The Home Medical Library Volume II Part 7

=Growths and Enlargements=

_Benign and Malignant Tumors--Treatment of Rupture--Hernia in Children--Varicocele--Causes of Varicose Veins--External and Internal Piles._

=TUMORS.=--A tumor--in its original meaning--signifies a swelling. As commonly used it means a new growth or enlargement of a part, which is not due to injury or inflammation. Tumors occur at all ages, in both s.e.xes, and may attack any part of the body. Tumors are usually divided into benign and malignant growths. In a general way the malignant tumors are painful; they do not move about freely but become fixed to the adjacent parts; their growth is more rapid; they often have no well-defined borders; frequently they return after removal; the skin covering them is often attached and cannot be moved readily without also moving the tumor. Malignant tumors are divided into cancers (carcinomata) and sarcomas (sarcomata). Cancer is much more frequent than sarcoma. Cancer occurs more often in persons over thirty; there appears to be a hereditary tendency to it in some families, and a number of individuals in the same house or locality sometimes develop cancer as if it were in some way communicated from one to another.

The common situations of cancer are the breast and womb in women, and the lip and stomach of men. The neighboring glands become enlarged, as are shown by the lumps which form under the jaw in cancer of the lip, and which may be felt sometimes in the armpit in cancer of the breast; these are, however, late signs, and the growth should never be permitted to remain long enough for them to develop. Paleness, weakness, and loss of strength often attend the development of cancer, but many do not exhibit these symptoms.

Sarcoma is often seen in the young and well nourished; it grows very rapidly; the skin is usually not adherent to the tumor; there is generally no pain; heredity has no relation to its development; paleness is absent in many cases; the favorite seats are the muscle, bone, glands of neck, brain, and many other localities; it is not nearly so common as cancer.

Cancer of the breast begins as a lump, occurring more often to the outside of the nipple, but may develop in any part. It may or may not be painful at first, but the skin becomes attached to it; and sooner or later the nipple is drawn in. It is seen in women over forty, as a rule. Lumps in the breast, occurring during the nursing period, are often due to inflammation, but these generally have no relation to cancer unless they persist for a long time. Any lump which appears in the breast without apparent cause, or which persists for a considerable time after inflammation ceases, should be promptly removed by the surgeon, as without microscopic examination the most skilled pract.i.tioners will be unable absolutely to distinguish between a harmless and malignant tumor. As even so-called benign tumors often become cancerous (e. g., inflammatory lumps in the breast, warts, and moles), an eminent surgeon (Dr. Maurice Richardson) has recently formulated the rule that all tumors, wherever situated, should if possible be removed, whatever their apparent nature. Cancer of the womb may be suspected in middle-aged women if flowing is more profuse than is usual, or occurs at irregular times; if there is a discharge (often of offensive odor) from the front pa.s.sage; and sometimes pain, as backache, and perhaps paleness. Early examination should be sought at the hands of a physician; it is suicidal to delay.

Cancer of the stomach is observed more often in men over forty, and begins with loss of appet.i.te; nausea or vomiting; vomiting of blood; pain in the stomach; loss of weight, and paleness. Some of these symptoms may be absent. Improved methods of surgery have rendered early operation for cancer of the stomach a hopeful measure, and if cure does not result, the life will be prolonged and much suffering saved.

Cancer of the lip arises as a small lump, like a wart generally, on the lower lip in men from forty to seventy. Sometimes it appears at first simply as a slight sore or crack which repeatedly scabs over but does not heal. Its growth is very slow and it may seem like a trivial matter, but any sore on the lower lip in a man of middle age or over, which persists, should demand the immediate attention of a surgeon, because early removal is more successful in cancer of the lip than in any other form.

There are, of course, many comparatively harmless or benign forms of tumors which will not return if removed and do not endanger life unless they grow to a large size. Among these are the soft, flattened, fatty tumors of the shoulders, back, b.u.t.tocks, and other parts, and the wen. This is often seen on the head and occurs frequently on the scalp, from the size of a pea to an egg, in groups. Wens are elastic lumps, painless and of slow growth, and most readily removed. s.p.a.ce does not permit us to recount the other forms of benign tumors and it would be impossible to describe how they could be distinguished from malignant growths.

=Causes.=--The causes of tumors are almost wholly unknown. There is no other branch of medicine which is receiving more scientific study the world over than cancer, and some definite and helpful knowledge may soon be expected. A cancer can be communicated by introduction of cancerous material into healthy tissues. This and other reasons have led many to believe that the disease was caused by a special germ; a chemical cause is thought to be the origin of cancer by other authorities. Neither of these theories has been substantiated and we are still completely at sea in the matter. Cancer appears to be excited sometimes by local irritation, as in the lip by the constant irritation of the hard, hot stem of a clay pipe; cancer of the tongue by the irritation of a rough, sharp tooth. Blows and injuries are also occasional agencies in the development of cancer. Malignant growths not rarely arise from moles and warts.

=Treatment.=--Early removal by the knife is the only form of treatment which is to be considered in most cases. Delay and neglect are suicidal in malignant disease. Cure is successful in just so far as the operation is done early. If dread of surgical operation were not so prevalent, the results of removal of cancer would be immeasurably better. The common, bad results of operation--that is, return of the disease--are chiefly due to the late stage in which surgeons are compelled to operate through the reluctance of the patient and, strangely enough, often of his family medical man. Cancer should be removed in so early a stage that its true nature can often not be recognized, except by microscopical examination after its removal. If Maurice Richardson's rule were followed, many cancers would never occur, or would be removed before they had developed sufficiently to show their nature.

All treatment by chemical pastes and special remedies is simply courting fatal results. Most special cures advertised to be performed in sanitoriums are money-getting humbugs. Even the X-ray has proved useless except in the case of most superficial growths limited to the skin or when directed against the scar left by removal of a cancer; and while the growth may disappear during treatment, in a large proportion of cases there is a recurrence. But when tumors are so far advanced that removal by the knife is inoperable, then other means will often secure great relief from suffering and will prolong life for a very considerable period in many cases.

=RUPTURE.=--Hernia or rupture consists in a protrusion of a portion of the contents of the abdomen (a part of the bowel or its covering, or both) through the belly wall. The common seats of rupture are at the navel and in the groin. Rupture at the navel is called umbilical hernia; that in the groin either inguinal or femoral, according to slight differences in site. Umbilical hernia is common in babies and occurs as a whole in only five per cent of all ruptures, whereas rupture in the groin is seen to the extent of ninety-four per cent of all ruptures. There is still another variety of hernia happening in the scars of wounds of the belly after injuries or surgical operations, and this may arise at almost any point.

=Causes.=--Rupture is sometimes present at birth. In other cases it is acquired as a result of various causes, of which natural weakness of the part is the chief. Twenty-five per cent of persons with rupture give a history of the same trouble in their parents. Rupture is three times more frequent in men than in women, and is favored by severe muscular work, fatness, chronic coughing, constipation, diarrhea, sudden strain, or blows on the abdomen.

=Symptoms.=--Rupture first appears as a fullness or swelling, more noticeable on standing, lifting, coughing, or straining. It may disappear entirely on lying down or on pressure with the fingers. In the beginning there may be discomfort after standing or walking for any length of time, and later there is often a dragging pain or uneasiness complained of, or a sensation of weakness or griping at the seat of the rupture. In case the rupture cannot be returned, it is called irreducible and is a more serious form. The great danger of hernias is the likelihood of their being strangulated, as the term is; that is, so nipped in the divided abdominal wall that the blood current is shut off and often the bowels are completely obstructed. If this condition is not speedily relieved death will ensue in from two to eight days. Such a result is occasioned, in persons having rupture, by heavy lifting, severe coughing or straining, or by a blow or fall.

The symptoms of strangulated hernia are sudden and complete constipation, persistent vomiting, and severe pain at the seat of the rupture or often about the navel. The vomiting consists first of the contents of the stomach, then of yellowish-stained fluid, and finally of dark material having the odor of excrement. Great weakness, distention of the belly, retching, hiccough, thirst, profound exhaustion, and death follow if the condition is not remedied. In some cases, where the obstruction is not complete, the symptoms are comparatively milder, as occasional vomiting and slight pain and partial constipation.

If the patient cannot return the protrusion speedily, a surgeon should be secured at all costs--the patient meanwhile lying in bed with an ice bag or cold cloths over the rupture. The surgeon will reduce the protrusion under ether, or operate. Strangulation of any rupture may occur, but of course it is less likely to happen in those who wear a well-fitting truss; still it is always a dangerous possibility, and this fact and the liability of the rupture's increasing in size make a surgical operation for complete cure advisable in proper subjects.

=Treatment.=--Two means of treatment are open to the ruptured: the use of the truss and surgical operation. By the wearing of a truss, fifty-eight per cent of ruptures recover completely in children under one year. In children from one to five years, with rupture, ten per cent get well with the truss. Statistics show that in rupture which has been acquired after birth but five per cent recover with a truss after the age of fifteen, and but one per cent after thirty. The truss must be worn two years after cure of the rupture in children, and in adults practically during the rest of their lives. A truss consists of a steel spring which encircles the body, holding in place a pad which fits over the seat of hernia. The Knight truss is one of the best. The truss is most satisfactory in ruptures which can be readily returned.

In very small or large hernias, and in those which are not reducible, the action of the truss is not so effective. In irreducible ruptures there is likely to be constipation and colic produced, and strangulation is more liable to occur. A truss having a hollow pad may prove of service in small irreducible ruptures, but no truss is of much value in large hernias of this kind. Every person with a reducible rupture should wear a proper truss until the rupture is cured by some means. Such a truss should keep in the hernia without causing pain or discomfort. It should be taken off at night, and replaced in the morning while the patient is lying down. In cases where the protrusion appears during the night a truss must be worn day and night, but often a lighter form will serve for use in bed. To test the efficiency of a truss let the patient stoop forward with his knees apart, and hands on the knees, and cough. If the truss keeps the hernia in, it is suitable; if not, it is probably unsuitable.

Operation for complete cure of the hernia is successful in 95 cases out of 100, in suitable subjects, in the ruptures in the groin. The death rate is but about 1 in 500 to 1,000 operations when done by surgeons skilled in this special work. Patients with very large and irreducible hernias, and those who are very fat and in advanced life, are unfavorable subjects for operation. In young men operation--if it can be done by a skillful surgeon and in a hospital with all facilities--is usually to be recommended in every case of rupture.

Umbilical hernias and ventral hernias, following surgical operations, may be held in place by a wide, strong belt about the body, which holds a circular flat or hollow plate over the rupture. These have been the most difficult of cure by operation; but recent improvements have yielded very good results--thirty-five cures out of thirty-six operations for umbilical rupture, and one death, by Mayo, of Rochester, Minn.--and they are usually the very worst patients, of middle age, or older, and very stout.

Umbilical rupture in babies is very common after the cord has dropped off. There is a protrusion at the navel which increases in size on coughing, straining, or crying. If the rupture is pushed in and the flesh is brought together from either side in two folds over the navel, so as to bury the navel out of sight, and held in this position by a strip of surgeon's plaster, reaching across the front of the belly and about two and one-half inches wide, complete recovery will usually take place within a few months. It is well to cover the plaster with a snug flannel band about the body. The plaster should be replaced as need be, and should be applied in all cases by a physician if one can be secured.

=VARICOSE VEINS.=--Varicose veins are enlarged veins which are more commonly present on the legs, but are also seen in other parts of the body. They stand out from the skin as bluish, knotty, and winding cords which flatten out when pressure is made upon them, and shrink in size in most cases upon lying down. Sometimes bluish, small, soft, rounded lumps, or a fine, branching network of veins may be seen. Oftentimes varicose veins may exist for years--if not extensive--without either increasing in size or causing any trouble whatsoever. At other times they occasion a feeling of weight and dull pain in the legs, especially on long standing. When they are of long duration the legs may become swollen and hard, and eczema, with itching, is then not uncommon. This leads to scratching and sores, and these may enlarge and become what are called varicose ulcers, which are slow and difficult of healing. Occasionally an old varicose vein may break open and give rise to profuse bleeding.

=Causes.=--Varicose veins are more frequent in women, especially in those who stand much, as do cooks. Any obstruction to the return flow of the blood from the veins toward the heart will produce them, as a tight garter about the leg; or the pressure of the large womb in pregnancy upon the veins, or of tumors in the same region. Heart and lung diseases also predispose to the formation of varicose veins.

=Treatment.=--Varicose veins are exceedingly common, and if they are not extensive and produce no discomfort they may be ignored.

Otherwise, it is well to have an elastic stocking made to come to, or above, the knee. The stocking should be put on and removed while lying down. Cold bathing, outdoor exercise, and everything which will improve the general health and tone are desirable, also the avoidance of constipation. In the most aggravated cases surgical operation will cure varicose veins. Bleeding from a broken vein is stopped by pressure of a bandage and lying on the back with the foot raised on a pillow.

=VARICOCELE.=--This consists of an enlargement of the veins in the s.c.r.o.t.u.m above the t.e.s.t.i.c.l.e of the male, on the left side in most cases. The large veins feel more like a bunch of earthworms than anything else. If they cause no discomfort they may be entirely neglected and are not of the slightest consequence. Even when they produce trouble it is chiefly imaginary, in most instances, since they are a common source of worry in young men in case of any irregularities in the s.e.xual functions. Advantage is taken of this fact by quacks, who find it for their profit to advertise all sorts of horrible and impossible results of the condition. The t.e.s.t.i.c.l.e on the diseased side may become smaller than its fellow, but in few cases does any serious consequence result from varicocele. Pain in the hollow of the back may be the only symptom of varicocele in cases where there are any symptoms. A dragging pain in the groin, a pain in the t.e.s.t.i.c.l.es and about the r.e.c.t.u.m and in the bladder may cause complaint.

=Causes.=--Varicocele occurs usually in young, unmarried men and often disappears of itself in later life. Undue s.e.xual excitement may produce the condition.

=Treatment.=--When any treatment is necessary, the application of a snugly fitting suspensory bandage--which can be procured at any good drug shop--and bathing the t.e.s.t.i.c.l.es night and morning in cold water, with the avoidance of constipation and of the cause noted, will be generally sufficient to relieve any discomfort arising from varicocele. The enlargement of the veins will not, of course, be altered by this treatment, and absolute cure can only be effected by a surgical removal of the veins, which is not a serious undertaking, but is rarely necessary.

=PILES--HEMORRHOIDS.=--Piles consist of enlarged, and often inflamed, veins in the r.e.c.t.u.m, or lower part of the bowel.

=External Piles.=--These are bluish swellings or little lumps which project from the bowel, interfering with walking or the toilet of the parts, and are sometimes exquisitely tender and painful when inflamed.

In the course of time these become mere projections or fringes of flesh and cause no trouble unless through uncleanliness or other reasons they are irritated. The treatment of external piles may be summed up in great cleanliness--washing the parts after each movement of the bowels; rest in bed, if the soreness is great; the application of cold water or powdered ice in a rubber bag, or of hot poultices, and of various drugs. Among these are hamamelis extract, or witch-hazel, with which the parts may be frequently bathed; an ointment of nut-gall and opium; or extract of belladonna and glycerin, equal parts. Sitting in cold water, night and morning, in a tub also will prove serviceable. The more rapid and effectual method of cure consists in opening of the recent pile by the surgeon, or clipping off the fleshy projections. The bowels should always be kept regular in any form of piles by small doses of Glauber's or Epsom salts taken in a gla.s.s of hot water on rising, or some mineral water.

In case these do not agree, extract of cascara or compound licorice powder may be taken at night. Equal parts of sulphur and cream of tartar is an old-fashioned domestic cathartic of which a teaspoonful may be taken each morning to advantage in piles.

=Internal Piles.=--In the beginning patients with internal piles feel as if the bowels were not wholly emptied after a pa.s.sage, and sometimes there is difficulty in urinating and also pains in the hollow of the back and in the thighs. There is often pain on movement of the bowels, and blood follows the pa.s.sage. Later, blood may be lost at other times, and the loss may be so great as to cause p.r.o.nounced paleness and weakness. Itching is a frequent occurrence. Mucus and pus (matter such as comes from an abscess) may also be discharged. Loss of s.e.xual desire and power is not uncommonly present. There may be no external protrusions; but bleeding, itching, and pain during movement of the bowels are the chief symptoms. If the pain is very severe during and also after a pa.s.sage, it is probable that there is also present a fissure or crack in the flesh, or ulcer at the exit of the bowel which needs surgical attention. It not infrequently happens that the piles come out during the bowel movement, when they should be thoroughly washed, greased, and pushed back. Sometimes this is impossible, although after lying down for a while and applying ice or cold water the ma.s.s may shrink so as to admit of its return. When a large ma.s.s is thus protruded and cannot be returned, and becomes nipped by the a.n.u.s muscles, it undergoes inflammation and is very painful, but a cure often results from its destruction. Such a mode of cure is not a safe or desirable one, however.

=Treatment.=--The cold sitz baths in the morning or injections of a half pint of ice water after a pa.s.sage are useful. Ointments may be introduced into the bowel upon the finger, or, better, with hard rubber plugs sold for the purpose; or suppositories may be employed.

An ointment, containing sixty grains of iron subsulphate to the ounce of lard (or, if there is much itching, an ointment consisting of orthoform, thirty grains, with one-half ounce of lard), will prove of value. Also the injection of one-half pint cold water, containing a teaspoonful of extract of hamamelis, after a pa.s.sage, affords relief.

Two or three grains of the subsulphate of iron may be employed in suppositories, and one of these may be introduced three times daily.

The compound gall ointment or the glycerite of tannin will be found to act successfully in some cases. When one remedy does not serve, try another. The only positive cure for piles consists in surgical operation for their removal. Self-treatment is not recommended, as the physician can do better, and an examination is always advisable to rule out other conditions which may be mistaken by the layman for piles.

=Causes.=--Piles are seen chiefly in adults, in those in advanced life, and in those who exercise little but eat much. Constipation favors their occurrence, and the condition is commonly present in pregnant women. Fatigue, exposure, horseback exercise, or an alcoholic debauch will cause their appearance. Certain diseases also occasion the formation of piles.

CHAPTER II

=Skin Diseases and Related Disorders=

_Household Remedies for Itching--Chafing and Chapping--Hives, Cold Sores and Pimples--Ringworms, Warts and Corns--Eczema and other Inflammatory Disorders._

No attempt will be made to give an extended account of skin diseases, but a few of the commoner disorders which can be readily recognized by the layman will be noticed. Although these cutaneous troubles are often of so trivial a nature that a physician's a.s.sistance is unsought, yet the annoyance is often sufficient to make it worth while for the patient to inform himself about the ailment. Then the affections are so frequent that they may occur where it is impossible to procure medical aid. Whenever an eruption of the skin is accompanied by fever, sore throat, headache, pains in back and limbs, vomiting, or general illness, one of the serious, contagious, eruptive diseases should be suspected, particularly in children, and the patient must be removed from contact with others, kept in isolation, and a physician immediately summoned.

=ITCHING= (_Pruritus_).--Itching is not a distinct disease by itself, but a symptom or sign of other skin or general disorders.

Occasionally it must be treated as if it were a separate disease, as when it occurs about the entrance to the bowel (_a.n.u.s_), or to the external female s.e.xual parts (_v.u.l.v.a_), or attacks the skin generally, and is not accompanied by any skin eruption except that caused by scratching, and the cause be unascertainable. Itching, without apparent cause, may be due to parasites, as lice and fleas, and this must always be kept in mind; although debilitated states of the body and certain diseases, as gout and diabetes, are sometimes the source.

Commonly, itching is caused by one of the many recognized skin diseases, and is accompanied by an eruption characteristic of the particular disorder existing, and special treatment by an expert, directed to remedy this condition, is the only reasonable way to relieve the itching and cure the trouble.

It may not, however, be improper to suggest means to relieve such a source of suffering as is itching, although unscientific, with the clear understanding that a cure cannot always be expected, but relief may be obtained until proper medical advice can be secured. The treatment to be given will be appropriate for itching due to any cause, with or without existing eruption on the skin, unless otherwise specified. If one remedy is unsuccessful, try others.

For itching afflicting a considerable portion of the skin, baths are peculiarly effective. Cold shower baths twice daily, or swimming in cold water at the proper time of year, may be tried, but tepid or lukewarm baths are generally more useful. The addition of saleratus or baking soda, one to two pounds to the bath, is valuable, or bran water obtained by boiling bran tied in a bag in water, and adding the resulting solution to the bath. Even more efficient is a bath made by dissolving half a cupful of boiled starch and one tablespoonful of washing or baking soda in four gallons of warm water. The tepid baths should be as prolonged as possible, without chilling the patient. The bran water, or starch water, may be put in a basin and sopped on the patient with a soft linen or cotton cloth and allowed to evaporate from the skin, without rubbing, but while the skin is still moist a powder composed of boric acid, one part, and pulverized starch, four parts, should be dusted on the itching area.

Household remedies of value include saleratus or baking soda (one teaspoonful to the pint of cold water), or equal parts of alcohol, or vinegar and water, which are used to bathe the itching parts and then permitted to dry on them. Cold solution of carbolic acid (one teaspoonful to the pint of hot water) is, perhaps, the most efficacious single remedy. But if it causes burning it must be washed off at once. Dressings wet with it must never be allowed to become dry, as then the acid becomes concentrated and gangrene may result.

Calamine lotion (p. 145) is also a serviceable preparation when there is redness and swelling of the skin. When the itching is confined to small areas, or due to a pimply or scaly eruption on the skin, the following ointments may be tried: a mixture of tar ointment and zinc ointment (two drams each) with four drams of cold cream, or flowers of sulphur, one part, and lard, twelve parts.

=CHAFING AND CHAPPING.=--Chafing occurs when two opposing skin surfaces rub together and are irritated by sweat, as in the armpits, under the b.r.e.a.s.t.s and beneath overlapping parts of the belly of fat people, and between the thighs and b.u.t.tocks. The same result is caused by the irritation induced by discharges constantly running over the skin, as that seen in infants, due to the presence of urine and bowel discharges, and that irritation which arises from saliva when the lips are frequently licked. The latter condition of the lips is commonly called chapping, but it is proper to consider chafing and chapping together as the morbid state of the skin, and the treatment is the same for both.

Chafing occurs more often in hot weather and after violent exercise, as rowing, riding, or running, and is aggravated by the friction of clothing or of tight boots. It may, on the other hand, appear in persons who sit a great deal, owing to constant pressure and friction in one place. The parts are hot, red, and tender, and emit a disagreeable odor when secretions are retained. The skin becomes sodden by retained sweat, and may crack and bleed. The same redness and tenderness are seen in chapping of the face and lips, and cracking of the lips is frequent.