Care of the Sick—Management of the Sick-Room—Food of
Invalids—Adaptation of Management to Particular Cases—Nurses,
and Things essential to Nursing—Importance of Calmness and
Patience.
Another duty of great importance devolves on woman, namely, the care of
the sick. From the highest to the lowest none are, properly speaking,
exempt from this charge. It is true that those who are rich can hire
experienced nurses; but still the responsibility, the anxiety, rests with
the mistress, for she cannot hire affection, thoughtful care, and all
those little attentions which make the sole comfort of an invalid; she
can merely secure a species of human machine which mechanically performs
its duties, and between whiles eats, drinks, sleeps, and comforts itself.
There are many excellent and kind-hearted professional nurses; but
there are also more who become, as it were, petrified by the habitual
contemplation of suffering, and who merely regard the patient with a
business-like eye.
In a sick-room, the kindness and attention of the nurse often work far
greater marvels than the skill of the doctor, for she is there every
hour, she sees every change, and can minister to so many little wants;
those trifles which make up the events of an invalid, those minor details
so unimportant to a person in health, those whims and desires, and
nervous susceptibilities which appear almost childish to lookers-on, will
be studied by a good, conscientious nurse, and overlooked or disregarded
by one who either does not feel interested in the patient, or has not
sufficient sympathy to induce her to study these matters. In the former
case, the invalid will be soothed and cheered; in the latter, irritated
and depressed. Surely, it is not difficult to conceive which influence
must act most beneficially upon the system.
Gentleness, watchfulness, firmness, judgment, some delicacy of feeling
and _savoir faire_, and a truly Christian spirit, are the distinguishing
characteristics which will best adapt a woman for fulfilling this phase
of her duties. There are many who, from intense solicitude and sense
of duty, will give way to those impulses of feeling which lead them to
devote themselves so entirely to the nursing of some beloved relative,
that all other duties, and even self, are wholly forgotten. What is the
consequence of this error of judgment? Their own health succumbs, and
they become not only useless, but render themselves sources of trouble
and anxiety. How much better to have husbanded their strength, so as to
be able to remain useful! That despised article, common sense, would
teach us all so much if we would but stop to listen, if we would not
mount, each one, our own peculiar hobby, and gallop off at a tremendous
rate, heedless of all sign-posts, and often regardless of even hedges and
ditches. Affection! feeling! sentiment! nerves! how much has been done
and left undone in these names, especially as regards the subject we are
now treating of, while poor dear common sense has been decried as a most
unfeeling person, and rudely ejected when she strove to make herself
heard!
Yet in few places is common sense a more valuable assistant than in the
sick-room; aided by self-command and good feeling, she will transform the
most uninitiated person into an excellent and efficient nurse. Let us
hear a few of her fundamental principles.
Speak in a low but perfectly distinct voice, both to the invalid and to
any one who enters the room, in order that, although no unnecessary sound
may be heard, the patient’s ear may not be fatigued by striving to catch
the words, or excited by mutterings or whispers addressed to some one
else.
Let your countenance be calm and cheerful, your manner soothing and
hopeful, and your words such as may cheer or comfort the mind. Avoid all
fuss, all hasty movements, all noises that may startle or disturb; let
even your dress and shoes be chosen with reference to quiet.
Keep everything in its place, so that in an instant you can put your hand
on it when required; have hot water, clean cups, spoons, and glasses,
and well-aired body and bed linen always handy; let the air of the room
be changed frequently; avoid all bad smells, or remove them as soon as
possible; pay strict attention to the temperature of the chamber, and
keep it as even as may be; and regulate the light with equal care.
All food offered to invalids should be daintily prepared, and presented
in the most careful manner. How often, when we have been longing for
food, have we turned from it with disgust, because we had seen the nurse
cool it with her breath, or taste it, and then drop the spoon back into
it, and present it to us! Nor is it well to inquire of invalids what
shall be got for them. If they express a wish for some particular thing,
well and good, let it be got for them, if reasonable; but a trifling
delicacy unexpectedly brought, will often tempt the appetite; besides,
a sick person, or even a convalescent, is often too languid to be at
the trouble of thinking about eating, and would sooner go without; or,
if he or she chooses something, it may be the very thing which would be
improper or prejudicial, and then comes disappointment, and a species of
disgust of all else, for in illness the appetite is ever capricious.
Nowhere is cleanliness of such paramount importance as in the sick-room.
Do not let us be misunderstood here. We do not mean that an immensity
of sweeping, scouring, and dusting is to be done, but simply that
the chamber must be kept clean and ventilated, that the bed and body
linen must be changed often enough to refresh without fatiguing the
patient, and that the air must be purified by means of vinegar, or other
disinfectants.
As there are so many kinds of illness, no general rules can be laid down,
and our friend, common sense, must be allowed to be the special adviser.
In one case body and mind may be paralysed by weakness or languor; in
another the body may be agonised, and yet the mind clear and active;
while in a third the body may be sane, the mind insane. Hence no one who
is a mere machine, guided by certain rules, can be a good and efficient
nurse; no one who does not study how to minister to the mind as well
as the body, who will not endeavour, to a certain extent, to identify
herself with the tastes, feelings, and even prejudices of the patient,
can be really useful.
What we have hitherto said applies chiefly to adult patients; to nurse a
sick child may seem a far easier task, but is not so. What gentleness,
firmness, playfulness, and, above all, what patience is needed in the
sick chamber of a child!—for in time of illness, a child is doubly a
child, almost a baby again.
The nurse should be constantly watchful over the little sufferer, and
mark attentively those positions, and the particular treatment, which
most effectually alleviate its sufferings, so that the latter may be
repeated under a recurrence of similar circumstances. One great principle
in child-nursing is to avoid over-feeding and over-dosing.
Every housekeeper should have a store of old linen, cambric, and calico
rags, and old pieces of flannel; these are easily obtained by saving
worn-out linen, flannel, and other garments, or at least the useful
portions of them, and treasuring old silk and cambric handkerchiefs. Such
things are invaluable in time of sickness for poultices, fomentations,
leeches, &c. Those who have them not will do well to visit a pawnshop,
or the emporium of a purchaser of wardrobes; and having there found one
or two articles of no value but to be torn up, to buy these, bring them
home, have them thoroughly washed, and then put them away for use.
It is good for us at times to be serious, to turn from the contemplation
of life’s pleasures and enjoyments, and look upon its darker pages; for
it has been beautifully said by an eminent writer, that “Suffering is
not a slender dark thread, winding every now and then through a warp of
dazzling brightness, but it is interwoven with the whole texture. It is
not incidental, but designed for us; it enters into God’s purposes; it
has a great work to do, and we know nothing of life until we comprehend
its purposes.” Again: “Suffering nourishes the tenderest sympathies of
our nature; it rouses us to energy and a consciousness of our own powers,
and at the same time infuses the meekest dependence on God; it stimulates
us to cherish and to prize the blessings of this world, and at the same
time weans us from and lifts us above mere earthly things.”
There is no home into which sickness may not come at any hour; and as
it is to woman that the office of nurse is invariably delegated, surely
every woman ought to learn betimes all that will best qualify her to
become the ministering angel, whose presence shall bless the long hours
of pain and confinement. False delicacy, foolish weakness, and all that
can detract from usefulness, should be early overcome. We have seen a
daughter scream, and weep, and wring her hands, while her mother lay
fainting before her; we have seen a mother shriek and fall on her knees
and utter words of agony, when some accident happened to her child. But
what did all this unavailing grief benefit the sufferers? How much better
she who, controlling her feelings, thinks calmly how she can administer
relief, and performs her duties in an intelligent and patient manner.
THE FAMILY MEDICAL GUIDE.
Under this head directions will be given for the domestic management
of some of the more frequent ailments to which families are subject.
Book-doctoring is a very doubtful economy, except where it is made the
means of enabling the nurse or the mother to co-operate intelligently
with the medical adviser. But there are cases, as among emigrants, or
persons residing in remote places in the country, in which medical aid
cannot readily be obtained. In such cases, the following papers will be
found of great value. A number of specific remedies for various minor
ailments will be found appended to the Medical Articles.
HOOPING-COUGH.
Hooping-cough is thought to have been introduced into Europe from Africa,
and, like most other complaints, varies much in intensity. It is a highly
infectious disease, and grown persons are liable to its influence; but it
commonly takes place between the ages of four months and twelve years.
It usually begins as a common cough, and is attended with the general
symptoms of having taken cold; but in its progress, soon becomes more
severe; though, the longer it is discoverable by the hoop, the more
favourable it is likely to be. A frequent discharge from the mouth,
nose, and eyes, food often rejected, together with large quantities of
phlegm, after which the child generally appears pretty well, and eats his
food heartily—these are the most common symptoms. When the disease is
violent, they become greatly aggravated, especially during the night, and
the child will appear almost strangled, becoming livid, and blood often
starting from the nose and eyes.
The following is a favourite prescription of the late Mr. Tuckwell,
of Oxford, who, for skill in his profession, courtesy of manners,
and kindness of heart, has had few equals, and who has left in that
University an almost imperishable memory:—
Dissolve one scruple of salt of tartar, in a quarter of a pint of soft
water: add to it ten grains of cochineal finely powdered, and sweeten it
with lump sugar.
This medicine is also highly recommended in the _Lancet_. The dose for an
infant is a tea-spoonful four times a day; from five years old upwards,
a table-spoonful may be taken: but as the paroxysms of this complaint
are much aggravated by the resistance of the child to swallow medicine,
it is very desirable to abstain, if possible, from giving any internal
remedy.
The following embrocation was prescribed by a gentleman, one of the
leading practitioners in Oxford; and for spasmodic coughs of all kinds,
as well as for inflammatory croup, it is invaluable:—
Two drachms of Tincture of Opium.
Two ounces of Camphor Liniment.
A tea-spoonful to be rubbed in over the throat and chest every night and
morning, and cover the parts immediately with flannel. If the chest is
loaded with phlegm, an emetic must be given once, twice, or three times a
week, as required. Ipecacuanha wine is most suitable, and the dose for a
child of four or five years is 2½ or 3 drachms.
During the first stages of this disorder, the patient should breathe
an equal temperature, as nearly as it can be managed, not too warm and
close, but equal; and when the virulence of the disorder _has passed
away_, the open air (if the weather be mild) may be frequently resorted
to; and a change of air, where it is practicable, will often remove at
once all remains of the complaint.
The only thing that remains to be mentioned, is the proper diet, which
is, indeed, of paramount importance; and for children of even six and
seven years of age, ought to be little more than milk and broths. These
are nourishing, and more readily digested than meats or puddings. One
prevalent error is, that milk engenders phlegm; but this is a mistake.
Should the milk be found to curdle on the stomach, a little common salt
must be added; or, better still, use asses’ milk, if it is attainable.
These light nutriments quickly pass out of the stomach, or if brought out
by coughing twenty times during the day (which is sometimes the case),
the child will immediately take more with avidity.
If thirst prevails, a little toast-and-water may be given. When taken in
time, and treated properly, hooping-cough is scarcely ever fatal, indeed
never, as long as the patient is free from fever, or other disease.
If the attack, from its length and severity, should cause a loss of
strength, health will soon be recruited by a cold infusion of bark,
gentle exercise, and pure uninfected air, and dieted with a nourishing
broth, made as follows:—
Take three-quarters of a pound of veal, the same quantity of beef,
chopped very fine, and simmered for three hours in about two quarts of
water. Strain it, and let the invalid drink the clear liquid, hot or
cold, as may be most agreeable.
_Mixture for Hooping-Cough._
Ipecacuanha Wine 2 drachms.
Carbonate of Soda ½ drachm.
Paregoric Elixir 2 drachms.
Water 1 ounce.
A tea-spoonful or two (according to the age of the patient) may
be given three times a day.
TEETHING.
This natural process in a child’s development, usually commences about
the third month, though it is seldom till the fifth or sixth that the
teeth make their appearance through the gums. The period when the teeth
may be expected is indicated by an increased irritability of the infant,
the gums become tense, shiny, and swollen; while the excited glands
in the neighbourhood pour out so large a quantity of saliva, that it
overflows the mouth, causing the infant to _drivel_, as the nurses call
this natural salivation. At the same time the child, as if to relieve
the heat and irritation it feels, thrusts its hands into its mouth in
the attempt to do what the watchful mother will do for it—_scratch_ the
top of the gum with her nail, or, making a rasp of a rough crust, or a
proper _gum-ring_, rub it freely along the top ridge, that, by abrading
it of the binding cuticle, the imprisoned gum may have the power to
expand. As the only benefit that can accrue from rubbing the child’s gum
is the tearing or relaxing this fine but tenacious cuticle, all smooth
surfaces, such as coral or ivory rings, are perfectly useless; such
instruments to be of any service, should be cut into small diamonds like
a fine file, and used frequently by the parent, exactly in that manner.
The crust, though serviceable from its roughness, is dangerous from the
chance of crumbs breaking off and getting into the infant’s throat. After
the irritation and drivelling have continued for some weeks, a white
line or a round spot appears on the top of the gum of the lower jaw, and
ultimately of the upper; through these white spots the teeth finally
burst their way in the following order: the two incisors of the lower
jaw are the first to make their appearance, though frequently several
weeks elapse between the advent of the first and second; the next cut
are the four incisors of the upper, then the remaining two incisors of
the lower jaw, one on each side, but not joining. There is now a pause
for a short time in the process. The next in succession are the four eye
teeth in either jaw, thus completing the infantine set of sixteen teeth.
Another pause, usually of some months, succeeds before nature resumes
her active operations; when she does, it is to place one double tooth on
each side of both jaws, thus perfecting the child’s complement of twenty
teeth. When these are shed, and nature completes her office, instead of
the first ten she places sixteen teeth in each jaw, thus doubling her
first complement, and making the adult set thirty-two. Each tooth as it
is formed makes half a circle on its axis, and rising sideways, pierces
the gum with the extreme point of its edge, revolving as it rises to the
perpendicular.
The _diseases_ that teething gives rise to in infants are very numerous,
and the consequences of so natural a process are some of the most
remarkable facts connected with the development of the human economy.
The disorders excited by difficult dentition are, diarrhœa, convulsions,
mesenteric disease, water on the brain, rickets, and remittent
fever—all of them to the infant fearfully mortal diseases. Each of these
affections, though so different in its locality, and so opposite in
its symptoms, is induced by the same cause—long-continued irritation
in the gums reacting on the delicate organization of the brain and
nervous system. And, as this irritation is caused by the difficulty the
imprisoned tooth finds in escaping from the fibrous membrane in which
it is enveloped, and making its way through the tightly bound gum, it
becomes the duty of the medical man or parent, as soon as the first
constitutional disturbance manifests itself, to assist the efforts
of nature to effect the escape of the tooth, by dividing the gum and
leaving an aperture through which the new-formed tooth may reach its
destination. But, as _lancing_ the gums, as the process is called, will
be worse than useless unless _effectually done_, the gums should never be
cut unless the tooth can be plainly felt below, and, to be of service,
the incision must be carried down to the tooth, or else the unyielding
membrane in which it is encased will be undivided, and the child put to
the inconvenience of lancing without effecting the slightest benefit. As,
however, the irritation commences from the first entrance of the tooth
into the gum on emerging from its bony socket, and long before the actual
pressure of the tooth can cause the graver mischief, or simply from the
increased amount of blood circulating in the parts, it is evident that
lancing the gums in so early a stage of formation is not only impolitic,
but hurtful.
Another mode of relief, both for the diarrhœa and convulsions that
so frequently occur in weakly infants at this period, must be looked
for; and that means, in all stages of dentition, from the first to the
last, will be found either a source of instant relief or of certain
recovery; that remedy is the _hot bath_, which, in all cases of infantine
suffering, is the mother’s best hope, and should be her unshaken
reliance. The time a child should be kept in a hot bath should seldom
exceed _two minutes_; and, as the object is to unload some congested
organ, or to relieve certain parts of their excess of blood by causing
a rapid determination to the skin, the water should be hot enough to
produce this effect as instantaneously as possible. When diarrhœa
continues in despite of the hot bath, a little magnesia or a few grains
of prepared chalk may be given two or three times a day until the
excessive action is checked; or if unabated by these means, a few drops
of tincture of kino is to be administered, as prescribed for diarrhœa.
SCARLET FEVER, OR SCARLATINA.
When scarlet fever becomes epidemic among adults, children rarely fail
of being attacked by it in great numbers, and very frequently sink under
it. It is, indeed, rather a child’s disease, and is very contagious
amongst children; but is not often communicated from them to adults. This
disease begins with the common symptoms of fever, often with languor and
disposition to fainting, shivering, sickness, a quick pulse, and pain in
the head; there is frequently, very early in the disorder, a stiffness
in the muscles of the neck, which is soon followed by some difficulty in
swallowing. This affection of the neck should be carefully inquired into,
especially in young children; the soreness of the throat being sometimes
not complained of in the most severe attacks of the disease, until but
little hope remains of any mode of treatment being attended with success.
The fever generally increases in the evening, and is often accompanied
with delirium; but some remission takes place towards morning, and
perspirations come on. There is no complaint in which delirium is of
so little consequence as in scarlatina. On the second or third day the
efflorescence (or redness) appears on the skin, and generally first on
the face, neck, and breast. Up to this period the disorder is sometimes
supposed to be measles, as many of the premonitory symptoms are similar;
but scarlatina is readily distinguished by the absence of that hoarse
cough, frequent sneezing, and watery discharge from the nose and eyes,
which are the constant attendants on the early stages of measles: in this
latter complaint also, the skin is covered with a _distinct_ eruption,
raised above the skin, leaving it clear and well-defined between the
marks,—while in scarlatina, the redness is _on_ the skin, and its
appearance seldom produces any remission of fever.
When the complaint is to terminate in health, the fiery redness abates
gradually, and is succeeded by a brown colour, when the skin, becoming
rough, peels off in small scales, and health is generally restored.
On the contrary, when it is to terminate fatally, the febrile symptoms
run very high from the first attack, the skin is intensely hot and dry,
the pulse is very frequent but small, great thirst prevails, the redness
appears on the second day or earlier, and about the third or fourth is
often interspersed with large livid spots, and the patient is cut off
about the sixth or eighth day. Sometimes a severe purging comes on,
which never fails to prove fatal. No complaint is more arbitrary in its
attacks, and none on which, humanly speaking, you can reckon with so
little certainty.
To determine to the surface of the body, it will be right to give the
simple saline, made as follows:—
Take of
Citric Acid 1½ drachm.
Bi-carbonate of Potash 2 drachms.
Water 7½ ounces.
Simple Syrup ½ ounce.
Spirits of Nitre 2 drachms.
Mix, and take a sixth part every four hours. If the child is
very young, give half the dose.
On the first appearance of this disorder, it will be proper to administer
an emetic of ipecacuanha powder; and for children of four years of
age, seven grains will be a sufficient quantity, and even a repetition
of it may be the means of preventing any disposition to diarrhœa
(purging). Throughout the whole of this disease it will be advisable to
make frequent use of some detergent (cleansing) gargle, which in young
children must be thrown into the throat with a syringe.
_Detergent Gargle._
Take of
Purified Alum 1 drachm.
Barley Water 8 ounces (half a pint).
Honey of Roses 1 ounce.
Mix, and gargle the throat frequently.
Camphor is a medicine much employed in scarlatina, and with good effect;
but more particularly where the pulse is very low, and the redness
disappears suddenly from off the skin. In these cases volatiles, the
aromatic confection, and wine will be proper remedies—this latter to be
given in moderate quantity, according to the age and other circumstances
of the patient, and it should be given in the food, which must consist of
thin, nutritious aliments, such as sago, arrow-root, barley water with
milk, &c., &c., and _thin_ warm barley water, _without_ milk, should be
often drunk, in order to induce moderate perspiration.
In a general way, a cordial plan is required throughout the disease;
and where the throat is much affected, either with sloughs (discharges
of matter), or total blackness, bark is indispensably necessary,
however thick and florid the rash, however hot and dry the skin. Bark,
in moderate doses (for children of four years of age, six grains of
Peruvian bark may be given four times a day), reduces the fever in the
milder species of scarlatina, above every other remedy; and in the more
malignant scarlet fever, it supports the system until the regular stages
of the fever are accomplished, and a perfect crisis is formed. Should it
be disposed to act too freely on the child’s bowels, one drop of opium
may be added.
An unpleasant turn in the complaint sometimes takes place in a secondary
fever, and is often the consequence of administering bark and wine _too
early_, or too liberally, in the _milder_ scarlatina.
As parents and nurses are naturally much alarmed at delirium, it may be
well to assure them that there is no disease in which delirium is of so
little consequence as in the one before us. In other fevers it seldom
comes on until they have arrived at a dangerous height, but it sometimes
accompanies scarlatina from the very first day, and many of the patients
never fail to be delirious every night, though, excepting this, there
exists no other unfavourable symptom from the beginning, and during the
illness.
THRUSH, OR APHTHÆ.
This is a disease of the mucous membrane of the mouth, stomach, and
bowels; and when severe, may be traced throughout the whole alimentary
canal. Though thrush may attack persons at any stage of life, still it is
regarded as a disease more peculiarly incident to childhood and infancy;
and is generally induced by an abrupt change of diet, or some cause
impairing the nutritive quality of the mother’s milk, which produces this
eruptive fever in the infant’s digestive organs. The _symptoms_ of thrush
are heat, pain, and restlessness, followed by a series of small, raised,
white spots, scattered over the mouth, tongue, and lips; sometimes there
are but few, at others the whole mouth is studded with them. After a
day or two, they enlarge and become distended with a white puriform
fluid; the eruption looking like a cross of minute beads: this completes
the suppurating or second stage; after which, the vesicles proceed to
ulceration, when they burst, discharge their fluid, and degenerate into
small flat ulcers, causing throughout, but especially in this the last
stage, considerable irritation and pain.
_Treatment._—Having, if possible found the immediate cause of the
disease, and if an improper food, removed it, the child must be carefully
fed on a diet that in no way can irritate the tender and inflamed lining
membrane; and, if necessary, a few spoonfuls of beef tea are to be given
occasionally as a gentle stimulant. The medical treatment consists in the
exhibition of the subjoined powders and mixture, and the employment, each
evening, of the warm bath as a sedative to the restless child.
Take of
Grey Powder 8 grains.
Scammony 6 grains.
Rhubarb 3 grains.
Mix and divide into nine powders for an infant from six to
twelve months, giving one powder twice a day; into six powders
for an infant from one to two years old, one twice a day; and
into four powders for a child of three years, to be given in
the same manner.
Take of
Mucilage ½ ounce.
Castor Oil 2 drachms.
Syrup 2 drachms.
Mix well in a mortar, and add
Dill Water ½ ounce.
Mix, and give a small tea-spoonful twice a day to an infant
from six to twelve months; three times a day to one of from one
to two years; and every six hours to a child of three years
old. Should the thrush have proceeded to ulceration, the mouth
of the infant or child should be washed out by a lotion, made
by dissolving a small quantity of alum or borax in water well
sweetened with honey; and then, by tying a fold of lint to a
piece of stick, and using it as a mop, to cleanse the mouth,
having first well wetted it in the lotion.
ITCH.
This cutaneous disease, the result of dirt and insufficient food, is
communicated by the merest contact; and as this is a misfortune that any
person may be exposed to, by touching in a cursory manner the person
of an affected individual, it is necessary to show the means by which,
with a day or two’s seclusion, it may be effectually eradicated. The
intolerable itching that so remarkably distinguishes this disease, is
the consequence of a very minute microscopic insect which burrows under
the scarf skin of the hands and body; and all that is necessary to
destroy the life of this insect, and of course cure the disease, is to
block up the pores of the skin, by rubbing in some stiff simple ointment
upon going to bed; use a hot bath in the morning to cleanse the body of
the grease, and repeat the ointment again; and so continue the one at
night, and the other in the morning till the cure is effected. For long
standing cases sulphur or creosote is necessary, but for trifling cases,
spermaceti ointment is quite sufficient, the hands being kept greased and
gloved both day and night.
ERYSIPELAS.
This disease is an inflammatory affection principally of the skin, when
it makes its appearance externally; it is most frequent in its attacks on
women and children, and on those of an irritable habit, rather than of a
full robust constitution. Erysipelas will sometimes return periodically,
attacking the patient once or twice in the year, or even once in the
month; and then, by its repeated attacks, it often gradually exhausts the
strength, especially if the sufferer be aged, or of a bad habit of body.
This disease is brought on by all the causes that are apt to excite
inflammation, such as injuries of all kinds, the external application of
stimulants, exposure to cold, and obstructed perspiration; and it may
likewise be occasioned by humours generated within the body, and thrown
out on its surface. In slight cases where it attacks the extremities, it
makes its appearance with a sensation of heat, accompanied by roughness,
pain, and redness of the skin, which becomes pale when the finger is
pressed upon it, and again returns to its fiery hue when the pressure is
withdrawn. There prevails some fever, and the patient is hot, thirsty,
and restless. If the attack is mild, these symptoms will continue only
for a few days, the surface of the part affected will become dry and
yellow, and the scarf skin (or outer skin) will fall off in scales; but
this complaint appears more frequently in the form of small vesicles,
or blisters, containing a thin fluid. In some instances the fluid is of
a different consistency, and instead of escaping when the blister is
broken, it adheres to, and dries upon the skin. In unfavourable cases,
these blisters sometimes degenerate into very obstinate ulcers, which
now and then become gangrenous. This, however, does not frequently
happen, for although it is not uncommon for the surface of the skin
and the blistered places to appear livid, or even blackish, yet this
usually disappears with the other symptoms of the disorder. No remission
of fever takes place on the appearance of the vesicles; and when the
complaint is not of a dangerous tendency, the inflammation and fever
cease gradually without any evident crisis. During these symptoms (fever
and inflammation) it will be proper to administer aperient medicines, and
nothing, perhaps, suits the purpose better than the old-fashioned black
draught. The external application of Goulard’s Lotion will allay heat and
irritation very successfully.
As erysipelatous fevers often terminate when profuse perspiration can
be induced, the patient must drink freely of tea, bran tea, or warm
barley water: and this is a necessary part of the treatment, which must
never be neglected. The vesicles must be kept lightly covered with pure,
unadulterated wheat flour; where the inflammatory symptoms run high, the
diet must consist of light nourishing food, such as sago, arrow-root,
bread pudding, and such like things; but in those cases where symptoms of
irritation prevail, a more generous diet, such as animal broths, ought to
be allowed.
When the attack is mild, the patient must be kept in the house, but need
not be confined to bed. Very earnestly impress on the minds of your
patients the baneful effects of opening the little watery blisters. An
instance of this kind occurred in the writer’s vicinity, followed by
the most lamentable and fatal results. The victim was a married woman,
about 33 years of age; the blister appeared on the upper lip, and she,
not knowing its nature, punctured it; inflammation, delirium, and death
quickly succeeded each other, and baffled the skill of two medical men of
long experience.
There is another species of erysipelatous inflammation, which usually
attacks the trunk of the body, and is vulgarly known as “Shingles.” It
consists of a number of blisters extending round the waist. Little or no
danger ever attends this species of erysipelas, but much pain is felt
darting through the body; and these pains will continue to annoy the
patient at times for some weeks after the eruption has disappeared.
SMALL-POX.
This, the most serious of all eruptive diseases, though having many
symptoms in common with other affections of this inflammatory class,
has some peculiar to itself, and which, carefully observed, will always
accurately define the disease, and point out small-pox from every other
analogous affection. These distinctive features are the _greater heat of
the skin_, the _nausea_ and _sickness_ that from the first attend it,
and the fact that the rash appears on the _fourth_ day of the illness,
and not on the third, as in other eruptive diseases. Small-pox usually
commences with shivering, pains in the back and head, heat, thirst,
nausea, often sickness, a general feeling of languor and debility, quick
full pulse, great heat and dryness of the skin, and a white furred
tongue. This state continues with the usual febrile symptoms and nightly
paroxysms till the fourth day, when a fine papillary rash, like grains
of millet seed, breaks out on the face, neck, arms, and breast; in a few
hours more extending over the rest of the body. On the fifth day the rash
has become more distinct, each papilla has become larger and filled with
a transparent fluid, changing its form into that of a vesicle, which, as
the disease advances, enlarges with a _flat head_ and _depressed_ centre,
the fluid passing from a transparent lymph into a yellowish matter. While
this change is taking place, the extremities and the head swell, the head
and face often becoming immensely distended, closing the eyes, and giving
to the countenance a deformed and unnatural appearance. About the eighth
day the maturation of the pustules is completed, and from thence to the
eleventh day the declension of the eruption takes place, the pustules
burst, the matter is effused, scabs are formed, and the dead cuticle
begins, from the twelfth day, to peel off or disquamate, leaving pits in
the skin, the consequence of the suppuration having destroyed the fatty
matter beneath the cuticle.
As the different stages of the disease are advancing, corresponding
changes are taking place in the constitution of the patient; the heat and
thirst increase, the pain, restlessness, and anxiety are augmented; the
inflammatory and febrile actions keep advancing, rendering the slightest
noise intolerable, and causing delirium and a chain of the most dangerous
symptoms.
_Treatment._—The inflammatory nature of small-pox renders what is called
the cooling mode of treatment, in all its details, a duty of imperative
importance. For this purpose, the room in which the patient is placed
should during the disease be kept dark and cool, and at least once a day
thoroughly ventilated by means of a fire in the grate, for a short time
night and morning, but especially at the latter period. The room, also,
should be frequently purified by sprinkling the floor with chloride of
lime, or by the burning of vinegar on a heated shovel. As the stomach is
the first organ sensibly affected, and continues more or less disturbed
during the whole disease, the treatment should begin by giving the
patient an emetic, composed, if an adult, of twenty grains of ipecacuanha
and one grain of tartar emetic; and as soon as that operation has ceased,
the following powders and saline purgatives are to be employed, giving
the mixture every _two_, and the powders every _four hours_.
Take of
Epsom Salts 1 ounce.
Mint Water 8 ounces.
Antimonial Wine 3 drachms.
Spirits of Nitre 2 drachms.
Syrup of Saffron 2 drachms.
Mix, and give to an adult two table-spoonfuls for a dose, and
to children, according to their age, from a dessert-spoonful
upwards.
Take of
Calomel 3 grains.
Powdered Antimony 2 grains.
Rhubarb 3 grains.
Jalap 10 grains.
Mix, and make a powder. Give _one_ of such a strength, every
_four hours_ to an adult till the bowels are _well_ acted on,
when they are to be discontinued; but the mixture is to be
persisted in, though less frequently, or in half the dose. For
a child from nine to twelve years of age, _half_ of one of the
above powders is to be given every _four hours_, till the same
result is effected; and for younger children, each powder of
the above strength is to be divided into _three parts_, and
administered as the others. For an ordinary drink, in which the
patient should on no account be stinted, lemonade, thin gruel,
or cold tea is to be used; all solid food or nutritious aliment
must be withheld, the patient kept low, his head cool, and the
feet hot.
When the fever runs high, and the head symptoms are severe, it may be
necessary to bleed, but if not, a blister is to be laid on the nape
of the neck, and perhaps two small ones behind the ears, to relieve
the tumefaction of the eyes, and where the want of sleep demands it, a
draught at bed-time, composed of fifteen grains of nitre dissolved in two
ounces of water, with twenty-five drops of laudanum; or to children, from
three to ten drops in a little gruel, according to their ages. Such, in
mild or _distinct_ small-pox, is generally all the treatment needed; and
even in the aggravated _confluent_, till the time of disquamation often
no other means are necessary.
In cases, however, where the rash, after showing favourably, suddenly
recedes from the skin, or only partly comes out, the patient must be
put into a warm, or rather hot bath for three or four minutes; and when
the pulse falls, and becomes small and feeble, as it becomes absolutely
necessary to bring back the rash to the skin, hot wine and water must be
given, together with soups, tonics, and stimulants, till the invigorated
constitution has power to re-act. Should this not have been called for, a
system of careful feeding, aided with wine and bark, must be commenced
at the period when nature begins to throw off the dead eruption.
The great object to be observed in the treatment of small-pox, is to
keep the patient cool, and on the lowest regimen, till the disquamation
begins to act freely on the bowels, and to allay fever by cooling drinks.
As soon as the patient is convalescent, the diet should be light, and
composed chiefly of farinaceous foods, puddings, custards, &c. The body
should be bathed once a week, and the cuticle excited by dry rubbing with
a towel, and especial care taken for some weeks to keep children from the
contact of the patient, who should for that time take an aperient every
three days.
To prevent the face and neck from being pitted, each pock in that
neighbourhood should be lightly wetted with a weak solution of lunar
caustic, at the period when the pustules are filled with a transparent
fluid, while they are yet round, and before suppuration has set in or
the tops of the vesicles grown flat—or in other words, at the end of the
second stage.
MEASLES.
This is a disease characterized by a species of inflammatory fever,
attended with all the symptoms of a severe cold, running at the nose
and eyes, sneezing, cough, cold chills, tightness at the chest,
languor, lassitude, pain in the back and head, and, in fact, by all the
indications of constitutional disturbance and fever; though the sign by
which it may be most readily known and determined, is the running of
humour from the eyes, and constriction of the chest, with a short dry
cough. The great secret in the treatment of measles to be borne in mind,
is not to discontinue the treatment with the subsidence of the symptoms,
for no disease leaves behind it so many and hurtful consequences;
therefore, to purify the system, and save the body of the child from
mumps, dropsy, tumours, bad eyes, and many other distressing affections,
it is necessary to keep up for some weeks, after the disease is cured, a
mild but steady action on the body; give the child change of air, plenty
of exercise, and a nutritive but light and stimulating diet.
The _symptoms_ of measles commence with cold chills and flushes,
lassitude, heaviness, pain in the head, and drowsiness, cough,
hoarseness, and extreme difficulty of breathing, frequent sneezing,
defluction or running at the eyes and nose, nausea, sometimes vomiting,
thirst, a furred tongue; the pulse throughout is quick, and sometimes
full and soft, at others hard and small, with other indications of an
inflammatory nature. On the _third_ day, small red spots make their
appearance, first on the face and neck, gradually extending over the
upper and lower part of the body.
On the fifth day the vivid red of the eruption changes into a brownish
hue, and in two or three days more the rash entirely disappears, leaving
a loose powdery disquamation on the skin, which rubs off like dandriff.
At this stage of the disease, a diarrhœa frequently comes on, and being
what is called “_critical_” should never be checked unless seriously
severe. Measles sometimes assumes a typhoid or malignant character, in
which form the symptoms are all greatly exaggerated, and the case from
the first becomes doubtful and dangerous. In this condition the eruption
comes out sooner, and only in patches, and often, after showing for a
few hours, suddenly recedes, presenting instead of the usual florid
red, a dark purple or blackish hue, a dark brown fur forms on the gums
and mouth, the breathing becomes laborious, delirium supervenes, and if
unrelieved, is followed by coma; a fœtid diarrhœa takes place, and the
patient sinks under the congested state of the lungs and the opposed
functions of the brain. The unfavourable symptoms in measles are a high
state of fever, excessive heat and dryness of the skin, hurried and short
breathing, and a particularly hard pulse. The ordinary after-consequences
of measles are, croup, bronchitis, mesenteric disease, abscesses behind
the ear, ophthalmia, and glandular swellings in other parts of the body.
_Treatment._—In the first place the patient should be kept in a cool
room, the temperature of which must be regulated to suit the child’s
feelings of comfort, and the diet adapted to the strictest principles of
abstinence. When the inflammatory symptoms are severe, bleeding in some
form is often necessary, though, when adopted, it must be in the first
stage of the disease; and if the lungs are the apprehended seat of the
inflammation, two or more leeches, according to the age and strength of
the patient, must be applied to the upper part of the chest, followed
by a small blister; or the blister may be substituted for the leeches,
the attendant bearing in mind that the benefit effected by the blister
can always be considerably augmented by plunging the feet into very hot
water, about a couple of hours after applying the blister, and keeping
them in the water for about two minutes. The first internal remedies
should commence with a series of aperient powders, and a saline mixture,
as prescribed in the following formularies; at the same time as a
beverage to quench the thirst, let a quantity of barley water be made,
slightly acidulated by the juice of an orange, and partly sweetened by
some sugar-candy, and of which, when properly made and cold, let the
patient drink as often as thirst or the dryness of the mouth renders
necessary.
_Aperient Powders._—Take of scammony and jalap, each twenty-four grains;
gray powder and antimonial powder, of each eighteen grains. Mix and
divide into twelve powders, if for a child between two and four years of
age; into eight powders, if for a child between four and eight years; and
into six powders for between eight and twelve years of age. One powder
to be given, in a little jelly or sugar and water, every three or four
hours, according to the severity of the symptoms.
_Saline Mixture._—Take of mint water, six ounces; powdered nitre, twenty
grains; antimonial wine, three drachms; spirits of nitre, two drachms;
syrup of saffron, two drachms. Mix. To children under three years, give
a tea-spoonful every two hours; from that age to six a dessert-spoonful
at the same intervals; and to children between six and twelve, a
table-spoonful every three or four hours. The object of these aperient
powders is to keep up a steady but gentle action on the bowels; but
whenever it seems necessary to administer a stronger dose, and effect a
brisk action on the digestive organs—a course particularly imperative
towards the close of the disease—two of these powders given at once,
according to the age, will be found to produce that effect. Thus, two of
the _twelve_ for a child under four years; and two of the eight, and two
of the six, according to the age of the patient. When the difficulty of
breathing becomes oppressive, as it generally does towards night, a hot
bran poultice laid on the chest will be always found beneficial. The diet
throughout must be light, and consist of farinaceous food, such as rice
and sago puddings, with beef tea and toast; and not till convalescence
sets in, should hard or animal food be given. When measles assumes the
malignant form, the advice just given must be broken through; food of
a nutritious and stimulating character should be at once substituted
and administered in conjunction with wine, and even spirits, and the
disease regarded and treated as a case of typhus. But as this form of
measles is not frequent, and, if occurring, hardly likely to be treated
without assistance, it is unnecessary to enter on the minutiæ of its
practice here. What we have prescribed in almost all cases will be found
sufficient to meet every emergency without resorting to a multiplicity
of agents. The great point to remember in measles is not to give up
the treatment with the apparent subsidence of the disease, as the
after-consequences of measles are too often more serious and more to be
dreaded than the measles themselves. To guard against this danger, and
thoroughly purify the system after the subsidence of all the symptoms of
the disease, a corrective course of medicine, and a regimen of exercise
should be adopted for some weeks, according to the cure of the disease.
CHICKEN-POX.
This disease, like the Small-Pox, seems to depend on specific contagion,
and seldom affects a person but once in his life. The eruption is often
succeeded by chilliness, succeeded by flushings, pains in the head and
back, thirst, restlessness, and a quick pulse; but at other times, none
of these premonitory symptoms are observable. Pustules soon appear, and
about the second or third day are filled with a watery fluid, which is
never converted into yellow matter, as in the small-pox (to which it
bears great affinity); and about the fifth day they usually dry away, and
are formed into hard crusts or scabs. No danger attends chicken-pox, but
often a good deal of suffering. The small-pox and chicken-pox differ:
the eruption of the former is preceded by a fever of a certain duration,
while that of the latter is either preceded by none, or by one of
uncertain duration; also in the pustules and succeeding scabs appearing
much earlier in the chicken-pox than in the small-pox; and in the fluid
of the pustules never acquiring the thick purulent appearance, which it
always does in distinct small-pox.
Let the patient partake freely of water or cooling drinks, as thirst
is always an attendant on the disease, and gentle laxatives should
be occasionally given—a tea-spoonful of lenitive electuary, with a
little milk of sulphur in it, is all that is generally required; but
should febrile symptoms run high, it may be advisable to take two or
three saline draughts during the day. The following is a recipe for
an excellent saline, to be drunk while effervescing:—Twenty grains of
carbonate of soda dissolved in a tumbler containing two table-spoonfuls
of water; add two tea-spoonfuls of lump sugar rolled; then put a
dessert-spoonful of lemon into a wine-glass (or fifteen grains of citric
acid dissolved in one table-spoonful of water). Pour it into the tumbler,
and drink it while the effervescence is taking place.
The benefit of this draught cannot be too highly estimated where the
stomach is deranged, and there is nausea and faintness, or in cases of
fever and thirst.
CROUP.
The Croup is a complaint somewhat similar to the hooping-cough, and to
which children _only_ are subject. There are two species of it, the one
acute, the other chronic: neither of them often attack children so late
as ten or twelve years of age; while they may seize infants newly weaned,
and are then the most severe. The cause of this disease is a morbid
secretion of thick mucus in the trachea (windpipe), adhering so firmly to
its sides as to impede respiration. The quantity and thickness of mucus
increasing, gradually lessens the diameter of the part, and if it effects
this to a considerable degree, the disease must of necessity prove fatal.
The symptoms by which croup is manifested, even to the most uninitiated
in the duties of the sick-room, is the peculiar croaking noise made in
respiration (from whence it takes its name); and when the disorder is
light, there is but little apparent indisposition between the paroxysms,
save a certain dulness, and a sense of fear in children of an age to
express it.
The fits frequently terminate by sneezing, coughing, or vomiting, and
return without any regularity. It is attended with a sharp and shrill
voice, and a flushed countenance, which grows livid during the paroxysms.
A warm bath should immediately be administered, and an emetic given as
soon as possible; say, ten drops of antimonial wine for a child three
years of age, and repeated every quarter of an hour until effectual, and
according to the age and strength of the patient; a blister should be
applied across the throat, the sufferer being made to inhale the vapour
of warm water with vinegar in it, and kept nearly upright in bed. A
doctor should be procured as soon as possible; and, until his arrival,
the foregoing directions may, in most cases, materially influence the
physician’s proceedings, and often save life.
Children liable to this disease should be warmly clad, wearing flannel
next the skin, and an emetic given upon the earliest appearance of
the attack; for remember, this disease requires prompt attention to
save life. With care, children usually grow out of it; that is, the
constitution will repel the attacks after the tenth or twelfth year.
NETTLE RASH.
This disease takes its name from its being attended by an eruption
similar to what is produced by the stinging of nettles. The causes of
this complaint are by no means obvious; but it seems to proceed either
from the perspiration being checked, or from some irritating matter in
the stomach. In all cases, there prevails considerable itching and some
heat in the parts affected; and, in some constitutions, a slight degree
of fever either precedes or attends the eruption. Its duration seldom
exceeds three or four days.
In some cases, Nettle Rash is accompanied with large wheals or bumps,
which appear of a solid nature, without any cavity or head, containing
either water or other fluid.
Half a tea-spoonful of magnesia, and the same quantity of cream of
tartar, mixed in half a tea-cupful of milk, an hour before breakfast, and
repeated as required, will be found very efficacious.
Some practitioners have entertained the idea that the humours of the body
are never vitiated to such a degree by the nettle rash as to require the
use of internal remedies, and that if the irritation could be certainly
allayed by external applications, there would be no necessity for any
other mode of cure.
As this disorder is very frequent in spring, when a hot sun, with
cold winds, prevail, the visitor will hear of a variety of herbs as
“never-failing cures” of nettle rash. Among these the nettle itself
is the Abernethy of the party, concocted into a sort of tea with a
proportion of one-third of ground-ivy infused in it. Although in a
chronic form, it is often of rheumatic origin. Nettle rash is never a
dangerous malady; but care should be taken to avoid currents of air, for,
if it recedes, or, as is the common expression, “driven in,” it produces
sickness, and other harassing symptoms.
We have always found, in such cases as these—and, indeed, at most
times—that simple remedies, easily accessible, are the most efficacious.
CONSUMPTION.
The persons most prone to consumption, are those of a sanguine or
phlegmatic temperament, with long neck, sharp shoulders, narrow chest,
slender fingers, clear skin, fair hair, and rosy complexion. The disease
usually begins with a short dry cough, followed, after a certain length
of time by a gradual loss of strength, lassitude, and great fatigue
upon small exertions; the pulse is quick and small, while the cough,
at first confined to the day, begins to extend into and through the
night; the breathing is hurried, with a sense of tightness at the chest,
accompanied with shooting pains; the expectoration at first frothy,
becomes viscid, opaque, often tinged with blood; and very copious in the
morning. As the disease advances, emaciation takes place, the cough,
pain, and difficulty of breathing increase, the face is flushed, the
soles of the feet and palms of the hands are affected with a dry burning
heat, the tongue, formerly white, now becomes clean and red, the pulse
is smaller and quicker, and hectic fever sets in, attended with profuse
perspiration; generally occurring twice a day, and, as the symptoms grow
more formidable, the appetite usually increases, filling the patient with
delusive hopes of recovery. The final symptoms, and those that indicate
approaching dissolution, are the setting in of diarrhœa, night sweats,
prominent cheek bones, hollow and cadaverous countenance, swollen legs,
great emaciation, and curved finger-nails. The expectoration has at the
same time altered its character with each stage of the disease; at first
scanty and frothy, it becomes opaque and presents a mixture of mucus and
pus, occasionally streaked with blood, and finally becomes all purulent,
sinking in water, and often combined with irregular pieces of green or
yellow substances.
_Treatment._—There are three objects to be aimed at in the treatment of
consumption; first, to promote the absorption of the diseased matter;
second, to subdue inflammation; and, third, to improve the general
health. For the first effect, it is the general practice to slightly
salivate the system by small doses of calomel and kino, followed by
a course of iodine, either in the form of burnt sponge, hydriodate
of potass, or tincture of iodine. Inflammation is subdued by small
bleedings, two or three times repeated, leeches on the chest, blisters,
or the counter-irritation of the tartar emetic ointment. The general
health is to be improved by exercise, cold ablutions, and friction every
morning, by a light and generous diet, and tonics with the mineral
acids. In confirmed consumption, and where all the worst symptoms are in
operation, the treatment must depend greatly on the actual state of the
patient, though the most ordinary course is comprised in the following
means and remedies: counter-irritation over the chest, by the tartar
emetic ointment; an opiate at bed-time; and two table-spoonfuls of such a
mixture as the following, every four or six hours.
Take of
Tartar Emetic 20 grains.
Infusion of Gentian 6 ounces.
Powdered Nitre ½ drachm.
Mix. Where the sweatings are excessive, or there is spitting
of blood with the cough, from fifteen to thirty drops of the
elixir of vitriol in a wine-glass of water, is to be sucked
through a quill every three or four hours.
No practice is so fatal as the sending a confirmed consumptive patient to
a warm climate, or even to remove him to a warmer residence in his own
country, as the increased temperature only developes the worst symptoms
more rapidly. To a patient only _predisposed_ to consumption, change of
scene and climate is highly beneficial; but with the disease on him, it
is suicidal. The modern practice of deluging the stomach with rancid fish
oil, is a very questionable procedure, as any good that can result from
its use must depend upon the amount of iodine or nitrogen the cod liver
oil may possess; remedies that can be given in greater quantities, in a
much less objectionable way.
In every stage of consumption, but especially in the early part of the
disease, the patient should exercise the lungs as much as possible, by
drawing deep inspirations of air, and inflating the organ to its fullest
extent, and then slowly expiring what he has imbibed, repeating the
process for ten minutes at a time, and resuming it four or five times
a day. For this purpose he can either stand at a window, on a hill, or
wherever the air is pure; when the atmosphere is damp, the air must
be drawn through a veil, folded three or four times. This makes an
infinitely better respirator than the metallic ones sold in the shops.
As the natural stimulant of the lungs is air, no means are so likely
to excite absorption of the tuberculous matter, as that which expands
every air cell of its structure, and while healthily exercising the
organ, stimulates it to increased action. That consumption is curable,
is a theory now rapidly gaining ground; but this can only be effected by
converting the acute into a chronic disease, and in that form following
the admonitions of nature as a guide to the practice; and the most
important of these is exercising the lungs themselves.
SCROFULA.
A peculiar condition of the body, in which the healthy vital energy is
in a measure in abeyance, where the system is less strong, the body less
perfect, the organization less harmonious, and the living power to resist
accidents less perfect and capable of resisting those influences of
time, air, contagion, and accident, ever at war on the frame of man, and
which robust health may rebut and for a time defy, but before which the
less perfect organization of scrofula ultimately succumbs. It is to this
unnatural weakness of the constitution that we owe many of those diseases
and ills that like a scourge afflict mortality; such as consumption,
mesenteric disease of the bowels in children, rickets, goître, cretinism,
hare-lip, white swellings, and many other local and constitutional
maladies; all deriving their origin from this physical and specific
weakness of the whole or a part of the human body. Any chronic swelling
of the absorbent glands is denominated scrofula, as shown both by the wen
in the throat and the white, shiny, and insidious swellings in the knee;
yet neither of them is, correctly speaking, scrofula, but merely the
local evidence of something we feel and know, but cannot define in the
system, couched in the blood, reflected in the want of general nervous
energy, and manifesting itself in some local character, to which science
gives a name and unprofessional wisdom assigns the disease. The chief
characters by which a scrofulous diathesis is known or may be suspected,
are a want of perfect bodily symmetry, small, thin, or crooked limbs, a
round or pigeon-breast, excessive enlargement of certain organs, broad
jaws, low forehead, long neck, and large occiput, great transparency of
the skin, with a rosy tint of the cheeks; when the complexion is dark, it
is of a dirty, viscid appearance, when fair, unnaturally clear; a bluish
ring round the eyes, which though large, clear, and sometimes black, are
more generally light blue, with swollen or puffed eyelids, long lashes,
upper lips thick and projecting, and the general expression of the
countenance voluptuous case, with want of decision and energy; the first
teeth are small, subject to decay, and the second white, liable to split,
and often become prematurely decayed.
COUGH.
A cough is an effort of nature to relieve the lungs and air passages from
any obstruction of mucus, phlegm, pus, or other sources of irritation in
the parts. There are, consequently, many varieties of cough, according
to the nature and situation of the disease or affection that excites it:
as the cough in consumption, that from bronchitis, the stomach cough of
children, hooping-cough, &c., beside which there is the common cough of
an ordinary cold, which this article especially refers to. The ordinary
cough is, in the first instance, generally hard and dry, becoming, after
a day or two, more relaxed and attended with free expectoration, which,
after passing through some changes of character, as regards quantity,
colour, and substance, usually cures itself. When the febrile symptoms
that attend a cold and cough are too slight to demand treatment, the
best cough mixture that can be taken is one composed of equal parts of
the syrup of squills, syrup of tolu, paregoric, and ipecacuanha wine, of
which a dessert-spoonful may be given every four hours. When the cough is
attended with great difficulty and tightness, a “warming plaster” should
be applied to the chest, and the following expectorant mixture, employed
to promote relaxation of the parts:—
Take of
Milk of Ammoniacum 6 ounces.
Dover’s Powder ½ drachm.
Mix in a mortar, and add
Oxymel of Squills 1 ounce.
Spirits of Sweet Nitre ½ ounce.
Syrup of Tolu 1 ounce.
Mix. One table-spoonful to be given three times a day, and two
on going to bed.
ASTHMA.
Is a functional affection of the respiratory organs, frequently depending
on constitutional causes, and seldom the result of organic disease.
Asthma generally attacks persons of advanced years, and of a weak and lax
system; it is, when not hereditary, often the result of sudden changes
of temperature, disorder of the digestive organs, or of mental anxiety.
An attack of asthma is usually indicated by a sense of constriction
or tightness round the chest, a fulness of the stomach, lassitude,
drowsiness, and headache. All these symptoms become more urgent towards
evening, accompanied with laborious breathing and difficult expiration,
attended at the same time with a wheezing noise in the chest and windpipe
at every inspiration. As night approaches a hard dry cough succeeds to
these symptoms, while the oppressed breathing and sense of suffocation
become so acute, as the paroxysm reaches its climax, that the patient is
compelled to spring up in bed, or rush to the open window, from fear of
instant suffocation. Asthma generally attacks the patient in the night,
and most frequently the severity of the fit endures for three or four
hours, usually terminating about two in the morning, when, after a free
expectoration of frothy mucus, the symptoms gradually subside, and the
patient, after much anxiety and suffering, falls asleep. A succession of
such paroxysms occur for several consecutive nights, before the symptoms
give way and allow the exhausted patient time to recover his strength and
tone.
_Treatment._—The first endeavour must be directed to shorten the fit
and to relieve the most distressing symptoms: the next, to remove the
exciting and predisposing causes. Where the patient is strong and not
far advanced in life, an emetic, composed of ten grains of ipecacuanha
and one grain of tartar emetic, mixed in a cup of warm water, should
be given in the first stage of the attack; followed up for some hours
by nauseating doses of antimony and squills, as in the following
mixture:—Antimonial wine, one ounce; water, four ounces and a half;
tincture of squills, three drachms. Mix; and take a table-spoonful every
hour so long as the urgency of the symptoms continues. When the attack
is slight, and devoid of the marked features of a paroxysm, and the
difficulty of breathing and sense of tightness in the chest are the chief
symptoms, much benefit will be derived from taking from five to ten drops
of hydrocyanic acid in a table-spoonful of water every two hours, for
three or four times.
The asthma of old age, however, must be treated very differently: here,
instead of debilitating, it becomes necessary to support and stimulate
the patient under the exhaustion of the paroxysms. For this purpose,
warmth should be early applied to the body and extremities, by the hot
bath or bottles of hot water. The chest and pit of the stomach should be
rubbed for a few minutes with hartshorn and oil; hot coffee, or small
doses of brandy-and-water, administered occasionally; and the following
mixture, according to the age and sex, given in doses of one or two
table-spoonfuls every two or four hours, as the state of the patient
may demand:—Carbonate of ammonia, one scruple; Dover’s powder, half a
drachm; peppermint water, six ounces; mix, and add tincture of squills,
spirits of lavender, and sulphuric ether, of each one drachm. When asthma
has been induced by a derangement of the digestive organs, it will be
necessary to give a dose of castor oil or an alterative pill; while for
the shortness of breath and difficulty of breathing that often precedes
and follows the full paroxysm, a poultice, composed of equal parts of
mustard and flour, and applied warm to the chest for ten or fifteen
minutes, will yield considerable relief. As an aperient, two compound
assafœtida pills will be found of the utmost benefit, especially to those
advanced in life.
BRONCHITIS.
Is now much milder in its attacks, and seldomer met with than formerly,
though it still remains a disease of both severity and danger.
_Acute bronchitis_ is characterised by general fever, heat of the
skin, difficulty of breathing, with hurried and sometimes laborious
respiration; a peculiar sense of fulness and roughness of the windpipe,
followed by hoarseness, oppression, or pain over the region of the
heart, accompanied by a short dry cough. After from six to twelve
hours, a secretion of mucus takes place in the trachea and bronchial
tubes, producing a wheezing rattling noise as the patient respires; and
in consequence of the blood not being freely exposed to oxygen in its
passage through the lungs, the lips and cheeks assume an ashy or dusky
hue. The pulse at the first is quick and hard, but after a time, becomes
full and what is called, soft; but so compressible, that a little extra
pressure of the finger will apparently extinguish it. There is at the
same time great prostration of strength, considerable anxiety and alarm,
with pain in the head, giddiness, and when the symptoms are severe, even
delirium.
Bronchitis arises in general from exposure to cold and humid atmosphere;
taking cold after violent exertion, or from any of the ordinary causes
of cold or sore throat. The hoarseness and dry full sense, experienced
in the nose and windpipe, is often felt extending far down the chest,
attended with considerable sneezing; and the efforts of a dry hard cough,
causing pain both in the chest and shoulders.
_Chronic Bronchitis_, when arising as a primary disease, presents some or
all of the previous symptoms, but in a considerably modified form; the
fulness in the windpipe, oppressed and laborious breathing, hoarseness
and cough, are, however, the most general symptoms of chronic bronchitis;
the expectoration, though after a time becoming more free, is far from
being copious, and consists of a discoloured mucus; sometimes of a
purulent appearance, at others stained with blood, or streaked with a
brick-coloured fibrinous matter. The symptoms are generally exaggerated
towards night, when they are attended with increased fever and night
sweats.
_Treatment of Acute Bronchitis._—In full-bodied constitutions, if the
disease be taken in its first stage, bleeding to the extent of eight
or ten ounces may be very safely and beneficially employed; but as the
debility that attends bronchitis is both great and sudden, unless adopted
in the _earliest_ stage, the practice would be highly culpable, as all
the physical stamina is required to throw off the collected mucus from
the bronchial passages so bleeding; therefore, unless employed early,
it can never properly be practised. When necessary, an emetic must be
immediately given, consisting of antimonial and ipecacuanha wines, of
each half an ounce, or the following powder:—Ipecacuanha 15 grains,
tartar emetic 1 grain, mix; to be dissolved in a little warm water and
drunk directly, following it up by frequent draughts of warm water. If
the first emetic does not operate freely, repeat the same dose within the
hour, assisting the action, if necessary, by tickling the throat with
a feather. As soon as the vomiting has subsided, apply a blister three
inches wide by six inches long, down the centre of the chest, and give a
table-spoonful of the mixture below every two hours.
Take of
Distilled Water 6 ounces.
Tartar Emetic 6 grains.
Powdered Nitre 1 scruple.
Dissolve, and add tincture of colomba, 2 drachms—mix. At the
same time, between the doses, let the patient inhale the steam
of hot vinegar and water, and wear a veil over the face, so as
always to breathe through a medium. When the blister has risen
and the plaster has been removed, apply a hot bread poultice,
which repeat every hour, for two or three times; and finally,
dress with violet powder.
When the expectoration changes its character and becomes thick, greenish
and ropy, it will be necessary to give stimulating expectorants, to
facilitate the discharge; for that purpose, the annexed mixture, in doses
of a table-spoonful every three or four hours, is to be employed.
_Expectorant Mixture._
Gum Ammoniacum 2 drachms.
Carbonate of Ammonia 1 drachm.
Rub into a powder, then add a tea-spoonful of water; triturate
till the whole is rubbed into a smooth creamy paste, when add,
by degrees, six ounces of water.
Syrup of Squills 1 ounce.
Tincture of Tolu 2 drachms.
Spirits of Sweet Nitre 2 drachms.
Paregoric ½ ounce.
Should there be much restlessness or want of sleep, 30 drops of laudanum
may be taken at bed-time in a little gruel, or added to a dose of the
expectorant mixture. Or when the mixture is not necessary, from 10 to
15 grains of Dover’s powder, according to the age and strength of the
patient, should be taken an hour before bed-time. It is also necessary
to take an occasional aperient, which should consist of two assafœtida
pills at night, and a black draught the following morning; or five grains
of blue pill, and a dose of Epsom salts, three hours afterwards. The
patient should be kept as much as possible in one temperature during the
attack; and all lengthened conversation and fatigue strictly avoided. The
diet should be light, low, and farinaceous, and consist of eggs, milk,
custards, and sago, and tapioca puddings; and only when the expectorant
or stimulating stage has been reached, should the drink be anything
stronger than gruel. But when the expectorants are indicated, it becomes
necessary to give wine, or other stimulants, and support the patient’s
strength by a more generous diet.
_Treatment of Chronic Bronchitis._—Where the symptoms are severe, the
treatment may begin by placing a blister on the throat, and giving the
expectorant mixture already prescribed. But in ordinary cases, it will be
sufficient to place a large hot bran poultice on the throat and chest,
renewing it every three or four hours; and twice a day rubbing the chest
and throat with the following embrocation:—
Dissolve, by heat, two drachms of camphor in two ounces of olive oil, and
add spirits of sal volatile half an ounce, and at the same time give the
expectorant mixture in table-spoonfuls every two hours.
Where there is much loss of rest, and much anxiety, the annexed mixture
to be substituted for the expectorant, and taken in doses of two
table-spoonfuls every four hours.
Dover’s Powder 1 drachm.
Carbonate of Ammonia 2 scruples.
Camphor Water 8 ounces.
Sulphuric Ether 1 drachm.
At the same time, the steam of hot vinegar and water is to be inhaled,
and the patient’s strength supported by a proper and efficient dietary;
with all the precautions advised in acute, observed in the management of
chronic bronchitis.
INFLUENZA.
A disease which, though unquestionably common to this country from remote
time, has only within the last thirty years obtained a distinctive
name and character. What the peculiar state of the atmosphere is, that
induces or predisposes to this disease, science has not yet discovered,
though the external causes, as far as appreciation enables us to form
an opinion, appear to be, a long-continued state of humidity, succeeded
by sudden heats, or seasons of alternate hot and wet weather, or a
long humid autumn followed by a cold and boisterous winter. In these
conditions of the climate the disease often becomes epidemic and puts
on a protean shape, and, though twenty persons in the same tenement are
attacked with it, not two perhaps present the same chain of symptoms,
or have been seized in the same way. The first sign of illness in one
is a sudden coma, that deprives the patient for some minutes of all
consciousness; another falls in a fit, a third is seized with an intense
pain on the top of the head, others by fits of sudden heat or cold, by
coughing, or pains in the back, chest, or throat; but however varied the
commencement may be, or different the general run of symptoms, there are
three signs that, taken together, always characterize influenza, and by
which it may in every case be at once identified; these are—severe and
splitting pain on the top of the head, great and sudden loss of strength,
and a rough excoriated sensation in the chest behind the breast-bone, as
if the lining membrane in that part was raw.
When influenza comes on gradually, the disease generally puts on the
following succession of SYMPTOMS: a sense of cold, lassitude, weariness,
cold chills, pains in the back, head, and loins; these symptoms are
followed by flushings, weight on the head and a great oppression on the
chest, sneezing, the eyes become bloodshot, a thin acrid discharge from
the nostrils occurs, with inflamed fauces and throat, followed by a
short cough with a thick viscid expectoration, which soon becomes thin,
discoloured mucus, mixed with purulent discharge. With these symptoms
there is extreme prostration of strength, loss of energy, and great
depression of spirits, the pain on the head continuing with unabated
violence. The pulse, which at the beginning was quick and small, becomes,
as the disease progresses, sharp, weak, and irregular. From the first
the appetite has failed, the tongue furred, and the stomach in a state
of nausea and often irritated to vomiting. The discrepancy in the state
of the pulse in influenza generally renders it an insecure guide to a
knowledge of the heart’s action by the number or the frequency of the
beats; the only true test of the vital strength of the patient is, the
amount of pressure by the finger the pulse will bear. Influenza, if not
speedily cured, is very prone to degenerate into bronchitis, pneumonia,
pleurisy, or some chronic thickening of the mucous membrane of the
throat, or enlarged tonsils.
_Treatment._—The foremost point to be remembered in the treatment of
this disease is, that the great debility is _real_, not a prostration
dependent on nervous pressure, but a _bonâ fide_ loss of vital power;
consequently, bleeding, strong relaxing medicines, or blisters, are,
except in very rare cases, highly injurious, and more likely to kill than
cure the patient; the treatment therefore required is more a course of
judicious dietary than one of physic. The medicinal means must consist of
the following mixture and pills, keeping the feet hot by hot bricks, or
bottles of water, and a hot bran poultice applied frequently to the neck
and chest.
Take of
Powder of Compound Tragacanth 2 drachms.
Hot Water ½ pint.
Lump Sugar 2 drachms.
Mix in a mortar, adding the water slowly till a smooth thin
mucilage is made of the whole; then add—
Tincture of Tolu 1 drachm.
Ipecacuanha Wine ½ oz.
Spirit of Nitre 6 drachms.
Shake well together, and lastly, add solution of acetate of
ammonia, 1½ ounce. Mix, and make a 12 ounce mixture: of which
let the patient take two large table-spoonfuls every four
hours.
Take of
Compound Rhubarb Pill ½ drachm.
Extract of Henbane ½ drachm.
Mix, and divide into 12 pills, two to be taken at bed-time
every other day.
To support the strength, the food must be of the lightest and most
nutritious kind, such as boiled mutton, custards, and sago puddings;
and as frequent stimulants are indispensable, claret glasses of warm
egg-flip, either made in the usual way with the addition of a little rum
or brandy, or egg-sherry must be given, with toast, every two hours. By
these means, and the addition of twenty drops of laudanum, at bed-time,
to a dose of the mixture, all ordinary cases of influenza may be safely
and expeditiously treated to recovery.
BILIOUS COMPLAINTS.
Persons are said to be bilious, when bile finds its way from the small
intestines into the stomach, and there, mixing with the digesting food
and irritating the coats of the stomach, becomes absorbed into the blood,
on which it acts like, a species of poison, producing a constitutional
disturbance of more or less severity. The symptoms that prognosticate
this kind of malady are intense pains in the head, weight and tenderness
of the stomach, nausea and sickness, fœtid breath, a bitter or coppery
taste in the mouth and throat, a coated tongue, and a quick sharp pulse.
The skin is dry, there is considerable thirst, and also occasional
shiverings.
_Treatment._—The effect of bile on the stomach should be considered in
the light of a chain of symptoms excited by the presence of some foreign
or unhealthy substance; and the rational view of the treatment of such
symptoms consists in expelling the intruding mischief as quickly as
possible; and, as it is always better to make the bile take its natural
course of exit—downwards—than urge it out of the system in an opposite
direction, the treatment should commence by taking such aperients as
will excite the whole alimentary canal, and carry it out of the stomach
through the bowels: at the same time avoiding by every means its
expulsion by vomiting. To carry off the bile by aperients, and allay the
sickness, is in fact, all that has to be done, for when these objects are
achieved, every other symptom will, as a natural consequence, subside.
As the nausea and headache are the most urgent and distressing symptoms,
they are the first to demand relief. A small blister, the size of the
round of a wine-glass, should be laid on the pit of the stomach, and a
dose of the subjoined effervescing mixture given every half hour; taking
advantage of the first lull in the retching to give two of the aperient
pills, which are to be repeated every six hours, till their action on the
bowels shows that the object for which they were taken has been obtained.
For females and persons of delicate constitution, one pill instead of
two should be taken as a dose. If the patient is in bed, bottles of hot
water should be kept at the feet; and as an after-corrective, the tonic
mixture prescribed below, is to be taken twice a day for about a week; at
the same time the convalescence will be facilitated, and the tone of the
stomach improved, if a little toasted bacon is eaten for breakfast, and a
dry biscuit and a glass of stout taken for lunch.
JAUNDICE.
Is the name given to the effect produced on certain parts and secretions
of the system by a diseased state of the liver, or whatever cause
prevents the bile from finding its natural outlet; and by confining it to
the gall-bladder, or the secreting vessels of the liver, causes it to be
absorbed into the blood, and, passing into the circulation, gives rise
to those symptoms, which constitute what is called jaundice. The word
“jaundice” signifies _yellow_, and is used to designate that impaired
state of the liver known by the external signs of a yellow skin, a yellow
tinge of the white coat of the eye, and a deep saffron colour imparted
to the secretion from the kidneys, while the other alimentary discharges
are almost white; these characteristics of jaundice are attended with
languor, loss of appetite, sometimes amounting to a loathing of food,
disturbed sleep, great avidity both of stomach and bowels, nausea, and
often sickness; a heavy bitter taste, that no cleanliness can eradicate,
pervades the mouth and fauces, while a dull heavy pain takes possession
of the right side, just over the liver, greatly increased by pressure,
but which no change of position abates. Attending these symptoms there
is always more or less of what is understood as fever: when the disease
is protracted, and the bile remains long unremoved from the blood, the
skin and eyes darken in their colour, and assume a _green_ aspect, and
when still more obstinate of cure, that green becomes of a deep purple or
blackish hue, when the disease is called black jaundice.
Jaundice is a very common disease in hot climates, especially to
Europeans newly arrived, and, indeed, is by no means rare in this
country and the sister island; and though, as we have already said, it
may proceed from any diseased condition of the liver, there are many
other causes that may induce it, such as pressure on the liver by the
formation of tumours, pregnancy, and the presence of gall-stones, though
in this latter case the cause is generally easily discovered by the
severity, sharpness, and continuance of the pain. Though the remedies
employed for jaundice are under all circumstances nearly alike, it is
both satisfactory and useful to discover as early as possible what is the
immediate cause that, obstructing the bile, has led to its absorption by
the blood; as on this knowledge much time may be saved in the treatment,
which is remarkably simple, and may be undertaken with the greatest
confidence without consulting any medical opinion. In all cases of
jaundice, especially when attended with pain, the warm bath is of the
utmost importance, as it will afford instant relief; and if the pain and
disease proceeds from a gall-stone, the heat of the bath, by expanding
the duct in which it is impacted, will almost immediately facilitate its
passage, and thus by removing the obstruction, at once remove the cause
of the disease.
As remedial means, the adult patient should take one of the following
pills three times a day, or one every eight hours, and every second
morning two tea-spoonfuls of Epsom salts dissolved in a tumblerful of
cold water, with a wine-glassful of dandelion-tea every four or five
hours, and continued as long as it is necessary to take the pills.
_Pills._
Take of
Camphor 2 grains.
Powdered Opium 2 grains.
Blue Pill 20 grains.
Mix and divide into six pills.
Take of
Dandelion Roots, washed and cut small 2 ounces.
Liquorice Root and Sassafras, of each 2 drachms.
Boiling Water 1½ pint.
Simmer slowly for twenty minutes; strain, and, when cold, give
a wine-glassful every four or five hours.
When the obstruction has been removed, and the cure has been effected—as
the restoration of the skin and eyes to their natural colour will
indicate—it is sometimes necessary to take a tonic for a few days, to
restore the tone of the stomach; this will be best effected by taking
a table-spoonful of the following mixture an hour before each meal for
four or five days:—Infuse 2 drachms of gentian, 2 drachms of carbonate
of soda, and 1 drachm of ginger for six hours in a pint of boiling
water; and, when cold, giving it in the above doses. To those subject
to jaundice, exercise and sea bathing should be vigorously adopted
after each recovery, so as to work the system into an energetic and
self-supporting condition; for if not excited out of its torpidity, the
body is very prone to relapse into its previous torpidity.
BOWEL COMPLAINTS.
These ailments are in all cases symptoms of the effect of other causes,
and never occur spontaneously, but are the result of indigestive food or
excessive acidity of the stomach, the presence of a large quantity of
bile in the small intestines, acrid and misacting medicines, wet feet or
exposure to cold; the result of disease in the mucous or muscular coats
of the bowels, exposure to miasmata or infectious air, and the inhalation
of noxious gases.
1. _Bowel Complaint, attended with Sickness and Vomiting._
The vomiting should be first allayed by small effervescing
draughts, or wine-glasses of soda-water, with a tea-spoonful
of brandy, given every half hour, and a blister the size of
a crown piece laid on the pit of the stomach: while for the
relief of the bowels the following mixture is to be given in
doses of two table-spoonfuls every hour till the relaxation is
checked.
Prepared Chalk 1 ounce.
Aromatic Powder 2 drachms.
Sugar 1 drachm.
Peppermint Water 8 ounces.
Mix well in a mortar, and add
Tincture of Kino 3 drachms.
When the bowel complaint is attended with pain or griping in
the stomach, 1 drachm of the TINCTURE OF ASSAFŒTIDA, and 40
drops of LAUDANUM are to be further added to the mixture, which
is still to be taken in the same quantity, and, if necessary,
repeated as frequently.
2. _Bowel Complaint, the result of Improper or Undigested Food._
Prepared Chalk 1 ounce.
Carbonate of Magnesia 2 drachms.
Carbonate of Soda 1 drachm.
Carbonate of Ammonia 2 scruples.
Camphor Water 8 ounces.
Mix well in a mortar, and add
Tincture of Kino 2 drachms.
Mix and take two table-spoonfuls directly, and one every hour
afterwards.
3. _Bowel Complaint from Exposure to Cold or Wet._
Infusion of Red Roses 8 ounces.
Epsom Salts ½ ounce.
Dissolve, and add
Diluted Sulphuric Acid 30 drops.
Mix, and take two table-spoonfuls every three hours, and one of
the following pills every four hours. Should the skin be dry
and hot, give ten grains of Dover’s powder, at bed-time, in a
little gruel.
Compound Rhubarb Pill,
Extract of Henbane,
of each one scruple. Mix, and divide into eight pills.
4. _Bowel Complaint, attended with Cramps and Spasms._
Apply hot mustard poultices, made with equal parts of mustard
and flour, over the bowels, and to the inside of each thigh,
and give the following mixture and pills every hour till relief
is afforded.
Prepared Chalk 1 ounce.
Aromatic Powder 2 drachms.
Carbonate of Ammonia 1 drachm.
Mint Water 8 ounces.
Mix well, and add
Tincture of Kino 3 drachms.
Sulphuric Ether 1 drachm.
Mix; two table-spoonfuls with one pill every hour.
Camphor 6 grains.
Powdered Opium 4 grains.
Calomel 9 grains.
Extract of Hemlock, enough to make into a mass,
which is to be divided into six pills.
5. _For the Bowel Complaints of Young Children_, the most
efficacious and convenient remedy is the tincture of kino,
given in doses of 20 to 60 drops, in a little sugar and water,
and repeated every hour or two till the relaxation is stopped.
When the bowels are disordered from teething, it is best to
give an alterative powder every four hours, for two or three
times, such as the following for an infant of nine months,
increasing the strength according to the age.
Grey Powder 6 grains.
Rhubarb 2 grains.
Scammony 9 grains.
Mix well, and divide into three powders.
When the relaxation has been stopped, it is always advisable to take an
aperient pill, in a day or two after, to restore the bowels to a healthy
condition. In many simple cases of bowel complaint, a dose of castor oil
is the only remedy required, and where resulting from improper food, by
its aperient action it both removes the cause and the effect with it. The
bowel complaint, or diarrhœa, that occurs as a critical symptom in fever,
is on no account to be hastily or injudiciously checked; but when calling
for treatment, the mixture No. 4 is the most advisable one to employ for
that purpose.
FLATULENCE.
Unless in exceptional cases, such as from ill-cooked food, an excess
of vegetable diet, &c., flatulence is always an indication of impaired
functional action of the stomach, either proceeding from a disease of
that organ or through sympathy with some other part; but by far the
greater number of those who suffer from flatulence owe it to a weakened
state of the stomach itself, often hereditary, frequently the result
of an erroneous dietary, and sometimes from the injudicious habit of
over-stimulating; besides these cases, it frequently proceeds from mental
anxiety, imperfect mastication of the food, and a close sedentary habit.
Flatulence is often completely cured by strict attention to dietetic
rules, such as avoiding for a time all vegetables and fruits, making the
breakfast and tea on hard crusts, biscuits, or dry toast, and _chewing_
these for a considerable time before _permitting_ the food to pass into
the _stomach_; at the same time taking as small a quantity of fluid in
the way of tea, coffee, or cocoa, as possible, and only sufficient to
facilitate the descent of the solid food; meat and bread for dinner, with
a sparing draught of cold gin and water, should constitute the meal. The
tea should be a repetition of the breakfast, and a supper of biscuit and
cheese with a small tumbler of cold spirits and water, the same as that
for dinner; a system like this, with exercise, repose on a sofa for half
an hour after each meal, and using the _flesh-brush_ night and morning
_over the chest and shoulders_, and especially across the stomach, so
as to excite the organ to increased action, will be found to yield the
fullest advantage, and in many cases will supersede the necessity of any
medicine whatever. When, however, there is much acidity in the stomach,
it should be neutralized by a tea-spoonful of magnesia, or half a drachm
of carbonate of soda, a short time before any one of the meals, and, when
the bowels require it, a compound assafœtida pill at bed-time; the same
regimen as to diet being persevered in, as that above. Where the stomach
has become seriously enfeebled by a long-continued state of flatulence,
it will be necessary, in addition to either of the former plans, to give
the organ tone and strength, by employing one or other of the subjoined
pills, adopting them in the order in which they stand.
Take of
Sulphate of Zinc 10 grains—powder.
Rhubarb, Powdered 20 grains.
Extract of Gentian, sufficient to make a mass, which
divide into thirty pills, one to be taken three
times a day.
Take of
Nitrate of Silver (Lunar Caustic) 3 grains—powder.
Quinine 4 grains.
Ginger 6 grains.
Mix well, and add extract of camomile sufficient to make a
mass, which divide into twenty-four pills, one to be taken
three times a day. When flatulence is attended with a sense of
coldness in the stomach, a tea-spoonful of Gregory’s powder,
with ten grains of soda, may be taken in a little aromatic
water before breakfast each morning.
DYSPEPSIA,
Or indigestion, is that impaired condition of the stomach when the food
is only half or imperfectly digested; producing want of appetite, a sense
of distension, debility, headache, languor, want of sleep, and all those
constitutional symptoms that usually attend an overtaxed and weakened
stomach.
_Treatment._—To effect a perfect restoration in the tone of the stomach,
an entire change in the mode of diet is absolutely necessary, also in the
habits and pursuits of the patient: the stomach must first be emptied
and slightly stimulated by an emetic, or by a few alterative doses of
blue pill and rhubarb, and the system submitted to a regular course of
such tonics as infusion of camomile with carbonate of soda, gentian
with potass, and, after a time, infusion of quassia with a few drops of
muriatic acid. The food should be at first light and simple, and comprise
the most solid aliments, and such as will compel a long mastication
before swallowing; all drinks or stimulants with the meal being strictly
prohibited till the salivary glands yield of themselves enough saliva to
macerate the food; and this can only be effected by a long and perfect
mastication.
DYSENTERY.
This is a disease more common in hot climates than cold ones, and both
in its type and character approaches much more nearly than any other
disease, to cholera. Dysentery is either the result of a congestive state
of the bowels, or it proceeds from a chronic inflammation of the lining
membrane of the colon.
_Symptoms._—Dysentery commences with shivering, a griping flatulent
state of the bowels, frequent discharges of mucus, or blood and mucus,
and often blood alone; with loss of appetite, sickness, fever, and great
debility.
_Treatment._—When depending on inflammatory action, it is necessary to
bleed and give cooling drinks with an emetic. In ordinary cases, the
treatment should begin with the warm bath or fomentations, with three
grains of calomel, one grain of opium, and three grains of assafœtida
pill; the whole made and divided into two pills, which are to be taken
every six hours, and a starch injection with assafœtida tincture twice
a day. As the symptoms improve, tonics are to be given, at first mild,
and gradually increased in strength, and combined with wine and a soft
unexciting diet.
DIARRHŒA.
A relaxation or looseness of the bowels, consequent upon a certain
condition of the mucous membrane of the alimentary canal; that is, either
a state of congestion, or stagnant state of the blood in the membrane; or
else from an inflammatory condition of the same tissue; or it may proceed
from ulceration of the bowels, the presence of indigestible food, or
acrid substances in the stomach; it may also occur as a crisis of fever,
and without any direct cause of irritation. The causes that produce
diarrhœa are very numerous, and often of the most opposite nature; though
the chief are, sudden cold applied to the body, checked perspiration,
powerful stimulants, the inhalation of noxious gases, &c.
_Symptoms._—Nausea, sickness, and vomiting, thirst, dry state of the
mouth and skin, frequent and copious evacuations, and a furred or red
condition of the tongue.
_Treatment._—The first step in the treatment of diarrhœa is to check the
vomiting; to effect this, the feet are to be plunged into hot water and
kept constantly warm, and a small blister or one or two leeches applied
to the pit of the stomach. The state of the tongue must decide the nature
of the subsequent treatment. When this organ is coated either with a
white or brownish fur, it indicates a congested state of the membrane
of the stomach, and must be treated by the exhibition of an emulsive
mixture of chalk, and when the symptoms are attended with pain, by an
opiate pill, as in the following prescription.
Prepared Chalk 1 ounce.
Honey ½ ounce.
Peppermint Water 6 ounces.
Mix into a smooth mass, of which give a table-spoonful every
hour, and a one-grain powdered opium pill every four or six
hours, till the pain is subdued. When, however, the tongue is
red both on its surface and sides, it indicates inflammatory
action, and must be treated by an opposite mode of practice,
and the following mixture administered; the opium, however,
being employed when pain is present, in the same form and
frequency as in the former state of the bowels.
Infusion of Rose Leaves 8 ounces.
Epsom Salts ½ ounce.
Dissolve, and add diluted sulphuric acid, half a drachm; mix,
and take a table-spoonful every hour. In all forms of diarrhœa,
the feet should be kept warm, and a hot bath, if procurable,
will, in every instance, be found beneficial. The diet should
always be soft and nutritious, but not liquid; the best dietary
consists of thick arrow-root, made with milk, blanc mange,
tapioca, sago, and semolina puddings, made with eggs, and eaten
moderately cool; and when animal food is given, it should
consist in the first instance of boiled meats, and the stomach
very cautiously brought back to digest roast or hard substances.
CHOLERA.
Although Cholera has, by the interposition of Providence, decreased in
virulence, and the cases that occur are comparatively few, it is well to
incorporate in our medical directions the circular issued by the Royal
College of Physicians relative to the treatment of this fatal disease.
In any case of sudden emergency, where medical attendance cannot be
immediately procured, these instructions will be of the greatest use.
“1. No degree of looseness of the bowels should be neglected for a
single hour. Medical advice should be at once sought when the looseness
begins; and, previous to the arrival of a medical attendant, some of the
medicines at other times used for checking diarrhœa should be taken:—for
example, the chalk mixture; the compound cinnamon powder; or the compound
chalk powder with opium, in doses from 20 to 40 grains for an adult.
“2. No saline aperients or drastic purgatives should be taken without the
advice of a medical man.
“3. Intemperance in eating or drinking is highly dangerous; but the
moderate use of vegetable as well as animal food may be recommended,
and, in general, such a plan of diet as each individual has found, by
experience, to be most conducive to his health; for any considerable
change in the diet to which a person has been accustomed, is seldom
advisable during the prevalence of an epidemic.
“4. Debility, exhaustion, and exposure to damp, render the poor
especially subject to the violence of the disease. The committee urge
upon the rich the necessity of supplying those in need with food, fuel,
and clothing.
“5. The extreme importance of removing or counteracting all impurities,
whether in the air, water, or soil—as by ventilation, cleanliness, and
the free use of the chloride of lime or chloride of zinc—cannot be too
strongly insisted upon.
“Lastly, since the reports made to the College of Physicians show that
of the persons who were engaged about the sick in the last epidemic, the
number of those who were attacked by the disease was, in proportion,
exceedingly small, the fear of infection may be practically disregarded.”
Nearly every chemist keeps an “anti-cholera mixture” in a state of
preparation, during the cholera season. And as these mixtures are
prepared from recipes issued by the Board of Health, or by medical men
skilled in the treatment of cholera, they may generally be depended
upon. The great thing to be borne in mind is to _take medicines to check
looseness of the bowels before the system becomes exhausted_.
FEVER.
Fever is the result of a diseased or impaired action of the system, and
though sometimes attending or following certain diseases as a symptom or
consequence, most frequently falls on the constitution as a substantive
disease, either developing its characteristic symptoms, as the disease
advances, or following the slow maturity of a chain of morbid actions.
Fevers may, in the first instance, be divided into those which proceed
from some indirect or secondary cause, and those that arise from
contagion, or causes the direct precursors of fever, having a definite
rise, an understood progress, and a well ascertained termination. In
the first named class of fevers, are comprised those febrile symptoms
that appear during or after some organic disease, accidents, surgical
operations, or other causes of physical suffering.
The second, or spontaneous class, is divided into two chief heads—nervous
and inflammatory fevers: under nervous fevers are classed typhus,
intermittent, continued, and remittent fevers; and under that of
inflammatory fevers, first, all eruptive fevers, as scarlet fever,
small-pox; and, secondly, the fevers attending all inflammatory actions
of organs or viscera, such as inflammation of the liver and bowels.
The general characteristics of fever are cold chills, lassitude,
headache, loss of appetite, thirst and nausea, with a moist furred
tongue, or else a tongue dry and coated, pain in the back and loins,
succeeded by cold shiverings, which gradually give place to heat,
diffusing itself over the body and becoming permanent; ringing in the
ears, intolerance of light, and cold extremities; the pulse is either
small and quick, or full and hard. Special fevers, and constitutional
temperament, very much magnify, or even mitigate these symptoms; still
those given are the ordinary characteristics, and sufficient to indicate
the presence of fever to the least accustomed eye.
The _treatment_, on the same broad principle, resolves itself into
relieving the congested organs, breaking the chain of morbid actions
on which fever depends, equalizing the circulation, and lastly, by the
adoption of a course of medicinal agents, correcting the vitiated state
of the secretions, and restoring the functions to a healthy performance
of their several duties. To effect the first it is often found necessary
to bleed, or else by leeches, cupping, or blisters, relieve the
overloaded organs; the second object is generally effected by an emetic,
which in some instances it becomes necessary to repeat. The warm, the
hot, or the shower bath, or aspersions of cold vinegar and water, are the
means employed to effect an equalization of the circulation, and restore
blood and warmth to the surface. The therapeutic means to be employed
during the career of a fever, must depend entirely upon the character of
the disease to be treated, and will be entered upon more particularly
under their several heads.
A remarkable peculiarity belonging to all fevers, is a periodicity of the
disease, or a property that all fevers have of arranging their effects
into periods of regular sections; as, first, into fits and paroxysms,
then into remissions, and finally into critical days. Most fevers have
three stages, called the _cold_, _hot_, and _sweating_; in some, these
divisions are perfect and distinct, in others, broken and imperfect;
these fits following in regular order, comprise a paroxysm, which may
return at certain hours or only at irregular periods.
The critical days are regarded as the 3, 5, 7, 9, 11, 14, 17, and 20; and
the non-critical days are the intervening ones.
The ages at which persons are most liable to fever, are from 20 to 30,
and in the following order, gradually declining from 30 to 40, 40 to 50,
and 50 to 60. As respects sex, females are more subject to fever than
males, but only in a small degree. All fevers are not infectious, but
those that are so are communicated by contact, exposure to the atmosphere
surrounding a fever patient, and whatever depresses the mind or weakens
the body, predisposes the system to infection. The best preventive
against the worst form of fever, is cleanliness, a cheerful disposition,
and an active body.
BRAIN FEVER.
Brain Fever is characterized by two distinct epochs or stages—excitement
and collapse; and though often distinct and well-defined, it occasionally
happens that the one stage is so blended with the other as not to be
appreciable, till the graver consequences of the second period evince
themselves. The symptoms of the first stage are deep and intense pain
in the head, tightness across the forehead, throbbing of the temporal
arteries, ringing in the ears, flushed face, bloodshot eyes, and a
wild and glistening stare; the pupils are contracted, and particularly
sensitive to light, while the ears are impatient and irritable to the
sense of noise: violent delirium, want of sleep, convulsive paroxysms,
attended with a hot dry skin, hard quick pulse, a white coated tongue,
great thirst, nausea and vomiting, and a confined state of the bowels.
Sometimes delirium is the first symptom, or the disease may progress to
a culminating point in a more insidious manner, often commencing with
an apparent attack of biliary vomiting. This formidable disease usually
proves fatal in a few days, sometimes in twelve hours.
_The mode of treatment_ resolves itself into blood-letting, purgatives,
and cold applications to the head. In bleeding, respect must be had to
the _effect_ produced, and not to the _quantity_ abstracted, that is,
till the pulse is affected, or fainting takes place; for this purpose,
the patient should be bled _standing_, and from a _large_ orifice, in a
full stream. About half an hour after the bleeding, and when the patient
has rallied from the fainting, cupping is to be employed behind the ears,
or the nape of the neck, while half a dozen leeches are applied to each
temple. At the same time, bladders of ice are to be applied to the shaved
head, occasionally varied by rubbing ether over the scalp briskly, and
allowing it to evaporate. As constipation is a marked feature of brain
fever, powerful purgatives must be employed from the first indication of
the disease; for this purpose, one of the following powders should be
given every three hours, and _three_ table-spoonfuls of the accompanying
mixture every _four_ hours.
_Powders._
Calomel 30 grains.
Jalap 2 drachms.
Ipecacuanha 6 grains.
Mix and divide into six powders.
_Mixture._