MEDICINES, MEDICAL APPLIANCES, ETC.
Weights and Measures.
Solids.
| A Grain | Symbol | Gr. | ||
| 20 Grains | 1 Scruple | { weights now rarely used | ” | ℈ |
| 60 Grains | 1 Drachm | ” | ℨ | |
| 437.5 Grains | 1 Ounce | ” | ℥ | |
| 16 Ounces | 1 Pound | ” | ℔ |
Note.—An ounce weighs not 8 but rather under 7½ drachms.
| 1 Gramme | about 15½ grains. |
| 1 Kilogramme | ” 2 lbs. 3¼ ozs. |
Liquids.
| 1 | Minim | About 1 drop, or 0.06 c.c. | Symbol | ♏ |
| 60 | Minims | One fluid drachm | ” | ℨ |
| 8 | Fluid drachms (480 Minims) | One fluid ounce | ” | ℥ |
| 20 | Fluid ounces | One pint | ” | O |
| 1 | Cubic centimetre | 17 Minims. |
| A teaspoonful | About one fluid drachm. |
| A dessertspoonful | About two fluid drachms. |
| A tablespoonful | About half a fluid ounce. |
| A wine-glassful | About two fluid ounces. |
| A tumblerful | About half a pint. |
| A litre | About a pint and three quarters. |
All bottles containing drugs should be doubly labelled, and the labels should be varnished, otherwise they will probably come off in a damp climate. Poisons should be kept in bottles of a special shape.
Drugs in a liquid state are inconvenient for travellers. They are bulky, and require very careful packing and handling.
As far as possible, therefore, compressed drugs should be selected. These must be of good quality.
Tablets are often taken in the solid form, but they will act more quickly and certainly if dissolved or suspended in about an ounce of water.
Some preparations, chiefly those used for preparing lotions, etc., e.g., of chinosol, are also made in compressed form.
In regard to drugs, I have kept well within the maximum dose, so that there may be no trouble on that account. For instance, in certain cases a medical man would give sixty drops of laudanum for a dose, but I advise travellers rarely to give more than sixty drops in twenty-four hours. The urgency of the case must be the guide as to the quantity of the drug to be given. The smallest dose which is effective is the best.
A supply of antiseptic gauze, wool and lint is necessary. The compressed forms are very convenient.
All antiseptic gauzes and other dressings should be very carefully protected from the air in order that their properties may be preserved. They should be wrapped in oiled paper or india-rubber tissue, and kept in a tin box.
A supply of bandages will also be needed. Each bandage should be two inches in width by six feet in length.
Dressing case.—The traveller should provide himself with a surgical dressing case. A suitable one should contain 1 pair of scissors, 1 pair of Spencer Wells’ artery forceps, 1 probe, 1 scoop and grooved director, 1 knife with two blades, 1 small saw with a detachable handle, and a packet containing silk, wire, needles, and pins.
All active poisons mentioned in the following pages are marked with an asterisk (*).
Aloin Co. tablets.—One taken three times a day after meals, in chronic constipation, gradually reduced as bowels become regular.
Alum.—Dose, five to ten grains. Is occasionally used as an internal astringent in the treatment of diarrhœa.
A solution containing five grains to the ounce of water may be used as a mouth wash for bleeding or inflamed gums, as a gargle for relaxed and sore throats, or as a lotion for inflamed eyes.
Ten to twenty ounces of a solution containing five grains to the ounce is sometimes used as an enema to check the diarrhœa in chronic dysentery.
The tablet of alum weighs ten grains.
Ammonia.—Three preparations of ammonia, viz., Sal volatile, Carbonate of ammonia, and Liquor ammoniæ, are extremely valuable as stimulants, and in this respect they are to be preferred to alcohol. All three are similar in their action, and are useful on account of their stimulating effect upon the heart in cases of fainting, or collapse caused by snake-bite, bullet-wound, or other injury; they relieve spasm, and promote sweating in feverish states. They also cause free expectoration, and are therefore useful in the later stages of bronchitis.
The chief objection to these drugs is that their strength is rapidly lost, unless they are kept in well-stoppered bottles, and in the dark.
All preparations of ammonia should be administered in about one ounce of water.
Sal volatile, or aromatic spirit of ammonia.—Dose, twenty to sixty drops for a single administration, or up to thirty drops if repeated frequently. This is the most convenient and pleasant preparation of ammonia, but is bulky. As a local application, it is of service in relieving the pain caused by the bites of certain insects, e.g., mosquitoes and fleas.
Carbonate of ammonia.—Dose, three to ten grains.
Liquor ammoniæ, or solution of ammonia.—Dose, five to twenty drops.
(Note.—This is not the strong solution, which is always labelled “Liq. Ammon. Fort.,” and which is three times stronger than liquor ammoniæ.)
Ammonium chloride.—Dose, five to twenty grains. This drug is chiefly used in congestion of the liver, especially where acute inflammation or abscess is threatened; at times it is useful in neuralgia and chronic bronchitis. It is also used for inflamed and relaxed sore throat, in the form of a gargle, five to ten grains to the ounce of water.
Antipyrine.—Dose, five to ten grains. (Uses as Phenacetin.)
* Araroba, Chrysarobin, or Goa powder.—Is not for internal use. One part of the powder mixed with one of acetic acid and fourteen of lard makes what is known as araroba ointment.
Araroba ointment is useful in many skin diseases, such as psoriasis; it easily destroys the parasites in ringworm, dhobie itch, or kraw kraw. It is a powerful drug, and should be used only in small amounts, for if applied too freely it will cause some inflammation and pain. Care must be taken that it is not rubbed into the eyes.
* Aromatic chalk with opium tablets.—Ten grains three times a day in severe cases of diarrhœa.
* Arsenic.—Dose, one-sixtieth to one-fifteenth of a grain. Is a powerful and poisonous drug, and should be taken with caution. It is useful in chronic malaria, and in anæmia and debility, especially that following an attack of fever.
It is best combined with iron in tablet form—iron and arsenic tablet—two of which may be taken twice a day, after food, for a week. This is a good general tonic.
Aspirin.—Dose 5 to 15 grains. Should be taken with a drink of water. Useful in rheumatic and febrile conditions; often relieves headache and the feeling of discomfort associated with chill. It is apt to be depressing in large doses, and some persons do not tolerate it well. Speaking generally it may be used in those conditions in which salicylate of soda is indicated.
Bismuth carbonate.—Dose, five to twenty grains. Useful in dyspepsia, pain in the stomach, vomiting and diarrhœa. The drug is heavy, and therefore gum or starch water should be used to suspend it.
It is often combined with opium and bicarbonate of soda to check vomiting and diarrhœa.
Bismuth may also be used as a dusting powder.
Boric acid, or boracic acid.—Chiefly used in solution, for its mild antiseptic properties, as a gargle, injection, eye lotion, or mouth wash. On the same account, it is used for washing wounds, or syringing out ulcers, or sore and inflamed ears. It is practically non-poisonous.
Lotions should contain from five to ten grains to the ounce. Boric ointment is a useful dressing for sores, burns, or wounds; it may be made by adding one part of powdered boric acid to nine of vaseline or fat.
Equal parts of finely-powdered boric acid, zinc oxide and starch makes a good dusting powder for moist eczema, bed-sores, chafes, and perspiring feet.
Boric lint (lint impregnated with boric acid) is useful as a dressing for wounds, ulcers, and abrasions.
Boric wool is absorbent cotton-wool impregnated with boric acid, and is the most generally useful antiseptic wool.
Bromides.—The bromides generally used are those of potassium, or ammonium. Dose in either case, five to twenty-five grains. They are sedatives, and are used in convulsions, epilepsy, and delirium; they relieve headache, especially if taken with sal volatile, and may be combined with chloral (see [Chloral]). The bromide of ammonium is less depressing than the bromide of potassium.
Calcium sulphide, i.e., sulphurated lime.—Dose, a quarter to one grain three times a day. Useful for those who are suffering from boils or carbuncles.
* Calomel, or subchloride of mercury.—Dose, two to five grains. Calomel may be used in almost all cases requiring an aperient; its action will be assisted by giving fruit salt, or citrate of magnesia, four hours later. In cases of insensibility or delirium it is specially useful, for the powder may be placed on the back of the tongue, and it will be swallowed unconsciously.
Four grains of calomel may usually be given with advantage, at the beginning of a malarial attack.
In syphilis, one grain may be given two or three times a day; but its action should be watched, and if it causes salivation, tenderness of the gums, and a coppery taste in the mouth, it should be discontinued until these symptoms disappear.
Camphor.—Dose, two to five grains. Is a stimulant, and an antispasmodic; it helps to calm the nervous system. It is used in cholera and in fevers, and is taken for colds in the head.
Camphor is slightly soluble in water, and this solution makes a cooling lotion, which is useful for inflamed or painful parts. A lump of camphor is a good repellent for sand-flies.
Spirit of camphor consists of one part of camphor in ten of alcohol; the dose is ten to twenty drops.
Camphorated oil consists of one ounce of camphor in four ounces of olive oil, and makes a stimulating liniment for stiff and painful parts. A stronger liniment may be made by adding to this an ounce of spirit, and half to one ounce of solution of ammonia or oil of turpentine.
* Carbolic acid, or phenol.—Dose, one or two grains may be given internally, well diluted, for acute diarrhœa, dysentery, and cholera. Is mostly used as an external application. Carbolic acid acts as a caustic, and may be applied on the end of a match in the case of boils ([p. 227]). A drop on a piece of cotton-wool applied to a hollow tooth quickly relieves pain.
It is much used as an antiseptic lotion for wounds and foul sores, and for cleansing hands and instruments before operation.
One part in twenty of water makes a strong solution for cleansing instruments and disinfecting dysenteric and other stools.
One part in sixty may be used for sponging or syringing sores and wounds.
One part added to nineteen of olive, or other oil, makes carbolic oil, which is a handy dressing for all kinds of wounds.
One part to nineteen parts of vaseline, or fresh lard, makes carbolic ointment.
Cascara sagrada, extract of.—Dose, two to six grains. Is a valuable aperient, especially in chronic constipation. Cascara tablets, two grains each, are convenient, and one or two should be taken at night.
Cathartic Co. Tablets.—A useful purge in cases of fever or liver derangement. Two or three for a dose when required.
Castor oil.—Dose, one to three tablespoonfuls. It is a good aperient, but is not very convenient for the traveller, as it takes up much space, which could be better used for aperients which are not so bulky, e.g., calomel or cascara. The usual dose of castor oil should be somewhat reduced in the tropics, where it is often not so well borne as in temperate climates.
Note.—The seeds of the castor oil plant should not be eaten, as they are poisonous.
Chinosol is a drug which has many of the advantages of carbolic acid without its poisonous or caustic properties. It is so generally useful that, at any rate for explorers, it will largely replace carbolic acid. It is antiseptic and disinfectant in its action, can be used as a mouth wash or gargle, for sore gums and ulcerated throats; it makes a good lotion for washing the hands, instruments, or wounds, and may be syringed into fresh wounds or into chronic ulcers.
It is put up in the compressed form, each tablet weighing eight and three-quarter grains, and the strength of the solutions here given are calculated strictly from this weight.
One tablet dissolved in a pint of water makes a solution of 1 in 1000 (equal to about 1 in 40, carbolic lotion), which is the most useful for general purposes, such as an antiseptic wash for the hands or for disinfecting surgical instruments.
A tablet in two pints of water makes a solution of 1 in 2000. This may be used for washing fresh wounds, burns, and suppurating surfaces, or as a gargle for sore throat.
As a healing dusting powder, one part of chinosol may be mixed with ten of boric acid, and used in the same manner as iodoform powder.
To disinfect typhoid or dysenteric stools, dissolve four tablets in one pint of water and add the mixture to the vessel containing the motions.
* Chloral.—Dose, five to twenty grains. Relieves restlessness and delirium, and produces sleep. Larger doses than twenty grains should not be given. In severe convulsions, due to certain poisons, e.g., strychnine, twenty grains or more of bromide of potassium may be added to the full dose of chloral, and given either by the mouth or bowel.
* Chloroform.—Dose, one to five drops. Two to four drops can be given with advantage with almost any drug, as a flavouring agent, and on account of its antispasmodic action.
From two to four drops put on a piece of loaf sugar and sucked will often stop sea-sickness or other vomiting.
Spirits of Chloroform, or Chloric Ether, consisting of one part of chloroform in twenty parts of alcohol, is a convenient form in which to administer the drug. It is useful in sea-sickness, cramps and colic, and should be given in doses of twenty drops added to a teaspoonful of water every quarter of an hour, until six such doses have been given.
* Cocaine.—A one per cent. solution may be used to diminish pain in the eye caused by injury or a piece of grit lodging under the lids. Two drops should be applied to the eyeball, and in about two minutes the application may be repeated; in another minute the sensibility of the part will be diminished, and a careful examination may be made for dust or other foreign bodies, which should of course be cautiously removed.
Creosote.—Dose, one to two drops; is best given in a capsule. In many cases of indigestion it gives great relief if administered immediately after food. Creosote applied to a hollow tooth, upon a piece of cotton-wool, will usually relieve the pain.
Cresol.—This is a valuable disinfectant which is found on the market under several names.
* Croton Oil.—Dose, half to one or two drops, mixed with bread crumb or in a pill.
Is a powerful purgative not usually given to Europeans. Native carriers like it. Useful in the case of unconscious patients, given in butter.
Copaiba, Balsam of.—Dose, five to twenty drops three times a day. Is best taken in capsules. It increases the expectoration, and is therefore useful in bronchitis; is a stimulating disinfectant to the urine, bladder and pipe, and is used in gonorrhœa and inflammation of the bladder. It may produce an irritating rash on the skin if taken in too large quantities.
Emetics.—The following are the usual emetics:—
| Common salt, two tablespoonfuls | in half a pint of water. |
| Mustard, one tablespoonful | ” ” |
| Ipecacuanha, thirty grains | ” ” |
| Zinc sulphate, thirty grains | ” ” |
In the absence of any of the above, give copious draughts of tepid water, followed by tickling the back of the throat with the finger or a feather.
Emetine.—The active principle of ipecacuanha. Of great value in amœbic dysentery ([p. 187]).
Enema.—Nutrient enema:
- Two eggs,
- Half teaspoonful of salt,
- A wine-glassful of milk.
Beat up the eggs, then add the salt and milk, and mix well. Raise the hips and inject slowly through the long tube well up into the bowel.
Nutrient enema:
- Benger’s beef jelly, two tablespoonfuls,
- Milk, about three ounces.
Warm-water enema. To relieve uneasiness of lower bowel, as in dysentery, piles, etc., half a pint or more of warm water, by the short tube.
Soothing enema. Laudanum, thirty drops; warm water about two ounces. A little thin starch water or gum may be added. Inject through the short tube, and repeat the injection in three hours if patient is not easier.
Quinine enema. Quinine, twenty grains or more; warm water, about two ounces. If the patient does not retain the injection, give a second one within an hour. Select a soluble preparation of quinine, such as the bisulphate or the hydrobromide.
Aperient enema. Lather soap in thirty ounces of warm water, using plenty of soap to make a good solution; or use plain warm water or weak gruel; the addition of one or two tablespoonfuls of oil is of advantage. Inject slowly into the bowel with short tube; if it does not cause uneasiness, inject the whole amount. The injection should be retained as long as possible.
Epsom salts, or sulphate of magnesia. Dose, two teaspoonfuls or more. Is a saline purgative, giving a copious watery motion, rapid in its action, and useful in fevers or congestion of the liver. It also increases the flow of urine.
Recently has been much used in dysentery ([p. 189]).
Friar’s Balsam.—(Tinct. Benzoin Co.) Dose, thirty drops or more.
Internally is useful as an expectorant in bronchitis. Can also be employed as an inhalation.
Externally, lint soaked with it is an efficient dressing for wounds and sores. When first applied it causes a good deal of smarting, but this soon passes off.
Gall and opium ointment is a useful application for piles.
Gauze, antiseptic. The best dressing for wounds is some form of antiseptic gauze. Cyanide gauze, which is impregnated with cyanide of mercury, is the most generally used.
Ginger, essence of.—Dose, five to twenty drops. It is useful in cases of cramp, colic, and indigestion, especially if combined with five or ten grains of bicarbonate of soda and two or three drops of chloroform.
If there is much pain, ten drops or more of chlorodyne or laudanum may be added.
* Goa powder.—See [Araroba].
* Goulard water.—For external use only. Is astringent, and may be used as a lotion for inflamed joints. Is also useful as an injection in gonorrhœa and gleet, as a soothing lotion in herpes, shingles, eczema, discharge from the ear, and itching and chafes of all kinds. It should not be used as an eye lotion.
Goulard water is made by adding one part of Liquor Plumbi Subacetatis Fortis, or Goulard Extract, and one of alcohol to seventy-eight of water.
One of the tablets of the subacetate of lead added to a quarter of a pint of water (distilled when convenient) makes a solution similar to Goulard water.
Gum acacia is used for forming a mucilage with which to suspend such drugs as carbonate of bismuth. One part of gum to three of water should be made and strained before use. Starch may be used for the same purpose.
Hazeline.—Dose, thirty to one hundred and twenty drops. It is a powerful astringent. May be applied freely to bleeding parts, such as the nose, gums, piles, or small wounds. One tablespoonful of hazeline to five of water may be injected into the bowel for bleeding piles. Hazeline snow is an elegant preparation for sunburn and other skin affections.
Ichthyol.—An ointment containing twenty per cent. of ichthyol is very soothing in most skin diseases, such as eczema and psoriasis. The ointment is of service in reducing the pain and swelling of mosquito bites.
Iodide of potassium.—Dose, five to ten grains in the later stages of syphilis.
* Iodine, tincture of.—Dose, two drops in a teaspoonful of water; given every hour, is most valuable for obstinate vomiting.
Used externally, it acts as a counter-irritant, and should not be painted on too freely as it may cause blistering. Does good if painted over swollen joints or enlarged glands, but should not be applied if the skin there is broken. Tincture of iodine may be painted on the chest or over the liver or spleen if there is pain. It is a valuable application for all open, recent wounds, and may be painted freely over and round the raw surface. It relieves the irritation of mosquito bites.
Is very useful in certain diseases of the skin, such as ringworm, kraw kraw, and dhobie itch.
Iodoform powder is a valuable antiseptic, and is used for all kinds of sores, or wounds, in which it rapidly promotes healing. One part of iodoform to eight parts of vaseline makes a good healing ointment.
| Ipecacuanha.—Dose, | expectorant, | half to two grains. |
| ” | emetic, | fifteen to thirty grains. |
| ” | for dysentery, | twenty to forty grains or more. |
In small doses, e.g., a quarter to half a grain, is a stomachic and may check vomiting.
Was formerly much used in amœbic dysentery ([p. 187]). Its active principle, emetine, is now employed.
By causing free expectoration, it is very useful in bronchitis, and is then usually combined with ammonia.
Is contained in Dover’s powder, and in this form is useful in coughs and colds, as it helps to cause sweating.
Iron.—Iron is much used on account of its tonic and blood-forming properties. It is especially useful in anæmia following fevers and other exhausting diseases, and it also gives tone to the nervous system.
Most preparations of iron are astringent in their action, some such as the sulphate and perchloride being more so than others; these are, therefore, useful in diarrhœa and in bleeding from the gums and bowel. Iron by its astringent action may cause constipation, and it may be necessary to add a small amount of an aperient, such as Epsom salts, to each dose.
The following preparations are those generally used:—
Tincture or perchloride of iron, or tincture of steel.—Dose, five to fifteen drops in at least an ounce of water. Good blood tonic. Is very astringent, and is therefore useful in internal bleeding and looseness of the bowels. It is of value in erysipelas.
Sulphate of iron.—Dose, one to three grains. Is a powerful astringent and blood tonic, and often does good in checking the looseness of the bowels which remains after an attack of dysentery.
Iron pill or Blaud’s pill.—Dose, five to fifteen grains. Is one of the best tonic preparations of iron, as it is not very astringent. It is put up in tablet form.
Solution of dialysed iron.—Dose, ten to thirty drops. Is a good blood tonic, and, unlike most preparations, is not astringent.
Parrish’s food.—Dose, thirty to a hundred and twenty drops in water. Is a good preparation of iron for children.
Iron and arsenic compound tablets.—A useful tonic in convalescence from malaria, one taken three times a day after meals.
Mercurial ointment forms a useful application in certain skin diseases. As it is rather strong, it should be diluted with two parts of vaseline.
White precipitate, or ammoniated mercurial ointment.—Useful in the case of head lice and several parasitic skin diseases.
Naso-pharyngeal Tablets.—Useful in nasal catarrh and pharyngitis.
* Opium.—Is a valuable drug, but it is also a poison, and great care should be observed in using it. Opium is narcotic and sedative in its action; it relieves pain of all kinds. Useful in diarrhœa, dysentery, cramp and colic. Promotes perspiration and checks vomiting. Sometimes it will cut short a cold or mitigate an attack of malaria.
No preparation containing opium should be given to children without medical advice, and the same is true as regards persons suffering from kidney disease.
The chief preparations containing opium are:—
* Chlorodyne.—The ordinary dose is ten to fifteen drops, but if there is great pain, then even thirty or forty drops may be given, but a second dose should not be administered for three or four hours; if two full doses have been given, do not give a third within at least twelve hours of the second dose, and do not give it at all if the patient is drowsy.
It is best not to give more than forty to sixty drops in twenty-four hours, unless there are very special reasons for giving a larger quantity. Is to be preferred to laudanum, as it is more palatable and more readily stops vomiting.
* Laudanum, or tincture of opium.—The doses and uses are precisely similar to those of chlorodyne. Laudanum has been put up in the compressed form, and is very convenient for transport.
* Dover’s powder, or compound ipecacuanha powder.—Dose five to fifteen grains. It contains opium and a small amount of ipecacuanha. Ten grains of Dover’s powder are equal to about fifteen drops of chlorodyne or laudanum. The tablet is an extremely handy preparation. Dover’s powder is especially useful in coughs and colds, the ipecacuanha it contains assisting the action of the opium. If a patient who is chilled is put to bed at once, kept warm with blankets and hot-water bottles, and is given ten or fifteen grains with a hot drink, he will perspire, and possibly the cold will be cut short.
Peppermint, spirits of.—Dose, five to twenty drops. Is a valuable drug in cases of flatulence and dyspepsia, especially if combined with bicarbonate of soda; it also masks the taste of unpleasant medicines. For children, one drop of the spirit and one grain of bicarbonate of soda may be added to one teaspoonful of water, and this dose may be frequently repeated.
Pepsin tablets, a useful digestive product, taken with food when digestion is weak, or may be used to predigest it.
* Perchloride of mercury tablets, for making lotions for disinfecting wounds, etc.
Phenacetin.—Dose, three to eight grains. Phenacetin is used for headaches, or for reducing the temperature in malaria and other febrile diseases, and to cause sweating. As it is very insoluble, it is best taken in the form of a powder, or in alcohol and hot water.
Potassium, bromide of. See Bromides.
* Potassium permanganate in solid form is a mild caustic, and is the active principle of Condy’s fluid, which contains about eight grains of the drug in one ounce.
It is disinfectant, deodorant, and antiseptic.
One part of this drug is soluble in about twenty parts of water.
One grain gives a purple colour to a gallon of water. Impure water turns the purple rapidly to a brown colour, therefore the permanganate is a rough test for the presence of organic matter in water.
A pale purple solution is useful as a gargle or mouth wash, also as an injection in gonorrhœa; wounds may be cleansed with a similar solution.
It is especially useful in poisoned wounds, such as snake-bites, and should in these cases be injected hypodermically ([p. 281]).
Is an antidote to poisoning by opium.
Of late years it has been extensively used in the treatment and prevention of cholera. The two-grain tablet is a convenient form for medication.
Purgatives may be divided into the following classes:—
1. Laxatives.
2. Simple purgatives.
3. Drastic purgatives or cathartics.
4. Saline purges.
1. Laxatives slightly stimulate the movements of the bowel, but cause practically no increase of the intestinal secretion. Examples of this class are fruit, wholemeal bread, small doses of castor oil, figs, prunes, etc. These may be given regularly in slight cases of chronic constipation.
2. Simple purges are more powerful than laxatives, and in addition to stimulating the movements of the bowel increase the secretion. The result is a soft, easy motion. Examples: rhubarb, senna, cascara sagrada.
3. Drastic purgatives or cathartics. The drugs cause a profuse flow of the intestinal secretions, and, occasionally, of the bile, with greatly increased bowel movements. They cause a copious watery evacuation, accompanied by a good deal of griping. Examples: calomel, colocynth, aloes, podophyllin, croton oil, jalap and oil of turpentine; of these, podophyllin and aloes cause an increase in the flow of bile, with increased intestinal movements, so they may be said to act directly upon the liver. The result is a profuse, watery, bile-stained motion.
Calomel does not act directly upon the liver, but stimulates the upper part of the bowel, so that its contents are hurried along before the bile can be reabsorbed, and a loose, watery, bile-stained motion ensues.
The most useful purgative of this class is the pill containing colocynth, calomel, and hyoscyamus, of which five to ten grains should be given when there is a furred tongue, constipation, heaviness or weight over the liver, and dyspepsia and loss of appetite.
4. Saline purgatives. These cause a free secretion of the intestinal juices, and a copious motion, proportionate to the size of the dose, is the result. The principal saline purges are Epsom salts (i.e., sulphate of magnesia), Glauber’s salts (i.e., sulphate of soda), seidlitz powder, the various forms of fruit salts, and the aperient mineral waters, such as Rubinat, Hunyadi Janos, etc.
A saline purgative may be given in the morning, to assist the action of an aperient pill administered the previous night.
Saline purgatives are useful, too, in many cases of habitual constipation, and, if necessary, a small dose may be given every morning in a tumbler of warm water.
Quinine.—Quinine is chiefly used for malarial fever, and the urgency of the case must be the guide as to the amount to be administered. It is seldom necessary to give more than ten grains three times a day; at times enormous doses, such as thirty grains three times a day, have been given with advantage, but such doses are rarely necessary, and in the absence of a medical man should never be given.
The administration of quinine sometimes causes headache, deafness, delirium, and partial or even complete blindness. In such cases the dose should be reduced or the drug withheld until these symptoms have disappeared.
It has been stated that quinine causes blackwater fever; this, I believe, is absolutely untrue. I have seen cases of blackwater fever, apparently resulting from the neglect of malarious attacks, which date the commencement of their recovery from the first administration of quinine.
Quinine is best given in solution; the nauseous taste can be somewhat disguised by adding chloroform water or essence of ginger or lime juice to the solution. Many men take the drug in a little beer or spirit for the same purpose.
Quinine pills are, as a rule, very insoluble, therefore they are not suitable for explorers. Quinine in the form of a tablet, or in a capsule, or wrapped in tissue paper, acts well, but even tablets should be cracked or crushed. Sugar-coated products are inadmissible in the tropics.
Sometimes, owing to frequent vomiting or other cause, the quinine administered by the mouth cannot be retained. It must then be given by means of an enema or by injection into the muscles.
If the traveller decides to give an intra-muscular injection of quinine, he should only give five grains at a time. The dose should be added to about a teaspoonful of water which should then be boiled and allowed to cool. The amount of water is of little importance so long as enough is used to dissolve the drug, and keep it in solution when the water is cool enough to be injected. The less fluid, however, injected the better.
Injections are best made deeply into the muscles of the buttock. This is a method best left to a medical man, as there is danger of injuring the sciatic nerve.
The preparations of quinine.—Many preparations of quinine are made; they are all popularly known as quinine, their uses are similar, and the doses are as follows:—
| Dose, | one to five grains, | as a tonic. |
| ” | five or more grains | as a preventive of malaria. |
| ” | five to twenty grains, | in fevers. |
Sulphate of quinine.—This is the preparation most commonly used; but it is very insoluble in water, and should be given along with a little dilute acid.
Acid sulphate of quinine, sometimes called bisulphate, soluble or neutral sulphate of quinine.
The acid sulphate is much more soluble than the sulphate, and is a more suitable preparation for administration by the mouth or for injection into the bowel.
Hydrochloride of quinine.—Is a very soluble preparation, and contains a large percentage of quinine.
Quinine hydrobromide.—Is more soluble than the sulphate, and less liable to cause headache and other quinine symptoms.
Acid quinine hydrobromide.—Very soluble and non-irritating. Solubility, one in six of water.
Tannate of quinine.—Is a weak preparation, but suitable for children. Solubility, one in ten of water.
Acid quinine hydrochloride, or quinine bihydrochloride.—Is a very soluble preparation, and is suitable for hypodermic injection, but is somewhat expensive.
It is soluble in less than its own weight of water.
For administration by the mouth or bowel, the traveller is advised to take either the hydrochloride or the bisulphate of quinine.
For intra-muscular administration the acid quinine hydrochloride is generally used.
Rhubarb, either in form of compound rhubarb pill, one of the most useful of ordinary aperients, two to four for a dose.
Compound Rhubarb Powder, otherwise known as Gregory’s Powder.
Sandal-wood oil.—Uses and doses as for balsam of copaiba.
Soda, bicarbonate of.—Dose, five to ten grains or more. Five to ten grains dissolved in water may be given twice a day for acidity, flatulence, heartburn. Useful in dysentery to allay irritation of stomach; for this purpose five or ten grains may be given an hour before each dose of ipecacuanha.
If the urine is acid and scalding, give twenty grains three times a day. Bicarbonate of soda is given in cases of blackwater fever when the urine is not sufficient in quantity; in such cases at least twenty grains should be given every six hours.
Soda mint tablets, useful for relieving flatulence, one or two being taken after meals.
Sodium salicylate.—Dose, ten to twenty grains. Relieves pain in rheumatic fever. Lowers temperature. Its action must be carefully watched, as too large doses may cause headache, buzzing in the ears, and even delirium.
Sulphur.—An ointment containing one part of sulphur to nine of lard, grease, or vaseline, makes a useful application for itch and other skin diseases.
Tannin.—Tannin is a powerful astringent, and may be used internally or externally.
In five to ten grain doses it helps to stop diarrhœa, bleeding from stomach, bowel, piles, and bladder. If there is continued bleeding, increase the dose to twenty grains, and repeat it as often as necessary.
Voice tablets, consisting of chlorate of potash, borax and cocaine are useful in cases of sore throat.
Warburg’s tincture.—One tablet is equal to thirty drops of the ordinary tincture. Stronger tablets are also available.
To produce sweating, first open the bowels, then give four to eight of the tablets with a little hot spirit and water. If necessary, repeat the dose in three hours, and in either case withhold if possible food or drink till after this period has elapsed, but if the patient is very thirsty give hot drinks of weak tea or spirit and water. Keep him covered up and put a hot-water bottle in the bed.
Urgency of the case is a guide as to how many tablets ought to be given.
Zinc oxide alone or mixed with an equal quantity of boric acid or starch makes a useful drying dusting powder.
Zinc ointment contains three parts of zinc oxide to seventeen parts of lard or vaseline. This is a most useful application for burns, eczema, chafes and sores.
Sulphate of zinc.—As a prompt emetic, give twenty to thirty grains in half a pint of warm water. If patient does not vomit give a pint or more of warm water and tickle the back of the throat. A second dose of the drug may be given.
Two grains to an ounce of water makes a valuable astringent lotion for gonorrhœa, raw surfaces, ulcers, and inflamed eyes and ears. The strength of this solution may be gradually increased to six grains to the ounce of water.
Temperature Taking, Hypodermic Injection, Baths, Catheters, Stomach Tubes, Enemas, and Poultices.
Pulse, Respiration and Temperature.
Normal pulse rate (adult) about 72 per minute.
Normal respiration rate (adult), 15 to 18 per minute.
Normal temperature, 98.4° F., but varying in health between 97.5° and 99°.
Temperature Taking.
The temperature of the body may be taken in the armpit, the mouth, or the lower part of the bowel.
In the Armpit.—Dry armpit well, put the bulb of the thermometer into it, and press the arm tightly against the body, so that the thermometer will be in close contact with the skin on either side for at least five minutes.
In the Mouth.—Wash the thermometer in an antiseptic solution, dry it and place the bulb well under the tongue and close the lips on the stem; at least three minutes should be allowed. This is a more reliable way of taking the temperature than in the armpit.
In the Bowel.—If the patient is very ill and light-headed, it is not advisable to place the thermometer in the mouth, and when a patient is having a cool bath to reduce his temperature a reading will be needed at least every quarter of an hour; in these cases it is best to pass the end of the thermometer, which has been previously greased, about two inches up the bowel, and to leave it there for at least two and a half minutes.
Do not trust in half-minute or minute thermometers, always allow the full time given above. Before taking a patient’s temperature see that the mercury in the thermometer is shaken down at least as low as 97° F. After the temperature has been taken, note it down carefully, wash the thermometer, and shake the mercury down to 97° F. If the thermometer is washed in hot water, the expanding mercury may break it.
Hypodermic Injection.
The best place to inject is under the skin of the back or chest. The forearm is usually selected, but there are many objections to it. If the injection is made into the leg or arm, the point of the needle should be directed towards the body.
1. Surgical cleanliness must be observed. The hands of the operator and the skin of the patient at the spot chosen for injection must be properly cleaned with an antiseptic lotion, e.g., chinosol (1 in 1000) or carbolic acid (1 in 60). The site of injection may, as an alternative, be painted with iodine which, indeed, is the preferable method.
2. The hypodermic syringe and needle must be perfectly cleaned; if possible they should be boiled, or an antiseptic lotion, or alcohol (brandy or whisky) may be syringed through them.
3. The solution to be injected should be made in a clean, i.e., boiled, spoon, by adding the drug to boiled water.
4. Draw solution into the syringe, hold the syringe with the needle end pointing upwards, so as to allow any air to rise above the fluid, and push the piston up till all air has been driven out and the solution begins to come through the needle.
5. Pinch up the skin where the injection is to be made, push the needle well through and then under it, keeping the point slightly away from the skin until the needle is almost entirely covered. The point of the needle will now lie in the loose tissue—between the skin and the muscle—into which the fluid is to be injected.
6. Holding the needle firmly, slowly press the piston until the required amount has been injected; withdraw the needle slowly, keep the finger over the minute opening in the skin, so as to close it at once, and with another finger rub for a few seconds, where the fluid has been injected, in a direction away from the opening, to assist its absorption.
After giving an injection, wash out the syringe as before, dry needle well, and pass a piece of thin wire through it to keep it open. The needles are sent out with wire in them to keep the fine channel open; of course the wire must be removed before the needle is put on to the syringe.
As strong solutions of permanganate of potash attack the plunger of the piston, when this drug has been injected, the syringe should be well washed with water directly after its use.
Hypodermic tablets.—Solutions for injection are best made from tablets which are specially prepared for the purpose. A hypodermic tablet should be dissolved in about ten drops of hot water, but as each contains a definite amount of the drug, it does not matter in exactly how much water the dose is dissolved. In injecting certain preparations of quinine, which are not easily soluble, so much water may be required that two or three separate injections are necessary; there is no objection to this, the important thing is to have the quinine really dissolved.
Usually only medical men should administer hypodermic injections. Frequently it is not necessary to give a hypodermic injection, for the hypodermic tablet will be absorbed, and act almost as quickly if placed under the tongue.
The traveller may be called upon to use one of the following hypodermic injections:—
Permanganate of potassium. See Snake-bite, [p. 281].
Morphia. An injection of a quarter of a grain of morphia may be necessary when there is much pain. The soothing action of opium and chlorodyne is due to this substance.
Strychnine. See Snake-bite, [p. 282].
Baths, etc.
Cool Bath.—Lift the patient gently in a blanket into a long bath containing water at about 90° F., add water as cold as can be obtained, keep the water circulating and running out; one boy must pour water on to the head all the time.
If a long bath is not at hand, put a blanket over a waterproof sheet, and let the patient lie on it; get six or eight boys to hold up the edges, and give patient his bath in that way.
A good plan is to dig a shallow trench in the sand and to spread a waterproof in it; it is less difficult then to keep the edges of waterproof up as the patient is lying in a groove. It is not necessary to make the bath really cold if the cool water can be kept running. I have hardly ever been able, in Africa, to get the water below 80° F.
Note the bowel temperature, and as soon as it falls to 101° F., remove the patient from the bath and put him between warm blankets, and feed with some hot soup. If there are any signs of faintness, ammonia, or equal parts of strong spirit and water, must be given. Weak spirit and water has little or no stimulating effect on the heart, therefore, in cases of fainting, shock, exhaustion, or collapse from any cause, give a little spirit, and give it strong.
Wet Pack.—Slip a waterproof under patient, wring a sheet out of cold water and pass it under him and wrap him in it, cover with three or four blankets, and tuck him in. At first he will feel cold and chilly, but soon the surface vessels will dilate, and he will begin to feel hot, and very likely will sweat; keep him in the wet pack with the clothes carefully tucked in round the neck, feet and sides for about half an hour. Then partially dry the patient, and put him into bed between warm blankets and with hot-water bottles, and give hot drinks to encourage perspiration.
Catheters.
At least six silk-webbed catheters should be taken as part of the equipment. The most suitable sizes are, 2, 3, 4, 6, 8, 10. They should be packed in a separate box, and should be kept dry with French chalk or any other dusting powder.
Before use the catheter should lie for at least a quarter of an hour in an antiseptic solution such as chinosol (1 in 1000), and the solution should be frequently syringed through it. The catheter should then be lubricated with eucalyptus, vaseline, or carbolic oil, or, better, with boric acid ointment.
Let the patient lie down, and thoroughly wash the genitals, especially the opening of the pipe, with an antiseptic solution, the operator having carefully cleaned his own hands. Then pass the catheter gently down the pipe and into the bladder. The silk-web catheters are so flexible that unless force is used they can do no harm; begin with a No. 8 size, and if this cannot be passed, try a No. 4.
After use, wash the catheter as before, dry with a soft handkerchief, and dust it with powder. On no account should the catheters be greased when they are being put away. Neglect of cleanly precautions in passing catheters may lead to inflammation of the bladder and even more serious mischief.
Stomach Tube.
The stomach tube consists of a piece of india-rubber tubing about three feet long, with a funnel at one end. The method of passing it is as follows:—The patient’s jaws should be kept apart by a gag such as a piece of stick wrapped in lint placed between the back teeth on either side. The left forefinger should be passed into the patient’s mouth as far as possible and the tongue drawn forward; the rubber tube, oiled or smeared with vaseline or glycerine, should then be passed by the side of the finger and down the throat for about twenty inches, taking care to use no great force. The funnel is then raised and slowly filled with water; when all the water has run down, the funnel is lowered and the liquid in the stomach is drawn out by the syphon action of the tube. The process should be repeated till the water returning from the stomach is clear.
If the patient is unconscious the tube should not be passed except by a doctor.
Enemas.
Enema Syringe.—This is fitted with long and short tube. To use the long tube, slip it over the short one, which will hold it firmly. After use hang it up to drain, dry it well, but do not oil it; carry it loose rather than coiled up, so as to avoid risk of the rubber kinking at the flexed portions of the tube.
To give an enema, the patient should be placed on his left side, and brought close to the edge of the bed, with his knees slightly drawn up towards the belly. The pipe or nozzle of the syringe should be well oiled or smeared with vaseline, and then carefully introduced into the outlet of the bowel, and passed gently upwards for about three inches, great care being taken not to exert any force.
The higher up into the bowel a nutrient or medicinal injection is passed, the more rapidly will it be absorbed; therefore the long tube is to be preferred, and the hips should be raised on a pillow, to assist the patient in retaining the injection.
A nutrient or medicinal enema is usually small in quantity, about two to four ounces, in order to prevent its being rejected by the bowel, and is administered by means of a small ball syringe provided with a long nozzle.
Before giving a medicinal or nutrient enema, it is best to wash the lower bowel with warm water, and always see that the mixture to be injected is warmed to “blood heat.”
Poultices.
Linseed-meal poultice.—Mix four ounces of linseed meal into about half a pint of boiling water, constantly stirring until the mixture is smooth and even. A piece of tow, teased out to the required size, or a piece of linen or thin cloth, is placed upon a table, and the poultice turned out upon it; then spread evenly in a layer about three-quarters of an inch thick, leaving a margin of tow or linen about an inch wide all round. This margin should be folded over, and the poultice applied to the affected part—with the meal next the body.
An Ice poultice is made by mixing pounded ice and sawdust, and enclosing the mixture in a waterproof material such as a mackintosh or gutta-percha.