The Home Medical Library Volume II Part 11

=INFANTILE SCURVY.=--Scurvy occasionally occurs in infants between twelve and eighteen months of age, and is due to feeding on patent foods, condensed milk, malted milk, and sterilized milk. In case it is essential to use sterilized or pasteurized milk, if the baby receives orange juice, as advised under the care of infants, scurvy will not develop.

Scurvy is frequently mistaken for either rheumatism or paralysis in babies.

=Symptoms.=--The lower limbs become painful, and the baby cries out when it is moved. The legs are at first drawn up and become swollen all around just above the knees, but not the knee joints themselves.

Later the whole thigh swells, and the baby lies without moving the legs, with the feet rolled outward and appears to be paralyzed, although it is only pain which prevents movement of the legs.

Sometimes there is swelling about the wrist and forearm, and the breastbone may appear sunken in. Purplish spots occur on the legs and other parts of the body. The gums, if there are teeth present, become soft, tender, spongy, and bleed easily. There may be slight fever, the temperature ranging from 101 to 102 F. The babies are exceedingly pale, and lose all strength.

=Treatment.=--The treatment is very simple, and recovery rapidly takes place as soon as it is carried out. The feeding of all patent baby foods--condensed or sterilized milk--must be instantly stopped. A diet of fresh milk, beef juice, and orange juice, as directed under the care of infants, will bring about a speedy cure.

=GOUT.=--Notwithstanding the frequency with which one encounters allusions to gout in English literature, it is unquestionably a rare disease in the United States. In the Ma.s.sachusetts General Hospital there were, among 28,000 patients admitted in the last ten years, but four cases of gout. This is not an altogether fair criterion, as patients with gout are not generally of the cla.s.s who seek hospitals, nor is the disease one of those which would be most likely to lead one into a hospital. Still, the experience of physicians in private practice substantiates the view of the rarity of gout in this country.

We are still ignorant of the exact changes in the bodily condition which lead to gout, but may say in a general way that in this disease certain products, derived from our food and from the wear and tear of tissues, are not properly used up or eliminated, and are retained in the body. One of these products is known as sodium biurate, and is deposited in the joints, giving rise to the inflammation and changes to be described. Gout occurs chiefly in men past forty. The tendency to the disease is usually inherited. Overeating, together with insufficient exercise and indulgence in alcohol, are conducive to its development in susceptible persons. Injuries, violent emotion, and exposure to cold are also thought to favor attacks.

The heavier beers and ales of England, together with their stronger wines, as port, Madeira, sherries, and champagne, are more p.r.o.ne to induce gout than the lighter beers drunk in the United States and Germany. Distilled liquors, as brandy and whisky, are not so likely to occasion gout. "Poor man's gout" may arise in individuals who lead the most temperate lives, if they have a strong inherited tendency to the disease, or when digestion and a.s.similative disorders are present, as well as in the case of the poor who drink much beer and live in bad surroundings, and have improper and insufficient food. Workers in lead, as typesetters and house painters, are more liable to gout than others.

=Symptoms.=--There is often a set of preliminary symptoms varying in different persons, and giving warning of an approaching attack of gout, such as neuralgic pains, dyspepsia, irritability, and mental depression, with restless nights. An acute attack generally begins in the early morning with sudden, sharp, excruciating pain in the larger joint of one of the big toes, more often the right, which becomes rapidly dark red, mottled, swollen, hot, tense, s.h.i.+ny, and exceedingly sensitive to touch. There is commonly some fever; a temperature of 102 to 103 F. may exist. The pain subsides in most cases to a considerable degree during the day, only to return for several nights, the whole period of suffering lasting from four to eight days.

Occasionally the pain may be present without the redness, swelling, etc., or _vice versa_.

Other joints may be involved, particularly the joint of the big toe of the other foot. Complete recovery ensues, as a rule, after the first attack, and the patient may thereafter feel exceptionally well. A return of the disease is rather to be expected. Several attacks within the year are not uncommon, or they may appear at much longer intervals.

Occasionally the gout seems to "strike in." In this case it suddenly leaves the foot and attacks the heart, causing the patient severe pain in that region and great distress in breathing; or the abdomen becomes the seat of violent pain, and vomiting, diarrhea, collapse and death rarely result. In the later history of such patients, the acute attacks may cease and various joints become chronically diseased, so that the case a.s.sumes the appearance of a chronic form of rheumatism.

The early history of attacks of sharp pain in the great toe and the appearance of hard deposits (chalk stones) in the knuckles and the ears are characteristic of gout.

The greatest variety of other disorders are common in those who have suffered from gout, or in those who have inherited the tendency.

"Goutiness" is sometimes used to describe such a condition. In this there may never be any attacks of pain or inflammation affecting the joints, but eczema and other skin diseases; tonsilitis, neuralgia, indigestion and biliousness, lumbago and other muscular pains, sick headache, bronchitis, disease of heart and kidneys, with a tendency to apoplexy, dark-colored urine, stone in the bladder, and a hot, itching sensation in the palms of the hands and soles of the feet, all give evidence of the gouty const.i.tution.

=Treatment.=--One of the most popular remedies is colchic.u.m--a powerful drug and one which should only be taken under the direction of a physician. A cathartic at the beginning is useful; for instance, two compound cathartic pills or five grains of calomel. It is well to give five grains of lithium citrate dissolved in a gla.s.s of hot water every three hours.

Laville's antigout liquid, imported by Fougera of New York, taken according to directions, may suffice during the absence of a physician. The inflamed toe should be raised on a chair or pillow, and hot cloths may be applied to it. The general treatment, between the attacks, consists in the avoidance of all forms of alcohol, the use of a diet rich in vegetables, except peas, beans, and oatmeal, with meats sparingly and but once daily. Sweets must be reduced to the minimum, but cereals and breadstuffs are generally allowable, except hot bread.

All fried articles of food, all smoked or salted meats, smoked or salted fish, pastry, griddle cakes, gravies, spices and seasoning, except red pepper and salt, and all indigestibles are strictly forbidden, including Welsh rarebit, etc. Fruit may be generally eaten, but not strawberries nor bananas. Large quant.i.ties of pure water should be taken between meals--at least three pints daily. Mineral waters offer no particular advantage.

Part III

s.e.xUAL HYGIENE

BY

KENELM WINSLOW

CHAPTER I

=Health and Purity=

_Duties of Parents--Abuse of the s.e.xual Function--False Teachings--Criminal Neglect--Secure the Child's Confidence--The Best Corrections--Marriage Relations._

Every individual should know how to care for the s.e.xual organs as well as those of any other part of the body, providing that the instruction be given by the proper person and at the proper time and place. Such information should be imparted to children by parents, guardians, or physicians at an early age and, if this is neglected through ignorance or false modesty, erroneous ideas of the nature and purpose of the s.e.xual function will very surely be supplied later by ignorant and probably evil-minded persons with correspondingly bad results. There is no other responsibility in the whole range of parental duties which is so commonly s.h.i.+rked and with such deplorable consequences. When the subject is shorn of the morbid and seductive mystery with which custom has foolishly surrounded it in the past, and considered in the same spirit with which we study the hygiene of the digestion and other natural functions, it will be found possible to give instruction about the s.e.xual function in a natural way and without exciting unhealthy and morbid curiosity.

A word in the beginning as to the harm produced by abuse of the s.e.xual function. The injury thus received is purposely magnified tenfold for reasons of gain by quacks who work upon the fears of their victims for their own selfish purposes. The voluntary exercise of the s.e.xual function--unlike that of any other important organs--is not necessary to health until maturity has been reached; on the contrary, continence is conducive to health, both physical and mental. Even after maturity, unless marriage occurs, or by improper living the s.e.xual desires are unnaturally stimulated, it is quite possible to maintain perfect health through life without exercising the s.e.xual function at all.

Undue irritation of the s.e.xual organs causes disorder of the nervous system, and if continued it will result ultimately in overfatigue and failure of the nervous activities which control the normal functions of every organ in the body. In other words, it will result in nervous exhaustion.

Damage is also wrought by exciting local irritation, congestion, and inflammation of the s.e.xual organs which result in impairment of the proper functions of these parts and in local disorders and distress.

It is unnecessary further to particularize other than to state that abuse of the s.e.xual organs in the young is usually owing to the almost criminal neglect or ignorance of the child's parents. But so far from increasing alarm in the patient it is almost always possible to enable the child to be rid of the habit by kindly instruction and judicious oversight in the future, and no serious permanent local damage to the s.e.xual organs or general injury to the nervous system will be likely to persist. The opposite teaching is that peculiar to the quack who prophesies every imaginable evil, from complete loss of s.e.xual function to insanity. Any real or fancied disorder of the s.e.xual function is extremely apt to lead to much mental anxiety and depression, so that a cheerful outlook is essential in inspiring effort to correct bad habits and is wholly warranted in view of the entire recovery in most cases of the young who have abused their s.e.xual organs. Insanity or imbecility are seldom the result but more often the cause of such habits. It is a sad fact, however, that, under the prevailing custom of failure of the parents to exercise proper supervision over the s.e.xual function of their children, self-abuse is generally practiced in youth, at least by boys.

This often leads to temporary physical and mental suffering and is very prejudicial to the morals, but does not commonly result in permanent injury except in the degenerate. Children at an early age--three to four years--should be taught not to touch, handle, rub, or irritate their s.e.xual organs in any way whatsoever except so far as is necessary in urination or in the course of the daily cleansing. If there seems to be any inclination to do so it will usually be found that it is due to some local trouble to which a physician's attention should be called and which may generally be readily remedied by him.

It is always advisable to ask the medical adviser to examine babies for any existing trouble and abnormality of the s.e.xual organs, as a tight, adherent, or elongated foreskin in boys--and rarely a corresponding condition in girls--may give rise to much local irritation and remote nervous disturbances. The presence of worms may lead to irritation in the bowel, which excites masturbation in children. Girl babies should be watched to prevent them from irritating the external s.e.xual parts by rubbing them between the inner surfaces of the thighs. As the child begins to play with other children he or she should be cautioned to avoid those who in any way try to thwart the parents' advice, and be instructed to report all such occurrences. It is wise also to try and gratify the child's natural curiosity about the s.e.xual function so far as may be judicious by explanations as to the purpose of the s.e.xual organs, when the child is old enough to comprehend such matters.

The reticence and disinclination of parents to instruct their children in matters relating to s.e.x cannot be too strongly condemned. It is perfectly natural that the youth should wish to know something of the origin of life and how human beings come into the world. The mystery and concealment thrown around these matters only serve to stimulate his curiosity. It is a habit of most parents to rebuke any questions relating to this subject as improper and immodest, and the first lesson the child learns is to a.s.sociate the idea of shame with the s.e.xual organs; and, since he is not enlightened by his natural instructors, he picks up his knowledge of the s.e.x function in a haphazard way from older and often depraved companions.

Evasive replies with the intent of staving off the dreaded explanation do no good and may result in unexpected evil. By securing the child's confidence at the start, one may not only keep informed of his actions but protect him from seeking or even listening to bad counsels. At the age of ten or twelve it is well that the family physician or parent should give instruction as to the special harm which results from unnaturally exciting the s.e.xual nature by handling and stimulating the s.e.xual organs and also warning the child against filthy literature and improper companions. At the age of p.u.b.erty he should be warned against the moral and physical dangers of s.e.xual intercourse with lewd women.

The physical dangers refer to the great possibility of infection with one or both of the common diseases--syphilis and gonorrhea--acquired by s.e.xual contact with one suffering from these terrible disorders (p.

199). It is usually quite impossible for a layman to detect the presence of these diseases in others, or rather, to be sure of their absence, and the permanent damage which may be wrought to the sufferer and to others with whom he may have s.e.xual relations is incalculable.

It is generally known that syphilis is a disease to be dreaded, but not perhaps that it not only endangers the life and happiness of the patient, but the future generation of his descendants. Gonorrhea--the much more common disease--while often treated lightly by youth, frequently leads to long, chronic, local disease and may even result fatally in death; later in life it may cause infection of a wife resulting in chronic invalidism and necessitating surgical removal of her maternal organs. These possibilities often occur long after the patient thinks he is wholly free from the disease. Gonorrhea in women is the most frequent cause of their sterility, and also is a common source of abortion and premature birth. It is the cause in most cases of blindness in infants (p. 205) and also of vulvo-vaginitis in girl babies. Furthermore, gonorrhea is so alarmingly prevalent that it is stated on good authority that the disease occurs in eighty per cent of all males some time during their lives. The disease is not confined to prost.i.tutes, but is common, much more frequently than is suspected, in all walks and cla.s.ses of life and at all ages. Even among boys attending boarding schools and similar inst.i.tutions the disease is only too frequent. It is particularly important that the true situation be explained to boys about to enter college or a business career, for it is at this period of life that their temptations become greatest. Alcohol is the most dangerous foe--next to bad companions--with which they must contend in this matter, for, weakened by its influence and a.s.sociated with persuasive friends, their will gives way and the advice and warning, which they may have received, are forgotten. Idleness is also another influential factor in indirectly causing s.e.xual disease; hard physical and mental work are powerful correctives of the pa.s.sions.

It may be of interest to readers to know that but recently an a.s.sociation of American physicians, alarmed by the fearful prevalence of s.e.xual diseases in this country, has been taking measures to inform youths and adults and the general public, through special instruction in schools, and by means of pamphlets and lectures to teachers and others, of the prevalence and great danger of this evil.

When young adult life has been attained it is also desirable for the parent, or the family physician, to inform the young man or woman--especially if either is about to enter a marriage engagement--that close and frequent personal contact with the opposite s.e.x, especially when the affections are involved, will necessarily, though involuntarily, excite local stimulation of the s.e.xual organs and general irritability and exhaustion of the entire nervous system.

Long engagements--when the partic.i.p.ants are frequent companions--are thus peculiarly unfortunate. It is only when the s.e.xual functions are normally exercised in adult life, as in s.e.xual intercourse, that s.e.xual excitement is not harmful.

Young women about to marry should receive instruction from their mothers as to the s.e.xual relations which will exist after marriage.

Most girls are allowed to grow up ignorant of such matters and in consequence may become greatly shocked and even disgusted by the s.e.xual relations in marriage--fancying that there must be something unnatural and wrong about them because the subject was avoided by those responsible for their welfare.

Any excess in frequency of s.e.xual intercourse after marriage is followed by feelings of depression and debility of some sort which may be readily attributed to the cause and so corrected. Any deviation from the natural mode of intercourse is pretty certain to lead to physical disaster; thus, unnatural prolongation of the act, or withdrawal on the part of the man before the natural completion of the act in order to prevent conception, often results in deplorable nervous disorders.

In conclusion, it may be said that parents must take upon themselves the burden of instructing their children in s.e.xual hygiene or s.h.i.+ft it upon the shoulders of the family physician, who can undertake it with much less mental perturbation and with more intelligence. Otherwise they subject their offspring to the possibility of incalculable suffering, disease, and even death--largely through their own inexcusable neglect.

CHAPTER II

=Genito-Urinary Diseases=

_Contagious Disorders--Common Troubles of Children--Inflammation of the Bladder--Stoppage and Suppression of Urine--Causes and Treatment of Bright's Disease._

=GONORRHEA.=--Gonorrhea is a contagious inflammation of the urethra, accompanied by a white or yellowish discharge. It is caused by a specific germ, the _gonococcus_, and is acquired through s.e.xual intercourse with a person suffering from this disease. Exceptionally the disease may be conveyed by objects soiled with the discharge, as basins, towels, and, in children, diapers, so that in inst.i.tutions for infants it may be thus transferred from one to the other, causing an epidemic. The mucous membrane of the lower part of the bowel and the eyes are also subject to the disease through contamination with the discharge. The disease begins usually three to seven days after s.e.xual intercourse, with symptoms of burning, smarting, and pain on urination, and a watery discharge from the pa.s.sage, soon followed by a yellowish or white secretion. Swelling of the p.e.n.i.s, frequent urination, and painful erections are also common symptoms. The disease, if uncomplicated and running a favorable course, may end in recovery within six weeks or earlier, with proper treatment. On the other hand, complications are exceedingly frequent, and the disorder often terminates in a chronic inflammation which may persist for years--even without the knowledge of the patient--and may result in the infection of others after all visible signs have ceased to appear.

=Treatment.=--Rest is the most important requisite; at first, best in bed; if not, the patient should keep as quiet as possible for several days. The diet should consist of large quant.i.ties of water or milk, or milk and vichy, with bread, cereals, potatoes, and vegetables--absolutely avoiding alcohol in any form. s.e.xual intercourse is harmful at any stage in the disease and will communicate the infection. Aperient salts should be taken to keep the bowels loose. The p.e.n.i.s should be soaked in hot water three times daily to reduce the inflammation and cleanse the organ. A small wad of absorbent cotton may be held in place by drawing the foreskin over it to absorb the discharge, or may be held in place by means of a bag fitting over the p.e.n.i.s. All cloths, cotton, etc., which have become soiled with the discharge, should be burned, and the hands should be washed after contact with the discharge; otherwise the contagion may be conveyed to the eyes, producing blindness. It is advisable for the patient to take one-half teaspoonful of baking soda in water three times daily between meals for the first four or five days, or, better, fifteen grains of pota.s.sium citrate and fifteen drops of sweet spirit of nitre in the same way. Painful erections may be relieved by bathing the p.e.n.i.s in cold water, urinating every three hours, and taking twenty grains of sodium bromide at night in water. After all swelling and pain have subsided, local treatment may be begun.

Injections or irrigations with various medicated fluids const.i.tute the best and most efficient measures of local treatment. They should be used only under the advice and management of the physician. No greater mistake can be made than to resort to the advertising quack, the druggist's clerk, or the prescription furnished by an obliging friend.