A condition known as anaphylaxis or hypersensitiveness, which at present is being much studied, may sometimes occur in the human being. This hypersensitiveness is manifested by the extraordinary peculiarity that any number of doses of antitoxin may be given provided they are administered within a period of less than ten or twelve days. On the other hand a single minute dose may induce this state after the period named, and, as we never know whether a patient is going to develop it or not, it becomes a question as to the safety of giving a second injection after ten or twelve days have elapsed following the administration of the initial treatment. As it is true that this hypersensitiveness once established in animals may continue throughout life, it becomes a question as to whether or not it is quite safe to administer antitoxin to an individual who has had the drug given him at some prior time, and we are not as yet in a position to definitely determine the risks that are involved in such a procedure. There is no reason to doubt that this hypersensitiveness is much less marked in man than in the lower animals, and there can be no question that it much less commonly develops, but notwithstanding this it would be the part of prudence to avoid a second administration of the drug after the interval referred to in all instances where this seems possible. Anaphylaxis is thus seen to bear an important relationship to what is commonly called the “immunizing treatment” to prevent diphtheria, which consists in giving a moderate dose of antitoxin to a person immediately after exposure to the disease. Under such circumstances a degree of immunity is undoubtedly secured, but this passes off in the course of a few weeks, and the patient then becomes just as susceptible as he was before. Should he now contract diphtheria, we would be confronted with the possibility that the treatment by means of antitoxin might possibly produce serious and even fatal results.
Occasionally rashes occur several days after the inoculation, but such disturbances are insignificant except for the immediate discomfort experienced. Antitoxin concentrated by the Gibson method has reduced to a considerable extent the number of cases in which rashes occur.
Treatment other than by antitoxin is symptomatic. Where the disease occurs in the wind-pipe, it may be necessary to pass a tube into its upper opening to allow the patient to breathe, and in other instances the wind-pipe is itself opened from the outside in order to permit a sufficient amount of air to enter the lungs to maintain life.
It is of the utmost importance that patients be kept in bed until all danger of complications has passed. Death from heart-failure several weeks after the diphtheria in the throat is well, is not an uncommon result of the disease, and is especially prone to follow even the slightest exertion. Patients under such circumstances have been known to die from raising themselves up in the bed.
Meningitis, or spotted fever, is one of the most terrible and fatal of all diseases, every case proving fatal in some local epidemics.
Although the cause of the disease has been known for a number of years, the exact method by which the germ that produces it spreads from man to man was until quite recently entirely unrecognized, and even now it cannot be said that the whole matter has been demonstrated.
Character and Course of the Disease.—Cerebrospinal meningitis is produced by a minute vegetable (bacterium), the Micrococcus intracellularis. This germ does not appear to occur normally in any of the lower animals, nor has it been found in the outer world, and is therefore to be regarded as distinctly a human parasite. It is very fortunately a germ of low vitality, as it develops only at about blood heat, and when expelled from its normal dwelling-place in the human body it dies very quickly.
The accompanying illustration shows how these bacteria appear under the microscope; the drawing was made from fluid taken from the spinal canal of a patient suffering from cerebrospinal meningitis. These germs get within the skull and spinal canal, and produce violent inflammation of the coverings of the brain and cord; these membranes are called “meninges,” hence the name “cerebrospinal meningitis.” Within a short time after their entrance pus is produced, and the condition becomes practically one of abscess around the brain and spinal cord.
In almost all cases the disease is preceded by a slight catarrhal condition of the nose and throat, the symptoms being those of an ordinary cold. The symptoms that point to the covering of the brain being attacked come on with great suddenness; there is usually a chill, followed by intense headache, vomiting, restlessness, with great dread of noises and bright light; in many cases reddish spots appear beneath the skin, and these are usually tender on pressure. In some cases the muscles of the neck become very stiff, and contract so that the head is drawn backward. The temperature is somewhat irregular, but is always above normal in the beginning, and sometimes goes very high; the pulse as a rule is normal, or but little accelerated. After the patient remains in this condition for a period varying from a few hours to several days, he generally becomes unconscious, and in a comparatively short time dies. In some cases the symptoms after starting off very violently quickly subside, and the patient makes a comparatively rapid recovery. In other instances the disease begins more mildly, the patient having more or less of the usual symptoms, but not so severely as is ordinarily the case; in such cases the patient may die, after lingering weeks or months; or may make a protracted recovery, frequently with partial paralytic conditions that permanently remain.
Unfortunately we possess no specific for this disease. Recently there has come into vogue a treatment by a serum supposed to have antitoxic power against this disease, but its exact value is, as yet, by no means settled; it must be used early if any good is to be expected from it. In addition to the antitoxin all that can be done is to keep the patient quiet with anodynes, and to minister to his comfort in every way possible. Ice applications to the head sometimes alleviate the intense headache. As the disease is practically an abscess around the brain and cord, perhaps the most rational treatment would be to open up the skull and let the pus drain away.
Mode of Infection.—As this disease is one that is due to a specific germ it is obvious that it cannot exist without the presence of this organism; the malady is therefore infectious, and must necessarily be to a certain extent contagious, notwithstanding the fact that it is generally thought not to be so. The reason that the affection has not been thought to be contagious may be explained by the following facts: Recent investigation has shown that in many, if not all, instances of this disease, the germ may be found in the nose and throat, where, as has already been explained, it sets up a condition resembling an ordinary cold. In all probability the infection takes place in the nasal cavity first, and the germ ultimately finds its way to the coverings of the brain. Now there is every reason to believe that in many, and probably in a great majority of instances, the germ goes no further than the mucous membrane of the nose, and the patient merely has as a consequence what he considers an ordinary cold. It is clear, however, that if another individual, who was very susceptible to this germ, should contract the disease from this person, he might have the meningeal form of it. In other words, it is probably true that the vast majority of people who are attacked by this organism simply get colds as a consequence, and only now and then does a person get meningitis as a result. This explains why the disease does not ordinarily appear contagious.
The facts above stated are of much importance in combating the spread of this disease. People who are exposed to those having meningitis should be exceedingly careful not to get upon their persons any of the secretions that come from the patient, and during periods of epidemics those who observe a bad cold coming on should promptly consult their physicians, and do everything to prevent the development of all catarrhal conditions in their noses.
During epidemics persons with colds should be very careful not to allow other people to become infected from them. As cold and wet are undoubtedly predisposing causes to colds it is well for everyone to shun such exposure during periods when meningitis is prevalent; debilitating influences, such as alcoholic excess and lack of sleep, should also be avoided.
This disease, as it occurs in man, is practically always conveyed by the bite of some animal, the dog being the usual offender. The poison is present in the saliva of the diseased animal and is transmitted through wounds made by its bite.
As observed in the dog, there are two types of the disease,—one the “furious,” the other the “paralytic.”
In the furious type the animal first appears to be restless and somewhat excited. He seeks dark places and apparently prefers to be by himself. In this stage of the disease the dog's appetite is good and may be excessive; he responds to orders although his attention can be attracted only for a moment at a time. As the malady progresses the animal becomes more and more restless, and develops a desire to tear those things about him into pieces. There is described a peculiar bark at this stage of the disease; instead of ending as it ordinarily does, it is prolonged and terminates in a higher pitched note simulating a cry. This is supposed to be very characteristic at this stage of the affection. The appetite gradually diminishes, food is refused, and swallowing becomes difficult. As the symptoms gradually progress the dog shows signs of delirium and begins to wander. As a rule, he goes about with his tail hung, mouth wide open, and with a wild look in his eyes, biting as he goes, anything that happens to be directly in his path; seldom does he turn aside to disturb anything or anybody. In the later stages of the disease paralysis generally develops, beginning in the hind legs and soon involving the body. If the animal be now carefully observed it will be seen that he cannot swallow. There is no dread of water, as the name “hydrophobia” implies, and as is commonly thought, the animal often attempting to drink, but owing to the paralysis of the muscles of the throat this is impossible. Inability then to swallow either water or solid food is one of the surest and most reliable signs of rabies. Weakness becomes very marked, and the animal finally lies down in a stupor and dies. The entire course of this type may last from six to ten days; generally it is four or five.
The paralytic type of the disease occurs in fifteen or twenty per cent. of the cases. The onset is, as a rule, the same as that observed in the furious type. Instead, however, of the dog beginning to wander, as previously mentioned, the animal becomes paralyzed, the paralysis first affecting the muscles of the jaw, later of the tongue. As is the case in the furious type of the disease, the animal loses the power to swallow both solids and liquids, but has no fear of water. The mouth remains wide open, the tongue protruding, and an abundant amount of thick saliva exudes. The animal remains quiet, does not attempt to bite any animal or individual. Death occurs on the second or third day of the disease.
Precautions.—When an individual is bitten by an animal either supposed or known to be rabid, the wound should be immediately cauterized with some caustic, preferably concentrated nitric acid. This should be applied without fear because it is safer to use too much than too little. In case this is not available any strong caustic may be used. Punctured wounds should be laid open with a knife and the surfaces freely cauterized. It should not be forgotten that the slightest scratch from the tooth of a rabid animal may lead to the development of hydrophobia in man, and it therefore behooves all persons bitten by dogs to take every precaution possible. Even though the animal at the time may appear to be healthy, some strong antiseptic should be applied to the wound, and the animal carefully watched until all possibility of his having the disease has passed. Many persons have died from slight wounds inflicted by animals appearing at the time to be perfectly well.
Attention should also be directed to the fact that wounds where the teeth of the animal pass through the clothing are not so dangerous as those where no such protection intervenes. Bites about the face and head are much more frequently followed by rabies than those inflicted on the extremities, and, of course, where wounds are deep the chances of infection are much greater; where injuries of the latter kind are inflicted it is practically out of the question to thoroughly cauterize them, and the patient should immediately receive the Pasteur treatment. It is probable that if thorough cauterization be not done within five minutes that it cannot be relied on to prevent the development of the disease; where there is any doubt the only safety lies in the Pasteur treatment. Where a person is bitten by a dog supposed to be rabid the animal should be caught, if possible, and kept carefully isolated for at least ten days; should it appear well after the expiration of this period no fear need be felt as to the results of its bite, but if it should die the head should be cut off, packed in ice, and sent to some laboratory for examination.
Under no condition should the animal be killed, as the best possible proof of the harmlessness of its bite would lie in its continuing to live.
Treatment.—Since the epoch-making researches of Pasteur, laboratories have been installed in various parts of the world for the purpose of making a vaccine by means of which it is possible, by gradual immunization, to prevent the development of hydrophobia in persons bitten by rabid dogs. This is done by a series of injections of a weak virus prepared according to the directions of Pasteur. It should always be remembered that no harm can come from the treatment whether the patient was bitten by a rabid dog or not, and that in all cases of doubt no hesitation should be felt in resorting to it.
Far too little attention is generally accorded to the proper care of the sick,—the prevailing opinion being that the royal road to recovery under the circumstances is opened up only through the taking of drugs, and that provided the appropriate ones be given in sufficient quantities recovery will result. No greater mistake is possible. As a matter of fact, there are very few diseases for which we have medicines that act in a specific manner, and far more is usually to be hoped for from good nursing. Fortunately the general public is beginning to recognize the truth of the statements just made. It has only been a short time since the trained nurse was unknown except in the larger medical centres, but now her presence and beneficent influence is being felt from one end of the land to the other, and her importance is destined to increase with the onward march of time; she is undoubtedly the greatest advance that we have made in medicine during the last decade.
Where persons are ill they should always be attended by a trained nurse if possible, but if this is out of the question a few suggestions as to the sick room and its hygiene should certainly not be omitted from any book dealing with rural sanitation.
Ventilation and Warmth.—The sick room if possible should be located on the sunny side of the house, and should have fire in a fireplace if the weather be cold. It is of the utmost consequence that the room have windows and doors by means of which it can be at all times thoroughly ventilated. At all seasons of the year a room on the lowest floor of the house is more satisfactory, since it is warmer in the winter and cooler in the summer. The room should not be uncomfortably cold, though it is much better to have the temperature too low than to have the air stuffy. In most diseases ventilation is of supreme importance, and should be secured at any cost. Where, however, it is compatible with thorough ventilation, a temperature of about 70°F. is generally considered most desirable.
Before a patient is moved into a room all superfluous furniture should be taken out, particularly carpets and hangings of all kinds. It is likewise of the utmost importance that all insects, particularly flies, be excluded by proper screening.
The patient's bed should be narrow, and a mattress is much to be preferred to a feather bed. The mattress should be protected by a rubber sheet or newspaper pads; oil-cloth cracks and wrinkles too badly to be of service for this purpose. The rubber sheet should of course be kept under the sheet nearest the mattress. The cover should consist of a sheet which is long enough to fold back at the head over the other covering for some distance, and blankets should be used for warmth in preference to quilts. The bed should be kept scrupulously clean, and the linen and covering should be removed when soiled. The nurse should see to it that bread-crumbs do not remain in the bed.
In removing soiled bed-clothes the following plan is the one usually adopted. The patient is moved to one side of the bed as near the edge as possible, and the sheet beneath him loosened at the head and the foot and on the opposite side; it is then rolled up toward the patient and pushed well up under him, leaving the side of the bed opposite to that upon which he is lying bare; upon this the new sheet is placed, which is then tucked under the edges of the mattress, and the patient rolls or is pulled back over on it. The soiled sheet is then removed and the edges of the fresh one pulled over the portions of the bed still uncovered, and secured in the usual way.
General Precautions.—The room should also be kept scrupulously clean; all sweepings should be burned. Soiled linen and all excretions from the patient should be promptly removed, and if the latter need not be preserved for the inspection of the physician, should be at once disinfected and properly disposed of. Milk and other food should not be left in the sick room; and soiled glasses and dishes should be removed and washed at once in boiling water.
Persons who are ill should not be allowed to have company. There is nothing more important in connection with the looking after patients with infectious diseases than this precaution. The writer has often seen in the country districts patients with typhoid fever and other infectious diseases surrounded by the neighbors from miles around,—the entire company often eating and drinking in the room occupied by the afflicted person. The strain that results on the patient from a practice of this kind might well in many cases have fatal consequences, and there is no question whatever that many diseases, particularly typhoid fever, are scattered in this way from house to house and from one community to another.
The diet should be given regularly and should consist strictly of only such things as are allowed by the physician.
All medicines should be given absolutely according to directions, as otherwise having a doctor is worse than useless.
All patients should have a daily bath, special attention being given to their hair, teeth, mouth and nails. In many cases it is necessary to wash the patient's mouth frequently with some antiseptic wash. This should only be done on the expressed instructions of the doctor.
Few things are of greater importance, and nothing is more neglected than instructing school-children how to act in emergencies. Particularly is such knowledge of value in the country. In cities the need of understanding matters of this kind is not so great, since it is usually possible to secure at short notice some one capable of dealing with any situation that may arise. Children very quickly grasp knowledge of this character, and opportunities frequently offer for an actual demonstration of the proper remedies in the case of accidents. When the instructor speaks of cuts and burns they at once understand what is meant.
The most serious result of our neglect in this particular is that our children pass through life with the most meagre knowledge of the proper way in which to meet accidents of all sorts, for where they are not taught during their school days they, for the most part, remain ignorant of matters of this kind throughout their maturer years. It is much to be hoped—though this is somewhat of a digression—that the old unscientific and senseless system of teaching, which persists even in the present time to a considerable degree, may in the future give way to a more rational and practical plan of instruction—one that will deal with perceptible needs rather than abstractions.
The most common emergencies will now be taken up and considered in detail.
Drowning.—The subject of drowning is one of especial interest in rural districts, since it is here that accidents of this kind are most apt to occur, and skilled attention is most difficult to obtain. It is of the utmost importance to remember that people may be resuscitated after having been under the water for considerable periods of time, and we should, therefore, look upon no ordinary cases as hopeless until the proper restorative measures have failed.
On removing the body from the water we should not waste time by attempting to drain the water from the victim's mouth, as the amount of this substance that enters the air-passages under such circumstances is so trifling that it may be entirely disregarded. The drowned person should be placed face down upon the ground with the head slightly turned to the left, and we should begin at once with artificial respiration.
Artificial Respiration.—This is accomplished by the operator kneeling between the separated legs of the patient and placing his hands on the small of his back, the thumbs nearly meeting at the middle of the spine, and the other fingers spread out over the lower portion of the chest; the operator then sways his body downward and forward slowly, counting three during the movement, then quickly swinging backward releasing the pressure on the patient's chest; again count three and repeat the original movement. The pressure should be brought to bear from twelve to fourteen times a minute, and the movement should be kept up until the patient begins to show evidences of being restored, or until it is quite evident that life is extinct.
This system of artificial respiration was originated by Professor Schafer, as the head of a commission appointed by the British Government, and is now universally regarded as being by far the most satisfactory of all such methods.
In the accompanying figures are shown the positions assumed by the patient and operator while carrying on artificial respiration.
It should be remembered that the victims of accidents of this kind suffer considerably from lowering of the temperature of the body as a consequence of the long exposure to water, and we should, therefore, also direct our attention toward bringing about an immediate reaction by means of warm blankets and hot bottles, and by vigorous rubbing of the patient's body.
Danger from Wounds.—Wounds may be produced by a great variety of objects, but chiefly, of course, by cutting instruments. Where they are caused by duller objects, producing more or less tearing and bruising of the tissues, they are more apt to be followed by infection with disease-producing germs than where smoothly cut, and consequently require greater care in treatment. Germs sufficient to produce death may be introduced into the body by the most minute wound; it is for example well known that fatal consequences have resulted from the bites of various insects, and the writer has personally seen a case where a pin-prick was followed by lockjaw and death. Such facts teach us that we should be careful in avoiding wounds of all kinds, and, that after they have been received, they deserve attention, however insignificant they may appear to be.
Wounds resulting from objects more or less covered with dirt are particularly dangerous, since under such circumstances the germs of lockjaw are apt to be introduced into the body, and fatal consequences not uncommonly ensue. It is astonishing how frequently the disease just referred to follows where a barefooted child sticks a dirty splinter or a rusty nail into its foot, and it cannot be too strongly urged that it is the duty of the parent in such instances to call in a competent physician at once. The reason that injuries of this kind are so apt to be followed by lockjaw is that the germ that produces the disease lives practically everywhere in the earth—being especially common in the rich soil of gardens and other highly fertilized earths; and the germs are so minute that thousands of them might be present on the point of a pin without being visible to the naked eye. The bacilli of lockjaw do not grow at all where exposed freely to the oxygen of the air, and as a consequence of this fact we rarely see the disease that they produce developing after slight superficial wounds; much more commonly the malady results from a wound made by some penetrating object, such as a splinter of wood, a nail, or a pin.
The lesson that these facts teach is that where wounds are small and deep it is the part of wisdom to cut them open freely in order that they may be cleansed as far as is possible, and at the same time allow the air to obtain free access to their deepest portions; a wound of this kind should not be sewn up, but should be left open and allowed gradually to heal up.
The reason why lockjaw so frequently follows wounds from the premature explosion of fireworks is that the paper used in fire crackers, etc., often contains the germs of the disease and is driven deeply into the tissues. In view of the very considerable mortality that yearly occurs among the children of this country it seems incomprehensible that our legislatures—which commonly exhibit such an uncontrollable desire to regulate their neighbors in every possible way—should not long ago have placed the ban on fireworks of all kinds.
Treatment of Wounds.—The treatment of wounds necessarily depends to a considerable extent on their character and general severity: there are certain practices, however, that apply in all cases, and should, therefore, be resorted to wherever injuries of this kind occur. Where the wound is superficial the bleeding is as a rule trifling in character, and very quickly stops of its own accord. In other cases, particularly where deep, larger blood-vessels may be severed, and if they be of any considerable size, the hemorrhage will not cease until the subject becomes exceedingly weak, and in some instances the bleeding will go on until death results. Where bleeding is profuse, it may generally be assumed that one of the larger vessels has been cut, and under such circumstances it should be compressed until skilled assistance arrives. There is a popular but very erroneous impression that arteries can only be stopped by tying; as a matter of fact any one possesses sufficient strength in the fingers to pinch them enough to stop the hemorrhage. If possible, the operator should get his finger down into the wound, after which he can quickly discover the exact point where pressure stops the bleeding. One who is unaccustomed to surgical practices would, of course, hesitate at doing this, but it cannot be too strongly urged that a procedure of this character produces little or no pain after the finger is first introduced, and that no one should be deterred by foolish squeamishness from immediately doing that which in many instances can only save the life of the victim.
Where arteries are evidently bleeding—which may be inferred from the spurting character of the hemorrhage—a tight bandage above the seat of the wound, if on one of the extremities, will often be followed by a cessation of the bleeding, and where only small vessels are cut, a bandage tightly applied over the wound itself may accomplish a similar result. Under such circumstances the reader should be warned that it is not safe to leave a limb tightly bandaged in this way for any considerable length of time, as complete death of the part below may result. Where then a ligature is placed above or over a wound, it should be loosened cautiously every twenty or thirty minutes, and should be left off for a time. If the wounded artery begins to bleed, one should resort to local pressure upon it with the finger for five or ten minutes, after which the bandage may again be applied.
As soon as all bleeding has ceased, the wound should be thoroughly washed out by means of water that has been boiled and allowed to cool; the operation may be greatly assisted by using a rag or a piece of cotton that was boiled in the water. If there be grease or other dirt that does not readily come away soap may be freely used.
After the wound has been thoroughly cleansed, some sort of antiseptic had better be applied. Unquestionably the best of all of these is tincture of iodine, a small amount of which should be poured directly into the wound. A saturated solution of carbolic acid in water is also a fairly good disinfectant, and may be employed where the tincture of iodine cannot be obtained. A solution of corrosive sublimate in water—one part of the former to one thousand parts of the latter—is much used as an antiseptic by surgeons, but when placed directly in wounds has a tendency to cause much irritation, and is by no means so efficient as either of the disinfectants just referred to. In the country it is an old custom to use turpentine, or resins from several different species of pines; these are fairly efficient antiseptics, and should be employed where it is impossible to obtain those that are better. It should always be remembered that thorough washing out with boiled water and soap is in itself a procedure that will remove a considerable proportion of any germs that may have got into the wound, and that if carefully done, it is almost as efficient as the best antiseptic.
After the wound has been thoroughly cleansed by water and antiseptics, it should then be bandaged with a cloth that has been previously boiled and dried, if no regular surgical dressing is at hand. Every precaution should then be taken to prevent it being reopened. Collodion is sometimes used over small wounds, and is quite efficient in that it forms a coating over any surface upon which it is placed that is impermeable to both air and water. Small wounds that have been thoroughly cleansed and disinfected with tincture of iodine may be safely and satisfactorily closed by means of the substance just mentioned, but it should never be forgotten that the germ of lockjaw—which is the one, ordinarily, most to be dreaded in such injuries—lives and grows best in the absence of the oxygen of the air, and that a covering of collodion would materially assist in the development of this dreadful disease.
In those instances where pus forms in wounds, they should be at once reopened and allowed to drain. It very often follows after cuts—particularly if they be not properly cleansed—that a scab forms on the outside, holding beneath a greater or less amount of pus. The presence of the latter can generally be inferred by a wound presenting a red and angry appearance around its edges, and from swelling and pain. As soon as such a condition is observed, the scab should be thoroughly soaked in water and removed, and it is then necessary that the wound be kept open and allowed to drain freely until it heals up from the bottom. A failure to observe precautions of this kind may result in blood-poisoning, and finally even in death. After a wound begins to suppurate it does little good to put antiseptics into it, as they cause considerable irritation, and under no circumstances do they put an end to the pus formation. Open drainage of the wound, and keeping up the general health of the patient, are the only means that we possess of successfully combating conditions of this kind.
Inasmuch as we possess an antitoxin that unquestionably has the power of preventing lockjaw, if given sufficiently early, it is the part of wisdom to administer at once a sufficient dose of this substance to any child who has received a penetrating wound from some dirty object, or from the explosion of fire-crackers. Statistics show that under such circumstances lockjaw may be prevented in almost all cases. If we wait until the disease develops, the antitoxin is of no value.
Care of Sprains.—The seriousness of sprains is very generally underestimated, and as a consequence many persons go through life with ankles that are abnormally weak, and even painful in bad weather, and in which there is a tendency to swell and become exceedingly troublesome after a slight wrench. In all true sprains there is more or less actual tearing of the ligaments that bind the joint together, and, if the injury be not properly treated and the joint thoroughly supported, complete recovery in many instances never takes place.
As soon as a sprain occurs the injured joint should be immersed in water just as warm as can be borne, and hot water should be from time to time added in order to keep the temperature sufficiently high. The bath should be continued for several hours—the longer the better. Thus the pain and swelling will be greatly reduced, and the tenderness which, in the beginning, is so excruciating, will largely disappear. The next step is to properly support the injured parts in order that unnecessary movement may be prevented, thus avoiding further tearing of the ligaments. This may be accomplished by means of various splints—the most popular being those made of plaster of Paris, or silicate of sodium, either of which will require the services of a physician in order to have them properly applied.
Within recent years a treatment has come much into vogue, which is exceedingly satisfactory, and has the advantage that it does not require the service of an expert in order to have it properly carried out. This consists in the application of strips of adhesive plaster to the skin over the seat of the injury and for some distance both above and below the joint affected. Ordinary sticking-plaster is not the best for this purpose, though in an emergency it might be used; much better is the so-called mole-skin plaster, which is much thicker, and does not require moistening before being applied. The plaster should be torn into strips about three-fourths of an inch wide and twelve to eighteen inches long. Where the ankle is the seat of the trouble, a strip is firmly applied to the back of the foot, beginning just behind the toes, and is brought around the ankle and carried up on to the calf of the leg—thus partially winding the plaster around the leg. The first strip having been applied, another is put on in a similar way, the edges of the latter overlapping those of the former. This is continued until one side of the ankle is fairly well covered, after which we may begin operations on the opposite side, carrying the strips around the leg in such a way as to meet and overlap those first put on. This process is continued until the entire joint is completely covered with the plaster. It is of the utmost importance that the foot be put in a natural position before we begin to apply the plaster, as, otherwise, it will be left in a constrained and uncomfortable position, which will do away largely with the good effects of the splint. Where carried out in the proper way it is in the highest degree astonishing to see how perfectly the joint is supported, with the effect that the use of the injured limb may be immediately resumed. The writer recalls having seen a young lady with a frightful sprain, who could not bear to touch her foot to the floor, improve to such an extent under the treatment as outlined that she was able to go to a ball and dance through the evening on the day the injury occurred.
Not only does the immediate resuming of the use of an injured limb, when treated in this way, appear not to be injurious, but the ultimate recovery seems actually hastened. After a day or so it is well to remove the plaster splint first applied and put on another, as the former has by this time usually ceased to fit the injured joint—owing to the diminution in the swelling. The splint may be changed three, four, or even five times, if deemed necessary, though two or three applications generally amply suffice. This or some other splint should be kept on the injured joint for at least a month or six weeks, as otherwise complete recovery frequently fails to occur, with the permanent weakening of the joint as a consequence.
Of course it is always desirable to have a physician apply the splints for a sprain where this is feasible, but with a little care it may be done by any intelligent person who will observe closely the directions given. The plaster should be put on moderately tight, but the utmost care must be exercised in not carrying this to an extreme, as in such cases serious results might ensue. In order that it may be determined as to whether or not the splint is too tight, it is advisable to watch the patient's toes for some hours after the plaster is put on, and should they be found to be very cold, and particularly should they begin to show a dusky discoloration, it is evidence that the strips are exerting too much pressure, and they should be at once removed. Under such circumstances, in a half an hour or so, the splint could be reapplied with safety.
The mole-skin plaster, which is used in making the splint just referred to, may be obtained in rolls of any width from all druggists; and as the plaster keeps practically indefinitely, it should be in the medicine-closet of everyone living at a distance from skilled medical aid.
After a sprained ankle the patient should wear shoes that come well up above the injured joint, and they should be laced tightly until some time after all symptoms of trouble have disappeared; it would be on the safe side to wear shoes of this kind from six months to a year, depending upon the severity of the injury.
Treating Bruises.—Bruises are not usually followed by serious consequences if properly treated. They result from injuries that tear the tissues beneath the skin to such a degree that hemorrhage from many minute blood-vessels occurs in the injured part. In the course of a few hours they often present a truly alarming appearance, being swollen and greatly discolored, but they are not as a rule followed by any permanent ill results. Where bruises are slight no treatment of any kind is required, as in a short time the effused blood is absorbed, and the part returns to a normal condition. Where more severe it is not a bad practice to cover them with flannels wrung out from hot water, the same being renewed from time to time, and the applications kept up for from six to twelve hours. Usually at the end of this time the soreness and swelling will have considerably abated, and the injured tissues quickly return to a normal condition.
The reader should be warned that under no circumstances should the skin be opened, even though it may be quite obvious that there is a bluish mass of blood immediately beneath. Where this mistake is made, infection of the injured tissues with the germs that produce pus inevitably results, and as a consequence the patient suffers with a discharging wound for a considerable period of time. In rare cases germs get into the injured parts without the skin having been opened, and there results under such circumstances a condition which closely resembles that of an ordinary abscess. The probability that this undesirable complication has arisen is shown by the swelling becoming greater and more painful some days after the injury has occurred, and under such circumstances a good physician should be at once consulted, as it will be necessary to make an incision into the diseased area.
Soothing Burns.—One of the most common and painful of injuries are burns. Small superficial burns require no particular treatment. Where, however, they are of sufficient severity to merit attention, the simplest and best of all treatments is to immerse the diseased part in cold water, and here it should remain at least some hours, or until competent medical aid can be secured. Medical treatment of injuries of this kind is not particularly satisfactory, though there are some drugs that may be used with more or less benefit. Chief among them is picric acid, which may be applied by means of a cloth wrung out of a one per cent. solution of this substance in water. Another treatment which has some merit, and which has long enjoyed a certain vogue among both medical men and the laity, is a combination of equal parts of lime-water with either olive or linseed oil; this is called carron oil and is applied in the same way as the picric acid solution. All three of the remedies referred to act largely by preventing the access of air to the burned surface, and they, therefore, may be replaced by any bland and non-poisonous substance which accomplishes like results.
Accidents from Heat and Cold.—The climate of the United States is characterized by extreme variations—there being over almost its entire extent during the winter months a series of “cold waves,” during which excessively low temperatures are often experienced,—particularly in the northern and western portions of the country. During the summer, on the other hand, we have almost everywhere periods during which the temperature goes very high—often accompanied by excessive atmospheric moisture. As a consequence of these extremes in temperature it could only be expected that we would often experience bad effects, so that serious illness, and even death, occasionally result.
Of the two extremes, excessive heat is much the more dangerous, and is by far more frequently followed by fatal results—particularly in crowded cities. Fortunately for the dwellers in rural districts the precise conditions under which excessive heat is followed by serious consequences are not so frequently encountered as in the more populous centers, and as a result we find that serious ill effects from high temperatures are by no means so common in the former as in the latter. There are, however, two quite well defined and distinct morbid conditions that are the result of high temperatures, and inasmuch as they differ in their symptoms as well as in their treatment, it will be necessary to consider them separately.
Sunstroke.—Sunstroke is characterized by a rapid onset, the patient usually complaining of an uncomfortable sense of burning heat and a feeling of dizziness and depression. Nausea, vomiting, and diarrhœa are common, frequently an intense headache, and sooner or later a muttering delirium. The patient's skin is dry and hot, the face is flushed, and the eyes suffused, and a thermometer will show a bodily temperature of from 105° to 110° or even 112°F. In fatal cases it is usually some hours before the patient dies, though sometimes he succumbs almost instantly.
When attacked, the patient should at once be removed to some shady place, and should be held in a sitting posture against any suitable object that may be at hand. The clothing should be loosened at once, and every endeavor should be directed towards lowering the temperature of the victim. This is best done by pouring ice-water or the coolest water that can be secured freely over the entire body of the patient. This treatment should be continued until the temperature approaches the normal—the vigor of the measure employed gradually decreasing, as the patient shows signs of getting better. Improvement is shown by a gradual return of consciousness.
Heat-Prostration.—Like true sunstroke, heat-prostration comes on with an extreme suddenness. The patient becomes suddenly dizzy, and sinks to the ground in a state of collapse. The skin is pale and cool, the pulse limp and weak, and the thermometer shows the temperature to be somewhat below normal. The patient should be laid on the ground in a cool, shady place, and stimulants at once given. By far the most efficient of them is a hypodermic injection of morphine and atropine, to which strychnine in appropriate doses may be added.
Guarding against Sunstroke and Heat-Prostration.—Excessive heat is the basis of both of these conditions, but there are many contributing causes which play a more or less important part in their production. Notwithstanding the fact that they are regarded as being different, and that the treatment and symptoms of the two conditions vary widely, there can be no doubt that certain depressing influences, in every way similar, play an important part in their causation.