MEDICINE. 



expectoration is occasionally streaked with blood, 

 or there may be severe bleeding from the lungs. 

 As the disease progresses, the cough becomes 

 more distressing, is often deep and hollow, 

 and there is an expectoration of purulent matter, 

 often in the form of flattened circular masses. 

 The patient becomes weaker, from the occur- 

 rence of copious perspirations during the night, 

 and the violence of the cough. The body 

 gradually wastes. In the centre of each cheek 

 there is often a diffuse spot of a delicate rose-tint, 

 the eyes become pearly white and brilliant, and 

 the patient has a refined and spiritual appearance 

 peculiar to the disease. The intellect is unim- 

 paired, and hope is usually strong. Death is 

 caused by exhaustion, or by an acute attack of 

 pleurisy or pneumonia, or by a severe haemorrhage 

 or bleeding. The symptoms above described are 

 so characteristic, that it does not require the art 

 of the physician to detect the disease ; but by 

 means of the stethoscope, he can watch its gradual 

 development, and can usually give information 

 regarding the exact condition of the lung. With 

 regard to treatment, it is of the greatest import- 

 ance to improve the general health. Anything 

 calculated to cause mental or bodily irritation 

 should be got rid of. The patient should be much 

 in the open air during fine weather, and should take 

 a nutritious diet. If bleeding take place, the blood 

 is of a bright red colour, and is frothy. The treat- 

 ment then is : rest in the recumbent posture, cold 

 drinks, sucking ice, and the administration of ten 

 grains of gallic acid, or one lead and opium pill every 

 three hours till the bleeding ceases. Consumptive 

 persons have usually weak powers of digestion, 

 and suffer from dyspepsia ; and the diet suitable 

 in one case may not be so in another. Relatives 

 should therefore study the likes and dislikes of 

 the patient, and endeavour, with the art of good 

 cookery, to introduce into the body, in one form 

 or other, milk (with lime-water, if there be 

 acidity of the stomach), eggs, butter, cream, beef- 

 tea, &c. A glass of good wine daily, or bitter 

 beer, is often useful. 



The next point to be attended to is climate. 

 There can be no doubt that in many cases of con- 

 sumption, life may be prolonged, and even saved, 

 by a judicious selection of a warmer and more 

 equable climate than that experienced in most 

 parts of the British Islands. The difficulty is, that 

 few can afford the expense of living at a distance 

 from home. But change even to a distance of a 

 few miles into the country may do good. During 

 the summer season, residence on the west coast, 

 by the side of one of the sea-lochs, where the 

 patient can be out in the open air for several 

 hours daily, is always beneficial during the earlier 

 stages of the disease. If the expense can be borne, 

 the patient may reside during the winter at Tor- 

 quay, Hastings, Bournemouth, or Penzance ; and 

 on the continent, at Mentone, Cannes, or Nice. 

 No journey should be undertaken to any of these 

 health resorts without medical advice, because the 

 climate of the one is not the same in many par- 

 ticulars as that of the other, and one place may 

 be more suitable for certain cases than for others. 

 During an early stage of the disease, a sea-voyage 

 is often very beneficial, but it should not be taken 

 without consulting a medical man. It is often a 

 very difficult task for the family physician to give 

 advice as to going abroad, and yet the matter 



must be left to the decision of one who knows all 

 the circumstances of the case. No doubt many 

 have sailed for foreign lands who should have 

 remained at home ; but, on the other hand, there 

 are persons now alive in such colonies as New 

 Zealand and Natal who would, in all human prob- 

 ability, have been in their graves had they re- 

 mained in their native country. With regard to 

 medicines, it may be stated generally that in 

 phthisis they are not of much avail, except in 

 the alleviation of symptoms. Nauseating cough- 

 mixtures should be avoided, as they impair appe- 

 tite. The great remedy is cod-liver oil, which 

 supplies fatty matter to the system. This oil 

 should be regarded as a form of food more than 

 as a medicine. Most persons can take it after 

 a little experience, and the results are almost 

 always good. Small doses, such as a tea-spoonful, 

 should be taken at first ; these may be increased 

 to the extent of a table-spoonful twice daily after 

 food. If cod-liver cannot be borne by the stomach, 

 cream, or milk and egg, should be substituted. 



IV. DISEASES OF THE ORGANS OF EXCRETION. 



The organs of excretion separate from the blood 

 matters hurtful to the economy. They are the 

 Bowels, the Lungs, the Liver, the Kidneys, and the 

 Skin (see HUMAN PHYSIOLOGY). The diseases 

 of the bowels and lungs have been already de- 

 scribed ; those of the skin are so numerous, and 

 require such special experience and knowledge 

 for their identification, as to place it beyond the 

 limits of this article, even to enumerate them, 

 far less to state their leading characteristics. We 

 have, therefore, now to deal with the affections of 

 the liver and kidneys. 



i. The Liver. This large gland is liable to con- 

 gestion and inflammation, both acute and chronic ; 

 but as these diseases are not common in this 

 country, we shall not describe them. There is a 

 form of inflammation of the organ which is not 

 unfrequent, called cirrhosis, or spirit-drinker's 

 liver, which is frequently met with. It occurs 

 usually in persons of middle life who have been in 

 the daily habit, for years, of introducing a con- 

 siderable quantity of alcohol into the system. 

 Alcohol is taken up by the blood-vessels of the 

 stomach, and conveyed by them to the liver. Here 

 it excites chronic inflammation of the connective 

 tissue between the small lobules of the liver, and 

 causes an hypertrophy, or increase in growth of 

 this tissue. At this period of the disease, the 

 organ is enlarged, and its edge may be felt ex- 

 tending far into the left side of the abdominal 

 cavity. After a time, the tissue contracts, and 

 presses on the blood-vessels supplying the lob- 

 ules, so as to prevent these obtaining a due amount 

 of blood. This leads to an atrophy or wasting 

 of the proper secreting structures of the liver 

 the hepatic cells; and the gland, in consequence, 

 does not efficiently perform its functions. At this 

 stage, it is smaller than natural, and its surface is 

 uneven, presenting little lumps or knobs, which 

 may be felt through the abdominal wall The 

 patient's general health suffers, the skin becomes 

 yellow or jaundiced, and from the obstruction to 

 the flow of the blood (collected from the stomach 

 and bowels) through the liver, dropsy, or the effu- 

 sion of serum into the abdominal cavity, is the 

 result. This disease is fatal, and is a sad example 



T7i 



