-' '-I'^ -v- :--':v •'."•^•'.'--:: v ; « 8$$ » amSHw Mm M# i : '.ri M»K 1 &*&*$» &H STO 88 B Si';; SSflSg ■L ft LWfiwi weSS* 11 HI mm An m liinilH i H i^M SWK &HK fO» mm i Hi JS®| IS : ' i'.;.. ■■■•■' ■- ., ill - : TP Class JK£AL Book__Jf4.1_ GqpightN . COPyRIGHT DEPOSIT. &>c^^(Q^*^^^ MEDICAL AND SURGICAL EMERGENCIES BT- WALTER CLINTON WALKER, M.D. Member of the American Association of Physicians and Surgeons, Etc. WITH ILLUSTRATIONS PUBLISHED BY THE W.C.WALKER CO. DETROIT, MICHIGAN THE LIBRARY OF CONGRESS. Two Copies Receivec SEP 23 1903 A Copyright Entry tLASS CL XXc. No Gift u COPY 8. Copyright, 1903, BY Walter Clinton Walker, M. D. >• • «» ' • • • a • • : ottle, and if the gauze is made properly tense, they will imitate the form and consistence of the nipple. If these sponges are not good or elegant enough, the bottles may be provided with mouth-pieces of gold, silver, tin or bone. Children drink very readily out of the perforated caoutchouc caps which lately have become so popular, and which are specially recommendable on account of their cleanliness. A very popular method of feeding infants is by the sugar-teat. It is prepared by mixing pulverized sugar-crackers with milk or water so as to form a dough, which is then put into a linen rag and tied with a string so as to form a ball about the size of a small apple. This soft, sweet ball is put into the mouth of the child, when it cannot be quieted by the ordinary means, at which it in- stantly begins to suck, and thus may be kept quiet for hours. In general, nothing more can be said against cleanly-kept, often- renewed sugar-teats, than that the cheeks of the child, by the con- stant sucking, become enormously distended, and form disgusting protuberances when the mouth is closed without them. Usually, however, the contents of the rag, from its contact with the warm mouth, soon begin to ferment, the mucus of the mouth becomes acid, and directly upon that digestive disturbance supervenes, and a fungous growth springs up upon the mucous membrane of the mouth, which only too often leads to a sorrowful end. It is there- fore the duty of every physician to prohibit the use of the sugar- teat whenever and wherever possible ; but this, in fact, can be more easily advised than accomplished, if we only think of the condition of a poor woman who all day long is plagued by a large number of small children, and at night, when she and the other members of the family absolutely require rest, the crying child will not leave her arm. She will then certainly say : "The physi- cian gives good advice, not to use the sugar-teat ; he, however, is not obliged to carry this crying child about all through the night ;" thus not one woman out of a hundred will withhold it from her child. From the lower classes it will hardly ever be possible to eradi- 3 34 MEDICAL AND SURGICAL EMERGENCIES. cate this fermenting ball, and among the better classes the child has a wet-nurse, or at least proper care, and the sugar-teat is re- newed often enough, whereby it is generally rendered harmless. So much for the nutrition for the first year of life. In the second year, the children may be allowed some soft, finely-cut meat. If they have no diarrhea, nor are predisposed to it, they tolerate fresh ripe fruit exceedingly well ; on the other hand, boiled green vegetables and husk fruits very generally cause them indigestion. For a child two years of age, for example, I prescribe the following diet : Mornings, between 6 and 7 o'clock in summer, or between 7 and 8 in winter, milk-gruel ; between 9 and 10 o'clock, a piece of wheat bread, with a very little butter on it; 12 o'clock, well prepared beef-soup, meat with a little gravy, or potato-broth, or in place of the meat a meal-broth pre- pared with eggs, but with very little fat, green vegetables very rarely and in very small quantities ; afternoon, between 3 and 4, bread and milk, in summer bread with fruit; evening, at 7, beef- soup or milk-broth. Sugar, in general, agrees very badly with children, .and it is highly important for their digestion to habitu- ate them to it as little as possible. After the children have passed the third year they tolerate all kinds of vegetables, and may, when otherwise well brought up, very appropriately be allowed to eat at the table with the family; it is only necessary to refuse them very salt, sour, and highly spiced victuals ; of all others they may partake in moderate quantities. Children should not be al- lowed to taste wine till they are fourteen years old, even beer is absolutely unnecessary, as likewise are tea and coffee. Home- made rye bread should be substituted for the ordinary wheat bread. It is well to cause children to eat the entire meal off one plate. They should consume all the soup allowed them before they can obtain anything from the next dish. Aside from the labor saved by not repeatedly changing the plates, children thereby ac- quire the good qualification of learning to eat everything and not to become lickerish. DISEASES OF CHILDHOOD. Diphtheria — Symptoms op — Treatment — Nursing — Trache- otomy — How to Prevent Diphtheria — Use op Anti-Toxine and Results op — Scarlet-Fever — Identical Terms — Causes and Symptoms — Beginning op Eruption, Diet and Treat- ment, Drinks to be Used, Medical Treatment — Measles — Cause, Symptoms, Complications, Treatment, Care op the Eyes in Measles — Whooping Cough — Symptoms, Compli- cations, How to Recognize, Nature and How it is Spread, Treatment and How to Prevent — Croup — Varieties op — Treatment — Chicken Pox or Varicella — Treatment — Cholera Inpantum — Causes — Symptoms — Treatment — Mumps or Parotiditis — Treatment — St. Vitus' Dance or Chorea — Symptoms, Course op Disease, Treatment — Dis- eases op the Ear in Children — Treatment. diphtheria, scarlet-pever, croup, whooping cough, measles.' chicken pox, and cholera inpantum. Diphtheria is a disease of antiquity. Medical historians trace it back, at least as far as the commencement of the Christian era. Aretaeus, at the close of the first century after Christ, described a malady which occurred chiefly among children and was character- ized by a false, white covering over the throat, a foul breath and, in some cases, food taken into the mouth and swallowed, would return through the nostrils, great difficulty of breathing was ex- perienced, often ending in suffocation. Since the commencement of the sixteenth century numerous epidemics have been observed in both Europe and America, and at the present time it is one of the most fatal maladies in both continents; while in many locali- ties, especially in large cities, it is always present. The majority 35 36 MEDICAL AND SURGICAL EMERGENCIES. of cases of this disease occur between the ages of two and ten years, under the age of one year the younger the child _ the less liability there is to take it, and it rarely ever occurs prior to the fourth month. Cases of diphtheria are infrequent after the middle period of life and old age is almost entirely free from it. The time from exposure to catching the disease is important ; I know of one case of a boy nine years of age, who was in the same room about one hour on Saturday with another case, he was taken down with the malignant form of the same disease. In another case two sis- ters, aged seven and five years, resided with their parents in a boarding-house. A playmate in the same house had symptoms which were supposed to be due to a cold, but which were found to he diphtheretic, when one night the throat disease became worse and ended fatally the next day. The two sisters were immediately removed to a hotel but seven days after the death of the playmate in the boarding-house diphtheria commenced in the seven-year-old child, the younger sister was then removed to a distant part of the same hotel, but on the sixth or seventh day subsequently she also became affected with the fatal form of the same disease. Conse- quently it is seen that the period between exposure and coming down with the disease varies in different cases, but in the majority it is from two to eight days, but now and then a case may extend even beyond these limits. SYMPTOMS OP DIPHTHERIA. This is a disease which affects the whole system, but the con- dition of the throat is of very great importance, and many mis- takes are made even by physicians in not interpreting correctly the character of the exudate which is found in the throat in all cases of diphtheria. It is a very dangerous disease and misleading ; no two cases begin in the same way, every case, as far as the symp- toms are concerned, seems to be a law unto itself but, in the ma- jority of cases it will begin with a sensation of dryness and tick- ling in the throat, with perhaps, slight pain when attempts are made to swallow, more or less stiffness along the angle of the jaw; swallowing becomes difficult and painful, there may be swelling of the glands at the angle of the jaw, but occasionally severe cases occur and run their whole course without any external swelling of the glands. However, when the disease commences and when MEDICAL AND SURGICAL EMERGENCIES. 37 fully established there will be noticed upon the throat, around the root of the tongue and tonsils whitish patches surrounded by red and inflamed parts. At this period the membrane can be easily removed but will immediately reappear in the same situation. The nostrils become clogged, great danger occurs when these white patches become general and pass down the throat into the windpipe and larynx and obstruct breathing to such an extent that the helpless patient dies from suffocation. Cause of diphtheria : It is due to an especial poison connected probably with bad hygiene; this poison is now known to be con- tained in a small germ and this germ may cling to the walls of a room for an indefinite period. It is fearfully contagious and may be communicated by the breath or membrane, and when one case occurs in a family or community there is great liability of other cases following, even if the strictest rules of prevention are ob- served. It is more intense during cold weather. TREATMENT. Strict isolation should be enforced, as in the contagious fevers. Thorough ventilation should be practiced, and everything coming from the patient should be scrupulously disinfected. Fever diet must be given, the patient being sustained every two hours as in typhoid fever. Free stimulation is usually resorted to, giving alcohol, for its effect on the strength, pulse and mind of the patient. There is great toleration for alcohol in this disease. Very early in the disease, when the membrane is first forming, the application of strong astringent solutions is resorted to, but after the membrane has formed strong applications are injurious. The throat should be then kept disinfected with potassium perman- ganate or a solution of salicylic acid (7 per cent) or thymol gr. iv., in glycerine and water. Saturated solutions of pepsin, trypsin or papain are sometimes sprayed into the throat with the view of dissolving the membrane. Tracheotomy. When all other remedies have failed, and life is fast passing away resort is often made to tracheotomy, and, if properly done and at a proper time, many lives are saved which otherwise would not be. This operation is simply making a small opening in the windpipe to prevent the little patient from dying 3 8 MEDICAL AND SURGICAL EMERGENCIES. from suffocation, as the opening will admit air, and, in quite a large number of cases, life will be sustained until the membrane in the throat has been dissolved enough to allow breathing through the natural channel. A small tube is inserted in the opening in the throat and needs careful attention. Above all other operations tracheotomy is the one of haste and emergency, done in hospitals often by the resident surgeon, at any hour, and at a moment's notice. It is an operation of con- siderable difficulty and great danger in some cases, needing the most careful and efficient nursing if it is to be successful. Let us suppose, then, you are left as night nurse in special charge of a case of diphtheria. The child is in its little cot or tent, the steam kettle is going; you are on the watch. What symp- toms will make, you call the doctor? The breathing is labored, the voice is harsh, the cough when it comes clanks and clangs with a brassy, bell-like note — all this you know ; but if you see the eyes becoming lusterless and the whites reddish, the lips blue, and, above all, if you see at each breath the ribs lifting and the side of the chest tucked in, then see that the physician is sent for. If he decides on operating, your chief and most important duty will be to hold the child and steady the head and neck. Wrap it up in a sheet, so that by pinning the sheet you can restrain its hands and limbs; bare the little neck to the chest, hold the head absolutely straight, watching the cleft of the chin, in the same line exactly with the upper cleft of the breast bone; and to project the neck forward, if you have not a little round pillow to put behind it, make one of a folded sheet or of your own left arm. Remember, absolute steadiness of your hands and of the patient's neck. Nursing. The operation being over, the nursing falls to you under three heads : i. The tube. The silver tube is in, both outer and inner; you have to keep the outer firmly fastened, and yet not too tight to hurt the neck, and you have to take the inner out every few minutes to clean from it the thick mucus and keep the breathing free — a troublesome, tedious task. 2. The room. It must be kept warm and moist. You must watch your thermometer and your fire and keep it perhaps to 70 degrees, moist ; your little kettle must be kept going. MEDICAL AND SURGICAL EMERGENCIES. 39 3. Nourishment. You will be told what to give, but you have to give it regularly, gently and cleanly. Duty to yourself. No nurse should think much of beauty or of self-preservation. That is not our business. Still no unnecessary risks should be run, and in tracheotomy for diphtheria it is right to remind you that you run risks of infection if by any chance the membrane or mucus be blown out of the tube with force and thus enter either mouth or eyes. When the tube is being inserted there is generally a great rush of bloody mucus which is most in- fectious ; so keep back your head for it is just the moment when you are apt to put it forward most eagerly ; also when cleaning or changing the tube, just keep your face out of the direct line of fire. Many a good nurse has been off duty for weeks from neglect of such simple precautions. How to prevent diphtheria. The occurrence of diphtheria in a family necessitates the prompt removal of all other children of the family, either out of the house or to some remote part of the same building, and the proper disinfection of the room and all contents of it, such as handkerchiefs, linen, spittoons and clothing of all kinds. Clothing on all the children when the disease is first noticed should be removed, disinfected and an entire new change of clothing upon all those who are removed from the one who is affected. Toe much care cannot be taken in this respect, as "eternal vigilance" in very many cases has prevented the spread of this much dreaded disease. When diphtheria is prevalent in a community, indispositions on the part of a child, especially when fever is present with some derangement in breathing, especially through the nostrils, should at once arrest attention, although there may be no soreness in the throat at this time, but the latter should be carefully examined, and if even redness is present the throat should be sprayed with some of the following remedies : Carbolic acid, 32 drops. Glycerine, 2 oz. Lime water, 5 oz. This should be mixed together and should be used with a hand atomizer every two hours through the day. Another preparation 40 MEDICAL AND SURGICAL EMERGENCIES. which is also excellent and has been in use extensively in the hospitals of New York city : Carbolic acid, 32 drops. Chlorate of potassium, 3 drachms. Glycerine, 3 oz. Water, 5 oz. Both these preparations can be used in the same manner, by opening the mouth of the child and throwing the spray into the throat, or the same can be used by painting the throat with a camel's-hair brush, or they can be used as a gargle, if the patient is old enough and capable of taking a mouthful into the throat, holding it there and gargling. Another preparation which has been used extensively during the last few years, with excellent results is peroxide of hydrogen. For a child from five to ten years old, this can be used, diluted with one-half of water. This also can be used as a gargle, with the spray atomizer, or with camel's-hair brush, similar to the other remedies, mentioned above. There are no domestic remedies which can be used safely in this disease. Nursing is very valuable. The strength of the patient must be kept up and there is nothing better to accomplish this end than beef-tea and egg-nog, made properly and given frequently. THE USE OP ANTITOXIN IN DIPHTHERIA — HOW IT IS PRODUCED THE RESULT OP ITS USE IN HOSPITALS. This remedy, as its name implies, is intended to counteract the poison of diphtheria. It is very interesting and instructive to understand in a general way how antitoxins are obtained, and how they are supposed to act when utilized in this disease. The first step in the production of antitoxin is to obtain the poison of diphtheria from the membrane of the throat, and by means of a sterilized platinum rod to transfer it to what is known as a cultivating medium. In the latter the microbes propagate; this cultivating medium is generally composed of gelatine. After the propagation of the microbes takes place, filtration is practiced, and the genuine poison, or toxin, is obtained, and is then used for the inoculation of animals. MEDICAL AND SURGICAL EMERGENCIES. 41 At the present time the horse is the chosen animal for inocula- tion. The animal is inoculated at stated times until it no longer reacts to the effects of the progressively increasing doses. Then the condition of what is popularly known as immunity is reached ; which is simply the impossibility, by the inoculation of these poisons, of making the animal sick. After the animal is thoroughly immuned (proof from effects of the disease), the watery element of the blood of the animal is then used for a human patient, who, through the introduction of this element into the human system, is guaranteed against the poison- ous influences of diphtheria. The horse does not suffer and the results on the human patient have been quite satisfactory, and it has been the means of saving many lives. This remedy, during the last year or more, has been used ex- tensively in European hospitals as well as American, and the results have been very satisfactory. At Harper Hospital in Detroit, this state, where formerly the mortality ranged from 30 to 40 per cent., with the proper use of antitoxin the mortality was reduced to five per cent. SCARLET-FEVER. The terms scarlet-fever, scarlet-rash, and scarlatina are identical, that is, these terms represent the same disease. Scarlet-fever is a very frequent and fatal contagious disase. It may occur at any age, but occurs most frequently in the young. It is frequent in cities, large towns and villages where it spreads by contact. There is probably no disease of childhood which is more treacherous, and which is approached by physicians with more dread than a severe case of scarlet fever. Complications may occur in any form of scarlet-fever, but they are most frequent in severe forms. The most serious complication which affects the nervous system, is convulsions. They may occur at the commencement of the disease, before the appearance of the rash and in these cases many of them recover. But when the convulsions occur after the rash has covered the body, then they are very serious and it has been the experience of many physicians, of wide experience, that cases never recover when convulsions occur after the rash has com- pletely developed. These convulsions are, no doubt, due to the congested condition of the nervous system, and the convulsions 42 MEDICAL AND SURGICAL EMERGENCIES. aggravate the congestion. Diphtheria may also complicate scarlet- fever, and it is absolutely necessary to make daily examinations of the throat in order to detect any complication of this character. Another complication to which we may allude is inflammation of the bowels, this ma, occur before the scarlet- fever or it may occur at the same time. Bronchitis and pneumonia, a frequent compli- cation of measles, do not often complicate scarlet-fever. Another frequent complication is rheumatism ; it may occur when the fever is leaving the patient. Attention is called to it by the child com- plaining of pain or tenderness in the affected joints. If the child is too young to complain, evidence of pain and tenderness will be manifested when the limbs are moved or pressed upon. There is also some swelling and redness in those parts. Complication from rheumatism is not necessarily serious nor does it retard recovery very much, unless some heart complication ensues. Other compli- cations are the following: inflammation of the covering of the bowels (peritonitis), of the covering of the lungs (plueritis) and of the heart (pericarditis) and many such complications of the latter are fatal. One of the most common complications and one which requires close attention from both physician and nurse is inflammation of the kidneys, which is the cause of dropsy. Inflam- mation of the ear is also a frequent complication ; matter will form in the interior of the ear and there will be a foul-smelling dis- charge, which will require constant treatment and attention. THE CAUSE OF S CAREET- FEVER. It is a very contagious disease. By contagion we mean being transferred from the sick to the healthy. When the disease spreads in a family or in a community it must be communicated or carried in some way ; it may be conveyed by coming in direct contact or it may be spread through the atmosphere, or by clothing which has been saturated with the poison of scarlet-fever. Animals such as dogs have been known to be around the sick-room where scarlet- fever existed and to convey it to other families ; a case is known in which the poison was conveyed in this way. For a number of days a little dog had been around children sick with scarlet-fever and by a single visit of a dog to the children of another family the disease was conveyed. It is a question at the present time whether or not this disease can be transferred in milk. MEDICAL AND SURGICAL EMERGENCIES. 43 PERIOD OF exposure:. The period from exposure until the occurrence of the disease varies from two to ten days, the average is from three to five. It may occur in a few hours after exposure. Age has a marked influ- ence, also individual predisposition. Children are the most suscep- tible to the influence of the poison between the second and seventh year, and as years increase the susceptibility decreases. When an individual has had one attack he is almost certain never to have another. SYMPTOMS OP SCARLET- FEVER. The symptoms vary with the severity of the fever. In moderate cases before the appearance of the eruption the patient will have more or less headache, pain in back and limbs, and, at first, cold- ness of the surface of the skin. Sometimes there will be bleeding from the nose ; in other cases there will be a chilly sensation, and in some, a distinct chill and in children, convulsions frequently occur. These symptoms are immediately followed by a sensation of intense heat with a rapid pulse, often from one hundred and twenty to one hundred and thirty per minute. There will be some nausea and vomiting, very distressing and persistent. The tem- perature may run high, at the outset from 100 to 104 degrees. BEGINNING OF THE ERUPTION. Within a period lasting from twelve to forty-eight hours, the average being thirty-six, the eruption makes its appearance and the fever increases. There is extreme restlessness, often some delirium, and nausea and vomiting becoming severe. The tongue will indicate a strawberry appearance, unlike any other disease, in this respect. In some cases the disease is so mild that there is but little dis- turbance except that caused by the eruption, the temperature not running over 104 degrees, Fahrenheit. In other cases the disease is ushered in by violent nervous symptoms, with delirium and sometimes a dull and drowsy, almost unconscious condition, accompanied by extreme exhaustion, and in some cases, the patient dies before the eruption makes its appearance, when the system is 44 MEDICAL AND SURGICAL EMERGENCIES. overwhelmed by the poison from scarlet-fever. During the earlier stages both children and adults complain of a prickling sensation in the throat, with some difficulty in swallowing. The throat be- comes red and congested, and often somewhat swollen, although there are some cases in which the throat symptoms are entirely absent at the first and do not come on until later in the disease. In an ordinary case of scarlatina or scarlet- fever, which runs the ordinary course, between the fifth and eighth days of the eruption the temperature begins to decline and at the same time the erup- tion begins to fade, so that on the eighth day, and sometimes as early as the sixth, it is no longer visible. Then sets in what is known as the period of desquamation, that is, the peeling of the . cuticle or outer layer of skin. This period lasts about two weeks, and during this period there is the greatest danger of the spread- ing of the disease, but at the end of this period, if no complications occur, the patient may be considered practically well. These fine particles which are thrown off from the skin contain the specific poison of scarlet-fever and they are so fine and so delicate that they may be blown about with every breath and carried with every current of air, so that an average case of scarlet- fever will come to an end at about the fourteenth day, sometimes as early as the tenth day. TREATMENT OF SCAREET-EEVER. Strict observance must be enforced in relation to the separation of the healthy from the one affected. Thorough ventilation of the room ought to be practiced and disinfection should be thoroughly carried out. All useless articles of furniture must be removed from the sick-room, fresh air be admitted as much as possible, as it ren- ders the contagion of scarlet-fever less powerful ; therefore free ventilation is very important. All clothes and excretions of the patient should be disinfected in the same manner as in typhoid fever. The surface of the body should be frequently sponged and after sponging, the surface should be rubbed with olive oil. These details should be practiced and carried out during the period of desquamation. Those convalescing should not be allowed to leave their room until desquamation is completed, which usually re- quires from two to three weeks. After the patient leaves the sick- room the apartments should be thoroughly disinfected, and the MEDICAL AND SURGICAL EMERGENCIES. 45 -windows and doors of the room should be allowed to remain open for a long time. DIET IN SCARI^T-FEVER. This is a disease accompanied by great physical and mental ex- haustion, consequently the proper regulation of the diet, in order to sustain the vitality of the patient, is of the utmost importance. Not only during the whole continuance of the fever but during convalescence. During all fevers the appetite is very much lessened. Milk, soups, broths and various gruels or arrow-root, farina, oatmeal, rice and barley flour are customarily given. It is the opinion of many, based on the fact that in children who are still nursing, complications are of very rare occurrence, that milk as an article of diet in scarlet-fever is of the most potent value. It is wise therefore to subject the patient to an exclusive milk diet during the commencement of the disease. From three to four pints every twenty-four hours will comfortably nourish a child from three to four years of age, and should be given regularly and in measured quantities every two or three hours. There are some ready methods of altering the taste of milk which may be borne in mind when the child tires of it. Caramel, ginger, a little chocolate, cocoa, or very weak tea added to the milk, will make the diet less monotonous. If difficulty is experienced by the stomach in handling milk, skimming or boiling it will render it more digestible. The flat taste of boiled milk can be remove'd by the aerating process, pouring it back and forth from one glass to another several times, or by adding any charged water. Dilution with plain water, one part to two or three of milk, renders diges- tion easier; or lime water, three or four tablespoonfuls or more to the glass of milk ; or Vichy, bottled plain soda, or Apollinaris may be added to the milk in any desired proportion. There are also modifications whereby milk may be smuggled in under disguise, such as koumiss, junket, whey and buttermilk. After the few days of rise of temperature in scarlet fever, the appetite generally returns, and the mistake is common of permit- ting at this time full diet. It is just at this very period that kidney complications are apt to manifest themselves and that dietetic errors are most costly. Although the fever has subsided, the rash faded, and the sore throat become a thing of the past, the poison is 46 MEDICAL AND SURGICAL EMERGENCIES. still in the system and the kidneys are still struggling with its elimination. If the desires of the patient are now allowed full sway, quick revenge may be expected at the hands of the laboring kidneys. Milk should still be the staple article of diet, though rice pudding, milk toast, cream toast, corn starch, wine jelly, farina, oatmeal and cream, mush and milk, crackers and milk, baked apples, stewed prunes, and oranges may be put upon the bill of fare. Stock soups, eggs and meat broths are safer out of the diet until after the fourth week. Individual cases may demand a strong beef tea or chicken broth, at an earlier period, but as a rule the animal extracts are not per- missible until the beginning of the second month. Substances from the meat are dissolved in them which may irritate the kid- neys, and do as much harm as the meat itself. With the comple- tion of desquamation, about the twenty-eighth day, soups and vegetables are permitted, and a little later a gradual resumption of animal fare, beginning with fish. Oysters, chickens and eggs should follow in order at two or three days interval before meat in moderation is ventured upon. DRINKS. The beverages of scarlet fever are quite varied, alcoholic drinks, coffee and tea being almost the only proscribed fluids. For the thirst during the fever stage, water, seltzer, Apollinaris, barley water, orange juice in Vichy, and soda lemonade may be used freely. A little vanilla ice cream is harmless, and very grateful and cooling to the dry and parched throat. After the subsidence of the fever, it is well to encourage free use of plain water or the alkaline mineral waters throughout the convalescent period, as they seem to aid the kidneys in their work of elimination. MEDICAL TREATMENT OE SCARLET EEVER. This is a disease which cannot be aborted, but if left to itself its natural course tends to recovery, if the fever and local symp- toms remain within certain bounds. It has certain stages to pass through and one cannot safely interfere with its regular course. To stand by and watch and, so far as possible, to guard against complications are the chief duties of the physician and nurse. All MEDICAL AND SURGICAL EMERGENCIES. 47 details are important as herein indicated and should be carried out with religious diligence. As soon as the period of desquamation has been reached the patient should have a warm bath once or twice during the day. The surface of the body should be washed with carbolized soap. The baths hasten the process of desquama- tion and in bringing about a healthy condition of the skin. They also assist in relieving the congestion of the kidneys. An excellent preparation to be given when the patient is nervous and the circulation poor and accompanied by drowsiness : carbon- ate of ammonia, citrate of iron and ammonia, one and one-half drachms ; simple syrup four ounces. One teaspoonful is to be given every second or third hour to a child from four to ten years of age. Diuretics should be given in order to increase the elimi- nating powers of the kidneys. A combination of the following: Acetate of potassium, one-half ounce; tincture of digitalis, one drachm; simple syrup added enough to make a four ounce mix- ture. A teaspoonful dose of the above should be given four times per day to a child from five to ten years old. When the temperature is running high, pulse rapid and great restlessness and depression, small doses of quinine, one grain to a child five years of age, every two hours is a good treatment and for a hot, burning condition of the skin, a sponge bath of cool water every few hours as the condition of the patient would seem to indicate. By intelligent observation the disease, in the majority of in- stances, can be detected early, and proper precautions may be taken, looking toward isolation and prevention of the spread of this disease ; and many lives will be saved and many cases of this disease prevented. MEASLES. This is a disease in the majority of instances, peculiar to child- hood, but it may occur at any age. Few persons escape it at some period of their life. It is less liable to occur in young infants than in children after dentition, and a second attack is of rare occur- rence. It may prevail as an epidemic but it occurs frequently in different localities, the number of cases not being enough to class it as always epidemic. 48 MEDICAL AND SURGICAL EMERGENCIES. THE CAUSE OF MEASLES. It is a contagious disease and, so far as we know at the present time, it is only spread by contagion. The poison of measles is located either in the secretions from the nose and throat, or it is exhaled or given off from the body of the sick one, and so con- taminating the air about the sick-room that when persons who have not had the disease are brought into contact the disease is developed. It has been proved that the blood and mucus secre- tions escape from the nose, and often the tears have the power to spread the disease by inoculation ; however, there is little question but that the disease can be conveyed in clothing and that it is a portable disease, capable of being carried around by individuals. The exact nature of the poison of measles is not known. The average period from the time a person is exposed to the poison of measles until the person is affected is about eight days. Persons are susceptible to this disease the same as to the other con- tagious diseases. The time in which the poison is most active, that is, most liable to infect the healthy, is not definitely determined, but there is abundant evidence to show that it may be spread throughout its entire course. THE SYMPTOMS OF MEASLES. From eight to ten days after exposure the patient begins to suffer from a discharge from the nose, feels tired, languid, chilly and irritable. Occasionally convulsions occur in the beginning among children. There may or may not be fever in the beginning, but very soon after the above symptoms are manifested there will be a marked increase in the temperature of the body. The eyes will be injected and watered; aversion to bright light. The eyelids will be red, more or less swollen ; a constant irritating discharge from the nose, with sneezing; pain in the head above the brows. There will be more or less sore throat ; voice will be husky; also a hoarse cough. The respiration will be hurried. There will be a sense of uneasiness and lightness across the chest, which will indicate a congestion of the bronchial tubes. After these early symptoms have continued, perhaps for twenty- four hours, the fever will develop. These catarrhal symptoms will MEDICAL AND SURGICAL EMERGENCIES. 49 continue from forty-eight hours to four days, then the eruption makes its appearance. ERUPTION STAGE. The eruption is first seen upon the face, about the chin, fore- head, mouth and side of the nose; then upon the neck; then it passes down upon the chest and over the lower part of the body, including the legs, and lastly upon the back and hands. The eruption upon the face feels like small shot early in the disease. Usually it is about four days from the time of the appearance of the eruption upon the face before it has passed over the entire body, and it begins to fade from that part about thirty-six hours after its appearance on that part, that is, it begins to fade from the face, then the neck and chest, and finally the back and hands. The odor is peculiar during this period. With the appearance of. the eruption there is more or less swelling of the surface with itching and burning. The color of the eruption will vary from a bright rose red to a dark mahogany hue. This difference in color depends upon the condition of the individual and the peculiarity of the type of the disease, rather than upon the change in the skin itself. Convulsions may in children be fatal. Blood from the nose is common. An increase of fever and rise of pulse and delirium at night often follow the first outburst of the eruption. COMPLICATIONS. One of the most important complications is bronchitis. Rarely is there a case of measles without more or less catarrh of the bronchial tubes, however, this complication is not serious unless the inflammation of the bronchial tubes passes down into the lungs. When it does the patient is in great danger. Pneumonia is also a serious complication. Inflammation of the brain occasionally is a complication. Inflammation of the ear is of frequent occurrence, especially in those who have some hereditary taint in their blood, such as scrofula or tuberculosis. TREATMENT OF MEASLES. In all cases of measles without any complications or irregularity in the development of the disease the outcome is nearly always 4 50 MEDICAL AND SURGICAL EMERGENCIES. favorable. The younger the child the danger is less. The chief duty to be performed by those in attendance upon cases of measles is to guard the patient against lung and other complications. The patient should be placed in a large, well-ventilated, darkened room, with a temperature of about sixty-five degrees. The darkened room is necessary on account of the congested condition of the eyelids. The chief article of diet should be milk. care of the: eyes in measles. If the patient complains of itching and burning of the surface of the body, it is well to sponge with warm water. This has a tendency to allay the itching and burning, and also to reduce the temperature. In an ordinary case this is all that will be necessary. Hot drinks or stimulants of any kind have been used extensively upon the supposition that they have power to hasten the appear- ance of the eruption, but it is doubtful if they are efficacious in that direction, and indeed they have been known to be followed by dangerous results ; bringing on convulsions in which death may oc- cur. Indeed, some of the very best authorities state emphatically that in an ordinary case stimulants should never be given during the initiatory period of the fever, unless there is some special indi- cation for their use, such as a feeble pulse and great prostration ; then they may be used with benefit. The greatest cleanliness should be observed, besides there should be free ventilation, avoiding all drafts in the sick-room. If there is thirst, cold water may be taken in small quantities at a time. It is the duty of those in at- tendance to watch closely for the occurrence of lung complications. The chest should be frequently examined. The inhalations of steam have afforded great relief in those cases where bronchitis is severe. The value of vapor inhalations in the treatment of this complication in measles is very great; even when pneumonia has developed the inhalations are of benefit. There is not so much danger from the use of stimulants after the eruption is fully estab- lished, and, indeed, when passing off and the fever declining, it is often useful, when given in proper quantities. There is perhaps nothing better when the little patient is rest- less, the fever running high and the eruption slow in making its appearance, than a small amount of opium, given in the form of MEDICAL AND SURGICAL EMERGENCIES. 51 Dover's Powders ; one-half grain may be given for every year the child is old ; if the child is five years of age from two to two and one-half grains may be given with safety and with marked benefit. The principal object to be remembered is to prevent complications of any kind, when the disease will run through its course and the child entirely recover, without any results which would have a tendency to deplete the constitution in the future. If the cough is severe, a mixture of the following is of benefit : Carbonate of ammonia, 15 grains. Muriate of ammonia, 15 grains. Paregoric, 2\ drachms. Simple syrup, enough to make 2 ounces. One-half teaspoonful given every two hours to a child from four to ten years of age. WHOOPING COUGH. Whooping cough is an acute, contagious disease, attended by a peculiar, characteristic, spasmodic cough. It is a disease of childhood, but cases occur in adults. It attacks an individual but once. SYMPTOMS. It has three well recognized stages. The first stage is the stage of catarrhal symptoms, in which there is a catarrhal condition of the nose and throat, similar to that which is seen in a common cold in children. The duration of this stage is from two days to three weeks, the average being ten days. The second stage, or spas- modic stage, is attended by a characteristic, spasmodic cough. This cough is very severe and distressing; the face grows red and then begins a long, clear, piping sound, followed by a series of rapid, convulsive and forcible expiratory puffs, which are suc- ceeded by a prolonged, shrill sound or whoop. If these fits last any length of time the cough becomes inaudible and a consider- able quantity of clear, sticky mucus is expectorated or vomited with the contents of the stomach. During the paroxysm the patient grows red or purple in the face. The eyes protrude and the tongue assumes a dark appearance, and the little sufferer seems on the verge of suffocation. Bleeding from the nose, mouth, ears and lungs often occurs during a violent paroxysm of cough- 52 MEDICAL AND SURGICAL, EMERGENCIES. ing. The face becomes puffy. Ulcers may form on the tongue. The eyelids may become injected. After spasms of coughing a period of exhaustion follows, with soreness of the muscles of the chest. The frequency and duration of the coughing spasms varies greatly in different cases; there may be one hundred in twenty- four hours. They are most frequent at night and, as a rule, the severer the paroxysms of coughing the oftener they occur. The disease usually attains its height by the end of the fourth or fifth week. In mild cases the patient is well in the intervals between the paroxysms of coughing, but in severe cases there may be weakness and debility, loss of appetite, headache, and more or less fever between the paroxysms. The third stage, or stage of decline. This stage is not ushered in by any well-marked symptoms, but by a great diminution in the severity and frequency of the paroxysms. The peculiar whoop ceases ; the cough and expectorations are less difficult ; the latter becomes more purulent in character and finally, after a period of about nine weeks, the characteristic cough ceases altogether and the little patient passes into rapid convalesence. SOME COMPLICATIONS. During the course of the disease, whenever the coughing fits lose their characteristic features, namely, the whoop, and become dry and hacking, accompanied by great difficulty in breathing, this continuing through the intervals between the coughing, and spasms with a marked rise in temperature, it indicates compli- cations of the lungs. Another complication which is particularly to be feared in this disease is congestion of the brain ; when, during a paroxysm, the countenance becomes flushed and swollen, the jugular veins turgid, with a gush of blood from the nose there is danger of such an occurrence. When the face is continually flushed, the head hot, the patient drowsy, or restless in his sleep, moaning and grinding his teeth, there is danger of convulsions and loss of consciousness, in which case the disease often termi- nates fatally. HOW TO RECOGNIZE WHOOPING COUGH. In the earlier stages it is not possible to recognize whooping cough with certainty, but its existence may be suspected if the MEDICAL AND SURGICAL EMERGENCIES. 53 cough is of a violent, spasmodic character and if the disease is prevalent in the community. When once the disease is established, the peculiar cough and the watery expectoration distinguish it from other diseases of childhood. THE NATURE OE WHOOPING COUGH, AND HOW IT IS SPREAD. The contagiousness of the disease becomes evident when a great number of cases follow from direct contact with persons affected. This has happened so often in this disease that the contagiousness is established beyond doubt. The majority of reputable physi- cians have expressed themselves emphatically that genuine cases of whooping cough attack children but once, although there are a few who claim to have observed this disease twice in the same person. It rarely, however, attacks adults, and then chiefly among the wealthy who have always been separated from their children and have thus escaped infection. Nevertheless, parents of chil- dren with whooping cough and the nursing maid frequently suf- fer from a milder form of spasmodic coughing which seems to be due to their being with the patient. Infants, before the commence- ment of dentition, are less susceptible than those several months older; still there are exceptional cases in which it has occurred even before dentition. It is not possible to state definitely the exact nature of the con- tagious principle, but it is most probably found in the particles of mucus expectorated, which, becoming dry, are diffused in the surrounding atmosphere and is then in a condition to be inhaled during inspiration. TREATMENT AND HOW TO PREVENT ITS SPREAD. How to prevent its spread consists entirely in the removal of the child from the place in which whooping cough is just appearing, but perfect separation in this disease is carried out with difficulty. Whenever possible an entire change of place is desirable. The chief indications in the treatment of whooping cough are : first, to diminish the severity of the paroxysms ; second, to prevent and treat, so far as possible, the complications, if any exist ; third, to attend to the general health and physical condition of the patient. There are no known means by which this infection can be re- 54 MEDICAL AND SURGICAL EMERGENCIES. moved; the paroxysms cannot be altogether prevented, but their severity may be lessened. Of all the internal remedies used they are of doubtful import- ance. There is no remedy that will prevent the cough and spasms entirely. Of all the remedies used the best that can be accom- plished with any of them is to alleviate the severity of the cough and spasm, and for this the following remedy has been found use- ful; to a child from four to ten years of age the following pre- scription may be given in one-half teaspoon ful doses, every two hours : Chloral hydrate, 40 grains. Elexir valerinate of ammonia, 4 drachms. Simple syrup, enough to make a two ounce mixture. The following prescription has been used extensively by the Germans : Quinine, 4 parts. Dilute sulphuric acid, 2 parts. Water, 200 parts. A small glass syringe is filled with this solution and ejected against the back part of the throat, the mouth being held open and the tongue depressed. Some of this is swallowed or spit out. This may be done every two or three hours during the first three or four days, when marked improvement has followed in many cases. Another favorite remedy, used also by the German physicians, is the following prescription: Muriate of quinine, 3 parts, rubbed with gum acacia, one part. This makes a fine powder, and about three grains, or what you can hold on the point of an ordinary jack-knife, is blown up into the nostrils or snuffed up by the patient, if possible, once or twice in twenty-four hours. This has also been followed by marked improvement in many cases. The Italian physicians use the following with good results: Quinine, pure, 3 parts, Benzoic acid, 1 part. This is also made into a powder and snuffed up into the nostrils. MEDICAL AND SURGICAL EMERGENCIES. 55 Eight cases reported by Italian physicians by this treatment were relieved and cut short very much in their course. During the third stage, or stage of convalescence, tonics of iron, quinine and cod liver oil are indicated, with a good nourishing diet ; plenty of milk in some form, either taken in its natural state, or prepared for digestion after the formula given in the chapter on the preparation of foods. Onion syrup, honey, and many other domestic remedies have been extensively employed, but they act by nauseating the patient and produce vomiting, and have no direct influence over the course of the disease. kinds o£ CROUP. There are two kinds of croup; one is a very serious disease which is accompanied by a membrane on the throat, resembling diphtheria. This false membrane may exist in a few patches, spot- ted here and there and of a whitish color over the wind-pipe and throat. There is often congestion and swelling of the parts also. The other form, which is known as false croup, is an entirely different disease and is the form in which it is met generally among children, and is very much dreaded by the laity. False croup is a simple catarrh of the throat and wind-pipe, is spasmodic, and it is the spasmodic condition of the wind-pipe which gives rise to the croupy symptoms which are more or less familiar to every mother's ears, and if once heard will never be forgotten. In. this form the croupy symptoms come on quite suddenly and the attack usually occurs at night. It may not be preceded or accompanied by any fever; there is no complete loss of voice, and there is an absence of any membrane on the throat and tonsils. There are various causes which are attributed to give rise to this form of croup; among these are irritation of the teeth and stomach, enlargement of the glands of the throat, and an undue excitability of the nervous system, the latter often occurring at the result of hereditary predisposition. The suddenness of the attack is almost characteristic of this disease. The child may go to bed feeling entirely well, and during the night arouse the anxious parents by the croupy cough and difficulty in breathing, so severe is the latter in many cases that life seems in imminent danger. 56 MEDICAL AND SURGICAL EMERGENCIES. This is a common disease and ordinarily occurs between the ages of two to five years. Some children in the same family are more liable to croup than others. It is not uncommon in the commencement of measles. Exposure to cold is often the exciting cause. The sleep preceding the attack may be quiet and natural, but when the child awakes there is a loud barking cough and the respirations may be harsh and whistling. The face is flushed and indicates great suffering. The child cries, goes from one position to another, wishes to be held or carried, seeking in vain for relief, the skin is hot and dry, and the pulse hurried. These symptoms continue usually from one-half hour to two or three. They should not last for over a half hour with proper treatment. When the little patient is relieved, exhaustion and sleep follow. The cough, though less frequent, remains for a time of a barking character and the respirations are not natural for some time, but they gradually become so. Often there is no return of the spasmodic symptoms but quite frequently an attack occurs at about the same time the following night. The termination is not always favorable ; it is often followed by other serious effects, which may prove fatal ; bronchitis often sets in or pneumonia. TREATMENT. The first indication to be followed is to relieve the spasms, and to do this a warm bath is indicated, at a temperature of about ioo degrees, or as warm as the child can reasonably and safely be kept in without scalding, and should be kept in it for ten or fifteen minutes in order to obtain its full relaxing effect. In mild cases a warm foot-bath may be sufficient. An emetic should be given at the same time as the bath. To children under three years of age there are many remedies which every household having children should keep on hand. They are simple, inex- pensive and not dangerous, and can be employed with great benefit and relief before a physician's services can be secured. The following remedies are very useful and very effective : a teaspoonful of powdered alum, mixed with honey or syrup. A small amount of this can be given every half hour until vomiting occurs. Another remedy which is equal to, if not better than, the above is the Compound Syrup of Squills, about a teaspoonful MEDICAL AND SURGICAL EMERGENCIES. 57 together with a teaspoonful of the Syrup of Ipecac. Generally one dose of the above will be sufficient to produce vomiting, if not another dose can be given, but it is scarcely ever necessary to give more than two or three doses. A warm bath and some of the above remedies should be given immediately when the croupy symptoms are present, when marked relief will generally follow if there are no complications. I have found also the inhalation of steam from hot water to be very useful. An old tea-pot or tea-kettle in which water can be heated and the steam allowed to escape in close proximity to the child's mouth and nose, and the child encouraged to inhale as much of it as possible. Mustard plasters applied to the throat and upper part of the chest are also very useful. Another domestic remedy which has proved to be of great value is onions, a poultice of onions placed in a cloth as warm as can be borne and applied to the throat of the little patient. All that is necessary is to have these remedies at hand and use them promptly and in an intelligent manner. After the immediate symptoms are relieved there generally follows a cough, which needs some treatment. The Syrup of Ipecac or the Syrup of Squills can be given every three hours, in from ten to twenty drop doses to a child aged five years. A mild laxative should also be given after the spasmodic symptoms have been relieved, and for this purpose there is probably nothing better than the Syrup of Cascara Cordial which is a harmless and very useful remedy, and is very extensively used among children and prescribed generally by the medical profession. The patient should be kept in a warm room for several days; the atmosphere should be moist. A general tonic should follow and the strength of the patient kept up by good nourishment. CHICKEN POX OR VARICELLA. Chicken pox is the mildest of the fevers accompanied by an eruption. It is very contagious, so that few children escape who have been exposed to it. The period from exposure to the breaking out of the disease is from fifteen to seventeen days. It is a disease of child-hood but also occurs in adults. It usually commences with a fever, chill, head-ache, sometimes aching in the back and limbs, and the pulse increases to 100 or 112. 58 MEDICAL AND SURGICAL EMERGENCIES. When the above symptoms have continued for about twenty- four hours the eruption appears on the trunk of the body and soon afterwards over the face and limbs. The only other disease with which it is liable to be confounded is small pox. TREATMENT. Rest in bed, cleanliness, nourishing diet and warm drinks, and with no complications, nothing further in the line of treatment is indicated. (See P. at end of book.) CHOLERA INFANTUM. This is what is commonly understood as the summer diarrhea of children. This is a disease which is to be greatly dreaded, in cities especially, where the mortality is extremely large. Among the principal causes heat may be enumerated. It is most prev- alent during the months of July and August, although cases occur from May to October ; a residence in an atmosphere loaded with noxious vapors, where gases rise from the decomposition of animal and vegetable matter, or the atmosphere is rendered im- pure by overcrowding and by personal and domestic uncleanliness. It is therefore more commonly found in tenement houses and parts of the city occupied by the poorer class of people, where there is less attention paid to cleanliness in general, and where it is impossible to secure a proper amount of fresh air. So long as the temperature is moderate the diarrhea will, in all probability, be simple in form, but, should the temperature rise from 85 degrees to 95 degrees Eahr. or even higher, and remain there for several days, as happens occasionally in our summer months, the form of diarrhea will immediately become much more severe and will be very liable to take the inflammatory form. SOME CAUSES OF CHOLERA INFANTUM. The next cause of importance is improper diet. Sudden weaning of the child from a natural food to an artificial ought to be avoided during the summer months. Unwholesome milk of any kind or the use of vegetables, unripe or unhealthy fruits, such ,as apples, currants, gooseberries or blackberries will sometimes MEDICAL AND SURGICAL EMERGENCIES. 59 bring on in a very few hours the most violent attacks of Cholera Infantum or change a comparatively mild and safe attack into a more violent and fatal form. Among the causes in cities, where epidemics have existed, the following conditions have been known to exist : 1. Decaying organic matters, bone, hide, fat and offal houses, neglected stables, putrescent mud and filth. 2. Bad drainage, local dampness, malaria. 3. Obstructed sewers, filthy streets, gutters, stables, garbage and cesspools. 4. Water and beverages in any manner contaminated by putrescent organic matter, particularly by any soakage from privies. 5. Neglected privies and putrefying excrement. 6. Overcrowding and neglect of ventilation. It is just where these conditions are most rife that choleraic diseases in children are most apt to occur. Amongst the poor, who inhabit the crowded quarters of cities, where the streets and alleys are small and narrow, where heaps of decaying vegetable and organic matter abound, where water is scant, or scantily used, where ventilation, from the manner in which the streets are laid out, and from the crowding together of buildings, is necessarily imperfect, we have the most numerous and severest forms of the disease. It is amongst the poor, too, that the food is often of necessity, as well as from ignorance and recklessness, of the most improper kind, and not infrequently insufficient in quantity. Age, sex, dentition, constitution and hereditary predisposition are all powerful factors in the causation of this disease. Statistics show that there are about twice as many fatal cases among chil- dren during the first year than in the second, although dentition is certainly more active and continuous during the second year than in the first; however, cases are rarely observed before the begin- ning of teething and the disease is certainly very rare after teething is completed. SYMPTOMS. Cholera Infantum is known as such when it occurs under five years of age ; after this date it is known as Cholera Morbus. The 60 MEDICAL AND SURGICAL EMERGENCIES. former sometimes commences abruptly, previous health of child having been good, in other cases there may have been a previous mild diarrhea. The stools become thinner than natural and some- what more frequent. Suddenly the evacuation becomes more frequent and watery, and the parents are surprised and frightened by the rapid sinking and real danger of the infant. Accompany- ing this condition is another symptom, namely, irritability of the stomach, vomiting, nausea, and retching without vomiting. The appetite is less and the thirst is intense ; cold water is craved for and taken with avidity; and, if the infant nurses, it eagerly seizes the breast in order to relieve the thirst; the tongue is moist, at first clean but it may be covered with a light fur. The temperature is elevated ; there is no disease of infancy in which the temperature of the blood rises higher, it may rise as high as 105 degrees, or even higher. The disease may approach a fatal termination in two or three days ; the limbs and cheeks become cool, the eyes blurred ; pupils contracted ; the urine scanty and suppressed. The pulse becomes more feeble and the surface clammy and cold; and stupor results. TREATMENT. Preventive treatment. The danger to which teething children are exposed from living in cities during the hot months of the year are now so well understood that most families remove to the country during the warm season and, by so doing, generally avoid the disease. This is undoubtedly the best plan to follow by those raising children in cities, however, when this cannot be done, the preventive treatment consists in the most careful atten- tion to diet, dress, thorough ventilation of the living rooms, and exposure to the open air. If the child is nursing it should be kept at the breast until it has passed through the second summer, as there is little danger from this disease after that period. If, for any cause, weaning must take place prior to that date it ought to be done before the hot weather begins. If the child is weaned the diet must be strictly attended to. Up to the age of ten months or a year, the food should consist almost wholly of milk contain- ing arrow-root, rice, oatmeal or some farinaceous substance in small quantity. A little plain chicken or mutton water, with rice MEDICAL AND SURGICAL EMERGENCIES. 61 boiled in it, or a piece of beef or chicken to suck may be given occasionally, but all vegetables and fruit should be strictly for- bidden. After the age of ten months, some light soup and small portions of mutton, chicken or very tender beef, minced very fine, may be given every day in addition to the milk food, which must still form the larger part of the child's diet. For further information on how to prepare these different forms of diet, we The dress should be arranged according to the heat of the day. refer the reader to the article on food in another part of this work. "We have not rarely known young children to be kept clothed all summer in thick flannel jackets, and petticoats and woolen socks. This is certainly wrong and too much for the heat which fre- quently occurs during the months of July and August and part of September, and is, we believe, very injurious. A light gauze flannel shirt is the only woolen garment that need be worn during the warm season. On hot days, a child should have only this, a muslin petticoat and frock and the lightest possible stockings, or none at all. If, as constantly happens in our climate, a cool day comes, there should be added a light flannel petticoat. It is important that the child should pass a large part of the day in the open air. We believe that, with a constant and wise attention to these points, namely, diet, dress, careful ventilation of house and bed room, exposure to the air, and exercise, much may be done towards preventing this disease, even if families are obliged to remain in the city during the summer. After the disease is once established something can be done by way of reducing the number of discharges, and also toward making the little patient more comfortable. The following pre- scription has had an extensive use among the leading physicians of New York city : Tincture of opium, 15 drops. Aromatic spirits of ammonia, -J drachm to I drachm. Subnitrate of bismuth, 2 drachms. Chalk mixture, i-J ounces. Simple syrup, \ ounce. An infant six months old should take about twenty drops every two hours ; and for a child one year old one-half a teaspoonful. 62 MEDICAL AND SURGICAL EMERGENCIES. When the skin is hot and the fever high, frequent sponging of the surface of the body with tepid water and alcohol has been found very grateful. Lime water and milk may also be given in the following amounts: Take two parts of milk with one of lime water, and add fifty per cent, water which has previously been boiled. A teaspoonful or two of this can be given every hour, when the little patient craves for something to drink. When the patient begins to improve, and when there is danger of taking food which will prolong the disease or cause a relapse, I have found the following very useful: equal parts of milk, cream, lime water and plain water can be given with comparative safety. Medicines, as a rule in this disease, have not yielded the best results; there is more to be accomplished by nursing, and proper diet, but this must be done intelligently, and the food be properly prepared and given in proper amounts. If this is not done, all remedies directed toward the relief of this disease will do very little good. (See prescription for same.) MUMPS OR PAROTIDITIS. In the human being there are located two glands, in front of and towards the lower side. of the ear, one on each side of the head, glands known as the parotids. Connected with this gland on the inside of the mouth and opening upon the molar teeth on each side, is a little tube about the size of a goose quill. During the mastication of our food, when it is being rolled around under the teeth, this gland gives out a fluid, which is carried and poured out on the food while under the teeth, by this little tube, which reaches up to the gland on either side. This is what is known as the saliva, or what is more commonly understood among the laity as the spittle. It performs a very important function in digestion by lubricating the different varieties of food and assisting in the first process of digestion. It is this parotid gland which becomes diseased when an indi- vidual has the mumps. This gland becomes tender and enlarged, the swelling gradually increases until the depression under the ear is filled, and the swelling may extend upwards and forwards upon the cheek, or downwards to a greater or less extent upon the MEDICAL AND SURGICAL EMERGENCIES. 63 neck. This inflamed or swollen condition of the gland is said to be due to a specific poison in the blood. The swelling reaches its full extent on from the third to the sixth day. The most prominent point in the swelling is generally underneath the ear. Movements of the jaw during mastication, and even talking, causes considerable pain. Fever is also present, but ordinarily does not last more than forty-eight hours. The swelling, when it has reached its full extent, remains so for a short time, when it begins to decline, and by the sixth or tenth day it has entirely disappeared. The total duration of the disease is usually from eight to ten days ; in mild cases it may not be more than five. The swelling of the glands sometimes abates suddenly; and in the male the testicles may become involved; while in the female the mammary glands or ovaries become affected. Young children or old people do not often take the mumps. Mumps are contagious, and the period from exposure until the person comes down with the disease is about twelve days. TREATMENT OF MUMPS. It is very simple. Anything soothing applied over the swelling will give relief. Mild laxatives, and warm drinks, such as lemon- ade, should be given, while the patient should be kept warm. A poultice of hot hops is also an excellent remedy. A mild diet, such as poached eggs and milk with a little beef soup, according to the formula given before, is all that is necessary. (Prescrip- tion for mumps will be found under above title.) ST. VITUS'S DANCE OR CHOREA. This is a disease of the nervous system marked by muscular twitchings. It is most frequently met with between the ages of six and sixteen. It is liable to follow any child whose parents have suffered from hysteria, epilepsy or other forms of nervous diseases. From two-thirds to three-fourths of all cases of St. Vitus's Dance occur in young girls. Feebleness of constitution, and the injurious system of forcing the education of children pre- disposes to chorea. The most common predisposing cause is un- doubtedly anemic condition of the system. There is generally 64 MEDICAL AND SURGICAL EMERGENCIES. an enfeebled condition present, with a deficiency in the richness of the blood. In many children with an hereditary tendency to nervousness a very slight cause will often bring on an attack. A not infrequent cause is fright, and a sudden excitation of the nervous system. SYMPTOMS. The muscular twitchings may be confined to one arm, or side of face or neck, or of one eye, or it may be general, when all the limbs and muscles of the face and body are involved. Statistics show that the left more than the right side is involved. COURSE OF THE DISEASE. Although the disease is obstinate, and even often incurable in adults, it usually terminates favorably in children in three or four months. Very often the first indication of the disease will be a restlessness; sometimes there will be a twitching of the fingers, and involuntary movements in walking, one will stumble, and they will often find great difficulty in putting food in the mouth. In a mild case in a child the patient will seem awkward; will break Paris green ) Scheele's green.. ) TREATMENT. f Provoke repeated vomiting, Give bland liquids, Stimulate, if necessary. Give an alkali, Provoke vomiting, Give bland fluids, Secure rest, Stimulate, if necessary. Provoke vomiting, Give dialysed iron and salt, Give dose of castor oil, Secure rest, Stimulate, if necessary. Sugar of lead < Give Epsom salts, Provoke vomiting, Give bland liquids, Give dose of castor oil. Repeat several times. Repeat several times. Alkalies — Hartshorn "I Soda ! Potash.... ! Lye J Corrosive sublimate Tartar emetic Phosphorus. Lunar caustic (nitrate of silver) '. Iodine Give an acid (vinegar), Provoke vomiting, Give bland liquids, Secure rest, Stimulate, if necessary. Provoke vomiting, Give strong tea without milk, Give raw eggs and milk, Give dose of castor oil, Stimulate, if necessary. r Provoke vomiting, Give five-grain doses sulphate of copper, or teaspoonful doses of turpentine. Give doses of magnesia, but no oil. Give strong salt and water, Provoke vomiting. Provoke vomiting, Give starch and water, Give bland fluids. Repeat several times. Repeat many times. 86 MEDICAL AND SURGICAL EMERGENCIES. POISON, TREATMENT. Opium — Morphine *| f Provoke vomiting, repeatedly, Laudanum > -J Give strong coffee, without milk, Paregoric, etc... J ^ Keep up the breathing. Chloral ( Same as opium ) f Provoke vomiting, Croton oil < Give bland fluids, and laud- [ anum or paregoric. f Provoke vomiting once or twice, Strychnine •{ Give a purgative, L Secure absolute quiet. A ^ f Provoke vomiting. Aconite ..... . ... I Stimulate well * Veratrum vinde ... J | Reep head ^ Jamestown weed Hemlock Nightshade (belladonna) . Toadstools Tobacco Provoke vomiting, Stimulate well. » , i , ( Provoke vomiting, Alcono1 ( Give hartshorn and water. -r^. , , f Provoke vomiting, Decayed meats or vege- J Giye a purgative f taDles t Give powdered charcoa.. To provoke vomiting, warm water may be used with or without ground mustard (a tablespoonful to a pint of water), or ipecac (a teaspoonful of the powder or a tablespoonful or so of the syrup), and thrusting a finger down the throat. It is best to give large quantities (that is, a pint at a time) of warm water whenever vomiting is to be excited. Bland liquids are milk, tea, coffee, whisky, wine, etc., or harts- horn and water. Of this a teaspoonful in a teacupful of water will be enough for a dose. In making tea or coffee one must not wait to do it as if for the table, but mix hot water and the leaves or grounds, squeeze them well, stir together, and give the whole — leaves, grounds, everything. At the same time some may be made regularly, if there are conveniences for it. Alkaline antidotes are hartshorn and water (a tablespoonful in two teacupfuls of water), soap and water, lime, whiting, soda, chalk, tooth powder, plaster, magnesia, whitewash, and even wood ashes. MEDICAL AND SURGICAL EMERGENCIES. 87 Acid antidotes are vinegar and lemon juice. In giving an anti- dote never wait for it to dissolve. Just stir it up in any fluid at hand except oil, and have it swallowed immediately. When laudanum is advised for such an irritant poison as croton oil, it must be given in a dose of half a teaspoonful to an adult, and this may be repeated in half an hour if the pain continues to be severe and there is no drowsiness. SUNSTROKE. Cause — Treatment and Subsequent Course of the Disease — Action of Cold Water. The following cases occurred in the wards of the Presbyterian Hospital, in the service of Dr. J. P. Thornley, with whose kind permission they are reported. During the six days from August 8th to 13th, inclusive, about one hundred and ten persons were brought to the hospital suffering more or less from the excessive heat. About fifty of the cases were of the milder forms, and not included in the report. Cold water was given, with which they sponged their heads and chests, and they were kept in a cool room and left the hospital in from fifteen minutes to twelve hours. Cause. The cumulative action of the heat was pronounced; it was the third day of excessively high temperature and humidity when the first cases occurred. Then, on six successive days there were two, six, ten, twenty-one, seven, and four, respectively. Of the fifty cases, twenty-seven were between three and eight o'clock in the afternoon, four from eight o'clock to midnight, four from midnight to 6 a. m., and six more before noon. From noon to 3 p. m., nine cases were brought in. Thus there were forty cases from noon to midnight, and but ten from midnight to noon. There were but few in women, forty-six of the sixty-one cases being men. The occupation of most of the patients involved exposure to the sun, though in a fair number, including all the women, this was not so. The average age was thirty-six years, the oldest being seventy and the youngest nineteen years of age. With few exceptions, the patients were large-framed, well- muscled, and robust individuals. Those that were the reverse did poorly as a rule. 88 MEDICAL AND SURGICAL EMERGENCIES. 89 Only one had had a previous attack, and that was on the day before admission. His was a fatal case. The use of alcohol seemed to have a direct and unfavorable in- fluence. The habit was marked in thirty-two per cent. ; moderate in forty-six per cent. ; denied in ten per cent. ; in the remaining twelve per cent, no history was or could be obtained. Eight per- sons were markedly alcoholic on admission, and of these four died. Treatment and subsequent course of the disease. The ambu- lance suregons were instructed to at least start undressing the comatose patients on their way to the hospital. Immediately after admission they were stripped of clothing, which took about thirty seconds. They were then immediately put into the bath, at least one of the house staff directing the treatment in each case. With the first five cases the netted cot was used, the patient being constantly rubbed and sponged with ice- water. They were all in coma, and the sponging was used only because the tubs were not in readiness, the cots having been sufficient for the small number of cases treated in previous years. The average temperature in these cases was 110.3 F., the lowest 105. 6° F., the highest 115 F. Thirty-two minutes was the average duration of the bath, varying from fifteen to fifty minutes. The baths were stopped at from 104.5 ° to 100.6 F., the average tem- perature of the patients when removed being 101.7 F. Following the bath at an average interval of fifty minutes, ranging from, thirty minutes to two hours, the temperature fell to from ioo° to 59 F., the average being 98 ° F. The tub bath was used in thirty-six cases, including those of all the comatose and delirious, and that of one conscious patient. The water was as cold as it could be kept, with ice constantly floating in it, usually at about 40 F. Four attendants continually rubbed briskly all parts of the body, the head being constantly bathed. The average temperature in these cases was 108.9 F., the lowest 105 F., the highest 112.2 F. The baths lasted from six to sixty- five minutes, the average being twenty-six. When the tempera- ture reached from 105 ° to 99.4 F., an average of 103. 2° F., the patients were removed from the bath. In a time averaging forty- eight minutes, and varying from twenty minutes to two hours, the temperature dropped to 97.6 F., as an average, the limits being 93 and ioo° F. 9b MEDICAL AND SURGICAL EMERGENCIES. Ice sponge baths were also used in five cases of conscious or stupid patients, with moderate -temperatures varying from 104 to 1 05. 2° F., and averaging 104.5 ^. They were bathed from eight to forty-five minutes, or an average of twenty-three minutes. The temperature at which they were removed was about 102 F., vary- ing from 101 to 103 F., falling to 98.9 F., as an average, but varying from 99.8 ° to 97 ° F., about forty-six minutes after their being removed from the bath. In all cases the temperature was taken every five minutes during the early part of the bath, and when it began to drop, as quickly as the thermometer would register. The temperature rose, even after the bath had been started, in five cases, but never rose over o.6° F., usually in about five minutes. - Only eight patients received stimulation by drugs during the bath, and they were patients in whom the pulse was almost imper- ceptible. Camphor and ether were used for rapid action, and then strychnine, all subcutaneously. The stimulating action of the cold water was remarkable. Patients that were apparently taking their last gasps would im- mediately respire more deeply, and a pulse almost impossible to feel would, in the course of a few minutes, be of good quality, though rapid. Those in coma would, when the temperature began falling, as a rule, rouse up, struggle, and become more or less de- lirious. Those delirious would resist the bath vigorously, then grow more quiet, and again become restless as the temperature fell more. On removing the patients from the bath, they were rubbed dry with crash towels and covered with a blanket, and hot-water bot- tles were placed at their feet. If their condition indicated it, either from pulse, respiration, or any considerable falling of the tempera- ture, they were further stimulated with camphor and ether, strych- nine, digitaline, or atropine, hypodermically, and with whisky and hot water by the rectum, or, when possible, by the mouth. Hydrotherapy and skilled and careful nursing seem to have been the chief factors ; and very frequent recording of the temperature enabling the baths to be given at the earliest and, therefore, most valuable time ; the use of the ice tub bath, with constant and gen- eral friction of the entire surface, thus reducing the temperature in the shortest possible time, and being stimulating rather than de- MEDICAL AND SURGICAL EMERGENCIES. 91 pressing; the use of the same bath for all severe secondary eleva- tions of temperature, and for the minor elevations sponge baths of ice water or of water at from jo° to 8o° F., depending upon the individual case; and the repetition of these baths whenever the temperature is high enough to make them seem advisable. All other means have seemed entirely inadequate. HEMORRHAGES OR BLEEDING. •' Course op the Arteries — Capillary Hemorrhage — Hemor- rhage From the Veins — Hemorrhage From the Arteries — For Wounds High up in the Arm — For Wounds op Arteries op the Finger — For Wounds op Arteries op the Hand — For Wounds Below the Elbow — Wounds op Ar- teries op the Foot or Leg — For Wounds in the Thigh — Bleeding From the Arteries op the Scalp — Recapitula- tion — Bleeders — Treatment — Special Hemorrhages — Bleeding From the Mouth — Bleeding From the Nose. There is no accident so appalling as hemorrhage, whether the bleeding comes from an external wound or from the rupture of a blood vessel in some internal organ. There is none which calls for so much nerve in combating it, nor any in which a little accurate knowledge can be more valuable. The subject of the control of the hemorrhage will be better understood after taking a concise view of the anatomy of the organs of circulation. This cannot be made absolutely accurate without being too technical, but the variations from accuracy will not affect its practical utility. (See illustration.) The blood starts from the left side of the heart, and is driven first into the aorta, which curves over above the heart and descends along the left side of the spinal column, within the chest and abdomen. From what is called the arch, at the beginning, are given off vessels which supply the head and arms. The former (the carotid arteries) run up alongside the windpipe and divide and subdivide in all directions. The latter curve forward and come out from under the chest over the first rib, and, passing under the collar bone near the shoulder, run down through the armpit and inside of the arm to the middle of the front of the forearm, on the thumb side, and the other along the little finger side. Thus, in the 92 MEDICAL AND SURGICAL EMERGENCIES. 93 tipper arm the arteries follow nearly the same line as the seam in a coat sleeve. The two arteries of the forearm, entering the palm of the hand, join in a loop, from which vessels run down, one on each side of each finger, and one on the inner face of the thumb. The aorta, as it descends through the chest and abdomen, gives off vessels to supply the internal organs, and near the lower end of the backbone divides and sends two large vessels out through the groin into the thigh. Each of these runs down in almost a straight line, between the muscles, to the middle of the hollow at the back of the knee. Just below this it divides into three branches. The first of these passes through to the front, between the two bones of the lower leg, and runs down under the muscle, close to the outer -side of the shin bone, and passes out upon the instep at about the middle of the front of the ankle joint. Here it breaks up into smaller vessels that supply the top of the foot. The second and third branches of the main artery of the thigh pass down the back of the lower leg, one on each side, close to the corresponding bones, and deep under the muscles. One passes oack of the inner ankle bone into the inner side and sole of the foot. The other passes back of the outer ankle bone, to the outer side and sole of the foot. The arteries of the sole of the foot, like those of the palm of the hand, unite to form a loop, from which a vessel is given off for each side of each toe. COURSE OF THE ARTERIES. This is a brief outline of the course of the arteries. As they ■divide and subdivide, like the branches of a tree, they become cor- respondingly smaller, and they end in an inexpressibly fine net- work of minute vessels. These are called capillaries. Then, as the capillaries are a sort of splitting up of the smallest arteries, so, on the other hand, by the confluence of a number of capillaries, larger trunks result, toward which the current of blood constantly sets, and the beginnings of the veins are formed. These unite in a manner the very reverse of the branching of the arteries, and, growing, like rills and brooks and rivers larger and larger by re- peated junctions of several into one, travel back to the heart in an opposite direction to, but alongside of, the arteries. Thus each -principal artery has at its side at least one important vein. Up the 94 MEDICAL AND SURGICAL EMERGENCIES. legs, up the inside of the abdomen and chest, up the arms and down the neck they pass, till they unite to form one trunk, which empties into the right side of the heart. From this point the blood is pumped into the lungs to be aerated ; from the lungs it is collected and emptied into the left side of the heart ; and from the left side, as we have seen, it is pumped out to begin the circuit through which we have just traced it. The previous illustration will give a fair idea of the course of the main blood-vessels, and will make clearer what may not have been understood from the preceding description. It will be observed that the course of the blood-vessels is always in the safest part of the body or limb. They all lie where they are protected by bending a limb or joint — a natural act when attacked. They are on the inner side of the arm and forearm, when these are used for attack or defense. They are on the inner side of the thigh and at the back part of the leg — out of harm's way. In endeavor- ing, as shall hereafter be recommended, to check bleeding by pressing upon a main blood-vessel, this fact may serve as a re- minder of the course it might be expected to run. To which this suggestion may be added, namely : When you are in doubt, feel for the pulsation of the artery and make pressure where you feel it beating. Another point, preliminary to considering the methods of arresting hemorrhage, is that blood from arteries is usually bright red and escapes in jets, while blood from veins is dark red or purple, and flows in a steady stream. Blood from capillaries is of a color between these two, and it oozes out. Capillary hemorrhage follows every cut. The color of the blood is red; the flow is generally slow and not very considerable. It usually stops of itself. If it does not, the part may be elevated and cold water or ice or snow, or even vinegar, applied. If there is oozing from a large raw surface, a towel may be folded, dipped in water as hot as the hand can possibly bear, lightly squeezed, so as. not to drip, and gently pressed upon the bleeding surface. This may have to be renewed once or twice, at intervals of a few minutes, but it usually acts like magic in this form of hemorrhage. Hemorrhage from the veins is generaly slow and steady, and the blood is darker than in other forms. It rarely demands special effort to control it. When severe, the application of cold, and firm continuous pressure upon and below the wound, generally MEDICAL AND SURGICAL EMERGENCIES. 95 suffices to stop it. Rupture of varicose veins in the leg may lead to dangerous hemorrhage, but this can usually be checked by applying a dry pad of cloth and binding it firmly upon the bleeding spot. In this case a ligature applied above the wound would only make matters worse. A wound of the jugular vein, on the side of the neck, may also be followed by dangerous hemorrhage. This is also treated with a pad and pressure, which can be best made with one finger laid above and one below the wound. Hemorrhage from the arteries is very\dangerous. Here the blood is bright red, and spurts in a stream orJeaps in jets from the divided vessel. If it be from a large artery, such as those in the root of the neck or the armpit, or the inside of the thigh near the groin, life will usually be quickly lost. Indeed, without a thorough acquaintance with anatomy, it is hardly likely that any advice that could be given here would be available in such cases. The only thing to suggest is to thrust a finger deep into the wound and see if firm pressure there will stop the bleeding. Or some other form of plug may be tried. The chances of success are, however, very slight. But every one may, while awaiting skilled aid, do something when the arteries of the limbs are cut. The first duty in all such cases is to be cool as possible, then, as quick as is consistent with coolness. The principle that must guide every attempt to stop the bleeding is to obstruct the artery at the spot, or between the center of the body and where it is cut ; for this is the direction in which the blood flows. For wounds high up in the arm, strong pressure may be made downward, behind the collar bone, about at its middle (see Fig. 4). The thumb, or the handle of a large door key, well wrapped, so as to make a tolerably thick mass, can be thrust down, and if it does not seem to strike the artery the first time, it can be moved along, toward the breast bone and toward the shoulder, to see if it will hit the right place. For wounds of arteries of the finger, pressure may be made on the side, by seizing it between the thumb and finger and pinching it, or by wrapping a cord around, or slipping on a rubber band. For wounds of arteries of the hand, raising this above the head and making firm pressure on the bleeding spot, or with both 96 MEDICAL AND SURGICAL EMERGENCIES. thumbs just above and in front of the wrist, will usually stop the bleeding. Or the wound may be packed with lint, or cotton, or old muslin, or linen, and bound firmly with a bandage. If this fail, resort must be had to the measures recommended for the next form of hemorrhage. For wounds below the elbow, first grasp the upper part of the arm with both hands and squeeze as hard as possible ; then let some one make a thick, hard knot, as big as an egg, in the middle of a handkerchief, place it over the middle of the front of the arm, im- mediately above the elbow, tie the ends tight at the back, and bend the forearm up so as to press hard against the knot (Fig. 4). This, Fig. 13. View showing compress to stop bleeding from arm. if successfully done, will obstruct the main blood-vessel (the brachial artery), which in this place lies in the middle line of the bend of the elbow. For wounds in the upper arm, pressure may be made against the hone on the inner side and just below the swelling muscle, of which most people are aware is called the biceps, as shown in Fig. 5. A knot as big as a fist may be made in any piece of cloth and shoved hard up into the armpit, and the elbow then brought straight down and held or bound firmly against the side of the chest. MEDICAL AND SURGICAL EMERGENCIES. 97 If either of these methods fail, or cannot be carried out, the "Spanish windlass" may be used. To do this, place some hard, round body, like a stone, in the large part of a handkerchief folded diagonally, and carry the ends of this around the limb, so as to leave the lump over the position of the artery — that is, over the bend of the elbow, or a little in front of the middle of the inside of the arm, near the shoulder. Then tie the ends of the handkerchief so as to make a loose loop, slip a stick through this and twist it round and round, so as to tighten the handkerchief, till the blood stops flowing, but no more ! This is a much rougher procedure than the method described before, but one cannot be overparticular Fig. 14. View showing compress to stop bleeding from hip. in such cases ; so if the former fails, or no bystander is cool enough to carry it out, no time must be lost before the "Spanish windlass" is used. Wounds of arteries of the foot or leg may be treated by firm pressure in the hollow just behind the knee (above the calf of the leg). This can be effected by placing there a knotted cloth, like that suggested for the armpit, and doubling the leg back until it 7 98 MEDICAL AND SURGICAL EMERGENCIES. presses hard against it. In doing this the thigh must be doubled up toward the abdomen or the bending of the knee will soon become intolerably painful. For wounds in the thigh, pressure must be made in the hollow immediately below the groin, about two-thirds of the way from the hip bone to the middle line of the body, where the artery of the thigh (femoral artery) comes out of the body, as shown in Fig. 6. This can be effected with the thumbs or with a rounded stick, or a key handle, or with a " Spanish windlass." The artery may also be closed by placing in the groin a knotted cloth or a large round stone, and doubling the leg back on the thigh (this is im- portant), and the thigh forward, hard against the abdomen. If this latter plan does not succeed promptly some other of those mentioned should be tried and no time be lost in doing it. Bleeding from the arteries of the scalp can be controlled by firm pressure upon and around the bleeding point. Recapitulation. To go over this briefly again ; remember : first, to keep cool; second, that the principal object is to obstruct the artery above the cut ; and that this can be effected by pressure, in the several cases, in front of the bend of the elbow, in the armpit, behind the bend of the knee, or just below the groin. This can be made with the fingers, or with a knot held hard against the artery by a tight bandage, or by bending the limb up against it — or, in case of the arm, by pressing it hard against the chest. In case of failure, the "Spanish windlass" is to be applied to the same places. In case none of the plans proposed can be carried out, a cut that bleeds profusely may be stuffed with a rag or dry earth, and this kept in place by pressure, with a bandage or handkerchief, or the cut part may be forcibly compressed in any way, or a finger thrust into the wound and held wherever it seems to do most good. Finally, let it be remembered that fainting may put an end to hemorrhage, and that when consciousness is restored the bleeding may recur. So this possibility should not be overlooked. The treatment of a faint under these circumstances is the same as that of any faint; in addition to the measures demanded to check the bleeding, the head must be lowered, the legs and arms may be elevated, and warmth applied to the body, while stimulants are carefully administered by the mouth. MEDICAL AND SURGICAL EMERGENCIES. 99 BLEEDERS. There are persons who are known as bleeders ; they belong to the class known to the medical profession under the name of "Hemor- rhagic diathesis." These individuals may bleed to death from a very slight wound ; extraction of a tooth has been followed by death from bleeding, also from the nose or in almost any other part. The bleeding may occur in some internal organ and death occur when the cause is very obscure. This condition is generally hereditary and often affects several members of the same family. The tendency to this form of bleeding may occur as early as the first year of life, but there is nothing in the appearance that indi- cates the existence of this form of hemorrhage, and it is not gen- erally known until the act, a fall on the nose or the pulling of a tooth, starts a bleeding which is uncontrollable ; the bleeding will be slow, oozing for days, until death comes from exhaustion and loss of blood. However, in many cases the bleeding slowly ceases and, after a long period, the person recovers. The blood may be discharged into the stomach, intestines, lungs, kidneys and brain. An entire family of "bleeders" has been discovered in New York. The family consists of seven members, father, mother and five children, four of which are boys (all bleeders), the fifth is a girl six years of age, who up to the present time has shown no in- clination to bleed more than any ordinary child. The oldest child, now twelve years of age, has had severe hemorrhages on an average once every year since he was two years old, the bleeding would continue from three weeks to three months before it could be stopped. Bleeding from the gums had been almost constant since he was five years of age. During the day the blood is expectorated, while at night it is either swallowed or allowed to flow out upon the pillow. The other boys have all had severe attacks of bleeding. One of them remained unconscious for five days from the loss of blood. The daughter, who is six years of age, has been cut and injured repeatedly, but up to the present time she has shown no inclination to bleed abnormally. This bears out the statement recently printed to the effect that bleeders are usually of the male sex, although the disease is trans- LofC. ioo MEDICAL AND SURGICAL EMERGENCIES. mitted by a non-bleeding member of a bleeder family and almost invariably by a female member. SPECIAL HEMORRHAGES. In bleeding from the mouth the blood must come from the gums, the throat, lungs or stomach. The most dangerous is bleeding from the lungs, and it is necessary to be able to determine whether the blood comes from the stomach or from the lungs. The following symptoms will be experienced when the blood comes from the stomach : a sense of warmth and fullness over the chest, with nausea and vomiting, paleness of the face, the surface becomes cold and clammy and the blood rushes up in a full stream through the mouth and nose and is often expelled during the dif- ferent acts of vomiting. The only other disease with which this bleeding is liable to be confounded is that of bleeding from the lungs. The person suffering from hemorrhage of the lungs will experience a sense of nausea with constriction across the chest, difficulty in breathing, and there will also be a hacking cough. The blood is coughed up in mouthfuls, bright red, frothy and mingled with sputum; there is also a sense of trickling behind the breast bone and for a few days after the bleeding has stopped the spittle will be tinged with blood. When the blood comes from the stomach there will often be found mixed with it particles of food and it will generally be of a darker color than when it comes from the lungs. Bleeding from the stomach does not often cause immediate death, except when due to some disease of the stomach, such as cancer, or ulceration, or diseases of the liver. When bleeding from the nose the blood will nearly always be seen in the nostrils, and there is no cough, and it becomes thick and coagulates readily. When the blood comes from the teeth or gums it can be readily detected by looking into the mouth and examining the parts. All these varieties of hemorrhage, from the lungs, stomach, nose and mouth, often come on suddenly, and valuable time is lost on account of the ignorance of those present. The two former are the most serious ; in the treatment of these the first thing to be done is to keep the person absolutely quiet and in a horizontal position ; ice should be taken freely and ice-bags applied across the chest; if MEDICAL AND SURGICAL EMERGENCIES. 101 ice-bags are not at hand, cold cloths, wrung out of cold water should be applied. If, upon examining the pulse, the heart is weak and the person faint, a small amount of stimulants should be given ; about a tablespoonful of brandy in about twice as much water. These remedies, which should be always at hand, if used intelli- gently, will be found of great benefit and will, in instances, save lives and will give the sick and dangerous person all the help that can be given during the time until the services of a physician are secured. Bleeding from the nose is often only nature's way of getting rid of an excess of blood ; but it may be so profuse as to threaten life. If this be the case, of course, medical aid will be summoned; but until it arrives the best thing that can be done is to snuff salt and water, or vinegar up the nose. A strong solution of alum in very warm water is also useful ; but vinegar is less disagreeable, and will rarely fail to check the bleeding, unless the case is beyond any except skilled help. Treatment: For this form of hemorrhage the same remedies must be used with greater persistence than in other forms of hemorrhage ; when the loss of blood is great, as it usually is, tonics of iron should be administered; from ten to twenty drops of the tincture of chloride of lime, three times per day, should be taken for several weeks, and a good and nourishing diet, composed of milk, eggs, and fresh meats should be combined with a moderate amount of exercise. With this treatment, also careful attention to the bowels, patient will slowly recover. When this inclination to bleeding is known to exist the person should avoid all conditions which would give rise to a hemorrhage in any part. MEDICAL AND SURGICAL EMERGENCIES. Supplies for Emergencies — Surgical Case — Use op Contents op Surgical Case — How to Make Poultices — Medicine Chest — Doses and Uses op the Medicines. supplies for emergencies. The suggestions in the preceding pages have been, so far as practicable, such as could be carried out without having made any special provision for them. Nevertheless, occasionally appliances and remedies have been suggested, which would very much facili- tate the treatment. These may be divided into medical and surgi- cal. They may be arranged separately or together, but the former arrangement would probably best suit individual necessities. SURGICAL CASE. A surgical case suitable for almost any emergency should not contain so many things as to confuse one who has not a medical education. Its supplies should be few and simple, such as — i. Some absorbent cotton. 2. A roll of old muslin or linen. 3. Bandages, two and one-half inches wide and six yards long, rolled up. 4. Rubber adhesive plaster, on a spool, in a strip two inches wide, and not less than a yard long. 5. Scissors. 6. Pins (ordinary and safety pins). 7. Needles threaded with stout thread. 8. A bottle of hartshorn, with a glass or rubber stopper. 9. A bottle of laudanum, with dose marked on it. 10. A bottle of good whisky or brandy. 102 "■ MEDICAL AND SURGICAL EMERGENCIES. 103 USE OF THE CONTENTS OF THE SURGICAL CASE. 1. Absorbent cotton can be obtained at any drug store. It is perfectly clean and soft, and is prepared in such a way that — in- stead of resisting moisture, as ordinary cotton does — it will absorb it with great rapidity. Thus it will take up discharges from wounds, and when a cool or hot application is desired, it can be soaked with cool or hot water. Sometimes it is very convenient to put it on dry, and then squeeze the water upon some part of it from a sponge, when every part will rapidly become saturated. For padding splints, or making cushions to prevent pressure of any kind, there is nothing so good as absorbent cotton. 2. Old muslin or linen can be torn into any shape or size that may be required, and can be used to spread poultices upon. It is also useful to make broad slings of. 3. Bandages of the kind described are used to keep applications in place, to secure parts to splints, and to prevent injurious motion. The simplest way to apply them is to make circular turns around any part. When the latter is of even size this is a very easy matter. Where the part is larger at one end than the other, the ordinary circular turns would not fit smoothly. To accomplish this, the rule is to begin at the small end and make a few turns, round and' round, one immediately over the other, and then to begin to move up the limb spirally. So long as a turn can be made to smoothly overlap the one before it about one-third, this spiral is all that is required. But as soon as it puckers, the bandage is not carried on as before, but is turned down, so that the inner face now looks out, and the bandage instead of passing up, passes downwards, so as to make a sort of inverted V — so, A. On now carrying the band- age on round the part, it will be found that it comes to the front, just overlapping the preceding turn, and the same process can be repeated, until the whole bandage is neatly applied. At joints, like the ankle, knee, and elbow, the bandage may make a sort of figure 8, the middle or crossing part being in the bend of the joint, and the two loops, one above and one below it. Bandages should never be put on so tight as to cause pain, and never drawn tighter above than below. Bandages may be fastened by pins, by stitching, by strips of adhesive plaster, or by splitting the end and carrying one tail on io4 MEDICAL AND SURGICAL EMERGENCIES. as before and turning the other back to meet it and then tying the two together. For narrow bandages, the latter is the simplest plan ; for wide ones some one of the others is better. The width of two and one-half inches is that which is oftenest convenient. When a narrow bandage is called for — as for a finger — one of the former may be torn down the middle ; or if rolled up, it can be laid on a firm surface and the whole roller cut in half with a sharp knife, just as one would cut a sausage. This quickly and easily makes two good finger bandages. 4. Rubber adhesive plaster is better than any other kind, because it can be applied without any heat or moisture. It sticks of itself. When applied to a hairy part, the hair should be shaved off if possible. If not, when the plaster comes to be removed, it must be soaked off, or it will pull the hair out and cause great pain. Another point to be remembered is, that in changing adhesive plaster dressings only so much should be removed as is necessary or as cleanliness demands. The rest may be left on and the new dressing applied up to it or over it. The plaster is most convenient to use when in strips, which can be cut easily and without waste if needed smaller, and additional strips applied side by side, if a greater width is wanted. 5, 6, 7. The use of scissors, pins and needles need not be ex- plained. The points of pins should never be left sticking out, and care should be used to avoid sticking either pins or needles through the patient's skin. 8. Hartshorn is to be used as a stimulant to the heart and to the nervous system. A teaspoonful may be put into a tumblerful of water and a teaspoonful of the mixture given every few minutes. Its use by the nose everybody is familiar with. Yet it may be worth while to say that a full bottle of hartshorn should never be brought near to a patient's face. The stopper may be wetted and held under the nose, or a few drops put on a handkerchief, or the hand, and used in the same way. 9. The laudanum bottle should be marked "Poison!" and have the dose marked on the label. In surgical cases, where there is much pain, a full dose is called for, and to give less is to trifle with the sufferer. MEDICAL AND SURGICAL EMERGENCIES. 105 As already remarked, laudanum is one of the very best local applications to wounds and bruises. It can be used by soaking a proper quantity of absorbent cotton, or a piece of old muslin, and laying it upon the injured part. 10. About the whisky, it may be remarked, that a large dose is almost invariably useless or injurious. Even for an adult — unless a confirmed drinker — the proper dose is a teaspoonful in a small quantity of hot water — or cold water, if hot cannot be had — re- peated every few minutes until some effect is produced, or a couple of ounces — about half a small teacup ful — have been given. HOW TO MAKE POULTICES. Poultices. The commonest materials for poultices are bread, flaxseed, hops and mush. A hop poultice may be made by pouring hot water upon hops till they are well moistened. A bread poultice is made by soaking the inside of bread in hot water or milk, and mashing it quite soft and even. With flaxseed or corn-meal the way is to put the poultice material on a plate, and add just enough hot water to moisten it. This is worked in with a large spoon or table knife, just as a salad dressing is made. Then to this thick but damp mass, enough hot water is gradually added and worked in until the whole is almost soft enough to run, but not quite. Poultices should be spread thick. To spread a poultice, a piece of fine, old muslin (or a piece of open-meshed stuff, such as cheese cloth is made of, can be used), twice as long as the poultice is to be, is laid on a flat surface, and one-half of it spread smooth with the poultice material. The other half is brought over and pressed down on top of the poultice material, or another piece of muslin, or a piece of tarlatan can be used for this purpose, so that the poultice material shall not come into immediate contact with the skin ; then, when it comes time to be removed, it will come off easily, all at one time, and not leave any behind to stick to the skin. A poultice must be put on hot. To secure this, it may be spread over a hot plate. A simpler plan, however, is to take the finished poultice up by its edges and lay it for a moment or two on some- thing hot, or dip it into a vessel containing boiling water. Care must however be taken not to put on a poultice so hot as to burn. 106 MEDICAL AND SURGICAL EMERGENCIES. To keep a poultice warm when applied, it should be covered with oiled silk or several folds of bandage. It may be remarked that nothing has been said here about the use of "lead water and laudanum" or arnica, so often recommended for bruises and cuts. The reason for this omission lies in the fact that neither has any merit superior to that of cold water or lauda- num alone. When a part is hot and angry, there is nothing better for it than the use of cold water constantly renewed until the heat and irritation have subsided. When pain is to be combated, lauda- num alone is the best thing to use locally. MEDICINE CHEST. A small box can be bought or made, to hold a few things likely to be useful in accidents or sudden sickness. It ought to contain — Absorbent cotton. Sticking plaster — rubber plaster (on a spool) is best, because it requires neither heat nor moisture for its application. Bandages of old muslin or flannel. A piece of oiled silk. Thread and needles. Pins (ordinary and safety pins). Cosmoline, vaseline, or cold cream, i. Aromatic spirits of ammonia. 2. Tincture of asafetida. 3. Oil of cloves. 4. Hoffman's anodyne. 5. Syrup of ipecac. 6. Laudanum. 7. Magnesia. 8. Mustard. 9. Paregoric. 10. Spiced syrup of rhubarb. 11. Turpentine. To these may be added, if quite convenient: camphor water, essence of ginger, lime water, and sweet spirits of nitre. Of the eleven first named, a convenient quantity to have would be two fluid ounces; except of No. 3 (oil of cloves), of which a fluid drachm would be plenty, and No. 7 (the magnesia), and No. 8 (the mustard), of both of which an ounce would suffice. MEDICAL AND SURGICAL EMERGENCIES. 107 The laudanum and paregoric ought to be in bottles of an alto- gether different shape from those containing the other remedies ; and these, as well as the oil of cloves bottle, should be marked "Poison !" and have a tape or small ball and chain attached to their necks, so that it could be felt in the dark. Each bottle should have its proper dose plainly printed or marked on the label. DOSES AND USES OF THE MEDICINES. 1. Ammonia. The aromatic spirits of ammonia — hartshorn — is a valuable remedy in cases of sick stomach, and even vomiting. It is also useful in cases of nervous or sick headache, as well as in simple nervousness. The dose is, for an adult, twenty-five drops ; for a child, ten drops, in about a wineglass full of water. This may be given every ten minutes, almost indefinitely. 2. Asafetida. The tincture of asafetida is a nerve tonic, and also very soothing to the bowels. There is nothing better for causing expulsion of wind. The dose is, for an adult, a teaspoon- f ul ;' for a child, twenty drops in a tablespoonful of water. It can often be used as an injection when it could not be given by the mouth. In this case the quantity to be given is a tablespoonful for an adult and a teaspoonful for a child, in a small teacupful of warm water. 3. Cloves. The oil of cloves is useful as a local application in toothache. It is also helpful in indigestion, in doses of three drops for an adult, and one drop for a child. It can be given rubbed up with a little sugar, or a teaspoonful of sweet oil. 4. Hoffman's anodyne is useful in cases of hysterics and nerv- ous frights or chills. The dose is, for an adult, a teaspoonful in a wineglassful of water. Children rarely require medicines of this sort. But when they do, as is the case with certain high- strung children, half the dose for an adult may be given. 5. Ipecac. The syrup of ipecac is a fairly good emetic. But it must be used freely. An adult should be given a good table- spoonful, and an infant, as near a teaspoonful as possible. It will do no harm, and when the emetic is called for, it is no time to run any risk that the dose given may not be large enough. It is often usefully employed in cases of poisoning, convulsions, croup, whooping cough or asthma. 6. Laudanum. Laudanum is the tincture of opium, and has 108 MEDICAL AND SURGICAL EMERGENCIES. all its properties. It is one of the most useful drugs in the world,, and yet it is a dangerous one. There need, however, be no fear of poisoning with any preparation of opium if ordinary doses are given, if these doses are not given closer together than half an hour, and if they are stopped as soon as pain is decidedly les- sened or drowsiness comes on. Occasionally small doses of opium cause great alarm, but there is much less fear about opium poison- ing among doctors now than there used to be. It may be consid- ered safe to give twenty-five drops of laudanum to any adult r when there is severe pain, and to repeat this dose every half hour until the pain is lessened or drowsiness begins to appear. One of the signs of the effect of opium upon the system is a contraction of the pupil of the eye, which does not expand in the dark. This ought always to lead to a discontinuance of any preparation of opium which has been used. To check diarrhea, sometimes, a drop of laudanum every hour will prove successful very soon. Yet, ten or fifteen drops may be given to an adult after each movement, if the smaller quantity does not suffice. For cuts and bruises there is no better application than pure laudanum. A soft cloth soaked in laudanum can be bound on, and occasionally wetted with it, without removal. It quiets pain and promotes healing. The same application is often very sooth- ing in face-ache, toothache and earache, as well as in the pains of rheumatism and neuralgia. (See "Paregoric") 7. Magnesia. Magnesia is a mild remedy to open the bowels, usually employed for children. The dose being a teaspoonful, given in water or milk. It may also be used for sour stomach, when a pinch will generally be enough. 8. Mustard. In the use of ground mustard for plasters, it should always be mixed with an equal part of flour. Even then it acts quickly and must be removed in a few minutes, as soon as the skin is well reddened. Where it is desired to leave a mustard plaster on for more than a few minutes, it should be made of one part mustard to three or more of flour. Every mustard plaster should be removed as soon as the skin becomes red, and not al- lowed to make a blister, because such blisters are excessively pain- ful and very hard to heal. MEDICAL AND SURGICAL EMERGENCIES. 109 As an emetic, mustard is used by stirring a teaspoonful of the ground seeds in a teacupful of luke-warm water. 9. Paregoric. Paregoric is an opium preparation which con- tains, besides opium and other things, some camphor. It is the best preparation for children, because the dose is easier to meas- ure than that of laudanum. An infant a few hours old will stand three drops and in a few days, five. In a month, ten are not too many, and twenty may be given any time after six months. An adult can take a tablespoonful. It may be used internally in all the cases where laudanum has been recommended. ( See "Lauda- num.") 10. Rhubarb. The spiced syrup of rhubarb is an excellent mild laxative for the bowels. A teaspoonful is the dose for an infant or small child. It is useful at the beginning of a diarrhea in children, as it empties the bowels of what irritates them, and also has a soothing and healing influence. 11. Turpentine. Spirits, or oil of turpentine can be used wherever mustard has been recommended as an external applica- tion. For this purpose a soft flannel or muslin cloth should be - 'ie- 1 ,->.VIK* '.£!• V Si Fig. 29. Germ of Typhoid Fever. rt^s j^3^i J * 3 Fig. 30. Germ of Tetanus or Lockjaw. Fig. 31. Germ of Tuberculosis. I89 190 MEDICAL AND SURGICAL EMERGENCIES. INFECTION. By the term infection, as applied to the individual, is usually understood that process by which bacteria gain entrance to the body and produce disease. On the other hand, it is common to speak of inanimate objects as being infected when they serve merely as the carriers of infection. Thus we speak of an infected house, or infected clothing. Again, the contagious principle is frequently termed the infec- tion. It will thus be seen that the word has been used in a rather wide sense. The term infectious has often been used to designate certain diseases. By an infectious disease is meant one which may be transmitted from one person to another without necessarily imply- ing direct personal contact with a person suffering from a disease ; while by a contagious disease, as the name signifies, is implied a disease communicated by direct personal contact. The modern interpretation of the term infectious, as applied to disease, signifies any disease which may, by any means, be transmitted from one person to another; while the term contagious is used in a more restricted sense, and is applied only to those diseases which are readily transmitted. As an example of an infectious disease might be mentioned typhoid fever, while in smallpox we have the best example of a contagious disease. According to this interpretation, a contagious disease is always infectious, while an infectious dis- ease is not necessarily contagious. INFECTIOUS PRINCIPLES. The infectious principle of a contagious disease is called the con- tagium, and is invariably a bacterium, though there still remain a number of diseases in which the specific micro-organism has not been discovered. A person is said to be immune from a certain disease, when, after having been brought into contact with the contagium, he is but slightly or not at all affected. At present we do not know the exact nature of this process. It is a well-known fact that in many cases of the contagious diseases, as, for example, smallpox, scarlet-fever, measles, and whooping cough, one attack protects against another and renders the person MEDICAL AND SURGICAL EMERGENCIES. 191 immune for life. Immunity may be transmitted from the mother to the offspring, and is also conferred by artificial means against certain diseases. For example, immunity is conferred against smallpox by vaccination, and against diphtheria by the serum of the blood of an immunized animal. As above stated, infection may take place through the respira- tory tract, through the digestive tract, or through the skin. It is probable that the first two modes of entrance are the most frequent. As has been stated, bacteria are universally present in the air, in water, and consequently in our food. So that it is not difficult to explain the development of the disease, given the necessary pres- ence of the specific micro-organism. Several factors, however, enter into the question of infection, and the mere access of the specific bacteria to the body by no means always produces the disease. Thus the invading bacteria may be weakened in virulence or gain access only in small numbers ; then, again, they may find the soil unfavorable or the resistive powers of the body very strong, so that they perish without causing harm. Those bacteria which gain entrance through the intestinal tract must run the gauntlet of the stomach, which, during digestion in health, contains a corrosive fluid highly destructive to bacteria. SOURCES OF INFECTION. The primary source of infection is always the person suffering from the disease. Not all bacteria which are present in the body of an infected person are eliminated, but many are destroyed in the body during the progress of the disease. It is important to bear in mind the channels through which bacteria escape from the body, so that they may be destroyed and infection of other persons thus be prevented. Indeed, such precautionary measures for the prevention of the spread of disease are too seldom taken. TRANSMISSION. In only a comparatively few diseases is the transmission of the infection direct from one person to another. Thus, bacteria may escape from the body of a person suffering from the disease, as, for example, the sputum of a patient suffering from tuberculosis 192 MEDICAL AND SURGICAL EMERGENCIES. of the lungs, which, if allowed to dry, is taken up by the air as dust, and is freely disseminated. Such a patient may, in this man- ner, become a menace to the household or to an entire community. The same may be said of typhoid fever, in case of failure to disin- fect the stools, which invariably contain the infectious principle. In this instance, however, the bacteria find their way to the soil and ultimately to drinking water, through which they gain en- trance to the body. It will, therefore, not be out of place to men- tion the most important infectious diseases and the channels through which the specific bacterium escapes from the body. The following diseases are due to recognized bacteria which escape from the patient in the following manner : Pneumonia is of different varieties due to different micro-organ- isms. Lobar pneumonia is due to the pneumococcus of Frankel. It escapes through the body through the sputum, and secretions from the mouth and nose. Its infectiousness is very slight, and the possibility of direct transmission from one person to another is doubted by many. Influenza is due to a bacillus which is present in the sputum and secretions from the mouth and nose. It is highly infectious and is probably transmitted through the air. Tuberculosis is due to a bacillus which escapes from the body through the sputum or by the secretions or excretions from any part of the body which may happen to be involved. It is moder- ately infectious and may be transmitted from one person to another. Whooping cough is due to a bacillus which is present in the sputum and secretions from the mouth and nose. It is highly in- fectious for persons not immune by previous attack. Diphtheria is due to a bacillus present in the secretions from the throat and nose. It is markedly infectious for children, only slightly so for adults. Asiatic cholera is due to a spirillum which is evacuated from the body through the gastro-intestinal tract, especially the stools. It is markedly infectious, and may be transmitted directly from one person to another. Yellow fever is due to a bacillus. Little is known about the manner of its escape from the body. It is very highly infectious and is said to gain entrance to the body through the lungs. MEDICAL AND SURGICAL EMERGENCIES. 193 Typhoid fever is due to a bacillus which escapes from the body through the secretions, the urine, and especially through the stools. Infection gains entrance to the body through the gastro-intestinal tract. The disease is only slightly infectious, rarely being trans- mitted directly from one person to another, and then only as a result of contamination of the hands, which in turn carry the in- fection directly to the mouth or to food or to drink. Leprosy is due to a bacillus which is present in the secretions from ulcers and mucous surfaces. Its infectiousness is not very marked, but it may be transmitted from one person to another. In the case of eruptive fevers, as measles, scarlet-fever, and smallpox, no specific bacteria have as yet been discovered. The ■contagious element in all these diseases is said to be present on the skin, and is thrown off during the process of desquamation. All these diseases are highly infectious and contagious. The bacteria which concern the surgeon differ from those caus- ing infectious diseases in the fact that they invariably gain entrance to the body through some wound, whether deliberately made by the surgeon, as, for example, operations, or wounds the result of .some accidental injury. A certain number of bacteria which gain entrance to the body in this manner universally produce a set of symptoms so characteristic as to admit of designation as special diseases. Among these may be mentioned tetanus, glanders, an- thrax, syphilis, and tuberculosis. WHERE BACTERIA ARE TO BE FOUND. The distribution of bacteria is almost universal. They are pres- ent in the air, the water, the ground, and on all objects, for ex- ample, our bodies, and utensils of every description are contami- nated to a greater or less extent with bacteria. But not all bacteria are dangerous or capable of infecting a wound, in fact only a comparatively few varieties are known to be dangerous; thus drinking water, unless contaminated from some other source, or the air from the dust of an operating room, seldom contains the bacteria known to infect a wound. Therefore, in order to elimi- nate as nearly as possible the danger of infection from these two sources, all water to be used at an operation is boiled, and hence .rendered sterile, and the operating room is kept free from dust. 15 194 MEDICAL AND SURGICAL EMERGENCIES. All objects including utensils, instruments of every kind, dressings, etc., are more or less infected, and in order to eliminate all source of infection, modern surgery requires that they be sterilized be- fore use. INFECTION OF WOUNDS. The most frequent source of infection of wounds is the surface of the body, especially the skin and its appendages, the hair and the nails. In fact, many of the most active of bacteria of wound in- fection are constantly present on the skin, and for certain species, the skin seems to be the most natural dwelling, especially the sur- face of the body which is constantly exposed, therefore the head and face, and especially the hands invariably contain bacteria capable of producing infection in a wound. Not only the skin, but the mucous membrane lining the nose and eyes, the mouth, the intestinal, respiratory and genito-urinary tracts invariably contain bacteria capable of producing wound infection. the: necessity for personal cleanliness. Personal cleanliness will to some extent lessen the number of bacteria present on the skin, by removing the superficial scales of the outside layer of the skin, which are constantly being thrown off, but it will not keep the skin sterilized. It was for a long time taught and practiced in the leading hospitals in the country that personal cleanliness was sufficient to avoid wound infection on the part of the operator and nurses, but modern surgery demands more than personal cleanliness. Indeed, virulent bacteria have been known to persist on the hands for three or four days after infection, notwithstanding the most painstaking and repeated efforts at disinfection. Puerperal infection is generally conceded to belong to the wound infections, the same cause producing it as is responsible for wounds elsewhere in the human organism, the source of the bac- teria being usually outside of the body, being conveyed to the points of inoculation by external agents, such as the hands, instru- ments, and the like. For the avoidance of puerperal infection, the same regulations should be carried out as are employed in the provision of infection of wounds in any other part of the body. FEEDING OF THE SICK. Gruels — Oatmeal, Cornmeal, Rice, Farina, Flour — Nourish- ing Drinks — Punch, Milk, Rum, Sherry, Hot Milk and Water, Egg-Nog, Oatmeal Soup, Beef-Tea, Mutton-Broth, Chicken-Broth, Hot Egg-Nog, Egg Water, Egg-Broth, Lemonade With Egg, Egg Flip, Lemonade, Corn Tea, Crust Coffee, Tea, Coppee, Chocolate — Tapioca Jelly, Sago, Arrow-Root, Arrow-Root Milk, Whipped Cream, Corn- starch Pudding, Beef Juice, Mint Tea, Cream Soup, Flax- seed Lemonade, Irish Moss Lemonade, Barley Water, Toast Water, Apple Water, Bran Tea, Wine Whey, Flax- seed Tea — Peptonized Foods- — Peptonized Milk, Peptonized Gruel, Peptonized Beep-Tea — Suggestions and Rules for Diet of Invalids — Fluid Diet. gruels. Oatmeal gruel. (Time 30 minutes.) One quart boiling water, half pint medium oatmeal, half teaspoonful salt. Pour the boiling water over the meal, stir it well and strain through wire sieve. Boil the liquid which is strained off until it thickens and looks clear; if too thick, add the boiling water until it is of the desired consistency; add the salt, and, if allowed, two tablespoonfuls of sweet cream, which will greatly improve taste. Cornmeal gruel. (Time, 2 hours.) One tablespoonful corn- meal, quart of boiling water, saltspoonful of salt. Sprinkle the meal into the water while boiling, stirring all the while to prevent lumps, add the salt and simmer slowly two hours ; if too thick, thin it with boiling water. Rice gruel. (Time, 2 hours.) Two tablespoonfuls rice, six tablespoonfuls cold water, one and a half pints new milk, one tea- spoonful sugar, half a teaspoonful salt. 195 196 MEDICAL AND SURGICAL EMERGENCIES. Wash the rice thoroughly, and soak in cold water one hour ; put it in a double kettle with the milk and simmer until the rice is well done, then pulp it through a wire sieve and add the sugar and salt. Farina gruel. (Time, 30 minutes.) One tablespoonful of farina, one pint of boiling water, half a saltspoonful salt. Sprinkle the farina into the boiling water, stirring all the time to prevent lumps, add the salt and simmer slowly half an hour. A teaspoonful of cream will improve the taste of the gruel, and, if allowed, should be stirred in just before it is removed from the fire. Flour gruel. (Time, 30 minutes.) Mix a tablespoonful of flour with milk enough to make a smooth paste and stir it into a quart of boiling milk. Boil for half an hour, being careful not to let it burn, salt and strain. VARIOUS NOURISHING DISHES FOR THE SICK. Milk punch. To half a pint of fresh cold milk, add two tea- spoonfuls of sugar and an ounce of brandy or sherry ; stir till the sugar is dissolved. Rum punch. Dissolve one teaspoonful of sugar in half a pint of milk, stir in two tablespoonfuls of rum, and mix well by pouring from one glass to another twice. Sherry punch. Put quarter pint of milk into a goblet, dissolve one teaspoonful of sugar in it, and add two tablespoonfuls of sherry wine. Hot milk and water. Boiling water and fresh milk in equal parts compose a drink highly recommended in cases of exhaustion, as it is quickly absorbed into the system, with very little digestive effort. Egg-nog, I. Beat the white of an egg stiffly, then stir into it in turn, a tablespoonful of sugar, the yolk of an egg, a tablespoonful each of ice-water, milk and wine ; do not beat, but stir very lightly. Egg-nog, 2. Beat up one egg with a tablespoonful of sugar, stir into this a cup of fresh milk, an ounce of sherry, or half an ounce of brandy, and a little nutmeg. Oatmeal soup. Put two ounces of oatmeal in a basin, pour over it a pint of cold water, stir it, and let it stand a minute ; then pour over it quickly, stirring all the time, a pint of good broth, pour MEDICAL AND SURGICAL EMERGENCIES. 197 through a fine strainer into a sauce-pan, taking care that none of the coarse part of the meal goes into the soup. Boil the soup for ten minutes, season and serve. Beef-tea. A pound of lean beef should be freed from fat, tendon, cartilage, bone, and vessels ; it should be chopped up fine, and put in a pint of cold water to digest for two hours. It should simmer on the range or stove for three hours, but the temperature should not exceed 160 degrees Fahrenheit. The water lost by evaporation should be made up by the addition of cold water, so that a pint of beef-tea should represent one pound of beef. It should be strained, the beef being carefully expressed. A wine- glassful every three hours is a suitable quantity for administration in ordinary, acute cases. Mutton-broth. Lean loin of mutton, one pound, exclusive of bone ; water, three pints. Boil very gently till tender, throwing in a little salt and onion according to taste. Pour out the broth in a basin, and, when it is cold, skim off the fat. It can be warmed up as wanted. Chicken-broth. Skin, and chop up small, a small chicken, or half a large fowl, and boil it bones and all, with a blade of mace, a sprig of parsley, and a crust of bread, in a quart of water, for an hour, skimming it from time to time. Strain it through a coarse colander. Hot egg-nog. Beat together the yolk of an egg and a teaspoon- ful of sugar, and stir into a pint of milk at boiling point, add' a tablespoonful of brandy or whisky, and grate a little nutmeg over the top. Egg water. Stir the whites of two eggs into half a pint of ice- water, without beating, and add enough salt or sugar to make it palatable. Egg-broth. Beat together one egg and half a teaspoonful of sugar, till very light, and pour on a pint of boiling water, stirring well to keep it from curdling, add salt, and serve hot. Lemonade with egg. Beat one egg with two tablespoonfuls of sugar, until very light, then stir in three tablespoonfuls of cold water, and the juice of a small lemon, fill the glass with pounded ice and drink through a straw. Egg flip. Beat one egg and four teaspoonfuls of sugar together until stiff and light, pour half a pint of hot beer (not boiling), 198 MEDICAL AND SURGICAL EMERGENCIES. into it, stirring briskly to prevent curdling, and pour it from one bowl to another, to make it foamy and light. N. B. — This is used when stimulant and nourishment are re- quired, and should only be taken in small quantities, unless other- wise ordered by physician. Lemonade, No. I. Two tablespoon fuls of lemon juice, one table- spoonful of sugar, half a pint of ice-water, one tablespoonful pounded ice, two thin slices of lemon. Put all in a large goblet, and stir until sugar is dissolved. Lemonade, No. 2. Two tablespoon fuls of lemon juice, one tablespoonful of sugar, half pint boiling water. Put all ingredients into a hot bowl, and stir until sugar is dissolved ; drink it hot. Corn tea. Parch brown a cupful of dry sweet corn, grind or pound it in a mortar, pour over it two cups of boiling water, and steep for a quarter of an hour, then strain and add boiled milk and sugar. Crust coffee. Take a pint of crusts — those of Indian bread are the best — brown them well in a quick oven, but do not let them burn, pour over them three pints boiling water, and steep for ten minutes, serve with cream. Tea. Tea should be made in an earthen pot, first rinsed in boil- ing water. Allow a teaspoonful of tea to each half pint of water. Put in the tea, and after letting it stand for a few moments in the steaming pot, add the water, freshly boiling, and let it stand where it will keep hot, but not boil, from three to five minutes. Coffee. Stir together two tablespoonfuls of freshly ground coffee, four of cold water and half an egg. Pour upon them a pint of fresh boiling water, and let them boil for five minutes, stir down the grounds, and let it stand where it will keep hot, but not boil, for five minutes longer. In serving, put sugar and cream in the cup first, and pour the coffee upon them. Chocolate. Scrape fine an ounce of chocolate, add two table- spoonfuls of sugar, and one tablespoonful of hot water ; stir over a hot fire for a minute or two, until it is smooth and perfectly dis- solved, then pour into it a pint of boiling milk, mix thoroughly and serve at once. If allowed to boil after the chocolate has been added to the milk, it becomes oily and loses flavor. Tapioca jelly. One cup of best tapioca- put to soak with a pint of cold water ; when soft put in a saucepan with one cup of sugar, MEDICAL AND SURGICAL EMERGENCIES. 199 the rind and juice of one lemon, a little salt, one pint more water; stir until it boils; turn into a mould; set to cool; add one glass of wine if desired. Sago. Put half an ounce of sago into an enameled saucepan with three-quarters of a pint of cold water, and boil gently for an hour and a quarter. Skim when it comes to a boil, and stir frequently. Sweeten with a dessertspoonful of sifted loaf sugar. If wine be ordered, two dessertspoonfuls ; and, if brandy, one dessertspoonful. Arrow-root. Mix two teaspoonfuls of the best arrow-root with half a wineglass of cold water ; add a pint of boiling water ; put it into an enameled saucepan, and stir over the fire for three minutes. Sweeten with three teaspoonfuls of sifted loaf sugar. Add either a wineglassful of white wine, or a tablespoonful of brandy, if permitted. Arrow-root milk. Mix two teaspoonfuls of arrow-root with a wineglassful of new milk ; add half a pint of boiling milk ; put it into an enameled saucepan, and stir over the fire for three minutes. Sweeten with a dessertspoonful of sifted loaf sugar. Whipped cream. Beat half a pint of fresh, sweet cream with a whisk, add a dessertspoonful of very finely powdered loaf sugar, and twenty drops of essence of vanilla or any other flavoring; when firm it is ready for use, but is much improved by being on the ice for an hour or two. Cornstarch pudding. One quart of milk, four tablespoonfuls of cornstarch, four eggs, one tablespoonful of butter, six tablespoon- fuls of sugar. Dissolve the cornstarch in a little cold milk, and, having heated the rest of the milk to boiling, stir this in and boil three minutes, stirring all the time. Take from the fire, and while still hot put in the butter. Set away until cold. Beat the eggs very light, whites and yolks separately. Stir the sugar and any flavor- ing desired in the yolks and then add the beaten whites, and stir in the cornstarch, beating thoroughly to a smooth custard. Turn into a buttered dish and bake half an hour. To be eaten cold. Beef juice. Broil quickly some pieces of round or sirloin, of a size to fit in the cavity of a lemon-squeezer. Both sides of the beef should be quickly scorched to prevent the escape of the juices, but the interior should not be fully cooked. As soon as ready, the pieces should be pressed in the lemon-squeezer, previously heated by being dipped in hot water. The juice, as it flows away, should 200 MEDICAL AND SURGICAL EMERGENCIES. be received in a hot wineglass, and, after being seasoned to the taste with salt and a little Cayenne pepper, eaten while hot. If preferred, the juice may be frozen. Mint tea. Put one pound each of beef, mutton and veal, cut into small pieces, into three pints of cold water. It should simmer for three or four hours, but not boil. When finished, the tea should be carefully strained, and seasoned with salt and Cayenne pepper, if preferred. Cream soup. Take one quart of good stock (mutton or veal), cut one onion into three quarters, slice three potatoes very thin, and put them into the stock with a small piece of mace ; boil gently for an hour ; then strain out the onion and mace ; the potatoes, by this time, have dissolved in the stock. Add one pint of milk, mixed with a very little cornflour to make it about as thick as cream. A little butter improves it. This soup may be made with milk instead of stock, if a little cream is used. Flaxseed lemonade. Three tablespoonfuls of flaxseed, two tablespoonfuls of sugar, one pint boiling water, three tablespoon- fuls lemon juice. Put the flaxseed and sugar into a pitcher, pour the boiling water over them, and steep on the back part of stove one hour, strain, add lemon juice, serve cold. Irish moss lemonade. Quarter pint Irish moss, quart boiling water, six tablespoonfuls lemon juice, four tablespoonfuls sugar. Wash the moss thoroughly and let it soak in cold water ten min- utes, then remove all imperfect parts, and any gravel that may adhere to it. Put it in a pitcher with all the other ingredients, cover closely, and steep on the back part of the stove two hours, then strain through a wire sieve, and serve either hot or cold. Barley water. Wash two ounces of pearl barley in cold water, then boil for three minutes, and throw both waters away, add two quarts of boiling water and boil until reduced to one quart — or about two hours — stirring frequently, strain, add the juice of a lemon and sweeten. Toast water. Toast three slices of stale bread to a very dark brown, but do not burn. Put into a pitcher, and pour over them a quart of boiling water, cover closely, and let it stand on ice until cold, strain. A little wine and sugar may be added, if desired. Apple water. Slice into a pitcher half a dozen juicy sour apples, MEDICAL AND SURGICAL EMERGENCIES. 201 add a tablespoonful of sugar, and pour over them a quart of boiling water, cover closely until cold, then strain. (Slightly laxative.) Bran tea. To a pint of wheat bran, add a quart of boiling water, let it stand where it will keep hot (but not boil) for an hour, strain and serve with sugar and cream. Wine whey. Put two pints of new milk in a saucepan, and stir it over a clear fire till it is nearly boiling ; then add a gill of sherry and simmer it for a quarter of an hour, skimming off the curd as it rises. Then add a tablespoonful more sherry, and skim again for a few minutes. Flaxseed tea. Flaxseed, whole, one ounce; white sugar, one ounce ; licorice root, half an ounce ; lemon juice, four tabiespoon- fuls. Pour on these materials two pints of boiling water ; let them stand in a hot place four hours, and then strain off the liquor. peptonized poods. The investigations of Dr. Roberts, of Manchester, have been of great service in the use of food which has been artificially digested, or peptonized food, as Dr. Roberts recommends it to be called. Benger's preparation of the natural digestive ferments is used extensively and is added to the milk or gruel, as the case may be, as follows: Peptonized milk. Dilute a pint of milk with a quarter pint of water and divide the mixture into two equal portions. Heat one portion to the boiling point, and then mix it with the cold portion. Now add to this three fluid drachms of pancreatic solution — Liquor Pancreatis (Benger) — and about twenty grains of bicar- bonate soda, mix well together and set aside in a covered jug, in a warm location, under a "cosy" for an hour or an hour and a half. Then boil for two or three minutes and serve like ordinary milk. Peptonized gruel. It may be prepared from oatmeal, wheaten flour, pearl barley, etc., and should be thick and strong and very well boiled. Allow the gruel to cool to a temperature so that it can be sipped without burning the mouth (140 Fahr.), and then to every pint of gruel add two teaspoonfuls of the pancreatic solu- tion, and mix well together, pour the whole into a jug with cover, and set it aside in a warm place for about a couple of hours. Finally boil it for three minutes and strain. 202 MEDICAL AND SURGICAL EMERGENCIES. Peptonized beef-tea. Mix half a pound of finely minced lean beef with a pint of water and twenty grains of bicarbonate soda, and let the whole simmer for an hour and a half; when it has cooled down to the temperature of 140 degrees Fahr., add a tea- spoonful of the pancreatic solution and place the mixture in a warm place for a couple of hours, stirring it from time to time, then strain off without pressure and boil the liquid for five minutes. VALUABLE SUGGESTIONS AND RULES FOR'THE DIET OF INVALIDS. For general rules for guidance in feeding the sick we copy the following from high authority: In acute diseases it is well to recommend a special plan of diet ; in chronic cases it is often more convenient simply to forbid those articles which are likely to prove harmful. Before recommending any article it is well to ascertain whether the patient likes it and how it agrees with him. No article of food should be forbidden unless one has good reason for doing so. Unless there is some strong contra-indication, attention should always be paid to the wishes and taste of the patient. This rule was first formulated by Hippocrates in the aphorism, "Such food as is most grateful, though not so wholesome, is to be preferred to that which is better, but distasteful ;" and Sydenham recognized its value when he wrote : "More importance is to be attached to the desires and feelings of the patient, provided they are not ex- cessive or dangerous, than to doubtful and fallacious rules of med- ical art." If any article of food disagrees it is better to reduce the quantity of it taken, before cutting it out of the dietary altogether. Changes in diet should, if possible, be made gradually. One should never prescribe a diet for a patient without having first ascertained what his habits are as regards work and exercise. FLUID DIET. This is the first diet in fever. It has the advantage of supplying water to the tissues, of which they stand in special need in fever ; they gratify thirst and do not necessitate chewing, which taxes the patient, owing to the diminution of the salivary secretions. Milk is the simplest and most available of nutritious liquid foods. It should form the basis of the diet. If it does not seem to agree MEDICAL AND SURGICAL EMERGENCIES. 203 with the patient give it in small proportions, and let it be taken very slowly and frequently, or modify it by adding water, or some alkaline, or effervescing water or lime water. It may be the fat in the milk which causes the trouble. In this case it should be skimmed. If the patient tires of it change the flavor ; a little cold coffee, caramel or malt extract will often be agreeable. The milk may be fortified by addition of cream, if easily borne, or by one of the carbohydrates, such as milk sugar or a pure gelatine in small quantity, or the white of Qgg, or several other food articles well known to the physician. Sometimes milk will produce vomiting and diarrhea, which makes it necessary to peptonize the milk or give kumyss instead. However, restrict the feeding to the plain (and if necessary diluted) milk diet, to the patient in bed with fevers of short duration, until you find that insufficient to repair nutrition. Two quarts a day will meet the demands and some- times even a little less in cases where the body can afford to a cer- tain extent to draw upon its own resources, and sometimes this must be allowed when the stomach is weak and very easily over- taxed. Soups, beef-tea and broths belong to fluid diet, but are not strictly speaking foods. They are slightly stimulating and used chiefly to excite the appetite and are grateful to the thirst of the patient. These may be given in the proportion of a pint a day. When diarrhea is present avoid the use of soups, broth, etc., con- taining meat extractives. DIET. What to Eat and What Not to Eat in Gout, Rheumatism,. Neurasthenia, Obesity and Acid Conditions of the Blood — List Prepared by an Eminent German Specialist in Nervous Diseases and Diseases op the Blood. EAT. Soups. Bouillon or beef-tea or clam broth occasionally, say twice a week. Meats. Mutton, lamb, chicken, squab, quail, and sparingly of beefsteak, roast beef, but medium weli done. Ham and bacon (occasionally). Eish. All kinds, broiled, except salmon. Oysters only raw, use only lemon juice and salt with them. Vegetables. Spinach, asparagus, egg plant, oyster plant, string beans, French peas (but tender), celery. Boil all vegetables, mix- ing one-fourth ounce bicarbonate of soda in water. Potatoes sparingly, either boiled, baked or mashed. Fruits. Apples, raw or baked without sugar, oranges, lemons (sparingly), pears (sparingly), grapes and peaches. Dessert. Light pudding occasionally, such as custard or bread pudding. Bread. Toast, stale white, stale whole meal, rye or zweiback. Crackers, sparingly. Beverages. Boiled milk (sparingly), better mixed with lime water. Coffee with plenty of boiled milk once a day only. Weak tea, with plenty of boiled milk. Buttermilk, kumyss or matzoon. Liquors. One ounce whisky diluted, once a day. Women, one- half ounce. Wines. California white or Moselle (still). Cider. 204 MEDICAL AND SURGICAL EMERGENCIES. 205 Eggs. Soft boiled, poached on toast or hard boiled, but must boil twenty minutes or longer. Butter. Sparingly. Salts. Freely. avoid. Soups. Rich, spicy, especially clam chowder. Meats. Fresh pork, veal, turkey, goose, duck, sausages, chopped meats, corned beef, smoked beef. Fish. Salmon. Oysters. Baked, fried or stewed. Crabs and lobsters, clams and shrimps. Vegetables. Rhubarb, tomatoes, succotash, corn, cabbage, cauli- flower, turnips and carrots. Potatoes. Fried and salad, also sweet potatoes. Salads. All kinds. Fruits. Strawberries and bananas. All sugar, vinegar, pastry, cereals, such as oatmeal, rice and mush, fresh bread, hot rolls, hot cakes. Beverages. Cocoa, chocolate, raw milk, all sparkling wines, malted liquors, clarets, all ice cream and especially ice cream soda. Eggs. Fried, scrambled, shirred, omelettes. Cheese of all kinds. Avoid pepper and all spices except salt. Catsup and Worcestershire sauce, sour horseradish. .Raisins, almonds, nuts. WATER AND ITS USE. Physiological Effects of Water, Internal — Physiological Effects of Water, External — Effects of Cold Water — Effects of Warm Water — Manner of Applying — The Wet-Pack, the Rubbing Wet-Pack, the Douche — The Sitz Bath, Bran Bath, Salt Bath, Mustard Foot Bath — The Hot and Cold Compress, Method, Physiological Ef- fects — Therapeutic Applications — The Hot and Cold Head Compress — The Hot and Cold Lung Compress — The Hot and Cold Kidney Compress — The Hot and Cold Gas- tro-Hepatic Compress — The Hot and Cold Intestinal Compress — The Hot and Cold Pelvic Compress — The Hot and Cold Heating Compress or Pack, Physiological Ef- fects — The Hot and Cold Chest Bath — The Hot and Cold Abdominal Pack, Use in Vomiting^-The Hot and Cold Lumbar Pack — The Hot and Cold Spinal Pack — The Hot and Cold Pelvic Pack — Special Forms of Com- press — The Cephalic Compress, Physiological Effects, Therapeutic Applications. some remarks on how and when to use water, internal and external. Physiological effects of water, internal. It need hardly be stated that water is an essential constituent of the tissues. A certain quantity of water or fluid aliment is necessary to the digestive process. An excessive quantity impairs digestion, by so far diluting the gastric juice as to render it incapable of dis- solving the foods. The free use of cold drinks — ices and iced water — seriously disorders digestion. To this state, induced by 206 MEDICAL AND SURGICAL EMERGENCIES. 207 the free use of very cold drinks during meals, or during the time of digestion, has been applied the term "ice water dyspepsia," a very common malady in the United States. A glass of cold water before breakfast will in many persons cause a satisfactory evacuation of the bowels. The activity of the water is increased by the addition to it of a teaspoonful of common salt. Although water is essential to the constitution of the fluids and solids of the body, there is no doubt that large and frequent draughts of water may prove injurious by too great increase in the fluidity of the blood, and a consequent damage to the red corpuscles. Physiological effects of water, external. The influence of temperature must necessarily be considered in connection with the effects of water when applied externally. Effects of cold water. When an extremity — for example the hand — is immersed in cold water, the temperature of the other hand also falls. Cold water abstracts the heat of the body, at least of its superficial surface, and affects the condition of the internal organs through the nervous system. When a cold bath is entered a marked sense of chilliness is experienced, the skin becomes pale and is roughened by the erec- tion of the hair follicles, the lips are blue, the breath has a spas- modic and catching character, and the pulse is quickened. The temperature of the surface is lowered, for the blood accumulates in internal organs, and the nerves of the skin are depressed. If the temperature of the water be not too low, and if the bodily vigor be sufficient to withstand the shock, the condition known as "reaction" speedily ensues. The coldness and depression are succeeded by warmth and a feeling of exhilaration; the pulse quickens, and the respiration becomes easy and unembarrassed ; and the muscular strength is increased. If, however, the body be immersed for too long a period, the condition of reaction is supplanted by coldness, depression, weakened pulse, and muscu- lar debility. Effects of warm water. The degree of effect which is pro- duced by the immersion of the body in warm water is influenced by the temperature ; but the quality of the effect is the same at all degrees from tepid to hot. The sense of warmth is at first grate- 208 MEDICAL AND SURGICAL EMERGENCIES. ;f ul to the feelings ; the skin becomes red from the increased activ- ity of its vessels; the pulse quickens in beats, but diminishes in tension; the respiration is more frequent; and giddiness, faint- ness, and muscular languor, are finally produced, if immersion be prolonged or the temperature be too high. Manner of applying the water. The water of a cold bath should have a temperature of 50 to 60 degrees Fahr. The tepid .bath has a temperature of from 85 to 95 degrees, the warm bath from 95 to 100, and the hot bath from 100 to 106 degrees Eahr. The vapor of water in the form of the Russian bath, steam- bath, or warm or hot wet-packing, may be used to accomplish the same objects as those obtained by the warm or hot bath. Without entering unduly into the details, it will suffice to state that the Russian bath consists in the exposure of the body in suit- able apartments to the vapor of hot water, at a temperature grad- ually increased from 95 to no degrees Fahr. The bath should not, under ordinary circumstances, exceed fifteen minutes in duration. In order to overcome the relaxing and debilitating effects of the bath, one should either enter a cold bath slowly, or have cold water dashed over the body. This expedient, conjoined with friction of the surface, increases materially the good effects of the Russian bath. In the absence of special arrangements for .giving the Russian bath, simple means will suffice. The patient may sit upon a low stool with a blanket pinned around his neck, and under this the vapor of water may be conducted. Or, if con- fined to bed, the patient may be placed on a gum-cloth, and the blanket may be elevated above him by hoops, arranged trans- versely, under which the vapor of water may be conveyed from an ordinary tea-kettle. Fresh lime is sometimes used to generate hot vapor. The patient is placed on a low stool and. surrounded by a blanket. Some pieces of freshly burned lime are then dropped into a vessel of water placed under the blanket. The slacking of the lime causes great heat, and the consequent gen- eration of a considerable quantity of watery vapor, which also carries up with it minute particles of lime. The proceeding is .said to be especially efficacious in membranous croup and diph- theria. The wet-pack. This produces the good effects of cold-water applications, and consists in wrapping the body in a linen sheet MEDICAL AND SURGICAL EMERGENCIES. 209 wrung out in cold water. The patient should be placed in an ordinary single bedstead, on which is a hard mattress covered with several thicknesses of blankets or comforters. The sheet is dipped in cold water, and, when thoroughly wrung out, is laid smoothly on the bed. The patient reclines on the sheet, his head supported by a pillow. One side of the sheet at a time is then drawn over the patient's body and neatly tucked under the oppo- site side, the feet and legs being lifted up and the sheet made to entirely envelop them. Some blankets or comforters are now closely applied around the body of the patient. There is first -experienced a disagreeable sense of chilliness and discomfort, which is soon succeeded by a delightful glow. When reaction is fully established, the wet-pack should be removed, and the body be well rubbed with dry towels. The duration of this application should be from fifteen minutes to an hour. The rubbing wet-pack. This' is a convenient mode of taking the morning bath as a hygienic measure, and also of procuring more speedily some of the good effects of the wet-pack as applied above. It consists in enveloping the body with a sheet dipped in cold water, and rubbing vigorously with the sheet to induce re- action quickly. The patient stands up during the application, and an attendant rubs those parts inaccessible to the patient. When the sheet is removed the skin is dried by the vigorous application of coarse towels, and the patient immediately puts on liis clothing. The douche. This consists in the impact against the body of a column of water from a height. No greater height than ten feet, and a column not larger than four inches, will be proper -or safe under any circumstances. A hose attached to a water-pipe, the supply being regulated by a stop-cock, is a convenient method of using the douche. In domestic practice a large pitcher or water-bucket, if provided with a suitable spout, may be utilized for this purpose. The douche may be either cold, tepid or hot ; it may have a direction descending, ascending, vertical, horizontal, or oblique; and the effect may be regulated by the height from which the water is projected, the size of the stream, and the force with which it is thrown against the part. As the effect of the douche is very great when the water is cold, when the volume of the stream is large, and when it is thrown with force, it is 14 210 MEDICAL AND SURGICAL EMERGENCIES. obvious that care must be used in directing it against the head, the chest, and the abdomen. As a. rule, it is too violent a measure to be employed in weak and susceptible subjects about the trunk, but it may be used freely, of course, on the extremities. The sitz bath. This bath may be cold, tepid, warm, or hot, as the indications seem to require. The apparatus for adminis- tering it consists of a tin or wooden tub of sufficient capacity to contain water enough to cover the hips and lower part of the abdomen when the patient sits down in it. The tub should have a raised back to support the patient, and should be sufficiently elevated above the floor, so that the feet may rest comfortably when the patient sits down in the water. In the absence of special arrangement of this kind, any ordinary washing-tub will suffice. The duration should be from five to thirty minutes. Bran bath. Put bran enough in a bath to make it milky. This bath is used for softening the skin when it is dry and flaky. It should never be used in stationary tubs, for in letting off the water the bran will be sucked down and will choke the pipe. Salt bath. Put in a pound of rock salt to four gallons of water; increase salt in proportion to water. This bath is useful in invigorating feeble constitutions. Mustard foot bath. Mustard foot baths are employed as a counter-irritant. To prepare a mustard bath, two tablespoons- ful or more of mustard should be tied in a cloth and agitated well with cold water ; then hot water may be added to make the bath. It is found by experiment that cold extracts the active principle far better than very hot does. In addition to what has already been said in relation to the use of water, and inasmuch as this very valuable remedy is within the reach of every one, the following method for its use externally will be found very valuable. THE HOT AND COU> COMPRESS. This procedure consists in the simultaneous and continuous applications of a hot and cold compress to separate skin surfaces collaterally related to a single internal part. This unique procedure is not applicable to all parts of the body, MEDICAL AND SURGICAL EMERGENCIES. 211 but may be applied under appropriate conditions to the head, chest, spine, abdomen, pelvis and legs. The hot and cold compress is a combined application of peculiar interest and value, since it can be relied upon to accomplish, under certain conditions, results which can be attained in no other way, and sometimes affords relief in cases of great suffering and imminent peril. METHOD. The adjustment of the hot and the cold compresses respectively, varies for different parts of the body and the different viscera, the circulation of which it is desired to influence. The manage- ment of the cold and hot process should be the same as previously indicated for continuous applications; that is, the nervous sensi- bility of the cutaneous surface to which the cold application is made must be kept alive by rubbing the parts with a dry warm flannel for one minute each time the compress is changed. The compress should be removed every ten or fifteen minutes, or as soon as its temeprature begins to approach that of the body. The hot application likewise should be changed every fifteen or twenty minutes for a cold application of thirty seconds to one minute, so as to empty the veins, restore the tone of the vessels, and to prevent too great accumulation of heat in the deeper parts. The duration of the hot and cold compress may be from fifteen minutes to one or two hours, or even longer. A good rule is to continue the application until the desired effect is produced, unless decided indications for its interruption appear. In the employment of the hot and cold compress it must be borne constantly in mind that the application should be made in such a way that the blood vessels of the congested organ in the interest of which the application is made will be caused to con- tract by the cold compress,* the veins or the arteries of the part being at the same time drained into another collaterally related sub-cutaneous area by means of the hot application, in accordance with principles explained elsewhere. To secure the best effects, the compresses should be adjusted with special relation to internal parts, as explained for each special form of this procedure. 212 MEDICAL AND SURGICAL EMERGENCIES. PHYSIOLOGICAL EFFECTS. The hot and cold compress is a hydriatic measure of great power. It is perhaps the most effective means of controlling the movement of the blood in the internal parts. It acts both reflexly and derivatively. A cold application applied to one cutaneous surface causes contraction of the vessels of the associated internal organ through stimulation of its controlling vasomotor centers, while the hot compress applied to another cutaneous surface, the vessels of which are collaterally related to those of the part, drain off a portion of blood into the dilated cutaneous veins and arteries. The partial reaction following the first impression made by the cold compress and the frequent renewal of the cold application facilitates the movement of blood through the affected part, thus insuring a constant supply of oxygen and fresh nutrient material, the removal of wastes, and the influx of leucocytes, while at the same time, the hot application combats stasis by drawing the blood into collateral venous and arterial channels, at the same time facili- tating the rate of movement of the blood through the arteries of the parts by lowering the pressure in the veins. By this combina- tion of effects the distension of blood vessels and stasis of blood is prevented, while the movement of blood is accelerated, thus restoring the normal status of the circulation and greatly facili- tating the healing processes. THERAPEUTIC APPLICATIONS. The conditions under which the hot and cold compress attains its special successes are those in which ordinary hot or cold appli- cations, if they afford any relief at all, secure no more than partial amelioration of the urgent symptom present, the beneficial effects which might be obtained through the revulsion produced by cold being antidoted by the thermic effects produced by the application ; while, on the other hand, hot applications prove too exciting, de- pressing the heart when long continued, or causing other un- toward effects. By a combination of the two, however, in these cases the evil effects resulting from each are antidoted, while the good effects are intensified. MEDICAL AND SURGICAL EMERGENCIES. 213 The following forms of the hot and cold compress have been tested, and found practical and useful : — the hot and cold head compress. Place an ice-bag to the back of the neck and the ice compress to the vertex. Apply very hot compresses to the face and ears. The hot compresses should not extend below the level of the jaw, thus avoiding the heating of the large vessels of the neck. The ice-bag causes contraction of the vertebral arteries ; the cold compress to the vertex causes reflex contraction of the meningeal and cerebral vessels, and cools the brain ; while the fomentation to the face and ears dilates the external branches of the carotid artery, thus es- tablishing collateral anemia of the brain. The fomentation also dilates some of the venous channels by which the cerebral sinuses are drained. A reverse method may sometimes be used advantageously in application to the head, as follows : — A rubber bag filled with hot water and covered with a moist flannel, or a fomentation, is applied to the upper and back part of the neck, while a soft cheese-cloth compress wrung out of cool or very cold water is applied to the face and the top of the head. The effect of the compress in relieving cerebral congestion is greatly increased by the application of the ice compress or ice-bag to the front of the neck, whereby the blood supply of the brain is lessened by contraction of the carotid arteries. The combination of heat and cold to the head in this manner renders it possible to make applications of heat to the head for a much longer time than could otherwise be tolerated, the cold antidoting any ill effect which might be produced by the heat, while encouraging the good effects of the application. The author has made use of this application for many years as a means for relieving certain forms of neurasthenic headache. It is exceedingly useful also in so-called nervous headache accom- panied by marked congestion of the brain. This procedure is especially useful in passive congestion of the brain, and serves a useful purpose as an adjunct procedure in the treatment of insomnia when due to cerebral hyperemia. It should 2i 4 MEDICAL AND SURGICAL EMERGENCIES. be avoided, however, in cases of insomnia due to excessive excita- bility of the cerebral cells, and is of course contraindicated in insomnia due to anemia. THE HOT AND COLD LUNG COMPRESS. A thick and very hot fomentation is applied over the back, reaching from the middle of the neck to the lumbar region, and extending to the axillary line on each side. The cold compress should cover the top of the lungs, the lower half of the neck in front, and the whole anterior surface of the chest to the level of the lower ribs. The fomentation diverts the blood from the bron- chial arteries by dilating the cutaneous branches of the inter- costals, while the cold compress contracts the bronchial arteries through reflex stimulation of the vasomotor centers controlling them. The effects of the application may be intensified by hot applications to the arms and legs applied simultaneously, especi- ally hot packs, which produce decided derivative effects. DISEASES IN WHICH THE HOT AND COLD COMPRESSES ARE VERY USEFUL. This procedure is exceedingly useful in the early stages of pneumonia, in broncho-pneumonia, in pulmonary hemorrhage, acute pulmonary congestion, and the congestion resulting from the use of ether in anesthesia. Its use in the last-named condition is especially important when much mucus is present, and when cyanosis, or blueness of the skin, indicates stasis from cardiac weakness or interference with oxygenation. It has for some time been the author's custom to apply a heating chest pack immedi- ately after removing the patient from the operating table when the foregoing symptoms were present. More recently the plan of applying the hot and cold lung compress in cases in which an anesthetic is administered has been tested. When ether is em- ployed, the application extends to the whole chest surface, as above described; when chloroform is used, a hot-bag is .placed to the back and an ice-bag or a cold compress over the heart. The compress should be at least as large as the surface covered by the patient's two hands placed side by side. The cold compress MEDICAL AND SURGICAL EMERGENCIES. 215 should be removed for a few seconds every ten minutes, and the surface rubbed with a dry, warm flannel till red, so as to maintain the cutaneous reflexes upon which this compress depends for its efficiency as a cardiac stimulant. EONG EXPERIENCE JUSTIFIES THE USE OE THE HOT AND COED PACK. The author has made use of the hot and cold chest pack for ten years or more and believes it to be one of the most valuable of all means for combating pulmonary congestion. The circulation of the lungs is controlled by the vasomotor centers located at the upper portion of the dorsal region, and the purpose of the hot application is to stimulate the activity of these centers ; while the cold application to the anterior portion of the chest causes first a contraction, and later active dilatation and fluxion of the vessels of the lungs, thus combating passive hyperemia and inflammation. This is an excellent means of relieving acute congestion of the lung in pulmonary hemorrhages, and combating the hypostatic congestions which occur in fevers of a low type. The application may be continued for half an hour or more, and should be repeated two or three times a day. This measure is of very great value for removing the pulmo- nary congestion which follows ether anesthesia, and thus combats the tendency to bronchial pneumonia, which is often a greater risk in old subjects than the operation itself. A special form of the hot and cold compress is of particular service in asthma. An ice compress is applied to the back of the neck and head while a fomentation is applied to the whole front part of the chest, extending from the clavicles to the umbilicus. The back may be included. The cold application lessens the blood supply of the medulla, and so diminishes the excitability of the respiratory centers, while the fomentation relaxes the spasm of the bronchioles. THE HOT AND COED KIDNEY COMPRESS. The hot application covers the back from the middle dorsal region to the coccyx. The cold application should consist of an ice-bag or a cold compress covering the lower third of the 216 MEDICAL AND SURGICAL EMERGENCIES. sternum. The connection of the portal circulation with the renal vein makes it undesirable that any of its outlets should be closed or its tension raised by reflex impressions from the general ab- dominal surface. The fomentation diverts the blood from the branches of the lumbar artery which are distributed to the capsule of the kidney, and leads off a portion of the blood from the renal vein into the anastomosing muscular branches, while the cold application causes reflex contraction of the blood-vessels of the kidney and increases its activity^ This measure is of special service in cases of acute congestion of the kidney, especially in connection with acute febrile diseases, as scarlet fever, typhoid fever, small pox, and diphtheria. It should be used in connection with the hot blanket pack or other general hot applications in the intervals as a means of continuing the effect of the general hot application. Care should be taken that the patient does not become chilled by the cold application. The: hot and cold gastro-hepatic compress. This compress influences not only the stomach and liver, but also the spleen and the pancreas through the intimate association of the circulation of these organs. The application is almost exactly the reverse of that of the renal compress. The fomenta- tion is applied anteriorly from the fourth rib to the umbilicus, extending to the axillary line on each side, while a cold bag at least eighteen inches long is applied to the dorsal and lumbar spine. Through the dilatation of the branches of the internal mam- mary arteries and associated veins, the blood is drawn off from the stomach, liver, spleen, and pancreas, while the reflex stimula- tion of the controlling vasomotor centers contracts the vessels of the arterial circulation. the: hot and cold intestinal compre:ss. The cold compress is applied over the whole abdominal surface, extending from the xyphoid cartilage to the pubes. The fomen- tation is simultaneously applied to the lumbar region and the left side, as it is desirable to divert the blood from the left kidney both, by establishing collateral hyperemia of the overlying structures, MEDICAL AND SURGICAL EMERGENCIES. 217 and also by diverting the venous blood from the kidney into the anastomosing muscular channels. This procedure is of special value in chronic duodenitis and colitis. THE HOT AND COLD PELVIC COMPRESS. The cold compress is applied to the hypogastrium in combina- tion with a fomentation across the lower part of the back. The fomentation may also profitably become a hip pack, or a hot leg and hip pack. When the inflammation is confined to one side, an ice-bag instead of the cold compress may be placed over the affected part. The ice-bag may be used in combination with the hot pelvic pack. This measure is especially valuable in the treatment of acute inflammations of the uterus, pubes, ovaries, and bladder, in ap- pendicitis and pelvic peritonitis. In cases of inflammation of the prostate, in proctitis, and cystitis, the ice-bag may be applied to the perineum in connection with the hip pack, or with the hip pack and the hot leg pack or foot bath applied simultaneously. THE HOT OR COLD HEATING COMPRESS OR PACK. This procedure differs from the hot and cold compress in the same way in which the ordinary heating compress differs from the cold compress. In the hot and cold compress the hot application is made continuous, or practically so, by the frequent renewal of the compress. In the hot and cold heating compress or pack the cold application is not renewed, but allowed to accumulate heat through reaction. The area covered by the cold application in this procedure is usually much greater than in the hot and cold compress. The duration is usually from one to two hours. This procedure is especially applicable to the chest, the abdomen, and the pelvic region. PHYSIOLOGICAL EFFECTS. The hot and cold pack is, next to the hot and cold compress, perhaps the most powerful of all known means of controlling the movement of blood through the viscera of the chest and abdomen. The heating pack depends for its special features upon the ana- 218 MEDICAL AND SURGICAL EMERGENCIES. tomical fact that the collateral relation between the arteries and the veins with internal parts does not closely coincide as regards the location of the related vessels in the skin, thus making possible the simultaneous application of two procedures differing in method, but each assisting the other. The explanation of the effects of the hot and cold compress applies only in part to the hot and cold heating compress or pack. In the former, the action of the cold application is continuous or nearly so, while in the heating process the stimulant effect of the cold soon disappears, giving place, under the influence of the powerful reaction, to extreme dilatation, and great activity of the cutaneous vessels. As the heat accumulates, venous stasis is de- veloped, producing powerful derivative effects upon the associated venous trunks, and thus by lessening the pressure in the veins, hastens the movement of blood through the arteries of the con- gested part. At the same time, the hot compress, being applied to a cutaneous area, the arteries of which are collaterally related to those of the deeper structures which it is designed to influence, produce powerful collateral anemia of the vessels of the congested organ. Several very powerful therapeutic factors are thus brought to bear simultaneously upon the diseased part, as follows : 1. By the application of the cold compress the vessels of the part are made to contract, thus forcing ^the stagnating blood on- ward into the veins. 2. As the heating compress warms and the cutaneous veins become filled with blood, the veins of the congested viscus are emptied, thus draining the tissues of the toxins which have accumulated in them. 3. By lowering the pressure in the veins, the arterial circulation through the affected part is facilitated, thus encouraging the nutrition and functional activity of the cells which are engaged in combating living germs, or which are seeking to repair damages which may have originated in any way. 4. The hot application diverts the blood into the cutaneous branches of the collateral arteries or into anastomosing vessels, thus preventing undue accumulation of blood and consequent em- barrassment of the affected tissues. The anatomical relationships through which these results are attained have been described elsewhere. MEDICAL AND SURGICAL EMERGENCIES. 219 the: hot and cold chest bath. The chest pack is applied in the ordinary way. The form known as the square chest pack is preferable. After the wet pack has been adjusted and before the woolen wrapping is arranged, a spine bag filled with water as hot as can be borne safely (140 to 160 ) is applied between the shoulders, reaching from the lower cervical to the lumbar region. The woolen wrapping is then brought snugly in place, and fastened in such a manner as com- pletely to cover the back, leaving no openings about the neck. The hot and cold abdominal pack. In this procedure the moist bandage is placed around the trunk at the level of the umbilicus in the usual manner for wet girdle. A rubber or aluminum coil is placed upon a wet towel just over the epigastrium. The blankets are then tucked snugly around the patient, and a stream of hot water is kept flowing through the coil continuously during the application, at a temperature as high as the patient can bear. The author has made use of this application ever since it was first suggested by Professor Winternitz, using instead of a coil, however, a rubber bag filled with very hot water, a thermophore, or a syphon sack. use: in vomiting. The hot and cold abdominal pack has rendered most valuable service in a great number of cases; and so positive and satis- factory have been its results in the hands of the author, that in his estimation it stands almost unrivaled as a hydriatic procedure in the certainty with which it produces the effects expected from it. This measure has proved especially successful in both sensory and motor disturbances of the stomach, especially in cases in which the patients complain of pain soon after eating, flatulence, eructations and regurgitations of food and vomiting of bile. In one case in which a lady had suffered four months from re- gurgitation of bile into the stomach, being reduced to a very low state, the reflux of bile was at once controlled by the application of this pack. It was applied half an hour before each of the two daily meals given the patient, and was retained two hours, so that 220 MEDICAL AND SURGICAL, EMERGENCIES. the process of digestion was begun under the influence of the pack. During the first few weeks of the treatment the difficulty returned occasionally when the compress was omitted, but after a few months, the patient was able to dispense with the pack, and was not only entirely relieved of the distressing symptom, but had gained twenty-five pounds in flesh, and was restored to health.. In another case a man had been afflicted for years in the same manner, having frequent attacks, lasting for several weeks, during which time vomiting occurred within a few minutes after each meal. The patient was taken to the Battle Creek Sanitarium in an extremely feeble condition. The hot and cold abdominal com- press, however, controlled the vomiting in a few days, and the patient's stomach was soon trained to the digestion of a reasonable amount of wholesome and simple food. Scores of similar cases might be related. Extreme nervous conditions of the abdominal sympathetic and of the solar plexus, also require the application of this powerful analgesic procedure. By its daily application for a few weeks, cases in which the ganglia are so sensitive that even very slight pressure excites almost excruciating pain, and in which as a re- sult the abdominal viscera are subject to painful affections of various sorts, may often be made completely comfortable, other constitutional measures being of course employed at the same time. In nervous asthma and disturbances due to disorders of the abdominal sympathetic, this measure renders invaluable service, as may be also noted in the majority of cases of nervous head- ache, or migraine, which is likewise a sympathetic nerve disorder. Obstinate vomiting, nausea, including the nausea and vomiting of- pregnancy, yield to this procedure with the most satisfactory readiness in nearly all cases. The hot and cold trunk pack has been found of great service in cases of hyperpepsia and in hypopepsia attended by gastric irritation. THE HOT AND COLD LUMBAR PACK. This application is made the same as for the hot and cold abdominal pack, except that the hot bag or coil is applied over the lumbar region. A large square bag is used for this purpose. This application is of special service as a means of combating MEDICAL AND SURGICAL EMERGENCIES. 221 portal or renal congestion. Care must be taken to apply the heat over the left kidney, as there is a direct communication between the left renal vein and the portal system. THE HOT AND COLD SPINAL PACK. A half sheet, one thickness, wrung out of very cold water, is placed about the trunk in the usual manner for the trunk pack. The patient then rolls to one side, and a long rubber bag half filled with hot water is placed in such a position that when he returns to the dorsal position, the bag will lie in contact with the center of the back its whole length. The blankets are then drawn around the patient in the usual manner. This procedure is especially valuable in cases of spinal irrita- tion which are aggravated by cold applications, and in which there is general passive congestion of the viscera of the chest and abdomen, — conditions present in a large proportion of cases of chronic dyspepsia, especially in women. In these cases there is generally an exceeding tenderness of the lumbar ganglia, of the intercostal nerves, and of the whole dorsal region. Hot applica- tions to the spine usually afford temporary relief, but are ex- hausting and weakening when long continued or often repeated. Much better results are obtained by the application of heat and cold as described. the: hot and cold pelvic pack. This measure is applied in the same manner as the ordinary cold pelvic pack, with the exception that a rubber bag rilled with riot water, or a coil is placed over the lower abdomen next the wet sheet. The effect of this application is to afford relief in congestions of the pelvic viscera, in which it is as useful as is the hot and cold abdominal pack, in congestions of the abdominal viscera. METHOD. The mode of application is precisely the same as that of the ordinary pelvic pack, except that a hot water bag or coil is slipped in between the folds of the blanket with one thickness intervening, and so placed as to fall over the uterus and bladder. 222 MEDICAL AND SURGICAL EMERGENCIES. THERAPEUTIC APPLICATIONS. The hot and cold pelvic pack is indicated in hyperesthesia of the uterus, ovaries, and bladder, in acute congestion of any of the pelvic viscera, accompanied by pain or muscular spasm, as tenes- mus of the bladder or rectum, and vaginismus. Painful ovarian congestion, congestion and hyperesthesia of the uterus, vesical irritation, ovarian irritation, — these and other like conditions in- dicate the employment of this useful measure, and are generally very readily relieved by it. Sexual erethism, irregular and pain- ful menstruation, and the heaviness and indescribable but dis- tressing symptoms with which so many invalid women suffer, yield to this remarkably efficient measure. SPECIAL FORMS OF COMPRESS. In addition to the various forms of compress which have been described in the foregoing pages, there are several special com- presses worthy of description because of their great practical utility, and concerning which there are various practical points which need to be understood, especially in relation to the tech- nique of their application. These are the cephalic compress, the chest pack, the throat compress, the neck compress, the joint com- press, the cotton poultice, the hip pack, the pelvic pack, the leg pack, the foot pack, and the hot and cold compress. The roller compress consists of a long strip of cheese cloth folded to three thicknesses, and of proper width. Thus prepared the bandage is rolled up. When wanted for use, it is immersed, wrung out quickly, and applied as soon as possible, so that its temperature may not be modified by contact of the air of the room. A number of such bandages of different widths should always be in readiness for use. THE CEPHALIC COMPRESS. The application is usually made to either the top or the back of the head. When applied to the back of the head, the upper part of the neck is usually included in the application. The applica- tion may be made to the top of the head and the face, to the face and the neck, or to the entire head, — scalp, face, and neck. MEDICAL AND SURGICAL EMERGENCIES. 223 In the application of the cold cephalic compress it is necessary to bear in mind the fact that a cold application to the face may have the effect to produce collateral hyperemia of the brain, by contracting the external branches of the carotid artery. A napkin moistened with ice-water and laid upon the forehead may do more harm than good, by contracting the supraorbital branch of the internal carotid, and thus diverting more blood into its internal branches in the cerebrum. This effect may be readily antagonized by a cold application about the neck, which will contract the caro- tids and the vertebral arteries and all their branches, and thus aid the reflex action from the face and scalp in lessening the volume of blood in the brain. These contrary and undesirable effects of cold applications are most likely to occur in conditions in which the vascular tension is low and fluctuating. They may give rise to local or circumscribed cyanosis from vascular spasm, and simultaneous collateral con- gestion. In making cold applications for the relief of cerebral congestion, special care should be given to the eyes. The compress should always cover them, and should be well pressed down upon them, so as to utilize the powerful reflex relations which exist between the eye and the brain through the sympathetic. The same principle governs applications to the hands and feet for relief of inflammatory conditions, involving deep structures. An ice-bag over the trunk of the artery supplying axilla, bend of elbow, groin, popliteal space will lessen the local congestion, as well as or even better than an application to the whole arm or leg ; while an application to the part alone might produce collateral internal congestion. PHYSIOLOGICAL EFFECTS. The effects of the application of cold to the head have already been considered. It may be mentioned further that the head compress is less exciting and more sedative than the cephalic douche. Applied continuously, or frequently renewed, the pro- longed cold head compress is highly sedative, lessening the cere- bral blood supply, and diminishing the activity of the brain. In active congestion, a continuous very cold application is best ; in pas- sive congestion, it is better to secure vasomotor exercise and fluxion 224 MEDICAL AND SURGICAL EMERGENCIES. of the brain by means of the repeated impressions obtained by frequent renewals of the cold compress, allowing only time for the beginning of reaction effects or slight warming of the com- press. The short cold compress increases the cerebral blood supply by reflex reaction effect. The hot or warm cephalic compress, or fomentation to the head, congests the cerebral vessels when long applied. A short hot application acts by revulsion to diminish the blood supply of the deeper parts. THERAPEUTIC APPLICATIONS. All forms of cerebral congestion, insomnia from cerebral hyper- emia, the delirium of infectious fevers, and congestive headache, require the cold head compress. The hot head compress, or fomentation to the head, excites cerebral activity, and is of great service in anemia in syncope, shock, and in collapse from any cause when associated with cerebral anemia. The short cold compress, followed by drying and rubbing of the scalp, may be used in the same conditions. The hot compress is to be preferred when pain is present, because of its powerful and revulsive and analgesic effects. Continuous cooling of the head may be secured by wetting the hair and allowing the head to remain uncovered. This mode of cooling, however, as also the use of the evaporating compress, is likely to give rise to rheumatic pains of the scalp, because of the long continued action of a degree of cold sufficient to chill by slow abstraction of heat, but not vigorous enough to induce re- action. The pain is doubtless due to disturbance of the blood sup- ply of the nerve trunks. The ice-bag applied to the back of the head is a valuable meas- ure in spermatorrhea accompanied by frequent losses. The appli- cation should be prolonged. It should be applied before going to bed at night, being so adjusted as to rest against the base of the skull while the patient is asleep. In vaginismus, and in mastur- bation in women, due to sexual erethism, the ice-bag may be applied with advantage to the upper cervical for twenty minutes several times a day. MEDICAL AND SURGICAL EMERGENCIES. 225 In anemic headache, the ice-bag may be applied to the upper part of the neck for one to three minutes. The reaction following increases the supply of blood to the brain. In nervous asthma, prolonged applications of the ice-bag to the back of the head will be found advantageous. For very rapid beating of the heart, apply the ice-bag for ten to twenty minutes to the back of the head or to the neck. A precordial compress should be applied at •the same time. Many of the above suggestions were taken from the lectures of Dr. J. H. Kellogg of Battle Creek, Mich., who is a valuable au- thority on this subject. 15 THE HAIR. Color — Thickness — A Proper Brush and Comb — The Hair of Adults — What to Wash the Hair With — Cutting of the Hair — Treatment of Ladies' Hair — Don't Crimp and Curl the Life Out of the Hair — Blanching or Turning Gray — Albinism — Sudden Blanching of the Hair — Causes — Capt. Markham's Experience — Treatment for the Loss of Hair — Common Baldness — The Restorative of the Hair — Dyeing the Hair — Some Vegetable Formu- las for so Doing and How to Apply Them. The rapidity with which hair grows is subject to great varia- tions, even among individuals of the same race. It is influenced greatly by the health of the individual, his occupation and age; in the young and middle-aged the growth is most rapid, and the same condition is seen in those living an active, outdoor life in preference to an indoor or sedentary one. The growth of the beard is undoubtedly accelerated by frequent shaving, and in a minor degree the cutting of the head hair has the same effect. A thorough stimulation of the scalp by rapid brushing morning and night is also conducive to the lengthening of the hair. color of the hair. It has been found that the human hair contains three colors; yellow, red and black, and that all shades are produced by a mixture of these three colors. In the pure golden-yellow hair, there is only the yellow pigment ; in the red hair the red pigment is mixed with more or less yellow, producing the various shades of red and orange. In black hair the black is always mixed with yellow and red, but the latter are overpowered by the black. A fine head of hair has, in all ages of the civilized world, been 226 MEDICAL AND SURGICAL EMERGENCIES. 227 looked upon as an essential element to beauty. While it is not possible for every person to have an exuberant growth of head- hair, or of the beard, it is possible, with proper care and attention, for all to be the possessors of a respectable hirsutic covering. To secure this, in its greatest degree, the hair should receive proper attention and care, from infancy up. Campbell, though a poet, recognized this fact, for he says in one of his poems : "To form a head of beauteous hair, Children claim our greatest care." "Cleanliness is next to Godliness," is an old aphorism, that might, to suit hirsutic hygiene, be changed so as to read "Cleanli- ness insures a good head of hair." Many parents are loath to wash or cleanse their children's heads. I often see babes in arms, with a thick, scurvy crust upon the scalp, through .the neglect of the parents to insure proper cleanliness of the child's head; this crust, being left on for a time, irritates the skin, and an eczematous eruption ensues, giving us our scald-head, as it is popularly called. This condition of affairs should not be allowed to take place, and it would not, if proper attention were paid to the child's scalp. Washing the baby's head in lukewarm water, with castile soap, twice or three times a week, or oftener if necessary, should be practiced from birth up; then a daily brushing of the scalp and hair should be made. For a very young infant the softest brushes only should be employed; a rather harsh one to be used first, to loosen the dirt, dried sebaceous material, and epithelial scales from the scalp, and to brush it out, and then a soft, fine brush to polish the hair and make it lie smoothly upon the child's head. A fine comb should not be used on a child's head, and a coarse one would be of no special use except to part or lay the hair. A PROPER BRUSH AND COMB. I 1 In the purchase of a brush or comb, care should be exercised to see that a properly manufactured one is selected. It may seem like a little matter to attempt advice on so seemingly unim- portant a subject, yet a great deal really depends upon it. "For want of a nail," you know, "the shoe was lost ; for want of a shoe the horse was lost ; and for want of a horse the officer was over- 228 MEDICAL AND SURGICAL EMERGENCIES. taken and slain by the enemy." So, ioo, if you get a hair-brush or comb, with slivery bristles or teeth, or teeth too sharp, the scalp will be scratched by the one and the hair will be broken with the use of the other. A proper brush is one made up of fine bristles, varying with the individual as regards the stiffness of them. The clusters should be evenly set into the back, equidistant from each other, so that the whole surface of the scalp, to which it is applied, will be touched by some one of the bristle bunches. Then the clusters should be made up of bristles of slightly unequal length, so as to still farther favor the brush in covering every portion of the scalp ; by this means every hair will be rubbed down on all sides, and there will be no streaks or spots of the scalp left untouched. A proper comb is one whose teeth are even and regular, with points not sharp, but rounded. It should be held up to the light so as to detect any splitting, or roughening of the teeth on the sides, for if they are so roughened, injury to the hair, through breakage of the shaft, will surely result. Should the teeth, through any cause become so split, as you value your hair, the offending members should be carefully cut from the comb ; the slight space of the scalp that would thus remain untouched would be of no moment, as the comb is not an article that is used for cleansing purposes, as is the brush. A word might properly be said here on the wire brushes now in use. In action they are really a comb, nothing more, nothing less. As to their promulgated virtues of magnetic influence on the scalp and hair, why, this is all nonsense. They are no better than a metal comb would be. However, as a stimulator of the scalp — that is by the friction of the teeth upon the scalp-surface a glow may be produced — if not used too harshly, they work very well, though are not equal to a good bristle brush. THE HAIR OF ADULTS. - Men, as a rule, are more negligent of their scalps than the opposite sex, probably because it is so little bother for them to arrange the hair, that they overlook the brushing and washing of the scalp almost entirely. Now, the adult scalp should be thoroughly washed as often as once a month, at the very least ; a MEDICAL AND SURGICAL EMERGENCIES. 229 daily brushing will not suffice ; brushing does not remove the oily particles from the scalp, except when dried down with dust and the scarf-scales of the skin. WHAT TO WASH THE HEAD WITH. One of the best cleansing substances I know of, for either male or female use, is the yolk of an egg. This should be well rubbed into the roots of the hair and upon the scalp ; then the whole washed out with tepid water and castile soap, rinsing with clear cold water. This done, it should be thoroughly dried by brisk rub- bing with towels, so as to get a roseate glow to the scalp, thus bringing a larger supply of blood to the hair papillae ; if found too dry a little pomade could be applied. The cocoanut oil is probably the best of any. Among the proprietary preparations Burnett's Cocoaine is probably the best, as it is made up almost entirely of cocoanut oil. Purified beef's marrow could also be made use of, though vegetable oils are the best to use, as they are less apt to become rancid than the animal oils. TREATMENT OF LADIES' HAIR. The general principles just announced should govern the ladies in the care they bestow upon their hirsute treasures. As they have from forty to one hundred miles of these possessions, it naturally follows that the care devolving upon them, for keeping them in proper healthful order, is greater than upon men. Still, wig-makers would ply less of a vocation if the few hygienic measures I have given, and those that follow, were heeded. As "fashion rules the world to a great degree," I cannot really ex- pect that all of this advice will be very closely heeded. Yet, the hair should be brushed, rather than combed, daily; its "tangles" carefully unraveled, its split ends cut off, and when done up, it should be bound in as easy rolls and coils as possible ; one reason for this is to allow as free ventilation as possible for the scalp, the other, that you may not break the hair or strain the roots, by tight tension upon them. Many a lady has lost a luxuriant head of hair by persisting in crimping it closely to the head, then bind- ing it in coils, as tightly down as possible, thus severing the con- nection (partially it may be) of the hair bulb from its living 230 MEDICAL AND SURGICAL EMERGENCIES. papilla at the bottom of the hair follicle, when death to the shaft is sure to result. don't crimp and curl the hair to death. Again, don't crimp or curl it to death. Hair was never intended to sleep in worse than a straight- jacket — crimping irons — nor to be broiled or steamed on a curling-tongs that bear the temperature of the gridiron on which Biddy broils a steak. You must not blame your hair for rebelling at this cannibalistic treatment, in the way of becoming irremediably stiff, harsh, wiry, broken and stunted in its growth. Don't bleach it out of its healthy color (should brown hair be the fashion when nature has made yours brown or black) by the use of strong caustics. You might as well try to bleach the healthy color from your lips, by unhygienic procedures, and then expect health to remain. The hair-bulb itself keeps pretty close watch on your maneuvers, and if you get to carrying your pro- ceedings too far, ends up by tossing it all off from your head — about the same line of treatment your stomach adopts for ridding itself of a late supper of green cucumbers, lobster salad, fried oysters and fruit cake. After a time you may get your hair all back again, when so lost, but it is never so healthy and thrifty as before. BLANCHING OR TURNING GRAY OF THE HAIR. Hair turning gray is really but a process of living animal decay, which we call "the decline of the aged." As regards the scalp, the tone of the blood-vessels and nerves is lessened, and hence perfect hair-cell growth, either of coloring or formative matter, is impossible. The final result of all this is a gradual blanching of the color of the hair. Light hair is slower to make this change than the darker colored, from the fact that a maximum amount of coloring matter was never secreted, and hence the papillae and pigment-making materials are not so soon exhausted. Usually the beard is the first to show the approach of age, turn- ing gray at its upper portion, near the ears, first of all. At about the same time the hair, over the region of the temples, begins to show the presence of "silvery locks." Creeping therefrom, the MEDICAL AND SURGICAL EMERGENCIES. 231 whiteness extends up to the crown of the head, and down to the forehead, and with this there is apt to be a gradual loss of hair. Yet, by no means should it be understood that because the hair is gray it is always of lessened vitality, since for years it may grow as strong and luxuriant as when of brown or raven hue. The upper portion of the papilla, or that which gives the coloring cells to the hair shaft, is undoubtedly the seat of disease in these cases; the lower portion remaining free, of course the formative cells of the hair shafts are furnished in normal quantity, and hence the shaft preserves its growth in length. The cause of the growth of white hair after burns of the scalp, or quite severe local inflammations, both in man and animals, is explainable on this same basis. The burn, or inflammatory action, has extended deep enough to destroy the top of the papilla, but not enough to implicate the base, and hence a white hair is the result. If we represent the papilla in the follicle diagrammatically by the letter A, then that portion above the cross-bar in the letter will represent the color-forming part of the papilla; that below, the hair- forming portion. SUDDEN BRANCHING OF THE HAIR. This is the third variety of disorders, and one, next to senile grayness, the most frequently seen. A part, or all, of the scalp- hair may be the portion blanched ; though the more usual way is to have but a portion of the scalp showing the whitening of its hirsute covering. This is due, mostly, to some severe nervous disturbance, induced by either fright or disease. Some strange freaks of nature are observed in the matter of this sudden de- coloration of the hair ; for often, in a single night, or in the space of a few hours, or even moments, hair, which was formerly of a dark color, is changed to a silvery gray. Many of these cases are historical facts, as notably that of Marie Antoinette, the Queen of Louis XVL, whose magnificent tresses changed to gray in a single night (1791), when the royal party was arrested at Varen- nes. Another royal instance is that of Mary, Queen of Scots, whose auburn hair, through fright and grief, was changed to gray in the course of a few days. It is also authentically stated that the hair of Sir Thomas Moore 2^2 MEDICAL AND SURGICAL EMERGENCIES. turned gray on the night preceding his execution ; and Dr. Parry related the instance of a Sepoy, of the Bengal army, aged twenty- four years, who was taken prisoner in 1858, and, while under examination, his hair, which was the jet black of the Bengalee, turned gray, all over his head, within the space of half an hour. Very similar to this last is the case of a Mr. Anderson, a circus Fig. 32. Follicle of human hair. performer, and friend of one of my patients. His age was thirty- nine at the time of the sudden blanching of his hair. During an accident to one of the cages he got confined between a large bear, that had just broken out, and an elephant which he had made angry by giving it a mouthful of tobacco a little while previously. He was expecting immediate destruction, and his hair, which was quite dark, in the space of a few moments changed to gray, never to regain its normal color. Turner relates the case of a young man, who had been seized by the king's guard, when holding a stolen interview with a lady of the Spanish court, and so incarcerated. This was a capital MEDICAL AND SURGICAL EMERGENCIES. 233 offense, and it so terrified the man, when sentence was pronounced upon him, that in the same night his hair was turned to gray. The occurrence, however, was fortunate, as it saved him his life. A German physiologist has observed that several of his delirium tremens cases, which he had in the hospital, have been affected with a sudden blanching of the hair. He examined the hairs under the microscope, and found that air was infiltrated throughout their substance. Moreau records the case of a man, thirty years of age, losing by death a dearly beloved wife ; on the morning following her demise his hair, through grief, was found white as snow. CAUSES. The nervous system is, undoubtedly primarily at fault, in most instances. In old age the nerves are among the first of the wheels of life to tire out, and break down ; the many instances of blanch- ing from fright and sorrow are also so many instances of per- verted nervous action ; even in the congenital cases it is the trans- mission of nervous (hereditary) impression from the parents to their offspring that leads to premature grayness. Among dys- peptics, too, gray hair is a common sign; and even here it is un- doubtedly a reflex nervous action that induces the decolorization of the hair, rather than the non-digestion of the food, per se ; of course the dyspepsia is the exciting cause. CAPTAIN MARKHAM'S EXPERIENCE;. It is also quite well authenticated that cold weather, if pro- longed, induces grayness of the beard. Capt. Markham, who once commanded a vessel on an exploring expedition to the Arctic regions, noted, as a curious fact, that those who were for a long period absent from their ship had their hair on their faces bleached nearly white. The loss of color was gradual, and, although noticed, was never alluded to, each one imagining that his companion's hair was turning gray from the effects of hardship and anxiety. It was only after their return to the ship that those possessing beards and moustaches discovered the change of hue 234 MEDICAL AND SURGICAL EMERGENCIES. in their own hair. And yet the color gradually returned in about three or four weeks, after being less exposed to the inclement weather. Somewhat akin to this is the fact that human hair also grows faster in summer than in winter ; also faster by day than by night. All these conditions, I think, are clearly explained by the per- verted nervous action induced by the cold and absence of the usual amount of daylight. The skin is shrunken by the action of the cold, and hence, from this, as a mechanical cause, less blood is brought to the scalp, less nutriment is supplied to the papillae, and so grayness or blanching results. The graying of the hair, as an effect of prolonged financial and business worry, may be explained in a similar way. Numerous instances are on record of the speedily turning gray of the hair after business reverses, the same as after grief following the loss of friends. Wearing of closely-fitting and illy-ventilated hats, especially in the house, or office, is another predisposing cause for early grayness. Heredity also has much to do as a predisposing cause, though it is not so much the white hair factor that is handed down, as it is the perverted nervous influences, vitiated constitutions, scrofula, and the like, that are transmitted, and which speedily induce secondarily, early or premature grayness, or even albinism. CONDITIONS WHICH INFLUENCE THE TURNING OF THE HAIR. Neuralgia and nerve injuries are frequently followed by a turning gray of the hair upon the parts supplied by the diseased nerve. I have several ladies under my professional care whose neuralgic headaches (confined to the summit of the head) last- ing, usually, two or three days at a time, are followed by a marked grayness of the scalp over the painful region, though the normal color returns after a few days. Dr. Anistie is himself a victim to the blanching of the hair upon the right side of the head, owing to persistent attacks of supraorbital neuralgia and migraine. There is no falling out of the hair, and in a few days, following the attack, the normal color is nearly or quite restored. Dr. Paget, in his "Surgical Pathology/' relates the case of a lady, subject to MEDICAL AND SURGICAL EMERGENCIES. 235 nervous headaches, who, on the morning following an attack, finds her hair, in spots, as white as if powdered with starch ; in a few days the normal color returns again. TREATMENT. In a general way this is referable to two plans — preventative and curative. The blanching of hair from fright, the condition known as albinismus, and the progressive whitening from age would come directly under the first division, as curative agents are rarely of avail. The portion of the article dealing with the hygiene of the hair can be referred to as a matter of general preventatory treatment; to this should be added the inferences that may be drawn, from reading the many instances cited, of what should be avoided, so far as possible. As to curative measures, a stimulating wash, such as : Tr. cantharidis (tr. Spanish fly), 1 ounce. Aceti destil. (distilled vinegar), 1Y2 ounces. Glycerini (glycerine), i 1 /^ ounces. Spr. rosmarini (spirits rosemary), 1V2 ounces. Aquae rosae (rose water), enough to make 8 ounces. M. S. Lotion, to be well rubbed into the scalp, night and morning, will be good to apply. Frictions of the scalp, with a bristle brush, night and morning, bathing the head with cold water, and if the scalp be unduly dry and harsh, a dressing, like the following, will prove of service : Olei cocois (cocoanut oil), 2 ounces. Tr. nucis vomicae, 3 drachms. Spr. myrciae (bay rum), 1 ounce. Ol. bergami (oil bergamont), 20 drops. As, in most cases, the nervous system is exhausted, remedies addressed thereto are of value. Nux vomica and phosphorus, combined with iron or arsenic, will be indicated. Cod liver oil is also an excellent adjuvant. There is a pill already prepared, in coated form, that is composed of phosphorus, 1-100 grain; 236 MEDICAL AND SURGICAL EMERGENCIES. strychnia, 1-60 grain; carbonate of iron, one grain, that will prove as valuable as any extemporaneous formula. The compound phosphorus and quinine pill will also prove of value ; this is com- posed of phosphorus, 1-50 grain; reduced iron, one grain; strych- nia, 1-60 grain; quinine, 1-2 grain. Either of these pills can be given in increasing doses as occasion may demand. Of arsenic^ the best form for administration is Fowler's solution, the follow- ing making a very eligible preparation: Lq. potassii arsenitis (Eowler's solution), 1 drachm. Tr. ferri chloridi (muriate tr. of iron), 2 drachms. Tr. cinchonae comp., 2 ounces. Tr. cardamomi comp. (comp. tr. cardamom), enough to make 4 ounces. M. S. Teaspoonful four times a day. If neuralgia is a prominent symptom, this must also be met by remedies calculated to overcome the cause; if this be found to be dependent upon carious teeth, a dentist should be consulted, and the offending members withdrawn ; if upon uterine derangements, which is one of the most common causes for early graying of the hair in the female, these should receive their proper local and con- stitutional treatment; if upon some vicious cicatrix, a surgeon's services should be secured, and the irritation from the contracted cicatrix relieved. Sulphur, administered internally, is thought by some to prove of benefit in supplying one of the elements for hair-growth to the waning papillae. The yolk of egg, which contains sulphur and also iron, applied locally, is also of service ; besides this it is olea- ginous, and so supplies this element to a harsh-feeling scalp. An iron solution, applied to the hair, will also prove of service, as for instance, the following: Eerri citratis (citrate of iron), 2 drachms. Tr. nucis vomicae, 2 drachms. Ol. cocois (cocoanut oil), 1^ ounces. Spr. myrciae (bay rum), i\ ounces Gray hair, when the filaments are scattered, should be removed by the use of hair-dressing tweezers ; as a rule these hairs so MEDICAL AND SURGICAL EMERGENCIES. 237 treated do not return. If the hair is split at the ends, or inordi- nately long, it should be clipped back, and so save the drain upon the other parts of the scalp as much as possible. But in spite of all treatment hair will turn gray when "old age" comes on. The author is indebted for much valuable information in the preceding and following pages on this subject to the following authorities: Buckley, Neuman, PifTard, Fox, Leonard, Kaposi, and Hebra. COMMON BALDNESS. This is the form of hair-loss usually seen in young adults, or those just reaching middle age; if in the aged, it may occur in those whose hair has not previously turned gray. As a rule, the light-haired individuals, from the fact that their hairs are finer, and hence more numerous to the square inch of the surface, are more prone to the loss of their head-covering than dark-haired persons. The hair usually begins to come on the combing or brushing of it; finally, it will be found on the clothing in quite free quan- tities, showing that there is a pretty free involvement of the fol- licles of the scalp. It is usually seen in our busy, young business men, or in an overtaxed mother, or in a young lady of delicate constitution. The reason that ladies are not more generally sub- ject to this annoyance is, undoubtedly, owing to the physiological fact that their bodies are less freely supplied with hair, and hence there is more hair-forming material furnished the scalp than in men. Another reason is that they are less subject to business worry, and do not heat their heads up continually with hats devoid of ventilation; the air gets more freely about the scalp and roots of a woman's hair than man's, from the fact that they less fre- quently cover their heads. As a rule, a bald-headed father transmits his peculiarity only to his male offspring. It is also a noteworthy fact, too, that the tendency to baldness develops earlier in the life of each succeeding generation than the one preceding; thus, if the father was bald at thirty-six, the son will be pretty sure to be so at thirty-four, and ;so on. 238 MEDICAL AND SURGICAL EMERGENCIES. CAUSES. These are multitudinous. Sometimes it may be owing to abuse in dressing the hair, as crimping it too tightly, burning it with curling irons, or the use of irritatng coloring matters, and the like ; or it may be due to the "old age" of the hair itself; for hair, as well as man, has its time of ripening, age, and death. When it becomes fully developed, and its life matured, it becomes con- tracted just above the bulb, and falls out ; the life germ, of course, remaining to fill the empty follicle with new hair at no very distant time. Among the more usual exciting causes can be men- tioned disease, enervating habits, mental worry, and loss of normal nerve nutrition. The worry of an accountant over his books, the merchant over his sales, the lawyer over his cases, the physician over his practice, the minister over his charge, all these are promi- nent factors in the cause of baldness. The reason is that there is not sufficient blood brought to the papilla of the hair-shaft, and hence the cell-formation, at the root of the hair, is not rapid enough to keep the hair follicle properly distended, so as it can perform its proper office of moulding the cells to the formation of a proper shaft; hence, at this interval, whether marked by ill- health or not, the follicle, through its circulary compressing fibres, strangles, or cuts in two, the mass of soft hair-cells, just forming into a hair-shaft, and the hair falls out as the result. Often there is a little bulb seen at the end of the hair, after it has been sub- jected to this choking off process ; this has led some observers to say that the root has been thrown out; but this is not the case; were it so, then there would be no regrowth of the hair, for when the root is once destroyed, hair-life can never be regenerated in that follicle. The loss of hair following fevers and other debilitating diseases takes place in much the same manner, and as the result of the weakened state of the forming papillae, the regrowth is apt to be of different color or shape; after a time, though, when the hair- forming organs regain their usual vigor, the normal color is usually wont to return. Loss of hair through head neuralgia, as is common to many of our ladies, is in the same manner. The proper amount of blood is not carried to the new cell-forming papilla, it is also vitiated, and MEDICAL AND SURGICAL EMERGENCIES. 239 the nervous excitement, indicated by pain, causes a reflex con- traction of the skin about the follicle, and hence the hair is girdled, and so falls out. Doubtless the change in color of the hair, through excitement, occurs from the same cause. When the excitement is calmed a normal blood circulation and nerve action ensues, hence the normal color-cells are secreted in their normal abundance, and, as a result, the color is restored. I believe the physiological action of the two to be similar, differing only in degree; if continued long enough, loss of hair would be the result. I have a patient under care now, a young married lady, with uterine disease, where the hair becomes very gray on the second morning following an attack of this head pain — at the top of the head — but in a day or two returns to its normal color (brown). If the pain were con- tinued long enough I doubt not that the final result would be local baldness, through the malnutrition of the follicles. In proof of this I cite the following case : Nayler gives an instance of a lady, in middle age, suffering from headaches, radiating from the temple to the crown, who had a total loss of hair over the seat of pain. In six months, after the neuralgia was cured, the hair grew rapidly again, though it was white in color; this gradually changed, however, to its normal hue. Syphilis is also a well known cause for the loss of hair, though it is not the common cause, as is often asserted. For centuries the loss of hair following this disease was not noticed ; thus, Brassa (1533) writes that "venereal symptoms have been observed which render it doubtful whether the disease is declining, or whether it has changed its character. The first of these symptoms is the falling off of the hair. One cannot help laughing at seeing men without beards, eyebrows or eyeleashed." TREATMENT. If you are an accountant take fewer hours at your desk, more in the open air ; the hair makes a good barometer (in truth, aneroid barometers are made from hair) for the state, of health, as well as of the atmosphere, and when you thus find it being progressively shed, look carefully to your occupation, to see if that is not the cause. If you are indoors a great deal, get in warmer friendship 240 MEDICAL AND SURGICAL EMERGENCIES. with your gun, rod and line, and horse, or even take a relaxation trip. Don't wear your hat in the counting room or store; go bareheaded as much as you can, and have your hat a ventilated one. If you are using tobacco excessively, put the brakes on there ; be temperate in all things, and above all secure a good night's rest ; court sleep, "Tired nature's sweet restorer, That knits up the unraveled sleeve of care." There is nothing like good sound sleep to recuperate the nervous system, for this is the system that is first out of order when the hair begins to fall. Leave your figures in your office ; don't take them to bed with you to dream over; or if you are an inventor, or writer, don't make your bed room, your study room, or your meal time a convenient time for straightening out that kink, plot, or ledger discrepancy. Take three full hours every day to eat your supper, breakfast and dinner in, and a mile walk after each, if possible. All this done, and if yet you feel tired and exhausted, go to some physician who will look your case over for you, and see what organs are still at fault. The bowels should be kept regular, .and for this purpose there is no remedy less harmless, or more to be depended upon, than one of the Rhamni, thus: Fl. ext. rhamni Purshianae (cascara sagrada), vel (or) Fl. ext. rhamni frangulae (buckthorn bark), 2 ounces. Syrupi sim. (simple syrup). Aq. cinnamomi (cinnamon water), aa. (of each) I ounce. M. S. Dessertspoonful before breakfast, or three times a day if necessary. Instead of this, oil, epsom salts, rhubarb, seltzer or Hunyadi water might be employed. As tonics, Peruvian bark and iron are among the best. The following is a very common prescription with me: Tr. cinchonae comp. (compound tr. cinchona), 2 ounces. Ferri citratis (citrate of iron), 3 drachms. Tr. nucis vomicae (tr. nux vomica ),i J drachms. Vini Xerici (sherry wine), 3 ounces. M. S. Teaspoonful one-half hour after meals. MEDICAL AND SURGICAL EMERGENCIES. 241 Besides, the head should be kept in as cleanly and hygienic a condition as possible. p- Among the many local applications that could be given, the following I have found to prove of great value: Tr. cantharidis (tr. Spanish fly), 2 drachms. Tr. nucis vomicae (tr. nux vomica), \ ounce. Tr. capsici (tr. capsicum), 1 drachm. Ol. ricini (castor oil), \\ ounces. Aq. cologniensis (cologne water), 2 ounces. M. S. Liniment. To be applied with a piece of sponge, night and morning after brushing the hair. If the oil is an objectionable feature, as it is with some, bay rum (spr. myrciae) may be substituted. Cocoa oil and cocoaleine also make good substitutes. A preparation of arsenic, given internally, is also of great bene- fit in most of these cases. It should not, however, be prescribed indiscriminately. The following makes a very eligible mixture, •combining all other tonics with it: Liq. potassii arsenitis (Fowler's solution), \\ drachms. Ferri citratis (citrate of iron), 2 drachms. Tr. nucis vomicae (tr. nux vomica), 1 drachm. Tr. cinchonae comp., q. s. ad 4 ounces (enough to make 4 oz.). Prof. Erasmus Wilson recommends the following: Lq. ammoniae (spr. hartshorn). Chloroformi. Ol. amygdalae dulcis (sweet almond oil), aa. (of each) I ounce. Spr. rosmarini (spr. rosemary), 5 ounces. This is to be rubbed into the roots of the hair, after brushing the scalp. Undoubtedly it is too strong for most scalps, and it will need to be diluted about one-half before applying. Cologne water, or rose water, may be used for this purpose. Dr. Pincus suggests the following treatment in the first stage of premature baldness (This stage is recognized by a daily loss of under fifty hairs, by diminished sensibility to pressure, and, after a time, by commencing hardness and immobility of the scalp) : a 16 242 MEDICAL AND SURGICAL EMERGENCIES. solution of caustic potash, one part to five hundred of water, or fifteen grains of the bicarbonate of potash to an ounce of water. Two or three drachms of this solution are to be rubbed into the scalp from three to five minutes daily. After a time this may be done every other day, and then only once a week. If this is con- tinued for a year or more, he avers, the baldness is arrested, and, in some cases, the lost hair is fully restored. The following is also a useful lotion : Liq. ammonii acetatis (spr. Minderus), 2 ounces. Ammonii carb. (carbonate of ammonia), -| drachm. Glycerini (glycerine), -J ounce. Ol. ricini (castor oil), -J ounce. Spr. myrciae (bay rum), 5 ounces. M. S. Lotion. Apply to roots of the hair, night and morning, with sponge, after brushing thoroughly. • The following is also a very good lotion : Tr. iodinii comp. (compound tr. iodine), 2 drachms. Tr. cantharidis (tr. Spanish fly), 2 drachms. Spir. myrciae (bay rum), 1^ ounces. Aq. cologniensis (cologne water), 2 ounces. M. S. Apply to the bald portion of the scalp twice a day. Pomades are sometimes ordered, but I do not like these, as a rule, as they mat the hair together more than lotions, and make it too greasy for the comfort of the user. Still, the following, when these features are not objectionable, will be very useful : Tr. iodinii (tr. iodine), 2 drachms. Pulv. cantharidis (powdered Spanish fly), \ drachm. Acidi tannici (tannic acid), 1 drachm. Ol. bergami (oil bergamont), 20 drops. Vaselini (vaseline), 2 ounces. M. S. Apply to the head night and morning. What has been said regarding the medical treatment of bald- ness in men, is equally applicable to the cases occurring in the opposite sex. Ladies, however, must forego the use of the crimp- MEDICAL AND SURGICAL EMERGENCIES. 243 ing pins and curling iron, as well as the use of bleaching or color- ing agents. The hair should be done Up loosely or suffered to hang down undressed. As the Manillians have the longest, blackest and most glossy hair of any nationality, and do not bind or curl it tightly to the head, but allow it to fall back behind, in its own natural looseness, it follows, that if our ladies would wish to preserve their hair as long as possible, that they should imitate the Manillians in this custom. The tonic systematic treatment is just as necessary in their cases as in the cases of men, and the preceding formulae are as good as any. Out-door exercise should be regularly taken ; if family cares are crowding too closely upon them, a trip to the seaside will be beneficial. Worrying or fretting over any matter only makes the fall of the hair the worse, hence all this should be avoided as much as possible. Good, healthy, plain food only should be taken ; eating of sweetmeats, late hours at the ball-room, and kindred enervating practices, should be abandoned, and a stay of eight hours in bed be taken each night, till the system becomes recuperated. In cleansing the head and hair, as it should be done every week or ten days, in summer time, less often in winter, there is nothing better than the yolk of an egg, beaten up in a little water, and rubbed thoroughly over the scalp and through the hair on a bit of sponge, and then the whole rinsed with warm water, and dried by pressing between cotton or linen towels. The ends of the hairs, if they split, should be trimmed off an inch or so and thus kept back until this tendency is overcome. In brushing the hair, only a soft brush should be used ; but this used carefully will be found to bring a warm glow to the scalp, and thus ma- terially aid recovery, for it is the aim of the whole treatment for baldness to quicken the sluggish circulation in the scalp. Electricity applied with proper care, to the scalp by means of a wet sponge, one of the poles of the battery being placed at the nape of the neck, will also be found of service in stimulating the nervous action, and thus increase the amount of blood sent to each hair follicle and its papilla. DYEING THE HAIR. I do not really recommend the use of these various dyes, even in the many cases of early blanching of the hair ; as regards my- 244 MEDICAL AND SURGICAL EMERGENCIES. self, the sight of gray hair is not unpleasant. I rather like gray hairs ; they are, in the aged, the emblems of wisdom ; they remind us of hearts that have been steadfast amid all external changes and friendships, and which time and circumstances have not changed or weakened. Almost all the so-called hair-dyes, which should more properly be called paints, depend upon the action of minerals for their blackening process. All of the patent right ones, with hardly an exception, contain lead in some form. A few varieties are made up of lead alone; these are absolutely harmless; those containing sulphur, or nitrate of silver, can be used so excessively as to be productive of hurt; yet, I think their dangerousness has been overrated, when they have been used in moderate quantities. The following iron preparation will be found valuable to darken the hair, and it also has the advantage of being non-poisonous : Sulphate of iron, i drachm. Alcohol, i ounce. Oil rosemary, 12 drops. Pure water, J pint. M. and apply frequently to the hair and scalp. This preparation has another advantage, that of being of use when dandruff is present upon the scalp. By leaving out the oil of rosemary and alcohol, and putting in equal parts of water and cologne water, a very eligible preparation is formed. A wash very similar to this is a great favorite among the fashionable Parisians. The following is said to give a good and natural-looking dye, free from the caustic action of silver salts and the poisonous effects of lead compounds. Two preparations are needed : No. 1. Citrate of bismuth, 1 ounce. Rose water, 2 ounces. Distilled water, 2 ounces. Alcohol, 5 drachms. Ammonia, q. s. M. S. Apply in the morning thoroughly to the hair. MEDICAL AND SURGICAL EMERGENCIES. 245 No. 2. Hyposulphite of soda, 12 drachms. Distilled water, 4 ounces. M. S. Apply in the evening thoroughly to the hair. Instead of waiting so long as this, the preparations could be applied, if necessary, an hour or so apart ; the morning and even- ing alternate application is usually found the best. This dye is based on the chemical action of the reduction of the hyposul- phate of soda by bringing it in contact with the citrate of bismuth, the result being a formation of the sulphate of bismuth. As red and blond hair contains sulphur in excess of the other colors, we know why such hair retains its color better than hair of other hue. Nitrate of silver is probably as generally used as any of the salts of the metals (unless it be the acetate of lead) for produc- ing a change in the coloring of the hair. Usually the strength of the solution is from five to ten grains of the silver to the ounce of water, as in the following: Nitrate of silver, 10 to 60 grains. Distilled water, 2 ounces. M. S. Apply to the hair, wetting it thoroughly. Then let dry slowly by evaporating in the sunshine, or heated room exposed to the light. If time is of importance, the darkening of the silver solution can be hastened by applying the following solution a few mo- ments after the nitrate of silver is used: Potassii sulphureti, 1 to 6 scruples. Distilled water, 2 ounces. This will make an almost instantaneous change to a black hue, if the silver solution has been first used. Where there are only streaks of gray here and there upon the scalp, a single application will be all that is required, till the hair is grown out quite a dis- tance, so that the portion nearest the follicles will need color-dres- sing again. The objection to this dye is that it stains the scalp and 246 MEDICAL AND SURGICAL EMERGENCIES. hands as thoroughly as it does the hair. To avoid this, great care should be used to protect the scalp, and gloves should be worn upon the hands during the application. A brush will probably be found the most convenient applicator. The ordinary lead preparations are made up of the sugar of lead, ten to twenty grains to the ounce of water, as follows : Sugar of lead, 40 grains. Distilled water, 2 ounces. Apply this to the hair thoroughly, and when about dry apply a solution of the sulphide of ammonium, about one-fourth the strength of the British Pharmacopoeia solution. The objection to the last compound is its very unpleasant odor. It gives though, an excellent brown or black color to the hair, according to the strength of the solutions employed, and does not stain the scalp. The mercuric dyes are best represented by the following: Corrosive sublimate, 12 grains. Rose water, four ounces. M. S. A poison. To be used with great caution and externally. If there are any abrasions on the scalp this solution should not be employed, as enough of it might be absorbed to produce dele- terious results. It is best applied to the hair by means of a brush dipped in the solution, and then thoroughly brushed through and over the hair. When it has become dry the following should then be employed : Sodii hyposulphate, 1 ounce. Water, 2 ounces. M. S. Apply externally. The same brush should not be used for making both applica- tions. The solutions can be applied, one at night, and the other in the morning, for a few days, then once or twice a week, until the desired result is obtained. This is quite a slow-acting dye. In the use of any of the above dyes, or indeed any of the fol- lowing, the hair should be thoroughly cleansed from all oleaginous MEDICAL AND SURGICAL EMERGENCIES. 247 material ; this may be done by washing in toilet-soap suds, or by the free use of bay rum and cologne water, and then drying. After the dye is once "set/' oil, cocoa-nut is the best, should be applied as a dressing to help bring out the color and the gloss; also to prevent too much drying of the hair. Brown hair dye. Sometimes plumbic acetate and sulphur are combined together in one and the same solution, of the strength of the following: Plumbi acetatis (acetate of lead), \ drachm. Sulphur sublimati (flowers of sulphur), 1 drachm. Aquae (water), 4 ounces. M. S. Shake well and apply night and morning for a week or so, then decrease the frequency of the application, gradually, to once a week, or once in two weeks. This is a slow dye, yet one that answers fairly when there is not much grayness to the hair. It also is a very mild preparation. The deposit left upon the skin can be easily brushed off when it becomes dry. Like all of the head dyes it acts best upon hair of a reddish tinge, though gray hair is turned to a brownish color by it. Its effect upon light hair is to give more of a dark brown tint to it. The following also makes a very good brown, and the tint can be darkened, as the fancy may desire, by a continued application of the two preparations : Sulphate of copper, 16 grains. Distilled water, 4 ounces. M. Apply thoroughly to the hair, and when dry or nearly dry use the following : Potassi ferrocyanidi, 16 grains. Distilled water. 4 ounces. M. Apply by means of a sponge or brush. This last solution is poisonous, if swallowed in any quantity, and hence should be kept out of the reach of children ; indeed so should all dyes. It does not stain the skin, and simulates, very 248 MEDICAL AND SURGICAL EMERGENCIES. closely, the normal brown coloring given by nature, when applied to gray hair. The following will also give a very good dark brown, and even black, if applied frequently enough : Ammonia-nitrate of silver, I drachm. Distilled water, 4 ounces. M. Care should be had not to bring this into contact with the skin any more than possible, as it will stain it. Its application should be followed, when the hair becomes dry, with the follow- ing: Pyrogallic acid, 2 drachms. Distilled water, 4 ounces. M. Apply by means of sponge or brush. The permanganate of potash may be used to give a light brown color to the hair ; it should be used in the strength of from ten to forty grains to the ounce of distilled water. It makes but little discoloration of the skin, and is perfectly harmless. The brown color can be deepened, and even changed to a black, by using, alternately with the permanganate solution, the solution of pyro- gallic acid just mentioned. To dye the hair red. This is usually on the plan of bleaching a darker colored hair down to this color ; though sometimes a true coloring principle is desired, as when gray, or light blonde hair is sought to be darkened to this color. The least harmful of all the dyes is the Persian Henna before described (see under the head- ing of black hair dyes). Auburn hair is hair having a tinge of red, and this stage is sometimes reached in bleaching dark brown hair down to that of yellow, or blonde hue. A strong infusion of saffron, to which has been added some carbonate of soda, if followed by an application of lemon juice or vinegar, will give a reddish yellow hue to dark-colored hair. Bronzonette, whatever that may be, will, it is said, with the aid of spirits of wine, give a crimson coloring to the hair. Thirty MEDICAL AND SURGICAL EMERGENCIES. 249 drops of the bronzonette to a couple of drachms of alcohol is the usual amount taken. As the color begins to pale, a new applica- tion of the alcohol will revive it considerably. Some of the salts of antimony are also made use of, as the ordi- nary tartar emetic, in hair dyeing. Thus : Tartar emetic, 1 drachm. Pure water, 2 ounces. Tartaric acid, 5 grains. M. Apply with sponge to the hair. Care must be taken that the scalp is not much wetted with this solution, lest enough become absorbed to vomit the individual. Its application is to be followed with a slution of ammonic sul- phide, one part to four parts water. This works the best upon light-brown hair. Yellow or ''blonde" dyes. The Roman ladies used a very im- pure kind of soap, made from ashes and goat's fat mixed, for blanching their locks. A town in Germany — for the Germans are by nature blondes, or a light-haired race — called Matium, used to furnish this substance in balls to the Roman cosmetic- vendor, and hence the common name for the article was "mattic balls." Akin to this is the "potash treatment" so much in vogue with us today, when maidens will persist in washing their dark- colored tresses with strong soap-suds, or a weak solution of caus- tic potash, and then expose themselves to the sun. The blanching of the hair is obtained by this method, and is perhaps the least harmful of any, though more slow in its action than some. How- ever, it is some form of chlorine or sulphurous acid, or nitric acid that is now most made use of for bleaching the hair. These agents work more rapidly than the alkalies (potash or soda), and are not so apt to injure the texture of the hair; they are used by our wig-makers to blanch the locks they are making up for sale. A weak solution of the nitro-muriatic acid, as it combines both nitrogen and chlorine, is the better agent to employ. The strength of this will need to vary as the occasion may require ; but starting with the weaker solution, whose strength can be increased after a time, frequently applied, will be the safer way ; you must remem- 250 MEDICAL AND SURGICAL EMERGENCIES. ber that in one sense you are killing the hair, that is its color, and hence caution is needed. A solution, somewhat as follows, would be well enough to start with : Acidi nitro-muriatici diluti, 4 drachms. Aquae, 4 ounces. M. S. Apply by means of a sponge, and dry in sunshine, or by the aid of hot irons. It will not injure the skin. The officinal aqua chlorinii, or chlorine water, might also be used in the same manner as the lotion just given to fulfill the same purposes. As harmless, though perhaps not quite so effectual as some of the other dyes spoken of, is the following wash : After washing the hair thoroughly with a solution of alum, the strength not im- portant, bathe it with a tea made of the annotta (the ordinary cheese-coloring produce), in which a little common baking soda has been dissolved. This application has to be made a number of times before much change is noted in the color, as it is very mild. If each application, when dry, is followed by a washing with vinegar, or water soured with lemon juice, the color will be deepened somewhat. It is only applicable for very light hair, as it contains no "bleaching'' agent. Stannic chloride, with a mordant of ammonic sulphide, will also turn the hair a yellow color, through the bleaching agency of the chlorine and sulphurous acid that is present in the two lotions. So also will the application of a solution of plumbic acetate, fol- lowed up with a mordant of potassic chromate. All of these bleaching agents, if used excessively, are apt to leave the hair crisp and dry, or even to extend their ravages far- ther and so destroy the existing growth entirely. MISCELLANEOUS. Treatment of Ringworm — Treatment of Sweating of the Feet — When Spectacles Should be Used — Some Uses of Electricity in the Treatment of Diseases — Signs of Death — Neurasthenia — Neuralgia — Tic Douloureux — Hypochondria — Hysteria — Insomnia — Skin Diseases — Bronchitis — Pneumonia — Hay Fever — Green Sickness or Chlorosis — Jaundice — Appendicitis — White Swelling — Hemorrhoids or Piles — Aphthae — Thrush — Canker Sore Mouth — Burns and Scalds — Enlarged Tonsils — Broken Breasts — Toe-Nail, Ingrowing — Urine, Incontinence of, Retention of — Preparation of Bottled Milk — Vegeta- rianism — The Eruptive Fevers — Period of Incubation. the treatment of ringworm. Dr. Saerlis recommends oil of turpentine for the cure of ring- worm of the scalp. The hair should be closely cut over the affected part, and for a short distance around, and then turpentine is to be liberally applied, and rubbed in well with the ringer. This is allowed to remain for about five minutes, and is then washed off with carbolic soap, and afterward with hot water, and the patch is then painted with dilute tincture of iodine, or with a two- per-cent. solution of iodine in turpentine. The application is to be made once or twice a day, and is not painful, though it causes a slight smarting. The writer asserts that he has cured, in ten days, by this method, cases of ringworm that have resisted all other modes of treatment. TREATMENT OF SWEATING OF THE FEET. Dr. Hebert gives the details of a method first suggested by Dr. Legoux, which he has found most efficacious for the relief of 251 252 MEDICAL AND SURGICAL EMERGENCIES. sweating of the feet. For three days the feet are bathed, for half an hour at a time, morning and evening, in tar-water. At the end of the third day the foot-baths are omitted, and the soles of the feet are painted once a day with perchloride of iron. After four days more the epidermis of the soles is found to be dry and hard. Dr. Hebert succeeded in obtaining a complete cure by this simple means. - WHEN SPECTACLES SHOULD BE USED. When we are compelled to remove small objects a considerable distance from the eye. When we find the light insufficient. When the object appears blurred, cloudy, or has a mist before it. When the letters of a book run together or appear double or treble. When the eyes become fatigued after reading or other exercise. These rules answer in many cases, but not always. Never choose a pair of spectacles when the eye is fatigued. Wait an hour or two, after you can be better suited. The tired eye needs rest, not glasses, and if they are purchased when the eye is excited or tired, errors are certain to occur in selecting the proper glasses. Wait patiently for an hour or two, or better still, three. SOME USES OF ELECTRICITY IN THE TREATMENT OF DISEASES. During the last decade, the uses to which electricity has been applied have been numerous, and while there is a difference of opinion as to the beneficial results from its use, the best physicians and surgeons of this country, as well as those across the water, are of the opinion that in a select number of cases the use of electricity supersedes all other methods of treatment. The efforts of some enthusiasts to find in electricity a panacea for all human ailments is, of course, absurd, and has had the effect of creating a certain amount of prejudice against its proper use. There are three forms of electricity which have been utilized, viz. : The estatic or frictional form, galvanic, and faradic. It is not within the province of this article to deal with the me- chanical side of electricity, nor to go into the general therapeutic action of electricity upon the different forms of disease. In order for one to apply this remedy intelligently, it is necessary to be MEDICAL AND SURGICAL EMERGENCIES. 253 familiar with the different forms, as well as the action of elec- tricity upon both diseased and healthy tissues. Probably the chief reason why it has not enjoyed a more exten- sive use in the past is on account of the incomplete construction of electrical equipment for medical uses, also the insufficient knowl- edge possessed by the regular physician as to its use. It has been used by the charlatan, or quack, in a grand-stand method, and of course its use was necessarily limited, and did not receive the sanction of the medical profession until the last few years. An eminent author and a practitioner in medicine for twenty- five years, has made a special study of electricity based upon physiological principles in the treatment of diseases, both in pub- lic institutions and in private practice. In connection with it, he has also found water, gymnastics, massage, manual and mechan- ical exercise, heat, sun-light, diet and other agents, to be of great utility in addition to medicines in accomplishing results. There are some forms of diseases in which one or more of the above will t>e found beneficial, and others in which a combination will achieve results. A chronic invalid who has gone the rounds of a physician with- out any lasting benefit, is often willing to grasp at a straw, and in not a few hopeless cases, the above various remedies, mechan- ical and otherwise, intelligently applied, have relieved many a chronic invalid from a life of misery and wretchedness. The single application of one remedy to some diseases is like trying to lift a large building with one jack-screw, while, in reality, a dozen or more is absolutely necessary to accomplish the result. The application of electricity to diseases is so numerous and technical in its detail that the reader had better consult a physician who has given the subject more or less attention. It is in order that he may appreciate the uses of electricity that the above re- marks are made in this work. There are a few diseases in which its application has been found very beneficial, for instance, for the relief of pain in the neuralgic joint. A mild galvanic current pre- ceded by hot applications are among the most useful measures for this affection. 254 MEDICAL AND SURGICAL EMERGENCIES. CERTAIN FORMS OF CHRONIC CONGESTION OF THE PELVIC ORGANS. The good effects obtained from local electrical applications has been experienced by many suffering individuals. The applications of electricity to paralyzed and shrunken muscles, together with the application of cold water and friction has had a marked effect in increase in the irritability and circulation and nerve force in that particular part. For the relief of pain in general the application of electricity renders most valuable service, together with the associations of heat. When the pain is neuralgic in character, a mild soothing current, combined with hot fomentations continued from fifteen to twenty minutes often causes powerful and gratifying results. The application for the relief of headache due to congestion of the brain, in which the cold applications do not produce favorable results, applications of the galvanic form may be made to the head and back of neck with very excellent results. When a tonic effect is desired, as in cases of anaemia, melan- cholia, and many other conditions in which there is a deficiency in the circulation of the blood to the extremities, the faradic cur- rent is generally found preferable. The use of electricity in the treatment of diseases in which the ends of the nerves are affected, has the most extended use, as for instance, paralysis of the muscles which move the eye, also those of the face, and those of the shoulder and arm, neuralgia of the chest, which includes the muscles of respiration; the use of the electric current in these forms very often causes immediate relief. The sciatic nerve, the principle nerve of the lower extremity, is probably most often affected of any of the larger nerves of the body, and disorder here is both painful and difficult to get rid of. Cold, wet, and overexertion of the leg are found to be the most frequent causes of this form of neuralgia. With the patient lying on the back, with the body lying upon it, the other electrode is applied along the different points in the course of the nerve, and gradually the current is applied with the latter electrode moving up and down as the points of pain would indicate, the applications being made daily or every other day. There is increase in the warmth of the part and a decrease in the pain with relief in not a few cases being permanent. MEDICAL AND SURGICAL EMERGENCIES. 255 ELECTRICITY IN DETECTING FEIGNED DISEASES. In addition to determining the presence, or absence, of nerve or muscle degeneration, and the discrimination between cerebral and spinal paralysis and the various types of peripheral palsy, it has been found of value in determining the length of time subjects have been dead. For instance, it is stated that muscular contrac- tions produced by the faradic current cannot exist four hours after the subject is dead. Maligners often assume epilepsy and paraly- sis ; a strong faradic current to the forehead or tibia, by means of a wire brush, applied to one feigning epilepsy, will cause intense pain to the false epileptic, but in the true epileptic, no pain will be felt. Feigned anaesthesias may also be told by the faradic wire brush, attached to the negative reophore, the limb will quickly respond and show how much actual anaesthesia exists ; it has also been found useful in motor paralysis. There are some basic principles in the use of the different forms of electricity with which it becomes necessary to be more or less familiar. In hysterical patients where paralysis exists muscular reactions to either faradic or galvanic currents may be increased ; in rheumatic paralysis electro-muscular contractility is, as a rule, more or less increased, although there are some exceptions. In peripheral paralysis both faradic and galvanic reactions are altered after ten days has elapsed, the muscular contractility being lost early to a greater or less extent. No alterations in the electro- contractility of muscles is observed in any of the diseases confined to the posterior part of the spinal cord. NERVOUS REACTIONS. When exaggerated on both sides under a weaker current than in health, the probability is that there exists a central lesion ; then again suppose a case of localized paralysis is thought to exist and the faradic and galvanic reactions of both nerve and its muscles are normal and exactly alike on both sides ; we have then reason to believe that the existing case is either hysteria, some lesion of a higher spinal segment than that from which the nerve arises, or a lesion within the brain. 256 MEDICAL AND SURGICAL EMERGENCIES. In unilateral paralysis, the muscles of the paralyzed side should be contrasted with those of sound side, and also the corre- sponding muscles. When both sides are impaired the standard of comparison is the sound patient. SIGNS OF DEATH. In the absence of a physician it sometimes becomes important that others shall be able to determine whether death has taken place or not. The occurrence of death can be recognized by the following signs: The breathing and pulse cease, the surface be- comes pale, the muscles relax, the lower jaw falls a little, the "sight" of the eye becomes dull and glazed, the upper lid falls so as to partly cover the eyeball, and the whole body gradually cools to the temperature of the surrounding air and becomes rigid, while later decomposition sets in, and usually shows itself first by a green discoloration of the surface of the abdomen. But it does not require the detection of all these signs to deter- mine that death has taken place. The cessation of breathing and of the heart-beat is a safe basis for an opinion. It requires some care, however, to decide that there is no breathing or circulation. To test the former, a cold piece of polished steel — like a razor blade or table knife — can be held under the nose and before the mouth. If no moisture condenses upon it, it is safe to say there is no breathing. To test the cessation of the heart-beat, it is not enough to feel for the pulse at the wrist. The largest blood-vessel of the body runs directly down from the heart, along the left side of the spinal column, and its strong beating can be plainly felt in most people by pressing the finger tips firmly down toward the backbone, at the point below the breastbone called the "pit of the stomach." In this place the slightest pulsation of the heart can be felt if the walls of the abdomen permit the finger to get near the backbone, and here examination should be made before de- ciding that the heart has ceased to beat. Another test is listening over the region of the heart, in front of the left side of the chest. An acute ear can always detect the movement of the heart by sounds made by its valves, which, when perfect, sound like the syllables "ub-dup," "uf-dup," and so on. If careful listenings fail MEDICAL AND SURGICAL EMERGENCIES. 257 to detect the heart sounds, and the cold metal fails to show any evidence of breathing, the individual may certainly be said to be dead. When, in addition to these signs, paleness, muscular relaxation, a glazing eye, increasing coldness and rigidity come on, it hardly requires the onset of decomposition — the infallible sign — to prove foeyond any possibility of doubt, that death has occurred. The electrical battery may be used, in doubtful cases. Electric- ity distinguishes with absolute certainty between life and death. Within two or three hours after the stoppage of the heart, the whole of the muscles of the body will have completely lost their electric excitability. When stimulated by electricity they no longer contract. If, then, when electricity is applied to the mus- cles of the face, limbs or trunk, after supposed death, there be no contraction, death has occurred. No faint, no trance, no stupor, however deep, can prevent the manifestation of electric muscular contractility. But ordinarily it is very easy to decide between death and life ; and the fear of being buried alive, which torments many people, is altogether without good foundation. The stories upon which it rests are such as an excited imagination might easily invent, and natural fear propagate, but they do not bear critical investigation. In certain European cities, for many years, the bodies of hundreds •of thousands of those supposed to be dead have been placed in rooms where ingenious appliances and careful watching have been used to detect the slightest evidence of life, and in not a single case has a mistake been found to be made. NEURASTHENIA. Synonyms. Spinal irritation ; nervous prostration ; nervous ex- haustion. Definition. A debility of the nervous system, causing an in- ability or lessened desire to perform or attend to the various duties or occupations of the individual. Causes. It may result from various chronic diseases; mental worry or emotion; overwork, as "whenever the expenditure of nerve force is greater than the daily income, physical bankruptcy 17 258 MEDICAL AND SURGICAL EMERGENCIES. sooner or later results" (Jackson). Neurotic temperament ; sexual excesses ; alcohol ; tobacco. Symptoms. Nervous debility may affect any organ of the body. It is a condition of nerve-tire or exhaustion, and hence the nerv- ous energy necessary for functional activity of any particular or- gan is wanting, a fair example being seen in cases of nervous dys- pepsia. One of the earliest manifestations of nervous exhaustion is an irritability or weakness of the mental faculties, as shown by ina- bility to concentrate the thoughts, and efforts to do so causing headache, vertigo, restlessness, fear, a feeling of weariness and depression, together with the army of symptoms attendant on nervousness. There may be occular disturbances, palpitation of the heart, coldness of the hands and feet, chilliness, followed by flashes of heat, followed in turn by slight sweating. Patients are also troubled with wakefulness, or when sleep does come, it is accom- panied with unpleasant dreams, and is not refreshing. It is of importance to determine between neurasthenia and other forms of nervous debility, due to organic diseases of the nervous system. These diseases are generally curable except when compli- cated with some form of mental derangement. The treatment is varied and important. Very often a change of scene is very de- sirable. If the patient lives in the country, a trip and visit in the city is often beneficial, while, on the other hand, if the patient lives in the city, a visit in the country, where the surroundings are pleasant, is very often just what is needed. In any event, remedies to build up the nervous system are always indicated, together with nourishing diet and relief, far as possible, from all mental and physical strain. NEURALGIA. Definition. A disease of the nervous system, manifesting itself by severe and sudden pain, of a sharp and darting character, mostly one-sided, following the course of some part of the nerve. Varieties. There are some five or six varieties, located in as many parts of the body. First, of the face ; second, of the head ; third, of the neck and shoulders; fourth, of the back and ribs; MEDICAL AND SURGICAL EMERGENCIES. 259 fifth, of the abdomen ; and sixth, of the limbs, or what is known as sciatica. Causes. Heredity; impoverished condition of the blood; ma- laria ; syphilis ; metallic poisons ; anxiety ; mental exertion, ex- posure to cold and damp; injuries of the nerve trunk. The old axiom is considered true today, with regard to the cause of neuralgia, that it is "the cry of the nerves for pure blood." TIC DOULOUREUX. This is a very severe form of neuralgia, accompanied by sharp pain, darting and stabbing in character. Its most common loca- tion is over the eye and the side of the face. It is attended with an increased secretion of tears, twitching of the eye-lids, and often pufrmess under the lids also. The second form of neuralgia is paroxysmal also, and pain is severe; it is located generally in the back of the head, and also on one or both sides, and extends from the back of the head down to the neck and shoulder, and upwards around the face as far as the cheek. The third form is also paroxysmal, the pain being severe, and burning in character. It extends from the shoulder down the arm, and along the side of the chest, while over the latter may be felt spots of tenderness. In the fourth form the pain is very much the same, but located in a different place — along the back, extending along the spinal nerves, where they emerge from the spinal cord. Treatment. Life is very seldom compromised by neuralgia, but when it is present, it causes intense suffering, and the general health may be seriously affected. When it occurs in early life, and there is no hereditary taint connected with it, the indications are that a recovery will take place. The treatment will depend upon the cause. Should the blood be impure, as is frequently the case, a liberal diet, with medicines to build up the system, such as quin- ine, iron and strychnine, as indicated in the following prescrip- tions : sometimes plasters are beneficial, also the electric current, and liniments, and very often hot water applied will give more relief, temporarily, than anything else. 260 MEDICAL AND SURGICAL EMERGENCIES. HYPOCHONDRIA. This is an affection of the nervous system characterized by the belief that one has some bodily ailment or disease. The patient has spells of moodiness. It is similar to melancholia. Monomania, or insanity upon one subject, is another evidence of the same condition. Rheumatism, headache, mental stupor, lack of resolution, hysteria, are a result of the same cause. Cause. A gradual loss of nerve control resulting from the irritating effects of indigestion and retained waste. A lack of proper nourishment reduces the vitality and physical force below par, and the patient is unable to exercise proper con- trol of himself. The brain becomes clouded and dull, and intelli- gent guidance is more or less disturbed, that is, the patient is unable to exercise proper control of his actions. Treatment. The treatment suggests itself. It consists of atten- tion to diet, digestion and elimination, also an abundance of pure water, fresh air, sunshine and proper exercise. Drug medication may be required and should be prescribed by a physician. Chloral, the bromides and asafetida are probably the best remedies. HYSTERIA. As a disorder of the nervous system it is generally confined to women, usually occurring in paroxysms, but in very nervous women approaching a chronic state. A paroxysm may vary from moaning and gesticulation to violent struggling. There may also be slight twitching of the muscles, and in some cases general con- vulsive movements. Consciousness is never wholly lost, and the paroxysm is be- lieved to be more or less under the control of the patient, who, if instead of giving way to her feelings, would endeavor to control them, might possibly escape a paroxysm altogether. Hysteria may, however, be developed during the course of an organic disease, when, owing to a weakened condition, the patient is less accountable for lack of self-control. Treatment. A five-grain pill of asafetida taken three times a day will generally control hysteria. MEDICAL AND SURGICAL EMERGENCIES. 261 Bromide of ammonia, 2 drachms. Aromatic spirits of ammonia, 1 drachm. Water, 4 ounces. A dessertspoonful three times a day. Muriate apomorphine, 1 grain. Syrup, 4 drachms. Water, 10 drachms. A teaspoonful as required. Repeat in a few hours if necessary. INSOMNIA. Insomnia is a disease of the nervous system in which there is inability to sleep. This may exist alone or be connected with some other affection. It is a sign of disease even if there is no pain or other evidence of suffering. It may be the result of mental over- work. Treatment. If an accompaniment of other disease, the treat- ment should be directed to the disease proper. If due to mental overwork, chloral or the bromides are the best remedies. Of the chloral, 20 grains, well diluted in water, may be given at one dose ; of the bromide of potash, 40 grains, also well diluted in water, may be given at one dose. Or better, 20 grains of each may be given together. If sleep is not produced in two or three hours, one-half the dose, 10 grains of each, may be given. The patient should be as free from care as possible, should take out-of-door exercise, and give special attention to diet, elimina- tion, etc. A hot bath for twenty to thirty minutes before going to bed, often induces sleep. Antipyrin, 1 to 2 drachms. Syrup orange peel, 1 ounce. Cinnamon water, 3 ounces. One tablespoon ful every hour or two until effective. Bromide of potassium, 4 drachms. Hydrate of chloral, 2 drachms. Syrup wild cherry, 1 ounce. Water, 3 ounces. A dessertspoonful in a wineglassful of water at bedtime. SKIN DISEASES. Acne, Eczema, Hives, Scabies (Itch). acne. This affection of the skin is the result of an inflammation of the sebaceous glands. It most frequently- appears about the time of puberty. It is usually chronic in character. Cause. Authorities state that acne is accompanied with di- gestive disturbances and that it is often associated with chronic diseases — anemia, scrofula and tuberculosis are examples. It is true that in many cases there may be no actual disease, yet there is some disturbance of digestion which results in a produc- tion of irritants in some form, and these irritants affect the ter- minal or outer ends of the peripheral nerves — those that supply the skin. Symptoms. The oily secretion of the gland is retained, but the retention is attended with inflammation. Inflamed, ugly-look- ing pimples are the result. Pustules may occur among the pim- ples. In the pustular variety of acne pustules are the rule. The face is the part most commonly affected, although the neck, back and shoulders may be subject to this eruption. Sometimes the color of the secretion which clogs the ducts varies from a white or yellowish to a gray or black, the last two being the result of dirt which becomes mixed with the secretions ; these are known as blackheads. Treatment. Avoid fatty foods as much as possible. Keep the bowels open freely. Bathe the face often and thoroughly in good soap and hot water. Keep the face protected from wind and cold. The pimples should not be squeezed or pressed between the finger- nails. At night after bathing in hot water, dust on a little white pre- cipitate and wash it off in the morning. 262 MEDICAL AND SURGICAL EMERGENCIES. 263 Sulphur, 2J drachms. Rose water, 1 drachm. Make an ointment. Apply locally. Sulphur, 2 drachms. Pulv. tragacanth, 20 grains. Spirits camphor, 2 drachms. Liq. calcis, 2 ounces. Distilled water enough to make 4 ounces. Make an ointment. Apply locally. In cases where the skin is oily, the following is recommended : Sulphur, 2 drachms. Spirits ether, J ounce. Alcohol, 3J ounces. As a local application. Especially applicable to blackheads : Sulphuric ether, 1 ounce. Carbonate of ammonia, 1 drachm. Boric acid, 20 grains. Water, 2 ounces. Mix and apply locally two or three times a day. ECZEMA. This is a manifestation of a systemic trouble. The eruption is but a local manifestation of a constitutional disease. Eczema may attack all ages and classes. There is a catarrhal inflammation of the corium, or deeper layer of the skin. First there is congestion of the vessels supplying the affected part, pro- ducing redness. In this variety there is a slight exudate from the swollen vessels, and when the moisture dries it forms in scales. The scales are composed of the solid elements from the blood, of the new cells which have grown as a result of the increased blood supply, and of such other matter as may inhabit the skin where the exudate occurs. There are several forms of eczema, as where it occurs in 264 MEDICAL AND SURGICAL EMERGENCIES. papules or points, where the papules contain fluid, or where they contain pus. Sometimes the inflammation and exudate cause the outer layer of the skin to become detached and it is cast off, leav- ing the inflamed corium, or deeper layer of the skin, exposed. This gives a red appearance, which differs from the other forms,, as it is a deeper red. If the inflammation is severe enough, some of the small vessels may be ruptured and blood may form part of the exudate. Cause. Any one having eczema must remember that his system is not in a healthy condition. More thorough elimination is needed and more attention should be paid to diet. In some cases, the use of alcohol may have been the starting point; in others,, possibly tobacco. Their effects would be produced by their inter- ference with digestion. Lack of exercise, too much hard work, laziness, or any other condition that tends to disturb the general health may produce eczema. Symptoms. There is always itching and burning in eczema. The diseased area presents no distinct outline or border, but the redness fades gradually into the surrounding healthy skin. The papules or vesicles that occur in erysipelas may resemble those of eczema, but erysipelas presents greater swelling, more heat, and the color is a deep red, tense and shiny. The inflammation is deeper seated. There is fever and frequent pulse. Erysipelas may set in with a chill, there may be nausea, vomiting, an abscess may form, or in some cases there may be delirium. Eczema presents none of these symptoms. The trouble is con- fined to itching, and sometimes a burning sensation, but the evi- dence is never severe. Treatments. In those cases where vesicles form, or where there is much moisture present, the following prescription will be found most beneficial : Salicylic acid, 10 grains. Subnitrate of bismuth, I drachm. Powdered starch, I drachm. Vaseline enough to make I ounce. Mix thoroughly, and apply two or three times a day. This ointment will be found satisfactory in the treatment of most cases. Careful attention should be given to digestion and MEDICAL AND SURGICAL EMERGENCIES. 265 keeping the bowels regular. Ten grains of salol should be taken three times a day. 2. Wash the diseased area with a solution of bicarbonate of soda, one or two tablespoonfuls to a quart or more of tepid water. Dry very gently and apply carbolated vaseline — 5 drops of car- bolic acid to 1 ounce of pure vaseline. HIVES — NETTLERASH — WHEALS — URTICARIA. All of these terms are applied to certain characteristic marks which appear in the skin following indigestion. The trouble is not dangerous. It usually occurs in children. Cause. Indigestion and usually lack of elimination. As a re- sult of indigestion, many irritants are present in the circulation. These irritants cause dilatation in groups of small blood-ves- sels which supply the skin. This dilatation is the result of the paralyzing effects of the irritants upon the nerve fibers which con- trol the size of the vessels. The dilatation is sudden, hence the rapid appearance of the spots, large or small. The spots are usually light in the center, and a reddish or some- times a bright red color around the border. They may vary from the size of a pea to a walnut, or be even larger. Symptoms. The sudden appearance of the spots. They may disappear as suddenly as they came, and reappear in some other part. With their appearance there is a tingling, itching and burning sensation. The spots are accompanied by digestive disturbances. Treatment. A large dose of castor oil, salts, or Seidlitz salts, with careful attention to diet. 2. Salicylate of soda, 3^ drachms. Aromatic elixir, 4 ounces. Mix. Dose for child five years old, one-third teaspoonful in water every three or four hours ; for adult, one teaspoonful every three or four hours. ITCH. Itch is caused by an animal parasite which burrows in the skin. These parasites multiply very fast, producing intense itching. The affection generally occurs on the hands between the fingers. 266 MEDICAL AND SURGICAL EMERGENCIES. TREATMENT. 1. Ammoniated mercury, 40 grains. Sulphur, 3 drachms. Vaseline enough to make 1 ounce. Wash the hands, dry, and apply the ointment twice a day or oftener. 2. Sulphur, 2 ounces. Lard, 4 ounces. Mix and apply freely at night, washing it off in the morning. 3. Carbolic acid, 10 drops. Water, 4 ounces. Mix, and apply locally. BRONCHITIS. Bronchitis means inflammation of the mucous membrane lining the air tubes, but does not include the smaller tubes or air cells. Usually the inflammation affects only the large and medium-sized tubes. Chronic bronchitis may follow the acute form, or may re- sult from other causes. I Cause. The cause of acute bronchitis is atmospheric changes, the same as those which produce other forms of catarrhal colds. j Symptoms. The symptoms are those of a common cold, which it accompanies. The catarrhal condition of the throat and nasal cavities extends downward into the air tubes. Headache is often present, there is a feeling of oppression and tightness in the chest, and cough begins as soon as the disease enters the bronchial tubes. At first the cough is dry, but later it becomes looser and expectora- tion is more profuse. There is usually some fever, and respiration is increased. Treatment. If one is subject to bronchitis, he should pay imme- diate attention to a simple cold and try to prevent it from extend- ing to the bronchial passages. If an acute attack occurs, the patient should be given a hot mustard foot-bath, and it is well to have the air of the room moistened with hot vapor, as steam from a kettle of boiling watetr. Bathe the throat and chest freely with cam- phorated oil and protect with flannels. MEDICAL AND SURGICAL EMERGENCIES. 267 Chloride of ammonia, 2 drachms. Fluid extract licorice, 2 drachms. Water enough to make 3 ounces. Teaspoonful every four hours. PNEUMONIA Pneumonia is an inflammation of a part of one or both lungs. It is seldom that both lungs are involved. The right lung is di- vided into three lobes and the left into two. An acute localized inflammation of one or more entire lobes is called lobar pneumonia. This is the form usually spoken of as pneumonia. The affected portion of the lung becomes solid and firm, no air passing through it. Double pneumonia is usually fatal. Pneumonia is an inflammation of the air cells, and cannot exist without producing bronchitis (inflammation of some of the smaller tubes), though bronchitis can, and usually does exist without pneumonia, the inflammatory process stopping before it reaches the smaller tubes and cells. Cause. The irritation produced by any of the conditions which cause chronic bronchitis may assume an acute form and produce pneumonia. Pneumonia is always the result of an unhealthy system. The blood contains an excess of irritants, and there is only needed an exciting cause, such as a cold, to precipitate acute in- flammation of the lungs. Another cause for pneumonia is found in the double circulation with which the lungs are supplied, and the fact that nearly all the blood in the body passes through these organs once every minute. Symptoms. The disease usually begins with a chill, followed by fever and pain, which is increased by the cough which devel- ops. The temperature rises rapidly. At first the pulse is full and strong, but may show early signs of embarrassed heart action. Respiration is shallow and rapid. The cough is harsh at first, but soon a frothy mucus appears, which later becomes thick and tenacious. There may be headache, sleeplessness and delirium. With children convulsions may take the place of the chill. Treatment. Send for the doctor at once. In the meantime put the feet in water as hot as can be borne, afterwards rub and dry 268 MEDICAL AND SURGICAL EMERGENCIES. them thoroughly, put the patient to bed, cover warmly and keep quiet. Give hot herb drinks and apply hot applications to the chest — hot cloths or poultices of mustard or flax-seed. HAY FEVER. So called because it usually occurs during the haying season. The only difference between asthma and hay fever is that in hay fever there is a slight rise in temperature and a catarrhal condi- tion of the eyes, nasal cavities, throat and air tubes of the lungs, but mostly in the air passages of the head. At first the mucous membrane may seem dry, but this is followed by an increase in the secretions. In some cases there is a profuse, watery discharge. Hay fever sometimes assumes all the seriousness of asthma. Treatment. Change of climate affords the greatest relief. Muriate of quinine, 4 to 8 grains. Water, 1 ounce. Use with atomizer. Antipyrin, -| ounce. Syrup orange peel, 1 ounce. Water, 3 ounces. A teaspoonful once to three times daily. SICK HEADACHE. There is a variety of causes which may produce sick headache. Usually it is due to disturbances of digestion and is spoken of as bilious headache. Exacting mental labor, worry, or insuffi- cient sleep may induce an attack of sick headache by interference with digestion or elimination. Defects of vision when glasses are needed, or the wearing of glasses which have not been properly fitted to the eyes, is the cause of much headache, and in case of severe eye strain, of sick headache. Irritation of the ovaries or womb is another cause of headache. Treatment. Nervous headache. Hot pack, dark room, bed and something to quiet the nerves. Sick headache. Hot water internally, or emetic. MEDICAL AND SURGICAL EMERGENCIES. 269 BURNS AND SCALDS. The danger arising from burns depends much upon the extent of the surface burned and the depth of the injury — if very exten- sive and deep, the patient may never rally ; or if flame to any con- siderable extent has been drawn into the lungs, the probability is that the person cannot be saved. The teaching is that where a burn covers one-third of the surface, death is almost sure to follow. The great danger from large burns is blood poisoning. All the tissues destroyed soon commence to decompose and many poisons are produced. These poisons are rapidly absorbed into the circu- lation, and this produces a condition of blood poisoning that may result fatally. Treatments. In the case of a severe burn or scald, if nothing else is at hand, apply cold water immediately and but little inflam- mation will follow. If one is burned by spilling hot tea or coffee, do not wait to remove clothing, but dash cold water on at once. This will prevent the hot clothing from burning deeper and pro- tect the skin at the same time. Lift the clothing and pour on more water, then remove the clothing and apply cold water by wetting cloths and laying over the surface. The cloths applied must be kept wet without removing them. Cold milk is better than cold water because it is thicker and offers better protection. To secure benefit from this treatment it must be applied almost immediately — quickly enough to arrest the heat before the skin has been destroyed. Otherwise it will not be so valuable as lime water and linseed oil, baking soda and other treatments. For pain following burns and scalds nothing gives greater re- lief than the application of cold sweet milk. This may be applied •on a cloth frequently changed, or when possible, immerse the in- jured surface in a vessel containing the milk. The application should be continued until there is freedom from pain, and followed by dressings of some mild, soothing antiseptic. 2. If burn is severe, cover surface with dry baking soda, and t>ind lightly with a soft cloth. 1 3. Use equal parts of lime water and linseed oil. Saturate ■cloths and lay over the burn. Keep cloths wet by pouring on the .solution. Do not take dressing off every day. If blisters form 270 MEDICAL AND SURGICAL EMERGENCIES. open at base to let fluid out. Do not make a large opening. After heat is out, dry boracic acid makes a good application. 4. Apply distilled witch hazel every few minutes. This will stop all smarting, even in the case of a burn from hot grease. 5. Common washing soda or baking soda, three tablespoonfuls to a pint of water. Apply freely. 6. If clothes stick to the flesh do not tear them off, but flood the part with olive oil. 7. Lay on cloths wet in olive oil and laudanum. To heal burns, apply an ointment made as follows: Vaseline, 1 ounce. Oxide of zinc, 1 drachm. Mix thoroughly and spread on linen cloths and apply to burns. In case of scalds, exclude the air at once with soda and flour, covering the parts and keeping them covered. white; swelling. This form of inflammation is always chronic, and occurs only in those previously unhealthy. In recent years white swelling is understood to mean tuberculosis or consumption. Consumption is a degenerative change which usually occurs in the lungs, but may occur in any other tissue or part. Occurring in a joint, it may first affect the bone, the membrane surrounding the joint, or any other structure entering into the joint formation. The low form of inflammation present first results in an overgrowth of con- nective tissue; later the new tissue and more or less of the joint structure softens and degenerates, the ligaments become relaxed and softened, and there is deformity in proportion. In some cases a large amount of fluid may collect during the earlier stages ; in others there may be early degeneration of some part of the mem- brane surrounding the joint. This results in an opening which may continue to the surface, forming a sinus, from which later there is a more or less constant discharge of pus. In all cases the joint is swollen and the skin thickened and firmly adherent to the deeper structures as a result of the low form of inflammation which has existed for some time. There is no red- ness because the disease is chronic. Nutrition is more or less lack- MEDICAL AND SURGICAL EMERGENCIES. 271 ing, circulation is poor, and the color is lighter than normal, hence the term white swelling. Treatments. The treatment is both general and local. The local treatment consists first of rest. Plaster casts and other forms of splints are recommended by some and objected to by others. A common seat of the disease is the knee joint, and here extension is valuable as in the treatment of hip joint disease. If there is no improvement at the end of one month, most surgeons advise in- jecting into the joint some form of antiseptic solution, usually a 10 per cent, solution of iodoform in glycerine. Some advise in- jecting balsam of Peru. The iodoform and balsam combined make a most excellent disinfectant and local stimulant. In those cases where there is a large collection of fluid, it should be re- moved by an aspirator. This local treatment, while recommended, often fails to cure, and in some cases affords no relief. The real treatment consists in improving the system by atten- tion to diet, elimination, fresh air, etc. There is always more or less stiffening of the joint in which the disease occurs, as the re- sult of the overgrowth and contraction of connective tissue, or the destruction of bone, tendons and ligaments, or of all combined. The following liniment may be used, bathing the affected part, night and morning, rubbing the liniment in well. Turpentine, 1 ounce. Tinct. Spanish fly, 1 ounce. Sweet oil, 1 ounce. Laudanum, 1 ounce. HEMORRHOIDS OR PILES. Piles are tumors situated about the anus or just within the rec- tum. The former are external piles, the latter, internal piles. Both varieties may exist at the same time. In some cases these tumors break and blood is discharged from them, in which case they are spoken of as bleeding piles ; if there is no discharge of blood, and they remain internal, they are spoken of as blind piles. Cause. What seems to be an imperfection in the anatomical structure of the veins surrounding the rectum is the primary cause of this trouble. The veins throughout the body and lower extremities are well ^2 MEDICAL AND SURGICAL EMERGENCIES. supplied with little valves which prevent a return of the blood, but for some unknown reason those surrounding the rectum are not thus supplied. The absence of these valves favors congestion, and the veins gradually bulge until small sacs are formed. Everything that irritates the lower bowel, as strong physics, habitual constipation and any of the causes which tend to produce it, as straining at stools, etc., will cause an increase of blood in this part and a consequent congestion, and piles are the usual re- sult. Symptoms. Pain, often a burning sensation, and a protuberance of the pile. Usually there is hemorrhage, which may be slight or very profuse. If the hemorrhoids are large and remain internal, there will be a constant desire to evacuate the bowels, as the sen- sation is the same as though the mass consisted of fecal matter. An examination will reveal the' true condition. Treatments. All conditions are benefited by the free use of in- testinal antiseptics : 10 grains of the sulphocarbolate of soda, in tablet form, or the same amount of salol, either in tablet form or powder, should be taken four times a day. To insure greater regularity of bowel movement, avoid meats and all heavy foods for supper. By eating light suppers difficul- ties of constipation are more readily overcome. Local applications. The following ointment will be found of value in many cases of piles : Vaseline, i ounce. Nut-galls, pulv., 80 grains. Pulverized opium, \ drachm. Mix together thoroughly, use after each movement of the bowels. If the bowel comes down, put it back, carrying it up with the index finger as far as possible. Cocaine hydrochlorate, 12 grains. Iodoform, 1 drachm. Extract opium, 30 grains. Petroleum, 1 ounce. Use as a salve. MEDICAL AND SURGICAL EMERGENCIES. 27s APPENDICITIS. The appendix is a narrow tube, usually from two to four inches in length, and in diameter about the size of a goose quill, or a little larger. It is situated in the abdominal cavity, rather low down and toward the right side. Appendicitis is inflammation of the appendix. Sometimes appendicitis occurs more than once in the same person, this is called recurrent appendicitis. If possible the appendix should be removed between the attacks. Cause. The first cause of appendicitis is indigestion ; following this is an unhealthy condition of the digestive tract. Constipation results, with the production of many poisons and irritating sub- stances. This condition causes inflammation which extends along the digestive tract and into the appendix. Symptoms. Sudden onset of pain in the abdominal cavity. Nausea and usually vomiting. Fever. Treatment. A physician should be called at once. The patient should be put to bed and kept as quiet as possible. All cases of appendicitis may be divided into three classes : First, those which are fulminating or gangrenous, and almost invariably result in death. Second, those which need a surgical operation. Third, those which get well, some permanently so, under proper medical treatment. In cases of this third class, the patient should be put to bed and absolute rest upon the back insisted upon. He must not rise to the sitting posture. An ice-bag should be placed over the appendix and such medicine given as directed by physician. The patient should receive a diet of broths or beef-tea, instead of milk, as the latter is apt to cause fermentation and the formation •of gas in large amounts in the intestine. GREEN SICKNESS OR CHLOROSIS. This is a term applied to a particular form of anemia, often distinguished by a greenish-yellow coloration of the skin. It occurs in young persons, chiefly girls about puberty. It is an anemic condition of a pronounced type. 18 274 MEDICAL AND SURGICAL EMERGENCIES. Cause. Disturbances of nutrition beginning with indigestion and constipation. Symptoms. The skin assumes a pallid hue, the flesh becomes flabby and the countenance, after the menses, which are either scanty or suppressed, has a greenish-yellow cast. There is no loss of flesh ; instead the patient sometimes takes it on. The feet and legs have a tendency to swell, the patient tires easily, has palpitation on slight exertion, the appetite is usually depraved, the digestion impaired and constipation the rule. Gastric ulcer may occur, and consumption, especially in those predisposed, is a common result. Treatment. The treatment consists in nourishing diet and every attention to the general health. Any of the following remedies may be taken to advantage : i. Extract aloes, I drachm. Sulphate of iron, 2 drachms. Asafetida, 4 drachms. Divide into 100 pills. From one to three pills three times a day. 2. Under the name of "Dewee's Emmenagogue Mixture," first devised by Professor Dewees of Philadelphia, the following formula has been largely used : Tinct. chloride of iron, 3 drachms. Tinct. catharidis, 1 drachm. Tinct. ammonia guaiac, i| drachms. Tinct. aloes, ^ ounce. Syrup enough to make 6 ounces. Tablespoonful three times a day. 3. Tinct. chloride of iron, J ounce. Glycerine, 2 ounces. Simple elixir, add to 4 ounces. Give one teaspoon ful after meals and at bedtime. 4. Fellow's syrup of hypophosphites, 5 ounces. Maltine, or a good preparation of extract of malt, 10 ounces. Shake the bottle and take a tablespoonful after meals and at bed- time. MEDICAL AND SURGICAL EMERGENCIES. 275 5. Blaud's pills, 5 grains each. Take one after each meal and at bedtime. Four a day. jaundice. Jaundice is a condition resulting from obstruction of the bile passages. It is characterized by a yellow discoloration of the skin, preceded or accompanied by languor, and often with nausea. There is also a yellowish tinge to the white of the eye. Constipa- tion is usually present. Cause. The cause is congestion of the bile ducts ; or the con- gestion may be confined to that portion of the duct that opens into the bowels. It is a catarrhal condition, and the catarrh is the same as may exist elsewhere. There is congestion, and a greater or less amount of mucus secretions collect in the tubes and obstruct the flow of bile. The catarrh may result from excessive eating fol- lowed by indigestion, from using too much alcohol, may be caused by malaria, or may be the result of taking cold. Symptoms. The symptoms are nausea, loss of appetite, and slight fever. There may be diarrhea or constipation, usually the latter. There is a yellowish color to the skin, which also shows in the whites of the eyes. There may be more or less pain in the region of the stomach and bowels. The mind becomes dull and the patient is languid. The urine contains bile. Treatments. An active cathartic should be given at once, such as a single dose of calomel of five to ten grains. The patient should diet for a few days and secure an abundance of fresh air. After securing thorough action from the calomel, the patient should take one teaspoonful of phosphate of soda dissolved in one-half to two-thirds of a glass of water. This should be taken one hour before each meal. The dose may be increased or diminished as found necessary. This remedy has a special action on the liver, will relieve the congestion and insure increased activity along the whole digestive tract. Tonics may be needed for a few days. For this purpose give the following : Tinct. of gentian^ 1 drachm. Tinct. of columbo, 1 drachm. Elixir of calisaya bark, enough to make 2 ounces. Take one teaspoonful before meals. 276 MEDICAL AND SURGICAL EMERGENCIES. ENLARGED TONSILS. Sometimes the tonsils remain permanently enlarged. In this case it is better to have them removed. The operation is neither difficult nor painful. Until this is deemed necessary, either of the following may be used to advantage: Treatments. Chlorate of potash, \ teaspoonful. Sulphite of soda, 1-3 teaspoonful. Put into a glass and fill with warm water Gargle the throat thoroughly with a tablespoonful of this solution from three to five times a day. Also paint the tonsils once in two or three days with the tincture of iodine, using a small brush. To do this, take a spoon handle, or something of the kind, and press the tongue down so that the tonsils may be treated readily. Iodine, 2 drachms. Glycerine, 6 drachms. Mix and apply daily with a brush. BROKEN BREASTS. The mammary glands for the secretion of milk in the breasts -consists of ducts, ten or twelve in number each, called lactiferous, meaning milk-bearing. These ducts terminate externally at the nipple ; internally, they branch into minute tubes like the roots of a tree. After delivery the increased nutrition that nature had pre- viously secreted in the uterus is diverted to the mammary glands for the sustenance of the child. Cause. If it happens that there is an excess of secretion in the "breasts, the milk tubes become choked and distended with it. This may result in an inflammation of the glands, and in some cases the patient is subject to a sharp febrile attack, called milk fever. In- flammation may also result from checking the flow of the milk too early, from exposure, from mental disturbance, as worry, fright, or undue excitement; also from external injury or pressure from too tight clothing. Symptoms. Severe local pain, increased by pressure, is caused MEDICAL AND SURGICAL EMERGENCIES. 277 by the inflammation, and usually there will be found a hard swel- ling. The tendency is toward suppuration, the fever increasing with the formation of the abscess. If the abscess breaks the con- dition is known as "broken breast." Treatment. Hot poultices, or heat in some form is most excel- lent treatment and always safe. Cold is also valuable if applied early. The first real evidence of inflammation of the breast is the presence of one or more small hard lumps. If a thin sack of ice is laid over- the breast at this time and kept there, it will prove very effectual; in fact, applied early, it is the ideal treatment. There need be no fear about taking cold. A laxative should be given early. When poultices are used the applications must be thorough. Gradually increase the heat as long as can be borne. Change the poultices often, every five or ten minutes, depending upon the size. TOE-NAIL, INGROWING. This difficulty usually occurs on the great toe. In some cases it is very painful. In every case the condition is unpleasant and there is always more or less soreness and pain. Cause. The edge of the nail either grows down into the tissues, or the tissue grows up over the edge of the nail ; both conditions may be present. Treatment. Very many cases may be benefited and often cured by taking a sharp-pointed knife and, by repeated strokes along the border gradually cutting through the nail, removing a strip from one-sixteenth to one-eighth of an inch in width, and sometimes more. Where the nail grows down into the tissue it is not attached on either side, and by cutting through, the sliver of nail may be readily removed. This relieves the pressure, and for a time relieves the pain and soreness. If the trouble recurs, repeat the treatment. If successful the first time, it will be successful every time, and eventually the nail will stop growing in that direction. Some cases, however, need surgical treatment. Henry Finch, M. D., reports, through the British Medical Journal, a method which he has followed in numerous cases with uniform success. If a small, thin, flat piece of silver plate be bent at one edge into 278 MEDICAL AND SURGICAL EMERGENCIES. a slight, deep groove and, after the toe has been poulticed twenty- four hours, slipped beneath the edge of the nail so as to protect the flesh from its pressure, and the rest of the thin plate bent around the side and front of the toe, being kept in position with a small portion of adhesive plaster passed around the toe, a speedy and almost painless cure will take place ; and the patient, after the first day, is able to walk. PREPARATION OF BOTTLED MIUC From birth to the third or fourth month : Milk, fresh, 8 tablespoonfuls. Lime water, fresh, 2 tablespoonfuls. Water, boiled, 30 tablespoonfuls. Milk sugar, pure, 9 even teaspoonfuls. From the fourth to the ninth month : Milk, fresh, 16 tablespoonfuls. Lime water, fresh, 2 tablespoonfuls. Water, boiled, 22 tablespoonfuls. Milk sugar, 9 even teaspoonfuls. Amount to be given. Enough of either of these to last for the day should be placed in a clean bottle or fruit can, one that has been thoroughly scalded, the bottle or can placed upright in a ves- sel containing a few inches of water, and the water heated to the boiling point. The bottle should then be taken from the fire, cooled quickly and kept tightly corked in a cool place. The number of tablespoonfuls of the mixture put into the feeding bottle should be as follows : For the first week, 2 to 3 tablespoonfuls. Second to sixth week, 3 to 7 tablespoonfuls. Sixth to twelfth week, 8 to 9 tablespoonfuls. Third to sixth month, 8 to 12 tablespoonfuls. Sixth to ninth month, 12 to 18 tablespoonfuls. APHTHAE — THRUSH — CANKER SORE MOUTH. This is a disease of the mouth in which small vesicles appear. These vesicles may ulcerate. If ulceration takes place, it is called MEDICAL AND SURGICAL EMERGENCIES. 279 aphthae or thrush ; if ulcertion does not take place, it is spoken of as canker sore mouth. Causes. It is a disease of infancy and may follow a catarrhal condition of the stomach, or may result from a lack of cleanliness of the mouth. It may also be caused or influenced by indigestion and an unhealthy condition of the bowels. Also said to be caused by teething. Symptoms. The child may refuse to nurse, and small vesicles appear in the mouth — on the tongue, gums, lips and mucous mem- brane of the cheek. The vesicles are first of a light color. If ulcers form they are quite painful. There is no odor. The child may worry a good deal and in some cases is quite troublesome. Treatments. Regulate the stomach and bowels, give good ven- tilation, and wash the mouth with the following mixture : Borax, powdered, 1 drachm. Lloyd's hydrastis, 4 drachms. Glycerine, 2 drachms. Water enough to make 2 ounces. Apply this with a soft cloth several times a day. The child's mouth should also be washed with a little warm water after nursing. To regulate the bowels give the following mixture : Carbonate of soda, 1 drachm Wine of ipecac, I drachm. Fluid hydrastis, 6 drachms. Syrup of rhubarb, enough to make 4 ounces. Dose. Ten drops to one-half teaspoonful twice a day, according to age. The above is applicable either to the ulcerated or simple form. URINE, INCONTINENCE OE. This means an involuntary evacuation of the bladder, although it is generally understood to mean inability to retain the urine during sleep. This is a disease of childhood and is overcome with age, but may also be relieved by treatment. Causes. Phimosis (a long prepuce or foreskin), adhesions of 28o MEDICAL AND SURGICAL EMERGENCIES. the prepuce, intestinal worms, or oversensitiveness of the urethral tract. These and other causes are given, although in many cases there can be no cause discovered. Possibly some cases are due to a lack of development of the nerve fibres which supply the neck of the bladder, hence the constrictory muscle is not under proper con- trol. Or, this nerve supply might be oversensitive, hence the pres- sure resulting from a distended bladder would allow or cause an involuntary passage of the urine during sleep. Treatment. In the treatment of this trouble atropine has proven very successful. It is well to give a dose of santonine for one or two nights. If there are any worms present, it will remove them without trouble ; if there are none, it will do no harm. Santonine is a remedy used by some for this trouble whether caused by worms or not, and is even claimed to be successful where atropine fails. If atropine is used, it should be given in several small doses frequently repeated, commencing two or three hours before the child goes to bed ; or one large dose may be given. The small dose is preferable, as there would then be no danger of overdosing. For a child from five to ten years old, give 1-500 of a grain every hour until the pupil of the eye is well dilated, or until the face is flushed, and give at bed-time one grain of santonine and one grain of calo- mel. In some cases it is necessary to repeat the atropine for some days. If the two or three doses of atropine do not produce the symptoms mentioned, begin the treatment earlier the second day and continue until effect. RETENTION OF URINE. In most cases with infants, retention of urine may be overcome by giving liberally of a tea made of pumpkin or watermelon seeds. Sometimes the urethral tract in the new-born male child is not complete, i. e., does not reach the surface. In such a case the physician should make an artificial opening, being careful to have it meet the natural opening. VEGETARIANISM. An English physician in commenting on what we gain, from a health standpoint, by becoming vegetarians, makes the following statements : "We lose most stomach complaints, such as indigestion, ulcera- MEDICAL AND SURGICAL EMERGENCIES. 281 tion and cancer of this organ. I do not mean to say, that because you are a vegetarian you will lose all stomach complaints, but by adopting a non-flesh diet, the number of these complaints will be considerably lessened and their severity diminished. "Fish, flesh and fowl are almost entirely digested only in the stomach, therefore, any one who adopts a non-flesh diet will lessen the work of the stomach, and by so doing lessens the liability to diseases of this organ. "Rheumatism and gout are practically unknown to vegetarians and one who is subject to these diseases may overcome his trouble by adopting a proper non-flesh diet. "Hardness of the arteries and tendency to apoplexy are greatly lessened by vegetarian diet. "Obesity or stoutness is rare among vegetarians. Abnormal thinness is also unknown. This seems to be the rule, that the very stout are reduced in flesh and the very thin are brought up to a heavier standpoint. "Liver troubles are rare among vegetarians, such as biliousness, jaundice, enlarged liver, shrunken liver and gall stones. "Kidney complaints are uncommon, be they diabetes, albumin- uria, stone in the kidney or in the bladder. "Heart diseases are rare, such as valvular diseases, functional disorder, enlarged heart and tachycardia, which is known by the attacks of rapid beating of the heart. The heart of the vegetarian beats more slowly than that of the meat eater, and by this slow action the life of the vegetarian is prolonged. Dropsy and like troubles arising from the heart are also lessened. "Nerve diseases are less frequent in vegetarians than in meat eaters. The vegetarian is less nervous, less sleepless, less irritable, less excitable and worries less than the average meat eater. "Chorea, or St. Vitus' dance, is less often seen in vegetarian children than in those of meat-eating families. "Anemia is less common among vegetarians than in meat eaters. Some doctors say that the green vegetables and the pulse foods contain iron in a state that can be used by the blood, and so this complaint is kept away. "Goitre is not common in vegetarians. "Skin troubles are greatly lessened, but not entirely banished by a non-flesh diet. 282 MEDICAL AND SURGICAL EMERGENCIES. "Insanity is very uncommon among vegetarians. Drunkenness is practically unknown ; infectious diseases are milder in kind and of shorter duration than among meat eaters. "Cancer is all but unknown among vegetarians. The diet makes his teeth better, they last longer and he suffers less from neuralgia and toothache than flesh eaters. "In fact, a vegetarian diet and observance of health rules add from ten to fifteen years to a person's life." THE ERUPTIVE FEVERS. SCARLET-FEVER. Period of incubation, four to seven days or shorter. Mode of onset, sudden ; very often at night ; sore throat ; vomit- ing ; convulsions in severe cases ; high fever. Eruption appears, at the end of first or during the second day. Eruption fades in three to five days ; disappearing first where it first appears. Danger of contagion. So long as desquamation continues, or a purulent discharge from the ear or an abscess keeps up ; indefinitely in clothing, toys, books, etc;, which have not been disinfected. MEASLES. Period of incubation, eight to ten days. Mode of onset, rather sudden; catarrhal symptoms; moderate fever. Eruption appears fourth day; less commonly on third or fifth. Eruption fades, in about four days. Danger of contagion. So long as desquamation lasts. GERMAN OR FRENCH MEASLES. Period of incubation, two or three weeks. Mode of onset, gradual; fever slight and transient; sometimes absent. Eruption appears, the eruption usually the first symptom. Eruption fades, in about four to six days without desquama- tion. Danger of contagion. The duration of the liability to communi- cate the disease is not known. 283 284 MEDICAL AND SURGICAL EMERGENCIES. SMALLPOX. Period of incubation, ten to fourteen days. Mode of onset, sudden; chill; high fever; headache; pain in loins, etc. Eruption appears, on the third or fourth day ; typical evolution,, about the sixth day or the ninth of the disease characteristic pus- tules fully formed. Eruption fades, desiccation at end of second week ; crusts slowly separate, leaving marked and enduring cicatrices. Danger of contagion. So long as crusts reform ; indefinitely in fomites, etc. VARIOLOID (MODIFIED SMALLPOX). Period of incubation, ten to fourteen days. Mode of onset, sudden; chill; high fever; headache; pain hx loins, etc. Eruption appears, third or fourth day; typical evolution, about the sixth day or the ninth of the disease, characteristic pustules fully formed. Eruption fades, pocks do not go on to suppuration, but begin to dry up from the vesicular stage, that is, the sixth or eighth day of the disease. Danger of contagion. So long as crusts form ; indefinitely iti fomites, etc. CHICKEN-POX. Period of incubation, about two weeks. Mode of onset, sudden. Eruption appears, at once and often in successive crops. Eruption fades, in a few days; dessication, as a rule, without suppuration. Danger of contagion. Duration of danger of contagion ends with the shedding of the dried crusts. VERY VALUABLE PRESCRIPTIONS. The following will be found to be very valuable prescriptions for the diseases for which they are intended. They are selected from those in use in the leading hospitals of Great Britain and the United States and also from those used by the leading specialists and general practitioners: BRONCHITIS. ^ No. i. Morphine sulphate, one grain. Ammonia chloride, one drachm. Fluid extract grindelia robusta, four drachms. Syrup wild cherry, two drachms. Mixture licorice compound, two drachms. Teaspoonful for cough. Especially useful in acute bronchitis. ^ No. 2. Morphine sulphate, one grain. Chloral, one drachm. Syrup ginger, four drachms. Mixture licorice, one fluid ounce. Teaspoonful every half-hour until relieved. For spasmodic asthma. I£ No. 3. Cod-liver oil, two ounces. Sugar, six drachms. Acacia, four drachms. Oil gaultheria, fifteen minims. Water, to make four fluid ounces. Emulsion of cod-liver oil. Mix the sugar and acacia thoroughly vyith one-half the amount of water until a uniform mucilage is 285 286 MEDICAL AND SURGICAL EMERGENCIES. formed; then add the oil slowly, mixing constantly, and subse- quently add the remainder of the water. It requires about an hour to make the perfect emulsion, to which may be added lacto-phos- phate of calcium or phosphoric acid, which will give it an agree- able acidulous taste. tf No. 5. Morphine sulphate, one grain. Ammonia carbonate, thirty grains. Syrup wild cherry, four drachms. Mixture licorice compound, four drachms. Teaspoonful in water for cough. Very useful when opiates can be used. FOR CATARRH OF NOSE AND THROAT. 5 No. 6. Tincture aconite, one drachm. Tincture belladonna, two drachms. Three drops every hour. ^ No. 7. Cocaine muriate, six grains. Bismuth subcarb., one-half drachm. Talc, one and one-half drachms. Enough to cover a silver five cent piece insufflated into each nostril every two hours. ^ No. 8. Chloroform, two drachms. Glycerine, one ounce. Brandy, one ounce. One teaspoonful in water every three hours. ^ No. 9. Boracic acid, sixty grains. Glycerine, twenty minims. Water, six drachms. Dissolve with heat and saturate cotton-wool, a thin sheet, with MEDICAL AND SURGICAL EMERGENCIES. 287 the solution and dry. Pack the upper part of the nose with the prepared cotton, leaving a space below for breathing. ^ No. 10. Soda bicarbonate, one ounce. Insufflate, or apply with finger to inflamed tonsil. If No. n. Salicylate of soda, two drachms. Borax, three drachms. Glycerine, four drachms. Water, enough to make six ounces. A dessertspoonful in pint of water, used with spray or douche. ^ No. 12. Resorcin, five to ten grains. Distilled water, two ounces. Use with atomizer twice daily, four minutes each time. CATARRH OF BRONCHIAL TUBES AND LUNGS. I? No. 13. Ammonium chloride, three drachms. Mucilage acacia, four ounces. A tablespoonful four times daily. 3£ No. 14. Ammonia carbonate, thirty-two grains. Extract senega fluid, one drachm. Extract squills fluid, one drachm. Paregoric, six drachms. Water, four drachms. Syrup tolu, enough to make four ounces. A teaspoonful every three or four hours. If No. 15. Syrup tolu, one ounce. Syrup wild cherry, one ounce. Tinct. hyoscyamus, one ounce. 288 MEDICAL AND SURGICAL EMERGENCIES. Spts. ether compound, one ounce. Water, one ounce. A teaspoonful three times daily. ^ No. 16. Tincture opium, three drops. Whisky, one ounce. Boiling water, four ounces. White sugar. Take at bed-time. GARGLES. Gargles are useful only in diseases of the fauces. They cannot -affect the nasal passages, or the lower pharynx or larynx. The preparations may be sedative, astringent, stimulant or antiseptic. Sedative. ^ No. 17. Bromide of potassium, thirty grains to one fluid ounce water. ^ No. 18. Nitrate of potassium, twenty grains. Chlorate of potassium, twenty grains. Hot water, one fluid ounce. Use as hot as it can be borne, as a gargle four times a day. Astringents. ^ No. 19. Tannic acid, twelve grains to two drachms to one fluid ounce water. ^ No. 20. Alum, eight grains to one fluid ounce of water. 1J No. 21. Borate of soda, twenty-five grains. Glycerine, twenty-five minims. Tincture of myrrh, twenty-five minims. Water, one fluid ounce. MEDICAL AND SURGICAL EMERGENCIES. 289 Stimulants. 1J No. 22. Carbolic acid, two to ten grains to one fluid ounce of water. ^ No. 23. Chlorate of potassium, ten to twenty-five grains to one fluid ounce water. Antiseptics. I£ No. 24. Permanganate of potassium, two to four grains to one ounce water. VAPOR INHALATIONS. An inhaler which is commonly used consists of a glass flask "holding about a quart. This has a perforated cork through which two glass tubes are passed, one to the bottom of the flask to admit the air, and the other through which the patient inhales the vapor, into its upper part. In the absence of an inhaler an earthen tea-pot may be used. The inhalations are prepared by adding a teaspoonful of the medicated solution to a pint of water at a temperature of about 150 degrees E., or as indicated by the formula. They should be used morning and evening for about five minutes each time, six respirations taken each minute. The vapors may be sedative, anti- spasmodic, antiseptic or stimulant. Sedative. If No. 25. Tincture benzoin compound, one fluid drachm. ^ No. 26. Paregoric, one fluid drachm. Anti-spasmodics. ^ No. 27. Nitrate of amyl eight minims to one fluid ounce. 19 290 MEDICAL AND SURGICAL EMERGENCIES. Stimulant. ^ No. 28. Terebene, one drachm. More stimulating and also antiseptic. ^ No. 29. Creosote, forty minims to one fluid ounce. ^ No. 30. Carbolic acid, thirty grains. Chloride of ammonia, thirty grains. Glycerine, one drachm. Distilled water, one ounce. ^ No. 31. Tincture iodine compound, five minims. Glycerine, one drachm. Distilled water, seven drachms. SPRAY INHALATIONS. Spray inhalations are to be used by the physician or patient in full strength with the compressed-air atomizer; the aqueous solu- tions may be used in about double strength, by the steam atomizer. These applications are useful principally in treating diseases of the fauces and of the nasal cavities. The inhalations may be classified as sedatives, astringents and stimulants, hemostatics, and antiseptics. Sedatives. ^ No. 32. Bromide of potassium, twenty grains to one fluid ounce. ^ No. 33. Carbolic acid, two and one-half grains. Menthol, five grains. Liquid albolene, one ounce. MEDICAL AND SURGICAL EMERGENCIES. 291 Astringents and stimulants. ^ No. 34. Tannic acid, three grains to one fluid ounce. ^ No. 35. Sulphate of zinc, two to ten grains to one fluid ounce. ^ No. 36. Chloride of zinc, two to ten grains to one fluid ounce. ^ No. 37. Alum, ten grains to one fluid ounce. 9 No. 38. Morphine sulphate, four grains. Tannic acid, thirty grains. Carbolic acid, thirty grains. Glycerine, four drachms. Distilled water, four drachms. ^ No. 39. Carbolic acid, thirty minims. Borax, one drachm. Bicarbonate of soda, one drachm. Glycerine, three and one-half drachms. Water, enough to make four ounces. CATARRH OF INTESTINES. I£ No. 40. Liq. potass, arsenitis, one-half ounce. One or two drops before meals. I£ No. 41. Ext. hydrastis fid., one-half ounce. Five to fifteen drops before meals, in water. To be continued some time. IJ No. 42. Tinct. capsicum, six drachms. 292 MEDICAL AND SURGICAL EMERGENCIES. 5 No-43- Tinct. nux vomica, two drachms. Two drops every four hours. 5 No. 44. Tinct. opium, sixteen drops. ^ No. 45. Bismuth subnitrate, two drachms. ^ No. 46. Syrup, four drachms. ^ No. 47. Cinnamon water, one and one-half ounces. Shake bottle. Give one teaspoonful every two to four hours. For child one year old. ^ No. 48. Bismuth subnitrate, two drachms. Pulv. ipecac compound, nine grains. Divide into twelve powders. One every three hours for child one year old. CATARRH OF THE) BLADDER. 5 No. 49. Potassii citrate, one-half ounce. Spts. chloroformi, two and one-half drachms. Tinct. digitalis, eighty minims. Infus. buchu, eight ounces. Two tablespoonfuls three or four times daily. ^ No. 50. Copaiba, two drachms. Spts. lavand. co., two drachms. Mucil. acacia, one-half ounce. Syrupi simp., three drachms. Aquae, four ounces. A tablespoonful twice daily. MEDICAL AND SURGICAL EMERGENCIES. 293 ^ No. 51. Infus. buchu, seven ounces. Potassii bicarb., one drachm. Tinct. hyoscami, two and one-half drachms. Ext. sarsse. fl., four drachms. Two tablespoon fuls three times daily. (In irritable bladder with acid urine.) ^ No. 52. Fol. hyoscami, one-half ounce. Aq. bullientis, one pint. Make infusion. A tablespoonful every half-hour for one fore- noon, unless throat becomes dry or patient drowsy. CHOLERA INFANTUM. 9 No. 53. Tinct. cocae (1 to 5), one ounce. Four to six drops every two hours at three months of age. Fifteen to twenty drops in older children. ^ No. 54. Salol, six grains. Sacch. lactis, ten grains. Divide into twelve powders. A powder every two hours for a child of six months. ty No. 55. Hydrarg. chlorid. mit., three grains. Cretse praep., thirty-six grains. Plumb, acetat., twelve grains. Pulv. ipecac, three grains. Divide into twelve powders. One every three hours. ^ No. 56. Tinct. opium, sixteen drops. Aromatic spirits ammonia, one drachm. Bismuth, subnitrate, two drachms. Syrup, four drachms. Chalk mixture, one and one-half ounces. 294 MEDICAL AND SURGICAL EMERGENCIES. Shake well, give teaspoonful every two or three hours to child eight to twelve months old. ty No. 57. Potassium bromide, two drachms. Syrup, one-half ounce. Peppermint water, one and one-half ounces. A teaspoonful every hour or two. ^ No. 58. Castor oil, two drachms. Pulv. acacia, two drachms. White sugar, two drachms. Tincture opium, twenty-one minims. Cinnamon water, to make four ounces. A teaspoonful every two or three hours. couc. ty No. 59. Aromatic syrup rhubarb, one ounce. Tinct. cardamomi compound, one ounce. Paregoric, one ounce. Cinnamon water, one ounce. Two to four teaspoonfuls. ^ No. 60. Magnesia carbonate, forty-five grains. White sugar, one and one-half drachms. Tinct. asafetida, one and one-half drachms. Tinct. opium, one-half drachm. Water, one and one-half ounces. Five to sixty drops, according to age. In infantile colic. I£ No. 61. Tinct. opium, twelve drops. Magnesia calcinate, twelve to twenty- four grains. White sugar, one drachm. Anise water, one and one-half ounces. Shake well. One teaspoonful to a child one year old. MEDICAL AND SURGICAL EMERGENCIES. 295 ^ No. 62. Tinct. valerian, two and one-half drachms. Spirits ether, one drachm. Peppermint water, four and one-half ounces. Syrup orange, one and one-half ounces. Take half wineglassful. For an adult. RENAL CALCULI OR GRAVEL. ^ No. 63. Diluted nitric acid, three drachms. Diluted hydrochloric acid, three drachms. Syrup orange peel, one ounce. Distilled water, to make one pint. A wineglassful three or four times daily. If No. 64. Ammonia benzoate, two to three drachms. Syrup, one and one-half ounces. Water, six ounces. A tablespoonful two or three times daily. ^ No. 65. Strychnine, one grain. Diluted nitric acid, one drachm. Water, twelve ounces. Two tablespoonfuls three times daily. BILIARY CALCULI OR GALL STONES. If No. 66. Ether, three drachms. Oil turpentine, two drachms. A half teaspoonful on sugar every day, in the morning, gradu- ally increased to one teaspoonful and continued until about a pound is taken. 1^ No. 67. Olive oil, one pint. To be taken in divided doses before breakfast. 296 MEDICAL AND SURGICAL EMERGENCIES. ^ No. 68. Soda bicarbonate, five drachms. Divide into twenty powders. One powder three times daily for several months. ^ No. 69. Chloroform, two drachms. Oil cinnamon, eight drops. Spirits camphor, one and one-half drachms. Tinct. opium, one and one-half drachms. Spirits wine, three drachms. Five to thirty drops in sweetened water every hour or two. ^ No. 70. Soda phosphate, one-half ounce. Divide into twelve powders. One before each meal, continued for months. ^ No. 71. Magnesia carbonate, one drachm. Borax, two drachms. Citric acid, two drachms. Boiling water, eight ounces. A tablespoonful three or four times daily. I£ No. J2. Liquid potassse, two drachms. Infusi. buchu, eight ounces. Three tablespoonfuls an hour after meals. TONICS. 5 No - 73- Quinine sulphate, thirty grains. Diluted sulphuric acid, to make solution. Water, two ounces. Tincture iron, one-half ounce. Spirits chloroform, six drachms. Glycerine, four ounces. A teaspoonful three times daily. MEDICAL AND SURGICAL EMERGENCIES. 297 If No. 74. Iron and ammonia citrate, thirty-two grains. Ammonia chloride, thirty-two grains. Syrup, two ounces. Anise water, two ounces. A teaspoonful three times daily. If No. 75. Spirits chloroform, five drachms. Dil. hydrochloric acid, two and one-half drachms. Inf. cinchona, fifteen ounces. Two tablespoonfuls three times daily. If No. 76. Tinct. iron chloride. Syrup, one ounce. Cinnamon water, two ounces. A teaspoonful three times daily. If No. yy. Infusi. cocae sacch., fify drachms. Glycerine, five drachms. Ext. cinchona fM., seventy-five minims. Tinct. canella, one drachm. Tinct. vanilla, forty-five minims. Tinct. cascarilla, one-half drachm. A tablespoonful three times daily. DIARRHEA, CHILDREN. If No. 78. Pulv. ipecac, one-half grain. Pulv. rhubarb, two grains. Soda bicarbonate, twelve grains. Divide into twelve powders. One powder every four to six hours to an infant one year old. In indigestion with acidity. If No. 79. Tinct. opium, sixteen drops. Bismuth subnitrate, two drachms. 298 MEDICAL AND SURGICAL EMERGENCIES. Syrup, one-half ounce. Chalk mixture, one and one-half ounces. Shake well and give one teaspoonful every three or four hours, to a child one year old. If No. 80. Salol, six grains. Divide into twelve powders. A powder dry on tongue, followed by a sip of water, every two hours, to a child of six months. If No. 8i. Magnesia sulphate, one drachm. Tinct. rhubarb, one drachm. Syrup ginger, one drachm. Aquae carui, nine drachms. A teaspoonful three times daily to child one year old. ^ No. 82. Soda bromide, one-half drachm. Mucilage acacia, one ounce. . - - Water, one ounce. A teaspoonful every three hours for child less than one year old. DIARRHEA, ADUI/TS. ^ No. 83. Paregoric, one-half ounce. Spirits ether compound, one-half-ounce. Ext. valerian fid., one-half ounce. Oil peppermint, thirty drops. Spirits lavender co., to make four ounces. A teaspoonful every two or three hours. ^ No. 84. Morphine sulphate, one-half grain. Hydrarg. chlorid. mit., one grain. Pulv. camphorse, one scruple. Mucil. acacia, to form mass. Divide into twelve pills. A pill every two hours. MEDICAL AND SURGICAL EMERGENCIES. 299 ty No. 85. Ext. hematoxyli, one-half drachm. Tinct. opium, two minims. Water, two ounces. A dessertspoonful three or four times daily. ^ No. 86. Tannic acid, fifteen grains. Ext. krameria, one-half drachm. Syrup, to form mass. Divide into twenty pills. One to ten pills daily. 5 No. 87. Prepared chalk, two drachms. Tinct. catechu, one-half ounce. Tinct. opium, eighty minims. Cinnamon water, eight ounces. Two tablespoon fuls after each motion. ^ No. 88. Tannic acid, thirty-six grains. Pulv. opium, four grains. Divide into twelve pills. One pill every three or four hours. ^ No. 89. Aquae camphorse, three ounces. Spts. lavend. co., one ounce. Sacch. albi., one drachm. A tablespoonful every two hours. DROPSY. ^ No. 90. Vini colchici. sem., one-half ounce. Liq. ammonii acetat., two and one-half ounces. Infusi petroselini, five ounces. Teaspoonful every four hours. Especially adapted to scarletinal dropsy. 3 oo MEDICAL AND SURGICAL EMERGENCIES. ^ No. 91. Spirits chloroform, twenty minims. Tinct. digitalis, ten minims. Infusion buchu, one ounce. To be taken three or four times daily and followed by a good drink of water. In renal dropsy. ^ No. 92. Potassium bicarbonate, ten grains. Iron and ammonia citrate, five grains. Tinct. digitalis, ten minims. Infusion buchu, one ounce. To be taken three times daily. In cardiac dropsy with gouty tendency or debility. 9 No. 93. Pulv. digatilis, thirty grains. Iron sulphate exsiccat., fifteen grains. Pulv. capsicum, forty grains. Pil. aloe and myrrh, two drachms. Make sixty pills. One pill twice daily. In cardiac dropsy with flatulent dyspepsia and constipation. DYSMEN0RRH0EA ( PAINFUL MENSTRUATION). ^ No. 94. Potassium bromide, four drachms. Chloral hydrate, four drachms. Syrup, two ounces. Water, two ounces. Two tablespoonfuls to be used as an enema, as required, for pain. 5 No - 95- Antipyrin, two drachms. Syrup tolu, two ounces. Two teaspoonfuls at first; one teaspoonful every hour or two afterward until pain is relieved. MEDICAL AND SURGICAL EMERGENCIES. 301 If No. 96. Tinct. Pulsatilla root, one-half ounce. Two or three drops every two hours for ten days preceding the period. If No. 97. Liq. ammonia acetat., four ounces. A tablespoonful every two or three hours with the following : Pulv. ipecac, four grains. Make twelve pills. One every two or three hours. DYSPEPSIA. If No. 98. Soda sulpho-carbolate, four drachms. Glycerine, two ounces. Infusion quassia, six ounces. A tablespoonful before meals. In flatulent dyspepsia. If No. 99. Bismuth subnitrate, four scruples. Mucilage acacia, one ounce. Soda bicarbonate, four scruples. Infusion columbo, eight ounces. Two tablespoonfuls before meals. Irritative dyspepsia with malnutrition and raw tongue. ^ No. 100. Tinct. capsicum, sixteen minims. Tinct. nux vomica, two drachms. Tinct. gentian compound, two ounces. A teaspoonful in water three times daily, with grain 1-5 aloin at l)ed-time, avoiding starchy diet. For aggravated dyspepsia with constipation. IJ No. 101. Bismuth subnitrate, one drachm. Soda bicarb., one drachm. 302 MEDICAL AND SURGICAL EMERGENCIES. Pulv. cubebs, one drachm. Pulv. ginger, one scruple. Make twelve powders. A powder in wineglassf ul water before each meal. ^ No. 102. Tinct. opium, twelve drops. Magnesia calcinate, twelve to twenty-four grains. White sugar, one drachm. Anise water, one and one-half ounces. Shake bottle. One teaspoonful every two hours to a child one year old until relieved. If much pain add a little chloroform or Hoffman's Anodyne to the mixture. INFLAMMATION OF THE BOWELS. 3J No. 103. Tinct. opium, one ounce. Ten drops every second or third hour, according to age, to the point of tolerance. I£ No. 104. Liq. potassii arsenitis, fifty drops. Tinct. opium, one hundred twenty drops. Water, three ounces. A teaspoonful before meals three times a day. In chronic form especially when malarial. ^ No. 105. Castor oil, one drachm. Pulv. acacia, one and one-half scruples. White sugar, one and one-half scruples. Tinct. opium, three minims. Cinnamon water, eleven drachms. A teaspoonful every four hours for a child of one year. IJ No. 106. Pulv. opium, five grains. Bismuth subnitrate, two drachms. Make twenty powders. A powder every two to four hours for child of five. MEDICAL AND SURGICAL EMERGENCIES. 303 EPILEPSY. If No. 107. Potassium bromide, one ounce. Ammonia bromide, one ounce. Ergot, fid. ext., one-half ounce. Water, to make four ounces. One teaspoonful, thrice daily. When maniacal excitement follows the attack, or cerebral congestion or hemorrhage if feared. If No. 108. Iron bromide, four grains. Potassium bromide, one ounce. Syrup, six ounces. Water, eight ounces. A teaspoonful twice daily. For anemic patients. ^ No. 109. Ext. conii fid. (Squibbs), two ounces. Fifteen to sixty drops, not over three times a day. IJ No. no. Nickel bromide, sixteen grains. Distilled water, two ounces. A teaspoonful several times daily, according to tolerance. If No. in. Acetanilid (antifebrine), one drachm. Spts. vini gallici, one ounce. Syrup, two and one-half ounces. A teaspoonful two or three times daily. CARBUNCLE. If No. 112. Resorcin, one drachm. Lanolin, one ounce. Ointment. Apply after making multiple, parallel incisions into carbuncle. 304 MEDICAL AND SURGICAL EMERGENCIES. If No. 113. Calcium sulphide, three grains. Ext. licorice, to make a mass. Divide into thirty pills. One pill every hour or two. ^ No. 114. Tinct. muriate iron, one ounce. Potassium chlorate, one drachm. Glycerine, one ounce. Water, four ounces. A teaspoonful in a wineglassful of w^ter every two hours. ^ No. 115. Nitrate of silver, four scruples. Distilled water, four drachms. To be applied two or three times on the inflamed surface, and beyond it on the healthy skin, to the extent of two or three inches. ^ No. 116. Linseed meal. Boiling water. Make poultice. Apply hot as bearable, cover with oil-silk, and renew when cool or dry at edges. CHIIvBIvAINS. The following prescriptions to be applied externally. I£ No. 117. Carbolic acid, ten grains. Cosmoline, one ounce. Oil turpentine, one ounce. Apply to affected part. ^ No. 118. Chloroform linament, two ounces. Apply with gentle friction. If No. 119. Tinct. iodine, one ounce. Apply with brush. MEDICAL AND SURGICAL EMERGENCIES. 305 SELECTED PRESCRIPTIONS. Acute Nasal Catarrh. Carbolic acid, eight minims. Ichthyol, one drachm. Dilute alcohol, two and one-half drachms. Distilled water enough to make three ounces. Use as a spray, by means of atomizer, two or three times a day. Bromoform Emulsion. Bromoform, one-half drachm. Tolu tincture, one drachm. Acacia mucilage, two drachms. Syrup, four drachms. Spearmint water enough to make two ounces. Place the mucilage in a bottle, and add an equal volume of syrup, then add the bromoform and tolu tincture in portions, shaking well after each addition. A thin emulsion results, to which the rest of the syrup and the mint-water are to be added with agitation. Take a teaspoonful four times a day. Expectorant. Tar oil, fifteen minims. Horehound extract, one-half drachm. Anise oil, one minim. Whisky, one ounce. Clarified honey enough to make two ounces. One-half to one teaspoonful several times a day. Influenza. Quinine salicylate, three grains. Phenacetin, two and one-fourth grains. Camphor, two to five grains. Six of such doses in twenty-four hours. Cough Syrup — Prize Formula. Codein, one hundred grains. Benzoic acid, two drachms. 20 306 MEDICAL AND SURGICAL EMERGENCIES. Chloroform, five drachms. Peppermint oil, one drachm. Fl. ext. ipecac, six and one-half drachms. Fl. ext. tolu, three ounces. Fl. ext. licorice, one and one-half ounces. Fl. ext. wild cherry, two and one-half ounces. Glycerine, two ounces. Tar water, saturated, fifteen ounces. Alcohol, twenty ounces. Distilled water, two and one-half pints. Sugar, four pounds. Caramel, q. s. Dissolve benzoic acid and oil in alcohol, and mix with other ingredients except the sugar, chloroform and codein, and let stand twenty- four hours ; filter and dissolve codein and chloroform in filtrate which pass through a percolator containing the sugar, and add water sufficient to make one gallon. Take dessertspoonful every three hours. Flatulence. Creosote, ten minims. Bismuth subcarbonate, two drachms. Glycerine, one ounce. Peppermint water, one ounce. One teaspoonful every three or four hours; or Saccharin, one drachm. Pulv. wood charcoal, two drachms. Bismuth subnitrate, two drachms. Divide into twelve powders. One powder to be taken half an hour before each meal. Family Liniment — Prize Formula. Camphor spirit, one ounce. Opium tincture, one ounce. Chloroform, four drachms. Ammonia spirit, four drachms. Peppermint spirit, four drachms. Capsicum tinct., four drachms. MEDICAL AND SURGICAL EMERGENCIES. 307 Sassafras oil, four drachms. Alcohol enough to make thirty-two ounces. For use externally as liniment. Diabetes Mellitus. (Sugar in urine.) Dried eucalyptus flowers, four drachms. Water, six ounces. Make an infusion. One such draught to be taken twice daily. Shampoo Jelly. White castile soap, four ounces. Hot water, sixteen ounces. Glycerine, four ounces. Lavender oil. Bergamot oil. Massage Cream. White wax, one-half ounce. Spermaceti, one-half ounce. Cocoanut oil, one ounce. Lanolin, one ounce. Oil of sweet almonds, two ounces. Melt in a porcelain dish, remove from the fire and add : Orange-flower water, one ounce. Tincture of benzoin, three drops. Mumps. Sulphate of magnesia, four drachms. Water, four ounces. Antimony and potassium tartrate, one grain. Sweet spirits of nitre, three drachms. Sugar, six drachms. A teaspoonful every three hours, after the bowels have been well moved. With flaxseed poultices locally. The following formulas are given as being practically the same as those contained in the so-called patent or secret formulas having an extensive sale : 308 MEDICAL AND SURGICAL EMERGENCIES. Allen's Lung Balsam. Blood root, tincture of, two ounces. Lobelia, tincture of, two ounces. Opium, tincture of, one ounce. Capsicum, tincture of, three drachms. Sassafras, essence of, two drachms. Anise, essence of, two drachms. New Orleans molasses, one pint. Bring the syrup to a boil, add slowly the other ingredients and mix. Ayer's Cherry Pectoral. Acetate morphine, three grains. Bloodroot, tincture of, two drachms. Antimony, wine of, three drachms. Ipecac, wine of, three drachms. Wild cherry, syrup of, three ounces. Mix together. Ayer's Hair Vigor. Lead, sugar of, three drachms. Sulphur, flour of, two drachms. Glycerine, fourteen drachms. Water, five pints. Ayer's Sarsaparilla. Sarsaparilla, fid. ext. of, three ounces. Stillingia, fid. ext. of, three ounces. Yellow dock, fid. ext. of, two ounces. Mayapple, fld. ext. of, two ounces. Sugar, one ounce. Potash, iodide of, ninety grains. Iron, iodide of, ten grains. Mix together. Parke-Davis' Uterine Tonic. Each pill contains : Viburnum prunifolium, one grain. Viburnum opulus, one grain. Star grass, one-half grain. MEDICAL AND SURGICAL EMERGENCIES. 309 Helonias, one-half grain. Squaw vine, one-half grain. Caulophyllum, one-quarter grain. Take one three or four times a day whenever there is head- ache, backache, and a dull pain and feeling of weight in the pelvic organs. Warner's Safe Kidney and Liver Cure. Lycopus virgin (the herb), extract of, three hundred and eight grains. Hepatica, extract of, two hundred thirty-two grains. Wintergreen, extract of, seven and one-half grains. Saltpetre, thirty-nine grains. Alcohol, two and one-half grains. Glycerine, ten drachms. Water sufficient to make one pint. Mix all together, and let stand for one week. Filter if neces- sary. Winslow's Soothing Syrup. Morphine, sulphate of, one-half grain. Soda, carbonate of, one grain. Simple syrup, one and one-half ounces. Pure water, one-half ounce. Fennel, spirits of, one drachm. Syrup of Figs. Senna leaves, one and three-quarter ounces. Coriander seed, six drachms. Figs, three ounces. Tamarind, two ounces. Cinnamon bark, two ounces. Prunes, one and one-half ounces. Licorice, extract of, one and one-half drachms. Peppermint, essence of, one and one-half drachms. Simple syrup, one pint. Thompson's Eye Water. Zinc, sulphate of, five grains. Copper, sulphate of, one and one-quarter grains. 310 MEDICAL AND SURGICAL EMERGENCIES. Saffron, tincture of, one-half drachm. Camphor, tincture of, fifteen drops. Rosewater, two ounces. Pure water, two ounces. Mix together and filter through filtering paper kept by drug- gists. Buckley's Uterine Tonic. Each pill contains : Helonin, one-sixth grain. Caulophyllum, one-sixth grain. Macrotin, one-sixth grain. Hyoscyamin amorphus, one-two-hundred-fiftieth grain. Take one pill every three hours, or four times a day. If the throat becomes dry, or the face flushed, it is evidence that the dose should be lessened. If these symptoms do not appear, the amount can be increased if desired. This prescription gives most satisfactory results, and has been used by many noted physicians. Beecham's Pills. Saffron, one grain. Sodium, sulphate of, one grain. Rhubarb, four grains. Aloes, twenty grains. Mix, and make into three-grain pills. Boscheen's German Syrup. Tar, oil of, one drachm. Ipecac, fluid extract of, one-half ounce. Wild cherry, fluid extract of, six drachms. Opium, tincture of, four drachms. Magnesia, carbonate of, three drachms. Water, six ounces. White sugar, ten ounces. Mix the magnesia first with the oil of tar, add the fluid ex- tracts, mix thoroughly, then add the tincture of opium and water. Filter and form a solution with the sugar by shaking the bottle. MEDICAL AND SURGICAL EMERGENCIES. 311 Brandreth's Pills. Aloes, four ounces. Colocynth, extract of, four drachms. Gamboge, two ounces. Castile soap, one ounce. Oil of peppermint, twenty drops. Cinnamon, seven drops. Mix and form into pills. Brown's Bronchial Troches. Licorice, extract of, pulverized, one pound. Sugar, pulverized, one and one-half pounds. Cubebs, pulverized, four ounces. Gum arabic, pulverized, four ounces. Conium, extract of, pulverized, one ounce. Mix. Bucklen's Arnica Salve. Arnica, extract of, one ounce. Resin cerate, eight ounces. Vaseline, two ounces. Seedless raisins, eight ounces. Fine-cut tobacco, one-half ounce. Water, a sufficient quantity. Boil the raisins and tobacco in one pint of water until the strength is extracted, press out the liquid and evaporate to four ounces. Soften the extract of arnica with a little hot water and mix the liquid with it. Add this to the cerate and vaseline, pre- viously warmed, and mix all thoroughly. Bull's Cough Syrup. Morphine, sulphate of, three-fourths grain. Granulated sugar, two drachms. Syrup, three ounces. Mix together. Carter's Little Liver Pills. Podophyllin, two and a half grains. 312 MEDICAL AND SURGICAL EMERGENCIES. Ground aloes, three grains. Gum arabic, mucilage of, enough to make a soft mass. Divide into twelve pills and coat with sugar. Take at bed-time one or more as needed. Castoria. Senna, four drachms. Manna, one ounce. Rochelle salts, one ounce. Fennel seed, bruised, one and a half drachms. Boiling water, eight ounces. Sugar, eight ounces. Oil of wintergreen, enough to flavor. Pour the water on the ingredients. Cover and macerate until cool. Strain; add sugar and oil of wintergreen. Cuticura Ointment. The much advertised Cuticura Ointment has been found to consist of a base of petroleum jelly, colored green, perfumed with oil of bergamot and containing two per cent, of carbolic acid, or nine drops to the ounce. Cuticura Resolvent. Aloes socot., one drachm. Rhubarb, powdered, one drachm. Iodide potassium, thirty-six grains. Whisky, one pint. Macerate over night and filter. Davis' (Perry) Pain Killer. Guaiacum, powdered, two and one-half ounces. Camphor, two drachms. Cayenne pepper, powdered, six drachms. Caustic liquor of ammonia, one drachm. Opium, powdered, one-half drachm. Digest these ingredients in one quart of alcohol for two weeks and filter. Fellow's Hypophosphites. Glucose (grape sugar), one pound. MEDICAL AND SURGICAL EMERGENCIES. 313 Lemon, syrup of, one pint. Calcium, hypophosphites of, one hundred twenty-eight grains. Potash, hypophosphites of, forty-eight grains. Iron, sulphate of, forty-eight grains. Magnesia, sulphate of, thirty-two grains. Strychnine, sulphate of, two grains. Quinine, sulphate of, fourteen grains. Dissolve the calcium and potassium hypophosphites in two ounces warm water. Add to one ounce water, three ounces syrup ; dissolve in mixture by aid of heat, the sulphates. Mix the solu- tions and set by a few hours covered. Filter into bottle contain- ing remainder of syrup, wash the residue with an ounce of boil- ing water and mix filtrate and washings with the syrup. Dis- solve the glucose in the mixture and add through the filter enough water to make two pints. Green Mountain Salve. Resin, ten ounces. Burgundy pitch, four drachms. Beeswax, four drachms. Mutton tallow, four drachms. Oil hemlock, one drachm. Balsam fir, one drachm. Oil origanum, one drachm. Oil red cedar, one drachm. Venice turpentine, one drachm. Oil wormwood, one-half drachm. Verdigris, powdered, one drachm. Melt the first articles together and add the oils. Rub up the verdigris with a little oil, put it in with the other articles, stir well, and then put the basin containing the mixture into a larger vessel of cold water, and work with the hands until cold enough to roll. Greene's Nervura. Cinchona, tincture of, five ounces. Damiana, tincture of, five ounces. Cocoa, tincture of, five ounces. Mix. 3 i4 MEDICAL AND SURGICAL EMERGENCIES. Green's August Flower. Rhubarb, three hundred sixty grains. Golden seal, ninety grains. Cape aloes, sixteen grains. Peppermint leaves, one hundred twenty grains. Potash, carbonate of, one hundred twenty grains. Capsicum, five grains. Sugar, five ounces. Alcohol, three ounces. Water, ten ounces. Peppermint, essence of, twenty drops. Powder the drugs and macerate in- the mixed alcohol and water for seven days; filter, and add enough diluted alcohol to make the whole measure one pint. Haarlem Oil. Sulphur, two ounces. Linseed oil, one pound. Amber, oil of, two ounces. Boil the sulphur and linseed oil on a slow fire until the sulphur is dissolved. When somewhat cooled take the oil of amber and enough oil of turpentine to bring the preparation to the con- sistence of molasses. Hop Bitters. Hops, tincture of, one-half ounce. Buchu, tincture of, three drachms. Senega, tincture of, three drachms. Podophyllin (dissolved in spirits of wine), ten grains. Cochineal, tincture of, twenty drops. Distilled water sufficient to make one pint. Mix. Hostetter's Bitters. Sugar, one ounce. Sweet flag root, one ounce. Orange peel, one ounce. Peruvian bark, one ounce. Gentian root, one ounce. Columbo root, one ounce. Rhubarb, two drachms. MEDICAL AND SURGICAL EMERGENCIES. 315 Cinnamon, one drachm. Cloves, one-half drachm. Diluted alcohol, one pint. Hunyadi Janos Water. Lime, sulphate of, seventy-two grains. Glauber salts, two and one-half ounces. Epsom salts, two and one-half ounces. Potash, sulphate of, six grains. Water, eight pints. Mix together and charge with gas if desired. Dose, one-half glassful more or less. This is an active cathartic. Liebig's Corn Cure. Indian hemp, extract of, five drachms. Salicylic acid, four ounces. Collodion, one-half ounce. Mix until dissolved. Apply with camel hair brush four con- secutive nights and mornings. Lydia Pinkham's Vegetable Compound. Cramp bark, four ounces. Partridge berry vine, four ounces. Poplar bark, two ounces. Unicorn root, two ounces. Cassia, two ounces. Beth root, one and one-half ounces. Sugar, one and one-half pounds. Alcohol, one pint. Water a sufficient quantity. The drugs should all be reduced to a moderately coarse pow- der. Pour on boiling water, let stand until cold, then percolate with water until the percolate measures one pint; add the sugar, bring to a boil. When cold add the alcohol and strain. One or two teaspoonfuls three or four times a day. Orange Blossom. Zinc, sulphate of, one drachm. Alum, fifteen grains. Cocoa butter, three drachms. 316 MEDICAL AND SURGICAL EMERGENCIES. White wax, one-half drachm. Sweet almonds, oil of, one and one-half drachms. Henbane, extract of, one grain. Paine's Celery Compound. Celery seed, two ounces. Red cinchona, one ounce. Orange peel, one-quarter ounce. Coriander seed, one-quarter ounce. Lemon peel, one-quarter ounce. Hydrochloric acid, fifteen drops. Alcohol, five ounces. v Glycerine, three ounces. Water, four ounces. Syrup, four ounces. Grind the solids to moderately coarse powder (No. 40), mix the acid and water, add glycerine and alcohol, and in the men- struum so prepared macerate the powder for twenty-four hours. Then percolate, adding enough water and alcohol in the propor- tion to make twelve fluid ounces. Finally add the syrup and if necessary, filter. Peruna. Copaiba, six drachms. Cubebs, two drachms. Calisaya bark, ground, two ounces. Stone root (collinsonia), ground, two ounces. Corydalis (Turkey corn), ground, two ounces. Deodorized alcohol, one pint. Add all the ingredients to the alcohol. Let stand one week. Shake the bottle frequently, finally strain or filter. Pettit's Eye Salve. Olive oil, four drachms. Spermaceti, one and one-half drachms. White wax, one-half drachm. Melt together and add gradually in a warm mortar the follow- ing in fine powder and thoroughly mix, stirring briskly while adding : MEDICAL AND SURGICAL EMERGENCIES. 317 Zinc, oxide of, thirty grains. White precipitate, twenty grains. Benzoic acid, two grains. Morphine, sulphate of, three-quarter grain. Rosemary, oil of, one-half grain. Stir until cool and keep in a well-covered vessel. Pierce's Favorite Prescription. Savin, one hundred fifty grains. Cinchona, one hundred fifty grains. Agaric, seventy-five grains. Cinnamon, seventy-five grains. Water sufficient to make eight ounces. To this add the following : Acacia, one hundred fifty grains. Sugar, seventy-five grains. Digitalis, tincture of, one-half drachm. Opium, one-half drachm. Anise, oil of, eight drops. Dissolve the gum and sugar in the strained decoction and add : Alcohol (in which the oil has previously been dissolved), two ounces. Pierce's Golden Medical Discovery. Cinchona, fluid extract of, sixteen ounces. Columbo, fluid extract of, four ounces. Guaiac, fluid extract of, eight ounces. Licorice, fluid extract of, four ounces. Opium, tincture of, one ounce. Podophyllin (resinoid), one hundred twenty grains. Glycerine, six pints. Alcohol enough to dissolve the podophyllin. Mix all together. One teaspoon ful from two to four times a