injection of one table-spoonful of castor oil and one ounce of warm
infusion of peppermint; or if the bowels require to be acted upon, give
sweet tincture of rhubarb with a little soda in it. Paregoric on a small
piece of sugar will generally give relief, but it is better not to use
it, when simpler medicines for expelling the wind from the stomach and
bowels and allaying the pains will answer the end in view.
Relief may also be frequently afforded the child by simply covering it
with hot flannels and laying it on its belly across the knees, at the
same time rocking it and gently tapping the back; but this must be done
with great care, as otherwise it may tend to increase the infant’s
sufferings.
---------------------
Cramps.
This is a sudden contraction of the muscles of the legs, thighs,
stomach, and other parts of the body; the affected part being, as it
were, “drawn into knots.” Drinking cold liquids when much heated and in
a state of perspiration, or vice versa, weakness, excess in eating or
drinking, and particularly overworking the muscles, are among the
principal causes which induce an attack, which, when it affects the
stomach, is a serious matter. Swimmers are very liable to cramps, which
so often prove fatal to them. When the suffering is due to overstraining
the muscles, the exercise must be moderated.
Rub the muscles well. This will help to bring it back to its natural
condition, and if the affected muscle be in the leg, tie a bandage
tightly above it, rubbing that part well with spirits of camphor, or
laudanum.
When the attack occurs in the stomach, hot fomentations should be
applied. Burnt brandy is also an excellent remedy, where the contracted
muscles are situated internally. The bowels should be kept well
regulated.
---------------------
Diarrhœa.—Looseness of the Bowels.
Frequent, copious, and thin or extremely liquid discharges point to a
loose or relaxed condition of the bowels. Children are very liable,
especially during the hot season, to this complaint, which often proves
fatal to them.
The excessive discharges are due to a variety of CAUSES; as bad and
unwholesome food, or food taken in large quantities, unripe fruit and
other substances, which, remaining undigested in the stomach, act as
irritants, until expelled; sudden changes of temperature; exposure to
long continued heat, or malarial influences; the application of cold to
the body producing congestion of the bowels; suppressed perspiration,
and inflammation or ulceration of some portion of the bowels. With
children the cause is very commonly due to eating unripe or unsound
fruit, when naturally attention will be given to any attack, but not
necessarily to its immediate suppression, as it may be only an effort of
Nature to throw off from the system what is injurious to it; but the
complaint must not be permitted to continue unchecked, as otherwise it
may become serious.
SYMPTOMS. The attack may come on suddenly when due to cold or some
undigested substance in the stomach; or there may be premonitory
symptoms, as restlessness, disturbed sleep, and passing abdominal pains,
and other signs indicative of indigestion, which may continue for some
time. There is a feeling of distension and weight in the lower part of
the stomach, attended by a rumbling noise in the bowels caused by the
presence of wind. This feeling is relieved when an evacuation takes
place, but returns when another is near at hand. Griping is frequently
present, and the face is pale and dry and after a while becomes sallow.
In addition to these symptoms the sufferer is troubled with nausea and
vomiting, and if the purging be not speedily arrested, great exhaustion,
accompanied by spasms and cramp, will follow.
Diarrhœa is distinguished from dysentery by the absence of blood in the
discharges as also of fever, inflammation, contagion and straining at
stool. As the disease progresses, the motions become very watery, the
strength rapidly diminishes, great emaciation takes place, and dropsy
generally ensues.
TREATMENT. In the treatment of this disease the remedy will of necessity
depend upon the originating cause, but whatever that may be, the simple
rule is to make the patient keep quiet and not to exert or expose
himself to sudden variations of the temperature, or (in hot weather) to
the direct rays of the sun. To rest quietly on the back is of the
greatest importance in this as in all cases of bowel complaint.
Generally speaking, if the discharges from the bowels have an offensive
odor, or if they have not acted for some time, then they must be cleared
out with a dose of castor oil or other aperient, before doing anything
else. In the case of a child, instead of castor oil give spiced syrup of
rhubarb, and a tea-spoonful will suffice for an infant. In every
instance, however, put the child to bed, bandaging it tightly round the
stomach with flannel, and leaving it without food for a few hours. Where
the motions are thin and frequent and attended by some degree of bearing
down, administer 5 drams of castor oil with 5 drops of tincture of
opium. This will give great relief. The same course should be adopted
when the attack is due to the introduction of oily or putrid food into
the stomach. If cold or suppressed perspiration be the cause, then the
secretions must be restored by administering to the patient medicines
which determine to the skin, such as James’ or Dover’s powders, five
grains of the former, or ten of the latter, in a little arrow-root or
gruel. The feet should be put in hot water every night. When there has
been an abuse of aperients, these must be discontinued. If there are
pains in the bowels with nausea and vomiting, apply a mustard poultice,
or else heat a plate in the oven and wrap it well round with flannel
wrung out of hot water, then place over the belly, covering with a dry
towel. This will afford all the requisite heat without the weight of a
large plaster. It is advisable to have another plate heating whilst one
is in use, so that a change can be immediately effected. A few drops of
laudanum and spirits of camphor, 5 drops of each for a child of 10
years, and 3 drops of each for one of 5 years, may be given every twenty
minutes so long as the diarrhœa or pain and vomiting continues. Neither
laudanum or paregoric should be administered to an infant, except under
medical advice.
---------------------
Dislocations.
The tendons and ligaments at the joint, which keep the bones together
and give the limb its freedom of action, may, through external violence
or undue tension, be displaced, severing the natural connection. In
these cases of accident, it is hazardous for an inexperienced person to
try and remedy the mischief, as, unless perfectly sure that the limb is
out of joint, the attempt to effect a reduction, may tend to bring about
a fracture instead. It is better to procure skillful advice in every
instance when such can be readily obtained. But _immediate_ action must
be taken, when by a heavy fall or otherwise the neck is partially
dislocated, for there is a bare possibility of recovery by prompt
action, but the accident usually terminates fatally. Carry out the
following directions.
NECK. Place the person at once on his back, planting the knees against
each shoulder. Hold the head firmly in the hands, and gradually and
gently turn it into its natural position. Absolute rest for some days
afterwards is necessary.
It must be borne in mind that, in giving the following directions for
the treatment of dislocations in other limbs of the body, the advice
above given, to keep the patient quiet and obtain professional
assistance, must not be forgotten by those without any proper and
technical knowledge.
FINGERS and TOES. Dislocations of these are not of frequent occurrence,
and usually happen between the first and second joints. The projection
caused by the dislocated bones is easily perceived and without much
difficulty reduced if effected speedily after the accident. Immerse the
limb in hot water and let the patient lie on the floor; then by bending
replace the displaced bone over the head of the bone from which it has
been disjoined. A good deal of extension and counter-extension may be
required in the more obstinate cases, for which purpose a piece of stout
tape should be wound round the finger, protecting the skin with some
wetted material. The wrist during the operation should be inclined
forward.
JAW. Here the jaw gets out of joint from opening the mouth too wide, as
in gaping, which becomes forced wide open, with much pain in front of
the ear, extending up to the temples. Put the person on a low seat and
place a thin stick across the mouth, pushing it far back; then press
backwards and downwards till the jaw slips back into its place; or else,
covering the thumbs with a handkerchief, place them in the mouth,
pressing slowly but firmly on the four back teeth, at the same time
raising the chin and pushing the jaw backwards.
SHOULDER. In a dislocation of this limb, the arm becomes powerless and
the shoulder appears flat when compared with the sound one, and all
attempts to move the elbow in the direction of the injured limb will
occasion pain. A depression will be seen at the top, and by passing the
fingers under the armpits the head of the bone will be felt. In this
case, where the depression is _downwards_, put the patient on a bed, or
the floor, with his head raised, and place your foot in the armpit,
against the head of the bone. Then taking a firm hold of the arm above
the elbow or at the wrist with your hands, or with a strong bandage
attached to it and passed round your neck, pull steadily and push with
the heel.
After doing this for some time, tell the person to turn quietly round,
when by a sudden strong pull you will feel the bone jerking into its
right place.
HIP. A dislocation of the hip causes a shortening of the leg, making the
foot incline inwards. When unless assured that there is a dislocation,
do nothing without proper advice. In cases of extreme urgency, act in a
similar manner as when the shoulder is put out; placing the foot between
the legs, at the same time making due provision for protecting the
parts.
WRIST, KNEE and ANKLE. All accidents occurring to these are of a serious
character, requiring surgical attendance. But when such professional
assistance cannot be readily obtained, the same principle should be
adopted as pertains in all cases of dislocation, that is, by extension
and counter-extension to get the muscles into that relaxed condition as
will permit the operator to push the bone back into its proper place.
WRIST. In the case of the wrist, the accident is generally caused by a
fall on the hands. The bones of the fore-arm may be thrown either
backwards or forwards on the wrist, causing the projection to be either
in front or behind. The bones are replaced by pulling the fore-arm and
hand in opposite directions, pressing sideways, if the displacement is
at the side. Put a straight, well padded splint on the back and front of
the fore-arm and wrist and tie a bandage over the whole. The arm should
be carried in a sling, and any inflammation kept down by applying cold
water or cooling lotions.
KNEE-PAN. This bone may be forced off the end of the thigh-bone
outwards, causing a projection on the outside, with inability to walk or
use the limb without great pain, or the bone may be thrown inwards,
(which is rare), causing a projection on the inside, and a like
inability to bend the knee. The leg should be bent forwards _on_ the
body and the knee kept as straight as possible. Then with the hands
press down on that edge of the knee-pan which is furthest from the
centre of the joint; this will raise the nearer edge of the bone, when
the muscles, assisted by a lateral pressure, will help to place the
disjointed member into its right position. The knee should be kept
slightly bent and a splint worn at the back of the limb. Apply cold
water or cooling lotions.
ANKLE. The dislocation here may be either backwards, forwards, inwards,
or outwards. The latter is the most frequent and is generally
accompanied by fracture of the small bone of the leg, above the ankle
joint.
These dislocations can all be readily ascertained by comparison with the
sound foot. Where the dislocation is outward, hold the foot very firmly
by the heels and front and draw steadily downwards and then force it
into position by moving the foot or ankle backwards and forwards for a
little while. The return will be greatly facilitated. The foot should be
confined in pasteboard splints, soaked in warm water and moulded to the
shape of the limb, with a foot piece at right angles. The patient must
be kept to his bed for five or six weeks, and when commencing to walk
again, the ankle should be supported with a roller bandage.
---------------------
Drowning.
The length of time that persons can remain under water and afterwards
recover, is from five to thirty minutes. The air being shut off from the
lungs, breathing stops and the immediate accumulation of carbonic acid
in the blood paralyzes the nervous system and insensibility immediately
follows. The heart continues to beat, however, from five to twenty
minutes after the occurrence of insensibility and apparent death.
Recovery may take place at any time before the heart ceases to beat, and
has been brought about in some cases even after this organ has become
still. It has taken place in some few instances as late as half an hour
after being under water, but it can scarcely be expected, even under the
best treatment, later than twenty minutes from the time of submersion,
and even as late as this the chances are much against restoration. Treat
the patient instantly on the spot in the open air.
1st. Loosen the clothing, place the face downward with the forehead
resting on one of the wrists and the face turned to one side. Open the
mouth, seize the tongue between the fingers covered with a handkerchief
or a piece of cloth and draw it forward between the teeth. Clear the
mouth and throat from mucous by passing the index-finger, covered with a
handkerchief or a piece of cloth, far back into the mouth, thus opening
a free passage into the windpipe.
2nd. Turn the body face upward, shoulders resting on a folded coat or
pillow, keep the tongue drawn forward, take hold of the arms just above
the elbows, draw them away from the sides and up over the head until the
hands meet, counting one, two, (this expands the chest and allows the
air to enter the lungs), lower them so that the elbows will come to the
sides and the hands cross on the pit of the stomach and press then
gently but strongly against the sides and chest, counting three, four,
(this forces the air out of the lungs); continue these two movements
(which produce artificial breathing) very deliberately about ten or
twelve times, in a minute and without ceasing until the patient breathes
naturally, or until satisfied that life is extinct.
3d. While this is being done, a little friction may be produced on the
chest by rubbing gently with warm flannel, and the body may be stripped
and wrapped in dry blankets. After natural breathing begins, continue
very gently for a few minutes the two movements which produced
artificial breathing.
After natural breathing is fully restored, give the patient a
tea-spoonful of brandy, hot gin, or tea, two or three times a minute
until the beating of the pulse can be felt at the wrist. Rub the arms
and legs upward and the feet and hands with warm and dry flannel. Apply
hot cloths to the body, legs and arms, and bottles of hot water to the
feet.
---------------------
Effects of Cold.—Frost Bites.
A temperature ranging from 60 to 70 degrees, though considerably lower
than that of the human body, which averages 98 degrees, is the one best
adapted to man’s requirements, since the proportion to the loss and
reproduction of heat are nearly equalized. A lowering of the temperature
tends to congeal the blood, and the effect of the impeded circulation is
quickly apparent in the smaller vessels of the skin, which are the first
to be affected, as this lowering increases the more important organs, as
the heart and arteries suffer, owing to the free course of the blood
being checked in the surface vessels, and not undergoing that natural
change in the lungs, as would otherwise naturally take place.
The fingers, ears, nose, and other projecting parts of the body are the
first to suffer from an undue exposure to the extreme cold, assuming a
blue or livid appearance caused by the weakened circulation, which, if
continued and not speedily arrested and restored, will lead to
mortification and death.
This lowering of the bodily temperature produces a general or local loss
of vitality and a strong desire to sleep, which must be prevented by
every possible means, otherwise a state of insensibility will arise,
brought about by congestion of the brain.
(Where the vitality is only locally or partially destroyed, a condition
occurs known as _Frost Bites_, which are treated of at the end of this
article.)
TREATMENT. The main object here is to restore the natural temperature of
the body, or affected part, and this must be done _gradually_; as Dr.
Hunter[2] says: “The degree of external heat should be in proportion to
the vitality.” When the life is weakened and nearly destroyed by frost,
the warmth imparted should be small, and rise no faster than life
returns.
In no case should a person overcome by cold be _suddenly_ exposed to any
considerable degree of heat or taken into a well warmed room. This would
only result in either seriously endangering the patient’s life, or in
the case of frost bites killing the affected member or causing violent
inflammation.
The body, after removing the clothes, should be covered with snow,
excepting the nose and mouth, but when this is not obtainable, immerse
the body in water as cold as possible for some minutes. When the body
has thus gradually thawed and the muscles begin to relax, place it,
after drying, in a cold bed and rub well with warm hands under the
clothes. The continuous friction will cause the temperature to rise. As
soon as signs of vitality appear and the flesh regains its normal
appearance, apply lard or sweet oil to the skin. The patient should be
well protected with heavy wraps. A small dose of brandy may now be
administered.
FROST BITES. When the cold affects some projecting part, as the ears,
nose, fingers, and toes, rub the part with snow or cold water until the
circulation is partially restored, and then with equal parts of brandy
or some other spirits until the restoration is complete. Troublesome
sores are often the result of frost bites and are difficult to heal. Red
precipitate ointment is the best remedy for them, and where there is
much inflammation, apply poultice.
---------------------
Epilepsy.—Epileptic Fits.
Epilepsy, or falling fits, as it is sometimes called, is a disease of
the brain characterized by paroxysms and convulsions occurring at
irregular periods, accompanied with loss of consciousness and voluntary
motion.
CAUSES. There are many causes which give rise to these attacks, such as
_external_ injuries to the brain and spinal cord, fracture of the skull,
etc.; or to _internal_ injuries and diseases; worms, concretions, tumor,
water on the brain, sudden frights, strong mental emotions, painful
domestic troubles, especially in women of nervous temperament when
pregnant, sexual excesses, self-abuse, etc. The disease may be inherited
or due to predisposition occasioned by the plethoric or debilitated
condition of the sufferer; when due to this latter cause, and happening
after the age of puberty, it is generally difficult to cure, but if the
attack occur in early life and is occasioned by worms or other
accidental cause, a cure may ordinarily be anticipated. The seizures may
take place at any period of life, but are more frequent between the ages
of ten and twenty years; occurring during childhood, there is a
possibility that the sufferer may outgrow the disease, but the
probability is that it will become constitutional and incurable.
SYMPTOMS. The attacks may be only a momentary and passing loss of
consciousness, or one of a more expressed and serious nature. In the
former case the symptoms are merely a sudden and brief loss of
consciousness and a fixed, steady look in the eyes, loss of
self-possession and an inclination to fall; but there is no swelling of
the face, no distortion of the features, no foaming at the mouth, no
biting of the tongue, no convulsions, and no warning cry,
characteristics of the more serious class of these seizures. These
latter are also sudden, and in general without warning. The patient may
apparently be in the enjoyment of good health, when all at once he
utters a loud and piercing shriek and falls down senseless and
convulsed. The face becomes greatly distorted with the head inclined to
one side. The eyes are set, or rolling wildly, the breathing is heavy
and the skin turgid and livid; there is a blood-tinged froth around the
mouth, due to biting of the tongue; the arms and lower limbs work
violently; there is a choking sensation in the windpipe, and the
sufferer is seemingly at death’s door.
After a longer or shorter interval, these symptoms gradually diminish
and at length cease, and the sufferer becoming partially conscious for a
time, drops off into a heavy sleep, which last for several hours and
from which he awakes without any knowledge of what has occurred during
the paroxysm. When the fit has passed off there is generally a headache
and a feeling of languor remaining as reminiscences of the attack.
Usually, as already stated, the patient immediately before the attack
utters a loud cry, but in some instances a peculiar sensation is
experienced as of a current of air or stream of water commencing either
in the extremities, or pit of the stomach, and working upwards to the
brain. This is the _epileptic aura_, a warning of a true attack of
epilepsy.
TREATMENT. During the attack but little can be done beyond keeping the
patient from injuring himself by the violence of the convulsions. Place
him in the middle of a bed, to prevent his rolling off, but if unable to
lift him, leave him in a recumbent position with the head slightly
raised, and insert a piece of leather or a tightly rolled handkerchief
in the mouth to prevent the tongue being bitten. Loosen the clothing
round the chest and neck and apply cold wet towels to the head and
temples and hot water bottles to the feet if cold, allowing free
circulation of the air. The treatment during the intervals must
necessarily depend upon the exiting cause, as worms, injuries to the
head, teething, etc., when attention will naturally be directed to its
removal.
In all cases, however, the diet should be carefully regulated. Where the
attack is due to a plethoric condition, the sufferer must be restricted
to a light, nutritious, but not stimulating diet, avoiding everything
that may produce a rush of blood to the head. The bowels must be kept
regular, by the diet if possible, the sleep taken at regular hours, with
daily exercise in the open air. When, on the other hand, the cause is
due to general weakness and debility, a generous diet should be adopted,
with tonics and other means for strengthening the system. Bromide of
potassium, given in doses of ten to twenty grains in half a glassful of
water, three times a day, has been found a very valuable remedy. The
writer has experienced the efficacy of the following prescription:
℞
Soda of bromide, ℥i.
Ammonia of bromide, ℥ss.
Aqua, ℥vii.
A tea-spoonful in two table-spoonfuls of water three times a day. It has
been said that a black silk handkerchief thrown over the face will at
once bring a person out of a fit, and when an _aura_ has preceded an
attack, its progress may be checked by means of a ligature, or by
applying to the nostrils five minims nitrite amyl pearl. By the
judicious employment of the proper remedies and a strict adherence to
the prescribed regimen, a permanent cure of these attacks may often be
effected, or, at all events, the sufferings greatly alleviated in those
cases which do not admit of cure.