Illustration: Fig. 1. False Membrane in Croup. From a specimen in Dr. Gross' cabinet.
Fig. 1. False Membrane in Croup. From a specimen in Dr. Gross' cabinet.

Every family should be made acquainted with the symptoms and treatment of this disease. Especially is this true in the case of those living remote from a physician. From the lack of this knowledge on the part of parents, many a little one has perished before medical assistance could be obtained. In some of its forms its progress is very rapid, and, unless relief is obtained in a few moments, or hours at the most, death ensues.

There are several quite distinct pathological conditions of the vocal and respiratory organs which have, in popular parlance, been designated as croup. But two of these are worthy of consideration here. These are true or membranous croup, in which a false, semi-organized membrane is formed, and spasmodic croup. Both may result fatally, but the former is much the more dangerous.

Membranous Croup is supposed to originate in the trachea, from which, as it progresses, it often extends upward to the larynx, and downward to the bronchial tubes. It is the result of severe inflammation of the mucous membrane, and is characterized by the formation of a false membrane, which covers or lines the inner surface of the true structure (see Fig. 1). It is formed of a coagulable, semi-fluid exudation from the mucous membrane. On being brought to the surface and into contact with the inspired air, this substance grows thick and tough, or leathery, as we find it. It is the obstruction in the respiratory canal which this foreign matter causes that gives rise to the labored breathing, and the ringing, brassy cough, together with the crowing or whistling inspiration characteristic of croup. Before recovery can take place this membrane must be detached and expelled. The cough is nature's effort to accomplish this work.

The formation of this adventitious membrane in the larynx is attended with more danger than when it is confined to the trachea. In most cases in which the disease has had a very speedily fatal termination, an examination has shown that the larynx was its chief seat.

Symptoms. True croup is generally preceded by what is known as "a cold." The child coughs, sneezes, and is hoarse. It is the hoarseness and the peculiar character of the cough which indicate the tendency to croup. This has been already described. In addition, the child is restless, fretful and feverish. The disease makes rapid strides. Finally the cough ceases to be loud and barking, and is very much suppressed; the voice is almost gone; the face is very pale; the head thrown back; the nostrils dilated and in perpetual motion, the pulse at the wrist very feeble, great exhaustion, more or less delirium, and, finally, death comes to the relief of the little sufferer. Convulsions sometimes occur in the last stages, and soon terminate fatally.

Treatment. No time should be lost in commencing treatment. Hot fomentations should be applied to the throat and upper portions of the chest. The free inhalation of steam should be employed early. The following treatment has been found very effectual in membranous croup, and is recommended by the highest authorities: Yellow subsulphate of mercury, or turpeth mineral, three to five grains, depending upon the age of the child, for one dose. If it does not cause vomiting in fifteen minutes, give a second dose. This, however, is seldom necessary. If the turpeth mineral cannot be obtained, sulphate of copper or sulphate of zinc may be given instead, as directed under the head of Emetics, in Part III, Chapter II. If there be a quick pulse, hot skin, a hurried breathing, and an occasional ringing cough, the child should be kept in bed, comfortably covered, but not overloaded with clothes, and the tincture or fluid extract of veratrum viride administered as follows: Take fluid extract of veratrum, five drops; sweet spirits of nitre, one teaspoonful; pure water, twenty teaspoonfuls; mix, sweeten with white sugar, and give a teaspoonful of the mixture every half-hour to two hours, according to the age of the child and the severity of the case. If there be great prostration, with cold extremities, the carbonate of ammonia should be administered, in doses of from one to two grains, every second hour, in gum arabic mucilage. Quinine is a valuable remedy, and is tolerated in large doses. The patient's body should be frequently sponged with warm water in which a sufficient quantity of saleratus or ordinary baking-soda has been dissolved to render it quite strongly alkaline. If the bowels be constipated they should be moved by an injection of starch-water. Beef tea and other concentrated, supporting diet should be administrated. In those cases in which there is a tendency to croup, the Golden Medical Discovery, together with iron and the bitter tonics, should be given to build up the system and counteract such tendency. The treatment which we have advised has been put to the severest tests in the most severe forms of the disease, and has resulted most successfully. If, however, in any case it does not give prompt relief, our advice is to lose no time in summoning a physician who is known to be skilled in the treatment of diseases of children.

Spasmodic Croup. In this affection no false membrane is formed. It seems to have a nervous origin. Most frequently the child is awakened in the night by a sense of suffocation. He may cry out that he is choking. The countenance is livid, the breathing is hurried and each respiration is attended by a crowing sound. The child has fits of coughing or crying, and makes vehement struggles to recover his breath. This complaint, unlike croup, is unattended by fever, it being of a purely spasmodic character with no inflammation.

Apply hot fomentations to the throat, and give frequent small doses of tincture or fluid extract or syrup of lobelia, to produce slight nausea; or, better still, an acetic syrup of blood-root, made by adding one teaspoonful of the crushed or powdered root to one gill of vinegar and four teaspoonfuls of white sugar. Heat this mixture to the boiling point, strain, and administer from one-fourth to one teaspoonful every half-hour or hour. Slight nausea should be kept up, but it is unnecessary to produce vomiting. This is usually all the treatment that is required.

WHOOPING-COUGH. (PERTUSSIS.)

This is primarily a disease of the nervous system, involving the respiratory organs through the medium of the pneumogastric nerve. It is considered a disease of childhood, though we have met with it in old age. It is eminently a contagious affection, and occurs generally but once during life.

Symptoms. It is at first manifested by a catarrhal cough, gradually developed. After a while it becomes paroxysmal, generally worse at night. The cough is severe, and long-continued; when a prolonged inspiration occurs, it is accompanied by a peculiar shrill sound, the characteristic whoop, which, when once heard, is never forgotten. The cough is attended by a copious secretion of glairy mucus, which is brought up at the latter part of the paroxysm. During, or at the end of the paroxysm, vomiting frequently occurs, and sometimes nosebleed. The cough is so severe at times, that the patient turns purple, gasps for breath, and presents all the symptoms of suffocation. Bronchitis sometimes is a troublesome complication. Immediately preceding a paroxysm of coughing a sense of impending danger appears to seize the child, and it runs to its mother, or grasps some support, as if for protection. Until the paroxysmal character and peculiar whoop is developed, the disease is diagnosed with difficulty.

Treatment. We have found the Golden Medical Discovery to modify the disease and cut it short. The philosophy of its action can be readily understood by its effect on the pneumogastric nerve, as explained under consumption and bronchitis. Jaborandi, described under the head of diaphoretics, often speedily arrests this disease. The employment of an infusion of red clover blossoms, in small doses, is of undoubted value in modifying the irritation of the air-passages, and may be used to good advantage with, or in alternation with the Golden Medical Discovery. Exposure to cold and wet should be avoided.

NOSEBLEED.

Hemorrhage from the nose is commonly the result either of a catarrhal or an inflammatory condition of the nasal mucous membrane. Individuals are susceptible to it who are oppressed by fever or constitutional diseases that reduce the strength. There is also a condition of the nervous system in which there is congestion of the nerve centres which favors manifestations of this somewhat troublesome difficulty.

Causes. In some instances an examination of the nose will reveal the presence of a small point of congested vessels, usually about the size of a split pea. Upon this portion of the mucous membrane small scabs form, and at any time when they may be dislodged, by accident or otherwise, a hemorrhage will ensue.

The constitutional conditions that produce the tendency to hemorrhage are most important. In individuals of a debilitated condition, it results from the lack of a proper amount of fibrin in the blood. Where the blood becomes thin, or loses a large share of its red corpuscles, the individual is pale, and hemorrhages are frequent from the mucous surfaces of any portion of the body, the nasal mucous surface being especially liable to such attacks.

Treatment. This is local and constitutional. Where there is constitutional imperfection, it should be remedied. Usually in young women there is some difficulty with the ovarian or uterine circulation, and the attack of hemorrhage from the nose is reflex in its character, appearing just before or at the time of the menstrual flow, accompanied with troublesome headache. The correction of this form is by the use of the "Favorite Prescription" and "Golden Medical Discovery," using of each a teaspoonful three times a day, taking the "Prescription" before meals and the "Discovery" after meals. If the bowels are constipated, the "Pellets" should be employed, in order to overcome any congestion of the liver which favors the manifestation of nosebleed. In children there is usually a debilitated state of the system, which is best remedied by the use of a half teaspoonful dose of the "Discovery," taken three times a day, after meals, with sweetened water. This treatment should be continued for a month or six weeks. By this means the blood-making organs rapidly improve in their activity and functions, the blood becomes rich in corpuscles and fibrin, thus strengthening the walls of the blood-vessels and tending to prevent a hemorrhage following undue excitement or injury. With men the use of laxatives is of great importance. One or more of the "Pellets," taken on retiring at night, are most beneficial. Where the blood is not up to the standard of purity, even though the individual be fleshy, the "Discovery" should be used, a teaspoonful or two, three times a day, after meals, in conjunction with plenty of outdoor exercise and the best of food. Where the hemorrhages occur in those having too much blood, the diet must be corrected by the use of vegetables and fruit, diminishing the amount of meat and pastries to a minimum. The amount of fibrin should also be increased by the use of the "Golden Medical Discovery."

Local Treatment. Of those applied directly to the membrane, Dr. Sage's Catarrh Remedy, used according to the directions which wrap the bottle, is excellent in bringing about a normal condition of the mucous surfaces. Following this, a small amount of Subnitrate of Bismuth may be snuffed into each nostril. Usually the amount required to cover a three-cent silver piece is sufficient. The powder dries the surface and favors the speedy formation of a coagulum, or clotted covering, which effectually checks any further hemorrhage. The application of a firm compress to the upper lip will also diminish the flow of blood through the arteries that run to the anterior portion of the mucous surface. Good effects often follow the use of a small piece of ice applied to the nape of the neck. This, with a reclining posture, will cause contraction of the blood-vessels. If the Subnitrate of Bismuth is not to be readily obtained, the use of any other powder such as starch, finely divided and baked so as to be free from a tendency to form starch paste when applied to a mucous surface, is equally good. Well-browned flour is also serviceable. The use of the contents of a puff-ball, which contains many millions of fine spores, has been employed from time immemorial. The use of such drying powders tends to favor the speedy formation of clots. Where the small points of engorged vessels are to be readily reached, use a solution of the Tincture of Chloride of Iron, one part in four of water, applying with a small pledget of soft cotton wrapped about, or fastened to, the end of a pencil or stick. In this way the solution may be applied in very small amount to the spot where the hemorrhage appears, and will give immunity from future attacks. Any of the styptics (see pages 320-325) can be called into service. Those who have the advantage of the city drug store may use a solution of basic ferric sulphate (Monsell's solution), or the spray of a three or four per cent. solution of cocaine. The latter is one of the most pleasant and effective remedies in these emergencies. Before its administration the nasal cavity should be cleansed by snuffing up the nostrils salt and warm water. When washed, immediately apply the spray. If the constitutional condition which led to the hemorrhage continues, the general remedies—of which the "Golden Medical Discovery" is the most efficacious—should be administered. This agent increases the number of red blood corpuscles, and enriches the blood in fibrin, so that the relief obtained is absolutely permanent.

INFLAMMATION OF THE STOMACH. (GASTRITIS.)

Gastritis is generally defined as an inflammation of the mucous membrane of the stomach. However, the cellular, muscular, and serous tissues are all liable to be more or less affected. Gastritis may be either acute or chronic. Either form is a distinct modification of disease, manifesting peculiar symptoms and requiring special remedies.

Acute Gastritis generally occurs as a result or complication of other diseases. It is an occasional feature In scarlatina, serious cases of bilious fever, and in cutaneous affections of every description. The mucous membrane of the stomach is placed in intimate communication with all the vital organs, by means of the nerves of the solar-plexus, hence the sympathy between the stomach and skin, and the morbid condition of the stomach occasioned by disease of other organs.

The Early Symptoms of acute gastritis are a burning sensation in the stomach, accompanied by nausea and frequent vomiting. The respiratory movements are rapid and shallow, the pulse is hard and short, and as the disease progresses, becomes small, frequent, and thready. The tongue usually retains its natural appearance, but it is sometimes dry and tinged with a vivid scarlet at the tip and edges. Intense thirst and hiccough are occasional symptoms. The facial expression is haggard, and indicative of the most intense suffering. The stomach will not retain the mildest liquids. In the early stages of the disease, the ejections consist of chyme and mucus, streaked with blood. As it progresses, the vomiting becomes a sort of regurgitation, the contents of the stomach being ejected without any apparent nausea or effort. The ejections then consist of a dark-colored granular matter, resembling what is known in yellow fever as black-vomit.

Causes. Formerly it was supposed that this was a very common disorder, and the term acute gastritis was applied to every development of symptomatic fever. But late clinical and pathological investigations clearly indicate that acute gastritis is of rare occurrence. It may be caused by the excessive and habitual use of alcoholic drinks, especially if taken without food, by copious draughts of cold water, or by intense emotions. But its general cause is the ingestion of irritating and corrosive poisons.

Where the former causes are known not to exist, the presence of poison should always be suspected. As the cause sometimes becomes a matter of legal investigation, it is very important that the practitioner should be able to determine the real origin. If caused by poison, the disease is very suddenly developed, the patient complaining of a very intense burning sensation in the throat and the lining membrane of the mouth, which will generally show the action of the poison. A diarrhea is also more apt to accompany the disease. If inorganic or vegetable poisons are known or suspected irritants, the appropriate antidotes should be promptly administered. For a list of the principal poisons and their antidotes, with practical suggestions for treatment, the reader is referred to the article in this volume, on Accidents and Emergencies.

Treatment. The inflammation should be allayed, and a tea made of peach-tree leaves is very serviceable. Small pieces of ice, swallowed, will generally allay the thirst and vomiting, and a mucilage of slippery-elm is very soothing to the inflamed mucous membrane. This is an important disease, and its management should be entrusted to a skillful physician.

CHRONIC INFLAMMATION OF THE STOMACH.

Chronic Gastritis is sometimes mistaken for dyspepsia or gastralgia. It is very necessary to discriminate between these diseases, as the appropriate remedies of the latter will often only aggravate and augment the former.

A chronic inflammation of the stomach is a very common affection and has many phases, but the term chronic gastritis is applied only to that species of inflammation occasioned and accompanied by irritation. It is seldom a result of the acute form.

The Symptoms of chronic gastritis are various and sometimes vague. Among those which are prominent we may mention an irregular appetite. At times it is voracious and the patient will consume every available article of diet, while at others he will experience nausea and disgust at the sight of food. Even when very hungry, one mouthful of food will sometimes produce satiety and cause vomiting. The appearance of the tongue is variable, sometimes natural, at others thickly coated. The desire for drink is capricious, varying from intense thirst to indifference. Another prominent symptom is a sense of heaviness and heat in the epigastric region, after partaking of food. Often a small quantity, as a teaspoonful of milk, will produce a sensation of weight, as a heavy ball lying at the pit of the stomach. This symptom is frequently accompanied by a frontal headache, and a small and wiry pulse. Dull or shooting pains are experienced in the stomach and between the shoulders, and the patient becomes weary, melancholy, and emaciated.

Causes. The general cause of chronic gastritis is excess in eating or drinking, and the use of alcoholic liquors. We have known it to be produced by drinking hard cider. Great mental excitement predisposes the system to this affection. Occasionally it is a result of febrile diseases, as scarlatina, typhoid fever, etc. In some families there is a constitutional tendency to its development.

Treatment. All medicines which tend to irritate the stomach, should be studiously avoided. The bowels should be kept regular, and the skin clean by frequent bathing. Stimulants of all kinds must be avoided. As a principle article of diet, we would recommend milk and farinaceous articles. If these precautions be observed, nature will sometimes effect a cure. Lime water and the subnitrate of bismuth, in twenty-grain doses three or four times a day, are useful to allay irritation. Other suggestions applicable to its domestic management, maybe found under the hygienic and medicinal treatment of dyspepsia, to which we refer the reader.

NEURALGIA OF THE STOMACH. (GASTRALGIA.)

Gastralgia is a neuralgic affection of the stomach, unaccompanied by inflammation. It is sometimes mistaken for chronic gastritis, although there is a marked difference in the symptoms.

A Prominent Symptom of Gastralgia is a paroxysmal pain radiating from the epigastric region, to all parts of the thoracic cavity. The pain is sometimes lessened by walking, lying on left side, or by gentle pressure, and usually abates after eating, but is renewed in a few hours. The patient occasionally experiences a sense of heaviness at the pit of the stomach, nausea, and frequent salty eructations. The tongue is white, the appetite variable, and there is no desire for liquids. The sleep is usually refreshing, and when not suffering from acute pain, the patient is apparently well.

The distinguishing symptom of this disease is a feeling of intense despondency, and, sometimes, a morbid fear of death.

An effectual method of distinguishing between gastralgia and chronic gastritis is by the administration of an alcoholic stimulant. If gastritis be the affection the pain will be augmented; whereas, if it be gastralgia, it will be relieved.

Cause. The cause of gastralgia is a local or sympathetic irritation of the nerves distributed to the stomach.

Treatment. The pain of gastralgia is sometimes allayed by using half a teaspoonful of subcarbonate of bismuth, and repeating the dose, if the attack is not relieved. The following is a very effectual remedy: take twenty grains of quinine, combined with one drachm of prussiate of iron, and divide it into ten powders, and administer a powder every three hours until the pain is completely arrested. Temporary relief may be given by administering one-quarter of a grain of morphine, or ten to twenty drops of chloroform in a teaspoonful of glycerine, slightly diluted, taken in one dose. One of the most effective remedies for preventing a return of the attacks is that invigorating tonic and alterative, the "Golden Medical Discovery." The patient should be careful in diet, and not eat too much food, which should not only be of a nutritious kind, but easy of digestion. Cleanliness, suitable clothing, bodily warmth, exercise, and rest must not be neglected. Sometimes it is lingering and requires long persistence in hygienic and medicinal treatment. Everything tending to promote the tone of the digestive organs, and improve the functions of the system generally may be considered advantageous in this neuralgic affection.

PERITONITIS.

The peritoneum, or serous membrane which lines the abdominal cavity and invests the intestines, is liable to become inflamed. When this occurs, the affection is termed peritonitis, and may be divided into the acute and chronic forms.

Acute Peritonitis. This form may be circumscribed; that is, confined to one spot, or it may extend over the entire surface of the peritoneum, when it is known as general.

Symptoms. There is headache, quick pulse, tongue coated white, countenance pallid, features pinched, respiration difficult, nausea and vomiting, severe pain in the abdomen, which is extremely sensitive to pressure and becomes very much distended. There is also pain in the limbs, the bowels are constipated, and, in exceptional cases, diarrhea is a prominent symptom. The urine is deficient in quantity, and there is sleeplessness, chilliness, and great general prostration. Vomiting and coughing or sneezing increase the pain. An erect position occasions intense suffering. The patient is compelled to assume a recumbent posture and is inclined to lie on the back, for in that position the sufferer experiences the least pressure of the vital organs against the peritoneum. There is also an inclination to draw up the lower limbs and retain them in a flexed position.

Causes. Prominent among these are injuries which have been inflicted upon the intestines, compression of the colon, or rectum, perforation of the stomach or bowels, either by violence or some pre-existing disease, thus allowing the discharge of blood, urine, bile, or fecal matter into the abdominal cavity; also abortion, over-exertion, and exposure to wet or cold. As acute peritonitis is always a grave disease, involving more or less danger to life, it is the wisest course to employ a physician and trust the case to his management. The same remark is equally applicable to the chronic form of the disease.

Chronic Peritonitis. Like the acute, it may be either circumscribed or general. This form is sometimes, though rarely, a sequel of the acute. When it appears independently of the acute, it is generally associated with some cutaneous affection pertaining to the abdominal cavity, and the inflammation is induced by the tumor. If chronic peritonitis be connected with the tubercular diathesis, tubercles may be discovered upon the surface of the stomach and alimentary canal, and may also be found in the lungs and brain.

When the affection is not tubercular there will appear in the abdominal cavity an effusion of serous fluid of greater or less quantity, mingled with blood and pus. When such an effusion takes place, the abdomen gradually increases in size, or becomes smaller than is natural. There is pain, attended by soreness upon pressure, and the patient becomes emaciated.

Inflammation of the peritoneum is frequently an accompaniment of puerperal fever, which is a disease peculiar to childbirth, and which may arise from cold, or be communicated from one parturient patient to another by midwives.

Treatment. In the remedial management of acute peritonitis, it is obviously necessary to use some agent which will at once influence and change the congested state and inflammatory condition. One of the best agents employed to make a decided impression upon the vascular system, subdue inflammation, and modify its action, is the fluid extract of veratrum viride, administered in full doses, and repeated until the system shows its effects in a decided manner. Warm fomentations applied to the abdomen are sometimes very serviceable, and are objectionable only because of their liability to dampen the bed-clothes. When the abdomen will bear a thick, warm poultice, apply it, and then cover the entire surface with oiled silk. The tincture of opium, in doses sufficient to relieve pain and quiet the peristaltic action of the intestines, is generally necessary.

This is an epidemic disease, supposed to be due to an impalpable specific poison, but as to the exact nature of this poisonous matter nothing definite is known.

This plague first made its appearance on our continent in 1834. Owing to its great fatality, it is a disease much to be dreaded.

Symptoms. These are well defined. It is characterized in its earlier stages by pain in the stomach and bowels, especially in the umbilical region, nausea, vomiting, diarrhea; later, the purging is excessive, and the matter dejected resembles rice-water, and contains white, solid, curd-like matter. The patient loses strength, and sinks rapidly. The secretory organs fail to perform their functions normally, the skin is sometimes moist, but oftener cold and dry; but little if any bile is found in the excretions, and the urine voided is very scanty. There is general nervous derangement, as indicated by the spasmodic contraction or cramping of the muscles. This first attacks the extremities, but soon affects the entire body, and gives rise to excruciating pains. The head is affected by singing, roaring, disagreeable noises in the ears, the pulse is feeble, but quick, the nails are of a bluish color, the tongue is coated white, the eyes are sunken, and the patient has a corpse-like appearance; the temperature of the body rapidly falls, the surface becomes deathly cold, and, unless the disease is promptly arrested in its course, speedy dissolution follows. The disease is rarely prolonged beyond twenty-four hours, and sometimes terminates within three or four hours after its first attack.

Treatment. The kind of medicine required depends upon the severity of the attack and stage of the disease. In all cholera epidemics, there are premonitory symptoms, such, as an uneasy sensation at the pit of the stomach, and a rumbling of the bowels. This is apt to be followed by a painless diarrhea, which occasions no alarm, and the patient pays but little attention to it. Herein is the great and dangerous mistake. The patient is already in the stage of invasion, which must be promptly arrested, or he will suddenly be precipitated into the stage of collapse. The patient should lie down, and have placed about him bottles filled with hot water, thereby exciting warmth upon the surface of the body. At the same time, administer two teaspoonfuls of the Extract of Smart-weed. If the symptoms are urgent, repeat the dose every fifteen minutes. Brandy, thickened with sugar, may also be given. In either the stage of invasion or collapse, the leading indication is to establish reaction by promoting perspiration. Bathe the feet in water as hot as can be borne, give the Extract of Swart-weed freely, and thus endeavor to excite profuse diaphoresis. No time should be lost, for delays are dangerous. When the reaction is established, the patient should remain quiet, and not attempt to exert himself.

After reaction has taken place, the sweating should be maintained for twelve hours, and the patient should drink slippery-elm tea and toast-water, and partake sparingly of soft toasted bread and chicken broth. The food should be fluid and nutritious, but taken in small quantities. Do not disturb the bowels with laxatives until the third day after the patient begins to improve, and then they may be moved by an injection of warm water. Great care should be taken that the patient does not indulge too soon or too freely in the use of food. When a skillful physician can be had, no time should be lost in securing his services, but since in epidemics of this nature, medical men are generally overworked, and not always easily and promptly to be had, we have been quite explicit in giving full directions for treatment.

Cholera Morbus, also known as sporadic cholera and simple cholera, usually occurs during the summer months. The attack may be sudden, although it is usually preceded by a sensation of uneasiness and colicky pains in the stomach.

Symptoms. Nausea, vomiting and purging are the most prominent symptoms. The discharge from the bowels is at first of a thin, yellow appearance, but finally it becomes almost colorless. Sometimes, after the contents proper of the bowels have been evacuated, the dejections have a bilious appearance. Severe cramps and pain accompany the vomiting. The vomiting and purging usually occur in paroxysms, but finally become less frequent, a reaction takes place, the extremities grow warm, and the patient gradually recovers. It may be accompanied by intense thirst and a quick pulse, yet the surface may be cool.

Causes. Cholera morbus is most prevalent in warm climates, and especially in malarial districts. It is generally the result of eating indigestible articles of food, such as unripe fruit or uncooked vegetables. Stimulating drinks, or those articles which furnish the elements for fermentation, also favor the production of this disease.

Treatment. If the attack be superinduced by eating unripe or stale fruit, it may be proper to give an emetic or a cathartic, but ordinarily first give a full dose of the Extract of Smart-weed, and, if the vomited matter is very sour, give the patient a weak, alkaline drink, which may be made by dropping a few live, hard-wood coals into a tumbler of water. This will not only assist in neutralizing the acidity of the stomach, but will help to allay the thirst and accompanying fever. If the patient throw up the first dose of the Extract of Smart-weed, a second should be given. Do not allow the patient to drink cold water, and give only tablespoonful doses of the alkaline solution every thirty minutes. If the thirst is great, occasionally give a tablespoonful of a tea made from scorched Indian meal, which not only allays the desire to drink, but also the irritation of the stomach. If to be obtained, give a tea of the leaves or bark of the peach tree. The patient should be well covered in bed and kept warm. Laudanum by the stomach, or by enema, may he necessary in severe cases to relieve the pain and check the purging. Hot fomentations applied to the bowels are very valuable. A mustard plaster applied over the abdomen will assist materially in relieving the nausea and vomiting. It should not be left on sufficiently long to blister. When the affection is promptly treated as we have suggested, the patient generally quickly recovers. If, however, it does not yield to these measures, the family physician should be called in.

ACCIDENTS AND EMERGENCIES.

Accidents and emergencies which require immediate attention frequently occur. Professional aid cannot always be quickly obtained and hence fatal results often follow. It is, therefore, important that all persons should not only know how to proceed under such circumstances, but that they should be able to exercise that deliberation and self-control so necessary in emergencies of all kinds. Most persons are more or less affected by the sight of blood or severe wounds, and it requires an effort to maintain self-possession. One should act resolutely; otherwise he will find himself overcome and unable to render any assistance.

WOUNDS.

Wounds may be classified as incised, punctured, contused, lacerated, or poisoned.

Incised wounds are those which are made with a sharp, cutting instrument, and are characterized by their extent of surface.

Punctured wounds are made with a pointed instrument, and distinguished for their depth rather than breadth.

Contused wounds are those produced by bruises.Lacerated wounds are those in which the flesh is torn and mangled.

Poisoned wounds are made with a poisoned instrument, or by some poisonous reptile or insect or rabid animal.

Illustration: Fig. 1. The field Tourniquet as applied.
Fig. 1. The field Tourniquet as applied.

In all cases of wounds, the immediate danger is in the shock produced upon the nervous system, and in the liability to hemorrhage.

Shock. If severe, the shock is attended with symptoms of extreme prostration, such as a feeble pulse, shivering, partial unconsciousness, fainting, hiccough, vomiting, and involuntary discharges of the urine and feces.

Illustration: Fig. 2. Mode of employing flexion for the arrest of hemorrhage from a wound located below the elbow.
Fig. 2. Mode of employing flexion for the arrest of hemorrhage from a wound located below the elbow.

Treatment of Shock. The clothing should be loosened immediately after the accident, so that the blood may have free circulation, and the patient should be kept in a recumbent position. He should have plenty of fresh air. Camphor or ammonia may be inhaled. If he can swallow, stimulants may be given, as whiskey or brandy, but with care that they do not run into the trachea, or windpipe. If he be unable to swallow, they may be administered as injections, but should gradually be discontinued as reaction takes place. A warm pillow placed at the back and the use of electricity may be beneficial.

Hemorrhage, or bleeding, may generally be controlled by a compress, tourniquet, flexion of the joint, or styptics. A compress consists of several folds of cloth laid upon a wound, the edges of which have been brought together, and made secure by a moderately tight bandage.

Illustration: Fig. 3. Mode of employing flexion for the arrest of hemorrhage from a wound below the knee.
Fig. 3. Mode of employing flexion for the arrest of hemorrhage from a wound below the knee.

A tourniquet may be extemporized by rolling a handkerchief into a cord and tying it around the limb, over a compress, between the wound and the heart. A stick should then be thrust between the handkerchief and skin and twisted around several times, until the pressure is sufficiently great to arrest the circulation of the blood in the wounded part. A representation of this operation may be seen in Fig. 1.

Illustration: Mode of employing flexion for the arrest of hemorrhage from a wound located between the thigh and knee.
Mode of employing flexion for the arrest of hemorrhage from a wound located between the thigh and knee.

Flexion of the joint, as represented in Figs. 2, 3, and 4, is adapted to many cases of hemorrhage. As water cannot flow through a rubber tube bent at a sharp angle, so the acute flexion of a limb prevents the free flow of blood through the arterial tubes.

In some cases, styptics may be directly applied to the wounded tissues. Cold acts as a powerful styptic, and may generally be made available for arresting hemorrhage.

Poisoned Wounds. The treatment of these should chiefly consist in the prevention of the spread of the poison. This may be done by tightly applying bandages above the wound and scarifying or sucking the parts. Nitrate of silver may then be used and the ligatures removed. Alcohol, in any form, is an antidote to snake poison. For the stings of insects, apply aqua ammonia, fresh earth, raw onion, plantain, or spirits of turpentine.

FRACTURES AND DISLOCATIONS.

The treatment of injuries received from the fracture of bones and the dislocation of joints should never be attempted by the inexperienced, nor should the management be left to incompetent physicians but skillful surgical aid should at once be summoned.

SPRAINS.

A sprain consists of a sudden and forcible stretching of the ligaments and tendons connected with a joint, without there being any dislocation. It is attended with severe pain and is followed by rapid swelling.

The treatment should consist of measures to prevent inflammation, promote absorption, and restore a healthy action. The affected part should be kept at rest in an elevated position, and hot or cold water applied frequently. If there is much inflammation, fomentations of hops may be used. The Compound Extract of Smart-weed is an excellent application.

When the acute symptoms have disappeared, absorption should be favored by systematic rubbing and the application of stimulating liniments, or by the use of a well-adjusted bandage. Passive motion may be resorted to gradually and the subject may use the joint moderately. Should any stiffness remain, warm salt water douches should be employed and the Extract of Smart-weed applied once a day.

BRUISES.

Bruises or contusions are caused by falls, wrenches, or blows from blunt instruments, without breaking the skin. The soft tissues are lacerated and blood is poured out into them, constituting ecchymosis. The discoloration passes through various shades from a bluish-black to a violet, a green, and finally, a yellow.

If the bruise is severe, the affected part should be kept at rest and frequently bathed with the Compound Extract of Smart-weed or the tincture of arnica. If inflammatory symptoms supervene, fomentations and poultices should be applied.

FOREIGN BODIES IN THE NOSE.

Foreign bodies, such as beads, peas, coffee-grains, and small gravel-stones are occasionally introduced into the nostrils of children, becoming fastened there, and causing great anxiety and alarm. If allowed to remain, they generally cause inflammation and suffering.

Such bodies may generally be washed out by gently injecting a stream of tepid salt water with a syringe or Dr. Pierce's Nasal Douche. In no case should force be used. If these means fail, a competent surgeon should be consulted.

FOREIGN BODIES IN THE THROAT AND AIR-PASSAGES.

Foreign bodies are generally arrested so high up that they may be seen by simply depressing the tongue, and removed with the finger or a pair of forceps. The head should be thrown back in such a position as to cause the chin to project as little as possible beyond the prominence known as Adam's apple, in order that the finger or forceps may be readily introduced and the body released and ejected. When the foreign bodies are so small as to pass out of sight in the larynx, windpipe, or esophagus, it is generally difficult to extract them, and the services of a surgeon are required. Fortunately, however, there is not much immediate danger from suffocation in such cases.

DROWNING.

Recovery from drowning sometimes occurs when life is apparently extinct. The treatment, however, should be immediate and energetic, and should be given in the open air, unless the weather be too cold.

Treatment. The patient should be gently placed upon the face with his wrists under his forehead. The tongue will then fall forward and the water run out of his mouth and throat, while the windpipe, or air-passage, will be free. To restore respiration, he should be instantly turned upon his right side, his nostrils excited with snuff or ammonia, and cold water dashed upon his face and chest. If this operation prove unsuccessful, replace the patient upon his face, care being taken to raise and support his chest, turn the body gently on the side and quickly again upon the face. Alternate these movements about every four seconds, and occasionally change sides. When the body is turned on the face, gentle but efficient pressure should be made along the back, between the shoulder blades, to assist in forcing the air out of the lungs, but this pressure ought to be removed before the patient is turned back on his side. Persistently repeat this operation, and success will often be the reward. As soon as respiration is established, warmth may be promoted by the application of warm flannels to the body and bottles of hot water to the stomach, armpits, thighs, and feet. During the entire process of restoration, the body should be thoroughly rubbed upwards. Turning the body upon the back or handling it roughly should be avoided. The person should not be held up by his feet, or be rubbed with salt or spirits. Rolling the body on a cask is improper, and injections of the smoke infusion of tobacco are injurious. Avoid the constant application of the warm bath, and do not allow a crowd to surround the body.

FAINTING.

When a person faints, he should be allowed to remain or be placed in a recumbent posture, and his clothing immediately loosened. The extremities should be rubbed, the patient permitted to have plenty of fresh air, and, if at hand, ammonia or camphor should be applied to the nostrils.

BURNS AND SCALDS.

The danger arising from burns and scalds depends not only upon the extent of surface involved, but also upon the depth of the injury. Burns are most dangerous when occurring upon the head, chest, or abdomen.

Treatment. Soothing applications, and those which will exclude the air, should be made. Grated potato, poultices of slippery-elm, sweet oil, cotton saturated in a mixture composed of two or three grains of carbolic acid and two ounces of glycerine, and linseed oil and white lead, are all beneficial for the treatment of burns. If internal treatment be necessary, it should be given under the direction of a competent physician.

SUN-STROKE.

In cases of sun-stroke, the patient should be at once removed into the shade. If the face is flushed, apply cold water to the head and neck, and mustard to the feet. The body should be bathed in tepid water and the head slightly elevated. If the countenance is pale, the symptoms denote exhaustion, and the patient should be kept in a recumbent position, the extremities rubbed, camphor and ammonia inhaled, mustard applied to the spine, and stimulants, such as brandy or whiskey, should be administered.