CHAPTER IV.
TREATMENT OF INFLAMMATION IN ITS INCIPIENT STAGES.
Usually the nurse or the mother does not treat disease, or administer medicine except under the direction of a physician, and it is not always necessary for her to know the principles that guide in their administration, or why particular medicines are given. But it is sometimes necessary for the nurse or mother to decide what shall be done, and to act before the doctor can be consulted. Accidents and emergencies occur, distress and sickness may suddenly attack some member of a family at any time, and little ailments are complained of every day by some of them; the question arises, what shall be done?
It is not necessary every time to send for the physician, and he cannot at a moment’s notice be obtained. For many ailments the mother prescribes, and many times the early and judicious use of medicines or regimen not only relieves present suffering, but also prevents the developement of serious, and protracted and dangerous maladies. This is especially true in regard to incipient inflammation, and I shall here speak particularly of its treatment.
What has heretofore been said about inflammation gives us some guide to enable us to know whether the case calling for our care is one of an inflammatory character. If the pulse is full and hard and a little more frequent than usual, and there is restlessness and some pain we may conclude that there is IRRITATION that precedes inflammation at least, before such symptoms as depression, chilliness followed by heat, headache, a furred tongue, loss of appetite, and apparent weakness come on. But if any of these symptoms are present we should search for the cause. Perhaps if the inflammation is external we shall be able to ascertain what produces the trouble. In every case we ought to know the cause if possible, as we thus have more clear indications for treatment.
But we may use the sedative treatment in all cases where these symptoms come on in a person who has previously been healthy. Of course you will not bleed—that, if done at all, should be done by the doctor. But all sources of irritation ought to be removed, so that the patient may enjoy perfect quiet; the sick room should be ventilated, and kept at the temperature of about 60°; let the diet be light; allow ice and cold water freely, and if there is much febrile excitement use sedatives and saline refrigerants. The best sedative is veratrum viride, and the following is a convenient way of administering it: Drop 30 drops of the fluid extract of veratrum in 30 teaspoonfuls of water and give 1 teaspoonful every two hours. To adult subjects if there is considerable fever two drops of the extract, or two teaspoonfuls of the diluted preparation may be given at first and the dose may be repeated in an hour, but it will not be best to continue such large doses. Aperients may be given if there are fecal accumulations in the bowels. Although quinine is a tonic, six to ten grains of it are sometimes given with good effect in a case of inflammation.
Opium is a good remedy judiciously given; one dose (1 grain for an adult) is good in a case of catarrh or cold; successive doses are necessary in a case of peritonitis or enteritis, but this should be given on a physician’s advice. It acts probably by quieting the nerves—by sustaining the faltering action of the heart, and by keeping the inflamed part at rest. Sometimes cold, and sometimes hot applications are made to inflamed parts, and it is said that the sensations of the patient are the best criterion of their usefulness. Except, however, in cases of inflammation of the brain, and perhaps even then, I think that hot applications are the best. When we wish to promote suppuration hot fomentations should be applied.
COUNTER IRRITANTS relieve inflammation of the deeper parts by drawing the circulating fluid and the nervous energy to the surface. The milder kinds called rubefacients, produce merely local warmth and redness; these may often be used advantageously. Mustard applied so as to redden the skin is generally useful.
VESICANTS, epispastics, or blistering agents are safe appliances but they are distressing, and their use may be deferred until a physician advises them.
I have said that the diet should be light while the pulse is hard and full. Afterwards when the pulse is natural, or if it becomes irregular or small, good broths or other nutrients are to be given, milk, cream, and even raw eggs may be administered. In general food should not be pressed upon a patient.
OF TOPICAL APPLICATIONS FOR INFLAMMATION.
I have mentioned counter irritants and I think it best at this time to advert to all the various topical applications, irritating, soothing and protective, and to give such instructions as I can in regard to them.
Counter irritants are frequently applied over or near the seat of the disease, and often also at a remote part to obtain what is called revulsive action. In both instances, however, their action may be revulsive. If applied to the thorax or chest, for example in a case of pneumonia, the cuticle to which it is applied is almost as remote from the lung by the way of the circulation, as is the cuticle of the wrist or ankle. But practically a sinapism may be very useful applied at either place—possibly more useful if applied over the seat of the inflammation, because there is a sympathy between the parts—they may be used very beneficially in domestic medication.
In a few succeeding pages I give some directions to the nurse who acts under the doctor’s orders.
AMMONIACAL LINIMENTS, and other washes and embrocations that are sufficiently irritating to produce redness when rubbed on the skin, should be rubbed on briskly so as to produce considerably increased circulation in the capillaries, &c. One of the most commonly used rubefacients is mustard. To make a mustard plaster, or sinapism, take one part of powdered mustard, and about three times the quantity of flour and mix into a paste with tepid water, and spread it evenly between two pieces of thin muslin. As hot water or vinegar weakens the active principle of mustard, tepid water is best, even if it seems cold when applied to the patient. Good sinapisms are conveniently made also by doubling brown paper several thicknesses, wetting it and sprinkling on the mustard alone.
The mustard must not be left on long enough to vesicate; usually it should be taken off within half an hour (or moved,) except when applied to the soles of the feet, when they may commonly be left on for several hours. Their action must be carefully watched upon an insensible or delirious patient, or a little child. In mixing the plaster for children glycerine may be used, and then the plaster may remain on longer. Confine in place by a bandage. If the patient complain of the burning or smarting after the plaster is removed, dust the part with starch or fine flour, or dress with vaseline to exclude the air.
You may make a cayenne pepper plaster in the same way that a mustard plaster is made, or you may sprinkle pepper upon a thin slice of pork. This makes good draughts for children and may be useful sometimes for sore throat if applied to the neck. But capsicum plasters, &c., can be bought at the drug store. In the country it is generally convenient to obtain and apply horse radish leaves; these are good rubefacients. In order to produce immediate VESICATION I have known a doctor to heat an iron spoon until it was sufficiently hot, and then rub it over a small space of skin; and a small blister may be quickly made by saturating a bit of cotton with hartshorn, putting it in a top thimble and applying it to the skin to remain seven or eight minutes. But the agent most commonly used to produce vesication is the CANTHARIDEAL PLASTER. If you are to produce a blister with this, the part should first be washed and dried, shaved if there is any hair upon it, then if you wish the blister to rise soon wet the plaster and also the skin with vinegar; apply, and secure the plaster in place by a bandage. Most commonly it will rise in from four to eight hours, but without waiting for it to rise fully you may remove the plaster and apply a poultice which will produce the desired effect. Do not tear the skin in taking the plaster off. When the blister is well raised make a slight incision or two for the escape of serum, and dress with vaseline or tallow. This is the usual way, but in some cases the physician may direct differently, perhaps may leave the blister undisturbed and allow the fluid to be reabsorbed.
Strangury and congestion of the kidneys sometimes follow the prolonged use of cantharides; to prevent this, it is sometimes recommended that tissue paper be well oiled and interposed between the plaster and skin. And as camphor corrects the action of cantharides upon the bladder, it is recommended that in case of a child particularly, a solution of camphor in ether be sprinkled upon the plaster. If a blister is applied to a young child, it should be carefully watched and not allowed to remain too long. In two or three hours the skin will be well reddened, and the plaster may be removed and a poultice applied.
TINCTURE OF IODINE is sometimes applied as a counter irritant, but several coats and repeated applications are necessary to produce a blister.
Local stimulation can be obtained from bits of cantharideal plaster kept on for an hour or two, and removed or changed before the point of vesication is reached. The same effect follows the rapid passage of a hot flat iron over a piece of brown paper or flannel laid upon the skin. It is generally best that the flannel should be wet first; and should an emergency arise when from hemorrhage or some other cause there is danger of immediate collapse, the application of heat in this way may rouse the sufferer and prevent immediate death. This or the actual cautery is sometimes used to relieve lumbago, or rheumatism. If you have thereby a slight burn, you may dress it in a solution of bicarbonate of soda and cover from air with rubber tissue.
If a SETON is inserted in the skin, the silk should be moved daily and the matter well cleared out.
WET CUPS are applied to relieve congestion and to abstract blood, the skin being first scarified.
DRY CUPPING is most practiced for the relief of pain and to draw the blood away from an inflamed organ. Small tumblers may be used in the absence of cupping glasses, if the edges are smooth. When you apply the cups have at hand also a lamp, a saucer of alcohol, a bit of sponge or a wad of lint fastened to the end of a stick. Have the cups perfectly dry, dip the sponge in the alcohol which you will ignite from the lamp, (they being near the patient), and let it burn for an instant in the inverted glass, then withdraw and extinguish it, and rapidly place the cup over the intended spot. As the heated air in the glass condenses in cooling, the skin will be forcibly sucked up, and the blood drawn towards the surface. Each cup will remain on from three to five minutes. Do not attempt to apply them to a bony and irregular surface, and be very careful not to burn the patient by getting the edges of the glass too hot. To remove the cup press with the finger close to the cup so that air will be admitted.
WET CUPPING will be attended to by the physician, who will provide the scarificator, and adhesive straps. See that plenty of soft towels are provided.
There are two varieties of LEECHES used in this country, the American and the foreign. The latter differs from the former in having five or six stripes down its back instead of three, and it will draw from five to six times its own weight of blood as it is larger and more voracious than the American variety.
The domestic variety is sometimes preferred for children, as it will draw a sufficient amount of blood usually. Leeches should not be applied over any large vessel, and preferably should be over a bony surface where pressure can be made to stop the blood if it continues to run. The leech should not be handled, it may be washed and dried in the folds of a towel.
To induce them to bite, the part to which they are to be applied must be perfectly clean, and it may be best to pick or scratch the skin so that the leech has first a taste of blood; or you may put the leech in a wine glass, test tube, leech glass, or small bottle filled with water; cover with a cord and invert over the place; hold it close and slip out the paper. The leech will then probably take hold and the glass can be taken off, and the water absorbed by a towel. If one is to be applied inside the mouth or nostril, put a thread through its tail to prevent its being swallowed. If such an accident should occur have the patient drink freely of salt and water, and induce vomiting.
If the leech seems sluggish when applied stroke it gently with a dry towel. When full it will drop off. If you wish to take them off sooner, do not remove by force, but put a little salt on their heads. If the bleeding from the orifice continues too long it may be checked by a compress of lint, an application of ice, or by touching with nitrate of silver, or carbolic acid. Leeches not used may be kept in a jar of water with sand in the bottom, and a perforated cover, or it may be covered with a linen cloth. The water in which they are kept should be changed twice a week in winter and oftener in summer. Salt will make a leech disgorge the blood with which it is filled, but if kept afterwards it is liable to be diseased, and to cause disease in those that are with it.
By FOMENTATIONS or stupes is commonly meant the application of flannels or towels wet with hot water or some medicinal decoction. If hot water only is used, they are a convenient means of applying warmth and moisture, but they require constant attention, needing to be changed every ten or fifteen minutes. They are chiefly of use in relieving pain and inflammation, and in promoting suppuration when that is desirable.
Two pieces of flannel should be at hand each doubled to the desired size; they are to be saturated with boiling water and wrung out dry as possible. To wring it out without scalding one’s fingers, put it inside a towel, and this may be made with a hem at the end so that a stick can be thrust through it. Wring the flannel so dry that it will not make the bed or bed clothing wet. Cover with oiled muslin a little larger than the fomentation, and over that lay some dry flannel or cotton. If the stupe is put on hot, and frequently changed, it derives or draws blood towards the skin, and is often useful in relieving spasm and pain; and the continued use of them prevents suppuration. Medicaments are sometimes added to make them more irritant or sedative; then they are not changed so often, but they must not be allowed to get cold. After the fomentations are discontinued, carefully wipe the parts dry to which they have been applied, and cover with a warm, dry flannel.
I subjoin a few useful fomentations in which decoctions or medicines are used.
1. Add one ounce muriate of ammonia and two ounces spirits of camphor to 1 quart of boiling water just before dipping the flannel into it.
2. For a fomentation to the bowels, chest, &c., of a child, take 1 oz. paragoric, 1 oz. Jamaica ginger, and 4 ozs. hot water.
3. Twenty drops spirits turpentine may be sprinkled over each stupe, but be careful about blistering the skin or making a sore.
4. A decoction of chamomile flowers, hops, or conium, may be used for the fomentation instead of water.
5. Twenty drops or more of laudanum may be dropped over each stupe. This might soothe pain without causing stupor.
POULTICES, like stupes, are means of applying warmth and moisture. If applied early, it is believed they may prevent the formation of pus, as they bring about a resolution of the inflammation. When suppuration has commenced they facilitate the passage of matter to the surface, and lessen the extent of the disease. When applied to an inflamed part or swelling they should extend over considerable surrounding surface, but for a suppurating wound they should be but little larger than the opening.
Avoid putting them on very hot in a case of paralysis and also upon children, though they should be applied quite hot usually.
To make BREAD POULTICES pour boiling water on slices of bread without crust, simmer a few minutes, then beat up the bread quickly and spread it upon a piece of muslin previously cut of the desired size, leaving about two inches of margin upon each side. Then put on the poultice some lard or oil or vaseline to keep it from getting dry and hard, and to make it less likely to stick. It will be well to put on it a cover of thin muslin or mosquito netting, or tulle, or illusion, and then fold over like a broad hem the edges of both the covers. The poultice should be evenly spread about a quarter of inch in thickness and may be carried to the patient on a small tray or board, and if you are changing the poultice you should also have a small basin to carry away the old ones. After applying the poultice cover with some impervious material (oiled muslin or rubber cloth) to keep in the heat. Such a poultice as this will keep warm for five or six hours, but it should not be allowed to become cold and hard. Milk should not be used in making poultices as it quickly sours.
POULTICES ARE MADE OF VARIOUS MATERIALS. Flax seed meal, starch, powdered slippery elm, Indian meal, and oat meal are used. They should all be made of such a consistence that they will be tenacious as possible, and should have at least a little oil on them to prevent their getting dry.
For PUTRID SORES some disinfectant solution may be used instead of water in making the poultice, such as a weak solution of chlorinated soda.
YEAST POULTICES are used to hasten the separation of gangrenous sloughs. Mix six ounces of yeast with the same quantity of water at blood heat. Stir in fourteen ounces of wheat flour and let it stand near the fire until it rises. Apply while fermenting, or, “Take of wheat flour a pound, yeast half a pint, mix, and expose the mixture to a gentle heat until it begins to rise.”
The following are old officinal forms for poultices:
ALUM CATAPLASM. Take the whites of two eggs, of alum a drachm, shake them together so as to form a coagulum. (A common mode of preparing the alum poultices is to rub the whites of two eggs briskly in a saucer with a lump of alum till the liquid coagulates.) The curd produced by coagulated milk with alum is sometimes used as a substitute. The alum cataplasm is sometimes employed in incipient or chronic opthalmia as an astringent application. It is placed over the eye enveloped in folds of cambric or soft linen.
CATAPLASM CARBONIS LIGNI. Take a sufficient quantity of wood charcoal red hot from the fire, and having extinguished it by sprinkling dry sand over it, reduce it to very fine powder and incorporate in the simple cataplasm in a tepid state. Charcoal recently prepared has the property of absorbing those principles upon which the offensive odor of putrefying, animal substance depends. In the form of poultice it is an excellent application to foul and gangrenous ulcers, correcting their fetor and improving the condition of the sore. It should be frequently renewed.
CONIUM CATAPLASM. Take of extract of poison hemlock (conium) two ounces, water a pint. Mix and add of bruised flax seed sufficient to produce a proper consistence. This cataplasm may be advantageously employed as an anodyne in cancerous, scrofulous, and other painful ulcers, but its liability to produce narcotic effects in consequence of the absorption of the active principle of the hemlock must not be overlooked.
Sometimes a bag is made to contain a poultice, and such a bag should be used if we desire to apply a large poultice to the chest or abdomen. One can be made for the breast and for the back at the same time, and two straps over the shoulder may unite them. A hop poultice is a thin bag loosely filled with hops and wrung out of hot water.
DRY FOMENTATIONS are sometimes employed. Thin bags filled with heated sand, ashes, salt, bran, or hops are used, to keep the heat applied to the skin; and to warm the feet and quicken the circulation in the extremities, hot bricks, bottles filled with water, &c., are applied. These should be rolled in hot flannel or at least enveloped in something.
OF THE APPLICATION OF COLD.
Cold applications are sometimes used to subdue inflammation in the early stages. They are not good when matter is forming, or during sloughing. When they are used they ought to be continuously applied so as to keep up a constant cooling effect. Sometimes either water or some lotion is used with the design of cooling by evaporation. If a part is wet with water, alcohol, vinegar, a solution of muriate of ammonia, or other fluid, and left uncovered, the effect will be to cool it. When you design to cool by evaporation do not lay on more than one thickness of muslin or lint, and this must be wet so often that it does not get nearly dry. But a part may be cooled by several folds of muslin wet in ice water, and changed for fresh ones before they get warm. It is important that they do not become warm, and hence they should be frequently changed; alternate cooling and reaction is hurtful rather than beneficial. A steady cold stream of water is one means of cooling, and another device is to carry across a part a long strip of muslin or lamp wicking, having one end in a vessel of cold water higher than the bed, and the other leading to a basin below it. Protect the bed well with India rubber cloth so that both the patient’s clothing and the bed are kept dry.
Rubber bags are made to contain ice, and these are made in different shapes to be adapted to different parts of the body. They should not be more than half filled, and as soon as the ice melts the supply must be renewed. The ice used should be finely broken; this may be done by wrapping it in a fine cloth and pounding it. If mixed with one-third saw dust the ice will keep longer. A fold of muslin should be interposed between the ice bag and the skin, and they should be kept in their place by a bandage or some other means. An ice bladder for application to the head can be kept from pressing on the head by being folded in a napkin, which may be attached to the pillow by a pin. A cup shaped sponge may answer in the place of the ice cap to contain the ice; this must be wrung out before it is saturated, so that the pillow may not become wet.
COLLYRIA are best applied to the eye at the outer angle; a glass dropper or a camel’s hair pencil may be used—this same one should be used for nothing else. Draw down the lower lid, and tell the patient to look up at the same time that the drop of eyewater is slid in. Do not leave moist cloths bound upon the eye as they become hot and may do harm.
If you rub in liniment with your hand, wash the hand carefully before touching a sensitive spot, as some of the ingredients may cause smarting or other injury.