Chapter V: Part 5

We can benefit the kidneys vastly through acting on the liver, as well as on themselves. By a large hot bran poultice over the liver we can add new life to that, and whatever does so tends to benefit the kidneys. After using this large poultice, with plenty of oil rubbed on before and after, say three or four times, place it over the kidneys and use it as often there. If the heat is well kept up for an hour at a time, one poultice a day would do, but, if the patient desires it, twice a day will be all the better. It is good to do the best that can be done with the skin. By means of soap and oil rubbing, and the cleansing effects of diluted acetic acid, very considerable help may be gained. Good can be done by a hot fomentation of the feet and legs to the knees, with oiling after, so as to have these extremities in a comfortable state. Tea, coffee, and sugar _must be avoided_.

Diarrhoea.--Sudden attacks of this, though in a mild form, are very troublesome. An enema of _cold_ water is in such cases often an immediate cure. The first injection may be followed by even an excessive motion, but if a second cold injection be given this will cease. But in more troublesome cases, where the patient is an infant, or very weak, this is not applicable. For such cases, mix equal quantities of honey and lemon juice (one or two teaspoonfuls of each), and add enough boiling water to dilute it for taking. Give this three or even four times a day. It will usually and speedily cure, and is relished by infants.

Often the cause of diarrhoea in infants is the infection of milk by flies (_see_ British Cholera), or from dirty feeding bottles. Bottles with tubes should _never_ be used. The india-rubber teat should be smelt to see that it is perfectly sweet and clean before the bottle is filled. Unsuitable or too rich food will bring this trouble on.

A tablespoonful of blackberry (or brambleberry as it is also called) jelly may be given--it is a powerful and simple remedy. In adults, a dose of castor oil, with a few drops of laudanum in it, will probably remove all trouble, if it be due to nothing more than indigestible food. Where the cold enema is dreaded, one of hot thin starch, with fifteen drops of laudanum in it, may be used for adults.

Stale vegetable or animal food, also impure water, are fruitful sources of diarrhoea.

The mind has a great effect on this trouble, anxiety and worry are frequent causes. _See_ Worry. A comfortable seat by the fire, and an interesting book, will often relieve.

When the diarrhoea is very serious, use the four-ply flannel bandage. _See_ Bandage; British Cholera; Dysentery.

Diet.--The composition of different articles of food varies. A turnip is not the same as a piece of cheese. It is more watery, and has more fibre in it, and we speak of it as less nutritious. There are, however, in almost all foods certain chemical substances present which have different duties to perform in the body, and which are present in widely different proportions in the various articles we use for food.

_Water_ is the most common of these substances. Soups, vegetables, fruits, puddings, are largely water. Some foods contain less of it than others, but on the whole a very large, if not the largest, part of all food consists of water. This large amount is needed. Water makes up two-thirds of the body, and nearly two quarts are given off daily in the various excretions and secretions. If enough be not taken the tissues get dry, and Nature indicates her want in thirst.

Another of these substances is _starch_, or its equivalent, sugar. Rice, bread, and vegetables in general, are largely made up of this starchy or sugary substance, which, as it contains a considerable quantity of carbon, we speak of as the _carbonaceous_ element in food. This is the substance which goes to feed the muscles, replacing the waste from work done, just as fuel is required for the fires of an engine.

Yet another substance in food is _fat_. It may be animal, such as beef or mutton fat, and butter, or vegetable, as the oils in nuts, in the olive, etc. Fat, like carbonaceous food, also goes to feed the muscles, but both are required in a healthy diet.

Of the first importance, however, is the _proteid_ element in food. Meat, milk, cheese, eggs, peas, etc., contain proteid in considerable quantities. Its use is to repair the exhausted tissues themselves. The muscles and nerves get worn out in their daily work, and require rebuilding. This is what proteid goes to do, and from this, its high import in animal economy, is called Proteid (protos--first). Finally, in all natural foods there are certain _salts_, which also build up, _e.g._, lime, which goes to make up bone. These salts may be seen in the ash of any common vegetable after being burnt.

These four kinds of food substance make up our daily food, and a certain amount of each substance is required to replace the daily expenditure, a proportion which varies, however, under different circumstances. _See_ Food in Health.

As the relative amount of proteid, carbonaceous matter, water, and salts, may vary considerably in different articles, we rightly have combinations of food at our meals. A pudding of corn-flour and water contains no building material, hence we add milk and eggs, which do. A meal of meat and cheese requires bread and potatoes, etc., etc.

Appetite is a good test of the amount and also of the particular kind of food required, provided the appetite is in a healthy condition. If a healthy man refrain from carbonaceous foods for a day or so, he feels a great longing for them, a sign that the body really needs them. It is of immense importance, then, that the appetite should not be accustomed to over-indulgence, for then it is no guide in our selection of foods (_see_ Appetite). If disease indicates such over-indulgence, food should be restricted till the appetite is accustomed to a smaller diet. Bilious people, for example, may have accustomed their appetite to desire more carbonaceous and fatty foods than necessary. On the contrary, badly-fed people often require a coaxing of the appetite to eat strengthening foods, such as oatmeal, cheese, and brown bread.

In order to regulate our diet, it is of importance to have some idea of the composition of common articles of food. We get our food, as everybody knows, from the vegetable and animal kingdoms. The majority of the Anglo-Saxon race live on a diet of animal and vegetable combined, but many exclude flesh from their diet. In Southern Asia, for example, the vast bulk of the people rarely, or never, touch meat. The vegetable kingdom supplies us largely with the carbonaceous or muscle-forming food, whereas the animal kingdom is rich in proteid, or tissue-forming food. Much proteid, however, can be obtained from the vegetable kingdom--peas, beans, lentils, dried fruits, and nuts being particularly rich in it. We should endeavour to cultivate an appetite for these vegetables containing proteid, as it is a great mistake to rely entirely for this element on meat, as so many of our race do. The animal products--such as cheese, milk, and eggs--will also form an efficient substitute for much flesh-food. This simple diet suits both the brain-worker and the athlete, though each will have to make a selection of those foods most required by him. Certainly much animal food is liable to produce kidney disease, gout, and kindred troubles. If we have a tendency to corpulence (and many have this in advancing years), to resort to an exclusive meat diet will produce these troubles. Far better abstain from vegetables, such as potatoes, and from sweet dishes, pastry, etc., and eat largely of the green-leaf vegetables and fruits with the articles of a simple diet which build but do not fatten the body. (_See_ Diet and Corpulence; Diet for Middle Age, and the Aged.)

Fruit is a very useful article of food. The acid helps to keep the blood alkaline (which alkalinity is necessary for the normal performance of its functions). It prevents acidity of the stomach. The dried fruits, such as dates, figs, raisins, are very rich in proteid. Nuts also are rich in proteid and in fat; they require, however, careful mastication. Mills can be purchased cheaply for grinding nuts; the ground meal, either alone or made into a cream, forms a delicious adjunct to stewed fruit.

Green vegetables are a much neglected food. The salts they contain are very useful. They require careful cooking. A cabbage boiled in the ordinary way loses in the water its valuable salts. In case of flatulence arising from indigestion, the use of vegetables may, however, require to be restricted, at least for a time. Some vegetables are palatable raw, such as salads and celery. Indeed, raw vegetables have a tonic effect on the bowels.

Bread should never be too fresh, and should be thoroughly chewed. Zwieback (twice baked) can be recommended, especially for those who suffer from indigestion. It is made by cutting bread, preferably wheaten, in thin slices, and putting these in a slow oven till thoroughly dry and lightly browned. Wholemeal bread should always be present on the table, as its use prevents constipation. Indian corn can be made into a number of palatable cakes, and is a very nutritious food. Home-made jam and honey are digestible forms of sugar, but like all sugar foods should be consumed in moderation, especially by sedentary individuals. Condiments should be avoided, the healthy appetite is better without them, and they irritate the stomach.

Regarding animal foods, they are often spoilt by over-cooking, and it should be remembered that when lightly done they are easiest to digest. White fish, tender steak, or juicy joint and cutlet are superior to the oily fish, and kidney, liver, and heart. These internal organs should be avoided, as they contain even more than the rest of the animal certain extracts liable to produce URIC ACID (_see_). Milk, cheese, eggs, and butter are not open to these objections. Cheese is a food very rich in proteid. It requires careful chewing, and may with advantage be grated before use. Buttermilk is a valuable and strengthening food. A generation or so ago the Scotch peasants lived almost exclusively on buttermilk and oatmeal, and were a magnificent type of men in every respect. Whey is a pleasant drink, and may be made a substitute for tea where the latter is prohibited. It is also beneficial for the kidneys. Jellies are a pleasant addition to the diet of convalescents, but have little nutritive value.

We would strongly urge upon our readers the advantages of simple diet. We mean by this the avoidance of all those rich and spiced dishes which are made up in so many ways to tempt the appetite, of alcohol in every form, of meat to the extent often consumed by the well-to-do, of pastry and such indigestible food as heavy cakes, of fried food in general; and, on the other hand, the adoption of a diet largely consisting of milk, cheese, eggs, butter, cereals, root and green vegetables, fruits, and nuts. It will not be found an expensive diet; on the contrary, it is remarkably cheap; it will give little trouble, for but little cooking will be needed. It may require some little effort at first, and some breakings with social customs, but far less of both than will be imagined. Seeing that a large part of disease is ultimately traceable to a rich and stimulating diet, and to too much food in general, simplicity is imperative on all who seek for the preservation of health. Eat less, eat better (or more slowly, with perfect mastication), eat simpler foods at your meals, eat at these meals only when you require it, and never between your meals. Such eating will ensure good digestion, good assimilation, good blood, and good health.

Diet and Corpulence.--A tendency to obesity should always be carefully checked by attention to diet and exercise (_see_ Exercise). The fattening foods are those which contain either fat or carbonaceous substances. Carbonaceous substances are found in bread, sugar, arrowroot, puddings in general, pastry, potatoes. The fats, such as butter, cream, and animal fat, should be much restricted in their use. As we have above indicated, however, it is not wise, as many corpulent people do in their efforts to get rid of this superabundance of fat, to make up for their restriction by an increase in the quantity of meat consumed. Cheese, peas, beans, buttermilk, and oatmeal might with advantage be drawn upon instead. At the same time, if the circulation is good it is well with such proteid diet to increase the amount of water drunk during the day, as this helps to eliminate the waste which would otherwise overtax the kidneys. Green vegetables and fruits should form a large part of the diet.

It must be remembered that it is dangerous to strike out at once all fattening foods from the diet; many have injured their health permanently by such injudicious haste, and brought on floating kidneys, etc. Remember, also, that exercise is a much safer reducer of fat than a very great reduction in diet, unless there has been a decided tendency to continually overeat. All alcoholic beverages must be strictly forbidden.

Diet for the Lean.--To a large extent the preceding article will suggest what is suitable here, remembering, however, that regular exercise will be also necessary in order to enable the muscles to increase in size. Green vegetables and fruits should be largely used in addition to the carbonaceous foods, as their FOOD SALTS (_see_) are necessary to keep the blood in a condition to allow of proper assimilation. In the case of nervous and consumptive patients, the more digestible forms of fat, such as cream and butter, are to be recommended. Some thin people do not seem able to assimilate much fat. These cases will do better on a smaller quantity. Remember always that it is not what is eaten, but what is assimilated, that goes to increase the weight, therefore if any particular food is found, after a careful trial, to constantly disagree, it must be accepted that for that one at all events, it is not a suitable article of diet.

Diet for Middle Age and the Aged.--In advancing years when less exercise is, as a rule, taken, a restriction in the amount of food consumed is highly desirable. The increasing corpulence, which often begins to show itself from 30 to 40, is far from being a healthy sign; indeed, is often the premonitory symptom of serious disease. It should be remembered that a lessening quantity of food is required from middle life on. This applies to all the elements of food. It is noticeable that a fat person seldom lives to old age, most octogenarians being thin and wiry, and almost all attribute their long life to increasing watchfulness over their health, and largely over what they eat.

When a person is young and taking active exercise, a good deal of surplus food can be worked off, and if the excess be too great, a bilious attack tends to prevent any more being taken, for a time at least.

But as we get on in life, the surplus food, if much is eaten, is deposited in various parts of the body as fatty or gouty accumulations. The liver becomes deranged, and loss of health and strength are at once apparent.

It is then, as Sir Henry Thompson has well pointed out, that the fond but foolish wife often does her husband incalculable harm by her efforts to "keep up his system." She urges and tempts him to take more food, fetching him, between meals, cups of beef-tea, soup, or cocoa, when he really would be greatly the better of total abstinence from all food for several days. What we have said about appetite being the best guide applies to the old especially, and if they could but realize what a very small quantity of food is necessary, they would not be perturbed to find that their appetite guided them to eat very much less than at a younger age.

Milk, which is the ideal food for the very young, is for that reason often undesirable for the old, and it is a great mistake for such to drink much of it with solid food.

Diet for the very aged becomes mainly a question of invalid diet, and it must be remembered that much should be granted to the individual's choice and liking. All foods for the aged should be light and easily digested, and careful attention paid to proper cooking.

A striking example of lost health recovered and life and activity prolonged to a great age, by strict temperance in food, is Cornaro, a Venetian nobleman of the sixteenth century, who lived over 100 years. He says:--"Our kind mother Nature, in order that old men may live to still greater age, has contrived matters so that they should be able to subsist on little, as I do, for large quantities of food cannot be digested by old and feeble stomachs. By always eating little, the stomach, not being much burdened, need not wait long to have an appetite. It is for this reason that dry bread relishes so well with me.... When one arrives at old age, he ought to divide that food of which he was accustomed to make but two meals into four, and as in his youth he made but two collations in a day, he should in his old age make four, provided he lessen the quantity as his years increase. And this is what I do, agreeably to my own experience; therefore my spirits, not oppressed by much food, but barely kept up, are always brisk, especially after eating, nor do I ever find myself the worse for writing immediately after meals, nor is my understanding ever clearer, or am I apt to be drowsy, the food I take being in too small a quantity to send up fumes to the brain. Oh, how advantageous it is for an old man to eat but little! Accordingly, I, who know it, eat but just enough to keep body and soul together."

Digestion.--Digestion is the process whereby the food we eat is turned into material fit to be assimilated by the blood. It begins in the mouth by the mechanical grinding and crushing of the food, and the chemical conversion of the starchy part into sugar, in which form alone it can be assimilated. This conversion is carried out by the saliva. Hence the necessity for thorough mastication, even of sloppy foods that do not seem to require it, and for attention to the teeth in order that they may thoroughly chew. Alcohol and tobacco, as they spoil the saliva, are very unfavourable to digestion, and should always be avoided. Twenty minutes longer to chew one's dinner is worth a whole box of pills, and no one need expect good digestion who neglects thorough chewing and salivation of the food. This may, with advantage, be increased to an extent which most people would think quite absurd. It has been proved that when all food is chewed until completely reduced to a liquid, its nutritive qualities are so increased that about half as much will suffice. This is of immense importance in all cases of weak digestion, or indeed whenever an absence of vigorous health renders the economy of vital energy important.

In the stomach the food meets with the gastric juice, which has the property of turning proteid (_see_ Diet for the various substances contained in food) into material ready for assimilation. The walls of the stomach are muscular, and their contraction churns the food with the juice. The gastric juice is secreted by glands embedded in the walls of the stomach, and is poured out when food is taken.

The whole food, now in the form of a paste, passes into a pipe about 12 inches long (the Duodenum), into which pours the secretion of the pancreas and that of the liver (bile). The pancreatic juice acts upon the starch which has escaped the action of the saliva, and also continues the work of the stomach. It furthermore emulsifies the fat or divides it into extremely fine drops.

The food passes now into a long coiled pipe--the small intestine. This secretes the intestinal juice which further assists the pancreatic juice. Absorption has been proceeding from the stomach onwards (_see_ Assimilation). The mass of undigested food is pushed along the small intestine by means of muscles in its walls and passes into the large intestine where a similar process to that of the small intestine goes on, the remains of the food ultimately reaching the vent in a semi solid form, consisting of the undigested part and the débris of digestion.

During this complex process much blood and energy is needed for the abdominal region, therefore hard work or exercise should not immediately follow a meal. It will be noticed that each stage of digestion prepares the food for the next stage _e.g._, the mouth prepares the food for the stomach. Now, as the food ceases to be under our control when it leaves the mouth, every effort should, as we have said, there be made to prepare the food for its reception by the stomach. Chew food dry as far as possible, for that excites saliva. It is best not to drink till after the meal. The digestive powers often become weakened in advancing years, but may be greatly preserved, and even restored to health after long debility, by careful attention to the above hints.

Drinks made of lemon juice or orange juice and water are often very good to help an invalid digestion, but nothing is better than sips of hot water for some time before a meal. Distilled water is especially a most valuable drink. Cooling applications to a fevered stomach and warm fomentations to a cold one will often promote digestion marvellously. The feet and legs may be fomented if cold while the cold cloth is pressed over the stomach, especially if the process be long continued. Where heat is necessary it should be gradually and cautiously applied, so that sickening the patient may be avoided. (_See also_ Assimilation, Food in Health, Indigestion).

Diet, Economy in.--Dr. Hutchison, one of our greatest authorities on the subject of Dietetics, has well said--

"The dearest foods are by no means the best. 'Cheap and nasty' is not a phrase which can be applied to things which you eat. A pound of Stilton cheese at 1s. 2d. contains no more nutriment than a pound of American cheese at sixpence. A given weight of bloater will yield more building material than the same quantity of salmon or sole.

"The upper classes in this country eat too much. The labouring classes are insufficiently fed--much worse fed than their brethren in America. One of the chief consequences is an undue craving for alcoholic stimulants; another is that our poor are not properly armed against tuberculosis and epidemic disease.

"How can this be rectified? Anyone who knows anything about the poor man's budget knows that he already spends as much on food as he is able. As it is, 50 per cent. of a workman's wages are absorbed in its purchase, so that half the struggle for life is a struggle for food.

"The only remedy is to buy the things which are the most nourishing and which yield the most energy. Quite a good diet can be obtained for fourpence a day, yet the average working man spends sevenpence.

"I advise the buying of more vegetable foods, particularly peas, beans, and lentils, and the cheaper varieties of fish. The working classes should also be taught how to cook cheese, and thus make it more digestible, as the Italians do. Cheese contains much building material, and is therefore a valuable article of diet.

"I strongly recommend one good meal of oatmeal a day, instead of so much bread, butter, and tea, which is the staple diet of so many poor families, because it is easily prepared, and because of human laziness.

"Skimmed milk is better than no milk at all, for it contains all the original proteids, and has only lost its fat. More dripping and margarine should be eaten, instead of jam; margarine being quite as digestible and nourishing as butter."

Vegetable oils are, however, more digestible than animal fats. Cocoanut butter is a cheap and excellent substitute for margarine or butter. As it contains no water it will go much further.

Another instance of bad economy is the use of cod liver oil. Butter or even cream are quite as fattening and much more digestible.

Malt extract is much dearer than honey, which is superior to it in value as a food.

To supply a healthy man with the amount of proteid required by him daily in beef extracts would cost 7s., in milk (a comparatively expensive food) would only cost about 1s.

Diphtheria.--The most striking symptom of diphtheria is the growth of a substance in the upper part of the windpipe, which threatens to close it entirely. Good medical skill is of first importance here, yet much may be done where that is not available. We have often seen the swallowing of a little hot water and treacle enable the children to throw up the entire obstruction and make the breathing perfectly free. Mark at once whether the feet are cold or warm. If cold, oil them well with olive oil, and pack in a hot blanket fomentation to the knees. When the feet and knees are thoroughly warm in this, put a cold cloth on the back of the neck down between the shoulders. Change this as often as felt comfortable. The throat may be brushed out with a weak solution of Condy's Fluid, but a strong solution of common salt will do very well. Good white vinegar and water (_see_ Acetic Acid) is perhaps best of all. We have never seen this fail in changing the character of such growths, and if the windpipe can be washed out repeatedly with it, we should feel sure of a desirable result. Now, we have seen a humble working man's wife wash out the throat of her son as well as any medical man could do it, using Condy's Fluid for the purpose with full success. When you can, have the help of a medical man, but when you are so placed that such help is impossible, you need not fear to try yourself. If there is much fever, cold cloths may be applied to the head to reduce the heat. As the disease is strongly infectious, care should be taken to isolate the patient, and attendants should avoid his breath. Abundance of fresh air and light should be allowed to enter the room, and one window at least should be open as far as possible.

Douche, Cold.--In its most powerful form this is a _solid_ stream of water directed down on the patient's shoulders and spine. It may be applied either by an apparatus fixed up for the purpose, or by merely pouring from a watering-can _without_ a rose. Its power depends on the great heating in the skin which springs up when it is withdrawn. This heating power again depends on the strong shock given to the system when it is applied. Thus it will be seen that what is called a "Spray" or "Spray Douche" is of little use for the same purpose, as it gives little or no primary shock. It is with this application as with many. The patient's feeling benefit is the great and true evidence of the treatment being right. When the douche issues in bodily comfort and cheering to the mind, all is right. If it issues in discomfort, then some other treatment must be tried.

"Downbearing."--This expression will cover many troubles especially common among women, where the weight of the internal organs becomes distressingly felt. These are usually supported without our being conscious of their weight at all. But in weakness, or after long fatigue and standing, it becomes felt as a severe downward pressure. This is often caused by the pressure of corset and skirts upon the waist. In cases where it is troublesome, much help will be derived by adopting some device for suspending the clothes from the shoulders. This may quite cure the trouble (_see_ Tight Lacing). For more serious cases, take daily a short SITZ-BATH (_see_) in cold water, with the feet in hot water. Internal syringing is often required, which is best done with the "Fountain Enema," and very weak acetic acid and water (_see_ Acetic Acid). A more powerful application is to have cold water poured over the front of the body while sitting in the sitz-bath, from a watering-can with a garden rose on the spout. This must be done gently at first, and afterwards more strongly and with colder water. This also prevents the troublesome "flooding" from the womb, which so often accompanies "down-bearing." The water employed in the douche must be _cold_, but it need not be icy cold. Ordinary cold tap water does very well. In serious cases medical advice should be sought, as the womb may be displaced. A golden rule for the prevention of this distressing ailment is to pass water frequently. If women would always do this before pushing heavy furniture, hanging up pictures, &c., many internal ailments would be prevented, as when the bladder is empty there is little danger of the womb being displaced.

After the system has been weakened by a miscarriage, this flooding often occurs. Apply the above treatment: it checks the flooding, and braces the parts.

Drinks, Refreshing.--This is a matter of great importance to the sick. Nor is anything more important to be said on them than this, that the foundation of all such drinks must be _water_. This water must be _pure_, and is best distilled, or boiled and filtered. Long boiling will spoil water, and half-an-hour is long enough to boil. To add to this pure water, we may take the juice of half a lemon, sweetened to taste. Few patients will fail to relish this. A whole orange may be used instead of half a lemon. A substitute may be made by taking half-a-teaspoonful of good white vinegar instead of the orange or lemon. Also in many cases where the cold drink is not relished, it may be taken warm.

Dropsy.--This trouble is rather a symptom than a disease. It rises from accumulation of watery waste in the body, owing to improper action of the skin, lungs, or kidneys, and sometimes follows scarlet or other fevers and lung affections. By far the greatest danger in such cases arises from fashionable medicines. It is of the last importance that nothing should be given to lessen life by injuring already weakened vital action. It is when this is done by metallic preparations that such cases become very grave and even hopeless. There is a prominent error in connection with all dropsical tendencies, which should be removed. That is the idea that the "water" which collects in such swellings is similar to good drinking water, and that giving the thirsty patient water to drink is increasing his illness. The so-called "water" which swells the face, or the feet, or any other part of the body, in dropsy, is used-up matter such as is, in good health, removed (imperceptibly, in greatest measure) by the organs fitted for that purpose.

Water, especially if given about blood heat, is at once used for most important vital purposes. This hot fresh water mingling with the poisonous "water" of dropsy dilutes it--renders it not only so much less injurious, but tends powerfully to its removal. The thirst of the patient is in perfect harmony with this truth, as all natural symptoms are ever in harmony with nature. If there are convulsive attacks, they are the result of used-up matter returning into the circulation, and reaching even the brain and central parts of the nervous system. The cure is gained when the defective organs are brought to act well. It is shortsighted action to deal with the kidneys alone in this trouble. They often fail because they are overloaded through the failure of lungs and skin to do their part. First, it is well to act on the lungs by gentle rubbing with hot olive oil between the shoulders and over all the back--done best in a warm room by the fire, or in bed. This may be continued for half-an-hour or more twice daily. The skin may be stimulated by a smart sponging with vinegar or weak acetic acid, and a rubbing all over with soap lather, and afterwards with hot olive oil. This lathering and rubbing to be done at another time from the first rubbing for the lungs. Then apply a large warm bran poultice to the lower part of the back behind the kidneys.

We have often found the following simple treatment effectual, where the patient is not very weak. If there are any signs of heart failure, do not use it. But if the patient is fairly strong, it is most beneficial. You have a case, say, of dropsy in the abdomen: put on two folds of soft flannel, wrung out of cold water; put two folds dry over the moist ones. Keep away all oiled silk and everything of the kind. You will very soon have an astonishing outflow of insensible perspiration, but it passes off through the soft porous flannel without any obstruction whatever. You will find that under this the swelling soon comes down, and even disappears entirely. It is necessary, in such treatment, to renew the bandage so as to keep all fresh and healthful, but your work is abundantly rewarded. In such a case as this the matter to be passed off is so great that a cotton or ordinary linen bandage may fail, as being too impervious, when a flannel bandage will succeed. A Kneipp linen bandage is perfectly porous, and will not irritate the skin as flannel often does. Worn-out underwear can be kept for this purpose.

If stronger heat seems to be needed, a soft cloth four-ply thick, large enough to cover the whole lower back, should be dipped in CAYENNE LOTION (_see_), slightly squeezed, and placed on the back. Over this a dry cloth should be placed, and the patient should lie down on a bran poultice or hot-water bag for an hour or two. Afterwards the back should be rubbed with olive oil, and a band of soft new flannel worn round the body.

Even if the swelling is caused by rupture this treatment is the best. The rupture must be reduced (_see_ Rupture) and sustained by a proper truss, for which the patient should apply to a responsible surgical instrument maker. This treatment alone has cured many dropsical patients. Where failure of the heart's action complicates the trouble, this treatment will usually relieve the heart as well as kidneys. For drink in such cases see article Drinks. For food give whatever is most easily digested and passed into good blood. Wheaten-meal food, oatmeal jelly, etc., are good. _See also_ Biscuits and Water.

Drowning.--Many valuable lives have been saved by an elementary knowledge of what to do in the case of one apparently suffocated or drowned.

Commence treatment immediately in the open air, with the face down, neck and chest exposed, and all tight clothing such as braces removed.

The points to be aimed at are--first and _immediately_, the Restoration of Breathing; and secondly, after breathing is restored, the promotion of Warmth and Circulation. The efforts to restore Breathing must be commenced immediately and energetically, and persevered in for one or two hours, or until a medical man has pronounced that life is extinct. Efforts to promote Warmth and Circulation beyond removing the wet clothes and drying the skin must not be made until the first appearance of natural breathing, for if circulation of the blood be induced before breathing has recommenced the restoration to life will be endangered.

_First_: Roll the patient over on his chest, with one of the arms under the forehead, when the water will readily leave the mouth. _Second_: If breathing does not recommence then, place him on his face, supporting the chest on a roll of clothing. Turn the body gently on the side, then briskly on the face repeating these movements, about 15 times in the minute. (By placing him on his chest the weight of the body forces the air out; when turned on the side air enters the chest). Five minutes is the longest that can be afforded to this treatment. _Third_: Turn him on his back, draw his tongue forward, keeping it forward by a band passing over it and under the chin, placing the roll of clothing under the shoulder blades. Then, kneeling at his head, grasp the arms just below the elbows, draw them above the head, keeping them stretched for about two seconds. Then turn down the arms and press them firmly for two seconds against the sides of the chest. (The outstretched position allows air to be drawn into the lungs, the other position allows it to be pressed out.)

When a spontaneous effort to respire is observed, proceed to induce Circulation and Warmth. This is accomplished by rubbing the limbs upwards with firm grasp and pressure underneath the warm blankets, or over the dry clothing which through bystanders or other means should have been already procured, apply hot flannels, hot water bottles, heated bricks, etc., to the pit of the stomach, the armpits, between the thighs and the soles of the feet.

Allow abundance of fresh air to play about the patient. Administer a teaspoonful of warm water, and then if the power of swallowing have returned, give hot milk, coffee, etc., in small quantities. The patient should be kept in bed and a disposition to sleep encouraged.

The above treatment should be persevered in for some hours, as it is an erroneous opinion that persons are irrecoverable because life does not soon make its appearance, persons having been restored after persevering for many hours. The appearances which generally accompany Death, are: Cessation of the heart's action, eyes half-closed, pupils dilated, tongue approaching to the inner edges of the lips, lips and nostrils covered with a frothy mucus. Coldness and pallor of surface increase.

_Cautions_: Prevent crowding, avoid rough usage; if the body is on the back have the tongue secured. Never hold up the body by the feet. Never place the body in a warm bath, unless under medical direction, and even then only momentarily.

Dwining.--We give this name to a trouble from which we have been able to save some patients, as expressing best the general failure and weakness which sometimes constitute a serious danger, even where all specific symptoms are wanting. Some cases of this kind we have cured, when they were supposed to be hopelessly dying, by the use of simple soap lather. The skin of the patient is usually dry, and the pulse feverish. In such a case take lather, made as directed in article Head, Soaping, and spread it gently all over the stomach and heart. Repeat this six or seven times, keeping the patient warm in bed. Then, after drying, do the same thing to the back. This does immense good. For the general skin stimulation, rub over with the mixture for NIGHT SWEATS (_see_). The skin is rubbed over with this five or six times, once a day.

Where there is no feverishness, but rather cold feelings, then use the _warm_ lather as directed, and rub well all over afterwards with hot olive oil. This treatment alone we know to have cured many.

Dysentery.--This is an affection of the bowels of the nature of diarrhoea, but much worse, as in it _blood_ accompanies the bowel discharge. It usually begins as diarrhoea, and at this stage may be cured by either warm vinegar and water or simple cold water injected into the bowel (_see_ Diarrhoea). Where there is any reason to suspect the water supply, that should be boiled for half-an-hour and cooled before use. Attention to the diet, taking for a time _milk_ diet alone, is also important. Nothing can be better than boiled bread and milk, giving no more than the sufferer feels he needs. When the diarrhoea has passed into true dysentery, with blood discharge, or the trouble begins as such, then enemas of weak acetic acid, or vinegar and water, given _warm_ (_i.e._, a little over blood heat), must be used instead of cold water. As much vinegar should be used as will make the mixture (_see_ Acetic Acid) very slightly smarting when applied to a tender part of the skin--say, to the corner of the eye. What is wanted is just as much acid as will act healingly on the injured vessels, and no more. An enema of this water mixed with acid may be repeated as long as required with perfect safety and good effect every time. Even if the disease has made very serious progress, this will tell upon it powerfully. These warm enemas should be very resolutely followed up as long as they give the least comfortable feeling. No one who has not felt their magical effect can conceive how powerful they are. We have seen a patient on the point of giving in and lying down as a helpless invalid made perfectly fit for work in less than an hour by this mode of treatment.

Where the trouble has passed into that stage where the patient is much weakened, in addition to this the ARMCHAIR FOMENTATION (_see_) should be employed; or if the patient be too weak, the fomentation may be properly wrapped round him in bed without rising. If the patient be too weak for wrapping round the body, he may be first wrapped round the legs, and so strengthened as to stand the stronger remedy. Olive oil must be rubbed on the skin before and after fomenting. The heat may be kept up for an hour. If too weak to stand even this, the feet and legs may be first fomented, and afterwards the body. This treatment has saved many cases from disaster. _See also_ British Cholera; Diarrhoea.

Dyspepsia.--_See_ Indigestion.

Earache.--In the common form this is purely neuralgic. The nerves are in shape and distribution like some tender plant, the root in the brain or spinal cord, and the ends of the branches in the organs supplied by them with nerve power. They are best affected, and most easily cured, by applications to the root rather than the branch ends. This is greatly the case with earache, which is a trouble of the nerves of the ear--not those of hearing, but the ordinary nerves supplying the part. The remedy is to press cold cloths on the _back of the head and neck_. This will often give instant relief. It is best done when the patient is thoroughly warm. If he be cold and clammy in feeling, the feet and legs must be well fomented before applying the cooling. Rub all parts treated with warm olive oil when the treatment is finished.

Ears, Running.--In this trouble there is indicated a failure somewhere of the clearance of waste from the body. This matter gathers locally in the ear, where suppuration and discharge take place. A cure must not be directed to the ear alone, but first the general waste-removing system should be stimulated with special reference to its service in the ear. Rubbing the back with hot olive oil and gentle pressure for a long time, say forty minutes daily, will go further to cure the ears than anything which can be done to themselves. Gatherings, by this treatment, are often quickly dissolved and dispersed.

Where actual waste matter runs out of the ear, the treatment is to have a round camel's-hair brush and soak the interior of the ear, using the brush, with warm weak vinegar, or weak acetic acid, just sour to the taste; then brush with a little fine almond oil, and wipe very gently as dry as possible.

Another way is to syringe the ears very gently with this dilute acetic acid; do not force the acid strongly against the internal parts of the ear, but rather let it soak in. It may be continued as long as is felt agreeable. Do this twice a day; have also a good warm bran poultice placed at the back of the head and neck for an hour each day, oiling the skin before and after. This is best done at bedtime. If this treatment be pursued carefully, the ears should soon come right.

Ears, Singing in the.--Partial deafness is often accompanied by noises in the ear, which are very annoying. This is caused by the internal state of the ear, and is often due especially to the state of the aural nerve. Similar noises are heard also when we place our fingers in our ears, or when we hold a shell or hollow vessel against one of them. In the latter case, what we hear is the rush of blood in the vessels of the ear. In this way, singing in the ears often arises in the course of the treatment recommended in the last article for running ears. If it become too loud, a cessation of the heating at the back of the head, and a brief cooling application, will relieve it. Therefore, in such cases, it is well to use COOLING IN HEATING (_see_).

Eczema.--Skin eruptions, known under this name, have very various causes. Treatment must vary accordingly.

Where the cause is a failure of the skin to act properly, the _whole_ skin of the body, especially the chest and back, will be dry and hard. In this case apply SOAPY BLANKETS (_see_).

If the soapy blanket be too severe on the patient, then apply general lathering with M'Clinton's Soap. Use a badger's-hair shaving brush, and have the lather like whipped cream with _no free water_ along with it. We have known a few of these applications cure a case of long standing.

Where general debility is present, along with the disease, use all means to increase the patient's vitality. Simple diet is best (_see_ Diet, Saltcoats' Biscuits, Barley, Assimilation, Digestion), and abundance of fresh air, within and without the house, by night and by day.

Where the disease results from a parasite, some ointment should be used, and is best applied under the immediate direction of a specialist in Diseases of the Skin.

Elbow Joint.--See Armpit Swelling and Bone.

Enemas, Cold Water.--Prejudice often exists against _cold_ treatment of any kind, but it must be overcome, unless the sick would lose some of the most precious means of relief which we possess. The Enema Syringe, or Fountain Enema, may be had from any druggist, and is used to inject liquid into the lower bowel. To inject _cold water_ by this means is a most efficient method of relief for internal heat and irritation, as well as for DIARRHOEA (_see_). Sick headaches are also often instantly cured by this means. What we are here concerned with, however, is to say that this remedy is as _safe_ as it is simple, so long as discomfort is not felt by the patient. Cold enemas may be given repeatedly, where they are felt to be comforting, without any danger whatever. If the bowels move after the first application, there is no need to be alarmed. Repeat the cold injection, and the diarrhoea will cease. The _cold_ enema does not produce or aggravate constipation; on the contrary, it often relieves and cures the sluggish bowels. In cases where medicine has to be almost constantly taken, its use, and the disuse of the drugs, will often effect a complete cure. In many instances in which outward cooling cannot be borne, the thermometer will indicate that there is excessive internal heat, and the pulse will be quick also. In such cases it will be possible to give the most delightful relief by cautiously applied internal cold.

Fever that might be relieved by cold packing and sponging with vinegar, or some such means, will be far more speedily reduced by these cold injections, and fever which cannot be reduced by these means alone will give way when this is added.

There are cases in which a sort of paralysis of the lower bowel renders what is called "opening medicine" constantly necessary. The consequence of these continued doses is to produce greater and greater paralysis, and ultimately death itself; in these cases the cold enema is of great value. If there is lack of power in the bowel, it is well to increase it by a warm bran poultice, or hot bag on the back, and to brace the vessels and muscles within with the cold enema. (_See_ Constipation.)

Epidemics.--The key to action in case of epidemics prevailing in the district is found, when we consider that always, many residing amid infection escape it. They do so in virtue of better resisting power, rather than because no seeds of disease ever reach them. In case of epidemic, then, besides daily sponging with acetic acid or vinegar, and _scrupulous cleanliness_, everything should be done to increase health and vitality in the household. Plenty of fresh air and sunlight, open windows day and night, and good plain food, are most powerful aids to resisting disease. The milk and water used in the household should all be boiled and _allowed to cool_ before use, the boiling lasting half-an-hour. The family where all this is done may expect to escape infection, and therefore may maintain that calmness and freedom from fear which is itself a very important help against it.

Epilepsy.--The first sign of such an illness is a brief and slight attack of "absence." We notice once or twice that the person "loses himself" for a few moments, but recovers so speedily that we scarcely are sure whether anything of importance has occurred. He is perfectly unaware that he has so "lost himself" or been "absent" at all. That part of the brain on the activity of which consciousness depends has been for the moment inactive.

There is another symptom--that is, the "falling" which gives one of its titles to this malady. It is called "the falling sickness." There is a peculiarity in the falling of one who is affected in this way. In some cases consciousness partially remains, but the balancing power of the brain is lost. A patient in this case sees the ground rise till it strikes him violently on the forehead. We remember a friend telling us that he was walking along a railway, when all at once the rail seemed to rise and strike him in the face: he had fallen on the rail, and seriously wounded himself. The same thing occurs to the person who has taken enough alcohol to deprive him for the time of brain action for the usual balancing of his body. Just as there is a certain part of the brain which gives men consciousness, so is there a part which gives muscular control, such as we use in balancing the body, and there is a stream of vital action flowing from the nerve sources by which both are supplied. If this stream is diverted from these organs, "absence" and "falling" are the natural and necessary result.

There are many cases in which there are only "absence" and "falling," but in others, symptoms much more alarming appear. The next of these which we notice introduces us to a totally distinct element in our explanation. It is found in the "screaming" that follows instantly on unconsciousness, and precedes the "falling" generally. The sufferer is entirely unaware of all that occurs with him, and screams by no voluntary act on his part. The symptom is purely bodily, and expresses no thought or feeling, good or bad, though it is similar to the scream of terror, and makes the same impression on the uninformed hearer. The muscles are used in the scream of epilepsy, just as the muscles of ordinary movement are used in St. Vitus' Dance, but there is nothing of the mind whatever in the movement. The organ of the mind is unsupplied with vital action, but the organs of voice are over-supplied. It is beyond doubt this over-supply which shows itself in the scream, for there is nothing else to account for it.

The same thing is true of the movements of the jaw that are so terribly strong, and so sorely wound the tongue, in the case of those suffering in this way. The jaws open and shut with great force, and without the mind regulating their movement. All the motor nerves are convulsed with strong action, and the muscles they supply are wrought to the utmost, while all consciousness and control are entirely suspended. There is such an overwhelming supply of activity to the mere muscular system that the sources of that supply are soon exhausted, and the motion ceases for a time. Consciousness does not at once return fully, but the convulsions cease, and something like a sleep follows before the brain has its needed supply.