_Symptoms._—In man the feet are the part_Hints to Travellers, Scientific and General, Vol. 2 Tenth edition, revised and corrected

chiggers being found between the toes and under the toe nails. When

people sleep on the ground other parts of the body may become affected

and large numbers of chiggers may be present at one time. There is

itching and irritation at the place of invasion, and when the latter is

examined a little dark dot will be seen. This is the posterior end of the

female flea, which is lying head downwards in her burrow. If not removed

suppuration occurs round her distended abdomen and the skin gets much

inflamed and swollen. When the eggs have been discharged ulceration takes

place and the flea is expelled. A small sore, however, is left which is

very liable to get contaminated, and, if neglected, may lead to very

severe complications.

_Prophylaxis._—Do not camp in the neighbourhood of native villages. Clean

the camping ground thoroughly and, if necessary, fire it. As insecticides

flaked naphthalene or a strong infusion of native tobacco are useful.

The latter may be used inside boots or shoes. Walking bare-foot should

be avoided, as should sleeping unprotected on the ground. In the case

of native carriers or porters a daily foot-parade should be instituted.

Some protection is afforded by smearing the feet, especially the spaces

between and under the toes, with a preparation like phenofax or with a

mixture of five drops of lysol or cresol and an ounce of vaseline.

_Treatment._—It is usually better to get a native to remove a chigger

as long practice makes them very expert in the little operation. The

latter consists in widening the skin orifice with a sharp clean needle,

and freeing the flea from the surrounding tissues in order to get it out

whole. If it ruptures forceps must be employed, and this is much more

painful and difficult than extracting the entire insect. The infected

parts should be carefully treated antiseptically.

_Fungus Diseases._—There is a great number of tropical diseases due to

fungi but only a few can be considered here, and these only very briefly.

(1) _Dhobie Itch_ is one of the best known and is so called because it

was thought to be derived from clothes infected by the persons (dhobies)

who washed them. The parts usually attacked are the groins, the upper

part of the thighs and the armpits. The condition is due to a fungus like

that of ringworm and the skin becomes red and raised and somewhat scurfy.

Dhobie itch causes great irritation and is sometimes associated with

considerable pain.

_Treatment._—Mild cases are best treated by using an ointment containing

resorcin two drachms, salicylic acid ten grains, and vaseline and

lanoline, of each four drachms. The parts may be painted with iodine but

this is somewhat irritating. An ointment of ammoniated mercury, two to

five per cent., is often effective. Bad cases require the application

of araroba (chrysarobin) ointment, but it should not be used unless

recommended by a doctor. Goulard water or Wright’s liquor carbonis

detergens (one tablespoonful to two pints of water) are soothing

applications.

(2) There is a fungus disease of the hairs, especially of the armpits

and the pubis, which occurs in tropical climates and is often very

troublesome. The hairs assume a coated, beaded or nodular appearance and

the deposit on them varies in colour and may be black, yellow or red.

The underclothing in contact with the affected parts becomes stained

and when the disease spreads to the skin, as it often does, the latter

becomes inflamed, thickened and painful.

_Prophylaxis._—Keep the axillae shaved. It is always well to do so in a

tropical climate. Failing this, dust with a mixture of powdered sulphur

and fuller’s earth, equal parts. Change the underclothing frequently and

bathe the parts liable to infection.

_Treatment._—Apply twice daily a lotion containing one drachm of formalin

in six ounces of rectified spirit, and at night rub in a two per cent.

sulphur ointment. If these measures fail apply tincture of iodine, except

in cases where the skin is involved. In such cases bathe with cold water

and employ a dusting powder or a soothing lotion.

(3) _Ringworm_ of the head is a disease due to a fungus. The part for

some distance round the affected area should be shaved, and any stumps

of hairs pulled out. The skin should be lightly painted with tincture

of iodine or strong solution of carbolic acid (one in ten of water); or

sulphur, white precipitate, or mercurial ointment may be gently rubbed in.

_Kraw-Kraw._—This is a term commonly employed by natives of the West

Coast of Africa to indicate almost any kind of itchy, papular, or

pustular eruption. Many of these appear to be contagious, and most of

them are best treated by opening up any pustules which may be present,

removing crusts by boric poultices, and scraping ulcers. Then scrub

thoroughly with sublimate lotion 1 in 1,000, dust with boric powder and

apply a dressing of medicated vaseline. The application should not be

disturbed for a week when, as a rule, the skin will be found to have

healed up. Clothing and any other articles which have been in contact

with the affected parts should be destroyed or thoroughly disinfected.

_Prickly Heat._—This condition is very frequent, especially in the moist

tropics. It is due to free sweating, and is accompanied by intense heat

and itching. The parts closely covered by clothing are specially apt to

be affected. The skin becomes covered with numerous slightly inflamed

papules, set close together, and the eruption may remain for months at a

time, varying in intensity according to circumstances.

_Prophylaxis._—Avoid long drinks, warm clothing, too much exercise, and

all conditions producing excessive perspiration. Sea-bathing should

be avoided, and soap should not be used in the bath. One should sleep

under as hygienic conditions as possible, with a well-ventilated bed and

without unnecessary clothing. A dusting powder of equal parts of boric

acid, oxide of zinc, and starch is useful.

_Treatment._—Ryan strongly recommends the so-called “Sulphaqua” bath

charge, which is sold in packets ready for use. The above-mentioned

dusting powder is helpful, as is the application of a lotion containing

salicylic acid and spirit. Some prefer oily applications. Whatever is

used, care should be taken to see that the bowels are well opened at the

beginning of an attack, preferably by a saline purge.

_Ulcers._—Ulcers are often very troublesome to the traveller, as the

healing process is frequently retarded by exposure, dirt and dust, and

the chafing of clothes. Want of sufficient animal food greatly favours

the spread of large ulcers.

A simple dressing of iodoform ointment, or ointment of boric acid, is

effective when the ulcer can be protected, and rest can be given to the

affected part. When the ulcer is deep and large it may be stimulated to

heal by the application of lint or cotton-wool, moistened with carbolic

oil, carbolic lotion, or other antiseptics.

Large, unhealthy ulcers should be well bathed with some antiseptic such

as carbolic acid, one in sixty of water, or a solution of chinosol (1 in

600); and after the sore has been cleansed it may be lightly dusted with

iodoform and then covered with a piece of lint moistened with carbolic

oil or smeared with iodoform ointment and supported by an evenly applied

bandage. Boric ointment, lano-creoline, izal ointment or other antiseptic

dressing may take the place of iodoform ointment.

In addition to the above general account, certain conditions leading to

ulceration require consideration.

_Oriental Sore._—This condition is commonly known as Baghdad Boil, Aleppo

Button, Frontier Sore, etc. It occurs in various hot countries, such

as Egypt, Syria, Asia Minor, Arabia, and Mesopotamia, and has been met

with in Europe and Greece. A special form affecting both skin and mucous

membranes is widely distributed in South America.

_Cause._—The cause is an organism to all appearance identical with that

which produces leishmaniasis or kala-azar. Indeed, Oriental sore is a

form of cutaneous leishmaniasis. In all probability infection is conveyed

by sand-flies, but our knowledge is still defective on this point.

_Symptoms._—The incubation period varies from a fortnight to a year. The

sore may occur on any exposed part of the body, but is most common on the

forearm, hands, and face. Multiple sores are frequent. The first sign is

a small red, scaly papule, which increases in size and eventually breaks

down, forming a painless ulcer, with a hard, dry edge. Non-ulcerating

forms occur, but are not common. The condition is very chronic, but

healing usually sets in after six to twelve months. When the ulcer heals

a white or pink scar is left, which is disfiguring.

_Prophylaxis._—Sleep under a sand-fly net, containing 22 holes to the

linear inch. Warn against the danger of infection by personal contact and

the risk of re-infecting oneself by scratching. It is advisable to paint

the sites of all fly and insect bites with iodine as soon as possible.

_Treatment._—The best treatment at present known is intravenous injection

of tartar emetic. This, of course, can be carried out only by a medical

man. Good results have, however, been obtained by applying a 2 per cent.

ointment of tartarate of antimony, and this method can be carried out by

the patient himself. Local injections of emetine have been recommended,

and there are various other ways of treating Oriental sore, but they need

not be here considered.

_Tropical Ulcer._—This is a special and serious form of ulcer found in

all parts of the world, and especially amongst East African natives. It

is found chiefly in the lower third of the leg and in the region of the

foot and ankle.

_Cause._—This is somewhat obscure, but it is believed to be due to

certain organisms possibly acting in association with one another.

_Symptoms._—The condition starts as a small, tender, and often itchy

papular bleb, surrounded by a dense inflammatory zone. An ulcer results,

which is more or less painless, and one of the characteristics of which

is the way it spreads and destroys all the tissues with which it comes

in contact. It is often mistaken for a syphilitic ulcer, but it does not

usually yield to anti-syphilitic remedies.

_Treatment._—The best remedy would appear to be formalin, though the

iodoform ointment mentioned under ulcers may aid the condition. It can be

effectually treated only by a medical man.

_Veldt Sore._—This condition, which is also known as Barcoo Rot, is

frequently in evidence in countries with hot, dry climates, as, for

example, Egypt, Palestine, South Africa, Mesopotamia, etc.

_Cause._—It is due to certain bacteriological organisms, and is apt to

occur in persons who are debilitated, who are not receiving proper food,

or who are living under conditions where it is not easy to keep clean.

Some think the sores are commonest in men who have to deal with horses.

_Symptoms._—Veldt sores are most common on the hands and forearms. They

begin as itchy papules, which become blebs, then pustules, and finally

ulcers. They are usually multiple, and when they heal they leave areas of

thin, glossy skin.

_Prophylaxis._—As for boils.

_Treatment._—The spread of ulcers can be checked by removing the hairs

from their bases and round their margins. Very often the ulcer can

be started on its healing process by employing dressings soaked in a

solution of 1.5 per cent. sodium citrate and 20 per cent. common salt.

Vaccines are often successfully used in this condition, and the stannoxyl

mentioned under boils may be employed, as may a salicylic acid ointment,

20 grains to the ounce.

_Sleeping Sickness._

This is the old “Negro lethargy,” and must not be confounded with what is

now called sleeping sickness in the British Isles and on the Continent,

which is quite a different disease. True sleeping sickness is limited to

Africa, and there are two chief types: that occurring in parts of the

West Coast and the French and Belgian Congos, in Angola, in portions

of the Anglo-Egyptian Sudan, in Uganda, and in parts of the Tanganyika

territory; and that which occurs in Northern Rhodesia, Nyasaland,

Portuguese West Africa, and the region of the Rovuma River.

_Cause._—The cause is a tiny animal blood parasite conveyed from the sick

to the healthy by certain species of tsetse flies. In the tsetse fly the

parasite, which is called a trypanosome, undergoes a definite development.

The two species of tsetse fly meriting special consideration here are

_Glossina morsitans_ and _Glossina palpalis_. The former, as a rule,

occurs in thin, deciduous bush, or low, comparatively open forest, while

the latter haunts the neighbourhood of streams and lakes, and is rarely

found any great distance from the water edge. These flies are about the

size of a small blue-bottle, but are not so stoutly built and, when

closed, their wings overlap and project beyond the end of the abdomen.

_Glossina morsitans_ is brownish coloured, with bands on its abdomen.

_Glossina palpalis_ is much darker, indeed almost black-looking. They

have a quick and darting flight, and are attracted by rapidly-moving

objects, like motor-bicycles and motor-cars. Once they alight they do not

move about. As a rule they bite only during the day, but they may attack

man on bright moonlight nights.

_Symptoms._—The incubation period is probably about three weeks. The

fly bite may be painful; and causes a slight local irritation. The

disease begins insidiously, with an irregular fever, and there may be

a skin eruption. The fever comes and goes, and the patient gets weaker

and suffers from headache. The glands in his neck and possibly in other

parts of his body become enlarged and may be tender. The first stage

of the disease is called trypanosome fever, and may end in recovery.

More usually the central nervous system becomes affected, and then the

symptoms of true sleeping sickness develop, slowly or with considerable

rapidity. The patient becomes dull and drowsy. Both his speech and

movements are affected. His face gets puffy, and he shuffles when he

walks. He still has fever, continues to lose flesh, and gradually passes

into a sleepy condition, which may be associated with convulsions. Saliva

dribbles from the lips, and half-masticated food may remain in the

mouth. The patient becomes helpless and indifferent to his surroundings,

and either dies from coma or from some intercurrent disease, such as

pneumonia or dysentery.

_Prophylaxis._—Personal prophylaxis consists in avoiding being bitten by

tsetse flies. When passing through fly belts in affected areas veils and

gloves may be worn.

_Treatment._—If taken in time sleeping sickness can be readily cured by

the use of the arsenical preparation atoxyl, combined with antimony. The

course of treatment, however, extends over a considerable period, and it

must be carried out under the supervision of a medical man.

_Sleeplessness._

This is common in those broken down by malaria, dysentery or debilitating

diseases; it is also induced by the irritation caused by mosquitoes and

other pests, such as the itch parasite. It is at times due to errors of

diet, prickly heat, mental worry and exhaustion, abuse of tea and coffee,

coldness of the feet and indigestion, and as most acute diseases are

worse at night, sleeplessness is very common amongst sick people.

_Treatment._—As far as possible remove the cause; kneading the feet and

legs, or the application of a hot-water bottle to the feet, will often

be of service. A cup of hot milk or soup should be taken at bedtime, and

again on waking in the night. The bowels must be regulated and alcohol

taken very sparingly.

The taking of sedative drugs should be avoided as much as possible. The

least harmful of these is sulphonal in doses of from twenty to thirty

grains, given several hours before bedtime, or bromide of potassium in

twenty or thirty-grain doses given at bedtime. A warm bath at night often

acts more satisfactorily than any other remedy. Only very rarely should

chloral, chlorodyne, or opium be resorted to.

Regular habits and plenty of work are potent factors in the production of

that healthy condition which predisposes to natural refreshing sleep.

The unfortunate man who has no hard work to do, who is without even a

hobby to occupy him, and has no interest in life but the torpid condition

of his liver, is a constant sufferer from insomnia. He should be purged

and put on a light plain diet. Alcohol must be forbidden and plenty of

exercise must be taken. A tumblerful of hot water is to be taken the

first thing in the morning and the last thing at night.

_Small-pox._

Very prevalent in the tropics, hence the importance of revaccination

before going abroad.

Incubation period, twelve days. Rash appears third day.

_Rash._—Before the appearance of the typical rash there are occasionally

earlier rashes, viz., a diffuse blush covering the whole body, resembling

scarlet fever, or a dark purple rash of effused blood beneath the skin of

the lower part of the belly, or occasionally in the armpit. The small-pox

rash proper consists of small red raised spots which first appear on

the face, forehead, and scalp, subsequently coming out over the rest

of the body, commencing at the top and working downwards. These spots

become prominent, and have a characteristic “shotty” feeling under the

finger. On the third day after their appearance a small bleb forms in

the centre of each spot; it is transparent at first, but subsequently

becomes yellowish, from the formation of matter in its interior. The

centre becomes depressed on the sixth day, then the bleb breaks down,

and discharges matter. Two or three days later the spot begins to dry

up, and ultimately heals under a scab. During the period of most active

inflammation the face may be very swollen and sodden.

The spots and pustules are not confined to the skin, but may occur on the

roof of the mouth and in the throat.

_Prophylaxis._—This consists in efficient vaccination, and as travellers

may themselves have to carry out the technique of vaccination, it is

important they should know something about it. The usual faults in

technique are a lack of cleanliness, resulting in sepsis, the use of

too strong an antiseptic when cleaning the skin, over-heating of the

lancet, needle or scarifier when purifying it, drawing too much blood,

which washes away the lymph, exposure of the recently vaccinated area

to the hot sun, and charring of the lymph in the capillary tube when

sealing. All that is necessary is to clean the part to be vaccinated with

soap and water, using a nail-brush, then rub the skin with alcohol, and

when the latter dries proceed with the little operation. There should

be four incisions, and the total area which will eventually be occupied

by the vaccine vesicles should not be less than half a square inch. It

may be noted that the vesicle is fully ripe on the seventh day after

vaccination.

_Treatment._—Isolation, similar to that of scarlet fever. The body may be

sponged and vaseline applied if there is much itching. The eyelids and

eyes should be frequently washed with weak boric acid solution.

_Snake Bite_ (_see_ p. 281).

_Sprue._

This is a chronic form of tropical diarrhœa, often called “white

diarrhœa,” the leading symptom of which is the frequent passage of large,

frothy, and pale-coloured motions; dyspepsia, and soreness of the tongue

and mouth, are also present, and there is marked anæmia and advancing

debility. The disease may follow attacks of diarrhœa or dysentery.

_Cause._—The actual cause of sprue is unknown, but the disease usually

develops in persons who have been for some considerable time in the

tropics, and it is commoner in India, Ceylon, and the Far East than

elsewhere.

_Treatment._—Put the patient to bed, give a simple aperient such as

castor-oil, to clear out the bowels; allow only a milk diet, to which, as

the symptoms begin to abate, meat juices and jellies should be cautiously

added. If any other disease, such as scurvy, is present, it must be

treated. Drugs are not usually of much service; however, a mixture

containing bismuth, soda, and one drop of carbolic acid in an ounce of

gum-water may be given three times a day for a week. The soreness of

the mouth and tongue may be treated by the application of borax and

glycerine, or mild antiseptic mouth washes, such as a weak solution of

permanganate of potash, or a lotion of boric acid. Special symptoms,

such as pain and collapse, must be treated as they arise. As soon as the

patient is strong enough, he should be removed to a temperate climate.

_Stroke, or Apoplexy._

This disease is caused by the rupture or blocking up of one of the

blood-vessels in the brain.

_Symptoms._—The person attacked falls down suddenly, and is unable to

move one or more of his limbs. He may be quite insensible, or soon become

so, or perhaps he is unable to talk. The mouth may be drawn to one side,

and the tongue, when protruded, be pushed to the right or left. The

condition is serious.

_Treatment._—Tight clothing must be removed. Six grains of calomel powder

should be placed on the back of the tongue, and the patient kept lying

on his back with the head slightly raised. Cold should be applied to the

head and a hot-water bottle to the feet, the room darkened, and absolute

quiet observed. An enema of hot water may be given, and while the patient

is insensible the lips should be moistened only with water. Food may be

given by the bowel on the second or third day. Stimulants are absolutely

forbidden. If the patient gets over the attack he ought to be sent home.

_Note._—It must not be forgotten that many of the above symptoms might be

caused by injury or poison.

_Sun-Stroke and Heat-Stroke._

These conditions are distinct. Sun-stroke, which is comparatively rare,

is due to the direct action of the sun on the brain and spinal cord.

Heat-stroke, on the other hand, would appear to be due to the lack of

escape of heat from the body, owing to insufficient evaporation from

the skin, and to the effect of muscular fatigue. As a result, poisonous

substances accumulate and act detrimentally upon the nerve cells. There

is also a deficient supply of oxygen to the blood. High relative humidity

plays a very important part in producing attacks of heat-stroke. The

milder forms are known as Heat exhaustion and Heat prostration; the

severe form is often associated with true sun-stroke.

_Symptoms._—Heat exhaustion is really a form of faintness, and recovery

soon takes place after a rest. The symptoms of heat prostration are

giddiness, often associated with nausea. The patient is bathed in a

clammy sweat, his pulse is thready, his breathing shallow, and, it

may be, sighing. The condition may pass into unconsciousness, but the

temperature is not raised, and death rarely results.

There are two kinds of true Heat-stroke; one a form with high

temperature, the other what is called Heat cramp, which is common amongst

ships’ firemen in the tropics. An early warning sign of heat-stroke is

a desire for frequent micturition, and other premonitory symptoms are

a dry skin, giddiness, drowsiness, headache, and intolerance of light.

The pulse becomes quick and irregular, the skin is hot and dry, and

the temperature elevated. The patient may become comatose, or exhibit

delirium or convulsions. There is an asphyxial type, in which the face

becomes cyanosed and the breathing is in abeyance.

_Prophylaxis._—Avoid severe exercise in a hot sun. Wear suitable

clothing, which should be loose and easy, and protect the head, and

especially the nape of the neck, from the sun’s rays. Dark or tinted

glasses are useful. Water should be taken freely, and the bowels kept

open; but alcohol must be avoided. Sniffing a mixture of water and

vinegar and damping the face are helpful measures.

_Treatment._—In the case of Heat prostration the patient should be laid

in the shade on his back, his clothes should be loosened, his limbs

massaged, and, if he is collapsed, stimulants in the form of ammonia

or camphor should be administered. The asphyxial type of heat-stroke

can only be treated by means of artificial respiration, which may have

to be continued for as long as a couple of hours. The ordinary form,

which has been called the paralytic type, must be treated promptly and

vigorously. One must aim at reducing the temperature, getting rid of the

toxic material in the body and preventing heart failure. Probably the

best way of treating the condition as an emergency is to lay the patient

naked on an inclined plane and drench him with cold water. When doing

so it is well to take the rectal temperature, and to stop this chilling

process when the thermometer registers 102° F. After the drenching wrap

the patient in blankets and apply hot bottles to the trunk and limbs. An

ice bag, if available, should be applied to the head, which in any case

should be swathed in cold cloths. It should be noted that in the absence

of ice, a sheet soaked in cold water or dilute alcohol, over which a

draught of air plays, is a useful substitute. A fan may be used to create

the air draught. Auxiliary methods of treatment can be efficiently

carried out only under medical supervision. As soon as the patient has

recovered somewhat, a dose of calomel should be given, followed by

salines.

_Syphilis._

Syphilis, or the Pox, is an infectious venereal disease, nearly always

communicated by direct contagion. The course of the disease is marked by

a primary sore, the chancre; early constitutional (secondary) symptoms,

and late constitutional (tertiary) symptoms.

In primary syphilis the disease is limited to the part or organ

originally infected, and the glands connected with that spot. After an

incubation period of from three to six weeks a small painless pimple

appears at the seat of infection; it breaks down, and forms a small ulcer

from which oozes a little watery fluid. The base of the ulcer and the

skin surrounding it are hard like gristle. The nearest glands, usually

those of the groin, enlarge and occasionally become tender. Unless badly

neglected, the original sore gradually heals and the glands resume their

normal size. Secondary symptoms now make their appearance. These are

fairly definite, and comprises (_a_) A skin rash, consisting of numerous

irregularly shaped copper-coloured spots, spread over the face, upper

part of the chest, the loins and the back of the arms. They do not itch.

(_b_) Moist lumps and warts form in the crutch, around the scrotum

(purse) and the outlet of the bowel. (_c_) Ulcerated sore throat. Large

deep ulcers form on each tonsil, having ragged undermined edges. (_d_)

Iritis or inflammation of the eye may also occur. These symptoms, even

if untreated, tend to heal, but always leave more or less marked traces

behind.

The discharge from either primary or secondary sores is infectious and

may convey the disease, so that great care needs to be taken in handling

such sores.

After an interval of apparent health, lasting perhaps only a few months,

but often for a year or two, the tertiary symptoms or “reminders” make

their appearance. These take the form of localised swellings, which soon

break down, forming deep ulcers, and if untreated, produce extensive

destruction of the part involved, with much deformity.

_Prophylaxis._—The methods available are now so well known that they

need not be discussed in a work of this kind. Mention need merely be

made of the fact that in some foreign countries, owing to unhygienic

conditions, there is a greater liability to contract the disease by what

may be called unusual methods, and therefore every care should be taken

to prevent such sources of infection, as, for example, the contaminated

seats of closets, etc.

_Treatment._—As soon as the disease is recognised, the treatment must be

commenced.

Local treatment.—Keep the sore perfectly clean by washing it with an

antiseptic solution such as chinosol (1 in 1000). Between the washings,

dress it with a piece of lint soaked in “black wash,” or dust it with

iodoform powder and cover it with a piece of lint smeared with boric

ointment.

For the sore throat, use an antiseptic gargle (_see_ Ulceration of

Throat, p. 244).

General treatment.—The patient must be put on a course of mercury at

once. Calomel, one grain twice a day, or grey powder, one grain three

times a day, must be administered, and continued until skilled advice

can be obtained. The effect of the mercury must be carefully watched,

and if the patient complains of soreness of the gums, a coppery taste in

the mouth and excessive flow of saliva, the dose must be reduced or the

administration of the drug stopped until these symptoms have disappeared.

If the calomel or grey powder causes looseness of the bowels, five grains

of Dover’s powder may be added to each dose.

In some cases, the addition of three grains of the iodide of potash to

each grain of calomel does good from the very first.

For the later symptoms, continue the mercurial treatment, and give at

least five grains of the iodide of potassium three times a day.

Since the above was written the whole treatment of syphilis has been

revolutionized by the introduction of certain organic arsenic compounds

as therapeutic agents. Of these the best known is the German salvarsan,

represented in this country by kharsivan, the so-called “606.” Treatment

with arsenic has now largely replaced the old method with mercury; but it

cannot be carried out except by one having medical training, and so need

not be further considered.

_Tick Fever._

One of the diseases which may be produced by the bites of insects is a

form of fever, conveyed by the bite of a tick, which is common in many

parts of Africa. This produces a series of symptoms which are similar to

those found in the disease known as relapsing fever, which has been known

to occur even in the United Kingdom, and which used to be called “famine

fever” (_see_ p. 218).

_Cause._—The cause is a corkscrew-shaped organism found in the blood,

and its vector is the tick above mentioned, which in its adult state and

unfed is roughly about the length of a finger-nail, that is, four-tenths

of an inch. It is of a greenish brown colour, and is covered by a

leathery integument, which looks as if it was spotted all over and which

is grooved in several places. When the tick is gorged, these grooves

disappear. A gorged female tick may be well over half an inch in length,

and very nearly of an equal breadth.

The tick lives in native houses and in rest houses, especially along

caravan routes. At night it sallies forth in search of blood, but during

the day it conceals itself in cracks and corners in the walls and floors,

and sometimes in cracks in native wooden bedsteads. Its bite is painful,

but the infection takes place not through the bite, but as a result of

the infected excreta of the tick contaminating the tick bite. One tick is

sufficient to cause infection.

_Symptoms._—The chief symptoms are those of a severe attack of fever,

ushered in by a shivering fit and acute symptoms such as are usually

found in cases of fever, for example, pains in the back and limbs, rapid

pulse, and sometimes severe vomiting and diarrhœa, frontal headache, and

painful bloodshot eyes are rather characteristic. The fever, which is

of the relapsing type, generally keeps up for about a week, after which

there may be an interval without fever for a few days, to be followed

later on by another attack of fever. There are usually several relapses.

As many as eleven have been noted.

_Prophylaxis._—Avoid sleeping in native huts and rest houses which have

been occupied by natives. Do not sleep on the ground or on wooden native

bedsteads. If the latter have to be used, their legs should be smoothed

to prevent ticks from climbing up them. In badly infested places, it is

well to employ a hammock. A mosquito-net is useful, as it excludes the

ticks; and it is well to make use of a night-light, which also keeps

them away. Packs and blankets should be periodically inspected to see

that they do not harbour ticks. If one has to camp on an infected area,

the ground should be fired and the floors of huts dug up and thereafter

removed and buried or treated with fire, care being taken that the ticks

do not escape during the process. Wandering ticks can be kept away from a

tent to some extent by digging round it a trench and filling it with wood

ashes.

_Treatment._—This is mainly symptomatic. Careful nursing is required

together with a light diet. In some cases the arsenic preparation known

as salvarsan (kharsivan) is found of value, but the specific treatment

of this malady can only be carried out by a medical man. In many cases

digitalis or strophanthus is required, owing to the risk of heart failure.

_Typhus Fever._

This disease is not so common in the tropics, but in certain sub-tropical

countries, such as Egypt, it frequently occurs, and it is of course

closely associated with military operations in the field.

_Cause._—The exact nature of the infection is as yet unknown, but the

disease is transmitted by lice, both the head and the body louse having

been proved to be carriers of the virus.

_Symptoms._—Incubation period 5 to 14 days, as a rule 12 days. Symptoms

vary, but at first somewhat resemble those of an influenzal attack

without the cold in the head. The patient is feverish and uncomfortable,

but not until the third day do the typical symptoms of typhus make

their appearance. Then the patient’s face becomes flushed and his eyes

congested, his pulse rate increases, and very soon his temperature rises

and runs up to 103 or 104° F. The rash, which varies in type, generally

appears on the fifth day, being found first on the upper part of the

abdomen. It does not occur upon the face, but is usually very profuse on

the back. If the rash develops the patient becomes seriously ill, and all

his symptoms are intensified. He becomes dull and lethargic, his mouth is

foul, and his general aspect is somewhat like that of a drunken man. His

voice becomes husky, his hands are tremulous, and his breathing is rapid.

In the second week, in most cases, he becomes delirious or comatose, and

lies in bed more or less like a log. In cases that recover, improvement

sets in about the fourteenth day, and is usually rapid and complete.

In cases which die the temperature remains high or rises, the general

condition becomes worse, and death usually takes place from heart failure.

_Prophylaxis._—Get rid of lice according to the methods detailed on

page 196. Those attending typhus patients should be protected from lice

by wearing overalls, etc. Patients suffering from typhus should be

thoroughly cleansed, their hair cut or shaved, and completely cleared of

lice. Bedding and clothing must be disinfected.

_Treatment._—Good nursing is of more importance in this disease than the

administration of drugs. The mouth must be kept in a good condition,

and the food must be strengthening, nourishing soups being indicated.

It is important to give the patient as much fresh air as possible, and

as a rule he will require stimulants, especially heart tonics such as

digitalis or strophanthus. Other measures can be carried out only under

medical supervision.

_Ulceration of the Throat._

Gargle with a weak antiseptic solution such as permanganate of potash or

chinosol. An astringent gargle may be made by dissolving five grains or

more of tannin in two ounces of hot water. Sulphate of iron can be used

for the same purpose, two grains or more to an ounce of water. If there

is much pain, apply poultices to throat.

If due to syphilis give one grain of calomel and three grains of iodide

of potassium, twice a day, in addition to the local treatment. Kharsivan,

or similar treatment, is also indicated (_see_ p. 240).

_Undulant (Malta) Fever._

The term Undulant Fever is applied to Malta Fever partly because the

latter is not a good name, as the disease occurs in various parts of the

world, and partly because the term Undulant affords a good description of

the type of the temperature curve.

_Cause._—The organism is a small bacterium, which is found in the blood

and tissues. Although theoretically the disease can be spread like

enteric fever or dysentery, in practice it is found that it is nearly

always conveyed by infected goats’ milk. Goats are apt to harbour the

organism and excrete it in their milk. It is also found in certain milk

products, such as cream and cheeses which are not allowed to ripen. In

addition to man and goats, cows, sheep, horses, mules and dogs, are all

liable to natural infection.

_Symptoms._—Incubation period 5 to 15 days. The disease begins with

headache, malaise, anorexia, and sleeplessness. The patient is usually

constipated, and there is tenderness in the splenic region, the spleen

being enlarged at an early date. The temperature rises gradually for

three or four days in a step-like manner, and then falls by a similar

descent, reaching the normal on or about the tenth day. At this early

stage bleeding from the nose may occur, and profuse night sweats are not

uncommon. The tongue is flabby and coated. When the temperature falls

the patient feels better for a few days, but is still apt to suffer

from night sweats, and continues to lose flesh. A relapse occurs, and

is usually accompanied by joint troubles and sometimes neuralgic pains.

A series of febrile waves continues to follow each other at short

intervals, and the illness is a very wearisome one, running an average

course of 60 to 70 days. It may, however, extend for nearly a year,

and in some cases terminates fatally. The long course of the illness

results in the patient becoming anæmic, and he often suffers from mental

depression. There are irregular forms of the fever which are apt to be

puzzling, and it is always well to remember that any cases of prolonged

pyrexia from tropical or sub-tropical regions may be Malta fever.

_Prophylaxis._—Avoid drinking goats’ milk and eating the local products

of such milk. If goats’ milk must be drunk it should be boiled. General

hygienic measures are also important, and it should not be forgotten that

the organism of the disease is found in urine, which should therefore be

disinfected.

_Treatment._—This is for the most part entirely symptomatic. Medical

attention and good nursing are essential. A vaccine has been introduced

and is worth trying, but vaccine treatment is best left to an expert.

It is sometimes necessary to give morphia for the joint pains and the

neuralgia, but there is a distinct risk of the patient’s acquiring the

morphia habit. Sleeplessness, which is often troublesome, should be

treated as indicated on page 235.

_Urine, Retention of._

Retention of, or inability to pass the water may be caused by stricture,

injury, shock, spasm, inflammation of some part of the passage, the

effects of drinking, or by chill.

_Symptoms._—The bladder is unable to expel its contents and it gets

fuller and fuller; it can be felt in its distended condition as a

painful, soft swelling in the lower part of the belly, below the navel,

underneath the skin and muscles. There may be fever, great pain and

constant desire to pass water, with inability to do so. When the bladder

becomes greatly distended, there is usually slight dribbling of water,

which is somewhat misleading, as the case may be considered, not one of

retention but rather of too frequent passing of urine.

_Treatment._—Give a saline purge such as Epsom salts, three or four

teaspoonfuls, and let the patient sit in a bath of hot water. If not

relieved very quickly, then pass a _clean_ catheter into the bladder, and

allow it to empty itself (_see_ Catheters, p. 272). After the bladder has

been emptied put the patient to bed and give a dose of opium or bromide

of potassium to procure rest. When he desires to pass water again let him

have another bath, and if this is not effectual, again withdraw the water

through a catheter. Patient should be careful to ward off further attacks

by avoiding chills, over-drinking, and other exciting causes. If there is

inflammation of the bladder, copaiba or sandal-wood capsules should be

used; if the urine is irritating, bicarbonate of soda must be given.

_Urine, Suppression of._

In this serious condition no urine is secreted by the kidneys, so that on

passing a catheter the bladder will be found to be empty.

_Causes._—Shock from injury, inflammation and blocking up of the kidneys.

Suppression of the urine is a common complication of severe cases of

blackwater fever.

_Treatment._—Hot baths, hot poultices to the loins, free use of

aperients, especially Epsom salts and other saline purges. Bicarbonate of

soda in full doses. Keep the skin acting freely by means of sweet nitre,

or Warburg’s tincture, or five-grain doses of antipyrine. Injections of

hot water into the lower bowel.

_Worms._

Worms are introduced into the system chiefly by means of dirty water or

imperfectly cooked food.

In the case of hook worms (ankylostomes), contaminated soil is the chief

medium of infection.

Of the worms which live in the bowels the most important are the

following:

_Tape Worms._—These worms may measure many feet in length; and their

presence in the body can only be certainly known by the appearance of

some of the segments or portions of the worm in the motions although

hunger and dyspepsia may be complained of.

_Treatment._—Administer a good aperient overnight so as to empty the

bowels; after the aperient nothing should be given by the mouth for eight

hours, then give sixty to one hundred and twenty drops of the liquid

extract of male fern in one ounce of thin gruel, milk, or gum water, and

follow this up in four hours by a good meal, and an aperient to remove

the worm, which should now be dead.

When the extract of male fern is not available, one tablespoonful of the

oil of turpentine may be used in its place.

If later on fresh segments appear in the motions, then the treatment must

be repeated.

_Round Worm._—The round worm resembles the garden worm and is several

inches in length; it may be observed in the vomit but more commonly is

seen in the motions. The symptoms are similar to those caused by the tape

worm and the treatment is the same, except that, instead of the male

fern, two to five grains of santonin should be given in a little milk;

and the treatment repeated every other day for a week.

_Threadworm._—The threadworm is a small round worm usually measuring less

than half an inch in length; it inhabits the lower end of the bowel and

causes great heat and itching about the outlet, especially at night.

_Treatment._—Wash out the lower bowel and inject into it about a third of

a pint of tea, or a similar quantity of water containing one teaspoonful

of salt, tannin, or alum; then apply a little mercurial ointment around

the outlet to diminish irritation. This should be done every third day

till the worms have disappeared from the motions.

_The Guinea Worm._—The guinea worm often measures several feet in length;

it chiefly causes trouble in the feet, ankles, and legs, where in order

to obtain an exit from the body it penetrates the skin, causing a small

ulcer at its point of exit.

Usually the presence of the guinea worm is attended with inflammation and

the formation of matter.

_Prophylaxis._—Infected persons should be kept away from water supplies,

and such sources of water supply as wells and water holes should be

protected. In areas where guinea worm occurs, all water should be

boiled. If this cannot be managed, it should be filtered through a piece

of clean cotton cloth, as this will remove from it the small crustacean

in which the larva of the guinea worm develops. Another method of

treating infected water is by means of permanganate of potash, one ounce

to every 2,000 gallons of well water. Caustic potash and quicklime are

also effective.

_Treatment._—When the worm can be seen at the base of the little ulcer,

it may be secured to a piece of match and a small portion may be wound on

to the match daily. If attempts are made to forcibly draw it out, it will

probably break and violent inflammation will result. During the time that

the worm is being wound out, the part should be kept very clean and an

antiseptic ointment applied.

There are other methods of treatment, but these can only be carried out

under medical supervision.

_The Hook Worm._—This is the American name for one or other of the

species of ankylostomes which infect man. The disease they cause is

known as ankylostomiasis, and it is common in many parts of the world,

especially in the tropics. It chiefly affects natives, owing to their

habits; but it occurs also in Europeans.

_Cause._—Hook worms are small, almost cylindrical worms, which inhabit

the human small intestine, to the wall of which they attach themselves

by means of their mouths, which are furnished with formidable hooks and

lancets. They suck blood, and the symptoms they produce are due in part

to loss of blood, in part to the destruction of the lining membrane of

the bowel, and possibly also in part to the effects of a poison which

they are believed to excrete. Their eggs are passed in the excrement, and

develop in the infected soil into larvæ, which are able to penetrate the

unbroken skin if they come in contact with it. This is the most important

route of infection, but it may occur also by means of infected drinking

water and from contaminated food.

_Symptoms._—The most marked feature of the disease is anæmia, which is

often associated with digestive troubles. Palpitation of the heart and

shortness of breath are frequently met with. In bad cases the appetite

is disordered or depraved. The patient becomes pot-bellied, and there

is swelling, chiefly about the face and ankles. The face is frequently

puffy, and the skin assumes a peculiar earthy hue. It should be noted

that a very early symptom is what is called ground itch. This is a skin

eruption, usually on the feet and legs, due to the irritation caused by

the larvæ penetrating the epidermis.

_Prophylaxis._—The chief measure consists in preventing contamination of

the soil by infected excrement. It is therefore important when camping to

make proper provision in the way of latrines. Care must also be taken to

prevent the fouling of water and food stuffs, such as vegetables, which

are eaten uncooked. It is very dangerous to go about bare-foot in regions

where the disease occurs, and camping sites should always be thoroughly

cleansed.

_Treatment._—Efficient treatment can only be carried out in association

with microscopic examination of the stools, and hence all that need

here be said is that various worm medicines are employed, of which

the most effectual are thymol and oil of chenopodium. These should be

administered only under careful medical supervision. The anæmia has to

be treated, and in the case of natives a nutritious and easily-digested

diet is indicated; for example, for native coolies the following has been

recommended: bread 1 pound, milk 2 pints, sugar 2 ounces, 2 eggs, and 4

bananas daily. Ground itch should be treated by an ointment containing

zinc oxide and salicylic acid.

_The Bilharzia Worm._—This worm, of which there are two species, produces

the disease known as Bilharziasis or Schistosomiasis, which occurs in one

or other, or both forms, in various parts of the world, but is specially

prevalent in Egypt.

_Cause._—The worms, which produce either urinary or rectal bilharziasis,

live in parts of the human vascular system, where they produce their

eggs. These eggs are furnished with spines, and hence cause irritation

when lodged in the tissues. In the urinary form the eggs have a terminal

spine, in the intestinal form the spine is lateral. These eggs are passed

either in the urine or in the excreta and reach water, where they develop

into larvæ. The larvæ enter special species of water snails, in which

they develop, producing eventually tiny forms known as cercariæ. These

cercariæ escape into the water and can penetrate the unbroken skin or

intact mucous membrane. They thus get access to the bodies of persons who

are bathing in the infected water, or who may drink it. Once in the human

body, the blood carries them to the place where they develop into the

adult worms, which eventually unite, and then the females begin producing

the spined eggs.

_Symptoms._—In the urinary form the chief symptom is the passage of

bloody urine, which usually shows itself about three months after

infection, and is often associated with a good deal of irritation of the

bladder and the pipe. The intestinal form may produce various symptoms.

Sometimes a condition resembling enteric fever occurs, sometimes one

like dysentery. Diarrhœa is common. The condition is chronic and, if

untreated, sets up all kinds of secondary effects, which need not be

discussed.

_Prophylaxis._—Carefully avoid any kind of personal contact with water

which may by any possibility be infected from urine or fæces. Bathing,

wading, washing in, or drinking any such waters, are all dangerous.

Wherever possible, water which may be infected should be boiled. If

this cannot be done, sodium bisulphate tablets may be used; two of the

16-grain water-purifying tablets in a quart water-bottle full of water

are efficient. Filtration through a Pasteur-Chamberland or Doulton candle

is efficient, as it excludes the cercariæ. Bathing water can be rendered

safe for immediate use by the addition of undiluted Army cresol in a

dilution of 1 in 10,000. If the water is kept overnight, 1 in 90,000 is

sufficient, as the storage of water tends to diminish infection.

_Treatment._—Certain forms of antimony have been found to cure the

condition, but can only be administered by a medical man. Indeed,

either form of bilharziasis can be properly treated only under medical

supervision. If this is not obtainable, some relief can be afforded by

the use of urotropin and sedative drugs.

There are many other worm diseases which afflict man, but no good object

would be served by mentioning them in detail. Most of them can be

diagnosed with certainty only by a medical man using the microscope, and

they all require scientific treatment which is beyond the scope of the

ordinary traveller.

_Yellow Fever._

This disease, the “Yellow Jack” of naval historians, occurs, so far as is

known, only in parts of the New World and on the West Coast of Africa.

One attack usually protects permanently against a second.

_Cause._—Quite recently the organism has apparently been discovered. It

is a corkscrew-shaped parasite which exists in the blood, and which is

allied to, though not identical with, the parasites of relapsing fever

and tick fever. The infection is conveyed from one patient to another by

the mosquito _Stegomyia fasciata_, which is a black and white insect,

commonly known from its striped legs as the tiger mosquito. Incubation

period two to five days.

_Symptoms._—The onset of the disease is very sudden, the highest

temperature being reached almost at once; then follows a period of

remission or calm, the pulse becomes abnormally slow, and this stage is

usually either succeeded by convalescence, or the symptoms become worse

and the patient dies. Some of the symptoms much resemble malaria, but the

rapidity of the onset, severe pain in the forehead, eyes, and loins, the

early scantiness of the urine, the marked jaundice, the bright eyes, the

narrow red tongue, and the absence of pain about the spleen are fairly

characteristic.

There is considerable thirst and vomiting, and in bad cases the vomit

becomes black, the colour being due to the presence of blood. (In

ordinary malaria the vomit is yellow, or in severe cases, such as

blackwater fever, it may be of a bright or dark-green colour.) In yellow

fever, jaundice is developed about the third day, and tends to increase,

whilst in blackwater fever it comes on very early and soon begins to

abate.

An important diagnostic sign in yellow fever is found in the fact that

the pulse does not increase in rapidity as the temperature rises.

_Prophylaxis._—Avoid being bitten by mosquitoes, employing the methods

mentioned on pages 206, 207. It must be remembered that _Stegomyia

fasciata_, unlike the anopheline mosquitoes, bites during the day, and

therefore it is more difficult to avoid its unwelcome attentions. It

usually breeds in the neighbourhood of houses, being what may be called

a domestic mosquito; and it is of the greatest importance to abolish

all potential breeding places or to protect them from the mosquito.

Practically any vessel holding water may become a nursery for Stegomyia,

and it is remarkable in what small quantities of water this mosquito will

lay her eggs. Patients suffering from the disease must be isolated and

kept under a mosquito net or in a mosquito-proof chamber, in order to

prevent them from infecting mosquitoes, which they are capable of doing

in the early part of the disease.

_Treatment._—Open the bowels well by means of calomel, six grains,

followed by a saline purge and hot-water enema. Some prefer castor oil

in large doses. Give ten grains of bicarbonate of soda three times a day.

Give cooling drinks, such as fruit salt. Make the skin act. Apply hot

fomentations to the back and mustard leaves to the pit of the stomach.

The question of feeding is very important. During the first two or three

days of the fever the patient is better without any food at all. As he

recovers his appetite returns, and great care must be exercised about

gratifying it. Only the plainest foods in very small quantities should be

permitted, the amounts being gradually increased, as otherwise relapses

may occur. Stimulants are usually required in the later stages of the

fever, but they must be carefully employed as they may tend to increase

the vomiting. It is possible that the discovery of the parasite may lead

to new and more efficient methods of treating the disease.

MEDICINES, MEDICAL APPLIANCES, ETC.

WEIGHTS AND MEASURES.

_Solids._

A Grain Symbol Gr.

20 Grains 1 Scruple { weights now ” ℈

60 Grains 1 Drachm { rarely used ” ℨ

437.5 Grains 1 Ounce ” ℥

16 Ounces 1 Pound ” ℔

_Note._—An ounce weighs not 8 but rather under 7½ drachms.

1 Gramme about 15½ grains.

1 Kilogramme ” 2 lbs. 3¼ ozs.

_Liquids._

1 Minim About 1 drop, or 0.06 c.c. Symbol ♏

60 Minims One fluid drachm ” ℨ

8 Fluid drachms (480 Minims) One fluid ounce ” ℥

20 Fluid ounces One pint ” O

1 Cubic centimetre 17 Minims.

A teaspoonful About one fluid drachm.

A dessertspoonful About two fluid drachms.

A tablespoonful About half a fluid ounce.

A wine-glassful About two fluid ounces.

A tumblerful About half a pint.

A litre About a pint and three quarters.

All bottles containing drugs should be doubly labelled, and the labels

should be varnished, otherwise they will probably come off in a damp

climate. Poisons should be kept in bottles of a special shape.

Drugs in a liquid state are inconvenient for travellers. They are bulky,

and require very careful packing and handling.

As far as possible, therefore, compressed drugs should be selected. These

must be of good quality.

Tablets are often taken in the solid form, but they will act more quickly

and certainly if dissolved or suspended in about an ounce of water.

Some preparations, chiefly those used for preparing lotions, etc.,

_e.g._, of chinosol, are also made in compressed form.

In regard to drugs, I have kept well within the maximum dose, so that

there may be no trouble on that account. For instance, in certain cases a

medical man would give sixty drops of laudanum for a dose, but I advise

travellers rarely to give more than sixty drops in twenty-four hours. The

urgency of the case must be the guide as to the quantity of the drug to

be given. The smallest dose which is effective is the best.

A supply of antiseptic gauze, wool and lint is necessary. The compressed

forms are very convenient.

All antiseptic gauzes and other dressings should be very carefully

protected from the air in order that their properties may be preserved.

They should be wrapped in oiled paper or india-rubber tissue, and kept in

a tin box.

A supply of bandages will also be needed. Each bandage should be two

inches in width by six feet in length.

_Dressing case._—The traveller should provide himself with a surgical

dressing case. A suitable one should contain 1 pair of scissors, 1 pair

of Spencer Wells’ artery forceps, 1 probe, 1 scoop and grooved director,

1 knife with two blades, 1 small saw with a detachable handle, and a

packet containing silk, wire, needles, and pins.

All active poisons mentioned in the following pages are marked with an

asterisk (*).

_Aloin Co. tablets._—One taken three times a day after meals, in chronic

constipation, gradually reduced as bowels become regular.

_Alum._—Dose, five to ten grains. Is occasionally used as an internal

astringent in the treatment of diarrhœa.

A solution containing five grains to the ounce of water may be used as

a mouth wash for bleeding or inflamed gums, as a gargle for relaxed and

sore throats, or as a lotion for inflamed eyes.

Ten to twenty ounces of a solution containing five grains to the ounce is

sometimes used as an enema to check the diarrhœa in chronic dysentery.

The tablet of alum weighs ten grains.

_Ammonia._—Three preparations of ammonia, viz., Sal volatile, Carbonate

of ammonia, and Liquor ammoniæ, are extremely valuable as stimulants,

and in this respect they are to be preferred to alcohol. All three are

similar in their action, and are useful on account of their stimulating

effect upon the heart in cases of fainting, or collapse caused by

snake-bite, bullet-wound, or other injury; they relieve spasm, and

promote sweating in feverish states. They also cause free expectoration,

and are therefore useful in the later stages of bronchitis.

The chief objection to these drugs is that their strength is rapidly

lost, unless they are kept in well-stoppered bottles, and in the dark.

All preparations of ammonia should be administered in about one ounce of

water.

_Sal volatile, or aromatic spirit of ammonia._—Dose, twenty to sixty

drops for a single administration, or up to thirty drops if repeated

frequently. This is the most convenient and pleasant preparation of

ammonia, but is bulky. As a local application, it is of service in

relieving the pain caused by the bites of certain insects, _e.g._,

mosquitoes and fleas.

_Carbonate of ammonia._—Dose, three to ten grains.

_Liquor ammoniæ, or solution of ammonia._—Dose, five to twenty drops.

(_Note._—This is not the strong solution, which is always labelled “Liq.

Ammon. Fort.,” and which is three times stronger than liquor ammoniæ.)

_Ammonium chloride._—Dose, five to twenty grains. This drug is chiefly

used in congestion of the liver, especially where acute inflammation or

abscess is threatened; at times it is useful in neuralgia and chronic

bronchitis. It is also used for inflamed and relaxed sore throat, in the

form of a gargle, five to ten grains to the ounce of water.

_Antipyrine._—Dose, five to ten grains. (Uses as Phenacetin.)

* _Araroba, Chrysarobin, or Goa powder._—Is not for internal use. One

part of the powder mixed with one of acetic acid and fourteen of lard

makes what is known as araroba ointment.

_Araroba ointment_ is useful in many skin diseases, such as psoriasis;

it easily destroys the parasites in ringworm, dhobie itch, or kraw kraw.

It is a powerful drug, and should be used only in small amounts, for if

applied too freely it will cause some inflammation and pain. Care must be

taken that it is not rubbed into the eyes.

* _Aromatic chalk with opium tablets._—Ten grains three times a day in

severe cases of diarrhœa.

* _Arsenic._—Dose, one-sixtieth to one-fifteenth of a grain. Is a

powerful and poisonous drug, and should be taken with caution. It is

useful in chronic malaria, and in anæmia and debility, especially that

following an attack of fever.

It is best combined with iron in tablet form—iron and arsenic tablet—two

of which may be taken twice a day, after food, for a week. This is a good

general tonic.

_Aspirin._—Dose 5 to 15 grains. Should be taken with a drink of water.

Useful in rheumatic and febrile conditions; often relieves headache

and the feeling of discomfort associated with chill. It is apt to be

depressing in large doses, and some persons do not tolerate it well.

Speaking generally it may be used in those conditions in which salicylate

of soda is indicated.

_Bismuth carbonate._—Dose, five to twenty grains. Useful in dyspepsia,

pain in the stomach, vomiting and diarrhœa. The drug is heavy, and

therefore gum or starch water should be used to suspend it.

It is often combined with opium and bicarbonate of soda to check vomiting

and diarrhœa.

Bismuth may also be used as a dusting powder.

_Boric acid, or boracic acid._—Chiefly used in solution, for its mild

antiseptic properties, as a gargle, injection, eye lotion, or mouth wash.

On the same account, it is used for washing wounds, or syringing out

ulcers, or sore and inflamed ears. It is practically non-poisonous.

Lotions should contain from five to ten grains to the ounce. Boric

ointment is a useful dressing for sores, burns, or wounds; it may be made

by adding one part of powdered boric acid to nine of vaseline or fat.

Equal parts of finely-powdered boric acid, zinc oxide and starch makes a

good dusting powder for moist eczema, bed-sores, chafes, and perspiring

feet.

Boric lint (lint impregnated with boric acid) is useful as a dressing for

wounds, ulcers, and abrasions.

Boric wool is absorbent cotton-wool impregnated with boric acid, and is

the most generally useful antiseptic wool.

_Bromides._—The bromides generally used are those of potassium, or

ammonium. Dose in either case, five to twenty-five grains. They are

sedatives, and are used in convulsions, epilepsy, and delirium; they

relieve headache, especially if taken with sal volatile, and may be

combined with chloral (_see_ Chloral). The bromide of ammonium is less

depressing than the bromide of potassium.

_Calcium sulphide, i.e., sulphurated lime._—Dose, a quarter to one grain

three times a day. Useful for those who are suffering from boils or

carbuncles.

* _Calomel, or subchloride of mercury._—Dose, two to five grains. Calomel

may be used in almost all cases requiring an aperient; its action will be

assisted by giving fruit salt, or citrate of magnesia, four hours later.

In cases of insensibility or delirium it is specially useful, for the

powder may be placed on the back of the tongue, and it will be swallowed

unconsciously.

Four grains of calomel may usually be given with advantage, at the

beginning of a malarial attack.

In syphilis, one grain may be given two or three times a day; but its

action should be watched, and if it causes salivation, tenderness of the

gums, and a coppery taste in the mouth, it should be discontinued until

these symptoms disappear.

_Camphor._—Dose, two to five grains. Is a stimulant, and an

antispasmodic; it helps to calm the nervous system. It is used in cholera

and in fevers, and is taken for colds in the head.

Camphor is slightly soluble in water, and this solution makes a cooling

lotion, which is useful for inflamed or painful parts. A lump of camphor

is a good repellent for sand-flies.

_Spirit of camphor_ consists of one part of camphor in ten of alcohol;

the dose is ten to twenty drops.

_Camphorated oil_ consists of one ounce of camphor in four ounces of

olive oil, and makes a stimulating liniment for stiff and painful parts.

A stronger liniment may be made by adding to this an ounce of spirit, and

half to one ounce of solution of ammonia or oil of turpentine.

* _Carbolic acid, or phenol._—Dose, one or two grains may be given

internally, well diluted, for acute diarrhœa, dysentery, and cholera. Is

mostly used as an external application. Carbolic acid acts as a caustic,

and may be applied on the end of a match in the case of boils (p. 227). A

drop on a piece of cotton-wool applied to a hollow tooth quickly relieves

pain.

It is much used as an antiseptic lotion for wounds and foul sores, and

for cleansing hands and instruments before operation.

One part in twenty of water makes a strong solution for cleansing

instruments and disinfecting dysenteric and other stools.

One part in sixty may be used for sponging or syringing sores and wounds.

One part added to nineteen of olive, or other oil, makes carbolic oil,

which is a handy dressing for all kinds of wounds.

One part to nineteen parts of vaseline, or fresh lard, makes carbolic

ointment.

_Cascara sagrada, extract of._—Dose, two to six grains. Is a valuable

aperient, especially in chronic constipation. Cascara tablets, two grains

each, are convenient, and one or two should be taken at night.

_Cathartic Co. Tablets._—A useful purge in cases of fever or liver

derangement. Two or three for a dose when required.

_Castor oil._—Dose, one to three tablespoonfuls. It is a good aperient,

but is not very convenient for the traveller, as it takes up much space,

which could be better used for aperients which are not so bulky, _e.g._,

calomel or cascara. The usual dose of castor oil should be somewhat

reduced in the tropics, where it is often not so well borne as in

temperate climates.

_Note._—The seeds of the castor oil plant should not be eaten, as they

are poisonous.

_Chinosol_ is a drug which has many of the advantages of carbolic acid

without its poisonous or caustic properties. It is so generally useful

that, at any rate for explorers, it will largely replace carbolic acid.

It is antiseptic and disinfectant in its action, can be used as a

mouth wash or gargle, for sore gums and ulcerated throats; it makes a

good lotion for washing the hands, instruments, or wounds, and may be

syringed into fresh wounds or into chronic ulcers.

It is put up in the compressed form, each tablet weighing eight and

three-quarter grains, and the strength of the solutions here given are

calculated strictly from this weight.

One tablet dissolved in a pint of water makes a solution of 1 in 1000

(equal to about 1 in 40, carbolic lotion), which is the most useful

for general purposes, such as an antiseptic wash for the hands or for

disinfecting surgical instruments.

A tablet in two pints of water makes a solution of 1 in 2000. This may be

used for washing fresh wounds, burns, and suppurating surfaces, or as a

gargle for sore throat.

As a healing dusting powder, one part of chinosol may be mixed with ten

of boric acid, and used in the same manner as iodoform powder.

To disinfect typhoid or dysenteric stools, dissolve four tablets in one

pint of water and add the mixture to the vessel containing the motions.

* _Chloral._—Dose, five to twenty grains. Relieves restlessness and

delirium, and produces sleep. Larger doses than twenty grains should

not be given. In severe convulsions, due to certain poisons, _e.g._,

strychnine, twenty grains or more of bromide of potassium may be added to

the full dose of chloral, and given either by the mouth or bowel.

* _Chloroform._—Dose, one to five drops. Two to four drops can be given

with advantage with almost any drug, as a flavouring agent, and on

account of its antispasmodic action.

From two to four drops put on a piece of loaf sugar and sucked will often

stop sea-sickness or other vomiting.

_Spirits of Chloroform, or Chloric Ether_, consisting of one part of

chloroform in twenty parts of alcohol, is a convenient form in which to

administer the drug. It is useful in sea-sickness, cramps and colic, and

should be given in doses of twenty drops added to a teaspoonful of water

every quarter of an hour, until six such doses have been given.

* _Cocaine._—A one per cent. solution may be used to diminish pain in

the eye caused by injury or a piece of grit lodging under the lids. Two

drops should be applied to the eyeball, and in about two minutes the

application may be repeated; in another minute the sensibility of the

part will be diminished, and a careful examination may be made for dust

or other foreign bodies, which should of course be cautiously removed.

_Creosote._—Dose, one to two drops; is best given in a capsule. In many

cases of indigestion it gives great relief if administered immediately

after food. Creosote applied to a hollow tooth, upon a piece of

cotton-wool, will usually relieve the pain.

_Cresol._—This is a valuable disinfectant which is found on the market

under several names.

* _Croton Oil._—Dose, half to one or two drops, mixed with bread crumb or

in a pill.

Is a powerful purgative not usually given to Europeans. Native carriers

like it. Useful in the case of unconscious patients, given in butter.

_Copaiba, Balsam of._—Dose, five to twenty drops three times a day. Is

best taken in capsules. It increases the expectoration, and is therefore

useful in bronchitis; is a stimulating disinfectant to the urine, bladder

and pipe, and is used in gonorrhœa and inflammation of the bladder.

It may produce an irritating rash on the skin if taken in too large

quantities.

_Emetics._—The following are the usual emetics:—

Common salt, two tablespoonfuls in half a pint of water.

Mustard, one tablespoonful ” ”

Ipecacuanha, thirty grains ” ”

Zinc sulphate, thirty grains ” ”

In the absence of any of the above, give copious draughts of tepid water,

followed by tickling the back of the throat with the finger or a feather.

_Emetine._—The active principle of ipecacuanha. Of great value in amœbic

dysentery (p. 187).

_Enema._—_Nutrient enema_:

Two eggs,

Half teaspoonful of salt,

A wine-glassful of milk.

Beat up the eggs, then add the salt and milk, and mix well. Raise the

hips and inject slowly through the long tube well up into the bowel.

_Nutrient enema_:

Benger’s beef jelly, two tablespoonfuls,

Milk, about three ounces.

_Warm-water enema._ To relieve uneasiness of lower bowel, as in

dysentery, piles, etc., half a pint or more of warm water, by the short

tube.

_Soothing enema._ Laudanum, thirty drops; warm water about two ounces. A

little thin starch water or gum may be added. Inject through the short

tube, and repeat the injection in three hours if patient is not easier.

_Quinine enema._ Quinine, twenty grains or more; warm water, about two

ounces. If the patient does not retain the injection, give a second one

within an hour. Select a soluble preparation of quinine, such as the

bisulphate or the hydrobromide.

_Aperient enema._ Lather soap in thirty ounces of warm water, using

plenty of soap to make a good solution; or use plain warm water or weak

gruel; the addition of one or two tablespoonfuls of oil is of advantage.

Inject slowly into the bowel with short tube; if it does not cause

uneasiness, inject the whole amount. The injection should be retained as

long as possible.

_Epsom salts, or sulphate of magnesia._ Dose, two teaspoonfuls or

more. Is a saline purgative, giving a copious watery motion, rapid in

its action, and useful in fevers or congestion of the liver. It also

increases the flow of urine.

Recently has been much used in dysentery (p. 189).

_Friar’s Balsam._—(Tinct. Benzoin Co.) Dose, thirty drops or more.

Internally is useful as an expectorant in bronchitis. Can also be

employed as an inhalation.

Externally, lint soaked with it is an efficient dressing for wounds and

sores. When first applied it causes a good deal of smarting, but this

soon passes off.

_Gall and opium ointment_ is a useful application for piles.

_Gauze, antiseptic._ The best dressing for wounds is some form of

antiseptic gauze. Cyanide gauze, which is impregnated with cyanide of

mercury, is the most generally used.

_Ginger, essence of._—Dose, five to twenty drops. It is useful in cases

of cramp, colic, and indigestion, especially if combined with five or ten

grains of bicarbonate of soda and two or three drops of chloroform.

If there is much pain, ten drops or more of chlorodyne or laudanum may be

added.

* _Goa powder._—_See_ Araroba.

* _Goulard water._—For external use only. Is astringent, and may be used

as a lotion for inflamed joints. Is also useful as an injection in

gonorrhœa and gleet, as a soothing lotion in herpes, shingles, eczema,

discharge from the ear, and itching and chafes of all kinds. _It should

not be used as an eye lotion._

Goulard water is made by adding one part of Liquor Plumbi Subacetatis

Fortis, or Goulard _Extract_, and one of alcohol to seventy-eight of

water.

One of the tablets of the subacetate of lead added to a quarter of a pint

of water (distilled when convenient) makes a solution similar to Goulard

water.

_Gum acacia_ is used for forming a mucilage with which to suspend such

drugs as carbonate of bismuth. One part of gum to three of water should

be made and strained before use. Starch may be used for the same purpose.

_Hazeline._—Dose, thirty to one hundred and twenty drops. It is a

powerful astringent. May be applied freely to bleeding parts, such as the

nose, gums, piles, or small wounds. One tablespoonful of hazeline to five

of water may be injected into the bowel for bleeding piles. Hazeline snow

is an elegant preparation for sunburn and other skin affections.

_Ichthyol._—An ointment containing twenty per cent. of ichthyol is

very soothing in most skin diseases, such as eczema and psoriasis. The

ointment is of service in reducing the pain and swelling of mosquito

bites.

_Iodide of potassium._—Dose, five to ten grains in the later stages of

syphilis.

* _Iodine, tincture of._—Dose, two drops in a teaspoonful of water; given

every hour, is most valuable for obstinate vomiting.

Used externally, it acts as a counter-irritant, and should not be painted

on too freely as it may cause blistering. Does good if painted over

swollen joints or enlarged glands, but should not be applied if the skin

there is broken. Tincture of iodine may be painted on the chest or over

the liver or spleen if there is pain. It is a valuable application for

all open, recent wounds, and may be painted freely over and round the raw

surface. It relieves the irritation of mosquito bites.

Is very useful in certain diseases of the skin, such as ringworm, kraw

kraw, and dhobie itch.

_Iodoform powder_ is a valuable antiseptic, and is used for all kinds

of sores, or wounds, in which it rapidly promotes healing. One part of

iodoform to eight parts of vaseline makes a good healing ointment.

_Ipecacuanha._—Dose, expectorant, half to two grains.

” emetic, fifteen to thirty grains.

” for dysentery, twenty to forty grains or more.

In small doses, _e.g._, a quarter to half a grain, is a stomachic and may

check vomiting.

Was formerly much used in amœbic dysentery (p. 187). Its active

principle, emetine, is now employed.

By causing free expectoration, it is very useful in bronchitis, and is

then usually combined with ammonia.

Is contained in Dover’s powder, and in this form is useful in coughs and

colds, as it helps to cause sweating.

_Iron._—Iron is much used on account of its tonic and blood-forming

properties. It is especially useful in anæmia following fevers and other

exhausting diseases, and it also gives tone to the nervous system.

Most preparations of iron are astringent in their action, some such

as the sulphate and perchloride being more so than others; these are,

therefore, useful in diarrhœa and in bleeding from the gums and bowel.

Iron by its astringent action may cause constipation, and it may be

necessary to add a small amount of an aperient, such as Epsom salts, to

each dose.

The following preparations are those generally used:—

_Tincture or perchloride of iron, or tincture of steel._—Dose, five to

fifteen drops in at least an ounce of water. Good blood tonic. Is very

astringent, and is therefore useful in internal bleeding and looseness of

the bowels. It is of value in erysipelas.

_Sulphate of iron._—Dose, one to three grains. Is a powerful astringent

and blood tonic, and often does good in checking the looseness of the

bowels which remains after an attack of dysentery.

_Iron pill or Blaud’s pill._—Dose, five to fifteen grains. Is one of the

best tonic preparations of iron, as it is not very astringent. It is put

up in tablet form.

_Solution of dialysed iron._—Dose, ten to thirty drops. Is a good blood

tonic, and, unlike most preparations, is not astringent.

_Parrish’s food._—Dose, thirty to a hundred and twenty drops in water. Is

a good preparation of iron for children.

_Iron and arsenic compound tablets._—A useful tonic in convalescence from

malaria, one taken three times a day after meals.

_Mercurial ointment_ forms a useful application in certain skin diseases.

As it is rather strong, it should be diluted with two parts of vaseline.

_White precipitate, or ammoniated mercurial ointment._—Useful in the case

of head lice and several parasitic skin diseases.

_Naso-pharyngeal Tablets._—Useful in nasal catarrh and pharyngitis.

* _Opium._—Is a valuable drug, but it is also a poison, and great care

should be observed in using it. Opium is narcotic and sedative in its

action; it relieves pain of all kinds. Useful in diarrhœa, dysentery,

cramp and colic. Promotes perspiration and checks vomiting. Sometimes it

will cut short a cold or mitigate an attack of malaria.

_No preparation containing opium should be given to children without

medical advice, and the same is true as regards persons suffering from

kidney disease._

The chief preparations containing opium are:—

* _Chlorodyne._—The ordinary dose is ten to fifteen drops, but if there

is great pain, then even thirty or forty drops may be given, but a second

dose should not be administered for three or four hours; if two full

doses have been given, do not give a third within at least twelve hours

of the second dose, and do not give it at all if the patient is drowsy.

It is best not to give more than forty to sixty drops in twenty-four

hours, unless there are very special reasons for giving a larger

quantity. Is to be preferred to laudanum, as it is more palatable and

_Symptoms._—In man the feet are the part most frequently affected, the