: '■.-.■■i ' FROM rHE MUTUAL LIFE ■ INSURANCE COMPANY ;" OF NEW YORK £faui fork Hate College of Agriculture At GfacneU Mnincraita Ktlfaca, N. f. ffiibtatjj Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924003520818 RC87.M95 0me " UniVerSi,yLibrary Accidents, emergencies, and illnesses; a 3 1924 003 520 818 ACCIDENTS EMERGENCIES and ILLNESSES A MANUAL FOR REFERENCE ISSUED BY The Mutual Life Insurance Company OF NEW YORK RICHARD A. McCURDY, President 1902 PUBLISHED BY THE COMPANY Copyright, 1900, BY Thb Mutual Life Insurance Company of New York. Board of Trustees SAMUEL D. BABCOCK Banker— Retired. Late firm Babcock Brothers & Co., N. Y. City RICHARD A. McCURDY President of the Company, N. Y. City JAMES C. HOLDEN President National Safe Deposit Co., N. Y. City HERMANN C. VON POST Oelrichs & Co., Agents North German Lloyd S. S. Co., N. Y. City OLIVER HARRIMAN Merchant — Retired, Late firm Low, Harriman & Co., N. V. City ROBERT OLYPHANT Ward & Olyphant, Miners and Shippers of Coal, N. Y. City GEORGE F. BAKER President First National Bank, N. Y. City Vice-President Central R. R. of New Jersey DUDLEY OLCOTT President Mechanics' and Farmers' Bank, Albany, N. Y, FREDERIC CROMWELL Treasurer of the Company, N. Y. City JULIEN T. DAVIES Counsellor-at-Law. Davies, Stone & Auerbach, N. Y. City CHARLES R. HENDERSON Banker. Henderson & Co., N. Y. City RUFUS W. PECKHAM Justice U. S. Supreme Court, Washington, D. C. J. HOBART HERRICK Banker and Broker. J. H. Herrick & Co., N. Y. City WILLIAM P. DIXON Counsellor at -Law. Miller, Peckham & Dixon, N. Y. City ROBERT A. GRANNISS Vice-President of the Company, N. Y. City HENRY H. ROGERS President National Transit Co., Standard Oil Co., N. Y. City JOHN W. AUCHINCLOSS Dry Goods Commission. Auchincloss Bros., N. Y. City THEODORE MORFORD Cashier Sussex County Nat. Bank, Newton, N. J. BOARD OF TRUSTEES-Continucd WILLIAM BABCOCK Commission Merchant. Parrott & Co., San Francisco, Cal. STUYVESANT FISH President Illinois Central R. R. Co., N. Y. City and Chicago AUGUSTUS D. JUILLIARD Dry Goods Commission. A. D. Juilliard & Co., N. Y. City CHARLES E. MILLER Counsellor-at-Law. Miller & Wells, N. Y. City WALTER R. GILLETTE, M. D. General Manager of the Company, N. Y. City H. WALTER WEBB 3d Vice-President N. Y. C. & H. R. R. R., N. Y. City GEORGE G. HAVEN Vice-President National Union Bank, N. Y. City GEORGE S. BOWDOIN Banker, Retired. Late J. P. Morgan & Co., N. Y. City ADRIAN ISELIN, Jr. Vice-President Guaranty Trust Co. of N. Y. Banker. Adrian Iselin & Co., N. Y. City WILLIAM C. WHITNEY Ex-Secretary of the Navy, N. Y. City WILLIAM ROCKEFELLER Standard Oil Co., N. Y. City JAMES N. JARVIE Arbuckle Bros., Coffee, N. Y. CSty CHARLES D. DICKEY, Jr. Banker. Brown Bros. & Co., N. Y. City ELBRIDGE T. GERRY Counsellor-at-Law. 261 Broadway, N. Y. City A. N. WATERHOUSE Life Insurance. Lambert & Waterhouse, Philadelphia, Pa. WILLIAM J. SEWELL United States Senator. Camden, N. J. JAMES SPEYER Banker. Speyer & Co., New York CHARLES LANIER Banker, Winslow h Lanier & Co., N. Y. PRCrACE. This book has been prepared and published in the hope that it will be of service in alleviating suffering and saving life by the timely application of the advice and instruction contained in its pages. In some respects it is a revised ediiion of two pamphlets form- erly published by The Mutual Life Insurance Com- pany of New York, entitled " Plain Directions for Accidents, Emergencies and Poisons " and " Plain Directions for the Care of the Sick." These little volumes were printed originally in 1875, and several large editions have since been gratuitously distributed. It has been deemed advisable to re-write them and em- body in the new production such additional changes in the matter as the advance in medical science dur- ing the past twenty-five years rendered necessary in order to make the teachings of the book conform to present practices. The book has been written and revised by competent physicians for gratuitous dis- tribution and is intended to indicate what should be done in cases of ordinary accidents and illnesses prior to the coming of the skilled assistance to be fur- nished by the trained nurse and the medical adviser. If what is hereinafter written shall in any way tend to prevent unnecessary suffering or contribute to save the life and activity of some member of the commu- nity, the company will feel amply rewarded for the trouble and expense involved in the preparation and publication of this book. CONTENTS. PAGE. SECTION I. ACCIDENTS .... 5 II. EMERGENCIES 51 III. POISONS 79 IV. CARE OF INVALIDS .... 115 V. REMEDIES 157 INDEX 167 SECTION I. ACCIDENTS. A policy in The Mutual Life Insurance Company of New York may not prevent an accident, but it will materially aid in recovery. INTRODUCTION. Scarcely a month passes by that we do not meet somewhere an accident or an emergency in which a little reliable information would be of the greatest service. One of the difficulties usually to be contended with in such cases is a lack of knowledge on the part of the bystanders as to what should be done. It will be found, as a rule, that the simplest and usually the most useful things are neglected, while there is a dis- position to rely upon cumbrous appliances, which are often disadvantageous, and sometimes positively hurt- ful. The object of this pamphlet is to present in a compressed form, for easy recollection and ready reference, a few suggestions as to what should be done in certain cases of emergency before the arri- val of skilled professional assistance. It is, perhaps, not too much to say that what can be done to give relief or save life must in many cases be done by some one before the aid of a physician can be procured. It has been truly said, "for want of timely care, millions have died of medicable wounds." As far as possible, the use of technical terms will be omitted, although where necessary they will be used, with a brief definition inclosed in brackets; but the writer would respectfully suggest that, whenever possible, the scientific terms be remembered and used, instead of the popular expressions for the same thing. A scientific term, the world over, means but one thing; while a popular expression, in one place, means one thing, and in another, two or three things ; and possibly, nothing at all. $&" InBore In Thb Mutual Lm IitacHAiroi Co, ot Nsw Yobr.) A wise precaution against accidents of all kinds is a life policy in The Mutual Life Insurance Company of New York. ACCIDENTS IN GENERAL. An accident usually assembles a crowd around the victim. The first thing to be done is to get the people away from the injured person. A space of at least ten feet on every side should be kept wholly free from everybody except the one or two who are in charge of the operations for relief. If others are needed to assist in some special duty, as lifting, removing of dress, etc., they can be specially selected from the crowd for the moment and then dismissed. The kindest thing a bystander can do is to insist upon a free space around the injured person, and to select Crowds and from the crowd those who will hold themselves in readiness to start for whatever the physician or the individual in charge of the case may require. To show how little real interest the inside layer of the crowd takes in the restoration of the patient, it will often be almost impossible to get one of them to run an errand in the interest of the sufferer. If the person has been t hrown from a ca rriage, in- jured by a fall from3 _height,-h1ow_oX-Qlhex-cause, while tEere may be nof racture or ot herjxternal injury evident, the nervous system has received what is called a "shock." As is commonly said, the person is "faint." A person suffering with such symptoms should be placed flat on the back, with the h ead, ne ck (CS" Ininre In Tax Hbtual Lctb Insitiiavok Oo. oiHiw Tobk.) 10 ACCIDENTS IN GENERAL. and sho ulders slightly raised. The limbs, at the General treatment of an injured person. Removing an injured person. same time^shouldbe straightene d out, if practicab le ; so that the hea?T7~which is already depressed in action, may act at as little disadvantage as possible. The crava t, collar and every thing else ca lculated to impede t he circulation toward the head or the movements of the chest snould be loosened or re- moved, - If the injury is slight, reaction will soon take place after giving the person a sip o f col d_water, br andy (a_ teaspoonful in a tablespoonful of cold water), or aromatic spirits o f ammonia (twenty drops in a tablespoontul of cold water) repeated_jnj^few minutes. Gentle friction s, to the extremities; a few drops nf_ rnlngnp-wafgr nn a handkerchief to the nostrjtjQ. if the weather is hot, the u se of a palm-leaf fan^ hot flannelsJLo the li mbs and epigasfnum7~(pit of the stomach), are all_likewise useful irfassisting reaction. By this time, should a surgeon have arrived, he will examine and decide upon the special nature of the injury, and inaugurate measures of special relief. Should he have not appeared, and it is thought best to remove the patient to the hospital or his home, a stretcher should be procured, or a substitute in the shape of a settee or shutter. The injured person shgaM—be— gg ntly slipped o n if, the^Jbody being su£p^rte^_3s__rxmch__as__pDssible along its lengtl^and the face cov ered so as__to— prevent, as much "as practicable, the uncomfortable— feeling of being stafe3Tj£3y~paslserg^b_y. Four persons of uniform-gait should then gentlvjift the stretcher and slowly carry the person to his destination^— In most cities, appliances for carrying injured persons are kept at the station-houses, and^can_J)e obtained__on \SSf Insure In Tub Mutual Lips Inbdranoi Co. ov Hew York.) SHOCK. 11 application, as well as^ the services of a good police- man. The authority of the latter is almost invaluable in keeping away the crowd while conveying the person through the streets. If the person is to be taken to the hospital, a dispatch from a police-station will secure, free of charge, an ambulance with competent attendants to take charge of the injured individual. Directions for fracture and dislocations are given elsewhere, pp. 32-33. SHOCK. Mild forms of shock, or collapse, as it is sometimes called, are^often, by the non-professional, confounded with fainting (syncope), and an ordinary attack of fainting is analogous to shock. The symptoms be- tween the two vary rather in degree and duration than in kind. Life_may_be destroyed by certain agencies, as a blow upon the "pit of_the_ stomach /' or a sudden and pow- erful emotion of the mind, and no visible trace be left in any part ofthe_bpdy^ This is called "death from shock" and is the extreme result of shock. Usually the patient lies in a state of utt er prost ration. There is pallor of the wKole suTf^ eJIh elips a re blood- less and pale. ""ThTeyes lose_ their lus ter, and the Symptoms, eyeball is usually partially - covered by the drooping upper lid. Tn~e~hostril s are usuafly jlilaifd. The skin is covered with a j^oldj_clammy moisture, often gath- ered in beadiTof swgaJL upon the .forehead. The tem- perature is Tow, and perhaps the person shivers. The weakness~oT~tEe~ muscles is most marked; as the phrase is, "the patiemiJgjrostrate57' The mind is bewildered, often insensible, unless - aroused ; and in ( t&~ Insure In The Vctual Lifs Ihsurancx Go. or Nxw Tone) Shock. 12 Causes. Influence of age. many cases, nausea and vomiting are_p_re§ent. In extreme cases, the nausea and~vomiting are not so apt to occur. - Sudden and severe injuries, particularly if extensive cause -shnrk . B urns — e specially of children — ex- tending over a larg e surface, even if not. to a great depth, are often followed by shock, and this com- plication requires the earliest attention. Certain poisons, as tobacco-asd— tartar emetic, act in this manner, depressing the system. So does a current of electricity-r-aaJa-seen in the effects of light- ning. Loss of blood produces or_aggravates shock. Hence a slight injury, with much loss of blood, may be at- tended with more shock than a co mpar atively more severe injury without the loss of blood. Debility favors the influence flf__shock. A weak system is more easily impressed by it, and, as should be ex- pected, reaction from its effects is longer in taking place. As the vital powers of life decline, from engrafted or natural causes, there is less power available as a reserve to meet contingencies. In youth there is an available fund of this kind; in the adult the re- sources of the system may be equal to the task of ordinary maintenance, but in the aged, as said before, there is much less ability to deal with sudden losses of strength. The aged, therefore, are slow to rally from the effects of shock. They have more power of re- sistance than the young. The shock does not readily make an impression, as it does in the young, but when it does, the impression endures. In the young the impression is more easily made, but sooner sub- sides. (tSTlnsure In Tub Mutual Lipk Insurance Co. or Niw Yobk.) SHOCK. 18 Treatment. — This consists in first placing the patie nt as flat on his back as possible, wit h the head ra ised not overm an inch. This is an important point in cases of~ of shock. whenever the vital powers are lants ^re^reguired. The aromatic character of brandy enables it to be retained by the jtomach when whi sky a nd other forms of alcohcda re rejected . A teaspoo nful on crac ked ice eve ry minute, u ntil six_or eight-hav* been taken, is the best way to give it. If the temperature of the bodyis _raised by it, and there seems a revival of the action of the heart, enough brandy has been"gjyen. Twenty jropsofth e arom atic spirit s of am monia-4a- a teaspoonf ul of water ma y be given every co urjle_oi min utes, un til four or jive dos es have been tak gn^-Applicatio ns of heat tn the ext remi- Treatment ties and "pi t of the s tom ach" are ver y usef ul. F lan- nels wrung put m-hot watery or bottle s nf hot water properly w rapped u p. sho uld not be n eglected. _ Mus- tard-p lasters ar e ofte n used, but they are so i nferio r to heat for the purpose, if that can b~F app"Ii edTand-so~apt to blistevthereby makinglt impossible to use anything else on the surface, that some reluctance is felt in ad- vising them. Nause a and -vnmjtjng are often prgsent in shock, and can best be allayed by getting thepatien T-to- swallow small chips - oTTclT whole. Ice canjje easily chipped by standing the piece jarith_the grain up- right, andr'splitting off a thin edge with the point of a pin. --"" Ammonia (smelling salts), applied to the nostrils, is often useful: and colog ae, on a handkerchief, is fre- quently pungent enough to be of service in the same way. (17* Insure in Th» Mutual Lira Insuranob Co. op Nsw York.) 14 FAINTING — ASPHYXIA. Treatment of fainting. FAINTING. The head of the party who haa_fainte4-6hould be kept lo wer_ than-the rest of thejjgdvj. Should the person be sitting in a chair at the moment, stand be- hind the chair, reach the hands over in front, so as to grasp the sides of the chair, take a step backward, and then slowly depress the back, the head being sup- ported until the floor is reached. An assistant by holding the knees will prevent lateral slipping off from the seat of the chair. It is so rapidly and easily done, besides so effective in its operation, that little-eke re- mains to be done. Usually the back_pi-the head of the patient scarcely reaches theTToor before conscious- ness returns. ASPHYXIA. Meaning of asphyxia. This commonly used word signifies an absence of p ulse. It states a condition, but not the c ause , and indicates suspended ^ animation , produced by the non- con version of the ve nous b lood in— the. lun gs i nto arterial. The supply of good air to the lungs being cut off by some cause, the necessary purification at that point no longer takes place, and death_of the entire body ensues from the absence of arterial blood, or the presence of venous blood ; some physiologists regard it as due to the one cause, and some to the other. In other words, the person dies because the blood is not purified. There are several varieties of asphyxia: (i) As- phyxia from submersipjiT-fis in the ordinary^ drowning in water or other fl wids ;-(2) asphyxia-feem mechanical causes, as by strangulation, or ha nging, and by-for- ' Treatment. — The burnt surface should be cle anse d carefully by allowing~~water to^JjrickTeT over it. The sTan~~over~a~T3lister should n ot be cutj off^ but should be snip ~ped wit h scissors near the edgg , and T re . : , ,-, t ,-, , the water gently squeezed out. This allows the skin to rem ain as a protective. If the blister re-forms, it may be necessary_Jo_ repea t th i s -op eratio n. If the burn or scald is slight in character, one of the best applications is the cold water dressing, p. 32, keeping the lin ens used constantly w et. In more s evere cases a v er y good ap plication- is carron oil, which is a mixture of linseedojL water^ in eq ual par ts. Sweet-oiriu'onejs_v£ry__,g od. Vaseline, wit h a little boric acid rubb ed up w ith it, is also very soothing. Lard and baking so3a~mixed will relieve_pain j: _ Wheaten flour is often dusted over the burn ; but this, with the dlschargesThardenT, and Ts^oTaslittle comfort as an appTlcaTTolT'oPsHair^rustsnor^bread would beJto_the_Sjured parti Cotton wool (c arded cotton^^cojttojLb^ttmgyis^often used,TiuTthe fibenTbe- come imbed^ejJn_the_d^schaTges7^n^~th^h^annot be detacTiedw ithout p ain anddlsturbance of the wound. Talcmn^owderrorTFuiler's ESthTTs^very^useTuTas Flour or cotton-wool not to be used. * Xamre In Tax Mutpai. Lira Insurance Co. op Nhw York.) 88 BURNS. Very simple measures. If shock or pain is present. Scalds. drying powders after the blister has been cut, or any of the skin becomes detached. If the burn or scald, particularly the latter, is super- ficial in character, a simple and useful dressing is the application by brush or a soft wisp of old muslin, of the white of egg to the injury. As soon as the first layer dries, another should be used. A lather of soap from the shaving-cup, applied by the brush in the same way, is often followed by immediate relief. These substances protect from the action of the air the ir- ritated nerves beneath. If a physician has been sent for, it is better not to make any domestic applications to the burned parts. Such things frequently prevent him from using those better adapted, and keep him from forming a cor- rect estimate of the real extent of the injuries. If there is much shock and depression, stimulants will be needed, such as aromatic spirits of ammonia, brandy or whisky. If there is much pain, laudanum can be given, five drops every two or three hours, until four or five doses have been administered. Burns and scalds practically differ but little from each other. Scalds are usually more confined to the outer cuticle, unless the substance containing the heat is viscid in character, as oil, pitch, etc., and does not rapidly run off the part with which it came in contact. As far as popular assistance is concerned, the two may be regarded as presenting no essential difference. Burns by lime, caustic potash and other alkalies. BURNS BY LIME, CAUSTIC POTASH, AND OTHER ALKALIES. As a rule, these are troublesome, since there is not only removal of the cuticle (superficial skin), but de- struction of the soft parts below. Lime is a powerful alkali, and rapidly destroys the parts with which it (QT Xniar* In Tub Mutual Lips Inaubamci Co. or Nsw York.) BURNS— CONTUSIONS. 29 comes in contact. As it is useless to attempt to pick it off, an application should at once be made of some- thing to unite with the alkali, so as to form a compara- tively harmless preparation. Vinegar diluted with water, lemon juice or any other dilute acid will answer. These things do not undo what has been done; they only prevent further mischief. The subse- quent treatment is the same as for burns. And what has been said about the alkali known as lime, may be said about other alkalies, potash, soda, ammonia, etc. BURNS BY ACIDS — SULPHURIC ACID (OIL OF VITRIOL), NITRIC ACID (AQUA FORTIS), ETC. As alkalies destroy the living tissue they come in contact with, so will acids of sufficient concentration. In such cases, applications of water will dilute them beyond their capacity to injure. Alkalies neu- B ^ ns b y tralize acids into harmless preparations, and cooking soda, washing-soda or saleratus can be used for this purpose. Common earth, gathered almost any- where, applied in handfuls, contains alkali enough of one kind or another to entitle it to the consideration of being one of the best (and at the same time most easily secured) applications in cases of burns by acids. CONTUSIONS. These common injuries are termed "bruises" by most people, and are the only injuries, besides Contusions wounds and fractures, produced by blows or pressure, or bruises. The injury may be of the simple form; only a slight shaking or jarring of the texture, with no visible change, except what results from the rupture of the (ty Insure In Tris SIctdal Lips Insurance Co. of Nxw Yohje.) acids. 30 CONTUSIONS. Symptoms. Treatment. blood-vessels. This is the most frequent. In the more severe but less frequent form, the contusion means broken blood-vessels, muscles, and tissues be- tween and around them; the parts are thoroughly crushed, sometimes to a pulp, damaged beyond re- covery, and ready to perish in the gangrene resulting from the extreme form of such an injury. In contusions, the first conspicuous symptom is that of shock, which generally, but not always, bears a relation to the extent of the injury. Thus a crushed finger is attended, as a rule, with much less shock than a crushed hand or foot. Contusion of certain parts, as the' larger joints, breasts, and other portions of the body, are followed by most severe symptoms of shock. The pain is not always as severe as might at first be thought, for the nerves are so much injured as to be deprived of their ability to receive and trans- mit the necessary impression. The quantity of blood escaping from the ruptured vessels depends, in a large degree, upon the size and number of the vessels injured, but in some degree upon the space in which the blood can accumulate. A single divided vessel in the scalp, owing to the loose- ness of the tissue in which the vessels are distributed, may permit a swelling, the result of the escape of blood, extending in area over a half of one side of the head. Discoloration is due to the color of the escaped blood, seen through the cuticle, and varies from black- ness usually indicating intense injury, through dark blue, purple, crimson, down to delicate pink, indi- cating only a blood-stained fluid. Treatment. — In the milder contusions, there is but little shock. Should there be more, place the patient * Insure In The Mutual Life Insurance Go. op Mew York.) CONTUSIONS. 31 on the back, head not elevated, and give stimulants as directed. (See shock, p. 13). The next thing is to limit the consequences likely to ensue from the rup- tured blood vessel. This is best done by lessening the supply of blood to the part by elevating this, if pos- sible, above the heart, and applying cold in the shape of powdered ice, tied up in towels, to the part, and along the course of the larger vessels going to the injury. A large piece of ice secured in a towel, so that the pieces cannot escape, can be reduced to fine fragments by a blow or two against the wall. After it has been on for a time, water may be substituted in the shape of a drip;* or several thicknesses of wet towel, may be applied, only they must be dipped in cold water, squeezed out, and changed every minute or two. If not changed, the wet towels really act as poultices to the part, inviting what we should try to prevent. When the surgeon appears, special meas- ures will be directed by him. Recollect it takes a great deal of heat to convert ice into water, and water into vapor, and if the patient has not got this heat, symptoms of chilliness will be observed. When this happens the application must be stopped, and the moisture must be taken up by a towel ; particular at- tention always being paid to keep the bed-clothing and everything else perfectly dry and neat. A common accident is a "mashed finger" from the member getting caught in a closing window, or want * A pitcher, or some other vessel of water, placed higher than the injured parts, with a moistened string or strip of linen. One end of the string is placed in the water, while the other hangs down on the outside, so that the water will drip along the string from the vessel to the point of contusion. (J3** Insnre ]n The Mutual T.ifr Iksuhancb Co. 09 New York.) 82 CONTUSIONS — FRACTURES. Mashed fin- ger and its treatment. of precision in using a hammer. The firm bone be- neath and the blow above usually contuse (bruise) the tissues (veins, vessels, muscles, etc.), between, and often the pain and other symptoms last some days. Wrap up in a bandage of old muslin, and keep con- stantly wet with cold water, or some mild astringent like Pond's Extract. If there is much pain add laud- anum. The discoloration and swelling may remain some days after the pain subsides. Stimulating lini- ments can now be used to encourage an extra flow of pure blood to the part and the washing away of the injured blood. FRACTURES. Fractures, varieties of. These may be divided for our purposes into two varieties — the simple and the compound. In a simple fracture the bone is broken and there is some lacera- tion of the soft parts around it, but no break in the skin. In a compound fracture the skin over the seat of the fracture is also broken, and sometimes the bone protrudes. There is always some shock, and great pain in the broken bone, especially if it is stirred. If surgical assistance can be obtained without removing the pa- tient, he should be left lying quietly. All that need be done is to cut the clothing over the affected part and put on it cloths wet with cold water, which will allay the pain to some degree. If he has to be re- moved, it will be necessary to make some kind of a splint which will hold the limb immovable. The best thing for this is two pieces of board, each long enough to extend beyond the joints above and below the broken bone and a little wider than the thickness CI3T Insure In Thb Mutual Life Isbukakcb Co. of Nbw York.) FRACTURES — DISLOCATIONS. 33 of the limb. These boards should be well padded with cotton batting, or several layers of cloth, or wool, or hay, or anything that will be soft enough to take off the direct pressure of the boards. They should then be placed on each side of the limb and firmly bound to it by tying handkerchiefs or strips Treatment, of cloth around them. If boards cannot be obtained, anything stiff may be used, as canes or umbrellas. A very good splint for the leg is a pillow, which is placed under the leg and then bound firmly around it. The patient can now be placed very gently on a stretcher, made of a shutter or a bench, and carried very care- fully horned Of course it will be necessary to consult surgical advice in order to have the bone properly set. If the fracture is compound, the break in the skin should be treated like any other wound and some antiseptic directly applied. (See p. 42 et seq.) Other- wise the treatment is the same as for a simple fracture. Simple fractures may be converted into compound fractures by careless handling. Therefore never lift an injured person until you have satisfied yourself as to the presence or absence of a fracture. DISLOCATIONS. These occur when one bone is displaced from an- other at a joint. Little can be done to reduce them Dislocations except by surgical aid. If it is necessary to move the patient before this can be had, it should be done very gently, and the parts kept as immovable as possible. If the dislocation should be compound, as rarely hap- pens, the open wound should be treated antiseptically. (See p. 42 et seq.) A joint which has been dislocated is |3F* Insure In The Mutual Life Insurance Co. of Xew York.) 84 DISLOCATIONS — SPRAINS — WOUNDS. Sprains. much weaker than before, and can be easily dislocated again. SPRAINS, These are due to the stretching and tearing of the ligaments around a joint, and are accompanied by great pain and swelling. Hot-water applications are the best to relieve the pain and reduce the swelling. The joint should be kept absolutely at rest. The best way to secure this is to strap the joint for some distance above and below with adhesive plaster, layer upon layer. Any weak spot which develops in the dressing can be easily rein- forced by an extra layer or two. Care should be taken that the strapping is not so tight as to interfere with the circulation of the blood. This can be determined by noting if the part below the strapping remains warm. If it becomes cold and remains so, the strapping is probably too tight, and should be promptly removed. After all, sprains are very unsatisfactory to treat. Not infrequently they take a longer time to heal than a fracture, and the joint is usually left weakened. WOUNDS. For systematic study, wounds may be classified ac- cording to their direction, or depth, or locality; but Wounds, f° r our purpose they may be arranged after the mode varieties of. of their infliction, (i) Incised wounds, as cuts or in- cisions, including the wounds where portions of the body are clearly cut off; (2) punctured wounds, as stabs, pricks, or punctures; (3) contused wounds, which are those combined with bruising or crushing of the divided portions; (4) lacerated wounds, where itW Insure la Thk Mutdal Lipb Insurinok Go. op New York.) WOUNDS. 85 the separation of tissue is effected by or combined with tearing of them; (5) poisoned wounds, including all wounds into which any poison, venom or virus is in- serted. Any of these wounds may be attended with ex- cessive hemorrhage or pain or the presence of dead or foreign matter. As all wounds tend to present several common features, a few words will be said about these before describing the distinctive charac- teristics of each. The first is hemorrhage (bleeding). This depends, as to quantity, upon several conditions, the chief of which is the size of the blood-vessels divided; and, to a degree, upon the manner in which it has been done. A vessel divided with a sharp instrument pre- sents a more favorable outlet for the escape of blood „ rrha than one that has been divided with a blunt or serrated f rom instrument, or one that has been torn across. Except wounds, in the first named, the minute fringes or roughness necessarily left around the edges of the vessel at the point of division retard the escape of blood and fur- nish points upon which deposits of blood, in the shape of clots, can take place. Hence, all other things being equal, an incised wound is usually attended with more hemorrhage than contused or lacerated wounds. The bleeding may be simply an oozing from the smallest blood-vessels, called the capillaries. This Capillary form of bleeding is not of much consequence, and can hemorrhage, easily be checked. It may be from a vein, and is then called venous. The veins are larger vessels, which are carrying the blood back to the heart. The blood from them is < . e ™° rr . age irom veins. purple and flows evenly without any force. (py Insure in The Mutual Life Insurance Co, of New Tobk.) m WOUNDS. Hemorrhage from arteries. Other symptoms of wounds. The bleeding may be from an artery, and is then called arterial. The arteries are large distributing vessels which carry the blood from the heart to the extremities. The blood from them is bright red and flows in pulsations or jets, with some force. This is the most dangerous form of bleeding and the hardest to control. While we are not able sometimes to tell the kind of hemorrhage from a given wound, we should al- ways try to determine it, for there may be consider- able difference in the treatment. There is always some pain present in a wound, and this varies largely with the location and extent of the injury. Often it is not near as much as we expect to find. In wounds of large size there is some shock, and when the wound is very extensive and crushing, the state of shock may be profound, even up to uncon- sciousness. In some people the mere sight of blood may be enough to cause fainting. This, of course, is very different from shock and much easier to treat. TREATMENT. There are several indications to meet in the treat- ment of a wound, and it can best be described under Treatment, the following heads : First — To stop bleeding. Second — To clean the wound. Third — To dress the wound. Fourth — To relieve the other symptoms. First. — Nature stops bleeding by causing the blood to coagulate into little clots, which plug up the open mouths of the divided blood-vessels and prevent any more blood from flowing out. The smaller the blood- itST Insure in Tub Mutual Lifh Insttbancs Co. op Nsw Yokx.) wounds. 87 vessel and the more sluggish the current of blood in it, the quicker this is done. Therefore, this coagula- How to tion occurs quickest in the capillaries, next in the stop the veins, and last of all in the arteries. All that we can hemorrhage do is to aid nature in this by making the current of blood flow slower or by making the mouths of the vessels smaller. If the wound is small and the bleeding mostly capil- lary oozing, the part should be elevated, and firm pressure applied directly to the "wound, preferably through a clean wet cloth. A few minutes of this will capillaries usually be enough. If it does not, we can try again, or we can apply water just as hot as can be borne with- out scalding, or we can apply pressure with a piece of ice wrapped up in a clean handkerchief or thin cloth. Heat and cold contract the blood-vessels, and pressure not only does this, but slows the current of blood. If the bleeding is from a small vein, the above meas- ure will usually be enough. If the vein is larger, the pressure may have to be applied for some time. To {rom velns do this, roll up a handkerchief or clean cloth into a small hard wad, wet it thoroughly and then bind it firmly over the wound by means of another handker- chief or a strip of cloth. It may have to be kept on for some hours before the clots in the vessels are strong enough. The pressure should be sufficient to check the bleeding entirely. If the bleeding is from a small artery, the above measures will often be enough, but if the artery is of any size, they alone will not do. As arterial bleed- trom arteries ing is very fast, whatever we do must be done quickly. We must bear in mind that besides applying pressure and heat or cold directly to the wound, what we wish to do is to slow the current of blood in the artery so lt3T Insure in Thh Mptdal Lira Insusancb Co. of Nbw Tobe.) WOUNDS, that firm clotting can take place. Now the blood is flowing in the artery from the heart to the wound. Therefore, if we can compress the artery above the wound, we diminish or stop altogether the flow of blood toward the wound. We will first consider the case of a wound in the upper extremity. The large Course of the artery which supplies the arm passes out of the chest over the first rib and under the collar-bone. It then reaches the side of the arm just behind and below the front fold of the arm-pit. It now passes down the side of the arm, gradually turning to the front, until, at the elbow, it is right in the middle. Its course is shown in the accompanying cut. main artery of the upper extremity. Note— The arm and forearm, with dotted lines, indicate the course of the arteries, and points at which pressure can be most judiciously applied. The arrow points the course of the current of the blood of the artery, from the heart to the extremities. d&'Inswe in TnB Mutual Lipb Insurance Co, of New York.) WOUNDS. 39 The part under the collar-bone is called the sub- clavian artery, that in the arm-pit the axillary, and that along the side of the arm the brachial. Pressure can best be applied along the brachial, the pulsations „ of which can be felt. It should be outward and slightly of arter j a i backward against the bone, and can easily be done by hemorrhage means of the fingers or thumbs firmly applied. While from the one person is doing this, another can tie in a handker- u PP er chief a small round stone or a piece of wood or a watch, or anything that is hard. If nothing like that can be found, tie several firm hard knots into one mass in the middle of the handkerchief. Lay the stone or knot over the artery right by the fingers that are compressing it. Then tie the ends of the handkerchief around the arm in a loose knot, through which is slipped a stick. By twisting this around and around we tighten the handkerchief until the blood extremity. &&• Insure In Thb Mutual Lifb Insubamcb Co. op Nbw Yomr.) 40 WOUNDS. Course of the main artery of the lower extremity. entirely stops flowing, but no tighter. This consti- tutes a "Spanish windlass" and is very effective. Its application is well shown in the preceding cut (p. 39). If the wound is in the forearm, we apply this just above the elbow. If the wound is high up in the arm, it may be necessary to compress the subclavian. This is done by thrusting the fingers or the handle of a large key firmly down behind the collar-bone and pressing the artery firmly against the first rib. It is difficult and painful to maintain pressure here for any great length of time. In the lower extremity the artery reaches the thigh just where it joins the abdomen, and it can easily be felt pulsating about the middle of the groin. It then passes down the inner surface of the thigh, gradually turning backward until it can be felt at the back of the Note — The thigh and groin, with dotted lines, suggest the course of the large arteries, and point at which pressure can be most successfuly used. The arrow indicates the direction of the current of the blood of the artery, from the heart to the extremities. (t^lDBure in Thx Mutual Lin Ihscbanob Co. o» N»w Yon*J WOUNDS. 41 knee in the middle between the cords. In the thigh it is called the 4ejaotaLattefy, back of the knee the popli teal. Its course is shown in the preceding dia- gra]ir(p. 40). Pressure can be used as indicated, and the applica- tion of the Spanish windlass is well shown in this cut : Treatment of arterial hemorrhage in the lower extremity. If the wound is below the knee, we can usually con- trol the hemorrhage by applying pressure to the pop- liteal artery, although as this is rather deeply situated, we may find it necessary to apply it to the femoral as shown in the above cut. If an artery in the scalp is cut, firm pressure over and around the wound will always control it. It is well to remember in a great emergency that nearly any bleeding can be checked for a time by Direct thrusting the fingers into the wound and pressing di- pressure, rectly upon the bleeding point. Second. — After the bleeding has entirely stopped, the next step is the cleansing of the wound. First (gylOHK 1e In Hctuai. Lin Ihsrk&nos Cc. 07 tfsw Tob* 48 WOUNBS. Cleaning of the wound. Ways in which wounds heal. we ought to make sure that our hands and our clothes are thoroughly clean. We should scrub our hands with soap and hot water and a nail-brush. It is ad- visable, if possible, to boil the cloths we use and the water we need for washing the wound. The surface around the wound should be thoroughly washed with soap and water. The wound itself should be very gently washed, and any clots lying on its surface carefully wiped or washed away. Then all the soap should be washed away with plenty of water. After this we should apply liberally to the surface of the wound, and all around it, one of the following solu- tions: Carbolic acid, 1-30; or corrosive sublimate, 1-2000; or boric acid, 5-100. (See pages 164-165.) Third. — The next step is dressing the wound. This varies considerably, according to the nature of the wound. Wounds heal usually in one of two ways, by first intention or by granulation. Healing by first intention occurs when the wound is clean and the edges can be brought together and kept so. There is very little reparative material needed, the time of heal- ing is short, and the scar left is thin and inconspicu- ous. Healing by granulation occurs when the edges of the wound cannot be brought together. The repara- tive material is poured out abundantly on the surface of the wound in the form of little granulations. These gradually increase and grow until they bridge over the gap in the tissues made by the wound. This takes a longer time, and the scar left is much larger. As the scar keeps contracting for a considerable time after the healing is completed, it sometimes causes serious deformities. When a wound becomes in- flamed, it is due to the presence of certain germs which multiply in the wound and irri- {tgrlnsure In Tbi Morrj ll Lira Imsdhabok Co. o* Nbw YobxJ WOUNDS. 43 tate it. These cause suppuration, the formation of "matter" or pus, which prevents healing by first intention. These germs are very common, and can only be kept out of a wound by thorough cleanliness and the use generally of some antiseptic which destroys them. If it is a small incised wound, the edges can be brought together by gentle pressure, and three or four layers of flexible collodion (see page 165) applied, for some distance around and over the wound, each layer being allowed to dry before the next is put on. If we have not this, we can cover it with adhesive plaster. Dr essin<* f If it is a large incised wound, we have to use adhesive an incised plaster, putting the strips across the line of the wound wound. and taking care that the edges of the wound are brought close together. The accompanying cut shows this very well, although the strips of plaster may have to be placed closer: :(3rloit?T*. !n Th« Hutual Lren Inscbancb Co. o» Ngw York.) 44 WOUNDS. Treatment of an inflamed incised wound- Dressing of a lacerated or contused wound. We then dust liberally over the entire length of the wound some dry antiseptic powder, such as iodoform, bismuth subnitrate, or the bismuth and boric acid mixture (see page i64). Over this we place two or three wide layers of lint, or absorbent cotton, or clean cloths which have been well boiled and dried. The whole is kept in place by a few turns of a bandage or strips of cloth or plaster. We are thus careful in the dressing in order to prevent suppuration. If the wound does not show signs of inflammation, such as pain, heat and throbbing, we can leave this dressing on for a week or more, and when we take it off we expect to find the wound healed. When a wound be- comes inflamed, we recognize the condition by these signs. In such a case we remove the dressing and see in what part the suppuration is taking place. We then take off the strips of plaster over that part. This permits the pus to escape if it has not already done so. We then wash out the cavity gently, but thor- oughly, with one of the antiseptic solutions and dust into it one of the dry antiseptic powders. This dress- ing will have to be repeated every two or three days. It is of advantage to give a free purgative, such as Epsom or Glauber's salts, when a wound becomes inflamed. If a wound is lacerated or the edges are badly con- tused, we do not expect to get healing by first in- tention. We do not try to bring the edges together, for it would be useless. Hence we omit the plaster in dressing such a wound, but in all other respects it should be treated like an incised wound. Inflammation, is much more common in this class of wounds, but oftentimes can be avoided by care. Even if it does not occur, we usually have to change the dressings a surgeon. ^f FOREIGN BODIES IN NOSTRILS AND EAR. The curious disposition of children to insert foreign bodies, as grains of coffee, corn, peas, pebbles, etc., up the nostrils, and into the ear, is too well known to need more than a mere allusion. If the body is soft, it absorbs moisture from adjacent parts, becomes swollen, and more difficult to remove. If the body is hard, the irritation and inflammation soon set up by it in contiguous parts materially increase the diffi- culties of removal. Hence the sooner these SUb- t'y lu sure la Trb Mutual Lips Ikiubamos Co. of Kiw Yobk.) FOREIGN BODIES IN NOSTRILS AND EAR. 59 stances are removed, the more easily will it be accom- plished. If the foreign body is up the nostril, the child should be made to take a full inspiration ("a full breath") ; then if the other nostril be closed with the finger, and Treatment of the mouth with the hand, the air of the lungs, escaping foreign through the nostril closed by the foreign body, bodies in the assisted by a sharp blow from the palm of the hand nostnl - to the back, will often expel the substance. If it will not escape in this way, and it is near the opening of the nostril, compression by. the fingers, just above, will prevent it getting further up, and it can be hooked out with the bent end of a wire or bodkin. Should these measures not remove the for- eign body, the child must at once be taken to a surgeon. / Foreign bodies in the ear are more troublesome to 'deal with. No effort to remove them with a probe, or anything: of the kind, should be made by any one , re ^tmento , . , , , . foreign except a professional man, for fear of permanent in- bo( j; es ; n tne jury to the ear. The head of the child, face downward, ear . should be firmly held between the knees, and with a Mattson's or Davidson syringe a stream of tepid water should be injected into the ear. The nozzle of the syringe should not be introduced into the cavity, as its presence may prevent the dropping out of the de- sired body after the water has been forced past and be- yond it. Should this means not succeed, consult a surgeon without delay. Insects sometimes get into the ear. The best way insects in the of getting them out is to hold the head of the person ear. with the disabled ear upward, and fill the cavity with sweet-oil or glycerine. This drowns the animal, by ((^Insure In Tub Mutctal Lips Insotlincb Co. of New York.) 80 BLEEDING FROM NOSE AND THROAT. Bleeding from the nose. Spitting of blood. closing up its breathing pores, and in a short time it floats to the surface of the fluid used. The tube of the ear is slightly curved, and when straightened somewhat by catching hold of the upper tip, and gently pulling it upward toward the crown of the head, the liquid flows in more readily. BLEEDING FROM THE NOSE. Bleeding from the nose is sometimes troublesome, but not often fatal. In severe and prolonged cases professional assistance can usually be had, and if not, the remedies and appliances to be used, cannot be properly described here. The most important thing is not to disturb the clot, closing the little ruptured vessels, by blowing the nose. The person should be kept flat on his back, the collar loosened and cold applied to the back of the neck. Do not forget that a small amount of blood will stain quite deeply a large amount of water. One common practice should be carefully avoided — that of holding the head over a vessel and letting the blood drip into it from the end of the nose. This attitude simply congests the head and prolongs the bleeding. SPITTING OF BLOOD. If the blood comes from the lungs, it is suggestive of trouble there, but not always so in young people, especially in young women. The amount of blood lost is in itself rarely fatal. As salt is always given in such cases, it has acquired a good deal of popular confidence for arresting the loss of blood. It and frag- •ments of ice may be given, and the person made to lie quietly on the back. Of course, a doctor should be sent for at once. ( £y Insure in Tub Mutual Lure iNauRAHon Co. or New York.) POISON-VINE — SUNSTROKE. 61 POISON-VINE ERUPTION, Several varieties of the Rhus, popularly known as the swamp-sumach or poison-sumach, poison-vine, and poison-oak, when brought in contact with the skin of many persons, produce itching, redness, a sense of burning, tumefaction, and even blistering. Sometimes the swelling is so great as to disguise the features. Poison-vine Some persons coming within the influence of merely eru P tion - the emanations from different species of the Rhus ex- perience the same symptons. The poisonous effects are usually observed shortly after exposure, and begin to decline within a week. Weak alkaline solutions — say a teaspoonful of com- mon baking soda to a quart of water, or even lime- water — kept to the part by dipping pieces of linen in them, are useful in allaying the inflammation. The addition of laudanum relieves the pain. Weakened lead-water is also recommended. Cream from milk is perhaps as useful as anything else. SUNSTROKE. Ordinary exhaustion, from overwork in a heated at- mosphere, is about the only disorder likely to be con- founded with sunstroke. The distinction between the Sunstroke, two will not be attempted here, as there is no essential difference in the treatment. Contrary to what is generally supposed, exposure of the head to the direct rays of the sun is not essential for sunstroke, as statistics show that it may occur in the shade, under shelter, and even at night; sometimes, Causes, even in persons who have not been exposed to the sun for days before. Intense heat, either solar or artificial, is necessary to produce it. Workmen in sugar re- (CST Insure In The Mutual Life Insurance Co. of New York.) 62 SUNSTROKE. Warning symptoms. Symptoms of the attack. fineries and laundries, engine and boiler rooms, are not infrequently subject to it. Sunstroke appears to be decidedly favored by intem- perance and want of acclimatization, and the debility which has been brought on by fatigue in a heated at- mosphere also favors it. Occupants of badly-venti- lated sleeping apartments appear to be oftener at- tacked than those who sleep in purer air. Symptoms. — It is generally thought by the non-pro- fessional that the symptoms of sunstroke come on without any warning whatever. Most cases, however, are preceded by pain in the head, wandering of the thoughts, or an inability to think, disturbed vision, irritability of temper, sense of pain or weight at the pit of the stomach, inability to breathe with the usual ease and satisfaction. These symptoms become more marked until insensibility is reached, sometimes pre- ceded by delirium. The skin is very hot, usually dry, but when not dry, covered with profuse perspiration. The face is dusky, or, as the saying is, "blue" ; breathing rapid and short, or slow and sighing. The action of the heart, indi- cated to the hand placed over it, is weak, rapid and tremulous, often compared to the "fluttering of a bird." In many instances, from what is popularly termed the commencement of the attack until it ends in death, the patient does not move a limb, nor even an eyelid. The breathing gradually fails; the blood therefore is not purified in the lungs, as is indicated by the livid, purplish appearance of the surface. We are led by it to conclude that death takes place by asphyxia, as described under the heads "Drowning," "Suffoca- tion," etc., pages 15-20. {X3T Insure in The Mutual Lite Ikscbawc* Oo. of New York.) SUNSTROKE. 63 While we know that certain things favor the disorder, that a high temperature is necessary to pro- duce it, and advise certain measures of precaution and relief, found by experience useful in such cases, but little is really known of the nature of the malady. It would seem that the great heat of the body induces some change in the character of the blood, disqualify- ing it for the usual purposes of blood. From this peculiar condition of the blood, the portions of the brain or nervous system controlling the action of the muscles of the chest and heart lose their ability to superintend properly the movements of breathing and circulation, and, as said before, the person dies from asphyxia. Treatment. — The person attacked should be carried at once to some shady spot. If a house in the neigh- borhood has a bath-tub large enough to hold the Treatment entire body, he should be taken there. The tub should if a bath-tut be filled with cool water. If it cannot be obtained cool is available, enough, ice should be added. The entire body should then be immersed, with the exception of the head, over which an ice-cap should be placed. This can be made very easily by putting a large fragment of ice in a towel and striking it a few times against the wall, thereby breaking it into small pieces. The pa- tient should be kept in the bath for ten or fifteen min- utes and then placed in a bed between blankets with- out being dried. If, at the end of fifteen minutes more, he shows no signs, or very feeble ones, of re- turning consciousness, he should be replaced in the bath and treated as before. This can be repeated at intervals of fifteen minutes, until consciousness is quite well established and the body remains cool. After being quite comfortable for some time, it occasion- (t3T Insure in Tbb Mutual Life Insurance Co. op New To»k.) 84 SUNSTROKE. Treatment, if a bath-tub is not available. Other measures of treatment. Preventive measures. ally happens that the person becomes stupid and his body gets hot again. If this occurs, repeat the bath, as before. If no bath-tub is available, the person should be placed in some such shady spot, as a large room, the shade of a building, or a tree. His clothing should be stripped off and his body and head thor- oughly sponged w'th ice-water for twenty minutes, using it very liberally. This should be repeated in fifteen minutes, as in the case of the bath. In fatt, there is no difference in the two methods, except that by means of a tub we can apply cold water much more thoroughly. Artificial respiration, until the natural breathing re- turns, may be resorted to, if necessary, as soon as the heated condition of the body is overcome. The dash- ing of cold water over the chest and face is a useful means of encouraging a return of the suspended breathing, and is practiced in asphyxia from other causes (page 14). The ready methods of page 13, however, had better be relied on for this purpose. Medicines, it will be seen, are of little value in this malady. A stimulant, however, may be useful, and the best stimulant in all such cases, if it can be ob- tained, is the aromatic spirits of ammonia, fifteen or twenty drops in a tablespoonful of water, which may be given every few minutes, until three or four doses have been taken. Prevention. — During very hot weather all use whatever of malt, fermented, or distilled drinks should be abstained from. Not only do they favor, in a general way, a condition of the system in many respects similar to that which leads to sunstroke, but they deaden sensibility at the very time that it ought C>tW Insure in The Hutiml Lira Insubance Co. op New Yobk.) SUNSTROKE. 65 to be on the alert, and the person is less able to detect slight changes in his feelings, which otherwise might have served as useful guides. Everything in any way calculated to impair the strength should be avoided. Sleep is a most wonder- ful restorer of strength, and the want of it is often caused by a badly-assorted late meal of the evening before. Defective ventilation leads to a condition of affairs favorable to the malady under consideration. Every night a bath should be taken ; but as this is not always possible in every house, the entire body should be washed off each night before lying down. Labor- ing men who work in the sun have no excuse for neglecting this, for water costs nothing, and three minutes' time is all that is required. Drinking large quantities of cold water, merely be- cause it is cold, should be avoided immediately be- fore, during and after meals. The debility resulting from the heat weakens the digestive powers, and water unnecessarily, used to excess at the times named tends preventive still further to retard the digestion of the food by weak- measures ening the solvent action of the secretions of the stom- (continued), ach. In other words, if there is a time above all others, the year around, when precaution for the preservation of health is required, it is during the hot months of summer. Loosely fitting light garments should be worn, if possible. Particular attention should be given the head. It should be protected from the heat of the sun, and at the same time the covering worn should favor the circulation of a free current of air over the scalp. A straw hat of loose texture, with a lining to the crown which can be kept constantly wet, ought to be worn ; <6^" Insure in Thb Mutual Lips Insdbancb Co. or Nirw York.) 66 FROST BITE. Frost bite, where located. Symptoms. and if it has brim enough to protect the neck, and even the shoulders, the wearer is more fortunate than other people. While attention should always be paid to these things in hct weather, it is particularly necessary, if any symptom be observed on some special day, that the greatest care should be taken not to let it extend into an attack of sunstroke. Discontinuance of work until the symptoms disappear, in such a case, would seem to be the only course to be pursued. It is said that persons who have once suffered from sunstroke, for a long time after are unable to bear much exposure to the heat without a recurrence of the symptoms of the malady. FROST BITE. Exposure to severe cold often leaves the fingers and toes, nose and ears and lips, more or less frozen. This condition, short of absolute death of the part, is termed frost bite. It will be observed that the portions of the body just enumerated are those most exposed, in area, to the influence of the cold, and are furthest situated from the heart; and it will, perhaps, be un- necessary to remark that persons who are debilitated are more apt to suffer with the same amount of ex- posure than the robust. When the circulation of any part begins to suc- cumb to the influence of the cold, it becomes puffy, bluish and smarting. This is because the blood moves more slowly than natural through the vessels exposed near the surface. Soon this blueness dis- appears, and the part becomes pallid, as if the influence of the cold had contracted the vessels to an extent in- compatible with the passage of blood through them. (JSTlosuro In The Mutual IiIfh InsfRANOB Go. op Nrw York.) FROST BITE. 67 The pain at this point ceases ; indeed, until the sufferer meets a friend, he often does not know of his mishap. At this stage, the injury has become so great that, unless proper means are taken to restore circulation, there ensues complete death of the part, which in due time sloughs away, and is detached from the living tissue. What takes place in a part of the body may take place in the whole of it, and then the person becomes "frozen to death." The blood of the extremities being general gradually forced from them, under the continued sub- freezing, jection to the cold, is driven inward upon the larger blood-vessels, heart, lungs and brain. There is in- creasing difficulty in breathing, owing to the engorged state of the chest, and, what should always be remem- bered by one so exposed to cold, an unconquerable de- sire to sleep. To sleep then is to die. If the person exihibits such a symptom, he must, by all means, be kept constantly moving. Treatment. — Persons exposed as described, must be treated promptly, and one thing should never be Treatment of lost sight of, that is, to keep the frozen person general away from the heat. A person taken up insensi- freezing, ble, or nearly so, from exposure to the cold, should be taken into a cold room and his clothing re- moved, and be thoroughly rubbed with snow, or with cloths wrung out with ice-water. The fric- tion to every part of the body, particularly the ex- tremities, must be continued for some time, until signs of returning animation appear. When the frozen limbs show signs of life, the person should be carefully dried ; put in a cold bed in a cold room ; artificial res- piration used until the natural is established; then brandy given, also ginger-tea and beef-tea. Usually, (f^~ Insure in The Mutual Life Insurance Co. of New York.; 68 FROST BITE — CHILBLAIN. Treatment of frost bite. Chilblain, symptoms. Treatment. by this time medical advice will have been secured to direct further treatment. Should this not be the case, do not forget that the patient is to be brought by degrees into rather warmer air ; and lest in some part there might still be defective circulation, he should be kept away from exposure to the heat of the fire. Milder degrees of the same condition, as suspension of life in the ear, nose, finger, or toe, from exposure to cold, must be treated with the same general directions in view. The part should be kept away from the heat, and rubbed with handfuls of snow, or with towels dipped in cold water, until circulation appears re-estab- lished. Exposure of the part to the heat before, as we might say, it has been rebuilt, is apt to be followed by sloughing. CHILBLAIN. As the name implies, this occurs when the circula- tion of the part has become chilled — disturbed — not destroyed. It is generally attended with much itching, tingling and smarting, and is usually found in the toes, outside edge of the feet, just where the toe emerges, or in the heel. Sometimes, in persons of debilitated state of health, the hands suffer. These symptoms are par- ticularly annoying just after lying down in bed. The most useful thing for these annoying symp- toms is to keep away from the fire, and every night, before retiring, bathe the feet in cold water, or rub them with snow. They should then be well dried with a soft towel. After this, the appli- cation of the ordinary compound resin ointment of the apothecaries is often of use in stimulating the circulation through the part. The efficiency of this ointment for the special purpose can be increased by asking the apothecary to add to an ounce of it a (17* Idsufo In The Mutual Life Inbukance Co. o* New York.) CONVULSIONS. 69 couple of drams of the oil of turpentine. It may be remarked, that persons who suffer in winter from cold feet are often benefited to a surprising degree by bath- ing them at night, before retiring, in cold water. Such persons should always keep their feet away from the fire. CONVULSIONS. Convulsions, or "fits," as they are often called, are a frequent cause of alarm in the streets, or at public assemblages. In the decided majority of instances, the convulsions may be safely presumed to be epileptic ; so, unless otherwise specified, the remarks here made epilept i c apply to that form. Ordinary fainting may be con- founded with it ; but here the face is pale, the person perfectly still, and there is no perceptible breathing. Besides, in fainting there are no convulsive move- ments. Frequently the epileptic seizure is ushered in with a peculiar sharp cry, as the person falls over. This does not always occur, but when it does, there can be no doubt, ' if it is a convulsion at all, that it is epileptic. There is frothing of the mouth, sometimes, tinged with blood from the tongue or a fold of the lips having been caught between the teeth at the moment the spasm commenced in the muscles of the jaws. Sometimes there are general convulsive move- ments of the whole body ; often of parts of it only. At first the face is pale, but usually, in the course of a few moments, it becomes livid, except around the mouth, which often continues pale, in strong contrast with the color of the rest of the face. As a general rule, it may be said that the convulsive feature of attack does not last much longer than four or five minutes, although to bystanders the time naturally seems longer. Then (tW Inenre in Tete Mutual Ltpb Insitbanoe Co. op New York.) Symptoms. CONVULSIONS. the person opens his eyes with a certain degree of in- telligence, or revives enough to speak ; and it is usually at this point of the attack that the most must be done. Sometimes there is nothing beyond it, and the individ- ual gets up, hurriedly puts on his hat, and walks off, apparently the least concerned person of all. If this happy termination does not take place, the brief semi-conscious interval gives way to a heavy stupor, varying in duration from thirty minutes to three or even six hours. Treatment. — In epileptic convulsions, there is usu- ally nothing to be done. Ignorant people on such oc- casions are apt, upon the general plea, "If you do not know what to do, do something," to insist upon "open- ing the hands," as the phrase is, saying that the pa- tient will be better as soon as they can do it. The truth is, they cannot do it until the patient is better. All interference of this kind is hurtful, and no good can come of it. All rude efforts aggravate the trouble, perhaps by exhausting still further the muscular strength of the patient. All that can be done is to keep the person from in- juring himself or hurting others during the violent convulsive movements, by removing him to some clear space, where there is nothing to strike against. Do not attempt to hold the limbs, but loosen every- thing about the throat and chest. A folded handker- chief or a cork can be slipped between the teeth, so as to prevent biting of the tongue. Care should be taken that it does not interfere with breathing. Wait a few minutes for the convulsive movements to cease, and the semi-conscious state to appear. As said above, it will soon be seen. Then, if the person is a stranger, get his name and residence, if possible, (OTIiwnre In Tnc Mutual Lrpa Insurance Co. of New Tons.) CONVULSIONS. 71 with such other knowledge as may be useful. In the meanwhile, keep the crowd away. This is a very important measure of assistance in convul- sions, as in every other emergency. By this it is not meant that no one must bend over the victim, but that a perfectly free space of at least ten feet on each side should be kept, with none in it but the one or two persons immediately assisting him. Thirty drops of the aromatic spirits of ammonia, in a teaspoonful of water, may be given to the patient, as it is thought by many physicians to lighten and shorten Treatment the later stage of stupor. The spasmodic condition after the of the muscles of the jaws, by means of a little gentle convulsion dexterity, can usually be sufficiently overcome to per- mit of the introduction of the restorative into the mouth by the assistance of another spoon or a piece of smooth stick. After getting the liquid into the mouth, press down the base of the tongue, and the mixture will readily run down the throat. As much of it will necessarily be lost during the operation, double the quantity may be prepared for use. If more than the thirty drops should be given, no trouble from it need be feared. If the name and residence have been secured, the friends of the person can be notified. If not, he should be taken to some place of security until consciousness returns. Persons liable to epileptic convulsions "should never be permitted to go from the house without a strip containing the name, residence and disease, attached E P ile P tics inside of the coat, where it will at once be seen upon , . , , , , always carry unbottoning the coat over the chest. A reference on their name it to a memorandum in some pocket containing a and address. suggestion as to the duration of the attack, and to (^"Insure In The Mutual Life Insurance Co. of New York.) 72 CONVULSIONS — DIARRHOEA. Apoplectic convulsions. Hysterical convulsions. some remedy which assists restoration, would often materially add to the comfort and advantage of the afflicted person. Other convulsions are apoplectic. These are com- paratively uncommon. As a rule, little can be done by bystanders, further than loosening everything about the neck. This should be done in all convulsions. The convulsions known as hysterical are usually found in young women who are not very strong. Until assistance comes, act as directed in epileptic con- vulsions. The distinction between them cannot be- expressed to unprofessional persons. Diarrhoea, causes. Symptoms. DIARRHEA. This very common summer complaint may be due to several causes. It may be caused by simple ex- cess of food, especially fruits and vegetables; or by improper food, such as these same things, when un- ripe; or by food that has begun to decompose, even though so slightly as not to be detected by the senses ; or by changes in the weather, the so-called catching cold, although this latter is more of a predisposing cause than an immediate one; or by changes in the drinking water. The symptoms vary much in severity, cases ranging from two or three movements a day to thirty or forty. The movements may be accompanied by pros- tration, by no pain or by considerable. The cases range from the harmless attacks, which no one pays much attention to, up to the border line of dysentery. In all cases the condition exists that some unsuit- able material is present in the intestines, that the latter are trying to get rid of it, and are already irritated by (t^-Insure In The Mutual Lira Insosakce Co. o» N«w Yobk.) DIARRHOEA. 73 it. We have then two indications ; First to remove this offensive matter. Second, to allay the irritation caused by it. For the first there is nothing better than castor-oil, a tablespoonful or two of which should be taken at once by an adult. A little less may be given to children, but they stand it very well. If this cannot be had, we can give a few grains of calomel or a few teaspoonfuls of Epsom or Glauber's salts in water; but these are not as good as castor-oil. To allay the irritation present in the intestines, we can apply hot cloths to the abdomen, and these are made more efficient by adding a few drops of turpen- tine to the hot water in which they are dipped. A large mustard plaster is also good. This should be quite weak — one part mustard to ten parts of flour — and should be made with cold water. These local ap- plications can be made as soon as we have given one of the purgatives above mentioned. In three or four hours more we can give some medicine, which will soothe the intestines. A simple but effective one is blackberry brandy with bismuth subnitrate, a table- spoonful of the former and an even teaspoonful of the latter every two or three hours. If much pain is present, we can add five drops of laudanum to each dose. Care should be taken that the diet is very sim- ple for the next few days, consisting mainly of milk, eggs and toast. If blackberry brandy cannot be had, any other mild astringent can be used. Even Pond's Extract will be of service. The bismuth will make the movements black, but that should not alarm any one. In very mild cases the castor-oil alone may be enough to cure the trouble. If the movements are at all frequent, it is better for the patient to remain in bed. (tylnioje in Tex Mutual Lot Ivbubascb Co. 07 Nsw Tobk.) Treatment 74 DYSENTERY — CHOLERA. Dysentery. DYSENTERY. When the movements are quite frequent, contain- ing blood or mucus, and are accompanied and fol- lowed by griping pain, the condition known as dys- entery is present. This is much more serious than diarrhoea, and every means should be taken to obtain the advice of a physician. If this cannot be had the measures indicated under "'Diarrhoea" should be car- ried out, and will oftentimes succeed. They must be done thoroughly, and if the attack lasts longer than two days, it will be necessary to give the castor-oil every second day. If blackberry brandy is not used, it will be necessary to give some other stimulant — a tablespoonful of brandy or whisky in water or milk every four or five hours. Cholera morbus, causes. Symptoms. CHOLERA MORBUS. This disease is due in most, if not all, cases to the eating of some poisonous food. This may be poison- ous naturally, as in the case of some mushrooms, or it may be so from beginning decomposition. De- composition causes in many foods, even before it can be detected by the senses, the formation of certain active principles called ptomaines, and these are often very irritating to the stomach and intestines. The symptoms are frequent retching and vomiting, profuse diarrhoea and marked prostration and weak- ness. These symptoms last only a few hours, as a rule, but they are sometimes fatal. A physician is nearly always required, as usually the medicines have to be given hypodermically, owing to the vomiting. Nothing should be given by mouth at (CF"Insnre In Tub Mutual Ldi ImuRixci Co. op N*w York.) Treatment CHOLERA. 75 first — not even water or ice. Hot cloths or a mustard plaster may be applied to the abdomen, and the ex- tremities can be rubbed to relieve the cramps which are often present. If no aoctor can be had, five drops of laudanum without any water can be placed on the tongue, and repeated every fifteen minutes until five or six doses have been taken. Some will be doubtless vomited, but enough may be absorbed to have some effect. After the vomiting has ceased for two hours, teaspoonful doses of brandy may be given every fifteen or twenty minutes. If any diarrhoea is present the next day, it should be treated. The diet should be very simple for a few days. EPIDEMIC CHOLERA. This is a very severe and fatal disease, spreading over the world in epidemics which regularly begin in Asia. From this circumstance it is often called Asiatic Epidemic cholera. It is caused by certain germs, which are usu- ally taken in with the drinking water, and then develop in the intestines. The symptoms are very much like cholera morbus, but much more fatal, one or two out of every three attacked dying. Little can be done during the attack except by a doctor. If he cannot be obtained, follow out the same treatment as laid down in cholera morbus. During an Treatmenf - epidemic of cholera, every diarrhoea, no matter how trifling, should be treated promptly and thoroughly. As a preventive measure during an epidemic, all the drinking water, and the water used in preparing the food and washing the dishes, should be well boiled. None of the ordinary filters are of any use. (pyinaure In Ths Motoal Life Insurance Co. op New Yohh.) cholera. 76 VOMITING — MALARIA. Treatment of vomiting. TO CHECK VOMITING. If due to mere irritability of the stomach or nervous system, the aromatic spirits of ammonia, in twenty- drop doses in ice-water, every few minutes, iced min- eral-water, iced champagne, thirty-drop doses of brandy, a mustard-plaster, cayenne-pepper plaster, broken ice in a bladder to the stomach, or opposite, over the spine, are all useful. This last often suc- ceeds where other things fail. Sometimes the vomiting is a proper effort to get something out of the stomach that ought not to be there. If this is known to be the case, assist it with a solution of salt and water, or pulverized ipecac- uanha. Malaria, cause of. Varieties. MALARIA. This disease is now known to be due to a living germ called the Plasmodium malariae. The Plas- modium obtains entrance to the blood from the drink- ing water, or possibly is injected through the skin by mosquitoes. There are several species of this or- ganism, and each gives rise to a distinct type of the disease. The symptoms of the disease are so well known and usually so easily recognized that we will not describe them. The most common variety in this country is inter- mittent fever, also called "chills and fever" and "fever and ague." In this there is a distinct interval between the chills during which the patient feels comparatively well. The chills and fever usually occur every other day, and then we speak of it as the tertian type; or every day, being then called quotidian ; or every third (grlnanre Id The Mutual Lir iNBDmiNOI Co. or N.w Yob*,] MALARIA. 77 day, then being called quartan. Or the symptoms in- cluding the fever may persist without intermission, and then we speak of it as continuous or remittent malarial fever. Or the disease may pass into a chronic state, without chill or fever, which is commonly known as "dumb ague." There is also the very severe form known as pernicious fever. This usually begins as ordinary chills and fever, but after one or two at- tacks the symptoms get very much worse in the next one, the patient becomes delirious, then stupid and unconscious, and dies in a few hours. Besides these varieties there are other rare forms, too numerous to mention. The treatment can be summed up in one word — quinine. This is best used in the form of bisulphate, which is more soluble and less irritating than the common sulphate. It is well to precede the adminis- tration of this by a dose of calomel, five or ten grains, to relieve the congestion of the liver, which is often present. Then take quinine, ten grains three times a day, until three days after the last chill. The dose can now be reduced to five grains three times daily until the seventh day after the last chill. Malaria has a distinct tendency to reappear on the seventh day, and for this reason it is a good plan to increase the dose on that day to ten grains three times. If this point is safely passed, quinine should still be taken for a week, one dose of five grains daily. In some cases quinine seems to lose its efficacy. In these Warburg's Tincture, which is a mixture of quinine, with aloes and aromatics, is of great service. A tablespoonful should be' taken each morning, fasting. In other cases, Clark's Powder will prove of value. This consists of quinine, ten grains ; capsicum, three grains, and pow- <£ZF"Iosure Id Thi Mdtual Lira Ihsctrahob Co. op New York.' Treatment Preventive measures. 78 MALARIA. dered opium, one grain. One dose should be taken about four hours before the expected chill, and small doses of quinine during the intervals. If quinine causes much headache or ringing in the ears, this can be largely overcome by taking bromide of sodium or potassium, grain for grain, with each dose of qui- nine. To prevent the development of malaria certain pre- cautions can be taken, which are of value. One should not go out after sunset, nor near freshly plowed land. The home should not be in a hollow and the bedroom should be on the second floor, or higher. A cup of strong coffee before getting up is also of service. The most efficient preventive, however, is a small dose of quinine, say two grains, every morning on arising. This can be kept up for a long time with benefit and without harm. (tSTIninre In Th* Mutual Lto Inbttbancb Go, op Nxw Tobk.) SECTION III. POISONS The effect of the accidental administration of poison may be greatly mitigated by a policy in The Mutual Life Insurance Company of New York. 81 POISONS. Under this term people are inclined to place only those things which, if taken internally, produce death. Physicians, however, consider it merely a relative term, and call anything a poison that does more harm than good to the body. A little of a good thing may be useful, but, beyond the point of usefulness, may be injurious. An exaggerated injury from the same cause may well be termed a poison. There is not a single poison in the entire list, which, in proper quanti- ties, and under favorable circumstances, may not be used with advantage to the human body; and on the other hand there is scarcely a single thing in ordinary use, which if indulged in beyond the require- ments of the body or its ability to properly dispose of it, may not be followed by symptoms of derangement of the economy, and in the above qualified sense is not miscalled, if termed a poison. In the majority of cases, the poison is introduced into the body through the stomach and as soon as swallowed may commence destructive action upon the ac tion mouth, throat, or stomach, as in the cases of acids, alkalies, arsenic, phosphorus, etc. While some sub- stances act in this way, others pass from the stomach through the mucous membrane without injuring it in- to the blood and are carried by it to the brain and other portions of the nervous system, where the really injurious action begins, overpowering them so that the breathing and action of the heart are not kept up. To this class of poisons belong alcohol, aconite, bella- donna, opium, strychnia, etc. B^" Insure la Thb Mutual Lips Insurance Co. of New Yobk.) Definition of a poison. Mode of TREATMENT OF POISONING. Treatment in general. A knowledge of the mode of action of a sub- stance will, therefore, of itself suggest an antidote or remedy. If an alkali has been taken, an acid will neutralize it, converting it into a compound less hurt- ful. The new compound is, perhaps, injurious, but not so active, and can be removed from the stomach some- what at leisure. On the other hand, if an acid has been taken, an alkali would naturally suggest itself as an antidote. Some poisonous substances cannot be neutralized by any convenient article, and must be removed from their lodging-place as soon as possible, and their ef- fects counteracted. If the agent does not act upon the stomach directly, but upon the brain and nervous system, reaching it through the blood, a recollection of what was said when certain gases have been inhaled will meet the case. Artificial respiration would, of course, be re- sorted to. This should continue until enough of the poison in the blood has been eliminated by the natural processes constantly going on in the body to permit the brain and nervous system to resume one of their old duties, that of attending to the respiration and cir- culation of the blood. As few persons have the necessary knowledge of the different poisons, each of these substances will be spoken of somewhat in detail, and alphabetically ar- ranged, so that, in case of need, immediate reference can be made to the particular substance supposed to have been taken. It should never be forgotten that the substance swallowed as a poison must be considered in its action as divided into two parts: that portion which has al- ready acted upon the mucous membrane (lining) of the Tbw York. ) 98 MINERAL POISONS. contains enough tannin to make it useful as an anti- dote. An insoluble, and perhaps inert, tannate of antimony is formed. ARSENIC. Poisonous In some places this is called "ratsbane," and poison- varieties of i n g often occurs from it. The yellow sulphuret of. arsenic. arsenic (orpiment), the red sulphuret of arsenic (real- gar), and the arsenite of copper (paris green), em- ployed in the arts have all been used internally with fatal effects. All these sources of poisoning by arsenic should be surrounded by every possible precaution to prevent them from being accidentally used. Many "fly-poisons" contain it, and what is used in medicine under the name of Fowler's Solution is a solution of arsenic. Arsenic acts as an irritant tp the stomach and Use of bowels, in many respects like antimony and its emetics. preparations. As soon as it becomes known that arsenic or any of its preparations has been swal- lowed in poisonous doses, the poison taken should be dislodged from the stomach, as far as pos- sible, by vomiting (see "Emetics," page 83), assisted by the finger to the throat, or the feather part of a quill. Free drinking of milk, white of egg and water, or flour and water, should be encouraged. Not only do these things encourage vomiting and dilute the poison, but at the same time they tend to envelop the particles of the poison until the mass can be removed from the stomach. The antidote to arsenic is the freshly prepared hy- drated sesquioxide of iron. This can be had of any (£&" Iaauro Id Tub Mutual Lipb Inbubanob Co. or New York.) MINERAL POISONS. apothecary in a few moments of time. It is quite jhe antiaote harmless in character, and may be given in almost and its any quantity. The iron, in this particular form, com- preparation, bines with the arsenic, forming a temporarily harm- less preparation. This newly formed compound should not be permitted to remain and be digested, but must be dislodged afterward by an emetic, which the bulk of the antidote favors. The hydrated sesquioxide can be made by almost any one in a few moments. Take a glass tumbler, or a graduated measure, pour in three or four tablespoonfuls (quantity not of much importance) of aqua ammoniae, and then a tablespoonful or more of tincture of chloride of iron. Instead of the ammonia we may use a strong solution of cooking or washing soda, two or three teaspoonfuls dissolved in as many tablespoonfuls of water. A thick, dark, reddish precipitate, like brick-dust, is at once seen in the mixed liquids, which may be increased in quantity by gently stirring with a broom- splint. This precipitate is the sesquioxide, and it must be separated from the liquid by spreading a fine handkerchief or closely woven piece of muslin over a cup and pouring on the mixture. The liquid will run through, leaving the desired oxide of iron as a reddish-brown, jelly-like powder. To free it from any excess of either substance used in its formation, a half pint or so of tepid water should be poured on in a gentle stream to wash the precipitate. The washed precipitate is now ready for use. A teaspoonful of it may be given every few minutes. Calcined magnesia and pulverized charcoal have also been recommended as antidotes in poisoning by (Z&" Insure In Thb Mutual Lifb Insubancb Co. osNbw Yoke.) 94 MINERAL POISONS. arsenic, but of their value nothing can be said by the writer. BARYTA. baryta. Copper. Treatment of copper- poisoning. This substance, largely used to adulterate certain paints, is sometimes accidentally swallowed in pois- onous doses. The antidote is water, acidulated to about the strength of lemonade with sulphuric acid. This con- verts the baryta into an insoluble compound, which must be dislodged from the stomach by an emetic. Epsom salt or Glauber's salt may be used instead of sulphuric acid. COPPER. Poisoning from copper occurs most commonly through the careless use of utensils made of it. Most acids form soluble salts with copper; hence acids should never be used for cooking purposes in copper vessels. Many of the ordinary vegetables and fruits contain enough acid to form poisonous salts with the metal. Even sugar, from the ease with which solu- tions of it are changed into acids, should be cau- tiously used in contact with copper. When copper is mentioned it must be understood to include brass and other alloys into which copper enters as a necessary component. The stomach must at once be emptied by an emetic, and copious draughts of milk, or the white of eggs mixed with water. Carbonate of soda (the ordinary baking-soda or cooking-soda will answer) is said to be an antidote. As much as will lie heaped up on a (tFTnauro in The Mutual Lifb Insurance Co. of New Took.) ] Iodine. Iron. MINERAL POISONS. 95 silver quarter can be given every five minutes, in water, or in the other named liquids. Yellow prus- siate, or ferrocyanide, of potash is an efficient anti- dote, if it can be obtained pure. IODINE. The common tincture of iodine, used for external application, is the usual form of this poison. Starch, in water, is a mild antidote, and may be freely given until vomiting is secured by an emetic. IRON. The form usually taken is a solution of the sulphate of iron (copperas, green vitriol). Its action, like most of the poisons heretofore described, is that of an ir- ritant poison in the mucous membrane (lining) of the stomach and bowels. The antidote is carbonate of soda. LEAD. Poisoning by this substance usually is due to the Lead acetate of lead (sugar of lead). The carbonate of lead, the "white lead" of the painters, and the red oxide ("red lead") are also sometimes swallowed in poison- ous doses. They all act as irritant poisons. The treatment of such cases consists in giving, as . ,. . , . , , , , , ' Antidote an antidote, water acidulated to about the strength of f or lead . lemonade with sulphuric acid ("oil of vitriol"). Sul- poisoning. phate of magnesia (Epsom salts), or the sulphate of soda (Glauber's salt), in water, are also good anti- lt3T Insure in Thb Mutual Life Insurance Co. op New York.) 96 MINERAL POISONS. Chronic lead-poison- ing. dotes. After the antidote has been given in poisoning by lead, an emetic should be given. When lead is taken for some time in any of the soluble forms in small doses as when water has been kept in leaden vessels, or food kept or cooked in vessels "glazed" with lead, or the use of wines "sweet- ened" with the same metal, a peculiar train of symp- toms slowly follows, known as "lead-poisoning," or "painters' colic." All such possible sources of the introduction of lead into the system should be care- fully avoided, and as soon as the effects of the absorp- tion begin to be suspected, no time should be lost in consulting a physician. LIME. Lime. If accidentally administered, acts like ammonia. (Page 9°-) MERCURY. The bichloride of mercury (corrosive sublimate), often used as a solution in houses for destroying vermin about beds, is a most active poison, when Mercury. taken internally. The red oxide of mercury (red precipitate) is another dangerous salt of the same metal. When swallowed, the white of eggs should at once be given, and often repeated. In the absence of this form of albumen, common milk can be used, or wheat flour beaten up with water. These salts of mercury not only irritate the stomach, but so rapidly inflame and destroy it that some writers discourage the use of emetics. If one can be given, however, before the poison has had time to produce (135- Insure in The Mutual Life Inbdhahoe Co. op New Yobjc.) MINERAL POISONS. ST these extreme results, there can be no objection to its use. The continued administration of the antidotes is soon followed, as a rule, by free vomiting. PHOSPHORUS. This is probably not often taken in a state of purity. It is the active ingredient of most of the popular "Ex- osp orus * terminators" for rats and other vermin. These, as well as the ends of matches, have been taken with fatal results. Phosphorus acts as an irritant poison, inflam- ing the mucous membrane with which it comes in contact. A good antidote is sulphate of copper, five or ten Treatment grains of which can be given in water every fifteen f po i S oning minutes until four doses have been taken. The sul- by phos- phate of copper is also a poison, but it is an active phorus. emetic, and all measures must be taken to promote vomiting. Another efficient antidote is turpentine, especially the old French variety. This can be given in fifteen- drop doses for five or six doses. As fat dissolves phosphorus, no form of food con- taining this should be given for a day or two, not even milk or eggs. POTASH. The caustic potash, in the form of common lye, or the concentrated lye, when swallowed, acts as other alkalies of the same general character. (See "Am- monia.") Nitrate of potash (saltpetre), in large doses, say half an ounce or more, taken internally, is followed (tylnsnre In Tea Mutual Lipb [NatTBANCB Co o. New York.) HO MINERAL POISON'S. by poisonous symptoms. There is pain, with heat Potash. in the stomach, vomiting, and purging of blood, great prostration, and other symptoms denoting the action of an irritant poison. No antidote is known. The treatment consists in rapidly evacuating the contents of the stomach by an emetic, and the free administrations of mucilagi- nous drinks, with some paregoric every little while, to allay the pain and irritation of the inflamed parts. SILVER. Silver. Antidote. The chief source of this poison is the nitrate of silver (lunar caustic), either solid or in solution. Its action as a "caustic" is well known, and it is in this manner that it acts upon the throat, stomach, etc., when taken internally, in solid stick or in solution. Nitrate of silver is the base of the numerous popular "hair dyes," and under this form has been accidentally and criminally taken. The antidote for the salts of silver is common salt, which immediately decomposes and destroys its activ- ity. The rapidity and completeness with which this is done is seen in the well-known domestic precau- tion of preventing solutions of silver employed as in- delible ink from staining, by immediately, while the spot is moist, touching it with salt and water. SODA. Soda. The same things are to be said about this alkali as about ammonia. (t^Insnre Id Tim Mutual Life Insurance Co, or New York.) Zinc. MINERAL POISONS — VEGETABLE POISONS. 99 TIN. Several compounds of this substance are used by Tin. dyers, and have been used as poisons. They all act as irritant poisons. The treatment consists in copious draughts of milk, white of eggs in water, and flour and water. ZINC. The sulphate of zinc (white vitriol) might be termed poisonous in very large doses, were it not for the fact that it at once causes vomiting, and is brought up be- fore damage can be done. Hence it is regarded as one of our most valuable emetics. VEGETABLE POISONS. Most of the class of poisons termed vegetable act as narcotics or as acro-narcotics. With some modi- fications, which will be mentioned in place, the treat- ment of all cases of narcotic poisoning is essentially the same; and a similar statement may be made in reference to the treatment of all cases of acro-narcotic poisoning. Hence, in speaking of the vegetable pois- on standing first in the alphabetical arrangement ol these substances, the directions have been given under two heads : the nature of the acrid or irritating symp- toms and the treatment of the narcotic symptoms. In speaking of the other poisons, to save space and avoid repetition, the reader will be directed, for details of treatment, to some one of the substances, where direc- tions are given in full. <£3T Insure In Thb Mutual Lifb Insuraitob Co. op Nrw Yoek.j Vegetable poisons. 100 VEGETABLE POISONS. ACONITE. Aconite. Treatment. Aconite is known under the names of "monkshood" and "wolfsbane." When swallowed in an overdose, it is rapidly followed by symptoms known as acro- narcotic; in other words, irritating to the throat and stomach, and narcotic to the brain and nervous sys- tem. The treatment naturally consists in getting out of the stomach all the poison there not already ab- sorbed into the blood. In acro-narcotic poisoning we have two reasons in view for such a course; first, to avoid, as much as possible, the irritating action of the poison on the mucous membrane which lines the stom- ach and its approaches, and, secondly, to prevent fur- ther absorption into the blood and narcotization of the brain and nervous system. The contents of the stomach are removed by tickling the throat and base of the tongue by the finger or a feather. An emetic (p. 83) of mustard and water, pulverized ipecacuanha, or sulphate of zinc, flaxseed tea, gum-arabic water, sugar and water, milk, white of egg, or things of this general character, should be freely given at the same time to protect the mucous membrane of the stomach from the irritating feature of the poison. As there is nothing known which will neutralize or destroy the poison in the blood acting through the brain and nervous system upon the important or- gans of breathing and circulation, the efforts for relief must consist in keeping up the respiration by artificial breathing (page 16) until the kidneys, skin and other organs have had time to eliminate the aconite. As this poison weakens the heart's action, we must freely use stimulants to counteract this, effect, (t3T Intiuro fn Thk Mittu al Lira iHBimANOB Go. ov New York.) VEGETABLE POISONS. 101 such as brandy or whisky, aromatic spirits of am- monia and strong coffee. ALCOHOL Alcohol itself, or in the form of brandy, gin, rum, whisky, taken in large quantities, is followed by symp- toms of a violent poisonous character, and if relief is not at once obtained, death often ensues. The press reports instances not infrequently where children have swallowed alcohol left within their reach, and have died in consequence. When quantities sufficiently large to be followed by alarming symptoms have been taken, the contents of the stomach should be evacuated without delay, by f acute tickling the throat with a feather or the tip of the poisoning by finger, by an emetic, such as ground mustard and alcohol, water, pulverized ipecacuanha, or sulphate of zinc; or the stomach-pump may be used, if convenient. The vomiting should be assisted by copious draughts of warm water. The alcohol in the stomach having thus been dis- posed of, the portion which has passed from the stom- ach into the blood, and has been carried to the brain and to the rest of the nervous system, where its poisonous action is being exerted, next claims atten- tion, should symptoms appear to demand it. The ac- tion of alcohol and its preparations upon the brain and nervous system is seen under the common name of in- toxication. This may consist of mere stupor, or the brain and nervous system may be so completely over- come by the poison in the blood that the influence of these parts upon the muscular movements of the chest and the heart is no longer kept up, and death ensues t3T* Insure In Thb Mutual Lifb Ihsubahck Co. op Ntw Ton,) 103 VEGETABLE POISONS. from asphyxia, as described under that head. For this Need of reason artificial respiration by the Sylvester method artificial (described on p. 16) is sometimes indicated, and respiration, may be maintained for hours. Strong coffee is also of much value as a stimulant. The practice of walking the patient around has no merit unless he is able to use his legs himself, and if he can do that, there is no need for the exercise. Cold water douches also are not advisable, although they seem to do good for a few moments. The body and extremities should be kept warm by flannels and hot-water bottles. Belladonna. Atropine. Symptoms of poisoning. BELLADONNA. Belladonna, or "deadly nightshade," has been intro- duced into our gardens as an ornamental flower, and poisoning sometimes occurs from eating the berries or leaves. Solutions of this or of its active principle, atropine, are used under various forms, and should never be left where they can be swallowed by mistake. Belladonna acts as a narcotic poison, like opium in many respects, only there is dilation, to a marked degree, of the pupil of the eye, and a peculiar redness or suffusion of the face, which are not seen in poison- ing by opium. The duskiness of the face is the symp- tom first observed by the physician. To discriminate between the two, it may be remarked, that stramo- nium (thorn apple, jimson weed) gives results closely resembling belladonna. Both of these substances — belladonna and stramonium — are attended, when swal- lowed in large doses, with a peculiar dryness of the throat and mouth, delirium, not accompanied at first with stupor, like opium, but with violent gestures, often violent laughter, and a peculiar disposition to (t3P~ Insure In The Mutual Lipb Insurance Co. or Ngw York.) VEGETABLE POISONS. 103 pick in the air, or at the clothing, for imaginary ob- jects. Treatment similar to that for aconite poisoning. BRYONY. The root of this plant, when swallowed in sufficient quantity, acts as an acrid, highly irritating poison. ; It is quite a common plant in Europe, but less seen in the United States. If taken in poisonous quantities, empty the stomach Bryony, as soon as possible; and, as in the case of all highly irritating poisons, this should be followed by free drinking of milk, flaxseed tea, white of egg and water, sugar and water, gum-arabic water, and similar things CAMPHOR. When taken in large doses, camphor acts as a narcotic poison. The contents of the stomach, in such cases, should be evacuated by an emetic (p. 83), followed by draughts of warm water, flaxseed tea, gum-arabic camphor, water, milk and similar substances. The strong odor of camphor in the breath and perspiration, in case of poisoning, with narcotic symptoms, would naturally indicate the character of the poison. CARBOLIC ACID. This is frequently used as a poison nowadays. In some cases the action is so promptly fatal that there is no time for treatment. If possible, the stomach Carbolic should be evacuated, and large doses of any soluble sulphate, such as Epsom or Glauber's salts, should be given. As the prostration is apt to be great, these will have to be followed by stimulants. (X&~ Insure In Thx Mutual Lips Insuili-ncb Co or Nxw Tobk.) acid. 104 VEGETABLE POISONS. Digitalis. Treatment of digitalis- poisoning. DIGITALIS ("FOXGLOVE"). This beautiful plant of the garden, cultivated in this country for its flower, and used, in proper quantities, as a valuable medicine, is a poison of the narcotic class, with a disposition to overcome the portion of the nervous system controlling the action of the heart. The treatment is very similar to that for aconite poisoning, although in medicinal doses this drug is used to strengthen the heart's action. The reason for this apparent inconsistency is that in poisonous doses digitalis enormously over-stjmulates the heart, so that in a little while it becomes very tired, and its action becomes weak. At this time, however, some Other stimulant may still be effective until the poisonous influence of the digitalis has been eliminated. Great care must be taken to keep the patient flat in bed. Even sitting-up may be sufficient to stop entirely the already weakened heart. Dulcamara. DULCAMARA ("BITTER SWEET," "WOODY NIGHT- SHADE"). This well-known plant belongs to the narcotic class of poisons, with symptoms like those of belladonna and stramonium. The treatment is the same as for aconite. HYOSCYAMUS ("HENBANE"). This vegetable, made use of in medicine, if taken in- ternally in improper quantities, acts as a narcotic pois- Hyoscyamus on, like others of the same natural order (Solanacae), such as belladonna, dulcamara and stramonium. The treatment is the same as for aconite. I Of Insure In Tim Mutual Lipe Insubanck Oo, op New Tobk.I Lobelia. VEGETABLE POISONS. 105 LOBELIA (" INDIAN TOBACCO "). This vegetable is not now much used as a medicine by physicians, as comparatively recent chemical dis- coveries have added substitutes to the list of drugs, which do not possess the peculiar disadvantages of this substance. In poisonous amount lobelia belongs to the class of acro-narcotics spoken of under the head of "Aconite" (p. 100). Fortunately one of the symptoms follow- ing its use is vomiting. This should be encouraged by drinks of tepid water, gum-arabic water, etc. ; and, if kept up until all the poison is rejected by the stom- ach, a favorable issue may be expected. Should vom- iting not occur at once, as a symptom, enough of the poison may be absorbed into the blood to exert a fatal narcotic influence upon the brain and nervous system ; or, to speak more precisely, through these organs upon the movements of respiration and circulation. OPIUM. This substance, or the numerous preparations of it used in medicine, is one of th« most frequent causes of poisoning a physician is called to see. A com- mon mistake is that of confounding laudanum and paregoric; a teaspoonful of the former contains six grains of opium, but of the latter only one-quarter of a grain. When the latter is supposed to have been given by the nurse, the mistake is not found out until poisoning it is often too late to be of material service in averting a fatal end. Morphine, the active principle of opium, is often kept as a solution, in private houses, for do- mestic use. !CF" Insure In The Mctual LrPB ImTmAxM Co. ov iSew Yohk.) Sources of opium 106 VEGETABLE POISONS. Treatment of opium poisoning. Any of these preparations of opium, in improper doses, are followed by symptoms of narcotic poison- ing. Not only these, but many popular nostrums, as "infant cordials" and soothing syrups of various kinds depend for their utility upon some preparation of opium, and are hence often followed by symptoms of narcotic poisoning. None of these things should be used. If a child cries, it does so usually because it feels pain; and instead of making it stupid with nar- cotics so that it can not feel the pain, it is better to go to work to find out the cause and remove it. There is some reason for the suspicion that, in many instances, where a modicum of the popular remedies of this class are not furnished by the mother to the nursery, the enterprise of the nurse ("rather than see the child suffer"), secures it from a neighboring apoth- ecary shop for the charge committed to her care. Opium, its preparations, and the active principle of the drug, morphia, all act in the same way, by ab- sorption into the blood, and distribution by it to the brain and nervous system. Through these organs the movements of the chest and heart become more or less interfered with. In this respect, its action is essentially like that of carbonic acid gas, alcohol and most of the vegetable poisons herein described, with- out, however, any acrid or irritating complication. Treatment. — What is in the stomach must be taken out, to prevent further absorption, and what is in the blood must be worked out, under proper guidance, by the processes of nature constantly engaged with such products. If the breathing and circulation tend to cease, because of the inability of the brain and nervous system to temporarily discharge these duties, (fcjrinanre In Toa Mutd*l Lifb Ixsctkaivce Co. of Nsw Tobx.)] VEGETABLE POISONS. 107 these essential movements must be taken charge of by a friend. An active emetic, like ground mustard, must be given at once, remembering that trouble may be found in getting it to act, because of the diminished sensibility to its presence, from the local stupefying action of the opium upon the mucous membrane of the stomach. The action of the mustard should be assisted by tickling the inside of the throat with the fingers or a feather. Sulphate of zinc, salt and water, pulverized ipe- cacuanha may be given ; in fact, anything to empty the stomach as soon as possible. If the respiration is not suspended, but is going on . at a diminished rate, above eight to the minute, arti- ficial respiration is not required, until the number of respiratory movements of the chest falls below this. A strong stimulant, in the shape of twenty or thirty drops of aromatic spirits of ammonia in a tablespoon- ful of water, may be given three or four times, at inter- vals of a couple or more minutes. It is better than . reatinent brandy, or anything alcoholic, because the mode of cases action of brandy is much the same upon the brain ofopium- as opium, and it might be rather adding to than tak- poisoning, ing from the poison that is at work. A few table- spoonfuls of very strong, freshly made coffee is a use- ful thing to give in such cases. If potassium per- manganate can be obtained, it should be given in doses of five grains in water every fifteen minutes until four doses have been taken. The most efficient antidote is belladonna or its act- ive principle, atropine. Ten drops of the tincture of Antidote, belladonna or one-hundredth of a grain of atropine should be given every fifteen minutes until four doses (PT Insure In The Mutual Life Insubaxcb Go. op Nhw York.) 108 VEGETABLE POISONS. Treatment in severe cases of opium- poisoning. After- treatment. have been taken. No more than this should be given without the advice of a physician. When the respirations get below eight to the min- ute, it is necessary to resort to artificial breathing by Sylvester's method (see p. 16). We may have to keep this up for hours before all danger is past. It is well to stop every fifteen minutes for a minute or two in order to see if the natural respirations will main- tain themselves at a rate over eight a minute. As long as this is the case we can rest ; but the breathing must be carefully noted all the time and counted with a watch. The body and extremities must be kept warmly covered and hot water bottles used, if neces- sary. The old measures of walking the patient around or of dashing him with cold water are only mentioned in order to be prohibited. They exhaust without do- ing any good. In case medical assistance shall not have been se- cured, and the patient shows signs of improvement, in the shape of more frequent respirations, stronger pulse and returning consciousness, many of these measures may be omitted as the apparent necessity disappears. In a short time the patient will appear as a person who is soundly sleeping from the effects of a full dose of opium or other narcotic, the quantity beyond that having been parted with by the blood. He may now be let alone, unless some return to the previous con- dition is noticed, when a dose or two of the strong and easily procured stimulant, aromatic spirits of am- monia, or coffee, may again be given him. If neces- sary, artificial respiration must be resumed. (t7"Iusiire la Tub Mutual Lm Inmdrancb Co. %9 Niw York j VEGETABLE POISONS. 109 OXALIC ACID. This substance is largely used in the arts, and in private households, for removing stains of iron from textures and surfaces, which it does by combining with an otherwise insoluble salt of iron, and converting it into a soluble oxalate of iron, easily removable by ** Ic water. From the strong resemblance oxalic acid bears to Epsom salts, it has often been taken instead of the well-known purgative of that name. To avoid the possibility of such an accident, oxalic acid should be kept in another part of the house from which medi- cines are kept, and no precaution omitted, by label and other marking of the parcel, to make the difference between them as decided as possible. It is well to remember also that, wholly unlike Epsom salts, the taste of oxalic acid, applied to the tongue, is quite , sour. When swallowed internally the activity of this poi- son admits of no delay. It belongs to the class of irri- tant poisons spoken of so often, and produces death chiefly by destructive action on the mucous membrane (lining) of the throat, stomach and bowels. Time can scarcely be lost to give an emetic; but something must be given to rapidly combine with the poison and divert its activity from the parts men- tioned. It has a strong affinity for lime, forming with it a comparatively insoluble oxalate of lime; and for magnesia, forming with it an insoluble oxalate of mag- nesia, which can be dislodged with less haste. A tea- Antidote for spoonful of lime from a whitewash bucket or at the oxalic acid, bottom of the bottle of lime water, when made as di- rected in another place (page 162), mixed with a cup of water, might be given every few minutes, or some ( ESrliianre lu Thb Mutual Lies Inburanck Go. or New Yoac.) 110 VEGETABLE POISONS. Oxalate of potash, or salts of lemon or sorrel. crushed chalk (a carbonate of lime), or some mag- nesia, may be given. All these things can easily be had, and not a moment need be lost in getting the per- son to swallow them. The common "whiting" used for polishing glass, making cheap paint and putty, is essentially the same as prepared chalk. After the oxalic acid is supposed to have been neutralized, an emetic of ground mustard or pulverized ipecacuanha may be given. Scraping the ceiling or wall will not procure the anti- dote if plaster of paris has been used instead of com- mon lime, as is often the case. The often recommend- ed mantel images of plaster of paris are also of little use. Lime in the sulphate (plaster of paris) is too firmly united to the sulphuric acid to give it up for oxalic. Oxalate of potash, commonly called salts of lemon or salts of sorrel, produces the same result as oxalic acid, and the treatment is the same. PULSATILLA. The eating of this plant, "meadow anemone," or parts of it, has been followed by symptoms of acro- Pulsatilla. narcotic poisoning. The plant is so active at times that when applied externally, irritation to the parts touched is felt. When poisoning results from swal- lowing it, the course of treatment recommended under 'Aconite" (p. ioo) may be followed. SANGUINARIA ("BLOOD-ROOT"). Sanguinaria Taken internally in an overdose, acts as acro-narcotic poison. See "Aconite" (p. ioo). .'E3T" Insure In Thb Mutual Lipk Ingubancb Co. or New Tobx.) Savine. VEGETABLE POISONS. Ill SAVINE. This is an active irritating poison, inflaming the stomach and bowels. When thus taken, vomiting, by tickling the throat with the finger or a feather, should be at once induced. The mucous membrane (lining) of the bowels should be protected from the irritating action of what has escaped beyond the stomach before it could be emptied by vomiting, by drinking large quantities of water or milk, with good quantities of gum-arabic dissolved in it. If the oil of savine, which is the usual form of the substance when used with a criminal intent, has been taken, it might be well to take a dose of castor oil. SPIGELIA. The use of this plant, commonly called "pink root," as a destroyer of worms, was given, it is said, to the whites by the Cherokee Indians, and has become very general throughout the entire country. It is given with a great deal of confidence and recklessness, and is often followed by symptoms of a narcotic charac- ter, attended also with convulsive movements. When such poisonous symptoms follow its use, vomiting pIge ia " should be promoted and kept up by frequent draughts of warm water. As in the case of other narcotics, a drink of strong coffee may be of service. Acidulated drinks, as water and vinegar, water with lemon juice, are thought to be useful, and probably are, in favoring the elimination of the poison absorbed into the blood, by the action of the skin and kidneys. the sick-room is not aired, but only more poisoned. The kind of air one requires is the best air of the neighborhood, and this usually comes from the outside of the house. With plenty of open windows to let in the pure air, and a little burning fuel to take off the chill, it is an easy matter to get that kind of air which all sick ((^"Insure lu The Mutual Life Insuring* Oo, of Nnw Toek.) TEMPERATURE. 121 persons need. It is a rare thing for a person to "catch cold" while in bed. Indeed, some physicians „ tchi say they never saw a case of it from such a cause, and co id" inbed. if the bed-clothes are properly tucked in about the shoulders it is hard to imagine how such a thing could occur, unless the air is so cold that it acts upon the lungs as it would upon the ear, nose or fingers, directly inflaming the organs of respiration as if by "frost bite." TEMPERATURE. Cold has been called "the great enemy of age," and as the same inability to resist death is found in the Influence of sick as in the aged, cold may be said to be the great co enemy of the weak. The report of the Registrar-Gen- eral of Great Britain for the cold months of the year 1875 shows that, while there was no new malady, but only the familiar forms of bronchitis, phthisis pulmo- nalis (consumption) and pneumonia (inflammation of the lungs) — always holding their own in the returns of the causes of death — yet these well-known diseases were answerable for a number of victims greatly in excess of the average. Thus, where the weekly average for ten years from the three specified causes had remained about stationary during the prevalence of the cold weather of December, there was an increase of twenty-five per cent, in the death rate. The prob- able or, at least, the only assignable cause of this mortality, was the low temperature which prevailed. This is true as to the cause of death; and the same authority shows that the death rate from all causes, among persons 60 years old and upward — which (jylnsare in Tsb Mutual Lips Insubuvoe Co. of Nhw York.) 122 TEMPERATURE. previously stood at 62 per thousand of all the deaths from these causes — rose during seven cold weeks to 130 per thousand, and during the cold weather of the last two weeks of December, 1874, rose still higher, to 150 per thousand. While cold leads to a great mortality among the weak and aged and the ve«y young it cannot be doubted, on the other hand, that in warmer latitudes reliable statistics would prove that the heat of summer leads to quite as great a mortality among the aged and debilitated. Ordinary observation- will sat- isfy any one of the truth of this about young children. Now, for practical purposes, there is a little differ- ence between an aged or a young person and a sick one. Hence, because violent and extreme changes should be avoided, as much as possible, at the periods of life mentioned — cold proving most destructive to the aged, and heat to the young — a corresponding carefulness should be observed in regard to the sick of every age. The consideration of these facts naturally leads to the inquiry whether we are helpless under the con- ditions which they disclose; but common sense and experience fortunately show that we are not. While the susceptibility is doubtless increased by the sudden variations of temperature referred to, the question appears whether the still greater variations to which people unthinkingly expose themselves may not be quite as dangerous. In this respect, an audience just leaving a hall or place of amusement is an instructive sight. It includes numbers of delicate women who habitually dress in furs and warm wraps, who have been sitting for two or three hours, with low dresses, in a heated, vitiated and relaxing (K3TInaure in Tub Mutual Life Insurance Co. of New York.) TEMPERATURE. 123 atmosphere. These wait, before starting home, in a cold, draughty lobby, standing in thin shoes, and while talking and laughing with their friends, take deep breaths of the raw cold air into lungs which have been previously breathing a vapor- bath. Many of these changes of temperature inci- dent to the customs of society are of a purely artificial character, scarcely to be resisted by the strong with the best of health. The waste of health and strength is often too great for the robust, and the weak had better avoid them. Many of the illnesses deplored under this head are doubtless due to the direct shock given by the sudden entrance of a volume of cold air into the lungs, which could have been avoided almost entirely by the simple t h rouR h the expedient of breathing only through the nostrils, and n ose. keeping the lips closed, so that the air would have become warmed before entrance into the lungs. The sudden changes from heat to cold do not all take place away from home. Many "colds" are due to the arrangement of private houses, which appear to be built for neither heat nor cold, and do Risks within not resist either. A person going from the house the house - to the outside cold air has been taught to put on a coat ; but a person going from one room to another has not this fear, and steps into a cold bath without warning. We say cold bath, for practically the com- municating entries of the house, with gas-burners at every landing of the stairs, are as well devised a means of getting the heat from the lower rooms, where needed, to the garret, where not needed, as if specially designed for the purpose — particularly if the lower outside doors are occasionally opened. Invalids should therefore always pass through entries (t^"tD3are In Tm McTUiL Live Insubancs Co, of New York.) 124 TEMPERATURE. Invalids must not be chilled. A cold is frequently the result of debility. and long stairways as well protected as if going into cold air on the other side of the front door. A time when people are very apt to catch cold is just after getting up from a warm bed, when the skin has become somewhat relaxed from many hours, or perhaps days, of lying there, and is rendered less capable of reaction. The same temperature which re- freshes a patient in bed while protected by the bed- clothing, might destroy the patient just arisen. Com- mon sense will tell us that while we want pure air, we of course want that which cannot chill the sick person. After all, a cold is as often the result of de- bility as the direct exposure to a draught of cold air. If each individual will observe his own case the next time a cold is contracted, he will find, more than likely, that it was preceded some days by lassitude, headache, more or less inability to exercise the think- ing faculties with the usual success, disturbed diges- tion, etc., etc. These symptoms have all become ex- aggerated by a very slight exposure, and sometimes the cold appears without any remembered exposure. When the above-named symptoms appear, it is wiser to examine into their cause rather than to inquire what particular exposure to a draught of air gave rise to the cold. A discovery of the remote cause of the attack may place it in the power of the person to pre- vent a recurrence, and a judicious, generous diet and attention to fresh air will often give more relief than "Squills" and other domestic remedies of the same kind. In many diseased conditions much less heat is pro- duced than in health ; and there is a constant ten- dency to a decline and ultimate extinction of the vital powers by the call made upon them to sustain the heat (Gy Insure to The Mctual Life Imhoiuncs Co. or New York ) TEMPERATURE. 123 of the body. In such cases, the patient should be carefully observed every little while, and as soon as invalids this tendency is discovered, the temperature of the produce less body should be kept up by heat externally applied, as heat than the warm bricks, tin cans or bottles filled with hot water, ^ eI1 e ^ pe " etc. Such cases of decline of the heat of the body occur morn ; ng at all times, even in summer. This coldness, indicat- ing a decline of vitality, is most apt to happen to- ward morning, at the time the effect of the preceding day's diet begins to be exhausted. Everybody knows that it is usually toward the morning that we begin to suffer from the effects of cold, because the vital forces are then beginning to slacken from the want of food. If this is the case in health, it is the same in disease. Hence, from midnight until nine or ten o'clock the next morning, the condition of the patient should always be carefully watched, and as soon as want of heat is noticed the nurse should at once take means to counteract it. During the day time the temperature of the room should be kept about 70 degrees. The night tempera- „ 1 1. .. , , ,,,, Tempera- ture should vary according to the health of the occu- ture of pant. If that is good, it can be as low as 50 degrees, room. or even 40 degrees, without discomfort, provided the bed-covering is sufficient. If the occupant is an in- valid, the temperature should not fall much below 60 degrees. It will often be necessary to stir up a little heat in the early morning to prevent too great a fall. fyy Insur* In Tm Mutual Life Insurance Go. op Nsw Tobk.) 130 CHAMBER UTENSILS. CHAMBER UTENSILS. Nothing should ever go into the "slop-pail" of a chamber but the refuse water from the wash-basin, etc., and then it should stand no longer than necessary. Under no circumstances whatever should the contents of any utensil used about the bed ever go into it.* * Some observations by Florence Nightingale upon these matters are given here from "Notes on Nursing" : "The use of any chamber utensil without a lid should be utterly abolished, whether among sick or well. You can easily convince yourself of the necessity of this absolute rule by taking one with a lid, and examining the under side of that lid. It will be found always covered, whenever the utensil is not empty, by condensed, offensive moisture. Where does that go when there is no lid ? "But never, never should the possession of this indispensable lid confirm you in the abominable practice of letting the chamber utensil remain in a patient's room unemptied except once in twenty-four hours — i.e., when the bed is made. Yes, impossible as it may appear, I have known the best and most attentive nurses guilty of this ; aye, and have known, too, a patient afflicted with severe diarrhoea for ten days, and the nurse (a very good one) not know of it because the chamber utensil (one with a lid) was emptied only once in twenty-four hours, and then by the housemaid who came in and made the patient's bed every evening. As well might you have a sewer under the room, or think that in a water-closet the plug need be pulled up but once a day. Also take care that your lid, as well as your utensil, be always thoroughly rinsed. "If a nurse declines to do this kind of thing for her patient, 'because it is not her business,' I should say that nursing was not her calling. I have seen surgical 'sisters,' women whose hands were worth to them two or three guineas a week, down upon their knees scouring a room or hut, because they thought it otherwise not fit for their patient to go into. I am far from wishing nurses to scour. It is a waste of power. But I do say that these women had the true nurse-calling — the good of their sick first, and second only the consideration what it was their place to do — and that the women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them. "Earthenware, or, if there is any wood, highly polished and varnished wood, are the only materials fit for patients' utensils. The very lid of the old abominable close stool is enough to breed a pestilence. It becomes saturated with offensive matter, which scouring is only wanted to bring out. I prefer an K3T Iusure In Thb Udtual Lifb Insurance Co. op Nrw York.) DISINFECTANTS. 127 DISINFECTANTS. An able medical lecturer in Philadelphia is in the habit of tersely saying before his class that fumiga- tions, as a rule, act on the principle of "one stink stink- ing out another stink." There is a deal of truth about it. The popular idea is that they destroy filthiness. Used in the ordinary way, they can do no such thing. They only make filthiness less evident, because they make the odor less perceptible, which is an indication of its presence. Remove the cause, and all the un- pleasant effects must cease. At the present time it is known that many diseases are caused by small living organisms, called microbes. Among these diseases are consumption, cholera, yel- low fever, typhoid fever, typhus fever, diphtheria, whooping-cough, small-pox, measles, scarlet fever and several others of less importance. Each of these is caused by its own particular microbe, which can be transferred to a healthy person and then start up the original disease. These microbes may be present in the dejections, in the vomit, in the expectoration, in the breath, or may be detached from the skin. In earthenware lid as being always cleaner. But there are various good new-fashioned arrangements. "A slop-pail should never be brought into a sick-room. It should be a rule invariable, rather more important in the private house than elsewhere, that the utensil should be carried directly to the water-closet, emptied there, rinsed there, and brought back. There should always be water and a cock in every water-closet for rinsing. But even if there is not, you must carry water there to rinse with. I have actually seen in a private sick-room the utensils emptied into the foot-pan, and put back unrinsed, under the bed. I can hardly say which is most abominable, whether to do this or to rinse the utensil in the sick-room. In the best hospitals it is now a rule that no slop-pail shall ever be brought into the wards, but that utensils shall be carried direct, to be emptied and rinsed at the proper place. I would it were so in the private house." (83T Insure In The Mutual Lipb Insurance Co. op New York.) Fumigation is usually worthless. Diseases which are due to microbes. 128 DISINFECTANTS. order to destroy them it is necessary to use disin- fectants which will kill them. In order to be of any avail, a disinfectant should remain in contact with the substance to be disinfected a sufficient length of time to accomplish the object in view, otherwise it is value- less. Among the disinfectants the following are the most important. For convenience they will be called STANDARD DISINFECTANT SOLUTIONS. Standard disinfectant solutions No. i. Chloride of Lime. — This has an odor which is quite offensive to many. It bleaches clothing readily and may even destroy delicate fabrics. A standard solution of 4 per cent, strength is made by adding six ounces to a gallon of pure water. No. 2. Bichloride of Mercury. — Commonly known as "corrosive sublimate." This cannot be used in contact with metal, as it is precipitated. A standard solution is made in the strength of 1 to 500 by adding fifteen grains to a pint of water. No. 3. Carbolic Acid. — A standard solution of 5 per cent, strength is made by adding seven ounces to the gallon of water. No. 4. Solution of Chlorinated Soda. — Com- monly called Labarraque's Solution. It bleaches veg- etable colors slowly. A standard solution of this in 10 per cent, strength is made by mixing it with nine parts of water. No. 5. Chloride of Zinc. — A standard solution of this in 10 per cent, strength is made by adding a pound to the gallon of water. All of these solutions are very poisonous and must be handled with care. To leave a dish of carbolic acid (Jj!r 'asure in Tub Mutual Lips Insurance Co. op Kbv York.) DISINFECTANTS. 129 in the room or to sprinkle some chloride of lime on the floor does not hurt the microbe unless the microbe rj is ; nfect _ happens to fall into it. Disinfectants must be applied ants must ie directly and thoroughly to the microbe-carrying sub- applied stance in order to do their work properly. The fol- thoroughly, lowing rules are given for the purposes noted. FOR EXCRETA. Mix each stool thoroughly with two quarts of No. i, the standard solution of chloride of lime, or of No. 3, the standard solution of carbolic acid. Let it Disinfection stand at least one hour with the former and four hours of excreta, with the latter before emptying. For privy-vaults and cesspools, use liberal amounts of No. 2, the standard solution of mercury bichloride , or of No. 3, the standard solution of carbolic acid, and scatter plentifully over the surface chloride of lime in powder. Rub down the walls frequently with No. 3, the stand- ard solution of carbolic acid. These measures are of especial value in cholera, typhoid, dysentery and tuberculosis. In cholera, diphtheria, yellow fever and scarlet fever, all vomited material should be treated in the same way. FOR THE EXPECTORATION. This should be discharged into a cup containing a considerable quantity of No. 1, the standard solu- Disinfection tion of chloride of lime, or of No. 2, the standard ofexpecto- solution of mercury bichloride, to each pint of which r ^ tion . espe- fifteen grains of potassium permanganate has been cla . y . added. It should remain in this for several hours be- consum p. fore emptying. All cloths which have been used to tion. wipe the mouth should be burnt. These measures (S3T Insure Id Thb Mutual Life Insurance Co. op New Tobk.) 130 DISINFECTANTS. are of great importance in consumption, diphtheria, scarlet fever and infectious pneumonia. When it is remembered that one-seventh of all deaths occur from consumption in some of its forms, and that it is very frequently caught by inhaling dried sputum, the im- portance of thorough disinfection in this disease can- not be too highly insisted on. FOR CLOTHING AND BEDDING. Disinfection of clothing and bedding. If of little value, destroy by fire. If it can be washed, boil for at least half an hour, or immerse for at least four hours in No. 2, the standard solution of mercury bichloride diluted twice, or in No. 3, the standard solu- tion of carbolic acid diluted once. If it cannot be washed, expose it for two hours to a dry heat at a temperature of 230 degrees Fahr., at least. Mattresses should have the cover removed or freely opened before disinfection. In fact, it is better to destroy them and blankets by fire. FOR THE PERSON. The hands and bodies of the attendants and of con- Disinfection valescents should be washed with No. 4, the 10 per of the cent, standard solution of chlorinated soda, or No. 3, person. the standard solution of carbolic acid diluted one-and- a-half times. FOR THE DEAD. Disinfection of the dead. Envelop the body in a sheet thoroughly saturated with No. 1, the standard solution of chloride of lime, or No. 2,the standard solution of mercury bichloride, or No. 3, the standard solution of cabolic acid. (XW Insure Id Thi Mctvai Lin Insurance Go. of New Tone.) DISINFECTANTS. 131 FOR THE SICK ROOM. While occupied, wash all surfaces occasionally with No. 2, the standard solution of mercury bichloride, diluted once, or No. 3, the standard solution of car- bolic acid, diluted once. After the patient has been removed, wash all the walls, floor and ceiling, and all other surfaces in the Disinfection ™ , . . , , , -. of sick-room room. Then close it tightly by stuffing rags or papers in the cracks of the windows and doors. Burn in it at least three pounds of sulphur to every 1,000 cubic feet. A good way to do this is to take a washtub and put in it a few inches of water and several bricks. On the bricks place an iron pot containing the sulphur. Pour over this a pint of alcohol and set fire to it. Let the room remain closed for at least twenty-four hours. Then wash all the surfaces with No. 2, the standard solution of mercury bichloride, diluted once, or of No. 3, the standard solution of carbolic acid, diluted once, and then with soap and water. After this use quantities of fresh air and as much sunlight as possible. Do not think that this question of disinfection is of little moment. If you remember that "an ounce „ , r . . , , , ,, ... Value of of prevention is worth a pound of cure, you will un- disinfect- derstand that a few cents spent for disinfectants may ants, save you a doctor's bill and possibly a funeral. And if you use them at all, do it thoroughly. Unless dis- infection is well done it is worse than useless, for it will induce a false sense of security. If you fail, do not blame these principles, but your own lack of at- tention to detail in carrying them out. (t3Tlnsure In Thb Mptual Life Ihsubajtcx Co. of Kbw Tohk.) 132 CLEANLINESS. CLEANLINESS. Lack of cleanliness in the house. Untidiness a drawback to the sick. A house may be filthy even where there is not a pile of dirt anywhere to be seen. Carpets, filled with dust and saturated with grease, uncleansed furniture, old papered walls of years' standing, are just as much sources of impurity to the air as a refuse heap in the cellar. They defile the atmosphere quite as much, and more or less tend to encourage disease. Sweep- ing with a broom certainly can remove much dirt from a floor, but what it does not sweep out it scatters through the air, making little true improvement. After the dust "settles," the room is usually "dusted," which practically means whipping the dust from one piece of furniture to another with a bunch of feathers. It really seems that the dust had better be left alone, unless it can be removed altogether, and the only way to do this is to wipe everything with a damp cloth. The floor of a sick room should really be without a carpet, or if there is one, it should be well beaten before the patient goes into the room, and again well beaten and aired as soon as the person is done with it. Few people — no matter who they may be — have any idea of the exquisite cleanliness required in the sick- room. The smoky chimney, the dusty furniture, the utensils emptied but once a day, even in the best houses, keep the air of the sick-room constantly dirty. What a person in health "may put up with" for a night only, may prove a source of suffering, postpone- ment of recovery, or even the hastening of a fatal end, to the sick person who is confined there, perhaps in one posture for twenty-four hours. None but those who have been sick, and know from personal experience, can tell how much delicious com- (£7"Influre Id Tan Mutual Lipk Insurance Co. of New 7obk,) CLEANLINESS. 183 fort may be secured by the careful washing and proper drying of the skin. It is not the mere feeling of com- fort which has been obtained, but an absolute relief of the sick the vital powers by the removal of something which from bach- was oppressing them. Cleanliness of skin and ventila- ing. tion have much the same end in view — the removal of noxious materials from the system as rapidly as possible. The various methods of washing the sick cannot be given here for want of space; besides this, the physi- cian is always ready to give any advice which may be needed. Care should be taken, in all these operations Do not chi11 of sponging, washing and cleansing the skin, not to the s expose too great a surface of the body at once, as this might check the perspiration and retard the re- covery from disease or renew the trouble in some other form. In several varieties of diarrhoea, dysentery, etc., when the skin is hard and harsh, the relief to the sick person from washing with water and an abundance of soap is almost beyond calculation. In other cases, sponging with tepid water and soap will be ordered, then with tepid water alone, followed by proper drying of the skin with a soft warm towel. anou ^ Sometimes when water alone is to be used, a little bath ; ng vinegar added to it makes the sponging more refresh- an invalid, ing. Of course, no one would think of using vinegar at the same time that soap is used. Bay rum or cologne is very acceptable, also, to the face, neck and hands of sick people, when used after sponging or bathing. If not convenient to use this, some common spirits diluted with water may be substituted. In this connection, it may be well to remark that special care should be observed in the use of water for (f&~Insare In The Mutual Lifb Ihsurancb Co. of New YoiKj Do not have 134 CLEANLINESS. bathing persons suffering with debility, the result of sickness or of age. In such persons, it is often seen that a bath which could be used with benefit in robust health, or at a younger age, is followed by palpitation of the heart, slackened pulse, more or less vertigo, shivering, and other feelings of discomfort, which last some time after its use. In ordinary cases, the water ^ ma y De accepted as a good rule that when- toocold. ever a bath, hot, tepid, or cold, is followed by a sense of oppression or inconvenience of any kind, it has not done good, and it may be well to suspect it having done harm. The amount of heat required to vaporize moisture is much larger than is popularly supposed, and if the person, aged or sick, or both, has not that surplus of heat to spare for the special pur- pose, over and beyond what he is likely to need for the ordinary purposes of the body, more or less disas- trous results are invited from the reckless expenditure. Even healthy persons, accustomed to a morning bath of cold water, sometimes feel an instinctive repug- nace to it, and on such occasions this should not be disregarded, but some other form of bathing used. A sponge bath or a warm bath in a well-heated room will answer better, followed by drying with a warm soft towel. By age, the writer does not mean the number of technical years the person has lived, but refers rather to the effect which the work he has done has had upon the "constitution," as it is called. LIGHT. A dark house, wherever found, is always an un- healthy one as well. Want of light discourages {Z2T Insure Id The Mutual Lipb Inbotlakce Co, of Nbw Toek. LIGHT, 135 growth, promotes scrofula, encourages "consump- tion," and, in fact, everything else which is bad. It i mportance is the unqualified experience of all who have had op- f light, portunities of judging, that light is second only in im- portance to fresh air; and the next worse thing after a close room is a dark one. Many suppose that it is upon the spirits only that sunlight acts, and not upon the body. The reverse is the case. It does the body good, and the brighter spirits show it. If possible, the sick-chamber should be the sunniest room of the house, and if the bed can be so placed that the person lying on it can see a good piece of the blue sky, so much the better will it be. If the patient can see out of two windows instead of one, he will be twice as well off. It is found in all hospitals that rooms facing the sun have fewer deaths, all other things con- Great value sidered, than such as are upon the shady side of the °' sunshine house; and where statistics have been kept for a period of years, it is found that the average time for recovery is less upon the sunny side than upon the shady side of the building. Not only do fewer patients die, per- haps, in the southerly exposed sides of hospitals, and sick people get well there faster than those on the northern exposure, but it has been shown recently that in asylums, prisons, etc., more of the inmates become ill who are compelled to dwell on the shady side of the building than of those who live on the sunny side. The first time the reader of this passes through the ward of a hospital, let him observe how almost all the patients lie with their faces turned toward the light. Ask one of them why he does so, and he will scarcely be able to give you an answer; but you see he does it. The reason is deeper down than his understanding. It is his nature to do so, just as it is the nature of (EF" Insure in Thh Mutual Line Insurance Co. or Mew York.) 136 Effect of noise on an invalid. Do not waken a sleeping patient. plants to always make their way toward the light, and their leaves or flowers to incline toward the sun. While you are looking at the faces turned toward the sunlight, count how many sick you see lying with their faces toward the wall. Among a hundred patients not more than half a score will be seen avoiding the light. REST. The loudness of a noise often does not hurt a patient. The putting up of a scaffold nearby, perhaps, will not trouble him — he knows what that is; while whispering or talking may annoy him beyond endurance. To some, however, any kind of noise is disturbing. A sharp and sudden noise, which is not steady, usually gives more distress than other kinds. Anything which suddenly awakens a patient out of his sleep will throw him into greater excitement, and consequently do him more harm than any con- tinuous sound, however loud it may be. When a patient sleeps never under any circum- stances let him be awakened, unless you have the sanc- tion of the physician. A sick person who has been asleep but a little while, and is then awakened, can very seldom go to sleep again; while, had he slept, a few hours, and then been aroused, he might have fallen asleep again in a few minutes with little effort. The reason is something like this : In a sick person the brain, as a usual thing, is weakened and debilitated like the other parts of the body and needs strength- ening. It gets this by sleep, which is rest. If rest is interrupted a few minutes after it begins, the brain is weakened so much more, and tends the less to sleep. The brain, therefore, not only loses the good of the (tarlnsare In Tbb Mutual Lira Insurakoi Co. of Kew Tobk.)] REST — NURSES. 187 little sleep it has had, but also its ability to sleep, be- coming what physicians call "irritable." If a patient sleeps for a time, the brain becomes so much the stronger, and can the more readily rest the next time. No noise which excites a patient's expectation should be made in his room. Hence, no one should Do not ever speak in low tones near the bed of the patient, whisper or hold a conversation in a room or passage where before a the sick person can occasionally overhead a word. P atlent - This is absolutely cruel. Another thing is frequently done by a thoughtless nurse. When she wishes to make some special in- quiry of the physician in regard to the condition of the patient, she usually remains in the room until the physician is ready to leave it and then states, with an air of conscious importance, that she has "something particular" to ask him about the patient. NURSES. The tact and qualities needed in the sick-room are not alwavs the result of experience, nor do amateur r ' nursing nurses always possess them. Now and then a lady is USU ally a born to them, and the physician to that house re- failure, joices exceedingly; for his own credit, as well as the recovery of the patient, is probably assured. He sel- dom, however, has this good fortune, because geniuses are not common. Many nurses cannot observe, and they will not think. The fire is alternately half ex- tinct, and blazing up the chimney. It is not warm at sunrise and sunset, arid moderate at midday, when the sun shines warmly. No care is taken to continue a priceless sleep, by keeping the cinders from falling on the unprotected fender ; or to gently restore the ft&"Xnsura In Tin Mutual Life Insurance Co. op New Tobx.) 188 NURSES. Affection not a substitute for experi- ence. Tact of a trained fire by quietly putting on lumps of coal, previously wrapped in pieces of damp paper, ready for noiseless use. The desired morning meal is brought in after the patient has passed from appetite to faintness. More than likely the tea is smoked. It is painful to see a patient in the hands of such a careless nurse, how- ever. Affection only, however warm, will not qualify a sick-nurse for her position. The cool head and steady hand of a professional stranger is often to be pre- ferred. Many a life has been sacrificed by ignorance, stupidity or anxiety of the affectionate nurse who un- doubtedly would have gladly died to save the patient. A good nurse should have keen perceptions and the nice ways of a lady, and at the same time she should not be above supplying all the patient's needs. She should never talk of the dying agonies of her last case, or relate any of her previous cases whatever they might have been. She should be able to judge when the patient must be kept quiet and when he may see a friend. Such a person, without giving offense, must assume the responsibility of forbidding the discus- sion of worrying, household troubles in the sick- 100m, or even getting rid of a visitor who stayed too long — especially of that class of persons who seem unwilling to lose a single opportunity of displaying bad taste and insensibility by telling the patient how some one else with the same symptoms had re- cently died in extreme convulsions. The lugubrious countenance assumed by such a visitor to har- monize with her conceptions of importance, usually confirms the fears of the sick person to a re- markable degree, and the nurse has increased labor in quieting the apprehensions thus cruelly excited. (£3T Insure In Thu Mutual Lipb Insurance Co. op Nkw York.) NURSES. 189 Conversations upon any subject should never be held fust outside the chamber door, where a word now and then can be overheard by those in the room ; and, as intimated, what is overheard, with what is suspected, by the poor patient, is frequently the beginning of the worst. Remember always that a cheerful face "doeth good like a medicine." Never, under any circumstances, ask within hearing whether the physician does not think the patient worse, the phvs ; cian or ask the physician his opinion as to the result of the a b ut the disease. Indeed, no question or reply calculated in patient in any way to suggest an unfavorable issue, should, under his presence, any pretext, be indulged in before the patient. There is a good deal of human nature even in sick people. A trained nurse commences her arrangements for m , . Make 3.11 the night before the patient begins to grow sleepy. arran „ e . She knows that arranging the pillows, moving the men ts for chairs, stirring the fire, and making up her own bed the night disturb the rest of the sick person. Sometimes an early. amateur does not think of this, and is surprised because the patient lies awake all night. A good nurse will also see in advance that nothing from down-stairs, likely to be needed before morning, has been omitted. It is the experience of most nurses that, when a „ . , ... . , ,. Do not read person is too sick to read, he is too sick to listen to much to a the reading of any one else. If you do read, let it be patient. done slowly, distinctly and steadily. Sick people almost always prefer having a thing told to having it read to them. The eyes of the convalescent and debilitated are easily injured by use. The greatest care should be Do not let a taken, therefore, to use them as little as possible be- P atiei) t read fore recovery. Quite aside from the patient's strength, muc ' the usual absence of the necessary amount of light for (tJT Insure in Tin Mutual Lot Insurance Co op Nbw Yore 140 NURSES. Make some variety in the sick Plants and flowers may be allowed. reading purposes makes reading in a sick-room al- most as dangerous to the sight as the use of print in the growing twilight — well known to be peculiarly destructive to the vision. No one but an old nurse, or a person who has been ill for a long time, can possibly know what a weary, dreary thing it is to be confined to the same room for a great while, and see no change in anything about it. It will be found that the majority of cheerful patients are those who are not confined to a single room, and the majority of depressed cases will be seen among those subjected to a long monotony of objects sur- rounding them. The nervous system really appears to suffer as much from want of change as the digestive organs would from continuance upon a single diet — i. e., the soldier from his "three years or during the war," of boiled beef. Unless a person has been sick, and has learned from personal experience, he can scarcely realize what a pleasant thing it is to see beautiful objects and brilliant colors while recovering from illness. Such cravings are termed "fancies" by some; but no matter what they are called, these indications are always valuable and should never be disregarded. The senses of sight and hearing require natural and innocent gratification as much as the stomach demands appropriate food. It is a helpful satisfaction to indulge them, and it should be done. If the indulgence makes the sick person .get well the faster, a wise nurse will observe these "fancies," and make them assist convalescence. It is a popular prejudice that plants and flowers should not be tolerated in the chamber, "because they give off carbonic acid gas, which is poisonous." So they do give off this gas, and the gas is poisonous; (|3P" Insure In Tub Mutual I.ipk Inbusakci Go, of Niw York.) NURSES. 141 but the quantity of carbonic acid gas given off from half a dozen bunches of flowers in half a dozen nights would scarcely equal the amount of the same gas given off from a couple of bottles of mineral water. The odor of certain flowers, as lilies, hyacinths, etc., is unpleasant to some people, and whenever such is the case, the objectionable ones should, of course, be avoided in the selection. A judicious variety in the colors should always be sought, and it may be well to remember that scarlet is rather stimulating in its ef- fects, while blue is rather soothing. In convalescence, even more than in illness, the attentions of an inexperienced nurse are often trying to an invalid. If he has been well nursed, he may still CO y al S es _ Urin8 be amenable to the discipline of the sick-room, and cence. will probably do what he is bid. If he has not learned to do as told without question, he has still many things to learn before he gets well. At first, perhaps, he will be allowed to sit up hours, when minutes was the physician's orders. He is able to persuade the nurse to give him a tumblerful when a wineglass was al- lowed. He is allowed to see a newspaper for a few minutes, and he reads an exciting novel. He is per- mitted to see a visitor, and has a roomful of company. He leaves the house for the first walk, muffled up, and is allowed to sit on a cold garden seat. Upon return- ing home exhausted, there is no nourishment ready for him, and probably the warmed clothing is taken off to put on his cold house suit. FOOD. A little food at a time and often repeated, is the general rule for sick people. Frequently, where a C£^"IonurQ in Tbb Mutual Ltpb Ihsuuhcb Co. of New York.) 142 FOOD. A little food at a time. A little food early in the morning. Dangers of alcoholics. physician orders beef-tea, or something of the kind, a nurse will try to give a cupful every three or four hours. More than likely the patient's stomach rejects it, whereas, had a tablespoonful been given every half hour or so, it would have been retained, digested and have done the patient the intended good. The majority of weak patients are unable to take food of any solid kind before eleven o'clock in the morning, and before that time comes around they are sure to be pretty well exhausted. This would not be so apt to occur if a spoonful of beef-tea, of wine and arrow-root, of whisky-punch, or of whatever stimu- lant has been ordered by the physician, could be given them every hour or two, from the early morn until then. Perhaps by noon, or even sooner, they might be able to eat food as substantial as a mutton-chop or a piece of nicely broiled beefsteak. If food as solid as these cannot be taken, of course the nurse will perse- vere in the use of beef-tea, prepared milk, or whatever else the physician has ordered. In this connection, it may be well to make a few remarks about the use of brandy, whisky and other stimulants for the sick. They are always easily obtain- able, and therefore, oftenest used. But where there is any hereditary tendency to the use of such things, where the individual has ever shown a disposition to use them as a beverage, or where the associations of the person in the future may peculiarly expose him to solicitation, none of these stimulants, under any consideration, should ever be ordered, unless there is absolutely no alternative. This is said, because in many instances substitutes can easily be found by the physician. (tVInBare la The Mutd al Lips Insubanoi Co. op Now Yobk.) FOOD. 143 The susceptibility of the very young to all forms of alcoholic stimulants must also be remembered, suscepti- Where we would give a tablespoonful of whisky or bilityofthe brandy every three or four hours to an adult a child young to of two would get ten drops every hour or two, a alconol 'cs. child of five a teaspoonful every two or three hours. If we are not careful, we are very apt to overstimulate a child. Never leave the patient's food untasted by his side from meal to meal, in the hope that he will eat it. He never does eat it, and you only add disgust to a Dat ; ent ' s his distaste, by leaving it in sight. Let the food be f 00 d by his brought at the right time, and if it is not eaten, be side sure to take it away in a little while. untasted. A sick person's plate should never be overloaded with food, nor should he ever see or smell the food Do not prepared for others. While eating, the patient should overload the be left alone as much as possible. p ate " Whatever is prepared for the sick must always be of the first quality, and cooked with the greatest care. The best oi Remember that sick-cookery should at least do half io °* and the work of the patient's weak digestion. Always keep your patient's cup and saucer per- fectly dry, so that no drops of liquid will fall on the Kee P the = U P sheets, pillow or dress. As a rule, nurses have no idea and saucer what a difference this minute want of care makes to the comfort and even willingness of the sick to take food. Florence Nightingale says on this subject that one of the most common errors among women in charge Beef . of the sick, respecting sick diet, is the belief that beef- of litt i e tea is the most nutritive of all articles. "Now just try," value, she says, "and boil down a pound of beef into beef-tea, evaporate the water, and see what is left of your beef. (ST* Insure in Tas Hotual Lips Insurance Go. op New Tore., 144 Do not overrate the value of eggs. Meat alone may produce scurvy. Animals require albumin You will find that there is barely a teaspoonful of solid nourishment to half a pint of water in beef-tea." There is, nevertheless, a certain nutritive value in it, as there is in tea. It may safely be given in almost any inflammatory disease, but it should never be alone depended upon, especially where much nourishment is needed. Again, it is an ever-ready saying that "an egg is equivalent to a pound of meat," whereas it is not so at all. Much trouble has occurred from this mistaken notion. It is a question whether, weight for weight, eggs are equal to beefsteak. Also, it is seldom noticed with how many patients, particularly those of nervous or bilious temperament, eggs disagree. Most pud- dings made with eggs are distasteful to them in con- sequence. An egg, whipped up with wine, is often the only form in which they can take this kind of nourish- ment. Again, if the patient is able to eat meat, it is sup- posed that to give him meat is the only thing needful for his recovery; whereas scorbutic (scurvy) sores have been known to appear among sick persons living in the midst of plenty, which could be traced to no other source than this — namely, that the nurse, de- pending on meat alone, had allowed the patient to be without vegetables for a considerable time, these latter being so badly cooked that he always left them un- touched. To all intents and purposes, he really had no fresh vegetables at all. Animals require in their food an albuminous con- stituent, a starchy one, and another of fat. The first, or albuminous (the purest form of which is the white of an egg), enters largely into the formation of the human body, the muscles being chiefly composed of it. ttylnsuro In The Mutual Lira iNauaANCB Co. of 3T»w York.) FOOD. 145 The second, or starchy component, does not enter into the structure of the body as such, but is converted starch into sugar during digestion, and has much to do with the formation of the tissues and heat. The oily parts enter largely into the composition of the brain, nerves, and, in fact, all other portions of the body, and, when broken up and consumed, supply a at ' good portion of the fuel for heat of the body. Besides these three mentioned, which are most con- spicuous, there are other substances, as common salt, phosphates, iron, etc. These are supplied through and salts, food, but our space will not permit more than a mere reference. All food must contain these substances in proportionate quantities. If it does not, the appetite craves the one missing, and if not properly supplied, the part of the body which needs the deficient com- ponent suffers. To feel assured of this, if the reader thinks a mo- ment, he will remember that no one likes bread alone, A)1 should but wants with it some butter, which supplies the oily be P resent i i.i. i.-i. • r 1 in the food- part, and the appetite craves, too, a piece of meat, cheese, or an egg — the albuminous part. We want butter with our rice or potatoes, because rice or potato is almost pure starch, and wanting in fatty matter ; so nature says we must add the wanting parts. As all food which properly sustains man must con- tain these principles, it will be readily seen that those Life cannot vegetable substances which are composed of but one be sustained of them, or even two, cannot alone support life. Ex- ' ' rr even two. perience confirms this view. Oils or fat are useful as oils or fat, but cannot supply the place of starch or sugar; nor can starch or sugar supply the place of albumen or flesh. (tylnsure In Thb Mutual Lifb Insurance Co. of New York.) 146 FOOD. To obtain all these needful constituents, we must Great value see ^ a var i et y i n our food, and not depend exclusively of milk. upon any single one for continued use. There are some apparent exceptions to this rule, as in the case of milk, which we know is capable, under certain cir- cumstances, of sustaining life for a length of time ; but when We examine into the matter the exception is only apparent, for milk contains all of the constituents necessary for perfect food. It has the starchy part ad- vanced a step into the shape of sugar, the albuminous part as the cheesy constituent, and the fatty as the creamy element. Hence milk can be taken as a sort of representative diet, and one better adapted to sus- tain the body in health, or to strengthen it in sickness, than any single article of food. Flour made from wheat, meal from oats or Indian corn, grits, etc., come next in order, perhaps, and stand at the head of the list of all articles of food grown for general consumption. Food of the above description is made up chiefly of starch, some albumen (under the form of gluten), and a certain amount of oil. Hence, bread made of flour may well be called the "staff of life," because, from containing these elements, it is capable of supporting life by itself, for a longer time than any other single article of food, excepting milk, as mentioned above. But, though containing these essential elements of life, yet flour, without the addi- tion of albuminous or oily matter, to a certain degree, cannot long properly sustain the human body. If flour cannot nourish the body in a proper manner, it will at once be seen that corn-starch, arrow-root, tapioca, and the like — which are nothing but pure forms of starch, made by washing away the oily and glutinous (albuminous) parts — cannot possibly be ex- Cir Insure la The Mutual Lips Immune! Co. op Nkw Took.} FOOD. 147 pected, when used alone, to afford more than a limited amount of nourishment; not, of course, as much as food prepared from flour, which has in it the deficient articles. Not only is flour more nutritive than arrow- root, or any preparation of starch, but it is less liable to ferment, and, as a rule, it should be preferred when- ever it can be used. Do not misunderstand what is meant. None of these articles, compared with flour, are spoken of as useless to the body ; but some preparations for the sick must be more useful than others, because they contain more of the elements of usefulness in the shape of albumen, starch, oil, etc. But if fresh milk is so valuable a food for the sick, the least sourness in it makes it, of all articles, per- haps, the most injurious. Diarrhoea is a common . ' be very result of fresh milk allowed to become at all sour. The f res h. nurse, therefore, ought to exercise the utmost care in this particular. Yet if you consider that the only drop of real nourishment in your patient's tea is the drop of milk, and how much all patients depend upon their tea, you will see the great importance of not depriving your patient of this milk. The desire shown by the sick, and especially by those who are getting well, for acid fruits, as oranges, Acid fruits baked apples, cranberries, lemons, etc., should never are often be disregarded. The important use the acids of fruits e rateful - play in the body is a long story ; so we can only insist upon the importance of regarding these "cravings" wherever found. Sometimes the physician has good reasons for not wishing them given, as the acid may neutralize or decompose some remedial agent em- ployed, but as a rule these fruits, properly prepared, may not only be given without injury, but with de- < ty laiore in Thi Mctval Lub Imuuitcz Go. of tfew You.) 148 FOOD. Jelly con- tains almost no nourish- ment. How to make beef-tea. cided benefit. So, whenever a sick person has a crav- ing for such things, be sure to call the physician's attention to it, and ask if you can give them. Calves-foot jelly is another article of diet in great favor with nurses and friends of the sick. Even if it could be eaten solid, it would not nourish. It is simply the height of folly to take one-eighth ounce of gela- tine and make it into a certain bulk by dissolving it in water, and then to give it to the sick, as if the mere bulk represented nourishment. It is not generally known that jelly does not nourish, that it has a ten- dency to produce diarrhoea, and to trust to it to repair the waste of a diseased constitution is simply to starve the sick under the guise of feeding them. If one hundred spoonfuls of jelly were given in the course of the day, you would have given one spoonful of gelatine, which spoonful has scarcely any nutritive power whatever. Dr. Christison says that "every one will be struck with the readiness with which certain classes of pa- tients will often take diluted meat-juice or beef-tea re- peatedly, when they refuse all other kinds of food." But beef-tea as ordinarily made is really only a stim- ulant, very much like coffee. To make a beef-tea that contains considerable nutriment, as well as stimulant, cut a thick piece of good, juicy steak into lumps about the size of a small lemon. Broil each piece slightly and then squeeze it thoroughly in an ordinary lemon- squeezer, or, better still, in one of the small meat- presses that are made nowadays for this purpose. You will not get a great deal of juice, but it is a fair nutri- ment for the sick. It can be served hot or cold, with salt and pepper to suit. (£2T Insure In Thb Mutual Livk Insurance Co. ef Nx-w Tobk.) FOOD. 149 A great ideal too much is said against tea* by wise people, and a great deal too much tea is given to Va i ue oi the sick by foolish people. When, however, you see tea and the natural and almost universal craving in the sick coffee, for their "tea," you cannot but feel that nature knows what she is about. But a little tea or coffee restores them quite as much as a great deal ; and a great deal of tea or coffee But do not impairs the little power of digestion they have. Yet give too a nurse, because she sees how one or two cups of mucn - tea or coffee restores her patient, often thinks that three or four cups will do twice as much. This is not the case at all ; it is, however, certain that there is nothing yet discovered which is a substitute to the patient for his cup of tea ; he can take it when he can take nothing else, and he often can take nothing else, * Persons about to incur great exhaustion, either from the nature of the service, or from their being not in a state fit for it, are frequently advised to eat a piece of bread. I wish the recommenders would themselves try the experiment of sub- stituting a piece of bread for a cup of tea or coffee, or beef-tea, as a refresher. They would find it a very poor comfort. When soldiers have set out fasting on a fatiguing duty, when nurses have to go fasting in to their patients, it is a hot restorative they want, and ought to have before they go, and not a cold bit of bread. If they can take a bit of bread with the cup of hot tea, so much the better, but not instead of it. The fact that there is more nourishment in bread than in almost anything else has probably induced the mistake. That it is a fatal mis- take there is no doubt. It seems, though very little is known on the subject, that what "assimilates" itself directly, and with the least trouble of digestion, with the human body, is the best under the above circumstances. Bread requires two or three processes of assimilation before it becomes like the human body. The almost universal testimony of men and women who have undergone great fatigue, such as riding long journeys without stopping, or sitting up several nights in succession, is that they could do it best upon an occasional cup of tea — and nothing else. Let experience, not theory, decide upon this as other things. (t^rlimirg la Thb Mutual LrpK Insubance Co. op Nsw York.) 150 FOOD — BEDDING. if he has not it. It would be very desirable to have the detractors of tea point out what to give to a patient after a sleepless night, instead of tea. If you give it at five or six in the morning, the patient may even sometimes fall asleep after it, and When to give £ et ' P er h a P s > his only two or three hours' sleep during tea or coffee, the twenty-four. At the same time, you never should give tea or coffee to the sick, as a rule, after five o'clock in the afternoon. Sleeplessness in the early night is usually due to excitement, and is increased by tea or coffee; sleeplessness which continues to the early morning is often from exhaustion, and is relieved by tea. BEDDING. In looking for an example of what not to do, we may take the specimen of an ordinary bed in a private house; a wooden bedstead, two or even three mat- tresses piled up above the height of a table, with a valance attached to the frame. Nothing but a miracle could ever thoroughly dry or air such a bed and bed- ding. The patient must certainly alternate between cold damp after his bed is made, and warm damp be- fore, both saturated with organic matter,* and this from the time the mattresses are put under him until the time they are picked to pieces, if this is ever done. Consider that an adult in health exhales by the * For the same reason, after washing a patient, if you must put the same night-dress on him again, always give it a prelim- inary warming at the fire. The night-gown he has worn must be, to some extent, damp. It has now become cold from having been off him for a few minutes. The fire will dry and at the same time air it. This procedure is much more itr- portant than with clean things. (ty Insure In Tub Mutual Life Insurance Co. or New York.} BEDDING. 151 lungs and skin, in the twenty-four hours, one or two pints of moisture, loaded with organic matter ready sheets to enter into putrefaction ; that the quantity in sick- should be ness is often greatly increased, the quality is always changed more noxious — and ask yourself where does all this 1 ai y or . , thoroughly moisture go? Chiefly into the bedding, because it a j rea . cannot go anywhere else. It stays there, because, with the exception of a weekly change of sheets, scarcely any other airing is attempted. A nurse will be careful to fidgetness about airing the clean sheets, because of their dampness, but airing the used sheets because of noxious damp will never occur to her. Besides this, very dangerous effluvia we know arise from the excreta of the sick. These are placed, at least tem- porarily, where they must throw their effluvia into the under side of the bed, and the space under the bed is never aired ; it cannot be with our arrangements. Must not such a bed be always saturated, and be always the means of introducing again into the body of the un- fortunate patient who lies in it that poisonous matter which nature is trying to get out of the system? If a bed is higher than a sofa, the patient often prefers not to get out at all, rather than undergo the Bed s houid fatigue of getting out. Were the bed a low one, he be low and might often feel like taking a few minutes' exercise near the every day in another room, or even in the open air. wmdow - It is very odd that people never think of this, or of how many more times a patient who is in bed for twenty-four hours is obliged to get in and out of bed, than are those who only get into bed and out of bed once during the twenty-four hours. A patient's bed should always be in the lightest spot in the room ; and he should be able to see out of a window. (%3f~ Iniare la Ta> Mutual Life Iksdbancb Co. op Nbw Yoejc. J Hfe BEDDING. Coverings should be light. How to arrange pillows. It is scarcely necessary to say that the old four-post bed with curtains is utterly inadmissible. Hospital bedsteads are in many respects very much better than private ones. Never use anything but light blankets as bed-cover- ing for the sick. The heavy cotton impervious coun- terpane is bad, for the very reason that it keeps in the emanations from the sick person, while the blanket allows them to pass through. Weak patients are in- variably distressed by a great weight of bed-clothes, which may prevent their getting any sound sleep whatever. One word about pillows. Every weak patient, be his illness what it may, suffers more or less from diffi- culty in breathing. To take the weight off the poor chest, which at best is hardly up to its work, ought therefore to be the object of the nurse in arranging his pillows. Now, what does she usually do, and what are the consequences? She piles the pillows one upon the other like a wall of bricks ; the head is thrown upon the chest, and the shoulders are pushed forward, so as not to allow the lungs room to expand. The pillows, in fact, lean upon the patient, not the patient upon the pillows. It is impossible to give a rule for the arrangement of pillows, because it must vary with the figure of the patient. Tall patients suffer much more than short ones, because of the drag of the long limbs upon the waist. But the ob- ject is to support, with pillows, the back below the breathing apparatus, and above the hips; so as to allow the shoulders room to fall back, and to support the head, without throwing it forward. The suffering of exhausted patients is greatly increased by neglect of these points. And many an invalid, too weak to (t3TIo9ure Id Th> Mutual Lira Insukahcb Co. of Nbv York.) 168 drag about his pillows himself, slips his book or anything at hand behind the lower part of his back to support it. DRAINAGE. This should be constructed so as to keep out of the air of the house any admixture of sewer-gas, but it often fails entirely, owing to incorrect or defective plumb- ing. The danger is not so much from the sewer-gas itself as it is from the germs of disease which may be present. These are not volatile, but are sprayed up into the air of the sewer by the breaking of bubbles on the surface. Their weight is so light that they are carried about by the air-currents. In order to pre- vent disease from this source, the house must be prop- erly plumbed. To do this, the soil-pipe should open on the roof, and every trap should be back-aired. The diagram on the following page shows these points. Besides the conditions enumerated which are ab- solutely essential, there are some others which it is well to bear in mind. The soil-pipe should be of iron and 4 inches in diameter. After it changes from the perpendicular it should have a slope of i in 30, so as to insure a current of at least 4J^ feet per second. The traps should be the S-shaped siphon traps, pref- erably without pans or hoppers, but flushing directly. The water-closets should not communicate directly with the house-tank, but with small waste-preventer tanks, which are filled automatically from the house- tank. <£g'"Iii8ure In Thb Mutual Lifb Tnsubanob Go, ov New Tobx.> 164 DRAINAGE. A is the sewer. ABCif the soil-pipe, opening on the roof at C, and trapped at D. E F is the ventilating-pipe, communi- cating with the soil-pipe just behind D. G J K H is the venti- lating-pipe to the traps, opening on the roof at G and giving off branches at J K and N to the traps of the fixtures L M O, which branches are connected on the soil-pipe side of the traps as indicated. P R is the leader from the roof, connected with the soil-pipe at B and trapped at R. The object of E F is to have a constant current of air blowing through the pipe. The air in B C being within the house, becomes heated and escapes through C, while fresh air enters through E F. The object of G H and its branches J K N is to prevent siphoning of the traps by an action similar to that of a Sprengel air-pump. * (The engraver has made all the traps in the diagram too shallow except at R. They should be so deep as to divide the U-shaped column of water into two distinct limbs, connected only at the bottom.) (lylDsare in Thb Hutual i.ifs InstraAltoa Co. of New Yojk.) 155 It is impossible for sewer-gas to enter a house plumbed in this way. But oftentimes many of these precautions are neglected, and the results are quite graphically shown in this diagram: SECTION OF ' •TREE.T 6EWEK !E9~ Insure In Tai Mdtoal Life Insdsanck Co. of Nkw ToaK. SECTION V. REMEDIES. Next in value to the prevention of disease or accident is indemnity for the possible results of both. The Mutual Life Insurance Company of New York, by its policies provides such indemnity. REMEDIES. 169 REMEDIES. In this section we will discuss briefly the simple remedies, both internal and external, which it is ad- visable to have in the house. Even in a city, where a drug store is always near, one will find it convenient and comfortable to have something of a medicine- chest. In the country it is almost an essential. Nowadays most medicines can be obtained in the form of tablets, each containing a definite quantity of drug, and we strongly urge the use of these whenever possible. The dosage is accurate, and the medicine keeps almost indefinitely without change or deteriora- tion. When liquids must be used, it is advisable to keep them in bottles with ground-glass stoppers. Most liquids evaporate slowly through an ordinary cork, and the result varies according to the nature of the preparation. In some, such as aromatic spirits of am- monia, it becomes very weak, and even useless. In others, such as laudanum, it may become two or three times as strong. We can readily appreciate how harmful an unknown change in either direction might be. Powders should be kept in wide-mouthed bottles. They undergo changes less readily there than in boxes, either of wood or pasteboard. There should always be a label on the bottle, even if there is one on the stopper too. In that way con- fusing mistakes can be avoided. All the medicines should be kept in one box or closet, which should be securely locked. The key to il^T Insure In Tub Mutual Life Insdtuncb Co. of New Tobx.) 160 INTERNAL REMEDIES. this should be put in some place where children can- not get it. In this way both destruction of property and risk of life will be avoided. We will divide remedies into two groups, internal and external, and will arrange them alphabetically in each. INTERNAL REMEDIES. ALCOHOL. This is of great value as a stimulant, and some form of it should be kept on hand. The best varieties for medicinal purposes are brandy, whisky and cham- pagne, but in an emergency any kind of liquor or wine may be used. Brandy and whisky contain about 50 per cent, of alcohol, port and sherry about 18 to 20, champagne about 15, red and white wines 8 to 12. The dose varies greatly according to the needs of the case. It should be borne in mind that children are rather susceptible to alcohol. Where a tablespoon- ful of whisky would be used in the case of an adult, we would give under similar circumstances to a child of two thirty drops ; to a child of six a teaspoonful. AMMONIA, This is an excellent stimulant and antacid. It is used in the form of aromatic spirits of ammonia. The dose of this is thirty drops to a teaspoonful in half a glass of water. It can be repeated as often as neces- sary. ATROPINE. This is the active principle of belladonna, and is used in the form of sulphate of atropine. It is of great i£W Insure In The Mutual Life Insora.nck Co. ov New Yook.) INTERNAL REMEDIES. 161 value in poisoning by mushrooms or opium. It can be obtained in tablets, and the dose is one one-hundredth of a grain, equivalent to ten drops of the tincture of belladonna. BELLADONNA. See "Atropine," which is always to be used if we can get it. If not, the tincture of belladonna can be given in doses of ten drops. This can be obtained in tablet form. BISMUTH. This is used in the form of the subnitrate or sub- carbonate of bismuth. These are both white insoluble powders, and may be used interchangeably. Either of them is of great value in all forms of diarrhoea and dysentery. It can be given quite freely, an even tea- spoonful every two or three hours not being excessive. It is also used as a drying powder over wounds, and has the great merit of being absolutely non-poison- ous and bland. BLACKBERRY BRANDY. This is used in diarrhoea and dysentery as a stimu- lating astringent. The dose is a tablespoonful every two or three hours. BROMIDE. This is of great value in allaying nervousness and promoting sleep, and also in strychnine poisoning. Either the bromide of sodium or potassium can be used, preferably the former. The dose is ten to twenty grains It can be obtained in tablet form, but we lt3T Insure in The Mutual Life Inbdsakcb Co. of New Toes. 162 INTERNAL REMEDIES. should be careful to dissolve the tablets before ad- ministering. CALOMEL. The value of this as a purgative is too well known to be described here. Formerly it was given in too large doses. Three or four half-grain tablets will work just as well as ten grains in powder. CASTOR OIL. This is of great value as a preliminary purgative in all forms of diarrhoea and dysentery. The dose is one or two tablespoonfuls. The disagreeable flavor can be largely overcome by rinsing the mouth out thoroughly with a teaspoonful or two of raw brandy or whisky, both before and after taking the oil. IPECAC This is a depressing emetic, and is of especial value in croup. It is so slow in its action that we prefer the sulphate of zinc in a case of poisoning. The dose of the powdered drug is fifteen grains, which can be repeated in twenty minutes. We generally give to children a teaspoonful of the syrup every twenty min- utes until vomiting is produced. LIME WATER. Put in a quart bottle a piece of freshly slacked lime as big as an English walnut. Fill the bottle with water and shake thoroughly. Let it stand, and in twenty-four hours we will have as good lime-water as can be made. It can be kept in the same bottle, care (far Insure In Tub Mutual Liph Insurance Co. of New York.) INTERNAL REMEDIES. 163 being taken not to disturb the sediment. The bottle may be filled twice more with water, the same lime being used. After that the sediment should be cleaned out and fresh lime introduced. MUSTARD. This is a stimulating emetic. A teaspoonful can be stirred into a pint of water and a glassful of this given every fifteen minutes until vomiting is induced. OPIUM. The best preparation of this is the deodorized tincture, which has the same strength as the ordinary tincture, commonly called laudanum. The dose is five drops, repeated every two or three hours if necessary. It can be obtained in tablet form. Children are very sus- ceptible to opium, and for this reason we give them the very weak preparation known as paregoric, the proper name of which is the camphorated tincture of opium. The dose of this for a child of two is ten drops ; for one of three, thirty drops ; for one of five, a teaspoonful. Even in these doses it should be used with great caution. QUININE. The best preparation of this is the bisulphate. It can be obtained in tablet or pill form. SALTS-EPSOM AND GLAUBER'S. The former is sulphate of magnesium, and is quite bitter. The latter is sulphate of sodium, and is much pleasanter to take. They are both purgatives, in doses of two to four teaspoonfuls dissolved in a glass of water. (CSTInsure in The Mutual Life Insurance Co. op New York.) 164 EXTERNAL REMEDIES. SULPHATE OF ZINC. This is a very prompt emetic, and of great use in case of poisoning, ""he dose is twenty grains, which can be repeated every fifteen minutes until vomiting is produced. Three or four powders of this size should always be kept on hand. EXTERNAL REMEDIES. BICHLORIDE OF MERCURY. This is commonly called "corrosive sublimate." It is of great value as an antiseptic and disinfectant. It is now very conveniently put up in tablet form. If each tablet contains 7 3-10 grains, this can be dissolved in a pint of water, making a solution of the strength of 1 to 1,000. If a quart of water is used, the strength of course will be 1 to 2,000. These solutions should not be put in metal dishes, as the mercury will leave the water and unite with the metal. As corrosive sublimate is a very deadly poison, all precaution must be used to prevent its being taken internally. BORIC ACID. This is not at all like an ordinary acid, but is a white powder, which dissolves easily in water. It is much used as a non-irritating, mild antiseptic. It is not strong enough for all purposes, but is of much value, as it is practically non-poisonous. A heaping tea- spoonful, dissolved in a glass of warm water, will make a solution of the strength of 4 to 100. It is a very efficient dry antiseptic when mixed with bismuth subnitrate or subcarbonate. Three teaspoonfuls of bismuth with one of boric acid make a very serviceable drying powder. (Cylniure in Thb Mutcal Lira Insurance Oo. op Nbw Toek.) EXTERNAL REMEDIES. 166 CARBOLIC ACID. This is an efficient antiseptic, but poisonous, and also very irritating unless well diluted. It should never be used stronger than i in 30. This can be made by mix- ing one tablespoonful with a pint of water. It takes a little time and shaking for the mixture to be complete. COLLODION, This is a solution of gun-cotton in alcohol and ether, with a little castor-oil added to make the mix- ture flexible. It is a very nice covering for small cuts, much better in every way than plaster. It is a liquid which is quickly applied by means of a small brush or swab to the dried surface. The alcohol and ether evaporate in a few seconds, leaving a firm flexible film closely applied to the parts. This is not affected by water MUSTARD PLASTER. This is an excellent counter-irritant, and is of great value in many conditions. It is usually made too strong. One part of mustard to ten parts of flour is quite strong enough. This can be well mixed with enough cool water to make a moderately thick paste. The size should be liberal, care being taken that the paste is separated from the skin by one layer of muslin or linen. It can be kept on for three or four hours usually. After it is removed, the skin should be carefully dried and smeared with vaseline or some ointment. If an immediate effect is wanted, the paste should be made of equal parts of mustard and flour. This, however, cannot be endured longer than a few minutes, and its action is frequently not as deep or far-reaching as that of the milder paste. j£gp Insure In The Mutual Life Insubanck Co, ov New Yobs-, INDEX. Accident in general, 9; treatment, 10. Acetic acid, see Acids. Acids, burns by, 29; poisoning by, 90. Aconite, poisoning by, 100. Alcohol, poisoning by, 101; as a remedy, 160. Alcoholic beverages, dangers of, 142; in the young, 143. Ammonia, poisoning by, 90; as a remedy, 160. Aromatic spirits of ammonia, 160. Antimony, poisoning by, 91. Aquafortis, see Nitric Acid. Arsenic, poisoning by, 92. Artificial respiration, Marshall Hall's method, 18; Sylvester's method, 16. Asphyxia, 14; varieties, 15; by drowning, 15; by hanging, 19; by suffocation, 20; by carbonic acid gas, 20; by burning charcoal, 23; by coal gas, 23; by illuminating gas, 24; by foul air, 24; by foreign bodies in the throat, 25. Atropine, poisoning by, 102; as a remedy, 160. Baryta, poisoning by, 94. Bathing the sick, 133. Bedding, 150. Beef-tea, value, of, 143; how made, 148. Belladonna, poisoning by, 102; as a remedy, 161. Bichloride of mercury, poisoning by, 96; as a remedy, 164. Bismuth, 161. Bites, 45; of dogs, 45; treatment of bite of rabid dog, 46. Blackberry brandy, 161. Bleeding from nose, 60; from wounds, see Hemorrhage. Blood-spitting, 60. Boric acid, 164. Brandy, 160; blackberry, 161. Bruises, 30; treatment, 31. Bromide, 161. Bryony, poisoning by, 103. Burns, 26; treatment, 27; by lime, caustic potash and other alkalies, 28; by acids, 29. Calomel, 162. 168 INDEX. Camphor, poisoning by, 103. Carbolic acid, as a disinfectant, 128; as a poison, 103; as a remedy, 165. Carbonic-acid gas, suffocation by, 20; precautions against, 21; treatment when suffocated by, 22. Carbonic oxide, 23. Castor oil, 162. Chamber utensils, 126. Champagne, 160. Charcoal, suffocation from burning, 23. Chilblain, 68. Chloride of lime, 128. Chloride of zinc, 128. Chlorinated soda, 128. Cholera morbus, 74; epidemic, 75. Cleanliness, 132. Coal gas, suffocation by, 24. Coffee, value of, 149. Cold, influence on the death rate, 121; how to avoid catching, 122 et seq. Collodion, 165. Conjunctivitis, 58. Contusions, 29; treatment, 31. Convalescence, risks during, 141. Convulsions in children, 55; epileptic, 69. Copper, poisoning by, 94. Corrosive sublimate, see Bichloride of Mercury. Cramps, when swimming, 18. Croup, 54. Diarrhoea, 72; treatment, 73. Digitalis, poisoning by, 104. Disinfectants, 127 et seq. Disinfection of excreta, 129; of the expectoration, 129; of the clothing and bedding, 130; of the person, 130; of the dead, 130; of the sick-room, 131. Dislocations, 33. Drainage, 153 et seq. Drowning, 15; treatment, 15 et seq. Dulcamara, poisoning by, 104. Dysentery, 74. Ear, foreign bodies in, 58. INDEX. 169 Earache, 53. Eggs, value of, 144. Emetics, in poisoning, 83. Epileptic convulsions, 69. Epsom salts, 163. Eye, foreign bodies in, 56. Faceache, 54. Fainting, 14. Fish, poisonous, 89. Flour, value of, 146. Flowers in sick-room, 140. Food, 141 et seq.; requisites of, 144-145. Foreign bodies in the ear, 58; eye, 56; nostrils, 58; throat, 25. Foul air in drains and privies, suffocation by, 24. Foxglove, poisoning by, 104. Fractures, 32; treatment, 33. Freezing, general, 67. Frost-bite, 66; treatment, 68. Fruits, value of as food, 147. Gas, suffocation by illuminating, 24. Glauber's salts, 163. Hanging, 19; treatment, 20. Heat, influence of on the death-rate, 122. Hemorrhage, from wounds, varieties, 35; treatment. 37. Henbane, poisoning by, 104. Hydrochloric acid, see Acids. Hyoscyamus, poisoning by, 104. Indian tobacco, poisoning by, 105. Insects in the ear, 59. Iodine, poisoning by, 95. Ipecac as an emetic for poisons, 85; as a remedy, 162. Iron, poisoning by, 95. Jelly, value of as food, 148. Jimson weed, poisoning by, 112. Labarraque's Solution, 128. Laudanum, 163. Lead, poisoning by, 95. Light, 134 et seq. Lightning, accidents from, 25. Lime in the eye, 58; burns by, 29; poisoning by, 96. Lime, chloride of, 128. 170 INDEX. Lime-water, 162. Lobelia, poisoning by,. 105. Lunar caustic^ poisoning by, 98. Malaria, 76; treatment, 77; preventive measures, 78. Marshall Hall's method of artificial respiration, 18. Meats, poisonous, 88. Mercury, poisoning by, 96. Milk, value of as a food, 146. Morphine, poisoning by, 105. Muriatic acid, see Acids. Mushrooms, poisoning by, 87. Mustard as an emetic, 83-163. Mustard plaster, 165. Nitric acid, see Acids. Nose, bleeding from, 60. Nurses, 137. Nux vomica, poisoning by, 112. Oil of vitriol, see Sulphuric Acid. Opium, poisoning by, 105; as a remedy, 163. Oxalic acid, poisoning by, 109. Oxalate of potash, poisoning by, no. Paregoric, 163. Phosphorus, poisoning by, 97. Pink-eye, 58. Pillows, how arranged, 132. Plants in sick-room, 140. Poisons, definition of, 81; treatment of poisoning in general, 82; emetics for, 83. Poison-vine eruption, 61. Potash, poisoning by, 97. Pulsatilla, poisoning by, no. Quinine, 163. Rabid dog, bite of, 46. Rabies in the dog, 48. Red precipitate, poisoning by, 96. Remedies, 157; internal, 160 et seq.; external, 164 et seq. Removing an injured person, 10. Respiration, artificial, Sylvester's method, 16; Marshall Hall's method, 18. Rest, 136. Salt as an emetic, 84. INDEX. 171 Salts of lemon or sorrel, no. Sanguinaria, poisoning by, no. Savine, poisoning by, in. Scalds, 28. Shock, 11; causes, 12; treatment, 13. Silver, poisoning by, 98. Soda, poisoning by, 98. Spanish windlass, aid in checking hemorrhage from wounds, 39- Spigelia, poisoning by, in. Spitting of blood, 60. Sprains, 34. Starches, value of as food, 146. Stomach-pump, 83. Stramonium, poisoning by, 112. Strychnia, poisoning by, 112. Suffocation, 20; by carbonic acid gas, 21; by fumes of char- coal, 23; by coal gas, 24; by illuminating gas, 24; by foul air, 24; by foreign bodies in the throat, 25. Sulphate of zinc, as an emetic, 85-164. Sulphuretted hydrogen, suffocation by, 24. Sulphuric acid, see Acids. Sunstroke, 61; treatment, 63; preventive measures, 64. Sylvester's method of artificial respiration, 16. Tea, value of, 149. Temperature of rooms, 125. Thorn apple, poisoning by, 112. Tin, poisoning by, 99. Tobacco, poisoning by, 113. Toothache, 54. Trained nurses, 138. Vegetable poisons, 99. Ventilation, 117 et seq. Vitriol, oil of, see Sulphuric Acid. Vomiting, measures to check, 76. Water as an emetic, 84. Whiskey, 160. Wounds, 34; varieties, 34; symptoms, 35; treatment of hemorrhage from, 37 et seq.; cleansing of, 41; dressing of, 42; healing of, 42. Zinc, poisoning by, 99; sulphate of, as an emetic, 85-164; chloride of, 128. till* 1111! II Mmml t'H'P Eft ::' ■■.■': if IS