until the pustular stage has set in, the carbolised oil penetrates more
or less into the epidermis which is being thrown off by the suppuration
of the pustule; as the pus is discharged by rupture of the epidermis the
oil mixes with the pus, disinfects it, and keeps it sweet, as is to be
observed by the entire non-existence of, or extremely modified condition
of, the horrid stench that accompanies small-pox, subsequent to the
pustular stage of the disease.
7. The exuviæ becoming loaded with the carbolised oil, are (probably)
disinfected and are incapable of spreading the disease.
8. If the eruption is prevented from reaching the pustular stage, the
complications that would otherwise have resulted from pus absorption are
no longer to be dreaded, such as the secondary fever, boils, abscesses,
acute cellulitis, erysipelas, pyæmia, &c. &c.
No eroding ulcers with deep cavities, leaving the well-known cicatrices
of small-pox, are produced.
9. The pustular stage having occurred before the carbolised oil
treatment was applied, it still proves of immense value, as it prevents
the pus becoming impure and poisonous, and this greatly ameliorates the
results of the disease even at this stage.
So long as the disease lasts is this application to be applied, limited
certainly to the extent of the eruption; as long as this treatment is
being adopted, not a drop of water should be allowed to touch any part
of the skin surface (no washing of any sort) until healthy action of the
skin has set in, recognised by the falling off of the crops of scabs,
without any raw, ulcerated surfaces.
Is there any danger to the patient from the absorption of the carbolic
acid into the system? So long as the oily solution is used, and no water
allowed to come into contact with the skin, I consider there is little
or no danger, but it is necessary _always to be careful_. Should the
patient be suffering from the absorption of the carbolic acid, you will
find a cold, clammy skin, rapid fall of both temperature and pulse, and
the urine of a smoky _greenish-brown_ colour, and having the odour of
carbolic acid. In many cases of small-pox, but where no carbolic acid
has been employed, the urine becomes smoky-brown, but it has not the
peculiar greenish tinge of where carbolic acid is present. To judge the
odour correctly, the urine should be put into a fresh dish and examined
in some other room, or, what is better, the open air, so that there can
be no mistake, as the air of any house gets so saturated with the odour
of carbolic acid that it is not easy to judge whether the odour is that
of the air or of the urine. If danger from excess of absorption of
carbolic acid is feared, do not give up the treatment, but lower the
strength of the carbolic acid in the oil to 1 in 20, and more or less
limit the number of the applications. But what is far more important,
see that there is abundance of ventilation in the room. I would fear
more from a close chamber and excess of carbolic acid vapour in the air
than the possibility of the excess of acid having been absorbed from the
oil. Remember you are not dealing with a _watery_ solution where there,
I believe, _is danger_, as water, besides quickly evaporating, rapidly
yields up its carbolic acid to the tissues, which too readily absorb it.
Oil but slowly evaporates, and with difficulty parts with the carbolic
acid it holds in solution to the tissues.
All the swabs, mops, &c., of cotton-wool, and the wool itself that may
have been employed in treating a case, should be burnt at once when they
are no longer required.
The blankets and bedding, after a good washing and exposure to sun, will
be found to be free of infection, and may be again with safety employed.
Upon the above principles I have treated the vesicle of vaccination,
with much comfort to the patient, and in most of the cases entirely
prevented the pustular stage.
AITCHISON.
APPENDIX D.
THE CLINICAL THERMOMETER.
The possession of a self-registering Clinical Thermometer in every
household, in a tropical or malarious climate is a necessity, more
especially when at a distance from medical aid. It is a means for
assisting to ascertain most accurately, in a very few minutes, whether a
child or patient is really ill, and the necessity there might be for the
administration of remedies; for calling in other and more proficient
assistance; or to allay anxiety that might have accrued from a nervous
fear, when possibly no actual illness existed.
From one single observation of an _abnormal_ temperature, we learn:
"1. That the patient is really bodily ill.
"2. When there is considerable elevation of temperature, we know that
there is fever.
"3. When there are extremes of temperature, we know that there is great
danger.
"The mean normal temperature of the human body in health is 98·6°
Fahrenheit's scale."[5] This may vary in health, in exceptional cases
from 97·5° to 99·5° Fahrenheit.
The accompanying diagrams represent (_A_) a thermometer that has been
employed, we will say, in a case of Intermittent fever, the Index
showing the temperature to have been 104°; (_B_) a thermometer with the
Index at 95°.
The Index in a Clinical Thermometer is a small quantity of mercury
separated by a bubble of air from the rest of the mercury; or, owing to
the peculiar construction of the glass tube, without any air being
present, a portion of the mercury separates itself from the bulk, and
remains separated in the tube, as an Index. Upon placing the Thermometer
in a favourable situation, in or against the body of a patient, owing to
the amount of heat with which it there comes in contact, the mercury in
the bulb expands, and the Index is pushed up to the highest point in the
Thermometer that the heat of the body at that time is capable of
causing, if the Thermometer is kept in contact with the body for the
requisite time; and when the Thermometer is removed from its contact
with the body, the mass of mercury suddenly cooling down, contracts, and
returns into the bulb, the Index being left behind at the point to which
the heat of the body had forced the mercury in the bulb to raise it;
thus the Thermometer in Diagram A shows that in that instance the Index
had been raised to 104° Fahrenheit and that that was the temperature of
the body at that observation.
In commencing to take the temperature of a patient, first of all see
that the Index is in the position as seen in Diagram _B_, not
necessarily always as low as 95°, but at all events well under the arrow
→, which marks off the mean normal temperature of any one in healthy
viz., 98·4° Fahrenheit, as given in most English thermometers (98·6° as
used on the Continent). The temperature of an infant or young child is
frequently found to be 99° whilst in health.
Supposing a Thermometer is put into any one's hands, reading as at
Diagram _A_ 104°, how is the Index to be replaced to the position it
occupies in Diagram _B_? Hold the Thermometer by its upper end (the bulb
being considered the lower end) then swing it round with your arm,
suddenly stopping the arm with a jerk, this jerk causes the Index to
fall towards the bulb, continue this, and after each jerk see how far
the Index has fallen, when it has got well under the arrow →, the
Thermometer for an ordinary case is ready for use.
When, however, one expects a low temperature, it is best to have the
Index of the Thermometer at or under 95°.
[Illustration: Fahrenheit's Scale.]
How and when to apply the Thermometer. With grown up children and adults
I have always found it more convenient to take the Temperature by
placing the bulbous end of the Thermometer into the mouth under the
tongue, keeping it there, with the mouth, shut, for the requisite time,
the patient in the meanwhile breathing only through the nostrils; with
infants the most convenient place is to put the Thermometer in the
flexure of the thigh, laying one of the thighs somewhat across the
other, but being careful not to allow the clothes to touch the
Thermometer; some prefer to place it in the armpit, or axilla. This I
have not found always as convenient as the other two localities; any of
these, however, is good for the purpose. Use the one you may deem most
convenient, but be careful to keep the clothes from coming into contact
with the Thermometer.
Thermometers are now made with such a rapid action, that at the very
longest they do not now require to be kept in position for more than
three minutes.
Immediately after having made an observation note down the temperature,
along with the time at which the observation was taken; having done so,
and not before, wash the Thermometer, but _not with hot water_, _and
then_ jerk down the Index; so that the Thermometer is ready for future
use. If the reading is in any way a doubtful one, take another
observation at once.
If there is any anxiety connected with the case, it is advisable to take
an observation every three hours, so long as the patient is awake;
_never disturb_ a patient during natural sleep for the purpose.
Ordinarily take an observation two or three times during the day, but at
set hours and at regular intervals, always noting the time.
Whenever the temperature of a patient is found to be below or above the
_normal_ 98·4°, viz., the arrow-mark on the Thermometer, then watch the
case, as one requiring care. If the temperature has fallen as low as
97°, or gone up to 100°, make up your mind that there is something
wrong; be vigilant. But a falling temperature below 97° means danger
from collapse, and a rising one reaching 105° is a dangerous fever heat.
In the last two occurrences remedial agents require to be applied to at
once, and medical assistance urgently asked for.
Along with each thermometric observation, it is advisable to count the
pulse, and the number of respirations [the average number of pulsations
in a minute of a healthy adult are about 72, and the number of
respirations about 16. In _young_ children and _infants_ the number of
pulsations and respirations are usually much higher than in the adult,
and so irregular that to the non-professional their value alone in
diagnosing disease may be considered as doubtful, other signs and
symptoms require to be more carefully studied, and taken into
consideration along with them, and the temperature] that occur during
the minute (the latter is easily done by laying the open hand on the
upper part of the abdomen, and counting the number of _rises_) noting
these, along with the temperature, and the time. Such data, if taken
carefully and at regular intervals of time, form an invaluable means for
assisting the physician in his diagnosis.
EXAMPLE.
+-----------------------+---------+---------+---------+
| | May 17. | May 17. | May 17. |
+-----------------------+---------+---------+---------+
|Time | 9 A.M. | 12 noon | 3 P.M. |
|Temperature | 98·4° | 100° | 100° |
|Number of Pulsations | 72 | 80 | 80 |
|Number of Respirations | 16 | 20 | 20 |
+-----------------------+---------+---------+---------+
AITCHISON.
[Footnote 5] _Medical Thermometry_, by Dr. C. A. Wunderlich, translated
by W. Batherst Woodman, M.D. 1871, p. 6.
APPENDIX E.
List of articles required for carrying out the directions
contained in this work:
A set of Apothecaries' Scales and Weights (with
an extra set of Weights).
1 Wedgwood Pestle and Mortar (medium size).
2 Measure Glasses (up to 6 ounces).
2 Minim Glasses.
1 Imperial Pint (20 ounces) Pewter Measure.
2 Glass Male (Urethral) Syringes.
2 Pewter ditto.
2 Glass Female (Vaginal) Syringes.
1 Metallic ditto ditto (large).
1 Enema Apparatus, fitted with metallic tubes,
&c. Those with India-rubber or Caoutchouc
flexible tubes are to be avoided, as they
readily spoil in hot climates.
1 Self-registering Clinical Thermometer.
2 Earthenware Slabs for mixing Ointments,
Pills, &c.
3 Spatulas varying in size and length.
1 Nest of Wedgwood or Tin Funnels.
1 Nutmeg Grater.
2 Lancets in a case.
3 Yards of best Diachylon or Sticking Plaster (in
tin case).
2 Yards of Lint.
1 Small Actual Cautery Iron.⎫ For snake-bites, advised
1 Sharp Penknife or Scalpel.⎬ by Sir J. Fayrer.
6 Pieces of Whipcord. ⎭ See Appendix B.
MEDICINES.
(These had better be purchased from some good firm of chemists and
druggists.)
All should be kept in glass-stoppered, or well-corked bottles,
protected, as far as possible, from the action of light and heat, and
placed under lock and key; some special person being responsible for
their being given out for use.
(It is as well to note here that _all_ the _Poisonous drugs_ and _their
preparations_ that are being dispensed should be _equally carefully_
cared for, and placed in a special locker of their own, marked POISON,
under a caretaker, who ought to be held responsible for their safe
custody.—_Aitchison._)
Sulphate of Quinine, 2 ounces.
Powdered Ipecacuanha, 8 "
Santonin, 4 "
Bromide of Potassium, 4 "
The following should be marked:
POISON
(To be administered with caution).
Calomel, 4 ounces.
Acetate of Lead, 8 ounces
Opium (in 1 grain pills), No. 200
" as Laudanum, 8 ounces
Liquor Ammoniæ, 8 "
(In a hot climate great care should be taken in handling and opening a
bottle containing Liquor Ammoniæ, as on very little provocation, as
shaking the bottle in trying to remove the stopper, which nearly always
becomes fixed, it is almost certain to burst. The stopper therefore
should be extracted with as little force as possible, and at the same
time care should be taken that the contents do not fly up into the face
and eyes.—_Aitchison._)
The following should be marked:
POISON
(For external application only).
Biniodide of Mercury, 4 ounces.
Blistering Fluid, 4 "
(this is the Liquor Epispasticus of the British Pharmacopœia.)
Carbolic Acid, 2 pints.
(When pure this is solid at a temperature of nearly 102° Fahr., above
that it becomes liquid; before giving it out therefore for use, liquefy
a sufficiency, by placing the _unstoppered_ bottle in the sun, or near a
fire, or in a little warm water, and then from the bottle measure out
the quantity required; in doing so, remember the fact that whilst pure
it is a _severe caustic_.—_Aitchison._)
INDEX OF ARTICLES.
PAGE
Abelmoschus esculentus, 9
Abrus precatorius, 10
Acacia Arabica, 12
„ Catechu, 41
Aconitum heterophyllum, 24
Aconite root, 191
Acorus Calamus, 13
Ægle Marmelos, 25
Affusion, Water, 163
Ajwain Seeds, 130
Aloe Indica, 15
„ litoralis, 15
„ Socotrina, 14
Aloes, 14
Alum, 17
„ Poultice, 18
„ Whey, 18
Am-chur, 245
Ammonia, Hydrochlorate of, 135
Ammonium, Chloride of, 135
Anamirta Cocculus, 48
Andrographis paniculata, 82
Andropogon, Sp. of, 89
Anethum Sowa, 61
Arrack, 150
Arrowroot, 182
Asafœtida, 22
Asteracantha longifolia, 23
Atís or Atees, 24
Azadirachta Indica, 105
Babúl Bark, 12
Bael Fruit, 25
„ Dietetic, 26
Banana Tree, 127
Bananas, Dried, 246
Barleria longifolia, 23
Beef Tea, 180
Bengal Kino, 32
Betel or Betle Leaves, 27
Biniodide of Mercury, 221, 249
Blistering fluid, 288
„ liquid, B.Ph., 147
Blisters, Remarks on, 147
Blue Stone, 49
Bonduc Nut, 28
Borax, 29
Brandy Mixture, 183
Butea frondosa, 32
„ Gum, 32
„ Seeds, 33
Cæsalpinia Bonducella, 28
Calcareous earth, 90
Calotropis gigantea, 97
„ procera, 97
Camphor, 34
„ Water or Julep, 34
„ Liniment, 34
„ Vapour Bath, 35
Cantharides, 146
Capsicum fastigiatum, 37
„ Fruit of, 37
Canara, Vegetable Tallow of, 157
Canarium strictum, 156
Carbolic Acid in Burns, 196
„ in Leprosy, 231
„ in Small-pox, 247-274
„ in Syphilis, 250
„ in Ulcers, 254
Carica Papaya, 120
Carum Ajowan, 130
Caryophyllus aromaticus, 47
Cassia alata, 38
„ lanceolata, 140
Castor Oil, 39
„ Plant, Leaves of, 40
Catechu, 41
Ceromel, 74
Charcoal, 43
„ Poultice, 43
Chaulmúgra, Seeds and Oil, 44
Chavica Betle, 27
Chicken Broth, 180
Chiretta, 45
Chloride of Ammonium, 135
Cinchona Febrifuge, 171
Cinnamon, 46
„ Country, 46
Cinnamomum iners, 46
„ Zeylanicum, 46
Citrus Bergamia, 94
Cloves, 47
Cocculus Indicus, 48
Conjee Water, 134
Cookery for the Sick, 180
Copper, Sulphate of, 49
Country Ipecacuanha, 155
„ Nutmegs, 111
„ Sarsaparilla, 72
Creyat, 82
Croton Tiglium, 52
„ Seeds, 52
„ Oil, 53
Cubeba officinalis, 54
Cubebs, 54
Curcuma longa, 150
Cybium commersonii, 61
Dammar, White, 156
„ Black, 156
Darjeeling Cinchona Alkaloid, 171
Datura alba, 55
„ fastuosa, 55
„ Poultice, 58
„ Epithem, 58
„ Liniment, 59
Dill Seeds, 61
„ Water, 61
Dipterocarpus lævis, 70
Drowning, Treatment of, 261
Egg Wine, 184
Evaporating Lotion, 160
Feronia Elephantum, 26
Fish-liver Oil, 61
Fomentations, Hot Water, 166
Galls, 66
Garcinia purpurea, 83
Ginger, 69
Guilandina Bonducella, 28
Gulancha, 148
„ Extract of, 149
Gunjah in Tetanus, 252
Gurjun Balsam, 70
Gynocardia odorata, 44
Hemidesmus Indicus, 72
Henna Shrub, 84
Hibiscus esculentus, 9
Honey, 74
Horseradish Tree, 96
Hydnocarpus inebrians, 44
Hydrochlorate of Ammonia, 135
Hydrocotyle Asiatica, 75
Indian Hemp in Tetanus, 252
„ Sarsaparilla, 72
„ Spikenard, 79
„ Liquorice, 10
„ Senna, 140
Ipecacuanha, Country, 155
„ in Dysentery, 210
„ as an Emetic, 206
Iron, Sulphate of, 76
Irrigation, 167
Ispaghúl Seed, 125
Jasminum Sambac, 235
Jatamansi, 79
Jatropha Curcas, 124
Jelly, Strengthening, 185
Jinjili Oil, 141
Kala-dana, 80
Kamala or Kaméla, 81
Káriyat, 82
Kerosene Oil, 177
Kino, Bengal, 32
Kokum Butter, 83
Laudanum, 112
Lawsonia alba, 84
Leeches, 85
Lemon-grass Oil, 89
Lemonade, 95
Lime, 90
„ Liniment, 94
„ Saccharated, 91
„ Water, 91
Limes (The Lime), 94
„ Juice of, 95
Liquor ammoniæ, 267-288
Liquor Epispasticus, 288
Liquorice root, country, 10
Mace, 111
Mallotus Phillippiensis, 81
Mangoes, Dried, 245
Margosa Tree, 105
Meat Juice, Raw, 180
Moringa pterygosperma, 96
Mudar, 97
Musa sapientum, 127
Mustard, 99
„ Poultices, 100
Mutton Broth, 180
Mylabris Cichorii, 145
Myrobalans, Chebulic, 103
„ Emblic, 104
Myristica officinalis, 110
„ Malabarica, 111
Nardostachys Jatamansi, 79
Ním Tree, 105
Nitrate of Potash, 107
Nitre, 107
„ Paper, 109
Nutmegs, 110
„ Country, 111
Nux vomica, 239
Oil, Castor, 39
„ Chaulmúgra, 44
„ Croton, 53
„ Fish-liver, 61
„ Jinjili, 141
„ Lemon-grass, 89
„ Nutmeg, Indian, 111
„ Omum, 132
„ Rock, 175
„ Sandal-wood, 139
„ Sesamum, 141
„ Til, 141
„ Turpentine, 151
„ Turtle, 62
„ Wood, 70
Okra, 9
Omum Seeds, 130
„ Oil, 132
„ Water, 131
Ophelia Chirata, 45
Opium, 111
„ Rules for administering, 114
Oryza sativa, 133
Oxide of calcium, 90
Papaver somniferum, 111
Papaw Tree, 120
Pedalium Murex, 122
Pepper, Black, 123
Petroleum, 175
Pharbitis Nil, 80
Phyllanthus Emblica, 104
Physic Nut Plant, 124
Piney Resin, 156
„ Tallow, 157
Piper Betle, 27
„ nigrum, 123
Pish-pash, Puss-pass, 182
Plantago Ispaghula, 125
Plantain, the, 127
Plumbago rosea, 128
Pomegranate Tree, 129
„ Rind, 129
„ Root-bark, 129
Potash, Nitrate of, 107
Proof Spirit, 150
Pterocarpus Marsupium, 32
Ptychotis Ajowan, 130
Punica Granatum, 129
Quinine in Fevers, 217-220
„ in Neuralgia, 238
Quinetum, 172
Raw Meat Juice, 180
Resin of Dammar, 156
Rice, 133
„ Flour, 134
„ Milk, 181
„ Poultice, 134
Ricinus communis, 39
Ringworm Shrub, 38
Rock Oil, 175
„ Salt, 178
Sago, 182
Sal Ammoniac, 135
Saltpetre, 107
Sambac Flowers, 235
Sandal-wood Oil, 139
Santalum album, 139
Santonin, 259
Sarsaparilla, Country, 72
Sat-giló (_Hind._), 149
Seir, 61
Senna, 140
Sesamum Indicum, 141
„ Oil, 141
Shark, white, 61
Sinapis juncea, 99
Sison Cordial, 131
Snake Bites, Treatment of, 266
„ Prevention of, 268
Soda, Biborate of, 29
Spikenard, Indian, 79
Squalus Carcharias, 61
Strengthening Jelly, 185
Sugar, 173
Sulphate of Copper, 49
„ Iron, 76
Sulphur, 143
„ Ointment, 143
Sweet Flag Root, 13
Tallow, Vegetable, 157
„ Piney, 157
Tamarinds, 145
Tamarindus Indicus, 145
Telini Fly, 145
Terminalia Chebula, 103
Thermometer, Clinical, 280
Til Oil, 141
Tinnevelly Senna, 140
Tinospora cordifolia, 148
Toddy, 149
„ Poultice, 149
Tourniquet, Stick, 224
Turmeric, 150
Turpentine, Oil of, 151
„ Enema, 153
„ Epithem, 152
„ Liniment, 154
„ Ointment, 154
„ Stupes, 152
Turtle Oil, 62
Tylophora asthmatica, 155
Vapour Bath, 168
Vateria Indica, 156
Vernonia anthelmintica, 157
Vinegar, 158
Water, 161
„ Affusion, 163
„ Fomentations, 166
„ "Irrigation", 167
„ Dressing, 167
Wax, 169
„ Ointment, 169
Wet Sheet, the, 169
White Wine Whey, 184
Wine, Egg, 184
„ Whey, 184
Wood Apple, 26
„ Oil, 70
Yeast Poultice, 150
Zingiber officinalis, 69
_Printed by_ BALLANTYNE, HANSON & CO.
_London and Edinburgh_