Chapter VII (5)

When, in despite of all such remedial means, the paroxysms of pain continue, it often becomes necessary to relieve any local congestion that may exist around the nerve, either by the application of five or six leeches over the source of the pain, or by the employment of cupping glasses or a mustard plaster. In case of both of these means failing, a blister may be applied behind the ear of the affected side, and in extreme cases a blister down the spine at the nape of the neck, which must be converted into an issue, and kept open for a week or two. It is seldom, however, that this has to be resorted to, the disease, however intense the paroxysms, generally yielding to any one course if steadily and judiciously carried through, unless, indeed, the disease is the consequence of a system shattered by wounds, campaigns, and climate, then, and only under such unfavourable circumstances, tic-douloureux becomes most formidable. The discovery of chloroform has, however, placed in the physician’s hand a boon that in a disease of this nature is in truth a very blessing to suffering nature, and may be employed in conditions of system and under circumstances where opium, morphia, brandy, and both narcotics and stimulants are inadmissible, or, from the necessary dose to effect relief, would be dangerous.

NEURALGIA.

A disease of the nerves, so called from a pain in the nerve. It is a form of nervous affection, that may either arise of itself, or be the result of some other constitutional disturbance. Neuralgia may either attack the root of the nerve, or where it arises from the brain or spinal marrow, attend its whole course, or only manifest itself in its branches, or even at the final termination of its smallest filament. According to the part affected, the disease has obtained different names. When the course of the nerve is affected, as in the hip or leg, it is called sciatica; when the extremity is affected, if in the teeth, it is called tooth-ache; and when the twigs and branches of the face are involved, tic-douloureux. The pain attending all neuralgic affections, is of the most acute and agonising description, being sharp, sudden, and plunging; coming on in a moment, and after a paroxysm of intense suffering, abating as abruptly as it commenced; and so erratic and uncertain are its attacks, that it will sometimes be induced by the most trivial motion, action, or lightest contact, while, not unfrequently, a blow or hard pressure has no effect on the part. The twitching, or tic, that attends neuralgia so frequently, is always more marked where there are many small muscles in the neighbourhood, an aching numbness being left in the part for some time after the subsidence of the more acute pain. Neuralgia, as well as attacking the root, course, and extremities of a nerve, occasionally shows itself in the organ to which the nerve ultimately distributes itself, as in the heart, in _angina pectoris_, the breasts of females, and other organs. Though the subject of neuralgia has been deeply investigated, no satisfactory hypothesis has been yet come to, to account for the origin of the disease; and whether it depends upon a morbid state of the nerve, inflammation of the neurilemma, or sheath of the nerve, from pressure, or some unhealthy condition of the nervous centres, is still an undecided question. The treatment of this most agonising disease must depend, as far it can be ascertained, upon the supposed cause. When it is symptomatic, the treatment is much easier and more simple, and must be regulated by that cause, the first endeavour being to remove the primary disease, and after brace the system by chalybeate, tonics, wine, bark, and exercise. When idiopathic, however, the most opposite treatments have occasionally been successful, and sometimes all modes of cure have failed; and when physician and patient have both been exhausted with fruitless efforts, the malady has subsided of itself. As a general rule, however, the constitutional tonic and anodyne system, with counter-irritation, has been found the most successful practice; the three modes enjoined very frequently effecting what neither the tonic, the sedative, nor the local irritation alone could achieve.

The safest mode of procedure in facial neuralgia, is to take an aperient pill, and the best for this purpose is the compound assafœtida, to be followed every four hours by a pill containing two grains of quinine for twenty-four hours; and during the second day, twenty grains of carbonate of iron in a little water, at the same periods, for the same time. Should the pain be unabated on the third day, either a couple of leeches are to be applied as near the seat of pain as possible, or a mustard and flour poultice, kept on for half an hour, with a glass of wine every four hours, and twenty to thirty drops of laudanum at bed-time, in conjunction with one or two assafœtida pills. Should these remedies fail of effect, the conjoined systems may then be adopted, and the following mixture and powders given as directed.

Take of

Carbonate of Ammonia 25 grains.
Dover’s Powder 40 grains.
Camphor Water 6 ounces.
Spirits of Ether 1 drachm.

Mix. Two table-spoonfuls every four hours.

Take of

Carbonate of Iron 2 drachms.
Quinine 12 grains.
Dry Carbonate of Soda 20 grains.

Mix, and divide into six powders, one to be taken in jelly or
water an hour after each dose of the mixture. At the same time,
apply a small blister behind the ear of the part affected.

In some constitutions, it is necessary to resort to extreme doses, both of sedatives and stimulants, before any mitigation of the tormenting pain can be effected; and then it is necessary to give opium, rather in regard to the effect desired than with any reference to its conventional dose, and administer wine out of goblets, rather than in glasses. Such cases are unfortunately by no means rare, but they are such that no suffering should induce a patient to adopt on his own responsibility, and unsanctioned by a medical man.

Electricity and galvanism have been so often employed for empirical purposes, and many, only partially informed of their real efficacy, are prejudiced against their use as health-restoring agents: it has therefore been thought advisable to give the medical routine of cure before pointing out a safe, easy, and very admirable remedial agent in the electro-galvanic chain, a small portable battery, that can be worn on any part of the body, and which, by keeping up a constant galvanic wave through the affected nerve, acts as a sedative, by equalizing the nervous current, and often affording relief where all other means have failed to effect a moment’s cessation of pain. The electro-galvanic chains, manufactured and invented by Pulvermacher, may be applied in any stage or in any kind of neuralgic pain, always with safety and relief, and in many cases with permanent cure.

LUMBAGO.

A painful affection of the muscles of the loins and small of the back; a rheumatism, or sub-acute inflammation of the muscular fibres of the part. Lumbago, like other forms of rheumatism, is induced by exposure to cold, moisture, or wet, from over-heating the body, and while in a state of perspiration, being exposed to draughts or cold air. When of long standing, it is not unusual for the kidneys to sympathise with the external inflammation, and complicate the disease.

The _symptoms_ of lumbago are too well known to require recapitulation; and as respects the _treatment_, the hot bath, either the complete or hip, is in all cases the first and most important means to adopt, being followed up by a vigorous rubbing in of the following embrocation twice a day, and the exhibition of thirty drops of the spirits of turpentine in a little gin, with a small quantity of water, upon going to bed.

Take of

Camphorated Oil 2 ounces.
Oil of Amber and Turpentine, of each 1 ounce.
Spirits of Hartshorn ½ ounce.

Mix, and use as an embrocation.

Where the pain is excessive, and the rest is disturbed, ten grains of Dover’s powder should be taken at bed-time in a little gruel, and a bottle of hot water placed under the hollow of the back. When the acuteness of the disease is subdued, it is advisable to wear a warm plaster on the loins for some short time afterwards, to keep up the heat, and guard against cold and a relapse.

RING-WORM.

This is a disease of the skin, and arises most frequently from coming in contact with those already affected by it; in some habits there is evidently a predisposition to it. It is a disease more frequently met with in warm climates than in cold ones, is of an exceedingly contagious nature, and in inveterate cases is very difficult to eradicate. It shows itself in small red pimples, which break out in a circular form, and contain a thin acrid (pungent) fluid. When the body is heated by exercise these itch intolerably, and upon being rubbed, discharge their contents, which by falling on the neighbouring parts, spread the disease to a considerable degree. The original size of the circle formed by the pimples, is usually about that of a sixpenny piece; but in process of time it will become, if neglected, as large as a man’s hand. Numerous are the remedies proposed for this very unpleasant complaint, but none are _certain_ except the following; and if _no other application has been previously used_, its success is sure:—two-thirds of pyroligneous acid to one-third of water; rub the spots carefully for three mornings: if cured, a scurf will appear, which must be softened with cold cream, or lard without salt, but no soap or water must be used.

It is desirable to cut off the hair from the immediate neighbourhood of the ring; and after the cure is effected, weaken the lotion still further, by the addition of more water, and well wash the head all over with it. It seldom happens that an internal use of medicine is requisite; but where the disease is very inveterate, we would recommend a powder to be given at bed-time once or twice. The following will answer very well for a child of seven years of age.

Calomel 1 grain.
Jalap, Powder 8 grains.

If other applications have been tried, the cure will not be so speedy.

SPRAINS

Consist in straining, wrenching, or tearing of the ligaments or tough structures which bind bones together to form joints. The wrist and ankle are the joints most commonly sprained. Sprains are among the most severe accidents to which we are subject, as regards the part itself; the pain is, at the moment, excruciating, often continues so on the slightest movement, and too frequently lays the foundation of what is commonly called White Swelling.

To treat a sprain properly, it should be kept perfectly at rest; and if it be of the ankle or knee, the patient must lie in bed, or on a sofa. Warm, moist flannels should be repeatedly applied for some hours, and a bread-and-water poultice on going to bed. These should be continued for some days, and no attempt made to use the joint. If the pain be very severe, and it continues so for the first or following days, leeches may be applied, and repeated if necessary. Some persons are fond of putting on a vinegar poultice at once; but this is better left alone till the tenderness has subsided, and there remains only a little pain and stiffness in the joint. Then a vinegar poultice is a very good application, as it produces a diversion of the inflammation going on in the ligaments, by bringing out a crop of pimples on the skin, at a time when the pressure of rubbing in any stimulating lotion cannot be borne.

When the pain has entirely ceased, the joint must not be carelessly used; and, if it be the knee or ankle sprained, walking till the joints become weak and ache must be most carefully avoided, as irreparable mischief is thereby very often caused. Short and gentle walks only, therefore, may be taken; and may be repeated by degrees more frequently during the day, if they do not produce pain or fatigue.

A joint often swells a long time after a sprain; under which circumstance it is best to bind it up with straps of soap-plaster, or a roller.

CHILBLAINS.

Chilblains consist of a peculiar inflammation of the skin of parts exposed to sudden alternations of temperature. They occur on the nose, ear, hands, but most frequently on the feet. The reason why they occur more frequently on the hands and feet is, because persons are apt directly they come in from the frosty air, to warm those parts at the fire. The face does not get warmed in the same manner, or its skin would be equally liable to chilblains.

In this inflammation, which constitutes chilblains, the sides of the small blood-vessels become paralyzed, and losing their contractility, are dilated by the pressure of the blood within them. If the inflammation be not abated, that is to say, if the little blood-vessels are not restored to their original size, and to their natural contractility, they burst, and matter will be formed, or mortification may ensue. This contractility depends upon proper nervous action in those small fibres which give life to the sides of the hair-like vessels, or small blood-pipes. Any sudden shock of cold or heat deprives these nerves of their power, and induces a local paralysis. The change from cold to heat oftener produces this shock than that from heat to cold; but either sudden alternation will produce chilblain. It need hardly be said that the nerves of persons in low states of health, persons of scrofulous habits, and young persons in whom the tissues are delicate, are more liable to be locally paralyzed in the manner described, than those persons of robust constitution, having a large quantity of vitality to resist such attacks. Hence we find such invalids, scrofulous persons, and children, more liable to chilblain than others. The liability to chilblain is often an indication of a low state of health, and want of healthy vital action in the system.

When the nature of chilblains is understood, the mode of prevention will be at once perceived, viz.—1st. To protect the parts most liable to the attack (hands and feet) from sudden alternations, either from cold to heat, or from heat to cold. 2dly. To keep the constitution in such a healthy state as to make all parts possess such vitality as to be able to resist slight alternations in temperature.

1. _Protection of the Parts._—Those substances which are good non-conductors of heat are the best coverings. Woollen stockings or socks, and warm boots and shoes, come under this category. Light shoes and stockings should be worn in the house, or the feet will become so accustomed to a high temperature that they will be more sensitive to cold. Warm leather gloves, being impervious to wind, are better for the hands than woollen ones, through which the dry frosty air is apt to pierce and chap the hands. Tight wristbands, tight garters, and boots which lace or button tightly about the ankles, must be avoided, because, by preventing the proper circulation of the blood in the hands or feet, they diminish the vitality of the part, and produce an unnatural pressure on the coats or walls of the small blood-vessels. _The most frequent cause of chilblain is the warming of numbed hands or feet at the fire_. _This habit must, of course, be relinquished entirely._ Gutta-percha soles, by preventing the wearers from warming their feet at the fire, have saved hundreds from the attacks of chilblains; but such soles should not be worn in the house. After walking in the snow, or in frosty weather, the coverings of the hands and feet should be removed. Dry stockings should be put on after _gently_ rubbing the feet with the pair which has been taken off. The fresh pair _must not be warmed_. It is well to wear woollen stockings when out, and cotton stockings when in-doors. The use of excessively hot water when the feet are cold, has produced mortification; but the frequent washing of the feet in tepid water and soap, restores the powers of the nerves in the parts, and renders them less likely to be affected by those alternations of temperature to which they are liable to be exposed.

2. _Constitutional Means of Prevention._—Persons in robust health are less liable to take infection, suffer less from injuries, and when wounded, are possessed of greater powers of nature for reparation, than partial or confirmed invalids. The cold of winter ought to stimulate us to exertion; and exercise is especially necessary to health in winter. Too warm clothing of the body enervates and debilitates; only sufficient clothing, therefore, should be worn. Rooms in winter are often made hotter than the air of summer; this, and bad ventilation, is another blow to constitutional strength. Enough, however, has been said on this subject to indicate the necessity of general attention to the health in persons who are excessively liable to chilblains.

3. _Treatment._—When the inflammation called chilblain has attacked any part, it should be considered whether it is a mere local affection, or whether it shows a constitutional state, which renders the hands or feet, or both, more liable to the attack than those parts ought to be. If hands and feet are both attacked in several spots at the same time, and this without any very evident cause, _constitutional_ treatment is pointed out, in addition to the use of remedial agents _locally_; where, however, there is only a single spot on the hands or feet, and a cause (such as warming the feet at the fire) is remembered, only local treatment is necessary. The hands and feet enjoy different conditions, however, and require slightly different management. Our treatment, therefore, resolves itself into three parts:—

CONSTITUTIONAL.

OF THE HANDS.

OF THE FEET.

_Constitutional Treatment._—Aperient medicines may be used to relieve the overloaded blood-vessels, and lessen the pressure upon the coats of the capillaries, or hair-like blood-pipes of the parts affected. After this has been done, small doses of tartrate of antimony wine (which seems to constringe the enlarged vessels) may be taken with advantage. The writer has seen this treatment (without local means) act as a sort of charm, and relieve full crops of chilblains on hands and feet. A dram of the wine may be added to half a pint of water, in which a drachm of saltpetre has been dissolved. Dose: for an adult, one or two table-spoonfuls every four hours; for a child, one or two tea-spoonfuls three times a day. It should not be given in such doses as to produce vomiting. The head, neck, and chest, should be washed in _cold_ water every morning, and brisk exercise taken at regular hours. Persons of a scrofulous habit should be particularly attentive to their general health in winter. The addition of salt to the washing water is recommended in their cases. It is not an uncommon practice for persons, after exposure to cold, to drink hot elder wine, or hot negus, or warm spirits and water; all such measures, having a tendency to produce rapid and violent reaction, are likely to render persons liable to chilblains.

_Treatment of the Hands._—Wash in cold water every three hours, and lather well with Windsor soap. When the hands are nearly dried with the towel, pour a little Eau de Cologne, or milk of roses, into the palm of one hand, and rub it over the whole of both; lastly, polish with the towel till every part glows with warmth, and is so completely dry that the lint from the towel does not stick to the skin. The writer believes this simple plan to be _infallible_.

_Treatment of the Feet._—All the plans for prevention are curative. Chilblain in the feet often assumes a more serious form than in the hands, and the application of _cold_ water is inadmissible, especially in the case of females. The three degrees of chilblain in the feet are: 1st. The skin is red in patches, and slightly swelled, with more or less itching or tingling, with slight tenderness. 2d. Small blisters appear, surrounded by a livid skin. 3d. Ulceration and mortification take place. For the first two cases, which are most common, the frequent application of tepid water (using plenty of soap) gives relief. A leech is a useful remedy to unload the overcharged blood-vessels; or the part may be pricked with a needle, or punctured with a lancet; in such cases a soft bread-and-water poultice should be kept on during the night, applied warm, so as to encourage the flow of blood.

LEECHES.

Common as leeches are now, few persons have any notion of the distance from which they are brought for our use. Our own country furnishes at present few, if any, medicinal leeches. Formerly they were imported from France, but now, many are brought from Syria, and, as they are very delicate creatures, vast numbers of them are often lost in a rough passage across the sea.

Leeches should be kept in a cool place, in a stone or glass jar, filled with river water, and tied over with coarse muslin to prevent their escape, though it allows them air. The water should be changed only when it begins to get foul, as too frequent disturbing destroys them. They are also sometimes found dead after storms.

There is often a great deal of trouble in getting leeches to fix. The part on which they are to be applied should be carefully cleared of perspiration, and wiped with a cool moist cloth, so as to leave it damp. If they do not take readily, the part may be moistened with a little sugar and water, or milk. But if this does not answer, the skin may be gently scratched with a needle-point, till the blood comes, and then they will take. If it be wished to put the leeches as near as possible on one spot, the best plan is to put them all in the deep part of a small pill-box, or in a small wine-glass, which is to be turned down on the part. If you wish them to spread over a large surface, as upon one of the limbs, or the stomach, they must be put on singly and by hand, which is often very tedious and tiresome work. They should then be held tightly by the tail, wrapped in a piece of wet rag, so that they may be less inconvenienced by the heat of the hand; and if the leech do not soon fix, it is best to put it again into the water to cool itself, and after applying others, to try it again. It is always best to have more leeches than the number directed, in case some will not bite.

When the proper number have been applied, they should be left quite alone, or they are apt to unfix, and, wandering about, are of no further use. When they have sucked their fill, they generally drop off, and should then be put in a plate with a _little_ salt, which quickly makes them throw up the blood; and, as soon as they have emptied themselves, they should be put into plenty of fresh cold water, so that they may get free from the salt, for if left in it, or if _too much be put on them_, they contract violently, and die almost immediately.

After the leeches have come off, the bleeding from the wounds is to be encouraged, by first quickly sponging off whatever clotted blood there may be, and then covering the part with a warm bread-and-water poultice, which must be changed every half hour, so long as it may be thought necessary to keep up the bleeding. This is much better than leaving the surface exposed, and mopping with a warm sponge, which is very fatiguing to the patient, besides exposing him to the danger of taking cold.

One disadvantage in the use of leeches is the great uncertainty, as to whether too little or too much blood is obtained by them. Getting too little blood, however, is a matter of very trifling consequence, in comparison with getting too much, for instances have occurred in which leech-bites have continued bleeding for days in grown-up persons as well as children, bringing them into a very dangerous condition; nay, there is no want of well-authenticated cases of death caused by bleeding leech-bites, and that, too, in the course of twenty-four hours. The cause of this serious business is sometimes a peculiar constitution, in which the blood will not clot with sufficient firmness to stop the bleeding; or it may be some little artery has been wounded by the bite in such a way that it cannot be stopped by a clot of blood.

If, then, a leech-bite continue bleeding for some hours, and the person, more especially if an infant, begins to be very faint, and the countenance and lips pallid and cold, like marble, no time must be lost in stopping the bleeding.

This is done by pressure with the finger; but, if that fail, by applying caustic, or by running a moderate sized darning needle into the skin on one side of the bite, and bringing its point well out on the other side. The whole wound is thus lifted up, and a piece of silk or strong thread is then to be wound round and round the bite, under the two ends of the needle. This will raise it up like a small spot, and generally stops the bleeding very effectually. In four days cut the silk and draw out the needle carefully, and there the matter usually ends. But in the peculiar state of constitution which has been before noticed, sometimes even after the removal of the needle and thread, the bleeding will continue. Nothing then remains, but to touch the bottom of the wound with a bit of thin iron wire heated white hot, which never fails to stop the bleeding. Though this may seem a very horrible proceeding, it is not very painful if the iron be _white hot_, as it destroys sensation in an instant; but whether it give pain or not is a matter of no consequence, as it is the only _sure_ mode of saving the patient.

BREAD-AND-WATER, OR EVAPORATING POULTICE.

Scald out a basin, for you can never make a good poultice unless you have perfectly boiling water; then, having put some into the basin, throw in coarsely-crumbled bread, and cover it with a plate. When the bread has soaked up as much of the 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. It may be said that this poultice will be very inconvenient if there be no lard in it, for it will soon get dry; but this is the very thing you want, and it can easily be moistened by dropping warm water on it, whilst a greasy poultice will be moist, but not wet.

A poultice thus made is, to the surgeon, what well-made stock is to the cook, a foundation to be seasoned or medicined with laudanum or poppy-water, with carrot or horse-radish juice, or with decoctions of herbs, with which the patient or the doctor may be inclined to medicate it, instead of loading an already irritable and very sensitive part with a heap of hard poppy-shells, or scraped carrots, or horse-radish, called poppy, carrot, and horse-radish poultices, but which increase rather than allay the sufferer’s pains.

When vegetables are used to medicate poultices, they should be bruised, put into a pot, covered with water, and simmered for about half an hour. The liquid is then to be strained off, and mixed with bread-and-water or linseed to the consistence of a poultice.

BANDAGES.

Bandages are those surgical appliances, made of linen, calico, or flannel, either in long narrow strips called rollers, in belts, fillets, or triangular sections; they are used to keep dressings in a proper situation, to compress blood-vessels, and check dangerous bleeding, to rectify deformities, maintain fractures in their position, and to unite wounds and breaches in the continuity of parts. Bandages, of whatever material made, should be strong enough to bear extension, and support the part to which they are applied; and sufficiently supple and elastic to fold with ease, and yield to the expansion of the tissues below them. They should be without either seam or selvage, and have smooth unravelled edges. Bandages are either simple or compound. A _simple bandage_ is a long narrow piece of linen, calico, or flannel of any length, from three to nine yards, and of a width varying from two to six inches. When such a strip is tightly and evenly rolled up, it is called a bandage or roller.

When rolled from both ends, and the two heads meet in the centre, the bandage is called a _double-headed roller_.

_Compound bandages_ are those where several pieces are sewn together in different forms or shapes, as in the more simple one of the letter T, or when the bandage is torn at the end into several strips, in which case it is called a many-tailed bandage.

The _handkerchief bandage_ is very useful to retain light dressings on the head, or to cover and keep in position bags of ice, or cold applications, where evaporation is not required. For this purpose, take a large silk handkerchief, throw it over the head and face, carry the back ends under the chin, and tie them securely; then neatly fold back the loose portion over the face, and making the fold grip the forehead, lead the ends to the nape of the neck, and there crossing, secure them in front of the throat.

In applying a simple bandage to the leg or arm, the envelopment of the limb must commence with the foot or hand, and requires to be performed with neatness and regularity, for, if the pressure or tightness is greater in one part than another, the limb will become unevenly marked by swollen and contracted ridges, causing both pain and mischief. Having carefully made a beginning by passing the roller a few times round the foot or hand, making every revolution cover a third of the former, it is in the same order carried up the limb from hand to hand, providing for the increasing size of the part by making a fold of the bandage; turning it sharply back on itself, and laying it smoothly down, each succeeding fold being made in the same line; when the whole limb is enveloped, either pin or sew the end to the fold beneath, or split the end of the bandage, and tie in a knot.

The _application of the double-headed roller_ is for wounds or bleeding at the temple. After applying a compress, a piece of lint or linen should be doubled square as many times as is required, and of a size commensurate with the purpose for which it is employed. The operator takes a head of the roller in each hand, and opening the bandage a short length, commences on the opposite side to the wound, and bringing both ends round to the compress, gives them a twist, and carrying one over the top of the head and the other under the chin, makes them meet where they began, and giving another twist, carries them horizontally, one over the forehead and the other round the back of the head, meeting again over the pledget, where the same operation is to be repeated, and the ends either tied on the top of the head or pinned over the temple.

The _roller bandage_ for the eye, to keep the dressings firmly in position; after making a few oblique turns over the eye and cheek, so as effectually to cover the eye, the bandage is to be doubled back and pinned in its place behind the head, and then carried horizontally round the head, to keep the oblique folds in position, and then secured by a couple of pins over the forehead. Each circle should lie, by the width of a hem, farther back than the preceding one.

For injuries to the chin, a bandage, consisting of a piece of calico about six inches broad and a yard long, is to be split down each end to within four inches of the centre. The unsplit part is then applied over the dressings on the chin, the outer margin overlapping the point of the jaw; the two outer tails are then carried to the crown of the head and tied, while the inner tails are led in like manner to the forehead, and there secured. A nightcap should be worn as a precaution to make the grip of the knots more secure.

A _bandage round the chest for fractured ribs_ is applied by means of a double-headed roller, which, commencing over the top of the breast-bone, is carried round to the back, and then led one over each shoulder, made to cross on the breast, passed under the armpits, cross each other at the back, and gradually tightening as they descend, cross again in front, till a sufficient depth is obtained, when one end is to be pinned over the other. But a much simpler and less elaborate bandage for fractured ribs is made out of a broad piece of jean or holland sewn tightly over in front by a strong needle and thin twine; cross straps, like braces, may be added, to keep the whole in place. When a bandage is thus adjusted, it will keep its position, without slackening, for weeks.

The _bandage_ T is generally used for wounds in the groin, or as a suspensory; the cross arms of the bandage on the top of the T are passed and secured round the middle, while the long end is conveyed between the legs, brought upwards, and fastened in the front to the other part.

BLISTER.

The term blister is applied to any substance that has the power to raise the outer skin into bladders or pustules. There are several varieties of blisters—animal, vegetable, and mineral, the principal being cantharides or Spanish flies, mustard, euphorbium, mezereon, savin, antimony, silver, vinegar, potassa, and ammonia.

Blistering and counter-irritation is a mode of treatment by which it is sought to cure one disease by establishing another of the same type, but less severe than the first; bearing this in mind, the general utility of all external stimulants, especially that of blisters, will be better understood and more fully appreciated.

Blisters are used in medicine as a means of depletion, either to carry off from the body a certain amount of blood in the form of serum, and thus act as a local bleeding, or in addition to this effect, to cause, by the inflammation they produce on the surface, a larger amount of blood to circulate through the adjacent cuticle, and thus relieve some deeper organ or part from the excess of blood that disease causes to be attracted to it. With this view only, and when no depletion is required, medical men are in the habit of using a milder form of blistering than that effected by raising the epidermis in bladders, and to this they give the name of rubifacients, or, in simple English, substances that “make red.”

From the benefit they afford, the ease of application, and the safety of their employment, blisters have become of universal use, and may be considered as an established domestic remedy. Yet there are certain points in connection with them that require explaining, both for protection and guidance. When the blister has sufficiently risen, remove the plaster, and nipping the blister where it bags most, gently press out the water, taking great care not to break the skin as it collapses; immediately place over the whole a warm bread poultice, the bread confined within a fold of muslin, and allow it to remain for one or two hours; then carefully remove the poultice, and sprinkle the blistered part with a thick layer of violet powder, cover this with a piece of linen, and, by a bandage or handkerchief, keep the whole in its place; every four hours add more violet powder, especially over the moist part, taking care not to remove the cake or crust that forms till the cuticle is sufficiently healed to permit of its being taken away, when the place is to be lightly dusted with the powder from time to time, to avoid cracking the new cuticle. It is seldom if ever necessary to interpose gauze or tissue paper between the blister and the skin, and, except in very rare and singular cases, should never be done, nor is there any time that can be fixed as the duration a blister should remain on; this must depend on the rising, which will take from eight to sixteen hours to effect; though in infancy and childhood, from the extreme delicacy of the cuticle, the time required is infinitely shorter. But this is a point that every nurse provides for by frequent inspection. When a blister is not at hand, steep a pewter plate or piece of flat metal in boiling water, and place it at once on the skin, pressing it down for a moment, and then allowing it to rise, and as it cools remove it; or in cases of still greater emergency, a blister may be obtained by wetting a part of the cuticle and rubbing on it for a few minutes, lunar caustic; or cut a circular hole out of a piece of adhesive plaster, which having adhered to the skin, tie some lint to the end of a stick, dip the padded end in nitric acid or aqua-fortis, and brush lightly and rapidly the skin exposed within the hole in the plaster, when a vesicle will be immediately produced. In this country it is seldom that any blister is used but that of cantharides or Spanish flies, except in extreme cases, that of mustard, as given above. The blister plaster as sold in the shops is a species of tough ointment, and is made of wax, suet, rosin, and lard, all melted over a slow fire, and while cooling the powdered flies stirred in, till the whole, when cold, becomes a smooth, firm, and tenacious mass. The mode of making a blister is to cut out a shape from a piece of adhesive plaster, either round, oval, oblong, or according to the part on which it has to be applied, and taking a piece of the blister plaster, and softening in the fingers with the right thumb wetted in water, extend it over the shape, leaving a margin of half an inch all round; the plaster is to be spread about the thickness of a shilling, and all over of an equal smoothness. This is then to be warmed for a moment before the fire, and applied evenly over the part, the edges of the plaster being nicked, where necessary, to make it lie flat. For the ears, the shape of the blister resembles the figure 6, the O part coming under the lobe of the ear, and the tail sweeping behind it; each ear, however, requires a different position of the figure, that of the left needing the 6 as it naturally stands; the right must have it reversed, as thus, 9.

CARBUNCLE

Is a hard circumscribed tumour of an inflammatory character, commencing in the cellular tissue and extending to the skin, and named from the intense burning pain that attends its progress. A carbuncle in general appearance resembles a boil, but differs from it in not having a core, and terminating in a gangrenous slough, instead of, as in the other, by suppuration.

In whatever part of the body a carbuncle is formed, it is first indicated by great redness and violent pain, excessive itching, and a burning heat.

Carbuncles are more frequent in advanced life than in the young; and are generally indications of a low, putrescent or typhoid state of the system; and not unfrequently the result of it. The extent of a carbuncle is as various as the part of the body in which it appears; it varies, from the size of a walnut to the dimensions of a plate; the parts of the body most subject to its attack are the neck, shoulder, armpit and hip.

_Treatment._—The local remedies, from first to last, are warm emollient poultices; which are to be applied directly the tumour shows itself, and continued every three or four hours, till the healing process is fairly established. As soon as the swelling becomes conical, the top is to be freely opened. The best poultice to use is either bread-and-water or linseed meal. To meet the constitutional disturbance, a mild alterative pill of equal parts of extract of colocynth and henbane, should be given every second day, and when the febrile action is considerable, two table-spoonfuls of the following mixture every four or six hours.

Camphor Water 6 ounces.
Nitrate of Potass 15 grains.
Tartar Emetic 3 grains.
Syrup of Saffron 2 drachms.

In addition, when there is much pain and want of sleep, add one
drachm of laudanum to the mixture, or give the patient 25 drops
at bed-time, while needed. When the abscess has been opened, it
will be necessary to administer tonics, with a liberal diet and
wine. For this purpose the following mixture is to be taken in
doses of two table-spoonfuls three times a day.

Quassia ½ drachm.
Cardamom Seeds 2 drachms—bruised.
Boiling Water 1 pint.

Infuse for six hours, strain, and add diluted nitric acid, 1
drachm.

If the debility is excessive it will be advisable to give
stimulants, in which case the following mixture is to be
employed.

Take of

Camphor Water 3 ounces.
Compound Tincture of Bark,
ditto Cinnamon, of each ½ ounce.
Spirits of Sal Volatile,
ditto Sulphuric Ether, of each 1 drachm.

Give a table-spoonful every hour, increasing the interval, as
the strength of the patient rallies; at the same time continue
the wine, and if required, brandy.

EXCORIATION.

This term implies any abrasion, peeling off, or separation of the cuticle, by which the sensitive and true skin is left unprotected. Many persons are subject to excoriation or chafing, from the slightest muscular exertion, more particularly in such parts as are exposed to friction. In general, excoriation is the result of inattention to the surface of the body, and is frequently excited by perspiration and dust or fine particles of sand adhering to the cuticle, and being rubbed by the play of the muscles into the lines and creases of the body. The perspiration secreted by fatiguing exertion will, from its acridity, if left on the body, very frequently act as an irritant on the cuticle and destroy its texture. Cleanliness, therefore, whether with adult or infant, is the best preventive against this painful affection.

The treatment of excoriation, when occurring in those parts of the body usually covered, should consist in first washing the place with warm water, and when well dried by a soft towel, to be freely dusted with violet powder, repeating the application every two hours: for all that is necessary is to remove the exciting cause, and keep the part cool and covered. When the abrasion is deep seated, a piece of lint wetted with the liquor plumbi (extract of lead), is to be laid on for an hour, and on its removal the abrasion dusted with violet powder or common flour; no other lotion will be needed, and ointments or grease should never be employed.

GOITRE.

Bronchocele, or the Derbyshire Neck, as this disease is variously called, is a chronic enlargement of the thyroid gland, a small glandular body lying in front of the organ of voice in the throat, and which in a natural state presents no external features, but when diseased, is capable of an almost incredible enlargement. Goitre is distinguished by a diffused, soft, elastic swelling, extending either quite across the neck, presenting larger prominence on either side than in the centre, or the enlargement may be all on one side, according as the whole gland, or only one of its lobes is affected. The swelling is entirely devoid of pain, and completely detached from the skin, which preserves its natural colour and appearance. Goitres usually make their appearance about the seventh or eighth year, and at first grow very slowly, but after a time develope more rapidly, extending in all directions, and frequently hanging over the chest. The disease is seldom dangerous, unless, from the size it attains when by pressing on the large blood-vessels of the neck, and retarding the return of blood from the head, or by compressing the windpipe, it produces dangerous symptoms. Women are more subject to this disease than men, though in many countries where it is always endemic, both sexes and all ages are found affected with it.

_Treatment._—Of all the remedies that have at various times been employed with the hope of curing this unsightly deformity, one only has ever produced any permanent benefit, namely, _Iodine_, in one or other of its forms. All operations are inadmissible and dangerous; and the cure is to be effected solely by a combination of external and internal remedies. In the first place, where possible, the patient should be removed from the neighbourhood where the disease was produced, the tumour is then to be gently excited by the application of three or four leeches, and the following ointment rubbed well into all parts of the swelling every night, intermitting for a day or two, whenever the skin becomes tender from the rubbing.

Take of

Powdered Camphor 15 grains.
Calomel 1 scruple.
Iodine 30 grains.
Spermaceti Ointment 1 ounce.

Mix thoroughly, and make an ointment. At the same time a
table-spoonful of the following mixture is to be taken three
times every day. Take of the hydriodate of potassa one drachm,
mint water, six ounces, mix.

This system should be persevered in for several weeks, the patient, however, carefully taking the measurement of the throat and tumour before commencing either course of treatment; and having accurately recorded the number of inches in circumference, test the diminution every week, by re-measuring the tumour till its absorption and the restoration of the throat to its natural figure.

HARE-LIP.

This disease, so called from a fancied resemblance to the appearance of that animal, is one of those distressing malformations that are born with a child. Hare-lip is more frequently found in the upper than in the under lip, and fortunately it is so, for, in the latter case, the child is unable to articulate or retain the saliva in the mouth, creating a source of ceaseless discomfort and pain. The disease consists of a fissure or longitudinal division of one or both lips, having a space between, wider at the bottom and narrowing to an apex at the gum, resembling the outline of the letter V reversed, Ʌ. This condition is called the simple hare-lip, but sometimes the fissure is double, having a pendant piece of the lip in the centre of both fissures. The compound hare-lip is that condition of deformity where the cleft extends along the bones of the palate, over the whole arch of the mouth, while in some cases the bones of the palate are entirely wanting—a most distressing malady, as the child can never articulate, and only with great difficulty eat or drink, as all sustenance passes into the nostrils. Independent of the deformity attending this malformation, the infant so afflicted is prevented from sucking, and must be reared by hand.

The _treatment_ of this misfortune is very simple and most satisfactory, and no mother out of apprehension of her child’s suffering should neglect to have the deformity cured; which, when in the simple form of the cleft lip, can be effectually done. The operation consists in making the two edges of the fissure even, bringing them together by means of two short silver needles, and keeping them in that position by silk thread passed over their ends like the figure 8, till the process of union has taken place, requiring about eight or ten days, when the needles are withdrawn, and in a week longer the permanent cure will be effected. The best period for performing the operation is between the age of six and twelve months, before the child can entertain any alarm at what is to be done, or by cries and restlessness materially interfere with the success of the operation.

INFLAMMATION.

By this term is generally understood that condition of a part in which it becomes painful, hotter, redder, and more turgid than in a state of health. The more considerable these symptoms become; or when they take place in very sensitive parts, they induce that condition of the system known as fever, and which, when the primary symptoms occur in certain tissues, becomes inflammatory fever. The seat of inflammation lies in the capillaries, those minute vessels or tubes that in health perform the office of secretion and nutrition, but diseased, become distended with red blood, consequently swell and cause the enlargement, the first symptom of inflammation; at the same time the increasing quantity of blood accumulating in the part, causes the redness and accession of heat; while the rigidity, tightness, and weight induced by the collected blood pressing on the sentient nervous filaments below, produce the dull, the sharp, or hot throbbing pain experienced according to the situation of the swelling, and constitute the last and most distressing symptom of local inflammation.

All inflammations are either local or general; when local, and attacking an organ, the disease is named after the part affected, as hepatitis—inflammation of the liver; phrenitis, of the brain; gastritis, of the stomach, and so with respect to other organs; but when it is general, as already said, it is called inflammatory fever. As there are degrees in the rapidity or slowness with which inflammation takes place, and also in the time the disease continues, inflammation has been divided into the _acute_, the _sub-acute_, and the _chronic_, each form demanding a separate and peculiar practice. Nature, that in all forms of disease attempts to effect a cure, has in the case of local inflammation provided several means, the chief of which are—

1st. Resolution, which is a gradual absorption of the accumulated blood.

2d. By hæmorrhage, or the bursting of the distended part, and the escape of the blood.

3d. By suppuration, or the conversion of the effused blood into pus, or matter, which, gradually pressing on the skin, causes absorption of its texture till an aperture is formed and the contents of the abscess escape; and

4th. By gangrene, or mortification, which, when a part has been killed by excessive inflammation, forms a line of demarcation, and separates the dead from the living part. The symptoms, general and local, of inflammation, are materially altered by the structure of the part in which the disease takes place; thus, the heat is much less, the pain infinitely more acute, and the pulse hard and sharp, when the inflammation attacks the _serous_ membrane, or that tissue which lines the chest; while in the _mucous_ membrane, or that which lines the mouth and stomach, there is less pain, more heat, and a full, round pulse.

The treatment of inflammation is both general and local. By the first is understood, bleeding from the arm, tartar emetic, opium, and saline purgatives; the latter, leeches, cupping, blisters, baths, and fomentations.

CHOKING.