Ankylosis

Note: The header for this article is listed as "Ankylosis. Anchylosis." in the text.

Stiffness of the Joints.

This is a stiffening of the joints or of some special joint, caused by diseases of the joints, rheumatism, and by keeping a limb fixed in one position. If the stiffness involves the bony union in the joint, nothing can be done to relieve it. If from deposits steaming the part and rubbing over it tincture of lobelia^[1] and then making motion vigorously may break up adhesions. When there is injury near a joint and anchylosis is feared, it is advisable to make proper passive motion frequently. Stiffness of fingers and limbs might thus often be prevented. Serious cases of anchylosis are often overcome by surgical operations.

^[1] I cannot find any evidence that lobeline, the natural alkaloid in lobelia inflata, would have any effect. Lobelia inflata, also known as "Indian tobacco" or "puke weed" is promoted by herbalists for smoking cessation (though is ineffective).

Anasarca

This term is used to designate extensive dropsy of the subcutaneous cellular tissue. See article on Dropsy.

Anaesthesia

Analgesia. Loss of Sensation.

This is a loss of sensation caused by disease of the nerves of sensation, and may therefore occur in any part of the body^[1]. Most commonly anaesthesia of the skin is met with — one half the surface, laterally, may be involved, or the upper or lower part of the body may be affected, or the whole surface. Anæsthesia may be confined to the sense of touch or the sense of pain. In testing for anæsthesia the patient should be blindfolded and various portions of the surface touched with the fingers, pencils, or heated keys or particles of ice. It will often be noticed that only some regions have lost feeling, and thus the exact nerves affected may be traced.

Analgesia is the term used to denote absence of power to realize pain. It may exist even when there is sensitiveness to touch, though usually loss of power to experience touch accompanies it. Blindfolding the patient and then running points of pins in him, or pinching him unawares, will give proof of analgesia. The cause of the difficulty must be ascertained and removed. When due to ''lethargy" of the skin or local causes, baths and friction and stimulating liniments are advisable. Electric baths^[2] are especially beneficial, and the electric brush attached to a battery and used freely over the skin will often accomplish permanent cure. For artificial anaesthesia see section on Remedies and Applications.

^[1] Anaesthesia and analgesia are currently used when discussing 'artificial' or medically induced states, with 'hypoesthesia' and 'hypoalgesia', indicating reduced sensation, now used to describe these somatosensory disorders.
^[2] I suspect the author is referring to what we now call galvanic baths, as opposed to early tanning beds.

Anaemia

Thin Blood. Chlorosis. Green Sickness.

From a great many causes the blood may become impoverished or be altered in character to such an extent as to prevent the proper sustenance of tissues and thus permit degenerate changes to take place. Sometimes the general amount of blood is less than it should be, and again there is a deficiency of albumen in the liquor sanguinis. As a rule the term anæmia is used to designate a deficiency of the red blood corpuscles. The causes of anæmia are numerous; improper diet; too great an amount of starchy foods and too little meats being eaten; deficiency of food; poor surroundings; too little sunlight^[1]; impure air; over study or too great mental exertion with insufficient bodily exercise; too rapid growth; excessive discharges, as in profuse menstruation or chronic abscesses, etc.; all these may bring about anæmia. But there is often anaemia with certain chronic diseases, such as cancer, scrofula, consumption, syphilis, Bright's disease, bleeding piles, etc.; also it may arise from impoverishment of the blood by the use of mercury, arsenic, antimony and other poisons. Men are not as liable to it as women. Girls just after puberty are peculiarly apt to manifest anæmia.^[2]

Symptoms. — Paleness of the face is always present, and general muscular weakness and a loss of energy are complained of, with exhaustion after slight exertion. Cold extremities, fainting, dizziness and palpitation are frequent, the pulse growing weaker and more easily varying as the condition advances. Constipation and headache are almost invariable symptoms. Girls are apt to have a waxy and greenish appearance of the face with the skin extremely soft and loose and the whites of the eyes looking pearly. In long continued cases dropsy may follow and functional derangements of various organs may become manifest; exhaustive diarrhœa may set in, and the peculiarities of appetite may become so great, or the stomach so sensitive that it may be impossible to take sufficient nourishment. Bleeding from the nose is common; and menstruation is interfered with, irregular and deficient in quantity and painful. It is possible for death to occur during a prolonged faint which may happen in severe cases of anæmia.

Treatment. — Rest from compulsory labors, such as business and study, must be obtained. An abundance of fresh air and moderate outdoor exercise should be provided. Going to the sea shore or up in the mountains is beneficial. Sunshine must be admitted freely to the house and must be courted outside. Salt water baths with friction^[3] are of advantage. Nourishing food must be supplied — broths, lean meats, game, eggnog (without alcoholic liquor) and other simple foods should be taken frequently. Care and hygienic measures can be almost entirely depended upon. Medicines may aid. The bowels should be kept open by mild but laxative liver pills. Iron is often praised as a maker of red blood corpuscles, but its reputation is not well founded.^[4] Tartrate of iron and potassa two grains and sulphate of hydrastia one grain, put together in a capsule and taken one hour after each meal, will aid intestinal digestion and thus nourishment will enter into the blood. The Compound Syrup of Mitchella (see formulas) often serves as a good tonic. Of course, if anæmia is the result of cancer, consumption, etc., no medication will avail, Often it is a result, as mentioned, of other troubles which may be overcome, and then the blood with proper care will return to its normal condition.

^[1] Vitamin D, synthesized in the skin with sun exposure, has been linked to red blood cell count in a number of studies.
^[2] Preschool-age children have the highest incidence of anaemia according to the World Health Organization.
^[3] "Friction" here refers to vigorous rubbing with a wet linen cloth.
^[4] Iron supplementation is often prescribed for anemia - iron deficiency is the most common cause of the disease.

Amyloid Disease

Frequently after prolonged suppuration, internal organs undergo a form of degeneration known as amyloid^[1] or lardaceous or waxy, which is liable to occur in phthisis^[2], syphilis and diseases of the kidneys, liver and spleen. It is more fully mentioned in the articles treating of those diseases.

^[1] The grammar here is inconsistent with contemporary use of the word - amyloidosis is the aggregation of amyloids, proteins that have folded and became insoluble.
^[2] Phthisis is more commonly referred to as tuberculosis.

Amimia

This is the loss of all ability to convey thoughts by the employment of gestures and may follow certain injuries or lesions in the brain^[1], the relief of which can alone overcome this peculiar loss of power.

^[1] Amimia appears to be most commonly associated with Parkinson's disease.

Allocheiria

Imperfect Sense of Touch. — This is a rare and peculiar nervous phenomenon in which impressions, such as handling or applications of heat, made upon one side of the body are recognized as though they were made upon the other side. It is caused by sclerosis of the spinal cord or cerebellum, and the treatment for myelitis (chronic inflammation of the spinal cord) is proper to be pursued.

Alexia

Inability to Read. — The loss of all power to read — written words conveying no idea to the patient. The result of lesion in the brain. See Myelitis.

Alcoholism

Acute. Chronic. Inebriety. Delirium Tremens.

The introduction of alcohol into the system always produces unnatural conditions; moderate quantities may cause no immediate appreciable symptoms because vitality may be able to overcome the effects, but in every instance vitality is weakened by the use of alcohol, and sooner or later must succumb in the effort to overcome the effects of the poison. When alcohol enters the circulation it is conveyed to every tissue, doing damage everywhere. It first irritates the nerves, which become depressed; it interferes with the proper oxydation of the blood, prevents normal tissue changes and interferes with nutrition.

Acute Alcoholism. — Persons unused to drinking alcoholic liquors, or those who consider themselves "moderate drinkers," are subject to acute alcoholism^[1], which is commonly known as intoxication. It often presents characteristics of disease which are intense and often dangerous.

Symptoms. — After a period of excitement, drowsiness occurs, more or less profound, and with persons accustomed to drinking recovery soon follows. But with others drowsiness may run into stupor, the extremities become icy cold, breathing is slow and stertorous, and the heart action weak and irregular, the face livid and the lips blue.

Treatment. — An emetic of mustard in warm salt water should be given, or the stomach pump used; then follow by strong coffee, arouse the patient by walking him about, slapping him, or by the application of electricity. Dashing cold water on the head is useful. Follow by small doses of third preparation of lobelia (see formulas), three drops in water; allow quiet after recovery.

Chronic Alcoholism. — Persons who have long been accustomed to the use of alcoholic liquors suffer from this disease in one form or another. All the organs of the body, chiefly the stomach and liver, being affected. Symptoms may be summed up as follows^[2]:

• The stomach is inflamed (gastritis), there is indigestion, disgust for food, nausea and thirst; retching and vomiting in the morning of stringy mucus, often containing blood or shreds of membrane. Ulceration of the stomach is common. Inflammation in the mouth, throat and pharynx is always present.
• The bowels are inflamed and irregular. Stools are very offensive and often contain blood.
• The liver becomes altered in character; the bile may enter the circulation or the organ may become enlarged and undergo fatty degeneration.
• The substance of the kidneys becomes inflamed or profoundly congested.
• The heart becomes weakened and the blood vessels degenerate; hemorrhages in the brain may occur, causing paralysis. The nerves are shattered and will power is lost. Trembling of the limbs and mental disturbances follow. Cowardice, treachery and untruthfulness take possession of the mind and the victim is a physical and mental wreck.
• The outward appearances are familiar to all — bloating, redness of the face and congested veins over the nose and cheeks.

Treatment. — Various combinations of poisonous drugs have been employed to overcome the desire for drink; such as strychnine, atropine, daturine, chloride of gold, etc. These destroy the nervous system and only add to the deplorable condition. The only hope seems to be to confine the victim in some retreat, and there to endeavor gradually to overcome the various disordered conditions of the liver, stomach, bowels, kidneys, etc., and sustain the strength by tonics and most nourishing food.

Delirium Tremens. — This usually occurs after a prolonged spell of drinking in persons already suffering from chronic alcoholism; sometimes it occurs with persons not in the habit of drinking, but who have taken perhaps their first large drink; and again, persons long accustomed to drink and who have been deprived of it may have an attack.

Symptoms. — Premonitory symptoms are usually manifested — sleeplessness, weakness, trembling, fear, bad taste in the mouth, constipation, and bad breath. The attack itself is accompanied by horrible delusions — usually most violent fear of reptiles, devils or other objects about to destroy the victim, who endeavors to escape them. The eyes stare, the body is covered with cold perspiration, the pulse is small and frequent, and violent trembling occurs. These symptoms may last several hours, and be followed by great physical and mental exhaustion.

Treatment. — Perfect quiet must be secured in a room well guarded, for the patient is liable to jump from the window or otherwise endeavor to escape imaginary enemies. For that reason a strong nurse should be present. Arguments are useless, strength alone can conquer. Often it is well to coincide with his ideas and bar the doors and windows and thus encourage the belief that the enemies are without, and he is safe within. Administer a strong infusion of scull-cap and cramp bark^[3] in tablespoonful doses every hour, or by injection every two hours. For the injection half an ounce of each in a pint of starch water is not too much. Give most nourishing food — broths, raw eggs, milk, etc., highly seasoned. Give no narcotic, and above all do not administer liquor to "gradually wean him." Sleep is to be desired, but never by narcotics. The following will be found most excellent to administer in a capsule every three hours for the general exhaustion and heart weakness following delirium tremens: Sulphate of hydrastia, capsicum and salicin, each one grain. Weeks may possibly be required for complete recovery from an attack of delirium tremens.^[4]

^[1] Acute alcoholism is an archaic term, as alcoholism implies dependence. The American Medical Association, for example, defines alcoholism as a chronic disease.
^[2] The list of symptoms remains accurate.
^[3] Scull-cap and cramp bark were both prescribed to treat muscle tension.
^[4] Omitting possible complications resulting from delirium tremens seems strange - the condition had a mortality rate of 35% prior to contemporary intensive care medicine.

Albino

Albinoism. Albinismus.

This is a condition where the coloring material is absent from the various tissues of the body, such as the skin, iris, middle coat of the eye and the hair.

Symptoms. — Partial Albinoism presents a mottled appearance of the skin and is most frequently met among negroes. Persons suffering from general albinoism are termed albinos, and may be of any race.

Their skin will be found very delicate and sensitive and of a peculiar lead white; the iris is pink, and there being no black coating within the eyes the pupil will appear red. The hair is very fine and a pure white or delicate straw color. All these appearances manifest themselves at birth.

Treatment. — So far it has been found impossible to devise any beneficial treatment for albinoism. Its sufferers are regarded as freaks of nature, but that does not imply that they are mentally different from others; only their extreme physical sensibility is apt to prove very annoying to them. They are very sensitive to heat and cold, and are far more liable than others to suffer from disease^[1]. For these reasons parents should take exceptional precautions in guarding albinos and in regulating their diet and clothing.

^[1] Albinism is associated with increased risk of skin cancer and vision defects, but not "disease" in general. Chédiak–Higashi syndrome, which presents with partial albinism, can increase susceptibility to infections.

Ague

Intermittent Fever. Chills and Fever.

Malaria (bad air) is responsible for the great number of cases of ague^[1]. The precise nature of the specific poison which causes ague is not fully known; but it is generally believed to be a vegetable spore^[2], the breathing of which into the lungs causes the poison to enter the circulation and produce disease — the nervous system, the liver and the spleen suffering most. Under the title of Malaria more will be found concerning this specific poison.

Ague proper, or intermittent fever, is a disease which, during its course, manifests itself in paroxysms which occur at regular intervals. The disease is most common in the fall, though when once the poison saturates the system ague may manifest itself at other times.

Symptoms. — Before a paroxysm of ague commences there are usually signs to warn of its approach. These are: A general feeling of lassitude, constipation, loss of appetite and perhaps nausea or sensitiveness of the stomach, a dull headache and dull aching pains in the lower part of the back and possibly in the joints, and a yellow colored fur on the tongue^[3]. These symptoms may last several hours or perhaps several days, and be followed by the paroxysm characteristic of the disease, which may be described as follows:

1. Cold Stage. — A creeping feeling along the back, increasing to decided chilliness, which no amount of heat or clothing overcomes, finally ending in a shaking chill, the teeth chattering, the hands and feet like ice, and the lips and finger tips blue, the face pinched and the whole skin seeming to be shrivelled. Great thirst and headache are present and sometimes nausea and vomiting. Breathing becomes difficult, and the pulse small and rapid and sometimes irregular. Altogether the condition seems to the patient a most deathly one. Its duration varies greatly from ten minutes to four or five hours, when gradually (sometimes suddenly) reaction commences.
2. Hot or Fever Stage. — Usually this starts in with alternate flushing and coldness over various parts of the body, soon developing into intense general fever. The face becomes red and hot and the lips dry and parched; thirst is intense and headache is violent, often causing delirium or convulsions in children; the urine is scanty and the pulse full and strong, the arteries of the neck seeming about to burst. This condition of high fever may last from two to eighteen hours, usually four or six hours.
3. Sweating Stage. — Gradually the skin becomes moist, and, commencing on the forehead, a warm perspiration breaks out and extends over the whole body, becoming very profuse and occasionally possessing a peculiar odor; the urine is passed freely and often has a reddish sediment; all the symptoms of fever subside and the patient usually falls asleep to awaken feeling comparatively well and with a good appetite. With the exception of a general feeling of weakness an intermission (varying in duration in different forms of ague) is enjoyed without any indications of disease.

The length of the intermission designates the class of the paroxysm.

1. Quotidian ague gives a paroxysm every twenty-four hours.
2. Tertian, every forty-eight hours, or every other day (the most common form).
3. Quartan, every seventy- two hours, or every third day.
4. Irregular ague, in which the paroxysms seem to have no definite time of attack.

Treatment. — Ague and quinine or other salts of Peruvian bark^[4] are usually associated in the minds of most people. In households where ague prevails the bottle of quinine will usually be found on the pantry shelf, and sole reliance is placed in from five to thirty grains daily, in small doses, during a "spell of ague." There is no question but that quinine or its equivalent form of Peruvian bark will aid in treatment of ague; but many can not take it, and there are better methods to be adopted. During a first paroxysm little can be done. Always during the cold stage rest and warmth should be provided, and, if the surface is very blue, composition should be given. During the hot stage, hot lemonade with ginger essence or infusion of pleurisy root will hasten the sweating stage of relief. Commencing as soon as the fever is gone tonics should be given in anticipation of another attack. The following will be found a prescription far superior to any salt of Peruvian bark.

Take:

• Fluid Ext. Gentian ... four drachms.
• Fluid Ext. Goldenseal - four drachms.^[5]
• Fluid Ext. Cascara ... two drachms.^[6]
• Salicin ... twenty grains.
• Comp. Tinct. Myrrh ... one drachm.
• Simple Syrup ... eight ounces.

Mix. Take one teaspoonful every three hours during the intermission, and every hour in the day of the paroxysms before the chill commences.

This is bitter, but can be relied upon. Complications may occur during ague, but they must be appropriately treated. Nourishing diet, fresh air and frequent baths should be provided. Removal from a malarial region is of course desirable. Under all circumstances keep the bowels from constipation.

Dumb Ague. — Occasionally a form of ague is met with where the chill or cold stage is not especially marked and the other stages perhaps but feebly manifested. Great depression and dull aching being pronounced in regular paroxysms. Such forms of the trouble require the same treatment as the regular forms.

Ague Cake. — Very often the spleen becomes enormously enlarged in those persons subject to ague, due to the crowding of blood upon the organs^[7], driven inward by the repeated chills and consequent contractions of the surface. In nearly every sufferer from ague the spleen will be found hardened and the liver enlarged.

Anemia following Ague. — Improper condition of the blood and excessive proportion of white corpuscles^[8] may follow ague; giving a pronounced and continued paleness to the countenance. Persons afflicted with ague and coming from a warm to a cold climate, perhaps to escape malaria, are very liable upon exposure to be attacked with pneumonia of a serious nature and often rapidly fatal. Such persons cannot be too cautious in guarding against such a difficulty.

^[1] Ague is an archaic term for the acute, intermittant fever typically associated with malaria.
^[2] Malaria is caused by parasitic micro-organisms. Mosquitoes were suspected to be the transmission vector for these parasites in the late 19th century, with the theory proved in 1987 by Sir Ronald Ross, who received the Nobel Prize for Physiology or Medicine for the discovery.
^[3] The "yellow colored fur" is probably a symptom of dehydration caused by the fever.
^[4] "Peruvian bark" refers to the Cinchona species, a source of quinine, which is still utilised in the treatment of malaria (and has been for almost 400 years).
^[5] Goldenseal, or tumeric root, contains berberine, which has been used in treating malaria.
^[6] Cascara is a common laxative - here used to prevent constipation.
^[7] The spleen is enlarged in chronic sufferers due to the destruction of red blood cells (hemolysis) carrying the parasite within the spleen.
^[8] Hemolytic anemia, again caused by the destruction of red blood cells carrying the parasite.

Agraphia

Inability to Write. — A condition following certain injuries of the brain^[1] by which the person afflicted loses the power of conveying his thoughts in writing. He may even be unable to form a single letter of the alphabet and still realize his inability.

^[1] Agraphia often appears with a number of disorders that can be caused by injuries: aphasia, dysarthria, agnosia, and apraxia. Albert Pitres, a french neurologist, presented a case of "pure" agraphia in 1884, which he saw as evidence of localisation of function within the cortex - function that could be impaired by injury.

Agoraphobia

Abnormal Fear of Strangers.

This is a species of nerve exhaustion, or rather a series of symptoms designating an ill-defined weakness of the brain or spinal cord, or of nerve-ganglia^[1]. The person afflicted fears to walk the streets or fields alone or to mingle in a crowd of strangers, or to travel where unacquainted. Such feelings are uncontrollable and agonizing; they may accompany other diseases, or they may be experienced by persons in apparently good health and for that reason call forth ridicule. But it should be remembered that the feelings are the result of nervous disturbance at some point.

Treatment. — Persons cannot be forced to overcome these feelings, and children especially should be treated with great kindness. The mind must be turned upon other thoughts and tact used in accustoming the person to situations dreaded. Diet should be nourishing; milk and eggs are good. Exercise should be regular in the open air^[2], and an interest awakened that will turn the thoughts to subjects other than self.

Agoraphobia was spelt as agorophobia in the text.

^[1] The attribution of an anxiety disorder to "ill-defined weakness" of the "nerve-ganglia" may seem strange, but the disorder had only been recently been named and described in 1871; and experimental psychology, psychoanalysis and psychotherapy were only recently receiving serious attention. A number of physicians believed that agoraphobia was a form of vertigo.
^[2] Perhaps the author had not encountered a patient with this form of anxiety?

Adenoma

Small Tumors. — These are morbid growths developed from tissues of glands; they are usually common around the throat and are about the size of a bean or pea. They are of no importance^[1]. The same character of growth may be found else-where involving glands that are important. See polypus, bronchocele, cysts, tumors.

^[1] Adenomas, which are benign tumours, may become malignant, or otherwise endanger the patient by compressing adjacent healthy structures.

Addison's Disease

Bronzed Skin. Degeneration of Renal Capsule.

By many this is known as bronzed skin. It is a disease of the capsules^[1] over the kidneys — they undergo cheesy degeneration^[2] and themselves become dark, enlarged and hardened. The cause of the disease is not definitely known^[3], but it is often present during cancer or tuberculosis.

Symptoms. — Great prostration and a bronzed olive-green hue to the skin are the prominent characteristics. The whites of the eyes assume a pearly look. The hands and feet become spotted, and dark spots may be seen about the mouth and on the lips. The heart beat is usually very feeble, especially in protracted cases. There is dyspepsia^[4] and pain over the stomach and in the back. Obstinate diarrhoea and vomiting may be present. Epilepsy or dementia may occur before death.

Treatment. — As far as known this disease is always fatal^[5]. Symptoms point to methods that might be resorted to for relief of diarrhoea, dyspepsia, etc. Hygienic surroundings, nourishing food, frequent baths and the use of tonics may prolong life, but recovery cannot be hoped for.

^[1] The "renal" or "supra-renal" capsules are now referred to as adrenal glands.
^[2] Cheesy degradation presumably meaning that the tissue becomes soft and dry, like cottage cheese (as can be the case with tissue affected by tuberculosis and syphilis).
^[3] The disease is caused by by insufficient steroid hormone production.
^[4] Dyspepsia is also known as indigestion.
^[5] Those with the disease are now treated with some form of cortisol replacement.

Actinomycosis

Disease from Vegetable Fungus.

This disease belongs properly to animals, and is caused by a fungus growth^[1] being established in the tissues and causing irritation and suppuration. Man cannot easily catch the disease directly from animals, the fungus requiring nourishment from vegetable fibre^[2] before it is dangerous to human beings; for that reason persons much about horses or cattle may become afflicted by the habit of eating bits of straws or hay taken from the manger. The fungus is made up of masses of very small particles, and altogether looks like a minute yellow chrysanthemum. The spores may get into the stomach or intestines or the lungs and cause fatal abscesses. Usually they are confined to the tissues beneath the jaw. Abscesses formed have a tendency to open outward. If they can be evacuated and the sacs thoroughly cleansed, recovery will follow; but if they are too deeply internal to be accessible the case is hopeless. Treatment consists of outward applications of compound tincture of myrrh, and the free internal use of composition infusion.

^[1] Actinomycosis was assumed to be a mycosis (fungal infection) because the bacteria responsible formed fungus-like colonies.
^[2] Actinomycosis cannot survive outside mammalian hosts.

Acromegaly

Englargement of Bones

This is an unusual disease, in which the prominences upon the bony structures of the body become enlarged to an enormous extent. The growth may be rapid or extend over several years. The lower jaw and the feet and hands are chiefly affected, though any bony prominence may be involved. The nose and ears may at the same time greatly increase in size. The skin and muscles of the body remain unchanged, which causes the morbid growths to appear Hideous. The sufferer grows distressed and his mind weakens. He usually leans his enlarged head forward, presenting an ungainly sight as it is carried between his enormous shoulders. Nothing is known regarding the cause of the trouble^[1], and no method of alleviation has yet been devised. The patient may live for years, though he is an easy prey to fatal disease; if not, exhaustion eventually causes death.

^[1] The link between pituitary enlargement and acromegaly had been found shortly before the publication of the book, in 1887, by Oscar Minkowski. The nature of the link was debated for some time: some thought that acromegaly was caused by pituitary hypersecretion, some thought hyposecretion, some thought that pituitary enlargement and acromegaly resulted from a nutritional disorder, and some didn't believe a correlation existed.

Acrodynia

Painful Joints. — Acrodynia is a name given to a peculiarly painful disease affecting the joints, causing swelling of the wrists and ankles, accompanied by an eruption and fever. It is mentioned by several authors as identical with breakbone fever or dengue, which is described elsewhere^[1].

^[1] We now know that Acrodynia was caused by mercury poisoning. It has become rare following the removal of mercury chloride (calomel) from teething powders in the 1950s (informed by the discovery of elevated mercury levels in children with acrodynia).

Acne

Blackheads, Pimples, Flesh Worms, Whiskey Nose.

There are several forms of skin disease included under the general name of Acne. They are never fatal, but are very annoying, and cause the afflicted person to present an unsightly appearance. The difficulty is also very persistent, often baffling every endeavor to overcome it.

Acne Punctata^[1] is caused by a retention in the skin of the secretion of the sebaceous glands. This secretion chokes up the little ducts and becomes hardened. These ducts are situated alongside of the hair follicles. The tips of the little masses of hardened secretion become black when exposed to the air, giving rise to the ordinary name of black heads or flesh worms^[2]. Some suppose these are actual worms in the skin, and they do look very much like them, for by pressure the ducts may be emptied of their contents, which look like yellowish worms with black heads. This form of acne is most common between the ages of fourteen and twenty-five, and usually makes its appearance over the face, and sometimes on the chest and back. Sometimes the retained secretion is deeper seated where air and dirt cannot reach it, and it remains white.

Treatment. — Permanent relief can not be obtained until the system is regulated. Over eating and improper diet are often causes^[3]. Eating fats or cheese or rich foods usually aggravate the trouble. Compound Syrup of Stillingia is an excellent internal remedy. Locally much may often be accomplished. Unskillful squeezing out of the "worms," is more detrimental than beneficial on account of increasing the inflammation present. First apply over the affected part a cloth wrung out of very hot water, let it remain a few minutes to relax the structures, then gently squeeze out the accumulations, taking care not to abrade the skin by pins or finger nails, then apply cloths wet with cold water and extract of witch. hazel in which borax has been dissolved.

Acne Rosacea, often spoken of as "whiskey nose," is a condition of enlargement and redness almost invariably at the tip of the nose, often causing the skin to look mottled by the dark blood in the minute venous capillaries of the parts. Indulgence in alcoholic liquors is the usual cause, though derangements through the system of special organs, such as the kidneys, liver and womb, may be indicated by its appearance. From whatever cause, this unsightly appearance of the nose is very annoying.

Treatment. — If from alcoholic drinking, it is an indication that should at once force the drinker to abandon his habit; for acne rosacea always indicates that damage is being done some organ or organs of the body. When caused by diseases of the kidneys, liver or other organic difficulty, the seat of the derangement must be found and attended to as mentioned under general diseases. Often this condition lasts for life despite all treatment, and occasionally it is seemingly inherited. Locally, but little can be accomplished. An ointment of sulphur and a very little boracic acid rubbed up in vaseline could be applied.

Acne Vulgaris very much resembles punctata and appears at the same places, but is a more aggravating difficulty. The retained secretions cause inflammation of a high degree, and as a result there is hardening of the parts or nodules formed in the skin, or else suppuration or pustules. Bad habits may cause acne vulgaris, but not always. Persons of scrofulous tendencies^[4] are most prone to be affected. The disease rarely exists or continues after the twenty-fifth year.

Treatment. — Constitutional treatment, as the use of Compound Syrup of Stillingia, is good. Locally use the treatment for acne punctata, but if the pustules are profuse or the tissues hardened and swollen, as is usually the case, a thin lancet should be plunged into the seat of each induration and then a rubber "cup" applied to draw out the pus and congested blood. This is a most effectual method and should be persisted in until relief is obtained.

Acne Sycosis is a form of acne attacking the hairy portions of the skin. Little tubercles or pustules are formed by suppuration of the hair follicles, and the exudated pus, drying in masses, forms scabs in which the hair becomes matted. Acne sycosis usually occurs on the chin in the follicles of the beard, from which it gets its name of "Barbers' Itch."^[5] It often follows eczema. After the scabs come off scars are left, upon which hair does not again grow, causing an unsightly appearance. By some this is regarded as a parasitic disease. It is contagious, and razors, combs, towels, etc., used by sufferers from it should be carefully kept from others. This disease of itself is never fatal, though erysipelas may follow^[6].

Treatment. — It must be treated about the same as acne punctata, though more energetically. The hairs about the roots of which pustules are formed should be drawn out early, and the pustules themselves pricked as soon as they "come to a head." Persons afflicted with barber's itch should keep well shaven and very cleanly. Borax and ammonia dissolved in water can be used freely to advantage. The following ointment is of great benefit: Take sublimed sulphur, 40 grains; starch, 1 drachm, and mix thoroughly, then add to it glycerine, 1 fluid ounce; borax, 20 grains, previously heated together; rub all these to the consistence of ointment with vaseline. Occasionally persons afflicted with acne sycosis bear the appearance at first glance of those afflicted with small-pox or with syphilis. But it may be always readily known because it attacks only hairy parts. Persons who never shave may have the disease, and women may have the difficulty make its appearance among the hairs of the temples.

^[1] Acne punctata seems to be an archaic term, referring to acne with black open comedo (blackheads).
^[2] There are surprisingly few hits in search engines for "flesh worms", thankfully. I refuse to believe that anyone was under the misapprehension that they were actually worms - the disease is just too common.
^[3] The role of diet in acne is still controversial.
^[4] "Scrofulous tendencies" referring to mycobacterial cervical lymphadenitis, or scrofula, as opposed to morally degenerate tendencies. Historically thought to be curable by a royal touch.
^[5] Acne sycosis also seems to be an archaic term, referring to a form of folliculitis known as sycosis vulgaris. Other conditions known as "Barber's itch" include pseudofolliculitis barbae (PFB) or tinea barbae.
^[6] Erysipelas is an acute infection of the upper dermis.

Abscess

Acute and Chronic, Superficial and Deep-Seated.

An abscess is an accumulation of pus at some particular spot, the pus being formed by the degeneration of tissue the result of congestion. Abscess may be caused by obstructions to the circulation, injury, irritation from foreign bodies or the absorption of poison, as in dissection work.

Acute Abscess.

Symptoms. — The formation of an abscess is preceded by pain, inflammation, redness, heat and swelling and in deep-seated abscess there may be general fever — the temperature perhaps reaching 104°^[1]. The swelling, hard at first, gradually softens before destruction commences. The brighter the redness the smaller will be the abscess, and the softer the feeling and the darker the appearance the more extensive will be the destruction of tissue. When pus begins to form there is usually a pronounced chill and a local throbbing, with increasing and constant pain. The pus always endeavors to get to the surface, causing elevation and a point to be raised which eventually ulcerates and bursts, allowing the pus to be naturally discharged. The deeper seated the abscess the longer will it be in "coming to a head," and the more liable is the pus to become poisonous. Thick yellow pus is termed "healthy," and after it is discharged healing is usually rapid. Thin, greenish or watery pus is always bad, indicating prostration and difficulty in after healing.

Treatment. — If there is much fever, sweating should be induced by the use of diffusive drinks, such as ginger and sage or pleurisy root tea. In large abscess where the surface is dark, composition (see formulas) should be used freely. Poultices of ground flax seed, sprinkled over with lobelia and golden seal will hasten pus toward the surface. After an abscess is opened dressing of poultices are usually sufficient. Keep the wound open by gentle pressure occasionally^[2], and if there is a tendency to degeneration, shown by a dark look of the part, compound tincture of myrrh should be used freely around the opening, and when the pus is poisonous, the tincture diluted can be injected into the wound by a small syringe. Deep seated or extensive abscesses should be opened with a thin and sharp pointed surgical knife as soon as pus forms, taking great care to avoid injuring blood vessels and important structures.

Chronic Abscess.

When the system is in an unhealthy condition during an ordinary abscess, a chronic abscess may result. Scrofulous persons are liable to be such sufferers. Decay of a bone, or of a small particle of bone broken off by fracture may likewise cause chronic abscess. The duration of such a trouble is very protracted, possibly continuing for years. When caused by bone decay there is usually considerable pain, and when there is an involvement of the nerve, spasms are liable to occur. Chronic abscesses may burrow into important structures and cause death, or decomposition of pus may cause fatal trouble, preceded by hectic fever, septicaemia, etc.

Treatment. — Ascertain the cause and remove it if possible. Pieces of decayed bone should be extracted. If there is a tendency to septicaemia, composition should be used freely, and the compound tincture of myrrh externally and internally. Do not open such abscesses prematurely. Let the diet be plain but nourishing, and keep the bowels open and the habits regular and temperate.

Abscesses in Special Localities.

An abscess may form in any organ as a result of injury or disease or obstructions to free circulation. The brain, stomach, liver, kidneys, spleen, bowels and lungs are especially liable to abscesses, and descriptions of these difficulties and their treatment are given in the articles upon diseases of those organs. Faecal abscess is mentioned under Appendicitis, and strumous abscess in the article on Scrofula.

^[1] 104° Farhrenheit is equivalent to 40° Celsius.
^[2] Conventional wisdom instead suggests that closing an abscess after draining improves healing.

Abortion

This accident^[1] not infrequently happens during the course of acute or chronic diseases. It is especially liable to occur during small-pox, relapsing fever, bilious-remittent fever, syphilis, St. Vitus dance^[2] and infectuous diseases. Its proper treatment is given in the article on Abortion in the section on Diseases of Women.

^[1] Spontaneous abortions are increasingly referred to as miscarriages, even in medical literature. There is a lot of literature discussing the use of "sensitive language".
^[2] St. Vitus Dance is a horrible archaic term for Sydenham's chorea, which is characterised by rapid, uncoordinated jerking movements.

Abdominal Injuries

Bruises, Contusions, Incisions, Lacerations.

The abdomen is liable to be injured in various ways; and if extensive injuries are neglected or improperly treated fatal results may follow. Falls and blows upon the abdomen may cause but slight external indications while they may severely injure internal organs. Deep seated pain, especially of a dull character, increased by pressure, and following - an injury to the abdomen, would point to internal difficulty. When pain becomes intense and of a throbbing nature, preceded by chills and some fever, several days after the injury, internal abscess should be suspected.

Incised wounds and larcerations are extremely liable to produce peritonitis^[1], which is fully described under the article on Peritonitis. In all such cases the greatest precautions for quietude and cleanliness should be taken, and the case placed in the hands of a skilful surgeon at once^[2].

Bruises and contusions require immediate applications of cold compresses; but if these have been neglected in the start hot compresses are best along with applications of stimulating liniment.

^[1] Peritonitis is an inflammation of the peritoneum, the tissue surrounding abdominal organs.
^[2] The first recorded laparotomy (done for exploration and lavage of the peritoneum) appears to have been performed "in the backwoods of Kentucky in 1807".

Abdominal Dropsy

This condition is technically known as Ascites^[1]. It is usually dependent upon diseases of the liver or portal vein, or of the kidney or the peritoneal membranes of the abdomen. In all cases the accumulation of fluid is the direct result of pressure upon the veins. For descriptions of symptoms and treatment, see article on Dropsy.

^[1] A number of societies have considered ascites as a divine punishment for oath-breaking.

Abdomen in Disease

Tenderness. Local and General Enlargement.

The abdomen is the portion of the body between the chest and pelvis, and encloses the large cavity containing the digestive and urinary organs and a portion of the generative organs. It is evident that many conditions of the organs mentioned will produce noticeable abdominal symptoms, and the observation of these and of their particular localities and characteristics will often lead to the recognition of the seat and nature of diseased conditions.

Tenderness usually denotes inflammation. If the tenderness is superficial the muscular structures only are involved; but if it is deep seated and increased by continued pressure the internal organs are affected.

Local enlargement of the abdomen is very frequent. If it is in the upper and center portion, the stomach is usually affected. If it is upon the right side, the liver is involved. If it is upon the left side spleenic trouble should be suspected. If it is toward the groins, ovarian troubles or appendicitis or obstructions of the bowels may be the cause. If it is low down, the bladder or the womb may be the source of trouble.

General enlargement of the abdomen may be due to inflammations of the bowels or womb or peritoneum (peritonitis). Dropsy^[1] may also give general enlargement; but in that case a doughy feeling and fluctuation may be readily recognized. Pregnancy will, of course, enlarge the abdomen, and in the cases of women, must always be borne in mind when no other cause of the enlargement is manifest.

Many acute diseases are at times accompanied by abdominal enlargements, and such enlargements are usually of serious import. They not infrequently occur in typhus and typhoid fever. But it must be remembered that abdominal enlargement does not always signify serious difficulties; for instance, it usually accompanies ordinary colic, from the intestines being distended with gas.

Treatment. — It is evident that no general treatment can be given for the removal of abdominal symptoms, as they may be the result of a variety of causes which must be removed according to the treatment given for the diseases of the special organs affected. But, as a rule, tenderness and pain in the abdomen, accompanied by enlargement may be relieved by the outward application of stimulating liniments or washes, or the laying on of flannel cloths wrung out of hot water, or the application of mustard^[2] or capsicum plasters^[3]. Such relief would, of course, be but temporary when deep seated organs are involved. To resort to the use of hypodermic injections or other methods of using opiates, would be more detrimental than beneficial.

The opening advice of the "diseases and treatment" section!

^[1] Dropsy, or what is now known as edema, is swelling due to an abnormal accumulation of fluid beneath the skin.
^[2] Mustard plasters, or sinapisms, can cause blistering of the skin. The intention is to improve circulation
^[3] Capsicum plasters seemingly remain in use within Korea for prevention of sore throats, vomiting and nausea, and post-operative pain.