Chapter VIII: Part 8

Hip-Joint Disease.--Thorough heating, with moist heat is the best treatment for this trouble. This implies time, work, and patience; but all these are well spent. Let a strong fomentation be given twice a day to the hip joint, with oiling before and after, each application lasting at least an hour (_see_ Cooling in Heating; Fomentation; Heat and Weakness). In all probability a gathering of matter will come to the surface and discharge itself. Treat this as recommended in article on Abscess, and persevere until the joint is thoroughly renovated. It may take a time, and the treatment should always be intermitted on Sabbath, and sometimes a few days' rest be given. The patient's _comfort_ is the safe guide in this.

Hives.--_See_ Rash.

Hoarseness.--This trouble we may consider in _three_ ways:--First, as the effect of overstrain in using the voice; in this case rest must be taken from speaking or other such work. Remedies which restore the voice without rest are very likely to do permanent injury. For application to the throat, use vinegar or weak ACETIC ACID (_see_) of such strength as to cause just slight smarting of the throat when applied as a gargle, or with a proper brush, such as any chemist will supply. This may be done frequently, and, together with rest, will rarely fail to cure. Rubbing the throat externally with acetic acid of full strength until a rash appears is often very helpful. Those engaged in public speaking would do well, especially in youth, to cultivate the habit of correct breathing (_see_ Breathing, Correct Method of). Articulation should be clear, and the words formed sonorously, and from the stomach, as it were. This, indeed, will apply to everyone. Such a method of producing the voice will not only be harmonious, but will exercise insensibly a beneficial influence on the nervous system and mental tone of the individual.

It is a fact that actors who study the method of voice production do not suffer from that form of sore throat known as clergymen's sore throat, simply because they have learned to produce their voice in this way.

Secondly, hoarseness may arise from exposure to cold, damp air. In this case it is best to apply mild heat to the _roots_ of the nerves which supply the voice organs. This is best done by applying a bran poultice to the back of the neck, oiling before and after with olive oil. Carefully dry the skin, and wear a piece of new flannel, for a time, over the part poulticed. This may be supplemented by brushing as above with the vinegar.

Thirdly, failure of skin action, or of the proper action of other waste-removing organs, may be the cause of hoarseness. In addition to the treatment recommended above, we must in this case stimulate the skin: this is best done by rubbing with Cayenne "Tea" (_see_) all over the body at bedtime. Let this be done for four or five nights, and the throat treatment be given in the morning, when a cure may be looked for. _See_ Underwear.

Hooping Cough.--_See_ Whooping Cough.

Hope and Healing.--The mind has always an influence on the body. Life rises and falls under the influences of ideas, so as to prove that these are a matter of life and death to man. To give an invalid _hope_ is, then, to help mightily in healing the disease, whereas to tell patients that they are incurable is the sure way to make them so. But there is, on the other hand, little good in falsehood and false hope: this has often been found to fail and leave the patient in complete despair. No one can tell the immense power for healing which is exerted when one who truly hopes for the patient looks brightly into his eyes, and speaks with a genuine ring of hope of the possibility of cure. So many cases found incurable by the usual treatment have yielded to that recommended in these papers, that in almost all cases we may see some ground for hope, if not of cure, at least of great alleviation. To give this impression to a patient is to half win the battle.

There are many who speak most carelessly, even wickedly, to those in trouble. They think it a duty to dash their hopes and predict gloomy things. Such should never enter a sick-room, and should, indeed, change entirely their manner of speech. To go about the world sowing doubt and gloom in men's hearts is a sorry occupation, and one that will have to be accounted for to Him who is emphatically the "God of hope."

Look, then, in treatment for every least sign of improvement. Discourage all doubts and encourage all hopes, and you will make what would be a really hopeless case, if the patient were left to despair, one that can be comparatively easily cured. "A word to the wise is enough."

Hot Flushings.--_See_ Flushings.

Hot-water Bags.--The flat rubber bags of various shapes, to be had from all rubber shops, make excellent substitutes for poultice or fomentation; but care must be taken to have two or more ply of _moist_ flannel between the bag and the skin of the patient. This ensures a supply of moist heat, which is in almost every case the best.

Housemaid's Knee.--To cure a swelling on the knee-joint is, as a rule, easy. _Rest_ is a first and paramount necessity. Bathing with hot water, not too hot for comfort, for at least an hour each day is usually sufficient. If the knee has been blistered, or leeched, it is more difficult to cure; but a cure may be expected if the bathing be continued for a long enough time. It is best done by wrapping a cloth dipped in vinegar round the knee, and placing the foot in a bath, then pouring hot water on the bandaged knee, lifting it from the bath in a jug.

When pain in bending is felt in the very centre of the knee-joint, this hot pouring may be needed for a month, or even longer. During the intervals of pouring a large cold compress should be worn, first well oiling the knee. Cover the compress with oiled silk. This will soften even a very stiff knee, so as at least to bring about ability to bend without pain. Of course, if there is any disjointing, good surgical aid must be had, if possible, to replace the bones in their natural position.

Hydrocele.--_See_ Dropsy.

Hysteria.--This is usually brought on by some excessive strain upon the brain nerves, and may show itself either in the violent or in the fainting form; it may even pass from the one to the other, fainting alternating with violent movements and cries. It may often be checked by plunging the patient's hands into _cold_ water.

In the silent stage, where sometimes unconsciousness continues for hours, a dry blanket should be laid on a bed, and another blanket must be rolled up and prepared with hot water as directed in Fomentation. Fold this until it is the size and shape of the patient's back, and lay her down on it, so that the whole back is well fomented. Take care not to burn the patient: soothing heat, not irritation, is required. Consciousness will usually return almost immediately. All except attendants should be excluded from the room. Allow the patient to rest in this comfortable warmth until signs of discomfort appear, then gently rub the back with hot olive oil, dry, and leave to rest or sleep if possible. Do all with great _steadiness of temper and kindness_; such a condition in the nurse is especially essential in these cases. Where the fit is violent, apply every mental soothing influence available, and remove from the room all excited persons. Then apply cold cloths to the spine to soothe the irritated nerves and brain. Two may gently and kindly hold the patient, while a third presses on the cooling cloths. In about half-an-hour the fit should be overcome. A difficulty in treating such cases is the terrifying effect of the violent movements, or unconsciousness; but these should not create fear. As a rule, a little patience and treatment as above remove all distress. Where there is a hysterical tendency, give abundance of good food, and let the patient live as much in the open-air as possible.

The patient should be kept employed. God made us all to be workers, and this sad affliction is frequently the punishment of idleness. No one has any excuse for this, for the world is full of those who are overworked and whose burden could be lightened. The girl whose only task is to exchange her armful of novels at the library will never know what true happiness is, nor deserve to. _See_ Imaginary Troubles.

Illness, The Root of.--In treating any trouble it is well to get to the root of it. On one occasion a patient complained that the doctor never struck at the _root_ of his illness. The doctor lifted his walking-stick and smashed the brandy bottle which stood on the table, remarking that his patient would not have to say that again. This will illustrate what we mean. Liquor drinking must be given up: it is the root of multitudinous ills; so must excessive tea drinking. Tobacco is one of the most insidious of poisons in its effects on the nerves, and is to be absolutely given up if a cure is expected in nervous cases. Chloral, laudanum, and opium in other forms, may give temporary relief; but they are deadly poisons, paralysing the nerves and ultimately completely wrecking the system. The continued use of digitalis for heart disease is a dreadful danger. We mention these by name as most common, to illustrate the truth that it is vain to treat a patient while the _cause_ of his illness is allowed to act. If any evil habit of indulgence has given rise to trouble, that habit must be given up; a hard fight may have to be fought, but the victory is sure to those who persevere. Often dangerous symptoms appear, but these must be faced: to relieve them by a return to drugs is to fasten the chains more surely on the patient. It is better to suffer a little than to be all one's life a slave.

Imaginary Troubles.--These are of two kinds, the one purely imaginary, the other where bodily trouble is mixed with the imagined. In the first case the patient is in agony with a pain, when nothing wrong can be discovered in the part, or even elsewhere, to account for it. In such a case, proper treatment of the BRAIN or SPINE (_see_) will often relieve. Again, a patient has set up such a standard of health that what would not trouble any ordinary person at all, gives him much distress. An intermitting pulse often is a source of great anxiety; but we have known people with intermitting pulses continuing in good health for forty years, and living to old age. So with many other heart symptoms that need give no concern at all. Sprains to some muscles are often taken for serious internal inflammation, and a slight cough and spit are taken for consumption. Care must be taken to resist all such fancies, and if not otherwise removable, _thoroughly competent_ medical advice will often put the patient right. In such a case a medical man of undoubted high standing is best consulted, for an inferior practitioner may nearly kill the patient by arousing needless fears, which are afterwards difficult to remove. _See_ Hysteria.

It must be remembered that diseases of the imagination are as actually painful to the patient as if they really were organic troubles. It is, therefore, useless to laugh at or pooh pooh the trouble, or suggest that the sufferer is only humbugging. Attention must be paid to diet, exercise, and to material, mental, and moral surroundings, so as in every way to relieve the patient from those apparent troubles that so annoy him. Great gentleness, firmness, hopefulness, and sympathy will often bring about an almost unconscious cure. If the trouble has been brought about by over-work and worry, complete rest will often be needed. If there is something in the surroundings that jars, a change may be advisable.

Indigestion.--(See also Digestion; Assimilation.) This subject leads naturally to a consideration of _food_ in relation to it. The trouble usually is that food easily enough digested by others causes distress to the patient. Here we at once see that _cooking_ plays a most important part. Potatoes, for example, when steeped for half-an-hour in hot water, which is changed before they are boiled, are much more easy of digestion. The water in which they have been steeped is found _green_ with unripe sap, which is all removed. Where _unripe_ juice is present in any root, this method of cookery is a good one. Eggs placed in boiling water, and allowed to remain so till the water is getting cool--say _half-an-hour_--are often found to be much more easily digested than as usually prepared. What we aim at in these illustrations is to show that digestion depends on the _relation of the food taken to the juices of the stomach which are to dissolve it_. It must be brought into a digestible state if weak stomachs are to deal with it.

Greasy, heavy dishes must always be avoided. Also unripe fruit. The diet should be spare, as very often indigestion proceeds simply from the stomach having had too much to do.

A very easily digested food is fine jelly of oatmeal made in the following way:--Take a good handful of the meal and put it in a basin with hot water, sufficient to make the mixture rather thin. Let it steep for half-an-hour. Strain out all the rough particles, and boil the milky substance till it is a jelly, with a very little salt. To an exceedingly weak patient you give only a dessertspoonful, and no more for half-an-hour. If the patient is not so weak you may give a tablespoonful, but nothing more for half-an-hour. In that time the very small amount of gastric juice which the stomach provides has done its work with the very small amount of food given. Really good blood, though only very little, has been formed. The step you have taken is a small one, but it is real. You proceed in this way throughout the whole day. The patient should not swallow it at once, but retain it in the mouth for a considerable time, so that it may mix with the saliva.

By this, or by porridge made from wheaten meal, you may secure good digestion when the gastric juice is scanty and poor; but we should not like to be restricted to that. We want a stomach that will not fight shy of any wholesome thing. We must treat it so that when suitable food is offered it may be comfortably digested.

Now, there is an exceedingly simple means for putting the glands in order when they are not so. About half-an-hour before taking any food, take half a teacupful of water as hot as you can sip it comfortably. This has a truly wonderful effect. Before food is taken, the mucous membrane is pale and nearly dry, on account of the contracted state of the arteries. In many cases the glands that secrete the gastric juice are feeble; in others they seem cramped, and far from ready to act when food is presented. The hot water has the same effect on them as it has everywhere else on the body--that of stimulating the circulation and bringing about natural action. It looks a very frail remedy; but when we can, as it were, see these glands opening and filling with arterial blood the instant they are bathed in this same water, and see how ready they become to supply gastric juice for digestion, the remedy does not look so insignificant.

We have, in scores of cases, seen its effects in the most delightful way. Persons who have to our knowledge been ill and miserable with their stomachs for years have become perfectly well from doing nothing but taking half a teacupful of hot water regularly before taking any food. It is true that great good is effected in cases of this kind by giving the weakened organ light work to do for a time. Wonders are done by feeding with wheaten-meal biscuits and water for some time, beginning with a very small allowance, and seeing that every mouthful is thoroughly chewed. Great things, too, are accomplished with such wheaten-meal porridge as we have already mentioned. But we feel disposed to regard the half-teacupful of hot water regularly before eating as the chief means of cure. It is wonderfully cheap: it goes hard with the druggist if his customers need nothing but a little hot water. Still, from what we have seen, and from what some of the very highest authorities have told us, we come more and more to look to this simple remedy as about all that is required inwardly to cure the worst cases of indigestion.

A little pepsin added to the hot water may be of use; also in cases of acidity a few drops of white vinegar mixed with the water will be found beneficial.

Soda, iron, lime, charcoal, even tar pills are used as remedies for indigestion; but none of them do much good, and some are highly injurious. If used at all, their use should be temporary, and under good medical advice.

If pain is felt, the stomach may be greatly soothed by soft fine lather (_see_ Lather and Soap). It acts in such cases like a charm. Spread it gently over the stomach, and wipe it off with a soft cloth. Cover again with fresh lather. Do this five or six times, and cover up the last coat with a soft cloth.

All indulgences which tend to weaken the stomach are to be avoided. Alcohol and tobacco must be given up. Over-excitement must be avoided, and abundance of fresh air breathed, if a cure is to be expected.

Where sudden and violent pain comes on after meals, a poultice or hot fomentation applied directly over the stomach is the best remedy at the time. _See_ Flatulence.

Infant Nursing.--A mother who has had strength to bear a child is, as a rule, quite strong enough to nurse it. Suckling is natural, and usually most beneficial to health. Many women have better health and appetite at such a time than at any other. Every mother ought, therefore, unless her health forbids it, to nurse her own child; no other food is so good for it as that which nature provides. We cannot too strongly condemn the mother who from indolence or love of pleasure shirks this sacred duty. By so doing she violates the laws of nature, which can never be done with impunity. Many troubles follow, and her constitution is seriously injured. Alas that we should ever have to say, with Jeremiah: "Even the sea monsters draw out the breast, they give suck to their young ones; the daughter of my people is become cruel, like the ostriches in the wilderness."

If a wet-nurse must be employed, great care should be exercised in choosing a healthy person with a child as near as possible to the age of the infant.

Let mothers remember that there is great _variety_ in milk. Not only does one mother's milk differ from another, but the same mother's milk varies from time to time. Variation in health and diet affects the milk very much. Many cases of infant trouble are traceable to the mother's milk, which should not be overlooked as a possible cause.

Again, an _abundance_ of milk is not always good. An infant may thrive better on a scanty supply of good milk than on an abundance of bad milk. Milk derived from drinking ale, porter, or alcoholic drinks of any kind, though abundant, is very far indeed from good, that produced by plain and simple diet is always best.

Again, the _state of the mother's mind_ has a great deal to do with the quality of her milk. A fright, or continued worry, may transform good milk into most injurious food for the child.

There need be no fear caused by these ideas: it is only in exceptional cases that nursing need be given up; the natural way is always the best. But where necessary there need be no hesitation in putting an infant on the bottle. The milk of a healthy cow, or condensed milk of first-rate brand, is much to be preferred to that of a wearied, worn-out, and worried mother.

Infants' Food.--For infants who cannot be nursed at the breast, cows' milk in the "bottle" is the best substitute. But all milk used from the cow should be sterilised and cooled before use. That is unless it is found on trial that the child thrives better on unsterilised milk. It is not necessary to have "one cow's milk;" but it is important to have the milk adapted in strength to the infant's need. If the milk be too rich, the infant will often break out into spots, or will vomit. A little more boiling water in the bottle mixture will remedy this, and often prevent serious trouble. The same proportion of water and milk will not always do. One dairy's milk, and even one cow's milk, differs from another; and so does the digestive power of infants. We have to find out that strength of milk to suit our own baby, and not be led astray by the advice of other mothers. In health the young infant does not require food oftener than every two hours, sometimes even every three. It may cry because of cold, wet, or discomfort, not from want of food. To overload the stomach with food is harmful and leads to serious disorders. Its food requires a certain time for digestion, even in an infant, and as the child grows, the intervals between meals ought to be increased.

A good mixture is two parts of cow's milk to one of water. To every pint of this add four teaspoonfuls of sugar, and a tablespoonful of cream. Barley water may be used instead of common water. The water should be boiling, and should be poured into the milk. The bottle should be thoroughly cleansed, and boiled in boiling water before re-filling. It must be remembered that the saliva does not possess the property of turning starch into sugar till the child is six months old; therefore starchy food, such as bread, arrowroot, etc., should on no account be given before that age. Preparations for weaning may then begin, by giving the child _small_ quantities of oatmeal jelly and milk, or even of porridge and milk, so that the weaning comes on gradually. The time of nursing should not exceed nine months. If, however, a child afterwards be ill, there is no harm in going back for a time to the bottle, even at two years old. Common sense must guide, and not hard-and-fast rule. Easily assimilated food must ever be chosen; and as a food for children, oatmeal porridge, well boiled, holds the first place--far before bread sops. If porridge be not easily digested, try oatmeal jelly. Most of the infant foods so largely advertised cannot be recommended.

* * * * *

It is now suspected that tuberculosis is transmitted to children mainly from the milk of cows affected with this disease. Cows are exceedingly liable to tuberculous disease of the udder. It is therefore very difficult to get milk guaranteed free from the tubercle bacillus, and recent examinations of that coming into Manchester and Liverpool showed that from 18 to 29 per cent. contained this deadly germ. (Strange to say, tubercular disease of the mother's breast is practically unknown, and children never derive the disease from their mother's milk.) It is therefore of the greatest importance that only the milk of cows proved free from this disease should be used. The disease is easily detected, and if a demand were created for milk guaranteed free from the germs, dairymen would soon supply it.

Unless it is _absolutely certain_ the cows supplying the milk are free from disease, the milk should be sterilised by heating to near boiling point, and then cooling _rapidly_. If kept twelve hours, the boiled taste goes off it, and children soon get to like it. Though sterilised milk will keep for some time without getting sour, it should be sterilised each day, specially if for infant use.

This treatment makes the milk keep without the use of preservatives, such as boric acid. We regret to say the use of these is not illegal, and they are largely used in preserving milk, butter, hams, etc. We have seen very serious illnesses produced in children (and adults too) by the heavy doses they have got when both the farmer and milk vendor have added these preservatives. This they often do at the season when the milk easily turns sour. Every care should therefore be taken to get milk guaranteed free from these noxious drugs; and if this is impossible, condensed milk should be used instead. As there is a great variety of brands of condensed milk in the market, always choose one which guarantees that the milk taken has been whole milk, and also unsweetened.

Infants' Sleep.--_See_ Children's Sleep.

Infection.--Few things have so great and distressing effect as the fear of infection in disease. As a rule this fear is not justified by the facts, where ordinary precautions are taken. These precautions, too, need not be costly, and involve in many cases little more than some careful work. Where scarlet fever has shown itself in any household, the very first thing is to see to the continuous freshening of the air in the sick-room and in all the house. Ventilation is, indeed, the first and most important method of disinfection. Chloride of lime and other disinfecting fluids will decompose the offensive and noxious odours, but pure air will sweep the organisms of disease themselves away. Fresh air kills the microbes of certain diseases, _e.g._, consumption, and is hostile to all disease. The stools of typhoid patients should be disinfected, and great care taken that no water or other fluid is contaminated by them through imperfect sanitation, etc. (_see_ Fever, Typhoid). Seeing that the seeds of disease are all around us, the best method of warding off their attacks is to keep the body in a state to resist their inroads by strict attention to diet, exercise and ventilation. Let all be done also, by fires if necessary, to thoroughly _dry_ the room and house. See that all the family breathe fresh air by night as well as by day; have open windows where and when possible.

Acetic acid is as powerful a disinfectant as carbolic acid, in proportion to its strength, and has the advantage of being harmless, unless in the glacial form.

In all cases of infectious disease these precautions are almost certain to prevent its spread, with, in addition, the special ones given under the head of the disease.

Inflammation, Deep-seated.--Often inflammation occurs in the centre of, or beneath, a mass of muscle, as the hip or thigh. We refer not to the formation of an ABSCESS (_see_), but to the violent, hot inflammatory action that often _issues_ in an abscess. For this the treatment should be strong moist heat applied to the back, where the _nerve roots_ of the inflamed part lie, and _persistent_ cooling of the part which is painful. The heat may be by bran poultice, fomentation, or hot-water bag and moist flannel. The cold must not be ice, but only cold water cloths frequently renewed.

It is curious to see how people are frightened at the only thing that gives relief, and not at all at that which does the most damage. A gentleman wrote us once that he had had eighteen blisters on, but was afraid to apply a cold cloth. We wrote him that if he still lived after eighteen fly blisters, he would surely not die under a cold cloth. They will say they have tried so many things. We reply, that if they had tried a million wrong things, and shrunk from the right one, they would be only so much the worse.

If there is local swelling, and signs that an abscess is forming, then treat as recommended for Abscess.

Inflammation of the Bowels.--_See_ Bowels.

Inflammation of the Brain.--_See_ Brain. _See also_ Knee; Limbs, Inflamed; Lungs, etc.

Inflammatory Outbreaks.--Sometimes a severe out-break and eruption will occur in and around the nostrils or lips, and spread over the face. (If of the nature of erysipelas, treat as under that head.) In ordinary cases, there is need for more than local treatment, as it is probable that more or less failure in the skin exists. Also the feet will be most probably cold and damp. Let these be bathed (_see_ Bathing Feet), and dried. Then rub them with CAYENNE LOTION (_see_) for some ten minutes, until in a glow of heat. Dry well, rub on hot olive oil, and dry again. Do this twice a day for a week. Warm and dry stockings must be worn. The skin of the back will probably be found dry and rough. Wash it down daily with SOAP (_see_) and hot water, and rub with warm olive oil. After a week of this treatment, probably the eruption will be much lessened. If it is still troublesome, apply cool cloths to the whole head, avoiding the sore parts, until it is generally cooled down and the skin softened, or the head may be, instead of this, packed in lather of the soap already mentioned. (_See_ Head, Soaping). For the sore itself, apply weak vinegar or _very weak_ ACETIC ACID (_see_), and a little olive oil after. But it is best if it can be healed in such cases without any local application, through the general treatment of feet and skin.

Internal Relaxation.--Pain is often felt in parts of the back or sides which will yield to no medicine such as usually relieves. This most probably arises from relaxation and swelling of some internal part of the body, so that there is more or less constant pressure on some nerves. It will be worse after fatigue or long standing, or any mental worry and excitement. This shows us that one thing necessary to cure is _rest_: entire rest if possible, if not, as much as can be taken. It is well to find out the _easiest_ posture in which to lie, and spend as much time as possible in that posture. Seek, also, by applying cold cloths to the painful parts, to reduce the swollen tissue. There may also be required fomenting of the feet and legs (_see_ Angina Pectoris) to prevent chill during this cooling. Often pain in the urinary organs is due to nothing but this relaxation, and yields to such treatment. Rest, however, is a primary necessity in all such cases.

Itch.--_See_ Rash.

Jaundice.--This disease, or its approach, may be known by several signs: a more or less yellow colour of the skin where otherwise white; a yellowness of the whites of the eyes, and failure of the bowels to act sufficiently, with lack of appetite. It may come on gradually, or may be induced suddenly by some disgusting mouthful or sight which affects the nervous system, and through this the liver and stomach. Where a disgust, or, as the Scotch call it, a "scunner," is taken at any food, especially with children, they should never be forced to eat it. Jaundice may follow if they are so forced. Those having the care of children should always remember this.

The cure is found first in nursing the sympathetic nerves, by a fomentation for an hour of the whole length of the middle of the back, oiling before and after with olive oil. Four hours later treat the stomach and bowels in the same way. In another four hours foment the feet and legs similarly. All this time give a tablespoonful of hot water every ten minutes. Then rest for twelve hours, and repeat the cycle of treatment. During the twelve hours' rest, the hot water may be taken in sips, as desired by the patient. If there is pain in the region of the liver, foment that region more strongly. If severe, place a bran poultice on above the liver, and keep it on all day, or even for twenty-four hours if the patient is comfortable in it. By the second day there should be a marked improvement.

Kidney Complaints.--_See_ Urinary Troubles.

Knee, Swelling of, or Pain in.--For ordinary slight injuries, complete rest, and rubbing with spirit lotion, should be sufficient. But where there is previous weakness, or constitutional tendency, even slight pain and stiffness, caused by wet or some blow or wrench, the joint must be treated thoroughly. Careless and wrong treatment may be given, and result in severe lameness. We wish, however, to point out that the treatment here recommended has cured many cases where this lameness appeared hopeless, and even restored walking power in limbs which had been ordered to be amputated by surgeons.

In the early stages of the trouble, it should be easy to cure in five or six days. First apply the SOAPY BLANKET (_see_) at bedtime. Then, about eleven o'clock in the fore-noon, place the leg so that the knee is over a small tub or bath full of very hot water, as hot as can be borne without pain. Pour this over the knee with a sponge or large soft cloth for an hour, adding hot water as it cools. If the patient becomes sick or faint, discontinue the bathing for a time. Dry the limb, rub with olive oil, and dry again gently. At five in the afternoon repeat the treatment of the knee. At bedtime sponge all over with hot vinegar, rub with hot olive oil, and put to bed. If the joint has been stiffened, gentle efforts to move it may be made during the treatment.

Sometimes during this treatment boils will break out over the knee and discharge a good deal, but as soon as their work in removing disease is done, these will heal up. Generally, however, this will not occur. The diet may be such as we recommend in cases of ABSCESS (_see_).

In bad cases, the treatment may be continued for weeks before much favourable change is noted. Patience and perseverance, however, will win the day. The soapy blanket should not be given oftener than three times a week, and a rest from all treatment on the Sabbath is best. _See also_ Housemaid's Knee.

Often in cases of knee pain and trouble, when local applications have little power, a BRAN POULTICE (_see_) on the lower back will effect a speedy cure. Sensible people will, of course, study and apply fresh treatment in such cases. Where the knee, for instance, is in the _hot_ stage of inflammation, hot applications will be injurious. In such a case, cold cloths on the knee, with bran poultice on the lower back, will be the proper treatment. Try heat first, and if it is hurtful, vary the treatment to cold and heat, continued as above.

Here, again, is a knee which gives its owner excruciating pain, and shows only a little swelling and no sign of diseased matter whatever. The hot fomentation and cold towels have both been tried, but there are now and again symptoms that show us that the root of the evil has not been reached. We try cold cloths on this knee, but they greatly increase the pain. We at length suspect that it is not the knee that is seriously diseased, but the root of one or more of the nerves that supply the link from the lower part of the spine. By this time the pain has returned into the knee dreadfully, and everything has failed. But very soon after a large, thick towel, folded and wrung out of cold water, having plenty of mustard spread on it, is placed across the haunches, relief is given in the most charming fashion. The cold cloth absorbs superfluous heat, and superfluous vital action to a certain extent, but the mustard draws it out so much more speedily and powerfully that the deep-seated roots of the nerves are reached and cooled down to their normal action. The pain ceases, and the poor sufferer blesses the mustard. We are just describing what actually occurs.

Sometimes a prejudice arises against heat. If, for example, an inflamed knee has been strongly heated during the hot stage of the trouble, the pains and injury will have been greatly increased. But one way or other that hot stage of the trouble has been got over, and now without heat it is impossible to cure. The patient, however, and probably the nurse waiting upon him, are decided against all hot appliances. These do so much mischief that it is believed to be out of the question to try them again. It may be that the prejudice is so strong that you simply can do nothing; it may not be quite so invincible as that. If you are able to point out that it was only because the heat was applied at a wrong time, or in far too great strength, and that now, since the inflammatory power is spent, heat will be sure to have a good effect, if it is only carefully applied, the prejudice may be removed. We have seen a patient in this stage, and with both knees bad, wrapped in a large hot blanket fomentation from the ankles to above the knees; and he was constrained to exclaim, "That's the right thing, beyond all doubt." Then there is no more prejudice.

Sufferers should not be disappointed if for a week or two they are not sensibly better. In some cases the effect is apparent in four or five days, but generally a fortnight or three weeks pass without much encouragement. We see great despondency sometimes just before all pain disappears. Still, as a rule, the new health is seen in the cheek and eye very soon. Where a _violent_ inflammation is obviously proceeding in the knee, the TURNIP POULTICE (_see_) is the best remedy. If there be great heat in all the body, there will be little or no need for heating any part; judgment must be used for each individual case in these matters. While resting as much as possible, the patient will find it best to lie on the back, with the sore knee supported a little higher than the body. A gently applied bandaging of the whole limb is also very beneficial, and may be used for all weak limbs, even when the patient is walking about.

In the treatment of stiffened knees, even where accidental bending of the joint gives very great pain, it is a grave mistake to put the knee in splints to prevent bending. What is wanted is to encourage bending as far as that can be done without much pain, so that the joint may not permanently stiffen. Even where, by the use of splints, permanent stiffness seems to have been brought on, the warm-water treatment recommended above will bring about a loosening and softening of the joint, which will permit first of a slight bending, and then, with gentle encouragement, a complete flexibility. The _complete_ restoration of the limb should be the object kept in view. No case of a stiffened joint, although it may be free from pain and disease, can be regarded as satisfactory, and hence treatment should be persevered in until all stiffness is gone. Common sense will direct as to hot and cold applications, when to apply each, and how long to continue either; the patient's comfortable feeling being the very best guide. We are glad to know of very many apparently hopeless limbs saved by our treatment, even where it has been imperfectly carried out.

Lacing, Tight.--This produces such serious deformity, and in many ways so interferes with the health of women, that we are constrained to write upon the subject. We find in cases which come before us that lacing, both of the feet and the waist, as practised by our women, has caused disease, and prevents our curing it. To begin with the lacing of boots. There is a certain form and size of foot which are supposed to be graceful. To obtain this, boots unsuitable in shape, and far too small in size, are used, and tightly laced down upon the foot and ankle, preventing circulation of the blood in these important parts. This causes corns and misshapen toes and nails; but its bad effects are also felt throughout all the body. We have pointed out in other articles the great curative power of bathing or fomenting the feet. The tight lacing of boots produces exactly the opposite effect. It is as powerful to injure as the other to cure. Cold feet are the cause of many most serious troubles. To keep tight-booted feet warm is almost impossible. True neatness abhors all such mistaken treatment of the feet. Moreover, no supposed good shape, in body or feet, can ever produce the impression of beauty which good health never fails to give, so that the tightly-booted high-heeled girl or woman defeats her own object.

A yet more serious evil is the wearing of corsets. From this comes very much of the ill-health from which women suffer. The stomach, liver, and other organs are forced downward, their proper blood supply is cut off, and indigestion, constipation, headache and backache are the inevitable consequence. The pressure of these organs causes falling of the womb and the terrible troubles which employ two-thirds of the fashionable surgeons. These have not failed to denounce the folly which brings so many patients to them.

Dr. Herbert Snow, the great authority on cancer, and physician to the London Cancer Hospital, attributes almost wholly to the use of corsets the fact that for one man who dies of cancer two women die of it. The compression of the womb makes it specially liable to be attacked, while the rubbing of the hard edge of the corset on the breast sets up cancer there.

Besides its evil effects on the abdominal organs, the lungs also suffer, the ribs are prevented from expanding and so the wearer can never breathe as deeply as is necessary. The muscles of the abdomen and trunk are greatly weakened; indeed to this is due the fact that a woman who is accustomed to corsets has great difficulty in giving them up. She feels as if she would "come to pieces" if not supported by them.

The exercises given in the appendix will help to restore tone to these muscles, and with perseverance in these, vigor and health will return, and the deformities such as flat or hollow chest, drooping shoulders, and protuberant abdomen, caused by muscular weakness, will disappear.

As we have said (_see_ Skin, Care of) clothing should be loose and porous in order that the skin may perform its functions. Corsets are both tight and impervious. The constriction of any part of the body by tight bands, and the hanging of the clothes from the hips, are highly injurious.

It is frequently urged that corsets are necessary if a woman is to have well-fitting clothes and a neat figure, but this is by no means the case. We illustrate a "good health waist" which has the advantage of allowing freedom of movement and respiration, producing no constriction of any part, and yet being well-fitting. Buttons are arranged, as shown in the illustration, to support the skirts so that their weight falls equally from the shoulders. This waist can be had from the Good Health Supply Department, 451 Holloway Road, London, N., who will send particulars on receipt of a post card.

Lancing Swellings.--See Abscess.

Lather, How to make.--One of the most powerful soothing influences which can be had, is found in the lather of M'Clinton's soap, so often recommended in these pages. Applied to the skin over a stomach which has been rejecting all food, and even retching on emptiness, for hours, it will almost at once stop the irritation. Applied to the head it is invaluable (_see_ Brain; Head; Hearing, etc.), and in many cases we have known it perform almost miracles of soothing effect. But the lather must be rightly made, and none but this soap used, if good results are to be got. Lather is first _Soap_, secondly _Water_, and thirdly _Air_, so wrought together to make a mass like whipped cream, or only a little more fluid. To get this, dip a _good_ shaving brush in hot water, rub it on the soap a little, take another slight dip of hot water, and work the brush in the hollow of the left hand patiently, until you have a handful of fine creamy foam, sufficiently solid not to run like water, and yet as soft in its consistency as cream. There is in the hand just the temperature, consistency, and shape that are required for working the lather, and no dish can properly replace it. The lather is to be gathered from the hand with the brush (a soft badger's-hair one preferred), and laid with it on the skin of the patient wherever necessary. Then another handful is quickly made, and so on until the required surface is covered. Or the lather may be transferred to a hot dish, placed over a bowl of boiling water, till enough is ready. After the application, a soft handkerchief may be laid loosely on, and, if the lather is to remain on as a pack, a dry covering put over this.

In many cases where it is inconvenient to apply the lather direct to the skin, it may be spread on a warm cloth of soft and clean linen or cotton, and this laid over the part to be treated before it is cold. This will also apply where the patient is too weak to sit or lie in the position required for lathering the skin. A dry cloth must be put on the top of the soapy one, and all fastened on by proper wrapping. In cases, however, where the skin has to be lathered in order to soothe the nervous system or to allay irritation of internal organs, it is well, if at all possible, to apply the lather direct to the skin, as described above.

Lather of this soap, made in this way, may be spread on the most sensitive sores (when ulcers have eaten through both outer and inner skins) with only a very slight feeling of smarting to the patient, and with the most healing effect. It is very different with soda soap made in the usual way. When the skin of the head has got inflamed (as we saw in the case of a child the other day, where the back of the head was a matted mass of most distressing sores), it is charming to see the effect of this lather. We took a number of handfuls of it, and soaked the matted hair and inflamed skin till the poor child looked up with an expression of astonished relief.

Legs, Pricking Pains in.--Sometimes curious pricking pains are felt in the legs, becoming so severe as even to confine a patient to bed. Nothing can be seen on the skin, and no swelling or other visible sign of trouble is present. Evidently this requires treatment more particularly of the nerves, which go to maintain a proper balanced state of feeling in the skin where the pricking is felt. The patient must give up using alcohol in any form, and should rest in bed. In treatment we do not look to the skin itself, but rather to the nerves, to effect a cure. There is a failure at the nerve roots, and indeed the patient will usually be weak and nervous generally. A popular remedy in such a case might be arsenic, which must be avoided, as likely greatly to injure instead of help. The cure is in increased nutrition of the nerve substances, by rest and light dietary. _See_ Biscuits and Water, Diet.

Limb, Saving a.--The proper growth of the body in any part depends on the power furnished by the nervous system and the cells of that part. This power enables these cells to use the nutritive substance in the blood for the formation of new tissue. By this process, growth in the healthy body is continuous through life, replacing equally continuous waste. But this all depends on a due balance of power in the process. Suppose one eats more than can be changed into healthy tissue, the food may all go into blood, but the nervous power of the cells is insufficient to deal with it. Sluggish living in bad air, tobacco, or alcoholic drinks, will all cause this. Then some slight wound or bruise is received, and the overloaded blood fails to act healthfully and heal this. A sore is formed, most likely somewhere in the foot or leg, and the limb goes from bad to worse in spite of all efforts, while this _inequality_ between the blood and the tissues continues. This goes on perhaps for years, and no effort is made to remedy it. Such a case may often be very easily cured, even where doctors pronounce it hopeless, if the patient will submit to proper regimen and treatment. Let the limb be thoroughly bathed, as far above the knee as possible, with water as hot as can be borne (_see_ Bathing Feet). Pour into the water about half-a-pint of strong vinegar. Keep up the heat for an hour. Repeat three times each day--at 11 a.m., 4 p.m., and at bedtime. Rest from treatment on the Sabbath. When perspiration follows this bath, dry the patient all over, and rub with vinegar. Dry this off and rub with olive oil. Dry again, and put on clothes.

When we have to foment a foot or knee in long heatings or bathings, we find it well sometimes to cool the lower part of the spinal nerves, and remove all irritation of them.

Then for _diet_, let the patient go on good wholesome wheaten biscuits (_see_ Biscuits and Water) three times a day as food, and pure water, with no alcohol of any kind, to drink. And let him give up the use of tobacco entirely. Many times over, when limbs have been condemned by the medical men, we have seen them saved in this way. We have seen the same treatment save arms and fingers, reducing them from swollen and unsightly sores to perfect shape and complete usefulness.

Limbs, Disjointed, or Sprained.--In the case of an overstretch, or sprain, which has resulted in a hardened, swollen, and painful state of the muscles of the arm, bathe the arm in hot water, using plenty of SOAP (_see_). While the arm lies in this bath, gently squeeze it with both hands, so as to make the muscles work gently over one another, and the blood run out and in to the stiff parts. Care must be taken to avoid hurting the patient. No such effort is needed as to require great strength--only so much squeezing as urges the blood out of the part squeezed, and lets it in again when the pressure is taken off. Persevere in this for half-an-hour, dry, and rub with warm olive oil. Do this twice daily until the arm is restored.

In the case of a broken or disjointed arm, FOMENTATION (_see_) should be vigorously applied until proper surgical aid can be had to set the bones. Even where a joint has been a long time out, such fomentation persevered in will soften the part, and permit of proper setting of the bones. Cold is unfavourable--cold water a decided mistake in such a case.

Of course a surgeon should be employed; but if no medical aid can be obtained, a person who understands anatomy may replace a disjointed limb by fomenting and oiling the muscles thoroughly, and then watching for a time when they are relaxed, and when the patient's attention is not fixed on the joint. This is the moment to slip the bone into its place. If medical aid can be obtained, it is always safe, while waiting for the doctor, to foment the broken or disjointed limb. Also a wet compress worn over the disjointed limb will, with the fomentation, make it much easier for him, when he comes, properly to set the bones.

When two bones in any part of the body are disjointed, the cords and muscles which tend to keep them firm in their ordinary position usually draw the ends past each other so that they overlap. To get the joint right, the bones must be drawn until the ends can pass each other, and then they must be brought into their proper position. Compare the disjointed bones with those same bones in a right position in some one's body, and thus you will see how they may be drawn right. There is a way of manipulating the muscles and tendons that in most cases renders it unnecessary to use much force, therefore the inexperienced should never draw forcibly. Sometimes a joint will repeatedly fail in this way. In such a case it may be supported; but means must be used by hot fomentations to strengthen the joint, and general rubbing, especially on the spine, must be used to increase vital force.