THE FAMILY MEDICAL GUIDE. (continued 3)

The causes that induce rheumatic fever, are generally exposure to cold damp air, or transitions from a warm moist atmosphere into a cold or wet one, and the period most liable to an attack is that of youth and vigorous manhood, the full-bodied and the active, rather than the spare and torpid; and men more frequently than women. The only other disease with which rheumatism can be confounded, is gout, and from this it can always be known by the indigestion and little constitutional disturbances which always precede gout; and lastly, by that disease attacking the small joints, as the toes or fingers, instead of, as in rheumatism, the shoulder, knee, or hip.

Treatment.—Bleeding has always been regarded as the chief if not sovereign remedy in this disease; but as depletion is known to favour that dangerous state known as metastasis, or a sudden removal of the disease from one part to another; and, not unfrequently, from the surface to some internal organ, bleeding should, therefore, if possible, not be repeated, the physician depending upon other means to effect the depletion necessary. Indeed, in many cases, the extraction of blood from the system is quite uncalled for, as all its benefits can be obtained by less serious and equally efficacious remedies, and by adopting the following mode of treatment—one that will generally be found sufficient to render the lancet quite unnecessary; or should bleeding in the first stage have been adopted, it may be employed with equal advantage after; only in that case, it will be less requisite to give the aperient pills in such large doses.

Take of

Powdered Nitre 1 drachm.

Tartar Emetic 4 grains.

Camphor Water 10 ounces.

Laudanum 2 drachms.

Mix. Give two large table-spoonfuls every three hours, apply a bottle of hot water to the feet, and administer two of the following pills an hour after the first dose of the mixture, and one every six hours after, till an effectual action is excited in the bowels, when they are to be discontinued.

Take of

Compound Extract of Colocynth 1 scruple.

Calomel 15 grains.

Camphor, powdered 4 grains.

Croton Oil 2 drops.

Mix thoroughly together, make into a mass, and divide into six pills. Should the pain continue excessive, and the patient be debarred from sleep by the nightly irritation, either twenty-five drops of laudanum, in half a wine-glass of water, with a tea-spoonful of spirits of sweet nitre, is to be given to him, if an adult, at bed-time; or else ten grains of Dover’s powder in a little gruel; and should it be required (one or the other), repeated at night for two, three, or more occasions, as may be needed; the patient, during the day, reverting to the mixture and an occasional pill, sufficient to excite one or two actions in the twenty-four hours. Thin gruel, lemonade, or linseed tea as a diluent, are to be used frequently to quench the thirst, and a diet of the least solid or exciting kind established till all the febrile symptoms are subdued. After a lapse of from four to twelve days, the inflammatory stage, or the acute form of the disease, will generally have been passed through; after which, the treatment assumes a different form, such as chronic rheumatism, though this term strictly signifies a disease of considerable standing; for the sake of perspicuity, that condition of the system existing at the termination of the acute form, has been classed under it, which, though not correct as to fact, is perfectly so as respects treatment, which is analogous in all conditions not attended with inflammatory fever. In chronic rheumatism, the inflammation and the pain are both confined to the locality or part, and the object of the treatment is to allay that pain by reducing the inflamed condition of the muscle or member. This is effected either by internal remedies, or what are called constitutional means, or through friction, by producing counter-irritation, or an artificial inflammation in the parts of the body immediately above the suffering place; or else by a judicious blending of the two modes of practice.

When the fever, or the acute stage has been subdued by the means already mentioned, and a part of the body remains swollen and tender, or when in old cases this condition comes on without other symptoms, the following mixture is to be given, and the part carefully guarded from the cold.

Take of

Solution of Acetate of Ammonia 2 ounces.

Wine of Colchicum ½ ounce.

Syrup of Saffron 2 drachms.

Camphor Water 3½ ounces.

Mix, and give a table-spoonful every three hours, and one of the following pills every night an hour before bed-time.

Take of

Ipecacuanha 3 grains.

Acetate of Morphia 1 grain.

Liquorice Powder 10 grains.

Mix well, form into a mass with conserve, and divide into six pills.

When the health is debilitated, and the appetite defective, a grain of quinine made into a pill may be taken an hour before each meal for a succession of days. If this course is not marked with early benefit, it will be necessary to employ friction, which may be carried on concurrently with the medicine, and the best agent for this purpose is the camphorated oil, which is to be rubbed gently but steadily in with the hand for several minutes three times a day, after a few days, or in old standing rheumatisms, increasing the strength at first by adding a third part of turpentine to the camphorated oil, and finally another third of spirits of hartshorn. Mustard plasters and even blisters are sometimes employed in cases of inveterate rheumatism, but the steady and judicious use of a stimulating embrocation with a hot bath, friction with the flesh-brush, warm clothing and exercise, will in almost every case cure a chronic rheumatism without the necessity of either rubifacient or blister.

TIC-DOULOUREUX.

This extremely painful affection of the nerves of the face, though receiving a special name, is in nothing different—except in the more acute violence of its pain—from the general or local forms of neuralgia; an inflamed or highly sensitive condition of a certain nerve or set of nerves, the result of constitutional disturbance, indigestion, or wounds in the course of one or other of the filaments of the nerves, being both the exciting cause and the disease itself. The causes that most frequently produce tic-douloureux, are almost always some long standing functional derangement of the digestive organs, affections of the liver or of the kidneys, or alimentary canal. Next in frequency to these causes, is exposure to long-sustained fatigue or sudden heat or cold, applied to the body, and sometimes sleeping in the sun. Tic-douloureux has been frequently known to follow a halt, during a long march in India, and like tetanus too, tic-douloureux sometimes supervenes upon wounds; and years after the injury, whether punctured, gunshot, or incised, has been healed, this agonising disease will break out upon any sudden application of heat or cold to the body, or indeed after any deep emotion of the mind. Whatever may be the predisposing cause, the suffering and consequences induced bear no proportion in their intensity to the insignificance of the agents that give rise to the disease.

The symptoms of tic-douloureux commence with a sudden plunging throbbing pain, darting as it were from over the eye, out of the cheekbone, under the orbit, or from the side of the lower jaw, and spreading, if the paroxysms are long continued, over the whole of one side of the face from forehead to chin. The pain is so abrupt, peculiar, and intense, as almost to deprive the sufferer of breath in its first assault. These shooting, throbbing, and as they are justly called, agonizing pains continue for an uncertain time, from only a few minutes to one or more hours in duration, subsiding either by degrees or by an instant cessation of pain, and ending as abruptly as the first shock began. Tic-douloureux is distinguished from tooth-ache by the situation, and from rheumatism, the only other affection it can be confounded with, by the peculiarity and violence of the pain, the shortness of its duration, by always coming on in paroxysms, and by the absence of all swelling and redness over the part. A peculiarity of this disease is, that though sometimes induced by the slightest touch of the finger, or the faintest breath of cold air, at another time the part may be slapped or rubbed with impunity.

Treatment.—This consists, in the first instance, acting on the digestive organs, correcting the functional disturbance, and lastly by elevating the tone of the system, and enabling it to restore the irritated nerves to a pristine soundness, or if this cannot be done by constitutional means, by the employment of local remedies for that purpose. First, the best mode of acting on the digestive organs is by the steady employment of gentle aperients, care being taken to avoid any active or drastic purgative. For this purpose, a five grain compound rhubarb pill should be taken every night for several days till the bowels are brought into a healthy state, or a pill composed of equal parts of the compound rhubarb and colocynth pill may be substituted, where a little more active medicine is needed, the nightly dose being the same in this as the former. Secondly, to correct the functional disturbance, if, as most frequently, the result of indigestion, two table-spoonfuls of the following mixture are to be taken every four or six hours.

Take of

Hops 2 drachms.

Cascarilla, bruised 1 drachm.

Cloves, bruised 2 drachms.

Infuse in a pint of boiling water for twelve hours; add

Carbonate of Potass 2 drachms.

Dissolve, and strain for use. Or where the stomach is cold and weak, as in advanced life, let the patient take a tea-spoonful of Gregory’s powder in a little peppermint water twice or three times a day. Thirdly, to elevate the tone of the system, the body must be braced by tonics, which may be effected by either of the two following forms of medicine.

Take of

Carbonate of Iron 2 drachms.

Sulphate of Quinine 18 grains.

Mix, and divide into six powders, one to be taken three times a day; or, take of

Infusion of Quassia 8 ounces.

Quinine 1 scruple.

Diluted Sulphuric Acid 30 drops.

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

NEURALGIA.

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

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

Take of

Carbonate of Ammonia 25 grains.

Dover’s Powder 40 grains.

Camphor Water 6 ounces.

Spirits of Ether 1 drachm.

Mix. Two table-spoonfuls every four hours.

Take of

Carbonate of Iron 2 drachms.

Quinine 12 grains.

Dry Carbonate of Soda 20 grains.

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

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

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

LUMBAGO.

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

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

Take of

Camphorated Oil 2 ounces.

Oil of Amber and Turpentine, of each 1 ounce.

Spirits of Hartshorn ½ ounce.

Mix, and use as an embrocation.

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

RING-WORM.

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

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

Calomel 1 grain.

Jalap, Powder 8 grains.

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

SPRAINS

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

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

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

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

CHILBLAINS.

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

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

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

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

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

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

Constitutional. Of the Hands. Of the Feet.

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

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

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

LEECHES.

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

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

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

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

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

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

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

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

BREAD-AND-WATER, OR EVAPORATING POULTICE.

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

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

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

BANDAGES.

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

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

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

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

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

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

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

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

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

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

BLISTER.

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

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

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

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

CARBUNCLE

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

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

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

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

Camphor Water 6 ounces.

Nitrate of Potass 15 grains.

Tartar Emetic 3 grains.

Syrup of Saffron 2 drachms.

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

Quassia ½ drachm.

Cardamom Seeds 2 drachms—bruised.

Boiling Water 1 pint.

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

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

Take of

Camphor Water 3 ounces.

Compound Tincture of Bark, ditto Cinnamon, of each ½ ounce.

Spirits of Sal Volatile, ditto Sulphuric Ether, of each 1 drachm.

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

EXCORIATION.

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

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

GOITRE.

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

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

Take of

Powdered Camphor 15 grains.

Calomel 1 scruple.

Iodine 30 grains.

Spermaceti Ointment 1 ounce.

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

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

HARE-LIP.

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

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

INFLAMMATION.

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

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

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

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

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

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

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

CHOKING.

When a mass of food, such as a piece of meat, potato, or other substance, lodges in the fauces, or the base of the tongue, if in sight, but too far for the fingers to reach, it should be immediately grasped with a pair of pincers, or, what is better, a pair of curling tongs, and dragged out. If neither are at hand, and as time is precious, press down the tongue with the fingers, and tickle all the surrounding parts with a feather, so as to induce heaving or vomiting, Nature by that action often getting rid of its obstruction. If, however, none of these means present a chance of relief, use the point of the curling tongs as a probe, and push the obstruction into the gullet. However quickly these operations may have been carried on, the sufferer may have died before the obstacle has been displaced, or become so apparently lifeless as seemingly to render all further steps useless; this, however, is not the case, cold water must be dashed on the face and chest, ammonia applied to the nostrils, and the lungs inflated with air. When the lodgement has been lower down and taken place in the gullet proper—a fact that can be ascertained by an examination of the mouth, and also by the mute indication of the sufferer’s fingers—the impediment to its descent to the stomach proceeds from some spasmodic action into which some of the muscular fibres are thrown, causing them to grip the body in its descent and retain it in that position, while its bulk pressing forward on the windpipe, causes the danger to life that results from the accident. Two or three sudden or sharp slaps between the shoulders, or water dashed abruptly in the face, will often, by producing a sudden gasp, release the spasm and cause the descent of the object; if not, a probe, flexible tube, or a quill, must be employed, and the substance pushed past the constriction; when, however, the bulk is too large to be moved by such simple means, and while a messenger is sent for a surgeon to bring the proper instrument, endeavours should be made to keep up a partial supply of air in the lungs, by means of the bellows.

POISONS.

Those substances which, when taken into the body, or applied externally, always produce such an effect or disturbance in the animal economy, as to induce disease, or a chain of symptoms that if uncorrected would eventuate in serious mischief to the health of the body, or even induce death. Or, to simplify the explanation: a poison is any agent capable of producing a morbid, noxious, or dangerous effect upon anything endowed with life. All poisons are common or relative: by the first, is understood those substances which produce morbid or dangerous symptoms on all conditions of animal life, on man as well as on the brute, on the fish as well as the fowl. By relative poisons is understood those agents which are only poisonous to man, or some particular species of animals; thus aloes, which is a useful medicine to man, is poisonous to dogs and wolves; and others which are deadly to the horse, form a nutritious food to the ox. As an instance of the common poisonous agent, affecting all animals in the same manner, may be advanced arsenic and corrosive sublimate. Agents or substances are poisonous only in regard to their dose, the part of the body they are applied to, and the subject on which they are applied.

To illustrate these facts, it is sufficient to say that both arsenic and corrosive sublimate are valuable medicines in certain modified doses, while in excess, they are deadly; secondly, a poison to the stomach may be innocuous to the lungs, or what would be fatal to the integrity of the system, applied to one part of the body, is harmless when administered to another; thus the carbonic acid gas which we imbibe with exhilarating satisfaction with our malt-liquor, soda-water, and champagne, is a deadly poison if instead of going down the gullet, it should descend the windpipe, and enter the lungs. There are only four ways by which a poison can enter the system, and prove injurious or fatal to life; of these the most common is by the mouth into the stomach, by the air passages into the lungs, by absorption through the skin, either in its natural state, or from an abrasion or scratch; and lastly by the bowels, from an enema. But whichever way they enter the system, they only re-act upon it in two forms of action; that is, that they are either absorbed into the blood, and conveyed by the circulation to the part or parts affected, or they produce an immediate influence on the nerves of the part with which the poison first comes in contact; and by a sympathetic action affect the whole nervous system. Poisons may belong to either of the three kingdoms, the animal, mineral, or the vegetable, but as the symptoms produced are sometimes nearly the same, from whichever class or kingdom they may be derived, it has become the custom to arrange the several poisons according to the most characteristic effect they produce on the animal economy, and to divide them into the Irritant Poisons, the Narcotic Poisons, and the Narcotic-Acrid Poisons, thus embracing all deleterious substances under one or other of the above classes.

Irritant Poisons

Are those that excite inflammation in some part, or the whole of the alimentary canal.

Nitric Acid

Muriatic Acid

Sulphuric Acid

Phosphorus

Sulphur

Chlorine

Iodine

Hydriodate of Potass

Bromine

Oxalic Acid

The fixed Alkalis

Nitre

Alkaline and Earthy Chlorides

Lime

Ammonia and its Salts

Alkaline Sulphurets

Baryta

Euphorbia

Castor Oil seeds

Croton

Bryony

Colocynth

Elaterium

Ranunculus

Anemone

Clematis

Mezereon

Cuckoo-Pint

Gamboge

Savin

Cattha

Poisonous Fish

Compounds of Arsenic

Compounds of Mercury

Ditto of Antimony

Ditto of Tin, Zinc, Silver, Bismuth, and Chrome

Compounds of Lead

Ditto of Copper

Venomous Serpents and Insects

Daffodil

Jalap

Cantharides

Decayed Animal Matter

Mechanical Irritants.

Narcotic Poisons

Are those poisons that produce an immediate and continued disorder of the nervous system.

Opium

Lactuca

Solanum

Nitric Oxide Gas

Chlorine Gas

Ammoniacal Gas

Sulphuretted Hydrogen

Carbonic Acid

Cyanogen

Hyoscyamus

Hydrocyanic Acid, and all vegetables producing it, as bitter almonds, cherry laurel, peach, and mountain ash, carbonic oxide, and oxygen.

Narcotic-Acrid Poisons.

The poisons of this class produce a double action, that of a local irritation, and a secondary, or after effect on the nervous system.

Nightshade

Hemlock

Tobacco

Water Hemlock

Monkshood

Squills

Ipecacuanha

Meadow Saffron

Foxglove

Nux Vomica

Camphor

Cocculus Indicus

Upas

Secale Cornutum

Darnel Grass

Alcohol

Ether

Thom-Apple

Fool’s-Parsley

Hellebore, Black

Hellebore, White

Strychnia

False Angustura

Poisonous Fungi

Mouldy Bread

Seeds of the Laburnum, and some empyreumatic oils.

Though chemistry has of late years made great progress in the science of analysis, vegetable poisons are so soon eliminated from the body, as to leave hardly any trace for the chemist’s tests to re-act upon, and the mineral poisons may be regarded as almost the only class on which science can operate with invariable certainty. The first duty of any one called to act in a case of poison, is to administer an antidote, of which there are supposed to be two; one, which given immediately, will chemically destroy the virulence of the poison—as in the case of a person who has swallowed a powerful acid, the exhibition of chalk will destroy the potency of the acid, by forming a new and harmless compound—and antidotes or drugs in many instances of a problematical effect, which are supposed to have the power of neutralizing the effect produced on the system, by the agency of the poison, and restoring the disorganised body to a pure and pristine health. Of this class of drugs once implicitly believed in, science has found few if any to bear the test of a rigid experience. To leave theory, and come at once to the practical, the first care of any one, when an individual has voluntarily, or by accident taken a poison, or any known or suspected deleterious substance, is to procure its instant evacuation from the system by vomiting. In many cases, either the drug itself, or the over-dose of it, excites this remedial step, and if so, the attendant should encourage the action of the stomach by all the means immediately procurable; or if the vomiting has not set in, to excite it at once, either by warm water in frequent draughts, or should that not be present, by a draught of mustard and water, or a few spoonfuls of common salt dissolved in water; or should neither of these be in readiness, and while the water is heating, and medical aid or other means is being sought, give copious draughts of cold water, and by the feathery part of a quill, tickle the fauces, or with the handle of a spoon press down the root of the tongue; when the contents of the stomach must be ejected. This process may be repeated; and even without further means, the poison may in this way be ejected from the stomach. In cases where vegetable, or what are called narcotic, poisons have been taken, it is sometimes extremely difficult if not impossible, to produce vomiting, though attempted with proper emetics; in all such, in fact in all vegetable poisons, the stomach pump becomes imperative, and the most valuable of agents, as it not only fills the stomach with water, but immediately after relieves it of that, and whatever poisonous matters it may hold in suspension or solution. This process of filling the stomach with tepid water, and again expelling it, must be continued till all apprehension that more poison remains, is removed from the mind of the operator. In cases of poisoning by narcotic and vegetable substances, to empty the stomach is the first, last, and most important duty, and till the chief agent, the stomach pump, can be procured, some of the means already advised should be adopted, but where more perfect remedies are at hand they should be employed; of such the best emetics for a vegetable poison are the minerals, especially the white vitriol or sulphate of zinc, twenty or thirty grains of which, dissolved in half a tumbler of warm water, will be found to act almost instantly. To rouse the energies after the ejection of the poison, electricity should, when possible, be applied; stimulants such as ammonia, hot coffee, or camphor administered; and when necessary, aspersions of cold water, and the patient constantly kept moving. In other cases blisters or hot mustard plasters must be applied to the spine, thighs, feet, or stomach; according to the nature and potency of the poison. In irritant or corrosive poisons, concurrent with the vomiting, which, when not induced by the poison itself, should be at once excited, agents to neutralize the virulence of the poison must be administered, and again repeated after each vomiting, to be in turn ejected, again taken, and again discharged. In all poisonings of this class, proceeding from the mineral acids or corrosive compounds, when proper emetics are at hand the vegetable, such as the ipecacuanha, is the most efficacious, twenty or twenty-five grains of which, dissolved in warm water will be found an effective dose; while as a corrective to the corroding nature of the poison, draughts of tepid water, in which shavings of brown soap have been scraped, must be drunk frequently, or half tumblers of water, in which half a tea-spoonful of soda, either the common or carbonate, or the same quantity of ordinary potass; frequent draughts of milk or mucilage, treacle, honey and water; or should none of these articles be at hand, spoonfuls of chalk and water, and in still more extreme cases, when no other aid is at hand to relieve the burning agony induced by the poison, the plaster from the wall or ceiling should be broken down, mixed in water, and given to the patient to neutralize the activity of the poison. Such are the general means adopted to eject the poison from the system; special poisons, however, require particular and special notice.

Arsenic, in addition to the vomiting, should be treated with the white of eggs mixed in water, and administered every ten minutes; or honey, treacle, sugar and water, or milk.

Oxalic Acid.—New milk must be given in frequent draughts after each fit of vomiting, or chalk and water.

Corrosive Sublimate and Verdigris are treated nearly in the same manner as arsenic; the chief antidotes being white of eggs, milk, and sugar and water; though for verdigris, iron filings dissolved in vinegar, and mixed with mucilage, are generally preferred for this rarely employed poison.

Nitrate of Silver, Or Lunar Caustic.—The best antidote, concurrent with the emetic, is common table-salt, dissolved in water, and taken frequently. A tea-spoonful of salt in a wine-glass of water is to be given every half hour.

Sulphuric, Muriatic, or Nitric Acid, or what is called the Mineral Acids, require, like oxalic acid, milk, but especially, magnesia, chalk, and soap or mucilage, but primarily magnesia.

Hydrocyanic Acid, or Prussic Acid.—Where this drug is not immediately fatal, and has only been taken in moderate quantity, the only antidotes are powerful stimulants of brandy, ammonia, and ether; and as emetics are valueless in this poison, sudden effusions of cold water must be adopted with stimulants to the stomach.

In all cases of poisoning by vegetable matter, whether acrid or narcotic, the first duty is to encourage the sickness, if set in, by warm water, and where the power of the stomach has been paralysed by an excessive dose, instantly to promote vomiting by a full dose of sulphate of zinc or white vitriol, in a dose varying from 20 to 30 grains, or else 10 or 15 grains of sulphate of copper or blue stone; but neither antimony nor ipecacuanha. When the stomach has been well evacuated, strong infusions of coffee, or draughts of vinegar and water are to be given occasionally. In all cases of corrosive or acrid poisons, when the lower bowels are affected, it becomes necessary to employ enemas of a soothing and corrective nature. All that the non-professional person can do in any case of poisoning, till the arrival of medical advice, is to empty the stomach of the hurtful matter by the quickest and readiest aids; and when emetics are not at hand, such natural and domestic means are to be resorted to as can be the easiest obtained; warm water, mustard, salt, tickling the gullet with a feather, or pressing down the tongue with a spoon, as already advised. It should be borne in mind, that for mineral poisons vegetable emetics are to be used, and for vegetable poisons mineral emetics: that in cases of poisoning from the mineral acids, it is useless to give emetics, and dangerous to administer water alone; in such cases, such articles are to be given as will counteract the corrosive virulence of the acid, and convert it into an inert compound, such as magnesia, soda, chalk, soap, or in extremity of means, the plaster from the walls: that where prussic acid has been taken, emetics are equally valueless; the prostrated powers are to be raised by powerful stimulants, and the means already indicated. For the poisons that are applied externally, and prove hurtful by absorption, such as the bite or sting of venomous reptiles, the first duty of an assistant is to tie a garter, tape, or some ligature tightly round the limb, a few inches above the wound, next to wash it immediately with warm water, and then, if there are no cracks in the lips or gums, fearlessly to apply the mouth to the bitten part, and slowly and steadily suck it; washing the mouth with cold water every time there is a rest, and the contents are spit out. When cupping glasses are at hand, they should be applied instead of the mouth; in either case, the part, after being sucked or cupped, is to be well rubbed over with lunar caustic, a warm poultice laid upon the place, the limb kept at rest, and, a few hours after the bandage or ligature removed. For the poisonous sting of gnats, bees, wasps, and other insects, a piece of lint, wetted in the pure extract of lead, is all that is necessary to cure one or the other. For the sickness, lassitude, and fainting, that often follow the sting of reptiles, it is requisite to administer ether, brandy, and ammonia, and sometimes opium.