It is my design in a subsequent part of this work, under the head of emergencies, to refer to those exceptional cases in which there is peculiar danger, where some prompt action, something done immediately may either save life or save from protracted disease. In such cases the well instructed nurse may often do something without assuming undue responsibility.
But I now intend to give such instruction in regard to the treatment of minor ailments and complaints which are liable to arise in every family daily, as will enable the mother or nurse to often relieve present distress, and prevent future sickness and suffering. But I hope it is fully understood that while I give such instruction as is founded upon many years of study, and experience, and observation, I do not expect that any one can become a doctor by the perusal of this small treatise, or that the student of this book will ever set herself in opposition to those who have devoted years to the study of the healing art. With the understanding, then, that the mother is to prescribe medicine only in such cases as mothers usually do prescribe, I will now give some directions that will enable the nurse or mother to act with promptness and assurance and efficiency.
Some medicine should be kept in every house, and I suggest the following as a good list: Aconite, veratrum, paregoric, aromatic ammonia, spirits camphor, essence peppermint, spirits nitre, syrup ipecac, witch hazel, adhesive plaster, chlorate of potash, gum arabic, compound licorice powder, carbolic acid, and the sanguinaria powder.
The last, which is the medicine that I always use in diphtheria, may be prepared according to the following formula: Take of pulverized blood root ½ ounce, Ferri sulphas Exsiccata ½ ounce. Triturate together. Dose, 1 grain put on the tongue dry every four hours. The medicine should be kept dry and is best kept in a phial corked.
All the medicines should be labeled with the name and ordinary dose.
A small quantity of medicine will suffice to keep in the house. I suggest the following amounts and labels: ½ oz. tinct. aconite. Dose, 1/20 of a drop (or less) every hour. Poison. ½ oz. veratrum viride. Dose, ½ drop every two hours. 1 oz. paregoric. Dose, 1 drop to a teaspoonful. 1 oz. aromatic ammonia. Dose, 20 drops diluted in water. 1 oz. ess. peppermint. Dose, 10 drops. 1 oz. spirits camphor. Dose, 1 to 5 drops. 1 oz. syrup ipecac. Dose, 5 drops to a teaspoonful. 1 oz. spirits nitre. Dose, ¼ teaspoonful in water. ½ oz. fld. ex. witch hazel. Dose, 1 drop every hour. ½ oz. chlorate potash. ¼ lb. compound licorice powder. Dose, 1 teaspoonful. 1 oz. gum Arabic. ¼ yd. adhesive plaster. 1 oz. carbolic acid and glycerine. Poison. 1 oz. sanguinaria powder. Dose, 1 grain.
I will now give my treatment of diphtheria which is mostly by the use of the Sanguinaria powder, as this very well illustrates the benefit of having some mild safe medicine in the house, and using it early in the disease. Nearly thirty years ago I was so well satisfied of the efficacy of this medicine, that I advised all the families with which I was acquainted and where I was their physician, to keep the powder in the house and use it whenever any of them had sore throat; very many of them did so, and it has happened that so far as I know, there has not been a fatal case of diphtheria among them.
I advise that it be given in all cases of sore throat, for although it is not so important a remedy in all these cases, it will very generally be useful in a greater or less degree, and as the sore throat is usually the first thing complained of in diphtheria, its early application is thereby assured.
A very small dose will suffice, but there is no objection to taking two or three grains for a dose every 4 hours, except the disagreeable taste. I advise that it be taken alone, and not covered up, as I believe that it acts locally perhaps directly upon the organism or germ that is the cause of the disease. I have not, however, relied exclusively upon the one medicine, but have always directed that they should give about a teaspoonful of the saturated solution of chlorate of potash every hour, and that they keep kerosene applied on the outside of the throat or neck. Give plenty of milk and other nourishing diet, and but little other medicine is usually required.
The SANGUINARIA (bloodroot) POWDER is properly given in other cases besides diphtheria. A small dose given three times a day is not only a good worm medicine, but will prevent the subsequent developement and growth and multiplication of worms for some time. It is also a cure for a cough that is dependent on an irritated state of the fauces.
Three grains taken after each meal is a good remedy in chlorosis or suppression of the menses. In these cases it can be taken covered up in wafers or in rice paper, thereby avoiding the bitter taste.
Aconite should be kept in the house, and very small doses given in cases where there is a little feverishness, and no marked symptoms of disease. It is useful when there is an ordinary cold, and may be given two drops of the tincture in half a glass of water, one teaspoonful every hour. These small doses may be given to a little child, and yet they have some effect upon older persons.
Ordinary colds, however, require more efficient treatment, and I often direct the following: A teaspoonful ginger, a teaspoonful cream of tartar, and three large teaspoonfuls of sugar in a small glass of water, to be drank as one draught after being stirred. Heat the feet and keep them warm especially at night. The combination of ginger, cream of tartar, &c., opens all the secretions so that the lungs, liver, bowels, skin, and kidneys act in a natural manner, and there is immediate benefit.
Veratrum has already been mentioned as a remedy in inflammation. If good extract or tincture is used it can always be relied on to reduce the force and frequency of the pulse. It is frequently applicable because in most of our diseases the force and frequency of the pulse is increased. The pulse should be counted when it is first given, and counted occasionally afterwards, and when the pulse becomes less frequent the dose must be diminished or omitted. If an overdose is given it is commonly vomited, otherwise it might be dangerous. Ordinarily half a drop every two hours of the fluid extract is sufficient, but for adults two drops may sometimes be given and repeated in an hour. We have so many maladies that are inflammatory, where the pulse is full and hard, that the indications for its use are frequent. Even in the commencement of fevers, when the pulse is full and quick—where it was formerly the practice of physicians to bleed, veratrum should be given till it has a decided effect upon the pulse. In intermittent fever the effect of this sedative upon it, given at the commencement of the fever or hot stage, is as salutary as is the effect of quinine given during the intermission.
Moderate doses are not liable to do harm except to those who have become quite weak and low. A convenient way of administering it is to prepare twenty drops of the extract in twenty teaspoonfuls of water, and the dose can be easily regulated.
Croup may generally be cured if veratrum is given early and in efficient doses. It is of no avail to administer it at an advanced stage when there is apnœa; the pulse becoming feeble and intermitting, the lips blue, the skin losing its heat; and when drowsiness, coma or other fatal symptoms are coming on. When cough, hoarseness, catarrh, and loss of voice are noticed in a young child, it should be narrowly watched and protected against all circumstances likely to aggravate inflammation; it should be kept in the house, and a warm, moist air should be kept in the room (about 65°), its diet should be milk or farinaceous food; the functions of the bowels and skin should be attended to; some aconite should be given; if there is a slight, ringing cough, place the patient in a warm bath for ten minutes, then confine it to bed; keep the air of the room moist by the evaporation of boiling water; give castor oil or other physic, and small doses of syrup ipecac, and spirits nitre. If the respiration becomes sonorous and difficult, the voice hoarse and gruff, the cough croupy and brassy as it is called, you have the characteristic symptoms of croup. But the peculiar breathing, making a sort of crowing sound with each inspiration, will always distinguish it, and there will always be some fever attending it. Croup sometimes commences with sore throat, and I believe that the sanguinaria powder will usually be efficacious in its cure; but prompt doses of veratrum are still more effectual. At the early stages you may give two drops of the extract, and the dose may be repeated in half an hour, and perhaps repeated afterwards. If there is not evident improvement an ounce of syrup of ipecac or a teaspoonful of sugar and alum pulverized together, may be given if necessary to make the child vomit.
In the meantime hot fomentations should have been applied to the throat. A sponge the size of a large fist, dipped in water as hot as can be borne, should be squeezed half dry and applied under the child’s chin so as to cover the larynx, and the temperature maintained by resoaking it every two or three minutes.
Baths may be used during the second stage of the croup; if the child has a temperature of 104°, a warm bath ought to be administered, and the child immersed in it up to its chin for fifteen or twenty minutes.
After the breathing is relieved, still give small doses of syrup of ipecac, or alum, or veratrum, sufficient to keep up nausea for a time. After there is a decided amelioration of the symptoms, give the following: To a teacupful of ginger tea add a teaspoonful of aromatic ammonia, and a teaspoonful syrup of ipecac, and give a teaspoonful every hour.
Veratrum is the medicine upon which you must rely in croupy cases; this disease requires vigorous treatment, but vigorous measures in the start will generally save the life of the patient.
Paregoric is a useful medicine for pain, diarrhœa, cough and restlessness, and may generally be given advantageously when two of these symptoms are present. Opium has some beneficial effect in inflammation, and very generally paregoric can be given where there is febrile excitement. I would never give it when the child is only cross and irritable, as a bad habit may thereby be engendered. There is always danger of giving an overdose of any opiate; and although an adult may sometimes take as much as two ounces of paregoric when he is suffering severe pain, I do not advise that it be given to children often in doses that exceed five drops.
Diarrhœa may be treated in the following manner: To four ounces of ginger tea add one teaspoonful paregoric, one teaspoonful aromatic ammonia, one teaspoonful ess. peppermint, one half teaspoonful spirits camphor, and two ounces of mucilage of gum arabic, and shake the whole together. This is good medicine for all forms of summer complaint, diarrhœa, dysentery, or cholera morbus. One-half teaspoonful of this is a dose, but it can be given efficiently in a larger or smaller dose. It acts by correcting the disordered state of the stomach, and it is upon this usually that these diseases depend.
If the diarrhœa continues for a day or two, some mild astringent may be given; perhaps three drops every two hours of the extract of witch hazel. The diet is important, and it is well in these cases to have some wheat flour boiled. (F. 47.) The flour grated from it and sifted, and made into a gruel, may be profitably used with milk.
A thin solution of gum Arabic with milk affords both food and drink, and is one of the most useful, and safe, and efficient remedies.
Such medicines as F. 74, 77, 79, 80, may be given in almost every case with benefit. The alkalies neutralize the acids in the stomach, and the aromatics have a grateful action. If the pain continues, a warm bath may be given. Should the gums be swollen, they should be cut down to the teeth.
But there are many cases of diarrhœa where my prescription would be the following: Give no kind of food save that of the milk of the mother, and that only once in four hours. Should the thirst require more fluid to satisfy it, give from time to time a teaspoonful of cold water; put flannel on its body, and woolen stockings on its legs; rub the abdomen three or four times a day with the bare warm hand; do not ever wake the child when asleep; when awake give it five drops paregoric every two hours.
In the preliminary stage of CHOLERA INFANTUM, besides giving the diarrhœa mixture with ar. ammonia, I would enjoin absolute rest in the recumbent position, with warmth to the surface and extremities; perhaps total abstention from mother’s and cow’s milk, and would order either condensed milk or arrow root prepared with water. I would also make counter irritation over the abdomen by poultices and sinapisms.
Dysentery when first coming on is attended with more fever than diarrhœa is. It will be distinguished by the character of the pain and the discharges. The patient is tormented by a sensation as if there was some excrement to be dislodged; he goes often to the night chair, and strains to get rid of the irritation; he discharges but little, and what is voided is either a jelly like or bloody mucus; perhaps mixed with films and membranous shreds. The pulse is hard and frequent, the skin hot, the face flushed, and the patient complains of headache and thirst.
You may give some veratrum at first; one-half drop of the extract every two hours for one day; and to allay the thirst, give cold water in which some wheat flour has been stirred.
My principal remedies if the diarrhœa mixture does not cure, is to give the sour drops (elixir vitriol), and either large or small doses of ipecac. I also use injections of starch and laudanum, and rectal suppositories. (F. 155, 160.)
You may find much benefit from some domestic remedies. Give either occasional doses of strong table tea, or spoonful doses of vinegar and table salt, or freshly prepared melted mutton suet.
Aromatic spirit of ammonia is useful in hysteria, flatulent colic and nervous debility. It is not a powerful medicine to overcome disease, but it is a medicine that ought to be at hand to relieve many little ailments that are liable to occur, when much medicine cannot be given. I advise those that are suffering from sick headache to take 30 or 40 drops of it as a stimulant antacid. It may be well also to take a teaspoonful of paregoric, and to lie down till sleep gives relief. Fainting fits or FAINTING may demand a remedy, and 15 drops ar. spts. ammonia may give the desired relief, if the sufferer lie down and a little cold water be sprinkled in her face also.
This medicine is a grateful antacid in cases of SOUR STOMACH, and it will usually give some relief in the flatulence and distress of DYSPEPSIA.
It may often be used as a slight stimulant, but as it is an alkaline remedy it should not be given conjoined with acids.
Essence peppermint and SPIRITS CAMPHOR are often used in ailments similar to those in which I use aromatic ammonia, and this may be given in combination with them. Some persons have a decided preference for essence cinnamon, or wintergreen, and these may be substituted for peppermint; aromatics also, such as sweet flag, will have a similar effect.
Spirits nitre is often a grateful stimulant to the stomach, but it is also used in febrile affections, and inflammatory complaints. Four parts of spirits nitre to one of ar. ammonia is diuretic, diaphoretic, and is well suited to certain states of febrile disease.
When given to promote the action of the kidneys, a half teaspoonful or more may be given every two hours in a spoonful of water. Scanty and high colored urine, especially when it is acrid and burning, is an indication for its use.
Syrup of ipecac is used as an expectorant and emetic in colds and coughs. If given to a child, one teaspoonful is an emetic dose, to be repeated every fifteen minutes till it operates. If given to loosen a cough, five or six drops repeated every half hour will suffice; but it may be given in much larger doses. It is often given in combination. (F. 137, 139.)
Witch Hazel. Pond’s Extract Hamamelis is kept by many people in the house, and as it is usually accompanied with directions, I shall refer to it very briefly. The ordinary fluid extract is perhaps five times as strong as Pond’s extract, and when used may be diluted accordingly. It is astringent, and a medicine of that kind is often useful both internally and externally. A few drops taken each day may prevent bleeding, when there is a tendency to hemorrhage, although ergot would be a more efficient remedy if given for immediate effect.
Chlorate of potash is very generally given in diphtheria, and is generally safe; no harm can come from the advice to keep it constantly in the house; it is not very soluble, and the saturated solution is not too strong for use. It is a good way to put a half teaspoonful of it in a glass, and keep a little water on it all the time, and give ten or twelve teaspoonful doses of the solution a day for any kind of sore throat or mouth.
Compound licorice powder (F. 108) is a mild laxative, and may be given to a young child in half teaspoonful doses. In larger doses it will serve well for older persons for physic. While I think it well to keep this in the house and to occasionally administer it, some other sort of cathartic may at times properly be preferred. A great variety of this sort of medicine is attainable, no one kind is always the best; this powder is however a good laxative, in doses of a teaspoonful repeated in eight hours if necessary.
Gum arabic is not often kept in the house as a medicine, but I think it eminently proper to keep it; scarcely any other medicine is so safe and harmless either in large or small doses, and few are more decidedly useful than this in some cases. Made into an emulsion and taken either alone or in combination with other medicine, or used as food, it is good in every variety of bowel complaint. A teaspoonful of the mucilage stirred into a cup of cold water and drank by the patient, may serve as medicine and drink and sustenance when he can take no other food. It may properly be added to expectorant and diuretic medicines; but the beneficial effects are most obvious when it is administered for inflammatory affections of the gastric and intestinal mucous membrane. Slippery elm and flaxseed tea have a similar effect, but are not so decidedly beneficial.
Carbolic acid nine parts and GLYCERINE one part may be kept mixed together; not because the glycerine assists or modifies the action of the carbolic acid, but because it renders the acid soluble in the water, so that the solution may be of any strength desired. Carbolic acid is not much used internally; it is so powerful that it ought to be regarded as a poison; its effect is good, however, if given in small doses very much diluted. It is believed to be destructive to disease germs, and may very properly be given in bad cases of diarrhœa and dysentery. Two drops of the acid in a glass of water is a weak solution, and may be given without harm; a half teaspoonful every two hours.
There is not space in this work to describe particularly the various cases in which it may be used externally. A solution one part in 100 of water, may be applied advantageously to any inflamed part or to any CUTANEOUS ERUPTION, or may be used as a wash or gargle in any SORE MOUTH or SORE THROAT. To cure sores or eruptions, however, it is often necessary to apply it much stronger. I apply a 1 to 5 solution to the sores once or twice, and to burns a solution 1 to 30 for a few days.
I will give more particular directions for its use in HEMORRHOIDS or PILES. Apply the acid and glycerine (9 to 1) to the piles by dropping 3 drops upon a bit of tissue paper and pressing it against the tumors, and into the anus. Repeat this each day for three days, then use a mild ointment or suppositories. (F. 206.)
A few doses of the compound licorice powder will be useful for piles if the bowels are not regular.
I have already given some specific directions in regard to some diseases in very young children; what further instructions I give will be of a general character.
Dentition predisposes to sickness, if it does not cause it, and it may call into activity latent tendencies to disease. It may cause such symptoms as the following: redness, heat, and tenderness of the gums; an increase of saliva; starting as if in fright; restlessness, or interrupted sleep; eruptions on the head or body; derangement of the digestive organs, and sometimes convulsions. During the period of dentition, be especially careful that the child has its food and sleep regularly, and that it is restricted to suitable quantities of food at a time. Keep the head cool and the feet warm; wash the child daily in cold water, and allow it to be much in the open air. If a child is worrisome and irritable it will be necessary to cut the gums. Lance them at the elevated points, cutting them down to the teeth. At the same time, aconite can be given, and perhaps a warm bath; and if there is considerable fever give ordinary doses of veratrum. These remedies are so generally useful where there is fever, that I will venture to recommend them when either THRUSH, MEASLES, German measles, MUMPS, SCARLET FEVER, CHICKEN POX, or WHOOPING COUGH is coming on or suspected. Each of these diseases have a natural course which they must run before they terminate, and it is best, as in diphtheria, not to give medicines powerful enough to interfere with the natural course of the disease. Do not give physic. (F. 121, 122.)
So in OPTHALMIA it is better to have nothing but a little salt in the water than it is to use harsh things to bathe the child’s eyes. Do not rub the eyes; let a small stream of tepid water trickle onto them, and wipe the discharges away with a soft rag. Burn the rag, wash your own hands, and keep them away from your own eyes, on account of the danger from contagion. (F. 210, 211.)
Constipation cannot be treated in all cases without giving some aperient medicine. (F. 108, 109.) Oat meal gruel as a diet may be helpful; and fresh vegetables—cabbages, turnips, onions, ripe fruit; oatmeal porridge with molasses, and brown bread may be taken freely. Infants may be partly fed on corn starch, and older children may have cracked wheat (F. 35), or peas, beans, squashes, and other fresh vegetables and fruits in their season. A good draught of water on rising and retiring is advisable; and a teaspoonful of soda and molasses mixed together and taken daily for a week may cure a costive habit. A suppository of castile soap may induce a movement in a child, or it may be best to give an injection of tepid water, or soap and water.
For CHAFINGS bathe the parts well in tepid water, dry with soft cloths, and apply by means of a soft sponge, F. 212.
The following diseases are inflammatory, and demand at first mild treatment with aconite, veratrum, and warm baths:
In TONSILITIS (quinsy), use the blood root powder and bicarbonate of soda. The patient can apply the bicarbonate of soda to the inflamed tonsil with his finger, or it can be blown into his throat through a quill, or through a hollow roll of stiff paper that contains a few grains. For the chronic form of tonsilar enlargement use F. 213.
Coryza or snivels is an inflammatory affection of the mucous lining of the nose, attended with an abnormal secretion. Sometimes the child can only breathe through its mouth; in such cases you may draw the breast milk, and feed the child by means of a spoon. Give aconite, and as a local application the inside of the nose may be often smeared with vaseline, or cold cream, or carbolated cosmoline.
Bronchitis, pneumonia, pleurisy, and other inflammatory diseases, may not show their distinctive character in their incipient stage, but there will be at first sufficient fever to indicate the need of aconite, veratrum, and perhaps the warm bath. Accessary means may be used, such as the following: the patient should be placed in a warm room (about 65°) and have only light bed clothing; if the child is taken out of bed he must have on a warm wrapper, or be otherwise well covered; he should not lie flat in bed, but he should be somewhat propped up with pillows; and it may be best to keep on a continuous poultice to the chest in front and back. The patient should be kept very quiet, have mucilaginous drinks and farinaceous diet; and the air of the room should be moistened by steam or the evaporation of wafer; and the ventilation of the apartment must not be neglected. They must have frequent sips of cold water to allay thirst, besides marshmallow, slippery elm, or flaxseed tea, and revulsives must be used as well as poultices and fomentations.
By the aid of a CLINICAL THERMOMETER many diseases may be distinguished even in the incipient stage.
If a person without any premonitory symptoms is seized with a chill, followed by rapid breathing, a dull pain in the chest, cough, high fever, and comparatively slow pulse; if the thermometer indicates a temperature of 104° or 105°, and the pulse does not beat over 110 a minute, the case is one of ACUTE PNEUMONIA. Sometimes the temperature is below 90°; if it exceed 120° it is almost certain to be fatal.
Ague. Chills recurring regularly for a few days indicate the intermittent nature of a disease. But during the first chill if the thermometer is applied, we may know that a case is one of fever and ague, if while the skin is yet cold the thermometer rises to 105°, and later to 107°, and during the stage of sweating the instrument shows a decline of 2° every fifteen minutes till it has reached 98½°. This rapid rise and decline is due only to malaria, and quinine is indicated. (F. 182.)
Tubercular Phthisis. If a patient has been losing flesh of late and been troubled with a short, dry cough, take his temperature at about six P. M. for a few evenings. If the thermometer records 99° to 100°, and no other cause exists for this regular nightly increase of temperature, the case can be put down as one of incipient consumption, especially if tuberculosis has been in the family. Endeavor to improve the general nutrition by attention to the quantity and quality of the food (as generous diet as can be taken without disturbing the stomach or increasing the feverish symptoms); by enjoining a residence in a healthy climate; by exercise in the open air; by warm clothing; by daily tepid sponging, with friction of the skin; and by cod-liver oil or petroleum emulsion with hypophosphites. An animal diet is generally necessary. If digestion fails and there is acidity of the stomach, give pepsin. (F. 72.) Add a teaspoonful of sweetened lime water to a tumbler full of milk, and if this agrees with his stomach, he can take that amount four times a day.
In TYPHOID FEVER the patient may complain of lassitude, headache, pain in the back, etc., for several days before he is feverish. Then his temperature is 99°, and it may be one degree higher each night, until on the sixth and seventh evening it is 104°; it being each morning one degree less than at night. Even if there is no diarrhœa, tympanitis, or eruption, we may by observing the temperature, feel sure that we have a case of typhoid fever. If it is a moderate case the temperature will be 104° at night, and 103½° in the morning, till the fourteenth day, when it may decline one degree in the morning, and half a degree or one degree in the evening. After that it may decline regularly till on the 21st day it may be 98½°. Relapse or chest difficulty may modify this regular decline, and the nurse must carefully note and report to the physician the temperature each morning and night.
In TYPHUS FEVER the temperature reaches its height, 104° or 105°, within thirty-six hours. It continues at that height, with morning remissions of one-half degree, till the eleventh or thirteenth day, when it rapidly falls to the normal; a sweat or a long sleep ushering in the favorable termination.
Scarlet Fever. If a child is suddenly taken ill with a chill, vomitings, very rapid pulse, and the thermometer records 105° or more, very early in the disease, it denotes scarlet fever; and from this sign alone, even without any sore throat or eruption, a diagnosis may be made. This disease may very frequently go on well without any danger till the eruption subsides, but danger arises from exposure of the child to cold any time during the subsequent four weeks.
Hysteria. There may be pain perhaps in the bowels, abdominal tenderness, and vomiting; or there may be symptoms of inflammation in some other part; if the thermometer does not register more than 98½° it is probably hysteria. Assafœtida, valerian, and such remedies will probably cure.
Apoplexy. In this disease the thermometer soon after the attack shows a temperature of only 97°, and lower still if there should be a second effusion to still more compress the brain. On the contrary, in a fully developed case of sunstroke, the thermometer will not record less than 107°.
It would be a good thing if every nurse and every mother kept a clinical thermometer.
The diseases last named were there mentioned because their distinctive character could be determined by the thermometer. They are, however, examples of the kind of cases that I design now to speak of particularly; where there is apparent cause for alarm, and where there is apparent necessity that something should be done immediately.
These cases demand the services of a physician, and my design is only to instruct you what to do before the doctor arrives; or rather I should say, the instructions that I give are not intended to supercede medical advice, though some cases may be of a kind in which little or nothing can be done. These emergencies are of every variety, and I shall bring the different kinds before you as fully as I can. Ordinarily it is not at first apparent what the real malady is.
We will suppose that during the heat of summer a man drops down unconscious. At first no one knows whether it is apoplexy or SUNSTROKE. Do not get excited and do things that are rash; if you do not know what ought to be done, do nothing; if you are not excited you may at least use what knowledge you have acquired.
Send a message to the doctor, giving a description as far as you can of the case, so that he may come prepared to treat it. Secure plenty of fresh air and room, and get rid of those who are around, who cannot be useful; if respiration is suspended, and there is immediate danger, something may be done at once; at least to know if the man has merely fainted. Have him laid in a horizontal position; you may soon have him carried to the nearest house. For this something should be provided on which he can lie horizontally; instruct the bearers to avoid unnecessary jolting; have a bed ready to put him on; if the case is supposed to be fainting give aromatic ammonia or a little stimulant of some kind; do not raise the head, but keep it low as the feet. If it is a severe case of sunstroke, the skin is hot and the pulse weak and fluttering; there may be convulsions, but probably there will be no movement; remove the clothing with as little disturbance as possible; do not cut anything that can be ripped; throw cold water on the head and chest, or put the patient in a cold bath of about 70° at first, and gradually reduce the degree of cold; give a cup of good table tea; do not give alcoholic stimulants without medical advice. If consciousness returns and the temperature again rises, repeat the cold applications to the head, neck, and chest; give ice water or ice tea; it may be best to rub the head and body an hour longer, and to give stimulant enemata.
Apoplexy can be distinguished from syncope by the pulse, which beats perhaps with unnatural force; the face instead of being pale is generally flushed, and turgid, and the respiration goes on though it may be labored and stertorous. The condition of the sensorial functions is much the same as it is in narcotic poisoning, or when a man is dead drunk. The nurse should make all necessary enquiries so that she can furnish the physician with a full history of the case to help him in his diagnosis. In apoplexy the pulse is rather slow though full, and the pupils of the eyes, one or both, dilated. There may be paralysis of one side.
Loosen the clothes, elevate the head and chest, apply cold water to the head, and heat to the extremities, and perhaps sinapisms also. Giving physic may be deferred until the doctor arrives; and in general you may pursue a similar course whether the case is one of CONCUSSION OF THE BRAIN, or COMPRESSION or narcotic poisoning; cold may be applied to the head by means of pounded ice in a bladder; keep the head cool and the feet warm.
Many of this class of cases require still very careful nursing after the dangerous symptoms are relieved. The skin should be kept healthy by daily friction and bathing. The bowels must not be permitted to become costive; the diet should be light, the food well chewed, the mind kept cheerful and free from excitement.
In cases of poisoning no time is to be lost in administering relief, and it is important that the nurse should be familiar with all the usual antidotes.
Most commonly in a case of poisoning, speedy free vomiting should be induced by those articles that are at hand, and that are quick and prompt in their effects.
Even if the poison has been taken hypodermically, emetics may be given; these will do no harm: Sulphate of zinc (white vitriol), is very prompt in its action, and may be used when it can be procured (F. 134); and if vomiting be present, we may aid it by giving warm water, or perhaps pulv. ipecac, or some other vegetable emetic.
But either common salt or mustard is nearly always at hand and may be given. Stir up a tablespoonful of salt or a teaspoonful of mustard in a cup of warm water, and give immediately, and repeat until a pint is swallowed; do not stop to stir them very much, but give as quickly as possible. You may tickle the throat with a finger or a feather to induce immediate vomiting. Do not give tartar emetic; do not give fluids so as to distend the stomach too much; some bland fluid may be given with or immediately after giving mustard and salt; either milk, lime water, white of egg, flour and water, gruel, drinks sweetened with honey or sugar. Oil should not be given unless ordered.
Before naming the antidotes for particular poisons I wish to instruct the nurse to not only note the symptoms, but also to examine every article of a suspicious nature, (such as phials, boxes, or papers containing powders), and preserve them. Preserve also all vomited matter and everything that may afford a clue to the poison for after inspection, if the nature of the poison is likely to be a subject of after inquiry.
In regard to the symptoms it may be well to know that Prussic acid, cyanide of potassium, strong ammonia, pure carbonic acid gas, or pure carbonic oxide may KILL almost at once, as indeed almost every poison may if taken in a very large dose; strong acids, alkalies, aconite, antimony, arsenic, tobacco, or lobelia may cause SPEEDY COLLAPSE.
Belladonna, hyoscyamus, strammonium, canabis indica, alcohol or camphor, may cause DELIRIUM.
Nux vomica, strychnine, antimony, or arsenic may cause TETANUS or tonic contraction of the muscles.
Antimony, arsenic, carbonic oxide, aconite, strong acids or alkalies may cause CONVULSIONS.
Gelsemium, conium, aconite, arsenic, or lead may cause PARALYSIS.
Belladonna, atropine, hyoscyamus, or strammonium causes DRY SKIN; and opium, aconite, antimony, alcohol or lobelia causes MOIST SKIN. The skin is almost always moist in collapse.
Belladonna, atropine, hyoscyamus, stammonium, aconite, alcohol, chloroform or conium may cause DILATED PUPILS.
Opium or chloral may cause CONTRACTED PUPILS, especially during sleep.
Prussic acid, laudanum, alcohol, carbolic acid, acetic acid, ammonia, chloroform, creosote, iodine, phosphorus, camphor, or nitro benzole can often be smelled in the BREATH.
Belladonna, atropine, hyoscyamus, strammonium or opium cause the MOUTH and TONGUE to be DRY.
Arsenic, ammonia, cantharides, jaborandi or mercury cause SALIVATION.
Arsenic, antimony, corrosive sublimate, cantharides, digitalis, colchicum or colycinth causes VOMITING and PURGING.
Lead, colycinth, copper, or arsenic causes COLIC. Arsenic, antimony and lead cause CROUP.
These include ACETIC, CITRIC, MURIATIC, NITRIC, OXALIC, SULPHURIC, and ARSENIOUS acids. Their irritating and corrosive character depend upon their strength and concentration, or the amount taken, some or all of them being salutary in small diluted doses. Their injurious effects are severe the moment they are swallowed, as they excoriate the throat and gullet at the time of swallowing. But antidotes will lessen their power on the stomach and bowels if given soon, and if given with the emetic will render the vomited matter less irritating. Their corrosive character causes severe pain, which may be followed by symptoms of shock.
Alkalies are the antidotes. Give some one that is at hand, either calcined magnesia, a solution of soda or soap, lime water or whiting. At the same time the emetics and alkalies are taken, give demulcents, such as milk, mucilage, gruel, flaxseed tea, etc. Of course the inflammation consequent on the poison must be treated.
Carbolic acid might be included among those above named; the same treatment would be proper, except that strong alkalies are ineffectual as antidotes. Besides emetics give milk, demulcent drinks, and carbonate of magnesia, with a little paregoric in water. Secure rest and warmth to the body, use counter irritants externally.
Arsenious acid is included in the above list. The antidote for this is hydrated peroxide of iron, recently prepared, and given in large doses. It is prepared by the addition of liq. ammonia to muriated tinct. of iron, or liq. ferri sulph., which yields the hydrated peroxide of iron as a dense precipitate; and this should be given in tablespoonful doses every five minutes until the symptoms are relieved. The nurse and attendant’s duty, however, is to give emetics and demulcents freely.
Alkalies are like the acids, irritating; if strong they excoriate the fauces and esophagus. Caustic potash, lye, soda and hartshorn are examples. In these cases give acids such as vinegar and lemon juice as antidotes, and oils also to unite with the alkali and render it less irritating. Demulcent drinks must be given with the emetics, and acids must be continued afterwards.
For LUNAR CAUSTIC (nitrate of silver) give two teaspoonfuls of salt in a pint of water, also the white of egg with other demulcents.
Corrosive sublimate. For this poison the antidote is white of egg and milk, or a mixture of wheat flour and water and soap, which may be given with emetics, or after them; before if no emetic is at hand. The attendant nervous symptoms may be alleviated with paregoric.
Tartar emetic of itself produces vomiting, but this may be kept up by giving mucilage and such astringent infusions as common tea, &c.
Copper. The sulphate or acetate of copper might act as an emetic, but small quantities remaining in the stomach might act as irritant poisons. Give large doses of simple syrup as warm as can be swallowed; give also the whites of eggs and large quantities of milk; and as an antidote the hydrated peroxide of iron.
For BISMUTH, IODINE, or COPPERAS taken in an overdose, give the same emetics and demulcents as for copper.
Zinc and Tin. The sulphate of zinc and the salts of tin when not vomited entirely, produce severe irritating effects on the stomach. Besides milk and albumen give carbonate of soda in solution.
Colycinth, CROTON OIL, and SAVINE OIL may produce like the above, vomiting, diarrhœa, and also constriction of the throat. Give copious doses of barley water, etc.; give opium and perhaps stimulants. These cases and all the rest of the above may be benefitted by taking freely of gum Arabic mucilage, and may demand treatment for inflammation.
Cantharides may produce severe pain in the bowels, bloody evacuations, strangury, burning thirst and fever. Give emollient drinks with enemata, to which some laudanum may be added, and also camphor; oil must not be given in cases of poisoning by cantharides or phosphorus.
Toadstools, AGARIC, ACONITE, BELLADONNA, CONIUM, COLCHICUM, HELLEBORE, and ALCOHOL, are acro-narcotics which may cause severe irritation of the throat and stomach, and such symptoms as burning heat of the esophagus and stomach, thirst, violent nausea, purging, dryness and constriction of the mouth and throat; and be followed by such symptoms as are produced by narcotic poisons: vertigo, headache, perversion of vision, sense of suffocation, disposition to sleep, numbness or paralysis of the limbs, prostration of the strength, cold extremities, feeble pulse, and stupor.
Strammonium, CAMPHOR, CHLORAL, DIGITALIS, BITTER-SWEET and HYOSCYAMUS may be called narcotic poisons. Give prompt emetics, demulcents, witch hazel, active purgatives, strong coffee; keep the patient roused, use electro-magnetism, cold douche, and employ friction.
For PHOSPHORUS, which a child sometimes obtains from the ends of matches, give emetics, and administer big doses of magnesia in water and mucilage. There are a few other poisons which might be classed as irritant, such as nitrate potash (salt petre) which need the same class of remedies as those already named. For nitre give also stimulants freely.
Opium and BELLADONNA are antidotes to each other, and if a person has taken an overdose of one, the other should be given if it is at hand. Evacuate the stomach perhaps by tickling the fauces; give also strong coffee, active stimulants, witch hazel; employ friction, perhaps electro magnetism, and keep the patient moving. Morphine of course demands the same.
For NUX VOMICA and STRYCHNINE, besides giving an emetic give aromatic spirits ammonia, and also chloroform internally in ½ drachm doses diluted. Give tannin and also animal charcoal, milk and spirits camphor in large doses.
Carbonate and ACETATE of LEAD sometimes act as poisons. Give sulphate of zinc as an emetic, and epsom or glauber salts as a cathartic. A mixture of syrup and persulphuret of iron may be given as an antidote to any mineral poison.
Hydrocyanic or PRUSSIC ACID, LAUREL WATER, and CYANIDE OF POTASH cause immediately extreme prostration, nausea, giddiness, pale countenance, slow breathing, and paralysis. Dash cold water on the face to produce a shock, taking care not to soak the clothes of the patient; we may produce a more decided effect if we alternate cold and hot effusions. Have the patient inhale steam containing liquor ammonia or hartshorn; give internally aromatic ammonia and chloroform; use friction, especially along the spine and feet; artificial respiration may be necessary. Give chlorine water of the strength of two drachms to the ounce.
Animal Poisons. For BITES OF SERPENTS apply a ligature above the wounded part; use carbolic acid or any active caustic; apply cupping glass (or mouth, when there is no sore in the mouth). Bisulphite of soda in large doses is said to be an antidote. Give stimulants in large quantities.
Mad Dog Bites. A person having been bitten by a mad dog, or one suspected of rabies, the wound must first be made to bleed, then washed, and finally cauterized. Enlarge the wound so that the blood may flow out freely; press out still more blood, and you may safely suck out some if you do not have any sore on your mouth or lips. After tying a bandage above the wound it must be washed until cauterization can be effected. This can be made either with Vienna paste, butter of antimony, chloride of zinc, or a red hot iron. If the dog can be secured and shut up it is better than that he should be immediately killed. If the dog does not prove to be mad, the person bitten should know the fact, as this may prevent the alarming fears that of themselves sometimes prove disastrous. The bitten person should have his mind diverted as much as possible.
Carbonic Acid Gas. A person having been poisoned by inhaling choke damp or the fumes of burning charcoal, loosen the clothing, dash cold water on the head and face, give plenty of fresh air, stimulants, and inhalations of ammonia. Employ artificial respiration if necessary. If the body is cold employ hot applications.
When a person is asphyxiated treat him instantly. Give all the fresh air possible; remove all light clothing from the chest and neck and face; try to restore respiration first; clear the throat by placing the patient on the face with one arm under the forehead; the tongue falls forward and leaves the windpipe free; then wipe and cleanse the mouth.
To excite respiration turn the patient on his side and apply some stimulating agent (as camphor or ammonia) near the nostrils, and dash cold water, or hot and cold water alternately on the chest, which may have been previously rubbed briskly. (The effort to promote warmth and circulation by rubbing should be kept up continuously as far as possible.) Should there be no respiration immediately you can use
Marshall Hall’s method to imitate respiration. “Turn the patient again on his face, raising and supporting the chest well on a folded coat or other article of dress; make gentle pressure on the back, after which turn him over on his side; then again on his face, and again press a little; repeat these motions at the rate of fifteen a minute. During the operation let one person attend to the movements of the head and the arm placed under it.” If there is respiration and consequent life, dry the hands, in cases of drowning; and as soon as you can, strip the body and gradually reclothe or cover it; but if the breathing is not satisfactory, after continuing these same efforts to restore respiration for about fifteen minutes, you may use
Sylvester’s Method. “Place the patient on the back on a flat surface, inclined a little upward from the feet; raise and support the shoulders and head on a cushion or a folded article of dress; draw forward the patient’s tongue, and keep it projecting beyond the lips, by having a band or string around the tongue and chin, or by raising the lower jaw so that the teeth retain it; standing at the patient’s head, grasp the arms near the elbows and draw them steadily upward above the head, and keep them stretched upwards for two seconds; then turn down the patient’s arms and press them gently and firmly against the chest for two seconds; repeat the movement alternately about fifteen times every minute until a spontaneous effort to inspire is perceived; then proceed TO INDUCE CIRCULATION AND WARMTH.” Rub the limbs upward with energy, and continue the friction under the blanket and over the dry clothing; promote the warmth of the body by applying flannels, bottles of hot water to the pit of the stomach, the armpit, the thighs, and the sole of the feet; then if the power of swallowing has returned, stimulants and coffee should be administered.
A STROKE OF LIGHTNING may cause immediate death by its effects on the nervous system. Sometimes it produces unconsciousness without being fatal. In attempting resuscitation employ artificial respiration, and if there are any signs of life treat as directed for shock. If there are burns complicating the case, of course the burns must be treated. When there is SHOCK the patient lies in an apoplectic state, the surface pale; there is faintness, trembling, cold perspiration, low temperature, feeble pulse, and probably nausea and vomiting. Keep the patient’s head low, give aromatic ammonia, and apply heat to the extremities and to the stomach. Strong beef tea should be given, and hot tea and coffee.
There are but few exigencies that generally occasion more alarm than CONVULSIONS. Fits may come on without premonitory symptoms; there is sudden loss of consciousness, accompanied by irregular and powerful contractions of the muscles. All the voluntary muscles may be affected, or there may be only spasm of the features, or of one side, or of a single limb. During a general paroxysm the countenance is distorted, and the face pallid or livid; generally there is stertorous breathing, and as the attack subsides a disposition to sleep. It is seldom fatal in adults, unless caused by brain or kidney disease.
Do not attempt too much treatment, but you may put the patient in such a condition as to help his recovery. His dress is to be loosened, and all clothing about his neck removed; place him where he can breathe pure and cool air, and you may prevent his falling out of bed; if the face is flushed, cold may be applied to the head and warmth and sinapisms to the extremities. If occurring in a young child you may give a warm bath, or a warm hip bath. If there is ability to swallow, give bromide of potassium, either alone or simultaneously with the administration of chloroform and ether.
If you give chloroform you may pour a few drops on a handkerchief and hold it an inch from the patient’s nose and lips. Ether and chloroform together may be poured, a teaspoonful at a time on a little cotton inside a cone of paper made large enough to fit over the mouth and nose, the air being nearly shut out. The head of the patient must be kept low while he is under the influence of it. Observe the pulse while giving it; a feeble pulse is a sign of danger, and if the pulse is growing weak, or the face is growing livid or pale, stop giving the chloroform; if the symptoms continue, and there is no natural respiration, draw the tongue forward so that it will not obstruct the trachea; have plenty of fresh air; apply friction by rubbing the limbs, and if necessary artificial respiration.