Phlebitis is an inflammation of veins, which may either be simple or suppurative. It may happen as a result of an accident to the vein walls or inflammation of the parts round about veins, whilst it is very commonly associated with gout. The vein becomes swollen and dusky red in colour, and there is a good deal of pain, especially on movement or pressure. A cordlike swelling is apparent in the case of superficial veins such as in the leg. The veins may become obstructed, and occasionally an abscess forms, due to suppuration.
When pain is present, absolute rest may be required, as if there is a clot in the part movement may cause it to become detached and carried off in the circulation, when it may plug an important artery in the brain or lungs. The limb may have to be elevated and evenly and firmly bandaged. If there is much pain, a mixture of glycerine and belladonna should be painted over the vein, or some lead and opium smeared on the part with a piece of lint. Hot poultices of lint wrung out of boracic. lotion should be placed over the part. If an abscess forms the doctor will have to open it antisep-tically. The patient should have light diet and be given occasional doses of salts.
In serious cases the inflammation becomes suppurative and spreads up the vein, when there is danger of blood-poisoning. It is important to attend to any constipation, which may be present, and the general health should be as much as possible improved. All severe exercise should be forbidden so long as there is the slightest tendency to phlebitis of the vein in the leg.
Phthisis, or consumption, is a tubercular disease of the lungs, caused by a minute germ called the tubercle bacillus. There are two types of the disease - acute, or galloping, consumption, and the chronic form, which persists for years, and which has been more amenable to treatment since open-air methods were utilised in this country. In acute phthisis, the patient may at first show the symptoms of ordinary bronchitis, and the temperature is what is called " hectic " in type - that is, it is normal in the morning and raised in the evening to 101 or 102 degrees. There is a good deal of cough, and night sweats are nearly always present. Weakness and progressive loss of weight are very characteristic in typical cases. The disease is commonest in young people,* especially where there is a family history of consumption. It may follow measles or whooping cough, or complicate other lung affections.
Treatment of acute phthisis does not come under the heading of domestic medicine.
Chronic tuberculosis of the lungs is very widespread in this country. It accounts for many thousands of deaths per annum which might be prevented. Like the acute form, it is caused by the tubercle bacillus, which finds its way into the lungs, sets up congestion, inflammation and suppuration, gradually destroying the lung tissue. The old idea of phthisis was that it was invariably hereditary, but we know now that it is only the tendency or weakness of disposition that is inherited, and that phthisis is always due to infection. The normal person is very resistant to infection. Everyone must be exposed constantly to the tubercle bacillus, which lurks in dust, which finds its way into milk and other foods, and which is constantly being shed into the atmosphere by the coughing of infected persons. When we are well, even if we breathe tubercle bacillus into our lungs, we can destroy them by sheer force of our own resisting power.
In circumstances of exhaustion, malnutrition, starvation, people are more susceptible to the disease, whilst it flourishes in unhealthy surroundings to an alarming extent. Indoor occupations, such as clerical work, shop work, dressmaking, etc., favour the development of the disease, and those who are exposed to a dust-laden atmosphere are more liable to contract consumption.
Symptoms. The disease is chronic. It comes on gradually, and in the early stages responds to treatment, especially since the introduction of modern hygienic measures. So that the earlier the disease is diagnosed, the better chance the patient has of complete recovery. Chronic cough, progressive weakness, and loss of weight are early symptoms in most cases, but the first manifestation of the disease may be haemorrhage from the lungs.
Young people in the prime of life are most likely to develop consumption, which sometimes comes on in the course of an acute lung attack, such as pleurisy or pneumonia. Whenever there is any suspicion of tubercular disease, prompt measures should be taken to check the tendency in its early stages. The temperature is an excellent guide, for so long as the temperature is normal, one need not be afraid that the tubercular process is making progress, even if it exists in the body.
Some authorities declare that of almost every person dying above the age of thirty, five have tubercular spots in the lungs, which means that the tubercular bacillus has attacked some part of the lung, leaving a scar after the patient has recovered and the affection has been overcome. There is not the same sense of hopelessness in dealing with cases of consumption nowadays as in the past, when hygienic conditions were not understood, and treatment was so ineffective that fatal results were very common.
When a doctor discovers by examining the sputum that tubercle bacilli are present, and when, by sounding the lungs, the presence of tubercular inflammation is apparent, the patient is made to take up a certain mode of life. He has to live as much as possible the open-air life, and take a definite amount of exercise carefully regulated so as to avoid over-fatigue. He has to be removed from any unhealthy environment, and when this is possible he has a good chance of recovery. Unfortunately, amongst the poor classes, where dust and dirt prevail, the mortality from phthisis is very high and the disease sometimes makes rapid progress. When these patients can be moved to a sanatorium, where regular life and open-air methods prevail, they have a very good chance, but even when people cannot afford sanatorium treatment, much can be done by method in the home.
The advantages of a sanatorium are many.
The patients are under the doctor's care from day to day. They are constantly exposed to fresh air and sunlight, which directly destroy the tubercle bacillus. They are given a large amount of the right kind of food and made to live entirely hygienic lives, whilst, at the same time, they have to rest when the temperature indicates that rest is necessary.
Over-fatigue is one of the worst things possible for patients suffering from phthisis. Good food is necessary to build up the strength of the patient, and to prevent him from losing weight. Thus the food should be abundant and appetising. In some sanatoria the patient is given thirteen pints of milk, or their equivalent in other foods, but over-feeding, without proper proportional exercise, is not a good thing, as the patient simply gets fat without affecting the course of the disease.
As a rule, a phthisical patient is not despondent, but rather optimistic in temperament; but even when there is no depression, the effect of amusement and recreation is good, although anything in the shape of excitement should be avoided. All these points are carefully attended to at sanatoria, and one excellent result of these places is that people who have been there generally take back their open-air habits into their homes.
When treatment is organised at home the great thing is to impress the importance of breathing fresh air day and night. As much time as possible should be spent out of doors and the windows must always be kept open day and night, whatever the weather may be. Whenever there is a strip of garden, a shelter can be erected. Indoors much can be done to make the patient sleep with windows wide open, and to pay attention to hygiene and cleanliness and the taking of food.
Pigeon Breast is a deformity of the chest which is found in rickets. It is a disease of malnutrition which will be described later. The rib and breast bones are altered in shape, and the chest is depressed at the sides, so that the breast-bone sticks out in front. It requires to be treated by a doctor, as the child's whole health will be affected unless proper diet and other hygienic treatment are provided. (See " Rickets.")
Piles, or Haemorrhoids, show a varicose condition of the veins of the lower intestine. It is associated with constipation, and in bad cases there may be a good deal of haemorrhage and pain. Headache, faintness, and anaemia, constant fatigue and irritability are common symptoms. There are various causes of haemorrhoids, but the chief of these is certainly constipation, associated often with a sedentary habit of life. The taking of alcohol causes congestion of the liver, and this in itself may produce piles; therefore, rich food or anything causing strain upon the liver should be avoided.
In treating this condition, regulation of diet and outdoor exercise are important. It is necessary to guard against constipation. A glass of mineral water in half a tumblerful of hot water should be taken night and morning. In bad cases the patient should rest in bed, and surgical treatment may be called for. To be continued.