Chapter XLIII (1)

2578. "Time," according to the old proverb, "is money;" and it may also, in many cases, and with equal truthfulness, be said to be life; for a few moments, in great emergencies, often turn the balance between recovery and death. This applies more especially to all kinds of poisoning, fits, submersion in water, or exposure to noxious gases; and many accidents. If people knew how to act during the interval that must necessarily elapse from the moment that a medical man is sent for until he arrives, many lives might be saved, which now, unhappily, are lost. Generally speaking, however, nothing is done--all is confusion and fright; and the surgeon, on his arrival, finds that death has already seized its victim, who, had his friends but known a few rough rules for their guidance, might have been rescued. We shall, therefore, in a series of papers, give such information as to the means to be employed in event of accidents, injuries, &c., as, by the aid of a gentleman of large professional experience, we are warranted in recommending.

List of Drugs, &c., necessary to carry out all Instructions.

2579. We append at once A LIST OF DRUGS, &c., and a few PRESCRIPTIONS necessary to carry out all the instructions given in this series of articles. It will be seen that they are few--they are not expensive; and by laying in a little stock of them, our instructions will be of instant value in all cases of accident, &c.--The drugs are--Antimonial Wine. Antimonial Powder. Blister Compound. Blue Pill. Calomel. Carbonate of Potash. Compound Iron Pills. Compound Extract of Colocynth. Compound Tincture of Camphor. Epsom Salts. Goulard's Extract. Jalap in Powder. Linseed Oil. Myrrh and Aloes Pills. Nitre. Oil of Turpentine. Opium, powdered, and Laudanum. Sal Ammoniac. Senna Leaves. Soap Liniment, Opodeldoc. Sweet Spirits of Nitre. Turner's Cerate.--To which should be added: Common Adhesive Plaster. Isinglass Plaster. Lint. A pair of small Scales with Weights. An ounce and a drachm Measure-glass. A Lancet. A Probe. A pair of Forceps, and some curved Needles.

2580. The following PRESCRIPTIONS may be made up for a few shillings; and, by keeping them properly labelled, and by referring to the remarks on the treatment of any particular case, much suffering, and, perhaps, some lives, may be saved.

2581. _Draught_.--Twenty grains of sulphate of zinc in an ounce and a half of water. This draught is to be repeated in a quarter of an hour if vomiting does not take place.

2582. _Clyster_.--Two tablespoonfuls of oil of turpentine in a pint of warm gruel.

2583. _Liniments_.--1. Equal parts of lime-water and linseed-oil well mixed together. [Lime-water is made thus: Pour 6 pints of boiling water upon 1/4 lb. of lime; mix well together, and when cool, strain the liquid from off the lime which has fallen to the bottom, taking care to get it as clear as possible.] 2. Compound camphor liniment.

2584. _Lotions_.--1. Mix a dessert-spoonful of Goulard's extract and 2 tablespoonfuls of vinegar in a pint of water.--2. Mix 1/2 oz. of sal-ammoniac, 2 tablespoonfuls of vinegar, and the same quantity of gin or whisky, in half a pint of water.

2585. _Goulard Lotion_.--1 drachm of sugar of lead, 2 pints of rain-water, 2 teaspoonfuls of spirits of wine. For inflammation of the eyes or elsewhere:--The better way of making Goulard Lotion, if for the eyes, is to add to 6 oz. of distilled water, or water that has been well boiled, 1 drachm of the extract of lead.

2586. _Opodeldoc_.--This lotion being a valuable application for sprains, lumbago, weakness of joints, &c., and it being difficult to procure either pure or freshly made, we give a recipe for its preparation. Dissolve 1 oz. of camphor in a pint of rectified spirits of wine; then dissolve 4 oz. of hard white Spanish soap, scraped thin, in 4 oz. of oil of rosemary, and mix them together.

2587. _The Common Black Draught_.--Infusion of senna 10 drachms; Epsom salts 10 drachms; tincture of senna, compound tincture of cardamums, compound spirit of lavender, of each 1 drachm. Families who make black draught in quantity, and wish to preserve it for some time without spoiling, should add about 2 drachms of spirits of hartshorn to each pint of the strained mixture, the use of this drug being to prevent its becoming mouldy or decomposed. A simpler and equally efficacious form of black draught is made by infusing 1/2 oz. of Alexandrian senna, 3 oz. of Epsom salts, and 2 drachms of bruised ginger and coriander-seeds, for several hours in a pint of boiling water, straining the liquor, and adding either 2 drachms of sal-volatile or spirits of hartshorn to the whole, and giving 3 tablespoonfuls for a dose to an adult.

2588. _Mixtures_--1. _Aperient_.--Dissolve an ounce of Epsom salts in half a pint of senna tea: take a quarter of the mixture as a dose, and repeat it in three or four hours if necessary.

2589. 2. _Fever Mixture_.--Mix a drachm of powdered nitre, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitre, in half a pint of water.

2590. 3. _Myrrh and Aloes Pills_.--Ten grains made into two pills are the dose for a full-grown person.

2591. 4. _Compound Iron Pills_.--Dose for a full-grown person: 10 grains made into two pills.

2592. _Pills_.--1. Mix 5 grains of calomel and the same quantity of antimonial powder with a little bread-crumb, and make into two pills. Dose for a full-grown person: two pills.--2. Mix 5 grains of blue pill and the same quantity of compound extract of colocynth together, and make into two pills, the dose for a full-grown person.

2593. _Powders_.--Mix a grain of calomel and 4 grains of powdered jalap together.

2594. In all cases, the dose of medicines given is to be regulated by the age of the patient.

2595. _Abernethy's Plan for making a Bread-and-Water Poultice_.--First scald out a basin; then having put in some boiling water, throw in coarsely-crumbled bread, and cover it with a plate. When the bread has soaked up as much water as it will imbibe, drain off the remaining water, and there will be left a light pulp. Spread it a third of an inch thick on folded linen, and apply it when of the temperature of a warm bath. To preserve it moist, occasionally drop warm water on it.

2596. _Linseed-Meal Poultice_.--"Scald your basin, by pouring a little hot water into it; then put a small quantity of finely-ground linseed-meal into the basin, pour a little hot water on it, and stir it round briskly until you have well incorporated them; add a little more meal and a little more water; then stir it again. Do not let any lumps remain in the basin, but stir the poultice well, and do not be sparing of your trouble. What you do next, is to take as much of it out of the basin as you may require, lay it on a piece of soft linen, and let it be about a quarter of an inch thick."--_Abernethy_.

2597. _Mustard Poultice_.--Mix equal parts of dry mustard and linseed-meal in warm vinegar. When the poultice is wanted weak, warm water may be used for the vinegar; and when it is required very strong, mustard alone, without any linseed-meal, is to be mixed with warm vinegar.

2598. _An ordinary Blister_.--Spread a little blister compound on a piece of common adhesive plaster with the right thumb. It should be put on just thickly enough to conceal the appearance of the plaster beneath. The part from which a blister has been taken should be covered till it heals over with soft linen rags smeared with lard.

Baths and Fomentations.

2599. All fluid applications to the body are exhibited either in a hot or cold form; and the object for which they are administered is to produce a stimulating effect over the entire, or a part, of the system; for the effect, though differently obtained, and varying in degree, is the same in principle, whether procured by hot or cold water.

2600. _Heat_.--There are three forms in which heat is universally applied to the body,--that of the tepid, warm, and vapour bath; but as the first is too inert to be worth notice, and the last dangerous and inapplicable, except in public institutions, we shall confine our remarks to the really efficacious and always attainable one--the

2601. _Warm and Hot Bath_.--These baths are used whenever there is congestion, or accumulation of blood in the internal organs, causing pain, difficulty of breathing, or stupor, and are employed, by their stimulating property, to cause a rush of blood to the surface, and, by unloading the great organs, produce a temporary inflammation in the skin, and so equalize the circulation. The effect of the hot bath is to increase the fulness of the pulse, accelerate respiration, and excite perspiration. In all inflammations of the stomach and bowels, the hot bath is of the utmost consequence; the temperature of the warm bath varies from 92° to 100°, and may be obtained by those who have no thermometer to test the exact heat, by mixing one measure of boiling with two of cold water.

2602. _Fomentations_ are generally used to effect, in a part, the benefit produced on the whole body by the bath; to which a sedative action is occasionally given by the use of roots, herbs, or other ingredients; the object being to relieve the internal organ, as the throat, or muscles round a joint, by exciting a greater flow of blood to the skin _over_ the affected part. As the real agent of relief is heat, the fomentation should always be as hot as it can comfortably be borne, and, to insure effect, should be repeated every half-hour. Warm fluids are applied in order to render the swelling which accompanies inflammation less painful, by the greater readiness with which the skin yields, than when it is harsh and dry. They are of various kinds; but the most simple, and oftentimes the most useful, that can be employed, is "Warm Water." Another kind of fomentation is composed of dried poppyheads, 4 oz. Break them to pieces, empty out the seeds, put them into 4 pints of water, boil for a quarter of an hour, then strain through a cloth or sieve, and keep the water for use. Or, chamomile flowers, hemlock, and many other plants, may be boiled, and the part fomented with the hot liquor, by means of flannels wetted with the decoction.

2603. _Cold_, when applied in excess to the body, drives the blood from the surface to the centre, reduces the pulse, makes the breathing hard and difficult, produces coma, and, if long continued, death. But when medicinally used, it excites a reaction on the surface equivalent to a stimulating effect; as in some cases of fever, when the body has been sponged with cold water, it excites, by reaction, increased circulation on the skin. Cold is sometimes used to keep up a repellent action, as, when local inflammation takes place, a remedy is applied, which, by its benumbing and astringent effect, causes the blood, or the excess of it in the part, to recede, and, by contracting the vessels, prevents the return of any undue quantity, till the affected part recovers its tone. Such remedies are called _Lotions_, and should, when used, be applied with the same persistency as the fomentation; for, as the latter should be renewed as often as the heat passes off, so the former should be applied as often as the heat from the skin deprives the application of its cold.

2604. _Poultices_ are only another form of fomentation, though chiefly used for abscesses. The ingredient best suited for a poultice is that which retains heat the longest; of these ingredients, the best are linseed--meal, bran, and bread. Bran sewed into a bag, as it can be reheated, will be found the cleanest and most useful; especially for sore throats.

How to Bleed.

2605. In cases of great emergency, such as the strong kind of apoplexy, and when a surgeon cannot possibly be obtained for some considerable time, the life of the patient depends almost entirely upon the fact of his being bled or not. We therefore give instructions how the operation of bleeding is to be performed, but caution the reader only to attempt it in cases of the greatest emergency. Place a handkerchief or piece of tape rather but not too tightly round the arm, about three or four inches above the elbow. This will cause the veins below to swell and become very evident. If this is not sufficient, the hand should be constantly and quickly opened and shut for the same purpose. There will now be seen, passing up the middle of the fore-arm, a vein which, just below the bend of the elbow, sends a branch inwards and outwards, each branch shortly joining another large vein. It is from the _outer_ branch--that the person is to be bled. The right arm is the one mostly operated on. The operator should take the lancet in his right hand, between the thumb and first finger, place the thumb of his left hand on the vein below the part where he is going to bleed from, and then gently thrust the tip of the lancet into the vein, and, taking care not to push it too deeply, cut in a gently curved direction, thus and bring it out, point upwards, at about half an inch from the part of the vein into which he had thrust it. The vein must be cut lengthways, and not across. When sufficient blood has been taken away, remove the bandage from above the elbow, and place the thumb of the left hand firmly over the cut, until all the bleeding ceases. A small pad of lint is then to be put over the cut, with a larger pad over it, and the two kept in their places by means of a handkerchief or linen roller bound pretty tightly over them and round the arm.

2606. When a person is bled, he should always be in the standing, or at any rate in the sitting, position; for if, as is often the case, he should happen to faint, he can, in, most eases at least, easily be brought to again by the operator placing him flat on his back, and stopping the bleeding. _This is of the greatest importance._ It has been recommended, for what supposed advantages we don't know, to bleed people when they are lying down. Should a person, under these circumstances, faint, what could be done to bring him to again? The great treatment of lowering the body of the patient to the flat position cannot be followed here. It is in that position already, and cannot be placed lower than it at present is--except, as is most likely to be the case, under the ground.

2607. BLEEDING FROM THE NOSE.--Many children, especially those of a sanguineous temperament, are subject to sudden discharges of blood from some part of the body; and as all such fluxes are in general the result of an effort of nature to relieve the system from some overload or pressure, such discharges, unless in excess, and when likely to produce debility, should not be rashly or too abruptly checked. In general, these discharges are confined to the summer or spring months of the year, and follow pains in the head, a sense of drowsiness, languor, or oppression; and, as such symptoms are relieved by the loss of blood, the hemorrhage should, to a certain extent, be encouraged. When, however, the bleeding is excessive, or returns too frequently, it becomes necessary to apply means to subdue or mitigate the amount. For this purpose the sudden and unexpected application of cold is itself sufficient, in most cases, to arrest the most active hemorrhage. A wet towel laid suddenly on the back, between the shoulders, and placing the child in a recumbent posture, is often sufficient to effect the object; where, however, the effusion resists such simple means, napkins wrung out of cold water must be laid across the forehead and nose, the hands dipped in cold water, and a bottle of hot water applied to the feet. If, in spite of these means, the bleeding continues, a little fine wool or a few folds of lint, tied together by a piece of thread, must be pushed up the nostril from which the blood flows, to act as a plug and pressure on the bleeding vessel. When the discharge has entirely ceased, the plug is to be pulled out by means of the thread. To prevent a repetition of the hemorrhage, the body should be sponged every morning with cold water, and the child put under a course of steel wine, have open-air exercise, and, if possible, salt-water bathing. For children, a key suddenly dropped down the back between the skin and clothes, will often immediately arrest a copious bleeding.

2608. SPITTING OF BLOOD, or hemorrhage from the lungs, is generally known from blood from the stomach by its being of a brighter colour, and in less quantities than that, which is always grumous and mixed with the half-digested food. In either case, rest should be immediately enjoined, total abstinence from stimulants, and a low, poor diet, accompanied with the horizontal position, and bottles of boiling water to the feet. At the same time the patient should suck through a quill, every hour, half a wine-glass of water in which 10 or 15 drops of the elixir of vitriol has been mixed, and, till further advice has been procured, keep a towel wrung out of cold water on the chest or stomach, according to the seat of the hemorrhage.

Bites and Stings.

2609. BITES AND STINGS may be divided into three kinds:--1. Those of Insects. 2. Those of Snakes. 3. Those of Dogs and other Animals.

2610. 1. _The Bites or Stings of Insects_, such as gnats, bees, wasps, &c., need cause very little alarm, and are, generally speaking, easily cured. They are very serious, however, when they take place on some delicate part of the body, such as near the eye, or in the throat. _The treatment_ is very simple in most cases; and consists in taking out the sting, if it is left behind, with a needle, and applying to the part a liniment made of finely-scraped chalk and olive-oil, mixed together to about the thickness of cream.

2611. Bathing the part bitten with warm turpentine or warm vinegar is also of great use. If the person feels faint, he should lie quietly on his back, and take a little brandy-and-water, or sal-volatile and water. When the inside of the throat is the part stung, there is great danger of violent inflammation taking place. In this case, from eight to twelve leeches should be immediately put to the outside of the throat, and when they drop off, the part to which they had been applied should be well fomented with warm water. The inside of the throat is to be constantly gargled with salt and water. Bits of ice are to be sucked. Rubbing the face and hands well over with plain olive-oil, before going to bed, will often keep gnats and musquitoes from biting during the night. Strong scent, such as eau-de-Cologne, will have the same effect.

2612. 2. _Bites of Snakes_.--These are much more dangerous than the preceding, and require more powerful remedies. The bites of the different kinds of snakes do not all act alike, but affect people in different ways.--_Treatment of the part bitten_. The great thing is to prevent the poison getting into the blood; and, if possible, to remove the whole of it at once from the body. A pocket-handkerchief, a piece of tape or cord, or, in fact, of anything that is at hand, should be tied tightly round the part of the body bitten; if it be the leg or arm, immediately _above_ the bite, and between it and the heart. The bite should then be sucked several times by any one who is near. There is no danger in this, provided the person who does it has not got the skin taken off any part of his mouth. What has been sucked into the mouth should be immediately spit out again. But if those who are near have sufficient nerve for the operation, and a suitable instrument, they should cut out the central part bitten, and then bathe the wound for some time with warm water, to make it bleed freely. The wound should afterwards be rubbed with a stick of lunar caustic, or, what is better, a solution of this--60 grains of lunar caustic dissolved in an ounce of water--should be dropped into it. The band should be kept on the part during the whole of the time that these means are being adopted. The wound should afterwards be covered with lint dipped in cold water. The best plan, however, to be adopted, if it can be managed, is the following:--take a common wine-glass, and, holding it upside down, put a lighted candle or a spirit-lamp into it for a minute or two. This will take out the air. Then clap the glass suddenly over the bitten part, and it will become attached, and hold on to the flesh. The glass being nearly empty, the blood containing the poison will, in consequence, flow into it from the wound of its own accord. This process should be repeated three or four times, and the wound sucked, or washed with warm water, before each application of the glass. As a matter of course, when the glass is removed, all the blood should be washed out of it before it is applied again.--_Constitutional Treatment_. There is mostly at first great depression of strength in these cases, and it is therefore requisite to give some stimulant; a glass of hot brandy-and-water, or twenty drops of sal-volatile, is the best that can be given. When the strength has returned, and if the patient has not already been sick, a little mustard in hot water should be given, to make him so. If, on the other hand, as is often the case, the vomiting is excessive, a large mustard poultice should be placed over the stomach, and a grain of solid opium swallowed in the form of a pill, for the purpose of stopping it. Only one of these pills should be given by a non-professional person. In all cases of bites from snakes, send for a surgeon as quickly as possible, and act according to the above directions until he arrives. If he is within any reasonable distance, content yourself by putting on the band, sucking the wound, applying the glass, and, if necessary, giving a little brandy-and-water.

2613. 3. _Bites of Dogs_.--For obvious reasons, these kinds of bites are more frequently met with than those of snakes. _The treatment_ is the same as that for snake-bites, more especially that of the bitten part. The majority of writers on the subject are in favour of keeping the wound open as long as possible. This may be done by putting a few beans on it, and then by applying a large linseed-meal poultice over them.

Injuries and Accidents to Bones.

2614. _Dislocation of Bones_.--When the end of a bone is pushed out of its natural position, it is said to be dislocated. This may be caused by violence, disease, or natural weakness of the parts about a joint.--_Symptoms_. Deformity about the joint, with unnatural prominence at one part, and depression at another. The limb may be shorter or longer than usual, and is stiff and unable to be moved, differing in these last two respects from a broken limb, which is mostly shorter, never longer, than usual, and which is always more movable.--_Treatment_. So much practical science and tact are requisite in order to bring a dislocated bone into its proper position again, that we strongly advise the reader never to interfere in these cases; unless, indeed, it is altogether impossible to obtain the services of a surgeon. But because any one of us may very possibly be placed in that emergency, we give a few rough rules for the reader's guidance. In the first place make the joint, from which the bone has been displaced, perfectly steady, either by fixing it to some firm object or else by holding it with the hands; then pull the dislocated bone in a direction towards the place from which it has been thrust, so that, if it moves at all from its unnatural position, it may have the best chance of returning to its proper place. Do not, however, pull or press against the parts too violently, as you may, perhaps, by doing so, rupture blood-vessels, and produce most serious consequences. When you _do_ attempt to reduce a dislocated bone, do it as quickly as possible after the accident has taken place, every hour making the operation more difficult. When the patient is very strong, he may be put into a warm bath until he feels faint, or have sixty drops of antimonial wine given him every ten minutes until he feels sickish. These two means are of great use in relaxing the muscles. If the bone has been brought back again to its proper place, keep it there by means of bandages; and if there is much pain about the joint, apply a cold lotion to it, and keep it perfectly at rest. The lotion should be, a dessert-spoonful of Goulard's extract, and two tablespoonfuls of vinegar, mixed in a pint of water. Leeches are sometimes necessary. Unless the local pain, or general feverish symptoms, are great, the patient's diet should be the same as usual. Dislocations may be reduced a week, or even a fortnight, after they have taken place. As, therefore, although the sooner a bone is reduced the better, there is no very great emergency, and as the most serious consequences may follow improper or too violent treatment, it is always better for people in these cases to do too little than too much; inasmuch as the good which has not yet may still be done, whereas the evil that _has_ been done cannot so easily be undone.

2615. FRACTURES OF BONES.--_Symptoms_. 1. Deformity of the part. 2. Unnatural looseness. 3. A grating sound when the two ends of the broken bone are rubbed together. 4. Loss of natural motion and power. In some cases there is also shortening of the limb.--Fracture takes place from several causes, as a fall, a blow, a squeeze, and sometimes from the violent action of muscles.--_Treatment_. In cases where a surgeon cannot be procured immediately after the accident, the following general rules are offered for the reader's guidance:--The broken limb should be placed and kept as nearly as possible in its natural position. This is to be done by first pulling the two portions of the bone in opposite directions, until the limb becomes as long as the opposite one, and then by applying a splint, and binding it to the part by means of a roller. When there is no deformity, the pulling is of course unnecessary. If there is much swelling about the broken part, a cold lotion is to be applied. This lotion (_which we will call Lotion No. 1_) may be thus made:--Mix a dessert-spoonful of Goulard's extract and two tablespoonfuls of vinegar in a pint of water. When the leg or arm is broken, always, if possible, get it to the same length and form as the opposite limb. The broken part should be kept perfectly quiet. When a broken limb is deformed, and a particular muscle is on the stretch, place the limb in such a position as will relax it. This will in most cases cure the deformity. Brandy-and-water, or sal-volatile and water, are to be given when the patient is faint. Surgical aid should, of course, be procured as soon as possible.

2616. JOINTS, INJURIES TO.--All kinds of injuries to joints, of whatever description, require particular attention, in consequence of the violent inflammations which are so liable to take place in these parts of the body, and which do so much mischief in a little time. The joint injured should always be kept perfectly at rest; and when it is very painful, and the skin about it red, swollen, hot, and shining, at the same time that the patient has general feverish symptoms, such as great thirst and headache--leeches, and when they drop off, warm poppy fomentations, are to be applied; the No. 1 pills above-mentioned are to be given (two are a dose for a grown person) with a black draught three hours afterwards. Give also two tablespoonfuls of the fever-mixture every four hours, and keep the patient on low diet. When the injury and swelling are not very great, warm applications, with rest, low diet, and a dose of aperient medicine, will be sufficient. When a joint has received a penetrating wound, it will require the most powerful treatment, and can only be properly attended to by a surgeon. The patient's friends will have to use their own judgment to a great extent in these and in many other cases, as to when leeches, fever-mixture, &c., are necessary. A universal rule, however, without a single exception, _is always to rest a joint well_ after it has been injured in any way whatever, to purge the patient, and to keep him on low diet, without beer, unless he has been a very great drinker indeed, in which case he may still be allowed to take a little; for if the stimulant that a person has been accustomed to in excess be all taken away at once, he is very likely to have an attack of delirium tremens. The quantity given should not, however, be much--say a pint, or, at the most, a pint and a half a day. Rubbing the joint with opodeldoc, or the application of a blister to it, is of great service in taking away the thickenings, which often remain after all heat, pain, and redness have left an injured joint. Great care should be observed in not using a joint too quickly after it has been injured. When the shoulder-joint is the one injured, the arm should be bound tightly to the body by means of a linen or flannel roller, and the elbow raised; when the elbow, it should be kept raised in the straight position, on a pillow; when the wrist, it should be raised on the chest, and suspended in a sling; when the knee, it should be kept in the straight position; and, lastly, when the ankle, it should be a little raised on a pillow.

2617. BRUISES, LACERATIONS, AND CUTS.--Wherever the bruise may be, or however swollen or discoloured the skin may become, two or three applications of the _extract of lead_, kept to the part by means of lint, will, in an hour or little more, remove all pain, swelling, and tenderness. Simple or clean cuts only require the edges of the wound to be placed in their exact situation, drawn close together, and secured there by one or two slips of adhesive plaster. When the wound, however, is jagged, or the flesh or cuticle lacerated, the parts are to be laid as smooth and regular as possible, and a piece of lint, wetted in the _extract of lead_, laid upon the wound, and a piece of greased lint placed above it to prevent the dressing sticking; the whole covered over to protect from injury, and the part dressed in the same manner once a day till the cure is effected.

2618. BRUISES AND THEIR TREATMENT.--The best application for a bruise, be it large or small, is moist warmth; therefore, a warm bread-and-water poultice in hot moist flannels should be put on, as they supple the skin. If the bruise be very severe, and in the neighbourhood of a joint, it will be well to apply ten or a dozen leeches over the whole bruised part, and afterwards a poultice. But leeches should not be put on young children. If the bruised part be the knee or the ankle, walking should not be attempted till it can be performed without pain. Inattention to this point often lays the foundation for serious mischief in these joints, especially in the case of scrofulous persons. In all conditions of bruises occurring in children, whether swellings or abrasions, no remedy is so quick or certain of effecting a cure as the pure extract of lead applied to the part.

Burns and Scalds.

2619. BURNS AND SCALDS being essentially the same in all particulars, and differing only in the manner of their production, may be spoken of together. As a general rule, scalds are less severe than burns, because the heat of water, by which scalds are mostly produced, is not, even when it is boiling, so intense as that of flame; oil, however, and other liquids, whose boiling-point is high, produce scalds of a very severe nature. Burns and scalds have been divided into three classes. The first class comprises those where the burn is altogether superficial, and merely reddens the skin; the second, where the injury is greater, and we get little bladders containing a fluid (called serum) dotted over the affected part; in the third class we get, in the case of burns, a charring, and in that of scalds, a softening or pulpiness, perhaps a complete and immediate separation of the part. This may occur at once, or in the course of a little time. The pain from the second kind of burns is much more severe than that in the other two, although the danger, as a general rule, is less than it is in the third class. These injuries are much more dangerous when they take place on the trunk than when they happen on the arms or legs. The danger arises more from the extent of surface that is burnt than from the depth to which the burn goes. This rule, of course, has certain exceptions; because a small burn on the chest or belly penetrating deeply is more dangerous than a more extensive but superficial one on the arm or leg. When a person's clothes are in flames, the best way of extinguishing them is to wind a rug, or some thick material, tightly round the whole of the body.

2620. _Treatment of the First Class of Burns and Scalds_.--_Of the part affected_.--Cover it immediately with a good coating of common flour, or cotton-wool with flour dredged well into it. The great thing is to keep the affected surface of the skin from the contact of the air. The part will shortly get well, and the skin may or may not peel off.--_Constitutional Treatment_. If the burn or scald is not extensive, and there is no prostration of strength, this is very simple, and consists in simply giving a little aperient medicine--pills (No. 2), as follows:--Mix 5 grains of blue pill and the same quantity of compound extract of colocynth, and make into two pills--the dose for a full-grown person. Three hours after the pills give a black draught. If there are general symptoms of fever, such as hot skin, thirst, headache, &c. &c., two tablespoonfuls of fever-mixture are to be given every four hours. The fever-mixture, we remind our readers, is made thus:-Mix a drachm of powdered nitro, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitro, in half a pint of water.

2621. _Second Class. Local Treatment_.--As the symptoms of these kinds of burns are more severe than those of the first class, so the remedies appropriate to them are more powerful. Having, as carefully as possible, removed the clothes from the burnt surface, and taking care not to break the bladders, spread the following liniment (No. 1) on a piece of linen or lint--not the _fluffy_ side--and apply it to the part: the liniment should be equal parts of lime-water and linseed-oil, well mixed. If the burn is on the trunk of the body, it is better to use a warm linseed-meal poultice. After a few days dress the wound with Turner's cerate. If the burn is at the bend of the elbow, place the arm in the _straight_ position; for if it is _bent_, the skin, when healed, will be contracted, and the arm, in all probability, always remain in the same un natural position. This, indeed, applies to all parts of the body; therefore, always place the part affected in the most _stretched_ position possible.--_Constitutional Treatment_. The same kind of treatment is to be used as for the first class, only it must be more powerful. Stimulants are move often necessary, but must be given with great caution. If, as is often the case, there is great irritability and restlessness, a dose of opium (paregoric, in doses of from sixty to a hundred drops, according to age, is best) is of great service. The feverish symptoms will require aperient medicines and the fever mixture. A drink made of about a tablespoonful of cream of tartar and a little lemon-juice, in a quart of warm water, allowed to cool, is a very nice one in these cases. The diet throughout should not be too low, especially if there is much discharge from the wound. After a few days it is often necessary to give wine, ammonia, and strong beef-tea. These should be had recourse to when the tongue gets dry and dark, and the pulse weak and frequent. If there should be, after the lapse of a week or two, pain over one particular part of the belly, a blister should be put on it, and a powder of mercury and chalk-grey powder, and Dover's powder (two grains of the former and five of the latter) given three times a day. Affections of the head and chest also frequently occur as a consequence of these kinds of burns, but no one who is not a medical man can treat them.

2622. _Third Class_.--These are so severe as to make it impossible for a non-professional person to be of much service in attending to them. When they occur, a surgeon should always be sent for. Until he arrives, however, the following treatment should be adopted:--Place the patient full-length on his back, and keep him warm. Apply fomentations of flannels wrung out of boiling water and sprinkled with spirits of turpentine to the part, and give wine and sal-volatile in such quantities as the prostration of strength requires; always bearing in mind the great fact that you have to steer between two quicksands--death from present prostration and death from future excitement, which will always be increased in proportion to the amount of stimulants given. Give, therefore, only just as much as is absolutely necessary to keep life in the body.

2623. CONCUSSION OF BRAIN--STUNNING.--This may be caused by a blow or a fall.--_Symptoms_. Cold skin; weak pulse; almost total insensibility; slow, weak breathing; pupil of eye sometimes bigger, sometimes smaller, than natural; inability to move; unwillingness to answer when spoken to. These symptoms come on directly after the accident.--_Treatment_. Place the patient quietly on a warm bed, send for a surgeon, _and do nothing else for the first four or six hours_. After this time the skin will become hot, the pulse full, and the patient feverish altogether. If the surgeon has not arrived by the time these symptoms have set in, shave the patient's head, and apply the following lotion (No. 2): Mix half an ounce of sal-ammoniac, two tablespoonfuls of vinegar, and the same quantity of gin or whisky, in half a pint of water. Then give this pill (No. 1); Mix five grains of calomel and the same quantity of antimonial powder with a little bread-crumb, and make into two pills. Give a black draught three hours after the pill, and two tablespoonfuls of the above-mentioned fever-mixture every four hours. Keep on low diet. Leeches are sometimes to be applied to the head. These cases are often followed by violent inflammation of the brain. They can, therefore, only be attended to properly throughout by a surgeon. The great thing for people to do in these cases is--nothing; contenting themselves with putting the patient to bed, and waiting the arrival of a surgeon.

2624. THE CHOLERA AND AUTUMNAL COMPLAINTS.--To oppose cholera, there seems no surer or better means than cleanliness, sobriety, and judicious ventilation. Where there is dirt, that is the place for cholera; where windows and doors are kept most jealously shut, there cholera will find easiest entrance; and people who indulge in intemperate diet during the hot days of autumn are actually courting death. To repeat it, cleanliness, sobriety, and free ventilation almost always defy the pestilence; but, in case of attack, immediate recourse should be had to a physician. The faculty say that a large number of lives have been lost, in many seasons, solely from delay in seeking medical assistance. They even assert that, taken early, the cholera is by no means a fatal disorder. The copious use of salt is recommended on very excellent authority. Other autumnal complaints there are, of which diarrhoea is the worst example. They come on with pain, flatulence, sickness, with or without vomiting, followed by loss of appetite, general lassitude, and weakness. If attended to at the first appearance, they may soon be conquered; for which purpose it is necessary to assist nature in throwing off the contents of the bowels, which may be one by means of the following prescription:--Take of calomel 3 grains, rhubarb 8 grains; mix and take it in a little honey or jelly, and repeat the dose three times, at the intervals of four or five hours. The next purpose to be answered is the defence of the lining membrane of the intestines from their acrid contents, which will be best effected by drinking copiously of linseed tea, or of a drink made by pouring boiling water on quince-seeds, which are of a very mucilaginous nature; or, what is still better, full draughts of whey. If the complaint continue after these means have been employed, some astringent or binding medicine will be required, as the subjoined:--Take of prepared chalk 2 drachms, cinnamon-water 7 oz., syrup of poppies 1 oz.; mix, and take 3 tablespoonfuls every four hours. Should this fail to complete the cure, 1/2 oz. of tincture of catechu, or of kino, may be added to it, and then it will seldom fail; or a teaspoonful of the tincture of kino alone, with a little water, every three hours, till the diarrhoea is checked. While any symptoms of derangement are present, particular attention must be paid to the diet, which should be of a soothing, lubricating, and light nature, as instanced in veal or chicken broth, which should contain but little salt. Rice, batter, and bread puddings will be generally relished, and be eaten with advantage; but the stomach is too much impaired to digest food of a more solid nature. Indeed, we should give that organ, together with the bowels, as little trouble as possible, while they are so incapable of acting in their accustomed manner. Much mischief is frequently produced by the absurd practice of taking tincture of rhubarb, which is almost certain of aggravating that species of disorder of which we have now treated; for it is a spirit as strong as brandy, and cannot fail of producing harm upon a surface which is rendered tender by the formation and contact of vitiated bile. But our last advice is, upon the first appearance of such symptoms as are above detailed, have _immediate_ recourse to a doctor, where possible.

2625. TO CURE A COLD.--Put a large teacupful of linseed, with 1/4 lb. of sun raisins and 2 oz. of stick liquorice, into 2 quarts of soft water, and let it simmer over a slow fire till reduced to one quart; add to it 1/4 lb. of pounded sugar-candy, a tablespoonful of old rum, and a tablespoonful of the best white-wine vinegar, or lemon-juice. The rum and vinegar should be added as the decoction is taken; for, if they are put in at first, the whole soon becomes flat and less efficacious. The dose is half a pint, made warm, on going to bed; and a little may be taken whenever the cough is troublesome. The worst cold is generally cured by this remedy in two or three days; and, if taken in time, is considered infallible.

2626. COLD ON THE CHEST.--A flannel dipped in boiling water, and sprinkled with turpentine, laid on the chest as quickly as possible, will relieve the most severe cold or hoarseness.

2627. SUBSTANCES IN THE EYE.--To remove fine particles of gravel, lime, &c., the eye should be syringed with lukewarm water till free from them. Be particular not to worry the eye, under the impression that the substance is still there, which the enlargement of some of the minute vessels makes the patient believe is actually the case.

2628. SORE EYES.--Incorporate thoroughly, in a glass mortar or vessel, one part of strong citron ointment with three parts of spermaceti ointment. Use the mixture night and morning, by placing a piece of the size of a pea in the corner of the eye affected, only to be used in cases of chronic or long-standing inflammation of the organ, or its lids.

2629. LIME IN THE EYE.--Bathe the eye with a little weak vinegar-and-water, and carefully remove any little piece of lime which may be seen, with a feather. If any lime has got entangled in the eyelashes, carefully clear it away with a bit of soft linen soaked in vinegar-and-water. Violent inflammation is sure to follow; a smart purge must be therefore administered, and in all probability a blister must be applied on the temple, behind the ear, or nape of the neck.

2630. STYE IN THE EYE.--Styes are little abscesses which form between the roots of the eyelashes, and are rarely larger than a small pea. The best way to manage them is to bathe them frequently with warm water, or in warm poppy-water, if very painful. When they have burst, use an ointment composed of one part of citron ointment and four of spermaceti, well rubbed together, and smear along the edge of the eyelid. Give a grain or two of calomel with 5 or 8 grains of rhubarb, according to the age of the child, twice a week. The old-fashioned and apparently absurd practice of rubbing the stye with a ring, is as good and speedy a cure as that by any process of medicinal application; though the number of times it is rubbed, or the quality of the ring and direction of the strokes, has nothing to do with its success. The pressure and the friction excite the vessels of the part, and cause an absorption of the effused matter under the eyelash. The edge of the nail will answer as well as a ring.

2631. INFLAMMATION OF THE EYELIDS.--The following ointment has been found very beneficial in inflammations of the eyeball and edges of the eyelids:--Take of prepared calomel, 1 scruple; spermaceti ointment, 1/2 oz. Mix them well together in a glass mortar; apply a small quantity to each corner of the eye every night and morning, and also to the edges of the lids, if they are affected. If this should not eventually remove the inflammation, elder-flower water may be applied three or four times a day, by means of an eye-cup. The bowels should be kept in a laxative state, by taking occasionally a quarter of an ounce of the Cheltenham or Epsom salts.

2632. FASTING.--It is said by many able physicians that fasting is a means of removing incipient disease, and of restoring the body to its customary healthy sensations. Howard, the celebrated philanthropist (says a writer), used to fast one day in every week. Napoleon, when he felt his system unstrung, suspended his wonted repast, and took his exercise on horseback.

Fits.

2633. Fits come on so suddenly, often without even the slightest warning, and may prove fatal so quickly, that all people should be acquainted at least with their leading symptoms and treatment, as a few moments, more or less, will often decide the question between life and death. The treatment, in very many cases at least, to be of the slightest use, should be _immediate_, as a person in a fit (of apoplexy for instance) may die while a surgeon is being fetched from only the next street. We shall give, as far as the fact of our editing a work for non-professional readers will permit, the peculiar and distinctive symptoms of all kind of fits, and the immediate treatment to be adopted in each case.

2634. APOPLEXY.--These fits may be divided into two kinds--the _strong_ and the _weak_.

2635. 1. _The strong kind_.--These cases mostly occur in stout, strong, short-necked, bloated-faced people, who are in the habit of living well.--_Symptoms_. The patient may or may not have had headache, sparks before his eyes, with confusion of ideas and giddiness, for a day or two before the attack. When it takes place, he falls down insensible; the body becomes paralyzed, generally more so on one side than the other; the face and head are hot, and the blood-vessels about them swollen; the pupils of the eyes are larger than natural, and the eyes themselves are fixed; the mouth is mostly drawn down at one corner; the breathing is like loud snoring; the pulse full and hard.--_Treatment_. Place the patient immediately in bed, with his head well raised; take off everything that he has round his neck, and bleed freely and at once from the arm. If you have not got a lancet, use a penknife or anything suitable that may be at hand. Apply warm mustard poultices to the soles of the feet and the insides of the thighs and legs; put two drops of castor oil, mixed up with eight grains of calomel, on the top of the tongue, as far back as possible; a most important part of the treatment being to open the bowels as quickly and freely as possible. The patient cannot swallow; but these medicines, especially the oil, will be absorbed into the stomach altogether independent of any voluntary action. If possible, throw up a warm turpentine clyster (two tablespoonfuls of oil of turpentine in a pint of warm gruel), or, if this cannot be obtained, one composed of about a quart of warm salt-and-water and soap. Cut off the hair, and apply rags dipped in weak vinegar-and-water, or weak gin-and-water, or even simple cold water, to the head. If the blood-vessels about the head and neck are much swollen, put from eight to ten leeches on the temple opposite to the paralyzed side of the body. Always send for a surgeon immediately, and act according to the above rules, doing more or less, according to the means at hand, and the length of time that must necessarily elapse until he arrives. A pint, or even a quart of blood in a very strong person, may be taken away. When the patient is able to swallow, give him the No. 1 pills, and the No. 1 mixture directly. [The No. 1 pills are made as follows:--Mix 5 grains of calomel and the same quantity of antimonial powder with a little bread-crumb: make into two pills, the dose for a full-grown person. For the No. 1 mixture, dissolve on ounce of Epsom salts in half a pint of senna tea: take a quarter of the mixture as a dose] Repeat these remedies if the bowels are not well opened. Keep the patient's head well raised, and cool as above. Give very low diet indeed: gruel, arrowroot, and the like. When a person is recovering, he should have blisters applied to the nape of the neck, his bowels should be kept well open, light diet given, and fatigue, worry, and excess of all kinds avoided.

2636. 2. _The weak kind_.--_Symptoms_. These attacks are more frequently preceded by warning symptoms than the first kind. The face is pale, the pulse weak, and the body, especially the hands and legs, cold. After a little while, these symptoms sometimes alter to those of the first class in a mild degree.--_Treatment._ At first, if the pulse is _very feeble indeed_, a little brandy-and-water or sal-volatile must be given. Mustard poultices are to be put, as before, to the soles of the foot and the insides of the thighs and legs. Warm bricks, or bottles filled with warm water, are also to be placed under the armpits. When the strength has returned, the body become warmer, and the pulse fuller and harder, the head should be shaved, and wet rags applied to it, as before described. Leeches should be put, as before, to the temple opposite the side paralyzed; and the bowels should be opened as freely and as quickly as possible. Bleeding from the arm is often necessary in these cases, but a non-professional person should never have recourse to it. Blisters may be applied to the nape of the neck at once. The diet in those cases should not be so low as in the former--indeed, it is often necessary, in a day or so after one of these attacks, to give wine, strong beef-tea, &c., according to the condition of the patient's strength.