Chapter IV: Part 4

Children's Treatment.--This should always be managed so as to soothe and not excite the little patients. They are very sensitive to heat and cold. When these are applied the child often cries, so that the "treatment" is condemned and given up. What should be condemned is the nurse's want of skill. In every case the cold or hot application should be so managed as to be agreeable. Very gentle heat at first may be succeeded by stronger heat without shock. So mildly cool applications may be followed by colder ones in the same way. There is no sense or benefit in dashing a burning poultice or freezing towel on a delicate person, either infant or adult, and sense is above all our guide in these pages.

Chills.--(1) Nerve or imaginary chills. These are _feelings_ of cold, where there is no real chilling; the back feels as if cold water were poured down it, or even the whole body feels chilled, when an examination will show that there is no real chill whatever. Nervous patients are peculiarly liable to this, and often are greatly alarmed at it. The treatment in such cases is partly mental; let the patient know that the chilly feeling is only a _feeling_, and nothing alarming. This will often of itself remove it; so will a cheery thought or a cheery talk. Physical treatment may begin with such a rubbing of the head as is recommended in Eyes, Squinting. Then treat the whole body to a gentle massage on similar principles. This will sometimes cause nerve chills at first to increase; but the patient will soon disregard this, and the squeezing very gently of the muscles will stimulate and revive the organic nerves. Warm olive oil used in this squeezing process will help greatly. It may be that a considerable time will be required before these nerve states are entirely overcome, but with anything like careful treatment they will gradually be so. Keep the patient warm in bed the while. Give easily assimilated food (_see_ Assimilation). A mixture of milk and _boiling_ water in equal quantities may be freely taken. This treatment will besides greatly help nervousness of every kind.

(2) In the case of _real_ chill to the surface of the body, _shivering_ is an early symptom. If the frame is strong, the shiver may pass off and no evil results follow: but frequently this is not the case, and trouble is apt to intervene. In such a case give a thorough rubbing all over the body, and especially the back and chilled part, with warm olive oil; this, if applied early enough, will probably prevent all ill consequences,--it will at least mitigate them. If the chill has passed into feverishness however, this treatment will not suit; but we only deal here with the cold shivering stage. The rubbing will be greatly assisted by a good hot fomentation to the feet, or even up to the haunches. The use of Kneipp linen underwear, by promoting a healthy action of the skin, and rapidly conducting away the perspiration from its surface, will do much to prevent chills, either real or imaginary. _See_ Angina Pectoris, Underwear, Massage.

Chloroform.--_See_ Child-bearing.

Circulation of the Blood.--Nothing is more important for the health or healing of any organ or part of the body than a good supply of arterial blood. Venous blood, collected by the veins after it has done its work all over the body, or blood stagnating in congested organs, is useless for growth and healing. To promote a vigorous circulation of blood in any part we wish to cure is, then, of great importance; this may be done by helping the heart in various ways, especially if that be weak. Lying down, and lying comfortably on the face, greatly assists circulation. Placing a fainting person in this position will often suffice to restore him. In congestion of any part, if possible keep that part,--head, hand, or foot, as the case may be--above the level, so that the escape of blood from it may be easy. _Raising_ an inflamed finger or toe thus, and keeping it up, will often relieve severe pain. In inflamed kidneys, make the sufferer lie on his face as much as possible. Other positions in other cases will be suggested by common sense.

Again, heat expands the vessels of the body, and cold contracts them. Cooling a congested part assists to drive excess of blood out of it, and heating some other part opens accommodation for the blood so expelled. This explains our hot poultice and fomentation as used with cold cloths. Common sense will show us how to apply it as a principle of treatment in many cases.

Again, a congested limb may often be very greatly relieved by proper rubbing along the soft parts, the strokes being firm and steady, and directed from the extremity of the limb towards the body. This rubbing along the thigh relieves very much all swellings in the foot, ankle, leg and knee. This principle may be widely applied by a little common-sense thought.

Climate and Soil.--The soil on which one lives is a matter of primary importance; it may be a matter of life or death for a weakly person, but it is important for every one. First, as regards the subsoil on which a house is built. If this be clay, or impervious rock, then no possible system of drainage can make the site a dry one; this condition of affairs will be very bad indeed for health. No house should be built on such a soil if at all possible to avoid it. Light open gravel and sand, as subsoil, make the very best health conditions. The surface soil is also important. If this be such that streets and garden walks dry quickly after rain, you have elements of health; if they remain long wet, then you have elements of unhealthiness. If the soil be right, then the climate is to be considered. The mere situation of two houses, only half a mile apart, will make all the difference in this, and should be carefully watched. A house sheltered on the south and west, exposed to the north and east, is badly situated; the opposite exposure is usually good. Plenty of sun should fall upon the house all day, and on all sides, if that be possible. Yet it must be seen that no hollow or stagnant air be chosen; it is nearly as bad as stagnant water, for in mild winds, dryness of soil and air, and abundant sun, lie much virtue for health and healing.

Clothing.--Clothing should be light yet warm, and sufficiently free so as not to interfere with bodily movements. The clothing next the skin should, we think, be linen, as being more porous and absorbent than wool (_see_ Underwear). No woman who values her health should submit to any tight lacing. The organs of the body require every inch of space for the proper performance of their functions, and if they are unduly squeezed many serious complaints may result. Besides the skin is a breathing organ, and it is most important that air should readily reach it (_see_ Tight Lacing).

Long trains should not be worn, as they are most effective agents for sweeping up germs of diphtheria, consumption, etc. Skirts should not be hung from the waist, but from the shoulders, and should be light in weight. Tight boots and high heels are both to be condemned.

The practice of wearing mufflers, or any tight wrapping round the neck region, is injurious and enervating to this part of the body. The sailor, though exposed to more rough weather than any other class, is free from throat or chest trouble, and can stand both heat and cold better than soldiers. Sailors are, indeed, the only sensibly dressed men in our country. Soldiers, in their tight-fitting tunic and stiff collars, are the worst. They constantly die of heat and apoplexy, when farm labourers doing more work are nothing the worse.

Club Foot.--Children are not unfrequently born with this deformity in one or other of its various shapes. The cause is to be sought in such a defective state of the nervous system as hinders the proper growth of these parts. If the nerves are treated rightly, the limbs will so grow that the defect will disappear. We speak from positive knowledge of cases so cured.

Treatment must first stimulate the spinal nerves; gentle, continued rubbing on each side of the spine with hot olive oil will do this. Proceed, after some time of this, to rub and knead the haunch, thigh, and leg with the same hot oil. Continue this, gradually descending, until the defective foot is reached and similarly treated. We have known even adults cured in this way, with perseverance. Ten or fifteen minutes of this treatment before a fire, or in a warm room, every night, will do wonders. A skilful surgeon can do much to remedy this, but one _really_ skilful should be chosen. _See_ Massage.

Cold in the Head.--Infants often are prevented sucking by this form of cold closing up the nostrils. In such a case have a small cap of cotton to fit the head. Wring this out of cold water, and fit it on the child's head. Put on over it a rather larger and thicker cap of the same material. Often the nostrils will open in two or three seconds, and the cold will speedily be cured, if no more be wrong. Observe that the child be _warm_ during this treatment. If the case is obstinate, secure good medical aid, for constitutional weakness, or even some deformity of the nostrils, may be present as cause, where the trouble exists from birth.

For adults similarly affected, a towel wrung out of cold water and wrapped round the head, with another _dry_ one above, will answer the purpose.

For severe cases, pack the feet and legs in hot fomentation for an hour, and apply a cold towel as above. This last method should always be pursued where the patient feels chilly. Cold in the head may often be checked by use of dilute vinegar. _See_ Nostrils.

Cold, Settled.--A cold is often easily overcome. At other times it "sits down," as country people say, and refuses to be cured, a hard dry cough continuing for a long time, and causing sleeplessness and general weakness. In such a case first try to secure an increase generally of vital energy. At night rub the feet and legs with hot olive oil. Pack them for three-quarters of an hour in a good _large_ blanket fomentation, open out, and dry well, oil and dry again, put on a pair of cotton stockings, and put the patient to bed. In the morning, place a towel tightly wrung out of cold water all round the back and breast. Cover this well with dry towels, and tuck the patient in, so that he becomes warm and comfortable. In three-quarters of an hour open out, dry the skin, oil it and dry again. Then the ordinary clothing may be put on. The second evening it will be well to pack in the SOAPY BLANKET (_see_). Next morning the towel envelope should be repeated as before. The third evening, put a large BRAN POULTICE (_see_) between the shoulders. While this is on apply cold to the chest, as in treatment for BRONCHITIS (_see_). It is good to take sips of hot water at any time if the cough is troublesome. A teaspoonful of boiled liquorice and linseed two or three times a day has a good effect. This treatment usually cures a pretty severe case.

Cold, Taking.--Where cold is easily "taken," it is the skin which is defective in its action. The cure must therefore deal with it. Even spasmodic asthma can be traced to the failure of the skin to throw off waste sufficiently. Men exposed to great heats and chills, women and children whose nervous energy is small, are liable to this skin failure. Kneipp linen underwear, besides being more absorbent of perspiration than woollens, has a stimulating effect on the skin owing to a certain hardness (by no means unpleasant) of the fibre. Wearing it is an excellent preventive of skin failure (_see_ Underwear). This may also be treated by careful, kindly rubbing over the whole body with warm olive oil, the patient being kept warm during the operation. This rubbing may with advantage come after a sponging with M'Clinton's soap (_see_ Soap). To face the wintry blast at half-past five in the morning is for many severely trying. This treatment the night before will give immense help to those who are so exposed. It is the best preventive against taking cold known to us.

There is one great difficulty that stands in the way of such a remedy as we have suggested--that is, the "trouble" which it implies, not so much to ourselves as to others. Many a useful life is lost lest "trouble" should be given. It needs to be well understood that this is a temptation. If we can buy a quantity of some drug from a chemist according to the prescription of some medical man, and just quietly swallow it, that "troubles" nobody. So powders to sweat us, and powders to stop our sweating, are readily "taken," greatly to increase all tendency to "take cold." Our relatives and others have, as the fruit of such a system, worlds of serious trouble and loss that might all be saved if only a very little trouble were given in the more natural and reasonable way.

Cold Cloths.--_See_ Towels, Cold Wet.

Constipation.--This trouble is often only aggravated and made chronic by the use of purgatives. Some simple change of diet, such as a ripe uncooked apple, eaten before breakfast, or a fruit diet for a day or two may put all right. So also with the use of wheaten meal porridge or bread. When this can be taken with pure CANE SYRUP (_see_), the two together will make such a change in the food as will frequently banish all inaction of the bowels. Rest must be reckoned on, especially if the patient has been using purgatives freely. Do not act as if castor oil were a necessary article of diet. When the constipation is more obstinate, in the case of a child, good golden syrup may be given, a teaspoonful after each meal. A quarter of a pound of the best Spanish liquorice, costing sixpence, should be boiled in a pint of water down to three-quarters of a pint and strained. A dessertspoonful of this after each meal may be given instead of the treacle. It is the best tonic we know, and infinitely better than quinine and other costlier drugs. If a stronger mixture be desired, put half-an-ounce of senna leaf in the juice while being boiled. This may be increased to a whole ounce of senna if still stronger effect be desired.

Some are more liable than others to attacks of constipation, but chronic constipation may generally be put down to errors in diet, or want of sufficient exercise. Indigestible foods, such as pastry and heavy puddings, as well as foods which leave little residue in the intestine, such as white bread, puddings, arrowroot, are highly constipating. Tea has also a similar effect, also large quantities of meat. Constipation is seldom found in vegetarians, since vegetables and fruits act as a stimulus to the intestine. Brown bread and oatmeal porridge have also an aperient effect. If it is suspected that milk has been a cause of constipation in any particular case, it may be boiled and used with coffee instead of tea.

Much may be done by judicious exercise to relieve chronic constipation, and help the liver to work (_see_ Appendix; Physical Culture). Deep breathing will also affect the intestines and urge a motion. Bathing and massage of the abdomen are also useful (_see_ Massage). Clothing should be light and loose, tight lacing being a frequent cause of constipation.

Every effort should be made to keep the bowels regular, as protracted constipation leads to many painful affections, such as headaches, piles, and even inflammation of the intestine, the various products of putrefaction being absorbed and carried through the blood stream. A daily motion should invariably be solicited at a regular hour. On rising, before the morning bath, is a good time, though some prefer just before retiring to bed, and more, probably, go immediately after breakfast. The great thing is to get into the habit of going daily at a fixed time; nothing should be allowed to interfere with this, and it is highly desirable that children should be accustomed to this habit. Parents should, therefore, see that the schools selected have sufficient closet accommodation, as schools in private houses often have but the one closet for a large number. As a result of this restricted accommodation, the habit of using aperient medicines is acquired with _very_ injurious results, for if the call of nature is neglected the desire passes away, and constipation is inevitable. It soon comes to be a settled condition and will often be the cause of life-long ill-health. The evils from the formation of such a physical habit will far outweigh all the so-called accomplishments that may be acquired.

Hot or cold water taken in sips throughout the day has often proved a most valuable cure for constipation.

When artificial means are required to move the bowels, an enema is much to be preferred to drugs. The way to administer it, so as to be most effective, is as follows: Use a fountain enema holding three quarts. Put into it two or three quarts of water as warm as can be comfortably borne. A teaspoonful of salt added to the water will make it more effective, or soapy water may be used, made from M'Clinton's soap. The fountain should be hung up as high above the patient as the india-rubber tube will allow. The patient should lie on the right side, with knees drawn up. The tube should then be introduced into the rectum, and should be three or four inches in. The water may then be turned on with the thumb valve. If the abdomen can be rubbed by an attendant in an upward direction it will be better. The water should be retained, if possible, twenty minutes or half-an-hour.

A HOT FOMENTATION (_see_) over the liver, before using the enema, will make it more effective.

A bulb enema syringe may be used instead of the fountain, and less water--a pint or even less, and the water tepid or cold, may be preferred by some. The disadvantage of a bulb syringe is however that sometimes air gets in along with the water, causing pain and discomfort.

Consumption, Prevention of.--This most insidious and deadly disease is caused by a tiny vegetable growth derived from persons or animals already suffering from tuberculosis. The spit of consumptive patients swarms with such germs, and when it dries and becomes dust the germs may be stirred up and breathed, or may mix with food, _e.g._, milk, and so enter the body. A dried handkerchief may also carry the infection.

But these germs, though continually carried into the lungs of almost all, do not develop in all. The healthy body can resist them, and it is only in the body which possesses little resistance, owing to a low state of health, that they take root, and so start the disease.

Want of pure air, such as is caused by badly ventilated rooms, dark, damp, and dirty houses, want of good food, or bad food, alcoholic drinks, frequent illnesses, dirty habits, are powerful causes in producing this low state of health, which is so favourable to the growth of the consumptive germ. Therefore we insist on fresh air, especially for children in schools, for employees in factories, for clerks in offices. All places of public resort should be provided with proper ventilation. The breath from the lungs is loaded with poisonous organic matter, and if continually re-breathed poisons the blood. The smell of a room is often an indication of whether the air is pure or not, especially in the nostrils of one entering from the outer air. Let all windows be kept open day and night, and let fresh air and sunlight continually flood the room. Nothing will kill disease germs quicker. Avoid choosing a residence with but little open spaces around, such as basement tenements and back to back houses. Have an open fireplace in the room. Gas or oil for lighting, heating, or cooking renders the air impure, and in need of constant renewal. _See_ Air.

Dirt, either in the house or around, poisons the air, and refuse should be removed to a distance from the dwelling. Tea leaves should be sprinkled on floors before being swept. Remove dust with damp dusters, which should be boiled. Cleanliness should be strictly attended to, and schools and factories should be plentifully supplied with soap and water.

The food consumed by the vast majority of people is far from being as nourishing as it should be. Tea and white bread have replaced porridge and milk. This should not be. Cocoa might with advantage replace tea, and porridge and milk by itself would make a highly nutritious meal (_see_ articles on Diet).

Stimulants are not required by the healthy body, and intemperance is a fruitful predisposing cause of consumption. Skim milk is not a suitable food for the young. _See_ Infants' Food.

Infectious diseases, such as Typhoid and Scarlatina, are frequently conveyed by cow's milk. There is also reason to believe that in certain cases of Tuberculosis the infection has been conveyed by milk from tuberculous cows. These risks can only be absolutely avoided by sterilising the milk, _i.e._, by placing the jug in a pan of water and bringing the water to the boil, keeping it so for twenty minutes. If the milk is kept covered, and rapidly cooled by placing in another pan of cold water, but little boiled taste will be felt. Sometimes, however, sterilised milk disagrees with an infant; if so, the strictest watch must be kept on the history of the milk used.

It should be remembered that this disease is not hereditary. It is only the delicacy of constitution predisposing to the disease that is inherited. This delicacy may, especially in childhood, be remedied. We have known hundreds of tender children made strong by liberal daily MASSAGE (_see_). In all cases where hereditary weakness is feared this should be resorted to. In many cases nothing more is needed to banish consumption out of families than the stimulation of the skin by this massage. Wearing linen underwear (_see_ Underwear) also assists in this direction and prevents chills. As it is of prime importance to increase the chest capacity, and this is most easily done in youth, great attention should be paid to chest expanding exercises (_see_ Appendix) and deep breathing. The cultivation of singing will greatly help.

Consumption, Treatment of.--Turning now to the case when consumption has actually shown itself, the above treatment is exactly the course to be pursued. But we would emphasise the fact that unlimited fresh air and good nourishing foods are the only cure. If the patient can afford it, it is best to go to one of the Sanatoria for consumptives in order that he may see how the fresh air cure is practically carried out. It means simply breathing every mouthful of air as pure as it can possibly be obtained. Sleeping out in a hut, with the side completely open, and with protection only from the rain, with abundance of clothing, and, if necessary, hot-water jars to supply the required heat, is strongly recommended, and every hour of the day, as far as possible, should be spent in the open air, reclining or taking gentle exercise.

The food should be nourishing and abundant. Plenty of milk, butter, and eggs should form the basis of the diet. The strictest precautions should be taken against spreading infection, and the patient be made to understand that these measures are intended not only to protect the public and his friends, but to allow of his social intercourse with them, and to assist his own cure. The source of danger being the spit, it should be collected in a pocket spittoon or piece of paper, and be destroyed before it has time to dry. Spitting on floors or elsewhere is highly dangerous. The spittoon should be boiled carefully. A consumptive should not swallow his phlegm, as the disease may thus be conveyed to parts of the body not already infected. Kissing a consumptive person on the lips is attended with risk, and consumptive patients should not wear a heavy moustache or beard, as the phlegm drying on the hair is a source of danger.

The bed on which the consumptive lies should not be in a corner, but out from the wall, so as to admit of cleaning and ventilation. Curtains and carpets are dust catchers; reduce the amount of such articles as much as possible. In the event of a death from consumption, the room occupied by the invalid should not be used again until it has been thoroughly disinfected. The Public Health Authorities are usually ready to carry out this work. If not, the floor and woodwork should be wiped with damp dusters, and then scoured with soap and water. If the walls are papered, the paper should be well damped, stripped off, and burnt. If the walls have been white-washed, this should be renewed with limewash, containing a quarter of a pound of chlorinated lime to the gallon of limewash. The quilt, pillow case, blankets, and sheets of the patient's bed should be steeped in boiling water and then washed.

Often consumption is associated with wasting sores on the neck or other parts, which are extremely difficult to heal. These should be soaked in warm weak ACETIC ACID (_see_) daily, and dressed with olive oil. They may be greatly mitigated, if not cured, by this simple means. _See_ Abscess; Bone, Diseased. The directions as to diet in cases of abscess apply also to these cases. Besides such outward applications, the rubbing along each side of the spine should be applied. _See_ Children's Healthy Growth. The ARMCHAIR FOMENTATION (_see_) may also be used.

The very rapid pulse, and extreme fever, which accompany advanced and rapid consumption, may often be greatly mitigated by cooling cloths applied over the heart. Sponging over the whole body with vinegar or weak ACETIC ACID (_see_) also greatly refreshes the patient. It may be done under the bedclothes, so as to avoid all possibility of chill. Cold cloths over the heart and chest, if they cause chilliness, may be accompanied with fomentation of the feet and legs.

The temperature of a consumptive should be recorded three times a day, and if above normal the patient should stay in bed till it is reduced.

When the temperature has been reduced, gentle exercise is very useful. Gradually increasing walks should be taken each day.

Contraction of Sinews.--This often occurs at the knee, bending the joint so that the patient cannot stretch his limb or walk properly. The injury in such a case is usually at the ends of the sinews, where they are inserted into the bone. If the limb be straightened and put up in splints, so as to secure perfect rest, it is well to see that once every twenty-four hours it be removed from its fastenings and treated in some way to obtain a cure. Otherwise the whole limb will harden into a straight and unbendable condition, worse than its original bend. When the fastenings are removed, then, each day, let the limb be rubbed and bathed for an hour. Treat the whole body with soaping and oil rubbing (_see_ Lather and Massage). While bathing the limb it is to be rubbed with this soap, and the lather rubbed gently into all the skin. Rub, after soaping and drying, with hot olive oil. Dry this off, and wrap the limb in warm flannel. With this treatment no splints or plaster jackets are at all likely to be required. The limb usually soon comes right.

Sometimes this contraction affects the hip joint, and causes great distress and lameness. The upper end of the thigh bone is even sometimes drawn a little out of its proper position. For this, the muscles of the back, and specially of the side and hip which is lame, are rubbed with gentle pressure and hot olive oil as often and as long as may be convenient. Strong fomentations are also applied for half-an-hour daily (_see_ Armchair Fomentation). We know of one case in which this treatment has cured such contraction both of the knee and hip joint. Whether the cause be rheumatism or other trouble, or an injury, the treatment is the same.

Convulsions.--For an ordinary convulsive attack in the case of a child, hold the child's head over a basin and pour tepid water (blood heat, 98 deg. F.) over the head. This will usually be sufficient. If not, seat the child in a bath of hot water nearly up to the waist. If bad, indigestible food causes the fit, give teaspoonfuls of hot water every few minutes for some hours. If the case is obstinate, a BRAN POULTICE (_see_) may be put over the lower back, and cold towels gently pressed over the stomach and bowels.

Fits from children's teething are more troublesome. They may often be prevented by placing a compress wrung out of cool water along the spine while the infant is warm in the cradle, and changing it so as to maintain the cooling effect. A handkerchief folded eight ply does very well. Four or five changes may be sufficient. Rub with a little warm oil when the cloth comes off. If the fits do come on, treat as above directed for fits from indigestion.

Cooking.--The cooking of vegetables requires particular care. The valuable salts and other nutritive ingredients they contain are easily dissolved by water, and when they are drained, and the water thrown away, as is usually done, all this nutriment is lost. Double cooking pots are easily procurable for meat, porridge, etc. These are quite suitable for vegetables--cabbage, turnips, carrots, peas, etc. The vegetable should be placed, without water, in the inner pot; it will take somewhat longer to cook than when boiled in the usual way. The outer vessel should be partly filled with water kept boiling. Any juice which comes out of the vegetable should be served in the dish along with it. It may be thickened with a little flour and butter, or if a regular white sauce is being made, the juice should be used instead of part of the water. If no double boiler is procurable, an ordinary tin can, inside a saucepan will serve very well. Many who consider certain vegetables indigestible, as usually prepared, will find that when cooked in this way they agree with them perfectly. The fact that the colour of cabbage, peas, etc., is not so green as when boiled in a great deal of water, is not of importance, when the flavour and wholesomeness are so much increased. In stews and vegetable soups the salts are, of course, preserved.

Cooling in Heating.--Often it is difficult to get a sufficient cooling effect by means of cold cloths without unduly chilling the patient. When the head has to be cooled, as in the very dangerous disease meningitis, the effect must pass through the mass of the skull before reaching the brain. A large and long continued application is needed for this. The surface is apt then to be overcooled before the interior of the head is affected. In such a case the surface of the head, when the patient feels it too cold, should be gently rubbed, as directed in Eyes, Squinting, until this feeling goes off. Then the cooling may be resumed. Or if rubbing be disagreeable, a warm cloth may be applied for a short time, and cooling then resumed. In this way a succession of _waves_ of heating and cooling can for a long time be sent through the surface, with good effect and no chill. The short heating restores the surface, and does not interfere with the cooling effect reaching the interior parts. The same principle applies to cooling any part of the body (_see_ Bathing). Any _deep-seated_ inflammation is best reached in this way.

For instance, in the large hip-joints it is of vast importance to reach inflammatory action in parts that are not near the surface, and cold cloths, pressed constantly, produce distress in the surface, if there is no intermission in supplying them. The patient is apt to rush to the conclusion that he must just yield to be blistered, painted with iodine, covered with belladonna plaster, or burned with red-hot irons! That is, he will yield to be made a great deal worse in every respect than he is, because he is not aware that it is quite possible to cure him without making him worse even for a moment.

Coughs.--These will be found treated under the various heads of Colds, Bronchitis, Consumption, etc., but some particular cases of _mere cough_ demand special attention. A tickling cough sometimes comes on, and seems to remain in spite of all efforts to get rid of it. It is worse at night, and keeps the sufferer from sleeping, causing much distress. Where the breathing organs are weak, this cough is caused by an extra flow of blood to them, especially on lying down, the blood acting as an irritant by pressing where it should not. In such cases a BRAN POULTICE (_see_) applied as directed for Bronchitis, with cooling applications to the part where the tickling is felt, should soon effect a cure. _See_ Restlessness.

We had a case lately in which these features were very marked. It seemed as if the patient had caught cold and this was showing itself in severe and alarming coughing. The skin was yellow, and there were other signs of failure in the organs that purify the blood. Irritating substances were passing into the lungs because of failure in the liver and kidneys, and not from anything in the lungs themselves. In such cases the cough is merely a way of throwing off everything which ought not to be in the breathing organs.

The remedy is very simple. Let the patient take about three tablespoonfuls of hot water every ten minutes for four hours. Before these four hours are expired, the substances causing irritation will be so diluted that they will cease to irritate, and the organs failing to do their duty will be in full working order.

Cramp in the Limbs.--The treatment of this is to apply cold cloths to the roots of the nerves which govern the affected limb or limbs. For the legs, the cold is applied to the lower spine; for the arms or hands, it is applied to the upper part. The limbs affected should also be rubbed briskly with the hands, or a rough towel. Often the irritating heat causing the cramp is in but a small part of the spine, and the whole body is cold, or at least too chilly to make the cold cloths a pleasant cure. In such a case FOMENTATION (_see_) of the feet and legs will supply sufficient heat to make the cure by cold pleasant and safe.

Cramp in the Stomach.--This very severe trouble, though resisting ordinary methods of treatment, is not difficult to cure by right means. If help is at hand, the patient may be placed in a shallow bath, and cold water splashed with a sponge or towel against the back. A bad case has been cured with two minutes of this treatment. After it, the patient must be well dried and put to bed.

When help is not available, a substitute for the cold splashing is a thick cold compress, the length of the spine, which must be laid on the bed, and the patient lie down on it. This must be changed when it grows hot, and a few changes usually give relief.

Persons who are suffering have often very strong prejudices. For example, one who has decided most firmly that he "cannot do at all with anything cold," is suffering from cramp, and nothing but cold will relieve him, but you must not even hint at any such application. You must in such a case consider how this prejudice took its rise. You will probably find that cold has been unskilfully applied to this patient, and bad effects have been produced, not by the cold, but by its unskilful application. For instance, in a case of cramp the irritation and excess of heat may be both confined to a very small space, no more than that which is filled by the root of one nerve; the rest of the body may be cold rather than hot. There is need first that this general cold should be dealt with, and a general heat produced by some means or other. This is usually best done by packing feet and legs in a hot blanket fomentation. But this again is not an easy matter when cramp prevails. If you move the limbs in the least the cramp comes on, and the patient screams with pain. Still, you need not be defeated; you can let the limbs lie, and heat them from above by placing the hot blanket over them as they lie. As soon as you get heat raised in the body generally, by some such means as this, you are safe enough to apply all the cold that is needed. That may be so little that a common pocket-handkerchief will be enough. This wrung out of cold water, and folded so as to cover about three inches square of the lower part of the spine, may be gently pressed. If this is really well done, there will be no shivering from the cold, and there probably will be a cessation of the cramp. The one thing wanted is that the cold cloth shall be placed right over the root of the nerve which is irritated, and consequently overheated. The prejudice is thus overcome, and it is seen that cold is not to be absolutely avoided, because it has been once or twice, or many times, wrongly applied.

To prevent the cramp returning, means must be adopted to increase vital energy in the system. Entire mental rest for an hour after meals must be taken. If the patient says "I cannot get this," then he simply will soon have to give up all work, and perhaps narrowly escape a departure from this working world altogether.

Each morning before rising, the compress should be applied as above for a short time; the back should then be rubbed with hot olive oil before dressing. This treatment, and proper rest, will prevent return of the cramp. If the patient falls asleep on the compress, allow this sleep to continue unbroken: it is invaluable. So also is the avoidance of all anxious thought, which is best secured by complete trust in a loving God and Saviour.

Croup, Less Serious Form.--The less serious croup proceeds from a nervous closing of the windpipe, the attack being brought on by any causes of irritation in the nervous system. In this case, when the fit reaches a certain stage, the throat opens, and breathing proceeds as usual. This croup is a cramp of the windpipe; the cramp is caused by an irritation of the nerves controlling it, which are already in a condition to be easily irritated. The cure is to apply cooling cloths to the spine. Take the child warm in bed in the morning, and rub the little back with warm olive oil. Ring out a towel of _cool_, not quite cold, water; fold this into a narrow compress, and place it along the spine; place a dry towel above it and wrap up warm. Change for a fresh cool towel in two or three minutes. If the child falls asleep on this, leave him till he wakes voluntarily. Rub the back again with oil before dressing. The cooling may continue for an hour or so. If this treatment fail, the child may be given medicine to produce vomiting, which frequently relieves. Before putting to bed at night wash the child all over with plenty of M'Clinton's SOAP (_see_), dry and rub over with warm olive oil. Continue this treatment for some days.

Croup, More Serious Form.--This is caused by an accumulation of material in the windpipe, which is coughed up in pieces of pipe-like substance, and which, if not removed, threatens suffocation. For treatment, first give sips of hot water (distilled water is best) frequently. We have seen only five teaspoonfuls of this taken by a child followed by the throwing off of such a quantity of matter from the throat as had nearly caused suffocation. The further treatment is the bran poultice between the shoulders, and cold cloths on the chest, as prescribed in the article on Bronchitis. These may not cure in all cases, but will do so in many apparently otherwise hopeless. The moment the symptoms are perceived, treatment should be begun, as this disease is very rapid in its progress.

When an actual attack of croup of this kind comes on, and is severe, it is usual to put the child in a warm bath. If the water is a little below blood heat, and laved on the back, this will go far to relieve; but it will not have a tenth of the effect which a cold towel will have, if placed along the spine. It is indeed wonderful how spasms and the various forms of cramp give way to this. When a little warm olive oil is first rubbed on and then off, there is no danger of cold or of any bad effect (_see_ Cramp in Stomach). If this croup is obstinate, there may be more serious disease of the throat, and good medical advice should be had.

Cures Losing their Effect.--After a fortnight's treatment often matters seem to come to a standstill in a case, and then the attendants are apt to despair. Such a state of things indicate only the need for some change in treatment, or perhaps for a rest from treatment for some days. Common sense must guide, and the case may be more keenly looked into: it may have changed its character in the time that has passed, and different treatment require to be given. It is well not to give up until all has been tried which in any way seems likely to suit the case. All the various articles bearing on it should be carefully read and pondered, and no doubt the way to change the treatment will open up. _See_ Changing Treatment.

Cures, as Self-Applied.--Often young people in lodgings are in difficulty for want of some one to apply the necessary treatment in their own case. It is often, however, possible to treat oneself quite successfully by exercising care and common sense. Help should always be got if possible, but where it cannot, it may be done without. In the case of applying cold cloths to any part, when it is necessary to change these frequently, a basin of cold water may stand by the bedside so that the patient can wring out towels without getting up. A still better plan is to have several towels wrung out to begin with--these may be hung over a rail or chairs until required. When the first has been heated it must be hung over the rail or chair so as to be as much spread out as possible. Evaporation will then cool it sufficiently to be used when its turn comes again. Each towel is to be treated in a similar way in turn. Four towels will give an hour's cooling with very little trouble in this way. So a bran poultice may be prepared and laid on the bed, so that one can lie down on it, and with the cold towels handy, as above, most effective treatment given. Common sense is the guide here, as everywhere in our treatment, and a little thought will solve difficulties at first apparently insoluble.

Damp Beds.--An ordinary bed which has not been slept in for some weeks, although perfectly dry to begin with, will _become_ damp, even in a dry house, and, unless properly dried, will be a great danger to its next occupant. This is a preventable danger, and all who entertain guests should see that they are not exposed to it. Many a fatal illness is due to the culpable carelessness of those who put a guest into such a bed. Ignorance in such a matter is shameful. All who have charge in a house should fully understand their responsibility in this matter.

But if you are put into such a bed it is infinitely better to rise and dress, and make the best of a night of discomfort, than to sleep among the damp. If, however, you have so slept, and feel the bad effect, the best cure will be the SOAPY BLANKET (_see_). If this cannot be had, a good hot footbath, with the heat kept just comfortable for half-an-hour or more, will do very well. This should be done at the earliest possible moment.

It will add greatly to the efficiency of such treatment if hot water can be had to drink in small quantities, and often. A few drops of cayenne "tea" in the water will act as a gentle stimulant. Old-fashioned folk place great confidence in a "hot drink" in such a case. This is all very well if they only keep the alcohol out of it: that destroys vital resources, but never supplies them. We have known cases in which all power was lost through a single night in a damp bed. Possibly in these cases it might not have been easy to restore the lost vitality by any amount of treatment; but we rather think that a speedy application of genial heat all over would have restored it. In some apparently hopeless instances it has done so.

Deafness.--_See_ Hearing.

Decline.--_See_ Consumption.

Declining Limb, A.--_See_ Limbs, Drawn up.

Delirium in Fever.--The best way of treating this truly distressing symptom is by cooling and soothing applications to the head. We have seen in one case large cool cloths applied to the head for some time every three hours or so. An almost immediate cessation of the delirium followed this application, and it only returned a few minutes before the time for the next cooling. If the pulse becomes rather slow than rapid, and the body rather cool than hot, while delirium still continues, then hot cloths may be applied to the head. When either hot or cold appliances are removed, rub olive oil into the roots of the hair, and dry off.

An excellent treatment is also to cover the whole head with soap lather. _See_ Head, Soaping.

It is to be noted that the state of the patient determines the treatment. If he is hot, cold treatment is required. If he is cool or chilly, then give the warm treatment. If he _changes_ from hot to cold, then alter the treatment accordingly.

In some diseases delirium occurs, not because of fever, but because of poisonous elements in the blood supplied to the brain. This is the case in liver and kidney troubles, when waste products are not got rid of by these organs as they should be.

To get these organs to work, the best thing is to drink half a teacupful of hot water every ten minutes for two hours at a time. Do this once a day for two days. Probably it will cause purging, but that is part of the cure. If the case does not yield in any way to this, a large hot bran poultice should be placed over the whole of the _right_ side under the arm, from the spine right round to the breast-bone (_see_ Bran Poultice). This should be renewed if necessary, so as to keep up the heat for an hour. Next day place a similar poultice over all the lower part of the back, so as to help the kidneys and bowels. Dry after these poultices, and rub gently with warm olive oil. The delirium will usually yield to a few days of such treatment. We have seen the reason under such treatment return with a rapidity that astonished the medical attendant. He had given the patient three months to gain what was complete in less than one. _See_ Fever.

Depression.--This is usually a bodily illness, though often regarded as mental only. It appears in loss of interest in all that otherwise would be most interesting. A mother loses interest in her children, a man in his business, and so on. Students, and children overpressed at lessons, are apt to suffer from it. It is simply the result of a drain of energy from the system, until the brain has an insufficient supply. Those who have the care of the young would do well to watch carefully against this state coming on. If it appears, all work should be given up, and as much play take its place as possible. No cramming of ideas into a weakening mind can ever be equal to the possession of health and energy, as a preparation for life.

Treatment should be such as to restore energy. The whole back should be fomented with a large blanket fomentation, being rubbed with olive oil before and after. Let this be done for an hour in the morning; in the evening give the ARMCHAIR FOMENTATION (_see_). Carry this on for a week, and then rest for another week, only rubbing the back with a little hot olive oil each night. Cultivate open-air life; sleep as much as possible--eight hours at least, or better nine. Carefully prepared and easily digested food should be given, and change of company, scene, and climate are most effective helps; but rest from work is the chief matter. _See_ Restlessness and Worry.

Diabetes.--There are two more or less distinct stages of this serious trouble; the first stage is generally curable, the second stage generally incurable. Yet good natural means of cure will very much alleviate even the incurable stage. The earlier as well as the later stages are marked by extreme _thirst_. This, in the case of some poor sufferers, is enormous. Gallons of water are taken, and the more is taken the more is wanted. But this thirst is not the effect of heat, as fever thirst is. It cannot be quenched by means of cold cloths often changed over the stomach, as fever thirst can. A sufferer in this disease will set a large pitcher down at the bedside to serve for the night, and drink it all before morning; but there is no extra heat anywhere to account for this. The thirst is more like that which is caused by eating very salt food. It points to the character of the juices which are affecting the stomach, and not to any heated condition of the stomach itself. The drinking is a desperate effort to dilute these juices; and, at least by cold water, that cannot be done. A wineglassful of hot water taken every ten minutes for an hour, or two hours, or three, or ten hours, as is felt to be comfortable, will do wonders in the early stages of this disease. This water, when taken at the right heat, at once mixes with the strongly concentrated juices of the stomach, and causes them to be easily managed by that and other organs. It is truly wonderful what this very simple remedy will effect by itself alone. The next thing to be noticed is the excessive hunger. The food, whatever it may be, fails to quell this hunger. Here, again, it is clearly the stomach with which we have to do. When the hunger is developed we should think the case further advanced than when thirst alone is experienced. The hot water meets this symptom as it meets the other. It is also of the very greatest moment to give right food. Oatmeal and buttermilk steeped together for a time and then moderately boiled, a very little salt or sugar being added, produces a food which we do not expect to see excelled by the most costly that can be got anywhere. Wheaten meal, or barley meal, will do as well as, and perhaps in some cases better than, oatmeal, but these may be chosen according to taste. The chief thing is the ease with which this food is converted into a large supply of the best of blood for all purposes of nourishment. Food containing much starchy matter, as white bread, rice, and all sugar, must be forbidden. To make up for this, an abundance of fat should be consumed. The bowels should be kept open by a suitable diet and exercise.

Now we come to the excessive urinary discharge which is so strong a feature of this disease. The body seems as if it were melting away in this.