In considering the maladies of the digestive system frequent references must be made to the anatomy of the alimentary tract, and to the physiology of digestion.


Among the common diseases of the lips are ulceration and fissure, which may often be induced to heal by light applications of nitrate of silver solution, in conjunction with diligent improvement of the general health. Cancer of the lip is not uncommon among men in advanced life, but is less frequent in females. It should be operated on in accordance with the rules already laid down, in discussing the subject of cancer. Hare-lip is a curious malformation, in which the upper lip has failed to develop in such a way as to unite in the centre previous to birth, and the child is left with a deep cleft, sometimes reaching all the way from the edge of the nostril. This malformation can generally be remedied by a surgical operation.


This is commonly met with in young infants, and is called "baby's sore mouth." It consists of an inflammation of the mucous membrane of the mouth and tongue.

Causes.—These may be:

1. Mechanical, chemical, thermal or parasitic.

2. Poisons, as mercury or lead.

3. In certain debilitating diseases, as consumption or diabetes.

4. It is most commonly found in young children, in connection with digestive disturbances, due to artificial feeding and bad hygienic surroundings, especially during the summer months.

General Symptoms.—There are six chief subdivisions of stomatitis and seven general symptoms common to all varieties. These are heat, pain and redness of the mouth, increased salivation, foul breath, restlessness and disinclination to nurse.



This is the most common form of inflammation of the mouth, and is usually the result of the action of irritants. It is frequent at all ages and is especially common in unhealthy subjects suffering from digestive disturbances.

Symptoms.—General redness. There may be areas of marked congestion where irritation is most intense. Mastication is painful.

Treatment.—In infants the mouth should be carefully sponged after each feeding. Chlorate of potash and sulphite of soda as mouth-washes and gargles, of the strength of a dram to four ounces of water, are useful, or, in severe cases, a dilute solution of nitrate of silver (three or four grains to ounce) may be applied, and attention ought to be paid to improving the general health by the use of tonics, nutritious food, and so forth.


This is characterized by the presence of small raised spots or vesicles, which may rupture, leaving small ulcers, surrounded with a red bole. This form of stomatitis occurs most frequently in children under three years of age. There are usually some digestive disturbances present.

Treatment.—Correct digestive disturbances; sterilize the milk; nurse at regular intervals, and cleanse the mouth with a linen rag after each nursing. Apply to mouth and gums three or four times a day.

            LATIN.                               ENGLISH.
Rx. Acid boric.............. gr. xv     Boric acid............. 15 grains
    Glycerini .............. f?ss       Glycerine...............1/2 ounce
    Aqua q. s. ad........... f?ij       Water up to............. 2 ounces

If the disease does not yield to this treatment, touch the ulcers with solid nitrate of silver stick.


This variety occurs especially in children after the first dentition. It is thought by some to be infectious, as it at times occurs in widespread epidemics. It attacks both adults and children.

Symptoms.—It occurs with low condition of nutrition. The gums of the lower jaw are chiefly affected. They are swollen, red and spongy. There is increased salivation, the teeth become loose, the breath foul and mastication painful. In rare cases there is necrosis (decay) of lower jaw.

Treatment.—Correct the hygiene. Touch ulcers with nitrate of silver, and use as a mouth-wash a solution of chlorate of potash, fifteen grains to the ounce. The best remedy is chlorate of potash, given internally, in doses of ten grains, three times a day, to a child, and double that amount to an adult.


This disease is dependent upon the growth of an irritating fungus (Saccharomysis albicaus). The development of thrush over the whole lining membrane of mouth and throat is very common shortly before death in wasting diseases, such as consumption and diabetes. It may occur at any age, but is especially common in children.

Symptoms.—It begins on the tongue as slightly raised pearly spots, which spread and coalesce. The membrane can be scraped off, and is readily recognized under the microscope. It may spread to the pharynx, esophagus or larynx.

Treatment.—Correct the hygiene; treat any gastric disturbances. Tonics are often indicated. Locally, use sulphite of sodium, one dram to the ounce of water, or

Borax .............................................. 1 dram
Glycerine .......................................... 2 drams
Water .............................................. 6 drams
    Apply two or three times a day to gums and mouth.


This terrible, but fortunately rare, disease is usually seen in debilitated children, between the ages of two and six years. It usually follows one of the specific fevers, especially measles and whooping-cough.

Symptoms.—The general symptoms of stomatitis are marked. The mucous membrane is first affected, usually of the gums or of one cheek. The process begins gradually. Externally the cheek is swollen hard, red and glazed, and inside the mouth is seen an ulcer with a great deal of proud flesh or slough.

Treatment.—Good hygiene; alcoholic stimulants; nutritious food and tonics, as iron, quinine and strychnia. Locally, there is nothing that will do much good, but the actual cautery applied to the surface is said to be of some use, as is the application of fuming nitric acid, followed by soda, the surrounding parts being protected with lint soaked with oil.


This form is very seldom seen at present, except in those who work in mercury.

Causes.—It may be caused by the administration of mercury in any form. It is most commonly produced by large doses, or even small doses, of calomel in those who are especially susceptible.

Symptoms.—Those first noticed are tenderness of the gums, manifested by forcibly bringing the teeth together, redness of gums near the insertion of the teeth, a metallic taste and an increased flow of saliva. If the disease is not checked at this stage these symptoms will become accentuated, and there will be profuse flow of saliva, foul breath, redness, swollen and tender gums. In severe cases there, may be ulceration of the gums.

Treatment.—The administration of mercury should be suspended as soon as there is the first symptom of salivation. Bowels should be opened by magnesium sulphate (half an ounce); best taken in half a glass of water before breakfast. Hot baths should be taken every evening, and alkaline waters should be taken in large quantities. Atropine sulphate, one one-hundredth of a grain may be taken twice a day, and iodide of potassium, five drops, three times a day.


These generally require the care of a dentist, and when connected with affections of the teeth, or their sockets in the alveolar processes, are usually so painful that prompt application to a dental practitioner is made.

Inflammation of the Gum.—This when conjoined with ulceration at the root of a tooth, gives rise to horrible suffering which lasts for three or four days, when it is usually relieved by the discharge of matter or pus. This may be hastened by hot applications.

Treatment.—The pain can be somewhat mitigated by anodynes, such as ten grains of Dover's powder or one-sixth of a grain of morphia, and poultices, but the best treatment is the extraction of the offending tooth, or the perforation of the alveolar process to the seat of trouble by drilling a hole through the spongy bone.


This is sometimes followed by ulceration, which may be hard to heal unless the whole cause of the difficulty is removed, which can now be accomplished under nitrous oxide gas so quickly, painlessly and safely, that no time should be lost in resorting to it. One extremely skillful operator in Philadelphia has now administered the gas for operations on the teeth in over one hundred thousand cases without a single fatal result.

Hypertrophy and atrophy of the gums are sometimes met with.


Treatment.—A very common cause of diseases of the stomach and bowels, and also of convulsions in children, is to be found in the hardening or induration of the gums at the time of teething, and this blunder of nature's ought to be promptly remedied whenever the gums in infants at the time of the first dentition are found to be red, swollen, and hot to the touch, by the use of the lancet. This little operation of lancing the gums, which, simple as it is, has probably saved the lives of thousands of young children. After the incisions are made bleeding should be encouraged, but care must be taken by wiping it off with a handkerchief to prevent the infant from swallowing the blood. It is astonishing what relief is often afforded to the little sufferer by a timely lancing of the gums.

Gum Tumors.—Tumors of various kinds sometimes make their appearance upon the gums, the most common of those which are non-malignant being the fibrous growths called epulis, often apparently caused by the irritation of diseased and neglected teeth. They all usually require surgical operations for their removal.

Perforation of Palate.—Perforation of the hard palate or roof of the mouth is sometimes a malformation present from birth, and due to the same kind of arrest of development as hare-lip. At other times it may be

(Continued on page pg0470)


        1. Hyoides bone joining many muscles of the tongue.
     2, 2. Muscles fastened at the corners of the jaw-bone to pull in
           the  tongue.
        3. Muscle formed by the outer edge.
        4. Deep muscle which turns the tongue toward the side.
  6, 6, 7. Muscles which facilitate the turning of the food in the
     8, 8. Salivary glands.
        9. Muscle of the bottom of the mouth.
       10. Cross muscle formed by the lip.

     1, 1. Muscles which form the outer border.
        2. Hyoides bone.
     3, 3. Muscles which move the base of the tongue.
     4, 4. Exterior insertion of transversal muscles.
     5, 5. Junction line of the transversal muscles.

        1. Tonsils or glands of the throat.
        2. Base of the epiglottis or valve to close the wind-pipe in 
        3. Lateral arches.
        4. Muscles joining the tongue to the epiglottis.
        5. Blind apertures in the base of the tongue called "blind foramen."
        7. Nerve endings like thread.
     8, 9. Fungiform nerve endings.
       10. Apex of the tongue.

        1. Exterior muscle of the tongue.
        2. Apertures of mucous glands.
        3. Apex.
        4. Under muscles with the cover removed.
        5. Periglottis turned back.
     6, 7. Conduits at the base of the tongue.
        8. Nerve endings at the base.
        9. Salivary glands.
       10. Muscles joining the tongue to the epiglottis.
    11,12. Depressions upon the periglottis.

     1, 2. Salivary conduits.
        3. Wharton conduits.
        4. Sublingual gland.
        5. Branches or arms of the jaw-bone.

        1. Nerve endings of the tongue.
  2, 2, 2. Submucous pellicle.
        3. Muscular larynx (deep).
        4. Band which joins transversal muscles.
        5. Transversal bands of the muscles.
6, 6, 7, 7. Salivary conduits.
        8. Muscles for pulling in the tongue.

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Image: ../figures/png120/fi0469-05.png Image: ../figures/png120/fi0469-06.png


For an explanation of the illustrations see text on opposite page.

due to venereal or scrofulous disease. A surgeon can do much to cure this deformity by operation, or to remedy the defect if incurable by surgical appliances, which substitute most ingeniously the deficient portions of the mouth.


The Tongue is subject to almost all the diseases already spoken of as affecting the inside of the mouth, for which similar treatment is required. Troublesome little ulcers on the tongue can often be promptly cured by holding in contact with the sore a pinch of powdered borax for ten or fifteen minutes. Deeper ulcers may require touching with the solid nitrate of silver, and if dependent upon the constitutional taint of syphilis will be very difficult to heal without the use of internal remedies also.


Cancer of the Tongue appears sometimes to have its origin late in life from the local irritation of the stem of a pipe in habitual smokers, or from the sharp corner of a broken or isolated tooth. Hence it is important to avoid these exciting causes as much as possible. The operation for removal of cancer when seated in the tongue is more justifiable than almost any other, because, if recurrence should take place in the glands of the neck, or still better, in some internal organ, death comes to the victim in a much less painful and horrible form.


Tongue-tie is a malformation in which, from the prolongation of the little membranous band, called the fraenum, underneath the tongue, the organ, even to its very tip, is in some cases tied down to the lower jaw. If, as occasionally happens, it interferes with a baby's nursing, it should be operated upon the next day after birth by nicking the band at the front edge, and then tearing it back to about the usual position. No cutting operation should be resorted to, except in this very superficial way, on account of a very active little artery which lies at the root of the tongue, and which, if wounded, might bleed so as to endanger an infant's life before the hemorrhage could be checked. On this account, if nursing is not seriously interfered with, it is better to wait some months before thus untying the tongue.


Sore throat, which may be considered as comprising inflammation, of the mucous membrane lining both the fauces and the pharynx, as they nearly always occur together, is one of the commonest disorders. It is occasionally produced by attempting to swallow some irritating article of food, or poison, but is ordinarily the result of cold. It also occurs in the course of various febrile affections, such as scarlet fever.

Symptoms.—The symptoms are pain on swallowing, redness of the surface, and at first dryness, but after a day or two later, excessive secretion from the mucous membrane. Subsequently to partial recovery from an acute sore throat, the condition may be one of relaxation, the membrane remaining loose and flabby, and often thrown into projecting folds. This state usually follows cold and sore throat, but may be induced by mechanical causes, such as severe, hoarse cough, screaming, shouting, or over-straining in reading or singing. It may also be brought on by excessive smoking.

Clergymen's Sore Throat.—One form of this malady, called clergyman's sore throat, is the result of excessive use of the voice in church service when the health is already impaired, especially when the air of the apartment in which such exertion is made has been rendered impure by overcrowding. In bad cases of sore throat, the inflammation may go on to ulceration, especially if neglected. The generally relaxed condition of the throat is partaken of by the uvula, or palate, as it is incorrectly called by many people, and this hanging down lower than it ought, may cause a hacking cough by tickling the epiglottis.

The above is a description of sore throat in general. The most common form of inflammation of the throat is tonsillitis.


Causes.—-The disease is most common in the young. It is rare in infants. Exposure to cold and wet with bad hygienic surroundings seem to be the chief exciting causes. Some writers claim that there is a close relation between this and rheumatism, but Osler has not found the relation between the two very striking, except in one point, viz., "that an attack of acute rheumatism is not infrequently preceded by an attack of inflammation of the tonsils." Personal susceptibility and heredity play an important part in its productions. At times it runs through a family, or a community, with such rapidity as to suggest an infectious origin.

Symptoms.—In the mild forms there may be no other symptoms than redness and dryness of throat with painful swallowing. The tonsils may be felt as hard lumps just behind the angle of the jaw.

Symptoms of More Severe Forms.—In the more severe forms it may begin with a chill followed by a rise of temperature which in children may reach as high as 105 degrees Fahrenheit. Pains in the back and limbs are not uncommon.

Local Symptoms.—The local symptoms are those of the mild form accentuated. If only one tonsil is swollen the uvula is drawn to the affected side.

Follicular Form.—In this variety white patches may be seen covering the tonsil. These are due to the accumulation of degenerated epithelial and white blood cells in the depressions, or cryps, in the tonsil.

Diagnosis.—The follicular form must be distinguished from diphtheria. The membrane of diphtheria is not in patches, but continuous over the surface of the tonsils, and extended up upon the pillars of the fauces and uvula, and is greyish-white in color. When this is stripped off it leaves a raw bleeding surface, which is not the case when the contents of the cryps are expressed in follicular tonsillitis.

Constitutional Treatment.—Bowels must be freely opened with calo- mel, one-quarter grain every half hour, for six doses;_ followed by mag- nesia sulphate (epsom salts), one-half ounce, to be given one hour after last dose of calomel; ten grains of Dover's powder at bedtime. Sali- cylate of soda is often beneficial, and may be given as:

Rx.---Salicylate of soda......................... 5     drachms
      Iodide of potassium........................ 2-1/2   "
      Syr. sarsaparilla...... ....................1-1/2 ounces
          Water sufficient to make four ounces. Take one drachm every
      four hours. The dose must be reduced in children to about

Local Treatment.—Gargles of borax, ten grains to the ounce, or salt and water, hot. The following will be found very serviceable:

Rx.---Tincture chloride of iron.................. 1   ounce
      Glycerine ................................. 1     "
      Chlorate of potash..........................1/2 drachm

Shake well before using, and use one drachm of the mixture to one ounce of water, as a gargle. Clean teeth after using.

Sprays of glyco-thymoline or super-renal extract are good; or swab throat with nitrate of silver solution, ten to twenty grains to the ounce.


This disease is a cause of great suffering to some persons in youth and middle age, but is rare in childhood, and often ceases its molestations after individuals commence the decline of life.

Causes.—Exposure to cold and wet are its common exciting causes.

Symptoms.—In the catarrhal form of quinsy the inflammation is often superficial, and after causing much pain and difficulty of swallowing, subsides in three or four days without suppuration. In the severer variety an abscess or boil forms in the substance of the tonsil, attended with great pain and swelling, difficulty of swallowing, a good deal of fever,, and some loss of strength. The patient often suffers from earache, and is somewhat deaf on account of the inflammation extending along the Eustachian tube. The breathing through the mouth is much interfered with, but the danger of suffocation is apparent only. The disease lasts on an average about seven days, but the abscess may break on the fifth day, or may linger until the tenth day, unless earlier opened by the lancet. The complaint is very apt to recur, and the sufferer from one attack rarely escapes without several every winter, until the tendency, which may be hereditary, is exhausted.

Treatment.—The treatment consists in. an effort to abort the disease by leeching, externally, and the use of guaiacum in teaspoonful doses of the tincture four times daily, by the mouth. If these remedies fail, poultices of little bags of hops dipped in hot vinegar and sprinkled with laudanum, and hypodermic injections of a quarter of a grain of morphia, may afford some relief. When suppuration is established, the period of suffering can be abbreviated by lancing the swelling in the throat, provided the spot where the abscess points is high enough to be felt by the, finger. The operation is performed by having a long, narrow-bladed knife wrapped with sticking-plaster, to within a quarter of an inch of its point, and then passing this down the throat, guarding it with the finger, and guided by the touch, as the patient can rarely open the mouth wide enough to admit of seeing, a small incision is made into the softened portion of the tumor. The relief afforded either by puncture in this way, or by spontaneous rupture, is wonderfully great. No after-treatment is necessary; but, as before mentioned, the complaint is very liable to recur, and it often happens, that in persons who are strongly predisposed to it, the first imprudent exposure on venturing out will light up the disease in the opposite tonsil, with an almost exact repetition of the suffering, within two weeks.


Inflammation of the Gullet.—This is a rare affection, and is usually due to swallowing some hot or corrosive liquid, although it may occur from the extension of simple or erysipelatous inflammation from the throat, or of the former variety from the stomach. Ulceration is also uncommon, although it does occur in connection with syphilitic complaints.

Stricture of Gullet.—This is the most frequent form of disease of the gullet.

Varieties of Stricture—1. Spasmodic stricture is a narrowing of the tube, caused by simple contraction of its muscular fibres. This condition is especially met with in hysterical females, and, though alarming at the time, seldom proves fatal to life.

Traumatic Stricture—2. This is the variety in which the constriction has been caused by irritation and inflammation due to an injury inflicted on the surface of the tube, in any part of its length, by the swallowing of scalding water or of some corrosive substance, or by a wound. The result of such a stricture is to render the act of swallowing always difficult, unless relieved by a surgical operation.

Simple Organic Stricture—3. This is occasionally seen, in which there is a mere narrowing of the gullet, without any apparent tendency to ulceration. The most common and fatal form of stricture is that due to cancerous deposit and ulceration. It may cause death by producing a complete obstruction, so that neither food nor drink can enter the stomach, or by ulcerating into some of the adjoining vital structures. The surgical operations sometimes performed for its relief are of very doubtful benefit or propriety.


The simplest and most common form of inflammation of the stomach is characterized by active congestion and excessive secretion of mucus, a condition known under the name of gastric catarrh, and very similar to that so frequently met with in the throat and air-passages.

Causes.—The causes of this malady are indigestible food, especially in children, irritant poisons, or alcoholic excess. But it may occur in connection with gout or as a symptom in some of the eruptive fevers.

Symptoms.—The symptoms of acute gastritis are pains, which are often severe over the pit of the stomach, shooting through to the back, and increased by taking food, but temporarily relieved by vomiting. Tenderness over the pit of the stomach is always present, and nausea and vomiting are prominent symptoms, the vomited matter consisting of a glairy mucus, stained with bile of a greenish-yellow or bright green color. The tongue is coated with fur, whilst the edges and tip are frequently red and irritated. The bowels are apt to be confined, and the urine scanty and high colored. These symptoms often set in with chilliness, followed by restlessness, hot skin, headache, and other febrile symptoms. In bad cases there may be great prostration, with cold, clammy skin, a weak, rapid pulse, some difficulty of breathing, and obstinate hiccough. Generally, however, under proper management, these distressing symptoms subside after a time, although they sometimes pass into those of the chronic form of gastritis.

General Treatment.—The treatment of this disease is, in the first place, if consequent upon the introduction of some poison or irritating material, to get rid of the offending substance by means of an emetic, followed by a purgative, which is perhaps in most cases best administered by enema.

Diet.—The food should be entirely liquid, and given in very small quantities; in fact, most cases would do better if nutritive injections were depended on to sustain life for a few days or a week or two. The thirst may be relieved by sucking small pieces of ice, but iced champagne is sometimes borne by the stomach when everything else is rejected, and iced carbonic-acid water is often acceptable.

Medicinal Treatment.—With the exception of subnitrate of bismuth, in quantities of five grains, and drop-doses of diluted hydrocyanic acid, it is usually advisable not to provoke the irritable stomach with medicines, the hypodermic injection of morphia being used to relieve pain, if the patient can take morphia, or morphia and atropia, in doses of one-eighth of a grain of the former and one one-hundredth of the latter in that way without nausea being produced. Thin and light poultices, as, for instance, of flaxseed meal and laudanum, laid over the region of the stomach, are frequently of service, or if the pain is very severe a few leeches may be applied. Convalescence from this malady is generally slow, and requires great care in regard to diet and exertion.


This affection, the great torment of civilized life, is to be considered rather as an unnatural functional difficulty than as a structural disease.

Varieties of.—Among its three chief varieties may be mentioned;

First Form.—The form due to sympathetic relations with other organs which are themselves in a morbid state, and which is therefore explainable as a reflex action. Of such a type is the nausea and occasional vomiting which attends irritation of the brain, lungs, liver or uterus. Sea-sickness is believed to be a form of this reflex dyspepsia.

Second Form.—This form is attributable to a scanty secretion of gastric juice, and is characterized by slowness of digestion, long retention of food in the stomach, prolonged distress after eating, especially with feelings of weight and uneasiness at the pit of the stomach, a tendency to decomposition of the food in the alimentary canal with the evolution of fetid gases and the appearance of undigested food in the evacuations from the bowels. The food may be considered to be delayed in the stomach when it remains there for more than two or three hours. Dyspepsia of this kind is often inherited, but much can be done to aggravate the tendency by mental over-exertion, prolonged and intense anxiety, especially if commencing directly after meals, sedentary habits, gluttony, and the use of alcoholic and other stimulants.

Third Form.—This form of dyspepsia appears to be owing to some abnormal quality of the gastric juice, and to diminished peristaltic movement of the stomach, so that food is not sufficiently mixed up with the digestive fluids.

Symptoms.—One of the most characteristic symptoms of this condition is pain at the cardiac end of the stomach, to which the name of cardialgia has been applied, on account of the distress being in such close proximity to the heart. Many dyspeptics, being also more or less hypochondriacs, imagine from this symptom that they are subjects of organic disease of the heart, and suffer intense, yet groundless, mental anxiety on that account. The names of heartburn, pyrosis and water-brash are applied to slight modifications of this symptom. Tobacco contains a poisonous principle which, in many persons, favors the development of dyspepsia, and some individuals suffer from smoking even a single cigar.

General Symptoms.—Inability to absorb liquids occurs in some varieties of dyspepsia, so that fluid which has been swallowed may be heard splashing around in the gastric cavity on any forcible agitation of the body, the stomach being usually distended to a great extent. As further aids in distinguishing between dyspepsia from deficient secretion of the gastric juice, and deficient motion of the stomach, it should be remembered that in the former neither flatulence nor constipation are generally present, whilst in the latter variety flatulence is one of the most characteristic symptoms and constipation is usually well marked. Some of the worst cases of dyspepsia from deficient secretion of the digestive fluid, in which pain after taking food, and other symptoms are particularly severe, appear entirely free from flatulence. The tendency of the fermentation which goes on in the slowly digesting food seems to be of a kind in which gases are not evolved. In all these forms there is a loss of appetite. The tongue is usually broad, pale and flabby. The pulse is weak, soft and compressible, and palpitation of the heart frequently occurs. There may be dyspnoea on exertion and a short dry cough, the stomach-cough of the older authors. The general nutrition, of course, suffers, and the face is pallid and bloodless to a greater or less degree.

Treatment—Diet—1. The treatment of dyspepsia must be chiefly dietetic, although medicines are not powerless in this complaint. In the first place all indigestible food, such as pork, veal and salt meats, and richly-made dishes, such as pastry of every description, ought to be avoided. In the acid forms of dyspepsia, which are connected with deficient muscular movement, pastry and saccharine substances are particularly harmful, and vegetables and fruit should be partaken of sparingly. In some instances an exclusive milk diet, persevered in for some weeks, has appeared to produce marvelously good results; but, except under such a regimen, water ought to be the habitual drink. Cocoa, deprived of its fatty ingredients, is often much to be preferred to tea and coffee, and these accessory foods, if taken at all, should be weak, cool and well diluted with milk. Rich or effervescent wines should be avoided, but the lighter Rhine wines or ale, or extract of malt, are often useful in atonic dyspepsia, with impaired movement of the digestive organs. In order to improve the general health all the agencies which favor the improvement of the nutrition and enrichment of the blood, such as abundant exercise in the fresh air, tepid or cool bathing, and warm clothing should be pressed into service. The successful prescription of a famous English physician to a rich and indolent patient who came to him complaining of the tortures of dyspepsia was, "Go and live on a shilling a day and earn it."

Medicinal Treatment—2. In the medicinal treatment for dyspepsia accompanied by undue acidity, as evidenced by the frequency of heartburn, if the urine is scanty and lets fall an abundant deposit, alkalies, such as the bicarbonate of soda or potash in quantities of ten to twenty grains thrice daily, are useful, and are best taken three or four hours after a meal. In acidity with anemia and debility, mineral acids, such as the diluted nitro-hydrochloric in five-drop doses, serve the purpose better. Vegetable bitters, of which columbo in doses of a wineglassful of the infusion thrice daily generally proves the mildest, and nux vomica or strychnia are good digestive tonics, and in slow digestion benefit is sometimes derived from very minute doses of ipecacuanha.

A good prescription is

Rx.---Tincture nux vomica ....................... 5-1/2 drachms
      Tincture cinchona syrup.................... 2     ounces
      Tincture gentian syrup..................... 2        "
    Take one drachm three times a day.

For vomiting, besides the remedies already spoken of under gastritis, very small quantities of Fowler's solution of arsenic, in two-drop doses, or creasote mixture may be tried. For flatulence the aromatic carminitives, such as ginger and cardamon, and powders of two grains each of charcoal with bismuth, also counter-irritation by means of small blisters over the stomach are often of great service. When the secretion of gastric juice is scanty, pepsin or lactopeptine, in quantities of ten grains, frequently proves itself invaluable as an aid to digestion; or a prescription containing

Rx.---Dilute hydrochloric acid................... 2-1/2 drachms
      Pepsin (soluble)........................... 2       "
      Glycerine ................................. 1     ounce
      Elix. aromatica............................ 2     ounces
      Water, sufficient quantity for............. 4       "
    Take one drachm of the mixture in water three times a day. 
  Best taken through glass tube.


The stomach is one of the most frequent seats of cancer, which is especially apt to attack this organ in men advanced in life who have subjected their digestive apparatus to more or less constant irritation. The tendency is very often hereditary. The cardiac end of the stomach is generally the seat of epithelial cancer, and the pyloric extremity of hard cancer or scirrhus. Its tendency is to extend around the organ, and hence it leads to an annular or ring-like constriction.

Symptoms.—The symptoms are those of gastritis or mere dyspepsia at first, but after a few weeks or months, in a majority of instances, a small amount of blood is vomited, and serves to indicate pretty clearly the true nature of the case. The blood in cancerous hematemesis of this kind being effused slowly and in small quantity is altered by the action of the gastric juice so as to present a brown color. This tint and the minute clots in which it appears have caused the expressive name of coffee ground vomit to be applied to it. Although not an infallible sign, it constitutes one of the surest early evidences we possess of the existence of cancer of the stomach. This disease is distinguished from gastric ulcer, which it most resembles, by its occurrence in advanced life instead of in the young; by the presence of a hereditary predisposition; by the character of the hematemesis; by the greater diffusion of the tenderness; by the constancy of the pain; by the cancerous cachexia, and, as emaciation advances, by the increasing tumor, which can be distinctly felt in most cases through the thinned walls of the abdomen. The average duration of cancer of the stomach is from six months to one year, and it always proves fatal.

Treatment.—The only treatment which offers any hope of recovery is surgical.


Causes.—This remarkable disease is attributed to the corroding action of gastric juice on the very membrane which has secreted it, in consequence of the vitality of that membrane becoming impaired by thrombosis of some small artery in the wall of the organ. Disorder of menstruation may develop an ulcer, tight lacing or any occupation which necessitates constant leaning over, as in shoemaking or tailoring. It is more common in females than males, and is more frequent in young women than those of middle or advanced age. Traumatism or swallowing any corrosive substance may lead to ulceration. Anderson believes that alcoholism, syphilis or mental worry may lead to the condition.

Appearance.—A simple gastric ulcer is round or oval, about one-quarter to one-half of an inch in diameter, with thin, clean-cut margins as if punched out, but deepest in the centre, like a shallow funnel, though varying in depth from a mere destruction of the mucous membrane to complete perforation of all the coats. It is usually single and most commonly situated at the back of the organ near its lower or pyloric orifice. The ulcer may happen to eat into some large blood-vessel, in which cases serious or fatal hemorrhage is apt to occur.

Terminations.—The terminations of such an ulcer are the favorable ones of its healing up with or without puckering in the wall of the stomach, or, on the other hand, of perforation, which may occur with the escape of the contents of the stomach into the peritoneal cavity. Such an accident is generally followed by peritonitis and almost certain death.

Symptoms.—The symptoms of gastric ulcer are pain and tenderness over the pit of the stomach, this pain coming on shortly after taking food, and increasing until the organ is emptied, by vomiting. Sometimes the distress seems to extend through into the back. The seat of tenderness coincides with that of pain, and is localized over a comparatively small surface. Vomiting of blood occurs in about one-third the cases, and though not so frequent as in cancer is much more profuse. It may be either in black clots or fresh blood, and not infrequently blood is passed by the bowels. Vomiting of food half an hour or an hour after eating is usual, and various dyspeptic symptoms are met with. The pain is often described by the patient as of a gnawing character, and is commonly made worse by condiments, animal food, saccharine substances and alcohol; whilst the pain in neuralgia of the stomach is frequently relieved by these articles of diet.

Medicinal Treatment.—The most successful treatment of gastric ulcer is perfect rest in bed and nourishment entirely by nutritive injections, for a period of from one to three weeks, or until the subsidence of the pain and tenderness indicate the healing of the ulcerated spot. Prussic or hydrocyanic acid and bismuth, as directed in gastritis, may be given to control vomiting, and morphia hypodermically, guarded if needful by atropia, to relieve pain. Stomach should be washed out twice a day. Small blisters over the stomach are frequently useful, and the first food administered should be lime-water and milk in very small quantities, gradually increased as the power of the organ to retain food is found to be restored. If vomiting of blood comes on, perfect rest, the quieting of the peristalic motion of the stomach and whole digestive tube by full doses of a grain every two hours of opium, or one-sixth of a grain of morphia, and the use of acetate of lead by the stomach in quantities of two grains every three hours, tannic acid and gallic acid by enema, and five grains of ergotin hypodermically, are to be resorted to. Ice in small pieces may be given frequently, and cold cloths applied over the gastric region. Perforation is indicated by severe pain and shock.

Surgical Treatment.—If the patient grows worse in spite of medical treatment, if hemorrhage is profuse, if pain is severe, or if the tenderness is marked, surgical treatment must be resorted to and should only be done by a skilled surgeon. A number of cases of perforation and hemorrhage have been saved by a surgical operation.


Character.—This dangerous malady is an inflammation of the peritoneum or serous sac covering the intestines, liver, spleen, and so forth, and reflected upon the inner surface of the wall of the abdomen. It is probably more liable to become quickly and violently inflamed than any other structure of the body. It may be either general or local. Local peritonitis may occur whenever any of the organs of the abdominal cavities become the seat of inflammation.

Causes 1.—Exposure to wet and cold.

2. Traumatism.

3. It may result from the perforation of an ulcer occurring in stomach, intestines or liver.

4. Inflammation of the uterus following confinement and constituting child-bed fever, which we see.

5. It may be secondary to some morbid disease as tuberculosis, rheumatism or Bright's disease.

Symptoms.—A chill with moderate fever, rapid pulse, intense abdominal pain, abdominal rigidity, painful respiration. The patient lies with thighs flexed, features are pinched, vomiting persistent and bowels are usually constipated.

Treatment.—Absolute rest is essential. Restrict the diet. Give frequent doses of opium, one grain, or morphine, one-quarter grain. Hot or cold applications to the abdomen. In non-perforating cases give saline purge. In perforating cases, which are the most frequent, a surgical operation offers the only hope.


Symptoms.—This disease is not very common, but may arise from taking cold, from the abuse of purgatives, from swallowing or inhaling irritant poisons, and from peritonitis. Its symptoms are diarrhoea with pain, often very severe, increased on pressure and most intense about the navel or in the right flank. The frequent discharges temporarily relieve the griping pains, which, however, soon return. The pulse is excited., generally full and strong and marked fever is present.

Treatment.—The treatment is by anodyne fomentations or poultices to the abdomen, such as the flaxseed poultice with laudanum, and grain doses of opium by enema or suppository. Rest in bed must be strictly enjoined.


Function of Appendix.—Appendicitis is the term applied to inflammation of the vermiform appendix. It is almost invariably the primary lesion of all those various conditions known as typhlitis or perityphlitis, terms which are well relegated to obscurity. The appendix is a small tube or diverticulum coming off from the postero-internal part of the caecum or beginning of the large bowel, and has no function in man, but in herbivora and rodents is a functionally active organ. The position of the appendix corresponds about to a point two inches from the anterior spine of the pubis on a line down from the spine to the umbilicus. This point is known as McBurney's point.

Causes.—At one time it was supposed that foreign bodies, as seeds, pins, etc., were important etiological factors in the production of the disease, but Fits' statistics show that only twelve per cent. of cases are caused by foreign bodies. Appendicitis is a bacterial disease, usually produced by the bacteria which are nominally present in all parts of the gastro-intestinal tract, which have a powerful action when the vitality of the appendix becomes impaired from any cause, as when the deverticulum is bruised, obstructed, or in a state of catarrhal inflammation.

Where non-traumatic inflammation occurs the swelling of the mucous membrane occludes the tissues, obstructing the full communication between the appendix and caecum, and the appendix becomes converted into a closed sac. Dieulafoy maintains forcibly that appendicitis is always caused by the conversion of the appendix into a closed cavity. Partial obstruction may be caused by calculi, which are composed of fecal material mixed with salts of lime or magnesia. These calculi are not formed in the colon but in the appendix. Pozzi believes that appendicular colic may be caused by bending of the appendix, and holds that pain may arise when there is no lesion of the appendix. A foreign body may produce immediate perforation giving rise to a diffuse septic peritonitis. Where the lesion of the appendix is occluded it begins to swell and becomes very much congested, the blood supply becomes lessened or cut off entirely. The microbes multiply with great rapidity and the wall of the appendix may become gangrenous, or it may ulcerate and perforate. Interference with the blood supply of the appendix will predispose to appendicitis.

When the appendix becomes inflamed gradually, the peritoneum around it partakes of the process and adhesions are usually formed, thus walling off the appendix. In a case of this kind, if perforation should occur or the inflammation go to the formation of pus, the adhesion would protect the general peritoneal cavity from the poisonous materials.

Who Are Most Subject.—Appendicitis occurs most frequently in males, as the blood supply is more abundant. It is rare in infants but occurs most frequently between the ages of sixteen and thirty years. Appendicitis that subsides may at any time recur, and the life of the patient is under constant menace. It always recurs after a second attack.

Varieties.—Appendicitis is divided into the catarrha1, obliterative, suppurative and gangrenous forms, but as a matter of fact appendicitis is always one disease which varies in intensity, and it is useless to divide it into a number of symptomatic groups.

Symptoms 1.—In what is known as appendicular colic there are colicky pains in the right iliac region most marked over McBurney's point but radiating towards the umbilicus, nausea, vomiting and usually constipation, but no tenderness in the right iliac fossa or abdominal rigidity.

2. In a genuine case of appendicitis the patient feels listless and out of sorts for two or three days before the attack, loss of appetite, furred tongue, foul breath and constipation is the rule, but in exceptional cases there may be diarrhoea.

3. The onset is usually with colicky pains which, at first may be general over the whole abdomen but most intense over McBurney's point. Circumscribed tenderness over McBurney's point and across may be felt. There is moderate fever and vomiting is usually present with constipation, abdominal muscular rigidity.

4. As the attack progresses the fever becomes more intense, radiating towards the umbilicus and the tenderness over McBurney's point recrosses. The pulse increases and fever rises, vomiting becomes worse, respiration more rapid and thoracic in character. The patient lies upon the back with right leg drawn up. The urine is scanty and highly colored. Any case may become suddenly desperately grave because of perforation or gangrene.

Terminations.—Appendicitis may terminate in recovery, in death, or in a condition of lowered vitality, renewed attacks being certain to occur.

Treatment 1.—In appendicular colic apply a hot water bag over McBurney's point, give a saline cathartic and watch the patient for further symptoms.

2. Many surgeons give a cathartic in undoubted cases of appendicitis, but the increase peristolsis and tension caused is liable to give rise to perforation.

3. In a genuine case of appendicitis perfect rest, liquid diet, ice bag to McBurney's point. Do not use opium in any form as it masks the symptoms. If the symptoms are not better in thirty-six hours operate. Deaver and Murphy operate in every case.

4. McBurney says, if six hours after the beginning of the attack the patient is no worse there is no pressing danger, if in twelve hours symptoms are not intensified they will soon begin to abate, but if in twelve hours the symptoms have become worse operation is necessary.

5. It is always better to operate in the interval between the attacks than during an attack. It is not safe to delay operation in a pus case. It must be remembered that the mildness of the symptoms is no assurance that even in an hour or two gangrene or perforation will not occur.


This term is applied to the obstruction of any part of the intestinal canal. It may be acute or chronic.

Causes.—Obstruction may be caused:

1. By a band, which becoming looped or attached to one or more organs, forms a noose through which the intestine slips. This manner of compression is known as strangulation.

3. By one portion of gut slipping into another. This is known as intussusception or invagination.

3. By kinking of the gut.

4. By the narrowing of the lumen, by contraction of scar tissue or the encroachment of tumors.

5. By the pressure of foreign bodies large enough to obstruct the lumen.

Symptoms of Acute Obstruction or Complete Obstruction.—The active symptoms are usually preceded by a period of constipation, with a feeling of lassitude, furred tongue and foul breath.

1. Pain comes on abruptly, first colicky, then continuous and intense.

2. Vomiting quickly supervenes and is, first, of the stomach contents, then bilious, and finally fecal.

3. Abdominal distension occurs if the obstruction is in the lower bowel, but may not be present if the obstruction is high up. Constitutional symptoms are those of shock. Thirst is intense, urine scanty and highly colored.

Symptoms of Chronic or Partial Obstruction.—Symptoms appear gradually with the increase of the narrowing until there is complete obstruction, or the symptoms of acute obstruction occur from time to' time.

Treatment.—Purgatives are contra-indicated. Food must be withheld and nutrition given only by the rectum. Give opium or morphine for the fever in doses of one grain of the former and one-quarter grain of the latter.

Accessory Treatment.—Washing out the stomach twice a day to control the vomiting. Distension of the bowel with gas or water should be practiced in doubtful cases and in intussusception. Senn recommends the infiltration of hydrogen gas. If these methods fail to relieve the obstruction a surgical operation must be done at once.


This is a febrile disease, characterized by severe colicky pains, followed by straining, which results in scanty mucous or bloody stools, containing little or none of the natural fecal matter or excrement.

Causes.—It is especially prevalent in warm climates, and warm weather and bad hygienic surroundings play an important role in its production. Ingestion of irritating foods, exposure to cold or wet, certain debilitated states, as scurvy, Bright's disease, etc., seem to be predisposing causes and may alone produce the simple form. The tropical form is due to an animal parasite, the amoeba coli.

Symptoms.—There is moderate fever, severe colicky pains in the abdomen, prostration, tenesmus or straining, constant desire to defecate with small mucus and bloody stools. These symptoms are aggravated during the night and early morning, and leave behind them the tormenting sensation that there always remains in the bowels something which has yet to be discharged. This sensation, which is technically called tenesmus, increases, and ultimately becomes the most striking feature of the disease. When the malady is fully established, the evacuations consist of bloody slime, sometimes tinged with bile, and containing shreds of membranous-like exudation thrown off from the interior of the bowels. They exhale an odor almost peculiar to dysentery, very offensive and yet quite different from that of ordinary feces. This complaint may prove fatal in consequence of the great loss of blood, but it more commonly causes death by wearing out the patient.

Other Symptoms.—When a fatal termination threatens, the symptoms assume a typhoid character, with great prostration, dry, brown tongue, hiccough and vomiting. In favorable cases improvement begins about the end of the first week, but convalescence is usually very protracted, and many cases stop half way, as it were, continuing to suffer for months or years with the chronic form of the affection.

Common to Children.—This disease is very common among young children, being especially prevalent and fatal among those who are cruelly kept in cities during the hot summer months, and it is the usual result of starvation or deterioration of food, especially if long continued and accompanied by hardship and privation, being then an extension of the diarrhoea which is apt to be first produced.

Treatment.—A mild laxative is indicated in the beginning as epsom salts, three drachms, or castor oil and laudanum might be selected. Bismuth is a valuable remedy. Absolute rest in bed and bland non-irritating liquid diet. The following may be found useful:

Rx.---Sulphate of morphia .......................... 1/2 grain
      Bismuth ...................................... 40 grains
      Creosote ..................................... 15 drops
      Simple syrup .................................. 2 ounces
            A teaspoonful every three hours.

After the more violently acute stage has passed, laudanum injections, or opium by suppositories, with such astringents as two grains of acetate of lead, half a grain of nitrate of silver, and of sulphate of copper combined with small doses of a quarter or half a grain of opium by the mouth, are generally beneficial, but care must be taken not to check the disease too suddenly by the use of these remedies.

Additional Treatment.—Flushing out the bowels with a saline solution may be tried, or starch water containing one grain of opium may be found beneficial. Hot fomentations over the abdomen may be used to relieve the pain. Injections of warm solutions of quinine, 1-5000 have been used in dysentery with advantage. Creolin, a drachm to the pint, has given good results.

Diet.—The diet, as pointed out before, should consist of the blandest and most unirritating substances, such as boiled milk with lime-water, beef essence, boiled rice, and if the debility is extreme, raw eggs beaten up with milk. Stimulants should not be administered unless absolutely necessary, on account of their locally irritating effect.


Causes.—In many cases this common malady is also rather a consequence or symptom of some morbid condition than itself a disease. The frequent discharge of loose or fluid evacuations from the bowels, without griping pain or tenesmus, is sometimes a wise effect of nature to get rid of some injurious or indigestible material, which has been imprudently swallowed into the stomach and has from there passed into the bowels. Diarrhoea may likewise be produced by some violent mental impression, or by exposure to taking cold, the bowels instead of the throat being often the weak spot of the individual. It also results from privation of food, food of poor quality, and many analogous causes.

Medicinal Treatment.—In the treatment of diarrhoea from indigestible food no attempt should, as a rule, be made at first to check it until the offending material, whatever it may be, is cast out of the system. In fact, a gentle and soothing laxative, such as a dose of castor-oil with a few drops of laudanum to hasten along the conservative action of emptying out the intestinal canal, is often of great service.

Stopping Evacuations.—After this is accomplished, however, each additional evacuation is an evil, which should be prevented by the use of five grains of bismuth or chalk, with three grains of tannic acid, or in a teaspoonful of either syrup of galls, or syrup of krameria, and a quarter of a grain of opium, or by opiates combined with carminitives like lavender, or ginger, and camphor, a good mixture being ten drops of laudanum, fifteen of compound spirits of lavender, and five of spirits of camphor, taken on a lump of sugar every hour or two until relieved.

Additional Treatment.—If the stomach is unsettled, as is frequently the case, the opiate and astringent may be administered with advantage by enema or suppository, and in patients who cannot, or think they cannot, retain medicines in either the stomach or rectum, hypodermic injections of the eight of a grain of morphia may often be resorted to with the happiest effect.

Diarrhoea Mixture.—A good rule in taking a diarrhoea mixture is to use a moderate dose every two hours, provided the loose passages recur within that time, but if at the end of two hours there has been no liquid or semi-liquid evacuation in the interval, to wait until such a one occurs before resorting again to the remedy. In this way the blunder of so overdoing the good work of checking the diarrhoea as to inflict upon the system its opposite evil of constipation may generally be avoided. The patient thus gains from the remedy all the good with as little of the necessary evil, which lurks in the bottom of every cup of blessing, as possible, a desideratum which should constantly and persistently be kept in view in every kind of medical treatment, as well as all other affairs of life.

Other Remedies.—Among the various other valuable remedies often beneficial in this exceedingly common disorder, may be mentioned the tincture of kino, catechu and logwood, acetate of lead, sulphate of copper and sulphate of zinc, nitrate of silver, spirits of chloroform, tincture of capsicum, spirits of camphor, compound spirits of lavender, and so forth,

Accessory Treatment.—In cases of diarrhoea, where the tongue is white and coated, the pulse accelerated, the temperature a little raised, and some pain or soreness, increased by pressure, is felt in the abdomen, small doses of epsom or Glauber's salts, in conjunction with hyoscyamus and opium, and perfect rest in bed with the most rigid attention to diet, are necessary, lest the slight irritation of the mucous lining of the alimentary canal become aggravated into actual inflammation, and more serious disease, such as dysentery, enteritis or obstinate chronic diarrhoea result.

Diet.—The diet of a person suffering from diarrhoea must be very strictly regulated, and, in fact, nothing but tapioca, sago, boiled rice or milk-toast with boiled milk, twice-boiled water, beef-tea and table-tea should, as a rule, be put into the stomach. Even after the malady seems to be cured, much caution must be exercised about returning to the ordinary diet. This disease, like most others indeed, exhibits as it passes away a singular analogy to a conflagration, which for days after it has apparently been extinguished is ready to break out again, if the remaining sparks happen to be fanned into a flame by the wind or any new fuel is supplied.


Definition.—This diseased condition, the direct opposite of the preceding one, may be defined as a retention of the fecal matters beyond the usual period, so that they are passed with difficulty and in a comparatively hardened state.

Causes.—The causes of constipation are almost infinitely various. Every form of impaired digestion may originate it; the existence of piles or hemorrhoids, a sedentary life, application to study, amenorrhea and uterine disease in females, all are apt to induce it, and almost every acute disease is frequently ushered in by constipation. It is more often met with among women than men, probably because the female sex fail to exercise sufficiently in the open air; and many articles of food largely contribute to establish the evil of habitual constipation.

Treatment of the Acute Form.—If the trouble be occasional and accidental any of the milder laxatives, such as a tablespoonful of epsom or Glauber's salts, rochelle salt, castor oil—which is the safest purgative, as a rule—ten or fifteen grains of rhubarb, senna, or the various purgative mineral waters may be employed. For some patients, injections of warm water, or soap and water, answer a very good purpose, and if administered with care are perfectly harmless.

Treatment of the Habitual Form.—Habitual constipation is best treated by the regulation of the diet, partaking of fresh or stewed fruits, bran, bread and vegetables in season, in proportions sufficient to antagonize the torpor of the bowels; at the same time resorting to active exercise in the open air, and endeavoring to correct any faulty habit of life, which may be the primary cause of the trouble. If the difficulty had its origin in hereditary tendency, or other deep-seated modification of the organism, laxatives should be resorted to, because, in the writer's opinion, at least, the evils of constipation are far greater than those arising from the constant employment of these medicines.

Additional Treatment.—It is probable that for most persons saline laxatives, such as rochelle salts, or purgative waters during the summer, and in cold weather pills of a grain of rhubarb, one-sixth of a grain of podophyllin and a grain of compound extract of colocynth, teaspoonful doses of the compound liquorice powder, or some of the many excellent gentle laxatives recommended in the pharmacopeia, best serve the purpose.

Relieving Constipation.—Obstinate constipation, that is, absence of evacuation for several days, or a week or two, is a dangerous condition, and should never be permitted to occur, since the large and densely-packed masses of feces may require the operation of drastic cathartics to dislodge them, and such medicines, in accomplishing their work, sometimes set up serious or fatal inflammation. Liberal potations of castor oil, aided by large enemas, may first be tried in such a case; then senna, in teaspoonful doses of the fluid extract; then quarter- or half-grain doses of tartar emetic, in conjunction with epsom salts, and if these fail, it may be necessary, under skillful advice of a physician, to resort to drastic cathartics, such as gamboge, calomel, elaterium and croton oil, provided no organic obstruction exists.


Definition.—Hernia is the name usually applied to the protrusion of some portion of the bowel or any abdominal viscera through the wall of the abdomen.

Varieties.—We may have umbilical hernia or protrusion of the bowel at the navel, a form often seen in children; and hernia in the groin or inguinal hernia, which is probably a most common variety. It has been estimated that about one man in every seven is affected with hernia, but in most cases the intestine is kept in its place more or less perfectly by some form of truss. When a hernia can be pushed back it is called reducible. An irreducible hernia cannot he returned into the cavity of the abdomen, and is constantly in danger of being inflamed, by some accidental blow for instance, and so becoming strangulated.

Causes.—Hernia is sometimes produced or driven out under some treacherous truss, which should protect against such an accident, by very slight causes, all of which should be carefully guarded against by those who have any hereditary tendency to this disease. It may be forced out by a jerk, such as suddenly pulling open a door that sticks, or by a fall, by an attempt to lift a heavy weight or to raise a moderate one whilst in a constrained position, or any other act which tends to bring a strain upon the bowels making them bear downward. It is also favored in its occurrence by overeating, by excessively exhausting exertion, and by severe effort at times when the body is enfeebled by disease. It is more common on the right than on the left side of the body.

Symptoms.—The symptoms of strangulated hernia are intense pain, not only in the neighborhood of the rupture but over the whole abdomen and especially around the navel, obstinate vomiting, and cessation of the passages from the bowels. At first there may be one or two evacuations of the fecal matters already below the seat of strangulation, but after that is cleared out the bowels cease to move, and if the strangulation is unrelieved the vomiting, which persists in spite of all remedies, results in bringing up fecal material through the throat. This is a very curious phenomenon, and seems to indicate that nature in her stupid zeal to get rid of digested materials, on finding that the usual avenue downward is blocked, soon reverses the normal peristaltic movement and tries to evacuate the bowels through the mouth. In accordance with this idea the importance of such stercoraceous vomiting, as it is called, in the diagnosis of strangulation of a hernia, or some similar obstruction, is very great.

Treatment of Strangulated Hernia.—When fecal vomiting occurs, if undecided before, not a moment should be lost in sending for the best medical skill which can be procured, and which even then may arrive too late. In the absence of medical assistance, reduction of an obstinate hernia on the point of becoming strangulated, or perhaps already compressed, may sometimes be accomplished by putting the patient in a warm bath, and so relaxing the system as already explained; or a full dose of opium or morphia, the former preferably by enema, may perhaps have the desired effect; or lastly, the administration of ether or chloroform, by one who is accustomed to giving these anesthetics, by still more fully relaxing the system, may happily allow the endangered fold of the intestine to be pushed back into its proper place. If the hernia cannot be reduced an operation is absolutely necessary and is attended with but very little risk in the hands of a skilled surgeon.

Treatment of Reducible Hernia.—In this form of hernia the contents of the sac can be reduced into the abdominal cavity. The treatment may be palliative or radical.

Palliative Treatment.—Prevent constipation, avoid sudden strains and violent exercise and order a truss. The continual employment of a truss, especially in young persons, may bring about a cure. The day truss should be applied before rising in the morning and be removed after lying down at night when a light truss may be substituted. A truss is always uncomfortable at first, but a person soon grows used to it. It should be kept perfectly clean, and it is well to dust borated talc powder upon the skin under the pad at least once a day. A truss which does not keep the hernia up increases pain and does harm. Too strong a spring tends to enlarge the hernial opening and thus aggravates the cause.

Radical Treatment.—This is operative and the sac is completely closed and a new canal formed. These operations show a very small percentage of recurrences.


The intestinal canal is often the home of parasites, commonly called worms, and in many parts of the country nearly all children between the ages of one and seven years, as well as many older persons, are troubled with these pests.

Varieties 1.—In childhood the usual inhabitant of the bowels is the round-worm or ascaris lumbricoides, a creature attaining the size of a large earth-worm, which it resembles in appearance, except that it is whitish or brownish, and stiffer and harder in its structure.

2. Children are also often infested with the oxyuris, commonly called the thread-worm, pin-worm, or seat-worm. This parasite is sometimes found in great numbers about and just within the fundament. In size they are very nearly that of a very small pin, or piece of thread about half an inch long, but by their number and activity they often contrive to prove very troublesome guests to their unwilling host.

3. The third common parasite which preys upon the human species is the taenia solium or tape-worm, of which some account has already been given. These parasites are always introduced into the system from outside, either with food or drink, and hence one great reason for the good cooking so strenuously urged in a former chapter. They are a great source of irritation as long as they remain, and in childhood, by the reflex irritation their movements in the intestines are capable of exciting, constitute one of the common causes of convulsions. Exactly what articles of food convey the eggs of the round-worms and the pin-worms into the human system has not yet been discovered, but the tape-worm is known to find its entrance into our bodies by the eating of raw meat, generally beef or pork.

Symptoms of Round-Worms.—The symptoms are often absent. When present there is usually symptoms of dyspepsia, diarrhoea with mucous stools, colicky pains in abdomen, voracious appetite which it is almost impossible to satisfy. There is anemia and often reflex nervous phenomena such as "night terrors," grinding of the teeth, itching of the nose and anus, twitching of the face and limbs and there may be convulsions.

Treatment.—The diet should be restricted before the anthelmintic is administered. The most effective remedy is santonin, which is best given with calomel, as in the following:

Rx.---Santonin ...................................... 5 grains
      Calomel ....................................... 5 grains
      Sugar ........................................ 20 grains
          Divide into ten powders, and take one powder morning and

Fluid extract of spigelia, one to three fluid drachms, often proves very effective.

Symptoms of Pin-Worms.—These chiefly affect the lower colon and rectum, and produce severe itching of he anus and adjacent parts.

Treatment.—Flush out the bowel with water, then inject infusion of quassia chips two to three drachms to the pint of water.

Symptoms of Tape-Worm.—These are frequently absent. There may be dyspeptic symptoms, colicky pains in abdomen, loss of flesh, capricious appetite and at times reflex nervous phenomena as vertigo, palpitation, "night terrors," convulsions, itching at nose and twitchings of limbs and face, especially the latter.

Treatment.—A light diet for a day or two previous to the administration of the anthelmintic, so that the worms will be hungry enough to feed upon the drugs administered. After an unsubstantial breakfast administer one of the following efficient remedes: Pumpkin seeds, two to three ounces, oleoresin of aspidium, one to two drachms; pomegranate, one drachm.

Auxiliary Treatment.—Before giving any of these the bowels should be thoroughly emptied by a good purge, and about twelve hours after the administration of the anthelmintic another purge, preferably castor oil, should be given. The treatment is successful only when the head is passed, so the stools must be watched carefully. If not successful the first time try again, in a day or two.


Colic is an acute spasmodic affection of the bowels without diarrhoea or much fever, but attended with severe cramps of the abdominal muscles.

Causes.—Its most common causes are indigestible food, reflex irritation from the uterine or ovarian disease, and lead poisoning.

Symptoms.—The great characteristics of colic are the griping, twisting pains, radiating from the navel and relieved by pressure. Care must be taken not to mistake these pains for those of strangulated hernia, or the converse, which would be a much more serious blunder.

Treatment.—The treatment is to relax the spasm by opiates, and remove the offending material if there is any in the bowels. For the former purpose twenty or thirty drops of laudanum by enema or hypodermics of one-eighth of a grain of morphia, and for the latter a tablespoonful of castor oil or a Seidlitz powder answer very well in most instances.


Hemorrhoids or piles are exceedingly common and troublesome complaints, consisting of little tumors which form at the edge or just inside the fundament, and give rise to intense suffering, especially when the bowels are evacuated.

Varieties.—There are three varieties, external, internal and mixed.

Causes.—Their production is favored by constipation, sedentary habits, hard seats, and some forms of liver complaint.

Symptoms.—The inflammatory enlargement is detected and is tender and inflammed[sic]. Pain on evacuation of bowels. The external variety do not bleed. Very often their surface, which in the internal variety is composed of the distended mucous membrane, exudes blood, in which case they are called bleeding piles. When seated outside the margin of the fundament they are not so apt to bleed, and receive the name of blind piles.

Treatment.—They may generally be prevented from developing by proper attention to the bowels, non-stimulating diet and rest, and, whilst small, an ointment of ten grains of extract of belladonna, thirty grains of tannin, and twenty grains of powdered opium in an ounce of simple ointment, will usually relieve them.

Auxiliary Treatment.—Injections of cold water into the rectum, bathing the parts with cold water after each bowel movement, or an ointment of

      Chrysaniline ....................................... 15 grains
      Iodoform ...........................................  5 grains
      Extract belladonna ................................. 10 grains
      Vaseline ...........................................  4 drachms
          Apply three times a day.

Apply this night and morning after carefully cleansing the part. Extract of hamamelis is a valuable application for external piles. When the acute symptoms subside use lead water and laudanum. If the internal piles prolapse and inflame use in addition to the above, Allinghour's ointment on the parts. If the piles are protruding and reduction cannot be affected put the patient to bed, give a hypodermic of morphine sulphate one-fourth grain and apply hot poultices.

Surgical Treatment.—If hemorrhoids do not yield to the above treatment a surgical operation is necessary, which is accompanied with very little danger. It may be done under local anesthesia, but general anesthesia enables an operator to accomplish his task with more thoroughness.


Causes.—Fistula in ano is a very painful disease, in which a communication at the side of the fundament is opened through the flesh into the rectum, or lower bowel, above the sphincter or muscle which ordinarily keeps it closed. It is usually the result of an abscess at the side of the intestine. There are several varieties of fistula, in the worst of which the fecal matters from the intestines constantly leak out through the hole or sinus, and besides causing great irritation and pain, render the sufferer disgusting to every one whom he approaches. Most of these different forms of fistula can, however, be cured by severe surgical operations.

Fissure of the Anus.—This is another painful affection, in which a slit or crack appears in the side of the fundament, often the result of a small ulcer at the edge of the opening. As it must be torn apart every time the bowels move it is very difficult to heal. Sometimes fissure of this kind can be cured by touching the sore with caustic, and using laudanum injections to keep the intestine in a state of comparative rest, but if these fail a surgical operation is the only remedy.

Prolapsus Ani.—Called also falling of the bowel, is the coming down of the rectum, which protrudes outside of the body sometimes to the distance of three or four inches. It generally results from constipation, and is especially apt to occur in weakly and neglected children. The protruding portion of the intestine should be carefully and gently pushed back to its place with the fingers covered with a well-oiled silk handkerchief, and suitable apparatus obtained from the instrument-makers to keep it in position. Sometimes an operation is necessary.



Jaundice is rather a symptom of disease than a separate malady.

Causes.—It may be due to a suppression of the secretion of bile by the hepatic cells; or, again, by an over-activity of these elements, and a super-abundant supply of bile in the system; or, thirdly, by obstruction to the outflow of bile, and reabsorption of its elements into the blood.

Symptoms.—It consists of a morbid yellowness of the skin, the white of the eye and other parts; but in bad cases this yellowness may become so intense as to appear olive-green, brown or even black. The urine is also of a yellow or saffron color, but the discharges from the bowels are pale and devoid of the natural brownish-yellow tint, sometimes having the bluish-white hue of potter's clay. Troublesome itching of the skin, slow pulse, low temperature, debility and a tendency to hemorrhage from the mucous membranes are frequent in jaundice.

Diagnosis.—The most important practical point is to determine whether the gall-ducts are obstructed or not. If they are closed, so that the stools contain no bile, the Jaundice speedily becomes intense and the swollen gall-bladder can sometimes be felt below the edge of the ribs. When not obstructed, the reverse is the case. Jaundice which comes on suddenly, is probably due either to a gall-stone or to nervous disturbance. Intense jaundice which has developed very gradually, probably results from pressure outside of the gall-duct, such as would be produced by a tumor or cancer.

Gall-Stones.—Intermittent attacks of jaundice point to gall-stones in old people, and to catarrh of the bile-ducts in children. Paroxysmal pain preceding jaundice points to gall-stones; following jaundice, to cancer of the liver. Jaundice with great enlargement of the liver, if the latter is painful and tender on pressure, indicates cancer; if painless, it suggests the waxy or lardaceous condition of the liver. When jaundice accompanies ascites, it is usually due either to cancer or cirrhosis. The danger of life from jaundice, unless it does indicate some fatal disease like cancer or cirrhosis is small; but in its severer forms it is often very obstinate, lasting for weeks or months.

Treatment.—The treatment consists of small doses of calomel or blue pill followed by a saline purge for a few days, avoiding salivation. The mercurial medicine may be substituted or aided by five grains of extract of taraxicum; podophyllin and leptandrin, in quarter-grain doses, and bicarbonate of soda in quantities of ten grains. Later on in the attack, five-drop doses of diluted nitro-muriatic acid may be administered with advantage, leaving a few days' interval between the last dose of any mercurial and the acid remedy.

Jaundice of Infancy.—It is very common to observe jaundice commence in the first or second day after birth. Usually of no importance. Probably due to diminished pressure in the portal system or to poteut ductus arteriosus. Recovery takes place in a few days or weeks. The severe forms may depend on septic poisoning with inflammation of the umbilical vein, congenital inflammation of the liver due to syphilis or congenital absence of the hepatic duct.


Causes.—Acute congestion of the liver may result from cold, from over-eating, or from the abuse of alcohol.

Symptoms.—Its symptoms are enlargement of the organ with tenderness on pressure, and a feeling of painful tension on the right side just above the edge of the ribs, often radiating to the right shoulder, slight jaundice, furred tongue, loss of appetite and scanty, high-colored urine are present, and the whole group of symptoms constitutes the condition commonly designated as "being bilious."

Treatment.—It is generally relieved by a small blue pill, or small doses of calomel followed by a saline purgative, and attention to diet for a few days. If neglected this form may run on to chronic congestion or lay the foundation of inflammation of the liver.


Abscess of the liver is the formation of pus in the substance of the organ. There may be one large abscess cavity or many small ones.

Causes 1.—It may be due to injury.

2. The presence in the liver of the amvela culi of dysentery.

3. Foreign bodies, gall-stones and retained bile.

4. Septic emboli which may come through the hepatic artery but usually through the portal vein from other diseased viscera and produce a purulent inflammation of the vein.

Symptoms.—The fever is of the hectic variety, high in the evening and low in the morning. Chills are sometimes present; pain is variable and may be felt in back of right shoulder. The liver is enlarged, painful and tender. Marked jaundice is rare. There may be bulging, and fluctuation is sometimes dectected[sic].

Treatment.—There is only one treatment, which is surgical.

Degenerations of the Liver.—Acute atrophy of the liver, waxy liver, and fibroid deposit in the liver are various forms of degeneration for which little can be done by medical treatment and which are fortunately rare. Not so, however, as far as regards infrequency, with cirrhosis of the liver, called also drunkard's liver and hob-nail liver, because of its origin in the abuse of alcohol and the peculiar contracted form which it presents. The process which the liver undergoes is a condensation of the substance and destruction of the secreting cells, with thickening of the connective tissue. The whole liver gradually contracts, ceases in great measure to manufacture bile and, becoming an obstruction to the venous circulation, produces ascites or abdominal dropsy, under which the sufferer generally succumbs.


Gall-stones are hard concretions which form within the gall-bladder, and when they attempt to pass out through the gall-duct often give rise to the most excruciating agony which the human being is capable of suffering.

Symptoms.—This pain is called hepatic colic, on account of its griping, tearing character, and may generally be distinguished by its coming on and passing off suddenly; by its frightful intensity; by being deep-seated instead of superficial; by being accompanied with vomiting and by the pulse being rapid and feeble. The onset may be marked by a chill and fever. It may last from a few moments to several days, and is often so severe that strong men will sometimes writhe and roll around on the floor, screaming in their agony. It seldom comes on before middle life, and women are much more frequently attacked than men. The pain is chiefly in the upper part of the abdomen on the right side. If a gall-stone remains in the duct for more than twelve hours, it is usually followed by jaundice coming on two or three days later. The affection terminates either by the stone slipping back into the gall-bladder or passing out through the duct into the bowel, in which latter event it may be found in the evacuations during the next week, and should always be searched for. The stone usually varies in size from that of a small shot to an inch or more in diameter, and in color from yellowish-white to dark-brown. If single, it is usually oval or rounded; but if two or more have been formed, the first one is marked by impressions of the others, and thus the prospect of future attacks can be estimated. Notwithstanding the alarming suffering, the danger to life is small, and death rarely eventuates from hepatic colic.

Treatment.—The treatment is by thirty-drop laudanum enemas or hypodermic injections of a quarter of a grain of morphia and one-one-hundredth of a grain of atropia, with chloroform or ether by inhalation, if the pain is unendurable. Hot fomentations, or hot baths, sometimes afford partial relief. In order to prevent the recurrence of hepatic colic, small doses of carbonate of soda, alkaline mineral waters, or a mixture of chloroform and turpentine have been highly recommended.

Value of X-Ray.—The use of the X-ray was found valuable in the diagnosis of gall-stones.


Symptoms.—The prominent symptom of ascites is the distension of the abdomen, which sometimes becomes enormously swollen, and by the pressure upward of the diaphragm gives rise to distressing dyspnoea.

Treatment.—When possible endeavor to remove the cause. Purge freely with concentrated salines, compound jalap powder twenty to thirty grains, elaterium one-eighth grain. Increase the action of the kidneys by infusion of digitalis two drachms, citrate of caffeine three to five grains, diuretin fifteen to thirty grains.

Auxiliary Treatment.—If the effusion is large and does not yield to the above treatment tapping is indicated, which is a procedure accompanied by very little danger. No anesthetic is required, and it gives almost immediate relief to the dyspnoea. Care must be taken not to draw off the fluid too rapidly, as this might cause collapse.

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Last Modified: Monday, 13-May-2013 15:31:46 EDT