■ tm* m \t \vipim \mmmmMmmmmmMmmmmm*m nm t m , HW , ***< l "" " 1 !"' "I 1 ' " * " ' ww— «' ■ ■ " i w w^i ww wHmiiiw wiii ■ ' ■' '■■ " ■'■ »" '■■ ■ WWWWWWIWfWWWWWMrtBMilpWWWWWI ^^ " !' I- ■—»»«■— M""* —»»«»nww» mmmmmmmmmtmmm Medical Hints or i mates Gharles lie a ton UCSB USKftflT Y- *D&^ J ^T^ MEDICAL HINTS FOR HOT CLIMATES. MEDICAL HINTS FOR HOT CLIMATES AND FOR THOSE OUT OF REACH OF PROFESSIONAL AW. BY CHARLES HEATON, M.D. (brux.), M.R.C.S. (en'g.), L.R.C.P. (lond.)- LONDON: W. THACKER & CO., 2, CREED LANE. CALCUTTA: THACKER, SPINK & CO. 1897. LONDON : PRINTED BY WILLIA3I CLOWES AND SON5, LIMITED. STAMl'OED 8TBEET AND CHABING CB03S. PREFACE. The need has been expressed for a portable volume of Medical reference for travellers and others out of reach of medical aid in the Tropics and Colonies. There are many good works on domestic medicine, but they are, as a rule, too bulky for easy carriage, or too scanty in their information for practical use. The present small work aims at portability, and also endeavours to insist upon the importance of antiseptic treatment of wounds in all cases, even in the absence of the surgeon, and the vital import- ance of the prevention of such diseases as typhoid, cholera, filaria, etc., by the efficient nitration and sterilization of water. The fewer drugs compatible with efficiency the better, and of these, those in tabloid form are to be preferred, both on the score of compactness, easy measurement, and durability. vi Preface. Chronic complaints are slightly touched upon, for no one with a serious chronic ailment ought to travel away from skilled aid. I trust that my many old friends and former patients will find this small work useful. C. H. London, 1897. CONTENTS. INTRODUCTION. Medicine Chests — List of Drugs and Appliances — Doses and Measures CHAPTER I. Health and how to preserve it — "Water and Filtration ... 1 CHAPTER II. Food, Diet, and Recipes ... ... ... ... 19 CHAPTER III. Fevers ... ... ... ... ... ... 25 CHAPTER IV. General Diseases, alphabetically arranged ... ... 41 CHAPTER V. Accidents : "Wounds, Fractures, Dislocation, Bleeding, Bed Sores, Drowning ... ... ... ... ... 113 CHAPTER VI. Description and use of the more common remedies and appliances, arranged in alphabetical order ... ... 133 INTRODUCTION. MEDICINE CHESTS — LIST OF DRUGS AND APPLI- ANCES — DOSES AND MEASURES. If, as is strongly recommended, the drugs are carried for the most part in solid tabloid form (Burroughs, Wellcome & Co.), scales are not needed, but the tabloids should be crushed in a spoon with water before being taken, if it is desired that they should act more readily. A small graduated medicine-glass, marked up to 60 drops, should always be carried. The medicine chest should contain — Tape, plaster, light bandages, absorbent cotton wool, lint, an enema syringe, a glass syringe, blunt-pointed surgical scissors, surgical needles, and ligature silk, and a packet of " Lister's cyanide-gauze " for dangerous wounds will be found very useful, two clinical thermometers, catheter No. 7 soft rubber, and a box of safety pins. A bottle of crystallized pure carbolic acid should always be handy, not only for wounds, but for daily comfort in many ways. Introduction, For description and use of the more common remedies and appliances, see chapter vi. Doses. — f of the adult dose at 18 years old. \ „ „ from 10 to 15. \ » »» « 5 „ 10. i „ „ at 2 years. T \j » » » 1 year. & » „ „ 6 months. Measurements. — Liquids are measured, solids are weighed. Of liquid. Of solids.. 20 drops or minims or grains = one scruple £j 60 „ » or 3 scruples = one drachm 3j 8 drachms * drachms = one ounce £j 20 ounces = one pint of liquid 8 pints = one gallon Rough Measurement — One tea-spoonful = a little more than one drachm. „ dessert spoonful = „ „ two drachms. „ table-spoonful = „ „ four drachms, or " half an ounce " „ wine glassful (port) = about two ounces. Medicines. — Kecommended in tabloid form (Bur- roughs, Wellcome & Co.) — Ammon. carbonate (sal volatile) 3 gr. in tabloid. Ammonium chloride (sal ammoniac) Antimony, Tartarated Antipyrin Arsenious acid Calomel Cascara compound tabloids 5 »» 5 „ i nro " 1 „ Drachm " is often written " dram " for brevity. Introduction. Cascara sagrada, extract Chloral Cocaine Colocynth hyoscyamus and bydrarg Dover's Powder Ginger, strong tincture Hydrarg. perchloride (sublimate) Soloids. Ipecac powder (similar to ipecacuanha wine) .. Ipecac powder Iron (Blaud's Formula) Nux vomica Potassium bromide „ nitrate „ permanganate Paregoric Quinine Rhubarb and soda Salicylate of soda Santonine Soda bicarbonate Soda mint tabloid Sulphate of soda Sulphonal Warburg's Tincture Kecommended in other form* — 2 gr. in tabloid. 10 » „ I n * 5 „ To » " 5 „ „ 3 drops „ 10 gr. „ 5 >» j» 2 n « 5drop8 „ 3 gr. and 5 gr. tabloid. 5 gr. in tabloid. 5 „ „ i 5 „ »> 30 „ „ 30 drops in each. Alum. Bcel. Borax. Boric acid powder. Camphor. Carbolic acid. * The following can generally be obtained in the Indian bazaars : — Alum, Hind. Phuthari. Bcel (JEgle Marmctios, Stone Apple), Hind. Beel geerie. Castor oil, Hind. Rindee Ka Tail, Apendi Ka Tel. Camphor, Hind. Kafoor. Borax, Hind. Sohaga. Chi- retta, Hind. Kreat. Sulphate of copper (blue vitriol), Hind. Morchut. Tutiya Pomegranate, Hind. \Anar. Sal ammoniac, Hind. Nawsagar. Sulphur, Hind. Gunduk. xii Introd action. Castor oil. Nitric acid. Caustic (nitrate of silver). Pomegranate. Chiretta. Sal ammoniac. Chlorodyne. Seidlitz powders. Chloroform. Sulphate of copper. Epsom salts (sulphate of Sulphur. magnesia). Sweet spirits of nitre. Glycerine. Turpentine. The smallest list of drugs for travelling, etc. : — 1. Quinine. 8. Paregoric. 2. Pill colocynth and henbane 9. Chlorodyne. and hydrarg. (tabloids), 10. Bromide of potassium. or any other laxative of 11. Ginger, essence of. personal choice. 12. Ipecacuanha powder. 3. Dover's Powder. 13. Carbonate of ammonia. 4. Cocaine. 14. Iron (Blaud's pill). 5. Sublimate soloids or car- 15. Potash nitrate. bolic acid. 16. Boric acid. 6. Soda bicarbonate. 17. Nux vomica. 7. Warburg's Tincture. All the above drugs and appliances may be obtained, packed, in the most convenient form, at any good chemist's. Perhaps the best forms are those of Burroughs, Wellcome & Co., and for personal use the " Metallic Indian," and " Sir William Moore's case," are recommended. The above may be obtained from Messrs. B., W. & Co., Snow Hill Buildings, Holborn, London ; and also at all European drug stores in large towns. CHAPTER I. HEALTH AND HOW TO PRESERVE IT. WATER AND FILTRATION. IV MEDICAL HINTS FOR HOT CLIMATES. CHAPTER I. GENERAL INSTRUCTIONS FOR THE PRESERVATION OF HEALTH. The following rules are recommended for the pre- servation of health : — DIET. 1. Be regular in the time of taking meals. Too long intervals between meals operate inju- riously by fatiguing the stomach, depriving it of its tone and impairing its digestive powers ; and too short intervals are injurious, by overloading the organ and throwing too much work upon it. Note. — A late breakfast (11.30 a.m.) is recom- mended as doing away with the necessity of any but a light luncheon (a biscuit, and a glass of dry sherry or cup of tea) and, as securing a long morning which may be devoted to the inspection of outdoor work, or to official correspondence, at 4 Medical Hints for Hot Climates. a time when both body and mind are in a state of the greatest vigour. 2. Do not eat too much at a time ; i.e. be content with a satiety, and leave off with an appetite. A popular idea prevails amongst Europeans, that owing to the depressing influences which a tropica] climate exerts on the economy, a large amount of food is required to supply the waste material which is constantly going on — a waste which they imagine to be even greater than occurs in temperate regions. That such an idea is an erroneous one there is not a shadow of a doubt, and so far from there being a necessity for an increase in the supply of food, just the reverse is the case, as in consequence of the elevated temperature, the waste or expenditure of tissue is actually less, and so also is the real demand for food. The natural tendency of an Indian climate is to produce decreased functional action of all the organs of the body, and especially those concerned in digestion, and under these circumstances, where a predisposition to decreased functional activity already exists, the consumption of larger quantities of food than are needed for the requirements of the system can only add fuel to the fire, and conduce directly to organic disease. 3. Take simple food, and avoid rich dishes. A hot, stimulating diet causes thirst, which leads to the imbibing of large quantities of fluid — too frequently alcoholic — most destructive to healthy digestion. The Preservation of Health. 5 4. Eschew heavy luncheons. Heavy luncheons are wholly unnecessary (unless an early breakfast is taken), and positively hurtful, especially when much beer or wine is consumed at them, by inducing a drowsy or sleepy state and a disinclination to exertion of any kind, mental or bodily. Sleep, if indulged in after luncheon, is usually followed by a sick headache, unpleasant taste in the mouth and restless nights. 5. Guard against intenrperance in the use of alcoholic drinks. The abuse of spirituous and alcoholic liquors is the most fertile source of disease of the brain, liver, kidneys, stomach, and bowels. It also increases the liability to epidemic diseases, especially cholera, and to nervous diseases, acute and chronic, causing exhaustion and a whole train of nervous phenomena, and, in aggravated cases, delirium tremens. 6. Always masticate the food well, and in order that you may do so, pay particular attention to the teeth, and you will be amply repaid for your trouble. Besides washing the teeth every morning, wash them also the last thing at night, with a soft brush and a little spirit and water. It is better and safer to use only water that has been boiled or filtered. Use the brush up and down (as in this way it gets between the interstices of the teeth), as well as from side to side. A good tooth-powder for use consists of 1 oz. prepared chalk and 10 Medical Hints for Hot Climates. grains bicarbonate of soda, rubbed up with a fragment of camphor to flavour. After washing the teeth, touch them back and front with a camel's-hair brush, soaked in spirits of wine, a small bottle of which should be kept on the dressing-table ready for use. The spirit hardens the enamel, and prevents and even arrests decay. When the teeth are neglected, the breath becomes offensive, mastication imperfect, toothache frequent, and the teeth loosen and fall out at a comparatively early age. 7. Eipe fruits in their season are always grateful and wholesome when taken in moderation, and cool the system. Fruits are most enjoyable and easiest of digestion when taken early in the morning ; but this applies mostly to heavy fruits such as apples ; light fruits such as oranges can be taken at any time. The acid fruits, such as orange and lime, containing as they do a free vegetable acid, are very useful in warding off scurvy. For the gouty an orange or a lemon at night is advantageous. 8. Alcohol. The habit so general throughout the tropics of taking " pegs " (soda-water and whisky) is most pernicious and enervating, and cannot too strongly be condemned. The exhilaration which ensues on their use is temporary only, and followed after a time by depression, which necessitates a resort to " another peg." It is quite astonishing how much The Preservation of Health. J alcohol is consumed in this way in the course of a day, and the finest constitution in the world must eventually break down under such a practice. The tremulousness of the hands, the want of appetite, the restless sleep at night, and the shaky feeling so often complained of by those habituated to the indulgence of " pegs," are so many symptoms pointing to their baneful influence on the constitution. 9. Wines, beer. Claret is by far the best wine for a hot climate. Haying an agreeable sub-acid taste, it forms a grate- ful and cooling drink especially in the hot season, and rarely causes acidity of stomach. It is, besides, a blood-making wine, since it contains a small quantity of iron, which renders it peculiarly adapted for the tropics. Beer is a fine bitter tonic when taken in moderation, but is apt to cause indigestion, unless combined with plenty of outdoor exercise. Port is rarely needed except in cases of sickness ; possessing astringent properties in a high degree, it is useful in supporting the strength in diarrhoea and dysentery. Sherry should be of the best quality and dry, and used in small quantities, as a condi- ment, to give a relish to food. 10. Observe what does and what does not agree with you in the way of food and drink ; adhere to the one, avoid the other. It is quite impossible to frame a dietetic scale which will suit every one, and each individual must be his or her own doctor or doctress, to a certain 8 Medical Hints for Hot Climates. extent, in this respect ; but, by the exercise of a little judgment and reason, there will be no diffi- culty in discovering what things conduce to health or the reverse. In a general way the advice of the aged " Parr " is worth remembering, " Keep your head cool by temperance, your feet warm by exercise, rise early, and go to bed soon ; and, if you are inclined to get fat, keep your eyes open and your mouth shut." EXERCISE. The most suitable time for taking exercise in the plains is in the early morning, so as to avoid the heat of the sun ; and of all kinds of exercise, riding is probably the best and most enjoyable, as calling the muscles and lungs into full play, increasing the aj)petite, and promoting a circulation and a healthy action of the bowels. Of course, it is to be understood that this remark applies to those who are in the enjoyment of sound health and manly vigour. For invalids, walking or carriage exercise is suitable, according to the strength of the patient. Exercise, to be beneficial, must be short of fatigue, and commenced gradually. Bicycling is strongly advised where it can be practised, for its gentle exercise with the modicum of exertion is a great inducement, and many ladies owe their good health to this. Note. — Ennui, indolence, and neglect of exercise tend to obesity, anaemia, and constipation. The Preservation of Health. BATHING. It is of paramount importance that a free action of the skin should be kept up, since it eliminates impurities from the blood by perspiration, and evaporation from the surface regulates the tempe- rature of the body. Nothing conduces more to a healthy action of the skin than systematic bathing. The best time to bathe is in the early morning, almost immediately after rising from bed, or on returning home after a brisk walk or ride, while the body is still warm. Perspiration should never be allowed to cool on the body under any circum- stances, or a chill may be the result, followed by a feverish attack or even more serious consequences ; hence the clothes should be changed at once, and the body rubbed dry with a rough towel before pro- ceeding to bathe. This is the safest course for men and women of delicate organization, who also should bathe in tepid water to counteract any tendency there may be to internal congestions. But pro- vided the constitution is strong, and that there is no functional or organic disease of the liver or spleen, by far the most bracing and refreshing way of bathing is to take a plunge-bath while the body is hot and perspiring freely (as many do after playing golf), taking the precaution, however, to bathe quickly, so that reaction may be thoroughly established, which is known by a glow and com- fortable feeling of warmth pervading the body. > io Medical Hints for Hot Climates. After bathing, the body should be well rubbed down with a rough towel. The cold shower-bath is that which is best suited to nervous people, and a most powerful agent in invigorating the human frame. It increases the muscular tone, and imparts a buoyancy to the spirits in a surprising manner ; hit it is not suited to stock as may he suffering from organic disease of any internal organ. In order that the shock may be complete, water that has been exposed to the night air in porous gurrahs should be used. The cold douche is the most common mode of bathing in India, by means of gurrahs containing cold water. The water may be reduced in tempe- rature by exposure to the night air, or freshly drawn, according to the feelings of the bather. SLEEP.* A sound sleep at night forms a most important element in the scale of health, for if the nights are restless and sleep broken, the general health becomes impaired and the nervous system shattered. In order to procure a sound sleep at night, do not sleep in the day. That nature has ordained the night as the appointed time for sleep is indicated by the following facts. Towards evening there is a fall in the pulse, the circulation is languid, and the nervous force more or less exhausted, according to * See, also, p. 102. The Preservation of Health. 1 1 the amount of fatigue gone through during the day. These circumstances, combined with the horizontal position, the silence of night, and the absence of external impressions on the organs of sense, are favourable to sleep. To sleep in the day, then, is a perversion of the order of things. Tempe- rate habits, a due regulation of the diet, daily exercise in the open air, and a mind free from anxiety and worry, will usually ensure a sound night's rest. During the hot months it is highly advisable, and, indeed, for most people absolutely necessary, to sleep under a punkah, or the system will rapidly succumb to the intense heat and profuse perspiration. Khuskhus tatties * should be worked only during the day, while the winds are blowing, and that they may be effectual in cooling the atmosphere of a room, one door of the apart- ment should remain open so as to create a draught. The tatties must be kept constantly wet, and not spasmodically so, or they are worse than useless, and may prove exceedingly dangerous, giving rise to fever and rheumatism by sudden alternations of temperature. If required at night-time, which is not advisable, a thermantidote may be put m opera- tion to make them play, as the wind, which blows strongly during the day, usually lulls or dies away towards evening. Note. — Do not sit or lie down quite close to a tatty ; and never sleep in the open air at night * Fans made of grass dipped in water. 1 2 Medical Hints for Hot Climates. time, or wind-stroke may be the result, producing paralysis of one side of the face. SMOKING. A too free indulgence in the use of tobacco is attended with evil consequences ; digestion is im- paired, the nervous system enervated, and the heart's action depressed. The following rules should be attended to : — 1. Never smoke early in the morning on an empty stomach. 2. Never smoke immediately before a meal. 3. If you must smoke do so after a meal, when perhaps it assists digestion. 4. If the hand becomes tremulous, the throat dry, and the head aches from use of tobacco, give up smoking at once. If a non-smoker, there is no need to become one, but an old hand had better continue a smoker. RESIDENCE IN UNHEALTHY LOCALITIES. When obliged to encamp in unhealthy and malarious localities, attend to the following rules : — 1. Unless absolutely necessary, never go out before sunrise or remain out after sunset. 2. Always take a cup of hot coffee or tea before going out in the morning. 3. Kindle fires near the camp, since they ward The Preservation of Health. off malaria, and by decomposing it, render it inert. 4. Avoid unnecessary fatigue. 5. Guard against intemperance. 6. Take a dose of quinine early, every morning, on an empty stomach. 7. Beware of damp, and always sleep under cover, as during sleep the system is more susceptible to the action of malarious influences. 8. Always keep the feet dry, and wear a flannel belt round the loins, especially during the rainy season. 9. If living in a house, keep doors and lower Venetians closed, etc. — if a tent, the purdahs — during the hours of repose. 10. Always endeavour to pitch your tent in such a way that it may be separated from the malarious tract by a sheet of water or belt of trees. (Marsh- miasm is absorbed or rendered innocuous by its transit across water, and its poisonous properties are arrested and neutralized by trees.) 11. Select a gravelly or chalky soil, an elevated site with sloping ground so as to secure natural drainage, a southern aspect, and pitch the tent on the windward side of the malarious tract. 12. Avoid low and moist situations, alluvial and clayey soil, the flat banks of rivers, the bases of mountain ranges or terais, especially if abounding in vegetation which is undergoing decomposition. Note. — Malaria is most virulent when the drying t 4 Medical Hints for Hot Climates. process is most active, i.e. immediately after the termination of the rains. 13. Clear away deciduous leaves, decomposing vegetation and greensward; but leave all natural vegetation intact, or replace them by grasses and herbage, to form a matting of vegetation over the soil. It is best to avoid cultivation in the compound in a malarious district, for it is well known that disturbance of the soil is a fertile cause of outbreaks of malaria. 14. If about to build a house, attend to the preceding conditions, and build one with two stories and a double roof. 15. If the soil retains the damp, make the ground flooring to each room of a layer of pukka bricks ; over this spread lime soorkee six inches thick, and finish with a layer of Portland cement or glazed tiles or dammer (a mixture of equal parts of soorkee and tar). 16. Sleep in a room in the upper story of the house ; thus you will be freer of all ill-effects of malaria and damp, si nce malaria lov^ s tlm p^m und^ and damp and night dew cling to the ground also. See that the drainage is good. 17. If attacks of intermittent fever are constant, increase the dose of quinine (especially if the. spleen enlarges), and leave the locality, if possible, for change of air or a sea voyage 18. Always drink filtered or boiled water. The Preservation of Health. 15 WATER. The quality of drinking water is a matter of life and death. Most intestinal troubles — cholera, typhoid, dysentery, fllaria, etc. — are directly trace- able to contaminated water, and probably malaria also. Microbes are destroyed by prolonged boiling, there- fore water should be boiled, and it is safer to boil it several times. After boiling or filtration the water should not be allowed to stand in open vessels exposed to the air, or it may again be contaminated ; it should be covered or kept in narrow-necked scalded bottles, with a plug of clean cotton wool in the top. FILTERS. These, as a rule, are useless in purifying water from germs ; in fact, they breed germs. The onlij filters which are of any use are " The Pasteur " * and the " Berkefeld." These are effectual, and every one is strongly advised to invest in the means of obtaining germ-free water both for drinking and washing the food, especially the vegetables, as there is no doubt that typhoid and cholera enter the system through unfiltered water used for domestic purposes. * It is most strongly recommended that all travellers should provide themselves with either a pocket " Pasteur filter " or " Berkefeld." 1 6 Medical Hints for Hot Climates. It is well to roughly clean the water by filtration through a Chatee or sand, etc. ; a little powdered alum may be added to the water, which causes the impurities to settle to the bottom, and the clean water may be drawn off and then filtered. "All" filters require regular cleansing, and the directions sold with the apparatus should be studied. Aerated waters do convey germs, and are not necessarily safe, unless made with sterilized water. It is to be hoped that all communities will follow the example set at Darjeeling, and have all the water supply filtered on the Pasteur system. CHOLERA EPIDEMICS. The preventive measures against an attack of cholera are — 1. Healthy employment of mind. 2. Cheerful society. 3. Generous diet. 4. Temperance. 5. Prompt treatment of diarrhoea. 6. Pure drinking water (vide Water). 7. Tonic medicines, of which quinine is the best. 8. Regular exercise, short of fatigue. 9. An absence of fear. 10. The avoidance of infected localities. 11. The immediate removal of cholera evacua- tions, which should be mixed with some disinfec- tant, such as carbolic acid or chloride of zinc, and The Preservation of Health. i 7 buried at a distance in a trench, or, best of all, burned. A common cause of cholera, dysenteric and typhoid contamination, is the native method of straining food through a loin cloth or other filthy rag. This is a fact which every one can verify for himself. HILL SANITARIA. The advantages offered by the climate of the hills are the following : — 1. Elevation, ensuring a freedom from the blasts of the hot winds that sweep the plains. 2. Invigorating atmosphere, bracing up the system, removing debility, giving sound sleep at night, and raising the tone to par. 3. Malaria is of a milder type. 4. Immunity of cholera. 5. The climate is congenial to exercise in the open air. Note. — (a) The hill climates are chiefly of use to convalescents from fever ; to comparatively short residence in India ; or to those whose strength has already been recruited by a furlough at home ; and to all such as are in a nervous and debilitated state, but free from structural or organic disease of the lungs, liver, or spleen. (b) Since hill-diarrhoea* and dysentery are * "Sprue." C Medical Hints for Hot Climates, common diseases, those who visit the hills from the plains should be most careful to adapt their clothing to the change of climate, or internal congestion of some organ is almost sure to follow. (c) The hill climates are unsuitable to those who are suffering from chronic diarrhoea or dysentery, or abscess of the liver, and for such a sea voyage is the proper course. Vaccination. (See Small-pox, p. 35.)— It is the duty of every one to see that he has been not only vaccinated, but re-vaccinated efficiently. Small-pox in an efficiently re-vaccinated person is unknown. It is well to carry a supply of vaccine lymph. The lymph can be applied to the cleansed skin on a few careful scratch marks. A papule appears in about three days, and runs a course similar to a small-pox pustule. The upper part of the arm is the most convenient place, and the scratches should be in three or four places about an inch or an inch and a half apart. The arm should be carefully rested and guarded from irritation, and after about eight or nine days antiseptic lotion may be applied with comfort. If inflammation is considerable, foment the arm with hot boric lotion continually, and apply carbolic oil. CHAPTER II. FOOD, DIET, AND RECIPES. ( 21 ) CHAPTER II. FOOD, DIET, AND RECIPES. Food of all kinds, especially milk, may convey disease. It is important to avoid contamination by dust, dirty hands, flies, etc., and especially by impure water (see Water, p. 15). Raw vegetables ought to be thoroughly washed in pure water. Always take food of some kind, and tea or coffee before making an early morning march, and do not take exercise after a full meal, especially if exposed to the sun. Alcohol is better avoided altogether, except occasionally after a heavy day's work. Milk * should always be strained and boiled, and allowed to cool in covered vessels ; a good method is to nearly fill narrow-necked bottles cleaned with boiling water, and then having closely plugged the mouth with clean cotton wool, to stand them in boiling water for half an hour, taking care not to let the wool get wet. A traveller's "Hawksley's * Cow's milk when it reaches the stomach always clots, but if the digestion is good this produces no discomfort. "Barley water " and " lime water " break up the clot. Human milk and goat's milk do not form such heavy clots. 22 Medical Hints for Hot Climates, Milk Sterilizer " will be the means of saving many children and also adults from typhoid and dysentery and diarrhoea, and enable a nutritious diet to be given with perfect safety. Jellies are of very little nutritious value. They are agreeable adjuncts to invalid diet, and help by aiding digestion. A man fed upon jelly alone would die of starvation. Cooling Drink Nitre 2 drams, juice of two limes, water two pints, with sugar. Imperial Drink. — Cream of tartar (bitartrate of potash) 2 drams, juice of two lemons, peel of one lemon, boiling water one quart. Cool, strain, sugar to taste, and drink ad lib. Diets. — Milk should be sipped, and not taken in large quantities at a time. Hot milk (not warm) agrees best, and is very stimulating. Farinaceous diet means milk, milk puddings, fish, congee, rice, vegetables, sago, sago and milk. Slo'p diet. — Beef tea, broth, light soup, congee, milk, soda and milk, and no solids whatever. Beef Tea, as usually made by " simmering," is very nice, but contains very little nourishment. To be nourishing it must be made as follows: — Cut up lean meat into small pieces, put into a clean pot, add sufficient cold water to cover it well, add a pinch of salt, and stir well. Place the pot Food, Diet, and Recipes inside a saucepan containing some warm water and then put on a slow fire and do not let the water become hotter than the hand can hear, and cover up with a closely fitting lid. In about an hour, take out the pot and strain off the red coloured beef juice, which must be set aside. A little more water can then be added to the meat and boiled (this will extract the flavouring matter) ; this is afterwards strained off and added to the " beef juice." When required for use this mixture can be heated, when it will become thicker and lose the mawkish taste. It contains all the nourishment of the beef as well as the flavour. Must be prepared fresh evefy day or oftener. In cases of severe illness the "beef juice " alone can be given cold, but it is rather nauseating unless mixed with sauce. Liebig's Extract contains no nourishment, but it is a strong stimulant, and is exceedingly useful for exhaustion, especially when made with very hot water, or added to beef tea as made above for flavouring. There are many valuable and reliable condensed meat extracts sold ; amongst these may be mentioned "Wyeth's Beef Juice," "Valentine's Meat Juice," "Bovril," and "Brand's." Barley Water. — One table-spoonful of barley boiled up with water and strained, improved by addition of lemon juice, helps to soften the clot of milk in the stomach, and is a pleasant, bland drink in 24 Medical Hints for Hot Climates. fevers, and especially in inflammation of the bladder, kidneys, or private passages, when it should be taken very freely. Egg and Brandy Mixture ("Egg-flip ").— Yolks of two eggs beaten up with one table-spoonful of brandy, and milk and sugar to taste. Improved by sprinkling nutmeg gratings on the surface. May be made with port wine, or the milk may be warmed. CHAPTER III. FEVERS. NOTE. In all fevers produced by germs there is probably produced in tlie body a protective substance, antitoxin, which is antagonistic to the disease. The successful com- bating of the disease depends upon the strength of the individual, the amount of antitoxin produced, and the virulence of the disease germ. Modern treatment aims at introducing into the body an artificial antitoxin; this has been accomplished in diphtheria and blood-poisoning (pyaemia), and possibly in cholera, typhoid, and plague. In vaccination a modified form of virus is introduced into the system, which produces an antitoxin which protects from small-pox. ( 2 7 ) CHAPTEK III. FEVERS. Fevers, for the most part, commence in the same way — with lassitude, headache, weakness or irrita- bility of the mental condition, and pains in the back and limbs. Then follows heat of the skin, quick pulse, furred tongue, disordered stomach, scanty and high-coloured urine, with thirst. General Treatment. — Eest in bed in a well venti- lated room, avoidance of chill, free action of the bowels. Light nourishing diet and plenty of bland fluid drinks. No alcoholic stimulants should be given, except in cases of great prostration, when it may be the means of saving life. Ardent Fever. (See Sun Fever, p. 36.) Dengue or Dandy Fever. — General feverish dis- turbance, with strong rheumatic pains in body, limbs, and eyeballs. May commence with sudden pain in a large joint. Sometimes the first thing noticed is stiffness of the fingers, spreading into stiffness and pain of the whole limb. The tempera- ture rises to 103° or 104°. Vomiting is common. 28 Medical Hints for Hot Climates. A rash breaks out in bright red patches, and sub- sides in a few hours. After twenty-four or thirty-six hours the temperature falls, without any sweating, to normal, and the discomfort ceases. An interval occurs of several days, and then the rash appears again, with much itching, and no fever, as a rule, but with some return of the pains. Appears in epidemics, and very few escape. It is scarcely ever fatal. Treatment. — Laxative at the onset. Eest in bed, and, when the fever abates, quinine or nux vomica or Fellow's Syrup. Hectic Feyer. Cause. — Long-continued discharge of matter from abscess or lung, as in phthisis. If the discharge is kept free from germs, hectic does not occur. Symptoms. — Feverish headache and restlessness, occurring towards evening and abating in the morning. The strength gradually fails, perspira- tion is profuse, and diarrhoea ensues. Treatment. — If the discharge of matter can be rendered aseptic, hectic disappears. (See Wounds, p. 129.) As much nourishment as possible, in small quan- tities, often repeated. Fellow's Syrup, tonics. Malaria. Ague. Intermittent Feyer. — Charac- terized by paroxysms of fever occurring at regular intervals. Fevers. Varieties. — 1. Quotidean. A paroxysm once in every twenty-four hours ; lasts about twelve hours. 2. Tertian. A paroxysm once in every forty- eight hours ; lasts about nine hours. 3. Quartan. A paroxysm once in every seventy- two hours ; lasts about six hours. These varieties may occur together in the same individual. The period which intervenes between the end of one attack and the beginning of another is called the intermission. If the fever does not entirely disappear, but only lessens or remits, it is called "remittent fever" (see p. 31). Symptoms. — For some days before the attack there is often exhilaration of body and mind, with irritability. An ague fit consists of three stages a cold, a hot, and a sweating stage. The first or " cold stage" is ushered in by languor, listlessness, yawning and stretching, and a sense of oppression at the pit of the stomach. To this succeeds shivering, headache, pains in the body and limbs and shrivelling of the skin, which becomes rouo-h or goose-skinned. The urine is scanty and the pulse small and frequent. This stage varies in length from an hour to two hours and a half, and passes into the second or hot stage and is one of reaction. It commences with transient flushes of heat, which gradually increases to a steady burning heat of the whole body, until the temperature is raised above normal. The face is flushed, the temples throb, the mouth is parched, thirst is Medical Hints for Hot Climates. urgent, the pulse full and hard, the urine high coloured and scanty. The duration of this stage is from three to eight hours, and passes into the third or " sweating stage." Perspiration breaks out over forehead, neck, face, and bends of the joints, and soon becomes profuse and general. Thirst and heat disappear, the pulse becomes natural, and the patient feels himself again, but weak. The tem- perature begins to rise several hours before the paroxysm commences, so that although the patient feels cold he is really hotter than is natural. For some days after the disease appears to have departed, a periodic increase of the temperature may be detected about the time of the old paroxysm, and so long as this continues the patient is not cured. Treatment. — Shorten the cold and hot stages by applications of warmth in bed and free drinking of hot tea, congee, or water, or imperial drink (p. 22). Encourage perspiration, but take great care to avoid chills. Quinine must be given immediately after the attack or towards the end of the sweating stage, and taken in from 5 to 10-grain doses every three or four hours during the intermission, but it should be omitted if it causes deafness, or noises in the head, or much singing in the ears. The bowels should be kept freely open. Old hands in ague usually find out by experience the dose that suits them best. When ague recurs a change of climate is necessary, for successive attacks lead to early wrecking of the constitution. Fevers. 3 1 In obstinate cases of recurrent fever Warburg's Tincture * (three to six tabloids) is necessary. It should be taken just before the attack, and re- peated afterwards ; the tabloid form is most con- venient. Tabloids of arsenious acid T J- - of a grain may be taken in chronic cases or very malarious districts ; one or two should be dissolved in water and taken three times a day one quarter of an hour after meals. An overdose produces pains in the bowels and diarrhoea, and irritation and congestion of the eyes, but it may be taken for a long time, and is a very powerful nerve tonic. Malarial Remittent Feyer (Jungle Fever). — Is an exaggerated intermittent fever, and often commences as such. The fever does not disappear altogether during the intermissions ; it only lessens or " remits." The symptoms are those of ague, without any distinct cold stage. The hot stage is longer, the prostration is greater, and there is generally some delirium, with vomiting and jaundice. The remissions occur with perspiration and a fall of the temperature, generally in the early morning. Unfavourable signs are increasing weakness, blood in the stools or urine, cold sweating, and in- sensibility. Treatment. — The bowels should be carefully regulated. Imperial drink should be taken freely, 3ee p. 150. J 2 Medical Hints for Hot Climates. or citrate of magnesia. Quinine should be given when the skin is moist, in a dose of 10 to 15 grains, and continued in 6-grain doses every three or four hours until the skin, becoming hot and dry, again be- tokens another paroxysm; it should be recommenced until an impression is produced as shown by a day or two being passed without an attack, after which the dose is to be reduced. As soon as possible a change to a healthy climate must be made. It is absolutely essential to have the most nourishing food that the patient can take, and to keep up a free action of the bowels. Jellies are not nourishing. (See Beef Tea, p. 22.) Quinine failing to influence fever, Warburg's Tincture should be taken. (See p. 150.) Arsenious acid ( t Jq grain) tabloids taken three times a day, after meals, are very useful. Malaria, Masked. — A slight febrile condition which may be remittent or intermittent. Inhabi- tants of malarial districts are prone to this con- dition, especially in the autumn and winter. Burning of the palms and the soles are pretty constantly present. It may continue for a long time, and proneness to full attacks are not an especial feature, but anaemia and debility and depression supervene. Delirium, mania, and many obscure conditions can be traced to it by means of the microscopical examination of the blood by the surgeon. Treatment.— A liberal diet, with small amounts of Fevers, CiS stimulants, wine, and coffee. Quinine, 2 grains or more, every day, and tabloids of arsenious acid grains, ^ grain. Malaria. Hints for Prevention. — All depressing agencies predispose to malaria. Malaria lies low, therefore avoid sleeping on the ground. Malarial exhalations are least at noon, most at morning and evening ; therefore keep your house during the fatal hours of sunrise and of sunset. When wet, make a complete change of clothing as soon as possible, and if this is not possible, keep the body warm by any means at hand ; avoid alcoholic stimulants, and take coffee. Take regular exercise, the best times being from G to 8 a.m., or from 4.30 to 6 p.m. ; but carefully avoid fatigue, for this predisposes to malaria. Have cement basements to the house under the whole occupied area, to cut off" sub-soil emanation and damp. Have plenty of vegetation round the house, and do not clear away natural vegetation (see p. 14). In notoriously malarial districts take 2 grains or more of quinine daily to ward off attacks. Use only filtered water. (See Filters, p. 15.) The cause of malaria is generally supposed to be " plasmodium malaria?," which lives in the red cells of the blood. Measles. — Highly contagious. It is unusual to have a second attack. The onset is from about eight D 34 Medical Hints for Hot Climates. to fourteen days after exposure to infection, ushered in by symptoms of an ordinary feverish cold. There is often sickness and intolerance of the eyes to light. The rash appears about the fourth day, first on the face and chest looking like flea-bites, but soon be- coming larger and of a dusky red colour, and lasting and fading during ten days. The temperature usually keeps below 102°. Inflammation of lungs is prone to occur, also diarrhoea. Treatment. — Put in a warm bath, then dry the skin thoroughly, carefully avoiding chill. Unless there is a cough there is no need for medicine. May drink freely of lemonade, etc., or imperial drink (p. 22), and take beef tea, or milk, or broth ; but no solid food to be taken whilst there is fever. If the eruption disappears suddenly, give a hot bath. For Diarrhcea (see p. 58), Cough (see p. 57). Isolate from other children for three weeks at least. Rheumatic Feyer. (See Eheumatism, p. 97.) Scarlet Feyer or Scarletina. — Scarletina is another name for scarlet fever, and signifies the same. Is not common in India or the Far East, and generally occurs from contagion of fresh arrivals from Europe. Is very contagious, and rarely occurs twice in the same person. Sij7iiptoms. — In from twenty-four hours to a few days, symptoms of violent fever occurs, shivering, sore throat, and sometimes sickness pains and some- times diarrhoea. The throat is a vivid red colour. Fevers. 35 The temperature usually is high from the first, 104° or 105°. The rash appears often 011 the second day, appearing like scattered tiny flea-bites, which, multi- plying and spreading, form a general bright scarlet blush all over the body. The tongue looks as though powdered with cayenne pepper. The rash lasts till the end of the week, gradually disappearing and leaving the skin scurfy and flaked. The temperature gradually falls. It is especially liable to affect the kidneys. In measles the rash is dusky red and blotchy and the temperature is not so high. Treatment. — Strict isolation for two months, and, indeed, as long as there is any scurfiness of the skin or discharge from the ears, nostrils, eyes, or private parts. Careful disinfection. In most cases little but rest in bed and a well-ventilated but warm room and nourishing diet is required. Thirst should be assuaged by barley water, lemonade, and especially imperial drink (p. 22). Swelling of the face and legs show that the kidneys are affected. Small-pox (Yariola).— About twelve days after infection the disease begins with shivering fever, headache, pain in the back, and sickness. On the second day pimples appear on the forehead, and if the hand be passed across it, it feels as though there were shot underneath the skin. The pimples become blisters, with a depressed centre, and at the end of the week contain matter ("pocks"), and, in a few more days, dry up and form scabs. When the 36 Medical Hints for Hot Climates. scabs fall off there will be " pitting." In severe cases the pocks run together (confluent small-pox). The temperature is very high at first, and falls with the appearance of the rash, and again rises when the pocks contain matter. When bleeding into the skin occurs, and there is much fever and collapse, it is called black-pox. Convalescence is slow, and there is often disease of the eyes, ears, or joints following. Treatment. — Isolation. Disinfection (p. 61). Rest in bed. Keep up a moderate action of the bowels. The eyes should be bathed with boric acid lotion (p. 136). The pocks to be covered with carbolic oil twice a day, in order to prevent decom- position, which is the cause of the secondary fever. Stimulants are generally required about the second week, especially egg and brandy mixture. When the pustules have burst and there is much fcetor, sponge the skin clean with warm carbolic lotion, later if not too weak, a warm bath with carbolic acid added in the proportion of one table-spoonful to the gallon. During convalescence give quinine. Modified Small-pox occurs sometimes in those who have been vaccinated; it is very mild, and seldom runs beyond the stage of shotty skin, giving no more inconvenience than an attack of measles. Small-pox is unknown after re-vaccination. Sun FeYer. — Common after exposure in the sun during the day. Slight feverishness causes restless Fevers, 6/ nights and loss of appetite, which quickly ameliorate after rest and purgation, or bromide of potassium 10 grains, in water every four hours, and cold sponging. What is called "Ardent Fever," occurs especially during the hottest months of the year, great headache, throbbing and nausea, high fever, and sometimes shivering lasts several hours and gradu- ally passes into insensibility or death. The treatment is the same as for sunstroke, great exhaustion occurs afterwards, and careful feeding and mild stimulants are required. Typhoid Fever ("Enteric Fever," "Gastric Fever"). — This is not typhus fever (see p. 38). It is not contagious. Cause. — A special microbe conveyed principally by water, and sometimes by foul emanations. Probably gains entrance by food that has been washed, and milk contaminated with water or dirty straw, etc.* Symjitoms. — Sets in gradually with slight diar- rhcea, clay-coloured stools, and feverishness, but often constipation, dry brown tongue, and vomiting, progressive weakness and increase of fever, ab- dominal pain and delirium, and in bad cases running into insensibility and death. During the second week of the fever, light small rose-coloured spots dis- appearing with pressure of the fingers, show upon the belly. There is frequently blood in the motions. * Ought to be avoided by more care on the part of the person responsible for the catering. (See pp. 15 and 21.) 8 Medical Hints for Hot Climates. The usual duration is about four weeks. Many cases which were formerly thought to be bad jungle fever, typho-malarial fever, etc., are now known to be typhoid. It especially attacks robust young men on their first arrival in India, and commonly takes a very acute and rapid course, with death in about ten days. High fever, abdominal pains, diarrhoea at commencement, quickly ushers in low mutterings, delirium, insensibility, and death. The bowels are always ulcerated. Treatment. — "No solid food whatever must be taken until one week after the temperature remains normal throughout the day. No fruit allowed. All food must be strained through fine muslin, for any solid particles might cause death by breaking through an ulceration in the bowels. Milk (boiled), milk and soda, and beef tea, and egg and brandy mixture only. Quinine, 3 grains every four hours (tabloids to be powdered). Brandy, and egg and brandy for exhaustion with rapid pulse. The stools must be disinfected and burned. Typhus Fever. — Connected with overcrowding, filth, and squalor, and never occurs in well-drained and ventilated places. Is contagious. Symptoms. — Sudden fever with headache, pains, and chills, lead to complete prostration with a marked aspect, patient lies on back, dull and partially deaf, with half-open eyes and mouth, and a dusky flush over the face. The fever rises to 104° or Fevers. 39 105° at end of week, and declines during the second week of illness, when recovery takes place or the symptoms grow worse until death about the third week. At end of first week there is a characteristic "mulberry "-coloured rash, generally appearing on wrists and then on trunk. There is seldom diarrha a or pains in the belly. Treatment. — Slop diet, and usually egg-flip or brandy for the prostration. Imperial drink. Bi- carbonate of potash, 20 grains, every four hours, with tincture of mix vomica, 5 drops. When the fever abates, give quinine. CHAPTER IV. GENERAL DISEASES, ALPHABETICALLY ARRANGED. ( 43 ) CHAPTEK IV. Abscess or Gathering. (See also Gumboil, Whitlow, Bubo.) Acute or hot. — The part is first inflamed, the centre becoming fluid and "ripening." As the swelling increases the pain increases, the skin over the abscess becomes stretched and hot, red and glazed. The matter finally bursts through the thinned skin, and becoming more liquid, gradually dries up. There is usually fever, headache, and pains in the back and joints in proportion to the hardness of the part and the health of the indi- vidual. The pain is most severe where the skin is thickest. (See Whitlow, p. 110.) The mischief is entirely caused by germs, and if the part were aseptic no inflammation would occur. Cold or chronic abscess takes a long time in form- ing, and is not usually accompanied by inflammation until the surface is reached or they are opened without antiseptic precautions ; they generally 44 Medical Hints for Hot Climates. occur in scrofulous people, and can only be treated by skilled operators. Treatment. — Open the bowels well. Give quinine. Apply carbolic oil over the skin and over that apply antiseptic poultice (p. 146), or lint wrung out in hot carbolic lotion (p. 138) and covered with oil- silk or a leaf, etc., to avoid evaporation. If the swelling is soft and angry looking, it may be lanced with a clean lance or knife soaked in strong car- bolic lotion (p. 137), and so much pain avoided. After the matter has come aAvay, apply carbolic oil freely on lint until healing occurs. It is well to bathe it in carbolic lotion twice a day, keeping the wound clean. Do not squeeze out the matter ; if necessary syringe it out with carbolic or soloid lotion. Do not apply water dressings ; they increase the purification, unless antiseptics are added. A plain poultice made without antiseptics increases the risk of putrification and spreading, and crops of boils often occur around. Anaemia (White Blood, Cachexia). — Is very com- mon, and usually follows the enervating effects of hot climates. Is due to want of iron colouring matter in the red corpuscles of the blood, malaria, or convalescence from any serious illness. Sleep- lessness and a continually tired feeling are usual, also headache and constipation. Treatment. — Open the bowels well. (See Consti- pation, p. 54.) Take very nourishing food, especially General Diseases. 45 digestible meats, beef tea, etc. Quinine and iron is by far the most efficacious remedy. Quinine in powder or tabloids with iron pills or tabloids, three times a day after meals, with occasional addition of nux vomica tabloids before meals. In chronic and malarial cases tabloids of arsenious acid may be taken twice or three times a day with meals. Gentle exercise must be taken, and fatigue always avoided. If there is indigestion present, nux vomica and soda mint tabloids after meals, or dilute nitric acid 10 drops, and nux vomica and kreat. Apoplexy. — Generally falls insensible, with flushed face, laboured breathing, and full, slow pulse. The face may be distorted and convulsions occur on one side of the body. There may be previous warnings by headache, giddiness, and constipation, and the attack may occur slowly and be similar to a fainting fit. There may be paralysis and distortion without insensibility, but with inability to speak. May pass off or merge into insensibility, in which the patient dies. Caused by rupture of a blood vessel in the brain. (See Insensibility, p. 80.) Treatment. — Absolute rest in recumbent position, bowels freely open, cold to the head. Keep watch for bed sores (see p. 119). See that urine is passed during the day ; if it is not, endeavour to draw it off with a catheter (p. 139). Asthma. — Paroxysmal attacks of difficult breath- ing. Few cases are alike, and no treatment is 46 Medical Hints for Hot Climates. efficacious in all cases, and the same applies to climate. Treatment. — Half a grain of cocaine dissolved in water, and half this taken generally gives instant relief, but the effects do not last. Ipecacu- anha wine used in a scent spray and inhaled gives relief in bronchitis cases. Datura tatula or stra- monium in cigarettes. Nitre dissolved in water and dried on blotting-paper and burnt and the fumes inhaled. Belly, Wounds of. (See p. 130.) Bilious Attack. Symptoms. — "Bilious headache," lassitude, dyspepsia, bad taste in the mouth, coated tongue, and irregular action of the bowels. Treatment. — A smart purge at night and a saline taken the first thing in the morning. Soda mint or potash and mix vomica. Avoid solid food and alcohol ; take light soup or beef tea, etc. Moderate exercise. The cold bath omitted during the attack. Afterwards take 10 drops of dilute nitric acid in water, or better in infusion of chiretta, kreat, or any vegetable bitter or nux vomica. Bilious Colic. (See Colic, p. 53.) Bladder. — Inflammation may be caused by injury, exposure to cold, or gout, irritation of a stone or stricture or extension backwards of inflammation of the private parts (urethra) as in gonorrhoea. An unclean catheter is a frequent cause. Symptoms. — Pain in the lower part of the belly, Gejieral Diseases. 47 and soreness on pressure between the fold of the groin and lower part of the belly. There is generally a sense of weight and burning in the part. The urine is passed frequently and in small quantities, often with great straining and aggravation of the burning pain. The urine is often thick and blood- stained, and may be offensive. Treatment. — Hot baths and fomentations to the part. The bowels to be freely opened. Absolute rest in bed. Barley water and imperial drink (pp. 22, 23) very freely taken. Ten grains of boric acid dissolved in water or milk to be taken every four hours. Diet — milk, beef tea, and broth only, until pain is gone. No coffee, tea, nor stimulants. In gouty cases give bicarbonate of potash, 20 grains, every four hours, and imperial drink as much as can be taken. Chronic Inflammation. — May ensue upon the acute form, but is generally caused by gout or gravel, or in elderly people, from enlargement of the " prostate gland " at the neck of the bladder. A surgeon must be consulted ; meanwhile, give boric acid 10 grains dissolved in plenty of water or boiled milk, twice a day ; live on the lightest possible diet, and keep the bowels freely open. Irritability. — Shown by frequent desire to pass water, or by pain on passing water in elderly persons, is generally caused by the enlarged prostate gland at the neck of the bladder, or from stone (especially when pain occurs at the end of passing water, and in 48 Medical Hints for Hot Climates. the tip of the penis, and there is blood in the water). Constipation also causes discomfort, also fissure of the anus (p. 69). Worms in children (p. 111). Cold or sudden change to a colder climate. Bleeding. (See Hemorrhage, p. 127.) Blood-spitting may be due to wound of the tongue, tooth, nose bleeding, congested throat or lungs, or more rarely consumption, a blood tumour (aneurism), or disease of the stomach. Boils. — Small abscesses at the root of the hairs. Often appear in crops, and depend upon bad health. Treatment (see Abscess, p. 43). — Apply carbolic oil at once, this often prevents further trouble, especially if the central hair be pulled out. Laxa- tives and tonics are generally wanted. Do not apply an ordinary poultice ; an antiseptic poultice (p. 146) is very beneficial, and quickly relieves pain. When the discharge is becoming thin, powder the part well with boric acid powder, after washing with carbolic lotion. Brain. (See Concussion, Compression, pp. 81, 82 ; Apoplexy, p. 45.) Brain, Inflammation of. — Chief signs, delirium, vomiting, headache, fever. Treatment. — Cold to the shaved head. Purge by calomel or sulphate of soda. Absolute rest and General Diseases. 49 quiet. Bromide of potassium, 10 grains, in water every four hours. Breast (see also Nipples, p. 91), Inflamma- tion of. Cause. — Injury, sore upon, or any irritation of the nipple, over-distension with milk. To Prevent. — Keep the nipple clean by gentle washing and occasional bathing with carbolic lotion (p. 138), and do not allow the breasts to become over-distended, but draw off the milk by suction. (In the absence of other contrivances, a soda-water bottle with a hole knocked in the bottom, the nipple to be placed in the neck, and suction to be made at the broken end protected with a handker- chief.) In many cases where the milk is blocked, gentle persistent suction will start the flow and save inflammation. Do not allow the nurse to rub the milk away or " break the strings of the nipple," which is a common cause of abscess. Painful or tender or easts in young people are common, and generally occur in those anaemic or weak. Tonics — iron and quinine — with occasional doses of bromide of potassium, 10 grains, in water twice a day, and cold applications. Do not leave the nipple in the child's mouth when it is not sucking. If abscess (p. 43) form, apply fomentation. If lanced, cut in a line radiating from the nipple. Stimulating diet and quinine and iron. Free action of the bowels. E 5 JlarK/uifiny thf Foot, round, & thefi-ee corner pi line, touertht.Kead. Tractokco ClAMCle, fCnllnrJione.) Treatment by ffnotted ffandforchief.^ Triangular handkerchief supporting dm f, 'i 'how. Triangular Tfandkerehief, The third handkerchief being knotted Thu corner of handkerchief 'is afterwards pinned Supporting the forearm. round the other th'O, so as to pull bacA- die -Shoulders rig the /.owe, Xeg U'd/t Straight Side Splints i T/ie leg being padded inside the? Splints. ! "5 CHAPTER V. I ACCIDENTS : WOUNDS, FRACTURES, DISLOCATION, BLEEDING, BED SORES, DROWNING. Carrying the Sick and Injured— To carry single-] landed an unconscious person, wlio lias no broken hones. — Turn patient on his face, with arms extended in a line with the body. Raise the trunk into a kneeling position. Place yourself under him so that his stomach rests on your right shoulder. Pass your arm between his thighs, and behind his right thigh. With your left arm draw his left hand forward under your left, and grasp the wrist with your right hand ; then raise yourself to an erect position. With two helpers. — Let each bearer grasp his left wrist with the right hand, and then with the left hand grasp the right wrist of his comrade. " Sedan chair." The bearers stoop down behind the patient, who sits up on the hands, and passes an arm round the neck of each bearer. » In all serious injuries and illness, patient must be carried in the lying-down position, by means of 1 1 6 Medical Hints for Hot Climates. stretchers, such as a hurdle, gate, door, plank, covered with any soft substance. Two coats with the slee^j turned inside out, pass two poles through the slee^l^ button the coats over them. Let the bearers wall^ " out of step " with short paces, and see that patient is comfortable. Dislocation. — Occurs when a bone is put out of joint. They must be carefully distinguished from fractures (see p. 123). In examining the patient, always have him stripped, and then compare the two sides of the body. Symptoms. — 1. Loss of power in the limb. 2. Alteration of the shape, comparing both sides of the body. 3. Pain and swelling. 4. The trouble is at a joint. 5. The limb is fixed and the patient cannot move it. 6. There is no crepitus (grating of broken ends of bones) felt. Rarely there is a fracture combined with the dis- location, and then the grating of the bone (crepitus) is felt. It must be treated as a fracture, and no attempt made at reduction except by the surgeon. Principles of Treatment. — Try to get the joint back as soon as possible whilst the muscles of the patient are weak. Pull on the limb, and at the same time twist the limb inwards and outwards and Accidents. 1 1 7 rotate it about, when it will often go back into the joint with a snap. Afterwards give complete rest, .tfe arm in a sling, the leg at rest in bed. Foment the part night and morning with very hot water. When the tenderness and pain are diminished, and there is no inflammation nor heat in the part, rub and knead it, and gently move the limb to prevent stiffness. Very hot douches, followed, whilst the part is red, by very cold douches, should be used con- tinually for several months afterwards. Care must be taken not to use the limb forcibly for many months, or the bone may again slip out of the socket. Dislocation of the Ankle. — Generally occurs with fracture of the lower part of the small bone on the outside of one leg, the foot is displaced outwards as a rule. Treatment. — Steadily pull the foot straight and bend it into same position as the sound limb. Keep it in position by a bandage binding it to a straight splint applied to the inner side of the leg and foot, the splint should be well padded, especially just about the ankle-joint. Dislocation of the Thigh — The leg is usually drawn a little upwards and on to the sound limb, the toe pointed to the top of the other foot, but it may become fixed in many other positions. Treatment. — Pull heavily and steadily upon the leg, putting the sole of your foot (with the boot 1 1 8 Medical Hints for Hot Climates. off) in the patient's crutch, and then bend the thigh upon the belly and roll and twist it outwards so that the foot of the injured limb curves over' to to the sound limb. Eepeat this manoeuvre, if necessary. Dislocation of the Elbow. — (Compare with other elbow.) There is a large projection behind the elbow-joint. The arm is bent, and cannot be straightened. Treatment. — Bend the forearm at the elbow, and, grasping the arm just above the elbow, pull forcibly with the other hand, or put your knee against the arm just above the elbow and pull the arm, at the same time bending it at the elbow. Dislocation of the Shoulder. — Compare both sides of the body. Flattening of the shoulder. Often numbness of the fingers and a lump to be felt in the armpit. The elbow sticks out. Treatment. — Let the patient lie flat on his back. Take your boot off, and press your heel firmly into the armpit, press outwards and pull steadily upon the arm. Keep arm in sling (see illustration No. 5). Dislocation of the Jaw. — May be caused by a blow during yawning or, in some people, by simply opening the mouth too wide. Signs. — The mouth remains open and fixed. Treatment. — Put the patient on a low seat, with head against wall. Wrap handkerchief or bandage Accidents. 1 1 9 round the thumbs, and press them firmly downwards on the gums behind the back teeth of the lower jaws. At the same time raise the chin with the fingers. Bed Sores. — Due to irritation and pressure upon feebly nourished or prominent bony parts, such as the shoulder blades, lower part of back between buttocks, over the head of the hip bone, and the heels. May also form under splints. Especially liable to form in apoplexy or brain or spinal mis- chief. Treatment. — Avoid by carefully arranging the clothes, so that one point is not more pressed upon than another. Turn patient over occasionally. Avoid wrinkles in bed clothes. Keep bed dry. If the part looks red or irritable, wash twice a day with warm water and soap, thoroughly dry, and then rub gently with brandy or whisky and water. If possible, cover the part and the bed clothes underneath with boric acid powder, or boric acid and starch mixed. When once formed, treat as a wound, bathing with carbolic or sublimate lotion, and covering with carbolic oil. Make cotton wool ring round the part, so that the sore itself is not pressed up. Bites.— From mad animals. (See Hydrophobia.) Snake-Bite (poisonous). — Immediately tie a tight band a few inches above the bite, between it and the trunk, to prevent the poison getting into the circulation. Cut and score the part freely with a 1 20 Medical Hints for Hot Climates. knife, and encourage bleeding by immersing in warm water, then rub in hard any of the following which may be at hand. Potassium permanganate crystals (p. 146) made into a paste with water, chloride of lime in a watery paste, strong ammonia, carbolic acid, and, before loosing the ligature, make a clean cut in the skin, or in a distended vein just below it, and encourage some free bleeding. Take internally nux vomica tabloids, up to 30 drops every hour or two ; also sal volatile or carbonate of ammonia and alcohol. Afterwards treat the wound (p. 129), raise the limb, and supply nourishment freely. The ligature is to be removed after the bite and bleeding have been attended to. The prospect of cure after snake-bite may be expected to be much greater, owing to recent investigations as to the curative power of injected serums prepared from immunized animals. Stings. — (Of insects, scorpions, etc.). Extract sting by pressing watch-key over it. Encourage bleeding. Bub in ammonia, or potash, or soda, and potassium permanganate solution (p. 146), or apply carbolic lotion (p. 138). If any inflammation, apply antiseptic poultice. Bruises. — Wash the part in carbolic or soloid lotion, and then put on cold applications, and rest. When tenderness is less, massage gently. Do not use arnica, as it is apt to cause troublesome eczema. If the forehead is bruised, bind a scarf or bandage Accidents. 1 2 1 tightly round the head over the bruise, to prevent swelling and a black eye, if the eye becomes irritable bathe it in boric acid lotion or very dilute hydrarg.-perchlor. lotion (p. 142), and wear a light shade or bandage. Burns and Scalds. Treatment. — If the clothing sticks to the part, saturate it with carbolic oil, and leave it until it loosens. Snip the blisters with clean scissors. Use any unirritating application that will keep out the air. Good applications are carron oil,* or carbolic oil and linseed oil, equal parts. If there is much inflammation and discharge, soak the part in warm carbolic lotion (p. 138) in a bath, taking care not to let the water get cold. Avoid exposure to the air. Give most nourishing diet, and attend to the bowels. Flour, oil, butter, chalk, bran, etc., are useful applications, but the above-mentioned remedies are to be preferred. If there is much discharge, powder freely with boric acid. Drowning. — To restore animation. Clear the air passages. Lay the patient upon his stomach, so that the head is lower than his body, wipe the mouth and nostrils, and put the arm under forehead. This allows the water to drain out and the tongue to fall forward, and leaves the windpipe free. Meanwhile, quickly remove wet clothes, and wrap in blankets, or place in the sun (taking care of the head). * Equal parts of linseed oil and liuue water shaken up together. 122 Medical Hints for Hot Climates. Adjust the position. — After a feAv minutes, turn the patient on to bis back upon a flat surface, inclined a little upwards from the feet. Place a small firm cushion or roll of clothes beneath the shoulders. Maintain free entrance of air into the windpipe. — Open the mouth, draw forward the tongue, and keep it projecting beyond the mouth by a piece of tape or elastic band passed round under the jaw. Imitate the movements of breathing. 1. To drew air into lungs. — Stand or kneel at patient's head. Grasp the arms just below the elbows, draw them gently and steadily up to the sides of the head and keep them stretched so for two seconds. 2. To press air out of the lungs. — Carry the arms to the sides of the chest and press them gently and firmly against the sides of the chest for a few seconds. Kepeat these movements perseveringly for about fifteen times a minute, until natural breathing begins, when they must be stopped. Do not hurry ; if sick, turn upon the side. Ifean while, the nostrils may be irritated by ammonia, smelling-salts, etc. Eub the limbs upwards towards the trunk, and keep the body warm. When power of swallowing has returned, give a little warm water, then small quantities of hot brandy and water or coffee, and especially strong Liebig's Extract made with hot water (p. 23). Encourage sleep. If breathing is difficult, apply hot fomentations or mustard poultices to chest. Accidents. Fracture. Symptoms. — Loss of power in the part; alteration in shape compared with the sound side; bending or shortening. Pain and perhaps swelling or unusual mobility at the seat of fracture. Grating (crepitus) of the ends of the bone,, felt when the injured part is gently moved. A simple fracture has the skin unbroken. A compound fracture has the skin broken and a wound leading to the site of fracture. Green-stick Fracture. — In children, whose bones are soft and bend when adult's bones would break ; there is no grating. Treatment. — Straighten and put on splints, etc. General principles of Treatment. — Attend to the fracture on the spot. If it is necessary to move a broken limb, place both hands underneath, one hand higher up than the fracture and one lower down, and hold it steadily and firmly. Cut clothing up the seams. Gently pull and manipulate the limb until, if possible, it is the same as the uninjured side. Support the limb immovably in this position by means of splints and bandages. Splints. — Can be made of thin board, laths, cigar- box wood, cardboard, sticks, rolls of newspaper, etc. Place soft padding evenly between splint and limb, such as cotton wool, handkerchief, etc. Bandages may be made of anything that will tie round the splints, keeping them in place without hurting the skin. If much swelling occurs, loosen the bandages. If the skin is broken, wash well with antiseptic 124 Medical Hints for Hot Climates. lotions (pp. 138, 142), and cover with wool soaked in carbolic oil. Compound Fracture. — The skin being broken, it must be treated as a wound (p. 129). Any piece of bone sticking out must be saturated with strong sublimate or carbolic lotion (pp. 138, 142), before it is replaced. All dirt to be carefully removed. In all accidents, see that the urine is passed, if not passed in a few hours, draw it off with a catheter (p. 139). SPECIAL FRACTURES. Skull. — Signs not always obvious. There may be bleeding from the ear, nose, or mouth, or a watery discharge from the ear. Insensibility, with symptoms of concussion or compression (see p. 81). Treatment. — Keep lying down in cool dark room, with the head slightly raised. Attend to any wound. Cool the head with ice, or cold water, or fan. No stimulants. See that the bowels are well open. Spine. Signs. — Pain and shock, loss of movement in the limbs below the injury. Treatment. — Move very carefully. Lay flat on back. Draw off the urine night and morning, oftener, if required. (See Cathetee, p. 139.) Bed sores are likely to form. Ribs. Signs. — Sharp catching pain on breathing, increased by drawing a deep breath or coughing. Treatment. — Confine the chest by a bandage or Accidents. 125 towel, or a scarf, and keep quiet in bed. If there is blood-spitting give chlorodyne or opiate. Union in about three weeks. Lower Jaw. Signs. — It is usually compound, with a tear through the gums between the teeth, but union takes place very readily. Treatment. — Eemove any loose teeth. Wash the mouth with potassium permanganate solution (p. 146) or boric lotion, etc., several times a day. Take a piece of bandage about two feet long, split each end so as to leave about three inches unsplit in the centre. Place the unsplit part of the bandage over the point of the chin, and tie the two opposite upper ends round the neck and the two lower oppo- site ends over the head. Feed with liquid diet. Collar Bone. Signs. — The shoulder drops. The elbow is supported by the other hand. Compare both sides carefully. Treatment. — Place soft pad under the armpit, and bandage the elbow to the side, raising the shoulder to the level of the opposite one. Put on a large arm-sling to support the elbow. Bind the arm firmly to the side just above the elbow (see illustration No. 8). Another good method is to use knotted handkerchiefs (see illustration No. 7). Arm Bone (above the elbow). Treatment. — Use a splint bent to a right angle, and large enough to reach from the armpit to the elbow, and from the elbow to the end of the hand. Apply it to the 126 Medical Hints for Hot Climates. inside of the arm and the palm of hand, then pnt on the shorter splints, one in front and one to the outer and back part of the fractured part. Support the forearm in a sling. Unites in about four weeks. Forearm (below the elbow). Treatment. — Bend the elbow to a right angle, and let the thumb point upwards. Place one flat splint on the inside of the forearm and another on the outside, reaching from the elbow to roots of the fingers. Bandage and use a large arm-sling (see illustration No. 6). Kub the arm gently when the splints are readjusted, and encourage movements of the fingers and thumbs or they will become stiff. Repair takes place in a month . Thigh. Treatment. — Apply a long splint from armpit to the ankle, another splint from the crutch on the inside to the knee. Extend the leg to its natural length as far as possible. Fix with bandage : (1) around the chest ; (2) waist ; (3) thigh, above fracture ; (4) thigh, below fracture ; (5) below the knee ; (6) round the ankle. See that the heel is not pressed upon, and that it does not even rest upon the clothes, or a sore will easily form. Must be in bed for six weeks, and not use foot for several weeks longer. A weight should be attached to the splint and hung over the end of the bed. Knee-cap. Signs. — There is inability to stand, and the fragments can be felt with a gap between them. Treatment. — Put a srjlint under the limb, reaching I Accidents. 1 2 7 from the upper part of the thigh to below the calf, or better, to below the heel with a foot-piece attached for the sole to rest upon. (N.B. — See that the heel is not pressed upon.) Bandage the leg firmly. Now raise the limb with a support under the leg, and force down the upper fragment towards the lower, and retain it in its place by a bandage wound round the limb above the upper fragment. Long strips of plaster are better than bandage. A stiff knee-cap will have to be worn afterwards. Must not move leg for several months. Haemorrhage (Bleeding). — Moderate bleeding usually ceases upon application of cold or pressure, or raising the limb. The best styptics are very hot water (as hot as the hand can possibly bear) ; very hot water mixed with alcohol of any sort ; turpen- tine, the latter especially, when applied on lint and pressed into the wound, it is also a capital antiseptic. Alum, powdered galls, or steel drops may be used. If any troublesome blood-vessel can be seen (if the bleeding is bad, it should be searched for) it should be seized by pincers or forceps, and twisted round several times, or caught with a sharp hook or sharp piece of wire, and tied round with strong thread or ligature, which should be allowed to hang out of the wound. It must be insisted upon that every article used to a wound . is to be surgically clean, and ought to be soaked in boiling water or passed through a flame. Lister's cyanide- 128 Medical Hints for Hot Climates, gauze (see introduction) is the best application. {All instruments should be very clean; see Wounds p. 129.) If unable to stop the bleeding, plug the wound with turpentine and lint, etc., and bandage firmly, elevate the part, and soak the part next day in cold carbolic lotion, allowing the plug to gradually loosen. In severe cases, the main artery can be felt for and pressed upon by finger and thumb, or a tourni- quet can be used by tying a strong band above round the limb and twisting it tight my means of a stick or any handy article; if the artery can be found, it is as well to place a stone or cork between it and the tourniquet. Sprains. — Secure complete rest by bandage or splint ; elevate, apply cold, and if this does not relieve pain, use very hot water. If there is doubt as to a fracture, treat as a fracture (p. 123). When the inflammation has subsided, rub gently with liniment, and strengthen by plunging joint into very hot water and then into very cold water. Sea water is the best. It is a great mistake to keep the joint immovable for more than a few days, for adhesions form inside the joint and cause stiffness afterwards, therefore, directly the inflammation has subsided, begin to move the joint and apj>ly massage and douches and, if the ankle, walk upon it soon. The art of the "bone-setter" lies in breaking down the adhesions in a stiff joint ; they break with a Accidents. 129 crack, and the humbug explains that this is " the small bone going into place," and generally the patient is cured, but in some cases severe inflamma- tion is set up, and the joint is ruined. Wounds. — General directions for treatment. 1. Arrest bleeding. (See HjEMOBRHAGE, p. 127.) 2. Perfect cleanliness. Hands, instruments, sponges, etc., must be washed and soaked in carbolic lotion (p. 138), or corrosive sublimate (p. 143), and the wound exposed to the air as little as possible. Use water that has been boiled recently or else filtered. Kemove all dirt and splinters, etc. 3. If the wound is clean cut, bring the outer edges together by plaster or stitches, if the latter, use clean white silk, horse-hair, or soft silver wire threaded on a surgical needle, and soak them in boiling water and antiseptic lotion before use. 4. Apply dressing with a betndetgc over it. Dry dressing. — Powder the part with boric acid or iodoform, and apply clean lint or wool or rags. Moist dressing. — Use iodoform or boric acid as with dry, and apply lint, etc., wrung out in carboli<- or corrosive lotion, and cover with oil silk, a plantain- leaf, tissue paper soaked in carbolic oil, or tin-foil, to prevent evaporation. If the wound is dirty, better apply wet antiseptic dressings. 5. Support the injured part with slings, etc., and make the patient as comfortable as possible. 6. If the wound is very dirty or foul and inflamed, 130 Medical Hints for Hot Climates. wash it thoroughly in strong carbolic lotion, and even pure carbolic acid may be applied without danger provided it do not run over the skin. After-treatment. — The more rest the injured part has the sooner will it heal. If the dry dressings have stuck, soak them in carbolic oil, and leave them, unless there is inflammation. Moist dressings require to be kept moist, and should be changed every day or oftener if there is much discharge, and the part bathed in antiseptic lotion and dusted with iodoform or boric acid, if these are at hand. If inflamed and throbbing, syringe the wound out with antiseptics, and see that no discharge is pent up. If the wound is foul, and no antiseptics are at hand, it must be freely washed in boiled water, and sprinkled with finely powdered sulphur, which can generally be procured, this will when acted upon by the flesh, be strongly germicidal, and make the wound clean. Wound of Chest. — Keep absolutely quiet on the injured side. Bind round the chest with a bandage after treating the wound (p. 129). Low diet. No alcohol. Chlorodyne, if there is much pain. If there is difficulty in breathing, sit the patient up. After a severe crush if great difficulty of breath- ing occurs, bleeding from the wound may save life. Wound of Belly. — Usually there is collapse and a fatal result, unless surgical aid can be quickly procured. Lay quite still on injured side, with the Accidents. 1 3 1 legs drawn up. Give Dover's Powder, 10 grains, or opium half a grain, or chlorodyne 10 drops, every four or six hours until drowsy, if there is much pain. Treat the wound with antiseptics and dressings, and do not close the edires. CHAPTER VI. DESCRIPTION AND USE OF THE MORE COMMON REMEDIES AND APPLIANCES, ARRANGED IN ALPHABETICAL ORDER. OO CHAPTER VI. DESCRIPTION AND USE OF MEDICINES. Alum (Hind. Phitkari). — A pinch of the powder added to dirty water causes impurities to fall to the bottom. Dissolved in water, it stops bleeding when applied to wounds. Used, as gargle in sore throats, and as a lotion for sore eyes and nipples. Ammonium Carbonate. — Three-grain dose, or one tabloid, dissolved in water, as " Sal Volatile " (Aromatic Spirits of Ammonia), 30 drops in water. An effective stimulant. Useful in fainting, and also in prostration. For wind, dyspepsia, or colic. Ammonium Chloride (Sal Ammoniac). — Is given for congested liver, and for chronic cough where there is much phlegm. Dose, 10 to 15 grains in water several times a day. Antimony Tartrate (Tartaratcd Antimony). — Dose in tabloid form (-^ grain), one or two every four hours. Often used as " Antimonial Wine." Dose : 5 to 15 drops in water. Small doses, often repeated, cause sweating and loosen phlegm on the chest. It is given in fever and inflammation of the lungs. 136 Medical Hints for Hot Climates. where breathing is difficult, cough is " tight " and painful, and the skin is dry. Is depressing, and should be discontinued when the phlegm becomes loose and easily coughed up. Antipyrin. — In 5-grain dose to relieve headache. Must not be continually nor habitually used, as it depresses the system, and may cause heart failure. Eeduces fever ; if the temperature of the body is high, the skin dry, and the strength good, it may be given in 5-grain doses every 3 or 4 hours till sweating commences. Is useful in ague and in sunstroke. Boel Fruit (fiegle Marmalos, Stone Apple. Hind. Bod gccric). — Is an astringent to the bowels, and also a slight aperient. Used in dysentery and chronic diarrhoea, and the irregularity of bowels so common with children. To make Decoction. — Boil 3 ounces of the dried fruit (or 1^ ounce of half-ripe fruit) in a pint of water, until it evaporates to half a pint. Dose for adult : a wine-glassful, several times a day. To make Syrup. — Add a wineglassful of water, and a tea-spoonful of sugar to the juicy part of the fruit. May be taken several times daily. Boric Acid (Boracic Acid). — Is a fine, smooth powder. A mild antiseptic. Can be freely dusted upon all wounds to soak up discharge. For sore feet, and also for stinking feet, after washing dust well Description and Use of Medicines. 137 with boric acid. For eye lotion, about 40 grains (half a tea-spoonful) to half-pint of boiled water, may be used to the eyes with impunity. Given in 5- grain doses, dissolved in water, for inflammation of the bladder. Makes an excellent mouth-wash. Carbolic Acid.— Sold in crystals or in liquid of various degrees of purity. (Jeyes', fluid is a crude carbolic acid, but is most efficient as a disinfectant for drains, etc.) Best carried in crystals in thick 2-ounce bottles or, for household purposes, in larger bottles. In hot climates it is generally liquid; but, if not, it can be easily dissolved by warming the bottle. It is the most universally useful and potent dis- infectant known, and the result of its use in all inflamed or dirty wounds, or in abscesses, will be apparent to the most careless observer. Taken internally, is a painful poison. Antidotes.- — A quantity of glycerine and an emetic or stomach pump ; oils, eggs, Epsom salts. The use of different strengths — " Pure!' — May be used to very foul dirty wounds, where there is much inflammation. Take a piece of wool or lint, moistened with the acid, in a pair of forceps, and dab it well into the wound, which should be well washed in " 1 in 60 " afterwards. If it touches the skin it will cause a painful burn, so do not let it run down the sides over the skin. 138 Medical Hints for Hot Climates. " 1 in 20." — Made by dissolving 1 part by measure in 20 parts of warm water, i.e. 1 ounce in 1 pint, or half an ounce to a tumblerful, or 1 tea- spoonful to about a wine-glassful and a half. Used for washing out poisoned wounds, or wounds that have been caused by dirty articles, and subse- quent application on lint wrung out in it. All instruments should be soaked in this, after cleaning them, before use. Is too strong for ordinary use. " 1 in 60." — Made by dissolving 1 part of acid in 00 parts of water (1 ounce to 3 pints of water, or 1 dram to half a pint of water). Is the most generally useful strength. Should be used to all inflamed surfaces (except the eye, when boric acid should be used, see p. 136), and to ordinary wounds, cuts, scratches, etc. Boils and carbuncles should be kept covered with lint or rag- soaked in it, and if covered with mackintosh con- stitutes an " antiseptic poultice " (see p. 146). Made with boiling water and linseed meal added, it makes an excellent application for a whitlow, buboe, or other abscess. Carbolic Oil. — Made by dissolving 1 part of carbolic acid in 10 parts of clean olive oil. Must be kept stoppered, and when used a little is to be poured into a small clean vessel and the lint soaked in it. Is perhaps the most generally con- venient and efficacious application in general use for applying to healing wounds, also to boils and Description and Use of Medicines. 130 abscesses, and to spread over the skin before apply- ing a poultice. Stops itching around the back passage (" pruritus "). Diluted with equal parts of olive, or better, castor oil, is used for lubricating catheters before use. (" weak carbolic oil "). • Castor Oil (Hind. Binder Ka Tail, Areendi Ka Tel). — Often to be had in the bazaars. See that it is fresh, and not rancid. Purgative : half an ounce to 1 ounce for adults, and half a dram to 2 drams for children. Is a safe medicine for delicate people, especially in pregnancy. The taste may be dis- guised by lemon-juice, peppermint-water, etc. For colic is excellent with addition of a few drops of chlorodyne. Catheter. — Should be made of soft gum elastic or indiarubber. Nos. 7 to 10 are the most useful sizes. Must be carefully washed before and after use (and a good stream of water passed through it), and also rinsed in carbolic or sublimate lotion (p. 143). Weak carbolic oil should be smeared upon the end before using. To use. — Well cleanse the end of the privates with carbolic lotion, and then pass gently and slowly into the passage until the urine flows, and when the full stream has ceased withdraw it. Keep the hand pressed upon the lower part of the belly until the instrument is removed. t 40 Medical Hints for Hot Climates. A wire is often provided inside to keep the catheter from bending. This should be taken out before using, and be cleaned before putting it back after use. Chiretta (Kreat). — Useful tonic. Boil half an ounce of the cut dried herb in water for half an hour. Dose : a wine-glassful twice daily before food. Chloral. — Used to produce sleep. If taken habitually it ruins the constitution. (No sleeping draughts should ever be taken for long, for they lose their efficacy.) Useful for bad neuralgia, delirium tremens, convulsions, nervous irritability, etc. It is better to try the effects of bromide of potassium first and, if that does not produce sleep, add 5 to 10 to 20 grains of chloral dissolved in water. (The dose of " syrup of chloral " sold by chemists is one tea-spoonful, corresponding to 10 grains.) Sulphonal (see p. 148) is a better and safer drug. Chlorodyne. — Best given in liquid form dissolved in water. Dose : 5 to 30 drops. Contains opium, chloroform, and spices. Used to relieve pain and to check diarrhoea, especially when cholera is about. The bottle should be well shaken before use. Chloroform. — Is useful to have handy, for in case of accident the doctor may not have it with him. Is used to produce insensibility by inhaling it, but requires very skilful handling, as it depresses the heart, therefore should never be administered except Description and Use of Medicines. 1 4 1 by a medical man. Chloroform water is made by adding one tea-spoonful of chloroform to a pint and half of cold water, and dissolving it by shak- ing ; it has a sweet warm taste, and is very useful in colic and dyspepsia. Dose : a wine-glassful. Cocaine. — Used for producing insensibility to pain in the eye, in wounds, and in toothache. For irritation of the eye from dust, etc., dissolve a tabloid in a few drops of water and pour them between the lids. For toothache, crush the tabloid and put the powder in the hollow of the tooth and on the gum outside. Colocynth, Hyoscyamus, and Hydrarg. Pills. — Can be obtained in "tabloid" form. Gently purga- tive. Apparently suit most people. Very useful in bilious attacks. Dover's Powder {Ipecacuanha and Opium). — Most useful for alleviating pain, and to add to quinine for ague. Also to prevent vomiting in dysentery, when ipecacuanha powder is given. Dose, 5 to 10 grains. Enema (or Clyster). — The best enema syringe is that known as " Higginson's indiarubber tube syringe;" with this, by working the ball, a con- tinuous stream can be produced. To use. — Fill the syringe with fluid, leaving the end under the surface. Oil the nozzle and gently insert it well into the back passage, and retain it there by fingers. Slowly pump in the fluid. 142 Medical Hints for Hot Climates. Composition : 1. For clearing out the rectum, (a) A pint of plain warm water, or with addition of soapsuds, or mixed with h to 1 ounce of castor oil or turpentine ; (&) Glycerine, one or two drams injected with a small syringe^ or else in form of "suppositories" made of glycerine jelly, or impromptu of cotton wool (soaked in glycerine), about size of a filbert, inserted into the rectum as far as finger can push. Acts within a few minutes. 2. For cleaning the lining of the gut. — As for chronic dysentery — sulphate of copper, 30 grains to half a pint of water, or a drachm of boric acid or chlorate of potash to the half-pint. 3. For stopping diarrhoea. — A wine-glassful of thick starch water with 30 drops of chlorodyne or tincture of opium. Galls and Opium, Ointment of. — A brown oint- ment which does not keep very well. Is a very efficacious remedy for piles when applied constantly night and morning. Ginger. — The tabloid form in 5-grain doses corre- sponds to 5 drops of the strong tincture. Dose : 5 to 20 drops in water for colic or griping pains in bowels, or with soda mint for indigestion. Hydrarg. Perchloride (" Sublimate Sfaloids")„ — Are an absolute necessity unless carbolic acid is carried. One soloid dissolved in a pint of water kills nearly all germs, and can be used as a disinfectant. Description and Use of Medicines. 143 " Sublimate soloids " must be kept safe, for if swal- lowed by mistake for sweets, poisoning will happen. Antidotes. — Emetics, raw eggs, milk ; opium to relieve pain, and brandy and water injected into rectum. For a lotion for wounds, abscesses, boils, carbuncles, etc., one soloid dissolved in a pint and a half or two pints of clean or boiled water. Ipecacuanha. — Generally used as " Ipecacuanha Wine : " dose 5 to 15 drops, to loosen " tightness of the chest " in lung affections. For children this is better than the powder; children take nearly as large a dose as adults. To produce vomiting give a tea-spoonful in half a wine-glassful of warm water, and repeat the dose every quarter of an hour til] vomiting occurs. Ipecacuanha poicdcr (tabloids of jJg grain correspond to about 2 drops of the wine). In large doses of 30 grains the powder is used for dysentery. Iron. — The principal use is to increase the colour- ing matter of the blood. Is most useful for pallor (anamria), and is usually needed for debility in combination with quinine. Blaud's pill in tabloid is the most useful form. Sulphate of Iron (Copperas or Green Vitriol ; Hera Kasees) in doses from 2 to 5 grains dissolved in water, is a powerful tonic. The bowels must be kept freely open, as iron tends to constipate. " Tincture of steel," or " solution of steel " (liquor ferri perchloridi), is a strong sherry- coloured fluid and a powerful tonic, and applied 1 44 Medical Hints for Hot Climates. to bleeding surfaces quickly arrests haBinorrhage. Dose : 10 drops dissolved in wine-glassful of water. Lead Lotion {Goulard Water. Solution of Acetate of Lead. Liquor Plumbi). — Two drams of the pharmacopoeal " Liquor " mixed with half a pint of water. Useful application to inflamed or irritable skin, as in prickly heat, sunburn, or snow-glare. It is also a good antiseptic. Made with hot water is a useful application to bruises (especially on the shin-bone) and sprains. Lime Water. — One ounce of quicklime mixed with 1 quart of cold water (boiled), cover, and after three hours the clear liquid may be poured off for use. Keep in stoppered bottle. Deteriorates with time. Dose : J to 3 ounces several times daily with milk. Helps to break up the clot of milk in the stomach. Useful in indigestion, dysentery, sprue, etc. Nitric Acid. — A strong corrosive acid. Diluted with 10 parts of water is known as Dilute Nitric Acid. Dose : 5 to 10 drops in water, with kreat, or nux vomica, or quinine. Is especially useful in chronic debility of the digestive apparatus, and after dyspepsia and bilious attacks. The stomach in health contains acid which destroys germs. Paregoric (Confound Tincture of Camphor). — Contains a small quantity of opium. Dose : 15 to 60 drops. A single dose of 60 drops in hot grog Description and Use of Medicines. 145 at night will often stave off a severe cold. Used for coughs and colds where the hacking is dis- tressing, and also where the expectoration is pro- fuse and thin. Pomegranate (Hind. Anar). — The rind of the fruit or the bark of the root is used for tapeworm, dysentery, diarrhoea, or astringent for sore throat. Is very useful for natives. To make decoction : 2 ounces of the rind or bark ; water, 2 pints ; boil down to a pint and strain. For bowel complaints, a wineglassful several times a day. For tapeworm, a pint taken during the day upon an empty stomach, and strong purge afterwards. Potassium * Bicarbonate. — Used in the same way as sodium bicarbonate, but is more powerful. Potassium Bromide. — Dose: 10 grains every four hours, or 30 grains at one dose, dissolved in water. Is a most valuable drug for reducing nervous ex- citability. In nearly all cases of brain irritation, nervousness, restlessness, insomnia, and anxiety, and often in neuralgia, great relief is secured. For insomnia, to produce sleep it should always be tried before using chloral. Is very efficacious in epilepsy. Must not be continued for more than a few days, or depression may ensue. Potassium Nitrate {Saltpetre, Hind. Shora). — Dose : 5 to 10 grains dissolved in water. Stimu- * "Potash." L 1 46 Medical Hints for Hot Climates. lates the skin and kidneys, and so cools the body. Useful in fever, inflammations, and rheumatism. Potassium Permanganate.— Two grains added to half a pint of water will make a light claret- coloured solution. Used to purify water, and as a disinfectant to remove offensive smells. As a mouth wash for offensive breath. Also in tabloids. Poultices. — Plain Poultice. — Never to be applied to a wound or inflamed surface or abscess ; mostly used for lung and belly complaints. Linseed meal is the best material ; but oatmeal, starch, bread, bran, or charcoal etc., may be used. Use boiling water ;,a* heat the basin by pouring hot water into it ; put the^F meal into the basin, gradually pour in the boiling water and beat into a thick paste ; spread the hot paste on linen. The paste should be about half an inch thick all over, and a margin of about one and a hall 1 inch should be left all round to turn up the linen over the edge of the poultice. If it has to be carried some distance, have it put between two hot plates. Antiseptic Poultice. — To the boiling water add carbolic acid in the proportion of 2 drams (2 tea- spoonfuls) to the half-pint (see p. 138) ; the process for making the " plain poultice " can then be gone through. A milder, better, and cleaner antiseptic poultice is made by applying lint soaked in hot carbolic lotion " 1 in GO " (see p. 138), and covering with Description and Use of Medicines. 14 7 mackintosh, gutta-percha, or wool, or a large leaf, to prevent evaporation and to keep in the heat. Mustard Poultice.— -Made by making a paste with mustard and water and spreading upon linen ; mustard leaves are better. Mustard may be added to plain poultices in various proportions. Children stand mustard better than adults. QUININE. Dose : 1 to 30 grains. Used in the form of " sulphate of quinine." It is insoluble in cold water, slightly soluble in alcohol or wine, but very soluble if acid be added in the form of a few grains of citric or tartaric acid, or a few drops of dilute sulphuric, hydrochloric, or nitric acid. Like all other drugs, it acts most quickly on an empty stomach, when less is required to produce 3 the same effect than a similar dose on a full stomach. It may be taken as a " powder " — mixed with food or rolled in a cigarette paper or cachet, and washed down with water, and so any objectionable taste avoided. The powder may be mixed in water or milk, and, as it is not dissolved, it will be scarcely tasted. When "dissolved" in acid or alcohol, it is extremely bitter, and so has more effect as an appetizer. Ammoniated Tincture of Quinine is a most useful remedv for ordinary " cold in the head," 148 Medical Hints for Hot Climates. especially when menthol snuff is used at the same time. It is best taken in teaspoonful closes in a small glass of wine (if mixed with water it pre- cipitates) several times a day. Quinine Wine usually contains but a very small quantity of quinine, but is a useful bitter appetizer. Uses. — In small doses 1 or 2 grains taken two or three times a day, it acts as a general tonic, wards off malaria, and is especially useful during con- valescence from severe illness. Two grains should be regularly taken every morning during residence in malarial districts, and from 10 to 30 grains should be taken during the hot stage of ague. (See Malaria, p. 33.) In typhoid, rheumatism, or other acute fevers, if the fever becomes raised above 105°, large doses of quinine should be given. For sore throat, the acid solution, mixed with chlorate of potash dissolved in water as much as the latter will take up, is a most efficient gargle. (About 4 grains of quinine to a wineglassful of solution.) For neuralgia, especially that form so often due to ague, it is almost a specific, especially when antifebrin 5 grains, or antipyrin or phenacetin, is taken at the same time. Soda Mint Tabloids. — Valuable in heart-burn and indigestion. One to three for a dose. Sulphonal. — Is the best and safest sleep-producer. Description and Use of Medicines. 149 It is nearly insoluble in water, if taken in tabloid form they should always be finely crushed. The action is slow, sleep often following on the second night. The best way to take it is to stir the powder in very hot water or milk. Being tasteless, the fine powder can be taken with the food. Dose : 10 to 30 grains. Sulphur (Hind. Gandhak). — Used for disinfection by burning it in the closed-up room. The fine powder (precipitated sulphur) made into a paste with water is a useful application to ulcerated throats, and also for foul wounds. Suppositories. — Are small cones about the size of the end of a little finger, made for insertion by the finger into the back passage. Are used — for producing a motion, and are then made of glycerine jelly, or home-made out of a piece of soap, or of wool soaked in glycerine ; or for easing pain, then con- taining opium or morphia, or for stopping diarrhoea, when they contain opium, or morphia, or lead, or tannin and various astringent substances. When used, they should be passed into the gut by the finger for a full inch and a half from the entrance, or they may not be retained. Thermometers. — Should be small, self-registering, and guaranteed to record the temperature in two minutes or under. The graduations should be plainly marked, and are more easily read if there 150 Medical Hints for Hot Climates. is a " magnifying index." The temperature is usually taken in one of two situations — in the mouth or in the bared ampit. The best plan, in order to become efficient, is to take a few lessons from the doctor or some one who understands the method. Be careful before placing the instrument in position, to thoroughly shake down the index below the " normal " mark at 98*6°. The armpit should be wiped dry, and the arm held close to the side and not exposed to draughts. It should always be washed with cold carbolic lotion after use, or disease may be conveyed upon it (hot water will crack the bulb). A slight rise of temperature is common and of little import, especially in children, but a considerably rise, 101° or 103° or more, continuing over 12 hours, generally indicates serious disease. Warburg's Tincture. — Contains quinine, aloes, opium, rhubarb, camphor, and several spices. Made into tabloid form for convenience. Is used for obstinate malarial fever (see p. 32). The bowels to be gently opened by some mild aperient, and then the drug administered in dram doses every 3 or 4 hours, but not giving more than 3 or 4 doses in the 24 hours. INDEX. PAGK Abscess 43 Accidents 113 Ague 28 Alcohol 6 Alum 135 Ammonium carbonate . . 135 chloride 135 Anaemia 44 Antimony tartrate . . . 135 Antimonial wine . . . 135 Antipyrin ...... 136 Anus, fissure of ... . 69 Apoplexy 45 Ardent fever 27 Asthma 45 Barley water 23 Bathing 8 Bedsores 119 Beef tea 22 Belly, wounds of . . . 130 Bilious attacks .... 46 Bites 119 Bladder, inflammation of 46 Blaud's pills 143 Blindness 67 Bleeding 127 Blood -spitting .... 48 Bcel fruit 136 Boils 48 Boric acid (Boracic) . . 136 , lotion 136 PAGE Brain, inflammation of . 48 , injury of ... . 82 Breasts 49 Bronchitis 50 Bruises 120 Bubo 51 Bums 121 Camphor, compound tinc- ture of 144 Carbolic oil 138 acid 137 lotion 138 Carron oil 121 Castor oil 139 Catarrh ...... 51 Catheter 139 Chest, wounds of, . . . 136 , inflammation (bron- chitis) 50 (pneumonia) ... 96 Chiretta 140 Chloral 140 Chloroform 140 Chlorodyne 110 Cholera 15, 52 Clyster (enema) . . . . 141 Cocaine 141 Cold in the head ... 51 Colic 53 , renal 85 , gall-stone .... 70 152 Index. PAGE Colocynth pills .... 141 Compression 82 Concussion 81 Condy's solution .... 146 Confinement 85 Conjunctivitis .... 66 Constipation 54 Consumption 56 Convulsions 56 Cooling drink .... 22 Cough 57 Cramps 57 Croup 57 Deafness 63 Delirium tremens ... 58 Dengue (Dandy fever) . 27 Dhobee itch 84 Diarrhoea 58, 59 , hill 103 Diet 3, 21, 22 Diphtheria 60 Disinfection 61 Dislocation ... 116-118 Doses of medicine. (See Introduction.) Dover's powder .... 141 Drowning 121 Drunkenness 83 Dysentery 62 Dyspepsia 78 Ear 63 Eczema 64 Egg-flip 24 Elephantiasis (see Fi- laeia) 69 Enema 141 Enteric fever (typhoid) . 37 Epilepsy 65 Erysipelas 65 Exercise 8 Eye 66 Face, paralysis of . . . 110 Fainting 68, 83 PACKS Farinaceous diet ... 22 Feet, sore 68 Fever 27 , ardent 27 , dengue or dandy . 27 , hectic 28 , malarial . . . 28-33 , measles 33 , rheumatic .... 34 , scarlet (scarletina) . 34 , small pox .... 35 , sun fever .... 36 ■ , typhoid 37 , tvphus 38 Filaria 68 Filters 14,69 Fissure 69 Fistula 70 Flatulence 78 Food 21 Fractures 123-127 Frost bite 70 Fruits 6 Galls ointment .... 142 Gall stones 70 Gastric fever 37 Gathering (abscess) . . 43 Ginger 142 Gonorrhoea 71 Gonorrhceal rheumatism . 99 Goulard water . . . . 144 Gout 72 Gravel 74 Guinea worm .... 74 Gumboil Ill Head injuries .... 74 Heartburn 75, 78 Haemorrhage 127 Haemorrhoids 92 Hectic fever 28 Hernia 100 Herpes 75 Higginson's syringe . . 139 Hill Sanitaria .... 17 Index. 153 PAGB Hooping cough. .... 75 Hydrocele 76 Hydrophobia 76 Hydrarg. bichlor. (or perchlor.) 142 Hyoscyamus pills . . . 139 Hysteria 77 Imperial drink .... 22 Indigestion . . . . 78, 79 Inflammation 79 Influenza 80 Insensibility 80 Insomnia 102 Ipecacuanha 143 Iron 143 Itch 84 Jaundice 84 Jellies 22 Jungle fever 31 Kidney disease and insen- sibility S3 colic 85 Labour 85 Lead lotion 144 Lime water 144 Liver 86, S7 Lockjaw (tetanus) . ._ . 106 Lotion, boric acid (bor acic) 136 , carbolic 137 , lead (goulard) . .144 , soloid 142 Lumbago Ill Malaria ... 12, 13, 28-33 Measles (morbilli) ... 33 Medicines, glasses and chests. (See Introduction.) Menstruation .... 87 Milk 21, 22 Miscarriage 88 Monthly periods .... 87 Moon-struck I") Mumps 90 PAGB Muscular rheumatism (see Lumbago) Ill Mustard poultice . . . 147 Nettle-rash 90 Neuralgia 90 Nipples 91 Nitric acid 144 Nose-bleeding .... 91 Ophthalmia C6 Opium-poisoning ... 91 Palpitation 92 Paralysis of face . . . . HO Paregoric 144 Pertussis 75 Phthisis 55 Piles 92-94 Pills 141 Plague 94,95 Pleurisy 96 Pneumonia 96 Pomegranate 145 Potassium (potash, potass.) , bicarbonate . . . 145 , bromide . . . . 145 , nitrate im , permanganate . . 146 Poultices H6 , antiseptic .... 146 , mustard .... 14<> Prickly heat 97 Quinine 147 Eabies 76 Remittent fever .... 31 Renal colic 85 Rheumatism 97-99 , gonorrhceal ... 99 , muscular (lumbago) 111 Rheumatic gout . . . . 98 Ringworm 99 Rupture (hernia) . . . 100 i54 Index. PAGE Syringe, enema .... 141 Scabies 84 Scalds »,m Scarletina 34 Scarlet fever 34 Scurvy 101 Shingles 75 Shock 81 Sickness 102 of pregnancy . . . 102 Skin peeling 102 Sleep 10 Sleeplessness 102 Slop diet 22 Smoking 12 Snake bite 110 Soda mint 148 Soloid lotion 142 Spasms 57 Sprains 128 Sprue 103 Squint 67 Steel, tincture of, . . . 141 Stings 120 Stunning (concuesion) . 81 Stye 104 Sublimate lotion .... 142 Suffocation 104 Sulphonal 148 Sulphur 149 Sun fever 36 Sunstroke 104 PAGE Suppositories 149 Syrup of Bcel fruit ... 136 , chloral 140 Teething 105 Testicle 105 Tetanus 106 Thermometers .... 147 Tongue 107 Toothache 108 Typhoid fever .... 37 Typhus 38 Ulcer 109 , varicose . . . . 109 Urticaria 90 Vaccination 18 Varicose veins .... 109 Variola (small-pox) . . 35 Warbury's tincture . . . 150 Water 15 Whooping cough ... 75 Whites 110 Whitlow , 110 Wines 7 Wind stroke 110 Worms Ill Wounds 129 of chest 130 of belly 130 LONDON: PRINTED BY WILLIAM CLOWES AND SONS, LIMITED, STAMFORD STREET AND CHARING CROSS. ™- Tabloid'— Medicine Cases, Fitted with 'Tabloid' Compressed Drugs, have formed the medical outfits of Stanley, Nansen, Jackson and all recent leading expeditions. They were also used in the recent Chitral, Ashantee and Egyptian campaigns, and extensively during the Turko-Grecian war. .In size they vary irpm small pocket cases to caravan chests. They are the most compact and complete medical outfits for tourists and travellers. The case illustrated above is the No. 17 'Tabloid' Medicine Case. Supplied by all chemists. Full particulars, illustrations, etc., from Burroughs, Wellcome & Co., LONDON and SYDNEY. F 30 'Kepler' Products, 'Kepler* Solution "AN IDEAL FORM FOR THE ADMINISTRATION OF COD LIVER OIL."— Brit. Med. Jour. Is a molecular incorporation of the finest Norwegian cod liver oil with 'Kepler* Malt Extract, which renders the assimilation of the oil easy to the most delicate* In flavour 'Kepler* Solution is like sweet cream.«£* <£ In small and large bottles. 'Kepler* — > Malt Extract Is the unsophisticated product of the finest winter-malted barley prepared by a special process. It is rich in diastase, maltose, dextrins and phosphates, and is of supreme value as a food and as a digester of foods. <£ In small and large bottles. OF ALL CHEMISTS. Burroughs Wellcome & Co., LONDON and SYDNEY. F 3' The Perfected Wyeth Beef Juice. Is of real nutritive value in sickness, convalescence, and general debility. It differs from stimulating extracts in that it contains the entire nutritious albuminous constituents of beef in an unaltered, soluble and palatable form. Hazelime, 9 '9 A Pure Drug. Is prepared from the fresh leaves and twigs of the witch hazel. It retains the full anodyne, styptic and astrin= gent principles of the plant of which it is the most active and agreeable preparation. Jt <>& <£