artery leading to the wound. If the wound is in the leg or foot,
pressure is to be made, either on the vessel above and near the wound,
or, where that cannot be easily found and compressed, make firm pressure
with the thumb or some hard substance, in the groin, about two and a
half inches at one side of the center of the pelvis, (wounded side) just
below the lower margin of the belly, towards the inner side of the
thigh, where the great artery (Femoral artery) can be felt pulsating. By
pressing firmly upon this artery, the blood is arrested in its flow into
the limb, and of course the bleeding from the wound soon ceases. If the
wound is in the arm or hand, _pressure_ is to be made, either just above
the wound, or on the inside of the arm, about one-third of the way from
the shoulder to the elbow, where the artery (Brachial) can be felt. To
secure the parts from further bleeding, the wounded artery must be taken
up and tied. Let it be seized by forceps, or the point of a needle may
be thrust into it, and the vessel stretched out a little, a thread put
round it and tied; cut off one end of the tie, and let the other hang
out of the wound, until it comes out by the vessel sloughing off. Bring
the lips of the wound together, and if it is large, put in stitches
enough to hold them, and put on an adhesive plaster, compress of cloths,
and bandages to keep it from straining the stitches, and protect it from
the air. The _Arnica_ plaster, made by JOHN HALL, of Cleveland, is the
best adhesive plaster of which I have any knowledge. Give the patient
_Aconite_ once in two hours, for a day after the accident.
_Slight Cuts_ about the joints, especially the knee, are dangerous, from
their liability to affect the ligaments, inflame, and produce _Lockjaw_.
Therefore, such wounds, ever so slight, are of great importance. They
should be at once closed up, whether they bleed or not, and covered with
an adhesive plaster, (Arnica plaster is the best) a bandage, and the
knee should not be bent, even when walking or sitting, until the wound
is healed. It is best to apply a splint from the hip to the heel, and
bandage the limb to it, so as to prevent bending of the joint.
_Bruises_ are to be treated with _Arnica_, applied to the part affected,
by putting twenty drops of the tincture into a gill of water, if the
skin is _not_ ruptured, or three drops into the same if it is, and
bathing freely. The _Arnica_ is to be taken internally at a higher
dilution. Keep the parts covered with cloths and wet in _Arnica_ water.
If a blow is received upon the head, by a fall, or in any other way,
producing a "stunning" effect, (concussion of the brain) so that the
patient appears lifeless for a time, and delirious when he begins to
come to, there is great danger of inflammation of the brain, and death
from the re-action, or in some cases, the shock is so great that the
patient will never revive unless he has the proper aid.
_Arnica_ is the great remedy to bring on reaction, arouse the patient,
and prevent _dangerous_ inflammation or congestion of the brain.
When a patient is "stunned" by a blow or fall, he should be conveyed
soon as possible, to some _quiet_ place, and as little noise as
practicable made about him, and the room kept darkened. _Arnica_ 3d
should be given immediately, and the nostrils wet with strongly
arnicated water.
If fever arise after he comes to, _Aconite_ should be given with
_Arnica_, and if the head aches, or becomes hot, _Bell._ is to be used.
This will prevent or arrest all symptoms of inflammation.
_Torn and Mangled_ wounds should not be handled much. If they bleed, the
blood must be stopped as in any other case. If they are dirty, warm
water may be gently applied to cleanse them. The wound should be covered
with some soft cloths, and kept constantly wet in Arnicated water of the
strength of four drops of the _tincture_ to a pint of water.
Piles--Hemorrhoids.
One important matter in all cases of habitual piles, is, to keep the
bowels regular. Much can be done for this purpose by diet and regimen.
On rising from bed in the morning drink freely, from a gill to half a
pint of cold water, at least half an hour before breakfast; use such
diet as is easily digested, and drink no alcoholic beverages. To relieve
the bowels when costive, take a dose of _Nux Vomica_ at night, and
_Podophyllin_ in the morning. This may be repeated from day to day until
the proper effect is produced.
To relieve from a severe attack of Piles, use _Bell._ and _Podophyllin_
in alternation every four hours, and apply to the tumors when inflamed,
cloths wrung out of hot water, or sit in hot water for a time.
A poultice made of fine-cut _Tobacco_ wet in hot water and crowded
firmly up against the pile-tumors, secured by a T bandage, will relieve
the most desperate cases for the time, and is attended with no danger or
disagreeable symptoms except in rare cases, when it produces sickness at
the stomach, which soon subsides on the poultice being removed. _Oil of
Arnica_ is an excellent application for inflamed Piles.
A most important point in the management of Piles, and one often
neglected, is to replace the prolapsed tumors. The tumors will be
protruded from within the anus by the act of evacuating, and if left in
that condition, will be pressed upon by the external parts, chafed and
inflamed. In all such cases, the patient should take particular pains to
return the tumors into the rectum; and to aid in that process a little
oil may be applied when they will be easily pushed back, and the
sphincter of the bowel will close below them, preventing any chafing,
and the consequent inflammation.
For _Bleeding Piles_, _Ipecac_ and _Bell_. are very efficient remedies.
They may be alternated every half hour, or oftener if the bleeding is
severe, or at longer intervals when it is only slight.
_Hamamelis V._, (Witch Hazel,) will in nearly all cases arrest the
bleeding at once. It should be applied to the parts and taken internally
at the same time. Drop doses to be put on the tongue once in fifteen or
twenty minutes.
An infusion of the _Hamamelis_ may be taken internally in doses of half
a teaspoonful, and the same injected into the bowel with excellent
effect.
The most effectual way, and the best for obtaining permanent relief from
Piles when the tumors have become hard, and remain all the time so as to
pass out of the anus at every evacuation, being constantly more or less
tender and painful, and often becoming inflamed, is to have them taken
off. But never let that be done with a knife. The bleeding would, in
such a case, be very excessive, and most likely fatal. The history of
knife operations for the excision of Pile tumors is written in blood,
and the tombstone stands as a monument of condemnation of the practice.
No trustworthy surgeon will at this day attempt it.
But however dangerous may be the knife operation, there is no danger at
all to be apprehended from removing the tumors by a _ligature_. To
accomplish this, take a soft cork about three-fourths of an inch in
diameter, and one inch long--make a hole through the center from end to
end, about one-eighth of an inch in diameter--cut crucial grooves in the
top of the cork about an eighth of an inch deep, bevel down the lower
end nearly to an edge, make a cord of saddler's silk, three fold twisted
together and waxed, about eight or ten inches long, double this in the
middle and pass the loop down through the cork out at the sharp end, the
two loose ends of the string being out at the grooved end. Make a strong
hickory stick about three-sixteenths of an inch in diameter, and just
long enough to pass across the square end of the cork. Now have the
patient protrude the Pile tumors as far out as possible, being placed on
his knees with the head bent to the floor, pressing out firmly as if to
evacuate the bowels. Let the tumors be dried as much as possible by
gently pressing a soft, dry cloth to them; then let the loop of the
string projecting from the flattened end of the cork, be pushed on over
the largest tumor, and held down at its base, while an assistant places
the stick in one of the grooves, ties the two ends of the cord firmly
down over the stick, or _toggle_, by a square bow knot; then turn the
stick round once, twice, or more, until the pressure upon the tumor is
sufficient to strangulate it perfectly, and prevent the string from
slipping off. Care should be taken to keep the cord down to the base of
the tumor while it is being tied and tightened, as in many cases the
base is much the larger part of the tumor, and the cord tends to slip
up. After the ligature is applied and tightened, apply arnicated water
to the parts, and a large, warm poultice of superfine slippery elm bark,
wet so as not to be too soft and slippery, on the face of which Arnica
may be put. Keep it on with a T bandage. The patient must be put to bed
and kept quiet until the ligature and tumor come off, which will be in
about six or seven days, sometimes sooner. Once a day the "toggle" must
be turned part, or the whole of a circle or more, to tighten the cord as
the patient can bear. This will be very painful from beginning to end of
the ligating, but any, even the most sensitive, patient can bear it. The
patient must have quite warm hip baths two, three, or more, times a day,
or as often as the pain is severe, the poultice being replaced after
each bath, and kept constantly on.
If there are several tumors protruding, apply ligatures to two of the
largest, when these are removed, the others will disappear.
Injections of mucillage of slippery elm should be carefully used to move
the bowels daily, or at least once in two days. Let the diet be of corn
or oat meal mush, or rice. As the tumor gradually sloughs off, the
surface heals, so that, though the base where the ligature was applied,
may have been an inch or more across it, there will not be a raw surface
of over an eighth of an inch in diameter, to which _Calendula Cerate_
should be applied. The patient must keep quiet for a few days longer.
Though this is a painful operation, it is not in the slightest degree
dangerous. I have effected complete and permanent cures by this mode in
numerous instances.
Sea-Sickness.
_Nux Vomica_ should be used once in about four hours, for twelve hours
before sailing, as a preventive to sea-sickness.
If, however, symptoms, such as dizziness or blur before the eyes, and
headache, begin to come on, a dose of _Nux_ should be taken, followed in
an hour with _Pulsatilla_.
If the nausea comes on, _Ipecac_ and _Arsenicum_ should be taken
alternately between the paroxysms of vomiting, should that symptom
appear.
If practicable, the patient should lay still upon the back until the
sickness passes off. I have removed sea-sickness immediately in several
instances with _Pulsatilla_ alone, and the last time I had an
opportunity to prescribe for this affection I gave _Podophyllin_. It
removed all the symptoms in a few minutes. That is the only time I ever
tried it, but from the provings I am satisfied it is one of the best
remedies.
Asiatic Cholera.
I was practicing in Cincinnati during the prevalence of Cholera in the
years 1849, and 1850, and in Northern Ohio in 1854, and had abundant
opportunity to observe and treat it. The disease generally begins with a
diarrhoea, which may continue for several days, or only a few hours
before other symptoms set in, such as vomiting, then cramping in the
stomach and muscles of the legs, arms, hands and feet, followed by cold
sweats, great prostration, restlessness, excessive and burning thirst,
drinks being immediately rejected. These symptoms continue, the patient
sinking rapidly into _collapse_, when the skin looks blue and shriveled,
the eyes sunken, the surface covered with a cold, clammy sweat, the
extremities, nose, ears, tongue and breath cold, the voice hollow and
unnatural. This condition continues from two to eight or ten hours, the
patient regularly failing, sometimes becoming delirious before he dies.
In some cases the vomiting and diarrhoea set in simultaneously, and
the other symptoms follow, as above described, in rapid succession. In
others the cramping may be the first symptom, the others following it.
In a large proportion of cases, the disease takes the course first
described above, the diarrhoea, called the _premonitory symptoms_, or
sometimes _cholerine_, coming on several hours, if not a day or more,
before any other symptoms.
The diarrhoea is not usually painful, hence the patient may not be
alarmed so as to attend to it until the more dangerous symptoms appear.
It begins in some cases with pain and some griping, the discharges
rather consistent, having a bilious appearance, so that the patient
supposes it to be an ordinary bilious diarrhoea, which is not
dangerous, his fears being thus quieted. But however the diarrhoea
begins, it becomes sooner or later, copious, watery, and light colored,
(rice water) painless but rapidly prostrating.
TREATMENT.
In the early stages of the diarrhoea, _Veratrum_, taken about twice as
often as the evacuations occur, will frequently arrest it in a few
hours, especially if the patient lies down and keeps quiet. But if not,
and it increases in frequency, or becomes more copious, or any sickness
is felt at the stomach, the patient should, at once, be laid upon a bed
and _strong tincture of Camphor_ should be given in drop doses, once in
five minutes, for one hour or more, and as the symptoms abate, once in
ten, fifteen or twenty minutes, for six or eight hours.
A teaspoonful of the _Camphor tincture_ may be put into a tumbler of
cold water, ice water if at hand, and the water agitated until it
becomes clear, giving a teaspoonful of this camphorated _cold_ water as
a dose, stirring the water each time. I think this is better than to
give the pure tincture. After the patient becomes quiet and easy,
_Veratrum_ should be given in alternation with Camphor, a dose in four
to six hours for several days, or oftener if he feels any symptoms like
a threatened return of the disease. These two medicines serve as
_prophylactics_ (preventives) of Cholera.
If, however, the disease continues in spite of the Camphor and Veratrum,
in the first instance, or later, (as the Camphor may be given in many
cases with success in the advance stage,) you must resort to other
remedies.
If vomiting comes on with burning in the stomach give _Ipecac_ and
_Arsenicum_ in alternation as often as the vomiting occurs, and if the
diarrhoea continues give _Veratrum_ between the doses of the other
two, in a violent case, as often as every ten to fifteen minutes, and at
longer intervals when the disease is slow in its progress. If the
vomiting and diarrhoea, or either, occur with a kind of explosion, the
vomiting ceasing suddenly for the time, after the first _gush_, or the
discharges from the bowels are involuntary, _Secale_ is the specific
remedy.
For the cramping, _Cuprum_ and _Veratrum_ are the remedies to be given
alternately.
If, however, the _cramping_ comes on as the first symptom, which is
sometimes the case, the patient being suddenly seized with it before any
other alarming symptoms occur, _Camphor_ is _the great remedy_, and in
this case it may be given in doses of double or treble the quantity
before directed.
If he sinks into the _collapse_ and lies quiet, indifferent to
everything, the pulse sinking, or he is pulseless, _Carbo Veg._ will
sometimes arouse and restore him, hopeless as the case appears. It
should be given once in half an hour until the pulse begins to rise. If,
however, instead of being quiet he is restless and thirsty, give
_Arsenicum_ in alternation with _Carbo Veg._, repeating the dose as
above directed. In some cases, after all the active symptoms cease, the
patient will become quiet and drop to sleep, and instead of the pulse
rising, as it will if he is recovering, it sinks, or does not appear if
he has been pulseless, and the breathing becomes irregular and
feeble--he is sinking. If aroused, he sinks back into the stupor in a
few moments as before. _Laurocerasus_ is a specific for this condition.
It should be given once an hour until he is aroused.
If, however, besides the stupor, the head is hot, the face red, the
breathing oppressed, the pulse slow and sluggish, _Opium_ is to be
used, and may be given in alternation with _Laurocerasus_.
For the irritation of the brain, and furious delirium that sometimes
sets in after the cessation of cholera symptoms, _Secale_ and
_Belladonna_ in alternation will prove specific.
Let the patient have warm or cold drink as he prefers, and let his
covering be light or plentiful as is most agreeable. As soon as he gets
easy, and the vomiting and purging cease, and his pulse begins to
return, keep him quiet as possible, let the room be darkened and
everything still, so that he may go to sleep, which he is inclined to
do, this being the surest restorer. I am quite sure I have known several
patients carried off by a return of the disease, after it had been
effectually arrested, in consequence of sleep being prevented by the
rejoicing officiousness and congratulations of friends, disturbing and
preventing that early and quiet slumber which nature so much needs, and
must have, or hopelessly sink. The diet for two or three days after
recovery, should be a little oat meal gruel or rice.
Small Pox--Variola.
This disease begins with pain in the head and back, chilly sensations,
followed by a high fever, so similar in all respects to a severe attack
of Bilious or "winter" fever, that it is difficult or impossible to
distinguish it with certainty, as Small Pox. The fact of the prevalence
of the disease at the time, and the exposure of the patient, may lead
the Physician and friends to suspect Small Pox. There is one very
striking symptom of Small Pox, however, that exists from the beginning,
which, though it may be present in fever simply, is not uniformly so.
This is a severe and constant aching _pain in the small of the back_.
The headache is also constant.
The Small Pox is of two varieties or degrees, _distinct_ and
_confluent_. The _distinct_ is when the pustules are separated from each
other, each one a distinct elevation, with more or less space between
them not affected by the eruption.
The _confluent_ is where the pustules spread out from their sides and
run together, covering the whole surface as one sore.
It may be distinct on some parts, as on the body, and confluent on
others, as the arms, face, and parts most exposed to the air.
In the _Distinct_ variety the fever continues without abatement until
the eruption appears, when it entirely subsides, and that quite
suddenly. The eruption comes out about the third day of the attack,
sometimes not discoverable until the end of the third or beginning of
the fourth day. The eruption is at first very slight, beginning with
small red pimples on the forehead, upper part of the cheeks, neck and
upper part of the breast, extending by degrees to the arms, and other
parts of the body and limbs. About the end of the fourth or forepart of
the fifth day, the eruption is complete.
There is a symptom, not mentioned in the books, which will often
determine the disease before the occurrence of any eruption. It is the
appearance of hard shot-like pimples, to be _felt under the skin_ in the
palms of the hands, while there is, as yet, no trace of eruption to be
seen upon the surface.
On the eighth or ninth day, the eruptions become vessicular, have
flattened tops, and contain a limpid fluid. The parts continue to
swell, the eruptions to enlarge, and become filled with purulent matter,
having a dark color at the top, up to about the fourteenth or fifteenth
day, when they begin to flat down, to dry up, and some of the scabs
become loose. At this time, some fever arises, often quite severe, with
headache and other inflammatory symptoms. If the eruption is very
severe, fever will be of corresponding violence, and lighter or wanting
when the eruption is mild. This fever rarely lasts more than twenty-four
hours, from which time the patient rapidly recovers.
In the _Confluent_ variety, all the symptoms are more violent, the fever
continuing after the eruption begins. The pustules burst early, and run
into each other, covering nearly or quite the whole skin; the surface
swells and turns black or dark brown, the lungs are more or less
irritated, producing cough, and not unfrequently the stomach is
nauseated, and vomiting ensues.
If the patient survives the irritation up to the fifteenth or sixteenth
day, when the _secondary fever_ sets in, he is liable to be taken off
by an affection of the brain or lungs, during this fever. If he
recovers, his whole surface, especially that part exposed to air, is
deeply pitted.
TREATMENT.
As it is not often known for a certainty, in the early febrile stage,
that it is the small pox, the treatment will be first adopted that would
be proper for a like fever arising from other causes. But in all my
observations in this disease, and they extend to several hundred cases,
I have not found in a single instance, any of the ordinary fever
remedies, such as _Aconite_ and _Bell._, which would be applicable for
such symptoms in an ordinary case, to do any good in small pox. They are
directed, however, for these symptoms by the authorities, in the febrile
stage of the small pox; but I am quite sure they are not the proper
remedies.
From the great similarity, the almost absolute identity of small pox
_headache_ and _backache_, with the same symptoms developed by the
_Macrotys racem._ as well as the nausea and restlessness produced by the
drug, I was led several years ago to the conclusion that this, or the
_Macrotin_ was valuable in small pox. Not only so, but during the
prevalence of small pox in Cincinnati, to an extraordinary degree in the
winter of 1849-50, I treated about one hundred cases, including both
sexes, and all ages, from infants a few weeks old, to very old persons,
giving the _Macrotin_ to all, and had the good fortune to see _all_ my
patients recover. Since that time I have prescribed it for every case
successfully.
Having then, been entirely successful in so many cases, with this
medicine, I am not inclined at this time to give any other the
preference. I must admit, however, that though my patients all
recovered, I was not able to greatly abridge the duration of the
disease, nor to prevent the development of all the stages in their
proper order, as is _claimed_ by M. TESTE, for his use of _Mercurius
cor._ and _Causticum_. I was satisfied with so far modifying the
symptoms, as to enable my patients to live through, and come _out well
in the end_. I would then direct, if small pox is suspected, the patient
having been exposed to contract it, or from the peculiarity of the
symptoms, in the early stage, or when the disease is discovered after
the eruption, to give _Macrotin_ at the first trituration, in one grain
doses, once in two hours, while the fever, headache and backache
continue, after which, during the whole course of the disease, give it
three times a day. This will prevent the development of a dangerous
secondary fever, as well as irritation of the lungs, stomach or bowels.
In addition to this medicine I give the patients daily, from half an
ounce to two ounces of _pure_ (_unrancid_) _Olive oil_. This serves to
prevent the development of pustules in the throat, lungs and stomach; is
more or less nutritious, and keeps the bowels in a healthy condition.
Wash the surface once a day in weak soap suds, following it with a bath
of milk and water, and keep cloths moistened with warm milk and water,
constantly upon all parts that are exposed to the air, lubricating the
surface with _Olive oil_ after the bath of milk and water. This keeps
the surface quite comfortable.
The best diet is corn or oat meal mush and molasses, to be taken in
small quantities. Cold water is the proper drink, though it should not
be very cold.
The room should, at all times, be well ventillated, but in cold or cool
weather, sufficient fire must be kept up, to keep the room warm and dry.
A temperature of about 65° is the best. Hardly any thing can be worse
for a small pox patient than to be in a cold or damp room, and to
breathe _cold_ air. Uniform temperature is important.
If the eruption is tardy about appearing, or after it is out, a
recession takes place, the Alcoholic Vapor bath will soon bring it out.
(See Rheumatism **p. 30).