COMMON ERRORS IN DOMESTIC MEDICINE.
BY AN OLD PRACTITIONER.
Among the various passions which are inherent in the human breast, none is stronger or more evident than the desire which every one manifests to practise the healing art in some form or other, either on himself or—more frequently—on his fellow-creatures; a propensity which betrays itself in the gratuitous administration of physic, the infliction of minor surgery, or, if these suggestions be not favourably received by the patient, in copious advice of a hygienic nature. This is particularly the case with the gentler sex. Every woman is a physician at heart, and nothing is more refreshing than to sit and listen to two ladies in confidential medical conversation respecting the merits of their favourite nostrums. It is to them that homœopathy especially appeals. What more delightful spectacle can be found than that of a fair amateur ‘doctress’ with her book, her case of phials and little gold spoon, dispensing globules to her family, to her servants, to her neighbours, to any one and every one; and to enjoy at the same time the sweet reflection that she is not doing a particle of harm! Nevertheless, there are some not unfrequent mistakes in the application of so-called household remedies, excellent in themselves; and to call attention to these, and to a few popular fallacies on the subject of health and disease, is the object of the present paper.
Let us commence with that finest of domestic institutions, the poultice—bread, linseed, or mustard—soothing, fomenting, or stimulating, according to circumstances. There are few remedies in the pharmacopœia of wider beneficial application in surgery and medicine than this; yet terrible mischief often follows its injudicious use. A man has a cough, or his child wheezes with a ‘tightness on the chest,’ and on goes a poultice straightway. So far, so good; in all probability they wake up next morning greatly relieved. But the father is off to his daily business, and the child runs about and plays as usual, while—since they feel so much better—neither takes any precaution, by extra clothing or otherwise, to guard against the consequences of the poultice itself. The skin and subjacent tissues have been rendered lax by the heat and moisture, the blood-vessels are dilated, and the circulation of the part increased; to use a common expression, the ‘pores’ are open, and there is thus a tenfold liability to catch cold, especially in winter-time, when these things most frequently happen. Ordinary colds which are said to have ‘run’ into congestion of the lungs, bronchitis, or pneumonia, may often be traced to their serious or fatal termination through the undefended use of a poultice.
It should be borne in mind that a common poultice—such as is made of linseed meal or bread—is merely a vehicle for the application of damp heat—a continuous fomentation, in fact—and has no specific curative action. A muslin bag filled with bran, or flannels dipped in hot water, have precisely the same effect, but are not so conveniently employed, as they have to be more frequently renewed. A poultice should always be thoroughly mixed and homogeneous in consistence throughout; just so wet as to permit of its retaining the mould of the cup when turned out, but not wet enough to exude water by its own weight when lightly applied. A hot poultice should never be allowed to remain on after its outer part is less than the temperature of the blood, nor must it get dry and caked. As a general rule, it may be said that bread makes a better cataplasm than linseed meal, but requires to be changed oftener. There are, of course, special medical reasons in occasional cases for the preference of one or the other, but such instances scarcely come within the scope of this article. Well-mashed carrots make a capital soothing application, and a poultice composed of tea-leaves is, owing to its slight astringent action, generally suitable when one is required about the region of the eye. An abominable mixture of soap and sugar is very popular as a local remedy in some parts of England, and is credited with great ‘drawing’ properties. On the other hand, it is good to know that the old-fashioned liniment of hartshorn and oil is one of the best embrocations ever invented under ordinary circumstances, and that therapeutical research amongst all the drugs that the vegetable and mineral kingdoms afford has never discovered an improvement on salt and water as a gargle for simple sore throat.
What British home would be a home without its little roll of sticking or court plaster? How often is it that little tearful eyes look mistily down on a poor scratched finger, held carefully out in the other hand, as if there were some danger of its coming off, while mamma cuts a thin yellow strip and wraps it round the injured member with comforting words, all lamentation being temporarily reduced to an occasional sob in the interest of the operation. That the sticking-plaster exercises a fine moral effect in such a case, there can be no doubt; but I fear there is as little doubt that it often does more harm than good from a physical point of view, and this arises from the fallacious belief in it as a healing agent. The only real service that sticking-plaster does is to hold two cut surfaces together while Nature’s process necessary for their union is being completed, acting for a slight wound as stitches do in a deep one. But to cover an abrasion or raw surface with it is worse than useless, as it only irritates it. The plea is often advanced that it serves to keep dust and dirt off. A bit of wet linen rag, however, would be far better for that purpose.
Most of the ordinary household cures for chilblains are well enough in their way, but an unfortunate mistake is often committed in applying certain of them, which are fit only for the chilblains in their early stage, to broken ones, setting up thereby great inflammation and producing very painful sores. A broken chilblain is a little ulcer, and must be treated as such. As for the thousand-and-one remedies in vogue for corns, it is wonderful that they should exist at all, since nine people out of ten could cure their own without any application whatever, by wearing properly fitting boots and shoes. It is irregularity of pressure which creates corns; boots which are too big being as productive of the tiny torments as tight ones. A wet rag covered with oiled silk—to retain the moisture—and bound round the corn, is one of the best cures.
A very common but reprehensible practice is that of holding a burn as close to the grate as possible, ‘to draw the fire out’—not out of the fireplace—but from the injured part. It is quite feasible to conceive that such a proceeding may give ease by deadening sensation in some instances; but it by no means follows that it does good or expedites recovery—indeed, we shall see that in such a case the loss of sensation really proves further damage to the tissues. Burns have been divided by surgeons into six classes: (1) Simple scorching, sufficient only to redden the surface. (2) Blistering; the cuticle raised and forming little bladders of water. (3) The skin denuded of its cuticle. This is the most painful stage of all, as it leaves the nerve-ends exposed. (4) Destruction of the entire thickness of the skin; painless or nearly so, because the sensitive nerve-bulbs are destroyed. (5) Destruction of all the soft parts; and (6) charring of the bone—two conditions very difficult to imagine as co-existent with any remnant of life. It can thus be readily understood how a burn of the third order of magnitude can be converted by additional heat into the fourth, and temporary relief from pain purchased by transforming a trifling injury into a serious one, liable to be followed by severe illness and permanent deformity. A most mysterious cause of death after burns is the ulceration and bursting of a certain blood-vessel in the stomach. The connection between the two has never been discovered. People talk about this or that being good for a burn, but not for a scald, or vice versâ; but practically no distinction is to be drawn between the two, further than that, as we know the highest temperature of water, we know the utmost limit of injury in a scald, whereas there is no limit to the possibilities of a burn. To keep the air from both is the main object in treatment. Cook, who generally appears on the scene of the disaster with her flour-dredge, is a very efficient surgeon for burns and scalds of the first degree—this little scientific technicality will comfort the sufferer marvellously; but where the skin is raised or broken, something of an oily nature—Carron oil, for instance—should be substituted. Cover it up with lots of cotton-wool, as though you wished to keep it as warm as possible; and, mind, no soap and sugar on any account!
What is the origin of the popular idea that the finger-nails are poisonous to a wound? It does not do a wound much good to scratch it, or indeed touch it, but that is no reason why those useful little shields of our finger-ends should be so libelled. Whence comes the notion that to pierce a girl’s ears and compel her to wear earrings improves her eyesight? Possibly this may have arisen from the fact that medical men sometimes put blisters behind the ears as counter-irritants, to relieve some chronic ophthalmic disorders. Why is a glass of hot rum-and-water with a lump of butter in it not only familiarly prescribed for but familiarly swallowed by catarrh-afflicted mankind? Speaking of colds generally, we may remark in passing that treacle posset, hot gruel, putting the feet in mustard-and-water, &c., are all capital things, but that they effect only the one object of inducing perspiration. There is nothing specifically curative about any of them. It is a mistake, however, to give spirits, negus, or any alcoholic fluids in influenza colds where there is much congestion of the mucous membranes, as it increases the incidental headache.
Some people fancy that a magnet will draw out a needle, broken off short in the hand, even when it has passed in altogether out of sight. When a medical practitioner is called upon to extract a broken needle, he usually finds that it has been driven beyond reach by injudicious squeezing and other futile home-attempts at extraction, for the lightest touch makes a needle travel. A very troublesome class of case this is, owing to the uncertainty of its exact situation, of the direction of its long axis, and of its even being there at all—each sufficient to create the disagreeable possibility of cutting into the flesh without finding it. In such a state of affairs, one might as well put a magnet in the mouth to draw one’s boots on, as to expect to extract the needle by its influence. But a celebrated surgeon, Mr Marshall, has devised an ingenious application of this force for the purpose of detection. A powerful magnet is held upon the part which contains the suspected needle for some time, so as to influence it. Then a finely-hung polarised needle is suspended over it, and is immediately deflected, if any metal be concealed beneath. Never press or squeeze the flesh about a broken needle or bit of glass. If you cannot lay hold of it with the fingers or scissors, or, still better, a pair of tweezers, and pull it right out at once, keep quite still until a doctor has seen it. By so doing, you may save yourself weeks or months of pain, and even possible amputation of a limb.
Tea if taken in excess is indigestible and nerve-destroying; but in sickness this delightful fluid gives a temporary stimulus to the brain, and though possessing no feeding qualities in itself, it prevents or retards the waste of tissue—a property of considerable importance in illness where but little food is taken. Above all, the fact of being allowed one favourite beverage, albeit greatly diluted, when everything else that pertains to the routine of daily life seems interdicted or upset, has a beneficial effect on the patient, who welcomes his cup of weak tea with something of the anticipation of that refreshment and social enjoyment he derives from it under brighter circumstances.
‘Is the bone broken, or only fractured, doctor?’ is an anxious question often asked apropos of an injured limb. Broken and fractured are synonymous terms in surgery, my dear madam—it is always a lady who asks this—but I think I know what you mean. A fully developed bone is rarely cracked—nearly always it snaps in two pieces—but the soft cartilaginous bones of children sometimes sustain what is called a ‘green-stick fracture,’ a name which almost explains itself, meaning that the bone is broken through part of its thickness, but not separated, as happens with the green bough of a tree. Many people have a totally erroneous idea, when an arm or leg is badly bruised only, that it would be better if it were broken. ‘Right across the muscle, too!’ implies that an injury has been received across the upper arm in the region of the biceps, that being the only ‘muscle’ which is honoured by general public recognition. How many people know that what they call their flesh, and the lean part of meat, is nothing but muscles, the pulleys by which every action of the body is performed? Common mistakes lie in trying to ‘walk off’ rheumatism, sprains, and other things which should be kept entirely at rest; and in squeezing collections of matter which have burst or been lanced, with a view to hasten their healing by the more speedy emptying of their contents.
Of late years, the Latin or other scientific equivalents for diseases have crept into general use, with the curious result that in many cases they are taken to mean different things. Scarlatina, for instance, not only sounds much nicer than scarlet fever, but is often considered to be that disease in a milder form; and the identity of pneumonia with inflammation of the lungs, or of gastric with typhoid fever, or of the various terms ending in ‘itis’ with the inflammation they are intended to specify, is far from being universally recognised. Abscess is a better word than ‘gathering;’ and though, on the other hand, ‘tumour’ seems very dreadful, we may find consolation in remembering that after all it only means a swelling, whatever the nature may be, from a gum-boil to a cancer. There is much in a name. Dipsomania sounds much better than the other thing; and kleptomania by any other name would not smell so sweet. Much in a name? I should think so. Read what follows, if you doubt it. When a ship arrives in an English port from abroad, before those on board are allowed to have any communication with the shore, the ship must be declared healthy by the sanitary authorities, who accordingly board her at once, inspect her bills of health, and especially the list of those who have been ill during the voyage. If any of these are entered on the sick-list as having suffered from intermittent fever, printed forms have to be filled up, declarations made and signed, certificates written out, all sorts of questions answered about whether their bedding or clothing has been destroyed; and the men themselves paraded on deck for inspection. But if it is stated, instead, that they have suffered from ague—only another word for intermittent fever—then no notice is taken of it!
After all, there is very little rationale in any amateur system of medicine; all its treatment is purely empirical, and has its root in that love of mysticism which prevails in everything. Medicine, like every other science, is built up of hard, unromantic facts, amenable to the laws of logic and common-sense. The popular idea runs always on specifics. Every bottle in a druggist’s shop is supposed to contain a definite remedy for a definite disease; and the patient weaving of link with link in a chain of logical inferences, of the correlation of causes and effects, which constitutes medical science, is unknown. ‘What’s good for so-and-so?’ is a query constantly put to a doctor; and if he answers honestly, he must confess that in nine cases out of ten he can give no absolute reply, but must preface his words with, ‘That depends!’ Take two very frequent illustrations by way of conclusion. What is ‘good for’ indigestion? and what for a headache? But what is indigestion? Not a disease, but a generic name for fifty different diseases, all attended with the same symptoms in some measure, but proceeding from not only different but often entirely opposite causes. Thus, the pain may be produced by a deficiency or by an excess of the gastric juice; and by any derangement, from a simple error in diet to a cancer; and it requires the practised eye, ear, and hand of the physician to detect and appreciate those minute differences which point to the root of the evil. As for a headache, such a complaint hardly exists per se, but is almost invariably a symptom only of some other disorder; and we all know how many varying states of the body will give us headache. Nevertheless, may the practice of domestic medicine and the virtues which go with it long continue in our midst, and let no man be so ill-advised as to banish the harmless little medicine-chest with its associations from his hearth.