Part 11
The food passes now into a long coiled pipe--the small intestine. This secretes the intestinal juice which further assists the pancreatic juice. Absorption has been proceeding from the stomach onwards (_see_ Assimilation). The mass of undigested food is pushed along the small intestine by means of muscles in its walls and passes into the large intestine where a similar process to that of the small intestine goes on, the remains of the food ultimately reaching the vent in a semi solid form, consisting of the undigested part and the débris of digestion.
During this complex process much blood and energy is needed for the abdominal region, therefore hard work or exercise should not immediately follow a meal. It will be noticed that each stage of digestion prepares the food for the next stage _e.g._, the mouth prepares the food for the stomach. Now, as the food ceases to be under our control when it leaves the mouth, every effort should, as we have said, there be made to prepare the food for its reception by the stomach. Chew food dry as far as possible, for that excites saliva. It is best not to drink till after the meal. The digestive powers often become weakened in advancing years, but may be greatly preserved, and even restored to health after long debility, by careful attention to the above hints.
Drinks made of lemon juice or orange juice and water are often very good to help an invalid digestion, but nothing is better than sips of hot water for some time before a meal. Distilled water is especially a most valuable drink. Cooling applications to a fevered stomach and warm fomentations to a cold one will often promote digestion marvellously. The feet and legs may be fomented if cold while the cold cloth is pressed over the stomach, especially if the process be long continued. Where heat is necessary it should be gradually and cautiously applied, so that sickening the patient may be avoided. (_See also_ Assimilation, Food in Health, Indigestion).
Diet, Economy in.--Dr. Hutchison, one of our greatest authorities on the subject of Dietetics, has well said--
"The dearest foods are by no means the best. 'Cheap and nasty' is not a phrase which can be applied to things which you eat. A pound of Stilton cheese at 1s. 2d. contains no more nutriment than a pound of American cheese at sixpence. A given weight of bloater will yield more building material than the same quantity of salmon or sole.
"The upper classes in this country eat too much. The labouring classes are insufficiently fed--much worse fed than their brethren in America. One of the chief consequences is an undue craving for alcoholic stimulants; another is that our poor are not properly armed against tuberculosis and epidemic disease.
"How can this be rectified? Anyone who knows anything about the poor man's budget knows that he already spends as much on food as he is able. As it is, 50 per cent. of a workman's wages are absorbed in its purchase, so that half the struggle for life is a struggle for food.
"The only remedy is to buy the things which are the most nourishing and which yield the most energy. Quite a good diet can be obtained for fourpence a day, yet the average working man spends sevenpence.
"I advise the buying of more vegetable foods, particularly peas, beans, and lentils, and the cheaper varieties of fish. The working classes should also be taught how to cook cheese, and thus make it more digestible, as the Italians do. Cheese contains much building material, and is therefore a valuable article of diet.
"I strongly recommend one good meal of oatmeal a day, instead of so much bread, butter, and tea, which is the staple diet of so many poor families, because it is easily prepared, and because of human laziness.
"Skimmed milk is better than no milk at all, for it contains all the original proteids, and has only lost its fat. More dripping and margarine should be eaten, instead of jam; margarine being quite as digestible and nourishing as butter."
Vegetable oils are, however, more digestible than animal fats. Cocoanut butter is a cheap and excellent substitute for margarine or butter. As it contains no water it will go much further.
Another instance of bad economy is the use of cod liver oil. Butter or even cream are quite as fattening and much more digestible.
Malt extract is much dearer than honey, which is superior to it in value as a food.
To supply a healthy man with the amount of proteid required by him daily in beef extracts would cost 7s., in milk (a comparatively expensive food) would only cost about 1s.
Diphtheria.--The most striking symptom of diphtheria is the growth of a substance in the upper part of the windpipe, which threatens to close it entirely. Good medical skill is of first importance here, yet much may be done where that is not available. We have often seen the swallowing of a little hot water and treacle enable the children to throw up the entire obstruction and make the breathing perfectly free. Mark at once whether the feet are cold or warm. If cold, oil them well with olive oil, and pack in a hot blanket fomentation to the knees. When the feet and knees are thoroughly warm in this, put a cold cloth on the back of the neck down between the shoulders. Change this as often as felt comfortable. The throat may be brushed out with a weak solution of Condy's Fluid, but a strong solution of common salt will do very well. Good white vinegar and water (_see_ Acetic Acid) is perhaps best of all. We have never seen this fail in changing the character of such growths, and if the windpipe can be washed out repeatedly with it, we should feel sure of a desirable result. Now, we have seen a humble working man's wife wash out the throat of her son as well as any medical man could do it, using Condy's Fluid for the purpose with full success. When you can, have the help of a medical man, but when you are so placed that such help is impossible, you need not fear to try yourself. If there is much fever, cold cloths may be applied to the head to reduce the heat. As the disease is strongly infectious, care should be taken to isolate the patient, and attendants should avoid his breath. Abundance of fresh air and light should be allowed to enter the room, and one window at least should be open as far as possible.
Douche, Cold.--In its most powerful form this is a _solid_ stream of water directed down on the patient's shoulders and spine. It may be applied either by an apparatus fixed up for the purpose, or by merely pouring from a watering-can _without_ a rose. Its power depends on the great heating in the skin which springs up when it is withdrawn. This heating power again depends on the strong shock given to the system when it is applied. Thus it will be seen that what is called a "Spray" or "Spray Douche" is of little use for the same purpose, as it gives little or no primary shock. It is with this application as with many. The patient's feeling benefit is the great and true evidence of the treatment being right. When the douche issues in bodily comfort and cheering to the mind, all is right. If it issues in discomfort, then some other treatment must be tried.
"Downbearing."--This expression will cover many troubles especially common among women, where the weight of the internal organs becomes distressingly felt. These are usually supported without our being conscious of their weight at all. But in weakness, or after long fatigue and standing, it becomes felt as a severe downward pressure. This is often caused by the pressure of corset and skirts upon the waist. In cases where it is troublesome, much help will be derived by adopting some device for suspending the clothes from the shoulders. This may quite cure the trouble (_see_ Tight Lacing). For more serious cases, take daily a short SITZ-BATH (_see_) in cold water, with the feet in hot water. Internal syringing is often required, which is best done with the "Fountain Enema," and very weak acetic acid and water (_see_ Acetic Acid). A more powerful application is to have cold water poured over the front of the body while sitting in the sitz-bath, from a watering-can with a garden rose on the spout. This must be done gently at first, and afterwards more strongly and with colder water. This also prevents the troublesome "flooding" from the womb, which so often accompanies "down-bearing." The water employed in the douche must be _cold_, but it need not be icy cold. Ordinary cold tap water does very well. In serious cases medical advice should be sought, as the womb may be displaced. A golden rule for the prevention of this distressing ailment is to pass water frequently. If women would always do this before pushing heavy furniture, hanging up pictures, &c., many internal ailments would be prevented, as when the bladder is empty there is little danger of the womb being displaced.
After the system has been weakened by a miscarriage, this flooding often occurs. Apply the above treatment: it checks the flooding, and braces the parts.
Drinks, Refreshing.--This is a matter of great importance to the sick. Nor is anything more important to be said on them than this, that the foundation of all such drinks must be _water_. This water must be _pure_, and is best distilled, or boiled and filtered. Long boiling will spoil water, and half-an-hour is long enough to boil. To add to this pure water, we may take the juice of half a lemon, sweetened to taste. Few patients will fail to relish this. A whole orange may be used instead of half a lemon. A substitute may be made by taking half-a-teaspoonful of good white vinegar instead of the orange or lemon. Also in many cases where the cold drink is not relished, it may be taken warm.
Dropsy.--This trouble is rather a symptom than a disease. It rises from accumulation of watery waste in the body, owing to improper action of the skin, lungs, or kidneys, and sometimes follows scarlet or other fevers and lung affections. By far the greatest danger in such cases arises from fashionable medicines. It is of the last importance that nothing should be given to lessen life by injuring already weakened vital action. It is when this is done by metallic preparations that such cases become very grave and even hopeless. There is a prominent error in connection with all dropsical tendencies, which should be removed. That is the idea that the "water" which collects in such swellings is similar to good drinking water, and that giving the thirsty patient water to drink is increasing his illness. The so-called "water" which swells the face, or the feet, or any other part of the body, in dropsy, is used-up matter such as is, in good health, removed (imperceptibly, in greatest measure) by the organs fitted for that purpose.
Water, especially if given about blood heat, is at once used for most important vital purposes. This hot fresh water mingling with the poisonous "water" of dropsy dilutes it--renders it not only so much less injurious, but tends powerfully to its removal. The thirst of the patient is in perfect harmony with this truth, as all natural symptoms are ever in harmony with nature. If there are convulsive attacks, they are the result of used-up matter returning into the circulation, and reaching even the brain and central parts of the nervous system. The cure is gained when the defective organs are brought to act well. It is shortsighted action to deal with the kidneys alone in this trouble. They often fail because they are overloaded through the failure of lungs and skin to do their part. First, it is well to act on the lungs by gentle rubbing with hot olive oil between the shoulders and over all the back--done best in a warm room by the fire, or in bed. This may be continued for half-an-hour or more twice daily. The skin may be stimulated by a smart sponging with vinegar or weak acetic acid, and a rubbing all over with soap lather, and afterwards with hot olive oil. This lathering and rubbing to be done at another time from the first rubbing for the lungs. Then apply a large warm bran poultice to the lower part of the back behind the kidneys.
We have often found the following simple treatment effectual, where the patient is not very weak. If there are any signs of heart failure, do not use it. But if the patient is fairly strong, it is most beneficial. You have a case, say, of dropsy in the abdomen: put on two folds of soft flannel, wrung out of cold water; put two folds dry over the moist ones. Keep away all oiled silk and everything of the kind. You will very soon have an astonishing outflow of insensible perspiration, but it passes off through the soft porous flannel without any obstruction whatever. You will find that under this the swelling soon comes down, and even disappears entirely. It is necessary, in such treatment, to renew the bandage so as to keep all fresh and healthful, but your work is abundantly rewarded. In such a case as this the matter to be passed off is so great that a cotton or ordinary linen bandage may fail, as being too impervious, when a flannel bandage will succeed. A Kneipp linen bandage is perfectly porous, and will not irritate the skin as flannel often does. Worn-out underwear can be kept for this purpose.
If stronger heat seems to be needed, a soft cloth four-ply thick, large enough to cover the whole lower back, should be dipped in CAYENNE LOTION (_see_), slightly squeezed, and placed on the back. Over this a dry cloth should be placed, and the patient should lie down on a bran poultice or hot-water bag for an hour or two. Afterwards the back should be rubbed with olive oil, and a band of soft new flannel worn round the body.
Even if the swelling is caused by rupture this treatment is the best. The rupture must be reduced (_see_ Rupture) and sustained by a proper truss, for which the patient should apply to a responsible surgical instrument maker. This treatment alone has cured many dropsical patients. Where failure of the heart's action complicates the trouble, this treatment will usually relieve the heart as well as kidneys. For drink in such cases see article Drinks. For food give whatever is most easily digested and passed into good blood. Wheaten-meal food, oatmeal jelly, etc., are good. _See also_ Biscuits and Water.
Drowning.--Many valuable lives have been saved by an elementary knowledge of what to do in the case of one apparently suffocated or drowned.
Commence treatment immediately in the open air, with the face down, neck and chest exposed, and all tight clothing such as braces removed.
The points to be aimed at are--first and _immediately_, the Restoration of Breathing; and secondly, after breathing is restored, the promotion of Warmth and Circulation. The efforts to restore Breathing must be commenced immediately and energetically, and persevered in for one or two hours, or until a medical man has pronounced that life is extinct. Efforts to promote Warmth and Circulation beyond removing the wet clothes and drying the skin must not be made until the first appearance of natural breathing, for if circulation of the blood be induced before breathing has recommenced the restoration to life will be endangered.
[Illustration: Turning on the Chest.]
_First_: Roll the patient over on his chest, with one of the arms under the forehead, when the water will readily leave the mouth. _Second_: If breathing does not recommence then, place him on his face, supporting the chest on a roll of clothing. Turn the body gently on the side, then briskly on the face repeating these movements, about 15 times in the minute. (By placing him on his chest the weight of the body forces the air out; when turned on the side air enters the chest). Five minutes is the longest that can be afforded to this treatment. _Third_: Turn him on his back, draw his tongue forward, keeping it forward by a band passing over it and under the chin, placing the roll of clothing under the shoulder blades. Then, kneeling at his head, grasp the arms just below the elbows, draw them above the head, keeping them stretched for about two seconds. Then turn down the arms and press them firmly for two seconds against the sides of the chest. (The outstretched position allows air to be drawn into the lungs, the other position allows it to be pressed out.)
[Illustration: Arms extended.]
When a spontaneous effort to respire is observed, proceed to induce Circulation and Warmth. This is accomplished by rubbing the limbs upwards with firm grasp and pressure underneath the warm blankets, or over the dry clothing which through bystanders or other means should have been already procured, apply hot flannels, hot water bottles, heated bricks, etc., to the pit of the stomach, the armpits, between the thighs and the soles of the feet.
Allow abundance of fresh air to play about the patient. Administer a teaspoonful of warm water, and then if the power of swallowing have returned, give hot milk, coffee, etc., in small quantities. The patient should be kept in bed and a disposition to sleep encouraged.
The above treatment should be persevered in for some hours, as it is an erroneous opinion that persons are irrecoverable because life does not soon make its appearance, persons having been restored after persevering for many hours. The appearances which generally accompany Death, are: Cessation of the heart's action, eyes half-closed, pupils dilated, tongue approaching to the inner edges of the lips, lips and nostrils covered with a frothy mucus. Coldness and pallor of surface increase.
[Illustration: Elbows on the Chest.]
_Cautions_: Prevent crowding, avoid rough usage; if the body is on the back have the tongue secured. Never hold up the body by the feet. Never place the body in a warm bath, unless under medical direction, and even then only momentarily.
Dwining.--We give this name to a trouble from which we have been able to save some patients, as expressing best the general failure and weakness which sometimes constitute a serious danger, even where all specific symptoms are wanting. Some cases of this kind we have cured, when they were supposed to be hopelessly dying, by the use of simple soap lather. The skin of the patient is usually dry, and the pulse feverish. In such a case take lather, made as directed in article Head, Soaping, and spread it gently all over the stomach and heart. Repeat this six or seven times, keeping the patient warm in bed. Then, after drying, do the same thing to the back. This does immense good. For the general skin stimulation, rub over with the mixture for NIGHT SWEATS (_see_). The skin is rubbed over with this five or six times, once a day.
Where there is no feverishness, but rather cold feelings, then use the _warm_ lather as directed, and rub well all over afterwards with hot olive oil. This treatment alone we know to have cured many.
Dysentery.--This is an affection of the bowels of the nature of diarrhoea, but much worse, as in it _blood_ accompanies the bowel discharge. It usually begins as diarrhoea, and at this stage may be cured by either warm vinegar and water or simple cold water injected into the bowel (_see_ Diarrhoea). Where there is any reason to suspect the water supply, that should be boiled for half-an-hour and cooled before use. Attention to the diet, taking for a time _milk_ diet alone, is also important. Nothing can be better than boiled bread and milk, giving no more than the sufferer feels he needs. When the diarrhoea has passed into true dysentery, with blood discharge, or the trouble begins as such, then enemas of weak acetic acid, or vinegar and water, given _warm_ (_i.e._, a little over blood heat), must be used instead of cold water. As much vinegar should be used as will make the mixture (_see_ Acetic Acid) very slightly smarting when applied to a tender part of the skin--say, to the corner of the eye. What is wanted is just as much acid as will act healingly on the injured vessels, and no more. An enema of this water mixed with acid may be repeated as long as required with perfect safety and good effect every time. Even if the disease has made very serious progress, this will tell upon it powerfully. These warm enemas should be very resolutely followed up as long as they give the least comfortable feeling. No one who has not felt their magical effect can conceive how powerful they are. We have seen a patient on the point of giving in and lying down as a helpless invalid made perfectly fit for work in less than an hour by this mode of treatment.
Where the trouble has passed into that stage where the patient is much weakened, in addition to this the ARMCHAIR FOMENTATION (_see_) should be employed; or if the patient be too weak, the fomentation may be properly wrapped round him in bed without rising. If the patient be too weak for wrapping round the body, he may be first wrapped round the legs, and so strengthened as to stand the stronger remedy. Olive oil must be rubbed on the skin before and after fomenting. The heat may be kept up for an hour. If too weak to stand even this, the feet and legs may be first fomented, and afterwards the body. This treatment has saved many cases from disaster. _See also_ British Cholera; Diarrhoea.
Dyspepsia.--_See_ Indigestion.
Earache.--In the common form this is purely neuralgic. The nerves are in shape and distribution like some tender plant, the root in the brain or spinal cord, and the ends of the branches in the organs supplied by them with nerve power. They are best affected, and most easily cured, by applications to the root rather than the branch ends. This is greatly the case with earache, which is a trouble of the nerves of the ear--not those of hearing, but the ordinary nerves supplying the part. The remedy is to press cold cloths on the _back of the head and neck_. This will often give instant relief. It is best done when the patient is thoroughly warm. If he be cold and clammy in feeling, the feet and legs must be well fomented before applying the cooling. Rub all parts treated with warm olive oil when the treatment is finished.
Ears, Running.--In this trouble there is indicated a failure somewhere of the clearance of waste from the body. This matter gathers locally in the ear, where suppuration and discharge take place. A cure must not be directed to the ear alone, but first the general waste-removing system should be stimulated with special reference to its service in the ear. Rubbing the back with hot olive oil and gentle pressure for a long time, say forty minutes daily, will go further to cure the ears than anything which can be done to themselves. Gatherings, by this treatment, are often quickly dissolved and dispersed.