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+Project Gutenberg's The Home Medical Library, Volume I (of VI), by Various
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever. You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Home Medical Library, Volume I (of VI)
+
+Author: Various
+
+Editor: Kenelm Winslow
+
+Release Date: January 31, 2009 [EBook #27943]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK THE HOME MEDICAL LIBRARY ***
+
+
+
+
+Produced by Juliet Sutherland, Chris Logan and the Online
+Distributed Proofreading Team at http://www.pgdp.net
+
+
+
+
+
+
+
+ The Home Medical
+ Library
+
+ By
+
+ KENELM WINSLOW, B.A.S., M.D.
+
+ _Formerly Assistant Professor Comparative Therapeutics, Harvard
+ University; Late Surgeon to the Newton Hospital;
+ Fellow of the Massachusetts Medical Society, etc._
+
+ With the Cooeperation of Many Medical
+ Advising Editors and Special Contributors
+
+ IN SIX VOLUMES
+
+ _First Aid :: Family Medicines :: Nose, Throat, Lungs,
+ Eye, and Ear :: Stomach and Bowels :: Tumors and
+ Skin Diseases :: Rheumatism :: Germ Diseases
+ Nervous Diseases :: Insanity :: Sexual Hygiene
+ Woman and Child :: Heart, Blood, and Digestion
+ Personal Hygiene :: Indoor Exercise
+ Diet and Conduct for Long Life :: Practical
+ Kitchen Science :: Nervousness
+ and Outdoor Life :: Nurse and Patient
+ Camping Comfort :: Sanitation
+ of the Household :: Pure
+ Water Supply :: Pure Food
+ Stable and Kennel_
+
+ NEW YORK
+
+ The Review of Reviews Company
+
+ 1907
+
+
+
+
+Medical Advising Editors
+
+
+Managing Editor
+
+ALBERT WARREN FERRIS, A.M., M.D.
+
+_Former Assistant in Neurology, Columbia University; Former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, New International Encyclopedia._
+
+
+Nervous Diseases
+
+CHARLES E. ATWOOD, M.D.
+
+_Assistant in Neurology, Columbia University; Former Physician, Utica
+State Hospital and Bloomingdale Hospital for Insane Patients; Former
+Clinical Assistant to Sir William Gowers, National Hospital, London._
+
+
+Pregnancy
+
+RUSSELL BELLAMY, M.D.
+
+_Assistant in Obstetrics and Gynecology, Cornell University Medical
+College Dispensary; Captain and Assistant Surgeon (in charge),
+Squadron A, New York Cavalry; Assistant in Surgery, New York
+Polyclinic._
+
+
+Germ Diseases
+
+HERMANN MICHAEL BIGGS, M.D.
+
+_General Medical Officer and Director of Bacteriological Laboratories,
+New York City Department of Health; Professor of Clinical Medicine in
+University and Bellevue Hospital Medical College; Visiting Physician
+to Bellevue, St. Vincent's, Willard Parker, and Riverside Hospitals._
+
+
+The Eye and Ear
+
+J. HERBERT CLAIBORNE, M.D.
+
+_Clinical Instructor in Ophthalmology, Cornell University Medical
+College; Former Adjunct Professor of Ophthalmology, New York
+Polyclinic; Former Instructor in Ophthalmology in Columbia University;
+Surgeon, New Amsterdam Eye and Ear Hospital._
+
+
+Sanitation
+
+THOMAS DARLINGTON, M.D.
+
+_Health Commissioner of New York City; Former President Medical Board,
+New York Foundling Hospital; Consulting Physician, French Hospital;
+Attending Physician, St. John's Riverside Hospital, Yonkers; Surgeon
+to New Croton Aqueduct and other Public Works, to Copper Queen
+Consolidated Mining Company of Arizona, and Arizona and Southeastern
+Railroad Hospital; Author of Medical and Climatological Works._
+
+
+Menstruation
+
+AUSTIN FLINT, JR., M.D.
+
+_Professor of Obstetrics and Clinical Gynecology, New York University
+and Bellevue Hospital Medical College; Visiting Physician, Bellevue
+Hospital; Consulting Obstetrician, New York Maternity Hospital;
+Attending Physician, Hospital for Ruptured and Crippled, Manhattan
+Maternity and Emergency Hospitals._
+
+
+Heart and Blood
+
+JOHN BESSNER HUBER, A.M., M.D.
+
+_Assistant in Medicine, University and Bellevue Hospital Medical
+College; Visiting Physician to St. Joseph's Home for Consumptives;
+Author of "Consumption: Its Relation to Man and His Civilization; Its
+Prevention and Cure."_
+
+
+Skin Diseases
+
+JAMES C. JOHNSTON, A.B., M.D.
+
+_Instructor in Pathology and Chief of Clinic, Department of
+Dermatology, Cornell University Medical College._
+
+
+Diseases of Children
+
+CHARLES GILMORE KERLEY, M.D.
+
+_Professor of Pediatrics, New York Polyclinic Medical School and
+Hospital; Attending Physician, New York Infant Asylum, Children's
+Department of Sydenham Hospital, and Babies' Hospital, N. Y.;
+Consulting Physician, Home for Crippled Children._
+
+
+Bites and Stings
+
+GEORGE GIBIER RAMBAUD, M.D.
+
+_President, New York Pasteur Institute._
+
+
+Headache
+
+ALONZO D. ROCKWELL, A.M., M.D.
+
+_Former Professor Electro-Therapeutics and Neurology at New York
+Post-Graduate Medical School; Neurologist and Electro-Therapeutist to
+the Flushing Hospital; Former Electro-Therapeutist to the Woman's
+Hospital in the State of New York; Author of Works on Medical and
+Surgical Uses of Electricity, Nervous Exhaustion (Neurasthenia), etc._
+
+
+Poisons
+
+E. ELLSWORTH SMITH, M.D.
+
+_Pathologist, St. John's Hospital, Yonkers; Somerset Hospital,
+Somerville, N. J.; Trinity Hospital, St. Bartholomew's Clinic, and the
+New York West Side German Dispensary._
+
+
+Catarrh
+
+SAMUEL WOOD THURBER, M.D.
+
+_Chief of Clinic and Instructor in Laryngology, Columbia University;
+Laryngologist to the Orphan's Home and Hospital._
+
+
+Care of Infants
+
+HERBERT B. WILCOX, M.D.
+
+_Assistant in Diseases of Children, Columbia University._
+
+
+
+
+Special Contributors
+
+
+Food Adulteration
+
+S. JOSEPHINE BAKER, M.D.
+
+_Medical Inspector, New York City Department of Health._
+
+
+Pure Water Supply
+
+WILLIAM PAUL GERHARD, C.E.
+
+_Consulting Engineer for Sanitary Works; Member of American Public
+Health Association; Member, American Society Mechanical Engineers;
+Corresponding Member of American Institute of Architects, etc.; Author
+of "House Drainage," etc._
+
+
+Care of Food
+
+JANET MCKENZIE HILL
+
+_Editor, Boston Cooking School Magazine._
+
+
+Nerves and Outdoor Life
+
+S. WEIR MITCHELL, M.D., LL.D.
+
+_LL.D. (Harvard, Edinburgh, Princeton); Former President, Philadelphia
+College of Physicians; Member, National Academy of Sciences,
+Association of American Physicians, etc.; Author of essays: "Injuries
+to Nerves," "Doctor and Patient," "Fat and Blood," etc.; of scientific
+works: "Researches Upon the Venom of the Rattlesnake," etc.; of
+novels: "Hugh Wynne," "Characteristics," "Constance Trescott," "The
+Adventures of Francois," etc._
+
+
+Sanitation
+
+GEORGE M. PRICE, M.D.
+
+_Former Medical Sanitary Inspector, Department of Health, New York
+City; Inspector, New York Sanitary Aid Society of the 10th Ward, 1885;
+Manager, Model Tenement-houses of the New York Tenement-house Building
+Co., 1888; Inspector, New York State Tenement-house Commission, 1895;
+Author of "Tenement-house Inspection," "Handbook on Sanitation," etc._
+
+
+Indoor Exercise
+
+DUDLEY ALLEN SARGENT, M.D.
+
+_Director of Hemenway Gymnasium, Harvard University; Former President,
+American Physical Culture Society; Director, Normal School of Physical
+Training, Cambridge, Mass.; President, American Association for
+Promotion of Physical Education; Author of "Universal Test for
+Strength," "Health, Strength and Power," etc._
+
+
+Long Life
+
+SIR HENRY THOMPSON, Bart., F.R.C.S., M.B. (Lond.)
+
+_Surgeon Extraordinary to His Majesty the King of the Belgians;
+Consulting Surgeon to University College Hospital, London; Emeritus
+Professor of Clinical Surgery to University College, London, etc._
+
+
+Camp Comfort
+
+STEWART EDWARD WHITE
+
+_Author of "The Forest," "The Mountains," "The Silent Places," "The
+Blazed Trail," etc._
+
+
+
+
+[Illustration: A DESIRABLE METHOD OF CARRYING THE INJURED.
+
+By this plan even the unconscious victim of an accident may be
+transported a long distance, because the bearers' hands are left
+entirely free and thus prevented from becoming cramped or tired, as
+when a "seat" is made with clasped hands. In the method illustrated
+above the patient is placed in a seat made by tying a blanket, sheet,
+rope, or strap in the form of a ring. Each bearer then places his
+inner arm about the patient's body and with his outer hand holds the
+patient's arm around his neck.]
+
+
+
+
+The Home Medical
+Library
+
+
+Volume I
+
+
+FIRST AID IN EMERGENCIES
+
+By KENELM WINSLOW, B.A.S., M.D. (Harv.)
+
+_Formerly Assistant Professor Comparative Therapeutics, Harvard
+University; Late Surgeon to the Newton Hospital; Fellow of the
+Massachusetts Medical Society, etc._
+
+ASSISTED BY
+
+ALBERT WARREN FERRIS, A.M., M.D.
+
+_Former Assistant in Neurology, Columbia University; former Chairman,
+Section on Neurology and Psychiatry, New York Academy of Medicine;
+Assistant in Medicine, University and Bellevue Hospital Medical
+College; Medical Editor, "New International Encyclopedia"_
+
+
+GERM DISEASES
+
+By KENELM WINSLOW, B.A.S., M.D. (Harv.)
+
+
+NEW YORK
+
+The Review of Reviews Company
+
+1907
+
+
+
+
+Copyright, 1907, by
+
+THE REVIEW OF REVIEWS COMPANY
+
+
+THE TROW PRESS, NEW YORK
+
+
+
+
+_Contents_
+
+
+ PART I
+
+ CHAPTER PAGE
+
+ I. RESTORING THE APPARENTLY DROWNED 27
+
+ Reviving the Patient--How to Expel Water from the
+ Stomach and Chest--Instructions for Producing
+ Respiration--When Several Workers are at Hand--When
+ One must Work Alone--How to Save a Drowning Person.
+
+ II. HEAT STROKE AND ELECTRIC SHOCK 39
+
+ First-aid Rules--Symptoms of Heat
+ Exhaustion--Treatment of Heat Prostration--What to
+ Do in Case of Electric Shock--Symptoms--Artificial
+ Respiration--Mortality in Lightning Strokes.
+
+ III. WOUNDS, SPRAINS, AND BRUISES 50
+
+ Treatment of Wounds--Bleeding from Arteries and
+ Veins--Punctured Wounds--Oozing--Lockjaw--Bruises--
+ Abrasions--Sprains and Their Treatment--Synovitis--
+ Bunions and Felons--Weeping Sinew--Foreign Bodies in
+ Eye, Ear, and Nose.
+
+ IV. FRACTURES 80
+
+ How to Detect Broken Bones--Fracture of Rib and
+ Collar Bone--Instructions for Applying
+ Dressings--Bandage for Broken Jaw--Fracture of
+ Shoulder-blade, Arm, Hip, Leg, and Other
+ Bones--Compound Fractures.
+
+ V. DISLOCATIONS 118
+
+ Varieties of Dislocations--Method of Reducing a
+ Dislocated Jaw--A Dislocated Shoulder--Indications
+ when Elbow is Out of Joint--Dislocation of Hip,
+ etc.--Forms of Bandages.
+
+ VI. ORDINARY POISONS 139
+
+ Unknown Poisons--Symptoms and Antidotes--Poisoning
+ by Carbolic and Other Acids--Alkalies--Metal
+ Poisoning--Aconite, Belladonna, and Other
+ Narcotics--Chloral--Opium, Morphine, Laudanum,
+ Paregoric, and Soothing Sirups--Tobacco, Strychnine,
+ etc.
+
+ VII. FOOD POISONS 147
+
+ Poisons in Shellfish and Other Food--Symptoms and
+ Remedies--How Bacteria are Nourished--Infected Meat
+ and Milk--Treatment of
+ Tapeworm--Trichiniasis--Potato Poisoning.
+
+ VIII. BITES AND STINGS 155
+
+ Country and City Mosquitoes--How Yellow Fever is
+ Communicated--Treatment of Mosquito Bites--Bee,
+ Wasp, and Hornet Stings--Lice--Fleas and
+ Flies--Centipedes and Scorpions--Spiders--Poisonous
+ Snakes--Cat and Dog Bites.
+
+ IX. BURNS, SCALDS, FROSTBITES, ETC. 171
+
+ General Rules for Treating Burns and Scalds--Hints
+ on Dressings--Burns Caused by Acids and
+ Alkalies--Remedies for Frostbite--Care of Blisters
+ and Sores--Chilblains--Ingrowing Toe Nails--Fainting
+ and Suffocation--Fits.
+
+
+ PART II
+
+ I. CONTAGIOUS MALADIES 191
+
+ Symptoms and Treatment of Scarlet
+ Fever--Diagnosis--Duration of Contagion--Difference
+ Between True and German Measles--Smallpox--Cure a
+ Matter of Good Nursing--Chickenpox.
+
+ II. INFECTIOUS DISEASES 221
+
+ Typhoid Fever--Symptoms and Modes of
+ Communication--Duration of the Disease--The Death
+ Rate--Importance of Bathing--Diet--Remedies for
+ Whooping Cough--Mumps--Erysipelas.
+
+ III. MALARIA AND YELLOW FEVER 247
+
+ Malaria Caused by Mosquitoes--Distribution of the
+ Disease--Severe and Mild Types--Prevention and
+ Treatment--Yellow Fever not a Contagious
+ Disease--Course of the Malady--Watchful Care and
+ Diet the only Remedies.
+
+
+
+
+INDEX
+
+_To First Aid and General Topics_
+
+NOTE.--The Roman numerals I, II, III, IV, V, and VI indicate the
+volume; the Arabic figures 1, 2, 3, etc., indicate the page number.
+
+
+ Abrasions, I, 64
+
+ Abscess, alveolar, II, 58
+
+ Acids, burns by, I, 176, 177
+ poisoning by, I, 140
+
+ Acne, II, 145
+
+ Adenoids, II, 61
+
+ Adulterated food, tests for, V, 91
+
+ Adulteration of food, V, 87
+
+ Ague, I, 247
+ cake, I, 254
+
+ Air-bath, the, IV, 159
+
+ Albumen, IV, 262
+
+ Alcohol, use of, IV, 44, 153
+
+ Alcoholic drinks, IV, 153
+
+ Alcoholism, III, 47, 52
+
+ Algae, remedy for, V, 56
+
+ Alkalies, burns by, I, 177
+ poisoning by, I, 140
+
+ Amenorrhoea, III, 75
+
+ Anaemia, III, 174
+
+ Ankle, sprain of, I, 65, 67, 68
+
+ Ankle-joint fracture, I, 115
+
+ Antitoxin, II, 77
+
+ Apoplexy, III, 49
+
+ Appendicitis, III, 256
+
+ Arm, fracture of, I, 91
+
+ Arteries, systemic, III, 168
+
+ Artery, bleeding from an, I, 51, 52
+
+ Arthritis, II, 177
+
+ Artificial respiration, I, 28
+
+ Asthma, II, 104
+
+ Astigmatism, II, 26
+
+ Athletics, home, IV, 69
+
+ Auricles of the heart, III, 168
+
+
+ =BABY=, bathing the, III, 109
+ care of the, III, 108
+ clothing of the, III, 110
+ diet for the, III, 134
+ food for the, III, 132; IV, 261
+ nursing the, III, 114
+ teething, III, 113
+ temperature of the, III, 110
+ weaning the, III, 117
+ weighing the, III, 112
+
+ Bacteria, destruction of, V, 238-253
+ in food, I, 147-154
+ in soil, V, 135
+
+ Baldness, II, 167; IV, 21
+
+ =BANDAGES=, I, 133
+ forms of, I, 132, 134, 136, 137
+ for bruises, I, 62-64
+ for fractures, I, 83-117
+ for sprains, I, 65-72
+ for wounds, I, 51-61
+
+ Barley water, IV, 263
+
+ Bathing, indoor, IV, 19, 155
+ outdoor, IV, 16
+ in convulsions, III, 35
+ in malaria, I, 259
+ in pneumonia, II, 94
+ in scarlet fever, I, 197
+ in skin irritations, II, 140
+ in smallpox, I, 216
+ in typhoid fever, I, 231
+ in yellow fever, I, 266
+
+ =BATHS=, cold, IV, 15
+ foot, IV, 157
+ hot, IV, 19, 156
+ tepid, IV, 19
+ Turkish, IV, 20, 159
+ warm, IV, 19
+
+ Bed sores, I, 233
+
+ Bed-wetting, II, 213
+
+ Bee stings, I, 158
+
+ Beef, broth, IV, 261
+ juice, IV, 262
+ parts of, IV, 198
+ scraped, IV, 262
+ tea, IV, 261
+
+ Bellyache, III, 247
+
+ Bilious fever, I, 247
+
+ Biliousness, III, 184
+
+ =BITES=, cat, I, 170
+ dog, I, 170
+ flea, I, 162
+ fly, I, 164
+ lice, clothes, I, 161
+ lice, crab, I, 162
+ lice, head, I, 160
+ mosquito, I, 155
+ snake, I, 166
+ spider, I, 164
+ tarantula, I, 164
+ wood tick, I, 159
+
+ Black eye, II, 14
+
+ Blackheads, II, 145
+
+ Black water fever, I, 256
+
+ Bladder, inflammation of the, II, 215
+ stone in the, III, 264
+
+ =BLEEDING=, from an artery, I, 51, 52
+ from a vein, I, 51, 52
+ from punctured wounds, I, 52, 53
+ from the lungs, I, 62
+ from the nose, I, 61
+ from the scalp, I, 60
+ from the stomach, I, 62
+ from the womb, III, 82
+
+ Blood, deficiency of, III, 174
+ oozing of, I, 54
+
+ Bloody flux, III, 222
+
+ Boils, II, 157
+
+ Bottles, milk, III, 128
+
+ Bowel, prolapse of the, III, 143
+
+ =BOWELS=, catarrh of the, III, 205
+ diseases of the, III, 205
+ inflammation of the, III, 252
+ obstruction of the, III, 268
+ passages from the, IV, 247
+
+ Bowleg, III, 162
+
+ Brain, anatomy of the, III, 22
+ arteries of the, III, 22
+ autopsies of the, II, 230
+
+ Breasts, care of, after childbirth, III, 105
+ inflammation of the, III, 140
+
+ Breath, holding the, III, 153
+
+ Breathing, how to test the, IV, 248
+ to produce artificial, I, 28, 34, 43, 178, 186
+
+ Bright's disease, acute, II, 220
+ chronic, II, 222
+
+ =BROKEN BONE=, I, 80
+ ankle, I, 115
+ arm, I, 91
+ collar bone, I, 85
+ finger, I, 101
+ forearm, I, 94
+ hand, I, 101
+ hip, I, 104
+ how to tell a, I, 80
+ jaw, I, 89
+ kneepan, I, 109
+ leg, I, 111
+ rib, I, 83
+ shoulder blade, I, 91
+ thigh, I, 106
+ wrist, I, 99
+
+ Bronchial tubes, diseases of the, II, 87
+
+ Bronchitis, II, 88, 91
+
+ Broth, beef, IV, 261
+ chicken, IV, 261
+ clam, IV, 263
+ mutton, IV, 261
+ oyster, IV, 267
+ veal, IV, 261
+
+ =BRUISES=, bandages for, I, 63
+ treatment of, I, 62, 63
+
+ Bunion, I, 72
+
+ =BURNS=, I, 171
+ about the eyes, II, 16
+ from acids, I, 176
+ from alkalies, I, 177
+ from electric shock, I, 45
+ first class, I, 172
+ second class, I, 172
+ third class, I, 173
+ severe, I, 174
+
+
+ Callus of the skin, II, 156
+
+ Camp comfort (See Contents VI)
+
+ Camp cookery (See Contents VI)
+
+ Camp cure (See Contents VI)
+
+ =CAMPING=, in the North Woods, VI, 195
+ in the Western Mountains, VI, 214
+ outfit, VI, 212
+
+ Cancer, II, 123
+ of the breast, II, 124
+ of the lip, II, 125
+ of the stomach, II, 125
+ of the womb, II, 125
+
+ Canker, II, 68
+
+ Capillaries, systemic, III, 168
+
+ Carbuncle, II, 161
+
+ Carotid arteries, III, 22
+
+ Catarrh, II, 41, 54, 55
+ of the bowels, III, 205
+ effect of, on the ears, II, 38, 41
+ of the stomach, III, 185
+
+ Catarrhal deafness, II, 39
+ inflammation of eye, II, 18
+
+ Cat bite, I, 170
+
+ Catheter, how to use a, II, 219; IV, 252
+
+ Centipede sting, I, 164
+
+ Cereals as food, IV, 35, 229
+
+ Cerebellum, III, 22
+
+ Cerebral arteries, III, 22
+
+ Chafing, II, 142
+
+ Chagres fever, I, 256
+
+ Change of life, III, 70
+
+ Chapping, II, 142
+
+ Chicken broth, IV, 261
+
+ Chickenpox, I, 217
+
+ Chilblains, I, 182
+
+ Childbed fever, III, 107
+
+ Childbirth, after-pains in, III, 105
+ articles needed during, III, 96
+ bleeding after, III, 86
+ care after, III, 103
+ care in, III, 98
+
+ =CHILDREN, DISEASES OF=, III, 140
+ adenoids, II, 61
+ bed-wetting, II, 213
+ bowel, prolapse of the, III, 143
+ bowels, catarrh of the, III, 209
+ bowleg, III, 162
+ breath, holding the, III, 153
+ breasts, inflammation of the, III, 140
+ chickenpox, I, 217
+ cholera infantum, III, 211
+ chorea, III, 155
+ colic, III, 267
+ constipation, III, 238
+ convulsions, III, 34
+ cord, bleeding of the, III, 142
+ cough, II, 91
+ croup, II, 83
+ diarrhea, III, 208, 209
+ diphtheria, II, 77
+ dysentery, III, 213
+ epilepsy, III, 39
+ earache, II, 48
+ fever, III, 146
+ food for, III, 132-139
+ foreskin, adhering, III, 141
+ glands, enlarged, III, 149
+ hip disease, III, 161
+ holding the breath, III, 153
+ knock knees, III, 163
+ larynx, spasm of the, III, 153
+ measles, I, 198
+ German measles, I, 203
+ membranous croup, II, 79
+ milk poisoning, III, 209, 211
+ mumps, I, 235
+ navel, sore, III, 142
+ pains, growing, III, 146
+ Pott's disease, III, 157
+ rickets, III, 151
+ ringworm, II, 149
+ rupture, II, 128
+ scarlatina, I, 192
+ scarlet fever, I, 192
+ scrofula, III, 149
+ scurvy, II, 182
+ sore mouth, II, 65
+ spine, curvature of the, III, 157, 159
+ St. Vitus's Dance, III, 155
+ stomach, catarrh of the, III, 209
+ urine, painful passage of, III, 141
+ urine, retention of, III, 141
+ wasting, III, 144
+ whooping cough, I, 238
+ worms, III, 240
+
+ Chills and fever, I, 247
+
+ Cholera, III, 228
+ infantum, III, 211
+ morbus, III, 226
+
+ Chorea, III, 158
+
+ Cinder in the eye, I, 176; II, 13
+
+ Circulation, the, III, 168
+
+ Circumcision, III, 142
+
+ Clam broth, IV, 263
+
+ Climacteric, the, III, 70
+
+ Clothing, proper, IV, 22
+
+ Cochlea, II, 46
+
+ Coffee, use of, IV, 43
+
+ Cold, exposure to, I, 181
+ in the head, II, 55
+ sore, II, 147
+
+ =COLIC=, III, 247
+ gallstone, III, 261
+ in babies, III, 267
+ intestinal, III, 249
+ mucous, III, 219
+ renal, III, 263
+
+ Collar-bone fracture, I, 85
+
+ Complexion, the, IV, 20
+
+ Confinement, III, 97
+
+ Congestion of the eyelid, II, 17
+
+ Conjunctivitis, II, 16, 18
+
+ Constipation, in adults, III, 233
+ in children, 238
+
+ Consumption, II, 96
+ fresh-air treatment for, II, 102
+ outdoor life for, VI, 72
+ prevention of, II, 104
+
+ Contagion, in cholera, 229
+ in conjunctivitis, II, 19
+ in diphtheria, II, 80
+ in eruptive fever, I, 191-220
+ in gonorrhea, II, 199
+ in grippe, II, 108
+ in mumps, I, 236
+ in syphilis, II, 206, 209
+ in whooping cough, I, 238
+
+ =CONTAGIOUS DISEASES=, I, 191
+
+ Convalescence (See Contents VI)
+
+ Convulsions, in children, III, 34
+ in adults, I, 188
+
+ =COOKING= (See Contents IV)
+ baking, IV, 171
+ boiling, IV, 180
+ braising, IV, 182
+ broiling, IV, 172
+ camp, VI, 220
+ cereals, IV, 229
+ eggs, IV, 184
+ entrees, IV, 219
+ fish, IV, 188
+ frying, IV, 175
+ game, IV, 202
+ poultry, IV, 202
+ roasting, IV, 171
+ sauces, IV, 216
+ sauteing, IV, 174
+ shellfish, IV, 195
+ soups, IV, 207
+ stewing, IV, 181
+ time of, IV, 177
+ utensils, IV, 232
+ vegetables, IV, 223
+
+ Copper sulphate method, V, 52
+
+ Copper vessels, use of, V, 67
+
+ Cord, bleeding of the, III, 142
+
+ Corns, II, 154
+
+ Costiveness, III, 233
+
+ =COUGH=, acute, II, 87, 91
+ whooping, I, 238
+
+ Cricoid cartilage, II, 70
+
+ Cross eye, II, 33
+
+ Croup, membranous, II, 79
+ ordinary, II, 83, 92
+
+ Curvature of the spine, III, 157, 159
+
+ Cystitis, II, 215
+
+
+ Dandruff, II, 167
+
+ Deafness, catarrhal, II, 39
+ chronic, II, 36
+ temporary, II, 33
+
+ Delirium tremens, III, 50
+
+ =DIARRHEA=, acute, III, 205
+ chronic, III, 217
+ of children, III, 208, 209
+
+ =DIET=, IV, 26, 107, 123, 138, 153
+ animal, IV, 39
+ details of, IV, 146
+ errors of, IV, 107
+ for babies, III, 132
+ for brain workers, IV, 126
+ for long life, IV, 107
+ for the aged, IV, 112
+ proper, IV, 138
+ relation to climate, IV, 108
+ rules for, IV, 110, 123
+ simplicity of, IV, 138
+ vegetable and animal, IV, 39
+
+ Digestion, effect of dress on, IV, 42
+ hygiene of, IV, 26
+ processes of, IV, 28
+
+ Diphtheria, II, 77
+
+ =DISINFECTANTS=, chemical, V, 243
+ physical, V, 240
+ solutions for, V, 247
+
+ Disinfection, V, 238
+ of rooms, V, 249
+
+ =DISLOCATIONS=, elbow, I, 125
+ hip, I, 129
+ jaw, I, 118, 120
+ knee, I, 119
+ shoulder, I, 122
+
+ Dog bite, I, 170
+
+ Doses of drugs, IV, 255
+
+ Dressings, for bruises, I, 63, 64
+ for wounds, I, 53, 57
+ surgical, I, 131
+
+ Drink, nutritious, IV, 118
+
+ Drinking, steady, III, 52
+
+ =DROWNED=, arousing the, I, 27
+ producing respiration in the, I, 28, 34
+ restoring the, I, 27
+ saving the, I, 36
+
+ Drowning person, death grasp of a, I, 37
+ saving a, I, 36
+ swimming to relief of a, I, 36
+
+ Drugs, doses of, IV, 255
+
+ Drum membrane, II, 33, 43, 45, 46, 48
+
+ Dysentery, in adults, III, 222
+ in children, III, 213
+
+ Dysmenorrhea, III, 71
+
+ =DYSPEPSIA=, III, 185
+ causes of, IV, 27
+ nervous, III, 190
+
+
+ =EAR=, anatomy of the, II, 33, 37, 46
+ diseases of the, II, 33
+ foreign bodies in the, I, 78; II, 39
+ water in the, II, 42
+ wax in the, II, 35
+
+ Earache, II, 40
+ moderate, II, 48
+
+ Eating, proper mode of, IV, 140-149
+
+ Eczema, II, 163
+ climatic, II, 164
+ occupation, II, 164
+ seborrheic, II, 164, 165, 167
+
+ Eggnog, IV, 268
+
+ Eggs, as food, IV, 33, 184
+ soft-boiled, IV, 266
+
+ Egg water, IV, 262
+
+ Elbow, dislocation of, I, 125
+
+ =ELECTRIC SHOCK=, I, 43, 46
+
+ Enteric fever, I, 221
+
+ Enteritis, catarrhal, III, 205
+
+ Entero-colitis, III, 209
+
+ Enteroptosis, IV, 43
+
+ Environment, importance of, III, 65
+
+ Epiglottis, II, 70
+
+ Epilepsy, III, 39
+ spasms in, III, 39
+ without spasms, III, 40
+
+ Erysipelas, I, 244
+
+ Eustachian tube, II, 37, 38, 41, 46, 49, 50
+
+ Exhaustion, mental and nervous, VI, 91-145
+
+ =EXERCISE=, IV, 48, 66
+ corrective, IV, 57
+ effect of, IV, 51
+ excessive, IV, 52
+ for all-round development, IV, 59, 101
+ for boyhood, IV, 69
+ for children, IV, 67
+ for elderly men, IV, 79
+ for everyone, IV, 66
+ for girls, IV, 73
+ for middle-aged men, IV, 77
+ for women, IV, 76
+ for young men, IV, 71
+ for youth, IV, 69
+ home, IV, 57
+ regular, IV, 53, 58
+ results of, IV, 98
+ without apparatus, IV, 57
+
+ =EYE=, anatomy of the, II, 30
+ astigmatism of the, II, 26 black, II, 14
+ catarrhal inflammation of the, II, 18
+ cinder in the, I, 76
+ cross, II, 33
+ diseases of the, II, 13
+ farsighted II, 21
+ foreign bodies in the, I, 76; II, 13
+ hyperopic, II, 22
+ lens of the, II, 30
+ muscles of the, II, 30
+ nearsighted, II, 25
+ pink, II, 19
+ retina of the, II, 30
+ sore, II, 16
+ strain, II, 21
+ wounds and burns of the, II, 16
+
+ Eyelid, congestion of the, II, 17
+ stye on the, II, 15
+ twitching of the, II, 15
+
+ Eye muscles, weakness of the, II, 28
+
+ Eye-strain, II, 21
+
+
+ Facial, neuralgia, III, 28
+ paralysis, III, 25
+
+ =FAINTING=, I, 185; III, 45
+
+ Farsightedness, II, 21
+
+ Fat as a food, IV, 35
+
+ Fatigue, causes of, IV, 50
+
+ Felon, I, 74, 75
+
+ =FEVER=, bilious, I, 247
+ black water, I, 256
+ Chagres, I, 256
+ chills and, I, 247
+ enteric, I, 221
+ gastric, III, 179
+ intermittent, I, 247
+ marsh, I, 247
+ remittent, I, 247
+ rheumatic, II, 169
+ scarlet, I, 192
+ swamp, I, 247
+ typhoid, I, 221
+ yellow, I, 261
+
+ Fever blister, II, 147
+
+ Fevers, eruptive contagious, I, 191
+
+ Fish as food, IV, 188
+
+ Finger, fracture of, I, 101
+
+ =FIT=, I, 188
+
+ Flea bites, I, 162
+
+ Fly bites, I, 164
+
+ Food, adulteration of, V, 87
+ containing parasites, I, 152
+ elements of, IV, 29
+ for babies, III, 132; IV, 261
+ for the sick, IV, 261
+ infected, I, 150
+ laws, V, 88
+ poisoning, I, 147
+ preparation of, IV, 171
+ pure, selection of, V, 89
+
+ Foods, advertised, IV, 116
+
+ Foot gear, IV, 24
+
+ Forearm fracture, I, 94
+
+ =FOREIGN BODIES=, in the ear, I, 78; II, 39
+ in the eye, I, 76; II, 13
+ in the nose, I, 79; II, 53
+
+ Foreskin, adhering, III, 141
+
+ Fourth-of-July accidents, I, 56
+
+ =FRACTURE= (See Broken Bone)
+ Colles', I, 99
+ compound, I, 80, 116
+ how to tell a, I, 81
+ simple, I, 80
+
+ Freckles, II, 150
+
+ Freezing, I, 178
+
+ =FROSTBITE=, I, 178, 180
+
+
+ Gallstone colic, III, 261
+
+ Ganglion, I, 75
+
+ Garbage, disposal of, V, 171
+
+ Gastric fever, III, 179
+
+ Genito-urinary diseases, II, 199
+
+ Germs (See Bacteria)
+
+ Girls, exercises for, IV, 73
+ physical training for, IV, 72; VI, 39
+
+ Glands, enlarged, III, 149
+
+ Gonorrhea, II, 199
+ in women, II, 203; III, 90
+
+ Gout, common, II, 183
+ rheumatic, II, 177
+
+ Grippe, la, II, 56, 108
+
+ Growing pains, III, 146
+
+
+ Hair, the, IV, 21
+
+ Hallucinations, II, 232
+
+ Hand, anatomy of the, III, 30
+ arteries of the, III, 30
+ fracture of the, I, 101
+ nerves of the, III, 30
+ tendons of the, III, 30
+
+ =HEADACHE=, constant, II, 120
+ due to disease, II, 117
+ due to eye strain, II, 29
+ due to heat stroke, II, 120
+ due to indigestion, II, 115
+ due to poisoning, II, 118
+ nervous, II, 117
+ neuralgic, II, 117
+ sick, II, 113
+ sympathetic, II, 116
+
+ Head gear, IV, 24, 160
+
+ Head injuries, III, 46
+
+ =HEART=, anatomy of the, III, 167, 168
+ enlargement of the, III, 169
+ palpitation of the, III, 171
+
+ Heart disease, III, 167
+
+ Heat exhaustion, I, 39, 40
+
+ Heating, cost of, V, 254
+ methods of, V, 161
+
+ =HEAT STROKE=, I, 39, 41
+
+ Hemorrhage (See Bleeding)
+
+ Hemorrhoids, II, 135
+
+ Heredity, III, 57
+ in consumption, II, 97
+
+ Hernia, II, 128 (See Rupture)
+ strangulated, II, 129
+ umbilical, II, 128
+ ventral, II, 128
+
+ Hiccough or hiccup, III, 21
+
+ Hip disease, III, 161
+
+ Hip, dislocation of, I, 129
+ fracture of, I, 104
+
+ Hives, II, 143
+
+ Hoarseness, II, 80
+
+ Hornet stings, I, 158
+
+ "Horrors," the, III, 50
+
+ House, proper construction of, V, 141
+
+ Housemaid's knee, I, 72
+
+ Hypodermic syringe, the, IV, 250
+
+ Hysteria, VI, 20
+
+
+ =INDIGESTION=, acute, III, 178
+ a result of errors, IV, 130
+ chronic, III, 185
+ intestinal, III, 202
+ not disease, IV, 134
+
+ Infants, bathing, III, 109
+ care of, III, 108
+ clothing for the, III, 110
+ feeding of, III, 118
+
+ Infection, V, 238
+ in erysipelas, I, 244
+ in malaria, I, 247
+ in typhoid fever, I, 221
+ in yellow fever, I, 261
+
+ =INFECTIOUS DISEASES=, I, 221
+
+ Influenza, II, 108
+
+ Ingrowing toe nail, I, 184
+
+ Injections, III, 238, 239
+
+ =INJURED, CARRYING THE=, I, Frontispiece
+
+ Insane, criminal, II, 234
+ delusions of the, II, 233
+ illusions of the, II, 231
+ sanitariums for the, II, 245
+
+ Insanity, II, 229; VI, 164
+ causes of, II, 239
+ false ideas regarding, II, 241
+ physical signs of, II, 235
+ prevention of, II, 240
+ types of, II, 236
+
+ Insensibility, III, 44
+
+ Insomnia, III, 23
+
+ Intermittent fever, I, 247
+
+ Invalids, care of, VI, 155
+
+ Itching, II, 139
+
+ Ivy poison, II, 152
+
+
+ Jaundice, III, 180
+
+ Jaw, dislocation of, I, 118, 120
+ fracture of, I, 89
+
+ Joint, injury of a, I, 65, 69
+
+ Junket, IV, 266
+
+
+ Kerosene, extermination of mosquitoes by, V, 77
+
+ Kidneys, inflammation of the, II, 220
+ Bright's disease of the, II, 219
+ stone in the, III, 265
+
+ Knee, dislocation of, I, 119
+ sprain of, I, 67, 70
+
+ Kneepan fracture, I, 109
+
+ Knock knees, III, 163
+
+
+ Laryngitis, II, 80
+
+ Larynx, anatomy of the, II, 70
+ spasm of the, III, 153
+
+ Leeches, use of, II, 43
+
+ Leg bones, fracture of, I, 111, 116
+
+ Leucorrhoea, III, 86
+
+ Lice, body, I, 161
+ clothes, I, 161
+ crab, I, 162
+ head, I, 160
+
+ Life-saving service, U. S., I, 27
+
+ Lightning stroke, I, 43
+
+ Limewater, IV, 268
+
+ =LOCKJAW=, I, 56
+
+ Long life, rules for (See Contents IV, Part III)
+
+ Lotions, II, 145, 151, 152, 155, 166
+
+ Lues, II, 206
+
+ Lumbago, II, 173
+
+ =LUNGS=, bleeding from the, I, 62
+ diseases of the, II, 87
+ inflammation of the, II, 93
+ tuberculosis of the, II, 96
+
+
+ =MALARIA=, I, 247
+ chronic, I, 253
+ mosquito as cause of, I, 157, 247
+ pernicious, I, 255
+ remittent, I, 254
+
+ Malt soup, IV, 267
+
+ Marasmus, III, 144
+
+ Marketing, hints on, IV, 232
+
+ Marriage relations, II, 197
+
+ Marsh fever, I, 247
+
+ Measles, common, I, 198
+ German, I, 203
+
+ Meat as food, IV, 32
+
+ Median nerve, III, 30
+
+ Medicine chest, contents of the, IV, 243
+
+ =MEDICINES, PATENT=, II, 245
+ antiphlogistine, II, 258
+ belladonna plasters, II, 257
+ dangers of, II, 260
+ hamamelis, II, 255
+ headache powders, II, 262
+ Listerine, II, 256
+ Platt's Chlorides, II, 259
+ Pond's Extract, II, 255
+ proprietary, II, 246
+ Scott's Emulsion, II, 257
+ vaseline, II, 254
+ witch-hazel, II, 255
+
+ Medulla oblongata, III, 22
+
+ Membranous croup, II, 79
+
+ Menopause, the, III, 70
+
+ Menstruation, III, 67
+ absence of, III, 75
+ arrest of, III, 79
+ cessation of, III, 78
+ delayed, III, 79
+ painful, III, 71
+ scanty, III, 79
+
+ Metals, poisoning by, I, 141
+
+ Miliaria, II, 148
+
+ =MILK=, as food, IV, 33
+ curd, IV, 266
+ mixtures, III, 124
+ peptonized, IV, 264
+ poisoning, III, 209, 211
+ porridge, IV, 267
+
+ Mind cure, VI, 31
+ disorder of the, II, 229
+
+ Miscarriage, danger of, III, 80
+
+ =MOSQUITO= bites, I, 155, 158; V, 71
+ destruction of the, I, 258; V, 75
+ exterminating the, V, 70
+ malaria due to the, I, 248
+ yellow fever due to the, I, 261; V, 70
+
+ Motor nerve, III, 38
+
+ Mouth-breathing, II, 60
+
+ Mouth, inflammation of the, II, 64
+ sore, II, 64
+
+ Mumps, I, 235
+
+ Muscular action, IV, 48
+ development, by will power, IV, 63
+
+ =MUSHROOM POISONING=, V, 112
+
+ Mushrooms, edible, V, 115
+ how to tell, V, 114
+ poisonous, V, 124
+
+ Mutton broth, IV, 261
+
+ Myalgia, II, 173
+
+ Myopia, II, 25
+
+
+ Narcotics, poisoning by, I, 142
+
+ Nasal cavity, II, 54
+
+ Navel, sore, III, 142
+
+ Nearsightedness, II, 25
+
+ Nervous debility, III, 13
+ diseases, III, 13
+ exhaustion, III, 13; VI, 70, 167
+
+ =NERVOUSNESS= (See Contents VI)
+ remedy for, VI, 70, 167; III, 20
+
+ Nervous system, reflex action of the, III, 38
+
+ Nettlerash, II, 143
+
+ Neuralgia, III, 27
+ facial, III, 28
+ of the chest, III, 29
+
+ Neurasthenia, III, 13
+
+ =NOSE=, anatomy of the, II, 54
+ bleeding from the, II, 51
+ catarrh of the, II, 55
+ diseases of the, II, 51
+ foreign bodies in the, I, 79; II, 53
+ obstructions in the, II, 60
+ septum of the, II, 51, 54, 61
+
+ Nosebleed, I, 61; II, 51
+
+ Nostrum, II, 248
+
+ Nurse and patient (See Contents VI)
+
+ Nurse, selection of the, VI, 150
+
+ Nursing, VI, 146
+
+
+ Oatmeal water, IV, 263
+
+ Olfactory nerves, III, 22
+
+ Oozing of blood, I, 54, 55
+
+ Optic nerves, III, 22
+
+ =OUTDOOR LIFE= (See Contents VI)
+ for consumption, VI, 72
+ for nervous exhaustion, VI, 70, 167
+
+ Overworked, hints for the, VI, 91
+
+ Oyster broth, IV, 267
+
+
+ Palmar arch, III, 30
+
+ Pains, growing, III, 146
+
+ Palpitation of the heart, III, 171
+
+ Paralysis, facial, III, 25
+
+ Paranoia, II, 237
+
+ Parasites, malarial, I, 247
+ yellow fever, I, 261
+
+ Paresis, II, 237
+
+ Patent medicines, II, 247
+
+ Peritonitis, III, 252
+
+ Petit mal, III, 40
+
+ Pharyngitis, II, 69
+
+ Phthisis, II, 96
+
+ Pigeon breast, II, 63
+
+ Piles, external, II, 135
+ internal, II, 136
+
+ Pimples, II, 145
+
+ Pink eye, II, 19
+
+ Plumbing, connections, V, 194
+ defects in, V, 231
+ drains, V, 206
+ fixtures, V, 216
+ joints, V, 194
+ pipes, V, 191, 206
+ tests, 233
+ traps, V, 198
+
+ Pneumonia, II, 93
+
+ =POISONING= (See Poisons)
+ by canned meats, I, 150
+ by fish, I, 148
+ by meat, I, 148, 150, 151
+ by milk, I, 148, 150, 151
+ food, bacterial, I, 147
+ food, containing parasites, I, 152
+ food, infected, I, 150
+ mushroom, V, 112
+ potato, I, 154
+
+ Poison ivy, II, 152
+
+ =POISONS=, acetanilid, I, 146
+ acid, carbolic, I, 140
+ acid, nitric, I, 140
+ acid, oxalic, I, 140
+ acid, sulphuric, I, 140
+ acids, I, 140
+ aconite, I, 142
+ alcohol, I, 143
+ alkalies, I, 140
+ ammonia, I, 141
+ antidotes, I, 139
+ antimony, I, 142
+ arsenic, I, 141
+ belladonna, I, 142
+ bichloride of mercury, I, 141
+ blue vitriol, I, 141
+ bug poison, I, 141
+ camphor, I, 142
+ caustic soda, I, 141
+ chloral, I, 143
+ cocaine, I, 145
+ copper, I, 141
+ corrosive sublimate, I, 141
+ digitalis, I, 142
+ ergot, I, 142
+ Fowler's solution, I, 141
+ headache powders, I, 146
+ hellebore, I, 142
+ ivy, II, 152
+ knockout drops, I, 143
+ laudanum, I, 144
+ lobelia, I, 142
+ lye, I, 141
+ matches, I, 142
+ mercury, I, 141
+ metals, I, 141
+ morphine, I, 144
+ narcotics, I, 142
+ nux vomica, I, 145
+ opium, I, 144
+ paregoric, I, 144
+ Paris green, I, 141
+ phenacetin, I, 146
+ phosphorus, I, 142
+ potash, I, 141
+ "rough on rats," I, 141
+ silver nitrate, I, 141
+ sleeping medicines, I, 143
+ soothing sirup, I, 144
+ strychnine, I, 145
+ tartar emetic, I, 142
+ tobacco, I, 144
+ unknown, I, 139
+ verdigris, I, 141
+ washing soda, I, 141
+ white precipitate, I, 141
+
+ Polypi, II, 54, 62
+
+ Pons Varolii, III, 22
+
+ Pott's disease, III, 157
+
+ Poultry as food, IV, 201
+
+ Pox, II, 206
+
+ Pregnancy, III, 91
+ diet during, III, 91
+ exercise during, III, 91
+ mental state during, III, 95
+ signs of, III, 80, 93
+
+ Prickly heat, II, 148
+
+ Proprietary medicines, II, 248
+
+ Pruritus, II, 139
+
+ Pulse, how to feel the, IV, 247
+
+ Punctured wound, bleeding from, a, I, 52, 53
+
+ Pure food bill, II, 249
+
+ =PURE FOOD, SELECTION OF=, V, 89-111
+ canned articles, V, 107
+ cereals, V, 98
+ chocolate, V, 107
+ cocoa, V, 107
+ coffee, V, 104
+ flavoring extracts, V, III
+ meat, V, 92
+ meat products, V, 95
+ olive oil, V, 110
+ shellfish, V, 94
+ spices, V, 108
+ sugar, V, 108
+ tea, V, 104
+ vegetables, V, 96
+ vinegar, V, 110
+
+ Purifying water supply, V, 52
+
+
+ Quinsy, II, 75
+
+
+ Radial nerve, III, 30
+
+ Recipes, for babies, IV, 261
+ for the sick, IV, 261
+
+ Reflex action illustrated, III, 38; IV, 49
+
+ Remittent fever, I, 247
+
+ Renal colic, III, 263
+
+ Respiration, to produce artificial, I, 28, 34, 43, 178, 186
+
+ Respirations, counting the, IV, 248
+
+ Rest cure, III, 20
+
+ Reversion, III, 59
+
+ Rheumatic fever, II, 169
+ gout, II, 177
+
+ =RHEUMATISM=, acute, II, 169
+ chronic, II, 175
+ effect on the heart, II, 170
+ inflammatory, II, 169
+ muscular, II, 173
+ of the chest, II, 174
+
+ Rhinitis, II, 77
+
+ Rib, broken, I, 83
+
+ Rice water, IV, 264
+
+ Rickets, III, 151
+
+ Ringworm, of body, II, 149
+ of scalp, II, 149
+
+ =RUN-AROUND=, I, 73
+
+ Rupture, II, 128
+
+
+ Salt rheum, II, 163
+
+ Sanitariums for the insane, II, 245
+
+ =SANITATION= (See Contents V)
+
+ Sarcoma, II, 124
+
+ =SCALDS=, I, 171
+
+ Scalp wounds, I, 60
+
+ Scarlatina, I, 192
+
+ Scarlet fever, I, 192
+
+ Sciatica, III, 31
+
+ Scorpion sting, I, 164
+
+ Scrofula, III, 149
+
+ Scurvy, common, II, 180
+ infantile, II, 182
+
+ Seasickness, III, 195
+
+ Self-abuse, II, 192
+
+ Semicircular canals, II, 46
+
+ Sensory nerve, III, 38
+
+ Septum, II, 54
+ deviation of the, II, 60
+
+ Serum, antivenomous, I, 169
+
+ Sewage, V, 170
+ disposal of, V, 172
+
+ Sewer gas, V, 187
+
+ Sewers, V, 182
+
+ Sexual organs, care of the, II, 191
+ diseases of the, II, 199
+
+ Sexual relations, II, 194
+
+ Shingles, III, 29
+
+ Shoulder, dislocation of, I, 122
+ sprain of, I, 67
+
+ Shoulder-blade fracture, I, 91
+
+ Sick, food for the, IV, 261
+
+ Sick room, the, VI, 150
+
+ =SKIN=, callus of the, II, 156
+ chafing of the, II, 142
+ chapping of the, II, 142
+ cracks in the, II, 156
+ discolorations of the, II, 150
+ diseases of the, II, 139
+ irritation of the, II, 142
+ itching of the, II, 139
+
+ Sleeplessness, III, 23
+
+ Sling, how to make a, 87, 88
+
+ Smallpox, I, 206
+
+ Snake bite, I, 166, 168
+
+ Soap, use of, IV, 32
+
+ Soil, bacteria in, V, 135
+ constituents of, V, 131
+ contamination of, V, 136
+ diseases due to, V, 139
+
+ Soil, improving the, V, 140
+ influence of, V, 137
+
+ Sore mouth, aphthous, II, 66
+ gangrenous, II, 67
+ simple, II, 65
+ ulcerous, II, 67
+
+ Sore eyes, II, 16
+
+ Sore throat, II, 69
+
+ Soup, malt, IV, 267
+
+ Soups, IV, 207
+
+ Spider bite, I, 164, 165
+
+ Spinal cord, III, 38
+
+ Spine, curvature of, III, 157, 159
+
+ Spleen, enlargement of, II, 254
+
+ Splinters, removing, I, 54
+
+ Splints, I, 61, 71, 93, 97, 102, 107, 110, 111, 114, 128
+
+ =SPRAINS=, bandages for, I, 65, 67
+ treatment of, 65, 66
+
+ Sprue, II, 66
+
+ Squint, II, 33
+
+ St. Vitus's Dance, III, 155
+
+ Stiff neck, II, 174
+
+ =STINGS=, bee, I, 158
+ centipede, I, 164
+ hornet, I, 158
+ scorpion, I, 164
+ wasp, I, 158
+
+ Stitching a wound, I, 58
+
+ =STOMACH=, bleeding from the, I, 62
+ catarrh of the, III, 185, 209
+ diseases of the, III, 178
+ neuralgia of the, III, 251
+
+ Stomachache, III, 247
+
+ Stone, in the bladder, III, 265
+ in the kidney, III, 263
+
+ Strabismus, II, 33
+
+ Stye, II, 15
+
+ =SUFFOCATION=, from gas, I, 186
+
+ Sunstroke, I, 40
+
+ Surgical dressings, I, 131
+
+ Swamp fever, I, 247
+
+ =SYNOVITIS=, I, 69
+
+ Syphilis, II, 206, 212
+
+ Syringe, the bulb, III, 239
+ the fountain, III, 238
+ the hypodermic, IV, 250
+
+
+ Tan, II, 150
+
+ Tapeworm, I, 152
+
+ Tarantula bite, I, 164
+
+ Tea, use of, IV, 43
+
+ Teeth, artificial, IV, 119
+ care of the, IV, 26
+
+ Teething, III, 113
+
+ Temperature, how to tell the, IV, 246
+ proper, IV, 161, 162
+
+ Tetter, II, 163
+
+ Thermometer, clinical, use of the, IV, 246
+
+ Thigh-bone fracture, I, 106
+
+ =THROAT=, diseases of the, II, 51,
+ sore, II, 69
+
+ Thrush, II, 66
+
+ Tic douloureux, III, 28
+
+ Toe nail, ingrowing, I, 184
+
+ Tongue, noting appearance of the, IV, 249
+
+ Tonsilitis, II, 71
+
+ Tonsils, enlarged, II, 63
+
+ Tooth, ulcerated, II, 58
+
+ Toothache, II, 58
+
+ Training, physical, IV, 124; VI, 38
+
+ Trichiniasis, I, 153
+
+ Truss, use of the, II, 130
+
+ Tuberculin, II, 101
+
+ Tuberculosis of the bones, III, 157
+ of the lungs, II, 96
+
+ =TUMORS=, II, 123
+
+ Turbinates, enlarged, II, 60
+
+ Typhoid fever, I, 221
+ complications of, I, 228
+
+
+ Ulcerated tooth, II, 58
+
+ Ulnar nerve, III, 30
+
+ =UNCONSCIOUSNESS=, III, 44
+ due to drunkenness, III, 47
+ due to epilepsy, III, 48
+ due to fainting, III, 45
+ due to head injuries, III, 46
+
+ Unconsciousness, due to kidney disease, III, 48
+ due to opium poisoning, III, 48
+ due to sunstroke, III, 48
+
+ Underclothing, proper, IV, 22
+
+ =URINE=, incontinence of, II, 213
+ involuntary passage of, II, 213
+ painful passage of, III, 141
+ retention of, II, 218; III, 141
+ stoppage of, II, 218
+ suppression of, II, 218
+
+ Urticaria, II, 143
+
+
+ Vaccination, I, 211-215
+
+ Varicocele, II, 134
+
+ Varicose veins, II, 132
+
+ Varioloid, I, 211
+
+ Veal broth, IV, 261
+
+ Vegetables as food, IV, 34, 223
+
+ Vein, bleeding from a, I, 51, 52
+
+ Veins, systemic, III, 168
+
+ =VENTILATION=, artificial, V, 157
+ forces of, V, 148
+ methods of, V, 150
+ natural, V, 151
+
+ Ventricles of the heart, III, 168
+
+ Vision, defects of, II, 21-33
+
+ Vocal cords, II, 70
+
+ =VOMITING=, III, 194
+ of blood, III, 200
+ of indigestion, III, 199
+ of pregnancy, III, 196
+
+
+ Wakefulness, III, 23
+
+ Warming, V, 160
+
+ Warts, flat, II, 154
+ moist, II, 154
+ seed, II, 153
+ threadlike, II, 153
+
+ Wasp stings, I, 158
+
+ Wasting, III, 144
+
+ =WATER=, barley, IV, 263
+ egg, IV, 262
+ lake, V, 27
+ lime, IV, 268
+ oatmeal, IV, 263
+ pure, V, 21, 52
+ rain, V, 26
+ rice, IV, 264
+ spring, V, 29
+ well, V, 31-37
+ wheat, IV, 264
+
+ Water cure, for nervous exhaustion, III, 20
+
+ Water distribution, V, 39
+ engines for, V, 42
+ hydraulic rams for, V, 40
+ pressure systems for, V, 47
+ storage tanks for, V, 46
+ windmills for, V, 41
+
+ Water supply, laws of, V, 37
+ plants which pollute, V, 54
+ pollution of, V, 22
+ purifying the, V, 52
+ sources of, V, 19
+ system for country, V, 47
+
+ Wax in the ear, II, 34
+
+ Wear and tear (See Contents VI)
+
+ Weaning, III, 117
+
+ =WEEPING SINEW=, I, 75
+
+ Wen, II, 126
+
+ Wheat water, IV, 264
+
+ Whey, mixtures, IV, 265
+ wine, IV, 266
+
+ Whites, III, 87
+
+ Whitlow, I, 74, 75
+
+ Whooping cough, I, 238
+
+ Womb, hemorrhage from the, III, 82
+
+ Women, exercises for, IV, 76
+
+ Wood tick, bite of, I, 159
+
+ =WORMS=, pin, III, 243
+ round, III, 242
+ tape, III, 245
+
+ =WOUNDS=, I, 50
+ about the eyes, II, 16
+ caused by pistols, I, 56
+ caused by firecrackers, I, 56
+ cleansing, I, 59
+ foreign bodies in, I, 54, 56
+ scalp, I, 60
+ stitching, I, 58
+ treatment of, I, 50, 57
+
+ Wrist, fracture of the, I, 99
+ sprain of the, I, 65, 67
+
+
+ Yellow fever, I, 261
+ mosquito as cause of, I, 157, 261, 265
+
+
+
+
+Preface
+
+
+Medicine, as the art of preserving and restoring health, is the
+rightful office of the great army of earnest and qualified American
+physicians. But their utmost sincerity and science are hampered by
+trying restrictions with three great classes of people: those on whom
+the family physician cannot call _every day_; those on whom he cannot
+call _in time_; and those on whom he cannot call _at all_.
+
+To lessen these restrictions, thus assisting and extending the
+healer's work, is the aim of the pages that follow.
+
+Consider first the average American household, where the family
+physician cannot call _every day_. Not a day finds this household
+without the need of information in medicine or hygiene or sanitation.
+More efforts of the profession are thwarted by ignorance than by
+epidemic. Not to supplant the doctor, but to supplement him, carefully
+prepared information should be at hand on the hygiene of
+health--sanitation, diet, exercise, clothing, baths, etc.; on the
+hygiene of disease--nursing and sick-room conduct, control of the
+nervous and insane, emergency resources, domestic remedies; above all,
+on the prevention of disease, emphasizing the folly of self-treatment;
+pointing out the danger of delay in seeking skilled medical advice
+with such troubles as cancer, where early recognition may bring
+permanent cure; showing the benefit of simple sanitary precautions,
+such as the experiment-stations method of exterminating the
+malaria-breeding mosquito. The volumes treating of these subjects
+cannot be made too clear, nontechnical, fundamental, or too well
+guarded by the supervision of medical men known favorably to the
+profession.
+
+Again, the physician cannot come _on time_ to save life, limb, or
+looks to the victim of many a serious accident. And yet some bystander
+could usually understand and apply plain rules for inducing
+respiration, applying a splint, giving an emetic, soothing a burn or
+the like, so as to safeguard the sufferer till the doctor's
+arrival--if only these plain rules were in such compact form that no
+office, store, or home in the land need be without them.
+
+Finally, the doctor _cannot come at all_ to hundreds of thousands of
+sailors, automobilists, and other travelers, to ranchers, miners, and
+country dwellers of many sorts. This third class has had, hitherto,
+little choice between some "Practice of Medicine," too technical to be
+helpful, on the one hand, and on the other, the dubious literature of
+unsanctioned "systems"; or the startling "cure-all" assertions
+emanating from many proprietors of remedies; or "Complete Family
+Physicians," which offer prescriptions as absurd for the layman as
+would be dynamite in the hands of a child, with superfluous and
+loathsome pictures appealing only to morbid curiosity, and with a
+general inaccuracy utterly out of touch with twentieth-century
+knowledge. What such people need, much more than the dwellers in
+settled communities, is to learn the views of modern medicine upon the
+treatment of the ever-present common ailments--the use of standard
+remedies, cautions against the abuse of narcotics, lessons of
+discrimination against harmful, useless, or expensive "patent
+medicines," and proper rules of conduct for diet, nursing, and general
+treatment.
+
+Authentic health literature existed abundantly before the preparation
+of these volumes, but it was scattered, expensive, and in most cases
+not arranged for the widest use. Not within our knowledge has the body
+of facts, most helpful to the layman on Sanitation and Hygiene, First
+Aid, and Domestic Healing, been brought together as completely, as
+clearly, as concisely, with a critical editing board so qualified, and
+with special contributions so authoritative as this work exhibits.
+
+"Utmost caution" has been a watchword with the editors from the start.
+Those to whom the doctor _cannot come every day_ have been repeatedly
+warned of the follies of self-treatment, and reminded that to-day it
+is the patient that is treated--not the disease. Those to whom the
+doctor _cannot come in time_ are likewise warned that the "First-aid
+Rules" of this Library are for temporary treatment only, in all
+situations where it is possible to get a physician. And the utmost
+conservatism has been striven for by the author and the several
+revisers in every part of the work that appeals particularly to
+dwellers in localities so removed that the doctor _cannot come at
+all_. Especial delicacy was also sought in the treatment of a chapter
+which, it is hoped, will aid parents to guide their children in sexual
+matters. The illustrations represent helpful, normal conditions (with
+the exception of some necessary representations of fracture, etc.)
+with instructive captions aimed to make them less a sensation than a
+real benefit; and no pictures appear of a sort to stimulate mere
+morbid curiosity.
+
+The greatest sympathy and appreciation of this work have been shown by
+the progressive and recognized practitioners who have seen early
+copies. They recognize it as a timely attempt to create and compile
+health literature in a form most complete within its limits of space,
+and in a manner most helpful and sane. The eager curiosity regarding
+_themselves_ that has been sweeping over the American people has been
+diverted into frivolous and harmful channels by much reckless talk and
+writing. A prominent newspaper, in its Sunday editions, recently took
+up the assertion, in a series of articles, that appendicitis
+operations resulted from a gigantic criminal conspiracy on the part of
+surgeons; that a sufficient cure for appendicitis, "as any honest
+doctor would tell you," is an injection of molasses and water! The
+endless harm done by such outright untruth is swelled by a joining
+stream of slapdash misinformation and vicious sensation, constantly
+running through the press.
+
+Education is sorely needed from authority. People _will_ read about
+their bodies. They have a right to information from the highest
+accredited source. And to apply such knowledge Dr. Winslow has labored
+for many years during his practicing experience, condensing and
+setting into clear order the most vitally important facts of domestic
+disease and treatment; an eminently qualified staff of practicing
+specialists has cooeperated, with criticism and supervision of
+incalculable value to the reader; and the accepted classics in their
+field follow: Dr. Weir Mitchell's elegant and inspiring essays on
+Nerves, Outdoor Life, etc.; Sir Henry Thompson's "precious documents
+of personal experience" on Diet and Conduct for Long Life; Dr. Dudley
+A. Sargent's scientific and long-prepared system of exercises without
+apparatus; Gerhard's clear principles of pure water supply; Dr.
+Darlington's notes and editing from the unequaled opportunity of a New
+York City Health Commissioner--and many other "special contributions."
+
+It is the widely accepted modern medicine, and no school or "system,"
+that is reflected here. While medicine, as a science, is far from
+being perfect, partly because of faulty traditions and misinterpreted
+experience, yet the aim of the modern school is to base practice on
+_facts_. For example, for many years physicians were aware that
+quinine cured malaria, in some unexplainable way. Now they not only
+know that malaria is caused by an animal parasite living and breeding
+in the blood and that quinine destroys the foe, but they know about
+the parasite's habits and mode of development and when it most readily
+succumbs to the drug. Thus a great discovery taught them to give
+quinine understandingly, at the right time, and in the right doses.
+
+An educated physician has at his command all knowledge, past and
+present, pertaining to medicine. He is free to employ any means to
+better his patient. Now it is impossible to cure, or even better, all
+who suffer from certain disease by any one method, and a follower of a
+special "system" thus ignores many agencies which might prove
+efficient in his case. While there is a germ of good and truth in the
+various "systems" of medical practice, their representatives possess
+no knowledge unknown to science or to the medical profession at large.
+Many persons are always attracted by "something new." But newness in a
+medical sect is too often newness in name only. These systems rise and
+fall, but scientific, legitimate medicine goes ever onward with an eye
+single to the discovery of new facts.
+
+That these volumes will result in an impetus to saner, quieter,
+steadier living, and will prove a helpful friend to many a physician
+and many a layman, is the earnest wish of
+
+ THE PUBLISHERS.
+
+
+
+
+Part I
+
+FIRST AID IN EMERGENCIES
+
+BY
+
+KENELM WINSLOW
+
+AND
+
+ALBERT WARREN FERRIS
+
+
+
+
+_Introductory Note_
+
+
+With the exception of the opening chapter, which contains the valuable
+Life-saving Service Rules _verbatim_, the Editors have adopted the
+plan of beginning each article in Part I of this volume with a few
+simple, practical instructions, telling the reader exactly what to do
+in case of an accident. For the purpose of distinguishing them from
+the ordinary text, and making them easy of reference, these
+_"First-aid Rules" are printed in light-faced type_.
+
+
+
+
+CHAPTER I
+
+=Restoring the Apparently Drowned=
+
+_As Practiced in the United States Life-Saving Service_
+
+
+ NOTE.--These directions differ from those given in the last
+ revision of the Regulations by the addition of means for securing
+ deeper inspiration. The method heretofore published, known as the
+ Howard, or direct method, has been productive of excellent results
+ in the practice of the service, and is retained here. It is,
+ however, here arranged for practice in combination with the
+ Sylvester method, the latter producing deeper inspiration than any
+ other known method, while the former effects the most complete
+ expiration. The combination, therefore, tends to produce the most
+ rapid oxygenation of the blood--the real object to be gained. The
+ combination is prepared primarily for the use of life-saving crews
+ where assistants are at hand. A modification of Rule III, however,
+ is published as a guide in cases where no assistants are at hand
+ and one person is compelled to act alone. In preparing these
+ directions the able and exhaustive report of Messrs. J. Collins
+ Warren, M.D., and George B. Shattuck, M.D., committee of the
+ Humane Society of Massachusetts, embraced in the annual report of
+ the society for 1895-96, has been availed of, placing the
+ department under many obligations to these gentlemen for their
+ valuable suggestions.
+
+
+=IF SEVERAL ASSISTANTS ARE AT HAND.=
+
+RULE I. _Arouse the Patient._--Do not move the patient unless in
+danger of freezing; instantly expose the face to the air, toward the
+wind if there be any; wipe dry the mouth and nostrils; rip the
+clothing so as to expose the chest and waist; give two or three quick,
+smarting slaps on the chest with the open hand.
+
+If the patient does not revive, proceed immediately as follows:
+
+RULE II. _To Expel Water from the Stomach and Chest_ (see Fig.
+1).--Separate the jaws and keep them apart by placing between the
+teeth a cork or small bit of wood, turn the patient on his face, a
+large bundle of tightly rolled clothing being placed beneath the
+stomach; press heavily on the back over it for half a minute, or as
+long as fluids flow freely from the mouth.
+
+[Illustration: FIG. 1.
+
+TO EXPEL WATER FROM STOMACH AND CHEST.
+
+Patient lying face downward; roll of clothes beneath stomach; jaws
+separated by piece of wood or cork; note rescuer pressing on back to
+force out water.]
+
+RULE III. _To Produce Breathing_ (see Figs. 2 and 3).--Clear the mouth
+and throat of mucus by introducing into the throat the corner of a
+handkerchief wrapped closely around the forefinger; turn the patient
+on the back, the roll of clothing being so placed as to raise the pit
+of the stomach above the level of the rest of the body. Let an
+assistant, with a handkerchief or piece of dry cloth, draw the tip of
+the tongue out of one corner of the mouth (which prevents the tongue
+from falling back and choking the entrance to the windpipe), and keep
+it projecting a little beyond the lips. Let another assistant grasp
+the arms, just below the elbows, and draw them steadily upward by the
+sides of the patient's head to the ground, the hands nearly meeting
+(which enlarges the capacity of the chest and induces inspiration).
+(Fig. 2.) While this is being done let a third assistant take position
+astride the patient's hips with his elbows resting upon his own knees,
+his hands extended ready for action. Next, let the assistant standing
+at the head turn down the patient's arms to the sides of the body, the
+assistant holding the tongue changing hands if necessary[1] to let the
+arms pass. Just before the patient's hands reach the ground the man
+astride the body will grasp the body with his hands, the balls of the
+thumb resting on either side of the pit of the stomach, the fingers
+falling into the grooves between the short ribs. Now, using his knees
+as a pivot, he will, at the moment the patient's hands touch the
+ground, throw (not too suddenly) all his weight forward on his
+hands, and at the same time squeeze the waist between them, as if he
+wished to force something in the chest upward out of the mouth; he
+will deepen the pressure while he slowly counts one, two, three, four
+(about five seconds), then suddenly let go with a final push, which
+will spring him back to his first position.[2] This completes
+expiration. (Fig. 3.)
+
+[Illustration: FIG. 2.
+
+TO PRODUCE BREATHING.
+
+First Position: Patient lying face upward; roll of clothes under back;
+tongue pulled out of mouth with handkerchief; note rescuer drawing
+arms upward to sides of head to start act of breathing in.]
+
+[Illustration: FIG. 3.
+
+TO PRODUCE BREATHING.
+
+Second Position: Forcing patient to breathe out; note rescuer with
+thumbs on pit of stomach, pressing against front of chest over lower
+ribs; also, assistant drawing down arms to body.]
+
+At the instant of his letting go, the man at the patient's head will
+again draw the arms steadily upward to the sides of the patient's head
+as before (the assistant holding the tongue again changing hands to
+let the arms pass if necessary), holding them there while he slowly
+counts one, two, three, four (about five seconds).
+
+Repeat these movements deliberately and perseveringly twelve to
+fifteen times in every minute--thus imitating the natural motions of
+breathing.
+
+If natural breathing be not restored after a trial of the bellows
+movement for the space of about four minutes, then turn the patient a
+second time on the stomach, as directed in Rule II, rolling the body
+in the opposite direction from that in which it was first turned, for
+the purpose of freeing the air passage from any remaining water.
+Continue the artificial respiration from one to four hours, or until
+the patient breathes, according to Rule III; and for a while, after
+the appearance of returning life, carefully aid the first short gasps
+until deepened into full breaths. Continue the drying and rubbing,
+which should have been unceasingly practiced from the beginning by
+assistants, taking care not to interfere with the means employed to
+produce breathing. Thus the limbs of the patient should be rubbed,
+always in an upward direction toward the body, with firm-grasping
+pressure and energy, using the bare hands, dry flannels, or
+handkerchiefs, and continuing the friction under the blankets, or over
+the dry clothing. The warmth of the body can also be promoted by the
+application of hot flannels to the stomach and armpits, bottles or
+bladders of hot water, heated bricks, etc., to the limbs and soles of
+the feet.
+
+RULE IV. _After Treatment. Externally._--As soon as breathing is
+established let the patient be stripped of all wet clothing, wrapped
+in blankets only, put to bed comfortably warm, but with a free
+circulation of fresh air, and left to perfect rest. _Internally:_ Give
+whisky or brandy and hot water in doses of a teaspoonful to a
+tablespoonful, according to the weight of the patient, or other
+stimulant at hand, every ten or fifteen minutes for the first hour,
+and as often thereafter as may seem expedient. _Later Manifestations:_
+After reaction is fully established there is great danger of
+congestion of the lungs, and if perfect rest is not maintained for at
+least forty-eight hours, it sometimes occurs that the patient is
+seized with great difficulty of breathing, and death is liable to
+follow unless immediate relief is afforded. In such cases apply a
+large mustard plaster over the breast. If the patient gasps for breath
+before the mustard takes effect, assist the breathing by carefully
+repeating the artificial respiration.
+
+
+=IF ONE PERSON MUST WORK ALONE.=
+
+MODIFICATION OF RULE III
+
+[_To be used after Rules I and II in case no assistance is at hand_]
+
+_To Produce Respiration._--If no assistance is at hand, and one person
+must work alone, place the patient on his back with the shoulders
+slightly raised on a folded article of clothing; draw forward the
+tongue and keep it projecting just beyond the lips; if the lower jaw
+be lifted, the teeth may be made to hold the tongue in place; it may
+be necessary to retain the tongue by passing a handkerchief under the
+chin and tying it over the head.[3]
+
+Grasp the arms just below the elbows and draw them steadily upward by
+the sides of the patient's head to the ground, the hands nearly
+meeting. (See Fig. 4.)
+
+Next lower the arms to the side, and press firmly downward and
+inward on the sides and front of the chest over the lower ribs,
+drawing arms toward the patient's head. (See Fig. 5.)
+
+Repeat these movements twelve to fifteen times every minute, etc.
+
+[Illustration: FIG. 4.
+
+ONE PERSON WORKING.
+
+First Position: Note arm movement same as in Fig. 2; also, tongue held
+between teeth by handkerchief tied under chin pressing teeth against
+wooden plug.]
+
+[Illustration: FIG. 5.
+
+ONE PERSON WORKING.
+
+Second Position: Note rescuer lowering arms to patient's sides and
+pressing downward and inward over lower ribs.]
+
+
+=INSTRUCTIONS FOR SAVING DROWNING PERSONS BY SWIMMING TO THEIR
+RELIEF.=
+
+1. When you approach a person drowning in the water, assure him, with
+a loud and firm voice, that he is safe.
+
+2. Before jumping in to save him, divest yourself as far and as
+quickly as possible of all clothes; tear them off, if necessary; but
+if there is not time, loose at all events the foot of your drawers, if
+they are tied, as, if you do not do so, they fill with water and drag
+you.
+
+3. On swimming to a person in the sea, if he be struggling do not
+seize him then, but keep off for a few seconds till he gets quiet, for
+it is sheer madness to take hold of a man when he is struggling in the
+water, and if you do you run a great risk.
+
+4. Then get close to him and take fast hold of the hair of his head,
+turn him as quickly as possible on to his back, give him a sudden
+pull, and this will cause him to float, then throw yourself on your
+back also and swim for the shore, both hands having hold of his hair,
+you on your back, and he also on his, and of course his back to your
+stomach. In this way you will get sooner and safer ashore than by any
+other means, and you can easily thus swim with two or three persons;
+the writer has even, as an experiment, done it with four, and gone
+with them forty or fifty yards in the sea. One great advantage of this
+method is that it enables you to keep your head up, and also to hold
+the person's head up you are trying to save. It is of primary
+importance that you take fast hold of the hair, and throw both the
+person and yourself on your backs. After many experiments, it is
+usually found preferable to all other methods. You can in this manner
+float nearly as long as you please, or until a boat or other help can
+be obtained.
+
+5. It is believed there is no such thing as a _death grasp_; at least,
+it is very unusual to witness it. As soon as a drowning man begins to
+get feeble and to lose his recollection, he gradually slackens his
+hold until he quits it altogether. No apprehension need, therefore, be
+felt on that head when attempting to rescue a drowning person.
+
+6. After a person has sunk to the bottom, if the water be smooth, the
+exact position where the body lies may be known by the air bubbles,
+which will occasionally rise to the surface, allowance being, of
+course, made for the motion of the water, if in a tide way or stream,
+which will have carried the bubbles out of a perpendicular course in
+rising to the surface. Oftentimes a body may be regained from the
+bottom, before too late for recovery, by diving for it in the
+direction indicated by these bubbles.
+
+7. On rescuing a person by diving to the bottom, the hair of the head
+should be seized by one hand only, and the other used in conjunction
+with the feet in raising yourself and the drowning person to the
+surface.
+
+8. If in the sea, it may sometimes be a great error to try to get to
+land. If there be a strong "outsetting tide" and you are swimming
+either by yourself or having hold of a person who cannot swim, then
+get on your back and float till help comes. Many a man exhausts
+himself by stemming the billows for the shore on a back-going tide,
+and sinks in the effort, when, if he had floated, a boat or other aid
+might have been obtained.
+
+9. These instructions apply alike to all circumstances, whether as
+regards the roughest sea or smooth water.
+
+
+FOOTNOTES:
+
+[1] Changing hands will be found unnecessary after some practice; the
+tongue, however, must not be released.
+
+[2] A child or very delicate patient must, of course, be more gently
+handled.
+
+[3] If there is stuck through the tongue a pin long enough to rest
+against the teeth and keep the tongue out of the mouth, the desired
+effect may be obtained.--EDITOR.
+
+
+
+
+CHAPTER II
+
+=Heat Stroke and Electric Shock=
+
+_How Persons are Overcome by Heat--Treatment of Sunstroke--Peculiar
+Cases--Dangers of Electric Shocks--How Death is Caused--Rules and
+Precautions._
+
+
+=HEAT EXHAUSTION.=
+
+_First Aid Rule 1.--Carry patient flat and lay in shade. Loosen
+clothes at neck and waist._
+
+_Rule 2.--Raise head and give him (a) teaspoonful of essence of ginger
+in glass of hot water, or give him (b) half a cup of hot coffee,
+clear._
+
+_Rule 3.--Put him to bed._
+
+
+=HEAT STROKE.=
+
+_First Aid Rule 1.--Send for physician._
+
+_Rule 2.--Remove quickly to shady place, loosening clothes on the
+way._
+
+_Rule 3.--Strip naked and put on wire mattress (or canvas cot), if
+obtainable._
+
+_Rule 4.--Sprinkle with ice water from watering pot, or dash it out of
+basin with hand._
+
+_Rule 5.--Dip sheet in ice water and tuck it snugly about patient._
+
+_Rule 6.--Sprinkle outside of sheet with ice water; rub body, through
+the sheet, with piece of ice. Put piece of ice to nape of neck._
+
+_Rule 7.--When temperature falls to 98.5 deg. F. put to bed with ice cap
+on head._
+
+
+=SUNSTROKE.=--There are two very distinct types of sunstroke: (1) Heat
+exhaustion or heat prostration. (2) Heat stroke.
+
+Heat prostration or exhaustion occurs when persons weakened by
+overwork, worry, or poor food are exposed to severe heat combined with
+great physical exertion. It often attacks soldiers on the march, but
+also those not exposed to the direct rays of the sun, as workers in
+laundries, in boiler rooms, and in stoke-holes of steamers. The attack
+begins more often in the afternoon or evening, in the case of those
+exposed to out-of-door heat. Feelings of weakness, dizziness, and
+restlessness, accompanied by headache, are among the first symptoms.
+The face is very pale, the skin is cool and moist, although the
+trouble often starts with sudden arrest of sweating. There is great
+prostration, with feeble, rapid pulse, frequent and shallow breathing,
+and lowered temperature, ranging often from 95 deg. to 96 deg. F. The patient
+usually retains consciousness, but rarely there is complete
+insensibility. The pernicious practice of permitting children at
+seaside resorts to wade about in cold water while their heads are
+bared to the burning sun is peculiarly adapted to favor heat
+prostration.
+
+Heat stroke happens more frequently to persons working hard under the
+direct rays of the sun, especially laborers in large cities who are in
+the habit of drinking some form of alcohol. It often occurs in
+unventilated tenements on stifling nights. Dizziness, violent
+headache, seeing spots before the eyes, nausea, and attempts at
+vomiting, usher in the attack. Compare it with heat prostration, and
+note the marked differences. The patient becomes suddenly and
+completely insensible, and falls to the ground, the face is flushed,
+the breathing is noisy and difficult, the pulse is strong, and the
+thermometer placed in the bowel registers 107 deg., 108 deg., or 110 deg. F., or
+rarely higher. The muscles are usually relaxed, but sometimes there
+are twitchings, or even convulsions. Death often occurs within
+twenty-four or thirty-six hours, preceded by failing pulse, deep
+unconsciousness, and rapid breathing, often labored or gasping,
+alternating with long intermissions. Sometimes delirium and
+unconsciousness last for days. Diminution of fever and returning
+consciousness herald recovery, but it is a very fatal disorder,
+statistics showing a death rate of from thirty to fifty per cent. Even
+when the patient lives, bad after effects are common. Peculiar
+sensibility to moderate heat is a frequent complaint. Loss of memory,
+weakened mental capacity, headache, irritability, fits, other mental
+disturbances, and impairment of sight and hearing are among the more
+usual sequels, occurring in those who do not subsequently avoid the
+direct rays of the sun, as well as an elevated temperature, and who
+indulge in alcoholic stimulants. A high degree of moisture in the air
+favors sunstrokes, but it is a curious fact that sunstroke is much
+more frequent in certain localities, and in special years than at
+other places and times with identical climatic conditions. This has
+led observers to suggest a germ origin of the disease, but this is
+extremely doubtful.
+
+=Treatment.=--Treatment for heat exhaustion is given in the
+"first-aid" directions. Little need be added to the directions for
+treatment of heat stroke. In place of the ice cap suggested in Rule 7,
+ice in cloths, or in a sponge bag may be substituted. The friction of
+the body, as directed in Rule 6, is absolutely necessary to stimulate
+the nervous system and circulation, and to prevent the blood from
+being driven into the internal organs by the cold applied externally.
+The cold-water treatment is applied until the temperature falls down
+to within a few degrees of normal--that is, 98.6 deg. F. Then the patient
+should be put into bed, there to remain, with ice to the head, until
+fully restored.
+
+It often happens that the fever returns, in which event the whole
+process of applying cold water must be repeated. The simplest way of
+reducing the fever consists in laying the patient, entirely nude, on a
+canvas cot or wire mattress, binding ice to the back of his neck, and
+having an attendant stand on a chair near by and pour ice water upon
+the patient from a garden watering pot.
+
+While the patient is insensible no attempt should be made to give
+anything by the mouth; but half a pint of milk and two raw eggs with a
+pinch of salt may be injected into the rectum every eight hours, after
+washing it out with cold water on each occasion. Two tablespoonfuls of
+whisky may be added to the injection, if the pulse is weak. If the
+urine is not passed spontaneously, it will be necessary to draw it
+once in eight hours with a soft rubber catheter which has been boiled
+ten minutes and lubricated with glycerin or clean vaseline.
+
+
+=ELECTRIC SHOCK OR LIGHTNING STROKE.=
+
+_First Aid Rule 1.--Protect yourself from being shocked by the victim.
+Grasp victim only by coat tails or dry clothes. Put rubber boots on
+your hands, or work through silk petticoat; or throw loop of rubber
+suspenders or of dry rope around him to pull him off wire, or pry him
+along with dry stick._
+
+_Rule 2.--Do not lift, but drag victim away from wire toward the
+ground. When free from wire, hold him head downward for two minutes._
+
+_Rule 3.--Assist heart to regain its strength. Apply mustard plaster
+(mustard and water) to chest over heart; wrap in blanket wrung out of
+very hot water; give hypodermic of whisky, thirty minims._
+
+_Rule 4.--Induce artificial respiration. Open his mouth and grasp
+tongue, pull it forward just beyond lips, and hold it there. Let
+another assistant grasp the arms just below the elbows and draw them
+steadily upward by the sides of the patient's head to the ground, the
+hands nearly meeting (which enlarges the capacity of the chest and
+induces inspiration, Fig. 2). While this is being done, let a third
+assistant take position astride the patient's hips with his elbows
+resting on his own knees, his hands extended, ready for action. Next,
+let the assistant standing at the head turn down the patient's arms to
+the sides of the body, the assistant holding the tongue changing
+hands, if necessary, to let the arms pass. Just before the patient's
+hands reach the ground, the man astride the body will grasp the body
+with his hands, the ball of the thumb resting on either side of the
+pit of the stomach, the fingers falling into the grooves between the
+short ribs. Now, using his knees as a pivot, he will at the moment the
+patient's hands touch the ground throw (not too suddenly) all his
+weight forward on his hands, and at the same time squeeze the waist
+between them, as if he wished to force something in the chest upward
+out of the mouth; he will deepen the pressure while he slowly counts
+one, two, three, four (about five seconds), then suddenly lets go with
+a final push, which will send him back to his first position. This
+completes expiration. (A child or delicate person must be more gently
+handled.)_
+
+_At the instant of letting go, the man at the patient's head will
+again draw the arms steadily upward to the sides of the patient's
+head, as before (the assistant holding the tongue again changing
+hands to let the arms pass, if necessary), holding them there while he
+slowly counts one, two, three, four (about five seconds)._
+
+_Repeat these movements deliberately and perseveringly twelve to
+fifteen times in every minute--thus imitating the natural motions of
+breathing. Continue the artificial respiration from one to four hours,
+or until the patient breathes; and for a while, after the appearance
+of returning life, carefully aid the first short gasps until deepened
+into full breaths._
+
+_Keep body warm with hot-water bottles, hot bricks to limbs and feet,
+and blankets over exposed lower part of body._
+
+_Rule 5.--Treat burn, if any. If skin is not broken, cover burn with
+cloths wet with Carron oil (equal parts of limewater and linseed or
+olive oil). If skin is broken, or raw surface is exposed, spread over
+it paste of equal parts of boric acid and vaseline, and bandage over
+all._
+
+=Conditions, Etc.=--A shock produced by contact with an electric
+current is not of rare occurrence. Lightning stroke is very uncommon;
+statistics show that in the United States each year there is one death
+from this cause to each million of inhabitants. There are several
+conditions which must be borne in mind when considering the accidental
+effect of an electric current. The pressure and strength of the
+current (voltage and amperage) are often not nearly so important in
+regard to the effects on the body, as the area, duration, and location
+of the points of contact with the current, and the resistance offered
+by clothing and dry skin to the penetration of the electricity.
+
+When the heart lies in the course of the circuit, the danger is
+greatest. A dog can be killed by a current of ten volts pressure when
+contacts are made to the head and hind legs, because the current then
+flows through the heart, while a current of eighty volts is required
+to kill a dog, under the same conditions, if contacts are made to head
+and fore leg. In a general way alternating currents of low frequency
+are the most injurious to the body, and any current pressure higher
+than two hundred volts is dangerous to life. On the other hand, a
+current of ninety-five volts has proved fatal to a human being. In
+this case the circumstances were particularly unfavorable to the
+victim, as he was standing on an iron tank in boots wet with an
+alkaline solution, and probably studded on the soles with nails, when
+he came in accidental contact with an industrial current. Moreover, he
+was an habitual drunkard. In an instance of the contrary sort, a man
+received a current of 1,700 volts (periodicity about 130) for fifty
+seconds, in one of the early attempts at electro-execution, without
+being killed. The personal equation evidently enters into the matter.
+A strong physique here, as in other cases, is most favorable in
+resisting the effects of electric shock.
+
+High-pressure alternating currents (1,300 to 2,000 volts) are employed
+in electro-executions, and the contacts are carefully made, so that
+the current will enter the brain and pass through the heart to the
+leg. The two most vital parts are thus affected. In industrial
+accidents such nice adjustments are fortunately almost impossible, and
+shocks received from high-pressure currents, even of 25,000 volts,
+have not proved fatal because both the voltage and amperage have been
+greatly lessened through poor contacts and great resistance of
+clothing and dry skin, and also because the heart is not usually
+included in the circuit.
+
+Death is induced in one of three ways: 1. Currents of enormous voltage
+and amperage, as occur in lightning, actually destroy, burst and burn
+the tissues through which the stroke passes. 2. Usually death follows
+accidents from industrial currents, owing to contraction of the heart,
+the effect being the same as observed on other muscles. The heart
+instantly ceases beating, and either remains absolutely quiet, or
+there is a fine quivering of some of its fibers, as seen on opening
+the chest in experiments upon animals. 3. A fatal issue may result
+from the passage of the current through the head, so affecting the
+nerve centers that govern respiration that the breathing ceases.
+
+=Symptoms.=--These are generally muscular contractions, faintness, and
+unconsciousness (sometimes convulsions, if the current passes through
+the head), with failure of pulse and of breathing. For instance, a
+man who was removing a brush from a trolley car touched, with the
+other hand, a live rail. His muscles immediately contracted throwing
+him back, and disconnecting him from contact with the current (500
+volts). He then fainted and became unconscious for a short time. The
+pulse was rapid and feeble, and the breathing also at first, but it
+later became slower than usual. On regaining sensibility the patient
+vomited and got on his feet, although feeling very weak for two hours.
+Unconsciousness commonly lasts only a few moments in nonfatal cases,
+but may continue for hours, its continuance being rather a favorable
+sign of ultimate recovery, if the heart and lungs are acting
+sufficiently. Bad after effects are rare. It is not uncommon for the
+patient to declare that the accident had improved his general
+feelings. Occasionally there is temporary loss of muscular power, and
+a case has been reported of nervous symptoms following electric shock
+similar to those observed after any accidental violence. Burns of
+varying degrees of intensity occur at the point of entrance of the
+current, from slight blisters to complete destruction of all the
+tissues.
+
+=Treatment.=--The treatment is completely outlined in the "first-aid"
+directions. Should contact be unbroken, an order to shut off the
+electric current should at once be telephoned to the station.
+Protection of the rescuer with thick rubber gloves is of course the
+ideal safeguard.
+
+In fatal cases the heart is instantaneously arrested, and nothing can
+be done to start it into action. If the current passes through the
+brain, by contact with the head or neck, then failure of breathing is
+more apt to be the cause of death. Theoretically, it is in the latter
+event only that treatment, i. e., artificial respiration, will be of
+avail.
+
+But as in any individual case the exact condition is always a matter
+of doubt, _artificial respiration_ is the most valuable remedial
+measure we possess; it should always be practiced for hours in
+doubtful cases. Two tablespoonfuls of brandy or whisky in a cup of
+warm water may be injected into the bowel, if a hypodermic syringe is
+not available and the patient needs decided stimulation.
+
+
+
+
+CHAPTER III
+
+=Wounds, Sprains and Bruises=
+
+_Treatment of Wounds--Rules for Checking Hemorrhage--Lockjaw--Bandages
+for Sprains--Synovitis--Bunions and Felons--Foreign Bodies in the Eye,
+Ear and Nose._
+
+
+=WOUNDS.=--A wound is a condition produced by a forcible cutting,
+contusing, or tearing of the tissues of the body, and includes, in its
+larger sense, bruises, sprains, dislocations, and breaks or fractures
+of bones. As ordinarily used, a wound is an injury produced by
+forcible separation of the skin or mucous membrane, with more or less
+injury to the underlying parts.
+
+_The main object during the care of wounds should be to avoid
+contamination with anything which is not surgically clean, from the
+beginning to the end of the dressing; otherwise, every other step in
+the whole process is rendered useless._
+
+Three essentials in the treatment of wounds are:
+
+1. The arrest of bleeding. 2. Absolute cleanliness. 3. Rest of the
+injured part. Dangerous bleeding demands immediate relief.
+
+Bleeding is of three kinds: 1. From a large artery. 2. From a vein. 3.
+General oozing.
+
+
+=BLEEDING FROM LARGE ARTERY IN SPURTS OF BRIGHT BLOOD.=
+
+_First Aid Rule 1.--Speed increases safety. Put patient down flat.
+Make pressure with hands between the wound and the heart till surgeon
+arrives, assistants taking turns._
+
+_Rule 2.--If arm or leg, tie rubber tubing or rubber suspenders tight
+about limb between wound and heart, or tie strap or rope over
+handkerchief or folded shirt wrapped about limb. If arm, put baseball
+in arm pit, and press arm against this. Or, for arm or leg, tie folded
+cloth in loose noose around limb, put cane or umbrella through noose
+and twist up the slack very tight, so as to compress the main artery
+with knot._
+
+_Rule 3.--Keep limb and patient warm with hot-water bottles till
+surgeon arrives._
+
+This treatment is of course only a temporary expedient, as it is
+essential for a surgeon to tie the bleeding vessel itself; therefore a
+medical man should be summoned with all dispatch.
+
+
+=BLEEDING FROM VEIN; STEADY FLOW OF DARK BLOOD.=
+
+_First Aid Rule 1.--Make firm pressure with pad of cloth directly over
+wound, also with hands between wound and extremity, that is, on side
+of cut away from the heart._
+
+_Rule 2.--Tie tight bandage about limb at this point, with rubber
+tubing or suspenders._
+
+_Rule 3.--Keep limb and patient warm with hot-water bottles till
+surgeon arrives._
+
+In the cases of bleeding from a vein, the flow of blood is continuous,
+and is of a dark, red hue, and does not spurt in jets, as from an
+artery. This kind of bleeding is not usually difficult to stop, and it
+is not necessary that the vein itself be tied--unless very
+large--provided that the wound be snugly bandaged after it is dressed.
+After the first half hour, release the limb and see if the bleeding
+has stopped. If so, and the circulation is being interfered with,
+owing to the tightness of the bandage, reapply the bandage more
+loosely.
+
+In the case of an injured artery of any considerable size, the amount
+of pressure required to stop the bleeding will arrest all circulation
+of blood in the limb, so that great damage, as well as pain, will
+ensue if it be continued more than an hour or two, and during this
+time the limb should be kept warm by thick covering and hot-water
+bags, if they can be obtained.
+
+Bleeding _from a deep puncture_ may be stopped by plugging the cavity
+with strips of muslin which have been boiled, or with absorbent
+cotton, similarly treated, keeping the plug in place by snug
+bandaging.
+
+
+=BLEEDING FROM PUNCTURED WOUND.=
+
+_First Aid Rule 1.--Extract pin, tack, nail, splinter, thorn, or
+bullet, IF YOU CAN SEE BULLET; do not probe._
+
+_Rule 2.--Pour warm water on wound and squeeze tissue to encourage
+bleeding. Send for small hard-rubber syringe._
+
+_Rule 3.--If deep, plug it with absorbent cotton, and put tight
+bandage over plug. If shallow, cover with absorbent cotton wet with
+boric-acid solution (one dram to one-half pint of water), or
+carbolic-acid solution (one teaspoonful to the pint of hot water)._
+
+_Rule 4.--When syringe comes, remove dressing, and clean wound by
+forcibly syringing carbolic solution directly into wound. Replace
+dressing._
+
+A small punctured wound should be squeezed in warm water to encourage
+bleeding and, if pain and swelling ensue, absorbent cotton soaked in a
+boric-acid solution (containing as much boric acid as the water will
+dissolve) or in carbolic-acid solution (one teaspoonful of pure acid
+to the pint of warm water) should be applied over the wound and
+covered with oil silk or rubber or enamel cloth for a few days, or
+until the soreness has subsided. The dressing should be wet with the
+solution as often as it becomes dry. Punctures by nails, especially if
+deep, should be washed out with a syringe, using one of the solutions
+just mentioned. A medicine dropper, minus the rubber part, attached to
+a fountain syringe, makes a good nozzle for this purpose. A moist
+dressing, like the one described, should then be applied, and the limb
+kept in perfect rest for a few days.
+
+When a surgeon's services are available, however, self-treatment is
+attended with too much danger, as a thorough opening up of such wounds
+with proper cleansing and drainage will afford a better prospect of
+early recovery, and avert the risk of serious inflammation and
+lockjaw, which sometimes follow punctured wounds of the hands and
+feet. Foreign bodies, as splinters, may be removed with tweezers or a
+needle, being careful not to break the splinter in the attempt. If a
+part remains in the flesh, or if the foreign body is a needle that
+cannot be found or removed at once, the continuous application of a
+hot flaxseed or other poultice will lead to the formation of "matter,"
+with which the splinter or needle will often escape after a few days.
+Splinters finding their way under the nail may be removed by scraping
+the nail very thin over the splinter and splitting it with a sharp
+knife down to the point where the end of the splinter can be grasped.
+
+
+=BLEEDING IN FORM OF OOZING.=
+
+_First Aid Rule 1.--Apply water as hot as hand can bear._
+
+_Rule 2.--Elevate the part, and drench with carbolic solution (one
+teaspoonful of carbolic acid to one pint of hot water)._
+
+_Rule 3.--Bandage snugly while wet._
+
+_Rule 4.--Keep patient warm with hot-water bottles._
+
+
+=GENERAL OOZING= happens in the case of small wounds or from abraded
+surfaces, and is caused by the breaking of numerous minute vessels
+which are not large enough to require the treatment recommended for
+large arteries or veins. It is rarely dangerous, and usually stops
+spontaneously. When the loss of blood has been considerable, so that
+the patient is pale, faint, and generally relaxed, with cold skin, and
+perhaps nausea and vomiting, he should be stripped of all clothing and
+immediately wrapped in a blanket wrung out of hot water, and then
+covered with dry blankets. Heat should also be applied to the feet by
+means of hot-water bags or bottles, with great care not to burn a
+semiconscious patient's skin. The head should be kept low, and two
+tablespoonfuls of brandy, whisky, or other alcoholic liquor should be
+given in a half cup of hot water by the mouth, if the patient can
+swallow. If much blood has been lost a quart of water, as hot as the
+hand can readily bear, and containing a teaspoonful of common salt,
+should be injected by means of a fountain syringe into the rectum.
+
+Somewhat the condition just described as due to loss of blood may be
+caused simply by shock to the nervous system following any severe
+accident, and not attended by bleeding. The treatment of shock is,
+however, practically the same as that for hemorrhage, and improvement
+in either case is shown by return of color to the face and strength in
+the pulse. Bleeding is apt to be much less in badly torn than in
+incised wounds, even if large vessels are severed, as when the legs
+are cut off in railroad accidents, for the lacerated ends of the
+vessels become entangled with blood and favor clotting.
+
+
+=LOCKJAW.=--In the lesser injuries, where bleeding is not an important
+feature, and in all wounds as well, after bleeding has been stopped,
+the main object in treatment consists in cleansing wounds of the germs
+which cause "matter" or pus, general blood poisoning, and lockjaw. The
+germs of the latter live in the earth, and even the smallest wounds
+which heal perfectly may later give rise to lockjaw if dirt has not
+been entirely removed from the wound at the time of accident. Injuries
+to the hands caused by pistols, firecrackers, and kindred explosives,
+seem especially prone to produce lockjaw, and fatalities from this
+disorder are deplorably numerous after Fourth-of-July celebrations in
+the United States.
+
+The wounds producing lockjaw usually occur in children who explode
+blank cartridges in the palm of the hand. In this way the germs of the
+disease are forced in with parts of the dirty skin and more or less of
+the wad from the shell. Since lockjaw is so frequent after these
+accidents, and so fatal, it is impossible to exert too much care in
+treatment. The wound should at once be thoroughly opened with a knife
+to the very bottom, under ether, by a surgeon, and not only every
+particle of foreign matter removed, but all the surrounding tissue
+should be cut out or cauterized. In addition, it is wise to use an
+injection under the skin of tetanus-antitoxin, to prevent the disease.
+Proper restriction of the sale of explosives alone will put a stop to
+this barbarous mode of exhibiting patriotism.
+
+=Treatment.=--It is not essential to use chemical agents or
+antiseptics to rid wounds of germs and so secure uninterrupted
+healing. The person who is to dress the wound should prepare to do so
+at the earliest possible moment after giving first aid. He should
+proceed promptly to boil some pieces of absorbent cotton, as large as
+an egg, together with a nail brush in water. Some strips of clean
+cotton cloth may be used in the absence of absorbent cotton. The
+boiling should be conducted for five minutes, when the basin or other
+utensil in which the brush and cotton are boiled should be taken off
+the fire and set aside to cool. Then the attendant should scrub his
+own hands for five minutes in hot water with soap and brush.
+
+He next takes the brush, which has been boiled, out of the water and
+cleans the patient's skin for a considerable distance about the wound.
+When this is done, and the water and cotton which have been boiled are
+sufficiently cool, the wound should be bathed with the cotton and
+boiled water until all foreign matter has been removed from the wound;
+not only dirt which can be seen, but germs which cannot be seen. Some
+of the boiled cotton cloth or absorbent cotton, wet as it is, should
+be placed over the wound and the whole covered by a bandage. Large
+gaping wounds are of course more properly closed by stitches, but very
+deep wounds should be left partly open, so that the discharge may
+drain away freely. Small, deep, punctured wounds are not to be closed
+at all, but should be sedulously kept open by pushing in strips of
+boiled cotton cloth, in order to secure drainage.
+
+If the attendant has the requisite confidence, there is no reason why
+he should not attempt stitching a wound, providing the patient is
+willing, and a surgeon cannot be obtained within twenty-four hours. In
+this case a rather stout, common sewing needle or needles are threaded
+with black or white thread, preferably of silk, and, together with a
+pair of scissors and a clean towel, are boiled in the same utensil
+with the cotton and the nail brush. After the operator has scrubbed
+his hands and cleansed the wound, he places the boiled towel about the
+wound so that the thread will fall on it during his manipulations and
+not on the skin. The needle should be thrust into and through the
+skin, but no lower than this, and should enter and leave the skin
+about a quarter of an inch from either edge of the wound. The stitches
+are placed about one-half inch apart, and are drawn together and tied
+tightly enough to join the two edges of the wound. The ends of the
+thread should be cut about one-half inch from the knot, being careful
+while using the needle and scissors not to lay them down on anything
+except the boiled towel. The wound is then covered with cotton, which
+has been boiled as described above, bandaged and left undisturbed for
+a week, if causing no pain. At the end of this time the stitches are
+taken out after the attendant has washed his hands carefully, and
+boiled his scissors as before.
+
+Court plaster or plaster of any kind is a bad covering or dressing for
+wounds, as it may be itself contaminated with germs. It effectually
+keeps in any with which the wound is already infected, and prevents
+proper drainage.
+
+It is impossible in a work of this kind to describe the details of the
+after treatment of wounds, as this can only be properly undertaken by
+a surgeon, owing to the varying conditions which may arise. In general
+it may be stated that the same cleanliness and care should be followed
+during the whole course of healing as has been outlined for the first
+attempt at treatment.
+
+If the wound is small, and there is no discharge from it, it may be
+painted with collodion or covered with boric-acid ointment (sixty
+grains of boric acid to the ounce of vaseline) after the first day. If
+large, it should be covered with cotton gauze or cloth which have been
+boiled or specially prepared for surgical purposes. If pus ("matter")
+forms, the wound must be cleansed daily of discharge (more than once
+if it is copious) with boiled water, or best with hydrogen dioxide
+solution followed by a washing with a solution of carbolic acid (one
+teaspoonful to the pint of hot water), or with a solution of mercury
+bichloride, dissolving one of the larger bichloride tablets, sold for
+surgical uses, in a quart of water.
+
+It is a surgical maxim never to be neglected that wounds should not be
+allowed to close at the top before healing is completed at the bottom.
+As to close at the surface is the usual tendency in wounds that heal
+slowly and discharge pus, it is necessary at times to enlarge the
+external opening by cutting or stretching with the blades of a pair of
+scissors, or, and this is much more rational and comfortable for the
+patient, by daily packing the outlet of the wound with gauze to keep
+it open.
+
+
+=BLEEDING FROM SCALP.=
+
+_First Aid Rule 1.--Cut hair off about wound, and clean thoroughly
+with carbolic-acid solution (one teaspoonful to pint of hot water)._
+
+_Rule 2.--Put pad of gauze or muslin directly over wet wound, and make
+pressure firmly with bandage._
+
+In case of wounds of the scalp, or other hairy parts, the hair should
+be cut, or better shaved, over an area very much larger than the
+wounded surface, after which the cleansing should be done. To stop
+bleeding of the scalp, water is applied as hot as can be borne, and
+then a wad of boiled cotton should be placed in the wound and
+bandaged down tightly into it for a time. Closing the wound with
+stitches will stop the bleeding much more effectively, however, and is
+not very painful if done immediately after the accident. The stitches
+should be tied loosely, and not introduced nearer to each other than
+half an inch, to allow drainage of discharge from the wound.
+
+=General Remarks.=--All wounds should be kept at rest after they are
+dressed. This is accomplished in the case of the lower limbs by
+keeping the patient in bed with the leg raised on a pillow.
+
+The same kind of treatment applies in severe injuries of the hands. In
+less serious cases a sling may be employed, and the patient may walk
+about. When the injury is near a joint, as of the fingers, knee,
+wrist, or elbow, a splint made of thin board or tin (and covered with
+cotton wadding and bandaged) should be applied by means of surgeon's
+adhesive plaster and bandage after the wound has been dressed. In
+injuries of the hand the splint should be applied to the palm side,
+and reach from the finger tips to above the wrist. Use a splint also.
+
+
+=NOSEBLEED.=
+
+_First Aid Rule 1.--Seat patient erect and apply ice to nape of neck._
+
+_Rule 2.--Put roll of brown paper under upper lip, and press lip
+firmly against it. Press facial artery against lower jaw of bleeding
+side, till bleeding stops. This artery crosses lower edge of jawbone
+one inch in front of angle of jaw._
+
+_Rule 3.--Plug nostril with strip of thin cotton or muslin cloth._
+
+_Rule 4.--Do not wash away clots; encourage clotting to close
+nostril._
+
+
+=BLEEDING FROM LUNGS; BRIGHT BLOOD COUGHED UP.=
+
+=BLEEDING FROM STOMACH; DARK BLOOD VOMITED.=
+
+_First Aid Rule for both. Let patient lie flat and swallow small
+pieces of ice, and also take one-quarter teaspoonful of table salt in
+half a glass of cold water._
+
+
+=BRUISE.=
+
+_First Aid Rule 1.--Bandage from tips of fingers, or from toes, making
+same pressure with bandage all the way up as you do over the injury._
+
+_Rule 2.--Apply heat through the bandage, over the injury, with
+hot-water bottles._
+
+=Cause, Etc.=--A bruise is a hidden wound; the skin is not broken. It
+is an injury caused by a blunt body so that, while the tougher skin
+remains intact, the parts beneath are torn and crushed to a greater or
+lesser extent. The smaller blood vessels are torn and blood escapes
+under the skin, giving the "black and blue" appearance so common in
+bruises of any severity. Sometimes, indeed, large collections of
+blood form beneath the skin, causing a considerable swelling.
+
+Use of the bruised part is temporarily limited. Pain, faintness, and
+nausea follow severe bruises, and, in case of bad bruises of the
+belly, death may even ensue from damage to the viscera or to the
+nerves. Dangerous bleeding from large blood vessels sometimes takes
+place internally, and collections of blood may later break down into
+abscesses. Furthermore, the bruise may be so great that the injury to
+muscle and nerve may lead to permanent loss of use of the part. For
+these reasons a surgeon's advice should always be sought in cases of
+bad bruises. Pain is present in bruises, owing to the tearing and
+stretching of the smaller nerve fibers, and to pressure on the nerves
+caused by swelling. The swelling is produced by escape of blood and
+fluid from the torn blood vessels.
+
+=Treatment.=--Even slight and moderate bruises should be treated by
+rest of the injured part. A splint insures the rest of a limb (see
+treatment of Fractures, p. 80). One of the best modes of treatment is
+the snug application of a flannel bandage which secures a certain
+amount of rest of the part to which it is applied, and aids in
+preventing further swelling. Where bandaging is not feasible, as in
+certain parts of the body, or before bandaging in any kind of a
+bruise, the use of a cold compress is advisable. One layer of thin
+cotton or linen cloth should be wet in ice water, and should be put on
+the bruised part and continually changed for newly moistened pieces
+as soon as the first grows warm. Alcohol and water, of each equal
+parts, may be used in the same manner to advantage.
+
+When cold is unavailable or unpleasant to the patient, several layers
+of cotton cloth may be wrung out in very hot water and applied to the
+part with frequent renewal. The value attributed to witch-hazel and
+arnica is mainly due to the alcohol contained in their preparations.
+Cataplasma Kaolini (U. S. P.) is an excellent remedy for simple
+bruises when spread thickly on the part and covered with a bandage. An
+ointment containing twenty-five per cent of ichthyol is also a useful
+application. Following severe bruises, the damaged parts should be
+kept warm by the use of hot-water bags, or by covering a limb with
+cotton wool and bandage, until such time as surgical advice may be
+obtained.
+
+When the pain and swelling of bruises begin to subside, treatment
+should be pursued by rubbing with liniment of ammonia or chloroform,
+or vaseline if these are not obtainable. Moderate exercise of the part
+is desirable.
+
+
+=ABRASIONS.=--When the surface skin is scraped off, as often happens
+to the shin, knee, or head, an ointment containing sixty grains of
+boric acid to the ounce of vaseline makes a good application, and this
+may be covered with a bandage. The same ointment is useful to apply to
+small wounds and cuts after the first bandage is removed.
+
+
+=SPRAIN; NO DISPLACEMENT OF BONES.=
+
+_First Aid Rule 1.--Immerse in water, hot as hand can bear, for half
+an hour._
+
+_Rule 2.--Dry and strap with adhesive plaster, if you know how. If
+not, bandage snugly, beginning with tips of fingers or with toes, and
+make same pressure all the way up that you do over injury._
+
+_Rule 3.--Rest. If ankle or knee is hurt, patient must go to bed._
+
+=Conditions, Etc.=--A sprain is an injury caused by a sudden wrench or
+twist of a joint, producing a momentary displacement of the ends of
+the bones to such a degree that they are forced against the membrane
+and ligaments surrounding the joint, tearing one or both to a greater
+or less extent. The wrist and ankle are the joints more commonly
+sprained, and this injury is more likely to occur in persons with
+flabby muscles and relaxed ligaments, as in the so-called
+"weak-ankled." The damage to the parts holding the joint in place may
+be of any degree, from the tearing of a few fibers of the membrane
+enwrapping the joint to its complete rupture, together with that of
+the ligaments, so that the bones are no longer in place, the joint
+loses its natural shape and appearance, and we have a condition known
+as dislocation. In a sprain then, the twist of the joint produces only
+a temporary displacement of the bones forming the joint, sufficient to
+damage the soft structures around it, but not sufficient to cause
+lasting displacement of the bones or dislocation.
+
+It will be seen that whether a sprain or dislocation results, depends
+upon the amount of injury sustained. Since it often happens that the
+bone entering into the joint is broken, it follows that whenever what
+appears to be a severe sprain occurs, with inability to move the joint
+and great swelling, it is important to secure surgical aid promptly.
+Since the discovery of the X-ray many injuries of the smaller bones of
+the wrist and ankle joint, formerly diagnosed as sprains by the most
+skillful surgeons, have, by its use, been discovered to be breaks of
+the bones which were impossible of detection by the older methods of
+examination.
+
+=Symptoms.=--The symptoms of sprain are sudden, severe pain, often
+accompanied by faintness and nausea, swelling, tenderness, and heat of
+the injured parts. The sprained joint can be only moved with pain and
+difficulty. The swelling is due not so much to leaking of blood from
+broken blood vessels as to filling up of the joint with fluid caused
+by the inflammation, although in a few days after a severe sprain the
+skin a little distance below the injury becomes "black and blue" from
+escape of blood caused by the injury.
+
+=Treatment.=--Since the treatment of severe sprains means first the
+discrimination between dislocation, a break of bone, and a rupture of
+muscle, ligament, or tendon, it follows that the methods herein
+described for treatment should only be employed in slight
+unmistakable sprains, or until a surgeon can be secured, or when one
+is unavailable. Nothing is better than immediate immersion of the
+sprained joint in as hot water as the hand can bear for half an hour.
+Following this, an elastic bandage of flannel cut on the bias about
+three and one-half inches wide should be snugly applied to the limb,
+beginning at the finger tips or at the toes and carrying the bandage
+some distance above the injured joint.
+
+In bandaging a part there is always danger of applying the bandage too
+tightly, especially if the parts swell under the bandage. If this
+happens, there is increase of pain which may be followed by numbness
+of the limb and, what is still more significant, coldness and blueness
+of the extremities below the bandage, particularly of the fingers and
+toes. In such cases the bandage must be removed and reapplied with
+less force. If the ankle or knee be sprained the patient must go to
+bed for at least twenty-four hours, and give the limb a complete rest.
+
+When the wrist or shoulder is sprained the arm should be confined in a
+sling. In the more serious cases the injured joint should be fixed in
+a splint before bandaging. An injured elbow joint is held at a right
+angle by a pasteboard splint, a bandage, and a sling, while the knee
+and wrist are treated with the limb in a straight line, as far as
+possible.
+
+In the case of the knee, the splint is applied to the back of the leg;
+in sprained wrist, to the palm of the hand and same side of the
+forearm. Sheet wadding, which may be bought at any drygoods store, is
+torn into strips about two inches wide and sewed together forming a
+bandage ten or fifteen feet long, and this is first wound about the
+sprained joint. Then pieces of millboard or heavy pasteboard are
+soaked in water and applied while wet in long strips about three
+inches wide over the wadding, and the whole is covered with bandage.
+In the case of the knee it is better to use a strip of wood for the
+splint, reaching from the lower part of the calf to four inches above
+the knee. It should be from a quarter to half an inch thick, a little
+narrower than the leg, and be padded thickly with sheet wadding. It is
+held in place by strips of surgeon's adhesive plaster, about two
+inches wide, passed around the whole circumference of the limb above
+and below the knee joint, and covered with bandage.
+
+In ordinary sprains of the ankle, uncomplicated by broken bone or
+ligament, it is possible for the patient, after resting in bed for a
+day, to go about on crutches, without bearing any weight on the foot
+until the third day after the accident. The treatment in the meanwhile
+consists in immersing the sprained ankle alternately, first in hot
+water for five minutes and then in cold water for five minutes,
+followed by rubbing of the parts about the injured joint with
+chloroform liniment for fifteen minutes, but not at the beginning
+touching the joint itself. The rubbing should be done by an assistant
+very gently the first day, with gradual increase in vigor as the days
+pass, not only kneading the ankle but moving the joint.
+
+This treatment should be pursued once daily, and followed by bandaging
+with a flannel bandage cut on the bias three and a half inches wide.
+With this method it is possible for the patient to regain the moderate
+use of the ankle in about two or three weeks.
+
+The same general line of treatment applies to the other joints;
+partial rest and daily bathing in hot and cold water, rubbing and
+movements of the joint by an assistant. Since sprains vary in severity
+it follows that some may need only the first day's preliminary
+treatment prescribed to effect a cure, while others may require
+fixation by a surgeon in a plaster-of-Paris splint for some time, with
+additional treatment which only his special knowledge can supply.
+
+[Illustration: This picture shows an excellent method of fixing a
+sprained joint, used by Prof. Virgil P. Gibney, M.D., Surgeon-in-Chief
+of the N. Y. Hospital for Ruptured and Crippled. It consists of
+strapping the joint by means of long, narrow strips of adhesive
+plaster incasing it immovably in the normal position. This procedure
+may be followed by anyone who has seen a surgeon practice it.]
+
+
+=SYNOVITIS--Severe Injury.=--Generally of ankle or knee from fall, or
+shoulder from blow.
+
+_First Aid Rule 1.--Provide large pitcher of hot water and large
+pitcher of cold water and basin. Hold joint over basin; pour hot
+water slowly over joint. Return this water to pitcher. Pour cold water
+over joint. Return water to pitcher. Repeat with hot water again, and
+follow with cold. Continue this alternation for half an hour._
+
+_Rule 2.--Put to bed, with hot-water bottles about joint, and wedge
+immovably with pillows._
+
+_Rule 3.--When tenderness and heat subside, strap with adhesive
+plaster in overlapping strips._
+
+=Conditions, Etc.=--This condition, which may affect almost any freely
+movable joints, as the knee, elbow, ankle, and hip, is commonly caused
+by a wrench, blow, or fall. Occasionally it comes on without any
+apparent cause, in which case there is swelling and but slight pain or
+inflammation about the joint. We shall speak of synovitis of the knee
+("water on the knee"), as that is the most common form, but these
+remarks will apply almost as well to the other joints. In severe cases
+there are considerable pain, redness and heat, and great swelling
+about the knee. The swelling is seen especially below the kneepan, on
+each side of the front of the joint, and also often above the kneepan.
+Frequently the only signs of trouble are swelling with slight pain,
+unless the limb is moved.
+
+=Treatment.=--If the knee is not red, hot, or tender to the touch, it
+will not be necessary for the patient to remain in bed, but when these
+symptoms are present a splint of some sort must be applied so that the
+leg is kept nearly straight, and the patient must keep to his bed
+until the heat, redness, and tenderness have subsided. In the meantime
+either an ice bag, hot poultice, cloths wrung out in hot water, or a
+hot-water bag should be kept constantly upon the knee.
+
+A convenient splint consists of heavy pasteboard wet and covered with
+sheet wadding (or cotton batting) shaped and affixed to the back of
+the leg, from six inches below to four inches above the joint, by
+strips of adhesive plaster, as shown in the illustration, and then by
+bandage, leaving the knee uncovered for applications. A wooden splint
+well padded may be used instead.
+
+In mild cases without much inflammation, and in others after the
+tenderness and heat have abated, the patient may go about if the knee
+is treated as follows: a pad of sheet wadding or cotton batting about
+two inches thick and five inches long and as wide as the limb is
+placed in the hollow behind the knee, and then the whole leg is
+encircled with sheet wadding from six inches below to four inches
+above the knee, covering the joint as well as the pad. Beginning now
+five inches below the joint, strips of surgeon's adhesive plaster, an
+inch wide and long enough to more than encircle the limb, are affixed
+about the leg firmly like garters so as to make considerable pressure.
+Each strip or garter overlaps the one below about one-third of an
+inch, and the whole limb is thus incased in plaster from five inches
+below the knee to a point about four inches above the joint.
+
+An ordinary cotton bandage is then applied from below over the entire
+plaster bandage. When this arrangement loosens, the plaster should be
+taken off and new reapplied, or a few strips may be wound about the
+old plaster to reenforce it. The patient may walk about with this
+appliance without bending the knee.
+
+When the swelling has nearly departed, the plaster may be removed and
+the knee rubbed twice daily about the joint and the joint itself moved
+to and fro gently by an attendant, and then bandaged with a flannel
+bandage. Painting the knee with tincture of iodine in spots as large
+as a silver dollar is also of service at this time. The knee should
+not be bent in walking until it can be moved by another person without
+producing discomfort.
+
+Such treatment may be applied to the other joints in a general way.
+The elbow must be fixed by a splint as recommended for dislocation of
+the joint (p. 128). The ankle is treated as advised for sprain of that
+joint (p. 68). When a physician can be obtained no layman is justified
+in attempting to treat a case of water on the knee or similar
+affection of other joints.
+
+
+=BUNION AND HOUSEMAID'S KNEE.=--Bunion is a swelling of the bursa, or
+cushion, at the first joint of the great toe where it joins the foot.
+It may not give much trouble, or it may be hot, red, tender, and very
+painful. It is caused by pressure of a tight boot which also forces
+the great toe toward the little toe, and thus makes the great toe
+joint more prominent and so the more readily injured.
+
+A somewhat similar swelling, often as large as an egg, is sometimes
+seen over the kneepan, more often in those who work upon their knees,
+hence the name housemaid's knee. The swelling may come on suddenly and
+be hot, tender, and painful, or it may be slow in appearing and give
+little pain.
+
+=Treatment.=--The treatment for the painful variety of bunion and
+housemaid's knee is much the same: absolute rest with the foot kept
+raised, and application of cloths kept constantly wet with ice or cold
+water; or a thick covering of Cataplasma Kaolini (U. S. P.) may be
+applied until the inflammation has subsided. If the trouble is
+chronic, or the acute inflammation does not soon abate under the
+treatment advised, the case is one for the surgeon, and sometimes
+requires the knife for abscess formation. In the milder cases of
+bunion, wearing proper shoes whose inner border forms almost a
+straight line from heel to toe, so that the great toe is not pushed
+over toward the little toe, and painting the bunion every few days
+with tincture of iodine, until the skin begins to become sore, will
+often be sufficient to secure recovery.
+
+
+=RUN-AROUND; WHITLOW OR FELON.=--"Run-around" consists in an
+inflammation of the soft parts about the finger nail. It is more
+common in the weak, but may occur in anyone, owing to the entrance of
+pus germs through a slight prick or abrasion which may pass unnoticed.
+The condition begins with redness, heat, tenderness, swelling, and
+pain of the flesh at the root of the nail, which extends all about the
+nail and may be slight and soon subside, or there may be great pain
+and increased swelling, with the formation of "matter" (pus), and
+result in the loss of the nail, particularly in the weak.
+
+Whitlow or felon is a much more serious trouble. It begins generally
+as a painful swelling of one of the last joints of the fingers on the
+palm side. Among the causes are a blow, scratch, or puncture. Often
+there is no apparent cause, but in some manner the germs of
+inflammation gain entrance. The end of the finger becomes hot and
+tense, and throbs with sometimes almost unbearable pain. If the
+inflammation is chiefly of the surface there may be much redness, but
+if mainly of the deeper parts the skin may be but little reddened or
+the surface may be actually pale. There is usually some fever, and the
+pain is made worse by permitting the hand to hang down. If the felon
+is on the little finger or thumb the inflammation is likely to extend
+down into the palm of the hand, and from thence into the arm along the
+course of the tendons or sinews of the muscles. Death of the bone of
+the last finger joint necessitating removal of this part, stiffness,
+crippling, and distortion of the hand, or death from blood poisoning
+may ensue if prompt surgical treatment is not obtained.
+
+=Treatment.=--At the very outset it may be possible to stop the
+progress of the felon by keeping the finger constantly wet by means of
+a bandage continually saturated with equal parts of alcohol and water,
+at night keeping it moist by covering with a piece of oil silk or
+rubber. Tincture of iodine painted all over the end of the finger is
+also useful, and the hand should be carried in a sling by day, and
+slung above the head to the headboard of the bed by night. If after
+twenty-four hours the pain increases, it is best to apply hot
+poultices to the finger, changing them as often as they cool. If the
+felon has not begun to abate by the end of forty-eight hours, the end
+of the finger must be cut lengthwise right down to the bone by a
+surgeon to prevent death of the bone or extension of the inflammation.
+Poultices are then continued.
+
+"Run-around" is treated also by iodine, cold applications, and, if
+inflammation continues, by hot poulticing and incision with a knife;
+but poulticing is often sufficient. Attention to the general health by
+a physician will frequently be of service.
+
+
+=WEEPING SINEW; GANGLION.=--This is a swelling as large as a large
+bean projecting from the back or front of the wrist with an elastic or
+hard feeling, and not painful or tender unless pressed on very hard.
+After certain movements of the hand, as in playing the piano or, for
+example, in playing tennis, some discomfort may be felt. Weeping sinew
+sometimes interferes with some of the finer movements of the hand.
+The swelling is not red or inflamed, but of the natural color of the
+skin. It does not continue to increase after reaching a moderate size,
+but usually persists indefinitely, although occasionally disappearing
+without treatment. The swelling contains a gelatinous substance which
+is held in a little sac in the sheath of the tendon or sinew, but the
+inside of the sac does not communicate with the interior of the sheath
+surrounding the tendon.
+
+=Treatment.=--This consists in suddenly exerting great pressure on the
+swelling with the thumb, or in striking it a sharp blow with a book by
+which the sac is broken. Its contents escape under the skin, and in
+most cases become absorbed. If the swelling returns a very slight
+surgical operation will permanently cure the trouble.
+
+
+=CINDERS AND OTHER FOREIGN BODIES IN THE EYE.=[4]--Foreign bodies are
+most frequently lodged on the under surface of the upper lid, although
+the surface of the eyeball and the inner aspect of the lower lid
+should also be carefully inspected. A drop of a two per cent solution
+of cocaine will render painless the manipulations. The patient should
+be directed to continue looking downward, and the lashes and edge of
+the lid are grasped by the forefinger and thumb of the right hand,
+while a very small pencil is gently pressed against the upper part of
+the lid, and the lower part is lifted outward and upward against the
+pencil so that it is turned inside out. The lid may be kept in this
+position by a little pressure on the lashes, while the cinder, or
+whatever foreign body it may be, is removed by gently sweeping it off
+the mucous membrane with a fold of a soft, clean handkerchief. (See
+Figs. 6 and 7.)
+
+[Illustration: FIG. 6.
+
+FIG. 7.
+
+REMOVING A FOREIGN BODY FROM THE EYE.
+
+In Fig. 6 note how lashes and edge of lid are grasped by forefinger
+and thumb, also pencil placed against lid; in Fig. 7 lid is shown
+turned inside out over pencil.]
+
+Hot cinders and pieces of metal may become so deeply lodged in the
+surface of the eye that they cannot be removed by the method
+recommended, or by using a narrow slip of clean white blotting-paper.
+All such cases should be very speedily referred to a physician, and
+the use of needles or other instruments should not be attempted by a
+layman, lest permanent damage be done to the cornea and opacity
+result. Such procedures are, of course, appropriate for an oculist,
+but when it is impossible to secure medical aid for days it can be
+attempted without much fear, if done carefully, as more harm will
+result if the offending body is left in place. It is surprising to see
+what a hole in the surface of the eye will fill up in a few days. If
+the foreign body has caused a good deal of irritation before its
+removal, it is best to drop into the eye a solution of boric acid (ten
+grains to the ounce of water) four times daily.
+
+
+=FOREIGN BODIES IN THE EAR.=--Foreign bodies, as buttons, pebbles,
+beans, cherry stones, coffee, etc., are frequently placed in the ear
+by children, and insects sometimes find their way into the ear passage
+and create tremendous distress by their struggles. Smooth,
+nonirritating bodies, as buttons, pebbles, etc., do no particular harm
+for a long time, and may remain unnoticed for years. But the most
+serious damage not infrequently results from unskillful attempts at
+their removal by persons (even physicians unused to instrumental work
+on the ear) who are driven to immediate and violent action on the
+false supposition that instant interference is called for. Insects, it
+is true, should be killed without delay by dropping into the ear sweet
+oil, castor, linseed, or machine oil or glycerin, or even water, if
+the others are not at hand, and then the insect should be removed in
+half an hour by syringing as recommended for wax (Vol. II, p. 35).
+
+To remove solid bodies, turn the ear containing the body downward,
+pull it outward and backward, and rub the skin just in front of the
+opening into the ear with the other hand, and the object may fall out.
+
+Failing in this, syringing with warm water, as for removal of wax,
+while the patient is sitting, may prove successful. The essentials of
+treatment then consist, first, in keeping cool; then in killing
+insects by dropping oil or water into the ear, and, if syringing
+proves ineffective, in using no instrumental methods in an attempt to
+remove the foreign body, but in awaiting such time as skilled medical
+services can be obtained. If beans or seeds are not washed out by
+syringing, the water may cause them to swell and produce pain. To
+obviate this, drop glycerin in the ear which absorbs water, and will
+thus shrivel the seed.
+
+
+=FOREIGN BODIES IN THE NOSE.=--Children often put foreign bodies in
+their noses, as shoe buttons, beans, and pebbles. They may not tell of
+it, and the most conspicuous symptoms are the appearance of a thick
+discharge from one nostril, having a bad odor, and some obstruction to
+breathing on the same side. If the foreign body can be seen, the
+nostril on the unobstructed side should be closed and the child made
+to blow out of the other one. If blowing does not remove the body it
+is best to secure medical aid very speedily.
+
+
+FOOTNOTES:
+
+[4] The Editors have deemed it advisable to repeat here the following
+instructions, also occurring in Vol. II, Part I, for the removal of
+foreign bodies in the eye, ear, and nose, as properly coming under the
+head of "First Aid in Emergencies."
+
+
+
+
+CHAPTER IV
+
+=Fractures=
+
+_How to Tell a Broken Bone--A Simple Sling--Splints and Bandage,--A
+Broken Rib--Fractures of Arm, Shoulder, Hand, Hips Leg and Other
+Parts._
+
+
+=BROKEN BONE; FRACTURE.=[5]
+
+_First Aid Rule 1.--Be sure bone is broken. If broken, patient can
+scarcely (if at all) move the part beyond the break, while attendant
+can move it freely in his hands. If broken, grating of rough edges of
+bone may be felt by attendant but should not be sought for. If broken,
+limb is generally shortened._
+
+_Rule 2.--Do not try to set bone permanently. Send at once for
+surgeon._
+
+
+=COMPOUND FRACTURE.=
+
+_Important. If there is opening to the air from the break, because of
+tearing of tissues by end of bone, condition is very dangerous; first
+treatment may save life, by preventing infection. Before reducing
+fracture, and without stirring the patient much, after scrubbing your
+hands very clean, note:_
+
+_First Aid Rule 1.--If hairy, shave large spot about wound._
+
+_Rule 2.--Clean large area about wound with soap and water, very
+gently. Then wash most thoroughly again with clean water, previously
+boiled and cooled. Flood wound with cool boiled water._
+
+_Rule 3.--Cover wound with absorbent cotton (or pieces of muslin)
+which has been boiled. Then attend to broken bone, as hereafter
+directed, in the case of each variety of fracture._
+
+_After the bone is set, according to directions, then note:_
+
+_Rule 4.--Renew pieces of previously boiled muslin from time to time,
+when at all stained with discharges. Every day wash carefully about
+wound, between the splints, with cool carbolic-acid solution (one
+teaspoonful to a pint of hot water) before putting on the fresh
+cloths._
+
+
+=BROKEN BONES OR FRACTURES.=[6]--It frequently happens that the first
+treatment of fracture devolves upon the inexperienced layman.
+Immediate treatment is not essential, in so far as the repair of the
+fracture is directly concerned, for a broken bone does not unite for
+several weeks, and if a fracture were not seen by the surgeon for a
+week after its occurrence, no harm would be done, provided that the
+limb were kept quiet in fair position until that time. The object of
+immediate care of a broken bone is to prevent pain and avoid damage
+which would ensue if the sharp ends of the broken bone were allowed to
+injure the soft tissues during movements of the broken limb.
+
+Fractures are partial or complete, the former when the bone is broken
+only part way through; simple, when the fracture is a mere break of
+the bone, and compound, when the end of one or both fragments push
+through the skin, allowing the air with its germs to come in contact
+with the wound, thus greatly increasing the danger. To be sure that a
+bone is broken we must consider several points. The patient has
+usually fallen or has received a severe blow upon the part. This is
+not necessarily true, for old people often break the thigh bone at the
+hip joint by simply making a false step.
+
+Inability to use the limb and pain first call our attention to a
+broken bone. Then when we examine the seat of injury we usually notice
+some deformity--the limb or bone is out of line, and there may be an
+unusual swelling. But to distinguish this condition from sprain or
+bruise, we must find that there is a new joint in the course of the
+bone where there ought not to be any; e. g., if the leg were broken
+midway between the knee and ankle, we should feel that there was
+apparently a new joint at this place, that there was increased
+capacity for movement in the middle of the leg, and perhaps the ends
+of the fragments of bones could be heard or felt grating together.
+
+These, then, are the absolute tests of a broken bone--unusual mobility
+(or capacity for movement) in the course of the bone, and grating of
+the broken fragments together. The last will not occur, of course,
+unless the fragments happen to lie so that they touch each other and
+should not be sought for. In the case of limbs, sudden shortening of
+the broken member from overlapping of the fragments is a sure sign.
+
+
+=SPECIAL FRACTURES.=
+
+=BROKEN RIB.=--_First Aid Rule.--Patient puts hands on head while
+attendant puts adhesive-plaster band, one foot wide, around injured
+side from spine over breastbone to line of armpit of sound side. Then
+put patient to bed._
+
+A rib is usually broken by direct violence. The symptoms are pain on
+taking a deep breath, or on coughing, together with a small, very
+tender point. The deformity is not usually great, if, indeed, any
+exists, so that nothing in the external appearance may call the
+attention to fracture. Grating between the fragments may be heard by
+the patient or by the examiner, and the patient can often place his
+finger on the exact location of the break.
+
+When it is a matter of doubt whether a rib is broken or not the
+treatment for broken rib should be followed for relief of pain.
+
+[Illustration: FIG. 8.
+
+METHOD OF BANDAGING BROKEN RIB (SCUDDER).
+
+Note manner of sticking one end of wide adhesive plaster along
+backbone; also assistant carrying strip around injured side.]
+
+=Treatment= consists in applying a wide band of surgeon's adhesive
+plaster, to be obtained at any drug shop. The band is made by
+overlapping strips four or five inches wide, till a width of one foot
+is obtained. This is then applied by sticking one end along the back
+bone and carrying it forward around the injured side of the chest over
+the breastbone as far as a line below the armpit on the uninjured side
+of the chest, i. e., three-quarters way about the chest. These four-
+or five-inch strips of plaster may be cut the right length first and
+laid together, overlapping about two inches, and put on as a whole,
+or, what is easier, each strip may be put on separately, beginning at
+the spine, five inches below the fracture, and continuing to apply the
+strips, overlapping each other about two inches, until the band is
+made to extend to about five inches above the point of fracture, all
+the strips ending in the line of the armpit of the uninjured side.
+(Fig. 8.)
+
+If surgeon's plaster cannot be obtained, a strong unbleached cotton or
+flannel bandage, a foot wide, should be placed all around the chest
+and fastened as snugly as possible with safety pins, in order to limit
+the motion of the chest wall. The patient will often be more
+comfortable sitting up, and should take care not to be exposed to cold
+or wet for some weeks, as pleurisy or pneumonia may follow. Three
+weeks are required for firm union to be established in broken ribs.
+
+
+=COLLAR-BONE FRACTURE.=
+
+_First Aid Rule.--Put patient flat on back, on level bed, with small
+pillow between his shoulders; place forearm of injured side across
+chest, and retain it so with bandage about chest and arm._
+
+[Illustration: FIG. 9.
+
+A BROKEN COLLAR BONE (SCUDDER).
+
+Usual attitude of patient with a fracture of this kind; note lowering
+and narrowed appearance of left shoulder.]
+
+Fracture of the collar bone is one of the commonest accidents. The
+bone is usually broken in the middle third. A swelling often appears
+at this point, and there is pain there, especially on lifting the arm
+up and away from the body. It will be noticed that the shoulder, on
+the side of the injury, seems narrower and also lower than its fellow.
+The head is often bent toward the injured side, and the arm of the
+same side is grasped below the elbow by the other hand of the patient
+and supported as in a sling. (See Fig. 9.) In examining an apparently
+broken bone _the utmost gentleness may be used_ or serious damage may
+result.
+
+=Treatment.=--The best treatment consists in rest in bed on a hard
+mattress; the patient lying flat on the back with a small pillow
+between the shoulders and the forearm of the injured side across the
+chest. This is a wearisome process, as it takes from two to three
+weeks to secure repair of the break. On the other hand, if the forearm
+is carried in a sling, so as to raise and support the shoulder, while
+the patient walks about, a serviceable result is usually obtained; the
+only drawback being that an unsightly swelling remains at the seat of
+the break. To make a sling, a piece of strong cotton cloth a yard
+square should be cut diagonally from corner to corner, making two
+right-angled triangles. Each of these will make a properly shaped
+piece for a sling. (See Figs. 10 and 11.)
+
+Fracture of the collar bone happens very often in little children,
+and is commonly only a partial break or splitting of the bone, not
+extending wholly through the shaft so as to divide it into two
+fragments, but causing little more than bending of the bone (the
+"green-stick fracture").
+
+[Illustration: FIG. 10.
+
+HOW TO MAKE A SLING (SCUDDER).
+
+In Fig. 10 note three-cornered bandage; No. 2 end is carried over
+right shoulder, No. 1 over left, then both fastened behind neck; No. 3
+brought over and pinned.]
+
+[Illustration: FIG. 11.
+
+HOW TO MAKE A SLING (SCUDDER).
+
+The above illustration shows sling in position. It is made of cotton
+cloth a yard square cut diagonally from corner to corner.]
+
+A fall from a chair or bed is sufficient to cause the accident. A
+child generally cries out on movement of the arm of the injured side,
+or on being lifted by placing the hands under the armpits of the
+patient. A tender swelling is seen at the point of the injury of the
+collar bone. A broad cotton band, with straps over the shoulders to
+keep it up, should encircle the body and upper arm of the injured
+side, and the hand of the same side should be supported by a narrow
+sling fastened above behind the neck.
+
+
+=LOWER-JAW FRACTURE.=
+
+_First Aid Rule.--Put fragments into place with your fingers, securing
+good line of his teeth. Support lower jaw by firmly bandaging it
+against upper jaw, mouth shut, using four-tailed bandage. (Fig. 12.)_
+
+Fracture of the lower jaw is caused by a direct blow. It involves the
+part of the jaw occupied by the lower teeth, and is more apt to occur
+in the middle line in front, or a short distance to one side of this
+point. The force causing the break usually not only breaks the bone,
+but also tears the gum through into the mouth, making a compound
+fracture. There is immediate swelling of the gum at the point of
+injury, and bleeding. The mouth can be opened with difficulty.
+
+The condition of the teeth is the most important point to observe.
+Owing to displacement of the fragments there is a difference in the
+level of the teeth or line of the teeth, or both, at the place where
+the fracture occurs. Also one or more of the teeth are usually
+loosened at this point. In addition, unusual movement of the
+fragments may be detected as well as a grating sound on manipulation.
+
+=Treatment.=--The broken fragments should be pressed into place with
+the fingers, and retained temporarily with a four-tailed bandage, as
+shown in the cut. Feeding is done through a glass tube, using milk,
+broths, and thin gruels. A mouth wash should be employed four times
+daily, to keep the mouth clean and assist in healing of the gum. A
+convenient preparation consists of menthol, one-half grain; thymol,
+one-half grain; boric acid, twenty grains; water, eight ounces.
+
+[Illustration: FIG. 12.
+
+BANDAGE FOR A BROKEN JAW (AMERICAN TEXT-BOOK).
+
+Above cut shows a four-tailed bandage; note method of tying; one strip
+supports lower jaw; the other holds it in place against upper jaw.]
+
+
+=SHOULDER-BLADE FRACTURE.=
+
+_First Aid Rule.--There is no displacement. Bandage fingers, forearm,
+and arm of affected side, and put this arm in sling. Fasten slung arm
+to body with many turns of a bandage, which holds forearm against
+chest and arm against side._
+
+Shoulder-blade fracture occasions pain, swelling, and tenderness on
+pressure over the point of injury. On manipulating the bone a grating
+sound may be heard and unnatural motion detected. The treatment
+consists in bandaging the forearm and arm on the injured side from
+below upward, beginning at the wrist; slinging the forearm bent at a
+right angle across the front of the body, suspended by a narrow sling
+from the neck, and then encircling the body and arm of the injured
+side from shoulder to elbow with a wide bandage applied under the
+sling, which holds the arm snugly against the side. This bandage is
+prevented from slipping down by straps attached to it and carried over
+each shoulder.
+
+
+=ARM FRACTURE.=
+
+_First Aid Rule.--Pad two pieces of thin board nine by three inches
+with handkerchiefs. Carefully pull fragments of bone apart, grasping
+lower fragment near elbow while assistant pulls gently on upper
+fragment near shoulder. Put padded boards (splints) one each side of
+the fracture, and wind bandage about their whole length, tightly
+enough to keep bony fragments firm in position. Put forearm and hand
+in sling._
+
+In fracture of the arm between the shoulder and elbow, swelling and
+shortening may give rise to deformity. Pain and abnormal motion are
+symptoms, while a grating sound may be detected, but manipulation of
+the arm for this purpose should be avoided. The surface is apt soon to
+become black and blue, owing to rupture of the blood vessels beneath
+the skin.
+
+The hand and forearm should be bandaged from below upward to the
+elbow. The bone is put in place by grasping the patient's elbow and
+pulling directly down in line with the arm, which is held slightly
+away from the side of the patient, while an assistant steadies and
+pulls up the shoulder. Then a wedge-shaped pad, long enough to reach
+from the patient's armpit to his elbow (made of cotton wadding or
+blanketing sewed in a cotton case) and about four inches wide and
+three inches thick at one end, tapering up to a point at the other, is
+placed against the patient's side with the tapering end uppermost in
+the armpit and the thick end down. This pad is kept in place by a
+strip of surgeon's adhesive plaster, or bandage passing through the
+small end of the wedge, and brought up and fastened over the shoulder.
+
+[Illustration: FIG. 13.
+
+FIG. 14.
+
+BANDAGE FOR BROKEN ARM (SCUDDER).
+
+In Fig. 13 note splints secured by adhesive plaster; also pad in
+armpit; in Fig. 14 see wide bandage around body; also sling.]
+
+While the arm is pulled down from the shoulder, three strips of
+well-padded tin or thin board (such as picture-frame backing) two
+inches wide and long enough to reach from shoulder to elbow, are laid
+against the front, outside, and back of the arm, and secured by
+encircling strips of surgeon's plaster or bandage. The arm is then
+brought into the pad lying against the side under the armpit, and is
+held there firmly by a wide bandage surrounding the arm and entire
+chest, and reaching from the shoulder to elbow. It is prevented from
+slipping by strips of cotton cloth, which are placed over the
+shoulders and pinned behind and before to the top of the bandage. The
+wrist is then supported in a sling, not over two inches wide, with the
+forearm carried in a horizontal position across the front of the body.
+Firm union of the broken arm takes place usually in from four to six
+weeks. (See Figs. 13 and 14.)
+
+
+=FOREARM FRACTURE.=
+
+_First Aid Rule.--Set bones in proper place by pulling steadily on
+wrist while assistant holds back the upper part of the forearm. If
+unsuccessful, leave it for surgeon to reduce after "period of
+inaction" comes, a few days later, when swelling subsides. If
+successful, put padded splints (pieces of cigar box padded with
+handkerchiefs) one on each side, front and back, and wind a bandage
+about whole thing to hold it immovably._
+
+Two bones enter into the structure of the forearm. One or both of
+these may be broken. The fracture may be simple or compound,[7] when
+the soft parts are damaged and the break of the bone communicates with
+the air, the ends of the bone even projecting through the skin.
+
+In fracture of both bones there is marked deformity, caused by
+displacement of the broken fragments, and unusual motion may be
+discovered; a grating sound may also be detected but, as stated
+before, manipulation of the arm should be avoided.
+
+[Illustration: FIG. 15.
+
+SETTING A BROKEN FOREARM (SCUDDER).
+
+See manner of holding arm and applying adhesive plaster strips; one
+splint is shown, another is placed back of hand and forearm.]
+
+When only one bone is broken the signs are not so marked, but there is
+usually a very tender point at the seat of the fracture, and an
+irregularity of the surface of the bone may be felt at this point. If
+false motion and a grating sound can also be elicited, the condition
+is clear. The broken bones are put into their proper place by the
+operator who pulls steadily on the wrist, while an assistant grasps
+the upper part of the forearm and pulls the other way. The ends of the
+fragments are at the same time pressed into place by the other hand of
+the operator, so that the proper straight line of the limb is
+restored.
+
+[Illustration: FIG. 16.
+
+FRACTURE OF BOTH BONES IN FOREARM (SCUDDER).
+
+This cut shows the position and length of the two padded splints; also
+method of applying adhesive plaster.]
+
+After the forearm is set, it should be held steadily in the following
+position while the splints are applied. The elbow is bent so that the
+forearm is held at right angles with the arm horizontally across the
+front of the chest with the hand extended, open palm toward the body
+and thumb uppermost. The splints, two in number, are made of wood
+about one-quarter inch thick, and one-quarter inch wider than the
+forearm. They should be long enough to reach from about two inches
+below the elbow to the root of the fingers. They are covered smoothly
+with cotton wadding, cotton wool, or other soft material, and then
+with a bandage. The splints are applied to the forearm in the
+positions described, one to the back of the hand and forearm, and the
+other to the palm of the hand and front of the forearm.
+
+Usually there are spaces in the palm of the hand and front of the
+wrist requiring to be filled with extra padding in addition to that on
+the splint. The splints are bound together and to the forearm by three
+strips of surgeon's adhesive plaster or bandage, about two inches
+wide. One strip is wound about the upper ends of the splints, one is
+wrapped about them above the wrist, and the third surrounds the back
+of the hand and palm, binding the splints together below the thumb.
+The splints should be held firmly in place, but great care should be
+exercised to use no more force in applying the adhesive plaster or
+bandage than is necessary to accomplish this end, as it is easy to
+stop the circulation by pressure in this part. There should be some
+spring felt when the splints are pressed together after their
+application. A bandage is to be applied over the splints and strips of
+plaster, beginning at the wrist and covering the forearm to the elbow,
+using the same care not to put the bandage on too firmly. The forearm
+is then to be held in the same position by a wide sling, as shown
+above. (See Figs. 15, 16, 17.)
+
+[Illustration: FIG. 17.
+
+DRESSING FOR BROKEN FOREARM (SCUDDER).
+
+Proper position of arm in sling; note that hand is unsupported with
+palm turned inward and thumb uppermost.]
+
+Four weeks are required to secure firm union after this fracture. When
+the fracture is compound the same treatment should be employed as
+described under Compound Fracture of Leg, p. 116.
+
+
+=FRACTURE OF THE WRIST; COLLES'S FRACTURE.=--This is a break of the
+lower end of the bone on the thumb side of the wrist, and much the
+larger bone in this part of the forearm. The accident happens when a
+person falls and strikes on the palm of the hand; it is more common in
+elderly people. A peculiar deformity results. A hump or swelling
+appears on the back of the wrist, and a deep crease is seen just above
+the hand in front. The whole hand is also displaced at the wrist
+toward the thumb side.
+
+[Illustration: FIG. 18.
+
+A BROKEN WRIST (SCUDDER).
+
+Characteristic appearance of a "Colles's fracture"; note backward
+displacement of hand at wrist; also fork-shaped deformity.]
+
+It is not usual to be able to detect abnormal motion in the case of
+this fracture, or to hear any grating sound on manipulating the part,
+as the ends of the fragments are generally so jammed together that
+it is necessary to secure a surgeon as soon as possible to pull them
+apart under ether, in order to remedy the existing "silver-fork"
+deformity. (See Figs. 18, 19, 20, 21, 22.)
+
+=Treatment.=--Until medical aid can be obtained the same sort of
+splints should be applied, and in the same way as for the treatment of
+fractured forearm. If the deformity is not relieved a stiff and
+painful joint usually persists. It is sometimes impossible for the
+most skillful surgeon entirely to correct the existing deformity, and
+in elderly people some stiffness and pain in the wrist and fingers are
+often unavoidable results.
+
+[Illustration: FIG. 19.
+
+FIG. 20.
+
+FIG. 21.
+
+FIG. 22.
+
+FRACTURE OF THE WRIST (SCUDDER).
+
+Above illustrations show deformities resulting from a broken wrist;
+Figs. 19 and 20 the crease at base of thumb; Fig. 21 hump on back of
+wrist; Fig. 22 twisted appearance of hand.]
+
+
+=FRACTURE OF BONE OF HAND, OR FINGER.=
+
+_First Aid Rule.--Set fragments of bone in place by pulling with one
+hand on finger, while pressing fragments into position with other
+hand. Put on each side of bone a splint made of cigar box, padded with
+folded handkerchiefs, and retain in place with bandage wound about
+snugly. Put forearm and hand in sling._
+
+This accident more commonly happens to the bones corresponding to the
+middle and ring finger, and occurs between the knuckle and the wrist,
+appearing as a swelling on the back of the hand. On looking at the
+closed fist it will be seen that the knuckle corresponding to the
+broken bone in the back of the hand has ceased to be prominent, and
+has sunken down below the level of its fellows. The end of the
+fragment nearer the wrist can generally be felt sticking up in the
+back of the hand.
+
+[Illustration: FIG. 23.
+
+A BROKEN FINGER (SCUDDER).
+
+Note splint extending from wrist to tip of finger; also manner of
+applying adhesive plaster strips and pad in palm.]
+
+If the finger corresponding to the broken bone in the back of the hand
+be pulled on forcibly, and the fragments be held between the thumb and
+forefinger of the other hand of the operator, pain and abnormal
+motion may be detected, and the ends of the broken bone pressed into
+place. A thin wooden splint, as a piece of cigar box, about an inch
+wide at base and tapering to the width of the finger should be applied
+to the palm of the hand extending from the wrist to a little beyond
+the finger tip, secured by strips of adhesive plaster, as in the cut,
+and covered by a bandage. The splint should be well padded, and an
+additional pad should be placed in the palm of the hand over the point
+of fracture. Three weeks are required for firm union, and the hand
+should not be used for a month.
+
+It is usually easy to recognize a broken bone in a finger, unless the
+break is near a joint, when it may be mistaken for a dislocation.
+Pain, abnormal motion, and grating between the fragments are observed.
+
+If there is deformity, it may be corrected by pulling on the injured
+finger with one hand, while with the other the fragments are pressed
+into line. A narrow, padded wooden or tin splint is applied, as in the
+cut (p. 102), reaching from the middle of the palm to the finger tip.
+Any existing displacement of the broken bone can be relieved by using
+pressure with little pads of cotton held in place by narrow strips of
+adhesive plaster where it is needed to keep the bone in line. The
+splint may be removed in two weeks and a strip of adhesive plaster
+wound about the finger to support it for a week or two more.
+
+In fracture of the thumb, the splint is applied along the back instead
+of on the palm side.
+
+
+=HIP FRACTURE.=
+
+_First Aid Rule.--Put patient flat on back in bed, with limb wedged
+between pillows till surgeon arrives._
+
+[Illustration: FIG. 24.
+
+TREATING A BROKEN HIP (SCUDDER).
+
+Note the manner of straightening leg and getting broken bone into
+line; also assistant carefully steadying the thigh.]
+
+A fracture of the hip is really a break of that portion of the thigh
+bone which enters into the socket of the pelvic bone and forms the hip
+joint. It occurs most commonly in aged people as a result of so slight
+an accident as tripping on a rug, or in falling on the floor from the
+standing position, making a misstep, or while attempting to avoid a
+fall. When the accident has occurred the patient is unable to rise or
+walk, and suffers pain in the hip joint. When he has been helped to
+bed it will be seen that the foot of the injured side is turned out,
+and the leg is perhaps apparently shorter than its fellow. There is
+pain on movement of the limb, and the patient cannot raise his heel,
+on the injured side, from the bed. Shortening is an important sign.
+
+With the patient lying flat on the back and both legs together in a
+straight line with the body, measurements from each hip-bone are made
+with a tape to the bony prominence on the inside of each ankle, in
+turn. One end of the tape is held at the navel and the other is swung
+from one ankle to the other, comparing the length of the two limbs.
+Shortening of less than half an inch is of no importance as a sign of
+fracture. The fragments of broken bone are often jammed together
+(impacted) so that it is impossible to get any sound of grating
+between them, and it is very unwise to manipulate the leg or hip
+joint, except in the gentlest manner, in an attempt to get this
+grating. If the ends of the fragments become disengaged from each
+other it often happens that union of the break never occurs.
+
+[Illustration: FIG. 25.
+
+TREATMENT FOR FRACTURED HIP (SCUDDER).
+
+Note method of holding splints in place with muslin strips; one above
+ankle, one below and one above knee, one in middle and one around
+upper part of thigh.]
+
+The treatment simply consists in keeping the patient quiet on a hard
+mattress, with a small pillow under the knee of the injured side and
+the limb steadied on either side by pillows or cushions until a
+surgeon can be obtained. (See Thigh-bone Fracture.)
+
+
+=THIGH-BONE FRACTURE.=
+
+_First Aid Rule.--Prepare long piece of thin board which will reach
+from armpit to ankle, and another piece long enough to reach from
+crotch to knee, and pad each with folded towels or blanket._
+
+_While one assistant holds body back, and another assistant pulls on
+ankle of injured side, see that the fragments are separated and
+brought into good line, and then apply the splints, assistants still
+pulling steadily, and fasten the splints in place with bandage, or by
+tying several cloths across at three places above the knee and two
+places below the knee._
+
+_Finally, pass a wide band of cloth about the body, from armpit to
+hips, inclosing the upper part of the well-padded splint, and fasten
+it snugly. The hollow between splint and waist must be filled with
+padding before this wide cloth is applied._
+
+In fracture of the thigh bone (between the hip and knee), there is
+often great swelling about the break. The limb is helpless and
+useless. There is intense pain and abnormal position in the injured
+part, besides deformity produced by the swelling. The foot of the
+injured limb is turned over to one side or the other, owing to a
+rolling over of the portion of the limb below the break. With both
+lower limbs in line with the body, and the patient lying on the back,
+measurements are made from each hip-bone to the prominence on the
+inside of either ankle joint. Shortening of the injured leg will be
+found, varying from one to over two inches, according to the
+overlapping and displacement of the fragments.
+
+=Treatment.=--To set this fracture temporarily, a board about five
+inches wide and long enough to reach from the armpit to the foot
+should be padded well with towels, sheets, shawls, coats, blanket, or
+whatever is at hand, and the padding can best be kept in place by
+surgeon's adhesive plaster, bicycle tape, or strips of cloth.[8]
+Another splint should be provided as wide as the thigh and long enough
+to reach along the back of the leg from the middle of the calf to the
+buttock, and also padded in the same way. A third splint should be
+prepared in the same manner to go inside the leg, reaching from the
+crotch to the inside of the foot. Still a fourth splint made of a thin
+board as wide as the thigh, extending from the upper part of the thigh
+to just above the knee, is padded for application to the front of the
+thigh.
+
+When these are made ready and at hand, the leg should be pulled on
+steadily but carefully straight away from the body to relax the
+muscles, an assistant holding the upper part of the thigh and pulling
+in the opposite direction. Then, when the leg has been straightened
+out and the thigh bone seems in fair line, the splints should be
+applied; the first to the outside of the thigh and body, the second
+under the calf, knee, and thigh; the third to the inside of the whole
+limb, and the fourth to the front of the thigh.
+
+Wide pads should be placed over the ribs under the outside splint to
+fill the space above the hips and under the armpit. Then all four
+splints are drawn together and held in place by rubber-plaster straps
+or strips of strong muslin applied as follows: one above the ankle;
+one below the knee; one above the knee; one in the middle of the
+thigh, and one around the upper part of the thigh. A wide band of
+strong muslin or sheeting should then be bound around the whole body
+between the armpits and hips, inclosing the upper part of the outside
+splint. The patient can then be borne comfortably upon a stretcher
+made of boards and a mattress or some improvised cushion. (See Figs.
+24 and 25.)
+
+When the patient can be put immediately to bed after the injury, and
+does not have to be transported, it is only necessary to apply the
+outer, back, and front splints, omitting the inner splint. It is
+necessary for the proper and permanent setting of a fractured thigh
+that a surgeon give an anaesthetic and apply the splints while the
+muscles are completely relaxed. It is also essential that the muscles
+be kept from contracting thereafter by the application of a fifteen-
+or twenty-pound weight to the leg, after the splints are applied, but
+it is possible to outline here only the proper first-aid treatment.
+
+
+=KNEEPAN FRACTURE.=
+
+_First Aid Rule.--Pain is immediate and intense. Separated fragments
+may be felt at first. Swelling prompt and enormous. Even if not sure,
+follow these directions for safety._
+
+_Prepare splint: thin board, four inches wide, and long enough to
+reach from upper part of thigh to just above ankle. Pad with folded
+piece of blanket or soft towels. Place it behind leg and thigh;
+carefully fill space behind knee with pad; fasten splint to limb with
+three strips of broad adhesive plaster, one around upper end of
+splint, one around lower end, one just below knee._
+
+_Lay large flat, dry sponge over knee thus held, and bandage this in
+place. Keep sponge and bandage wet with ice water. If no sponge is
+available, half fill rubber hot-water bottle with cracked ice, and lay
+this over knee joint. Put patient to bed._
+
+Fracture of kneepan is caused either by direct violence or muscular
+strain. It more frequently occurs in young adults. Immediate pain is
+felt in the knee and walking becomes impossible; in fact, often the
+patient cannot rise from the ground after the accident. Swelling at
+first is slight, but increases enormously within a few hours.
+Immediately after the injury it may be possible to feel the separate
+broken fragments of the kneepan and to recognize that they are
+separated by a considerable space if the break is horizontally across
+the bone.
+
+[Illustration: FIG. 26.
+
+A BROKEN KNEEPAN (SCUDDER).
+
+A padded splint, supporting knee, is shown reaching from ankle to
+thigh. Note number and location of adhesive plaster strips.]
+
+Nothing can be done to set the fracture until the swelling about the
+joint has been reduced, so that the first treatment consists in
+securing immediate rest for the kneejoint, and immobility of the
+fragments. A splint made of board, about a quarter of an inch thick
+and about four inches wide for an adult, reaching from the upper part
+of the thigh above to a little above the ankle below, is applied to
+the back of the limb and well padded, especially to fill the space
+behind the knee. The splint is attached to the limb by straps of
+adhesive plaster two inches and a half wide; one around the lower end
+of the splint, one around the upper part, and the third placed just
+below the knee. To prevent and arrest the swelling and pain, pressure
+is then made on the knee by bandaging.
+
+One of the best methods (Scudder's) is to bind a large, flat, dry
+sponge over the knee and then keep it wet with cold water; or to apply
+an ice bag directly to the swollen knee; a splint in either case being
+the first requisite. The patient should of course be put to bed as
+soon as possible after the accident, and should lie on the back with
+the injured leg elevated on a pillow with a cradle to keep the clothes
+from pressing on the injured limb. (See cut, p. 110.)
+
+
+=FRACTURE OF LEG BONES, BETWEEN KNEE AND ANKLE.=
+
+_First Aid Rule.--Handle very carefully; great danger of making
+opening to surface. Special painful point, angle or new joint in bone,
+disability, and grating felt will decide existence of break. Let
+assistant pull on foot, to separate fragments, while you examine part
+of supposed break. If only one bone is broken, there may be no
+displacement._
+
+_Put patient on back. While two assistants pull, one on ankle and one
+on thigh at knee, thus separating fragments, slide pillow lengthwise
+under knee, and, bringing its edges up about leg, pin them snugly
+above leg._
+
+_Prepare three pieces of thin wood, four inches wide and long enough
+to reach from sole of foot to a point four inches above knee. While
+assistants pull on limb again, as before, put one splint each side
+and third behind limb, and with bandage or strips of sticking plaster
+fasten these splints to the leg inclosed in its pillow as tight as
+possible._
+
+In fracture of the leg between the knee and ankle we have pain,
+angular deformity or an apparent false joint in the leg, swelling and
+tenderness over the seat of fracture, together with inability to use
+the injured leg. Two bones form the framework of the leg; the inner,
+or shinbone, the sharp edge of which can be felt in front throughout
+most of its course, being much the larger and stronger bone. When both
+bones are broken, the displacement of the fragments, abnormal motion
+and consequent deformity, are commonly apparent, and a grating sound
+may be heard, but should not be sought for.
+
+[Illustration: FIG. 27.
+
+FRACTURE OF BOTH LEG BONES (SCUDDER).
+
+This cut shows the peculiar deformity in breaks of this kind; see
+position of kneepan; also prominence of broken bone above ankle.]
+
+An open wound often communicates with the break, making the fracture
+compound, a much more serious condition. To avoid making the fracture
+a compound one, during examination of the leg, owing to the sharp
+ends of the bony fragments, the utmost gentleness should be used.
+Under no circumstances attempt to move the fragments from side to
+side, or backward and forward, in an effort to detect the grating
+sound often caused by the ends of broken bones. The greatest danger
+lies in the desire to do too much. We again refer the reader to First
+Aid Rule 1.
+
+[Illustration: FIG. 28.
+
+BANDAGE FOR BROKEN LEG (SCUDDER).
+
+Note the pillow brought up around leg and edges pinned together; also
+length and method of fastening splint with straps.]
+
+When one bone is broken there may be only a point of tenderness and
+swelling about the vicinity of the break and no displacement or
+grating sound. When in doubt as to the existence of a fracture always
+treat the limb as if a fracture were present. "Black and blue"
+discoloration of the skin much more extensive than that following
+sprain will become evident over the whole leg within twenty-four
+hours.
+
+=Treatment.=--When a surgeon cannot be obtained, the following
+temporary pillowdressing, recommended by Scudder in his book on
+fractures, is one of the best. With the patient on his back, the leg
+having been straightened and any deformity removed as far as possible
+by grasping the foot and pulling directly away from the body while an
+assistant steadies the thigh, a large, soft pillow, inclosed in a
+pillowcase, is placed under the leg. The sides of the pillow are
+brought well up about the leg and the edges of the pillowcase are
+pinned together along the front of the leg.
+
+Then three strips of wood about four inches wide, three-sixteenths to
+a quarter of an inch thick, and long enough to reach from the sole of
+the foot to about four inches above the knee, are placed outside of
+the pillow along the inner and outer aspects of the leg and beneath
+it. The splints are held in place, with the pillow as padding beneath,
+by four straps of webbing (or if these cannot be obtained, by strips
+of stout cloth, adhesive plaster, or even rope); but four pads made of
+folded towels should be put under the straps where they cross the
+front of the leg where little but the pillowcase overlaps. These
+straps are applied thus: one above the knee, one above the ankle, and
+the other two between these two points, holding all firmly together.
+This dressing may be left undisturbed for a week or even ten days if
+necessary. (See Figs. 27 and 28.)
+
+The leg should be kept elevated after the splints are applied, and
+steadied by pillows placed either side of it. From one to two months
+are required to secure union in a broken leg in adults, and from three
+to five months elapse before the limb is completely serviceable. In
+children the time requisite for a cure is usually much shorter.
+
+
+=ANKLE-JOINT FRACTURE.=
+
+_First Aid Rule.--One or both bones of leg may be broken just above
+ankle. Foot is generally pushed or bent outward. Prepare two pieces of
+thin wood, four inches wide and long enough to go from sole of foot to
+just below knee:--the splints. Pad them with folded towels or pieces
+of blanket._
+
+_While assistants pull bones apart gently, one pulling on knee, other
+pulling on foot and turning it straight, apply the splints, one each
+side of the leg._
+
+A fracture of the ankle joint is really a fracture of the lower
+extremities of the bones of the leg. There are present pain and great
+swelling, particularly on the inner side of the ankle at first, and
+the whole foot is pushed and bent outward. The bony prominence on the
+inner side of the ankle is unduly marked. The foot besides being bent
+outward is also displaced backward on the leg. This fracture might be
+taken for a dislocation or sprain of the ankle. Dislocation of the
+ankle without fracture is very rare, and when the foot is returned to
+its proper position it will stay there, while in fracture the foot
+drops back to its former displaced state. In sprained ankle there are
+pain and swelling, but not the deformity caused by the displacement of
+the foot.
+
+This fracture may be treated temporarily by returning the foot to its
+usual position and putting on side splints and a back splint, as
+described for the treatment of fracture of the leg.
+
+
+=COMPOUND OR OPEN FRACTURE OF THE LEG.=--This condition may be
+produced either by the violence which caused the fracture also leading
+to destruction of the skin and soft parts beneath, or by the end of a
+bony fragment piercing the muscles and skin from within. In either
+event the result is much more serious than that of an ordinary simple
+fracture, for germs can gain entrance through the wound in the skin
+and cause inflammation with partial destruction or death of the part.
+
+=Treatment.=--Immediate treatment is here of the utmost value. It is
+applicable to open or compound fracture in any part of the body. The
+area for a considerable distance about the wound, if covered with
+hair, should be shaved. It should then be washed with warm water and
+soap by means of a clean piece of cotton cloth or absorbent cotton.
+Then some absorbent cotton or cotton cloth should be boiled in water
+in a clean vessel for a few minutes, and, after the operator has
+thoroughly washed his hands, the boiled water (when sufficiently cool)
+should be applied to the wounded area and surrounding parts with the
+boiled cotton, removing in the most painstaking way all visible and
+invisible dirt. By allowing some of the water to flow over the wound
+from the height of a few feet this result is favored. Finally some of
+the boiled cotton, which has not been previously touched, is spread
+over the wound wet, and covered with clean, dry cotton and bandaged.
+
+Splints are then applied as for simple fracture in the same locality
+(p. 113). If a fragment of bone projects through the wound it may be
+replaced after the cleansing just described, by grasping the lower
+part of the limb and pulling in a straight line of the limb away from
+the body, while an assistant holds firmly the upper part of the limb
+and pulls in the opposite direction. During the whole process neither
+the hands of the operator nor the boiled cotton should come in contact
+with anything except the vessel containing the boiled water and the
+patient.
+
+
+FOOTNOTES:
+
+[5] The engravings illustrating the chapters on "Fractures" and
+"Dislocations" are from Buck's "Reference Handbook of Medical
+Science," published by William Wood & Co., New York; also, Scudder's
+"Treatment of Fractures" and "American Text-Book of Surgery,"
+published by W. B. Saunder's Company, Philadelphia.
+
+[6] It should be distinctly understood that the information about
+fractures is not supplied to enable anyone to avoid calling a surgeon,
+but is to be followed only until expert assistance can be obtained
+and, like other advice in this book, is intended to furnish first-aid
+information or directions to those who are in places where physicians
+cannot be secured.
+
+[7] For treatment of compound fracture, see Compound Fracture of Leg
+(p. 116).
+
+[8] This method follows closely that recommended by Scudder, in his
+book "The Treatment of Fractures."
+
+
+
+
+CHAPTER V
+
+=Dislocations=
+
+_How to Tell a Dislocation--Reducing a Dislocated Jaw--Stimson's
+Method of Treating a Dislocated Shoulder--Appearance of Elbow when Out
+of Joint--Hip Dislocations--Forms of Bandages._
+
+
+=DISLOCATIONS; BONES OUT OF JOINT.=
+
+=JAW.=--Rare. Mouth remains open, lower teeth advanced forward.
+
+_First Aid Rule 1.--Protect your thumbs. Put on thick leather gloves,
+or bind them with thick bandage._
+
+_Rule 2.--Assistant steadies patient from behind, with hands both
+sides of his head, operator presses downward and backward with his
+thumbs on back teeth of patient, each side of patient's jaw, while the
+chin is grasped between forefingers and raised upward. Idea is to
+stretch the ligament at jaw joint, and swing jaw back while pulling on
+this ligament. (Fig. 29.)_
+
+_Rule 3.--Tie jaw with four-tailed bandage up against upper jaw for a
+week. (Fig. 12, p. 90.)_
+
+
+=SHOULDER.=--Common accident. No hurry. See p. 122.
+
+
+=ELBOW.=--Rare. No hurry. See p. 125.
+
+
+=HIP.=--No hurry. See p. 129.
+
+
+=KNEE.=--Rare. Easily reduced. Head of lower bone (tibia) is moved to
+one side; knee slightly bent.
+
+_First Aid Rule 1.--Put patient on back._
+
+_Rule 2.--Flex thigh on abdomen and hold it there._
+
+_Rule 3.--Grasp leg below knee and twist it back and forth, and
+straighten knee._
+
+
+=DISLOCATIONS.=--A dislocation is an injury to a joint wherein the
+ends of the bones forming a joint are forced out of place. A
+dislocation is commonly described as a condition in which a part (as
+the shoulder) is "out of joint" or "out of place." A dislocation must
+be distinguished from a sprain, and from a fracture near a joint. In a
+sprain, as has been stated (p. 65), the bones entering into the
+formation of the joint are perhaps momentarily displaced, but return
+into their proper place when the violence is removed. But, owing to
+greater injury, in dislocation the head of the bone slips out of the
+socket which should hold it, breaks through the ligaments surrounding
+the joint, and remains permanently out of place. For this reason there
+is a peculiar deformity, produced by the head of the bone's lying in
+its new and unnatural situation, which is not seen in a sprain.
+
+Also, the dislocated joint cannot be moved by the patient or by
+another person, except within narrow limits, while a sprained joint
+can be moved, with the production of pain it is true, but without any
+mechanical obstacle. In the case of fracture near a joint there is
+usually increased movement in some new direction. When a dislocated
+joint is put in proper place it stays in place, whereas when a
+fractured part is reduced there is nothing to keep it in place and, if
+let alone, it quickly resumes its former faulty position.
+
+Only a few of the commoner dislocations will be considered here, as
+the others are of rare occurrence and require more skill than can be
+imparted in a book intended for the laity. The following instructions
+are not to be followed if skilled surgical attendance can be secured;
+they are intended solely for those not so fortunately situated.
+
+
+=DISLOCATION OF THE JAW.=--This condition is caused by a blow on the
+chin, or occurs in gaping or when the mouth is kept widely open during
+prolonged dental operations. The joint surface at the upper part of
+the lower jaw, just in front of the entrance to the ear, is thrown out
+of its socket on one side of the face, or on both sides. If the jaw is
+put out of place on both sides at once, the chin will be found
+projecting so that lower front teeth jut out beyond the upper front
+teeth, the mouth is open and cannot be closed, and the patient is
+suffering considerable pain. When the jaw is dislocated on one side
+only, the chin is pushed over toward the uninjured side of the face,
+which gives the face a twisted appearance; the mouth is partly open
+and fixed in that position. A depression is seen on the injured side
+in front of the ear, while a corresponding prominence exists on the
+opposite side of the face, and the lower front teeth project beyond
+the upper front teeth.
+
+[Illustration: FIG. 29.
+
+REDUCING DISLOCATION OF JAW (AMERICAN TEXT-BOOK).
+
+Thumbs placed upon last molar teeth on each side; note jaw grasped
+between fingers and thumbs to force it into place.]
+
+=Treatment.=--A dislocation of one side of the jaw is treated in the
+same manner as that of both sides.
+
+The dislocation may sometimes be reduced by placing a good-sized cork
+as far back as possible between the back teeth of the upper and lower
+jaws (on one or both sides, according as the jaw is out of place on
+one or both sides), and getting the patient to bite down on the cork.
+This may pry the jaw back into place.
+
+The common method is for the operator to protect both thumbs by
+wrapping bandage about his thumbs, or wearing leather gloves, and
+then, while an assistant steadies the head, the operator presses
+downward and backward on the back teeth of the patient on each side of
+the lower jaw with both thumbs in the patient's mouth, while the chin
+is grasped beneath by the forefingers of each hand and raised upward.
+When the jaw slips into place it should be maintained there by a
+bandage placed around the head under the chin and retained there for a
+week. During this time the patient should be fed on liquids through a
+tube, so that it will not be necessary for him to open his mouth to
+any extent. (See Fig. 29.)
+
+
+=DISLOCATION OF THE SHOULDER.=--This is by far the most common of
+dislocations in adults, constituting over one-half of all such
+accidents affecting any of the joints. It is caused by a fall or blow
+on the upper arm or shoulder, or by falling upon the elbow or
+outstretched hand. The upper part (or head) of the bone of the arm
+(humerus) slips downward out of the socket or, in some cases, inward
+and forward. In either case the general appearance and treatment of
+the accident are much the same. The shoulder of the injured side loses
+its fullness and looks flatter in front and on the side. The arm is
+held with the elbow a few inches away from the side, and the line of
+the arm is seen to slope inwardly toward the shoulder, as compared
+with the sound arm.
+
+The injured arm cannot be moved much by the patient, although it can
+be lifted up and away from the side by another person, but cannot be
+moved so that, with the elbow against the front of the chest, the hand
+of the injured arm can be laid on the opposite shoulder. Neither can
+the arm, with the elbow at a right angle, be made to touch the side
+with the elbow, without causing great pain.
+
+=Treatment.=--One of the simplest methods (Stimson's) of reducing this
+dislocation consists in placing the patient on his injured side on a
+canvas cot, which should be raised high enough from the floor on
+chairs, and allowing the injured arm to hang directly downward toward
+the floor through a hole cut in the cot, the hand not touching the
+floor. Then a ten-pound weight is attached to the wrist. The gradual
+pull produced by this means generally brings the shoulder back into
+place without pain and within six minutes. (Fig. 30.)
+
+[Illustration: FIG. 30.
+
+TREATING A DISLOCATED SHOULDER.
+
+(REFERENCE HANDBOOK.)
+
+Patient lying on injured side; note arm hanging through hole in cot
+raised from floor on chairs; also weight attached to wrist.]
+
+The more ordinary method consists in putting the patient on his back
+on the floor, the operator also sitting on the floor with his
+stockinged foot against the patient's side under the armpit of the
+injured shoulder and grasping the injured arm at the elbow, he pulls
+the arm directly outward (i. e., with the arm at right angles with the
+body) and away from the trunk. An assistant may at the same time aid
+by lifting the head of the arm bone upward with his fingers in the
+patient's armpit and his thumbs over the injured shoulder.
+
+If the arm does not go into place easily by one of these methods it is
+unwise to continue making further attempts. Also if the shoulder has
+been dislocated several days, or if the patient is very muscular, it
+will generally be necessary that a surgeon give ether in order to
+reduce the dislocation. It is entirely possible for a skillful surgeon
+to secure reduction of a dislocation of the shoulder several weeks
+after its occurrence. After the dislocation has been relieved the arm,
+above the elbow, should be bandaged to the side of the chest and the
+hand of the injured side carried in a sling for ten days.
+
+
+=DISLOCATION OF THE ELBOW.=--This is more frequent in children, and is
+usually produced by a fall on the outstretched hand. The elbow is
+thrown out of joint, so that the forearm is displaced backward on the
+arm, in the more usual form of dislocation. The elbow joint is swollen
+and generally held slightly bent, but cannot be moved to any extent
+without great pain. The tip of the elbow projects at the back of the
+joint more than usual, while at the front of the arm the distance
+between the wrist and the bend of the elbow is less than that of the
+sound arm. (See cut, p. 126.)
+
+[Illustration: FIG. 31.
+
+Above cut shows characteristic appearance of a dislocated shoulder;
+note loss of fullness; also elbow held away from side and inward
+sloping of arm.
+
+FIG. 32.
+
+DISLOCATED ELBOW AND SHOULDER.
+
+(AMERICAN TEXT-BOOK.)
+
+Fig. 32 shows dislocation of elbow backward; note swollen condition of
+left elbow held slightly bent; also the projection of back of joint.]
+
+For further proof that the elbow is out of joint we must compare the
+relations of three points in each elbow. These are the two bony
+prominences on each side of the joint (belonging to the bone of the
+arm above the elbow) and the bony prominence that forms the tip of the
+elbow which belongs to the bone of the forearm.
+
+[Illustration: FIG. 33.
+
+TREATMENT OF DISLOCATED ELBOW (SCUDDER).
+
+Note padded right-angled tin splint; also three strips of surgeon's
+plaster on arm and forearm.]
+
+In dislocation backward of the forearm, the tip of the elbow is
+observed to be farther back, in relation to the two bony prominences
+at the side of the joint, than is the case in the sound elbow. This is
+best ascertained by touching the three points on the patient's elbow
+of each arm in turn with the thumb and middle finger on each of the
+prominences on the side of the joint, while the forefinger is placed
+on the tip of the elbow. The lower end of the bone of the upper arm
+is often seen and felt very easily just above the bend of the elbow in
+front, as it is thrown forward (see Fig. 32, p. 126).
+
+Fracture of the lower part of the bone of the arm above the elbow
+joint may present much the same appearance as the dislocation we are
+describing, but then the whole elbow is displaced backward, and the
+relation of the three points described above is the same in the
+injured as in the uninjured arm. Moreover in fracture the deformity,
+when relieved, will immediately recur when the arm is released, as
+there is nothing to hold the bones in place; but in dislocation, after
+the bones are replaced in their normal position, the deformity will
+not reappear.
+
+=Treatment.=--The treatment for dislocation consists in bending the
+forearm backward to a straight line, or even a little more, and then
+while an assistant holds firmly the arm above the elbow, the forearm
+should be grasped below the elbow and pulled with great force away
+from the assistant and, while exerting this traction, the elbow is
+suddenly bent forward to a right angle, when the bones should slip
+into place.
+
+The after treatment is much the same as for most fractures of the
+elbow. The arm is retained in a well-padded right-angled tin splint
+which is applied with three strips of surgeon's plaster and bandage to
+the front of the arm and forearm (see Fig. 33) for two or three weeks.
+The splint should be removed every few days, and the elbow joint
+should be moved to and fro gently to prevent stiffness, and the
+splint then reapplied.
+
+
+=DISLOCATION OF THE HIP.=--This occurs more commonly in males from
+fifteen to forty-five years of age, and is due to external violence.
+In the more ordinary form of hip dislocation the patient stands on the
+sound leg with the body bent forward, the injured leg being greatly
+shortened, with the toes turned inward so much that the foot of the
+injured limb crosses over the instep of the sound foot. The injured
+limb cannot be moved outward and but slightly inward, yet may be bent
+forward. Walking is impossible. Pain and deformity of the hip joint
+are evident.
+
+The only condition with which this would be likely to be confused is a
+fracture of bone in the region of the hip. Fracture of the hip is
+common in old people, but not in youth or middle adult life. In
+fracture there is usually not enough shortening to be perceived with
+the eye; the toes are more often turned out, and the patient can often
+bear some weight on the limb and even walk.
+
+=Treatment.=--The simplest treatment is that recommended by Stimson,
+as follows: the patient is to be slung up in the air in a vertical
+position by means of a sheet or belt of some sort placed around the
+body under the armpits, so that the feet dangle a foot or so from the
+floor, and then a weight of about ten or fifteen pounds, according to
+the strength of the patient's muscles, is attached to the foot of the
+injured leg (bricks, flatirons, or stones may be used), and this
+weight will usually draw the bone down into its socket within ten or
+fifteen minutes.
+
+[Illustration: FIG. 34.
+
+REDUCING DISLOCATION OF HIP (REFERENCE HANDBOOK).
+
+Patient lying on table; uninjured leg held by assistant; leg of
+dislocated side at right angles; note weight at bend of knee.]
+
+Or the patient may assume the position shown in the accompanying cut,
+lying prone upon a table with the uninjured leg held horizontally by
+one person, while another, with the injured thigh held vertically and
+leg at right angles, grasps the patient's ankle and moves it gently
+from side to side after placing a five-to ten-pound sand bag, or
+similar weight of other substance, at the flexure of the knee. When
+the dislocation has been overcome the patient should stay in bed for a
+week or two and then go about gradually on crutches for two weeks
+longer.
+
+
+=SURGICAL DRESSINGS.=--Sterilized gauze is the chief surgical dressing
+of the present day. This material is simply cheese cloth, from which
+grease and dirt have been removed by boiling in some alkaline
+preparation, usually washing soda, and rinsing in pure water. The
+gauze is sterilized by subjecting it to moist or dry heat. Sterilized
+gauze may be bought at shops dealing in surgeons' supplies and
+instruments, and at most drug stores. Gauze or cheese cloth may be
+sterilized (to destroy germs) by baking in a slow oven, in tin boxes,
+or wrapped in cotton cloth, until it begins to turn brown. It is well
+to have a small piece of the gauze in a separate package, which may be
+inspected from time to time in order to see how the baking is
+progressing, as the material to be employed for surgical purposes
+should not be opened until just before it is to be used, any remainder
+being immediately covered again. Cut the gauze into pieces as large as
+the hand, before it is sterilized, to avoid cutting and handling
+afterwards. Gauze may also be sterilized by steaming in an Arnold
+sterilizer, such as is used for milk, or by boiling, if it is to be
+applied wet. Carbolized, borated, and corrosive-sublimate gauze have
+little special value.
+
+[Illustration: PLATE I.
+
+Fig. I.
+
+Fig. II.
+
+Fig. III.
+
+Fig. IV.
+
+APPLYING A ROLLER BANDAGE (REFERENCE HANDBOOK).
+
+Fig. I shows method of starting a spiral bandage; Fig. II, ready to
+reverse; Fig. III, the reverse completed; Fig. IV shows spica bandage
+applied to groin.]
+
+Absorbent cotton is also employed as a surgical dressing, and should
+also be sterilized if it is to be used on raw surfaces. It is not so
+useful for dressing wounds as gauze, since it mats down closely, does
+not absorb secretions and discharges so well, and sticks to the parts.
+When torn into balls as large as an egg and boiled for fifteen minutes
+in water, it is useful as sponges for cleaning wounds. Sheet wadding,
+or cotton, is serviceable in covering splints before they are applied
+to the skin. Wet antiseptic surgical dressings are valuable in
+treating wounds which are inflamed and not healing well. They are made
+by soaking gauze in solutions of carbolic acid (half a teaspoonful of
+the acid to one pint of hot water), and, after application, covering
+the gauze with oil silk, rubber dam, or paraffin paper. Heavy brown
+wrapping paper, well oiled or greased, will answer the purpose when
+better material is not at hand.
+
+
+=BANDAGES.=--Bandaging is an art that can only be acquired in any
+degree of perfection by practical instruction and experience. Some
+useful hints, however, may be given to the inexperienced. Cotton
+cloth, bleached or unbleached, is commonly employed for bandages; also
+gauze, which does not make so effective a dressing, but is much
+easier of application, is softer and more comfortable, and is best
+adapted to the use of the novice. A bandage cannot be put on properly
+unless it is first rolled. A bandage for the limbs should be about two
+and a half inches wide and eight yards long; for the fingers,
+three-quarters of an inch wide and three yards long. The bandage may
+be rolled on itself till it is as large as the finger, and then rolled
+down the front of the thigh, with the palm of the right hand, while
+the loose end is held taut in the left hand.
+
+[Illustration: PLATE II.
+
+Fig. I.
+
+Fig. II.
+
+Fig. III.
+
+Fig. IV.
+
+DIFFERENT FORMS OF BANDAGES.
+
+(AMERICAN TEXT-BOOK AND REFERENCE HANDBOOK.)
+
+Fig. I shows application of figure-of-eight bandage; Fig. II, a spica
+bandage of thumb; Fig. III, a spica bandage of foot; Fig. IV, a
+T-bandage.]
+
+Two forms of bandages are adapted to the limbs, the figure-of-eight,
+and the spiral reversed bandage. In applying a bandage always begin at
+the lower extremity of the limb and approach the body. Make a few
+circular turns about the limb (see Fig. I, p. 132), then as the limb
+enlarges, draw the bandage up spirally, reversing it each time it
+encircles the limb, as shown in Fig. I, p. 134. In reversing, hold the
+bandage with the left thumb so that it will not slip, and then
+allowing the free end to fall slack, turn down as in Fig. II, p. 132.
+
+The T-bandage is used to bandage the crotch between the thighs, or
+around the forehead and over the top of the skull. (See Fig. IV, p.
+134.) In the former case, the ends 1-1 are put about the body as a
+belt, and the end 2 is brought from behind, in the narrow part of the
+back, down forward between the thighs, over the crotch, and up to the
+belt in the lower part of the belly. The figure-of-eight bandage is
+used on various parts, and is illustrated in the bandage called spica
+of the groin, Fig. IV, p. 132. Beginning with a few circular turns
+about the body in the direction of 1, the bandage is brought down in
+front of the body and groin, as in 2, and then about the back of the
+thigh up around the front of the thigh, as in 3, across the back and
+once around the body and down again as in 2. Other bandages
+appropriate to various parts of the body are also illustrated that by
+their help the proper method of their application may be understood.
+See pages 132, 134, 136, 137. The triangular bandage (see p. 88) made
+from a large handkerchief or piece of muslin a yard square, cut or
+folded diagonally from corner to corner, will be found invaluable in
+emergency cases. It is easily and quickly adjusted to almost any part
+of the body, and may be used for dressing wounds, or as a bandage for
+fractures, etc.
+
+[Illustration: PLATE III.
+
+Fig. I.
+
+Fig. II.
+
+BANDAGES FOR EXTREMITIES (AMERICAN TEXT-BOOK).
+
+Fig. I shows a spiral reversed bandage of arm and hand, requiring
+roller 2-1/2 inches wide and 7 yards long; Fig. II shows a spiral
+reversed bandage of leg and foot, requiring roller 2-1/2 inches wide
+and 14 yards long.]
+
+[Illustration: PLATE IV.
+
+Fig. I.
+
+Fig. II.
+
+Fig. III.
+
+Fig. IV.
+
+BANDAGES FOR HEAD AND HAND.
+
+(AMERICAN TEXT-BOOK.)
+
+Fig. I shows a gauntlet bandage; Fig. II, a circular bandage for the
+jaw; Fig. III, a circular bandage for the head; Fig. IV, a
+figure-of-eight bandage for both eyes.]
+
+
+
+
+CHAPTER VI
+
+=Ordinary Poisons=
+
+_Unknown Poisons--Antidotes for Poisoning by Acids and Alkalies--The
+Stomach Pump--Emetics--Symptoms and Treatment of Metal Poisoning--
+Narcotics._
+
+
+_First Aid Rule 1.--Send at once for physician._
+
+_Rule 2.--Empty stomach with emetic._
+
+_Rule 3.--Give antidote._
+
+In most cases of poisoning emetics and purgatives do the most good.
+
+
+=UNKNOWN POISONS.=--Act at once before making inquiry or
+investigation.
+
+_First Aid Rule.--Give two teaspoonfuls of chalk (or whiting, or
+whitewash scraped from the wall or a fence) mixed with a wineglass of
+water. Beat four eggs in a glass of milk, add a tablespoonful of
+whisky, and give at once._
+
+Meanwhile, turn to p. 186, and be prepared to follow Rule 2 under
+Suffocation, in case artificial respiration may be necessary, in spite
+of the stimulant and antidotes. After having taken the first steps,
+try to ascertain the exact poison used, but waste no time at the
+start. If you can find out just what poison was swallowed, give the
+treatment advised under that poison, excepting what you may already
+have given.
+
+
+=ACIDS.=--Symptoms: Corrosion or bleeding of the parts with which they
+come in contact, followed by intense pain, and then prostration from
+shock. Nitric acid stains face yellow; sulphuric blackens; carbolic
+whitens the mucous membrane, and also causes nausea and stupor.
+
+=Treatment.=--_Carbolic:_ Give a tablespoonful of alcohol or wineglass
+of whisky or brandy at once; or one tablespoonful of castor oil, also
+a half pint of sweet oil, also a pint of milk. Put to bed, and apply
+hot-water bottles.
+
+_Nitric and Oxalic:_ Chalk, lime off walls, whitewash scraped off
+fence or wall, one teaspoonful mixed with a quarter of a glass of
+water. Give one tablespoonful castor oil, and half a pint of sweet
+oil. Inject into the rectum one tablespoonful of whisky in two of
+water.
+
+_Sulphuric:_ Soapsuds, half a glass; a pint of milk.
+
+_Other Acids:_ Limewater, or two teaspoonfuls of aromatic spirit of
+ammonia diluted with a glass of water. One tablespoonful of castor
+oil.
+
+
+=ALKALIES.=--Symptoms: Burning and destruction of the mucous membrane
+of mouth, severe pain, vomiting and purging of bloody matter, rapid
+death by shock.
+
+_Ammonia; Potash; Lye; Caustic Soda; Washing Soda:_ Give half a glass
+of vinegar mixed with half a glass of water; also juice of four lemons
+in two glasses of water. One teaspoonful of castor oil in half a glass
+of olive oil. If prostrated, give tablespoonful of whisky in a quarter
+of a glass of hot water.
+
+
+=METALS.=--Symptoms: Great irritation, cramps and purging, suppression
+of urine, delirium or stupor, collapse, and generally death.
+
+_Arsenic; Paris Green; Fowler's Solution; "Rough on Rats":_ Intense
+pain, thirst, griping in bowels, vomiting and bloody purging, shock,
+delirium. Patient picks at the nose. Send to druggist's for two ounces
+hydrated sesquioxide of iron, the best antidote, and give
+tablespoonful every quarter hour in half a glass of water. Meanwhile,
+or if antidote is not to be had, give a glass or two of limewater,
+followed by a teaspoonful of mustard dissolved in a glass of water,
+followed by warm water in any quantity.
+
+_Copper; Blue Vitriol; Verdigris:_ Give one tablespoonful of mustard
+in a glass of warm water. After vomiting, give whites of three eggs,
+one pint of milk.
+
+_Mercury; Corrosive Sublimate; Bug Poison; White Precipitate;
+Bichloride of Mercury:_ Give whites of four eggs for every grain of
+mercury suspected; cause vomiting by giving a tablespoonful of mustard
+mixed with a glass of warm water, or thirty grains of powdered ipecac
+mixed with half a glass of water.
+
+_Silver Nitrate:_ Give two teaspoonfuls of table salt dissolved in
+two glasses of hot water. After half an hour give a tablespoonful of
+castor oil.
+
+_Phosphorous; Matches:_ Give teaspoonful of mustard mixed in a glass
+of water. After vomiting has occurred, give a tablespoonful of gum
+arabic dissolved in a tumblerful of hot water. An hour later give
+tablespoonful of Epsom salts dissolved in a glass of water. GIVE NO
+OIL.
+
+_Antimony; Tartar Emetic:_ Symptoms as stated for metals. Give thirty
+grains of powdered ipecac stirred in wineglass of water, even if
+vomiting has occurred. Give three cups of strong tea, or hot infusion
+of oak bark, and two teaspoonfuls of whisky in wineglass of hot water.
+Use hot-water bottles to keep patient warm.
+
+
+=NARCOTICS.=--_Aconite; Belladonna; Camphor; Digitalis; Ergot;
+Hellebore; Lobelia:_ These all cause nausea, numbness, stupor,
+rapidity of the heart followed by weakness of heart, delirium or
+convulsions, coma, and death. There is often an acid taste in mouth,
+with dryness of throat and mouth, fever, vomiting and diarrhea, with
+severe pain in the bowels. Pupils are dilated.
+
+In either case use the stomach pump at once. If no pump is at hand,
+siphon out stomach with rubber tube and funnel. If tube is not
+available, give thirty grains of powdered ipecac stirred in a
+wineglass of water, followed by two glasses of warm water. As the
+patient vomits, give more warm water. When vomiting ceases, give two
+cups of strong hot coffee, and then a tablespoonful of castor oil.
+
+Keep patient awake by rubbing; do not exhaust him by walking him
+about. He must lie flat. If prostration follows, give two teaspoonfuls
+of whisky in wineglass of hot water from time to time, if repetition
+is necessary.
+
+_Alcohol; Liquors Containing It:_ Symptoms of drunkenness, stupor,
+drowsiness, irritability of temper, rapid, weak heart, sleep, coma.
+Breath testifies.
+
+If possible, use stomach pump early, or tube and funnel. Or give
+thirty grains of powdered ipecac stirred in a wineglass of water, and
+when vomiting ceases give thirty drops of aromatic spirit of ammonia
+in a wineglass of water every half hour till pulse has become full and
+rapid. Then apply cold to the head and heat to the extremities.
+
+_Chloral; Patent Sleeping Medicines; "Knock-out Drops."_ Symptoms:
+Nausea, coldness and numbness, stupidity, prostration, often vomiting
+and purging, sleep, coma. Heart very weak, with pulse at wrist very
+feeble. Constriction of the mouth and throat, with dryness. Pain in
+bowels is marked before stupor appears.
+
+Use stomach pump if possible, or empty stomach with rubber tube and
+funnel, siphoning fluids out. Or give thirty grains of powdered ipecac
+stirred in a wineglass of water. When vomiting ceases, give two
+teaspoonfuls of whisky in half a glass of hot water. Give hypodermic
+injection of sulphate of strychnine, one-twentieth of a grain every
+two or three hours, till patient is roused and weakness is past.
+Rubbing of the surface, application of hot-water bottles to the body
+and legs.
+
+If breathing ceases, follow Rule 2 under Suffocation (p. 186) till
+breathing is well established again.
+
+_Opium; Morphine; Laudanum; Paregoric; Soothing Syrups._ Symptoms:
+Drowsiness, sleep, stupor when roused, pupils very small--"pin point"
+unless patient is used to the drug--constipation, cold skin.
+
+Use stomach pump, if at hand. Or give emetic of thirty grains of
+powdered ipecac stirred in a wineglass of water, followed by two
+glasses of warm water, as vomiting proceeds. Let the patient inhale
+ammonia or smelling salts. Give him half a grain of permanganate of
+potash dissolved in a wineglass of water, every half hour. Inject two
+ounces of black coffee, at blood heat, into the rectum.
+
+Rub the lower part of the body and legs briskly toward the heart,
+while artificial respiration is being carried out. See Rule 2 under
+Suffocation (p. 186). Thirty drops of tincture of belladonna to an
+adult, every hour, will assist the breathing. Do not exhaust the
+patient by walking him around, slapping him with wet towels, or
+striking him on the calves; keep him awake by rubbing.
+
+_Tobacco when Swallowed:_ Nausea and vomiting occur, with severe pain
+and great prostration; delirium or convulsions may follow. The heart,
+at first rapid and full, becomes weak and compressible.
+
+Give emetic at once: thirty grains of powdered ipecac stirred in
+wineglass of water, followed by two glasses of warm water, by degrees.
+Give whisky, two teaspoonfuls in wineglass of hot water. Keep patient
+warm.
+
+_Nux Vomica; Strychnine._ Symptoms: Excitement, rapid heart action,
+restlessness, panic of apprehension, twitching of forearms and hands,
+possibly convulsions, during consciousness.
+
+Use stomach pump, if possible, or give thirty grains of powdered
+ipecac stirred in a wineglass of water. Then, when vomiting has
+ceased, give twenty grains of chloral, together with thirty grains of
+bromide of sodium in half a glass of water, at blood heat, injected
+into the rectum. Give twenty grains of bromide of sodium in a
+wineglass of water, every hour, by the mouth.
+
+If convulsions, put chloroform before nose and mouth, as follows: pour
+twenty drops of chloroform on a handkerchief and hold it close to the
+mouth, letting air pass freely under it. Stop when patient relaxes.
+Resume if he becomes rigid again.
+
+_Cocaine._ Symptoms: General nervousness, irritability of temper,
+wakefulness, followed quickly by great pallor, dilatation of the
+pupils, unconsciousness, and convulsions.
+
+Give the patient two teaspoonfuls of whisky in a wineglass of water
+every hour. Give, if possible, a hypodermic of a thirtieth of a grain
+of strychnine, every two hours, or as he may require it, to keep the
+pulse full and strong. Use hot-water bottles to feet and legs.
+
+_Phenacetin; Acetanilid; Headache Powders:_ Give two teaspoonfuls of
+whisky in a wineglass of hot water. If the heart flags, give tincture
+of digitalis, five minims in tablespoonful of water, every two hours,
+or till three doses are given. It is better to use digitalin, one
+one-hundredth of a grain hypodermically, if possible.
+
+
+
+
+CHAPTER VII
+
+=Food Poisoning=
+
+_Food Containing Bacterial Poisons Resulting from Putrefaction; Food
+Infected with Disease Germs; Food Containing Parasites--Tapeworm--
+Trichiniasis--Potato Poisoning._
+
+
+=FOOD POISONING.=--Much the same symptoms from all meats, fish,
+shellfish, milk, cheese, ice cream, and vegetables; namely, vomiting,
+cramps, diarrhea, headache, prostration, weak pulse, cold hands and
+feet, possibly an eruption.
+
+_First Aid Rule 1.--Rid patient of poison. Cause repeated vomiting by
+giving three or four glasses of warm water, each containing half a
+level teaspoonful of mustard. Put finger down throat to assist. Empty
+bowels by giving warm injection of soapsuds and water by fountain
+syringe._
+
+_Rule 2.--Support heart and rally nerve force. Give teaspoonful of
+whisky in tablespoonful of hot water every half hour, as needed. Put
+hot-water bottles at feet and about body._
+
+=Conditions, Etc.=--Bacterial poisons, constituting irritants of the
+stomach and bowels, are found in certain mussels, oysters from
+artificial beds, eels out of stagnant ditches--as well as the uncooked
+blood of the common river eel--certain fish at all times, certain fish
+when spawning, putrefied fish, fermented canned fish, sausages of
+which the ingredients have putrefied, putrefied meat, imperfectly
+cured bacon, putrefied cheese, milk improperly handled and not cooled
+before being transported, ice cream which fermented before freezing,
+or ice cream containing putrid gelatin, and mouldy corn meal and the
+bread made from it.
+
+These poisons are called toxins, or toxalbumins, or bacterial
+proteids. They are no longer called ptomaines, because many ptomaines
+are not poisonous. They are formed within the cells of the bacteria,
+and result from the combination of certain constituents of the food
+material that nourishes the bacteria, in some way not quite
+understood. Some decomposition must have taken place in the food
+before it can furnish to the bacteria the nourishment it needs. If
+this has happened, the bacteria multiply rapidly, and the toxins that
+are formed are taken up by the lymphatics and carried away from the
+tissues as fast as possible. But so great is their virulence that they
+act on several vital organs before they can be antagonized by the
+natural elements of the blood.
+
+=Symptoms.=--The symptoms are much the same in all the cases of
+bacterial poisoning mentioned. Sudden and violent vomiting and
+diarrhea appear a few hours after eating the spoiled food, or may be
+delayed. There may be headache, colic, and cramps in the muscles.
+Marked prostration and weak pulse with cold hands and feet are
+characteristic. The appearance of skin eruptions is not uncommon. The
+occurrence of such symptoms in several persons, some hours after
+partaking of the same food, is sufficient to warrant one in
+pronouncing the trouble food poisoning.
+
+=Treatment.=--The objects of treatment are to rid the patient of the
+poison, and to stimulate the heart and general circulation, and draw
+on the reserve nerve force. It is best to procure medical aid to wash
+out the stomach, but when this is impossible, the patient should be
+encouraged to swallow plenty of tepid water and then vomit it. If
+there is no natural inclination to do so, vomiting may be brought
+about by putting the finger in the back of the throat. The same
+process should be repeated a number of times, and the result will be
+almost as good as though a physician had used a stomach tube. A
+teaspoonful of salt or tablespoonful of mustard in the water will
+hasten its rejection. Then the bowels should likewise be emptied. If
+vomiting continues this will not be possible by means of drugs given
+by the mouth, although calomel may be retained given in half-grain
+tablets hourly to an adult, until the bowels begin to move, or till
+eight to ten tablets are taken. When vomiting is excessive, emptying
+of the bowels may be brought about quickly by giving warm injections
+of soapsuds into the bowel with a fountain syringe. Brandy or whisky
+in teaspoonful doses given in a tablespoonful of hot water at
+half-hour intervals should follow the emptying of the stomach and
+bowels, and the patient must be kept quiet. He must also be kept warm
+by means of hot-water bags and blankets.
+
+
+=INFECTED FOOD.=--A frequent source of illness is infection by disease
+germs transmitted in food. The meat of animals slaughtered when sick
+with abscess, pneumonia, kidney disease, diarrhea, or anthrax
+(malignant pustule) carries disease germs and causes serious illness;
+so does the meat of animals killed after recent birth of their young,
+and probably having fever. Oysters may be contaminated with excrement
+from typhoid patients, and may then transmit the disease to those who
+eat them.
+
+Milk from diseased animals, or contaminated with germs of typhoid
+fever, scarlet fever, tuberculosis, diphtheria, etc., is apt to cause
+the same disease in the human being who drinks it.
+
+If such infected food is eaten raw, the diseases with which it is
+contaminated may be transmitted. If subjected to cooking at a
+temperature of at least the boiling point, comparative safety is
+secured; but the toxins accompanying the disease germs in the infected
+food are not as a rule rendered harmless. Treatment must be directed
+to each disease thus transmitted.
+
+Poisoning resulting from eating canned meats has sometimes been
+attributed to supposed traces of tin, zinc, or solder, which have
+become dissolved in the fluids of the meat, but in the vast majority
+of cases such poisoning is due to toxins accompanying the germs of
+putrefaction, the meats having been unfit for canning at the outset.
+In such cases the symptoms are the same as in other food poisoning,
+and the treatment must be such as is elsewhere directed (see pp. 147
+and 149).
+
+While human breast milk is germ free, the cows' milk sold in cities is
+a very common source of disease. Scrupulous care of the cows, of the
+clothing and hands of the milkers, of the stables at which the herds
+are quartered, and of the cans, pails, and pans used, reduces to a
+minimum the amount of filth and impurity otherwise mixed with milk. In
+the household, as well as during transportation, milk should be kept
+cool, with ice if necessary. It should also never be left uncovered,
+for it readily absorbs gases, effluvia, and contaminating substances
+in the air, and affords an excellent medium for the growth and
+propagation of germs. When partially or entirely soured, it should not
+be used, except in the preparation of articles of food by cooking, as
+directed in cook books. It should never be used if there is any doubt
+about its purity. Unless all doubt has been removed, it is best to
+subject milk intended for children's consumption to a temperature of
+160 deg. F. for ten minutes, and then put it on the ice, especially during
+hot weather. Germs are thus rendered harmless, and the nourishing
+qualities of the milk remain unimpaired.
+
+Summer diarrhea of children, also called cholera infantum, occurs as
+an epidemic in almost all large cities during the hottest days of
+summer. The disease is largely fatal, especially during the first hot
+month, because the most susceptible and tender children are the first
+affected. It is due to the absorption into the systems of these
+children of the toxins formed during the putrefying of milk in the
+stomachs and bowels of the little sufferers. Clean, pure sweet milk,
+free from bacteria should be used to prevent the occurrence of this
+disease. Its treatment is outlined in Vol. III. Exactly what bacteria
+cause the disease is not decided. Possibly the milk is infected, but
+probably the poisonous results come from toxins.
+
+
+=FOOD CONTAINING PARASITES.=--The parasites found in food in this
+country are echinococcus, guineaworm, hookworm, trichina, and
+tapeworm. Echinococcus cannot be understood or diagnosed by the
+layman. Guineaworm is excessively rare in the United States; it gains
+access into the body through drinking water which contains the
+individuals. Hookworm is the cause of "miners' anaemia," and is
+extremely rare in this country.
+
+The entrance of living food parasites can be absolutely prevented by
+thorough cooking of meats, especially pork and beef. Heat destroys the
+"measles" and the trichina worms.
+
+
+=TAPEWORM.=--This is developed in man after eating "measly" beef or
+pork. "Measles" are embryo tapeworms called, from their appearance,
+"bladder worms." In from six to ten weeks after being received into
+the intestine of a man, these bladder worms become full grown, and
+measure from ten to thirty feet in length--the tapeworms.
+
+=Symptoms.=--Vertigo, impairment of sight and of hearing, itching of
+the nose, salivation, loss of appetite, dyspepsia, emaciation, colic,
+palpitation of the heart, and sometimes fainting accompany the
+presence of the tapeworm. Generally the condition becomes known
+through the passage in the excrement of small sections of the worm.
+These sections resemble flat portions of macaroni.
+
+=Treatment.=--This, to be successful, must be directed by a physician.
+When no physician can be procured, the patient may attempt his own
+relief. After fasting for twenty-four hours, pumpkin seed, from which
+the outer coverings have been removed by crushing, are soaked
+overnight in water and taken on an empty stomach in the morning; a
+child takes one or two ounces thoroughly mashed and mixed with sirup
+or honey, and an adult four ounces (see Vol. III, p. 245).
+
+
+=TRICHINIASIS.=--This is a dangerous disease caused by the presence in
+the muscles and other tissues of the trichinae, little worms which are
+swallowed in raw or partly cooked pork, ham, or bacon. Nausea,
+vomiting, colic, and diarrhea appear early, generally on the second
+day after eating the infected meat. Later, stiffness of the muscles
+occurs, with great tenderness, swelling of the face and of the
+extremities, sweating, hoarseness, difficult breathing, inability to
+sleep, bronchitis, and pneumonia.
+
+There is no treatment for the disease. Many cases which are not fatal
+are probably considered to be obscure rheumatism. Many cases of
+pneumonia are caused by the worm.
+
+
+=POTATO POISONING.=--There remains one variety of food poisoning which
+needs mention, since it occurs when least expected, and when proper
+food has been subjected to natural growth. As the potato belongs to
+the botanical family containing the dangerous belladonna, tobacco,
+hyoscyamus, and stramonium, it is not surprising that is should also
+contain a powerful poisonous alkaloid, namely, solanine. Solanine is
+developed in potatoes, especially during their sprouting stage.
+Violent vomiting and diarrhea and inflammation of the stomach and
+bowels are caused by it. Careful peeling of sprouting potatoes, and
+removal of their eyes, will lessen, if not wholly obviate, the danger
+from eating them. This form of food poisoning is rare.
+
+
+
+
+CHAPTER VIII
+
+=Bites and Stings=
+
+_Several Kinds of Mosquitoes--Cause of Yellow Fever--Bee, Wasp, and
+Hornet Stings--Wood Ticks, Lice, and Fleas--Scorpions and
+Centipedes--Poisonous Snakes--Dog and Cat Bites._
+
+
+=MOSQUITOES.=--The female mosquito is the offender. During or after
+sucking blood she injects a poison into the body which causes itching,
+swelling, and, in some susceptible persons, considerable inflammation
+of the skin. The bites of the mosquitoes living on the shores of the
+Arctic Ocean and in the tropics are the most virulent. The most
+important relation of mosquitoes to man was only recently discovered.
+They are probably the sole cause of malaria and yellow fever in the
+human being. The malarial parasite which lives in the blood of man,
+when he is suffering from malaria, first inhabits the body of a
+certain kind of mosquito. The mosquito acquires the undeveloped
+parasite by biting the human malarial patient, and then acts as a
+medium of infection by transmitting the active parasite to some
+healthy man, through the bite.
+
+The more common house mosquito, the Culex, does not carry the parasite
+of malaria, and it is important to be able to distinguish the
+Anopheles which is the source of malaria. The Anopheles is more common
+in the country, while the Culex is a city pest. The Culex has very
+short palpi, the name given to the projections parallel to the
+proboscis; while those of Anopheles are so large that it appears to
+have three probosces. There are no markings on the wings of the
+ordinary species of Culex, while the wings of Anopheles are distinctly
+mottled. The Culex, sitting on a wall or ceiling, holds its hind legs
+above its back and its body nearly parallel to the wall or ceiling,
+but the Anopheles carries its hind legs either against the wall or
+hanging down (rarely above the back), and its body, instead of lying
+parallel to the wall or ceiling, hangs away at an angle of about
+forty-five degrees from it.
+
+The Culex lays her eggs in sinks, tanks, cisterns, and water about
+houses, but the Anopheles deposits her ova in shallow pools and
+sluggish streams, especially those on which is a growth of green scum
+or algae. Such are the main distinguishing features of the
+malaria-carrying mosquito, the Anopheles, and the commoner house
+variety, the Culex.
+
+To prevent malaria, mosquito bites must be prevented by nettings in
+houses, especially for the protection of sleepers. Pools, ponds, and
+marshy districts must be drained in order to destroy the breeding
+places of Anopheles, and in the malarial season, petroleum (kerosene)
+must be poured on the surface of such waters to arrest the development
+of the immature insects (larvae).
+
+The mosquito is believed to be the sole cause of yellow fever, being
+capable of communicating the germ of the disease to man by its bite
+two weeks after it has itself been contaminated with the germ in
+feeding on the blood of a yellow-fever patient. This invaluable
+discovery was made by Dr. Walter Reed, U. S. A., in 1901, as a result
+of his labors and those of other members of the yellow-fever
+commission of the U. S. Army in Cuba, involving the death of one of
+the members of the commission (Dr. Lazear), and utilizing the heroism
+of a number of our young soldiers who voluntarily offered themselves
+to be bitten by mosquitoes that had previously bitten yellow-fever
+patients, and who experimentally occupied premises containing all
+sorts of articles infected by yellow-fever patients. The result of
+their research proves that yellow fever is not contagious at all, in
+the usual sense, but is communicated only through the medium of
+mosquitoes. This shows the fallacy of many quarantine rules regarding
+yellow-fever patients, and of the fear of nursing the sick, and will
+result in controlling the disease.
+
+In the case of malaria or yellow fever, there is a vicious circle into
+which man and the mosquito enter; malaria and yellow-fever patients
+contaminate the mosquitoes which bite them, and the mosquitoes in
+their turn infect man with these diseases. A patient with malaria
+coming into a nonmalarial place, and being bitten by mosquitoes, may
+lead to an epidemic of the disorder which becomes endemic. To
+terminate this condition, it is necessary to prevent the contact of
+man with mosquitoes and to kill these insects. Both malaria and
+yellow fever will doubtless be practically eradicated before long
+through the result of these scientific discoveries.
+
+=Treatment of Mosquito Bites.=--To prevent mosquitoes, fleas, lice,
+horseflies, etc., from biting, it is necessary merely to dip the clean
+hands into a pail of water in which, while hot, one ounce of pure
+carbolic acid was dissolved, and while they are thus wet rub the
+solution over all the exposed skin and allow it to dry naturally. A
+mixture of kerosene (petroleum) and water used in the same way will
+also afford protection. All poisons introduced into the body by
+insects are of an acid nature, and to this quality are due the pain
+and irritation which it is our object to overcome. The best remedy,
+naturally, is an alkali of some sort. Water of ammonia, diluted, or a
+strong solution of saleratus or baking soda in water, are the two most
+successful remedies to apply, either through bathing, or on cloths
+saturated in one of the solutions. Clean clay, mixed with water to
+make a mud poultice, is a useful application in emergencies.
+
+
+=BEE, WASP, AND HORNET STINGS.=--The pain and swelling are produced by
+the poison of the insect which leaves the poison bag at the base of
+the barb at the instant that the person is stung. The bee stings but
+once, as the sting being barbed is broken off, and is retained in the
+flesh of the victim. The sting of the wasp and hornet is merely
+pointed, and is not lost during the stinging process so that they can
+repeat the act. Bee keepers, after being stung a number of times,
+usually become immune, i. e., they are no longer poisoned by bites of
+these insects.
+
+It is well to extract the sting of bees before all of the poison has
+come away. A fine pair of forceps is useful for this purpose; or, by
+pressing the hollow tube of a small key directly down over the
+puncture made by the sting, it may be squeezed out.
+
+Ammonia water, as recommended for mosquitoes, is the best remedy to
+relieve the pain.
+
+
+=WOOD TICKS.=--Ticks inhabit the woods and bushes throughout the
+temperate zone, and at certain periods during the summer season attack
+passing men and animals.
+
+The common tick is nearly circular in shape, very flat, with a dark,
+brown, horny body about one-sixteenth to one-eighth inch in diameter.
+Each of its eight legs possesses two claws, and the proboscis incloses
+feelers which are similarly armed. The beetle plunges its barbed
+proboscis into the flesh of man or animals, and holds on very firmly
+with its other members till it is gorged with blood, growing as large
+as a good-sized bean, when it drops off. The bite is painless, and it
+is not until the insect is engorged with blood that it is perceptible;
+if, however, attempts are made to remove the tick before it is ready
+to let go, the proboscis may be torn off and left in the skin, when
+painful local suppuration will follow.
+
+=Treatment.=--As the presence of tick is far from agreeable, the
+insect may often be removed by painting it with turpentine, which
+either kills it or causes the claws to be relaxed; in either case the
+tick loosens its hold and drops to the ground. A tropical variety,
+carapato, buries the whole head in the flesh of its host before it is
+perceived, and if turpentine does not loosen its hold, the head must
+be dug out with a clean needle or knife blade.
+
+
+=LICE= (_Pediculi_).--Head lice are most common. They are gray with
+black margins, about one-twenty-fifth to one-twelfth inch long, and
+wingless. The color changes with the host, as the lice are black on
+the negro, and white in the case of the Eskimos. The female lays fifty
+to sixty eggs ("nits"), seen as minute, white specks glued to the side
+of a hair; usually not more than one or two on a single hair. The eggs
+hatch in six days.
+
+The irritation produced by the presence of the parasites on the head
+leads to general itching, more particularly on the lower part of the
+back of the head. The constant scratching starts an inflammation of
+the skin with the formation of pimples, weeping spots, and crusts,
+from the dried discharge, possessing a bad odor. The denuded spots
+becoming infected, the neighboring glands enlarge and are felt as
+tender lumps beneath the skin at the back of the neck, under the jaw,
+or at either side of the neck. Whenever there are persistent itching
+and irritation of the scalp, particularly at the back of the head,
+lice or "nits" should be sought for. Sometimes it is more easy to find
+them on a fine-tooth comb passed through the hair. Lice are very
+common in dirty households, and are occasionally seen on the most
+fastidious persons, who accidentally acquire them in public places or
+conveyances.
+
+=Treatment.=--The hair should be cut short when permissible. Any
+crusts on the head should be softened by the application of sweet oil,
+and then removed by washing in soap and warm water. Petroleum or
+kerosene is a good remedy. It must be rubbed on the head two
+successive nights, the head being covered by a cap, and washed off
+each morning with hot water and soap. The patient must be cautioned
+not to approach an open flame after kerosene has been put on his head.
+
+The eggs or "nits" are next to be attacked with vinegar, which is
+sponged on the hair and the fine-tooth comb plied daily for a week.
+The remaining irritation of the scalp can be cured by washing the head
+daily and applying sweet oil.
+
+A simpler plan consists of drenching hair and scalp twice with cold
+infusion of (poisonous) larkspur seed, made by steeping for an hour an
+ounce of the seed in six ounces of hot water.
+
+This treatment will destroy both insects and eggs. After twenty-four
+hours the hair and scalp must be shampooed with warm water thoroughly.
+
+
+=CLOTHES LICE.=--These insects are a trifle larger than the head lice,
+being one-twelfth to one-eighth inch long, of a dirty, yellowish-gray
+color, and only infesting the most filthy people. The lice are
+generally only seen on the clothes, where they live, coming out on the
+body only to feed. The visible signs on the body are varying degrees
+of irritation from redness to ulceration, due to scratching. The
+treatment is simply cleanliness of the body and clothes.
+
+
+=CRAB LICE.=--The crab louse or "crab" inhabits the skin covered by
+hair about and above the sexual organs most frequently, and from
+thence spreads to the hairy region on the abdomen, chest, armpits,
+beard, and eye lashes. Itching and scratching first call attention to
+the presence of the parasites, which are even more troublesome than
+the other species.
+
+Application of kerosene to the part is sufficient to kill the lice,
+but this treatment must be repeated several times at intervals of a
+week, in order to kill the parasites subsequently hatched.
+
+
+=FLEA.=--Flea bites are recognized by the itching caused by the poison
+introduced by the insect, and by points of dried blood surrounded for
+a little while by a red zone. In the case of children and people with
+delicate skins, red or white lumps appear resembling nettlerash.
+Generally the skin is simply covered with minute, red points, perhaps
+raised a little by swelling above the surface, and when very numerous
+may remotely resemble the rash of measles. Fleas, unlike lice, do not
+breed on the body, but as soon as they are satiated leave their host.
+Their eggs are laid in cracks in floors, on dirty clothes and similar
+spots, and it is only the mature flea which preys upon man. The human
+flea may infest the dog and return to man, but the dog flea is a
+distinct species, and never remains permanently on the human host. For
+these reasons it is not difficult to get rid of fleas after they have
+attacked the body, unless continually surrounded by them.
+
+
+=JIGGER OR SAND FLEA.=--Also called chique, chigo, and nigua. It is
+common in Cuba, Porto Rico, and Brazil. About one-half the size of the
+ordinary flea, it is of a brownish-red color with a white spot on the
+back. The female lives in the sand and attacks man, on whom she lives,
+boring into the skin about the toe nail, usually, and laying her eggs
+under the skin, which gives rise to itching at first and then violent
+pain. The insect sucks blood and grows as it gorges itself, producing
+a white swelling of the skin in the center of which is seen a black
+spot, the front part of the flea. The flea after expelling its eggs
+drops off and dies. People with habitually sweaty feet are exempt from
+attacks of the pest.
+
+Unless the flea is unattached, one must either wait until the insect
+comes away of its own free will, or remove it with a red-hot needle in
+order to destroy the eggs. The negroes peel the skin from the swelling
+with a needle and squeeze out the eggs. Ordinarily the bites do no
+permanent injury, but occasionally if numerous, or if the insect is
+pressed into the skin in the efforts to remove it, or if sores
+resulting from bites are neglected, then violent inflammation, great
+pain, and even death of the part may result. Sound shoes and a night
+and morning inspection of the feet will protect against the inroads of
+the sand fleas.
+
+
+=FLIES.=--The common housefly does not bite, but is constantly
+inimical to human health by conveying disease germs of typhoid fever,
+cholera, and other disorders from bowel discharges of patients
+suffering from these diseases to articles of food on which the insects
+light. Flies have been a fruitful source of sickness in military
+camps, as evidenced in the recent Spanish-American and Anglo-African
+campaigns. The bites of the sandfly, gadfly, and horsefly may be both
+relieved and prevented by the same means recommended in the case of
+mosquitoes for these purposes.
+
+
+=SCORPION OR CENTIPEDE STING.=
+
+_First Aid Rule.--Squeeze lemon juice on wound._
+
+
+=SPIDER OR TARANTULA BITE.=
+
+_First Aid Rule.--Pour water of ammonia on bite. If patient is
+depressed, give strong coffee._
+
+
+=SCORPIONS AND CENTIPEDES.=--These both inhabit the tropics and
+semitropical regions, and lurk in dark corners and out-of-the-way
+places, crawling into the boots and clothing during the night.
+Scorpions sting with their tails, which are brought over the head and
+back for the purpose, while holding on to the victim with their
+lobsterlike claws. The poisonous centipede has a flattened
+brownish-yellow body, with a single pair of short legs for each body
+segment, and long, many-jointed antennae.
+
+The wounds made by either of these pests are rarely dangerous, except
+in young children and those in feeble health. The stings are usually
+relieved by bathing with a two per cent solution of carbolic acid,
+with rum, or with lemon juice.
+
+
+=SPIDERS.=--Many of the tropical spiders bite the human being.
+Trapdoor spiders are among the commonest of these pests. Their bodies
+grow to great size, two to two and a half inches long, and are covered
+with hair giving them a horrid appearance. They live in holes bored in
+the ground, and provided with a trapdoor contrivance which is closed
+when the insect is at home.
+
+The trapdoor spider resembles the tarantula, by which name it is
+usually known in Cuba and Jamaica, but is somewhat smaller and
+commoner. Neither the stings of the trapdoor spider nor true tarantula
+are usually dangerous although the wounds caused by the bites may heal
+slowly.
+
+Application of water of ammonia and of the other remedies recommended
+for mosquito bites (p. 158) are indicated here, and if the patient is
+generally depressed by the poison, strong coffee forms a good
+antidote.
+
+
+=SNAKE BITE.=
+
+_First Aid Rule 1.--Make the wound bleed. Cut slit through the wound,
+lengthwise of limb, two inches long and half an inch deep. Squeeze
+tissues._ DO NOT SUCK THE WOUND.
+
+_Rule 2.--Keep poison out of general circulation. Tie large cord or
+bandage tightly about part between wound and heart. Loosen in fifteen
+minutes._
+
+_Rule 3.--Use antidote. Wash wound and cut with fresh solution of
+chloride of lime (one part to sixty parts of water). Inject
+anti-venene with hypodermic syringe, ten cubic centimeters, as on
+label. Or, inject with hypodermic syringe thirty minims of solution of
+permanganate of potash (five grains to two ounces of water), three
+times in different places. If no syringe at hand, pour permanganate
+solution into wound._
+
+_Rule 4.--Support heart if weak. Inject with hypodermic syringe
+one-thirtieth grain of sulphate of strychnine into leg. Repeat as
+needed every thirty minutes with caution._
+
+_Rule 5.--Give no whisky or other liquor. Do not burn the wound._
+
+
+=SNAKE BITE.=--There are many different species of poisonous snakes in
+the United States. The more common are the rattlesnake, the moccasin,
+the copperhead, and the common viper.
+
+All the venomous snakes have certain characteristics by which they may
+be distinguished from their harmless brethren. The head is generally
+broad and flat and of a triangular shape, the wide, heavy jaws
+tapering to a point at the lips. There is a depression or pit between
+the nostril and eye on the upper lip, hence the name "pit vipers"
+given to poisonous snakes. The pupil of the eye is long and vertical,
+of an oval or elliptical shape.
+
+Venomous snakes are thicker in proportion to their length than
+harmless snakes, the surface of their bodies is rougher, and their
+tails are blunt or club-shaped. Conversely, harmless snakes possess
+long narrow heads, the pupils of their eyes are round, not vertical
+slits, and their bodies are not thick for their length, but long and
+slim with pointed tails. The bite of vipers of all kinds is much more
+poisonous in tropical regions, and in the North fatal snake bite is a
+rare occurrence.
+
+If there is a doubt whether a snake is poisonous, the neck may be
+pressed down against the ground between the jaws of a forked stick,
+and the poison fangs looked for without danger. These hang directly
+down from the front part of the upper jaw, or are thrust horizontally
+forward just in front of the upper lip, and may drip saliva and venom.
+
+In Cuba and Porto Rico there is a viper called Juba, or Boaquira,
+which is a counterpart of the Northern rattlesnake, and the most
+poisonous of the many species in that region. Among venomous species
+of the Philippines are two boas and also a viper from nine to ten feet
+long, which exceptionally pursues and attacks man. This snake is
+easily killed by a blow on the neck. Another small viper with a
+club-shaped tail, inhabiting these islands, is nocturnal in its
+habits, and may get into boots at night. Boots, therefore, should
+always be inspected before one puts them on in the morning.
+
+Usually it is only the young, old, and weak who succumb to snake bite.
+
+=Symptoms.=--The symptoms of snake bite of all poisonous species are
+similar. At first there is some pain in the wound, which rapidly
+increases together with swelling and discoloration until death of the
+part may ensue. The vital centers in the brain controlling the heart
+and breathing apparatus, are paralyzed by the poison. There is often
+drowsiness and stupor, and the breathing is labored and the pulse weak
+and irregular, with faintness and cold sweats.
+
+=Treatment.=--The treatment consists first in keeping the poison out
+of the general blood stream. With this purpose in view a handkerchief,
+piece of cotton clothing, string, or strap should be immediately wound
+about the bitten limb above the wound, between it and the heart. This
+will retard absorption of the poison only for a time; it is said
+twenty-five minutes. The knife is the most effective means of removing
+the poison by making an oval cut on each side of the wound so that the
+two incisions meet and remove all the flesh below and around the
+wound. Bleeding should be encouraged to drain out the poison. The skin
+containing the wound may be lifted up, and the whole wound cut out by
+one snip of the scissors where this is practicable.
+
+Some advocate burning out the wound with a red-hot wire, or darning
+needle, instead of cutting, but the treatment is less effective and
+more painful. Rambaud forbids burning. As to the general condition: if
+stupor is a prominent symptom the patient must be made to move about
+and exercise to keep alive his nerve centers. Otherwise one
+tablespoonful of whisky may be given in half a cup of hot water
+hourly, to sustain the weakened heart and respiration until recovery
+ensues.
+
+The most effective treatment, according to Dr. George Rambaud,
+Director of the Pasteur Institute of New York City, is thorough
+washing of the wound (after it has been opened with the knife) with
+freshly prepared solution of chloride of lime, in the proportion of
+one part of lime to sixty of water. The burning of a wound is bad
+practice. If necessary, chloride-of-lime solution should be injected
+into the tissues around the wound. One about to go into a place where
+the most venomous snakes are found should inject into himself a dose
+of Calmette's antivenomous serum every two or three weeks as a means
+of prevention. If the serum is used, whisky should not be given in the
+treatment of one who has been bitten, for the anti-venene is a
+powerful cell stimulator.
+
+Calmette, the Director of the Pasteur Institute in Lille, France,
+several years ago discovered antivenomous serum. That serum is
+efficient for the bites of most of the venomous snakes of different
+countries, including the rattlesnake, cobra, python, etc.
+
+It is prepared in the dry form so that it can be carried easily, and
+will keep almost indefinitely. The proper course to be followed by
+persons going into countries infested by venomous snakes is always to
+have on hand a few doses of it. Its value has been positively
+demonstrated within the last few years in India, where it is used in
+the British Army, as well as in other countries.
+
+In the fluid form it should be used hypodermically, a dose of ten
+cubic centimeters being injected within eighty or ninety minutes of
+the reception of the poison.
+
+
+=DOG BITE OR CAT BITE.= (See Hydrophobia, Vol. V, p. 264.)
+
+_First Aid Rule 1.--Make sure animal is mad. Send patient to Pasteur
+institute if one is within reach._
+
+_Rule 2.--Remove poison from wound. Encourage bleeding by squeezing
+tissue about wound. Suck wound, if you have no cracks in lips, and
+spit out fluid. Pour hot carbolic solution into wound (a third of a
+teaspoonful of carbolic acid to a pint of hot water)._
+
+_Rule 3.--Cauterize. Dip wooden meat skewer, or lead pencil, into pure
+nitric acid, and rub into wound. Or, use red-hot poker, or red-hot
+nail grasped by tongs or pincers, or red coal from fire._
+
+_Rule 4.--Do not kill the animal. If he is alive and well at the end
+of a week, he was not mad._
+
+
+
+
+CHAPTER IX
+
+=Burns, Scalds, Frostbites, Etc.=
+
+_Classes of Burns--Treatment--Burns Caused by Acids and
+Alkalies--First Aid Rules for Frostbites--Real Freezing--Ingrowing Toe
+Nail--Fainting--Suffocation--Fits._
+
+
+=BURNS AND SCALDS.=--If slight, skin very red, unbroken.
+
+_First Aid Rule.--Cover with cloths wet in strong solution of baking
+soda in cold water. Dry gently, and spread with white of egg, thick._
+
+If deeper, blisters, skin broken, thick swelling; there may be some
+bleeding.
+
+_First Aid Rule 1.--Stop pain quickly. Cut away clothing very gently.
+Break no blisters. Cover with Carron oil (equal parts of limewater and
+linseed or olive oil) and light bandage. Give fifteen drops of
+laudanum[9] every half hour in tablespoonful of water, till relieved
+in part or three doses are taken._
+
+_Rule 2.--Combat shock. If patient is cold, pulse weak, head confused,
+give tablespoonful of whisky in a quarter of a glass of hot water. Put
+hot-water bottles at feet._
+
+_Rule 3.--Quench thirst with pieces of ice held in mouth or a swallow
+of cold milk._
+
+See page 174 for subsequent treatment.
+
+A burn is produced by dry heat, a scald by moist heat; the effect and
+treatment of both are practically identical. Burns are commonly
+divided into three classes, according to the amount of damage
+inflicted upon the body.
+
+_First Class._--There is redness, pain, and some swelling of the skin,
+followed, in a few days, by peeling of the surface layer (epidermis)
+and recovery. Sunburn and burns caused by slight exposures to gases
+and vapors fall into this category.
+
+=Treatment.=--The immediate immersion of the part in cold water is
+followed by relief, or the application of cloths wet with a saturated
+solution of saleratus or baking powder is useful. Anything which
+protects the burned skin from the irritating effect of the air is
+efficacious, and in emergencies any one of the following may be
+applied: starch, flour, molasses, white paint, or a mixture of white
+of egg and sweet oil, equal parts. Usually after the first pain has
+been relieved by bathing with soda and water, or its application on
+cloths, the employment of a simple ointment suffices, as cold cream or
+vaseline.
+
+_Second Class._--In this class of cases the inflammation is more
+severe and the deeper layers of the skin are involved. In addition to
+the redness and swelling of the skin there are present blisters which
+appear at once or within a few hours. The general condition is
+affected according to the size of the burn. If half of the body is
+only reddened, death usually results, and a burn of a third of the
+body is often fatal. The shock is so great at times that pain may not
+be at once intense. Shock is evidenced by general depression, with
+weakness, apathy, cold feet and hands, and failure of the pulse. If
+the patient rallies from this condition, then fever and pain become
+prominent. If steam has been inhaled, there may be sudden death from
+swelling of the interior of the throat, or inflammation of the lungs
+may follow inhalation of smoke and hot air.
+
+_Third Class._--In this class are included burns of so severe a nature
+that destruction and death of the tissues follows; not only of the
+skin but of the flesh and bones in the worst cases. It is impossible
+to tell by the appearance of the skin what the extent of the
+destruction may be until the dead parts slough away after a week or
+ten days. The skin is of a uniform white color in some cases, or may
+be of a yellow, brown, gray, or black hue, and is comparatively
+insensitive at first. Pus ("matter") begins to form around the dead
+part in a few days, and the dead tissue comes away later, to be
+followed by a long course of suppuration, pain, excessive granulations
+("proud flesh"), and, unless skillfully treated, by contraction of the
+surrounding area, leaving ugly scars and interfering with the
+appearance and usefulness of the parts. The treatment of such cases
+after the first care becomes that to be pursued in wounds generally
+(p. 50), and belongs within the domain of the surgeon.
+
+=Treatment of the More Severe Burns.=--If the patient is suffering
+from shock he should receive some hot alcoholic drink, as hot water
+and whisky, and be put to bed under warm coverings with hot-water bags
+or bottles at his feet.
+
+The clothing must be cut away from the burned parts with the greatest
+care, and only a portion of the body should be uncovered at a time and
+in a warm room. Pain may be subdued by laudanum[10]; fifteen drops may
+be given to an adult, and the drug may be repeated at hour intervals
+in doses of ten drops until the suffering has been allayed. Lumps of
+ice held in the mouth will quench thirst, and the diet should be
+liquid, as milk, soups, gruels, white of egg, and water. The bowels
+should be moved daily by rectal injections of soap and warm water. As
+a matter of local treatment, the surface layer of the skin should be
+kept intact if possible. Blisters are not to be disturbed unless they
+are large and tense; if so, their bases may be pricked with a needle
+sufficiently to let out the fluid contents.
+
+Carron oil (equal parts of olive oil and limewater) has been the
+common remedy for burns, and it is an efficient, though very dirty,
+dressing, useful if the skin is generally unbroken. It should be
+applied on clean, soft linen or cotton cloth, which is soaked in the
+oil, laid over the burned area, and covered with a thick layer of
+cotton batting and a bandage. When the skin is denuded, leaving a raw
+surface exposed, the burn must be treated on the same plan as wounds,
+and should be kept as clean and free from germs as possible. An
+ointment made of equal parts of boric acid and vaseline, spread
+thickly on clean cloth, is a good antiseptic preparation in cases
+where the skin is broken. It is best not to change the dressing
+oftener than once in two or three days, unless the discharge or odor
+are considerable. Fresh dressing is very painful and often harmful.
+
+When the dressing is removed, warm saline solution (one teaspoonful of
+common salt in a quart of water) is allowed to flow over the burn
+until all discharge is washed off. Then the raw surface is dusted over
+with pure boric acid or aristol, and the boric-acid ointment applied
+as before. The cloth upon which the ointment is spread should be made
+free from germs by boiling in water, and then drying it in an oven and
+keeping it well wrapped in a clean towel except when wanted.
+
+The same care is requisite as that described under wounds (p. 50) in
+regard to cleanliness.
+
+Very extensive burns are most satisfactorily treated by complete
+immersion of the burned limbs or entire body in salt solution (same
+strength as above), which is kept at a temperature of from 94 deg. to
+104 deg. F., according to the feelings of the patient. The patient lies in
+a bath tub on horsehair, or better, rubber mattress and rubber
+pillows; completely covered with water except the head. The urine and
+bowel discharges must be passed in the water, which is then changed,
+and the temperature is kept at an even mark by allowing warm water to
+continually run into the tub to displace that which runs out. The
+latter can be arranged by siphonage with a rubber tube. While this
+method requires more care, and running hot and cold water, it is the
+most comfortable treatment for these cases, usually attended by awful
+suffering, and at the same time it is most favorable to healing.
+
+It is beyond the scope of this work to describe the various
+complications and the details of the after treatment in severe burns,
+including skin grafting, which may tax all the ingenuity of the
+skilled surgeon. It is hoped that the foregoing may give a clear idea
+of the treatment to be pursued in emergencies and may prove of some
+use to those who may unfortunately be compelled to care for burns
+during a considerable time without the aid of a physician.
+
+
+=BURN BY STRONG ACID.=
+
+_First Aid Rule 1.--Neutralize the acid. Scatter baking soda thickly
+over burn, or pour limewater over it._
+
+_Rule 2.--Control pain. Wash off soda with stream of water. Apply
+Carron oil (equal parts of limewater and linseed oil or olive oil).
+Bandage lightly._
+
+
+=BURN BY STRONG ALKALI.=--As ammonia, quicklime, lye.
+
+_First Aid Rule 1.--Neutralize the alkali. Pour vinegar over the
+burn._
+
+_Rule 2.--Control pain. Wash off vinegar with stream of water. Dry
+gently. Apply vaseline or cold cream._
+
+
+=BURNS CAUSED BY STRONG MINERAL ACIDS OR BY ALKALIES.=--If acids are
+the cause, the skin should not be washed at first, but either chalk,
+whiting, or some mild alkali, as baking soda, should be strewn over
+the burn, and then after the effect of the acid is neutralized, wash
+off the soda with stream of warm water. Dry gently with gauze. Apply
+Carron oil or paste of boric acid and vaseline, equal parts. If strong
+alkalies have been spilled on the skin, as ammonia, potash, or
+quicklime, then vinegar is the proper substance to employ, followed by
+washing. Then dry gently. Vaseline or cold cream is usually sufficient
+as after treatment. Limewater is useful in counteracting the effect of
+acids spattered in the eye. In the case of alkalies in the eye, the
+vinegar used should be diluted with three parts of water. Albolene or
+liquid vaseline is the best agent to drop in the eye after either
+accident, in order to relieve the irritation and pain, and the
+patient should stay in a dark room.
+
+
+=FROSTBITE, REAL FREEZING.=--Nose, ears, fingers, toes; insensible to
+touch, stiff, pale or blue. Person may be unconscious.
+
+_First Aid Rule 1.--Restore circulation. Rub gently, then vigorously,
+with snow._
+
+_Rule 2.--Restore heat very gradually. Sudden heat is fatal. Keep in
+cold room, and rub with cloth wet with very cold water till
+circulation is established. Then rub with equal parts of alcohol and
+water and expose gradually to heat of living room._
+
+_Rule 3.--If person ceases to breathe, resuscitate as if drowned. Open
+his mouth, grasp his tongue, and pull it forward and keep it there.
+Let another assistant grasp the arms just below the elbows and draw
+them steadily upward by the sides of the patient's head to the ground,
+the hands nearly meeting (which enlarges the capacity of the chest and
+induces inspiration.) (See pp. 30 and 31.) While this is being done,
+let a third assistant take position astride the patient's hips with
+his elbows resting on his own knees, his hands extended ready for
+action. Next, let the assistant standing at the head turn down the
+patient's arms to the sides of the body, the assistant holding the
+tongue changing hands if necessary to let the arms pass. Just before
+the patient's hands reach the ground the man astride the body will
+grasp the body with his hands, the ball of the thumb resting on
+either side of the pit of the stomach, the fingers falling into the
+grooves between the short ribs. Now, using his knees as a pivot, he
+will at the moment the patient's hands touch the ground throw (not too
+suddenly) his whole weight forward on his hands, and at the same time
+squeeze the waist between them, as if he wished to force something in
+the chest upward out of the mouth; he will deepen the pressure while
+he slowly counts one, two, three, four (about five seconds), then
+suddenly lets go with a final push, which will send him back to his
+first position. This completes expiration. (A child or a delicate
+person must be more gently handled.)_
+
+_At the instant of letting go, the man at the head of the patient will
+again draw the arms steadily upward to the sides of the patient's head
+as before (the assistant holding the tongue again changing hands to
+let the arms pass, if necessary), holding them there while he slowly
+counts one, two, three, four (about five seconds)._
+
+_Repeat these movements deliberately and perseveringly twelve or
+fifteen times in every minute--thus imitating the natural motions of
+breathing. Continue the artificial respiration from one to four hours,
+or until the patient breathes; and for a while after the appearance of
+returning life carefully aid the first short gasps until deepened into
+full breaths._
+
+_Keep body warm after this with warm-water bottles._
+
+
+=FROSTBITE.=--The nose, chin, ears, fingers, and toes are the parts
+usually frozen, although severe results ending in death of the frozen
+part occur more often owing to low vitality of the patient than to the
+cold itself. In the milder degree of frostbite there is stiffness,
+numbness, and tingling of the frozen member; the skin is of a pale,
+bluish hue and somewhat shrunken. Recovery ensues with burning pain,
+tingling, redness, swelling and peeling of the epidermis, as after
+slight burns. The skin is icy cold, white, and insensitive in severe
+forms of frostbite, and, if not skillfully treated, becomes, later,
+either swollen and discolored, or shriveled, dry, and black. In either
+case the frozen part dies and is separated from the living tissue
+after the establishment of a sharp line of inflammation which results
+in ulceration and formation of pus, and thus the dead part sloughs
+off. It is, however, possible for a part thoroughly frozen to regain
+its vitality.
+
+=Treatment.=--The essential element in the treatment is to secure a
+very gradual return of blood to the frozen tissues, and so avoid
+violent inflammation. To obtain this result the patient should be
+cared for in a cold room, the frozen parts are rubbed gently with
+snow, or cloth wet with ice water, until they resume their usual
+warmth. Then it is well to rub them with a mixture of alcohol and
+water, equal parts, for a time and expose them to the usual
+temperature of a dwelling room. Warm drinks are now administered to
+the patient. The frozen member, if hand or foot, is raised high in
+the air on pillows and covered well with absorbent cotton and bandage.
+If much redness, swelling, and pain result this dressing is removed
+and the part is wrapped in a single thickness of cotton cloth kept
+continually wet with alcohol and water.
+
+Subsequent treatment consists in keeping the damaged parts covered
+with vaseline or cold cream, absorbent cotton, and bandage. If
+blisters and sores result, the care is similar to that described for
+like conditions under burns. If death of the frozen part becomes
+inevitable, the hand or foot should be suspended in a nearly vertical
+position to keep the blood out, and the part bathed twice daily with a
+solution of corrosive sublimate (one 7.7 gr. tablet to pint of water),
+dusted well with aristol, and dressed with absorbent cotton and
+bandage until the dead tissue separates and comes away. If the frozen
+part is large it may be necessary to remove it with a knife, but this
+is not essential when the tips of the fingers or toes are frozen.
+
+=General Effect of Cold.=--Sudden exposure to severe cold causes
+sleep, stupor, and death. Persons found apparently frozen to death
+should be brought into a cold room, which should be gradually heated,
+and the body rubbed with snow or ice water, and artificial respiration
+employed, as just directed. Attempts at resuscitation ought to be
+persistent, as recoveries have been reported after several hours of
+unconsciousness and apparent death from freezing.
+
+
+=CHILBLAINS AND MILD FROSTBITES.=--The effects of severe cold on the
+body are very similar to those of intense heat, though they are very
+much slower in making their appearance. After a person has frozen a
+finger or toe he may not notice much inconvenience for days, when
+suddenly violent inflammation may set in. The fingers, ears, nose, and
+toes are the members which suffer most frequently from the effects of
+cold. Similar symptoms of inflammation, described under burns, also
+result from cold, that is, redness and swelling of the skin, blisters
+with more severe and deeper inflammatory involvement, or, in case the
+parts are thoroughly frozen, local death and destruction of the
+tissues. But it is not essential that the body be exposed to the
+freezing temperature or be frozen at all, in order that some harm may
+result, for chilblains often follow when the temperature has not been
+lower than 40 deg. F., or thereabouts.
+
+The effect of cold is to contract the blood vessels, with the
+production of numbness, pallor, and tingling of the skin. When the
+cold no longer acts then the blood vessels dilate to more than their
+usual and normal state, and more or less inflammation results. The
+more sudden the return to warmth the greater the inflammatory sequel.
+
+Chilblains represent the mildest morbid effect of cold on the body.
+They exist as bluish-red swellings of the skin, usually on the feet or
+hands, but may attack the nose or ears, and are attended by burning,
+itching, and smarting. This condition is caused by dilatation of the
+vessels following exposure to cold. It is more apt to happen in young,
+anaemic women. Chilblains usually disappear during warm weather.
+Scratching, friction, or the severity of the attack may lead to the
+appearance of blisters and sores. In severe cases the fingers and toes
+present a sausage-like appearance, owing to swelling.
+
+=Treatment.=--Susceptible persons should wear thick, warm (not rough)
+stockings and warm gloves. The chilled members must never be suddenly
+warmed. Regular exercise and cold shower baths are good to strengthen
+the circulation, but the feet and hands must be washed in warm water
+only, and thoroughly dried. If sweating of these parts is a common
+occurrence, starch or zinc oxide should be dusted on freely night and
+morning. Cod-liver oil is an efficacious remedy in these cases; one
+teaspoonful of Peter Moeller's pure oil three times daily after meals.
+The affected parts are bathed twice daily in a solution of zinc
+acetate (one dram to one pint of water), and followed by the
+application, on soft linen or cotton, of zinc-oxide ointment
+containing two per cent of carbolic acid. If this is not curative,
+iodine ointment mixed with an equal quantity of lard may be tried.
+Exposure to cold will immediately bring on a recurrence of the
+trouble. If the affection of the feet is severe the patient must rest
+in bed. If the parts become blistered and open sores appear, then the
+same treatment as for burns is indicated. Wash with a weak solution
+of corrosive sublimate (one tablet for surgical purposes in two quarts
+of warm water) and apply an ointment of boric acid and vaseline, equal
+parts, spread on soft, clean cotton or linen. Rest of the part and
+existence in a warm atmosphere will complete the cure.
+
+
+=INGROWING TOE NAIL.=--This is a condition in which the flesh along
+the edges of the great toe nail becomes inflamed, owing either to
+overgrowth of the nail or to pressure of the soft parts against it.
+Improper footgear is the most common cause, as shoes which are too
+narrow across the toes, or not long enough, or those with high heels
+which throw the toes forward so that they are compressed by the toe of
+the boot, especially in walking downhill.
+
+A faulty mode of cutting the toe nails in a healthy foot may favor
+ingrowing toe nails. Toe nails should be cut straight across, and not
+trimmed away at the corners to follow the outline of the toes--as then
+the flesh crowds in at the corners of the nails, and when the nail
+pushes forward in its growth it presses into the flesh. Nails which
+have a very rounded surface are more apt to produce trouble, because
+then the edges are likely to grow down into the flesh. Inflammation in
+ingrowing toe nail usually arises along the outer edge of the nail.
+The flesh here becomes red, tender, painful, and swollen so that it
+overlaps the nail. After a time "matter" or pus forms and finds its
+way under the nail, and the parts about it ulcerate, and "proud
+flesh" or excessive granulation tissue springs up and imbeds the edge
+of the nail. Wearing a shoe, or walking, becomes impossible. The
+condition may last for months, or even years, if not rightly treated.
+
+=Treatment.=--Properly fitting footgear must be worn--broad at the
+toes with low heels and of sufficient length. If pus ("matter") forms,
+the cut edge should be raised up by pushing in a little absorbent
+cotton under the nail every day. Hot poultices of flaxseed meal, or
+other material will relieve any special pain and inflammation. Soaking
+the foot frequently in hot water, and observing especial cleanliness,
+will aid recovery. Tannic acid, or some antiseptic powder like
+nosophen, should be dusted along the edge of the nail, and the flesh
+crowded away from the nail by pushing in a little cotton with some
+tannic acid upon it.
+
+If there is a raw surface about the border of the nail, powdered lead
+nitrate may be dusted upon it each morning for four or five days, till
+the ulcerated tissue shrinks away and the edge of the nail becomes
+visible. The toe should be covered with absorbent cotton and a
+bandage. As soon as the toe is really inflamed the case becomes
+surgical, and as such demands the care of a surgeon when one can be
+obtained.
+
+
+=FAINTING.=
+
+_First Aid Rule 1.--Remove impediments to respiration. Remove collar,
+loosen all waist bands and cords, unhook corset or cut the laces at
+person's back._
+
+_Rule 2.--Assist heart and brain with blood pressure. Put cushion
+under buttocks, wind skirt close about legs, and raise feet in air.
+Wait ten seconds._
+
+_Rule 3.--Aid respiration. Put mild smelling salts under nose. Spatter
+cold water in face._
+
+
+=SUFFOCATION FROM GAS IN WELLS, CISTERNS, OR MINES, OR FROM
+ILLUMINATING GAS.=
+
+_First Aid Rule 1.--Remove quickly into pure air._
+
+_Rule 2.--Resuscitate as if drowned. Open his mouth, grasp his tongue,
+pull it forward and keep it there. Let another assistant grasp the
+arms just below the elbows, and draw them steadily upward by the sides
+of the patient's head to the ground, the hands nearly meeting, which
+enlarges the capacity of the chest and induces inspiration. (See pp.
+30 and 31.) While this is being done, let a third assistant take
+position astride the patient's hips with his elbows resting on his own
+knees, his hands extended ready for action. Next, let the assistant
+standing at the head turn down the patient's arms to the sides of his
+body, the assistant holding the tongue, changing hands if necessary to
+let the arms pass._
+
+_Just before the patient's hands reach the ground, the man astride the
+body will grasp the body with his hands, the ball of the thumb resting
+on either side of the pit of the stomach, the fingers falling into
+the grooves between the short ribs. Now, using his knees as a pivot,
+he will, at the moment the patient's hands touch the ground, throw
+(not too suddenly) his whole weight forward on his hands, and at the
+same time squeeze the waist between them, as if he wished to force
+something in the chest upward out of the mouth; he will deepen the
+pressure while he slowly counts one, two, three, four (about five
+seconds), then suddenly lets go with a final push, which will send him
+back to his first position. This completes expiration. A child or a
+delicate person must be more gently handled._
+
+_At the instant of letting go, the man at the head of the patient will
+again draw the arms steadily upward, to the sides of the patient's
+head, as before (the assistant holding the tongue again, changing
+hands if necessary to let the arms pass, holding them there while he
+slowly counts one, two, three, four (about five seconds))._
+
+_Repeat these movements deliberately and perseveringly twelve or
+fifteen times in every minute, thus imitating the natural motions of
+breathing. Continue the artificial respiration from one to four hours,
+or until the patient breathes; and for a while after the appearance of
+returning life, carefully aid the first short gasps until deepened
+into full breaths._
+
+_Keep the body warm with hot-water bottles and blanket._
+
+_Rule 3.--Give oxygen to breathe from a cylinder, for two days, at
+short intervals, in the case of illuminating gas._
+
+
+=FIT; CONVULSION.=
+
+_First Aid Rule 1.--Aid breathing. Loosen collar, waist bands, and
+unhook corset, or cut the laces behind._
+
+_Rule 2.--Protect from injury. Gently restrain from falling or rolling
+against furniture; lay flat on bed._
+
+_Rule 3.--Protect tongue from being bitten. Open jaws and put between
+teeth rubber eraser tied to stout string, or rubber stopper tied to
+stout string._
+
+_Rule 4.--Crush pearl of amyl nitrite in handkerchief, and hold close
+to patient's nose and mouth, till face is red and patient relaxes._
+
+_Rule 5.--Let patient sleep after fit without rousing._
+
+
+FOOTNOTES:
+
+[9] Caution. Dangerous. Use only on physician's order.
+
+[10] Caution. Dangerous. Use only on physician's order.
+
+
+
+
+Part II
+
+GERM DISEASES
+
+BY
+
+KENELM WINSLOW
+
+
+
+
+CHAPTER I
+
+=Contagious Diseases=
+
+_Scarlet Fever--Symptoms and Treatment--Precautions
+Necessary--Measles--Communicating the
+Disease--Smallpox--Vaccination--How to Diagnose Chickenpox._
+
+
+=ERUPTIVE CONTAGIOUS FEVERS= (_including Scarlet Fever, Measles,
+German Measles, Smallpox, and Chickenpox_).--These, with the exception
+of smallpox, attack children more commonly than adults. As they all
+begin with fever, and the characteristic rash does not appear for from
+one to four days after the beginning of the sickness, the diagnosis of
+these diseases must always be at the onset a matter of doubt. For this
+reason it is wise to keep any child with a fever isolated, even if the
+trouble seems to be due to "a cold" or to digestive disturbance, to
+avoid possible communication of the disorder to other children. While
+colds and indigestion are among the most frequent ailments of
+children, they must not be neglected, for measles begins as a bad
+cold, smallpox like the _grippe_, and scarlet fever with a sore throat
+or tonsilitis, and vomiting.
+
+By isolation is meant that the sick child should stay in a room by
+himself, and the doors should be kept closed and no children should
+enter, nor should any objects in the room be removed to other parts of
+the house after the beginning of its occupation by the patient.
+
+The services of a physician are particularly desirable in all these
+diseases, in order that an early diagnosis be made and measures be
+taken to protect the family, neighbors, and community from contagion.
+The failure of parents or guardians to secure medical aid for children
+is regarded by the law as criminal neglect, and is subject to
+punishment. Boards of health require the reporting of all contagious
+diseases as soon as their presence is known, and failure to comply
+with their rules also renders the offender liable to fine or
+imprisonment in most places.
+
+
+=SCARLET FEVER= (_Scarlatina_).--There is no difference between
+scarlet fever and scarlatina. It is a popular mistake that the latter
+is a mild type of scarlet fever. Fever, sore throat, and a bright-red
+rash are the characteristics of this disease. It occurs most
+frequently in children between the ages of two and six years. It is
+practically unknown under one year of age. Prof. H. M. Biggs, of the
+New York Department of Health, has seen but two undoubted cases in
+infants under twelve months. It is rare in adults, and one attack
+usually protects the patient from another. Second attacks have
+occurred, but many such are more apparent than real, since an error in
+diagnosis is not uncommon. The disease is communicated chiefly by
+means of the scales of skin which escape during the peeling process,
+but may also be acquired at any time from the onset of the attack from
+the breath, urine, and discharges from the body; or from substances
+which have come in contact with these emanations. Scarlet fever is
+probably a germ disease, and the germs may live for weeks in toys,
+books, letters, clothing, wall paper, etc. Close contact with the
+patient, or with objects which have come in close touch with the
+patient, is apparently necessary for contagion.
+
+=Period of Development.=--After exposure to the germs of scarlet
+fever, usually from two to five days elapse before the disease shows
+itself. Occasionally the outbreak of the disease occurs within
+twenty-four hours of exposure, and rarely is delayed for a week or ten
+days.
+
+=Symptoms.=--The onset is usually sudden. It begins with vomiting (in
+very young children sometimes convulsions), sore throat, fever,
+chilliness, and headache. The tongue is furred. The patient is often
+stupid; or may be restless and delirious. Within twenty-four hours or
+so the rash appears--first on the neck, chest, or lower part of
+back--and rapidly spreads over the trunk, and by the end of
+forty-eight hours covers the legs and entire body excepting the face,
+which may be simply flushed. The rash appears as fine, scarlet pin
+points scattered over a background of flushed skin. At its fullest
+development, at the end of the second or third day, the whole body may
+present the color of a boiled lobster. After this time the rash
+generally fades away and disappears within five to seven days. It is
+likely to vary much in intensity while it lasts. As the rash fades,
+scaling of the skin begins in large flakes and continues from ten days
+to as many weeks, usually terminating by the end of the sixth to
+eighth week. One of the notable features is the appearance of the
+tongue, at first showing red points through a white coating, and after
+this has cleared away, in presenting a raspberry-like aspect. The
+throat is generally deep red, and the tonsils may be dotted over with
+white spots (see Tonsilitis) or covered with a whitish or gray
+membrane suggesting diphtheria, which occasionally complicates scarlet
+fever. The fever usually is high (103 deg. to 107 deg. F), and the pulse
+ranges from 120 to 150; both declining after the rash is fully
+developed, generally by the fourth day. The urine is scanty and dark.
+There is, however, great variation in the symptoms as to their
+presence or absence, intensity, and time of occurrence and
+disappearance.
+
+=Complications and Sequels.=--These are frequent and make scarlet
+fever the most dreaded of the eruptive diseases, except smallpox.
+Enlarged glands under the jaw and at the sides of the neck are common,
+and appear as lumps in these sites. Usually not serious, they may
+enlarge and threaten life. Pain and swelling in the joints, especially
+of the elbows and knees, are not rare, and may be the precursors of
+serious inflammation of these parts. One of the most frequent and
+serious complications of scarlet fever is inflammation of the kidneys,
+occurring more often toward the end of the second week of the disease.
+Examination of the urine by the attending physician at frequent
+intervals throughout the course of the disorder is essential, although
+puffiness of the eyelids and face, and of the feet, ankles, and hands,
+together with lessened secretion of urine--which often becomes of a
+dark and smoky hue--may denote the onset of this complication. The
+disease of the kidneys usually results in recovery, but occasionally
+in death or in chronic Bright's disease of these organs. Inflammation
+of the middle ear with abscess, discharge of matter from the ear
+externally, and--as the final outcome--deafness, is not uncommon. This
+complication may be prevented to a considerable extent by spraying the
+nose and throat frequently and by the patient's use of a nightcap with
+earlaps, if the room is not sufficiently warm. Inflammation of the
+eyelids is an occasional complication. The heart is sometimes attacked
+by the toxins of the disease, and permanent damage to the organ, in
+the form of valvular trouble, may result. Blindness and nervous
+disorders are among the rarer sequels including paralyses and St.
+Vitus's dance.
+
+=Determination of Scarlet Fever.=--When beginning with vomiting,
+headache, high fever, and sore throat, and followed in twenty-four
+hours with a general scarlet rash, this is not difficult; but
+occasionally other diseases present rashes, as indigestion, _grippe_,
+and German measles, which puzzle the most acute physicians. Measles
+may be distinguished from scarlet fever in that measles appears first
+on the face, the rash is patchy or blotchy, and does not show for
+three to four days after the beginning of the sickness. The patient
+seems to have a bad cold, with cough, running at the nose, and sore
+eyes. German measles is mild, and while the rash may look something
+like that of scarlet fever, the patient does not seem generally ill,
+is hardly affected at all, though rarely troubled with slight catarrh
+of the nose. In no sickness are the services of a physician more
+necessary than in scarlet fever; first, to determine the existence of
+the disease, and then to prevent or combat the complications which
+often approach insidiously.
+
+=Outlook.=--The average death rate of scarlet fever is about ten per
+cent. It is very fatal in children about a year old, and most of the
+deaths occur in those under the age of six. But the mortality varies
+greatly at different times and in different epidemics. In 1904-5, in
+many parts of the United States, the disease was very prevalent and
+correspondingly mild, and deaths were rare.
+
+=Duration of Contagion.=--The disease is commonly considered
+contagious only so long as peeling of the skin lasts. But it seems
+probable that any catarrhal secretion from the nose, throat, or ear is
+capable of communicating the germs from a patient to another person
+for many days after other evidences of the disease are past. Scarlet
+fever patients should always be isolated for as long a period as six
+weeks--and better eight weeks--without regard to any shorter duration
+of peeling, and if peeling continues longer, so should the isolation.
+
+=Treatment.=--In case a physician is unobtainable the patient must be
+put to bed in the most airy, sunshiny room, which should be heated to
+70 deg. F., and from which all the unnecessary movables should be taken
+out before the entrance of the patient. A flannel nightgown and light
+bed clothing are desirable. The fever is best overcome by cold
+sponging, which at the same time diminishes the nervous symptoms, such
+as restlessness and delirium. The body is sponged--part at a
+time--with water at the temperature of about 70 deg. F., after placing a
+single thickness of old cotton or linen wet with ice or cold water
+(better an ice cap) over the forehead. The part is thoroughly dried as
+soon as sponged, and the process is repeated whenever the temperature
+is over 103 deg. F. There need be no fear that the patient may catch cold
+if only a portion of the body is exposed at any one time. If there is
+any chilliness following sponging, a bag or bottle containing hot
+water may be placed at the feet. It is well that a rubber bag
+containing ice, or failing this a cold cloth, be kept continually on
+the head while fever lasts. The throat should be sprayed hourly with a
+solution of hydrogen peroxide (full strength) and the nose with the
+same, diluted with an equal amount of water, three times a day. The
+outside of the throat it is wise to surround with an ice bag, or
+lacking this, a cold cloth frequently wet and covered with a piece of
+oil silk (or rubber) and flannel.
+
+The diet should consist of milk, broths, or thin gruels, and plenty of
+water should be allowed. Sweet oil or carbolized vaseline should be
+rubbed over the whole body night and morning during the entire
+sickness and convalescence. The bowels must be kept regular by
+injections or mild cathartics, and, after the fever subsides,
+vegetables, fruit, cereals, and milk may be permitted, together with
+meat or eggs once daily. It is imperative for the nurse and also the
+mother to wear a gown and cap over the outside clothes, to be slipped
+off in the hall at the door of the sick room when leaving the latter.
+
+
+=MEASLES.=--Measles is a contagious disease, characterized by a
+preliminary stage of fever and catarrh of the eyes, nose, and throat,
+and followed by a general eruption on the skin. One attack practically
+protects a person from another, yet, on the other hand, second attacks
+occur with extreme rarity. It is more contagious than scarlet fever,
+and isolation of a patient in a house is of less service in preventing
+communication to other inmates, whereas in scarlet fever half the
+number of susceptible children may escape the disease through this
+precaution. The germs which cause measles perish rapidly, so that
+infected clothes or other objects merely require a thorough airing to
+be rendered safe, whereas in scarlet fever the danger of transmission
+of the contagion may lurk in infected clothing and other substances
+for weeks, unless they are subjected to proper disinfection. A patient
+with measles is capable of communicating the disorder from its onset,
+before the appearance of the rash, through the breath, discharges from
+the nose and eyes, tears and saliva and all the secretions. At the end
+of the third week of the disease the patient is usually incapable of
+giving the disease to others. Close contact with a patient is commonly
+necessary for one to acquire the disease, but it is frequently claimed
+that it is carried by a third person in the clothes, as by a nurse. It
+is infrequent in infants under six months, and most frequent between
+the second and sixth year. Adults are attacked by measles more often
+than by scarlet fever.
+
+=Development.=--A period of from seven to sixteen days after exposure
+to measles elapses before the disease becomes apparent.
+
+=Symptoms.=--The disease begins like a severe nasal catarrh with
+fever. The eyes are red and watery, the nose runs, and the throat is
+irritable, red, and sore, and there is some cough, with chilliness and
+muscular soreness. The fever, higher at night, varies from 102 deg. to
+104 deg. F., and the pulse ranges from 100 to 120. There is often marked
+drowsiness for a day or two before the rash appears. Coated tongue,
+loss of appetite, occasional vomiting, and thirst are present during
+this period. The appearance of minute, whitish spots, surrounded by a
+red zone, may often be seen in the inside of the mouth opposite the
+back teeth for some days before the eruption occurs.
+
+The preliminary period, when the patient seems to be suffering with a
+bad cold, lasts for four days usually, and on the evening of the
+fourth day the rash breaks out. It first appears on the face and then
+spreads to the chest, trunk, and limbs. Two days are generally
+required for the complete development of the rash; it remains thus in
+full bloom for about two days more, then begins to subside, fading
+completely in another two days--six days in all.
+
+The rash appears as bright-red, slightly raised blotches on the face,
+which is generally somewhat swollen. The same rash extends to the
+abdomen, back, and limbs. Between the mottled, red rash may be seen
+the natural color of the skin. At this time the cough may be hoarse
+and incessant, and the eyes extremely sensitive to light. The fever
+and other symptoms abate when the rash subsides, and well-marked
+scaling of the skin occurs.
+
+=Complications and Sequels.=--Severe bronchitis, pneumonia, croup,
+laryngitis, sore eyes, ear abscess and deafness, violent diarrhea,
+convulsions, and, as a late result, consumption sometimes accompany or
+follow measles. For the consideration of these disorders, see special
+articles in other parts of this work.
+
+=Outlook.=--The vast majority of healthy patients over two years old
+recover from measles completely. Younger children, or those suffering
+from other diseases, may die through some of the complications
+affecting the lungs. The disease is peculiarly fatal in some epidemics
+occurring among those living in unhygienic surroundings, and in
+communities unaccustomed to the ravages of measles. Thus, in an
+epidemic attacking the Fiji Islanders, over one-quarter of the whole
+population (150,000) died of measles in 1875. Measles is more severe
+in adults than in children.
+
+=Diagnosis.=--For one not familiar with the characteristic rash a
+written description of it will not suffice for the certain recognition
+of the disease, but if the long preliminary period of catarrh and
+fever, and the appearance of the eruption on the fourth day, be taken
+into account--together with the existence of sore eyes and hoarse,
+hard cough--the determination of the presence of measles will not be
+difficult in most cases.
+
+=Treatment.=--The patient should be put to bed in a darkened,
+well-ventilated room at a temperature of 68 deg. to 70 deg. F. While by
+isolation of the patient we may often fail to prevent the occurrence
+of measles in other susceptible persons in the same house, because of
+the very infectious character of the disease, and because it is
+probable that they have already been exposed during the early stages
+when measles was not suspected, yet all possible precautions should be
+adopted promptly. For this reason other children in the house should
+be kept from school and away from their companions, and they ought
+not to be sent away from home to spread the disease elsewhere. The
+bowels should be kept regular by soapsuds injections or by mild
+cathartics, as a Seidlitz powder. If the fever is over 103 deg. F. and is
+accompanied by much distress and restlessness, children may be sponged
+with tepid water, and adults with water at 80 deg. F., every two hours or
+so as directed under scarlet fever. When cough is incessant or the
+rash does not come out well, there is nothing better than the hot
+pack.
+
+The patient is stripped and wrapped from feet to neck in a blanket
+wrung out of hot water containing two teaspoonfuls of mustard stirred
+into a gallon of water. This is then covered with two dry blankets and
+the patient allowed to remain in the blankets for two or three hours,
+when the application may be repeated. It is well to keep a cold cloth
+on the head during the process. Cough is also relieved by a mixture
+containing syrup of ipecac, twenty drops; paregoric, one teaspoonful,
+for an adult (or one-third the dose for a child of six), which should
+be given in one-quarter glass of water and may be repeated every two
+hours. If there is hoarseness, the neck should be rubbed with a
+mixture of sweet oil, two parts; and oil of turpentine, one part, and
+covered with a flannel bandage. The cough mixture will tend to relieve
+this condition also. A solution of boric acid (ten grains of boric
+acid to the ounce of water) is to be dropped in both eyes every two
+hours with a medicine dropper. Although usually mild, the eye symptoms
+may be very severe and require special treatment, and considerably
+impaired vision may be the ultimate result. Severe diarrhea is
+combated with bismuth subnitrate, one-quarter teaspoonful, every three
+hours. For adults, the diet consists of milk, broths, gruels, and raw
+eggs. Young children living on milk mixtures should receive the
+mixture to which they are accustomed, diluted one-half with barley
+water. Nourishment must be given every two hours except during sleep.
+The patient should be ten days in bed, and should remain three days in
+his room after getting up (or three weeks in all, if there are others
+who may contract measles in the house), and after leaving his room
+should stay in the house a week longer. The principal danger after an
+attack of measles is of lung trouble--pneumonia or tuberculosis
+(consumption)--and the greatest care should be exercised to avoid
+exposure to the wet or to cold draughts.
+
+
+=GERMAN MEASLES= (_Roetheln_).--German measles is related neither to
+measles nor scarlet fever, but resembles them both to a certain
+extent--more closely the former in most cases. It is a distinct
+disease, and persons who have had both measles and scarlet fever are
+still susceptible to German measles. One attack of German measles
+usually protects the patient from another. Adults, who have not been
+previously attacked, are almost as liable to German measles as
+children, but it is rare that infants acquire the disease. It is a
+very contagious disorder--but not so much so as true measles--and
+often occurs in widespread epidemics. The breath and emanations from
+the skin transmit the _contagium_ from the appearance of the first
+symptom to the disappearance of the eruption.
+
+=Development.=--The period elapsing after exposure to German measles
+and before the appearance of the symptoms varies greatly--usually
+about two weeks; it may vary from five to eighteen days.
+
+=Symptoms.=--The rash may be the first sign of the disease and more
+frequently is so in children. In others, for a day or two preceding
+the eruption, there may be headache, soreness, and redness of the
+throat, the appearance of red spots on the upper surface of the back
+of the mouth, chilliness, soreness in the muscles, loss of appetite,
+watering of the eyes. Catarrhal symptoms are most generally absent, an
+important point in diagnosis. When present, they are always mild.
+These preliminary symptoms, if present, are much milder and of shorter
+duration than in measles, where they last for four days before the
+rash appears; and the hard, persistent cough of measles is absent in
+German measles. Also, while there is sore throat in the latter, there
+is not the severe form with swollen tonsils covered with white spots
+so often seen in scarlet fever. Fever is sometimes absent in German
+measles; usually it ranges about 100 deg. F., rarely over 102 deg. F. Thus,
+German measles differs markedly from both scarlet fever and measles
+proper. The rash usually appears first on the face, then on the chest,
+and finally covers the whole body, in the space of a few
+hours--twenty-four hours at most. The eruption takes the form of
+rose-red, round or oval, slightly raised spots--from the size of a pin
+head to that of a pea--sometimes running together into uniform
+redness, as in scarlet fever. The rash remains fully developed for
+about two days, and often changes into a coppery hue as it gradually
+fades away. There are often lumps--enlarged glands--to be felt under
+the jaw, on the sides and back of the neck, which occur more commonly
+in German than in true measles. The glands at the back of the neck are
+the most characteristic. They are enlarged in about two-thirds of the
+cases.
+
+=Determination.=--The diagnosis or determination of the existence of
+measles must be made, in the absence of a physician, on the general
+symptoms rather than on the rash, which requires experience for its
+recognition and is subject to great variations in appearance, at one
+time simulating measles, at another scarlet fever.
+
+German measles differs from true measles in the following points: the
+preliminary period--before the rash--is mild, short, or absent; fever
+is mild or absent; the cold in the nose and eyes and cough are slight
+or may be absent, as contrasted with these symptoms in measles, while
+the enlarged glands in the neck are more pronounced than in measles.
+The onset of German measles is not so sudden as in scarlet fever and
+not accompanied with vomiting as in the latter, while the sore throat
+and fever are much milder in German measles. The peeling, which is so
+prominent in scarlet fever with the disappearance of the rash, is not
+infrequently present. It may be absent. Its presence or absence seems
+to depend upon the severity of the eruption. The desquamation when
+present is finer than in either measles or scarlet fever.
+
+=Outlook.=--Recovery from German measles is the invariable rule, and
+without complications or delay.
+
+=Treatment.=--Little or no treatment is required. The patient should
+remain in bed in a darkened room on a liquid diet while fever lasts,
+and be isolated from others indoors until all signs of the eruption
+are passed. The eyes should be treated with boric acid as in measles;
+the diet, during the fever, consisting of milk, broths, thin cereals,
+beef juice, raw eggs or eggnog, for adults and older children; while
+infants should have their milk mixture diluted one-half with barley
+water. A bath and fresh clothing for the patient, and thorough
+cleansing and airing of the sick room and clothing are usually
+sufficient after the passing of the disease without chemical
+disinfection.
+
+
+=SMALLPOX.=--Smallpox is one of the most contagious diseases known. It
+is extremely rare for anyone exposed to the disease to escape its
+onslaught unless previously protected by vaccination or by a former
+attack of the disease. One is absolutely safe from acquiring smallpox
+if recently and successfully vaccinated, and thus has one of the most
+frightful and fatal scourges to which mankind has ever been subject
+been robbed of its dangers. The _contagium_ is probably derived
+entirely from the scales and particles of skin escaping from smallpox
+patients, and in the year 1905-6 the true germ of the disease was
+discovered by Councilman, of Boston. It is not necessary to come in
+direct contact with a patient to contract the disease, as the
+_contagium_ may be transmitted some little distance through the air,
+possibly even outside of the sick room. One attack almost invariably
+protects against another. All ages are liable to smallpox; it is
+particularly fatal in young children, and during certain epidemics has
+proved more so in colored than in white people.
+
+=Development.=--A period of ten or twelve days usually elapses after
+exposure to smallpox before the appearance of the first symptoms of
+the disease. This period may vary, however, from nine to fifteen days.
+
+=Symptoms.=--There is a preliminary period of from twenty-four to
+forty-eight hours after the beginning of the disease before an
+eruption occurs. The onset is ushered in by a set of symptoms
+simulating those seen in severe _grippe_, for which smallpox is often
+mistaken at this time. The patient is suddenly seized with a chill,
+severe pains in the head, back, and limbs, loss of appetite and
+vomiting, dizziness on sitting up, and fever--103 deg. to 105 deg. F. In young
+children convulsions often take the place of the chill seen in
+adults. On the second day a rash often appears on the lower part of
+the belly, thighs, and armpits, which may resemble that characteristic
+of measles or scarlet fever, but does not last for over a day or two.
+It is very evanescent and, consequently, rarely seen. Diarrhea often
+occurs, as well as vomiting, particularly in children. On the evening
+of the fourth day the true eruption usually appears; first on the
+forehead or face, and then on the arms, hands, and legs, palms, and
+soles. The eruption takes successively four forms: first, red, feeling
+like hard pimples or like shot; then, on the second or third day of
+the eruption, these pimples become tipped with little blisters with
+depressed centers, and surrounded by a red blush. Two or three days
+later the blisters are filled with "matter" or pus and present a
+yellowish appearance and are rounded on top. Finally, on about the
+tenth day of the eruption, the pustules dry up and the matter exudes,
+forming large, yellowish or brownish crusts, which, after a while,
+drop off and leave red marks and, in severe cases, pitting. The fever
+preceding the eruption often disappears upon the appearance of the
+latter and in mild cases does not reappear, but in severe forms the
+temperature remains about 100 deg. F., and when the eruption is at its
+height again mounts to 103 deg. to 105 deg. F., and gradually falls with
+convalescence. The eruption is most marked on the face, hands, and
+forearms, and occurs less thickly on the body. It appears also in the
+mouth and throat and when fully developed on the face gives rise to
+pain and considerable swelling and distortion of the features, so that
+the eyes are closed and the patient becomes frightfully disfigured and
+well-nigh unrecognizable. Delirium is common at this time, and
+patients need constant watching to prevent their escape from bed. In
+the severe forms the separate eruptive points run together so that the
+face and hands present one distorted mass of soreness, swelling, and
+crusting. In these, pitting invariably follows, while in those cases
+where the eruption remains distinct, pitting is not certain to occur.
+A still worse form is that styled "black smallpox," in which the skin
+becomes of a dark-purplish hue, from the fact that each pustule is a
+small blood blister, and bleeding occurs from the nose, mouth, etc.
+These cases are almost, without exception, fatal in five to six days.
+
+The patient may say that the eruption was the first symptom he
+observed. This was particularly noticed in negroes, many of whom had
+never been vaccinated. The eruption may exhibit but a dozen or so
+points, especially about the forehead, wrists, palms, and soles. After
+the first four days the fever and all the disagreeable symptoms may
+subside, and the patient may feel absolutely well. The eruption,
+however, passes through the stages mentioned, although but half the
+time may be occupied by the changes; five or six days instead of ten
+to twelve for crusts to form. In such cases the death rate has been
+exceedingly low, although it is perfectly possible for a person to
+contract the most severe smallpox from one of these mild (and often
+unrecognized) cases, as has unfortunately happened. Smallpox occurring
+after successful vaccination resembles, in its characteristics, the
+cases just described, and unless vaccination had been done many years
+previously, the results are almost always favorable as regards life
+and absence of pitting.
+
+=Detection.=--Smallpox is often mistaken for chickenpox, or some of
+the skin diseases, in its mild forms. The reader is referred to the
+article on chickenpox for a consideration of this matter. The mild
+type should be treated just as rigidly as severe cases with regard to
+isolation and quarantine, being more dangerous to the community
+because lightly judged and not stimulating to the adoption of
+necessary precautions. The preliminary fever and other symptoms
+peculiar to smallpox will generally serve to determine the true nature
+of the disease, since these do not occur in simple eruptions on the
+skin. The general symptoms and course of smallpox must guide the
+layman rather than the appearance of the eruption, which requires
+educated skill and experience to recognize. Chickenpox in an adult is
+less common than in children. Smallpox is very rare in one who has
+suffered from a previous attack of the disease or in one who has been
+successfully vaccinated within a few years.
+
+=Outlook.=--The death rate of smallpox in those who have been
+previously vaccinated at a comparatively recent date, or in
+varioloid, as it is called when thus modified by vaccination, is only
+1.2 per cent. There are, however, severe cases following vaccinations
+done many years previous to the attack of smallpox. While these cannot
+be called varioloid, yet the death rate is much lower than in smallpox
+occurring in the unvaccinated. Thus, before the mild epidemic of 1894
+the death rate in the vaccinated was sixteen per cent; since 1894 it
+has been only seven per cent; while in the unvaccinated before 1894 it
+was fifty-eight per cent; and since that date it has been but
+seventeen per cent, as reported by Welch from the statistics of 5,000
+cases in the Philadelphia Municipal Hospital.
+
+=Complications.=--While a variety of disorders may follow in the
+course of smallpox, complications are not very frequent in even severe
+cases. Inflammation of the eyelids is very common, however, and also
+boils in the later stages. Delirium and convulsions in children are
+also frequent, as well as diarrhea; but these may almost be regarded
+as natural accompaniments of the disease. Among the less common
+complications are: laryngitis, pneumonia, diseases of the heart,
+insanity, paralysis, various skin eruptions, inflammation of the
+joints and of the eyes and ears, and baldness.
+
+=Treatment.=--Prevention is of greatest importance. Vaccination stands
+alone as the most effective preventive measure in smallpox, and as
+such has no rival in the whole domain of medicine. The modern method
+includes the inoculation of a human being with matter taken from one
+of the eruptive points on the body of a calf suffering with cowpox.
+Whether cowpox is a modified form of smallpox or a distinct disease is
+unknown.
+
+The period of protection afforded by a successful vaccination is
+uncertain, because it varies with different individuals. In a general
+way immunity for about four or five years is thus secured; ten or
+twelve years after vaccination the protection is certainly lost and
+smallpox may be then acquired. Every individual should be vaccinated
+between the second and third month after birth, and between the ages
+of ten and twelve, and at other times whenever an epidemic threatens.
+An unvaccinated person should be vaccinated and revaccinated, until
+the result is successful, as immunity to vaccination in an
+unvaccinated person is practically unknown. When unsuccessful, the
+vaccine matter or the technique is faulty. A person continuously
+exposed to smallpox should be vaccinated every few weeks--if
+unsuccessful, no harm or suffering follow; if successful, it proves
+liability to smallpox. A person previously vaccinated successfully may
+"take" again at any time after four or five years, and, in event of
+possible exposure to smallpox, should be revaccinated several times
+within a few weeks--if the vaccination does not "take"--before the
+attempt is given up. An unvaccinated person, who has been exposed to
+smallpox, can often escape the disease if successfully vaccinated
+within three days from the date of the exposure, but is not sure to
+do so.
+
+Diseases are not introduced with vaccination now that the vaccine
+matter is taken from calves and not from the human being, as formerly.
+Most of the trouble and inflammation of the vaccinated part following
+vaccination may be avoided by cleanliness and proper care in
+vaccinating.
+
+In the absence of a physician, vaccination may be properly done by any
+intelligent person when the circumstances demand it. Vaccination is
+usually performed upon the outside of the arm, a few inches below the
+shoulder, in the depression situated in that region. If done on the
+leg, the vaccination is apt to be much more troublesome and may
+confine the patient to bed. The arm should be thoroughly washed in
+soap and warm water, from shoulder to elbow, and then in alcohol
+diluted one-third with water. When this has evaporated (without
+rubbing), the dry arm is scratched lightly with a cold needle which
+has previously been held in a flame and its point heated red hot. The
+point must thereafter not be touched with anything until the skin is
+scratched with it. The object is not to draw blood, but to remove the
+outer layer of skin, over an area about one-fourth of an inch square,
+so that it appears red and moist but not bleeding. This is
+accomplished by very light scratching in various directions. Another
+spot, about an inch or two below, may be similarly treated. Then
+vaccine matter, if liquid, is squirted on the raw spots, or, if dried
+on points, the ivory point is dipped in water which has been boiled
+and cooled, and rubbed thoroughly over the raw places. The arm must
+remain bare and the vaccination mark untouched until the surface of
+the raw spot is perfectly dry, which may take half an hour. A piece of
+sterilized surgical gauze, reaching halfway about the arm and kept in
+place with strips of adhesive plaster (or an absolutely clean
+handkerchief bound about the arm, and held by sewing or safety pins),
+ought to cover the vaccination for three days. After this time the
+sore must only come in contact with soft and clean old cotton or
+linen, which may be daily pinned in the sleeve of the under garment.
+If the scab is knocked off and an open sore results it should be
+treated like any wound.
+
+If the vaccination "takes," it passes through several stages. On the
+third day following vaccination a red pimple forms at the point of
+introduction of the matter, which is surrounded by a circle of
+redness. Some little fever may occur. On the fifth day a blister or
+pimple containing clear fluid with a depressed center is seen, and a
+certain amount of hard swelling, itchiness, and pain is present about
+the vaccination. A sore lump (gland) is often felt under the arm. The
+full development is reached by the eighth day, when the pimple is full
+and rounded and contains "matter," and is surrounded by a large area
+of redness. From the eleventh day the vaccination sore dries, and a
+brown scab forms over it about the end of the fourteenth day, and the
+redness and swelling gradually depart. At the end of about three weeks
+the scab drops off, leaving a pitted scar or mark. Not infrequently
+the vaccination results in a very slight pimple and redness, which
+passes through the various stages described, in a week or ten days, in
+which case the vaccination should be repeated. Unless the vaccination
+follows very closely the course described, it cannot be regarded as
+successful, although after the first one or two vaccinations the
+result is often not so severe, and the time of completion of the
+various stages somewhat shortened.
+
+Rarely an eruption, resembling that at the vaccination site, appears
+on the vaccinated limb and even becomes general upon the body, due to
+urticaria or to inoculation, through scratching.
+
+The special treatment of an attack of smallpox is largely a matter of
+careful nursing. A physician or nurse can scarcely lay claim to any
+great degree of heroism in caring for smallpox patients, as there is
+no danger of contracting the disease providing a successful
+vaccination has been recently performed upon them. The patient should
+be quarantined in an isolated building, and all unnecessary articles
+should be removed from the sick room, in the way of carpets and other
+furnishings. It is well that the room be darkened to save irritation
+of the eyes. The diet should be liquid: milk, broths, and gruels.
+Laudanum, fifteen drops, or paregoric, one tablespoonful in water,
+may be given to adults, once in three hours, to relieve pain during
+the first few days. Sponging throughout the course of the disease is
+essential; first, with cool water, as directed for scarlet fever, with
+the use of cold on the head to relieve the itching, fever, and
+delirium. The cold pack is still more efficient. To give this, the
+patient is wrapped in a sheet wrung out in water at a temperature
+between 68 deg. and 75 deg. F. The sheet surrounds the naked body from feet to
+neck, and is tucked between the legs and between the body and arms;
+the whole is then covered with a dry blanket, and a cold, wet cloth or
+ice cap is placed upon the head. The patient may be permitted to
+remain in the pack for an hour, when it may be renewed, if necessary,
+to allay fever and restlessness; otherwise it may be discontinued. The
+cold sponging or cold pack are indicated when the temperature is over
+102.5 deg. F., and when with fever there are restlessness and delirium.
+Great cleanliness is important throughout the disease; the bedclothes
+should be changed daily and the patient sponged two or three times
+daily with warm water, unless fever is high. Cloths wet with cold
+carbolic-acid solution (one-half teaspoonful to the pint of hot water)
+should be kept continuously on the face and hands. Holes are cut in
+the face mask for the eyes, nose, and mouth, and the whole covered
+with a similar piece of oil silk to keep in the moisture. Such
+applications give much relief, and to some extent prevent pitting.
+The hair must be cut short, and crusts on the scalp treated with
+frequent sponging and applications of carbolized vaseline, to soften
+them and hasten their falling. The boric-acid solution should be
+dropped into the eyes as recommended for measles, and the throat
+sprayed every few hours with Dobell's solution. Diarrhea in adults may
+be checked with teaspoonful doses of paregoric given hourly in water.
+Vaseline and cloths used on a patient must not be employed on another,
+as boils are thus readily propagated. All clothing, dishes, etc.,
+coming in contact with a patient must be boiled, or soaked in a
+two-per cent carbolic-acid solution for twenty-four hours, or burned.
+When the patient is entirely free from scabs, after bathing and
+putting on disinfected or new clothes outside of the sick room, he is
+fit to reenter the world.
+
+
+=CHICKENPOX.=--Chickenpox is a contagious disease, chiefly attacking
+children. While it resembles smallpox in some respects, at times
+simulating the latter so closely as to puzzle physicians, it is a
+distinct disease and is in no way related to smallpox. This is shown
+by the fact that chickenpox sometimes attacks a patient suffering
+with, or recovering from, smallpox. Neither do vaccination nor a
+previous attack of smallpox protect an individual from chickenpox.
+Chickenpox is not common in adults, and its apparent presence in a
+grown person should awaken the liveliest suspicion lest the case be
+one of smallpox, since this mistake has been frequently made, and
+with disastrous results, during an epidemic of mild smallpox. One
+attack of chickenpox usually protects against another, but two or
+three attacks in the same individual are not unknown. The disease may
+be transmitted from the patient to another person from the time of the
+first symptom until the disappearance of the eruption. The disease
+ordinarily occurs in epidemics, but occasionally in isolated cases.
+
+=Development.=--A period of two weeks commonly elapses after exposure
+to the disease before the appearance of the first symptom of
+chickenpox, but this period may vary from thirteen to twenty-one days.
+
+=Symptoms.=--The characteristic eruption is often the first warning of
+chickenpox, but in some cases there may be a preliminary period of
+discomfort, lasting for a few hours, before the appearance of the
+rash; particularly in adults, in whom the premonitory symptoms may be
+quite severe. Thus, there may be chilliness, nausea, and even
+vomiting, rarely convulsions in infants, pain in the head and limbs,
+and slight fever (99 deg. to 102 deg. F.) at this time. The eruption shows
+first on the body, in most cases, especially the back. It consists of
+small red pimples, which rapidly develop into pearly looking blisters
+about as large as a pea to that of the finger nail, and are sometimes
+surrounded by a red blush on the skin. These blisters vary in number,
+from a dozen or so to two hundred. They do not run together, and in
+three to four days dry up, become shriveled and puckered, and covered
+with a dark-brown or blackish crust, and drop off, leaving only
+temporary red spots in most cases. The fever usually continues during
+the eruption. During the first few days successive fresh crops of
+fresh pimples and blisters appear, so that while the first crop is
+drying the next may be in full development. This forms one of its
+distinguishing features when chickenpox is compared with smallpox. In
+chickenpox the eruption is seen on the unexposed skin chiefly, but may
+occur on the scalp and forehead, and even on the palms, soles,
+forearms, and face. In many cases the eruption is found in the mouth,
+on its roof, and the inside of the cheeks. The blisters rarely contain
+"matter" or pus, as in smallpox, unless they are scratched. Scratching
+may lead to the formation of ugly scars and should be prevented,
+especially when the eruption is on the face. Pitting rarely occurs.
+
+=Determination.=--The discrimination between chickenpox and smallpox
+is sometimes extremely puzzling and demands the skill of an
+experienced physician. When one is unavailable, the following points
+may serve to distinguish the two disorders: smallpox usually begins
+like a severe attack of _grippe_, with pain in the back and head,
+general pains and nausea or vomiting, with high fever (103 deg. to 104 deg.
+F.) These last two or three days, and may completely subside when the
+rash appears. In chickenpox preliminary discomfort is absent, or lasts
+but a few hours before the eruption. The eruption of smallpox usually
+occurs first on the forehead, near the hair, or on the palms of the
+hands, soles of the feet, the arms and legs, but is usually sparse on
+the body. The eruption appears about the same time in smallpox and not
+in successive crops, as in chickenpox. Chickenpox is more commonly a
+disease of childhood; smallpox attacks all ages. The crusts in
+chickenpox are thin, and appear in four or five days, while those of
+smallpox are large and yellow, and occur after ten or twelve days.
+
+=Outlook.=--Chickenpox almost invariably results in a rapid and speedy
+recovery without complications or sequels. The young patients often
+feel well throughout the attack, which lasts from eight to twelve
+days.
+
+=Treatment.=--Children should be kept in bed during the eruptive stage
+until the blisters have dried. To prevent scratching, the calamine
+lotion may be used (Vol. II, p. 145), or carbolized vaseline, or
+bathing with a solution of baking soda, one teaspoonful to the pint of
+tepid water. The diet should be that recommended for German measles.
+Patients should be kept in the house and isolated until all signs of
+the eruption are passed, and then receive a good bath and fresh
+clothing before mingling with others. The sick room should be
+thoroughly cleaned and aired; thorough chemical disinfection is not
+essential.
+
+The services of a physician are always desirable in order that it may
+be positively determined that the disease is not a mild form of
+smallpox.
+
+
+
+
+CHAPTER II
+
+=Infectious Diseases=
+
+_Typhoid Fever--How it is Contracted--Complications and Sequels--Rest,
+Diet, and Bathing the Requisites--Mumps--Whooping Cough--Erysipelas._
+
+
+=TYPHOID FEVER (ENTERIC FEVER).=--Through ignorance which prevailed
+before the discovery of the germ of typhoid fever and exact methods
+for determining the presence of the same, the term was loosely applied
+and is to this day. Thus mild forms of typhoid are called gastric
+fever, slow fever, malarial fever, nervous fever, etc., all true
+typhoid in most cases; while typhoid fever, common to certain
+localities and differing in some respects from the typical form, is
+often named after the locality in which it occurs, as the "mountain
+fever" common to the elevated regions of the western United States.
+This want of information is apt to prevail in regions remote from
+medical centers, and leads to neglect of the necessary strict measures
+for the protection of neighboring communities, for the excretion of
+one typhoid patient has led to thousands of cases and hundreds of
+deaths.
+
+Typhoid fever is a communicable disease caused by a germ which attacks
+the intestines chiefly, but also invades the blood, and at times all
+the other parts of the body, and is characterized by continued fever,
+an eruption, tenderness and distention of the bowels, and generally
+diarrhea. It is common to all parts of the earth in the temperate
+zones, and occurs more frequently from July to December in the north
+temperate zone, from February to July in the south temperate zone. It
+is most prevalent in the late summer and autumn months and after a
+hot, dry summer. Individuals between the ages of fifteen and thirty
+are more prone to typhoid fever, but no age is exempt. The sexes are
+almost equally liable to the disease, although it is said that for
+every four female cases there are five male cases. The robust succumb
+as readily as the weak.
+
+=Cause and Modes of Communication.=--While the typhoid germ is always
+the immediate cause, yet it is brought in contact with the body in
+various ways. Contamination of water supply through bad drainage is
+the principal source of epidemics of typhoid. Before carefully
+protected public water supplies were in vogue in Massachusetts, there
+were ninety-two deaths from typhoid fever in 100,000 inhabitants,
+while thirty-five years after town water supplies became the rule,
+there were only nineteen deaths for the same population. Whenever
+typhoid is prevalent, the water used for drinking and all other
+household purposes should be boiled, and uncooked food should be
+avoided. Flies are carriers of typhoid germs by lighting on the nose,
+the mouth, and the discharges of typhoid patients, and then conveying
+the germs to food, green vegetables, and milk. Cooking the food,
+preventing contact of flies with the patients, and keeping flies out
+of human habitations becomes imperative. Milk is a source of contagion
+through contaminated water used to wash cans, or to adulterate it, or
+through handling of it by patients or those who have come in contact
+with patients. Oysters growing in the mouths of rivers and near the
+outlets of drains and sewers are carriers of typhoid germs, and, if
+eaten raw, sometimes communicate typhoid fever. Dust is an occasional
+medium of communication of the germ. It is probable, however, that the
+germ always enters the body by being swallowed with food or drink, and
+does not enter through the lungs. There is little doubt on this point.
+Ice may harbor the germ for many months, for freezing does not kill
+it, and epidemics have been traced to this source. Clothing, wood,
+utensils, door handles, etc., which have been contaminated by contact
+with discharges from patients, may also prove mediums of communication
+of the typhoid germ to healthy individuals. Typhoid germs escape from
+patients sick with the disease chiefly in the bowel discharges and
+urine, sometimes in the sweat, saliva, and vomited matter.
+
+Sewer gas and emanations from sewage and filth will not communicate
+typhoid fever directly, but the latter afford nutriment for the growth
+of the germ, and after becoming infected, may eventually come in
+contact with drinking water or food, and so prove dangerous. Improper
+care of discharges of excrement and urine--with the assistance of
+flies--are responsible for the enormous typhoid epidemics in military
+camps, so that in the late Spanish-American War one-fifth of all our
+soldiers in camp contracted the disease. In the upper layers of the
+soil typhoid germs may live for six months through frosts and thaws.
+The disease is preventable, and will probably be stamped out in time.
+In some of the most thickly populated cities in the world, as in
+Vienna, its occurrence is most infrequent, owing to intelligent
+sanitary control and pure water supply, while in the most salubrious
+country districts its inroads are the most serious and fatal through
+ignorance and carelessness.
+
+=Development.=--From eight to twenty-three days elapse from the time
+of entrance of typhoid germs into the body before the patient is taken
+sick. One attack usually protects one against another, but two or
+three attacks are not unheard of in the same person.
+
+=Symptoms.=--Typhoid fever is subject to infinite variations, and it
+will here be possible only to outline what may be called a typical
+case. In a work of this kind the preliminary symptoms are of most
+importance in warning one of the probability of an attack, so that the
+prospective patient can govern himself accordingly, as in no other
+disease is rest in bed of more value. Patients who persist in walking
+about with typhoid fever for the first week or so are most likely to
+die of the disease.
+
+The average duration of the disease is about one month. During the
+first week the onset is gradual, the temperature mounting a little
+higher each day--as 99.5 deg. F. the first evening, 101 deg. the second, 102 deg.
+the fourth, 104 deg. the fifth, 105 deg. the sixth, and 105.5 deg. the seventh. In
+the morning of each day the temperature is usually about a degree or
+more lower than that of the previous night. From the end of the first
+week to the beginning of the third the temperature remains at its
+highest point, being about the same each evening and falling one or
+two degrees in the morning. During the third week the temperature
+gradually falls, the highest point each evening being a degree or so
+lower than the previous day, while in the fourth week the temperature
+may be below normal in the morning and a degree or so above normal at
+night. So much for this symptom. After the entrance of typhoid germs
+into the bowels and before the recognized onset of the disease, there
+may be lassitude and disinclination for exertion. The disease begins
+with headache, backache, loss of appetite, sometimes a chill in adults
+or a convulsion in children, soreness in the muscles, pains in the
+belly, nosebleed, occasional vomiting, diarrhea, coated tongue, often
+some cough, flushed face, pulse 100, gradually increasing as
+described.
+
+These symptoms are, to a considerable extent, characteristic of the
+beginning of many acute diseases, but the gradual onset with constant
+fever, nosebleed, and looseness of the bowels are the most suggestive
+features. Then, if at the end of the first week or ten days pink-red
+spots, about as large as a pin head, appear on the chest and belly to
+the number of two or three to a dozen, of very numerously, and
+disappear on pressure (only to return immediately), the existence of
+typhoid fever is pretty certain. Headache is now intense. These rose
+spots--as they are called--often appear in crops during the second and
+third weeks, lasting for a few days, then departing.
+
+During the second week there is often delirium and wandering at night;
+the headache goes, but the patient is stupid and has a dusky, flushed
+face. The tongue becomes brownish in color, and its coat is cracked,
+and the teeth are covered with a brownish matter. The skin is
+generally red and the belly distended and tender. Diarrhea is often
+present with three to ten discharges daily of a light-yellow, pea-soup
+nature, with a very offensive odor. Constipation throughout the
+disease is, however, not uncommon in the more serious cases. The pulse
+ranges from 80 to 120 a minute.
+
+During the third week, in cases of moderate severity, the general
+condition begins to improve with lowering of the temperature, clearing
+of the tongue, and less frequent bowel movements. But in severe cases
+the patient becomes weaker, with rapid, feeble pulse, ranging from 120
+to 140; stupor and muttering delirium; twitching of the wrists and
+picking at the bedclothes, with general trembling of the muscles in
+moving; slow, hesitating speech, and emaciation; while the urine and
+faeces may be passed unconsciously in bed. Occasionally the patient
+with delirium may require watching to prevent him from getting out of
+bed and injuring himself. He may appear insane.
+
+During the fourth week, in favorable cases, the temperature falls to
+normal in the morning, the pulse is reduced to 80 or 100, the diarrhea
+ceases, and natural sleep returns.
+
+Among the many and frequent variations from the type described, there
+may be a fever prolonged for five or six weeks, with a good recovery.
+Chills are not uncommon during the disease, sometimes owing to
+complications. Relapse, or a return of the fever and other symptoms
+all over again, occurs in about ten per cent of the cases. This may
+happen more than once, and as many as five relapses have been recorded
+in one patient. A slight return of the fever for a day or two is often
+seen, owing to error in diet, excitement, or other imprudence after
+apparent recovery. Death may occur at any time from the first week,
+owing to complications or the action of the poison of the disease.
+Pneumonia, perforation of and bleeding from the bowels are the most
+frequent dangerous complications. Unfavorable symptoms are continued
+high fever (105 deg. to 106 deg. F.), marked delirium, and trembling of the
+muscles in early stages, and bleeding from the bowels; also intense
+and sudden pain with vomiting, indicating perforation of the
+intestines. The result is more apt to prove unfavorable in very fat
+patients, and especially so in persons who have walked about until the
+fever has become pronounced. Bleeding from the bowels occurs in four
+to six per cent of all cases and is responsible for fifteen per cent
+of the deaths; perforation of the bowels happens in one to two per
+cent of all cases and occasions ten per cent of the deaths.
+
+=Detection.=--It is impossible for the layman to determine the
+existence of typhoid fever in any given patient absolutely, but when
+the symptoms follow the general course indicated above, a probability
+becomes established. Unusual types are among the most difficult and
+puzzling cases which a physician has to diagnose, and he can rarely be
+absolutely sure of the nature of any case before the end of the first
+week or ten days, when examination of the blood offers an exact
+method of determining the presence of typhoid fever. Typhoid
+fever--especially where there are chills--is often thought to be
+malaria, when occurring in malarial regions, and may be improperly
+called "typhoid malaria." There is no such disease. Rarely typhoid
+fever and malaria coexist in the same person, and while this was not
+uncommon in the soldiers returning from Cuba and Porto Rico, it is an
+extremely unusual occurrence in the United States. Examination of the
+blood will determine the presence or absence of both of these
+diseases.
+
+=Complications and Sequels.=--These are very numerous. Among the
+former are diarrhea, delirium, mental and nervous diseases,
+bronchitis, pleurisy, pneumonia, ear abscess, perforation of and
+hemorrhage from the bowels, inflammation of the gall bladder, disease
+of heart, kidney, and bladder, and many rarer conditions, depending
+upon the organ which the germ invades. Among sequels are boils,
+baldness, bone disease, painful spine, and, less commonly, insanity
+and consumption. While convalescence requires weeks and months, the
+patient often gains greatly in flesh and feels made over anew, as in
+fact he has been to a great extent, through the destruction and repair
+of his organs.
+
+=Outlook.=--The death rate varies greatly in different epidemics and
+under different conditions. During the Spanish-American War in the
+enormous number of cases--over 20,000--the death rate was only about
+seven per cent, which represents that in the best hospitals of this
+country and in private practice. Osler states that the mortality
+ranges from five to twelve per cent in private practice, and from
+seven to twenty per cent in hospital practice, because hospital cases
+are usually advanced before admission. The chances of recovery are
+much greater in patients under fifteen years, and are also more
+favorable between the twenty-second and fortieth years.
+
+=Treatment.=--There is perhaps no disease in which the services of a
+physician are more desirable or useful than in typhoid fever, on
+account of its prolonged course and the number of complications and
+incidents which may occur during its existence. It is the duty of the
+physician to report cases of typhoid to the health authorities, and
+thus act as a guardian of the public health. If, however, in any
+circumstances one should have the misfortune to have the care of a
+typhoid patient remote from medical aid, it is a consolation to know
+that the outlook is not greatly altered by medicine or special
+treatment of any sort. There have been epidemics in remote parts of
+this country where numbers of persons have suffered with typhoid
+without any professional care, and yet with surprisingly good results.
+Thus, in an epidemic occurring in a small community in Canada,
+twenty-four persons sickened with typhoid and received no medical care
+or treatment whatever, and yet there was but one death. The essentials
+of treatment are comprised in _Rest, Diet, and Bathing_. Rest to the
+extent of absolute quiet in the horizontal position, at the first
+suspicion of typhoid, is requisite in order to avoid the dangers of
+bleeding and perforation of the bowels resulting from ulceration of
+structures weakened by the disease. The patient should be assisted to
+turn in bed, must make no effort to rise during the sickness, and
+should pass urine and bowel discharges into a bedpan or urinal under
+cover. In case of bleeding from the bowels, the bedpan should not be
+used, but the discharges may be received for a time in cloths, without
+stirring the patient.
+
+=Diet.=--This should consist chiefly of liquids until a week after
+the fever's complete disappearance. A cup of liquid should be given
+every two hours except during a portion of the sleeping hours. Milk,
+diluted with an equal amount of water, forms the chief food in most
+cases unless it disagrees, is refused, or is unobtainable.
+
+In addition to milk, albumen water--white of raw egg, strained and
+diluted with an equal amount of water, and flavored with a few drops
+of lemon juice or with brandy--is valuable; also juice squeezed from
+raw beef--in doses of four tablespoonfuls--coffee, cocoa, and strained
+barley, rice, or oatmeal gruel, broths, unless diarrhea is marked and
+increased by the same. Soft custard, jellies, ice cream,
+milk-and-flour porridge, and eggnog may be used to increase the
+variety. Finely scraped raw or rare beef, very soft toast, and
+soft-boiled or poached eggs are allowable after the first week of
+normal temperature, at the end of the third or fourth week of the
+disease, and during the course of the disease under circumstances
+where the fluids are not obtainable or not well borne. An abundance of
+water should be supplied to the patient throughout the disease.
+
+=Bathing.=--The importance of cold, through the medium of water, in
+typhoid fever accomplishes much, both in reducing the temperature and
+in stimulating the nervous system and relieving restlessness and
+delirium. Bathing is usually applied when the temperature rises above
+102.5 deg. F., and may be repeated every two or three hours if
+restlessness, delirium, and high temperature require it.
+
+The immersion of patients in tubs of cold water, as practiced with
+benefit in hospitals, is out of the question for use by inexperienced
+laymen. The patient should have a woven-wire spring bed and soft hair
+mattress, over which is laid a folded blanket covered by a rubber
+sheet. Sponging the naked body with ice water will suffice in some
+cases; in others, when the temperature is over 102-1/2 deg. F., enveloping
+the whole body in a sheet wet in water at 65 deg., and either rubbing the
+surface with ice or cloths wet in ice-cold water, for ten or fifteen
+minutes, is advisable. Rubbing of the skin of the chest and sides is
+necessary during the application of cold to prevent shock. The use of
+a cold cloth on the head and hot-water bottle at the feet, during the
+sponging, will also prove beneficial. In children and others objecting
+to these cold applications, the vapor bath is effective. For this a
+piece of cheese cloth (single thickness) is wet with warm water--100 deg.
+to 105 deg.--and is wrapped about the naked body from shoulders to feet,
+and is continually wet by sprinkling with water at the temperature of
+98 deg.. The evaporation of the water will usually, in fifteen to twenty
+minutes, cool the body sufficiently if the patient is fanned
+continuously by two attendants. In warm weather the patient should
+only be covered with a sheet for a while after the bath, which should
+reduce the temperature to 3 deg.. Hot water at the feet, and a little
+brandy or whisky given before the sponging if the pulse be feeble,
+will generally prevent a chill. Patients should be gently dried after
+the bath and covered with dry bedclothing. The utmost care should be
+taken not to agitate a feeble patient during sponging.
+
+The long period of lying in bed favors the occurrence of bedsores.
+These are apt to appear about the lower part of the spine, and begin
+with redness of the skin, underneath which a lump may be felt.
+Constant cleanliness and bathing with alcohol, diluted with an equal
+amount of water, will tend to prevent this trouble, while moving the
+patient so as to take the pressure off this region and avoiding any
+rumpling of the bedding under his body are also serviceable, as well
+as the ring air cushion. Medicine is not required, except for special
+symptoms, and has no influence either in lessening the severity of or
+in shortening the disease. Brandy or whisky diluted with water are
+valuable in severe cases, with muttering delirium, dry tongue, and
+feeble pulse; it is not usually called for before the end of the
+second week, and not in mild cases at any time. A tablespoonful of
+either, once in two to four hours, is commonly sufficient. Pain and
+distention of the belly are relieved by applying a pad over the whole
+front of the belly--consisting of two layers of flannel wrung out of a
+little very hot water containing a teaspoonful of turpentine--and
+covered by a dry flannel bandage wrapped about the body. Also the use
+of white of egg and water, and beef juice, instead of milk, will
+benefit this condition.
+
+Diarrhea--if there are more than four discharges daily--may be checked
+by one-quarter level teaspoonful doses of bismuth subnitrate, or
+teaspoonful doses of paregoric, once in three hours. Constipation is
+relieved by injections of warm soapsuds, once in two days. Bleeding
+from the bowels must be treated by securing perfect quiet on the
+patient's part, and by giving lumps of ice by the mouth, and cutting
+down the nourishment for six hours. Fifteen drops of laudanum should
+be given to adults, if there is restlessness, and some whisky, if the
+pulse becomes feeble, but it is better to reserve this until the
+bleeding has stopped. Patients may be permitted to sit up after a week
+of normal temperature, but solid food must not be resumed until two or
+three weeks after departure of fever, and then very gradually,
+avoiding all coarse and uncooked vegetables and fruit.
+
+The greatest care must be exercised by attendants to escape
+contracting the disease and to prevent its communication to others.
+The bowel discharges must be submerged in milk of lime (one part of
+slaked lime to four parts of water), and remain in it one hour before
+being emptied. The urine should be mixed with an equal amount of the
+same, or solution of carbolic acid (one part in twenty parts of hot
+water), and the mixture should stand an hour before being thrown into
+privy or sewer. Clothing and linen in contact with the patient must
+be soaked in the carbolic solution for two hours. The patient's
+expectoration is to be received on old muslin pieces, which must be
+burned. The bedpan and eating utensils must be frequently scalded in
+boiling water. The attendant should wash his hands always after
+touching the patient, or objects which have come in contact with
+patient or his discharges, and thus will avoid contagion. If farm or
+dairy workers come in contact with the patient, the latter precaution
+is especially important. If there is no water-closet in the house, the
+disinfected discharges may be buried at least 100 feet from any well
+or stream. Typhoid fever is only derived from the germs escaping in
+the urine, and in the bowel, nose, or mouth discharges of typhoid
+patients.
+
+
+=MUMPS.=--Mumps is a contagious disease characterized by inflammation
+of the parotid glands, situated below and in front of the ears, and
+sometimes of the other salivary glands below the jaw, and rarely of
+the testicles in males and the breasts in females.
+
+Swelling and inflammation of the parotid gland also occur from injury;
+and as a complication of other diseases, as scarlet fever, typhoid
+fever, etc.; but such conditions are wholly distinct from the disease
+under discussion. Mumps is more or less constantly prevalent in most
+large cities, more often in the spring and fall, and is often
+epidemic, attacking ninety per cent of young persons who have not
+previously had the disease. It is more common in males, affecting
+children and youths, but rarely infants or those past middle age. One
+attack usually protects against another.
+
+=Development.=--A period of from one to three weeks elapses, after
+exposure to the disease, before the first signs develop. The germ has
+not yet been discovered, and the means of communication are unknown.
+The breath has been thought to spread the germs of the disease, and
+mumps can be conveyed from the sick to the well, by nurses and others
+who themselves escape.
+
+=Symptoms.=--Sometimes there is some preliminary discomfort before the
+apparent onset. Thus, in children, restlessness, peevishness, languor,
+nausea, loss of appetite, chilliness, fever, and convulsions may usher
+in an attack. Mumps begins with pain and swelling below the ear on one
+side. Within forty-eight hours a large, firm, sensitive lump forms
+under the ear and extends forward on the face, and downward and
+backward in the neck. The swelling is not generally very painful, but
+gives a feeling of tightness and disfigures the patient. It makes
+speaking and swallowing difficult; the patient refuses food, and talks
+in a husky voice; chewing causes severe pain. After a period of two to
+four days the other gland usually becomes similarly inflamed, but
+occasionally only one gland is attacked. There is always fever from
+the beginning. At first the temperature is about 101 deg. F., rarely much
+higher than 103 deg. or 104 deg.. The fever continues four or five days and
+then gradually declines. The swelling reaches its height in from two
+to five days, and then after forty-eight hours slowly subsides, and
+disappears entirely within ten to fourteen days. The patient may
+communicate the disease for ten days after the fever is past, and
+needs to be isolated for that period. Earache and noises in the ear
+frequently accompany mumps, and rarely abscess of the ear and deafness
+result. The most common complication occurs in males past puberty,
+when, during recovery or a week or ten days later, one or both
+testicles become painful and swollen, and this continues for as long a
+time as the original mumps. Less often the breasts and sexual organs
+of females are similarly affected.
+
+=Complications and Sequels.=--Recovery without mishap is the usual
+result in mumps, with the exception of involvement of the testicles.
+Rarely there are high fever, delirium, and great prostration.
+Sometimes after inflammation of both testicles in the young the organs
+cease to develop, and remain so, but sexual vigor is usually retained.
+Sometimes abscess and gangrene of the inflamed parotid gland occur.
+Recurring swelling and inflammation of the gland may occur, and
+permanent swelling and hardness remain. Meningitis, nervous and joint
+complications are among the rarer sequels.
+
+=Treatment.=--The patient should remain in bed while the fever lasts.
+A liquid diet is advisable during this time. Fever may be allayed by
+frequent sponging of the naked body with tepid water. High fever and
+delirium demand the constant use, on the head, of the ice cap (a
+rubber bag, made to fit the head, containing ice). The relief of pain
+in the swollen gland is secured by the frequent application of a thick
+layer of sheet cotton, large enough to cover the whole side of the
+neck, wrung out of hot water and covered with oil-silk or rubber
+sheeting, with a bandage to retain it in place.
+
+Paregoric may be given for the same purpose--a tablespoonful for
+adults; a teaspoonful for a child of eight to ten, well diluted with
+water, and not repeated inside of two hours, and not then unless the
+pain continues unabated. Inflammation of the testicles demands rest in
+bed, elevation of the testicle on a pillow after wrapping it in a
+thick layer of absorbent cotton, or applying hot compresses, as
+recommended for the neck. After the first few days of this treatment,
+adjust a suspensory bandage, which can be procured at any apothecary
+shop, and apply daily the following ointment: guiacol, sixty grains;
+lard, one-half ounce, over the swollen testicle.
+
+
+=WHOOPING COUGH.=--A contagious disease characterized by fits of
+coughing, during which a whooping or crowing sound is made following a
+long-drawn breath. Whooping cough is generally taken through direct
+contact with the sick, rarely through exposure to the sick room, or to
+persons or clothing used by the sick. The germ which causes the
+disease is probably in the mucus of the nose and throat. Whooping
+cough is usually more or less prevalent in all thickly settled
+civilized communities, at times is epidemic, and often follows
+epidemics of measles. It occurs chiefly in children from six months to
+six years of age. Girls and all weak and delicate subjects are
+slightly more susceptible to the disease. Some children are naturally
+immune to whooping cough. One attack usually protects against another.
+
+=Development.=--A variable period elapses between the time of exposure
+to whooping cough and the appearance of the first symptoms. This may
+be from two days to two weeks; usually seven to ten days.
+
+=Symptoms.=--Whooping cough begins like an ordinary cold in the head,
+with cough, worse at night, which persists. The coughing fits increase
+and the child gets red in the face, has difficulty in getting its
+breath during them, and sometimes vomits when the attack is over.
+After a variable period, from a few days to two weeks from the
+beginning of the cough, the peculiar feature of the disease appears.
+The child gives fifteen or twenty short coughs without drawing breath,
+the face swells and grows blue, the eyeballs protrude, the veins stand
+out, and the patient appears to be suffocating, when at last he draws
+in a long breath with a crowing or whooping sound, which gives rise to
+the name of the disease. Several such fits of coughing may follow one
+another and are often succeeded by vomiting and the expulsion of a
+large amount of phlegm or mucus, which is sometimes streaked with
+blood. In mild cases there may be six to twelve attacks in twenty-four
+hours; in severe cases from forty to eighty. The attacks last from a
+few seconds to one or two minutes. Occasionally the whoop comes before
+the coughing fit, and sometimes there may be no whooping at all, only
+fits of coughing with vomiting. Between the attacks, puffiness of the
+face and eyes and blueness of the tongue persist. The coughing fits
+and whooping last usually from three to six weeks, but the duration of
+the disease is very variable. Occasionally it lasts many months,
+especially when it occurs in winter. The contagiousness of whooping
+cough continues about two months, or ceases before that time with the
+cessation of the cough. Oftentimes there may be occasional whooping
+for months; or, after ceasing altogether for some days, it may begin
+again. In neither of these conditions is the disease considered still
+contagious after two months. When an attack of whooping is coming on,
+the child often seems to have some warning, as he seems terrified and
+suddenly sits up in bed, or, if playing, grasps hold of something, or
+runs to his mother or nurse. Coughing fits are favored by emotion or
+excitement, by crying, singing, eating, drinking, sudden change of
+temperature, and by bad air.
+
+=Complications and Sequels.=--These are many and make whooping cough a
+critical disease for very young children. Bronchitis and pneumonia
+often complicate whooping cough in winter, and diarrhea frequently
+occurs with it in summer. Convulsions not infrequently follow the
+coughing fits in infants, and, owing to the amount of blood forced to
+the head during the attacks, nosebleed and dark spots on the forehead
+and surface of the eyes appear from breaking of small blood vessels in
+these places. Severe vomiting and diarrhea occasionally aggravate the
+case, and pleurisy and consumption may occur. The violent coughing may
+permanently damage the heart. Rupture of the lung tissue happens from
+the same cause, and paralysis sometimes follows breaking of a blood
+vessel in the brain. But in the vast majority of cases in children
+over two years old no dangerous sequel need be feared.
+
+=Outlook.=--Owing to the numerous complications, whooping cough must
+be looked upon as a very serious disease, especially in infants under
+two years, and in weak, delicate children. It causes one-fourth of all
+deaths among children, the death rate varying from three to fifteen
+per cent in different times and under different circumstances. For
+this reason a physician's services should always be secured when
+possible.
+
+=Treatment.=--A host of remedies is used for whooping cough, but no
+single one is always the best. It is often necessary to try different
+medicines till we find one which excels. Fresh air is of greatest
+importance. Patients should be strictly isolated in rooms by
+themselves, and it is wise to send away children who have not been
+exposed. Morally, parents are criminally negligent who allow their
+children with whooping cough to associate with healthy children. If
+the coughing fits are severe or there is fever, children should be
+kept in bed. Usually there is not much fever; perhaps an elevation of
+a degree or two at first, and at times during the disease. Otherwise,
+children may be outdoors in warm weather, and in winter on warm, quiet
+days. Sea air is especially good for them. It is best that the sick
+should have two rooms, going from one to the other, so that the
+windows in the room last occupied may be opened and well ventilated.
+Fresh air at night is especially needful, and the patient should sleep
+in a room which has been freshly aired. The temperature should be kept
+at an even 70 deg. F., and the child should not be exposed to draughts.
+Vaporizing antiseptics in the sick room has proved beneficial. A two
+per cent solution of carbolic acid in water is useful for this
+purpose, or a substance called vapo-cresoline, with which is sold a
+vaporizing lamp and directions for use. A one per cent solution of
+resorcin, or of hydrogen dioxide, diluted with four parts of water,
+used in an atomizer for spraying the throat, every two hours, has
+given good results. In the beginning of the disease, before the
+whooping has begun, a mixture of paregoric and syrup of ipecac will
+relieve the cough, ten drops of the former with five of the latter,
+for a child of two years, given together in water every three hours.
+The bromide of sodium, five grains in water, every three hours during
+the day, for a child of two, is serviceable in relieving the fits of
+coughing in the day; while at night, two grains of chloral, not
+repeated, may be given in water at bedtime to secure sleep, in a child
+of two. The tincture of belladonna, in doses of two drops in water,
+three times daily, for a child of two, is also often efficacious.
+Quinine, given in the dose of one-sixth grain for each month of the
+child's age under a year; or in one and one-half grain doses for each
+year of age under five, is one of the older and more valuable
+remedies. It should be given three times daily in pill with jelly, or
+solution in water. Bromoform in doses of two drops for a child of two,
+and increasing to five drops for a child of six, may be given in syrup
+three times daily with benefit. Most of these drugs should be employed
+only with a doctor's advice, when this is possible. To sum up, use the
+vapo-cresoline every day. When no physician is available, begin with
+belladonna during the day, using bromide of sodium at night. If this
+fails to modify the whooping after five days' trial, use bromide and
+chloral. In severe cases use bromoform. During a fit of coughing and
+whooping, it is well to support the child's head, and if he ceases to
+breathe, he should be slapped over the face and chest with a towel wet
+with cold water. Interference with sleep caused by coughing, and loss
+of proper nourishment through vomiting, lead to wasting and debility.
+Teaspoonful doses of emulsion of cod-liver oil three times daily,
+after eating, are often useful in convalescence, and great care must
+be taken at this time to prevent exposure and pneumonia. Change of air
+and place will frequently hasten recovery remarkably in the later
+stages of the disease.
+
+
+=ERYSIPELAS.=--Erysipelas is a disease caused by germs which gain
+entrance through some wound or abrasion in the skin or mucous
+membranes. Even where no wound is evident it may be taken for granted
+that there has been some slight abrasion of the surface, although
+invisible. Erysipelas cannot be communicated any distance through the
+air, but it is contagious in that the germs which cause it may be
+carried from the sick to the well by nurses, furniture, bedding,
+dressings, clothing, and other objects. Thus, patients with wounds,
+women in childbirth, and the newborn may become affected, but modern
+methods of surgical cleanliness have largely eliminated these forms of
+erysipelas, especially in hospitals, where it used to be common.
+Erysipelas attacks people of all ages, some persons being very
+susceptible and suffering frequent recurrences. The form which arises
+without any visible wound is seen usually on the face, and occurs most
+frequently in the spring. The period of development, from the time the
+germs enter the body until the appearance of the disease, lasts from
+three to seven days.
+
+Erysipelas begins with usually a severe chill (or convulsion in a
+baby) and fever. Vomiting, headache, and general lassitude are often
+present. A patch of red appears on the cheeks, bridge of nose, or
+about the eye or nostril, and spreads over the face. The margins of
+the eruption are sharply defined. Within twenty-four hours the disease
+is fully developed; the skin is tense, smooth, and shiny, scarlet and
+swollen, and feels hot, and is often covered with small blisters. The
+pain is more or less intense, burning or itching occurs, and there is
+a sensation of great tightness or tension. On the face the swelling
+closes the eye and may interfere with breathing through the nose. The
+lips, ears, and scalp are swollen, and the person may become
+unrecognizable in a couple of days. Erysipelas tends to spread like a
+drop of oil, and the borders of the inflammatory patch are well
+marked. It rarely spreads from the face to the chest and body, and but
+occasionally attacks the throat. During the height of the inflammation
+the temperature reaches 104 deg. F, or over. After four or five days, in
+most cases, erysipelas begins to subside, together with the pain and
+temperature, and recovery occurs with some scaling of the skin. The
+death rate is said to average about ten per cent in hospitals, four
+per cent in private practice. Headache, delirium, and stupor are
+common when erysipelas attacks the scalp. The appearance of the
+disease in other locations is similar to that described. Relapses are
+not uncommon, but are not so severe as the original attack. Spreading
+may extend over a large area, and the deeper parts may become
+affected, with the formation of deep abscesses and great destruction
+of tissue. Certain internal organs, heart, lungs, spleen, and kidneys,
+are occasionally involved with serious consequences. The old, the
+diseased, and the alcoholic are more apt to succumb, also the newborn.
+It is a curious fact that cure of malignant growths (sarcoma), chronic
+skin diseases, and old ulcers sometimes follows attacks of erysipelas.
+
+=Treatment.=--The duration of erysipelas is usually from a few days to
+about two weeks, according to its extent. It tends to run a definite
+course and to recovery in most cases without treatment. The patient
+must be isolated in a room with good ventilation and sunlight.
+Dressings and objects coming in contact with him must be burned or
+boiled. The diet should be liquid, such as milk, beef tea, soups, and
+gruels. The use of cloths wet constantly with cold water, or with a
+cold solution of one-half teaspoonful of pure carbolic acid to the
+pint of hot water, or with a poisonous solution of sugar of lead, four
+grains to the pint, should be kept over small inflamed areas. Fever is
+reduced by sponging the whole naked body with cold water at frequent
+intervals. A tablespoonful of whisky or brandy in water may be given
+every two hours to adults if the pulse is weak. Painting the borders
+of the inflamed patch with contractile collodion may prevent its
+spreading. The patient must be quarantined until all scaling ceases,
+usually for two weeks.
+
+
+
+
+CHAPTER III
+
+=Malaria and Yellow Fever=
+
+_The Malarial Parasite--Mosquitoes the Means of Infection--Different
+Forms of Malaria--Symptoms and Treatment--No Specific for Yellow
+Fever._
+
+
+=MALARIA; CHILLS AND FEVER; AGUE; FEVER AND AGUE; SWAMP OR MARSH
+FEVER; INTERMITTENT OR REMITTENT FEVER; BILIOUS FEVER.=--Malaria is a
+communicable disease characterized by attacks of fever occurring at
+certain intervals, and due to a minute animal parasite which inhabits
+the body of the mosquito, and is communicated to the blood of man by
+the bites of this insect.
+
+In accordance with this definition malaria is not a contagious disease
+in the sense that it is acquired by contact with the sick, which is
+not the case, but it is derived from contact with certain kinds of
+mosquitoes, and can be contracted in no other way, despite the many
+popular notions to the contrary. Mosquitoes, in their turn, acquire
+the malarial parasite by biting human beings suffering from malaria.
+It thus becomes possible for one malarial patient, coming to a region
+hitherto free from the disease, to infect the whole district with
+malaria through the medium of mosquitoes.
+
+=Causes.=--While the parasite infesting mosquitoes is the only direct
+cause of malaria, yet certain circumstances are requisite for the life
+and growth of the mosquitoes. These are moisture and proper
+temperature, which should average not less than 60 deg. F. Damp soil,
+marshes, or bodies of water have always been recognized as favoring
+malaria.
+
+Malaria is common in temperate climates--in the summer and autumn
+months particularly, less often in spring, and very rarely in winter,
+while it is prevalent in the tropics and subtropics all the year
+round, but more commonly in the spring and fall of these regions. The
+older ideas, that malaria was caused by something arising in vapors
+from wet grounds or water, or by contamination of the drinking water,
+or by night air, or was due to sleeping outdoors or on the ground
+floors of dwellings, are only true in so far as these favor the growth
+of the peculiar kind of mosquitoes infected by the malarial parasites.
+Two essentials are requisite for the existence of malaria in a region:
+the presence of the particular mosquito, and the actual infection of
+the mosquito with the malarial parasite. The kind of mosquito acting
+as host to the malarial parasite is the genus _Anopheles_, of which
+there are several species. The more common house mosquito of the
+United States is the _Culex_. The _Anopheles_ can usually be
+distinguished from the latter by its mottled wings, and, when on a
+wall or ceiling, it sits with the body protruding at an angle of 45 deg.
+from the surface, with its hind legs hanging down or drawn against the
+wall. In the case of the _Culex_, the body is held parallel with the
+wall, the wings are usually not mottled, and the hind legs are carried
+up over the back.
+
+When a mosquito infected with the malarial parasite bites man, the
+parasite enters his blood along with the saliva that anoints the
+lancet of the mosquito. The parasite is one of the simplest forms of
+animal life, consisting of a microscopical mass of living, motile
+matter which enters the red-blood cell of man, and there grows,
+undergoes changes, and, after a variable time, multiplies by dividing
+into a number of still smaller bodies which represent a new generation
+of young parasites. This completes the whole period of their
+existence. It is at that stage in the development of the parasite in
+the human body when it multiplies by dividing that the chills and
+fever in malaria appear. What causes the malarial attack at this point
+is unknown, unless it be that the parasites give rise to a poison at
+the time of their division. Between the attacks of chills and fever in
+malaria there is usually an interval of freedom of a few hours, which
+corresponds to the period intervening in the life of the parasite in
+the human body, between the birth of the young parasites and their
+growth and final division, in turn, into new individuals. This
+interval varies with the kind of parasite. The common form of malaria
+is caused by a parasite requiring forty-eight hours for its
+development. The malarial attacks caused by this parasite then occur
+every other day, when the parasite undergoes reproduction by division.
+However, an attack may occur every day when there are two separate
+groups of these parasites in the blood, the time of birth of one set
+of parasites, with an accompanying malarial attack, happening one day;
+that of the other group coming on the next, so that between the two
+there is a daily birth of parasites and a daily attack of malaria. In
+cases of malaria caused by one group of parasites the attacks appear
+at about the same time of day, but when the attacks are caused by
+different groups of parasites the times of attack may vary on
+different days. In the worst types of malaria the parasites do not all
+go through the same stages of development at the same time, as is
+commonly the case in the milder forms prevalent in temperate regions,
+so that the fever--corresponding to the stage of reproduction of the
+parasites--occurs at irregular intervals.
+
+In a not uncommon type of malaria the attacks occur every third day,
+with two days of intermission or freedom from fever. Different groups
+of parasites causing this form of malaria, and having different times
+of reproduction, may inhabit the same patient and give rise to
+variation in the times of attack. Thus, an attack may occur on two
+successive days with a day of intermission.
+
+The reproduction of the parasite in the human blood is not a sexual
+reproduction; that takes place in the body of the mosquito.
+
+When a healthy mosquito bites a malarial patient, the parasite enters
+the body of the mosquito with the blood of the patient bitten. It
+enters its stomach, where certain differing forms of the parasite,
+taking the part of male and female individuals, unite and form a new
+parasite, which, entering the stomach wall of the mosquito, gives
+birth in the course of a week to innumerable small bodies as their
+progeny. These find their way into the salivary glands which secrete
+the poison of the mosquito bite, and escape, when the mosquito bites a
+human being, into the blood of the latter and give him malaria.
+
+=Distribution.=--Malaria is very widely distributed, and is much more
+severe in tropical countries and the warmer parts of temperate
+regions. In the United States malaria is prevalent in some parts of
+New England, as in the Connecticut Valley, and in the course of the
+Charles River, in the country near Boston. It is common in the
+vicinity of the cities of Philadelphia, New York, and Baltimore, but
+here is less frequent than formerly, and is of a comparatively mild
+type. More severe forms prevail along the Gulf of Mexico and the
+shores of the Mississippi and its branches, especially in Mississippi,
+Texas, Louisiana, and Arkansas, but even here it is less fatal and
+widespread than formerly. In Alaska, the Northwest, and on the Pacific
+Coast of the United States malaria is almost unknown, while it is but
+slightly prevalent in the region of the Great Lakes, as about Lakes
+Erie and St. Clair.
+
+=Development.=--Usually a week or two elapses after the entrance of
+the malarial parasite into the blood before symptoms occur; rarely
+this period is as short as twenty-four hours, and occasionally may
+extend to several months. It often happens that the parasite remains
+quiescent in the system without being completely exterminated after
+recovery from an attack, only to grow and occasion a fresh attack, a
+month or two after the first, unless treatment has been thoroughly
+prosecuted for a sufficient time.
+
+=Symptoms.=--Certain symptoms give warning of an attack, as headache,
+lassitude, yawning, restlessness, discomfort in the region of the
+stomach, and nausea or vomiting. The attack begins with a chilliness
+or creeping feeling, and there may be so severe a chill that the
+patient is violently shaken from head to foot and the teeth chatter.
+Chills are not generally seen in children under six, but an attack
+begins with uneasiness, the face is pinched, the eyes sunken, the lips
+and tips of the fingers and toes are blue, and there is dullness and
+often nausea and vomiting. Then, instead of a chill, the eyelids and
+limbs begin to twitch, and the child goes into a convulsion. While the
+surface of the skin is cold and blue during a chill, yet the
+temperature, taken with the thermometer in the mouth or bowel, reaches
+102 deg., 105 deg., or 106 deg. F., often. The chill lasts from a few minutes to
+an hour, and as it passes away the face becomes flushed and the skin
+hot. There is often a throbbing headache, thirst, and sometimes mild
+delirium. The temperature at this time, when the patient feels
+intensely feverish, is very little higher than during the chill. The
+fever lasts during three or four hours, in most cases, and gradually
+declines, as well as the headache and general distressing symptoms
+with the onset of sweating, to disappear in an hour or two, when the
+patient often sinks into a refreshing sleep. Such attacks more
+commonly occur every day, every other day, or after intermissions of
+two days. Rarely do attacks come on with intervals of four, five, six,
+or more days. The attacks are apt to recur at the same time of day as
+in the first attack. In severe cases the intervals may grow shorter,
+in mild cases, longer. In the interval between the attacks the patient
+usually feels well unless the disease is of exceptional severity.
+There is also entire freedom from fever in the intervals except in the
+grave types common to hot climates. Frequently the chill is absent,
+and after a preliminary stage of dullness there is fever followed by
+sweating. This variety is known as "dumb ague."
+
+=Irregular and Severe Form--Chronic Malaria.=--This occurs in those
+who have lived long in malarial regions and have suffered repeated
+attacks of fever, or in those who have not received proper treatment.
+It is characterized by a generally enfeebled state, the patient having
+a sallow complexion, cold hands and feet, and temperature below
+normal, except occasionally, when there may be slight fever. When the
+condition is marked, there are breathlessness on slight exertion,
+swelling of the feet and ankles, and "ague cake," that is, enlargement
+of the spleen, shown by a lump felt in the abdomen extending downward
+from beneath the ribs on the left side.
+
+Among unusual forms of malaria are: periodic attacks of drowsiness
+without chills, but accompanied by slight fever (100 deg. to 101 deg. F.);
+periodic attacks of neuralgia, as of the face, chest, or in the form
+of sciatica; periodic "sick headaches." These may take the place of
+ordinary malarial attacks in malarial regions, and are cured by
+ordinary malarial treatment.
+
+=Remittent Form (unfortunately termed "bilious").=--This severe type
+of malaria occurs sometimes in late summer and autumn, in temperate
+climates, but is seen much more commonly in the Southern United States
+and in the tropics. It begins often with lassitude, headache, loss of
+appetite and pains in the limbs and back, a bad taste, and nausea for
+a day or two, followed by a chill, and fever ranging from 101 deg. to 103 deg.
+F., or more. The chill is not usually repeated, but the fever is
+continuous, often suggesting typhoid fever. With the fever, there are
+flushed face, occasional delirium, and vomiting of bile, but more
+often a drowsy state. After twelve to forty-eight hours the fever
+abates, but the temperature does not usually fall below 100 deg. F., and
+the patient feels better, but not entirely well, as in the ordinary
+form of malaria, where the fever disappears entirely between the
+attacks. After an interval varying from three to thirty-six hours the
+temperature rises again and the more severe symptoms reappear, and so
+the disease continues, there never being complete freedom from fever,
+the temperature sometimes rising as high as 105 deg. or 106 deg. F. In some
+cases there are nosebleed, cracked tongue, and brownish deposit on the
+teeth, and a delirious or stupid state, as in typhoid fever, but the
+distention of the belly, diarrhea, and rose spots are absent. The skin
+and whites of the eyes often take on the yellowish hue of jaundice.
+This fever has been called typhomalarial fever, under the supposition
+that it was a hybrid of the two. This is not the case, although it is
+possible that the two diseases may occur in the same individual at the
+same time. This, indeed, frequently happened as stated, in our
+soldiers coming from the West Indies during the Spanish-American
+War--but is an extremely uncommon event in the United States.
+
+=Pernicious Malaria.=--This is a very grave form of the disease. It
+rarely is seen in temperate regions, but often occurs in the tropics
+and subtropics. It may follow an ordinary attack of chills and fever,
+or come on very suddenly. After a chill the hot stage appears, and the
+patient falls into a deep stupor or unconscious state, with flushed
+face, noisy breathing, and high fever (104 deg. to 105 deg. F.). Wild delirium
+or convulsions afflict the patient in some cases. The attack may last
+for six to twenty-four hours, from which the patient may recover, only
+to suffer another like seizure, or he may die in the first. In another
+form of this pernicious malaria the symptoms resemble true cholera,
+and is peculiar to the tropics. In this there are violent vomiting,
+watery diarrhea, cramps in the legs, cold hands and feet, and
+collapse. Sometimes the attack begins with a chill, but fever, if any,
+is slight, although the patient complains of great thirst and inward
+heat. The pulse is feeble and the breathing shallow, but the intellect
+remains clear.
+
+Death often occurs in this, as in the former type of pernicious
+malaria, yet vigorous treatment with quinine, iron, and nitre will
+frequently prove curative in either form.
+
+=Black Water Fever.=--Rarely in temperate climates, but frequently in
+the Southern United States and in the tropics, especially Africa;
+after a few days of fever, or after chilliness and slight fever, the
+urine becomes very dark, owing to blood escaping in it. This sometimes
+appears only periodically, and is often relieved by quinine. It is
+apparently a malarial fever with an added infection from another
+cause.
+
+=Chagres Fever.=--A severe form of malarial fever acquired on the
+Isthmus of Panama, apparently a hemorrhagic form of the pernicious
+variety, and so treated.
+
+=Detection.=--To the well-educated physician is now open an exact
+method of determining the existence of malaria, and of distinguishing
+it from all similar diseases, by the examination of the patient's
+blood for the malarial parasite--its presence or absence deciding the
+presence or absence of the disease. For the layman the following
+points are offered: intermittency of chills and fever, or of fever
+alone, should suggest malaria, particularly in a patient living in or
+coming from a malarial region, or in a previous sufferer from the
+disease. In such a case treatment with quinine will solve the doubt in
+most cases, and will do no harm even if the disease be not malaria.
+Malaria is one of the few diseases which can be cured with certainty
+by a drug; failure to stop the symptoms by proper amounts of quinine
+means, in the vast majority of cases, that they are not due to
+malaria. There are many other diseases in which chills, fever, and
+sweating occur at intervals, as in poisoning from the presence of
+suppuration or formation of pus anywhere in the body, but the layman's
+ignorance will not permit him to recognize these in many instances.
+The quinine test is the best for him.
+
+=Prevention.=--Since the French surgeon, Laveran, discovered the
+parasite of malaria in 1880, and Manson, in 1896, emphasized the fact
+that the mosquito is the medium of its communication to man, the way
+for the extermination of the disease has been plain. "Mosquito
+engineering" has attained a recognized place. This consists in
+destroying the abodes of mosquitoes (marshes, ponds, and pools) by
+drainage and filling, also in the application of petroleum on their
+surface to destroy the immature mosquitoes. Such work has already led
+to wonderful results.[11] Open water barrels and water tanks prove a
+fruitful breeding place for these insects, and should be abolished.
+The protection of the person from mosquito bites is obtained by proper
+screening of habitations and the avoidance of unscreened open air, at
+or after nightfall, when the pests are most in evidence. Dwellings on
+high grounds are less liable to mosquitoes. Persons entering a
+malarial region should take from two to three grains of quinine three
+times a day to kill any malarial parasites which may invade their
+blood, and should screen doors and windows. Patients after recovery
+from malaria must prolong the treatment as advised, and renew it each
+spring and fall for several years thereafter. A malarial patient is a
+direct menace to his entire neighborhood, if mosquitoes enter.
+
+=Treatment.=--The treatment of malaria practically means the use of
+quinine given in the proper way and in the proper form and dose.
+Despite popular prejudices against it, quinine is capable of little
+harm, unless used in large doses for months, and no other remedy has
+yet succeeded in rivaling it in any way. Quinine is frequently useless
+from adulteration; this may be avoided by getting it of a reliable
+drug house and paying a fair price for the best to be had. Neither
+pills nor tablets of quinine are suitable, as they sometimes pass
+through the bowels undissolved. The drug should be taken dissolved in
+water, or, more pleasantly, in starch wafers or gelatin capsules. When
+the drug is vomited it may be given (in double the dose) dissolved in
+half a pint of water, as an injection into the bowels, three times
+daily. Infants of a few months may be treated by rubbing an ointment
+(containing thirty grains of quinine sulphate mixed with an ounce and
+a half of lard) well into the skin of the armpits and groins, night
+and morning. Children under the age of two can be best treated by
+quinine made into suppositories--little conical bodies of cocoa butter
+containing two grains each--one being introduced into the bowel, night
+and morning.
+
+During an attack of malaria the discomfort of the chill and fever may
+be relieved to considerable extent by thirty grains of sodium bromide
+(adult dose) in water. Hot drinks and hot-water bottles with warm
+covering may be used during the chill, while cold sponging of the
+whole naked body will afford comfort during the hot stage. In the
+pernicious form, attended with unconsciousness, sponging with very
+cold water, or the use of the cold bath with vigorous friction of the
+whole body and cold to the head are valuable. The effect of quinine is
+greatest during the time of birth of a new generation of young
+parasites in the blood, which corresponds with the time of the
+malarial attack. But in order that the quinine shall have time to
+permeate the blood, it must be given two to four hours before the
+expected chill, and then will probably prevent the next attack but
+one. A dose of ten grains of quinine sulphate taken three times daily
+for the first three days of treatment; then a dose of three grains,
+three times daily for two weeks; and finally two grains, three times
+daily for the rest of the month of treatment will, in many cases,
+complete a cure. If the quinine cause much ringing in the ears and
+deafness, it will be found that sodium bromide taken with the quinine
+(in twice the dose) dissolved in water, will correct this trouble. If
+the patient is constipated and the bowel discharges are light colored,
+a few one-quarter grain doses of calomel may be taken every two hours,
+and followed in twelve hours by a dose of Epsom salts, on the first
+day of treatment, with quinine. It is no use to take quinine by the
+mouth later than two hours before an attack, and if the patient cannot
+secure treatment before this time, he should take a single dose of
+twenty grains of quinine.
+
+To children may be given a daily amount of quinine equal to one grain
+for each year of their age. In the severe forms of remittent and
+pernicious types of malaria it may be necessary for the patient to
+take as much as thirty grains of quinine every three days or so to cut
+short the attack. But, unfortunately, the digestion may be so poor
+that absorption of the drug does not occur, and in such an event the
+use of quinine in the form of the bisulphate in thirty-grain doses,
+with five grains of tartaric acid, will in some cases prove effective.
+Chronic malaria is best treated with small doses of quinine, together
+with arsenic and iron. A capsule containing two grains of quinine
+sulphate, one-thirtieth grain of arsenious acid, and two grains of
+reduced iron should be taken three times daily for several weeks.
+
+
+=YELLOW FEVER.=--This is a disease of tropical and subtropical
+countries characterized by fever, jaundice, and vomiting (in severe
+cases vomiting of blood), caused by a special germ or parasite which
+is communicated to man solely through the agency of the bites of a
+special mosquito, _Stegomyia fasciata_.
+
+=Distribution.=--Yellow fever has always been present in Havana, Rio,
+Vera Cruz, and other Spanish-American seaports; also on the west coast
+of Africa. It is frequently epidemic in the tropical ports of the
+Atlantic in America and Africa, and there have been numerous epidemics
+in the southern and occasional ones in the northern seacoast cities of
+the United States. The last epidemic occurred in the South in 1899.
+Rarely has the disease been introduced into Europe, and it has never
+spread there except in Spanish ports. The disease is one requiring
+warm weather, for a temperature under 75 deg. F. is unsuitable to the
+growth of the special mosquito harboring the yellow-fever parasite. It
+spreads in the crowded and unsanitary parts of seacoast cities, to
+which it is brought on vessels by contaminated mosquitoes or
+yellow-fever patients from the tropics. Havana has heretofore been the
+source of infection for the United States, but since the disease has
+been eradicated by the American army of occupation, that danger has
+been removed. Yellow fever is not at all contagious in the sense that
+a healthy person can contract the disease by contact with a
+yellow-fever patient, or with his discharges from the stomach, bowels,
+or elsewhere, and is probably only communicated to man by the bite of
+a particular kind of mosquito harboring the yellow-fever organism in
+its body. Both these facts have been incontestably proved,[12] in part
+by brave volunteers from the United States Army who submitted to sleep
+for twenty-one days on clothes soiled with discharges from patients
+dying of yellow fever, and escaped the disease; and by others living
+in uncontaminated surroundings who permitted themselves to be bitten
+by infected mosquitoes and promptly developed yellow fever.
+
+=Development.=--After a person has been bitten by an infected
+mosquito, from fourteen hours to five days and seventeen hours elapse
+before the development of the first symptoms--usually this period
+lasts from three to four days. With the appearance of a single case in
+a region, a period of two weeks must elapse before the development of
+another case arising from the first one. This follows because a
+mosquito, after biting a patient, cannot communicate the germ to
+another person for twelve days, and two days more must elapse before
+the disease appears in the latter.
+
+=Symptoms.=--During the night or morning the patient has a chill (or
+feels chilly) and experiences discomfort in the stomach, with
+sometimes nausea and vomiting. There is pain through the forehead and
+eyes, in the back and thighs, and often in the calves. The face is
+flushed and slightly swollen--particularly the upper lip--and the eyes
+are bloodshot, and gradually, in the course of thirty-six hours, the
+whites become yellowish. This is one of the most distinguishing
+features of the fever, but is often absent in children. The tongue is
+coated, there are loss of appetite, lassitude, sore throat, and
+constipation. In the beginning the temperature ranges from 101 deg. to
+103 deg. F., or in severe cases as high as 105 deg. or 106 deg. F., and the pulse
+from 110 to 120 beats a minute. The fever continues for several
+days--except in mild cases--but the pulse usually falls before the
+temperature does. For example, the temperature may rise a degree
+during the third day to 103 deg. F., while the pulse falls ten or more
+beats at the same time and may not be over 70 or 80, while the
+temperature is still elevated. This is another peculiar feature of the
+disease. Vomiting often increases on the second or third day, and the
+dreaded "black vomit" may then occur. This presents the appearance of
+coffee grounds or tarry matter and, while a dangerous symptom, does
+not by any means presage a fatal ending. The black color is due to
+altered blood from the stomach, and bleeding sometimes takes place
+from the nose, throat, gums, and bowels, with black discharges from
+the latter. The action of the kidneys is usually interfered with,
+causing diminution in the amount of urine. It is extremely important
+to pay regard to this feature, because failure of the patient to pass
+a proper amount of urine calls for prompt action to avert fatal
+poisoning from retained waste matters in the blood. The normal amount
+of urine passed in twenty-four hours in health is over three pints,
+and while not more than two-thirds of this amount could be expected to
+be passed by a fever patient, yet in yellow fever the passage of urine
+may be almost or wholly suppressed. The course of the disease varies
+greatly. In children--especially of the Creoles--it is frequently so
+mild as to pass unnoticed. In adults the fever may only last a few
+hours, or two or three days, with gradual recovery from the various
+symptoms, and yellowness of the skin lasting for some time. This is
+not seen readily during the stage of fever when the surface is
+reddened, but at that time may be detected by pressure on the skin for
+a minute, when the skin will present a yellow hue on removing the
+finger before the blood returns to the pressure spot. With fall of
+fever, and abatement of symptoms after two or three days, the patient,
+instead of going on to recovery may, after a few hours or a day or
+two, again become very feverish and have vomiting--perhaps of blood or
+black vomit--yellow skin, feeble pulse, failure of kidney action with
+suppression of urine, delirium, convulsions, stupor, and death; or may
+begin to again recover after a few days. Mild fever, slight jaundice,
+and absence of bleeding are favorable signs; black vomit, high fever,
+and passage of little urine are unfavorable signs. The death rate is
+very variable in different epidemics and among different classes;
+anywhere from fifteen to eighty-five per cent. Among the better
+classes it is often not greater than ten per cent in private practice.
+Heavy drinkers and those living in unfavorable surroundings are apt to
+succumb.
+
+=Prevention.=--Yellow fever, like malaria, is a preventable disease,
+and will one day be only a matter of historic interest. Dr. W. C.
+Gorgas, U. S. A., during 1901, by ridding Havana of the mosquito
+carrying the yellow-fever organism through screening barrels and
+receptacles holding water, and by treating drains, cesspools, etc.,
+with kerosene, succeeded in also eradicating yellow fever from that
+city, so that in the following year there was not one death from this
+disease; whereas, before this time, the average yearly mortality had
+been 751 deaths in Havana. Spread of the disease is controlled by
+preventing access of mosquitoes to the bodies of living or dead
+yellow-fever patients; while personal freedom from yellow fever may be
+secured by avoiding mosquito bites, through protection by screens
+indoors, and covering exposed parts of the face, hands, and ankles
+with oil of pennyroyal or spirit of camphor, while outdoors.
+
+=Treatment.=--There is unfortunately no special cure known for yellow
+fever such as we possess in malaria. The patient should be well
+covered and surrounded with hot-water bags during chill. It is
+advisable to give a couple of compound cathartic pills or a
+tablespoonful of castor oil at the start. Two, or at most three,
+ten-grain doses of phenacetin at three hours intervals will relieve
+the pain during the early stage. Cracked ice given frequently by the
+mouth and the application of a mustard paper or paste (one part
+mustard, three parts flour, mixed with warm water and applied between
+two layers of thin cotton) over the stomach will serve to allay
+vomiting. Cold sponging (see Typhoid Fever, p. 232) is the best
+treatment for fever. The black vomit may be arrested by one-quarter
+teaspoonful doses of tincture of the chloride of iron, given in four
+tablespoonfuls of water, every hour after vomiting. The bowels should
+be moved daily by injection of warm soapsuds. The patient should not
+rise from his bed, but should use a bedpan or other receptacle. In
+addition, a pint of warm water, containing one-half teaspoonful of
+salt, should be injected into the bowel night and morning and, if
+possible, retained by the patient. The object of the latter is by its
+absorption to stimulate the action of the kidneys. The diet should
+consist of milk, diluted with an equal amount of water, broths,
+gruels, etc., and only soft food should be given for ten days after
+recovery. Iced champagne in tablespoonful doses at frequent intervals,
+or two teaspoonful doses of whisky in a little ice water, given every
+half hour, relieves vomiting and supports the strength.
+
+
+FOOTNOTES:
+
+[11] See Volume V, p. 76, for detailed methods.--EDITOR.
+
+[12] See Frontispiece, Vol. V.
+
+
+
+
++--------------------------------------------------------------------+
+| TRANSCRIBER'S NOTE. |
+| =================== |
+| |
+| The following change was made: |
+| |
+| Part II, Chapter II, Typhoid Fever, Symptoms (p. 225) |
+| |
+| Original text: |
+| |
+| "... flushed face, pulse 100 deg., gradually increasing as |
+| described." |
+| |
+| Changed to: |
+| |
+| "... flushed face, pulse 100, gradually increasing as |
+| described." |
+| |
+| "Pulse 100" was preferred over "temperature 100 deg.". |
+| |
++--------------------------------------------------------------------+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Home Medical Library, Volume I (of
+VI), by Various
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