Effort Syndrome

Effort Syndrome Neurocirculatory Asthenia—Soldier's Heart. These many long names merely indicate a weak heart, and a weak heart does not imply a diseased heart.

Because a man's heart cannot stand the inhuman strain of soldiering, it does not necessarily follow that he is not good for anything, and is an invalid; just as well as the mental abhorrence of war does not prove a man a coward or mentally unbalanced.

But the inhuman physical and mental strain of war is enough to cripple both the heart and mind of the average normal man, as the overwhelming number of physical and mental breakdowns among soldiers have proved.

That is why "soldier's heart" is also called "neurocirculatory asthenia," because it is a complete oozing out of nerve energy and an exhaustion of the heart and circulation, from the unnatural physical and mental strain. In this condition, the patient feels weak, faint, dizzy and has a suffocating, breathtaking pressure around the heart.

His pulse is rapid, and his blood pressure high. He may be covered with a cold sweat, feel numb in his limbs, and tremble all over, but he has no fever. His breathing is rapid and he cannot hold his breath for more than a few seconds, while the normal person can hold his breath for a few minutes.

After an exercise test his pulse rate stays high, while in a healthy person the pulse rate returns to normal in a minute Or two. In all such cases, the presence of organic diseases of the heart, lungs and other organs must be excluded.

If such diseases are present, they must receive prompt treatment, otherwise the treatment consists of separating the patient from his exhausting task, giving him a complete rest in bed, a light but nourishing diet, and absolute abstention from alcohol, tobacco and coffee.

Neurocirculatory asthenia is not exclusively a soldier's disease, civilians who overwork, overeat, and knock themselves out with indulgence in alcoholic beverages and tobacco will get similar attacks. And the treatment is the same as for the soldier.

But don't let yourself in for the "nerve section" operation which has been done in such cases.

Carbolic Acid Uses

Carbolic Acid or phenol is a corrosive poison and should never be used internally. It should not be used even in the small doses doctors were wont to prescribe as an intestinal antiseptic; neither should it be used as an external application for any length of time.

Don't use carbolized vaseline too freely, or for a long time, or for application over large areas of the body. Carbolic acid is easily absorbed by the skin, and may cause damage to internal organs and general poisoning.

It is very injurious to the small blood vessels, depriving tissue of its blood supply, and causing, first, anesthesia of the skin, then blanching, and finally turning it dark and gangrenous.

In weak solutions or as carbolized vaseline it may be used only in emergencies on wounds or infection of the skin or for the relief of itching; but never for continuous or frequent application.

Don't use it as an application for the destruction of warts or blemishes without a doctor's supervision. If carbolic acid spills on the skin accidentally, wash it off with alcohol immediately and then rinse with lots of water.

If swallowed, give whites of several eggs and make the patient vomit; give diluted alcohol, made by diluting whiskey or other liquor with four times as much water, and make the patient vomit right after. Repeat it twice, then give lime water for further vomiting.

Follow this with strained gruels in small quantities, to be retained. Diluted cider vinegar is one of the best antidotes for carbolic acid poisoning. Epsom salt is also good if there is nothing else on hand. It is advisable to give Epsom salt daily for a few days even if other antidotes have been used.

 If none of the above antidotes are around, scrape plaster from the wall, powder it well, mix with water and have the patient drink it. Get a doctor; meanwhile keep the patient warm and give artificial respiration if needed.

Ice and Ice Bag

Ice can be as badly contaminated with disease-producing germs as polluted water. It was found that freezing does not kill the typhoid bacillus nor many other germs which produce intestinal disease.

Natural ice can be pretty safe if taken from clean lakes and rivers, because it has been proved that ice is purer than the water from which it forms, but if it comes from contaminated waters it is dangerous to use in your drinks or foods.

It is perfectly safe, however, to keep food on it for preservation and refrigeration, provided the food does not come in direct contact with the ice. The food should be well wrapped or in a container. Artificial ice, which is now the kind mostly used in large communities, is safer than natural ice, provided it is manufactured from pure city water or from boiled water.

However, if ice produced from the cleanest water is handled carelessly in dirty containers, or if the clean icecake is dragged over the sidewalk or floor of the restaurant cellar and then brought into contact with food or beverages, it is one of the most dangerous sources of infection by food contamination.

 Clean ice cubes which have been cleanly produced and cleanly delivered to your restaurant, but handed over to you by the unclean hands of a waiter are equally as dangerous as ice that has been badly produced.

Just two days ago when visiting a nearby soda fountain I saw a waitress, with not too clean looking hands in the first place, who patted the cat, made change for a few customers, and then picked up a cube of ice and threw it into a customer's glass.

People handling food should have absolutely clean hands, should refrain from handling money or cats unless they wash their hands right after touching any unclean object, and should pick up the ice cubes with a clean spoon or tongs, and deliver them that way into the customer's glass.

Ice cubes made at home in the refrigerator should be made in a clean compartment, in clean trays and handled cleanly as mentioned above. If you are using an icebox, it should be scoured frequently and disinfected with chlorox, and the food should be well wrapped and placed directly on the ice.

Only a short while ago, we here in New York had a Health Commissioner who made it his business to see that food was prepared, distributed, cared for and handled in accordance with the scientific rules of hygiene and sanitation; but his services were quickly dispensed with by high pressure politics under the pretense that he was not scientific enough.

Presumably, a scientific Health Commissioner is supposed to sit high up in his offices and dream scientific dreams, but not go out of his way to apply his scientific knowledge to practical use in protecting the people's health.

ICEBAG 

An icebag is very helpful when applied to the head in case of high fever. In such cases the icebag is applied over a cloth napkin placed directly on the head, it should not be allowed to stay on the head longer than five or ten minutes in one place, and should be removed altogether after half an hour, and reapplied again a half hour later if necessary.

Over an inflamed appendix you may keep an icebag for much longer periods at a time. Icebag applications to inflamed parts are some times helpful to check the infection and inflammation if used in the early stage before the infection has progressed very far.

An icebag applied to the head is most useful to stop an attack of dizziness. It is also used in stopping a hemorrhage from any part of the body.

Tennis Elbow

The elbow is a hinge joint formed by the arm bone (humerus) and the two forearm bones (radius and ulna). The inner bone (ulna) of the forearm, situated on the small finger side, has a hooked end (olecranon) which fits and glides around the grooved, spoollike end of the humerus forming the hinge.

The outer bone or radius of the forearm, situated on the thumb side of the fore arm, has only a free connection by ligaments to this joint, so as to enable it to turn like a spindle around the fixed ulna and thereby make it possible to turn the hand almost 180 degrees in a semicircle, palm up, palm down.

The elbow joint is bound up with very strong ligaments holding the three bones together. Fracture of the upper end of the radius is very common and often is caused by accidentally striking the elbow against a hard surface or edge.

The bone usually splits in the joint. An X-ray should be taken. There will be a swelling and discoloration on the outer side of the joint. The treatment requires an elastic cotton bandage around the joint, and holding the arm in a straight down position and not using it for about two weeks. After that, light massage and slight movement is begun.

Heat by pad or lamp is also useful. This condition usually heals in about four weeks, when light work may be attempted. Dislocation of the elbow sometimes occurs by falling on an outstretched hand and arm with the palm up.

The patient will hold the dislocated forearm slightly bent and rigid. The will of the dislocated forearm bones will be sticking out behind the elbow. In order to get the bones back into place it will require a slight straightening of the bent joint, and pulling upon the arm and forearm until the bones slip back into place.

This can be accomplished by putting the operator's knee against the bend of the elbow, while pulling the arm and fore arm. X-ray will show if the bones are in place, also if there is no fracture. After
the reduction of the dislocation, the arm is bandaged in a sharply flexed position, and suspended by strong bandage tied around the wrist and hung around the neck.

Fracture of the upper end of the ulna is usually accompanied by dislocation of the radius as well. The reduction is a more complicated procedure than the others and the arm is put into a right angle position, palm up, in splints (metal or plaster) exending from the knuckles to the middle of the upper arm.

Fracture and dislocation of the elbow, especially if they occur together, require very prompt treatment. Delay will cause bad results. Put the arm, in the position you find it, between splints or support it with a triangular sling from the neck, and get the patient to a doctor or hospital.

The veins in front of the elbow are most often used for taking specimens of blood and for injection and transfusion because these veins are of good size and convenient to get into. "Tennis forearm" or "golf forearm" is an inflammation of the tendons and muscles attached to either side of the elbow joint and follows overstrain in these competitive games.

A game played for fun and for pleasure only is not likely to cause injury, because you stop when you wish and feel like stopping, and before you become exhausted and overstrained. The treatment for such sore elbows is rest of the arm in an extended position, that is, keeping the arm straight down.

Also apply a cotton elastic bandage and use heat daily by pad, hot water bag or lamp. "Miner's elbow" is a swelling of the bursa at the tip of the elbow. It gets filled up with serum, which may turn into pus if the irritation from the occupation is continued, and the skin over the bursa is cut or scraped.

Any other occupation which involves much irritation to the point of the elbow joint will cause bursitis in this region. Treatment is rest from the particular occupation, and strapping tightly with short, adhesive plaster strips.

Don't let the adhesive plaster encircle the whole elbow, because that will cause injury by obstructing the circulation. The quickest way to get relief from an elbow bursa is to have your doctor aspirate the serum from it with a syringe.

If the skin over the bursa is red, inflamed, sore and throbbing, it has prob-ably been infected and the pus will have to be evacuated by a small incision or aspiration, as the doctor sees fit.

Continuous hot application of boric acid or Epsom salt solution compresses may be tried for a couple of days in the hope of spontaneous breaking and healing.

During the night, or when compresses are not being applied, use the following ointment:

Ichthyol 2 drams
Menthol 15 grains
Belladonna ointment and Lanolin (in equal parts to make 1 ounce)
Mix, make an ointment; direct to apply thickly to the swelling, then cover with gauze and bandage.

Eustachian Tube Dysfunction

EUSTACHIAN TUBE The Eustachian tube is a duct connecting each side of the throat (pharynx) with the middle ear. It is about an inch and a half long, and its purpose is to admit air into the middle ear so as to equalize the pressure on the inner side of the ear drum with the outside air pressure, lest it rupture.

If you hold your nostrils tightly closed between your fingers, shut your mouth tightly and blow out your cheeks, you will hear a click of increased air pressure in the middle ear from the force of the blowing.

However, don't make a routine practice of this experiment, because blowing air forcefully into the Eustachian tube may hurt the drum, and also force secretions from the throat into the tube and middle ear, and thus spread infection.

When blowing the nose for the purpose of clearing it, hold the paper tissue against both nostrils without compressing them, then blow, and no secretion or forced air currents will enter the Eustachian tube.

The accepted way of blowing the nose used to be: to compress one nostril while clearing the other; but nose specialists now advise the first method as the safer one.

In cases of colds in the head and sore throats, the Eustachian tube becomes swollen and closed up, so that no air can pass to the middle ear; this causes retraction of the eardrum inward.

Inflammation of the opening of the Eustachian tube and retraction of the eardrum produce temporary deafness and pain in the ear, although the ear itself is not really inflamed.

 A few drops of Glucophedrin (watery solution) dropped in one nostril while lying flat on the back, immediately turning the head well toward that side for two minutes, and repeating this process with the other nostril, turning to the corresponding side for two minutes, will promptly dilate the opening of the Eustachian tube and relieve the pain and deafness.

If a cold or sore throat is neglected, with continued exposure to cold and lack of treatment, the inflammation in the opening of the tube will extend the whole length of the tube, into the ear and eardrum.

In this case Sulfa or Penicillin should be taken, else the infection will cause rupture of the drum or the drum will have to be lanced in order to free the accumulation of pus.

Cholera Symptoms

Cholera or Asiatic cholera is an acute infectious, epidemic disease caused by the comma bacillus of Koch. This disease is acquired mostly by drinking contaminated water or consuming contaminated food.

 It is also transmitted directly or indirectly by "carriers." In a few hours or a couple of days after swallowing the germs, the patient starts to experience headache, general weakness, loss of appetite, diarrhea and fever.

The disease may go no further than that, and subside gradually in a few days. But in many cases the diarrhea becomes worse from hour to hour, the stools become very watery and bloody, severe cramps attack every muscle in the body, there is continuous vomiting and the thirst is extreme.

If not checked, collapse follows. Some cases recover even after reaching the stage of collapse. The prevention of cholera requires isolation and quarantine of all patients until their stools are free from the cholera germ.

All water used for drinking and washing, and all food must be boiled; nothing is to be eaten raw. Everything about the house should be washed and disinfected with a lysol solution. Flies and all other insects must be excluded from the house, as they are likely to be carriers. There is an effective serum for immunization.

The patient should drink plenty of barley water, rice water and plain water, with enough salt and sugar, to combat the dangerous dehydration caused by the diarrhea. Swallowing cracked ice on which spirit of peppermint has been sprinkled is recommended.

The following prescription will help the diarrhea:

Calcium carbonate 2 ounces
Kaolin 3 ounces
Syrup acacia 2 ounces
Cinnamon water, enough to make 8 ounces Mix; label "Shake well before using." Take a tablespoonful every 3 hours. 

Apply hot compresses to the abdomen, and keep the patient warm by a hot water bag to the feet. Streptomycin and penicillin in large doses have been reported to be effective.

Endometritis Treatment

Endometritis is an inflammation of the inner lining of the womb and is always the result of infection. It may be acute or chronic. The acute or recent infection is manifested by sudden appearance of pain in the lower part of the abdomen, a feeling of pressure in the rectum and bladder, and a desire to urinate frequently.

The patient has high fever, rapid pulse, headache, chills and a general sick feeling, sometimes nausea and vomiting.

It may follow gonorrheal or other germ infections, or be caused by certain treatments like cauterization of a lacerated cervix, radium or X-ray treatments, incomplete abortion, or contraceptive pessaries introduced into the womb but not by the rubber diaphragms.

The discharge is at first slight, but after a few days it becomes profuse. The treatment in acute endometritis at present is by sulfa and penicillin. Tablets of 100.000 units of penicillin are given by mouth every 3 hours alternately with sulfadiazine 71/2 grain tablets, at the same time give large quantities of liquids adding 1/2 teaspoonful of baking soda to the drinks 3 or 4 times a day.

The patient is propped up in bed in a halfsitting posture. An ice bag is applied to the lowest part of the abdomen, changing it from side to side, and to the center, every half hour. As soon as the fever is down, hot applications should be used instead of cold, and hot douches twice a day are also given.

A tablespoonful of salt or boric acid to a quart of water is used for douching, and the nozzle is to be inserted no further than an inch or two. Tablets ergotrate, 1/320 of a grain, are given every four hours if there is bleeding or blood spotting.

While there is fever, the patient should be kept on a liquid diet; plenty of water, milk and water half and half, eggnogs, strained thin cereal and fruit juices should be given. As soon as the fever is down, the diet should be gradually increased to the full, wellnourishing kind, supplemented by the following prescription:

Liver, Iron and Red Bone Marrow (Armour) 8 ounces Take 2 teaspoonfuls twice a day, after lunch and after dinner.
In chronic endometritis there is always a heavy disagreeable discharge with chronic backaches and headaches, frequent urination, and irregular bleeding.

It also is sometimes caused by an old gonorrheal infection, but most often by the streptococcus and other pus germs, and it is very often caused by the colon bacillus, Trichomona parasite or a mixture of the last named.

Except the gonorrheal type, which is always a personal contact infection, all the other infections are the result of carelessness in personal hygiene. Don't walk barefooted and then go to bed with the germladen feet unwashed.

Don't walk barefooted at any time. Never sit on the floor, no matter how cleanlooking or well carpeted it is. Never wash the rectum by a forward motion, and thus infect the vaginal opening. Don't flush the toilet while you are on the toilet seat.

Don't take a tub bath unless you have thoroughly washed the rectum with plenty of soap and water, and wash the tub well before it is filled with water. If you do not take the above precautions, you will sooner or later develop an infectious discharge, which will in turn travel upward, into the opening of the womb (cervix), and then spread to the inner lining of the womb producing chronic endometritis.

The treatment of this chronic condition consists of hot douches, as for the acute condition above, and improved personal hygiene. Always carry a small tampon of absorbent cotton in the vaginal opening, discard it after using the toilet and insert a fresh piece of cotton every time.

The cotton drains and absorbs the discharge preventing the soiling of clothes, irritation and reinfection. The bowels must be kept clean daily. The diet must be balanced and wellnourishing. Plenty of sleep, and fresh air day and night must be secured. The same tonic recommended for the acute endometritis should be taken.

In all cases a laboratory examination of a specimen of the discharge ought to be had. A couple of disinfectant treatments of the cervix by silver compound applications done by a doctor will hasten the cure of chronic endometritis. A course of penicillin treatment should be taken in every case.

ENDOMETRIOSIS

Endometriosis is an affection of the female pelvic organs, characterized by swellings in and around the womb caused by the implantation of tissue cells from the inner lining of the womb into the surrounding tissues.

 Endometriosis is caused by obstruction to the free menstrual flow on account of faulty position of the womb or cysts and tumors, or it can be caused by tests performed on the womb.

Some cases clear up without treatment, others clear up at the menopause. Severe cases, in which the swellings get larger and gives rise to much suffering, will need an operation.