Chapter 22

No one who has not seen how readily the surplus vital action passes out of the system when simple cold is rightly applied, can imagine how easily such cases are cured. It seems to us absurd to speak of "heart disease" in many of the cases in which people talk of it and set the case down as hopeless. It is absurd, simply because it is not heart disease, but only a little more action than is comfortable, and which is reduced in a few minutes by a cold towel. No doubt care and willingness to work a little are required, if one would relieve a sufferer in such a case as this, but that care and energy are sure to have the best of all rewards.

Palpitation often arises from indigestion, in which case _see_ Indigestion.

Palsy.--_See_ Paralysis.

Paralysis.--This serious trouble in slighter forms affects one side of the face, or even one eye only. More serious attacks involve the arm, and even an entire half of the body. It may come suddenly, or may creep slowly over the frame. In very old persons the case is usually hopeless, as life itself is fading. In earlier life, and in less serious cases, a cure is to be expected from proper treatment. Cupping, blistering, or opiates must be avoided, as all tending to reduce vital energy. Treatment must aim at increasing this, not reducing it. Take first the case of paralysis slightly affecting the face. When the patient is warm in bed, place a BRAN POULTICE (_see_) not too hot, on the back of the head and neck. Let the patient lie on it, first rubbing the neck and back of head with olive oil. Do this for an hour each day. At another time wash the back of head and neck with SOAP (_see_) and water, then with vinegar, and finally rub with hot olive oil. Keep the parts warm with good flannel always.

If the whole side be affected, foment strongly the whole spine, and treat it in a similar way to the back of the head, as prescribed above. We have known cases of comparatively speedy cure by this simple means. The heat simply vitalises the partially dead nerves. For paralysis of the lower limbs, the treatment is applied to the lower part of the spine principally, but also to the whole spinal system. There is no fear of injuring the patient in this treatment, and we know of many cases of most delightful cure secured by it. What is called the ARMCHAIR FOMENTATION (_see_) is an excellent method of dealing with paralysis of the lower limbs or any part of them, and may be resorted to if the above treatment fails. Care must be taken in any case to avoid a chill after fomenting, which might make matters worse than at first.

Perspiration.--By this term we mean not only the sensible perspiration which is felt as a distinct wetness on the skin during exertion or heat, or in some illnesses, but also, and chiefly, the constant insensible perspiration. This latter is far more important than the former. No one could live many hours without it, for by its means several pounds weight of waste is got rid of every day. Its importance we saw lately in the case of a child greatly swollen in dropsy. A flannel BANDAGE (_see_) wrung out of warm water, placed round the body, reduced this swelling completely, without any _sensible_ sign of excretion. A very gentle treatment, increasing this insensible sweating, will often cure without weakening, where violent perspiring medicines or treatment cause great weakness. A damp flannel bandage placed round the lower half of the body all night for a few nights will produce a remarkable increase of insensible perspiration, and in many case forms a good substitute for sweating drugs. Along with this the soapy lather may be used at bedtime all over the skin (_see_ Lather and Soap). We have seen a swelling of the hand, which made a medical man talk of amputation, cured by these means. Acetic acid, or white-wine vinegar, rubbed over the skin, produces a similar increase of insensible perspiration, and may be used without fear of injury. This done once a week will go far to reduce sensitiveness to cold. Indeed, the use of M'Clinton's soap and water, along with good acetic acid sponging once a week, will prevent many serious ills by securing a constant gentle excretion of hurtful waste through the stimulated skin.

Piles.--This very common trouble is caused by one or more of the veins in the lower bowel losing their elasticity, so as to protrude more or less from the anus, especially when the stress of a motion of the bowels forces them out. When no blood proceeds from this swollen vein, it is sometimes called a _blind_ pile. If blood comes, it is called a _bleeding_ one.

There are few illnesses more prevalent than this, few that seem to be less rationally dealt with, and yet few that are more easily cured.

It is distressing to think of what some poor people have to suffer from this disease, while they are still compelled to go on working, and even walking, in the most depressing sufferings. It is still more distressing to think of the painful operations which some have to undergo in having the relaxed portions of these veins cut out. Even when the piles have got to a very advanced stage it is not difficult to cure. It will generally be found that there is Constipation (_see_), so first of all, the bowels must be regulated. This may be done by means of liquorice and senna mixture, and strict attention to diet and exercise. Then the nerve action in the lower back is to be stimulated by applying to the back below the waist a large BRAN POULTICE (_see_). Rub the back after this with hot vinegar, dry, rub with olive oil, and wipe off the oil gently. Do this at bedtime. Into the bowels may be injected (with the fountain enema) first one or two injections of warm water; then an injection of warm water and white-wine vinegar. Be particular to have this mixture not too strong. A trial may be made with one tablespoonful of vinegar to a pint of water. If any pain is caused, inject simple lukewarm water and use the vinegar and water next time weaker. A very weak mixture has a wonderfully healing effect. After one pint of this mixture has been injected, an injection of cool water (but not cold) should follow. The vinegar should be so weak that it will cause no pain, properly speaking,--only just the slightest sensation of smarting. It will be possible to use the water colder and the vinegar stronger as you get on with the cure, but in both, your own feelings and good sense will guide you. This direction will suit other cases of internal syringing, in which membranes have got relaxed, and need to be braced with cold and weak acid. In all such troubles it should be remembered that the warm or tepid water is used at first only because the cold might be felt uncomfortable till the surfaces are prepared for it. It is the cold that does the good. After this, protruding piles may be gently manipulated by the fingers and pushed back into their place. During this the patient must press outwards, as if to discharge fæces from the bowel. The anus will then open and permit of the piles being pressed in. The injecting treatment may be given twice a day. If too painful, even bathing the parts with the vinegar and cold water has great healing power.

Let the sufferer, if at all possible, have _entire rest_ for a fortnight during the treatment, and lie down as much as convenient.

In mild cases, simply bathe the piles with cold water and press them back into their places. A daily wash of the anus with SOAP (_see_) and warm water, followed by a cold sponging, will do much to prevent piles.

Pimples on the Face.--_See_ Face.

Pleurisy.--The pleura is the tender double web, or membrane, which lines the inside of the chest on the one side and covers the lung, or rather encloses the lung with its other fold. Each of the two lungs has its pleura in which it works, and each side of the chest is lined by one side of this sensitive organ. The slender lining passes round the greater part of one whole side of the body with one-fold, and round the whole of the lung with the other. Let us suppose (which often takes place) that the front of the body is defended with what is called a "chest protector," but the sides and back are exposed to a chilling atmosphere. Part of the pleura, and that part which is farthest from the surface, is sheltered, but the greater part of it, and that nearest the surface, has no such protection. In the case especially of women this is the state of things. It seems as if people thought that they only need to keep a few inches of the breast warm--that is keeping the chest all right--though the sides just under the arms, and the back under the shoulder-blades, are of far greater importance. The throat is even muffled, and a "respirator" worn, so that fresh air is not allowed to get inside the lungs, while the pleura is exposed to chill at the back. The consequence of this is that vital action is so abstracted from the pleura that the tension of its small vessels is relaxed, and blood is admitted as it is not intended it should be.

Severe pain is felt on one or both sides, and round under the shoulder-blade. A painful cough arises, and great fever is produced. In such a case the treatment is on the same principle as that given in Lungs, Inflammation of the, which should be read. The inflamed part must be cooled by applying towels well wrung out of cold water round the side, applying a fresh one when that on the part becomes warm. If the pain does not leave in half-an-hour of this treatment, or if the patient be weak to begin with, or if any chilliness is felt, pack the feet and legs in a large hot fomentation. The cooling of the side may then go on safely until a curative effect is produced. We may not be able to give the theory of action of this treatment, but we know that in many cases it has perfectly and very speedily been successful, and that it leaves no bad results, as blistering and drugging are apt to do. We know of one case in which it took twenty-four hours' constant treatment to effect a cure. But it did effect it. Two friends took "shifts," and saw that all was thoroughly done. This will give an idea of the proper way to go about the matter.

Poisoning.--The following are the antidotes and remedies for some of the more common forms of poisoning.

Alcohol.--The patient is quite helpless, and there is usually a strong smell of alcohol. If the patient is intoxicated at the time give an emetic. If there is evident prostration from a long bout, keep him quiet and warm. Hot tea not too strong may be given.

Alkalis (_e.g._, ammonia, soda or potash).--Give dilute vinegar, followed by white of egg.

Arsenic.--Emetic, followed by white of egg. Keep very warm.

Carbolic.--Readily identified by smell of tar or carbolic. Wash mouth well with oil. Give an emetic.

Chloral.--Emetic; warm coffee, and even an enema of coffee. Artificial respiration (_see_ Drowning) may be necessary if breathing gets very low.

Chloroform or Ether (inhaled).--Fresh air. Pull tongue forward, and begin artificial respiration. If heart has stopped, strike chest two or three times over region of heart.

Chloroform or Ether (swallowed).--Emetic; enema of hot coffee; keep awake. If necessary, artificial respiration.

Copper.--Emetic, white of egg to follow.

Laudanum.--There is intense drowsiness and contraction of pupils of eye. Give an emetic and plenty of strong coffee. Walk patient up and down. On no account allow him to give way to the desire for sleep.

Mineral Acids and Glacial Acetic.--If any neutralising agent, such, _e.g._, as lime, chalk, soda, or calcined magnesia, is at hand, give it at once. Or give an emetic, followed by oil or milk and water.

Mushrooms.--Emetic; castor oil and enema.

Nicotine (tobacco).--Emetic; stimulate and keep warm; keep patient lying down.

Oxalic Acid.--Neutralise by chalk or lime water, but not by soda or any alkali. Give plenty of water; apply hot fomentations to loins.

Phosphorus.--Often caused by children sucking matches. There is a burning in the throat, and often vomiting. Give an emetic. After this some barley water or milk may be given.

Prussic Acid.--Almost hopeless. Emetic; artificial respiration.

Snake Bite.--Suck the wound, and apply a drop or two of strong ammonia to the bite. Ammonia may be also inhaled. Artificial respiration often necessary.

Strychnine.--Emetic; keep quiet and darken the room. Chloral or bromide of potassium may be given. If spasms threaten respiration, artificial respiration is necessary.

Tartar Emetic or other Antimonial Poisons.--If vomiting is not present, induce it by an emetic. Give doses of strong tea. Keep very warm by hot blankets.

Good domestic emetics are a teaspoonful of mustard in a tumblerful of water, or a tablespoonful of salt in the same quantity of water.

Poisoning, Blood.--Where this arises from a more or less putrid wound, what is aimed at in the treatment is to stop the manufacture of the poison in the wound by cleansing and healing it. This done, the other symptoms will subside. The wound should be carefully brushed with a camel's-hair brush and vinegar or dilute ACETIC ACID (_see_). This should be followed up with a poultice of boiled potatoes or turnips, beaten up with the same weak acid. Leave this on all night. Brush again well with the acid in the morning. In the matter of diet eat what will produce healthy blood, and by open-air exercise seek the same end. But the daily brushing and poulticing, or even twice daily if necessary, will work wonders on the poisoned wound. Care should be taken where any cut or wound has been made in the flesh, that it is carefully washed, and any dirt or foreign matter removed. Especially is this to be attended to if a rusty nail or penknife has inflicted the injury.

Polypus.--_See_ Nostrils.

Potato Poultice.--Potatoes boiled and beaten up with buttermilk, spread out in the usual way, make this useful poultice. Weak acid or vinegar may also be used instead of buttermilk. The potatoes should be boiled as recommended below.

Potato, The.--The proper cooking of this root is so important for health, owing to its universal use, that we here give directions which, if followed out, make potatoes a dish acceptable to even a very delicate stomach. Difficulty of digestion often arises from the potatoes not ripening properly, especially in cold soil, and since disease has become so widespread. Their unripe juice is positively poisonous, and when they are merely boiled is not completely expelled. The potatoes should be _steeped_ in warm water for an hour before they are boiled. The water in which they have been steeped will be greenish with bad juice, and must be thrown away, and the roots boiled in fresh water as usual, giving a thorough _drying_ after the boiling water is poured or strained off. So prepared, the potatoes make a very digestible dish.

Poultice, Bran.--_See_ Bran Poultice.

Prostration, Nervous.--The various articles under Nerves and Nervousness should be read. Here we give simply the treatment for failure in the digestion and bowel action. This arises from failure in the great nerve centres near the middle of the body. External treatment may be given as follows:--Dip a cotton cloth, four-ply thick, and large enough to cover the stomach and bowels, into cayenne Lotion (_see_), and lightly wring it. Lay this gently over the stomach and bowels. Over this an india-rubber bag of hot water is laid. Take care that the heat is not _too great_ or the mixture _too strong_. All must be just hot enough to be comfortable. This application may remain on for two hours, and then be repeated. The cayenne is greatly to be preferred to mustard for many reasons. Give the most easily assimilated food possible. A teaspoonful of gruel each half-hour, increased to a dessertspoonful, if the digestion will bear it, and preceded in all cases by a tablespoonful of hot water. This should be continued for twenty-four hours. Proceed very cautiously then to increase the nourishment, on the lines of Assimilation, Diet, Digestion, etc., giving oatmeal jelly, wheaten porridge, Saltcoats biscuits, and such diet, _gradually_ bringing the patient back to ordinary food.

Pulse, Counting the.--Most valuable information as to the nature and progress of disease is derivable from the pulse. Every one should learn to count it, and to distinguish the broad differences in the rapidity and nature of the beat. Such a distinction as that between BRONCHITIS and ASTHMA (_see these articles_), which require almost directly opposite treatment, is at once discerned from the pulse. In bronchitis it beats much too quickly, in asthma it is natural or too slow. In many cases we have seen asthma, which in cough and spit is very like bronchitis, treated as bronchitis, with bad results. These would all have been avoided if the pulse had been intelligently counted. Count the pulse, if at all possible, for _half-a-minute_. This multiplied by two will give the rate per minute, by which it is judged. If this rate per minute be above 100, there is a good deal of feverish or inflammatory action somewhere. If below 60, there is considerable lack of vital power, requiring rest and food to restore it.

In adults the rate for males is from 70 to 75 beats per minute, and for females 75 to 80. In infants the healthy pulse may be at birth 130 to 140 per minute, diminishing with increase of age. In the case of any child under five and over one year, if the pulse beats, say, 108 in the minute, it is too fast. The pulse of an adult may go down as low as 60 or even 50 per minute, but there is then something wrong.

Cooling the head is always safe with high pulse and feverishness, and often this alone will ward off disease and restore the healthy condition. If the pulse be low, fomentations to the feet should be applied, along with cooling action elsewhere, if necessary.

Purple Spots on Skin.--These arise first as small swellings. The swellings fall, and leave purple patches behind, which, if the trouble continues, become so numerous as to spoil the appearance of the skin. This especially occurs in children or young people, whose skin is exceptionally delicate. What has occurred is really much the same as the result of a blow or pinch, leaving the skin "black and blue." Some of the delicate vessels in the skin have given way, and dark blood collects on the spot.

The treatment is to sponge all over the body and limbs with warm CAYENNE "TEA" (_see_), only strong enough to cause a slight smarting. It should never cause pain. If it does so, the tea is too strong, and should be diluted with warm water. The soapy LATHER (_see_) may also be used, and olive oil may with advantage be rubbed on as well. Milk and boiling water should be given to the patient every two hours during the day, with a few drops of the cayenne "tea" in it. This is a true stimulant, and worth all the whiskey in the world. The object of the treatment is to nurse the patient's strength, and stimulate the skin. An intelligent study of many articles in this book will guide the thoughtful how to act.

Racks from Lifting.--_See_ Muscular Pains; Sprains.

Rash, or Hives.--Infants are often troubled with large red, angry-looking spots, breaking out over the body, and causing trouble by their heat and itching. These are commonly known as hives. If the water in which a child is washed be hard, it will sometimes cause the skin to inflame and become "hivey." If the soap has much soda in it, it will also cause this. What is called glycerine soap, and much of what is sold as peculiarly desirable, is utterly unsuitable for an infant's skin. Soda soap will cause serious outbreaks even worse than "hives," and will often not be suspected at all, as a cause.

Only M'Clinton's soap, which is made from the ash of plants, should be used on tender skins.

When the "hives" are not very troublesome, they are apt to be neglected; but this should not be, as in most cases this is the time they may be easily cured. The true element in cure is found in attention to the _skin_, as distinct from the stomach or blood. M'Clinton's soap (_see_ Soap) applied as fine creamy lather will _cure_ hives, and will never, we think, fail to do so. We know of a nurse plastering an infant's body with this soap, so that it was blistered. This is a totally wrong way of working. The right way is to work the soap and hot water as described in article Lather, and to apply it gently with the brush to the parts affected. After applying it with gentle rubbing for some time, and leaving some on the sore places, the infant will usually be soothed to sleep. Where over-cooling is feared, with a weak child, a little olive oil is gently rubbed on with the second coat of lather. In any case of itchiness the above treatment is almost certain to cure. Often the infant is suffering from too rich diet. (_See_ Children's Food.) In such cases, thinner milk, and a little fluid magnesia administered internally will effect a cure.

Remedy, Finding a.--It will sometimes occur, in the case of those endeavouring to cure on our system of treatment, that on applying what is thought to be the correct remedy, the trouble becomes worse. For example, where there are violent pains in the legs, a bran poultice is put on the lower back, and it is rubbed with oil. The pains become worse instead of better, and perhaps our whole system is abandoned and condemned. Now, all that is required here is to think and try until we find the _true_ remedy. If the pain in the legs is rheumatic, the hot poultice is all right. If it has been cramp, what is needed is a cold cloth on the lower back, instead of heat. In the example above given, what is needed is not to abandon the treatment, but to rectify the mistake, and apply cold instead of heat. In a great many forms of illness the same principle holds good. It is safer, where there is any doubt, to try heat first, but not in a very strong manner. If this gentle heating makes matters worse, gentle cooling may be tried. If the heat does good, it may be continued and increased, but never beyond the point of comfort. If the cold does good, it also may be continued on the same principle. What the patient feels relieving and comforting, is almost sure to be the cure for his trouble, if persisted in. _See_ Changing Treatment.

Rest.--In every person there is a certain amount only of force which is available for living. Also this force, or _vitality_, is _produced_ at only a certain definite rate. Where the rate is very low, only perfect quiet in bed for a time can bring down the expenditure far enough to enable the vital force gradually to accumulate, and a cure to be effected. Sitting, in such cases, may be serious overwork.

When rest is ordered, we are often met by the reply that it is impossible, as work cannot be given up. It is, however, often possible to get a great deal more than is taken. Every spare moment should be spent lying down in the most restful position. It is an important element in nursing to give such a comfortable recumbent position to a patient as constitutes perfect rest, and the nurse who does so, does a great deal to cure.