Chapter II: Preface (2)

TREATMENT. In the treatment of this disease the remedy will of necessity depend upon the originating cause, but whatever that may be, the simple rule is to make the patient keep quiet and not to exert or expose himself to sudden variations of the temperature, or (in hot weather) to the direct rays of the sun. To rest quietly on the back is of the greatest importance in this as in all cases of bowel complaint. Generally speaking, if the discharges from the bowels have an offensive odor, or if they have not acted for some time, then they must be cleared out with a dose of castor oil or other aperient, before doing anything else. In the case of a child, instead of castor oil give spiced syrup of rhubarb, and a tea-spoonful will suffice for an infant. In every instance, however, put the child to bed, bandaging it tightly round the stomach with flannel, and leaving it without food for a few hours. Where the motions are thin and frequent and attended by some degree of bearing down, administer 5 drams of castor oil with 5 drops of tincture of opium. This will give great relief. The same course should be adopted when the attack is due to the introduction of oily or putrid food into the stomach. If cold or suppressed perspiration be the cause, then the secretions must be restored by administering to the patient medicines which determine to the skin, such as James’ or Dover’s powders, five grains of the former, or ten of the latter, in a little arrow-root or gruel. The feet should be put in hot water every night. When there has been an abuse of aperients, these must be discontinued. If there are pains in the bowels with nausea and vomiting, apply a mustard poultice, or else heat a plate in the oven and wrap it well round with flannel wrung out of hot water, then place over the belly, covering with a dry towel. This will afford all the requisite heat without the weight of a large plaster. It is advisable to have another plate heating whilst one is in use, so that a change can be immediately effected. A few drops of laudanum and spirits of camphor, 5 drops of each for a child of 10 years, and 3 drops of each for one of 5 years, may be given every twenty minutes so long as the diarrhœa or pain and vomiting continues. Neither laudanum or paregoric should be administered to an infant, except under medical advice.

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Dislocations.

The tendons and ligaments at the joint, which keep the bones together and give the limb its freedom of action, may, through external violence or undue tension, be displaced, severing the natural connection. In these cases of accident, it is hazardous for an inexperienced person to try and remedy the mischief, as, unless perfectly sure that the limb is out of joint, the attempt to effect a reduction, may tend to bring about a fracture instead. It is better to procure skillful advice in every instance when such can be readily obtained. But _immediate_ action must be taken, when by a heavy fall or otherwise the neck is partially dislocated, for there is a bare possibility of recovery by prompt action, but the accident usually terminates fatally. Carry out the following directions.

NECK. Place the person at once on his back, planting the knees against each shoulder. Hold the head firmly in the hands, and gradually and gently turn it into its natural position. Absolute rest for some days afterwards is necessary.

It must be borne in mind that, in giving the following directions for the treatment of dislocations in other limbs of the body, the advice above given, to keep the patient quiet and obtain professional assistance, must not be forgotten by those without any proper and technical knowledge.

FINGERS and TOES. Dislocations of these are not of frequent occurrence, and usually happen between the first and second joints. The projection caused by the dislocated bones is easily perceived and without much difficulty reduced if effected speedily after the accident. Immerse the limb in hot water and let the patient lie on the floor; then by bending replace the displaced bone over the head of the bone from which it has been disjoined. A good deal of extension and counter-extension may be required in the more obstinate cases, for which purpose a piece of stout tape should be wound round the finger, protecting the skin with some wetted material. The wrist during the operation should be inclined forward.

JAW. Here the jaw gets out of joint from opening the mouth too wide, as in gaping, which becomes forced wide open, with much pain in front of the ear, extending up to the temples. Put the person on a low seat and place a thin stick across the mouth, pushing it far back; then press backwards and downwards till the jaw slips back into its place; or else, covering the thumbs with a handkerchief, place them in the mouth, pressing slowly but firmly on the four back teeth, at the same time raising the chin and pushing the jaw backwards.

SHOULDER. In a dislocation of this limb, the arm becomes powerless and the shoulder appears flat when compared with the sound one, and all attempts to move the elbow in the direction of the injured limb will occasion pain. A depression will be seen at the top, and by passing the fingers under the armpits the head of the bone will be felt. In this case, where the depression is _downwards_, put the patient on a bed, or the floor, with his head raised, and place your foot in the armpit, against the head of the bone. Then taking a firm hold of the arm above the elbow or at the wrist with your hands, or with a strong bandage attached to it and passed round your neck, pull steadily and push with the heel.

After doing this for some time, tell the person to turn quietly round, when by a sudden strong pull you will feel the bone jerking into its right place.

HIP. A dislocation of the hip causes a shortening of the leg, making the foot incline inwards. When unless assured that there is a dislocation, do nothing without proper advice. In cases of extreme urgency, act in a similar manner as when the shoulder is put out; placing the foot between the legs, at the same time making due provision for protecting the parts.

WRIST, KNEE and ANKLE. All accidents occurring to these are of a serious character, requiring surgical attendance. But when such professional assistance cannot be readily obtained, the same principle should be adopted as pertains in all cases of dislocation, that is, by extension and counter-extension to get the muscles into that relaxed condition as will permit the operator to push the bone back into its proper place.

WRIST. In the case of the wrist, the accident is generally caused by a fall on the hands. The bones of the fore-arm may be thrown either backwards or forwards on the wrist, causing the projection to be either in front or behind. The bones are replaced by pulling the fore-arm and hand in opposite directions, pressing sideways, if the displacement is at the side. Put a straight, well padded splint on the back and front of the fore-arm and wrist and tie a bandage over the whole. The arm should be carried in a sling, and any inflammation kept down by applying cold water or cooling lotions.

KNEE-PAN. This bone may be forced off the end of the thigh-bone outwards, causing a projection on the outside, with inability to walk or use the limb without great pain, or the bone may be thrown inwards, (which is rare), causing a projection on the inside, and a like inability to bend the knee. The leg should be bent forwards _on_ the body and the knee kept as straight as possible. Then with the hands press down on that edge of the knee-pan which is furthest from the centre of the joint; this will raise the nearer edge of the bone, when the muscles, assisted by a lateral pressure, will help to place the disjointed member into its right position. The knee should be kept slightly bent and a splint worn at the back of the limb. Apply cold water or cooling lotions.

ANKLE. The dislocation here may be either backwards, forwards, inwards, or outwards. The latter is the most frequent and is generally accompanied by fracture of the small bone of the leg, above the ankle joint.

These dislocations can all be readily ascertained by comparison with the sound foot. Where the dislocation is outward, hold the foot very firmly by the heels and front and draw steadily downwards and then force it into position by moving the foot or ankle backwards and forwards for a little while. The return will be greatly facilitated. The foot should be confined in pasteboard splints, soaked in warm water and moulded to the shape of the limb, with a foot piece at right angles. The patient must be kept to his bed for five or six weeks, and when commencing to walk again, the ankle should be supported with a roller bandage.

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Drowning.

The length of time that persons can remain under water and afterwards recover, is from five to thirty minutes. The air being shut off from the lungs, breathing stops and the immediate accumulation of carbonic acid in the blood paralyzes the nervous system and insensibility immediately follows. The heart continues to beat, however, from five to twenty minutes after the occurrence of insensibility and apparent death. Recovery may take place at any time before the heart ceases to beat, and has been brought about in some cases even after this organ has become still. It has taken place in some few instances as late as half an hour after being under water, but it can scarcely be expected, even under the best treatment, later than twenty minutes from the time of submersion, and even as late as this the chances are much against restoration. Treat the patient instantly on the spot in the open air.

1st. Loosen the clothing, place the face downward with the forehead resting on one of the wrists and the face turned to one side. Open the mouth, seize the tongue between the fingers covered with a handkerchief or a piece of cloth and draw it forward between the teeth. Clear the mouth and throat from mucous by passing the index-finger, covered with a handkerchief or a piece of cloth, far back into the mouth, thus opening a free passage into the windpipe.

2nd. Turn the body face upward, shoulders resting on a folded coat or pillow, keep the tongue drawn forward, take hold of the arms just above the elbows, draw them away from the sides and up over the head until the hands meet, counting one, two, (this expands the chest and allows the air to enter the lungs), lower them so that the elbows will come to the sides and the hands cross on the pit of the stomach and press then gently but strongly against the sides and chest, counting three, four, (this forces the air out of the lungs); continue these two movements (which produce artificial breathing) very deliberately about ten or twelve times, in a minute and without ceasing until the patient breathes naturally, or until satisfied that life is extinct.

3d. While this is being done, a little friction may be produced on the chest by rubbing gently with warm flannel, and the body may be stripped and wrapped in dry blankets. After natural breathing begins, continue very gently for a few minutes the two movements which produced artificial breathing.

After natural breathing is fully restored, give the patient a tea-spoonful of brandy, hot gin, or tea, two or three times a minute until the beating of the pulse can be felt at the wrist. Rub the arms and legs upward and the feet and hands with warm and dry flannel. Apply hot cloths to the body, legs and arms, and bottles of hot water to the feet.

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Effects of Cold.—Frost Bites.

A temperature ranging from 60 to 70 degrees, though considerably lower than that of the human body, which averages 98 degrees, is the one best adapted to man’s requirements, since the proportion to the loss and reproduction of heat are nearly equalized. A lowering of the temperature tends to congeal the blood, and the effect of the impeded circulation is quickly apparent in the smaller vessels of the skin, which are the first to be affected, as this lowering increases the more important organs, as the heart and arteries suffer, owing to the free course of the blood being checked in the surface vessels, and not undergoing that natural change in the lungs, as would otherwise naturally take place.

The fingers, ears, nose, and other projecting parts of the body are the first to suffer from an undue exposure to the extreme cold, assuming a blue or livid appearance caused by the weakened circulation, which, if continued and not speedily arrested and restored, will lead to mortification and death.

This lowering of the bodily temperature produces a general or local loss of vitality and a strong desire to sleep, which must be prevented by every possible means, otherwise a state of insensibility will arise, brought about by congestion of the brain.

(Where the vitality is only locally or partially destroyed, a condition occurs known as _Frost Bites_, which are treated of at the end of this article.)

TREATMENT. The main object here is to restore the natural temperature of the body, or affected part, and this must be done _gradually_; as Dr. Hunter[2] says: “The degree of external heat should be in proportion to the vitality.” When the life is weakened and nearly destroyed by frost, the warmth imparted should be small, and rise no faster than life returns.

In no case should a person overcome by cold be _suddenly_ exposed to any considerable degree of heat or taken into a well warmed room. This would only result in either seriously endangering the patient’s life, or in the case of frost bites killing the affected member or causing violent inflammation.

The body, after removing the clothes, should be covered with snow, excepting the nose and mouth, but when this is not obtainable, immerse the body in water as cold as possible for some minutes. When the body has thus gradually thawed and the muscles begin to relax, place it, after drying, in a cold bed and rub well with warm hands under the clothes. The continuous friction will cause the temperature to rise. As soon as signs of vitality appear and the flesh regains its normal appearance, apply lard or sweet oil to the skin. The patient should be well protected with heavy wraps. A small dose of brandy may now be administered.

FROST BITES. When the cold affects some projecting part, as the ears, nose, fingers, and toes, rub the part with snow or cold water until the circulation is partially restored, and then with equal parts of brandy or some other spirits until the restoration is complete. Troublesome sores are often the result of frost bites and are difficult to heal. Red precipitate ointment is the best remedy for them, and where there is much inflammation, apply poultice.

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Epilepsy.—Epileptic Fits.

Epilepsy, or falling fits, as it is sometimes called, is a disease of the brain characterized by paroxysms and convulsions occurring at irregular periods, accompanied with loss of consciousness and voluntary motion.

CAUSES. There are many causes which give rise to these attacks, such as _external_ injuries to the brain and spinal cord, fracture of the skull, etc.; or to _internal_ injuries and diseases; worms, concretions, tumor, water on the brain, sudden frights, strong mental emotions, painful domestic troubles, especially in women of nervous temperament when pregnant, sexual excesses, self-abuse, etc. The disease may be inherited or due to predisposition occasioned by the plethoric or debilitated condition of the sufferer; when due to this latter cause, and happening after the age of puberty, it is generally difficult to cure, but if the attack occur in early life and is occasioned by worms or other accidental cause, a cure may ordinarily be anticipated. The seizures may take place at any period of life, but are more frequent between the ages of ten and twenty years; occurring during childhood, there is a possibility that the sufferer may outgrow the disease, but the probability is that it will become constitutional and incurable.

SYMPTOMS. The attacks may be only a momentary and passing loss of consciousness, or one of a more expressed and serious nature. In the former case the symptoms are merely a sudden and brief loss of consciousness and a fixed, steady look in the eyes, loss of self-possession and an inclination to fall; but there is no swelling of the face, no distortion of the features, no foaming at the mouth, no biting of the tongue, no convulsions, and no warning cry, characteristics of the more serious class of these seizures. These latter are also sudden, and in general without warning. The patient may apparently be in the enjoyment of good health, when all at once he utters a loud and piercing shriek and falls down senseless and convulsed. The face becomes greatly distorted with the head inclined to one side. The eyes are set, or rolling wildly, the breathing is heavy and the skin turgid and livid; there is a blood-tinged froth around the mouth, due to biting of the tongue; the arms and lower limbs work violently; there is a choking sensation in the windpipe, and the sufferer is seemingly at death’s door.

After a longer or shorter interval, these symptoms gradually diminish and at length cease, and the sufferer becoming partially conscious for a time, drops off into a heavy sleep, which last for several hours and from which he awakes without any knowledge of what has occurred during the paroxysm. When the fit has passed off there is generally a headache and a feeling of languor remaining as reminiscences of the attack.

Usually, as already stated, the patient immediately before the attack utters a loud cry, but in some instances a peculiar sensation is experienced as of a current of air or stream of water commencing either in the extremities, or pit of the stomach, and working upwards to the brain. This is the _epileptic aura_, a warning of a true attack of epilepsy.

TREATMENT. During the attack but little can be done beyond keeping the patient from injuring himself by the violence of the convulsions. Place him in the middle of a bed, to prevent his rolling off, but if unable to lift him, leave him in a recumbent position with the head slightly raised, and insert a piece of leather or a tightly rolled handkerchief in the mouth to prevent the tongue being bitten. Loosen the clothing round the chest and neck and apply cold wet towels to the head and temples and hot water bottles to the feet if cold, allowing free circulation of the air. The treatment during the intervals must necessarily depend upon the exiting cause, as worms, injuries to the head, teething, etc., when attention will naturally be directed to its removal.

In all cases, however, the diet should be carefully regulated. Where the attack is due to a plethoric condition, the sufferer must be restricted to a light, nutritious, but not stimulating diet, avoiding everything that may produce a rush of blood to the head. The bowels must be kept regular, by the diet if possible, the sleep taken at regular hours, with daily exercise in the open air. When, on the other hand, the cause is due to general weakness and debility, a generous diet should be adopted, with tonics and other means for strengthening the system. Bromide of potassium, given in doses of ten to twenty grains in half a glassful of water, three times a day, has been found a very valuable remedy. The writer has experienced the efficacy of the following prescription:

℞
Soda of bromide, ℥i.
Ammonia of bromide, ℥ss.
Aqua, ℥vii.

A tea-spoonful in two table-spoonfuls of water three times a day. It has been said that a black silk handkerchief thrown over the face will at once bring a person out of a fit, and when an _aura_ has preceded an attack, its progress may be checked by means of a ligature, or by applying to the nostrils five minims nitrite amyl pearl. By the judicious employment of the proper remedies and a strict adherence to the prescribed regimen, a permanent cure of these attacks may often be effected, or, at all events, the sufferings greatly alleviated in those cases which do not admit of cure.

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Fainting.—(Fits.)

Fainting is a condition of total or partial unconsciousness, produced by the feeble action of the heart and lungs, causing an interruption of the requisite supply of blood to the brain. The principal characteristics are: a low, weak pulse, slight respiration, and the marked absence of convulsions. The attack may be sudden, or marked by

PREMONITORY SYMPTOMS, such as singing in the ears, dizziness, a clammy sweat, and a death-like pallor of the face. The limbs are unable to support the body, which falls helpless and apparently lifeless to the ground. This is an absolute faint. The attacks are in general only partial and limited in duration.

CAUSES. These are various and even peculiar; a particular scent, the presentation of certain objects, sudden emotions of joy, fear, or surprise, loss of blood, or whatever causes debility of the nervous system, all are predispositions to attacks of this nature.

TREATMENT. When a person faints let him remain or place him in a horizontal position, with the head low; dash cold water on the face and neck, loosening whatever presses on the body and neck; allow the air to play freely round him, and apply smelling salts or camphor to the nostrils, not too frequently, and mustard to the feet, or rub the latter frequently. As soon as the patient revives and is able to swallow, give a small glass of equal parts of spirits and water.

The cause will naturally govern the after-treatment, which should strictly be those of hygiene and general health.

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Fish Hooks, Crochet Needles, Thorns, Splinters, Etc., in the Flesh.

When a _fish hook_ has entered the flesh, do not wriggle it about till you have made an opening, nor try to work it out backwards. The best plan is, first, to cut the line from the hook, and then turning the point upwards, push it through in the direction in which it entered, until it pierces the skin; clip or file off the flat end of the hook, and taking the remaining portion by the point, pull it through. If the accident be caused by a _crochet needle_, which has entered deeply into the flesh, do not attempt to pull it out, as this will only inflame and tear the part, but get a surgeon to remove it; but if the services of one cannot be readily procured, first ascertain on which side the hook is, and then push a smooth ivory knitting needle _down_ the wound till it reaches the hook and draw them both out together. Accidents from _thorns, splinters and other pointed substances_ very commonly happen to the hands, feet, and legs. If such can be _entirely_ extracted, no evil consequences will arise, but if the body has been penetrated or any part left in the flesh, inflammation is set up, sometimes followed by an abscess, which should be opened as soon as it has formed. Where the thorn, etc., cannot be taken hold of to remove it, a bread and water poultice should be applied till the offending substance is drawn out.

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Fits.—Convulsions.

These sudden and violent attacks are common to both children and adults. In the former they are occasioned by a variety of causes, such as teething, the striking in of a rash, or when suffering from worms, flatulency, water on the brain, or the presence of some foreign or irritating substance in the intestines. They are frequently produced by slight functional disorders, and the younger and more excitable the child, the more liable it is to these attacks, which may be immediately fatal or occur daily or even several times a day and linger on for some time. But though fits are due to several and different causes, they invariably are indisputable evidence that the brain has in some way been disturbed.

In adults, fits are apoplectic, epileptic, puerperal, or other seizure, as the case may be. They are due to narcotic poisons, such as opium, prussic acid, ardent spirits, and indigestible matter. Fits are not in themselves a disease, but only symptoms of a disease, and the treatment must consequently be determined by the cause creating it. In nearly every instance these attacks are so sudden that the necessity for immediate action is imperative, before professional advice can be procured.

TREATMENT. _Infants._ Teething usually occurs between the ages of 5 and 7 months, when the gums should be carefully watched, and as soon as they show signs of swelling from the pressure of the teeth, lance them entirely down to the rising teeth, so that there shall be no impediment to their free growth. This may often avert any fatal disease of the brain and afford almost immediate relief to the child. If a fit has come on before a doctor can attend, put the feet in hot mustard and water till quite red and apply cold water to the head. Administer two or three tea-spoonfuls of syrup of ipecacuanha, or a little mustard and warm water, sufficient to produce vomiting.

_Worms._ For this complaint a worm powder or some other vermifuge should be given. For a child of four years the following is recommended. Pink-root, one-half an ounce; one-quarter ounce of senna and of fennel; pour a pint of boiling water on them, and give a table-spoonful three times a day.

_Improper food and indigestion._ If the stomach be at fault, give a mild emetic followed by a purgative dose.

_Acrid matter._ Give an injection to loosen the bowels a little more than natural.

_Flatulency._ Administer medicine to expel the wind from the stomach and bowels. The following is a simple and effective carminative. Bruised cloves, two drams; boiling water, one pint; soften by steeping in a closed vessel for two hours, and then give one wine-glassful occasionally.

_Effusion on the brain._ Apply cold lotions to the head and keep the bowels well open by purgatives.

_Disappearance of eruptions._ In this case place the child in a hot bath.

The above are the chief ailments inducing fits in young children, but whatever the cause, it is essential that the sufferer should be kept quiet, and the diet judiciously given.

TREATMENT. _Adults._ For adults, fits may be apoplectic, epileptic, cataleptic, hysterical, or seizure, as the case may happen. When a person is taken with a fit, loosen all portions of the clothing that presses on the body and neck, apply cold water to the head and volatile stimulants to the nostrils. The proper treatment, however, at the first, in each of these several varieties are fully set forth under their respective names.

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Foreign Bodies in the Gullet.

When such foreign bodies, as coins, buttons, or marbles, are swallowed, they generally reach the stomach without much difficulty and are evacuated in the ordinary course of nature in a day or so. If the obstacle has not gone far down the gullet and can be reached with the finger and thumb, try and pull it out, or use a pair of curved forceps, which will reach a little lower. Or failing this, place one hand on the chest of the choking person and give a smart slap or two on the back between the shoulders with the other hand. Where the substance has gone some distance down the gullet, it may be pushed down into the stomach with some blunt instrument. If the stomach contain food when the accident occurs, an emetic of 5 to 20 grains of powdered alum or ipecac with water may be administered, but where there is no food in the stomach, it is advisable to distend the intestines by giving hearty meals of batter pudding, porridge, or something similar previous to the emetic being administered.

Farinaceous food should especially be given, when the article swallowed is some sharp substance, as _pins_, _needles_, or _pieces of broken glass_. The object being to allow these to pass well enveloped with the other contents of the stomach. No aperients should be given, as their action on the bowels may force the pointed substance into the mucous membrane of the bowels and bring an ulceration, or even cause death.

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Foreign Bodies in the Windpipe.

These will, in some cases, remain a considerable time in the windpipe, but beyond producing a slight inflammation and an irritating cough, no immediate danger need be apprehended. If the obstacle has passed below the epiglottis (that is the valve, which, when a person is in the act of swallowing, closes down on top of the windpipe, and prevents the food from entering the breath-passage), but little can be done beyond giving the person a little snuff or ordinary pepper to induce sneezing, and get him to expel the air from the lungs by coughing suddenly and energetically a few times. This may have the effect of driving out the substance.

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Foreign Bodies in the Ear.

Foreign bodies, flies and other insects, frequently find a lodgment in the ear. Only last summer, while I was stopping in the country, in the early part of the evening a number of persons were sitting on the piazza. A flying insect lodged in one of the ladies’ ear. Instead of the bug coming out, it was going further into the ear. Between the irritation and the buzzing noise of the bug, the lady was greatly annoyed. She was running in and out of the house, apparently going crazy. Every one in the house was in a great excitement, but fortunately it happened that I was in the house. I poured a few drops of sweet oil into the ear (thus killing the bug instantly, as oil will kill any insect), and then I syringed the ear with a little soap and lukewarm water. The bug floated to the top and was removed with the water. If a living insect gets into the ear, stuff up the ear with a piece of cotton wool, thoroughly saturated with a strong solution of common salt or vinegar, sufficiently large to plug it completely, thus preventing the admission of air. After its introduction, turn the patient on the affected side, and allow the hand to press firmly on the ear. In a few minutes the noise will cease, and if the plug at this time be withdrawn, the insect will probably be found partially imbedded in its substance. If not, take hold of the tip of the ear at the top and pull the ear up a little. This straightens the tube. Then pour sweet oil freely into it and hold it there for a while. Then wash out the ear with warm water and soap, and the insect will rise to the surface. If the insect is dead and remain in the ear, his presence need give no special anxiety, as it will come out itself a day or two afterward.

If any hard substance, like a bead, shell, button or pebble be pushed into the ear, a stream of warm water may be syringed with advantage, as, if the water pass in any way between the hard substance and the ear drum, it will not unfrequently force it out. That side of the head should be held towards the floor, so that the object may more easily fall out. But should it be something that will swell with moisture, like a bean, pea, corn, or seeds, no syringing should be resorted to, as it will excite the object to swell and increase the mischief, and dry heat must be employed. The patient should lie upon a sofa or bed with the affected ear turned downwards. Then give with the flat of your hand two or three sharp sudden blows on the ear, shaking the head at the same time, and most likely the offending substance will drop out. If you do not succeed, lie quietly down upon the affected side and send for a physician.

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Foreign Substances in the Nose.

This vicious habit young children sometimes fall into of putting small objects into the nose, is not more remarkable than the variety of things which they put into the mouth, with this difference though, that their removal from the mouth is quite an easy matter, while from the nose it is oftentimes quite difficult, owing to the fact that the entrance is the smallest part.

Moreover, a timid child oftentimes refrains from telling what has happened, and an object which might easily have been extracted at the outset, becomes firmly fixed by the swelling of the mucous membrane, excited by its presence, and becomes difficult to extract afterward, especially if it be a pea, or bean, or seed; indeed, anything of a kind that can imbibe the moisture of the part and so become swollen. The sooner it is removed, the better.

When any foreign substance gets lodged in the nose, by careful examination determine which nostril the obstruction is in, close the mouth and the opposite nostril and then blow forcibly through the obstructed side. Snuff may be introduced into the opposite nostril in order to induce sneezing. If this be done soon after the accident two or three efforts usually shoot the unwelcome lodger out. If this is not successful, press the thumb against the nose above the obstructing body, so as to prevent it getting further in, and then make a hook of a piece of wire or a bent pin, and pressing it up over the offending substance, pull it down.

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Hydrophobia (Rabies).

The general dread of hydrophobia creates a more universal fear of a bite from a dog than almost any other accident. It is due to a poison introduced into the system from the bite of a person or animal suffering from the disease, though usually with the dog. Bites from dogs, even when in play, should be treated as poisonous wounds, as the excitement may cause a change in the saliva with which the mouth is plentifully supplied.

The interval between the bite and the appearance of the disease varies from one to six weeks. Death usually occurring from one to eight days after.

SYMPTOMS. The chief symptoms of this well known canine madness are: spasmodic contractions of the larynx, preventing the sufferer, though thirsty, from swallowing any kind of liquid. The moment water approaches his mouth, a spasmodic shudder seizes him and he pushes it away with horror. He suffers from pain and stiffness in the neck and the throat, which becomes contracted, and is filled with a sticky mucus which he is constantly endeavoring to spit out or extract with his fingers. Thus, between the convulsions and the comparative quiet which follow them and during which there is great depression of spirits, the unhappy sufferer dies either in a spasm or from sheer exhaustion.

TREATMENT. As no positive cure has been discovered for this terrible disease, all efforts must be preventive. When a person is bitten by a dog or other animal supposed to be mad, the wound should at once be thoroughly washed with a solution of carbolic acid, one to fifty. Then apply dry cupping, or suction. Take a stick of nitrate of silver (lunar caustic) and rub it well into the wound. This, if properly done directly after the bite, will prove the most effectual method of preventing hydrophobia.

The nitrate of silver acts not only as a caustic to the parts, but appears to efficaciously neutralize the poison.

The wound should once more be washed by holding it under a stream of tepid water for a considerable time. If there be any doubt about the poison being all removed, a strong solution of lunar caustic should be applied. Then treat as any other wound.

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Lockjaw.

This is a contraction of a spasmodic and generally fatal nature. The rigidity may be local, affecting only the muscles of the jaw, but sometimes general, when not only these muscles, but those of the whole frame are affected and the spasms are of so violent a character as to produce fractures of the teeth or bones.

Exposure to the cold and bodily injuries, such as are experienced by the wounded on a battle-field, but particularly injury to a nerve, are the principal causes of this nervous disease. Inhaling chloroform or ether or taking them in sufficient quantities to allay the spasms, are the best known remedies. The ordinary methods of treatment are to give the patient a hot bath, or to wrap him in flannels or a blanket wrung out of hot water. Shower baths and stimulant liniments, such as turpentine and opodeldoc, applied down the spine, have been found efficacious.

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Paralysis—Palsy.

Paralysis is the total or partial loss of power and sensation, or both, in one or more parts of the body, in some cases commencing gradually, for a long period may elapse before the loss of nervous energy is absolute, but more frequently coming suddenly and extending from one portion to the whole frame.

It is a warning of other diseases, and often a precursor of apoplexy, to which it is akin in symptoms and in which it not unfrequently terminates. There are three several _forms_ of paralysis or palsy; as where only one side of the body is attacked (hemiphlegia); or when the stroke is confined to the lower extremities and the parts about the pelvis (paraphlegia), and again it may be local, affecting only a single limb or muscle. There are also _varieties_ of paralysis or palsy, such as facial, infantile, diphtheritic, and shaking.

CAUSES. The general paralysis is caused by the rupture of a vessel of the brain, which may take place, even in sleep, and without any previously marked apoplectic symptoms. Intemperance in either eating or drinking, mechanical injuries to the head or spinal cord, the pressure of blood or water on the brain, the striking-in of eruptions, all are inducing causes, but in every instance the brain is the source of the malady, and the disorder, if confined to one side and does not include both, will, in all probability, extend to the other.

SYMPTOMS. There _may_ be no premonitory indications, except a slight faintness and confusion of ideas antecedent to the attack, which may take place during sleep, and the sufferer is unconscious of the fact till he awakes to his loss, either of speech or motion in one or more limbs; but when there present such apparent symptoms, very similar to those peculiar to apoplexy, as headache, flushed face, swelling about the head and neck, incoherent speech, disconnected ideas, inclination to sleep, and a tingling sensation in a certain limb, or part of the body, then an attack may be regarded as close at hand.

TREATMENT. Bleeding and cupping in the neck is the right treatment for a person of full habit, and where the bowels are costive, they must be moved by purgatives of 5 grains of calomel, followed by a dose of senna mixture, or croton pills, or pulverized scammony, 12 grains; pulverized gamboge, 12 grains; elaterium, 2 grains; croton oil, 8 drops; extract of stramonium, 3 grains. Mix and make into 12 pills, and administer one every hour until it operates, and give an injection of castor oil, one gill; red pepper, 10 grains; molasses, one gill; table salt, one tea-spoonful, and one pint of warm water.

If the attack be sudden and severe and the symptoms similar to those in apoplexy, such as flow of blood to the head, throbbing of the temporal arteries, full and hard pulse, place the patient in a half declining position, loosening all garments, especially around the neck, and apply cold wet cloths or ice frequently to the head. _See Apoplexy._ In case of faintness and wandering of the intellect, administer a tea-spoonful of sal volatile in a glass of water, and, if required, repeat the dose in about an hour’s time. No alcohol must be given. Place the patient in a warm bed, with the head and shoulders well raised, and put the legs and feet in a hot mustard and water bath. Cupping the neck should be followed by a blister, and if necessary a seton be put in. The bowels, after they have once acted well, should be kept well regulated with rhubarb or castor oil. The diet should be spare, and the patient kept as quiet as possible. Where it is the lower part of the body that is attacked (paraphlegia), it is often very difficult to get the bladder to act properly, and when it does, the urine flows involuntarily. Great attention should be paid to this. Counter-irritants should be applied down the spine, such as blisters, moxa, compound of tar, or pitch plasters, and small blisters on the inside of the legs and thighs. In facial palsy, when due to a blow, a few leeches applied behind the ear and at the angle of the jaw, will prove beneficial. Hot fomentations and stimulating liniments should be used when the attack is due to cold, and also in the case where the hands or extremities are affected.

This disease sometimes follows Painters’ Colic arising from the absorption of lead, which is generally confined to the wrists. Use galvanism, friction, and shampooing with chalybeate water.

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Poison—Ivy.

Any person is liable to get poisoned by dogwood, Ivy, etc., when in the country. While walking in the fields the leaves of the ivy-vine or the dogwood leaves will come in contact with your hands and face and will poison you at once. You will first feel a discomfort and itching. By scratching yourself you will be poisoned all over. To prevent this spreading, you should immediately bathe yourself all over in an ordinary bath-tub, changing the water twice. The itching may be relieved by bathing the parts in a mixture of two tea-spoonfuls of carbolic acid, two table-spoonful of glycerine, one-half pint of water. If there is any swelling of the hands or face, apply a solution of sugar of lead, or still better, a decoction of witch-hazel bark.

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Poisons.

Accidents from poisons are of such common occurrence that every person should know the proper remedies and not be obliged to wait the arrival of a physician before the corrective is applied.

In treatment, two objects are to be kept in view. First, how to get rid of the poison; second, to stop its action. The first is to remove the poison from the stomach by giving emetics to cause vomiting. The simplest way to provoke vomiting, is to give a table-spoonful of ground mustard or common salt in a tumbler of warm water, a quarter of it at one time, followed by a cup of warm water. Then another quarter, and more warm water. Keep this up until vomiting is secured. Tickling the back of the throat with the finger or a feather will help. Some of the emetics are ipecacuanha, tartar emetic, sulphate of zinc, and sulphate of copper. Sulphate of zinc in twenty grains doses is the best. Vomiting should be promoted until the stomach is entirely empty. The second indication is to use antidotes, such as sweet oil, vinegar and water, beaten up raw eggs, strong hot tea, warm milk, or strong coffee.

If stupor or sleep is impending, take the patient into the open air and walk him up and down. Dash cold water over the head and face, and keep up artificial breathing, if necessary, (see page 63), and do not on any account, until the effects of the poison are gone off, allow him to go to sleep. If you do, he never will wake again.

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Poisons and their Antidotes.

In all cases of poisoning, it must be taken as a general rule that the person should be made to vomit, especially if seen immediately after taking the poison. A tea-spoonful of mustard, or two or three of alum, taken in warm water, will effect this purpose.

Only a few of the principal substances of a poisonous character which enter into the daily economy, with their antidotes are here given.

ACIDS. _Sulphuric_ (oil of vitriol), _Nitric_ (aquafortis), _Muriatic_ (spirits of salt), _Oxalic_, or _Oxalates_. But not Prussic acid.

TREATMENT. Give plenty of calcined magnesia, an ounce to a pint of water, every two or three minutes, in a wine-glass. Whiting, chalk, or a piece of plaster broken off the wall and pounded small, will answer the purpose, if the magnesia be not ready at hand. A table-spoonful of soft soap, or common soap, cut up into small pieces, should be got ready, and given in tea-spoonfuls of water.

_Carbolic._ _Creosote._ Administer plenty of white of egg and an emetic. One tea-spoonful of mustard in warm water, followed by a mixture of olive oil and magnesia.

PRUSSIC ACID. (Oil of bitter almonds, laurel water, cyanide of potassium), used by photographers and others.

TREATMENT. Throw cold water over the face, head and back, even when convulsions have occurred. Give sal volatile and water, and apply smelling salts to the nose, but not too strong in either instance.

ARSENIC. Every preparation of arsenic is an irritant poison. Amongst the commonest forms are: _Scheele’s green_, _ague drops_, _rat poison_, _etc._

TREATMENT. Give plenty of raw milk and eggs, lime water, or flour and water, and then castor oil.

ANTIMONY. (Tartar emetic, Butter of Antimony, Oxide of Antimony.) Poisoning by these, when taken accidentally in large quantities, cause severe vomiting and great prostration.

TREATMENT. If sufficient quantity has not been taken to produce vomiting, induce and facilitate it by copious draughts of warm water and by tickling the throat. Give strong tea, or a decoction of cinchona bark.

ALKALIES. (_Ammonia_, or _Hartshorn_, _Potassa Caustic_, _Soda Caustic_, _Lye of Wood Ashes_, _Quicklime_.)

TREATMENT. Two or three table-spoonfuls, of vinegar, or lime juice, in as much again of water sufficient to neutralize the alkali. Then give olive oil or milk. Do not give emetics.

BAD FISH. (Mussels, Lobsters, Crabs, etc.)

TREATMENT. Empty the stomach as quickly as possible with a little mustard and warm water, salt and water, tickling the top of the throat. Then administer a good dose of castor oil with some warm spice; if necessary, put a mustard plaster on the stomach.

BUG POISON. (Corrosive Sublimate.)

This is the ordinary bed bug poison, which is often taken by accident.

TREATMENT. Mix up as quickly as possible the whites of six eggs in a pint of cold water, giving a glassful every three or four minutes, and in the interval plenty of milk, till the stomach can contain no more. Wheat flour mixed with water is a good remedy.

(See below Mercury and its compounds.)

COPPER COMPOUNDS. (Blue Vitriol, Verdigris.)

MERCURY COMPOUNDS. (Corrosive Sublimate, White Precipitate, Red Precipitate, Vermilion).

ZINC COMPOUNDS. (White Vitriol.)

TREATMENT. Give abundance of white of eggs, then warm water with a tea-spoonful of mustard to induce vomiting. After vomiting administer white of egg and milk, or wheat flour and milk as a batter.

IODINE. (Tincture or Solution.)

TREATMENT. Give freely fresh paste of starch or wheat flour mixed with water, then a little mustard and warm water to excite vomiting. White of eggs and milk and mucilaginous drinks are excellent substitutes.

LEAD COMPOUNDS (Sugar of Lead, White Lead, Red Lead, Litharge.)

TREATMENT. Induce vomiting in the usual way with a little mustard and warm water and by tickling the throat. Give an ounce of Epsom salts dissolved in water. If sulphate of zinc be at hand, give from 10 to 30 grains instead of the mustard as an emetic.

LUNAR CAUSTIC. (Nitrate of Silver.)

This has often been accidentally swallowed when used for touching a sore throat.

TREATMENT. Give a large tea-spoonful of salt in a glass of water, repeated every ten minutes; then administer a dose of castor oil, and linseed tea or barley water for a drink.

LAUDANUM. (Opium, Morphine, Soothing Syrups.)

TREATMENT. Empty the stomach as quickly as possible by vomiting. Give finely powdered fresh charcoal (by quickly pounding coal from a wood fire). After the stomach has been well cleared, give very strong coffee or tea; put a mustard plaster around the calf of each leg, and if the patient be cold and sinking, give a good quantity of spirits and water. Keep the patient till the effect has passed off by beating the soles of the feet, dashing cold water on the face and keeping him as much as possible on the move. The inclination to sleep must under no circumstances be indulged in.

CHLOROFORM. (Chloral, Ether.)

TREATMENT. Excite vomiting in the ordinary way, mustard and warm water, etc. Dash cold water over the head, face and body. Induce artificial respiration as in drowning (see page 63). Place a piece of ice in the rectum. Suspend the patient for a few moments by his legs.

STRYCHNINE. (Nux Vomica, Rat Poison, etc.)

There is lockjaw and considerable twitchings and convulsions; the body being bent backwards.

TREATMENT. Empty the stomach by an emetic, and then give linseed tea or barley water, adding for an adult 30 drops of laudanum, occasionally to relieve the spasms. Two ounces of camphor dissolved in a quart of whiskey, and given freely, is said to be an excellent antidote.

POISONOUS PLANTS AND SEEDS.

Children and others often suffer from accidentally eating poisonous fungi, mistaking them for mushrooms, etc. The stomach should at once be cleared by an emetic, warm water with mustard, or salt, or soft soap. If there be no purging, then administer a dose of castor oil. If the patient be in a faint and sinking condition, give stimulants.

IVY-POISONING.

Apply soft soap freely to the affected parts, or bathe them with a weak tincture of belladonna.

PHOSPHOROUS. (Lucifer matches.)

Children often play with and suck these matches composed of this poisonous substance; the effect is similar to the symptoms caused by arsenic.

TREATMENT. Give large doses of warm water with mustard or magnesia, chalk, or even flour mixed with it. Induce vomiting, but give nothing of an oleaginous character.

GENERAL REMARKS.

It must be always remembered that cases of poisoning require prompt treatment.

In many cases of accident and diseases time is not of that essential consequence that it is in the cases of these. The life or death of the sufferer may depend upon the way you employ the few moments in which you have to act.

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Sea Sickness.

This sickness is classified under the head of diseases of the general system. I placed it here for the benefit of those who are going to make an ocean voyage for the first time, as I know that most people never or seldom think to prepare themselves for it. Sea sickness has a number of varieties and is the great terror of persons who for the first time cross the ocean. At first there is no vomiting, but a feeling of constant dizziness, confusion of ideas and perhaps a dull headache take its place. Even in such cases there is more or less loss of appetite, and in nearly all there is obstinate constipation. Without doubt the close atmosphere of the vessel plays an important part in the production of the vomiting, since even those who are not much affected may lose control of their stomachs if they venture into the neighborhood of the cook’s galley. Intense as the suffering may be, it is rarely that the malady ends fatally.

For some reason consumptive persons appear less subject to sea sickness than most others, and it said that dark complexioned persons suffer more from it than others.

Persons about to proceed to sea should put their stomach and bowels in order by the use of mild aperients a few days before starting. If it can not be entirely prevented, it may be mitigated by lying flat upon the back. To lie on deck in the open air is much better than lying in the close air of the cabin or state-room. As the vessel descends, draw in the breath, and as it ascends, exhale the breath. (This prevents the movements of the organs which act immediately upon sea sickness.)

Hold fast by the ropes on the side of the ship so as to move with all its motions. Take a dose of some purgative that will empty the bowels. A wine-glassful of brandy or from 10 to 30 drops of laudanum will relieve the sickness very much. For a child it is sometimes sufficient to wet a cloth with laudanum and lay upon the pit of the stomach. Morphine is sometimes even better than laudanum. Creosote, one drop at a dose made into a pill, is excellent. Ten drops of hartshorn in half a tumbler of water is good for some.

But the best known remedy is chloroform taken in doses of from 40 to 60 drops in water by means of a little gum arabic.