There are two essentials requisite to the successful treatment of the sick: (1.) Medical skill; (2.) Good nursing. The former is necessary in order that the condition of the patient be fully understood, and the proper means be employed to effect his recovery. The latter is essential, in order that all influences favoring the production and development of disease may be removed, the tendencies to restoration be promoted by every possible means, and the directions of the physician be properly observed.
Success in the treatment of the sick requires good nursing. Without it, the most skillful physicians fail to effect a cure; with it, the most unqualified may succeed. If certain hygienic agencies are essential to the maintenance of health, how much more necessary it is that they be employed in sickness! If certain conditions cause disease, how great the necessity is that such conditions be obviated and hygienic ones substituted!
Notwithstanding the importance of good nursing, in the rural districts it is frequently difficult to find a professional nurse, or, if one can be obtained, it is often impossible for the invalid to procure such services, on account of the expense which must necessarily be incurred. Hence, this office usually devolves upon some relative who is considered to be the best qualified for the position; or, as is often the case, necessity demands that the patient be left to a change of nurses. A woman is generally selected for this important position. Hersoft hand and soothing voice, her kindly, sympathetic, and provident nature, together with her scrupulous cleanliness, render her man's equal, if not his superior, in the capacity of nurse. There are circumstances, however, in which the services of a man are indispensable; hence the necessity that all should be qualified to care for the sick.
A nurse should be attentive to the requirements of physician and patient, for she sustains an intimate relation to both. She should observe the directions of the physician, and faithfully perform them. She should note all the symptoms of the patient, and do everything in her power to promote comfort and recovery. She should anticipate the wishes, and not cause the patient to ask for everything which is desired. So far as practicable, let the wishes be gratified. The senses of the sick often become morbidly acute, and those things which in health would pass unnoticed, in sickness are so magnified as to occasion annoyance and vexation. Sick persons are not all alike, and the peculiarities of each must be studied separately. The nurse must bekind, butfirm, and not yield to such whims of the patient as may be detrimental to recovery; neither must she arouse dislike or anger by opposition, but endeavor towinthe patient from all delusions. The feelings of the patient should never be trifled with, for idealities become realities.
The nurse should possess an inexhaustible store of patience. Disease affects the mind of the patient and fills it with strange delusions. The sick are often querulous, fretful, and unreasonable, and should be treated with kindness, forbearance, and sympathy. The nurse should always be cheerful, look on the bright side of every circumstance, animate them with encouragement, and inspire them with hope. Hope is one of the best of tonics. It stimulates the flagging, vital energies, and imparts new life to the weak and exhausted forces. Gloom, sadness, and despondency depress the vital forces and lead to death. We have seen patients rapidly sinking, who had given up all hope, and were quietly awaiting the coming of death, snatched, as it were, from its grasp, and restored to health, by words of cheer and encouragement.
The nurse should possessmoral principles, which alone canwin the confidence of the patient. She should have judgment, circumspection, intelligence, forethought, alacrity, carefulness, and neatness. In a word she should exercisecommon sense.
We deem it but justice to say a word in behalf of the nurse. She, too, is a human being, subject to disease, and, unless hygienic conditions be observed, will soon be stricken low by its presence. She must be relieved occasionally and get rest, or she cannot long withstand the combined influence of fatigue and disease. Her office is an arduous one at best, and the long, weary hours of night-watching should be compensated by exercise in the open air, as well as by sleep during the day. Unless this be done, the system will become exhausted, and sleep will intrude itself upon her at the time when the greatest diligence is required for the welfare of the patient, when the vital powers are at their lowest ebb. She should be supplied with plenty of suitable food during the night, to sustain her and to serve as a safeguard against the invasion of disease. She should be treated with kindness and respect, else her disposition may become morose and reflect itself upon the patient, causing peevishness and despondency.
The Sick-roomshould be as comfortable, cheerful, and pleasant, as circumstances will allow. Let the room be large and airy, and furnished with a stove, or better still, a fireplace. All articles of clothing and furniture, not necessary to the comfort of the patient, should be removed from the room, and inmalignantorcontagiousdiseases the carpets, even, should not be permitted to remain. The surroundings beget happiness or gloom, in proportion as they are pleasant or disagreeable. A tidy attendant, a few flowers and books, wonderfully enhance the cheerfulness of the room. Permit no unnecessary accumulation of bottles, or any thing that can in any way render the room unpleasant. Medicines, drink, or nourishment should never be left uncovered in the sick-room, since they quickly absorb the gaseous emanations from the patient, and become unfit for the purpose which they were intended to serve. Their presence gives the room an untidy appearance, suggestive of filth and slovenliness, and imparts to the patient a feeling of loathing and disgust for articles of diet.
The Bedshould not be of feathers, on account of theirundue warmth, which causes a sensation of languor throughout the system. A husk or sea-grass mattress, or even a straw bed, covered with a cotton quilt, is far preferable. The bedding should be changed frequently. It is better that the bed should be away from the wall, so as to admit of greater freedom of movement about it.
Pure Air. The air in the sick-room should be kept as pure as possible. That which is so necessary in health, is indispensable in sickness. The importance, therefore, of a perfect and free ventilation of the sick-room cannot be too thoroughly impressed; and yet to properly secure this end, may call forth a considerable amount of ingenuity on the part of the nurse. A window should be open, but the current of air must not be allowed to blow directly upon the patient. One window may be raised from the bottom and another lowered from the top. This will permit the entrance of pure air from without, and the exit of the vitiated air from within. The patient, if sufficiently covered in bed, is not liable to take cold from a proper ventilation of the room. Especially is this true, when the bodily temperature is raised by febrile or inflammatory affections. Thetemperatureof a room is no indication of thepurityof the air. It is a prevalent, but mistaken notion, that when a room is cold, the air must be pure. Cold air is as readily contaminated with impurities as warm air, therefore, it is not sufficient that the room be kept cool, but the air should be frequently changed. During convalescence, great care is necessary to protect the patient from taking cold. Air which is admitted into the sick-room should not be contaminated by passing over foul drains, privies, or other sources of infection, since, instead of invigorating, it depresses the physical forces and generates disease.
Lightis as necessary to health as is pure air. Banish either for any continuous period of time, and serious results follow. The strong, robust man, when deprived of light, soon degenerates into a feeble, sickly being, and finally dies.
According to the investigations of the Massachusetts Medical Society, it was found that absence of sunlight, together with moisture, not only favor the development of tubercular consumption, but act as an exciting cause. It is well known thatpersons living in shaded dwellings often suffer from forms of disease which resist all treatment until proper admission of light is secured.
The physician to the Emperor of Russia found upon examination that patients confined in well lighted wards, were four times as liable to recover as were those in poorly lighted rooms. Children reared away from the sunlight are apt to be deformed and idiotic, while those partially deformed have been restored by being admitted to the light.
Patients sometimes wish to have their rooms darkened, because the light is painful to their weak and sensitive eyes. It is far better to shade the eyes and admit the sunlight into the room, since its rays cause chemical changes to take place, which favor the return of health. Many invalids can ascribe their recovery to the influence of a sun bath. There are, however, conditions in which the patients should be screened from the light. In such cases a little arrangement of the curtains or shutters will accomplish all that is to be desired.
Patients convalescing from acute, or suffering from chronic diseases, should receive the influence of light in the open air, and be in it several hours every day. Light and pure air stimulate a healthful development, induce cheerfulness, hope, and recovery, while darkness begets gloom, sadness, despondency, disease, and ultimately death.
Warmthis essential to the well-being of the patient, and it is necessary that a proper temperature be maintained in the room. Except in very warm weather, a little fire should be kept in the room, and at the same time fresh air should be admitted from without, and a uniform temperature thus preserved. This arrangement is especially necessary in localities where great variations in temperature are experienced during the day and night.
The normal temperature of the body ranges from 98° to 99° Fahr. The minimum occurs from 2 to 6 A.M.; the maximum, from 1 to 6 P.M. The deviation of a few degrees from this standard indicates disease, and the greater the deviation, the greater is its severity. During the early stages of acute diseases, the animal heat is generally increased, and should be allayed by bathing, and cooling or acidulated drinks. In thelatter stages, the temperature becomes diminished and the condition of the system is favorable to congestions, which are most likely to occur between the hours of 2 and 6 A.M., when the vital powers are lowest. The patient then becomes feeble, his extremities grow cold, and he has what is termed a "sinking spell," and perhaps dies. It is during these hours that additional covering, the application of hot bricks to the feet, and bottles of hot water to the limbs and body, friction upon the surface, stimulating drinks, and increased vigilance on the part of the nurse will often save the patient's life. But, unfortunately, at these hours the nurse is apt to get sleepy and inattentive, the demands of the patient go unheeded, and a sacrifice of life is the result.
Persons suffering from chronic diseases, or those in feeble health, should preserve their vital energies by dressing warmly, by wearing flannels next to the skin, and by carefully protecting the feet from cold and moisture.
Cleanlinesscannot be too thoroughly impressed upon the minds of those who have the care of the sick. Filthiness is productive of disease and favorable to its development. Bathing at least once a day, with pure, soft water and toilet-soap, is strongly urged, and as this is designed for cleanliness, the temperature of the bath should be made agreeable to the patient.
The Clothing and Bedding of the Patientin acute diseases, should be changed frequently and thoroughly aired, if not washed. As soon as removed, these articles should be taken from the room, replaced by otherswell aired and warmed.The hands and face of the patient should be bathed frequently, the hair combed, the teeth brushed, the nails cleaned, the lips moistened, and everything about him kept clean and tidy. These observances, although in themselves trifling, promote comfort and cheerfulness, and contribute largely to the recovery of the sick. All excretions from the patient should be buried, and not committed to privies to communicate disease to those who frequent them.
The Dietcontains a very important relation to health. During the process of acute disease, the appetite is generally much impaired, if not entirely absent. It should then be the study of the nurse to devise such articles of nourishment as willbe acceptable to the patient and suitable to the condition. The food should be light, nutritious, and easy of digestion.
Each individual disease requires a diet adapted to its peculiarities. Those of an inflammatory character require an unstimulating diet, as gruel, barley-water, toast, etc. An exhausted or enfeebled condition of the brain, unattended by irritability, demands a stimulating diet, as beef, eggs, fish, Graham bread, oysters, etc. In wasting diseases, in which the temperature of the system is low, beef, fatty substances, rich milk, sweet cream, and other carbonaceous articles of diet are recommended. In the various forms of chronic ailments, the diet must be varied according to the nature of the disease and the peculiarities of the patient. Deranged digestion is generally an accompaniment of chronic disease. A return to normal digestion should be encouraged by selecting appropriate articles of food, paying due regard to its quantity and quality, as well as to the manner and time of eating. The appearance of food, and the manner in which it is offered, have much to do with its acceptance, or rejection by the patient. Let the nourishment be presented in a nice, clean dish, of a size and shape appropriate to the quantity. More food than can be eaten by the patient should not be placed before him at one time, since a great quantity excites disgust and loathing. In taking nourishment, drink, or medicine, the patient, if feeble, should not be obliged to change his position.
Milkis one of the most important foods in fevers and acute diseases attended with great prostration, and in which the digestive powers are enfeebled. It contains within itself all the elements of nutrition.
Beef Teafurnishes an excellent nourishment for the sick, but there are few, even among professional nurses who know how to properly prepare it. We give three good recipes. One method is to chip up lean beef, put it in a porcelain or tin saucepan, cover it withcoldwater, and bring it up to just below the boiling point, at which temperatureretain itfor ten minutes, then season and serve. Another method is similar to the foregoing, with this difference, that the juices of the meat are squeezed through a piece of muslin or crash, making the tea richer. Another way, which we consider preferable toeither of the above, is to take lean beef, cut it into fine bits, put them in a tightly covered vessel, which is placed in a kettle of water kept boiling. Thus the whole strength of the juice will be obtained from the meat without losing any of its properties. It can be seasoned to the taste, and reduced with water to suit the needs of the patient.
Sleepis "Nature's grand restorer, a balm to all mankind; the best comforter of that sad heart whom fortune's spite assails." It is necessary in health, and doubly so in sickness. During sleep, the vital energies recuperate, the forces are less rapidly expended, and the strength increases. It is the great source of rest and refreshment. Often a day's rest in bed, free from the cares and anxieties of an active life, is sufficient to ward off the approach of disease. If quiet and rest are essential to recuperation in health, their necessity in disease must be apparent. Life frequently depends on tranquility and repose, and the least noise or confusion disturbs the sufferer and diminishes the chances of recovery. Nothing annoys sick or nervous persons more than whispering and the rustling of newspapers. If conversation be necessary, let the tones be modified, but never whisper. In sickness, when the vital forces are low, the more natural rest and sleep the patient obtains, the greater is the prospect for recovery. As a rule,a patient should never be awakened when sleeping quietly, not even to takemedicine, unless inextreme cases. If the patient does not sleep, the cause should be ascertained and the appropriate remedies employed; if it arise from rush of blood to the head, cooling lotions should be applied, and warmth to the feet; if, from restlessness or general irritability, a sponge bath, followed by friction should be administered; if the wakefulness is due to noise or confusion, quiet is the remedy. When these means fail, anodynes, or nervines, should be employed. Lying on the side instead of on the back should be practiced. Patients afflicted with chronic diseases, on rising, should take a cold bath, dry the surface quickly with a coarse towel, followed by friction with the hand. Great benefit may be derived by following these suggestions when the nature of the disease is not such as to forbid it.
Exerciseand rest necessarily alternate with each other.Exercise, so necessary to health, in many forms of disease greatly contributes to recovery. It sends the sluggish blood coursing through the veins and arteries with increased force and rapidity, so that it reaches every part of the system, supplying it with nourishment. It increases the waste of old material and creates a demand for new.
Convalescing patients, or those suffering from chronic diseases, whenever the weather will permit, should take exercise every day in the open air. This should be done with regularity. The amount of exercise must be regulated by the strength of the patient; never take so much as to produce fatigue, but, as the strength increases, the exercise may be increased proportionately. Some interesting employment, commensurate with the patient's strength, should be instituted, so that the mind may be agreeably occupied with the body.
When unable to take active exercise, the invalid, properly protected by sufficient clothing, should ride in a carriage or boat, and each day a new route should be chosen, so that a change of scenery may be observed, thus arousing new trains of thought, which will be exhilarating and prove beneficial to him.
Sexual Influences. During the progress of disease or convalescence, entire continence must be observed. It is then necessary that all of the vital energies should be employed in effecting a recovery from disease, without having the additional tax imposed of overcoming the debilitating effects of sexual expenditure. This holds true with regard to all diseases, and especially those of the nervous system and genitourinary organs.
Visiting the Sickmay be productive of good or evil results. Mental impressions made upon the sick exert a powerful influence upon the termination of disease. The chances of recovery are in proportion to the elevation or depression of spirits. Pleasant, cheerful associations animate the patient, inspire hope, arouse the vital energies, and aid in his recovery; while disagreeable and melancholy associations beget sadness and despondency, discourage the patient, depress the vital powers, enfeeble the body, and retard recovery.
Unless persons who visit the sick can carry with them joy,hope, mirth, and animation, they had better stay away. This applies equally in acute and chronic diseases. It does not matter what a visitor maythinkwith regard to the patient's recovery,an unfavorable opinion should never find expression in the sick-room. Life hangs upon a brittle thread, and often that frail support ishope. Cheer the sick by words of encouragement, and the hold on life will be strengthened; discourage, by uttering such expressions as, "How bad you look!" "Why, how you have failed since I saw you last!" "I would have another doctor; one who knows something!" "You can't live long if you don't get help!" etc., and the tie which binds them to earth is snapped asunder. The visitor becomes amurderer!Let all persons be guided by this rule:Never go into the sick-room without carrying with you a few rays of sunshine!
If the patient is very weak the visitor may injure him by staying too long. The length of the visit should be graduated according to the strength of the invalid. Never let the sufferer be wearied by too frequent or too lengthy visits, nor by having too many visitors at once. Above all things, do not confine your visitations to Sunday. Many do this and give themselves credit for an extra amount of piety on account of it, when, if they would scrutinize their motives more carefully, they would see that it was but a contemptible resort to save time. The sick are often grossly neglected during the week only to be visited to death upon Sunday.
The use of Tobacco and Opium. The recovery of the sick is often delayed, sometimes entirely prevented, by the habitual use of tobacco or opium. In acute diseases, the appetite for tobacco is usually destroyed by the force of the disease, and its use is, of necessity, discontinued; but in chronic ailments, the appetite remains unchanged, and the patient continues his indulgence greatly to the aggravation of the malady.
The use of tobacco is a pernicious habit in whatever form it is introduced into the system. Its active principle, Nicotin, which is an energetic poison, exerts its specific effect on the nervous system, tending to stimulate it to an unnatural degree of activity, the final result of which is weakness, or evenparalysis. The horse, under the action of whip and spur, may exhibit great spirit and rapid movements, but urge him beyond his strength with these agents, and you inflict a lasting injury. Withhold the stimulants, and the drooping head and moping pace indicate the sad reaction which has taken place. This illustrates the evils of habitually exciting the nerves by the use of tobacco, opium, narcotic or other drugs. Under their action, the tone of the system is greatly impaired, and it responds more feebly to the influence of curative agents. Tobacco itself, when its use becomes habitual and excessive, gives rise to the most unpleasant and dangerous pathological conditions. Oppressive torpor, weakness or loss of intellect, softening of the brain, paralysis, nervous debility, dyspepsia, functional derangement of the heart, and diseases of the liver and kidneys are not uncommon consequences of the excessive employment of this plant. A sense of faintness, nausea, giddiness, dryness of the throat, tremblings, feelings of fear, disquietude, and general nervous prostration must frequently warn persons addicted to this habit that they are sapping the very foundation of health. Under the continued operation of a poison, inducing such symptoms as these, what chance is there for remedies to accomplish their specific action? With the system already thoroughly charged with an influence antagonistic to their own, and which is sure to neutralize their effect, what good can medicine do?
Dr. King says, "A patient under treatment should give up the use of tobacco, or his physician should assume no responsibility in his case, further than to do the best he can for him." In our own extensive experience in the treatment of chronic diseases, we have often found it necessary to resort to the same restriction.
The opium habit, to which allusion has also been made, is open to the same objections, and must be abandoned by all who would seek recovery.
Knowledge which is conducive to self-preservation is ofprimaryimportance. That great educator, profound thinker, and vigorous writer, Herbert Spencer, has pertinently said that, "As vigorous health and its accompanying high spirits, are larger elements of happiness than any other things whatever, the teaching how to maintain them is a teaching that yields to no other whatever. And therefore we assert that such a course of physiology as is needful for the comprehension of its general truths and their bearings on daily conduct is an all-essential part of a rational education."
Believing that the diffusion of knowledge for the prevention of disease is quite as noble a work as the alleviation of physical suffering by medical skill, we have devoted a large portion of this volume to the subjects of physiology and hygiene. These we have endeavored to present in as familiar a style as possible, that they may be understood by every reader. Freely as we have received light upon these subjects have we endeavored to reflect it again, in hopes that a popular presentation of these matters made plain and easy of comprehension to all people, may lead the masses into greater enjoyment of life—the result of a better preservation of health. This we do in part as a public acknowledgment of our obligations to society, to whom every professional man is a debtor. He belongs to it, is a part of its common stock, and should give as well as receiveadvantages, return as well as accept benefits. We know of no better way to signify our appreciation of the public confidence and patronage, so generously accorded to us, than to offer this volume to the people at a price less than the actual cost for an edition of ordinary size. This we do as a token of the cordial reciprocation of their good will. In giving to the people wholesome advice, by which they may be enabled to ward off disease and thus preserve the health of multitudes, we believe we shall receive their hearty approval, as well as the approbation of our own conscience, both of which are certainly munificent rewards. We believe that good deeds are always rewarded, and that the physician who prevents sickness manifests a genuine and earnest devotion to the common interests of humanity.
We have no respect for the motives of those medical men who would withhold that information from the people which will direct the masses how to take care of themselves, and thereby prevent much sickness and suffering. Nor is the diffusion of such knowledge antagonistic to the best interests of the true and competent physician. The necessity for his invaluable services can no more be set aside by popularizing physiological, hygienic, and medical truths, than we can dispense with those of the minister and lawyer by the inculcation of the principles of morality in our public schools. The common schools do not lessen the necessity for colleges or universities, but rather contribute to their prosperity. Nor are we so presumptuous as to anticipate that we could possibly make this volume so instructive as to render "every man his own physician." No man can with advantage be his own lawyer, carpenter, tailor, and printer; much less can he hope to artfully repair his own constitution when shattered by grave maladies, which not only impair the physical functions, but weaken and derange the mental faculties. What physician presumes to prescribe for himself, when suddenly prostrated by serious illness? He very sensibly submits to the treatment of another, because he realizes that sickness impairs his judgment, and morbid sensations mislead and unfit him for the exercise of his skill. If this is true of the physician, with how much greater force does it apply to the unprofessional! If a sick sea-captain is unfit to stand at the helm and direct his ship, how utterly incompetentmust the raw sailor be when similarly disqualified! Nor is the physician as competent to treat those near and dear to him, when they are suffering from dangerous illness, as another medical man not similarly situated, whose judgment is not liable to be misled by intense anxiety and affectionate sympathy.
Notwithstanding all these facts, however, a knowledge on the part of the unprofessional, of something more than physiology and hygiene, and appertaining more closely to medicine proper, will many times prove valuable.
In the first stage of many acute affections which, if unheeded, gradually assume a threatening aspect, endangering life and demanding the services of the most skilled physician to avert fatal results, the early administration of some common domestic remedy, such as a cathartic, or a diaphoretic herb, associated with a warm bath, a spirit vapor-bath, or a hot foot-bath, will very often obviate the necessity for calling a family physician, and frequently save days and weeks of sickness and suffering.
So, likewise, are there numerous, acute diseases of a milder character which are easily and unmistakably recognized without the possession of great medical knowledge, and which readily yield to plain, simple, medical treatment which is within the ready reach of all who strive to acquaint themselves with the rudiments of medical science. But in sudden and painful attacks of acute disease, life may be suddenly and unexpectedly jeopardized, and immediate relief prove necessary. While under these circumstances the prompt application of such domestic treatment as good common-sense may dictate, guided by a knowledge of those first principles of medical learning which we shall hereafter endeavor to make plain, may result in speedy and happy relief, yet at the same time there should be no delay in summoning a competent physician to the bedside of the sufferer.
Then, and not the least important, there are the various chronic or lingering diseases, from all of which few individuals indeed, who pass the meridian of life, entirely escape. In this class of ailments there is generally no immediate danger, and, therefore, time may be taken by the invalid for studying his disease and employing those remedies which are best suited for its removal.Or, if of a dangerous or complicated character, and, therefore, not so readily understood, he may consult either personally or by letter, some learned and well-known physician, who makes a specialty of the treatment of such cases, and whose large experience enables him to excel therein.
In consideration, therefore, of the foregoing facts, we deem it most profitable for our readers that Part Fourth of this volume should be arranged in the following manner:
The milder forms of uncomplicated, acute diseases, which may be readily and unmistakably recognized, and successfully managed without professional aid, will receive that attention which is necessary to give the reader a correct idea of them, and their proper remedial treatment.
We shall devote only such attention to the severe and hazardous forms of acute diseases as is necessary in order to consider their initial stage, with their proper treatment, not attempting to trace their numerous complications, or portray the many pathological conditions which are liable to be developed. For, even by devoting much space to the latter, we could not expect to qualify our unprofessional readers for successfully treating such obscure and dangerous conditions.
We shall devote the largest amount of space to a careful and thorough consideration of those chronic diseases, which, by a little study, may be readily recognized and understood by the masses, and for the cure of which we shall suggest such hygienic treatment and domestic remedies as may be safely employed by all who are in quest of relief. In the more dangerous, obscure, or complicated forms of chronic diseases, the correct diagnosis and successful treatment of which tax all the skill possessed by the experienced specialist, the invalid will not be misled into the dangerous policy of relying upon his own judgment and treatment, but will be counseled not to postpone until too late, the employment of a skillful physician.
The apportionment of space which is made in considering the various diseases and their different stages, as well as the course which the people are advised to pursue under the different circumstances of affliction, is not always in accordance with the plans and recommendations which have been made by others who have written works on domestic medicine. Most of theseauthors have attempted, by lengthy disquisitions, to teach their readers how to treat themselves without the services of a physician, even in the most hazardous forms of disease. In such dangerous maladies as typhoid, typhus, yellow, and scarlet fevers, typhoid pneumonia, and many others, in which life is imminently imperiled, such instruction and advice is decidedly reprehensible, as it may lead to the most serious consequences. We are confident, therefore, that the manner of disposing of the different subjects which are discussed in the succeeding chapters, and the course of action which is advised, will commend themselves to our readers as being such as are calculated to promote and subserve their best interests.
Skill in the art of healing is indicated in three ways: (1.) by ascertaining thesymptoms, seat, andnatureof the disease, which is termeddiagnosis; (2.) by foretelling the probable termination, which is termedprognosis; (3.) by the employment of efficacious and appropriate remedies, which is calledtreatment. Of these three requisites to a prosperous issue, nothing so distinguishes the expert and accomplished physician from the mere pretender as his ready ability to interpret correctly, the location, extent, and character of an affection from its symptoms. By medical diagnosis, then, is understood the discrimination between diseases by certain symptoms which are distinguishing signs. Every malady is accompanied by its characteristic indications, some of which arediagnostic, i.e., they particularize the affection and distinguish it from all others.
Medical diagnosis is both ascienceand anart; a science when the causes and symptoms of a disease are understood, and an art when this knowledge can be applied to determine its location and exact nature. Science presents the general principles of practice; art detects among the characteristic symptoms the differential signs, and applies the remedy. Da Costa aptly remarks: "No one aspiring to become a skillful observer can trust exclusively to the light reflected from the writings of others; he must carry the torch in his own hands, and himself look into every recess."
The critical investigation of symptoms, with the view ofascertaining their signs, is essential to successful practice. Without closely observing them, we cannot accurately trace out the diagnosis, and a failure to detect the right disease is apt to be followed by the use of wrong medicines.
General diagnosis considers the surroundings of the patient as well as the actual manifestations of the disease. It takes into account the diathesis,i.e., the predisposition to certain diseases in consequence of peculiarities of constitution. We recognize constitutional tendencies, which may be indicated by the contour of the body, its growth, stature, and temperament, since all these facts greatly modify the treatment. Likewise the sex, age, climate, habits, occupation, previous diseases, as well as the present condition, must be taken into account.
Auscultation, as practiced in detecting disease, consists in listening to the sounds which can be heard in the chest.
Percussion consists in striking upon a part with the view of appreciating the sound which results. The part may be struck directly with the tips of the fingers, but more generally one or more fingers of the other hand are interposed between the points of the fingers and the part to be percussed, that they, instead of the naked chest, may receive the blow; or, instead of the fingers, a flat piece of bone or ivory, called apleximeter, is placed upon the chest to receive the blow.
Latterly, improved instruments greatly assist the practitioner of medicine in perfecting this art. Themicroscopeassists the eye, and helps to reveal the appearance and character of the excretions, detecting morbid degenerations;chemistrydiscloses the composition of the urine, which also indicates the morbid alterations occurring in the system; by percussion we can determine the condition of an internal organ, from the sound given when the external surface is percussed; the ear, with the aid of thestethoscope, detects the strange murmurs of respiration, the fainter, more unnatural pulsations of life, and the obscurer workings of disease; with thespirometerwe determine the breathing capacity of the lungs, and thus ascertain the extent of the inroads made by disease; thedynamometerrecords the lifting ability of the patient; thethermometerindicates the morbid variation in the bodily temperature; various instrumentsinform us of the structural changes causing alterations in the specific gravity of fluids,e.g., theurinometerindicates those occurring in the urine; and thus, as the facilities for correct diagnosis increase, the art of distinguishing and classifying diseases becomes more perfect, and their treatment more certain. While physiology treats of all the natural functions, pathology treats of lesions and altered conditions.
Illustration: Fig. 146. Dr. Brown's Spirometer.Fig. 146. Dr. Brown's Spirometer.
By the termsymptomswe mean the evidence of some morbid effect or change occurring in the human body, and it requires close observation and well-instructed experience to convert these symptoms into diagnostic signs. Suppose "Old Probabilities" (as we commonly designate the invaluable Signal Department) hangs out his warning tokens all along our lake borders and ocean coasts; our sailors behold the fluttering symbols indicating an approaching storm, but if no one understood their meaning, a fearful disaster might follow. But if these signals are understood, a safe harbor is sought and the mariner is protected. So disease may hang out all her signals of distress, in order that they may be seen, but unless correctly interpreted, and a remedial harbor is sought, these symptoms are of little practical value.
Undoubtedly the reason why so many symptom-doctors blunder is because they prescribe according to the apparent symptoms, without any real reference to the nature of the affection. They fail to discover how far a symptom points out the seat, and also the progress of a disease. They do not distinguish the relative importance of the different symptoms. The practical purpose of all science is to skillfully apply knowledge to salutary and profitable uses. The patient himself may carefully note the indications, but it is only the expert physician who can tell the import of each symptom.
Symptomsare within every one's observation, but only the physician knows the nature and value ofsigns. We have read an anecdote of Galen, who was a distinguished physician in his day, which illustrates the distinction between sign and symptom. Once, when dangerously ill, he overheard two of his friends in attendance upon him recount his symptoms, such as "Redness of the face, a dejected, haggard, and inflamed appearance," etc. He cried out to them to adopt every necessary measure forthwith, as he was threatened with delirium. The two friends saw thesymptomswell enough; but it was only Galen himself, though thepatient, who was able to deduce thesignof delirium—that is, he alone was able to translate those symptoms into signs. To determine the value of symptoms, as signs of disease, requires close observation.
We shall refer to a few symptoms which any unprofessional reader may readily observe and understand.
Position of Patient. When a patient is disposed to lie upon his back continually during the progress of an acute disease, it is a sign ofmuscular debility. If he manifests no desire to change his position, or cannot do so, and becomes tremulous at the least effort, it indicatesgeneral prostration. When this position is assumed, during the progress of continued fever, and is accompanied by involuntary twitching of the muscles, picking of the bed-clothes, etc., then danger is imminent andthe patient is sinking. Fever, resulting from local inflammation, does not produce muscular prostration, and the patient seldom or never assumes the supine position. If this inflammation is in the extremities, those parts are elevated, in order to lessen the pressure of the blood, which a dependent, position increases.
For example, let us change the scene, and introduce a patient with head and shoulders elevated, who prefers to sit up, and who places his hands behind him and leans back, or leans forward resting his arms and head upon a chair. The next week he is worse, and no longer tries to lie in bed, but sits up all the time; note the anxious expression of countenance, the difficult or hurried breathing, the dry and hacking cough, and observethat the least exertion increases the difficulty of respiration and causes palpitation of the heart. These plain symptoms signify thoracic effusion, the collection of water about the lungs.
The Countenancedisplays diagnostic symptoms of disease. In simple, acute fevers, the eyes and face are red and the respiration is hurried; but in acute, sympathetic fever, these signs are wanting. We cannot forget the pale, sharp, contracted, and pinched features of those patients whose nostrils contract and expand alternately with the acts of respiration. How hard it was for them to breathe. The contraction and expansion of the nostrils indicate active congestion of the lungs.
As a general rule, chronic inflammation of the stomach, duodenum, liver, and adjacent organs, imparts a gloomy expression to the countenance, at the same time the eye is dull, the skin dusky or yellow, and the motions are slow. But in lung diseases, the spirits are buoyant, the skin is fair, and the cheeks flushed with fever and distinctly circumscribed with white, for delicacy and contrast, almost exceed the hues of health in beauty. Note, too, the pearly lustre and sparkling light of the eye, the quivering motion of the lips and chin, all signs of pulmonary disease.
The Story of Sexual Abuseis plainly told by the downcast countenance, the inability to look a person fairly in the face, the peculiar lifting of the upper lip and the furtive glance of the eye. The state of the mind and of the nervous system corroborates this evidence, for there seems to be a desire to escape from conversation and to elude society. The mind seems engrossed and abstracted, the individual appears absorbed in a constant meditation, he is forgetful and loses nearly all interest in the ordinary affairs of life. The whole appearance of a patient, suffering from spermatorrhea, is perfectly understood by the experienced physician, for the facial expressions, state of mind, and movements of the body, all unconsciously betray, and unitedly proclaim his condition.
Tongue. Much may be learned from the appearance, color, and form of the tongue, and the manner of its protrusion. If pale, moist, and coated white, it indicates a mild, febrile condition of the system. If coated in the center, and the sideslook raw, it indicates gastric irritation. If red and raw, or dry and cracked, it is a sign of inflammation of the mucous membrane of the stomach. If the inflammation is in the large intestine, the tip of the tongue presents a deep red color, while the middle is loaded with a dark brown coating. When the tongue is elongated and pointed, quickly protruded and withdrawn, it indicates irritation of the nerve-centers, as well as of the stomach and bowels. If tremulous, it denotes congestion and lack of functional ability; this may be observed in congestive fevers.
Pulse. Usually the pulse beats four times during one respiration, but both in health and disease its frequency may be accelerated or retarded. In adults, there are from sixty-five to seventy-five beats in a minute, and yet in a few instances we have found, in health, only forty pulsations per minute. But when the heart beats from one hundred and twenty to one hundred and forty times a minute, there is reason to apprehend danger, and the case should receive the careful attention of a physician.
Irregularity of the pulse may be caused by disease of the brain, heart, stomach, or liver; by the disordered condition of the nervous system; by lack of muscular nutrition, as in gout, rheumatism, or convulsions; by deficiency of the heart's effective power, when the pulse-wave does not reach the wrist, or when it intermits and then becomes more rapid in consequence of septic changes of the blood, as in diphtheria, erysipelas, and eruptive fevers.
Pain. The import of pain depends on its seat, intensity, nature, and duration. An acute, intense pain usually indicates inflammation of a nerve as well as the adjacent parts. Sharp, shooting, lancinating pains occur in inflammation of the serous tissues, as in pleurisy. A smarting, stinging pain attends inflammation of the mucous membrane. Acute pain is generally remittent and not fixed to one spot. Dull, heavy pain is more persistent, and is present in congestions, or when the substance of an organ is inflamed, and it often precedes hemorrhage. Burning pain characterizes violent inflammations involving the skin and subjacent cellular tissue, as in case of boils and carbuncles. Deep, perforating pain accompaniesinflammation of the bones, or of their enveloping membranes. Gnawing, biting, lancinating pain attends cancers.
The location of pain is not always at the seat of the disease. In hip-disease, the pain is not first felt in the hip, but in the knee-joint. In chronic inflammation of the liver, the pain is generally most severe in the right shoulder and arm. Disease of the kidneys occasionally produces numbness of the thigh and drawing up of the testicle, and commonly causes colicky pains. Inflammation of the meninges of the brain is often indicated by nausea and vomiting before attention is directed to the head. These illustrations are sufficient to show that pain often takes place in some part remote from the disease.
In chronic, abdominal affections, rheumatic fevers, gout, and syphilis, the entire system is thrown into a morbid state, the nervous system is disturbed, and wandering pains manifest themselves in different parts of the body. Fixed pain, which is increased by pressure, indicates inflammation. If it be due only to irritation, pressure will not increase it. Some rheumatic affections and neuralgia not only bear pressure, but the pain diminishes under it. Permanent pain shows that the structures of an organ are inflamed, while intermittent pain is a sign of neuralgia, gout, or rheumatism. Absence of pain in any disease, where ordinarily it should be present, is an unfavorable sign. Internal pain, after a favorable crisis, is a bad omen. Or, if pains cease suddenly without the other symptoms abating, the import is bad. If, however, pain and fever remit simultaneously and the secretions continue, it is a favorable sign.
A dull pain in the head indicates fullness of the blood-vessels from weakness, low blood, or general debility. It may be caused by taking cold, thus producing passive congestion of the brain. It may proceed from gastric disturbance, constipation of the bowels, or derangement of the liver. Heaviness of the head sometimes precedes inflammation of the brain, or chronic disease of its membranes. A dull, oppressive pain in the head indicates softening of the brain, and is generally accompanied by slowness of the pulse and of the speech. A pulsating pain of the head occurs in heart disease, hysteria, and frequently accompanies some forms of insanity.
The Eyeindicates morbid changes and furnishes unmistakable signs of disease. Sinking of the eye indicates waste, as in consumption, diarrhea, and cholera. In fevers it is regarded as a fatal symptom. A dark or leaden circle around the eye, seen after hard work, indicates fatigue and overdoing. If the mucous covering of the inner surface of the lids and the ball of the eye is congested and inflamed, it exhibits redness, and may indicate congestion or even inflammation of the brain.
A dilated pupil is often observed in catarrhal consumption, congestion of the brain, low fevers, and chlorosis.
The pupil contracts in inflammation of the meninges, when there is increased sensibility and intolerance of light, also in spinal complaints. In some diseases the lustre of the eye increases, as in consumption. But if it decreases with the attack of violent disease, it indicates great debility and prostration.
Examination of the Urine. All medical authors and physicians of education, freely admit and even insist upon the importance of critically examining the patient's urine, in all cases in which there is reason to suspect disease of the kidneys or bladder. In chronic affections it is particularly serviceable, especially in derangements of the liver, blood, kidneys, bladder, prostate gland, and nervous system. Many scholarly physicians have sadly neglected the proper inspection of the urine, because they were afraid of being classed with the illiterate "uroscopian" doctors, or fanatical enthusiasts, who ignorantly pretend to diagnose correctlyalldiseases in this manner, thus subjecting themselves and their claims to ridicule. Nothing should deter one from giving to this excretion the attention it deserves.
The urine which is voided when the system is deranged or diseased is altered in its color and composition, showing that its ingredients vary greatly. So important an aid do examinations of the urine furnish in diagnosing many chronic ailments, that at the Invalids' Hotel and Surgical Institute, where many thousands of cases are annually treated, a chemical laboratory has been fitted up, and a skillful chemist is employed, who makes a specialty of examining the urine, both chemically and microscopically, and reporting the result to the attending physicians. His extended experience renders his services invaluable. Withhis assistance, maladies which had hitherto baffled all efforts put forth to determine their true character, have frequently been quickly and unmistakably disclosed.
Microscopical Examination. This method of examination affords a quicker and more correct idea of a deposit or deposits than any other method. The expert, by simply looking at a specimen, can determine the character of the urine, whether blood, mucus, pus, uric acid, etc., are present or not. But when no deposit is present, then it is necessary to apply chemical tests, and in many cases the quantity of the suspected ingredient must be determined by analysis. As a detailed account, of the various modifications which the urine undergoes in different diseases, would be of no practical use to the masses, since they could not avail themselves of the advantages which it would afford for correct diagnosis, except by the employment of a physician who does not ignore this aid in examining his patients, we shall omit all further details upon the subject. For the same reason we shall not often, in treating of the different diseases in which examinations of the urine furnish such valuable aid in forming a diagnosis, make mention of the changes which are likely to have occurred.
The termInflammationsignifies a state in which the infected part is hotter, redder, more congested, and more painful than is natural. Inflammation is limited to certain parts, while fever influences the system generally. Inflammation gives rise to new formations, morbid products, and lesions, or alterations of structure. The morbid products of fever, and its modification of fluids are carried away by the secretions and excretions.
The susceptibility of the body to inflammation maybenaturaloracquired. It is natural when it is constitutional; that is, when there is an original tendency of the animal economy to manifest itself in some form of inflammation. We may notice that some children are far more subject to boils, croups, and erysipelatous diseases than others. This susceptibility, when innate, may be lessened by careful medication, although it may never be wholly eradicated. When acquired, it is the result of the influence of habits of life, climate, and the state of mind over the constitution
Phlegmonous inflammation is the active inflammation of the cellular membrane, one illustration of which is a common boil. The four principal symptoms are redness, swelling, heat, and pain; and then appears a conical, hard, circumscribed tumor, having its seat in the dermoid texture. At the end of an indefinite period, it becomes pointed, white or yellow, and discharges pus mixed with blood. When it breaks, a small, grayish, fibrous mass sometimes appears, which consists of dead, cellular tissue, and which is called thecore.
There are certain morbid states of the constitution which lead to local inflammation, subsequent upon slight injury; or, in some cases, without any such provocation, as in gout, rheumatism, and scrofula. One of the first results of the inflammation, in such cases, is a weakening of the forces which distribute the blood to the surface and extremities of the body. It is generally admitted that in scrofulous persons the vascular system is weak, the vessels are small, and because nutrition is faulty, the blood isimperfectly organized. The result is failure in the system, for if nutrition fails, there may be lacking earthy matter for the bones, or the unctious secretions of the skin; the sebaceous secretion is albuminous and liable to become dry, producing inflammation of the parts which it ought to protect.
Disorder of the alimentary canal and other mucous surfaces are sometimes reflected upon the skin. We have occasionally observed cutaneous eruptions and erysipelas, when evidently they were distinct signs of internal disorder.
Inflammation may be internal as well as external, as inflammation of the brain, lungs, or stomach, and it is frequently the result of what is called acold. No matter how the body is chilled, the blood retreats from the surface, which becomes pale and shrunken, there is also nervous uneasiness, and frequently a rigor, accompanied with chattering of the teeth. After the cold stage, reaction takes place and fever follows. The sudden change from a dry and heated room to a cool and moist atmosphere is liable to induce a cold. Riding in a carriage until the body is shivering, or sitting in a draft of air when one has been previously heated, or breathing a very cold air during the night when the body is warm, especially when not accustomed to doing so, or exposing the body to a low temperature wheninsufficiently clothed, are all different ways of producing inflammation.
Inflammation may result in consequence of local injury, caused by a bruise, or by a sharp, cutting instrument, as a knife or an axe, or it may be caused by the puncture of a pin, pen-knife blade or a fork-tine, or from a lacerated wound, as from the bite of a dog, or from a very minute wound poisoned by the bite of a venomous reptile. Local inflammations may arise from scalds, burns, the application of caustics, arsenic, corrosive sublimate, cantharides, powerful acids, abrasions of the surface by injuries, and from the occurrence of accidents.
Theswellingof the part may be caused by an increase of the quantity of blood in the vessels, the effusion of serum and coagulating lymph, and the interruption of absorption by the injury, or by the altered condition of the inflamed part.
The character of thepaindepends upon the tissue involved, and upon the altered or unnatural state of the nerves. Ordinarily, tendon, ligament, cartilage, and bone are not very sensitive, but when inflamed they are exquisitely so.
The heat of the inflamed part is not so great, when measured by the thermometer, as might be supposed from the patient's sensations.
Termination of Inflammation. Inflammation ends in one of six different ways. Inflammation may terminate inresolution, i.e., spontaneous recovery; bysuppuration, in the formation of matter; byeffusion, as the inflammation caused by a blister-plaster terminates by effusion of water; byadhesion, the part inflamed forming an attachment to some other part; byinduration, hardening of the organ; or bygangrene, that is, death of the part.
Thus, inflammation of the lungs may terminate by recovery, that is, by resolution, by suppuration and raising of "matter," by hardening and solidification of the lung, or by gangrene. Inflammation of the endocardium, the lining membrane of the heart, may cause a thickening of it, and ossification of the valves of the heart, thus impairing its function. Inflammation of the pericardium may terminate in effusion, or dropsy, and inflammation of the liver may result in hardening and adhesion to adjacent parts.
Remove the exciting causes as far as practicable. If caused by a splinter or any foreign substance, it should be withdrawn, and if the injury is merely local, apply cold water to the parts to subdue the inflammation. If caused by a rabid animal, the wound should be enlarged and cupped, and the parts cleansed or destroyed by caustic. The patient should remain quiet and not be disturbed. The use of tincture of aconite internally, will be found excellent to prevent the rise of inflammation. A purgative is also advised, and four or five of Dr. Pierce's Pleasant Purgative Pellets will be sufficient to act upon the bowels. If there is pain, an anodyne and diaphoretic is proper. Dr. Pierce's Compound Extract of Smart-weed will fulfill this indication. In local inflammation cold water is a good remedy, yet sometimes hot water, or cloths wrung out of it, will be found to be the appropriate application. When the inflammation is located in an organ within a cavity, as the lungs, hot fomentations will be of great service. Bathing the surface with alkaline water must not be omitted. Whenever the inflammation is serious the family physician should be early summoned.
In fever all the functions are more or less deranged. In every considerable inflammation there is sympathetic fever, but in essential fevers there are generally fewer lesions of structure than in inflammation. Fever occasions great waste of the tissues of the body, and the refuse matter is carried away by the organs of secretion and excretion. The heat of the body in fever is generally diffused, the pulse is quicker, there is dullness, lassitude, chilliness, and disinclination to take food. We propose to give only a general outline of fevers, enough to indicate the principles which should be observed in domestic treatment.
Most fevers are distinctly marked by four stages: 1st, the forming stage; 2d, the cold stage; 3d, the hot stage; 4th, the sweating or declining stage. During the first stage the individual is hardly conscious of being ill, for the attack is so slight that it is hardly perceptible. True, as it progresses, there is afeeling of languor, an indisposition to make any bodily or mental effort, and also a sense of soreness of the muscles, aching of the bones, chilliness, and a disposition to get near the fire. There is restlessness, disturbed sleep, bad dreams, lowness of spirits, all of which are characteristic of the formative stage of fever.
The next is the cold stage, when there is a decided manifestation of the disease, and the patient acknowledges that he is really sick. In typhus and typhoid fever the chills are slight; in other fevers they are more marked; while in ague they are often accompanied by uncontrollable shaking. When the chill is not so distinct the nails look blue and the skin appears shriveled, the eye is sunken and a dark circle circumscribes it, the lips are blue, and there is pain in the back. The pulse is frequent, small, and depressed, the capillary circulation feeble, the respiration increased, and there may be nausea and vomiting. These symptoms vary in duration from a few minutes to more than an hour. They gradually abate, reaction takes place, and the patient begins to throw off the bed-clothes.
Then follows the hot stage, for with the return of the circulation of the blood to the surface of the body, there is greater warmth, freer breathing, and a more comfortable and quiet condition of the system. The veins fill with blood, the countenance brightens, the cheeks are flushed, the intellect is more sprightly, and if the pulse is frequent, it is a good sign; if it sinks, it indicates feeble, vital force, and is not a good symptom. If there is considerable determination of blood to the head it becomes hot, the arteries of the neck pulsate strongly, and delirium may be expected. During the hot stage, if the fever runs high, the patient becomes restless, frequently changes his position, is wakeful, uneasy, and complains of pain in his limbs. In low grades, the sensibility is blunted, smell, taste, and hearing are impaired.
The patient in the hot stage is generally thirsty, and if he is allowed to drink much, it may result in nausea and vomiting. Moderate indulgence in water, however, is permissible. There is aversion to food, and if any is eaten, it remains undigested. The teeth are sometimes covered with darksordes(foul accumulations) early in the fever, and the appearance of the tonguevaries, sometimes being coated a yellowish brown, sometimes red and dry, at other times thickly coated and white. The condition of the bowels varies from constipation to diarrhea, although sometimes they are quite regular. The urine is generally diminished in quantity, but shows higher color.
The sweating stage in some fevers is very marked, while in others there is very little moisture, but an evident decline of the hot stage, the skin becoming more natural and soft. The pulse is more compressible and less frequent, the kidneys act freely, respiration is natural, the pains subside, although there remains languor, lassitude, and weariness, a preternatural sensibility to cold, an easily excited pulse, and a pale and sickly aspect of the countenance. The appetite has failed and the powers of digestion are still impaired.
Domestic Management of Fevers. It is proper to make a thorough study of the early, insidious symptoms of fever, in order to understand what ought to be done. If it arises in consequence of malaria, the treatment must be suited to the case. If from irritation of the bowels and improper articles of diet, then a mild cathartic is required. If there is much inflammation, a severe chill, and strong reaction, then the treatment should be active. If the fever is of the congestive variety and the constitution is feeble, the reaction imperfect, a small, weak pulse, a tendency to fainting, a pale countenance, and great pain in the head, apply heat and administer diaphoretics, and procure the services of a good physician.
As a general rule, it is proper to administer a cathartic, unless in typhoid fever, and for this Dr. Pierce's Purgative Pellets answer the purpose, given in doses of from four to six, according to the state of the bowels. If these are not at hand, a tea of sage and senna may be drunk until it produces a purgative effect, or a dose of Rochelle salts taken. In nearly all fevers we have found that a weak, alkaline tea, made from the white ashes of hickory or maple wood, is useful, taken weak, three or four times daily, or if there be considerable thirst, more frequently. Some patients desire lemon juice, which enters the system as an alkali and answers all purposes.
Diaphoretic medicines are also indicated, and the use of Dr. Pierce's Extract of Smart-weed will prove very serviceable.Drinking freely of pleurisy-root tea, or of a strong decoction of boneset is frequently useful. After free sweating has been established, then it is proper to follow by the use of diuretic teas, such as that of spearmint and pumpkin seed combined, or sweet spirits of nitre, in doses of twenty to thirty drops, added to a teaspoonful of the Extract of Smart-weed, diluted with sweetened water.
To lessen the frequency of the pulse, fluid extract or tincture of aconite or veratrum may be given in water, every hour. During the intermission of symptoms, tonic medicines and a sustaining course of treatment should be employed. If the tongue is loaded and the evacuations from the bowels are fetid, a solution of sulphite of soda is proper; or, take equal parts of brewer's yeast and water, mix, and when the yeast settles, give a tablespoonful of the water every hour, as an antiseptic. Administering a warm, alkaline hand-bath to a fever patient every day, is an excellent febrifuge remedy, being careful not to chill or induce fatigue. If there is pain in the head, apply mustard to the feet; if it is in the side, apply hot fomentations.
The symptoms which indicate danger are a tumid and hard abdomen, difficult breathing, offensive and profuse diarrhea, bloody urine, delirium, or insensibility. Favorable symptoms are a natural and soft state of the skin, eruptions on the surface, a natural expression of the countenance, moist tongue, free action of the kidneys, and regular sleep. If the domestic treatment which we have advised does not break the force of the disease and mitigate the urgency of the symptoms, it will be safer to employ a good physician, who will prescribe such a coarse of treatment as the case specially requires. It is our aim to indicate what may be done before the physician is called, for frequently his services cannot be obtained when they are most needed. Besides, if these attacks are early and properly treated with domestic remedies, it will often obviate the necessity of calling upon a physician. If, on the other hand, fevers are neglected and no treatment instituted, they become more serious in character and are more difficult to cure.
To recapitulate, our treatment recommends evacuation through nature's outlets, the skin, kidneys, and bowels, maintaining warmth, neutralizing acidity, using antiseptics, tonics,and the hand-bath, and the fluid extract or tincture of aconite, or veratrum to moderate the pulse by controlling the accelerated and unequal circulation of the blood. It is a simple treatment, but if judiciously followed, it will often abort a fever, or materially modify its intensity and shorten its course.
The description of fever already given applies well to this form of it, only the symptoms in the former stage are rather more distinct than in the other varieties. Weariness, lassitude, yawning, and stretching, a bitter taste in the mouth, nausea, less of appetite, the uneasy state of the stomach and bowels are more marked in the premonitory stages of intermittent fevers. The cold stage commences with a chilliness of the extremities and back, the skin looks pale and shriveled, the blood recedes from the surface, respiration is hurried, the urine is limpid and pale, sometimes there is nausea and vomiting, and towards the conclusion of the stage, the chilly sensations are varied with flushes of heat. The hot stage is distinguished by the heat and dryness of the surface of the body and the redness of the face; there is great thirst, strong, full, and hard pulse, free and hurried respiration and increased pain in the head and back. The sweating stage commences by perspiration appearing upon the forehead, which slowly extends over the whole body, and soon there is an evident intermission of all the symptoms. In the inflammatory variety of intermittent fever, all these symptoms are acute, short, and characterized by strong reaction. Gastric fever, the most frequent variety of intermittent fever, is marked by irritation of the stomach and bowels, and a yellow appearance of the white of the eye.
Causes. The cause of the malarial fevers, intermittent, remittent, and congestive, is supposed to bemiasm, a poisonous, gaseous exhalation from decaying vegetation, which is generally most abundant in swamps and marshes, and which is absorbed into the system through the lungs.
Treatment. During the entire paroxysm the patient should be kept in bed, and in the cold stage, covered with blankets and surrounded with bottles of hot water. The Compound Extract of Smart-weed should be administered insome diaphoretic herb-tea. During the hot stage, the extra clothing and the bottles of hot water should be gradually removed and cold drinks taken instead of warm. During the sweating stage the patient should be left alone, but as soon as the perspiration ceases, from two to four of the Purgative Pellets should be administered, as a gentle cathartic. A second paroxysm should, if possible, be prevented. To accomplish this, during the intermission of symptoms, the Golden Medical Discovery should be taken in doses of from two to three teaspoonfuls every four hours in alternation with three-grain doses of the sulphate of quinine. If the attack is very severe, and is not relieved by this treatment, a physician should be summoned to attend the case.
The distinction betweenintermittentandremittentfever does not consist in a difference of origin. In the former disease there is a complete intermission of the symptoms, while in the latter there is only a remission.
Treatment.The treatment should consist in the employment of those remedial agents advised in intermittent fever, the Golden Medical Discovery and quinine being taken during the remission of symptoms. During the height of the fever, tincture of aconite maybe given and an alkaline sponge-bath administered with advantage. As in intermittent fever, should the course of treatment here advised not promptly arrest the disease, the family physician should be summoned.
This is the most severe and dangerous form of malarial fever. It may be either intermittent or remittent in character. In some instances the first paroxysm is so violent as to destroy life in a few hours, while in others it comes on insidiously, the first one or two paroxysms being comparatively mild. It is frequently characterized by stupor, delirium, a marble-like coldness of the surface, vomiting and purging, jaundice, or hemorrhage from the nose and bowels. In America this fever is only met with in the Mississippi valley, and in other localities where the air contains a large quantity of malarial poison.
Treatment.This fever is so dangerous that a physician should be summoned as soon as the disease is recognized. For the benefit of those who are unable to obtain medical attendance, we will say that the treatment should be much the same as in intermittent fever, but more energetic. Quinine should be taken in doses of from five to fifteen grains every two or three hours. If it be not retained by the stomach, the following mixture may be administered by injection: sulphate of quinine, one-half drachm; sulphuric acid, five drops; water, one ounce; dissolve, and then add two ounces of starch water.
The symptoms of these fevers do not intermit and remit, butcontinuewithout any marked variation for a certain period. They are usually characterized by great prostration of the system, and are calledputridwhen they manifest septic changes in the fluids, andmalignantwhen they speedily run to a fatal termination.Typhoidandtyphusfevers belong to this class. We shall not advise treatment for these more grave disorders which should always, for the safety of the patient, be attended by the family physician, except to recommend some simple means which may be employed in the initial stage of the disease, or when a physician's services cannot be promptly secured.