Part 17

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

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

If the soapy blanket be too severe on the patient, then apply general lathering with M'Clinton's Soap. Use a badger's-hair shaving brush, and have the lather like whipped cream with no free water along with it. We have known a few of these applications cure a case of long standing.

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

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

Elbow Joint.--See Armpit Swelling and Bone.

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

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

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

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

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

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

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

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

How is it that vital action seizes these mere motor nerves and leaves the brain? There is a symptom in cases of epilepsy which tends to throw some light on this question. It is seen in the extreme activity of the brain, indicated by the incessant talking of the patient before a series of convulsions come on, when taken along with the extreme depression and silence that follow such a series. During whole nights, even, the sufferer will talk, till every organ is exhausted; then comes a series of violent convulsions, then a season of perfect silence and bewilderment.

This explanation of the disease points to the remedy. That which will nurse the brain, and at the same time lessen nervous force in the system, will tend to cure the evil. Strong fomentations round the lower part of the body may be used. Soap in fine LATHER (see) should be made to cover the skin at bedtime, and washed off with weak ACETIC ACID (see) in the morning. Easily digested food should be taken, and all so-called stimulants strictly avoided. We should endeavour to secure the soothing of the spinal system of nerves. This is done in a degree that is incredible to those who have not actually witnessed it by a persevering use of the cold treatment of the back. The best time is early in the morning, after the patient has had a good night's sleep. For a whole hour spinal treatment should then be used. We have no faith in any royal road to success in such a cure, but we have faith in common sense and right good work. Taking three towels, and putting two of them in cold water, the "operator" is ready to begin. It will be well first to rub the patient's back gently with a little warm olive oil. This will obviate all danger of shock or shiver when the cold cloth is placed on the skin. Then wring out one of the cold towels thoroughly, so as to have it damp and not dripping; fold it lengthways eight ply. Put the one over the other, place both on the centre of the patient's back as he is sitting up in bed to receive them, keeping the damp towel next the skin. Adjust these cloths nicely, make the patient lie down upon them, and cover him snugly up with the bedclothes. So long as the feeling is nice, let well alone. When the towel becomes hot, wring out the second, and change it on the back. Carry this out for a full hour, and if the patient is disposed to go to sleep again, encourage him to do so.

Continued for weeks every morning this humble treatment, without any addition, has an incredibly soothing effect on an excitable system. But it will be well to add to it some nursing of the head and feet, so that every encouragement may be given to a diffusion of nerve action over the body. At night, before going to bed, the feet and legs should be bathed in hot water for a quarter of an hour, dried, rubbed gently with warm olive oil, and a pair of soft cotton stockings drawn on. While the patient is being treated, every possible wearing and irritation of the brain must be avoided, and when lying on the cold towel, the head should be soothingly rubbed by a gentle hand. If an actual violent attack comes on, loose all tight clothes, place a piece of cork between the patient's teeth to prevent biting the tongue, give plenty of fresh air, and keep the patient in a recumbent position.

Everything should be done, by training, to increase the patient's self-control, and all stimulants should be avoided as most injurious. See Head, Rubbing the.

It is important that those liable to these attacks should be kept employed. Nothing is so harmful as idleness. Everything tending to good health is of value, but the essentials of the treatment are found in soothing the spine as above, and stimulating the brain by the head rubbing. Unless in cases in which the very structure of the system has been, so to speak, altered by long-continued disease of this sort, we should look for good results from such treatment as this. Even in the worst cases it would be possible to mitigate the severity of the distress.

A difference in the focus of the eyes often causes a strain on the brain in the effort to adjust them. This sometimes causes epilepsy, and we have known many cases cured by the use of spectacles made to correct this inequality. In all cases of this disease, therefore, an optician should be consulted, to see if there is any defect in the eyes.

Other illnesses are sometimes mistaken for epilepsy: for example, the liver and kidneys in a defective state and impurities passing in the blood to the brain, will explain certain forms of that which passes as epilepsy. It is often easy to cure attacks of this nature by merely bringing the liver and kidneys into working order. If there is a yellowness of the skin, or other signs of the blood failing to be purified in a natural way, then that should first be dealt with, and the fits will often be removed as soon as good action is established in the purifying organs. But in all cases in which there is anything like real "fits," it will be found of great importance to study the over-and-under-actions of the nerve system as by far the most essential elements in the disease. See Jaundice.

Eruptions.--See Hives; "Outstrikes;" Saltrome, etc.

Erysipelas.--This troublesome disease is also known as St. Anthony's Fire, or the Rose. The skin becomes fiery red or even purplish in hue. A violent heat and pain in the part accompany this, and fever and general disturbance of the system follow in a severe case. Swelling of the parts follows, with much distress and danger. Air irritates violently the sore parts, and is usually excluded.

In curing the trouble, regard must be had to the cause, which is usually a general failure of strength from overwork, worry, or some other disease. If a cure is to be effected, rest of mind and body is necessary, and must be secured at any possible cost. For local application, the sore parts are thickly dusted with fine fresh flour, and covered with soft wadding or surgeon's lint. The air is excluded, and all is kept strictly dry. A waterproof covering over the lint will help this, but is not absolutely necessary.

But, now, is there nothing that can be done to quicken that inner action, the slowness of which has paved the way for all this mischief? This might be done in two ways. After the affected parts, say the face, have been secured in this pack of flour, it will be easy to place a hot blanket, soaked partly, but not at all wet, with boiling water, all round the head of the patient. As soon as the heat begins to enter the head, a sense of comfort will be experienced. Care must be taken to keep the inner cloths dry, and heat is best given by an india-rubber bag. When this cannot be had, however, the blanket may be used. At intervals, as the patient feels it desirable, this fomentation may be renewed. It will hasten recovery as well as arrest the spreading of the malady, while it will secure such recovery as will not readily dispose to a return of the evil. The feet and legs are likely to be cold. As the sufferer lies still in bed, but not when the other fomentation is on, these should be wrapped in a hot fomentation, allowed to lie in it for a good half-hour, taken out of it and dried, rubbed with warm olive oil, and covered with a pair of soft cotton stockings. If this treatment is at all well carried out, the feeling of comfort given will soon tell how it is working. Of course, if the feet and legs are the parts affected, the fomentation must be applied elsewhere, say on the back, or on the haunches.

Where erysipelas appears in connection with wounds or sores, the same treatment is to be pursued, as far as possible consistent with dressing the sores. These should be carefully cleansed, dusted with boric acid, and covered with a layer of wadding bandage. The limb should be raised to a horizontal position. Simple food should be given, and the sufferer kept quiet. In all cases of skin trouble, linen should be worn next the skin. See Underwear.

Exercise.--Where this is advised medically, it is often taken in a manner far from wise. For weakly people seeking strength, exercise should never be pursued to the extent of fatigue. Up to a certain point it does good; beyond that, harm. The beginning of harm is indicated by the feeling of weariness. At the same time it must be remembered that what is felt as weariness may be merely laziness. This must be energetically combated. There is no royal road to health any more than to learning.

In some cases this disinclination for exercise may arise from too much or too rich food, and a more sparing diet may remove it. See Appendix; Physical Culture.