In all cases of serious illness a doctor should be in attendance.. The information given in this section merely serves as a guide in recognising the most common ailments

Giddiness, or Vertigo, is a sensation of disturbed equilibrium, or may be exceedingly slight, following upon sudden movement, or become so marked as to cause staggering, reeling, or falling down. It may be due to a great variety of causes. Simple anaemia, or debility, is a common cause of giddiness in young people. It is frequently present in convalescence, due to the same cause - viz., poverty of blood and debility of the heart and circulatory system generally. In these cases an attack of giddiness may result in fainting, or may pass off, especially if the patient lies down quietly. In old people giddiness is sometimes associated with heart weakness or high tension in the circulation, due, perhaps, to uric acid in the blood. On the other hand, excessive smoking is a simple and very common cause of giddiness, from its depressing action upon the heart. Alcohol acts in the same way, and certain drugs, such as quinine, cause giddiness and ringing in the ears. Giddiness is very often associated with disorders of the eyes and ears. It may be caused by short sight or by squint. In both cases there is weakness of the muscles of the eyeball. This form of giddiness can generally be distinguished by the simple expedient of shutting the eyes, when the dizzy sensation passes off. The giddiness of Alpine climbers and the sea-sickness of many people frequently originate from some minor defect in the anatomy of the eye.

When giddiness is associated with deafness, the cause of the trouble is almost certainly due to some auditory defect. In such cases an ear specialist should always be consulted, as attention to the ear condition is the best method of dealing with the giddiness. Many nervous affections, including hysteria and neurasthenia, are associated with attacks of giddiness. It is this nervous giddinesss that often affects people who are overworked or undergoing great nerve or mental strain, and treatment consists in nerve rest, attention to general health, and removal of any cause of worry or strain. The vertigo of epilepsy has been described under that disease.

Lastly, giddiness is sometimes associated with disorders of the digestive system, and attention to any existing derangement of digestion is an important detail in treatment. Whenever the giddiness is associated with headache, vomiting, or convulsions, a doctor should be consulted, as these symptoms suggest some affection of the nervous system which requires professional care.

Glands (Enlarged). Swelling or enlargement of the lymphatic glands, especially in the neck, armpit, and groin, is a comparatively frequent occurrence from various causes. During the acute fevers the lymphatic glands swell. In diphtheria the glands of the neck are very much affected, due to the absorption of poison from the throat. Tubercular disease of the glands of the neck is very common amongst children, and requires treatment, as there is danger that, when they are neglected, they may ulcerate and leave a permanent scar. In such poisonous conditions of the blood as in cancer, enlargement of the glands invariably arises. Injuries which are followed by absorption of septic or poisoned matter into the blood give rise to enlargement of the neighbouring glands. If dirt is allowed to enter by some wound about the foot, or dye from a stocking is absorbed into the blood, swelling of the glands at the groin very frequently occurs. In the same way the glands at the elbow and arm-pit may become painful and enlarged when septic matter is absorbed from a wound in the finger.

Domestic treatment in most cases of glandular enlargement is of very little use. In some cases no action requires to be taken, but in other cases of enlarged glands surgical interference is called for.

Gout is a disease associated with disordered nutrition and excessive formation of uric acid in the system. This produces acute inflammation of the joints, due to the deposit of sodium urate round about the joints. The cause of the disorder is not definitely determined. There is some defect in the oxidation of the food, and the waste products of the body are not properly disposed of. The hereditary influence is considerable. Certain families seem to be more liable to the disease, which occurs almost entirely in men over the prime of life. Comfortable living, associated with a liberal allowance of alcohol, encourage gout. Excess of butcher's meat and nitrogenous food, and the drinking of heavy wines, such as port, sherry, and malt liquors, increase any tendency to the disease. Lead-workers are more liable to gout, whilst lack of muscular exercise is a very important factor. Asa general rule, an excess of nitrogenous food, especially flesh foods, brings about an accumulation of waste products in the system, the chief of which is uric acid. This uric acid circulates in the blood, and gets deposited about the joints in a crystalline form, causing sudden inflammation in the joints.

Changes take place in the tissues of the joints, the first generally involved being the great toe, the ankles and knees, and the joints of the hands and wrists. Little chalk stones sometimes appear, underneath the skin in the neighbourhood of the joints, which may ulcerate. The joint gradually becomes stiff and immovable, and chalky deposits may appear in the cartilage of the ear and nose as small white lumps.

There are three main forms of gout - acute, chronic, and irregular.

Acute gout generally begins with a twinge somewhere in the joints of the hands and feet, irritability of temper, and dyspeptic symptoms. The joint at the base of the big toe is the most frequently affected, and the pain is said to be of an agonising description. The joint swells and becomes hot and red, and there may be a good deal of fever or rise of temperature. The symptoms are generally worse at night, and may last several nights in succession, causing sleeplessness. The dyspeptic symptoms consist of lack of appetite and tenderness over the stomach and liver. There may be catarrh of the mucous membranes of the nose and throat. After an attack of gout the patient is generally much better in health for a few weeks or months, but as time goes on the intervals between attacks become shorter, and the disease becomes more or less chronic, or constant.

In chronic gout several joints are affected, and they gradually become irregular and deformed. Little chalk stones become deposited near the joints and over the tendons, and ulceration of these chalk stones very commonly occurs about the knuckles. Occasionally more acute attacks are apt to develop, and depression and irritability, owing to the pain and poisoned condition of the blood, are occasioned.

Irregular gout is the name given to a sort of gouty state of the general health. In certain gouty families one or two may suffer from acute or chronic gout, whilst others may escape any joint affection, but show symptoms of irregular gout, such as dyspepsia, eczema, attacks of biliousness, or affections of the heart and circulatory system. Headache and neuralgia are sometimes gouty in origin, and people who are of the gouty type are liable to suffer from chronic bronchitis and certain eye affections.

The treatment of gout will be dealt with in Part 12.