Rhus Tox. – Involuntary nocturnal discharges; cutting pains in the abdomen; almost constant urging to stool.
Sulphur. – Obstinate cases, where ordinary remedies fail in affording relief, especially where there is constitutional taint, or haemorrhoidal disease; also as an intercurrent remedy.
Administration. – In urgent cases a dose every twenty or thirty minutes; in less severe, every three or four hours.
CHRONIC DYSENTERY. – Phosphorus, Ac.-Nit., Sulphur, China, Colchicum, Calcarea carb., Verbascum-Vir., and Ac.-Phosphorus, are our chief remedies.
ACCESSORY MEANS. – The patient should maintain a recumbent posture in bed, in a well-ventilated apartment, and, in severe case, s use the bed-pan instead of getting up. Local applications afford great relief, the best of which is the Abdominal Compress (see Secale 28). If the pains are very severe, large hot poultices, or flannels wrung out of hot water, should be applied over the abdomen, a second hot flannel being ready when the first is removed. Great benefit often results from injection, if there be not too much inflammation to admit of the introduction of the enema tube they may be administered after each evacuation if they prove beneficial. The first two or three injections may consist of from half a pint to a pint of tepid water, the temperature being afterwards gradually reduced. Mucilaginous injections are also frequently of service, especially of linseed tea. The drink should consist of cold water, toast-water, gum- water, barley-water, etc.; the diet should be restricted to soda- water-and-milk, arrowroot, coca, broths, ripe grapes, and other liquid forms of food-all cold.
PREVENTIVE MEASURES. – Besides avoidance of the conditions pointed out under Causes, it is necessary promptly to remove, disinfect, and bury the evacuations from a dysenteric patient, and to adopt the Accessory and Precautionary Measures pointed out under Enteric Fever.
160. – Hernia-Rupture.
DEFINITION. – A protrusion of some of its contents through the walls of the abdomen, causing a swelling.
22 The term hernia is applied to the protrusion of any of the abdominal contents from the cavity of the abdomen. The popular term rupture is misleading, as the formation of a hernia is not attended with tearing of tissue.
VARIETIES. – The following are the most common – Umbilical Hernia makes its appearance at the navel, usually in infantile life; inguinal, in the groin; femoral, also in the groin, but a little lower than the inguinal region; and scrotal, in the scrotum. Reducible Hernia is one that can be returned into the abdomen; irreducible, cannot be returned; strangulated, is so constricted that the contents of the bowel cannot pass onwards and the circulation of the blood is impeded.
The general condition of the patient does not necessarily correspond with the gravity of the changes in the hernial contents, and is sometimes so little disturbed that he is able to sit up or even walk, although the bowel is already gangrenous.
The symptoms of strangulated hernia are essentially those of intestinal obstruction associated with a tender, tense and irreducible swelling. There is flatulent distension and colicky pains, with vomiting; desire to go to stool, and inability to pass anything, unless there be faecal matter in the bowel the seat of the obstruction.
If the condition is not relieved the patient sinks with symptoms of progressive toxaemia. The temperature is usually subnormal; the face is pale and drawn, and the expression anxious. There is great complaint of thirst. The tongue is dry and brown; the pulse small and rapid.
The alternatives before a patient with reducible hernia are, either to have the hernia controlled by a truss, or to have it cured by operation.
CAUSES. – Weakness of the abdominal walls from disease, injury, or congenital deficiency; violent exertion, as in lifting; immoderate straining, as in passing urine through a stricture, or in relieving the bowels.
TREATMENT. – No time should be lost in trying to push a hernia back into the abdomen, gentle force being exerted chiefly upwards and outwards as the patient lies with the hips raised, and the thigh on the ruptured side flexed. A copious injection of tepid water the author has known to be successful in cases which assumed a serious aspect, the escape of water from the bowel being rapidly followed by return of the rupture. But if not successful, the patient should be laid on a board, so placed as to form a steep inclined plane, so that the patient’s feet and hips are very much higher than his head; he should be firmly held in this posture by an assistant, when by pressure on the swelling, and often without any, the bowels will fall towards the chest, drawing with them the constricted portion. A gurgling sound will be the signal of success. After returning the Hernia a properly fitting truss should be employed, to exert a sufficient amount of pressure to prevent the subsequent protrusion. A truss should be worn constantly during the day time, and applied before rising from the horizontal posture. The skin of the part on which it presses should be washed daily, and for the first few weeks bathed with Eau-de-cologne or spirit-and- water, to prevent excoriation and the formation of boils.
If the ruptures resist the measures just recommended, the best surgeon within reach should be immediately sent for. Strangulation must be relieved, and the contents of the hernia returned within the belly with the least possible delay and this is best done by operation. In the meantime the foot of the bed is elevated ten or twelve inches, and hot fermentations applied over the hernia. While awaiting the result of these measures the preparations for operation are proceeded with and Aconite and Nux V. should be administered every fifteen or twenty minutes in alternation.
161. – Parasitic Disease of the Intestines – Worms.
(Entozoa).
The three most common parasites are the following – the Oxyuris Vermicularis (the small thread-worm), and the Ascaris lumbricoides (the long round worm); the Taenia solium (or pork tape-worm), and Taenia saginata (the beef-worm), the common tape- worm of this country. The tape-worm is the least frequent of the three types, and is very rare till after the third year. There are many other worms parasitic on man, but these three are the ones commonly met with.
The OXYURIS, from a quarter to nearly an inch long, is the smallest of the worms that infest the intestines; they often exist in clusters, rolled up in masses of considerable size, chiefly, but not exclusively, in the rectum. They are thread- like, white, and move very rapidly, and when touched contract to nearly one-half their usual length. The term maw worm is sometimes applied to them, from the irritation caused in the stomach by a reflex action. They do not exist in infants fed at the breast, unless other food, especially starch food, is also given, but are often met with in older children, and occasionally in adults. The symptoms to which this variety give rise are, – itching or irritation about the anus, especially troublesome in the evening, depraved or irregular appetite, offensive breath, picking of the nose, straining at stool, disturbed, and more or less general restlessness. The local irritation excited may be very considerable, extend to contiguous parts, and occasion a mucous or bloody discharge from the vagina, and even operate as a cause of masturbation., the same result may occur from direct migration of the worms from the anal to the vaginal or urethral orifice. The frequent but ineffectual desire to go to stool may occasion straining and Prolapsus Ani, effects which may continue after the expulsion of the worms. When the presence of thread-worms is suspected, they may often be found on examination of the stools, or crawling about the radiating folds of the anus after the patient gets warm in bed.
THE ASCARIS LUMBRICOIDES is very similar to the common earth – worm, but of a paler colour, sometimes almost white. It is of variable length, from six to fifteen inches, inhabits chiefly the small intestines, when it feeds on the chyle, but hot infrequently pass into the stomach and is vomited; or downwards in to the colon and is ejected with the evacuations. It has been seen in the gall bladder and hepatic duct, has visited the oesophagus, pharynx, and glottis; and has been found in. the air- passages coming by way of the oesophagus, and trachea, causing death by strangulation. Usually not more than one or two re present, but occasionally they exist in numbers. The disease is said to be most common in ill-fed children between the ages of three and ten years. The chief symptoms are, pains and swelling of the abdomen, depraved appetite, foetid breath, slimy stools, tenesmus, itching of the anus, and sometimes chronic Diarrhoea, most trouble some at night, with offensive, scanty, thin motions, much straining, and often prolapse of the bowel. Nervous symptoms are also common, -pallid countenance, dilated pupils, vertigo, disturbed sleep with grinding of the teeth, convulsions, chorea, etc. These symptoms my, however, be due, in part a least to the general functional derangement which favours other production of he parasite, and not alone to direct irritations.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."