Illustration: Fig. 147.
Fig. 147. A A.—Enlarged Tonsils. B.—Elongated Uvula.

Chronic enlargement of the tonsils, as shown in Fig. 147, A A, is an exceedingly common affection. It is most common to those of a scrofulous habit. It rarely makes its appearance after the thirtieth year, unless it has existed in earlier life, and has been imperfectly cured. Both tonsils are generally, though unequally enlarged. A person affected with this disease is extremely liable to sore throat, and contracts it on the slightest exposure; the contraction of a cold, suppression of perspiration, or derangement of the digestive apparatus being sufficient to provoke inflammation.

[pg 418]Causes. Repeated attacks of quinsy, scarlet fever, diphtheria, or scrofula, and general impairment of the system, predispose the individual to this disease.

Symptoms. The voice is often husky, nasal or guttural, and disagreeable. When the patient sleeps, a low moaning is heard, accompanied with snoring and stentorian breathing, and the head is thrown back so as to bring the mouth on a line with the windpipe, and thus facilitate the ingress of air into the lungs. When the affection becomes serious, it interferes with breathing and swallowing. The chest is liable to become flattened in front and arched behind, in consequence of the difficulty of respiration, thus predisposing the patient to pulmonary disease. On looking into the throat, the enlarged tonsils may be seen, as in the figure. Sometimes they are so greatly increased in size that they touch each other.

Treatment. The indications to be carried out in the cure of this malady are:

(1.) To remedy the constitutional derangement.

(2.) To remove the enlargement of the tonsil glands.

The successful fulfillment of the first indication may be readily accomplished by attention to hygiene, diet, clothing, and the use of the Golden Medical Discovery, together with small daily doses of the Pleasant Purgative Pellets. This treatment should be persevered in for a considerable length of time after the enlargement has disappeared, to prevent a return.

To fulfill the second indication, astringent gargles may be used. Infusions of witch-hazel or cranesbill should be used during the day. The following mixture is unsurpassed: iodine, one drachm; iodide of potash, four drachms; pure, soft water, two ounces. Apply this preparation to the enlarged tonsils twice a day, with a probang, or soft swab, being careful to paint them each time. A persevering use of these remedies, both internal and local, is necessary to reduce and restore the parts to a healthy condition.

Sometimes the enlarged tonsils undergo calcareous degeneration; in this case, nothing but their removal by a surgical operation is effectual. This can be readily accomplished by any competent surgeon. We have operated in a large number of cases, and have never met with any unfavorable results.

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ELONGATION OF THE UVULA.

Chronic enlargement or elongation of the uvula, or palate, as shown at B, Fig. 147, may arise from the same causes as enlargement of the tonsils. It subjects the individual to a great deal of annoyance by dropping into and irritating the throat. It causes tickling and frequent desire to clear the throat, change, weakness, or entire loss of voice, and difficulty of breathing, frequently giving rise to the most persistent and aggravating cough.

Treatment. The treatment already laid down for enlarged tonsils, with which affection, elongation of the uvula is so often associated, is generally effectual. When it has existed for a long time and does not yield to this treatment, it may be removed by any competent surgeon.

ANÆMIA.

When the blood contains less than the ordinary number of red corpuscles, the condition is known as anÆmia, and is characterized by every sign of debility. A copious hemorrhage, in consequence of a cut, or other serious injury, will lessen the quantity of blood and may produce anÆmia. After sudden blood-letting, the volume of the circulation is quickly restored by absorption of fluid, but the red corpuscles cannot be so readily replaced, so that the blood is poorer by being more watery. This is only one way in which the blood is impoverished.

The blood may be exhausted by a drain upon the system, in consequence of hard and prolonged study. Severe mental employment consumes the red corpuscles, leaving the blood thin, the skin cool and pale, and the extremities moist and cold.

AnÆmia may arise from lack of exercise, or it may be occasioned by mental depression, anxiety, disappointment, trouble, acute excitement of the emotions or passions, spinal irritation; in fact, there are many special relations existing between the red corpuscles of the blood and the various states of the mind and the nervous system. The latter depends directly upon the health and quantity of these red corpuscles for its ability to execute its functions.

[pg 420]AnÆmia may arise in consequence of low diet, or because the alimentary organs do not properly digest the food, or when there is not sufficient variety in the diet. No matter how anÆmia is occasioned, whether by labor and expenditure, by hemorrhages, lead poisoning, prolonged exposure to miasmatic influences, deprivation of food, indigestion, imperfect assimilation, frequent child-bearing, or lactation, the number of the red corpuscles in the blood is materially diminished.

The diagnostic symptoms of anÆmia are pallor of the face, lips, tongue, and general surface, weakness of the vital organs, hurried respiration on slight exercise, swelling or puffiness of the eyes, and a murmur of the heart, resembling the sound of a bellows.

This disorder of the blood tends to develop low inflammation, dropsical effusion, tubercular deposits, Bright's disease, derangements of the liver, diarrhea, leucorrhea, and is a precursor of low, protracted fevers. This condition of the blood predisposes to the development of other affections, providing they are in existence, and often it is found associated with Bright's disease, cancer, and lung difficulties.

Treatment. (1.) Prevent all unnecessary waste and vital expenditure.

(2.) Place the patient under favorable circumstances for recovery, by regulating the exercise and clothing entertaining the mind, and furnishing plenty of pure air.

(3.) Prescribe such a nutritious diet as will agree with the enfeebled condition of the patient.

(4.) Regular habits should be established in regard to meals, exercise, recreation, rest, and sleep.

(5.) The use of tonics and stimulants, as much as the stomach will bear, should be encouraged. Bathe the surface with a solution of a drachm of quinine in a pint of whiskey.

(6.) Iron, in some form, is the special internal remedy in anÆmia. Meantime, it is proper to treat the patient with gentle, manual friction, rubbing the surface of the body lightly and briskly with the warm, dry hand, which greatly stimulates the circulation of the blood. AnÆmia occurs more frequently in the female than in the male, because her functions and duties are more likely to give rise to it.

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APNOEA.

Apnoea, or short, hurried, difficult respiration, is occasioned by certain conditions of the blood. When anything interferes with the absorption of oxygen, or the elimination of carbonic acid, the blood is not changed from venous to arterial, and becomes incapable of sustaining life. This morbid condition is termed asphyxia. We often read of persons going into wells where there are noxious gases, or remaining in a close room where there are live coals generating carbonic acid gas and thus becoming asphyxiated, dying for want of oxygen.

Deficiency of oxygen is the cause of apnoea, and sometimes the red corpuscles themselves are so few, worn out, or destroyed, that they cannot carry sufficient oxygen, and the consequence is that the patient becomes short of breath, and when a fatal degeneration of the corpuscles ensues, he dies of asphyxia. Many a child grows thin and wan and continues to waste away, the parents little dreaming that the slow consumption of the red corpuscles of the blood is the cause which is undermining the health. Sometimes this disease is the result of starvation, irregular feeding, improper diet, want of care, and, at other times, want of fresh air, proper exercise, and sunlight.

Treatment. The first essential to success in the treatment of this disease, is the removal of the exciting cause. Exercise in the outdoor air and sunlight, with good, nutritious food, and well-ventilated sleeping apartments, are of the greatest importance. The bitter tonics, as hydrastin, with pyrophosphate of iron, should be employed to enrich the blood and build up the strength.

LEUCOCYTHÆMIA.

This term is used to designate a condition in which there is an excess of colorless blood-corpuscles. In health, the colorless corpuscles should exist only in the proportion of one, to one or two hundred of the red corpuscles. These colorless corpuscles increase when there is disease of the lymphatic glands, but whether this is the cause of their increase or perversion is not known.

They have been found abundant in the blood in diseases of the spleen and of the liver. Diarrhea usually attends this [pg 422]complaint, together with difficult breathing, loss of strength, gradual decline, fever, diminution of vital forces, and finally death. The recovery of a well-marked case of this disease is very doubtful. Its average duration is about one year.

DROPSIES.

Transudation is the passage of fluid through the tissue of any part of the body without changing its liquid state, while exudation means, medically, the passage of matter which coagulates and gives rise to solid deposits. When transudations are unhealthy, they may accumulate in serous cavities or in cellular structures, and constitute dropsy. Exudation is the result of inflammation, and the product effused coagulates and becomes the seat of a new growth of tissue. Exosmosis means the passage of fluid from within outward, and is a process constantly taking place in health; while transudation takes place because the blood is watery and the tissues are feeble and permeable, permitting the serum and watery elements of the blood to pass into certain cavities, where they accumulate.

The cause of dropsies may be low diet, insufficient exercise, indigestion, hemorrhages, wasting diseases, in fact, any thing which impoverishes the blood and increases the relative amount of serum. The tardy circulation of blood in the veins, or its obstruction in any way, is a condition highly favorable to the development of dropsy.

General dropsy is called anasarca, and is readily distinguished by bloating or puffiness of the skin all over the body. This condition is also called oedema. The skin is pale, yields under the finger without pain, and preserves the impression for some time. The oedema usually appears first in the lower extremities, next in the face, and from thence extends over the body.

General dropsy is commonly due to an impoverished condition of the blood, and this may be the result of albuminuria, a disease of the kidneys. Albuminuria is frequently the sequel of scarlatina. Hence, the utmost care should be taken against exposure of a patient recovering from scarlatina, and the same caution should be exercised during convalescence from measles, erysipelas, and rheumatism. Dropsies may be general, as in anasarca, or local, as dropsy of the heart, called cardiac dropsy: [pg 423]dropsy of the peritoneum, the serous membrane which lines the abdominal cavity, called ascites; dropsy of the chest, called hydrothorax; dropsy of the head, called hydrocephalus; dropsy of the scrotum, called hydrocele.

Dropsy is not, therefore, of itself a disease, but only the symptom of a morbid condition of the blood, kidneys, liver, or heart. Thus disease of the valves of the heart, may obstruct the free flow of blood and thus retard its circulution. In consequence the pulse grows small and weak, and the patient cannot exercise or labor as usual, and finally the lower limbs begin to swell, then the face and body, the skin looks dusky, the appetite is impaired, the kidneys become diseased, there is difficulty in breathing, and the patient, it is said, dies of dropsy, yet dropsy was the result of a disease of the heart, which retarded the circulation and enfeebled the system, and which was actually the primary cause of death.

Treatment. Dropsy being only a symptom of various morbid conditions existing in the system, any treatment to be radically beneficial must, therefore, have reference to the diseased conditions upon which the dropsical effusion, in each individual case, depends. These are so various, and frequently so obscure, as to require the best diagnostic skill possessed by the experienced specialist, to detect them. There are, however, a few general principles which are applicable to the treatment of nearly all cases of dropsy. Nutritious diet, frequent alkaline baths to keep the skin in good condition and favor excretion through its pores, and a general hygienic regulation of the daily habits, are of the greatest importance. There are also a few general remedies which may prove more or less beneficial in nearly all cases. We refer to diuretics and hydragogue cathartics. The object sought in the administration of these is the evacuation of the accumulated fluids through the kidneys and bowels, thus giving relief. Of the diuretics, queen of the meadow, buchu, and digitalis generally operate well. As a cathartic, the Purgative Pellets accompanied with a teaspoonful or two of cream of tartar, will prove serviceable. Beyond these general principles of treatment it would be useless for us to attempt to advise the invalid suffering from any one of the many forms of dropsy. The specialist skilled by large [pg 424]experience in detecting the exact morbid condition which causes the watery effusion and accumulation, can select his remedies to meet the peculiar indications presented by each individual case. Sometimes the removal of the watery accumulation by tapping becomes necessary, in order to afford relief and give time for remedies to act. We have found it necessary to perform this operation very frequently in cases of hydrocele, and also quite often in cases of abdominal dropsy. The chest has also been tapped and considerable quantities of fluids drawn off, and this has been followed by prompt improvement and a final cure.

CASES TREATED.

Case I. A Canadian gentleman, aged 68, applied at the Invalids Hotel and Surgical Institute, for examination and treatment. He had been dropsical for over two years, and had become so badly affected as to be unable to lie down at night. His legs were so filled with water and enlarged as to render it almost impossible for him to walk, and there was a general anasarca. The least exertion was attended with the greatest difficulty of breathing. He had been under the treatment of several eminent general practitioners of medicine in Canada but found no relief. They were unable to discover the real cause of his ailment, but to the specialist who has charge of this class of diseases at our institution, and who annually examines and treats hundreds of such cases, it was at once apparent that the dropsy was caused from a weakened condition of the heart, which rendered it unable to perform its functions. He was put upon a tonic and alterative course of treatment, which also embraced the use of such medicines as have been found to exert a specific, tonic action upon the muscular tissues of the heart. He improved so rapidly that in less than two months he was able to lie down and sleep soundly all night. The bloating disappeared, his strength improved, and in three month's more he was discharged perfectly cured.

Case II. A man aged 42, consulted us by letter, stating that he was

troubled with general bloating which had made its appearance gradually and was attended by general debility and other symptoms which have been enumerated as common to general dropsy. He had been under the treatment of several home physicians without receiving any benefit; he had steadily grown worse until he felt satisfied that if he did not soon get relief he could not live very long. He was requested to send a sample of his urine for examination, as we had suspicions, from the symptoms which he gave, that the cause of his dropsy was albuminuria, or Bright's disease of the kidneys. On examination of the urine, albumen in very perceptible quantities was found to be present. We had, about this time, come into possession of a remedy said by very good authority, to be a specific in degeneration of the kidneys when not too far advanced, and we determined to test it upon this well-marked case. We accordingly prescribed it, together with other proper tonics and alteratives, at the same time giving the patient important hygienic advice, which must be complied with if success is attained in the management of this very fatal malady. Our patient gradually improved, and in a few months' time was restored to perfect health, which he has continued to enjoy ever since. From our [pg 425]subsequent experience, embracing the treatment of quite a large number of cases of Bright's disease of the kidneys, we are satisfied that it is, in its early stage, quite amenable to treatment.

Case III. A man aged 35, single, consulted us for what he supposed

to be enlargement of the testicles. The scrotum was as large as his head, and it was with difficulty that he could conceal the deformity from general observation. The disease was immediately recognized by the attending surgeon as hydrocele. The liquid was promptly drawn oft by tapping, and a stimulating injection was made into the scrotum to prevent re-accumulation. We mention this case only because it is one among a very large number who have consulted us supposing that they were suffering from enlargement of the testicles, cancer, or some other morbid growth within the scrotum, when a slight examination has shown the affection to be hydrocele, a disease which is speedily cured by tapping, with a little after treatment. The operation is perfectly safe and almost entirely painless.

Case IV. A lady, aged 24, consulted us by letter enumerating a long list of symptoms which clearly indicated abdominal dropsy, resulting from suppression of the menses. A well-regulated, hygienic treatment was advised, and medicines to restore the menstrual function by gradually toning up and regulating the whole system, were forwarded to her by express. After four months' treatment, perfect recovery resulted. Cases like this latter are very common and generally yield quite readily to proper management. No harsh or forcing treatment for restoring the menstrual function should be employed, as it will not only fail to accomplish the object sought, but it is also sure to seriously and irreparably injure the system. The most difficult cases which we have had to deal with, have been those which had been subjected by other physicians to the administration of strong emmenagogues in the vain effort to bring on the menses.

RHEUMATISM.

Prominent among constitutional diseases is the one known as rheumatism. It is characterized by certain local symptoms or manifestations in fibrous tissues. This term has been applied to neuralgic affections and to gout, but it differs from each in several essential particulars. Rheumatism may be divided into (1) Acute, (2) Chronic, (3) Muscular.

Acute Articular Rheumatism. Acute articular rheumatism implies an affection of the articulations or joints. It usually commences suddenly; sometimes pain or soreness in the joints precedes the disclosure of the disease. The symptoms are pain in the joints, tenderness, increased heat, swelling and redness of the skin. The pain varies in its intensity in different oases, and is increased by the movement of the affected parts. Swelling of the joints occurs, especially those of the knee, ankle, wrist, elbow, and the smaller joints of the hands and feet. The swelling and redness are generally in [pg 426]proportion to the acuteness of the attack. Acute articular rheumatism is always accompanied with more or less fever. Sweating is generally a prominent symptom, being strongly acid and more profuse during the night. The appetite is impaired, the tongue is coated, the bowels are constipated, or there is diarrhea.

The Duration of this Disease. Unlike fevers, its course is marked by fluctuations; frequently after a few days the pain subsides, the fever disappears, and convalescence is apparently established, when, suddenly, all the symptoms are renewed with even greater intensity than before. This disease rarely proves fatal, unless the heart is involved.

Causes. Rheumatism is frequently supposed to be occasioned by a suppression of the functions of the skin, and is generally attributed to the action of cold upon the surface of the body. But this acts only as an exciting cause. It is a disease of the blood. This form of rheumatism usually occurs between the age of fifteen and thirty, and prevails most extensively in changeable climates. Acute articular rheumatism seldom terminates in the chronic form.

Chronic Articular Rheumatism. Articular rheumatism, in the subacute or chronic form, is frequently observed in medical practice. The symptoms are pain and more or less swelling of the joints, although not of as grave a character as in acute rheumatism. There is frequently an absence of increased heat and redness. As in the acute form, the different joints are liable to be affected successively and irregularly, until, after a time, the disease becomes fixed in a single joint, and the fibrous tissues entering into the ligaments and tendons are liable to be affected. The appetite, digestion, and nutrition are often good, and, in mild cases, patients are able to pursue their daily vocations. The disease is supposed to be the same as in the acute form, but milder, and, strange to say, more persistent. A diseased condition of the blood is supposed to be involved in both instances, but this morbid state is less extended, and, at the same time, more obstinate in the chronic than in the acute form. Sub-acute articular rheumatism is not always chronic, and may disappear in a shorter time than in the acute form. Chronic articular rheumatism is not generally fatal, but there is danger of permanent deformities.

[pg 427]Muscular Rheumatism. This affection is closely allied to neuralgia, and may properly be called myalgia. It exists under two forms, acute and chronic. In acute muscular rheumatism, there is at first a dull pain in the muscles, which gradually increases. When the affected muscles are not used the pain is slight, and certain positions may be assumed without inducing it constantly; but in movements which involve contraction of the muscles the pain is very violent. In some cases, the disease is movable, changing from one muscle to another, but usually it remains fixed in the muscle first attacked. The appetite and digestion are not often impaired, and there is no fever. The duration of this form of rheumatism varies from a few hours to a week or more.

In subacute or chronic muscular rheumatism, pain is excited only when the affected muscles are contracted with unusual force, and then it is similar to that experienced in the acute form. The chronic form is more apt to change its position than the acute. The duration of this form is indefinite. In both the acute and chronic forms some particular parts of the body are more subject to the affection than others.

The muscles on the posterior part of the neck are subject to rheumatic affection. It is termed torticollis or cervical rheumatism in such cases, and should be distinguished from ordinary neuralgia. When the muscles of the loins are affected, it is commonly known as lumbago. In case the thoracic muscles are affected, it is known as pleurodynia. In coughing, sneezing, and the like, the pain produced is not unlike that in pleuritis and intercostal neuralgia.

One of the most marked features of muscular rheumatism, is the cramp-like pain, induced by the movements of the affected muscles, whereas the pain is slight when those muscles are uncontracted. This feature is very serviceable in distinguishing muscular rheumatism, or myalgia, from neuralgic affections. Another trait which distinguishes muscular rheumatism from neuralgia, is that the former is characterized by great soreness, while the latter is not. There is also a distinction between inflammation of the muscles and muscular rheumatism. In the case of the former, there is continued pain, swelling of the parts, occasional redness, and the presence of [pg 428]more or less fever, which conditions do not exist in the latter. Persons subject to rheumatism of the muscles, are apt to suffer from an attack, after exposure of the body to a draught of air during sleep, or when in a state of perspiration.

Treatment of Acute Rheumatism. Administer the spirit vapor-bath to produce free perspiration, which should be maintained by full doses of the Compound Extract of Smart-weed. The anodyne properties of the latter also prove very valuable in allaying the pain. Tincture or fluid extract of aconite root may also be employed, to assist in equalizing the circulation, and also to secure its anodyne action. Black cohosh seems to exert a specific and salutary influence in this disease, and the tincture or fluid extract of the root of this plant may be advantageously combined with the aconite. Take fluid extract of aconite-root, thirty drops; fluid extract of black cohosh, one drachm; water, fifteen teaspoonfuls; mix. The dose is one teaspoonful every hour. The whole person should be frequently bathed with warm water, rendered alkaline by the addition of saleratus or soda. The painful joints may be packed with wool or with cloths wrung from the hot saleratus water, and the patient kept warm and quiet in bed. The acetate of potash taken in doses of five grains, well diluted with water, every three or four hours, is very valuable in acute rheumatism. Its alkaline qualities tend to neutralize the acid condition of the fluids of the system, and it also possesses diuretic properties which act upon the kidneys, removing the offending blood-poison from the system through these organs. If the joints are very painful, cloths wet with the Compound Extract of Smart-weed and applied to them, and covered with hot fomentations, very frequently relieve the suffering. The majority of cases yield quite promptly to the course of treatment already advised, if it is persevered in. The disease, however, sometimes proves obstinate and resists for many days the best treatment yet known to the medical profession.

Treatment of Chronic Rheumatism. The general alkaline baths recommended in the acute affection are also valuable in the chronic. The spirit vapor-bath, the Turkish, as well as the sulphur vapor-bath, are all worthy of a trial in this obstinate and painful disease. Alternatives are a very valuable [pg 429]class of agents in chronic rheumatism. The following mixture, in teaspoonful doses three times a day, in alternation with the Golden Medical Discovery, has proved very successful in this disease: acetate of potash, one ounce; fluid extract of black cohosh, one ounce; fluid extract of poison hemlock, two drachms; simple syrup, six ounces. This thorough alterative course, if well persevered in, together with the use of alkaline and vapor-baths, will generally prove very successful. The specialist, however, dealing with chronic diseases exclusively, will occasionally meet with a case which has been the rounds of the home physicians without benefit, that will tax his skill and require the exercise of all his perceptive faculties to determine the exact condition of the patient's system, upon which the obstinacy of the disease depends. When this is ascertained, the remedies will naturally suggest themselves, and the malady will generally yield to them. But, although the treatment of this disease has entered largely into our practice at the Invalid's Hotel, and has been attended by the most happy results, yet the cases have presented so great a diversity of abnormal features, and have required so many variations in the course of treatment, to be met successfully, that we frankly acknowledge our inability to so instruct the unprofessional reader as to enable him to detect the various systemic faults common to this ever-varying disease, and adjust remedies to them, so as to make the treatment uniformly successful. If the several plans of treatment which we have given do not conquer the disease, we can not better advise the invalid than to recommend him to employ a physician of well-known skill in the treatment of chronic diseases. If such a one is not accessible for personal consultation, a careful statement of all the prominent symptoms, in writing, may be forwarded to a specialist of large experience in this disease, who will readily detect the real fault, in which the ailment has its foundation. Particularly easy will it be for him to do so, if he be an expert in the analysis of urine. A vial of that which is first passed in the morning, should be sent with the history of the case, as chronic rheumatism effects characteristic changes in this excretion, which clearly and unmistakably indicate the abnormal condition of the fluids of the body upon which the disease depends.

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DISEASES OF THE SKIN.