MEDICAL TREATMENT OF CAMP DISEASES
In this day of compact pharmaceuticals one can carry a complete
equipment of medicines in a vest pocket almost. The old day of
ponderous powders and nauseating liquids has passed. The physician now
who prescribes for his patients immense bottles of "shotgun" mixtures
writes himself down a back number. This manner of administering drugs
can be taken advantage of by the man who wishes to carry with him upon
his outing a supply of remedies for the relief of such ailments as may
befall him.
Oliver Wendell Holmes once said in delivering an address to the
graduating medical class of Harvard, "Young men, you have been taught
here at least twenty remedies for every disease; after you have
practiced medicine twenty years you will have one remedy for twenty
diseases."
The genial autocrat was nearly right. The longer one continues in the
practice of medicine, the fewer remedies he learns to depend upon. An
Irish medical friend of mine once put the thing in very apt form when
he said, "If I had to practice medicine on an island where I could have
only three remedies, I should choose castor oil, opium, and strychnia.
I'd physic them with the castor oil, constipate them with the opium,
and stimulate them with the strychnia."
These remarks are a little beside the subject, but I am constrained to
quote them to illustrate that but few medicines are needed, if these be
well understood, and the indications for their use can be mastered by
anyone in a short time.
For the past several years my emergency medical case has contained only
ten remedies, and with these I have not hesitated to make professional
trips of many miles. The case should be made of sole leather with a
pocket for a small note book and loops for a clinical thermometer. The
bottles should hold half an ounce and have screw caps. Have the glazier
etch with his diamond the numbers from 1 to 10 on the sides of the
bottles. The reason for this is that numbers pasted on are liable to
rub off, and as many tablets look much alike confusion may occur. Then
fill them in this manner:
No. 1: Calomel, gr. 1/4. Make this entry in the little note book that
is contained in the pocket. "No. 1, calomel gr. 1/4. Dose, one tablet
every thirty minutes for four hours. Indications, biliousness, headache
from disordered stomach, diarrhea, colds, and the beginning of all
fevers."
No. 2: Dosimetric trinity (Full strength). Dose, one granule every
half hour until skin becomes moist. Indications, all fevers, colds,
threatened pneumonia, and threatened typhoid.
No. 3: Chlorodyne. Dose, one tablet every hour to relief. Indications,
any gastric pain, cramps, diarrhea (after cleaning out the bowels),
colic, acute indigestion.
No. 4: Intestinal antiseptic. Dose, one tablet every hour for
four hours; then one every three hours. Indications, after bowels
have been cleaned out to correct any disorder of the tract, as a
routine treatment of typhoid; always valuable in diarrhea and other
inflammatory conditions of the bowels.
No. 5: Quinine sulphate, gr. 5. Dose, one tablet every four hours.
Indications, colds and catarrh, bilious fevers, specific in malaria.
No. 6: Elaterin, gr. 1/16. Dose, one tablet. Indications, to remove all
fermenting food matters in the stomach and bowels, produces excessive
watery evacuations. Valuable in dropsy; especially applicable where you
want to get rid of the entire contents of the bowels.
No. 7: Phenacetine, gr. 5. Dose, one tablet every three hours to
profuse perspiration. Indications, reduce fever where pulse is full and
bounding. Relieves headache; taken early cures severe cold.
No. 8: Sun Cholera. Dose, one every three hours. Indications, similar
to No. 3, only more powerful, valuable in severe summer complaint due
to eating fresh fruit, meat, drinking too much water. Relieves gastric
pain.
No. 9: Apomorphia hydrochlorate, gr. 1/10. Dose, two tablets followed
by swallow of hot water. Indications, as an emetic in poisoning. Use
cautiously.
No. 10: Digitalin, gr. 1/100. Dose, one tablet every hour to effect.
Indications, the most powerful heart tonic and reconstructive. Must be
used cautiously. Valuable in loss of blood, excessive heart action from
altitude, and all conditions where heart is not performing properly.
It will be noted that I did not mention morphine, strychnia, or
cocaine, as they were spoken of in connection with the hypodermic. In
the case I also place a one-minute clinical thermometer. All of these
instruments are now made self-registering and must be shaken down after
each using. This should be done, not by a jar, but with a long sweep of
the arm. Too sudden a jar will snap the instrument in two. Shake until
the mercury column stands below the △ mark. This △ mark indicates the
body heat at normal condition, that is, 98.4° F.
Every man should familiarize himself with certain physiological facts,
and with these as guideposts he ought to be able to follow a train of
indications to a reasonably fair diagnosis. The pulse rate, taken at
the wrist, is generally a fair index of the condition of the body. The
normal man has a pulse rate of about seventy-two beats per minute,
women somewhat more rapid; high elevations also produce a more rapid
pulse.
If there is an increase of heart beat above eighty per minute,
accompanied by other subjective symptoms, it is an indication that
something is wrong. In the absence of a clinical thermometer, one can
arrive at a pretty fair knowledge of the body heat by counting the
pulse. It is estimated that there will be an elevation of one degree F.
for every ten beats above the normal. This rule varies, but is a fair
average.
The appearance of the tongue is a valuable signpost, but one that
is difficult of mastery. A few prominent indications will be noted.
A thin, white, even furring of the tongue is indicative of gastric
disturbances and mild fever states. A flabby, swollen, indented tongue
covered with a uniform yellow, pasty fur is indicative of profound
gastric states and gastro-duodenitis; it may also be produced by a
continued moderate fever.
A narrow tongue, with deep median fissure on each side of which
is a thick rough fur, the tip and edges being red and denuded, is
characteristic of typhoid states whether arising from typhoid or
not. The same condition will be found in profound intoxication from
septic poisons. If the tongue becomes dry and brown, tremulous when
protruded, and the patient returns it slowly when requested to do so,
he has typhoid beyond question. A brown fur on the root of the tongue,
especially in the morning, indicates a sluggish condition of the liver.
In jaundice the tongue is yellow.
It is estimated that the normal man in a state of rest will breathe
sixteen times per minute. Any radical departure from the rate will
indicate disease. An increase of two respirations per minute is
supposed to indicate a rise of one degree F. in the body temperature,
though this rule is subject to variations. Inspection of the bare chest
tells the trained physician much regarding the condition of his patient
and even the layman can glean much knowledge from that source.
If the patient is breathing from twenty-five to thirty-five times per
minute, the respiration being confined to one lung as indicated by the
lack of expansion in the other, and if he lies so as to take the strain
off the lung that does not expand, it is almost sure that the patient
has pneumonia. In case the lung is fixed rigidly by the muscles and the
opposite lung forced to do all the work, then the patient has pleurisy.
In profound typhoid states the breathing is very much slowed and
irregular, at last presenting what is known as the Cheyne-Stokes
respiration, in which the patient will breathe several short shallow
respirations, pause for a time, heave a deep sigh and then repeat the
rapid breathing. This type of breathing is looked upon as a very grave
symptom in all conditions characterized by lack of physical strength.
It will be readily appreciated that only enough discussion of symptoms
has been given above to aid somewhat in arriving at a diagnosis. To go
deeply into physical indications of diseases would be manifestly out
of place in an article of this character. We will now proceed to the
consideration of the diseases that will be most frequently encountered
in the camp. Of these the intestinal troubles stand pre-eminent. Change
of water, food, methods of life, and personal habits account for the
fact that nearly every person who seeks the outdoors at some time
during his stay is afflicted with some one of the diarrheas. Without
attempting to go deeply into the various classifications of the enteric
complaints, a brief résumé of the guiding symptoms common to all will
be given.
It matters very little so far as the treatment is concerned whether it
be an ileo-colitis, an ileitis, or simply colitis. The same treatment
would obtain in each case, and the same general trend of symptoms
would be present. The patient feels a general indisposition, loss of
appetite, headache, and sleeplessness, which is followed by pain and
griping in the bowels; then comes the diarrhea, which may be profuse
and watery or scanty and accompanied by much pain. The evacuations
become exceedingly frequent, sometimes as many as fifty or sixty per
day.
The patient vomits frequently and is quite ill, his face becomes
pinched and dusky, with an anxious look in the eyes. There is some
fever and thirst, though the water drunk is generally vomited. In the
above has been pictured an extreme case of summer diarrhea. There will
be all gradations below this, from a mere soreness of the abdomen and
looseness of the bowels up to profound prostration from constant drain
on the system induced by the evacuations.
By a sort of strange medical paradox, in order to stop the evacuations
it becomes necessary to increase them. We must sweep out the nest of
troublesome bacteria that are causing the disturbance. An ordinary
cathartic will not accomplish this. It is necessary to administer
something that will produce a profuse watery discharge from the bowels.
Nothing accomplishes this better than a heaping tablespoonful of
Epsom salts in hot water, but as we have not provided for such bulky
medicines in our case we will give our patient one tablet of elaterin
which will accomplish the same purpose.
Then, too, the patient is not nearly so liable to vomit the
elaterin. If he does, however, the vomiting can be controlled by the
administration of cocaine by the mouth, though this latter drug must be
used very cautiously. A tablet of 1/4 gr. cocaine hydrochlorate given
in a swallow of hot water will stop vomiting until the other remedies
can produce their effect. Before giving any other medicines await the
free action of the cathartic.
The patient should have at least three very copious discharges; then
begin to combat the inflammatory condition that exists in the bowels.
The chlorodyne tablet will in all ordinary cases, do this best of
all your remedies. There will be some few instances where it will be
necessary to resort to more powerful remedies; in that case the Sun
Cholera tablet given according to directions is the best. As an after
treatment in these cases the intestinal antiseptic gives the best
results. A tablet every four hours for two days will annihilate every
vestige of bacterial invasion that may remain.
Bronchial and pulmonary diseases supply a large percentage of the camp
ailments in the fall and early winter during the deer hunting season.
An attack of pneumonia following a severe drenching from being out
all day in a rain, or accidentally tumbling into the creek, is not
a pleasant thing to contemplate. It usually comes in the night. The
patient wakes out of a sound sleep with a chill. There is a sharp
sticking pain as though a knife were being thrust between the ribs, at
some point on the chest wall. The breath comes in short gasps and the
patient instinctively turns toward the affected side in order to ease
the pain.
The chill may or may not be followed by vomiting, and the fever lights
up immediately, rising to 102–4° F. A distressing short cough comes
along to add to the discomfort as each act of coughing increases the
pain in the chest. In less than twenty-four hours the patient begins to
expectorate what we call "prune-juice" mucus, that is, mucus streaked
with blood until it resembles the juice of cooked prunes. When you see
this "prune-juice" you need have no doubt as to the diagnosis. You
should, however, have been busy long before this.
There is no doubt now among educated physicians that pneumonia, taken
in time, can be aborted. When the pain first manifests itself set
somebody to baking hot cakes made from flour stirred with water. While
these are still as hot as can be borne lay them over the painful spot
on the lung, renewing as fast as they become cool. To accomplish much
good this treatment must be kept up until the period of expectoration
and even after, at least twenty-four hours. At the same time begin by
administering calomel in 1/4 gr. doses every thirty minutes until at
least three grains have been given.
Two hours after the last tablet of calomel has been given, give a
tablet of elaterin. When the latter has "worked," start in with the
dosimetric trinity tablets and push them until the skin becomes moist
and the fever falls below 100° F. Do not give any of the coal tar
products in pneumonia, that is, do not give phenacetine or acetanilide.
When the patient is recovering it is well to keep up the heart by
strychnia or digitalin.
There is such a thing as giving too much of these heart stimulants
though, and you should watch the pulse closely. Stimulating the heart
too greatly is liable to cause congestion of the small blood vessels in
the lungs and defeat the very purpose you set out to accomplish.
Taking "cold" is a very popular camp method of feeling bad. The man who
does not at least once, while in camp, stuff himself full of a good
old-fashioned "cold" feels that he has been cheated out of a part of
the enjoyment of his outing. For the benefit of those of his companions
who do not appreciate his "barking" in season and out, the following
rules are suggested: First, take a bath; it may be painful but
necessary. Second, assist overworked eliminants to remove the debris
that has accumulated by reason of the failure of the ordinary processes
of waste removal.
This can be done very nicely with a heroic dose of calomel; by heroic
about three grains is meant. Follow up the calomel with several
five-grain doses of phenacetine, or until the patient is in a profuse
perspiration, roll him in warm blankets, and await developments. A
careful observance of the foregoing will annihilate any able-bodied
"cold" on earth.
The man who contracts rheumatism in camp has my sincere sympathy.
It requires no special skill to tell when one has it, but it does
require special powers of divination to tell when he will get rid of
it. Medical science has discovered only one drug that will affect the
progress of the disease in the least, and that only after an extended
course. Salicylic acid in one or another of its various combinations
furnishes the sheet anchor in the treatment of rheumatism. I purposely
omitted it from our pocket case of drugs because of the fact that the
combination that would suit one man's stomach would not another.
In practice we have to take many things into consideration in the
administration of the salicylates. The man with rheumatism in camp can
seek only to relieve the pain and assist Nature to eliminate the waste.
A thorough flushing of the bowels should be the first thing, followed
by aconitine, gr. 1/134, one tablet every hour for four hours; then one
every three hours. At the same time keep dry. If it be a limb that is
affected wrap it in blankets and "cook" it in front of the fire.
Cases of poisoning arising in camp will usually be confined to two
causes—the eating of poisoned foods and eating poisonous mushrooms. In
these days of tinned meats and vegetables it is not unusual to hear of
persons becoming seriously and even fatally poisoned by eating certain
canned goods. Canned fish and beef are the worst offenders in this
regard.
The symptoms of ptomaine poisoning are characteristic and generally
easily traced to the material producing them. There is a dryness and
metallic taste in the mouth shortly after eating suspected food. This
is followed by severe cramps, vomiting, violent purging, rapid loss of
strength, great depression and coldness of the surface of the body.
The hands and face break out in clammy sweat and the temperature falls
below normal. The picture is very characteristic and when once seen is
readily recognized.
The treatment consists in getting rid of the offending substance as
quickly as possible. Nothing accomplishes this more readily than a
quick emetic. Apomorphia hydrochlorate furnishes us with the most
convenient emetic, though mustard water or hot salt water will do.
Take a tablet of 1/10 gr. apomorphia hypodermically, or two tablets
of the same size by the mouth, followed by a swallow of hot water.
Hypodermically the emetic acts in a very short time; by the mouth
it requires somewhat longer, say ten minutes. Purge the bowels with
elaterin, one tablet, then keep up the vital forces by administering
strychnia, 1/60 gr. every hour or two, watching the circulation
meanwhile.
In severe cases, in addition to the strychnia, it may become necessary
to resort to external heat, hot water bottles, hot stones, etc. The
patient is much debilitated for several days and requires careful diet.
Mushrooms should never be eaten unless the person gathering them is
known to be thoroughly conversant with the different varieties. Certain
poisonous varieties resemble the edible so closely that only an expert
can tell the difference. The knowledge, however, is one that every
hunter and camper should familiarize himself with as mushrooms are
usually plenty in the hills and furnish an agreeable addition to the
menu.
Phalline, the toxic principle of the _phalloidæ_ group of mushrooms,
is a toxalbumin of extreme violence and resembles very much the toxic
albuminose of rattlesnake virus; in fact, it seems to act upon the
digestion very much as crotalin does upon the circulation. There is
another toxic principle present in certain other varieties of fungi
called muscarine; both these poisons act very similarly.
The symptoms are a feeling of giddiness coming on from one hour to
fifteen hours after eating the fungus. This is followed by profuse
salivation, the water running out of the patient's mouth in a stream.
Blindness ensues, and vomiting and diarrhea come in their train. The
heart is weakened and the patient breathes with difficulty. At the last
he lies in a stupor.
The treatment is similar to that of ptomaine poisoning. Remove the
offending material at once by the same process. For a purgative
oleaginous agents are the best if available, castor oil being
preferable; failing in that any active cathartic will do. The heart
then must be stimulated by the digitalin; strychnia also plays a
prominent role here.
It had not been my intention to mention typhoid, but upon reflection I
have decided to include it. Typhoid fever is little liable to attack
people living under such conditions as exist in the mountains where the
air is pure, the water comes from eternal springs, and flies are few.
Summer camps along lake shores and the larger, slow-moving streams are
liable to it, and it is just as well to recognize it when it arrives.
The person about to come down with typhoid generally feels extremely
tired for several days, the head and back ache, the nose frequently
bleeds slightly, a rumbling is present in the right side just below
the ribs, and the ears rings as though one had taken an overdose of
quinine. The tongue is characteristic of the disease, so much so, in
fact, that we speak of a particular condition as the "typhoid tongue."
After a few days the patient begins to feel feverish. All the symptoms
increase until he is quite ill and takes to his bed. About this time
tiny red spots called "rose spots" appear on the abdomen, perhaps only
a few, again they are quite frequent. The mind becomes dull and the
hearing imperfect.
Typhoid is said to be a self-limiting disease, that is, it cannot be
cut short or aborted in any way. That, however, is hardly the case. By
vigorous treatment, at the outset, it is now thought by a great many
that the disease can be limited to a few days. If the treatment is not
begun early and carried out, the disease will run a course of some
twenty-one days.
The treatment consists in eradicating the nest of typhoid bacillus
that is setting up the disturbance. Here, again, we resort to calomel.
Four grains given in quarter-grain doses every half hour will usually
produce sufficiently free passages. After this administer the
intestinal antiseptic religiously, with aconitine for the fever. Give
plenty of water to drink and restrict the diet. If the disease gets
beyond control, the routine treatment is the intestinal antiseptic.
Cold packs for the fever, in the later stages of the disease, will
be found preferable to any medicines. All the time the diet should
be watched. No solid foods should be allowed. Milk, light broths,
fruit juices, and rice water supply sufficient nourishment and do not
irritate the tender glands of Peyer and Brunner that are the seat of
the disease. These glands become very friable in typhoid, and any
violent action of the walls of the intestines, as in digesting food,
will cause them to break through and permit the bowel contents to
enter the general peritoneal cavity, when the patient will die from
inflammation of the bowels.
SERPENT WOUNDS AND THEIR
TREATMENT