ACCIDENTS AND EMERGENCIES.

The present work has been undertaken in the belief not only that it will supply a want felt by those who have had no surgical education and training, and are by circumstances placed where professional skill and assistance cannot readily be had, but also in the desire of imparting to such a general knowledge of the nature, course of treatment, and ordinary results of such accidents and emergencies that are of common occurrence and a description of which has ordinarily to be sought in technical works intended for professional readers and understood with difficulty by others.

Accidents, (a, from cadere, to fall,) are events that happen suddenly, and are beyond man’s foresight and control.

Emergencies, (e, from mergere, to plunge), taken in this connection are conditions, or connection of circumstances calling for prompt action and a ready resource. Colic, Cholera, 8Diarrhœa, etc., cannot, strictly speaking, be regarded in the light of accidents, but the suddenness of such attacks lends them all the gravity that attaches to “Accidents.” In this sense, the terms “Accidents and Emergencies” have been coupled together as the title of this work, and in which they have been treated in the following pages. Life is beset with possible perils. Infractions of the moral, no less surely than those of the natural law, bring punishment which ignorance and selfishness invite. But there are dangers to which we are exposed through causes beyond our control. In such cases, presence of mind, and the power of taking things quietly, is of the chiefest importance. “Old women of both sexes,” who give way to their feelings by hysterical screams, or even hinder those who know what to do, not only complicate matters, but are a nuisance that should at once be removed. In such cases it is doubly true that “he who ruleth his spirit is greater than he who ruleth a city.”

Not every one can preserve the requisite coolness and decision of character, when suddenly called upon to do so; but there are some 9who can master their own feelings and overcome the natural dread of blood and pain sufficiently to forget self in those larger and nobler feelings evoked by that “one touch of nature which makes the whole world akin.”

With these few brief introductory remarks I will proceed to consider the immediate effects and treatment of such Accidents and Emergencies as are of ordinary occurrence, namely:

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Accidents on the Water.

Many such occur yearly, and much loss of life and personal injury can be prevented by exercising a little common sense and self-possession. If swamped or overturned in a boat, and unable to swim, your chief endeavor must be to keep your head above water. This is easily done if you will simply throw yourself on your back, lying perfectly still, just moving the hands to and fro on the water, in the same level with the body. Or else fold the arms over each other, keeping them some little distance from the body, the latter being in a perpendicular position, instead of a horizontal one, as in the former case. When on board a vessel that has been run down, do not crowd round the boats and thus hamper the efforts of the sailors, nor to that side to which the vessel lists. The story of the “Birkenhead” shows what discipline and coolness will do in saving human life.

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Apoplexy.

Apoplexy may be defined as the sudden deprivation of all the vital functions, save those of the heart and lungs; though feeling and will are at once suspended, and in an instant, and often without any premonitory warning, a person in apparently robust health falls down in a state of insensibility, and as if in a deep sleep, stricken down by the sudden blow. One form of the attack is, (A) where the face becomes flushed, the breathing heavy, and the pulse full and not frequent with occasional convulsions. But the attack may be preceded, (B) by a sudden pain in the head accompanied by faintness and vomiting; the skin becomes cold, and the pulse feeble, and at times convulsions follow. The patient may fall to the ground, but will revive for a while and recover from all these symptoms, though the headache will continue, and then by degrees he becomes heavy and forgetful, and his ideas wandering and disconnected, till at last he sinks into a state of stupor from which there is no recovery. This form of attack, though less alarming, at the beginning, to those present, is more dangerous 13than the one previously mentioned. The tendency to these attacks increases with advancing years, and more generally between the ages of 45 to 60, and to persons of square stout build, with short necks and large heads, though their opposites physically are by no means exempt. Men are more liable to apoplectic attacks than women; youths and children rarely suffer from them. Apoplexy may be cerebral—that is, arising from congestion or rupture of the brain; or pulmonary, due to hemorrhage of the parenchyma of the lungs. The first is the commoner form. The attack may be sudden and violent, or comparatively slight at first and progressive in intensity; or it may commence with apoplexy terminating in paralysis, or commence with the latter and terminating with the former.

Causes. Apoplectic attacks are due to constitutional predisposition or exciting causes, among which may be mentioned sex, age, bodily conformation—all of which have already been touched upon above. Excessive mental anxiety and exertion, such as business troubles, or extreme emotions or passions; too free indulgence in either eating or drinking, 14especially by persons of advanced years; severe bodily or mental strain, in fact, whatever produces a tendency to quicken the circulation of blood to the head, or retards its return from it.

Treatment. When the symptoms are such as described in the first form (A), immediately place the patient in a recumbent position, with the head and shoulders raised, remove everything about the neck and loosen the clothes. Admit the air freely, and apply ice—if obtainable—or cold wet clothes to the head, changing them frequently. In the second set of symptoms mentioned, (B), raise the head and shoulders, loosening the clothes, and removing whatever presses on the neck, applying ice, etc., as set forth above; but the patient’s skin being cold and the pulse small and fluttering, apply strong spirits of ammonia to the nostrils and hot flannels to the legs, and hot water-bottles to the feet, or put the feet into warm water with a little mustard. Then, if the sufferer is able to swallow, administer slowly from 15 to 20 drops of aromatic spirits of ammonia in a half glass of water, or one-half dram of aromatic spirits of ammonia in one and one-half ounces of camphor mixture. Purgatives 15should be given as soon as possible, 10 grains of calomel placed on the tongue, followed by a black draught; or 2 or 3 drops of croton oil rubbed on the back of the tongue, and an injection given composed of two table-spoonfuls of common salt with a little butter; or a pint of warm water; or an injection composed of soap suds and four ounces of sweet oil. If the attack be after a heavy meal, an emetic should be administered of a scruple of sulphate of zinc with a grain or two of tartar emetic. To guard against future attacks, mild tonics should be taken, the body daily washed and rubbed and the bowels kept well regulated. It is hardly necessary to add that on any occasion of an attack a physician should at once be called in.

Asiatic Cholera.

This terrible disease is of a very violent and sudden character. It attacks a person without any warning, and generally within a few hours leaves him—a corpse.

Causes. The actual cause is not well determined, but the effects are most disastrous in crowded towns and cities where dirt and disregard 16of sanitation prevail. Impure water, improper food, indulgence in sensual habits, and intoxicating beverages, or whatever tends to weaken and undermine the constitution, are all so many invitations to a visitation of this dire disease. Fear, especially when the epidemic is present in the district, is also a not infrequent cause.

Symptoms. The attack of the commencement is marked by derangement of the digestive organs, want of appetite, pains in the loins and knees, thirst, and looseness of the bowels; then follow sickness and purging—the discharges having the appearance of rice water, very unlike those presented in diarrhœa, or bilious purging—accompanied by severe and painful cramps in the calves of the legs, and afterwards in the bowels, stomach, and other parts of the body, which becomes bent, with the limbs twisted. The thirst is intensified, the breathing hurried and difficult, with a hardly perceptible pulse. The eyes are sunken and surrounded by a dark rim, and the skin is cold and clammy; there is a feeling of intense heat in the stomach accompanied by violent thirst. The patient is entirely prostrated, and sinks into a state of apathy, 17from which, unless a change very speedily takes place, he never recovers.

Treatment. Although the writer has met with a case where the patient recovered when all hope had been abandoned; still when once the disease has taken hold of a person, it is very seldom indeed that he is ever again restored to health. There is no known cure, or any proper course of treatment to be followed, agreed upon by medical men whose views of how this disease should be treated, have of late years undergone somewhat of a change. The time when a cure is most likely to be effected is at the initial stage. Put the patient to bed, and apply hot bricks and fomentations to the extremities and mustard plasters to the bowels, the looseness of which should receive prompt attention. Five to ten drops of laudanum, repeated a few times every three hours, will generally put a stop to this. Dr. Watson^[1], however, expresses as his opinion, “that the one important and guiding rule of treatment is not to attempt by opiates or by other direct repressive means to arrest a diarrhœa while there is reason to believe that the bowels contain a considerable amount of morbid and offensive 18materials. The purging is the natural way of getting rid of the irritant cause. We may favor the recovery by directing the patient to drink copiously any simple diluent liquid—water (cold or tepid), toast-water, barley-water, or weak tea; and we may often accelerate the recovery by sweeping out the alimentary canal by some safe purgative and then, if necessary, soothing it by an opiate.” The diet should of course be very carefully regulated, and more sparingly partaken of than in health, but not particularly changed except to abjure all food known to be indigestible and injurious. When the patient reaches the stage of purging, vomiting and cramps, the treatment must be energetic. The failing powers must be sustained by chloroform, opium and ammonia, or camphor, opium and cayenne. Brandy may also be freely administered and the warmth of the body promoted by all possible means. These remedies should be energetically pursued, especially the stimulants, and the efforts to promote warmth in the surface, until the final stage of prostration and apathy is reached.

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Broken Bones.—Fractures.

Falls, and other trifling accidents occasioning the breaking of some bone or other, are among the commonest incidents of life, (particularly in the cold weather, when the bones are more brittle than at other times), often occurring when surgical aid cannot be immediately obtained. The fact that a bone is broken is easily detected by the inability to raise the limb, or from its being bent, shortened, or twisted, as also from the pain. Much additional suffering may be spared the patient, and increased mischief prevented by the exercise of a little care and judgment.

The limbs should be tied together, or placed as near as possible in a natural position, and the patient laid on a door or hurdle, covered with straw, blankets, etc., upon which he should be laid as gently as possible and carried to the nearest house. If no hurdle, etc., be available, a convenient frame can be readily extemporized by tying firmly two short poles across two long ones, and laying upon these a few planks, covered with straw or clothing, etc.; or, a blanket securely attached to the four corners, like a 20cot-bed, will adequately fulfill the end in view. In dealing with the treatment, we will commence with the head, working down to the extremities.

Head. All injuries sufficiently severe to break any bones in the head or face, or to produce insensibility, are especially dangerous, and need immediate skilled attendance. The head should be raised and cold water applied, particularly if there be any bleeding, and the sufferer kept as quiet and free from excitement as the circumstances will permit.

Collar Bone. This bone runs from the top of the breast bone to the shoulder. This fracture is perhaps one of the most ordinary accidents that can happen, as it is also one of the most readily detected. It generally occurs about the middle of the bone, and is commonly caused by falling upon the arm or shoulder. The fracture will be noticed by a lump, the broken bones rising one above the other, with considerable pain and tenderness in the injured part, and inability to raise the arm. The principal object is naturally to keep the shoulder back so as to facilitate the union of the bones. The most simple and efficacious way for non-professional 21persons to effect this, is the following. Make a round pad of some soft material, about five inches long and thick, and wrap it in a small shawl. Push the shoulder backwards, pressing the fracture with the other hand, till you get the bones back into their proper place. Now place the pad well under the armpit on the injured side, bringing the ends of the shawl back and front over the opposite shoulder, then crossed and tied under the sound arm. The sore arm should be well supported in an ample sling, extending from the elbow to the wrist. A surgeon should then be seen to set the fracture right. If there be a tendency to swelling, the arm will require to be bandaged from the fingers upwards.

Broken Ribs are generally due to a fall or blow affecting one or more of the bones. A sharp pain is experienced, which is intensified when taking a deep breath or coughing, and by placing the hand upon the injured part a grating sensation will at the same time be felt. A possible injury to the lungs from the sharp points of the fractured rib, and the consequent inflammation, is the chief danger to be apprehended from this accident. If there should be 22any spitting of blood, the patient must be kept perfectly still, and no stimulants given him. A piece of some stout material, from 8 to 10 inches wide, should be bound tightly round the chest several times to prevent the rise and fall of the ribs in breathing, commencing as near as possible to the armpits, down to the pit of the stomach.

If there be a bruise, apply hot fomentations, hot plaster, or hot bran-bags. Should there be any inflammation, the patient must be kept to his bed, resting in that position which affords him the greatest comfort, and restricted to a low diet. The pulse must be quieted by administering a dose of from 3 to 5 drops of tincture of American hellebore (veratrum viride) every one or two hours in a little sweetened water, and gradually increasing till the pulse comes down to about seventy. If the accident occur away from the house, bind some substantial substance tightly over the clothes, until the sufferer can be conveyed home. In all cases of a wound to the chest, the person must lie on the wounded side.

Arm. Above the elbow. A fracture of the humeral, or upper arm bone, occurs most 23generally about the middle, but less commonly within an inch or so of the extremities. It can be readily detected by taking hold of the arm, just above and below the suspected fracture, and trying to bring the upper and lower portions together, when the broken ends can easily be felt, and a grating heard as they rub against each other. The injured limb is bent and helpless, and if the bones overlap each other shortened. The arm should be pulled gently and gradually to its natural length, the operator in the meanwhile setting the bone, and a bandage applied, but not too tightly, from the shoulder to the elbow. Over this bandage, four splints, well padded with lint or wadding and of the same length as the bandage, should be placed, one in front, one behind, and one on either side of the broken bone. The splints should be furnished with tapes to tie or buckle. The arm must be confined to the side, and the hand and fore-arm carried in a sling. The dressing should be removed in a week or ten days, to see that all is right and proper progress made.

Elbow. In this instance, though the patient is able to bend, he cannot straighten his arm, which when moved backwards and forwards 24makes a grating sound and gives intense pain. Falls or blows are the usual causes producing this fracture. The point of the elbow seems gone, being drawn into the back of the upper arm. Apply leeches and evaporating lotions to reduce any inflammation that may be present. When this is done, straighten the arm and bandage carefully from the fingers to the joint, and set the broken bone, continuing the bandage, passing it over and above the injured part. A well padded splint, extending from the hand to nearly the shoulder, should now be applied on the inner side and a similar one on the outside of the arm. The joint must be rested from four to five weeks, removing the splints some three or four times during that interval to ascertain that the skin is not being chafed, nor the bone disturbed.

Arm below the elbow. In the upper arm we have but one bone, but here there are two: one running from the elbow to the wrist at the end of the little finger, and the other on the side next the thumb. When both bones are broken the fracture can be readily detected, but not so when only one is broken, as the sound bone assists to keep the other in place, and the injury 25is not so easy to discover. In a fracture of the outer and thicker bone (ulna), the arm seemingly retains its normal shape, though broken at the elbow or some other part of its length. In this case the elbow should be bent and the hand turned upwards, as if to lay it flat on the chest. Then apply two splints, placing one on the palm of the hand reaching to the bend of the arm, and the other, and outer one, from a little beyond the elbow to about the knuckles. The arm should be well raised towards the chest, so as to keep the outer from the inner bone (radius). When the fracture occurs in this inner bone, the same treatment must be observed, with this one exception: that to ensure the bones being kept apart, the hand must be lowered instead of raised. When both bones are broken, the operation is naturally a more difficult one and requires skilled attention. In bandaging fractures, due allowance must be made for swelling, which is present during the first two or three days.

Hand, Wrist, or Finger.

Hand. Fracture of the Hand. An accident to these bones, which lie between the wrist and the fingers, should be treated in the following 26way. Place in the palm a ball of small but firm material, or a ball of newspaper rolled tightly, closing the thumb and fingers tightly over it, and bandaging them in that position to preserve the natural arch, which the application of flat splinters will not do. The arm should be supported in a sling from four to five weeks to permit the bones to re-unite.

Finger. Fracture of the Finger. After gentle extension and counter-extension to bring the broken parts together, and having attained that end, apply narrow pasteboard splints or small pieces of gutta-percha on the upper and lower sides and bandage sufficiently tight to keep the finger in an extended position. The arm should rest in a sling from four to five weeks; and if any swelling occurs, the bandage must be loosened and cooling lotions applied.

Wrist. Fracture of the Wrist. In a fracture of the wrist bones apply a splint front and back and tie a bandage firmly round from above the injured part to nearly the tips of the fingers. The arm should be supported in a sling till such time as it can be prudently dispensed with.

Hip Joint. In such accidents, to which 27elderly people are more particularly liable, the sufferer should be as soon as possible placed in bed, and after carefully removing his clothing, the doctor sent for.

Thigh. The fracture of the thigh bone is an accident of a very grave character, though easily discerned by the inability to raise the leg and the consequent pain in attempting to do so. The chief difficulty in this case is to obtain a proper union, for the violent spasms of the muscles, acting lengthwise, cause the fractured parts to overlap each other, occasioning much suffering. This is especially the case when the fracture is an oblique one. A long straight splint is the best to use, lightly bandaged at first and gradually tightened to accustom the limb to the pressure. If the accident occur away from home, bind the injured limb with a temporary splint, made of very thin boards or stiff straw, or with a felt hat, cut into long slips and secured by neckcloths, handkerchiefs, etc., over the fracture. On getting the sufferer home to bed, if the spasms be severe, apply a bandage around the ankle and over the instep and attach a weight of eight or nine pounds, letting the foot hang over the edge 28of the bed. This will give the patient much relief.

Knee-pan. This fracture may be either up or down, or across, but more commonly the latter, and is generally due to a fall, or as is sometimes the case, from a violent muscular exertion in throwing out the leg. The sufferer loses all natural support from the limb. The treatment should in the first instance be directed to reduce any inflammation that may be present by applying tincture of arnica, leeches, or lotions. Then straighten the leg and apply a well padded splint behind to prevent any movement of the knee. The patient should be in a half-sitting posture, with the leg well raised above the level of the hip. Apply a bandage over the splint, commencing half-way up the thigh, extending as far as the fractured knee-pan; above and below the knee the bandage should be drawn tightly to prevent the broken bone from slipping under it. The broken bones should now be brought together and a bandage passed several times above and below the knee to assist the union of the bones. If the patient is obliged to move, the leg should be well supported by a firm bandage passing round the 29neck and under the foot, lifting the latter well off the ground.

Leg. The leg is that part of the limb between the knee and ankle, and here again, as in the fore-arm, there are two bones, the smaller one (fibula) on the outside, and the larger one, the shinbone (tibia), on the inner and front side. A fracture of the former is not easy to find, and it is not very material to do so, as the shinbone will act as a natural splint. But if this too should be broken, it is impossible to walk upon the limb, which loses its shape and becomes bent, while the broken portions may be felt or heard grating against each other. The treatment is the same as in other fractures. That is, bring the broken portions together by extension and counter-extension. Then apply two splints, one on the outer side, from the knee to about four inches below the sole of the foot, and the other upon the inside, and over these use a bandage extending from the toes to the knee. The leg may rest on any side most agreeable to the patient. The dressing can be removed in about a week’s time to ascertain if the bones have joined properly. A month, at least, must elapse before the dressing 30can be dispensed with, and even then the leg must be used gradually and with great care.

Ankle and Foot. Fractures in these cases require similar treatment as those which happen to the hand and wrist. These accidents, which are serious, are often accompanied with lacerations of the flesh and ligaments. Pasteboard splints should be used, and in case of any matter forming, it should at once be released.

Bruises.

It is unnecessary to describe these results of accidents, with which we are all familiar in a greater or less degree from our childhood. They are easily caused and as easily cured when the injured person is in the enjoyment of ordinary good health. When the skin comes into contact with some substance harder than itself, the softer substance naturally receives an injury more or less severe (called a bruise), producing a rupture of a number of tiny blood vessels under the skin, giving it the appearance of “black and blue.” The treatment is simple; the chief object being to prevent inflammation. Bathe the injured parts with cold water, or 31equal parts of Goulard water and vinegar. Or apply a lotion of one part of tincture of arnica to eight of water.

Bleeding from the Nose.

Do not, unless it be violent, interfere with a bleeding from the nose. A bleeding from the nose is frequently an effort of Nature to relieve itself, and therefore, unless it be likely to weaken the patient, ought not to be restrained. If it be necessary to restrain the bleeding, first ascertain whether the blood escapes from both nostrils, or from the right or left. Press the nose firmly for a few minutes between the thumb and forefinger; this alone will often stop the bleeding. If it should not, inject with a syringe a quantity of ice-water or a solution of common salt, in the proportion of one table-spoonful to half a tumbler of water; or a piece of lint, twisted and moistened with the solution, may be forced up the nostril and allowed to remain until the bleeding ceases.

If these plans fail, then try what bathing the nose and the forehead with water quite cold and plunging the hand and the fore-arm into 32cold water for a few minutes will do. Then take them out and raise the arm above the head. The arm is raised to distribute the force of the heart’s action and to take the pressure off the carotid vessels, diminishing the strength of the current through them. This plan has frequently succeeded when others have failed. When the blood comes from laceration of the naso-palatine artery, all these measures are apt to fail and the posterior nares must then be plugged. The operation of plugging is simple, and does not require a great amount of skill. It may be performed with a gum-elastic catheter, (No. 4 or 5 will do). Through the eye of the instrument pass a string, allowing the ends to hang down. Introduce the catheter through the nostril into the mouth and draw the string, which is hanging from its end, out beyond the lips. To this attach a piece of sponge sufficiently large to fill up the opening in the posterior nares, completely filling its cavity. This method scarcely ever fails to control the most obstinate bleeding.

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Bleeding from Cut or Wound.

If bleeding occur from any part where a bone lies near the surface, as the head or face, it may generally be stopped by pressing firmly against the bone with the finger or a piece of cork, or by binding on tightly a hard pad. If this does not succeed, lift up each edge of the wound and examine carefully to see if any small stream of blood is spouting out in jets. If so, an artery is wounded, and the point of small forceps or tweezers must be dipped in where the jets come from, the spouting mouth taken hold of and drawn out, and a strong silk thread passed round it and tied below the forceps. The white and gaping mouth of the vessel may then be seen.

If the bleeding be profuse from an arm, the whole current of blood to that limb must be cut off, which may be done by some person pressing a thumb firmly into the neck behind the middle of the collar bone. This will dam up the blood in the great artery of the arm as it comes out of the chest. The handle of a door-key, wrapped in several folds of linen, may be pressed upon the place for a long time 34until medical assistance can be had. Dangerous bleeding from the thigh or leg may often be stopped by pressing the great artery just below the crease of the groin. If the bleeding be below the middle of the upper arm, or middle of the thigh, pass a handkerchief once or twice around the limb, as far above the wound as possible, and tie it loosely. Slip a stiff stick under this and turn it round, like the handle of an auger, until the handkerchief becomes so tight as to stop the bleeding. The tight bandage tied round the limb may be an injury if long continued. Let there be no delay in sending for the doctor.

Burns and Scalds.

A burn is the effect of concentrated heat acting upon living tissues. The effects are inflammation and sometimes complete disorganization and destruction of the parts.

A scald is an injury produced by applying hot water or other fluid to the skin or mucous membrane. The natural temperature of the human body is ninety-eight degrees; that of boiling 35water two hundred and twelve degrees. Bringing the skin in contact with a fluid heated so far above it, produces redness and pain, and when nothing is done instantly to ward off the injury, the scarf skin is raised from the true skin in the form of a blister filled with water.

The degree of danger from a burn or scald depends upon the extent of the injured surface and also upon the depth of the injury. An extensive burn or scald may prove fatal in a few hours, the patient never rallying from the first prostration. These injuries are most dangerous when upon the head, neck, chest and belly. Old persons, and those who are feeble and have shattered constitutions, will sink under burns and scalds from which robust persons will suffer but little.

In simple burns which do not involve the true skin, very little treatment is necessary.

Prepared lard, that is to say lard without salt, is an admirable remedy for burns and scalds. All that has to be done is to spread the lard either on pieces of old linen rag or on lint and then to apply them smoothly to the parts affected, keeping them in their places by means of bandages.

36Another valuable remedy for burns is carron oil, which is made by mixing equal parts of linseed-oil and lime-water in a bottle, and shaking it up well before using it.

When the true skin is partially or completely destroyed, a thick layer of flour may be placed over the burned surface and covered with cotton. I have seen the best results from the employment of flour and carron oil, and prefer them over all others for loosening the flour when it is to be taken off. Poultices are useful. Whatever dressing is employed, it should not be disturbed until separated by the exudation underneath, or unless foul odors arise. In changing, every particle should be carefully removed and the parts thoroughly washed with some disinfectant liquid, such as solution of carbolic acid, 1 to 80.

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Catalepsy.—Trance.

Catalepsy, or what is more generally known as trance, is a sudden spasmodic suspension of the senses of volition, in which the limbs become rigid, preserving a fixed position, no matter how uncomfortable or painful. The patient retaining exactly the same attitude as when seized, and if during the attack the position of the limbs be varied, they will remain as placed. The mind is apparently so absolutely engrossed in something outside of the person, that all control over, and union with the body seems lost, leaving it as it were dead; but after the paroxysm has passed there will generally be no recollection of what has transpired during the time that consciousness was suspended. In this respect persons in a cataleptic fit resemble those in a mesmeric state, or in the condition of insensibility produced by inhaling ether or chloroform. A peculiarity of this disease is that the thread of conscious life is taken up at the very point it was interrupted by the attack. An incomplete act will be completed; an unfinished sentence concluded at the end of the fit, though it should last for several minutes or perhaps hours.

38Causes. The causes of this disease, to which women are more liable than men, are rarely local, but such as influence the whole body; catamenia, painful mental emotions, worms, an impaired digestion, may be cited as amongst the principal. Sometimes these attacks terminate in apoplexy, epilepsy, or melancholia.

Treatment. This must depend upon the probable cause of the disease. If the patient be of a full habit, cupping at the back of the neck, blisters, a seton or an issue, and purgatives should be given. But if in a weak, low state tonics and medicines to allay the spasms must be administered. During the attack mustard plasters should be applied to the hands and feet and pit of the stomach. Should the fit be a protracted one, cold water must be dashed over the head and face and strong ammonia applied to the nostrils. The following liniment may be beneficially used along the spine once a day: oil of hemlock, 2 drams; oil of vriganum, one dram; camphor, one dram; alcohol, 5 ounces. On recovery the patient should have nourishing diet, moderate exercise with sea bathing, or cold shower-baths. Mild tonics should also be taken to strengthen the system.

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Choking.

Some children eat much too fast; they bolt their food rather than eat it; if not carefully watched fill the mouth so full and swallow lumps of food in such hot haste as to choke themselves. Instantly put your finger into the throat and feel if the substance be within reach. If it is food, force it down, and thus liberate the breathing. Should it be a hard substance, thrust the finger and thumb as far back into the throat as possible, and if there be anything there attempt to pull it out at once. Whilst you are doing this, sometimes a violent fit of coughing will take place and expel it. If you cannot reach it give a good smart blow with the flat of the hand on the back just below the neck, which will often relieve the windpipe when obstructed. If that does not have the desired effect, tickle the throat with the finger so as to ensure the immediate vomiting and the subsequent ejection of the offending substance. Of the treatment of things that pass down at once into the stomach, such as pieces of money, buttons, and many articles of a like kind, which children, playing with frequently put into their 40mouth and sometimes swallow, little need be said, for they are seldom followed by any serious consequences. Sooner or later the foreign body passes through the alimentary canal with the food, and is thus got rid of. I may add, however, that in this case it is a very common practice to give repeated doses of aperient medicine; now unless the bowels should become confined, such a measure is rather injurious than useful.

Cholera Morbus.

This disease is very apt to make its appearance in the night, and is very common during the prevalence of warm weather. It is also known as Bilious Cholera from the great amount of bile secreted and discharged.

Causes. These are principally due to excessive heat, especially in malarial districts, and sudden atmospheric changes; but dampness and wet feet will also tend to produce an attack.

Symptoms. The disease, which commences with sickness and distress at the stomach, is followed by violent griping with severe cramps, 41especially in the bowels, attended by vomiting of a thin dirty, yellowish, whitish or greenish fluid, with discharges similar to that vomited. The nausea and distress generally continue between the intervals of purging and vomiting, at the same time the pain is intense. The pulse is rapid, soon becoming feeble and small, the tongue is dry, the urine highly colored. There is great thirst, yet at the same moment the skin is cool, but no drink can be retained on the stomach. The bilious discharges, which characterize this disease, distinguish it from diarrhœa.

Treatment. Put the patient to bed, and apply a large mustard plaster over the stomach and liver. Give liberal draughts of warm water, or flax-seed tea, which will clear out all the solid contents of the stomach and bowels. Then every half hour administer a tea-spoonful of compound powder of rhubarb and potassa, adding to each dose 5 to 10 drops of laudanum if necessary, until the vomiting and nausea are checked. Or else 10 drops of laudanum and 10 of spirits of camphor after each evacuation. To promote warmth of the body and of the stomach is of primary importance in this disease. Warm 42injections must be given frequently and hot bricks applied to the feet, while the whole body should be enveloped in warm flannels. The following is a valuable remedy in this disease, as also in diarrhœa: Syrup of orange peel, one ounce; acetate of morphia, 2 grains; tincture of cinnamon, 6 drams; tincture of cardomum, 6 drams. Mix, and give in doses of one tea-spoonful.

Clothes Catching Fire.

It is perhaps unreasonable to look for presence of mind when this frightful accident occurs. Yet it is never more needed than at such a time. If you continue on your feet, the blaze will rapidly ascend and increase the chances of the chest being burned and of the flames being inhaled. If you run to and fro to seek relief from others not present, you will create a current of air that will fan the flame into a swifter work of destruction. The instant persons perceive their clothes to be on fire and in a blaze, they should slip off a coat or shawl and seize the nearest piece of carpet, large rug, cloths, blanket, cloak, or any other article, and wrapping them tight 43around you, throw yourself flat and roll over and over on the floor. If you do this with energy and effectually, you will put out the fire instantly. If it be a child or other person that is on fire, let any person present treat it in the same way. If the person is badly burnt before the fire is extinguished, as quickly as possible dash plenty of water upon it to prevent the burns from becoming deeper.

Colic.

There are several varieties, arising from different causes, of this complaint, more commonly known as gripes, which are marked by severe pains in the parts about the navel, with distension or flatulence, but without purging or looseness of the bowels, and accompanied in some cases with nausea and vomiting.

Causes. Worms, cold, superabundance of vitiated bile, over-indulgence in indigestible or unripe food, or taking copious draughts of water on an overheated stomach, are among the principal causes which produce this malady, of which there are some seven distinct kinds recognized 44by medical men, the commonest forms of which we will now proceed to describe.

WIND OR FLATULENT COLIC.

This is a severe and distressing pain in the bowels, with sometimes a stoppage and swelling about the pit of the stomach.

The CAUSES are due to weakness in the digestive organs, eating indigestible food or unwholesome fruit, costiveness, and cold.

Symptoms. There is a sense of fullness about the lower part of the stomach, accompanied with more or less pain, the wind—which is a characteristic of this form of the complaint—moving from one part to another of the bowels, making a sort of rumbling noise. Pressure does not increase the pain as in the case of inflammation. The pulse is quick, and there is a slight fever attended with nausea.

Treatment. If the pain be caused by having eaten of anything indigestible, the stomach should at once be relieved by administering an emetic. If this does not have the desired effect, a dose of salts, salts and senna, or sweet tincture of rhubarb may be given. At all events the irritating substance must be expelled before 45the pains will subside. If there is no sickness of the stomach, a little essence of peppermint in water, or ginger in hot water, or brandy and hot water may be sufficient to expel the wind and give relief. If there be costiveness and the pain continues, the bowels should be moved by stimulating injections.

The following is well recommended. Castor oil, one ounce; salts of tartar, one-half ounce, and hot water, one pint. Mix well together.

BILIOUS COLIC.

This is a dangerous disease, and may be due to a morbid condition of the liver. The pain, which is chiefly about the navel, but sometimes extends over the whole body, is of a griping, tearing, twisting nature.

Causes. The disease may be due to long exposure to the cold, a torpid liver and skin, irritating substances taken into the stomach, vitiated bile, great unnatural heat with dampness, or malaria in the atmosphere, since it more commonly occurs in the autumn after a hot season.

Symptoms. It comes and goes in paroxysms. Sometimes the abdomen is drawn in, at other 46times it is distended and stretched like a drum-head. The pain can, at the first, be relieved by pressure, but after a while the belly becomes tender to the touch. There is a thirst and heat and a discharge of bilious matter from the stomach. In the worst cases the pulse is small, the face pale, the features shrunken, and the whole body is covered with cold sweat. While the head is hot, the feet are cold, and in the advanced stages of the disease the action of the bowels is sometimes reversed, the feces being forced up through the mouth.

Treatment. Administer immediately an active purgative injection. Mix together four grains of pulverized camphor, 12 grains of cayenne, and one scruple of white sugar. Divide into four powders, and give one every fifteen minutes. This will relieve the pain. At the same time cover the whole belly with a large mustard poultice. The sickness of the stomach may be allayed by effervescing draughts, to which from 10 to 25 drops of laudanum have been added; or by hot draughts, with a like quantity of laudanum over the stomach and feet. A strong decoction of yam-root, drank freely, is a valuable remedy for relieving the 47intestinal spasms. Croton oil, given in one-drop doses done up in crumbs of bread, will often act as successfully as a purgative medicine; or castor oil and spirits of turpentine, in equal parts, in two large spoonful doses, may be taken before trying the croton oil. A warm bath and hot water bottles, or hot bricks rolled in flannel applied to the feet and sides, are good for inducing perspiration. Hot fomentations to the bowels should also not be forgotten.

Persons subject to this complaint may derive great benefit by taking after each meal one pill of the following recipe: extract of high cranberry bark, one scruple; cypridia, one scruple; aletridia, one scruple; pulv. cayenne, one scruple. Mix and make into pills. A sponge bath, rubbing the body well after it, should be taken daily, and also a reasonable amount of out-door exercise, without undue exposure to the sun.

PAINTERS’ COLIC.

Painters’ colic, known also as Devonshire colic, but more generally under the former designation, affects principally those engaged in the manufacture of white lead, or who employ it in their trade for mixing colors.

48The name fully explains the CAUSE, which is due to slow absorption of the carbonate of lead into the system through the lungs, stomach and skin.

The Symptoms of lead poisoning are, as a rule, gradual. The appetite becomes impaired, and there are transient pains in the umbilical parts, accompanied by languor, nausea, belching, obstinate costiveness, and vomiting of acrid bile. The attack which is paroxysmal in its nature, may be severe, or so mild as not to merit any notice, but by degrees the pains increase in severity and have a twisting character. The edges of the gums have a bluish tinge, and the belly becomes hard and contracted and tender to the touch. The pain, which may lessen at times, but never wholly leaves the patient as in other forms of colic, will in severe cases mount up to the chest, and down the arms, even affecting the bladder, making the passage of the urine painful. The face becomes pale and contracted, and a cold sweat suffuses the body.

Treatment. To relieve the pain and open the bowels, much the same course should be adopted as in Bilious Colic. Give at once a 49hot bath and a dose of from 20 to 30 drops of laudanum; afterwards one-fourth of the following mixture should be taken every four hours. Sulphate of magnesia, one ounce; powdered alum, two drams; tincture of opium, half a dram; water, six ounces. Alum is considered to have special curative powers where this disease has become chronic.

The following recipe is recommended to those exposed to the dangers of lead poisoning. Elixir vitriol, one-half ounce; tincture of prickly ash berries, one ounce; mix, and take a tea-spoonful in a gill of water three or four times a day.

Paralysis or palsy sometimes arises from this disease, but is in general confined to the wrists. Galvanism, with friction and shampooing should be applied, with chalybeate waters.

COLIC IN CHILDREN.

Young children are very liable to attacks of colic, owing to acidity in the stomach arising from injudicious over-feeding, or from giving them solid food at too early an age. They often suffer severely from the pains, throwing 50their little legs wildly about and screaming loudly.

Treatment. When the attack is due to costiveness, administer an injection of one table-spoonful of castor oil and one ounce of warm infusion of peppermint; or if the bowels require to be acted upon, give sweet tincture of rhubarb with a little soda in it. Paregoric on a small piece of sugar will generally give relief, but it is better not to use it, when simpler medicines for expelling the wind from the stomach and bowels and allaying the pains will answer the end in view.

Relief may also be frequently afforded the child by simply covering it with hot flannels and laying it on its belly across the knees, at the same time rocking it and gently tapping the back; but this must be done with great care, as otherwise it may tend to increase the infant’s sufferings.

51

Cramps.

This is a sudden contraction of the muscles of the legs, thighs, stomach, and other parts of the body; the affected part being, as it were, “drawn into knots.” Drinking cold liquids when much heated and in a state of perspiration, or vice versa, weakness, excess in eating or drinking, and particularly overworking the muscles, are among the principal causes which induce an attack, which, when it affects the stomach, is a serious matter. Swimmers are very liable to cramps, which so often prove fatal to them. When the suffering is due to overstraining the muscles, the exercise must be moderated.

Rub the muscles well. This will help to bring it back to its natural condition, and if the affected muscle be in the leg, tie a bandage tightly above it, rubbing that part well with spirits of camphor, or laudanum.

When the attack occurs in the stomach, hot fomentations should be applied. Burnt brandy is also an excellent remedy, where the contracted muscles are situated internally. The bowels should be kept well regulated.

52

Diarrhœa.—Looseness of the Bowels.

Frequent, copious, and thin or extremely liquid discharges point to a loose or relaxed condition of the bowels. Children are very liable, especially during the hot season, to this complaint, which often proves fatal to them.

The excessive discharges are due to a variety of CAUSES; as bad and unwholesome food, or food taken in large quantities, unripe fruit and other substances, which, remaining undigested in the stomach, act as irritants, until expelled; sudden changes of temperature; exposure to long continued heat, or malarial influences; the application of cold to the body producing congestion of the bowels; suppressed perspiration, and inflammation or ulceration of some portion of the bowels. With children the cause is very commonly due to eating unripe or unsound fruit, when naturally attention will be given to any attack, but not necessarily to its immediate suppression, as it may be only an effort of Nature to throw off from the system what is injurious to it; but the complaint must not be permitted to continue unchecked, as otherwise it may become serious.

53Symptoms. The attack may come on suddenly when due to cold or some undigested substance in the stomach; or there may be premonitory symptoms, as restlessness, disturbed sleep, and passing abdominal pains, and other signs indicative of indigestion, which may continue for some time. There is a feeling of distension and weight in the lower part of the stomach, attended by a rumbling noise in the bowels caused by the presence of wind. This feeling is relieved when an evacuation takes place, but returns when another is near at hand. Griping is frequently present, and the face is pale and dry and after a while becomes sallow. In addition to these symptoms the sufferer is troubled with nausea and vomiting, and if the purging be not speedily arrested, great exhaustion, accompanied by spasms and cramp, will follow.

Diarrhœa is distinguished from dysentery by the absence of blood in the discharges as also of fever, inflammation, contagion and straining at stool. As the disease progresses, the motions become very watery, the strength rapidly diminishes, great emaciation takes place, and dropsy generally ensues.

54Treatment. In the treatment of this disease the remedy will of necessity depend upon the originating cause, but whatever that may be, the simple rule is to make the patient keep quiet and not to exert or expose himself to sudden variations of the temperature, or (in hot weather) to the direct rays of the sun. To rest quietly on the back is of the greatest importance in this as in all cases of bowel complaint. Generally speaking, if the discharges from the bowels have an offensive odor, or if they have not acted for some time, then they must be cleared out with a dose of castor oil or other aperient, before doing anything else. In the case of a child, instead of castor oil give spiced syrup of rhubarb, and a tea-spoonful will suffice for an infant. In every instance, however, put the child to bed, bandaging it tightly round the stomach with flannel, and leaving it without food for a few hours. Where the motions are thin and frequent and attended by some degree of bearing down, administer 5 drams of castor oil with 5 drops of tincture of opium. This will give great relief. The same course should be adopted when the attack is due to the introduction of oily or putrid food into the stomach. 55If cold or suppressed perspiration be the cause, then the secretions must be restored by administering to the patient medicines which determine to the skin, such as James’ or Dover’s powders, five grains of the former, or ten of the latter, in a little arrow-root or gruel. The feet should be put in hot water every night. When there has been an abuse of aperients, these must be discontinued. If there are pains in the bowels with nausea and vomiting, apply a mustard poultice, or else heat a plate in the oven and wrap it well round with flannel wrung out of hot water, then place over the belly, covering with a dry towel. This will afford all the requisite heat without the weight of a large plaster. It is advisable to have another plate heating whilst one is in use, so that a change can be immediately effected. A few drops of laudanum and spirits of camphor, 5 drops of each for a child of 10 years, and 3 drops of each for one of 5 years, may be given every twenty minutes so long as the diarrhœa or pain and vomiting continues. Neither laudanum or paregoric should be administered to an infant, except under medical advice.

56

Dislocations.

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

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

It must be borne in mind that, in giving the 57following directions for the treatment of dislocations in other limbs of the body, the advice above given, to keep the patient quiet and obtain professional assistance, must not be forgotten by those without any proper and technical knowledge.

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

Jaw. Here the jaw gets out of joint from opening the mouth too wide, as in gaping, which becomes forced wide open, with much pain in front of the ear, extending up to the 58temples. Put the person on a low seat and place a thin stick across the mouth, pushing it far back; then press backwards and downwards till the jaw slips back into its place; or else, covering the thumbs with a handkerchief, place them in the mouth, pressing slowly but firmly on the four back teeth, at the same time raising the chin and pushing the jaw backwards.

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

After doing this for some time, tell the person to turn quietly round, when by a sudden 59strong pull you will feel the bone jerking into its right place.

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

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

Wrist. In the case of the wrist, the accident is generally caused by a fall on the hands. The bones of the fore-arm may be thrown either backwards or forwards on the wrist, causing the projection to be either in front or behind. The bones are replaced by pulling the fore-arm and 60hand in opposite directions, pressing sideways, if the displacement is at the side. Put a straight, well padded splint on the back and front of the fore-arm and wrist and tie a bandage over the whole. The arm should be carried in a sling, and any inflammation kept down by applying cold water or cooling lotions.

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

Ankle. The dislocation here may be either backwards, forwards, inwards, or outwards. The 61latter is the most frequent and is generally accompanied by fracture of the small bone of the leg, above the ankle joint.

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

Drowning.

The length of time that persons can remain under water and afterwards recover, is from five to thirty minutes. The air being shut off from the lungs, breathing stops and the immediate accumulation of carbonic acid in the blood paralyzes the nervous system and insensibility 62immediately follows. The heart continues to beat, however, from five to twenty minutes after the occurrence of insensibility and apparent death. Recovery may take place at any time before the heart ceases to beat, and has been brought about in some cases even after this organ has become still. It has taken place in some few instances as late as half an hour after being under water, but it can scarcely be expected, even under the best treatment, later than twenty minutes from the time of submersion, and even as late as this the chances are much against restoration. Treat the patient instantly on the spot in the open air.

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

2nd. Turn the body face upward, shoulders 63resting on a folded coat or pillow, keep the tongue drawn forward, take hold of the arms just above the elbows, draw them away from the sides and up over the head until the hands meet, counting one, two, (this expands the chest and allows the air to enter the lungs), lower them so that the elbows will come to the sides and the hands cross on the pit of the stomach and press then gently but strongly against the sides and chest, counting three, four, (this forces the air out of the lungs); continue these two movements (which produce artificial breathing) very deliberately about ten or twelve times, in a minute and without ceasing until the patient breathes naturally, or until satisfied that life is extinct.

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

After natural breathing is fully restored, give the patient a tea-spoonful of brandy, hot gin, or tea, two or three times a minute until the 64beating of the pulse can be felt at the wrist. Rub the arms and legs upward and the feet and hands with warm and dry flannel. Apply hot cloths to the body, legs and arms, and bottles of hot water to the feet.

Effects of Cold.—Frost Bites.

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

The fingers, ears, nose, and other projecting 65parts of the body are the first to suffer from an undue exposure to the extreme cold, assuming a blue or livid appearance caused by the weakened circulation, which, if continued and not speedily arrested and restored, will lead to mortification and death.

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

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

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

In no case should a person overcome by cold be suddenly exposed to any considerable degree 66of heat or taken into a well warmed room. This would only result in either seriously endangering the patient’s life, or in the case of frost bites killing the affected member or causing violent inflammation.

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

Frost Bites. When the cold affects some projecting part, as the ears, nose, fingers, and toes, rub the part with snow or cold water until the circulation is partially restored, and then with equal parts of brandy or some other spirits until the restoration is complete. Troublesome sores are often the result of frost bites and are 67difficult to heal. Red precipitate ointment is the best remedy for them, and where there is much inflammation, apply poultice.

Epilepsy.—Epileptic Fits.

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

Causes. There are many causes which give rise to these attacks, such as external injuries to the brain and spinal cord, fracture of the skull, etc.; or to internal injuries and diseases; worms, concretions, tumor, water on the brain, sudden frights, strong mental emotions, painful domestic troubles, especially in women of nervous temperament when pregnant, sexual excesses, self-abuse, etc. The disease may be inherited or due to predisposition occasioned by the plethoric or debilitated condition of the sufferer; when due to this latter cause, and happening after the age of puberty, it is generally difficult to cure, but if the attack occur 68in early life and is occasioned by worms or other accidental cause, a cure may ordinarily be anticipated. The seizures may take place at any period of life, but are more frequent between the ages of ten and twenty years; occurring during childhood, there is a possibility that the sufferer may outgrow the disease, but the probability is that it will become constitutional and incurable.

Symptoms. The attacks may be only a momentary and passing loss of consciousness, or one of a more expressed and serious nature. In the former case the symptoms are merely a sudden and brief loss of consciousness and a fixed, steady look in the eyes, loss of self-possession and an inclination to fall; but there is no swelling of the face, no distortion of the features, no foaming at the mouth, no biting of the tongue, no convulsions, and no warning cry, characteristics of the more serious class of these seizures. These latter are also sudden, and in general without warning. The patient may apparently be in the enjoyment of good health, when all at once he utters a loud and piercing shriek and falls down senseless and convulsed. The face becomes greatly distorted with the 69head inclined to one side. The eyes are set, or rolling wildly, the breathing is heavy and the skin turgid and livid; there is a blood-tinged froth around the mouth, due to biting of the tongue; the arms and lower limbs work violently; there is a choking sensation in the windpipe, and the sufferer is seemingly at death’s door.

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

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

70Treatment. During the attack but little can be done beyond keeping the patient from injuring himself by the violence of the convulsions. Place him in the middle of a bed, to prevent his rolling off, but if unable to lift him, leave him in a recumbent position with the head slightly raised, and insert a piece of leather or a tightly rolled handkerchief in the mouth to prevent the tongue being bitten. Loosen the clothing round the chest and neck and apply cold wet towels to the head and temples and hot water bottles to the feet if cold, allowing free circulation of the air. The treatment during the intervals must necessarily depend upon the exiting cause, as worms, injuries to the head, teething, etc., when attention will naturally be directed to its removal.

In all cases, however, the diet should be carefully regulated. Where the attack is due to a plethoric condition, the sufferer must be restricted to a light, nutritious, but not stimulating diet, avoiding everything that may produce a rush of blood to the head. The bowels must be kept regular, by the diet if possible, the sleep taken at regular hours, with daily exercise in the open air. When, on the other hand, the 71cause is due to general weakness and debility, a generous diet should be adopted, with tonics and other means for strengthening the system. Bromide of potassium, given in doses of ten to twenty grains in half a glassful of water, three times a day, has been found a very valuable remedy. The writer has experienced the efficacy of the following prescription:

℞

Soda of bromide, ℥i.

Ammonia of bromide, ℥ss.

Aqua, ℥vii.

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

72

Fainting.—(Fits.)

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

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

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

Treatment. When a person faints let him remain or place him in a horizontal position, with the head low; dash cold water on the face and 73neck, loosening whatever presses on the body and neck; allow the air to play freely round him, and apply smelling salts or camphor to the nostrils, not too frequently, and mustard to the feet, or rub the latter frequently. As soon as the patient revives and is able to swallow, give a small glass of equal parts of spirits and water.

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

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

When a fish hook has entered the flesh, do not wriggle it about till you have made an opening, nor try to work it out backwards. The best plan is, first, to cut the line from the hook, and then turning the point upwards, push it through in the direction in which it entered, until it pierces the skin; clip or file off the flat end of the hook, and taking the remaining portion by the point, pull it through. If the accident be caused by a crochet needle, which has 74entered deeply into the flesh, do not attempt to pull it out, as this will only inflame and tear the part, but get a surgeon to remove it; but if the services of one cannot be readily procured, first ascertain on which side the hook is, and then push a smooth ivory knitting needle down the wound till it reaches the hook and draw them both out together. Accidents from thorns, splinters and other pointed substances very commonly happen to the hands, feet, and legs. If such can be entirely extracted, no evil consequences will arise, but if the body has been penetrated or any part left in the flesh, inflammation is set up, sometimes followed by an abscess, which should be opened as soon as it has formed. Where the thorn, etc., cannot be taken hold of to remove it, a bread and water poultice should be applied till the offending substance is drawn out.

75

Fits.—Convulsions.

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

In adults, fits are apoplectic, epileptic, puerperal, or other seizure, as the case may be. They are due to narcotic poisons, such as opium, prussic acid, ardent spirits, and indigestible matter. Fits are not in themselves a disease, but only symptoms of a disease, and the treatment must consequently be determined by the cause creating it. In nearly every instance these attacks are so sudden that the 76necessity for immediate action is imperative, before professional advice can be procured.

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

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

Improper food and indigestion. If the 77stomach be at fault, give a mild emetic followed by a purgative dose.

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

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

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

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

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

Treatment. Adults. For adults, fits may be apoplectic, epileptic, cataleptic, hysterical, or seizure, as the case may happen. When a person is taken with a fit, loosen all portions of the clothing that presses on the body and neck, apply cold water to the head and volatile 78stimulants to the nostrils. The proper treatment, however, at the first, in each of these several varieties are fully set forth under their respective names.

Foreign Bodies in the Gullet.

When such foreign bodies, as coins, buttons, or marbles, are swallowed, they generally reach the stomach without much difficulty and are evacuated in the ordinary course of nature in a day or so. If the obstacle has not gone far down the gullet and can be reached with the finger and thumb, try and pull it out, or use a pair of curved forceps, which will reach a little lower. Or failing this, place one hand on the chest of the choking person and give a smart slap or two on the back between the shoulders with the other hand. Where the substance has gone some distance down the gullet, it may be pushed down into the stomach with some blunt instrument. If the stomach contain food when the accident occurs, an emetic of 5 to 20 grains of powdered alum or ipecac with water may be administered, but where there is no food in the stomach, it is advisable to distend the intestines 79by giving hearty meals of batter pudding, porridge, or something similar previous to the emetic being administered.

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

Foreign Bodies in the Windpipe.

These will, in some cases, remain a considerable time in the windpipe, but beyond producing a slight inflammation and an irritating cough, no immediate danger need be apprehended. If the obstacle has passed below the epiglottis (that is the valve, which, when a person is in the act of swallowing, closes down on top of the windpipe, and prevents the food from entering the breath-passage), but little can be done beyond giving the person a little snuff or ordinary 80pepper to induce sneezing, and get him to expel the air from the lungs by coughing suddenly and energetically a few times. This may have the effect of driving out the substance.

Foreign Bodies in the Ear.

Foreign bodies, flies and other insects, frequently find a lodgment in the ear. Only last summer, while I was stopping in the country, in the early part of the evening a number of persons were sitting on the piazza. A flying insect lodged in one of the ladies’ ear. Instead of the bug coming out, it was going further into the ear. Between the irritation and the buzzing noise of the bug, the lady was greatly annoyed. She was running in and out of the house, apparently going crazy. Every one in the house was in a great excitement, but fortunately it happened that I was in the house. I poured a few drops of sweet oil into the ear (thus killing the bug instantly, as oil will kill any insect), and then I syringed the ear with a little soap and lukewarm water. The bug floated to the top and was removed with 81the water. If a living insect gets into the ear, stuff up the ear with a piece of cotton wool, thoroughly saturated with a strong solution of common salt or vinegar, sufficiently large to plug it completely, thus preventing the admission of air. After its introduction, turn the patient on the affected side, and allow the hand to press firmly on the ear. In a few minutes the noise will cease, and if the plug at this time be withdrawn, the insect will probably be found partially imbedded in its substance. If not, take hold of the tip of the ear at the top and pull the ear up a little. This straightens the tube. Then pour sweet oil freely into it and hold it there for a while. Then wash out the ear with warm water and soap, and the insect will rise to the surface. If the insect is dead and remain in the ear, his presence need give no special anxiety, as it will come out itself a day or two afterward.

If any hard substance, like a bead, shell, button or pebble be pushed into the ear, a stream of warm water may be syringed with advantage, as, if the water pass in any way between the hard substance and the ear drum, it will not unfrequently force it out. That side 82of the head should be held towards the floor, so that the object may more easily fall out. But should it be something that will swell with moisture, like a bean, pea, corn, or seeds, no syringing should be resorted to, as it will excite the object to swell and increase the mischief, and dry heat must be employed. The patient should lie upon a sofa or bed with the affected ear turned downwards. Then give with the flat of your hand two or three sharp sudden blows on the ear, shaking the head at the same time, and most likely the offending substance will drop out. If you do not succeed, lie quietly down upon the affected side and send for a physician.

Foreign Substances in the Nose.

This vicious habit young children sometimes fall into of putting small objects into the nose, is not more remarkable than the variety of things which they put into the mouth, with this difference though, that their removal from the mouth is quite an easy matter, while from the nose it is oftentimes quite difficult, owing 83to the fact that the entrance is the smallest part.

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

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

84

Hydrophobia (Rabies).

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

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

Symptoms. The chief symptoms of this well known canine madness are: spasmodic contractions of the larynx, preventing the sufferer, though thirsty, from swallowing any kind of liquid. The moment water approaches his mouth, a spasmodic shudder seizes him and he pushes it away with horror. He suffers from pain and stiffness in the neck and the throat, which becomes contracted, and is filled with a sticky mucus which he is constantly endeavoring to spit out or extract with his fingers. 85Thus, between the convulsions and the comparative quiet which follow them and during which there is great depression of spirits, the unhappy sufferer dies either in a spasm or from sheer exhaustion.

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

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

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

86

Lockjaw.

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

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

87

Paralysis—Palsy.

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

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

Causes. The general paralysis is caused by the rupture of a vessel of the brain, which may take place, even in sleep, and without any previously marked apoplectic symptoms. Intemperance in either eating or drinking, mechanical 88injuries to the head or spinal cord, the pressure of blood or water on the brain, the striking-in of eruptions, all are inducing causes, but in every instance the brain is the source of the malady, and the disorder, if confined to one side and does not include both, will, in all probability, extend to the other.

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

Treatment. Bleeding and cupping in the neck is the right treatment for a person of full habit, and where the bowels are costive, they must be moved by purgatives of 5 grains of calomel, followed by a dose of senna mixture, 89or croton pills, or pulverized scammony, 12 grains; pulverized gamboge, 12 grains; elaterium, 2 grains; croton oil, 8 drops; extract of stramonium, 3 grains. Mix and make into 12 pills, and administer one every hour until it operates, and give an injection of castor oil, one gill; red pepper, 10 grains; molasses, one gill; table salt, one tea-spoonful, and one pint of warm water.

If the attack be sudden and severe and the symptoms similar to those in apoplexy, such as flow of blood to the head, throbbing of the temporal arteries, full and hard pulse, place the patient in a half declining position, loosening all garments, especially around the neck, and apply cold wet cloths or ice frequently to the head. See Apoplexy. In case of faintness and wandering of the intellect, administer a tea-spoonful of sal volatile in a glass of water, and, if required, repeat the dose in about an hour’s time. No alcohol must be given. Place the patient in a warm bed, with the head and shoulders well raised, and put the legs and feet in a hot mustard and water bath. Cupping the neck should be followed by a blister, and if necessary a seton be put in. The bowels, after 90they have once acted well, should be kept well regulated with rhubarb or castor oil. The diet should be spare, and the patient kept as quiet as possible. Where it is the lower part of the body that is attacked (paraphlegia), it is often very difficult to get the bladder to act properly, and when it does, the urine flows involuntarily. Great attention should be paid to this. Counter-irritants should be applied down the spine, such as blisters, moxa, compound of tar, or pitch plasters, and small blisters on the inside of the legs and thighs. In facial palsy, when due to a blow, a few leeches applied behind the ear and at the angle of the jaw, will prove beneficial. Hot fomentations and stimulating liniments should be used when the attack is due to cold, and also in the case where the hands or extremities are affected.

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

91

Poison—Ivy.

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

Poisons.

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

92In treatment, two objects are to be kept in view. First, how to get rid of the poison; second, to stop its action. The first is to remove the poison from the stomach by giving emetics to cause vomiting. The simplest way to provoke vomiting, is to give a table-spoonful of ground mustard or common salt in a tumbler of warm water, a quarter of it at one time, followed by a cup of warm water. Then another quarter, and more warm water. Keep this up until vomiting is secured. Tickling the back of the throat with the finger or a feather will help. Some of the emetics are ipecacuanha, tartar emetic, sulphate of zinc, and sulphate of copper. Sulphate of zinc in twenty grains doses is the best. Vomiting should be promoted until the stomach is entirely empty. The second indication is to use antidotes, such as sweet oil, vinegar and water, beaten up raw eggs, strong hot tea, warm milk, or strong coffee.

If stupor or sleep is impending, take the patient into the open air and walk him up and down. Dash cold water over the head and face, and keep up artificial breathing, if necessary, (see page 63), and do not on any account, until the effects of the poison are gone off, allow 93him to go to sleep. If you do, he never will wake again.