The Home Medical Library Volume II Part 10

If itching is p.r.o.nounced, remove crusts and scabs after soaking with olive oil, dust borax, finely powdered on the surface. If the itching is not controlled in twenty minutes, wipe off the borax with a very oily cloth (using olive oil), and then apply a little solution of carbolic acid (made by adding a half teaspoonful of carbolic acid to a pint of hot water). If this does not allay the itching, wipe it off thoroughly with the oiled cloth, and rub in the tar ointment made of equal parts of "pix liquida" and olive oil. After the itching ceases, treat as directed according to the variety existing. Itching often disappears after a good saline cathartic has acted--Roch.e.l.le salts, solution of magnesia citrate, or phosphate of soda. Scratching must be avoided. In the case of children it is prevented by putting mittens of muslin on the hands.

The best cathartic for young children is a teaspoonful of castor oil.

Carbolic-acid solution must not be used on them. The folds and creases of their skin must be kept dry and powdered with borated talc.u.m. A great point in the treatment of all eczema is to avoid the use of water, and to subst.i.tute oiling with olive oil and wiping off for the usual washing of the affected area.

=BALDNESS AND DANDRUFF.=--Baldness is commonly caused by seborrhea of the scalp, an affection probably due to a microbe, and consisting of an inflammation of the skin, with great increase of dandruff of a thick, greasy variety. Sometimes it appears as a thick film, not only covering the scalp, but also the forehead and back of the neck. The greasy substance should be removed with olive oil or vaseline, and the scalp treated with ointment of ammoniated mercury, four per cent strength. Shampoos with tar-soap suds should be given once in four or five weeks, and the hair should not be wet with water between the shampoos. The hair must be arranged by combing, the brush being used to smooth the surface of the hair only. Deep and repeated brushing does great damage, which is equalled only by the frequent washing some ill-advised sufferers employ. Ma.s.sage of the scalp is useless to control seborrheic eczema, which is practically always present in these cases.

Tight hats are sometimes a cause of baldness. The lead used in the preparation of the "sweat leather" of hats is said to be a cause of loss of hair over the temples. When once killed, hair can rarely be made to grow again. Early treatment of seborrhea is the best preventive of baldness.

The baldness occurring during an attack of syphilis, when the hair falls out in round patches, is treated and often relieved by antisyphilitic remedies (see p. 210).

FOOTNOTES:

[9] Caution. Poisonous.

CHAPTER III

=Rheumatism and Kindred Diseases=

_Causes of Rheumatic Fever--Relief of Pain in the Joints--Lumbago--Stiff Neck--Gout--Symptoms and Cure of Scurvy._

=RHEUMATIC FEVER; INFLAMMATORY RHEUMATISM; ACUTE RHEUMATISM.=--This variety of rheumatism is quite distinct from the other forms, being in all probability due to some special germ. It occurs in temperate climates during the fall, winter, and spring--less often in summer.

Persons more frequently suffer between the ages of ten and forty years. It is rare in infants; their pain and swelling of the limbs can be attributed more often to scurvy (p. 180), or to surgical disease with abscess of joint or bone. Exposure to cold and damp, in persons insufficiently fed, fatigued, or overworked, is the most common exciting cause.

=Symptoms.=--Rheumatic fever may begin with tonsilitis, or other sore throat, with fever and pains in the joints. The joints rapidly become very painful, hot, red, swollen, and tender, the larger joints, as the knees, wrists, ankles, and elbows, being attacked in turn, the inflammation skipping from one joint to another. The muscles near the joints may be also somewhat swollen and tender. With the fever, which may be high (the temperature ranging from 102 to 104 F.), there are rapid pulse, copious sweating, and often the development of various rashes and minute blisters on the skin. There is also loss of appet.i.te, and the bowels are constipated. The urine is usually very dark-colored. Altogether, victims of the disease are truly pitiable, for they suffer agony, and are unable to move without increasing it.

The weakness and prostration are marked. Small, hard lumps, from the size of a shot to that of a pea, sometimes appear on the skin of the fingers, hands, wrists, knees, and elbows. These are not tender; they last for weeks and months. They are seen more often in children, and are most characteristic of rheumatic fever, but do not show themselves till late in the disease.

Complications of rheumatic fever are many. In about half the cases the heart becomes involved, and more or less permanent crippling of the heart persists in after life. Unconsciousness and convulsions may develop--more often when the fever runs high.

Lung trouble and pleurisy are not infrequent. Ch.o.r.ea or St. Vitus's dance follows inflammatory rheumatism, in children, in some instances.

Repeated attacks at intervals, varying from one to four or five years, are rather the rule--more particularly in young persons. Acute rheumatism frequently takes a milder form, with slight fever (the temperature running not over 100 or 101 F.) and slight pain, and swelling of the joints. In children this is a common occurrence, but heart disease is just as apt to follow, and, therefore, such cases should receive a physician's attention at the earliest moment.

Recovery from rheumatic fever is the usual result, but with an increased tendency to future attacks, and with the possibility of more or less permanent weakness of the heart, for acute rheumatism is the most common origin of chronic heart troubles. The milder form often follows the more severe, and may persist for a long time. The duration of rheumatic fever is variable; in severe cases the patient is bedridden for six weeks or so.

Rheumatism may be named through a mistake in diagnosis. There are numerous other febrile disorders in which inflammation of the joints may occur. Among these are gonorrhea, pneumonia, scarlet fever, blood poisoning, diphtheria, etc. The joint trouble in these cases is caused by the toxins accompanying the special germ which occasions the original disease, and the joint inflammation is not in any way connected with rheumatism. The constant attention of a physician is emphatically demanded in every case of rheumatic fever, since the complications are so numerous, and since permanent damage of the heart may be prevented by proper care. Only frequent examinations of the heart by the medical man will reveal the presence or absence of heart complications.

=Treatment.=--It appears extremely doubtful whether rheumatic fever can be cut short by any form of treatment. The disease is self-limited, that is, it will pa.s.s away of itself after a certain time. The pain, however, can be rapidly abated by treatment. Warmth is of great value. It is best for the patient to sleep between blankets instead of sheets, and to wear flannel nightgowns, changing them as often as they become damp with sweat. To facilitate the changing, it is well to have the nightgowns slit all down the front, and also on the outside of the sleeves. Wrapping the joints in cotton batting and applying splints to secure absolute rest are great aids to comfort.

The diet should be fluid, consisting of gruels, milk, broths, and soups. To relieve pain in the joints, cloths, wrung out of a saturated solution of baking soda and very hot water, wrapped about the joint and covered with oil silk will be found extremely serviceable. Oil of wintergreen is another remedy which has proven of value when applied to the joints on cloths saturated in the oil and covered with cotton wool.

The bed must be smooth and soft, with good springs. High fever is reduced by the employment of cold to the head and by sponging the body with cool water at intervals of two hours or so.

The two drugs of most value are some form of salicylic acid and an alkali. Sodium salicylate in solution in water should be given to the adult in doses of ten to fifteen grains every two hours till the pain is relieved, and then once in four hours as long as the fever lasts.

At the same time baking soda should be administered every three hours, one-half a level teaspoonful dissolved in water, and this may be continued as long as the fever persists. The patient must use a bedpan in relieving the bladder and bowels, and should remain in bed for a great while if the heart is damaged. It is a disease which no layman should think of treating if it is possible to obtain the services of a medical man.

=MUSCULAR RHEUMATISM= (_Myalgia_).--In this disease there is pain in the muscles, which may be constant, but is more p.r.o.nounced on movement. Exposure to cold and wet, combined with muscular strain, frequently excite an attack. On the other hand, it often occurs during hot, dry, fine weather. Attacks last usually but a few days, but may be prolonged for weeks. The pain may be dull, as if the muscle had been bruised, but is often very sharp and cramplike. There is, commonly, slight, if any, fever, and no general disturbance of the health. The following are the most common varieties:

=LUMBAGO.=--This attacks the muscles in the small part of the back. It comes on often with great suddenness, as on stooping or lifting. It may be so severe that the body cannot be moved, and the patient may fall in the street or be unable to rise or turn in bed. In less severe cases the pain "catches" the patient when attempting to straighten up after stooping. Pain in the back is often attributed by the laity to Bright's disease, but is rarely seen in the latter disorder, and is much more often due to rheumatism.

=STIFF NECK.=--This is a very common variety of muscular rheumatism, and is seen more especially in young persons. It may appear very suddenly, as on awakening. It attacks the muscles of one side and back of the neck. The head is held stiffly to one side, and to turn the head the body must be turned also, as moving the neck causes severe pain. Sometimes the pain on moving the neck suddenly, or getting it into certain positions, is agonizing, but when it is held in other positions a fair amount of comfort may be secured.

=RHEUMATISM OF THE CHEST.=--In this form there is more or less constant pain, much increased by coughing, sneezing, taking long breaths, or by movements. It attacks usually one side, more often the left. It may resemble neuralgia or pleurisy. In neuralgia the pain is more limited and comes in sharper attacks, and there are painful spots. The absence of fever in rheumatism of the chest will tend to separate it from pleurisy, in which there is, moreover, often cough.

Examination of the chest by a physician, to determine the breath sounds, is the only method to secure certainty in this matter.

Muscular rheumatism also affects the muscles about the shoulder and shoulder blade and upper part of the back; sometimes also the muscles of the belly and limbs.

=Treatment.=--Rest, heat, and rubbing are the most satisfactory remedies. In stiff neck, rub well with some liniment, as chloroform liniment, and lie in bed on a hot-water bag. Phenacetin or salophen in doses of ten grains, not repeated more frequently than once in four hours for an adult, may afford relief; only two or three doses should be taken in all. In lumbago the patient should remain in bed and have the back ironed with a hot flatiron, the skin being protected by a piece of flannel. This should be repeated several times a day. Or a large, hot, flaxseed poultice may be applied to the back, and repeated as often as it becomes cool. At other times the patient may lie on a hot-water bag. Plasters will give comfort in milder cases, or when the patient is able to leave the bed. A good cathartic, as two compound cathartic pills, sometimes acts very favorably at the beginning of the attack. Salicylate of sodium is a useful remedy in many cases, the patient taking ten grains three times daily, in tablets after eating, for a number of days. In rheumatism of the chest, securing immobility by strapping the chest, as recommended for broken rib (Vol. I, p. 84), gives more comfort than any other form of treatment. Many other measures may be employed by the physician, and are applicable in persistent cases, as electricity and tonics. The hot bath, or Turkish bath, will sometimes cut short an attack of muscular rheumatism if employed at the onset of the trouble.

=CHRONIC RHEUMATISM.=--Chronic rheumatism is a disease attacking persons of middle age, or after, and is seen more commonly in poor, hard-working individuals who have been exposed to cold and damp, as laborers and washerwomen. Several of the larger joints, as the knees, shoulders, and hips, are usually affected, but occasionally only one joint is attacked. There is little swelling and no redness about the joint; the chief symptoms are pain on motion, stiffness, and tenderness on pressure. The pain is increased by cold, damp weather, and improved by warm, dry weather. There is no fever. The general health suffers if the pain is severe and persistent, and patients become pale, dyspeptic, and weak. The disease tends rather to grow worse than recover, and the joints, after a long time, to become immovable and misshapen. Life is not, however, shortened to any considerable degree by chronic rheumatism. Heart disease is not caused by this form of rheumatism, although it may arise from somewhat similar tendencies existing in the same patient. It may be distinguished from other varieties of rheumatism by the fact that the larger joints are those attacked, and also by the age of the patients and general progress of the disease. It very rarely follows acute rheumatism.

=Treatment.=--The treatment of chronic rheumatism is generally not very successful unless the patient can live in a warm, dry climate the year round. Painting the joint with tincture of iodine and keeping it bandaged in flannel affords some relief. The application of a cold, wet cloth covered with oil silk and bandage, by night, also proves useful. Hot baths at night, Turkish baths, or special treatment conducted under the supervision of a competent medical man at one of the hot, natural, mineral springs, as those in Virginia, often prove of great value. Rubbing and movement of the joints is of much service in all cases; any liniment may be used. Drugs are of minor importance, but cod-liver oil and tonics may be required. These should be prescribed by a physician.

=RHEUMATIC GOUT= (_Arthritis_).--Notwithstanding the name, this disease has no connection with either gout or the other forms of rheumatism described. It occurs much more frequently in women, with the exception of that form in which a single joint is attacked. The disease may appear at any age, but more often it begins between the years of thirty and fifty-five. The cause is still a matter of doubt, although it often follows, or is a.s.sociated with, nervous diseases, and in other cases the onset seems to be connected with the existence of influenza or gonorrhea, so that it may be of germ origin. Constant exposure to cold and dampness, excessive care and anxiety, and injury are thought to favor the disease. The disease is sometimes limited to the smaller joints of the fingers and toes, little, hard k.n.o.bs appearing on them. At times the joints may be swollen, tender, and red, and are usually so at the beginning of the disease, as well as at irregular intervals, owing to indigestion, or following injury. At first only one joint, as of the middle finger, may be attacked, and often the corresponding finger on the other hand is next affected.

The joints of the fingers become enlarged, deformed, and stiffened.

The results of the disease are permanent so far as the deformity is concerned and the stiffness which causes interference with the movement of the finger joints, but the disease may stop during any period of its development, leaving a serviceable, though somewhat crippled, hand. In these cases the larger joints are not generally involved. There is some evidence to indicate that this form of the disease is more commonly seen in the long-lived.

=General Form.=--In this type the disease tends to attack all the joints, and, in many cases, to go from bad to worse. The hands are usually first attacked, then the knees, feet, and other joints. In the worst cases every joint in the body becomes diseased, so that even movements of the jaw may become difficult. There are at first slight swelling, pain and redness about the joints, with tenderness on pressure. Creaking and grating are often heard during motion of the affected joints. This condition may improve or subside for intervals, but gradually the joints become misshapen and deformed. The joints are enlarged, and irregular and stiff; the fingers become drawn over toward the little finger, or bent toward the palm, and are wasted and clawlike. The larger limbs are often bent and cannot be straightened, and the muscles waste away, making the joints look larger. In the worst cases the patient becomes absolutely crippled, helpless, and bedridden, and the joints become immovable. The pain may be great and persistent, or slight. Usually the pain grows less as the disease advances. Numbness and tingling of the skin often trouble the patient, and the skin is sometimes smooth and glossy or freckled.

The general health suffers, and weakness, anaemia, and dyspepsia are common. Even though most of the joints become useless, there is often sufficient suppleness in the fingers to allow of their use, as in writing or knitting. In old men the disease is seen attacking one joint alone, as the hip, shoulder, knee, and spine. Children are occasionally sufferers, and in young women it may follow frequent confinements or nursing, and often begins in them like a mild attack of rheumatic fever. The heart is not damaged by rheumatic gout.

It is frequently impossible to distinguish rheumatic gout from chronic rheumatism in the beginning. In the latter, creaking and grating sounds on movement of the joints are less marked, the small joints, as of the hand, are not so generally attacked, nor are there as great deformity and loss of motion as is seen in late cases of rheumatic gout.

=Outlook.=--It often happens that after attacking several joints, the disease is completely arrested and the patient becomes free from pain, and only a certain amount of interference with the use of the joint and stiffness remain. Life is not necessarily shortened by the disease. The deformity and crippling are permanent.

=Treatment.=--Rheumatic gout is a chronic disease in most instances, and requires the careful study and continuous care of the medical man.

He may frequently be able to arrest it in the earlier stages, and prevent a life of pain and helplessness. In a general way nourishing food, as milk, eggs, cream, and b.u.t.ter, with abundance of fresh vegetables, should be taken to the extent of the digestive powers.

Everything that tends to reduce the patient's strength must be avoided. Cod-liver oil and tonics should be used over long periods.

Various forms of baths are valuable, as the hot-air bath, and hot natural or artificial baths. A dry, warm climate is most appropriate, and flannel clothing should be worn the year round. Moderate exercise and outdoor life, in warm weather, are advisable, and ma.s.sage, except during the acute attacks of pain and inflammation, is beneficial.

Surgical measures will sometimes aid patients in regaining the usefulness of crippled limbs.

=SCURVY.=--Scurvy used to be much more common than it is now. In the Civil War there were nearly 50,000 cases in the Union Army. Sailors and soldiers have been the common victims, but now the disease occurs most often among the poorly fed, on sh.o.r.e. It is caused by a diet containing neither fresh vegetables, preserved vegetables, nor vegetable juices. In the absence of vegetables, limes, lemons, oranges, or vinegar will prevent the disease. It is also thought that poisonous substances in the food may occasion scurvy, as tainted meat has experimentally produced in monkeys a disease resembling it.

Certain conditions, as fatigue, cold, damp quarters, mental depression and homesickness, favor the development of the disease. It attacks all ages, but is most severe in the old.

=Symptoms.=--Scurvy begins with general weakness and paleness. The skin is dry, and has a dirty hue. The gums become swollen, tender, spongy, and bleed easily, and later they may ulcerate and the teeth loosen and drop out. The tongue is swollen, and saliva flows freely.

The appet.i.te is poor and chewing painful, and the breath has a bad odor. The ankles swell, and bluish spots appear on the legs which may be raised in lumps above the surface. The patient suffers from pain in the legs, which sometimes become swollen and hard. The blue spots are also seen on the arms and body, and are due to bleeding under the skin, and come on the slightest bruising. Occasionally there is bleeding from the nose and bowels. The joints are often swollen, tender, and painful. Constipation is rather the rule, but in bad cases there may be diarrhea, nausea, and vomiting, and the victim becomes a walking skeleton. Mental depression or delirium may be present.

=Treatment.=--Recovery is usually rapid and complete, unless the disease is far advanced. Soups, fresh milk, beef juice, and lemon or orange juice may be given at first, when the digestion is weak, and then green vegetables, as spinach (with vinegar), lettuce, cabbage, and potatoes. The soreness of the mouth is relieved by a wash containing one teaspoonful of carbolic acid to the quart of hot water.

This should be used to rinse the mouth several times daily, but must not be swallowed. Painting the gums with a two per cent solution of silver nitrate in water, by means of a camel's-hair brush, twice daily, will also prove serviceable. To act as a tonic, a two-grain quinine pill and two Blaud's pills of iron may be given three times daily.