Chapter XIX: Preface: iii (18)

DIABETES MELLITUS.--A disorder of nutrition in which sugar accumulates in the blood and is excreted in the urine, the daily amount of which is greatly increased.

Causes.--Hereditary influences play an important role and cases are on record of its occurrence in many members of the same family. Men are more frequently affected than women, the ratio being about three to two. Persons of a nervous temperament are often affected. It is a disease of the higher classes. Hebrews seem especially prone to it. The disease is comparatively rare in the colored race; women more than men in the negro,- nine to six. In a considerable proportion of the cases of diabetes the patients have been very fat at the beginning of or prior to the onset of the disease. It is more common in cities than in country districts. The combination of intense application to business, over-indulgence in food and drink, with a sedentary life, seem particularly prone to induce the disease. Injury to or disease of the spinal cord or brain has been followed by diabetes. It is much more frequent in European countries than here. Acute and chronic forms are recognized in the former.

Symptoms.--The only difference is that the patients are younger in acute forms, the course is more rapid and the wasting away is more marked. The onset of the disease is gradual and either frequent passing of urine (six to forty pints in twenty-four hours) or inordinate thirst attracts attention. When it is fully established, there is great thirst, the passage of large quantities of sugar urine, a terrible appetite, and, as a rule, progressive emaciation. The thirst is one of the most distressing symptoms. Large quantities of water are required to keep the sugar in solution and for its excretion in the urine. Some cases do not have the excessive thirst; but in such case the amount of urine passed is never large. The thirst is most intense an hour or two after meals. The digestion is generally good, but the appetite is inordinate. Pain in the back is common. The tongue is usually dry, red and glazed, and the saliva is scanty. The gums may become swollen. Constipation is the rule. The skin is dry and harsh and sweating rarely occurs. The temperature is under normal. In spite of the enormous amount of food eaten a patient may become rapidly emaciated. Patients past middle life may have the disease for years without much disturbance of the health; on the other hand I have seen them die after that age. Progress is more rapid the younger the person. Death usually occurs from coma of diabetes. This is most common in young patients.

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1. There is a sudden onset after exertion of weakness, feeble pulse, stupor, coma, death in a few hours.

2. Sudden headache, coma, death in a few hours.

3. After nausea, vomiting or a lung complication, there are headache, delirium, abdominal pain, rapid labored breathing, sweetish odor of the breath, stupor, rapid feeble pulse, coma and death within a few days.

Recovery.--Instances of cure in true diabetes are rare.

Treatment. Preventive.--The use of starchy and sugary articles of diet should be restricted in families with a marked disposition to this disease. Sources of worry should be avoided and he should lead an even quiet life, if possible, in an equable climate. Flannel and silk should be worn next to the skin, and the greatest care should be taken to promote its action. A lukewarm and, if tolerably robust, a cold bath should be taken every day. An occasional Turkish bath is useful.

Diet.--Let the patients eat food of easy digestion, such as veal, mutton and the like, and abstain from all sorts of fruit and garden stuff. In Johns Hopkins' Hospital these patients are kept for three or four days on the ordinary ward diet, which contains a moderate amount of carbo-hydrates, in order to ascertain the amount of sugar excretions. For two days more the starches are gradually cut off. They are then placed on the following standard non-carbohydrate diet.

Breakfast: 7:30, six ounces of tea or coffee; four ounces of beefsteak, mutton chops without bone, or boiled ham; one or two eggs.

Lunch: 12:30, six ounces of cold roast beef; two ounces celery, fresh cucumbers or tomatoes with vinegar, olives, pepper and salt to taste, five drams of whisky with thirteen ounces of water, two ounces of coffee without milk or sugar.

Dinner: 6:00 P. M., six ounces of clear bouillon; seven and a half ounces of roast beef; one and one-half drams of butter; two ounces of green salad with two and a half drams of vinegar, five drams of olive oil, or three tablespoonfuls of some well-cooked green vegetable: three sardines; five drams of whisky with thirteen ounces of water.

Supper: 9:00 P. M., two eggs, raw or cooked, thirteen ounces of water .

The following is a list of articles which a diabetes patient may take as given by one of the best authorities in the world on diabetes:

Liquids: Soups.--Ox tail, turtle bouillon and other clear soups. Lemonade, coffee, tea, chocolate and cocoa; these to be taken without sugar, but they may be sweetened with saccharin. Potash or soda water and appollinaris, or the Saratoga-vichy and milk in moderation may be used.

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Animal Food.--Fish of all sorts, including crabs, oysters, salt and fresh butcher's meat (with the exception of liver), poultry and game, eggs, buttermilk, curds and cream cheese.

Bread.--Gluten and bran bread, almond and cocoanut biscuits.

Vegetables.--Lettuce, tomatoes, spinach, chickory, sorrel, radishes, asparagus, water-cress, mustard and cress, cucumber, celery and endives; pickles of various sorts.

Fruits.--Lemons and oranges, currants, plums, cherries, pears, apples (tart), melons, raspberries and strawberries may be taken in moderation. Nuts, as a rule, allowable.

Must Not Take--

Thick Soups and Liver. Ordinary bread of all sorts (in quantity), rye, wheaten, brown or white. All farinaceous (starchy) preparations, such as hominy, rice, tapioca, arrowroot, sago and vermicelli.

Vegetables: Potatoes, turnips, parsnips, squashes, vegetable-marrows of all kinds, beets, common artichokes.

Liquids: Beer, sparkling wine of all sorts and the sweet aerated drinks.

Medicines. Codeine.--A patient may begin with one-half grain three times a day, which may be gradually increased to six or eight grains in the twenty-four hours (under the doctor's care); withdraw it gradually when sugar is absent or reduced as far as possible.

DIABETES INSIPIDUS.--A chronic affection characterized by the passage of large quantities of normal urine of low specific gravity.

Causes.--It is most often found in young males and is probably of nervous origin. It may follow excitement or brain injury.

Symptoms.--The onset is usually gradual. The urine is pale; ten to twenty quarts a day. Thirst, dryness of the mouth and skin. Appetite and general conditions are usually normal; sometimes there are feebleness and emaciation. Death usually occurs from some other disease.

Treatment.--There is no known cure. Keep the general health in good condition according to the advice of your family physician.

OBESITY.--An excessive development of fat; it may be hereditary. It occurs most frequently in women of middle age and in children. Its chief cause is excessive eating and drinking, especially of the starch and sugar foods and malt liquors, and lack of exercise. The increase of fat is in all the normal situations and the heart and liver are often large and fatty. The condition in general may be good or there may be inactivity of the mind and body. Disturbances of digestion and symptoms of a fatty heart. There is less power to resist disease. Death may occur from fatty infiltration of the heart, resulting in dilatation or rupture.

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Treatment.--Must be in regulating the diet. The person must avoid all excess in food and drink, and avoid especially foods that contain starch and sugar. There must be regular and systematic exercise, hot baths and massages are helps. Medicines made from the poke berry are much used and are successful in some cases.

Diet.--The food of a fleshy person should be cut down gradually. Its bulk can be great, but its nourishing properties should be small. The diet for reduction of obesity should consist chiefly of bulky vegetables, but not too much of any one article or set of articles. The following list is recommended by Dr. Hare of Philadelphia:

For Breakfast.--One or two cups of coffee or tea, without milk or sugar, but sweetened with a fraction of a grain of saccharin. Three ounces of toasted or ordinary white bread or six ounces of brown bread; enough butter may be used to make the bread palatable, not more than one ounce. Sliced raw tomatoes with vinegar, or cooked tomatoes without any sugar or fats. This diet may be varied by the use of salted or fresh fish, either at breakfast or dinner. This fish must not be rich like salmon or sword-fish, but rather like perch or other small fish.

Noon Meal--Dinner.--One soup plate of bouillon, consomme julienne, or other thin soup, or Mosqueras beef-jelly, followed by one piece of the white meat of any form of fowl or a small bird. Sometimes a small piece, the size of one's hand, of rare beef, or mutton but no fat, may be allowed, and this should be accompanied by string beans, celery (stewed or raw), spinach, kale, cabbage, beans, asparagus, beets and young onions. Following this, lettuce with vinegar and a little olive oil (to make a French dressing), a cup of black coffee or one of tea, and a little acid fruit, such as sour grapes, tamarinds and sour oranges, or lemons may be taken, and followed by a cigar, if the patient has such a habit.

Supper.--This should consist of one or two soft boiled eggs, which may be poached, but not fried, a few ounces of brown bread, some salad and fruit and perhaps a glass or two of light, dry (not sweet) wine, if the patient is accustomed to its use.

Before Going to Bed.--To avoid discomfort from a sensation of hunger during the night, the patient may take a meal of panada, or he may soak graham or bran crackers or biscuits in water and flavor the mess with salt and pepper. The reduction of the diet is generally best accomplished slowly and should be accompanied by measures devoted to the utilization of the fat present for the support of the body. Thus, the patient should not be too heavily clad, either day or night, should resort to exercise, daily becoming more severe, and should not drink freely of water, unless sweating is established sufficiently to prevent the accumulation of liquid in vessels and tissues. Baths of the proper kind, cold or Turkish, should be used, if the patient stands them well. The bowels should be kept active by laxative fruit or purges. Salts are useful if drinks are thrown off rapidly. If proper exercise is impossible the rest cure with massage, electricity, passive exertion and absolute skimmed milk diet may be resorted to, particularly in those persons known as "fat anemics," who have not enough red corpuscles in their blood to carry sufficient oxygen to the tissues to complete oxidation.

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CANCER.--(In the following article on cancer we quote in part from material issued by the Public Health Department of the State of Michigan).

Cancer is curable if it be operated upon in its early stages.--If it be left to grow and develop, cancer is always fatal. It may be partially removed when in an advanced stage, and relief may be had for some time after operation; but beyond the early stage, cancer cannot at present be permanently removed, nor permanently cured. Permanent cure of a cancer is possible if the afflicted person obtains an early diagnosis and receives early attention from a skilled surgeon. The only permanent cure for cancer known at the present time is early surgical operation.

Have Operations Failed to Cure?--Very few persons die from operations performed by skilled surgeons for the removal of cancer. Where cancer operation is done by experienced surgeons the fatality in America for the past fourteen years is less than one case out of a hundred, or in other words ninety-nine persons out of a hundred survive operation for cancer. Many persons have died from the return of the cancerous growth even after operation by a skilled surgeon, and this fact has led many persons to believe that operation for cancer is, therefore, unsuccessful, that it does not cure. This is not the fact. It is true that cancer often returns after operation, and that this method does not always effect a permanent cure; but it is not true that operations are, therefore, useless. The reason that operations do not remove cancers permanently in a great number of cases is that such cases do not submit to operation soon enough. The majority of persons suffering from cancer seek surgical aid too late. If a house is on fire and one refuses to turn in an alarm until the fire has spread from cellar to garret, neither blame nor disparagement must be placed upon the fire department if it failed to save the burning house. So with cancer; if the public refuses or neglects to operate for cancer at the time when it can be eradicated, the public cannot censure or belittle surgery. A cancer is like a green and ripe thistle. Pull up the green thistle and you have gotten rid of it. But if you wait until the thistle is ripe, and the winds have blown away the seeds, there is no use of pulling up that thistle. Early operations are successful. Late ones are not.

No reliable surgeon claims to save his patient or cure him of cancer if the disease be in an advanced stage. But experienced surgeons do recognize the fact that cancer in its early stage can be permanently removed and a permanent cure can be effected by surgical operation. No other means of permanent cure are known.

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Caustic pastes applied to cancerous growths or sera, are sometimes successful in obliterating the cancer for a time; but they are not reliable for effecting enduring cures, and usually are merely palliative, The fact that a cancer does not return for three years after removal is not sure proof that it will not return; the return of a cancerous growth depends upon its state of development and other conditions at the time of removal from the cancer. In Johns Hopkins' Hospital forty-seven per cent of all patients with cancers of the breast operated upon remained well for three years or more, and seventy-five per cent of this forty-seven per cent were cured, being in the most favorable condition for cure at the time of the operation. But where conditions are not favorable at the time of the operation, many patients have a return of the cancer even after the three years of apparent cure have elapsed.

What is Cancer?--A cancer is a growth of cancerous cells in a network of connective tissue. The cause of cancer is not known. It has not been proved to be communicable and the majority of investigators of this subject believe that it is not caused by a germ. Nor is it thought to be inherited. Out of 8,000 cases of cancer at Middlesex Hospital, London, no evidence of heredity was found. Until the cause of cancer is known, it cannot be prevented. The only safeguard lies in an early diagnosis of the condition and an immediate operation. Eminent investigators are carrying on extensive research and thousands of dollars are being spent annually to ascertain, if possible, what is the cause of this dread disease, and it is confidently believed that final success will crown this labor.

When to Suspect Cancer and What to Do.--External or Exposed Cancer.--Cancer of the exposed or surface parts of the body, such as the skin of the lip, nose, cheek, forehead, temples, etc., is more readily recognized than internal cancer, and is therefore more liable to early operation and prompt cure. One rarely sees these forms of cancer in an advanced stage, because such cases are readily seen and recognized by physicians in the early stage of development, when operation can be sufficiently early to effect a lasting cure.

The least malignant of all cancers is that kind which first exhibits itself by a hardening of the skin, forming a nodule looking pimple or a mole and having a dark red color, due to tortuous blood vessels, upon the sides of the nose near the eyes, upon the cheek bones, forehead or temples. This form of epithelioma is called rodent ulcer, flat epithelioma or cancroid and sometimes does little harm for many years, but should receive the attention of a physician familiar with cancer and its eradication.

Deep or squamous cancer occurs on the lip, the tongue or the forehead or wherever the mucous membrane joins the skin, and is characterized by a hard, deep-seated sore formed upon any such part, growing down into the flesh and having a dark red or purplish-red color.

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If such a cancer is suspected of being present, the patient should at once seek diagnosis from a competent physician. Cancer of the lip is more frequent in men than in women, occurring usually in the under lip and called "Smoker's Cancer." Any hard persistent nodule in the under lip should cause suspicion and should be taken to a skilled surgeon, as cancer of the under lip is easily removed when in its early stage of development.

CANCER OF THE STOMACH.--The beginning of cancer of the stomach is very difficult to recognize and it is far safer and wiser, upon the appearance of the first suspicious symptom, to seek the aid of some physician skilled in cancer diagnosis than to ignore and neglect these early warnings of the disease. Although cancer of the stomach may occur in younger persons, it is usually met with in persons after forty years of age. Therefore, any person at this age who suffers from continuous indigestion or characterized by retention and prolonged fermentation of food in the stomach, should at once consult a competent physician. In the early stages of the cancer of the stomach the patient loses weight, but in the later stages there is more or less pain.

Whenever a physician finds that a patient has a pappy, insipid taste with a furred, pale, rarely dry and red tongue, and is suffering from continuous, dull sensations or pain in the region of the stomach, periodically increasing to paroxysms, often induced by pressure or increased by it, together with a sensation of weight, drawing pains of varying character, and frequent pain in the shoulder, loss of appetite, frequent belching of fetid gas from the stomach, severe and frequent vomiting, often periodical, often occurring before partaking of a meal but more often afterwards with slight indigestion, but vomitus being more or less watery and containing mucus and blood, usually decomposed and recurring frequently, together with constipation of the bowels, the skin being sallow, yellowish, dry and flaccid, and losing weight and strength, he should suspect cancer of the stomach and where possible advise an immediate surgical operation for the removal of the cancer.

CANCER OF THE UTERUS.--What women should know regarding it. The menopause or change of life comes on gradually, rarely suddenly. It is not preceded by excessive flowing or discharge or pain in a healthy woman.

By cancer period is understood those years after forty, although rarely it may occur earlier. The first symptoms of uterine cancer are:

1. Profuse flowing, even if only a day more than usual. Flowing or spotting during the interval or after the use of a syringe or the movement of the bowels.

2. Whites or Leucorrhea, if not existing previously. If existing but getting more profuse, watery, irritating, or producing itching is a very suspicious symptom.

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3. Loss of weight, if no other cause is apparent. Pain in the region of the womb, back or side.

If any of the above symptoms occur after the age of thirty-five or forty, a woman should seek relief and insist on thorough investigation of the cause and prompt treatment.

Cancer is always at first a local disease and can be removed if early recognized and an absolute, permanent cure brought about.

CANCER OF THE BREAST.--Eighty-one per cent of an tumors of the breast are cancer or become so. Whenever a woman feels a lump in her breast, particularly if she be at the cancerous age, she should consult a skilled physician at once and keep that breast under medical observation. If so advised by her physician or by a skilled surgeon, she should have an operation for the removal of the cancer, as it can be completely eradicated when operated upon in its early stages. If left to grow and develop it will get beyond the aid of even the most skillful surgeon. Early diagnosis plus surgery is the only hope for a cancerous person. Operation offers a most hopeful outlook for those afflicted with cancer. It is more important to make an early diagnosis in cancer of the breast than it is in appendicitis.

CANCER (CARCINOMA).--This is very malignant. This kind is divided into two classes, Scirrhus and Epithelial.

1. Scirrhus cancer. This is a hard, irregular growth of moderate size. Its special seat is the breast, the pyloric (smaller) end of the stomach and in few instances the glands of the skin.

Soft Medullary or Encephaloid cancer. This type resembles brain tissue both in appearance and consistence. It appears quite soft and may be mistaken for an abscess. In form, it differs according to the organ attacked. Special seats: The testicle, liver, bladder, kidney, ovary, the eye and more rarely the breast.

Colloid cancer; jelly-like substance.--The cancer cells have undergone a degeneration in one of the preceding varieties. The material it contains is a semi-translucent, glistening, jelly-like substance. Its special seats are the stomach, bowel, omentum, ovary and, occasionally, the breast.

Diagnosis.--This kind is very rare before thirty years of age and common after forty. They involve the gland early, contrary to what the sarcoma variety does. Innocent growths occur, as a rule, in younger patients, do not grow so rapidly, do not become adherent to neighboring parts and do not ulcerate.

2. The Epithelial Cancer (Carcinoma).--These always spring from free epithelium-clad surfaces, as the skin, and mucous membranes or from the glands of the same. These growths appear with great frequency at the points of junction of mucous membranes and skin surfaces, probably because these parts are subjected to more frequent and varied forms of mechanical and chemical irritation, Special seats: Skin surfaces, the nose, the lower lip, the penis and scrotum, the vulva, the anus (mucous surfaces), tongue, palate, gums, tonsils, larynx, pharynx, gullet, bladder, womb.

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MOTHERS' REMEDIES.--l. Cancer, Simple Remedy for.--"Give a teaspoonful of sarsaparilla tea four times daily, made with two ounces of sarsaparilla root and quart of water boiled to one pint and apply to cancer growth a poultice made of carrots scraped or mashed cranberries." These simple remedies will relieve and often cure growths taken for cancers, but if it is really a cancerous growth no medicine will help and a physician should be consulted at once.

2. Cancer, Nettles and Laudanum Will Help.--"Take the juice of common nettles inwardly and mix a little laudanum with the juice and rub the parts outwardly. Cancer has often yielded to this treatment." This remedy will no doubt help an ugly looking ulcer, repeatedly taken for cancer, by the patients themselves and frequently the doctor. It is always well to give this simple home remedy a trial, at least, for it is frequently admitted by the medical fraternity to-day that ugly ulcers are often treated in this way as cancers, sometimes to the lasting detriment of the sufferer. Then why not try some efficient home remedy like the above until you are certain that it is a cancer?

TUMORS.--A tumor is a new growth which produces a localized enlargement of a part, or an organ, has no tendency to a spontaneous cure, has no useful function, in most cases tends to grow during the whole of the individual's life. Clinically, tumors are divided into the benign and the malignant.

A benign tumor is usually composed of tissues, resembling those in which it originates.

A malignant tumor usually consists of tissues widely different from those in which it originates; its growth is rapid and therefore often painful; it infiltrates all the surrounding tissues, however resistant, even bone, because it is never encapsulated; it thus early becomes immovable; the overlying skin is apt to become adherent, especially when the breast is involved. Sooner or later it usually infects the group of lymphatic glands intervening between it and the venous circulation and from these new centres, or directly through the veins, gives rise to secondary deposits in the internal organs.

Some varieties. 1. Fibrous tumors; these consist of fibrous tissues. 2. Fatty tumors (or lipomata); these consist of normal fat tissue. 3. Cartilaginous tumors; consist of cartilage. 4. Osseous (bony) tumors. 5. Mucous tumors (myxomata). 6. Muscular tumors (myomata). 7. Vascular tumors (Angeiomata). 8. Nerve tumors (Neuromata).

Malignant Sarcoma (Sarcomata).--These are a variety of tumors. The result of these varies with the location of the tumor. If located in the jaw, an operation may cure it. If in the tonsil or lymphatic gland, it destroys life rapidly. If in the sub-cutaneous tissue, it may be repeatedly removed, the system remaining free, or the amputation of the limb involved will probably cure the disease.

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TUMORS.--Diagnosis. It is uncommon under thirty, quite common after. Epithelioma of the lower lip is limited almost entirely to men. If, then, a man of from forty to seventy develops a small tumor in the lower lip which ulcerates early, it is likely to be the cancer. The same applies to some extent to the tongue. These growths and sores need attention early.

Treatment.--The best treatment is early free removal of the entire growth before the glands are involved.

DISEASES OF THE CIRCULATORY SYSTEM

HEART DISEASE, Emergency Treatment.--For collapse or fainting, loosen clothing, lie down, rub camphor on forehead, and keep quiet.

To Revive When Fainting.--Smell of camphor or aromatic spirits of ammonia. Put one to two teaspoonfuls of whisky or brandy in eight teaspoonfuls of hot water, and give one or two teaspoonfuls at a time and repeat often. Some are not accustomed to stimulants and it may strangle them, so give it slowly. Pulse is weak in such cases, calling for stimulants.

2. Pearls of Amylnitrite. Break one in a handkerchief and put the handkerchief to the patient's nose so that he may inhale the fumes.

Stimulant.--A person with heart valvular trouble should always carry pearls of amylnitrite. Inhale slowly so as not to get too much of it at once.

HEART FAILURE.--The pulse may be slow and weak or fast and weak.

Digitalis.--Give five drops of the tincture in a little water. Another dose can be given in fifteen minutes. Then another in an hour, if necessary.

PALPITATION OF THE HEART.--Irregular or forcible heart beat action usually perceived by the person troubled.

Causes.--Hysteria, nervous exhaustion, violent emotions or sexual excesses; overdose of tea and coffee: alcohol or tobacco.

Symptoms.--There may be only a sensation of fluttering with that of distention or emptiness of the heart. There may be flushing of the skin, violent beating of the superficial arteries, with rapid pulse, difficult breathing and nervousness. Attack lasts from a few minutes to several hours.

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MOTHERS' REMEDIES.-l. Palpitation of the Heart, Tea of Geranium Root for.--"Make an infusion of geranium root, half an ounce in pint of boiling water, strain, cool, and give wine glass full three or four times a day." The geranium root will be found to be an excellent remedy where female weakness has caused the palpitation of the heart.

2. Palpitation of the Heart, Hot Foot Bath and Camphor for.--"Place the feet in hot mustard water and give two grains camphor every two or three hours, or two drops aconite every hour. This remedy is very good and is sure to give relief."

3. Palpitation of the Heart, Valuable Herb Tea for.--"All excitement must be avoided. Where there is organic disease, all that can be done is to mitigate the severity of the symptoms. For this take the following herb tea: One ounce each of marigold flowers, mugwort, motherworth, century dandelion root, put in, two quarts of water and boil down to three pints; pour boiling hot upon one-half ounce of valerian, and one-half ounce of skullcap. Take a wineglassful three times a day. Let the bowels be kept moderately open and live principally upon vegetable diet, with plenty of outdoor exercise."

MOTHERS' REMEDIES.--1. Heartburn, Home Remedy for.--"A few grains of table salt allowed to dissolve in the mouth and frequently repeated will sometimes give relief." People who have too little acid in the stomach will be much benefited by this remedy.

2. Heartburn, Soda a Popular Remedy for.--"One-half teaspoonful soda in glass of water. Everybody uses this in the neighborhood."

3. Heartburn, Excellent Remedy for.--

"Powdered Rhubarb 1/2 ounce
Spirits of Peppermint. 2 drams
Water 4 ounces
Bicarbonate of Soda 1/2 ounce

Dose--One Tablespoonful after meals."

The bicarbonate of soda relieves the gas and swelling of the stomach, while the rhubarb has a tonic action and relieves the bowels. The spirits of peppermint stimulates the mucous membrane.

4. Poor Circulation, Remedy for Stout Person.--"Ten cents worth of salts, five cents worth of cream of tartar; mix and keep in a closed jar. Take one teaspoonful for three nights, then skip three nights." This is an old-time remedy known to be especially good, as the salts move the bowels and the cream of tartar acts on the kidneys, carrying off the impurities that should be thrown off from these organs.

PHYSICIAN'S TREATMENT FOR PALPITATION.--When caused by valvular trouble, digitalis can be given as above directed under heart failure.

When Caused by the Stomach.--From gas or too much food, take salts to move the bowels. Hot whisky is good when caused by gas; or soda, one teaspoonful in hot water is also good when gas causes palpitation.

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Difficult Breathing.--If caused by gas, soda, hot whisky or brandy will relieve. If caused by too fast beating of the heart, give digitalis as above directed. If caused by dropsy, the regular remedies for dropsy. If the dropsy is due to scanty urine you can use infusion of digitalis, dose one to four drams; or cream of tartar and epsom salts, equal parts, to keep the bowels open freely.

PHYSICIAN'S CAUTIONS:--Quiet the patient's mind and assure him there is no actual danger; moderate exercise should be taken as a rule with advantage. Regular hours should be kept and at least ten hours out of twenty-four should be spent in lying down. A tepid bath may be taken in the morning, or if the patient is weakly and nervous, in the evening, followed by a thorough rubbing. No hot baths or Turkish bath. Tea, coffee and alcohol are prohibited. Diet should be light, and the patient should avoid overeating at any meals. Foods that cause gas should not be used. If a smoker the patient must give up tobacco. Sexual excitement is very pernicious, and the patient should be warned especially on this point. Absolute rest for the distressing attacks of palpitation which occur with nervous exhaustion. In these cases we find the most distressing throbbing in the abdomen, which is apt to come after meals, and is very much aggravated by the accumulation of gas.

Diet.--A person with heart disease should not bring on palpitation from over-eating or eating the wrong kind of food. Such a person dare not be a glutton. The diet must be simple, nutritious, but food that is easily digested. Any food that causes trouble must be avoided; starchy foods, spiced foods, rich greasy foods, are not healthy for such a person. The stomach must be carefully treated by such a patient. The bowels should move daily. The kidneys should always do good work and pass enough urine and of the right color and consistency. Stimulants like alcohol, tea and coffee are not to be used. Weak cocoa is all right in most cases. Hot water, if any drink must be taken, at meals. Such a patient in order to live and live comfortably, must take life easy. He cannot afford to run, to over lift, or over exert, to walk fast upstairs, hurry or to "catch the car." He must not get angry or excited. Games of all kinds that have a tendency to make him nervous must be avoided. The same caution applies to exciting literature. In short, a patient with organic heart disease must be a drone in the hum of this busy, fast-rushing life, if he would hope to keep the spark of life for many years. Sleep, rest and quiet is a better motto for you than the strenuous life.

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The Heart.--The heart is the central organ of the entire system and consists of a hollow muscle; by its contraction the blood is pumped to all parts of the body through a complicated series of tubes, termed arteries. The arteries undergo enormous ramifications (branchings) in their course throughout the body and end in very minute vessels, called arterioles, which in their turn open into a close meshed network of microscopic (very minute) vessels, termed capillaries. After the blood has passed through the capillaries it is collected into a series of larger vessels called veins by which it is returned to the heart. The passage of the blood through the heart and blood vessels constitutes what is termed the circulation of the blood. The human heart is divided by a septum (partition) into two halves, right and left, each half being further constricted into, two cavities, the upper of the two being termed the auricle and the lower the ventricle. The heart consists of four chambers or cavities, two forming the right half, the right auricle and right ventricle, and two forming the left half, the left auricle and left ventricle. The right half of the heart contains the venous or impure blood; the left the arterial or pure blood. From the cavity of the left ventricle the pure blood is carried into a large artery, the aorta, through the numerous branches of which it is distributed to all parts of the body, with the exception of the lungs. In its passage through the capillaries of the body the blood gives up to the tissues the material necessary for their growth and nourishment and at the same time receives from the tissues the waste products resulting from their metabolism, that is, the building up and tearing down of the tissues, and in so doing becomes changed from arterial or pure blood into venous or impure blood, which is collected by the veins and through them returned to the right auricle of the heart.

From this cavity the impure blood passes into the right ventricle from which it is conveyed through the pulmonary (lung) arteries to the lungs. In the capillaries of the lungs it again becomes arterialized by the air that fills the lungs and is then carried to the left auricle by the pulmonary veins. From this cavity it passes into that of the left ventricle, from which the cycle once more begins. The heart, then, is a hollow muscular organ of a conical form, placed between the lungs and enclosed in the cavity of the pericardium. It is placed obliquely in the chest. The broad attached end or base is directed upwards, backwards and to the right and extends up to the right as high as the second rib and the center of the base lies near the surface underneath the breast bone. The apex (point) is directed downwards, forward and to the left and corresponds to the space between the cartilage of the fifth and sixth ribs, three-fourths of an inch to the inner side, and one and one-half inches below the nipple, or about three and one-half inches from the middle line of the breast bone. The heart is placed behind the lower two- thirds of the breast bone and extends from the median line three inches to the left half of the cavity of the chest and one and one-half inches to the right half of the cavity of the chest.

Size: In adults it is five inches long, three and one-half inches in breadth at its broadest part and two and one-half inches in thickness. Weight in the male ten to twelve ounces; in the female eight to ten. It increases up to an advanced period of life. The tricuspid valve (three segments) closes the opening between the right auricle and right ventricle. Pulmonary semilunar valves guard the orifice of the pulmonary artery, keeping the blood from flowing back into the right ventricle. The mitral valve guards the opening to the left ventricle from the left auricle. The semilunar valves surround the opening from the left ventricle into the aorta and keep the blood from flowing back. If any one of these valves becomes diseased it may not thoroughly close the opening it is placed to guard and then we have a train of important symptoms.

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PERICARDITIS.--This is an inflammation of the pericardium, the sac containing the heart.

Primary or First Causes.--They refer in this disease to a peculiar constitution. Children that have a tuberculous constitution are more liable to this disease. Acute rheumatism or tonsilitis are the causes and this trouble follows or goes with them. Infectious diseases also cause it.

Symptoms.--Slight pain in the heart region, fever moderate. These subside or effusion may set in and this usually occurs with acute rheumatism, tuberculosis and septicemia. Sometimes these symptoms are absent.

Treatment of Pericarditis.--The patient must rest quietly in bed and a doctor should be in attendance. An ice bag placed over the heart frequently gives relief and quiets the distress and pain. There is apt to be liquid in the sac (pericardium) and to lessen the tendency to this there should not be much drink or liquid food taken. There should be what is called a dry diet. (See Nursing Department for this.)

ENDOCARDITIS.--Inflammation of the lining of the heart chiefly confined to the valves; it may be acute or chronic.

Simple Kind, Cause.--Occurs at all ages, but most often in children and young adults. It most frequently comes with acute rheumatism, chorea, tonsilitis, scarlet fever, and pneumonia. The valves in the left heart are most often affected, the mitral simply swollen or bearing small growths.

Symptoms.--If it is caused by acute rheumatism, there may be higher temperature, without increase of joint symptoms. Heart beats faster and is irregular. It may run into chronic valvular disease.

Treatment of Endocarditis.--Preventive.--Much can be done to prevent this disease by closely watching the patient having the disease that causes it. The heart should be closely watched. Acute inflammatory rheumatism is a frequent cause and the heart must be watched continually in this disease. When the patient has this disease he must be quiet and in bed. This is essential. A doctor must be called, for the disease is serious and dangerous.

Diet.--Should be liquid. Milk or preparations made with it is the usual diet. Care must be taken that the stomach and bowels be not disordered. Gas collecting in the stomach causes much distress to one who has endocarditis or valvular disease.

Caution.--Avoid early exertion after getting well.

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CHRONIC ENDOCARDITIS.--Usually occurs in persons under middle age. Generally follows acute endocarditis. It may be caused by syphilis, alcoholism, gout, and prolonged over-exertion. The edges of the valve become thickened and then the thickened parts separate and cannot meet exactly and therefore fail to close the opening they are set to guard.

CHRONIC VALVULAR DISEASE.--Results of valve lesions. Narrowing of a valve causes increased difficulty in emptying the chamber of the heart behind it. Insufficiency of a valve allows the return of the blood through the valve during the dilation of a chamber, thus increasing the amount of blood entering the chamber beyond the normal. Either trouble causes dilation of the chamber and compensatory hypertrophy. Enlargement of its wall must take place in order to perform the extra work demanded constantly, for the normal reserve force of the heart muscles can accomplish the extra task only temporarily. This enlargement increases the working power of the heart to above normal, but the organ is relatively less efficient than the normal heart, as its reserve force is less and sudden or unusual exertion may cause disturbance or failure of the compensation acquired by the enlargement. If this loss of reserve force is temporary, compensation is restored by further enlargement and by diminution, by rest, of the work demanded of the heart. Any valvular lesion, whether a stenosis (narrowing) of the outlet or insufficiency from the moment of its origin, leads to certain alterations in the distribution of pressure upon each side of the affected valve. If the body of the heart itself did not possess a series of powerful compensatory aids, that is, the power of making good a defect or loss, or restoring a lost balance, to improve this relation of altered pressure, then every serious lesion at its very beginning would not only cause serious general disturbances of circulation, but very soon prove fatal. Without compensation of the power of making good the defect or loss, the blood in every valvular disease or lesion would be collected behind the diseased valve. The heart's reserve power prevents to a certain extent such a dangerous condition; the sections of the heart lying behind the diseased valve work harder, diminish the blood stoppage and furnish enough blood to the peripheral arteries. The reserve force is used in stenosis to overcome the obstacle, whereas in insufficiency it must force more blood forward during the succeeding phase through the diseased valve. To effect this increased work permanently, anatomic changes in the heart are bound to follow. The changes consist in hypertrophy (enlargement of the heart muscle) and dilatation of the different chambers. Under this head, compensation, is included the increased filling and increased work of certain heart chambers with their resulting dilatation and hypertrophy. But this compensation cannot last forever. It fails sometimes and certain symptoms follow as hereafter related. Therefore persons who have valvular disease and who have been informed that the heart has adapted itself to the condition by enlarging of its walls and chambers and thus forming the condition called compensation, should be very careful of their mode of living and not put any undue or sudden strain upon the heart that might destroy the conditions that make compensation continue. In the following pages symptoms are given showing what happens when compensation continues and when it fails.

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AORTIC INSUFFICIENCY OR INCOMPETENCY.--The valves are not doing their work thoroughly.

Symptoms.--They are often long absent; headache, dizziness, faintness, flashes of light, difficult breathing, and palpitation on exertion, and pain in the heart region may occur early. The pain may be dull and localized, or sharp and radiating to the neck or left arm. When compensation fails, we have difficult breathing, which is worse at night, swelling of the eyes and feet, cough, anemia. Sudden death is more common in this than with any other valvular disease. You can hear a soft blowing sound by listening with your ear.

NARROWING (Aortic Stenosis).--Caused by chronic endocarditis, etc. Their valve segments are usually adherent to each other by their margins and are thickened and distorted.

Symptoms.--When compensation is gone, diminished blood in the brain causes dizziness and faintness.

MITRAL INSUFFICIENCY OR INCOMPETENCY.--This is the most common valvular disease. The segments of the valve may be shortened and deformed. There is often stenosis (narrowing) caused by this deformity. The effects are regurgitation, flowing back of blood from the left ventricle into the left auricle, which is also receiving blood from the lungs, causing dilatation of the auricle and its enlargement to expel the extra blood; dilatation and other enlargement of the left ventricle occurs on account of the large quantity of blood forced in by the auricle; obstruction to flow of blood from pulmonary veins due to extra blood in left auricle, hence dilatation and enlargement of right ventricle which forces blood through the lungs; dilatation and enlargement of right auricle.

Symptoms.--If compensation is slightly disturbed we have blueness (cyanosis), clubbing of the fingers, hard breathing on exertion, and attacks of bronchitis and bleeding from the lungs. If compensation is seriously disturbed we are likely to have the blueness (cyanosis) more marked, heart beat feeble and irregular, constant hard breathing, with cough and water or bloody sputum, dropsy in the feet first and going up and involving the abdomen and chest cavities.

MITRAL STENOSIS.--This is the narrowing of the valve opening. It is most common in young persons, chiefly females. The narrowing of the valve opening may be due to thickening or hardening of the valve segments, adhesion of their edges, thickening and contraction of the tendinous cords of the valve ring.

Symptoms.--Similar to mitral insufficiency, but they develop slower and those symptoms of venous congestion of the lungs, liver, etc., are more marked; bleeding from the lungs is more common.

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TRICUSPID (VALVE) INSUFFICIENCY.--Cause.--Usually due to dilatation of the right ventricle in mitral disease or with lung emphysema or other obstruction to the lungs' circulation.

TRICUSPID STENOSIS (NARROWING).--Rare except in cases from the time of birth.

Recovery from the valvular disease, depends upon the degree of compensation maintained and is best when this is acquired spontaneously. This is to be judged by the heart action. The prognosis is poor in children. It is better in women than in men.

Treatment (a) While Compensated.--Medicine is not necessary at this period. The patient should lead a quiet, regulated, orderly life, free from excitement and worry; and the risk of certain death makes it necessary that those suffering from a disease of the aorta should be especially warned against over-exertion and hurry. An ordinary healthy diet in moderate quantities should be taken, tobacco and stimulants not allowed at all.

The feelings of the patient must control the amount of exercise; so long as no heart distress or palpitation follows, moderate exercise will be of great help. A daily bath is good. No hot baths should be taken and a Turkish bath absolutely prohibited. For the full-blooded, fleshy patient an occasional dose of salts should be taken. Patients with a valvular trouble should not go into any very high altitudes; over-exertion, mental worry and poor digestion are harmful.

(b) The stage of broken compensation. Rest. Disturbed compensation may be completely restored by rest of the body. In many cases with swelling of the ankles, moderate dilatation of the heart and irregularity of the pulse, the rest in bed, a few doses of the compound tincture of cardamon and a saline purge suffice within a week or ten days to restore the compensation. For medicine a doctor must be consulted as each individual case must be treated according to its peculiar symptoms.

FATTY HEART.--This occurs often in old age, prolonged, infectious, wasting disease, anemia, alcoholism, poisoning by phosphorus and arsenic.

ANGINA PECTORIS.--True angina, which is a rare disease, is characterized by paroxysms of agonizing pain in the region of the heart, extending into the arms and neck. In violent attacks there is the sensation of impending death. Usually during the exertion and excitement, sudden onset of agonizing pain in the region of the heart and a sense of constriction, as if the heart had been seized in a vise. The pains radiate up the neck and down the arm. The fingers may be numb. The patient remains motionless and silent, the face usually pale or ashy with profuse perspiration. Lasts for several seconds or a minute or two.

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Treatment.--Live an absolutely quiet life, avoid excitement and sudden muscular exertion. During the attack, break a pearl of amylnitrite in a handkerchief and inhale the fumes. These should always be carried. If no relief is had in a minute or two chloroform should be given at once. It is dangerous and you must look to your physician for advice and treatment.

ARTERIOSCLEROSIS.--A localized or diffused thickness of the inner coat and then of the other coats of the arteries. Arteries look lumpy and are crooked, dilated with stiff, thin or calcified walls. All coats, especially the middle, show degeneration. It usually comes in later life.

Treatment.--Regulate the mode of life, avoid alcohol, excess of eating, drinking, exertion, excitement and worry. Keep the bowels and kidneys acting regularly. There is no medicine for it.

ANEURISM.--This is a local dilatation of an artery. A local tumor.

Treatment.--Absolute rest, restrict fluids. There is always danger from rupture.

MYOCARDITIS.--This is an inflammation of the muscle substance of the heart. It may be acute or chronic.

Causes.--Endocarditis and pericarditis in the course of rheumatism; acute fevers like typhoid, etc.; clots lodging in the heart arteries, coming from diseases such as septicemia and pyemia.

Symptoms.--The heart is weak. The pulse is rapid, small and irregular, palpitation and fainty sensations come on suddenly during the course of diseases mentioned. The outlook is serious and life may end suddenly.

Treatment.--The same as that given for endocarditis. Absolute rest is necessary. A good nourishing diet must be given and a doctor is always needed.

PHLEBITIS, INFLAMMATION OF THE VEINS.--Causes.--Some irritation of the vein, as a puncture or any other injury accompanied by infection.

Symptoms.--Pain and tenderness along the course of the vein with discolored skin and acute swelling (watery) below the obstruction. Pulse rapid, high temperature, chills, dry and brown tongue and pain.

Treatment.--Absolute quiet is necessary, with the affected limb elevated. Lead and laudanum wash should be applied, or hot antiseptic fomentations if an abscess is forming. An abscess should be opened, keep up the patient's strength.

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VARICOSE VEINS (Varix).--This term means an enlarged, elongated, tortuous, knotty condition of the veins. The term "varicose veins" is restricted in general use to the veins of the extremities, and especially those belonging to the lower extremity. The disease begins with a slow dilation of the vein, which gradually becomes thickened and tortuous. The inner lining membrane or coat of the vein is altered, the valves are shortened and thus rendered insufficient to support the column of blood. The outer coat becomes thickened. The varicose conditions affect chiefly the superficial veins.

Predisposing Causes.--They are most frequent in the female sex. The tendency increases as the age advances. Obstruction. Anything that obstructs the full return of blood in the veins, as tight garters below the knee, etc. Standing work may bring it on.

Exciting Causes.--Tumors in the pelvis; diseases of the heart and lungs; pregnancy. These all obstruct the full return of blood in the veins.

PHYSICIANS' TREATMENT FOR VARICOSE VEINS.--Palliative.--Remove the cause if possible. Treat the heart and lung troubles. Remove the pelvic tumors. In pregnancy, the woman afflicted with this trouble should not be much on her feet, but should remain lying down in bed as much as possible. This position removes the weight of the pregnant womb from the veins and allows a free return of the venous blood. An elastic bandage, or a perfectly fitting elastic stocking, supports the veins, equalizes the circulation and turns the flow to the deeper veins, which do not, as a rule, become varicose. This silk stocking should be made to order. This treatment gives much comfort in chronic varicose veins.

DISEASES OF THE EYE AND EAR

The first thing we notice in looking at the eye may be the lids and at each edge are the eyelashes. When this edge becomes inflamed it is called Blenharitis Marginalis or inflammation of the margin of the eyelids. It is called thus from the name of the eyelid "Blepharon;" It is always means inflammation.

If we turn down the lower lid and turn up the upper, we see a red membrane called the conjunctiva (connecting). This is the mucous membrane of the eye. It lines the inner surface of both lids and is reflected over the fore part of the Sclerotic and Cornea--two other coats of the eye, The palpebral or eyelid portion of the conjunctiva is thick, opaque, highly vascular (filled with blood vessels) and covered with numerous papillae. It turns back (reflects) over the Cornea, but it consists only of a very thin structure (epithelium) forming the anterior layer of the cornea and is, in health, perfectly transparent. Upon the sclerotic it is loosely attached to the globe. When the conjunctiva becomes inflamed it is called (Conjunctiv(a)itis) conjunctivitis. The sclerotic-cornea forms the external tunic (coat) of the eyeball, the sclerotic being opaque and forming the posterior five-sixths of the globe; the cornea, which forms the remaining sixth (the front white part that is plainly seen) being transparent. The sclerotic (means dense and hard) serves to maintain the form of the globe, the eyeball.

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The cornea.--This is almost circular in shape. It is convex anteriorly and projects forward from the sclerotic in the same manner that a watch glass does from its case. This layer covers what we call the pupil.