Remarks on the Uses of some of the Bazaar Medicines and Common Medical Plants of India / With a full index of diseases, indicating their treatment by these and other agents procurable throughout India; to which are added directions for treatment in cases of drowning, snake-bites &c.

by Edward John Waring

PRECAUTIONS TO BE OBSERVED BY PERSONS RESIDING IN SNAKE-INFESTED LOCALITIES.

That prevention is better than cure is admitted on all hands; hence those persons whose lot is cast in snake-infested localities will do well to lay to heart the following passage from the official "Report on Indian and Australian Snake-poisoning," by Drs. Joseph Ewart, Vincent Richards, and S. Coull Mackenzie (Calcutta, 1874).

The poisonous snakes of India, as a general rule, "are, until provoked, perfectly inoffensive to all animals not required by them as food. They seldom assume the aggressive until they are rudely and accidentally disturbed. Thus a native sleeping on the ground rolls over a venomous snake, or whilst walking in the jungle, or long grass, or in the dark, treads upon some part of a snake's body. In either case the snake bites if he can. It is in this way that a large proportion of snake accidents happen.

"A large number of lives would be saved annually if the native population could be prevailed upon to sleep on charpoys, and if they got into the habit of never stepping from their beds at night without first seeing, by means of a light, that the ground below is clear, and free from snakes. Much of the immunity which Europeans and educated natives enjoy from snakebite is due to their using these very necessary precautions, especially during the rainy season, and in the mofussil by their never walking abroad at night without a light. There is scarcely a European of experience in the mofussil who cannot recount examples of lives (often their own) having been saved by means of these simple precautions."

To the above judicious advice (the most important points of which I have italicised) may be added the following excellent practical precautions, communicated to me by friends whose Indian experience gives great weight to their suggestions.

1. Snakes never voluntarily traverse rough or broken ground: it is therefore advisable in snake-infested localities to surround your dwelling with a cordon or belt of broken bricks or kunkur—a breadth of three or four feet is quite sufficient for the purpose.—Dr. Norman Chevers.

2. Be careful, especially during the wet season, to keep the verandahs, &c., free from frogs: a frog is a temptation which a snake has little or no power to resist.—Dr. Norman Chevers. The same remark is equally applicable to rats.

3. In the cold season, if you see a snake coiled up or in an apparently lifeless state in an open, well-frequented road or pathway, be careful how you approach him. Should you handle or disturb him roughly, he will in all probability rouse up and bite you. He is only torpid from cold, not dead.—Dr. Norman Chevers.

4. Have a piece of perforated zinc or tin fitted to the opening made for the purpose of carrying off the water out of the bath-room, if it be on the ground floor. A similar piece should be added to the bottom of the bath-room door should it not (as it rarely does) reach the ground beneath.—Mr. Arthur J. Waring.

5. Discard vegetation, especially thick straggling shrubs like the Rangoon Creeper, close to your house. They are very apt to harbour snakes.

6. Important as are the above "Precautions," they are comparatively of small moment compared with the destruction—extermination if possible—of the snakes themselves. And this can only be efficiently carried out under Government supervision. That this is the only mode of effectually grappling with this gigantic evil, under which thousands of lives are annually sacrificed—the numbers are 19,060 in 1880, and 18,610 in 1881, besides 4568 cattle in the two years—is forcibly set forth by Sir Joseph Fayrer in two able papers in Nature, December 28, 1882, and January 18, 1883. Most earnestly is it to be hoped that Government, agreeably to his suggestion, will lose no time in establishing a department, with a responsible chief and subordinate agents, under whom a system of organised, determined, and sustained efforts for the destruction of the snakes shall be adopted and carried out. It would be a public boon if Sir Joseph's two papers were reprinted in pamphlet form, and circulated throughout the length and breadth of India.

In the meanwhile zealous individual effort should be brought to bear in the same direction. To this end money rewards (heading the list with eight annas for a Cobra) should be freely offered to the natives for every dead poisonous snake brought in, but for poisonous ones alone. Of these there are life-like coloured plates in Fayrer's Thanatophidia of India, and in Ewart's Poisonous Snakes of India, one or other of which works is to be found in almost every large station, and which it is highly desirable for every one to make himself acquainted with. One other point remains to be noticed, namely, the necessity of carefully impounding every such dead snake brought in and paid for; otherwise it is likely to do duty a few hours later, or even next day, or it may be made the means of extracting further "buck-sheesh" from one or more of the neighbouring "Sáhib-lóg!"

[4] Reprinted by permission from Sir Joseph Fayrer's splendid work, The Thanatophidia of India. Folio. London: Churchill. 1874.

APPENDIX C.
METHOD OF TREATMENT OF SMALL-POX BY MEANS OF CARBOLISED OIL.

My reason for giving this treatment of small-pox in detail is the frequent presence of the disease in India, in an epidemic form amongst the natives, with the hope that it may prove useful in ameliorating it, and thus save many useful lives which otherwise would probably succumb to its ravages from the terrible purulent discharge acted upon by a hot climate, creating a form of disease scarcely known in colder latitudes.

Before attending upon or assisting in the treatment of a case of small-pox, it is the duty of every one to see that they, their households, and those others who are likely to attend upon the case are sufficiently protected from the likelihood of infection by having been properly vaccinated, and that this operation had been successfully performed within at least four years. When there is a necessity for any one coming into immediate contact with the disease, as on the occurrence of an epidemic, it is advisable to be vaccinated whenever such epidemics occur.

There is a general belief that vaccination does not prove a success in the hot weather in India; do not credit this. If small-pox occurs as virulently as it does during the hot weather, on occasion, the success of the vaccination is also a certainty, if performed with care and a determination in its success.

Never mind how young an infant is, vaccinate it, even if it is only a day old, if you believe there is any probability whatsoever of its having come into, or likely to come into, contact with the infection of small-pox. Remember "the mortality of small-pox in childhood is very high up to the age of ten years. Infants usually succumb to the disease even in the discrete form."

Since the time that I first gave my opinion to Dr. Waring (in 1872) upon the treatment of small-pox with carbolised oil, I have seen a good deal more of the disease, and I still, with slight modifications, maintain my preference for this form of treatment. When I first used the application I employed a mixture of one part of Carbolic Acid and ten parts of Sweet Oil, applied twice daily over the whole body. I now advocate the employment of one part of Carbolic Acid to fifteen parts of any bland or Sweet Oil, moistening the body on such parts as may require it, frequently during the day and night.

Sesamum or Til Oil is ordinarily the most easily procurable throughout India, but any of the following will do: Poppy, Ground-nut, Apricot, Walnut, Cocoa-nut, Linseed, Almond, or Olive Oil, the two last being rather expensive. On no account be led into using any of the Mustard oils, which, owing to the natives using some of them in their diet, are occasionally spoken of as "sweet oils."

At whatever stage of the disease the patient comes under treatment, at once apply this liniment over all the parts being affected, or are affected by the eruption, by means of a mop of soft cotton-wool (never on any account employ a sponge); apply the liniment freely as if you were treating a severe burn, and then carefully cover the oiled surface with cotton-wool, so as to exclude all air, and keep the cotton-wool dressing in position. The carbolised oil to be freshly reapplied every four or six hours, so as to keep the parts moist, and the cotton-wool to be renewed every forty-eight hours. If flakes of wool stick into the broken skin, moisten these freely with oil, but do not tear them away. Any amount of cotton-wool can be obtained throughout India at the smallest hamlet, on a few hours' notice; and at all hours in any bazaar.

Let the patient lie between blankets, not cotton sheets; in commencing to dress the patient on the first occasion have a layer of cotton-wool placed upon the lower blanket, then place the patient on this cotton-wool naked, cover with a similar sheet of cotton-wool and over this again a blanket; having done this, set to and piecemeal dress the whole body, where the presence of the coming eruption requires it, with the carbolised oil, and cotton-wool, supporting the position of the cotton by means of very light bandages, or by a few stitches with a needle and thread, so as to keep the wool carefully together as well as firmly against the body. If suitable under the circumstances, a thin elastic gauze jersey and drawers keep the cotton protected from being rubbed off by restless patients.

So soothing and comforting is the application of the oil, that almost the youngest patients look forward to its re-application, will at once tell you when the body is getting hot and dry, and will in all probability ask to be allowed to apply the liniment themselves when they begin to feel uncomfortable, especially at the inflammatory stage of the vesicles when they are just changing to their pustular condition.

What is gained by the above treatment?

1. The carbolised oil soothes and cools down the inflamed surface of the skin, exactly as is done when oil is applied to a burn.

2. The cotton keeps all air from the skin, and aids in keeping the skin moist with the oil.

3. The oil saturates the surface of the eruption, penetrates into the skin desiccation, and as the oil becomes heated by the temperature of the body it gives off some of its carbolic acid in the form of gas.

4. The carbolic acid keeps the oil from becoming rancid.

5. If the liniment is applied to the eruption at a sufficiently early stage, viz., when the eruption is becoming vesicular, the carbolised oil on the surface of the eruption, and the gaseous carbolic acid, between the skin and the cotton and in the interstices of the cotton, prevent the microbes of the atmosphere from coming into direct contact with the epidermis, and subsequently with the contents of the vesicle, the result of which is the contents of the vesicle do not become pustular and purulent; and the eruption dries up without ulceration.

6. If the liniment is applied late in the vesicular stage, or not until the pustular stage has set in, the carbolised oil penetrates more or less into the epidermis which is being thrown off by the suppuration of the pustule; as the pus is discharged by rupture of the epidermis the oil mixes with the pus, disinfects it, and keeps it sweet, as is to be observed by the entire non-existence of, or extremely modified condition of, the horrid stench that accompanies small-pox, subsequent to the pustular stage of the disease.

7. The exuviæ becoming loaded with the carbolised oil, are (probably) disinfected and are incapable of spreading the disease.

8. If the eruption is prevented from reaching the pustular stage, the complications that would otherwise have resulted from pus absorption are no longer to be dreaded, such as the secondary fever, boils, abscesses, acute cellulitis, erysipelas, pyæmia, &c. &c.

No eroding ulcers with deep cavities, leaving the well-known cicatrices of small-pox, are produced.

9. The pustular stage having occurred before the carbolised oil treatment was applied, it still proves of immense value, as it prevents the pus becoming impure and poisonous, and this greatly ameliorates the results of the disease even at this stage.

So long as the disease lasts is this application to be applied, limited certainly to the extent of the eruption; as long as this treatment is being adopted, not a drop of water should be allowed to touch any part of the skin surface (no washing of any sort) until healthy action of the skin has set in, recognised by the falling off of the crops of scabs, without any raw, ulcerated surfaces.

Is there any danger to the patient from the absorption of the carbolic acid into the system? So long as the oily solution is used, and no water allowed to come into contact with the skin, I consider there is little or no danger, but it is necessary always to be careful. Should the patient be suffering from the absorption of the carbolic acid, you will find a cold, clammy skin, rapid fall of both temperature and pulse, and the urine of a smoky greenish-brown colour, and having the odour of carbolic acid. In many cases of small-pox, but where no carbolic acid has been employed, the urine becomes smoky-brown, but it has not the peculiar greenish tinge of where carbolic acid is present. To judge the odour correctly, the urine should be put into a fresh dish and examined in some other room, or, what is better, the open air, so that there can be no mistake, as the air of any house gets so saturated with the odour of carbolic acid that it is not easy to judge whether the odour is that of the air or of the urine. If danger from excess of absorption of carbolic acid is feared, do not give up the treatment, but lower the strength of the carbolic acid in the oil to 1 in 20, and more or less limit the number of the applications. But what is far more important, see that there is abundance of ventilation in the room. I would fear more from a close chamber and excess of carbolic acid vapour in the air than the possibility of the excess of acid having been absorbed from the oil. Remember you are not dealing with a watery solution where there, I believe, is danger, as water, besides quickly evaporating, rapidly yields up its carbolic acid to the tissues, which too readily absorb it. Oil but slowly evaporates, and with difficulty parts with the carbolic acid it holds in solution to the tissues.

All the swabs, mops, &c., of cotton-wool, and the wool itself that may have been employed in treating a case, should be burnt at once when they are no longer required.

The blankets and bedding, after a good washing and exposure to sun, will be found to be free of infection, and may be again with safety employed.

Upon the above principles I have treated the vesicle of vaccination, with much comfort to the patient, and in most of the cases entirely prevented the pustular stage.

Aitchison.

APPENDIX D.
THE CLINICAL THERMOMETER.

The possession of a self-registering Clinical Thermometer in every household, in a tropical or malarious climate is a necessity, more especially when at a distance from medical aid. It is a means for assisting to ascertain most accurately, in a very few minutes, whether a child or patient is really ill, and the necessity there might be for the administration of remedies; for calling in other and more proficient assistance; or to allay anxiety that might have accrued from a nervous fear, when possibly no actual illness existed.

From one single observation of an abnormal temperature, we learn:

"1. That the patient is really bodily ill.

"2. When there is considerable elevation of temperature, we know that there is fever.

"3. When there are extremes of temperature, we know that there is great danger.

"The mean normal temperature of the human body in health is 98·6° Fahrenheit's scale."[5] This may vary in health, in exceptional cases from 97·5° to 99·5° Fahrenheit.

The accompanying diagrams represent (A) a thermometer that has been employed, we will say, in a case of Intermittent fever, the Index showing the temperature to have been 104°; (B) a thermometer with the Index at 95°.

The Index in a Clinical Thermometer is a small quantity of mercury separated by a bubble of air from the rest of the mercury; or, owing to the peculiar construction of the glass tube, without any air being present, a portion of the mercury separates itself from the bulk, and remains separated in the tube, as an Index. Upon placing the Thermometer in a favourable situation, in or against the body of a patient, owing to the amount of heat with which it there comes in contact, the mercury in the bulb expands, and the Index is pushed up to the highest point in the Thermometer that the heat of the body at that time is capable of causing, if the Thermometer is kept in contact with the body for the requisite time; and when the Thermometer is removed from its contact with the body, the mass of mercury suddenly cooling down, contracts, and returns into the bulb, the Index being left behind at the point to which the heat of the body had forced the mercury in the bulb to raise it; thus the Thermometer in Diagram A shows that in that instance the Index had been raised to 104° Fahrenheit and that that was the temperature of the body at that observation.

In commencing to take the temperature of a patient, first of all see that the Index is in the position as seen in Diagram B, not necessarily always as low as 95°, but at all events well under the arrow →, which marks off the mean normal temperature of any one in healthy viz., 98·4° Fahrenheit, as given in most English thermometers (98·6° as used on the Continent). The temperature of an infant or young child is frequently found to be 99° whilst in health.

Supposing a Thermometer is put into any one's hands, reading as at Diagram A 104°, how is the Index to be replaced to the position it occupies in Diagram B? Hold the Thermometer by its upper end (the bulb being considered the lower end) then swing it round with your arm, suddenly stopping the arm with a jerk, this jerk causes the Index to fall towards the bulb, continue this, and after each jerk see how far the Index has fallen, when it has got well under the arrow →, the Thermometer for an ordinary case is ready for use.

When, however, one expects a low temperature, it is best to have the Index of the Thermometer at or under 95°.

Fahrenheit's Scale.

How and when to apply the Thermometer. With grown up children and adults I have always found it more convenient to take the Temperature by placing the bulbous end of the Thermometer into the mouth under the tongue, keeping it there, with the mouth, shut, for the requisite time, the patient in the meanwhile breathing only through the nostrils; with infants the most convenient place is to put the Thermometer in the flexure of the thigh, laying one of the thighs somewhat across the other, but being careful not to allow the clothes to touch the Thermometer; some prefer to place it in the armpit, or axilla. This I have not found always as convenient as the other two localities; any of these, however, is good for the purpose. Use the one you may deem most convenient, but be careful to keep the clothes from coming into contact with the Thermometer.

Thermometers are now made with such a rapid action, that at the very longest they do not now require to be kept in position for more than three minutes.

Immediately after having made an observation note down the temperature, along with the time at which the observation was taken; having done so, and not before, wash the Thermometer, but not with hot water, and then jerk down the Index; so that the Thermometer is ready for future use. If the reading is in any way a doubtful one, take another observation at once.

If there is any anxiety connected with the case, it is advisable to take an observation every three hours, so long as the patient is awake; never disturb a patient during natural sleep for the purpose. Ordinarily take an observation two or three times during the day, but at set hours and at regular intervals, always noting the time.

Whenever the temperature of a patient is found to be below or above the normal 98·4°, viz., the arrow-mark on the Thermometer, then watch the case, as one requiring care. If the temperature has fallen as low as 97°, or gone up to 100°, make up your mind that there is something wrong; be vigilant. But a falling temperature below 97° means danger from collapse, and a rising one reaching 105° is a dangerous fever heat. In the last two occurrences remedial agents require to be applied to at once, and medical assistance urgently asked for.

Along with each thermometric observation, it is advisable to count the pulse, and the number of respirations [the average number of pulsations in a minute of a healthy adult are about 72, and the number of respirations about 16. In young children and infants the number of pulsations and respirations are usually much higher than in the adult, and so irregular that to the non-professional their value alone in diagnosing disease may be considered as doubtful, other signs and symptoms require to be more carefully studied, and taken into consideration along with them, and the temperature] that occur during the minute (the latter is easily done by laying the open hand on the upper part of the abdomen, and counting the number of rises) noting these, along with the temperature, and the time. Such data, if taken carefully and at regular intervals of time, form an invaluable means for assisting the physician in his diagnosis.

Example.

	May 17.	May 17.	May 17.
Time	9 A.M.	12 noon	3 P.M.
Temperature	98·4°	100°	100°
Number of Pulsations	72	80	80
Number of Respirations	16	20	20

Aitchison.

[5] Medical Thermometry, by Dr. C. A. Wunderlich, translated by W. Batherst Woodman, M.D. 1871, p. 6.