tag:blogger.com,1999:blog-42994668244676150882024-03-07T23:31:48.927-08:00MEDICAL AND HEALTHmedical and healthsuehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-4299466824467615088.post-54426168432314267032009-04-13T06:03:00.000-07:002009-04-13T06:08:06.906-07:00Symptoms - BBaby birth injury<br /><br />Most babies are born with a minor injury such as bruising, temporary deformation of the head or face, or a swelling on the scalp. These are normal side-effects of birth and may be fairly conspicuous if the labour was unduly prolonged or if forceps or a ventouse vacuum<br />extractor were used.<br /><br />Forceps can cause temporary paralysis of the face as a result of pressure on the nerves that activate the facial muscles. The ventouse often produces a large blood swelling on the top of the scalp (called a cephalhaematoma) which is eventually absorbed. Premature babies often suffer birth injuries. Even limb fractures may occur during difficult deliveries, but healing is remarkably easy and rapid in babies and there are seldom any adverse long-term consequences. Bottom-first (breech) deliveries tend to cause injuries to the nerves of the arms, sometimes causing temporary paralysis.<br /><br />Contrary to the widely held belief, cerebral palsy is not a common consequence of birth injury, nor are epilepsy and mental retardation. These are more likely to be due to other factors not related to the<br />birth.<br /><br />Backache<br />See Pain in the back.<br /><br />Bad breath<br />The medical euphemism for had breath — halitosis — is rarely used today but bad breath is still a problem for many. It is unusual because those most concerned that<br />they might have bad breath usually don't, and those worst affected are usually oblivious to the fact.<br /><br />All smells, pleasant or otherwise, are caused by tiny chemical molecules floating in the air. Bad-smelling breath may acquire these odorous molecules from the mouth, nose or lungs — rarely from the stomach. Food debris in the mouth, especially around the teeth, will inevitably ferment and produce odours, unless it is removed by regular brushing. Some foodstuffs, such as garlic, are highly efficient and persistent odour-producers when fresh, let alone when decaying. For these, the only remedy is to wait for the odour to dissipate. Oil of garlic, taken in Capsules, does not have the same odour as cooked or raw fresh garlic and socauses much less offence to others.<br /><br />Bad breath can also be caused by:<br />• infection of the gums (gingivitis);<br />• rotten teeth;<br />• some degenerative conditions of the nose lining;<br />• sinusitis;<br />• tonsillitis;<br />• throat infections;<br />• pharyngeal pouch (an abnormal sac which forms at the top of the oesophagus — see Swallowing difficulty).<br /><br />Added to the above, nearly everyone has slight bad breath in the morning because the self-cleaning mechanisms of the mouth also 'go to sleep' during the night. Normal tooth brushing will deal with this.<br />A few ingested substances, including some of the ingredients of alcoholic drinks, are partially excreted in the breath, but beware any persistent and genuine odour in the breath which comes from deep in the lungs. This suggests a cause arising in the body. These possible causes and types of odour include:<br /><br />• diabetes - an acetone-like smell;<br />• kidney failure with build-up of waste products in the blood (uraemia) - a urine-like smell;<br />• lung abscess, lung cancer, or abnormal widening of the air passages with stagnation of secretions (bronchiectasis) - a putrid odour;<br />• liver failure - a mousy smell.<br /><br />Forget the common notion that the state of the breath somehow reflects the condition of the digestion or the function of the bowels. In general, this is nonsense. Only in rare instances, such as stomach cancer with outlet blockage and food retention, will . foul-smelling belching occur.<br />Many people suffer from the unjustified conviction that they have bad breath. Mostly this is no more thana mild social anxiety, but sometimes it is an indication either of depression or of imagined illness - (hypochondriasis). Hypochondriacs usually exaggerate normal body activity in their own minds. Occasionally, a fixed conviction of bad breath may be a feature of a more serious obsessive or paranoid disorder. It may even result from the delusion that there is internal putrefaction. Rarely, there may be a genuine hallucination caused by temporal lobe epilepsy. The delusion is a false belief; the hallucination is a genuinely experienced but false sensation.<br /><br />Most cases of bad breath I are easily remedied. The real answer is to remove the cause rather than try to cover up the problem with peppermint or spearmint. Antiseptic mouthwashes and antibiotic 'f lozenges are unsatisfactory 4 because they interfere with the mouth's normal bacterial content and may encourage thrush. Unfortunately, most sufferers are often unaware that they have bad breath because they get used to it,<br />and the majority of best friends lack the necessary moral courage to break the news.<br />Baldness<br />Common baldness is hereditary and affects males in early adult life. The medical term is alopecia. In toxic alopecia, which sometimes affects children, the hair loss occurs some weeks after a severe feverish illness such as scarlet fever. Baldness may also be caused by disease, anti-cancer chemotherapy or radiation and treatment with thallium compounds, vitamin A or the related group of chemical substances known as retinoids. Scarring alopecia may follow burns, skin atrophy, ulceration, fungus infection of the scalp (kerion) or skin tumours.<br />Alopecia areata is a form of patchy baldness, of unknown cause, often affecting only one or two small circular areas of the scalp, but sometimes affecting all the hair of the body. The drug minoxidil, sold under the trade names of Rogaine and Regaine, was first brought out as a treatment forhigh blood pressure. It can cause regrowth of fine fuzzy hair in many cases, but you have to keep using it and this gets expensive.<br />Bandy legs See Bow legs.<br /><br />Bat ears<br />This is a lay term for a minor childhood disfigurement in which the ears are larger and more protruding than usual. The problem may not, however, seem so minor for the child who may be subjected to abuse from his or her peers. Children's ears are always relatively large - the ear is three-quarters grown at the age of three and almost fully grown by eight - so any unusual prominence is more obvious than in an adult. Should there be a significant psychological disadvantage, the condition may easily be remedied by a simple plastic surgical procedure known as otoplasty.<br /><br />The skeleton of the ear is a single piece of gristle (cartilage) of complicated shape, and this is covered with skin which is firmly stuck to the front surface but more loosely attached behind. This is convenient, because, to conceal the scars, the surgeon performs the operation on the back of the ear. If the prominence is due to a folding outwards of the cartilage, the aim is to thin, or weaken, it along an almost vertical line so that it can easily be bent backwards towards the head. If the ear prominence is due solely to a large angle between the ear and the head, a different operation is necessary. In this case, the skin removal behind the ear is more extensive. When this is done, the bared area includes the angle between the ear and the head. When the free edges of this area are sewn together vertically, the ear is brought close against the head and becomes less prominent. In very severe cases, where both angles are large, the two procedures may have to be combined.<br /><br />Bedsores<br />These are often worse than most people realize. Bed‑<br />sores, technically known as decubitus ulcers, are especially likely in debilitated or unconscious patients or in people who have had a stroke or are paralysed. Unless such people are frequently moved, they suffer sustained compression of the skin against the bed or wheelchair in the areas that take the weight of the body. This leads to local loss of blood supply, local loss of feeling so that there is no pain and, eventually, local tissue death (gangrene) with ulceration. Skin can remain healthy and intact only if it has a constant supply of blood, carrying oxygen, sugars and other essential nutrients. Local pressure compresses the small skin blood vessels, so this supply is cut off. Bedsores may be very large and the ulceration may progress to complete local loss of skin with exposure of the underlying tendons or bone.<br /><br />Bedsores are most likely to affect the buttocks, the heels, the elbows and the back of the head and are particularly common in people with defective sensation from neurological damage. They can be avoided by regular changes of position and by skilled nursing to detect and deal with early signs of trouble. Diabetics, and those with compromised blood supply to the limbs from arterial disease, such as atherosclerosis, are especially liable and require special attention. Modem technology has devised all kinds of ingenious beds, which, by differential air inflation of bed segments, or movement of fluid, constantly alter the sites taking the body weight. If economics allow, these can greatly help to reduce the risk of bedsores, but they do not eliminate the need for regular passive body movement and vigilance. The skin should also be inspected daily and kept clean, dry and in good condition.<br /><br />Bedwetting<br />This is not usually a symptom of any organic disease, but it can be. Ordinary bedwetting usually occurs during sleep. The normal child develops<br />adequate control early in life, but one in 10 still wets regularly at the age of five. With all children, accidents will occasionally happen, especially in times of stress, but persistent bedwetting after five is considered abnormal. Most children with this problem are merely slow in developing full nerve control and, unless there is some underlying disease, bedwetting nearly always stops before puberty.<br /><br />Training to pass urine regularly during the day is helpful as is a simple, battery-operated electrical bed alarm which rings as soon as urine is passed. Avoid giving drinks last thing at night and insist on a visit to the toilet before bed. Persistent bedwetting should always be medically investigated. Possible organic causes include:<br /><br />• urinary infection; • kidney trouble;<br />• diabetes;<br />• sickle-cell anaemia.<br />The problem may also result from emotional disturbance. If no organic cause is found, counselling by a child psychologist is often helpful.<br /><br />Black stools<br />If your stools turn tarry black report the matter to your doctor at once. A Black faeces (melaena) result from chemical change in blood released by bleeding into the stomach or upper part of the intestine. This is an important indication of disease such as gastric or duodenal ulcer. Blackening may also be caused by iron tablets taken for anemia. Red<br />blood in the faeces usually comes from piles (hemorrhoids) but may be a sign of colitis or cancer of the rectum or colon, especially in older people. A None of these signs should be ignored. Prudent people always take a quick look at what they have produced before flushing the toilet.<br />Blackening and loss of the extremities<br />This is a rather extreme symptom, but it can start in a small way and the earlier it is recognized the better.<br /><br />Death of body tissues is called gangrene. This usually occurs in an arm or leg because of an inadequate blood supply. Gangrene is commonly caused by severe arterial disease, such as atherosclerosis, in which the amount of blood able to get through the narrowed and easily obstructed arteries is not enough to keep the remoter parts alive. Diabetes also increases the possibility of gangrene, mainly because of its effect on the blood vessels, but also by encouraging infection. Other important causes include:<br /><br />• embolism;<br />• thrombosis;<br />• severe arterial injury; • Buerger's disease, an<br />obstructive arterial<br />condition (see below).<br /><br />The rye fungus ergot can cause gangrene by inducing prolonged tight spasm that shuts off the arteries. Mechanical obstruction to the arterial blood supply can also cause gangrene, as occurs in the bowel with a strangulated hernia or a gangrenous appendix.<br /><br />Limb gangrene usually starts in the toes or fingers. If the dead part does not become infected, it becomes dry and turns brown or black. At the junction between the dead and living tissue there is a zone of inflammation and sometimes this is where the dead part will drop off. This form of dry gangrene is commonest in the fingers and toes.<br /><br />Wet gangrene occurs when flesh becomes infected and putrefies. Infection with anaerobic organisms, such as the common, gas-producing Clostridiurn welchii, which is present in most cultivated soils, causesthe very dangerous gas gangrene. In this type, gas makes body tissue, especially muscles, swell greatly or balloon, and the gangrene spreads rapidly to healthy tissue. There is discoloration, a smell of putrefaction, and the affected person is gravely ill from poisoning. Gas gangrene was a major cause of death in World War I when so many deep wounds were contaminated by cultivated soil.<br /><br />The condition has nothing to do with poison gas.<br />Buerger's disease (also known as thromboangiitis obliterans) is a fortunately rare disorder affecting young adult males who are heavy smokers. It is a severe inflammation of the medium arteries and veins of the legs, and less commonly of the arms. The inflammation causes the blood vessels to block resulting in death of the tissues (gangrene) so that the affected limbs, or part of them, may have to be amputated. Initially, there is pain in the hands and feet with colour changes - white, blue then red (Raynaud's phenomenon) in cold weather. If the sufferer stops smoking, the disease will usually progress no further. The extraordinary thing is that, even after being told about this, many sufferers continue to smoke - some have done so until they have lost all four limbs.<br /><br />Blackheads<br />See Skin spots in adolescence.<br />Blackout<br />This is not a medical term and is loosely applied to any condition in which there is loss of consciousness for a short time. Such conditions include:<br /><br />• fainting;<br />• epilepsy;<br />• minor stroke;<br />• concussion;<br />• hysterical attacks.<br />The important thing is to try to identify possible causes. Consider these and also whether there are other symptoms (if so, look them up).<br />Blackwater fever<br />See Fever and black urine.<br />Bleeding during pregnancy<br />You must always take seriously any vaginal bleeding occurring early in pregnancy. This is an unmistakable sign that there is a risk that you might lose the baby, and is called a threatened abortion. Often there is a slight pain, like a period pain, in the lower abdomen. Although the embryo or fetus remains alive and still attached to the wall of the womb, the bleeding indicates that there is a threat of separation. There is a 25 percent chance of spontaneous abortion, but more usually things settle down. If the bleeding stops, the pregnancy will continue to full term with delivery of a healthy, normal baby. In such cases, threatened abortion does not imply that there is anything wrong with the baby.<br /><br />If the bleeding gets worse and the pain becomes more severe and cramping, there comes a point when you have to accept that abortion is inevitable. Inevitable abortion means that the cervix has opened and the contents of the womb are being expelled by contractions. Blood clots and membranes, enclosing the fetus, will have passed into the vagina. Sometimes bleeding from an inevitable abortion is very severe, and may even call for a blood transfusion. Often the expulsion is incomplete and a minor operation, under general anaesthesia, may be needed. This is called evacuation of retained products of conception (ERPC). The womb is emptied by suction, and the lining is carefully scraped with a sharp-edged spoon called a curette.Adrugisthengiventomake the womb contract, and antibiotics may also be necessary.<br /><br />When bleeding occurs from the vagina after the 28th week of pregnancy it is known as antepartum haemorrhage. Most cases are caused by partial separation of the afterbirth (placenta) from the inside of the womb or because the placenta is not in the normal position. Usually the bleeding itself is painless but there may be pain in the abdomen. Antepartum haemorrhage is a threat to the baby and sometimes to the mother as well. So this requires immediate investigation in hospital. There the condition of the baby can be monitored and the mother can be treated, if necessary, for blood loss. Transfusion is sometimes required and, if the baby is at risk, delivery by caesarean section.<br /><br />Bleeding gums<br />These usually occur when the gums are inflamed (gingivitis). This arises when normal tooth care has been neglected to the extent that plaque and tartar (dental calculus) accumulate around the necks of the teeth. Occasionally bleeding gums are due to severe vitamin C deficiency (scurvy). Inflamed gums are red, thickened, bulgy and will bleed even on minor tooth brushing. You can't get rid of tartar by brushing or flossing, but need to have your teeth scaled by your dentist or dental hygienist. Afterwards, resolve to prevent plaque from forming by regular flossing.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-81802894605148171742009-04-13T05:20:00.000-07:002009-04-13T05:23:41.410-07:00Symptoms (A)Absence of menstrual periods<br />This is called amenorrhoea and it has many causes. Menstruation usually begins after the age of 11 and should be occurring by 16. If periods have not started by this age, see your doctor. When periods stop after they have been occurring regularly, it may be due to a number of factors, the commonest being pregnancy. Stopping the contraceptive pill after using it for a time usually results in absent periods for six to eight weeks but sometimes for much longer — even up to a year. Other causes include:<br />• severe emotional disturbance;<br />• anorexia nervosa;<br />• intense and prolonged<br />athletic activity;<br />• cysts or tumours of the<br />ovaries;<br />• the menopause.<br />The menopause may occur as early as 40 but more usually when a woman is between 45 and 50. Amenorrhoea is permanent, of course, if the womb is removed surgically (hysterectomy).<br />Accident proneness<br />Some people are certainly more prone to accidents than others, but this is not a symptom of any particular disease. People who are emotionally upset and preoccupied and, as a result, less watchful than normal, have an increased tendency to mishaps. The same is true of aggressive men who often behave in such a way as to cause accidents to themselves and others. Some people are just plain careless.<br />Ageing<br />Ageing is not a disease but it is sometimes blamed for symptoms that are caused by disease. Although the tissues of the body do gradually deteriorate with age, many of the disorders that affect elderly people are due to other factors. These include:<br />• lack of exercise;<br />• the wrong kind of food; • too much exposure to sunlight;<br />• smoking;<br />• excessive drinking;<br />• conforming to expected patterns of behaviour (in a way that elderly people think they should behave rather than how they feel).<br />Memory need not decline severely with age and is usually well preserved in people who are in the habit of using their<br />minds. Elderly people are more conscious of normal lapses of memory than the young and are liable to worry unnecessarily about these, thinking that they might be developing dementia or Alzheimer's disease. The first real indication of either is when someone gets lost in formerly familiar areas. This is called disorientation. However, great philosophers and scientists have been known to get lost simply because their minds were on other things.<br />Sexual activity need not decline much with age. The reason some elderly people are less sexually active is often only because of a lack of opportunity.<br />Age spots<br />See Skin spots in elderly people.<br />Agitation<br />This shows itself by constant, aimless, physical restlessness, and it is usually caused by anxiety. If there is a real cause for the anxiety, agitation is normal and is known<br />as reactive anxiety. But if there is no appropriate cause, agitation suggests an anxiety disorder, often with an underlying physical cause, possibly alcohol or drug withdrawal. Depression in the elderly often causes agitation. Some drugs, especially those used to treat psychiatric cont.litions, cause constant movements of the body. This is called akathisia and it is not the same as agitation.<br />Air swallowing<br />Everyone swallows some air from time to time, but greedy or anxious people, or those who regularly feel the need to belch, may swallow a great deal of air. This causes a feeling of fullness that is relieved only by bringing the air up again. People who belch frequently at times other than after eating are usually air swallowers. There is no great harm in this but it can be boring for others. Air swallowing is sometimes a symptom of stomach ulceration or indigestion from unsuitable diet and eating at irregular times.<br />Allergies<br />See Contact reactions.<br />Amnesia<br />See Loss of memory.<br />Anal protrusions<br />The commonest protrusions are internal piles (haemorrhoids) that have slipped down. These cause a lot of irritation (see Itching anus).<br />A more major and dramatic condition causing anal protrusion is prolapse of the rectum. This is a condition in which the mucous membrane lining of the anus (the lower part of the rectum) turns inside-out and passes out of the anus. In incomplete prolapse, only the lining of the anus appears, but in complete prolapse the whole thickness of the bowel protrudes as a thick cylindrical mass with the mucous membrane lining on the outside.<br />Incomplete prolapse is common in young children and usually requires no treatment. At the most, they will have their buttocks strapped together or be given a small injection to encourage internal adhesion of the lining. Complete prolapse occurs in adults, mostly in women, because of weakness of the muscle ring around the anus (anal sphincter), or of the supporting floor of the pelvis, following childbirth. Anal surgery or haemorrhoids may also predispose adults to the condition.<br />Prolapses are easily pushed back in but tend to recur. Complete prolapses usually require a surgical operation to tighten the anal sphincter or to fix the rectum internally.<br />Antisocial attitudes<br />People with persistent difficulty in getting on with others may have what is sometimes described as a borderline personality disorder. This is a rather vague name for a vaguely defined condition, lying somewhere between a social disorder and an actual mental illness. The unfortunate people in this category may be:<br />• moody;<br />• unreasonable;<br />• prone to outbursts ofanger;<br />• incapable of forming or maintaining long-term relationships;<br />• addictive gamblers; • petty criminals;<br />• prone to self-damaging or even suicidal behaviour.<br />Changes of mood are rapid and often inappropriate. Psychiatrists argue about this condition; some say that it is a psychiatric condition calling for treatment, others claim that it is not. It seems likely that the condition arises from unfortunate early life experience with lack of parental affection and the absence of consistent guidance on acceptable conduct.<br />People who consistently behave without regard to the rights or safety of others, and who refuse to conform to normally accepted standards of behaviour, are said to have an antisocial personality disorder. They used to be called<br />psychopaths or sociopaths<br />and many of them are actual criminals. Antisocial personality disorder almost certainly<br />originates early in life as a result of defective training or conditioning and often a serious lack of parental affection and concern. Occasionally parents insist, however, that such people were 'born bad'. It is possible that there might be a hereditary element. Behaviour therapy or residence in therapeutic communities is sometimes successful in correcting the defect.<br />'Ants' crawling under skin See Itching.<br />Anxiety<br />No one is wholly free from anxiety, which is a normal and necessary part of life. Anxiety - an unpleasant sense of uneasiness or fear - becomes medically significant only when these fear reactions occur without obvious external cause and interfere with normal living. There is a fair range of disorders in which anxiety is the main feature. These affect about one person in 25 and include generalized anxiety disorder (previously known as anxiety neurosis),<br />panic attacks, phobias, post- traumatic stress disorders and obsessive/compulsive disorders. If you have an anxiety disorder you will certainly be aware of the fact.<br />Anxiety, from whatever cause, is always associated with the release within the body of the hormone adrenaline, and with overaction of the part of the nervous system concerned with involuntary control of the internal organs (the autonomic nervous system). As a result, there are few parts of the body that are not affected by anxiety. These effects are purely physical. They include:<br />• fast pulse;<br />• awareness of the heartbeat;<br />• 'butterflies in the stomach';<br />• dryness of the mouth; • trembling of the hands; • tightness in the chest; • sighing and<br />overbreathing<br />(hyperventilation);<br />• tense muscles.<br />Tightening the muscles persistently soon results in aching and tiredness. (Prolonged muscle tension is a common cause of backache and neck pain.) It also affects the urinary system, causing frequent desire to empty the bladder, and even affects the skin, causing blushing or pallor and sweating.<br />Anxiety is additionally known to disrupt the intestinal system causing:<br />• loss of appetite;<br />• a sense of fullness;<br />• difficulty in swallowing (sometimes);<br />• nausea;<br />• vomiting;<br />• belching;<br />• irritable bowel with frequent diarrhoea:<br />Abnormal anxiety features constant fears. These might be fear of death, serious illness, psychiatric breakdown, financial loss, social disasters or work inadequacy. With this anxiety comes an increased dependency on others, fatigue, insomnia and frightening dreams. A strong and persistent conviction that one is suffering from a serious disease is common. This is called hypochondriasis - sufferers are hypochondriacs.<br />Anxiety is the hallmark of most neurotic disorders and, although various theories have been put forward to explain it, no one really knows its cause. Anxious people deserve every sympathy and need help. There is little evidence that psychoanalysis can cure anxiety, but there are effective remedies. Wise psychotherapy by a mature and experienced counsellor, behaviour therapy, learning relaxation techniques or carefully selected drug treatment can help greatly. The tricyclic antidepressant drugs are often useful in panic conditions. Fluoxetine (Prozac) is really only appropriate if the condition is basically a depression. It is best to<br />avoid the benzodiazepines - drugs like Valium — if possible, because it is all too easy to get addicted. Beta-blockers can help anxiety, and much can be done to relieve the problem, especially if you have a sympathetic doctor.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-32968392749855686462009-02-26T09:23:00.001-08:002009-02-26T17:56:37.360-08:00Skin Diseases (5)WEN (ATHEROMA, SEBACEOUS CYST).<br />A wen is an abnormally developed sebaceous or oil gland, resulting in a growth or sac filled with an oily or fatty material, usually appearing on the scalp, the neck, or the face, but sometimes on other parts of the body. The growth starts with a plugging of the gland outlet, or with some unusual activity of its secreting portion, resulting in a sac lined with the lining membrane of the gland and containing material similar to that secreted by the gland.<br /><br />Growth may continue for months or years, but eventually ceases, in some cases while the tumor is still quite small. Large wens, however, are not unusual. They may be from one to several in number, and from the size of a pea to that of an orange. They may be whitish, pinkish, or purplish in color. They may be either soft, doughy, elastic, or firm to the touch.<br />Wens seldom show up before middle age, and almost never during the growing years of life.<br /><br />They are rarely tender or painful, but may eventually become chronically inflamed and form pus. Very rarely, they may become malignant in elderly people. When located on the scalp where they are most often found the skin over a wen is usually bald, the hair follicles having either, been killed or having their activity stopped by the pressure of the growing tumor. Surgical removal of a wen is advisable, not only for the sake of appearance but also for safety. The operation is simple and safe, and is permanently successful if care is taken to remove the entire sac as well as its contents.<br /><br />What to Do<br />Have the tumor surgically removed. Any other treatment is useless.<br /><br />Parasitic Diseases<br /><br />GROUND ITCH (CUTANEOUS AN CYLOSTOMIASIS).<br />BODY LICE (PEDICULOSIS CORPORIS).<br />A body louse is slightly larger than a head louse, and it is usually grayish in color. It lives in the seams of the underclothing most of the time, particularly in the regions of the back, the chest, and the waistline, laying its eggs there. The eggs hatch in about six days, the young being ready to reproduce in about two weeks. They invade the skin of the body only when they wish to feed.<br /><br />The presence of body lice causes severe itching. If the clothing has recently been changed, the lice may be hard to find on the body. The itching, however, the bloody spots or streaks which result from scratching, and the location of the same are enough to indicate the nature of the disease. The parasites themselves can usually be found in considerable numbers in the seams of underclothing worn for a few days or longer. The infestation is spread by body contact, by wearing infested clothing, or by sleeping in an infested bed.<br />Body lice are known to be able to transmit several different infectious diseases, the most serious of which is typhus fever.<br /><br />What to Do<br />1. Do not sleep in underwear worn during the daytime. Underwear and hose that will not be harmed by boiling should be boiled for ten minutes in soapsuds. Pressing the seams of clothing with a hot iron will kill many of the lice and their eggs.<br />2. A 5 percent DDT powder dusted on the inner surface of the underclothing, especially the seams, is effective.<br />3. The skin may be dusted lightly with a 5 percent DDT powder.<br /><br />CRAB LICE (PEDICULOSIS PUBIS).<br />The crab louse, smaller than either the head louse or the body louse, translucent in appearance and nearly round in form, usually infests the hair covered part of the pubic region. It may, however, be found on other hairy regions of the body, though rarely on the scalp. The bite of this louse causes a sensation like a sharp pinprick. It produces intense itching and often a skin eruption, which may become severe enough to resemble eczema.<br /><br />The infestation is spread by body contact as a rule most often at the time of sexual intercourse though sometimes by means of infested toilet seats. The infestation is often considered a disgrace because of its being associated with promiscuity. It is frequently mentioned in connection with venereal disease because in both cases illicit intercourse is a common method of spread.<br /><br />What to Do<br />1. Shave or clip the hair from the infested regions, and burn this hair.<br />2. Wash the area or areas daily with soap and warm water. After washing, apply a 25 percent emulsion of benzyl benzoate or Kwell lotion each morning for three mornings. This kills the "nits" by dissolving them off the hair stumps.<br />3. Dust a 5 percent DDT powder on the affected skin areas each night for three nights. This will kill the active adult lice.<br />4. One week after completing the treatment program, if there are any signs or symptoms indicating that the infestation is not completely cleared up, repeat the treatment program.<br /><br />HEAD LICE (PEDICULOSIS CAPITIS).<br />The presence of head lice on the scalp causes severe itching. Scratching, which is almost sure to occur, causes the oozing of fluid, watery at first, but later pussy or bloody. This fluid usually dries and forms crusts, but may remain sticky and mat the hair. It has a bad odor.<br /><br />The lice live at the base of the hairs, near the scalp. They are quite dark in color and large enough to be seen easily with the unaided eye. During the short space of six days, a female louse can lay as many as fifty eggs. These are glued to the hair shafts and can easily be seen, being white in color.<br /><br />They hatch in from three to eight days, and the young lice are able to reproduce in two weeks. Infestation from one person to another is usually spread by personal contact or by the wearing of infested headgear. Since body lice are known to transmit typhus fever and certain other diseases, some medical authorities believe that head lice may also transmit them.<br /><br />What to Do<br />1. If any tiny white louse eggs can be seen attached to the base of hairs, usually in the region near the back of the neck, try to loosen and remove them by long continued soaking and washing with a gauze washcloth and a warm mixture of two parts of water and one part of vinegar. Then rinse and dry the scalp.<br />2. Dust 5 percent DDT powder on the scalp twice a day for three days.<br />3. One week later inspect the scalp and hair shafts carefully. If any evidence of persistent infestation or of reinfestation is seen, obtain a 1 percent gamma benzene hexachloride lotion (marketed as Kwell) and use as directed.<br /><br />SCABIES (THE ITCH).<br />Scabies is a contagious skin disease caused by the itch mite, which bores beneath the surface of the skin, forming burrows. The disease is characterized by intense itching, especially at night, and by a form of eczema caused by scratching. The mite is yellowish-white and barely large enough to be seen by the unaided eye. The female, which is larger than the male, burrows into the skin to lay its eggs. The burrow may be either straight or crooked, is an eighth of an inch (3 mm.) or more in length, and looks somewhat like a very narrow and light pencil mark.<br /><br />The itch mite seems to prefer the tenderest parts of the skin, such as the webs between the fingers, the inner surfaces of the forearms, thighs, and legs, the armpits, the breasts, the buttucks, and the navel. The face, scalp, palms, and soles are rarely attacked, but breast-fed infants are an exception to this rule. When one member of a family is infested, other members are very likely to become so.<br /><br />Severe inflammation, with the development of papules, blisters, pustules, and crusts, may come as a result of infection from scratching. The disease may become fully developed within two weeks; the eggs hatch in about six days, and the parasites grow very rapidly. It may persist for months or even years if not recognized or properly treated. It is transmitted by body contact with others suffering from it, or by sleeping in an infested bed or wearing infested clothing.<br /><br />What to Do<br />1. If the skin has infected scratch marks or pustules on it, this infection should be treated first before giving treatment for the itch itself. For this purpose, use Neosporin ointment rubbed into the affected skin four or five times a day.<br />2. Then every night for three nights apply an ointment such as mentioned in the next paragraph to the entire body from the level of the mouth and earlobes downward. Do not leave any area uncovered with the ointment, or the condition may recur. Be sure to apply it beneath the toenails and fingernails and all about the genital regions as well.<br />Many different ointments have been used in treating scabies. Some of the patent ointments have proved most effective. Among these, Eurax and Kwell may be mentioned.<br />3. Use the sane underclothes, nightclothes, and sheets throughout the course of the treatment.<br />4. The first night, before applying the ointment, scrub the entire body with soap and warm water. Each night, apply new ointment without washing off the old ointment. If it is impossible to leave the ointment on during the daytime, wash it off each morning, but continue the treatment for five days instead of three.<br />5. The next night following the nights of the treatment, take a thorough hot bath and change into clean sheets, nightclothes, and under clothes. All clothes used before and during the treatment should be disinfected by dry cleaning, washing in cleaning solvent, sending them to a laundry, or boiling.<br />6. During the treatment and every night thereafter for a week, spray the bed and mattress with some liquid such as Flit or a 5 percent DDT solution to kill any living parasites with which they may be infested.<br />7. Immediately after completing the course of ointment treatment outlined above, apply 1 percent phenol in calamine lotion four or five times a day as a soothing and drying lotion.<br />8. If the skin still feels irritated, take starch baths for half an hour once or twice a day, mixing one or two cupfuls of Linit starch in a tub of bath water.<br />9. One week after completing the treatment program, if it seems that the condition is not entirely cleared up, repeat the treatment with ointment, et cetera.<br />10. A 25 percent emulsion of benzyl benzoate may be used one night, or two successive nights, instead of the ointment for from three to five nights, but it is more likely to be uncomfortable or irritating.<br /><br />Perspiratory Disorders<br />Three perspiratory disorders are common enough to merit discussion here: anhidrosis, or lack of sweat; bromidrosis, or foul-smelling sweat; and hyperhidrosis, or too profuse sweat.<br /><br />Anhidrosis may be caused by sluggish action of the autonomic nerves. The condition may be present from the time of birth. It is a common symptom in ichthyosis, extensive psoriasis, and vitamin A deficiency. If the causative condition can be determined, the an hidrosis can sometimes be corrected, but this is often difficult. As a rule, the best that can be accomplished by way of relief is through care in adjusting to the weather. Cocoa butter, lanolin, or some other soothing creamy application may be used to relieve the dryness and harshness of the skin.<br /><br />Bromidrosis is usually the result of fermentation, bacterial infection, or a chemical change in the perspiration after it has escaped from the sweat glands onto the skin surface. It is most obvious on parts of the body where perspiration is free but cannot readily evaporate, such as the armpits, or the feet if confined in poorly ventilated shoes. Certain foods, drugs, and germs give the perspiration characteristic odors, and some of these are unpleasant. As to this kind of bromidrosis, the only effective preventive measure is obvious. Bromidrosis affecting the feet or the armpits calls for more than usual care in cleanliness, with perhaps a change to better ventilated shoes or clothing.<br /><br />Hyperhidrosis may affect the whole skin surface or only parts of it, such as the hands, feet, brow, et cetera. Nervous tension or fear may cause it. If small, circumscribed areas of the skin are affected, increased activity of one or more of the autonomic ganglia may be to blame. In such diseases as tuberculosis, malaria, undulant fever, exophthalmic goiter, and diabetes, profuse sweating is common at times.<br /><br />When the underlying cause of the hyperhidrosis is corrected, the excessive sweating is usually checked, but this requires effective treatment of any systemic disease that may be present. X-ray treatments may be used in localized areas, but not on the whole skin surface. They work by crippling or destroying the secreting cells of the sweat glands, a result which would be disastrous if too widespread.<br /><br />Cleanliness is the best method of controlling the unpleasant features of either bromidrosis or hyperhidrosis. A daily bath, with change of underclothing and hose, is recommended. A 5 percent solution of alum or zinc sulfate in 70 percent alcohol, dabbed on the surface of the skin areas especially concerned and allowed to dry on, may be helpful. A good powder for perspiring and malodorous feet is made as follows:<br /><br />Salicylic acid............. 1|<br />Aluminum chloride............... 1|<br />Powdered alum ............... 3|<br />Starch ....................15|<br />Talcum powder ...............15|<br /><br />Mix thoroughly Virus Diseases<br />COLD SORE (FEVER BLISTER, HERPES SIMPLEX).<br />A cold sore is a virus disease characterized by acutely inflamed areas of skin, upon which groups of small blisters appear. The sores are usually located on the face, especially the lips, but may also appear on the external genital organs or other parts of the body. The affected spots are not often large, but several of them may appear at the same time or in rapid succession.<br /><br />They cause moderate stinging, itching, burning, and general discomfort; but they are only slightly tender. The blisters tend to dry up and form yellowish-brown crusts which drop off in a week or two, leaving no scars.<br /><br />Cold sores often appear as a complication accompanying disease in which fever is a prominent symptom. Sometimes they develop in conjunction with a severe cold, influenza, pneumonia, sun exposure, or menstruation; or they may manifest themselves without any such condition being present.<br /><br />They may be unusually severe, causing feverishness and weakness, with soreness and swelling of the lymph nodes near the area where they are located. Indigestion or any toxic condition or chronic infection may also bring on a crop or a series of crops of cold sores.<br /><br />What to Do<br />1. Eat sparingly for a few days, depending chiefly on fruits and liquids.<br />2. Dab a 1:500 solution of aluminum acetate or spirits of camphor on the sore frequently.<br />3. If attacks are persistent or frequently repeated, have a physician, preferably a skin specialist, study the case to find the cause if possible. There are several methods of treatment which he may use, among them being the use of vaccines. Repeated applications of smallpox vaccine sometimes prove effective, for some reason not clearly understood.<br />4. If the cold sores are obviously a complication of some other existing disease, the treatment should be directed to the underlying condition, and the above directions may not all be suitable.<br /><br />SHINGLES (HERPES ZOSTER)<br />Shingles is an acute and painful in flammatory virus disease affecting the skin overlying one or more sensory nerve trunks and the nerve trunks themselves. It is characterized by groups of small blisters on inflamed red skin areas.<br /><br />The skin eruption breaks out in crops, each succeeding crop tending to locate nearer the end of the related nerve trunk than did the preceding crop. The groups of blisters, each with a red base, dry and form crusts after a week or two. When the crusts fall off, scars are sometimes left. The blisters sometimes become pustules before drying. In severe cases they may turn into small spots of gangrene.<br /><br />The pain, neuralgic in character, may develop before the blisters appear; and it may persist for weeks, months, or years after all signs of the eruption are gone. This is especially true of elderly people, and outstandingly so when the forehead and face are involved.<br /><br />The nerves which supply the skin of the chest are most likely to be affected. The eruption in a typical attack of shingles appears on one side of the chest, spreading from near the spinal column around almost to the breast bone.<br /><br />Nerves on both sides of the body, or more than one nerve on the same side, may be affected, with correspondingly widespread eruption. Occasionally nerves that supply the skin of the neck, arms, abdomen, or thighs are attacked; but second in frequency to the chest, shingles tends to appear on one side of the forehead and face, following the course of the supraorbital branch of the trigeminal nerve.<br /><br />Shingles is usually less severe in young persons than in old. Overwork, general debility, damp and chilly weather, or the absorption of certain drugs, particularly certain compounds of arsenic, or contact with a case of chicken pox, favor development of the disease. The specific cause, however, is a virus which affects both the nerve roots and the skin over them. One attack of shingles gives a high degree of immunity. Second attacks are rare.<br /><br />What to Do<br />1. In severe cases, bed rest is important.<br />2. Take a simple and easily digestible diet, including an abundance of fluids.<br />3. An electric heating pad, or the light and heat from an ordinary strong incandescent light globe, applied to the painful area or areas will relieve some of the pain of shingles. The light globe should be held as close as possible without making the skin feel unbearably hot.<br />4. Applying 1 percent phenol in calamine lotion will help to dry up the blisters. Do not use ointments of any kind on the eruption.<br />5. It is best to consult a physician in all cases of shingles, but especially in severe cases. Pain may be so distressing that more relief will be needed than home treatments can give. A physician may give treatments that will shorten the course of the disease and help to prevent complications. Cortisone given early may prevent the persistent neuralgic pain.<br /><br />WART (VERRUCA).<br />A wart is an overgrowth of certain structures of the. skin. There is conclusive evidence that warts are caused by a virus, and they are contagious under certain circumstances. They appear most commonly in the early years of life, rarely after the age of twenty; but they sometimes persist for years. While they must be distinguished from skin cancer, there is no proof that they never become cancerous.<br /><br />Though the largest and most troublesome warts occur on the soles of the feet or the external genital organs, they are most common on the hands. Small, slender, threadlike forms occur on the neck, the eyelids, and the bearded areas. This latter form may be spread by shaving.<br /><br />What to Do<br />1. If located where they are readily accessible, common seed warts or flat<br />warts may be safely treated by repeated applications of the following:<br /><br />Salicylic acid ............. 4|<br />Acetone .............15|<br />Flexible collodion.............. 15 |<br />Mix thoroughly<br /><br />CAUTION: Take care not to smear this paste on the healthy skin.<br />2. A 3 percent solution of salicylic acid in 40 percent alcohol may be used in the same way, with the same caution.<br />3. If the wart is large, not readily accessible, subject to irritation, or has persisted a long time, have it removed by a physician, preferably a skin specialist.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-67874256766858911952009-02-26T09:21:00.000-08:002009-02-26T18:00:20.128-08:00Skin Diseases (4)Metabolic Diseases<br />SEBORRHEA.<br />Seborrhea is a functional disorder of the sebaceous glands, resulting in more than the normal amount of oil secretion, and characteristically giving the skin a shiny, greasy appearance, sometimes accompanied by acne. A comparatively dry form of seborrhea, characterized by accumulations of cheesy material consisting of oil mixed with dead epithelial cells and other tissue debris, may occur at any time in life.<br /><br />The simple, oily form, however, is found more often during adolescent years, and especially in Negroes. It is probable that altered fat metabolism underlies the disturbed action of the glands; and, if tested, the thyroid gland is often found to be less than normally active. Acne, blackheads, oily dandruff, and seborrheic dermatitis often, but not always, accompany seborrhea. Seborrhea itself does not cause any physical discomfort and does not affect the general health. It is objectionable chiefly on account of the oily appearance of the skin.<br /><br />What to Do<br />1. Cleanse the skin frequently with such fat solvents as soap and water, alcohol, or one of the newer detergents.<br />2. Take a diet low in fats, starches, and sweets.<br />3. Apply lotio alba to the face at bedtime.<br />4. In the morning, apply a powder made as follows:<br /><br />Sulfur ppt. .............2|<br />Talcum powder.............. 28|<br />Mix thoroughly<br /><br />5. Have a basal metabolism test made under a physician's supervision. If it shows the thyroid action is sluggish, take thyroid tablets as he may direct, but do not take them otherwise.<br />6. In severe or persistent cases, consult a skin specialist. He can give X-ray treatments, which are usually effective.<br /><br />Miscellaneous Skin Ailments<br /><br />BALDNESS, FALLING HAIR (ALOPECIA).<br />Loss of hair, alopecia, or baldness, may occur in patches or over the entire body. It may be caused by hormone imbalance, seborrheic dermatitis (dandruff), syphilis, or other bacterial, fungous, or virus infections. The type and time of onset of ordinary baldness, however, are largely hereditary. Baldness may also be caused by acute fevers, certain drugs or chemicals taken internally or applied to the skin surface, X-ray or other burns, disturbed action of certain glands (particularly the thyroid or pituitary), or emotional shock.<br /><br />Nothing effective can be done about common baldness of a hereditary nature. Discovering the causes of other types of baldness in any individual case may be difficult. Local treatments of the scalp or hair in such cases, however, are likely to be useless until the causes are found. Some of the possible causes are diseases or abnormalities which need treatment as a protection to present or future health; therefore it is especially important that they be discovered and treated, whether or not the treatment brings about improvement in the condition of baldness.<br /><br />There is some basic cause, though not always curable, which accounts for the baldness; and money spent on advertised "hair growers" is likely to be wasted unless this basic cause is found and can be corrected. In many cases finding the cause and treating it will call for a physician's attention; and even a physician may not be able to bring about much improvement.<br /><br />What to Do<br />1. Do not expect a cure if common baldness of a hereditary nature has already developed.<br />2. The following program may have some value in delaying the onset or in slowing the progress of the condition:<br />Twice a week for oily scalps, or once a week for dry scalps, wash the scalp and hair with warm water and mild soap, rinsing and drying the hair thoroughly. Then apply a little bay rum.<br />. Gentle massage may help, unless the scalp is very oily.<br />Avoid the use of others' combs or brushes.<br />3. Take a diet low in fats, sweets, and starches. Supplement with vitamin A not more than 25,000 units to the tablet or capsule one tablet or capsule with breakfast each morning, and with some standard preparation of vitamin B complex.<br />4. If you are not sure the baldness is of the common hereditary type, have a physician make a study of the possible causes, and correct them if possible.<br /><br />BEDSORE (DECUBITUS ULCER).<br />A bedsore is an ulceration of the skin and underlying tissue that occurs typically in debilitated patients who are confined to bed and remain in one position so long that pressure on the skin areas that bear the patient's weight deprives them of their normal blood supply. Gradually an involved area becomes dark in color, the skin breaks down, and an ulcer results. Prevention is much to be preferred, for cure is tedious and difficult.<br /><br />What to Do<br />Prevention:<br />1. Turn a bed patient frequently.<br />2. Use padding or inflated rubber rings to diffuse the pressure of body weight, particularly over the bony prominences.<br />3. If the patient has edema (swollen tissues), give attention to the appropriate means of removing the edema.<br />4. Maintain strict cleanliness of the skin.<br />5. After bathing the skin, use mild stimulation, such as gentle massage with lubricating cream, or an alcohol rub, to increase blood circulation.<br />6. Use talcum powder and proper clothing to protect the skin from friction against the bed sheets. Treatment once a bedsore has developed:<br />1. Use a special air mattress designed for this purpose, in which adjacent areas are alternately inflated and deflated automatically by mechanical means.<br />2. Clean and dress the ulcer daily, using sterile saline solution and sterile dressings.<br />3. Antibiotic ointments may sometimes hasten healing.<br />4. Make sure that the patient is receiving a balanced, adequate diet.<br /><br />CALLOUS (CALLOSITAS).<br />A callous is merely a patch of thickened and hardened epidermis, caused by long-continued pressure or friction. It is uncommon for a callous to be either very tender or very painful, or even to cause any marked discomfort. For a permanent cure, the cause must of course be removed.<br /><br />What to Do<br />1. As far as possible, relieve the affected area from pressure or friction.<br />2. At bedtime apply a bit of the following mixture to the affected area only and cover with adhesive:<br /><br />Salicylic acid ......... 3|<br />Lactic acid ...........3|<br />Flexible collodionq.s. ad ..........15|<br /><br />An alternative is to apply small pads of cotton or gauze that have been dipped in 40 percent salicylic acid.<br />3. In the morning remove the adhesive and scrape off the softened skin tissue.<br />4. Continue (2) and (3) until the callous has been reduced to the thickness of normal skin.<br /><br />CORN (CLAVUS).<br />A corn is similar to a callous in texture and has similar causes; but while a callous may be found on any one of several different parts of the skin surface, a corn is almost always on a foot, and usually on a toe, possibly on several toes. A corn is less broad than a callous, and is conical in shape with the apex of the cone directed inward. This shape accounts for the pain felt when pressure is applied to a corn. So-called "soft corns" are usually located between the toes where they are kept moist and softened by the perspiration.<br /><br />What to Do<br />1. Wear comfortable, broad-toed, "foot-form" shoes, made of soft and pliable leather, with heels not too high.<br />2. Surround the corn with a felt ring or corn protector. (These can be bought in almost any drugstore.) Each day, for three to five days, apply to the corn the mixture described under Callous, "What to Do," (2). Then soak the part for fifteen minutes in warm water and try to lift or pick the corn out. If it cannot be completely removed from its bed, continue the application for a day or two longer, and then try again. (Sometimes the application of this mixture will eventually make the tissues sore, even though a corn protector is worn continually. If this happens, the treatment should be temporarily discontinued.)<br />3. If the above treatment does not succeed, the corn may have to be surgically removed.<br /><br />FRECKLES.<br />Freckles are merely spots of skin in which more than the usual amount of normal pigment has developed or has been deposited. They cause no distress and do no harm, except to the appearance of the skin. In many cases they are most numerous in childhood and tend to become less numerous or to disappear completely in later years.<br /><br />What to Do<br />1. Avoid exposure to sunlight and strong wind.<br />2. Small amounts of the following peeling lotion may be painted on the affected spots three times a day:<br /><br />Mercuric chloride.............. |1<br />Camphor gum ..............2|<br />Salicylic acid............. 4|<br />Rubbing alcohol q.s. ad............ 90|<br /><br />An alternative is to use 5 percent ammoniated mercury ointment, which is a good bleaching agent in this case.<br />3. If the skin becomes uncomfortably irritated, stop the use of the lotion and apply rose water ointment several times a day for relief.<br /><br />GRAY HAIR.<br />Grayness of the hair is usually the natural result of aging, coming from a failure of pigment formation in the hair follicles. It may, however, be a symptom of endocrine disturbances, most often of the thyroid gland. It is known to accompany hyperthyroidism occasionally and to disappear after adequate treatment, the hair then regaining its natural color. In some cases of premature grayness, which is often familial, there are a few gray hairs in childhood, a sprinkling during adolescence, and complete grayness between the ages of twenty-five and thirty years.<br /><br />While worry, overwork, grief, anxiety, and nervous strain are contributing factors in the graying of the hair, stories of overnight blanching or whitening of the hair are contrary to physiological and anatomic facts. The graying of the hair is a slow process. In some cases early graying of the hair accompanies anemia, especially pernicious anemia.<br /><br />The streak of white hair on the brow which many consider attractive is sometimes congenital and permanent, but is often acquired following the disease alopecia areata. It is typical for regrowth of hair following this disease to be white at first, but it usually regains its normal color after a time.<br />The person who chooses to conceal grayness of the hair by using hair dyes needs to be careful. Dyes which contain silver nitrate, pyrogallic acid, or paraphenylenediamine may be dangerous to the health; and if hair dyes are to be used at all, they should first be tested for skin sensitivity.<br /><br />What to Do<br />1. Try to determine the causes for the graying of your hair. Some of these may possibly be removed or corrected.<br />2. Do not waste time or money on any so-called "anti-gray-hair" vitamins. Calcium pantothenate, formerly marketed in this way, is use¬less for adult humans, and is quite unlikely to be needed for children.<br /><br />HAIR, SUPERFLUOUS (HYPERTRICHOSIS, HIRSUTISM).<br />Hypertrichosis is too heavy a growth of, hair on normally hairy skin areas, or a visible growth on areas where such growth should not occur.<br /><br />It is usually either an inherited tendency, an evidence of imbalance in thyroid, pituitary, suprarenal, or sex-gland activity, or a result of tumors of these glands. Nothing can be done about heredity, but glandular activity can in some cases be brought back to normal and tumors can sometimes be removed. As a result of such treatment, a return to normal hair growth and distribution can sometimes be accomplished.<br /><br />Hypertrichosis is no greater a sign of glandular abnormality in women than in men. It is only our idea of what is pleasing in appearance that makes most women ashamed of superfluous hair and many men proud of it.<br /><br />What to Do<br />1. Have a dermatologist make a careful study, if possible, with the aim of detecting any abnormal glandular activity that may be present.<br />2. Hair-removing creams (chemical depilatories) may be used safely<br />186<br />if the directions are followed carefully. They may be somewhat irritating to the skin.<br />3. The only completely safe way to remove unwanted hair is to have a registered electrologist remove it hair by hair by the use of an electric needle.<br />4. Contrary to what most people think, shaving of unwanted hair is safe and inexpensive and does not cause the hair to grow faster or coarser.<br /><br />ITCHING, GENERAL (PRURITUS).<br />Itching in itself is not a disease, but a symptom of many different diseases or abnormal conditions. Permanent relief, obviously, can be obtained only by avoiding or correcting the causes; but the simple measures described below should give at least temporary relief in most cases where skin eruption or other signs of disease do not appear. Some diseases not primarily skin diseases have itching as a symptom, diabetes mellitus being one of them.<br /><br />What to Do<br />1. Take a diet low in fats, sweets, starches, and spices. Drink plenty of water. Avoid alcohol, coffee, and tea.<br />2. Bran, starch, or vinegar should be added to the bath water in the case of any warm, cleansing bath. Experience will prove which works best. Following the bath, the skin should be dried without harsh rubbing. Baths should not be more frequent than necessary.<br />3. Wear underclothing that will not irritate the skin. Launder it with care, making sure that all traces of alkali and soap are rinsed out.<br />4. Try applying 1 percent phenol in calamine lotion three times a day to the itching areas, if not too extensive. If this proves too drying to the skin, substitute for it a lotion made as follows:<br /><br />Menthol............ 1|<br />Phenol .......... 2|<br />Glycerin........... 15|<br />Alcohol, 35% q.s. ad.......... 240|<br /><br />In the use of any lotion for the relief of itching, take care not to let any of it get into the eyes. This will not be difficult unless it is the skin of the eyelids that is itching.<br />5. Most important of all, try to find out the cause of the itching and avoid, treat, or correct it. This may call for the aid of a physician, especially in the case of persistent itching in the genital or anal regions.<br /><br />ITCHING IN THE ANAL REGION (PRURITUS ANI).<br />Pruritus ani is a persistent itching, frequently with redness, maceration, and fissuring of the skin, occurring in the skin around the rectal outlet. The itching sometimes becomes so distressing as to demand vigorous treatment. It tends to be worse at night. There are many possible causes for this condition, but the commonest is an infection of the superficial skin layers by a yeastlike organism called "monilia" (candida) . The constant moisture between the buttocks lessens the normal firmness of the skin. Germs and the yeastlike organisms, being always present, have a chance to grow in this softened skin.<br /><br />Pruritus ani may accompany dermatitis from soap or douches, diabetes mellitus, diarrhea, intertrigo, leukorrhea, lichen simplex, seborrheic dermatitis, and nervous tension. Whatever the cause of the itching, the most important local treatment factor in controlling it is to keep the skin clean and dry. It may be necessary to keep a pad of dry absorbent cotton between the buttocks for this purpose.<br /><br />What to Do<br />1. Avoid the use of soap, but keep the skin about the rectal outlet clean by washing it gently but thoroughly with warm water after each bowel movement and drying after each washing. Repeat at other times, if necessary, to total at least two bathings daily. Soft, wet tissue or cotton rather than toilet paper should be used as an aid in washing.<br />2. The washing after the bowel movement can be made more thorough by taking a small, half-pint (225 c.c.) plain warm water enema after the movement but before the washing.<br />3. After the washing and drying, apply a lotion made as follows:<br /><br />Phenol ..............1|<br />Glycerin ............15|<br />Rose water q.s. ad......... 120|<br /><br />4. After the lotion has dried, apply a generous amount of powder, and repeat the application of powder every two hours. A good powder is made as follows:<br /><br /><br />Salicylic acid ........2|<br />Talcum powder ..........58|<br />Mix thoroughly.<br /><br />5. Each night at bedtime apply a small amount of a salve made as follows:<br /><br />Salicylic acid ........... 1|<br />Sulfur ppt. ............2|<br />Cold cream q.s. ad............ 60|<br /><br />6. If the above treatment does not bring permanent relief within one week, have a physician make special studies to determine the underlying cause of the condition and to prescribe more appropriate remedies.<br /><br />LIVER SPOT (CHLOASMA).<br />Chloasma manifests itself as medium-sized yellowish-brown patches or spots on the skin, more frequently seen in women than in men or children. These spots are most common in elderly people, in this respect being opposite to freckles, which in other respects they resemble. They are skin areas in which the normal skin pigment is considerably increased in quantity.<br /><br />The pigmented areas are usually somewhat rounded and have well-defined margins, but they may become numerous enough and close enough together to merge and produce irregular shapes.<br /><br />The appearance of these spots does not indicate any disease or ill health, and they cause no discomfort. The common name "liver spot" is not accurate there are no skin pigmentations directly caused by either the normal or the abnormal action of the liver, except the yellowing caused by jaundice. Known causes of liver spots include sun exposure, pregnancy, and the use of birth-control tablets, perfumes, skin oils, and certain medicines.<br /><br />What to Do<br />1. If possible, have a thorough medical study made to detect any possible underlying disease or glandular disorder which may have caused the appearance of the pigmented spots on the skin. Such a disease or disorder may respond to treatment; and, if it does, the spots may clear up. That such a disease or disorder may be found, however, is not very likely.<br />2. In the usual case, with no real cure possible, the spots may be given the same treatment as that suggested for freckles.<br /><br />STASIS DERMATITIS AND STASIS ULCER.<br />This disease involves a deterioration of the tissues of the skin in the legs which follows an interference with or slackening of the flow of blood through the veins of the legs. The condition frequently develops over a period of several years, often in the wake of known disease of the veins of the legs, such as varicose veins or thrombophlebitis. The skin itches, becomes reddened, and sometimes swells. Small injuries heal slowly, and the healed areas are scarred and pigmented (brown) . As the condition worsens, injured areas fail to heal and ulcers form.<br /><br />What to Do<br />1. Avoid standing in one position for long periods of time.<br />2. When seated, elevate the legs to the level of the hips.<br />3. In stubborn cases, elevate the foot of the bed about four inches above the level of the head of the bed to facilitate the return of blood from the legs during sleep.<br />4. If the veins of the leg are prominent, use elastic bandage or elastic hose to minimize the stagnation of blood in the veins.<br />5. Engage in exercise requiring the use of the legs as the general condition may permit.<br />6. Use leg baths with contrasting hot and cold water (three minutes of hot followed by a few seconds of cold, then repeat, up to fifteen minutes per treatment) two or three times per day.<br />7. Take precautions against bumps and injuries to the skin of the legs.<br />8. If an ulcer develops, a physician must use surgical techniques for removing fragments of dead tissue from the base of the ulcer. Use antibiotic ointment or powder to minimize infection. Cover with a "pressure sandwich" type of dressing, gently applied, to minimize the stagnation of blood in the area.<br /><br />VITILIGO (LEUKODERMA).<br />Vitiligo is a condition in which spots on the skin completely lose their normal pigment, or from birth have no pigment. The cause is not known, except that a hereditary tendency has been noticed in many cases. The condition, however, often accompanies psoriasis or arthritis. There is no known cure, but it is comforting to know that vitiligo causes no physical distress and does not harm the general health. The white patches on the skin are especially subject to sunburn, and tanning of the surrounding skin makes them more noticeable.<br /><br />What to Do<br />1. Avoid exposure to sunlight or tanning of the skin in the areas where the white spots are located. Use a sun-screening lotion before going into the sunlight.<br />2. Avoiding tea, coffee, and carbonated drinks, and taking a diet high in vitamin B complex has been recommended on general principles, but there is no guarantee that doing so will make any difference in the appearance of the spots.<br />3. Consult a dermatologist, who may use a medication especially recommended for the disease.<br /><br />WHITEHEAD (MILIUM).<br />Milia, or whiteheads, are small, comparatively firm masses of sebaceous material, similar to blackheads but never infected, and covered by the outer layer of the skin instead of extending up to or above the surface. They are usually located on the eyelids, cheeks, or temples, causing slight elevations of the skin which may be felt as tiny, hard nodules.<br />The development of whiteheads is hard to explain, but they are painless and harmless, though when numerous they give the affected skin areas an unattractive appearance. They are usually associated with acne in teenagers or with aging skin in mature individuals.<br /><br />What to Do<br />After sterilizing the affected skin area with 2 percent tincture of iodine, shell out the small masses by carefully opening the tops of the small nodules with a sterilized needle and gently squeezing them out. A blackhead remover will be helpful in this.<br /><br />Nail Disorders<br />Nearly all abnormalities of the nails result from one or another of the following: congenital defects, accidental damage to the nail bed, bacterial infections, fungous infections, or some dis¬ease that affects the entire body or the skin in the region of the nails.<br /><br />Those abnormalities caused by systemic diseases usually correct themselves when these diseases are successfully treated. Until a study of the individual case is made by a physician, preferably a skin specialist, not much can be done about nail disorders of this sort.<br /><br />Such a study is strongly urged, since some of the possible causative diseases such as syphilis or psoriasis should never go without treatment. This is especially true of syphilis, which may easily be present without the victim's knowledge and which may have disastrous later results.<br /><br />Brittleness of the nails may be caused by sluggish thyroid action, hypochromic anemia, or long use of fingernail polish. A basal metabolism test is advised to determine whether or not the action of the thyroid is sluggish. Thyroid tablets will improve the nails if their brittleness is due to sluggish thyroid action, but they should never be taken without a physician's supervision. A blood count, with careful study of the blood cells, will either prove or rule out hypochromic anemia. If the use of fingernail polish is the cause, discontinuing its use will be curative. Anointing the nails nightly with olive oil or castor oil wi!1 help toughen them, especially if dressings are applied to keep the oil from being rubbed off during sleep. The following cream, which should also be applied every night, is better than oil in some cases:<br /><br />Lanolin..................... 1|<br />White wax .................. 1|<br />White petrolatum................ 3|<br />Triethanolamine.............. 4|<br />Water q.s. ad ..............30|<br /><br /><br />NAIL DISEASES.<br />The four involvements of the fingernails or toenails shown here relate to other skin diseases or in the case of koilonychia to a systemic disease.<br /><br />Onychomycosis is considered else where in the chapter under "Ringworm of the Nails." The patient should not attempt self-treatment of this disease because it is difficult to arrest. The physician may have to remove a considerable portion of the affected nail or nails and then prescribe medicated applications more potent than for usual manifestations of fungous disease.<br /><br />The nails become involved in at least 15 percent of the cases of psoriasis The treatment of psoriasis of the nails is the same as for the disease in general.<br /><br />Eczema often affects the nails when this disease involves the hands or feet. In such cases soothing lotions frequently prove helpful. The more heroic forms of treatment such as X ray or the corticosteroids are used only, of course, under the physician's supervision.<br />Koilonychia is usually associated with some such disease as anemia, thyroid disorder, or syphilis. It responds to the treatment of the parent disease.<br /><br />INGROWING TOENAIL.<br />In this condition the skin and flesh at one or both corners of a nail, usually the nail of a great toe, become tender and often inflamed. Shoes that are either too short or too narrow across the toes may cause this trouble. High heels may also cause it by throwing the foot forward so that the toes are pushed into and pinched by the pointed front of the shoe. A faulty method of trimming the nails may also cause in growing toenails. The nails should be cut straight across and left long enough so there is no flesh in front of the corners. If they are cut short, especially if rounded at the corners, the skin and flesh are pressed inward in front of these corners, and as the nail grows it cuts into the skin and flesh and makes the trouble.<br /><br />What to Do<br />1. As a preventive measure, cut the toenails as suggested above.<br />2. If a toenail is already ingrown, proceed as follows:<br />Apply a strip of adhesive plaster, drawing it around under the toe and attaching the ends so as to pull the skin and flesh away from the corners and edges of the nail.<br />Gently pack a small amount of oiled cotton or a bit of oiled gauze under the buried edge and corner of the nail.<br />If the toe is inflamed, give alternate hot and cold foot baths twenty minutes night and morning.<br />Cut a V-groove in the nail near the sore side and parallel to it, going as deep as possible without drawing blood.<br />If all these treatments fail, consult a physician, who can cure the condition by a simple operation.<br /><br />PARONYCHIA.<br />This is a staphylococcal infection of the skin at a nail margin, commonly called a "run-around." It should be treated in the same way as a boil .If the pocket of infection is unusually deep and painful, however, it is advisable to have a physician open and drain it, rather than wait for it to open of itself.<br /><br />A pus pocket in this location seems to be partly buried under the nail and thus unusually difficult to drain unless thoroughly opened. Furthermore, the tips of the fingers are so richly supplied with nerve endings that they are extremely sensitive to pain. A small paronychia may cause as much misery as a large boil located elsewhere.<br /><br />Neoplastic Diseases<br />CANCER (CARCINOMA) OF THE SKIN.<br />Skin cancers are new growths of epithelial cells of the skin, tending to spread into surrounding tissues, or giving rise to the transfer of such cells from one organ or part of the body to another. Some skin cancers begin as small scaly or warty spots called keratoses, from which thick scales tend to loosen and fall off from time to time.<br /><br />Others begin as waxy pimples or small, whitish, blackhead like nodules. Since they are of various types, it requires special training and experience to tell one type from another, or to tell whether or not some suspicious growth or nodule on the skin is really cancerous. Many that are cancerous are mixed or intermediate in type, so are not characteristic of either type.<br /><br />Cancers which begin as scaly or warty spots tend to grow rather rapidly, becoming both broader and deeper and eventually forming large ulcers that bleed easily. These ulcers are surrounded by narrow zones of hard tissue.<br /><br />As they become larger, malignant cells often spread from them through lymph channels to surrounding and underlying structures. Rarely they spread through the bloodstream to distant parts of the body, especially the lungs. In the early stages, both pain and itching are slight or entirely absent, which may cause one to ignore the condition until it has spread far enough and deep enough to be really dangerous.<br /><br />Later there is more or less pain. After an extensive spread has taken place, no treatment can save life. Fortunately, the growth or spread is not so rapid that a really watchful person cannot seek for examination and treatment in time. Skin cancer is about 98 percent curable when treated properly.<br /><br />Cancers that begin as waxy pimples or whitish or blackheadlike nodules are inclined to grow very slowly as a rule, forming small and comparatively shallow ulcers in the centers of broad, firm nodules. Causing very little pain, such cancers may spread over considerable areas before they begin to travel through lymph or blood channels. They are therefore less dangerous than the other type, but it is still not safe to let them go untreated.<br /><br />Overexposure of the skin to sunlight is the principal cause of skin cancer, especially if the skin is dry, harsh, and of a complexion that does not easily tan. Repeated or continuous irritation of any kind also has a causative influence. Pipe smokers' cancer of the lip is a common form caused by irritation by pipe stems. Irritation by soot, paraffin, tar, or lubricating oils of petroleum origin is especially likely to cause cancer of the skin. Tampering with the waxy pimples or the nodules will hasten their malignant development.<br /><br />Skin cancer occurs most frequently on the face or on the skin of other exposed parts of the head. The neck, back of the hands, and genital regions are also fairly common sites of skin cancer. Other areas of the body surface are rarely affected.<br /><br />What to Do<br />1. If some waxy pimple or scaly or warty spot appears on the skin, does not itch, yet persists more than one to three months, consult a physician, preferably a dermatologist, without further delay. Let him make a study to determine whether or not the spot is, or may become, cancerous. Nothing short of complete destruction or removal of the seemingly simple but possibly malignant growth is safe; and the sooner, the better. The physician may use X rays, surgery, or cautery in treatment.<br />2. Do not try caustics, pastes, or ointments on your own responsibility or on the recommendation of others.<br /><br />KELOID.<br />Keloids are overgrowth of scar tissue or of tissue similar to that in scars, which continue to grow and form nodules or irregular tumors. They usually result from injury such as burns, surgery, or disease, the new growth of tissue persisting and often involving adjoining healthy skin. Keloids, however, are not malignant, and they do not endanger life.<br /><br />The tendency to form keloids seems to run in families and is more common in Negroes than in people with fair skin. They may cause mild pricking and burning sensations, and they are often tender and painful. They are difficult to treat successfully since they tend to recur after removal. Surgery is the simplest method of removal, but it is also the method most likely to result in recurrence. X-ray and carbon-dioxide applications are usually helpful in flattening the keloid tumor and relieving the tenderness.<br /><br />What to Do<br />1. Do not try home treatment. It will not succeed.<br />2. Consult a skin specialist if possible. He may use surgery, radium,<br />X rays, carbon-dioxide snow, or other methods of removing or destroying the growth; but he cannot guarantee complete and permanent success.<br /><br />LIPOMA (FATTY TUMOR).<br />A lipoma is a benign and painless tumor made up of fat cells and developing in or close beneath the skin. There is little danger that a lipoma a soft, slowly growing, freely movable tumor will ever become malignant; but it may become the seat of gangrene or of fat necrosis. Even though this may not happen, if such tumors are large or numerous they may cause awkwardness of motion, discomfort from weight or from irritation, and a very ugly appearance. Surgical removal is simple and safe.<br /><br />What to Do<br />1. Do not try home treatments. They will prove useless.<br />2. If the tumor is large enough to cause discomfort, to interfere with normal body movements, to be sore on account of irritation, or is located where it is unsightly, have it removed by a surgeon.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-44198725779074738602009-02-26T09:17:00.000-08:002009-02-26T17:29:33.150-08:00Skin Diseases (3)LICHEN PLANUS.<br /><br />Lichen planus is an inflammatory skin disease characterized by small, frequently angular, violet-colored, raised spots with flat, shiny tops, occurring singly or in patches, and appearing chiefly on the flexor surfaces of the wrists, on the ankles, genitals, and lips, and on the mucous membranes of the mouth or vagina.<br /><br />In some cases the eruption may appear elsewhere, or even become generalized, but the face and scalp are rarely attacked. If the rash is found on one limb or one side of the body, the opposite limb or side of the body will also show it. Sometimes the mucous membranes only are affected. Cases are not uniform in appearance. Spots on mucous membranes are characteristically covered with a lacy network of white lines.<br /><br />Though the onset is sometimes gradual and the course chronic, in the typical acute case of the disease there is usually a general feeling of illness immediately before the rash begins to appear. Then within one or two days the eruption is complete, the slightly raised, red or light-purplish spots usually causing intense itching.<br /><br />The exact cause of lichen planus remains unknown, but it is believed that mental or physical strain or a general run-down condition may give rise to it. It may be accompanied by a considerable degree of general debility, and it will often call for the attention of a skin specialist for recognition as well as treatment.<br /><br />What to Do<br /><br />1. Give the patient the benefit of good, plain food, hygienic living, and, when possible, outdoor life with freedom from worry or care.<br /><br />2. Apply the following lotion frequently and remove it by using any convenient kind of oil.<br /><br /><br />Sol. coal tar ......................12|<br />Zinc oxide ........................24|<br />Starch ...........................24|<br />Glycerin ..........................36|<br />Water q.s. ad ..............120|<br /><br />3. In severe or persistent cases, consult a skin specialist, who can give more effective treatments as needed.<br /><br />LICHEN SIMPLEX CHRONICUS (LOCALIZED NEURODERMATITIS).<br /><br />Lichen simplex is a chronic skin disease characterized by a slight inflammation but much itching. The eruption occurs in comparatively large patches, of which there may be from one to several present on the back of the neck, the inner surfaces of the thighs, the external genital organs, the ankles, eyelids, and ear canals.<br /><br />The affected skin areas are dry, thickened, leathery, and pigmented. The condition may be a late stage of any chronic or irritative skin inflammation, or it may develop on normal skin. It often affects people of Oriental extraction and women past forty. Scratching gives temporary relief, but the itching is likely to return later in a more intense form. The itching causes the skin to swell, and this produces more itching. The disease tends to be very persistent, but it may disappear from one area without any apparent reason, only to appear in another.<br /><br />What to Do<br /><br />1. Avoid stress or emotional upsets.<br /><br />2. Avoid scratching the affected areas.<br /><br />3. Avoid the use of soap.<br /><br />4. Try applying the following lotion four times a day:<br /><br />Menthol.................... 1|<br />Phenol ..................2|<br />Glycerin .................15|<br />Alcohol, 35%, q.s. ad ..............240|<br /><br />5. Consult a skin specialist if possible. The most effective treatments or remedies cannot be given in the home or by people without medical training.<br /><br />LUPUS ERYTHEMATOSUS.<br /><br />Lupus erythematosus is a chronic, nontuberculous, inflammatory disease of the skin, characterized by dusky red disklike patches, which do not tend to form nodules or ulcers. The patches are covered with dry scales and crusts which tend to adhere; but if they fall off, they leave dull-white scars.<br /><br />The patches have definite borders. They may include one or more small scarred areas, in which enlarged and empty hair follicles can be seen. The right and left sides are usually both affected, and about equally. The nose, cheeks, and ears are most often affected; and the most characteristic distribution is in a "butterfly" pattern. The eruption may sometimes appear on the scalp or the arms.<br /><br />This disease usually begins after puberty and before age thirty, but it tends to persist throughout the remainder of life if not successfully treated. Its causes are not definitely known. It has been observed to develop following sunburn, the external factor being exposure to sunlight.<br /><br />Chronic infections apparently help to cause it in many cases. An occasional acute case, where the eruption spreads rapidly over a considerable area, may be associated with a hidden or general infection and may prove fatal. As a rule the chronic disease is not accompanied by a feeling of illness, and rarely by any discomfort. It is persistent, and because long and faithful treatment is required for a cure, in no case can a cure be guaranteed.<br /><br />While the chronic form is rarely a menace to life, it is the cause of some physical and much mental distress, chiefly on account of its looks and scarring.<br /><br />Rarely, lupus erythematosus occurs in a disseminated form, either before, during, or after the appearance of skin manifestations, with a great variety of acute symptoms due to the involvement of many different organs and systems. This variety of the disease tends to prove fatal, but the attacks are likely to present such distressing symptoms that a physician is almost certain to be called. Even the best physician, however, may find it a difficult diagnostic problem and an ailment hard to treat.<br /><br />What to Do<br /><br />1. Live a hygienic life, giving careful attention to a simple diet, abundant in vitamins, especially vitamin B complex. For potatoes, substitute white or brown rice, noodles, macaroni, spaghetti, or barley. Avoid tea, coffee, chocolate, spices, tobacco, and alcoholic liquors, especially beer. Drink coffee substitutes or milk.<br /><br />2. Avoid exposure to sunlight and all strong light, and take no X-ray or light treatments.<br /><br />3. For the first few days, apply 1 percent phenol in calamine lotion three times a day. Later, use this lotion morning and noon and apply lotio alba at night. Remember, however, that no ordinary remedy is likely to be curative.<br /><br />4. A dermatologist may prescribe antimalarial drugs, cortisone liquids and creams, or other remedies impossible or unsuitable for use in home treatment.<br /><br />PEMPHIGUS.<br /><br />Pemphigus is an acute or chronic skin disease characterized by blisters which appear on the skin and mucous membranes. These develop suddenly, often on apparently normal skin, and are accompanied by constitutional disturbances of varying severity and by itching and burning sensations.<br /><br />The blisters may vary in size from that of a pea to that of an egg. Their number varies from a few to scores, and they may appear singly or in crops. The walls of the blisters are thin and tense, and they enclose a clear fluid similar to blood serum. This fluid later becomes turbid or bloody.<br /><br />When a blister breaks, a crust usually forms. The blisters may also appear on the mucous membranes of the mouth, throat, or vagina. Sometimes they are intermingled with other types of skin eruptions, which may for a time make diagnosis difficult; but eventually the blisters become so prominent a part of the picture that the true nature of the disease becomes evident.<br /><br />Without proper treatment, pemphigus is almost always fatal. Its course may extend over several months or even years, or it may end in death within a few weeks. This is especially true of a very severe form of the disease well known in the central part of South America, where it is called fogo selvagem, which makes its victims more miserable than almost any other malady they could possibly have. Fogo selvagem (savage fire, or Brazilian wildfire) differs from other forms of pemphigus in that it frequently attacks youth and even children.<br /><br />The acute form of pemphigus may be caused by some infective agent, possibly a virus, but the identity of this agent remains unknown, and it may not be the same in all cases. The chronic form is believed by some authorities to be of intestinal origin, but there is insufficient proof of this theory. Pemphigus is a disease of adult life, and it often affects Hebrews and people of Eastern European extraction.<br /><br />What to Do<br /><br />1. If pemphigus is suspected, seek expert medical help at once. Life may be in danger, and home remedies or treatments alone have no chance of success.<br /><br />2. Try to build up the general health. Take a liberal diet, rich in vitamins, especially vitamin D. Take plenty of rest. In severe cases, rest in bed on an air or water mattress may be necessary.<br /><br />3. Carefully open the blisters and let out the fluid. Then dust the affected skin thickly with the following powder:<br /><br />Zinc stearate ...............20|<br />Powdered starch ...............20|<br />Talcum powder .....................20|<br /><br />Mix thoroughly<br /><br />4. Soak or bathe the affected skin areas of the patient in a 1:5,000 solution of potassium permanganate in water for at least an hour every day.<br /><br />5. Cortisone is the most effective remedy for pemphigus and may even be lifesaving. Of course its use must be carefully supervised by a physician.<br /><br />NOTE —In the Penfigo Adventist Hospital of Campo Grande, Mato Grosso, Brazil, pemphigus is treated with a medicine called Jamarsan. This treatment effects a cure in about 77 percent of the cases.<br /><br />PITYRIASIS ROSEA.<br /><br />Pityriasis rosea is an inflammatory disease. It is sometimes classed among the virus diseases because it runs a definite course of about six weeks and seems to build up an immunity, but the virus has not been definitely discovered.<br /><br />Second attacks are rare. It is not contagious. It will subside of itself eventually, in three to six months, even if untreated. It deserves attention here chiefly for two reasons: (1) It is fairly common, and (2) those who have it may fear that it is something serious. Unrelieved fear may do more harm than the disease itself.<br /><br />This disease manifests itself as numerous small, oval, yellowish or fawn-colored, sometimes pinkish or reddish, slightly scaly spots or patches, scattered over more or less of the trunk and those parts of the limbs adjacent to it. As a rule, a single comparatively large patch appears first somewhere near the waistline. This is called a herald or mother patch. The general eruption comes a week or two later. The long diameter of the patches lies in the direction of the natural wrinkles of the skin.<br /><br />Dry, crinkly scales usually form on the patches, beginning in their centers. The larger patches may clear in their centers, forming rings, which are not, however, raised as much at the edges as are those of ringworm of the body, with which it may be easily confused. Mild itching is usually the only symptom, and the eruption disappears in a matter of weeks or months, leaving neither scar nor any other sign of permanent damage. In fact, the symptoms are so mild and the ordinarily visible parts of the skin surface so rarely affected that the eruption may be present for several days before its presence is noticed.<br /><br />What to Do<br /><br />1. If pityriasis rosea is suspected, consult a skin specialist if possible, not because the disease is serious, but for two other reasons: (1) The eruption somewhat resembles that of other more serious diseases, and its true nature needs to be known. (2) A short course of cortisone, administered by the physician will usually clear up the eruption promptly.<br /><br />2. If the eruption is noticeably uncomfortable, which is not often true, use starch baths, mixing one to two cupfuls of Linit starch to a tub of bath water.<br /><br />POISON IVY (CONTACT DERMATITIS, POISON OAK).<br /><br />What we are discussing here is an acute inflammation of the skin, typical cases of which are caused by contact with poison ivy or sumac in the East and poison oak in the West. There are other plants in other parts of the world that cause similar skin inflammation by contact, and there are substances other than plants that may cause a similar inflammation.<br /><br />The inflamed, swollen, and intensely itching skin areas, thickly covered with tiny blisters in the early stages, are so familiar to most people that recognition of the condition is often easy. Characteristically there are linear blisters associated with scratch marks.<br /><br />The substance causing ivy or oak poisoning is a waxy or resinous material which can be dissolved by strong soapsuds or rendered harmless by strong oxidizingagents. Extracts of poison ivy or poison oak have been prepared for use as vaccines. These vaccines seem to have afforded some protection to a number of people, but for others they have proved useless.<br /><br />There are so many substances causing inflammation of the skin by contact that it is impossible to discuss them all here. Some affect a large proportion of all persons exposed to them, while others only occasionally cause trouble. It is usually a matter of individual sensitivity to the particular material in question.<br /><br />Fur, feathers, leather, various dyes, some of the plastics, and numerous drugs and chemicals are common offenders. The effect may vary from a slight and temporary reddening of the skin with mild itching to a severe inflammation with blisters and pustules that may not clear up for months.<br /><br />Skin specialists always keep in mind the possibility of contact dermatitis when a puzzling skin eruption comes to their attention. The same treatments and preventive measures are of value in most cases of this type of skin inflammation. Avoiding further contact with the offending substance is obviously the most important preventive measure.<br /><br />What to Do<br /><br />1. If contact with the offending poison is recognized within a few minutes of the time it occurs, much of the poison can be removed or destroyed by washing the endangered skin areas with strong soapsuds, or by painting them with a 1:500 solution of potassium permanganate in water. Later, avoid the use of soap. (Note: The recommended permanganate solution is a strong one, and it may deeply, though not permanently, stain the skin.)<br /><br />2. During the stage of blisters and oozing, use cold (never hot) wet dressings as much of the time as practicable. For the dressings, use eight to ten layers of gauze, fluffed and crumpled, then wet with one or other of the following solutions: (1) saturated solution of aluminum acetate (Burow's solution) diluted 1 to 15, (2) saturated solution of magnesium sulfate (Epsom salts), or (3) 1 percent solution of zinc sulfate. Apply the wet dressings over the entire affected skin areas, cover with waxed paper, oiled silk, or plastic to keep in the moisure, and bind on snugly with bandages. The dressings should be kept wet, and the room kept warm enough to protect the patient from chilling.<br /><br />3. When the blisters have dried and the oozing ceased, apply 1 percent phenol in calamine lotion three times a day.<br /><br />4. As a preventive measure before going into places where there is danger of contact with poison ivy or poison oak, apply to the skin a vanishing cream to which 5 percent of sodium perborate powder has been added. If you must stay in such a place very long, wash away the medicated cream and make a fresh application about every three hours.<br /><br />PRICKLY HEAT (HEAT RASH).<br /><br />Prickly heat is characterized by a red rash with many very tiny blisters appearing on the skin surface, most often affecting babies and stout persons, particularly those of fair complexion.<br /><br />The name is well descriptive of this familiar condition, for the skin feels both prickly and hot. The chief external causes of the rash are hot weather and the wearing of too much or too warm clothing. The use of alcoholic liquor encourages prickly heat to develop.<br /><br />With proper treatment, the rash should clear up in a week or less; but in severe cases with a large part of the body surface involved, body temperature regulation may be interfered with because the sweat gland outlets may have been damaged, and there may be a fatal outcome.<br /><br />What to Do<br /><br />1. Avoid the use of soap in cleansing the affected skin areas. Use thin starch water instead.<br /><br />2. Apply the following lotion four times a day:<br /><br />Menthol .......................1|<br />Phenol .......................2|<br />Glycerin .....................15|<br />Alcohol, 35%, q.s. ad ................240|<br /><br />3. Keep the affected areas cool and dry, as far as possible. When the acute stage of the rash is past, keep these areas thickly dusted with cornstarch.<br /><br />4. If the causes of prickly heat cannot be avoided, dabbing on a small amount of a 10 percent solution of tannic acid in alcohol twice a day may toughen the skin and help prevent further attacks; but this does not always succeed, and should never be done for more than a week at a time.<br /><br />PSORIASIS.<br /><br />Psoriasis is sometimes an acute, but much more often a chronic, inflammatory skin disease, characterized by dry, well-defined, reddish patches, fairly large and covered with an abundance of silvery scales. The patches are most commonly found on the scalp, the knees, the elbows, or the sacral region. Much of the trunk, however, may be involved, and, in severe cases, no part of the body surface is exempt from the eruption.<br /><br /><br />The silvery scales which characterize this disease keep falling off continually a fact which helps in its recognition. If the scales are rubbed off forcibly, blood may ooze from "bleeding points" on the inflamed skin beneath.<br /><br />No clear evidence exists that psoriasis is infectious, and it is not contagious. Sometimes mild itching accompanies this disease, but it does not cause any feeling of general illness. It is often worse in cold seasons.<br /><br />While usually chronic and persistent, psoriasis will sometimes disappear for some time without treatment, though usually recurring later.<br /><br />Many ointments, lotions, and other remedies have been recommended for the treatment of psoriasis, but as yet none of them has succeeded in bringing about more than temporary improvement or relief. General improvement in health habits offers the most hope for the psoriasis victim, but X-ray and quartz-light treatments are often helpful.<br /><br />What to Do<br /><br />1. Take a low carbohydrate diet. Avoid tea, coffee, tobacco, and especially alcoholic beverages. Avoid exposure to cold.<br /><br />2. Eat freely of fruits and vegetables. Be sure that the diet contains an abundance of vitamins. To obtain enough of vitamins A and D without taking too much fat or oil, some rich source of these vitamins, such as halibut-liver oil, should be taken in moderate amounts.<br /><br />3. If constipation is present, do not use mineral oil to control it.<br /><br />4. In any possible acute stage, avoid all irritating applications. The following lotion can be recommended for use twice a day or oftener:<br /><br />Cornstarch.................. 24|<br />Zinc oxide................. 24|<br />Glycerin ....................12|<br />Limewater q.s. ad ................. 120|<br /><br />5. After the acute stage is past, or in any ordinary subacute case which has no acute stage, remove the scales from the spots by using warm water, mild soap, and a soft brush. Avoid causing any considerable amount of bleeding. Then every evening apply 3 percent crude coal tar ointment or the following lotion:<br /><br />Sol. coal tar.............. 12|<br />Zinc oxide .............24|<br />Starch ............. 24|<br />Glycerin ..............36|<br />Water q.s. ad ...............120|<br /><br />In the morning, scrub or wash away any remnant of the ointment or lotion.<br /><br />(Caution: If the eruption is on the scalp, apply nothing but 5 percent ammoniated mercury ointment.)<br /><br />6. In the chronic stage, apply 5 percent ammoniated mercury ointment twice a day.<br /><br />7. In either the subacute or the chronic stage, expose the affected skin areas to sunlight as much as possible, avoiding sunburn, and remembering that prior use of tar-containing preparations increases the sensitivity of the skin to sunlight. After exposure to sunlight, soften the skin areas with a little olive oil.<br /><br />8. X-ray or quartz-light treatments may be very beneficial, but they must be given by, or according to the orders of, a physician; and he may be able to prescribe other useful remedies.<br /><br />9. Remember that psoriasis is seldom really cured, but can often be controlled.<br /><br /><br />SAVAGE FIRE.<br /><br />SEBORRHEIC DERMATITIS (DANDRUFF).<br /><br />Seborrheic dermatitis is a very common affliction, characterized by mild itching and free oily scaling, usually found on the scalp, but sometimes affecting the face, neck, chest, armpits, groins, or genital regions. It is included in the list of inflammatory skin conditions, first, because of its outward resemblance to certain other inflammatory conditions, second, because of a constant though very mild inflammation of the skin, and, third, because no proof exists that any infection is primarily involved.<br /><br />Called "dandruff" when located on the scalp, it is so common that few people are completely free from it. When it appears on the body elsewhere, the eruption is more likely to be characterized by more or less oily crusts instead of dry scales. The skin beneath the crusts is somewhat thickened and mildly inflamed. The only unpleasant sensation is the mild itching.<br /><br />A hereditary tendency, hormone imbalance, nutritional states, and emotional stress are possible causative factors. If any factor of infection is involved, it is probably secondary, and the causative organism or organisms cannot yet be definitely classified as either bacteria or fungi. Seborrheic dermatitis tends to persist for a period of years, though it may come on in successive attacks, each of which may last from weeks to years.<br /><br />What to Do<br /><br />1. Take a diet low in fats, sweets, starches, spices, and hot drinks.<br /><br />2. Try to build up the general health by means of a program of all good health habits, including proper diet.<br /><br />3. Take some standard preparation of vitamin B complex, preferably one containing an ample proportion of vitamin B.<br /><br />4. If possible, have a basal metabolism test made. If the metabolism is much below normal, take thyroid tablets as directed by a physician. Do not take them on your own responsibility.<br /><br />5. For "dry" dandruff on the scalp, proceed as follows:<br /><br />Shampoo three times a week for four weeks afterward once a week until a satisfactory cure is accomplished. Once a week, at bedtime, after a shampoo, apply Pragmatar ointment, which contains salicylic acid and sulfur and is available at any drugstore.<br /><br />The following morning, wash away all traces of the ointment with mild soap and warm water, massaging the scalp well. After the washing and massage, rub into the scalp a little of the following lotion:<br /><br />Phenol ............. |5<br />Castor oil .................1|5<br />Salicylic acid 2 Alcohol, 70% q.s. ad...................... 120|<br /><br />6. For "oily" dandruff, proceed as in (5) above, but make the morning washing rather brief and avoid all massage.<br /><br />7. Though the condition is not primarily infectious, germs may bepresent and may make the condition worse, so sterilize your comb at least once a week. Use no hairbrush, because a hairbrush cannot be sterilized.<br /><br />8. If the skin of the face or the body is affected, try the following:<br /><br />Alternate nights at bedtime, rub in 5 percent sulfur ointment.<br /><br />On the in-between nights, apply lotio alba.<br /><br />9. X-ray or quartz-light treatments given by a skin specialist may be beneficial to change the chemistry of the skin and to discourage the growth of any bacteria that may be present. Some of the most effective remedies also are obtainable only by a physician's prescription.<br /><br />SUNBURN.<br /><br />Sunburn is an inflammation of the skin characterized by burning and redness, due to overexposure to the rays of the sun. It needs little discussion; but sometimes one forgets that the redness and burning do not develop until some time after the exposure and that sunlight reflected from a glass or water surface can burn as well as direct sunlight. A person cannot tell by feeling alone at the time whether or not he is overexposing his skin. Every exposure to the sun produces some damage to the skin, especially to fair-skinned individuals.<br /><br />Certain diseases that may be present, and a considerable number of drugs taken orally or applied to the skin, make the skin more sensitive to sunlight. Fair-skinned, blue-eyed people are more sensitive to it than dark-skinned. Severe sunburn over a large part of the skin surface is more dangerous than many people realize. It is well to remember that in extreme cases it can cause crippling or even death.<br /><br />In severe cases involving a large fraction of the skin surface, there is likely to be pain, swelling, blistering with later peeling, a gastrointestinal upset, and considerable fever for several days. A toxic condition develops, probably because of some decomposition of the deeper skin tissues damaged by the sun's rays. If crippling develops later, it is likely to be the result of stiffening and contracture of damaged tendons. A still later possible effect is permanent hardening of the skin, or even skin cancer.<br /><br />What to Do<br /><br />1. Apply continuous wet dressings of a saturated solution of aluminum acetate (Burow's solution) diluted with twenty times its volume of cold water. Continue until the pain and smarting are permanently relieved.<br /><br />2. A similar effect, may be obtained by getting into a lukewarm starch bath, prepared by stirring one or two cupfuls of Linit starch into a tub of bath water.<br /><br />3. If large areas of skin are involved, and if the burning is severe, bed rest and the attention of a physician may be necessary.<br /><br />4. The following sunburn ointment is recommended for application before exposure to the sun's rays:<br /><br />Zinc oxide.................. 2|<br />Glycerin ..................4|<br />Quinine hydrochloride.................. 6|<br />Rose water ointment................. 30|<br /><br />5. Even more protection is afforded by a heavy coat of standard zinc oxide ointment thickly dusted with talcum powder, but to apply this over large areas of skin is not convenient.<br /><br />Malformations<br /><br />HEMANGIOMA (BIRTHMARK, VASCULAR NEVUS).<br /><br />The ordinary birthmark of reddish or purplish color is composed of a mass or network of tiny blood vessels in the skin. In the simplest case the skin is smooth and normal in every respect except for the excessive number of the blood vessels in it. In more severe cases, the skin may be thickened or the area may show one or more "blood blisters." The birthmark may even be an irregular and unsightly tumor mass of one or more lobes.<br /><br />The unsightliness, however, is the chief disadvantage. Such tumor masses rarely become cancerous, but they may occasionally ulcerate. They do not injure the general health unless they become infected, which does not often happen. As a general rule, treatment begun early in life is more likely to give satisfactory results than if begun later, so whatever is to be done should not be too long delayed. A large majority of birthmarks, especially the flat ones, will disappear by age six even if not treated.<br /><br /><br />What to Do<br /><br />1. Do not try any home remedies.<br /><br />2. Skin specialists can use carbon-dioxide snow, electrodesiccation, quartz light with pressure, radium, X rays, cautery, injections, or other methods of treatment that are effective.<br /><br />ICHTHYOSIS (FISHSKIN DISEASE, XERODERMA).<br /><br />Ichthyosis is characterized by dryness, roughness, and thick, adherent scaliness of the skin. The outer layer or epidermis of the skin is thick and may show numerous shallow cracks, the surface tending to peel in rather large scales. In mild cases there is merely a persistent dryness and roughness of the skin surface.<br /><br />This condition appears early in life, and seems to run in families. Sluggishness of the thyroid gland is found in many cases.<br /><br />Ichthyosis affects only the outer layer of the skin and does not harm the general health. In occasional cases, however, the ability to perspire is lessened, and the afflicted person tends to become more readily feverish or overheated than he normally would. In most cases, the chief disadvantage is the more or less unsightly appearance, but, fortunately, the face, hands, and feet are rarely noticeably affected. During warm weather, mild cases will show improvement and the skin may appear practically normal. Dry air and cold weather make the condition worse.<br /><br /><br />What to Do<br /><br />1. Do not expect a real cure, because the skin of the affected person is permanently short of sweat and oil glands.<br /><br />2. Daily, but especially after each bath, apply some bland oil or ointment, such as petrolatum, cocoa butter, or oil of sweet almonds. Petrolatum to which 1 to 3 percent of salicylic acid has been added has some advantages over plain petrolatum.<br /><br />3. Bathing should be restricted, as it adds to the dryness already present.<br /><br />4. When a bath is taken, the water should be soft, preferably water that is naturally soft.<br /><br />5. Use soap sparingly. It is advisable, however, to use it on body folds when bathing.<br /><br />6. A basal metabolism test should be made under a physician's direction. If it indicates a sluggish action of the thyroid gland, thyroid tablets should be taken as the physician directs. Do not take them otherwise.<br /><br />MOLE (NEVUS).<br /><br />Moles are usually present at birth or appear early in life. In time they may grow and become considerably larger. In color most of them resemble the surrounding skin. Although they may never make trouble aside from their unsightliness, some of them may become cancerous, spreading cancerous cells through the bloodstream to other parts of the body, giving rise to a condition that may prove fatal. Moles<br /><br />which are black, bluish-black, or grayish-blue and flat, especially those located where they are exposed to irritation, are most likely to become malignant. Any mole which shows signs of irritation or which begins to grow rapidly, whatever its color, should be considered suspicious.<br /><br />Moles showing any signs or symptoms suggesting possible developing malignancy should be promptly removed. Small moles can often be effectively treated by using an electrical instrument that kills and dries the tissue.<br /><br />What to Do<br /><br />1. Do not attempt self-treatment.<br /><br />2. Have a physician, preferably a skin specialist, remove the growth, particularly if it is dark-colored, begins to change color or grow, or begins to feel tender or irritated. He will know what to do and how to do it.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-46006868340715369022009-02-26T08:33:00.000-08:002009-02-26T17:42:58.947-08:00Skin Diseases (2)BARBER'S ITCH.<br /><br />CANDIDIASIS (MONILIASIS).<br /><br />Candidiasis of the skin, caused by the same organism that causes thrush in the mouths of babies, may affect the mucous membranes of the digestive tract or the vagina in debilitated people or those who have been taking antibiotics by mouth for a long time. It most commonly attacks obese people, people who sweat freely, or people who have diabetes mellitus.<br /><br />The skin areas most commonly involved are the regions around the anus or vagina, corners of the mouth, fingernail folds, and/or the body folds. The affected areas are red, raw, and beefy in appearance, but may have whitish, curd-like deposits on their surfaces. There may be mild burning sensations present, but itching is much more likely to be troublesome. Warmth and moisture make the condition worse.<br /><br />What to Do<br /><br />1. If the afflicted person has been taking antibiotic by mouth, this medication should be stopped at once.<br /><br />2. Have a physician make the necessary examinations to detect the possible presence of diabetes mellitus, and, if found, to start vigorous treatment for it.<br /><br />3. If the afflicted person is obese, continue a weight-reducing program until a normal weight is reached.<br /><br />4. Keep the affected skin areas as cool and dry as possible.<br /><br />5. Apply 1 percent gentian violet solution to the affected skin areas twice a week. Vioform 3 percent cream is also useful and has less tendency to stain the skin and clothing.<br /><br />6. Griseofulvin is not of value in this condition, but a physician may be able to prescribe other and more effective remedies that cannot be purchased without a prescription.<br /><br />RINGWORM OF THE BEARD (BARBER'S ITCH).<br /><br />Ringworm of the beard is a contagious disease caused by a parasitic fungus, beginning with inflammation in and around the hair follicles of the beard. It is more persistent than either ringworm of the scalp or ringworm of the body, but fortunately it is not very common. It may be contracted in insanitary barbershops.<br /><br />Small, superficial nodules appear at first. Later these become larger and more deep-seated because the parasites work down to the bottom of the follicles. Inflammation is general over the skin of the affected areas, but more marked over the nodules, which have a tendency to occur in groups. Usually a brittle hair projects from the center of each nodule. It is loose and can be pulled out easily.<br /><br />The follicles may discharge thin pus. The disease causes considerable itching and discomfort, and it is sometimes mildly painful.<br /><br />A staphylococcic infection of the bearded area may closely resemble ringworm of the beard, except that the hairs do not loosen. It requires different treatment. Partly because of this fact, self-diagnosis is not easy, and self-treatment may not succeed, so in any suspected case of barber's itch a dermatologist should be consulted.<br /><br />What to Do<br /><br />1. The person who suspects that he may have barber's itch should carefully guard others from infection by not letting anybody else use his razor, toilet articles, washcloths, or towels; and each time after using such articles himself he should sterilize them.<br /><br />2. Secure the services of a physician, if possible. If not, try the treatment recommended under Ringworm of the Scalp.<br /><br />RINGWORM OF THE BODY (TINEA CIRCINATA, TINEA CORPORIS).<br /><br />Ringworm of the body is a mildly contagious disease caused by a fungous infection affecting the skin of the face, neck, body, arms, and legs. It is characterized by reddened patches, round or irregular in shape, and usually scaly. The patches are pea-size at first, but grow rapidly. They usually have a tendency to heal in the center, thus forming rings. The outer edges of the rings consist of tiny papules and a few small blisters.<br /><br />These are slightly elevated, causing the centers to look depressed. The rings may become as much as two inches (5 cm.) broad. Sometimes they do not heal in the center, but continue as inflamed and more or less scaly patches. This disease causes no feeling of general illness and only a mild itching, but it is quite unsightly. It is frequently contracted through contact with infected domestic animals, especially cats.<br /><br />What to Do<br /><br />1. Apply calamine lotion to the affected areas every three hours during the day to help control itching.<br /><br />2. Every night for one week apply half-strength Whitfield's ointment or an undecylenic acid ointment such as Desenex. Avoid getting this ointment near the eyes. If the Whitfield's ointment is at all irritating, dilute it to quarter-strength or less with petrolatum, or use 10 percent undecylenic acid ointment instead. Do not overtreat.<br /><br />3. Griseofulvin taken under a physician's supervision is an effective remedy for ringworm of the body.<br /><br /><br />RINGWORM OF THE GROIN (CROTCH ITCH, JOCK ITCH).<br /><br />Ringworm of the groin manifests itself as brownish or reddish, somewhat scaly patches, with tiny blisters at the spreading edges, commonly affecting the inner surface of the upper thighs, the scrotum, the groin, the perineum, and the anal region.<br /><br />This condition may be caused by different kinds of fungi, and by some is considered as only another variety of ringworm of the body. In many cases the same patient has athlete's foot the probable source of fungous infection which now affects the skin of the groin. Heat, moisture, profuse perspiration, and chafing by the clothing can prepare the way for the infection to take hold. It is more common and more troublesome in the tropics than in cooler climates. Mild itching or smarting sensations are the only forms of discomfort caused by it.<br /><br /><br />What to Do<br /><br />1. Keep the affected skin areas as clean and dry as possible. Wear cool, soft, loose-fitting clothing.<br /><br />2. Just before bedtime take a tepid 1:5,000 potassium permanganate or starch sitz bath. Dry the skin thoroughly and apply half-strength Whitfield's ointment or 10 percent undecylenic acid ointment thinly. If ointments tend to keep the skin moist, do not continue their use, but use a small .amount of dilute (not more than 1 percent) tincture of. iodine, and let it dry on.<br /><br />3. In the morning, dust on talcum powder containing 10 percent of calcium propionate. Use this powder freely during the day to decrease friction when walking.<br /><br />4. Griseofulvin taken under a physician's supervision is an effective remedy for ringworm of the groin.<br /><br />RINGWORM OF THE NAILS.<br /><br />This fungous infection causes the nails to become thickened, brittle, broken, white, and often ridged. It seldom, if ever, causes any pain, itching, or other discomfort, and frequently only one nail is affected. It is an exceedingly persistent infection, however, and only the expert attention of a skin specialist is likely to bring about a cure. It can be caused by one or more of the many kinds of fungi that cause ringworm of other kinds. In extreme cases, the nails degenerate into irregular masses of hard, crumbly material, with little or no resemblance to normal nails. Surgical removal of the diseased nails may be necessary for a cure.<br /><br /><br />What to Do<br /><br />1. Mechanical removal of as much of the affected nail as possible by chipping and scraping is an important part of any successful treatment. This can often be done most conveniently by the patient after he has thoroughly soaked the hand or foot in warm water.<br /><br />2. While not curative, the following applications have been recommended: (a) double strength Whit-field's ointment, (b) 5 to 7 percent tincture of iodine followed by regular strength Whitfield's ointment, (c) a saturated solution of sodium thiosulfate in water.<br /><br />3. Consult a skin specialist if possible, as self-treatment cannot be expected to do any permanent good. Griseofulvin taken under a physician's supervision for six to twelve months is probably the most effective remedy yet found, but surgery may be needed.<br /><br /><br />RINGWORM OF THE SCALP (TINEA CAPITAS).<br /><br />Ringworm of the scalp appears first as small, round, reddish, scaly spots with blisters. The spots enlarge rapidly, become grayish in color, show definite boundaries, and generally cause loss of hair. The infection seldom, if ever, attacks persons past puberty; and if it is present earlier, it tends to clear up by itself when puberty arrives.<br /><br /><br />When the affected spots are numerous, they may grow together, forming large, irregular patches. The hair in these spots becomes dry, lusterless, and brittle, breaking off and leaving short stumps which can easily be pulled from the scalp. Baldness may occur, but it is not likely to be permanent. There tends to be a constant mild itching of the scalp. The disease is usually curable within a few months.<br /><br /><br />Ringworm of the scalp may be caused by more than one variety of fungus. One form is caught by contact with pets, especially kittens or puppies, which may carry the causative organisms without showing signs of active infection. It may also be acquired through contact with an infected person or contaminated article, in a barbershop, by wearing somebody's contaminated hat, or by using somebody's contaminated comb or hairbrush.<br /><br /><br />What to Do<br /><br />Griseofulvin taken for two weeks under a physician's supervision is usually curative.<br /><br /><br />TINEA VERSICOLOR.<br /><br />Tinea versicolor manifests itself as small, rounded, velvety, flat spots, yellow or brownish-yellow in color, usually appearing on the chest, shoulders, armpits, and abdomen. The patient has an odd speckled appearance. The disease is discussed here, not because it is serious, but because it often worries people who do not understand its nature. The spots are covered with small dry scales, which are not always plainly visible. They may grow in size until they are an inch (2.5 cm.) or more in diameter. When they are numerous, they may grow together and form large, irregular patches. The skin of the affected spots will not tan.<br /><br /><br />This disease has no symptoms but mild itching, does not affect the general health, and is only slightly contagious. It is possible, however, to be re-infected by wearing underwear that has not been sterilized. People who sweat considerably are more prone to this disease and to having recurrences.<br /><br />What to Do<br /><br />1. Twice a day, wash the affected skin vigorously with soap and warm water, dry thoroughly, and apply a 10 to 15 percent solution of sodium thiosulfate in water, letting it dry on.<br /><br />2. At bedtime, apply Whitfield's ointment thinly or a sulfur ointment like Pragmatar.<br /><br />3. Griseofulvin has no use in this condition. Also to go to a doctor is usually unnecessary if one recognizes this rash for what it really is.<br /><br />Inflammatory and Allergic Diseases<br /><br />ANGIONEUROTIC EDEMA.<br /><br />Angioneurotic edema is characterized by rapidly developing, extensive swellings, usually affecting the lips, eyelids, or ears, but not limited to these parts of the body. The swellings —similar to those of hives, but larger and more persistent—are accompanied by itching, burning, tension, and stiffness in the affected parts. They are caused by internal or external contact with some substance to which the person concerned is sensitive, though the identity of this substance cannot always be determined. They may lead to death by suffocation if they involve the larynx. Much that is included in the discussion of hives also applies to angioneurotic edema.<br /><br />What to Do<br /><br />1. If the affected areas are accessible, bathe them frequently with cool, thin starch water or a strong solution of baking soda.<br /><br />2. Follow the advice given under Hives, "What to Do," (1), (2), (3), (6), (7), and (8).<br /><br />3. Ephedrine sulfate by mouth or adrenalin or cortisone by injection may be needed in severe cases; but such remedies require the supervision of a physician.<br /><br />CHAFING (INTERTRIGO).<br /><br />Intertrigo is a chafed patch of skin —red, moist, and somewhat raw in appearance, and characterized by smarting and burning sensations. It most often affects chubby children and fleshy older people. The rubbing of two skin areas together is the usual cause, but clothes rubbing on the skin can produce a similar effect. In some cases the smarting and burning become severe enough to amount to actual pain. Failure to keep the skin, especially folds in the skin, free from dirt and decomposing sweat makes chafing almost certain, particularly in warm weather. It is far better to prevent the condition. than to make treatment necessary because of neglect. If the skin areas likely to become chafed are kept clean, dry, and well powdered, intertrigo will rarely develop.<br /><br />What to Do<br /><br />1. Carefully clean the affected skin areas with a soft cloth and warm water. Use a little mild soap at first, if necessary, but rinse all of it off carefully. Dry thoroughly, and apply a suitable powder liberally. A powder made of equal parts of talcum and zinc stearate, or of starch and zinc oxide, will usually be effective. Powders act as a lubricant and facilitate the movement of skin over skin. If the afflicted person is an infant or a young child, great care should be taken to prevent inhalation of any of the powder, particularly that containing zinc stearate.<br /><br />2. If the affected areas are located where one rubs on the other, it may be necessary to keep them separated by cotton pads dusted thickly with powder. As far as possible, avoid any activity which produces rubbing.<br /><br />3. In persistent cases, the treatment recommended under Ringworm of the Groin in the section on Fungous Diseases may be effective.<br /><br /><br />CHILBLAINS.<br /><br />Chilblains are dark red or purplish inflamed areas of skin, usually on the feet, hands, face, or ears. They are caused by frequent or long-continued exposure to cold not severe enough to cause freezing of the tissues, together with a naturally sluggish circulation. They cause much discomfort from itching, smarting, and burning. With continued or repeated exposure to cold temperatures after chilblains have developed, ulceration, scarring, fibrosis, and atrophy of the affected tissues may occur.<br /><br /><br />The best plan is to prevent chilblains by protecting the susceptible parts of the body from exposure to cold, and by treatments that will stimulate the circulation, especially in those parts. After chilblains have once developed, it may take long treatment to bring about a cure; and subsequent exposure to cold is especially likely to cause a recurrence.<br /><br />What to Do<br /><br />1. Avoid vigorous rubbing or massage. Keep the affected parts dry, but not too warm. Wear enough clothing, or use any other practicable method, to prevent further chilling.<br /><br />2. Immediately before bedtime, give alternate hot and cold baths or compresses to the parts for twenty minutes, dry thoroughly, massage gently with olive oil, and apply the following ointment:<br /><br /><br />Ichthyol .............................3|<br /><br />Lanolin .............................27|<br /><br /><br />3. Try to improve the general circulation by taking regular exercise and by taking a brief cold bath or shower every morning, followed by a brisk rub with a coarse towel.<br /><br /><br />DANDRUFF.<br /><br />DRUG RASH (DERMATITIS MEDICAMENTOSA).<br /><br />Drug rash is caused by sensitivity to some drug being taken at or just before the time when the condition manifests itself. There are more than a hundred drugs known to produce rashes in people sensitive to them. Drug rashes are great imitators, and the rashes may look like skin eruptions from other causes. Suspicion of a drug rash is justified if a person, as far as can be determined, has no disease characterized by a rash, and at the same time is taking a drug. An investigation should be started at once to determine the true nature of the rash.<br /><br />Among the common drugs that frequently cause rashes are: acetanilide, aminopyrine, arsenicals, barbiturates, bromides, chloral hydrate, ephedrine, iodides, novocain, penicillin, phenacetin, phenolphthalein, quinine, salicylates, various sulfas, turpentine, and many trademarked preparations the constituents of which may be unknown.<br /><br /><br />Many of these drugs or their compounds are often taken without a physician's advice or knowledge; so if a physician is called to look at a rash, be sure to tell him if the person concerned is, or recently has been, taking a drug and, if so, what drug it is.<br /><br /><br />What to Do<br /><br />Stop the use of the drug that may be causing the rash. It may be necessary to consult a physician to determine the true cause of the rash. Drug rashes vary so greatly in appearance that they are often hard to recognize, and the rash suspected of being caused by a drug may be from some other cause. In some cases of proved drug rash further treatment is needed after the drug is discontinued. No simple, general treatment will fit all cases.<br /><br /><br />ECZEMA (ATOPIC DERMATITIS).<br /><br />Eczema is an inflammatory but noncontagious condition of the skin, characterized by itching, burning, and redness. Some medical authorities consider eczema a group of related diseases rather than one disease. Others include in the group any inflammatory skin eruption of unknown cause, and there are many cases of skin disease in this category. The eruption tends to appear chiefly on the face, neck, upper trunk, and in the bends of the elbows and knees. It is common at ages up to twenty-five.<br /><br /><br />Typical eczema begins with the "erythematous" stage, with itching, burning, and redness of the skin. Then, in the "vesicular" stage, blisters form on the reddened skin areas, some or all of which may become filled with pus, bursting early and allowing clear or pussy fluid to ooze out. During such oozing the disease is often called "weeping" eczema. Usually the blisters or pustules tend to dry down into scales or crusts. The dry-scaly stage is likely to persist a long time. In any stage, the affected skin areas usually have ill-defined borders. Considerable itching and burning are unpleasant symptoms present throughout the course of the disease.<br /><br /><br />Among the local causes of eczema are such things as the following: chemical 'irritants, including dyes, antiseptics, strong soaps, and contact with plants; thermal irritants, including cold, strong wind, and the sun's rays; mechanical irritants, such as scratching, friction, pressure; and the action of parasites. Some constitutional conditions that may prepare the way for eczema are these: emotional or mental strain, insufficient rest, errors in diet, indigestion, faulty elimination, lowered body resistance, inflammation of the kidneys, and diabetes.<br /><br /><br />In many afflicted people there seems to be a peculiar individual skin sensitivity, often hereditary in nature. It can sometimes be detected by a series of skin sensitivity tests; but these fail more often than not. A careful study of the patient's personal and family history is more likely to disclose the cause or causes. Food sensitivity is an occasional cause of eczema in infants, but this sensitivity tends to become much less marked in later years.<br /><br />Eczema may be checked or cured in any of its stages, but any of its stages may also prove chronic and persistent. For these reasons the disease appears in many forms. There are three aims in treatment: (1) to correct the causes as far as they can be detected and corrected, (2) to soothe the skin in the acute or inflamed stages or forms, and (3) to stimulate the skin to heal in the chronic stages or forms.<br /><br />This stimulation, however, should always be mild. The use of harsh or irritating remedies does more harm than good. Hundreds of remedies for eczema have been recommended, but no single remedy has proved really effective in more than a small fraction of cases. This most common of all skin diseases remains, to date, a persistent nuisance to its victims and a knotty problem for their physicians.<br /><br /><br />What to Do<br /><br />1. Regulate the bowels, preferably by eating plenty of vegetables and fruits and drinking plenty of water rather than by the use of cathartics. It is best, however, to avoid eating citrus fruits, strawberries, and tomatoes, because many people are more or less sensitive to one or more of these items.<br /><br />2. Eliminate any food from the diet which experience has proved hard to digest. Make a careful search with the aid of a physician if possible for any foods or other substances to which the afflicted person may be internally or externally sensitive.<br /><br />3. It is advisable to try eliminating from the diet candy, pastries, sweets, chocolate and cocoa, fried foods, seafoods, pork, milk, eggs, fish, shellfish, and all or nearly all salt.But one should remember that, except in infancy, food is probably no more than a minor factor either in causing or in curing eczema.<br /><br />4. Do not use tea, coffee, or alcoholic beverages.<br /><br />5. Use as little water and soap or detergents on the affected skin areas as possible. It is better to cleanse them with olive oil, especially when it is desirable to soften the crusts.<br /><br />6. If the hands are affected, it is wise to wear rubber gloves when they must be put into water or soapsuds.<br /><br />7. As far as possible, avoid overwork, worry, loss of sleep, lack of exercise, or any other practice that will lower physical, mental, or emotional vigor.<br /><br />8. In the acute stage of eczema, either the erythematous (itching) or the vesicular (weeping) type, try wet dressings or a lotion in the daytime and a powder at night. For wet dressings, use Burow's solution diluted with 15 to 20 volumes of water. For the lotion, mix equal parts of olive oil and the standard calamine lotion. For the powder, use the following:<br /><br />Boric acid powder ....................... 2|<br /><br />Zinc oxide ...................................10|<br /><br />Talcum powder ..........................18|<br /><br />9. If the erythematous (itching) stage persists more than two weeks, or if the vesicular (weeping) stage dries down into a reddened swelling with little or no crusting, apply a suitable ointment freely three times a day. One of the following may be used:<br /><br /><br /><br />I<br /><br />Salicylic acid ........................1|<br /><br />Zinc oxide ..........................12|<br /><br />Starch ................................12|<br /><br />Petrolatum .......................25|<br /><br /><br /><br />II<br /><br />Ichthyol ...........................1|<br /><br />Zinc oxide .......................8|<br /><br />Petrolatum ..................20|<br /><br />10. In the scaly or crusted stage, some stimulating ointment is usually the best treatment. Try either of the following twice a day:<br /><br />I<br />Salicylic acid ............................1|<br /><br />Coal tar ....................................2|<br /><br />Zinc oxide ..............................25|<br /><br />Petrolatum ............................90|<br /><br />If this proves nonirritating after a week's use, the proportions of tar and salicylic acid may be gradually increased until they are double.<br /><br />II<br /><br />Resorcinal ...............................1|<br /><br />Powdered sulfur ....................3|<br /><br />Hydrous wool fat ................30|<br /><br />White wax ..............................4|<br /><br />Petrolatum ..........................30|<br /><br /><br />If this proves nonirritating after a week's trial, the proportion of resorcinol may be gradually increased until signs of mild irritation appear.<br /><br />11. Make every reasonable effort to consult a skin specialist, especially in the case of a baby with eczema. This disease is frequently so resistant to treatment that special remedies may be needed, some of which cannot be secured without a physician's prescription. (This may be true also of the above prescription containing resorcinol.)<br /><br /><br />ERYTHEMA MULTIFORME.<br /><br />Erythema multiforme is an acute, inflammatory condition of the skin, characterized by flat or raised spots of a reddish color, commonly affecting the backs of the hands, the upper surfaces of the feet, the face, the sides of the neck, and sometimes the legs and the backs of the forearms.<br /><br /><br />It occurs most commonly in the spring or the fall, and young adults are most often attacked. The eruption develops within twelve to twenty-four hours, the spots of various sizes being accompanied by little or no itching or pain.<br /><br /><br />There may be headache, backache, and some fever. The flat or elevated spots may develop into blisters and pustules, which sometimes become ring-shaped. Pressure on a spot with a fingertip will cause the red color to fade, but it returns quickly when the pressure is released. Within ten to fourteen days, the red color changes to a faint purple, and eventually all abnormal color disappears, leaving no scars.<br /><br /><br />Erythema multiforme rarely attacks a person in good health. It is most often observed on the skin of people who have rheumatism, some acute or chronic infection, sensitivity to certain foods or drugs, or a general run-down condition. In some people, damp and chilly weather seems to bring out the eruption.<br /><br /><br />The remedies that may prove useful depend on the underlying causes. Since these causes may vary so widely, a course of treatment suited to one patient may do another very little good. All but the simplest cases, which show prompt improvement when a good hygienic program is begun, should if possible be carefully studied by a physician, who can recommend treatment aimed at the correction of general debility or any other specific condition revealed by his study as a possible cause of the skin eruption. No local treatment does much good, as a rule, and the care of blisters or pustules and the giving of some of the treatments which many erythema multiforme victims need are best left in the hands of an experienced physician.<br /><br /><br />What to Do<br /><br />1. Try an elimination diet. Do not eat eggs, wheat products, or cow's milk in any form. For cow's milk, substitute goat's milk or soybean milk, preferably diluted. For wheat foods, substitute cornmeal mush, other foods made from corn, or rye crisp. Eat oranges, grapefruit, prunes, plums, apples, pears, and bananas, or drink fruit juices. As vegetables, use peas, lettuce, squash, string beans, carrots, potatoes, and asparagus. Substitute margarine for butter. Drink at least two quarts (liters) of water and juices every day.<br /><br />2. Avoid the use of tea, coffee, and alcoholic beverages.<br /><br />3. Rest in bed as long as any fever is present.<br /><br />4. Daily starch baths may be useful. Use one or two cupfuls of starch per tub of water. Boil the starch for five minutes in ten parts of water before adding to the bath water, which should be warm. The bath may be continued for fifteen minutes, but somebody should constantly watch the patient for possible signs of fainting.<br /><br />5. For local applications, follow the directions given under Eczema, "What to Do," (8) and (9).<br /><br />ERYTHEMA NODOSUM.<br /><br />Erythema nodosum is an acute inflammatory skin disease, marked by very tender red nodules which appear in successive crops, usually on the front surfaces of the legs but sometimes on the forearms, accompanied by intense itching and burning sensations. The nodules are from one-half inch to two inches (1.2 to 5 cm.) in diameter. Their appearance is often accompanied by mild fever, a general feeling of lack of energy, and rheumatic or joint pains. On careful examination, a patient who develops erythema nodosum will usually be found to have infected tonsils, rheumatism, tuberculosis, valley fever, or some other infection needing medical care. This makes it doubly important to consult a physician, if possible, as soon as the characteristic eruption appears.<br /><br />What to Do<br /><br />1. The patient should take no exercise for at least two weeks, and if possible should stay in bed.<br /><br />2. The bowels and kidneys should be kept active, preferably by means of suitable diet and abundant fluids.<br /><br />3. Local applications of any kind will not do much toward curing the condition, though they may reduce the discomfort. An ointment made according to the following prescription may be applied liberally to the nodules three times a day:<br /><br />Ichthyol........................ 3|<br /><br />Lanolin ........................27|<br /><br />4. Have a thorough medical examination to detect if possible the underlying cause of the skin condition. It may well be some infection or disease which itself needs treatment.<br /><br />EXFOLIATIVE DERMATITIS.<br /><br />Exfoliative dermatitis is not a specific skin disease, but an inflammatory condition of a serious nature, characterized by a reddening and scaling or peeling of much of the skin surface, and accompanied by fever and various other signs or symptoms of general illness. The name means an inflammation of the skin resulting in the peeling off of pieces of considerable size. Sometimes the patient loses the whole outer layer of the skin before the attack subsides.<br /><br />Because of the variety of possible causes, no definite group of symptoms characterizes the condition. Neither is there any characteristic appearance, though rather large blisters and pustules are found in many cases. In others there may be at first a severe redness and a burning sensation in comparatively large skin areas, followed a few days later by the aforementioned peeling.<br /><br />Bacterial or fungous infections, spread of psoriasis, seborrheic dermatitis, toxic effects from arsenicals or other drugs, dietary upsets, malignant diseases of lymph and blood-forming tissues, vitamin deficiences, external irritants, or any one of several other possible conditions may lie at the root of the skin inflammation that is the first step of this disease. Obviously it is the underlying condition that needs the most attention, and applications of lotions or ointments to the skin can do little more than help relieve itching or other unpleasant sensations. Since, however, the condition can become rapidly worse and put life in peril, expert attention should be sought as soon as exfoliative dermatitis seems to be developing. Do not waste time in trying to see what local applications will do.<br /><br />What to Do<br /><br />Without delay, consult a dermatologist or experienced physician. Hospitalization is often advisable.<br /><br /><br />HIVES (NETTLE RASH, URTICARIA).<br /><br />Urticaria is caused by a poison within the body or by one attacking it from the outside. The poison causes the small blood vessels to dilate, and fluid oozes out of them into spots on the skin which become swollen and itch violently. The swollen spots look somewhat like those which result from contact with nettles or from insect bites or stings.<br /><br /><br />The area around one of these spots is usually slightly reddened, but the spot itself appears almost white. A typical spot is from one-quarter inch to one inch (.6 to 2.5 cm.) in diameter, but it may be larger. Lasting from a few minutes to several hours, the spots disappear, leaving no trace; but others may quickly follow. Scratching, with its temporary relief from itching, produces irritation and usually leads to the appearance of additional and more severe swellings.<br /><br />The poison which causes urticaria is rarely a substance poisonous to everybody, but one to which the individual concerned is especially sensitive. The commonest source of these special poisons is food. For this reason one aim in treatment should always be to clean out the intestinal tract by administration of a cathartic.<br /><br />What to Do<br /><br />1. Try to learn the cause of the attack, and if possible avoid it in the future.<br /><br />2. Take a tablespoonful of Epsom salts or of castor oil as a cathartic.<br /><br />3. To allay itching, apply a strong solution of baking soda to the affected skin areas freely every two hours, or apply small amounts of a 10 percent solution of menthol in alcohol as often as desired. Sometimes the following prescription applied freely is effective:<br /><br /><br />Thymol ................................1|<br /><br />Glycerin ..............................8|<br /><br />Alcohol (95%) ................110|<br /><br />Water .............................100|<br /><br /><br /><br />4. Avoid the use of tea, coffee, and alcoholic beverages.<br /><br />5. Avoid eating foods to which you may be sensitive, for example: fish, shellfish, pork, cheese, chocolate, citrus fruits, garlic, melons, mushrooms, onions, pickles, strawberries, or tomatoes.<br /><br />6. If repeated or long-continued attacks occur, consult a physician.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-46723502660271837662009-02-26T08:31:00.000-08:002009-02-26T17:52:37.973-08:00Skin Diseases (1)Diseases of the skin are usually unsightly, and are frequently the result of, or occasionally the cause of, ill health of other parts of the body. While they are often uncomfortable, few of them are a menace. to life; but many of them may be quite persistent.<br /><br />Their visibility aids in their early recognition and in judging the effectiveness of treatment. But since they result from the widely differing hereditary tendencies, habits, environmental conditions, and diets of mankind, and are affected by both mental and physical powers and limitations, a great variety of skin abnormalities are exhibited by skin diseases.<br /><br />Some of these may be so unusual or malignant that only a competent physician or specialist is qualified to recognize their true nature or to treat them. In cases where any doubt exists regarding the nature of a persistent skin eruption, attempts at self-diagnosis or self-treatment are not wise. In such a condition, giving the wrong treatment, or delay in giving the right treatment, may be serious.<br /><br />There are numerous skin disorders, however, which an intelligent person with little guidance can recognize and treat, at least temporarily, when he is out of reach of a skin specialist or is unable to afford professional medical care. In discussing the various skin diseases included in this chapter, we have tried to give the reader a reliable basis for judging what can safely be done without prior consultation with a physician, and what circumstances indicate such consultation necessary or at least wise.<br /><br />Perhaps the most important warning that should be heeded by all, but especially by those who try to treat skin diseases without professional supervision, is this: Do not over treat. While a skin disease is being treated, any increase in the signs of irritation or inflammation should be taken as evidence of probable over treatment, or as an allergic reaction to the applied medication.<br />New remedies for skin diseases are being discovered or devised all the time. Furthermore, no two patients and no two physicians are exactly alike; and what a physician uses or recommends will depend to a considerable degree on his past experience in dealing with patients.<br /><br />It often happens that a remedy or treatment program that works well in one physician's practice does not work so well in the practice of another. Do not be surprised, therefore, if a physician prescribes remedies or treatments differing from those recommended in this book.<br />Among the great number of "patent" or "proprietary" remedies on the market, there are many for skin diseases. As a general rule, we have not named or recommended such remedies even though they may be effective, because in most cases there are several similar remedies, and it is not our purpose to favor one manufacturer over another.<br /><br />The only exceptions to this rule are a few products which have become well-known and widely used under their trade names, and are quite generally prescribed by physicians under these names.<br /><br />Most of the new effective remedies discovered in recent years cannot be purchased without a physician's prescription, and many cannot be safely used without a physician's supervision. We consider it unwise to recommend in this book a remedy that the reader cannot buy on his own, or that would be unsafe for him to use if he could buy it. We have limited our recommendations to remedies that have stood the test of time, to those that can usually be obtained without a physician's prescription, and to those that are not likely to be harmful if used as directed.<br /><br />Some drugstores refuse to fill any prescription unless written and signed by a physician, no matter how simple or harmless the remedy may be; so you may find some druggist unwilling to fill some prescription which we have judged safe to include in our discussions and advice.<br /><br />In some cases their unwillingness may be the result of the increasing stringency of laws and regulations regarding the dispensing of drugs. We find no fault with this stringency. We agree that much harm has been done by the use of powerful drugs when they were not needed, and that unintelligent drugging is all too common.<br /><br /><br />Allergy<br />Some people are abnormally sensitive to certain substances which may be present in the air they breathe, in the food they eat, or in something they get on their skin or may brush against. These same substances may be harmless to other members of the family and to other people in general. This sensitivity may be present from birth, in which case it is said to be atopic; but it is more often built up as a result of repeated contacts with the offending substance or substances. The sensitivity itself is called allergy; and, if comparatively prompt and violent, the reaction of the body when brought into contact with a substance to which it is sensitive is called anaphylaxis.<br /><br />Allergy might properly be discussed in relation to any or all of several different body systems. It is mentioned in this volume as a causative factor in the discussions of many diseases that have no relation to the skin. We discuss it in a general way in this chapter, however, because so many of its most common manifestations are in the skin. See also the chapter on "Allergy" which appears later in this same volume.<br /><br />Almost every body tissue may show allergic reactions, and the reactions may take many different forms. Reactions associated with skin diseases will be discussed later in this chapter in their due order. Sometimes the reactions come on immediately after contact with the offending substance, but sometimes they come after a delay of one or more days. Delayed reactions are 'comparatively common when the digestive tract is concerned, and hence they may cause much perplexity. The person concerned may eat some of the offending food and not notice any trouble till considerably later. The tendency then will be to blame some food eaten shortly before the distress became manifest, and the true offender will not be detected.<br /><br />A variety of diseases, at least in a large proportion of the people suffering from them, may be caused by allergy. Hay fever and asthma, acute vomiting or purging especially in children-eczema, hives, and several other skin affections are prominent examples. Occasionally a single individual may at times suffer from more than one of these conditions.<br /><br />Among the offending substances frequently affecting these abnormally sensitive individuals are these common ones: various pollens from plants; hair or dandruff; emanations from cats, dogs, or horses; various kinds of fur or feathers; such foods as milk, eggs, fish, shellfish, pork, fowl, wheat, oranges, and strawberries; and, in children, some of the cereals and butter.<br /><br /><br />What to Do<br />1. Try to find out the identity of the offending food or other substance and avoid it. This may call for the aid of a physician, and one of the methods he may use in his detective work is a series of skin tests.<br />2. When an attack occurs, possibly because of some food, stop the use of all food and take a tablespoonful of Epsom salts in a glass of water.<br />3. Itching may be troublesome. The various skin diseases in which allergy plays a part are discussed later in this chapter in their proper order, together with suitable treatment. Further suggestions as to the relief of itching are given there under the subject of "Pruritus."<br />4. If the attack is severe and a physician is available, consult him. He may be able to give some injection that will give prompt relief and to prescribe other remedies to fit the individual case.<br /><br />Atrophies<br />KRAUROSIS VULVAE.<br />This is a malady peculiar to middle-aged or elderly women, characterized by atrophy, shriveling, and constriction of the skin and mucous membrane of the external genital region. While rarely present in a fully developed form, it is a chronic and stubborn disorder, with surface changes, including hardening, drying, and graying of the skin, and sometimes of the underlying tissues, resulting in a narrowing of the vaginal opening. Itching may be intense, but tends to lessen in time. One reason why suitable treatment is important is that, if untreated or improperly treated, there is a possibility that a cancerous condition may develop.<br /><br />What to Do<br />1. Apply wet dressings of Burow's solution, diluted with from 16 to 32 times as much water as stock solution. Such dressings or packs often allay inflammation and relieve itching.<br />2. Take a diet rich in vitamins, especially vitamin A, which has considerable preventive value, and which may be curative in early cases.<br />3. If possible, consult a dermatologist, because there are some effective treatments, such as hormone therapy and cortisone creams, which cannot be self-administered; and surgery may even be needed.<br /><br />SENILE ATROPHY (ATROPHIA SENILIS).<br />Senile atrophy is a skin condition accompanying advancing age, appearing as patches of tightened, dry and inelastic, or thin and shiny skin, abnormally discolored, especially in spots, and frequently giving rise to more or less itching. It is not a disease with a specific cause, but only a manifestation of one of the body changes due to a reduction in hormones, which to some degree affect all elderly people.<br /><br />It seldom becomes noticeable before the fiftieth year, and is most pronounced in slender individuals. This type of atrophy, aggravated by exposure to sun- light through the years and resulting from a decrease in the amount of fat normally padding the deep layer of the skin, is characterized by spots or areas of skin that are usually yellowish or brownish in color, appearing most noticeably on the backs of the hands, the legs, the neck, or the face. Itching is most troublesome in cold or very dry weather.<br /><br />What to Do<br />1. Remember that the character of this ailment is such that a restoration of the former normal skin condition is impossible.<br />2. Partial relief from discomfort (which is not always present) is possible through the following procedures: (A.) Keep the skin softened by using some simple ointment, such as cocoa butter or rose-water ointment. Apply as often as needed, but especially after each bath. (B.) Use a mild soap, preferably one that is superfatted.<br />Bacterial and Rickettsial Diseases<br /><br />ACNE (ACNE VULGARIS).<br />Acne is characterized by pimples or eruptions of varying severity on the face and often the upper back and/or chest papules, pustules, nodules, or small abscesses, which may be superficial or deep-seated. It is not actually caused by a bacterial infection, but is frequently complicated by one.<br /><br />An acne pimple develops first as a small, red papule, and pus usually appears at its center within a few days unless it is unusually deep-seated. Superficial pustules tend to open and drain of themselves if left alone, leaving no lasting trace; but it is possible for deep-seated abscesses to leave permanent scars, whether they open and drain or not.<br /><br />Prominent among possible causes are a hereditary tendency, sex hormone imbalance at puberty, and impaired fat metabolism. Germs are frequently present in the pus from acne pimples, especially Staphylococcus albus, acne bacillus, and other pus germs of mild virulence. Germs alone, without other factors, will not cause the disease; and in any case they should be considered only as secondary invaders.<br /><br />A typical acne pimple is simply an obstructed and inflamed oil gland, and the pimples are most numerous where the oil glands are most abundant. Naturally, an oily skin is more likely to be affected than a dry skin.<br /><br />Since the pimples often accompany adolescence and appear from about the twelfth to the fifteenth year, they are logically associated with the increased glandular activity, especially of the sex glands, that comes during and following puberty. Eunuchs seem to be immune to acne because they lack male sex hormones. The pimples usually stop forming in the early twenties in males and by age twenty-five in females, whether the ailment is treated or not.<br /><br />Some mild itching and soreness may be present with acne, but serious symptoms are uncommon. Acne causes the formation of scars in the skin. The disease comes at a time of life when young people naturally want to look their best. Actually, then, those who have acne suffer more from psychological stress than from poor general health.<br /><br />The possible effect of diet in causing acne has not been positively determined. Some think it is an important factor. To be on the safe side, it is wise for a person with acne to take counsel from his doctor regarding diet.<br /><br /><br />What to Do<br />1. Use a conservative diet, avoiding excesses of fat (especially the "saturated fats" of animal origin), rich foods, chocolate, and pastries.<br />2. Avoid tea, coffee, cocoa, cola drinks, and all alcoholic beverages.<br />3. Take no medicines by mouth unless prescribed by a physician. Bromides and iodides are especially to be avoided.<br />4. Get eight and a half to nine hours of sleep each night.<br />5. Keep the bowels open, preferably by means of an abundance of fresh fruit and vegetables in the diet.<br />6. Take gentle exercise daily, but avoid violent exertion which causes you to perspire freely.<br />7. No cream, oil, ointment, or grease of any kind should be allowed to come in contact with the face or other affected skin areas. Keep your hands away from your face, and do not lean your chin on your hands.<br />8. Shampoo your scalp twice a week with a simple soft soap (non-medicated).<br />9. Wash your face with tepid water and mild soap twice a day. After the evening washing, use lotio alba (white lotion) or the following prescription on the affected skin, including that of the upper chest and back:<br />.<br />Sulfur ppt ............................................3|6<br />Zinc sulfate .........................................3|6<br />Sodium borate.....................................6|0<br />Zinc oxide ............................................6|0<br />Acetone ..............................................30|0<br />Camphor water .................................45|0<br />Rose water .........................................45|0<br /><br />Apply the lotion with the tips of the fingers, and let it dry on the skin.<br />10. Never squeeze the pimples at any time.<br />11. Suitable antibiotics may be helpful, but should be taken only as directed by a physician.<br />12. When acne is persistent, a skin specialist should be consulted. He may recommend the use of an abrasive soap. He may arrange for treatments by sunlight or by ultraviolet lamp and prescribe hormones for a woman patient. fie may resort to X-ray treatments or minor surgical procedures.<br /><br />BLACKHEADS (COMEDONES). Blackheads are small, tallow like plugs formed in the skin pores by the accumulation of oil and dead skin scales. The blackness of the exposed ends results more from oxidation of the oil than from dirt. Although it has never been proved that germs play a part in the formation of blackheads, blackheads may be infected. An acne pimple differs little from an inflamed blackhead, and the two conditions are often found together.<br /><br />In most cases blackheads begin to appear about the time of puberty; and they often keep coming until about the age of twenty-five, after which they gradually diminish. In most cases blackheads cause no itching or pain; but, like acne, they give rise to a distressing sense of inferiority because of an unsightly appearance.<br /><br />What to Do<br />1. Follow the first eight directions given under Acne<br />2. Wash your face with tepid water and mild soap at least three times a day. Do not use hot water.<br />3. Occasionally, gently squeeze out the visible blackheads with a metal blackhead remover not with your fingers. After doing so, briefly wash the area with tepid water and abrasive soap, and wipe dry. Then with the fingertips dab on the lotion prescribed for acne under (9) above, letting it dry on the skin. (Blackhead removers are sold in most drugstores. )<br />4. If blackheads are numerous or large, skin-peeling treatments may be advisable, but such treatments call for the services of a physician, preferably a dermatologist.<br />5. Exposure to sunlight or quartz-light treatments often improve the condition.<br /><br />BOILS (CARBUNCLES, FURUNCLES).<br />Boils are hard, red, painful, and rather deep-seated swellings, usually beginning as pimples or nodules about hair roots. They increase rapidly in size and develop "cores" in their centers. Furuncle is another name for a boil. Carbuncles are unusually severe forms of boils, ordinarily characterized by more than one core or head, and accompanied by considerable systemic disturbance and general illness and debility.<br /><br />Boils and carbuncles are caused by the same kind of germ a more or less virulent strain of Staphylococcus aureus as a rule. To start a boil or carbuncle, the germs must gain entrance to an oil or sweat gland or to a hair follicle. It has often been noticed, however, that a general low level of resistance, a low metabolic rate, rubbing in of dirt by clothing, or the presence of diabetes mellitus paves the way for the development of boils or carbuncles facts which emphasize the need for a physician to study cases characterized by a "run of boils."<br /><br />The core of a boil consists of a collection of innumerable bacteria surrounded by and interspersed with white blood cells. It tends to soften and form a thick liquid pus around it, which normally eventually escapes through a break in the skin. The pus, containing living germs, may spread the infection and cause other boils if it comes in contact with unprotected skin.<br /><br />Warmth and moisture hasten the formation and breakdown of the core, and help to keep the skin soft so that the pus may more easily break through. If the skin is kept wet continually, however, it may become soft enough to encourage the spread of germs through it. Dressings wet with strong solutions of salt or other suitable chemicals tend to stimulate the drainage of the pus out of the tissues and into the dressings. Boils are most painful if located on a skin area with but little soft tissue between the skin and the underlying bone. They continue to be painful until free drainage of pus is established. Following adequate drainage, a boil subsides quickly.<br /><br />The danger of squeezing or picking at boils needs to be emphasized. The collection of germs in the forming core may be broken up and spread into surrounding tissues, thus making the boil larger than it would otherwise be. The germs may even spread into the bloodstream, causing septicemia or "blood poisoning," which may prove fatal. The most dangerous spot in all the body for a boil to be located is the area marked out by the bridge of the nose, the corners of the mouth, and the outer corners of the eyes. This includes the inside of the nostrils. Many cases of fatal septicemia or meningitis have resulted from improper interference with boils or pimples in this area.<br /><br />What to Do<br />1. Immediately upon the appearance of a pimple which appears severe enough to develop into a boil if it is not deep-seated and has a small yellow spot in the center dip the point of a needle into tincture of iodine or carbolic acid and open the pimple by thrusting the needle sideways through the yellow spot and lifting the needle. Do not press or squeeze. Wipe off the small amount of pus with a bit of sterile gauze or absorbent cotton. Apply 2 percent tincture of iodine to and around the opened pimple at once. This may abort the boil.<br /><br />2. If the pimple is deep-seated, or if it does not have a definite yellow center, do not attempt to open it, but paint it and the surrounding skin twice a day with 2 percent tincture of iodine. Let the solution dry on the skin and apply no dressing of any kind for one hour. This will help to protect the surrounding skin from infection.<br /><br />3. After the skin has been left dry for an hour as directed in (2) above, apply dressings of several layers of gauze kept wet with a warm saturated solution of magnesium sulfate (Epsom salts) on a repeat schedule of two hours on and one hour off. The dressings may be covered with waxed paper, oiled silk, or plastic to prevent their drying out. It is helpful to keep them warm by covering with a hot-water bottle with a layer or two of Turkish toweling between dressing and bottle. Other preparations have been recommended for dressings instead of magnesium sul¬fate. Five percent ammoniated mercury ointment is good.<br /><br />4. The pain of the boil will be considerably relieved if the course of treatment outlined in (2) and (3) above is followed, and the boil will probably come to a head and break<br />within a few days without other help. The boil should never be squeezed, and it should not be opened too soon. If instrumental opening becomes necessary, it is better to have a physician do it.<br /><br />5. Penicillin injections and sulfadiazine by mouth are recommended for a carbuncle or a severe boil. The use of these requires the supervision of a physician.<br /><br />6. From the start, but especially after the discharge of pus begins, it is wise to keep a wide area of skin surrounding the boil disinfected by frequent applications of rubbing alcohol or the mild tincture of iodine described in (2) above, to prevent the germs in the pus from getting a foothold in the skin and possibly starting new boils.<br /><br />7. A "run of boils" should always lead to consultation with a physician. Special examinations and laboratory tests are necessary to determine the identity and nature of the causative germs and other possible causative factors, especially if diabetes happens to be one of them. Diabetes must be treated if found present, and sometimes it is advisable to build up resistance to the special strain of staphylococcus germ causing the boils by giving a long course of injections of "autogenous vaccine," which the physician can have made. Frequent changes of clothing, alcohol sponging, and frequent baths are also important and helpful.<br /><br />CELLULITIS.<br />Cellulitis is a spreading, inflammatory infection, somewhat similar to erysipelas but usually less acute. It most commonly affects the skin, but it usually involves deeper structures as well. It is often found elsewhere than on the face, and the affected skin area does not show a distinct border. It may be caused by either streptococci or staphylococci, which gain entrance through a break in the skin but do not cause pus formation. The skin area concerned is hot, red, and painful. Without proper treatment, the condition is persistent and tends to recur. The involved area may become permanently swollen or thickened, especially after persistent or recurrent attacks.<br /><br />What to Do<br />Call a physician at once. Home treatments are of little use, but treatments by a physician using antibiotics and/or sulfas is usually promptly effective.<br /><br />CHANCRE (HARD CHANCRE, HUNTERIAN SORE).<br />CHANCROID (SOFT CHANCRE).<br />ERYSIPELAS.<br />Erysipelas is caused by a virulent strain of streptococci affecting the skin and the tissues immediately beneath it. It is characterized by redness, discoloration, small blisters, and swelling, most commonly attacking the face, and accompanied by high fever and other manifestations of acute illness.<br /><br />The skin shows a glazed appearance, and the affected area has a combined itching and burning sensation and shows a clearly defined margin. The swollen area feels firm and hot to the touch. There may be only a small patch of affected skin at first, but it tends to spread in all directions from the original site.<br /><br />The victim of erysipelas feels extremely ill, with a marked feeling of lassitude, chills, headache, vomiting, joint and back pains, and a rapidly rising fever, which may go even higher than 104° F. (40° C.). He is likely to have an unusually rapid pulse. In severe cases, delirium is common. In children, vomiting and convulsions often occur. The disease is serious, possibly even proving fatal in aged people, in babies, and in women who have recently given birth. It is likely to cause abortion in pregnant women.<br /><br />The serious nature of erysipelas makes it impossible for a layman to administer effective remedies or treatments. Prompt attention by a physician is important, but the suggestions outlined below may be helpful in delaying the multiplication of germs and slowing the progress of the disease until a physician can begin treatment. At present, penicillin and wide-spectrum antibiotics are the most successful known remedies, but there may be other treatments or remedies that the individual physician has found valuable.<br /><br />What to Do<br />1. Call a physician at once, but until he comes keep the patient in bed and isolated from all except the person caring for him.<br />2. Give him a liquid diet. See that he takes at least three quarts (liters) of water or other fluids a day.<br />3. Keep the affected skin areas covered with ice bags or ice-cold compresses (twenty minutes on and ten minutes off) until a physician takes charge of the treatment.<br />4. Cold compresses to the head are useful in relieving the headache, which is frequently distressing.<br />5. Remember that erysipelas is contagious. The person nursing the patient must wear rubber gloves, and should never come in contact with or care for children or other sick persons at the same time. Ice bags applied to the patient should be disinfected by immersion for five minutes in a solution of lysol—one teaspoonful to the pint (450 c.c.) of water. Cloths used for compresses should be soaked in the same solution for ten minutes before being laundered.<br /><br />FELON (WHITLOW).<br />A felon is a condition of swelling, throbbing pain, and extreme tenderness, characteristically affecting a finger or a thumb. It may at first seem to be an infection or inflammation of the skin, and for this reason it is discussed in this chapter. The germs causing the infection are usually virulent staphylococci, carried in through the skin by a deep pinprick, a thorn, a splinter, or some other sharp object.<br /><br />The inflammation and pus are deep down among the tendons and tendon sheaths, or even near the bone. If thorough lancing is not done promptly, the tendons may slough or the bone be damaged, causing a crippled or deformed thumb or finger. If the pus is not drained, there is danger that the infection may travel to other parts of the hand, resulting in more serious crippling. Or the infection may reach the bloodstream, causing a possibly fatal "blood poisoning."<br /><br />What to Do<br />Call a physician promptly and have the felon lanced. Because of the need for deep lancing and the extreme tenderness of the involved area, it is often necessary to use a local or general anesthetic. The physician will prescribe and supervise the aftercare.<br /><br />FOLLICULITIS.<br />Folliculitis is caused by a staphylococcic infection of one or more hair follicles, with pustule formation. It is related to boils, but is a much milder infection, apparently caused by much less virulent germs. It is most common in men and tends to involve the bearded areas of the skin, but may attack any area in which hair follicles are found.<br /><br />When deep-seated and chronic, it is called sycosis; and the skin around the pustules becomes reddened and crusted. In most cases of sycosis, several to many follicles are involved. Symptoms are not usually acute, being limited to mild burning and itching, with pain only when an involved hair is pulled. Contamination of other skin areas by pus from a pustule is likely to lead to infection of other follicles.<br /><br />If not properly treated, folliculitis may become chronic and persist, for months or even years. It is sometimes confused with barber's itch, which it resembles to some extent<br /><br /><br />What to Do<br />1. Apply 2 percent or 5 percent ammoniated mercury ointment several times a day, spreading the remedy onto the surrounding skin to help protect it from pus contamination.<br />2. If this treatment clears up the condition within one week, apply any antibiotic ointment except penicillin twice a day for another week to help prevent new infections.<br />3. If a pustule is on the upper lip, the nose, the eyelids, or the face on either side of the nose, or if it does not clear up within one week, consult a physician. A deep or persistent infection, or one located in any of the indicated areas, may be dangerous.<br /><br />IMPETIGO.<br />Impetigo is an acute, contagious disease, usually attacking the skin of the face, in children more commonly than in adults. It begins as a reddening of one or more small spots on the skin, soon followed by small blisters.<br /><br />These become pustules, which dry into loosely attached, golden-yellow or honey-colored crusts, each with a narrow zone of reddened skin around it. All of these stages may develop within one or two days. If the crust is forcibly removed, a red area that oozes a little blood will be found beneath it.<br /><br />Impetigo causes considerable itching, but no pain. It is so mild that there is seldom any feeling of illness. It is a pest, however, because it easily spreads from child to child, because it makes them look so repulsive, and because it is often resistant to treatment; but it is seldom dangerous to anybody but infants.<br /><br />Both streptococci and staphylococci are often found in cases of this disease, but they are of only slight virulence. They work only on the skin or a short distance below the surface. Rarely are scars left after recovery.<br /><br />What to Do<br />1. See that the patient's fingers are kept away from the crusts. Scratch¬ing the crusts is the usual means by which the disease is spread.<br /><br />2. Twice a day use a soft cloth or a piece of gauze dipped in "alibour water" or magnesium sulfate (Epsom salts) solution to soak and loosen the crusts. Gently but completely remove the crusts. Then cover the raw area with Neosporin ointment or 2 percent ammoniated mercury ointment. Apply more ointment every one or two hours.<br /><br />3. If the ointment gets rubbed off between treatments, put on more.Except when the crusts are being removed, the affected skin areas should be kept liberally covered with ointment.<br /><br />4. See that nobody else uses the towels and washcloths used by the patient. Boil them for five minutes after using. Disinfect them by soaking for thirty minutes in a solution of lysol--one teaspoonful to the pint (450 c.c.) of water before laundering.<br />5. To protect the skin surrounding the crusts from infection, sponge it several times a day with rubbing alcohol.<br /><br />6. Germs may become resistant to any remedy within a week or two, making it necessary to alternate remedies from week to week. If an increase in inflammation should occur, it may be because the skin has become sensitive to the remedy being used at the time. In this case, do not use this remedy again.<br /><br />7. Calling for the services of a physician is recommended in severe cases or in cases that persist longer than two weeks under the treatment described in (2) and (6) above; and the physician may prescribe penicillin or other antibiotic injections, sulfadiazine by mouth, or other local treatments.<br /><br />8. Special care needs to be exercised in cases involving young babies. Impetigo spreads rapidly on their tender skin, and their bodies seem unable to build antibodies against the germs. They are unable to do anything to cooperate in the treatment, and the disease may prove fatal.<br /><br />WHITLOW<br />Fungous Diseases<br />Fungous diseases may attack various parts of the body, but probably attack the skin most often. Fungi, a more complex form of vegetable organisms than bacteria, usually multiply by means of spores, a characteristic that classifies them midway between bacteria and seed plants. Diseases caused by fungi are rarely acute, but tend to be persistent. They seldom cause fever or result in true pus formation unless complicated by a secondary bacterial infection.<br /><br />Many fungi are enemies of most of the common disease-producing bacteria, and other bacteria are enemies to them: This fact is the basis for the production of most of the antibiotic remedies. But these fungi are also enemies of certain bacteria which abound in the body and are friendly to it. This is especially true of certain bacteria commonly found in the intestine and/ or the vagina of a normally healthy person.<br /><br />So, when antibiotic remedies have been used for a considerable period of time, the friendly bacteria may have been killed off, and certain fungous diseases or yeasts which ordinarily are held in check by these friendly bacteria may take hold and begin to cause trouble.<br /><br />Generally speaking, ordinary antibiotics are not only useless in treating fungous diseases, but may actually help prepare the way for their development. The outstanding exception to this rule is a special antibiotic—griseofulvin—an effective oral remedy for many fungous skin diseases. It may, however, give a variety of uncomfortable side reactions, so it should be taken only under the supervision of a physician. Also, since many fungous diseases may be caused by more than one variety of fungus, and different varieties of fungi differ in their response to treatment with griseofulvin, laboratory tests are often needed to determine what variety of fungus is present, as a guide to the physician in his use of this or perhaps some other remedy.<br /><br /><br />ATHLETE'S FOOT (DERMATOPHY- TOSIS, TINEA PEDIS).<br />Athlete's foot is caused by one or another of a group of parasitic fungi which almost always attack the skin of the feet. Many people are plagued by this malady, since the organisms which cause it are spread from contaminated floors surrounding pools, showers, and other public places.<br /><br />The skin between the outer few toes is most frequently attacked, but the disease may spread to any part of the feet, and it is possible for it to break out on the hands. However, what appears on the hands is usually caused by absorbed toxins circulating in the bloodstream rather than directly by the causative organisms themselves. Nevertheless, by scratching the sores on the feet, one may carry the infection on the hands or under the nails and spread it to other parts of the body.<br /><br />As athlete's foot develops, blisters or cracks, or more often both, appear in the skin, which softens, turns white, and tends to peel off in flakes. Pustules and ulcers may form in severe cases, and there is more or less itching and burning occasionally pain. The dis¬ease is more severe in warm weather than in cool weather, and it is aggravated by any condition which keeps the feet warm, moist, and sweaty.<br /><br />What to Do<br />1. Keep the affected skin areas as cool and dry as possible. Wearing sandals or open-toed shoes will help.<br />2. Protect other members of the household from infection by refraining from walking barefoot about the house, especially about the bathroom. Do not use the family shower, and before using the bathtub soak the feet for at least five minutes in a warm 1:5,000 solution of potassium permanganate.<br />3. Every night at bedtime wash the feet briefly with mild soap and warm water, avoiding too much soaking and softening of the skin. Then with a bit of gauze pick and rub away all loose bits of skin, taking care not to get any of the contaminated material under your fingernails. Then apply some half-strength Whitfield's ointment or, preferably, some 10 percent undecylenic acid ointment, such as Desenex.<br />4. Every morning, wipe away the remaining ointment with dry gauze and dust the skin area thickly with antiseptic powder. The following are two prescriptions for good powders to use in such cases:<br /><br />I<br /><br />Menthol ...........................................|1<br />Thymol iodide ...............................1|<br />Zinc stearate .................................3|<br />Boric acid powder ......................10|<br />Talcum powder .......................100|<br /><br />II<br /><br />Undecylenic acid ..........................1|<br />Zinc stearate ................................3|<br />Zinc undecylenate .....................10|<br />Talcum powder .........................50|<br /><br />5. Sometimes soaking the feet for half an hour in a warm 1:5,000 solution of potassium permanganate or a 15 percent solution of sodium thiosulfate works better than the brief washing described in (3) above. Any blisters present should be opened before such a soaking begins. Dry the feet thoroughly after soaking. If the skin is much inflamed, reduce the Whitfield's ointment to quarter strength or less with petrolatum, but do not omit the use of powder as ad¬vised in (4) above.<br /><br />6. Wear cotton hose, preferably white, changing to a fresh pair every day. To launder hose, boil for ten minutes to kill the organisms, or reinfection is certain and a cure may be impossible.<br /><br />7. If sores appear on the hands, unless an examination has been made and the causative organisms found, do not use any treatment on them except mild and soothing ointments. If itching is severe, apply 1 percent phenol in calamine lotion. When the sores on the feet have healed, those on the hands will probably disappear.<br /><br />8. To prevent a relapse after the infection appears to be cured, apply 2 percent ammoniated mercury ointment each evening, and talcum powder containing 1 percent of salicylic acid each morning, continuing the treatment for several weeks. Dust the same powder into the shoes daily.<br /><br />9. In severe cases, keep off the feet, if possible, and use permanganate soaks and ointment as in (5) twice a day instead of once.<br /><br />10. Consult a dermatologist, if possible, in all persistent cases of athlete's foot. Griseofulvin is not of as much value in this type of fungous infection as it is in some others, but it is worth trying; and X rays, stronger fungicide creams, or other effective treatments, difficult or impossible to use without a physician's supervision, may be necessary.<br /><br />11. Protect others by not going into public showers or swimming pools. If you do not have this disease, it is best to keep away from public swimming pools unless you wear rubber or wooden sandals when walking about the pools, showers, or dressing rooms. Tanks of supposedly disinfectant solution have not proved very effective preventives of infection.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-67686755375345537482009-02-26T02:37:00.000-08:002009-02-26T02:39:50.864-08:00Diseases of the Female Sex OrgansThe female sex organs include the breasts, the ovaries, the oviducts, the uterus, the vagina, and the vulva. Their fundamental function is to help produce a new human being and nourish it until it can take other food than milk. In the production of such a new human being, no substitute has been found for either the ovaries or the uterus, but the breasts all too often fail to do their duty or are discharged from the job whether they should be or not.<br /><br />Breast Diseases<br />ACUTE MASTITIS (INFLAMMATION OF THE BREAST).<br />The most common acute disorder of the breast is acute inflammation. It nearly always occurs during the early stages of the nursing period. Cracks or small injuries of the nipples usually precede the inflammation and prepare the way for the entrance of the disease germs which cause the trouble.<br /><br />The inflammation occasionally affects only the nipples and the surrounding skin. In such cases careful cleansing of the nipples, with frequent applications of a saturated solution of boric acid, is all that is necessary. Boric acid solution, however, should not be applied to the nipples while the baby is being breast fed, unless thoroughly rinsed off with cooled boiled water after being applied.<br /><br />When it is only the nipple or the nipple area that is affected, the use of a nipple shield at the time of nursing is often helpful. Should tiny fissures (cracks) develop in the nipple, they can be painted with tincture of benzoin, which is readily available at the drugstore.<br /><br />The inflammation is often more extensive, however, than described above, affecting deeper parts of the breast; and then it may not respond to simple treatment. It should be noted here that while we have been speaking of the breasts in the plural, an acute inflammation much more often affects only one breast rather than both of them.<br /><br />The first signs and symptoms noticed when an infection begins to affect the deeper tissues of the breast are tenderness, pain, and swelling. There may be a chill, and the fever may be moderate or high, depending on the severity of the infection. In comparatively severe cases there will be a rapid pulse, with headache and other characteristic symptoms that usually accompany infection and fever.<br /><br /><br />What to Do<br />1. When the first signs and symptoms of breast inflammation appear, consult a physician at once. The use of penicillin or some other antibiotic will usually prevent the formation of an abscess.<br />2. Take the baby off the breast, so the breast can be at rest.<br />3. There should be bed rest, but with toilet privileges.<br />4. Support the inflamed breast with a well-fitting brassiere or binder, which, however, should not be too tight.<br />5. The patient should be allowed to drink water freely, and as long as the fever lasts the diet should consist of soft and liquid foods only.<br />6. Cover the inflamed breast with a dry towel and lay an ice bag over the towel, keeping it in place for about two hours. The procedure should be repeated every three hours.<br />7. Do not try to pump milk out of the breast unless it becomes painfully engorged. If a physician is supervising the case, which will probably be true, he should give orders about the use of a breast pump.<br />8. If an abscess forms, the physician will take care of such surgical drainage as may be needed.<br /><br />CANCER OF THE BREAST.<br />CHRONIC CYSTIC MASTITIS.<br />About the time of the menopause, or even before, somewhat tender and quite freely movable lumps are likely to develop in one or both breasts. These lumps may be harmless cysts or early cancer.<br /><br />What to Do<br />1. Have the lump or lumps examined by a physician as soon as possible. The only reliable way to detect or exclude cancer is to have a sample of the lump tissue removed and studied under a microscope.<br />2. If cancer is found, arrange for surgery as soon as possible, since breast cancer begins to spread fairly early.<br /><br />Miscellaneous Diseases of the Female Sex Organs<br />FEMALE GENITAL FISTULAS. Accidents, infections, abscesses, malignancies, or tissue damage such as occurs infrequently at childbirth, may result in perforations or lacerations of various parts of the female genital tract; and fistulas of various sorts may be formed. There may be openings between the bladder and the uterus or the vagina, or between the urethra and the vagina, resulting in a dribbling of urine from the vaginal outlet. There may be an opening between the rectum and the vagina, with fecal material seeping into and out of the vagina. Other fistuals are rare.<br /><br />What to Do<br />Arrange for surgical repair.<br />LEUKORRHEA.<br />Leukorrhea is not a disease, but it may be a symptom of some disease of the vagina, cervix, body of the uterus, oviducts, or some of the glands associated with the genital tract. It is a troublesome discharge of fluid containing pus or mucus or both.<br /><br />The discharge is usually white or whitish in color, which fact explains the word "leukorrhea." This word literally means "something white running or flowing down." Such a discharge is commonly present in chronic infections of the cervix, in gonorrhea, and in a host of other conditions, each of which may require its own specific treatment after careful study of its true nature by a physician.<br /><br />A common and persistent form of leukorrhea results from an infection by a parasite called Trichomonas vaginalis. This infection affects the cervix and the membrane lining the vagina. It causes not only a discharge but a chronic inflammation with more or less itching and burning. Another parasitic infection which often causes intense itching and burning of the cervix and vaginal lining is that of Candida albicans, which produces a thick, white, cheesy vaginal discharge.<br /><br />What to Do<br />Learn the cause of the discharge. It cannot be checked safely and permanently unless the cause is removed or corrected. Both detection and removal or correction usually require the aid of a physician. For each of the several causes of leukorrhea there is a specific treatment. It is especially important not to delay consulting a physician if the discharge between periods is at all blood-tinged.<br /><br />PERINEAL LACERATIONS.<br />Some injury to the mother's pelvic outlet is unavoidable in childbirth. The tissues are more or less bruised, stretched, and torn. But with good obstetrical care the amount of laceration is usually so slight that it can be successfully repaired by a few stitches taken immediately after the delivery of the child. In spite of the best of care, however, bad lacerations, involving a large part of the pelvic floor, sometimes occur.<br /><br />The severity of the tear may not be apparent until a thorough examination is made a few weeks after delivery.<br />Unrepaired perineal lacerations may cause a feeling of heaviness in the pelvis, a sense of loss of support to the pelvic organs, pain in the ovaries, headache, general lassitude, physical debility, and nervousness. Constipation is common.<br /><br />The uterus is invariably in an abnormal position, pulling on some of the organs surrounding it and pressing on others. It may have sagged down to such an extent that the cervix protrudes from the vagina. Straining at stool causes the rectum to pouch into the vagina, producing what is called rectocele. Lack of proper support allows the bladder to pouch in on the front of the vagina, producing cystocele. This interferes with the proper emptying of the bladder, and cystitis may result. All these conditions taken together and many of them may exist at the same time result in a vast amount of discomfort and ill health.<br /><br />What to Do<br />If there are symptoms indicating persistent results from cervical lacerations, have a physician, preferably a gynecologist, make a careful examination. Have a perineal repair operation performed if he so recommends. Surgical repair may mean the difference between chronic semi-invalidism and good health.<br /><br />STERILITY (INFERTILITY).<br />The inability of a woman to become pregnant may be due to underdevelopment of some of the sex organs, for which there is usually no cure, though hormone injections may help in some cases.<br /><br />It may also be caused by constitutional conditions, or by physical overwork, nervous tension, endocrine disorders (especially ovarian), infections, tumors, cervical erosions, or obstructions or strictures of the oviducts. Before surgery or any other extensive procedures are undertaken on behalf of the wife, consultation should be sought regarding sex habits, and the husband's genital organs and semen should be examined.<br /><br />What to Do<br />1. Consult a physician, preferably a gynecologist, to study the cause of the trouble. He may be able to detect it, and in some cases to correct it.<br />2. Before going ahead with extensive corrective measures of the wife's condition, have the husband examined.<br /><br />URETHRITIS (INFLAMMATION OF THE URETHRA).<br />Inflammation of the urethra is commonly caused by a venereal infection. It can also be caused by other types of infection. In still other cases, no infectious agent can be demonstrated (nonspecific urethritis).<br /><br />URETHRAL CARUNCLE.<br />Urethral caruncles are small tumors protruding from the urethral opening. They may be angiomas (blood-vessel tumors), small masses of granulation tissue growing from the membrane lining the urethra, or polyps. They are usually exceedingly sensitive and produce extreme pain on urination. A few of them become malignant.<br /><br />What to Do<br />Do not attempt any home treatment. Consult a physician, preferably a urologist or a gynecologist, since surgery is the only effective remedy.<br />Ovarian Disorders<br /><br />MENOPAUSE.<br />It is hardly proper to call the menopause a disease, because it comes naturally to every normal woman who lives out an average lifetime. But it is so often accompanied by various distressing symptoms that it is discussed here among the diseases of women's sex organs.<br /><br />There is some logic, however, in considering it as an ovarian disorder. Menstruation begins as a result of the maturing of the ovaries, and it ends when their normal function ceases. The action of ovarian hormones has much to do with the changes in the lining of the uterus which produce the menstrual flow, and the use of ovarian hormones is often a useful remedy for the unpleasant symptoms of the menopause.<br /><br />Menstrual periods normally come about once a month from puberty to the menopause, except during pregnancy or lactation. As the menopause, or change of life, approaches, there is often an irregularity of the flow-a missing of a period, or too frequent or too profuse flows. The menopause usually comes at about age forty-eight, but it may occur several years earlier or somewhat later.<br /><br />At this time the pelvic organs begin to shrink in size, and the sex organs lose their reproductive power. As the menopause approaches, women often have hot flashes followed by chilliness. Some of them fail in general health, lose weight, and have a poor or capricious appetite. There may be reflex nervous symptoms nausea, vomiting, and disturbances of the action of the heart or other organs. There may also be extreme weakness, depression, and even melancholia. All the symptoms that commonly plague women seem to crowd in during the menopause headache, backache, digestive disturbances, fainting, constipation, diarrhea, soreness of the breasts, nervousness, et cetera.<br /><br />The duration of the menopause varies greatly in different women. Some cease menstruating abruptly with no disturbing symptoms at all. On the average, the nervous and irregular menstrual symptoms last from a few months to a year or two. With some women the discomfort and nervous symptoms may persist for many years.<br /><br />The menopause is a critical time in the life of a woman; and, before she reaches it, care should be taken to avoid disturbing influences as far as possible and to put the body into as good a condition of general health as can be attained. Much of the suffering that accompanies the change of life could be avoided by careful treatment of menstrual disorders before this time comes and by maintenance of good general health, both physical and mental.<br /><br />What to Do<br />1. Light work, outdoor exercise, plenty of sleep, a wholesome diet, and tonic treatments such as daily cold mitten frictions could usually improve the general health and make the menopausal symptoms less severe.<br />2. Hormones taken under the direction of a physician are often helpful in relieving the headache, nervousness; and hot flashes characteristic of the menopause in many women. The physician may give the hormones by injection or prescribe them to be taken by mouth.<br /><br />OVARIAN TUMORS.<br />Some tumors of the ovaries come as a result of abnormal developments in connection with the normal function of the ovaries. The ovaries normally produce the ova, or egg cells, any one of which, when fertilized by union with a male sperm, can develop into a child. Each of these ova lies in a separate sac in the ovary, and at a certain time in relation to each menstrual period one of them should normally escape when the sac containing it bursts. The little sacs (follicles) containing the ova sometimes fail to burst, however, and gradually become distended with fluid, forming troublesome ovarian cysts.<br /><br />Cysts of other origin may also form in an ovary. Some of them can reach an immense size if not discovered and removed in time. These very large ovarian cysts, however, are rarely seen in places where the services of modern surgeons are available because they are discovered and removed before they reach such a large size. Cases are on record in the experience of missionary doctors where a woman weighed scarcely half as much after the removal of such an ovarian cyst as she did before it was removed.<br /><br />One type of ovarian cyst is called a dermoid. This type is peculiar in that various body structures, such as bones, teeth, or hair, are found in the cysts. Solid tumors of the ovary also occur. Any tumor of the ovary may, as it becomes larger, produce pain and abdominal distention. All ovarian tumors that do not subside spontaneously within a short time should be surgically removed, as harmful or dangerous complications may occur if they are allowed to remain and grow.<br /><br />Some ovarian tumors are cancerous, or may become so, though the great majority are nonmalignant. The possibility of cancer, however, is another reason to have them removed.<br /><br />What to Do<br />1. As soon as the presence of an ovarian tumor is suspected, consult a physician, preferably a gynecologist, and have him examine the condition to find out whether or not such a tumor is present.<br />2. If a tumor is found, arrange to have it surgically removed.<br />ECTOPIC PREGNANCY (TUBAL PREGNANCY).<br /><br />ABSENCE OF MENSTRUATION (AMENORRHEA).<br />Amenorrhea is a condition in which the menstrual flow fails to appear for one or more months during the time between puberty and the menopause. That which occurs during pregnancy or lactation is normal, of course, and needs no treatment. Fundamentally, amenorrhea may not indicate a disease of the uterus at all, the fault being elsewhere; but the uterus is the organ in which its manifestations appear.<br /><br />It is a symptom, and not a disease. The condition occurs fairly often during the first few years after puberty. When it occurs in girls past the age of fifteen, it is most often because of overwork, excessive study, some infectious disease, heart disease, or merely emotional tension. As some women put on weight, they have a diminished flow; or the flow may entirely cease. This does not preclude pregnancy, though it makes it less likely.<br /><br />Amenorrhea may be due to an obstruction in the cervical canal or to some malformation of the female organs. In rare cases the uterus remains in an infantile state; and, though hormone injections may help, as a rule no treatment does any good. Most cases of cervical obstruction and some cases of organ malformation can be corrected by surgery; but a cure, of amenorrhea in the majority of cases must come from removal, correction, or treatment of the underlying cause by other than surgical methods.<br /><br />What to Do<br />1. Give attention to the afflicted person's program of work or study, and to her general health habits. The way to cure her amenorrhea may thus become obvious. To change her work or study program may be difficult, but amenorrhea from these causes is not of itself a cause for alarm.<br />2. If the girl or woman is in rundown condition, correct the health habits. She should take an adequate amount of nourishing food. She should take at least an hour of moderate physical exercise in the open air every day. A cold mitten friction should be taken every day, except the days when the menstrual flow is due (or in progress). Alternate hot and cold applications every week would be helpful. She should get at least nine hours of sleep a night.<br />3. If the cause of the amenorrhea is not obvious, or if it is something that home treatments cannot cope with, consult a physician. Some causes of amenorrhea cannot be detected without study by a physician, and some of the most effective treatments for it must be professionally administered.<br /><br />CANCER OF THE UTERUS.<br />CERVICAL LACERATIONS.<br />Childbirth is always attended by some injury to the cervix (the outlet of the uterus) . Small lacerations usually heal without trouble. Extensive lacerations, however, may cause much discomfort and ill health. Chronic inflammation of the membrane lining the uterus and a disagreeable discharge from the vagina are common complications of neglected cervical lacerations. Old, unrepaired, eroded lacerations predispose to cancer, a common and most serious disease of the cervix.<br /><br />About six weeks after childbirth, every mother should return to her physician for a pelvic examination, at which time, if needed, treatment may be given to the cervix to prevent the development of possible chronic trouble. If this were done following every delivery of a child, and if the examination were repeated annually thereafter, most cases of cervical cancer could be prevented or detected at an early curable stage. Much suffering would thus be avoided and many lives saved.<br /><br />What to Do<br />Follow the pelvic examination program outlined above, and have any abnormal conditions repaired without delay.<br /><br />DISPLACEMENTS OF THE UTERUS.<br />The uterus is held in position by four pairs of ligaments, by the muscles and fascia below, and by the fat found in the tissues of the pelvis. The organ may be displaced backward, sideways, or downward.<br /><br />Tumors of the uterus may drag or push it into various abnormal positions. Tumors located in any of the surrounding structures may displace it by pressure. Lastly, imperfect development of the supporting structures of the organ may result in displacement.<br />There are only two types of uterine displacement that may cause trouble. One is retroversion, or a backward tipping of the organ. This backward tipping may be accompanied by a sagging downward also. The most common position of the body of the uterus is forward and upward.<br /><br />The other type of displacement is prolapse, or a settling downward of the organ, which is sometimes so extreme that the cervix , protrudes from the vulva, and may drag down with it a part of the bladder and of the rectum. This condition is more common after the change of life than before. Loss of weight, weakening of the ligaments, and unrepaired lacerations are the chief causes of this downward sagging.<br /><br />A displacement may be responsible for a woman's being unable to become pregnant; and, if she does conceive, abortion may result. With the backward position, the supporting ligaments may be stretched, causing congestion of the oviducts, ovaries, and uterus as they are pulled back into the hollow of the sacrum against the rectum. Other results are backache low over the sacrum, constipation, and menstrual pain. Most retroversions, however, are symptomless.<br /><br />What to Do<br /><br />1. If there is discomfort, and if displacement of the uterus is suspected, have a physician, preferably a gynecologist, make an examination to determine the true condition. If he finds the condition sufficiently serious, he may advise the insertion of tampons or pessaries into the vagina to help support the uterus. He may recommend surgery.<br />2. If it is not necessary to have surgery or to use tampons or pessaries, and if the displacement is backward, as is usually the case, the following measures are recommended:<br />A. Avoid heavy lifting as far as possible, and do not stand any more than necessary while at work.<br />B. Build up the general health by taking moderate exercise, plenty of rest, a balanced diet, and hot half baths.<br />C. If the displacement is due to a heavy uterus which has failed to return to its normal size after childbirth, a cold rubbing bath every day except during the menstrual period may help.<br /><br />DYSMENORRHEA (PAINFUL OR DIFFICULT MENSTRUATION).<br />There are two forms of dysmenorrhea: the primary or congenital form in which no abnormality can be found in the pelvic organs, and the secondary or acquired form in which an examination reveals some abnormal condition as the cause of the pain. The acquired form may be the result of pelvic inflammation, tumors of the ovary or uterus, or obstruction to free uterine drainage. Obstruction may be caused by scar tissue following surgery or by a small tumor in some part of the uterine canal, most often in the cervix.<br /><br />Many cases of dysmenorrhea can be partly or wholly relieved without the aid of a doctor, and it is recommended that the advice given below be tried before consulting one. Correct health habits will do much toward making the female organs function properly and without distress. It is remarkable what favorable results sometimes follow the correction of constipation. Taking cold, exposure to cold or wet, mental stress, late hours, and dissipation are common causes of pain at the menstrual periods, especially if they occur a short time before the flow begins; and one way to avoid such pain is obvious.<br /><br />For the relief of pain, heat is the best local application. Heat or any other means of increasing the pelvic circulation will often help the flow to start; and, once the flow is well started, pain and other unpleasant sensations as a rule will gradually subside except in cases where obstruction is causing the trouble.<br /><br />What to Do<br />1. Two days before the expected time for the flow to begin, reduce the amount of work done and increase the amount of rest. Take a warm tub bath or a warm half bath each evening for half an hour.<br />2. When the flow starts, go to bed and keep hot-water bottles to the feet and lower abdomen.<br />3. A hot saline enema will help both to clear the bowels and to relieve the pain.<br />4. Fomentation over the lower abdomen and lower part of the back often give relief from pain.<br />5. If distress persists after giving the above program a fair trial, consult a physician. He may find by examination that some obstruction is the cause of the trouble. If so, surgery may bring relief. If not, he may be able to give other useful advice, including the use of a mild analgesic.<br /><br />ENDOMETRIOSIS.<br />Some comparatively young women, often sterile and troubled with irregular and painful menstruation, are afflicted with this unusual condition, which is characterized by masses or patches of tissue similar to the endometrium (the membrane lining the uterus) .<br /><br />These may be attached to the lower part of the colon, the ovaries, or other structures in the vicinity of the uterus. When the uterine lining goes through its regular changes, including swelling and bleeding, during the menstrual cycle, these masses or patches of tissue do the same, giving rise to pain and hemorrhage wherever they are located. A physician can usually detect or at least guess at the condition by ordinary examination, but it may require surgical exploration to prove it.<br /><br />What to Do<br />1. If irregular and painful periods are not known to have some other cause, a physician should study the case to detect possible endometriosis. The likelihood of it is greater if the woman concerned is sterile.<br />2. Medical treatment for suppressing of menstruation may relieve the distress, but the remedies used may have undesirable side effects.<br />3. Surgical removal of the abnormally placed tissue may be necessary.<br /><br />FIBROID TUMORS OF THE UTERUS (FIBROMYOMAS).<br />Fibroid tumors of the uterus are composed partly of muscle tissue growing from and resembling the muscle in the walls of the organ. Tumors of this sort are rarely found elsewhere in the body. With this special muscle tissue are intermingled varying amounts of fibrous connective tissue. Fibroids are usually multiple that is, several occur at the same time in the same organ.<br /><br />They vary much in size, from that of a pea to immense masses weighing two pounds or more. They are approximately spherical in shape, except when influenced by pressure, and are firm in consistency. Their cause is not known.<br /><br />They are hardly ever malignant.<br />When located in the lower part of the uterus, fibroid tumors are a source of danger during childbirth. If they are still lower down in the cervix or mouth of the uterus, they may press upon the bladder and the rectum. If located in the body of the uterus and close beneath its lining membrane, they usually cause profuse and prolonged menstruation, sometimes to the extent ofmenacing life from loss of blood.<br /><br />The discomfort and the hemorrhage tend to increase until the sufferer must remain in bed during the whole period of menstrual flow. There may be a feeling of weight in the pelvis, with backache; and, if the tumor is at all large, definite pressure symptoms may occur, such as irritation of the bladder, with a frequent sensation of need to urinate.<br /><br />The pressure sensations in the rectum are somewhat similar, but they are accompanied by chronic constipation. Pain does not come, as a rule, until the tumor has reached considerable size. Chronic anemia is common because of the abnormally profuse menstrual flow. Leukorrhea may be troublesome between the periods.<br /><br />What to Do<br />1. If the tumor or tumors cause no symptoms, no treatment is needed. They should be watched for changes, however.<br />2. No medicine or home treatment is of any use.<br />3. When symptoms give rise to a suspicion of the presence of fibroid tumors, consult a physician, preferably a gynecologist. His examination will detect a tumor or tumors of any considerable size. Surgical removal is the only cure; and if the tumors are large or numerous, it may be necessary to remove the entire body of the uterus.<br /><br />HEMORRHAGE FROM THE UTERUS.<br />Excessive bleeding from the uterus most often occurs in connection with the menstrual periods, in which case it is called menorrhagia. Bleeding at other times is called metrorrhagia. The most frequent causes of uterine hemorrhage are the following:<br />1. Fibroid tumors, especially those located near the lining membrane of the uterus.<br />2. Uterine polyps.<br />3. Cancer of the body of the uterus, of which either menorrhagia or metrorrhagia may be a complication.<br />4. Hyperplasia of the endometrium, a condition in which the membrane lining the uterine cavity is overgrown, thick and soft, and full of blood vessels.<br />5. Ovarian cysts.<br />6. Retention of a portion of the placenta following childbirth.<br />7. General debility.<br />8. Endocrine gland imbalance.<br />9. Disordered circulation because of disease of the heart, liver, or lungs.<br /><br />What to Do<br />1. For all sufferers from excessive menstrual flow, especially if they are debilitated, every possible effort should be made to build up the general health between periods, giving emphasis to moderate exercise, ample rest, and an abundant, nourishing, and easily digestible diet.<br />2. Between periods, a debilitated patient may benefit by a daily cold mitten friction.<br />3. More than the usual care is needed during and immediately after any childbirth so that the uterus will be restored to its normal size and not become a large, soft, and soggy organ.<br />4. It is important to determine the cause of the hemorrhage. A physician should study the case. Successful treatment will depend on dealing with the cause, and there is no single treatment that will succeed in all cases. Surgery or other treatments that can be given only by a physician may be needed.<br />5. Frequently the anemia produced by the excessive loss of blood requires special treatment.<br /><br />PUERPERAL INFECTION.<br />The cause of puerperal infection is the entrance of disease germs, especially streptococci, into the exposed tissues of the cervical canal and the uterine cavity at the time of childbirth, miscarriage, or abortion. It is practically impossible to keep the vulva and vaginal tissues free from germs; therefore the introduction of instruments, fingers, or other objects into the birth canal or uterus, while sometimes necessary, is always accompanied by some danger of infection. Proper care during delivery, however, would prevent most cases of puerperal infection.<br /><br />Such infections are always serious and may be fatal. The inflammation may extend from the uterus to the ovaries or to the tissues around the uterus, causing abscesses, and to the general peritoneum, resulting in peritonitis. In some cases the infection involves the large veins of the pelvis and the thighs, producing thrombophlebitis, or "milk leg”.<br /><br />A woman who has apparently been doing well after delivery, a miscarriage, or an abortion may have a rise of temperature, possibly preceded by a chill, on the third or fourth day. There may be no pain at all. The sudden rise in temperature in such a case indicates the strong possibility of puerperal infection and signals the urgent need for prompt professional care.<br /><br />What to Do<br />1. If the symptoms give rise to a suspicion of puerperal infection, be sure that the woman concerned is under the care of a physician. Suitable sulfas or antibiotics given early will usually control the infection.<br />2. Do not use vaginal irrigations of any kind without a physician's orders, and he is not likely to order them.<br />3. Give the patient all the water she will drink.<br />4. As long as acute symptoms persist, keep an ice bag applied to the patient's lower abdomen twenty minutes out of each hour.<br />5. The diet should be abundant, but should consist only of soft and liquid foods as long as the fever persists.<br />6. When the acute symptoms have subsided, keep the patient out in the open air as much as possible.<br /><br />Diseases of the Oviducts<br /><br />TUBAL PREGNANCY<br />In an occasional case of early pregnancy the united sex cells fail to make their way into the uterus as is normally the case. In such event, the unborn child will begin its development wherever the united sex cells happen to lodge. This constitutes a so-called ectopic (misplaced) pregnancy. By far the commonest site for an ectopic pregnancy is within one of the oviducts, where it is called a tubal pregnancy.<br /><br />The usual cause of a tubal pregnancy is that the oviduct is inflamed or so narrowed that the product of conception does not have room to pass through the remaining portion of the oviduct and on into the uterus.<br /><br />The hazard of tubal pregnancy is that the tissues of the oviduct are not designed to stretch as much as are those of the uterus. Thus, after about three months of development, the fetus has grown to such proportions that it causes the oviduct to rupture, producing a serious hemorrhage for which prompt surgical treatment is the only satisfactory remedy. In the meantime, the unborn child perishes.<br /><br />INFLAMMATORY DISEASE OF THE OVIDUCTS (SALPINGITIS).<br />Inflammation of the female reproductive organs occurs in connection with three kinds of infection: that of gonorrhea (60 percent of cases), that produced by streptococcic and staphylococcic organisms (35 percent of cases), and that of tuberculosis (5 percent of cases) .<br /><br />Although more than one of the pelvic organs and their surrounding tissues may be involved, it is usually' the oviducts that are most seriously affected. Such an inflammatory involvement of the oviducts is called salpingitis.<br /><br />The germs of gonorrhea gain access to the female reproductive organs by way of sexual intercourse with a partner already infected with this disease. The germs first cause an infection of the tissues in the vicinity of the vulva and the lower part of the cervix of the uterus.<br /><br />Then the infection follows the lining of the uterus upward and enters the oviducts, where it usually causes the greatest damage. It may continue through the oviducts to involve, the peritoneum and the ovaries. This involvement of the oviducts may occur promptly after the initial gonorrheal infection or it may occur some time later even years later. The lining membrane of the oviduct is virtually destroyed. There may be abscess formation. The oviduct is no longer capable of transmitting the ova, and permanent inability to become pregnant is a usual complication.<br /><br />Infection by streptococcic or staphylococcic organisms usually begins as a puerperal infection, in which these germs enter the tissues or the cervix of a uterus which has been unfortunately injured at the time of childbirth or miscarriage or, more commonly, in connection with an abortion. In this type of infection the germs find their way into the tissues which surround the uterus and are then carried by the veins and lymphatic vessels to the oviducts. The lining of the oviducts is not always destroyed in this type of infection, and thus in some cases it is still possible for the patient to become pregnant after the infection subsides.<br /><br />Involvement of the oviducts by tuberculosis is always secondary to a tuberculous infection in some other part of the body, usually the lungs. The germs are carried to the oviducts by the blood. Early cases of tuberculous salpingitis may respond favorably to the administration of drugs now used for the treatment of tuberculosis in other parts of the body. Usually, however, it becomes necessary sooner or later to have the involved tissues removed by surgery.<br /><br />Symptoms of salpingitis vary somewhat with the type of infection. In acute gonorrheal salpingitis the patient experiences severe pain in the lower abdomen with distension of the abdomen. There is nausea, vomiting, fever, and rapid pulse.<br /><br />In the septic type of salpingitis (that produced by streptococcus or staphylococcus organisms) the patient is weak with pelvic pain and possibly has chills along with the fever. In tuberculosis of the oviducts the symptoms are usually not as severe as in the other types, but pelvic pain is common and persistent, usually becoming worse at the time of menstruation. Sometimes there is excessive uterine bleeding. Often the complaint which brings the patient to the doctor is the inability to become pregnant.<br /><br />What to Do<br /><br />For the first two types of acute salpingitis the general program for the care of the patient is as follows:<br />1. Keep the patient in bed with the head of the bed raised eighteen or twenty inches higher than the foot (Fowler position).<br />2. Give the patient soft food including abundant fluid.<br />3. Take care to prevent the patient's becoming dehydrated. Dehydration may occur quickly on account of the vomiting.<br />4. Provide heat to the pelvic region. The best method is by hot sitz baths in which the patient sits in a specially designed tub of hot water while his knees and legs hang over the edge of the tub. (At home, use hot tub bath, with patient sitting up. The temperature of the water should be gradually increased up to the patient's tolerance. The treatment should last about twenty minutes and may be given two or three time a day.<br />5. The physician in charge will doubtless prescribe a course of sulfonamides and antibiotics chosen to combat the specific infection.<br />6. When the acute phase has passed, the physician may recommend surgical removal of damaged tissues and organs.<br />For cases of tuberculous salpingitis, the first motive in caring for the patient is to combat the tuberculous infection, using the general principles of patient care mentioned in the chapter on tuberculosis .If the case is taken early, the physician will doubtless prescribe drugs effective in combating tuberculosis. Even in a late case, these drugs are useful as a preparation for the surgical removal of the pelvic organs involved in the infection.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-89317108033583414782009-02-26T01:28:00.000-08:002009-02-26T01:29:54.504-08:00Venereal InfectionsIn one sense venereal infections do not differ from others. They are caused by specific disease organisms which can be seen and studied by means of a microscope and other facilities available in almost any clinical laboratory. But there are two important respects in which such infections differ. First, they are usually transmitted by sexual intercourse, and more often than not by illicit activities of this kind. So long as prostitution continues, we shall have such infections to deal with. Also widespread promiscuity among teen-agers and college students has increased the problem to almost epidemic proportions in some areas. So the fight against venereal infections is at least as much a social problem as it is a medical problem. Second, with the most common of all venereal infections, gonorrhea, one attack does not immunize against future attacks; and there is no vaccine that can do this.<br /><br />CHANCROID (SOFT CHANCRE).<br />Chancroid is a specific infection, transmitted as a rule by sexual contact. It may appear from one to ten days after exposure or contact. A small pimple appears first, nearly always somewhere on the genital organs. The pimple rapidly forms pus and ruptures, becoming a painful and pus-bathed ulcer, with considerable swelling in the surrounding tissues. The adjacent lymph nodes in the groin, usually on one side only, become swollen, tender, and often abscessed. The ulceration may become extensive and destructive if treatment is not begun early, but by use of the proper remedies most cases can be cured in a few days. Chancroids may be easily confused with syphilitic chancres, and for this reason a thorough examination by a physician is important, the treatment for the two conditions being entirely different.<br />What to Do<br />1. When a chancroid is suspected, immediately consult a physician, preferably a skin specialist, for a definite diagnosis. He will order such treatments as may be needed.<br />2. Avoid alcohol, stimulants, and unnecessary exercise. In severe cases hospitalization may be needed.<br />3. If abscessed nodes develop in the groin, the pus in them may have to be drawn out with a special needle.<br />4. Careful cleaning of the ulcers twice a day with mild soap and warm water is recommended.<br />5. Compresses wet with a 1:10,000 solution of potassium permanganate and kept applied to the ulcers two hours out of every three will hasten the healing.<br />6. Suitable sulfas and tetracycline antibiotics are effective medical remedies, but these must be prescribed by a physician.<br /><br />GONORRHEA.<br />Gonorrhea is caused by a specific germ, the gonococcus. This germ is extremely active in invading mucous membranes, especially those of the eyes and the genital organs. As soon as infection takes place, the white cells of the blood attack the intruders by passing through the invaded membranes. The gonococci are mostly engulfed or swallowed by them, and may be seen inside of these cells, as well as outside of them, with the aid of a microscope.<br /><br />The mass of germs and white blood cells forms pus in abundance.<br />In men, gonorrheal infection causes inflammation, pain, burning, and a profuse discharge of rather thick, light-yellow pus from the urethra. In some parts of the world the great majority of all males have this disease at least once in their lifetime.<br /><br />The male urethra, being much longer than that of the female, and having many glands and passages connected with it, is subject to a more severe early reaction to the germs of gonorrhea. Anterior urethritis, or disease in the terminal part of the urinary tract, easily becomes posterior urethritis also by backward extension of the infection. The germs may then gain access to the bladder, the prostate, the glands along the urethra, the seminal vesicle, the ductus deferens, and the epididymis; and they may cause inflammation in any or all of these organs or structures.<br /><br />A condition which may follow gonorrhea, sometimes a long time after the acute infection has cleared up, is a narrowing or stricture of the urethra, which makes urination difficult and at times impossible, thus causing dangerous distention of the bladder. Stricture also develops in women, though much less often; but it does not develop in either sex until the, disease becomes chronic. It tends to persist indefinitely, and must be treated by dilating or cutting the constriction. The treatment is painful and must be continued for many weeks and perhaps repeated later to prevent complications.<br /><br />Stricture of the ductus deferens may also occur. If it does, sterility is the usual result. Epididymitis may develop. It is a painful and sometimes serious complication.<br />Gonorrhea is less prevalent among women than among men, probably the chief reason being that a smaller proportion of women engage in illicit sexual relations. Many of the women who do become infected get the disease from their husbands who have contracted it before marriage and have not been entirely cured, or who have become infected through illicit sexual intercourse after marriage.<br /><br />But, being internal, women's organs cannot be so readily treated as can those of men. Then, too, a married woman is not likely to begin treatment early, because, not suspecting that her husband has the disease, she does not apprehend any trouble until severe leucorrhea or pain compels her to seek medical aid. By that time the disease has become fully established.<br /><br />Gonorrhea in a woman may begin with pain and burning on urination and a discharge of pus from the urethra, similar to the early symptoms in a man; but much more often the first noticeable sign is a profuse discharge of pus from the vagina, sometimes with fever and pain and tenderness in the lower part of the abdomen on one or both sides. Gonorrhea may be present and may persist in a woman, however, even though she has no noticeable symptoms; and sometimes it is difficult to determine definitely whether or not she has a gonorrheal infection.<br /><br /><br />The infection may travel up through the uterus and the oviducts until it passes out through the open ends of these tubes into the abdominal cavity and causes peritonitis. If peritonitis is not caused, or if it quiets down without causing death or severe illness, the infection tends to become chronic in the oviducts and eventually to seal them shut in one or more places. Oviducts thus sealed shut will not allow ova to pass from the ovaries to the uterus, resulting in sterility.<br /><br />An oviduct sealed shut in two or more places forms one or more closed pus pockets. These pus pockets are dangerous foci of infection, and may lead to much pain, distress, and general ill health. Surgery finally becomes necessary in a considerable proportion of such cases to prevent complete invalidism.<br /><br />In women, glands near the outlet of the vagina, especially the Bartholin's glands, may become infected and form painful and tender pus-filled pockets, requiring surgical drainage.<br /><br />A very serious, though not very comb moan, form of gonorrheal infection is called ophthalmia neonatorum, or sore eyes of the newborn. It is caused by the germs' getting into the child's eyes during birth. So serious is infection of this kind that failure on the part of a physician to treat every newborn child so as to prevent this disease is considered a crime in many countries. The result of gonococcic infection in the eyes of an infant, if left untreated, is blindness in almost every case. The infection shows itself a few days after birth as a profuse discharge of pus from the eyes. It requires intensive and expert treatment if the little one's sight is to be saved.<br /><br />Sometimes gonorrheal ophthalmia occurs in older children or adults. A person with genital gonorrhea may carry the germs to his eyes if he is not careful to disinfect his hands after urinating or changing dressings. If he tries to conceal his condition from other members of the household, they may unknowingly contaminate their hand by touching or handling objects whit he has carelessly contaminated, at then carry the germs to their eyes by rubbing them, though this rarely happens.<br /><br />Sometimes—also rarely—gonerheal ophthalmia results from a blood borne infection.<br />Gonorrhea sometimes occurs little girls. It is characterized by a discharge of thick yellow pus from the vagina. The infection may come from diapers handled by the mother or a nurse who has the disease, from abnormal sex practices of older persons, occasionally from contaminated toilet seal or from sleeping in the same bed with older persons who have gonorrhea. Jot all vaginal discharges from little girls are due to gonorrhea, however, and it may require special laboratory procedures to determine whether or iot gonorrhea germs are present. Furthermore, in little girls there is less tendency for the infection to travel upward beyond the vagina, so the disease is less likely to have serious complications with them than it is with older girls and women.<br /><br />Gonorrhea, while local in its early and usual manifestations, may become t general infection by getting into the Blood. As a blood disease, it may gain access to the joints, causing painful arthritis; it may be carried to the eyes, pausing ophthalmia; or it may result in infection of the heart valves, causing a usually fatal type of valvular heart disease.<br /><br />Gonorrheal arthritis occurs much more commonly in men than in women, is might be expected. The knee, the elbow, the ankle, and the hip are the joints most frequently attacked. The joints become hot and very tender and painful. When the acute symptoms subside, the joints are likely to be left stiff; and vigorous and painful treatment by a physician is necessary to restore them to their normal motion.<br /><br />In its early stage, gonorrhea can usually be cured in a short time by proper treatment. For this reason, one who notices any smarting or burning or discharge from the urethra or the vagina a few days after sexual relations with a person not known to be free from the disease should immediately consult a physician for diagnosis, and for treatment if needed.<br /><br />It must be remembered that accurate diagnoses cannot be made without microscopic examinations and that it cannot be surely known that a cure has been accomplished until repeated microscopic examinations and cultures fail to find the germs. Relapses are not uncommon. Indulgence in alcohol and in sexual intercourse are the most potent causes, of relapse.<br /><br />What to Do<br />1. If any symptoms suspicious of gonorrhea are noticed, consult a physician without delay, preferably a urologist. It is perilous to postpone any needed treatment, to attempt self-treatment, or to depend on remedies sold without a physician's prescription.<br /><br />2. Treatment of gonorrhea has been revolutionized by the use of certain sulfas, and especially of penicillin and certain other antibiotics. The use of these drugs can in most cases bring the infection under control within a very few days; but these remedies can be used safely and properly only under a physician's supervision.<br /><br />3. Since exposure to infection with gonorrhea may carry with it the danger of exposure to infection with syphilis, anybody being treated for gonorrhea should also have a blood test for syphilis, and, if the first test proves to be negative, have it repeated one month later.<br /><br />GRANULOMA INGUINALE (GRANULOMA VENEREUM).<br />Granuloma inguinale is a venereal infection, spread by sexual contact. It is believed to be caused by very small germs called Donovan bodies, which by microscopic examination can be seen packed inside the walls of certain rather large characteristic cells.<br />The first stage of this disease is a blister or small, flat pimple or nodule appearing on the external, genital organs. Then a spreading ulcer develops, usually with new nodules forming around it as it extends. In severe cases there is much scarring and tissue destruction. More than one spot may be involved from the first, and the destructive ulceration may spread not only to the genital organs but to the groins and thighs, or even farther. With proper treatment most cases are curable, but an occasional case is so resistant to treatment that it may progress until it comes to a fatal end.<br /><br />What to Do<br />If granuloma inguinale is suspected, do not try self-treatment. Call a physician at once. If he finds the condition actually present, he can use chloramphenicol, streptomycin, chloromycetin, or tetracycline antibiotics; all prove effective.<br />LYMPHOGRANULOMA VENEREUM (LYMPHOGRANULOMA INGUINALIS, CLIMATIC BUBO).<br />Venereal lymphogranuloma, which has at least a dozen other names, is an infectious virus disease, usually transmitted by sexual contact. A typical case begins as a papule or small ulcer somewhere on the external genital organs about two weeks after exposure. Next, the neighboring lymph nodes, usually in one or both groins in male patients but fairly often about the anus in females, become swollen and tender.<br /><br />The skin over these nodes turns purplish and then breaks down, forming persistent, tender ulcers into which more or less pus drains from the nodes beneath. During the period of swelling and ulceration there may be some fever and other general symptoms of an acute infection. The ulcers tend to heal, but very slowly and with much scarring. This scarring, especially in female patients, may cause a stricture of the anus or rectum, which is one of the most common and most troublesome of the late complications.<br /><br />One of the most useful procedures in diagnosis is the Frei test. The material used for this test—Frei antigen—is prepared from pus obtained from the infected nodes of a person known to have lymphopathia venereum.<br /><br />What to Do<br />1. As soon as venereal lymphogranuloma is suspected, consult a physician, preferably a skin specialist, to help find out the true nature of the disease. If needed, he can give or prescribe suitable sulfonamide and antibiotic remedies.<br />2. Choose foods that leave a small, or at least a smooth, residue after digestion.<br />3. Alternate hot and cold compresses over the swollen nodes in the groin will help to relieve pain and clear up the infection.<br /><br />SYPHILIS (LUES VENEREA, PDX).<br />Syphilis is caused by a specific germ, Treponema pallidum, corkscrew-shaped and much larger than most bacteria. To contract syphilis, a person must get the germs from a living source, as a rule. They must enter the body through a break in the skin or mucous membrane, or be transmitted by a mother through the placenta to her unborn child.<br /><br />Syphilis contracted because of entrance of the germs into the body after birth is called acquired syphilis. Syphilis transmitted before birth is called congenital syphilis.<br /><br />Syphilis is usually contracted during sexual intercourse. Sometimes surgeons or dentists are infected through pricking or cutting their hands while operating on syphilitic patients. A few people are infected by using contaminated silverware, drinking glasses, or other utensils, but more by kissing people who have lesions of the disease in their mouths or on their lips. Even in such cases, the moist, living germs must enter through a break in the skin or penetrate a mucous membrane and get into the circulation before they can produce the disease. Drying kills syphilis germs very quickly. That is one reason why so few people get syphilis except by sexual intercourse.<br />The first sign of acquired syphilis is an ulcer called a chancre—sometimes called a hard chancre or Hunterian sore. The ulcer usually has well-defined edges and a small amount of slightly blood-tinged, watery discharge, but it is not painful.<br /><br />It may be easily seen, or entirely obscured by overlapping skin or mucous membrane. It appears from ten days to three or four weeks after exposure, and lasts from a few days to several weeks. It may disappear and soon be forgotten, but it usually leaves a scar.<br /><br />The chancre occurs most often on the mucous surfaces of the genital organs, but it may be on the skin. It may be in the mouth or on the lips. Women often contract syphilis without knowing it, because the chancre is likely to develop on the cervix or some other location within the vagina where it can be neither seen nor felt. This inability to detect early syphilis in a woman makes intercourse with prostitutes a frequent source of syphilitic infection.<br /><br />From a few weeks to a few months after the appearance of the chancre, an eruption •usually appears on the body. This may consist of only a few red, pimply blemishes, or it may be a profuse crop of various types of blotches. At this stage the germs are already widely distributed throughout the body. The infected person may have chills, fever, swollen lymph nodes, anemia, and pains in the bones and joints.<br /><br />The eruptive stage lasts for a few weeks, a few months, or, rarely, years. During this and a still later stage, very infectious lesions, known as mucous patches, are formed in the mouth and on other mucous surfaces of the body. From these, a considerable proportion of the new cases of syphilis are contracted.<br /><br />The third stage of syphilis occurs generally from three to twenty years after the first lesion. Hard tumor masses called gummas appear in different parts of the body. These gummas may slough away and leave ulcers; they may form tumor masses in the abdomen, the lungs, the pelvis, or other parts of the body; and they may form in the bones and thus weaken them, causing fractures. Large sores, difficult to heal, may develop on the skin and cover a large part of the body.<br /><br />The most distressing features of syphilis come as late effects of the disease. A man, perhaps in the prime of life, begins to have abdominal pains which he cannot account for. These increase in severity, resembling a girdle-like constriction about his trunk. Excruciating pains shoot through his legs and body. He soon finds that he cannot walk well in the dark. He loses control of his legs. He cannot control the discharges from his bowels and bladder. He becomes a helpless invalid for the rest of his life because syphilis has wrecked his nervous system; yet he may live on for years in this pitiful state, for syphilis seldom kills quickly.<br />Tabes dorsalis, or locomotor ataxia, the terrible condition just described, is only one of many serious conditions or diseases caused by the germs of syphilis. Senile dementia or some cases of apoplexy, epilepsy, insanity, paralysis, and partial or complete blindness may have syphilis as their cause.<br /><br />Many of the rapidly fatal cases of heart disease are brought on by syphilis. In such cases that part of the aorta near the heart is usually attacked first, and the aortic valve is so badly damaged that it cannot hold. The resultant excessive leakage throws such a heavy burden on the heart that it first enlarges greatly and finally fails completely.<br /><br />Many inmates of mental institutions are there because of syphilis. The mental disease resulting from syphilis has various names, among which are general paresis, dementia paralytica, and general paralysis of the insane (GPI) .<br /><br />While the victims of general paresis rarely suffer pain and often act as if they were "on top of the world," there is no cure for their condition; and they are a burden on public finances for the rest of their lives, which may drag on for many years.<br /><br />The innocent children of syphilitic parents show some of the most pitiful effects of this disease. A large proportion of the babies born with syphilis die early, usually during their first year of life. A typical syphilitic baby has fissures about the angles of its mouth, a nasal discharge with "snuffles," a coppery-brown-colored rash, and/or blisters on its buttocks and face. If it lives, it develops slowly, both physically and mentally, and is troubled with restlessness and disturbed sleep. Its bones<br />grow in an abnormal, characteristic manner, easily detectable by X ray. When the teeth come in, especially the permanent teeth, they are likely to be notched and peg-shaped. The eyes and ears may be diseased in various ways, with impairment or even loss of eyesight and hearing.<br /><br />Besides all this trouble, the unfortunate child has a strong chance of being an idiot or of being epileptic or neurotic in various ways; and he may later have any or all of the third-stage developments that characterize acquired syphilis.<br /><br />Syphilis must be diagnosed and proper treatment begun early if grave aftereffects are to be avoided. Any ulcer or persistent sore on the genital organs, especially following illicit sex relations, should be immediately examined by a physician. No person should attempt to treat the sore himself; for improper treatment may so obscure the disease germ that the real condition cannot be reliably diagnosed, yet the disease will be permitted to go on and produce its terrible aftereffects.<br /><br />When a doctor sees a sore which he suspects may be a chancre, he will probably make what is called a dark-field microscopic examination of scrapings or serum from the ulcer, or have such an examination made.<br /><br />This test offers about a fifty-fifty chance of discovering the germs if they are present. If they are found, treatment can begin at once. If not, a little later he will draw a specimen of blood for special tests which are much more likely than a dark-field examination to detect the true condition, though waiting for the results of such tests means unavoidable delay in starting treatment.<br /><br />These blood tests, of which there are several kinds, are applicable in all suspected cases of syphilis a few weeks after the initial infection—usually in time to make treatment fairly sure of success. Probably the best known of these blood tests is the Wassermann test.<br /><br />Late syphilis is frequently detected by applying the Wassermann test or some equivalent test to fluid drawn from the spinal canal. When the disease has disappeared from all other tissues or fluids, the spinal fluid often gives evidence of its presence.<br /><br />The fluid must be drawn with great care by a physician and tested even more expertly than the blood is tested. While not all of the late ill effects of syphilis can be prevented if treatment is delayed until the central nervous system is invaded as shown by the spinal fluid test, modern treatment is so efficient that it can do a great deal of good if begun before actual symptoms of the third stage of syphilis have appeared.<br /><br />If begun during the first half of pregnancy, the treatment of an expectant mother who has syphilis may enable her to give birth to a baby who is free from the disease. If all such expectant mothers were thus treated, congenital syphilis could be practically wiped out, because a syphilitic child "catches" the disease from its mother and does not inherit it from its father.<br /><br />Most people, at least most men, who have syphilis know they have been exposed; but many of them do not know they have the disease. An even larger number of women, especially married women, who have syphilis neither know they have it nor know that they. have been exposed. The chancre is painless, and may develop in a place where it escapes notice.<br /><br />The skin eruptions and other signs and symptoms of the second stage may be so mild that they either go unnoticed or are mistaken for something of little importance. The interval between the second and third stages of the disease may be very long. During this time the disease is called latent syphilis, and it shows no signs or symptoms of any kind; but a blood test taken during this period is likely to be positive.<br /><br />Treatment taken during this period will usually prevent the deplorable damage that comes with the third stage.<br />There are more than a few people scattered here and there who have latent syphilis and do not know it, but its presence could usually be detected by a blood test, and its progression to the third stage could be checked.<br /><br />Knowledge of this fact has given rise to the almost universal practice of giving all expectant mothers blood tests fairly early in their pregnancy, so that if any of them happen to have latent syphilis its presence can be detected and they can be treated so as to prevent their passing the disease on to their unborn children.<br /><br />In many hospitals all patients admitted are given blood tests; and cases of latent syphilis are fairly often discovered in this way. In many communities blood-testing campaigns are carried on from time to time. Such practices, plus the vigorous case-finding programs of health departments, have greatly reduced the prevalence of syphilis; but much still remains to be done before the disease is stamped out.<br /><br />What to Do<br />1. As soon as a suspicious sore or ulcer is discovered or there is any other reason to suspect a syphilitic infection, have a physician, preferably a urologist or a skin specialist, make such examinations and tests as are needed to determine the true condition.<br />2. Meanwhile, avoid sexual inter‑<br />course.<br />3. Remember that neither diet, hydrotherapy, nor any home treatment can cure syphilis; but there are remedies that can, and doctors can use them.<br />4. All effective remedies must be given or prescribed by a physician, but proper remedies correctly given can come as near to curing syphilis in two weeks in our day as used to be possible in two years.<br />5. To help make medical treatments more effective, especially in cases of late syphilis, certain general health-building principles should receive attention. Some of these are:<br />A. Foods made largely from grains, fruits, nuts, and vegetables, together with milk and eggs in moderation, compose the best diet.<br />B. Alcohol, tobacco, stimulants, tea, coffee, and highly seasoned foods should be avoided.<br />C. The patient should drink water freely, especially between meals.<br />D. Plenty of sleep and a reasonable amount of outdoor exercise are important.<br />E. Frequent bathing is helpful. The practice of taking a hot bath for ten minutes before retiring, cooling the water to a little below body temperature at the end, and doing this at least two or three times a week, is recommended.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-59858576381700259922009-02-26T00:33:00.000-08:002009-02-26T00:38:19.927-08:00Lymphoid tissue DiseasesIn the human body there are several organs or masses composed of lymphoid tissue. This tissue is largely formed from special cells of small size called lymphocytes. They are identical with certain cells which normally make up about a third of the total number of white blood cells; and it is evident that lymphoid tissue is the origin of this class of blood cells.<br /><br />Some of the lymphoid organs are the spleen, a large solid structure in the upper left side of the abdominal cavity; the thyyntis, in the chest cavity, just behind the upper part of the breastbone; and the lymph nodes, of which there are five or six hundred scattered in different parts of the body. These latter vary in size but are all small, most not larger than a small bean. There are many in the sides of the neck, the armpits, the groin, the central part of the chest cavity, and the abdominal cavity.<br /><br />Other important collections of lymphoid tissue are the Peyer's patches in the lower part of the small intestine; the tonsils, situated on the sidewalls of the throat near the back part of the tongue; the adenoids, also called the pharyngeal tonsils, on the upper part of the rear wall of the throat; and the appendix, attached to the large intestine near the place where the small intestine joins it.<br /><br />Any of these structures or collections of lymphoid tissue, except the Peyer's patches, can be removed without causing any apparent harm to the body, though while they are in it and in normal health they serve very important purposes. Most of them act as obstructions to foreign particles, disease germs, and even chemical poisons, in their passage toward the bloodstream. All the channels or vessels that carry the lymph from the various parts of the body toward the large veins in the chest pass through lymph nodes on the way. The nodes act as sieves to catch and sift out harmful objects or materials. The importance of this activity of lymphoid tissue should not be disregarded when removal of tonsils or adenoids is being considered.<br /><br />Diseases associated with the thymus, also inflammations of the tonsils, adenoids, and appendix, are discussed elsewhere in this volume. Inflammation of the Peyer's patches occurs almost solely as a feature of typhoid fever. The spleen is involved in several different diseases, but it is seldom if ever the seat of a disease by itself. Virtually every infection or infectious disease that attacks the human body involves the lymph nodes but usually only secondarily. In this chapter we shall consider in detail only Hodgkin's disease, in which the lymph nodes are primarily affected, and swelling of the lymph nodes, which occurs almost every time they are involved in any other disease. It is important to know that this involvement sooner or later always occurs with cancers as well as with infections by disease germs or viruses.<br /><br />HODGKIN'S DISEASE.<br />Hodgkin's disease is a chronic, progressive, usually fatal disease which has a higher incidence among men and boys than among women and girls. Typically it begins in young adulthood. Its cause is not yet surely known. Its onset is gradual. The lymph nodes enlarge progressively. Those located where they can be felt are firm and elastic to the touch, but they remain freely movable and do not mat together. Troublesome itching is likely to develop early, and there may be excessive sweating. Later the victim has spells of moderate fever, is weak, loses weight, and becomes pale and anemic. The symptoms and signs of this disease, however, are so nearly like those of some other diseases that about the only sure way to detect its presence is for a physician to arrange for the removal and microscopic examination of one of the enlarged lymph nodes.<br /><br />There are many possible distressing developments in the course of Hodgkin's disease. While the lymph nodes in the neck are usually the first to be affected, and while the swollen nodes are not painful, those in the interior of the body often press upon various organs and structures and interfere with their functions. The physician in charge of the case will usually be able to judge from the symptoms where the enlarged nodes are, how great the need of antineoplastic drugs and X-ray treatments is, and whether or not some other treatment should be tried. Suitable dietary and nursing measures may help to maintain the victim's strength and add to his comfort. No matter how treated, however, Hodgkin's disease is usually fatal, its course typically running not more than five years; but with the best treatment life is made more endurable or even comfortable, and sometimes prolonged for as much as twenty years. Mild cases in which the involvement is limited to a single area, when treated early, may remain symptom-free for many years, during which time life and its activities may be apparently normal.<br /><br />What to Do<br />1. If Hodgkin's disease is suspected, place the victim under a physician's supervision immediately. He will first do what is necessary to determine whether or not the disease is actually present; and, if so, he can begin at once to give the most effective treatment.<br />2. The victim should be encouraged to follow a program that will build up his general health. He should never be made to feel that all he can do is to lie down and wait for death.<br /><br />SWELLING OF THE LYMPH NODES.<br />Nearly all the disease conditions affecting the lymph nodes produce an enlargement which can easily be seen and felt if the affected nodes are situated near the body surface. These swellings are more likely to be painful and tender if they are caused by inflammation or if they develop rapidly.<br /><br />A sore throat, a sore mouth, a bad cold, infected tonsils, or disease of the middle ear is usually accompanied by swollen and tender lymph nodes on the sides of the neck and underneath the jaws. An infected hand or a sore on a hand or an arm is likely to be accompanied by swelling of the nodes in the corresponding armpit. Sores on the scalp often lead to swollen nodes behind the ears and on the back of the neck. Infections of the feet or legs frequently cause swelling of the nodes in the groin. These swellings usually subside with the disappearance of the conditions which occasioned them, but meanwhile some of them may require medical or surgical treatment on their own account.<br /><br />In various acute infectious diseases, including scarlet fever, smallpox, and typhoid fever, many of the lymph nodes throughout the body are inflamed and swollen. Bubonic plague gets its common name from the fact that, in most cases, the lymph nodes throughout the body, but often most noticeably those in the groin, are inflamed, and pus forms in them. Such inflamed lymph nodes are called buboes. Uninformed or ignorant people sometimes call them "blue balls."<br /><br />There is a peculiar disease known as glandular fever or infectious mononucleosis, in which many of the lymph nodes throughout the body, but especially those in the neck, may be swollen and tender. This disease may last from a few days to three or four weeks, but is seldom a menace to life. It is probably caused by a virus. It is characterized by fever, sore throat, and general weakness in addition to the swollen lymph nodes; and the spleen is often enlarged and the liver often inflamed.<br /><br />Occasionally there is a skin rash. The most distinctive sign, however, is the presence in the blood of a special form of white blood cell, called a mononuclear, which, of course, cannot be detected without an examination of the blood. In the most severe cases, weakness may persist for two or three months after all other symptoms have subsided.<br /><br />Tuberculosis frequently involves the lymph nodes of the body. In most cases of tuberculosis in which the nodes seem to be affected more than any other tissues, children are the victims; and the nodes eventually heal, but with calcium deposits in many of them, especially those in the chest. Tuberculous nodes may break down and form pus, however. Lancing such a node is not likely to do much good, but sometimes it is advisable to remove the entire node. In many such cases, the cattle tubercle bacillus is the cause of the infection, the child having been infected by drinking raw milk or eating raw milk products coming from tuberculous cows.<br /><br />Syphilis always involves the lymph nodes. Accompanying the primary sore on the genitals, there is painless swelling of the nodes in the groin. Later, in the second stage of the disease, the nodes throughout the body become hard and feel as if they were enlarged; but they neither become painful nor have pus in them.<br /><br />As mentioned earlier in this chapter, there is an important connection between cancer and the lymph nodes. Enlargement of the nodes because of cancer is different from that from many other causes. It comes from the transference of cancer cells to the nodes from the original sites and the development of cancer in the nodes themselves.<br /><br />An outstanding example of this process occurs in the armpits, cells being carried there from cancer in the breast. Other nodes frequently involved are those under the jaws and on the neck, to which cells are carried from cancer of the lips, mouth, or tongue. In the treatment of cancer anywhere it is as important to detect any lymph nodes that may be involved and to remove them as it is to detect and remove the original tumor. Otherwise no real cure is possible, and improvement is only temporary.<br /><br />What to Do<br />1. Try to learn the cause of the swelling, securing the aid of a physician if needed.<br />2. If the swollen lymph nodes are painful and tender, and if they are located in an accessible place near the body surface, apply hot fomentations over them three times a day.<br />3. Keep the patient under a physician's care, if possible, so that any pus formation may be promptly detected, and the node or nodes may be lanced and drained without delay if such treatment should be needed.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-41651790398625280672009-02-26T00:04:00.000-08:002009-02-26T00:05:57.652-08:00Wonder DrugsFor centuries man has sought cures for disease. Before the recent scientific understanding of the causes of disease, remedies used were generally chosen either because of supposed mystical properties in them or because of an observed association between them and improvement in a particular disease condition.<br />With the discovery of germs and the recognition, late in the nineteenth century, that many a disease is caused by a specific germ, there developed a general impression that the eventual conquering of germ-produced diseases would consist of discovering the means for killing the responsible germs.<br /><br />This hope of conquering disease by killing germs began to be realized first in the field of preventive medicine. People correctly reasoned that by keeping germs from entering the body they could largely prevent the diseases which these germs produced. Here we have the basic concept of our present methods of sanitation and hygiene, discussed in detail in the previous chapter.<br /><br />The use of disinfectants for decontaminating surgical instruments and high heat for sterilizing surgical dressings also constitutes part of the program to prevent disease by destroying germs before they gain access to the human body. These methods of pre-venting surgical infections have been so effective as to prove beyond a doubt that germs can be killed and that many diseases can be prevented by taking precautions against the entry of germs into the body.<br /><br />The next logical step in applying the growing knowledge of the relationship between germs and disease was to try to treat diseases by killing the offending germs after they had already invaded human tissues. Thus the emphasis shifted from prevention to cure. We have already dealt with immunization's role in this endeavor, a procedure which prevents contraction of disease after exposure. But what if invading germs have already made the patient ill—then what can be done to kill the germs? Such questions impelled medical scientists, beginning several decades ago, to search for drugs which would be effective in controlling infections once they had become established.<br />Chemical disinfectants were introduced for use in cleansing open wounds. Tincture of iodine became popular as a local application to kill germs when the skin was broken and even in cleansing the torn tissues of a deep wound. Other disinfectant solutions have now come into greater favor than tincture of iodine, but the attempt to kill germs that may enter the tissues when damaged remains standard medical practice.<br /><br />The real need in trying to cure disease caused by germs was to find a chemical agent which would destroy the germs without damaging the body tissues. Thus the chemical or drug, carried by blood circulation and other body fluids, would kill the germs inside the body without killing the person who harbored the germs. Many substances were known to kill germs and could thus be classed as disinfectants. But most disinfectants when taken into the body were damaging to the tissues as well as to the germs.<br />In the early decades of the twentieth century several poisonous drugs became popular in the treatment of germ-produced diseases. Quinine was one, a drug known to be poisonous and to produce such symptoms as ringing in the ears, loss of hearing, impairment of vision, convulsions, irregularities of the heart, and even collapse and death. But even though poisonous when taken in sizable doses and thus dangerous, quinine was able to kill the parasites which cause malaria. Thus, physicians used quinine for the prevention and cure of malaria even though they realized the damage it could cause within the human body. Their attempt was to give just enough of the drug to kill the malarial parasite but not quite enough to kill the malaria patient.<br /><br />A similar approach was made to the treatment of patients with intestinal parasites. The drugs used in such cases, though highly poisonous, were administered in carefully graduated doses within the level of human tolerance but fatal to the organisms lodged within the intestine.<br /><br />The most effective drugs in the early part of the century for the treatment of syphilis contained either arsenic or bismuth. Both of these metals are highly poisonous and, even when used in the concentrations necessary to kill the spirochetes which cause syphilis, produced symptoms of mild poisoning. Justification for the use of such preparations was simply that the patient would die prematurely if the syphilitic infection was allowed to go untreated. Even though his life might be shortened somewhat by the use of - such powerful drugs, this loss was considered better than allowing the syphilis to run its course.<br />The Sulfonamides<br />It was in the early 1930's that rumors began making their rounds in medical circles that a "wonder drug" was in the offing. Of course medical scientists can't believe rumors. They deal with matters of life and death.<br /><br /><br />They must possess verified facts before they dare alter their method of treating disease in human subjects.<br />But in 1936 the rumors were backed up by scientific reports emanating from Germany and France. The reason for the delay in making final announcement was that it took time to check results. A new drug must be tried out first in the laboratory. If it passes scrutiny, then, cautiously, it can be tried on humans.<br />As the exciting story unfolded, it indicated that "prontosil," as used by certain medical scientists in Germany, had prevented the death, laboratory animals infected with streptococci—the germs responsible for many severe infections, including many of the skin, one form of meningitis, and the infection accountable for the death of mothers following childbirth.<br /><br />Prontosil is a member of a chemical family of substances developed for use in the dye industry. Sulfanilamide, the original member of this group, had been developed in 1908. A few scattered observations indicated that certain members of this group of dye substances had the effect of killing bacteria; but, strangely, no research had been done to determine how toxic they might be to living tissues. Now, in the middle 1930's, it was demonstrated that their toxicity was low, meaning that living tissues tolerated these chemicals well, whereas germs were apparently brought under control by their action.<br /><br />A great deal of professional enthusiasm developed in both the United States and Britain over the hope of curing infections by the use of sulfonamides. In Britain the early successes attended treatment of infections following childbirth. In the United States sulfonamides were administered to lab- oratory animals to discover possible dangers in their use. Then they were given cautiously to human patients suffering from various kinds of infection.<br /><br />In this early use of the sulfonamides enthusiasm ran high. Medical scientists hoped they had found the miracle drug which would prove harmless to the human body but destructive to all or nearly all germs that invade it. There were mixed emotions, then, as the results began to be tabulated and re- ported in medical literature. Cures wrought in certain infections were truly remarkable. Patients with infections caused by the streptococcus germ began to show improvement within a matter of hours, and many cases were practically rid of infection within two or three days. At the same time similar cases without such treatment ended fatally or had to suffer through many days, even weeks, of serious illness.<br /><br />But it was soon apparent that not all infections responded as dramatically as did those caused by the streptococcus germ. Infections caused by the staphylococcus germ were usually reduced by sulfanilamide, but the improvement was not as dramatic as in those caused by the streptococcus.<br /><br />Pneumonia can be caused by more than one kind of germ, one common type being pneumococcus. Inasmuch as pneumonia was at that time one of the major killers, it had been sincerely hoped that the new drugs would be as helpful in controlling infections by this germ as they had been with others. Gradually the truth dawned, however, that sulfanilamide rendered practically no benefit in the treatment of infections caused by the pneumococcus. It did provide some benefit, however, in the treatment of infections caused by the germ which commonly produced meningitis ( the meningococcus) . It also re- lieved infections caused by gonococcus, the bacterium responsible for many cases of venereal disease and other serious infections such as those of the eyes.<br /><br />Disappointment over sulfanilamide's failure to help in the conquest of pneumoccic pneumonia did not last long. While physicians were gathering data on the advantages and limitations of sulfanilamide, chemists were busy in the laboratory developing chemical modifications of this same preparation. Presently sulfapyridine, another sulfonamide developed in England, proved effective in the control of pneumococcic pneumonia. With the use of this new drug, the mortality rate of this type of pneumonia dropped suddenly from more than 25 percent to a little less than 10 percent. This type of pneumonia was so common that this sharp decline in mortality. represented a saying of thousands of lives per year.<br /><br />Collaboration between physicians and chemists continued, with the result that other sulfonamides soon came into general use, each with its particular advantages and limitations. In addition to sulfapyridine, the list soon included sulfathiazole, sulfadiazine, sulf amerazine, sulfaguanidine, and sulfasuxidine. These various sulfonamides closely re- semble each other in chemical structure but differ just enough so that some are adapted to the treatment of one infection and others to another.<br />Following the realization that the sulfonamides really were . effective agents in the control of infections, med- ical scientists began to concern themselves with the question of how the sulfonamides produced their marvelous results. Previously physicians had been so concerned with finding out what the drugs would do in the control of infections that they had hardly taken time to ask the question, How do they accomplish what they do?<br /><br />Even to the present time, the exact means by which the sulfonamides in hibit germs, that cause infection is not known. It seems certain, however, that they bring about conditions within the tissues that retard the growth and re-production of germs that may be present. Under favorable circumstances germs within the tissues multiply very rapidly. But under the influence of the sulfonamides this rapid multiplication is prevented. Fortunately, however, the body can still produce antibodies to resist the invasion of germs just as well as usual.<br /><br />Thus far in our story of wonder drugs it probably seems that the sulfonamides provided a nearly perfect answer to the problems of the control of infection. And as yet we have not come to the part of the story relating to the antibiotics, At this point the reader might even ask, Why was it necessary to have any other drugs in addition to the sulfonamides?<br /><br />No drug is perfect, and the longer the sulfonamides have been used, the more apparent it has become that they have limitations. When used in doses too large for the individual's tolerance, they produce signs of intoxication, meaning that a person can tolerate only so much of the sulfonamides within his body fluids. The limit of tolerance varies from one person to another.<br /><br />The commonest signs of intolerance of the sulfonamides or of an overdose are nausea, vomiting, and mental confusion. These signs usually disappear quickly when the drug is reduced or discontinued. Prolonged use of the sulfonamides may interfere with the production of blood cells. Another possible complication is an irritation of the tissues of the kidneys, resulting in a reduced production of urine. It was soon learned that this effect on the kidneys_ can be largely prevented by requiring the patient to ;drink a larger than usual volume of fluid during the time the sulfonamides are being taken and by using some chemical substance to keep the urine's reaction from becoming acid.<br /><br />The sulfonamides continue to be valuable drugs even though, in the meantime, antibiotics have been developed. The antibiotics did not replace the sulfonamides in the treatment of disease but only served as a supplement, so that the physician now has more than one effective treatment as he deals with serious infections that affect the human body.<br /><br />The Antibiotics<br />Research developments were taking place, even while the sulfonamides were being acclaimed, which soon produced an entirely separate group of wonder drugs—the antibiotics. The story starts in 1928 with an accidental observation made by Sir Alexander Fleming. After serving as a medical officer in World War I, Fleming de voted himself to research in bacteriology at St. Mary's Hospital Medical School in London. One day when examining a culture plate of the staphylococcus germ which had become contaminated by the growth of mold, he suddenly became fascinated as he observed that surrounding the area of the mold was a zone in which no germs were growing.<br /><br />This caused Fleming to speculate on whether the mold was capable of producing a substance that was deadly for staphylococcus germs. His subsequent experiments indicated that this was indeed true. Thus Alexander Fleming became famous as the discoverer of the mold culture which he named penicillin. For this and his continuing research in the field, he was awarded the Nobel Prize in 1945.<br /><br />As far as its application in the treatment of germ-produced diseases is concerned, Fleming's discovery lay dormant for eleven years. Then it was, in 1939, that a group of research workers at Oxford University, as they searched for drugs that would supplement the sulfonamides, decided to make a trial run with penicillin. In their experiments on laboratory mice, it proved z surprisingly effective in controlling infections caused by the staphylococcus as well as by some other germs. Then, . cautiously, they tried it on human beings and were highly gratified to find it effective in controlling certain infections and also remarkably low in toxicity for human cells.<br /><br />Next came the problem of developing ways to produce penicillin in large enough quantities to make it available wherever needed as a medicinal agent. Cooperation between pharmaceutical manufacturers in England and the United States soon resulted in methods of mass production. Its manufacture still uses the processes of mold fermentation, just as in Fleming's laboratory.<br /><br />In the intervening years, scientists have developed several hundred anti- biotic compounds, all of them related, as far as the structure of their molecules is concerned, to the original penicillin. Most of these have limited uses because they are toxic or because of side effects when used medicinally. Of these, about a score have found important places in the treatment of infections.<br /><br />Antibiotics are particularly effective in the treatment of infections caused by the staphylococcus germ. They are also useful in combating the pneumococcus and the germs that produce the common venereal diseases.<br /><br />Antibiotic drugs can be administered by mouth and also by either intramuscular or intravenous hypodermic injection. They are used not only in the treatment of infections, but also, very importantly, in the prevention of certain infections. One member of the group (streptomycin) is important in the treatment of tuberculosis.<br /><br /><br />During the years since antibiotics have come into use, many varieties of germs have become resistant to these drugs. This is one of the facts that has urged medical scientists to develop other forms of antibiotics. When a certain germ becomes resistant to one member of the antibiotic group, another member which differs slightly in its chemical structure may still be effective.<br />Another complication seriously affecting the usefulness of antibiotics is that a small percentage of persons develop an allergic reaction by which, after they have received some such drug on a previous occasion, they manifest a dangerous sensitivity to its subsequent use. Physicians now test a patient for sensitivity before administering certain antibiotics.<br /><br />Anticancer Agents<br />Another frontier along which medical science is making progress is the development of chemical substances helpful in the control of some types of cancer. Popular reports on these chemicals have sometimes given the false impression that they are "cancer cures." But when we understand the means by which these anticancer agents act, we recognize that they are only adjuncts to the longer-established methods of treating cancer and that they do not cure the disease but rather merely increase the survival time of the cancer patient.<br /><br />These are chemicals which combine with certain constituents within the cells of the cancerous tissue in a way that prevents the growth and multiplication of these cells. We must recognize, however, that a chemical powerful enough to have this effect on the cells of cancer will also have adetri- mental effect on normal cells.<br />Anticancer agents are limited, for practical purposes, to certain types of cancer. They are valuable in many cases of childhood leukemia, also in chronic leukemia occurring in adults when used in combination with X-ray therapy. They have also prolonged life in cases of multiple myeloma. They have been used beneficially as adjuncts to other methods of treatment in selected cases of other forms of cancer.<br />It has already been implied that these anticancer agents may harm normal tissues of the body. Tissues which usually suffer most are those that produce the body's blood cells. Thus serious anemia may develop.<br /><br />Drugs Which Influence the Brain<br />Two other groups of drugs which deserve mention in this chapter are the tranquilizers and the antidepressants—those that relax mental processes and those that stimulate them. The development of these drugs has greatly influenced the methods of treating persons with mental disorders. Depressed cases often benefit by the proper use of antidepressant drugs—those that whip up the mental processes. In similar fashion, patients who develop panic, fear, hostility, and delusions may be helped by the appropriate use of tranquilizers.<br /><br />Many persons with mental illness can now be treated without having to go to a mental hospital. Other cases still have to be admitted, but the time spent in the hospital is greatly reduced. It must be emphasized, however, that the particular effect of any one of these drugs on a certain individual is difficult to predict. Possible side effects may be undesirable. Use of some drugs of this group may develop pathological dependence in the patient. Some may cause harmful effects on the liver, on the blood-forming organs, or in the brain itself. Some have the effect of raising the blood pressure.<br />Important as these drugs are, then, in the treatment of mental illness, they must be used only under the supervision of a physician skilled in this area of medical practice.<br /><br />Conclusion<br />Treatment of disease by the use of drugs has undergone a remarkable revolution. At the beginning of the present century medicines used for treating disease were chosen empirically. In most cases the exact effect of the drug on the human body was not known, the medicine being used only because of its supposed beneficial influence or because of its relief of symptoms.<br /><br />Now that medical science has advanced to the place that cause-and-effect relationships serve as the basis for the treatment for illness, the use of drugs is based on combating the cause rather than on merely relieving symptoms. Most drugs in use today are those of known effect on the body's tissues and fluids. This does not mean, however, that modern drugs are always safe. Many have marked effects on the functions of the tissues and organs of the body. In many cases a delicate balance exists between beneficial effects and harmful side effects. Reactions Differ from person to person.<br /><br />The wonder drugs have prolonged millions of lives, certainly , a cause for gratitude. But the same drugs which, when used appropriately, may be lifesaving can, on the other hand, if used indiscriminately, produce great harm and even death. Physicians trained in chemistry, pharmacology, and modern methods of therapeutics are the only ones in a position to make available to a patient the benefits of the wonder drugs. For the layman, therefore, the only safe policy to follow is to avoid self-medication.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-13046717661657905922009-02-25T08:05:00.000-08:002009-02-26T18:36:02.866-08:00Intestinal ParasitesAnimal parasites are commonly found in the human intestine, more often in children than in adults. Though especially common in countries with warm climates, this problem is not limited to such parts of the world. The parasites secure their food from the contents of the intestine in which they live, or from their victim's blood, which they usually obtain by attaching themselves to the intestinal wall. Most of them are either protozoans, roundworms, or tapeworms, though at least one of some importance is a fluke. Some of them are harmless, or at the worst do very little damage; others cause disease or distress; and a few are a grave menace to life, though usually not until the passage of considerable time.<br /><br />Fluke or Trematode Infections<br />There are many flukes that can infect the human body but only one that spends any considerable time in the intestine. The disease which it causes is called fasciolopsiasis, and the name of the fluke is Fasciolopsis buski. The eggs of this fluke are passed out in the feces. They hatch out in water. Their first stage of development takes place in the bodies of snails. Then the partially developed parasites encyst upon water plants most commonly caltrops, water chestnuts, or water hyacinths. If these are eaten raw, the parasites mature in the eater's intestine. They usually attach themselves to the lining of the duodenum or the jejunum, causing inflammation and sometimes ulceration and bleeding. Diarrhea and abdominal pain are common. Later the stools become greenish-yellow and contain much undigested food. In severe infections, there is likely to be fluid in the abdomen, nausea, vomiting, and edema of the face, abdominal wall, and the lower extremities. These symptoms are suggestive that the infection is present, and would be meaningful if the person concerned had been eating any of the indicated foods; but a definite diagnosis depends upon finding the eggs in the stools. Death rarely results from the disease itself, except in children; but the victim is likely to become so weakened by it that some other disease easily overcomes him.<br /><br />This disease is rare in the Western Hemisphere, but it is fairly common in the Orient.<br /><br />What to Do<br />1. If the disease is suspected, have a stool examination to find the eggs of the parasite.<br />2. When the disease is known to be present, its treatment should preferably be supervised by a physician. The accepted remedy is hexylresorcinol, available in 100-milligram pills. Recommended dosage for respective age groups is as follows:<br /><br />Under six years of age, 1 pill for each year of age.<br />6 to 8 years of age, 6 pills.<br />8 to 12 years of age, 8 pills. Adults and children over 12, 10 pills.<br /><br />The evening before the drug is given, the patient should have a light supper and before retiring should take 1 tablespoonful of sodium sulfate in a half glass of water as a laxative. The next morning, the correct dose of hexylresorcinol should be taken on an empty stomach. Two hours after the pills are taken, another tablespoonful of sodium sulfate in a half glass of water should be taken. This completes one course of treatment. A second course, and perhaps a third course, of treatment is usually necessary, at four-day intervals.<br />3. As a preventive measure avoid eating raw caltrops, water chestnuts, or any other roots, plants, or "nuts" that might have Fasciolopsis buski cysts attached to them.<br /><br />Protozoal Infections<br />Different kinds of protozoans may be found in the human intestine; but only two of them are important causes of disease. These are Endamoeba histolytica and Balantidium coli. Diseases caused by the former are much more common in warm climates than elsewhere, but it is not unusual to find cases in the United States and other countries in temperate zones. Most of these, however, are in people who have picked up their infection while. living or traveling in tropical or subtropical regions or in areas where sanitation is poor.<br /><br />AMEBIC DYSENTERY (AMEBIASIS).<br />Amebiasis, or infection with End-amoeba histolytica, is far more common than most people realize. Many are infected with this parasite without knowing it or being made noticeably ill by it. The parasite apparently always gains entrance to the body through the digestive tract, being carried in by contaminated foods or beverages.<br /><br />When the parasites produce severe intestinal disease, the victim has diarrhea, cramps, and colicky pains; but these symptoms usually come on gradually rather than with a sudden onset. The stools contain pus, mucus, and blood, and may number twenty or more in a single day. Occasionally fever and a rapid pulse are present. In a majority of cases the diarrhea and other symptoms are mild, but more or less chronic, and tend to alternate between better and worse by spells. In some cases there may be only repeated spells of abdominal colic, with no diarrhea at all. The true nature of the condition can be proved, however, by finding the active amoebas or their cysts in the stools; and it is wise to suspect any case of recurring or chronic diarrhea as being amebic dysentery until proved otherwise, especially in warm climates.<br /><br />Anybody infected with Endamoeba histolytica should have thorough and persistent treatment to rid his body of the parasites. A severe case may prove fatal. Even a mild infection one so mild as to go unnoticed because of no definite intestinal symptoms may cause a general impairment of health. Arthritic pains may be caused by a mixed infection with shigella organisms. Abscess of the liver is an occasional complication of amebiasis, but an amebic liver abscess may develop without there having been any previous detectable intestinal symptoms. The organisms are carried from the intestine to the liver through the portal circulation. As a rule, only one such liver abscess is present in a given case, but there may be more than one.<br /><br />All of the effective remedies for amebiasis yet discovered are drugs that may harm the body if given improperly or in too large quantities. Emetine hydrochloride, carbarsone, vioform, terramycin and certain other antibiotics, and several other remedies have been used with good results; but they should be given only under the supervision of a physician. The treatment should be continued not only until all symptoms have been brought under control, but until the organisms can no longer be found in the stools.<br /><br />Prevention of infection is obviously important, and this includes prevention of the spread of infection from a known case to other people. The following preventive measures are recommended:<br /><br />1. Protect all food, water, and other beverages from any chance of fecal or sewage contamination.<br />2. Carefully dispose of all human excreta.<br />3. Kill all flies, as far as possible, and take all practicable measures to prevent their breeding. All garbage should be kept in leakproof, covered containers. All animal fertilizer should be spread thinly on the ground or kept in tightly covered bins. All toilets or latrines should be carefully screened.<br />4. People living in places without fully adequate water sanitation should boil all drinking water, and after boiling store it in covered containers to prevent contamination.<br />5. Wherever human excreta are used to fertilize the soil, no vegetables or fruits should be eaten raw unless disinfected as recommended by local public-health officials.<br />6. Food handlers should give carefuI attention to their personal habits.<br />Fingernails should be kept trimmed and clean. Hands should always be washed with soap and water after defecation, and again immediately before beginning to handle food.<br />7. Before employing any person as a cook or other food handler, have his stools examined for the possible presence of amoebas or their cysts. Many people are unknowingly carrying these organisms. People who continue to be food handlers in areas where amebic dysentery is known to occur should have annual stool examinations.<br /><br />What to Do<br />1. If amebic infection is suspected, have a stool examination made to detect the presence of the causative<br />organisms.<br />2. If the infection is found to be present, the infected person should stay under the supervision of a physician, since no home treatment or remedy is effective.<br />3. Have the victim's stools reexamined weekly until recovery seems to be complete, and yearly thereafter, since there is always considerable danger of relapse.<br />BACILLARY DYSENTERY.<br />BALANTIDIAL DYSENTERY (BALANTIDIASIS).<br />Balantidial dysentery is in many respects similar to amebic dysentery, but less common and less severe, though more widespread geographically. A large proportion of the infected individuals are apparently healthy carriers of the parasite Balantidium coli and are never made ill by it. This is a common parasite of swine, and the infection is considerably more common among people who have contact with these animals than among people who do not. Liver abscesses are not produced as a complication of this infection, as is the case with amebiasis. Of the remedies that have proved valuable in cases of amebiasis, carbarsone is more effective than any of the others for balantidiasis; but some of the tetracycline antibiotics that have little or no effect on amoebas are of definite value against balantidia. For these reasons, the treatment of balantidiasis is less difficult than that for amebiasis.<br /><br />What to Do<br />1. Follow the advice given under Amebic Dysentery.<br />2. Follow-up stool examinations are recommended, preferably yearly.<br />Roundworm Infections<br /><br />COMMON ROUNDWORM INFECTION (ASCARIASIS)<br />Common roundworm infection is most prevalent in places with a warm, moist climate, but no part of the world is free from it. The worm is from six to fourteen inches (15 to 35 cm.) long, the female being larger than the male. It lives chiefly in the upper part of the small intestine, but may travel to other parts of the digestive tract. It may enter the stomach and be vomited up, or may find its way up into the throat, sometimes getting into the windpipe and the air passages, where it may cause strangulation or other serious injury. Only one or two may be present in the intestine, or possibly many.<br /><br />The females produce large numbers of eggs, readily recognizable with the aid of a microscope. Several weeks' time is required for the embryo worms to develop in the eggs before they can infect humans. The eggs abound in places contaminated with fecal material. Children playing in contaminated dirt around houses or in gardens get the eggs on their hands, especially under their fingernails. Handling dogs or cats, or other pets that run about in contaminated places, may have the same result. Then when one eats with unwashed hands or uncleaned fingernails, or puts the fingers into the mouth, the eggs get into the mouth and go down to the stomach and into the intestine, where they hatch, liberating the tiny embryos. The embryos then burrow into the intestinal walls and migrate through the tissues to the lungs, from there making their way back to the intestine in much the same way that hookworm larvae do. In the intestine, the embryo worms develop into adults and live for a considerable period of time.<br />During the migration of the immature worms through the lungs, symptoms similar to those caused by the migration of hookworm larvae may be caused if the numbers of the parasites are considerable. The presence of these forms in the intestines, of children especially, may give rise to abdominal pain, fever, diarrhea, grinding of the teeth, restlessness, and sometimes convulsions; or their presence, especially if they are few in number, may cause no recognizable symptoms and may not even be suspected unless one of the worms is passed in the stool or unless a chance stool examination reveals the eggs. In regions known to be contaminated .periodic examinations of the stools of children are recommended.<br /><br />What to Do<br />1. The diagnosis of common roundworm infection should be confirmed by a laboratory examination of the stool specimen.<br />2. If a physician is available, arrange for him to order and supervise the treatment. Several effective remedies are now available, and it is best for the physician to choose the one best suited to the individual case.<br />3. At the time of writing, the remedy which is generally favored for the treatment of roundworm infection is piperazine. The dosage depends on the weight of the patient .<br />4. One month after the course of treatment, another stool examination should be made to determine whether the worm eggs are still present. If so, another course of treatment should be given.<br /><br />HOOKWORM INFECTION (ANCYLOSTOMIASIS).<br />Hookworms cause more cases of serious illness than do any other of the intestinal parasites. In many parts of the world, including some sections of the United States, hookworm disease is present in a considerable proportion of the population. In such localities, the average health and vigor of the people are below normal, their mental as well as physical efficiency being impaired.<br /><br /><br />Hookworms are small and slender, about half an inch (8 to 13 mm.) in length, the female being somewhat longer than the male. They live in the small intestine, where they attach themselves to the intestinal lining by means of their hooked mouths; and they feed by puncturing the blood vessels with their sharp teeth.<br /><br />The female worms produce great numbers of eggs, which the human host expells with his stools and these hatch out after leaving the body. Contact with warm, moist soil favors the hatching of these eggs and the rapid development of the young embryos. When a skin surface, such as bare feet or hands, comes in contact with the moist earth containing these young worms, so small that they can scarcely be seen without a microscope, they rapidly penetrate the skin and enter the blood vessels. They are then carried by the blood to the lungs.<br /><br />From the lungs the young bookworms gain entrance to the air passages, make their way to the throat, and are then swallowed. In this roundabout way they finally reach the intestine, where they develop into full‑grown worms. If fewer than a hundred worms are present, symptoms are not likely to be noticeable. But the presence of five hundred or more will cause typical symptoms. In some of the most severe cases more than four thousand worms have been found in a single individual.<br /><br />The only way to be sure that a person is infected with hookworms is to find the eggs or the worms themselves in his bowel discharges, but in most cases there are characteristic signs and symptoms. The soiling of the skin of the hands or feet with contaminated earth, and the resulting penetration of the minute worms through the skin, cause itching and burning of the affected skin, followed by the formation of small papules and blisters, and later by crusting. This condition, commonly called ground itch, is also known as miner's itch, foot itch, toe itch, dew itch, or water itch. During the time when the immature parasites are passing through the lungs, there may be spells of coughing, with sore throat and bloody sputum.<br /><br />While the parasites are attaching themselves to the intestinal wall and growing to maturity, the characteristic symptoms are diarrhea, flatulence, and abdominal discomfort. Later, weakness, pallor, fatigability, weight loss, anemia, and difficulty of breathing become common. The symptoms are particularly noticeable in growing children in whom a definite slowing of mental development and body growth occurs. Many people with hookworm disease have the habit of eating clay, chalk, or other abnormal substances. In some cases, especially where the number of worms is large, there may be swelling of the feet or of the entire body, and an accumulation of fluid in the abdominal cavity. In time the anemia may become very severe, the hemoglobin of the blood sometimes being as low as 10 percent of the normal amount. A person with such sever symptoms cannot live long unless tb worms are expelled.<br /><br />The problem of preventing hookworm disease is one of great importance. Infected people must be helpe to expel the worms from their intestines, and then be taught how to pry vent further infection. Keeping tr hands out of the soil and the wearing of shoes by people working in hookworm areas would help; but it is c prime importance to make safe disposal of all human bowel discharges E the ground is not contaminated b them. Modern flush toilets or proper] designed and constructed privies, used as the sole depositories of fecal matter, would go far toward stamping out hookworm disease.<br /><br />As a conclusion to the general discussion of hookworm infection, mention should be made of a peculiar condition called Larva migrans (creeping eruption) . This is caused by the larva of the dog and cat hookworm, which penetrate the human skin and migrate from place to place in it, usually wit] out going deeper or traveling moi than a few inches. The migration causes intense itching and a reddis eruption in the form of narrow crooked, slightly elevated ridges. TI eruption tends to persist for sever months, but the migrating larvae finalIy die and are absorbed by the ti sues. If they are numerous enough be very troublesome, and especially they are located near the skin surface as is often true, a physician may u special methods to kill them. If th penetrate deeper, as sometimes h, pens, nothing can be done except give symptomatic treatment while w, ing for them to die.<br /><br />What to Do<br />1. Tetrachloroethylene is among the most effective remedies, but i dangerous to give it to alcoholic patients or to those with gastrointestinal disorders, severe constipation, any marked degree of anemia, or liver disease. It is difficult to be sure that none of the conditions warned against is present without tests and studies by a physician, and a physician should supervise the use of the drug. The physician may prefer some other remedy.<br />2. If no physician is available, piperazine may be used, administering it in the same way as recommended for a case of "Ascariasis."<br /><br />PINWORM INFECTION (SEAT WORM INFECTION, OXYURIASIS, ENTEROBIASIS).<br />Pinworms live in the large intestine, especially in the rectum. They are usually present in large numbers, and f e-males ready to lay eggs often crawl out through the anus and lay their eggs upon the surrounding skin. They cause much itching in this region, especially at night.<br />These worms are white in color and small in size. The female, much larger than the male, averages less than half an inch (8 to 13 mm.) long. She lays large numbers of eggs, and there is danger of the infection's being carried to other people, or of the child's reinfecting himself, through scratching about the itching anal region and later handling food or objects that he or other people will eat or handle, or by putting the fingers into the mouth. Underclothing and bedclothing easily become contaminated, and it has proved difficult to clear up the infection in one member of a family unless all the other members are treated at the same time.<br />When the eggs are swallowed, they 'hatch out in - the duodenum and mi- grate downward. If the skin around the anus is not kept clean, the eggs may hatch out there and the immature worms migrate back through the anus into the rectum. Pinworm infection does not cause severe symptoms, aside from the itching, as a rule; but there may be vague gastrointestinal discomfort, restlessness, and insomnia.<br /><br />What to Do<br />1. If a physician is available, arrange for him to order and supervise the treatment.<br />2. One of the preferred drugs for the treatment of pinworm infection is piperazine. Tablets of piperazine citrate or piperazine phosphate are usually available in either the 250 milligram or the 500 milligram sizes.<br />3. For itching of the skin, apply 1 percent phenol in petrolatum or 1 percent yellow oxide of mercury ointment, as needed<br />4. Have any infected person wear tight-fitting shorts day and night, or use any other effective method to prevent him from scratching the anal region.<br />5. Change underclothing and bed linen daily, and use boiling as a part of the laundering procedure.<br />6. Scrub toilet seats with soap and water every day.<br />7. For greater safety, have all members of the family treated.<br />8. All members of the family should carefully wash their hands with soap and water after each bowel movement and before all meals; and their fingernails should be trimmed short and kept clean. They should all be warned to keep their fingers out of their mouths and not to scratch the skin in the anal region.<br /><br />STRONGYLOIDIASIS (STRONGYLOIDES STERCORALIS [THREAD-WORM] INFECTION)<br />Strongyloides stercoralis infection is common in tropical and subtropical areas in all parts of the world, including the southeastern part of the United States. The larvae of this parasite usually enter the body and migrate through it in much the same way as do hookworm larvae. Some of them, however, may complete much of their development in the lungs or the air passages, giving rise to symptoms resembling those of bronchitis or bronchopneumonia. Infection of the intes tines, which is the usual form, may produce no noticeable symptoms, though a watery diarrhea fairly often shows up, and occasional cases go on to ulceration.<br />The adult worms resemble hookworms in general appearance, but they are smaller. They are found in greater numbers in the duodenum than in any other part of the intestine. The anemia which they may cause is much less severe than that from hookworm infec tion. The eggs do not pass out in the stools as do the eggs of hookwormE but hatch while still in the intestinE and usually then the larvae pass ou and contaminate the soil. Occasionall, a few of the larvae do not pass out o the intestine, but perforate its walls causing an unusually severe illness.<br /><br />What to Do<br />1. Confirmation of the diagnosis of this infection depends, of course on the finding of eggs and larvae ii the feces.<br />2. If at all possible, the treatment should be under the direction of physician.<br />3. At the time of writing, the drug most satisfactory in the treatment of strongyloidiasis is dithiaza nine iodide. For an adult, this should be given by mouth in doses of 20+ milligrams taken three times a day for ten days.<br /><br />TRICHINOSIS (TRICHINIASIS).<br />In contrast to other roundworms, trichinae live for only a comparatively short time in the intestines. Trichinosis is contracted by eating raw or insufficiently cooked flesh of animals containing the parasites in a dormant form. Nearly always the contaminated meat is the flesh of swine, though in a considerable number of reported cases it was bear meat, and apparently in a few cases other kinds of meat that had simply been chopped on the same block used to chop pork.<br />When infected meat is eaten, the embryo worms are liberated in the stomach and the intestine, where, in about three days, they grow to full size, most of them becoming rather deeply embedded in the intestinal mucous membrane. They do not lay eggs that pass out of the intestine, but produce great numbers of young worms, most of which burrow into the tissues and are carried throughout the body by the blood and lymph circulation. They finally become encysted and dormant in the muscle tissue as tiny coiled worms. They are not equally abundant in all muscles, but the diaphragm gets more than its proportionate share of them.<br />After infected meat is eaten, six or seven days are required for the full development of the first brood of young embryos, which are then ready to mi- grate in the body. The production of embryos continues for six weeks or longer. Bowel symptoms, such as dis-comfort and diarrhea, may occur at the time of the multiplication of the worms in the intestine, and other and quite different symptoms develop while the young worms are migrating. These symptoms may be such as to arouse a suspicion of typhoid fever or rheumatism. They may be so severe that death results in some cases. Fever, chills, and abdominal and muscle pains are common. There is much muscle tenderness, with swelling of the muscles and the overlying skin during the pe- riod while the embryo worms are becoming encysted. The small worms may lie dormant in the muscles as long as twenty years, but the symptoms of their presence largely disappear after the first few weeks or months.<br /><br />Autopsy surgeons who have made a search for the encysted parasites in dead bodies have reported that in some parts of the world where pork consumption is high and where certain pork products are often eaten raw, more than 20 percent of the population is probably infected. The amount of illness caused by so much infection must be great. Many of the fevers, aches, and pains that people in such areas attribute to other causes are really due to their fondness for pork.<br />Of people with trichinosis severe enough to be recognized as such, prob- ably one in twenty will die because of the infection, so it must be considered a very serious matter. Once the infection has taken place, there is no way to stop its progress, so prevention of infection is of vital importance. Those who do not eat flesh food, but especially pork, are safe; but others should remember that encysted trichinae embryos can be killed by thorough cooking of the meat containing them. It has also been proved that freezing the meat and keeping it frozen for several months will kill at least most of the parasites.<br /><br />What to Do<br />1. If symptoms suspicious of trichinosis appear within three or four days after a person has eaten meat that might have been infected, the stomach and bowels should be thoroughly cleaned out, taking Epsom salts purgatives and copious enemas<br />2. After the worms have begun to migrate through the tissues, no remedy or treatment can stop them; but a physician can use remedies that will at least partially relieve the symptoms.<br />3. Long-continued hot baths—temperature about 100° to 102 ° F (38° to 39° C.) may help to relieve muscle pains; but cold compresses to the head must be given at the same time to prevent fainting, and the baths should not be continued long enough to produce profuse sweating (See Volume 3, chapter 20.)<br />WHIPWORM INFECTION (TRICHURIASIS).<br />Whipworms are about one and a half to two inches (35 to 50 mm.) long They get their common name from their shape, looking like a whip with a slender lash and a thicker handle. The small end of the lash is the head of the worm. Sometimes as many as a thousand worms are found in a single individual's intestine. They live chiefly it the large intestine and rarely cause any symptoms. They produce large numbers of eggs of a characteristic appearance, being easily recognized under a microscope by a person who knows what they look like. The worms are usually detected by being passed in the- stools from time to time. If present in great numbers, which is seldom true, they may cause some intestinal distress, diarrhea, and flatulence.<br />Whipworm eggs pass out of the intestine and hatch in the soil as a rule. They enter the body in larval form, but their manner of entry is similar to that of the eggs of the common round- worm.<br /><br />What to Do<br />1. If whipworm infection is suspected, watch for the easily visible worms to be passed in the stools.<br />2. When a physician is available,. arrange for him to supervise the treatment.<br />3. Dithiazanine iodide is presently the favored drug for the treatment of trichuriasis. The course of treatment lasts five days. The total daily quota of the drug should be divided into two or three doses spaced through the day.<br /><br />Tapeworm Infections<br />Ordinarily, a tapeworm has a double life history. The larva, after being hatched from the egg, is found in the flesh of some of the lower animals. Eating raw. or insufficiently cooked flesh containing the larvae transfers them into the digestive tract of man, where they develop into their mature form.<br /><br />All tapeworms are long, flat, and thin, with segmented bodies. The head is small and has sucking discs or hooklets or both, by which means it holds onto the intestinal wall. The old segments gradually drop from the back end as new segments are formed near the head. The segments that drop off and escape with the bowel movements often contain great numbers of eggs. These may later chance to be eaten by some lower animal along with its food. In the stomach and intestines of this animal, the eggs hatch into larvae, which migrate into the muscles or other parts of the animal's body and become encysted or dormant there, not developing further until the infected flesh of the animal is eaten by a human being or some other suitable host.<br />The • varieties of tapeworms most commonly found in the human intestine are separately described below.<br /><br />BEEF TAPEWORM (TAENIA SAGINATA).<br />The head of the beef tapeworm has no hooklets. This may account for the comparative ease with which this worm is dislodged from its attachment to the intestinal wall when the proper remedy is used. Beef tapeworms may grow to a length of more than thirty feet (nearly 10 meters) .<br />Eggs pass out in great numbers in the victim's bowel movements, but even more of them are discharged in the segments of the worm, which are frequently broken off from the back end of the worm. These separate segments seem to have an activity of their own, and often pass from the bowel at other times than when feces are passed.. Anybody acquainted with the characteristic appearance of . a tapeworm segment can easily tell the kind of worm from which it came.<br />The presence of the beef tapeworm sometimes causes diarrhea, hunger pains, and loss of weight. A greater than usual appetite may be the only noticeable symptom. All symptoms, however, are uncertain and are often absent. One can be sure of the para- site's presence only by discovering the segments of the worm as discharged from the bowel or by a miscroscopic examination of the stools to discover the tiny eggs.<br /><br />DWARF TAPEWORM (HYMENOLEPIS NANA).<br />This is the smallest of the tapeworms whose adult forms infect man. It lives in the small intestine, sometimes in small numbers, but there may be as many as a thousand in one intestine. Individual worms grow to be from one to one and a half inches (25 to 35 mm.) long. This worm is found more often in children than in grown people, and the eggs can hatch out and grow to maturity without leaving the intestine. Infection comes generally from swallowing the eggs rather than from eating flesh containing the larval worms. This tapeworm may produce nervous symptoms and loss of appetite, but often it causes no symptoms at all. When it is present, there are many eggs in the bowel movements. These have a characteristic appearance, and are easily recognized by a trained observer with a microscope.<br />With Hymenolepis nana should be classed the rat tapeworm, Hymenolepis diminuta, and the dog tapeworm, Dipylidium caninum, which also infects cats. Both of these latter two worms are comparatively small. They do not often infect human beings, but they seem to be transmitted most commonly by the accidental swallowing of worms or insects containing the larval forms. The last of the three has reddish segments shaped like melon seeds, and it is somewhat larger that the other two.<br /><br />FISH TAPEWORM (DIPHYLLOBOTHRIUM LATUM).<br />This is the largest of the tapeworms infecting man. It is not common in the United States. It may grow to a length of nearly forty feet ( more than 10 meters) . The segments may be half an inch (13mm.) broad, and one worm may have three thousand or more segments. The egg of this worm must hatch out in the water, the larvae find entrance into the body of some fish, and the flesh of this fish be eaten by some person, if the person is to be infected with a fish tapeworm. Freshwater fishes are most often infected. Salting or smoking the flesh of the fish does not kill the larvae, but thorough cooking does. In some cases the fish tapeworm causes an anemia similar to pernicious anemia. Its presence may give rise to hunger pains, diarrhea, ab- dominal distress, and loss of weight.<br /><br />PORK TAPEWORM (TAENIA SOLIUM).<br />In the United States the pork tapeworm is less common than the beef tapeworm; but this is not true everywhere. The muscles of the animal's body most often infected by the larvae are those of the neck, tongue, and shoulders. In many cases the infection produces no noticeable symptoms; but in some the infected person has digestive disturbances, hunger pains, and diarrhea alternating with constipation.<br /><br />The pork tapeworm is comparatively difficult to expel, and may require repeated treatments. It sometimes grows to a length of about twenty feet (about 6 meters ), and may live in the intestine for many years. In some cases people become infected with the larval form of this tapeworm from accidentally swallowing its eggs, but the larvae do not stay in the intestine. They burrow through the walls of the intestine and may infect almost any part of the body, including the brain, where their presence may cause symptoms similar to those of epilepsy or of brain tumor.<br /><br />What to Do<br />Quinacrine hydrocholoride (atabrine) is the drug of choice. It is not recommended that it be used without a physician's supervision. A physician can arrange for proper safeguards and can best make the follow-up investigation needed to determine whether or not the treatment has been effective.<br /><br />HYDATID DISEASE (ECHINOCOCCOSIS)<br />This is a tapeworm disease in one sense, but the adult worm does not infect the human intestine and the usual method of expelling the worm cannot be used, hence the discussion is kept separate from those concerning the worms that do infect the .intestine and that can be thus expelled.<br />Echinococcosis is common in many sheep-raising regions. The adult tape- worm, Echinococcus granulosus, usually infects the intestines of dogs, foxes, wolves, et cetera, which animals become infected by eating the carcasses of sheep containing the larval worms. Infection of humans is with the larval form, and usually results from swallowing food accidentally contaminated with dog feces or from handling dogs and then putting the fingers into the mouth.<br /><br />When a person thus swallows the eggs, they hatch out in the intestine. The young worms spend but a short time there, and then burrow into the tissues. Most of those that survive lodge in the liver, where they cause the formation of cysts filled with fluid and lined with a membrane that may produce large numbers of immature worm heads. Each of these heads could produce a mature worm if swallowed, but they would never be swallowed by any human under normal circum- stances. Some of these cysts act like malignant tumors, so hydatid disease may become a severe malady. If this disease is to be prevented, care must be used in handling sheep dogs and in disposing of sheep carcasses.<br /><br />What to Do<br />1. No medicine or home treatment is of any use.<br />2. If a cyst grows large enough to cause symptoms, or if it ruptures, consult a physician. An operation may be beneficial.<br /><br />Conclusion<br />In the whole range of the diseases of man it is in the field of intestinal para- sites that obedience to the rules of<br />cleanliness and the laws of sanitation proves most effective in preventing disease. Adequate provision for the disposal of all human excreta and the use of proper toilets should become universal. Human excreta should not be used for fertilizing fields or gardens —at least in any way that creates a danger of contaminating food being grown for human consumption.<br /><br />Neither children nor adults should go barefooted in places where the ground may be contaminated. They should keep their bodies clean, and wash their hands thoroughly after defecating, before eating, and before handling food. Care is necessary in association with domestic animals, including especially dogs and cats. Children run the greatest risk of infection, because of their natural carelessness and because they come into such close contact with floors, the ground, and animal pets. They should be provided with clean places in which to play, and they should be taught to keep their fingers and all other objects except proper food and drink out of their mouths.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-4072681561484015902009-02-25T04:35:00.001-08:002009-02-26T18:33:16.741-08:00Nutritional DiseasesIt should be clear to everybody that too little food will result in starvation and that in most cases too much food will cause obesity, and also that both of these conditions are menaces to health. It is still a matter of argument as to whether or not obesity should be called a disease. In this book we shall consider it as such, because it paves the way for many other more serious diseases and because even without any other disease it often causes discomfort and reduces physical efficiency.<br /><br />Nearly all nutritional diseases, however, are deficiency diseases not necessarily from a limited total quantity of food, but from a shortage of certain food constituepts, usually vitamins, sometimes minerals, occasionally proteins. On the other hand, a harmful excess of either minerals .r vitamins, though uncommon, could cause nutritional disorders.<br /><br />For instance, large doses of vitamin D sometimes prescribed in medical treatment have in some cases seriously upset calcium metabolism in the body. Excessive vitamin A has also proved harmful.<br /><br />Vitamin deficiency diseases are collectively called avitaminoses. Discussions of avitaminoses will comprise the bulk of this chapter, but a few other diseases with a nutritional basis will be included. Then, in the latter half of the chapter, problems aid diseases of metabolism will be discussed, the term metabolism including the several processes by which the body assimilates nutrients.<br /><br />Avitaminoses<br />VITAMIN A DEFICIENCY.<br />A mild deficiency of vitamin A tends to produce roughness and dryness of the skin. A greater degree of deficiency increases this tendency and causes damage to the epithelial tissues of the body, which become more susceptible to infection.<br /><br />In later stages, severe infections of the mouth, the genitourinary tract, the respiratory organs, and the eyes are likely to occur. The eye infection often develops into, or in connection with, a serious condition called xerophthalmia, which may lead to blindness. Another common effect on the eyes is a loss of ability to see in dim light, a condition called night blindness.<br /><br />What to Do<br />1. Include more vitamin A in the diet. It may be convenient to take some oil rich in vitamin A, such as cod-liver oil or halibut-liver oil. Vitamin A is also available in purified form and may be taken as such.<br />2. It is best to consult a physician, especially if eye symptoms are troublesome. He can advise as to what to take, how much, and how long to continue the treatment; and he can give, or arrange for giving, such special treatments as the eyes may need.<br /><br />VITAMIN B DEFICIENCIES.<br />The so-called vitamin B complex consists of four separate vitamins: thiamine (vitamin B1), riboflavin (vitamin B2), niacin or nicotinic acid, and vitamin B12. Likewise, there are four separate nutritional problems in this area, each associated with a deficiency of one of these vitamins. There are two other B vitamins, folic acid and pyrodoxine, each with its associated nutritional problems.<br /><br />A. Thiamine (Vitamin B1) Deficiency. The disease beriberi is the most common manifestation of serious thiamine deficiency. It is characterized by an inflammation and degeneration of nerve trunks, producing disturbances of both motion and sensation. There is loss of appetite. The patient becomes weak, especially in the legs. His muscles tend to waste away. Partial paralysis and a tendency to dropsy are common. The nerves controlling the heart action may be badly affected, and heart failure and sudden death may result.<br /><br />Beriberi occurs most frequently among people whose diet consists mostly of polished rice, but anybody who lives chiefly on highly refined starchy or sugary foods may get it. It may develop in infants, especially those nursed by mothers who have the disease. If the disease is not far advanced, correction of the diet usually will bring about rapid and complete recovery. If the neuritis has continued until the nerve trunks have degenerated, however, normal motion, sensation, and heart action can never be restored.<br /><br />Wernicke's syndrome is also a condition caused by a deficiency of thiamine. It occurs most commonly among heavy users of alcohol. It is characterized by a clouded mental state, weakness of the muscles which move the eyes, unsteadiness, and deterioration of many of the nerves (peripheral neuritis) .<br /><br />What to Do<br />Correct the diet. No other remedy or treatment can do much good. Thiamine abounds in the outer layers of the grains of rice, wheat, and other cereals. Fresh milk, eggs, brewer's yeast, concentrated yeast extracts, and malt extract also contain generous amounts of thiamine. Fresh fruits and vegetables are helpful. Among flesh foods, liver is best.<br /><br />B. Riboflavin (Vitamin B2) Deficiency. Riboflavin deficiency is likely to cause visual disturbances, eye pain in bright light, an overflow of tears, and redness of the eyes. Perhaps the commonest signs are wrinkling, moistness, and fissures of the skin at the angles of the mouth. The tongue tends to be unnaturally red. Loss of weight and vigor are common. B2 deficiency is often associated with B1 deficiency, giving a somewhat confusing picture. When either deficiency seems to be present, look for signs of the other.<br /><br />What to Do<br />1. See that the diet contains adequate milk each day, and plenty of eggs and green vegetables.<br />2. In severe cases consult a physician. He will probably prescribe liver extract or tablets of riboflavin, among other things.<br />C. Niacin Deficiency (Pellagra) . One characteristic sign of pellagra is a peculiar skin eruption. The eruption looks much like a bad case of sunburn, with considerable cracking, crusting, and scaling, and occasionally some small blisters. It usually appears on the exposed areas of the skin, such as the backs of the hands and wrists, the face, and the neck, less frequently on the legs and ankles, and occasionally on the external genitals. The upper edge of the eruption usually has a- well-defined border, giving rise to the descriptive term "glove-like" when it occurs on the hands and wrists. Exposure of the skin to sunlight is believed to stimulate the appearance of the eruption.<br /><br />People with pellagra usually have capricious appetites and frequently digestive disturbances. Diarrhea is common. A victim's tongue usually looks abnormally smooth and deep red. Patients are often addicted to alcohol, and about one in fifty of them will probably eventually have mental disturbances severe enough to amount to true dementia.<br /><br />Many of them are troubled with such nervous symptoms as weakness, dizziness, insomnia, and disturbances of the sense of touch.A correct diet will cure most cases of pellagra, but a pellagrin who continues to drink alcoholic liquor will be hard to cure. The cure is usually complete, except in those cases that have resulted in insanity; and even in them the mental condition is often much improved.<br /><br />What to Do<br />1. In the acute stage of the disease there should be bed rest. The diet should consist of milk, vegetable purees, tomato juice, and soft-boiled or poached eggs. Yeast extract broths can be given with benefit.<br />2. If diarrhea is troublesome, give a teaspoonful of bismuth subcarbonate in water every three or four hours.<br />3. Lanolin to which 5 percent of boric acid powder has been added will help soothe the skin eruption.<br />4. When the acute stage of the disease is past, the chief remedy is still the diet. It should include a quart of milk a day and plenty of eggs and green leafy vegetables. Lean meat is allowable, but fat meat is valueless. The milk may be fresh, dried, canned, or buttermilk. Brewer's yeast or some concentrated yeast extract will prove helpful.<br /><br />The following foods are all low in or almost devoid of niacin: corn and all products made from it, molasses, potatoes, carrots, yellow turnips, rice, ripe onions, most animal fats, cottonseed oil, and gelatin. In parts of the country where people live wholly or chiefly on foods in this list, pellagra is common.<br /><br />5. Alcoholic beverages should be left alone.<br />6. In severe cases the services of a physician are advisable.<br /><br />D. Vitamin B12 Deficiency. A deficiency of B12 is the cause of pernicious anemia. This problem is discussed in detail in the consideration of blood diseases in chapter 10 of this volume.<br />Persons who eliminate all animal products from their diet, including dairy products, are particularly likely to develop a deficiency of vitamin B12 with symptoms of pernicious anemia. Treatment consists of including milk and eggs in the diet and using vitamin B12 supplements.<br /><br />E. Folic Acid Deficiency (Megaloblastic Anemia of Infancy and of Pregnancy) . Folic acid, one of the group of B vitamins, is an important and widely distributed vitamin which occurs abundantly in many vegetables. Long-continued cooking of food is progressively destructive to folic acid.<br />Deficiency of folic acid occurs commonly among persons who are malnourished and produces a form of anemia very similar to pernicious anemia. The megaloblastic anemia resulting from a deficiency of folic acid is most likely to occur under conditions in which the body requirement for folic acid is greater than usual: in infancy and during pregnancy.<br /><br />The megaloblastic anemia of infancy typically occurs between five and eleven months of age, a period of rapid growth. Infants who were born prematurely and those who have had repeated infections of the gastrointestinal organs are particularly susceptible. The condition may be easily confused with that caused by a deficiency of vitamin B12. It is important to avoid such confusion, for the cure of this condition depends specifically on the administration of folic acid.<br /><br />Megaloblastic anemia of pregnancy (pernicious anemia of pregnancy) appears in about one percent of pregnancies during the last three months, at a time when the personal requirements for folic acid are increased because of the rapid growth of the unborn child.<br />The administration of tablets of folic acid, under a physician's direction, brings about a dramatic cure in almost all cases.<br /><br />F. Pyridoxine (Vitamin Bs) Deficiency. Pyridoxine is another member of the vitamin B group. Symptoms of this deficiency are particularly important in infancy and early childhood, when they consist of convulsions. They develop in infants who have received formulas in which the milk or the cereal has been "over processed," prolonged processing having depleted the vitamin.<br /><br />What to Do<br />There is an adequate quantity of pyridoxine in human milk, also in cow's milk and in cereals if these latter are not over processed.<br />For the immediate treatment of convulsions due to a deficiency, an intramuscular injection of pyridoxine gives prompt relief. For infants who seem to be in danger of this deficiency, the physician will arrange for small doses of the vitamin to be added to the diet.<br /><br /><br />VITAMIN C DEFICIENCY (SCURVY).<br />A person with scurvy tends to become weak and anemic, to have spongy gums and loosening teeth, and to be subject to hemorrhages, especially about the joints and beneath the skin. The joint hemorrhages cause severe pain and sometimes lead to a mistaken diagnosis of arthritis or rheumatism.<br /><br />The spongy gums may bleed easily, become ulcerated, or become the seat of infection. In case the patient suffers a wound, the wound heals slowly.<br />A baby that is developing scurvy will be pale and stop gaining weight. The slightest bruise of its skin will result in a black-and-blue spot. Its gums will not make much trouble until the teeth begin to come through. The pain and swelling of the joints will likely be severe and cause the child to be irritable and to cry a great deal.<br /><br />In scurvy, either in babies or in older people, correction of the diet brings about almost miraculous improvement. Pain may disappear within a day or two, and all other symptoms within a week or two. The same diet that will cure scurvy will prevent it. A person who takes a properly balanced diet will never have this disease.<br /><br />What to Do<br />1. For a baby with scurvy, give fruit juice. Orange juice is good, but lemon, grapefruit, or tomato juice may be used instead. Fruits and green vegetables should be added to the baby's diet as soon as it can take them.<br /><br />2. For an older child or an adult, be sure there are plenty of green vegetables and fruit in the diet. Additional fruit juice may be helpful. Some very good sources of vitamin C are citrus fruits, strawberries, cantaloupes, tomatoes, green peppers, and raw cabbage (especially green cabbage).<br /><br />VITAMIN D DEFICIENCY (OSTEOMALACIA, RICKETS).<br />Rickets develops almost exclusively among young children, though its effects may persist throughout life. Osteomalacia is a similar condition sometimes seen in adults. Rickets is most common between the ages of six months and eighteen months.<br /><br />It can be caused by a deficiency of calcium, phosphorus, or vitamin D in the diet. The vitamin D deficiency, however, is more common than the mineral deficiency. Calcium and phosphorus are the chief mineral elements in the framework of the body. Vitamin D is necessary for the work of building these elements into bones and teeth, and vitamin C helps it in this work.<br /><br />The earliest symptoms of rickets are restlessness, irritability, and sweating of the head. Then the joints between bone and cartilage at the front end of the ribs begin to enlarge, forming two rows of hard nodules, one row beginning a short distance from each side of the upper end of the breastbone and running obliquely downward and sideways to the lower border of the ribs. These nodules can be easily seen in thin children with rickets, and they may be felt in those who appear to be well nourished.<br /><br />The child's head gradually takes on a somewhat square shape. The fontanels, or "soft spots," in the top of the skull may remain open long after they should be closed. The bones that form the wrist joints, and often other joints, are softer and larger than they should be. The child with rickets is frequently bowlegged, though sometimes knock-kneed, and becomes even more so when he begins to walk.<br /><br />His abdomen may protrude markedly and his bowels be constipated. If his blood is tested, it will be found below normal in phosphorus or in calcium, but not necessarily in both. X rays of the joints of his limbs will show a characteristic lack of development near the ends of his long bones. Pelvic deformity due to rickets in a girl may persist until mature years, making normal childbirth difficult.<br /><br />Since skeletal deformity resulting from advanced rickets is in so many cases an incurable condition, prevention is of prime importance. If it is not entirely prevented, but detected early, however, a satisfactory cure is not difficult. It is usually easy to obtain a diet containing sufficient calcium and phosphorus, especially if an ample quantity of milk is available.<br /><br />Milk is a good source of calcium, contains a considerable amount of phosphorus, and is a good source of vitamin D if whole milk is used, especially if the cows giving the milk spend a large part of their time out in the sunshine. Egg yolks also furnish good amounts of both phosphorus and vitamin D.<br /><br />What to Do<br />1. Give a child who shows any signs of possible rickets at least a quart of whole milk a day. Milk fortified with vitamin D is now common.<br /><br />2. From the age of five or six months onward, one egg yolk a day will be helpful.<br /><br />3. Daily sunbaths are also helpful. Exposure to sunlight, within reasonable limits, causes the skin to produce a certain amount of vitamin D.<br /><br />4. Give the child cod-liver oil or some other good source of vitamin D. Begin at three or four weeks of age, giving half a teaspoonful twice a day, and increase gradually to one and a half teaspoonfuls twice a day at the age of three or four months and thereafter. A few drops of halibut-liver oil or of viosterol may be used instead of cod-liver oil, and this is better for babies who tend to be fat. It is well also to see that the baby's diet is not short of vitamin C. (See above.)<br /><br />5. Properly graduated quartz-light treatments may take the place of sunbaths.<br /><br />VITAMIN E DEFICIENCY.<br />Vitamin E is apparently conducive to health in several rather indefinite ways, but whether or not a deficiency of it will cause disease in human beings has not yet been conclusively proved. Furthermore, almost any otherwise well-balanced diet will contain sufficient vitamin E.<br />VITAMIN K DEFICIENCY.<br /><br />Vitamin K occurs in sufficient abundance in most green leafy vegetables to make any serious deficiency of this vitamin rather uncommon. When an insufficient amount of it is eaten or absorbed, however, an increased tendency to hemorrhage develops; and laboratory studies have shown that this tendency is associated with a lessened amount of prothrombin in the blood.<br /><br />Hemorrhages due to this condition can often be prevented or checked by injections of vitamin K.<br />Vitamin K deficiency exists most commonly in newborn infants or in people with jaundice and whose intestinal absorption of digested food is poor.<br /><br />Attention to the diet is usually not enough to correct such a condition in people past infancy because dietary deficiency is rarely the sole cause. Ensuring that a prospective mother's diet contains an abundance of vitamin K is the best way to prevent a deficiency of this vitamin in her newborn baby. If her diet is possibly inadequate in this respect, she should have injections of vitamin K during the last month or two of her pregnancy.<br /><br />What to Do<br />If a newborn baby shows tendencies to hemorrhage, have a physician take charge of the case immediately. There may be other reasons for the tendency, but injections of vitamin K may prove to be the most helpful remedy.<br /><br />Other Nutritional Diseases<br />NONTOXIC GOITER.<br />NUTRITIONAL EDEMA (FAMINE EDEMA, WAR EDEMA).<br />Nutritional edema results from long-continued deprivation of protein that is biologically complete. It usually occurs in famine areas. The first step in its development is a general weight loss. Later there is water retention, which appears to check the loss of weight but leads to a pitting edema, appearing first in the legs but later spreading upward and sometimes involving the entire body.<br /><br />A variety of nutritional edema fairly prevalent among babies and young children in parts of Africa, Asia, southern Europe, and Central and South America, where low protein foods are fed and milk is not available, has been called kwashiorkor. In this disease the liver is enlarged and the pancreatic tissue more or less degenerated.<br /><br />In addition to showing edema, the young victims do not grow well and are irritable and apathetic. Their appetite is poor, and they are troubled with vomiting and diarrhea. They are likely to have skin rashes, irregularity of pigmentation of skin and hair, and ulceration or inflammation about the mouth and eyes. If not treated early and properly, more than half of the victims of kwashiorkor die.<br /><br />What to Do<br />Provide an abundant diet, otherwise well-balanced, but containing an abundance of protein, a considerable proportion of which should ordinarily come from non vegetable sources. The amount needed to cure an adult who has developed nutritional edema is from 120 to 150 grams per day. For babies and young children, the most important dietary treatment is to give an abundance of milk and eggs.<br /><br />Since the disease usually attacks poor people, the expense of providing suitable dietary protein may be an obstacle to effective treatment. In some places a mixture of vegetable proteins has worked well. This should be easier where soybeans are grown or otherwise available, because soybeans are the best known vegetable source of complete protein.<br /><br />OBESITY.<br />Obesity is nearly always due to overeating. There are a few cases—usually in childhood or early youth—in which glandular imbalance plays an important part. Obesity is objectionable chiefly because it is apparently a prelude to many cases of diabetes and heart disease. It makes arthritis of the hips and knees worse because of the abnormally great pressure it puts on the joints and articular cartilages. Different people may have other reasons for not wanting to be overweight, but very few have anything reasonable to say in its favor.<br /><br />What to Do<br />1. If there is any question about the cause of the obesity, have a physician study the case.<br />2. If it is clear that overeating is the chief or only cause, reduce the weight to normal.<br />PERNICIOUS ANEMIA.<br />SPRUE.<br />Inborn Errors of Metabolism<br />A person's characteristics are determined in part by heredity and in part by environment. Heredity gives the individual his start in life and determines physical and mental traits which provide the gross outline of his body and of his personality. The influence of environment is then superimposed on that of heredity to fill in the details.<br /><br />With respect to disease, there is considerable variation in the relative importance of heredity and environment. In some diseases the influence of heredity seems to be the main factor, with environment playing the minor role. In others environment plays the major role, with the influence of heredity serving only to make the person more or less susceptible to the disease. Under this subhead, "Inborn Errors of Metabolism," we deal with certain faults of metabolism caused essentially by unique heredity rather than by what may have happened to the person since his birth.<br /><br />DISORDERS IN PIGMENT METABOLISM.<br />The outstanding example here is the disease porphyria, in which there is a disturbance of the metabolic process by which the body uses the chemical substance known as porphyrin to help build its hemoglobin and some of its other pigments and enzymes. Heredity is blamed for most cases of porphyria. There are various forms of the disease, all resulting in an excess of porphyrin compounds in the urine.<br /><br />In some forms of this disease there is a sensitivity of the skin to sunlight or to artificial ultraviolet light, with resulting skin lesions and abnormal pigmentation. In one form the patient shows symptoms of abdominal pain, vomiting, and constipation, together with paralysis of certain of the muscles. Acute attacks are usually brought on by the use of alcohol, by certain drugs, or by infections.<br /><br />The treatment consists largely of avoiding alcohol and drugs and of protecting the skin from sunlight.<br /><br />DISORDERS IN PROTEIN METABOLISM.<br />Here the example is the disease phenylketonuria, the cause of which is hereditary. The laws of some states now require that tests be made on the blood or urine of newborn infants as a means of detecting this disease in time to prevent its tragic complications. The problem occurs in about one child out of every 25,000.<br /><br />The disease is caused by the lack of an enzyme necessary to the proper synthesis of tyrosine (one of the amino acids) within the body. As a result, phenylalanine (a precursor of tyrosine) accumulates within the body's tissues and fluids and flows over into the urine. The complications of the full-blown disease include damage to the patient's brain with resulting abnormal movements and mental retardation.<br /><br />The treatment, which is quite effective, consists of arranging a diet which contains a minimum of phenylalanine. Obviously, a child with this disease must be under the care of a physician.<br /><br />DISORDERS IN CARBOHYDRATE METABOLISM.<br />In this category there are two important hereditary diseases. First is galactosemia. In this disease the infant's body is unable to convert one form of carbohydrate into another (galactose to glucose) because of the absence of the necessary enzyme. An infant with this disease appears normal at birth but after a few days develops difficulty in feeding and begins to vomit. If the disease goes untreated, failure in growth and eventual death from malnutrition will result. Treatment is relatively simple, consisting merely of eliminating from the diet all galactose-containing foods. This means that milk and milk products are strictly forbidden. Even though the patient is still an infant, it will do very well on a properly designed diet which provides all the nutritional essentials by foods other than milk.<br /><br />The second disease is glycogen storage disease. It is usually fatal within the first year or two of life, for it involves an inability to convert glucose to glycogen (two forms of carbohydrate) and vice versa, with the result that excesses of glycogen become deposited in various tissues of the body. Symptoms are fatigability and hypoglycemia (low blood sugar) with resulting shock and convulsions. In some cases the hypoglycemia can be combated by frequent feedings. If the patient survives the period of early childhood, his condition may gradually improve.<br /><br />DISORDERS IN LIPID (FAT) METABOLISM.<br />In hereditary disorders of lipid metabolism some patients suffer from an increase in the amount of lipids in the body fluids and tissues, and others from a decrease. Perhaps the most notable disease in this group is essential hypercholesteremia (xanthomatosis) .<br /><br />Here the amount of cholesterol is increased more than the other lipids that normally occur in the body, the amount in the blood serum being perhaps two or three times normal. Swellings produced by accumulations of cholesterol-laden cells (foam cells) occur in the skin (xanthomas) ; in the subcutaneous areas at pressure points such as knees, elbows, and buttocks; in the heart; and in certain tendons. Conditions such as arteriosclerosis and coronary artery disease, which are associated with an increase in cholesterol, are, of course, more frequent than usual in cases of essential hypercholesteremia.<br /><br />These cases are benefited by instituting measures which tend to lower the concentration of cholesterol in the blood serum. Of first importance is a diet regimen which excludes the sources of saturated fatty acids such as meat, dairy products, eggs, and the common cooking fats. In their stead the patient may use vegetables and unsaturated fats such as corn oil. In extreme cases the physician may prescribe one of the cholesterol-lowering drugs.<br /><br />DISORDERS IN KIDNEY TRANSPORT.<br />Among the numerous functions which the kidneys have to perform is the recovery from the "glomerular filtrate" of the chemical substances needed by the body's tissues.<br />As blood comes into the kidneys for renovation, the waste products to be eliminated from the body plus a great deal of water and such chemical molecules and radicals as glucose, carbonate, sodium, chloride, potassium, phosphate, calcium, and sulfate pass through the delicate membranes into the kidney tubules.<br /><br />All this makes up the so-called glomerular filtrate. But many of these chemicals cannot properly be spared, and so specialized cells which line the kidney tubules reach out and salvage what the body needs as the filtrate passes by.<br />In the hereditary disorders of kidney transport, the specialized cells of the kidney tubules are defective to the extent that they permit certain molecules or radicals to pass on through into the<br />bladder.<br /><br />A notable example of these diseases is called renal rickets. In this condition the cells of the kidney fail to recover as much phosphate as they should from the glomerular filtrate, with the result that the concentration of phosphate in the body's tissues and fluids falls to low levels. Symptoms similar to those of ordinary rickets develop. But even though the symptoms are similar, this disease typically does not respond to the administration of vitamin D as ordinary rickets does. The disease usually progresses to a fatal termination.<br /><br />Diseases of Metabolism<br />In this group of diseases the metabolism (transport, synthesis, breakdown, or excretion) of some normal chemical constituent of the body occurs in an abnormal manner, and this abnormality of metabolism seems to be the primary cause of the illness. The various proc?<br />esses of metabolism are usually altered in other kinds of disease, but in these other instances the metabolic changes are the consequences of the disease rather than its cause.<br /><br />CYSTIC FIBROSIS.<br />This is a serious disease of hereditary origin which affects that part of the pancreas which produces digestive enzymes, some of the salivary glands, glands of the respiratory tract, and sweat glands of the skin. The com cations are (1) malnutrition because the deficiency of the pancreatic dig five enzymes, (2) infections of the i piratory organs, and (3) a tendency heat exhaustion because of the ex( sive loss of sodium chloride throe the sweat. The disease typically be in childhood, and many children v~ this disorder do not live to adult With improved methods of treatment the prospective length of life has creased.<br /><br />What to Do<br />1. The recommended diet is h in calories, high in protein, and m moderately low in fat.<br />2. Vitamin A in relative la doses is recommended.<br />3. Pancreatic extract to sups ment the reduced output of the j creas helps to allay the digest symptoms and improves the patie nutritional status.<br />4. The control of respiratory fections by the use of antibiotics; other medicinal agents is imports<br />GOUT.<br />Gout is mentioned here because fundamental cause is a defect in m, bolic processes with the result 1 deposits of uric acid occur in var: parts of the body, notably in cer joints and in the kidneys. This ca a very distressing type of arthritis. C as a disease is discussed in chapte of this volume.<br />DIABETES MELLITUS.<br />Of the two kinds of diabetes, betes mellitus and diabetes insip: diabetes mellitus is by far the common. When a person uses the "diabetes" without qualification, h feres to diabetes mellitus.<br /><br /><br />This is a disorder of carbohydrate metabolism, with obvious hereditary background in about 50 percent of cases, characterized by the production of large quantities of urine and by excesses of glucose (blood sugar) in the blood and the urine.<br /><br />It used to be assumed that the fundamental cause of diabetes mellitus is a deterioration of the islets of Langerhans in the pancreas, the cell groups which produce insulin. When the pancreases of persons who have died from diabetes mellitus are examined, in many cases there is an obvious deterioration of the islets of Langerhans.<br /><br />Strangely, however, in some cases no such deterioration can be detected. This observation together with other significant items of evidence has persuaded medical scientists that the disease is not always caused by difficulty in the pancreas itself. Other circumstances within the body's tissues can also interfere with the metabolism of carbohydrate. For this reason our discussion of diabetes mellitus is included here with diseases of metabolism rather than in the chapter on "Endocrine Gland Diseases."<br /><br />Diabetes mellitus is not only a serious disease but a common one, occurring sometime during the lifetime of 4 percent of females and 2 percent of males in the United States. The onset may be at any age. Usually the disease first becomes apparent following some major demand on the body's resources such as severe injury, a serious infection, or a circumstance of emotional stress. The incidence of diabetes mellitus is higher in overweight persons than in people of normal weight.<br />In diabetes mellitus there is a deficit in the storage and release of glucose by the liver and an interference with the process by which the body's cells are able to use glucose as their source of energy. A person suffering from this disease must therefore derivemore of his energy from the metabolism of protein and fat than is normally the case.<br /><br />Prior to the days of adequate treatment, the mortality rate for diabetes mellitus ran high. Even now for cases which begin in childhood it runs significantly higher than for those which begin in adult life. For a case in which the disease appeared first in adulthood, the life expectancy can be virtually as high as in a normal person, provided the treatment program is so carefully controlled at all times that the body processes proceed normally.<br /><br />Symptoms the Patient Notices: When diabetes begins during childhood, the symptoms include excess production of urine, excessive thirst, a desire to void at night, bed-wetting, an increase in appetite in spite of a loss of body weight, weakness, and itching of the skin. For cases which begin during adulthood, the symptoms are excessive production of urine, increased thirst, weakness, and itching of the skin.<br /><br />What the Physician Finds: When a physician examines a person with diabetes, he finds sugar in the urine, a higher than normal concentration of glucose in the blood, and evidence (revealed by a "glucose tolerance test") that the individual is not using up his blood sugar as quickly, following a meal, as in a normal case. These evidences all indicate that the body is unable to use glucose (the form in which carbohydrate appears in the circulating blood) in a normal manner. In other words, glucose accumulates in the blood and is eliminated by the way of the urine instead of being used in the body for the production of energy.<br /><br />A tragic feature of diabetes mellitus is that when it goes untreated serious complications develop, thus reducing the patient's life expectancy. One of these is a tendency to early degeneration of the body's arteries with arteriosclerosis developing throughout the body and with the coronary arteries of the heart being particularly involved. Abnormal conditions also tend to develop in the nervous system, such as peripheral neuritis, loss of the sense of vibration, and loss of normal control of the urinary bladder. Another complication of inadequately treated diabetes is kidney disease.<br /><br />A tendency to infection of the skin and other body tissues is much greater than normal. Also ever-present is the danger of a loss of consciousness due to an imbalance between the amounts of insulin and glucose in the patient's blood and tissues.<br /><br />Two situations representing opposite conditions may cause unconsciousness in a case of diabetes. The first develops gradually, when for some reason the glucose in the blood reaches high levels and is not offset by an adequate amount of insulin. This condition is called diabetic coma. The second may develop quite suddenly, when the patient has taken too much insulin or for some reason has depleted the supply of glucose in his blood and tissues so that his blood sugar runs dangerously low, not allowing enough to provide the energy food which his cells need. This condition is called insulin coma or hypoglycemic shock.<br />For the emergency treatment of these two conditions, "Handling Emergencies," under Unconsciousness, subsections B and C.<br /><br />It is because of the lurking danger of insulin coma that a diabetic patient is advised to carry a wallet card or wear a bracelet stating that he is a diabetic, and that if he is found to be acting strangely or if he becomes unconscious, his doctor or an ambulance should be called at once.<br /><br />The card should also give the following information: patient's name, address and telephone number; and physician's name, address, and telephone number.<br />Diet is perhaps the most important factor in the treatment of diabetes. Many cases, particularly those that develop during adulthood, can be handled satisfactorily without the use of insulin or other medicines, provided the patient follows a consistent dietary program. A suitable diet for a diabetic patient is relatively normal, with the exception that it does not include the more rapidly absorbed carbohydrates except in small amounts. The special feature in administering the diet is that all portions must be carefully measured so that the patient eats neither too much nor too little. In other words, the various food elements in his diet must be very carefully regulated. It is when a diabetic patient becomes careless in following his diet, by eating more or less of some particular item, that he encounters difficulty.<br /><br />The second important factor in the treatment of diabetes is the administration of insulin by hypodermic or of one of the newer "hypoglycemic agents" by mouth. Insulin (or its substitutes) is a necessary part of the treatment program for most juvenile diabetics and for adults who cannot control the condition by diet alone. Great advances have been made in the preparation of insulin for use by diabetic patients so that a physician can choose among various products available as he adapts the program of treatment to the needs of the patient.<br />Once a case of diabetes has been diagnosed, it is well for the patient to spend several days in the hospital under the direct supervision of the physician and of the dietitian. Here he learns how to regulate and control his diet and also how to take his insulin or insulin substitutes if this is necessary. His ability to enjoy good health thereafter depends very definitely on his being consistent in following his treatment program. Also, periodic checkups are necessary as a means of measuring his progress and of modifying the treatment program to fit changes in his condition.<br /><br />Certain circumstances requiring special provisions may occur in the experience of a diabetic patient. During pregnancy, for instance, a diabetic patient requires closer supervision than usual. Infant mortality is higher in a poorly controlled diabetic mother. When a diabetic patient must have surgery, it is necessary for his treatment program to be altered accordingly and to be regulated very closely, day by day, throughout the period of his surgery and recovery. In case an infection develops in the skin or in any other of the body's tissues, the treatment program must be altered accordingly.<br />The diabetic patient must regulate the amount of his physical exercise almost as carefully as he regulates his diet. It is beneficial for him to have some physical exercise each day. Inasmuch as the amount of exercise changes his requirements for energy food, the possible consequences of his taking either too little or too much exercise during a given period may be just as serious as taking too little or too much food.<br /><br />HYPOGLYCEMIA (LOW BLOOD SUGAR).<br />Hypoglycemia is the condition in which the amount of glucose (blood sugar) drops below the level of 50 mg. of glucose per 100 ml. of blood. Hypoglycemia is not a separate disease as such, for it may stem from any one of several causes.<br />The symptoms of hypoglycemia may follow two patterns, which can occur separately or in combination. First, certain symptoms relate to the nervous system and result from the brain's being deprived of sufficient glucose (energy food) to maintain the normal activity of its cells. These symptoms may include mental confusion and anxiety,hallucinations, aimless activity, convulsions, and eventual coma.<br /><br />Second, other symptoms result from the body's automatic attempt to compensate for the lack of blood sugar by producing an emergency supply of epinephrine. These include sweating, pallor, chilliness, trembling, hunger, weakness, palpitation, and faintness.<br /><br />1'he Causes of Hypoglycemia:<br />1. Hypoglycemia may result from an overdose of insulin. Insulin has the effect of accelerating the body's use of blood sugar. An overdose of insulin, therefore, reduces the amount of blood sugar available in the blood.<br />2. A failure to eat the usual amount of food after taking insulin may cause hypoglycemia. In a diabetic patient, the amount of insulin must be carefully balanced against the amount of food the patient is expected to eat in order to maintain the level of blood sugar at its normal. When the patient does not eat this necessary amount of food after taking insulin, the effect is comparable to that of an overdose of insulin, with the result that the blood sugar is reduced.<br />3. Hypoglycemia may result from excessive exercise by a person not conditioned for this overexertion. If the body's sources for replenishing the available supply of blood sugar thus used up are not momentarily adequate, hypoglycemia will result. A person with diabetes mellitus is particularly susceptible in this instance.<br />4. Hypoglycemia may result from an overproduction of insulin within the body, as in the particular type of tumor of the pancreas in which the insulin-producing tissue becomes overactive.<br />5. It may develop in cases of liver disease in which the blood sugar is not stored or released by the liver in a normal manner.<br />6. Hypoglycemia may occur in connection with diseases of certain endocrine organs, as the adrenals and pituitary. Oddly, the "hypo" condition may occur early in the course of diabetes, before the usual "hyper" phase.<br /><br /><br />What to Do<br />1. The treatment of an acute attack of hypoglycemia will vary depending upon whether the patient is in the hospital or must be given emergency treatment elsewhere and on whether he is still able to swallow or has already lost consciousness. When in the hospital, the administration by vein of 10 to 25 gms. of glucose will usually restore the patient, momentarily, to a relatively normal condition. Subsequent treatment is determined by the results of laboratory tests indicating the level of the patient's blood sugar.<br /><br />When the patient is not in the hospital but is still able to swallow, he should be given any sort of sweetened drink, such as orange juice, or its equivalent in candy or sugar. The symptoms of the immediate attack should improve within fifteen minutes. Then he should eat bread or other food containing starch and protein to provide the necessary source from which his tissues can produce additional glucose.<br /><br />When the patient is not able to swallow, he may be given sweetened fruit juice or a 5 percent solution of glucose by stomach tube. Prompt effort should be made to secure the services of a physician or to take the patient to the emergency room of a hospital.<br />2. For cases in which the cause of hypoglycemia may be organic disease of the pancreas or liver, a physician should study the case in order to determine the exact cause and arrange the treatment accordingly. Surgery or other definitive treatment may need to be carried out promptly.<br />3. For cases of functional hypoglycemia in which there is no actual disease of the liver or pancreas, an alteration in the patient's diet may correct the tendency to hypoglycemia. In such cases, the body's control mechanisms may have become unusually sensitive to the taking of food containing carbohydrate to the extent that insulin is produced in excessive amounts. A helpful procedure here is to adopt a diet which is low in carbohydrate and high in protein and fat, thus enabling the individual to derive the necessary amount of calories for his energy needs without overstimulating his own production of insulin.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.comtag:blogger.com,1999:blog-4299466824467615088.post-18208658428700161512009-02-23T23:29:00.000-08:002009-02-26T18:28:23.646-08:00Mental and Nervous DisordersPLEASE Note: It is urged that the following introductory pages be consulted before reading the discussions of individual diseases which follow. The basic understanding of the causes and manifestations of the nervous disorders thus acquired will enable the reader to place a better evaluation on the particular nervous disease in which he is interested.<br /><br />General Considerations. The brain and spinal cord are composed of very fragile tissue. Both are protected by bones, the former by the skull and the latter by bony components of the vertebrae. In addition these organs are surrounded by durable fibrous coverings (the meninges), which provide further protection from injury.<br /><br />Thus, despite their delicate nature, these organs of the central nervous system fare very well under normal conditions. But once they are attacked by disease, once their supply of blood is curtailed, or once they receive a mechanical impact violent enough to injure their delicate tissues, their welfare is in jeopardy. And when a part of the nervous system is deranged, other parts of the body, or even the entire body, suffer also.<br /><br />In the case of nervous disorders, home treatment is usually not appropriate. Furthermore, the outcome of most nervous disorders often depends upon whether the condition is recognized early enough to allow adequate and appropriate care to be given in time to save the life or at least to minimize permanent damage.<br /><br />When symptoms develop which indicate disease of the nervous system, a physician should be consulted promptly. Every physician is trained in the recognition and handling of the usual nervous disorders, but a specialist will be needed for those more complex.<br /><br /><br />Common Causes for Nervous Disorders<br />Many diseases and conditions involve the nervous system, some affecting only the organs of the nervous system but others, more general in nature, affecting additional parts of the body. The most common causes of nervous disorders are listed as follows:<br /><br />A. Developmental Defects. When congenital faults of development affect the nervous system, the results to the individual depend upon just what part of the nervous system is affected and omthe degree of severity of the defect. Hydrocephalus an enlargement of the head due to an increase of cerebrospinal fluid within the brain is an example of developmental defects that may affect the central nervous system.<br /><br />B. Infections and Inflammatory Disorders, These may affect the brain, spinal cord, or nerves just as they affect other tissues of the body. Two examples are poliomyelitis and brain abscess.<br /><br />C. Toxic, Metabolic, and Nutritional Disorders. These are conditions that often affect the entire body as well as the nervous system. Toxins produced by germs (as in tetanus, diphtheria, and botulism), absorption of certain heavy metals (such as lead), or the ingestion of certain chemical agents (such as alcohol) , commonly cause damage to the brain and other tissues of the nervous system. Examples of metabolic disorders which affect the nervous system are phenylketonuria and diabetes. The nervous system is particularly susceptible to deficiencies in the diet, as when the B vitamins are insufficient.<br /><br />D. Trauma. Although the organs of the nervous system are well protected by their bony coverings, falls or car accidents resulting in skull fracture or back injury may cause serious damage. In contusion, the delicate brain tissue is damaged by impact or by shearing stresses which pass through its substance causing varying degrees of disruption of the tissue.<br />Hemorrhage into the brain or spinal cord may cause damage by disruption of the tissue and also by the pressure of the resulting blood clot. In some cases of injury the healing process involves the development of extensive scars which may produce such irritation of the delicate tissues of the brain as to cause convulsions. In some injuries certain of the nerves are torn, perhaps as they leave the brain to pass through the skull, or anywhere along their course to the structures they serve.<br /><br />E. Vascular Disorders. The blood supply to the brain and spinal cord is very generous necessarily so because the cells of these active tissues are critically dependent on a continuous supply of oxygen and nutrient materials. When the blood vessels of the body become diseased, the brain and spinal cord often suffer more quickly and more seriously than do other organs. Certain symptoms of senility are the result of a gradual diminution of the blood supply to the brain. When the blood supply to a particular part of the brain or spinal cord is shut off, the resulting symptoms are directly related to the malfunction of this part. This is the usual background of a "stroke" in which a vessel becomes obstructed.<br /><br />F. Tumors. Tumors of the brain and spinal cord are classed as "benign" if they do not tend to grow rapidly and invade the surrounding tissue, or "malignant" if they do grow rapidly and invade the surrounding tissues, thus eventually causing death. Tumors involving the brain or spinal cord are usually considered more serious than those involving other parts of the body because surgical treatment is more difficult. Brain surgeons have become very skillful, however, in gaining access to most parts of the nervous system. The sooner a tumor of the brain or spinal cord can be treated, the more favorable will be the outcome.<br /><br /><br />Common Symptoms Produced by Nervous Disorders<br />Symptoms of nervous disorders differ in an important respect from symptoms of diseases involving primarily other parts of the body, mainly in that they arise from interference along the nerve pathways.<br /><br /><br />By comparing the human nervous system with a modern communications network, this peculiarity of nerve disorder symptoms can be understood, the symptoms being caused by a "break in the lines," an interruption of the nerve fibers responsible for some particular activity of the body. That is, if the nerve fibers that control a group of muscles are severed, these muscles will be paralyzed even though they may be at a great distance from the actual site of the injury. Also, if some of the fibers which normally bring sensations from a certain part of the body to the brain are severed, the particular sensations carried by these fibers can no longer reach the brain and thus loss of feeling in that particular part of the body will result.<br /><br />The important symptoms of nervous disorders are more directly related to the particular part of the nervous system affected than to the specific cause of the disorder. Although a few areas of the brain can be affected without producing specific symptoms, most areas, when involved by disease or other impairment of function, cause interference in the control of muscles, in reception of sensations, or in coordination of speech.<br /><br />The common symptoms which occur in connection with nervous disorders are listed as follows:<br />A. Abnormalities of Movement (of Muscle Action) . One of the functions of the nervous system is to control the activities of the muscles throughout the body. When those parts of the brain and spinal cord concerned with muscle activity become diseased or when the nerve connections between the central nervous system and the muscles are affected, the action of the muscles will be correspondingly altered and the particular type of these alterations will give a clue to the nature of the disease.<br /><br />1. Weakness. Weakness consists of a reduced ability to use muscles in the normal manner.<br /><br />2. Paralysis. Paralysis, in contrast to weakness, involves a total inability of a muscle or muscle group to respond to voluntary commands rather than simply a reduced ability.<br /><br />3. Spasticity (stiffness) . In conditions of health certain mechanisms cause the larger muscles of the body to remain firm, enabling a person to maintain his posture, for example, without his having to give continuous thought to the movements of his body. When the person desires to use these same muscles in some rapid movement, the mechanism which otherwise causes then& to remain firm is automatically canceled out so that they can now move quickly. In certain diseases of the brain and spinal cord this ability to release the muscles from their contracted state is lost so that they remain firm even when the person desires to move them quickly. Spasticity, therefore, is somewhat different from paralysis because the muscles may still retain their power but lack their ability to respond quickly.<br /><br />4. Involuntary (uncontrollable) movements. In certain disorders of the nervous system, such as chorea and athetosis, spontaneous, purposeless movements develop, involving certain muscles or muscle groups.<br /><br />• 5. Gait disturbance. Walking is such a complex function that many types of disturbance of the nervous system may interfere with its normal progress. Gait may be altered by weakness, paralysis, spasticity, lack of coordination, disturbed sense of position, and even by hysteria.<br /><br />6. Tetany. Tetany is a condition in which the muscles become abnormally responsive to stimulation. It occurs in the disease tetanus in conditions where the amount of calcium in the blood drops to low levels (as in hypoparathyroidism), or in conditions of alkalosis as when a person loses acid from the stomach by excessive vomiting or when a nervous person breathes too deeply with consequent loss of carbon dioxide from the body. Tetany also occurs in certain nervous disorders in which cells within the brain become abnormally responsive to the ordinary stimuli.<br /><br />B. Disturbances of Speech and Swallowing. Both of these functions require a high degree of integration of muscle action. Disturbances of speech are particularly significant because they may indicate difficulty not only in the control of the muscles by the brain but in the intellectual processes..<br /><br />C. Convulsions. A convulsion usually consists of the abrupt occurrence of violent involuntary contractions of the muscles, often accompanied by loss of consciousness.<br /><br />D. Disturbances of General Sensations. By general sensations we refer to those that come from the skin, the membranes, and the muscles (pain, temperature, touch, position) as opposed to those which come from the organs of special sense (vision, hearing, equilibrium, taste, and smell).<br />When a given sensation is lost, such as of pain, temperature, or touch, we speak of "anesthesia," or else we speak of a loss of position sense. Oftentimes this loss of sensation is limited to some particular part of the body and the physician interprets from this clue what part of the nervous system is affected. If irritation of the sensory nerve fibers causes abnormal sensations, such as the feeling of "pins and needles," we then speak of "paresthesia." If a normal sensory experience is exaggerated, we speak of "hyperesthesia.<br /><br />E. Headache. Headache is perhaps mankind's most common symptom, occurring in many disorders of the nervous system. Its many causes and its possible involvements with other bodily ailments are summarized in the chapter of Volume 3 entitled "List of Signs and Symptoms" under Headache.<br /><br />F. Dizziness. Dizziness is a very uncomfortable symptom in which the individual receives a false sense of motion. There are several possible causes of this symptom, some being more mysterious than others.<br /><br />G. Impairment of Vision. Impairment or loss of vision should be taken seriously, and a physician who specializes in diseases of the eyes or of the nervous system should be consulted for an evaluation. Not all impairments of vision relate to the eyes themselves, for the difficulty may be in the pathways of nerve fibers that pass between the eyes and the brain or even in the tissues of the brain cortex. Oftentimes defects of vision follow a significant pattern; for example, a restriction in the right side of what is seen by the right eye and in the left side of what is seen by the left eye (bitemporal hemianopsia). A person may not notice such a pattern of sight loss unless he checks the vision of each eye separately.<br /><br />H. Unconsciousness. The term "consciousness" is difficult to define, though the difference between the conscious and the unconscious state is easy enough to recognize. Perhaps the closest we can come to a definition of consciousness is to describe it as the normal functioning of a person's mental faculties to the extent that he is aware of his present circumstances and alert to happenings around him.<br /><br />Consciousness, in its broad sense, requires the normal functioning of the whole brain. Whatever interferes with a certain function of the brain interferes, to this extent, with the full experience of consciousness. Placed in the order of increasing impairment of consciousness, we may mention such terms as dullness, lethargy, stupor, and coma.<br /><br />A decrease in awareness of one's surroundings does not necessarily indicate a serious nervous disorder. It may only mean a temporary deficit in the blood supply to the brain, such as occurs in fainting, or the presence of toxins produced by germs causing some generalized disease.<br /><br />However, it may indicate a concussion or pressure produced by a tumor. Impairments of consciousness must therefore be evaluated by a physician. Hallucinations are false sensory experiences, the individual concerned seeming to hear, see, or smell something when, actually, his eyes, ears, or olfactory organs are not being stimulated in a manner to produce these sensations.<br /><br />Since some hallucinations are the result of abnormal stimulation of the brain areas where these sensations are ordinarily perceived, their occurrence justifies a study of the case by a physician or a specialist in nervous diseases.<br /><br />Delusions are false beliefs to which an individual adheres in spite of evidence to the contrary. A person with delusions may confuse his identity with that of another, or he may draw conclusions that are false with respect to the information in hand. Delusions are more typical of mental disorders than of nervous disorders, but they may occur in either.<br /><br />Consideration of the Individual Nervous Disorders<br />ABSCESS OF THE BRAIN.<br />An abscess of the brain is a localized infectious process with destruction of tissue. It is usually caused by the staphylococcus germ or sometimes by the streptococcus or the pneumococcus.<br /><br />The infection may be introduced at the time of a fracture or a penetrating wound of the skull or may spread from some neighboring area such as from an infection of the inner ear or an infection of the mastoid cells of the skull. In other cases, the infection originates in the lungs or the heart and is brought to the brain by way of the bloodstream.<br /><br />Some symptoms of brain abscess are generalized, relating more directly to the infectious process. These include chills, fever, loss of appetite, and a general feeling of illness. Other symptoms are caused by the irritation of the covering membranes (the meninges) and, possibly, of the brain cortex. These include stiffness of the neck and convulsions.<br /><br />Still other symptoms are caused by the disruption or compression of certain nerve fibers as the abscess enlarges.<br />Abscess of the brain is always a serious condition and carries a mortality rate of up to 50 percent even with the best of care. It deserves prompt and adequate professional care. The treatment requires attention to the infection involved and to the need for surgical drainage of the fluid-filled abscess cavity.<br /><br />AMYOTROPHIC LATERAL SCLEROSIS.<br />This is a rather rare, progressive disease which affects men more commonly than women and typically occurs above age forty. There is a degeneration of the nerve cells and fibers which supply the muscles of the body, with more and more cells and fibers being involved as the disease progresses. The average length of life after onset may be expected to be about three years.<br /><br />Weakness and atrophy of muscles are the characteristic manifestations.<br />The number of muscles thus involved gradually increases and various parts of the body may be affected, the most serious development being interference with breathing, swallowing, and chewing.<br /><br />In spite of extensive studies, the cause of this disease is not yet known, nor has a satisfactory remedy been found. The patient should be encouraged to avoid fatigue but remain as active as possible. Annual death rate in the United States from this disease is about one per 100,000 population.<br /><br />ATAXIA.<br />A. Cerebellar Ataxia. This is a manifestation of disease of the cerebellum that part of the brain located in the back part of the skull. Disease of the cerebellum from any cause may produce the main symptom of ataxia, failure of muscle coordination.<br /><br />There is no loss of muscle power as in paralysis but rather a series of back-and-forth groping movements when any precise action is undertaken. Writing and speaking are seriously handicapped. The development of ataxia indicates the need for professional care by a specialist in nervous disorders.<br /><br />B. Friedreieh's Ataxia. This is an hereditary disease, dominant in some families and recessive in others, which usually begins in childhood or youth and is characterized by unsteadiness and tremor. In addition to the lack of coordination of muscle movements, there is a paralysis of certain muscles and a lateral curvature of the spinal column.<br /><br />No specific treatment is known. The disease progresses slowly, with death occurring, usually, at about the age of twenty.<br /><br />BELL'S PALSY.<br />CEREBELLAR ATAXIA.<br /><br />CEREBRAL PALSY (LITTLE'S DISEASE).<br />This condition is characterized by weakness of certain muscles (more commonly in the legs) coupled with spasticity (stiffness) and with awkward, jerking movements. The extent of the involvement and the severity of the manifestations will vary a great deal from case to case.<br /><br />There may be convulsions, impaired speech, and a degree of mental deficiency; but in many cases mentality remains quite normal. Some patients may be unjustly assumed to be mentally deficient because of their awkwardness and difficult speech.<br /><br />The cause of cerebral palsy is not always clear. Either localized or diffuse damage to the brain which may have occurred prior to the time of birth or during the birth process, may cause it. Other possibilities include an inadequate supply of oxygen to the brain, mechanical injury, developmental defect, intrauterine encephalitis, and brain damage caused by some toxic agent.<br /><br />Sometimes the infant appears to be handicapped from the time of birth with vomiting, irritability, and difficulty in nursing. In many cases the manifestations of the disease are noted first when the child is about six months old, the evidences being a delay in the ability to sit up, crawl, and stand.<br /><br />Many children with this affliction are capable of living relatively normal Iives. The handling of a case centers around speech training, muscle reeducation, the wearing of braces, special tutoring in school, and vocational guidance.<br /><br />CERVICAL RIB.<br />A small percentage of persons develop an extra rib on one or both sides, just above the usual first rib. This extra rib is in the lower part of the neck. Resulting symptoms, when they occur, are caused by a squeezing of nerves and blood vessels leading to the arm and lying between the extra rib and the scalenus anterior muscle.<br /><br />The symptoms are made worse when the arm is used for weight carrying or when it is raised for long periods above the head as in hanging up clothes or in washing walls. Usually the patient experiences no difficulty until adulthood. The symptoms consist of pain, tingling, numbness, and coolness in the forearm and hand, often on the side of the little finger. The muscles of the hand in this same area may atrophy.<br /><br />This combination of symptoms is typical of several circumstances which cause damage to the roots of those nerves which supply the arm. Sometimes the symptoms occur when there is no extra rib, being caused only by the pressure produced by a large scalenus anterior muscle.<br /><br />When the condition is not severe, the symptoms can be relieved by the avoidance of lifting with the involved arm and by care in supporting it by a pillow during sleep. For an overweight person, reducing often helps. In more severe cases, treatment requires surgery and involves the loosening of the attachment of the scalenus anterior muscle so that it no longer compresses the neighboring structures.<br /><br />CHOREA.<br />Two principal diseases carry this name, As will be seen from the descriptions which follow, they differ greatly except that they present the common feature of purposeless, jerking, involuntary movements.<br />A. Huntington's Chorea. This hereditary disease is characterized by purposeless, jerking, involuntary movements and by progressive mental deterioration.<br /><br />Symptoms usually appear about age thirty or forty. The purposeless movements and the mental deterioration usually appear concurrently, but in some cases one group of symptoms precedes the other. The purposeless movements consist of grimacing, lurching, and an unsteady, waltzing gait characteristic of drunkenness. As the disease progresses, the muscles become progressively weaker.<br /><br />The mental symptoms vary from case to case, some patients being very cheerful and others suspicious, spiteful, and destructive. The intellectual faculties gradually deteriorate until the patient must be cared for in an institution. The disease usually progresses to death in about ten to fifteen years.<br /><br />Many of the nerve cells throughout the brain and spinal cord show evidences of deterioration. The specific nature of the disease is not understood, but inasmuch as it runs in families as a dominant characteristic, it is advised that persons born into such families deliberately abstain from parenthood so as not to pass this disease on to their children.<br /><br />B. Sydenham's Chorea (Saint Vitus's Dance). Sydenham's chorea is a disorder of childhood characterized by rapid, involuntary, jerking movements which are irregular and purposeless. It occurs more commonly in females and is most frequently manifest between the ages of five and fifteen.<br /><br />As the illness begins, there is a clumsiness and a tendency to drop things. Presently the purposeless, involuntary movements begin and involve almost all muscles except those of the eyes. Purposeful movements can usually be executed but are performed in a jerky fashion. Coordination is poor, and a certain degree of weakness may develop. Chewing and swallowing may become difficult. Recovery usually occurs in six to ten weeks. In about one third of the cases, the illness recurs at some later time.<br /><br />Although the exact cause of Sydenham's chorea is not known, a relationship to rheumatic fever and priorstreptococcal infections seems probable. About half of all young patients with rheumatic fever develop chorea; and about three fourths of all chorea cases develop in persons who have had or are having rheumatic fever.<br /><br />There is no specific treatment for Sydenham's chorea, but rheumatic fever should be looked for and treated when present. It is advised that a child ill with this disease should be kept quiet at home or in a hospital. Sedation may be necessary. As much attention should be given to his peace of mind as to his physical comfort. Certain procedures of hydrotherapy such as warm baths, fomentations, and continuous flowing baths may be helpful.<br /><br />CONCUSSION.<br /><br />CONVULSIVE DISORDERS.<br />The cause of convulsions is not fully understood, but they are associated with a functional disturbance of the cortex of the brain such as can be demonstrated by the electroencephalogram (tracing of brain waves) . Children are more prone to convulsions than adults and may outgrow the tendency. In some instances, however, convulsions begin in later life.<br /><br />A major ("grand mal") convulsion consists typically of the abrupt occurrence of violent, involuntary contractions of the body muscles, usually accompanied by loss of consciousness. The attack is often of short duration, but may recur.<br /><br />Recurring convulsions are commonly called epilepsy. The duration and severity of the attacks may vary from case to case. In susceptible children, diseases with high fever or ordinary breath holding (such as during a tantrum) may bring on convulsions. Convulsions may occur in persons with low blood sugar or low blood calcium.<br /><br />They may occur when the blood's reaction becomes more alkaline than normal as in continued deep breathing, persistent vomiting with loss of acid from the body, or the taking of too much alkali by mouth. They may occur when a confirmed alcoholic suddenly stops drinking or when a person addicted to barbiturates suddenly discontinues the drug.<br /><br />Conditions that reduce the blood in certain parts of the brain or otherwise irritate it may cause convulsions: brain tumors, cerebral infections, brain injury, or diseases of the blood vessels within the brain.<br /><br />Convulsions may occur in eclampsia, a serious complication of the latter period of pregnancy. They may also occur in cases of tetanus (lockjaw) .<br /><br />The occurrence of convulsions, especially in an adult who has not been known to have convulsions previously, should be considered a clue to some underlying disease. Therefore the services of a physician should be secured promptly. It will then be the physician's responsibility to discover the nature of the underlying condition and arrange suitable treatment. In the meantime, the patient should receive appropriate first-aid care.<br /><br />DISK, HERNIATED.<br />ENCEPHALITIS.<br /><br />In the present connection, it is important to notice that certain nervous manifestations tend to appear after apparent recovery from the acute disease.<br /><br />Among patients who recover from epidemic encephalitis some later develop residual nervous disorders which are often grouped under the term "chronic encephalitis." Some develop, after ten or more years, a form of parkinsonism.<br /><br />Others develop disorders of the personality, including irritability and asocial types of behavior. Narcolepsy develops in some cases. Some develop various abnormal movements of the muscles such as tics, grimaces, or tremors. Occasionally an oculogyric crisis occurs (uncontrollable turning of the eyes upward), which renders the patient helpless until it subsides, spontaneously or after rest.<br /><br />EPILEPSY.<br />FACIAL PARALYSIS (BELL'S PALSY).<br />In facial paralysis the patient loses function of the muscles of facial expression on one side of the face. These muscles are supplied by the facial nerve. Although the basic cause often is not known, the paralysis results from a malfunction of this nerve.<br /><br />It is impossible for the patient to close the eye or wrinkle the forehead on the affected side of the face. The mouth droops on the involved side and is drawn to the opposite side when the person smiles.<br /><br />Facial paralysis often causes undue alarm because of its being confused with the same type of paralysis in a stroke. However, in a stroke the weakness is mainly in the lower part of the face with little or no involvement of the muscles about the eye and forehead.<br /><br />In favorable cases, improvement begins within two weeks. In a few cases recovery may take several months, and in rare cases, the paralysis may be permanent.<br /><br />What to Do<br />There is no specific remedy for facial paralysis, although some medicines prescribed by the doctor may hasten recovery. During the course of the illness it is important to protect the eye on the affected side, which does not close securely, so that its membranes do not become injured and infected.<br /><br />A mild antiseptic solution designed for use in the eye should be dropped into the space behind the eyelids at least twice a day. It is also desirable to support the muscles on the affected side of the face during the time they are paralyzed so that the facial tissues do not become stretched by sagging. This can be accomplished very satisfactorily by elevating the cheek with two or three strips of scotch tape, which can also be used to hold the eye closed during sleep.<br /><br />FAMILIAL PERIODIC PARALYSIS.<br />FRIEDREICH'S ATAXIA.<br /><br />HEAD INJURIES.<br /><br />The more common types of head injury are listed as follows:<br /><br />A. Skull Fracture. Usually the actual fracture of the skull is not serious in itself although concurrent injury to the brain may be. Skull fracture may be complicated, however, by bleeding which, if it occurs inside the skull, can cause damaging pressure against the brain.<br /><br />Also when a fragment of the skull is depressed, the surgeon must relieve the pressure against the underlying brain tissue by elevating that portion of the bone which has been displaced. A compound skull fracture may permit the entrance of infection into the tissues of the brain. In some extensive skull fractures, the cerebrospinal fluid, which is watery in appearance, may escape from the nose or from one or both of the ears.<br /><br />B. Concussion. In concussion there has been sufficient shock to the brain to produce a lapse of consciousness. The severity is roughly measured by the duration of the unconscious period. Often it is associated with a loss of memory for events just preceding the head injury (retroactive amnesia) . In minor head injuries the period of unconsciousness seldom lasts more than a few minutes. In major injuries, the unconsciousness may last for several hours or possibly even several days.<br /><br />C. Cerebral Contusion and Laceration. In severe head injuries the surface of the brain may become bruised and torn. As a result there may be hemorrhage into the brain substance or into the space around the brain, and generally there is swelling of the brain tissue. In severe injuries with these complications surgical intervention may be necessary in order to control the hemorrhage or to relieve the increased pressure within the skull.<br /><br />D. Hemorrhage. Hemorrhage into the brain substance often occurs in connection with a severe injury in which the brain is damaged. Frequently bleeding into the brain tissue occurs in many locations throughout the area of the injury without any single large accumulation of blood.<br />In many cases of head injury, associated either with skull fracture or with tearing of the membranes which surround the brain, bleeding will occur and an accumulation of blood will develop either between the skull and these membranes or between the membranes and the brain. Oftentimes such an accumulation of blood develops slowly.<br /><br />As time passes and the blood clot degenerates, it absorbs fluid and swells. The swelling produces such pressure against the brain as may endanger the patient's life. This critical complication of hemorrhage inside the<br />skull may develop several hours or even several weeks after the original head injury.<br /><br />The only satisfactory remedy is to remove the blood clot through a surgical opening.<br />It is important that the person who has suffered a severe head injury be observed carefully during his period of recovery. In case there is a secondary lapse of consciousness, impaired speech, or dragging or weakness of a limb, this should be reported promptly to the physician, for once the pressure produced by a blood clot becomes great enough to interfere with consciousness, the relief of the pressure must be accomplished quickly if the patient's life is to be saved.<br /><br />E. Damage to the Cranial Nerves. In some cases of skull fracture, particularly those involving the base of the skull, there may be damage to certain of the cranial nerves at the site where they leave the skull. The nerve most commonly damaged is the olfactory nerve, which conveys impulses for the sense of smell. Other nerves, such as the optic nerve or the auditory nerve, may also be damaged.<br /><br />Aftereffects tereffects of Head Injuries. In many cases of head injury certain symptoms follow which are collectively called the "postconcussion syndrome." This group of symptoms, which may persist for some time after a head injury, includes headache, dizziness, difficulty in concentrating, and certain alterations in the personality.<br /><br />The severity of the symptoms may not correlate with the severity of the injury. In favorable cases in which the individual receives adequate medical care, the symptoms gradually disappear. In other less fortunate cases the symptoms interfere with the patient's return to normal life, causing prolonged disability.<br /><br />Another possible complication of severe head injury is the later development of recurring convulsions. These are presumably caused by the irritation of the brain by scar formation. Such convulsions are usually treated by the use of anticonvulsant drugs. In an occasional case, surgery is indicated.<br /><br />HERPES ZOSTER.<br />The disease is self-limited, usually terminating after several days. In the meantime, the treatment consists essentially of relieving the intense pain by appropriate medication and of preventing secondary infection of the skin lesions. Occasionally, in elderly individuals, the pain persists even after the lesions have healed (postherpetic neuralgia) .<br /><br />HUNTINGTON'S CHOREA.<br />HYDROCEPHALUS.<br />Hydrocephalus is a condition in which the head enlarges because of an excessive amount of cerebrospinal fluid. Cerebrospinal fluid is a watery fluid most of which is produced within the internal spaces of the brain (ventricles).<br /><br />It circulates slowly throughout the brain spaces and the space between the exterior of the brain and the membranes which enclose it and the spinal cord. Normally the cerebrospinal fluid is absorbed at the same rate it is produced; but in hydrocephalus, there is either an overproduction of cerebrospinal fluid, a reduction of absorption of the same, or a blocking of its normal flow.<br /><br />Thus the amount of fluid gradually increases, producing pressure within the skull.<br />Many cases of hydrocephalus are congenital. In such a case the infant's head becomes enlarged and portions of the brain atrophy because of the increased pressure. Usually, the enlargement of the infant's head is not noticeable until several weeks or months after birth. If the condition is not successfully treated, death may be expected within months or a few years.<br /><br />By certain surgical procedures the excess cerebrospinal fluid can be drained away through an implanted plastic tube which empties into a vein, a body cavity, or the heart itself. The opinion of a neurosurgeon should be obtained regarding the advisability of such treatment.<br /><br />LITTLE'S DISEASE.<br />MENIERE'S SYNDROME.<br />This very troublesome form of illness is characterized by attacks of extreme dizziness along with nausea and vomiting. The patient may complain of continuous ringing in the ear and progressive deafness. In most cases only one ear is affected at first, but later both may become involved.<br />Meniere's syndrome occurs in middle life. The group of symptoms are probably caused by an increase of fluid within the semicircular canals and the inner ear. The basic cause of this development is not known, although it has been observed that this syndrome occurs in persons who experience considerable emotional stress.<br /><br />The individual attack lasts from a few minutes to several hours.<br />There is no completely satisfactory treatment for Meniere's syndrome. A person with this difficulty is advised to consult a specialist in either nervous diseases or diseases of the ear. In extreme cases, surgical destruction of the semicircular canals and middle ear on one side is used as a last resort to obtain relief from symptoms.<br /><br />MENINGITIS, ACUTE.<br />MENINGITIS, TUBERCULOUS.<br />Meningitis caused by a tuberculous infection is perhaps the most common type of this disease, except during epidemics of meningococcal meningitis. Tuberculous meningitis develops secondarily to a tuberculous infection in some other part of the body usually the lungs. And it may develop in a patient totally unaware of any such infection.<br /><br />The disease occurs most frequently in children between one and five years of age, but it may occur at any age. The onset of the infection of the meninges (the coverings of the brain) is usually gradual with symptoms of irritability, drowsiness, headache, loss of appetite, vomiting, and a mild fever. The drowsiness may progress to stupor, and convulsions may develop. Certain of the cranial nerves may be affected with resulting difficulties in vision or hearing. Without treatment, tuberculous meningitis usually leads to death within about three months.<br /><br />The patient should be under the care of a physician well informed on the intensive treatments of tuberculosis. Most important is specific drug therapy, but the patient's general nutritional needs must be met adequately, even to the extent of using artificial feedings as may be indicated. Treatment must be continued for weeks.<br /><br />MENINGITIS CAUSED BY FUNGOUS INFECTIONS.<br />Several kinds of fungous infections may involve the meninges. Examples of fungous infections which may cause meningitis are actinomycosis, cryptococcosis, candidiasis, cocidioidomycosis, blastomycosis, and histoplasmosis.<br /><br />The symptoms are often those of a subacute meningitis. In other cases the onset of symptoms is sudden, and the disease progresses rapidly to a fatal outcome. The symptoms are headache, dizziness, vomiting, and, usually, stiffness of the neck.<br /><br />Effective drugs are available for the treatment of most of these infections, but before beginning treatment the physician must identify the fungus which is causing the infection. This requires hospitalization and extensive laboratory procedures.<br /><br />MONGOLISM.<br />Mongolism is a serious congenital condition characterized by mental retardation (intelligence quotient between 20 and 50), stunted growth, small skull, coarse and scanty hair, flat face, depressed bridge of the nose, short and thick hands and feet, and a laxity of the ligaments. Mongolism occurs about once in 600 births and accounts for nearly 10 percent of feeblemindedness.<br /><br />Mongolism is usually associated with a defect in the chromosomes which is designated as "trisomy 21." By this it is meant that the chromosomes designated as "pair 21" produce three individual chromosomes rather than the usual two, giving a total of forty-seven chromosomes in each cell of the body rather than the normal forty-six.<br /><br />Because of the congenital nature of mongolism, it is understandable that no cure for it exists. The problem of caring for a child with this abnormality centers around training him to do as much as it is possible for him to doand sheltering him from life's competitions. Some cases are best cared for by relatives, whereas others would fare better if placed in an institution.<br /><br />MULTIPLE SCLEROSIS.<br />This slowly progressive disease involves various parts of the central nervous system and presents numerous symptoms which tend to come and go only to return again in greater severity. The symptoms usually begin between ages twenty and forty, men and women being affected about equally.<br /><br />In some cases the progression of the disease is so slow that the patient lives out a normal life-span and dies of some other cause. In other cases the disease progresses to a fatal outcome in five to ten years. Early in the course of the disease the patient will appear to be perfectly normal during the periods of remission.<br /><br />At the time of writing, a tremendous amount of research is being carried forward in the hope of discovering the basic cause of multiple sclerosis, though as yet no definite cause has been established. The lesions of multiple sclerosis which interrupt the nerve pathways are characterized by a loss of the usual insulating material (myelin) which covers the nerve fibers.<br /><br />The symptoms vary a great deal from case to case and from time to time in the same case. The mental symptoms include lack of judgment, inattention, and, frequently, unwarranted optimism, but occasionally depression. There is often a reduced emotional control. In some cases there are convulsions; in some, abnormal or reduced sensations; and in others, paralysis in certain parts of the body. Some patients have difficulty in finding the right words.<br /><br />In many cases there are episodes of double vision or partial blindness. Scanning speech is a common symptom as are also tremors and lack of coordination.<br /><br />What to Do<br />As yet no cure is known for multiple sclerosis. Effort should be made, therefore, to help the patient live as nearly a normal life as possible, consistent with his physical and mental condition. He should use moderation in all he does and avoid fatigue. Physical therapy measures are useful in preventing deformities of those parts of the body that may be weakened or paralyzed.<br />MUSCULAR ATROPHY.<br /><br />Another name for this disease is "familial progressive spinal muscular atrophy of childhood" a rare disease with many characteristics of a recessive hereditary disorder. In some family lines, however, it is transmitted as an incomplete dominant trait.<br /><br />The onset of symptoms is usually within the first year of life. Although the child is mentally alert and able to smile and recognize his family members, he does not learn to sit up and stand as a normal child does. He has poor control of his head and there is difficulty in swallowing.<br /><br />Eventually he develops difficulty in breathing. Inability to contract the muscles becomes progressively worse, and death usually occurs in about five years.<br /><br />For purposes of comparison with other diseases it should be mentioned that the difficulty here is in the nervous control of the muscles, not in the muscle tissue itself. There appears to be a reduction in the number of nerve cells which normally activate the muscles and also a loss of the insulating laver (myelin) on the nerve fibers that serve the muscles. There is no satisfactory treatment for this disease. Physical therapy procedures may be of some help.<br /><br />MUSCULAR DYSTROPHY.<br />This is an inherited disease characterized by a progressive degeneration of muscle fibers with resulting weakness. It is to be differentiated from muscular atrophy because, in this disease, the primary difficulty is with the muscle tissue rather than with the nerves which control the muscle.<br />The usual age of onset for muscular dystrophy is during childhood or youth. Occasionally it appears later.<br /><br />It is usually the muscles in the shoulders, arms, and thighs that are affected first, with involvement of the smaller muscles of the hands and feet coming later. As the muscles become weaker, there is a tendency for the back to become swayed and the arms and legs to assume abnormal positions. Occasionally the disease becomes arrested spontaneously and the patient gets no worse.<br /><br />There is no suitable treatment. The aim in caring for a patient should be prolong the period of time during which he can move about and engage in routine activities. The use of appropriate braces and of surgical procedures to correct the deformities may help to keep the patient active.<br /><br />MYASTHENIA GRAVIS.<br />Myasthenia gravis is a rare disease characterized by the development of muscular weakness which fluctuates from time to time and which especially affects the muscles about the eyes and face. The muscles of swallowing and those of the limbs are also affected in most cases.<br /><br />The disease may begin at any age but most commonly in the second and third decades, beginning earlier in women than in men. The muscles fatigue quickly on use, the first few excursions being quite normal but the muscle power fading with continued use.<br /><br />Some cases progress rapidly to a fatal termination, with death being caused by failure of the respiratory muscles. In others, the patient lives on for years.<br /><br />The immediate cause of myasthenia gravis is an alteration in the chemical activity at the junction between the nerve fibers and the muscle fibers. Patients with this disease respond miraculously for short periods following the administration of one of the cholinergic drugs.<br /><br />The use of such a drug does not cure the disease nor even retard its progress, but it does make life temporarily more acceptable to the sufferer. Such drugs must be taken under the supervision of a physician, for there is danger of overdose with resulting severe weakness and other complications. Tumors of the thymus gland are frequently associated with this condition.<br /><br />MYOTONIA.<br />In myotonia, of which there are several types, there is difficulty in relaxing the muscles after they have once contracted. Repeated use of the same muscles seems to "warm them up" so that their function becomes virtually normal. Many cases of this unique disorder seem to have an hereditary background. Some forms of myotonia appear early in life, others later. In some cases the difficulty is aggravated by prolonged rest, by exposure to low temperatures, and by emotional excitement.<br /><br />There is no satisfactory treatment for myotonia, but in many cases the disease does not shorten life. Many victims of the disease learn to live quite normally in spite of their handicap.<br /><br />NARCOLEPSY.<br />Narcolepsy is a syndrome (group of symptoms) characterized by (1) the tendency to fall asleep spontaneously, even during the daytime and in spite of adequate sleep at night, and (2) the sudden occurrence of muscle weakness so severe that the patient falls even though he does not lose consciousness.<br /><br />This is called cataplexy and usually comes in response to some surprisingemotional experience such as mirth, anger, or fear. The symptoms develop most commonly during the second decade of life. Narcolepsy is relatively uncommon, but it occurs four times as frequently in men as in women.<br /><br />It does not interfere with the usual life-span except as it introduces an element of hazard because of the tendency to go to sleep even while otherwise occupied as while driving a car. Treatment consists of the carefully supervised use of drugs which tend to keep the individual awake.<br /><br />NEURALGIA.<br />Neuralgia is generally considered to be a symptom rather than a disease. It consists of a series of attacks of acute pain in the area supplied by some particular nerve, usually one of the cranial nerves located in the face or neck region. In neuralgia, in contrast to neuritis, no demonstrable change occurs in the structure of the nerve involved.<br /><br />Formerly, certain painful conditions such as sciatica were placed under the heading of neuralgia. Now it is recognized that sciatica is usually caused by a compression of one or more nerve roots by the herniation of an intervertebral disk. The usual examples of true neuralgia are trigeminal neuralgia, glossopharyngeal neuralgia, and causalgia.<br /><br />A. Trigeminal Neuralgia (Tic Douloureux) . The trigeminal nerve is the sensory nerve to the face and consists of three branches, one supplying the skin of the forehead and eye, one supplying the skin of the side of the face between the eye and the mouth, and the third supplying the skin of the side of the jaw and the lower lip. One or more of these branches may be involved in trigeminal neuralgia.<br /><br />Trigeminal neuralgia may occur at any time in adult life but usually begins about age fifty. It is somewhat more common in women than in men.<br />The pain is a lightning-like stab which occurs in paroxysms and usually lasts one or two minutes. In the early stages it may not recur for days. As the disease advances, the intervals between paroxysms become shorter.<br /><br />The pain of trigeminal neuralgia is usually so intense that the patient writhes in agony. In most cases there is some activity of the face that seems to trigger the attack—touching or washing of the face, exposure to cold, talking, eating, or drinking.<br /><br />Trigeminal neuralgia usually persists regardless of medical treatment. The use of narcotic painkilling drugs should be avoided because of the great danger of addiction. The injection of alcohol into the involved nerve may cause temporary cessation of the pain for eighteen months, more or less.<br /><br />Surgical procedures for destroying the sensory portion of this nerve have been more permanently successful in many cases. It is advised that the patient with trigeminal neuralgia consult a specialist in neurology or neurosurgery.<br /><br />B. Glossopharyngeal Neuralgia. In this type of neuralgia there are paroxysms of pain which involve one side of the throat, the tonsil, the back of the tongue, and the middle ear. The symptom usually makes its first appearance after age forty and, strangely, affects males more commonly than females. The attack is often brought on by chewing, swallowing, talking, or yawning. The attack of pain is brief, lasting only a few minutes but being so severe that the patient sometimes faints.<br /><br />The use of drugs in the treatment of glossopharyngeal neuralgia is seldom completely satisfactory. Indiscriminate use of narcotics leads to addiction. Surgical treatment by severing or removing the involved nerve offers the best prospect of relief.<br /><br />C. Causalgia. Causalgia, though nota typical example of neuralgia, is included here because of the element of excruciating pain. This symptom follows injury to a nerve such as the median nerve in the arm or the sciatic nerve in the hip, thigh, or leg. The pain, a persistent burning pain, is easily aggravated by almost any stimulus such as exposure of the involved area to the air, a sudden noise, some startling experience, or mere emotional excitation.<br /><br />It is believed that injury to the sympathetic nerve fibers contained in the injured nerve is responsible for this unusual symptom. In some cases relief has been obtained by surgical severing of the sympathetic nerve fibers which supply this part of the body. A person with causalgia should consult a specialist in neurology.<br /><br />NEURITIS.<br />Neuritis is a condition in which degenerative changes occur in one or more nerves as a result of mechanical damage to the nerve, metabolic disturbance, or toxic insult.` When a single nerve is involved, we speak of mononeuritis; when many nerves are involved, we speak of polyneuritis.<br /><br />Because most of the body's nerves contain several kinds of fibers, the symptoms appearing in neuritis correspond to the various types of nerve fibers injured. In the usual case there will be symptoms resulting from damage to the sensory fibers. These include various kinds of discomfort, described as stabbing pains, burning sensations, sensations of tingling, the feeling of "pins and needles," and numbness.<br /><br />Involvement of the motor fibers in a nerve produces weakness of the muscles which may progress to complete paralysis with eventual atrophy of the muscles. Involvement of the autonomic nerve fibers may produce an increase in skin temperature in the involved area, sweating, and skin lesions. In other cases there may be paleness and dryness of the skin. The various types of neuritis are now discussed.<br /><br />A. Mechanical Damage to the Nerve. This may occur in connection with penetrating injuries, crushing injuries, or fractures of bones in which nerves are damaged. It may be caused by long-continued pressure against a nerve, as when an intoxicated person sleeps in a chair with his arm over the back.<br /><br />B. Metabolic Disturbance of the Nerve Tissue. In this condition the damage is usually to many nerves, and therefore we speak of polyneuritis. It occurs in any condition or disease in which there is not a sufficient amount of thiamine (vitamin B1) in the diet.<br /><br />This kind of polyneuritis develops in such diseases as beriberi and pellagra, and in alcoholism. The chronic alcoholic derives much of his energy from the calories contained in the alcohol and thus does not eat sufficient food to provide the required nutritional elements, including thiamine. Other metabolic diseases, such as diabetes, may also cause polyneuritis.<br /><br />C. Toxic Insults to the Nerves. Here we include the toxic conditions that come from diseases such as diphtheria, in which neuritis may develop because the toxin from the germs damages certain nerves. Also, there are many chemicals and heavy metals which injure nerve tissue. These include alcohol, carbon tetrachloride, and benzine among the chemicals, and lead, arsenic, mercury, and bismuth among the heavy metals. Persons exposed to these substances in excess are prone to develop symptoms of polyneuritis.<br /><br />Treatment of neuritis consists of discovering and removing the cause of the damage to the nerves. Once the cause is removed, recovery may be prompt in mild cases. In severe cases, however, in which damage to thenerves has been inflicted over a long period, the normal function of the nerve may never be completely restored. A good diet and high intake of vitamins may hasten recovery.<br /><br />PALSY.<br />PARALYSIS AGITANS.<br />PARALYSIS, FAMILIAL PERIODIC.<br /><br />Familial periodic paralysis is a rare hereditary disease characterized by recurring attacks of profound weakness of the muscles of the trunk, and extremities. Usually the muscles of breathing and those of the face remain normal.<br /><br />The individual attack lasts somewhere between two and twenty-four hours. Attacks may occur every day or as infrequently as once a year. The disease usually begins during the first or second decade of life, persists for a few years, and then improves over the next few years, with attacks becoming less frequent and less severe.<br /><br />Interestingly, attacks usually occur after a period of rest or after a meal consisting largely of carbohydrate food. Oftentimes a person will suffer an attack upon awakening in the morning. In most cases attacks are associated with a reduction in the concentration of potassium in the blood serum.<br /><br />Usually persons with this disease live out an average life-span, but occasionally death occurs because of involvement of the muscles of breathing.<br /><br />In most cases the attack of paralysis can be relieved by the administration by mouth of potassium chloride. This is not advisable for all cases, however, because in some reduction in the concentration of potassium in the blood serum is not the problem.<br /><br />Noting this diversity, some scientists believe that the fundamental difficulty is in the body's metabolism of sodium rather than in the handling of potassium. In fact, when the amount of sodium in the diet is reduced appreciably, attacks of paralysis do not occur. The handling of a case of familial periodic paralysis should be under the direction of a physician.<br /><br />PARESIS (GENERAL PARESIS).<br />PARKINSONISM (PARALYSIS AGITANS).<br />Parkinsonism is a chronic, progressive disorder, usually occurring in middle-aged or elderly persons, which is characterized by slowness of movement, rigidity of the muscles, involuntary tremor, and progressive weakness.<br /><br />The usual case of parkinsonism begins gradually and is without known cause. The rate of progress of the disease will vary from case to case. Usually the patient becomes gradually incapacitated over a period of several years. Parkinsonism occurring earlier in life may be a sequel to encephalitis or to some circumstance in which the cells of the brain were deprived of their supply of oxygen for at least five to ten minutes and were thus permanently damaged. Such a circumstance may develop in connection with carbon monoxide poisoning, asphyxia, or head injury.<br /><br />The victim of parkinsonism presents a characteristic appearance. The muscles of his face become immobile so that he appears to stare and seems unable to register his emotions. In advanced cases, saliva often drools from the corners of the mouth.<br /><br />The patient leans forward as he walks, moves with short steps, and may break into a run as though he were trying to keep from falling forward. Typically his arms are flexed at the elbows and he carries his hands near his abdomen. There may be tremors in various parts of his body,but the most characteristic one involves a repetitive movement by which the tips of the fingers brush past the ball of his thumb—the so-called "pill-rolling movement." The tremors are worse when the patient is tired or when he becomes excited.<br /><br />Although weakness of the muscles develops gradually in parkinsonism, there is a rigidity which interferes with rapid movement of any part of the body. Speech becomes hampered both in volume of sound and in clarity of enunciation. Intellectual capacity is retained quite well until the terminal phase of the disorder.<br /><br />Inasmuch as there is no satisfactory treatment for parkinsonism, the care of a patient with this disorder centers around keeping him active as long as possible, maintaining his morale by cheerful surroundings, and using such drugs as may minimize his tremors and reduce the rigidity of his muscles. Various surgical procedures have been tried which aim to destroy those parts of the brain in which the tremors and the spasticity are activated.<br /><br />It must b. realized, however, that the fundamental cause of parkinsonism is a deterioration of certain cells within the brain. Further destruction of brain areas by surgery only serves to control some of the symptoms without altering the ultimate progress of the disease.<br /><br />PHENYLKETONURIA.<br />Phenylketonuria is one of several hereditary metabolic diseases, perhaps the best known of the group. The disease, striking about one child in every 25,000, is caused by the lack of an enzyme necessary to the proper synthesis of tyrosine (one of the essential amino acids). As a result of this metabolic defect, phenylalanine (a precursor of tyrosine) accumulates in the body's tissues and fluids and the excess is eliminated by way of the urine.<br /><br />From the standpoint of our present consideration of nervous disorders, the importance of phenylketonuria is that children with this disease display mental deficiency of varying degrees and, in about half the cases, display awkward gait, tremors, and continuous purposeless movements of the hands. Epileptic seizures occur in about one fourth of the cases.<br /><br />The mental deficiency of phenylketonuria develops gradually, beginning soon after birth. If the infant so afflicted is placed on a special diet soon after birth—a diet which contains only a minimum of phenylalanine—he may not develop mental deficiency or the other neurological manifestations.<br /><br />Of course, it is not easy to determine in the case of a young infant whether or not he is becoming mentally retarded and is possibly afflicted with phenylketonuria. The only way to be sure is to make tests of the blood or urine. Some states require that these blood or urine examinations be carried out on all newborn infants as a means of detecting the occasional one whd would benefit by treatment for phenylketonuria and thus be spared the tragedy of becoming mentally deficient. The special diet must be adapted by the physician to the needs of the individual.<br /><br />POLIOMYELITIS.<br />POLYNEURITIS.<br />POSTEROLATERAL SCLEROSIS (COMBINED SYSTEM DISEASE).<br /><br />Posterolateral sclerosis is a serious involvement of the nervous system associated with pernicious anemia or other macrocytic anemias. In other words, the deficiency of vitamin B12, the cause of pernicious anemia, has its effect on the tissues of the nervous system, causing a degeneration of parts ofthe spinal cord. Tie egeneration interferes with the normal transmission of certain nervous impulses.<br /><br />Oftentimes it is the symptoms of posterolateral sclerosis that first call the physician's attention to the possibility of pernicious anemia in a given case. The first symptoms usually consist of tingling and numbness in the skin of the toes and soles of the feet.<br /><br />Soon the same sensations develop in the fingers. If the disease still goes unrecognized and untreated, these sensations spread to the feet and legs and, possibly, to the thighs and lower parts of the body. The tingling and numbness of the fingers usually spreads to include the hands but seldom does it involve the upper arms.<br /><br />Next is noticed an unsteadiness and stiffness in gait, which may be accompanied by weakness of the muscles of the legs. The patient tends to stumble, especially when walking in the dark. As the weakness progresses, the knees may give way unexpectedly. The hands become clumsy.<br /><br />In severe cases there is an involvement of the brain with certain psychic symptoms including loss of recent memory, ideas of persecution, and even stupor and coma. Commonly, vision is impaired with a developing blindness at the center of the visual field.<br /><br />In untreated cases of pernicious anemia, the symptoms of posterolateral sclerosis become progressively worse. When treatment is begun early, at least by the time unsteadiness in gait is first noticed, there is a good prospect that the symptoms will disappear and, if treatment is continued consistently for the remainder of life, that the victim of this disease can live out a normal life-span. If treatment is long delayed, however, the damage to the tissues of the spinal cord becomes so serious that normal conditions can probably never be reestablished. Even in such cases, however, treatment may bring about a significant improvement.<br /><br />Since posterolateral sclerosis is part of pernicious anemia, the treatment is one and the same. It consists of the administration, by intramuscular injection, of vitamin B12. A case of pernicious anemia with posterolateral sclerosis should, of course, remain under the continuing supervision of a physician.<br /><br />RABIES.<br />RIB.<br />SAINT VITUS'S DANCE.<br />SCLEROSIS.<br /><br />SCIATICA.<br /><br />Sciatica is a term used to describe pain in the distribution of the sciatic nerve. This nerve derives its fibers from the spinal cord in the lower part of the back and passes through the buttock and thigh into the leg. The usual cause of sciatic pain is pressure produced by a herniated intervertebral disk.<br />SHINGLES.<br /><br />SPINA BIFIDA.<br />Spina bifida is a malformation of the vertebral column which, in the more serious cases, involves the spinal cord.<br /><br />It usually occurs in the lower part of the back and affects about three vertebrae. It is commonly associated with other congenital defects such as clubfoot or hydrocephalus. In the least severe cases there are no symptoms relating to the nervous system; the only clue to such a defect may be a dimple in the skin at the site of the deformity, a discoloration of the overlying skin, or a tuft of hair in this area. The deformity of the vertebrae can be discerned, of course, by X-ray examination.<br /><br />In the moderately severe cases in which certain of the nerve roots are involved, the infant may show a tardiness in learning to walk or may have a clumsy gait. In the very severe cases there may be a wasting and weakness of the muscles of the legs and feet in addition to some diminution of the skin sensations in the areas of the buttocks and adjacent portions of the thighs.<br /><br />In these more severe cases there is usually a protrusion of the membranes that normally cover the spinal cord, the protrusion appearing in the midline at the lower part of the back. 'his protruding sac of soft tissue may in some cases include portions of the large nerve roots.<br />In these cases an opening may be eroded in this protruding soft tissue through which cerebrospinal fluid may escape. There is then grave danger, of course, of an infection of the meninges with resulting meningitis.<br /><br />The immediate treatment for ` spina bifida is reparative surgery. However, surgery will not restore functions of the nervous system already deficient. Furthermore, hydrocephalus sometimes develops as a complication after surgery.<br /><br />The care of the patient includes a carefully planned program of rehabilitation aimed to make it possible for the child, as he grows up, to live a reasonably normal life.<br /><br />SPINAL INJURIES.<br />By the term spinal injuries we refer to those accidents that damage the vertebral column and may, at the same time, injure the spinal cord or some of the spinal nerves. The reason some spinal injuries affect the spinal cord or the spinal nerves is that a very close anatomical relationship exists between the vertebral column and its related supporting structures and the spinal cord with its emerging spinal nerves.<br /><br />The vertebral column consists essentially of the bodies of the vertebrae plus their bony processes which extend to the sides and backward from the vertebral bodies. These bony processes form a complete series of arches behind the vertebral bodies. It is within the spinal canal formed by these arches that the delicate spinal cord ( a downward continuation from the brain) is located.<br /><br />The spinal nerves originate from the spinal cord and then pass outward on the right and on the left between the bony processes.<br /><br />The greatest danger to the spinal cord occurs when the vertebrae are crushed or sharply bent on one another so that they pinch or crush the spinal cord, or when one vertebra is displaced in its relation to its neighbor so that the spinal cord is sheared. The spinal nerves which emerge between the bony processes of the vertebrae may be compressed or damaged by injuries which bring pressure against them. There are four principal types of spinal injuries as indicated in the following descriptions:<br /><br />A. Herniated Intervertebral Disks. The intervertebral disks are composed of fibrocartilage and dense connective tissue and are interposed between .the vertebral bodies to provide for cushioning and also to permit a certain amount of flexibility. Each of these intervertebral disks is composed of a softer central part, the nucleus pulposus, and a surrounding ring of densetissue designated as the anulus fibrosus.<br /><br />Injuries to the intervertebral disks constitute the most common type of spinal injury. When a disk is injured, the nucleus pulposus often herniates through the damaged part of the anulus fibrosus and brings pressure against an adjacent nerve root, causing discomfort and some loss of function.<br /><br />Herniation of an intervertebral disk occurs most commonly in the lumbar region of the lower back. The second most common site is in the lower part of the neck. The usual cause of damage to a disk in the lumbar region is lifting while in a stooping or twisted position. At the time of this first injury the patient will usually suffer pain for a few days, experiencing a "catch in the back" or a "crick in the neck." The discomfort is caused by torn ligaments or strained muscles. It may be some time later, possibly after several incidents of discomfort, that the nucleus pulposus at the center of the intervertebral disk actually squeezes out and brings pressure against the adjacent nerve root, causing the typical pain that radiates throughout the course of the nerve thus compressed.<br /><br />The discomfort associated with a herniated disk located in the lower back usually consists of severe aching pain in the buttock and the back and side of the thigh and leg. Often numbness and tingling is felt in the same area. The pain is often aggravated by coughing or sneezing or by straining at stool. It may be made worse by twisting, stooping, or lifting.<br /><br />Certain muscles in the thigh, leg, or foot may become weak. There may or may not be pain in the lower part of the back. When the damaged intervertebral disk is in the lower part of the neck, the pain involves the shoulder, the arm, the forearm, and the hand, the latter either on the thumb side or on the little finger side. Again there will be numbness and tingling in these areas with a weakness of certain muscles particularly the triceps muscle in the back of the arm.<br /><br />Treatment for cases of herniated intervertebral disk falls into two categories: conservative and surgical. Conservative treatment consists of bed rest for several days or a few weeks in order to eliminate the mechanical pressure which has caused the intervertebral disk to collapse and bulge.<br /><br />In cases where the damaged disk is in the lower back, the patient's bed should be very firm so as to keep the structures of the vertebral column in the most favorable position. A relatively unyielding mattress should be used, and this should be laid on plywood or other firm foundation.<br />For cases in which the injury is in the neck, it is often advisable to provide traction.<br /><br />This is arranged by attaching a weight by a rope that runs over a pulley at the head of the bed so as to exert a continuous pull on a closely fitting head harness. As the patient improves, he may be allowed out of bed during the daytime provided he wears a supporting collar. The traction is usually continued at night for a longer time.<br /><br />Surgical treatment for herniated intervertebral disk involves removing the nucleus pulposus pressing against the nerve root and, in some cases, inserting a bone graft to stabilize the cerebral column at the site of difficulty.<br /><br />B. Sprains. A sprain of the vertebral column involves a stretching of the spinal ligaments which hold the vertebrae in place. Inasmuch as the cervical portion (in the neck) of the vertebral column is most flexible, this is the part most commonly sprained. It is this type of injury, occurring in the neck, that is called "whiplash." It occurs as a result of direct violence or of excessive muscle pull as when the head is suddenly thrown backward in an automobile accident.<br />In a sprain, the vertebrae are usually not displaced; therefore seldom does a sprain injure the spinal cord.<br /><br />Symptoms consist of pain on moving the neck, of local tenderness, and of stiffness.<br />Occasionally a person who has sustained this type of sprain becomes self-centered in his desire for sympathy or compensation. This attitude tends to prolong the symptoms even beyond the time required for the tissues to heal. Most physicians therefore advise these patients to return to their normal way of life within a reasonable period of time, encouraging them to ignore their continuing symptoms.<br /><br />C. Dislocations. In a dislocation of the vertebral column an actual displacement of one vertebra in its relation to another takes place. Dislocations are often associated with fractures, torn ligaments, and injuries to the intervertebral disks. Because of the displacement, there is great danger of injury to the spinal cord.<br /><br />Dislocations may be caused by diving into shallow water or by falling on the head, shoulder, or even in a standing-up position. A heavy blow such as causes the vertebral column to bend sharply in any direction may cause a dislocation. Symptoms consist of local pain, tenderness, and a deformity of the bony structures such as can be observed by X ray or by careful digital examination.<br /><br />In any case of dislocation of the vertebrae, great care must be taken in handling the patient lest damage be done to the spinal cord. Even a slight movement of the patient's body might cause the displaced vertebra to compress the spinal cord, with resulting permanent damage.<br />Immediate care of the case requires the same precautions as when the back is broken. If the patient must be transported, great care should be taken to avoid body or neck movement.<br /><br /><br />Usual hospital treatment for such a patient includes traction of the head so that if the parts of the vertebral column which are injured shift their position, they will do so in the direction of their normal position rather than in a direction that might press on the spinal cord.<br /><br />D. Fractures. Fractures of the vertebrae are somewhat more common in the middle and lower back. Sometimes they consist merely of the compression of a vertebral body without its being displaced. As mentioned above under dislocations, fractures may well be associated with damage to the intervertebral disk or to the Iigaments that normally hold the vertebral bodies in place. Fractures are usually the result of a fall or a direct blow on the back or of the intense pressures produced by convulsive muscle action as in a convulsion.<br /><br />If there is no displacement of the bony structures so as to endanger the spinal cord or the nerve roots, fractures are not as serious to the patient's total welfare as are dislocations. Symptoms of a fracture consist of local pain, tenderness, and muscle spasm. Treatment consists, usually, of the use of casts and braces to support the patient's back during the period of healing. For instruction on the first-aid handling of persons with fractures of the vertebral column.<br /><br />STROKE.<br />A stroke, commonly called apoplectic stroke or a stroke of paralysis, is caused by severe damage to some part of the brain resulting from an interruption of the blood supply to this part. The exact symptoms in a particular case are determined by the specific part of the brain that has been damaged. The paralysis that commonly occurs in connection with a stroke.<br /><br />Not all strokes are the result of something that happens to the blood vessels inside the skull. Sometimes an obstruction to the flow of blood develops in the vessels of the neck. Thus the brain is deprived of its usual blood supply just as effectively as when the mishap occurs inside the skull.<br /><br />Usually certain warning signs indicate that the brain is not receiving a sufficient amount of blood. There may be "transient strokes" in which the symptoms last only a few minutes. It can then be determined by an X-ray study of the vessels (arteriography) whether the difficulty is caused by a narrowing of the vessels in the neck. If so, the lumens of these vessels may be enlarged by a surgical procedure (endarterectomy) .<br /><br />SYDENHAM'S CHOREA.<br />SYPHILIS OF THE NERVOUS SYSTEM.<br />Syphilis is produced by a spiral-shaped germ, the Treponema pallidum. It is classed as one of the social diseases and is usually transmitted by sexual contact. it affects many organs and tissues of the body. In the present chapter we are concerned with its involvement of the nervous system.<br /><br />Antibiotic drugs have brought about a marvelous improvement in the treatment of syphilis. When adequately used early in the course of the disease, they will prevent most of the serious complications from developing.<br /><br />Syphilis could doubtless be stamped out within a few months or years if all who have the disease, throughout the world, would submit to adequate treatment. The facts that syphilis is transmitted by sexual contacts, however, and that syphilis patients are reticent to admit their social indiscretions, make it difficult for physicians and health agencies to conduct a successful campaign against the disease.<br /><br />Involvement of the nervous system is one of the later manifestations of syphilis, occurring typically in the so-called third stage of the disease. The germs of syphilis seem to remain quiescent in the tissues of the nervous system for many months or even several years after they have entered these tissues. Then, for some unknown reason, they begin to produce damage so disastrous that even intensive treatment may not restore the patient completely to his previous condition.<br /><br />A person .need not remain in uncertainty as to whether he needs treatment for a syphilitic infection. Blood tests for syphilis are now available at any doctor's office, at any venereal-disease clinic, and at any public-health headquarters. More than this, it is possible, by drawing a sample of the cerebrospinal fluid, to determine whether or not the germs of syphilis have entered the nervous system. If they have, the need for intensive treatment adapted to this complication is most urgent even though no symptoms of the involvement of the brain or spinal cord have yet appeared.<br /><br />Syphilis affects the brain and spinal cord in several ways. It may produce a unique type of meningitis or it may involve, primarily, the blood vessels of these organs. It may produce degenerative changes which seriously affect the intellect or cause a destruction of certain of the nerve pathways. In the present consideration we will discuss only the two most important manifestations of syphilis of the nervous system: (A) general paresis and (B) tabes dorsalis.<br /><br />A. General Paresis of the Insane.<br />This is a serious late complication of syphilis, typically developing several years after the individual's first syphilitic infection. It is serious because it destroys the intellect and progressively limits the victim's usual activities, bringing death, on the average, about three years after the first appearance of symptoms. Fortunately, general paresis of the insane is seldom seen now because most cases of syphilis receive adequate treatment in their earlier stages.<br /><br />The general symptoms of this disorder include headache, ataxia (unsteadiness of gait and station), slurred speech, tremor of the fingers and tongue, and mental deterioration.<br />Personality-wise there is a progressive impairment of the individual's efficiency both in family life and in business. He begins to use poor judgment and is prone to make serious mistakes such as unnecessarily incurring debt or spending money for things not needed.<br /><br />There is a progressive failure in memory and a tendency to tell untruths. The individual becomes disoriented so that he no longer knows the time of day or the day of the week or month and is confused as to his whereabouts and the identity of himself and those he contacts. This leads to a dreamlike state. A person with this condition commonly has delusions, imagining himself to be somebody great. The emotions of joy and sorrow may alternate suddenly and without adequate justification. There is a rapid deterioration of moral and ethical standards. As the disease continues, the victim becomes apathetic and finally completely demented.<br /><br /><br />Intensive treatment with antibiotic drugs may at least partially arrest the progress of general paresis; but, inasmuch as the disease involves a degeneration of nerve cells and nerve fibers, treatment cannot always be expected to restore the individual to his normal state. Because of such reasons it is urged that any syphilitic infection be treated intensively early in its course.<br />B. Tabes Dorsalis (Locomotor Ataxia) .<br /><br />In this manifestation of syphilis it is primarily the spinal cord and the nerve roots that are affected. Fortunately this disease is much less common now than it was before adequate treatment for syphilis became available. Tabes dorsalis tends to develop from five to twenty years after the primary syphilitic infection.<br /><br />In the usual case, the first symptom is an aching pain in the legs, often confused with rheumatism. The pain becomes progressively worse until it is described as knifelike. These pains come in bouts, usually occurring at least once during each twenty-four hours, the severity usually being more intense at night than during the day. In some cases the patient receives the impression of a tight girdle about his abdomen.<br /><br />In others agonizing pains (so-called tabetic crises) develop in certain organs of the body. These excruciating pains occur most commonly in relation to the stomach. They may last for several days, the pain being either continuous or intermittent. Any attempt to drink or eat causes vomiting. The pain may disappear as suddenly as it begins, only to recur at a later time.<br />Various neuralgias, involving nerves here and there throughout the body, may develop as a part of tabes dorsalis.<br /><br />There may be numbness and a feeling of coldness in various skin areas. Often the patient reports a sensation as though he were "walking on air." Certain areas of the skin may beless sensitive than normal, approaching a complete loss of sensation. The sense of position suffers greatly in most cases so that the individual becomes unaware of the position of his feet or legs except as he watches these and observes their movement and position.<br /><br />With walking thus made difficult, the victim typically uses a cane and watches each step he takes. When he stands, he stands with his feet wide apart so as to brace himself because of his unsteadiness. There is often a loss of tone in the muscles of his extremities so that they move in a flail-like manner. His strength and energy become progressively poor.<br /><br />In well-established tabes dorsalis as well as in general paresis of the insane, the deteriorated nerve fibers cannot be restored even by intensive treatment. Once the damage has been done, repair is impossible. Again it should be emphasized that any syphilitic infection should be treated intensively as soon as possible after the infection has been acquired.<br /><br />SYRINGOMYELIA.<br />This is an unusual disease in which a cavity develops in the central portion of the spinal cord causing a progressive destruction of the adjacent nerve fibers. The cause of the disease is unknown, but some evidence indicates that it harks back to a congenital fault of development. Exact symptoms depend upon which part of the spinal cord happens to be involved, whether a part up near the head or lower down.<br /><br />The first symptoms often appear between ages ten and thirty. The disease is slowly progressive but may remain stationary for several years. Some patients live as long as forty years after the disease begins.<br /><br />At first the patient notices loss of certain sensations—those for pain and temperature—in the particular part of the body related to the location of the cavity within the spinal cord. The sense of touch remains normal. This loss of sensation for pain and temperature is usually brought to the patient's attention when he observes that he suffers no pain in some particular part of his body, even from a burn.<br />Another early evidence of the disease is progressive weakness and atrophy of certain of the small muscles such as those in the hands.<br /><br />There is no satisfactory treatment for syringomyelia. The patient should be encouraged to remain active as long as feasible. In view of the danger of burns of the skin, now that the natural protective influence of pain and temperature has been lost, appropriate means to prevent injury to the victim should be employed.<br /><br />Reasonable measures should be taken to help the patient retain an attitude of cheerfulness in spite of his handicap. In some cases surgery may provide partial relief of symptoms and may retard the progress of the disease.<br /><br />TABES DORSALIS.<br />TIC DOULOUREUX.<br />TORTICOLLIS.<br />TRAUMA.<br />TRIGEMINAL NEURALGIA.<br /><br />TUMORS.<br />A. Tumors of the Brain. There are various kinds of brain tumors. Some grow slowly, others rapidly. All kinds are hazardous because their increase in size brings pressure against the delicate tissues of the brain. Some invade the brain tissue itself, causing destruction of the nerve cells and fibers as they do so.<br /><br />Others remain Nvith. a brous capsule and inflict damage by the pressure which their growth produces. Those which grow rapidly and invade the nervous tissue are usually the most dangerous and threaten the patient's life within the shortest period of time. Tumors of the brain occur at any time of life but are most common in early adulthood and middle age.<br /><br />Based on the possibility of cure, tumors of the brain may be classed as either benign or malignant. Benign tumors are curable if they can be safely removed by surgery. An example of a benign tumor is the meningioma which develops in the membranes surrounding the brain.<br />Malignant tumors are seldom curable because of their tendency to grow rapidly, to invade the tissues, and to recur after removal.<br /><br />These may be subdivided into primary and secondary tumors. Primary brain tumors originate within the skull. An example of a primary malignant tumor is the astrocytoma-which consists of wild cells that have developed from cells which normally support the nerve cells of the brain. Secondary malignant tumors are those which bud off from a tumor located in some other part of the body such as the breast or the lung. Small portions of such a tumor are carried by the blood to the brain where they become secondarily implanted.<br /><br />Symptoms of tumors of the brain are of two types: (1) those that result from the pressure which the tumor produces, and (2) those caused by the destruction of nerve cells and nerve fibers. A tumor located in one part of the brain will produce a different group of symptoms from one located in some other part, even though the size of the two tumors may be the same.<br />Headache is often the first symptom of a brain tumor.<br /><br />Inasmuch as headache is commonly produced by other causes, this symptom is not diagnostic except as it may persist unnaturally. Unexplained nausea and vomiting are also symptoms which occur commonly in brain tumor. In some cases weakness, awkardness, and/or convulsive seizures develop. In other cases there may be drowsiness, changes in personality, and strange conduct.<br /><br />Treatment for tumors of the brain, always of course under the direction of a neurosurgeon, is either surgical removal or radiation therapy.<br /><br />B. Tumors of the Spinal Cord. These are much less frequent than tumors of the brain, but are classified in about the same manner. Symptoms depend upon the particular groups of nerve fibers or of nerve cells destroyed or compressed as the tumor grows.<br /><br />There may be weakness of certain muscles, also changes in the sensations relating to certain parts of the skin area—either abnormal sensations or the loss of sensation. Early surgical removal of a tumor of the spinal cord usually offers the best possibility of a favorable result. Even then the outcome will depend upon how much tissue of the spinal cord has already been destroyed. In selected cases of tumor of the spinal cord, radiation therapy is preferable to surgery.<br /><br />WRYNECK.<br />The first portion of this chapter was concerned with disorders in which organs of the nervous system are affected to the extent that the patient's general health is impaired or certain of his normal abilities may be diminished or destroyed.<br /><br />In this final portion of the chapter, devoted to mental disorders, we are dealing with abnormalities of the personality usually not based on disease as such but on the individual's unfavorable adjustment to life. We are concerned now with psychological problems rather than neurological problems. Physicians who specialize in such disorders are spoken of as psychiatrists.<br /><br />Psychoneuroses<br /><br />In the psychoneuroses the affected individual reacts in an abnormal manner to certain conflicting circumstances in his life but still retains his mental capacities to the extent that he is able to think normally and, for the most part, to exercise . normal judgment.<br /><br />The person with a psychoneurosis often realizes that his reactions under some circumstances are different from those of other people. The psychoneuroses are not forms of insanity but, rather, personality disorders in which the behavior, the patterns of thinking, and the emotional responses are abnormal.<br /><br />The several classic types of the psycho-neuroses will now be described, followed at the end with a paragraph on treatment.<br /><br />THE ANXIETY REACTION.<br />In this type of emotional illness there are attacks of an unsettled state of mind characterized by apprehension, nervous tension, physical and mental fatigue, and panic. Attacks occurring at night may be associated with nightmares. The attack is often accompanied by physical symptoms of vomiting, diarrhea, and urinary urgency.<br /><br />There is an overpowering dread of some imminent disaster. The attack may vary in duration from a few minutes to longer periods. Usually the problem dates back in the individual's history to some intolerable thwarting experience.<br /><br />THE DISSOCIATIVE REACTION.<br />This is similar to the anxiety reaction except that it is more intense. In this instance, the individual actually loses control of certain of his mental functions so that he experiences extreme stupor or loses his memory or conducts himself automatically without being aware of his actions or resorts to aimless running.<br /><br />THE CONVERSION REACTION (HYSTERIA).<br />In the conversion reaction the individual subconsciously converts energy pent up as a result of intense anxiety or frustration into some abnormal form of behavior or into some form of supposed illness.<br /><br />The conversion reaction is a great imitator of many symptoms of disease, such as paralysis, anesthesia, blindness, or loss of consciousness. Oftentimes the physician's skill is taxed to tell the difference between the conversion reaction and actual disease. Typically, the nature of the conversion is such as to excuse the individual from facing up to some unpleasant reality of life.<br /><br />THE PHOBIC REACTION (PHOBIAS).<br />In the phobic reaction, the individual manifests an unreasonable, unjustified anxiety regarding some particular situation. Consciously he recognizes that no actual danger is involved, but he finds himself unable to control his intense fear, even so.<br /><br />Phobias may be directed toward high places, closed spaces, elevators, dirt, the danger ofcontamination, cancer, or certain animals. Phobias represent a carry-over of some unresolved conflict. It is assumed that the phobia becomes symbolic of this conflict to the extent that the individual puts the true conflict out of consciousness by focusing on the phobia.<br /><br />THE DEPRESSIVE REACTION.<br />In this type of psychoneurosis the individual becomes downcast, pessimistic, unhappy. He feels that he is personally inadequate. He lacks energy and becomes disinterested in most of the activities about him. The depressive reaction may be accompanied by certain symptoms relating to the body's functions, such as loss of appetite, constipation, headache, and sleeplessness. The condition is often associated with anxiety.<br /><br />The attitude of discouragement may become so profound that the individual may secretly contemplate suicide and may even make an attempt in this direction. Proper precautions should be taken so that the patient with a depressive reaction is not left alone.<br /><br />THE OBSESSIVE-COMPULSIVE REACTION.<br />An obsession consists of an almost uncontrollable urge to follow the same line of thought over and over. Often the thought is unwelcome but, try as he may, the individual finds it nearly impossible to banish it from his thinking.<br /><br />A compulsion consists of an unreasonable urge to perform some act even though the act is entirely unnecessary and may even be foolish in nature. A person may become obsessed with the thought that he is carrying a germ which could infect other members of his family and even cause their death.<br /><br />As a result he may develop the compulsion to wash his hands frequently, particularly at certain times such as before eating, after shaking hands, or at fifteen-minute intervals. A person may develop the obsession that he is changing in appearance, and this may prompt the compulsion that Forces him to look in the mirror repeatedly for evidences of such change.<br /><br />A person with an obsession may be constantly troubled by obscene thoughts which are out of harmony with his standards of conduct. A religious per-;on may be obsessed by doubts re-larding the foundation of his beliefs. A person may develop the compulsion hat he must remove his clothes in a certain routine.<br /><br />This may become so troublesome that if anything interferes with the routine, he will have to put its clothes on again and start the routine all over. A person with a compulsion may feel that he is forced to ouch all power poles as he passes hem on the sidewalk.<br />The obsessive-compulsive reaction is supposed to be a subconscious form of penance associated with guilt and self-condemnation.<br /><br />The individual who develops these obsessions and compulsions is not consciously aware of the background of his reactions. Treatment of the Psycho neuroses. Frequently the person with a psycho-neurosis will benefit by a series of conversations with a psychiatrist intended to help him recognize the relationship between his present symptoms and the unsolved problems which lie at their foundation.<br /><br />The patterns of thinking and acting are usually so firmly established that a mere explanation of the cause of the symptoms will not enable the individual to overcome them. The patient has to have time to reorient his thinking to the extent of accepting the facts of his unfavorable circumstances and planning ways of being realistic rather than hiding behind excuses or dodging the real issues.<br /><br />Psychotic Disorders<br />The psychotic disorders include several forms of mental derangement any one of which constitutes "insanity" in the usual meaning of the word. When a person becomes ill with a psychosis, he loses control of his thinking and acting to the extent that his behavior no longer is in harmony with accepted standards nor consistent with the realities of his situation in life.<br /><br />Efforts to persuade him that his thinking is confused or that his actions are not acceptable do not change his abnormal patterns. The person with a psychosis is no longer able to carry his share of responsibility in the family or in the community. He may be irrational and irresponsible and, for his own good, may have to be required to comply with regulations that others consider best rather than being allowed to follow his own dictates.<br /><br />Fundamental causes of the psychoses are still debated. Most psychiatrists feel that an hereditary factor sometimes makes one person less able than others to adjust successfully to life's demands and that such an individual's personality may disintegrate under stresses in life that require greater adjustments than the patient is capable of making. Others, however, believe that the psychoses are caused by some yet undiscovered abnormality of the chemical processes that occur within the nerve cells of the brain.<br /><br />In some instances persons with a psychotic disorder become difficult to manage.<br />THE AFFECTIVE PSYCHOSIS (MANIC-DEPRESSIVE PSYCHOSIS).<br />This form of psychosis is characterized by an exaggerated mood rather than by the inability to think. The affective psychosis tends to occur in attacks, between which the individual is reasonably normal.<br /><br />The disturbances of mood may be in either direction, that of mania and elation or that of depression and melancholy. In one attack, mania may predominate; in another, depression. In some patients, the mood in each attack shifts toward mania; in others, toward depression. In still other cases, there may be a shift from mania to depression or vice versa in the same attack.<br /><br />The first attack of affective psychosis typically occurs in young adulthood. It is assumed that heredity plays an important role in setting the stage for the development of this illness. Without adequate treatment, the typical attack of affective psychosis may last about a year. With modern methods of treatment, the time is usually shortened to about three months.<br /><br />In the manic phase of the illness, the patient is very much excited. There are tireless over activity and feelings of elation. The patient may be mischievous, to the extent of tearing his clothing, disarranging his room, and engaging in mild vandalism.<br /><br />Commonly he sings and shouts and even displays occasional delusions of grandeur. He may become easily annoyed with those who try to restrain or control him. He talks a great deal but not on sensible topics.<br /><br />In the depressed phase the patient is downhearted and fearful and experiences feelings of inadequacy. He sleeps poorly, and all physical activity is accomplished with great effort. He may develop delusions by which he believes that others are plotting to harm him. There may be attempts at suicide. In extreme cases a state of stupor develops.<br /><br />Treatment of the affective psychosis consists of three parts: placing the patient in suitable surroundings, using shock therapy or drugs to hasten recovery from the attack, and influencing him by kind conversation to look forward to recovery and resumption of his usual activities. There is no essential loss of mentality in the affective psychosis, and the patient is influenced by his surroundings and conversation to a greater extent than he appears to be. He may even understand quite well that he is ill. Most cases respond favorably to kind treatment.<br /><br />SCHIZOPHRENIA (DEMENTIA PRAECOX).<br />Schizophrenia is the most serious one of the group of mental disorders. Although recovery occurs in some cases in response to modern methods of treatment, many cases become chronic and progressively incapacitating.<br /><br />The usual chronic nature of the illness can be emphasized by noting that less than 20 percent of the first admissions to public mental hospitals are for schizophrenia whereas about 60 percent of all who remain permanently in these hospitals are victims of this disease.<br />In schizophrenia the patient loses his ability to distinguish clearly between fantasy and reality. Both his ability to think and his emotional responses become confused.<br /><br />It is generally assumed that some particular hereditary predisposition makes certain people susceptible to a breakdown of personality structure once they are subjected to difficult situations. There are persons who live perfectly normal lives who have traits of personality that resemble, in mild degree, the victim of schizophrenia.<br /><br />Presumably such persons would become ill with this type of mental disorder should they become seriously distressed because of problems in their environment for which they could not find adequate solutions. The fact that some people respond more favorably than others to treatment suggests that the hereditary predisposition is more pronounced in some individuals than in others.<br /><br />Schizophrenia may develop at any age, but it seldom appears in childhood or after age fifty. The disease often begins insidiously. As the victim begins to withdraw from reality, he appears to others to be preoccupied. His conversations may assume an odd pattern, but the individual experiences no concern even when this is brought to his attention.<br /><br />As the disease progresses, delusions, hallucinations, and odd mannerisms develop. In his delusions, the patient with schizophrenia often hears persons saying unkind things about him. He seems to live in a world apart and spends time staring at himself in themirror or smiling or laughing to himself. His emotional responses are often inappropriate.<br /><br />Treatment for schizophrenia has been modified a great deal in recent years. The use of drugs particularly adapted for psychotic disorders has now largely replaced the previous use of shock therapy. The use of psychotherapy and maintenance of a friendly, understanding attitude by workers in the hospital where the schizophrenic is placed contribute greatly to the success of the drug therapy. Although many cases do not recover completely, a large proportion respond well enough to be able to live relatively normal lives outside the hospital.<br /><br />PARANOIA.<br />Paranoia is not a clear-cut disease independent of those just described. It is a type of response seen in persons who may have schizophrenia or who may have affective psychosis. It is characterized by delusions in which the individual attempts to bolster his self-esteem by assuming that people are plotting against him. He craves recognition; but, having failed to obtain the acclaim he desires, he develops false explanations which indicate that he has failed in life only because of the plottings and jealousies of others.<br /><br />Paranoia may have its roots in childhood because of experiences that deprived the individual of the degree of social acceptance which most children receive. In these early stages, disappointment in life could have been overcome had the individual become successful in his chosen enterprises. Success in these would have brought about the recognition he desired. In persons who have found life to be disappointing, however, it is easy for the early childhood experiences of sullenness and hatred to become exaggerated to the extent that a psychosis develops.<br /><br />The delusions of paranoia often lead the patient to imagine himself as being some great person a king or queen. The paranoid may become dangerous because of the possibility that he may do bodily harm to those he feels have plotted against him.<br /><br />Many patients will respond favorably, however, to the kindness and sympathy of some person whom they feel they can trust. It is such a person who may be able to bring about improvement in a case of paranoia as he tactfully persuades the patient to accept reasonable interpretations of his circumstances. Successful treatment of paranoia consists more of sympathetic relationships than of any specific therapy.<br /><br />Organic Brain Syndromes<br />Many conditions of poor general health exert an influence on the functioning of the brain and may be responsible for symptoms similar to those produced by genuine psychotic disorders. The fundamental fault is with the systemic disease that has adversely affected the brain and only secondarily with the person's way of thinking or reacting to life's realities.<br /><br />Many forms of illness cause temporary mental confusion which we commonly designate as delirium. Arteriosclerosis, as it affects the vessels of the brain, is frequently the cause of mental confusion and excitement with deterioration of the intellectual capacities. Tumors of the brain, general paresis of the insane (a complication of syphilis), chronic alcoholism, and other toxic conditions may also have such adverse effects.<br /><br />Treatment of the organic brain syndrome obviously consists of removing the cause of the problem if such removal is possible.suehttp://www.blogger.com/profile/00449853505690250818noreply@blogger.com