MEDICINES AND OTHER REMEDIES
ACTION OF DRUGS.--Modern medical practice increasingly emphasizes diet,
baths, exercises, and other hygienic measures in the treatment of
sickness. Drugs are given far less than they were a generation ago; yet
medicines are still the most familiar of all remedies, and the most
abused by those who persist in treating themselves. Misuse of medicine
even by intelligent people is astonishingly common.
Problems of sickness and health would be enormously clarified if the
uses and limitations of drugs were more generally understood. Many
people still believe that every disease can be cured by a drug if only
the doctor is clever or lucky enough to think of the right one to give.
Such beliefs result naturally enough from centuries of faith in charms
and magic, and occasionally are confirmed by remarkable cures apparently
brought about by drugs, but really pure coincidence or the result of
suggestion.
It is a fact that a few medicines are known which if rightly used
actually do cure certain diseases. An example of their action is the
curative effect of quinine in malaria. Such medicines, unfortunately,
are few. In the great majority of cases medicines do not cure disease;
their beneficial action is ordinarily indirect and is due to their power
either to increase or to check certain processes within the body.
It is here that the abuse of drugs comes in. Disordered bodily processes
give rise to symptoms of disease; and it is the symptoms of disease, not
the disease itself, that trouble the patient. A patient with typhoid,
for example, is not conscious of the toxins in his blood, but of
headache, weakness, and fever; the man with eyestrain is not aware of an
imperfectly shaped lens, but of headache and indigestion. What the
patient wants is to have his symptoms relieved; in some cases they can
be controlled by drugs, and the sufferer then considers himself cured.
But the original condition persists: it may in the meantime be
improving, but it may on the other hand be growing worse.
Not infrequently it is best to check symptoms, and to check them by
means of drugs. When they should be checked, only a thoroughly trained
physician is qualified to decide. The question is not one for amateurs,
since the whole practice of medicine, including the prescription of
drugs, constantly becomes more nearly an exact science. People should
obtain and follow expert advice in regard to health as they would in
regard to other affairs of life. The constant self-dosing practised by
thousands of people is harmful and unintelligent; it is, however, no
less irrational to go to the other extreme and refuse to take medicine
prescribed by a competent doctor.
AMATEUR DOSING.--Amateur dosing either of oneself or of others is
dangerous in more ways than one. In the first place, time is lost.
Moreover, symptoms are characteristic; checking or altering them
increases the difficulty of finding the real trouble. The man with
eyestrain who takes one drug to stop his headache and another to "cure"
his stomach, is simply delaying the time when properly adjusted glasses
will relieve both. In this case the result may not be serious; but such
a loss of time in finding the trouble and beginning proper treatment
might prove fatal in the case of tuberculosis.
Another objection to amateur prescription of medicine is the fact that
most drugs have more than one effect. In addition to their main action
they have others, subordinate or ordinarily less marked. These minor
effects may be serious in some cases. Many headache remedies, for
example, affect the heart; a dose that is harmless for a normal person
may be strong enough to injure seriously a person with a weak heart. A
doctor, and a doctor only, is competent to decide when and in what
quantity medicines will be beneficial, because he alone understands both
the condition of the patient and all the possible effects of the drug.
In no circumstances should medicine prescribed for one person be taken
by another. This rule seems obvious enough; yet every day people pass on
their pet remedies to friends. Some medicines deteriorate after
standing, and others grow stronger; nevertheless, medicine supposed to
have cured a cough or a tonic supposed to have strengthened some member
of the family after an attack of grippe is cheerfully administered
months later to another member of the family, who, to make matters
worse, may differ in age, strength, and probably in the nature of his
sickness. Drugs are expensive, and it is considered economical to use
them up; measured by lost time and impaired health such practices may be
anything but thrifty.
Cathartics, tonics, and various drugs to relieve pain and sleeplessness
are among the remedies most commonly taken without medical advice.
Enough has already been said about constipation to indicate proper
hygienic treatment, but another warning should be given against
habitual use of cathartics. Many of these drugs are irritating; even
when not irritating, they are harmful, since the body depends more and
more upon the drug to do for it what it should be enabled to do for
itself, by remedying the original cause of the trouble. Licorice powder,
cascara, saline cathartics such as Seidlitz powders and Rochelle Salts
and some others are harmless for occasional use, if occasional is not
too liberally interpreted.
Tonics are poor substitutes for proper diet, rest, and fresh air. Using
them may be likened to beating a tired horse; the horse goes faster, but
he is not really stronger. In some emergencies the horse must go faster
and there is nothing to do but beat him, and in some cases the tonic
should be given; these, however, are cases for a doctor to decide.
People persist in taking tonics because they are unwilling or unable to
rest, or otherwise to change their ways of living.
Medicines to stop pain or to induce sleep are probably the most
pernicious of all self-prescribed remedies, for they add to other
dangers the possibility of forming drug habits. These habits are so
insidious and so powerful that it is not safe to take habit-forming
drugs even once except by a doctor's direction. In short periods of time
strong people, apparently firm in will and character, have acquired
habits from supposedly moderate use of drugs like morphine, cocaine, and
alcohol. No one, no matter how sure of his own self-control, can afford
to run so grave a risk.
PATENT REMEDIES.--Objections to self dosing in general apply even more
strongly to using patent medicines. The ingredients of patent medicines
are ordinarily unknown, so that using them is unintelligent at best.
Sometimes they contain habit-forming or other harmful drugs. In other
cases the ingredients are innocent enough, but totally unable to bring
about the results claimed for them. The old story about a powerful
remedy discovered by accident and thus unknown to the medical profession
deceives only the ignorant or credulous; with our present knowledge of
chemistry and physiology powerful remedies are not discovered in that
way.
Even to these comparatively harmless patent preparations there are two
serious objections. One is the loss of time, during which the patient
may grow worse. The other is that money is obtained under false
pretenses; fraud is a common element in the success of patent remedies.
One of the least harmful, a substance called "Murine" may be taken as an
example[2]. This substance was widely advertised at one time as a
"positive cure for sore eyes." Analysis showed it to be a solution of
borax, which cost about five cents a gallon to prepare. It sold for one
dollar an ounce, or at the rate of $128.00 a gallon. Although it could
not bring about the wonderful cures advertised, it was practically
harmless, and buyers of "Murine" must have been injured chiefly in
pocket. But with "cancer cures" and "consumption cures" it is a
different story. Early treatment of these diseases is essential to
recovery; delay in many cases means robbing the sufferer of his only
chance of life. No drugs are now known that will cure these diseases,
and it seems incredible that anyone should be willing to practise such
cruel deception upon ignorant people merely for the sake of making
money.
ADMINISTRATION OF MEDICINE.--Medicines may be introduced into the body
in a number of ways. In the majority of cases they are swallowed and
finally carried to the tissues by the blood just as digested food is
carried.
Except in rare emergencies no medicine should be given to a sick person
without the doctor's order. The prescribed dose should be accurately
measured in a medicine glass having a scale to show the number of
teaspoonfuls. When measuring medicine, think only of what you are doing;
neither talk nor listen to conversation. First read the label on the
bottle. Next, shake the bottle, if the medicine is liquid, in order to
mix the contents thoroughly. Then remove the cork with the second and
third fingers, and hold it between them while pouring, thus keeping the
cork clean and protecting the contents of the bottle. Hold the medicine
glass on a level with the eyes, and in the other hand hold the bottle,
with the side bearing the label uppermost to avoid soiling it; pour out
the dose, measuring exactly, wipe the bottle, replace the cork, and
again read the label on the bottle.
Most medicines should be diluted with a little water. Pills and capsules
should not be presented to patients in the attendant's fingers, but on a
saucer or teaspoon. Acids and medicines containing iron should be taken
through a glass tube kept for medicine exclusively. Tubes and glasses
should be washed at once after use, and neither they nor the bottles
should stay in the patient's room. If a dose is omitted for any reason,
do not increase the next dose; give the regular dose at the next regular
time.
Serious mistakes in giving or taking drugs are far too common, and no
precautions are too great to guard against them. Never use medicine from
a box or bottle that has no label. Never take or give another person a
medicine selected in the dark, even though you have positive knowledge
that there is no other bottle or box of medicine in the whole house; in
just such circumstances the fatal mistakes occur.
A few things can be done to make medicines more palatable. The water
used to dilute the dose and to be taken after it should be very cold.
Holding the nose is helpful. A piece of cracker, a peppermint, or a
slice of lemon or orange, if allowed, may be taken afterward. Giving
disagreeable medicine in ordinary food, as lemon juice, orange juice, or
milk, and giving bitter powders in jam or jelly, is unwise because it
sometimes results in life long dislike for a useful article of diet.
Where food is given directly after the dose to take away its taste, the
association of dislike seems to be formed less frequently.
The taste of castor oil is so disgusting that it often causes vomiting,
but if skillfully given the oil need not be tasted by a patient who is
willing to coöperate. Its way of sticking to the tongue and teeth
constitutes the chief difficulty; the object therefore is to prevent it
from sticking by swallowing the dose all at once. To administer the oil,
wet the inside of a medicine glass or large spoon with very cold water,
and leave a little water in the bottom. Pour the required dose in slowly
and cover it with more cold water. Let the patient hold in his hand
something to take away the taste,--cracker, bread, peppermint, or
whatever is allowed; for castor oil water is not very effectual. Then
direct him to hold his nose, open his mouth, and hold his breath;
caution him to let the oil run down without swallowing until all has
been taken, and afterward to chew the cracker, continuing to hold his
nose until he has swallowed the cracker. When the patient understands
and is ready, pour the dose in quickly as far back as possible, taking
care not to spill the last drop on the lips. This process may seem
unduly troublesome, but when castor oil is needed it is badly needed and
efforts to make it stay down are worth while. The following method also
effectually disguises the taste of castor oil: place in a glass a
teaspoonful of baking soda, add the prescribed dose of oil and then the
juice of half a lemon. Mix all together thoroughly and let the patient
take the mixture while it is effervescing. This method may be used
unless the patient is not allowed soda and lemon juice. Castor oil may
be bought in capsules, but on account of their size many people find the
capsules impossible to swallow.
SUPPOSITORIES.--Sometimes medicines are given through the rectum. For
this purpose they are combined with cocoa butter or other material, and
made into small cones called suppositories. They melt at a low
temperature and should be kept on ice until needed. A suppository
should be lubricated with vaseline, and inserted very gently as far as
the finger can be introduced, while the patient is lying on the back or
left side.
ENEMATA.--An injection of a fluid into the rectum is called an enema.
(Plural, enemas, or enemata.) Enemas are generally used to cause
evacuation of the bowels.
For a simple purgative enema one of the following is generally used:
plain water; or a solution of common salt in the proportion of one
teaspoonful of salt to one pint of water; or soap suds made with a white
soap such as castile or ivory. Unless otherwise ordered the temperature
of the enema should be between 105° and 110° F.
To give an enema, one should proceed as follows: First protect the bed
by placing under the patient's hips a rubber sheet, covered by a draw
sheet or large towel. Let the patient lie on the back, with the knees
flexed and head low. Bring to the bedside a commode or bedpan, and
lastly the solution contained in a fountain syringe having a long rubber
tube, stopcock and short hard rubber nozzle. The bag of the syringe may
be hung on the bed post or elsewhere, but it should not be more than
three feet at most above the patient's head. Lubricate the nozzle with
vaseline either from a tube, or removed from a jar by means of a piece
of toilet paper; never dip the nozzle itself into a vaseline jar. Let
the solution flow into the bedpan until it runs warm and smoothly; a
jerky flow means presence of air bubbles which cause pain if injected
into the bowels. Unless the patient is able to do it herself, gently
insert the nozzle, and at the same time start the flow. Force must not
be used in inserting the nozzle, and the flow should be gentle; if the
solution goes in rapidly the patient may be unable to retain it. If
there is a desire to expel the enema as soon as the injection has begun,
shut off the current and wait a minute, meanwhile making gentle pressure
upon the patient's abdomen with one hand; then lower the bag a little
and begin again. A grown person should take from two to four pints, and
a child from one to two pints. After the enema is finished give the
bedpan immediately; the enema will, however, be more effective if
retained a few minutes. The bedpan should be given and removed according
to the directions on page 176. Sometimes an enema is expelled with such
violence that it soils the upper sheet; to protect the covers a rubber
sheet may be spread over the patient's knees and legs. Since an enema
sometimes causes nausea or faintness, a patient should be watched
constantly during the process.
To give an enema to a baby one may use a small syringe having a soft
rubber bulb with a nozzle directly attached, or the ordinary fountain
syringe with the small, hard rubber tip designed for infants. The enema
should be given in a warm room free from draughts, and the baby must be
warmly covered throughout the process. First cover the lap with a pad or
folded blanket. Upon the blanket place a warmed rubber sheet, and over
the rubber a warm diaper. Hold the baby on your lap, so that he lies on
his back with his knees drawn up. Hold his feet or legs firmly in your
left hand. Lubricate the nozzle thoroughly with vaseline. Be sure that
all the air is expelled from the syringe, and then proceed as already
directed. A baby will take from two or three ounces up to half a pint or
even more, according to the size of the child. After the injection is
finished place a small vessel under the baby's hips, and hold it until
the fluid has been expelled, keeping the child well covered all the
time.
After being used, the nozzle of a fountain syringe should be washed with
soap and water, boiled, dried and put away in a clean place. Inserting
the nozzle into the bag of the syringe immediately after withdrawing it
from the rectum is a filthy but not uncommon practice. The syringe
should be kept clean inside and out; it should be washed in hot
soapsuds, rinsed in clean hot water, drained, and when thoroughly dry
wrapped in a clean towel or tissue paper. The ordinary fountain syringe
hanging for months by a dirty string on a hook in the bath room is an
unpleasant and generally an unclean object.
SPRAYS AND GARGLES.--Several other methods of administering medicines
are occasionally employed. Some remedies may be applied directly to the
throat by gargles, and to the nose and throat by sprays. The throat may
be cleansed by gargling with a solution of a teaspoonful of baking soda
or common salt in a glass of warm water. Nose sprays should not be used
except under medical advice, and it is well to remember that if the
mouth washes, gargles, and sprays advertised to be disinfectants were
really strong enough to kill germs, they would be too harsh for common
or continued use. The nozzles of nose and throat sprays should be boiled
immediately after use. A surprising number of families who have
progressed far beyond common drinking cups and towels, continue to use a
common nose spray without even washing the nozzle. Children while they
are well should be taught to gargle the throat; a child with a sore
throat and an aching head is in a poor condition to learn anything.
INHALATION or breathing in, is another method used to introduce drugs
into the membranes of the nose, throat, and lungs. Smelling salts are an
example of substances used for inhalation; they are used to stimulate
persons who are faint. They should not be placed close to the nostrils,
nor used at all when the patient is totally unconscious.
Inhalations of steam are often used in asthma, croup, and bronchitis.
Special croup kettles are made for the purpose, but an ordinary pitcher
half full of boiling water may be used instead. The patient's head
should be held closely over the pitcher, and a towel should be adjusted
around the top covering the patient's nose and mouth, but admitting just
enough air to make it possible for him to breathe. If a drug is ordered
it should be added to the water.
INUNCTION, or rubbing a substance into the skin, is sometimes ordered
for delicate babies and children. After the skin of the abdomen has been
washed with warm soapy water and thoroughly dried, the substance
ordered, generally olive oil or cod liver oil, should be applied by
means of a circular movement of the palm of the hand. The oil should be
warm and the rubbing continued until it is absorbed.
Ointments are also applied by inunction. A small quantity at a time
should be rubbed in, using a circular motion. If an ointment is ordered
to be applied where the skin is broken, the ointment should be spread
upon gauze and applied without friction. Liniments are rubbed in in the
same way as ointments. In many cases rubbing accomplishes more than the
ointment or liniment itself, so that this part of the treatment must not
be slighted.
HOUSEHOLD MEDICINE CUPBOARD.--In every household a small cupboard is
needed for medical and surgical supplies. Glass shelves are desirable,
because they show when dirty and are easily cleaned, but a wooden
cupboard can easily be lined with clean paper or white enamel cloth held
in place with thumb tacks. Dirty, stained shelves should not be
tolerated. The cupboard should be kept locked and the key put well out
of the reach of children. In the cupboard should be kept medicines in
daily use; they should not be paraded on family dinner tables.
Poisonous drugs should have rough glass bottles and conspicuous labels.
All medicine bottles should be kept well corked, since evaporation may
take place and the remaining solution, by becoming stronger, may be
dangerous to use in the ordinary amount. Pills and tablets sometimes
deteriorate by standing, and may become so hard that they pass through
the stomach and intestines without dissolving. It is best to buy drugs
and surgical supplies in small quantities; when it is cheaper to buy
more at a time the druggist should be asked whether they will
deteriorate or not.
Almost every family needs to keep on hand some cathartics, some
disinfectants, some material for first aid, and a few simple appliances.
Most families have certain other needs peculiar to themselves, and for
those who live at a distance from drug stores a greater quantity and
variety may be required. Elaborate equipment and extensive supplies of
medicines are neither economical nor necessary for household use.
Castor oil, Rochelle or other laxative salts, and two grain cascara
tablets ordinarily constitute a sufficient supply of cathartics. The
dose of castor oil is one or two teaspoonfuls for a baby up to a
tablespoonful for an adult. Rochelle salts and seltzer aperient are
given dissolved in water; the ordinary dose is from one to four
teaspoonfuls. Seidlitz powders come in two packets, one white and one
blue. The contents of the packets should first be dissolved in separate
glasses each filled about a quarter full of water. One solution should
then be poured into the other and the mixture taken while it is
effervescing. Cascara tablets are generally given in one to ten grain
doses.
A small bottle of tincture of iodine and one of 70% alcohol should be
kept for disinfecting. Neither one is for internal use. The iodine is
used to disinfect small wounds and abrasions of the skin. It is applied
with cotton swabs and several swabs should be made and kept on hand in a
box or envelope. Alcohol is used to disinfect thermometers and other
instruments that cannot be boiled, for rubbing, and may also be used for
disinfecting the skin. A 90% solution is sometimes used for rubbing; it
need not be bought until needed. Denatured and wood alcohol are poisons
and should be used in households only in spirit lamps; they are not safe
for other purposes.
First aid materials may include two gauze bandages two and one-half
inches wide and two bandages one inch wide, one American Red Cross First
Aid Outfit, a small package of absorbent cotton, a roll of old muslin, a
package of adhesive plaster one inch wide, boracic ointment, picric acid
gauze or other application for burns, safety pins, and a pair of
scissors.
For use in cases of fainting or exhaustion it is well to keep aromatic
spirits of ammonia on hand. Its bottle should have a rubber stopper. The
dose is one-half to one teaspoonful, in a quarter to half a glass of
water. Hot coffee and tea are also good stimulants, but the time
necessary to prepare them makes it desirable to have aromatic ammonia
on hand. Household or ordinary ammonia must not be used as a substitute.
Olive oil, mustard, and baking soda may be brought from the kitchen when
needed. It is assumed that vaseline, cold cream, hand lotion, talcum
powder, and other toilet preparations will also be available.
Only a few appliances are necessary. Among them are a medicine glass, a
teaspoon, clinical thermometer, hot water bag, fountain syringe, and an
alcohol lamp in houses without gas or electric stoves. It is better not
to buy other appliances until they are needed, particularly rubber goods
since they deteriorate rapidly.
EXERCISES
1. Why is it dangerous for persons without medical training to prescribe
medicines? What is the especial danger of dosing oneself?
2. What is meant by a habit-forming drug? Name all you can, and tell why
they are peculiarly dangerous.
3. What are the special objections to patent medicines?
4. What precautions should be taken in order to administer medicine
accurately? What precautions to avoid giving wrong medicines?
5. How may some disagreeable medicines be made more palatable?
6. Tell how to prepare and give a soapsuds enema.
7. How should a fountain syringe be cared for? a throat spray?
8. Describe methods for giving steam inhalations.
9. Describe the equipment and care of a household medicine cupboard.
10. What drugs is it well for a family to keep on hand? What appliances?
What materials for first aid?
11. How many drugs in addition to those prescribed by a physician have
you or your family on hand at the present time? How many do you consider
really necessary? Are any of these medicines used to remedy troubles
that might be cured by sufficient attention to rest, exercise, diet, and
fresh air?
FOR FURTHER READING
Health and Disease--Roger I. Lee, Chapter VI.
How to Live--Fisher and Fisk, Supplementary Notes, Sections IV, V.
Scientific Features of Modern Medicine--Frederic S. Lee, Chapters III,
VIII.
The Human Mechanism--Hough and Sedgwick, Chapter XX.
The Conquest of Nerves--Courtney.
Primitive Psychotherapy and Quackery--Lawrence, Chapters I-V.
Nostrums and Quackery--American Medical Association. (See especially
"Cancer Cures" and "Consumption Cures.")
FOOTNOTES:
[2] See "Nostrums and Quackery," p. 445.