Part 135

Imitation Kumys (Koumiss).--(_a_) Fill into a strong champagne bottle, good, fresh, unboiled cow’s milk to such a height that after the addition of 1 oz. granulated or powdered sugar, and after corking, there would still be left at least 1 in. of empty space below the cork. Before corking, add a piece of fresh compressed yeast, about the size of 2 peas, then cork and tie the cork firmly down. In place of compressed yeast, 1 teaspoonful good beer yeast may be taken. The contents of the bottle are well shaken, repeatedly, then the bottles are placed in the cellar, where they are turned up and down a few times during the day. From and after the fifth day the mixture is ready and may be drunk to about the twentieth day. It is best to prepare about 6 bottles full at a time, refilling each after it has been emptied and cleaned, so that the treatment, after being begun, may not be interrupted. On opening the bottles, the contents are very apt to foam over, hence the bottle should be opened while being held over a plate. It should never be opened where there may be any furniture or dresses about, which might be soiled by spattering. A good milk-wine or kumys should have a homogeneous appearance of the consistence of thin cream, should be effervescent when poured out, of an acidulous, agreeably vinous odour and taste, and should not be full of lumps, or taste like butter-milk. On first using kumys it produces loose bowels, but this effect soon passes off.

(_b_) 200 parts condensed milk, 2000 parts water, 2 parts lactic acid, 1 part citric acid, and 30 parts brandy are mixed and carbonated. Cork well and let it stand for 2 days in a warm room till it froths.

=Administering Physic.=--Never allow a bottle of lotion for external use to stand beside a bottle of medicine to be taken internally. Keep them entirely separate, and _keep all medicines in a place where children cannot by any possibility reach them_. One further piece of advice, which is unfortunately but seldom attended to, is deserving of attention, namely, after an illness has terminated either in recovery or death, _empty out all the medicine bottles_, and on no account retain any of them for future use. Spoons differ very much in size, and it is not wise to trust to them in measuring medicines. It is best to get a medicine glass or spoon, either of which can be got at a chemist’s for a few pence. In giving sick people medicine there are 3 points which ought carefully to be remembered--namely, regularity, punctuality, and exactitude. Those intrusted with the administration of medicine to sick persons should _always_ read the label of the bottle before administering the medicine. By doing so they will probably save themselves a lifelong reproach. An inhaler for taking medicated vapours in bronchial and catarrhal affections may be extemporised out of a pickle bottle fitted with a perforated cork and a bit of tube. A special apparatus (Dr. Felton’s) is sold at 7_s._ 6_d._ by Savory and Moore.

To mask the taste of cod-liver oil:--(_a_) Use Allan and Hanbury’s “perfected” oil. (_b_) Put a little salt in the mouth before taking the oil. (_c_) Add 30 drops sulphuric ether to the dose and take it quite cold. (_d_) Add a little iodoform and essence of anise; say 96 grm. oil, 20 c. grm. iodoform, 4 drops essence.

Quinine may be enclosed in gelatine capsules when otherwise refused. If in powder it is best mixed with a little milk.

Keep a separate measure and separate glass for administering such drugs as castor-oil, cod-liver oil, asafœtida, valerian, &c.

Pills should be placed well towards the gullet and washed down with a drink. Or they may be hidden in jam, or wrapped in rice paper, and then washed down. Powders may be mixed in jam, treacle, honey, milk, or water.

To remove the taste of nauseous medicines from the mouth chew a small piece of bread and spit it out.

The best times for administering medicines, according to the frequency with which they are ordered, are as follows:--

“Daily.”--At 9 A.M. or at bedtime.

“Night and morning.”--9 A.M. and bedtime.

“Twice-a-day.”--10 A.M. and 6 P.M.

“Three times a day.”--10 A.M., 2 P.M., 6 P.M.

“Every 4 hours.”--10 A.M., 2 P.M., 6 P.M., 10 P.M., 2 A.M., 6 A.M.

Never wake a patient to administer medicine or food unless ordered to do so.

To apportion doses according to age, reckon 21 years and upwards as adults requiring full dose; then 17 will take ¾, 14 will take ½, 7 will take ⅓, 4 will take ¼, 3 will take ⅙, and 2 years or under will take ⅛ of the full dose.

Medicines are classified according to their general properties, the following being the chief:--

_Anæsthetics_--produce insensibility to pain. _Anodynes_--procure relief from pain. _Antiseptics_--prevent putrefaction. _Antispasmodics_--check spasms and cramps. _Caustics_--destroy animal tissues by a kind of burning. _Collyrium_--an eyewash. _Diaphoretics_--induce perspiration. _Diuretics_--increase the flow of urine. _Emetics_--cause sickness (vomiting). _Expectorants_--favour spitting. _Liniments_--for rubbing in. _Narcotics_--induce sleep. _Purgatives_--cause very loose bowels. _Refrigerants_--cooling. _Sedatives_--calm the nerves. _Soporifics_--induce sleep. _Styptics_--arrest bleeding. _Tonics_--increase the appetite and give a stimulus to the system.

The principal domestic remedies, with their doses (m. means minims, gr. grains, table. tablespoonful, tea. teaspoonful, dr. drams, oz. ounces, dess. dessertspoonful) and properties, are as follows:--

Aloes (compound decoction): 1-3 tablespoonfuls; pleasant purgative, useful in habitual constipation, and will often relieve headache.

Alum: 10-20 gr. in whooping cough and internal bleeding; 1 tea. (in treacle) as an emetic; 15 gr. in 10 oz. water as a collyrium; 60 gr. in 10 oz. water for gargles and injections; astringent (coddling the mouth) and styptic.

Ammonio-citrate of iron: 5-10 gr. in water; tonic.

Antimonial wine: 5-15 m. 3 times a day in bronchitis and fever, diaphoretic; 1 table. (for adults), emetic.

Aromatic chalk: 20 gr. in water checks diarrhœa.

Belladonna liniment (compound): externally applied on rag covered with waterproof for 12 hours as local remedy for rheumatism and lumbago; anodyne.

Bicarbonate of potash: 15-20 gr.; antacid; taken with lemon juice or citric acid as a cooling drink.

Bicarbonate of soda: 10-20 gr.; antacid; checks heartburn and stops diarrhœa.

Blue pill: 3-5 gr.; alterative; cures bilious attacks.

Borax: 1 in 24 parts water as a gargle for sore throat.

Calomel: 1-3 gr.; powerful purgative and alterative; taken for biliousness.

Camphor liniment (compound): stimulant liniment.

Carbonate magnesia: 5-30 gr. in milk; antacid, gentle aperient; useful for children.

Castor oil: ½ tea. (infants), 2 table. (adults), on milk, wine, or orange juice, or blended with glycerine or egg-yolk; most reliable aperient.

Chlorate potash: 10-20 gr., stimulant; 1 dr. with 4 dr. honey and 8 oz. water, gargle for sore throat; lozenges, overcomes effect of high altitudes on the respiratory system.

Chloric ether: 20-30 m. in water, cordial and antispasmodic; relieves cramp, violent cough, spasms, &c.

Chloroform: not to be inhaled or taken except in a doctor’s presence; sedative; applied to rheumatism, stings, and toothache as an anodyne.

Citrate of iron and quinine: 3-5 gr. in water; tonic and binding.

Citrate of magnesia (granular effervescent): 1 dess. in tumbler cold water; cooling aperient.

Cream of tartar: 20-60 gr., diuretic and cooling; ½ oz. in 1 qt. of water, fever drink.

Dover’s power: unfit for children; 5 gr. in wineglassful water, diaphoretic, checks diarrhœa and cures fresh colds; 3 gr. after meals prevents chest-ache.

Epsom salts: 1-4 dr. in water; purgative.

Essence of camphor: 30 m. in wineglassful water; exhilarating.

Essence of ginger: ½ tea. in wineglassful water; cordial stimulant, useful in chest-ache.

Essence of peppermint: 10-15 m. on sugar; exhilarating, warming and antispasmodic.

Extract of bark: 10-30 m. in wineglassful water; valuable tonic in neuralgia and fever.

Friar’s balsam: ½-1 dr. with sugar and egg-yolk, stimulating expectorant; applied on cuts.

Glycerine: may replace sugar for sweetening drinks and medicines; much used for softening the skin.

Goulard’s extract: 5 m. in wineglassful water as an eyewash; 1 in 40 of water, astringent, applied to bruises and sprains as a wash.

Gregory’s powder: 1 tea. in wineglassful water, cooling mild aperient.

Grey powder: 3-5 gr. (adult); aperient, acting on the liver.

Ipecacuanha powder: 15 gr. emetic.

Ditto wine: 10-20 m., expectorant for coughs; 1 table. (adults), repeated at 10 minutes intervals, emetic.

Jalapine: 2-6 gr., aperient for children.

Laudanum: 10-20 m., anodyne and soporific; with equal quantity opodeldoc, applied as an anodyne.

Lime-water: antacid; checks infantile diarrhœa; mixed with sweet oil affords great relief when applied to burns.

Liquorice powder (compound): 1 tea., mild aperient, best for piles.

Milk of sulphur: 1 tea. rubbed up with milk, gentle aperient and cooling, useful in rheumatism and piles.

Morphia bimeconate: 5 m. increasing every 3 hours; most valuable sedative and soporific; applied as an anodyne after the part has been reddened by compound camphor liniment.

Muriate (chloride) of ammonia: 10 gr. in wineglassful water, good expectorant in bronchitis; 1 oz. with 1 oz. alcohol and 10 oz. water; stimulant lotion for sprains.

Nitrate of silver: 2-4 gr. in 1 oz. water, lotion for sore nipples; 20 gr. in 1 oz. water, throat wash in diphtheria.

Nitre (saltpetre): 5 gr. in saline draught, cooling and diuretic for fever; ¼ oz. in ½ pint barley water, gargle for inflamed sore throat.

Nitric acid (dilute): 10 m. with 5 m. tincture of chiretta, 15 m. tincture of orange and 10 m. syrup in 1 wineglassful water, excellent between meal-times for convalescents.

Opodeldoc (soap liniment): excellent applied to bruises, stops swelling and discoloration.

Paregoric: 30-60 m., checks coughing.

Prepared chalk: 15-30 gr. repeated, with cinnamon and tincture of catechu, antacid and astringent for diarrhœa and cholera; made into a cream with water, cooling shield for burns.

Rhubarb: 1-5 gr., tonic to bowels; 10-20 gr., aperient followed by astringent.

Sal volatile: 30-60 m. in wineglassful camphor julep; antacid, antispasmodic, and exhilarating.

Santonine: 2-3 gr. on 3 alternate nights, followed by castor oil in the morning, expels threadworms from children.

Spirit of minderus: 15-20 m. in gruel at bedtime, excellent diaphoretic and cure for coryza (cold in the head); 20 m. in wineglassful water, eyewash; 1 table. in tumbler water, cooling lotion.

Spirit of nitre: 20-30 drops in wineglassful water, or 1 tea. in hot gruel at bedtime, diuretic and diaphoretic, for colds.

Sulphate of copper: 10-15 gr. in wineglassful water, rapid emetic in poisoning.

Sulphate of potash: 10-20 gr. with 10 gr. rhubarb and 15 gr. sugar in peppermint-water, mild aperient.

Sulphate of quinine: 1-5 gr. 2 or 3 times a day, tonic, useful in neuralgia, dyspepsia, weakness and fever.

Sulphate of zinc: 20 gr. in wineglassful water, emetic; 1 gr. in 1 oz. water, eyewash, astringent.

Sulphuric ether: ½-1 tea. in camphor julep, exhilarant.

Syrup of senna: 1 tea. (adults), mild aperient.

Tincture of arnica: with 4 times its bulk in hot water for fomenting bruises.

Tincture of chiretta: 10-30 m., tonic, useful in dyspepsia.

Tincture of colchicum: 10-20 m. at night after a light meal, diaphoretic, valuable in gout, rheumatism, and dropsy.

Tincture of henbane: 15-60 m., narcotic and anodyne.

Tincture of lavender (compound): 1 tea. with ½ tea. sal volatile in water, stimulant, antispasmodic, and exhilarant.

Tincture of quinine: 1-2 tea. in wineglassful water 2 or 3 times a day, tonic.

Tincture of rhubarb: 2-4 tea., cordial and purgative.

Tincture of squills: 1 tea. with wineglassful water, expectorant; take 1 dess. at short intervals to check coughing.

Tincture of steel: 5-15 m. in wineglassful water, tonic, astringent, and diuretic, good in weakness and dyspepsia.

Tincture of valerian: 1 tea. in camphor water, antispasmodic and stimulant, valuable in nervous headache.

_Common Complaints._--Without making the least pretence to give such information as will enable the sick man to dispense with the services of the physician or surgeon, whose aid should be promptly sought, there are many matters which by careful study may enable the threatened attack to be warded off, and there are a variety of ailments and troubles which are not generally deemed of sufficient importance to be worth troubling a doctor about. It is these subjects which claim treatment here, and with which the following paragraphs will deal, leaving all special and serious diseases in hands which have been trained to the work.

=Accidents and Emergencies.=--The first piece of advice to every one is to attend a series of lectures given every winter by the St. John’s Ambulance Association at very numerous centres all over the kingdom. This will convey an amount of knowledge and practical experience such as can never be attained by reading alone. Even Volunteers, who have gone through a course for the Army Hospital Corps, will do well to supplement it for every-day life with a course of St. John’s Ambulance lectures.

When you have not witnessed the occurrence of an accident, make some inquiry of the bystanders or patient as to its cause before taking any other steps, as this will often indicate what kind of injury is to be looked for. Never proceed to lift or remove a patient with broken limbs or bleeding wounds till the necessary bandaging and staunching have been done: let traffic be interrupted, if need be, rather than risk converting a simple hurt into a fatal one.

The ordinary accidents and emergencies of every-day life will now be dealt with in alphabetic order.

_Bites and Stings._--These may be divided into two classes--those of insects and those of poisonous or rabid animals.

Of Insects.--First remove the sting (of a bee or wasp) by pressing a small key on the spot, whereby the sting is forced into the hollow barrel; then apply any of the following lotions:--(_a_) Rub the bite of mosquitoes with a solution of borax in ammonia. (_b_) When bitten by midges, the best applications are oil of camphor and laudanum, equal parts, applied on lint; or (_c_) 6 oz. Goulard water, ½ oz. laudanum, applied on lint. (_d_) ½ dr. extract of belladonna; ½ oz. glycerine; 3½ oz. water; to be well mixed, and made into a lotion. The parts to be washed with a small quantity--about a teaspoonful or two at a time. (_e_) Goulard water mixed with a little Eau de Cologne makes an excellent wash for the skin in case of gnat bites. (_f_) Keep an onion always at hand, and instantly when bitten squeeze or cut it, so that the juice should flow into the puncture, rubbing it gently over the place; its effects are equally efficacious in the sting of a wasp or bee, always provided the sting does not remain in the wound. (_g_) Ipecacuanha powder is very effective in allaying the pain caused by the sting of scorpion, hornet, and wasp, also mosquito and midge bites. For scorpion stings, &c., make a paste of the powder with a little water, and apply it to the wound in a patch about the size and thickness of a shilling. (_h_) In bee sting, first remove the sting as quickly as possible with a forceps or by scratching with a finger, but never with the thumb and forefinger, because this squeezes more of the poison into the wound. Next squeeze the wound until a drop of blood comes out, and rub the place as large as a florin with an aqueous or dilute alcoholic solution of salicylic acid. The effect is still better by injecting the salicylic acid into the wound with the hypodermic syringe. After this the spot is painted with collodion, to keep out the air. (_i_) Gnat bites, stings of wasps, bees, &c., may be cured by applying a tincture of minderus, laudanum, and Goulard water in equal parts. (_j_) Sweet oil, or camphorated spirit of wine, is a good thing to apply to bite of the mosquito. (_k_) One raw egg well beaten, ½ pint vinegar, ½ oz. spirit of turpentine, ¼ oz. spirit wine, ¼ oz. camphor; these ingredients to be well beaten together, then put in a bottle and shaken for 10 minutes, after which to be corked down tightly to exclude the air. In ½ hour it is fit for use. To be well rubbed in 2, 3, or 4 times a day. (_l_) The leaves of the common dock, bruised and well rubbed on the part affected, alleviate the pain. (_m_) For bee stings: after pulling out the stings, break some lettuce leaves close to the stalk, and apply the milk afterward. (_n_) Anything “strong,” in a popular sense, will generally suffice to decompose and destroy an organic poison if instantly applied. This is why the juice of an onion answers the purpose. Anything equally pungent would do as well. (_Lancet._)

Poisonous bites.--There is great similarity in the immediate treatment desirable in the bite of snakes and mad dogs, the object being to prevent, as far as possible, the absorption of the poison by the blood. In the same category come any poisonous wound, as from arrows, &c. (_a_) Buckland recommends the following outlines:--(1) Suck the wound, if possible, most vigorously, taking care that there be _no sores on the lips or in the mouth_. In all cases before sucking fill the mouth with oil or salt and water if possible. (2) Apply, if you can, a cupping glass, or cut off the tip of a cow-horn, cut the bottom level, apply it over the wound, and exhaust the air by the mouth; when exhausted fill up the hole by means of a bit of wax or other material placed into the mouth before the operation of sucking is commenced. This is the mode adopted by the Kaffirs. (3) Wash the parts with hartshorn (ammonia). (4) Tie a ligature tightly above the wounded part. (5) Give doses of hartshorn and water as strong and as frequently repeated as the patient can bear them. (6) Send for the doctor as quickly as you can.

(_b_) Favourable results have followed using chloride of lime, a filtered solution of which was injected into the same place where the fatal virus (snakes’) had previously been introduced. In 17 trials made in succession, the poisoned animal survived without the slightest disturbance of its healthy condition.

(_c_) First tie a ligature above the part bitten. Then slightly cauterise with a lucifer match. Next swallow tumbler of raw brandy, to be repeated whenever the feeling of sinking comes on, till the liquor (which goes down like water) is tasted, and begins to affect the head. Meanwhile the patient is to be walked about by two men by force if he cannot do so alone or wants to lie down, which would be fatal. (Sir R. Burton.)

(_d_) Permanganate of potash may be added to the list of antidotes, as it is said to counteract very effectively the poison of serpents, when an equal quantity of filtered (1 per cent.) solution of permanganate of potash is injected 1-2 minutes after the poison.

(_e_) Probably a vapour bath immediately after being bitten by a venomous reptile or rabid dog will be found to prove one of the best remedies, the intense perspiration induced carrying off the poison. Excessive exercise following a poisonous bite generally effects a cure for this reason.

_Bleeding._--Bleeding may result from a wound or from the bursting of a blood vessel, and may occur outwardly or inwardly. Bleeding from a wound may be arterial (coming from the arteries which carry the blood from the heart to the body and limbs), venous (coming from the veins which take the blood back to the heart), or capillary (coming from the capillaries which convey the blood to the extremities and surface of the body). In arterial bleeding, the blood is bright scarlet, and escapes in jerks, as if from a pump; this is highly dangerous. In venous bleeding, the blood is dark coloured, and flows away in an uninterrupted stream. In capillary bleeding, the blood leaks or oozes out. In some wounds all three kinds of bleeding will occur simultaneously. The foremost method of arresting external bleeding is by pressure, either on the wound itself or on the blood vessels feeding it, and in the case of a limb, it should be elevated above the body to retard the flow of blood towards the part. As the pressure is to be made on the vessels leading to the wound, it is obvious that in arterial bleeding the pressure must be between the heart and the wound, while in venous bleeding it must be beyond the wound.

The simplest and readiest way to apply pressure is by the fingers. But first of all some knowledge of anatomy and physiology is necessary to guide the operator where to press. Bleeding from the head and upper neck requires pressure to be exerted on the large artery which passes up beside the windpipe and just above the collar-bone, as in Fig. 110. The artery supplying the arm and hand runs down the inside of the upper arm almost in line with the coat seam, and should be pressed, as shown in Fig. 111. The artery feeding the leg and foot can be felt in the crease of the groin, just where the flesh of the thigh seems to meet the flesh of the abdomen, and this is the best spot to select in the case of a male patient; but in the case of a female, unless the injury were very high up the thigh, it would be more judicious perhaps to apply increased pressure around the leg about half-way between the hip and the knee. Pressure with the hands will not suffice to restrain severe bleeding for any length of time, and recourse must be had to a ligature.

The simplest and most available form of ligature is a pocket-handkerchief or neck-wrap, or any other article of attire long and strong enough to bind the limb. Fold the article necktie fashion, then place a smooth stone or anything serving as a firm pad on the artery, tie the handkerchief loosely, insert any available stick in the loop, and proceed to twist it as if wringing a towel until tight enough to stop the flow of blood, as in Fig. 111.

In the case of bleeding from an external wound or sore on the body, employ direct pressure over the bleeding point. If the bleeding is from the interior of the nose or other cavity, apply cold water or ice over the bleeding part or near it, and keep the patient perfectly quiet on the back, or let the patient stand erect with head well thrown back. Injection of hot water into the nostrils is very effective. When the bleeding is from a diseased surface or ulcer, and direct pressure does not stay it, a compress should be soaked in a strong solution of alum, or in steel-drops, and again applied over the point which is bleeding. Should the wound from which the blood is coming be large and gaping, you may stuff firmly into it a compress of some soft material large enough to fill the cavity; but this should always be avoided if possible, as it prevents the natural junction of the sides of the wound, and is very likely to introduce the germs of poison. In any case of bleeding the patient may become weak or may faint, but unless the blood is flowing actively, this is not necessarily a serious sign, and the quiet condition of the circulation during the faint often assists nature in staying the bleeding, by allowing the blood to clot, and so block up any wound in a blood-vessel. Unless the faint is prolonged, or the patient is losing much blood, it is better not to hasten to relieve the faint condition.

When blood is being coughed or vomited up in considerable quantities, ice or iced water or milk should be given, and the patient be allowed to breathe cool fresh air freely. If the blood is coming from the lungs, inhaling steam of turpentine and hot water mixed (2 tablespoonfuls turpentine to 1 qt. hot water) will often reduce the evil; apply cold wet cloths to the chest.