Medicine and Dressings for Wounds.

Medical stores.

On one of Nelson’s boat expeditions up a tropical river, the medical chest was unanimously voted a piece of lumber; but, before the arduous voyage had been completed, the only regret was that sufficient medicine had not been taken. An unmanly fear of fever, or other sickness, would probably aid in bringing it on, but reasonable precaution ought never to be neglected.

Many countries have an unenviable notoriety for the prevalence of peculiar and local diseases: some are perfect hotbeds of fever in various forms; and wounds from gunshot, sharp-edged tools or weapons, bruised and fractured bones, are casualties that may befall the traveller in any country, and therefore a few articles for the dressing of these should certainly find a place among his stores.

In case of wounds, cleanliness and repeated washing in cold or tepid water as may be best for the particular case, is the most generally successful treatment, and for this purpose plenty of sponge or flannel should be provided; the sponges should be of moderate size, perfectly clean from grit or bits of shell, close grained, and soft. Flannel is a good substitute; but if a piece of either is used for washing an unhealthy wound on one person, it should never again be used upon another, as it might convey infection, and, indeed, it would be much safer to destroy it utterly.

Lint is, of course, well known to be one of the best coverings for an injured part, and a good supply ought to be taken as, although the underclothing, or sometimes even the bedding, of the party, may supply bandages, very few travellers going on a serious exploration in a wild country would think of taking linen shirts, while sheets would be equally scarce among their bedding.

Cambric or lawn handkerchiefs would be good substitutes.

Calico, for bandages or rollers, would be more likely to be at hand in some parts of Africa, such as the Portuguese stations on the Zambesi, or at Great Fish Bay, where a wrapper of six feet square forms the dress of the native who borders on the possessions of the white man; while in Kafirland or Damaraland, where soft untanned leather is the prevailing dress, it would be less certain to form any considerable part of the equipment.

Adhesive plasters.—Of these perhaps common diachylon is the best; but in a hot country, like Africa, we have seen a roll of it soften during the journey, and, in exemplification of its name, sticking so fast together that it looked more like a field marshal’s baton than anything else, and the spreading out of it again into a sheet was a hopeless task. It would therefore be better to carry the diachylon in a gallipot, and spread it when required on thin cotton. Isinglass and court plaster are useful for keeping clean small hurts—the fluid obtained by boiling tendons in water spread on silk makes a very useful plaster—though, in trifling cases, we are in favour of letting the coagulated blood form the natural covering while the cut heals up beneath it.

Cerate, which may, on occasion, be made of beeswax and pure fat or oil, in such proportions as the temperature of the country may require, is very useful, spread on lint or linen, as a cooling ointment for sores that require to be kept soft.

Spongio pilene, a material composed of small fragments of sponge, attached to a backing of india-rubber sheeting, will be found valuable in applying hot or cold water to injured surfaces. It can be cut with readiness to any required size or shape.

During the Zambesi expedition, Dr. Kirk was provided with a good store of gutta-percha tissue, in sheets, for the purpose of covering poultices, moist applications, &c. The tissue should be cut much larger than the lint or other material, the moisture of which is to be confined. Other sheets were of various thicknesses, from that of writing paper up to cardboard or millboard, so as to give support, if necessary, as well as covering. He also carried gutta-percha splints for the leg or arm, properly fitted, for inside or outside, right or left; and cases might occur in which the possession of one of these, at the moment it was required, would be invaluable. They packed very easily one within the other, occupying little more room than so many flat sheets.

Millboard in strips, 18in. long and 6in. wide, for leg splints, or 15in. by 4in. for the arm, would stow easily, and by moistening would be easily moulded on the limb of a healthy person to the shape required. A few bandages, 3in. wide and 6ft. or 8ft. long, should be kept rolled up in the medicine chest; but if a store of calico is carried, there is no need to tear off more till they are wanted. (N.B. They should always be torn—not cut.) It is not to be expected that every traveller should carry or be able to use the formidable array of deadly looking keen-edged knives, of saws, and other instruments of torture; nevertheless, it would be prudent that a small selection should be taken, and we extract from a clever little work, “First Help in Accidents,” the following list:—

Small pocket cases containing all the requisite instruments are to be obtained of any surgical instrument maker. Among medicines quinine stands pre-eminent as an effectual, though perhaps not always an infallible, febrifuge; it is, however, so excellent a tonic that its moderate and occasional use may safely be recommended, and we do not know of a better remedy in case of fever. It is best dissolved in wine, if the traveller should be fortunate enough to be able to carry any. It may be given in rum or other spirit, which is more portable and likely to be at hand, and which is also useful for preserving insects; but if a man wants any peace while passing through most wild countries, or is doubtful of his own powers of self-denial, we would recommend him to convert all his wine into a strong solution of quinine before starting, and to do the same with half his rum or spirit of wine, having the rest strongly methylated for use, either in a spirit lamp or preservation of specimens. Let both these be labelled with a death’s head and cross bones, such as is used by chemists in the Cape and other countries, where many of the native population cannot read, or do not understand, English, to signify poison.

A proportion of wine or spirit may, of course, be reserved for prudent and moderate use, as a glass, or even a bottle judiciously given may go very far to gain the good will of a native chief, or to induce either the proper servants or occasional assistants of the traveller to work heartily in helping him out of some difficulty. We have generally found a good pannikin of hot coffee accepted readily enough by the people after a long night journey; but there are times when a fire could not be made, and a drop of spirit, imparting a momentary sensation of warmth, even if it produces no other good effect, has, at least, that of showing that their employer cares for them, and does what he can to cheer them after their labour.

In most tropical rivers there are extensive deltas, intersected with netlike labyrinths of shallow impracticable channels, alternated with shoals, which the advanced guard of mangroves is just reclaiming from the sea, and where tangled, dank, and unwholesome wildernesses and swamps are formed, there fever, in its most deadly forms, is sure to prevail.

The delta of the Zambesi is also a place of danger from this cause; and persons of a full stout habit are said, and we believe with some reason, to be more liable to fever than others of a spare and meagre build; indeed, the Portuguese, when they see a well-framed athletic man, in prime condition, enter the river, prophetically mark him as one of the first victims. We have ourselves suffered severely and continuously from this malady, which generally came on with a cold shivering or ague, and was succeeded by the fever, accompanied by intense perspiration, prostration of strength, nausea and inability to eat, or even to retain the necessary medicine or cooling drink; an immoderately exaggerated idea of the length of time; short uneasy slumbers, disturbed by incongruous dreams—generally of some difficulty previously experienced—or total want of sleep, total failure of memory, and in bad cases delirium while awake.

When the “Pearl” first entered the Zambesi Dr. Kirk ordered that a glass of spirit with quinine in it should be served to the men every morning; and we would frequently, as the large doses administered were intensely bitter, make up the quinine into pills, with chocolate or cocoa paste, or sometimes place the quinine powder dry on the tongue, and then swallow a copious draught of water to wash it down.

We give, first, Dr. Livingstone’s remedy for fever; but, useful and effective as it really is, we cannot say, from experience, that it is infallible; and the fatality among the gentlemen of the mission proves that we do not, as yet, possess a remedy for the fever that will supply the place of a sufficient and generous diet, total cessation of exposure to the malaria, and removal to a more elevated and healthy country, even though it be but a few hours’ journey from the infected district. The doctor’s receipt is as follows:—

“Linyante, 12th of September, 1855.

“A pill composed of three or four grains of resin of jalap, three or four of calomel, and an equal number of quinine; a drop or two of tincture of cardamoms to dissolve the resin to form the bolus.

“I have had a great many cases in hand, and never met with a single case of failure; it ought not to purge; the quantity of resin must be regulated to produce only a gentle movement, which, when felt, is accompanied by perspiration and a sound sleep. A check to this perspiration has, in my own experience, given rise to vomiting large quantities of pure blood.”

In another letter:—

“We make a pill of equal parts of resin of jalap, calomel, rhubarb, and quinine; say for a powerful man eight grains of resin of jalap, eight grains of calomel, four or six grains of rhubarb, and four or six grains of quinine; make the whole into pills with tincture of cardamoms. This relieves the very worst cases in a few hours.

“We then give quinine till the system is affected with cinchonism, the calomel is removed at once from the system, and, curiously enough, decreasing doses serve. In some of us half a grain of the mass produces as much effect as twenty-four grains did at first.”

A friend in Capetown, who had travelled in the Brazils, gave us the following receipt, used, we believe, by an Italian doctor; there he tells us it was efficacious, but we have not had opportunity to put it to the test:—

“To one bottle of water add 36grs. of sulphate of quinine, 2 teaspoonfuls of Epsom salts, 34 drops of sulphuric acid, and 40 drops of ether; this mixture is called antiperiodic water; a wine-glassful three times a day as soon as the first symptoms are perceived, and continued for three or four days after recovery. If delirious, an injection of 1 tablespoonful of vinegar to 10 of this water.”

Warburg’s fever drops are well spoken of. Very large doses of quinine are given in India and Africa, sixteen or twenty grains at a time; and we have frequently taken in powder as much as would lie upon a shilling.

Sometimes violent exertion, producing perspiration and exhaustion, if practised in time, may avert an attack. We have heard of a doctor visiting a man when the shivering fit was about to come on, who locked the door, mixed two glasses of stiff hot grog, put on the gloves, and engaged his patient in a boxing match, which, at least, for that time averted the fever.

We do not give our unqualified recommendation of this treatment; but we have often found that, during a period of severe and long sustained labour, we have remained in health, but that an attack of fever has accompanied the reaction induced by an intermission of the work.

Simple aperients should be taken; we have used Cockle’s anti-bilious pills, salts, senna, or jalap; and their opposites in case of diarrhœa. With a little opium and a bit of carpenter’s chalk, we have been able to give almost marvellous relief to a poor coloured woman in excruciating agony.

Take a good supply of Chlorodyne. Opium both in gum and tincture. A few drops of the latter, placed within the eyelids of those suffering from snow blindness, often prove of the greatest advantage; chloroform must be used with caution; still, in cases of great suffering, it is worth while to try it. We have known one exceedingly severe case of illness in which messengers had to be sent to every white man within 240 miles for medicines, and letters were written on the chance that some passing vessel might take them to a port whence by some other agency a supply of drugs might be forwarded.

Emetics, which are commonly sold in doses, white and grey, and of different degrees of strength.

Sudorifics—among which we have used Dover’s powders as a convenient form.

Eyewashes.—Weak solutions, sulphate of zinc and diacetate of lead, or weak brandy and water, may be used.

It may be needful to carry a small quantity of blistering plaster—or rather the materials of which to make it—soft wash-leather, ointment of Spanish fly, &c., or mustard.

Tincture of arnica, used in the proportion of one part tincture to eight parts water, is a valuable application for strains or contusions.

Glycerine, or cold cream, may be used as cooling applications to irritated surfaces.

Effervescing powders.—The blue paper contains carbonate of soda, 30grs.; the white, tartaric acid, 25grs. 1lb. of carbonate of soda, and 13½oz. of tartaric acid, make 256 powders of each sort; or, 1½oz. of carbonate of soda, and 3oz. of tartarised soda, packed in blue, and 7drs. of tartaric acid, in white, will make twelve sets.

All salts must be kept in bottles closely stoppered, and only put in paper for immediate use.

Antiscorbutics.—Almost any vegetable; plenty of sugar; fresh fruit; dried tamarinds; good lime juice, vinegar, or citric acid; raw potatoes, with the strong earthy taste as fresh as possible; the pulp of the cream of tartar tree or Baobab in Africa, or of the Gouty-stem (Adansonia Gregorii) in Australia. Dr. Kane, in his Arctic voyages, found fresh raw meat a remedy.

It will be well for the traveller to limit his equipment to a few simple and really useful medicines, of which a sufficient supply for the maladies to be expected in the country he is bound for should be taken. A complicated assortment would serve only to confuse him, and it is better even to trust solely to nature than to tamper unskilfully with dangerous remedies.

Poisons and antidotes.

Poisoning, whether from accident or otherwise, should always be provided for, and it will be well to be supplied with a few antidotes. Some poisons are best ejected by vomiting—draughts of salt or mustard and warm water, half a wine-glassful of ipecacuanha wine, or a glassful of warm water with twenty or thirty grains of sulphate of zinc. Antimonial preparations, as tartar emetic, are too depressing, and not controllable.

In others, the action on the stomach may be diminished by mucilaginous or oily drinks, as milk, barley water, white of egg, and salad oil.

For poisonous acids use no emetics; alkaline remedies are proper. Soda or potash in water, given plentifully; carbonate of magnesia, Dinneford’s solution, common whitening, or chalk in water, followed by some mucilaginous fluid, as milk or barley water.

Against alkalies, as potash, soda, &c., acids must be used—diluted vinegar, citric or tartaric acid, lemon juice or sour beer; soothing drinks as before, after the poison has been neutralised.

For metallic poisons an emetic may generally be tried.

For arsenic, avoid emetics. Take a mixture of milk and lime water, or soda water in equal quantities. Light magnesia diffused in water may be taken. Common animal charcoal may be tried.

For corrosive sublimate give white of egg and plenty of milk; if eggs are not at hand, use flour mixed with water.

Vegetable irritants.—Give an early emetic and demulcent drinks.

Narcotic poisons.—Opium. Give an emetic; pour cold water on the head and neck and shoulders; place mustard poultices on the calves of the legs or feet; give hot strong coffee and free air; keep the patient moving till drowsiness passes off.

Prussic acid in small doses.—Give ammonia or strong coffee; pour cold water on head and chest, rubbing dry with warm towels, and give free air; in large doses no treatment will avail.

Strychnine.—In Australia, South Africa, and some other countries strychnine is extensively used; and a correspondent thus writes in the Field concerning it:—“It sometimes happens that dogs are poisoned, accidentally or otherwise, by nux-vomica, or its alkaloid. It may not, therefore, be useless to inform the reader what treatment should be adopted in such a case. The poison acts very rapidly, tetanus comes on, and the dog soon dies, exhausted by the violence of the fits. If the poison have only been just taken, and no fits have occurred, the best remedy is tannin, in the form of pounded galls, or the areca-nut powder so much used in kennels. But if the dog be already seized with tetanus, the only remedy is the permanganate of potash. I have found, in several experiments on animals, that, when once the tetanic spasm has set in, permanganate of potash is the only remedy giving any chance of recovery; if administered in time it is most successful. Condy’s fluid, now so much used in the stable and kennel, is the most convenient form for its administration. A wineglassful of Condy’s fluid, slightly diluted, may be given. During the treatment the dog must be kept quiet, and touched as little as possible. This treatment, which has never yet been suggested (to my knowledge), I beg to offer to those readers who may be in need of it; but I cannot speak of its effects on the human subject.”

Alcohol in excess.—Evacuation of the stomach, followed by hot coffee, external stimulants and friction.

Suffocation by gases, &c.—Removal to pure air, cold water on face and chest, artificial inducement of respiration, friction of surface, followed by hot coffee or brandy and water.

Animal poisons—stings of insects, snake-bites, &c.—If a sting remains in the wound, extract it, and apply a strong wash of ammonia in spirit or water, or, in its absence, warm oil; if faintness follows, some stimulant, as brandy and water, may be given freely for snake-bites; in addition to this cauterise the wound with nitric acid or a white-hot iron.

The trappers of America place great dependance on strong whisky; if great exertion can be maintained, so as to produce excessive fatigue and perspiration, the system may throw off the poison.

In the Cape colony an antidote for snake-bites is sold under the name of Croft’s Tincture of Life. This was analysed, when we were in Grahamstown, by the faculty, and the ingredients they found were pronounced good; but there were others which the maker would not reveal. We have seen several testimonials as to its efficacy. The medical men, however, arranged a case somewhat larger than a fifty-likeness carte-de-visite album, containing lancet, ligature, cupping-glass, a bottle of ammonia, lint, and a piece of lunar caustic; but it was much too large to be carried about by any traveller in expectation of being bitten by a snake. We therefore took a small tin vesta match box, put a lancet, small bottle of ammonia, lunar caustic, in a stoppered bottle, lint, and ligature in it, and kept it in the waggon. We are happy to say we never had to put it to the test, for we were never bitten by a serpent. Sometimes a little judicious humouring of the patient does as much good as medicine.

In the Bushman country around Lake Ngami, where the entrails of the Ngwa or poisonous grub are used to give such fatal effect to the insignificant-looking arrows, a small plant with a yellow star-like flower, called the Kala-haetlwe, is used as an antidote. Fat is also rubbed into the wound and also given internally till the effect of the poison is neutralised.

The snake-stone of India, if it has any good qualities, seems to owe them entirely to its absorbent properties, and these would be more efficiently performed by scarification and the cupping glass.

Ipecacuanha, applied as a poultice, has been by some considered a most valuable antidote to snake-bites. This antidote is equally effective in the stings of scorpions and other venomous reptiles.

The fiction of the cup of rhinoceros horn, which caused all poisonous drink to effervesce and bubble over, is so firmly believed, that we have known a Cape trader offer to drink any poison we could give him out of such a cup; but we declined the experiment.

A preparation of the guaco plant is highly esteemed on the Spanish main as an antidote against bites of snakes of all kinds.

Acetic acid rubbed on the wound caused by the bite of scorpions or centipedes is very efficacious. In the absence of this, chewed tobacco is often made use of; but the natives are of opinion that the scorpion inflicting the wound crushed between two stones and laid on the injured part is a certain remedy, and, from what we have been enabled to learn from them on the subject, there seems to be some foundation for the belief.

Imaginary ailments of natives.

The imaginary ailments of natives are neither few nor far between; but it is not at all times wise to disregard them. We have known our followers come, night after night, with small sicknesses, when we had but a few doses of fever mixture left, and, by some chance or other, a little currie powder. Now, had we sent away a man with his “little sickness,” he would have been really ill next morning. We therefore looked as wise as possible, felt his pulse, looked at his tongue, read a paragraph or two, and sent him to boil some water and bring it to us; we then carefully measured out a spoonful of currie powder, mixed it, saw him drink it off, and sent him to make himself as warm as he could till next morning.

Horse Medicines and Farrier’s Stores.

If an expedition is about to be undertaken where the services of many horses or mules are required, a list of medicine stores should be furnished for them, which may be approximately as follows, the quantities being arranged for twenty animals for six months:—

Old flannel and sheeting for bandages, two or three sponges, a packet of pins, a hank of fine twine, six pieces of coarse tape, a pestle and mortar, set of scales and weights, palate knife, graduated measure, a quire of whitey-brown paper, two pairs of scissors, one straight and the other curved; a drenching-horn, phleam, lancet (horse size), glyster syringe (quart size), and blood can. Hoof picker, searcher, drawing knife, buffer, pincers, shoeing hammer, hoof rasp, and set of hobbles. The use of these matters will be treated on under the head of “[Veterinary Surgery].”