or overdistending the foreskin, can be done.
A somewhat corresponding condition in girls occasionally causes bed-wetting and other troubles. It can be discovered by a physician. Children who wet theirbeds, or clothes, should not drink liquid after five in the afternoon, and should be taken up frequently during the night to pass water. The bed covering must be light, and they should be prevented from lying on the back while asleep by wearing a towel knotted in the small part of the back. Elevation of the foot of the bed a few inches is recommended as having a corrective influence. Masturbation, if present, must be corrected.
It is a very difficult disorder to treat, and physicians must be excused for failures even after every attempt has been made to discover and remove the cause. Even when cure seems assured, the disorder may recur.
INFLAMMATION OF THE BLADDER(Cystitis).—The condition which we describe under this head commonly causes frequent painful urination. Primarily there is usually some agency which mechanically or chemically irritates the bladder, and if the irritation does not subside, inflammation follows owing to the entrance of germs in some manner. The introduction into the bladder of unboiled, and therefore unclean, instruments is a cause; another cause is failure to pass urine for a long period, from a feeling of delicacy in some persons when in unfavorable surroundings. Nervous spasm of the urinary passage from pain, injuries, and surgical operations constitutes another cause. Inflammation may extend from neighboring parts and attack the bladder, as in gonorrhea, and in various inflammations of the sexual organs of women, as in childbed infection. Certain foods, waters, anddrinks, as alcohol in large amounts, and drugs, as turpentine or cantharides applied externally or given internally, may lead to irritation of the bladder. Exposure to cold in susceptible persons is frequently a source of cystitis, as well as external blows and injuries. The foregoing causes are apt to bring on sudden or acute attacks of bladder trouble, but often the disease comes on slowly and is continuous or chronic.
Among the causes of chronic cystitis, in men over fifty, is obstruction to the outflow of urine from enlargement of the prostate gland, which blocks the exit from the bladder. In young men, narrowing of the urethra, a sequel to gonorrhea, may also cause cystitis; also stone in the bladder or foreign bodies, tumors growing in the bladder, tuberculosis of the organ. Paralysis of the bladder, which renders the organ incapable of emptying itself, thus retaining some fermenting urine, is another cause of bladder inflammation.
Symptoms.—The combination of frequency of and pain during urination, with the appearance of blood or white cloudiness and sediment in the urine, are evidences of the existence of inflammation of the bladder. The trouble is aggravated by standing, jolting, or active exercise. The pain may be felt either at the beginning or end of urination. There is also generally a feeling of weight and heaviness low down in the belly, or about the lower part of the bowel. Blood is not frequently present, but the urine is not clear, if there is much inflammation, but deposits a white andoften slimy sediment on standing. In chronic inflammation of the bladder the urine often has a foul odor and smells of ammonia.
Treatment.—The treatment of acute cystitis consists in rest—preferably on the back, with the legs drawn up, in bed. The diet should be chiefly fluid, as milk and pure water, flaxseed tea, or mineral waters. Potassium citrate, fifteen grains, and sweet spirit of nitre, fifteen drops, may be given in water to advantage three times daily. Hot full baths or sitz baths two or three times a day, and in women hot vaginal douches (that is, injections into the front passage), with hot poultices or the hot-water bag over the lower part of the abdomen, will serve to relieve the suffering. If, however, the pain and frequency attending urination is considerable, nothing is so efficient as a suppository containing one-quarter grain each of morphine sulphate and belladonna extract, which should be introduced into the bowel and repeated once in three hours if necessary. This treatment should be employed only under the advice of a physician. In chronic cystitis, urotropin in five-grain doses dissolved in a glass of water and taken four times daily often affords great relief, but these cases demand careful study by a physician to determine their cause, and often local treatment. Avoidance of all source of irritation is also essential in these cases, as sexual excitement and the use of alcohol and spices. The diet should consist chiefly of cereals and vegetables, with an abundance ofmilk and water. The bowels should be kept loose by means of hot rectal injections in acute cystitis.
RETENTION, STOPPAGE, OR SUPPRESSION OF URINE.—Retention refers to that condition where the urine has been accumulating in the bladder for a considerable time—over twelve hours—and cannot be passed. It may follow an obstruction from disease, to which is added temporary swelling and nervous contraction of some part of the urinary passage; or it may be due to spasm and closure of the outlet from nervous irritation, as in the cases of injuries and surgical operations in the vicinity of the sexual organs, the rectum, or in other parts of the body. Overdistention of the bladder from failure to pass water for a long time may lead to a condition where urination becomes an impossibility. Various general diseases, as severe fevers, and conditions of unconsciousness, and other disorders of the nervous system, are frequently accompanied by retention of urine. In retention of urine there is often an escape of a little urine from time to time, and not necessarily entire absence of outflow.
Treatment.—Retention of urine is a serious condition. If not relieved, it may end in death from toxæmia, caused by back pressure on the kidneys, or from rupture of the bladder. Therefore surgical assistance is demanded as soon as it can be obtained. Failing this, begin with the simpler methods. A hot sitz bath, or, if the patient cannot move, hot applications, asa hot poultice or hot cloths applied over the lower part of the belly, may afford relief. Injections of hot water into the bowel are often more efficient still. A single full dose of opium in some form, as fifteen drops of laudanum[10]or two teaspoonfuls of paregoric[10]or one-quarter grain of morphine,[10]will frequently allow of a free passage of urine. The introduction of a suppository into the bowel, containing one-quarter grain each of morphine sulphate,[10]and belladonna extract, is often preferable to giving the drug by the mouth. These measures proving of no avail, the next endeavor should be to pass a catheter. If a soft rubber or elastic catheter is used with reasonable care, little damage can be done, even by a novice. The catheter should be boiled in water for ten minutes, and after washing his hands thoroughly the attendant should anoint the catheter with sweet oil (which has been boiled) or clean vaseline and proceed to introduce the catheter slowly into the urinary passage until the urine begins to flow out through the instrument.