Plate I.APPLYING A ROLLER BANDAGE (Reference Handbook).Fig. I shows method of starting a spiral bandage; Fig. II, ready to reverse; Fig. III, the reverse completed; Fig. IV shows spica bandage applied to groin.
Plate I.
APPLYING A ROLLER BANDAGE (Reference Handbook).
Fig. I shows method of starting a spiral bandage; Fig. II, ready to reverse; Fig. III, the reverse completed; Fig. IV shows spica bandage applied to groin.
Absorbent cotton is also employed as a surgical dressing, and should also be sterilized if it is to be used on raw surfaces. It is not so useful for dressing wounds as gauze, since it mats down closely, does not absorb secretions and discharges so well, and sticks to the parts. When torn into balls as large as an egg and boiled for fifteen minutes in water, it is useful as sponges for cleaning wounds. Sheet wadding, or cotton, is serviceable in covering splints before they are applied to the skin. Wet antiseptic surgical dressings are valuable in treating wounds which are inflamed and not healing well. They are made by soaking gauze in solutions of carbolic acid (half a teaspoonful of the acid to one pint of hot water), and, after application, covering the gauze with oil silk, rubber dam, or paraffin paper. Heavy brown wrapping paper, well oiled or greased, will answer the purpose when better material is not at hand.
BANDAGES.—Bandaging is an art that can only be acquired in any degree of perfection by practical instruction and experience. Some useful hints, however, may be given to the inexperienced. Cotton cloth, bleached or unbleached, is commonly employed for bandages; also gauze, which does not make so effective adressing, but is much easier of application, is softer and more comfortable, and is best adapted to the use of the novice. A bandage cannot be put on properly unless it is first rolled. A bandage for the limbs should be about two and a half inches wide and eight yards long; for the fingers, three-quarters of an inch wide and three yards long. The bandage may be rolled on itself till it is as large as the finger, and then rolled down the front of the thigh, with the palm of the right hand, while the loose end is held taut in the left hand.
Plate II.Plate II.DIFFERENT FORMS OF BANDAGES.(American Text-Book and Reference Handbook.)Fig. I shows application of figure-of-eight bandage; Fig. II, a spica bandage of thumb; Fig. III, a spica bandage of foot; Fig. IV, a T-bandage.
Plate II.
DIFFERENT FORMS OF BANDAGES.
(American Text-Book and Reference Handbook.)
Fig. I shows application of figure-of-eight bandage; Fig. II, a spica bandage of thumb; Fig. III, a spica bandage of foot; Fig. IV, a T-bandage.
Two forms of bandages are adapted to the limbs, the figure-of-eight, and the spiral reversed bandage. In applying a bandage always begin at the lower extremity of the limb and approach the body. Make a few circular turns about the limb (seeFig. I, p. 132), then as the limb enlarges, draw the bandage up spirally, reversing it each time it encircles the limb, as shown inFig. I, p. 134. In reversing, hold the bandage with the left thumb so that it will not slip, and then allowing the free end to fall slack, turn down as inFig. II, p. 132.
The T-bandage is used to bandage the crotch between the thighs, or around the forehead and over the top of the skull. (SeeFig. IV, p. 134.) In the former case, the ends 1–1 are put about the body as a belt, and the end 2 is brought from behind, in the narrow part of the back, down forward between the thighs, over the crotch, and up to the belt in the lower part of the belly. The figure-of-eight bandage is used on various parts, and is illustrated in the bandage called spica of thegroin,Fig. IV, p. 132. Beginning with a few circular turns about the body in the direction of 1, the bandage is brought down in front of the body and groin, as in 2, and then about the back of the thigh up around the front of the thigh, as in 3, across the back and once around the body and down again as in 2. Other bandages appropriate to various parts of the body are also illustrated that by their help the proper method of their application may be understood. See pages132,134,136,137. The triangular bandage (see p.88) made from a large handkerchief or piece of muslin a yard square, cut or folded diagonally from corner to corner, will be found invaluable in emergency cases. It is easily and quickly adjusted to almost any part of the body, and may be used for dressing wounds, or as a bandage for fractures, etc.
Plate III.BANDAGES FOR EXTREMITIES (American Text-Book).Fig. I shows a spiral reversed bandage of arm and hand, requiring roller 21/2inches wide and 7 yards long; Fig. II shows a spiral reversed bandage of leg and foot, requiring roller 21/2inches wide and 14 yards long.
Plate III.
BANDAGES FOR EXTREMITIES (American Text-Book).
Fig. I shows a spiral reversed bandage of arm and hand, requiring roller 21/2inches wide and 7 yards long; Fig. II shows a spiral reversed bandage of leg and foot, requiring roller 21/2inches wide and 14 yards long.
Plate IV.BANDAGES FOR HEAD AND HAND.(American Text-Book.)Fig. I shows a gauntlet bandage; Fig. II, a circular bandage for the jaw; Fig. III, a circular bandage for the head; Fig. IV, a figure-of-eight bandage for both eyes.
Plate IV.
BANDAGES FOR HEAD AND HAND.
(American Text-Book.)
Fig. I shows a gauntlet bandage; Fig. II, a circular bandage for the jaw; Fig. III, a circular bandage for the head; Fig. IV, a figure-of-eight bandage for both eyes.
Ordinary Poisons
Unknown Poisons—Antidotes for Poisoning by Acids and Alkalies—The Stomach Pump—Emetics—Symptoms and Treatment of Metal Poisoning—Narcotics.
First Aid Rule 1.—Send at once for physician.
Rule 2.—Empty stomach with emetic.
Rule 3.—Give antidote.
In most cases of poisoning emetics and purgatives do the most good.
UNKNOWN POISONS.—Act at once before making inquiry or investigation.
First Aid Rule.—Give two teaspoonfuls of chalk (or whiting, or whitewash scraped from the wall or a fence) mixed with a wineglass of water. Beat four eggs in a glass of milk, add a tablespoonful of whisky, and give at once.
Meanwhile, turn to p.186, and be prepared to follow Rule 2 under Suffocation, in case artificial respiration may be necessary, in spite of the stimulant and antidotes. After having taken the first steps, try to ascertain the exact poison used, but waste no timeat the start. If you can find out just what poison was swallowed, give the treatment advised under that poison, excepting what you may already have given.
ACIDS.—Symptoms: Corrosion or bleeding of the parts with which they come in contact, followed by intense pain, and then prostration from shock. Nitric acid stains face yellow; sulphuric blackens; carbolic whitens the mucous membrane, and also causes nausea and stupor.
Treatment.—Carbolic:Give a tablespoonful of alcohol or wineglass of whisky or brandy at once; or one tablespoonful of castor oil, also a half pint of sweet oil, also a pint of milk. Put to bed, and apply hot-water bottles.
Nitric and Oxalic:Chalk, lime off walls, whitewash scraped off fence or wall, one teaspoonful mixed with a quarter of a glass of water. Give one tablespoonful castor oil, and half a pint of sweet oil. Inject into the rectum one tablespoonful of whisky in two of water.
Sulphuric:Soapsuds, half a glass; a pint of milk.
Other Acids:Limewater, or two teaspoonfuls of aromatic spirit of ammonia diluted with a glass of water. One tablespoonful of castor oil.
ALKALIES.—Symptoms: Burning and destruction of the mucous membrane of mouth, severe pain, vomiting and purging of bloody matter, rapid death by shock.
Ammonia; Potash; Lye; Caustic Soda; Washing Soda:Give half a glass of vinegar mixed with half a glass of water; also juice of four lemons in two glasses of water. One teaspoonful of castor oil in half a glass of olive oil. If prostrated, give tablespoonful of whisky in a quarter of a glass of hot water.
METALS.—Symptoms: Great irritation, cramps and purging, suppression of urine, delirium or stupor, collapse, and generally death.
Arsenic; Paris Green; Fowler's Solution; "Rough on Rats":Intense pain, thirst, griping in bowels, vomiting and bloody purging, shock, delirium. Patient picks at the nose. Send to druggist's for two ounces hydrated sesquioxide of iron, the best antidote, and give tablespoonful every quarter hour in half a glass of water. Meanwhile, or if antidote is not to be had, give a glass or two of limewater, followed by a teaspoonful of mustard dissolved in a glass of water, followed by warm water in any quantity.
Copper; Blue Vitriol; Verdigris:Give one tablespoonful of mustard in a glass of warm water. After vomiting, give whites of three eggs, one pint of milk.
Mercury; Corrosive Sublimate; Bug Poison; White Precipitate; Bichloride of Mercury:Give whites of four eggs for every grain of mercury suspected; cause vomiting by giving a tablespoonful of mustard mixed with a glass of warm water, or thirty grains of powdered ipecac mixed with half a glass of water.
Silver Nitrate:Give two teaspoonfuls of table saltdissolved in two glasses of hot water. After half an hour give a tablespoonful of castor oil.
Phosphorous; Matches:Give teaspoonful of mustard mixed in a glass of water. After vomiting has occurred, give a tablespoonful of gum arabic dissolved in a tumblerful of hot water. An hour later give tablespoonful of Epsom salts dissolved in a glass of water.Give no oil.
Antimony; Tartar Emetic:Symptoms as stated for metals. Give thirty grains of powdered ipecac stirred in wineglass of water, even if vomiting has occurred. Give three cups of strong tea, or hot infusion of oak bark, and two teaspoonfuls of whisky in wineglass of hot water. Use hot-water bottles to keep patient warm.
NARCOTICS.—Aconite; Belladonna; Camphor; Digitalis; Ergot; Hellebore; Lobelia:These all cause nausea, numbness, stupor, rapidity of the heart followed by weakness of heart, delirium or convulsions, coma, and death. There is often an acid taste in mouth, with dryness of throat and mouth, fever, vomiting and diarrhea, with severe pain in the bowels. Pupils are dilated.
In either case use the stomach pump at once. If no pump is at hand, siphon out stomach with rubber tube and funnel. If tube is not available, give thirty grains of powdered ipecac stirred in a wineglass of water, followed by two glasses of warm water. As the patient vomits, give more warm water. When vomiting ceases, give two cups of strong hot coffee, and then a tablespoonful of castor oil.
Keep patient awake by rubbing; do not exhaust him by walking him about. He must lie flat. If prostration follows, give two teaspoonfuls of whisky in wineglass of hot water from time to time, if repetition is necessary.
Alcohol; Liquors Containing It:Symptoms of drunkenness, stupor, drowsiness, irritability of temper, rapid, weak heart, sleep, coma. Breath testifies.
If possible, use stomach pump early, or tube and funnel. Or give thirty grains of powdered ipecac stirred in a wineglass of water, and when vomiting ceases give thirty drops of aromatic spirit of ammonia in a wineglass of water every half hour till pulse has become full and rapid. Then apply cold to the head and heat to the extremities.
Chloral; Patent Sleeping Medicines; "Knock-out Drops."Symptoms: Nausea, coldness and numbness, stupidity, prostration, often vomiting and purging, sleep, coma. Heart very weak, with pulse at wrist very feeble. Constriction of the mouth and throat, with dryness. Pain in bowels is marked before stupor appears.
Use stomach pump if possible, or empty stomach with rubber tube and funnel, siphoning fluids out. Or give thirty grains of powdered ipecac stirred in a wineglass of water. When vomiting ceases, give two teaspoonfuls of whisky in half a glass of hot water. Givehypodermic injection of sulphate of strychnine, one-twentieth of a grain every two or three hours, till patient is roused and weakness is past. Rubbing of the surface, application of hot-water bottles to the body and legs.
If breathing ceases, follow Rule 2 under Suffocation (p.186) till breathing is well established again.
Opium; Morphine; Laudanum; Paregoric; Soothing Syrups.Symptoms: Drowsiness, sleep, stupor when roused, pupils very small—"pin point" unless patient is used to the drug—constipation, cold skin.
Use stomach pump, if at hand. Or give emetic of thirty grains of powdered ipecac stirred in a wineglass of water, followed by two glasses of warm water, as vomiting proceeds. Let the patient inhale ammonia or smelling salts. Give him half a grain of permanganate of potash dissolved in a wineglass of water, every half hour. Inject two ounces of black coffee, at blood heat, into the rectum.
Rub the lower part of the body and legs briskly toward the heart, while artificial respiration is being carried out. See Rule 2 under Suffocation (p.186). Thirty drops of tincture of belladonna to an adult, every hour, will assist the breathing. Do not exhaust the patient by walking him around, slapping him with wet towels, or striking him on the calves; keep him awake by rubbing.
Tobacco when Swallowed:Nausea and vomiting occur, with severe pain and great prostration; delirium or convulsions may follow. The heart, at first rapid and full, becomes weak and compressible.
Give emetic at once: thirty grains of powdered ipecac stirred in wineglass of water, followed by two glasses of warm water, by degrees. Give whisky, two teaspoonfuls in wineglass of hot water. Keep patient warm.
Nux Vomica; Strychnine.Symptoms: Excitement, rapid heart action, restlessness, panic of apprehension, twitching of forearms and hands, possibly convulsions, during consciousness.
Use stomach pump, if possible, or give thirty grains of powdered ipecac stirred in a wineglass of water. Then, when vomiting has ceased, give twenty grains of chloral, together with thirty grains of bromide of sodium in half a glass of water, at blood heat, injected into the rectum. Give twenty grains of bromide of sodium in a wineglass of water, every hour, by the mouth.
If convulsions, put chloroform before nose and mouth, as follows: pour twenty drops of chloroform on a handkerchief and hold it close to the mouth, letting air pass freely under it. Stop when patient relaxes. Resume if he becomes rigid again.
Cocaine.Symptoms: General nervousness, irritability of temper, wakefulness, followed quickly by great pallor, dilatation of the pupils, unconsciousness, and convulsions.
Give the patient two teaspoonfuls of whisky in awineglass of water every hour. Give, if possible, a hypodermic of a thirtieth of a grain of strychnine, every two hours, or as he may require it, to keep the pulse full and strong. Use hot-water bottles to feet and legs.
Phenacetin; Acetanilid; Headache Powders:Give two teaspoonfuls of whisky in a wineglass of hot water. If the heart flags, give tincture of digitalis, five minims in tablespoonful of water, every two hours, or till three doses are given. It is better to use digitalin, one one-hundredth of a grain hypodermically, if possible.
Food Poisoning
Food Containing Bacterial Poisons Resulting from Putrefaction; Food Infected with Disease Germs; Food Containing Parasites—Tapeworm—Trichiniasis—Potato Poisoning.
FOOD POISONING.—Much the same symptoms from all meats, fish, shellfish, milk, cheese, ice cream, and vegetables; namely, vomiting, cramps, diarrhea, headache, prostration, weak pulse, cold hands and feet, possibly an eruption.
First Aid Rule 1.—Rid patient of poison. Cause repeated vomiting by giving three or four glasses of warm water, each containing half a level teaspoonful of mustard. Put finger down throat to assist. Empty bowels by giving warm injection of soapsuds and water by fountain syringe.
Rule 2.—Support heart and rally nerve force. Give teaspoonful of whisky in tablespoonful of hot water every half hour, as needed. Put hot-water bottles at feet and about body.
Conditions, Etc.—Bacterial poisons, constituting irritants of the stomach and bowels, are found incertain mussels, oysters from artificial beds, eels out of stagnant ditches—as well as the uncooked blood of the common river eel—certain fish at all times, certain fish when spawning, putrefied fish, fermented canned fish, sausages of which the ingredients have putrefied, putrefied meat, imperfectly cured bacon, putrefied cheese, milk improperly handled and not cooled before being transported, ice cream which fermented before freezing, or ice cream containing putrid gelatin, and mouldy corn meal and the bread made from it.
These poisons are called toxins, or toxalbumins, or bacterial proteids. They are no longer called ptomaines, because many ptomaines are not poisonous. They are formed within the cells of the bacteria, and result from the combination of certain constituents of the food material that nourishes the bacteria, in some way not quite understood. Some decomposition must have taken place in the food before it can furnish to the bacteria the nourishment it needs. If this has happened, the bacteria multiply rapidly, and the toxins that are formed are taken up by the lymphatics and carried away from the tissues as fast as possible. But so great is their virulence that they act on several vital organs before they can be antagonized by the natural elements of the blood.
Symptoms.—The symptoms are much the same in all the cases of bacterial poisoning mentioned. Sudden and violent vomiting and diarrhea appear a few hours after eating the spoiled food, or may be delayed.There may be headache, colic, and cramps in the muscles. Marked prostration and weak pulse with cold hands and feet are characteristic. The appearance of skin eruptions is not uncommon. The occurrence of such symptoms in several persons, some hours after partaking of the same food, is sufficient to warrant one in pronouncing the trouble food poisoning.
Treatment.—The objects of treatment are to rid the patient of the poison, and to stimulate the heart and general circulation, and draw on the reserve nerve force. It is best to procure medical aid to wash out the stomach, but when this is impossible, the patient should be encouraged to swallow plenty of tepid water and then vomit it. If there is no natural inclination to do so, vomiting may be brought about by putting the finger in the back of the throat. The same process should be repeated a number of times, and the result will be almost as good as though a physician had used a stomach tube. A teaspoonful of salt or tablespoonful of mustard in the water will hasten its rejection. Then the bowels should likewise be emptied. If vomiting continues this will not be possible by means of drugs given by the mouth, although calomel may be retained given in half-grain tablets hourly to an adult, until the bowels begin to move, or till eight to ten tablets are taken. When vomiting is excessive, emptying of the bowels may be brought about quickly by giving warm injections of soapsuds into the bowel with a fountain syringe. Brandy or whisky in teaspoonful doses given in a tablespoonful of hot water at half-hour intervals should follow the emptying of the stomach and bowels, and the patient must be kept quiet. He must also be kept warm by means of hot-water bags and blankets.
INFECTED FOOD.—A frequent source of illness is infection by disease germs transmitted in food. The meat of animals slaughtered when sick with abscess, pneumonia, kidney disease, diarrhea, or anthrax (malignant pustule) carries disease germs and causes serious illness; so does the meat of animals killed after recent birth of their young, and probably having fever. Oysters may be contaminated with excrement from typhoid patients, and may then transmit the disease to those who eat them.
Milk from diseased animals, or contaminated with germs of typhoid fever, scarlet fever, tuberculosis, diphtheria, etc., is apt to cause the same disease in the human being who drinks it.
If such infected food is eaten raw, the diseases with which it is contaminated may be transmitted. If subjected to cooking at a temperature of at least the boiling point, comparative safety is secured; but the toxins accompanying the disease germs in the infected food are not as a rule rendered harmless. Treatment must be directed to each disease thus transmitted.
Poisoning resulting from eating canned meats has sometimes been attributed to supposed traces of tin, zinc, or solder, which have become dissolved in thefluids of the meat, but in the vast majority of cases such poisoning is due to toxins accompanying the germs of putrefaction, the meats having been unfit for canning at the outset. In such cases the symptoms are the same as in other food poisoning, and the treatment must be such as is elsewhere directed (see pp.147and149).
While human breast milk is germ free, the cows' milk sold in cities is a very common source of disease. Scrupulous care of the cows, of the clothing and hands of the milkers, of the stables at which the herds are quartered, and of the cans, pails, and pans used, reduces to a minimum the amount of filth and impurity otherwise mixed with milk. In the household, as well as during transportation, milk should be kept cool, with ice if necessary. It should also never be left uncovered, for it readily absorbs gases, effluvia, and contaminating substances in the air, and affords an excellent medium for the growth and propagation of germs. When partially or entirely soured, it should not be used, except in the preparation of articles of food by cooking, as directed in cook books. It should never be used if there is any doubt about its purity. Unless all doubt has been removed, it is best to subject milk intended for children's consumption to a temperature of 160° F. for ten minutes, and then put it on the ice, especially during hot weather. Germs are thus rendered harmless, and the nourishing qualities of the milk remain unimpaired.
Summer diarrhea of children, also called cholera infantum, occurs as an epidemic in almost all large cities during the hottest days of summer. The disease is largely fatal, especially during the first hot month, because the most susceptible and tender children are the first affected. It is due to the absorption into the systems of these children of the toxins formed during the putrefying of milk in the stomachs and bowels of the little sufferers. Clean, pure sweet milk, free from bacteria should be used to prevent the occurrence of this disease. Its treatment is outlined in Vol. III. Exactly what bacteria cause the disease is not decided. Possibly the milk is infected, but probably the poisonous results come from toxins.
FOOD CONTAINING PARASITES.—The parasites found in food in this country are echinococcus, guineaworm, hookworm, trichina, and tapeworm. Echinococcus cannot be understood or diagnosed by the layman. Guineaworm is excessively rare in the United States; it gains access into the body through drinking water which contains the individuals. Hookworm is the cause of "miners' anæmia," and is extremely rare in this country.
The entrance of living food parasites can be absolutely prevented by thorough cooking of meats, especially pork and beef. Heat destroys the "measles" and the trichina worms.
TAPEWORM.—This is developed in man after eating "measly" beef or pork. "Measles" are embryo tapeworms called, from their appearance, "bladder worms." In from six to ten weeks after being received into the intestine of a man, these bladder worms become full grown, and measure from ten to thirty feet in length—the tapeworms.
Symptoms.—Vertigo, impairment of sight and of hearing, itching of the nose, salivation, loss of appetite, dyspepsia, emaciation, colic, palpitation of the heart, and sometimes fainting accompany the presence of the tapeworm. Generally the condition becomes known through the passage in the excrement of small sections of the worm. These sections resemble flat portions of macaroni.
Treatment.—This, to be successful, must be directed by a physician. When no physician can be procured, the patient may attempt his own relief. After fasting for twenty-four hours, pumpkin seed, from which the outer coverings have been removed by crushing, are soaked overnight in water and taken on an empty stomach in the morning; a child takes one or two ounces thoroughly mashed and mixed with sirup or honey, and an adult four ounces (see Vol. III, p. 245).
TRICHINIASIS.—This is a dangerous disease caused by the presence in the muscles and other tissues of the trichinæ, little worms which are swallowed in raw or partly cooked pork, ham, or bacon. Nausea, vomiting, colic, and diarrhea appear early, generally on the second day after eating the infected meat. Later, stiffness of the muscles occurs, with great tenderness, swelling of the face and of the extremities, sweating, hoarseness, difficult breathing, inability to sleep, bronchitis, and pneumonia.
There is no treatment for the disease. Many cases which are not fatal are probably considered to be obscure rheumatism. Many cases of pneumonia are caused by the worm.
POTATO POISONING.—There remains one variety of food poisoning which needs mention, since it occurs when least expected, and when proper food has been subjected to natural growth. As the potato belongs to the botanical family containing the dangerous belladonna, tobacco, hyoscyamus, and stramonium, it is not surprising that is should also contain a powerful poisonous alkaloid, namely, solanine. Solanine is developed in potatoes, especially during their sprouting stage. Violent vomiting and diarrhea and inflammation of the stomach and bowels are caused by it. Careful peeling of sprouting potatoes, and removal of their eyes, will lessen, if not wholly obviate, the danger from eating them. This form of food poisoning is rare.
Bites and Stings
Several Kinds of Mosquitoes—Cause of Yellow Fever—Bee, Wasp, and Hornet Stings—Wood Ticks, Lice, and Fleas—Scorpions and Centipedes—Poisonous Snakes—Dog and Cat Bites.
MOSQUITOES.—The female mosquito is the offender. During or after sucking blood she injects a poison into the body which causes itching, swelling, and, in some susceptible persons, considerable inflammation of the skin. The bites of the mosquitoes living on the shores of the Arctic Ocean and in the tropics are the most virulent. The most important relation of mosquitoes to man was only recently discovered. They are probably the sole cause of malaria and yellow fever in the human being. The malarial parasite which lives in the blood of man, when he is suffering from malaria, first inhabits the body of a certain kind of mosquito. The mosquito acquires the undeveloped parasite by biting the human malarial patient, and then acts as a medium of infection by transmitting the active parasite to some healthy man, through the bite.
The more common house mosquito, the Culex, does not carry the parasite of malaria, and it is important to be able to distinguish the Anopheles which is the source of malaria. The Anopheles is more common inthe country, while the Culex is a city pest. The Culex has very short palpi, the name given to the projections parallel to the proboscis; while those of Anopheles are so large that it appears to have three probosces. There are no markings on the wings of the ordinary species of Culex, while the wings of Anopheles are distinctly mottled. The Culex, sitting on a wall or ceiling, holds its hind legs above its back and its body nearly parallel to the wall or ceiling, but the Anopheles carries its hind legs either against the wall or hanging down (rarely above the back), and its body, instead of lying parallel to the wall or ceiling, hangs away at an angle of about forty-five degrees from it.
The Culex lays her eggs in sinks, tanks, cisterns, and water about houses, but the Anopheles deposits her ova in shallow pools and sluggish streams, especially those on which is a growth of green scum or algæ. Such are the main distinguishing features of the malaria-carrying mosquito, the Anopheles, and the commoner house variety, the Culex.
To prevent malaria, mosquito bites must be prevented by nettings in houses, especially for the protection of sleepers. Pools, ponds, and marshy districts must be drained in order to destroy the breeding places of Anopheles, and in the malarial season, petroleum (kerosene) must be poured on the surface of such waters to arrest the development of the immature insects (larvæ).
The mosquito is believed to be the sole cause ofyellow fever, being capable of communicating the germ of the disease to man by its bite two weeks after it has itself been contaminated with the germ in feeding on the blood of a yellow-fever patient. This invaluable discovery was made by Dr. Walter Reed, U. S. A., in 1901, as a result of his labors and those of other members of the yellow-fever commission of the U. S. Army in Cuba, involving the death of one of the members of the commission (Dr. Lazear), and utilizing the heroism of a number of our young soldiers who voluntarily offered themselves to be bitten by mosquitoes that had previously bitten yellow-fever patients, and who experimentally occupied premises containing all sorts of articles infected by yellow-fever patients. The result of their research proves that yellow fever is not contagious at all, in the usual sense, but is communicated only through the medium of mosquitoes. This shows the fallacy of many quarantine rules regarding yellow-fever patients, and of the fear of nursing the sick, and will result in controlling the disease.
In the case of malaria or yellow fever, there is a vicious circle into which man and the mosquito enter; malaria and yellow-fever patients contaminate the mosquitoes which bite them, and the mosquitoes in their turn infect man with these diseases. A patient with malaria coming into a nonmalarial place, and being bitten by mosquitoes, may lead to an epidemic of the disorder which becomes endemic. To terminate this condition, it is necessary to prevent the contact of manwith mosquitoes and to kill these insects. Both malaria and yellow fever will doubtless be practically eradicated before long through the result of these scientific discoveries.
Treatment of Mosquito Bites.—To prevent mosquitoes, fleas, lice, horseflies, etc., from biting, it is necessary merely to dip the clean hands into a pail of water in which, while hot, one ounce of pure carbolic acid was dissolved, and while they are thus wet rub the solution over all the exposed skin and allow it to dry naturally. A mixture of kerosene (petroleum) and water used in the same way will also afford protection. All poisons introduced into the body by insects are of an acid nature, and to this quality are due the pain and irritation which it is our object to overcome. The best remedy, naturally, is an alkali of some sort. Water of ammonia, diluted, or a strong solution of saleratus or baking soda in water, are the two most successful remedies to apply, either through bathing, or on cloths saturated in one of the solutions. Clean clay, mixed with water to make a mud poultice, is a useful application in emergencies.
BEE, WASP, AND HORNET STINGS.—The pain and swelling are produced by the poison of the insect which leaves the poison bag at the base of the barb at the instant that the person is stung. The bee stings but once, as the sting being barbed is broken off, and is retained in the flesh of the victim. The sting of the wasp and hornet is merely pointed, and is notlost during the stinging process so that they can repeat the act. Bee keepers, after being stung a number of times, usually become immune, i. e., they are no longer poisoned by bites of these insects.
It is well to extract the sting of bees before all of the poison has come away. A fine pair of forceps is useful for this purpose; or, by pressing the hollow tube of a small key directly down over the puncture made by the sting, it may be squeezed out.
Ammonia water, as recommended for mosquitoes, is the best remedy to relieve the pain.
WOOD TICKS.—Ticks inhabit the woods and bushes throughout the temperate zone, and at certain periods during the summer season attack passing men and animals.
The common tick is nearly circular in shape, very flat, with a dark, brown, horny body about one-sixteenth to one-eighth inch in diameter. Each of its eight legs possesses two claws, and the proboscis incloses feelers which are similarly armed. The beetle plunges its barbed proboscis into the flesh of man or animals, and holds on very firmly with its other members till it is gorged with blood, growing as large as a good-sized bean, when it drops off. The bite is painless, and it is not until the insect is engorged with blood that it is perceptible; if, however, attempts are made to remove the tick before it is ready to let go, the proboscis may be torn off and left in the skin, when painful local suppuration will follow.
Treatment.—As the presence of tick is far from agreeable, the insect may often be removed by painting it with turpentine, which either kills it or causes the claws to be relaxed; in either case the tick loosens its hold and drops to the ground. A tropical variety, carapato, buries the whole head in the flesh of its host before it is perceived, and if turpentine does not loosen its hold, the head must be dug out with a clean needle or knife blade.
LICE(Pediculi).—Head lice are most common. They are gray with black margins, about one-twenty-fifth to one-twelfth inch long, and wingless. The color changes with the host, as the lice are black on the negro, and white in the case of the Eskimos. The female lays fifty to sixty eggs ("nits"), seen as minute, white specks glued to the side of a hair; usually not more than one or two on a single hair. The eggs hatch in six days.
The irritation produced by the presence of the parasites on the head leads to general itching, more particularly on the lower part of the back of the head. The constant scratching starts an inflammation of the skin with the formation of pimples, weeping spots, and crusts, from the dried discharge, possessing a bad odor. The denuded spots becoming infected, the neighboring glands enlarge and are felt as tender lumps beneath the skin at the back of the neck, under the jaw, or at either side of the neck. Whenever there are persistent itching and irritation of the scalp, particularly at theback of the head, lice or "nits" should be sought for. Sometimes it is more easy to find them on a fine-tooth comb passed through the hair. Lice are very common in dirty households, and are occasionally seen on the most fastidious persons, who accidentally acquire them in public places or conveyances.
Treatment.—The hair should be cut short when permissible. Any crusts on the head should be softened by the application of sweet oil, and then removed by washing in soap and warm water. Petroleum or kerosene is a good remedy. It must be rubbed on the head two successive nights, the head being covered by a cap, and washed off each morning with hot water and soap. The patient must be cautioned not to approach an open flame after kerosene has been put on his head.
The eggs or "nits" are next to be attacked with vinegar, which is sponged on the hair and the fine-tooth comb plied daily for a week. The remaining irritation of the scalp can be cured by washing the head daily and applying sweet oil.
A simpler plan consists of drenching hair and scalp twice with cold infusion of (poisonous) larkspur seed, made by steeping for an hour an ounce of the seed in six ounces of hot water.
This treatment will destroy both insects and eggs. After twenty-four hours the hair and scalp must be shampooed with warm water thoroughly.
CLOTHES LICE.—These insects are a trifle larger than the head lice, being one-twelfth to one-eighth inch long, of a dirty, yellowish-gray color, and only infesting the most filthy people. The lice are generally only seen on the clothes, where they live, coming out on the body only to feed. The visible signs on the body are varying degrees of irritation from redness to ulceration, due to scratching. The treatment is simply cleanliness of the body and clothes.
CRAB LICE.—The crab louse or "crab" inhabits the skin covered by hair about and above the sexual organs most frequently, and from thence spreads to the hairy region on the abdomen, chest, armpits, beard, and eye lashes. Itching and scratching first call attention to the presence of the parasites, which are even more troublesome than the other species.
Application of kerosene to the part is sufficient to kill the lice, but this treatment must be repeated several times at intervals of a week, in order to kill the parasites subsequently hatched.
FLEA.—Flea bites are recognized by the itching caused by the poison introduced by the insect, and by points of dried blood surrounded for a little while by a red zone. In the case of children and people with delicate skins, red or white lumps appear resembling nettlerash. Generally the skin is simply covered with minute, red points, perhaps raised a little by swelling above the surface, and when very numerous may remotely resemble the rash of measles. Fleas, unlike lice, do not breed on the body, but as soon as they are satiated leave their host. Their eggs are laid in cracksin floors, on dirty clothes and similar spots, and it is only the mature flea which preys upon man. The human flea may infest the dog and return to man, but the dog flea is a distinct species, and never remains permanently on the human host. For these reasons it is not difficult to get rid of fleas after they have attacked the body, unless continually surrounded by them.
JIGGER OR SAND FLEA.—Also called chique, chigo, and nigua. It is common in Cuba, Porto Rico, and Brazil. About one-half the size of the ordinary flea, it is of a brownish-red color with a white spot on the back. The female lives in the sand and attacks man, on whom she lives, boring into the skin about the toe nail, usually, and laying her eggs under the skin, which gives rise to itching at first and then violent pain. The insect sucks blood and grows as it gorges itself, producing a white swelling of the skin in the center of which is seen a black spot, the front part of the flea. The flea after expelling its eggs drops off and dies. People with habitually sweaty feet are exempt from attacks of the pest.
Unless the flea is unattached, one must either wait until the insect comes away of its own free will, or remove it with a red-hot needle in order to destroy the eggs. The negroes peel the skin from the swelling with a needle and squeeze out the eggs. Ordinarily the bites do no permanent injury, but occasionally if numerous, or if the insect is pressed into the skin inthe efforts to remove it, or if sores resulting from bites are neglected, then violent inflammation, great pain, and even death of the part may result. Sound shoes and a night and morning inspection of the feet will protect against the inroads of the sand fleas.
FLIES.—The common housefly does not bite, but is constantly inimical to human health by conveying disease germs of typhoid fever, cholera, and other disorders from bowel discharges of patients suffering from these diseases to articles of food on which the insects light. Flies have been a fruitful source of sickness in military camps, as evidenced in the recent Spanish-American and Anglo-African campaigns. The bites of the sandfly, gadfly, and horsefly may be both relieved and prevented by the same means recommended in the case of mosquitoes for these purposes.
SCORPION OR CENTIPEDE STING.
First Aid Rule.—Squeeze lemon juice on wound.
SPIDER OR TARANTULA BITE.
First Aid Rule.—Pour water of ammonia on bite. If patient is depressed, give strong coffee.
SCORPIONS AND CENTIPEDES.—These both inhabit the tropics and semitropical regions, and lurk in dark corners and out-of-the-way places, crawling into the boots and clothing during the night. Scorpions sting with their tails, which are brought over thehead and back for the purpose, while holding on to the victim with their lobsterlike claws. The poisonous centipede has a flattened brownish-yellow body, with a single pair of short legs for each body segment, and long, many-jointed antennæ.
The wounds made by either of these pests are rarely dangerous, except in young children and those in feeble health. The stings are usually relieved by bathing with a two per cent solution of carbolic acid, with rum, or with lemon juice.
SPIDERS.—Many of the tropical spiders bite the human being. Trapdoor spiders are among the commonest of these pests. Their bodies grow to great size, two to two and a half inches long, and are covered with hair giving them a horrid appearance. They live in holes bored in the ground, and provided with a trapdoor contrivance which is closed when the insect is at home.
The trapdoor spider resembles the tarantula, by which name it is usually known in Cuba and Jamaica, but is somewhat smaller and commoner. Neither the stings of the trapdoor spider nor true tarantula are usually dangerous although the wounds caused by the bites may heal slowly.
Application of water of ammonia and of the other remedies recommended for mosquito bites (p.158) are indicated here, and if the patient is generally depressed by the poison, strong coffee forms a good antidote.
SNAKE BITE.
First Aid Rule 1.—Make the wound bleed. Cut slit through the wound, lengthwise of limb, two inches long and half an inch deep. Squeeze tissues.Do not suck the wound.
Rule 2.—Keep poison out of general circulation. Tie large cord or bandage tightly about part between wound and heart. Loosen in fifteen minutes.
Rule 3.—Use antidote. Wash wound and cut with fresh solution of chloride of lime (one part to sixty parts of water). Inject anti-venene with hypodermic syringe, ten cubic centimeters, as on label. Or, inject with hypodermic syringe thirty minims of solution of permanganate of potash (five grains to two ounces of water), three times in different places. If no syringe at hand, pour permanganate solution into wound.
Rule 4.—Support heart if weak. Inject with hypodermic syringe one-thirtieth grain of sulphate of strychnine into leg. Repeat as needed every thirty minutes with caution.
Rule 5.—Give no whisky or other liquor. Do not burn the wound.
SNAKE BITE.—There are many different species of poisonous snakes in the United States. The more common are the rattlesnake, the moccasin, the copperhead, and the common viper.
All the venomous snakes have certain characteristics by which they may be distinguished from theirharmless brethren. The head is generally broad and flat and of a triangular shape, the wide, heavy jaws tapering to a point at the lips. There is a depression or pit between the nostril and eye on the upper lip, hence the name "pit vipers" given to poisonous snakes. The pupil of the eye is long and vertical, of an oval or elliptical shape.
Venomous snakes are thicker in proportion to their length than harmless snakes, the surface of their bodies is rougher, and their tails are blunt or club-shaped. Conversely, harmless snakes possess long narrow heads, the pupils of their eyes are round, not vertical slits, and their bodies are not thick for their length, but long and slim with pointed tails. The bite of vipers of all kinds is much more poisonous in tropical regions, and in the North fatal snake bite is a rare occurrence.
If there is a doubt whether a snake is poisonous, the neck may be pressed down against the ground between the jaws of a forked stick, and the poison fangs looked for without danger. These hang directly down from the front part of the upper jaw, or are thrust horizontally forward just in front of the upper lip, and may drip saliva and venom.
In Cuba and Porto Rico there is a viper called Juba, or Boaquira, which is a counterpart of the Northern rattlesnake, and the most poisonous of the many species in that region. Among venomous species of the Philippines are two boas and also a viper from nine to ten feet long, which exceptionally pursues and attacksman. This snake is easily killed by a blow on the neck. Another small viper with a club-shaped tail, inhabiting these islands, is nocturnal in its habits, and may get into boots at night. Boots, therefore, should always be inspected before one puts them on in the morning.
Usually it is only the young, old, and weak who succumb to snake bite.
Symptoms.—The symptoms of snake bite of all poisonous species are similar. At first there is some pain in the wound, which rapidly increases together with swelling and discoloration until death of the part may ensue. The vital centers in the brain controlling the heart and breathing apparatus, are paralyzed by the poison. There is often drowsiness and stupor, and the breathing is labored and the pulse weak and irregular, with faintness and cold sweats.
Treatment.—The treatment consists first in keeping the poison out of the general blood stream. With this purpose in view a handkerchief, piece of cotton clothing, string, or strap should be immediately wound about the bitten limb above the wound, between it and the heart. This will retard absorption of the poison only for a time; it is said twenty-five minutes. The knife is the most effective means of removing the poison by making an oval cut on each side of the wound so that the two incisions meet and remove all the flesh below and around the wound. Bleeding should be encouraged to drain out the poison. The skin containing the wound may be lifted up, andthe whole wound cut out by one snip of the scissors where this is practicable.
Some advocate burning out the wound with a red-hot wire, or darning needle, instead of cutting, but the treatment is less effective and more painful. Rambaud forbids burning. As to the general condition: if stupor is a prominent symptom the patient must be made to move about and exercise to keep alive his nerve centers. Otherwise one tablespoonful of whisky may be given in half a cup of hot water hourly, to sustain the weakened heart and respiration until recovery ensues.
The most effective treatment, according to Dr. George Rambaud, Director of the Pasteur Institute of New York City, is thorough washing of the wound (after it has been opened with the knife) with freshly prepared solution of chloride of lime, in the proportion of one part of lime to sixty of water. The burning of a wound is bad practice. If necessary, chloride-of-lime solution should be injected into the tissues around the wound. One about to go into a place where the most venomous snakes are found should inject into himself a dose of Calmette's antivenomous serum every two or three weeks as a means of prevention. If the serum is used, whisky should not be given in the treatment of one who has been bitten, for the anti-venene is a powerful cell stimulator.
Calmette, the Director of the Pasteur Institute in Lille, France, several years ago discovered antivenomous serum. That serum is efficient for the bitesof most of the venomous snakes of different countries, including the rattlesnake, cobra, python, etc.
It is prepared in the dry form so that it can be carried easily, and will keep almost indefinitely. The proper course to be followed by persons going into countries infested by venomous snakes is always to have on hand a few doses of it. Its value has been positively demonstrated within the last few years in India, where it is used in the British Army, as well as in other countries.
In the fluid form it should be used hypodermically, a dose of ten cubic centimeters being injected within eighty or ninety minutes of the reception of the poison.
DOG BITE OR CAT BITE.(See Hydrophobia, Vol. V, p. 264.)
First Aid Rule 1.—Make sure animal is mad. Send patient to Pasteur institute if one is within reach.
Rule 2.—Remove poison from wound. Encourage bleeding by squeezing tissue about wound. Suck wound, if you have no cracks in lips, and spit out fluid. Pour hot carbolic solution into wound (a third of a teaspoonful of carbolic acid to a pint of hot water).
Rule 3.—Cauterize. Dip wooden meat skewer, or lead pencil, into pure nitric acid, and rub into wound. Or, use red-hot poker, or red-hot nail grasped by tongs or pincers, or red coal from fire.
Rule 4.—Do not kill the animal. If he is alive and well at the end of a week, he was not mad.