Backwoods Surgery & Medicine

by Charles Stuart Moody

In profound typhoid states the breathing is very much slowed and irregular, at last presenting what is known as the Cheyne-Stokes respiration, in which the patient will breathe several short shallow respirations, pause for a time, heave a deep sigh and then repeat the rapid breathing. This type of breathing is looked upon as a very grave symptom in all conditions characterized by lack of physical strength.

It will be readily appreciated that only enough discussion of symptoms has been given above to aid somewhat in arriving at a diagnosis. To go deeply into physical indications of diseases would be manifestly out of place in an article of this character. We will now proceed to the consideration of the diseases that will be most frequently encountered in the camp. Of these the intestinal troubles stand pre-eminent. Change of water, food, methods of life, and personal habits account for the fact that nearly every person who seeks the outdoors at some time during his stay is afflicted with some one of the diarrheas. Without attempting to go deeply into the various classifications of the enteric complaints, a brief résumé of the guiding symptoms common to all will be given.

It matters very little so far as the treatment is concerned whether it be an ileo-colitis, an ileitis, or simply colitis. The same treatment would obtain in each case, and the same general trend of symptoms would be present. The patient feels a general indisposition, loss of appetite, headache, and sleeplessness, which is followed by pain and griping in the bowels; then comes the diarrhea, which may be profuse and watery or scanty and accompanied by much pain. The evacuations become exceedingly frequent, sometimes as many as fifty or sixty per day.

The patient vomits frequently and is quite ill, his face becomes pinched and dusky, with an anxious look in the eyes. There is some fever and thirst, though the water drunk is generally vomited. In the above has been pictured an extreme case of summer diarrhea. There will be all gradations below this, from a mere soreness of the abdomen and looseness of the bowels up to profound prostration from constant drain on the system induced by the evacuations.

By a sort of strange medical paradox, in order to stop the evacuations it becomes necessary to increase them. We must sweep out the nest of troublesome bacteria that are causing the disturbance. An ordinary cathartic will not accomplish this. It is necessary to administer something that will produce a profuse watery discharge from the bowels. Nothing accomplishes this better than a heaping tablespoonful of Epsom salts in hot water, but as we have not provided for such bulky medicines in our case we will give our patient one tablet of elaterin which will accomplish the same purpose.

Then, too, the patient is not nearly so liable to vomit the elaterin. If he does, however, the vomiting can be controlled by the administration of cocaine by the mouth, though this latter drug must be used very cautiously. A tablet of 1/4 gr. cocaine hydrochlorate given in a swallow of hot water will stop vomiting until the other remedies can produce their effect. Before giving any other medicines await the free action of the cathartic.

The patient should have at least three very copious discharges; then begin to combat the inflammatory condition that exists in the bowels. The chlorodyne tablet will in all ordinary cases, do this best of all your remedies. There will be some few instances where it will be necessary to resort to more powerful remedies; in that case the Sun Cholera tablet given according to directions is the best. As an after treatment in these cases the intestinal antiseptic gives the best results. A tablet every four hours for two days will annihilate every vestige of bacterial invasion that may remain.

Bronchial and pulmonary diseases supply a large percentage of the camp ailments in the fall and early winter during the deer hunting season. An attack of pneumonia following a severe drenching from being out all day in a rain, or accidentally tumbling into the creek, is not a pleasant thing to contemplate. It usually comes in the night. The patient wakes out of a sound sleep with a chill. There is a sharp sticking pain as though a knife were being thrust between the ribs, at some point on the chest wall. The breath comes in short gasps and the patient instinctively turns toward the affected side in order to ease the pain.

The chill may or may not be followed by vomiting, and the fever lights up immediately, rising to 102–4° F. A distressing short cough comes along to add to the discomfort as each act of coughing increases the pain in the chest. In less than twenty-four hours the patient begins to expectorate what we call "prune-juice" mucus, that is, mucus streaked with blood until it resembles the juice of cooked prunes. When you see this "prune-juice" you need have no doubt as to the diagnosis. You should, however, have been busy long before this.

There is no doubt now among educated physicians that pneumonia, taken in time, can be aborted. When the pain first manifests itself set somebody to baking hot cakes made from flour stirred with water. While these are still as hot as can be borne lay them over the painful spot on the lung, renewing as fast as they become cool. To accomplish much good this treatment must be kept up until the period of expectoration and even after, at least twenty-four hours. At the same time begin by administering calomel in 1/4 gr. doses every thirty minutes until at least three grains have been given.