2560. Though professional accuracy has divided this disease into several forms, we shall keep to the one disease most generally mot with, the common or simple scarlet fever, which, in all cases, is characterized by an excessive heat on the skin, sore throat, and a peculiar speckled appearance of the tongue.
2561.Symptoms.—Cold chills, shivering, nausea, thirst, hot skin, quick pulse, with difficulty of swallowing; the tongue is coated, presenting through its fur innumerable specks, the elevated papillae of the tongue, which gives it the speckled character, that, if not the invariable sign of scarlet fever, is only met with in cases closely analogous to that disease. Between thesecondand __third_ day, but most frequently on thethird, a bright red efflorescence breaks out in patches on the face, neck, and back, from which it extends over the trunk and extremities, always showing thicker and deeper in colour wherever there is any pressure, such as the elbows, back, and hips; when the eruption is well out, the skin presents the appearance of a boiled lobster-shell. At first, the skin is smooth, but, as the disease advances, perceptible roughness is apparent, from the elevation of the rash, or, more properly, the pores of the skin. On thefifthandsixthdays the eruption begins to decline, and by theeighthhas generally entirely disappeared. During the whole of this period, there is, more or less, constant sore throat.
2562. TheTreatmentof scarlet fever is, in general, very simple. Where the heat is great, and the eruption comes out with difficulty, or recedes as soon as it appears, the body should be sponged with cold vinegar-and-water, or tepid water, as in measles, poured over the chest and body, the patient being, as in that disease, wrapped in a blanket and put to bed, and the same powders and mixture ordered in measles administered, with the addition of a constant hot bran poultice round the throat, which should be continued from the first symptom till a day or two after the declension of the rash. The same low diet and cooling drink, with the same general instructions, are to be obeyed in this as in the former disease.
2563. When the fever runs high in the first stage, and there is much nausea, before employing the effusions of water, give the patient an emetic, of equal, parts of ipecacuanha and antimonial wine, in doses of from a teaspoonful to a tablespoonful, according to age. By these means, nine out of every ten cases of scarlatina may be safely and expeditiously cured, especially if the temperature of the patient's room is kept at an even standard of about sixty degrees.
Hooping-Cough.
2564. THIS is purely a spasmodic disease, and is only infectious through the faculty of imitation, a habit that all children are remarkably apt to fall into; and even where adults have contracted hooping-cough, it has been from the same cause, and is as readily accounted for, on the principle of imitation, as that the gaping of one person will excite or predispose a whole party to follow the same spasmodic example. If any one associates for a few days with a person who stammers badly, he will find, when released from his company, that the sequence of his articulation and the fluency of his speech are, for a time, gone; and it will be a matter of constant vigilance, and some difficulty, to overcome the evil of so short an association. The manner in which a number of school-girls will, one after another, fall into a fit on beholding one of their number attacked with epilepsy, must be familiar to many. These several facts lead us to a juster notion of how to treat this spasmodic disease. Every effort should, therefore, be directed, mentally and physically, to break the chain of nervous action, on which the continuance of the cough depends.
2565.Symptoms.—Hooping-cough comes on with a slight oppression of breathing, thirst, quick pulse, hoarseness, and a hard, dry cough. This state may exist without any change from one to two or three weeks before the peculiar feature of the disease-thehoop-sets in. As the characteristics of this cough are known to all, it is unnecessary to enter here, physiologically, on the subject. We shall, therefore, merely remark that the frequent vomiting and bleeding at the mouth or nose are favourable signs, and proceed to the
2566.Treatment, which should consist in keeping up a state of nausea and vomiting. For this purpose, give the child doses of ipecacuanha and antimonial wines, in equal parts, and quantities varying from half to one and a half teaspoonful once a day, or, when the expectoration is hard and difficult of expulsion, giving the following cough mixture every four hours. Take of
Syrup of squills 1/2 ounce.Antimonial wine 1 ounce.Laudanum 15 drops.Syrup of Toulou 2 drachms.Water 1-1/2 ounce.
Mix. The dose is from half a spoonful to a dessertspoonful. When the cough is urgent, the warm bath is to be used, and either one or two leeches applied over the breastbone, or else a small blister laid on the lower part of the throat.
2567. Such is the medical treatment of hooping-cough; but there is a moral regimen, based on the nature of the disease, which should never be omitted. And, on the principle that a sudden start or diversion of the mind will arrest a person in the act of sneezing or gaping, so the like means should be adopted with the hooping-cough patient; and, in the first stage, before thehoopinghas been added, the parent should endeavour to break the paroxysm of the cough by abruptly attracting the patient's attention, and thus, if possible, preventing the cough from reaching that height when the ingulp of air gives the hoop or crow that marks the disease; but when once that symptom has set in, it becomes still more necessary to endeavour, by even measures of intimidation, to break the spasmodic chain of the cough. Exercise in the open air, when dry, is also requisite, and charge of scene and air in all cases is of absolute necessity, and may be adopted at any stage of the disease.
Croup.
2568. This is by far the most formidable and fatal of all the diseases to which infancy and childhood are liable, and is purely an inflammatory affection, attacking that portion of the mucous membrane lining the windpipe and bronchial tubes, and from the effect of which a false or loose membrane is formed along the windpipe, resembling in appearance the finger of a glove suspended in the passage, and, consequently, terminating the life of the patient by suffocation; for, as the lower end grows together and becomes closed, no air can enter the lungs, and the child dies choked. All dull, fat, and heavy children are peculiarly predisposed to this disease, and those with short necks and who make a wheezing noise in their natural breathing. Croup is always sudden in its attack, and rapid in its career, usually proving fatal within three days; most frequently commences in the night, and generally attacking children between the ages of three and ten years. Mothers should, therefore, be on their guard who have children predisposed to this disease, and immediately resort to the means hereafter advised.
2569.Symptoms.—Languor and restlessness, hoarseness, wheezing, and short, dry cough, with occasional rattling in the throat during sleep, the child often plucking at its throat with its fingers; difficulty of breathing, which quickly becomes hard and laboured, causing great anxiety of the countenance, and the veins of the neck to swell and become knotted; the voice in speaking acquires a sharp, crowing, or croupy sound, while the inspirations have a harsh, metallic intonation. After a few hours, a quantity of thick, ropy mucus is thrown out, hanging about the mouth, and causing suffocating fits of coughing to expel.
2570. Treatment.—Place the child immediately in a hot bath up to the throat; and, on removal from the water, give an emetic of the antimonial or ipecacuanha wine, and, when the vomiting has subsided, lay a long blister down the front of the throat, and administer one of the following powders every twenty minutes to a child from three to six years of age.
2571. Take of calomel, 12 grains; tartar emetic, 2 grains; lump sugar, 30 grains. Mix accurately, and divide into 12 powders. For a child from six to twelve years, divide into 6 powders, and give one every half-hour.
2572. Should the symptoms remain unabated after a few hours, apply one or two leeches to the throat, and put mustard poultices to the foot and thighs, retaining them about eight minutes; and, in extreme cases, a mustard poultice to the spine between the shoulders, and at the same time rub mercurial ointment into the armpits and the angles of the jaws.
2573. Such is a vigorous and reliable system of treatment in severe cases of croup; but, in the milder and more general form, the following abridgment will, in all probability, be all that will be required:—First, the hot bath; second, the emetic; third, a mustard plaster round the throat for five minutes; fourth, the powders; fifth, another emetic in six hours, if needed, and the powders continued without intermission while the urgency of the symptoms continues. When relief has been obtained, these are to be discontinued, and a dose of senna tea given to act on the bowels.
Diarrhoea.
2574. The diarrhoea with which children are so frequently affected, especially in infancy, should demand the nurse's immediate attention, and when the secretion, from its clayey colour, indicates an absence of bile, a powder composed of 3 grains of grey powder and 1 grain of rhubarb, should be given twice, with an interval of four hours between each dose, to a child from one to two years, and, a day or two afterwards, an aperient powder containing the same ingredients and quantities, with the addition of 2 or 3 grains of scammony. For the relaxation consequent on an overloaded stomach, or acidity in the bowels, a little magnesia dissolved in milk should be employed two or three times a day.
2575. When much griping and pain attend the diarrhoea, half a teaspoonful of Dalby's Carminative (the best of all patent medicines) should be given, either with or without a small quantity of castor oil to carry off the exciting cause.
2576. For any form of diarrhoea that, by excessive action, demands a speedy correction, the most efficacious remedy that can be employed in all ages and conditions of childhood is the tincture of Kino, of which from 10 to 30 drops, mixed with a little sugar and water in a spoon, are to be given every two or three hours till the undue action has been checked. Often the change of diet to rice, milk, eggs, or the substitution of animal for vegetable food, orvice versa, will correct an unpleasant and almost chronic state of diarrhoea.
2577. A very excellent carminative powder for flatulent infants may be kept in the house, and employed with advantage, whenever the child is in pain or griped, by dropping 5 grains of oil of aniseed and 2 of peppermint on half an ounce of lump sugar, and rubbing it in a mortar, with a drachm of magnesia, into a fine powder. A small quantity of this may be given in a little water at any time, and always with benefit.
2578. "Time," according to the old proverb, "is money;" and it may also, in many cases, and with equal truthfulness, be said to be life; for a few moments, in great emergencies, often turn the balance between recovery and death. This applies more especially to all kinds of poisoning, fits, submersion in water, or exposure to noxious gases; and many accidents. If people knew how to act during the interval that must necessarily elapse from the moment that a medical man is sent for until he arrives, many lives might be saved, which now, unhappily, are lost. Generally speaking, however, nothing is done—all is confusion and fright; and the surgeon, on his arrival, finds that death has already seized its victim, who, had his friends but known a few rough rules for their guidance, might have been rescued. We shall, therefore, in a series of papers, give such information as to the means to be employed in event of accidents, injuries, &c., as, by the aid of a gentleman of large professional experience, we are warranted in recommending.
List of Drugs, &c., necessary to carry out all Instructions.
2579. We append at once A LIST OF DRUGS, &c., and a few PRESCRIPTIONS necessary to carry out all the instructions given in this series of articles. It will be seen that they are few—they are not expensive; and by laying in a little stock of them, our instructions will be of instant value in all cases of accident, &c.—The drugs are—Antimonial Wine. Antimonial Powder. Blister Compound. Blue Pill. Calomel. Carbonate of Potash. Compound Iron Pills. Compound Extract of Colocynth. Compound Tincture of Camphor. Epsom Salts. Goulard's Extract. Jalap in Powder. Linseed Oil. Myrrh and Aloes Pills. Nitre. Oil of Turpentine. Opium, powdered, and Laudanum. Sal Ammoniac. Senna Leaves. Soap Liniment, Opodeldoc. Sweet Spirits of Nitre. Turner's Cerate.—To which should be added: Common Adhesive Plaster. Isinglass Plaster. Lint. A pair of small Scales with Weights. An ounce and a drachm Measure-glass. A Lancet. A Probe. A pair of Forceps, and some curved Needles.
2580. The following PRESCRIPTIONS may be made up for a few shillings; and, by keeping them properly labelled, and by referring to the remarks on the treatment of any particular case, much suffering, and, perhaps, some lives, may be saved.
2581.Draught.—Twenty grains of sulphate of zinc in an ounce and a half of water. This draught is to be repeated in a quarter of an hour if vomiting does not take place.
2582.Clyster.—Two tablespoonfuls of oil of turpentine in a pint of warm gruel.
2583.Liniments.—1. Equal parts of lime-water and linseed-oil well mixed together. [Lime-water is made thus: Pour 6 pints of boiling water upon 1/4 lb. of lime; mix well together, and when cool, strain the liquid from off the lime which has fallen to the bottom, taking care to get it as clear as possible.] 2. Compound camphor liniment.
2584.Lotions.—1. Mix a dessert-spoonful of Goulard's extract and 2 tablespoonfuls of vinegar in a pint of water.—2. Mix 1/2 oz. of sal-ammoniac, 2 tablespoonfuls of vinegar, and the same quantity of gin or whisky, in half a pint of water.
2585.Goulard Lotion.—1 drachm of sugar of lead, 2 pints of rain-water, 2 teaspoonfuls of spirits of wine. For inflammation of the eyes or elsewhere:—The better way of making Goulard Lotion, if for the eyes, is to add to 6 oz. of distilled water, or water that has been well boiled, 1 drachm of the extract of lead.
2586.Opodeldoc.—This lotion being a valuable application for sprains, lumbago, weakness of joints, &c., and it being difficult to procure either pure or freshly made, we give a recipe for its preparation. Dissolve 1 oz. of camphor in a pint of rectified spirits of wine; then dissolve 4 oz. of hard white Spanish soap, scraped thin, in 4 oz. of oil of rosemary, and mix them together.
2587.The Common Black Draught.—Infusion of senna 10 drachms; Epsom salts 10 drachms; tincture of senna, compound tincture of cardamums, compound spirit of lavender, of each 1 drachm. Families who make black draught in quantity, and wish to preserve it for some time without spoiling, should add about 2 drachms of spirits of hartshorn to each pint of the strained mixture, the use of this drug being to prevent its becoming mouldy or decomposed. A simpler and equally efficacious form of black draught is made by infusing 1/2 oz. of Alexandrian senna, 3 oz. of Epsom salts, and 2 drachms of bruised ginger and coriander-seeds, for several hours in a pint of boiling water, straining the liquor, and adding either 2 drachms of sal-volatile or spirits of hartshorn to the whole, and giving 3 tablespoonfuls for a dose to an adult.
2588.Mixtures—1.Aperient.—Dissolve an ounce of Epsom salts in half a pint of senna tea: take a quarter of the mixture as a dose, and repeat it in three or four hours if necessary.
2589. 2.Fever Mixture.—Mix a drachm of powdered nitre, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitre, in half a pint of water.
2590. 3.Myrrh and Aloes Pills.—Ten grains made into two pills are the dose for a full-grown person.
2591. 4.Compound Iron Pills.—Dose for a full-grown person: 10 grains made into two pills.
2592.Pills.—1. Mix 5 grains of calomel and the same quantity of antimonial powder with a little bread-crumb, and make into two pills. Dose for a full-grown person: two pills.—2. Mix 5 grains of blue pill and the same quantity of compound extract of colocynth together, and make into two pills, the dose for a full-grown person.
2593.Powders.—Mix a grain of calomel and 4 grains of powdered jalap together.
2594. In all cases, the dose of medicines given is to be regulated by the age of the patient.
2595.Abernethy's Plan for making a Bread-and-Water Poultice.—First scald out a basin; then having put in some boiling water, throw in coarsely-crumbled bread, and cover it with a plate. When the bread has soaked up as much water as it will imbibe, drain off the remaining water, and there will be left a light pulp. Spread it a third of an inch thick on folded linen, and apply it when of the temperature of a warm bath. To preserve it moist, occasionally drop warm water on it.
2596.Linseed-Meal Poultice.—"Scald your basin, by pouring a little hot water into it; then put a small quantity of finely-ground linseed-meal into the basin, pour a little hot water on it, and stir it round briskly until you have well incorporated them; add a little more meal and a little more water; then stir it again. Do not let any lumps remain in the basin, but stir the poultice well, and do not be sparing of your trouble. What you do next, is to take as much of it out of the basin as you may require, lay it on a piece of soft linen, and let it be about a quarter of an inch thick."—Abernethy.
2597.Mustard Poultice.—Mix equal parts of dry mustard and linseed-meal in warm vinegar. When the poultice is wanted weak, warm water may be used for the vinegar; and when it is required very strong, mustard alone, without any linseed-meal, is to be mixed with warm vinegar.
2598.An ordinary Blister.—Spread a little blister compound on a piece of common adhesive plaster with the right thumb. It should be put on just thickly enough to conceal the appearance of the plaster beneath. The part from which a blister has been taken should be covered till it heals over with soft linen rags smeared with lard.
Baths and Fomentations.
2599. All fluid applications to the body are exhibited either in a hot or cold form; and the object for which they are administered is to produce a stimulating effect over the entire, or a part, of the system; for the effect, though differently obtained, and varying in degree, is the same in principle, whether procured by hot or cold water.
2600.Heat.—There are three forms in which heat is universally applied to the body,—that of the tepid, warm, and vapour bath; but as the first is too inert to be worth notice, and the last dangerous and inapplicable, except in public institutions, we shall confine our remarks to the really efficacious and always attainable one—the
2601.Warm and Hot Bath.—These baths are used whenever there is congestion, or accumulation of blood in the internal organs, causing pain, difficulty of breathing, or stupor, and are employed, by their stimulating property, to cause a rush of blood to the surface, and, by unloading the great organs, produce a temporary inflammation in the skin, and so equalize the circulation. The effect of the hot bath is to increase the fulness of the pulse, accelerate respiration, and excite perspiration. In all inflammations of the stomach and bowels, the hot bath is of the utmost consequence; the temperature of the warm bath varies from 92° to 100°, and may be obtained by those who have no thermometer to test the exact heat, by mixing one measure of boiling with two of cold water.
2602.Fomentationsare generally used to effect, in a part, the benefit produced on the whole body by the bath; to which a sedative action is occasionally given by the use of roots, herbs, or other ingredients; the object being to relieve the internal organ, as the throat, or muscles round a joint, by exciting a greater flow of blood to the skinoverthe affected part. As the real agent of relief is heat, the fomentation should always be as hot as it can comfortably be borne, and, to insure effect, should be repeated every half-hour. Warm fluids are applied in order to render the swelling which accompanies inflammation less painful, by the greater readiness with which the skin yields, than when it is harsh and dry. They are of various kinds; but the most simple, and oftentimes the most useful, that can be employed, is "Warm Water." Another kind of fomentation is composed of dried poppyheads, 4 oz. Break them to pieces, empty out the seeds, put them into 4 pints of water, boil for a quarter of an hour, then strain through a cloth or sieve, and keep the water for use. Or, chamomile flowers, hemlock, and many other plants, may be boiled, and the part fomented with the hot liquor, by means of flannels wetted with the decoction.
2603.Cold, when applied in excess to the body, drives the blood from the surface to the centre, reduces the pulse, makes the breathing hard and difficult, produces coma, and, if long continued, death. But when medicinally used, it excites a reaction on the surface equivalent to a stimulating effect; as in some cases of fever, when the body has been sponged with cold water, it excites, by reaction, increased circulation on the skin. Cold is sometimes used to keep up a repellent action, as, when local inflammation takes place, a remedy is applied, which, by its benumbing and astringent effect, causes the blood, or the excess of it in the part, to recede, and, by contracting the vessels, prevents the return of any undue quantity, till the affected part recovers its tone. Such remedies are calledLotions, and should, when used, be applied with the same persistency as the fomentation; for, as the latter should be renewed as often as the heat passes off, so the former should be applied as often as the heat from the skin deprives the application of its cold.
2604.Poulticesare only another form of fomentation, though chiefly used for abscesses. The ingredient best suited for a poultice is that which retains heat the longest; of these ingredients, the best are linseed—meal, bran, and bread. Bran sewed into a bag, as it can be reheated, will be found the cleanest and most useful; especially for sore throats.
How to Bleed.
2605. In cases of great emergency, such as the strong kind of apoplexy, and when a surgeon cannot possibly be obtained for some considerable time, the life of the patient depends almost entirely upon the fact of his being bled or not. We therefore give instructions how the operation of bleeding is to be performed, but caution the reader only to attempt it in cases of the greatest emergency. Place a handkerchief or piece of tape rather but not too tightly round the arm, about three or four inches above the elbow. This will cause the veins below to swell and become very evident. If this is not sufficient, the hand should be constantly and quickly opened and shut for the same purpose. There will now be seen, passing up the middle of the fore-arm, a vein which, just below the bend of the elbow, sends a branch inwards and outwards, each branch shortly joining another large vein. It is from theouterbranch—that the person is to be bled. The right arm is the one mostly operated on. The operator should take the lancet in his right hand, between the thumb and first finger, place the thumb of his left hand on the vein below the part where he is going to bleed from, and then gently thrust the tip of the lancet into the vein, and, taking care not to push it too deeply, cut in a gently curved direction, thus and bring it out, point upwards, at about half an inch from the part of the vein into which he had thrust it. The vein must be cut lengthways, and not across. When sufficient blood has been taken away, remove the bandage from above the elbow, and place the thumb of the left hand firmly over the cut, until all the bleeding ceases. A small pad of lint is then to be put over the cut, with a larger pad over it, and the two kept in their places by means of a handkerchief or linen roller bound pretty tightly over them and round the arm.
2606. When a person is bled, he should always be in the standing, or at any rate in the sitting, position; for if, as is often the case, he should happen to faint, he can, in, most eases at least, easily be brought to again by the operator placing him flat on his back, and stopping the bleeding.This is of the greatest importance.It has been recommended, for what supposed advantages we don't know, to bleed people when they are lying down. Should a person, under these circumstances, faint, what could be done to bring him to again? The great treatment of lowering the body of the patient to the flat position cannot be followed here. It is in that position already, and cannot be placed lower than it at present is—except, as is most likely to be the case, under the ground.
2607. BLEEDING FROM THE NOSE.—Many children, especially those of a sanguineous temperament, are subject to sudden discharges of blood from some part of the body; and as all such fluxes are in general the result of an effort of nature to relieve the system from some overload or pressure, such discharges, unless in excess, and when likely to produce debility, should not be rashly or too abruptly checked. In general, these discharges are confined to the summer or spring months of the year, and follow pains in the head, a sense of drowsiness, languor, or oppression; and, as such symptoms are relieved by the loss of blood, the hemorrhage should, to a certain extent, be encouraged. When, however, the bleeding is excessive, or returns too frequently, it becomes necessary to apply means to subdue or mitigate the amount. For this purpose the sudden and unexpected application of cold is itself sufficient, in most cases, to arrest the most active hemorrhage. A wet towel laid suddenly on the back, between the shoulders, and placing the child in a recumbent posture, is often sufficient to effect the object; where, however, the effusion resists such simple means, napkins wrung out of cold water must be laid across the forehead and nose, the hands dipped in cold water, and a bottle of hot water applied to the feet. If, in spite of these means, the bleeding continues, a little fine wool or a few folds of lint, tied together by a piece of thread, must be pushed up the nostril from which the blood flows, to act as a plug and pressure on the bleeding vessel. When the discharge has entirely ceased, the plug is to be pulled out by means of the thread. To prevent a repetition of the hemorrhage, the body should be sponged every morning with cold water, and the child put under a course of steel wine, have open-air exercise, and, if possible, salt-water bathing. For children, a key suddenly dropped down the back between the skin and clothes, will often immediately arrest a copious bleeding.
2608. SPITTING OF BLOOD, or hemorrhage from the lungs, is generally known from blood from the stomach by its being of a brighter colour, and in less quantities than that, which is always grumous and mixed with the half-digested food. In either case, rest should be immediately enjoined, total abstinence from stimulants, and a low, poor diet, accompanied with the horizontal position, and bottles of boiling water to the feet. At the same time the patient should suck through a quill, every hour, half a wine-glass of water in which 10 or 15 drops of the elixir of vitriol has been mixed, and, till further advice has been procured, keep a towel wrung out of cold water on the chest or stomach, according to the seat of the hemorrhage.
Bites and Stings.
2609. BITES AND STINGS may be divided into three kinds:—1. Those of Insects. 2. Those of Snakes. 3. Those of Dogs and other Animals.
2610. 1.The Bites or Stings of Insects, such as gnats, bees, wasps, &c., need cause very little alarm, and are, generally speaking, easily cured. They are very serious, however, when they take place on some delicate part of the body, such as near the eye, or in the throat.The treatmentis very simple in most cases; and consists in taking out the sting, if it is left behind, with a needle, and applying to the part a liniment made of finely-scraped chalk and olive-oil, mixed together to about the thickness of cream.
2611. Bathing the part bitten with warm turpentine or warm vinegar is also of great use. If the person feels faint, he should lie quietly on his back, and take a little brandy-and-water, or sal-volatile and water. When the inside of the throat is the part stung, there is great danger of violent inflammation taking place. In this case, from eight to twelve leeches should be immediately put to the outside of the throat, and when they drop off, the part to which they had been applied should be well fomented with warm water. The inside of the throat is to be constantly gargled with salt and water. Bits of ice are to be sucked. Rubbing the face and hands well over with plain olive-oil, before going to bed, will often keep gnats and musquitoes from biting during the night. Strong scent, such as eau-de-Cologne, will have the same effect.
2612. 2.Bites of Snakes.—These are much more dangerous than the preceding, and require more powerful remedies. The bites of the different kinds of snakes do not all act alike, but affect people in different ways.—Treatment of the part bitten. The great thing is to prevent the poison getting into the blood; and, if possible, to remove the whole of it at once from the body. A pocket-handkerchief, a piece of tape or cord, or, in fact, of anything that is at hand, should be tied tightly round the part of the body bitten; if it be the leg or arm, immediatelyabovethe bite, and between it and the heart. The bite should then be sucked several times by any one who is near. There is no danger in this, provided the person who does it has not got the skin taken off any part of his mouth. What has been sucked into the mouth should be immediately spit out again. But if those who are near have sufficient nerve for the operation, and a suitable instrument, they should cut out the central part bitten, and then bathe the wound for some time with warm water, to make it bleed freely. The wound should afterwards be rubbed with a stick of lunar caustic, or, what is better, a solution of this—60 grains of lunar caustic dissolved in an ounce of water—should be dropped into it. The band should be kept on the part during the whole of the time that these means are being adopted. The wound should afterwards be covered with lint dipped in cold water. The best plan, however, to be adopted, if it can be managed, is the following:—take a common wine-glass, and, holding it upside down, put a lighted candle or a spirit-lamp into it for a minute or two. This will take out the air. Then clap the glass suddenly over the bitten part, and it will become attached, and hold on to the flesh. The glass being nearly empty, the blood containing the poison will, in consequence, flow into it from the wound of its own accord. This process should be repeated three or four times, and the wound sucked, or washed with warm water, before each application of the glass. As a matter of course, when the glass is removed, all the blood should be washed out of it before it is applied again.—Constitutional Treatment. There is mostly at first great depression of strength in these cases, and it is therefore requisite to give some stimulant; a glass of hot brandy-and-water, or twenty drops of sal-volatile, is the best that can be given. When the strength has returned, and if the patient has not already been sick, a little mustard in hot water should be given, to make him so. If, on the other hand, as is often the case, the vomiting is excessive, a large mustard poultice should be placed over the stomach, and a grain of solid opium swallowed in the form of a pill, for the purpose of stopping it. Only one of these pills should be given by a non-professional person. In all cases of bites from snakes, send for a surgeon as quickly as possible, and act according to the above directions until he arrives. If he is within any reasonable distance, content yourself by putting on the band, sucking the wound, applying the glass, and, if necessary, giving a little brandy-and-water.
2613. 3.Bites of Dogs.—For obvious reasons, these kinds of bites are more frequently met with than those of snakes.The treatmentis the same as that for snake-bites, more especially that of the bitten part. The majority of writers on the subject are in favour of keeping the wound open as long as possible. This may be done by putting a few beans on it, and then by applying a large linseed-meal poultice over them.
Injuries and Accidents to Bones.
2614.Dislocation of Bones.—When the end of a bone is pushed out of its natural position, it is said to be dislocated. This may be caused by violence, disease, or natural weakness of the parts about a joint.—Symptoms. Deformity about the joint, with unnatural prominence at one part, and depression at another. The limb may be shorter or longer than usual, and is stiff and unable to be moved, differing in these last two respects from a broken limb, which is mostly shorter, never longer, than usual, and which is always more movable.—Treatment. So much practical science and tact are requisite in order to bring a dislocated bone into its proper position again, that we strongly advise the reader never to interfere in these cases; unless, indeed, it is altogether impossible to obtain the services of a surgeon. But because any one of us may very possibly be placed in that emergency, we give a few rough rules for the reader's guidance. In the first place make the joint, from which the bone has been displaced, perfectly steady, either by fixing it to some firm object or else by holding it with the hands; then pull the dislocated bone in a direction towards the place from which it has been thrust, so that, if it moves at all from its unnatural position, it may have the best chance of returning to its proper place. Do not, however, pull or press against the parts too violently, as you may, perhaps, by doing so, rupture blood-vessels, and produce most serious consequences. When youdoattempt to reduce a dislocated bone, do it as quickly as possible after the accident has taken place, every hour making the operation more difficult. When the patient is very strong, he may be put into a warm bath until he feels faint, or have sixty drops of antimonial wine given him every ten minutes until he feels sickish. These two means are of great use in relaxing the muscles. If the bone has been brought back again to its proper place, keep it there by means of bandages; and if there is much pain about the joint, apply a cold lotion to it, and keep it perfectly at rest. The lotion should be, a dessert-spoonful of Goulard's extract, and two tablespoonfuls of vinegar, mixed in a pint of water. Leeches are sometimes necessary. Unless the local pain, or general feverish symptoms, are great, the patient's diet should be the same as usual. Dislocations may be reduced a week, or even a fortnight, after they have taken place. As, therefore, although the sooner a bone is reduced the better, there is no very great emergency, and as the most serious consequences may follow improper or too violent treatment, it is always better for people in these cases to do too little than too much; inasmuch as the good which has not yet may still be done, whereas the evil thathasbeen done cannot so easily be undone.
2615. FRACTURES OF BONES.—Symptoms. 1. Deformity of the part. 2. Unnatural looseness. 3. A grating sound when the two ends of the broken bone are rubbed together. 4. Loss of natural motion and power. In some cases there is also shortening of the limb.—Fracture takes place from several causes, as a fall, a blow, a squeeze, and sometimes from the violent action of muscles.—Treatment. In cases where a surgeon cannot be procured immediately after the accident, the following general rules are offered for the reader's guidance:—The broken limb should be placed and kept as nearly as possible in its natural position. This is to be done by first pulling the two portions of the bone in opposite directions, until the limb becomes as long as the opposite one, and then by applying a splint, and binding it to the part by means of a roller. When there is no deformity, the pulling is of course unnecessary. If there is much swelling about the broken part, a cold lotion is to be applied. This lotion (which we will call Lotion No. 1) may be thus made:—Mix a dessert-spoonful of Goulard's extract and two tablespoonfuls of vinegar in a pint of water. When the leg or arm is broken, always, if possible, get it to the same length and form as the opposite limb. The broken part should be kept perfectly quiet. When a broken limb is deformed, and a particular muscle is on the stretch, place the limb in such a position as will relax it. This will in most cases cure the deformity. Brandy-and-water, or sal-volatile and water, are to be given when the patient is faint. Surgical aid should, of course, be procured as soon as possible.
2616. JOINTS, INJURIES TO.—All kinds of injuries to joints, of whatever description, require particular attention, in consequence of the violent inflammations which are so liable to take place in these parts of the body, and which do so much mischief in a little time. The joint injured should always be kept perfectly at rest; and when it is very painful, and the skin about it red, swollen, hot, and shining, at the same time that the patient has general feverish symptoms, such as great thirst and headache—leeches, and when they drop off, warm poppy fomentations, are to be applied; the No. 1 pills above-mentioned are to be given (two are a dose for a grown person) with a black draught three hours afterwards. Give also two tablespoonfuls of the fever-mixture every four hours, and keep the patient on low diet. When the injury and swelling are not very great, warm applications, with rest, low diet, and a dose of aperient medicine, will be sufficient. When a joint has received a penetrating wound, it will require the most powerful treatment, and can only be properly attended to by a surgeon. The patient's friends will have to use their own judgment to a great extent in these and in many other cases, as to when leeches, fever-mixture, &c., are necessary. A universal rule, however, without a single exception,is always to rest a joint wellafter it has been injured in any way whatever, to purge the patient, and to keep him on low diet, without beer, unless he has been a very great drinker indeed, in which case he may still be allowed to take a little; for if the stimulant that a person has been accustomed to in excess be all taken away at once, he is very likely to have an attack of delirium tremens. The quantity given should not, however, be much—say a pint, or, at the most, a pint and a half a day. Rubbing the joint with opodeldoc, or the application of a blister to it, is of great service in taking away the thickenings, which often remain after all heat, pain, and redness have left an injured joint. Great care should be observed in not using a joint too quickly after it has been injured. When the shoulder-joint is the one injured, the arm should be bound tightly to the body by means of a linen or flannel roller, and the elbow raised; when the elbow, it should be kept raised in the straight position, on a pillow; when the wrist, it should be raised on the chest, and suspended in a sling; when the knee, it should be kept in the straight position; and, lastly, when the ankle, it should be a little raised on a pillow.
2617. BRUISES, LACERATIONS, AND CUTS.—Wherever the bruise may be, or however swollen or discoloured the skin may become, two or three applications of theextract of lead, kept to the part by means of lint, will, in an hour or little more, remove all pain, swelling, and tenderness. Simple or clean cuts only require the edges of the wound to be placed in their exact situation, drawn close together, and secured there by one or two slips of adhesive plaster. When the wound, however, is jagged, or the flesh or cuticle lacerated, the parts are to be laid as smooth and regular as possible, and a piece of lint, wetted in theextract of lead, laid upon the wound, and a piece of greased lint placed above it to prevent the dressing sticking; the whole covered over to protect from injury, and the part dressed in the same manner once a day till the cure is effected.
2618. BRUISES AND THEIR TREATMENT.—The best application for a bruise, be it large or small, is moist warmth; therefore, a warm bread-and-water poultice in hot moist flannels should be put on, as they supple the skin. If the bruise be very severe, and in the neighbourhood of a joint, it will be well to apply ten or a dozen leeches over the whole bruised part, and afterwards a poultice. But leeches should not be put on young children. If the bruised part be the knee or the ankle, walking should not be attempted till it can be performed without pain. Inattention to this point often lays the foundation for serious mischief in these joints, especially in the case of scrofulous persons. In all conditions of bruises occurring in children, whether swellings or abrasions, no remedy is so quick or certain of effecting a cure as the pure extract of lead applied to the part.
Burns and Scalds.
2619. BURNS AND SCALDS being essentially the same in all particulars, and differing only in the manner of their production, may be spoken of together. As a general rule, scalds are less severe than burns, because the heat of water, by which scalds are mostly produced, is not, even when it is boiling, so intense as that of flame; oil, however, and other liquids, whose boiling-point is high, produce scalds of a very severe nature. Burns and scalds have been divided into three classes. The first class comprises those where the burn is altogether superficial, and merely reddens the skin; the second, where the injury is greater, and we get little bladders containing a fluid (called serum) dotted over the affected part; in the third class we get, in the case of burns, a charring, and in that of scalds, a softening or pulpiness, perhaps a complete and immediate separation of the part. This may occur at once, or in the course of a little time. The pain from the second kind of burns is much more severe than that in the other two, although the danger, as a general rule, is less than it is in the third class. These injuries are much more dangerous when they take place on the trunk than when they happen on the arms or legs. The danger arises more from the extent of surface that is burnt than from the depth to which the burn goes. This rule, of course, has certain exceptions; because a small burn on the chest or belly penetrating deeply is more dangerous than a more extensive but superficial one on the arm or leg. When a person's clothes are in flames, the best way of extinguishing them is to wind a rug, or some thick material, tightly round the whole of the body.
2620.Treatment of the First Class of Burns and Scalds.—Of the part affected.—Cover it immediately with a good coating of common flour, or cotton-wool with flour dredged well into it. The great thing is to keep the affected surface of the skin from the contact of the air. The part will shortly get well, and the skin may or may not peel off.—Constitutional Treatment. If the burn or scald is not extensive, and there is no prostration of strength, this is very simple, and consists in simply giving a little aperient medicine—pills (No. 2), as follows:—Mix 5 grains of blue pill and the same quantity of compound extract of colocynth, and make into two pills—the dose for a full-grown person. Three hours after the pills give a black draught. If there are general symptoms of fever, such as hot skin, thirst, headache, &c. &c., two tablespoonfuls of fever-mixture are to be given every four hours. The fever-mixture, we remind our readers, is made thus:-Mix a drachm of powdered nitro, 2 drachms of carbonate of potash, 2 teaspoonfuls of antimonial wine, and a tablespoonful of sweet spirits of nitro, in half a pint of water.
2621.Second Class. Local Treatment.—As the symptoms of these kinds of burns are more severe than those of the first class, so the remedies appropriate to them are more powerful. Having, as carefully as possible, removed the clothes from the burnt surface, and taking care not to break the bladders, spread the following liniment (No. 1) on a piece of linen or lint—not thefluffyside—and apply it to the part: the liniment should be equal parts of lime-water and linseed-oil, well mixed. If the burn is on the trunk of the body, it is better to use a warm linseed-meal poultice. After a few days dress the wound with Turner's cerate. If the burn is at the bend of the elbow, place the arm in thestraightposition; for if it isbent, the skin, when healed, will be contracted, and the arm, in all probability, always remain in the same un natural position. This, indeed, applies to all parts of the body; therefore, always place the part affected in the moststretchedposition possible.—Constitutional Treatment. The same kind of treatment is to be used as for the first class, only it must be more powerful. Stimulants are move often necessary, but must be given with great caution. If, as is often the case, there is great irritability and restlessness, a dose of opium (paregoric, in doses of from sixty to a hundred drops, according to age, is best) is of great service. The feverish symptoms will require aperient medicines and the fever mixture. A drink made of about a tablespoonful of cream of tartar and a little lemon-juice, in a quart of warm water, allowed to cool, is a very nice one in these cases. The diet throughout should not be too low, especially if there is much discharge from the wound. After a few days it is often necessary to give wine, ammonia, and strong beef-tea. These should be had recourse to when the tongue gets dry and dark, and the pulse weak and frequent. If there should be, after the lapse of a week or two, pain over one particular part of the belly, a blister should be put on it, and a powder of mercury and chalk-grey powder, and Dover's powder (two grains of the former and five of the latter) given three times a day. Affections of the head and chest also frequently occur as a consequence of these kinds of burns, but no one who is not a medical man can treat them.
2622.Third Class.—These are so severe as to make it impossible for a non-professional person to be of much service in attending to them. When they occur, a surgeon should always be sent for. Until he arrives, however, the following treatment should be adopted:—Place the patient full-length on his back, and keep him warm. Apply fomentations of flannels wrung out of boiling water and sprinkled with spirits of turpentine to the part, and give wine and sal-volatile in such quantities as the prostration of strength requires; always bearing in mind the great fact that you have to steer between two quicksands—death from present prostration and death from future excitement, which will always be increased in proportion to the amount of stimulants given. Give, therefore, only just as much as is absolutely necessary to keep life in the body.
2623. CONCUSSION OF BRAIN—STUNNING.—This may be caused by a blow or a fall.—Symptoms. Cold skin; weak pulse; almost total insensibility; slow, weak breathing; pupil of eye sometimes bigger, sometimes smaller, than natural; inability to move; unwillingness to answer when spoken to. These symptoms come on directly after the accident.—Treatment. Place the patient quietly on a warm bed, send for a surgeon,and do nothing else for the first four or six hours. After this time the skin will become hot, the pulse full, and the patient feverish altogether. If the surgeon has not arrived by the time these symptoms have set in, shave the patient's head, and apply the following lotion (No. 2): Mix half an ounce of sal-ammoniac, two tablespoonfuls of vinegar, and the same quantity of gin or whisky, in half a pint of water. Then give this pill (No. 1); Mix five grains of calomel and the same quantity of antimonial powder with a little bread-crumb, and make into two pills. Give a black draught three hours after the pill, and two tablespoonfuls of the above-mentioned fever-mixture every four hours. Keep on low diet. Leeches are sometimes to be applied to the head. These cases are often followed by violent inflammation of the brain. They can, therefore, only be attended to properly throughout by a surgeon. The great thing for people to do in these cases is—nothing; contenting themselves with putting the patient to bed, and waiting the arrival of a surgeon.
2624. THE CHOLERA AND AUTUMNAL COMPLAINTS.—To oppose cholera, there seems no surer or better means than cleanliness, sobriety, and judicious ventilation. Where there is dirt, that is the place for cholera; where windows and doors are kept most jealously shut, there cholera will find easiest entrance; and people who indulge in intemperate diet during the hot days of autumn are actually courting death. To repeat it, cleanliness, sobriety, and free ventilation almost always defy the pestilence; but, in case of attack, immediate recourse should be had to a physician. The faculty say that a large number of lives have been lost, in many seasons, solely from delay in seeking medical assistance. They even assert that, taken early, the cholera is by no means a fatal disorder. The copious use of salt is recommended on very excellent authority. Other autumnal complaints there are, of which diarrhoea is the worst example. They come on with pain, flatulence, sickness, with or without vomiting, followed by loss of appetite, general lassitude, and weakness. If attended to at the first appearance, they may soon be conquered; for which purpose it is necessary to assist nature in throwing off the contents of the bowels, which may be one by means of the following prescription:—Take of calomel 3 grains, rhubarb 8 grains; mix and take it in a little honey or jelly, and repeat the dose three times, at the intervals of four or five hours. The next purpose to be answered is the defence of the lining membrane of the intestines from their acrid contents, which will be best effected by drinking copiously of linseed tea, or of a drink made by pouring boiling water on quince-seeds, which are of a very mucilaginous nature; or, what is still better, full draughts of whey. If the complaint continue after these means have been employed, some astringent or binding medicine will be required, as the subjoined:—Take of prepared chalk 2 drachms, cinnamon-water 7 oz., syrup of poppies 1 oz.; mix, and take 3 tablespoonfuls every four hours. Should this fail to complete the cure, 1/2 oz. of tincture of catechu, or of kino, may be added to it, and then it will seldom fail; or a teaspoonful of the tincture of kino alone, with a little water, every three hours, till the diarrhoea is checked. While any symptoms of derangement are present, particular attention must be paid to the diet, which should be of a soothing, lubricating, and light nature, as instanced in veal or chicken broth, which should contain but little salt. Rice, batter, and bread puddings will be generally relished, and be eaten with advantage; but the stomach is too much impaired to digest food of a more solid nature. Indeed, we should give that organ, together with the bowels, as little trouble as possible, while they are so incapable of acting in their accustomed manner. Much mischief is frequently produced by the absurd practice of taking tincture of rhubarb, which is almost certain of aggravating that species of disorder of which we have now treated; for it is a spirit as strong as brandy, and cannot fail of producing harm upon a surface which is rendered tender by the formation and contact of vitiated bile. But our last advice is, upon the first appearance of such symptoms as are above detailed, haveimmediaterecourse to a doctor, where possible.
2625. TO CURE A COLD.—Put a large teacupful of linseed, with 1/4 lb. of sun raisins and 2 oz. of stick liquorice, into 2 quarts of soft water, and let it simmer over a slow fire till reduced to one quart; add to it 1/4 lb. of pounded sugar-candy, a tablespoonful of old rum, and a tablespoonful of the best white-wine vinegar, or lemon-juice. The rum and vinegar should be added as the decoction is taken; for, if they are put in at first, the whole soon becomes flat and less efficacious. The dose is half a pint, made warm, on going to bed; and a little may be taken whenever the cough is troublesome. The worst cold is generally cured by this remedy in two or three days; and, if taken in time, is considered infallible.
2626. COLD ON THE CHEST.—A flannel dipped in boiling water, and sprinkled with turpentine, laid on the chest as quickly as possible, will relieve the most severe cold or hoarseness.
2627. SUBSTANCES IN THE EYE.—To remove fine particles of gravel, lime, &c., the eye should be syringed with lukewarm water till free from them. Be particular not to worry the eye, under the impression that the substance is still there, which the enlargement of some of the minute vessels makes the patient believe is actually the case.
2628. SORE EYES.—Incorporate thoroughly, in a glass mortar or vessel, one part of strong citron ointment with three parts of spermaceti ointment. Use the mixture night and morning, by placing a piece of the size of a pea in the corner of the eye affected, only to be used in cases of chronic or long-standing inflammation of the organ, or its lids.
2629. LIME IN THE EYE.—Bathe the eye with a little weak vinegar-and-water, and carefully remove any little piece of lime which may be seen, with a feather. If any lime has got entangled in the eyelashes, carefully clear it away with a bit of soft linen soaked in vinegar-and-water. Violent inflammation is sure to follow; a smart purge must be therefore administered, and in all probability a blister must be applied on the temple, behind the ear, or nape of the neck.
2630. STYE IN THE EYE.—Styes are little abscesses which form between the roots of the eyelashes, and are rarely larger than a small pea. The best way to manage them is to bathe them frequently with warm water, or in warm poppy-water, if very painful. When they have burst, use an ointment composed of one part of citron ointment and four of spermaceti, well rubbed together, and smear along the edge of the eyelid. Give a grain or two of calomel with 5 or 8 grains of rhubarb, according to the age of the child, twice a week. The old-fashioned and apparently absurd practice of rubbing the stye with a ring, is as good and speedy a cure as that by any process of medicinal application; though the number of times it is rubbed, or the quality of the ring and direction of the strokes, has nothing to do with its success. The pressure and the friction excite the vessels of the part, and cause an absorption of the effused matter under the eyelash. The edge of the nail will answer as well as a ring.
2631. INFLAMMATION OF THE EYELIDS.—The following ointment has been found very beneficial in inflammations of the eyeball and edges of the eyelids:—Take of prepared calomel, 1 scruple; spermaceti ointment, 1/2 oz. Mix them well together in a glass mortar; apply a small quantity to each corner of the eye every night and morning, and also to the edges of the lids, if they are affected. If this should not eventually remove the inflammation, elder-flower water may be applied three or four times a day, by means of an eye-cup. The bowels should be kept in a laxative state, by taking occasionally a quarter of an ounce of the Cheltenham or Epsom salts.
2632. FASTING.—It is said by many able physicians that fasting is a means of removing incipient disease, and of restoring the body to its customary healthy sensations. Howard, the celebrated philanthropist (says a writer), used to fast one day in every week. Napoleon, when he felt his system unstrung, suspended his wonted repast, and took his exercise on horseback.
Fits.
2633. Fits come on so suddenly, often without even the slightest warning, and may prove fatal so quickly, that all people should be acquainted at least with their leading symptoms and treatment, as a few moments, more or less, will often decide the question between life and death. The treatment, in very many cases at least, to be of the slightest use, should beimmediate, as a person in a fit (of apoplexy for instance) may die while a surgeon is being fetched from only the next street. We shall give, as far as the fact of our editing a work for non-professional readers will permit, the peculiar and distinctive symptoms of all kind of fits, and the immediate treatment to be adopted in each case.
2634. APOPLEXY.—These fits may be divided into two kinds—thestrongand theweak.
2635. 1.The strong kind.—These cases mostly occur in stout, strong, short-necked, bloated-faced people, who are in the habit of living well.—Symptoms. The patient may or may not have had headache, sparks before his eyes, with confusion of ideas and giddiness, for a day or two before the attack. When it takes place, he falls down insensible; the body becomes paralyzed, generally more so on one side than the other; the face and head are hot, and the blood-vessels about them swollen; the pupils of the eyes are larger than natural, and the eyes themselves are fixed; the mouth is mostly drawn down at one corner; the breathing is like loud snoring; the pulse full and hard.—Treatment. Place the patient immediately in bed, with his head well raised; take off everything that he has round his neck, and bleed freely and at once from the arm. If you have not got a lancet, use a penknife or anything suitable that may be at hand. Apply warm mustard poultices to the soles of the feet and the insides of the thighs and legs; put two drops of castor oil, mixed up with eight grains of calomel, on the top of the tongue, as far back as possible; a most important part of the treatment being to open the bowels as quickly and freely as possible. The patient cannot swallow; but these medicines, especially the oil, will be absorbed into the stomach altogether independent of any voluntary action. If possible, throw up a warm turpentine clyster (two tablespoonfuls of oil of turpentine in a pint of warm gruel), or, if this cannot be obtained, one composed of about a quart of warm salt-and-water and soap. Cut off the hair, and apply rags dipped in weak vinegar-and-water, or weak gin-and-water, or even simple cold water, to the head. If the blood-vessels about the head and neck are much swollen, put from eight to ten leeches on the temple opposite to the paralyzed side of the body. Always send for a surgeon immediately, and act according to the above rules, doing more or less, according to the means at hand, and the length of time that must necessarily elapse until he arrives. A pint, or even a quart of blood in a very strong person, may be taken away. When the patient is able to swallow, give him the No. 1 pills, and the No. 1 mixture directly. [The No. 1 pills are made as follows:—Mix 5 grains of calomel and the same quantity of antimonial powder with a little bread-crumb: make into two pills, the dose for a full-grown person. For the No. 1 mixture, dissolve on ounce of Epsom salts in half a pint of senna tea: take a quarter of the mixture as a dose] Repeat these remedies if the bowels are not well opened. Keep the patient's head well raised, and cool as above. Give very low diet indeed: gruel, arrowroot, and the like. When a person is recovering, he should have blisters applied to the nape of the neck, his bowels should be kept well open, light diet given, and fatigue, worry, and excess of all kinds avoided.
2636. 2.The weak kind.—Symptoms. These attacks are more frequently preceded by warning symptoms than the first kind. The face is pale, the pulse weak, and the body, especially the hands and legs, cold. After a little while, these symptoms sometimes alter to those of the first class in a mild degree.—Treatment.At first, if the pulse isvery feeble indeed, a little brandy-and-water or sal-volatile must be given. Mustard poultices are to be put, as before, to the soles of the foot and the insides of the thighs and legs. Warm bricks, or bottles filled with warm water, are also to be placed under the armpits. When the strength has returned, the body become warmer, and the pulse fuller and harder, the head should be shaved, and wet rags applied to it, as before described. Leeches should be put, as before, to the temple opposite the side paralyzed; and the bowels should be opened as freely and as quickly as possible. Bleeding from the arm is often necessary in these cases, but a non-professional person should never have recourse to it. Blisters may be applied to the nape of the neck at once. The diet in those cases should not be so low as in the former—indeed, it is often necessary, in a day or so after one of these attacks, to give wine, strong beef-tea, &c., according to the condition of the patient's strength.
2637.Distinctions between Apoplexy and Epilepsy.—1. Apoplexy mostly happens in people overthirty, whereas epilepsy generally occurs under that ago; at any rate for the first time. A person who has epileptic fits over thirty, has generally suffered from them for some years. 2. Again,in apoplexy, the body is paralyzed; and, therefore, has notthe convulsions which take place in epilepsy. 3. The peculiarsnoringwill also distinguish apoplexy from epilepsy.
2638.Distinctions between Apoplexy and Drunkeness.—1. The known habits of the person. 2. The fact of a person who was perfectly sober and sensible a little time before, being found in a state of insensibility. 3. The absence, in apoplexy, of thesmell of drinkon applying the nose to the mouth. 4. A person in a fit of apoplexy cannot be roused at all; in drunkenness he mostly can, to a certain extent.
2639.Distinction between Apoplexy and Hysteria.—Hysterics mostly happen in young, nervous, unmarried women; and are attended with convulsions, sobbing, laughter, throwing about of the body, &c. &c.
2640.Distinction between Apoplexy and Poisoning by Opium.—It is exceedingly difficult to distinguish between these two cases. In poisoning by opium, however, we find the particular smell of the drug in the patient's breath. We should also, in forming our opinion, take into consideration the person's previous conduct—whether he has been low and desponding for some time before, or has ever talked about committing suicide.
2641. EPILEPSY.—Falling Sickness.—Those fits mostly happen, at any rate for the first time, to young people, and are more common in boys than girls. They are produced by numerous causes.—Symptoms. The fit may be preceded by pains in the head, palpitations, &c. &c.; but it mostly happens that the person falls down insensible suddenly, and without any warning whatever. The eyes are distorted, so that only their whites can be seen; there is mostly foaming from the mouth; the fingers are clinched; and the body, especially on one side, is much agitated; the tongue is often thrust out of the mouth. When the fit goes off, the patient feels drowsy and faint, and often sleeps soundly for some time.—Treatment. During the fit, keep the patient flat on his back, with his head slightly raised, and prevent him from doing any harm to himself; dash cold water into his face, and apply smelling-salts to his nose; loosen his shirt collar, &c.; hold a piece of wood about as thick as a finger—the handle of a tooth-brush or knife will do as well—between the two rows of teeth, at the back part of the mouth. This will prevent the tongue from being injured. A teaspoonful of common salt thrust into the patient's mouth, during the fit, is of much service. The after-treatment of these fits is various, and depends entirely upon their causes. A good general rule, however, is always to keep the bowels well open, and the patient quiet, and free from fatigue, worry, and excess of all kinds.
2642.Fainting Fitsare sometimes very dangerous, and at others perfectly harmless; the question of danger depending altogether upon the causes which have produced them, and which are exceedingly various. For instance, fainting produced by disease of the heart is a very serious symptom indeed; whereas, that arising from some slight cause, such as the sight of blood, &c., need cause no alarm whatever. The symptoms of simple fainting are so well known that it would be quite superfluous to enumerate them here. Thetreatmentconsists in laying the patient at full length upon his back, with his head upon a level with the rest of his body, loosening everything about the neck, dashing cold water into the face, and sprinkling vinegar and water about the mouth; applying smelling-salts to the nose; and, when the patient is able to swallow, in giving a little warm brandy-and-water, or about 20 drops of sal-volatile in water.
2643.Hysterics.—These fits take place, for the most part, in young, nervous, unmarried women. They happen much less often in married women; and even (in some rare cases indeed) in men. Young women, who are subject to these fits, are apt to think that they are suffering from "all the ills that flesh is heir to;" and the false symptoms of disease which they show are so like the true ones, that it is often exceedingly difficult to detect the difference. The fits themselves are mostly preceded by great depression of spirits, shedding of tears, sickness, palpitation of the heart, &c. A pain, as if a nail were being driven in, is also often felt at one particular part of the head. In almost all cases, when a fit is coming on, pain is felt on the left side. This pain rises gradually until it reaches the throat, and then gives the patient a sensation as if she had a pellet there, which prevents her from breathing properly, and, in fact, seems to threaten actual suffocation. The patient now generally becomes insensible, and faints; the body is thrown about in all directions, froth issues from the mouth, incoherent expressions are uttered, and fits of laughter, crying, or screaming, take place. When the fit is going off, the patient mostly cries bitterly, sometimes knowing all, and at others nothing, of what has taken place, and feeling general soreness all over the body.Treatment during the fit. Place the body in the same position as for simple fainting, and treat, in other respects, as directed in the article on Epilepsy.Always well loosen the patient's stays; and, when she is recovering, and able to swallow, give 20 drops of sal volatile in a little water. Theafter-treatmentof these cases is very various. If the patient is of a strong constitution, she should live on plain diet, take plenty of exercise, and take occasional doses of castor oil, or an aperient mixture, such as that described as "No. 1," in previous numbers. If, as is mostly the case, the patient is weak and delicate, she will require a different mode of treatment altogether. Good nourishing diet, gentle exercise, cold baths, occasionally a dose of No. 3 myrrh and aloes pills at night, and a dose of compound iron pills twice a day. [As to the myrrh and aloes pills (No. 3), 10 grains made into two pills are a dose for a full-grown person. Of the compound iron pills (No. 4), the dose for a full grown person is also 10 grains, made into two pills.] In every case, amusing the mind, and avoiding all causes of over-excitement, are of great service in bringing about a permanent cure.
2644. LIVER COMPLAINT AND SPASMS.—A very obliging correspondent recommends the following, from personal experience:—Take 4 oz. of dried dandelion root, 1 oz. of the best ginger, 1/4 oz. of Columba root; braise and boil all together in 3 pints of water till it is reduced to a quart: strain, and take a wine-glassful every four hours. Our correspondent says it is a "safe and simple medicine for both liver complaint and spasms."
2645. LUMBAGO.—A "new and successful mode" of treating lumbago, advocated by Dr. Day, is a form of counter-irritation, said to have been introduced into this country by the late Sir Anthony Carlisle, and which consists in the instantaneous application of a flat iron button, gently heated in a spirit-lamp, to the skin. Dr. Corrigan published, about three years ago, an account of some cases very successfully treated by nearly similar means. Dr. Corrigan's plan was, however, to touch the surface of the part affected, at intervals of half an inch, as lightly and rapidly as possible. Dr. Day has found greater advantages to result from drawing the flat surface of the heated button lightly over the affected part, so as to act on a greater extent of surface. The doctor speaks so enthusiastically of the benefit to be derived from this practice, that it is evidently highly deserving attention.
2646. PALPITATION OF THE HEART.—Where palpitation occurs as symptomatic of indigestion, the treatment must be directed to remedy that disorder; when it is consequent on a plethoric state, purgatives will be effectual. In this case the patient should abstain from every kind of diet likely to produce a plethoric condition of body. Animal food and fermented liquor must be particularly avoided. Too much indulgence in sleep will also prove injurious. When the attacks arise from nervous irritability, the excitement must be allayed by change of air and a tonic diet. Should the palpitation originate from organic derangement, it must be, of course, beyond domestic management. Luxurious living, indolence, and tight-lacing often produce this affection: such cases are to be conquered with a little resolution.
2647. Poisons shall be the next subject for remark; and we anticipate more detailed instructions for the treatment of persons poisoned, by giving a simple LIST OF THE PRINCIPAL POISONS, with their ANTIDOTES OR REMEDIES.
Oil of Vitriol ……………\Aquafortis ………………. Magnesia, Chalk, Soap-and-Water.Spirit of Salt ……………/
Emetic Tartar…………….. Oily Drinks, Solution of Oak-bark.
Salt of Lemons, or………… Chalk, Whiting, Lime or Magnesia andAcid of Sugar…………….. Water. Sometimes an EmeticDraught.
Pump on back, Smelling-Salts to nose,Prussic Acid………………. Artificial Breathing,Chloride of Lime to nose.
Pearlash ………………….\Soap-Lees…………………. \Smelling-Salts…………….. \Nitre…………………….. Lemon-Juice and Vinegar-and-WaterHartshorn…………………. /Sal-Volatile………………./
Arsenic……………………\Fly-Powder, or…………….. Emetics, Lime-Water, Soap-and-Water,White Arsenic……………… Sugar and Water, Oily Drinks.Kings Yellow, or…………… /Yellow Arsenic……………../
Mercury……………………\Corrosive Sublimate………… Whites of Eggs, Soap-and-Water.Calomel……………………/
Opium…………………….. Emetic Draught, Vinegar-and-Water,Laudanum………………….. dashing Cold Water onchest andface, walking up and down two orthree hours.
Lead………………………\White Lead………………… Epsom Salts, Castor Oil, Emetics.Sugar of Lead………………/Goulard's Extract…………./
CopperBlue-stone ……………….. Whites of Eggs, Sugar-and-Water,Verdigris…………………. Castor Oil, Gruel.
Zinc …………………….. Lime-Water, Chalk-and-Water,Soap-and-Water.
Iron …………………….. Magnesia, Warm Water.
Henbane……………………\Hemlock…………………… Emetics and Castor Oil;Nightshade………………… Brandy-and-Water, if necessary.Foxglove…………………../
Poisonous Food…………….. Emetics and Castor Oil.
2648. The symptoms of poisoning may be known for the most part from those of some diseases, which they are very like, from the fact of their coming onimmediatelyafter eating or drinking something; whereas those of disease come on, in most cases at least, by degrees, and with warnings. In most cases where poison is known, or suspected, to have been taken, the first thing to be done is to empty the stomach, well and immediately, by means of mustard mixed in warm water, or plain warm salt-and-water, or, better, this draught, which we call No. 1:—Twenty grains of sulphate of zinc in an ounce and a half of water. This draught to be repeated in a quarter of an hour if vomiting does not ensue. The back part of the throat should be well tickled with a feather, or two of the fingers thrust down it, to induce vomiting. The cases where vomiting must not be used are those where the skin has been taken off, and the parts touched irritated and inflamed by the poison taken, and where the action of vomiting would increase the evil. Full instructions are given in the article on each particular poison as to where emetics are or are not to be given. The best and safest way of emptying the stomach is by means of the stomach-pump, as in certain cases the action of vomiting is likely to increase the danger arising from the swollen and congested condition of the blood-vessels of the head, which often takes place. In the hands, however, of any one else than a surgeon, it would be not only useless, but harmful, as a great deal of dexterity, caution, and experience are required to use it properly. After having made these brief introductory remarks, we shall now proceed to particulars.