18--Rocky Mt. Fever
I. TYPHOID FEVER
Definition.--According to modern medical science, the cause of typhoid fever is a germ known by the name of bacillus typhosus. The disease is characterized anatomically by hyperplasia and ulceration of the intestinal lymph follicles, swelling of the mesenteric glands and spleen, and parenchymatous changes in other organs. There are cases in which the local changes are slight or absent; in some others there is ulceration. In severe cases there is a secondary disease set up in the lungs, spleen, kidneys, or cerebro-spinal centers. The disease is marked by fever, and on about the seventh or eighth day red spots appear on the abdomen. Sometimes there is diarrhea, and then again constipation; always abdominal tenderness where the disease is fully developed. Tympanitis is very distressing, and in some cases there is overstimulation of the heart from pressure. Osler declares that these symptoms are extremely inconstant, and even the fever varies in its character.
The above is as good a definition as can be given of the opinions of the leading authorities. For the benefit of my readers, I shall give my opinion of this disease, and as the treatment proves my opinion right, that should be proof enough.
Etiology.--Typhoid fever is the result of imprudent eating, bringing on decomposition in the stomach and bowels. Any case of typhoid fever treated properly will not last beyond eight to fourteen days. After the third day there will be no special pain or discomfort, and the patient will rest all night, so that, when asked how he is at the morning call, he will say he is "feeling fine" and rested well. In cases where complications appear, they are produced by improper treatment, and no doubt, on account of the decomposition in the bowels taking place in cases that are treated improperly, there will be developed germs galore; but they are an after-consideration and have nothing at all to do with the beginning of the disease.
Typhoid fever prevails in temperate climates and constitutes the most common form of continued fever. Indeed, all continued fevers, if badly treated and nursed, will develop typhoid complications to such an extent that they cannot be distinguished from the regular type.
The disease is pretty generally distributed throughout the World, and of course presents the same characteristics. Why not? The treatment is very much the same in every country, the initiative symptoms are very much the same, and the cause must be the same. In an experience running over many years I can say that I have not seen a case of septic development except in cases that have been badly managed, and there are certainly no germs of typhoid fever until after sepsis has developed.
According to Osler, the United States has a disgraceful amount of typhoid fever. From 1900 to 1904 the death-rate from this cause was 33.8 per one hundred thousand. It is estimated that from thirty-five to forty thousand persons die of it every year. It is more prevalent in country districts than in the cities. Why? Because cities are better drained; sanitary conditions generally are very much better in cities and towns than in the country.
In the Spanish-American War one-fifth of the soldiers in the National Encampment had typhoid fever. The disgrace was on the army physicians, who did not do their duty in looking after the sanitary conditions of the army. Today the armies are being taken care of in an enlightened manner, so far as sanitation is concerned. The credit for doing away with so-called typhoid fever is given to typhoid inoculation; but it would be very easy to knock the inoculation belief into discredit, if the sanitary condition of the armies would be allowed to retrograde to the state that existed during the Spanish-American War.
Sex.--Males and females are equally liable to have the disease.
Age.--Typhoid fever is a disease of youth and early adult life. Why? This is the age when indulgences are greatest. This is the age when overeating is more common than at any other age, and, as the disease starts from gastro-intestinal derangement, it is perfectly natural that young people should have it.
Immunity.--Not all who are exposed take the disease. In other words, not all who are imprudent in bringing on gastro-intestinal derangement will take down with the fever. Quite a good many who are imprudent will have a short sick spell, lasting for a few days, with vomiting, sometimes diarrhea, which clears out the stomach and bowels; and the disease goes no farther. Of course, such cases as this will be recognized as gastric fever. But a badly treated case of what is known as gastric fever to start with is often developed into a typical typhoid fever, Those interested in the germ theory are referred to the encyclopedia or some leading text-book on theory and practice. As regards the distribution of germs, those outside of the body, those found in milk, the mode of conveyance, infection in water, typhoid-carriers, infection in food, oysters, flies, etc., the history of these things may be gotten from any first-class text-book; but it does not appeal to me to incumber this work with a lot of history with which I am not in sympathy. I do not teach it, because I do not believe in it. I believe in cleanliness, but not in the germ delusion.
Morbid Anatomy.--In so-called typical cases there is a catarrhal condition existing throughout the small and large bowels. Specific changes, such as ulceration, are found chiefly in the region of the ilium. This is why this disease is often confounded with appendicitis. Peyer's glands in the jejunum have always been credited with taking on ulceration in typhoid fever, and it is considered diagnostic. These glands, however, will never be involved in any case that is not fed and medicated.
Necrosis and Sloughing.--When the hyperplasia has taken on ulceration, necrosis or death of the tissues often takes place from a shutting-off of the circulation. This favors sloughing, and even fatal hemorrhage takes place. But, as stated before, no case will ever develop these symptoms unless it is fed and medicated.
Symptoms.--There is a period, described by the leading authorities on the subject as lasting from eight to fourteen days, known as the stage of incubation. This means that the disease which is to follow the first two weeks is being hatched. In the first fourteen days, if the case has been properly treated, the patient will probably take his first walk in the open air and sunshine at the end of this so-called incubation stage. This opinion, being based on years of private practice, would naturally put me completely out of sympathy, and wholly unfit me for devoting twenty to thirty pages to describing conditions that never can occur except when the disease has been subjected to malpractice.
There surely could be nothing so unreasonable or absurd as for me to give the amount of space occupied by such a work as Osler's in giving the details of a type of disease that cannot have an existence unless a physician is educated into a plan of treatment that brings out these symptoms.
All the symptoms anyone will ever see, in treating a case of typhoid fever according to my plan, will be a feeling of discomfort, perhaps dizziness, slight headache, and a feeling of heaviness and dullness, with the patient rather inclined to be stupid. The first day or two, when these symptoms present, there will be no temperature. If there is, it will seldom be above 99-1/2° to 100° F. The tongue will look a little red around the edges. If the case is to be of a nervous type, the tongue will be long and pointed. Most cases will have the usual appetite, and feel rather impatient when told that they should not eat anything. If the food is withdrawn at once, the slight discomfort may continue for seven days--usually only three days. If the patient is sick enough to go to bed, there will usually be backache, aching in the loins, and the legs probably will ache. Some cases of a nervous type will have considerable headache, and the first night or two will be spent in tossing about. The sleep will be very fitful. At the end of the first week the temperature may come up to 101° F.; and from that time on there will be decline. In all cases there will be a sluggish state of the bowels. Just a few will start with a little vomiting and diarrhea. If the case is treated properly, the symptoms enumerated will be all that will ever develop. About the seventh or eighth day there will be rose-colored spots on the abdomen, characteristic of the disease.
There may be some readers who would like to know what the symptoms will be the first week, if the case is not treated according to my plan. The thermometer will show an increase in temperature; the pulse will run higher; the patient will become more nervous; the tongue will become more coated; the breath will develop a foulness that it has not had before, and the patient will complain of more aching in the back, limbs, and head, with perhaps nose-bleed. It is just possible that the case may have enough gastro-intestinal derangement to start off with symptoms as severe as those just named. The treatment, however, should be identically the same, and if a patient has an increase in symptoms at the seventh day, it will be almost positive proof that the instructions have not been followed, and that the patient has been fed without the physician's knowledge. If this could be proved not to be true, it would be necessary to look for complications. The urine should be examined to see if there is an inflammation of the kidneys developing. The bowels should be thoroughly examined. There may not have been a thorough cleaning-out, in spite of the enemas; hence the enemas should be given every three hours until the temperature goes down and the symptoms decline in such a manner as to convince the nurse or physician that the cause of the complication has been removed.
If no trouble can be found with the bowels, there should be an examination of the bladder to see if, from some cause, there be a retention of urine. All these suppositions are far-fetched, because, if the disease is to be typhoid, and the case has been started right in its incipiency, and treated correctly, it is almost, if not quite, impossible to have a complication of any kind spring up. Where there is an unusual symptom, the disease is not typhoid. Complications never occur except where there is septicemia; and septicemia cannot develop unless there is decomposition taking place in the alimentary canal; and decomposition and sepsis cannot develop in the canal unless the patient is fed.
Treatment.--Osler says: "The profession was long in learning that typhoid is not a disease to be treated mainly with drugs. Careful nursing and a regulated diet are the essentials in the majority of cases." I presume that is in a nutshell what all the leading teachers of the world will say regarding typhoid fever. Then, after making that statement, they will go ahead and tell about how to get the room ready; what kind of a bed the patient should lie on--just the kind of mattress and springs, how the bed should be made up, and the necessity of placing rubbercloth under the sheet, etc.; and then about the necessity of selecting a first-class nurse. Why all this preparation? Because feeding and nursing, along with what little medicine it is considered proper to give, prolong this disease twice to three times the duration it will have on the drugless and foodless treatment; and, when this is true, it is necessary to make extra preparation for the comfort of the patient.
The very best clinicians, including Dr. Osler, recommend milk, eggs, buttermilk, boiled milk, koumiss, peptonized milk, meat-juices, strained vegetable soup, barley water, iced tea, ice cream, etc.
The food taken into the stomach at such a time decomposes, the rotting processes that take place in the bowels cause septic poisoning, and every complication that is named in the best works on the practice of medicine is produced by this septic condition. If patients are allowed no food at all, no sepsis will occur; hence there can be no complications; in fact, the prospective typhoid fever is jugulated and in reality never develops. All diseases threatening to take on a typhoid condition, even typhoid fever itself, will thus be expunged from the nomenclature; for they will never have an existence, if treated properly.
This no doubt sounds exceedingly radical even to liberal-minded physicians.
A person who is just developing the fever, and who has no well-defined symptoms (indeed, the patient can hardly describe his feelings--he simply knows that he is not feeling well), should be told that he is threatened with typhoid fever, but that, if he will follow instructions, it need not develop. He should go to bed, and stop eating. There is no objection to drinking all the water desired. Every night he should have an enema of two quarts of water and a tablespoonful of salt. If in two or three days there is a feeling of discomfort in the abdomen, a towel wet in cold water should be placed on the abdomen, and a dry towel pinned around the body in such a manner as to keep the wet towel in place. The wetting may be renewed about three times in twenty-four hours. The feet should be looked after; if there is a tendency for them to be cold, or cool, something warm should be put in the foot of the bed--a hot jug or a hot-water bottle. The feet must not be neglected. If they are, it will cause the patient to be sick much longer than necessary.
Company should not be permitted. If the patient is not suffering, has no discomfort of any kind, there is no objection to the nurse reading to him for a half-hour in the forenoon and a half-hour in the afternoon; but he must not be worried or tired out by company, nor must he tire himself out attempting to read papers or books. Often these patients are so comfortable that they will insist on being allowed to entertain themselves by reading; but this uses up nerve-energy, and the reflex irritation from reading will make them unnecessarily nervous, and tends to prolong the disease.
At bedtime, after using the enema, the patient is to be sponged with tepid water. The sponging should be carried over the entire body quickly, and then followed with dry-towel rubbing, not too harsh; and, last of all, the spine should be gently rubbed for fifteen to twenty minutes. This rubbing, when done properly, will prove to be quieting. It will cause the patient to drop off to sleep, and he will probably rest comfortably until morning. The following is a description of the rubbing: Lay the hand flat on the patient's spine, and then begin a rotary movement, describing a circle. Each time the hand passes over the spine, the heel, or the part at the root of the thumb, may be pressed gently on the spinal column, and each circle made with the hand should be about two inches lower than the previous; in this way the hand travels slowly down to the end of the spine. Then it should be slipped back again, begin at the neck, and the movement repeated. Continue to repeat in this manner for ten to twenty minutes. If the patient appears comfortable and inclined to rest, continue the rubbing for the maximum time--twenty minutes. If at any time through the night the patient should get nervous, this rubbing may be given for five minutes, or even ten, if it appears to bring the quiet for which it is given. I do not encourage night nursing. I have found that this rubbing quiets the nervous system, and certainly takes the place of remedies that are generally used for securing rest. Where the patient is extremely nervous, the rubbing can be over the entire body first, then on the abdomen, and lastly on the spine.
As a rule, most of the discomfort will pass away at the end of the third or fourth day. From that time on there will be no special discomfort, except being tired of the bed--and the rubbing will relieve this. After the nervousness has passed off, and the discomfort is well under control, if the patient has a little craving for acid, a quarter of a lemon may be squeezed into a glass of hot water and taken about every three hours.
If the abdomen is closely watched, the rose-colored spots will be seen to appear in the neighborhood of the seventh or eighth day, even in those cases where the temperature never runs higher than 101° F., in the evening and 99-1/2° to 100° in the morning. The pulse in such cases will range from 80 to 100. After the fifth day the pulse may not go higher than 80. When the temperature and pulse come down to the normal--be that the seventh, eighth, or fourteenth day--the patient may be permitted a little fruit--at first just the fruit-juice, which should be fruit juice and water, half and half. There is no objection to a little fresh sweet cider, or the juice of orange, grapefruit, or any fruit desired that can be taken without sugar. Sugar will cause fermentation, and should not be permitted. After two days of fruit-juice, fresh fruit may be eaten. It must be thoroughly masticated.
If all goes well the next day, fruit may be taken for breakfast; salad at noon. If the afternoon is spent in comfort, a little meat may be taken for the evening meal--a lamb-chop with a dish of salad. If the patient is improving right along, by this time he will be going out, perhaps walking. In fact, patients lose so little strength, when treated in this way, that they recuperate rapidly. Within a week or ten days they are as strong as ever. Why not? There has been no septic poisoning that causes a long convalescence.
When called in consultation, or called to take charge of a case that has been subjected to malpractice, at the end of three or six weeks, the physician must at once stop all that is being done in the line of feeding, medicating, and a great deal of the officious nursing.
Nurses should be instructed about putting the lights out at nine o'clock, and they themselves must retire and stay away from the patient until six in the morning. Water can be left by the bedside for the patient to relieve thirst during the night.
II. RELAPSING FEVER
We have relapsing fevers in this country. We have patients who appear to be improving, and who then suffer a relapse, to be followed by another improvement and another relapse--all of it due to malpractice and officious nursing. If a case of this kind should be taken care of according to our plan, I should be very much surprised if it did not yield readily and fail to make its first relapse.
III. SMALLPOX (Variola)
An accute infectious disease characterized by pronounced skin eruptions. The eruptions have four stages: papule, vesicle, pustule, and crust. When the crust forms, it comes off, leaving a pit in the skin. In confluent types of the disease the scar is most pronounced, sometimes destroying otherwise good features.
Etiology.--Smallpox is considered one of the most virulent of contagious diseases, and it is generally believed that persons exposed are almost invariably attacked, unless protected by vaccination. This is one of the most stupendous exaggerations to be found in medical literature. My experience has been that very few people take it when exposed to it.
I remember quite a number of years ago being connected with a pest-house, where I was appointed physician and spent two hours a day with confluent smallpox for three months, without taking the disease. It is true I had a vaccination scar from childhood, but I have long since given up the opinion that that afforded me any protection. With me in that epidemic was a thirteen-year-old girl, who was caught and held there by the health authorities. She waited upon the sick people, and in all that time did not spend one hour outside of the house except in the small yard. She never had been vaccinated, and she failed to contract the disease. I could give many instances of personal experience where many were exposed without a single development. In this particular epidemic two German nurses took down, in spite of the fact that they had been vaccinated and re-re-vaccinated in the old country, where they do the work "just right."
Age.--The disease is common to all ages, and is very fatal to the extremely old and young. The unborn child may be attacked, but only when the mother develops the disease. It is said that in the case of twins only one may be attacked, thus showing that there is an immunity without vaccination.
Race.--It is said that the aboriginals suffered terribly from smallpox. Why? Because it is a disease of filth. The uncivilized people are just filthy enough to be good subjects for this disease. It is said that, when it was first introduced into America, the Mexicans died by the thousand. They yet suffer very greatly. Only a few years ago I was corresponding with a physician, located in Mexico, whose function was to take care of the miners for a large corporation. He gave me much information in regard to the severity of the disease among the natives. It is said the North American Indians have been decimated by this disease. The negroes are especially susceptible, and the mortality among them is great, being about forty-two per cent, against twenty-nine for whites.
Variation in the Virulence.--Sydenham states that smallpox has its peculiar kinds, taking one form during one series of years and another during another; which means that the severity of the epidemic probably varies with the atmospheric and local conditions. There is no question but that perfect sanitation has almost obliterated this disease, and sooner or later will dispose of it entirely. Of course, when that time comes, in all probability the credit will be given to vaccination; but if we could drop back to the aboriginal condition and do away with sanitation generally, smallpox would return with all its virulence.
Prevalence.--In the United States there has been a steady decrease.
When receiving orthodox treatment, pustules sometimes make their appearance on the tongue and throat and in the rectum. The disease has also been known to pass down the esophagus, and even down into the stomach. In decidedly severe cases of confluent smallpox it would be hard to say what part of the anatomy is not affected. There is no disease so dreadful as the worst types of smallpox. That mortality should be great in this disease is obvious; for the entire surface of the body is involved to such an extent that radiation of heat must be sadly interfered with.
Symptoms.--Smallpox is divided into three forms: discrete, confluent, and the hemorrhagic variety. The discrete form is where the pustules are isolated and do not run together. The confluent form is where the surface is a mass of pustules all run together. The hemorrhagic variety is called black smallpox, because the hemorrhage into the skin turns it black. When receiving proper treatment only the first form develops.
There is a modified smallpox known as varioloid. This is supposed to be modified by vaccination, but I have seen cases of pronounced types of discrete smallpox that had no modification by vaccination, and the patients were not prostrated nor confined to the bed to exceed twenty-four hours. They were around, reading, doing chores, while the pustules were forming and drying up. The semi-confluent and confluent smallpox is a disease to be dreaded; but the force of the disease is undoubtedly being controlled by sanitation. In fact, the disease is one of filth, not only on the outside of the body, but also on the inside of the body. When people learn to live correctly, and domestic and civic sanitation is what it should be, it will be impossible for this disease to get a foothold even in the lightest form.
When a physician is called to see a case of smallpox, the patient may be complaining of headache; certainly a decided backache and bone-ache--in the olden times it was called the "breakbone fever." A never-failing symptom is a feeling of shot under the skin. By passing the hand gently over the forehead, cheeks, or arms--or, in fact, any part of the body--long before the skin is reddening there will be shot-like projections felt just beneath the skin. There is nothing about the early symptoms of smallpox that is so positively diagnostic as those symptoms. Some of these very discrete cases will have one or two pox in the roof of the mouth. The first twenty-four hours there will be heavy aching in the back, and perhaps vomiting and headache. After that, unless it is a case of confluent smallpox, the patient will be comfortable for the remainder of the sickness--that is, if the case if properly nursed and treated.
Desiccation.--The pustules terminate by either breaking and drying up, or drying up without breaking, and forming a crust. This takes place about the third week. In confluent smallpox the crust adheres for a long time. The reason for it is that the inflammation dips deep and leaves a permanent scar.
Complications.--Complications may set up in any of the mucous membranes, the lungs, bowels, or eyes. Pericarditis is a serious complication. Bright's disease may follow. Inflammation of the reproductive organs of both male and female may result. It is not my intention to give anything but a very short sketch of this disease. Those who would like to know its history, complications, variations--in fact, give exhaustive study to the subject--I would recommend to read Osler's "Practice of Medicine." There will be no complications if the patient is treated properly. Complications are made by regular practice.
Treatment.--Patients should be separated as widely as possible. It is very dangerous to bring two cases of confluent smallpox together in what might be called a large room; indeed, a large drawing-room is small enough for one case. Huddling such cases together will cause great mortality. The disease should be treated in tents, and out in the open as much as possible. Some authorities recommend opium to relieve the pain in the back. I think this is the worst kind of malpractice. The hot bath will relieve the pain, put the skin in as comfortable a condition as possible, and certainly will be a safe remedy to relieve all suffering. The baths should be continued long enough to relieve the pain. The bowels should be washed out every night regularly, using two quarts of water.
The patient should be given all the water desired, but positively no food of any kind. By some authorities it is recommended to give barley water, oatmeal water, lemon juice, etc. Until the temperature has been reduced to the normal, the patient should be given plenty of cold water, and nothing else. In case of diarrhea, a small opiate, such as paregoric, has been recommended; but there will be no diarrhea unless the patient is fed. The patient should be kept as clean as possible around the eyes, nose, ears, and the outlets of the body. If the bathing is kept up often enough to give full relief from suffering, this, in addition to applying a little olive oil to the skin, will keep the surface more pliable, and prevent discomfort and stiffness of the skin. In convalescence a patient should be warned not to eat too heartily the first week, After that, if convalescence is fairly rapid, by the second week the patient may eat moderately of all the food given to a well person.
IV. CHICKEN-POX (Varicella)
Definltion.--This is a slightly contagious disease of children, characterized by an eruption of vesicles on the surface of the body. Children may get off with a dozen pox, and sometimes the disease is so severe that they have one hundred and fifty to two hundred on the entire body As a rule, it is a very insignificant disease. By that I mean that it is not of sufficient importance to worry about.
Etiology.--The disease occurs in epidemic, endemic, and sporadic forms; that is to say, it may spread all over the country, it may be confined to just one locality, and then again a case may occur in a community without any other cases developing. This is true of all so-called contagious diseases, showing that contagion requires a proper physical state of the one taking the disease before it will manifest itself. No one will take any of the so-called epidemic or contagious diseases who is not in a favorable condition to be stricken down.
Symptoms.--It is said that after exposure it requires from ten to fifteen days for the disease to develop. In some cases it starts with a slight chill. Most children are a little irritable and cross--just as they might be with indigestion; and, indeed, they have indigestion, or they would not take the disease. The question, therefore, is: Is it the indigestion that causes the disease, or causes the chicken-pox, or does the chicken-pox cause the indigestion? The epidemic influence exists for certain diseases, but it must find the constitutional derangement exactly fitted before chicken-pox, or any other specific disease, can manifest. All such diseases represent a peculiar chemical state of the fluids of the body. Then, when the proper domestic or civic influence is created, the combination ends in a certain type of disease. This is true of all so-called contagious diseases. This definition may be used for diphtheria, scarlet fever, smallpox, etc. Nothing will come of chicken-pox per se. Children who are abused very greatly and have deranged digestions, and who possibly are predisposed to tuberculosis, may break down from an attack of chicken-pox; but it is a mistake to recognize chicken-pox as the cause. It only marks the beginning of the breaking-down, because the constitutional derangement was in existence before the chicken-pox developed.
Treatment.--Children should be put to bed and the bowels washed out daily. No food at all, but all the hot water desired may be given. As soon as there is freedom from discomfort and no increase in temperature, feeding may begin with fruit juices and water, half and half, the first day; fruit two meals and salad one meal the next few days. Then return to regular eating.
V. SCARLET FEVER
Definion.--An infectious disease with a diffuse exanthem (scarlet rash) and sore throat.
Etiology.--None of the infectious diseases vary so greatly in intensity. This is probably due to the interference with radiation that takes place on account of the skin complications, The disease is more common in the fall than in the summer or spring. Like all other diseases, in some years it is mild and in others more malignant. It acts epidemically, endemically, and sporadically. I have seen the most intense cases isolated, when there was no possible chance to trace the contagion, and the disease ended with those cases. One case had gangrene of the throat, which ran rapidly to a fatal termination. In seventy-two hours the throat had melted away and the child died. The malignant type of scarlet fever and diphtheria has almost disappeared.
Ninety per cent of the cases occur in children under ten years of age. Children at the breast are rarely attacked. It is thought to be less liable to occur than measles, and it is held that there are more prostrations from measles than there are from scarlet fever. Years ago, when this disease was very much more common and fatal than it is today, it was not uncommon to have two or three children die in one family, while at the same time many children were exposed to the infection who did not take it. It is strictly a disease of filth--the same as all contagious and infectious diseases. Authors declare that an attack confers subsequent immunity. This is in line with a great deal of professional opinion in regard to infectious diseases. When the great majority of mankind do not take a disease at all, it would be strange if those who do take it would develop the disease two or three times. Thus it is simply a gratuitous statement for authors to say that one attack brings immunity. More than one, and sometimes three, attacks have been observed in all contagious diseases. There is no contagion in the sense now understood.
The disease does not seem to affect the people of India. The reason for this perhaps is that such diseases as cholera and bubonic plague kill off those who are susceptible to so-called contagion.
Concerning the cause or character of scarlet-fever infection nothing is known. In this disease there have yet been no germs discovered, hence no serums made for its cure--for its immunization; but the disease has kept steadily declining in mortality for the past twenty years, and is today as much under control (?) as is diphtheria--and that, too, without the profession knowing anything at all about the character of the infection. If antitoxin has caused the rapid decline in severity and mortality of diphtheria, what is the cause of a like decline in scarlet fever? This is a question that should be answered before too much boasting is indulged in regarding the immunizing of diphtheria, smallpox, and other diseases.
It is generally conceded that the poison in scarlet fever is given off from the skin by the shedding of the skin after the rash is gone. This desquamation is supposed to be carried by the air and distributed in communities, thereby causing the disease to spread. I do not agree with this idea at all; for I have known of children desquamating (shedding dead skin) while in school, going among children day after day, until the skin had thrown off all the dead cuticle; yet not a case of the disease developed in the entire school. During a so-called epidemic I found, when in active general practice, that there were about twenty cases of scarlatinal angina to one case of scarlet fever Those presenting a sore throat probably were not in the physical condition required for a full development of the disease. All cases have indigestion preceding the attack. After holidays, feasts, and social affairs, which break down resistance, those who have been brought to a stage of enervation by improper indulgence are the ones who develop these diseases. Children in full vigor, with perfect digestion and regular bowels, can pass through all the epidemics peculiar to children without taking any of them. Authors declare that no germ has been found, but that the streptococcus pyogenes has often been found in the blood during life and after death, These germs are to be found in the blood of all cases that die of septic poisoning. Children who die of scarlet fever, diphtheria, measles, or typhoid fever, die of septic poisoning; and the streptococcus would be found in all such cases, if an investigation were made after death. If these diseases had been treated properly there would not have been these complications.
Symptoms.--Incubation is said to be from two to seven days. The disease usually starts suddenly. It may be preceded by a stage of irritability, nervousness, and a slight chill. In severe cases the temperature runs very high within the first twenty-four hours. A very common type will begin suddenly--six, eight, or twelve hours after apparently full health. The child may eat a very hearty dinner at noon or in the evening, and the next day be prostrated with the disease.
Vomiting is almost invariably at the beginning of the disease. Vomiting in such cases means imprudent eating up to the time of the vomiting, and if children were not indulged in overeating, they probably would not have such diseases at all. Convulsions are not uncommon. The fever, in severe cases, always runs high--104°, 105°, and even 106° and 107° F. Cases that run from 106° to 107° are almost invariably fatal. The tongue is furred, and the breath is always pungent--just such a breath as one would expect in gastric fever. This, however, does not last very long; for when septic poisoning begins, the breath becomes fetid, There is always throat trouble, and sometimes this is very severe. The nasal passages will also take on inflammation. Indeed, I have noticed symptoms of throat and nose so very like diphtheria, and so often, that I have associated the two diseases together as being one and the same. In one type there is an exanthem, and in the other the skin complication is absent. The symptoms from the start of a severe attack indicate a very grave disease. The eruption begins within seventy-two hours. Some cases show an eruption in from thirty-six to forty-eight hours. It begins with little points of redness on the surface of the body--on the chest, inside the thighs, in the bend of the elbow, and around the neck. At first it is of a flushed appearance, more than an indication of a rash. Often the entire body is covered with an intense redness within forty-eight hours after the rash begins to appear, which is three days from the beginning of the disease. The rash remains from two to three days, and then begins to disappear.
The tongue has the appearance of a strawberry. It is called a "strawberry tongue." This condition of the tongue is sometimes present in gastric fevers. Indeed, so common are these symptoms in gastric fever and in scarlet fever that I have always recognized gastric, or a pronounced gastric, irritation as one of the symptoms of scarlet fever. Sometimes I have been persuaded to the idea that the disease originates in the stomach--starts as a profound gastric fever, superinduced by toxins generated from putrefaction. If differs from the ordinary gastric fever in the intense toxemia from putrefaction; the lighter forms of the disease brought on from simple fermentation without putrefaction.
When the toxic state grows more profound, the surface becomes darker; the rash loses its scarlet redness and becomes dull in appearance. The skin gets rough, and in some cases feels like goose flesh. The eruption sometimes appears in the roof of the mouth, and by some authors this is considered diagnostic; but in pronounced cases of scarlet fever no one need be in doubt about the disease. Sometimes the eruption does not come out on the face at all. At times itching becomes intense at the end of the first week. The throat trouble differs widely. In some cases it is very mild; in others it is the most serious symptom connected with the disease. Where the mucous membrane of the nose becomes involved, the inflammation may be carried to the eyes through the lachrymal ducts.
Dr. Osler, in his last work on the "Practice of Medicine," reports the temperature of mild cases at 103° F., and in severe cases hyperpyrexia of 108° to 109°. In one case that comes to my mind the temperature was 111°. Of course, the child was dying. This was the most intense fever that I have ever observed. While the temperature runs very high, the pulse seldom goes above 120--usually about 115 to 116. Sometimes it becomes more rapid when hyperpyrexia is established. In severe cases the shedding of the skin is very intense--even the hair and nails are shed. In some cases the shedding will not be finished until the sixth or seventh week. Children in this state should not be exposed to sudden changes of temperature. They should be carefully looked after; for it is this class of cases that leaves sequels, such as scarlatinal nephritis. In malignant forms of the disease the throat symptoms become very intense, and often spread to the ear through the eustachian tube, or through the nose down through the trachea. Death may take place in from three to five days. Some cases could not be distinguished from malignant diphtheria if it were not for the rash. There are many complications, such as nephritis and arthritis. Derangements of the heart, lungs, and bronchial tubes are other frequent complications. Adenitis and tuberculosis sometimes follow.
Mild Forms of the Disease.--Some cases are so mild that they will be passed unnoticed. The mother may notice a little rash, to which she pays no attention, the child not being sick enough to complain, more than to be a little cross and irritable. In due course of time there will be a little scaling, or shedding of the skin; and even this may pass without notice. In the course of a few weeks or months the child will begin to show symptoms that force the parents to call or consult a physician. If the urine is examined, it will be found albuminous. The disease was so slight in the first place that the child was not cared for properly. It was allowed to be more or less exposed to weather of all kinds. Kidney and ear complications not infrequently follow scarlet fever of so light a type that it escapes notice.
Prophylaxis.--Good health is the best immunization that can be given any child. Children can have good health if they are fed and cared for properly; but so long as haphazard reigns in all families of children--so long as no attention is paid to what children eat, except to give them all they want and anything they select--there will be socalled contagious diseases. For, whatever may be said of the infection, there must be a system prepared for the infection; and improper eating--improperly combined foods, overeating, and too frequent eating--to develop fermentation in the alimentary canal, creates a favorable culture-soil medium for the ever-present ferment of disease.
Treatment--The treatment of scarlet fever should not be different from that of fevers in general. The patient is to be made comfortable, If necessary, when the temperature is runnning high--104° to 106° F.--he should have a bath every three hours. Start with hot water, of a temperature of 100°. Then add cold water until the temperature is reduced to 90°. If in the course of ten minutes there is no indication of a decrease in temperature, reduce the water ten more degrees, and end the bath at about twenty minutes. No possible harm can come to a child by bathing in this way about every three hours until the high temperature has been brought down and confined at 103° and below. Authorities say that the disease cannot be cut short. I say it can. If I should feed broths and fruit, I should not expect to cut the disease short. There should not be any fruit juice fed until after the temperature has been reduced to 100°. Nothing but water should be given.
An enema should be given every night. Start with two quarts of water and a teaspoonful of baking-soda. Use as much in the bowels as can be used without giving the patient too much distress. The bowels should be washed out; for, while scarlet fever has the reputation of being an infectious disease, its establishment and continuance are wholly dependent upon putrefaction in the intestine and the absorption of toxins from this source.
When desquamation, or shedding of the skin, begins, it will be well to give the child a thorough oil rubbing every night, and then a warm bath in the morning. It will not be necessary to use soap. After the bath, a reasonable amount of light rubbing by the open hand is advisable. When children are nervous, the nurse should be instructed to give a gentle spinal rubbing, the same as described under the treatment of typhoid fever. If the hot bath is given as directed, food is avoided, and the bowels are kept cleared out by enemas, there will be very little danger of renal complications, or any other complications.
As for drugs, they are an abomination and can do nothing except to complicate the case and make the patient feel uncomfortable. In cases of hyperpyrexia (fevers from 107 degrees and up) the bathing should be managed very carefully. When possible, a physician should be with the patient during a few of the first baths, so as to educate the attendant or nurse in knowing how it is to be managed. As advised before, the bath should be started at a temperature of 100°. Allow the patient to be in the bath two or three minutes. Then reduce the temperature by allowing the cold water to run in at the head of the tub while the warm water runs out at the foot; or the hot water may be dipped in a little at a time, and thoroughly stirred around the patient, so as to keep the water at a uniform temperature. Reduce to 80°. Watch for five minutes. If there is no lowering of the patient's temperature, reduce that of the water to 70°. If the fever still stays high, do not hesitate to reduce to 60°. If that does not effect a lowering of the temperature, go to 50°, and then to 40°. The heart must be watched. If the temperature begins to subside, and the pulse goes down in frequency, take the patient out of the bath and put him to bed. Then, if the temperature goes up in three hours, give another just such bath as before; and keep doing this every three hours until the fever is thoroughly controlled.
This disease kills because of the high grade of fever more than because of anything else. By not feeding, and by keeping the bowels washed out, there can be no continuation of the absorption of the toxins or putrefaction in the bowels. When the temperature is normal, the pulse normal, and there is no discomfort, feeding may be started.
Fruit juices and water, half and half, the first day; then orange juice in the morning, salad at noon, and fresh fruit in the evening, for a day or so. If all goes well, have fruit in the morning, salad at noon, broth and salad in the evening.
Definition.--A highly contagious fever, marked by a breaking-out on the surface of the body--irritation of the air passages and skin.
Etiology.--Measles is the manner in which a child's body throws off toxemia. When children are cared for improperly, they become toxemic, and their skin eliminates toxin to a greater degree than does the skin of grown people. It is said that measles causes more deaths than any other of the acute fevers in childhood. In the large cities whooping-cough is a running-mate of measles in the matter of mortality. Statistics show that ninety-four per cent of the deaths from measles occur among children under five years of age. This disease, like scarlet fever, starts with a decided derangement of the gastro-intestinal canal, and where patients are fed to keep up their strength, it is made very much more intense than where they are given water, and left entirely without food or drugs until the disease has spent its force. As in the case of scarlet fever, the germ of measles is not known. But, of course, from my standpoint I am not looking for germs, and shall be surprised when one is discovered that really causes the disease. There will, however, be plenty of germs found in the intestine, and in those cases which are fed until the bowels are filled with decaying food the type of the disease will become septic.
Nursing children of a year or two of age will often be killed by frequent feeding. Mothers will nurse them until the rotting process set up in the intestine brings on a state of congestion of the lungs that ends fatally. These cases are given food when they really want nothing but water. If the child happens to be taking the breast, or using milk as the principal diet, the thirst will be mistaken for hunger, and the child will be forced through its thirst to take sufficient milk to start up enough decomposition to cause the disease to end fatally. This is the reason why measles is so fatal. Feeding in older children leads to the same results--the same fatal termination.
Symptoms.--It is supposed that the disease starts with a rash--an elevation or puffy condition of the skin, in from seven to eight, and in some cases fourteen, days after exposure. It often begins with headache, nausea, vomiting, and sometimes with a chill. Preceding this there will be a cough and sneezing, and the eyes will water. These symptoms will continue until the disease is well established. The eyes will be so irritated that often the room must be darkened to give the patient comfort. The cough is often accompanied by wheezing, which prevents rest, and in cases where children are fed and given cough medicine, the cough will continue until there is a decided congestion or engorgement of the lungs. The complications--such as nose-bleed, hemorrhage from the bowels, laryngitis, edema of the glottis, bronchitis, pneumonia, inflammation of the kidneys, inflammation of the sac around the heart--are all unnecessary under the proper treatment.
Treatment.--Keep the patient confined to bed, and have the room well ventilated, but avoid drafts over the patient. Fever seldom runs high in measles unless there is a septic condition developed from improper feeding. If the rash does not come out well, the patient should be given a warm bath and then covered up well until the rash appears. Care must be taken in not allowing the patient to cool off too quickly. The bowels should be washed out once or twice a day with an enema similar to the one recommended in scarlet fever. The patient should have all the water desired. Sometimes drinking cold water will hurry the rash to the surface. In cases where the temperature runs exceedingly high, the patient should be put in a hot bath, and kept there until thoroughly relieved; but high fever is not likely to occur unless patients have been fed and medicated. Medicines are given by physicians to relieve the distressing cough. It has been my experience that, if patients are not fed, there will be little cough after the rash comes out, and I would certainly not recommend drugs for relief.
Children should be prevented from getting out in the open air too soon. If they do, they are liable to catch cold and cause a complication that will last through life, on the order of a bronchial cough, or granulated eyelids, etc. Most of these complications, however, are due to patients being infected by decomposition in the bowels. When the fever is gone and the rash has subsided, the children may be fed the same as directed under scarlet fever.
VII. MUMPS (Parotitis)
Definition.--This disease is said to be infectious. It is characterized by a swelling of the salivary glands, especially the parotid gland situated in front of and below the ear. Sometimes it is confined to one side, and then again both sides may be involved.
Symptoms.--The period of incubation is said to be from two to three weeks. Rarely any symptoms show previous to the attack. It starts with a slight fever, and soreness at the angle of the jaw just below the ear. There are exceptions, however, where the temperature runs to 103° and 104° F. Such cases are accompanied by gastric or intestinal fermentation, and the patient becomes more or less infected from decomposition in the bowels. Sometimes the disease will start on one side, and then in a few days develop on the other side. There is seldom very much pain. A feeling of pain and discomfort will often follow the suggestion of acid. This is supposed to be a characteristic of this disease. Sometimes the ear becomes involved, considerable inflammation will be set up, and the hearing may be impaired afterwards. The swelling usually lasts from six to ten days. Sometimes, when patients do not take the proper care of themselves, they do not get rid of the swelling in fourteen days. While mumps is a mild disease, and no particular anxiety is felt when it becomes established in a family, there is danger of complications that may be far-reaching, such as orchitis. This disease is very painful when it starts up as a complication, and it is supposed to leave a patient sterile where both testes are affected; hence in male children it is well to see that they do not catch cold, and that they are kept from being exposed to bad air.
On rare occasions the disease is accompanied by a very high grade of fever and great prostration. Even typhoid symptoms may develop. I have never met with such cases in my practice, and I do not believe it is necessary for these complications to arise, for I think they are due to sensuality and imprudent feeding.
In girl patients there may be vaginitis, and the breasts may become enlarged and tender. Inflammation of the ovaries is said to be very rare.
. Treatment--The patient should be kept quiet and comfortably warm. Exposure should be prevented, and no medicine or food is to be given. If necessary, use an enema to wash out the bowels. In fact, if the patient from the beginning shows more or less gastro-intestinal derangement, this should be looked after by using an enema every day until cleared out. As soon as the swelling has subsided the patient may be fed as directed in scarlet fever.
VIII. WHOOPING COUGH
Definition.--Characterized by a convulsive cough of long-drawn inspirations, with a whooping sound.
Symptoms.--It is said that the incubation for this disease is from seven to ten days. It is described as catarrhal, and paroxysmal stages can be recognized. I do not recognize it as a catarrhal disease. It is strictly a nervous affection. The base of the trouble is cerebral and spinal. It starts with a dry, harassing cough, which seems to have no excuse for existence, as there is no irritation of the throat or lungs. This spasmodic cough lasts for two weeks. Then the characteristic whoop begins. Patients cough in paroxysms. The coughing is so hard that it often ends in vomiting--just a slight amount from the stomach, perhaps mucus, or food if there is any food in the stomach. After two weeks of whooping, the disease requires about two weeks more to decline and come to an end.
This disease is very harassing, but it can be made tolerable by giving the children the proper care. If it starts in children who already have deranged digestion, and they are then fed, not allowing them to miss a meal, complications are liable to occur, such as tremendous engorgement of the brain during the paroxysms. The blood-vessels will stand out like whip-cords on the forehead, and when the child is over the paroxysm it is completely exhausted. Unless such a case is fasted, the cough grows more severe; the stomach derangement increases, causing more and heavier coughing, until there is danger of bringing on a brain complication. Children who are in very good condition will, of course, become flushed in the face, the eyes will become suffused, and they will cough until they gag; but as soon as the paroxysm is over they appear to be as well as ever. The child, however, that sinks down exhausted, and becomes fretful and nervous, and seemingly afraid of an approaching paroxysm, is in danger. In such cases there is congestion of the brain. This condition of the brain is marked by red spots on the forehead and ecchymosis of the conjunctiva, which means red spots on the whites of the eyes, caused by rupture of a capillary blood-vessel. Bleeding from the nose and ears, and occasionally from the lungs, takes place. Sudden death has been known to occur from hemorrhage of the brain.
Treatment.--In a recent system of medicine there were nearly fifty drugs recommended for use in this disease. Whooping cough is considered very grave in the centers of population, but, as in the case of all other children's diseases, the mortality is due to the care and treatment. Dr. Osler, in his latest work on practice, declares that the treatment is notoriously unsatisfactory. He further says that, if he were asked the two most important things in the treatment of this disease, it would be six weeks and a good big bottle of paregoric. Some practitioners are foolish enough to give quinine, which, of course, produces more or less irritation of the nervous system. Certain remedies have been recommended to be used as a swab in the throat. Indeed, it would be just as rational to rub salve on the end of a dog's tail for a sore ear, as to swab the throat to control the coughing in whooping-cough; for whooping-cough is a disease of the nerve centers--brain and spinal cord--and the cough is strictly a reflex irritation.
The excessive coughing disturbs the stomach and causes vomiting; but to use remedies for the stomach and to swab the throat is the height of folly. The child's nervous system must be taken care of. Children with whooping cough must be sent to bed. The feet should be kept warm--not toasted too much, but they should be looked after and kept comfortable. The rest in bed will quiet down the nervous system. If this treatment is adopted on the onset of the disease, it is doubtful if the child will ever reach the stage of whooping.
No food should be given until full relaxation has been brought about. That ought to occur in two or three days. The bowels should be emptied by using the enemas. About the fourth day a little fruit juice and water, half and half, may be given in the morning; also at noon and at night. But if, after this eating, there is a tendency for the cough to grow worse, stop the feeding. By managing the child in this way, there will be no danger of any complications leading to death. The mortality in this disease, when the epidemic or endemic is of the mildest form, is about six percent. Death is unnecessary if children are sent to bed and fasted. When the symptoms have subsided and the case is convalescing, give fruit juices diluted for a day or so; then fruit morning and night, and a salad at noon.
Gentle rubbing to the spine several times a day, and especially at night, will quiet down the child so that it should sleep. In very restless cases, a hot bath two or three times a day, until the nervousness is controlled, will be found very efficient. A child nursed and cared for in this way will not need to be watched closely when the stage of convalescence is reached, for fear a fatal bronchial pneumonia will develop; for that disease is induced by wrong nursing and feeding.
IX. INFLUENZA (La Grippe)
Definition.--A pandemic disease, coming at irregular intervals, traveling very rapidly, and extending over a vast territory in a very short time. In intra-pandemic years there are epidemics and endemics as well as sporadic outbreaks. In fact, some parts of the country are experiencing this disease all the time.
Etiology.--The difference between influenza and the ordinary cold is the tendency of the former to continue long after the time for a hard cold to disappear. In influenza there is a constitutional disturbance. Some patients complain of being very weak, and in some cases the weakness continues to run on for weeks. The catarrh, which is always pronounced, hangs on continuously. One day the patient feels as though he were almost well, and the next day he knows that he is not well. He feels that he is going backward rather than forward.
At the time of an epidemic of influenza there are the usual number of colds or catarrhal fevers. My individual experience has led me to believe that the different forms of catarrhal fevers, colds, influenza, etc., are one and the same, only differing in degree, and that the difference in degree depends entirely upon the condition of the stomach and bowels. Those who are toxemic, who have much decomposition in the large intestine, with the accompanying toxin absorption, and who have bad eating habits and are negligent in the care of the body, will always develop the severest form. The very young and the very old are not inclined to get over the disease as rapidly as those in middle life. The sensualist is always a victim to a severe form. All those who are enervated have difficulty in throwing off the disease. Of course, this disease, the same as all other diseases, has epidemic years; which means that at such times the type of the disease is more severe than in endemic years.
Symptoms.--The incubation period of influenza is from one to four days--generally from three to four days. It usually begins with fever, and sometimes chill. In pronounced cases the mucous membrane is involved from the nose through the entire bronchial tubes; the lungs often become engorged. Pneumonia may develop soon after the attack. It is, however, brought on from improper treatment and nursing. Where the bronchial tubes and lungs are involved, delirium is often present, along with much prostration. According to some of the leading authorities, the disease may develop in a manner similar to that of typhoid fever. Pleurisy is also a disease that is liable to spring up during the life of influenza. There are nervous forms of this disease, characterized by headache, much pain in the joints, also marked prostration. There are quite a good many forms of influenza. One of these is the intestinal--a type that is marked by much fever, and the complications of which are given as pericarditis, endocarditis, septicemia, peritonitis, etc., all of which is brought on from imprudent eating on the part of the patient as advised by the physician.
Treatment.--As soon as the disease starts, the patient should stop eating, and take a hot bath, preceded by a copious enema of two quarts of water and a tablespoonful of salt. After the bowels have been moved, the bath should be taken, and continued until all pain and discomfort are gone. The bathing should be kept up daily, headache, and pain in the body, all the discomfort should be removed by a hot bath, even if the bath has to be taken every three hours. The water should be as warm as the patient can stand comfortably. After the patient has been in the bath for five minutes, the water should be heated to as high a temperature as he can stand. Just how long the bath should be continued depends upon how quickly the patient gets relief. When relaxation and comfort come, the bath should be stopped. If there is a tendency for cold feet and hands, hot applications should be kept to the feet. Positively no food or drugs are to be given in such cases. if this plan is carried out, there will be no complications, there will be no spasm, and the disease--even the very worst forms of it--will terminate in one week. Such symptoms as delirium, spasms, peritonitis, etc., can be developed only in those patients who are fed and medicated.
Definition.--An infectious disease of the lungs, which usually terminates by a crisis in seven or eight days.
Etiology.--Children are very liable to have pneumonia. The predisposition of children up to six years of age is to take the disease. Then there is a diminution of attacks in children up to fifteen. From this time on there is an increase. Anything that has a tendency to enervate renders the subject of a scrofulous diathesis liable to take this disease. Without question it is a disease that originates in the intestine. It is really a disease caused by toxins. An enervated state, followed by unusually heavy eating or a change in diet--eating in an unaccustomed way--may be the exciting cause. It is thought to come from a cold. Nearly all diseases start with a cold, for nearly all diseases are caused by toxin absorption from the bowels; and when we become better acquainted with the real cause of disease, we shall know that, at the base and foundation, all diseases are alike--that is, they begin with toxin poisoning. Just why in one person it locates in the lungs, in another in the membranes of the brain and spinal cord, and in another causes infantile paralysis, are questions for the laws of heredity and nutrition to solve--germs will not solve them. An injury may sometimes be given as the cause, but the real cause lies back in nutrition.
Climate and seasons do not appear to have a controlling influence, for the disease is found in every month in the year. Winter, however, is probably the season showing the largest proportion of pneumonia cases.
Conditions Favoring Infection.--According to Dr. Osler, the majority of people harbor the germs in the mouth, nose, and throat. This is said of all infectious diseases. But Osler also says that some individuals are less resistant. If we are resistant at one time and not resistant at another, what is the reason? If it is possible to be resistant at one time and not at another, is it not possible to put the health in such a condition that it will be resistant all the time? This, I believe, is true as regards man's relationship to all diseases. There is a serum which is used to immunize, but it is doubtful if it has been more successful than any other immunizing on this order. There are supposed to be forty different varieties of pneumonia. This is a delusion of the profession. If the stomach and bowels have no decomposition in them there will never be any pneumonia developed.
A really good state of health is the proper immunizer against this disease, the same as against all others.
Symptoms.--Pneumonia usually starts with symptoms of a cold, which may last two or three days. In other cases there are symptoms of a slight cold, with coughing and soreness in the chest. In the majority of cases the disease begins with a chill. Cough is annoying from the very start. The disease has the appearance of an acute fever, with pains and aching throughout the body. In a certain percentage of cases the pain in the chest is very severe. This is especially true where there is a pleuritic complication. If one lung is affected, the face is usually flushed on that side. Where both lungs are affected, both cheeks will carry a flush. The breathing is short and hurried, often running forty at the doctor's first call.
The expression of the eyes is that of anxiety, caused by precordial oppression. The expectoration is often tinged with blood during the first twenty-four hours. Then again it will be white and frothy, and the blood tinging does not appear for forty-eight to, sometimes, seventy-two hours. This would indicate that the seat of the trouble is low down in the lungs. Where it is located high, the expectoration becomes diagnostic earlier in the disease. The temperature varies from 102° to 106° F--usually from 101° to 102° in the morning and 104° in the evening. In severe types of the disease it will reach 106°, and even 107°. The distress from coughing and oppression in breathing is persistent until about the seventh day. This is called the crisis in the case. Then the temperature drops down, and the breathing becomes easier. From this point on the convalescence should run along rapidly. In those whose general condition is bad, and whose nursing and treatment have not been exactly what they should be, there may develop a typhoid condition at this stage. Where this is true, the temperature goes up rather than down, and all symptoms increase, typhoid symptoms develop, and death is liable to occur. This disease is very severe on old people; and it is pretty generally understood that drunkards, or those who have the drinking habit, never get over an attack.
The crisis comes on the seventh day--this is the average time. In slight cases the crisis often develops on the third day, and there are other cases that are prolonged to the tenth; but in those that reach the crisis on the third day it is just barely possible that there has been a pneumonic state existing in a light form for several days before sufficient attention was given to determine that it was pneumonia.
Cough.--The cough at first is dry and persistent, causing pain and discomfort. Patients will clamor for relief; but it is a very great mistake to give anything in the line of opiates to relieve. They should be encouraged to wait until the expectoration stage appears, which it will do on about the third or fourth day, provided they have been handled carefully with respect to nursing, etc. After the stage of expectoration is reached, the secretion lubricates and relieves the friction caused by the cough. From this time on the patient should be fairly comfortable. At first the expectoration is mucus. Then it becomes tinged with a little blood. Later on the blood tinge imparts a rusty appearance to the sputum, and it loses its stickiness or tenaciousness, which makes it difficult to raise.
Where there is liver derangement, the sputum may take on a yellowish appearance from bile. As the fever declines--which it generally does after the expectoration is fully established--the expectoration becomes lighter, until it entirely disappears.
There is an unusual type of pneumonia, affecting the apices of both lungs. I have never seen a case of this character get well. When the secretion or expectoration stage is reached, the amount of material thrown off is so great and so tenacious that the patient is unable to throw it out of the lungs, and he dies drowned in his own secretions.
Condition of Digestive Organs.--The tongue is usually furred. Where the contents of the intestinal canal are in a state of decomposition, and the absorption of the toxins is very pronounced, the tongue will be very greatly furred, the breath bad, and some cases will vomit profusely the first few days, The patient has no appetite. The bowels are more commonly constipated than otherwise.
Skin.--ln this condition herpes frequently occurs on different parts of the body. This in itself is often a source of a great deal of discomfort. The cutaneous derangement affects the lips more than any other part of the body, and more in pneumonia than in any other disease. There is a superstition that where this occurs patients will get well. There is just a possibility that this idea is based more on facts than on fiction; for in cases where herpes manifests it would indicate that the disease is not so profoundly established in the lungs. In other words, where herpes appears on the surface, on the principle that two diseases cannot exist in activity at the same time, the pneumonia must not be so profound a type as to center all the morbid process on the lungs.
Cerebral Symptoms--Children frequently have convulsions, headache, backache, and become extremely nervous in the evening. There is always more or less precordial oppression, (difficult breathing) but worse as the evening comes on. Delirium is very common in pneumonia where there is great oppression in breathing. There is a tendency on the part of the patient to leave the bed in a semi-delirium; or it would be better described as a halfsleep--just too sleepy to be awake, and yet too distressed in breathing to permit a complete loss of consciousness. Where the drowsiness is profound, the struggle for life is very great; for life depends upon breath, and many times the breathing is so oppressed that it is necessary for the patient to stay awake to breathe.
Treatment.--All diseases are self-limited; but if one would find types to correspond with text-book descriptions, the diseases must be treated according to the textbooks. It is easy for one to understand that the influence of a dinner may be said to be self-limited. The influence of a cup of coffee is self-limited. The influence of one acute attack of toxin poisoning is self-limited. Pneumonia, or other so-called infectious diseases, represent a state of toxemia, and if nothing is added--if no more toxin be turned loose in the system after the disease is once established--it is self-evident that the poison must be self-limited, and the limitation must always be the same; but if more toxin poisoning is added after treatment is begun, it is obvious that it would be impossible to have any disease originating in this way ending in any kind of regularity, unless it were in death. Pneumonia is a disease that is brought on from toxin poisoning, but the subject must be prepared by weeks and months of improper life--tilling the soil, so to speak, and cultivating it for the propagation of disease. After it is once started, to bring it to as hasty a termination as possible, food must be stopped absolutely. All the water desired should be given. Wash the bowels frequently--at least once every day--with warm water.
If there is a tendency for cold feet and hands, warm applications should be put to the feet. If the temperature is running high, a hot bath should be given every three hours, if necessary to bring comfort and reduce the temperature. If the patient is fairly comfortable, he may be given a bath every evening. Have the water quite hot--100° or perhaps 102°--and allow the patient to remain in the tub long enough to become relaxed and comfortable. A half-hour is not too long, if that length of time is required to bring the desired results. While the patient is in the bath, hot water should be added to keep the bath temperature up to 100° or 102°. If there is a great deal of difficult breathing, hot cloths wrung through a wringer should be put on the chest. Fresh air must be procured, but the patient must not be in a draft. The temperature of the room should be from 50° to 60° F. when the temperature runs up, if the patient becomes nervous, and cough is annoying, use the hot bath every three hours, if necessary, to bring full relief. Sheet cotton oiled with olive oil, placed on the chest and held on by a roll bandage, often gives relief. If there is pain in the abdomen at any time, put the towel wrung out of hot water over the point of pain. The patient should not be annoyed through the night. The lights should be put out; the nurse should stay within hearing distance, so as to be ready to meet any needs of the patient; but the patient should not know that she is close by. In other words, the patient should not be encouraged to wish much attendance at night. Patients treated in this way will get along very nicely as soon as the expectorating stage, such as I have described, has been established.
All pneumonia patients possessing a fair constitution should be convalescing nicely in from seven to eight days. When the temperature and pulse are normal, the feeding may be the same as described under typhoid fever.
The treatment suggested above presupposes that it is begun at the time the patient is taken ill. If, however, a case is taken charge of after it has been badly managed for a week or ten days, and typhoid symptoms are presenting and the patient is delirious, with engorgement of the lungs and precordial oppression pronounced, the treatment should not vary materially from that which has been suggested above. There should be heat to the feet, and a mustard plaster to the chest. After relief comes the mustard plaster may be removed and antiphlogistine substituted, being renewed about twice in twenty-four hours.
Such cases have undoubtedly been medicated and fed, or they would not develop such desperate symptoms, The bowels should be cleared out. Two enemas should be given each day, if necessary--at least one each night.
The first day's bathing, washing-out of bowels, and suspension of all food should make a change in the patient. On the second day, two hot baths will be all the bathing that is necessary. When the temperature has gone to normal, and all the symptoms have subsided, then feed as recommended for convalescing in other fevers.
Morphine, or any other preparation of opium, is very dangerous in pneumonia, as it causes a filling-up of the lungs and an inability to expectorate, and the patient will frequently die from lack of power to free the lungs. One of the worst symptoms following the use of opiates is the semi-delirium. Patients are made sleepy because of the drug, and on account of difficult breathing they struggle to stay awake. This makes a case look very desperate, when no doubt the symptoms would all be very light if it were not for the peculiar influence of the drug. Pneumonia is a disease that will surrender to kind nursing and complete absence of anything in the drug line. In those cases where there is double pneumonia, and the disease is located in the apices, the mortality is one hundred per cent. The mortality in ordinary pneumonia should be almost nil.
Definition.--An infectious disease characterized by an exudation thrown out on the mucous membrane of the pharynx, tonsils, larynx, and sometimes in the trachea and bronchial tubes. By believers in bacteriology it is declared that there is a diphtheritic bacillus or germ which is diagnostic, and that without this particular germ the disease is not diphtheria. But this germ is frequently found in the throats of people who have not had the disease!
Etiology.--This disease has been epidemic, endemic, and sporadic. For the last twenty-five years it has gradually been declining in severity.
Children who are overfed, who have developed in the intestinal tract a state of decomposition or putrescence, running on for some time, and who have broken down their resistance, will develop a state of toxemia which will cause them to be susceptible to the prevailing influences, atmospheric and otherwise.
Children who are fed too frequently or fed improperly, and who are troubled with constipation and the passing of undigested food with the bowel movements, are made susceptible not only to diphtheria, but also to scarlet fever, measles, whooping-cough, etc. Indeed, it can be proved that normal, healthy children--children who have bowels that are regular, and who are not troubled with intestinal indigestion--cannot be made to take any of these diseases.
Symptoms.--The pharyngeal type starts very much as tonsilitis. There are symptoms of cold, and if these conditions develop, the throat becomes sensitive, painful, and swollen. Diphtheria is located on the tonsils and in the pharynx when these locations are inflamed.
Children usually complain of slight discomfort. If the parents look into the throat, they will see a little redness and swelling, and perhaps two or three white specks about the size of a wheat-grain. If the disease is light, these specks may coalesce, the inflammation will not extend very far down, and the child will complain of difficult swallowing for a few days; but within a week the throat will be well without any special treatment, except to inhibit eating.
Where the infection is intense, the temperature will run to 102° and 103°, the tonsils will become very much enlarged, and the diphtheritic membrane will form over these parts, sometimes extending pretty well up on the soft palate. In such cases swallowing is almost impossible. The disease may even extend into the nostrils. If such patients are fed, brain complications may develop, and the patients die in the course of ten days to two weeks. The glands in the neck become very much swollen, due to infection. The membrane that forms will at first have a grayish-white color, then change into a dirty gray or brown, sometimes a yellowish white; it is firmly adherent, and, if loosened and thrown off, leaves the surface completely denuded and decidedly irritated, but it is soon covered with another exudate.
Where the larynx and trachea are involved, the symptoms at first are those of ordinary croup. Children will begin by coughing with a croupy sound. In the majority of cases they do not appear to be very ill; in fact, they win entertain and amuse themselves with their playthings and playmates, sometimes for two days; and again I have known cases to run on for three days, the cough becoming a little more croupy each afternoon and evening, but this symptom passing off more or less in the fore part of the night and the forenoon. Parents seldom are uneasy, because the croup is not severe; it does not affect the breathing very materially, and the child usually has an appetite, and will eat its regular meals where it is permitted to do so. If examined by the trained ear, there will be evidence of a deposit taking place in the bronchial tubes.
Years ago, when 1 was doing a general practice, it was my misfortune to meet with a great many of these cases. In those days it was not uncommon for me to be called to prescribe for a child with a slight attack of croup. All that the parents seemed to think would be necessary for me to do was to give the patient a little croup medicine, so insignificant were the symptoms. To strengthen this belief, when I called to make the examination, I would often find the child playing with other children. On looking into the throat, perhaps I would see a little redness of the pharynx. Then, on placing my ear between the shoulder-blades, I would hear a mucous rale, which not only diagnosed the case, but also prognosed it. I never knew a case to get well. Where this disease is located in the pharynx, and passes down only a very short distance into the trachea, sometimes the membrane is thrown off and the child recovers; but this is so rare that I have heard of only a few cases.
Many people will confuse diphtheritic croup, or diphtheria, with catarrhal croup. This is a very great mistake; for children should invariably recover from catarrhal croup, while in diphtheritic croup, or true croup, where the membrane extends, down to the bronchial tubes, the mortality is one hundred per cent.
Treatment.--The entire profession is enlisted on the side of antitoxin as the proper remedy. I have no faith in it, do not believe in the theory, hence have not recommended it--nor shall I. The claims that there has been a tremendous reduction in the amount of diphtheria, and especially in the mortality of the disease, because of the use of serum, I am not prepared to accept. Scarlet fever is just as formidable a disease, just as contagious, and just as dangerous to life as diphtheria has ever been. It keeps pace with diphtheria in growing less severe in type and in having fewer epidemics. Indeed, mortality statistics show that there is a larger percentage of fatal cases in diphtheria than in scarlet fever, and the profession does not claim to know anything at all about the specific cause of scarlet fever; so, until the subject is illuminated to my entire satisfaction, I shall use the decline in severity of scarlet fever to prove that there is nothing in the contention of the bacteriologists that diphtheria has been controlled by antitoxin. The severity of all so-called contagions has declined in the last twenty years, and so has murderous treatment.
The proper treatment is to wash out the bowels two or three times a day, when the child is first taken sick, using as large enemas as can be put into the bowels.
See that the child has nothing at all to eat. It should not be encouraged to drink, nor to swallow anything. It should be encouraged to wash its mouth and spit out rather than to swallow. Thirst must be controlled by small water enemas.
The child should be placed on its right side, leaning well forward, with its face rather down, so that the saliva will drain from the mouth on a cloth. These cloths should be burned. The child should not be allowed to lie in such a position that the secretion will run down the throat into the stomach.
A small towel may be wet in tepid salt water, pressed snugly against the throat, and held there by pinning a dry towel around the neck. The towel may be wet every three or four hours. No sprays or washes of any kind should be used. it is to be hoped that the old-fashioned gargling has passed into oblivion. Gargling, or spraying the throat, only aggravates the disease and encourages swallowing. The disease must be confined to the throat as much as possible, and the child must be allowed to lie in a position where everything will drain well out of the mouth. This is to prevent further infection. When the child is tired of lying on one side, it may be changed to the other side, but kept in the same position--lying on the side, inclining well forward, with either the left or right leg, whichever is uppermost, bent at a right angle with the body, so as to prevent the child from rolling over on its face.
If the temperature is above 103° F., the child should have a hot bath once or twice a day. After being in the hot water about five minutes, cold water may be added to reduce the temperature of the water from 100° to 60°. If the child's temperature is not above 102°, simply a warm bath morning and night is enough. When the child is showing great restlessness, it may have an extra bath, and the water may be extra warm to bring on relaxation and relief. The child should have its spine rubbed at least once a day before bedtime. This is to relieve any aching and tire. The rubbing should be very gentle, and should be continued until the child is quieted down and asleep. Children with this disease should be left as much alone as possible. Certainly there are to be no questions asked, and curious people should not be permitted in the room. Of course, where quarantine is thoroughly carried out, no one except the nurse will be permitted to see a sick child.
No feeding, nor swallowing even of water, is to be indulged in until the disease is thoroughly under control. No drugs are necessary.
The above are my suggestions for pharyngeal or nasal diphtheria. I have no treatment to offer for laryngeal croup or diphtheritic croup, or what is commonly called true croup, where the membrane extends to the bronchial tubes. This type of the disease is necessarily fatal.
Definition.--This is said to be an acute contagious disease, characterized by an inflammatory condition of the skin, caused by a specific germ. My definition for this disease is: an inflammatory disease of the skin, characterized by septic poisoning.
Etiology.--Erysipelas is a disease that affects all sections of the country more or less. Depressing atmospheric influences prove to be allies joining forces with toxemia to produce the disease called erysipelas. No one will have erysipelas who is not toxemic from intestinal infection. It requires constipation and the eating of too much animal proteid to prepare the system for this particular disease. As a rule, it requires a little wounding of the skin to start the disease. In some cases it does not appear to require an injury of any kind. However, when the disease starts on the face, its initiative point usually is the nose, and there is always catarrhal state of that organ. My experience with erysipelas would lead me to define it as septic herpes. It appears to locate without any special exciting cause. Like septic poisoning from any type of disease, it can be conveyed to others, but the disease is not infectious to unbroken surfaces. By this I mean that the disease cannot be transferred from the patient who initiates it to another unless the virus is brought in contact with a denuded surface; and then it will not establish inflammation except in those who are susceptible to septic inflammation.
Mothers, immediately after childbirth or at childbirth, are susceptible to septic inflammation coming from any other source. Besides, if the uterine drainage is not perfect, septic poisoning will start up without any further infective agency than simply retention of waste products which become septic and infectious.
The specific infection of erysipelas must be septic, and of the same character as the infections of all other diseases developing a septic character. Medical writers declare that people who are susceptible to the disease are those suffering from wounds or abrasions of any sort. A skin wound that does not drain may become septic. If the septic inflammation is confined to the surface, it will be of an erysipelatous character. If the inoculation is deep, the disease will be septic in character. Those most susceptible to the disease are the people who are broken down from disease, work, or worry.
Symptoms.--This disease is supposed to have an incubation period of from three to seven days. It starts with a chill, a rapid rise in temperature, and about all the symptoms with which a fever would start--aching back, headache, perhaps a sensitive spot on the end of the nose, or simply puffiness and redness, with no particular point worse than another. From this location it generally spreads to the cheeks. The swelling is usually great enough to cause a very smooth appearance of the skin. There is redness and heat. The elevation of the temperature at the inflamed point is very much greater than that of the surface of the face in the immediate region.
The first feeling the patient will have is one of stiffness, with a gradually growing sensitiveness. If the disease is severe, the swelling will be very rapid, and the part first affected will be the first to lose redness and swelling. When the disease spreads only over the forehead, it marches apparently with an elevated ridge; or the line of demarcation between the surface not affected and that which is affected is very acute and easily distinguished. Where the skin is very tender, small blisters may appear, which break, discharging a serum-like fluid.
The glands of the neck usually take on a little enlargement; but this condition is often heightened by the swelling of the skin and cellular tissue. Where the disease spreads over much of the head, there is a tendency for delirium. Where the ears become involved, there is danger of the disease passing into the membranes of the bone. In people who are much depleted--those who are in the habit of taking alcoholics, or who have broken down their resistance by the use of much coffee or tea, or by sensual habits--there is a liability to develop symptoms of brain and meningeal complications. It is said, however, that post-mortems seldom show a meningeal complication, This being true, death must result from toxic poisoning of the brain. In drunkards and in the aged the mortality is very heavy.
Treatment.--Strict cleanliness, and warm bathing morning and night, should be the rule. If the tongue is pallid, thick, and presenting the prints of the teeth on the edges, the local application should be a saturated solution of baking-soda. By a saturated solution I mean all the soda that a given amount of water will dissolve. Wet cotton with this fluid, squeeze out the superfluous portion so that there will not be enough to drain and wet the pillow, and place the compress over the inflamed part. Then put a towel or bandage around the head, in such a manner as to keep the soda dressing on the disease.
Positively no food is to be given. The first and second day it would be well to give a little alkaline drink--about what soda would lie on a nickel, placed dry on the tongue, and washed into the stomach with a glass of water--three or four times a day. After the second or third day, simply give water and cut off the internal administration of the alkali.
Where there is a putrescent odor from the breath, use chlorate of potash for the solution in place of the soda. The soda drink can be used for two or three days, as suggested above.
If the tongue is inclined to be small and red, or long and pointed, cranberries mashed and made into a poultice will make an excellent local application. Mash the berries and run them through a colander. Then put the crushed berries between layers of cheese-cloth and lay them on the inflamed part. If the patient has a desire for lemon in water without sugar, he may have it. The bowels must be cleansed by enema twice a day for the first three days, and then every night until the disease is entirely under control. If there is much nervousness at any time, the spinal rubbing will bring quiet and rest. The patient should not be annoyed by company. The bedroom should be ventilated, but there must be no drafts on the patient. If cranberries are not to be had, use cotton with lemon juice for a poultice. If lemon juice irritates the skin, reduce it with water; and if the cranberries irritate the skin, apply a little olive oil before the berry poultice is put on. If this treatment is carried out faithfully, there will be no mortality, and patients will make a very quick recovery.
In regular practice there is an established habit among physicians, in treating erysipelas, to give tincture of iron in doses of half a dram to a dram every three or four hours. As a rule, the same physicians recommend a diet that is very nutritious. The iron will positively prevent digestion. Then is there any wonder that patients treated in such a way will become extremely restless, nervous, delirious, and that some of them die?
XIII. RHEUMATIC FEVER
Definition.--An acute fever that is caused by absorption of toxin from intestinal decomposition in those of gouty diathesis, characterized by inflammation of one or many joints, with a marked tendency for inflammation involving the fibrous tissues around the joints.
Etiology.--Rheumatism is found in almost every country. Damp weather is supposed to be a cause. People working in mines that are wet, and people living in countries where there are many rainy months, are supposed to have rheumatism because of this dampness. Any weather conditions that depress and enervate will precipitate an attack of rheumatism--not as a cause per se, but rather as an exciting cause. The foundation for rheumatism is laid at the table, and in neglect of the body in the way of bathing and clothing. There is usually a history of constipation, and in some cases colitis. Some authors declare that the disease prevails most in dry years, or during a succession of dry years. The same may be said of rainy seasons and a succession of rainy season. Any continuous or monotonous weather causes enervation, and this often is the last straw in precipitating an attack of rheumatic fever.
The disease may be found in children as well as in adults. Children who have been overweight, and have been recognized as exceedingly healthy, are inclined to take on rheumatic fever. If the weight has been excessive, so that nutrition has been gradually perverted, very great care and proper nursing will be required to bring the patient back to normal. If parents have been careless, and such patients have had one or two relapses, there is danger of heart complications springing up that will ruin the patient for life.
Symptoms.--The disease usually begins like an ordinary fever--perhaps with a chill and vomiting. In other cases no stomach symptoms whatever will be found, and ill-defined pains may start up in a joint, in either the lower or the supper extremities. As in the case of nearly all fevers, there is a chilly sensation to start with, and in some cases real chills, like ague, which may lead those in attendance to believe the subject has an attack of malarial fever that will pass off in a short time. This, of course, is true only of cases developing in malarial countries.
Within twenty-four hours after the disease is developed, one or more joints are swollen, red, and very sensitive to touch. The pulse will not be more than 90 to 100. The temperature may run from 102° to 104° F. Some cases will desire to eat; but, as a rule, there is not much appetite. Constipation is usually present, and the urine is very decidedly acid. The perspiration from such patients has a very strong, acid odor, permeating the whole house.
The mind is usually clear, except in cases that show an excessive temperature; then patients may be delirious.
As I allow my mind to ' run back, one case in particular comes to me. It occurred perhaps sixty years ago. I was called to see a woman about twenty-eight years of age, the mother of one child--a fine-looking woman, of medium stature, but a little overweight. One ankle was badly swollen and very sensitive, and she suffered a great deal of pain. At the second call, twenty-four hours after the first, the swelling had gone out of the ankle into the knee. In another twenty-four hours it had gone from that knee over into the other knee. On the fourth morning the pain and swelling were in her left elbow. The husband, and the patient too, clamored for relief. They insisted on having something to rub on the joint to relieve the pain. I was young and afraid to take any chances. I explained to them that the tendency for the disease was to migrate, that I did not care to do anything which would favor its jumping from one place to another, and the proper thing to do was to keep a comfortable dressing on the inflamed joint, and otherwise let the patient alone. In the evening of the fourth day I received a note, telling me that they had sent for another physician, and that he was not afraid to give them relief. Relief was experienced, and in twenty-four hours the patient was dead. That early in my professional career I had it demonstrated to me that it was very dangerous to use local applications, rub inflamed joints, or tamper with palliatives of any kind; and from that day to this I never have treated rheumatic-fever patients in that way.
Treatment.--There is not much to do in rheumatism, except to stop building it. Patients should not take anything internally except water, and they should be encouraged to drink water very freely--a half gallon or more each day. A solution of bicarbonate of soda (common baking-soda), one ounce to the pint, may be applied with absorbent cotton; or gauze may be wet in this solution and bound on the inflamed joint. Then, over this dressing, cotton may be wrapped. Arrangement should be made to prevent the bed-clothing from resting on inflamed joints. Where it is possible to give patients a hot bath, this should be done as often as every three hours, if the suffering is very great. When a patient is put into the bath, the water should be at a temperature of 100°. Then hot water may be added until the patient's limit of endurance is reached. From time to time more hot water may be added, to keep it as near one temperature as possible. The bath may be from one-half hour to one hour in duration, depending upon how soon relief is obtained and how well the patient bears up under it. If there is a tendency for the heart to palpitate and the pulse to run high, or if there is any feeling of faintness which cold-water sipping and putting cold water on the head do not relieve, the patient should be removed to his bed. At least one bath of long enough duration to bring full relief should be given daily, and as many more as the patient's strength will permit.
The excessive sweating and the amount of acid that is thrown out of the system cannot be disposed of in any way better than through frequent bathing and frequent change of clothing. By no means should such patients be allowed to lie in clothing wet with perspiration. If necessary to change clothing every three hours, it should be done. In this way the patient is enabled to throw off a severe attack in a very reasonable time. This treatment is satisfactory, because it hurries the patient to a recovery without complications of any kind--which is more than can be said of any other treatment given for the disease. That being true, it would be well for those who have faith in drugs to try my simple plan.
After the disease is thoroughly under control, the patient may be fed as outlined for typhoid fever.
XIV. CHOLERA MORBUS
Definition.--This is a disease brought on from indigestion.
Etiology.--Those who are subject to cholera morbus have brought on enervation from hard work, hot weather, and excessive eating and bad food combinations. It usually develops suddenly a short time after a heavy meal.
Symptoms.--There is vomiting, with purging, and cramps of the muscles of the hands, arms, feet, and legs. It is hard to tell in what way the patient suffers most. The cramps usually make the subject of this disease writhe with agony. It requires several attendants to rub and hold the fingers, hands, and arms straight, because the cramp is so fierce that it rolls the fingers into the palms of the hands, the hands on to the forearm, and the forearm on to the arm. If genuine Asiatic cholera is many times more severe than this disease when developed at its worst, it is easy to see why the mortality is so great; indeed, it is a wonder that anyone can survive the disease for any length of time.
The worst forms of cholera morbus that I have seen have gone so far as to have what is known as "rice-water discharges." I have not seen or heard of a case for fifty years; but previous to that, in doing a general practice, I was called to see several cases of this disease every summer. At that time I used drugs--used hypodermics of morphine; but today I should handle such cases very differently.
Treatment.--As soon as possible, the patient should be put into a hot bath, of a temperature of 100° F.; then hot water should be added until the temperature has been increased to the patient's toleration; and the bath should be continued until complete relaxation is obtained. If the suffering is not too profound at the outset, the bowels should be washed out by a copious enema--two or three quarts of water and a tablespoonful of bicarbonate of soda; but, after the patient is once in the bath, he should be kept there until relaxed and comfortable. So long as there is any tendency for cramping of the muscles, the bath must be continued. The water should not be allowed to cool. A certain amount should be dipped out and replaced by hot, so as to keep the temperature of the bath just as hot as the patient can tolerate. When put to bed, the patient is to be left quietly alone. Artificial heat should be put to the feet. If anything is given internally, it should be hot water. Positively no food of any kind must be given until all symptoms have passed away and the patient has been comfortable for twenty-four hours. Then baked apples may be given for breakfast; at noon, lamb broth or chicken broth; and baked apples for the evening meal. The second day, baked apples for breakfast; at noon, a little stewed meat, and a combination salad or grapefruit; and in the evening, two ounces of toasted bread and an apple. The next day, baked apples for breakfast; baked potato and a salad for the noon meal; and two ounces of toasted bread and an apple in the evening. If all is going well after this, the patient may resume his ordinary diet, and, to prevent another attack, he should eat proper combinations.
Definition.--The definition for syphilis, as given by the modem text-books, is that it is a specific disease caused by the Spirochaeta pallida, and that it is developed by infection. That is when it is acquired, or derived by hereditary transmission--congenital syphilis.
Etiology.--This is a disease which the medical world feels that it knows all about. Indeed, laymen generally think they know positively that syphilis is a specific disease. It would require volumes to hold the literature that has grown up around this subject. The popular idea is that syphilis starts with an inoculation or infection incurred by cohabiting with a person who has the disease, and that, when it is once started, the ending is doubtful, notwithstanding the fact that the medical profession has discovered many specific remedies. The regular profession is quite positive that there is no such thing as a specific remedy for a specific disease. The idea of specifics has been denounced by the best-educated physicians throughout modern times. But this one disease has been associated with mercury, arsenic, and iodide of potassium as specific remedies. In the last decade a remedy has been discovered that is recognized as more specific than the old remedies; yet, in spite of this new synthetic remedy of specific fame, the old remedies are still in use. Indeed, in institutions where the disease is treated the synthetic remedy commonly known as "606" is used, and at the same time mercury, arsenic, and iodide of potassium are given--probably on the principle that, if one should fail, the other may be the thing needed. This simply shows that, in spite of the so-called specific remedies, the medical mind is not yet ready to accept the fact that there is a specific.
Syphilis, like everything that has a bad reputation, must be the scapegoat for every smaller or minor disreputable thing of its class. If people of pronounced diathesis, and who live in such a way as to create derangements of all kinds--derangements of the blood, nervous system, glandular system, and circulatory system--consult a modern physician, there is a strong probability that most of these symptoms will be charged to syphilis. So cocksure is the profession that this is true that it will not even believe in the negative findings of a Wassermann test, notwithstanding it has as much faith in this test as it has in syphilis itself.
To see a physician struggle with all his might and main to force a blood-test to show a positive reaction is pathetic, to say the least. I have many patients coming to me during the year, from different parts of the world, bringing written examinations and reports showing the results of many examinations; and if there should be nine negative examinations and one positive, that one is sufficient to settle the question that the patient has syphilis. Occasionally I have patients who have been treated for syphillis, and whom the physicians have positively declared to have syphilis, despite the fact that several Wassermann tests have shown a negative reaction. The fact of the matter is that the mind of the medical profession is positively settled on this subject, and that there is no hope of anything contrary to the general belief receiving any attention whatever.
As I am not at all in sympathy with any part of the medical history of syphilis, or the present general beliefs, I shall recommend those who want to know what the popular opinions are on this subject to consult the leading text-books; for I have no desire or inclination to write from that standpoint. Hence, what I have to say in the following pages will be strictly my individual opinion, with no apologies for differing with the whole world, if I do. I can very well afford to stand alone, when I stand with as clear a conscience in the matter as I do, and have as fine a list of cured subjects as I have.
Symptoms.--The disease begins with a very small denuded surface. This may look like a speck of herpes; and, indeed, that may be, and probably is, the initial stage in many cases. After that, from this small denuded spot it will spread. There is a hypersecretion about the foreskin or glans. If watched carefully, the parts will be seen to be quite moist; they should be looked at every three hours, and the secretions removed. In a day or two the spot begins to be a defined ulcer in shape. If not treated properly, the ulcer grows quite rapidly, swelling of the prepuce takes place, and a sensitive and swollen condition of the glands in the groin appears. The lymphatics in the groins take on enlargement. If the treatment is of an irritative character, such as cauterizing or cleaning with peroxide of hydrogen, the parts become quite sensitive, and the ulcer spreads with a thickened, indurated border. If taken hold of by the fingers, there will be a sensation of hardness. The thickened and indurated parts will present a ring of hardness standing all around the ulcer. If the patient has quite an acid condition, shown in a white tongue--one that is broad, pallid, and with prints of the teeth on the edges--and if the case is treated with local applications of mercury, the ulceration will take on a very active growth, because of the local poisoning caused by the mercury coming in contact with the acid secretion.
Treatment.--In the beginning of the
treatment, Dr. Osler says in his work on practice--
That the later stages which come under the charge of the physician are so common, results, in great part, from the carelessness of the patient, who, wearied with treatment, cannot understand why he should continue to take medicine after all the symptoms have disappeared; but, in part, the profession also is to blame for not insisting more urgently that acquired syphilis is not cured in a few months, but takes at least three years, during which time the patient should be under careful supervision.
Knowing, as I do, that syphilis is as easily cured as any infection--knowing, as I do, that without gastrointestinal decomposition, no disease, not even syphilis, can put up a winning fight against real health and normal elimination--I am surprised at what the leading English teacher of medicine has to say on the subject.
On the treatment of syphilis is where I part company with modern medical science. I have been in the profession many years; I have treated many cases of syphilis; and, where I have been favored with an early call, about two to four months is as long as I have ever kept a case under my supervision. No wonder there is a universal taint, when a patient is kept under treatment for three years! He will certainly have a medicine disease built in that time which probably will last for the remainder of his life. Every symptom developed during those three years will be attributed to the disease, when, in reality, it comes from a ridiculous manner of living on the part of the patient and the drugs be has been given.
The chancre should be treated the same as any ulcer. It must be kept clean. What I mean by keeping the chancre clean is that it should be washed with a very mild soap two or three times a day, and rinsed with warm soda water--a heaping teaspoonful of the soda to a pint of warm water. The parts should be bathed thoroughly with this alkaline water, so as to remove any soap. Then a little white vaseline may be used, and a light dressing of cotton, retained by a T-bandage. Under no circumstances should a dressing be put on that is retained by a cord, or, what is worse, a rubber band. Anything that constricts the organ will cause a puffiness in the foreskin. The more the circulation is interfered with, the slower the ulceration will be in getting well, and the more absorption and systemic infection will take place. If the primary disease is taken care of in a sensible, rational way, it will heal just the same as any ordinary sore; and if this can be carried through, and at the same time the inguinal glands prevented from becoming involved, there will be no constitutional derangement to be overcome.
The general care of the patient should be the same as would be given to overcome or prevent the spread of any disease; namely, a five-to-ten-minute warm bath, followed with a cold sponge-bath; and the cold sponge-bath should be followed with ten minutes' dry towel-rubbing before retiring. If the bathroom is warm of a morning, the bath should be taken at that time, and a dry rubbing given at night.
Until the disease is thoroughly under control, the patient should have nothing at all to eat except fruit--fresh, uncooked fruit morning, noon, and night, and at no other time. Water should not be taken. It is a mistake to drink freely of water; for the kidneys are forced to do vicarious work for the bowels, and this leaves the bowels constipated, causing infection.
The bowels should be moved every day. If the bowels do not move during the day, before retiring a small enema--a pint of water--may be put into the rectum and held for five minutes, and then a movement solicited.
The above treatment is so simple and so effective that it is hard for some patients, and many doctors, to believe that it can be trusted.
Sometimes I am not consulted until the ulceration is very great and the glandular involvement is pronounced. This means that infection has taken place, Now the question is, what kind of infection has taken place? Septic infection. I insist that syphilis is nothing more nor less than a badly treated septic infection, coming from maltreatment of a common ulcer. We do not believe in the doctrine that, unless patients are fed, the disease will master them; indeed, we know positively that feeding patients only feeds disease. The chancre or ulcer should be taken care of, it matters not how large it is, just as an ordinary ulcer would be managed. There is nothing in specific medication. The fact of the matter is that nature is fully capable of throwing off any and all diseases, if they have not advanced to such organic destruction that there can be no hope; and if nature cannot effect a cure--if nature cannot throw off disease--it will be because she is prevented by treatment and nursing.
Those who would have no further symptoms, no nervous diseases--tabes, or any of the diseases said to be due to syphillis--twenty-five to fifty years after, should live correctly.
Definition.--This is a septic infection of the mucous membrane of the urethra. I have some views that are not strictly orthodox in regard to this disease as well as to syphilis; and all I have to offer as proof that my particular views are well founded is that my plan of treatment works, and works better than any other plan of treatment of which I know. If my ideas are wrong in regard to the cause of syphilis and gonorrhea, or any other disease, I want someone to prove to me that I am wrong, by producing a treatment that is as good as mine, or better.
Etiology.--It is generally understood that this disease is caused by a germ, gonococcus. As I have stated all specific infections are at the base septic or toxic. Septic inflammation of the urethra is accompanied by the gonococcus. A septic inflammation of Peyer's glands in the bowels develops a typhoid fever, and the character of the septic material is that it is accompanied by the typhoid bacillus. A septic inflammation in the lungs is accompanied by the tuberculous bacillus; etc. etc. The stock-in-trade toxin that accompanies all suppurative inflammations is septic. The location of the disease in the body determines the character of the germ that is found in the necrosed or broken-down tissues and in the excretion and it will never be found in the early stages of any disease.
Symptoms.--Gonorrhea starts with a feeling of uneasiness at the meatus, or the mouth of the urethra; perhaps a feeling of itching--just enough to call the attention of the patient to it; and perhaps, on examination, he finds a little discharge. Certainly by the next day the disease will have developed to such an extent that there will be no question about its existence; for, on getting up in the morning, there will be a feeling of discomfort, and, on examination, there will be quite a copious discharge. The patient experiences considerable discomfort in urinating, such as burning or smarting. This discomfort seemingly grows worse every time urine is passed, until the patient is very uncomfortable. Much, however, depends upon the constitutional state of the patient. If he has been living in such a way as to cause a decidedly acid urine, then the smarting, burning, and discomfort in urinating will be more pronounced.
Some cases develop an edematous state of the prepuce or foreskin. It sometimes swells to such an extent that the glans is completely covered, making it very difficult to keep the parts clean. This complication, however, is unnecessary; it is brought about by maltreatment. Any irritating treatment aggravates the symptoms and causes what would be a very light inflammation to develop into a very intense inflammation. Where the swelling is very great, sometimes the circulation is so cut off that there is danger of gangrene.
Treatment--As soon as the disease is discovered, the patient should stop eating, and clear out the bowels by enemas or mineral water. He should put on a belt next to the body; then double a towel and pin it to the belt in front. This is for the purpose of cleanliness, and will prevent any discharge from coming in contact with the underclothing. As soon as the towel is soiled it should be replaced by a clean one. The penis should be bathed in hot water--as hot as can be borne--for from ten to fifteen minutes three times a day. The parts must be kept absolutely clean, even if bathing in hot water is necessary every three hours.
The patient should not eat anything until absolutely comfortable. Then, for the first three days after eating is started, a pint of buttermilk may be given morning, noon, and night. The patient should be instructed to retire early, and the mind must be free from irritations--certainly from lascivious thoughts. A general bath may be taken before retiring at night. Have the water as hot as the body will bear. The patient may stay in this bath for five minutes. Then follow with a quick cold sponge-bath. Follow this with dry rubbing. Where it is possible for the patient to stay in bed, a disease of this kind can usually be gotten rid of in from one to four weeks. If it is impossible to go to bed, the disease will last from three to six weeks. If the patient has hard work to do, this has a tendency to prolong the disease. Riding horseback--any kind of jolting of the body--increases the trouble and has a tendency to prolong the disease. But where the patient can take proper care of himself, there is very little discomfort, and the disease is brought to a successful termination in from four to six weeks. Many cases that I have treated have considered themselves well in two weeks--but not so; they must be cautious about taking the proper care of themselves, for if they indulge in overeating, or indulge sensually in any way, the disease will be reestablished, and a chronic state may develop. The longer any disease runs on, the more difficult it is to cure.
All the time during the treatment of this disease the bowels should be kept open, by enemas, if necessary. After three days of buttermilk as suggested, light eating of fruit and vegetables may be taken for three days more. If there is no irritation developing and perfect comfort is experienced, light regulation eating can begin.
This treatment is so very simple that those who believe in doing something--believe in copious douches, passing gallons of water through the urethra into the bladder--will really think that it is almost no treatment at all; but in the course of a year I see many cases hunting cures who have been treated with copious douches of hot water and permanganate of potash, and the use of other drugs.
Systemic Infection.--I have seen gonorrheal rheumatism that was very intractable. This is a disease that resists treatment. I do not know but that this should be a diagnostic symptom. It often follows gonorrheal infection of the testes. Abscesses frequently form, and burrow in such a manner as to make their way into the bladder. I remember a case that I had thirty years ago, where pus would sometimes amount to fifty per cent of the urine passed , and no urine was passed that did not show ten to twenty-five per cent pus. The case had been diagnosed as gonorrheal infection of the left kidney, and an operation for the removal of that organ was recommended when the young man came into my hands. I gave it as my opinion that there was, no need of kidney extirpation. I based that opinion on his general systemic condition, which was altogether too good to have anything seriously wrong with a kidney. I told him that the proper thing for him to do was to be careful about his eating; in fact, I put him on a strict diet. In the course of three years he ceased to have pus in the urine.
This disease is most liable to take on this intense form in those who are most dissipated--alcohol and tobacco users--and those with sensual minds and a disposition to be as lascivious as possible.
In women this disease cannot develop to such an intensity as, in men, because the drainage can be so much more efficient through copious vaginal douches. These douches should free the patient of the disease in half the time necessary in men, but those unfortunate enough to get the disease should be very willing to be extra careful. Sex life certainly should be given up absolutely until perfect health is established. While the disease is at its most acute stage, copious alkaline douches can be used--a dessert spoonful of baking soda in a quart of hot water--two to four times a day, depending upon the amount of discharge.
The suggestions for eating should be the same as for such cases in men. If there is a chronic catarrhal inflammation of the womb, great care should be used in using the douche to keep from forcing the infection into the mouth of the womb. Where this complication is established, there is no telling how far it will go. Intra-uterine infection may pass to the fallopian tubes and bring on infection of the tubes. These cases often have to go to the surgeon or go to bed for about four months.
Definition.--The definition, according to modern medical science, is an infectious disease caused by the bacillus tuberculosis. The lesions are characterized by nodular bodies, called tubercles. These tubercles undergo cheesy degeneration, sometimes a hardening or fibrous degeneration, and again they become limy. This is the ending in spontaneous recoveries.
Etiology.--The disease is universal. It is found in animals. Cattle are supposed to be afflicted with the disease a very great deal. Forty to forty-five years ago Koch declared that bovine tuberculosis was similar to human tuberculosis, and that man could contract tuberculosis from cattle. The last years of his life he recanted, but I think his followers persisted in advocating his first declaration in this matter. Those who wish to be thoroughly informed on this subject from a bacteriological standpoint should get special works on the subject. I recognize the disease as coming from perverted nutrition brought on from crowded digestion, in those who are predisposed to take the disease.
Such people are very imprudent. Young men and young women, at the time when they are enjoying the best of health, practice gross imprudence, such as dancing until very warm, then standing in a draft or sitting in a draft; also persisting in eating wrong combinations, overeating, and taxing the nervous system in every kind of way. Young men use tobacco, and abuse, the stomach by eating all kinds of trash between meals; in fact, it seems that young people who are predisposed to this disease are born with a lack of judgment. Self-abuse enters largely into the cause of this disease by breaking down digestive power, enervating the subject, and forcing indigestion, decomposition, and the generation of toxins in the intestine, which are absorbed and poison the system. Besides the causes that I have mentioned, there is no question but that vaccination, inoculation, and serum injections have much to do with starting up a glandular derangement. A morbid process set up by vaccination in just the right individual--one with a dyscrasia--may be the beginning of the development of tuberculosis. Infection in childhood may run on, and show itself, or its evil influence, at forty-five or fifty years, of age. Instead of the cause of disease being unitary, it is, decidedly multiple; and this is especially true in tuberculosis. No two persons will be broken down in exactly the same way. All, however, must have their resistance brought to a very low ebb before the disease will manifest itself.
The Beginning of TubercuIosis.--Indigestion, characterized by frequent symptoms of derangement of the stomach, brought on from overeating or imprudent eating. These patients will be troubled with cough. After they have gotten over one attack of indigestion, they have a period of comparative health. Then they will have another spell of indigestion, developing a similar derangement that may be diagnosed as bronchitis. The coughing may be quite persistent, but after running on for some time there may be a complete respite, the patient having quite good health; but there is always a little inclination for coughing and expectorating that will be recognized as perhaps a little bronchial irritation. At last there may be an attack of bronchitis, so-called. There will be a hacking cough with some temperature. The temperature may run up to 102 degrees in the morning or evening, but the temperature will not last twenty-four hours. However, it will return in the form of a periodic fever. Some cases may be treated for malaria. Particularly will this be true in malarial countries. In sections of the country where there is no malaria, the present day diagnosis will be an infection from streptococci.
Such cases will have fits of indigestion, perhaps sore throat, and it will be diagnosed streptococcus infection. The cough and expectoration becomes continuous, and a little fever will show every day-not much-perhaps less than one hundred, with an increase to 102 degrees. By this time the doctors will be diagnosing tuberculosis. They will begin the regulation treatment for that disease. The patient suffers psychologically from this diagnosis, He will be inclined to be despondent and hopeless, and will require a great deal of encouragement from family and friends. There are a few temperaments which will always be looking on the optimistic side-they expect to be cured, but they are not cured.
If the lungs are watched, there will be found a growing dullness in one or both lungs--perhaps only the left lung. This means an accumulation of phlegm in the bronchial tubes.
Treatment.--lf taken to be treated at this stage, an effort should be made to empty the lungs of the accumulation. This can be accomplished more or less by having the patient lie in a position that will allow the accumulation to gravitate to the throat. Every day the patient should get into that position, and he will soon learn from experience that he can unload his lungs or get a freer breathing because of being able to expectorate a great deal of the accumulation.
This will not benefit the patient at all unless a rigid dietary is introduced. That means cutting out the dairy products and the starch; living largely on raw fruit and raw vegetables. The proteins should be watched. If a small amount can be taken care of without an increase in the cough and expectoration, it can be continued. There is no need for experimenting with starch for it will increase cough and expectoration from the bronchial tubes. From this point on the patient should improve until completely recovered, if the rigid dietary is adhered to. Some cases, if taken at quite an advanced stage, can be relieved within a month, and a very great deal of the dullness in the lungs overcome.
Scrupulous cleanliness is, necessary. A sponge bath of a morning, after a certain amount of exercise, and a tub bath at least every other night. That means a hot water bath and it should be continued for twenty to thirty minutes. If the patient is a female, vaginal douches should be used every day--if the patient be a virgin or a married woman, the douche should be used just the same. There is sometimes prejudice against young women being treated in this manner, but it is due to ignorance.
It is not a good thing to have the patient kept too warm. Bed clothing should be just enough to keep the patient comfortable, with the addition of a foot warmer, and the foot warmer is not to be used continuously. It should be kept to one side of the foot of the bed and as soon as the feet begin to show a coolness, the warmer can be brought to the feet. The feet should not be against the foot warmer. In other words, keep the feet warm, but do not allow them to sweat from overheat.
The patient should be encouraged to read and even study. The mind must be kept off himself by being interested in something outside of himself.
This line of treatment ought to save every patient, and if this care is begun early in the beginning of the development of symptoms, few would ever get far enough along to have to go to bed. It is curable in its beginning, one hundred per cent. Tuberculosis is doctored to death.
If this treatment is adopted early, there will be no tubercular bacilli, hence those who believe that there is no tuberculosis except in cases where the bacilli are to be found, will not believe that the disease can be jugulated as I have described. If it is any gratification to the profession and the people to believe in the present diagnosis and treatment, it is up to them to enjoy it. Those who will follow me will not need to develop that kind of tuberculosis.
XVIII. ROCKY MOUNTAIN FEVER--TICK FEVER
We hear occasionally of this disease in the mountains of Idaho, Nevada, and Wyoming. It is supposed to be produced by the bite of a tick. The disease begins with chill, fever, and severe pain in the limbs. A rash appears from the second to the seventh day. Sometimes there is bleeding. Those who have seen the disease declare the rash to be not unlike that of typhus fever. Some patients have hemorrhage from the mucous membrane. The temperature ranges from 103° to 105° F. When the fever runs very high, there is delirium and stupor. The death-rate in this disease is very great. It is said to run as high as seventy per cent in Montana, but in Idaho not more than two or three per cent. The discrepancy is so great that there must be a very decided difference in the types of the disease found in the two states.
The disease should yield to the ordinary treatment of fasting, bathing, washing the bowels every day, and absolute quiet. When the temperature runs high, give a warm bath, reduced by cooling the water to 40°. The patient should be kept in the bath long enough to reduce his temperature to, 101° or 102° F. This should be done twice a day until the temperature stays below 102°. There is no question but that there must be a septic state. A hyperpyrexia, or high grade of fever, must be overcome to prevent the disease from becoming intense.
We have given this as you will find it in books on the subject, but our belief is, that it is psychological. Doctors scare the patients to death. As soon as people in the Rocky Mountain country find a tick on them, they get the jitters. After a doctor has been called and gives his treatment, the patient is certainly sick. We must not forget that we can kill people by building a psychological pathology. If it were possible for people to call a physician who would make fun of the tick fever, and encourage the patient to understand there is nothing to it further than what follows the bite of the ticks of the middle states, we would bear very little of the mountain fever in a short time. We still believe in the mad dog insanity. This is tick insanity, and if we can keep insanity out of our disease the mortality will drop exceedingly low in a very short time.