Aliorum medicus, ipse ulceribus scates=--A physician to others, while you yourself are full of ulcers.
Then there's the story of the man who avoided reality for 70 years with drugs, sex, alcohol, fantasy, TV, movies, records, a hobby, lots of sleep... And on his 80th birthday died without ever having faced any of his real problems. The man's younger brother, who had been facing reality and all his problems for 50 years with psychiatrists, nervous breakdowns, tics, tension, headaches, worry, anxiety and ulcers, was so angry at his brother for having gotten away scott free that he had a paralyzing stroke. The moral to this story is that there ain't no justice that we can stand to live with. -- R. Geis
Oh, unforeseen utility of the useless! Charity of great things! Goodness of giants! This huge monument, which had embodied an idea of the Emperor's, had become the box of a street urchin. The brat had been accepted and sheltered by the colossus. The bourgeois decked out in their Sunday finery who passed the elephant of the Bastille, were fond of saying as they scanned it disdainfully with their prominent eyes: "What's the good of that?" It served to save from the cold, the frost, the hail, and rain, to shelter from the winds of winter, to preserve from slumber in the mud which produces fever, and from slumber in the snow which produces death, a little being who had no father, no mother, no bread, no clothes, no refuge. It served to receive the innocent whom society repulsed. It served to diminish public crime. It was a lair open to one against whom all doors were shut. It seemed as though the miserable old mastodon, invaded by vermin and oblivion, covered with warts, with mould, and ulcers, tottering, worm-eaten, abandoned, condemned, a sort of mendicant colossus, asking alms in vain with a benevolent look in the midst of the cross-roads, had taken pity on that other mendicant, the poor pygmy, who roamed without shoes to his feet, without a roof over his head, blowing on his fingers, clad in rags, fed on rejected scraps. That was what the elephant of the Bastille was good for. This idea of Napoleon, disdained by men, had been taken back by God. That which had been merely illustrious, had become august. In order to realize his thought, the Emperor should have had porphyry, brass, iron, gold, marble; the old collection of planks, beams and plaster sufficed for God. The Emperor had had the dream of a genius; in that Titanic elephant, armed, prodigious, with trunk uplifted, bearing its tower and scattering on all sides its merry and vivifying waters, he wished to incarnate the people. God had done a grander thing with it, he had lodged a child there.
And then, in proportion as he regained life, the old ulcers of his memory opened once more, he reflected again on the past, Colonel Pontmercy placed himself once more between M. Gillenormand and him, Marius, he told himself that he had no true kindness to expect from a person who had been so unjust and so hard to his father. And with health, there returned to him a sort of harshness towards his grandfather. The old man was gently pained by this. M. Gillenormand, without however allowing it to appear, observed that Marius, ever since the latter had been brought back to him and had regained consciousness, had not once called him father. It is true that he did not say "monsieur" to him; but he contrived not to say either the one or the other, by means of a certain way of turning his phrases. Obviously, a crisis was approaching.
The symptoms arise from the anatomical changes indicated, and they vary according to the parts attacked. Three types of disease are usually described--(1) nodular, (2) smooth or anaesthetic, (3) mixed. In the first the skin is chiefly affected, in the second the nerves; the third combines the features of both. It should be understood that this classification is purely a matter of convenience, and is based on the relative prominence of symptoms, which may be combined in all degrees. The incubation period of leprosy--assuming it to be due to infection--is unknown, but cases are on record which can only be explained on the hypothesis that it may be many years. The invasion is usually slow and intermittent. There are occasional feverish attacks, with the usual constitutional disturbance and other slight premonitory signs, such as changes in the colour of the skin and in its sensibility. Sometimes, but rarely, the onset is acute and the characteristic symptoms develop rapidly. These begin with an eruption which differs markedly according to the type of disease. In the nodular form dark red or coppery patches appear on the face, backs of the hands, and feet or on the body; they are generally symmetrical, and vary from the size of a shilling upwards. They come with one of the feverish attacks and fade away when it has gone, but only to return. After a time infiltration and thickening of the skin become noticeable, and the nodules appear. They are lumpy excrescences, at first pink but changing to brown. Thickening of the skin of the face produces a highly characteristic appearance, recalling the aspect of a lion. The tissues of the eye undergo degenerative changes; the mucous membrane of the nose and throat is thickened, impairing the breathing and the voice; the eyebrows fall off; the ears and nose become thickened and enlarged. As the disease progresses the nodules tend to break down and ulcerate, leaving open sores. The patient, whose condition is extremely wretched, gradually becomes weaker, and eventually succumbs to exhaustion or is carried off by some intercurrent disease, usually inflammation of the kidneys or tuberculosis. A severe case may end fatally in two years, but, as a rule, when patients are well cared for the illness lasts several years. There is often temporary improvement, but complete recovery from this form of leprosy rarely or never occurs. The smooth type is less severe and more chronic. The eruption consists of patches of dry, slightly discoloured skin, not elevated above the surface. These patches are the result of morbid changes affecting the cutaneous nerves, and are accompanied by diminished sensibility over the areas of skin affected. At the same time certain nerve trunks in the arm and leg, and particularly the ulnar nerve, are found to be thickened. In the further stages the symptoms are those of increasing degeneration of the nerves. Bullae form on the skin, and the discoloured patches become enlarged; sensation is lost, muscular power diminished, with wasting, contraction of tendons, and all the signs of impaired nutrition. The nails become hard and clawed; perforating ulcers of the feet are common; portions of the extremities, including whole fingers and toes, die and drop off. Later, paralysis becomes more marked, affecting the muscles of the face and limbs. The disease runs a very chronic course, and may last twenty or thirty years. Recovery occasionally occurs. In the mixed form, which is probably the most common, the symptoms described are combined in varying degrees. Leprosy may be mistaken for syphilis, tuberculosis, ainhum (an obscure disease affecting negroes, in which the little toe drops off), and several affections of the skin. Diagnosis is established by the presence of the bacillus leprae in the nodules or bullae, and by the signs of nerve degeneration exhibited in the anaesthetic patches of skin and the thickened nerve trunks. Entry: LEPROSY
In the Red Sea regions frankincense is valued not only for its sweet odour when burnt, but as a masticatory; and blazing lumps of it are not infrequently used for illumination instead of oil lamps. Its fumes are an excellent insectifuge. As a medicine it was in former times in high repute. Pliny (_Nat. Hist._ xxv. 82) mentions it as an antidote to hemlock. Avicenna (ed. Plempii, lib. ii. p. 161, Lovanii, 1658, fol.) recommends it for tumours, ulcers of the head and ears, affections of the breast, vomiting, dysentery and fevers. In the East frankincense has been found efficacious as an external application in carbuncles, blind boils and gangrenous sores, and as an internal agent is given in gonorrhoea. In China it was an old internal remedy for leprosy and struma, and is accredited with stimulant, tonic, sedative, astringent and vulnerary properties. It is not used in modern medicine, being destitute of any special virtues. (See Waring, _Pharm. of India_, p. 443, &c.; and F. Porter Smith, _op. cit._, p. 162.) Entry: FRANKINCENSE
The mucous membranes participate in the same lesions as are present in the skin, and this is particularly the case with the interior of the nose, where indeed, in many instances, the disease first of all shows itself. This organ becomes greatly swollen and inflamed, while from one or both nostrils there exudes a copious discharge of highly offensive purulent or sanguineous matter. The lining membrane of the nostrils is covered with papules similar in character to those on the skin, which form ulcers, and may lead to the destruction of the cartilaginous and bony textures of the nose. The diseased action extends into the throat, mouth and eyes, while the whole face becomes swollen and erysipelatous, and the lymphatic glands under the jaws inflame and suppurate. Not unfrequently the bronchial tubes become affected, and cough attended with expectoration of matter similar to that discharged from the nose is the consequence. The general constitutional symptoms are exceedingly severe, and advance with great rapidity, the patient passing into a state of extreme prostration. In the acute form of the disease recovery rarely if ever occurs, and the case generally terminates fatally in a period varying from two or three days to as many weeks. Entry: GLANDERS
_Syphilitic Laryngitis._--Invasion of the larynx in syphilis is very common. It may occur in both stages of the disease and in the inherited form. In the secondary stage the damage is superficial, and the symptoms those of a slight acute laryngitis. The injury in the tertiary stage is much more serious, the deeper structures are invaded with the formation of deep ulcers, which may when they heal form strong cicatrices, which produce a narrowing of the air-passage which may eventually require surgical interference. Occasionally a fatal oedema may arise. The treatment consists of administering constitutional remedies, local treatment being of comparatively slight importance. Entry: LARYNGITIS
GLANDERS, or FARCY (_Equinia_), a specific infective and contagious disease, caused by a tissue parasite (_Bacillus mallei_), to which certain animals, chiefly the horse, ass and mule, are liable, and which is communicable from them to man. Glanders in the domesticated animals is dealt with under VETERINARY SCIENCE; it is happily a rare form of disease in man, there being evidently less affinity for its development in the human subject than in the equine species. For the pathology see the article PARASITIC DISEASES. It occurs chiefly among those who from their occupation are frequently in contact with horses, such as grooms, coachmen, cavalry soldiers, veterinary surgeons, &c.; the bacillus is communicated from a glandered animal either through a wound or scratch or through application to the mucous membrane of the nose or mouth. A period of incubation, lasting from three to five days, generally follows the introduction of the virus into the human system. This period, however, appears sometimes to be of much longer duration, especially where there has been no direct inoculation of the poison. The first symptoms are a general feeling of illness, accompanied with pains in the limbs and joints resembling those of acute rheumatism. If the disease has been introduced by means of an abraded surface, pain is felt at that point, and inflammatory swelling takes place there, and extends along the neighbouring lymphatics. An ulcer is formed at the point of inoculation which discharges an offensive ichor, and blebs appear in the inflamed skin, along with diffuse abscesses, as in phlegmonous erysipelas. Sometimes the disease stops short with these local manifestations, but more commonly goes on rapidly accompanied with symptoms of grave constitutional disturbance. Over the whole surface of the body there appear numerous red spots or pustules, which break and discharge a thick mucous or sanguineous fluid. Besides these there are larger swellings lying deeper in the subcutaneous tissue, which at first are extremely hard and painful, and to which the term farcy "buds" or "buttons" is applied. These ultimately open and become extensive sloughing ulcers. Entry: GLANDERS
_Static Electricity._--For treatment by static electricity the Wimshurst type of machine is the one most generally used. A number of electrodes are required; thus for the application of sparks a brass ball and brass roller electrode, for the "breeze" a single point and a multiple point electrode, and another multiple point electrode in the form of a metal cap that can be placed over the patient's head. The polarity of the machine must always be tested, as either knob may become positive or negative, though the polarity rarely changes when once the machine is in action. The oldest method of subjecting a patient to electric influence is that in which static electricity is employed. The patient is insulated on a suitable platform and treated by means of charges and discharges from an electrical machine. The effect is to increase the regularity and frequency of the pulse, raise the blood pressure and increase the action of the skin. The nervous system is quieted, sleep being promoted, the patient often becoming drowsy during the application. If while the patient is being treated a point electrode is brought towards him he feels the sensation of a wind blowing from that point; this is an electric breeze or brush discharge. The breeze is negative if the patient is positively charged and vice versa. The "breeze discharge" treatment is especially valuable in subduing pain of the superficial cutaneous nerves, and also in the treatment of chronic indolent ulcers. Quite recently this form of treatment has been applied with much success to various skin lesions--psoriasis, eczema and pruritus. Static electricity is also utilized for medical purposes by means of "sparks," which are administered with a ball electrode, the result being a sudden muscular contraction at the point of application. The electrode must be rapidly withdrawn before a second spark has time to leap across, as this is a severe form of treatment and must be administered slowly. It is mainly employed for muscular stimulation, and the contractions resulting from spark stimulation can be produced in cases of nerve injury and degeneration, even when the muscles have lost their reaction to faradism. The sensory stimulation of this form of treatment is also strong, and is useful in hysterical anaesthesia and functional paralysis. Where a milder sensory stimulation is required friction can be used, the electrode being in the form of a metal roller which is moved rapidly outside the patient's clothing over the spine or other part to be treated. The clothing must be dry and of wool, and each additional woollen layer intensifies the effect. Entry: ELECTROTHERAPEUTICS
ELEPHANTIASIS (_Barbadoes leg_; _Boucnemia_), is a disease dependent on chronic lymphatic obstruction, and characterized by hypertrophy of the skin and subcutaneous tissue. Two distinct forms are known, (1) elephantiasis arabum, due to the development of living parasites, filaria sanguinis hominis (or filaria Bancrofti), and (2) the non-filarial form due to lymphatic obstruction from any other cause whatsoever, as erysipelas, the deposit of tuberculous or cancerous material in the lymphatic glands, phlegmasia dolens (white leg), long-continued eczema, &c. The enlargement is limited to a particular part of the body, generally one, or in rare cases both of the lower limbs, occasionally the scrotum, one of the labiae or the mammary gland; far more rarely the face. An attack is usually ushered in by febrile disturbance (elephantoid fever), the part attacked becoming rapidly swollen, and the skin tense and red as in erysipelas. The subcutaneous tissues become firm, infiltrated and hard, pitting only on considerable pressure. The skin becomes roughened with a network of dilated lymphatics, and vesicles and bullae may form, discharging a chyle-like fluid when broken (lymphorrhoea). In a later stage still the skin may be coarse and wart-like, and there is a great tendency for varicose ulcers to form. At the end of a variable time enlargement ceases to take place, and the disease enters a quiescent state: but recrudescences occur at irregular intervals, always ushered in by elephantoid fever. At the end of some years the attacks of fever cease, and the affected part remains permanently swollen. The only difference in the history of the two forms of the disease lies in the fact that the non-filarial form progresses steadily, until either the underlying condition is cured, or in the case of cancer, &c., brings about a fatal issue. The elephantiasis due to filaria is spread by the agency of mosquitoes, in whose bodies the intermediate stage is passed. The dead mosquito falls upon the water, which thus becomes infected, and hence the ova reach the human stomach. The young worm develops, bores through the gastric mucous membrane and finally becomes lodged in the lymphatics, usually of one or other of the extremities. A large number of embryonic filariae are produced. Some remain in the lymphatic spaces and cause lymphatic obstruction, while others enter the blood stream by night (filaria nocturna), or by day (filaria diurna). It is supposed that a mosquito, biting an infected person, itself becomes infected with the blood it abstracts, and that so a new generation is developed. Entry: ELEPHANTIASIS
_The Small Intestine._--Little remains to be added to the account of inflammatory lesions in connexion with the small intestine. It offers but few conditions peculiar to itself, save in typhoid fever, and the ease with which it contrives to become kinked, or intussuscepted, producing obstruction, or to take part in hernial protrusions. The first section, the duodenum, is subject to development of ulcers very similar to those of the gastric mucous membrane. For long duodenal ulceration has been regarded as a complication of extensive burns of the skin, but the relationship between them has not yet been quite satisfactorily explained. The condition of colic in the bowel usually arises from overdistension of some part of the small gut with gas, the frequent sharp turns of the gut facilitating temporary closure of its lumen by pressure of the dilated gut near a curve against the part beyond. In the large bowel accumulations of gas seldom cause such acute symptoms, having a readier exit. Entry: TABLE
HOUSELEEK, _Sempervivum_, a genus of ornamental evergreen plants belonging to the natural order _Crassulaceae_. About 30 species are known in gardens, some of which are hardy perennial herbs, and grow well in dry or rocky situations; the others are evergreen shrubs or undershrubs, fit only for cultivation in the greenhouse or conservatory. The genus _Sempervivum_ is distinguished from the nearly allied _Sedum_ by having more than five (about 12) petals, and by the glands at the base of the ovary being laciniated if present. The common houseleek, _S. tectorum_ (Ger. _Hauswurzel_, Fr. _joubarbe_), is often met with in Britain on roofs of outhouses and wall-tops, but is not a native. Originally it was indigenous in the Alps, but it is now widely dispersed in Europe, and has been introduced into America. The leaves are thick, fleshy and succulent, and are arranged in the form of a rosette lying close to the soil. The plant propagates itself by offsets on all sides, so that it forms after a time a dense cushion or aggregation of rosettes. The flowering stem, which is of rather rare occurrence, is about 1 ft. high, reddish, cylindrical and succulent, and ends in a level-topped cyme, reflexed at the circumference, of reddish flowers, which bloom from June to September. The houseleek has been known variously as the houselick, homewort or great houseleek. _Sedum acre_ (stone-crop) is styled the little houseleek. In Germany it is sometimes called _Donnerkraut_, from being supposed to protect the house on which it grows from thunder. The leaves are said to contain malic acid in considerable quantity, and have been eaten as salad, like _Portulaca_. _S. glutinosum_ and _S. balsamiferum_, natives respectively of Madeira and the Canary Islands, contain a very viscous substance in large quantity, and are used for the preparation of bird-lime; fishermen in Madeira, after dipping their nets in an alkaline solution, rub them with this substance, rendering them as tough as leather. _S. montanum_, indigenous in Central Europe, according to Gmelin, causes violent purging; _S. arboreum_, [Greek: to mega aeizôon] of Dioscorides, is employed in Cyprus, the East, and northern Africa as an external remedy for malignant ulcers, inflammations and burns, and internally for mucous discharges. Entry: HOUSELEEK
The dysentery poison appears to exert its effects upon the glandular structures of the large intestine, particularly in its lower part. In the milder forms of the disease there is simply a congested or inflamed condition of the mucous membrane, with perhaps some inflammatory exudation on its surface, which is passed off by the discharges from the bowels. But in the more severe forms ulceration of the mucous membrane takes place. Commencing in and around the solitary glands of the large intestine in the form of exudations, these ulcers, small at first, enlarge and run into each other, till a large portion of the bowel may be implicated in the ulcerative process. Should the disease be arrested these ulcers may heal entirely, but occasionally they remain, causing more or less disorganization of the coats of the intestines, as is often found in chronic dysentery. Sometimes, though rarely, the ulcers perforate the intestines, causing rapidly fatal inflammation of the peritoneum, or they may erode a blood vessel and produce violent haemorrhage. Even where they undergo healing they may cause such a stricture of the calibre of the intestinal canal as to give rise to the symptoms of obstruction which ultimately prove fatal. One of the severest complications of the disease is abscess of the liver, usually said to be solitary, and known as tropical abscess of the liver, but probably is more frequently multiple than is usually thought. Entry: DYSENTERY
Of local antiseptics which are of use may be mentioned the actual cautery, chlorine water, freshly prepared silver nitrate or protargol, and the yellow oxide of mercury. These different agents are of course not all equally applicable in any given case; it depends upon the severity as well as upon the nature of the inflammation which is the most suitable. For instance, the actual cautery is employed only in the case of the deeper septic or malignant ulcers, in which the destruction of tissue is already considerable and tending to spread further. Again the yellow oxide of mercury should only be used in the more superficial, strumous forms of inflammation. Many other substances are also in use, but need not here be referred to. Entry: 2
Traction diverticula of the oesophagus not uncommonly occur as sequels to suppurative inflammation of cervical lymphatic glands. More frequently dilatation of a section is met with, due as a rule to the presence of a stricture. The stomach often diverges from the normal in size, shape and position. Normally capable in the adult of containing from fifty to sixty ounces, either by reason of organic disease, or as the result of functional disturbance, its capacity may vary enormously. The writer has seen post mortem a stomach which held a gallon (160 ounces), and again one holding only two ounces. Cancer spread over a large area and cirrhosis of the stomach wall cause diminution in capacity; pyloric obstruction, weakness of the muscular coat, and nervous influences are associated with dilatation. A peculiar distortion of the shape of the stomach follows cicatrization of ulcers of greater or lesser curvature; the gastric cavity becomes "hour-glass" in shape. In addition, the stomach may be displaced downwards as a whole, a condition known as gastroptosis: if the pyloric portion only be displaced, the lesion is termed pyloroptosis. Ptoses of other abdominal organs are described; the liver, transverse colon, spleen and kidneys may be involved. Displacements downwards of the stomach and transverse colon, along with a movable right kidney and associated with dyspepsia and neurasthenia, form the malady termed by Glénard enteroptosis. A general visceroptosis often occurs in those patients who have some tuberculous lesion of the lungs or elsewhere, this disease causing a general weakening and subsequent stretching of all ligaments. Displacements of the abdominal viscera are almost invariably accompanied by symptoms of dyspepsia of a neurotic type. The rectum is liable to prolapse, consequent upon constipation and straining at stool, or following local injuries of the perineal floor. Entry: TABLE