Part 137

As soon as a natural effort to breathe is produced, endeavour to restore circulation and warmth. Wrap the body in dry blankets and commence rubbing the limbs upwards firmly and energetically under the blanket or over warm clothing, which can generally be got from bystanders. Then put the patient into a warm bed, and cover over with hot flannels, applying bottles or bladders of hot water, or heated bricks, to the pit of the stomach, the armpits, between the thighs, and to the soles of the feet. When the patient is able to swallow, give him warm fluids by spoonfuls--coffee, tea, brandy and water, wine--but not in too great quantities. Warm baths should never be used but when ordered by the doctor.

Choking.--When a person gets a fish-bone or other substance in the throat, at once insert a finger into the mouth and press upon the root of the tongue, so as to induce vomiting. If this fails, let the patient swallow a piece of soft bread. If the substance can be felt by the finger, insert 2 fingers into the mouth and bring it away, using the safeguard of putting some hard substance between the teeth. A medical man should at once be sent for. Repeatedly sucking lemons will help to dissolve the bone. A marble or similar article in a child’s throat may be dislodged by turning him heels upwards and shaking.

Suffocation.--Remove the patient immediately to the fresh air; dash cold water in the face and on the chest; keep up the warmth of the body, and apply mustard plaisters over the heart and round the ankles. If these means fail, without loss of time try artificial respiration, as already described.

Before entering a suffocating atmosphere to rescue persons, tie a towel soaked in vinegar and water over the mouth. Admit fresh air to the room if possible.

_Fits, Fainting, and Unconsciousness._--These bear a strong outward resemblance to each other while due to very different causes. The latter are principally: (_a_) injuries to the brain, with or without fractures of the skull; (_b_) diseases of the brain (including fits), apoplexy, epilepsy, &c.; (_c_) poisoning by narcotics and by retention of urine (in kidney disease); (_d_) fainting (paralysis of the heart through fright, exhaustion, loss of blood, &c.).

In such cases gather a history of the occurrence, and note the position of the body and its surroundings; also whether the breath smells of spirits, which shows there has been drinking, but remember that other and more serious conditions (paralysis, injury to the brain, &c.) may co-exist with intoxication. Lay the body on the back, with the head low if the face is pale, as in faintness after great loss of blood. If the face is red, the head must be raised. If sickness sets in, incline the head at once, so that the vomited matters may not be drawn into the lungs. Undo all clothing round the neck. Allow free circulation of air round the patient. Remove the patient as quickly as possible to the nearest hospital or doctor on a stretcher.

In epileptic fits, recognised by convulsive spasms of the limbs and body, contorted and congested face, foaming at the mouth, and bitten tongue, act on the rules just mentioned, and do all in your power to prevent the patient injuring himself, without attempting to restrain his movements. Lay something soft under his head, put something between the teeth, watch till the fit is over, and then remove him. In cases of fainting at once lay the patient flat, with the head brought to the same level as the body, to enable the blood more easily to circulate through the brain, for it is want of power in the heart to propel the blood to the brain that has caused the insensibility. If bleeding is going on, it must at once be arrested. As stimulants, eau de Cologne, sal volatile, ammonia, &c., may be used, but the important thing to remember is the position of head and body. Stimulation is apt to start afresh the bleeding arrested by fainting. In cases of snoring, with face flushed (apoplexy), undo clothing round the neck, keep the head raised, dash cold water on the top of the head, and apply hot-water bottles to the feet; send for doctor; do not give brandy.

_Frostbite._--In serious frostbite or cases of exposure to intense cold, endeavours to restore life should be made with the greatest care. If you bring the patient suddenly into a warm room, death will follow certainly. Carry him carefully into a closed but cold room, and undress him with care for fear of breaking the stiffened limbs. If snow is to be had, cover and vigorously rub the whole body with it. If not, cover and rub with cold wet cloths or cold sand, or put him into a cold bath. Alternately with this try artificial means to restore breathing (as in drowning). When the patient begins to breathe naturally, and the limbs become less stiff, he should be carried into a moderately warm room and covered lightly with cold coverings and sheets. After this, he may be rubbed by degrees with warm cloths, and the warmth of the room gradually increased. Then try by means of smelling-salts, ammonia, or ether, and slightly stimulating drinks, such as light cold wine, cold coffee or soup, to recall consciousness. Should any part of the body remain without sensation, blue, swollen, or blistered, there is great danger of mortification setting in.

For after consequences, which recur most frequently in cold weather, apply balsam of copaiba, spread thickly on a piece of linen or muslin, the affected parts being covered with the application, which is allowed to remain over the night. By day, some of the balsam is to be spread over the affected parts. After one or two applications the pains cease and the redness disappears; whilst a few additional applications seem to give to the parts a power of resistance to frostbite.

Dr. Lapatin advises that fingers and toes which have been slightly frost-bitten, and which subsequently suffer from burning, itching, and pricking sensations, should be painted, at first once, and afterwards twice a day, with a mixture of dilute nitric acid, and peppermint water in equal proportions. After this application has been made for 3-4 days, the skin becomes darkened and the epidermis is shed, healthy skin appearing under it. The cure is effected in 10-14 days.

The members of the Austro-Hungarian Polar Expedition found most benefit from a mixture of iodine and collodion.

_Lightning Stroke._--Apply cold to the head, and, if necessary, warmth to the extremities; rub the limbs well, and give stimulants as soon as the patient can swallow.

_Poisons._--In all cases of poisoning, at once note the position and surroundings of the patient, and whether bottles likely to have contained poison are at hand. Send for the nearest doctor, and proceed immediately to get the poison out of the stomach by encouraging vomiting. Vomiting is often one of the first and most important signs of poisoning, and then only requires fostering by large draughts of warm water. If vomiting is not present, at once administer an emetic, such as sulphate of zinc in 20-30 gr. doses, 2 tablespoonfuls ipecacuanha wine mixed with warm water. In the absence of these, resort to mustard and water, a teaspoonful or two in warm water frequently repeated, or common salt and water may be used; vomiting may also be excited by tickling the back of the throat, and by freely drinking hot greasy water. A stomach pump must only be used by a surgeon; but a safe substitute, if the patient is conscious, is a piece of rubber tubing, about 3 yd. long and ½ in. diameter. Let the patient swallow about 2 ft. of this, then hold the free end of the tube above his head (Fig. 125) and pour down through a funnel 1-2 pints warm water, which will go direct into the stomach. By lowering the free end (Fig. 126) the stomach empties itself readily. By frequent repetition the cavity of the stomach is completely washed out.

Try to ascertain what the poison is, and proceed to administer antidotes. Most poisons may be grouped under two classes--narcotic and irritant; the former being mainly organic (vegetable) substances, and the latter chiefly minerals. In narcotic poisoning, vomiting must be induced or the stomach emptied in some other way, and means must be taken to prevent sleep ensuing, by walking the patient about, slapping with wet towels, dashing cold water in the face, &c.; give strong black coffee to drink (or with an enema); put icy cold compresses on the head, and mustard plaisters on the stomach and calves of the legs. In irritant poisoning, the poison itself is pretty sure to cause vomiting, which then need not be encouraged. To protect the stomach and gullet from the corrosive action of irritant poisons, bland and oily fluids, such as salad oil, egg-white, milk, flour and water, should be freely administered.

The following summary of poisons and antidotes will be found useful:--

NARCOTIC POISONS.

_Poison._ _Antidote._

Aconite, monkshood emetics; warmth; rub the skin. Alcohol, alcoholic drinks emetics; cold douche; keep awake.

Belladonna, deadly nightshade emetics; strong coffee; hot and cold douches alternately; artificial respiration. Chloral hydrate emetics; strong coffee enema; hot blankets, and water bottle to feet; artificial respiration; keep awake. Chloroform fresh air and artificial respiration; hot and cold douche. Cyanide of potassium, prussic emetics; stimulants; cold and hot acid, laurel water, essential douche; artificial respiration. oil of almonds, benzol. Ether as chloroform. Fool’s parsley brandy; strong tea; warm applications to extremities. Foxglove emetics; stimulants; prolonged recumbence. Hemlock emetics; strong tea; warmth and rubbing; artificial respiration. Henbane a large spoonful of animal charcoal, emetics 10 minutes later, then brandy or coffee; keep awake. Laburnum pods or seeds 5-6 gr. zinc sulphate as an emetic. Meadow saffron brandy; strong tea; warm mucilaginous drinks. Mushrooms emetics; stimulants; warmth and rubbing. Opium, chlorodyne, Godfrey’s emetics; hot coffee; cold douche; cordial, poppies, keep awake; artificial respiration. soothing syrups. Poison ivy {on the body} apply a weak solution of sugar of Poison dogwood {on the body} lead. Spurge laurel, mezereum brandy and warm mucilaginous drinks. Strychnine, vermin-killers emetics; chloroform in an inhaler. Yew berries emetics; brandy; warmth to extremities recumbent position.

IRRITANT POISONS.

Acid--carbolic, creosote. emetics; lime-water; salad oil; coffee. Acid--oxalic, potassium oxalate, water containing chalk or whiting, salt of sorrel, salt of lemon. but not ammonia, potash, or soda. Acids--acetic, hydrochloric, abundance of water containing chalk, nitric, sulphuric; magnesia, sal-volatile, washing spirit of salt. soda, or whiting; egg-white, milk, thick gruel. Alkalies--ammonia, potash, water containing lemon-juice or soda. vinegar; salad oil, milk, egg-white, gruel. Antimony, tartar emetic emetic if needed; plenty of strong coffee; egg-white, milk. Arsenic, emerald green, emetics; magnesia; warmth and friction; fly paper strong coffee; best antidote is moist peroxide of iron, which can be made by dissolving ½ oz. iron sulphate and ½ oz. potash carbonate (or ¾ oz. soda carbonate) separately in warm water and mixing, adding ¼ oz. magnesia-- calcined if handy--dilute with ½ pint hot water, and drink very hot. Bichromate of potash emetics; magnesia, chalk, or whiting. Blistering fluid emetics; egg-white, barley water, gruel; not oil. Bluestone emetic if needed; milk, eggs, barley water, gruel. Caustic, nitrate of silver abundance of salt in water or milk, egg-white, barley water. Chloride of mercury, emetic if needed; raw egg beaten up in milk, corrosive sublimate gruel, arrowroot; strong coffee. Iodine emetics; plenty of gruel, arrowroot or starch. Phosphorus, matches, rat poison emetics; 10 drops oil of turpentine, every ¼ hour in gruel or milk with a little magnesia; egg-white, barley water. Pyrogallol emetics. Sugar of lead, paint emetics, zinc sulphate best; ½ oz. Epsom salts in water; egg-white, milk, barley water. Turpentine, furniture polish emetics; milk, egg-white, barley water. White precipitate emetics; coffee; egg-white beaten up in water, barley water, arrowroot.

_Sprains._--A sprain is a sudden forcible stretching of the tendons or ligaments, or both combined, of a joint, and is always accompanied by most acute pain, and generally followed by rapid swelling. It is always tedious and troublesome, and hence often leads to more serious results; in all but very slight cases, a surgeon should be seen. Meantime give the injured part perfect rest, keep it in an elevated position, and apply cold water continuously, or immerse in water as hot as can be possibly borne, and after keeping it there for ¼ hour, frequently apply hot bran (or oatmeal and vinegar) poultices. As an embrocation, put ¼ lb. camphor in ½ lb. methylated spirits of wine; when dissolved, add 1 oz. oil of origanum, and rub the place night and morning, or use Elliman’s embrocation. In many cases of supposed severe sprain, some of the bones forming the injured joint are broken, therefore it is wise to treat these cases by the rules for broken bones before removing the patient.

_Sunstroke._--In cases of simple exhaustion, ordinary treatment is all that is needed. Removal to a cooler locality, the cold douche (but not too much prolonged), or the administration of stimulants, may be beneficial. Tight or oppressive clothing should be removed, and the patient treated as in syncope from other causes. Rest and freedom from exposure to over-exertion, fatigue, or great heat, should be enjoined. In that form of sunstroke where the person is struck down suddenly by a hot sun, the patient should be removed into the shade, and the douche of cold water being allowed to fall in a stream on the head and body from a pump (or, as in India from the mussuck, or other similar contrivance), should be freely resorted to, the object being twofold--to reduce the temperature of the over-heated centres, and to rouse them into action. Mustard-plaisters and purgative enemata may be useful. If recovery be imperfect, and followed by any indication of injury to the nerve-centres, or by the supervention of meningitis, other treatment may be necessary according to the indications. Much exposure to the sun should be carefully guarded against; and, unless recovery be complete and rapid, the sufferer should be removed to a cooler climate, the most perfect rest and tranquillity of mind and body enjoined, and the greatest care be observed in regard to extreme moderation in the use of stimulants. (Dr. Fayrer.) For prevention, wear light head-gear with good protection to the nape of the neck; let the lining be double, one of green and the other of yellow material, and have ventilation holes at the sides and top.

=Common Complaints=:--

_Brain worries._--To the broad question, Are people suffering from overwork? Dr. Samuel Wilks, Physician to Guy’s Hospital, would have no hesitation in saying “No.” His remarks on the subject are worth repeating. He proceeds:--“On the contrary, if both sexes be taken, I should say the opposite is nearer the truth, and that more persons are suffering from idleness than from excessive work. Medically speaking, I see half a dozen persons suffering from want of occupation to one who is crippled by his labours. I have, therefore, very little sympathy with the prevalent notion that nervous and other diseases are due to overwork. As regards the community generally, or at least those of its number who come before the medical man on account of their ailments, my belief is that the explanation they offer arises from a delusion; and amongst girls, so far from any studies or other work being injurious, I could instance numerous cases of restoration to health on the discovery of an occupation. Very often, when a business man complains of being overdone, it may be found that his meals are very irregular and hurried, that he takes no exercise, is rather partial to brandy and soda, and thinks it not improper to half poison himself with nicotine every night and morning. The lady in the same way eats no breakfast, takes a glass of sherry at 11 o’clock, and drinks tea all the afternoon; when night arrives she has become ready to engage in any performance to which she may have been invited. When the man of business presents himself, with his nerves really overstrained, he is found to be a man of delicate or actually insane temperament. The rule, however, is that when a patient comes before me with his nerves unstrung, hypochondriacal, and goes through the whole machinery of his body to inform me of its working, previously committing all the facts to paper lest an important one should be forgotten, that man is getting rusty from having no occupation.... We forget sometimes what a formidable machine is the animal body, with its force-producing nervous system. The brain is an engine of many horse power; its energy must be accounted for in some way; if not used for good purposes, it will be for bad, and ‘mischief will be found for idle hands to do.’ It is fortunate that, with many girls, the frivolities of life keep them idly busy, and so, having a safety valve, they are harmless to others and themselves; but let a girl occupy herself neither with what is useful nor with amusement, she falls into bad health, she becomes a prey to her own internal fires or forces, and every function of her body is deranged, as well as her moral nature perverted. Cases of this kind appear to me of the commonest order, and at the same time very difficult of cure, because the mother’s aid can rarely be gained to assist the doctor; but, on the other hand, her sympathies too often only foster her daughter’s morbid proclivities by insisting on her delicacy and the necessity of various artificial methods for her restoration, as well as her resistance to the doctor’s advice for a more natural life, since she is sure it cannot be undertaken. Her daughter is too delicate for any of the occupations or modes of exercise proposed. What she requires is medical attendance, and to be alcoholised and physicked. It is remarkable, however, what a young lady can do under the power of a stimulus--as, for example, a gentleman lately expressed his surprise to me how his daughter, who could not walk many yards for a long time, owing to a pain in her back, was soon able to walk many miles a day when she procured the support of her lover’s arm. It is from considerations of this kind that, when the superfluity of women, amounting to half a million, doomed to be unmated, ask for employment, I cannot deny it to them. The human body is made for work, physical and mental. The amount it can do is of course proportionate to the power of the machine; but, unlike all other machines, its strength is only maintained by use, as assuredly it rusts and decays by disuse. Just as the muscles are better prepared for work by previous training, so the nervous system, whether it be the brain or spinal cord, becomes more energised by use. If healthy and vigorous persons be taken, there appears no absolute necessity for rest at all in the popular sense of the term. The rest required is gained during sleep, during meals, and necessary healthful exercise. It is only during sleep that the brain is actually inactive, although even then not absolutely, for at meals cheerful conversation keeps the mind employed, and even in our walks the attention is fixed on objects around. In times so occupied there are many persons whose minds are never idle, and who yet live to a good old age. Practically they have no rest, for when one object of study is complete, they commence to pursue another. It is by the happy faculty of diverting the powers into different channels that this is accomplished. Instances might easily be quoted of statesmen, judges, and members of our own profession who know no absolute rest, and who would smile at the suspicion of hard work injuring any man. I make it a custom to ask young men what their second occupation is--what pursuit have they besides their bread-earning employment. Those are happiest who possess some object of interest, but I am sorry to say there are few who find delight in any branch of science. The purely scientific man finds his best recreation in literature or art, but even in intellectual work so many different faculties are employed that a pleasant diversion is found in simply changing the kind of labour. For example, a judge after sitting all day, and giving his closest attention to the details of the cases before him, may yet find relief in his evenings by solving problems in mathematics. The subject of overwork, then, is one of the greatest importance to study, and has to be discussed daily by all of us. My own opinion has already been expressed, that the evils attending it on the community at large are vastly over-estimated; and, judging from my own experience, the persons with unstrung nerves who apply to the doctor are, not the Prime Minister, the bishops, judges, and hard-working professional men, but merchants and stock-brokers retired from business, Government clerks who work from 10 to 4, women whose domestic duties and bad servants are driving them to the grave, young ladies whose visits to the village school or Sunday performance on the organ is undermining their health, and so on. In short, and this is the object of my remarks, I see more ailments arise from want of occupation than from overwork, and, taking the various kinds of nervous and dyspeptic ailments which we are constantly treating, I find at least six due to idleness to one from overwork.”