In this day of compact pharmaceuticals one can carry a complete equipment of medicines in a vest pocket almost. The old day of ponderous powders and nauseating liquids has passed. The physician now who prescribes for his patients immense bottles of "shotgun" mixtures writes himself down a back number. This manner of administering drugs can be taken advantage of by the man who wishes to carry with him upon his outing a supply of remedies for the relief of such ailments as may befall him.

Oliver Wendell Holmes once said in delivering an address to the graduating medical class of Harvard, "Young men, you have been taught here at least twenty remedies for every disease; after you have practiced medicine twenty years you will have one remedy for twenty diseases."

The genial autocrat was nearly right. The longer one continues in the practice of medicine, the fewer remedies he learns to depend upon. An Irish medical friend of mine once put the thing in very apt form when he said, "If I had to practice medicine on an island where I could have only three remedies, I should choose castor oil, opium, and strychnia. I'd physic them with the castor oil, constipate them with the opium, and stimulate them with the strychnia."

These remarks are a little beside the subject, but I am constrained to quote them to illustrate that but few medicines are needed, if these be well understood, and the indications for their use can be mastered by anyone in a short time.

For the past several years my emergency medical case has contained only ten remedies, and with these I have not hesitated to make professional trips of many miles. The case should be made of sole leather with a pocket for a small note book and loops for a clinical thermometer. The bottles should hold half an ounce and have screw caps. Have the glazier etch with his diamond the numbers from 1 to 10 on the sides of the bottles. The reason for this is that numbers pasted on are liable to rub off, and as many tablets look much alike confusion may occur. Then fill them in this manner:

• No. 1: Calomel, gr. 1/4. Make this entry in the little note book that is contained in the pocket. "No. 1, calomel gr. 1/4. Dose, one tablet every thirty minutes for four hours. Indications, biliousness, headache from disordered stomach, diarrhea, colds, and the beginning of all fevers."
• No. 2: Dosimetric trinity (Full strength). Dose, one granule every half hour until skin becomes moist. Indications, all fevers, colds, threatened pneumonia, and threatened typhoid.
• No. 3: Chlorodyne. Dose, one tablet every hour to relief. Indications, any gastric pain, cramps, diarrhea (after cleaning out the bowels), colic, acute indigestion.
• No. 4: Intestinal antiseptic. Dose, one tablet every hour for four hours; then one every three hours. Indications, after bowels have been cleaned out to correct any disorder of the tract, as a routine treatment of typhoid; always valuable in diarrhea and other inflammatory conditions of the bowels.
• No. 5: Quinine sulphate, gr. 5. Dose, one tablet every four hours. Indications, colds and catarrh, bilious fevers, specific in malaria.
• No. 6: Elaterin, gr. 1/16. Dose, one tablet. Indications, to remove all fermenting food matters in the stomach and bowels, produces excessive watery evacuations. Valuable in dropsy; especially applicable where you want to get rid of the entire contents of the bowels.
• No. 7: Phenacetine, gr. 5. Dose, one tablet every three hours to profuse perspiration. Indications, reduce fever where pulse is full and bounding. Relieves headache; taken early cures severe cold.
• No. 8: Sun Cholera. Dose, one every three hours. Indications, similar to No. 3, only more powerful, valuable in severe summer complaint due to eating fresh fruit, meat, drinking too much water. Relieves gastric pain.
• No. 9: Apomorphia hydrochlorate, gr. 1/10. Dose, two tablets followed by swallow of hot water. Indications, as an emetic in poisoning. Use cautiously.
• No. 10: Digitalin, gr. 1/100. Dose, one tablet every hour to effect. Indications, the most powerful heart tonic and reconstructive. Must be used cautiously. Valuable in loss of blood, excessive heart action from altitude, and all conditions where heart is not performing properly.

It will be noted that I did not mention morphine, strychnia, or cocaine, as they were spoken of in connection with the hypodermic. In the case I also place a one-minute clinical thermometer. All of these instruments are now made self-registering and must be shaken down after each using. This should be done, not by a jar, but with a long sweep of the arm. Too sudden a jar will snap the instrument in two. Shake until the mercury column stands below the ? mark. This ? mark indicates the body heat at normal condition, that is, 98.4° F.

Every man should familiarize himself with certain physiological facts, and with these as guideposts he ought to be able to follow a train of indications to a reasonably fair diagnosis. The pulse rate, taken at the wrist, is generally a fair index of the condition of the body. The normal man has a pulse rate of about seventy-two beats per minute, women somewhat more rapid; high elevations also produce a more rapid pulse.

If there is an increase of heart beat above eighty per minute, accompanied by other subjective symptoms, it is an indication that something is wrong. In the absence of a clinical thermometer, one can arrive at a pretty fair knowledge of the body heat by counting the pulse. It is estimated that there will be an elevation of one degree F. for every ten beats above the normal. This rule varies, but is a fair average.

The appearance of the tongue is a valuable signpost, but one that is difficult of mastery. A few prominent indications will be noted. A thin, white, even furring of the tongue is indicative of gastric disturbances and mild fever states. A flabby, swollen, indented tongue covered with a uniform yellow, pasty fur is indicative of profound gastric states and gastro-duodenitis; it may also be produced by a continued moderate fever.

A narrow tongue, with deep median fissure on each side of which is a thick rough fur, the tip and edges being red and denuded, is characteristic of typhoid states whether arising from typhoid or not. The same condition will be found in profound intoxication from septic poisons. If the tongue becomes dry and brown, tremulous when protruded, and the patient returns it slowly when requested to do so, he has typhoid beyond question. A brown fur on the root of the tongue, especially in the morning, indicates a sluggish condition of the liver. In jaundice the tongue is yellow.

It is estimated that the normal man in a state of rest will breathe sixteen times per minute. Any radical departure from the rate will indicate disease. An increase of two respirations per minute is supposed to indicate a rise of one degree F. in the body temperature, though this rule is subject to variations. Inspection of the bare chest tells the trained physician much regarding the condition of his patient and even the layman can glean much knowledge from that source.

If the patient is breathing from twenty-five to thirty-five times per minute, the respiration being confined to one lung as indicated by the lack of expansion in the other, and if he lies so as to take the strain off the lung that does not expand, it is almost sure that the patient has pneumonia. In case the lung is fixed rigidly by the muscles and the opposite lung forced to do all the work, then the patient has pleurisy.

In profound typhoid states the breathing is very much slowed and irregular, at last presenting what is known as the Cheyne-Stokes respiration, in which the patient will breathe several short shallow respirations, pause for a time, heave a deep sigh and then repeat the rapid breathing. This type of breathing is looked upon as a very grave symptom in all conditions characterized by lack of physical strength.

It will be readily appreciated that only enough discussion of symptoms has been given above to aid somewhat in arriving at a diagnosis. To go deeply into physical indications of diseases would be manifestly out of place in an article of this character. We will now proceed to the consideration of the diseases that will be most frequently encountered in the camp. Of these the intestinal troubles stand pre-eminent. Change of water, food, methods of life, and personal habits account for the fact that nearly every person who seeks the outdoors at some time during his stay is afflicted with some one of the diarrheas. Without attempting to go deeply into the various classifications of the enteric complaints, a brief rÉsumÉ of the guiding symptoms common to all will be given.

It matters very little so far as the treatment is concerned whether it be an ileo-colitis, an ileitis, or simply colitis. The same treatment would obtain in each case, and the same general trend of symptoms would be present. The patient feels a general indisposition, loss of appetite, headache, and sleeplessness, which is followed by pain and griping in the bowels; then comes the diarrhea, which may be profuse and watery or scanty and accompanied by much pain. The evacuations become exceedingly frequent, sometimes as many as fifty or sixty per day.

The patient vomits frequently and is quite ill, his face becomes pinched and dusky, with an anxious look in the eyes. There is some fever and thirst, though the water drunk is generally vomited. In the above has been pictured an extreme case of summer diarrhea. There will be all gradations below this, from a mere soreness of the abdomen and looseness of the bowels up to profound prostration from constant drain on the system induced by the evacuations.

By a sort of strange medical paradox, in order to stop the evacuations it becomes necessary to increase them. We must sweep out the nest of troublesome bacteria that are causing the disturbance. An ordinary cathartic will not accomplish this. It is necessary to administer something that will produce a profuse watery discharge from the bowels. Nothing accomplishes this better than a heaping tablespoonful of Epsom salts in hot water, but as we have not provided for such bulky medicines in our case we will give our patient one tablet of elaterin which will accomplish the same purpose.

Then, too, the patient is not nearly so liable to vomit the elaterin. If he does, however, the vomiting can be controlled by the administration of cocaine by the mouth, though this latter drug must be used very cautiously. A tablet of 1/4 gr. cocaine hydrochlorate given in a swallow of hot water will stop vomiting until the other remedies can produce their effect. Before giving any other medicines await the free action of the cathartic.

The patient should have at least three very copious discharges; then begin to combat the inflammatory condition that exists in the bowels. The chlorodyne tablet will in all ordinary cases, do this best of all your remedies. There will be some few instances where it will be necessary to resort to more powerful remedies; in that case the Sun Cholera tablet given according to directions is the best. As an after treatment in these cases the intestinal antiseptic gives the best results. A tablet every four hours for two days will annihilate every vestige of bacterial invasion that may remain.

Bronchial and pulmonary diseases supply a large percentage of the camp ailments in the fall and early winter during the deer hunting season. An attack of pneumonia following a severe drenching from being out all day in a rain, or accidentally tumbling into the creek, is not a pleasant thing to contemplate. It usually comes in the night. The patient wakes out of a sound sleep with a chill. There is a sharp sticking pain as though a knife were being thrust between the ribs, at some point on the chest wall. The breath comes in short gasps and the patient instinctively turns toward the affected side in order to ease the pain.

The chill may or may not be followed by vomiting, and the fever lights up immediately, rising to 102–4° F. A distressing short cough comes along to add to the discomfort as each act of coughing increases the pain in the chest. In less than twenty-four hours the patient begins to expectorate what we call "prune-juice" mucus, that is, mucus streaked with blood until it resembles the juice of cooked prunes. When you see this "prune-juice" you need have no doubt as to the diagnosis. You should, however, have been busy long before this.

There is no doubt now among educated physicians that pneumonia, taken in time, can be aborted. When the pain first manifests itself set somebody to baking hot cakes made from flour stirred with water. While these are still as hot as can be borne lay them over the painful spot on the lung, renewing as fast as they become cool. To accomplish much good this treatment must be kept up until the period of expectoration and even after, at least twenty-four hours. At the same time begin by administering calomel in 1/4 gr. doses every thirty minutes until at least three grains have been given.

Two hours after the last tablet of calomel has been given, give a tablet of elaterin. When the latter has "worked," start in with the dosimetric trinity tablets and push them until the skin becomes moist and the fever falls below 100° F. Do not give any of the coal tar products in pneumonia, that is, do not give phenacetine or acetanilide. When the patient is recovering it is well to keep up the heart by strychnia or digitalin.

There is such a thing as giving too much of these heart stimulants though, and you should watch the pulse closely. Stimulating the heart too greatly is liable to cause congestion of the small blood vessels in the lungs and defeat the very purpose you set out to accomplish.

Taking "cold" is a very popular camp method of feeling bad. The man who does not at least once, while in camp, stuff himself full of a good old-fashioned "cold" feels that he has been cheated out of a part of the enjoyment of his outing. For the benefit of those of his companions who do not appreciate his "barking" in season and out, the following rules are suggested: First, take a bath; it may be painful but necessary. Second, assist overworked eliminants to remove the debris that has accumulated by reason of the failure of the ordinary processes of waste removal.

This can be done very nicely with a heroic dose of calomel; by heroic about three grains is meant. Follow up the calomel with several five-grain doses of phenacetine, or until the patient is in a profuse perspiration, roll him in warm blankets, and await developments. A careful observance of the foregoing will annihilate any able-bodied "cold" on earth.

The man who contracts rheumatism in camp has my sincere sympathy. It requires no special skill to tell when one has it, but it does require special powers of divination to tell when he will get rid of it. Medical science has discovered only one drug that will affect the progress of the disease in the least, and that only after an extended course. Salicylic acid in one or another of its various combinations furnishes the sheet anchor in the treatment of rheumatism. I purposely omitted it from our pocket case of drugs because of the fact that the combination that would suit one man's stomach would not another.

In practice we have to take many things into consideration in the administration of the salicylates. The man with rheumatism in camp can seek only to relieve the pain and assist Nature to eliminate the waste. A thorough flushing of the bowels should be the first thing, followed by aconitine, gr. 1/134, one tablet every hour for four hours; then one every three hours. At the same time keep dry. If it be a limb that is affected wrap it in blankets and "cook" it in front of the fire.

Cases of poisoning arising in camp will usually be confined to two causes—the eating of poisoned foods and eating poisonous mushrooms. In these days of tinned meats and vegetables it is not unusual to hear of persons becoming seriously and even fatally poisoned by eating certain canned goods. Canned fish and beef are the worst offenders in this regard.

The symptoms of ptomaine poisoning are characteristic and generally easily traced to the material producing them. There is a dryness and metallic taste in the mouth shortly after eating suspected food. This is followed by severe cramps, vomiting, violent purging, rapid loss of strength, great depression and coldness of the surface of the body. The hands and face break out in clammy sweat and the temperature falls below normal. The picture is very characteristic and when once seen is readily recognized.

The treatment consists in getting rid of the offending substance as quickly as possible. Nothing accomplishes this more readily than a quick emetic. Apomorphia hydrochlorate furnishes us with the most convenient emetic, though mustard water or hot salt water will do. Take a tablet of 1/10 gr. apomorphia hypodermically, or two tablets of the same size by the mouth, followed by a swallow of hot water. Hypodermically the emetic acts in a very short time; by the mouth it requires somewhat longer, say ten minutes. Purge the bowels with elaterin, one tablet, then keep up the vital forces by administering strychnia, 1/60 gr. every hour or two, watching the circulation meanwhile.

In severe cases, in addition to the strychnia, it may become necessary to resort to external heat, hot water bottles, hot stones, etc. The patient is much debilitated for several days and requires careful diet.

Mushrooms should never be eaten unless the person gathering them is known to be thoroughly conversant with the different varieties. Certain poisonous varieties resemble the edible so closely that only an expert can tell the difference. The knowledge, however, is one that every hunter and camper should familiarize himself with as mushrooms are usually plenty in the hills and furnish an agreeable addition to the menu.

Phalline, the toxic principle of the phalloidÆ group of mushrooms, is a toxalbumin of extreme violence and resembles very much the toxic albuminose of rattlesnake virus; in fact, it seems to act upon the digestion very much as crotalin does upon the circulation. There is another toxic principle present in certain other varieties of fungi called muscarine; both these poisons act very similarly.

The symptoms are a feeling of giddiness coming on from one hour to fifteen hours after eating the fungus. This is followed by profuse salivation, the water running out of the patient's mouth in a stream. Blindness ensues, and vomiting and diarrhea come in their train. The heart is weakened and the patient breathes with difficulty. At the last he lies in a stupor.

The treatment is similar to that of ptomaine poisoning. Remove the offending material at once by the same process. For a purgative oleaginous agents are the best if available, castor oil being preferable; failing in that any active cathartic will do. The heart then must be stimulated by the digitalin; strychnia also plays a prominent role here.

It had not been my intention to mention typhoid, but upon reflection I have decided to include it. Typhoid fever is little liable to attack people living under such conditions as exist in the mountains where the air is pure, the water comes from eternal springs, and flies are few. Summer camps along lake shores and the larger, slow-moving streams are liable to it, and it is just as well to recognize it when it arrives.

The person about to come down with typhoid generally feels extremely tired for several days, the head and back ache, the nose frequently bleeds slightly, a rumbling is present in the right side just below the ribs, and the ears rings as though one had taken an overdose of quinine. The tongue is characteristic of the disease, so much so, in fact, that we speak of a particular condition as the "typhoid tongue."

After a few days the patient begins to feel feverish. All the symptoms increase until he is quite ill and takes to his bed. About this time tiny red spots called "rose spots" appear on the abdomen, perhaps only a few, again they are quite frequent. The mind becomes dull and the hearing imperfect.

Typhoid is said to be a self-limiting disease, that is, it cannot be cut short or aborted in any way. That, however, is hardly the case. By vigorous treatment, at the outset, it is now thought by a great many that the disease can be limited to a few days. If the treatment is not begun early and carried out, the disease will run a course of some twenty-one days.

The treatment consists in eradicating the nest of typhoid bacillus that is setting up the disturbance. Here, again, we resort to calomel. Four grains given in quarter-grain doses every half hour will usually produce sufficiently free passages. After this administer the intestinal antiseptic religiously, with aconitine for the fever. Give plenty of water to drink and restrict the diet. If the disease gets beyond control, the routine treatment is the intestinal antiseptic.

Cold packs for the fever, in the later stages of the disease, will be found preferable to any medicines. All the time the diet should be watched. No solid foods should be allowed. Milk, light broths, fruit juices, and rice water supply sufficient nourishment and do not irritate the tender glands of Peyer and Brunner that are the seat of the disease. These glands become very friable in typhoid, and any violent action of the walls of the intestines, as in digesting food, will cause them to break through and permit the bowel contents to enter the general peritoneal cavity, when the patient will die from inflammation of the bowels.

SERPENT WOUNDS AND THEIR
TREATMENT