121. Inspiration (Silvester). 122. Expiration (Silvester).
121. Inspiration (Silvester). 122. Expiration (Silvester).
121. Inspiration (Silvester). 122. Expiration (Silvester).
When 2 persons are present, Francis’s plan may be adopted, thus: The body of the patient is laid on the back, with clothes loosened, and the mouth and nose wiped; 2 bystanders pass their right hands under the body at the level of the waist, and grasp each other’s hands, then raise the body until the tips of the fingers and the toes of the patient alone touch the ground; count 15 rapidly; then lower the body flat to the ground, and press the elbows to the side hard; count 15 again; then raise the body again for the same length of time, and so on, alternately raising and lowering. The head, arms, and legs are to be allowed to dangle down quite freely when the body is raised.
When 3 or more persons can assist, Marshall Hall’s method is available. To excite breathing, turn the patient quite on the side, supporting the head, and induce inspiration and expiration by alternately rolling the body over on its face, and back again, at 15 seconds intervals, as shown in Figs. 123 and 124.
123. Inspiration (Marshall Hall). 124. Expiration (Marshall Hall).
123. Inspiration (Marshall Hall). 124. Expiration (Marshall Hall).
123. Inspiration (Marshall Hall). 124. Expiration (Marshall Hall).
As soon as a natural effort to breathe is produced, endeavour to restore circulationand warmth. Wrap the body in dry blankets and commence rubbing the limbs upwards firmly and energetically under the blanket or over warm clothing, which can generally be got from bystanders. Then put the patient into a warm bed, and cover over with hot flannels, applying bottles or bladders of hot water, or heated bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet. When the patient is able to swallow, give him warm fluids by spoonfuls—coffee, tea, brandy and water, wine—but not in too great quantities. Warm baths should never be used but when ordered by the doctor.
Choking.—When a person gets a fish-bone or other substance in the throat, at once insert a finger into the mouth and press upon the root of the tongue, so as to induce vomiting. If this fails, let the patient swallow a piece of soft bread. If the substance can be felt by the finger, insert 2 fingers into the mouth and bring it away, using the safeguard of putting some hard substance between the teeth. A medical man should at once be sent for. Repeatedly sucking lemons will help to dissolve the bone. A marble or similar article in a child’s throat may be dislodged by turning him heels upwards and shaking.
Suffocation.—Remove the patient immediately to the fresh air; dash cold water in the face and on the chest; keep up the warmth of the body, and apply mustard plaisters over the heart and round the ankles. If these means fail, without loss of time try artificial respiration, as already described.
Before entering a suffocating atmosphere to rescue persons, tie a towel soaked in vinegar and water over the mouth. Admit fresh air to the room if possible.
Fits, Fainting, and Unconsciousness.—These bear a strong outward resemblance to each other while due to very different causes. The latter are principally: (a) injuries to the brain, with or without fractures of the skull; (b) diseases of the brain (including fits), apoplexy, epilepsy, &c.; (c) poisoning by narcotics and by retention of urine (in kidney disease); (d) fainting (paralysis of the heart through fright, exhaustion, loss of blood, &c.).
In such cases gather a history of the occurrence, and note the position of the body and its surroundings; also whether the breath smells of spirits, which shows there has been drinking, but remember that other and more serious conditions (paralysis, injury to the brain, &c.) may co-exist with intoxication. Lay the body on the back, with the head low if the face is pale, as in faintness after great loss of blood. If the face is red, the head must be raised. If sickness sets in, incline the head at once, so that the vomited matters may not be drawn into the lungs. Undo all clothing round the neck. Allow free circulation of air round the patient. Remove the patient as quickly as possible to the nearest hospital or doctor on a stretcher.
In epileptic fits, recognised by convulsive spasms of the limbs and body, contorted and congested face, foaming at the mouth, and bitten tongue, act on the rules justmentioned, and do all in your power to prevent the patient injuring himself, without attempting to restrain his movements. Lay something soft under his head, put something between the teeth, watch till the fit is over, and then remove him. In cases of fainting at once lay the patient flat, with the head brought to the same level as the body, to enable the blood more easily to circulate through the brain, for it is want of power in the heart to propel the blood to the brain that has caused the insensibility. If bleeding is going on, it must at once be arrested. As stimulants, eau de Cologne, sal volatile, ammonia, &c., may be used, but the important thing to remember is the position of head and body. Stimulation is apt to start afresh the bleeding arrested by fainting. In cases of snoring, with face flushed (apoplexy), undo clothing round the neck, keep the head raised, dash cold water on the top of the head, and apply hot-water bottles to the feet; send for doctor; do not give brandy.
Frostbite.—In serious frostbite or cases of exposure to intense cold, endeavours to restore life should be made with the greatest care. If you bring the patient suddenly into a warm room, death will follow certainly. Carry him carefully into a closed but cold room, and undress him with care for fear of breaking the stiffened limbs. If snow is to be had, cover and vigorously rub the whole body with it. If not, cover and rub with cold wet cloths or cold sand, or put him into a cold bath. Alternately with this try artificial means to restore breathing (as in drowning). When the patient begins to breathe naturally, and the limbs become less stiff, he should be carried into a moderately warm room and covered lightly with cold coverings and sheets. After this, he may be rubbed by degrees with warm cloths, and the warmth of the room gradually increased. Then try by means of smelling-salts, ammonia, or ether, and slightly stimulating drinks, such as light cold wine, cold coffee or soup, to recall consciousness. Should any part of the body remain without sensation, blue, swollen, or blistered, there is great danger of mortification setting in.
For after consequences, which recur most frequently in cold weather, apply balsam of copaiba, spread thickly on a piece of linen or muslin, the affected parts being covered with the application, which is allowed to remain over the night. By day, some of the balsam is to be spread over the affected parts. After one or two applications the pains cease and the redness disappears; whilst a few additional applications seem to give to the parts a power of resistance to frostbite.
Dr. Lapatin advises that fingers and toes which have been slightly frost-bitten, and which subsequently suffer from burning, itching, and pricking sensations, should be painted, at first once, and afterwards twice a day, with a mixture of dilute nitric acid, and peppermint water in equal proportions. After this application has been made for 3-4 days, the skin becomes darkened and the epidermis is shed, healthy skin appearing under it. The cure is effected in 10-14 days.
The members of the Austro-Hungarian Polar Expedition found most benefit from a mixture of iodine and collodion.
Lightning Stroke.—Apply cold to the head, and, if necessary, warmth to the extremities; rub the limbs well, and give stimulants as soon as the patient can swallow.
Poisons.—In all cases of poisoning, at once note the position and surroundings of the patient, and whether bottles likely to have contained poison are at hand. Send for the nearest doctor, and proceed immediately to get the poison out of the stomach by encouraging vomiting. Vomiting is often one of the first and most important signs of poisoning, and then only requires fostering by large draughts of warm water. If vomiting is not present, at once administer an emetic, such as sulphate of zinc in 20-30 gr. doses, 2 tablespoonfuls ipecacuanha wine mixed with warm water. In the absence of these, resort to mustard and water, a teaspoonful or two in warm water frequently repeated, or common salt and water may be used; vomiting may also be excited by tickling the back of the throat, and by freely drinking hot greasy water. Astomach pump must only be used by a surgeon; but a safe substitute, if the patient is conscious, is a piece of rubber tubing, about 3 yd. long and ½ in. diameter. Let the patient swallow about 2 ft. of this, then hold the free end of the tube above his head (Fig. 125) and pour down through a funnel 1-2 pints warm water, which will go direct into the stomach. By lowering the free end (Fig. 126) the stomach empties itself readily. By frequent repetition the cavity of the stomach is completely washed out.
125. 126. Stomach-tube.
125. 126. Stomach-tube.
125. 126. Stomach-tube.
Try to ascertain what the poison is, and proceed to administer antidotes. Most poisons may be grouped under two classes—narcotic and irritant; the former being mainly organic (vegetable) substances, and the latter chiefly minerals. In narcotic poisoning, vomiting must be induced or the stomach emptied in some other way, and means must be taken to prevent sleep ensuing, by walking the patient about, slapping with wet towels, dashing cold water in the face, &c.; give strong black coffee to drink (or with an enema); put icy cold compresses on the head, and mustard plaisters on the stomach and calves of the legs. In irritant poisoning, the poison itself is pretty sure to cause vomiting, which then need not be encouraged. To protect the stomach and gullet from the corrosive action of irritant poisons, bland and oily fluids, such as salad oil, egg-white, milk, flour and water, should be freely administered.
The following summary of poisons and antidotes will be found useful:—
Narcotic Poisons.
Poison.Antidote.Aconite, monkshoodemetics; warmth; rub the skin.Alcohol, alcoholic drinksemetics; cold douche; keep awake.Belladonna, deadly nightshadeemetics; strong coffee; hot and cold douches alternately; artificial respiration.Chloral hydrateemetics; strong coffee enema; hot blankets, and water bottle to feet; artificial respiration; keep awake.Chloroformfresh air and artificial respiration; hot and cold douche.Cyanide of potassium, prussic acid, laurel water, essential oil of almonds, benzol.emetics; stimulants; cold and hot douche; artificial respiration.Etheras chloroform.Fool’s parsleybrandy; strong tea; warm applications to extremities.Foxgloveemetics; stimulants; prolonged recumbence.Hemlockemetics; strong tea; warmth and rubbing; artificial respiration.Henbanea large spoonful of animal charcoal, emetics 10 minutes later, then brandy or coffee; keep awake.Laburnum pods or seeds5-6 gr. zinc sulphate as an emetic.Meadow saffronbrandy; strong tea; warm mucilaginous drinks.Mushroomsemetics; stimulants; warmth and rubbing.Opium, chlorodyne, Godfrey’s cordial, poppies, soothing syrups.emetics; hot coffee; cold douche; keep awake; artificial respiration.Poison ivy{on the body}apply a weak solution of sugar of lead.Poison dogwood {on the body}Spurge laurel, mezereumbrandy and warm mucilaginous drinks.Strychnine, vermin-killersemetics; chloroform in an inhaler.Yew berriesemetics; brandy; warmth to extremities recumbent position.
Irritant Poisons.
Acid—carbolic, creosote.emetics; lime-water; salad oil; coffee.Acid—oxalic, potassium oxalate, salt of sorrel, salt of lemon.water containing chalk or whiting, but not ammonia, potash, or soda.Acids—acetic, hydrochloric, nitric, sulphuric; spirit of salt.abundance of water containing chalk, magnesia, sal-volatile, washing soda, or whiting; egg-white, milk, thick gruel.Alkalies—ammonia, potash, soda.water containing lemon-juice or vinegar; salad oil, milk, egg-white, gruel.Antimony, tartar emeticemetic if needed; plenty of strong coffee; egg-white, milk.Arsenic, emerald green, fly paperemetics; magnesia; warmth and friction; strong coffee; best antidote is moist peroxide of iron, which can be made by dissolving ½ oz. iron sulphate and ½ oz. potash carbonate (or ¾ oz. soda carbonate) separately in warm water and mixing, adding ¼ oz. magnesia— calcined if handy—dilute with ½ pint hot water, and drink very hot.Bichromate of potashemetics; magnesia, chalk, or whiting.Blistering fluidemetics; egg-white, barley water, gruel; not oil.Bluestoneemetic if needed; milk, eggs, barley water, gruel.Caustic, nitrate of silverabundance of salt in water or milk, egg-white, barley water.Chloride of mercury, corrosive sublimateemetic if needed; raw egg beaten up in milk, gruel, arrowroot; strong coffee.Iodineemetics; plenty of gruel, arrowroot or starch.Phosphorus, matches, rat poisonemetics; 10 drops oil of turpentine, every ¼ hour in gruel or milk with a little magnesia; egg-white, barley water.Pyrogallolemetics.Sugar of lead, paintemetics, zinc sulphate best; ½ oz. Epsom salts in water; egg-white, milk, barley water.Turpentine, furniture polishemetics; milk, egg-white, barley water.White precipitateemetics; coffee; egg-white beaten up in water, barley water, arrowroot.
Sprains.—A sprain is a sudden forcible stretching of the tendons or ligaments, or both combined, of a joint, and is always accompanied by most acute pain, and generally followed by rapid swelling. It is always tedious and troublesome, and hence oftenleads to more serious results; in all but very slight cases, a surgeon should be seen. Meantime give the injured part perfect rest, keep it in an elevated position, and apply cold water continuously, or immerse in water as hot as can be possibly borne, and after keeping it there for ¼ hour, frequently apply hot bran (or oatmeal and vinegar) poultices. As an embrocation, put ¼ lb. camphor in ½ lb. methylated spirits of wine; when dissolved, add 1 oz. oil of origanum, and rub the place night and morning, or use Elliman’s embrocation. In many cases of supposed severe sprain, some of the bones forming the injured joint are broken, therefore it is wise to treat these cases by the rules for broken bones before removing the patient.
Sunstroke.—In cases of simple exhaustion, ordinary treatment is all that is needed. Removal to a cooler locality, the cold douche (but not too much prolonged), or the administration of stimulants, may be beneficial. Tight or oppressive clothing should be removed, and the patient treated as in syncope from other causes. Rest and freedom from exposure to over-exertion, fatigue, or great heat, should be enjoined. In that form of sunstroke where the person is struck down suddenly by a hot sun, the patient should be removed into the shade, and the douche of cold water being allowed to fall in a stream on the head and body from a pump (or, as in India from the mussuck, or other similar contrivance), should be freely resorted to, the object being twofold—to reduce the temperature of the over-heated centres, and to rouse them into action. Mustard-plaisters and purgative enemata may be useful. If recovery be imperfect, and followed by any indication of injury to the nerve-centres, or by the supervention of meningitis, other treatment may be necessary according to the indications. Much exposure to the sun should be carefully guarded against; and, unless recovery be complete and rapid, the sufferer should be removed to a cooler climate, the most perfect rest and tranquillity of mind and body enjoined, and the greatest care be observed in regard to extreme moderation in the use of stimulants. (Dr. Fayrer.) For prevention, wear light head-gear with good protection to the nape of the neck; let the lining be double, one of green and the other of yellow material, and have ventilation holes at the sides and top.
Common Complaints:—
Brain worries.—To the broad question, Are people suffering from overwork? Dr. Samuel Wilks, Physician to Guy’s Hospital, would have no hesitation in saying “No.” His remarks on the subject are worth repeating. He proceeds:—“On the contrary, if both sexes be taken, I should say the opposite is nearer the truth, and that more persons are suffering from idleness than from excessive work. Medically speaking, I see half a dozen persons suffering from want of occupation to one who is crippled by his labours. I have, therefore, very little sympathy with the prevalent notion that nervous and other diseases are due to overwork. As regards the community generally, or at least those of its number who come before the medical man on account of their ailments, my belief is that the explanation they offer arises from a delusion; and amongst girls, so far from any studies or other work being injurious, I could instance numerous cases of restoration to health on the discovery of an occupation. Very often, when a business man complains of being overdone, it may be found that his meals are very irregular and hurried, that he takes no exercise, is rather partial to brandy and soda, and thinks it not improper to half poison himself with nicotine every night and morning. The lady in the same way eats no breakfast, takes a glass of sherry at 11 o’clock, and drinks tea all the afternoon; when night arrives she has become ready to engage in any performance to which she may have been invited. When the man of business presents himself, with his nerves really overstrained, he is found to be a man of delicate or actually insane temperament. The rule, however, is that when a patient comes before me with his nerves unstrung, hypochondriacal, and goes through the whole machinery of his body to inform me of its working, previously committing all the facts to paper lest an important one should be forgotten, that man is getting rusty from having no occupation.... We forget sometimes what a formidable machine is the animal body, with itsforce-producing nervous system. The brain is an engine of many horse power; its energy must be accounted for in some way; if not used for good purposes, it will be for bad, and ‘mischief will be found for idle hands to do.’ It is fortunate that, with many girls, the frivolities of life keep them idly busy, and so, having a safety valve, they are harmless to others and themselves; but let a girl occupy herself neither with what is useful nor with amusement, she falls into bad health, she becomes a prey to her own internal fires or forces, and every function of her body is deranged, as well as her moral nature perverted. Cases of this kind appear to me of the commonest order, and at the same time very difficult of cure, because the mother’s aid can rarely be gained to assist the doctor; but, on the other hand, her sympathies too often only foster her daughter’s morbid proclivities by insisting on her delicacy and the necessity of various artificial methods for her restoration, as well as her resistance to the doctor’s advice for a more natural life, since she is sure it cannot be undertaken. Her daughter is too delicate for any of the occupations or modes of exercise proposed. What she requires is medical attendance, and to be alcoholised and physicked. It is remarkable, however, what a young lady can do under the power of a stimulus—as, for example, a gentleman lately expressed his surprise to me how his daughter, who could not walk many yards for a long time, owing to a pain in her back, was soon able to walk many miles a day when she procured the support of her lover’s arm. It is from considerations of this kind that, when the superfluity of women, amounting to half a million, doomed to be unmated, ask for employment, I cannot deny it to them. The human body is made for work, physical and mental. The amount it can do is of course proportionate to the power of the machine; but, unlike all other machines, its strength is only maintained by use, as assuredly it rusts and decays by disuse. Just as the muscles are better prepared for work by previous training, so the nervous system, whether it be the brain or spinal cord, becomes more energised by use. If healthy and vigorous persons be taken, there appears no absolute necessity for rest at all in the popular sense of the term. The rest required is gained during sleep, during meals, and necessary healthful exercise. It is only during sleep that the brain is actually inactive, although even then not absolutely, for at meals cheerful conversation keeps the mind employed, and even in our walks the attention is fixed on objects around. In times so occupied there are many persons whose minds are never idle, and who yet live to a good old age. Practically they have no rest, for when one object of study is complete, they commence to pursue another. It is by the happy faculty of diverting the powers into different channels that this is accomplished. Instances might easily be quoted of statesmen, judges, and members of our own profession who know no absolute rest, and who would smile at the suspicion of hard work injuring any man. I make it a custom to ask young men what their second occupation is—what pursuit have they besides their bread-earning employment. Those are happiest who possess some object of interest, but I am sorry to say there are few who find delight in any branch of science. The purely scientific man finds his best recreation in literature or art, but even in intellectual work so many different faculties are employed that a pleasant diversion is found in simply changing the kind of labour. For example, a judge after sitting all day, and giving his closest attention to the details of the cases before him, may yet find relief in his evenings by solving problems in mathematics. The subject of overwork, then, is one of the greatest importance to study, and has to be discussed daily by all of us. My own opinion has already been expressed, that the evils attending it on the community at large are vastly over-estimated; and, judging from my own experience, the persons with unstrung nerves who apply to the doctor are, not the Prime Minister, the bishops, judges, and hard-working professional men, but merchants and stock-brokers retired from business, Government clerks who work from 10 to 4, women whose domestic duties and bad servants are driving them to the grave, young ladies whose visits to the village school or Sunday performance on the organ is undermining their health, and so on. In short, and this isthe object of my remarks, I see more ailments arise from want of occupation than from overwork, and, taking the various kinds of nervous and dyspeptic ailments which we are constantly treating, I find at least six due to idleness to one from overwork.”
For a long time it has been well known to the medical profession that in various critical states of the human system absolute silence, or the nearest possible approach to it, is not the least important condition to be secured. Accordingly muffled knockers, streets covered with straw or spent tan, and attendants moving about with noiseless step, are universally recognised as the signs and the requirements of severe disease. But the truth that noise is a contributor to the wear and tear of modern city life has scarcely yet been realised by the faculty, not to speak of the outside public. Consequently, while a zealous war is being urged against other anti-sanitary agencies, no general attempts for the abolition of superfluous noise have yet been made. We cannot, perhaps, give anything approaching to a scientific explanation why sound in excess should have an injurious effect upon our nervous system. We feel that noise is distressing, exhaustive. The strongest man after days spent amidst noise and clatter, longs for relief, though he may not know from what. It may even be suggested that the comparative silence of the sea-side, the country, or the mountains, is the main charm of our summer and autumn holidays, and contributes much more than does ozone to restore a healthy tone to the brains of our wearied men of business. Indeed, if we consider, we shall find that this is the most unnatural feature of modern life. In our cities and commercial towns the ear is never at rest, and is continually conveying to the brain impressions rarely pleasant, still more rarely useful or instructive, but always perturbing, always savouring of unrest. In addition to the indistinct but never-ceasing sea of sound made up of the rolling of vehicles, the hum of voices, and the clatter of feet, there are the more positively annoying and distracting elements, such as German bands, organ grinders, church bells, railway whistles, and the like. In simpler and more primitive times, and to some extent even yet in the country, the normal condition of things is silence, and the auditory nerves are only occasionally excited. It is scarcely to be expected that such a change can be undergone without unpleasant consequences.
The question has been raised, why should some noises interfere with brain work by day and disturb our rest at night so much more than other? A strange explanation has been proposed. We are told that sound made incidentally and unintentionally—such as the rolling of wheels, the clatter of machinery (except very close at hand), the sound of footsteps, and, in short, all noises not made for the sake of noise—distress us little. We may become as completely habituated to them as to the sound of the wind, the rustling of trees, or the murmur of a river. On the other hand, all sounds into which human or animal will enters as a necessary element are in the highest degree distressing. Thus it is, to any ordinary man, impossible to become habituated to the screaming of a child, the barking and yelping of dogs, the strains of a piano, a harmonium, or a fiddle on the other side of a thin party-wall, or the clangour of bells. These noises, the more frequently we hear them, seem to grow more irritating and thought-dispelling.
But while admitting a very wide distinction between these two classes of sounds, we must pause before ascribing these differences to the intervention or non-intervention of will. We shall find certain very obvious distinctions between the two kinds of sound. The promiscuous din of movement, voice, and traffic, even in the busiest city, has in it nothing sharp or accentuated; it forms a continuous whole, in which each individual variation is averaged and toned down. The distressing sounds, on the other hand, are often shrill, abrupt, distinctly accentuated and discrete rather than continuous. Take, for instance, the ringing of bells: it is monotonous in the extreme, but it recurs at regular intervals. Hence its action upon the brain is intensified, just as in the march of troops over a suspension bridge, each step increases the vibration. The pain to the listener is the greater because he knows that the shock will come, and awaits it. Very similar is the case with another gratuitous noise, the barking of dogs. Each bark, be itacute or grave, is in the highest degree abrupt, sharply marked, orstaccato, as we believe a musician would term it. Though the intervals are less regularly marked than in the case of church bells, we still have a prolonged series of distinct shocks communicated to the brain. All the other more distressing kinds of noise possess the characters or shrillness, loudness, and of recurrent beats or blasts.
As an instance of an undesigned, unintentional noise being distressing to those within ear-shot, we may mention the dripping of water. A single drop, whether penetrating through a defective roof, falling from the arch of a cavern, or issuing from a leaky pipe, and repeated at regular intervals, is as annoying as the tolling of a bell, the barking of a dog, or the short, sharp screams of a fretful infant. The only difference is that the noise is not heard as far. We may hence dismiss the “will” theory, and refer the effects of noises of this class to regularity, accentuation, and sharpness.
It is particularly unfortunate that the multiplication of sound should accompany, almost hand in hand, that increase of nervous irritability and that tendency to cerebral disease which rank among the saddest features of modern life. A people worn out with overwork, worry, and competitive examinations might at least be spared all unnecessary noise. Many persons cannot or will not understand how necessary silence is to the thinker. A friend of the writer’s, engaged in investigating certain very abstruse questions in physics, is often compelled to throw aside his work when an organ grinder enters the street, and suffers with acute pain in the head if he attempts to go on with his researches.
We should therefore propose, as measures of sanitary reform, the absolute prohibition of street music, which is more rampant in London than in any other capital in Europe. The present law, which throws upon the sufferer the burden of moving in the matter, is a mere mockery. Another necessary point is the abolition of church bells. In these days of innumerable clocks and watches every one can tell when it is the time for divine service without an entire neighbourhood being disturbed for some 20 minutes at a time. Nonconformist places of worship collect their congregations without this nuisance. Further, all dogs convicted of persistent barking should be disestablished. And lastly, harmoniums, American organs, and wind instruments in general should be prohibited, except in detached houses. (Journal of Science.)
Chapped Hands.—(a) Some persons are sadly troubled with their hands cracking. It sometimes comes from a persons health; but there is one great thing to keep in mind—that is, every time you wash or wet your hands, be sure and dry them well. Always, after wiping them, hold them to the fire till quite dry. This is very important. As an outward application, spermaceti ointment, with a small quantity of lead acetate and some camphor well mixed is a good thing. Rub some well in at night on going to bed, and do not use strong soap.
(b) A mixture of 1-2 dr. hydrochloric acid to 4 oz. water for use in case of chapped hands, and even when the skin is cracked and bleeding, relieves the complaint at once, and if persevered in effects a cure.
(c) Into a 3 oz. glass-stoppered bottle pour ½ oz. pure glycerine; fill up with distilled water and shake. A few drops in the palm rubbed and distributed over the hands when nearly dry, after washing, will in a short time render the skin like satin. It is well to scald the bottle before filling, to check the development of vegetable organisms (“ropiness”). Do not increase this quantity of glycerine, or it will make your hands sticky.
(d) One part (say 1 oz.) pure glycerine, 1 of Eau-de-Cologne, 2 of water; mix them in a bottle and use a few drops well rubbed in after every washing of the hands, and as frequently in the day as can conveniently be done.
(e) Mix equal quantities pure glycerine and pure water together, and add as much common salt as the liquid will dissolve. Rub this frequently on the cracked portions of the hands, giving an extra quantity just before going to bed.
(f) Salicylic acid and borax, each 1½ dr., glycerine up to 2 oz.
(g) Equal quantities carbolic acid and glycerine.
Chilblains.—(a) Chilblains are likely to be caused by sudden change from cold to heat orvice versâ. This will explain why the hands and feet, nose and ears, are mostly the parts affected, because they are the parts most prominently exposed to such changes. Invalids and scrofulous persons are more likely to suffer than the robust and healthy. As prevention is better than cure, care should be taken to protect the parts by substances which are non-conductors of heat. Woollen socks, stout boots, and warm gloves are safe preventives, and especially taking care not to warm the parts affected by cold by any other means than friction, and in case of persons predisposed to chilblains, the frequent ablution of the extremities in tepid water and the use of good yellow soap is advisable, bathing the feet and hands in tepid water slightly salted, every night, is a good antiphlogistic. Should these means fail, where the skin is not broken, use a liniment of 1 oz. camphorated spirits of wine mixed with ½ oz. Goulard’s extract; but the best remedy is a lotion composed of 1 dr. iodine in 3 oz. rectified spirits of wine, to be applied with a brush not more than once a day. Should the chilblain be broken or ulcerated a different treatment must be adopted—warm poultices ought to be applied, and discontinued after about 3 days; the sores must then be touched with the tincture of iodine once a day, and then dressed with basilicon ointment; when they begin to granulate freely, a simple dressing of the above ointment is sufficient to complete a cure. Care ought always to be taken not to let chilblains break through the skin, as they are very liable to mortify.
(b) Copper sulphate in solution is about the best thing to allay the itching before they break. Also is used with very good effect an embrocation composed of 1 dr. tincture of capsicum and 7 dr. soap liniment. After they have broken, the best application will be carbolic acid and linseed oil—1 part of the former to 5 of the latter, to be applied with a feather (the pure acid should be used for this). This is the most useful application for any open sore.
(c) 1 dr. sugar of lead, 2 dr. white vitriol, then add 4 oz. water; shake well before using. Rub well on the affected parts with the hand before a good fire; the best time is in the evening. Do not use this on those that are broken. This scarcely ever fails to cure the most inveterate chilblains by once or twice using.
(d) Quite effective for unbroken chilblains, but it might be poisonous to broken ones, so be very careful:—A small quantity of yellow soap is dissolved in very little water, then methylated spirit is added to just thin it a little, then add, while hot, tincture of iodine drop by drop, stirring it the while; when it begins to change colour there is enough; let get cold, and apply night and morning, letting it dry on. It is only good while the spirit is in it.
(e) Take some precipitated chalk, and mix it in a mortar (or with a knife in a plate, but the first way is best) with some salad oil to something thicker than cream—about the thickness of Devonshire cream. At night apply it thoroughly over all the fingers, rubbing it in, and smearing it thickly on them, putting a pair of gloves on. Persevere every night.
(f) 6 gr. copper sulphate, ½ oz. Eau-de-Cologne, ½ oz. distilled water. To be applied twice a day with camel-hair brush. A capital remedy to arrest inflammation in chilblains.
(g) 2 oz. black bryony root, 10 oz. spirit of wine, 2 oz. water. Macerate 7 days and filter. Apply night and morning with a camel-hair pencil.
Cold Feet.—(a) There are two remedies—the hot bottle and lamb’s-wool socks, either or both of which may be used. When we consider that during the day, whilst we are active, we wear stockings and shoes, does it not seem strange that at night, when the temperature of the air is lower, and when we are inactive, that our feet should have less covering than during the day? The reasonable plan is to have a special pair of socks fornight use, putting them on when going to bed, and change them when getting up; the result will be better and more serene sleep, consequently we shall be more able to undergo our daily exertions. A good walk for ½ hour before retiring warms the feet, and sends a nice glow all through the body, and disposes to sleep. (b) Wear horse-hair soles winter and summer, as a remedy for cold and damp feet.
Coughs and Colds.—TheBritish Medical Journalremarks that there are several well-known processes by which a cold may be caught. As a disease, there is nothing so common; and yet it is only very recently that anything like an approach to a knowledge of its pathology has been attained. There is now, however, a large accumulation of evidence which points very strongly in the direction that “taking cold” is actually “being cold.” Colds are most frequently caught from a wetting. The clothes we wear are good non-conductors of heat, and so prevent the loss of body-heat which would occur without them. But let them become moist or saturated with water, and then they become heat-conductors of a much more active character, and a rapid and excessive loss of body-heat follows. Nothing is more certain, however, than that prolonged exposure in wet clothes is commonly followed by no evil results; that is, so long as there is also active exercise. The loss of heat is then met by increased production of heat, and no harm results. But let the urchin who has been drenched on his way to school sit in his wet clothes during school-hours, and a cold follows. No matter how inured to exposure the person may be who, when drenched, remains quiet and inert in his wet clothes, he takes a cold. Here there is an increased loss without a corresponding production of heat, and the temperature of the body is lowered, or the person “catches cold.”
The effect of exercise in producing heat is well known. Unless the surrounding air be of a low temperature and the clothes light, the skin soon glows with the warm blood circulating in it, and then comes perspiration with its cooling action. Here there is a direct loss of heat induced to meet the increased production of heat. Exercise, then, in wet clothes, produces more or less a new balance, and obviates the evil consequences which would otherwise result.
The loss of heat is more certainly induced if the skin be previously glowing and the circulation through the skin, the cooling area, be active. Thus, a person leaves a ballroom with his cutaneous vessels (pores of the skin) dilated, and a rapid loss of body-heat follows, unless there be a thick great-coat or a brisk walk; if the clothes become moistened by rain, or be saturated with perspiration, the radiation of heat is still more marked. Such is the causation of the cold commonly caught after leaving a heated ballroom. It is probable that exhaustion is not without its effect in lowering the tonicity of the vessels, and so those of the skin do not readily contract and arrest the loss of heat.
A damp bed gives a cold, because the moist bedclothes are much better conductors of heat than are the same clothes when dry. The temperature of the body is lowered, and a cold results. Long exposure in bathing leads to similar consequences. The second feeling of cold in bathing tells that the body is becoming chilled, and that the production of heat is insufficient to meet the loss. A run on the river-bank, or a brisk walk after dressing, commonly restores the lost balance.
The plan of permitting the wet clothes to dry on the wearer is very objectionable. The abstraction of heat from the body by the evaporation of moisture in the clothes produces a marked depression of the body-temperature, and a severe cold. This is most strikingly seen in the effects of a wetting in the Tropics. The smart shower or downpour is quickly followed by a hot sun and a breeze, and the loss of heat under these circumstances is considerable. The person is “chilled to the bone,” and the effects are felt for a long time afterwards.
Alcohol has been abandoned in Arctic regions. It dilates the cutaneous vessels and increases the loss of body-heat. The drunken man perishes of cold when the abstainer survives.
When the exposure follows a long continued warmth, the cutaneous vessels do not contract, but become dilated or paralysed, and then a large bulk of warm blood courses through the cooling surface, and a great loss of body-heat is entailed. Not only so, but the current of chilled blood passes inwards to the right heart and the lungs. Inflammations of the lungs are common along with severe colds; and this is possibly the explanation. Such inflammation is specially liable to occur if at the same time cold air be inspired. The cold respired air and the currents of chilled blood together, produce those vaso-motor disturbances in the lungs which, in their graver aspects, are known as pneumonia.
The practical considerations which are the outcome of this review of the pathology of cold are these. Never wear wet clothes after active muscular exertion has ceased, but change them at once; meet the loss of the body-heat by warm fluids and dry clothes; avoid long-sustained loss of heat which is not met by increased production of heat; increase the tonicity of the vessels of the skin by cold baths, &c., so educating them to contract readily on exposure—by a partial adoption, indeed, of the “hardening” plan; avoid too warm and debilitating rooms and temperatures; take especial care against too great a loss of heat when the skin is glowing; and prevent the inspiration of cold air by the mouth by some protecting agent, as a respirator. We can readily understand how a respirator should be an effective protection against winter bronchitis in those so disposed. Of course, no one should, even in summer, dispense with the use of flannel next the skin, or some substitute, such as merino. It is as important at that period of the year, as in winter.
Dr. Graham gives the following advice: “When you come out of a cold atmosphere you should not at first go into a room that has a fire in it, or if you cannot avoid that, you should keep for a considerable time at as great a distance as possible, and, above all, refrain from taking warm or strong liquors when you are cold. This rule is founded on the same principle as the treatment of any part of the body when frost-bitten. If it were brought to a fire it would soon mortify, whereas, if rubbed with snow, no bad consequences follow from it. Hence, if the following rule were strictly observed—when the whole body, or any part of it, is chilled, bring it to its natural feeling and warmth by degrees—the frequent colds we experience in winter would in a great measure be prevented.”
To neglect the conditions upon which strength of constitution and purity of blood depend, and then strive to avoid in a sedulously careful manner the evil influence of colds upon the body, is like neglecting the substance for the shadow of health; or more properly, it is like one who starves his body, and then strives to keep quiet in order that his strength shall not be exhausted. Let food be taken, and the exhaustion from exercise will not ensue; let all the conditions of health be observed, and then the natural changes of the weather will fall harmlessly on the healthy functions of the body.
Occasionally a cold may be arrested, in the first stage, by taking at the very outset, a hot bath on retiring to rest, with 10 gr. Dover’s powder at bedtime, followed by a hot drink, such as a basin of hot gruel or a tumbler of hot toddy, with a dose of castor-oil in the early morning about 6 o’clock. It is well to remain indoors for the day. Should, however, these means fail, or the ailment have progressed too far before the remedy is applied, and the patient complains of soreness of chest, with cough and feverishness, then he should keep bed for 3 days. Mustard and linseed poultices are to be applied to the chest, warm diluent drinks are to be given, such as gruel, with honey and vinegar in it, to promote gentle perspiration, and to relieve the severity of the cough. Ipecacuanha wine, 10-15 drop doses in water every 4 hours, will be found useful in promoting expectoration. Laxative medicine will probably be necessary, and the diet should be light.
The Continental remedy, lime-flower tea or tisane de tilleul is made in a teapot inthe same way that tea is made, substituting lime blossoms for tea leaves, and using about 4 times the quantity to make it. It is taken hot, and used for colds, coughs, &c., much in the same way that gruel, wheys, and possets are taken in England.
Dr. Ferrier, of King’s College, communicates a remedy for cold in the head, which has been found effectual. It is a white powder used as snuff, and composed as follows:—2 gr. hydrochlorate morphia, 2 dr. acacia powder, 6 dr. bismuth trisnitrate. The whole makes up a quantity of powder, ¼-½ of which may be safely taken in 24 hours. Dr. Ferrier has twice cured himself of very severe colds by this means, once by the use of bismuth trisnitrate alone, which is a very powerful remedy for catarrh of the mucous membrane, and is the most important ingredient in the above mixture. Others have used the snuff with perfect success. Instead of increasing the tendency to sneeze, it almost immediately begins to diminish it. (Lancet.)
Prof. Strambio, in a note to an Italian medical journal, says that, notwithstanding the failure of all remedies hitherto recommended for the immediate cure of a cold, he wishes to communicate to the profession the great success he has found attending a new one in his own person, and to ask them to test its efficiency. He found prolonged mastication and swallowing of a dried leaf or two of theEucalyptus Globulus(Blue gum) almost immediately liberated him from all the effects of a severe cold.
In the treatment of persistent cold in the head, or nasal catarrh, when there is much discharge from the nasal passages, we are advised to use a spray-producer with the following solution:—1 gr. carbolic acid, 2 dr. glycerine, 2 oz. water. After the passages are clean, a small quantity of vaseline is melted in the bowl of the spray-producer, and 2-5 drops pinus canadensis mixture are added. This mixture consists of:—15 gr. pinus canadensis, ½ oz. glycerine, ½ gr. carbolic acid, 1½ oz. water. This is to be applied by the spray to every part.
Dr. Sheppard says, in respect to the use of hot water as a remedial agent in the treatment of inflammation of the mucous membranes:—“I have used hot water as a gargle for the past 6-8 years. In throat and tonsil inflammation, and in coryza (cold in the head), if properly used in the commencement of the attack, it constitutes one of our most effective remedies, being frequently promptly curative. To be of service, it should be used in considerable quantity (½-1 pint at a time), and just as hot as the throat will tolerate.”
Coughing is greatly under the control of the will, and children ought to be taught to try to restrain the inclination to cough; very often, by this very effort, the desire to cough will vanish. If it cannot be avoided, they should be taughthowto cough. It is not in the least necessary to give way to coughing on every occasion, even though there be really something to expectorate, until the mucus or other irritating matter be within easy reach, and then one good, effective, deliberate cough will do as much, or probably more, for the relief of the individual, than perhaps a dozen repeated, noisy, resultless fits of coughing. The noise which accompanies the act can be greatly modified at the will of the individual. There are some people who make not the slightest effort to lessen this annoyance. In many cases the mouth may be closed, and in all the hand may be held before the mouth during the act, whereby considerable modification of the noise may be attained.
Avoid making use of any nostrum vaunted as a cure for all sorts of coughs and colds: all contain opium in some form, and may prove prejudicial to the complaint which initiates the cough. At the same time, a distressing cough calls for amelioration. There never can be harm in causing the patient to inhale steam from a sponge or basin of boiling water; or infusion of hops may be inhaled. Lozenges of various kinds are often useful, e.g. fruit, gum, glycerine, liquorice, marsh-mallow, tamarind, ipecacuanha, &c. Linseed-tea is a bland, soothing demulcent, useful in sore throat, and in allaying tickling cough.
The common mullein,Verbascum thapsus, has long been used in Ireland as a domesticremedy for consumptive cough, and Dr. Quinlan finds that when boiled in milk the patient takes the decoction readily, and experiences a physiological want when it is omitted. Its power of checking phthisical looseness of the bowels and the relief afforded to coughing are very marked, so that patients take hardly any other cough mixture. In early stages it appears to have a distinct power of increasing weight, but in advanced cases Dr. Quinlan remarks that he is not aware of anything that will do this except koumiss. (Brit. Med. Jour.)
Dr. Square recommends a solution of 1 part ethyl bromide in 200 of water as a remedy for whooping-cough. This is of similar strength to the chloroform water of the British Pharmacopœia, and its dose is the same, namely, ½-2 oz.
A German journal mentions a case of whooping-cough treated with turpentine by Ringk, of Berlin, with astonishing results. The patient was a little girl 3½ years of age, and a fatal issue seemed imminent. The doctor prescribed ol. terebinth., 10 grams; syr. altheæ, 80 grams; a teaspoonful every 3 hours. The next day the child was sitting up in bed, with a great slice of bread and butter in her hand, which she was eating and evidently enjoying. The cough had totally disappeared, and no evil results followed.
Following are a few simple recipes for expectorants, useful for winter coughs. The first is particularly suitable for young children:—(a) 1 fl. dr. syrup of squills, ½ fl. dr. gum acacia, powdered, 8 gr. ammonium chloride, enough peppermint water to make 2 fl. oz. Dose for a child, 1 teaspoonful every 2 hours. (b) For older children and adults, 2 parts syrup of ipecac., 4 syrup of squills, 1 paregoric. Dose, ½-1 teaspoonful, repeated as often as necessary. (c) 1 oz. syrup of ipecac., 1 oz. syrup of tolu, ½ oz. paregoric, 1 oz. syrup wild cherry. (d) For hoarseness, Dr. Eichelberger gives the following, which he says is very good:—2 dr. tinct. chloride of iron, 4 dr. glycerine, 4 dr. water. Dose, ½ teaspoonful.
Sore throat is a constant accompaniment of some very serious disorders, such as scarlet fever, measles, smallpox, diphtheria, &c., but is most frequently the result of exposure to cold and damp, when the body is heated. It may be confined to the parts situated at the back of the mouth, i.e. the tonsils, palate, and pharynx, or it may extend a little further into the windpipe. The affection is an inflammation of the mucous membrane of the parts enumerated. Many cases speedily recover without any active treatment, provided the invalid will have patience for a few days, confine himself to the house, better to one apartment, and still better to bed, for a couple of days; avoid all conversation; apply a warm poultice to the throat, or a moist compress round the throat night and day. This last is made by wringing a piece of lint, or a pockethandkerchief, out of water sufficiently so that it does not drip, and it is of small moment whether the water be cold or warm; it is now applied to the throat, and covered with a piece of macintosh, and then a woollen comforter is put over all. Ice may be sucked continuously, if agreeable to the patient. If it be not, then a gargle of warm milk and water should be employed every hour. A smart aperient dose of Epsom salts or castor oil should be taken in the morning before breakfast, 1 tablespoonful salts in a tumblerful of hot water. If, under this treatment, the throat do not improve in 2 days, it has ceased to be a minor ailment, and the physician must be sent for.
A very painful form of sore throat is that called quinsy. It is inflammation of the tonsils, two glands situated at the back of the mouth. This inflammation is principally observed in changeable climates; and seems to attack, by preference, young adults. Children rarely suffer from quinsy. Persons who have once been the subjects of this ailment are very liable to a recurrence of the disorder. The most common exciting cause is exposure to wet and cold, with a chilly east wind.
Those who are liable to this form of sore throat, and know from the premonitory symptoms what is impending, ought at once to adopt preventive measures. These consist in using strong astringent gargles; in the administration of single drop doses of tincture of aconite, every hour, for half a day, and a brisk saline purgative in the morning,such as a dose of Rochelle salts. For gargle, one of the best is the old-fashioned homely mixture, consisting of 3 tablespoonfuls red wine (port or claret), 1 of vinegar, ½ teaspoonful powdered alum, and a little sugar, in a tumbler of cold water. This to be used every hour. If, however, the affection has gone too far for this abortive treatment, then the patient must be confined to bed; hot poultices must be kept constantly applied to the throat; steam from hot water should be inhaled often; a gargle of hot milk and water should be used hourly; and ice, if grateful, may be constantly sucked. A sal prunelle ball may be allowed slowly to dissolve in the mouth. The diet should be in semi-solid form, e.g. arrowroot made with milk, soup thickened with rice-flour, or better still, beef-jelly, if the patient can be persuaded to swallow at all. If the abscess do not speedily rupture, and more particularly if both tonsils be simultaneously affected, then it may be necessary to call in the aid of the surgeon to lance it. The necessity for this will be evident by continued and increasing distress of the sufferer, great difficulty in breathing, and extreme restlessness and feverishness. In a first attack, too great delay ought not to be allowed to take place before getting professional assistance.
Every one has a cure for sore throat, but simple remedies appear to be most effectual. Salt and water is used by many as a gargle, but a little alum and honey dissolved in sage tea is better. An application of cloths wrung out of hot water and applied to the neck, changing as often as they begin to cool, has the most potency for removing inflammation. It should be kept up for a number of hours; during the evening is the usually most convenient time for applying this remedy.
For loss of voice in singers and speakers, Dr. Corson recommends the patient to put a small piece of borax (2-3 gr.) into the mouth and let it dissolve slowly. An abundant secretion of saliva follows. Speakers and singers about to make an unusual effort should the night before take a glass of sugared water containing 2 dr. potassium nitrate (saltpetre) in order to induce free perspiration. In similar circumstances this gargle may also be used:—6 oz. barley water, 1-2 dr. alum, ½ oz. honey. Mix, and use as a gargle. Or an infusion of jaborandi, made by putting 2 scr. of the leaves in a small cup of boiling water, drunk in the morning before getting up. The free sweating is said very quickly to restore the strength of the voice.
Constipation.—Short of mechanically obstructive disease, there are many states in which constipation is the most marked feature. On the nature of these, apart from the mere symptom, the possibility of permanent relief by treatment must of course largely depend. We may procure comfort with a pill, but often we cannot retain it with many. Habit cannot be reformed or expelled by purges. Accordingly, when we proceed against the fault of habit, now under notice, we must take account of the constitution and circumstances in which it is formed. By so doing we do much to ensure the desired relief, though it may be that even then we fail somewhat of complete success. A bowel long deficient in activity, dilated irregularly, with torpid though thickened walls, does not soon, if ever, renew its original tone and contractility. The difficulty is a pathological one, and arises from structural as well as functional perversion. The natural efforts to obtain relief are hindered and enfeebled by the effects of some cause which may still be operative. If we would undo the past or prevent further mischief, we must seek and treat that cause. Aperients of different kinds, however potent at the time, are but temporary palliatives of discomfort so long as no pains are taken to trace the trouble to its origin. Whether it be a sedentary habit of life, an excess of food overloading and overworking the viscus, purgation draining and depleting it, gout, diabetes, struma, chlorosis, altering either the structure of the intestinal wall or the consistence of its contents, it must be sought for as a chief guide to the means of cure. It is not likely that constipation will ever form the chosen hobby of a specialist. A far too general view of medicine and its adjuvant sciences is necessary for successful treatment to encourage such appropriation. We are not, however, outside the sphere of nostrums. There is in our time, if anything too much reliance on physic-taking forconstipation. More might be done by appropriate dieting and by inculcating active habits of life than is customary. It may be noted, with regard to diet in particular, that a free use of simple fluids, as water, or mild mineral waters, is of distinct advantage in assisting both digestion and evacuation. There are also many aperient vegetable foods which, with the same end in view, we should like to see in daily use at the table. Almost any kind of wholesome fruit and green vegetable might thus be made serviceable. When, again, we come to medicines, we must remember that the disorder which we have to combat is a complex one. We cannot in this case, more than in any other morbid state, put a finger on one tissue as alone or invariably at fault. Thus in the costiveness of anæmia we have atony of the intestinal muscle combined with defective secretion, and both but part of a general tissue starvation; in the gouty disorder of elderly people the same conditions appear, though due to a very different dyscrasia; and so on. We may say, therefore, speaking generally, that no single drug can be relied on to meet the intestinal difficulty. An agent which aids secretion either of bowel or liver will not alone suffice. The long-inactive muscular coat likewise requires assistance. A free purge may have its value now and then, but when the object to be attained is the correction of a habit, a milder remedy used regularly is much more effective. To meet these various necessities, perhaps no combination is superior to the time-honoured union of belladonna with the compound rhubarb pill and nux vomica, or the most recent mixture of the fluid extract of cascara with the last-named drug. An agreeable change of remedy is afforded by many aperient mineral waters. The effect of these latter, however, is unfortunately apt to pass off after a time, probably from their causing a too copious intestinal secretion. The action of saline or other enemata is not quite similar. More strictly local, and exerted rather on the fæces than the bowel, it gives relief without so much exhausting the latter by secretion or peristalsis; while the very rest which the colon thus easily obtains is itself a help to the recovery of normal nutrition and muscular tone. The chief points which we would therefore bear in mind, whatever the remedies used in combating the habit of costiveness, are the need for recognition of its primary cause, and the fact that its proximate condition is an atonic bowel. (Lancet.)
Dr. Mortimer Granville gives 3 prescriptions for habitual constipation. It is indispensable to regard persistent inactivity of the bowels, when not demonstrably due to other causes, as the result of, either defect of peristaltic action; deficient glandular secretion; or interruption of thehabitof periodic evacuation.
When there is a lax and torpid condition of the muscular coat of the alimentary canal, we get food retained in the stomach or intestines until it ferments, or sometimes “decomposes,” with the result of distension, pain mechanically induced, and either eructations or incarcerated flatus. In a considerable number of cases this last-mentioned trouble is so great, and at the same time so masked, as to give rise to the impression that grave disease exists; whereas every anomalous symptom has quickly disappeared as soon as the muscular tone has been restored, and the contents of the bowels have commenced to pass naturally on their course. The essential fault is partial, in some instances almost complete, loss of the reflex contractility of the muscular coat, so that the presence of ingesta at any part of the canal does not excite the intestine to contract and propel it onwards. It is worse than useless to employ ordinary aperients in such a condition as this; they only irritate without strengthening the nerves, on the healthy activity of which everything depends. When, therefore, there is the form of “constipation” which requires treatment, use a prescription something like the following; and it is, in the majority of instances, successful:—