cold water in the face and on the chest; keep up the warmth of the
body, and apply mustard plaisters over the heart and round the
ankles. If these means fail, without loss of time try artificial
respiration, as already described.
Before entering a suffocating atmosphere to rescue persons, tie a
towel soaked in vinegar and water over the mouth. Admit fresh air to
the room if possible.
_Fits, Fainting, and Unconsciousness._--These bear a strong outward
resemblance to each other while due to very different causes. The
latter are principally: (_a_) injuries to the brain, with or without
fractures of the skull; (_b_) diseases of the brain (including
fits), apoplexy, epilepsy, &c.; (_c_) poisoning by narcotics and by
retention of urine (in kidney disease); (_d_) fainting (paralysis of
the heart through fright, exhaustion, loss of blood, &c.).
In such cases gather a history of the occurrence, and note the
position of the body and its surroundings; also whether the breath
smells of spirits, which shows there has been drinking, but remember
that other and more serious conditions (paralysis, injury to the
brain, &c.) may co-exist with intoxication. Lay the body on the
back, with the head low if the face is pale, as in faintness after
great loss of blood. If the face is red, the head must be raised.
If sickness sets in, incline the head at once, so that the vomited
matters may not be drawn into the lungs. Undo all clothing round the
neck. Allow free circulation of air round the patient. Remove the
patient as quickly as possible to the nearest hospital or doctor on a
stretcher.
In epileptic fits, recognised by convulsive spasms of the limbs
and body, contorted and congested face, foaming at the mouth, and
bitten tongue, act on the rules just mentioned, and do all in your
power to prevent the patient injuring himself, without attempting
to restrain his movements. Lay something soft under his head, put
something between the teeth, watch till the fit is over, and then
remove him. In cases of fainting at once lay the patient flat, with
the head brought to the same level as the body, to enable the blood
more easily to circulate through the brain, for it is want of power
in the heart to propel the blood to the brain that has caused the
insensibility. If bleeding is going on, it must at once be arrested.
As stimulants, eau de Cologne, sal volatile, ammonia, &c., may be
used, but the important thing to remember is the position of head
and body. Stimulation is apt to start afresh the bleeding arrested
by fainting. In cases of snoring, with face flushed (apoplexy), undo
clothing round the neck, keep the head raised, dash cold water on the
top of the head, and apply hot-water bottles to the feet; send for
doctor; do not give brandy.
_Frostbite._--In serious frostbite or cases of exposure to intense
cold, endeavours to restore life should be made with the greatest
care. If you bring the patient suddenly into a warm room, death will
follow certainly. Carry him carefully into a closed but cold room,
and undress him with care for fear of breaking the stiffened limbs.
If snow is to be had, cover and vigorously rub the whole body with
it. If not, cover and rub with cold wet cloths or cold sand, or put
him into a cold bath. Alternately with this try artificial means
to restore breathing (as in drowning). When the patient begins to
breathe naturally, and the limbs become less stiff, he should be
carried into a moderately warm room and covered lightly with cold
coverings and sheets. After this, he may be rubbed by degrees with
warm cloths, and the warmth of the room gradually increased. Then
try by means of smelling-salts, ammonia, or ether, and slightly
stimulating drinks, such as light cold wine, cold coffee or soup,
to recall consciousness. Should any part of the body remain without
sensation, blue, swollen, or blistered, there is great danger of
mortification setting in.
For after consequences, which recur most frequently in cold weather,
apply balsam of copaiba, spread thickly on a piece of linen or
muslin, the affected parts being covered with the application, which
is allowed to remain over the night. By day, some of the balsam is
to be spread over the affected parts. After one or two applications
the pains cease and the redness disappears; whilst a few additional
applications seem to give to the parts a power of resistance to
frostbite.
Dr. Lapatin advises that fingers and toes which have been slightly
frost-bitten, and which subsequently suffer from burning, itching,
and pricking sensations, should be painted, at first once, and
afterwards twice a day, with a mixture of dilute nitric acid, and
peppermint water in equal proportions. After this application has
been made for 3-4 days, the skin becomes darkened and the epidermis
is shed, healthy skin appearing under it. The cure is effected in
10-14 days.
The members of the Austro-Hungarian Polar Expedition found most
benefit from a mixture of iodine and collodion.
_Lightning Stroke._--Apply cold to the head, and, if necessary,
warmth to the extremities; rub the limbs well, and give stimulants as
soon as the patient can swallow.
_Poisons._--In all cases of poisoning, at once note the position
and surroundings of the patient, and whether bottles likely to
have contained poison are at hand. Send for the nearest doctor,
and proceed immediately to get the poison out of the stomach by
encouraging vomiting. Vomiting is often one of the first and most
important signs of poisoning, and then only requires fostering by
large draughts of warm water. If vomiting is not present, at once
administer an emetic, such as sulphate of zinc in 20-30 gr. doses,
2 tablespoonfuls ipecacuanha wine mixed with warm water. In the
absence of these, resort to mustard and water, a teaspoonful or two
in warm water frequently repeated, or common salt and water may
be used; vomiting may also be excited by tickling the back of the
throat, and by freely drinking hot greasy water. A stomach pump must
only be used by a surgeon; but a safe substitute, if the patient is
conscious, is a piece of rubber tubing, about 3 yd. long and ½ in.
diameter. Let the patient swallow about 2 ft. of this, then hold
the free end of the tube above his head (Fig. 125) and pour down
through a funnel 1-2 pints warm water, which will go direct into the
stomach. By lowering the free end (Fig. 126) the stomach empties
itself readily. By frequent repetition the cavity of the stomach is
completely washed out.
[Illustration: 125. 126. Stomach-tube.]
Try to ascertain what the poison is, and proceed to administer
antidotes. Most poisons may be grouped under two classes--narcotic
and irritant; the former being mainly organic (vegetable) substances,
and the latter chiefly minerals. In narcotic poisoning, vomiting
must be induced or the stomach emptied in some other way, and means
must be taken to prevent sleep ensuing, by walking the patient
about, slapping with wet towels, dashing cold water in the face,
&c.; give strong black coffee to drink (or with an enema); put icy
cold compresses on the head, and mustard plaisters on the stomach
and calves of the legs. In irritant poisoning, the poison itself is
pretty sure to cause vomiting, which then need not be encouraged. To
protect the stomach and gullet from the corrosive action of irritant
poisons, bland and oily fluids, such as salad oil, egg-white, milk,
flour and water, should be freely administered.
The following summary of poisons and antidotes will be found useful:--
NARCOTIC POISONS.
_Poison._ _Antidote._
Aconite, monkshood emetics; warmth; rub the skin.
Alcohol, alcoholic drinks emetics; cold douche; keep awake.
Belladonna, deadly nightshade emetics; strong coffee; hot and cold
douches alternately; artificial
respiration.
Chloral hydrate emetics; strong coffee enema; hot
blankets, and water bottle to feet;
artificial respiration; keep awake.
Chloroform fresh air and artificial respiration;
hot and cold douche.
Cyanide of potassium, prussic emetics; stimulants; cold and hot
acid, laurel water, essential douche; artificial respiration.
oil of almonds, benzol.
Ether as chloroform.
Fool’s parsley brandy; strong tea; warm
applications to extremities.
Foxglove emetics; stimulants; prolonged
recumbence.
Hemlock emetics; strong tea; warmth and
rubbing; artificial respiration.
Henbane a large spoonful of animal charcoal,
emetics 10 minutes later, then
brandy or coffee; keep awake.
Laburnum pods or seeds 5-6 gr. zinc sulphate as an emetic.
Meadow saffron brandy; strong tea; warm mucilaginous
drinks.
Mushrooms emetics; stimulants; warmth and
rubbing.
Opium, chlorodyne, Godfrey’s emetics; hot coffee; cold douche;
cordial, poppies, keep awake; artificial respiration.
soothing syrups.
Poison ivy {on the body} apply a weak solution of sugar of
Poison dogwood {on the body} lead.
Spurge laurel, mezereum brandy and warm mucilaginous drinks.
Strychnine, vermin-killers emetics; chloroform in an inhaler.
Yew berries emetics; brandy; warmth to extremities
recumbent position.
IRRITANT POISONS.
Acid--carbolic, creosote. emetics; lime-water; salad oil;
coffee.
Acid--oxalic, potassium oxalate, water containing chalk or whiting,
salt of sorrel, salt of lemon. but not ammonia, potash, or soda.
Acids--acetic, hydrochloric, abundance of water containing chalk,
nitric, sulphuric; magnesia, sal-volatile, washing
spirit of salt. soda, or whiting; egg-white, milk,
thick gruel.
Alkalies--ammonia, potash, water containing lemon-juice or
soda. vinegar; salad oil, milk, egg-white,
gruel.
Antimony, tartar emetic emetic if needed; plenty of strong
coffee; egg-white, milk.
Arsenic, emerald green, emetics; magnesia; warmth and friction;
fly paper strong coffee; best antidote is moist
peroxide of iron, which can be made
by dissolving ½ oz. iron sulphate and
½ oz. potash carbonate (or ¾ oz. soda
carbonate) separately in warm water
and mixing, adding ¼ oz. magnesia--
calcined if handy--dilute with ½ pint
hot water, and drink very hot.
Bichromate of potash emetics; magnesia, chalk, or whiting.
Blistering fluid emetics; egg-white, barley water,
gruel; not oil.
Bluestone emetic if needed; milk, eggs, barley
water, gruel.
Caustic, nitrate of silver abundance of salt in water or milk,
egg-white, barley water.
Chloride of mercury, emetic if needed; raw egg beaten up
in milk,
corrosive sublimate gruel, arrowroot; strong coffee.
Iodine emetics; plenty of gruel, arrowroot
or starch.
Phosphorus, matches, rat poison emetics; 10 drops oil of turpentine,
every ¼ hour in gruel or milk with
a little magnesia; egg-white,
barley water.
Pyrogallol emetics.
Sugar of lead, paint emetics, zinc sulphate best; ½ oz.
Epsom salts in water; egg-white,
milk, barley water.
Turpentine, furniture polish emetics; milk, egg-white, barley water.
White precipitate emetics; coffee; egg-white beaten up
in water, barley water, arrowroot.
_Sprains._--A sprain is a sudden forcible stretching of the tendons
or ligaments, or both combined, of a joint, and is always accompanied
by most acute pain, and generally followed by rapid swelling. It
is always tedious and troublesome, and hence often leads to more
serious results; in all but very slight cases, a surgeon should be
seen. Meantime give the injured part perfect rest, keep it in an
elevated position, and apply cold water continuously, or immerse in
water as hot as can be possibly borne, and after keeping it there for
¼ hour, frequently apply hot bran (or oatmeal and vinegar) poultices.
As an embrocation, put ¼ lb. camphor in ½ lb. methylated spirits of
wine; when dissolved, add 1 oz. oil of origanum, and rub the place
night and morning, or use Elliman’s embrocation. In many cases of
supposed severe sprain, some of the bones forming the injured joint
are broken, therefore it is wise to treat these cases by the rules
for broken bones before removing the patient.
_Sunstroke._--In cases of simple exhaustion, ordinary treatment is
all that is needed. Removal to a cooler locality, the cold douche
(but not too much prolonged), or the administration of stimulants,
may be beneficial. Tight or oppressive clothing should be removed,
and the patient treated as in syncope from other causes. Rest and
freedom from exposure to over-exertion, fatigue, or great heat,
should be enjoined. In that form of sunstroke where the person is
struck down suddenly by a hot sun, the patient should be removed into
the shade, and the douche of cold water being allowed to fall in a
stream on the head and body from a pump (or, as in India from the
mussuck, or other similar contrivance), should be freely resorted
to, the object being twofold--to reduce the temperature of the
over-heated centres, and to rouse them into action. Mustard-plaisters
and purgative enemata may be useful. If recovery be imperfect, and
followed by any indication of injury to the nerve-centres, or by
the supervention of meningitis, other treatment may be necessary
according to the indications. Much exposure to the sun should be
carefully guarded against; and, unless recovery be complete and
rapid, the sufferer should be removed to a cooler climate, the most
perfect rest and tranquillity of mind and body enjoined, and the
greatest care be observed in regard to extreme moderation in the use
of stimulants. (Dr. Fayrer.) For prevention, wear light head-gear
with good protection to the nape of the neck; let the lining be
double, one of green and the other of yellow material, and have
ventilation holes at the sides and top.
=Common Complaints=:--
_Brain worries._--To the broad question, Are people suffering from
overwork? Dr. Samuel Wilks, Physician to Guy’s Hospital, would
have no hesitation in saying “No.” His remarks on the subject are
worth repeating. He proceeds:--“On the contrary, if both sexes be
taken, I should say the opposite is nearer the truth, and that
more persons are suffering from idleness than from excessive work.
Medically speaking, I see half a dozen persons suffering from want of
occupation to one who is crippled by his labours. I have, therefore,
very little sympathy with the prevalent notion that nervous and other
diseases are due to overwork. As regards the community generally,
or at least those of its number who come before the medical man on
account of their ailments, my belief is that the explanation they
offer arises from a delusion; and amongst girls, so far from any
studies or other work being injurious, I could instance numerous
cases of restoration to health on the discovery of an occupation.
Very often, when a business man complains of being overdone, it may
be found that his meals are very irregular and hurried, that he takes
no exercise, is rather partial to brandy and soda, and thinks it
not improper to half poison himself with nicotine every night and
morning. The lady in the same way eats no breakfast, takes a glass
of sherry at 11 o’clock, and drinks tea all the afternoon; when
night arrives she has become ready to engage in any performance to
which she may have been invited. When the man of business presents
himself, with his nerves really overstrained, he is found to be a
man of delicate or actually insane temperament. The rule, however,
is that when a patient comes before me with his nerves unstrung,
hypochondriacal, and goes through the whole machinery of his body
to inform me of its working, previously committing all the facts
to paper lest an important one should be forgotten, that man is
getting rusty from having no occupation.... We forget sometimes what
a formidable machine is the animal body, with its force-producing
nervous system. The brain is an engine of many horse power; its
energy must be accounted for in some way; if not used for good
purposes, it will be for bad, and ‘mischief will be found for idle
hands to do.’ It is fortunate that, with many girls, the frivolities
of life keep them idly busy, and so, having a safety valve, they are
harmless to others and themselves; but let a girl occupy herself
neither with what is useful nor with amusement, she falls into bad
health, she becomes a prey to her own internal fires or forces,
and every function of her body is deranged, as well as her moral
nature perverted. Cases of this kind appear to me of the commonest
order, and at the same time very difficult of cure, because the
mother’s aid can rarely be gained to assist the doctor; but, on the
other hand, her sympathies too often only foster her daughter’s
morbid proclivities by insisting on her delicacy and the necessity
of various artificial methods for her restoration, as well as her
resistance to the doctor’s advice for a more natural life, since
she is sure it cannot be undertaken. Her daughter is too delicate
for any of the occupations or modes of exercise proposed. What she
requires is medical attendance, and to be alcoholised and physicked.
It is remarkable, however, what a young lady can do under the power
of a stimulus--as, for example, a gentleman lately expressed his
surprise to me how his daughter, who could not walk many yards for
a long time, owing to a pain in her back, was soon able to walk
many miles a day when she procured the support of her lover’s arm.
It is from considerations of this kind that, when the superfluity
of women, amounting to half a million, doomed to be unmated, ask
for employment, I cannot deny it to them. The human body is made
for work, physical and mental. The amount it can do is of course
proportionate to the power of the machine; but, unlike all other
machines, its strength is only maintained by use, as assuredly it
rusts and decays by disuse. Just as the muscles are better prepared
for work by previous training, so the nervous system, whether it
be the brain or spinal cord, becomes more energised by use. If
healthy and vigorous persons be taken, there appears no absolute
necessity for rest at all in the popular sense of the term. The
rest required is gained during sleep, during meals, and necessary
healthful exercise. It is only during sleep that the brain is
actually inactive, although even then not absolutely, for at meals
cheerful conversation keeps the mind employed, and even in our walks
the attention is fixed on objects around. In times so occupied there
are many persons whose minds are never idle, and who yet live to a
good old age. Practically they have no rest, for when one object of
study is complete, they commence to pursue another. It is by the
happy faculty of diverting the powers into different channels that
this is accomplished. Instances might easily be quoted of statesmen,
judges, and members of our own profession who know no absolute rest,
and who would smile at the suspicion of hard work injuring any man.
I make it a custom to ask young men what their second occupation
is--what pursuit have they besides their bread-earning employment.
Those are happiest who possess some object of interest, but I am
sorry to say there are few who find delight in any branch of science.
The purely scientific man finds his best recreation in literature
or art, but even in intellectual work so many different faculties
are employed that a pleasant diversion is found in simply changing
the kind of labour. For example, a judge after sitting all day, and
giving his closest attention to the details of the cases before
him, may yet find relief in his evenings by solving problems in
mathematics. The subject of overwork, then, is one of the greatest
importance to study, and has to be discussed daily by all of us. My
own opinion has already been expressed, that the evils attending it
on the community at large are vastly over-estimated; and, judging
from my own experience, the persons with unstrung nerves who apply
to the doctor are, not the Prime Minister, the bishops, judges,
and hard-working professional men, but merchants and stock-brokers
retired from business, Government clerks who work from 10 to 4, women
whose domestic duties and bad servants are driving them to the grave,
young ladies whose visits to the village school or Sunday performance
on the organ is undermining their health, and so on. In short, and
this is the object of my remarks, I see more ailments arise from
want of occupation than from overwork, and, taking the various kinds
of nervous and dyspeptic ailments which we are constantly treating, I
find at least six due to idleness to one from overwork.”
For a long time it has been well known to the medical profession
that in various critical states of the human system absolute
silence, or the nearest possible approach to it, is not the least
important condition to be secured. Accordingly muffled knockers,
streets covered with straw or spent tan, and attendants moving about
with noiseless step, are universally recognised as the signs and
the requirements of severe disease. But the truth that noise is a
contributor to the wear and tear of modern city life has scarcely
yet been realised by the faculty, not to speak of the outside
public. Consequently, while a zealous war is being urged against
other anti-sanitary agencies, no general attempts for the abolition
of superfluous noise have yet been made. We cannot, perhaps, give
anything approaching to a scientific explanation why sound in excess
should have an injurious effect upon our nervous system. We feel that
noise is distressing, exhaustive. The strongest man after days spent
amidst noise and clatter, longs for relief, though he may not know
from what. It may even be suggested that the comparative silence of
the sea-side, the country, or the mountains, is the main charm of
our summer and autumn holidays, and contributes much more than does
ozone to restore a healthy tone to the brains of our wearied men of
business. Indeed, if we consider, we shall find that this is the most
unnatural feature of modern life. In our cities and commercial towns
the ear is never at rest, and is continually conveying to the brain
impressions rarely pleasant, still more rarely useful or instructive,
but always perturbing, always savouring of unrest. In addition to the
indistinct but never-ceasing sea of sound made up of the rolling of
vehicles, the hum of voices, and the clatter of feet, there are the
more positively annoying and distracting elements, such as German
bands, organ grinders, church bells, railway whistles, and the like.
In simpler and more primitive times, and to some extent even yet
in the country, the normal condition of things is silence, and the
auditory nerves are only occasionally excited. It is scarcely to
be expected that such a change can be undergone without unpleasant
consequences.
The question has been raised, why should some noises interfere with
brain work by day and disturb our rest at night so much more than
other? A strange explanation has been proposed. We are told that
sound made incidentally and unintentionally--such as the rolling of
wheels, the clatter of machinery (except very close at hand), the
sound of footsteps, and, in short, all noises not made for the sake
of noise--distress us little. We may become as completely habituated
to them as to the sound of the wind, the rustling of trees, or the
murmur of a river. On the other hand, all sounds into which human or
animal will enters as a necessary element are in the highest degree
distressing. Thus it is, to any ordinary man, impossible to become
habituated to the screaming of a child, the barking and yelping of
dogs, the strains of a piano, a harmonium, or a fiddle on the other
side of a thin party-wall, or the clangour of bells. These noises,
the more frequently we hear them, seem to grow more irritating and
thought-dispelling.