,the ,home ,medical ,library ,by ,,kenelm ,,winslow1 ,b4,a4,s41 ,m4,d4 ,formerly ,assistant ,professor ,comparative ,therapeutics1 ,harvard ,university2 ,late ,surgeon to the ,newton ,hospital2 ,fellow of the ,massachusetts ,medical ,society1 etc4 ,with the ,cooeperation of ,many ,medical ,advising ,editors and ,special ,contributors ,,in ,,six ,,volumes ,first ,aid 33 ,family ,medicines 33 ,nose1 ,throat1 ,lungs1 ,eye1 and ,ear 33 ,stomach and ,bowels 33 ,tumors and ,skin ,diseases 33 ,rheumatism 33 ,germ ,diseases ,nervous ,diseases 33 ,insanity 33 ,sexual ,hygiene ,woman and ,child 33 ,heart1 ,blood1 and ,digestion ,personal ,hygiene 33 ,indoor ,exercise ,diet and ,conduct for ,long ,life 33 ,practical ,kitchen ,science 33 ,nervousness and ,outdoor ,life 33 ,nurse and ,patient ,camping ,comfort 33 ,sanitation of the ,household 33 ,pure ,water ,supply 33 ,pure ,food ,stable and ,kennel ,,new ,,york ,the ,review of ,reviews ,company #aijg ,medical ,advising ,editors ,managing ,editor ,,albert ,,warren ,,ferris1 ,a4,m41 ,m4,d4 ,former ,assistant in ,neurology1 ,columbia ,university2 ,former ,chairman1 ,section on ,neurology and ,psychiatry1 ,new ,york ,academy of ,medicine2 ,assistant in ,medicine1 ,university and ,bellevue ,hospital ,medical ,college2 ,medical ,editor1 ,new ,international ,encyclopedia4 ,nervous ,diseases ,,charles ,e4 ,,atwood1 ,m4,d4 ,assistant in ,neurology1 ,columbia ,university2 ,former ,physician1 ,utica ,state ,hospital and ,bloomingdale ,hospital for ,insane ,patients2 ,former ,clinical ,assistant to ,sir ,william ,gowers1 ,national ,hospital1 ,london4 ,pregnancy ,,russell ,,bellamy1 ,m4,d4 ,assistant in ,obstetrics and ,gynecology1 ,cornell ,university ,medical ,college ,dispensary2 ,captain and ,assistant ,surgeon 7in charge71 ,squadron ,a1 ,new ,york ,cavalry2 ,assistant in ,surgery1 ,new ,york ,polyclinic4 ,germ ,diseases ,,hermann ,,michael ,,biggs1 ,m4,d4 ,general ,medical ,officer and ,director of ,bacteriological ,laboratories1 ,new ,york ,city ,department of ,health2 ,professor of ,clinical ,medicine in ,university and ,bellevue ,hospital ,medical ,college2 ,visiting ,physician to ,bellevue1 ,st4 ,vincent's1 ,willard ,parker1 and ,riverside ,hospitals4 ,the ,eye and ,ear ,j4 ,,herbert ,,claiborne1 ,m4,d4 ,clinical ,instructor in ,ophthalmology1 ,cornell ,university ,medical ,college2 ,former ,adjunct ,professor of ,ophthalmology1 ,new ,york ,polyclinic2 ,former ,instructor in ,ophthalmology in ,columbia ,university2 ,surgeon1 ,new ,amsterdam ,eye and ,ear ,hospital4 ,sanitation ,,thomas ,,darlington1 ,m4,d4 ,health ,commissioner of ,new ,york ,city2 ,former ,president ,medical ,board1 ,new ,york ,foundling ,hospital2 ,consulting ,physician1 ,french ,hospital2 ,attending ,physician1 ,st4 ,john's ,riverside ,hospital1 ,yonkers2 ,surgeon to ,new ,croton ,aqueduct and other ,public ,works1 to ,copper ,queen ,consolidated ,mining ,company of ,arizona1 and ,arizona and ,southeastern ,railroad ,hospital2 ,author of ,medical and ,climatological ,works4 ,menstruation ,,austin ,,flint1 ,,jr41 ,m4,d4 ,professor of ,obstetrics and ,clinical ,gynecology1 ,new ,york ,university and ,bellevue ,hospital ,medical ,college2 ,visiting ,physician1 ,bellevue ,hospital2 ,consulting ,obstetrician1 ,new ,york ,maternity ,hospital2 ,attending ,physician1 ,hospital for ,ruptured and ,crippled1 ,manhattan ,maternity and ,emergency ,hospitals4 ,heart and ,blood ,,john ,,bessner ,,huber1 ,a4,m41 ,m4,d4 ,assistant in ,medicine1 ,university and ,bellevue ,hospital ,medical ,college2 ,visiting ,physician to ,st4 ,joseph's ,home for ,consumptives2 ,author of ,consumption3 ,its ,relation to ,man and ,his ,civilization2 ,its ,prevention and ,cure4 ,skin ,diseases ,,james ,c4 ,,johnston1 ,a4,b41 ,m4,d4 ,instructor in ,pathology and ,chief of ,clinic1 ,department of ,dermatology1 ,cornell ,university ,medical ,college4 ,diseases of ,children ,,charles ,,gilmore ,,kerley1 ,m4,d4 ,professor of ,pediatrics1 ,new ,york ,polyclinic ,medical ,school and ,hospital2 ,attending ,physician1 ,new ,york ,infant ,asylum1 ,children's ,department of ,sydenham ,hospital1 and ,babies' ,hospital1 ,n4 ,y42 ,consulting ,physician1 ,home for ,crippled ,children4 ,bites and ,stings ,,george ,,gibier ,,rambaud1 ,m4,d4 ,president1 ,new ,york ,pasteur ,institute4 ,headache ,,alonzo ,d4 ,,rockwell1 ,a4,m41 ,m4,d4 ,former ,professor ,electro-,therapeutics and ,neurology at ,new ,york ,post-,graduate ,medical ,school2 ,neurologist and ,electro-,therapeutist to the ,flushing ,hospital2 ,former ,electro-,therapeutist to the ,woman's ,hospital in the ,state of ,new ,york2 ,author of ,works on ,medical and ,surgical ,uses of ,electricity1 ,nervous ,exhaustion 7,neurasthenia71 etc4 ,poisons ,e4 ,,ellsworth ,,smith1 ,m4,d4 ,pathologist1 ,st4 ,john's ,hospital1 ,yonkers2 ,somerset ,hospital1 ,somerville1 ,n4 ,j42 ,trinity ,hospital1 ,st4 ,bartholomew's ,clinic1 and the ,new ,york ,west ,side ,german ,dispensary4 ,catarrh ,,samuel ,,wood ,,thurber1 ,m4,d4 ,chief of ,clinic and ,instructor in ,laryngology1 ,columbia ,university2 ,laryngologist to the ,orphan's ,home and ,hospital4 ,care of ,infants ,,herbert ,b4 ,,wilcox1 ,m4,d4 ,assistant in ,diseases of ,children1 ,columbia ,university4 ,special ,contributors ,food ,adulteration ,s4 ,,josephine ,,baker1 ,m4,d4 ,medical ,inspector1 ,new ,york ,city ,department of ,health4 ,pure ,water ,supply ,,william ,,paul ,,gerhard1 ,c4,e4 ,consulting ,engineer for ,sanitary ,works2 ,member of ,american ,public ,health ,association2 ,member1 ,american ,society ,mechanical ,engineers2 ,corresponding ,member of ,american ,institute of ,architects1 etc42 ,author of ,house ,drainage1 etc4 ,care of ,food ,,janet ,,mckenzie ,,hill ,editor1 ,boston ,cooking ,school ,magazine4 ,nerves and ,outdoor ,life ,s4 ,,weir ,,mitchell1 ,m4,d41 ,,ll4,d4 ,,ll4,d4 7,harvard1 ,edinburgh1 ,princeton72 ,former ,president1 ,philadelphia ,college of ,physicians2 ,member1 ,national ,academy of ,sciences1 ,association of ,american ,physicians1 etc42 ,author of essays3 ,injuries to ,nerves1 ,doctor and ,patient1 ,fat and ,blood1 etc42 of scientific works3 ,researches ,upon the ,venom of the ,rattlesnake1 etc42 of novels3 ,hugh ,wynne1 ,characteristics1 ,constance ,trescott1 ,the ,adventures of ,francois1 etc4 ,sanitation ,,george ,m4 ,,price1 ,m4,d4 ,former ,medical ,sanitary ,inspector1 ,department of ,health1 ,new ,york ,city2 ,inspector1 ,new ,york ,sanitary ,aid ,society of the #ajth ,ward1 #ahhe2 ,manager1 ,model ,tenement-houses of the ,new ,york ,tenement-house ,building ,co41 #ahhh2 ,inspector1 ,new ,york ,state ,tenement-house ,commission1 #ahie2 ,author of ,tenement-house ,inspection1 ,handbook on ,sanitation1 etc4 ,indoor ,exercise ,,dudley ,,allen ,,sargent1 ,m4,d4 ,director of ,hemenway ,gymnasium1 ,harvard ,university2 ,former ,president1 ,american ,physical ,culture ,society2 ,director1 ,normal ,school of ,physical ,training1 ,cambridge1 ,mass42 ,president1 ,american ,association for ,promotion of ,physical ,education2 ,author of ,universal ,test for ,strength1 ,health1 ,strength and ,power1 etc4 ,long ,life ,,sir ,,henry ,,thompson1 ,bart41 ,f4,r4,c4,s41 ,m4,b4 7,lond47 ,surgeon ,extraordinary to ,his ,majesty the ,king of the ,belgians2 ,consulting ,surgeon to ,university ,college ,hospital1 ,london2 ,emeritus ,professor of ,clinical ,surgery to ,university ,college1 ,london1 etc4 ,camp ,comfort ,,stewart ,,edward ,,white ,author of ,the ,forest1 ,the ,mountains1 ,the ,silent ,places1 ,the ,blazed ,trail1 etc4 ,illustration3 ,a ,,desirable ,,method ,,of ,,carrying ,,the ,,injured4 ,by this plan even the unconscious victim of an accident may be transported a long distance1 because the bearers' hands are left entirely free and thus prevented from becoming cramped or tired1 as when a seat is made with clasped hands4 ,in the method illustrated above the patient is placed in a seat made by tying a blanket1 sheet1 rope1 or strap in the form of a ring4 ,each bearer then places his inner arm about the patient's body and with his outer hand holds the patient's arm around his neck4 ,the ,home ,medical ,library ,volume ,i ,,first ,,aid ,,in ,,emergencies ,by ,,kenelm ,,winslow1 ,b4,a4,s41 ,m4,d4 7,harv47 ,formerly ,assistant ,professor ,comparative ,therapeutics1 ,harvard ,university2 ,late ,surgeon to the ,newton ,hospital2 ,fellow of the ,massachusetts ,medical ,society1 etc4 ,,assisted ,,by ,,albert ,,warren ,,ferris1 ,a4,m41 ,m4,d4 ,former ,assistant in ,neurology1 ,columbia ,university2 former ,chairman1 ,section on ,neurology and ,psychiatry1 ,new ,york ,academy of ,medicine2 ,assistant in ,medicine1 ,university and ,bellevue ,hospital ,medical ,college2 ,medical ,editor1 ,new ,international ,encyclopedia ,,germ ,,diseases ,by ,,kenelm ,,winslow1 ,b4,a4,s41 ,m4,d4 7,harv47 ,,new ,,york ,the ,review of ,reviews ,company #aijg ,copyright1 #aijg1 by ,,the ,,review ,,of ,,reviews ,,company ,,the ,,trow ,,press1 ,,new ,,york ,contents ,,part ,i ,,chapter ,,page ,i4 ,,restoring ,,the ,,apparently ,,drowned #bg ,reviving the ,patient--,how to ,expel ,water from the ,stomach and ,chest--,instructions for ,producing ,respiration--,when ,several ,workers are at ,hand--,when ,one must ,work ,alone--,how to ,save a ,drowning ,person4 ,,ii4 ,,heat ,,stroke ,,and ,,electric ,,shock #ci ,first-aid ,rules--,symptoms of ,heat ,exhaustion--,treatment of ,heat ,prostration--,what to ,do in ,case of ,electric ,shock--,symptoms--,artificial ,respiration--,mortality in ,lightning ,strokes4 ,,iii4 ,,wounds1 ,,sprains1 ,,and ,,bruises #ej ,treatment of ,wounds--,bleeding from ,arteries and ,veins--,punctured ,wounds--,oozing--,lockjaw--,bruises-- ,abrasions--,sprains and ,their ,treatment--,synovitis-- ,bunions and ,felons--,weeping ,sinew--,foreign ,bodies in ,eye1 ,ear1 and ,nose4 ,,iv4 ,,fractures #hj ,how to ,detect ,broken ,bones--,fracture of ,rib and ,collar ,bone--,instructions for ,applying ,dressings--,bandage for ,broken ,jaw--,fracture of ,shoulder-blade1 ,arm1 ,hip1 ,leg1 and ,other ,bones--,compound ,fractures4 ,v4 ,,dislocations #aah ,varieties of ,dislocations--,method of ,reducing a ,dislocated ,jaw--,a ,dislocated ,shoulder--,indications when ,elbow is ,out of ,joint--,dislocation of ,hip1 etc4--,forms of ,bandages4 ,,vi4 ,,ordinary ,,poisons #aci ,unknown ,poisons--,symptoms and ,antidotes--,poisoning by ,carbolic and ,other ,acids--,alkalies--,metal ,poisoning--,aconite1 ,belladonna1 and ,other ,narcotics--,chloral--,opium1 ,morphine1 ,laudanum1 ,paregoric1 and ,soothing ,sirups--,tobacco1 ,strychnine1 etc4 ,,vii4 ,,food ,,poisons #adg ,poisons in ,shellfish and ,other ,food--,symptoms and ,remedies--,how ,bacteria are ,nourished--,infected ,meat and ,milk--,treatment of ,tapeworm--,trichiniasis--,potato ,poisoning4 ,,viii4 ,,bites ,,and ,,stings #aee ,country and ,city ,mosquitoes--,how ,yellow ,fever is ,communicated--,treatment of ,mosquito ,bites--,bee1 ,wasp1 and ,hornet ,stings--,lice--,fleas and ,flies--,centipedes and ,scorpions--,spiders--,poisonous ,snakes--,cat and ,dog ,bites4 ,,ix4 ,,burns1 ,,scalds1 ,,frostbites1 ,,etc4 #aga ,general ,rules for ,treating ,burns and ,scalds--,hints on ,dressings--,burns ,caused by ,acids and ,alkalies--,remedies for ,frostbite--,care of ,blisters and ,sores--,chilblains--,ingrowing ,toe ,nails--,fainting and ,suffocation--,fits4 ,,part ,,ii ,i4 ,,contagious ,,maladies #aia ,symptoms and ,treatment of ,scarlet ,fever--,diagnosis--,duration of ,contagion--,difference ,between ,true and ,german ,measles--,smallpox--,cure a ,matter of ,good ,nursing--,chickenpox4 ,,ii4 ,,infectious ,,diseases #bba ,typhoid ,fever--,symptoms and ,modes of ,communication--,duration of the ,disease--,the ,death ,rate--,importance of ,bathing--,diet--,remedies for ,whooping ,cough--,mumps--,erysipelas4 ,,iii4 ,,malaria ,,and ,,yellow ,,fever #bdg ,malaria ,caused by ,mosquitoes--,distribution of the ,disease--,severe and ,mild ,types--,prevention and ,treatment--,yellow ,fever not a ,contagious ,disease--,course of the ,malady--,watchful ,care and ,diet the only ,remedies4 ,,index ,to ,first ,aid and ,general ,topics ,,note4--,the ,roman numerals ,i1 ,,ii1 ,,iii1 ,,iv1 ,v1 and ,,vi indicate the volume2 the ,arabic figures #a1 #b1 #c1 etc41 indicate the page number4 ,abrasions1 ,i1 #fd ,abscess1 alveolar1 ,,ii1 #eh ,acids1 burns by1 ,i1 #agf1 #agg poisoning by1 ,i1 #adj ,acne1 ,,ii1 #ade ,adenoids1 ,,ii1 #fa ,adulterated food1 tests for1 ,v1 #ia ,adulteration of food1 ,v1 #hg ,ague1 ,i1 #bdg cake1 ,i1 #bed ,air-bath1 the1 ,,iv1 #aei ,albumen1 ,,iv1 #bfb ,alcohol1 use of1 ,,iv1 #dd1 #aec ,alcoholic drinks1 ,,iv1 #aec ,alcoholism1 ,,iii1 #dg1 #eb ,algae1 remedy for1 ,v1 #ef ,alkalies1 burns by1 ,i1 #agg poisoning by1 ,i1 #adj ,amenorrhoea1 ,,iii1 #ge ,anaemia1 ,,iii1 #agd ,ankle1 sprain of1 ,i1 #fe1 #fg1 #fh ,ankle-joint fracture1 ,i1 #aae ,antitoxin1 ,,ii1 #gg ,apoplexy1 ,,iii1 #di ,appendicitis1 ,,iii1 #bef ,arm1 fracture of1 ,i1 #ia ,arteries1 systemic1 ,,iii1 #afh ,artery1 bleeding from an1 ,i1 #ea1 #eb ,arthritis1 ,,ii1 #agg ,artificial respiration1 ,i1 #bh ,asthma1 ,,ii1 #ajd ,astigmatism1 ,,ii1 #bf ,athletics1 home1 ,,iv1 #fi ,auricles of the heart1 ,,iii1 #afh ,,baby1 bathing the1 ,,iii1 #aji care of the1 ,,iii1 #ajh clothing of the1 ,,iii1 #aaj diet for the1 ,,iii1 #acd food for the1 ,,iii1 #acb2 ,,iv1 #bfa nursing the1 ,,iii1 #aad teething1 ,,iii1 #aac temperature of the1 ,,iii1 #aaj weaning the1 ,,iii1 #aag weighing the1 ,,iii1 #aab ,bacteria1 destruction of1 ,v1 #bch-bec in food1 ,i1 #adg-aed in soil1 ,v1 #ace ,baldness1 ,,ii1 #afg2 ,,iv1 #ba ,,bandages1 ,i1 #acc forms of1 ,i1 #acb1 #acd1 #acf1 #acg for bruises1 ,i1 #fb-fd for fractures1 ,i1 #hc-aag for sprains1 ,i1 #fe-gb for wounds1 ,i1 #ea-fa ,barley water1 ,,iv1 #bfc ,bathing1 indoor1 ,,iv1 #ai1 #aee outdoor1 ,,iv1 #af in convulsions1 ,,iii1 #ce in malaria1 ,i1 #bei in pneumonia1 ,,ii1 #id in scarlet fever1 ,i1 #aig in skin irritations1 ,,ii1 #adj in smallpox1 ,i1 #baf in typhoid fever1 ,i1 #bca in yellow fever1 ,i1 #bff ,,baths1 cold1 ,,iv1 #ae foot1 ,,iv1 #aeg hot1 ,,iv1 #ai1 #aef tepid1 ,,iv1 #ai ,turkish1 ,,iv1 #bj1 #aei warm1 ,,iv1 #ai ,bed sores1 ,i1 #bcc ,bed-wetting1 ,,ii1 #bac ,bee stings1 ,i1 #aeh ,beef1 broth1 ,,iv1 #bfa juice1 ,,iv1 #bfb parts of1 ,,iv1 #aih scraped1 ,,iv1 #bfb tea1 ,,iv1 #bfa ,bellyache1 ,,iii1 #bdg ,bilious fever1 ,i1 #bdg ,biliousness1 ,,iii1 #ahd ,,bites1 cat1 ,i1 #agj dog1 ,i1 #agj flea1 ,i1 #afb fly1 ,i1 #afd lice1 clothes1 ,i1 #afa lice1 crab1 ,i1 #afb lice1 head1 ,i1 #afj mosquito1 ,i1 #aee snake1 ,i1 #aff spider1 ,i1 #afd tarantula1 ,i1 #afd wood tick1 ,i1 #aei ,black eye1 ,,ii1 #ad ,blackheads1 ,,ii1 #ade ,black water fever1 ,i1 #bef ,bladder1 inflammation of the1 ,,ii1 #bae stone in the1 ,,iii1 #bfd ,,bleeding1 from an artery1 ,i1 #ea1 #eb from a vein1 ,i1 #ea1 #eb from punctured wounds1 ,i1 #eb1 #ec from the lungs1 ,i1 #fb from the nose1 ,i1 #fa from the scalp1 ,i1 #fj from the stomach1 ,i1 #fb from the womb1 ,,iii1 #hb ,blood1 deficiency of1 ,,iii1 #agd oozing of1 ,i1 #ed ,bloody flux1 ,,iii1 #bbb ,boils1 ,,ii1 #aeg ,bottles1 milk1 ,,iii1 #abh ,bowel1 prolapse of the1 ,,iii1 #adc ,,bowels1 catarrh of the1 ,,iii1 #bje diseases of the1 ,,iii1 #bje inflammation of the1 ,,iii1 #beb obstruction of the1 ,,iii1 #bfh passages from the1 ,,iv1 #bdg ,bowleg1 ,,iii1 #afb ,brain1 anatomy of the1 ,,iii1 #bb arteries of the1 ,,iii1 #bb autopsies of the1 ,,ii1 #bcj ,breasts1 care of1 after childbirth1 ,,iii1 #aje inflammation of the1 ,,iii1 #adj ,breath1 holding the1 ,,iii1 #aec ,breathing1 how to test the1 ,,iv1 #bdh to produce artificial1 ,i1 #bh1 #cd1 #dc1 #agh1 #ahf ,bright's disease1 acute1 ,,ii1 #bbj chronic1 ,,ii1 #bbb ,,broken ,,bone1 ,i1 #hj ankle1 ,i1 #aae arm1 ,i1 #ia collar bone1 ,i1 #he finger1 ,i1 #aja forearm1 ,i1 #id hand1 ,i1 #aja hip1 ,i1 #ajd how to tell a1 ,i1 #hj jaw1 ,i1 #hi kneepan1 ,i1 #aji leg1 ,i1 #aaa rib1 ,i1 #hc shoulder blade1 ,i1 #ia thigh1 ,i1 #ajf wrist1 ,i1 #ii ,bronchial tubes1 diseases of the1 ,,ii1 #hg ,bronchitis1 ,,ii1 #hh1 #ia ,broth1 beef1 ,,iv1 #bfa chicken1 ,,iv1 #bfa clam1 ,,iv1 #bfc mutton1 ,,iv1 #bfa oyster1 ,,iv1 #bfg veal1 ,,iv1 #bfa ,,bruises1 bandages for1 ,i1 #fc treatment of1 ,i1 #fb1 #fc ,bunion1 ,i1 #gb ,,burns1 ,i1 #aga about the eyes1 ,,ii1 #af from acids1 ,i1 #agf from alkalies1 ,i1 #agg from electric shock1 ,i1 #de first class1 ,i1 #agb second class1 ,i1 #agb third class1 ,i1 #agc severe1 ,i1 #agd ,callus of the skin1 ,,ii1 #aef ,camp comfort 7,see ,contents ,,vi7 ,camp cookery 7,see ,contents ,,vi7 ,camp cure 7,see ,contents ,,vi7 ,,camping1 in the ,north ,woods1 ,,vi1 #aie in the ,western ,mountains1 ,,vi1 #bad outfit1 ,,vi1 #bab ,cancer1 ,,ii1 #abc of the breast1 ,,ii1 #abd of the lip1 ,,ii1 #abe of the stomach1 ,,ii1 #abe of the womb1 ,,ii1 #abe ,canker1 ,,ii1 #fh ,capillaries1 systemic1 ,,iii1 #afh ,carbuncle1 ,,ii1 #afa ,carotid arteries1 ,,iii1 #bb ,catarrh1 ,,ii1 #da1 #ed1 #ee of the bowels1 ,,iii1 #bje effect of1 on the ears1 ,,ii1 #ch1 #da of the stomach1 ,,iii1 #ahe ,catarrhal deafness1 ,,ii1 #ci inflammation of eye1 ,,ii1 #ah ,cat bite1 ,i1 #agj ,catheter1 how to use a1 ,,ii1 #bai2 ,,iv1 #beb ,centipede sting1 ,i1 #afd ,cereals as food1 ,,iv1 #ce1 #bbi ,cerebellum1 ,,iii1 #bb ,cerebral arteries1 ,,iii1 #bb ,chafing1 ,,ii1 #adb ,chagres fever1 ,i1 #bef ,change of life1 ,,iii1 #gj ,chapping1 ,,ii1 #adb ,chicken broth1 ,,iv1 #bfa ,chickenpox1 ,i1 #bag ,chilblains1 ,i1 #ahb ,childbed fever1 ,,iii1 #ajg ,childbirth1 after-pains in1 ,,iii1 #aje articles needed during1 ,,iii1 #if bleeding after1 ,,iii1 #hf care after1 ,,iii1 #ajc care in1 ,,iii1 #ih ,,children1 ,,diseases ,,of1 ,,iii1 #adj adenoids1 ,,ii1 #fa bed-wetting1 ,,ii1 #bac bowel1 prolapse of the1 ,,iii1 #adc bowels1 catarrh of the1 ,,iii1 #bji bowleg1 ,,iii1 #afb breath1 holding the1 ,,iii1 #aec breasts1 inflammation of the1 ,,iii1 #adj chickenpox1 ,i1 #bag cholera infantum1 ,,iii1 #baa chorea1 ,,iii1 #aee colic1 ,,iii1 #bfg constipation1 ,,iii1 #bch convulsions1 ,,iii1 #cd cord1 bleeding of the1 ,,iii1 #adb cough1 ,,ii1 #ia croup1 ,,ii1 #hc diarrhea1 ,,iii1 #bjh1 #bji diphtheria1 ,,ii1 #gg dysentery1 ,,iii1 #bac epilepsy1 ,,iii1 #ci earache1 ,,ii1 #dh fever1 ,,iii1 #adf food for1 ,,iii1 #acb-aci foreskin1 adhering1 ,,iii1 #ada glands1 enlarged1 ,,iii1 #adi hip disease1 ,,iii1 #afa holding the breath1 ,,iii1 #aec knock knees1 ,,iii1 #afc larynx1 spasm of the1 ,,iii1 #aec measles1 ,i1 #aih ,german measles1 ,i1 #bjc membranous croup1 ,,ii1 #gi milk poisoning1 ,,iii1 #bji1 #baa mumps1 ,i1 #bce navel1 sore1 ,,iii1 #adb pains1 growing1 ,,iii1 #adf ,pott's disease1 ,,iii1 #aeg rickets1 ,,iii1 #aea ringworm1 ,,ii1 #adi rupture1 ,,ii1 #abh scarlatina1 ,i1 #aib scarlet fever1 ,i1 #aib scrofula1 ,,iii1 #adi scurvy1 ,,ii1 #ahb sore mouth1 ,,ii1 #fe spine1 curvature of the1 ,,iii1 #aeg1 #aei ,st4 ,vitus's ,dance1 ,,iii1 #aee stomach1 catarrh of the1 ,,iii1 #bji urine1 painful passage of1 ,,iii1 #ada urine1 retention of1 ,,iii1 #ada wasting1 ,,iii1 #add whooping cough1 ,i1 #bch worms1 ,,iii1 #bdj ,chills and fever1 ,i1 #bdg ,cholera1 ,,iii1 #bbh infantum1 ,,iii1 #baa morbus1 ,,iii1 #bbf ,chorea1 ,,iii1 #aeh ,cinder in the eye1 ,i1 #agf2 ,,ii1 #ac ,circulation1 the1 ,,iii1 #afh ,circumcision1 ,,iii1 #adb ,clam broth1 ,,iv1 #bfc ,climacteric1 the1 ,,iii1 #gj ,clothing1 proper1 ,,iv1 #bb ,cochlea1 ,,ii1 #df ,coffee1 use of1 ,,iv1 #dc ,cold1 exposure to1 ,i1 #aha in the head1 ,,ii1 #ee sore1 ,,ii1 #adg ,,colic1 ,,iii1 #bdg gallstone1 ,,iii1 #bfa in babies1 ,,iii1 #bfg intestinal1 ,,iii1 #bdi mucous1 ,,iii1 #bai renal1 ,,iii1 #bfc ,collar-bone fracture1 ,i1 #he ,complexion1 the1 ,,iv1 #bj ,confinement1 ,,iii1 #ig ,congestion of the eyelid1 ,,ii1 #ag ,conjunctivitis1 ,,ii1 #af1 #ah ,constipation1 in adults1 ,,iii1 #bcc in children1 #bch ,consumption1 ,,ii1 #if fresh-air treatment for1 ,,ii1 #ajb outdoor life for1 ,,vi1 #gb prevention of1 ,,ii1 #ajd ,contagion1 in cholera1 #bbi in conjunctivitis1 ,,ii1 #ai in diphtheria1 ,,ii1 #hj in eruptive fever1 ,i1 #aia-bbj in gonorrhea1 ,,ii1 #aii in grippe1 ,,ii1 #ajh in mumps1 ,i1 #bcf in syphilis1 ,,ii1 #bjf1 #bji in whooping cough1 ,i1 #bch ,,contagious ,,diseases1 ,i1 #aia ,convalescence 7,see ,contents ,,vi7 ,convulsions1 in children1 ,,iii1 #cd in adults1 ,i1 #ahh ,,cooking 7,see ,contents ,,iv7 baking1 ,,iv1 #aga boiling1 ,,iv1 #ahj braising1 ,,iv1 #ahb broiling1 ,,iv1 #agb camp1 ,,vi1 #bbj cereals1 ,,iv1 #bbi eggs1 ,,iv1 #ahd entrees1 ,,iv1 #bai fish1 ,,iv1 #ahh frying1 ,,iv1 #age game1 ,,iv1 #bjb poultry1 ,,iv1 #bjb roasting1 ,,iv1 #aga sauces1 ,,iv1 #baf sauteing1 ,,iv1 #agd shellfish1 ,,iv1 #aie soups1 ,,iv1 #bjg stewing1 ,,iv1 #aha time of1 ,,iv1 #agg utensils1 ,,iv1 #bcb vegetables1 ,,iv1 #bbc ,copper sulphate method1 ,v1 #eb ,copper vessels1 use of1 ,v1 #fg ,cord1 bleeding of the1 ,,iii1 #adb ,corns1 ,,ii1 #aed ,costiveness1 ,,iii1 #bcc ,,cough1 acute1 ,,ii1 #hg1 #ia whooping1 ,i1 #bch ,cricoid cartilage1 ,,ii1 #gj ,cross eye1 ,,ii1 #cc ,croup1 membranous1 ,,ii1 #gi ordinary1 ,,ii1 #hc1 #ib ,curvature of the spine1 ,,iii1 #aeg1 #aei ,cystitis1 ,,ii1 #bae ,dandruff1 ,,ii1 #afg ,deafness1 catarrhal1 ,,ii1 #ci chronic1 ,,ii1 #cf temporary1 ,,ii1 #cc ,delirium tremens1 ,,iii1 #ej ,,diarrhea1 acute1 ,,iii1 #bje chronic1 ,,iii1 #bag of children1 ,,iii1 #bjh1 #bji ,,diet1 ,,iv1 #bf1 #ajg1 #abc1 #ach1 #aec animal1 ,,iv1 #ci details of1 ,,iv1 #adf errors of1 ,,iv1 #ajg for babies1 ,,iii1 #acb for brain workers1 ,,iv1 #abf for long life1 ,,iv1 #ajg for the aged1 ,,iv1 #aab proper1 ,,iv1 #ach relation to climate1 ,,iv1 #ajh rules for1 ,,iv1 #aaj1 #abc simplicity of1 ,,iv1 #ach vegetable and animal1 ,,iv1 #ci ,digestion1 effect of dress on1 ,,iv1 #db hygiene of1 ,,iv1 #bf processes of1 ,,iv1 #bh ,diphtheria1 ,,ii1 #gg ,,disinfectants1 chemical1 ,v1 #bdc physical1 ,v1 #bdj solutions for1 ,v1 #bdg ,disinfection1 ,v1 #bch of rooms1 ,v1 #bdi ,,dislocations1 elbow1 ,i1 #abe hip1 ,i1 #abi jaw1 ,i1 #aah1 #abj knee1 ,i1 #aai shoulder1 ,i1 #abb ,dog bite1 ,i1 #agj ,doses of drugs1 ,,iv1 #bee ,dressings1 for bruises1 ,i1 #fc1 #fd for wounds1 ,i1 #ec1 #eg surgical1 ,i1 #aca ,drink1 nutritious1 ,,iv1 #aah ,drinking1 steady1 ,,iii1 #eb ,,drowned1 arousing the1 ,i1 #bg producing respiration in the1 ,i1 #bh1 #cd restoring the1 ,i1 #bg saving the1 ,i1 #cf ,drowning person1 death grasp of a1 ,i1 #cg saving a1 ,i1 #cf swimming to relief of a1 ,i1 #cf ,drugs1 doses of1 ,,iv1 #bee ,drum membrane1 ,,ii1 #cc1 #dc1 #de1 #df1 #dh ,dysentery1 in adults1 ,,iii1 #bbb in children1 ,,iii1 #bac ,dysmenorrhea1 ,,iii1 #ga ,,dyspepsia1 ,,iii1 #ahe causes of1 ,,iv1 #bg nervous1 ,,iii1 #aij ,,ear1 anatomy of the1 ,,ii1 #cc1 #cg1 #df diseases of the1 ,,ii1 #cc foreign bodies in the1 ,i1 #gh2 ,,ii1 #ci water in the1 ,,ii1 #db wax in the1 ,,ii1 #ce ,earache1 ,,ii1 #dj moderate1 ,,ii1 #dh ,eating1 proper mode of1 ,,iv1 #adj-adi ,eczema1 ,,ii1 #afc climatic1 ,,ii1 #afd occupation1 ,,ii1 #afd seborrheic1 ,,ii1 #afd1 #afe1 #afg ,eggnog1 ,,iv1 #bfh ,eggs1 as food1 ,,iv1 #cc1 #ahd soft-boiled1 ,,iv1 #bff ,egg water1 ,,iv1 #bfb ,elbow1 dislocation of1 ,i1 #abe ,,electric ,,shock1 ,i1 #dc1 #df ,enteric fever1 ,i1 #bba ,enteritis1 catarrhal1 ,,iii1 #bje ,entero-colitis1 ,,iii1 #bji ,enteroptosis1 ,,iv1 #dc ,environment1 importance of1 ,,iii1 #fe ,epiglottis1 ,,ii1 #gj ,epilepsy1 ,,iii1 #ci spasms in1 ,,iii1 #ci without spasms1 ,,iii1 #dj ,erysipelas1 ,i1 #bdd ,eustachian tube1 ,,ii1 #cg1 #ch1 #da1 #df1 #di1 #ej ,exhaustion1 mental and nervous1 ,,vi1 #ia-ade ,,exercise1 ,,iv1 #dh1 #ff corrective1 ,,iv1 #eg effect of1 ,,iv1 #ea excessive1 ,,iv1 #eb for all-round development1 ,,iv1 #ei1 #aja for boyhood1 ,,iv1 #fi for children1 ,,iv1 #fg for elderly men1 ,,iv1 #gi for everyone1 ,,iv1 #ff for girls1 ,,iv1 #gc for middle-aged men1 ,,iv1 #gg for women1 ,,iv1 #gf for young men1 ,,iv1 #ga for youth1 ,,iv1 #fi home1 ,,iv1 #eg regular1 ,,iv1 #ec1 #eh results of1 ,,iv1 #ih without apparatus1 ,,iv1 #eg ,,eye1 anatomy of the1 ,,ii1 #cj astigmatism of the1 ,,ii1 #bf black1 ,,ii1 #ad catarrhal inflammation of the1 ,,ii1 #ah cinder in the1 ,i1 #gf cross1 ,,ii1 #cc diseases of the1 ,,ii1 #ac farsighted ,,ii1 #ba foreign bodies in the1 ,i1 #gf2 ,,ii1 #ac hyperopic1 ,,ii1 #bb lens of the1 ,,ii1 #cj muscles of the1 ,,ii1 #cj nearsighted1 ,,ii1 #be pink1 ,,ii1 #ai retina of the1 ,,ii1 #cj sore1 ,,ii1 #af strain1 ,,ii1 #ba wounds and burns of the1 ,,ii1 #af ,eyelid1 congestion of the1 ,,ii1 #ag stye on the1 ,,ii1 #ae twitching of the1 ,,ii1 #ae ,eye muscles1 weakness of the1 ,,ii1 #bh ,eye-strain1 ,,ii1 #ba ,facial1 neuralgia1 ,,iii1 #bh paralysis1 ,,iii1 #be ,,fainting1 ,i1 #ahe2 ,,iii1 #de ,farsightedness1 ,,ii1 #ba ,fat as a food1 ,,iv1 #ce ,fatigue1 causes of1 ,,iv1 #ej ,felon1 ,i1 #gd1 #ge ,,fever1 bilious1 ,i1 #bdg black water1 ,i1 #bef ,chagres1 ,i1 #bef chills and1 ,i1 #bdg enteric1 ,i1 #bba gastric1 ,,iii1 #agi intermittent1 ,i1 #bdg marsh1 ,i1 #bdg remittent1 ,i1 #bdg rheumatic1 ,,ii1 #afi scarlet1 ,i1 #aib swamp1 ,i1 #bdg typhoid1 ,i1 #bba yellow1 ,i1 #bfa ,fever blister1 ,,ii1 #adg ,fevers1 eruptive contagious1 ,i1 #aia ,fish as food1 ,,iv1 #ahh ,finger1 fracture of1 ,i1 #aja ,,fit1 ,i1 #ahh ,flea bites1 ,i1 #afb ,fly bites1 ,i1 #afd ,food1 adulteration of1 ,v1 #hg containing parasites1 ,i1 #aeb elements of1 ,,iv1 #bi for babies1 ,,iii1 #acb2 ,,iv1 #bfa for the sick1 ,,iv1 #bfa infected1 ,i1 #aej laws1 ,v1 #hh poisoning1 ,i1 #adg preparation of1 ,,iv1 #aga pure1 selection of1 ,v1 #hi ,foods1 advertised1 ,,iv1 #aaf ,foot gear1 ,,iv1 #bd ,forearm fracture1 ,i1 #id ,,foreign ,,bodies1 in the ear1 ,i1 #gh2 ,,ii1 #ci in the eye1 ,i1 #gf2 ,,ii1 #ac in the nose1 ,i1 #gi2 ,,ii1 #ec ,foreskin1 adhering1 ,,iii1 #ada ,fourth-of-,july accidents1 ,i1 #ef ,,fracture 7,see ,broken ,bone7 ,colles'1 ,i1 #ii compound1 ,i1 #hj1 #aaf how to tell a1 ,i1 #ha simple1 ,i1 #hj ,freckles1 ,,ii1 #aej ,freezing1 ,i1 #agh ,,frostbite1 ,i1 #agh1 #ahj ,gallstone colic1 ,,iii1 #bfa ,ganglion1 ,i1 #ge ,garbage1 disposal of1 ,v1 #aga ,gastric fever1 ,,iii1 #agi ,genito-urinary diseases1 ,,ii1 #aii ,germs 7,see ,bacteria7 ,girls1 exercises for1 ,,iv1 #gc physical training for1 ,,iv1 #gb2 ,,vi1 #ci ,glands1 enlarged1 ,,iii1 #adi ,gonorrhea1 ,,ii1 #aii in women1 ,,ii1 #bjc2 ,,iii1 #ij ,gout1 common1 ,,ii1 #ahc rheumatic1 ,,ii1 #agg ,grippe1 la1 ,,ii1 #ef1 #ajh ,growing pains1 ,,iii1 #adf ,hair1 the1 ,,iv1 #ba ,hallucinations1 ,,ii1 #bcb ,hand1 anatomy of the1 ,,iii1 #cj arteries of the1 ,,iii1 #cj fracture of the1 ,i1 #aja nerves of the1 ,,iii1 #cj tendons of the1 ,,iii1 #cj ,,headache1 constant1 ,,ii1 #abj due to disease1 ,,ii1 #aag due to eye strain1 ,,ii1 #bi due to heat stroke1 ,,ii1 #abj due to indigestion1 ,,ii1 #aae due to poisoning1 ,,ii1 #aah nervous1 ,,ii1 #aag neuralgic1 ,,ii1 #aag sick1 ,,ii1 #aac sympathetic1 ,,ii1 #aaf ,head gear1 ,,iv1 #bd1 #afj ,head injuries1 ,,iii1 #df ,,heart1 anatomy of the1 ,,iii1 #afg1 #afh enlargement of the1 ,,iii1 #afi palpitation of the1 ,,iii1 #aga ,heart disease1 ,,iii1 #afg ,heat exhaustion1 ,i1 #ci1 #dj ,heating1 cost of1 ,v1 #bed methods of1 ,v1 #afa ,,heat ,,stroke1 ,i1 #ci1 #da ,hemorrhage 7,see ,bleeding7 ,hemorrhoids1 ,,ii1 #ace ,heredity1 ,,iii1 #eg in consumption1 ,,ii1 #ig ,hernia1 ,,ii1 #abh 7,see ,rupture7 strangulated1 ,,ii1 #abi umbilical1 ,,ii1 #abh ventral1 ,,ii1 #abh ,hiccough or hiccup1 ,,iii1 #ba ,hip disease1 ,,iii1 #afa ,hip1 dislocation of1 ,i1 #abi fracture of1 ,i1 #ajd ,hives1 ,,ii1 #adc ,hoarseness1 ,,ii1 #hj ,hornet stings1 ,i1 #aeh ,horrors1 the1 ,,iii1 #ej ,house1 proper construction of1 ,v1 #ada ,housemaid's knee1 ,i1 #gb ,hypodermic syringe1 the1 ,,iv1 #bej ,hysteria1 ,,vi1 #bj ,,indigestion1 acute1 ,,iii1 #agh a result of errors1 ,,iv1 #acj chronic1 ,,iii1 #ahe intestinal1 ,,iii1 #bjb not disease1 ,,iv1 #acd ,infants1 bathing1 ,,iii1 #aji care of1 ,,iii1 #ajh clothing for the1 ,,iii1 #aaj feeding of1 ,,iii1 #aah ,infection1 ,v1 #bch in erysipelas1 ,i1 #bdd in malaria1 ,i1 #bdg in typhoid fever1 ,i1 #bba in yellow fever1 ,i1 #bfa ,,infectious ,,diseases1 ,i1 #bba ,influenza1 ,,ii1 #ajh ,ingrowing toe nail1 ,i1 #ahd ,injections1 ,,iii1 #bch1 #bci ,,injured1 ,,carrying ,,the1 ,i1 ,frontispiece ,insane1 criminal1 ,,ii1 #bcd delusions of the1 ,,ii1 #bcc illusions of the1 ,,ii1 #bca sanitariums for the1 ,,ii1 #bde ,insanity1 ,,ii1 #bbi2 ,,vi1 #afd causes of1 ,,ii1 #bci false ideas regarding1 ,,ii1 #bda physical signs of1 ,,ii1 #bce prevention of1 ,,ii1 #bdj types of1 ,,ii1 #bcf ,insensibility1 ,,iii1 #dd ,insomnia1 ,,iii1 #bc ,intermittent fever1 ,i1 #bdg ,invalids1 care of1 ,,vi1 #aee ,itching1 ,,ii1 #aci ,ivy poison1 ,,ii1 #aeb ,jaundice1 ,,iii1 #ahj ,jaw1 dislocation of1 ,i1 #aah1 #abj fracture of1 ,i1 #hi ,joint1 injury of a1 ,i1 #fe1 #fi ,junket1 ,,iv1 #bff ,kerosene1 extermination of mosquitoes by1 ,v1 #gg ,kidneys1 inflammation of the1 ,,ii1 #bbj ,bright's disease of the1 ,,ii1 #bai stone in the1 ,,iii1 #bfe ,knee1 dislocation of1 ,i1 #aai sprain of1 ,i1 #fg1 #gj ,kneepan fracture1 ,i1 #aji ,knock knees1 ,,iii1 #afc ,laryngitis1 ,,ii1 #hj ,larynx1 anatomy of the1 ,,ii1 #gj spasm of the1 ,,iii1 #aec ,leeches1 use of1 ,,ii1 #dc ,leg bones1 fracture of1 ,i1 #aaa1 #aaf ,leucorrhoea1 ,,iii1 #hf ,lice1 body1 ,i1 #afa clothes1 ,i1 #afa crab1 ,i1 #afb head1 ,i1 #afj ,life-saving service1 ,u4 ,s41 ,i1 #bg ,lightning stroke1 ,i1 #dc ,limewater1 ,,iv1 #bfh ,,lockjaw1 ,i1 #ef ,long life1 rules for 7,see ,contents ,,iv1 ,part ,,iii7 ,lotions1 ,,ii1 #ade1 #aea1 #aeb1 #aee1 #aff ,lues1 ,,ii1 #bjf ,lumbago1 ,,ii1 #agc ,,lungs1 bleeding from the1 ,i1 #fb diseases of the1 ,,ii1 #hg inflammation of the1 ,,ii1 #ic tuberculosis of the1 ,,ii1 #if ,,malaria1 ,i1 #bdg chronic1 ,i1 #bec mosquito as cause of1 ,i1 #aeg1 #bdg pernicious1 ,i1 #bee remittent1 ,i1 #bed ,malt soup1 ,,iv1 #bfg ,marasmus1 ,,iii1 #add ,marketing1 hints on1 ,,iv1 #bcb ,marriage relations1 ,,ii1 #aig ,marsh fever1 ,i1 #bdg ,measles1 common1 ,i1 #aih ,german1 ,i1 #bjc ,meat as food1 ,,iv1 #cb ,median nerve1 ,,iii1 #cj ,medicine chest1 contents of the1 ,,iv1 #bdc ,,medicines1 ,,patent1 ,,ii1 #bde antiphlogistine1 ,,ii1 #beh belladonna plasters1 ,,ii1 #beg dangers of1 ,,ii1 #bfj hamamelis1 ,,ii1 #bee headache powders1 ,,ii1 #bfb ,listerine1 ,,ii1 #bef ,platt's ,chlorides1 ,,ii1 #bei ,pond's ,extract1 ,,ii1 #bee proprietary1 ,,ii1 #bdf ,scott's ,emulsion1 ,,ii1 #beg vaseline1 ,,ii1 #bed witch-hazel1 ,,ii1 #bee ,medulla oblongata1 ,,iii1 #bb ,membranous croup1 ,,ii1 #gi ,menopause1 the1 ,,iii1 #gj ,menstruation1 ,,iii1 #fg absence of1 ,,iii1 #ge arrest of1 ,,iii1 #gi cessation of1 ,,iii1 #gh delayed1 ,,iii1 #gi painful1 ,,iii1 #ga scanty1 ,,iii1 #gi ,metals1 poisoning by1 ,i1 #ada ,miliaria1 ,,ii1 #adh ,,milk1 as food1 ,,iv1 #cc curd1 ,,iv1 #bff mixtures1 ,,iii1 #abd peptonized1 ,,iv1 #bfd poisoning1 ,,iii1 #bji1 #baa porridge1 ,,iv1 #bfg ,mind cure1 ,,vi1 #ca disorder of the1 ,,ii1 #bbi ,miscarriage1 danger of1 ,,iii1 #hj ,,mosquito bites1 ,i1 #aee1 #aeh2 ,v1 #ga destruction of the1 ,i1 #beh2 ,v1 #ge exterminating the1 ,v1 #gj malaria due to the1 ,i1 #bdh yellow fever due to the1 ,i1 #bfa2 ,v1 #gj ,motor nerve1 ,,iii1 #ch ,mouth-breathing1 ,,ii1 #fj ,mouth1 inflammation of the1 ,,ii1 #fd sore1 ,,ii1 #fd ,mumps1 ,i1 #bce ,muscular action1 ,,iv1 #dh development1 by will power1 ,,iv1 #fc ,,mushroom ,,poisoning1 ,v1 #aab ,mushrooms1 edible1 ,v1 #aae how to tell1 ,v1 #aad poisonous1 ,v1 #abd ,mutton broth1 ,,iv1 #bfa ,myalgia1 ,,ii1 #agc ,myopia1 ,,ii1 #be ,narcotics1 poisoning by1 ,i1 #adb ,nasal cavity1 ,,ii1 #ed ,navel1 sore1 ,,iii1 #adb ,nearsightedness1 ,,ii1 #be ,nervous debility1 ,,iii1 #ac diseases1 ,,iii1 #ac exhaustion1 ,,iii1 #ac2 ,,vi1 #gj1 #afg ,,nervousness 7,see ,contents ,,vi7 remedy for1 ,,vi1 #gj1 #afg2 ,,iii1 #bj ,nervous system1 reflex action of the1 ,,iii1 #ch ,nettlerash1 ,,ii1 #adc ,neuralgia1 ,,iii1 #bg facial1 ,,iii1 #bh of the chest1 ,,iii1 #bi ,neurasthenia1 ,,iii1 #ac ,,nose1 anatomy of the1 ,,ii1 #ed bleeding from the1 ,,ii1 #ea catarrh of the1 ,,ii1 #ee diseases of the1 ,,ii1 #ea foreign bodies in the1 ,i1 #gi2 ,,ii1 #ec obstructions in the1 ,,ii1 #fj septum of the1 ,,ii1 #ea1 #ed1 #fa ,nosebleed1 ,i1 #fa2 ,,ii1 #ea ,nostrum1 ,,ii1 #bdh ,nurse and patient 7,see ,contents ,,vi7 ,nurse1 selection of the1 ,,vi1 #aej ,nursing1 ,,vi1 #adf ,oatmeal water1 ,,iv1 #bfc ,olfactory nerves1 ,,iii1 #bb ,oozing of blood1 ,i1 #ed1 #ee ,optic nerves1 ,,iii1 #bb ,,outdoor ,,life 7,see ,contents ,,vi7 for consumption1 ,,vi1 #gb for nervous exhaustion1 ,,vi1 #gj1 #afg ,overworked1 hints for the1 ,,vi1 #ia ,oyster broth1 ,,iv1 #bfg ,palmar arch1 ,,iii1 #cj ,pains1 growing1 ,,iii1 #adf ,palpitation of the heart1 ,,iii1 #aga ,paralysis1 facial1 ,,iii1 #be ,paranoia1 ,,ii1 #bcg ,parasites1 malarial1 ,i1 #bdg yellow fever1 ,i1 #bfa ,paresis1 ,,ii1 #bcg ,patent medicines1 ,,ii1 #bdg ,peritonitis1 ,,iii1 #beb ,petit mal1 ,,iii1 #dj ,pharyngitis1 ,,ii1 #fi ,phthisis1 ,,ii1 #if ,pigeon breast1 ,,ii1 #fc ,piles1 external1 ,,ii1 #ace internal1 ,,ii1 #acf ,pimples1 ,,ii1 #ade ,pink eye1 ,,ii1 #ai ,plumbing1 connections1 ,v1 #aid defects in1 ,v1 #bca drains1 ,v1 #bjf fixtures1 ,v1 #baf joints1 ,v1 #aid pipes1 ,v1 #aia1 #bjf tests1 #bcc traps1 ,v1 #aih ,pneumonia1 ,,ii1 #ic ,,poisoning 7,see ,poisons7 by canned meats1 ,i1 #aej by fish1 ,i1 #adh by meat1 ,i1 #adh1 #aej1 #aea by milk1 ,i1 #adh1 #aej1 #aea food1 bacterial1 ,i1 #adg food1 containing parasites1 ,i1 #aeb food1 infected1 ,i1 #aej mushroom1 ,v1 #aab potato1 ,i1 #aed ,poison ivy1 ,,ii1 #aeb ,,poisons1 acetanilid1 ,i1 #adf acid1 carbolic1 ,i1 #adj acid1 nitric1 ,i1 #adj acid1 oxalic1 ,i1 #adj acid1 sulphuric1 ,i1 #adj acids1 ,i1 #adj aconite1 ,i1 #adb alcohol1 ,i1 #adc alkalies1 ,i1 #adj ammonia1 ,i1 #ada antidotes1 ,i1 #aci antimony1 ,i1 #adb arsenic1 ,i1 #ada belladonna1 ,i1 #adb bichloride of mercury1 ,i1 #ada blue vitriol1 ,i1 #ada bug poison1 ,i1 #ada camphor1 ,i1 #adb caustic soda1 ,i1 #ada chloral1 ,i1 #adc cocaine1 ,i1 #ade copper1 ,i1 #ada corrosive sublimate1 ,i1 #ada digitalis1 ,i1 #adb ergot1 ,i1 #adb ,fowler's solution1 ,i1 #ada headache powders1 ,i1 #adf hellebore1 ,i1 #adb ivy1 ,,ii1 #aeb knockout drops1 ,i1 #adc laudanum1 ,i1 #add lobelia1 ,i1 #adb lye1 ,i1 #ada matches1 ,i1 #adb mercury1 ,i1 #ada metals1 ,i1 #ada morphine1 ,i1 #add narcotics1 ,i1 #adb nux vomica1 ,i1 #ade opium1 ,i1 #add paregoric1 ,i1 #add ,paris green1 ,i1 #ada phenacetin1 ,i1 #adf phosphorus1 ,i1 #adb potash1 ,i1 #ada rough on rats1 ,i1 #ada silver nitrate1 ,i1 #ada sleeping medicines1 ,i1 #adc soothing sirup1 ,i1 #add strychnine1 ,i1 #ade tartar emetic1 ,i1 #adb tobacco1 ,i1 #add unknown1 ,i1 #aci verdigris1 ,i1 #ada washing soda1 ,i1 #ada white precipitate1 ,i1 #ada ,polypi1 ,,ii1 #ed1 #fb ,pons ,varolii1 ,,iii1 #bb ,pott's disease1 ,,iii1 #aeg ,poultry as food1 ,,iv1 #bja ,pox1 ,,ii1 #bjf ,pregnancy1 ,,iii1 #ia diet during1 ,,iii1 #ia exercise during1 ,,iii1 #ia mental state during1 ,,iii1 #ie signs of1 ,,iii1 #hj1 #ic ,prickly heat1 ,,ii1 #adh ,proprietary medicines1 ,,ii1 #bdh ,pruritus1 ,,ii1 #aci ,pulse1 how to feel the1 ,,iv1 #bdg ,punctured wound1 bleeding from1 a1 ,i1 #eb1 #ec ,pure food bill1 ,,ii1 #bdi ,,pure ,,food1 ,,selection ,,of1 ,v1 #hi-aaa canned articles1 ,v1 #ajg cereals1 ,v1 #ih chocolate1 ,v1 #ajg cocoa1 ,v1 #ajg coffee1 ,v1 #ajd flavoring extracts1 ,v1 ,,iii meat1 ,v1 #ib meat products1 ,v1 #ie olive oil1 ,v1 #aaj shellfish1 ,v1 #id spices1 ,v1 #ajh sugar1 ,v1 #ajh tea1 ,v1 #ajd vegetables1 ,v1 #if vinegar1 ,v1 #aaj ,purifying water supply1 ,v1 #eb ,quinsy1 ,,ii1 #ge ,radial nerve1 ,,iii1 #cj ,recipes1 for babies1 ,,iv1 #bfa for the sick1 ,,iv1 #bfa ,reflex action illustrated1 ,,iii1 #ch2 ,,iv1 #di ,remittent fever1 ,i1 #bdg ,renal colic1 ,,iii1 #bfc ,respiration1 to produce artificial1 ,i1 #bh1 #cd1 #dc1 #agh1 #ahf ,respirations1 counting the1 ,,iv1 #bdh ,rest cure1 ,,iii1 #bj ,reversion1 ,,iii1 #ei ,rheumatic fever1 ,,ii1 #afi gout1 ,,ii1 #agg ,,rheumatism1 acute1 ,,ii1 #afi chronic1 ,,ii1 #age effect on the heart1 ,,ii1 #agj inflammatory1 ,,ii1 #afi muscular1 ,,ii1 #agc of the chest1 ,,ii1 #agd ,rhinitis1 ,,ii1 #gg ,rib1 broken1 ,i1 #hc ,rice water1 ,,iv1 #bfd ,rickets1 ,,iii1 #aea ,ringworm1 of body1 ,,ii1 #adi of scalp1 ,,ii1 #adi ,,run-,,around1 ,i1 #gc ,rupture1 ,,ii1 #abh ,salt rheum1 ,,ii1 #afc ,sanitariums for the insane1 ,,ii1 #bde ,,sanitation 7,see ,contents ,v7 ,sarcoma1 ,,ii1 #abd ,,scalds1 ,i1 #aga ,scalp wounds1 ,i1 #fj ,scarlatina1 ,i1 #aib ,scarlet fever1 ,i1 #aib ,sciatica1 ,,iii1 #ca ,scorpion sting1 ,i1 #afd ,scrofula1 ,,iii1 #adi ,scurvy1 common1 ,,ii1 #ahj infantile1 ,,ii1 #ahb ,seasickness1 ,,iii1 #aie ,self-abuse1 ,,ii1 #aib ,semicircular canals1 ,,ii1 #df ,sensory nerve1 ,,iii1 #ch ,septum1 ,,ii1 #ed deviation of the1 ,,ii1 #fj ,serum1 antivenomous1 ,i1 #afi ,sewage1 ,v1 #agj disposal of1 ,v1 #agb ,sewer gas1 ,v1 #ahg ,sewers1 ,v1 #ahb ,sexual organs1 care of the1 ,,ii1 #aia diseases of the1 ,,ii1 #aii ,sexual relations1 ,,ii1 #aid ,shingles1 ,,iii1 #bi ,shoulder1 dislocation of1 ,i1 #abb sprain of1 ,i1 #fg ,shoulder-blade fracture1 ,i1 #ia ,sick1 food for the1 ,,iv1 #bfa ,sick room1 the1 ,,vi1 #aej ,,skin1 callus of the1 ,,ii1 #aef chafing of the1 ,,ii1 #adb chapping of the1 ,,ii1 #adb cracks in the1 ,,ii1 #aef discolorations of the1 ,,ii1 #aej diseases of the1 ,,ii1 #aci irritation of the1 ,,ii1 #adb itching of the1 ,,ii1 #aci ,sleeplessness1 ,,iii1 #bc ,sling1 how to make a1 #hg1 #hh ,smallpox1 ,i1 #bjf ,snake bite1 ,i1 #aff1 #afh ,soap1 use of1 ,,iv1 #cb ,soil1 bacteria in1 ,v1 #ace constituents of1 ,v1 #aca contamination of1 ,v1 #acf diseases due to1 ,v1 #aci ,soil1 improving the1 ,v1 #adj influence of1 ,v1 #acg ,sore mouth1 aphthous1 ,,ii1 #ff gangrenous1 ,,ii1 #fg simple1 ,,ii1 #fe ulcerous1 ,,ii1 #fg ,sore eyes1 ,,ii1 #af ,sore throat1 ,,ii1 #fi ,soup1 malt1 ,,iv1 #bfg ,soups1 ,,iv1 #bjg ,spider bite1 ,i1 #afd1 #afe ,spinal cord1 ,,iii1 #ch ,spine1 curvature of1 ,,iii1 #aeg1 #aei ,spleen1 enlargement of1 ,,ii1 #bed ,splinters1 removing1 ,i1 #ed ,splints1 ,i1 #fa1 #ga1 #ic1 #ig1 #ajb1 #ajg1 #aaj1 #aaa1 #aad1 #abh ,,sprains1 bandages for1 ,i1 #fe1 #fg treatment of1 #fe1 #ff ,sprue1 ,,ii1 #ff ,squint1 ,,ii1 #cc ,st4 ,vitus's ,dance1 ,,iii1 #aee ,stiff neck1 ,,ii1 #agd ,,stings1 bee1 ,i1 #aeh centipede1 ,i1 #afd hornet1 ,i1 #aeh scorpion1 ,i1 #afd wasp1 ,i1 #aeh ,stitching a wound1 ,i1 #eh ,,stomach1 bleeding from the1 ,i1 #fb catarrh of the1 ,,iii1 #ahe1 #bji diseases of the1 ,,iii1 #agh neuralgia of the1 ,,iii1 #bea ,stomachache1 ,,iii1 #bdg ,stone1 in the bladder1 ,,iii1 #bfe in the kidney1 ,,iii1 #bfc ,strabismus1 ,,ii1 #cc ,stye1 ,,ii1 #ae ,,suffocation1 from gas1 ,i1 #ahf ,sunstroke1 ,i1 #dj ,surgical dressings1 ,i1 #aca ,swamp fever1 ,i1 #bdg ,,synovitis1 ,i1 #fi ,syphilis1 ,,ii1 #bjf1 #bab ,syringe1 the bulb1 ,,iii1 #bci the fountain1 ,,iii1 #bch the hypodermic1 ,,iv1 #bej ,tan1 ,,ii1 #aej ,tapeworm1 ,i1 #aeb ,tarantula bite1 ,i1 #afd ,tea1 use of1 ,,iv1 #dc ,teeth1 artificial1 ,,iv1 #aai care of the1 ,,iv1 #bf ,teething1 ,,iii1 #aac ,temperature1 how to tell the1 ,,iv1 #bdf proper1 ,,iv1 #afa1 #afb ,tetter1 ,,ii1 #afc ,thermometer1 clinical1 use of the1 ,,iv1 #bdf ,thigh-bone fracture1 ,i1 #ajf ,,throat1 diseases of the1 ,,ii1 #ea1 sore1 ,,ii1 #fi ,thrush1 ,,ii1 #ff ,tic douloureux1 ,,iii1 #bh ,toe nail1 ingrowing1 ,i1 #ahd ,tongue1 noting appearance of the1 ,,iv1 #bdi ,tonsilitis1 ,,ii1 #ga ,tonsils1 enlarged1 ,,ii1 #fc ,tooth1 ulcerated1 ,,ii1 #eh ,toothache1 ,,ii1 #eh ,training1 physical1 ,,iv1 #abd2 ,,vi1 #ch ,trichiniasis1 ,i1 #aec ,truss1 use of the1 ,,ii1 #acj ,tuberculin1 ,,ii1 #aja ,tuberculosis of the bones1 ,,iii1 #aeg of the lungs1 ,,ii1 #if ,,tumors1 ,,ii1 #abc ,turbinates1 enlarged1 ,,ii1 #fj ,typhoid fever1 ,i1 #bba complications of1 ,i1 #bbh ,ulcerated tooth1 ,,ii1 #eh ,ulnar nerve1 ,,iii1 #cj ,,unconsciousness1 ,,iii1 #dd due to drunkenness1 ,,iii1 #dg due to epilepsy1 ,,iii1 #dh due to fainting1 ,,iii1 #de due to head injuries1 ,,iii1 #df ,unconsciousness1 due to kidney disease1 ,,iii1 #dh due to opium poisoning1 ,,iii1 #dh due to sunstroke1 ,,iii1 #dh ,underclothing1 proper1 ,,iv1 #bb ,,urine1 incontinence of1 ,,ii1 #bac involuntary passage of1 ,,ii1 #bac painful passage of1 ,,iii1 #ada retention of1 ,,ii1 #bah2 ,,iii1 #ada stoppage of1 ,,ii1 #bah suppression of1 ,,ii1 #bah ,urticaria1 ,,ii1 #adc ,vaccination1 ,i1 #baa-bae ,varicocele1 ,,ii1 #acd ,varicose veins1 ,,ii1 #acb ,varioloid1 ,i1 #baa ,veal broth1 ,,iv1 #bfa ,vegetables as food1 ,,iv1 #cd1 #bbc ,vein1 bleeding from a1 ,i1 #ea1 #eb ,veins1 systemic1 ,,iii1 #afh ,,ventilation1 artificial1 ,v1 #aeg forces of1 ,v1 #adh methods of1 ,v1 #aej natural1 ,v1 #aea ,ventricles of the heart1 ,,iii1 #afh ,vision1 defects of1 ,,ii1 #ba-cc ,vocal cords1 ,,ii1 #gj ,,vomiting1 ,,iii1 #aid of blood1 ,,iii1 #bjj of indigestion1 ,,iii1 #aii of pregnancy1 ,,iii1 #aif ,wakefulness1 ,,iii1 #bc ,warming1 ,v1 #afj ,warts1 flat1 ,,ii1 #aed moist1 ,,ii1 #aed seed1 ,,ii1 #aec threadlike1 ,,ii1 #aec ,wasp stings1 ,i1 #aeh ,wasting1 ,,iii1 #add ,,water1 barley1 ,,iv1 #bfc egg1 ,,iv1 #bfb lake1 ,v1 #bg lime1 ,,iv1 #bfh oatmeal1 ,,iv1 #bfc pure1 ,v1 #ba1 #eb rain1 ,v1 #bf rice1 ,,iv1 #bfd spring1 ,v1 #bi well1 ,v1 #ca-cg wheat1 ,,iv1 #bfd ,water cure1 for nervous exhaustion1 ,,iii1 #bj ,water distribution1 ,v1 #ci engines for1 ,v1 #db hydraulic rams for1 ,v1 #dj pressure systems for1 ,v1 #dg storage tanks for1 ,v1 #df windmills for1 ,v1 #da ,water supply1 laws of1 ,v1 #cg plants which pollute1 ,v1 #ed pollution of1 ,v1 #bb purifying the1 ,v1 #eb sources of1 ,v1 #ai system for country1 ,v1 #dg ,wax in the ear1 ,,ii1 #cd ,wear and tear 7,see ,contents ,,vi7 ,weaning1 ,,iii1 #aag ,,weeping ,,sinew1 ,i1 #ge ,wen1 ,,ii1 #abf ,wheat water1 ,,iv1 #bfd ,whey1 mixtures1 ,,iv1 #bfe wine1 ,,iv1 #bff ,whites1 ,,iii1 #hg ,whitlow1 ,i1 #gd1 #ge ,whooping cough1 ,i1 #bch ,womb1 hemorrhage from the1 ,,iii1 #hb ,women1 exercises for1 ,,iv1 #gf ,wood tick1 bite of1 ,i1 #aei ,,worms1 pin1 ,,iii1 #bdc round1 ,,iii1 #bdb tape1 ,,iii1 #bde ,,wounds1 ,i1 #ej about the eyes1 ,,ii1 #af caused by pistols1 ,i1 #ef caused by firecrackers1 ,i1 #ef cleansing1 ,i1 #ei foreign bodies in1 ,i1 #ed1 #ef scalp1 ,i1 #fj stitching1 ,i1 #eh treatment of1 ,i1 #ej1 #eg ,wrist1 fracture of the1 ,i1 #ii sprain of the1 ,i1 #fe1 #fg ,yellow fever1 ,i1 #bfa mosquito as cause of1 ,i1 #aeg1 #bfa1 #bfe ,preface ,medicine1 as the art of preserving and restoring health1 is the rightful office of the great army of earnest and qualified ,american physicians4 ,but their utmost sincerity and science are hampered by trying restrictions with three great classes of people3 those on whom the family physician cannot call every day2 those on whom he cannot call in time2 and those on whom he cannot call at all4 ,to lessen these restrictions1 thus assisting and extending the healer's work1 is the aim of the pages that follow4 ,consider first the average ,american household1 where the family physician cannot call every day4 ,not a day finds this household without the need of information in medicine or hygiene or sanitation4 ,more efforts of the profession are thwarted by ignorance than by epidemic4 ,not to supplant the doctor1 but to supplement him1 carefully prepared information should be at hand on the hygiene of health--sanitation1 diet1 exercise1 clothing1 baths1 etc42 on the hygiene of disease--nursing and sick-room conduct1 control of the nervous and insane1 emergency resources1 domestic remedies2 above all1 on the prevention of disease1 emphasizing the folly of self-treatment2 pointing out the danger of delay in seeking skilled medical advice with such troubles as cancer1 where early recognition may bring permanent cure2 showing the benefit of simple sanitary precautions1 such as the experiment-stations method of exterminating the malaria-breeding mosquito4 ,the volumes treating of these subjects cannot be made too clear1 nontechnical1 fundamental1 or too well guarded by the supervision of medical men known favorably to the profession4 ,again1 the physician cannot come on time to save life1 limb1 or looks to the victim of many a serious accident4 ,and yet some bystander could usually understand and apply plain rules for inducing respiration1 applying a splint1 giving an emetic1 soothing a burn or the like1 so as to safeguard the sufferer till the doctor's arrival--if only these plain rules were in such compact form that no office1 store1 or home in the land need be without them4 ,finally1 the doctor cannot come at all to hundreds of thousands of sailors1 automobilists1 and other travelers1 to ranchers1 miners1 and country dwellers of many sorts4 ,this third class has had1 hitherto1 little choice between some ,practice of ,medicine1 too technical to be helpful1 on the one hand1 and on the other1 the dubious literature of unsanctioned systems2 or the startling cure-all assertions emanating from many proprietors of remedies2 or ,complete ,family ,physicians1 which offer prescriptions as absurd for the layman as would be dynamite in the hands of a child1 with superfluous and loathsome pictures appealing only to morbid curiosity1 and with a general inaccuracy utterly out of touch with twentieth-century knowledge4 ,what such people need1 much more than the dwellers in settled communities1 is to learn the views of modern medicine upon the treatment of the ever-present common ailments--the use of standard remedies1 cautions against the abuse of narcotics1 lessons of discrimination against harmful1 useless1 or expensive patent medicines1 and proper rules of conduct for diet1 nursing1 and general treatment4 ,authentic health literature existed abundantly before the preparation of these volumes1 but it was scattered1 expensive1 and in most cases not arranged for the widest use4 ,not within our knowledge has the body of facts1 most helpful to the layman on ,sanitation and ,hygiene1 ,first ,aid1 and ,domestic ,healing1 been brought together as completely1 as clearly1 as concisely1 with a critical editing board so qualified1 and with special contributions so authoritative as this work exhibits4 ,utmost caution has been a watchword with the editors from the start4 ,those to whom the doctor cannot come every day have been repeatedly warned of the follies of self-treatment1 and reminded that to-day it is the patient that is treated--not the disease4 ,those to whom the doctor cannot come in time are likewise warned that the ,first-aid ,rules of this ,library are for temporary treatment only1 in all situations where it is possible to get a physician4 ,and the utmost conservatism has been striven for by the author and the several revisers in every part of the work that appeals particularly to dwellers in localities so removed that the doctor cannot come at all4 ,especial delicacy was also sought in the treatment of a chapter which1 it is hoped1 will aid parents to guide their children in sexual matters4 ,the illustrations represent helpful1 normal conditions 7with the exception of some necessary representations of fracture1 etc47 with instructive captions aimed to make them less a sensation than a real benefit2 and no pictures appear of a sort to stimulate mere morbid curiosity4 ,the greatest sympathy and appreciation of this work have been shown by the progressive and recognized practitioners who have seen early copies4 ,they recognize it as a timely attempt to create and compile health literature in a form most complete within its limits of space1 and in a manner most helpful and sane4 ,the eager curiosity regarding themselves that has been sweeping over the ,american people has been diverted into frivolous and harmful channels by much reckless talk and writing4 ,a prominent newspaper1 in its ,sunday editions1 recently took up the assertion1 in a series of articles1 that appendicitis operations resulted from a gigantic criminal conspiracy on the part of surgeons2 that a sufficient cure for appendicitis1 as any honest doctor would tell you1 is an injection of molasses and water6 ,the endless harm done by such outright untruth is swelled by a joining stream of slapdash misinformation and vicious sensation1 constantly running through the press4 ,education is sorely needed from authority4 ,people will read about their bodies4 ,they have a right to information from the highest accredited source4 ,and to apply such knowledge ,dr4 ,winslow has labored for many years during his practicing experience1 condensing and setting into clear order the most vitally important facts of domestic disease and treatment2 an eminently qualified staff of practicing specialists has cooeperated1 with criticism and supervision of incalculable value to the reader2 and the accepted classics in their field follow3 ,dr4 ,weir ,mitchell's elegant and inspiring essays on ,nerves1 ,outdoor ,life1 etc42 ,sir ,henry ,thompson's precious documents of personal experience on ,diet and ,conduct for ,long ,life2 ,dr4 ,dudley ,a4 ,sargent's scientific and long-prepared system of exercises without apparatus2 ,gerhard's clear principles of pure water supply2 ,dr4 ,darlington's notes and editing from the unequaled opportunity of a ,new ,york ,city ,health ,commissioner--and many other special contributions4 ,it is the widely accepted modern medicine1 and no school or system1 that is reflected here4 ,while medicine1 as a science1 is far from being perfect1 partly because of faulty traditions and misinterpreted experience1 yet the aim of the modern school is to base practice on facts4 ,for example1 for many years physicians were aware that quinine cured malaria1 in some unexplainable way4 ,now they not only know that malaria is caused by an animal parasite living and breeding in the blood and that quinine destroys the foe1 but they know about the parasite's habits and mode of development and when it most readily succumbs to the drug4 ,thus a great discovery taught them to give quinine understandingly1 at the right time1 and in the right doses4 ,an educated physician has at his command all knowledge1 past and present1 pertaining to medicine4 ,he is free to employ any means to better his patient4 ,now it is impossible to cure1 or even better1 all who suffer from certain disease by any one method1 and a follower of a special system thus ignores many agencies which might prove efficient in his case4 ,while there is a germ of good and truth in the various systems of medical practice1 their representatives possess no knowledge unknown to science or to the medical profession at large4 ,many persons are always attracted by something new4 ,but newness in a medical sect is too often newness in name only4 ,these systems rise and fall1 but scientific1 legitimate medicine goes ever onward with an eye single to the discovery of new facts4 ,that these volumes will result in an impetus to saner1 quieter1 steadier living1 and will prove a helpful friend to many a physician and many a layman1 is the earnest wish of ,,the ,,publishers4 ,part ,i ,,first ,,aid ,,in ,,emergencies ,,by ,,kenelm ,,winslow ,,and ,,albert ,,warren ,,ferris ,introductory ,note ,with the exception of the opening chapter1 which contains the valuable ,life-saving ,service ,rules verbatim1 the ,editors have adopted the plan of beginning each article in ,part ,i of this volume with a few simple1 practical instructions1 telling the reader exactly what to do in case of an accident4 ,for the purpose of distinguishing them from the ordinary text1 and making them easy of reference1 these ,first-aid ,rules are printed in light-faced type4 ,,chapter ,i ,restoring the ,apparently ,drowned ,as ,practiced in the ,united ,states ,life-,saving ,service ,,note4--,these directions differ from those given in the last revision of the ,regulations by the addition of means for securing deeper inspiration4 ,the method heretofore published1 known as the ,howard1 or direct method1 has been productive of excellent results in the practice of the service1 and is retained here4 ,it is1 however1 here arranged for practice in combination with the ,sylvester method1 the latter producing deeper inspiration than any other known method1 while the former effects the most complete expiration4 ,the combination1 therefore1 tends to produce the most rapid oxygenation of the blood--the real object to be gained4 ,the combination is prepared primarily for the use of life-saving crews where assistants are at hand4 ,a modification of ,rule ,,iii1 however1 is published as a guide in cases where no assistants are at hand and one person is compelled to act alone4 ,in preparing these directions the able and exhaustive report of ,messrs4 ,j4 ,collins ,warren1 ,m4,d41 and ,george ,b4 ,shattuck1 ,m4,d41 committee of the ,humane ,society of ,massachusetts1 embraced in the annual report of the society for #ahie-if1 has been availed of1 placing the department under many obligations to these gentlemen for their valuable suggestions4 ,,if ,,several ,,assistants ,,are ,,at ,,hand4 ,,rule ,i4 ,arouse the ,patient4--,do not move the patient unless in danger of freezing2 instantly expose the face to the air1 toward the wind if there be any2 wipe dry the mouth and nostrils2 rip the clothing so as to expose the chest and waist2 give two or three quick1 smarting slaps on the chest with the open hand4 ,if the patient does not revive1 proceed immediately as follows3 ,,rule ,,ii4 ,to ,expel ,water from the ,stomach and ,chest 7see ,fig4 #a74--,separate the jaws and keep them apart by placing between the teeth a cork or small bit of wood1 turn the patient on his face1 a large bundle of tightly rolled clothing being placed beneath the stomach2 press heavily on the back over it for half a minute1 or as long as fluids flow freely from the mouth4 ,illustration3 ,,fig4 #a4 ,,to ,,expel ,,water ,,from ,,stomach ,,and ,,chest4 ,patient lying face downward2 roll of clothes beneath stomach2 jaws separated by piece of wood or cork2 note rescuer pressing on back to force out water4 ,,rule ,,iii4 ,to ,produce ,breathing 7see ,figs4 #b and #c74--;,clear the mouth and throat of mucus by introducing into the throat the corner of a handkerchief wrapped closely around the forefinger2 turn the patient on the back1 the roll of clothing being so placed as to raise the pit of the stomach above the level of the rest of the body4 ,let an assistant1 with a handkerchief or piece of dry cloth1 draw the tip of the tongue out of one corner of the mouth 7which prevents the tongue from falling back and choking the entrance to the windpipe71 and keep it projecting a little beyond the lips4 ,let another assistant grasp the arms1 just below the elbows1 and draw them steadily upward by the sides of the patient's head to the ground1 the hands nearly meeting 7which enlarges the capacity of the chest and induces inspiration74 7,fig4 #b47 ,while this is being done let a third assistant take position astride the patient's hips with his elbows resting upon his own knees1 his hands extended ready for action4 ,next1 let the assistant standing at the head turn down the patient's arms to the sides of the body1 the assistant holding the tongue changing hands if necessary#a to let the arms pass4 ,just before the patient's hands reach the ground the man astride the body will grasp the body with his hands1 the balls of the thumb resting on either side of the pit of the stomach1 the fingers falling into the grooves between the short ribs4 ,now1 using his knees as a pivot1 he will1 at the moment the patient's hands touch the ground1 throw 7not too suddenly7 all his weight forward on his hands1 and at the same time squeeze the waist between them1 as if he wished to force something in the chest upward out of the mouth2 he will deepen the pressure while he slowly counts one1 two1 three1 four 7about five seconds71 then suddenly let go with a final push1 which will spring him back to his first position4#b ,this completes expiration4 7,fig4 #c47 ,illustration3 ,,fig4 #b4 ,,to ,,produce ,,breathing4 ,first ,position3 ,patient lying face upward2 roll of clothes under back2 tongue pulled out of mouth with handkerchief2 note rescuer drawing arms upward to sides of head to start act of breathing in4 ,illustration3 ,,fig4 #c4 ,,to ,,produce ,,breathing4 ,second ,position3 ,forcing patient to breathe out2 note rescuer with thumbs on pit of stomach1 pressing against front of chest over lower ribs2 also1 assistant drawing down arms to body4 ,at the instant of his letting go1 the man at the patient's head will again draw the arms steadily upward to the sides of the patient's head as before 7the assistant holding the tongue again changing hands to let the arms pass if necessary71 holding them there while he slowly counts one1 two1 three1 four 7about five seconds74 ,repeat these movements deliberately and perseveringly twelve to fifteen times in every minute--thus imitating the natural motions of breathing4 ,if natural breathing be not restored after a trial of the bellows movement for the space of about four minutes1 then turn the patient a second time on the stomach1 as directed in ,rule ,,ii1 rolling the body in the opposite direction from that in which it was first turned1 for the purpose of freeing the air passage from any remaining water4 ,continue the artificial respiration from one to four hours1 or until the patient breathes1 according to ,rule ,,iii2 and for a while1 after the appearance of returning life1 carefully aid the first short gasps until deepened into full breaths4 ,continue the drying and rubbing1 which should have been unceasingly practiced from the beginning by assistants1 taking care not to interfere with the means employed to produce breathing4 ,thus the limbs of the patient should be rubbed1 always in an upward direction toward the body1 with firm-grasping pressure and energy1 using the bare hands1 dry flannels1 or handkerchiefs1 and continuing the friction under the blankets1 or over the dry clothing4 ,the warmth of the body can also be promoted by the application of hot flannels to the stomach and armpits1 bottles or bladders of hot water1 heated bricks1 etc41 to the limbs and soles of the feet4 ,,rule ,,iv4 ,after ,treatment4 ,externally4--,as soon as breathing is established let the patient be stripped of all wet clothing1 wrapped in blankets only1 put to bed comfortably warm1 but with a free circulation of fresh air1 and left to perfect rest4 ,internally3 ,give whisky or brandy and hot water in doses of a teaspoonful to a tablespoonful1 according to the weight of the patient1 or other stimulant at hand1 every ten or fifteen minutes for the first hour1 and as often thereafter as may seem expedient4 ,later ,manifestations3 ,after reaction is fully established there is great danger of congestion of the lungs1 and if perfect rest is not maintained for at least forty-eight hours1 it sometimes occurs that the patient is seized with great difficulty of breathing1 and death is liable to follow unless immediate relief is afforded4 ,in such cases apply a large mustard plaster over the breast4 ,if the patient gasps for breath before the mustard takes effect1 assist the breathing by carefully repeating the artificial respiration4 ,,if ,,one ,,person ,,must ,,work ,,alone4 ,,modification ,,of ,,rule ,,iii ,to be used after ,rules ,i and ,,ii in case no assistance is at hand ,to ,produce ,respiration4--,if no assistance is at hand1 and one person must work alone1 place the patient on his back with the shoulders slightly raised on a folded article of clothing2 draw forward the tongue and keep it projecting just beyond the lips2 if the lower jaw be lifted1 the teeth may be made to hold the tongue in place2 it may be necessary to retain the tongue by passing a handkerchief under the chin and tying it over the head4#c ,grasp the arms just below the elbows and draw them steadily upward by the sides of the patient's head to the ground1 the hands nearly meeting4 7,see ,fig4 #d47 ,next lower the arms to the side1 and press firmly downward and inward on the sides and front of the chest over the lower ribs1 drawing arms toward the patient's head4 7,see ,fig4 #e47 ,repeat these movements twelve to fifteen times every minute1 etc4 ,illustration3 ,,fig4 #d4 ,,one ,,person ,,working4 ,first ,position3 ,note arm movement same as in ,fig4 #b2 also1 tongue held between teeth by handkerchief tied under chin pressing teeth against wooden plug4 ,illustration3 ,,fig4 #e4 ,,one ,,person ,,working4 ,second ,position3 ,note rescuer lowering arms to patient's sides and pressing downward and inward over lower ribs4 ,,instructions ,,for ,,saving ,,drowning ,,persons ,,by ,,swimming ,,to ,,their ,,relief4 #a4 ,when you approach a person drowning in the water1 assure him1 with a loud and firm voice1 that he is safe4 #b4 ,before jumping in to save him1 divest yourself as far and as quickly as possible of all clothes2 tear them off1 if necessary2 but if there is not time1 loose at all events the foot of your drawers1 if they are tied1 as1 if you do not do so1 they fill with water and drag you4 #c4 ,on swimming to a person in the sea1 if he be struggling do not seize him then1 but keep off for a few seconds till he gets quiet1 for it is sheer madness to take hold of a man when he is struggling in the water1 and if you do you run a great risk4 #d4 ,then get close to him and take fast hold of the hair of his head1 turn him as quickly as possible on to his back1 give him a sudden pull1 and this will cause him to float1 then throw yourself on your back also and swim for the shore1 both hands having hold of his hair1 you on your back1 and he also on his1 and of course his back to your stomach4 ,in this way you will get sooner and safer ashore than by any other means1 and you can easily thus swim with two or three persons2 the writer has even1 as an experiment1 done it with four1 and gone with them forty or fifty yards in the sea4 ,one great advantage of this method is that it enables you to keep your head up1 and also to hold the person's head up you are trying to save4 ,it is of primary importance that you take fast hold of the hair1 and throw both the person and yourself on your backs4 ,after many experiments1 it is usually found preferable to all other methods4 ,you can in this manner float nearly as long as you please1 or until a boat or other help can be obtained4 #e4 ,it is believed there is no such thing as a death grasp2 at least1 it is very unusual to witness it4 ,as soon as a drowning man begins to get feeble and to lose his recollection1 he gradually slackens his hold until he quits it altogether4 ,no apprehension need1 therefore1 be felt on that head when attempting to rescue a drowning person4 #f4 ,after a person has sunk to the bottom1 if the water be smooth1 the exact position where the body lies may be known by the air bubbles1 which will occasionally rise to the surface1 allowance being1 of course1 made for the motion of the water1 if in a tide way or stream1 which will have carried the bubbles out of a perpendicular course in rising to the surface4 ,oftentimes a body may be regained from the bottom1 before too late for recovery1 by diving for it in the direction indicated by these bubbles4 #g4 ,on rescuing a person by diving to the bottom1 the hair of the head should be seized by one hand only1 and the other used in conjunction with the feet in raising yourself and the drowning person to the surface4 #h4 ,if in the sea1 it may sometimes be a great error to try to get to land4 ,if there be a strong outsetting tide and you are swimming either by yourself or having hold of a person who cannot swim1 then get on your back and float till help comes4 ,many a man exhausts himself by stemming the billows for the shore on a back-going tide1 and sinks in the effort1 when1 if he had floated1 a boat or other aid might have been obtained4 #i4 ,these instructions apply alike to all circumstances1 whether as regards the roughest sea or smooth water4 ,,footnotes3 #a ,changing hands will be found unnecessary after some practice2 the tongue1 however1 must not be released4 #b ,a child or very delicate patient must1 of course1 be more gently handled4 #c ,if there is stuck through the tongue a pin long enough to rest against the teeth and keep the tongue out of the mouth1 the desired effect may be obtained4--,,editor4 ,,chapter ,,ii ,heat ,stroke and ,electric ,shock ,how ,persons are ,overcome by ,heat--,treatment of ,sunstroke--,peculiar ,cases--,dangers of ,electric ,shocks--,how ,death is ,caused--,rules and ,precautions4 ,,heat ,,exhaustion4 ,first ,aid ,rule #a4--;,carry patient flat and lay in shade4 ,loosen clothes at neck and waist4 ,rule #b4--,raise head and give him 7a7 teaspoonful of essence of ginger in glass of hot water1 or give him 7b7 half a cup of hot coffee1 clear4 ,rule #c4--,put him to bed4 ,,heat ,,stroke4 ,first ,aid ,rule #a4--,send for physician4 ,rule #b4--,remove quickly to shady place1 loosening clothes on the way4 ,rule #c4--,strip naked and put on wire mattress 7or canvas cot71 if obtainable4 ,rule #d4--,sprinkle with ice water from watering pot1 or dash it out of basin with hand4 ,rule #e4--;,dip sheet in ice water and tuck it snugly about patient4 ,rule #f4--,sprinkle outside of sheet with ice water2 rub body1 through the sheet1 with piece of ice4 ,put piece of ice to nape of neck4 ,rule #g4--,when temperature falls to #ih4e deg4 ,f4 put to bed with ice cap on head4 ,,sunstroke4--,there are two very distinct types of sunstroke3 7#a7 ,heat exhaustion or heat prostration4 7#b7 ,heat stroke4 ,heat prostration or exhaustion occurs when persons weakened by overwork1 worry1 or poor food are exposed to severe heat combined with great physical exertion4 ,it often attacks soldiers on the march1 but also those not exposed to the direct rays of the sun1 as workers in laundries1 in boiler rooms1 and in stoke-holes of steamers4 ,the attack begins more often in the afternoon or evening1 in the case of those exposed to out-of-door heat4 ,feelings of weakness1 dizziness1 and restlessness1 accompanied by headache1 are among the first symptoms4 ,the face is very pale1 the skin is cool and moist1 although the trouble often starts with sudden arrest of sweating4 ,there is great prostration1 with feeble1 rapid pulse1 frequent and shallow breathing1 and lowered temperature1 ranging often from #ie deg4 to #if deg4 ,f4 ,the patient usually retains consciousness1 but rarely there is complete insensibility4 ,the pernicious practice of permitting children at seaside resorts to wade about in cold water while their heads are bared to the burning sun is peculiarly adapted to favor heat prostration4 ,heat stroke happens more frequently to persons working hard under the direct rays of the sun1 especially laborers in large cities who are in the habit of drinking some form of alcohol4 ,it often occurs in unventilated tenements on stifling nights4 ,dizziness1 violent headache1 seeing spots before the eyes1 nausea1 and attempts at vomiting1 usher in the attack4 ,compare it with heat prostration1 and note the marked differences4 ,the patient becomes suddenly and completely insensible1 and falls to the ground1 the face is flushed1 the breathing is noisy and difficult1 the pulse is strong1 and the thermometer placed in the bowel registers #ajg deg41 #ajh deg41 or #aaj deg4 ,f41 or rarely higher4 ,the muscles are usually relaxed1 but sometimes there are twitchings1 or even convulsions4 ,death often occurs within twenty-four or thirty-six hours1 preceded by failing pulse1 deep unconsciousness1 and rapid breathing1 often labored or gasping1 alternating with long intermissions4 ,sometimes delirium and unconsciousness last for days4 ,diminution of fever and returning consciousness herald recovery1 but it is a very fatal disorder1 statistics showing a death rate of from thirty to fifty per cent4 ,even when the patient lives1 bad after effects are common4 ,peculiar sensibility to moderate heat is a frequent complaint4 ,loss of memory1 weakened mental capacity1 headache1 irritability1 fits1 other mental disturbances1 and impairment of sight and hearing are among the more usual sequels1 occurring in those who do not subsequently avoid the direct rays of the sun1 as well as an elevated temperature1 and who indulge in alcoholic stimulants4 ,a high degree of moisture in the air favors sunstrokes1 but it is a curious fact that sunstroke is much more frequent in certain localities1 and in special years than at other places and times with identical climatic conditions4 ,this has led observers to suggest a germ origin of the disease1 but this is extremely doubtful4 ,treatment4--,treatment for heat exhaustion is given in the first-aid directions4 ,little need be added to the directions for treatment of heat stroke4 ,in place of the ice cap suggested in ,rule #g1 ice in cloths1 or in a sponge bag may be substituted4 ,the friction of the body1 as directed in ,rule #f1 is absolutely necessary to stimulate the nervous system and circulation1 and to prevent the blood from being driven into the internal organs by the cold applied externally4 ,the cold-water treatment is applied until the temperature falls down to within a few degrees of normal--that is1 #ih4f deg4 ,f4 ,then the patient should be put into bed1 there to remain1 with ice to the head1 until fully restored4 ,it often happens that the fever returns1 in which event the whole process of applying cold water must be repeated4 ,the simplest way of reducing the fever consists in laying the patient1 entirely nude1 on a canvas cot or wire mattress1 binding ice to the back of his neck1 and having an attendant stand on a chair near by and pour ice water upon the patient from a garden watering pot4 ,while the patient is insensible no attempt should be made to give anything by the mouth2 but half a pint of milk and two raw eggs with a pinch of salt may be injected into the rectum every eight hours1 after washing it out with cold water on each occasion4 ,two tablespoonfuls of whisky may be added to the injection1 if the pulse is weak4 ,if the urine is not passed spontaneously1 it will be necessary to draw it once in eight hours with a soft rubber catheter which has been boiled ten minutes and lubricated with glycerin or clean vaseline4 ,,electric ,,shock ,,or ,,lightning ,,stroke4 ,first ,aid ,rule #a4--,protect yourself from being shocked by the victim4 ,grasp victim only by coat tails or dry clothes4 ,put rubber boots on your hands1 or work through silk petticoat2 or throw loop of rubber suspenders or of dry rope around him to pull him off wire1 or pry him along with dry stick4 ,rule #b4--;,do not lift1 but drag victim away from wire toward the ground4 ,when free from wire1 hold him head downward for two minutes4 ,rule #c4--;,assist heart to regain its strength4 ,apply mustard plaster 7mustard and water7 to chest over heart2 wrap in blanket wrung out of very hot water2 give hypodermic of whisky1 thirty minims4 ,rule #d4--;,induce artificial respiration4 ,open his mouth and grasp tongue1 pull it forward just beyond lips1 and hold it there4 ,let another assistant grasp the arms just below the elbows and draw them steadily upward by the sides of the patient's head to the ground1 the hands nearly meeting 7which enlarges the capacity of the chest and induces inspiration1 ,fig4 #b74 ,while this is being done1 let a third assistant take position astride the patient's hips with his elbows resting on his own knees1 his hands extended1 ready for action4 ,next1 let the assistant standing at the head turn down the patient's arms to the sides of the body1 the assistant holding the tongue changing hands1 if necessary1 to let the arms pass4 ,just before the patient's hands reach the ground1 the man astride the body will grasp the body with his hands1 the ball of the thumb resting on either side of the pit of the stomach1 the fingers falling into the grooves between the short ribs4 ,now1 using his knees as a pivot1 he will at the moment the patient's hands touch the ground throw 7not too suddenly7 all his weight forward on his hands1 and at the same time squeeze the waist between them1 as if he wished to force something in the chest upward out of the mouth2 he will deepen the pressure while he slowly counts one1 two1 three1 four 7about five seconds71 then suddenly lets go with a final push1 which will send him back to his first position4 ,this completes expiration4 7,a child or delicate person must be more gently handled47 ,at the instant of letting go1 the man at the patient's head will again draw the arms steadily upward to the sides of the patient's head1 as before 7the assistant holding the tongue again changing hands to let the arms pass1 if necessary71 holding them there while he slowly counts one1 two1 three1 four 7about five seconds74 ,repeat these movements deliberately and perseveringly twelve to fifteen times in every minute--thus imitating the natural motions of breathing4 ,continue the artificial respiration from one to four hours1 or until the patient breathes2 and for a while1 after the appearance of returning life1 carefully aid the first short gasps until deepened into full breaths4 ,keep body warm with hot-water bottles1 hot bricks to limbs and feet1 and blankets over exposed lower part of body4 ,rule #e4--,treat burn1 if any4 ,if skin is not broken1 cover burn with cloths wet with ,carron oil 7equal parts of limewater and linseed or olive oil74 ,if skin is broken1 or raw surface is exposed1 spread over it paste of equal parts of boric acid and vaseline1 and bandage over all4 ,conditions1 ,etc4--,a shock produced by contact with an electric current is not of rare occurrence4 ,lightning stroke is very uncommon2 statistics show that in the ,united ,states each year there is one death from this cause to each million of inhabitants4 ,there are several conditions which must be borne in mind when considering the accidental effect of an electric current4 ,the pressure and strength of the current 7voltage and amperage7 are often not nearly so important in regard to the effects on the body1 as the area1 duration1 and location of the points of contact with the current1 and the resistance offered by clothing and dry skin to the penetration of the electricity4 ,when the heart lies in the course of the circuit1 the danger is greatest4 ,a dog can be killed by a current of ten volts pressure when contacts are made to the head and hind legs1 because the current then flows through the heart1 while a current of eighty volts is required to kill a dog1 under the same conditions1 if contacts are made to head and fore leg4 ,in a general way alternating currents of low frequency are the most injurious to the body1 and any current pressure higher than two hundred volts is dangerous to life4 ,on the other hand1 a current of ninety-five volts has proved fatal to a human being4 ,in this case the circumstances were particularly unfavorable to the victim1 as he was standing on an iron tank in boots wet with an alkaline solution1 and probably studded on the soles with nails1 when he came in accidental contact with an industrial current4 ,moreover1 he was an habitual drunkard4 ,in an instance of the contrary sort1 a man received a current of #a1gjj volts 7periodicity about #acj7 for fifty seconds1 in one of the early attempts at electro-execution1 without being killed4 ,the personal equation evidently enters into the matter4 ,a strong physique here1 as in other cases1 is most favorable in resisting the effects of electric shock4 ,high-pressure alternating currents 7#a1cjj to #b1jjj volts7 are employed in electro-executions1 and the contacts are carefully made1 so that the current will enter the brain and pass through the heart to the leg4 ,the two most vital parts are thus affected4 ,in industrial accidents such nice adjustments are fortunately almost impossible1 and shocks received from high-pressure currents1 even of #be1jjj volts1 have not proved fatal because both the voltage and amperage have been greatly lessened through poor contacts and great resistance of clothing and dry skin1 and also because the heart is not usually included in the circuit4 ,death is induced in one of three ways3 #a4 ,currents of enormous voltage and amperage1 as occur in lightning1 actually destroy1 burst and burn the tissues through which the stroke passes4 #b4 ,usually death follows accidents from industrial currents1 owing to contraction of the heart1 the effect being the same as observed on other muscles4 ,the heart instantly ceases beating1 and either remains absolutely quiet1 or there is a fine quivering of some of its fibers1 as seen on opening the chest in experiments upon animals4 #c4 ,a fatal issue may result from the passage of the current through the head1 so affecting the nerve centers that govern respiration that the breathing ceases4 ,symptoms4--,these are generally muscular contractions1 faintness1 and unconsciousness 7sometimes convulsions1 if the current passes through the head71 with failure of pulse and of breathing4 ,for instance1 a man who was removing a brush from a trolley car touched1 with the other hand1 a live rail4 ,his muscles immediately contracted throwing him back1 and disconnecting him from contact with the current 7#ejj volts74 ,he then fainted and became unconscious for a short time4 ,the pulse was rapid and feeble1 and the breathing also at first1 but it later became slower than usual4 ,on regaining sensibility the patient vomited and got on his feet1 although feeling very weak for two hours4 ,unconsciousness commonly lasts only a few moments in nonfatal cases1 but may continue for hours1 its continuance being rather a favorable sign of ultimate recovery1 if the heart and lungs are acting sufficiently4 ,bad after effects are rare4 ,it is not uncommon for the patient to declare that the accident had improved his general feelings4 ,occasionally there is temporary loss of muscular power1 and a case has been reported of nervous symptoms following electric shock similar to those observed after any accidental violence4 ,burns of varying degrees of intensity occur at the point of entrance of the current1 from slight blisters to complete destruction of all the tissues4 ,treatment4--,the treatment is completely outlined in the first-aid directions4 ,should contact be unbroken1 an order to shut off the electric current should at once be telephoned to the station4 ,protection of the rescuer with thick rubber gloves is of course the ideal safeguard4 ,in fatal cases the heart is instantaneously arrested1 and nothing can be done to start it into action4 ,if the current passes through the brain1 by contact with the head or neck1 then failure of breathing is more apt to be the cause of death4 ,theoretically1 it is in the latter event only that treatment1 i4 e41 artificial respiration1 will be of avail4 ,but as in any individual case the exact condition is always a matter of doubt1 artificial respiration is the most valuable remedial measure we possess2 it should always be practiced for hours in doubtful cases4 ,two tablespoonfuls of brandy or whisky in a cup of warm water may be injected into the bowel1 if a hypodermic syringe is not available and the patient needs decided stimulation4 ,,chapter ,,iii ,wounds1 ,sprains and ,bruises ,treatment of ,wounds--,rules for ,checking ,hemorrhage--,lockjaw--,bandages for ,sprains--,synovitis--,bunions and ,felons--,foreign ,bodies in the ,eye1 ,ear and ,nose4 ,,wounds4--,a wound is a condition produced by a forcible cutting1 contusing1 or tearing of the tissues of the body1 and includes1 in its larger sense1 bruises1 sprains1 dislocations1 and breaks or fractures of bones4 ,as ordinarily used1 a wound is an injury produced by forcible separation of the skin or mucous membrane1 with more or less injury to the underlying parts4 ,the main object during the care of wounds should be to avoid contamination with anything which is not surgically clean1 from the beginning to the end of the dressing2 otherwise1 every other step in the whole process is rendered useless4 ,three essentials in the treatment of wounds are3 #a4 ,the arrest of bleeding4 #b4 ,absolute cleanliness4 #c4 ,rest of the injured part4 ,dangerous bleeding demands immediate relief4 ,bleeding is of three kinds3 #a4 ,from a large artery4 #b4 ,from a vein4 #c4 ,general oozing4 ,,bleeding ,,from ,,large ,,artery ,,in ,,spurts ,,of ,,bright ,,blood4 ,first ,aid ,rule #a4--,speed increases safety4 ,put patient down flat4 ,make pressure with hands between the wound and the heart till surgeon arrives1 assistants taking turns4 ,rule #b4--;,if arm or leg1 tie rubber tubing or rubber suspenders tight about limb between wound and heart1 or tie strap or rope over handkerchief or folded shirt wrapped about limb4 ,if arm1 put baseball in arm pit1 and press arm against this4 ,or1 for arm or leg1 tie folded cloth in loose noose around limb1 put cane or umbrella through noose and twist up the slack very tight1 so as to compress the main artery with knot4 ,rule #c4--,keep limb and patient warm with hot-water bottles till surgeon arrives4 ,this treatment is of course only a temporary expedient1 as it is essential for a surgeon to tie the bleeding vessel itself2 therefore a medical man should be summoned with all dispatch4 ,,bleeding ,,from ,,vein2 ,,steady ,,flow ,,of ,,dark ,,blood4 ,first ,aid ,rule #a4--,make firm pressure with pad of cloth directly over wound1 also with hands between wound and extremity1 that is1 on side of cut away from the heart4 ,rule #b4--,tie tight bandage about limb at this point1 with rubber tubing or suspenders4 ,rule #c4--,keep limb and patient warm with hot-water bottles till surgeon arrives4 ,in the cases of bleeding from a vein1 the flow of blood is continuous1 and is of a dark1 red hue1 and does not spurt in jets1 as from an artery4 ,this kind of bleeding is not usually difficult to stop1 and it is not necessary that the vein itself be tied--unless very large--provided that the wound be snugly bandaged after it is dressed4 ,after the first half hour1 release the limb and see if the bleeding has stopped4 ,if so1 and the circulation is being interfered with1 owing to the tightness of the bandage1 reapply the bandage more loosely4 ,in the case of an injured artery of any considerable size1 the amount of pressure required to stop the bleeding will arrest all circulation of blood in the limb1 so that great damage1 as well as pain1 will ensue if it be continued more than an hour or two1 and during this time the limb should be kept warm by thick covering and hot-water bags1 if they can be obtained4 ,bleeding from a deep puncture may be stopped by plugging the cavity with strips of muslin which have been boiled1 or with absorbent cotton1 similarly treated1 keeping the plug in place by snug bandaging4 ,,bleeding ,,from ,,punctured ,,wound4 ,first ,aid ,rule #a4--;,extract pin1 tack1 nail1 splinter1 thorn1 or bullet1 ,,if ,,you ,,can ,,see ,,bullet2 do not probe4 ,rule #b4--,pour warm water on wound and squeeze tissue to encourage bleeding4 ,send for small hard-rubber syringe4 ,rule #c4--;,if deep1 plug it with absorbent cotton1 and put tight bandage over plug4 ,if shallow1 cover with absorbent cotton wet with boric-acid solution 7one dram to one-half pint of water71 or carbolic-acid solution 7one teaspoonful to the pint of hot water74 ,rule #d4--,when syringe comes1 remove dressing1 and clean wound by forcibly syringing carbolic solution directly into wound4 ,replace dressing4 ,a small punctured wound should be squeezed in warm water to encourage bleeding and1 if pain and swelling ensue1 absorbent cotton soaked in a boric-acid solution 7containing as much boric acid as the water will dissolve7 or in carbolic-acid solution 7one teaspoonful of pure acid to the pint of warm water7 should be applied over the wound and covered with oil silk or rubber or enamel cloth for a few days1 or until the soreness has subsided4 ,the dressing should be wet with the solution as often as it becomes dry4 ,punctures by nails1 especially if deep1 should be washed out with a syringe1 using one of the solutions just mentioned4 ,a medicine dropper1 minus the rubber part1 attached to a fountain syringe1 makes a good nozzle for this purpose4 ,a moist dressing1 like the one described1 should then be applied1 and the limb kept in perfect rest for a few days4 ,when a surgeon's services are available1 however1 self-treatment is attended with too much danger1 as a thorough opening up of such wounds with proper cleansing and drainage will afford a better prospect of early recovery1 and avert the risk of serious inflammation and lockjaw1 which sometimes follow punctured wounds of the hands and feet4 ,foreign bodies1 as splinters1 may be removed with tweezers or a needle1 being careful not to break the splinter in the attempt4 ,if a part remains in the flesh1 or if the foreign body is a needle that cannot be found or removed at once1 the continuous application of a hot flaxseed or other poultice will lead to the formation of matter1 with which the splinter or needle will often escape after a few days4 ,splinters finding their way under the nail may be removed by scraping the nail very thin over the splinter and splitting it with a sharp knife down to the point where the end of the splinter can be grasped4 ,,bleeding ,,in ,,form ,,of ,,oozing4 ,first ,aid ,rule #a4--;,apply water as hot as hand can bear4 ,rule #b4--;,elevate the part1 and drench with carbolic solution 7one teaspoonful of carbolic acid to one pint of hot water74 ,rule #c4--;,bandage snugly while wet4 ,rule #d4--,keep patient warm with hot-water bottles4 ,,general ,,oozing happens in the case of small wounds or from abraded surfaces1 and is caused by the breaking of numerous minute vessels which are not large enough to require the treatment recommended for large arteries or veins4 ,it is rarely dangerous1 and usually stops spontaneously4 ,when the loss of blood has been considerable1 so that the patient is pale1 faint1 and generally relaxed1 with cold skin1 and perhaps nausea and vomiting1 he should be stripped of all clothing and immediately wrapped in a blanket wrung out of hot water1 and then covered with dry blankets4 ,heat should also be applied to the feet by means of hot-water bags or bottles1 with great care not to burn a semiconscious patient's skin4 ,the head should be kept low1 and two tablespoonfuls of brandy1 whisky1 or other alcoholic liquor should be given in a half cup of hot water by the mouth1 if the patient can swallow4 ,if much blood has been lost a quart of water1 as hot as the hand can readily bear1 and containing a teaspoonful of common salt1 should be injected by means of a fountain syringe into the rectum4 ,somewhat the condition just described as due to loss of blood may be caused simply by shock to the nervous system following any severe accident1 and not attended by bleeding4 ,the treatment of shock is1 however1 practically the same as that for hemorrhage1 and improvement in either case is shown by return of color to the face and strength in the pulse4 ,bleeding is apt to be much less in badly torn than in incised wounds1 even if large vessels are severed1 as when the legs are cut off in railroad accidents1 for the lacerated ends of the vessels become entangled with blood and favor clotting4 ,,lockjaw4--,in the lesser injuries1 where bleeding is not an important feature1 and in all wounds as well1 after bleeding has been stopped1 the main object in treatment consists in cleansing wounds of the germs which cause matter or pus1 general blood poisoning1 and lockjaw4 ,the germs of the latter live in the earth1 and even the smallest wounds which heal perfectly may later give rise to lockjaw if dirt has not been entirely removed from the wound at the time of accident4 ,injuries to the hands caused by pistols1 firecrackers1 and kindred explosives1 seem especially prone to produce lockjaw1 and fatalities from this disorder are deplorably numerous after ,fourth-of-,july celebrations in the ,united ,states4 ,the wounds producing lockjaw usually occur in children who explode blank cartridges in the palm of the hand4 ,in this way the germs of the disease are forced in with parts of the dirty skin and more or less of the wad from the shell4 ,since lockjaw is so frequent after these accidents1 and so fatal1 it is impossible to exert too much care in treatment4 ,the wound should at once be thoroughly opened with a knife to the very bottom1 under ether1 by a surgeon1 and not only every particle of foreign matter removed1 but all the surrounding tissue should be cut out or cauterized4 ,in addition1 it is wise to use an injection under the skin of tetanus-antitoxin1 to prevent the disease4 ,proper restriction of the sale of explosives alone will put a stop to this barbarous mode of exhibiting patriotism4 ,treatment4--,it is not essential to use chemical agents or antiseptics to rid wounds of germs and so secure uninterrupted healing4 ,the person who is to dress the wound should prepare to do so at the earliest possible moment after giving first aid4 ,he should proceed promptly to boil some pieces of absorbent cotton1 as large as an egg1 together with a nail brush in water4 ,some strips of clean cotton cloth may be used in the absence of absorbent cotton4 ,the boiling should be conducted for five minutes1 when the basin or other utensil in which the brush and cotton are boiled should be taken off the fire and set aside to cool4 ,then the attendant should scrub his own hands for five minutes in hot water with soap and brush4 ,he next takes the brush1 which has been boiled1 out of the water and cleans the patient's skin for a considerable distance about the wound4 ,when this is done1 and the water and cotton which have been boiled are sufficiently cool1 the wound should be bathed with the cotton and boiled water until all foreign matter has been removed from the wound2 not only dirt which can be seen1 but germs which cannot be seen4 ,some of the boiled cotton cloth or absorbent cotton1 wet as it is1 should be placed over the wound and the whole covered by a bandage4 ,large gaping wounds are of course more properly closed by stitches1 but very deep wounds should be left partly open1 so that the discharge may drain away freely4 ,small1 deep1 punctured wounds are not to be closed at all1 but should be sedulously kept open by pushing in strips of boiled cotton cloth1 in order to secure drainage4 ,if the attendant has the requisite confidence1 there is no reason why he should not attempt stitching a wound1 providing the patient is willing1 and a surgeon cannot be obtained within twenty-four hours4 ,in this case a rather stout1 common sewing needle or needles are threaded with black or white thread1 preferably of silk1 and1 together with a pair of scissors and a clean towel1 are boiled in the same utensil with the cotton and the nail brush4 ,after the operator has scrubbed his hands and cleansed the wound1 he places the boiled towel about the wound so that the thread will fall on it during his manipulations and not on the skin4 ,the needle should be thrust into and through the skin1 but no lower than this1 and should enter and leave the skin about a quarter of an inch from either edge of the wound4 ,the stitches are placed about one-half inch apart1 and are drawn together and tied tightly enough to join the two edges of the wound4 ,the ends of the thread should be cut about one-half inch from the knot1 being careful while using the needle and scissors not to lay them down on anything except the boiled towel4 ,the wound is then covered with cotton1 which has been boiled as described above1 bandaged and left undisturbed for a week1 if causing no pain4 ,at the end of this time the stitches are taken out after the attendant has washed his hands carefully1 and boiled his scissors as before4 ,court plaster or plaster of any kind is a bad covering or dressing for wounds1 as it may be itself contaminated with germs4 ,it effectually keeps in any with which the wound is already infected1 and prevents proper drainage4 ,it is impossible in a work of this kind to describe the details of the after treatment of wounds1 as this can only be properly undertaken by a surgeon1 owing to the varying conditions which may arise4 ,in general it may be stated that the same cleanliness and care should be followed during the whole course of healing as has been outlined for the first attempt at treatment4 ,if the wound is small1 and there is no discharge from it1 it may be painted with collodion or covered with boric-acid ointment 7sixty grains of boric acid to the ounce of vaseline7 after the first day4 ,if large1 it should be covered with cotton gauze or cloth which have been boiled or specially prepared for surgical purposes4 ,if pus 7matter7 forms1 the wound must be cleansed daily of discharge 7more than once if it is copious7 with boiled water1 or best with hydrogen dioxide solution followed by a washing with a solution of carbolic acid 7one teaspoonful to the pint of hot water71 or with a solution of mercury bichloride1 dissolving one of the larger bichloride tablets1 sold for surgical uses1 in a quart of water4 ,it is a surgical maxim never to be neglected that wounds should not be allowed to close at the top before healing is completed at the bottom4 ,as to close at the surface is the usual tendency in wounds that heal slowly and discharge pus1 it is necessary at times to enlarge the external opening by cutting or stretching with the blades of a pair of scissors1 or1 and this is much more rational and comfortable for the patient1 by daily packing the outlet of the wound with gauze to keep it open4 ,,bleeding ,,from ,,scalp4 ,first ,aid ,rule #a4--;,cut hair off about wound1 and clean thoroughly with carbolic-acid solution 7one teaspoonful to pint of hot water74 ,rule #b4--,put pad of gauze or muslin directly over wet wound1 and make pressure firmly with bandage4 ,in case of wounds of the scalp1 or other hairy parts1 the hair should be cut1 or better shaved1 over an area very much larger than the wounded surface1 after which the cleansing should be done4 ,to stop bleeding of the scalp1 water is applied as hot as can be borne1 and then a wad of boiled cotton should be placed in the wound and bandaged down tightly into it for a time4 ,closing the wound with stitches will stop the bleeding much more effectively1 however1 and is not very painful if done immediately after the accident4 ,the stitches should be tied loosely1 and not introduced nearer to each other than half an inch1 to allow drainage of discharge from the wound4 ,general ,remarks4--,all wounds should be kept at rest after they are dressed4 ,this is accomplished in the case of the lower limbs by keeping the patient in bed with the leg raised on a pillow4 ,the same kind of treatment applies in severe injuries of the hands4 ,in less serious cases a sling may be employed1 and the patient may walk about4 ,when the injury is near a joint1 as of the fingers1 knee1 wrist1 or elbow1 a splint made of thin board or tin 7and covered with cotton wadding and bandaged7 should be applied by means of surgeon's adhesive plaster and bandage after the wound has been dressed4 ,in injuries of the hand the splint should be applied to the palm side1 and reach from the finger tips to above the wrist4 ,use a splint also4 ,,nosebleed4 ,first ,aid ,rule #a4--,seat patient erect and apply ice to nape of neck4 ,rule #b4--,put roll of brown paper under upper lip1 and press lip firmly against it4 ,press facial artery against lower jaw of bleeding side1 till bleeding stops4 ,this artery crosses lower edge of jawbone one inch in front of angle of jaw4 ,rule #c4--,plug nostril with strip of thin cotton or muslin cloth4 ,rule #d4--;,do not wash away clots2 encourage clotting to close nostril4 ,,bleeding ,,from ,,lungs2 ,,bright ,,blood ,,coughed ,,up4 ,,bleeding ,,from ,,stomach2 ,,dark ,,blood ,,vomited4 ,first ,aid ,rule for both4 ,let patient lie flat and swallow small pieces of ice1 and also take one-quarter teaspoonful of table salt in half a glass of cold water4 ,,bruise4 ,first ,aid ,rule #a4--;,bandage from tips of fingers1 or from toes1 making same pressure with bandage all the way up as you do over the injury4 ,rule #b4--;,apply heat through the bandage1 over the injury1 with hot-water bottles4 ,cause1 ,etc4--,a bruise is a hidden wound2 the skin is not broken4 ,it is an injury caused by a blunt body so that1 while the tougher skin remains intact1 the parts beneath are torn and crushed to a greater or lesser extent4 ,the smaller blood vessels are torn and blood escapes under the skin1 giving the black and blue appearance so common in bruises of any severity4 ,sometimes1 indeed1 large collections of blood form beneath the skin1 causing a considerable swelling4 ,use of the bruised part is temporarily limited4 ,pain1 faintness1 and nausea follow severe bruises1 and1 in case of bad bruises of the belly1 death may even ensue from damage to the viscera or to the nerves4 ,dangerous bleeding from large blood vessels sometimes takes place internally1 and collections of blood may later break down into abscesses4 ,furthermore1 the bruise may be so great that the injury to muscle and nerve may lead to permanent loss of use of the part4 ,for these reasons a surgeon's advice should always be sought in cases of bad bruises4 ,pain is present in bruises1 owing to the tearing and stretching of the smaller nerve fibers1 and to pressure on the nerves caused by swelling4 ,the swelling is produced by escape of blood and fluid from the torn blood vessels4 ,treatment4--,even slight and moderate bruises should be treated by rest of the injured part4 ,a splint insures the rest of a limb 7see treatment of ,fractures1 p4 #hj74 ,one of the best modes of treatment is the snug application of a flannel bandage which secures a certain amount of rest of the part to which it is applied1 and aids in preventing further swelling4 ,where bandaging is not feasible1 as in certain parts of the body1 or before bandaging in any kind of a bruise1 the use of a cold compress is advisable4 ,one layer of thin cotton or linen cloth should be wet in ice water1 and should be put on the bruised part and continually changed for newly moistened pieces as soon as the first grows warm4 ,alcohol and water1 of each equal parts1 may be used in the same manner to advantage4 ,when cold is unavailable or unpleasant to the patient1 several layers of cotton cloth may be wrung out in very hot water and applied to the part with frequent renewal4 ,the value attributed to witch-hazel and arnica is mainly due to the alcohol contained in their preparations4 ,cataplasma ,kaolini 7,u4 ,s4 ,p47 is an excellent remedy for simple bruises when spread thickly on the part and covered with a bandage4 ,an ointment containing twenty-five per cent of ichthyol is also a useful application4 ,following severe bruises1 the damaged parts should be kept warm by the use of hot-water bags1 or by covering a limb with cotton wool and bandage1 until such time as surgical advice may be obtained4 ,when the pain and swelling of bruises begin to subside1 treatment should be pursued by rubbing with liniment of ammonia or chloroform1 or vaseline if these are not obtainable4 ,moderate exercise of the part is desirable4 ,,abrasions4--,when the surface skin is scraped off1 as often happens to the shin1 knee1 or head1 an ointment containing sixty grains of boric acid to the ounce of vaseline makes a good application1 and this may be covered with a bandage4 ,the same ointment is useful to apply to small wounds and cuts after the first bandage is removed4 ,,sprain2 ,,no ,,displacement ,,of ,,bones4 ,first ,aid ,rule #a4--;,immerse in water1 hot as hand can bear1 for half an hour4 ,rule #b4--;,dry and strap with adhesive plaster1 if you know how4 ,if not1 bandage snugly1 beginning with tips of fingers or with toes1 and make same pressure all the way up that you do over injury4 ,rule #c4--,rest4 ,if ankle or knee is hurt1 patient must go to bed4 ,conditions1 ,etc4--,a sprain is an injury caused by a sudden wrench or twist of a joint1 producing a momentary displacement of the ends of the bones to such a degree that they are forced against the membrane and ligaments surrounding the joint1 tearing one or both to a greater or less extent4 ,the wrist and ankle are the joints more commonly sprained1 and this injury is more likely to occur in persons with flabby muscles and relaxed ligaments1 as in the so-called weak-ankled4 ,the damage to the parts holding the joint in place may be of any degree1 from the tearing of a few fibers of the membrane enwrapping the joint to its complete rupture1 together with that of the ligaments1 so that the bones are no longer in place1 the joint loses its natural shape and appearance1 and we have a condition known as dislocation4 ,in a sprain then1 the twist of the joint produces only a temporary displacement of the bones forming the joint1 sufficient to damage the soft structures around it1 but not sufficient to cause lasting displacement of the bones or dislocation4 ,it will be seen that whether a sprain or dislocation results1 depends upon the amount of injury sustained4 ,since it often happens that the bone entering into the joint is broken1 it follows that whenever what appears to be a severe sprain occurs1 with inability to move the joint and great swelling1 it is important to secure surgical aid promptly4 ,since the discovery of the ,x-ray many injuries of the smaller bones of the wrist and ankle joint1 formerly diagnosed as sprains by the most skillful surgeons1 have1 by its use1 been discovered to be breaks of the bones which were impossible of detection by the older methods of examination4 ,symptoms4--,the symptoms of sprain are sudden1 severe pain1 often accompanied by faintness and nausea1 swelling1 tenderness1 and heat of the injured parts4 ,the sprained joint can be only moved with pain and difficulty4 ,the swelling is due not so much to leaking of blood from broken blood vessels as to filling up of the joint with fluid caused by the inflammation1 although in a few days after a severe sprain the skin a little distance below the injury becomes black and blue from escape of blood caused by the injury4 ,treatment4--,since the treatment of severe sprains means first the discrimination between dislocation1 a break of bone1 and a rupture of muscle1 ligament1 or tendon1 it follows that the methods herein described for treatment should only be employed in slight unmistakable sprains1 or until a surgeon can be secured1 or when one is unavailable4 ,nothing is better than immediate immersion of the sprained joint in as hot water as the hand can bear for half an hour4 ,following this1 an elastic bandage of flannel cut on the bias about three and one-half inches wide should be snugly applied to the limb1 beginning at the finger tips or at the toes and carrying the bandage some distance above the injured joint4 ,in bandaging a part there is always danger of applying the bandage too tightly1 especially if the parts swell under the bandage4 ,if this happens1 there is increase of pain which may be followed by numbness of the limb and1 what is still more significant1 coldness and blueness of the extremities below the bandage1 particularly of the fingers and toes4 ,in such cases the bandage must be removed and reapplied with less force4 ,if the ankle or knee be sprained the patient must go to bed for at least twenty-four hours1 and give the limb a complete rest4 ,when the wrist or shoulder is sprained the arm should be confined in a sling4 ,in the more serious cases the injured joint should be fixed in a splint before bandaging4 ,an injured elbow joint is held at a right angle by a pasteboard splint1 a bandage1 and a sling1 while the knee and wrist are treated with the limb in a straight line1 as far as possible4 ,in the case of the knee1 the splint is applied to the back of the leg2 in sprained wrist1 to the palm of the hand and same side of the forearm4 ,sheet wadding1 which may be bought at any drygoods store1 is torn into strips about two inches wide and sewed together forming a bandage ten or fifteen feet long1 and this is first wound about the sprained joint4 ,then pieces of millboard or heavy pasteboard are soaked in water and applied while wet in long strips about three inches wide over the wadding1 and the whole is covered with bandage4 ,in the case of the knee it is better to use a strip of wood for the splint1 reaching from the lower part of the calf to four inches above the knee4 ,it should be from a quarter to half an inch thick1 a little narrower than the leg1 and be padded thickly with sheet wadding4 ,it is held in place by strips of surgeon's adhesive plaster1 about two inches wide1 passed around the whole circumference of the limb above and below the knee joint1 and covered with bandage4 ,in ordinary sprains of the ankle1 uncomplicated by broken bone or ligament1 it is possible for the patient1 after resting in bed for a day1 to go about on crutches1 without bearing any weight on the foot until the third day after the accident4 ,the treatment in the meanwhile consists in immersing the sprained ankle alternately1 first in hot water for five minutes and then in cold water for five minutes1 followed by rubbing of the parts about the injured joint with chloroform liniment for fifteen minutes1 but not at the beginning touching the joint itself4 ,the rubbing should be done by an assistant very gently the first day1 with gradual increase in vigor as the days pass1 not only kneading the ankle but moving the joint4 ,this treatment should be pursued once daily1 and followed by bandaging with a flannel bandage cut on the bias three and a half inches wide4 ,with this method it is possible for the patient to regain the moderate use of the ankle in about two or three weeks4 ,the same general line of treatment applies to the other joints2 partial rest and daily bathing in hot and cold water1 rubbing and movements of the joint by an assistant4 ,since sprains vary in severity it follows that some may need only the first day's preliminary treatment prescribed to effect a cure1 while others may require fixation by a surgeon in a plaster-of-,paris splint for some time1 with additional treatment which only his special knowledge can supply4 ,illustration3 ,this picture shows an excellent method of fixing a sprained joint1 used by ,prof4 ,virgil ,p4 ,gibney1 ,m4,d41 ,surgeon-in-,chief of the ,n4 ,y4 ,hospital for ,ruptured and ,crippled4 ,it consists of strapping the joint by means of long1 narrow strips of adhesive plaster incasing it immovably in the normal position4 ,this procedure may be followed by anyone who has seen a surgeon practice it4 ,,synovitis--,severe ,injury4--,generally of ankle or knee from fall1 or shoulder from blow4 ,first ,aid ,rule #a4--,provide large pitcher of hot water and large pitcher of cold water and basin4 ,hold joint over basin2 pour hot water slowly over joint4 ,return this water to pitcher4 ,pour cold water over joint4 ,return water to pitcher4 ,repeat with hot water again1 and follow with cold4 ,continue this alternation for half an hour4 ,rule #b4--,put to bed1 with hot-water bottles about joint1 and wedge immovably with pillows4 ,rule #c4--,when tenderness and heat subside1 strap with adhesive plaster in overlapping strips4 ,conditions1 ,etc4--,this condition1 which may affect almost any freely movable joints1 as the knee1 elbow1 ankle1 and hip1 is commonly caused by a wrench1 blow1 or fall4 ,occasionally it comes on without any apparent cause1 in which case there is swelling and but slight pain or inflammation about the joint4 ,we shall speak of synovitis of the knee 7water on the knee71 as that is the most common form1 but these remarks will apply almost as well to the other joints4 ,in severe cases there are considerable pain1 redness and heat1 and great swelling about the knee4 ,the swelling is seen especially below the kneepan1 on each side of the front of the joint1 and also often above the kneepan4 ,frequently the only signs of trouble are swelling with slight pain1 unless the limb is moved4 ,treatment4--,if the knee is not red1 hot1 or tender to the touch1 it will not be necessary for the patient to remain in bed1 but when these symptoms are present a splint of some sort must be applied so that the leg is kept nearly straight1 and the patient must keep to his bed until the heat1 redness1 and tenderness have subsided4 ,in the meantime either an ice bag1 hot poultice1 cloths wrung out in hot water1 or a hot-water bag should be kept constantly upon the knee4 ,a convenient splint consists of heavy pasteboard wet and covered with sheet wadding 7or cotton batting7 shaped and affixed to the back of the leg1 from six inches below to four inches above the joint1 by strips of adhesive plaster1 as shown in the illustration1 and then by bandage1 leaving the knee uncovered for applications4 ,a wooden splint well padded may be used instead4 ,in mild cases without much inflammation1 and in others after the tenderness and heat have abated1 the patient may go about if the knee is treated as follows3 a pad of sheet wadding or cotton batting about two inches thick and five inches long and as wide as the limb is placed in the hollow behind the knee1 and then the whole leg is encircled with sheet wadding from six inches below to four inches above the knee1 covering the joint as well as the pad4 ,beginning now five inches below the joint1 strips of surgeon's adhesive plaster1 an inch wide and long enough to more than encircle the limb1 are affixed about the leg firmly like garters so as to make considerable pressure4 ,each strip or garter overlaps the one below about one-third of an inch1 and the whole limb is thus incased in plaster from five inches below the knee to a point about four inches above the joint4 ,an ordinary cotton bandage is then applied from below over the entire plaster bandage4 ,when this arrangement loosens1 the plaster should be taken off and new reapplied1 or a few strips may be wound about the old plaster to reenforce it4 ,the patient may walk about with this appliance without bending the knee4 ,when the swelling has nearly departed1 the plaster may be removed and the knee rubbed twice daily about the joint and the joint itself moved to and fro gently by an attendant1 and then bandaged with a flannel bandage4 ,painting the knee with tincture of iodine in spots as large as a silver dollar is also of service at this time4 ,the knee should not be bent in walking until it can be moved by another person without producing discomfort4 ,such treatment may be applied to the other joints in a general way4 ,the elbow must be fixed by a splint as recommended for dislocation of the joint 7p4 #abh74 ,the ankle is treated as advised for sprain of that joint 7p4 #fh74 ,when a physician can be obtained no layman is justified in attempting to treat a case of water on the knee or similar affection of other joints4 ,,bunion ,,and ,,housemaid',s ,,knee4--,bunion is a swelling of the bursa1 or cushion1 at the first joint of the great toe where it joins the foot4 ,it may not give much trouble1 or it may be hot1 red1 tender1 and very painful4 ,it is caused by pressure of a tight boot which also forces the great toe toward the little toe1 and thus makes the great toe joint more prominent and so the more readily injured4 ,a somewhat similar swelling1 often as large as an egg1 is sometimes seen over the kneepan1 more often in those who work upon their knees1 hence the name housemaid's knee4 ,the swelling may come on suddenly and be hot1 tender1 and painful1 or it may be slow in appearing and give little pain4 ,treatment4--,the treatment for the painful variety of bunion and housemaid's knee is much the same3 absolute rest with the foot kept raised1 and application of cloths kept constantly wet with ice or cold water2 or a thick covering of ,cataplasma ,kaolini 7,u4 ,s4 ,p47 may be applied until the inflammation has subsided4 ,if the trouble is chronic1 or the acute inflammation does not soon abate under the treatment advised1 the case is one for the surgeon1 and sometimes requires the knife for abscess formation4 ,in the milder cases of bunion1 wearing proper shoes whose inner border forms almost a straight line from heel to toe1 so that the great toe is not pushed over toward the little toe1 and painting the bunion every few days with tincture of iodine1 until the skin begins to become sore1 will often be sufficient to secure recovery4 ,,run-,,around2 ,,whitlow ,,or ,,felon4--,run-around consists in an inflammation of the soft parts about the finger nail4 ,it is more common in the weak1 but may occur in anyone1 owing to the entrance of pus germs through a slight prick or abrasion which may pass unnoticed4 ,the condition begins with redness1 heat1 tenderness1 swelling1 and pain of the flesh at the root of the nail1 which extends all about the nail and may be slight and soon subside1 or there may be great pain and increased swelling1 with the formation of matter 7pus71 and result in the loss of the nail1 particularly in the weak4 ,whitlow or felon is a much more serious trouble4 ,it begins generally as a painful swelling of one of the last joints of the fingers on the palm side4 ,among the causes are a blow1 scratch1 or puncture4 ,often there is no apparent cause1 but in some manner the germs of inflammation gain entrance4 ,the end of the finger becomes hot and tense1 and throbs with sometimes almost unbearable pain4 ,if the inflammation is chiefly of the surface there may be much redness1 but if mainly of the deeper parts the skin may be but little reddened or the surface may be actually pale4 ,there is usually some fever1 and the pain is made worse by permitting the hand to hang down4 ,if the felon is on the little finger or thumb the inflammation is likely to extend down into the palm of the hand1 and from thence into the arm along the course of the tendons or sinews of the muscles4 ,death of the bone of the last finger joint necessitating removal of this part1 stiffness1 crippling1 and distortion of the hand1 or death from blood poisoning may ensue if prompt surgical treatment is not obtained4 ,treatment4--,at the very outset it may be possible to stop the progress of the felon by keeping the finger constantly wet by means of a bandage continually saturated with equal parts of alcohol and water1 at night keeping it moist by covering with a piece of oil silk or rubber4 ,tincture of iodine painted all over the end of the finger is also useful1 and the hand should be carried in a sling by day1 and slung above the head to the headboard of the bed by night4 ,if after twenty-four hours the pain increases1 it is best to apply hot poultices to the finger1 changing them as often as they cool4 ,if the felon has not begun to abate by the end of forty-eight hours1 the end of the finger must be cut lengthwise right down to the bone by a surgeon to prevent death of the bone or extension of the inflammation4 ,poultices are then continued4 ,run-around is treated also by iodine1 cold applications1 and1 if inflammation continues1 by hot poulticing and incision with a knife2 but poulticing is often sufficient4 ,attention to the general health by a physician will frequently be of service4 ,,weeping ,,sinew2 ,,ganglion4--,this is a swelling as large as a large bean projecting from the back or front of the wrist with an elastic or hard feeling1 and not painful or tender unless pressed on very hard4 ,after certain movements of the hand1 as in playing the piano or1 for example1 in playing tennis1 some discomfort may be felt4 ,weeping sinew sometimes interferes with some of the finer movements of the hand4 ,the swelling is not red or inflamed1 but of the natural color of the skin4 ,it does not continue to increase after reaching a moderate size1 but usually persists indefinitely1 although occasionally disappearing without treatment4 ,the swelling contains a gelatinous substance which is held in a little sac in the sheath of the tendon or sinew1 but the inside of the sac does not communicate with the interior of the sheath surrounding the tendon4 ,treatment4--,this consists in suddenly exerting great pressure on the swelling with the thumb1 or in striking it a sharp blow with a book by which the sac is broken4 ,its contents escape under the skin1 and in most cases become absorbed4 ,if the swelling returns a very slight surgical operation will permanently cure the trouble4 ,,cinders ,,and ,,other ,,foreign ,,bodies ,,in ,,the ,,eye4#d--;,foreign bodies are most frequently lodged on the under surface of the upper lid1 although the surface of the eyeball and the inner aspect of the lower lid should also be carefully inspected4 ,a drop of a two per cent solution of cocaine will render painless the manipulations4 ,the patient should be directed to continue looking downward1 and the lashes and edge of the lid are grasped by the forefinger and thumb of the right hand1 while a very small pencil is gently pressed against the upper part of the lid1 and the lower part is lifted outward and upward against the pencil so that it is turned inside out4 ,the lid may be kept in this position by a little pressure on the lashes1 while the cinder1 or whatever foreign body it may be1 is removed by gently sweeping it off the mucous membrane with a fold of a soft1 clean handkerchief4 7,see ,figs4 #f and #g47 ,illustration3 ,,fig4 #f4 ,,fig4 #g4 ,,removing ,a ,,foreign ,,body ,,from ,,the ,,eye4 ,in ,fig4 #f note how lashes and edge of lid are grasped by forefinger and thumb1 also pencil placed against lid2 in ,fig4 #g lid is shown turned inside out over pencil4 ,hot cinders and pieces of metal may become so deeply lodged in the surface of the eye that they cannot be removed by the method recommended1 or by using a narrow slip of clean white blotting-paper4 ,all such cases should be very speedily referred to a physician1 and the use of needles or other instruments should not be attempted by a layman1 lest permanent damage be done to the cornea and opacity result4 ,such procedures are1 of course1 appropriate for an oculist1 but when it is impossible to secure medical aid for days it can be attempted without much fear1 if done carefully1 as more harm will result if the offending body is left in place4 ,it is surprising to see what a hole in the surface of the eye will fill up in a few days4 ,if the foreign body has caused a good deal of irritation before its removal1 it is best to drop into the eye a solution of boric acid 7ten grains to the ounce of water7 four times daily4 ,,foreign ,,bodies ,,in ,,the ,,ear4--,foreign bodies1 as buttons1 pebbles1 beans1 cherry stones1 coffee1 etc41 are frequently placed in the ear by children1 and insects sometimes find their way into the ear passage and create tremendous distress by their struggles4 ,smooth1 nonirritating bodies1 as buttons1 pebbles1 etc41 do no particular harm for a long time1 and may remain unnoticed for years4 ,but the most serious damage not infrequently results from unskillful attempts at their removal by persons 7even physicians unused to instrumental work on the ear7 who are driven to immediate and violent action on the false supposition that instant interference is called for4 ,insects1 it is true1 should be killed without delay by dropping into the ear sweet oil1 castor1 linseed1 or machine oil or glycerin1 or even water1 if the others are not at hand1 and then the insect should be removed in half an hour by syringing as recommended for wax 7,vol4 ,,ii1 p4 #ce74 ,to remove solid bodies1 turn the ear containing the body downward1 pull it outward and backward1 and rub the skin just in front of the opening into the ear with the other hand1 and the object may fall out4 ,failing in this1 syringing with warm water1 as for removal of wax1 while the patient is sitting1 may prove successful4 ,the essentials of treatment then consist1 first1 in keeping cool2 then in killing insects by dropping oil or water into the ear1 and1 if syringing proves ineffective1 in using no instrumental methods in an attempt to remove the foreign body1 but in awaiting such time as skilled medical services can be obtained4 ,if beans or seeds are not washed out by syringing1 the water may cause them to swell and produce pain4 ,to obviate this1 drop glycerin in the ear which absorbs water1 and will thus shrivel the seed4 ,,foreign ,,bodies ,,in ,,the ,,nose4--,children often put foreign bodies in their noses1 as shoe buttons1 beans1 and pebbles4 ,they may not tell of it1 and the most conspicuous symptoms are the appearance of a thick discharge from one nostril1 having a bad odor1 and some obstruction to breathing on the same side4 ,if the foreign body can be seen1 the nostril on the unobstructed side should be closed and the child made to blow out of the other one4 ,if blowing does not remove the body it is best to secure medical aid very speedily4 ,,footnotes3 #d ,the ,editors have deemed it advisable to repeat here the following instructions1 also occurring in ,vol4 ,,ii1 ,part ,i1 for the removal of foreign bodies in the eye1 ear1 and nose1 as properly coming under the head of ,first ,aid in ,emergencies4 ,,chapter ,,iv ,fractures ,how to ,tell a ,broken ,bone--,a ,simple ,sling--,splints and ,bandage1--,a ,broken ,rib--,fractures of ,arm1 ,shoulder1 ,hand1 ,hips ,leg and ,other ,parts4 ,,broken ,,bone2 ,,fracture4#e ,first ,aid ,rule #a4--;,be sure bone is broken4 ,if broken1 patient can scarcely 7if at all7 move the part beyond the break1 while attendant can move it freely in his hands4 ,if broken1 grating of rough edges of bone may be felt by attendant but should not be sought for4 ,if broken1 limb is generally shortened4 ,rule #b4--;,do not try to set bone permanently4 ,send at once for surgeon4 ,,compound ,,fracture4 ,important4 ,if there is opening to the air from the break1 because of tearing of tissues by end of bone1 condition is very dangerous2 first treatment may save life1 by preventing infection4 ,before reducing fracture1 and without stirring the patient much1 after scrubbing your hands very clean1 note3 ,first ,aid ,rule #a4--;,if hairy1 shave large spot about wound4 ,rule #b4--;,clean large area about wound with soap and water1 very gently4 ,then wash most thoroughly again with clean water1 previously boiled and cooled4 ,flood wound with cool boiled water4 ,rule #c4--;,cover wound with absorbent cotton 7or pieces of muslin7 which has been boiled4 ,then attend to broken bone1 as hereafter directed1 in the case of each variety of fracture4 ,after the bone is set1 according to directions1 then note3 ,rule #d4--,renew pieces of previously boiled muslin from time to time1 when at all stained with discharges4 ,every day wash carefully about wound1 between the splints1 with cool carbolic-acid solution 7one teaspoonful to a pint of hot water7 before putting on the fresh cloths4 ,,broken ,,bones ,,or ,,fractures4#f--;,it frequently happens that the first treatment of fracture devolves upon the inexperienced layman4 ,immediate treatment is not essential1 in so far as the repair of the fracture is directly concerned1 for a broken bone does not unite for several weeks1 and if a fracture were not seen by the surgeon for a week after its occurrence1 no harm would be done1 provided that the limb were kept quiet in fair position until that time4 ,the object of immediate care of a broken bone is to prevent pain and avoid damage which would ensue if the sharp ends of the broken bone were allowed to injure the soft tissues during movements of the broken limb4 ,fractures are partial or complete1 the former when the bone is broken only part way through2 simple1 when the fracture is a mere break of the bone1 and compound1 when the end of one or both fragments push through the skin1 allowing the air with its germs to come in contact with the wound1 thus greatly increasing the danger4 ,to be sure that a bone is broken we must consider several points4 ,the patient has usually fallen or has received a severe blow upon the part4 ,this is not necessarily true1 for old people often break the thigh bone at the hip joint by simply making a false step4 ,inability to use the limb and pain first call our attention to a broken bone4 ,then when we examine the seat of injury we usually notice some deformity--the limb or bone is out of line1 and there may be an unusual swelling4 ,but to distinguish this condition from sprain or bruise1 we must find that there is a new joint in the course of the bone where there ought not to be any2 e4 g41 if the leg were broken midway between the knee and ankle1 we should feel that there was apparently a new joint at this place1 that there was increased capacity for movement in the middle of the leg1 and perhaps the ends of the fragments of bones could be heard or felt grating together4 ,these1 then1 are the absolute tests of a broken bone--unusual mobility 7or capacity for movement7 in the course of the bone1 and grating of the broken fragments together4 ,the last will not occur1 of course1 unless the fragments happen to lie so that they touch each other and should not be sought for4 ,in the case of limbs1 sudden shortening of the broken member from overlapping of the fragments is a sure sign4 ,,special ,,fractures4 ,,broken ,,rib4--,first ,aid ,rule4--,patient puts hands on head while attendant puts adhesive-plaster band1 one foot wide1 around injured side from spine over breastbone to line of armpit of sound side4 ,then put patient to bed4 ,a rib is usually broken by direct violence4 ,the symptoms are pain on taking a deep breath1 or on coughing1 together with a small1 very tender point4 ,the deformity is not usually great1 if1 indeed1 any exists1 so that nothing in the external appearance may call the attention to fracture4 ,grating between the fragments may be heard by the patient or by the examiner1 and the patient can often place his finger on the exact location of the break4 ,when it is a matter of doubt whether a rib is broken or not the treatment for broken rib should be followed for relief of pain4 ,illustration3 ,,fig4 #h4 ,,method ,,of ,,bandaging ,,broken ,,rib 7,,scudder74 ,note manner of sticking one end of wide adhesive plaster along backbone2 also assistant carrying strip around injured side4 ,treatment consists in applying a wide band of surgeon's adhesive plaster1 to be obtained at any drug shop4 ,the band is made by overlapping strips four or five inches wide1 till a width of one foot is obtained4 ,this is then applied by sticking one end along the back bone and carrying it forward around the injured side of the chest over the breastbone as far as a line below the armpit on the uninjured side of the chest1 i4 e41 three-quarters way about the chest4 ,these four- or five-inch strips of plaster may be cut the right length first and laid together1 overlapping about two inches1 and put on as a whole1 or1 what is easier1 each strip may be put on separately1 beginning at the spine1 five inches below the fracture1 and continuing to apply the strips1 overlapping each other about two inches1 until the band is made to extend to about five inches above the point of fracture1 all the strips ending in the line of the armpit of the uninjured side4 7,fig4 #h47 ,if surgeon's plaster cannot be obtained1 a strong unbleached cotton or flannel bandage1 a foot wide1 should be placed all around the chest and fastened as snugly as possible with safety pins1 in order to limit the motion of the chest wall4 ,the patient will often be more comfortable sitting up1 and should take care not to be exposed to cold or wet for some weeks1 as pleurisy or pneumonia may follow4 ,three weeks are required for firm union to be established in broken ribs4 ,,collar-,,bone ,,fracture4 ,first ,aid ,rule4--,put patient flat on back1 on level bed1 with small pillow between his shoulders2 place forearm of injured side across chest1 and retain it so with bandage about chest and arm4 ,illustration3 ,,fig4 #i4 ,a ,,broken ,,collar ,,bone 7,,scudder74 ,usual attitude of patient with a fracture of this kind2 note lowering and narrowed appearance of left shoulder4 ,fracture of the collar bone is one of the commonest accidents4 ,the bone is usually broken in the middle third4 ,a swelling often appears at this point1 and there is pain there1 especially on lifting the arm up and away from the body4 ,it will be noticed that the shoulder1 on the side of the injury1 seems narrower and also lower than its fellow4 ,the head is often bent toward the injured side1 and the arm of the same side is grasped below the elbow by the other hand of the patient and supported as in a sling4 7,see ,fig4 #i47 ,in examining an apparently broken bone the utmost gentleness may be used or serious damage may result4 ,treatment4--,the best treatment consists in rest in bed on a hard mattress2 the patient lying flat on the back with a small pillow between the shoulders and the forearm of the injured side across the chest4 ,this is a wearisome process1 as it takes from two to three weeks to secure repair of the break4 ,on the other hand1 if the forearm is carried in a sling1 so as to raise and support the shoulder1 while the patient walks about1 a serviceable result is usually obtained2 the only drawback being that an unsightly swelling remains at the seat of the break4 ,to make a sling1 a piece of strong cotton cloth a yard square should be cut diagonally from corner to corner1 making two right-angled triangles4 ,each of these will make a properly shaped piece for a sling4 7,see ,figs4 #aj and #aa47 ,fracture of the collar bone happens very often in little children1 and is commonly only a partial break or splitting of the bone1 not extending wholly through the shaft so as to divide it into two fragments1 but causing little more than bending of the bone 7the green-stick fracture74 ,illustration3 ,,fig4 #aj4 ,,how ,,to ,,make ,a ,,sling 7,,scudder74 ,in ,fig4 #aj note three-cornered bandage2 ,no4 #b end is carried over right shoulder1 ,no4 #a over left1 then both fastened behind neck2 ,no4 #c brought over and pinned4 ,illustration3 ,,fig4 #aa4 ,,how ,,to ,,make ,a ,,sling 7,,scudder74 ,the above illustration shows sling in position4 ,it is made of cotton cloth a yard square cut diagonally from corner to corner4 ,a fall from a chair or bed is sufficient to cause the accident4 ,a child generally cries out on movement of the arm of the injured side1 or on being lifted by placing the hands under the armpits of the patient4 ,a tender swelling is seen at the point of the injury of the collar bone4 ,a broad cotton band1 with straps over the shoulders to keep it up1 should encircle the body and upper arm of the injured side1 and the hand of the same side should be supported by a narrow sling fastened above behind the neck4 ,,lower-,,jaw ,,fracture4 ,first ,aid ,rule4--,put fragments into place with your fingers1 securing good line of his teeth4 ,support lower jaw by firmly bandaging it against upper jaw1 mouth shut1 using four-tailed bandage4 7,fig4 #ab47 ,fracture of the lower jaw is caused by a direct blow4 ,it involves the part of the jaw occupied by the lower teeth1 and is more apt to occur in the middle line in front1 or a short distance to one side of this point4 ,the force causing the break usually not only breaks the bone1 but also tears the gum through into the mouth1 making a compound fracture4 ,there is immediate swelling of the gum at the point of injury1 and bleeding4 ,the mouth can be opened with difficulty4 ,the condition of the teeth is the most important point to observe4 ,owing to displacement of the fragments there is a difference in the level of the teeth or line of the teeth1 or both1 at the place where the fracture occurs4 ,also one or more of the teeth are usually loosened at this point4 ,in addition1 unusual movement of the fragments may be detected as well as a grating sound on manipulation4 ,treatment4--,the broken fragments should be pressed into place with the fingers1 and retained temporarily with a four-tailed bandage1 as shown in the cut4 ,feeding is done through a glass tube1 using milk1 broths1 and thin gruels4 ,a mouth wash should be employed four times daily1 to keep the mouth clean and assist in healing of the gum4 ,a convenient preparation consists of menthol1 one-half grain2 thymol1 one-half grain2 boric acid1 twenty grains2 water1 eight ounces4 ,illustration3 ,,fig4 #ab4 ,,bandage ,,for ,a ,,broken ,,jaw 7,,american ,,text-,,book74 ,above cut shows a four-tailed bandage2 note method of tying2 one strip supports lower jaw2 the other holds it in place against upper jaw4 ,,shoulder-,,blade ,,fracture4 ,first ,aid ,rule4--,there is no displacement4 ,bandage fingers1 forearm1 and arm of affected side1 and put this arm in sling4 ,fasten slung arm to body with many turns of a bandage1 which holds forearm against chest and arm against side4 ,shoulder-blade fracture occasions pain1 swelling1 and tenderness on pressure over the point of injury4 ,on manipulating the bone a grating sound may be heard and unnatural motion detected4 ,the treatment consists in bandaging the forearm and arm on the injured side from below upward1 beginning at the wrist2 slinging the forearm bent at a right angle across the front of the body1 suspended by a narrow sling from the neck1 and then encircling the body and arm of the injured side from shoulder to elbow with a wide bandage applied under the sling1 which holds the arm snugly against the side4 ,this bandage is prevented from slipping down by straps attached to it and carried over each shoulder4 ,,arm ,,fracture4 ,first ,aid ,rule4--,pad two pieces of thin board nine by three inches with handkerchiefs4 ,carefully pull fragments of bone apart1 grasping lower fragment near elbow while assistant pulls gently on upper fragment near shoulder4 ,put padded boards 7splints7 one each side of the fracture1 and wind bandage about their whole length1 tightly enough to keep bony fragments firm in position4 ,put forearm and hand in sling4 ,in fracture of the arm between the shoulder and elbow1 swelling and shortening may give rise to deformity4 ,pain and abnormal motion are symptoms1 while a grating sound may be detected1 but manipulation of the arm for this purpose should be avoided4 ,the surface is apt soon to become black and blue1 owing to rupture of the blood vessels beneath the skin4 ,the hand and forearm should be bandaged from below upward to the elbow4 ,the bone is put in place by grasping the patient's elbow and pulling directly down in line with the arm1 which is held slightly away from the side of the patient1 while an assistant steadies and pulls up the shoulder4 ,then a wedge-shaped pad1 long enough to reach from the patient's armpit to his elbow 7made of cotton wadding or blanketing sewed in a cotton case7 and about four inches wide and three inches thick at one end1 tapering up to a point at the other1 is placed against the patient's side with the tapering end uppermost in the armpit and the thick end down4 ,this pad is kept in place by a strip of surgeon's adhesive plaster1 or bandage passing through the small end of the wedge1 and brought up and fastened over the shoulder4 ,illustration3 ,,fig4 #ac4 ,,fig4 #ad4 ,,bandage ,,for ,,broken ,,arm 7,,scudder74 ,in ,fig4 #ac note splints secured by adhesive plaster2 also pad in armpit2 in ,fig4 #ad see wide bandage around body2 also sling4 ,while the arm is pulled down from the shoulder1 three strips of well-padded tin or thin board 7such as picture-frame backing7 two inches wide and long enough to reach from shoulder to elbow1 are laid against the front1 outside1 and back of the arm1 and secured by encircling strips of surgeon's plaster or bandage4 ,the arm is then brought into the pad lying against the side under the armpit1 and is held there firmly by a wide bandage surrounding the arm and entire chest1 and reaching from the shoulder to elbow4 ,it is prevented from slipping by strips of cotton cloth1 which are placed over the shoulders and pinned behind and before to the top of the bandage4 ,the wrist is then supported in a sling1 not over two inches wide1 with the forearm carried in a horizontal position across the front of the body4 ,firm union of the broken arm takes place usually in from four to six weeks4 7,see ,figs4 #ac and #ad47 ,,forearm ,,fracture4 ,first ,aid ,rule4--,set bones in proper place by pulling steadily on wrist while assistant holds back the upper part of the forearm4 ,if unsuccessful1 leave it for surgeon to reduce after period of inaction comes1 a few days later1 when swelling subsides4 ,if successful1 put padded splints 7pieces of cigar box padded with handkerchiefs7 one on each side1 front and back1 and wind a bandage about whole thing to hold it immovably4 ,two bones enter into the structure of the forearm4 ,one or both of these may be broken4 ,the fracture may be simple or compound1#g when the soft parts are damaged and the break of the bone communicates with the air1 the ends of the bone even projecting through the skin4 ,in fracture of both bones there is marked deformity1 caused by displacement of the broken fragments1 and unusual motion may be discovered2 a grating sound may also be detected but1 as stated before1 manipulation of the arm should be avoided4 ,illustration3 ,,fig4 #ae4 ,,setting ,a ,,broken ,,forearm 7,,scudder74 ,see manner of holding arm and applying adhesive plaster strips2 one splint is shown1 another is placed back of hand and forearm4 ,when only one bone is broken the signs are not so marked1 but there is usually a very tender point at the seat of the fracture1 and an irregularity of the surface of the bone may be felt at this point4 ,if false motion and a grating sound can also be elicited1 the condition is clear4 ,the broken bones are put into their proper place by the operator who pulls steadily on the wrist1 while an assistant grasps the upper part of the forearm and pulls the other way4 ,the ends of the fragments are at the same time pressed into place by the other hand of the operator1 so that the proper straight line of the limb is restored4 ,illustration3 ,,fig4 #af4 ,,fracture ,,of ,,both ,,bones ,,in ,,forearm 7,,scudder74 ,this cut shows the position and length of the two padded splints2 also method of applying adhesive plaster4 ,after the forearm is set1 it should be held steadily in the following position while the splints are applied4 ,the elbow is bent so that the forearm is held at right angles with the arm horizontally across the front of the chest with the hand extended1 open palm toward the body and thumb uppermost4 ,the splints1 two in number1 are made of wood about one-quarter inch thick1 and one-quarter inch wider than the forearm4 ,they should be long enough to reach from about two inches below the elbow to the root of the fingers4 ,they are covered smoothly with cotton wadding1 cotton wool1 or other soft material1 and then with a bandage4 ,the splints are applied to the forearm in the positions described1 one to the back of the hand and forearm1 and the other to the palm of the hand and front of the forearm4 ,usually there are spaces in the palm of the hand and front of the wrist requiring to be filled with extra padding in addition to that on the splint4 ,the splints are bound together and to the forearm by three strips of surgeon's adhesive plaster or bandage1 about two inches wide4 ,one strip is wound about the upper ends of the splints1 one is wrapped about them above the wrist1 and the third surrounds the back of the hand and palm1 binding the splints together below the thumb4 ,the splints should be held firmly in place1 but great care should be exercised to use no more force in applying the adhesive plaster or bandage than is necessary to accomplish this end1 as it is easy to stop the circulation by pressure in this part4 ,there should be some spring felt when the splints are pressed together after their application4 ,a bandage is to be applied over the splints and strips of plaster1 beginning at the wrist and covering the forearm to the elbow1 using the same care not to put the bandage on too firmly4 ,the forearm is then to be held in the same position by a wide sling1 as shown above4 7,see ,figs4 #ae1 #af1 #ag47 ,illustration3 ,,fig4 #ag4 ,,dressing ,,for ,,broken ,,forearm 7,,scudder74 ,proper position of arm in sling2 note that hand is unsupported with palm turned inward and thumb uppermost4 ,four weeks are required to secure firm union after this fracture4 ,when the fracture is compound the same treatment should be employed as described under ,compound ,fracture of ,leg1 p4 #aaf4 ,,fracture ,,of ,,the ,,wrist2 ,,colles',s ,,fracture4--,this is a break of the lower end of the bone on the thumb side of the wrist1 and much the larger bone in this part of the forearm4 ,the accident happens when a person falls and strikes on the palm of the hand2 it is more common in elderly people4 ,a peculiar deformity results4 ,a hump or swelling appears on the back of the wrist1 and a deep crease is seen just above the hand in front4 ,the whole hand is also displaced at the wrist toward the thumb side4 ,illustration3 ,,fig4 #ah4 ,a ,,broken ,,wrist 7,,scudder74 ,characteristic appearance of a ,colles's fracture2 note backward displacement of hand at wrist2 also fork-shaped deformity4 ,it is not usual to be able to detect abnormal motion in the case of this fracture1 or to hear any grating sound on manipulating the part1 as the ends of the fragments are generally so jammed together that it is necessary to secure a surgeon as soon as possible to pull them apart under ether1 in order to remedy the existing silver-fork deformity4 7,see ,figs4 #ah1 #ai1 #bj1 #ba1 #bb47 ,treatment4--,until medical aid can be obtained the same sort of splints should be applied1 and in the same way as for the treatment of fractured forearm4 ,if the deformity is not relieved a stiff and painful joint usually persists4 ,it is sometimes impossible for the most skillful surgeon entirely to correct the existing deformity1 and in elderly people some stiffness and pain in the wrist and fingers are often unavoidable results4 ,illustration3 ,,fig4 #ai4 ,,fig4 #bj4 ,,fig4 #ba4 ,,fig4 #bb4 ,,fracture ,,of ,,the ,,wrist 7,,scudder74 ,above illustrations show deformities resulting from a broken wrist2 ,figs4 #ai and #bj the crease at base of thumb2 ,fig4 #ba hump on back of wrist2 ,fig4 #bb twisted appearance of hand4 ,,fracture ,,of ,,bone ,,of ,,hand1 ,,or ,,finger4 ,first ,aid ,rule4--,set fragments of bone in place by pulling with one hand on finger1 while pressing fragments into position with other hand4 ,put on each side of bone a splint made of cigar box1 padded with folded handkerchiefs1 and retain in place with bandage wound about snugly4 ,put forearm and hand in sling4 ,this accident more commonly happens to the bones corresponding to the middle and ring finger1 and occurs between the knuckle and the wrist1 appearing as a swelling on the back of the hand4 ,on looking at the closed fist it will be seen that the knuckle corresponding to the broken bone in the back of the hand has ceased to be prominent1 and has sunken down below the level of its fellows4 ,the end of the fragment nearer the wrist can generally be felt sticking up in the back of the hand4 ,illustration3 ,,fig4 #bc4 ,a ,,broken ,,finger 7,,scudder74 ,note splint extending from wrist to tip of finger2 also manner of applying adhesive plaster strips and pad in palm4 ,if the finger corresponding to the broken bone in the back of the hand be pulled on forcibly1 and the fragments be held between the thumb and forefinger of the other hand of the operator1 pain and abnormal motion may be detected1 and the ends of the broken bone pressed into place4 ,a thin wooden splint1 as a piece of cigar box1 about an inch wide at base and tapering to the width of the finger should be applied to the palm of the hand extending from the wrist to a little beyond the finger tip1 secured by strips of adhesive plaster1 as in the cut1 and covered by a bandage4 ,the splint should be well padded1 and an additional pad should be placed in the palm of the hand over the point of fracture4 ,three weeks are required for firm union1 and the hand should not be used for a month4 ,it is usually easy to recognize a broken bone in a finger1 unless the break is near a joint1 when it may be mistaken for a dislocation4 ,pain1 abnormal motion1 and grating between the fragments are observed4 ,if there is deformity1 it may be corrected by pulling on the injured finger with one hand1 while with the other the fragments are pressed into line4 ,a narrow1 padded wooden or tin splint is applied1 as in the cut 7p4 #ajb71 reaching from the middle of the palm to the finger tip4 ,any existing displacement of the broken bone can be relieved by using pressure with little pads of cotton held in place by narrow strips of adhesive plaster where it is needed to keep the bone in line4 ,the splint may be removed in two weeks and a strip of adhesive plaster wound about the finger to support it for a week or two more4 ,in fracture of the thumb1 the splint is applied along the back instead of on the palm side4 ,,hip ,,fracture4 ,first ,aid ,rule4--,put patient flat on back in bed1 with limb wedged between pillows till surgeon arrives4 ,illustration3 ,,fig4 #bd4 ,,treating ,a ,,broken ,,hip 7,,scudder74 ,note the manner of straightening leg and getting broken bone into line2 also assistant carefully steadying the thigh4 ,a fracture of the hip is really a break of that portion of the thigh bone which enters into the socket of the pelvic bone and forms the hip joint4 ,it occurs most commonly in aged people as a result of so slight an accident as tripping on a rug1 or in falling on the floor from the standing position1 making a misstep1 or while attempting to avoid a fall4 ,when the accident has occurred the patient is unable to rise or walk1 and suffers pain in the hip joint4 ,when he has been helped to bed it will be seen that the foot of the injured side is turned out1 and the leg is perhaps apparently shorter than its fellow4 ,there is pain on movement of the limb1 and the patient cannot raise his heel1 on the injured side1 from the bed4 ,shortening is an important sign4 ,with the patient lying flat on the back and both legs together in a straight line with the body1 measurements from each hip-bone are made with a tape to the bony prominence on the inside of each ankle1 in turn4 ,one end of the tape is held at the navel and the other is swung from one ankle to the other1 comparing the length of the two limbs4 ,shortening of less than half an inch is of no importance as a sign of fracture4 ,the fragments of broken bone are often jammed together 7impacted7 so that it is impossible to get any sound of grating between them1 and it is very unwise to manipulate the leg or hip joint1 except in the gentlest manner1 in an attempt to get this grating4 ,if the ends of the fragments become disengaged from each other it often happens that union of the break never occurs4 ,illustration3 ,,fig4 #be4 ,,treatment ,,for ,,fractured ,,hip 7,,scudder74 ,note method of holding splints in place with muslin strips2 one above ankle1 one below and one above knee1 one in middle and one around upper part of thigh4 ,the treatment simply consists in keeping the patient quiet on a hard mattress1 with a small pillow under the knee of the injured side and the limb steadied on either side by pillows or cushions until a surgeon can be obtained4 7,see ,thigh-bone ,fracture47 ,,thigh-,,bone ,,fracture4 ,first ,aid ,rule4--,prepare long piece of thin board which will reach from armpit to ankle1 and another piece long enough to reach from crotch to knee1 and pad each with folded towels or blanket4 ,while one assistant holds body back1 and another assistant pulls on ankle of injured side1 see that the fragments are separated and brought into good line1 and then apply the splints1 assistants still pulling steadily1 and fasten the splints in place with bandage1 or by tying several cloths across at three places above the knee and two places below the knee4 ,finally1 pass a wide band of cloth about the body1 from armpit to hips1 inclosing the upper part of the well-padded splint1 and fasten it snugly4 ,the hollow between splint and waist must be filled with padding before this wide cloth is applied4 ,in fracture of the thigh bone 7between the hip and knee71 there is often great swelling about the break4 ,the limb is helpless and useless4 ,there is intense pain and abnormal position in the injured part1 besides deformity produced by the swelling4 ,the foot of the injured limb is turned over to one side or the other1 owing to a rolling over of the portion of the limb below the break4 ,with both lower limbs in line with the body1 and the patient lying on the back1 measurements are made from each hip-bone to the prominence on the inside of either ankle joint4 ,shortening of the injured leg will be found1 varying from one to over two inches1 according to the overlapping and displacement of the fragments4 ,treatment4--,to set this fracture temporarily1 a board about five inches wide and long enough to reach from the armpit to the foot should be padded well with towels1 sheets1 shawls1 coats1 blanket1 or whatever is at hand1 and the padding can best be kept in place by surgeon's adhesive plaster1 bicycle tape1 or strips of cloth4#h ,another splint should be provided as wide as the thigh and long enough to reach along the back of the leg from the middle of the calf to the buttock1 and also padded in the same way4 ,a third splint should be prepared in the same manner to go inside the leg1 reaching from the crotch to the inside of the foot4 ,still a fourth splint made of a thin board as wide as the thigh1 extending from the upper part of the thigh to just above the knee1 is padded for application to the front of the thigh4 ,when these are made ready and at hand1 the leg should be pulled on steadily but carefully straight away from the body to relax the muscles1 an assistant holding the upper part of the thigh and pulling in the opposite direction4 ,then1 when the leg has been straightened out and the thigh bone seems in fair line1 the splints should be applied2 the first to the outside of the thigh and body1 the second under the calf1 knee1 and thigh2 the third to the inside of the whole limb1 and the fourth to the front of the thigh4 ,wide pads should be placed over the ribs under the outside splint to fill the space above the hips and under the armpit4 ,then all four splints are drawn together and held in place by rubber-plaster straps or strips of strong muslin applied as follows3 one above the ankle2 one below the knee2 one above the knee2 one in the middle of the thigh1 and one around the upper part of the thigh4 ,a wide band of strong muslin or sheeting should then be bound around the whole body between the armpits and hips1 inclosing the upper part of the outside splint4 ,the patient can then be borne comfortably upon a stretcher made of boards and a mattress or some improvised cushion4 7,see ,figs4 #bd and #be47 ,when the patient can be put immediately to bed after the injury1 and does not have to be transported1 it is only necessary to apply the outer1 back1 and front splints1 omitting the inner splint4 ,it is necessary for the proper and permanent setting of a fractured thigh that a surgeon give an anaesthetic and apply the splints while the muscles are completely relaxed4 ,it is also essential that the muscles be kept from contracting thereafter by the application of a fifteen- or twenty-pound weight to the leg1 after the splints are applied1 but it is possible to outline here only the proper first-aid treatment4 ,,kneepan ,,fracture4 ,first ,aid ,rule4--,pain is immediate and intense4 ,separated fragments may be felt at first4 ,swelling prompt and enormous4 ,even if not sure1 follow these directions for safety4 ,prepare splint3 thin board1 four inches wide1 and long enough to reach from upper part of thigh to just above ankle4 ,pad with folded piece of blanket or soft towels4 ,place it behind leg and thigh2 carefully fill space behind knee with pad2 fasten splint to limb with three strips of broad adhesive plaster1 one around upper end of splint1 one around lower end1 one just below knee4 ,lay large flat1 dry sponge over knee thus held1 and bandage this in place4 ,keep sponge and bandage wet with ice water4 ,if no sponge is available1 half fill rubber hot-water bottle with cracked ice1 and lay this over knee joint4 ,put patient to bed4 ,fracture of kneepan is caused either by direct violence or muscular strain4 ,it more frequently occurs in young adults4 ,immediate pain is felt in the knee and walking becomes impossible2 in fact1 often the patient cannot rise from the ground after the accident4 ,swelling at first is slight1 but increases enormously within a few hours4 ,immediately after the injury it may be possible to feel the separate broken fragments of the kneepan and to recognize that they are separated by a considerable space if the break is horizontally across the bone4 ,illustration3 ,,fig4 #bf4 ,a ,,broken ,,kneepan 7,,scudder74 ,a padded splint1 supporting knee1 is shown reaching from ankle to thigh4 ,note number and location of adhesive plaster strips4 ,nothing can be done to set the fracture until the swelling about the joint has been reduced1 so that the first treatment consists in securing immediate rest for the kneejoint1 and immobility of the fragments4 ,a splint made of board1 about a quarter of an inch thick and about four inches wide for an adult1 reaching from the upper part of the thigh above to a little above the ankle below1 is applied to the back of the limb and well padded1 especially to fill the space behind the knee4 ,the splint is attached to the limb by straps of adhesive plaster two inches and a half wide2 one around the lower end of the splint1 one around the upper part1 and the third placed just below the knee4 ,to prevent and arrest the swelling and pain1 pressure is then made on the knee by bandaging4 ,one of the best methods 7,scudder's7 is to bind a large1 flat1 dry sponge over the knee and then keep it wet with cold water2 or to apply an ice bag directly to the swollen knee2 a splint in either case being the first requisite4 ,the patient should of course be put to bed as soon as possible after the accident1 and should lie on the back with the injured leg elevated on a pillow with a cradle to keep the clothes from pressing on the injured limb4 7,see cut1 p4 #aaj47 ,,fracture ,,of ,,leg ,,bones1 ,,between ,,knee ,,and ,,ankle4 ,first ,aid ,rule4--,handle very carefully2 great danger of making opening to surface4 ,special painful point1 angle or new joint in bone1 disability1 and grating felt will decide existence of break4 ,let assistant pull on foot1 to separate fragments1 while you examine part of supposed break4 ,if only one bone is broken1 there may be no displacement4 ,put patient on back4 ,while two assistants pull1 one on ankle and one on thigh at knee1 thus separating fragments1 slide pillow lengthwise under knee1 and1 bringing its edges up about leg1 pin them snugly above leg4 ,prepare three pieces of thin wood1 four inches wide and long enough to reach from sole of foot to a point four inches above knee4 ,while assistants pull on limb again1 as before1 put one splint each side and third behind limb1 and with bandage or strips of sticking plaster fasten these splints to the leg inclosed in its pillow as tight as possible4 ,in fracture of the leg between the knee and ankle we have pain1 angular deformity or an apparent false joint in the leg1 swelling and tenderness over the seat of fracture1 together with inability to use the injured leg4 ,two bones form the framework of the leg2 the inner1 or shinbone1 the sharp edge of which can be felt in front throughout most of its course1 being much the larger and stronger bone4 ,when both bones are broken1 the displacement of the fragments1 abnormal motion and consequent deformity1 are commonly apparent1 and a grating sound may be heard1 but should not be sought for4 ,illustration3 ,,fig4 #bg4 ,,fracture ,,of ,,both ,,leg ,,bones 7,,scudder74 ,this cut shows the peculiar deformity in breaks of this kind2 see position of kneepan2 also prominence of broken bone above ankle4 ,an open wound often communicates with the break1 making the fracture compound1 a much more serious condition4 ,to avoid making the fracture a compound one1 during examination of the leg1 owing to the sharp ends of the bony fragments1 the utmost gentleness should be used4 ,under no circumstances attempt to move the fragments from side to side1 or backward and forward1 in an effort to detect the grating sound often caused by the ends of broken bones4 ,the greatest danger lies in the desire to do too much4 ,we again refer the reader to ,first ,aid ,rule #a4 ,illustration3 ,,fig4 #bh4 ,,bandage ,,for ,,broken ,,leg 7,,scudder74 ,note the pillow brought up around leg and edges pinned together2 also length and method of fastening splint with straps4 ,when one bone is broken there may be only a point of tenderness and swelling about the vicinity of the break and no displacement or grating sound4 ,when in doubt as to the existence of a fracture always treat the limb as if a fracture were present4 ,black and blue discoloration of the skin much more extensive than that following sprain will become evident over the whole leg within twenty-four hours4 ,treatment4--,when a surgeon cannot be obtained1 the following temporary pillowdressing1 recommended by ,scudder in his book on fractures1 is one of the best4 ,with the patient on his back1 the leg having been straightened and any deformity removed as far as possible by grasping the foot and pulling directly away from the body while an assistant steadies the thigh1 a large1 soft pillow1 inclosed in a pillowcase1 is placed under the leg4 ,the sides of the pillow are brought well up about the leg and the edges of the pillowcase are pinned together along the front of the leg4 ,then three strips of wood about four inches wide1 three-sixteenths to a quarter of an inch thick1 and long enough to reach from the sole of the foot to about four inches above the knee1 are placed outside of the pillow along the inner and outer aspects of the leg and beneath it4 ,the splints are held in place1 with the pillow as padding beneath1 by four straps of webbing 7or if these cannot be obtained1 by strips of stout cloth1 adhesive plaster1 or even rope72 but four pads made of folded towels should be put under the straps where they cross the front of the leg where little but the pillowcase overlaps4 ,these straps are applied thus3 one above the knee1 one above the ankle1 and the other two between these two points1 holding all firmly together4 ,this dressing may be left undisturbed for a week or even ten days if necessary4 7,see ,figs4 #bg and #bh47 ,the leg should be kept elevated after the splints are applied1 and steadied by pillows placed either side of it4 ,from one to two months are required to secure union in a broken leg in adults1 and from three to five months elapse before the limb is completely serviceable4 ,in children the time requisite for a cure is usually much shorter4 ,,ankle-,,joint ,,fracture4 ,first ,aid ,rule4--,one or both bones of leg may be broken just above ankle4 ,foot is generally pushed or bent outward4 ,prepare two pieces of thin wood1 four inches wide and long enough to go from sole of foot to just below knee3--the splints4 ,pad them with folded towels or pieces of blanket4 ,while assistants pull bones apart gently1 one pulling on knee1 other pulling on foot and turning it straight1 apply the splints1 one each side of the leg4 ,a fracture of the ankle joint is really a fracture of the lower extremities of the bones of the leg4 ,there are present pain and great swelling1 particularly on the inner side of the ankle at first1 and the whole foot is pushed and bent outward4 ,the bony prominence on the inner side of the ankle is unduly marked4 ,the foot besides being bent outward is also displaced backward on the leg4 ,this fracture might be taken for a dislocation or sprain of the ankle4 ,dislocation of the ankle without fracture is very rare1 and when the foot is returned to its proper position it will stay there1 while in fracture the foot drops back to its former displaced state4 ,in sprained ankle there are pain and swelling1 but not the deformity caused by the displacement of the foot4 ,this fracture may be treated temporarily by returning the foot to its usual position and putting on side splints and a back splint1 as described for the treatment of fracture of the leg4 ,,compound ,,or ,,open ,,fracture ,,of ,,the ,,leg4--,this condition may be produced either by the violence which caused the fracture also leading to destruction of the skin and soft parts beneath1 or by the end of a bony fragment piercing the muscles and skin from within4 ,in either event the result is much more serious than that of an ordinary simple fracture1 for germs can gain entrance through the wound in the skin and cause inflammation with partial destruction or death of the part4 ,treatment4--,immediate treatment is here of the utmost value4 ,it is applicable to open or compound fracture in any part of the body4 ,the area for a considerable distance about the wound1 if covered with hair1 should be shaved4 ,it should then be washed with warm water and soap by means of a clean piece of cotton cloth or absorbent cotton4 ,then some absorbent cotton or cotton cloth should be boiled in water in a clean vessel for a few minutes1 and1 after the operator has thoroughly washed his hands1 the boiled water 7when sufficiently cool7 should be applied to the wounded area and surrounding parts with the boiled cotton1 removing in the most painstaking way all visible and invisible dirt4 ,by allowing some of the water to flow over the wound from the height of a few feet this result is favored4 ,finally some of the boiled cotton1 which has not been previously touched1 is spread over the wound wet1 and covered with clean1 dry cotton and bandaged4 ,splints are then applied as for simple fracture in the same locality 7p4 #aac74 ,if a fragment of bone projects through the wound it may be replaced after the cleansing just described1 by grasping the lower part of the limb and pulling in a straight line of the limb away from the body1 while an assistant holds firmly the upper part of the limb and pulls in the opposite direction4 ,during the whole process neither the hands of the operator nor the boiled cotton should come in contact with anything except the vessel containing the boiled water and the patient4 ,,footnotes3 #e ,the engravings illustrating the chapters on ,fractures and ,dislocations are from ,buck's ,reference ,handbook of ,medical ,science1 published by ,william ,wood ,co41 ,new ,york2 also1 ,scudder's ,treatment of ,fractures and ,american ,text-,book of ,surgery1 published by ,w4 ,b4 ,saunder's ,company1 ,philadelphia4 #f ,it should be distinctly understood that the information about fractures is not supplied to enable anyone to avoid calling a surgeon1 but is to be followed only until expert assistance can be obtained and1 like other advice in this book1 is intended to furnish first-aid information or directions to those who are in places where physicians cannot be secured4 #g ,for treatment of compound fracture1 see ,compound ,fracture of ,leg 7p4 #aaf74 #h ,this method follows closely that recommended by ,scudder1 in his book ,the ,treatment of ,fractures4 ,,chapter ,v ,dislocations ,how to ,tell a ,dislocation--,reducing a ,dislocated ,jaw--,stimson's ,method of ,treating a ,dislocated ,shoulder--,appearance of ,elbow when ,out of ,joint--,hip ,dislocations--,forms of ,bandages4 ,,dislocations2 ,,bones ,,out ,,of ,,joint4 ,,jaw4--,rare4 ,mouth remains open1 lower teeth advanced forward4 ,first ,aid ,rule #a4--,protect your thumbs4 ,put on thick leather gloves1 or bind them with thick bandage4 ,rule #b4--;,assistant steadies patient from behind1 with hands both sides of his head1 operator presses downward and backward with his thumbs on back teeth of patient1 each side of patient's jaw1 while the chin is grasped between forefingers and raised upward4 ,idea is to stretch the ligament at jaw joint1 and swing jaw back while pulling on this ligament4 7,fig4 #bi47 ,rule #c4--,tie jaw with four-tailed bandage up against upper jaw for a week4 7,fig4 #ab1 p4 #ij47 ,,shoulder4--,common accident4 ,no hurry4 ,see p4 #abb4 ,,elbow4--,rare4 ,no hurry4 ,see p4 #abe4 ,,hip4--,no hurry4 ,see p4 #abi4 ,,knee4--,rare4 ,easily reduced4 ,head of lower bone 7tibia7 is moved to one side2 knee slightly bent4 ,first ,aid ,rule #a4--,put patient on back4 ,rule #b4--;,flex thigh on abdomen and hold it there4 ,rule #c4--;,grasp leg below knee and twist it back and forth1 and straighten knee4 ,,dislocations4--,a dislocation is an injury to a joint wherein the ends of the bones forming a joint are forced out of place4 ,a dislocation is commonly described as a condition in which a part 7as the shoulder7 is out of joint or out of place4 ,a dislocation must be distinguished from a sprain1 and from a fracture near a joint4 ,in a sprain1 as has been stated 7p4 #fe71 the bones entering into the formation of the joint are perhaps momentarily displaced1 but return into their proper place when the violence is removed4 ,but1 owing to greater injury1 in dislocation the head of the bone slips out of the socket which should hold it1 breaks through the ligaments surrounding the joint1 and remains permanently out of place4 ,for this reason there is a peculiar deformity1 produced by the head of the bone's lying in its new and unnatural situation1 which is not seen in a sprain4 ,also1 the dislocated joint cannot be moved by the patient or by another person1 except within narrow limits1 while a sprained joint can be moved1 with the production of pain it is true1 but without any mechanical obstacle4 ,in the case of fracture near a joint there is usually increased movement in some new direction4 ,when a dislocated joint is put in proper place it stays in place1 whereas when a fractured part is reduced there is nothing to keep it in place and1 if let alone1 it quickly resumes its former faulty position4 ,only a few of the commoner dislocations will be considered here1 as the others are of rare occurrence and require more skill than can be imparted in a book intended for the laity4 ,the following instructions are not to be followed if skilled surgical attendance can be secured2 they are intended solely for those not so fortunately situated4 ,,dislocation ,,of ,,the ,,jaw4--,this condition is caused by a blow on the chin1 or occurs in gaping or when the mouth is kept widely open during prolonged dental operations4 ,the joint surface at the upper part of the lower jaw1 just in front of the entrance to the ear1 is thrown out of its socket on one side of the face1 or on both sides4 ,if the jaw is put out of place on both sides at once1 the chin will be found projecting so that lower front teeth jut out beyond the upper front teeth1 the mouth is open and cannot be closed1 and the patient is suffering considerable pain4 ,when the jaw is dislocated on one side only1 the chin is pushed over toward the uninjured side of the face1 which gives the face a twisted appearance2 the mouth is partly open and fixed in that position4 ,a depression is seen on the injured side in front of the ear1 while a corresponding prominence exists on the opposite side of the face1 and the lower front teeth project beyond the upper front teeth4 ,illustration3 ,,fig4 #bi4 ,,reducing ,,dislocation ,,of ,,jaw 7,,american ,,text-,,book74 ,thumbs placed upon last molar teeth on each side2 note jaw grasped between fingers and thumbs to force it into place4 ,treatment4--,a dislocation of one side of the jaw is treated in the same manner as that of both sides4 ,the dislocation may sometimes be reduced by placing a good-sized cork as far back as possible between the back teeth of the upper and lower jaws 7on one or both sides1 according as the jaw is out of place on one or both sides71 and getting the patient to bite down on the cork4 ,this may pry the jaw back into place4 ,the common method is for the operator to protect both thumbs by wrapping bandage about his thumbs1 or wearing leather gloves1 and then1 while an assistant steadies the head1 the operator presses downward and backward on the back teeth of the patient on each side of the lower jaw with both thumbs in the patient's mouth1 while the chin is grasped beneath by the forefingers of each hand and raised upward4 ,when the jaw slips into place it should be maintained there by a bandage placed around the head under the chin and retained there for a week4 ,during this time the patient should be fed on liquids through a tube1 so that it will not be necessary for him to open his mouth to any extent4 7,see ,fig4 #bi47 ,,dislocation ,,of ,,the ,,shoulder4--,this is by far the most common of dislocations in adults1 constituting over one-half of all such accidents affecting any of the joints4 ,it is caused by a fall or blow on the upper arm or shoulder1 or by falling upon the elbow or outstretched hand4 ,the upper part 7or head7 of the bone of the arm 7humerus7 slips downward out of the socket or1 in some cases1 inward and forward4 ,in either case the general appearance and treatment of the accident are much the same4 ,the shoulder of the injured side loses its fullness and looks flatter in front and on the side4 ,the arm is held with the elbow a few inches away from the side1 and the line of the arm is seen to slope inwardly toward the shoulder1 as compared with the sound arm4 ,the injured arm cannot be moved much by the patient1 although it can be lifted up and away from the side by another person1 but cannot be moved so that1 with the elbow against the front of the chest1 the hand of the injured arm can be laid on the opposite shoulder4 ,neither can the arm1 with the elbow at a right angle1 be made to touch the side with the elbow1 without causing great pain4 ,treatment4--,one of the simplest methods 7,stimson's7 of reducing this dislocation consists in placing the patient on his injured side on a canvas cot1 which should be raised high enough from the floor on chairs1 and allowing the injured arm to hang directly downward toward the floor through a hole cut in the cot1 the hand not touching the floor4 ,then a ten-pound weight is attached to the wrist4 ,the gradual pull produced by this means generally brings the shoulder back into place without pain and within six minutes4 7,fig4 #cj47 ,illustration3 ,,fig4 #cj4 ,,treating ,a ,,dislocated ,,shoulder4 7,,reference ,,handbook47 ,patient lying on injured side2 note arm hanging through hole in cot raised from floor on chairs2 also weight attached to wrist4 ,the more ordinary method consists in putting the patient on his back on the floor1 the operator also sitting on the floor with his stockinged foot against the patient's side under the armpit of the injured shoulder and grasping the injured arm at the elbow1 he pulls the arm directly outward 7i4 e41 with the arm at right angles with the body7 and away from the trunk4 ,an assistant may at the same time aid by lifting the head of the arm bone upward with his fingers in the patient's armpit and his thumbs over the injured shoulder4 ,if the arm does not go into place easily by one of these methods it is unwise to continue making further attempts4 ,also if the shoulder has been dislocated several days1 or if the patient is very muscular1 it will generally be necessary that a surgeon give ether in order to reduce the dislocation4 ,it is entirely possible for a skillful surgeon to secure reduction of a dislocation of the shoulder several weeks after its occurrence4 ,after the dislocation has been relieved the arm1 above the elbow1 should be bandaged to the side of the chest and the hand of the injured side carried in a sling for ten days4 ,,dislocation ,,of ,,the ,,elbow4--,this is more frequent in children1 and is usually produced by a fall on the outstretched hand4 ,the elbow is thrown out of joint1 so that the forearm is displaced backward on the arm1 in the more usual form of dislocation4 ,the elbow joint is swollen and generally held slightly bent1 but cannot be moved to any extent without great pain4 ,the tip of the elbow projects at the back of the joint more than usual1 while at the front of the arm the distance between the wrist and the bend of the elbow is less than that of the sound arm4 7,see cut1 p4 #abf47 ,illustration3 ,,fig4 #ca4 ,above cut shows characteristic appearance of a dislocated shoulder2 note loss of fullness2 also elbow held away from side and inward sloping of arm4 ,,fig4 #cb4 ,,dislocated ,,elbow ,,and ,,shoulder4 7,,american ,,text-,,book47 ,fig4 #cb shows dislocation of elbow backward2 note swollen condition of left elbow held slightly bent2 also the projection of back of joint4 ,for further proof that the elbow is out of joint we must compare the relations of three points in each elbow4 ,these are the two bony prominences on each side of the joint 7belonging to the bone of the arm above the elbow7 and the bony prominence that forms the tip of the elbow which belongs to the bone of the forearm4 ,illustration3 ,,fig4 #cc4 ,,treatment ,,of ,,dislocated ,,elbow 7,,scudder74 ,note padded right-angled tin splint2 also three strips of surgeon's plaster on arm and forearm4 ,in dislocation backward of the forearm1 the tip of the elbow is observed to be farther back1 in relation to the two bony prominences at the side of the joint1 than is the case in the sound elbow4 ,this is best ascertained by touching the three points on the patient's elbow of each arm in turn with the thumb and middle finger on each of the prominences on the side of the joint1 while the forefinger is placed on the tip of the elbow4 ,the lower end of the bone of the upper arm is often seen and felt very easily just above the bend of the elbow in front1 as it is thrown forward 7see ,fig4 #cb1 p4 #abf74 ,fracture of the lower part of the bone of the arm above the elbow joint may present much the same appearance as the dislocation we are describing1 but then the whole elbow is displaced backward1 and the relation of the three points described above is the same in the injured as in the uninjured arm4 ,moreover in fracture the deformity1 when relieved1 will immediately recur when the arm is released1 as there is nothing to hold the bones in place2 but in dislocation1 after the bones are replaced in their normal position1 the deformity will not reappear4 ,treatment4--,the treatment for dislocation consists in bending the forearm backward to a straight line1 or even a little more1 and then while an assistant holds firmly the arm above the elbow1 the forearm should be grasped below the elbow and pulled with great force away from the assistant and1 while exerting this traction1 the elbow is suddenly bent forward to a right angle1 when the bones should slip into place4 ,the after treatment is much the same as for most fractures of the elbow4 ,the arm is retained in a well-padded right-angled tin splint which is applied with three strips of surgeon's plaster and bandage to the front of the arm and forearm 7see ,fig4 #cc7 for two or three weeks4 ,the splint should be removed every few days1 and the elbow joint should be moved to and fro gently to prevent stiffness1 and the splint then reapplied4 ,,dislocation ,,of ,,the ,,hip4--,this occurs more commonly in males from fifteen to forty-five years of age1 and is due to external violence4 ,in the more ordinary form of hip dislocation the patient stands on the sound leg with the body bent forward1 the injured leg being greatly shortened1 with the toes turned inward so much that the foot of the injured limb crosses over the instep of the sound foot4 ,the injured limb cannot be moved outward and but slightly inward1 yet may be bent forward4 ,walking is impossible4 ,pain and deformity of the hip joint are evident4 ,the only condition with which this would be likely to be confused is a fracture of bone in the region of the hip4 ,fracture of the hip is common in old people1 but not in youth or middle adult life4 ,in fracture there is usually not enough shortening to be perceived with the eye2 the toes are more often turned out1 and the patient can often bear some weight on the limb and even walk4 ,treatment4--,the simplest treatment is that recommended by ,stimson1 as follows3 the patient is to be slung up in the air in a vertical position by means of a sheet or belt of some sort placed around the body under the armpits1 so that the feet dangle a foot or so from the floor1 and then a weight of about ten or fifteen pounds1 according to the strength of the patient's muscles1 is attached to the foot of the injured leg 7bricks1 flatirons1 or stones may be used71 and this weight will usually draw the bone down into its socket within ten or fifteen minutes4 ,illustration3 ,,fig4 #cd4 ,,reducing ,,dislocation ,,of ,,hip 7,,reference ,,handbook74 ,patient lying on table2 uninjured leg held by assistant2 leg of dislocated side at right angles2 note weight at bend of knee4 ,or the patient may assume the position shown in the accompanying cut1 lying prone upon a table with the uninjured leg held horizontally by one person1 while another1 with the injured thigh held vertically and leg at right angles1 grasps the patient's ankle and moves it gently from side to side after placing a five-to ten-pound sand bag1 or similar weight of other substance1 at the flexure of the knee4 ,when the dislocation has been overcome the patient should stay in bed for a week or two and then go about gradually on crutches for two weeks longer4 ,,surgical ,,dressings4--,sterilized gauze is the chief surgical dressing of the present day4 ,this material is simply cheese cloth1 from which grease and dirt have been removed by boiling in some alkaline preparation1 usually washing soda1 and rinsing in pure water4 ,the gauze is sterilized by subjecting it to moist or dry heat4 ,sterilized gauze may be bought at shops dealing in surgeons' supplies and instruments1 and at most drug stores4 ,gauze or cheese cloth may be sterilized 7to destroy germs7 by baking in a slow oven1 in tin boxes1 or wrapped in cotton cloth1 until it begins to turn brown4 ,it is well to have a small piece of the gauze in a separate package1 which may be inspected from time to time in order to see how the baking is progressing1 as the material to be employed for surgical purposes should not be opened until just before it is to be used1 any remainder being immediately covered again4 ,cut the gauze into pieces as large as the hand1 before it is sterilized1 to avoid cutting and handling afterwards4 ,gauze may also be sterilized by steaming in an ,arnold sterilizer1 such as is used for milk1 or by boiling1 if it is to be applied wet4 ,carbolized1 borated1 and corrosive-sublimate gauze have little special value4 ,illustration3 ,,plate ,i4 ,fig4 ,i4 ,fig4 ,,ii4 ,fig4 ,,iii4 ,fig4 ,,iv4 ,,applying ,a ,,roller ,,bandage 7,,reference ,,handbook74 ,fig4 ,i shows method of starting a spiral bandage2 ,fig4 ,,ii1 ready to reverse2 ,fig4 ,,iii1 the reverse completed2 ,fig4 ,,iv shows spica bandage applied to groin4 ,absorbent cotton is also employed as a surgical dressing1 and should also be sterilized if it is to be used on raw surfaces4 ,it is not so useful for dressing wounds as gauze1 since it mats down closely1 does not absorb secretions and discharges so well1 and sticks to the parts4 ,when torn into balls as large as an egg and boiled for fifteen minutes in water1 it is useful as sponges for cleaning wounds4 ,sheet wadding1 or cotton1 is serviceable in covering splints before they are applied to the skin4 ,wet antiseptic surgical dressings are valuable in treating wounds which are inflamed and not healing well4 ,they are made by soaking gauze in solutions of carbolic acid 7half a teaspoonful of the acid to one pint of hot water71 and1 after application1 covering the gauze with oil silk1 rubber dam1 or paraffin paper4 ,heavy brown wrapping paper1 well oiled or greased1 will answer the purpose when better material is not at hand4 ,,bandages4--,bandaging is an art that can only be acquired in any degree of perfection by practical instruction and experience4 ,some useful hints1 however1 may be given to the inexperienced4 ,cotton cloth1 bleached or unbleached1 is commonly employed for bandages2 also gauze1 which does not make so effective a dressing1 but is much easier of application1 is softer and more comfortable1 and is best adapted to the use of the novice4 ,a bandage cannot be put on properly unless it is first rolled4 ,a bandage for the limbs should be about two and a half inches wide and eight yards long2 for the fingers1 three-quarters of an inch wide and three yards long4 ,the bandage may be rolled on itself till it is as large as the finger1 and then rolled down the front of the thigh1 with the palm of the right hand1 while the loose end is held taut in the left hand4 ,illustration3 ,,plate ,,ii4 ,fig4 ,i4 ,fig4 ,,ii4 ,fig4 ,,iii4 ,fig4 ,,iv4 ,,different ,,forms ,,of ,,bandages4 7,,american ,,text-,,book ,,and ,,reference ,,handbook47 ,fig4 ,i shows application of figure-of-eight bandage2 ,fig4 ,,ii1 a spica bandage of thumb2 ,fig4 ,,iii1 a spica bandage of foot2 ,fig4 ,,iv1 a ,t-bandage4 ,two forms of bandages are adapted to the limbs1 the figure-of-eight1 and the spiral reversed bandage4 ,in applying a bandage always begin at the lower extremity of the limb and approach the body4 ,make a few circular turns about the limb 7see ,fig4 ,i1 p4 #acb71 then as the limb enlarges1 draw the bandage up spirally1 reversing it each time it encircles the limb1 as shown in ,fig4 ,i1 p4 #acd4 ,in reversing1 hold the bandage with the left thumb so that it will not slip1 and then allowing the free end to fall slack1 turn down as in ,fig4 ,,ii1 p4 #acb4 ,the ,t-bandage is used to bandage the crotch between the thighs1 or around the forehead and over the top of the skull4 7,see ,fig4 ,,iv1 p4 #acd47 ,in the former case1 the ends #a-a are put about the body as a belt1 and the end #b is brought from behind1 in the narrow part of the back1 down forward between the thighs1 over the crotch1 and up to the belt in the lower part of the belly4 ,the figure-of-eight bandage is used on various parts1 and is illustrated in the bandage called spica of the groin1 ,fig4 ,,iv1 p4 #acb4 ,beginning with a few circular turns about the body in the direction of #a1 the bandage is brought down in front of the body and groin1 as in #b1 and then about the back of the thigh up around the front of the thigh1 as in #c1 across the back and once around the body and down again as in #b4 ,other bandages appropriate to various parts of the body are also illustrated that by their help the proper method of their application may be understood4 ,see pages #acb1 #acd1 #acf1 #acg4 ,the triangular bandage 7see p4 #hh7 made from a large handkerchief or piece of muslin a yard square1 cut or folded diagonally from corner to corner1 will be found invaluable in emergency cases4 ,it is easily and quickly adjusted to almost any part of the body1 and may be used for dressing wounds1 or as a bandage for fractures1 etc4 ,illustration3 ,,plate ,,iii4 ,fig4 ,i4 ,fig4 ,,ii4 ,,bandages ,,for ,,extremities 7,,american ,,text-,,book74 ,fig4 ,i shows a spiral reversed bandage of arm and hand1 requiring roller #b-a_/b inches wide and #g yards long2 ,fig4 ,,ii shows a spiral reversed bandage of leg and foot1 requiring roller #b-a_/b inches wide and #ad yards long4 ,illustration3 ,,plate ,,iv4 ,fig4 ,i4 ,fig4 ,,ii4 ,fig4 ,,iii4 ,fig4 ,,iv4 ,,bandages ,,for ,,head ,,and ,,hand4 7,,american ,,text-,,book47 ,fig4 ,i shows a gauntlet bandage2 ,fig4 ,,ii1 a circular bandage for the jaw2 ,fig4 ,,iii1 a circular bandage for the head2 ,fig4 ,,iv1 a figure-of-eight bandage for both eyes4 ,,chapter ,,vi ,ordinary ,poisons ,unknown ,poisons--,antidotes for ,poisoning by ,acids and ,alkalies--,the ,stomach ,pump--,emetics--,symptoms and ,treatment of ,metal ,poisoning-- ,narcotics4 ,first ,aid ,rule #a4--,send at once for physician4 ,rule #b4--;,empty stomach with emetic4 ,rule #c4--;,give antidote4 ,in most cases of poisoning emetics and purgatives do the most good4 ,,unknown ,,poisons4--,act at once before making inquiry or investigation4 ,first ,aid ,rule4--,give two teaspoonfuls of chalk 7or whiting1 or whitewash scraped from the wall or a fence7 mixed with a wineglass of water4 ,beat four eggs in a glass of milk1 add a tablespoonful of whisky1 and give at once4 ,meanwhile1 turn to p4 #ahf1 and be prepared to follow ,rule #b under ,suffocation1 in case artificial respiration may be necessary1 in spite of the stimulant and antidotes4 ,after having taken the first steps1 try to ascertain the exact poison used1 but waste no time at the start4 ,if you can find out just what poison was swallowed1 give the treatment advised under that poison1 excepting what you may already have given4 ,,acids4--,symptoms3 ,corrosion or bleeding of the parts with which they come in contact1 followed by intense pain1 and then prostration from shock4 ,nitric acid stains face yellow2 sulphuric blackens2 carbolic whitens the mucous membrane1 and also causes nausea and stupor4 ,treatment4--,carbolic3 ,give a tablespoonful of alcohol or wineglass of whisky or brandy at once2 or one tablespoonful of castor oil1 also a half pint of sweet oil1 also a pint of milk4 ,put to bed1 and apply hot-water bottles4 ,nitric and ,oxalic3 ,chalk1 lime off walls1 whitewash scraped off fence or wall1 one teaspoonful mixed with a quarter of a glass of water4 ,give one tablespoonful castor oil1 and half a pint of sweet oil4 ,inject into the rectum one tablespoonful of whisky in two of water4 ,sulphuric3 ,soapsuds1 half a glass2 a pint of milk4 ,other ,acids3 ,limewater1 or two teaspoonfuls of aromatic spirit of ammonia diluted with a glass of water4 ,one tablespoonful of castor oil4 ,,alkalies4--,symptoms3 ,burning and destruction of the mucous membrane of mouth1 severe pain1 vomiting and purging of bloody matter1 rapid death by shock4 ,ammonia2 ,potash2 ,lye2 ,caustic ,soda2 ,washing ,soda3 ,give half a glass of vinegar mixed with half a glass of water2 also juice of four lemons in two glasses of water4 ,one teaspoonful of castor oil in half a glass of olive oil4 ,if prostrated1 give tablespoonful of whisky in a quarter of a glass of hot water4 ,,metals4--,symptoms3 ,great irritation1 cramps and purging1 suppression of urine1 delirium or stupor1 collapse1 and generally death4 ,arsenic2 ,paris ,green2 ,fowler's ,solution2 ,rough on ,rats3 ,intense pain1 thirst1 griping in bowels1 vomiting and bloody purging1 shock1 delirium4 ,patient picks at the nose4 ,send to druggist's for two ounces hydrated sesquioxide of iron1 the best antidote1 and give tablespoonful every quarter hour in half a glass of water4 ,meanwhile1 or if antidote is not to be had1 give a glass or two of limewater1 followed by a teaspoonful of mustard dissolved in a glass of water1 followed by warm water in any quantity4 ,copper2 ,blue ,vitriol2 ,verdigris3 ,give one tablespoonful of mustard in a glass of warm water4 ,after vomiting1 give whites of three eggs1 one pint of milk4 ,mercury2 ,corrosive ,sublimate2 ,bug ,poison2 ,white ,precipitate2 ,bichloride of ,mercury3 ,give whites of four eggs for every grain of mercury suspected2 cause vomiting by giving a tablespoonful of mustard mixed with a glass of warm water1 or thirty grains of powdered ipecac mixed with half a glass of water4 ,silver ,nitrate3 ,give two teaspoonfuls of table salt dissolved in two glasses of hot water4 ,after half an hour give a tablespoonful of castor oil4 ,phosphorous2 ,matches3 ,give teaspoonful of mustard mixed in a glass of water4 ,after vomiting has occurred1 give a tablespoonful of gum arabic dissolved in a tumblerful of hot water4 ,an hour later give tablespoonful of ,epsom salts dissolved in a glass of water4 ,,give ,,no ,,oil4 ,antimony2 ,tartar ,emetic3 ,symptoms as stated for metals4 ,give thirty grains of powdered ipecac stirred in wineglass of water1 even if vomiting has occurred4 ,give three cups of strong tea1 or hot infusion of oak bark1 and two teaspoonfuls of whisky in wineglass of hot water4 ,use hot-water bottles to keep patient warm4 ,,narcotics4--,aconite2 ,belladonna2 ,camphor2 ,digitalis2 ,ergot2 ,hellebore2 ,lobelia3 ,these all cause nausea1 numbness1 stupor1 rapidity of the heart followed by weakness of heart1 delirium or convulsions1 coma1 and death4 ,there is often an acid taste in mouth1 with dryness of throat and mouth1 fever1 vomiting and diarrhea1 with severe pain in the bowels4 ,pupils are dilated4 ,in either case use the stomach pump at once4 ,if no pump is at hand1 siphon out stomach with rubber tube and funnel4 ,if tube is not available1 give thirty grains of powdered ipecac stirred in a wineglass of water1 followed by two glasses of warm water4 ,as the patient vomits1 give more warm water4 ,when vomiting ceases1 give two cups of strong hot coffee1 and then a tablespoonful of castor oil4 ,keep patient awake by rubbing2 do not exhaust him by walking him about4 ,he must lie flat4 ,if prostration follows1 give two teaspoonfuls of whisky in wineglass of hot water from time to time1 if repetition is necessary4 ,alcohol2 ,liquors ,containing ,it3 ,symptoms of drunkenness1 stupor1 drowsiness1 irritability of temper1 rapid1 weak heart1 sleep1 coma4 ,breath testifies4 ,if possible1 use stomach pump early1 or tube and funnel4 ,or give thirty grains of powdered ipecac stirred in a wineglass of water1 and when vomiting ceases give thirty drops of aromatic spirit of ammonia in a wineglass of water every half hour till pulse has become full and rapid4 ,then apply cold to the head and heat to the extremities4 ,chloral2 ,patent ,sleeping ,medicines2 ,knock-out ,drops4 ,symptoms3 ,nausea1 coldness and numbness1 stupidity1 prostration1 often vomiting and purging1 sleep1 coma4 ,heart very weak1 with pulse at wrist very feeble4 ,constriction of the mouth and throat1 with dryness4 ,pain in bowels is marked before stupor appears4 ,use stomach pump if possible1 or empty stomach with rubber tube and funnel1 siphoning fluids out4 ,or give thirty grains of powdered ipecac stirred in a wineglass of water4 ,when vomiting ceases1 give two teaspoonfuls of whisky in half a glass of hot water4 ,give hypodermic injection of sulphate of strychnine1 one-twentieth of a grain every two or three hours1 till patient is roused and weakness is past4 ,rubbing of the surface1 application of hot-water bottles to the body and legs4 ,if breathing ceases1 follow ,rule #b under ,suffocation 7p4 #ahf7 till breathing is well established again4 ,opium2 ,morphine2 ,laudanum2 ,paregoric2 ,soothing ,syrups4 ,symptoms3 ,drowsiness1 sleep1 stupor when roused1 pupils very small--pin point unless patient is used to the drug--constipation1 cold skin4 ,use stomach pump1 if at hand4 ,or give emetic of thirty grains of powdered ipecac stirred in a wineglass of water1 followed by two glasses of warm water1 as vomiting proceeds4 ,let the patient inhale ammonia or smelling salts4 ,give him half a grain of permanganate of potash dissolved in a wineglass of water1 every half hour4 ,inject two ounces of black coffee1 at blood heat1 into the rectum4 ,rub the lower part of the body and legs briskly toward the heart1 while artificial respiration is being carried out4 ,see ,rule #b under ,suffocation 7p4 #ahf74 ,thirty drops of tincture of belladonna to an adult1 every hour1 will assist the breathing4 ,do not exhaust the patient by walking him around1 slapping him with wet towels1 or striking him on the calves2 keep him awake by rubbing4 ,tobacco when ,swallowed3 ,nausea and vomiting occur1 with severe pain and great prostration2 delirium or convulsions may follow4 ,the heart1 at first rapid and full1 becomes weak and compressible4 ,give emetic at once3 thirty grains of powdered ipecac stirred in wineglass of water1 followed by two glasses of warm water1 by degrees4 ,give whisky1 two teaspoonfuls in wineglass of hot water4 ,keep patient warm4 ,nux ,vomica2 ,strychnine4 ,symptoms3 ,excitement1 rapid heart action1 restlessness1 panic of apprehension1 twitching of forearms and hands1 possibly convulsions1 during consciousness4 ,use stomach pump1 if possible1 or give thirty grains of powdered ipecac stirred in a wineglass of water4 ,then1 when vomiting has ceased1 give twenty grains of chloral1 together with thirty grains of bromide of sodium in half a glass of water1 at blood heat1 injected into the rectum4 ,give twenty grains of bromide of sodium in a wineglass of water1 every hour1 by the mouth4 ,if convulsions1 put chloroform before nose and mouth1 as follows3 pour twenty drops of chloroform on a handkerchief and hold it close to the mouth1 letting air pass freely under it4 ,stop when patient relaxes4 ,resume if he becomes rigid again4 ,cocaine4 ,symptoms3 ,general nervousness1 irritability of temper1 wakefulness1 followed quickly by great pallor1 dilatation of the pupils1 unconsciousness1 and convulsions4 ,give the patient two teaspoonfuls of whisky in a wineglass of water every hour4 ,give1 if possible1 a hypodermic of a thirtieth of a grain of strychnine1 every two hours1 or as he may require it1 to keep the pulse full and strong4 ,use hot-water bottles to feet and legs4 ,phenacetin2 ,acetanilid2 ,headache ,powders3 ,give two teaspoonfuls of whisky in a wineglass of hot water4 ,if the heart flags1 give tincture of digitalis1 five minims in tablespoonful of water1 every two hours1 or till three doses are given4 ,it is better to use digitalin1 one one-hundredth of a grain hypodermically1 if possible4 ,,chapter ,,vii ,food ,poisoning ,food ,containing ,bacterial ,poisons ,resulting from ,putrefaction2 ,food ,infected with ,disease ,germs2 ,food ,containing ,parasites--,tapeworm-- ,trichiniasis--,potato ,poisoning4 ,,food ,,poisoning4--,much the same symptoms from all meats1 fish1 shellfish1 milk1 cheese1 ice cream1 and vegetables2 namely1 vomiting1 cramps1 diarrhea1 headache1 prostration1 weak pulse1 cold hands and feet1 possibly an eruption4 ,first ,aid ,rule #a4--,rid patient of poison4 ,cause repeated vomiting by giving three or four glasses of warm water1 each containing half a level teaspoonful of mustard4 ,put finger down throat to assist4 ,empty bowels by giving warm injection of soapsuds and water by fountain syringe4 ,rule #b4--,support heart and rally nerve force4 ,give teaspoonful of whisky in tablespoonful of hot water every half hour1 as needed4 ,put hot-water bottles at feet and about body4 ,conditions1 ,etc4--,bacterial poisons1 constituting irritants of the stomach and bowels1 are found in certain mussels1 oysters from artificial beds1 eels out of stagnant ditches--as well as the uncooked blood of the common river eel--certain fish at all times1 certain fish when spawning1 putrefied fish1 fermented canned fish1 sausages of which the ingredients have putrefied1 putrefied meat1 imperfectly cured bacon1 putrefied cheese1 milk improperly handled and not cooled before being transported1 ice cream which fermented before freezing1 or ice cream containing putrid gelatin1 and mouldy corn meal and the bread made from it4 ,these poisons are called toxins1 or toxalbumins1 or bacterial proteids4 ,they are no longer called ptomaines1 because many ptomaines are not poisonous4 ,they are formed within the cells of the bacteria1 and result from the combination of certain constituents of the food material that nourishes the bacteria1 in some way not quite understood4 ,some decomposition must have taken place in the food before it can furnish to the bacteria the nourishment it needs4 ,if this has happened1 the bacteria multiply rapidly1 and the toxins that are formed are taken up by the lymphatics and carried away from the tissues as fast as possible4 ,but so great is their virulence that they act on several vital organs before they can be antagonized by the natural elements of the blood4 ,symptoms4--,the symptoms are much the same in all the cases of bacterial poisoning mentioned4 ,sudden and violent vomiting and diarrhea appear a few hours after eating the spoiled food1 or may be delayed4 ,there may be headache1 colic1 and cramps in the muscles4 ,marked prostration and weak pulse with cold hands and feet are characteristic4 ,the appearance of skin eruptions is not uncommon4 ,the occurrence of such symptoms in several persons1 some hours after partaking of the same food1 is sufficient to warrant one in pronouncing the trouble food poisoning4 ,treatment4--,the objects of treatment are to rid the patient of the poison1 and to stimulate the heart and general circulation1 and draw on the reserve nerve force4 ,it is best to procure medical aid to wash out the stomach1 but when this is impossible1 the patient should be encouraged to swallow plenty of tepid water and then vomit it4 ,if there is no natural inclination to do so1 vomiting may be brought about by putting the finger in the back of the throat4 ,the same process should be repeated a number of times1 and the result will be almost as good as though a physician had used a stomach tube4 ,a teaspoonful of salt or tablespoonful of mustard in the water will hasten its rejection4 ,then the bowels should likewise be emptied4 ,if vomiting continues this will not be possible by means of drugs given by the mouth1 although calomel may be retained given in half-grain tablets hourly to an adult1 until the bowels begin to move1 or till eight to ten tablets are taken4 ,when vomiting is excessive1 emptying of the bowels may be brought about quickly by giving warm injections of soapsuds into the bowel with a fountain syringe4 ,brandy or whisky in teaspoonful doses given in a tablespoonful of hot water at half-hour intervals should follow the emptying of the stomach and bowels1 and the patient must be kept quiet4 ,he must also be kept warm by means of hot-water bags and blankets4 ,,infected ,,food4--,a frequent source of illness is infection by disease germs transmitted in food4 ,the meat of animals slaughtered when sick with abscess1 pneumonia1 kidney disease1 diarrhea1 or anthrax 7malignant pustule7 carries disease germs and causes serious illness2 so does the meat of animals killed after recent birth of their young1 and probably having fever4 ,oysters may be contaminated with excrement from typhoid patients1 and may then transmit the disease to those who eat them4 ,milk from diseased animals1 or contaminated with germs of typhoid fever1 scarlet fever1 tuberculosis1 diphtheria1 etc41 is apt to cause the same disease in the human being who drinks it4 ,if such infected food is eaten raw1 the diseases with which it is contaminated may be transmitted4 ,if subjected to cooking at a temperature of at least the boiling point1 comparative safety is secured2 but the toxins accompanying the disease germs in the infected food are not as a rule rendered harmless4 ,treatment must be directed to each disease thus transmitted4 ,poisoning resulting from eating canned meats has sometimes been attributed to supposed traces of tin1 zinc1 or solder1 which have become dissolved in the fluids of the meat1 but in the vast majority of cases such poisoning is due to toxins accompanying the germs of putrefaction1 the meats having been unfit for canning at the outset4 ,in such cases the symptoms are the same as in other food poisoning1 and the treatment must be such as is elsewhere directed 7see pp4 #adg and #adi74 ,while human breast milk is germ free1 the cows' milk sold in cities is a very common source of disease4 ,scrupulous care of the cows1 of the clothing and hands of the milkers1 of the stables at which the herds are quartered1 and of the cans1 pails1 and pans used1 reduces to a minimum the amount of filth and impurity otherwise mixed with milk4 ,in the household1 as well as during transportation1 milk should be kept cool1 with ice if necessary4 ,it should also never be left uncovered1 for it readily absorbs gases1 effluvia1 and contaminating substances in the air1 and affords an excellent medium for the growth and propagation of germs4 ,when partially or entirely soured1 it should not be used1 except in the preparation of articles of food by cooking1 as directed in cook books4 ,it should never be used if there is any doubt about its purity4 ,unless all doubt has been removed1 it is best to subject milk intended for children's consumption to a temperature of #afj deg4 ,f4 for ten minutes1 and then put it on the ice1 especially during hot weather4 ,germs are thus rendered harmless1 and the nourishing qualities of the milk remain unimpaired4 ,summer diarrhea of children1 also called cholera infantum1 occurs as an epidemic in almost all large cities during the hottest days of summer4 ,the disease is largely fatal1 especially during the first hot month1 because the most susceptible and tender children are the first affected4 ,it is due to the absorption into the systems of these children of the toxins formed during the putrefying of milk in the stomachs and bowels of the little sufferers4 ,clean1 pure sweet milk1 free from bacteria should be used to prevent the occurrence of this disease4 ,its treatment is outlined in ,vol4 ,,iii4 ,exactly what bacteria cause the disease is not decided4 ,possibly the milk is infected1 but probably the poisonous results come from toxins4 ,,food ,,containing ,,parasites4--,the parasites found in food in this country are echinococcus1 guineaworm1 hookworm1 trichina1 and tapeworm4 ,echinococcus cannot be understood or diagnosed by the layman4 ,guineaworm is excessively rare in the ,united ,states2 it gains access into the body through drinking water which contains the individuals4 ,hookworm is the cause of miners' anaemia1 and is extremely rare in this country4 ,the entrance of living food parasites can be absolutely prevented by thorough cooking of meats1 especially pork and beef4 ,heat destroys the measles and the trichina worms4 ,,tapeworm4--,this is developed in man after eating measly beef or pork4 ,measles are embryo tapeworms called1 from their appearance1 bladder worms4 ,in from six to ten weeks after being received into the intestine of a man1 these bladder worms become full grown1 and measure from ten to thirty feet in length--the tapeworms4 ,symptoms4--,vertigo1 impairment of sight and of hearing1 itching of the nose1 salivation1 loss of appetite1 dyspepsia1 emaciation1 colic1 palpitation of the heart1 and sometimes fainting accompany the presence of the tapeworm4 ,generally the condition becomes known through the passage in the excrement of small sections of the worm4 ,these sections resemble flat portions of macaroni4 ,treatment4--,this1 to be successful1 must be directed by a physician4 ,when no physician can be procured1 the patient may attempt his own relief4 ,after fasting for twenty-four hours1 pumpkin seed1 from which the outer coverings have been removed by crushing1 are soaked overnight in water and taken on an empty stomach in the morning2 a child takes one or two ounces thoroughly mashed and mixed with sirup or honey1 and an adult four ounces 7see ,vol4 ,,iii1 p4 #bde74 ,,trichiniasis4--,this is a dangerous disease caused by the presence in the muscles and other tissues of the trichinae1 little worms which are swallowed in raw or partly cooked pork1 ham1 or bacon4 ,nausea1 vomiting1 colic1 and diarrhea appear early1 generally on the second day after eating the infected meat4 ,later1 stiffness of the muscles occurs1 with great tenderness1 swelling of the face and of the extremities1 sweating1 hoarseness1 difficult breathing1 inability to sleep1 bronchitis1 and pneumonia4 ,there is no treatment for the disease4 ,many cases which are not fatal are probably considered to be obscure rheumatism4 ,many cases of pneumonia are caused by the worm4 ,,potato ,,poisoning4--,there remains one variety of food poisoning which needs mention1 since it occurs when least expected1 and when proper food has been subjected to natural growth4 ,as the potato belongs to the botanical family containing the dangerous belladonna1 tobacco1 hyoscyamus1 and stramonium1 it is not surprising that is should also contain a powerful poisonous alkaloid1 namely1 solanine4 ,solanine is developed in potatoes1 especially during their sprouting stage4 ,violent vomiting and diarrhea and inflammation of the stomach and bowels are caused by it4 ,careful peeling of sprouting potatoes1 and removal of their eyes1 will lessen1 if not wholly obviate1 the danger from eating them4 ,this form of food poisoning is rare4 ,,chapter ,,viii ,bites and ,stings ,several ,kinds of ,mosquitoes--,cause of ,yellow ,fever--,bee1 ,wasp1 and ,hornet ,stings--,wood ,ticks1 ,lice1 and ,fleas--,scorpions and ,centipedes--,poisonous ,snakes--,dog and ,cat ,bites4 ,,mosquitoes4--,the female mosquito is the offender4 ,during or after sucking blood she injects a poison into the body which causes itching1 swelling1 and1 in some susceptible persons1 considerable inflammation of the skin4 ,the bites of the mosquitoes living on the shores of the ,arctic ,ocean and in the tropics are the most virulent4 ,the most important relation of mosquitoes to man was only recently discovered4 ,they are probably the sole cause of malaria and yellow fever in the human being4 ,the malarial parasite which lives in the blood of man1 when he is suffering from malaria1 first inhabits the body of a certain kind of mosquito4 ,the mosquito acquires the undeveloped parasite by biting the human malarial patient1 and then acts as a medium of infection by transmitting the active parasite to some healthy man1 through the bite4 ,the more common house mosquito1 the ,culex1 does not carry the parasite of malaria1 and it is important to be able to distinguish the ,anopheles which is the source of malaria4 ,the ,anopheles is more common in the country1 while the ,culex is a city pest4 ,the ,culex has very short palpi1 the name given to the projections parallel to the proboscis2 while those of ,anopheles are so large that it appears to have three probosces4 ,there are no markings on the wings of the ordinary species of ,culex1 while the wings of ,anopheles are distinctly mottled4 ,the ,culex1 sitting on a wall or ceiling1 holds its hind legs above its back and its body nearly parallel to the wall or ceiling1 but the ,anopheles carries its hind legs either against the wall or hanging down 7rarely above the back71 and its body1 instead of lying parallel to the wall or ceiling1 hangs away at an angle of about forty-five degrees from it4 ,the ,culex lays her eggs in sinks1 tanks1 cisterns1 and water about houses1 but the ,anopheles deposits her ova in shallow pools and sluggish streams1 especially those on which is a growth of green scum or algae4 ,such are the main distinguishing features of the malaria-carrying mosquito1 the ,anopheles1 and the commoner house variety1 the ,culex4 ,to prevent malaria1 mosquito bites must be prevented by nettings in houses1 especially for the protection of sleepers4 ,pools1 ponds1 and marshy districts must be drained in order to destroy the breeding places of ,anopheles1 and in the malarial season1 petroleum 7kerosene7 must be poured on the surface of such waters to arrest the development of the immature insects 7larvae74 ,the mosquito is believed to be the sole cause of yellow fever1 being capable of communicating the germ of the disease to man by its bite two weeks after it has itself been contaminated with the germ in feeding on the blood of a yellow-fever patient4 ,this invaluable discovery was made by ,dr4 ,walter ,reed1 ,u4 ,s4 ,a41 in #aija1 as a result of his labors and those of other members of the yellow-fever commission of the ,u4 ,s4 ,army in ,cuba1 involving the death of one of the members of the commission 7,dr4 ,lazear71 and utilizing the heroism of a number of our young soldiers who voluntarily offered themselves to be bitten by mosquitoes that had previously bitten yellow-fever patients1 and who experimentally occupied premises containing all sorts of articles infected by yellow-fever patients4 ,the result of their research proves that yellow fever is not contagious at all1 in the usual sense1 but is communicated only through the medium of mosquitoes4 ,this shows the fallacy of many quarantine rules regarding yellow-fever patients1 and of the fear of nursing the sick1 and will result in controlling the disease4 ,in the case of malaria or yellow fever1 there is a vicious circle into which man and the mosquito enter2 malaria and yellow-fever patients contaminate the mosquitoes which bite them1 and the mosquitoes in their turn infect man with these diseases4 ,a patient with malaria coming into a nonmalarial place1 and being bitten by mosquitoes1 may lead to an epidemic of the disorder which becomes endemic4 ,to terminate this condition1 it is necessary to prevent the contact of man with mosquitoes and to kill these insects4 ,both malaria and yellow fever will doubtless be practically eradicated before long through the result of these scientific discoveries4 ,treatment of ,mosquito ,bites4--,to prevent mosquitoes1 fleas1 lice1 horseflies1 etc41 from biting1 it is necessary merely to dip the clean hands into a pail of water in which1 while hot1 one ounce of pure carbolic acid was dissolved1 and while they are thus wet rub the solution over all the exposed skin and allow it to dry naturally4 ,a mixture of kerosene 7petroleum7 and water used in the same way will also afford protection4 ,all poisons introduced into the body by insects are of an acid nature1 and to this quality are due the pain and irritation which it is our object to overcome4 ,the best remedy1 naturally1 is an alkali of some sort4 ,water of ammonia1 diluted1 or a strong solution of saleratus or baking soda in water1 are the two most successful remedies to apply1 either through bathing1 or on cloths saturated in one of the solutions4 ,clean clay1 mixed with water to make a mud poultice1 is a useful application in emergencies4 ,,bee1 ,,wasp1 ,,and ,,hornet ,,stings4--,the pain and swelling are produced by the poison of the insect which leaves the poison bag at the base of the barb at the instant that the person is stung4 ,the bee stings but once1 as the sting being barbed is broken off1 and is retained in the flesh of the victim4 ,the sting of the wasp and hornet is merely pointed1 and is not lost during the stinging process so that they can repeat the act4 ,bee keepers1 after being stung a number of times1 usually become immune1 i4 e41 they are no longer poisoned by bites of these insects4 ,it is well to extract the sting of bees before all of the poison has come away4 ,a fine pair of forceps is useful for this purpose2 or1 by pressing the hollow tube of a small key directly down over the puncture made by the sting1 it may be squeezed out4 ,ammonia water1 as recommended for mosquitoes1 is the best remedy to relieve the pain4 ,,wood ,,ticks4--,ticks inhabit the woods and bushes throughout the temperate zone1 and at certain periods during the summer season attack passing men and animals4 ,the common tick is nearly circular in shape1 very flat1 with a dark1 brown1 horny body about one-sixteenth to one-eighth inch in diameter4 ,each of its eight legs possesses two claws1 and the proboscis incloses feelers which are similarly armed4 ,the beetle plunges its barbed proboscis into the flesh of man or animals1 and holds on very firmly with its other members till it is gorged with blood1 growing as large as a good-sized bean1 when it drops off4 ,the bite is painless1 and it is not until the insect is engorged with blood that it is perceptible2 if1 however1 attempts are made to remove the tick before it is ready to let go1 the proboscis may be torn off and left in the skin1 when painful local suppuration will follow4 ,treatment4--,as the presence of tick is far from agreeable1 the insect may often be removed by painting it with turpentine1 which either kills it or causes the claws to be relaxed2 in either case the tick loosens its hold and drops to the ground4 ,a tropical variety1 carapato1 buries the whole head in the flesh of its host before it is perceived1 and if turpentine does not loosen its hold1 the head must be dug out with a clean needle or knife blade4 ,,lice 7,pediculi74--,head lice are most common4 ,they are gray with black margins1 about one-twenty-fifth to one-twelfth inch long1 and wingless4 ,the color changes with the host1 as the lice are black on the negro1 and white in the case of the ,eskimos4 ,the female lays fifty to sixty eggs 7nits71 seen as minute1 white specks glued to the side of a hair2 usually not more than one or two on a single hair4 ,the eggs hatch in six days4 ,the irritation produced by the presence of the parasites on the head leads to general itching1 more particularly on the lower part of the back of the head4 ,the constant scratching starts an inflammation of the skin with the formation of pimples1 weeping spots1 and crusts1 from the dried discharge1 possessing a bad odor4 ,the denuded spots becoming infected1 the neighboring glands enlarge and are felt as tender lumps beneath the skin at the back of the neck1 under the jaw1 or at either side of the neck4 ,whenever there are persistent itching and irritation of the scalp1 particularly at the back of the head1 lice or nits should be sought for4 ,sometimes it is more easy to find them on a fine-tooth comb passed through the hair4 ,lice are very common in dirty households1 and are occasionally seen on the most fastidious persons1 who accidentally acquire them in public places or conveyances4 ,treatment4--,the hair should be cut short when permissible4 ,any crusts on the head should be softened by the application of sweet oil1 and then removed by washing in soap and warm water4 ,petroleum or kerosene is a good remedy4 ,it must be rubbed on the head two successive nights1 the head being covered by a cap1 and washed off each morning with hot water and soap4 ,the patient must be cautioned not to approach an open flame after kerosene has been put on his head4 ,the eggs or nits are next to be attacked with vinegar1 which is sponged on the hair and the fine-tooth comb plied daily for a week4 ,the remaining irritation of the scalp can be cured by washing the head daily and applying sweet oil4 ,a simpler plan consists of drenching hair and scalp twice with cold infusion of 7poisonous7 larkspur seed1 made by steeping for an hour an ounce of the seed in six ounces of hot water4 ,this treatment will destroy both insects and eggs4 ,after twenty-four hours the hair and scalp must be shampooed with warm water thoroughly4 ,,clothes ,,lice4--,these insects are a trifle larger than the head lice1 being one-twelfth to one-eighth inch long1 of a dirty1 yellowish-gray color1 and only infesting the most filthy people4 ,the lice are generally only seen on the clothes1 where they live1 coming out on the body only to feed4 ,the visible signs on the body are varying degrees of irritation from redness to ulceration1 due to scratching4 ,the treatment is simply cleanliness of the body and clothes4 ,,crab ,,lice4--,the crab louse or crab inhabits the skin covered by hair about and above the sexual organs most frequently1 and from thence spreads to the hairy region on the abdomen1 chest1 armpits1 beard1 and eye lashes4 ,itching and scratching first call attention to the presence of the parasites1 which are even more troublesome than the other species4 ,application of kerosene to the part is sufficient to kill the lice1 but this treatment must be repeated several times at intervals of a week1 in order to kill the parasites subsequently hatched4 ,,flea4--,flea bites are recognized by the itching caused by the poison introduced by the insect1 and by points of dried blood surrounded for a little while by a red zone4 ,in the case of children and people with delicate skins1 red or white lumps appear resembling nettlerash4 ,generally the skin is simply covered with minute1 red points1 perhaps raised a little by swelling above the surface1 and when very numerous may remotely resemble the rash of measles4 ,fleas1 unlike lice1 do not breed on the body1 but as soon as they are satiated leave their host4 ,their eggs are laid in cracks in floors1 on dirty clothes and similar spots1 and it is only the mature flea which preys upon man4 ,the human flea may infest the dog and return to man1 but the dog flea is a distinct species1 and never remains permanently on the human host4 ,for these reasons it is not difficult to get rid of fleas after they have attacked the body1 unless continually surrounded by them4 ,,jigger ,,or ,,sand ,,flea4--,also called chique1 chigo1 and nigua4 ,it is common in ,cuba1 ,porto ,rico1 and ,brazil4 ,about one-half the size of the ordinary flea1 it is of a brownish-red color with a white spot on the back4 ,the female lives in the sand and attacks man1 on whom she lives1 boring into the skin about the toe nail1 usually1 and laying her eggs under the skin1 which gives rise to itching at first and then violent pain4 ,the insect sucks blood and grows as it gorges itself1 producing a white swelling of the skin in the center of which is seen a black spot1 the front part of the flea4 ,the flea after expelling its eggs drops off and dies4 ,people with habitually sweaty feet are exempt from attacks of the pest4 ,unless the flea is unattached1 one must either wait until the insect comes away of its own free will1 or remove it with a red-hot needle in order to destroy the eggs4 ,the negroes peel the skin from the swelling with a needle and squeeze out the eggs4 ,ordinarily the bites do no permanent injury1 but occasionally if numerous1 or if the insect is pressed into the skin in the efforts to remove it1 or if sores resulting from bites are neglected1 then violent inflammation1 great pain1 and even death of the part may result4 ,sound shoes and a night and morning inspection of the feet will protect against the inroads of the sand fleas4 ,,flies4--,the common housefly does not bite1 but is constantly inimical to human health by conveying disease germs of typhoid fever1 cholera1 and other disorders from bowel discharges of patients suffering from these diseases to articles of food on which the insects light4 ,flies have been a fruitful source of sickness in military camps1 as evidenced in the recent ,spanish-,american and ,anglo-,african campaigns4 ,the bites of the sandfly1 gadfly1 and horsefly may be both relieved and prevented by the same means recommended in the case of mosquitoes for these purposes4 ,,scorpion ,,or ,,centipede ,,sting4 ,first ,aid ,rule4--,squeeze lemon juice on wound4 ,,spider ,,or ,,tarantula ,,bite4 ,first ,aid ,rule4--,pour water of ammonia on bite4 ,if patient is depressed1 give strong coffee4 ,,scorpions ,,and ,,centipedes4--,these both inhabit the tropics and semitropical regions1 and lurk in dark corners and out-of-the-way places1 crawling into the boots and clothing during the night4 ,scorpions sting with their tails1 which are brought over the head and back for the purpose1 while holding on to the victim with their lobsterlike claws4 ,the poisonous centipede has a flattened brownish-yellow body1 with a single pair of short legs for each body segment1 and long1 many-jointed antennae4 ,the wounds made by either of these pests are rarely dangerous1 except in young children and those in feeble health4 ,the stings are usually relieved by bathing with a two per cent solution of carbolic acid1 with rum1 or with lemon juice4 ,,spiders4--,many of the tropical spiders bite the human being4 ,trapdoor spiders are among the commonest of these pests4 ,their bodies grow to great size1 two to two and a half inches long1 and are covered with hair giving them a horrid appearance4 ,they live in holes bored in the ground1 and provided with a trapdoor contrivance which is closed when the insect is at home4 ,the trapdoor spider resembles the tarantula1 by which name it is usually known in ,cuba and ,jamaica1 but is somewhat smaller and commoner4 ,neither the stings of the trapdoor spider nor true tarantula are usually dangerous although the wounds caused by the bites may heal slowly4 ,application of water of ammonia and of the other remedies recommended for mosquito bites 7p4 #aeh7 are indicated here1 and if the patient is generally depressed by the poison1 strong coffee forms a good antidote4 ,,snake ,,bite4 ,first ,aid ,rule #a4--,make the wound bleed4 ,cut slit through the wound1 lengthwise of limb1 two inches long and half an inch deep4 ,squeeze tissues4 ,,do ,,not ,,suck ,,the ,,wound4 ,rule #b4--,keep poison out of general circulation4 ,tie large cord or bandage tightly about part between wound and heart4 ,loosen in fifteen minutes4 ,rule #c4--,use antidote4 ,wash wound and cut with fresh solution of chloride of lime 7one part to sixty parts of water74 ,inject anti-venene with hypodermic syringe1 ten cubic centimeters1 as on label4 ,or1 inject with hypodermic syringe thirty minims of solution of permanganate of potash 7five grains to two ounces of water71 three times in different places4 ,if no syringe at hand1 pour permanganate solution into wound4 ,rule #d4--,support heart if weak4 ,inject with hypodermic syringe one-thirtieth grain of sulphate of strychnine into leg4 ,repeat as needed every thirty minutes with caution4 ,rule #e4--;,give no whisky or other liquor4 ,do not burn the wound4 ,,snake ,,bite4--,there are many different species of poisonous snakes in the ,united ,states4 ,the more common are the rattlesnake1 the moccasin1 the copperhead1 and the common viper4 ,all the venomous snakes have certain characteristics by which they may be distinguished from their harmless brethren4 ,the head is generally broad and flat and of a triangular shape1 the wide1 heavy jaws tapering to a point at the lips4 ,there is a depression or pit between the nostril and eye on the upper lip1 hence the name pit vipers given to poisonous snakes4 ,the pupil of the eye is long and vertical1 of an oval or elliptical shape4 ,venomous snakes are thicker in proportion to their length than harmless snakes1 the surface of their bodies is rougher1 and their tails are blunt or club-shaped4 ,conversely1 harmless snakes possess long narrow heads1 the pupils of their eyes are round1 not vertical slits1 and their bodies are not thick for their length1 but long and slim with pointed tails4 ,the bite of vipers of all kinds is much more poisonous in tropical regions1 and in the ,north fatal snake bite is a rare occurrence4 ,if there is a doubt whether a snake is poisonous1 the neck may be pressed down against the ground between the jaws of a forked stick1 and the poison fangs looked for without danger4 ,these hang directly down from the front part of the upper jaw1 or are thrust horizontally forward just in front of the upper lip1 and may drip saliva and venom4 ,in ,cuba and ,porto ,rico there is a viper called ,juba1 or ,boaquira1 which is a counterpart of the ,northern rattlesnake1 and the most poisonous of the many species in that region4 ,among venomous species of the ,philippines are two boas and also a viper from nine to ten feet long1 which exceptionally pursues and attacks man4 ,this snake is easily killed by a blow on the neck4 ,another small viper with a club-shaped tail1 inhabiting these islands1 is nocturnal in its habits1 and may get into boots at night4 ,boots1 therefore1 should always be inspected before one puts them on in the morning4 ,usually it is only the young1 old1 and weak who succumb to snake bite4 ,symptoms4--,the symptoms of snake bite of all poisonous species are similar4 ,at first there is some pain in the wound1 which rapidly increases together with swelling and discoloration until death of the part may ensue4 ,the vital centers in the brain controlling the heart and breathing apparatus1 are paralyzed by the poison4 ,there is often drowsiness and stupor1 and the breathing is labored and the pulse weak and irregular1 with faintness and cold sweats4 ,treatment4--,the treatment consists first in keeping the poison out of the general blood stream4 ,with this purpose in view a handkerchief1 piece of cotton clothing1 string1 or strap should be immediately wound about the bitten limb above the wound1 between it and the heart4 ,this will retard absorption of the poison only for a time2 it is said twenty-five minutes4 ,the knife is the most effective means of removing the poison by making an oval cut on each side of the wound so that the two incisions meet and remove all the flesh below and around the wound4 ,bleeding should be encouraged to drain out the poison4 ,the skin containing the wound may be lifted up1 and the whole wound cut out by one snip of the scissors where this is practicable4 ,some advocate burning out the wound with a red-hot wire1 or darning needle1 instead of cutting1 but the treatment is less effective and more painful4 ,rambaud forbids burning4 ,as to the general condition3 if stupor is a prominent symptom the patient must be made to move about and exercise to keep alive his nerve centers4 ,otherwise one tablespoonful of whisky may be given in half a cup of hot water hourly1 to sustain the weakened heart and respiration until recovery ensues4 ,the most effective treatment1 according to ,dr4 ,george ,rambaud1 ,director of the ,pasteur ,institute of ,new ,york ,city1 is thorough washing of the wound 7after it has been opened with the knife7 with freshly prepared solution of chloride of lime1 in the proportion of one part of lime to sixty of water4 ,the burning of a wound is bad practice4 ,if necessary1 chloride-of-lime solution should be injected into the tissues around the wound4 ,one about to go into a place where the most venomous snakes are found should inject into himself a dose of ,calmette's antivenomous serum every two or three weeks as a means of prevention4 ,if the serum is used1 whisky should not be given in the treatment of one who has been bitten1 for the anti-venene is a powerful cell stimulator4 ,calmette1 the ,director of the ,pasteur ,institute in ,lille1 ,france1 several years ago discovered antivenomous serum4 ,that serum is efficient for the bites of most of the venomous snakes of different countries1 including the rattlesnake1 cobra1 python1 etc4 ,it is prepared in the dry form so that it can be carried easily1 and will keep almost indefinitely4 ,the proper course to be followed by persons going into countries infested by venomous snakes is always to have on hand a few doses of it4 ,its value has been positively demonstrated within the last few years in ,india1 where it is used in the ,british ,army1 as well as in other countries4 ,in the fluid form it should be used hypodermically1 a dose of ten cubic centimeters being injected within eighty or ninety minutes of the reception of the poison4 ,,dog ,,bite ,,or ,,cat ,,bite4 7,see ,hydrophobia1 ,vol4 ,v1 p4 #bfd47 ,first ,aid ,rule #a4--,make sure animal is mad4 ,send patient to ,pasteur institute if one is within reach4 ,rule #b4--,remove poison from wound4 ,encourage bleeding by squeezing tissue about wound4 ,suck wound1 if you have no cracks in lips1 and spit out fluid4 ,pour hot carbolic solution into wound 7a third of a teaspoonful of carbolic acid to a pint of hot water74 ,rule #c4--;,cauterize4 ,dip wooden meat skewer1 or lead pencil1 into pure nitric acid1 and rub into wound4 ,or1 use red-hot poker1 or red-hot nail grasped by tongs or pincers1 or red coal from fire4 ,rule #d4--;,do not kill the animal4 ,if he is alive and well at the end of a week1 he was not mad4 ,,chapter ,,ix ,burns1 ,scalds1 ,frostbites1 ,etc4 ,classes of ,burns--,treatment--,burns ,caused by ,acids and ,alkalies--,first ,aid ,rules for ,frostbites--,real ,freezing--,ingrowing ,toe ,nail--,fainting--,suffocation--,fits4 ,,burns ,,and ,,scalds4--,if slight1 skin very red1 unbroken4 ,first ,aid ,rule4--,cover with cloths wet in strong solution of baking soda in cold water4 ,dry gently1 and spread with white of egg1 thick4 ,if deeper1 blisters1 skin broken1 thick swelling2 there may be some bleeding4 ,first ,aid ,rule #a4--,stop pain quickly4 ,cut away clothing very gently4 ,break no blisters4 ,cover with ,carron oil 7equal parts of limewater and linseed or olive oil7 and light bandage4 ,give fifteen drops of laudanum#i every half hour in tablespoonful of water1 till relieved in part or three doses are taken4 ,rule #b4--;,combat shock4 ,if patient is cold1 pulse weak1 head confused1 give tablespoonful of whisky in a quarter of a glass of hot water4 ,put hot-water bottles at feet4 ,rule #c4--,quench thirst with pieces of ice held in mouth or a swallow of cold milk4 ,see page #agd for subsequent treatment4 ,a burn is produced by dry heat1 a scald by moist heat2 the effect and treatment of both are practically identical4 ,burns are commonly divided into three classes1 according to the amount of damage inflicted upon the body4 ,first ,class4--,there is redness1 pain1 and some swelling of the skin1 followed1 in a few days1 by peeling of the surface layer 7epidermis7 and recovery4 ,sunburn and burns caused by slight exposures to gases and vapors fall into this category4 ,treatment4--,the immediate immersion of the part in cold water is followed by relief1 or the application of cloths wet with a saturated solution of saleratus or baking powder is useful4 ,anything which protects the burned skin from the irritating effect of the air is efficacious1 and in emergencies any one of the following may be applied3 starch1 flour1 molasses1 white paint1 or a mixture of white of egg and sweet oil1 equal parts4 ,usually after the first pain has been relieved by bathing with soda and water1 or its application on cloths1 the employment of a simple ointment suffices1 as cold cream or vaseline4 ,second ,class4--,in this class of cases the inflammation is more severe and the deeper layers of the skin are involved4 ,in addition to the redness and swelling of the skin there are present blisters which appear at once or within a few hours4 ,the general condition is affected according to the size of the burn4 ,if half of the body is only reddened1 death usually results1 and a burn of a third of the body is often fatal4 ,the shock is so great at times that pain may not be at once intense4 ,shock is evidenced by general depression1 with weakness1 apathy1 cold feet and hands1 and failure of the pulse4 ,if the patient rallies from this condition1 then fever and pain become prominent4 ,if steam has been inhaled1 there may be sudden death from swelling of the interior of the throat1 or inflammation of the lungs may follow inhalation of smoke and hot air4 ,third ,class4--,in this class are included burns of so severe a nature that destruction and death of the tissues follows2 not only of the skin but of the flesh and bones in the worst cases4 ,it is impossible to tell by the appearance of the skin what the extent of the destruction may be until the dead parts slough away after a week or ten days4 ,the skin is of a uniform white color in some cases1 or may be of a yellow1 brown1 gray1 or black hue1 and is comparatively insensitive at first4 ,pus 7matter7 begins to form around the dead part in a few days1 and the dead tissue comes away later1 to be followed by a long course of suppuration1 pain1 excessive granulations 7proud flesh71 and1 unless skillfully treated1 by contraction of the surrounding area1 leaving ugly scars and interfering with the appearance and usefulness of the parts4 ,the treatment of such cases after the first care becomes that to be pursued in wounds generally 7p4 #ej71 and belongs within the domain of the surgeon4 ,treatment of the ,more ,severe ,burns4--,if the patient is suffering from shock he should receive some hot alcoholic drink1 as hot water and whisky1 and be put to bed under warm coverings with hot-water bags or bottles at his feet4 ,the clothing must be cut away from the burned parts with the greatest care1 and only a portion of the body should be uncovered at a time and in a warm room4 ,pain may be subdued by laudanum#aj2 fifteen drops may be given to an adult1 and the drug may be repeated at hour intervals in doses of ten drops until the suffering has been allayed4 ,lumps of ice held in the mouth will quench thirst1 and the diet should be liquid1 as milk1 soups1 gruels1 white of egg1 and water4 ,the bowels should be moved daily by rectal injections of soap and warm water4 ,as a matter of local treatment1 the surface layer of the skin should be kept intact if possible4 ,blisters are not to be disturbed unless they are large and tense2 if so1 their bases may be pricked with a needle sufficiently to let out the fluid contents4 ,carron oil 7equal parts of olive oil and limewater7 has been the common remedy for burns1 and it is an efficient1 though very dirty1 dressing1 useful if the skin is generally unbroken4 ,it should be applied on clean1 soft linen or cotton cloth1 which is soaked in the oil1 laid over the burned area1 and covered with a thick layer of cotton batting and a bandage4 ,when the skin is denuded1 leaving a raw surface exposed1 the burn must be treated on the same plan as wounds1 and should be kept as clean and free from germs as possible4 ,an ointment made of equal parts of boric acid and vaseline1 spread thickly on clean cloth1 is a good antiseptic preparation in cases where the skin is broken4 ,it is best not to change the dressing oftener than once in two or three days1 unless the discharge or odor are considerable4 ,fresh dressing is very painful and often harmful4 ,when the dressing is removed1 warm saline solution 7one teaspoonful of common salt in a quart of water7 is allowed to flow over the burn until all discharge is washed off4 ,then the raw surface is dusted over with pure boric acid or aristol1 and the boric-acid ointment applied as before4 ,the cloth upon which the ointment is spread should be made free from germs by boiling in water1 and then drying it in an oven and keeping it well wrapped in a clean towel except when wanted4 ,the same care is requisite as that described under wounds 7p4 #ej7 in regard to cleanliness4 ,very extensive burns are most satisfactorily treated by complete immersion of the burned limbs or entire body in salt solution 7same strength as above71 which is kept at a temperature of from #id deg4 to #ajd deg4 ,f41 according to the feelings of the patient4 ,the patient lies in a bath tub on horsehair1 or better1 rubber mattress and rubber pillows2 completely covered with water except the head4 ,the urine and bowel discharges must be passed in the water1 which is then changed1 and the temperature is kept at an even mark by allowing warm water to continually run into the tub to displace that which runs out4 ,the latter can be arranged by siphonage with a rubber tube4 ,while this method requires more care1 and running hot and cold water1 it is the most comfortable treatment for these cases1 usually attended by awful suffering1 and at the same time it is most favorable to healing4 ,it is beyond the scope of this work to describe the various complications and the details of the after treatment in severe burns1 including skin grafting1 which may tax all the ingenuity of the skilled surgeon4 ,it is hoped that the foregoing may give a clear idea of the treatment to be pursued in emergencies and may prove of some use to those who may unfortunately be compelled to care for burns during a considerable time without the aid of a physician4 ,,burn ,,by ,,strong ,,acid4 ,first ,aid ,rule #a4--,neutralize the acid4 ,scatter baking soda thickly over burn1 or pour limewater over it4 ,rule #b4--;,control pain4 ,wash off soda with stream of water4 ,apply ,carron oil 7equal parts of limewater and linseed oil or olive oil74 ,bandage lightly4 ,,burn ,,by ,,strong ,,alkali4--,as ammonia1 quicklime1 lye4 ,first ,aid ,rule #a4--,neutralize the alkali4 ,pour vinegar over the burn4 ,rule #b4--;,control pain4 ,wash off vinegar with stream of water4 ,dry gently4 ,apply vaseline or cold cream4 ,,burns ,,caused ,,by ,,strong ,,mineral ,,acids ,,or ,,by ,,alkalies4--,if acids are the cause1 the skin should not be washed at first1 but either chalk1 whiting1 or some mild alkali1 as baking soda1 should be strewn over the burn1 and then after the effect of the acid is neutralized1 wash off the soda with stream of warm water4 ,dry gently with gauze4 ,apply ,carron oil or paste of boric acid and vaseline1 equal parts4 ,if strong alkalies have been spilled on the skin1 as ammonia1 potash1 or quicklime1 then vinegar is the proper substance to employ1 followed by washing4 ,then dry gently4 ,vaseline or cold cream is usually sufficient as after treatment4 ,limewater is useful in counteracting the effect of acids spattered in the eye4 ,in the case of alkalies in the eye1 the vinegar used should be diluted with three parts of water4 ,albolene or liquid vaseline is the best agent to drop in the eye after either accident1 in order to relieve the irritation and pain1 and the patient should stay in a dark room4 ,,frostbite1 ,,real ,,freezing4--,nose1 ears1 fingers1 toes2 insensible to touch1 stiff1 pale or blue4 ,person may be unconscious4 ,first ,aid ,rule #a4--,restore circulation4 ,rub gently1 then vigorously1 with snow4 ,rule #b4--,restore heat very gradually4 ,sudden heat is fatal4 ,keep in cold room1 and rub with cloth wet with very cold water till circulation is established4 ,then rub with equal parts of alcohol and water and expose gradually to heat of living room4 ,rule #c4--;,if person ceases to breathe1 resuscitate as if drowned4 ,open his mouth1 grasp his tongue1 and pull it forward and keep it there4 ,let another assistant grasp the arms just below the elbows and draw them steadily upward by the sides of the patient's head to the ground1 the hands nearly meeting 7which enlarges the capacity of the chest and induces inspiration47 7,see pp4 #cj and #ca47 ,while this is being done1 let a third assistant take position astride the patient's hips with his elbows resting on his own knees1 his hands extended ready for action4 ,next1 let the assistant standing at the head turn down the patient's arms to the sides of the body1 the assistant holding the tongue changing hands if necessary to let the arms pass4 ,just before the patient's hands reach the ground the man astride the body will grasp the body with his hands1 the ball of the thumb resting on either side of the pit of the stomach1 the fingers falling into the grooves between the short ribs4 ,now1 using his knees as a pivot1 he will at the moment the patient's hands touch the ground throw 7not too suddenly7 his whole weight forward on his hands1 and at the same time squeeze the waist between them1 as if he wished to force something in the chest upward out of the mouth2 he will deepen the pressure while he slowly counts one1 two1 three1 four 7about five seconds71 then suddenly lets go with a final push1 which will send him back to his first position4 ,this completes expiration4 7,a child or a delicate person must be more gently handled47 ,at the instant of letting go1 the man at the head of the patient will again draw the arms steadily upward to the sides of the patient's head as before 7the assistant holding the tongue again changing hands to let the arms pass1 if necessary71 holding them there while he slowly counts one1 two1 three1 four 7about five seconds74 ,repeat these movements deliberately and perseveringly twelve or fifteen times in every minute--thus imitating the natural motions of breathing4 ,continue the artificial respiration from one to four hours1 or until the patient breathes2 and for a while after the appearance of returning life carefully aid the first short gasps until deepened into full breaths4 ,keep body warm after this with warm-water bottles4 ,,frostbite4--,the nose1 chin1 ears1 fingers1 and toes are the parts usually frozen1 although severe results ending in death of the frozen part occur more often owing to low vitality of the patient than to the cold itself4 ,in the milder degree of frostbite there is stiffness1 numbness1 and tingling of the frozen member2 the skin is of a pale1 bluish hue and somewhat shrunken4 ,recovery ensues with burning pain1 tingling1 redness1 swelling and peeling of the epidermis1 as after slight burns4 ,the skin is icy cold1 white1 and insensitive in severe forms of frostbite1 and1 if not skillfully treated1 becomes1 later1 either swollen and discolored1 or shriveled1 dry1 and black4 ,in either case the frozen part dies and is separated from the living tissue after the establishment of a sharp line of inflammation which results in ulceration and formation of pus1 and thus the dead part sloughs off4 ,it is1 however1 possible for a part thoroughly frozen to regain its vitality4 ,treatment4--,the essential element in the treatment is to secure a very gradual return of blood to the frozen tissues1 and so avoid violent inflammation4 ,to obtain this result the patient should be cared for in a cold room1 the frozen parts are rubbed gently with snow1 or cloth wet with ice water1 until they resume their usual warmth4 ,then it is well to rub them with a mixture of alcohol and water1 equal parts1 for a time and expose them to the usual temperature of a dwelling room4 ,warm drinks are now administered to the patient4 ,the frozen member1 if hand or foot1 is raised high in the air on pillows and covered well with absorbent cotton and bandage4 ,if much redness1 swelling1 and pain result this dressing is removed and the part is wrapped in a single thickness of cotton cloth kept continually wet with alcohol and water4 ,subsequent treatment consists in keeping the damaged parts covered with vaseline or cold cream1 absorbent cotton1 and bandage4 ,if blisters and sores result1 the care is similar to that described for like conditions under burns4 ,if death of the frozen part becomes inevitable1 the hand or foot should be suspended in a nearly vertical position to keep the blood out1 and the part bathed twice daily with a solution of corrosive sublimate 7one #g4g gr4 tablet to pint of water71 dusted well with aristol1 and dressed with absorbent cotton and bandage until the dead tissue separates and comes away4 ,if the frozen part is large it may be necessary to remove it with a knife1 but this is not essential when the tips of the fingers or toes are frozen4 ,general ,effect of ,cold4--,sudden exposure to severe cold causes sleep1 stupor1 and death4 ,persons found apparently frozen to death should be brought into a cold room1 which should be gradually heated1 and the body rubbed with snow or ice water1 and artificial respiration employed1 as just directed4 ,attempts at resuscitation ought to be persistent1 as recoveries have been reported after several hours of unconsciousness and apparent death from freezing4 ,,chilblains ,,and ,,mild ,,frostbites4--,the effects of severe cold on the body are very similar to those of intense heat1 though they are very much slower in making their appearance4 ,after a person has frozen a finger or toe he may not notice much inconvenience for days1 when suddenly violent inflammation may set in4 ,the fingers1 ears1 nose1 and toes are the members which suffer most frequently from the effects of cold4 ,similar symptoms of inflammation1 described under burns1 also result from cold1 that is1 redness and swelling of the skin1 blisters with more severe and deeper inflammatory involvement1 or1 in case the parts are thoroughly frozen1 local death and destruction of the tissues4 ,but it is not essential that the body be exposed to the freezing temperature or be frozen at all1 in order that some harm may result1 for chilblains often follow when the temperature has not been lower than #dj deg4 ,f41 or thereabouts4 ,the effect of cold is to contract the blood vessels1 with the production of numbness1 pallor1 and tingling of the skin4 ,when the cold no longer acts then the blood vessels dilate to more than their usual and normal state1 and more or less inflammation results4 ,the more sudden the return to warmth the greater the inflammatory sequel4 ,chilblains represent the mildest morbid effect of cold on the body4 ,they exist as bluish-red swellings of the skin1 usually on the feet or hands1 but may attack the nose or ears1 and are attended by burning1 itching1 and smarting4 ,this condition is caused by dilatation of the vessels following exposure to cold4 ,it is more apt to happen in young1 anaemic women4 ,chilblains usually disappear during warm weather4 ,scratching1 friction1 or the severity of the attack may lead to the appearance of blisters and sores4 ,in severe cases the fingers and toes present a sausage-like appearance1 owing to swelling4 ,treatment4--,susceptible persons should wear thick1 warm 7not rough7 stockings and warm gloves4 ,the chilled members must never be suddenly warmed4 ,regular exercise and cold shower baths are good to strengthen the circulation1 but the feet and hands must be washed in warm water only1 and thoroughly dried4 ,if sweating of these parts is a common occurrence1 starch or zinc oxide should be dusted on freely night and morning4 ,cod-liver oil is an efficacious remedy in these cases2 one teaspoonful of ,peter ,moeller's pure oil three times daily after meals4 ,the affected parts are bathed twice daily in a solution of zinc acetate 7one dram to one pint of water71 and followed by the application1 on soft linen or cotton1 of zinc-oxide ointment containing two per cent of carbolic acid4 ,if this is not curative1 iodine ointment mixed with an equal quantity of lard may be tried4 ,exposure to cold will immediately bring on a recurrence of the trouble4 ,if the affection of the feet is severe the patient must rest in bed4 ,if the parts become blistered and open sores appear1 then the same treatment as for burns is indicated4 ,wash with a weak solution of corrosive sublimate 7one tablet for surgical purposes in two quarts of warm water7 and apply an ointment of boric acid and vaseline1 equal parts1 spread on soft1 clean cotton or linen4 ,rest of the part and existence in a warm atmosphere will complete the cure4 ,,ingrowing ,,toe ,,nail4--,this is a condition in which the flesh along the edges of the great toe nail becomes inflamed1 owing either to overgrowth of the nail or to pressure of the soft parts against it4 ,improper footgear is the most common cause1 as shoes which are too narrow across the toes1 or not long enough1 or those with high heels which throw the toes forward so that they are compressed by the toe of the boot1 especially in walking downhill4 ,a faulty mode of cutting the toe nails in a healthy foot may favor ingrowing toe nails4 ,toe nails should be cut straight across1 and not trimmed away at the corners to follow the outline of the toes--as then the flesh crowds in at the corners of the nails1 and when the nail pushes forward in its growth it presses into the flesh4 ,nails which have a very rounded surface are more apt to produce trouble1 because then the edges are likely to grow down into the flesh4 ,inflammation in ingrowing toe nail usually arises along the outer edge of the nail4 ,the flesh here becomes red1 tender1 painful1 and swollen so that it overlaps the nail4 ,after a time matter or pus forms and finds its way under the nail1 and the parts about it ulcerate1 and proud flesh or excessive granulation tissue springs up and imbeds the edge of the nail4 ,wearing a shoe1 or walking1 becomes impossible4 ,the condition may last for months1 or even years1 if not rightly treated4 ,treatment4--,properly fitting footgear must be worn--broad at the toes with low heels and of sufficient length4 ,if pus 7matter7 forms1 the cut edge should be raised up by pushing in a little absorbent cotton under the nail every day4 ,hot poultices of flaxseed meal1 or other material will relieve any special pain and inflammation4 ,soaking the foot frequently in hot water1 and observing especial cleanliness1 will aid recovery4 ,tannic acid1 or some antiseptic powder like nosophen1 should be dusted along the edge of the nail1 and the flesh crowded away from the nail by pushing in a little cotton with some tannic acid upon it4 ,if there is a raw surface about the border of the nail1 powdered lead nitrate may be dusted upon it each morning for four or five days1 till the ulcerated tissue shrinks away and the edge of the nail becomes visible4 ,the toe should be covered with absorbent cotton and a bandage4 ,as soon as the toe is really inflamed the case becomes surgical1 and as such demands the care of a surgeon when one can be obtained4 ,,fainting4 ,first ,aid ,rule #a4--,remove impediments to respiration4 ,remove collar1 loosen all waist bands and cords1 unhook corset or cut the laces at person's back4 ,rule #b4--;,assist heart and brain with blood pressure4 ,put cushion under buttocks1 wind skirt close about legs1 and raise feet in air4 ,wait ten seconds4 ,rule #c4--;,aid respiration4 ,put mild smelling salts under nose4 ,spatter cold water in face4 ,,suffocation ,,from ,,gas ,,in ,,wells1 ,,cisterns1 ,,or ,,mines1 ,,or ,,from ,,illuminating ,,gas4 ,first ,aid ,rule #a4--,remove quickly into pure air4 ,rule #b4--,resuscitate as if drowned4 ,open his mouth1 grasp his tongue1 pull it forward and keep it there4 ,let another assistant grasp the arms just below the elbows1 and draw them steadily upward by the sides of the patient's head to the ground1 the hands nearly meeting1 which enlarges the capacity of the chest and induces inspiration4 7,see pp4 #cj and #ca47 ,while this is being done1 let a third assistant take position astride the patient's hips with his elbows resting on his own knees1 his hands extended ready for action4 ,next1 let the assistant standing at the head turn down the patient's arms to the sides of his body1 the assistant holding the tongue1 changing hands if necessary to let the arms pass4 ,just before the patient's hands reach the ground1 the man astride the body will grasp the body with his hands1 the ball of the thumb resting on either side of the pit of the stomach1 the fingers falling into the grooves between the short ribs4 ,now1 using his knees as a pivot1 he will1 at the moment the patient's hands touch the ground1 throw 7not too suddenly7 his whole weight forward on his hands1 and at the same time squeeze the waist between them1 as if he wished to force something in the chest upward out of the mouth2 he will deepen the pressure while he slowly counts one1 two1 three1 four 7about five seconds71 then suddenly lets go with a final push1 which will send him back to his first position4 ,this completes expiration4 ,a child or a delicate person must be more gently handled4 ,at the instant of letting go1 the man at the head of the patient will again draw the arms steadily upward1 to the sides of the patient's head1 as before 7the assistant holding the tongue again1 changing hands if necessary to let the arms pass1 holding them there while he slowly counts one1 two1 three1 four 7about five seconds774 ,repeat these movements deliberately and perseveringly twelve or fifteen times in every minute1 thus imitating the natural motions of breathing4 ,continue the artificial respiration from one to four hours1 or until the patient breathes2 and for a while after the appearance of returning life1 carefully aid the first short gasps until deepened into full breaths4 ,keep the body warm with hot-water bottles and blanket4 ,rule #c4--;,give oxygen to breathe from a cylinder1 for two days1 at short intervals1 in the case of illuminating gas4 ,,fit2 ,,convulsion4 ,first ,aid ,rule #a4--;,aid breathing4 ,loosen collar1 waist bands1 and unhook corset1 or cut the laces behind4 ,rule #b4--,protect from injury4 ,gently restrain from falling or rolling against furniture2 lay flat on bed4 ,rule #c4--,protect tongue from being bitten4 ,open jaws and put between teeth rubber eraser tied to stout string1 or rubber stopper tied to stout string4 ,rule #d4--;,crush pearl of amyl nitrite in handkerchief1 and hold close to patient's nose and mouth1 till face is red and patient relaxes4 ,rule #e4--,let patient sleep after fit without rousing4 ,,footnotes3 #i ,caution4 ,dangerous4 ,use only on physician's order4 #aj ,caution4 ,dangerous4 ,use only on physician's order4 ,part ,,ii ,,germ ,,diseases ,,by ,,kenelm ,,winslow ,,chapter ,i ,contagious ,diseases ,scarlet ,fever--,symptoms and ,treatment--,precautions ,necessary--,measles--,communicating the ,disease--,smallpox--,vaccination--,how to ,diagnose ,chickenpox4 ,,eruptive ,,contagious ,,fevers 7including ,scarlet ,fever1 ,measles1 ,german ,measles1 ,smallpox1 and ,chickenpox74--,these1 with the exception of smallpox1 attack children more commonly than adults4 ,as they all begin with fever1 and the characteristic rash does not appear for from one to four days after the beginning of the sickness1 the diagnosis of these diseases must always be at the onset a matter of doubt4 ,for this reason it is wise to keep any child with a fever isolated1 even if the trouble seems to be due to a cold or to digestive disturbance1 to avoid possible communication of the disorder to other children4 ,while colds and indigestion are among the most frequent ailments of children1 they must not be neglected1 for measles begins as a bad cold1 smallpox like the grippe1 and scarlet fever with a sore throat or tonsilitis1 and vomiting4 ,by isolation is meant that the sick child should stay in a room by himself1 and the doors should be kept closed and no children should enter1 nor should any objects in the room be removed to other parts of the house after the beginning of its occupation by the patient4 ,the services of a physician are particularly desirable in all these diseases1 in order that an early diagnosis be made and measures be taken to protect the family1 neighbors1 and community from contagion4 ,the failure of parents or guardians to secure medical aid for children is regarded by the law as criminal neglect1 and is subject to punishment4 ,boards of health require the reporting of all contagious diseases as soon as their presence is known1 and failure to comply with their rules also renders the offender liable to fine or imprisonment in most places4 ,,scarlet ,,fever 7,scarlatina74--,there is no difference between scarlet fever and scarlatina4 ,it is a popular mistake that the latter is a mild type of scarlet fever4 ,fever1 sore throat1 and a bright-red rash are the characteristics of this disease4 ,it occurs most frequently in children between the ages of two and six years4 ,it is practically unknown under one year of age4 ,prof4 ,h4 ,m4 ,biggs1 of the ,new ,york ,department of ,health1 has seen but two undoubted cases in infants under twelve months4 ,it is rare in adults1 and one attack usually protects the patient from another4 ,second attacks have occurred1 but many such are more apparent than real1 since an error in diagnosis is not uncommon4 ,the disease is communicated chiefly by means of the scales of skin which escape during the peeling process1 but may also be acquired at any time from the onset of the attack from the breath1 urine1 and discharges from the body2 or from substances which have come in contact with these emanations4 ,scarlet fever is probably a germ disease1 and the germs may live for weeks in toys1 books1 letters1 clothing1 wall paper1 etc4 ,close contact with the patient1 or with objects which have come in close touch with the patient1 is apparently necessary for contagion4 ,period of ,development4--,after exposure to the germs of scarlet fever1 usually from two to five days elapse before the disease shows itself4 ,occasionally the outbreak of the disease occurs within twenty-four hours of exposure1 and rarely is delayed for a week or ten days4 ,symptoms4--,the onset is usually sudden4 ,it begins with vomiting 7in very young children sometimes convulsions71 sore throat1 fever1 chilliness1 and headache4 ,the tongue is furred4 ,the patient is often stupid2 or may be restless and delirious4 ,within twenty-four hours or so the rash appears--first on the neck1 chest1 or lower part of back--and rapidly spreads over the trunk1 and by the end of forty-eight hours covers the legs and entire body excepting the face1 which may be simply flushed4 ,the rash appears as fine1 scarlet pin points scattered over a background of flushed skin4 ,at its fullest development1 at the end of the second or third day1 the whole body may present the color of a boiled lobster4 ,after this time the rash generally fades away and disappears within five to seven days4 ,it is likely to vary much in intensity while it lasts4 ,as the rash fades1 scaling of the skin begins in large flakes and continues from ten days to as many weeks1 usually terminating by the end of the sixth to eighth week4 ,one of the notable features is the appearance of the tongue1 at first showing red points through a white coating1 and after this has cleared away1 in presenting a raspberry-like aspect4 ,the throat is generally deep red1 and the tonsils may be dotted over with white spots 7see ,tonsilitis7 or covered with a whitish or gray membrane suggesting diphtheria1 which occasionally complicates scarlet fever4 ,the fever usually is high 7#ajc deg4 to #ajg deg4 ,f71 and the pulse ranges from #abj to #aej2 both declining after the rash is fully developed1 generally by the fourth day4 ,the urine is scanty and dark4 ,there is1 however1 great variation in the symptoms as to their presence or absence1 intensity1 and time of occurrence and disappearance4 ,complications and ,sequels4--,these are frequent and make scarlet fever the most dreaded of the eruptive diseases1 except smallpox4 ,enlarged glands under the jaw and at the sides of the neck are common1 and appear as lumps in these sites4 ,usually not serious1 they may enlarge and threaten life4 ,pain and swelling in the joints1 especially of the elbows and knees1 are not rare1 and may be the precursors of serious inflammation of these parts4 ,one of the most frequent and serious complications of scarlet fever is inflammation of the kidneys1 occurring more often toward the end of the second week of the disease4 ,examination of the urine by the attending physician at frequent intervals throughout the course of the disorder is essential1 although puffiness of the eyelids and face1 and of the feet1 ankles1 and hands1 together with lessened secretion of urine--which often becomes of a dark and smoky hue--may denote the onset of this complication4 ,the disease of the kidneys usually results in recovery1 but occasionally in death or in chronic ,bright's disease of these organs4 ,inflammation of the middle ear with abscess1 discharge of matter from the ear externally1 and--as the final outcome--deafness1 is not uncommon4 ,this complication may be prevented to a considerable extent by spraying the nose and throat frequently and by the patient's use of a nightcap with earlaps1 if the room is not sufficiently warm4 ,inflammation of the eyelids is an occasional complication4 ,the heart is sometimes attacked by the toxins of the disease1 and permanent damage to the organ1 in the form of valvular trouble1 may result4 ,blindness and nervous disorders are among the rarer sequels including paralyses and ,st4 ,vitus's dance4 ,determination of ,scarlet ,fever4--,when beginning with vomiting1 headache1 high fever1 and sore throat1 and followed in twenty-four hours with a general scarlet rash1 this is not difficult2 but occasionally other diseases present rashes1 as indigestion1 grippe1 and ,german measles1 which puzzle the most acute physicians4 ,measles may be distinguished from scarlet fever in that measles appears first on the face1 the rash is patchy or blotchy1 and does not show for three to four days after the beginning of the sickness4 ,the patient seems to have a bad cold1 with cough1 running at the nose1 and sore eyes4 ,german measles is mild1 and while the rash may look something like that of scarlet fever1 the patient does not seem generally ill1 is hardly affected at all1 though rarely troubled with slight catarrh of the nose4 ,in no sickness are the services of a physician more necessary than in scarlet fever2 first1 to determine the existence of the disease1 and then to prevent or combat the complications which often approach insidiously4 ,outlook4--,the average death rate of scarlet fever is about ten per cent4 ,it is very fatal in children about a year old1 and most of the deaths occur in those under the age of six4 ,but the mortality varies greatly at different times and in different epidemics4 ,in #aijd-e1 in many parts of the ,united ,states1 the disease was very prevalent and correspondingly mild1 and deaths were rare4 ,duration of ,contagion4--,the disease is commonly considered contagious only so long as peeling of the skin lasts4 ,but it seems probable that any catarrhal secretion from the nose1 throat1 or ear is capable of communicating the germs from a patient to another person for many days after other evidences of the disease are past4 ,scarlet fever patients should always be isolated for as long a period as six weeks--and better eight weeks--without regard to any shorter duration of peeling1 and if peeling continues longer1 so should the isolation4 ,treatment4--,in case a physician is unobtainable the patient must be put to bed in the most airy1 sunshiny room1 which should be heated to #gj deg4 ,f41 and from which all the unnecessary movables should be taken out before the entrance of the patient4 ,a flannel nightgown and light bed clothing are desirable4 ,the fever is best overcome by cold sponging1 which at the same time diminishes the nervous symptoms1 such as restlessness and delirium4 ,the body is sponged--part at a time--with water at the temperature of about #gj deg4 ,f41 after placing a single thickness of old cotton or linen wet with ice or cold water 7better an ice cap7 over the forehead4 ,the part is thoroughly dried as soon as sponged1 and the process is repeated whenever the temperature is over #ajc deg4 ,f4 ,there need be no fear that the patient may catch cold if only a portion of the body is exposed at any one time4 ,if there is any chilliness following sponging1 a bag or bottle containing hot water may be placed at the feet4 ,it is well that a rubber bag containing ice1 or failing this a cold cloth1 be kept continually on the head while fever lasts4 ,the throat should be sprayed hourly with a solution of hydrogen peroxide 7full strength7 and the nose with the same1 diluted with an equal amount of water1 three times a day4 ,the outside of the throat it is wise to surround with an ice bag1 or lacking this1 a cold cloth frequently wet and covered with a piece of oil silk 7or rubber7 and flannel4 ,the diet should consist of milk1 broths1 or thin gruels1 and plenty of water should be allowed4 ,sweet oil or carbolized vaseline should be rubbed over the whole body night and morning during the entire sickness and convalescence4 ,the bowels must be kept regular by injections or mild cathartics1 and1 after the fever subsides1 vegetables1 fruit1 cereals1 and milk may be permitted1 together with meat or eggs once daily4 ,it is imperative for the nurse and also the mother to wear a gown and cap over the outside clothes1 to be slipped off in the hall at the door of the sick room when leaving the latter4 ,,measles4--,measles is a contagious disease1 characterized by a preliminary stage of fever and catarrh of the eyes1 nose1 and throat1 and followed by a general eruption on the skin4 ,one attack practically protects a person from another1 yet1 on the other hand1 second attacks occur with extreme rarity4 ,it is more contagious than scarlet fever1 and isolation of a patient in a house is of less service in preventing communication to other inmates1 whereas in scarlet fever half the number of susceptible children may escape the disease through this precaution4 ,the germs which cause measles perish rapidly1 so that infected clothes or other objects merely require a thorough airing to be rendered safe1 whereas in scarlet fever the danger of transmission of the contagion may lurk in infected clothing and other substances for weeks1 unless they are subjected to proper disinfection4 ,a patient with measles is capable of communicating the disorder from its onset1 before the appearance of the rash1 through the breath1 discharges from the nose and eyes1 tears and saliva and all the secretions4 ,at the end of the third week of the disease the patient is usually incapable of giving the disease to others4 ,close contact with a patient is commonly necessary for one to acquire the disease1 but it is frequently claimed that it is carried by a third person in the clothes1 as by a nurse4 ,it is infrequent in infants under six months1 and most frequent between the second and sixth year4 ,adults are attacked by measles more often than by scarlet fever4 ,development4--,a period of from seven to sixteen days after exposure to measles elapses before the disease becomes apparent4 ,symptoms4--,the disease begins like a severe nasal catarrh with fever4 ,the eyes are red and watery1 the nose runs1 and the throat is irritable1 red1 and sore1 and there is some cough1 with chilliness and muscular soreness4 ,the fever1 higher at night1 varies from #ajb deg4 to #ajd deg4 ,f41 and the pulse ranges from #ajj to #abj4 ,there is often marked drowsiness for a day or two before the rash appears4 ,coated tongue1 loss of appetite1 occasional vomiting1 and thirst are present during this period4 ,the appearance of minute1 whitish spots1 surrounded by a red zone1 may often be seen in the inside of the mouth opposite the back teeth for some days before the eruption occurs4 ,the preliminary period1 when the patient seems to be suffering with a bad cold1 lasts for four days usually1 and on the evening of the fourth day the rash breaks out4 ,it first appears on the face and then spreads to the chest1 trunk1 and limbs4 ,two days are generally required for the complete development of the rash2 it remains thus in full bloom for about two days more1 then begins to subside1 fading completely in another two days--six days in all4 ,the rash appears as bright-red1 slightly raised blotches on the face1 which is generally somewhat swollen4 ,the same rash extends to the abdomen1 back1 and limbs4 ,between the mottled1 red rash may be seen the natural color of the skin4 ,at this time the cough may be hoarse and incessant1 and the eyes extremely sensitive to light4 ,the fever and other symptoms abate when the rash subsides1 and well-marked scaling of the skin occurs4 ,complications and ,sequels4--,severe bronchitis1 pneumonia1 croup1 laryngitis1 sore eyes1 ear abscess and deafness1 violent diarrhea1 convulsions1 and1 as a late result1 consumption sometimes accompany or follow measles4 ,for the consideration of these disorders1 see special articles in other parts of this work4 ,outlook4--,the vast majority of healthy patients over two years old recover from measles completely4 ,younger children1 or those suffering from other diseases1 may die through some of the complications affecting the lungs4 ,the disease is peculiarly fatal in some epidemics occurring among those living in unhygienic surroundings1 and in communities unaccustomed to the ravages of measles4 ,thus1 in an epidemic attacking the ,fiji ,islanders1 over one-quarter of the whole population 7#aej1jjj7 died of measles in #ahge4 ,measles is more severe in adults than in children4 ,diagnosis4--,for one not familiar with the characteristic rash a written description of it will not suffice for the certain recognition of the disease1 but if the long preliminary period of catarrh and fever1 and the appearance of the eruption on the fourth day1 be taken into account--together with the existence of sore eyes and hoarse1 hard cough--the determination of the presence of measles will not be difficult in most cases4 ,treatment4--,the patient should be put to bed in a darkened1 well-ventilated room at a temperature of #fh deg4 to #gj deg4 ,f4 ,while by isolation of the patient we may often fail to prevent the occurrence of measles in other susceptible persons in the same house1 because of the very infectious character of the disease1 and because it is probable that they have already been exposed during the early stages when measles was not suspected1 yet all possible precautions should be adopted promptly4 ,for this reason other children in the house should be kept from school and away from their companions1 and they ought not to be sent away from home to spread the disease elsewhere4 ,the bowels should be kept regular by soapsuds injections or by mild cathartics1 as a ,seidlitz powder4 ,if the fever is over #ajc deg4 ,f4 and is accompanied by much distress and restlessness1 children may be sponged with tepid water1 and adults with water at #hj deg4 ,f41 every two hours or so as directed under scarlet fever4 ,when cough is incessant or the rash does not come out well1 there is nothing better than the hot pack4 ,the patient is stripped and wrapped from feet to neck in a blanket wrung out of hot water containing two teaspoonfuls of mustard stirred into a gallon of water4 ,this is then covered with two dry blankets and the patient allowed to remain in the blankets for two or three hours1 when the application may be repeated4 ,it is well to keep a cold cloth on the head during the process4 ,cough is also relieved by a mixture containing syrup of ipecac1 twenty drops2 paregoric1 one teaspoonful1 for an adult 7or one-third the dose for a child of six71 which should be given in one-quarter glass of water and may be repeated every two hours4 ,if there is hoarseness1 the neck should be rubbed with a mixture of sweet oil1 two parts2 and oil of turpentine1 one part1 and covered with a flannel bandage4 ,the cough mixture will tend to relieve this condition also4 ,a solution of boric acid 7ten grains of boric acid to the ounce of water7 is to be dropped in both eyes every two hours with a medicine dropper4 ,although usually mild1 the eye symptoms may be very severe and require special treatment1 and considerably impaired vision may be the ultimate result4 ,severe diarrhea is combated with bismuth subnitrate1 one-quarter teaspoonful1 every three hours4 ,for adults1 the diet consists of milk1 broths1 gruels1 and raw eggs4 ,young children living on milk mixtures should receive the mixture to which they are accustomed1 diluted one-half with barley water4 ,nourishment must be given every two hours except during sleep4 ,the patient should be ten days in bed1 and should remain three days in his room after getting up 7or three weeks in all1 if there are others who may contract measles in the house71 and after leaving his room should stay in the house a week longer4 ,the principal danger after an attack of measles is of lung trouble--pneumonia or tuberculosis 7consumption7--and the greatest care should be exercised to avoid exposure to the wet or to cold draughts4 ,,german ,,measles 7,roetheln74--,german measles is related neither to measles nor scarlet fever1 but resembles them both to a certain extent--more closely the former in most cases4 ,it is a distinct disease1 and persons who have had both measles and scarlet fever are still susceptible to ,german measles4 ,one attack of ,german measles usually protects the patient from another4 ,adults1 who have not been previously attacked1 are almost as liable to ,german measles as children1 but it is rare that infants acquire the disease4 ,it is a very contagious disorder--but not so much so as true measles--and often occurs in widespread epidemics4 ,the breath and emanations from the skin transmit the contagium from the appearance of the first symptom to the disappearance of the eruption4 ,development4--,the period elapsing after exposure to ,german measles and before the appearance of the symptoms varies greatly--usually about two weeks2 it may vary from five to eighteen days4 ,symptoms4--,the rash may be the first sign of the disease and more frequently is so in children4 ,in others1 for a day or two preceding the eruption1 there may be headache1 soreness1 and redness of the throat1 the appearance of red spots on the upper surface of the back of the mouth1 chilliness1 soreness in the muscles1 loss of appetite1 watering of the eyes4 ,catarrhal symptoms are most generally absent1 an important point in diagnosis4 ,when present1 they are always mild4 ,these preliminary symptoms1 if present1 are much milder and of shorter duration than in measles1 where they last for four days before the rash appears2 and the hard1 persistent cough of measles is absent in ,german measles4 ,also1 while there is sore throat in the latter1 there is not the severe form with swollen tonsils covered with white spots so often seen in scarlet fever4 ,fever is sometimes absent in ,german measles2 usually it ranges about #ajj deg4 ,f41 rarely over #ajb deg4 ,f4 ,thus1 ,german measles differs markedly from both scarlet fever and measles proper4 ,the rash usually appears first on the face1 then on the chest1 and finally covers the whole body1 in the space of a few hours--twenty-four hours at most4 ,the eruption takes the form of rose-red1 round or oval1 slightly raised spots--from the size of a pin head to that of a pea--sometimes running together into uniform redness1 as in scarlet fever4 ,the rash remains fully developed for about two days1 and often changes into a coppery hue as it gradually fades away4 ,there are often lumps--enlarged glands--to be felt under the jaw1 on the sides and back of the neck1 which occur more commonly in ,german than in true measles4 ,the glands at the back of the neck are the most characteristic4 ,they are enlarged in about two-thirds of the cases4 ,determination4--,the diagnosis or determination of the existence of measles must be made1 in the absence of a physician1 on the general symptoms rather than on the rash1 which requires experience for its recognition and is subject to great variations in appearance1 at one time simulating measles1 at another scarlet fever4 ,german measles differs from true measles in the following points3 the preliminary period--before the rash--is mild1 short1 or absent2 fever is mild or absent2 the cold in the nose and eyes and cough are slight or may be absent1 as contrasted with these symptoms in measles1 while the enlarged glands in the neck are more pronounced than in measles4 ,the onset of ,german measles is not so sudden as in scarlet fever and not accompanied with vomiting as in the latter1 while the sore throat and fever are much milder in ,german measles4 ,the peeling1 which is so prominent in scarlet fever with the disappearance of the rash1 is not infrequently present4 ,it may be absent4 ,its presence or absence seems to depend upon the severity of the eruption4 ,the desquamation when present is finer than in either measles or scarlet fever4 ,outlook4--,recovery from ,german measles is the invariable rule1 and without complications or delay4 ,treatment4--,little or no treatment is required4 ,the patient should remain in bed in a darkened room on a liquid diet while fever lasts1 and be isolated from others indoors until all signs of the eruption are passed4 ,the eyes should be treated with boric acid as in measles2 the diet1 during the fever1 consisting of milk1 broths1 thin cereals1 beef juice1 raw eggs or eggnog1 for adults and older children2 while infants should have their milk mixture diluted one-half with barley water4 ,a bath and fresh clothing for the patient1 and thorough cleansing and airing of the sick room and clothing are usually sufficient after the passing of the disease without chemical disinfection4 ,,smallpox4--,smallpox is one of the most contagious diseases known4 ,it is extremely rare for anyone exposed to the disease to escape its onslaught unless previously protected by vaccination or by a former attack of the disease4 ,one is absolutely safe from acquiring smallpox if recently and successfully vaccinated1 and thus has one of the most frightful and fatal scourges to which mankind has ever been subject been robbed of its dangers4 ,the contagium is probably derived entirely from the scales and particles of skin escaping from smallpox patients1 and in the year #aije-f the true germ of the disease was discovered by ,councilman1 of ,boston4 ,it is not necessary to come in direct contact with a patient to contract the disease1 as the contagium may be transmitted some little distance through the air1 possibly even outside of the sick room4 ,one attack almost invariably protects against another4 ,all ages are liable to smallpox2 it is particularly fatal in young children1 and during certain epidemics has proved more so in colored than in white people4 ,development4--,a period of ten or twelve days usually elapses after exposure to smallpox before the appearance of the first symptoms of the disease4 ,this period may vary1 however1 from nine to fifteen days4 ,symptoms4--,there is a preliminary period of from twenty-four to forty-eight hours after the beginning of the disease before an eruption occurs4 ,the onset is ushered in by a set of symptoms simulating those seen in severe grippe1 for which smallpox is often mistaken at this time4 ,the patient is suddenly seized with a chill1 severe pains in the head1 back1 and limbs1 loss of appetite and vomiting1 dizziness on sitting up1 and fever--#ajc deg4 to #aje deg4 ,f4 ,in young children convulsions often take the place of the chill seen in adults4 ,on the second day a rash often appears on the lower part of the belly1 thighs1 and armpits1 which may resemble that characteristic of measles or scarlet fever1 but does not last for over a day or two4 ,it is very evanescent and1 consequently1 rarely seen4 ,diarrhea often occurs1 as well as vomiting1 particularly in children4 ,on the evening of the fourth day the true eruption usually appears2 first on the forehead or face1 and then on the arms1 hands1 and legs1 palms1 and soles4 ,the eruption takes successively four forms3 first1 red1 feeling like hard pimples or like shot2 then1 on the second or third day of the eruption1 these pimples become tipped with little blisters with depressed centers1 and surrounded by a red blush4 ,two or three days later the blisters are filled with matter or pus and present a yellowish appearance and are rounded on top4 ,finally1 on about the tenth day of the eruption1 the pustules dry up and the matter exudes1 forming large1 yellowish or brownish crusts1 which1 after a while1 drop off and leave red marks and1 in severe cases1 pitting4 ,the fever preceding the eruption often disappears upon the appearance of the latter and in mild cases does not reappear1 but in severe forms the temperature remains about #ajj deg4 ,f41 and when the eruption is at its height again mounts to #ajc deg4 to #aje deg4 ,f41 and gradually falls with convalescence4 ,the eruption is most marked on the face1 hands1 and forearms1 and occurs less thickly on the body4 ,it appears also in the mouth and throat and when fully developed on the face gives rise to pain and considerable swelling and distortion of the features1 so that the eyes are closed and the patient becomes frightfully disfigured and well-nigh unrecognizable4 ,delirium is common at this time1 and patients need constant watching to prevent their escape from bed4 ,in the severe forms the separate eruptive points run together so that the face and hands present one distorted mass of soreness1 swelling1 and crusting4 ,in these1 pitting invariably follows1 while in those cases where the eruption remains distinct1 pitting is not certain to occur4 ,a still worse form is that styled black smallpox1 in which the skin becomes of a dark-purplish hue1 from the fact that each pustule is a small blood blister1 and bleeding occurs from the nose1 mouth1 etc4 ,these cases are almost1 without exception1 fatal in five to six days4 ,the patient may say that the eruption was the first symptom he observed4 ,this was particularly noticed in negroes1 many of whom had never been vaccinated4 ,the eruption may exhibit but a dozen or so points1 especially about the forehead1 wrists1 palms1 and soles4 ,after the first four days the fever and all the disagreeable symptoms may subside1 and the patient may feel absolutely well4 ,the eruption1 however1 passes through the stages mentioned1 although but half the time may be occupied by the changes2 five or six days instead of ten to twelve for crusts to form4 ,in such cases the death rate has been exceedingly low1 although it is perfectly possible for a person to contract the most severe smallpox from one of these mild 7and often unrecognized7 cases1 as has unfortunately happened4 ,smallpox occurring after successful vaccination resembles1 in its characteristics1 the cases just described1 and unless vaccination had been done many years previously1 the results are almost always favorable as regards life and absence of pitting4 ,detection4--,smallpox is often mistaken for chickenpox1 or some of the skin diseases1 in its mild forms4 ,the reader is referred to the article on chickenpox for a consideration of this matter4 ,the mild type should be treated just as rigidly as severe cases with regard to isolation and quarantine1 being more dangerous to the community because lightly judged and not stimulating to the adoption of necessary precautions4 ,the preliminary fever and other symptoms peculiar to smallpox will generally serve to determine the true nature of the disease1 since these do not occur in simple eruptions on the skin4 ,the general symptoms and course of smallpox must guide the layman rather than the appearance of the eruption1 which requires educated skill and experience to recognize4 ,chickenpox in an adult is less common than in children4 ,smallpox is very rare in one who has suffered from a previous attack of the disease or in one who has been successfully vaccinated within a few years4 ,outlook4--,the death rate of smallpox in those who have been previously vaccinated at a comparatively recent date1 or in varioloid1 as it is called when thus modified by vaccination1 is only #a4b per cent4 ,there are1 however1 severe cases following vaccinations done many years previous to the attack of smallpox4 ,while these cannot be called varioloid1 yet the death rate is much lower than in smallpox occurring in the unvaccinated4 ,thus1 before the mild epidemic of #ahid the death rate in the vaccinated was sixteen per cent2 since #ahid it has been only seven per cent2 while in the unvaccinated before #ahid it was fifty-eight per cent2 and since that date it has been but seventeen per cent1 as reported by ,welch from the statistics of #e1jjj cases in the ,philadelphia ,municipal ,hospital4 ,complications4--,while a variety of disorders may follow in the course of smallpox1 complications are not very frequent in even severe cases4 ,inflammation of the eyelids is very common1 however1 and also boils in the later stages4 ,delirium and convulsions in children are also frequent1 as well as diarrhea2 but these may almost be regarded as natural accompaniments of the disease4 ,among the less common complications are3 laryngitis1 pneumonia1 diseases of the heart1 insanity1 paralysis1 various skin eruptions1 inflammation of the joints and of the eyes and ears1 and baldness4 ,treatment4--,prevention is of greatest importance4 ,vaccination stands alone as the most effective preventive measure in smallpox1 and as such has no rival in the whole domain of medicine4 ,the modern method includes the inoculation of a human being with matter taken from one of the eruptive points on the body of a calf suffering with cowpox4 ,whether cowpox is a modified form of smallpox or a distinct disease is unknown4 ,the period of protection afforded by a successful vaccination is uncertain1 because it varies with different individuals4 ,in a general way immunity for about four or five years is thus secured2 ten or twelve years after vaccination the protection is certainly lost and smallpox may be then acquired4 ,every individual should be vaccinated between the second and third month after birth1 and between the ages of ten and twelve1 and at other times whenever an epidemic threatens4 ,an unvaccinated person should be vaccinated and revaccinated1 until the result is successful1 as immunity to vaccination in an unvaccinated person is practically unknown4 ,when unsuccessful1 the vaccine matter or the technique is faulty4 ,a person continuously exposed to smallpox should be vaccinated every few weeks--if unsuccessful1 no harm or suffering follow2 if successful1 it proves liability to smallpox4 ,a person previously vaccinated successfully may take again at any time after four or five years1 and1 in event of possible exposure to smallpox1 should be revaccinated several times within a few weeks--if the vaccination does not take--before the attempt is given up4 ,an unvaccinated person1 who has been exposed to smallpox1 can often escape the disease if successfully vaccinated within three days from the date of the exposure1 but is not sure to do so4 ,diseases are not introduced with vaccination now that the vaccine matter is taken from calves and not from the human being1 as formerly4 ,most of the trouble and inflammation of the vaccinated part following vaccination may be avoided by cleanliness and proper care in vaccinating4 ,in the absence of a physician1 vaccination may be properly done by any intelligent person when the circumstances demand it4 ,vaccination is usually performed upon the outside of the arm1 a few inches below the shoulder1 in the depression situated in that region4 ,if done on the leg1 the vaccination is apt to be much more troublesome and may confine the patient to bed4 ,the arm should be thoroughly washed in soap and warm water1 from shoulder to elbow1 and then in alcohol diluted one-third with water4 ,when this has evaporated 7without rubbing71 the dry arm is scratched lightly with a cold needle which has previously been held in a flame and its point heated red hot4 ,the point must thereafter not be touched with anything until the skin is scratched with it4 ,the object is not to draw blood1 but to remove the outer layer of skin1 over an area about one-fourth of an inch square1 so that it appears red and moist but not bleeding4 ,this is accomplished by very light scratching in various directions4 ,another spot1 about an inch or two below1 may be similarly treated4 ,then vaccine matter1 if liquid1 is squirted on the raw spots1 or1 if dried on points1 the ivory point is dipped in water which has been boiled and cooled1 and rubbed thoroughly over the raw places4 ,the arm must remain bare and the vaccination mark untouched until the surface of the raw spot is perfectly dry1 which may take half an hour4 ,a piece of sterilized surgical gauze1 reaching halfway about the arm and kept in place with strips of adhesive plaster 7or an absolutely clean handkerchief bound about the arm1 and held by sewing or safety pins71 ought to cover the vaccination for three days4 ,after this time the sore must only come in contact with soft and clean old cotton or linen1 which may be daily pinned in the sleeve of the under garment4 ,if the scab is knocked off and an open sore results it should be treated like any wound4 ,if the vaccination takes1 it passes through several stages4 ,on the third day following vaccination a red pimple forms at the point of introduction of the matter1 which is surrounded by a circle of redness4 ,some little fever may occur4 ,on the fifth day a blister or pimple containing clear fluid with a depressed center is seen1 and a certain amount of hard swelling1 itchiness1 and pain is present about the vaccination4 ,a sore lump 7gland7 is often felt under the arm4 ,the full development is reached by the eighth day1 when the pimple is full and rounded and contains matter1 and is surrounded by a large area of redness4 ,from the eleventh day the vaccination sore dries1 and a brown scab forms over it about the end of the fourteenth day1 and the redness and swelling gradually depart4 ,at the end of about three weeks the scab drops off1 leaving a pitted scar or mark4 ,not infrequently the vaccination results in a very slight pimple and redness1 which passes through the various stages described1 in a week or ten days1 in which case the vaccination should be repeated4 ,unless the vaccination follows very closely the course described1 it cannot be regarded as successful1 although after the first one or two vaccinations the result is often not so severe1 and the time of completion of the various stages somewhat shortened4 ,rarely an eruption1 resembling that at the vaccination site1 appears on the vaccinated limb and even becomes general upon the body1 due to urticaria or to inoculation1 through scratching4 ,the special treatment of an attack of smallpox is largely a matter of careful nursing4 ,a physician or nurse can scarcely lay claim to any great degree of heroism in caring for smallpox patients1 as there is no danger of contracting the disease providing a successful vaccination has been recently performed upon them4 ,the patient should be quarantined in an isolated building1 and all unnecessary articles should be removed from the sick room1 in the way of carpets and other furnishings4 ,it is well that the room be darkened to save irritation of the eyes4 ,the diet should be liquid3 milk1 broths1 and gruels4 ,laudanum1 fifteen drops1 or paregoric1 one tablespoonful in water1 may be given to adults1 once in three hours1 to relieve pain during the first few days4 ,sponging throughout the course of the disease is essential2 first1 with cool water1 as directed for scarlet fever1 with the use of cold on the head to relieve the itching1 fever1 and delirium4 ,the cold pack is still more efficient4 ,to give this1 the patient is wrapped in a sheet wrung out in water at a temperature between #fh deg4 and #ge deg4 ,f4 ,the sheet surrounds the naked body from feet to neck1 and is tucked between the legs and between the body and arms2 the whole is then covered with a dry blanket1 and a cold1 wet cloth or ice cap is placed upon the head4 ,the patient may be permitted to remain in the pack for an hour1 when it may be renewed1 if necessary1 to allay fever and restlessness2 otherwise it may be discontinued4 ,the cold sponging or cold pack are indicated when the temperature is over #ajb4e deg4 ,f41 and when with fever there are restlessness and delirium4 ,great cleanliness is important throughout the disease2 the bedclothes should be changed daily and the patient sponged two or three times daily with warm water1 unless fever is high4 ,cloths wet with cold carbolic-acid solution 7one-half teaspoonful to the pint of hot water7 should be kept continuously on the face and hands4 ,holes are cut in the face mask for the eyes1 nose1 and mouth1 and the whole covered with a similar piece of oil silk to keep in the moisture4 ,such applications give much relief1 and to some extent prevent pitting4 ,the hair must be cut short1 and crusts on the scalp treated with frequent sponging and applications of carbolized vaseline1 to soften them and hasten their falling4 ,the boric-acid solution should be dropped into the eyes as recommended for measles1 and the throat sprayed every few hours with ,dobell's solution4 ,diarrhea in adults may be checked with teaspoonful doses of paregoric given hourly in water4 ,vaseline and cloths used on a patient must not be employed on another1 as boils are thus readily propagated4 ,all clothing1 dishes1 etc41 coming in contact with a patient must be boiled1 or soaked in a two-per cent carbolic-acid solution for twenty-four hours1 or burned4 ,when the patient is entirely free from scabs1 after bathing and putting on disinfected or new clothes outside of the sick room1 he is fit to reenter the world4 ,,chickenpox4--,chickenpox is a contagious disease1 chiefly attacking children4 ,while it resembles smallpox in some respects1 at times simulating the latter so closely as to puzzle physicians1 it is a distinct disease and is in no way related to smallpox4 ,this is shown by the fact that chickenpox sometimes attacks a patient suffering with1 or recovering from1 smallpox4 ,neither do vaccination nor a previous attack of smallpox protect an individual from chickenpox4 ,chickenpox is not common in adults1 and its apparent presence in a grown person should awaken the liveliest suspicion lest the case be one of smallpox1 since this mistake has been frequently made1 and with disastrous results1 during an epidemic of mild smallpox4 ,one attack of chickenpox usually protects against another1 but two or three attacks in the same individual are not unknown4 ,the disease may be transmitted from the patient to another person from the time of the first symptom until the disappearance of the eruption4 ,the disease ordinarily occurs in epidemics1 but occasionally in isolated cases4 ,development4--,a period of two weeks commonly elapses after exposure to the disease before the appearance of the first symptom of chickenpox1 but this period may vary from thirteen to twenty-one days4 ,symptoms4--,the characteristic eruption is often the first warning of chickenpox1 but in some cases there may be a preliminary period of discomfort1 lasting for a few hours1 before the appearance of the rash2 particularly in adults1 in whom the premonitory symptoms may be quite severe4 ,thus1 there may be chilliness1 nausea1 and even vomiting1 rarely convulsions in infants1 pain in the head and limbs1 and slight fever 7#ii deg4 to #ajb deg4 ,f47 at this time4 ,the eruption shows first on the body1 in most cases1 especially the back4 ,it consists of small red pimples1 which rapidly develop into pearly looking blisters about as large as a pea to that of the finger nail1 and are sometimes surrounded by a red blush on the skin4 ,these blisters vary in number1 from a dozen or so to two hundred4 ,they do not run together1 and in three to four days dry up1 become shriveled and puckered1 and covered with a dark-brown or blackish crust1 and drop off1 leaving only temporary red spots in most cases4 ,the fever usually continues during the eruption4 ,during the first few days successive fresh crops of fresh pimples and blisters appear1 so that while the first crop is drying the next may be in full development4 ,this forms one of its distinguishing features when chickenpox is compared with smallpox4 ,in chickenpox the eruption is seen on the unexposed skin chiefly1 but may occur on the scalp and forehead1 and even on the palms1 soles1 forearms1 and face4 ,in many cases the eruption is found in the mouth1 on its roof1 and the inside of the cheeks4 ,the blisters rarely contain matter or pus1 as in smallpox1 unless they are scratched4 ,scratching may lead to the formation of ugly scars and should be prevented1 especially when the eruption is on the face4 ,pitting rarely occurs4 ,determination4--,the discrimination between chickenpox and smallpox is sometimes extremely puzzling and demands the skill of an experienced physician4 ,when one is unavailable1 the following points may serve to distinguish the two disorders3 smallpox usually begins like a severe attack of grippe1 with pain in the back and head1 general pains and nausea or vomiting1 with high fever 7#ajc deg4 to #ajd deg4 ,f47 ,these last two or three days1 and may completely subside when the rash appears4 ,in chickenpox preliminary discomfort is absent1 or lasts but a few hours before the eruption4 ,the eruption of smallpox usually occurs first on the forehead1 near the hair1 or on the palms of the hands1 soles of the feet1 the arms and legs1 but is usually sparse on the body4 ,the eruption appears about the same time in smallpox and not in successive crops1 as in chickenpox4 ,chickenpox is more commonly a disease of childhood2 smallpox attacks all ages4 ,the crusts in chickenpox are thin1 and appear in four or five days1 while those of smallpox are large and yellow1 and occur after ten or twelve days4 ,outlook4--,chickenpox almost invariably results in a rapid and speedy recovery without complications or sequels4 ,the young patients often feel well throughout the attack1 which lasts from eight to twelve days4 ,treatment4--,children should be kept in bed during the eruptive stage until the blisters have dried4 ,to prevent scratching1 the calamine lotion may be used 7,vol4 ,,ii1 p4 #ade71 or carbolized vaseline1 or bathing with a solution of baking soda1 one teaspoonful to the pint of tepid water4 ,the diet should be that recommended for ,german measles4 ,patients should be kept in the house and isolated until all signs of the eruption are passed1 and then receive a good bath and fresh clothing before mingling with others4 ,the sick room should be thoroughly cleaned and aired2 thorough chemical disinfection is not essential4 ,the services of a physician are always desirable in order that it may be positively determined that the disease is not a mild form of smallpox4 ,,chapter ,,ii ,infectious ,diseases ,typhoid ,fever--,how it is ,contracted--,complications and ,sequels--,rest1 ,diet1 and ,bathing the ,requisites--,mumps--,whooping ,cough--,erysipelas4 ,,typhoid ,,fever 7,,enteric ,,fever74--,through ignorance which prevailed before the discovery of the germ of typhoid fever and exact methods for determining the presence of the same1 the term was loosely applied and is to this day4 ,thus mild forms of typhoid are called gastric fever1 slow fever1 malarial fever1 nervous fever1 etc41 all true typhoid in most cases2 while typhoid fever1 common to certain localities and differing in some respects from the typical form1 is often named after the locality in which it occurs1 as the mountain fever common to the elevated regions of the western ,united ,states4 ,this want of information is apt to prevail in regions remote from medical centers1 and leads to neglect of the necessary strict measures for the protection of neighboring communities1 for the excretion of one typhoid patient has led to thousands of cases and hundreds of deaths4 ,typhoid fever is a communicable disease caused by a germ which attacks the intestines chiefly1 but also invades the blood1 and at times all the other parts of the body1 and is characterized by continued fever1 an eruption1 tenderness and distention of the bowels1 and generally diarrhea4 ,it is common to all parts of the earth in the temperate zones1 and occurs more frequently from ,july to ,december in the north temperate zone1 from ,february to ,july in the south temperate zone4 ,it is most prevalent in the late summer and autumn months and after a hot1 dry summer4 ,individuals between the ages of fifteen and thirty are more prone to typhoid fever1 but no age is exempt4 ,the sexes are almost equally liable to the disease1 although it is said that for every four female cases there are five male cases4 ,the robust succumb as readily as the weak4 ,cause and ,modes of ,communication4--,while the typhoid germ is always the immediate cause1 yet it is brought in contact with the body in various ways4 ,contamination of water supply through bad drainage is the principal source of epidemics of typhoid4 ,before carefully protected public water supplies were in vogue in ,massachusetts1 there were ninety-two deaths from typhoid fever in #ajj1jjj inhabitants1 while thirty-five years after town water supplies became the rule1 there were only nineteen deaths for the same population4 ,whenever typhoid is prevalent1 the water used for drinking and all other household purposes should be boiled1 and uncooked food should be avoided4 ,flies are carriers of typhoid germs by lighting on the nose1 the mouth1 and the discharges of typhoid patients1 and then conveying the germs to food1 green vegetables1 and milk4 ,cooking the food1 preventing contact of flies with the patients1 and keeping flies out of human habitations becomes imperative4 ,milk is a source of contagion through contaminated water used to wash cans1 or to adulterate it1 or through handling of it by patients or those who have come in contact with patients4 ,oysters growing in the mouths of rivers and near the outlets of drains and sewers are carriers of typhoid germs1 and1 if eaten raw1 sometimes communicate typhoid fever4 ,dust is an occasional medium of communication of the germ4 ,it is probable1 however1 that the germ always enters the body by being swallowed with food or drink1 and does not enter through the lungs4 ,there is little doubt on this point4 ,ice may harbor the germ for many months1 for freezing does not kill it1 and epidemics have been traced to this source4 ,clothing1 wood1 utensils1 door handles1 etc41 which have been contaminated by contact with discharges from patients1 may also prove mediums of communication of the typhoid germ to healthy individuals4 ,typhoid germs escape from patients sick with the disease chiefly in the bowel discharges and urine1 sometimes in the sweat1 saliva1 and vomited matter4 ,sewer gas and emanations from sewage and filth will not communicate typhoid fever directly1 but the latter afford nutriment for the growth of the germ1 and after becoming infected1 may eventually come in contact with drinking water or food1 and so prove dangerous4 ,improper care of discharges of excrement and urine--with the assistance of flies--are responsible for the enormous typhoid epidemics in military camps1 so that in the late ,spanish-,american ,war one-fifth of all our soldiers in camp contracted the disease4 ,in the upper layers of the soil typhoid germs may live for six months through frosts and thaws4 ,the disease is preventable1 and will probably be stamped out in time4 ,in some of the most thickly populated cities in the world1 as in ,vienna1 its occurrence is most infrequent1 owing to intelligent sanitary control and pure water supply1 while in the most salubrious country districts its inroads are the most serious and fatal through ignorance and carelessness4 ,development4--,from eight to twenty-three days elapse from the time of entrance of typhoid germs into the body before the patient is taken sick4 ,one attack usually protects one against another1 but two or three attacks are not unheard of in the same person4 ,symptoms4--,typhoid fever is subject to infinite variations1 and it will here be possible only to outline what may be called a typical case4 ,in a work of this kind the preliminary symptoms are of most importance in warning one of the probability of an attack1 so that the prospective patient can govern himself accordingly1 as in no other disease is rest in bed of more value4 ,patients who persist in walking about with typhoid fever for the first week or so are most likely to die of the disease4 ,the average duration of the disease is about one month4 ,during the first week the onset is gradual1 the temperature mounting a little higher each day--as #ii4e deg4 ,f4 the first evening1 #aja deg4 the second1 #ajb deg4 the fourth1 #ajd deg4 the fifth1 #aje deg4 the sixth1 and #aje4e deg4 the seventh4 ,in the morning of each day the temperature is usually about a degree or more lower than that of the previous night4 ,from the end of the first week to the beginning of the third the temperature remains at its highest point1 being about the same each evening and falling one or two degrees in the morning4 ,during the third week the temperature gradually falls1 the highest point each evening being a degree or so lower than the previous day1 while in the fourth week the temperature may be below normal in the morning and a degree or so above normal at night4 ,so much for this symptom4 ,after the entrance of typhoid germs into the bowels and before the recognized onset of the disease1 there may be lassitude and disinclination for exertion4 ,the disease begins with headache1 backache1 loss of appetite1 sometimes a chill in adults or a convulsion in children1 soreness in the muscles1 pains in the belly1 nosebleed1 occasional vomiting1 diarrhea1 coated tongue1 often some cough1 flushed face1 pulse #ajj1 gradually increasing as described4 ,these symptoms are1 to a considerable extent1 characteristic of the beginning of many acute diseases1 but the gradual onset with constant fever1 nosebleed1 and looseness of the bowels are the most suggestive features4 ,then1 if at the end of the first week or ten days pink-red spots1 about as large as a pin head1 appear on the chest and belly to the number of two or three to a dozen1 of very numerously1 and disappear on pressure 7only to return immediately71 the existence of typhoid fever is pretty certain4 ,headache is now intense4 ,these rose spots--as they are called--often appear in crops during the second and third weeks1 lasting for a few days1 then departing4 ,during the second week there is often delirium and wandering at night2 the headache goes1 but the patient is stupid and has a dusky1 flushed face4 ,the tongue becomes brownish in color1 and its coat is cracked1 and the teeth are covered with a brownish matter4 ,the skin is generally red and the belly distended and tender4 ,diarrhea is often present with three to ten discharges daily of a light-yellow1 pea-soup nature1 with a very offensive odor4 ,constipation throughout the disease is1 however1 not uncommon in the more serious cases4 ,the pulse ranges from #hj to #abj a minute4 ,during the third week1 in cases of moderate severity1 the general condition begins to improve with lowering of the temperature1 clearing of the tongue1 and less frequent bowel movements4 ,but in severe cases the patient becomes weaker1 with rapid1 feeble pulse1 ranging from #abj to #adj2 stupor and muttering delirium2 twitching of the wrists and picking at the bedclothes1 with general trembling of the muscles in moving2 slow1 hesitating speech1 and emaciation2 while the urine and faeces may be passed unconsciously in bed4 ,occasionally the patient with delirium may require watching to prevent him from getting out of bed and injuring himself4 ,he may appear insane4 ,during the fourth week1 in favorable cases1 the temperature falls to normal in the morning1 the pulse is reduced to #hj or #ajj1 the diarrhea ceases1 and natural sleep returns4 ,among the many and frequent variations from the type described1 there may be a fever prolonged for five or six weeks1 with a good recovery4 ,chills are not uncommon during the disease1 sometimes owing to complications4 ,relapse1 or a return of the fever and other symptoms all over again1 occurs in about ten per cent of the cases4 ,this may happen more than once1 and as many as five relapses have been recorded in one patient4 ,a slight return of the fever for a day or two is often seen1 owing to error in diet1 excitement1 or other imprudence after apparent recovery4 ,death may occur at any time from the first week1 owing to complications or the action of the poison of the disease4 ,pneumonia1 perforation of and bleeding from the bowels are the most frequent dangerous complications4 ,unfavorable symptoms are continued high fever 7#aje deg4 to #ajf deg4 ,f471 marked delirium1 and trembling of the muscles in early stages1 and bleeding from the bowels2 also intense and sudden pain with vomiting1 indicating perforation of the intestines4 ,the result is more apt to prove unfavorable in very fat patients1 and especially so in persons who have walked about until the fever has become pronounced4 ,bleeding from the bowels occurs in four to six per cent of all cases and is responsible for fifteen per cent of the deaths2 perforation of the bowels happens in one to two per cent of all cases and occasions ten per cent of the deaths4 ,detection4--,it is impossible for the layman to determine the existence of typhoid fever in any given patient absolutely1 but when the symptoms follow the general course indicated above1 a probability becomes established4 ,unusual types are among the most difficult and puzzling cases which a physician has to diagnose1 and he can rarely be absolutely sure of the nature of any case before the end of the first week or ten days1 when examination of the blood offers an exact method of determining the presence of typhoid fever4 ,typhoid fever--especially where there are chills--is often thought to be malaria1 when occurring in malarial regions1 and may be improperly called typhoid malaria4 ,there is no such disease4 ,rarely typhoid fever and malaria coexist in the same person1 and while this was not uncommon in the soldiers returning from ,cuba and ,porto ,rico1 it is an extremely unusual occurrence in the ,united ,states4 ,examination of the blood will determine the presence or absence of both of these diseases4 ,complications and ,sequels4--,these are very numerous4 ,among the former are diarrhea1 delirium1 mental and nervous diseases1 bronchitis1 pleurisy1 pneumonia1 ear abscess1 perforation of and hemorrhage from the bowels1 inflammation of the gall bladder1 disease of heart1 kidney1 and bladder1 and many rarer conditions1 depending upon the organ which the germ invades4 ,among sequels are boils1 baldness1 bone disease1 painful spine1 and1 less commonly1 insanity and consumption4 ,while convalescence requires weeks and months1 the patient often gains greatly in flesh and feels made over anew1 as in fact he has been to a great extent1 through the destruction and repair of his organs4 ,outlook4--,the death rate varies greatly in different epidemics and under different conditions4 ,during the ,spanish-,american ,war in the enormous number of cases--over #bj1jjj--the death rate was only about seven per cent1 which represents that in the best hospitals of this country and in private practice4 ,osler states that the mortality ranges from five to twelve per cent in private practice1 and from seven to twenty per cent in hospital practice1 because hospital cases are usually advanced before admission4 ,the chances of recovery are much greater in patients under fifteen years1 and are also more favorable between the twenty-second and fortieth years4 ,treatment4--,there is perhaps no disease in which the services of a physician are more desirable or useful than in typhoid fever1 on account of its prolonged course and the number of complications and incidents which may occur during its existence4 ,it is the duty of the physician to report cases of typhoid to the health authorities1 and thus act as a guardian of the public health4 ,if1 however1 in any circumstances one should have the misfortune to have the care of a typhoid patient remote from medical aid1 it is a consolation to know that the outlook is not greatly altered by medicine or special treatment of any sort4 ,there have been epidemics in remote parts of this country where numbers of persons have suffered with typhoid without any professional care1 and yet with surprisingly good results4 ,thus1 in an epidemic occurring in a small community in ,canada1 twenty-four persons sickened with typhoid and received no medical care or treatment whatever1 and yet there was but one death4 ,the essentials of treatment are comprised in ,rest1 ,diet1 and ,bathing4 ,rest to the extent of absolute quiet in the horizontal position1 at the first suspicion of typhoid1 is requisite in order to avoid the dangers of bleeding and perforation of the bowels resulting from ulceration of structures weakened by the disease4 ,the patient should be assisted to turn in bed1 must make no effort to rise during the sickness1 and should pass urine and bowel discharges into a bedpan or urinal under cover4 ,in case of bleeding from the bowels1 the bedpan should not be used1 but the discharges may be received for a time in cloths1 without stirring the patient4 ,diet4--,this should consist chiefly of liquids until a week after the fever's complete disappearance4 ,a cup of liquid should be given every two hours except during a portion of the sleeping hours4 ,milk1 diluted with an equal amount of water1 forms the chief food in most cases unless it disagrees1 is refused1 or is unobtainable4 ,in addition to milk1 albumen water--white of raw egg1 strained and diluted with an equal amount of water1 and flavored with a few drops of lemon juice or with brandy--is valuable2 also juice squeezed from raw beef--in doses of four tablespoonfuls--coffee1 cocoa1 and strained barley1 rice1 or oatmeal gruel1 broths1 unless diarrhea is marked and increased by the same4 ,soft custard1 jellies1 ice cream1 milk-and-flour porridge1 and eggnog may be used to increase the variety4 ,finely scraped raw or rare beef1 very soft toast1 and soft-boiled or poached eggs are allowable after the first week of normal temperature1 at the end of the third or fourth week of the disease1 and during the course of the disease under circumstances where the fluids are not obtainable or not well borne4 ,an abundance of water should be supplied to the patient throughout the disease4 ,bathing4--,the importance of cold1 through the medium of water1 in typhoid fever accomplishes much1 both in reducing the temperature and in stimulating the nervous system and relieving restlessness and delirium4 ,bathing is usually applied when the temperature rises above #ajb4e deg4 ,f41 and may be repeated every two or three hours if restlessness1 delirium1 and high temperature require it4 ,the immersion of patients in tubs of cold water1 as practiced with benefit in hospitals1 is out of the question for use by inexperienced laymen4 ,the patient should have a woven-wire spring bed and soft hair mattress1 over which is laid a folded blanket covered by a rubber sheet4 ,sponging the naked body with ice water will suffice in some cases2 in others1 when the temperature is over #ajb-a_/b deg4 ,f41 enveloping the whole body in a sheet wet in water at #fe deg41 and either rubbing the surface with ice or cloths wet in ice-cold water1 for ten or fifteen minutes1 is advisable4 ,rubbing of the skin of the chest and sides is necessary during the application of cold to prevent shock4 ,the use of a cold cloth on the head and hot-water bottle at the feet1 during the sponging1 will also prove beneficial4 ,in children and others objecting to these cold applications1 the vapor bath is effective4 ,for this a piece of cheese cloth 7single thickness7 is wet with warm water--#ajj deg4 to #aje deg4--and is wrapped about the naked body from shoulders to feet1 and is continually wet by sprinkling with water at the temperature of #ih deg44 ,the evaporation of the water will usually1 in fifteen to twenty minutes1 cool the body sufficiently if the patient is fanned continuously by two attendants4 ,in warm weather the patient should only be covered with a sheet for a while after the bath1 which should reduce the temperature to #c deg44 ,hot water at the feet1 and a little brandy or whisky given before the sponging if the pulse be feeble1 will generally prevent a chill4 ,patients should be gently dried after the bath and covered with dry bedclothing4 ,the utmost care should be taken not to agitate a feeble patient during sponging4 ,the long period of lying in bed favors the occurrence of bedsores4 ,these are apt to appear about the lower part of the spine1 and begin with redness of the skin1 underneath which a lump may be felt4 ,constant cleanliness and bathing with alcohol1 diluted with an equal amount of water1 will tend to prevent this trouble1 while moving the patient so as to take the pressure off this region and avoiding any rumpling of the bedding under his body are also serviceable1 as well as the ring air cushion4 ,medicine is not required1 except for special symptoms1 and has no influence either in lessening the severity of or in shortening the disease4 ,brandy or whisky diluted with water are valuable in severe cases1 with muttering delirium1 dry tongue1 and feeble pulse2 it is not usually called for before the end of the second week1 and not in mild cases at any time4 ,a tablespoonful of either1 once in two to four hours1 is commonly sufficient4 ,pain and distention of the belly are relieved by applying a pad over the whole front of the belly--consisting of two layers of flannel wrung out of a little very hot water containing a teaspoonful of turpentine--and covered by a dry flannel bandage wrapped about the body4 ,also the use of white of egg and water1 and beef juice1 instead of milk1 will benefit this condition4 ,diarrhea--if there are more than four discharges daily--may be checked by one-quarter level teaspoonful doses of bismuth subnitrate1 or teaspoonful doses of paregoric1 once in three hours4 ,constipation is relieved by injections of warm soapsuds1 once in two days4 ,bleeding from the bowels must be treated by securing perfect quiet on the patient's part1 and by giving lumps of ice by the mouth1 and cutting down the nourishment for six hours4 ,fifteen drops of laudanum should be given to adults1 if there is restlessness1 and some whisky1 if the pulse becomes feeble1 but it is better to reserve this until the bleeding has stopped4 ,patients may be permitted to sit up after a week of normal temperature1 but solid food must not be resumed until two or three weeks after departure of fever1 and then very gradually1 avoiding all coarse and uncooked vegetables and fruit4 ,the greatest care must be exercised by attendants to escape contracting the disease and to prevent its communication to others4 ,the bowel discharges must be submerged in milk of lime 7one part of slaked lime to four parts of water71 and remain in it one hour before being emptied4 ,the urine should be mixed with an equal amount of the same1 or solution of carbolic acid 7one part in twenty parts of hot water71 and the mixture should stand an hour before being thrown into privy or sewer4 ,clothing and linen in contact with the patient must be soaked in the carbolic solution for two hours4 ,the patient's expectoration is to be received on old muslin pieces1 which must be burned4 ,the bedpan and eating utensils must be frequently scalded in boiling water4 ,the attendant should wash his hands always after touching the patient1 or objects which have come in contact with patient or his discharges1 and thus will avoid contagion4 ,if farm or dairy workers come in contact with the patient1 the latter precaution is especially important4 ,if there is no water-closet in the house1 the disinfected discharges may be buried at least #ajj feet from any well or stream4 ,typhoid fever is only derived from the germs escaping in the urine1 and in the bowel1 nose1 or mouth discharges of typhoid patients4 ,,mumps4--,mumps is a contagious disease characterized by inflammation of the parotid glands1 situated below and in front of the ears1 and sometimes of the other salivary glands below the jaw1 and rarely of the testicles in males and the breasts in females4 ,swelling and inflammation of the parotid gland also occur from injury2 and as a complication of other diseases1 as scarlet fever1 typhoid fever1 etc42 but such conditions are wholly distinct from the disease under discussion4 ,mumps is more or less constantly prevalent in most large cities1 more often in the spring and fall1 and is often epidemic1 attacking ninety per cent of young persons who have not previously had the disease4 ,it is more common in males1 affecting children and youths1 but rarely infants or those past middle age4 ,one attack usually protects against another4 ,development4--,a period of from one to three weeks elapses1 after exposure to the disease1 before the first signs develop4 ,the germ has not yet been discovered1 and the means of communication are unknown4 ,the breath has been thought to spread the germs of the disease1 and mumps can be conveyed from the sick to the well1 by nurses and others who themselves escape4 ,symptoms4--,sometimes there is some preliminary discomfort before the apparent onset4 ,thus1 in children1 restlessness1 peevishness1 languor1 nausea1 loss of appetite1 chilliness1 fever1 and convulsions may usher in an attack4 ,mumps begins with pain and swelling below the ear on one side4 ,within forty-eight hours a large1 firm1 sensitive lump forms under the ear and extends forward on the face1 and downward and backward in the neck4 ,the swelling is not generally very painful1 but gives a feeling of tightness and disfigures the patient4 ,it makes speaking and swallowing difficult2 the patient refuses food1 and talks in a husky voice2 chewing causes severe pain4 ,after a period of two to four days the other gland usually becomes similarly inflamed1 but occasionally only one gland is attacked4 ,there is always fever from the beginning4 ,at first the temperature is about #aja deg4 ,f41 rarely much higher than #ajc deg4 or #ajd deg44 ,the fever continues four or five days and then gradually declines4 ,the swelling reaches its height in from two to five days1 and then after forty-eight hours slowly subsides1 and disappears entirely within ten to fourteen days4 ,the patient may communicate the disease for ten days after the fever is past1 and needs to be isolated for that period4 ,earache and noises in the ear frequently accompany mumps1 and rarely abscess of the ear and deafness result4 ,the most common complication occurs in males past puberty1 when1 during recovery or a week or ten days later1 one or both testicles become painful and swollen1 and this continues for as long a time as the original mumps4 ,less often the breasts and sexual organs of females are similarly affected4 ,complications and ,sequels4--,recovery without mishap is the usual result in mumps1 with the exception of involvement of the testicles4 ,rarely there are high fever1 delirium1 and great prostration4 ,sometimes after inflammation of both testicles in the young the organs cease to develop1 and remain so1 but sexual vigor is usually retained4 ,sometimes abscess and gangrene of the inflamed parotid gland occur4 ,recurring swelling and inflammation of the gland may occur1 and permanent swelling and hardness remain4 ,meningitis1 nervous and joint complications are among the rarer sequels4 ,treatment4--,the patient should remain in bed while the fever lasts4 ,a liquid diet is advisable during this time4 ,fever may be allayed by frequent sponging of the naked body with tepid water4 ,high fever and delirium demand the constant use1 on the head1 of the ice cap 7a rubber bag1 made to fit the head1 containing ice74 ,the relief of pain in the swollen gland is secured by the frequent application of a thick layer of sheet cotton1 large enough to cover the whole side of the neck1 wrung out of hot water and covered with oil-silk or rubber sheeting1 with a bandage to retain it in place4 ,paregoric may be given for the same purpose--a tablespoonful for adults2 a teaspoonful for a child of eight to ten1 well diluted with water1 and not repeated inside of two hours1 and not then unless the pain continues unabated4 ,inflammation of the testicles demands rest in bed1 elevation of the testicle on a pillow after wrapping it in a thick layer of absorbent cotton1 or applying hot compresses1 as recommended for the neck4 ,after the first few days of this treatment1 adjust a suspensory bandage1 which can be procured at any apothecary shop1 and apply daily the following ointment3 guiacol1 sixty grains2 lard1 one-half ounce1 over the swollen testicle4 ,,whooping ,,cough4--,a contagious disease characterized by fits of coughing1 during which a whooping or crowing sound is made following a long-drawn breath4 ,whooping cough is generally taken through direct contact with the sick1 rarely through exposure to the sick room1 or to persons or clothing used by the sick4 ,the germ which causes the disease is probably in the mucus of the nose and throat4 ,whooping cough is usually more or less prevalent in all thickly settled civilized communities1 at times is epidemic1 and often follows epidemics of measles4 ,it occurs chiefly in children from six months to six years of age4 ,girls and all weak and delicate subjects are slightly more susceptible to the disease4 ,some children are naturally immune to whooping cough4 ,one attack usually protects against another4 ,development4--,a variable period elapses between the time of exposure to whooping cough and the appearance of the first symptoms4 ,this may be from two days to two weeks2 usually seven to ten days4 ,symptoms4--,whooping cough begins like an ordinary cold in the head1 with cough1 worse at night1 which persists4 ,the coughing fits increase and the child gets red in the face1 has difficulty in getting its breath during them1 and sometimes vomits when the attack is over4 ,after a variable period1 from a few days to two weeks from the beginning of the cough1 the peculiar feature of the disease appears4 ,the child gives fifteen or twenty short coughs without drawing breath1 the face swells and grows blue1 the eyeballs protrude1 the veins stand out1 and the patient appears to be suffocating1 when at last he draws in a long breath with a crowing or whooping sound1 which gives rise to the name of the disease4 ,several such fits of coughing may follow one another and are often succeeded by vomiting and the expulsion of a large amount of phlegm or mucus1 which is sometimes streaked with blood4 ,in mild cases there may be six to twelve attacks in twenty-four hours2 in severe cases from forty to eighty4 ,the attacks last from a few seconds to one or two minutes4 ,occasionally the whoop comes before the coughing fit1 and sometimes there may be no whooping at all1 only fits of coughing with vomiting4 ,between the attacks1 puffiness of the face and eyes and blueness of the tongue persist4 ,the coughing fits and whooping last usually from three to six weeks1 but the duration of the disease is very variable4 ,occasionally it lasts many months1 especially when it occurs in winter4 ,the contagiousness of whooping cough continues about two months1 or ceases before that time with the cessation of the cough4 ,oftentimes there may be occasional whooping for months2 or1 after ceasing altogether for some days1 it may begin again4 ,in neither of these conditions is the disease considered still contagious after two months4 ,when an attack of whooping is coming on1 the child often seems to have some warning1 as he seems terrified and suddenly sits up in bed1 or1 if playing1 grasps hold of something1 or runs to his mother or nurse4 ,coughing fits are favored by emotion or excitement1 by crying1 singing1 eating1 drinking1 sudden change of temperature1 and by bad air4 ,complications and ,sequels4--,these are many and make whooping cough a critical disease for very young children4 ,bronchitis and pneumonia often complicate whooping cough in winter1 and diarrhea frequently occurs with it in summer4 ,convulsions not infrequently follow the coughing fits in infants1 and1 owing to the amount of blood forced to the head during the attacks1 nosebleed and dark spots on the forehead and surface of the eyes appear from breaking of small blood vessels in these places4 ,severe vomiting and diarrhea occasionally aggravate the case1 and pleurisy and consumption may occur4 ,the violent coughing may permanently damage the heart4 ,rupture of the lung tissue happens from the same cause1 and paralysis sometimes follows breaking of a blood vessel in the brain4 ,but in the vast majority of cases in children over two years old no dangerous sequel need be feared4 ,outlook4--,owing to the numerous complications1 whooping cough must be looked upon as a very serious disease1 especially in infants under two years1 and in weak1 delicate children4 ,it causes one-fourth of all deaths among children1 the death rate varying from three to fifteen per cent in different times and under different circumstances4 ,for this reason a physician's services should always be secured when possible4 ,treatment4--,a host of remedies is used for whooping cough1 but no single one is always the best4 ,it is often necessary to try different medicines till we find one which excels4 ,fresh air is of greatest importance4 ,patients should be strictly isolated in rooms by themselves1 and it is wise to send away children who have not been exposed4 ,morally1 parents are criminally negligent who allow their children with whooping cough to associate with healthy children4 ,if the coughing fits are severe or there is fever1 children should be kept in bed4 ,usually there is not much fever2 perhaps an elevation of a degree or two at first1 and at times during the disease4 ,otherwise1 children may be outdoors in warm weather1 and in winter on warm1 quiet days4 ,sea air is especially good for them4 ,it is best that the sick should have two rooms1 going from one to the other1 so that the windows in the room last occupied may be opened and well ventilated4 ,fresh air at night is especially needful1 and the patient should sleep in a room which has been freshly aired4 ,the temperature should be kept at an even #gj deg4 ,f41 and the child should not be exposed to draughts4 ,vaporizing antiseptics in the sick room has proved beneficial4 ,a two per cent solution of carbolic acid in water is useful for this purpose1 or a substance called vapo-cresoline1 with which is sold a vaporizing lamp and directions for use4 ,a one per cent solution of resorcin1 or of hydrogen dioxide1 diluted with four parts of water1 used in an atomizer for spraying the throat1 every two hours1 has given good results4 ,in the beginning of the disease1 before the whooping has begun1 a mixture of paregoric and syrup of ipecac will relieve the cough1 ten drops of the former with five of the latter1 for a child of two years1 given together in water every three hours4 ,the bromide of sodium1 five grains in water1 every three hours during the day1 for a child of two1 is serviceable in relieving the fits of coughing in the day2 while at night1 two grains of chloral1 not repeated1 may be given in water at bedtime to secure sleep1 in a child of two4 ,the tincture of belladonna1 in doses of two drops in water1 three times daily1 for a child of two1 is also often efficacious4 ,quinine1 given in the dose of one-sixth grain for each month of the child's age under a year2 or in one and one-half grain doses for each year of age under five1 is one of the older and more valuable remedies4 ,it should be given three times daily in pill with jelly1 or solution in water4 ,bromoform in doses of two drops for a child of two1 and increasing to five drops for a child of six1 may be given in syrup three times daily with benefit4 ,most of these drugs should be employed only with a doctor's advice1 when this is possible4 ,to sum up1 use the vapo-cresoline every day4 ,when no physician is available1 begin with belladonna during the day1 using bromide of sodium at night4 ,if this fails to modify the whooping after five days' trial1 use bromide and chloral4 ,in severe cases use bromoform4 ,during a fit of coughing and whooping1 it is well to support the child's head1 and if he ceases to breathe1 he should be slapped over the face and chest with a towel wet with cold water4 ,interference with sleep caused by coughing1 and loss of proper nourishment through vomiting1 lead to wasting and debility4 ,teaspoonful doses of emulsion of cod-liver oil three times daily1 after eating1 are often useful in convalescence1 and great care must be taken at this time to prevent exposure and pneumonia4 ,change of air and place will frequently hasten recovery remarkably in the later stages of the disease4 ,,erysipelas4--,erysipelas is a disease caused by germs which gain entrance through some wound or abrasion in the skin or mucous membranes4 ,even where no wound is evident it may be taken for granted that there has been some slight abrasion of the surface1 although invisible4 ,erysipelas cannot be communicated any distance through the air1 but it is contagious in that the germs which cause it may be carried from the sick to the well by nurses1 furniture1 bedding1 dressings1 clothing1 and other objects4 ,thus1 patients with wounds1 women in childbirth1 and the newborn may become affected1 but modern methods of surgical cleanliness have largely eliminated these forms of erysipelas1 especially in hospitals1 where it used to be common4 ,erysipelas attacks people of all ages1 some persons being very susceptible and suffering frequent recurrences4 ,the form which arises without any visible wound is seen usually on the face1 and occurs most frequently in the spring4 ,the period of development1 from the time the germs enter the body until the appearance of the disease1 lasts from three to seven days4 ,erysipelas begins with usually a severe chill 7or convulsion in a baby7 and fever4 ,vomiting1 headache1 and general lassitude are often present4 ,a patch of red appears on the cheeks1 bridge of nose1 or about the eye or nostril1 and spreads over the face4 ,the margins of the eruption are sharply defined4 ,within twenty-four hours the disease is fully developed2 the skin is tense1 smooth1 and shiny1 scarlet and swollen1 and feels hot1 and is often covered with small blisters4 ,the pain is more or less intense1 burning or itching occurs1 and there is a sensation of great tightness or tension4 ,on the face the swelling closes the eye and may interfere with breathing through the nose4 ,the lips1 ears1 and scalp are swollen1 and the person may become unrecognizable in a couple of days4 ,erysipelas tends to spread like a drop of oil1 and the borders of the inflammatory patch are well marked4 ,it rarely spreads from the face to the chest and body1 and but occasionally attacks the throat4 ,during the height of the inflammation the temperature reaches #ajd deg4 ,f1 or over4 ,after four or five days1 in most cases1 erysipelas begins to subside1 together with the pain and temperature1 and recovery occurs with some scaling of the skin4 ,the death rate is said to average about ten per cent in hospitals1 four per cent in private practice4 ,headache1 delirium1 and stupor are common when erysipelas attacks the scalp4 ,the appearance of the disease in other locations is similar to that described4 ,relapses are not uncommon1 but are not so severe as the original attack4 ,spreading may extend over a large area1 and the deeper parts may become affected1 with the formation of deep abscesses and great destruction of tissue4 ,certain internal organs1 heart1 lungs1 spleen1 and kidneys1 are occasionally involved with serious consequences4 ,the old1 the diseased1 and the alcoholic are more apt to succumb1 also the newborn4 ,it is a curious fact that cure of malignant growths 7sarcoma71 chronic skin diseases1 and old ulcers sometimes follows attacks of erysipelas4 ,treatment4--,the duration of erysipelas is usually from a few days to about two weeks1 according to its extent4 ,it tends to run a definite course and to recovery in most cases without treatment4 ,the patient must be isolated in a room with good ventilation and sunlight4 ,dressings and objects coming in contact with him must be burned or boiled4 ,the diet should be liquid1 such as milk1 beef tea1 soups1 and gruels4 ,the use of cloths wet constantly with cold water1 or with a cold solution of one-half teaspoonful of pure carbolic acid to the pint of hot water1 or with a poisonous solution of sugar of lead1 four grains to the pint1 should be kept over small inflamed areas4 ,fever is reduced by sponging the whole naked body with cold water at frequent intervals4 ,a tablespoonful of whisky or brandy in water may be given every two hours to adults if the pulse is weak4 ,painting the borders of the inflamed patch with contractile collodion may prevent its spreading4 ,the patient must be quarantined until all scaling ceases1 usually for two weeks4 ,,chapter ,,iii ,malaria and ,yellow ,fever ,the ,malarial ,parasite--,mosquitoes the ,means of ,infection--,different ,forms of ,malaria--,symptoms and ,treatment--,no ,specific for ,yellow ,fever4 ,,malaria2 ,,chills ,,and ,,fever2 ,,ague2 ,,fever ,,and ,,ague2 ,,swamp ,,or ,,marsh ,,fever2 ,,intermittent ,,or ,,remittent ,,fever2 ,,bilious ,,fever4--,malaria is a communicable disease characterized by attacks of fever occurring at certain intervals1 and due to a minute animal parasite which inhabits the body of the mosquito1 and is communicated to the blood of man by the bites of this insect4 ,in accordance with this definition malaria is not a contagious disease in the sense that it is acquired by contact with the sick1 which is not the case1 but it is derived from contact with certain kinds of mosquitoes1 and can be contracted in no other way1 despite the many popular notions to the contrary4 ,mosquitoes1 in their turn1 acquire the malarial parasite by biting human beings suffering from malaria4 ,it thus becomes possible for one malarial patient1 coming to a region hitherto free from the disease1 to infect the whole district with malaria through the medium of mosquitoes4 ,causes4--,while the parasite infesting mosquitoes is the only direct cause of malaria1 yet certain circumstances are requisite for the life and growth of the mosquitoes4 ,these are moisture and proper temperature1 which should average not less than #fj deg4 ,f4 ,damp soil1 marshes1 or bodies of water have always been recognized as favoring malaria4 ,malaria is common in temperate climates--in the summer and autumn months particularly1 less often in spring1 and very rarely in winter1 while it is prevalent in the tropics and subtropics all the year round1 but more commonly in the spring and fall of these regions4 ,the older ideas1 that malaria was caused by something arising in vapors from wet grounds or water1 or by contamination of the drinking water1 or by night air1 or was due to sleeping outdoors or on the ground floors of dwellings1 are only true in so far as these favor the growth of the peculiar kind of mosquitoes infected by the malarial parasites4 ,two essentials are requisite for the existence of malaria in a region3 the presence of the particular mosquito1 and the actual infection of the mosquito with the malarial parasite4 ,the kind of mosquito acting as host to the malarial parasite is the genus ,anopheles1 of which there are several species4 ,the more common house mosquito of the ,united ,states is the ,culex4 ,the ,anopheles can usually be distinguished from the latter by its mottled wings1 and1 when on a wall or ceiling1 it sits with the body protruding at an angle of #de deg4 from the surface1 with its hind legs hanging down or drawn against the wall4 ,in the case of the ,culex1 the body is held parallel with the wall1 the wings are usually not mottled1 and the hind legs are carried up over the back4 ,when a mosquito infected with the malarial parasite bites man1 the parasite enters his blood along with the saliva that anoints the lancet of the mosquito4 ,the parasite is one of the simplest forms of animal life1 consisting of a microscopical mass of living1 motile matter which enters the red-blood cell of man1 and there grows1 undergoes changes1 and1 after a variable time1 multiplies by dividing into a number of still smaller bodies which represent a new generation of young parasites4 ,this completes the whole period of their existence4 ,it is at that stage in the development of the parasite in the human body when it multiplies by dividing that the chills and fever in malaria appear4 ,what causes the malarial attack at this point is unknown1 unless it be that the parasites give rise to a poison at the time of their division4 ,between the attacks of chills and fever in malaria there is usually an interval of freedom of a few hours1 which corresponds to the period intervening in the life of the parasite in the human body1 between the birth of the young parasites and their growth and final division1 in turn1 into new individuals4 ,this interval varies with the kind of parasite4 ,the common form of malaria is caused by a parasite requiring forty-eight hours for its development4 ,the malarial attacks caused by this parasite then occur every other day1 when the parasite undergoes reproduction by division4 ,however1 an attack may occur every day when there are two separate groups of these parasites in the blood1 the time of birth of one set of parasites1 with an accompanying malarial attack1 happening one day2 that of the other group coming on the next1 so that between the two there is a daily birth of parasites and a daily attack of malaria4 ,in cases of malaria caused by one group of parasites the attacks appear at about the same time of day1 but when the attacks are caused by different groups of parasites the times of attack may vary on different days4 ,in the worst types of malaria the parasites do not all go through the same stages of development at the same time1 as is commonly the case in the milder forms prevalent in temperate regions1 so that the fever--corresponding to the stage of reproduction of the parasites--occurs at irregular intervals4 ,in a not uncommon type of malaria the attacks occur every third day1 with two days of intermission or freedom from fever4 ,different groups of parasites causing this form of malaria1 and having different times of reproduction1 may inhabit the same patient and give rise to variation in the times of attack4 ,thus1 an attack may occur on two successive days with a day of intermission4 ,the reproduction of the parasite in the human blood is not a sexual reproduction2 that takes place in the body of the mosquito4 ,when a healthy mosquito bites a malarial patient1 the parasite enters the body of the mosquito with the blood of the patient bitten4 ,it enters its stomach1 where certain differing forms of the parasite1 taking the part of male and female individuals1 unite and form a new parasite1 which1 entering the stomach wall of the mosquito1 gives birth in the course of a week to innumerable small bodies as their progeny4 ,these find their way into the salivary glands which secrete the poison of the mosquito bite1 and escape1 when the mosquito bites a human being1 into the blood of the latter and give him malaria4 ,distribution4--,malaria is very widely distributed1 and is much more severe in tropical countries and the warmer parts of temperate regions4 ,in the ,united ,states malaria is prevalent in some parts of ,new ,england1 as in the ,connecticut ,valley1 and in the course of the ,charles ,river1 in the country near ,boston4 ,it is common in the vicinity of the cities of ,philadelphia1 ,new ,york1 and ,baltimore1 but here is less frequent than formerly1 and is of a comparatively mild type4 ,more severe forms prevail along the ,gulf of ,mexico and the shores of the ,mississippi and its branches1 especially in ,mississippi1 ,texas1 ,louisiana1 and ,arkansas1 but even here it is less fatal and widespread than formerly4 ,in ,alaska1 the ,northwest1 and on the ,pacific ,coast of the ,united ,states malaria is almost unknown1 while it is but slightly prevalent in the region of the ,great ,lakes1 as about ,lakes ,erie and ,st4 ,clair4 ,development4--,usually a week or two elapses after the entrance of the malarial parasite into the blood before symptoms occur2 rarely this period is as short as twenty-four hours1 and occasionally may extend to several months4 ,it often happens that the parasite remains quiescent in the system without being completely exterminated after recovery from an attack1 only to grow and occasion a fresh attack1 a month or two after the first1 unless treatment has been thoroughly prosecuted for a sufficient time4 ,symptoms4--,certain symptoms give warning of an attack1 as headache1 lassitude1 yawning1 restlessness1 discomfort in the region of the stomach1 and nausea or vomiting4 ,the attack begins with a chilliness or creeping feeling1 and there may be so severe a chill that the patient is violently shaken from head to foot and the teeth chatter4 ,chills are not generally seen in children under six1 but an attack begins with uneasiness1 the face is pinched1 the eyes sunken1 the lips and tips of the fingers and toes are blue1 and there is dullness and often nausea and vomiting4 ,then1 instead of a chill1 the eyelids and limbs begin to twitch1 and the child goes into a convulsion4 ,while the surface of the skin is cold and blue during a chill1 yet the temperature1 taken with the thermometer in the mouth or bowel1 reaches #ajb deg41 #aje deg41 or #ajf deg4 ,f41 often4 ,the chill lasts from a few minutes to an hour1 and as it passes away the face becomes flushed and the skin hot4 ,there is often a throbbing headache1 thirst1 and sometimes mild delirium4 ,the temperature at this time1 when the patient feels intensely feverish1 is very little higher than during the chill4 ,the fever lasts during three or four hours1 in most cases1 and gradually declines1 as well as the headache and general distressing symptoms with the onset of sweating1 to disappear in an hour or two1 when the patient often sinks into a refreshing sleep4 ,such attacks more commonly occur every day1 every other day1 or after intermissions of two days4 ,rarely do attacks come on with intervals of four1 five1 six1 or more days4 ,the attacks are apt to recur at the same time of day as in the first attack4 ,in severe cases the intervals may grow shorter1 in mild cases1 longer4 ,in the interval between the attacks the patient usually feels well unless the disease is of exceptional severity4 ,there is also entire freedom from fever in the intervals except in the grave types common to hot climates4 ,frequently the chill is absent1 and after a preliminary stage of dullness there is fever followed by sweating4 ,this variety is known as dumb ague4 ,irregular and ,severe ,form--,chronic ,malaria4--,this occurs in those who have lived long in malarial regions and have suffered repeated attacks of fever1 or in those who have not received proper treatment4 ,it is characterized by a generally enfeebled state1 the patient having a sallow complexion1 cold hands and feet1 and temperature below normal1 except occasionally1 when there may be slight fever4 ,when the condition is marked1 there are breathlessness on slight exertion1 swelling of the feet and ankles1 and ague cake1 that is1 enlargement of the spleen1 shown by a lump felt in the abdomen extending downward from beneath the ribs on the left side4 ,among unusual forms of malaria are3 periodic attacks of drowsiness without chills1 but accompanied by slight fever 7#ajj deg4 to #aja deg4 ,f472 periodic attacks of neuralgia1 as of the face1 chest1 or in the form of sciatica2 periodic sick headaches4 ,these may take the place of ordinary malarial attacks in malarial regions1 and are cured by ordinary malarial treatment4 ,remittent ,form 7unfortunately termed bilious74--,this severe type of malaria occurs sometimes in late summer and autumn1 in temperate climates1 but is seen much more commonly in the ,southern ,united ,states and in the tropics4 ,it begins often with lassitude1 headache1 loss of appetite and pains in the limbs and back1 a bad taste1 and nausea for a day or two1 followed by a chill1 and fever ranging from #aja deg4 to #ajc deg4 ,f41 or more4 ,the chill is not usually repeated1 but the fever is continuous1 often suggesting typhoid fever4 ,with the fever1 there are flushed face1 occasional delirium1 and vomiting of bile1 but more often a drowsy state4 ,after twelve to forty-eight hours the fever abates1 but the temperature does not usually fall below #ajj deg4 ,f41 and the patient feels better1 but not entirely well1 as in the ordinary form of malaria1 where the fever disappears entirely between the attacks4 ,after an interval varying from three to thirty-six hours the temperature rises again and the more severe symptoms reappear1 and so the disease continues1 there never being complete freedom from fever1 the temperature sometimes rising as high as #aje deg4 or #ajf deg4 ,f4 ,in some cases there are nosebleed1 cracked tongue1 and brownish deposit on the teeth1 and a delirious or stupid state1 as in typhoid fever1 but the distention of the belly1 diarrhea1 and rose spots are absent4 ,the skin and whites of the eyes often take on the yellowish hue of jaundice4 ,this fever has been called typhomalarial fever1 under the supposition that it was a hybrid of the two4 ,this is not the case1 although it is possible that the two diseases may occur in the same individual at the same time4 ,this1 indeed1 frequently happened as stated1 in our soldiers coming from the ,west ,indies during the ,spanish-,american ,war--but is an extremely uncommon event in the ,united ,states4 ,pernicious ,malaria4--,this is a very grave form of the disease4 ,it rarely is seen in temperate regions1 but often occurs in the tropics and subtropics4 ,it may follow an ordinary attack of chills and fever1 or come on very suddenly4 ,after a chill the hot stage appears1 and the patient falls into a deep stupor or unconscious state1 with flushed face1 noisy breathing1 and high fever 7#ajd deg4 to #aje deg4 ,f474 ,wild delirium or convulsions afflict the patient in some cases4 ,the attack may last for six to twenty-four hours1 from which the patient may recover1 only to suffer another like seizure1 or he may die in the first4 ,in another form of this pernicious malaria the symptoms resemble true cholera1 and is peculiar to the tropics4 ,in this there are violent vomiting1 watery diarrhea1 cramps in the legs1 cold hands and feet1 and collapse4 ,sometimes the attack begins with a chill1 but fever1 if any1 is slight1 although the patient complains of great thirst and inward heat4 ,the pulse is feeble and the breathing shallow1 but the intellect remains clear4 ,death often occurs in this1 as in the former type of pernicious malaria1 yet vigorous treatment with quinine1 iron1 and nitre will frequently prove curative in either form4 ,black ,water ,fever4--,rarely in temperate climates1 but frequently in the ,southern ,united ,states and in the tropics1 especially ,africa2 after a few days of fever1 or after chilliness and slight fever1 the urine becomes very dark1 owing to blood escaping in it4 ,this sometimes appears only periodically1 and is often relieved by quinine4 ,it is apparently a malarial fever with an added infection from another cause4 ,chagres ,fever4--,a severe form of malarial fever acquired on the ,isthmus of ,panama1 apparently a hemorrhagic form of the pernicious variety1 and so treated4 ,detection4--,to the well-educated physician is now open an exact method of determining the existence of malaria1 and of distinguishing it from all similar diseases1 by the examination of the patient's blood for the malarial parasite--its presence or absence deciding the presence or absence of the disease4 ,for the layman the following points are offered3 intermittency of chills and fever1 or of fever alone1 should suggest malaria1 particularly in a patient living in or coming from a malarial region1 or in a previous sufferer from the disease4 ,in such a case treatment with quinine will solve the doubt in most cases1 and will do no harm even if the disease be not malaria4 ,malaria is one of the few diseases which can be cured with certainty by a drug2 failure to stop the symptoms by proper amounts of quinine means1 in the vast majority of cases1 that they are not due to malaria4 ,there are many other diseases in which chills1 fever1 and sweating occur at intervals1 as in poisoning from the presence of suppuration or formation of pus anywhere in the body1 but the layman's ignorance will not permit him to recognize these in many instances4 ,the quinine test is the best for him4 ,prevention4--,since the ,french surgeon1 ,laveran1 discovered the parasite of malaria in #ahhj1 and ,manson1 in #ahif1 emphasized the fact that the mosquito is the medium of its communication to man1 the way for the extermination of the disease has been plain4 ,mosquito engineering has attained a recognized place4 ,this consists in destroying the abodes of mosquitoes 7marshes1 ponds1 and pools7 by drainage and filling1 also in the application of petroleum on their surface to destroy the immature mosquitoes4 ,such work has already led to wonderful results4#aa ,open water barrels and water tanks prove a fruitful breeding place for these insects1 and should be abolished4 ,the protection of the person from mosquito bites is obtained by proper screening of habitations and the avoidance of unscreened open air1 at or after nightfall1 when the pests are most in evidence4 ,dwellings on high grounds are less liable to mosquitoes4 ,persons entering a malarial region should take from two to three grains of quinine three times a day to kill any malarial parasites which may invade their blood1 and should screen doors and windows4 ,patients after recovery from malaria must prolong the treatment as advised1 and renew it each spring and fall for several years thereafter4 ,a malarial patient is a direct menace to his entire neighborhood1 if mosquitoes enter4 ,treatment4--,the treatment of malaria practically means the use of quinine given in the proper way and in the proper form and dose4 ,despite popular prejudices against it1 quinine is capable of little harm1 unless used in large doses for months1 and no other remedy has yet succeeded in rivaling it in any way4 ,quinine is frequently useless from adulteration2 this may be avoided by getting it of a reliable drug house and paying a fair price for the best to be had4 ,neither pills nor tablets of quinine are suitable1 as they sometimes pass through the bowels undissolved4 ,the drug should be taken dissolved in water1 or1 more pleasantly1 in starch wafers or gelatin capsules4 ,when the drug is vomited it may be given 7in double the dose7 dissolved in half a pint of water1 as an injection into the bowels1 three times daily4 ,infants of a few months may be treated by rubbing an ointment 7containing thirty grains of quinine sulphate mixed with an ounce and a half of lard7 well into the skin of the armpits and groins1 night and morning4 ,children under the age of two can be best treated by quinine made into suppositories--little conical bodies of cocoa butter containing two grains each--one being introduced into the bowel1 night and morning4 ,during an attack of malaria the discomfort of the chill and fever may be relieved to considerable extent by thirty grains of sodium bromide 7adult dose7 in water4 ,hot drinks and hot-water bottles with warm covering may be used during the chill1 while cold sponging of the whole naked body will afford comfort during the hot stage4 ,in the pernicious form1 attended with unconsciousness1 sponging with very cold water1 or the use of the cold bath with vigorous friction of the whole body and cold to the head are valuable4 ,the effect of quinine is greatest during the time of birth of a new generation of young parasites in the blood1 which corresponds with the time of the malarial attack4 ,but in order that the quinine shall have time to permeate the blood1 it must be given two to four hours before the expected chill1 and then will probably prevent the next attack but one4 ,a dose of ten grains of quinine sulphate taken three times daily for the first three days of treatment2 then a dose of three grains1 three times daily for two weeks2 and finally two grains1 three times daily for the rest of the month of treatment will1 in many cases1 complete a cure4 ,if the quinine cause much ringing in the ears and deafness1 it will be found that sodium bromide taken with the quinine 7in twice the dose7 dissolved in water1 will correct this trouble4 ,if the patient is constipated and the bowel discharges are light colored1 a few one-quarter grain doses of calomel may be taken every two hours1 and followed in twelve hours by a dose of ,epsom salts1 on the first day of treatment1 with quinine4 ,it is no use to take quinine by the mouth later than two hours before an attack1 and if the patient cannot secure treatment before this time1 he should take a single dose of twenty grains of quinine4 ,to children may be given a daily amount of quinine equal to one grain for each year of their age4 ,in the severe forms of remittent and pernicious types of malaria it may be necessary for the patient to take as much as thirty grains of quinine every three days or so to cut short the attack4 ,but1 unfortunately1 the digestion may be so poor that absorption of the drug does not occur1 and in such an event the use of quinine in the form of the bisulphate in thirty-grain doses1 with five grains of tartaric acid1 will in some cases prove effective4 ,chronic malaria is best treated with small doses of quinine1 together with arsenic and iron4 ,a capsule containing two grains of quinine sulphate1 one-thirtieth grain of arsenious acid1 and two grains of reduced iron should be taken three times daily for several weeks4 ,,yellow ,,fever4--,this is a disease of tropical and subtropical countries characterized by fever1 jaundice1 and vomiting 7in severe cases vomiting of blood71 caused by a special germ or parasite which is communicated to man solely through the agency of the bites of a special mosquito1 ,stegomyia fasciata4 ,distribution4--,yellow fever has always been present in ,havana1 ,rio1 ,vera ,cruz1 and other ,spanish-,american seaports2 also on the west coast of ,africa4 ,it is frequently epidemic in the tropical ports of the ,atlantic in ,america and ,africa1 and there have been numerous epidemics in the southern and occasional ones in the northern seacoast cities of the ,united ,states4 ,the last epidemic occurred in the ,south in #ahii4 ,rarely has the disease been introduced into ,europe1 and it has never spread there except in ,spanish ports4 ,the disease is one requiring warm weather1 for a temperature under #ge deg4 ,f4 is unsuitable to the growth of the special mosquito harboring the yellow-fever parasite4 ,it spreads in the crowded and unsanitary parts of seacoast cities1 to which it is brought on vessels by contaminated mosquitoes or yellow-fever patients from the tropics4 ,havana has heretofore been the source of infection for the ,united ,states1 but since the disease has been eradicated by the ,american army of occupation1 that danger has been removed4 ,yellow fever is not at all contagious in the sense that a healthy person can contract the disease by contact with a yellow-fever patient1 or with his discharges from the stomach1 bowels1 or elsewhere1 and is probably only communicated to man by the bite of a particular kind of mosquito harboring the yellow-fever organism in its body4 ,both these facts have been incontestably proved1#ab in part by brave volunteers from the ,united ,states ,army who submitted to sleep for twenty-one days on clothes soiled with discharges from patients dying of yellow fever1 and escaped the disease2 and by others living in uncontaminated surroundings who permitted themselves to be bitten by infected mosquitoes and promptly developed yellow fever4 ,development4--,after a person has been bitten by an infected mosquito1 from fourteen hours to five days and seventeen hours elapse before the development of the first symptoms--usually this period lasts from three to four days4 ,with the appearance of a single case in a region1 a period of two weeks must elapse before the development of another case arising from the first one4 ,this follows because a mosquito1 after biting a patient1 cannot communicate the germ to another person for twelve days1 and two days more must elapse before the disease appears in the latter4 ,symptoms4--,during the night or morning the patient has a chill 7or feels chilly7 and experiences discomfort in the stomach1 with sometimes nausea and vomiting4 ,there is pain through the forehead and eyes1 in the back and thighs1 and often in the calves4 ,the face is flushed and slightly swollen--particularly the upper lip--and the eyes are bloodshot1 and gradually1 in the course of thirty-six hours1 the whites become yellowish4 ,this is one of the most distinguishing features of the fever1 but is often absent in children4 ,the tongue is coated1 there are loss of appetite1 lassitude1 sore throat1 and constipation4 ,in the beginning the temperature ranges from #aja deg4 to #ajc deg4 ,f41 or in severe cases as high as #aje deg4 or #ajf deg4 ,f41 and the pulse from #aaj to #abj beats a minute4 ,the fever continues for several days--except in mild cases--but the pulse usually falls before the temperature does4 ,for example1 the temperature may rise a degree during the third day to #ajc deg4 ,f41 while the pulse falls ten or more beats at the same time and may not be over #gj or #hj1 while the temperature is still elevated4 ,this is another peculiar feature of the disease4 ,vomiting often increases on the second or third day1 and the dreaded black vomit may then occur4 ,this presents the appearance of coffee grounds or tarry matter and1 while a dangerous symptom1 does not by any means presage a fatal ending4 ,the black color is due to altered blood from the stomach1 and bleeding sometimes takes place from the nose1 throat1 gums1 and bowels1 with black discharges from the latter4 ,the action of the kidneys is usually interfered with1 causing diminution in the amount of urine4 ,it is extremely important to pay regard to this feature1 because failure of the patient to pass a proper amount of urine calls for prompt action to avert fatal poisoning from retained waste matters in the blood4 ,the normal amount of urine passed in twenty-four hours in health is over three pints1 and while not more than two-thirds of this amount could be expected to be passed by a fever patient1 yet in yellow fever the passage of urine may be almost or wholly suppressed4 ,the course of the disease varies greatly4 ,in children--especially of the ,creoles--it is frequently so mild as to pass unnoticed4 ,in adults the fever may only last a few hours1 or two or three days1 with gradual recovery from the various symptoms1 and yellowness of the skin lasting for some time4 ,this is not seen readily during the stage of fever when the surface is reddened1 but at that time may be detected by pressure on the skin for a minute1 when the skin will present a yellow hue on removing the finger before the blood returns to the pressure spot4 ,with fall of fever1 and abatement of symptoms after two or three days1 the patient1 instead of going on to recovery may1 after a few hours or a day or two1 again become very feverish and have vomiting--perhaps of blood or black vomit--yellow skin1 feeble pulse1 failure of kidney action with suppression of urine1 delirium1 convulsions1 stupor1 and death2 or may begin to again recover after a few days4 ,mild fever1 slight jaundice1 and absence of bleeding are favorable signs2 black vomit1 high fever1 and passage of little urine are unfavorable signs4 ,the death rate is very variable in different epidemics and among different classes2 anywhere from fifteen to eighty-five per cent4 ,among the better classes it is often not greater than ten per cent in private practice4 ,heavy drinkers and those living in unfavorable surroundings are apt to succumb4 ,prevention4--,yellow fever1 like malaria1 is a preventable disease1 and will one day be only a matter of historic interest4 ,dr4 ,w4 ,c4 ,gorgas1 ,u4 ,s4 ,a41 during #aija1 by ridding ,havana of the mosquito carrying the yellow-fever organism through screening barrels and receptacles holding water1 and by treating drains1 cesspools1 etc41 with kerosene1 succeeded in also eradicating yellow fever from that city1 so that in the following year there was not one death from this disease2 whereas1 before this time1 the average yearly mortality had been #gea deaths in ,havana4 ,spread of the disease is controlled by preventing access of mosquitoes to the bodies of living or dead yellow-fever patients2 while personal freedom from yellow fever may be secured by avoiding mosquito bites1 through protection by screens indoors1 and covering exposed parts of the face1 hands1 and ankles with oil of pennyroyal or spirit of camphor1 while outdoors4 ,treatment4--,there is unfortunately no special cure known for yellow fever such as we possess in malaria4 ,the patient should be well covered and surrounded with hot-water bags during chill4 ,it is advisable to give a couple of compound cathartic pills or a tablespoonful of castor oil at the start4 ,two1 or at most three1 ten-grain doses of phenacetin at three hours intervals will relieve the pain during the early stage4 ,cracked ice given frequently by the mouth and the application of a mustard paper or paste 7one part mustard1 three parts flour1 mixed with warm water and applied between two layers of thin cotton7 over the stomach will serve to allay vomiting4 ,cold sponging 7see ,typhoid ,fever1 p4 #bcb7 is the best treatment for fever4 ,the black vomit may be arrested by one-quarter teaspoonful doses of tincture of the chloride of iron1 given in four tablespoonfuls of water1 every hour after vomiting4 ,the bowels should be moved daily by injection of warm soapsuds4 ,the patient should not rise from his bed1 but should use a bedpan or other receptacle4 ,in addition1 a pint of warm water1 containing one-half teaspoonful of salt1 should be injected into the bowel night and morning and1 if possible1 retained by the patient4 ,the object of the latter is by its absorption to stimulate the action of the kidneys4 ,the diet should consist of milk1 diluted with an equal amount of water1 broths1 gruels1 etc41 and only soft food should be given for ten days after recovery4 ,iced champagne in tablespoonful doses at frequent intervals1 or two teaspoonful doses of whisky in a little ice water1 given every half hour1 relieves vomiting and supports the strength4 ,,footnotes3 #aa ,see ,volume ,v1 p4 #gf1 for detailed methods4--,,editor4 #ab ,see ,frontispiece1 ,vol4 ,v4 ---------------------------------------- ---------------------------- ,,transcriber',s ,,note4 ,the following change was made3 ,part ,,ii1 ,chapter ,,ii1 ,typhoid ,fever1 ,symptoms 7p4 #bbe7 ,original text3 444 flushed face1 pulse #ajj deg41 gradually increasing as described4 ,changed to3 444 flushed face1 pulse #ajj1 gradually increasing as described4 ,pulse #ajj was preferred over temperature #ajj deg44 ---------------------------------------- ----------------------------