239. Angular Deformity of the Spine Kyphosis Pott’s Curvature
DEFINITION- An angular deformity of the spinal column due to erosion and destruction by tuberculous disease (q.v.) of the bone, on the anterior aspect of the column.
It is liable to be associated with the formation of large abscesses, and with nervous symptoms referable to pressure on the spinal cord. It may occur at any period of life, but in at least fifty per cent. of cases it attacks children below the age of ten.
The tuberculous process may affect any portion of the spine and as a rule is limited to one region. The spinous processes of the affected vertebrae project and form a prominence in the middle line of the back.
CAUSES- Sometimes a fall, or blow, or other local injury is referred to as the immediate cause of the disease but the true cause is tuberculous infection of the bones. The progress of the disease is not necessarily rapid, hence the deformity may not become prominent till adult life.
TREATMENT- Attention should be given to the constitutional cachexia, and the following remedies be administered as may be most appropriate:- Calc-Phosphorus, Calc-C., Ac-Phosphorus, Silicea, Hep-S., Sulphur, Asafoetida, Mez., etc. (See also the Section on “Tuberculosis.”)
One important feature of the treatment is to relieve the pressure on the diseased bones and cartilages; and to accomplish this rest to the affected part for a period of at least a year is absolutely required. This is attained by suitable apparatus which fixes and supports the spine. Generous, nutritious diet must be given, and deleterious elements avoided. Bathing and friction should be daily practiced. When sufficiently recovered, out of door exercise in fine weather, with the suitable supporting apparatus, should be secured.
230. Lateral Curvature of the Spine Scoliosis.
DEFINITION- A persistent deviation of the spine from the natural erect form to the right or left side; chiefly affecting females from about the age of ten to sixteen or upwards. A curvature is said to be right or left according as the convexity of the curve is towards one or other side. The spine assumes a double curvature one being termed primary the other is a compensatory curve in the opposite direction to restore the balance, disturbed by the primary curvature, and is termed secondary.
SYMPTOMS- The spine is curved something like the letter S, and also twisted in its long axis one of the scapulae, and the other side of the bosom project, and one (usually the right) shoulder and side of the chest are preternaturally high and rounded, while the opposite are depressed and concave. Correspondingly, the hip on the side opposed to the convexity projects, and the loin on the same side is curved inwards.
CAUSES- Spinal curvatures are readily produced, in weakly patients, by occupations and pastimes that tax one side of the body more than the other; bad postures while sewing, ironing, writing, drawing, reading, playing the piano, riding, carrying a child on one arm, and the exercise of many kinds of handwork. Even bad postures in lying, sitting, and standing are liable to cause Lateral Curvature. All occupations which require the raising of one shoulder-blade and arm, standing at ease on one leg, crossing the legs, sitting on one side of the seat, leaning on one hip; want of unrestrained open-air exercises; tight dresses stays and bodices with steel, whalebone, or wooden supports, may operate as causes of curvatures. One leg being shorter than the other, walking with an artificial leg, Hip-joint disease, Rickets, paralytic affections of the lower extremities, Rheumatism, etc., may also cause distortion.
Scoliosis is due to the combined influence of weak muscles and ligaments, imperfectly ossified bones, and the repeated, or habitual assumption of faulty attitudes. The excessive use of one arm in the carrying of weights, the habit of resting on one leg more than the other, or the occasional assumption of a faulty attitude, in writing or in playing the piano or violin, doubtless determine the seat and direction of the curvature, and when it has once commenced tend to aggravate and perpetuate it, but too much stress has hitherto been laid on such factors in the causation of the deviation.
The development of scoliosis is always slow and insidious. As a rule attention is first attracted to the deformity about the age of puberty, but in most cases it has existed for a considerable time before it is observed. The patient usually a girl, though it occurs in boys is easily fatigued, has difficulty in keeping herself erect, and often complains of pain in the back and shoulders, and along the spaces between the ribs on the side of the convexity. To relieve the muscles of the back she is inclined to lounge in easy and ungainly attitudes.
TREATMENT- This must be both constitutional and local, and be regulated by the nature, extent, and cause of the deformity. If treatment is neglected, curvatures, however slight, will certainly get worse, for the extreme flexibility of the spine in youth, while it offers a favourable condition for cure, equally tends to an aggravation of the deformity if treatment is neglected. Further, as rigidity of the column increases with years, so the prospect of improvement diminishes at the same time, and for the same reason, Curvatures of long standing are less likely to grow worse.
REMEDIES- Calc-Phosphorus, Calc-C., Ac-Phosphorus, Silicea, Pulsatilla, Sulph, etc. Externally, a weak Arnica Liniment may be used.
The child must not be allowed to assume awkward attitudes while reading, writing or playing the piano; she must sit on a low chair, the seat of which slopes slightly downwards and backwards, and the back-rest of which reaches as high as the shoulders, and is at an angle of 100 degree to 110 degree with the seat. The feet should rest on a sloping stool, and when the child is reading or writing, a desk sloping at an angle of 45 degree should be used. In weakly girls approaching the period of puberty, special care should be taken to avoid compression of the trunk by tight corsets. Adenoids or other sources of respiratory obstruction must be removed, and if the patient is short-sighted suitable glasses should be provided. Standing should be avoided as there is great tendency to throw the weight on to one leg, but walking, running, swimming and other exercises which bring both sides of the body into action equally are permitted under supervision. Horse riding is a suitable form of exercise, but girls must ride astride.
In mild cases the above measures must be rigidly enforced, and gymnastics exercises prescribed. These should not be commenced, however, until after a period of rest in the recumbent position, all pain and feeling of tiredness in the back have disappeared.
In cases in which the curvature is not obliterated by suspension the deformity is irremediable, but by suitable exercises it may be prevented from becoming worse.
Appliances, such as supporting jacket, have no curative effect and can only be expected to relieve symptoms.
231. Morbus Coxae Tuberculous Disease of the Hip-Joint.
This is a slow, insidious, and serious disease. The child is supposed to be suffering from “growing pains” for months before the disease assumes an active form.
SYMPTOMS- The first distinctive symptoms are slight pain, not infrequently referred to the knee lameness, and weariness, and the limb is flexed and relaxed. Remedies are often applied to the knee, but the disease is in the hip. As the disease progresses, the nates of the effected side waste and become flabby; the limb is shortened, either by caries of the neck of the femur, or by destruction of the ligaments of the joints and consequent dislocation of the joint upwards on the dorsum ilii. There is increased fulness about the limb, the pains increase in severity, especially at night, and there are often startings of the limb during sleep Abscesses form, and afterwards burst on the nates or groin, or burrow deeply and discharge their contents into the rectum. Wasting of the nates of the affected side is one of the earliest symptoms of disease of the hip.
The duration of the disease varies from two to three months to several years. But it is much modified, both as to its duration and results, by skilful treatment.
White swelling of the joints is a disease of similar character.
TREATMENT- The medicines likely to prove beneficial are Aconite, Belladonna, Tuberculinum bov., Coloc., Hep-S. and Arsenicum, in the early stage of the disease for special symptoms, Calc-C., Silicea and Phosphorus
ACCESSORY TREATMENT- Rest of the affected part; surgical appliances are necessary to insure it. The diet should be nourishing, and include Cod-liver oil. Pure air, and especially a change by the sea-side, will expedite the cure. (See under “Tuberculosis”).
232 Acute Abscess.
Acute circumscribed abscess is the term applied to a localized rapidly formed collection of pus in a cavity produced by the suppurative process.
(a) Acute Abscess commences with a sensation of tension, gradually increasing to a definite throbbing pain, tenderness, heat, bright redness, and swelling of the part; these symptoms are soon followed by suppuration, which is marked by an alteration in the colour of the skin, and a change in the character of the pain, the former being livid, and the latter less acute, being rather felt as a sensation of weight and tension. After this, the parts between the Abscess and the surface become successively softened and disintegrated. The tumour becomes more and more prominent the centre exhibits a dusky-red or bluish tint, the cutis ulcerates, the cuticle bursts, and the pus escapes. But where pus is formed under dense fasciae, or deep in the breast or pelvis, and cannot quickly make its way to the surface, the pain is not relieved, but much aggravated by the increase of distension; and constitutional fever and chills are much more intense.
(b) CHRONIC ABSCESS first appears as an indistinct tumour, the fluctuation being more or less marked according to the distance from the surface. The inflammatory symptoms of the acute variety are altogether absent, unless the disease be far advanced or accidentally irritated.
ABSCESS AND DISEASED BONE- Chronic Abscess is sometimes a consequence of Inflammation of bone. This may be suspected whenever persistent inflammatory enlargement and tenderness exist, especially it it can be traced to an injury, and there is a fixed pain at one particular spot, which is increased at night. Often requires surgical measures for its relief and cure.
MAMMARY ABSCESS- gathered breast is specially treated of in “The Lady’s Homoeopathic Manual.”
CAUSES- Abscesses, with few exceptions, are indicative of constitutional debility, and are a frequent sequel of low exhausting fevers. Sometimes they result from blows, or from foreign bodies introduced into the skin or flesh splinters, thorns, etc.
Diseased bone, as stated above, may cause Abscess, or inflammatory enlargement of a part.
EPITOME OF TREATMENT:-
1. Before suppuration- Aconite, Belladonna, or Mercurius Lint saturated with a lotion of the same remedy as administered may be used locally.
2. During suppuration- Hep-S., Silicea, Arsenicum, China.
3. After suppuration- Calc-C., China, Ac-Phosphorus, Sulphur, etc.
LEADING INDICATIONS- Hepar Sulph. This remedy promotes the suppurative process in acute Abscesses, and is frequently sufficient. The local measures pointed out further on should be adopted.
Silicea- Tardy, long-continued discharge chronic Abscesses and Abscess of bone. It facilitates suppuration, or moderates it when excessive.
Mercurius- Painful Abscess, with copious discharge of thick matter; chilliness, with thirst, and nocturnal aggravation of the pains.
Belladonna- Severe pains, Headache, and much constitutional disturbance.
Arsenicum- Severe burning pain, with symptoms of general vital depression Abscess having a gangrenous appearance, or discharging pus tinged with blood.
China- Abscesses following prolonged disease; prostration, from excessive discharge of matter or blood, Diarrhoea, etc. It generally sustains the constitution during suppuration.
Calcarea- This remedy assists the healing of the Abscess after suppuration is completed, and the elimination of disease from the constitution.
Aconitum- Well-marked, feverish symptoms, during any stage of the disease.
LOCAL TREATMENT- In the early stage, when suppuration is doubtful, treat as for acute inflammation with hot fomentations frequently repeated. Abscesses arising from local injury should be freed from all sources of irritation, such as thorns, splinters, etc. Fomentations relax tension, and, consequently, relieve pain; if applied directly an Abscess begins to develop, they will either disperse or restrict the formation of pus. If suppuration have proceeded too far to be arrested, fomentations facilitate the progress of the pus to the surface and its ultimate expulsion.
OPENING OF ABSCESSES- When the presence of pus is clearly indicated, it ought to be let out by incision. The latter relieves all the symptoms quicker, accelerates healing, and much less scarring will remain when healing is complete than if the abscess be left to burst spontaneously. An abscess left to itself may, moreover, discharge into some internal cavity, where the result may be serious. For those who dread pain even in the trifling operation here referred to, the use of local anaesthetic agents is recommended.
After an Abscess has been opened, and it contents discharged, the Calendula lotion (one teaspoonful of the tincture to three tablespoonfuls of water) greatly expedites recovery. It may be applied on a fomentation, covering it with oil-silk. The dressing should be renewed two or three times a day.
DIET AND HYGIENE- As Abscesses are generally indications of debility, a liberal allowance of nourishing food is of great importance it should include good animal broths, broiled mutton chops, chocolate or cocoa, and, in some cases, but rarely, good bear or wine. Change of air, with residence by the sea-side or in the country, forms an important part of the hygienic treatment.
DEFINITION- A Ganglion is a small swelling, filled with fluid or jelly, formed on one or more of the tendons, frequently of the back of the wrists, rarely larger than a child’s marble, generally smaller, attended with weakness, but free from pain.
CAUSES- Protrusion of the lining synovial membrane through the fibrous tendon sheath. Ganglions are often seen in pianists who practise many hours daily. But they are not confined exclusively to this class of persons.
TREATMENT- (1) Subcutaneous rupture by pressure. (2) Puncture followed by pressure. (3) Excision. A method suggested by Dr. Clifton, of Northampton, is the internal and external use of Benzoic Acid; 2 drops of the 2x dil. thrice daily. For external use Benzoic Acid, gr. iij. Glycerine Cerate, 3zj.; to be well rubbed into the part morning or night. Phyto. and Mez. are also efficient.
234. Obesity Corpulence.
DEFINITION- The excessive accumulation of fat under the skin and around the organs of the body, so as to exercise a prejudicial influence on the health, usefulness, or comfort of the patient. It is not a favourable condition for resisting disease.
Obesity may be said to exist only when fat is present in such large quantities as to disqualify the person for performing the various duties of life, by occasioning difficulty of breathing, panting on slight exertion, deranging the circulation, and causing various functional disturbances, with diminution of mental and bodily activity. The term Corpulence is restricted to cases in which the quantity of fat is not so great as to amount to positive inconvenience or discomfort.
CAUSES- Hereditary tendency or constitutional predisposition can alone account for the excessive accumulation of fat in many instances. Some persons are naturally fat, others lean; some become corpulent on a moderate diet, others spare in the lap of luxury. These are matters of common observation, but which we can offer no explanation. Age exercises considerable influence; children are usually fatter than adults after the middle period of life, fat often accumulates in considerable quantities. In old age, however, the adipose tissue, and the fat it contains, generally diminish. Race, again, is an important element in the question. The Americans are remarkable for their leanness, and the Arab is almost destitute of fat; Europeans, and especially the English and the Dutch, on the other hand, are proverbially fat; hence, John Bull is always pictured excessively corpulent.
Besides individual or accidental causes of corpulency, the following circumstances directly influence the production of fat. Food, rich in hydrocarbons; for although a certain amount of such food is necessary to maintain the temperature of the body, if it be taken in excess, such excess is often stored up as fat. Ease of mind and repose of body are conditions highly favourable to the formation and accumulation of fat; whereas anxiety, fretfulness, night-watching, etc., have a directly opposite effect. Thus science proves the truth of the adage “A contented mind is a continual feast.” A comfortable temperature is an important element in the production of corpulence; for although a high temperature does not directly engender fat, it is a condition favourable to the formation of fat, and one in which less is consumed.
TREATMENT- The treatment of Corpulence brought prominently before the public by the late Mr. Banting, ( *See the Fourth Edition of Mr. Banting’s pamphlet.) in the simple story of his remarkable experience, proves that a proper diet alone is sufficient to remove the condition, with its long train of evils, without the addition of nauseous drugs, or of those active exercises which it is in vain to instruct unwieldy patients to take.
The chief feature in the Banting dietary is the exclusion of two elements starch and sugar from the ordinary food of a well-to-do gentleman: Bread, (except toasted, or the crust off a common loaf), potatoes, sweet roots, butter, sugar, cream, beer, port and champagne.
These articles of food and drink contain starch or saccharine matter and are the chief fat-producing elements in our dietary, and to relinquish them is often the only means necessary to escape the thralldom of corpulence. In one year, on this diet, Mr. Banting reduced his weight 46 lbs. and his bulk about 12 inches; at the same time his numerous corporeal infirmities were greatly mitigated or altogether removed. Seven years afterwards he wrote:-
“I can conscientiously assert that I never lived so well as under the new plan of dietary, which I should formerly have thought a dangerous, extravagant trespass upon health; I am very much better, bodily and mentally, pleased to believe that I hold the reins of health and comfort in my own hand.”
The “Plan of Dietary” suggested in Secale 2, with the sugar, butter, cocoa, superfluous bread, potatoes, etc., eliminated from it, would meet the requirements of most corpulent persons admirably. A Banting diet cannot, however, be recommended indiscriminately. Persons who may deem it necessary to make great changes in their diet should consult a physician.
As a resume for the guidance of the corpulent, it may be said that the fat of meat; butter, cream, sugar and sweets; pastry, puddings farinaceous articles, as rice, sago, tapioca, etc.; potatoes, carrots parsnips, beet-root; sweet ales, porter, stout; port-wine and all sweet wines, should be avoided, or only taken to the most sparing extent. The articles allowable, and they should be taken to the extent of satisfying a natural appetite, are lean meat, poultry, game, eggs, milk moderately, green vegetables, turnips, succulent fruits, light wines (as claret, Burgundy, hock, etc.), dry sherry, bitter ale in moderation, and spirits. Wheaten bread should be consumed sparingly, and brown bread is to some extent better than white. The gluten biscuits prepared for the diabetic may, on account of their comparative freedom from starch, be advantageously used as a substitute for bread in the treatment of Obesity. Pavy on Food.
235. Old Age and Senile Decay.
Human life may be divided into three great epochs the period of development, that of middle life, and that of physical decay. (*See Dr. Anstie on Neuralgia, in Reynold’s System of Medicine, vol. I).
Under the first division is included the whole time from birth up to about the twenty-fifth year, during which the vegetative organs and those of the lower animal life are consolidating. The central nervous system is more slow in reaching its highest development, and the brain especially is many years later in acquiring its maximum of organic consistency and functional power.
The middle period of life between about the twenty-fifth and the forty-fifth year is the time that the individual is subjected to the greatest pressure from external causes. The industrial classes are absorbed in the struggle for maintaining themselves and their families; the rich and idle are immersed in dissipation, or haunted by the mental disgust it excites. At the same time, the women are going through the exhausting process of child-bearing, and are either surrounded with the cares and duties of a poor household, or equally pressed with anxiety to attain positions for themselves and their children in fashionable life; or they are idle and heart-weary; or forced to an unnatural celibacy. Frequently they are both idle and anxious.
The period of decline may be said to commence when the first indications of distinct physical decay manifest themselves, and when a new set of vital conditions come into force. But there are no sharp lines of demarcation between the epochs thus indicated, the one insensibly growing into the following.
YOUTH AND AGE- Although the activity of the growth of the organs in childhood and youth offers a striking contrast with their decline in old age, there is, notwithstanding, a resemblance in the diseases of the two extremes of life, like the tints of the rising and setting sun. Infantile. Convulsions, and senile Convulsions; infantile Diarrhoea, and senile Diarrhoea; infantile Eczema, and senile Eczema; may be adduced as illustrations of the resemblance of the diseases affecting the two extremes of life. In the early period the constitution has not acquired its vigour; in the closing, it is losing it.