_Conjee_ (322), Decoction of Abelmoschus (2), or of Ispaghúl Seeds (305)
and the Hip Bath (392) generally afford relief. _For Retention_ _of
Urine_, Opium (287*) and a Hip Bath (392), with Hot Water Fomentations
to the pubes, often succeed in recent cases; if these fail, _no time
should be lost in placing the patient under medical care_.
_Uterus, Painful Affections of._ Camphor (73), Opium (289*), Datura
Poultices (130), and Hip Bath (392), either alone or conjointly, are
calculated to afford relief. _Chronic Affections of_, Borax and Cinnamon
(58). _For Prolapsus or descent of_, use vaginal injections of Decoction
of Galls (147), or of Babúl Bark (9), holding Alum (25*) in solution.
_Bleeding from_, see _Hæmorrhage_, and _Menstrual Discharge, Excessive_.
_Vaginal Discharges._ Cubebs (125), and Gurjun Balsam (160) internally
(_given by the mouth_) and vaginal injections of Lime Water (224), Alum
(30) and Decoctions of Babúl Bark (9), Galls (149), or Pomegranate Rind
(313) are indicated. [Employ at first simply cold or warm water
injections, regulating the temperature according to the feelings of the
patient; if these do not benefit, try Solution of Sugar (one part),
Water (four parts). Add Alum or other astringents, if necessary, but do
not commence with them until a fair trial has been given to the simpler
means.—_Aitchison._] For the _Vaginal Discharges of Young Children_, the
local application of Lime Water (224), with Fish Liver Oil (138)
internally offer the best chance of success.
_Vaginal Irritation_ is often removed, like a charm, by the application
to the parts of a very weak solution of Carbolic Acid (one to twenty of
Sweet Oil); if used stronger it is apt to cause pain, this pain is at
once removed by a free application of sweet oil alone (_Aitchison_).
_Voice, Loss of._ Catechu (89), or any of the other measures directed
for _Hoarseness_.
_Vomiting._ Amongst the remedies to allay this, are Infusion of Cloves
(105), Infusion of Ginger, (155), Lemon Grass Oil (216*), and Omum Water
(318), with or without the addition of a little Opium (290). Apply
Mustard Poultices (251), or Turpentine Stupes (362). In obstinate cases
try Leeches (213). Lime Water (223*), though especially adapted for
_Vomiting arising from Acidity of the Stomach_, is well worthy of a
trial in all obstinate cases, especially in the _Vomiting of Infants and
Young Children_. It is best given in milk. _Vomiting in Fevers._ Hot
Water (358).
_Warts_ seldom resist the persevering application for a week or two of
Sulphate of Copper (108); a piece of it moistened should be rubbed
lightly over the wart, avoiding the surrounding skin. It may be applied
once every day, or every other day.
_Wasps Stings of._ See _Bites, Venomous_.
_Water on the Brain._ See _Hydrocephalus_.
_Water-brash (Pyrosis)._ Butea Gum (62), and Lime Water (223) may often
be used with advantage.
_Whites._ See _Leucorrhœa, and Vaginal Discharges_.
_Womb, Affections of._ See _Uterus, Affections of_.
_Worms._ _For Tænia, or Tape Worm_, give Kamala (189), Pomegranate Root
Bark (314), or Turpentine (365). When one fails another will often
succeed. _For Lumbricus or Common Round Worm_, try Butea Seeds (64),
Vernonia Seeds (373_b_), or Papaw Juice (295).
The best remedy in these cases is SANTONIN, and considering the great
prevalence of these worms amongst the people of India, and the many
anomalous nervous and other affections to which they give rise, it is
advisable always to have on hand a supply of this drug. The dose for
children under four years is from two to four grains; above twelve years
from six to eight grains, rubbed up with about twice its weight of sugar
repeated every six or eight hours thrice in succession. A good plan is
to give the Santonin at bedtime, and a small dose of Castor Oil in the
morning, three days in succession. In many cases, it has been stated, no
aperient is needed, one or two stools succeeding its administration
containing the worms, if any are present; still, it is safer to follow
up its use by an aperient. It is of little or no use in Tape Worm; and
in Thread Worm, though it will aid, often strikingly, in removing the
worms, it will not prevent their reappearance. For Round Worm it is by
far the most effectual remedy we possess. _For Ascarides, or Thread
Worm_, use enemas of Lime Water (227), Asafœtida (36), or Turpentine
(365).
_Wounds, Ulcerated._ See _Ulcers, Bleeding from_. See _Hæmorrhage_.
APPENDIX A.
DIRECTIONS FOR RESTORING THE APPARENTLY DEAD FROM DROWNING.
(_Reprinted by permission from the Directions issued by the
Royal Humane Society._)
As soon as the body is taken out of the water, lay it on the ground,
wipe it dry, and let the wind blow freely upon the surface. With this
view, on no account let people crowd round the body.
The points to aim at are—first, and immediately, the RESTORATION OF
BREATHING; and secondly, after breathing is restored, the PROMOTION OF
WARMTH AND CIRCULATION.
Treatment to Restore Natural Breathing.
RULE 1.—_To maintain a Free Entrance of Air into the Windpipe._—Cleanse
the mouth and nostrils;[3] open the mouth; draw forward the patient's
tongue, and keep it forward; an elastic band over the tongue and under
the chin will answer this purpose. Remove all tight clothing from about
the neck and chest.
RULE 2.—_To adjust the Patient's Position._—Place the patient on his
back on a flat surface, inclined a little from the feet upwards; raise
and support the head and shoulders on a small firm cushion or folded
article of dress placed under the shoulder blades.
RULE 3.—_To imitate the Movements of Breathing._—Grasp the patient's
arms just above the elbows; and draw the arms gently and steadily
upwards, till they meet above the head (this is for the purpose of
drawing air into the lungs), and keep the arms in that position for two
seconds. Then turn down the patient's arms, and press them gently and
firmly for two seconds against the sides of the chest. _See_ Engravings
I. and II. (This is with the object of pressing air out of the lungs.
Pressure on the breastbone will aid this.)
Repeat these measures alternately, deliberately, and perseveringly,
fifteen times in a minute, until a spontaneous effort to respire is
perceived, immediately upon which, cease to imitate the movements of
breathing, and proceed to INDUCE CIRCULATION AND WARMTH (_as below_).
Should a warm bath be procurable, the body may be placed in it up to the
neck, continuing to imitate the movements of breathing. Raise the body
in twenty seconds in a sitting position, and dash cold water against the
chest and face, and pass ammonia under the nose. The patient should not
be kept in the warm bath longer than five or six minutes.
[Illustration:
I.—INSPIRATION.
II.—EXPIRATION.
_To illustrate the position of the Body during the employment of
this Method of Inducing Respiration._]
RULE 4.—_To excite Inspiration._—During the employment of the above
method excite the nostrils with snuff or smelling salts, or tickle the
throat with a feather. Rub the chest and face briskly, and dash cold and
hot water alternately on them.
Treatment after Natural Breathing has been Restored.
RULE 5.—_To induce Circulation and Warmth._—Wrap the patient in dry
blankets and commence rubbing the limbs upwards, firmly and
energetically. The friction must be continued under the blankets or over
the dry clothing.
Promote the warmth of the body by the application of hot flannels,
bottles or bladders of hot water, heated bricks, &c., to the pit of the
stomach, the armpits, between the thighs, and to the soles of the feet.
Warm clothing may generally be obtained from bystanders.
On the restoration of life, when the power of swallowing has returned, a
teaspoonful of warm water and subsequently small quantities of wine,
warm brandy and water, or coffee should be given. The patient should be
kept in bed, and a disposition to sleep encouraged. During reaction
large mustard plasters to the chest and below the shoulders will greatly
relieve the distressed breathing. Great care is requisite to maintain
the restored vital actions, and at the same time to prevent undue
excitement.
The above treatment is to be persevered in for three or four hours, or
until the pulse and breathing have ceased for at least one hour. It is
an erroneous opinion that persons are irrecoverable because life does
not soon make its appearance; as cases are on record of a successful
result even after five hours' perseverance in the use of the above means.
APPEARANCES WHICH GENERALLY INDICATE DEATH.
There is no breathing or heart's action; the eyelids are generally half
closed; the pupils dilated; the jaws clenched; the fingers
semi-contracted; the tongue appearing between the teeth, and the mouth
and nostrils are covered with a frothy mucus. Coldness and pallor of
surface increase.
[Footnote 3] A good plan is to turn the body gently over for a few
seconds with the face to the ground, one of the hands being placed under
the forehead. By this means the water will run out of the mouth and the
tongue will fall forward, leaving the breathing opening free. On no
account should the body be held up by the feet as has been advised by
some old writers.
APPENDIX B.
SUMMARY OF TREATMENT OF PERSONS BITTEN BY VENOMOUS SNAKES.[4]
As soon as possible after a person is bitten by a snake, apply a
ligature, made of a piece of cord, round the limb or part at about two
or three inches above the bite.
Introduce a piece of stick or other lever between the cord and the part,
and by twisting tighten the ligature to the utmost (See Stick
Tourniquet, p. 224).
Apply other two or three ligatures above the first one at intervals of
four or six inches, and tighten them also. After the ligature has been
applied, scarify by cutting across the puncture to the depth of a
quarter of an inch with a penknife or other similar cutting instrument,
and let the wounds bleed freely; or better still, excise the punctured
part.
Apply either a hot iron or live coal to the bottom of these wounds as
quickly as possible, or some carbolic or nitric acid.
If the bite be not on a finger or toe or part where a ligature can be
applied, raise up the integument with the finger and thumb, and with a
sharp penknife cut out a circular piece as big as a finger nail round
each puncture, _i.e._, round the points of the finger and thumb, to the
depth of quarter to half an inch. Then apply the hot coal or hot iron to
the very bottom of the wounds.
Give fifteen drops of Liquor Ammoniæ, diluted with an ounce of water,
immediately, and repeat it every quarter of an hour for three or four
doses, or longer, if symptoms of poisoning appear.
Or give hot brandy, or rum, or whisky, or other spirit, with an equal
quantity of water, about an ounce of each (for an adult) at the same
intervals.
Should no symptoms of poisoning appear in half an hour after the
application of the ligatures they should be relaxed, or the part will
perish from gangrene; if they should, however, appear, the ligatures
should not be relaxed until the person be recovering from the poison, or
until the ligatured part be cold and livid.
Suction of the wounds is likely to be beneficial, but as it may be
dangerous to the operator, it cannot be recommended as a duty.
If, notwithstanding, symptoms of poisoning set in, and increase, if the
patient become faint or depressed, unconscious, nauseated or sick, apply
Mustard Poultices, or Liquor Ammoniæ on a cloth, over the stomach and
heart; continue the stimulants, and keep the patient warm, but do not
shut him up in a hot, stifling room or small native hut; rather leave
him in the fresh air than do this.
Do not make him walk about if weary or depressed; rouse him with
stimulants, mustard poultices, or ammonia, but let him rest.
If the person be first seen some time after the bite has been inflicted,
and symptoms of poisoning are present, the same measures are to be
resorted to. They are less likely to be successful, but nothing else can
be done.
In many cases the prostration is due to fear; the bite may have been
that of a harmless or exhausted snake, and persons thus bitten will
rapidly recover under the use of the above measures. If poisoned, but,
as is frequently the case, not fatally, these measures are the most
expedient; if severely poisoned, no others are likely to be more
efficacious.
People should be warned against incantations, popular antidotes, and
loss of time in seeking for aid.
To the above remarks, Sir J. Fayrer adds: "The measures suggested are no
doubt severe, and not such as under other circumstances should be
entrusted to non-professional persons. But the alternative is so
dreadful that even at the risk of unskilful treatment, it is better that
the patient should have this chance of recovery."
PRECAUTIONS TO BE OBSERVED BY PERSONS RESIDING IN SNAKE-INFESTED
LOCALITIES.
That prevention is better than cure is admitted on all hands; hence
those persons whose lot is cast in snake-infested localities will do
well to lay to heart the following passage from the official "Report on
Indian and Australian Snake-poisoning," by Drs. Joseph Ewart, Vincent
Richards, and S. Coull Mackenzie (Calcutta, 1874).
The poisonous snakes of India, as a general rule, "are, until provoked,
perfectly inoffensive to all animals not required by them as food. They
seldom assume the aggressive until they are rudely and accidentally
disturbed. Thus a native sleeping on the ground rolls over a venomous
snake, or whilst walking in the jungle, or long grass, or in the dark,
treads upon some part of a snake's body. In either case the snake bites
if he can. It is in this way that a large proportion of snake accidents
happen.
"A large number of lives would be saved annually if the native
population could be prevailed upon to _sleep on charpoys_, and if they
got into the habit of _never stepping from their beds at night without
first seeing, by means of a light, that the ground below is clear, and
free from snakes_. Much of the immunity which Europeans and educated
natives enjoy from snakebite is due to their using these very necessary
precautions, especially during the rainy season, and in the mofussil by
their _never walking abroad at night without a light_. There is scarcely
a European of experience in the mofussil who cannot recount examples of
lives (often their own) having been saved by means of these simple
precautions."
To the above judicious advice (the most important points of which I have
italicised) may be added the following excellent practical precautions,
communicated to me by friends whose Indian experience gives great weight
to their suggestions.
1. Snakes never voluntarily traverse rough or broken ground: it is
therefore advisable in snake-infested localities to surround your
dwelling with a cordon or belt of broken bricks or kunkur—a breadth of
three or four feet is quite sufficient for the purpose.—_Dr. Norman
Chevers._
2. Be careful, especially during the wet season, to keep the verandahs,
&c., free from frogs: a frog is a temptation which a snake has little or
no power to resist.—_Dr. Norman Chevers._ The same remark is equally
applicable to rats.
3. In the cold season, if you see a snake coiled up or in an apparently
lifeless state in an open, well-frequented road or pathway, be careful
how you approach him. Should you handle or disturb him roughly, he will
in all probability rouse up and bite you. He is only torpid from cold,
not dead.—_Dr. Norman Chevers._
4. Have a piece of perforated zinc or tin fitted to the opening made for
the purpose of carrying off the water out of the bath-room, if it be on
the ground floor. A similar piece should be added to the bottom of the
bath-room door should it not (as it rarely does) reach the ground
beneath.—_Mr. Arthur J. Waring._
5. Discard vegetation, especially thick straggling shrubs like the
Rangoon Creeper, close to your house. They are very apt to harbour
snakes.
6. Important as are the above "Precautions," they are comparatively of
small moment compared with the destruction—extermination if possible—of
the snakes themselves. And this can only be efficiently carried out
under Government supervision. That this is the only mode of effectually
grappling with this gigantic evil, under which thousands of lives are
annually sacrificed—the numbers are 19,060 in 1880, and 18,610 in 1881,
besides 4568 cattle in the two years—is forcibly set forth by Sir Joseph
Fayrer in two able papers in _Nature_, December 28, 1882, and January
18, 1883. Most earnestly is it to be hoped that Government, agreeably to
his suggestion, will lose no time in establishing a department, with a
responsible chief and subordinate agents, under whom a system of
organised, determined, and sustained efforts for the destruction of the
snakes shall be adopted and carried out. It would be a public boon if
Sir Joseph's two papers were reprinted in pamphlet form, and circulated
throughout the length and breadth of India.
In the meanwhile zealous individual effort should be brought to bear in
the same direction. To this end money rewards (heading the list with
eight annas for a Cobra) should be freely offered to the natives for
every dead poisonous snake brought in, but _for poisonous ones alone_.
Of these there are life-like coloured plates in Fayrer's _Thanatophidia
of India_, and in Ewart's _Poisonous Snakes of India_, one or other of
which works is to be found in almost every large station, and which it
is highly desirable for every one to make himself acquainted with. One
other point remains to be noticed, namely, the necessity of carefully
impounding every such dead snake brought in and paid for; otherwise it
is likely to do duty a few hours later, or even next day, or it may be
made the means of extracting further "buck-sheesh" from one or more of
the neighbouring "_Sáhib-lóg!_"
[Footnote 4] Reprinted by permission from Sir Joseph Fayrer's splendid
work, _The Thanatophidia of India_. Folio. London: Churchill. 1874.
APPENDIX C.
METHOD OF TREATMENT OF SMALL-POX BY MEANS OF CARBOLISED OIL.
My reason for giving this treatment of small-pox in detail is the
frequent presence of the disease in India, in an epidemic form amongst
the natives, with the hope that it may prove useful in ameliorating it,
and thus save many useful lives which otherwise would probably succumb
to its ravages from the terrible purulent discharge acted upon by a hot
climate, creating a form of disease scarcely known in colder latitudes.
Before attending upon or assisting in the treatment of a case of
small-pox, it is the duty of every one to see that they, their
households, and those others who are likely to attend upon the case are
sufficiently protected from the likelihood of infection by having been
properly vaccinated, and that this operation had been successfully
performed within at least four years. When there is a necessity for any
one coming into immediate contact with the disease, as on the occurrence
of an epidemic, it is advisable to be vaccinated whenever such epidemics
occur.
There is a general belief that vaccination does not prove a success in
the hot weather in India; do not credit this. If small-pox occurs as
virulently as it does during the hot weather, on occasion, the success
of the vaccination is also a certainty, if performed with care and a
determination in its success.
Never mind how young an infant is, vaccinate it, even if it is only a
day old, if you believe there is any probability whatsoever of its
having come into, or likely to come into, contact with the infection of
small-pox. Remember "the mortality of small-pox in childhood is very
high up to the age of ten years. Infants usually succumb to the disease
even in the discrete form."
Since the time that I first gave my opinion to Dr. Waring (in 1872) upon
the treatment of small-pox with carbolised oil, I have seen a good deal
more of the disease, and I still, with slight modifications, maintain my
preference for this form of treatment. When I first used the application
I employed a mixture of one part of Carbolic Acid and ten parts of Sweet
Oil, applied twice daily over the whole body. I now advocate the
employment of one part of Carbolic Acid to fifteen parts of any bland or
Sweet Oil, moistening the body on such parts as may require it,
frequently during the day and night.
Sesamum or Til Oil is ordinarily the most easily procurable throughout
India, but any of the following will do: Poppy, Ground-nut, Apricot,
Walnut, Cocoa-nut, Linseed, Almond, or Olive Oil, the two last being
rather expensive. On no account be led into using any of the Mustard
oils, which, owing to the natives using some of them in their diet, are
occasionally spoken of as "sweet oils."
At whatever stage of the disease the patient comes under treatment, at
once apply this liniment over all the parts being affected, or are
affected by the eruption, by means of a mop of soft cotton-wool (_never
on any account employ a sponge_); apply the liniment freely as if you
were treating a severe burn, and then carefully cover the oiled surface
with cotton-wool, so as to exclude all air, and keep the cotton-wool
dressing in position. The carbolised oil to be freshly reapplied every
four or six hours, so as to keep the parts moist, and the cotton-wool to
be renewed every forty-eight hours. If flakes of wool stick into the
broken skin, moisten these freely with oil, but do not tear them away.
Any amount of cotton-wool can be obtained throughout India at the
smallest hamlet, on a few hours' notice; and at all hours in any bazaar.
Let the patient lie between blankets, not cotton sheets; in commencing
to dress the patient on the first occasion have a layer of cotton-wool
placed upon the lower blanket, then place the patient on this
cotton-wool naked, cover with a similar sheet of cotton-wool and over
this again a blanket; having done this, set to and piecemeal dress the
whole body, where the presence of the coming eruption requires it, with
the carbolised oil, and cotton-wool, supporting the position of the
cotton by means of very light bandages, or by a few stitches with a
needle and thread, so as to keep the wool carefully together as well as
firmly against the body. If suitable under the circumstances, a thin
elastic gauze jersey and drawers keep the cotton protected from being
rubbed off by restless patients.
So soothing and comforting is the application of the oil, that almost
the youngest patients look forward to its re-application, will at once
tell you when the body is getting hot and dry, and will in all
probability ask to be allowed to apply the liniment themselves when they
begin to feel uncomfortable, especially at the inflammatory stage of the
vesicles when they are just changing to their pustular condition.
What is gained by the above treatment?
1. The carbolised oil soothes and cools down the inflamed surface of the
skin, exactly as is done when oil is applied to a burn.
2. The cotton keeps all air from the skin, and aids in keeping the skin
moist with the oil.
3. The oil saturates the surface of the eruption, penetrates into the
skin desiccation, and as the oil becomes heated by the temperature of
the body it gives off some of its carbolic acid in the form of gas.
4. The carbolic acid keeps the oil from becoming rancid.
5. If the liniment is applied to the eruption at a sufficiently _early_
stage, viz., when the eruption is becoming vesicular, the carbolised oil
on the surface of the eruption, and the gaseous carbolic acid, between
the skin and the cotton and in the interstices of the cotton, prevent
the microbes of the atmosphere from coming into direct contact with the
epidermis, and subsequently with the contents of the vesicle, the result
of which is the contents of the vesicle do not become pustular and
purulent; and the eruption dries up without ulceration.